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Drug checking reveals high levels of fentanyl contamination in Vancouver street drugs
Liz Highleyman, 2017-05-16 07:50:00
A pilot project to check the purity of drugs at
Vancouver's Insite safe injection facility found that around 80% of tested
samples contained fentanyl, and people who learned their drugs were
contaminated were more likely to reduce their drug doses and less likely to
overdose, researchers reported yesterday at the 25th Harm Reduction International
Conference (HR17) in Montreal.
Fentanyl is a synthetic opioid that is 50 times
stronger than heroin. Pharmaceutical fentanyl is approved for the management of
severe pain, but illegally produced fentanyl - often mixed with other drugs -
is increasingly available through the illicit drug trade. Fentanyl may be added
to heroin or other street drugs such as methamphetamine to intensify their effects or to disguise poor
Mark Lysyshyn from Vancouver Coastal Health and the
University of British Columbia presented findings from an analysis of a drug-checking
program to test for fentanyl at Insite, the first supervised injection site in
Fentanyl is blamed for a recent upsurge in overdose
deaths. Many people who inject drugs do not realize their heroin or other
substances are laced with fentanyl, which can cause respiratory depression,
seizures, and death at a much lower dose than heroin. The US Drug Enforcement
Administration issued a fentanyl alert in March 2015,
and Public Health England and the National Crime Agency recently issued similar warnings in the UK.
Canada is also experiencing an opioid overdose
epidemic. The steep increase in overdose deaths starting around two years is
mostly attributable to fentanyl, according to Lysyshyn. Insite - which averages
more than 400 visits per day - went from seeing 10-20 overdoses per week to 110-120 in
late 2016, he said.
A previous urine screening study found that among more
than 200 participants tested at Vancouver harm reduction sites, 29% tested
positive for fentanyl, and three-quarters of these were not aware they had
Realising that the urine test strips could also be
used to directly test for fentanyl in drug samples, the Insite team offered
clients the option to check drugs they brought with them to use at the injection
facility. Participants could either have their drugs tested before or after
use, the latter done with residue left in syringes.
of 1138 drug checks were performed between July 2016 and March 2017, about 40%
before consumption and about 60% afterwards.
researchers found that, overall, 79% of all drug samples contained fentanyl.
Contamination was more common in heroin and crystal methamphetamine samples
(83% and 82%, respectively), and less so in samples of cocaine (40%) or other
was more likely to be detected in post-consumption samples (82%) compared to
pre-consumption samples (74%), which Lysyshyn attributed to clients being more
likely to get their drugs checked if they felt they were more potent than
of people whose drugs tested positive for fentanyl disposed of them. This is
not surprising, Lysyshyn said, because clients were dependent on opioids and
would get sick without them, and they knew injecting under supervision with
naloxone on hand would be safe. But 64% did reduce their drug dose if they knew
it contained fentanyl.
Looking at overdose and naloxone administration, 13%
of people with fentanyl-positive drug samples experienced overdose, compared to
just 2% of those with negative samples - more than a six-fold higher risk
(p<0.01). Similarly, 10% of clients with fentanyl-positive samples required
naloxone, compared to 2% of those with negative samples (p<0.01).
and naloxone administration were more often associated with post-consumption
drug checks. People who checked their drugs prior to consumption had the
opportunity to lower their dose if it tested positive for fentanyl, thereby
reducing their chances of overdosing and needing naloxone. Clients who reduced their drug
doses were 25% less likely to experience overdose, Lysyshyn said.
program "reduced overdose risks by helping clients identify contaminated
drugs and be more cautious when injecting," the researchers concluded.
noted that some street-level drug sellers said they used the drug checking
programme to identify contaminated drugs, allowing them to warn buyers or avoid
selling to inexperienced users.
limitation of this study is that the test strips were not able to detect the
presence of other opioids, such as the fentanyl analogue carfentanil, which is
even more potent and has also been implicated in recent overdose epidemics.
No one has died from an overdose at Insite in its 13-year history, and
supervised injection is generally safe even if drugs contain fentanyl. However,
Lysyshyn suggested, distribution of drug checking strips might offer even more
benefit for street users who do not have naloxone and medical assistance readily
"This study proves that the alarm bells that have
been sounding over this public health emergency are fully warranted," said
Harm Reduction International executive director Rick Lines. "Street drugs
are costing lives and this research confirms what we've long known - that
supervised injection sites and drug checking can prevent unnecessary