Promising signs fentanyl test strips may also detect analogues as Vancouver authorities expand access

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      Vancouver health officials are cautiously expanding access to drug-testing equipment that detects fentanyl, the synthetic opioid associated with hundreds of deaths in B.C. each year.

      Dr. Mark Lysyshyn is the Vancouver Coastal Health (VCH) lead on harm reduction and substance use. He told the Straight that authorities have deemed a yearlong trial at the city’s first legal injection facility, Insite, a success, and are now making the test strips available at additional locations.

      “We’ve had over 1,500 tests conducted [at Insite] and the results look positive,” he said in a telephone interview. “If you do your test before you use, you are more likely to reduce your dose and then less likely to overdose.”

      VCH statistics covering a nine-month period of the trial show that when drugs test positive for fentanyl, a user is 10 times more likely to reduce their dose and 25 percent less likely to overdose.

      “They can reduce harm,” Lysyshyn said. “So now we’re in the process of training at various overdose-prevention sites. And hopefully, by the end of the summer, we’ll have them available there.”

      Vancouver officials recently announced the city hit an all-time high for fatal overdoses in a single year. As of August 14, there had been 232 suspected drug-overdose deaths in 2017. That puts Vancouver on track for more than 400 deaths by the end of this year, as compared with 231 confirmed deaths in 2016, 136 the year before that, and 101 in 2014.

      "The rising number of overdose deaths this year is horrendous and absolutely heartbreaking," said Mayor Gregor Robertson quoted in a media release.

      The first two locations to receive the fentanyl-test strips are facilities at 62 East Hastings and 380 East Hastings Street.

      Lysyshyn emphasized that the equipment has limitations. While it indicates whether fentanyl is present, it says nothing about how much is present. There is also uncertainty about how good the strips are at detecting drugs different from but similar to fentanyl—carfentanil, for example, which is significantly more toxic. However, Lysyshyn said on this question, there may be good news.

      “There is starting to be information available that suggests the strips actually perform better than we’ve thought they do,” he explained. Lysyshyn said that the strips’ manufacturer, Ontario-based BTNX Inc., and a U.S. nonprofit called DanceSafe have been experimenting with fentanyl analogues like carfentanil, and while the results are not yet official, it appears the strips are finding them.

      “Informally, they believe that the strips detect many of the fentanyl analogues as well,” Lysyshyn said. “If the strips actually do detect all or most of the relevant analogues…then our hope will be to also offer these beyond the overdose-prevention sites.”

      Testing strips available at Insite indicate the presence of fentanyl with a single indicator line while two lines means no fentanyl is present in a mixture.
      Travis Lupick

      In September 2016, the Straight reported that anyone can purchase the test strips directly from BTNX Inc. A package of 50 costs $175, plus shipping.

      More recently, on August 22, CBC News reported that in Toronto, a private donor was making BTNX Inc.'s test strips available via harm-reduction advocates who work with drug users there.

      "They can use it to meet the challenge of this epidemic, to see if they can save lives," the company's CEO, Iqbal Sunderani, told the broadcaster.

      Back in B.C., the health authority held its first training session for the strips on August 17 at the headquarters of the Vancouver Area Network of Drug Users (VANDU). Sarah Blyth, a cofounder of the overdose-prevention site at 62 East Hastings, attended that meeting. In a telephone interview, she described the strips like this: “It’s not rocket science.”

      “It’s like a pregnancy test,” Blyth explained. “You stir it around with some water and you stick the strip in there. And if there is only one line, there is fentanyl; if there are two lines, there isn’t fentanyl.”

      At 62 East Hastings, Blyth said that so far, she’s only seen the strips used a half-dozen times, but she added that every one of those tests has been positive for fentanyl.

      According to VCH, of the 1,500 tests at Insite conducted over the past year, 84 percent of samples that users believed to be heroin tested positive for fentanyl. For non-opioid drugs (methamphetamine and cocaine, for example), that number was 65 percent.

      Hugh Lampkin, a long-time VANDU board member, was also at VCH’s first training session. He works at the overdose-prevention site at 380 East Hastings and recounted his initial experience there offering the test strips.

      A man was preparing to inject a substance he though was heroin but which had a strange, burgundy colour to it. Lampkin offered to test the man’s drugs for fentanyl and he agreed. The test was positive. Lampkin relayed that inform and in response, the man still injected, but with a smaller dose.

      “That was kind of cool,” Lampkin said. “He told me, ‘That’s why I came where’.”

      TRAVIS LUPICK / B.C. CORONERS SERVICE

      Beyond Vancouver, the province is also on track to see a record number of overdose deaths this year. There were 780 fatal overdoses across B.C. during the first six months of 2017.

      That puts B.C. on track for 1,536 deaths in 2017. It compares to 978 during all of 2016 and an average of 204 deaths per year observed between 2001 and 2010.

      According to a July 2017 B.C. Coroners Service report, fentanyl was detected in 78 percent of fatal overdoses recorded during the first five months of 2017.

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