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If a $1 fentanyl test strip can save lives, why not deploy it?

New legislation seeks to allow the legal distribution of fentanyl test strips in Rhode Island, as a harm reduction strategy to prevent OD deaths

Photo by Richard Asinof

A fentanyl test strip manufactured by a biotech company near Toronto, Canada, that costs about $1, which can detect the presence of fentanyl in illicit drugs.

By Richard Asinof
Posted 5/14/18
A simple consumer test strip, costing $1, can identify the presence of deadly fentanyl in illicit drugs, saving lives and potentially creating a way to change behavior. New legislation to make the distribution of fentanyl test strips has been introduced before the R.I. General Assembly.
When will there be a statewide harm reduction strategy that includes the distribution of fentanyl test strips? When will the diseases of despair become part of the conversation around the epidemic of overdose deaths, tied to the forces of economic disruption and isolation? Is there an opportunity to develop safe injection facilities in Rhode Island, modeled on the Vancouver, British Columbia, model, which would incorporate fentanyl test strip distribution?
A new Rhode Island PBS documentary, “The Fix: Examining Rhode Island’s Opioid Epidemic,” with the purpose of exploring what is being done to combat the epidemic, will have a public screening on May 21. Will the use of fentanyl test strips be identified as a strategy to save lives in order to combat the epidemic in the documentary? Good question.
Will the documentary include any coverage of community-led efforts to establish a safe injection site facility in Rhode Island? Another good question.
Will the research by Shannon Monnat around the diseases of despair, including the mortality statistics for alcohol, suicide and drugs, be included? Yet another good question.
Will chronic alcohol intoxication, one of the leading causes of transports to hospital emergency rooms, be discussed as an important co-morbidity of substance use disorders?
Probably not.

PROVIDENCE – The image displayed atop this story is a fentanyl test strip. It is manufactured by BTNX, a biotech company located near Toronto, Canada. It costs about $1 to purchase.

The testing strip can detect presence of fentanyl, a substance implicated in some 70 percent of the 323 overdose deaths in Rhode Island in 2017.

Without a testing strip, most if not all users have no way of knowing if their drugs contain the deadly fentanyl.

Fentanyl is a powerful synthetic opioid, 50 to 100 times more potent than heroin, often laced by dealers into illicit drugs such as heroin, cocaine and methamphetamine.

A major study published earlier this year by Johns Hopkins Bloomberg School of Public Health and Brown University found that fentanyl test strips could serve as an effective tool in harm reduction, providing an accurate, inexpensive way of detecting the presence of fentanyl in illicit drugs.

The research study recruited 335 active drug users as participants in Providence, Boston and Baltimore, asking them if they would employ the test strip and if knowing that the drugs contained fentanyl, how would that change their behavior.

84 percent said that they were concerned that the drugs they used may contain fentanyl

89 percent agreed that it would make them feel better about protecting themselves from overdose

70 percent said that knowing their drugs contained fentanyl would lead them to modify their behavior.

The study also found that the test strip detected fentanyl with 100 percent accuracy in drug samples from Baltimore and with 96 percent accuracy in Providence.

Translated, if the goal is to save lives of Rhode Islanders, then distributing fentanyl test strips to drug users could become a top priority as part of an overall statewide harm reduction strategy.

Overcoming legal hurdles
One problem is that distributing such a fentanyl test strip tool falls into a legal gray area because it involves testing illicit drugs.

To help remedy that, Rep. Aaron Regunberg, a candidate running for Lt. Governor in the 2018 Democratic primary, introduced legislation on April 27, 2018 – HR 8132, which would amend the Good Samaritan Overdose Prevention Act of 2016 as follows:

“Any person may provide, administer, or utilize a narcotic testing product to assist another person in determining whether a narcotic or substance contains chemicals, toxic substances, or hazardous compounds. Narcotic testing products shall include, but not be limited to, fentanyl test strips.”

The legislation continues: “A person who provides, administers or utilizes a narcotic testing product to assist another person shall not be subject to civil liability or criminal prosecution as a result of providing, administering, or utilizing the narcotic testing product to assist another person.”

We few, we band of brothers and sisters
On Thursday May 10, outside the Providence Safety Complex, a small band of advocates held a news conference to tout the new legislation, joined by Regunberg.

A first hearing had been held the previous day on May 9 before the House Judiciary Committee, where the bill was held for further study.

Michael Galipeau, the president of the Rhode Island User’s Union, opened with a moment of silence and then read a lengthy statement, much to the consternation of some in news media, who wanted a more media savvy approach, for Galipeau to bark out the key messages of the story. At least one member of the news media covering the event said that they had never heard of fentanyl test strips before.

Michelle McKenzie, a member of the Governor’s Task Force on Overdose Prevention and Intervention, and a former board chair of RICARES, a community advocacy organization, spoke about how the potential use of fentanyl test strips as part of a larger harm reduction strategy that “meets people where they are,” which would fit well as a companion strategy to the distribution of naloxone kits.

Regunberg, in response to questions from WPRO’s Steve Klamkin, provided the answers to the who, what why, where and when of the story, including the fact that by approving the legislation, Rhode Island would become the first state in the nation to approve the legal distribution of fentanyl test strips.

The advocates’ intent for the new legislation, according to Galipeau, was to deploy fentanyl test strips as a new consumer tool to promote safety through engagement, education and testing, working in tandem with law enforcement and emergency medical professionals. “Let us keep our communities safe, one strip at a time,” he said.

Still, the stigma toward drug users appeared to pervade opposition voiced to the proposed law permitting the use of fentanyl test strips. There are those who saw this effort to distribute fentanyl test strips as enabling drug use, rather than saving lives.

As one Facebook commenter wrote, in reply to an interview with Rep. Julie Casimiro, a co-sponsor of the legislation, which had been posted by GoLocal’s news editor, Kate Nagle: “Dumb,” said Doreen Costa, a former Republican legislator.

“How about helping them [get] off drugs instead of enabling them,” Costa continued. “This is ridiculous; here, let me help you get high but first let’s test the drug.”

Instead of getting stuck in such arguments, whether fentanyl test strips save lives or enable drug use, it may require reframing the conversation. As Jonathan Goyer, a member of the Task Force and manager of Anchor Recovery’s Mobile Outreach Recovery Efforts, told the U.S. Surgeon General during his visit to Pawtucket in February, “The opposite of addiction is not sobriety; it is connectedness.”

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