Since mid-July, an experiment at Insite, Vancouver’s supervised-injection facility, has allowed drug users to test substances for fentanyl, a synthetic opioid that is largely responsible for B.C.’s fatal-overdose epidemic.
Last Sunday morning (September 18), the Straight watched a drug user take a tiny amount of white powder and place it in a small dish to which water was added. The individual then dipped a paper testing strip into the solution and gave it a little stir.
Less than one minute later, two lines appeared on the piece of paper. The white substance did not contain fentanyl, according to those two lines. If it had, only one line would have appeared.
That result was atypical. According to the latest data supplied by Vancouver Coastal Health (VCH), 85 percent of heroin mixtures (and 80 percent of all drugs) checked at Insite between July 7 and September 8 (332 checks) tested positive for fentanyl.
For now, the test strips are only available at Insite—on East Hastings Street near Main Street—on a trial basis. They were designed for urinary analysis and adapted to test raw substances at VCH’s request. Questions remain about their effectiveness and impact on user behaviour, but Vancouver health authorities and practitioners told the Straight the test strips have “huge potential” as a new tool that could help bring the province’s skyrocketing rate of overdose deaths back under control.
Dr. Mark Lysyshyn is a medical health officer with VCH, the regional body that operates Insite alongside the nonprofit Portland Hotel Society. He told the Straight that the idea is not necessarily to deter people from using drugs. “We don’t think that’s realistic,” he explained. “What we do hope is that people will adopt safer drug-use practices. That they will inject with a friend, start with a lower dose, use Insite more often, and get themselves a take-home naloxone kit.”
Lysyshyn emphasized that the test strips are no magic bullet. Although they are proving reliable in detecting fentanyl so far, they cannot identify very similar drugs—what researchers call an analog—which can be just as deadly as fentanyl or even more dangerous. He stressed that authorities are concerned the strips could create a false sense of security among drug users who see a negative test result. But Lysyshyn said he’s encouraged by the trial at Insite and noted that there are no significant hurdles preventing VCH from expanding access to the kits.
One challenge Lysyshyn predicted that VCH will encounter is the question of how to get drug-testing equipment into the hands of middle- and upper-class drug users—a lawyer who uses cocaine, for example, or a university student who buys oxycodone on the street—who are not comfortable stopping at a clinic in the Downtown Eastside.
“An intervention like this is potentially more interesting with recreational drug users because they actually might be more willing to dispose of their drugs,” he noted. “We would eventually like to do this in the community.”
Before 2015, the all-time high for drug-overdose deaths in B.C. was set in 1998, when there were 400. In 2015, there were 505 fatal overdoses in the province. During the first eight months of 2016, there were 488, according to the B.C. Coroners Service. So far this year, fentanyl has been detected in about 60 percent of those deaths, up from 30 percent in 2015.
While Insite is still the only bricks-and-mortar location in Vancouver where one can obtain a testing strip, the kits are more easily available than most people know.
The company supplying VCH is Ontario-based BTNX Inc. On the phone from Markham, the company’s president and CEO, Iqbal Sunderani, said wider distribution is a simple question of supply and demand.
“We would have to package them individually,” he explained. “For us to do that, we would have to get them manufactured in that way.…So until we are approached by a pharmacy that is really interested, we are reluctant to go and make so many.”
Sunderani noted that current regulations do not allow BTNX to market the product for use as a urinary diagnostic test because, in Canada, only health-care professionals are permitted to use them that way. But if the testing strips are used to check raw substances—what the company refers to as a forensic test—that is perfectly legal.
BTNX does not accept online orders for the kits, Sunderani said, but they can be obtained by contacting the company via phone or email. A package of 50 strips costs $175, plus shipping.
“The problem is that we don’t have a pharmacy where people can go and buy them,” Sunderani said. “So the problem is, how do we get it to them?”
In past interviews with the Straight, the Vancouver Police Department and the B.C. Centre for Disease Control, among other authorities, embraced the idea of making drug-testing equipment or testing sites more easily available to members of the public.
Dr. Thomas Kerr, director of the B.C. Centre for Excellence in HIV/AIDS’ urban health research initiative, has studied harm reduction in the Downtown Eastside for two decades. In a telephone interview, he expressed cautious enthusiasm for the program.
“The thing that is tricky about what they are doing at Insite is they are using that test in a novel way,” he explained. “It’s designed to test urine; it’s not designed to test drugs. We don’t even know how accurate it is.”
On middle- and upper-class users, Kerr noted there is academic research that suggests people from those groups can be less likely to seek out harm-reduction supplies like a drug test for fentanyl. He said that means there is a need to normalize the distribution of such supplies in places where every kind of user feels comfortable.
“Mail order is an option,” he continued. “I think pharmacies are good because people are used to going to pharmacies and buying things they might be a little embarrassed about. Condoms, lube, and things like that. I think that would be a good venue for drug-checking [equipment].”
Back at Insite, the facility's coordinator, Darwin Fisher, told the Straight that making the strips available via an online mail-order system could be the easiest way to ensure professionals such as bankers and lawyers feel comfortable obtaining them. But he added it's his preference to see the strips distributed in places where health-care professionals are available to explain their shortcomings and answer users' questions.
“I don’t think it [a drug test] has ever been touted as any sort of perfect solution here," he said. "But I think it’s been good to get proactive."