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British Columbia Drug checking takes on elevated role as illicit fentanyl sweeps country and fuels surge in overdose deaths

Kyle Besaw, left, drug checking tech aid with Vancouver Coastal Health, and Trey Helten, right, supervisor at the Overdose Prevention Society safe injection site, check samples of heroin for fentanyl and other substances in Vancouver, British Columbia, July 11, 2019.

Rafal Gerszak/The Globe and Mail

Kyle Besaw carefully tips over a small, paper cup, pouring a tiny, bluish-green pebble onto the plate of a drug-checking machine. With a metal tool, he positions the sample over a tiny crystal and lowers a clamp.

The woman who purchased the drug and asked for it to be checked expects it to be fentanyl. But she’s worried it may also contain benzodiazepines – a class of drugs commonly used to treat anxiety and sleep disorders that is now being cut into the local illicit supply.

Mr. Besaw, a drug-checking technician with Vancouver Coastal Health (VCH), scans the substance, analyzing the lines that appear on his monitor. Beside him, overdose-prevention site supervisor Trey Helten dilutes a small sample with water before dipping two test strips into the solution, watching a single red line appear on each.

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The substance contains caffeine, a sugar alcohol, fentanyl and benzodiazepines. When combined, the latter two increase the risk of overdose and can knock a person unconscious for hours.

“We’ve noticed a lot of concern [about benzodiazepines] from females,” Mr. Besaw said. “I think that’s because the benzos can make you really incapacitated. And since women are higher risk in the community anyway, there is a big fear of sexual assault and robbery.”

He scoops the sample off the machine and wipes it down with a tissue in preparation for the next test.

Drug checking emerged in the early 1990s in Europe as a way for people to minimize harms associated with taking “party drugs” such as MDMA and cocaine, often at raves and music festivals. The strategy eventually spread to North America.

But drug checking has taken on an elevated role in recent years as illicit fentanyl swept the country and fuelled a surge in overdose deaths. Without significant changes to the highly toxic drug supply that is driving Canada’s overdose crisis, drug checking has become an important tool in at least identifying and mitigating some of its harms.

“What we really need to look at is replacing the drug supply for people,” said Rob Boyd, Oasis program director at the Sandy Hill Community Health Centre in Ottawa, which has operated a drug-checking program since May, 2018.

“[But] if everything else remains the same, then it’s a necessary intervention. If nothing else is going to change, we need to give people the information to help them to be safe.”

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Vancouver became the first city in Canada to officially facilitate the service in 2016, when VCH started offering checks for fentanyl at the Insite supervised consumption site using simple test strips.

The following year, the city and the BC Centre on Substance Use (BCCSU) purchased a portable Fourier-transform infrared (FTIR) spectrometer – a device that can test a range of substances and identify multiple compounds at once within a couple of minutes – and made it available at rotating VCH sites.

There are now seven such devices in use in the Lower Mainland, run by different groups, and about a handful of other organizations across Canada offer drug checking to the public in some capacity.

The nascent intervention has already yielded some notable findings. One 2017-18 study of drug-checking services in Vancouver found fentanyl had largely replaced heroin in the illegal market, with only 17.6 per cent of more than 1,700 samples sold as heroin containing any of the drug at all. Meanwhile, 90.6 per cent tested positive for fentanyl.

Another study, conducted in 2016-17 at Insite, found that people who had fentanyl-positive tests in the drug checking were almost 10 times more likely to reduce their dose than those who had fentanyl-negative tests. Those who reduced their dose, in turn, had significantly lower odds of overdose.

“[That leads] us to conclude that drug checking can potentially reduce overdose by encouraging people to reduce their dose,” said Mark Lysyshyn, a medical health officer with VCH.

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In 2017, VCH launched its Real-time Drug Alert & Response (RADAR) system, a text-message-based alert system that draws from user reports and drug-check findings to warn of “bad dope” in circulation.

This year, benzodiazepines being cut into the local supply of “down” – the colloquial term for an opioid such as heroin or fentanyl – have led to a spate of particularly troubling overdoses: people unconscious for hours at a time; women waking up having been sexually assaulted. Several recent RADAR alerts warned of fentanyl and benzodiazepines being sold as down.

In Toronto, the Centre on Drug Policy Evaluation is planning to pilot drug-checking services at three harm-reduction agencies beginning in September.

Operations manager Karen McDonald said the centre will use gas chromatography-mass spectrometers (GC-MS) – sophisticated devices that provide more detailed results than the FTIR spectrometers but require highly trained technicians to operate and more time to analyze.

At the University of Victoria, researchers are piloting a drug-checking program using four types of technologies, including FTIR and GC-MS spectrometers.

Bruce Wallace, associate professor of social work, said the project aims to offer drug checking to those who want it while simultaneously evaluating the various technologies to see which ones might be most effective in a community setting should the intervention be scaled up.

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He is hopeful that drug checking will play a role in large-scale, safer-supply initiatives but said, in the mean time, the technology will at least provide more information to people who use illicit substances.

“If government’s going to continue to concede to the illicit drug market, how can we at least put in as many quality controls as possible?" he said.

Long-time cannabis activist Dana Larsen purchased two FTIR spectrometers using funds from his marijuana dispensary in Vancouver’s West End and has been checking illicit drugs mailed in from across the country and in-person at the site of his recently shuttered dispensary near the Downtown Eastside.

His clientele mostly test “party drugs," such as MDMA and cocaine, while those visiting the various licensed overdose prevention sites in the city skew more toward injectable opioids, he said.

“People shouldn’t have drug checking because your drugs should be getting checked before you buy them at the store,” Mr. Larsen said. “We don’t have alcohol-checking machines because people can buy regulated alcohol.”

With a file from Mike Hager.

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