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Research led by a Rhode Island Hospital opioid expert has demonstrated the potential to utilize portable field devices to test street drugs for the presence of fentanyl – a technique that could aid public health advocates and public safety agencies in their effort to curb a nationwide epidemic of fatal overdoses from the potent synthetic narcotic.
Traci Green, Ph.D., M.Sc., co-director of the hospital’s Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, is the lead author of a paper just published in the International Journal of Drug Policy. The research was funded by a grant from the Bloomberg American Health Initiative at Johns Hopkins Bloomberg School of Public Health.
The study, led by Green and Susan G. Sherman, Ph.D., a professor in the Bloomberg School’s Department of Health, Behavior and Society, is a response to an opioid epidemic that is responsible for thousands of deaths each year. Fentanyl was confirmed in 64 percent of opioid deaths in Rhode Island and 85 percent of opioid deaths in Massachusetts in 2017. Yet many consuming drugs are unaware their drugs contain fentanyl or how much fentanyl it contains, according to research from Green and others.
One strategy for increasing safety—already established in Europe—is to introduce real-time drug testing at community programs providing such drug user services as safe consumption sites, sterile syringes, and mobile clinics. This tactic (often called “drug checking”) can reduce the risk of accidental overdose while also providing public health officials with valuable information about the presence of fentanyl and other harmful cutting agents in street drugs.
Green and colleagues partnered with the Providence and Baltimore police departments and the Rhode Island Department of Health to acquire and blind test over 200 samples of police-confiscated street drugs using three separate portable devices designed for field testing: an infrared spectrometer, a Raman spectrometer, and fentanyl testing strips.
Testing street drugs that had already been confiscated and professionally tested in labs for police allowed the researchers to simulate the utility of these devices in a real-world drug-checking scenario. In their evaluation they considered each device’s speed, ease of use, accuracy, cost, and ability to detect small amounts of fentanyl from tiny samples without destroying them.
They determined that fentanyl test strips were best at detecting fentanyl and at very low levels in street drugs. But the fentanyl test strips don’t differentiate among the many types of fentanyl or detect other harmful contaminants or drugs. For this reason, the authors discuss, a two-pronged drug checking approach is best: the infrared spectrometer, which provides detailed chemical profile information (valuable for public health surveillance purposes) and fentanyl test strips, which are cheap and cheap and simple to use and highly sensitive to fentanyl.
“This study showed us that there are valid and easy-to-use devices that can provide critical insights that are meaningful to both people who use drugs and public health decision makers,” says Green, the study’s lead author. “Public health has built an impressive capacity to quickly detect harmful bacteria when it enters the food supply, which prevents sickness and death. Why not try to apply the same principles to the illicit drug supply and protect the health of all consumers? We shouldn’t have to wait for an overdose, a death, or an investigation to know what’s in our communities when we have tools like these to help us guide action and harm reduction.”
More information about the Bloomberg-funded research can be found at the school’s website.
In addition to her role at Rhode Island Hospital, Green is an adjunct associate professor of emergency medicine and epidemiology at Brown University and recently was appointed director of Brandeis University’s Opioid Policy Research Collaborative in the Heller School for Social Policy and Management.
Green is co-director of the Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, which was established at Rhode Island Hospital in 2018 with a five-year, Phase I grant from the National Institute of General Medical Sciences. The COBRE works in partnership with Brown University and Women and Infant’s Hospital to develop and sustain a critical mass of investigators specializing in opioid use disorder.
The research team included Eric Struth of Rhode Island Hospital, Michelle McKenzie of the Center for Prisoner Health and Human Rights at The Miriam Hospital, Ju Nyeong Park of the Johns Hopkins Bloomberg School of Public Health, William Clarke of the Johns Hopkins School of Medicine, and independent researcher Michael Gilbert of Portland, Oregon