Could fentanyl test strips prevent fatal drug overdoses in Pa?

Maryland officials have a new tool in their fight against fatal drug overdoses: test strips that can detect fentanyl, the incredibly powerful synthetic opioid that is now the top killer drug in Pennsylvania.

Maryland officials plan to distribute 60,000 of kits by the end of the month through various agencies and organizations, according to the Capital Gazette.

Could the simple $1 strips be useful right next door in Pennsylvania to combat thousands of unnecessary drug deaths?

Yes, according to experts and advocates.

But not so fast, according to government officials who say the kits could be considered “drug paraphernalia” under Pennsylvania law. Under that scenario, people who distribute them and people who use them to try to save lives potentially could be prosecuted.

Maryland changed its paraphernalia law last year to exclude drug-checking kits such as the fentanyl test strips from the definition of paraphernalia.

A spokesman from the Pennsylvania Department of Health said a similar change would be required by state lawmakers in Pennsylvania before the test kits could be distributed legally.

“The commonwealth has discussed fentanyl test strips as a form of harm reduction,” said Nate Wardle, the health department’s main spokesman. “A statutory change would be required for fentanyl strips to be approved, and that would need to be approved by the Drug Device and Cosmetic Board.”

Wardle would not say whether department officials were actively advocating for the law to be changed.

“There continues to be discussions on various levels to determine what steps will assist Pennsylvania in further addressing the opioid crisis,” Wardle said.

As it stands, Pennsylvania’s law prohibiting paraphernalia defines paraphernalia in part as “any device, which is used or is intended to be used for the purpose of planting, propagating, cultivating, growing…testing, analyzing, packing, repacking,” a controlled substance.

While the Department of Health said the strips would be considered paraphernalia, likely under the “testing and analyzing” portion of the law, the state’s Attorney General and a spokesman for the state’s District Attorneys Association would not interpret that section of law for PennLive.

Among the people who are advocating for expanded access to fentanyl test strips are harm reduction advocates and emergency department physicians.

A group of physicians from Penn Medicine in Philly issued a news release in November that called for more test strips after a cluster of 18 overdoses over four days linked to “crack” cocaine that had been laced with fentanyl. Three people died. None of the patients had previously used opioids.

Fentanyl – which is cheaper to produce than heroin and more addictive – has drenched much of the heroin and crack cocaine drug supply and was found in nearly 85 percent of Philadelphia’s 1,217 overdoses in 2017, according to the Penn Medicine news release.

Fentanyl was present in nearly 80 percent of all fatal overdoses in Dauphin County last year, according to the coroner’s recently released year-end report. A potential cluster of cocaine/fentanyl-related deaths emerged in Dauphin County in mid-April, claiming a 52-year-old man, a 34-year-old woman and a 48-year-old man.

When fentanyl is slipped into non-opioid drugs like cocaine or marijuana, experts say, it becomes even more deadly as the person using likely doesn’t have any knowledge or tolerance for it.

That’s where the test strips could be potentially most useful, said Jeanmarie Perrone, MD, a professor of Emergency Medicine and director of the division of Medical Toxicology in the Perelman School of Medicine at the University of Pennsylvania.

The outbreak in Philly involving non-opioid users was a first, she said, and was “indicative of a larger problem with fentanyl in the city that we need to continue to quickly act on. Having these strips for people who inject drugs is important in curtailing unintentional fentanyl use and reducing the risk of overdose in those who intend to use it. They can influence people to use less, take slower injections, or not use alone.”

The test strips don’t provide the quantity of fentanyl in a drug, just the fact that fentanyl is present. And that’s most important for people who use non-opioid drugs and for people in areas of the state where fentanyl hasn’t yet widely tainted the drug supply.

The strips originally were manufactured for urine drug tests but can be used off-label to identify fentanyl and fentanyl analogues in the drug supply.

To use the strips, users mix a small amount of powder drugs into a cup of water and then place the strip inside the cup. Results are revealed in about 30 seconds, similar to a pregnancy test with two red or pinkish lines to indicate fentanyl.

A Brown University study released in January found drug users in Rhode Island “not only used the strips, but also reported changing their behavior to reduce overdose risk if they detected fentanyl.”

Devin Reaves, of the Pennsylvania Harm Reduction Coalition, said harm reduction advocates know how beneficial the test kits could be, yet most are reluctant to hand out the kits until there is more legal clarity.

Maryland officials have prioritized harm reduction services such as sterile syringe services, where people can get free sterile equipment, but such programs remain “underutilized” in Pennsylvania, Reaves said.

“Pennsylvania is the only state in the northeast that has not expanded access to sterile syringes, leaving harm reduction as an intervention in a murky space,” he said.

People who use drugs and participate in sterile syringe programs are five times more likely to seek treatment, according to a fact sheet from the Centers for Disease Control and Prevention.

The drug-checking kits could be just as useful by getting people who use drugs plugged into an official public health program, Reaves said.

Syringe services programs also reduce needle-stick injuries among first responders by providing proper disposal as well as reducing overdoses and new HIV and viral hepatitis infections, according to the CDC. Sterile syringe programs “don’t increase drug use or crime,” according to the CDC’s fact sheet.

According to the Drug Policy Alliance, a recent pilot program in Vancouver showed drug checking prevents fentanyl overdoses. Of drugs checked, 79% contained fentanyl. Those who checked drugs prior to use were ten times more likely to reduce their dose and were 25% less likely to overdose.

But there are three big hurdles before Pennsylvanians could see wide use of drug-checking kits like the fentanyl test strips: legal issues, finding effective distribution channels and identifying funding sources.

Needle exchanges are currently only sanctioned in Philadelphia and Pittsburgh, because of specific local ordinances. Agencies operating in other areas of the state and distributing needles or drug-checking kits are risking their freedom to help people using drugs, Reaves said.

“We need to decriminalize harm reduction in Pennsylvania so we can save lives,” Reaves said. “This is a public health issue.

“It shouldn’t be a death sentence to use drugs and this tool allows that to be possible.”