1
|
Zhao JY, Uddin M, Unsihuay D, Butler W, Xia TW, Xu JZ, Wang S, Sheng X, Jannetto PJ, Wang P, Xia X. Rapid and Sensitive Detection of Fentanyl and Its Analogs by a Novel Chemiluminescence Immunoassay. Clin Chem 2024; 70:978-986. [PMID: 38757262 DOI: 10.1093/clinchem/hvae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Abuse of fentanyl and its analogs is a major contributor to the opioid overdose epidemic in the United States, but detecting and quantifying trace amounts of such drugs remains a challenge without resorting to sophisticated mass spectrometry-based methods. METHODS A sensitive immunoassay with a sub-picogram limit of detection for fentanyl and a wide range of fentanyl analogs has been developed, using a novel high-affinity antibody fused with NanoLuc, a small-size luciferase that can emit strong and stable luminescence. When used with human urine samples, the assay has a sub-picogram limit of detection for fentanyl, with results fully concordant with LC-MS. RESULTS When applied to clinical samples, the novel chemiluminescence immunoassay can detect low positive fentanyl missed by routine screening immunoassays, with a limit of detection of 0.8 pg/mL in human urine. When applied to environmental samples, the assay can detect levels as low as 0.25 pg fentanyl per inch2 of environment surface. Assay turnaround time is less than 1 h, with inexpensive equipment and the potential for high-throughput automation or in-field screening. CONCLUSIONS We have established a novel assay that may have broad applications in clinical, environmental, occupational, and forensic scenarios for detection of trace amounts of fentanyl and its analogs.
Collapse
Affiliation(s)
| | - Mezbah Uddin
- Instanosis Inc., King of Prussia, PA, United States
| | - Daisy Unsihuay
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - William Butler
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Jayson Z Xu
- ATGC Inc., King of Prussia, PA, United States
| | - Simon Wang
- ATGC Inc., King of Prussia, PA, United States
| | | | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Ping Wang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Xiaofeng Xia
- ATGC Inc., King of Prussia, PA, United States
- Instanosis Inc., King of Prussia, PA, United States
| |
Collapse
|
2
|
Kutscher E, Grossi MB, LaPolla F, Lee JD. Fentanyl Test Strips for Harm Reduction: A Scoping Review. J Addict Med 2024; 18:373-380. [PMID: 38829042 PMCID: PMC11290989 DOI: 10.1097/adm.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND High potency synthetic opioids like fentanyl have continued to replace or contaminate the supply of illicit drugs in North America, with fentanyl test strips (FTSs) often used as a harm reduction tool for overdose prevention. The available evidence to support FTS for harm reduction has yet to be summarized. METHODS A search of PubMed, Ovid Embase, and Web of Science was conducted in March 2023. A 2-stage review was conducted to screen by title and abstract and then by full text by 2 reviewers. Data were extracted from each study using a standardized template. RESULTS A total of 91 articles were included, mostly from North America, predominantly reporting on FTS along with other harm reduction tools, and all conducted after 2016. No randomized controlled trials are reported. Robust evidence exists supporting the sensitivity and specificity of FTS, along with their acceptability and feasibility of use for people who use drugs and as a public health intervention. However, limited research is available on the efficacy of FTS as a harm reduction tool for behavior change, engagement in care, or overdose prevention. CONCLUSIONS Though FTSs are highly sensitive and specific for point of care testing, further research is needed to assess the association of FTS use with overdose prevention. Differences in FTS efficacy likely exist between people who use opioids and nonopioid drugs, with additional investigation strongly needed. As drug testing with point-of-care immunoassays is embraced for nonfentanyl contaminants such as xylazine and benzodiazepines, increased investment in examining overdose prevention is necessary.
Collapse
Affiliation(s)
- Eric Kutscher
- NYU Grossman School of Medicine
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
| | | | | | | |
Collapse
|
3
|
Gozdzialski L, Louw R, Kielty C, Margolese A, Poarch E, Sherman M, Cameron F, Gill C, Wallace B, Hore D. Beyond a spec: assessing heterogeneity in the unregulated opioid supply. Harm Reduct J 2024; 21:63. [PMID: 38491435 PMCID: PMC10941387 DOI: 10.1186/s12954-024-00980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Drug checking services aim to provide compositional information for the illicit drug supply and are being employed in public health responses to extreme rates of overdose associated with fentanyl within street opioids. The technologies used within these services range from basic qualitative tests, such as immunoassay test strips, to comprehensive quantitative analyses, such as mass spectrometry. In general, there is concern that heterogeneity of a drug mixture adds significant uncertainty when using drug checking results based on a small subsamples. The presence of hot spots of active drug components in this context is often termed the 'chocolate chip cookie effect'. Establishing the limitations of the service are essential for interpretation of the results. METHODS This study assesses the consequence of drug heterogeneity and sampling of consumer level opioid purchased in Victoria, British Columbia ( n = 21 , 50-100 mg each) on quantitative fentanyl results determined from testing with paper spray mass spectrometry. RESULTS Using descriptive statistics, such as relative standard deviation and interquartile range, the results demonstrate varied distributions of fentanyl concentrations within a single drug batch. However, the presence of hot spots, defined as outliers, were relatively rare. CONCLUSIONS This study found that the variability in fentanyl concentration from drug heterogeneity and sampling is greater than that attributed to the analytical technique. On a practical level, this provides data to help guide communication of limitations of drug checking services, supporting the aim of trust and transparency between services and people who use drugs. However, if drug checking services continue to be restricted from fully engaging with the reality of manufacturing, buying, selling, mixing and dosing practices, the accuracy, usefulness, and impact will always be limited.
Collapse
Affiliation(s)
- Lea Gozdzialski
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Rebecca Louw
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Collin Kielty
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Ava Margolese
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Eric Poarch
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Miriam Sherman
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | | | - Chris Gill
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
- Applied Environmental Research Laboratories (AERL), Department of Chemistry, Vancouver Island University, Nanaimo, V9R 5S5, Canada
- Department of Chemistry, Simon Fraser University, Burnaby, V5A 1S6, Canada
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, 98195, USA
| | - Bruce Wallace
- School of Social Work, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Dennis Hore
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada.
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada.
- Department of Computer Science, University of Victoria, Victoria, V8W 3P6, Canada.
| |
Collapse
|
4
|
Halifax JC, Lim L, Ciccarone D, Lynch KL. Testing the test strips: laboratory performance of fentanyl test strips. Harm Reduct J 2024; 21:14. [PMID: 38238757 PMCID: PMC10795297 DOI: 10.1186/s12954-023-00921-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The overdose crisis driven by synthetic opioids continues to escalate in the USA. We evaluated the efficacy of multiple manufacturing lots of a fentanyl test strip (FTS) to detect fentanyl and fentanyl analogs and assessed cross-reactivity with possible interferences. METHODS Drug standards were dissolved in water in a laboratory setting and serially diluted. Drug dilutions were tested using five different manufacturing lots of BTNX Rapid Response (20 ng/mL cutoff) lateral flow chromatographic immunoassay strips to assess lot-to-lot variability for FTS sensitivity and cross-reactivity for the analytes of interest. RESULTS All five manufacturing lots cross-reacted with fentanyl and eleven fentanyl analogs. Diphenhydramine, lidocaine, MDMA, and methamphetamine were found to cause false positives with the strips. There was notable lot-to-lot variability in the sensitivity of the strips for fentanyl, fentanyl analogs, and known interferences. DISCUSSION FTS remains an important overdose prevention tool, but lot-to-lot variability in performance complicates robust instructions that balance the prevention of false positives and false negatives. Continued lot-to-lot performance assessment is recommended to ensure health education for FTS remains accurate. More sophisticated drug checking technologies and services are needed in the community landscape to augment personal FTS use to facilitate informed consumption and overdose risk mitigation.
Collapse
Affiliation(s)
- John C Halifax
- Department of Laboratory Medicine, ZSFG Clinical Laboratory, UCSF, 1001 Potrero Ave. Bldg. 5 2M16, San Francisco, CA, 94110, USA.
| | - Lilly Lim
- Department of Laboratory Medicine, ZSFG Clinical Laboratory, UCSF, 1001 Potrero Ave. Bldg. 5 2M16, San Francisco, CA, 94110, USA
| | - Daniel Ciccarone
- Department of Family and Community Medicine, University of California San Francisco, 500 Parnassus Avenue, MU-3E, Box 900, San Francisco, CA, 94143, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, ZSFG Clinical Laboratory, UCSF, 1001 Potrero Ave. Bldg. 5 2M16, San Francisco, CA, 94110, USA
| |
Collapse
|
5
|
Shell S, Clinton Frazee C, Garg U. Quantification of Fentanyl and Norfentanyl in Whole Blood Using Liquid Chromatography-Tandem Mass Spectrometry. Methods Mol Biol 2024; 2737:275-282. [PMID: 38036829 DOI: 10.1007/978-1-0716-3541-4_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Fentanyl is a synthetic opioid used in pain management with a potency 50-100 times that of morphine. Due to fentanyl's high potency, very low dosages are needed to elicit the desired response. Fentanyl is gaining popularity as a drug of abuse. Overdose of fentanyl causes respiratory depression that can lead to death. Fentanyl undergoes N-dealkylation in the liver to its inactive metabolite norfentanyl. Quantitation of fentanyl and its metabolite norfentanyl in whole blood can be performed using liquid chromatography-mass spectrometry. In this method, whole blood samples are spiked with deuterated internal standards for fentanyl and norfentanyl. The samples are alkalized with potassium hydroxide and the drugs are extracted with an organic solvent. Extracts are dried and reconstituted, then injected on LC-MS/MS. They are quantitated using positive ion multiple reaction monitoring (MRM) mode.
Collapse
Affiliation(s)
- Serena Shell
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | - C Clinton Frazee
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | - Uttam Garg
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.
- University of Missouri School of Medicine, Kansas City, MO, USA.
| |
Collapse
|
6
|
Tobias S, Ferguson M, Palis H, Burmeister C, McDougall J, Liu L, Graham B, Ti L, Buxton JA. Motivators of and barriers to drug checking engagement in British Columbia, Canada: Findings from a cross-sectional study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104290. [PMID: 38101275 DOI: 10.1016/j.drugpo.2023.104290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Responding to increasing rates of illicit drug toxicity mortality in British Columbia, regional health authorities introduced various types and models of drug checking services starting in 2016. Uptake has been gradual yet consistent, but motivators and barriers of service use have not been well-described. METHODS The British Columbia Harm Reduction Client Survey is a cross-sectional survey conducted at harm reduction sites across British Columbia. Data for the present findings were collected between March 2021 and January 2022. Participants (n = 537) were asked about their use of drug checking services and what prevented them from using available services. Responses were analyzed with descriptive statistics and multivariable logistic regression. RESULTS Of all participants, 519 (96.6 %) answered the survey question on drug checking with 144 (27.7 %) reporting having used services within six months. Participants highlighted barriers such as not knowing where to access services (21.0 %), or not having services in their area (10.0 %). Among people who did not report recent use of fentanyl, 49.6 % stated they would not use their drugs if they tested positive for fentanyl. Other harm reduction behaviors were positively associated with drug checking, such as use of overdose prevention sites (adjusted odds ratio [AOR]: 2.75, 95 % confidence interval [CI]: 1.65, 4.59) and having a naloxone kit (AOR: 2.67, 95 %CI: 1.14, 6.28). Receipt of opioid agonist therapy in the previous six months was also positively associated with drug checking (AOR: 1.72, 95 %CI: 1.05, 2.83). DISCUSSION Drug checking uptake remains low in British Columbia, however this study identified desire for services among participants, suggesting a need for expanded drug checking services. Behavioral change was reported among a high proportion of people who said they would not use their drugs if they tested positive for fentanyl, meaning that immunoassay strips alone have utility in the context of a pervasive fentanyl supply.
Collapse
Affiliation(s)
- Samuel Tobias
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Max Ferguson
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Heather Palis
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada; Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Charlene Burmeister
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Jenny McDougall
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Lisa Liu
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Brittany Graham
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
| |
Collapse
|
7
|
Hayes KL, Lieberman M. Assessment of two brands of fentanyl test strips with 251 synthetic opioids reveals "blind spots" in detection capabilities. Harm Reduct J 2023; 20:175. [PMID: 38057832 DOI: 10.1186/s12954-023-00911-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Fentanyl test strips (FTS) are a commonly deployed tool in drug checking, used to test for the presence of fentanyl in street drug samples prior to consumption. Previous reports indicate that in addition to fentanyl, FTS can also detect fentanyl analogs like acetyl fentanyl and butyryl fentanyl, with conflicting reports on their ability to detect fentanyl analogs like Carfentanil and furanyl fentanyl. Yet with hundreds of known fentanyl analogs, there has been no large-scale study rationalizing FTS reactivity to different fentanyl analogs. METHODS In this study, 251 synthetic opioids-including 214 fentanyl analogs-were screened on two brands of fentanyl test strips to (1) assess the differences in the ability of two brands of fentanyl test strips to detect fentanyl-related compounds and (2) determine which moieties in fentanyl analog chemical structures are most crucial for FTS detection. Two FTS brands were assessed in this study: BTNX Rapid Response and WHPM DanceSafe. RESULTS Of 251 screened compounds assessed, 121 compounds were detectable at or below 20,000 ng/mL by both BTNX and DanceSafe FTS, 50 were not detectable by either brand, and 80 were detectable by one brand but not the other (n = 52 BTNX, n = 28 DanceSafe). A structural analysis of fentanyl analogs screened revealed that in general, bulky modifications to the phenethyl moiety inhibit detection by BTNX FTS while bulky modifications to the carbonyl moiety inhibit detection by DanceSafe FTS. CONCLUSIONS The different "blind spots" are caused by different haptens used to elicit the antibodies for these different strips. By utilizing both brands of FTS in routine drug checking, users could increase the chances of detecting fentanyl analogs in the "blind spot" of one brand.
Collapse
Affiliation(s)
- Kathleen L Hayes
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556, USA.
| |
Collapse
|
8
|
Grace Rose C, Pickard AS, Kulbokas V, Hoferka S, Friedman K, Epstein J, Lee TA. A qualitative assessment of key considerations for drug checking service implementation. Harm Reduct J 2023; 20:151. [PMID: 37848875 PMCID: PMC10580636 DOI: 10.1186/s12954-023-00882-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND With many drug-related deaths driven by potent synthetic opioids tainting the illicit drug supply, drug checking services are becoming a key harm reduction strategy. Many drug checking technologies are available, ranging from fentanyl test strips to mass spectrometry. This study aimed to identify key considerations when implementing drug checking technologies and services to support harm reduction initiatives. METHODS Key informant interviews were conducted with harm reduction stakeholders throughout Illinois. Participants included members of existing drug checking services and recovery centers. Interviews were recorded, transcribed, and coded by two researchers using the framework method. Findings were contextualized according to micro (client)-, meso (organization)-, and macro (policy)-level themes. RESULTS Seven interviews were conducted with ten participants. Fourier transform infrared spectroscopy was consistently identified as a technology of choice given its accuracy, range of substance detection, portability, and usability. Recommendations included the use of confirmatory testing, which can help address the limitations of technologies and provide a mechanism to train technicians. Locations of drug checking services should maximize public health outreach and leverage existing harm reduction agencies and staff with lived experience, who are critical to developing trust and rapport with clients. Criminalization and loss of privacy were major concerns for clients using drug checking services. Additional issues included the need to raise awareness of the legitimacy of services through public support from governing bodies, and funding to ensure the sustainability of drug checking services. CONCLUSIONS This research facilitated the identification of issues and recommendations from stakeholders around key considerations for the adoption of drug checking technologies, which not only included the cost and technical specifications of instrumentation, but also broader issues such as accessibility, privacy, and well-trained personnel trusted by clients of the service. Successful implementation of drug checking services requires knowledge of local needs and capacity and an in-depth understanding of the target population.
Collapse
Affiliation(s)
- Chloe Grace Rose
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA.
| | - Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Stacey Hoferka
- Office of Policy, Planning, and Statistics, Illinois Department of Public Health, 122. S. Michigan Ave, 7th Floor, Chicago, IL, 60603, USA
| | - Kaitlyn Friedman
- Office of Policy, Planning, and Statistics, Illinois Department of Public Health, 122. S. Michigan Ave, 7th Floor, Chicago, IL, 60603, USA
| | - Jennifer Epstein
- Office of Policy, Planning, and Statistics, Illinois Department of Public Health, 122. S. Michigan Ave, 7th Floor, Chicago, IL, 60603, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| |
Collapse
|
9
|
Friedman NMG, Molina CA, Glenn MJ. Harm reduction and emergency medical services: Opportunities for evidence-based programming. Am J Emerg Med 2023; 72:85-87. [PMID: 37499554 DOI: 10.1016/j.ajem.2023.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/12/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Overdose fatalities are increasingly attributed to synthetic opioids, including fentanyl, which may be added to samples of illicit substances unknowingly to the user. As recently as April 2023, the Centers for Disease Control and Prevention has also raised awareness of the risks of xylazine, an animal tranquilizer that has been found in adulterated samples of illicit substance. A growing body of evidence supports the use of drug testing services, including fentanyl and xylazine test strips, to reduce the risks associated with substance use and prevent fatal overdoses. Emergency medical services clinicians serve on the frontline of the opioid epidemic and are uniquely positioned to distribute harm reduction materials. In this article, we advocate for emergency medical services to distribute fentanyl and xylazine test strips. We also critically evaluate legal and other barriers to implementation.
Collapse
Affiliation(s)
- Nicholas M G Friedman
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States of America.
| | - Caitlin A Molina
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, 1100 Glendon Ave., Suite 850, Los Angeles, CA 90024, United States of America.
| | - Melody J Glenn
- Departments of Emergency Medicine and Psychiatry, University of Arizona College of Medicine, 1501 N. Campbell Ave. AHSL 4161 E, Tucson, AZ 85724, United States of America.
| |
Collapse
|
10
|
Turley B, Evans A, Benzio K. Comparative toxicology of syringe exchange and postmortem blood samples in the District of Columbia: Trends and affinity analysis. J Anal Toxicol 2023; 47:588-596. [PMID: 37530762 DOI: 10.1093/jat/bkad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/23/2023] [Accepted: 08/01/2023] [Indexed: 08/03/2023] Open
Abstract
This cross-sectional analysis aimed to understand the similarities and differences between drugs detected in syringes collected from syringe service providers in the District of Columbia and fatal overdose deaths captured by the State Unintentional Drug Overdose Reporting System. Substance exposures for these fatal and non-fatal drug use outcomes have not been previously compared. Substance distributions were examined and a paired significance test was used to compare changes over time. Affinity analysis was employed to reveal substance co-occurrences. Between September 2020 and September 2022, 1,118 postmortem blood samples (PBSs) and 3,646 syringes exchange samples (SESs) were processed, with fatal overdoses increasing 24.1%. Polysubstance use was more commonly found in postmortem blood (82.5%) than in syringe samples (48.6%). Of samples containing opioids, 94.8% of blood samples and 86.3% of syringes contained fentanyl, fentanyl analogs or fentanyl precursors/metabolites. PBSs had double the frequency of co-occurring stimulants and opioids (43.9%) as SESs (21.8%). Major changes in occurrence frequency over time were found for opioid and stimulant exposure in both groups, especially in the increased occurrence of fluorofentanyl (>400%), methamphetamine (>90%) and xylazine (>60%), while the incidence of fentanyl, heroin and metabolite morphine declined. These results indicate that while fatal use and syringe exchange populations have distinct substance exposures, which may contribute to differences in mortality rate, their substance distributions have similar change magnitudes. This study highlights the utility of using multiple data sources to provide a comprehensive description of drug use patterns and discusses the limitations in reporting data from each source.
Collapse
Affiliation(s)
- Ben Turley
- DC Department of Health, 899 North Capitol St NE, Washington, DC 20002, USA
- CDC Foundation, 600 Peachtree St NE #1000, Atlanta, GA 30308, USA
| | - Alexandra Evans
- DC Department of Forensic Sciences, 401 E St SW, Washington, DC 20024, USA
| | - Katharine Benzio
- DC Office of the Chief Medical Examiner, 401 E St SW, Washington, DC 20024, USA
| |
Collapse
|
11
|
Grace Rose C, Kulbokas V, Carkovic E, Lee TA, Pickard AS. Contextual factors affecting the implementation of drug checking for harm reduction: a scoping literature review from a North American perspective. Harm Reduct J 2023; 20:124. [PMID: 37667312 PMCID: PMC10478363 DOI: 10.1186/s12954-023-00856-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The opioid epidemic continues to be a significant cause of morbidity and mortality in the US. In 2020, 83% of opioid-related overdose deaths were due to synthetic opioids, such as fentanyl. Drug checking services have been widely implemented as a harm reduction intervention to facilitate the identification of substances in a drug sample. There is a need to inform decision-making on drug checking technologies and service implementation. This research aims to outline contextual considerations for the implementation of a drug checking service. METHODS A scoping review was conducted using a structured search strategy in PubMed and EMBASE. Articles were independently screened by two reviewers, and included if they were primary literature and reported on an actionable consideration(s) for drug checking services. Data elements were extracted using a standardized form, and included study design, study population, drug checking technology utilized or discussed, and main findings. RESULTS Twenty-nine articles were selected for inclusion, and four primary areas of consideration were identified: drug checking technologies, venue of a drug checking service, legality, and privacy. Technological considerations include the need for highly accurate, quantitative results which appeal to both populations of people with drug use disorder and recreational users. Accessibility of services was identified as an important factor that may be impacted by the location, integration with other services, how the service is provided (mobile vs. fixed), and the hours of operation. Maintaining plausible deniability and building trust were seen as important facilitators to service use and engagement. Issues surrounding legality were the most frequently cited barrier by patrons, including fear of criminalization, policing, and surveillance. Patrons and stakeholders identified a need for supportive policies that offer protections. Maintaining anonymity for patrons is crucial to addressing privacy-related barriers. CONCLUSION This review highlights the need to understand the local population and climate for drug checking to implement a drug checking service successfully. Common themes identified in the literature included considerations related to the choice of technology, the type of venue, and the impact of legality and privacy. We intend to utilize these considerations in future research to help guide discussions with US-based stakeholders.
Collapse
Affiliation(s)
- Chloe Grace Rose
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Emir Carkovic
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA.
| |
Collapse
|
12
|
Rodriguez-Cruz SE. Evaluating the sensitivity, stability, and cross-reactivity of commercial fentanyl immunoassay test strips. J Forensic Sci 2023; 68:1555-1569. [PMID: 37420315 DOI: 10.1111/1556-4029.15332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/17/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
Illicit fentanyl has flooded the United States' drug market, increasing the risk of overdose and poisonings throughout the general population and accidental exposure among law enforcement officers confiscating the increasing number of seizures. Fentanyl test strips (FTS) are used to obtain presumptive information about the presence of fentanyl in a suspected sample. However, their adoption by law enforcement personnel and seized-drug analysts has been limited because most products are advertised for urine testing, not for assays using water solutions. This study presents an evaluation of four commercial FTS: Rapid Response from BTNX, Inc.; T-Dip Fentanyl (FTY) Urine Dip Cards obtained from Amazon.com; Premier BioDip FYL10 from Premier Biotech Inc.; and MobileDetect Fentanyl strips from DetectaChem, Inc. Performance characteristics curves were used to compare the products' sensitivity, showing that all can reliably detect fentanyl in aqueous solutions at concentrations below 1 μg/mL, with some of the tests able to reliably detect the drug at 200 ng/mL. A stability study demonstrates the performance of all four FTS brands was only slightly affected after 30 days of storage at two extreme environmental conditions. Fentanyl-related substances are also evaluated using the Rapid Response FTS, which showed high cross-reactivity with para-fluorofentanyl and acetylfentanyl, but lower with ortho-chlorofentanyl, carfentanil, and 4-ANPP. Users should be aware that FTS may give false-negative results even when potentially dangerous levels of carfentanil are present. When testing other common drugs, adulterants, and diluents frequently encountered in seized tablets, concentration-dependent results were obtained and multiple instances of false positives were recorded.
Collapse
Affiliation(s)
- Sandra E Rodriguez-Cruz
- Drug Enforcement Administration, Special Testing and Research Laboratory, Dulles, Virginia, USA
| |
Collapse
|
13
|
Ti L, Grant CJ, Tobias S, Hore DK, Laing R, Marshall BDL. Development of a neural network model to predict the presence of fentanyl in community drug samples. PLoS One 2023; 18:e0288656. [PMID: 37440523 DOI: 10.1371/journal.pone.0288656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Increasingly, Fourier-transform infrared (FTIR) spectroscopy is being used as a harm reduction tool to provide people who use drugs real-time information about the contents of their substances. However, FTIR spectroscopy has been shown to have a high detection limit for fentanyl and interpretation of results by a technician can be subjective. This poses concern, given that some synthetic opioids can produce serious toxicity at sub-detectable levels. The objective of this study was to develop a neural network model to identify fentanyl and related analogues more accurately in drug samples compared to traditional analysis by technicians. METHODS Data were drawn from samples analyzed point-of-care using combination FTIR spectroscopy and fentanyl immunoassay strips in British Columbia between August 2018 and January 2021. We developed neural network models to predict the presence of fentanyl based on FTIR data. The final model was validated against the results from immunoassay strips. Prediction performance was assessed using F1 score, accuracy, and area under the receiver-operating characteristic curve (AUROC), and was compared to results obtained from analysis by technicians. RESULTS A total of 12,684 samples were included. The neural network model outperformed results from those analyzed by technicians, with an F1 score of 96.4% and an accuracy of 96.4%, compared to 78.4% and 82.4% with a technician, respectively. The AUROC of the model was 99.0%. Fentanyl positive samples correctly detected by the model but not by the technician were typically those with low fentanyl concentrations (median: 2.3% quantity by weight; quartile 1-3: 0.0%-4.6%). DISCUSSION Neural network models can accurately predict the presence of fentanyl and related analogues using FTIR data, including samples with low fentanyl concentrations. Integrating this tool within drug checking services utilizing FTIR spectroscopy has the potential to improve decision making to reduce the risk of overdose and other negative health outcomes.
Collapse
Affiliation(s)
- Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron J Grant
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Samuel Tobias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dennis K Hore
- Department of Chemistry, University of Victoria, Victoria, British Columbia, Canada
- Department of Computer Science, University of Victoria, Victoria, British Columbia, Canada
| | - Richard Laing
- Strategic Research and Science Development, Health Canada Drug Analysis Service, Burnaby, British Columbia, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, United States of America
| |
Collapse
|
14
|
Palamar JJ. Awareness that cocaine can contain fentanyl among nightclub and festival attendees in New York City, 2018-2022. Public Health Nurs 2023; 40:566-571. [PMID: 36961114 PMCID: PMC10330086 DOI: 10.1111/phn.13193] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/03/2023] [Accepted: 03/12/2023] [Indexed: 03/25/2023]
Abstract
People who attend nightclubs and dance festivals-particularly those that feature electronic dance music (EDM), are at high risk for use of cocaine and other party drugs. Given that cocaine is now sometimes adulterated with fentanyl, this study examines trends in people's knowledge about such risk of adulteration to inform prevention and harm reduction efforts. Adults were surveyed entering randomly selected EDM events (including dance festivals) in New York City in 2018, 2019, 2021, and 2022 (n = 2107). They were asked whether they agree that some dealers sell cocaine containing fentanyl, and trends in agreement were estimated. Prevalence of agreement that cocaine can be adulterated increased from 42.1% (95% CI: 36.8-47.6) in 2018 to 65.6% (95% CI: 54.1-75.4) in 2022-a 55.8% increase (p < .001). Between 2018 and 2022, particular increases occurred among those not reporting past-year cocaine use (by 61.6%, p < .001), among White individuals (by 68.1%, p < .001), those with some college (by 68.5%, p = .021), and those age ≥26 (by 83.8%, p = .001). Awareness that cocaine can contain fentanyl is increasing in this high-risk population. Continued education is needed for high-risk populations regarding both opioid overdose response and test strips that can test drugs for the presence of fentanyl.
Collapse
Affiliation(s)
- Joseph J. Palamar
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
- New York University Rory Meyers College of Nursing, New York, NY
| |
Collapse
|
15
|
Uljon S. Advances in fentanyl testing. Adv Clin Chem 2023; 116:1-30. [PMID: 37852717 DOI: 10.1016/bs.acc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Fentanyl is a synthetic opioid that was approved by the FDA in the late 1960s. In the decades since, non-prescription use of fentanyl, its analogs, and structurally unrelated novel synthetic opioids (NSO) has become a worsening public health crisis. There is a clear need for accessible testing for these substances in biological specimens and in apprehended drugs. Immunoassays for fentanyl in urine are available but their performance is restricted to facilities that hold moderate complexity laboratory licenses. Immunoassays for other matrices such as oral fluid (OF), blood, and meconium have been developed but are not widely available. Point of care tests (POCT), such as lateral flow immunoassays or fentanyl test strips (FTS), are widely available but not approved by the FDA for clinical use. All immunoassays are vulnerable to false positive and false negative results. Immunoassays may or may not be able to detect fentanyl analogs and NSOs. Mass spectrometry (MS) can accurately and reliably measure fentanyl and its major metabolite norfentanyl in urine and oral fluid. MS is available at reference laboratories and large hospitals. Liquid chromatography paired with tandem mass spectrometry (LC-MS/MS) is the most widely used method and has outstanding specificity and sensitivity for fentanyl and norfentanyl. When compared to immunoassays, MS is more expensive, requires more technical skill, and takes longer to result. Newer mass spectrometry methods can measure fentanyl analogs and NSO. Both mass spectrometry assays and immunoassays [in the form of fentanyl test strips (FTS)] have potential use in harm reduction programs.
Collapse
Affiliation(s)
- Sacha Uljon
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
16
|
Ondocsin J, Ciccarone D, Moran L, Outram S, Werb D, Thomas L, Arnold EA. Insights from Drug Checking Programs: Practicing Bootstrap Public Health Whilst Tailoring to Local Drug User Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5999. [PMID: 37297603 PMCID: PMC10252652 DOI: 10.3390/ijerph20115999] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
The year 2021 was the most deadly year for overdose deaths in the USA and Canada. The stress and social isolation stemming from the COVID-19 pandemic coupled with a flood of fentanyl into local drug markets created conditions in which people who use drugs were more susceptible to accidental overdose. Within territorial, state, and local policy communities, there have been longstanding efforts to reduce morbidity and mortality within this population; however, the current overdose crisis clearly indicates an urgent need for additional, easily accessible, and innovative services. Street-based drug testing programs allow individuals to learn the composition of their substances prior to use, averting unintended overdoses while also creating low threshold opportunities for individuals to connect to other harm reduction services, including substance use treatment programs. We sought to capture perspectives from service providers to document best practices around fielding community-based drug testing programs, including optimizing their position within a constellation of other harm reduction services to best serve local communities. We conducted 11 in-depth interviews from June to November 2022 via Zoom with harm reduction service providers to explore barriers and facilitators around the implementation of drug checking programs, the potential for integration with other health promotion services, and best practices for sustaining these programs, taking the local community and policy landscape into account. Interviews lasted 45-60 min and were recorded and transcribed. Thematic analysis was used to reduce the data, and transcripts were discussed by a team of trained analysts. Several key themes emerged from our interviews: (1) the instability of drug markets amid an inconsistent and dangerous drug supply; (2) implementing drug checking services in dynamic environments in response to the rapidly changing needs of local communities; (3) training and ongoing capacity building needed to create sustainable programs; and (4) the potential for integrating drug checking programs into other services. There are opportunities for this service to make a difference in overdose deaths as the contours of the drug market itself have changed over time, but a number of challenges remain to implement them effectively and sustain the service over time. Drug checking itself represents a paradox within the larger policy context, putting the sustainability of these programs at risk and challenging the potential to scale these programs as the overdose epidemic worsens.
Collapse
Affiliation(s)
- Jeff Ondocsin
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Daniel Ciccarone
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Lissa Moran
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Simon Outram
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Dan Werb
- Centre on Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Division of Infectious Diseases & Global Public Health, UC San Diego School of Medicine, University of California, San Diego, CA 92093, USA
| | - Laura Thomas
- San Francisco AIDS Foundation, San Francisco, CA 94103, USA
| | - Emily A. Arnold
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| |
Collapse
|
17
|
Swartz JA, Mackesy-Amiti ME, Jimenez AD, Robison-Taylor L, Prete E. Feasibility study of using mobile phone-based experience sampling to assess drug checking by opioid street drug users. Pilot Feasibility Stud 2023; 9:91. [PMID: 37237323 DOI: 10.1186/s40814-023-01321-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND To date, evaluations of take-home fentanyl (and/or benzodiazepine) test strip use - the most common form of drug checking services - and potential effects on overdose risk have relied on retrospective accounts for some preceding time period, usually a week to several months. Such accounts, however, are subject to recall and memory biases. This pilot study assessed the feasibility of using experiential sampling to collect daily information in situ on drug checking and associated overdose risk reduction - the primary outcomes - among a sample of street opioid users and compared the results to retrospective reports. METHODS We recruited 12 participants from a Chicago-based syringe services program. Participants were 18 years of age or older, reported using opioids purchased on the street 3 + times per week in the past month, and had an available Android mobile phone. A phone-based app was programmed to collect daily drug checking information and provided to each participant along with a supply of fentanyl and benzodiazepine test strips and instructions for use over 21 days. Comparable retrospective data were collected via follow-up in-person surveys at the conclusion of daily report collection. RESULTS We found a reasonably high rate of daily reporting (63.5%) with participants submitting reports on 160 "person-days" out of 252 possible days. Participants submitted daily reports an average of 13 of 21 days. Reports of test strip use frequency varied between the retrospective and daily reports with a relatively higher percentage of days/time using test strips obtained from the daily reports. We also found higher proportions reporting overdose risk reduction behaviors on the daily reports compared with the retrospective reviews. CONCLUSIONS We believe the results support using daily experience sampling to collect information on drug checking behaviors among street drug users. Although resource intensive in comparison to retrospective reports, daily reporting potentially provides more detailed information on test strip use and its association with overdose risk reduction and, ultimately, fewer overdoses. Needed are larger trials and validation studies of daily experience sampling to identify the optimum protocol for collecting accurate information on drug checking and overdose risk reduction behavior.
Collapse
Affiliation(s)
- James A Swartz
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 W. Harrison Street, (MC 309), Chicago, IL, 60607, USA.
| | - Mary Ellen Mackesy-Amiti
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, USA
| | - A David Jimenez
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, USA
| | | | - Elizabeth Prete
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, USA
| |
Collapse
|
18
|
Whitehead HD, Hayes KL, Swartz JA, Prete E, Robison-Taylor L, Mackesy-Amiti ME, Jimenez AD, Lieberman M. Validated method for the analysis of 22 illicit drugs and their metabolites via liquid chromatography tandem mass spectrometry (LC-MS/MS) in illicit drug samples collected in Chicago, IL. Forensic Chem 2023; 33:100475. [PMID: 36910306 PMCID: PMC9997102 DOI: 10.1016/j.forc.2023.100475] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Drug checking services are being utilized worldwide to provide people who use drugs information on the composition and contents of their drugs as a tool for harm reduction and accidental overdose prevention. Existing drug checking services use a variety of techniques including immunoassay strips and spectroscopic techniques like FTIR and Raman. Few services utilize LC-MS based methods for primary or secondary analysis and few methods exist for direct analysis of illicit drugs. To address this, an LC-MS/MS method was developed for 22 illicit drugs and cutting agents using LC-MS/MS with application to 124 illicit drug samples that were collected from Chicago, IL. Samples were also analyzed using fentanyl and benzodiazepine immunoassay test strips. Fentanyl test strips gave a positive result for 86% of samples with only one sample showing a positive result on a benzodiazepine test strip. LC-MS/MS analysis of samples show that opioids were the most commonly quantified in 96% of samples, followed by stimulants at 12% and benzodiazepines at 1%. Fentanyl was measured in 91% of samples, co-occurring with heroin in 58% of opioid-containing samples. A comparison of the gold-standard LC-MS/MS results to fentanyl test strips shows a high level of accuracy for the fentanyl test strips, with just 5% of samples being classified as false negatives and no false positives. These results demonstrate the strengths and benefits of LC-MS/MS when incorporated as a secondary analysis tool for drug checking.
Collapse
Affiliation(s)
- Heather D Whitehead
- Department of Chemistry and Biochemistry, University of Notre Dame. Notre Dame, IN, 46556, United States
| | - Kathleen L Hayes
- Department of Chemistry and Biochemistry, University of Notre Dame. Notre Dame, IN, 46556, United States
| | - James A Swartz
- Jane Addams College of Social Work, University of Illinois Chicago. 1040 W. Harrison Street MC (309) Chicago, IL 60607, United States
| | - Elizabeth Prete
- Jane Addams College of Social Work, University of Illinois Chicago. 1040 W. Harrison Street MC (309) Chicago, IL 60607, United States
| | - Lisa Robison-Taylor
- Jane Addams College of Social Work, University of Illinois Chicago. 1040 W. Harrison Street MC (309) Chicago, IL 60607, United States
| | - Mary Ellen Mackesy-Amiti
- School of Public Health, University of Illinois Chicago. 1603 W. Taylor St., Chicago IL 60612, United States
| | - Antonio D Jimenez
- School of Public Health, University of Illinois Chicago. 1603 W. Taylor St., Chicago IL 60612, United States
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame. Notre Dame, IN, 46556, United States
| |
Collapse
|
19
|
Rahmandar MH. Urine Drug Testing in Adolescents: Common Questions and Uses. Pediatr Ann 2023; 52:e166-e169. [PMID: 37159063 DOI: 10.3928/19382359-20230307-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Identifying adolescent substance use can be complicated, as symptoms can be nonspecific and testing can be difficult to obtain and interpret appropriately. Familiarity with consent and confidentiality issues surrounding urine drug testing is important when discussing testing with adolescents and families. Understanding the pros and cons of testing can help pediatricians decide when and how to obtain urine drug screening as well as inform result interpretation. Being aware of home drug testing concerns and having a basic knowledge of fentanyl test strips can assist pediatricians in guiding families and their adolescents. [Pediatr Ann. 2023;52(5):e166-e169.].
Collapse
|
20
|
Nielsen S, Barratt M, Hiley S, Bartlett M, Latimer J, Jauncey M, Roux C, Morelato M, Clark N, Kowalski M, Gilbert M, Francia L, Shipton A, Gerostamoulos D, Glowacki L, Lam T. Monitoring for fentanyl within Australian supervised injecting facilities: Findings from feasibility testing of novel methods and collaborative workshops. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104015. [PMID: 37043848 DOI: 10.1016/j.drugpo.2023.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/31/2023] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Australia is yet to see widespread fentanyl-contaminated heroin, despite the established presence of fentanyl in other countries. International mortality trends alongside a local cluster of fentanyl-related deaths prompted interest in developing methods to monitor for fentanyl and other potentially harmful novel psychoactive substances (NPS) in Australia. METHODS We tested novel methods to monitor for fentanyl and other NPS. From 2017-2021, clients from supervised injecting facilities (SIFs) in Melbourne and Sydney, Australia, contributed urine screens (UDS) with BTNX Rapid Response™ fentanyl test strips (FTS) paired with surveys, and injecting equipment associated with opioid overdoses for laboratory analysis. A single site piloted drug checking using FTS with laboratory confirmation. Two workshops were conducted with SIF staff, content experts and people with lived experience to determine how results can inform practices within SIFs. RESULTS Of the 911 UDS with FTS conducted, less than 1% (n=8) yielded positive results that were not explained by self-reported pharmaceutical fentanyl use, with two laboratory confirmed fentanyl positive results. Injecting equipment from 59 overdoses was tested and neither fentanyl nor other NPS were identified. Drug checking with FTS (n=34) indicated the presence of fentanyl on three tests. Two specimens were subsequently sent for laboratory testing and classified as false positives as the presence of fentanyl was not confirmed. Workshop participants (n=21) felt routine monitoring with FTS currently had limited value. A process for using pre-defined signals to trigger surveillance was developed. CONCLUSION The high false positive rates with FTS, relative to the small number of positive results and potential for them to undermine confidence in FTS emphasised the need for confirmatory testing. The role of routine surveillance was unclear within the current low-fentanyl context, however, a process was developed to upscale testing should signals of increased fentanyl prevalence in the Australian heroin market emerge.
Collapse
Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia.
| | - Monica Barratt
- National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia; Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, VIC, Australia
| | - Sarah Hiley
- Medically Supervised Injecting Room, North Richmond Community Health, VIC, Australia
| | - Mark Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Julie Latimer
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Claude Roux
- Centre for Forensic Science, University of Technology Sydney, NSW, Australia
| | - Marie Morelato
- Centre for Forensic Science, University of Technology Sydney, NSW, Australia
| | - Nico Clark
- Medically Supervised Injecting Room, North Richmond Community Health, VIC, Australia
| | | | | | - Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia
| | - Alexandra Shipton
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia; Department of Forensic Medicine, Monash University, VIC, Australia
| | - Linda Glowacki
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia
| |
Collapse
|
21
|
CERDÁ MAGDALENA, KRAWCZYK NOA, KEYES KATHERINE. The Future of the United States Overdose Crisis: Challenges and Opportunities. Milbank Q 2023; 101:478-506. [PMID: 36811204 PMCID: PMC10126987 DOI: 10.1111/1468-0009.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Policy Points People are dying at record numbers from overdose in the United States. Concerted action has led to a number of successes, including reduced inappropriate opioid prescribing and increased availability of opioid use disorder treatment and harm-reduction efforts, yet ongoing challenges include criminalization of drug use and regulatory and stigma barriers to expansion of treatment and harm-reduction services. Priorities for action include investing in evidence-based and compassionate policies and programs that address sources of opioid demand, decriminalizing drug use and drug paraphernalia, enacting policies to make medication for opioid use disorder more accessible, and promoting drug checking and safe drug supply.
Collapse
Affiliation(s)
- MAGDALENA CERDÁ
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
| | - NOA KRAWCZYK
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
| | | |
Collapse
|
22
|
Tilhou AS, Zaborek J, Baltes A, Salisbury-Afshar E, Malicki J, Brown R. Differences in drug use behaviors that impact overdose risk among individuals who do and do not use fentanyl test strips for drug checking. Harm Reduct J 2023; 20:41. [PMID: 36978170 PMCID: PMC10053743 DOI: 10.1186/s12954-023-00767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Opioid-involved overdose continues to rise, largely explained by fentanyl adulteration of the illicit opioid supply. Fentanyl test strips are a novel drug checking tool that can be used by people who use drugs to detect the presence of fentanyl in drug products. However, it is unclear whether fentanyl test strip use can prompt behavior changes that impact risk of overdose.
Methods
In this mixed-methods study involving a structured survey (n = 341) of syringe service program clients in southern Wisconsin, we examined the association between fentanyl test strip use and overdose risk behaviors in scenarios where the presence of fentanyl is confirmed and unknown. Individual items were transformed into summary scales representing the performance of riskier and safer behaviors. Linear regression examined the association of behaviors with FTS use. Models are adjusted for study site, race/ethnicity, age, gender, drug of choice, indicator of polysubstance use, times used per day, and lifetime overdose count.
Results
In response to survey questions before prompting about fentanyl risk, people who used fentanyl test strips reported an increased number of safer (p = 0.001) as well as riskier behaviors (p = 0.018) relative to people who did not use fentanyl test strips. The same held true in situations when fentanyl adulteration was suspected, though fentanyl test strip use lost significance in the fully adjusted model examining safer behaviors (safer: p = 0.143; riskier: p = 0.004). Among people who use fentanyl test strips, in unadjusted models, a positive test result was associated with more safer behaviors and fewer riskier behaviors, but these associations became nonsignificant in fully adjusted models (safer: p = 0.998; riskier: p = 0.171). Loss of significance was largely due to the addition of either polysubstance use or age to the model.
Conclusions
Fentanyl test strip use is associated with behaviors that may impact overdose risk, including safer and riskier behaviors. Specifically, a positive test result may promote more risk reducing behaviors and fewer risk enhancing behaviors than a negative test result. Results suggest that while FTS may promote safer drug use behaviors, outreach and education should emphasize the need for multiple harm reduction techniques in all scenarios.
Collapse
|
23
|
Gozdzialski L, Wallace B, Hore D. Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations. Harm Reduct J 2023; 20:39. [PMID: 36966319 PMCID: PMC10039693 DOI: 10.1186/s12954-023-00764-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/07/2023] [Indexed: 03/27/2023] Open
Abstract
Drug checking is increasingly being explored outside of festivals and events to be an ongoing service within communities, frequently integrated within responses to illicit drug overdose. The choice of instrumentation is a common question, and the demands on these chemical analytical instruments can be challenging as illicit substances may be more complex and include highly potent ingredients at trace levels. The answer remains nuanced as the instruments themselves are not directly comparable nor are the local demands on the service, meaning implementation factors heavily influence the assessment and effectiveness of instruments. In this perspective, we provide a technical but accessible introduction to the background of a few common drug checking methods aimed at current and potential drug checking service providers. We discuss the following tools that have been used as part of the Vancouver Island Drug Checking Project in Victoria, Canada: immunoassay test strips, attenuated total reflection IR-absorption spectroscopy, Raman spectroscopy from powder samples, surface-enhanced Raman scattering in a solution of colloidal gold nanoparticles, and gas chromatography-mass spectrometry. Using four different drug mixtures received and tested at the service, we illustrate the strengths, limitations, and capabilities of such instruments, and expose the scientific theory to give further insight into their analytical results. Each case study provides a walk-through-style analysis for a practical comparison between data from several different instruments acquired on the same sample. Ideally, a single instrument would be able to achieve all of the objectives of drug checking. However, there is no clear instrument that ticks every box; low cost, portable, rapid, easy-to-use and provides highly sensitive identification and accurate quantification. Multi-instrument approaches to drug checking may be required to effectively respond to increasingly complex and highly potent substances demanding trace level detection and the potential for quantification.
Collapse
Affiliation(s)
- Lea Gozdzialski
- Department of Chemistry, University of Victoria, Victoria, V8W 3V6, Canada
| | - Bruce Wallace
- School of Social Work, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8W 2Y2, Canada
| | - Dennis Hore
- Department of Chemistry, University of Victoria, Victoria, V8W 3V6, Canada.
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8W 2Y2, Canada.
- Department of Computer Science, University of Victoria, Victoria, V8W 3P6, Canada.
| |
Collapse
|
24
|
Balcaen M, Ventura M, Gil C, Luf A, Martins D, Cunha M, Tögel-Lins K, Wolf D, Blanckaert P, Deconinck E. Challenges in Drug Surveillance: Strengthening the Analysis of New Psychoactive Substances by Harmonizing Drug Checking Services in Proficiency Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4628. [PMID: 36901637 PMCID: PMC10002093 DOI: 10.3390/ijerph20054628] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Drug checking is a proven harm reduction strategy and provides real-time information on the market of new psychoactive substances (NPS). It combines chemical analysis of samples with direct engagement with people who use drugs (PWUD), giving the ability to increase preparedness and responsiveness towards NPS. Next to that, it supports rapid identification of potential unwitting consumption. However, NPS cause a toxicological battle for the researchers, as factors such as the unpredictability and quick shift of the market complicate the detection. METHODS To evaluate challenges posed towards drug checking services, proficiency testing was set up to evaluate existing analytical techniques and investigate the capability to correctly identify circulating NPS. Twenty blind substances, covering the most common categories of substances, were analyzed according to the existing protocols of the existing drug checking services, including several analytical methods such as gas chromatography-mass spectrometry (GC-MS) and liquid chromatography with diode array detector (LC-DAD). RESULTS The proficiency test scores range from 80 to 97.5% accuracy. The most common issues and errors are mainly unidentified compounds, presumably due to no up-to-date libraries, and/ or confusion between structural isomers, such as 3- and 4-chloroethcathinone, or structural analogs, such as MIPLA (N-methyl-N-isopropyl lysergamide) and LSD (D-lysergic acid diethylamide). CONCLUSIONS The participating drug checking services have access to adequate analytical tools to provide feedback to drug users and provide up-to-date information on NPS.
Collapse
Affiliation(s)
- Margot Balcaen
- Unit Illicit Drugs, Lifestyle and Chronic Diseases, Scientific Direction Epidemiology, Sciensano, 1050 Brussels, Belgium
| | - Mireia Ventura
- Energy Control, Associació Benestar i Desenvolupament, 08041 Barcelona, Spain
| | - Cristina Gil
- Energy Control, Associació Benestar i Desenvolupament, 08041 Barcelona, Spain
| | - Anton Luf
- Clinical Department of Laboratory Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | | | - Mar Cunha
- Kosmicare, 1170-283 Lisbon, Portugal
| | | | - Danny Wolf
- Legal-high-Inhaltsstoffe, 60439 Frankfurt, Germany
| | - Peter Blanckaert
- Unit Illicit Drugs, Lifestyle and Chronic Diseases, Scientific Direction Epidemiology, Sciensano, 1050 Brussels, Belgium
| | - Eric Deconinck
- Service Medicines and Health Products, Scientific Direction Physical and Chemical Health Risks, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium
| |
Collapse
|
25
|
Crepeault H, Socias ME, Tobias S, Lysyshyn M, Custance A, Shapiro A, Ti L. Examining fentanyl and its analogues in the unregulated drug supply of British Columbia, Canada using drug checking technologies. Drug Alcohol Rev 2023; 42:538-543. [PMID: 36423900 PMCID: PMC10033320 DOI: 10.1111/dar.13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The emergence of fentanyl and its analogues have contributed to a drastic rise in overdose-related mortality in recent years. The objective of this study was to determine the number of drug checking samples containing fentanyl and fentanyl analogues using both point of care and confirmatory drug checking technologies. METHODS Point-of-care drug checking data, using a combination of fentanyl immunoassay strips and Fourier-transform infrared spectroscopy (FTIR), were collected at harm reduction sites in Vancouver and Surrey, British Columbia. Based on current recommendations from the British Columbia Centre on Substance Use Drug Checking Project, a subset of these samples was sent for confirmatory analysis using quantitative nuclear resonance spectroscopy, gas chromatography-mass spectrometry and/or liquid chromatography-mass spectrometry. RESULTS A total of 22,916 samples were tested using FTIR and fentanyl immunoassay strips, of which 6125 (29%) were positive for fentanyl and/or fentanyl analogues. FTIR identified a fentanyl analogue in five samples (all carfentanil). Of the 1467 samples sent for confirmatory analysis, fentanyl was identified in 855 (58%) and fentanyl analogues in 85 (6%), including: carfentanil (n = 56), acetyl fentanyl (n = 15), furanyl fentanyl (n = 9) and cyclopropyl fentanyl (n = 5). DISCUSSION AND CONCLUSION Our research found that FTIR does not consistently distinguish between fentanyl and its analogues at point of care and that highly sensitive confirmatory drug checking technologies are needed to identify fentanyl analogues. These findings underscore the limitations of current drug checking technologies and the importance of using both point of care and confirmatory drug checking initiatives for monitoring changes in the drug supply.
Collapse
Affiliation(s)
- Hannah Crepeault
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - M. Eugenia Socias
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Samuel Tobias
- British Columbia Centre on Substance Use, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Mark Lysyshyn
- Vancouver Coastal Health Authority, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Aaron Shapiro
- British Columbia Provincial Toxicology Centre, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Lianping Ti
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| |
Collapse
|
26
|
Fockele CE, Morse SC, van Draanen J, Leyde S, Banta-Green C, Huynh LN, Zatzick A, Whiteside LK. "That Line Just Kept Moving": Motivations and Experiences of People Who Use Methamphetamine. West J Emerg Med 2023; 24:218-227. [PMID: 36976607 PMCID: PMC10047723 DOI: 10.5811/westjem.2022.12.58396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/16/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Methamphetamine use is on the rise with increasing emergency department (ED) visits, behavioral health crises, and deaths associated with use and overdose. Emergency clinicians describe methamphetamine use as a significant problem with high resource utilization and violence against staff, but little is known about the patient's perspective. In this study our objective was to identify the motivations for initiation and continued methamphetamine use among people who use methamphetamine and their experiences in the ED to guide future ED-based approaches. METHODS This was a qualitative study of adults residing in the state of Washington in 2020, who used methamphetamine in the prior 30 days, met criteria for moderate- to high-risk use, reported recently receiving care in the ED, and had phone access. Twenty individuals were recruited to complete a brief survey and semi-structured interview, which was recorded and transcribed prior to being coded. Modified grounded theory guided the analysis, and the interview guide and codebook were iteratively refined. Three investigators coded the interviews until consensus was reached. Data was collected until thematic saturation. RESULTS Participants described a shifting line that separates the positive attributes from the negative consequences of using methamphetamine. Many initially used methamphetamine to enhance social interactions, combat boredom, and escape difficult circumstances by numbing the senses. However, continued use regularly led to isolation, ED visits for the medical and psychological sequelae of methamphetamine use, and engagement in increasingly risky behaviors. Because of their overwhelmingly frustrating experiences in the past, interviewees anticipated difficult interactions with healthcare clinicians, leading to combativeness in the ED, avoidance of the ED at all costs, and downstream medical complications. Participants desired a non-judgmental conversation and linkage to outpatient social resources and addiction treatment. CONCLUSION Methamphetamine use can lead patients to seek care in the ED, where they often feel stigmatized and are provided little assistance. Emergency clinicians should acknowledge addiction as a chronic condition, address acute medical and psychiatric symptoms adequately, and provide positive connections to addiction and medical resources. Future work should incorporate the perspectives of people who use methamphetamine into ED-based programs and interventions.
Collapse
Affiliation(s)
- Callan Elswick Fockele
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Sophie C Morse
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Jenna van Draanen
- University of Washington School of Public Health, Department of Health Systems and Population Health, Seattle, Washington
- University of Washington, Department of Child, Family, and Population Health Nursing, Seattle, Washington
| | - Sarah Leyde
- Harborview Medical Center, University of Washington, Department of Medicine, Seattle, Washington
| | - Caleb Banta-Green
- School of Public Health, University of Washington, Department of Health Services and Population Health, Seattle, Washington
- University of Washington School of Medicine, Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, Washington
| | - Ly Ngoc Huynh
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Alina Zatzick
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Lauren K Whiteside
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| |
Collapse
|
27
|
Tilhou AS, Birstler J, Baltes A, Salisbury-Afshar E, Malicki J, Chen G, Brown R. Characteristics and context of fentanyl test strip use among syringe service clients in southern Wisconsin. Harm Reduct J 2022; 19:142. [PMID: 36522777 PMCID: PMC9753354 DOI: 10.1186/s12954-022-00720-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Fentanyl adulteration of illicit drugs is a major driver of opioid-involved overdose in the USA. Fentanyl test strips are increasingly used by people who use drugs to check for fentanyl. However, little is known about factors that influence test strip use in this population. METHODS In this mixed-methods study employing semi-structured open-ended interviews (n = 29) and a structured survey (n = 341), we examined characteristics associated with test strip use, characteristics of test strip use, and situational, logistical and psychosocial factors influencing test strip use. Respondents were recruited from a syringe service program in southern Wisconsin. Bivariate tests of association and multivariable logistic regression examined the relationship between respondent characteristics and test strip use. Summary statistics were used to describe how situational, logistical and psychosocial factors impact test strip use. RESULTS Most respondents were male (59.6%), non-Hispanic white (77.4%), young (mean 35.7 years), reported heroin as their primary drug (70.7%), injection as their primary route (87.9%), and use ≥ 3 times daily (78.6%). In multivariable models, site, race and ethnicity, drug of choice, and seeking fentanyl were associated with test strip use. Among test strip users, 36.5% use them most of the time or more and 80.6% get positive results half the time or more. Among individuals reporting heroin, fentanyl, methamphetamine, or cocaine or crack cocaine at least once per month, 99.1%, 56.8%, 42.2%, and 55.7% reported testing these drugs, respectively. Test strip use is supported by information from suppliers, regular transportation, diverse distribution locations, recommendations from harm reduction staff, and having a safe or private place to use. CONCLUSIONS We found that individuals who use fentanyl test strips are more often non-Hispanic white, use heroin, and seek drugs with fentanyl relative to individuals without test strip use. Findings confirm high fentanyl penetration in the Wisconsin drug supply. Low rates of stimulant testing suggest inadequate awareness of fentanyl penetration. Findings support outreach to key populations, increased diversity of distributing locations, efforts to correct misperceptions about drug wasting, emphasis on pre-consumption testing, and the importance of adjunct behaviors to prevent overdose given high rates of intentional fentanyl use.
Collapse
Affiliation(s)
- Alyssa Shell Tilhou
- grid.189504.10000 0004 1936 7558Department of Family Medicine, Boston University/Boston Medical Center, 771 Albany St., Dowling 5 South, Rm 5507A, Boston, MA 02118 USA
| | - Jen Birstler
- grid.14003.360000 0001 2167 3675Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Amelia Baltes
- grid.14003.360000 0001 2167 3675Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Elizabeth Salisbury-Afshar
- grid.14003.360000 0001 2167 3675Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Julia Malicki
- grid.14003.360000 0001 2167 3675Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Guanhua Chen
- grid.14003.360000 0001 2167 3675Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Randall Brown
- grid.14003.360000 0001 2167 3675Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| |
Collapse
|
28
|
Winer JM, Yule AM, Hadland SE, Bagley SM. Addressing adolescent substance use with a public health prevention framework: the case for harm reduction. Ann Med 2022; 54:2123-2136. [PMID: 35900132 PMCID: PMC9341337 DOI: 10.1080/07853890.2022.2104922] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Adolescence is a developmental stage defined in part by risk-taking. Risk-taking is critical to normal development and has important benefits including trying new activities and exploring new relationships. Risk-taking is also associated with the initiation of substance use. Because substance use often begins in adolescence, much focus has been on primary prevention with the goal of preventing initial substance use. Secondary or tertiary prevention approaches, such as counselling to eliminate substance use or offering treatment, are common approaches for adolescents with problematic substance use or a substance use disorder. While this is important, for some adolescents, treatment or cessation of use may not be desired. In these cases, Healthcare Practitioners (HCPs) can offer clear advice that incorporates harm reduction. Harm reduction, which is often applied for adults who use substances, reduces the negative impacts associated with drug use without requiring abstinence. Harm reduction is crucial to keeping adolescents safe and healthy and can offer opportunities for future engagement in treatment. The objective of this review is to describe strategies for integrating harm reduction principles in clinical settings that are developmentally appropriate. A patient-centered, harm reduction approach can validate perceived benefits of substance use, offer strategies to minimise harm, and advise reduction of use and abstinence.KEY MESSAGES:Substance use often begins in adolescence and traditional approaches are often rooted in prevention framework.Harm reduction should be incorporated for adolescents with problematic substance use or a substance use disorder.This review offers strategies for integration of harm reduction principles tailored towards adolescents.
Collapse
Affiliation(s)
- James Michael Winer
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Amy M Yule
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Scott E Hadland
- Division of Adolescent and Young Adult Medicine, MassGeneral Hospital for Children, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.,Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
29
|
Chen H, Kim S, Hardie JM, Thirumalaraju P, Gharpure S, Rostamian S, Udayakumar S, Lei Q, Cho G, Kanakasabapathy MK, Shafiee H. Deep learning-assisted sensitive detection of fentanyl using a bubbling-microchip. LAB ON A CHIP 2022; 22:4531-4540. [PMID: 36331061 PMCID: PMC9710303 DOI: 10.1039/d2lc00478j] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Deep learning-enabled smartphone-based image processing has significant advantages in the development of point-of-care diagnostics. Conventionally, most deep-learning applications require task specific large scale expertly annotated datasets. Therefore, these algorithms are oftentimes limited only to applications that have large retrospective datasets available for network development. Here, we report the possibility of utilizing adversarial neural networks to overcome this challenge by expanding the utility of non-specific data for the development of deep learning models. As a clinical model, we report the detection of fentanyl, a small molecular weight drug that is a type of opioid, at the point-of-care using a deep-learning empowered smartphone assay. We used the catalytic property of platinum nanoparticles (PtNPs) in a smartphone-enabled microchip bubbling assay to achieve high analytical sensitivity (detecting fentanyl at concentrations as low as 0.23 ng mL-1 in phosphate buffered saline (PBS), 0.43 ng mL-1 in human serum and 0.64 ng mL-1 in artificial human urine). Image-based inferences were made by our adversarial-based SPyDERMAN network that was developed using a limited dataset of 104 smartphone images of microchips with bubble signals from tests performed with known fentanyl concentrations and using our retrospective library of 17 573 non-specific bubbling-microchip images. The accuracy (± standard error of mean) of the developed system in determining the presence of fentanyl, when using a cutoff concentration of 1 ng mL-1, was 93 ± 0% in human serum (n = 100) and 95.3 ± 1.5% in artificial human urine (n = 100).
Collapse
Affiliation(s)
- Hui Chen
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Sungwan Kim
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Joseph Michael Hardie
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Prudhvi Thirumalaraju
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Supriya Gharpure
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Sahar Rostamian
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Srisruthi Udayakumar
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Qingsong Lei
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Giwon Cho
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Manoj Kumar Kanakasabapathy
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| | - Hadi Shafiee
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, Massachusetts 02139, USA.
| |
Collapse
|
30
|
Validation of a lateral flow chromatographic immunoassay for the detection of fentanyl in drug samples. Drug Alcohol Depend 2022; 240:109610. [PMID: 36115223 PMCID: PMC9588631 DOI: 10.1016/j.drugalcdep.2022.109610] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Drug overdose deaths remain the primary cause of unintentional injuries in the United States. We examined the validity of a fentanyl test strip (FTS) in detecting fentanyl and its related analogs in water-based illicit drug solutions. METHODS Illicit drugs obtained from law enforcement (N = 343) were tested using a lateral flow chromatographic immunoassay FTS (BTNX Rapid Response) and Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) at a clinical chemistry laboratory in Baltimore, Maryland. RESULTS The FTS assay detected fentanyl at 200 ng/ml in water, and 13 additional fentanyl analogs, but failed to detect carfentanil and furanyl fentanyl at or below 1000 ng/ml. Overall sensitivity and specificity for detecting fentanyls was 98.5 % and 89.2 %; and the false negative and positive rate was 1.5 % and 10.9 %. False negatives (n = 2) occurred in fentanyl and a fentanyl precursor. False positives (n = 23) occurred in the presence of other illicit drugs and compounds (56.5 %) or when fentanyls were present below 40 ng/ml (43.5 %). False positive/negative rates remained low when testing cocaine and prescription opioid (PO) samples. CONCLUSIONS FTS is a valid drug checking tool, however, rapid immunoassays and other drug checking instruments that can detect a wider range of fentanyl analogs including carfentanil need to be prioritized to minimize accidental exposure to the full spectrum of fentanyls.
Collapse
|
31
|
Hawangchu D, Rene Lamy F, Stephan Felix M, Phukao D. Transition from nonmedical prescribed opioids to non-injection heroin use among young integrated Thai male users in Bangkok. J Ethn Subst Abuse 2022:1-27. [PMID: 36190323 DOI: 10.1080/15332640.2022.2126421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Opioid use and misuse are understudied in Thailand despite evidence suggesting that a portion of young Thai male integrated drug users are initiating use of non-medical prescribed opioids with some transitioning to heroin. This study aims to capture and analyze the individual and social factors influencing these transitions. Twenty in-depth semi-structured interviews were conducted between December 2019 and January 2020 in the Bangkok metropolitan area with young male opioid users who transitioned to heroin. Sixteen respondents initiated opioid through a Tramadol cocktail named "YaPro" and tended to transition to heroin use within 21 months. The interaction of specific social and individual factors such as joining recreational activities, curiosity or experimentation gradually modified the opioid-related meanings, attitude and practices of Thai users, who ultimately transition to heroin use. These results indicate that drug prevention programs in Thailand should encompass young opioid users in their intervention and further research need to focus on nonmedical use of prescription opioids in Thailand.
Collapse
Affiliation(s)
- Donlachai Hawangchu
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Francois Rene Lamy
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Mark Stephan Felix
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Darunee Phukao
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| |
Collapse
|
32
|
Zhong ZT, He YF, Tang YJ, Ashraf G, Yang H, Chen W, Liu B, Wang GP, Zhao YD. Terminal deoxynucleotidyl transferase associated with split G-quadruplex/hemin deoxyribozyme amplification detection for various contaminants in milk based on pregnancy test strip platform. Biosens Bioelectron 2022; 216:114644. [PMID: 36007409 DOI: 10.1016/j.bios.2022.114644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/02/2022]
Abstract
Contaminant residue analysis in milk can provide essential assistance for safety quality and contamination level management of milk production, which is critical for safeguarding public health. In this study, the pregnancy test strip is employed to achieve multiple analytes detection based on the specific recognition of aptamer and terminal deoxynucleotidyl transferase associated with split G-quadruplex/hemin deoxyribozyme system. Through the subsequent enzyme catalyzed reaction, the detection signal can be further amplified to improve the sensitivity. The method does not need to assemble test strip, prepare and purify antibodies/haptens, nor design complex probe sequences. By coupling human chorionic gonadotrophin with DNA probes and combining magnetic separation technology, the targets can be determined via the test strip. Under the optimized conditions, the visual detection limits for mercury ion, bisphenol A, and penicillin are 1, 0.1 and 0.05 nM, respectively. The detection results show that the method displays good accuracy and practicability in spiked milk sample. The method presents a simple scheme, low cost as well as good design versatility, which demonstrates great application prospect for the sensitive, low-cost, and convenient detection of food matrices.
Collapse
Affiliation(s)
- Zi-Tao Zhong
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China
| | - Yan-Fei He
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China
| | - Yuan-Ju Tang
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China
| | - Ghazala Ashraf
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China
| | - Huai Yang
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China
| | - Wei Chen
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China
| | - Bo Liu
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China
| | - Guo-Ping Wang
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China.
| | - Yuan-Di Zhao
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China; Key Laboratory of Biomedical Photonics (HUST), Ministry of Education, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, PR China.
| |
Collapse
|
33
|
Abstract
OBJECTIVES United States drug overdose deaths now overwhelmingly involve fentanyl and fentanyl analogs. The emergency department (ED) is an important setting to provide harm reduction for persons who use drugs, but ED-based fentanyl test strip distribution has not yet been described. METHODS This is an observational study of patients with an opioid-related visit to an ED in downtown Chicago, Illinois. We offered fentanyl test strips alongside an existing take-home naloxone program and report on the number of patients who accepted fentanyl test strips. We assessed patient familiarity with fentanyl and fentanyl test strips during the index ED visit and attempted to contact patients 1 month after the ED visit to determine testing outcomes. RESULTS We offered fentanyl test strips to 23 consecutive ED patients (mean age, 39.8 years; male, 73.9%) with an opioid-related ED visit (87.0% for opioid overdose). Sixteen patients (69.5%) had heard of fentanyl, and 2 (8.7%) had prior experience using fentanyl test strips. Eighteen patients (78.2%) accepted the fentanyl test strips, 2 of which left the test strips behind in the ED alongside their take-home naloxone kit. Of the 16 total patients who departed with fentanyl test strips, we were able to reach 3 (18.8%) by phone 1 month after their ED visit; 9 had disconnected or wrong numbers listed. All 3 patients reported a positive fentanyl test strip result; tested substances included heroin, alprazolam, and cocaine. CONCLUSIONS This report demonstrates the feasibility and acceptability of ED fentanyl test strip distribution among patients with opioid-related ED visits.
Collapse
|
34
|
Lam T, Barratt MJ, Bartlett M, Latimer J, Jauncey M, Hiley S, Clark N, Gerostamoulos D, Glowacki L, Roux C, Morelato M, Nielsen S. Infrequent detection of unintentional fentanyl use via urinalysis among people who regularly inject opioids in Sydney and Melbourne, Australia. Addiction 2022; 117:2331-2337. [PMID: 35129225 PMCID: PMC9544654 DOI: 10.1111/add.15832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/17/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM The current phase of the North American 'opioid crisis' is characterised by illicit fentanyl use; however, the presence of illicit fentanyl in Australia is unknown. This study aimed to monitor unintentional fentanyl consumption in Australia. DESIGN Rapid urine drug screens (UDS) paired with surveys conducted within supervised injecting facilities (SIFs) and confirmatory laboratory testing. SETTING Sydney and Melbourne, Australia. PARTICIPANTS Clients who used heroin within the past 2 days (n = 911 tests, 2017-2021). Participants were demographically similar to the overall client base (median age 43, 72% male). MEASUREMENTS UDS were conducted using BTNX Rapid Response fentanyl urine strip tests with cross-reactivity to numerous fentanyl analogues. Positive urine samples were analysed using liquid chromatography coupled with tandem mass spectrometry. Surveys covered past 3 day drug use and lifetime report of fentanyl in heroin. FINDINGS Two percent of participants reported intentional use of fentanyl, mostly through fentanyl patches. Of the 911 rapid UDS conducted, 17 (1.9%) yielded positive results. Eight of these (all from Melbourne) were not explained by survey-reported fentanyl use in the past 3 days. Of these 8 unexplained positives, confirmatory laboratory analysis was conducted on 6, with 4 deemed to be false positives, and 2 confirmed for the presence of fentanyl. This represents the first confirmation of unintended use of fentanyl type substances in this population. CONCLUSION There is limited evidence of unintentional fentanyl use among people in Sydney and Melbourne, Australia who regularly inject heroin, suggesting that, currently, there is very little illicit fentanyl in Australian drug markets accessed by supervised injecting facilities attendees. This study demonstrates the feasibility of quick onsite testing to cost-effectively screen large samples for fentanyl; however, the high false positive rate emphasises the need for confirmation of positive tests through advanced analytical techniques.
Collapse
Affiliation(s)
- Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Monica J. Barratt
- Social and Global Studies Centre and Digital Ethnography Research CentreRMIT UniversityMelbourneVICAustralia,National Drug and Alcohol Research CentreUNSWSydneyNSWAustralia
| | - Mark Bartlett
- Uniting Medically Supervised Injecting CentreSydneyNSWAustralia
| | - Julie Latimer
- Uniting Medically Supervised Injecting CentreSydneyNSWAustralia
| | | | - Sarah Hiley
- Medically Supervised Injecting Room, North Richmond Community HealthMelbourneVICAustralia
| | - Nico Clark
- Medically Supervised Injecting Room, North Richmond Community HealthMelbourneVICAustralia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic MedicineMelbourneVICAustralia,Department of Forensic MedicineMonash UniversityMelbourneVICAustralia
| | - Linda Glowacki
- Victorian Institute of Forensic MedicineMelbourneVICAustralia
| | - Claude Roux
- Centre for Forensic ScienceUniversity of Technology SydneyNSWAustralia
| | - Marie Morelato
- Centre for Forensic ScienceUniversity of Technology SydneyNSWAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneVICAustralia,National Drug and Alcohol Research CentreUNSWSydneyNSWAustralia
| |
Collapse
|
35
|
Reed MK, Guth A, Salcedo VJ, Hom JK, Rising KL. “You can't go wrong being safe”: Motivations, patterns, and context surrounding use of fentanyl test strips for heroin and other drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103643. [DOI: 10.1016/j.drugpo.2022.103643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 12/29/2022]
|
36
|
Hauck BC, Riley PC, Ince BS. Effect of environmental conditions on the performance of fentanyl field detection tests. Forensic Chem 2022. [DOI: 10.1016/j.forc.2021.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
37
|
Wang M, Cetó X, Del Valle M. A novel electronic tongue using electropolymerized molecularly imprinted polymers for the simultaneous determination of active pharmaceutical ingredients. Biosens Bioelectron 2022; 198:113807. [PMID: 34836712 DOI: 10.1016/j.bios.2021.113807] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/02/2022]
Abstract
The combination of chemometrics and electrochemical sensors modified with molecularly imprinted polymers (MIPs) towards the development of MIP-based electronic tongues (ETs) was explored herein. To demonstrate the potential of such an approach, the simultaneous determination of paracetamol, ascorbic acid and uric acid mixtures in pharmaceutical samples was evaluated. To this aim, MIP-based sensors for the different compounds were prepared by in situ electropolymerization of pyrrole in the presence of p-toluenesulfonate anion (pTS-), which acted as functional doping ion of the polypyrrole (PPy) MIP backbone. Morphological characterization of the MIPs was done by scanning electron microscopy (SEM), while functionalization of the electrodes was monitored electrochemically. Under the optimized measuring conditions, the developed sensors showed a good performance, with good linearity at the μM level (R2 > 0.992, limits of detection between 1 and 24 μM) as well as good repeatability (intra- and inter-day RSD values between 3 and 6% over 30 consecutive measurements). Finally, the quantification of the individual substances in different pharmaceutical samples was achieved by an artificial neural networks (ANNs) model, showing satisfactory agreement between expected and obtained values (R2 > 0.987).
Collapse
Affiliation(s)
- Mingyue Wang
- Sensors and Biosensors Group, Department of Chemistry, Universitat Autònoma de Barcelona, Edifici Cn, 08193, Bellaterra, Barcelona, Spain
| | - Xavier Cetó
- Sensors and Biosensors Group, Department of Chemistry, Universitat Autònoma de Barcelona, Edifici Cn, 08193, Bellaterra, Barcelona, Spain
| | - Manel Del Valle
- Sensors and Biosensors Group, Department of Chemistry, Universitat Autònoma de Barcelona, Edifici Cn, 08193, Bellaterra, Barcelona, Spain.
| |
Collapse
|
38
|
Abstract
Harm reduction is an approach to reduce the risk of harms to an individual using substances without requiring abstinence. This review discusses substance-specific interventions for opioids, alcohol, and stimulants that can minimize harms for individuals who use these substances. Topics discussed include overdose prevention, infection prevention, and low-barrier substance use disorder treatment.
Collapse
Affiliation(s)
- Carolyn A Chan
- Program in Addiction Medicine, Section of General Internal Medicine, Department of Medicine, 367 Cedar Street, Harkness Hall A Suite - Suite 305, New Haven, CT 06510, USA
| | - Bethany Canver
- Section of General Internal Medicine, Department of Medicine, 367 Cedar Street, Harkness Hall A Suite - Suite 305, New Haven, CT 06510, USA
| | - Ryan McNeil
- Program in Addiction Medicine, Section of General Internal Medicine, Department of Medicine, 367 Cedar Street, Harkness Hall A, New Haven, CT 06510, USA
| | - Kimberly L Sue
- Program in Addiction Medicine, Section of General Internal Medicine, Department of Medicine, 367 Cedar Street, Harkness Hall A Suite - Suite 417A, New Haven, CT 06510, USA.
| |
Collapse
|
39
|
Macmadu A, Batthala S, Correia Gabel AM, Rosenberg M, Ganguly R, Yedinak JL, Hallowell BD, Scagos RP, Samuels EA, Cerdá M, Paull K, Marshall BDL. Comparison of Characteristics of Deaths From Drug Overdose Before vs During the COVID-19 Pandemic in Rhode Island. JAMA Netw Open 2021; 4:e2125538. [PMID: 34533569 PMCID: PMC8449276 DOI: 10.1001/jamanetworkopen.2021.25538] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/15/2021] [Indexed: 11/14/2022] Open
Abstract
Importance The rate of deaths from overdose has increased during the COVID-19 pandemic, and recent US overdose mortality rates have been markedly high. However, scant data are available on the causes of this increase or subpopulations at elevated risk. Objective To evaluate the rates and characteristics of deaths from drug overdose before vs during the COVID-19 pandemic. Design, Setting, and Participants This retrospective, population-based cohort study used data from 4 statewide databases linked at the person level via the Rhode Island Data Ecosystem on adults with deaths due to overdose in Rhode Island from January 1 to August 31, 2019, and January 1 to August 31, 2020. Main Outcomes and Measures The rates of unintentional deaths from drug-related overdose during the 2019 and 2020 observation periods overall and by sociodemographic characteristics, drugs contributing to the cause of death, location of death, and socioeconomic factors were evaluated. In subgroup analyses restricted to Medicaid beneficiaries (n = 271), the proportions of deaths from overdose by behavioral health treatment and diagnosis claims in the year before death were also examined. Results A total of 470 adults who died of drug overdose were included in the analysis (353 men [75%]; mean [SD] age, 43.5 [12.1] years). The rate of deaths from overdose in Rhode Island increased 28.1%, from 29.2 per 100 000 person-years in 2019 to 37.4 per 100 000 person-years in 2020 (P = .009). Compared with 2019, rates of deaths due to overdose during 2020 were higher among men (43.2 vs 59.2 per 100 000 person-years; P = .003), non-Hispanic White individuals (31.0 vs 42.0 per 100 000 person-years; P = .005), single individuals (54.8 vs 70.4 per 100 000 person-years; P = .04), deaths involving synthetic opioids (20.8 vs 28.3 per 100 000 person-years; P = .005), and deaths occurring in a personal residence (13.2 vs 19.7 per 100 000 person-years; P = .003). A decrease in the proportion of deaths from overdose involving heroin (11 of 206 [5%] vs <2% [exact value suppressed]; P = .02) and an increase among persons experiencing job loss (16 of 206 [8%] vs 41 of 264 [16%]; P = .01) from 2019 to 2020 were observed. Among individuals who died of overdose and were Medicaid beneficiaries, the proportions of those aged 50 to 59 years with anxiety (11 of 121 [9%] vs 29 of 150 [19%]; P = .03), men with depression (27 of 121 [22%] vs 57 of 150 [38%]; P = .008), and men with anxiety (28 of 121 [23%] vs 55 of 150 [37%]; P = .02) increased during 2020 compared with 2019. Conclusions and Relevance In this cohort study, during the first 8 months of 2020, the rate of deaths from overdose increased in Rhode Island compared with the same period in 2019, and several emerging characteristics of deaths from drug overdose during the first year of the COVID-19 pandemic were identified. These findings may inform interventions that address macroenvironmental changes associated with the pandemic.
Collapse
Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Sivakumar Batthala
- Executive Office of Health and Human Services, State of Rhode Island, Cranston
| | | | - Marti Rosenberg
- Executive Office of Health and Human Services, State of Rhode Island, Cranston
| | - Rik Ganguly
- Executive Office of Health and Human Services, State of Rhode Island, Cranston
| | - Jesse L. Yedinak
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | - Rachel P. Scagos
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Magdalena Cerdá
- Division of Epidemiology, Department of Population Health, Center for Opioid Epidemiology and Policy, School of Medicine, New York University, New York
| | - Kimberly Paull
- Executive Office of Health and Human Services, State of Rhode Island, Cranston
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| |
Collapse
|
40
|
Portable gas chromatography-mass spectrometry in drug checking: Detection of carfentanil and etizolam in expected opioid samples. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103409. [PMID: 34392112 DOI: 10.1016/j.drugpo.2021.103409] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND There has been a recent increase in adulteration of opioids with low concentration actives such as fentanyl analogues and benzodiazepines. As drug checking projects using vibrational spectroscopy continue to seek confirmatory lab-based testing, the concern and reality of missing these potentially harmful substances in point-of-care testing is prevalent. METHODS A portable GC-MS was used to analyze select opioid samples acquired at a drug checking service in Victoria, Canada (n=59). Certified reference standards of several fentanyl analogues and benzodiazepines were measured to guide targeted analysis of these samples. Results were compared with those obtained using a lab-based paper spray mass spectrometer. RESULTS Portable GC-MS was able to identify 62% of samples containing carfentanil and 36% of samples containing etizolam. In the case of etizolam, the success rate was higher for more potent samples: 78% of etizolam-containing samples were identified when the etizolam concentration was above 3% by weight. In comparison, infrared spectroscopy was able to detect etizolam in only 9% of the etizolam-containing samples, and is not sensitive enough to detect carfentanil at relevant concentrations. CONCLUSIONS Portable GC-MS has potential in identifying low concentration substances in a point-of-care setting, without relying on subsequent off-site confirmatory testing.
Collapse
|