A pilot project to test illicit drugs for fentanyl at Vancouver's supervised-injection site has piqued the interest of other health-care providers in North America – but they are being cautioned against replicating the experiment over fears a negative test could give users a false sense of security.
Vancouver Coastal Health began offering Insite clients fentanyl test strips in July, giving them the opportunity to find out, within a minute, whether there is fentanyl in the drug they are about to inject. Clients mix a small sample with water in a cooker then dip the test strip into the solution; one line means it contains fentanyl, two lines means it does not.
In the first month of testing, 86 per cent of drugs – 90 per cent of what users believed was heroin – tested positive for the powerful synthetic opioid.
Since then, about a dozen groups – including a pharmacy in Winnipeg, a physician in Calgary and a harm-reduction organization in New York – have contacted Vancouver Coastal Health (VCH) and the test's manufacturer, Ontario-based BTNX Inc., wanting to learn more and offer the affordable and easy-to-use tests themselves.
However, the health authority and manufacturer stress that there are variables to consider and that the strips – intended for urine tests, to be administered by physicians – should not be distributed freely among the general public at this early stage.
"We really don't know if a negative drug check means that the drugs are safer," said Mark Lysyshyn, medical health officer for VCH. "There are a lot of contaminates in street drugs that could interfere with the test results. We also know there are things in street drugs that can't be detected by these strips.
"We also have some concerns about drug users being able to interpret the tests themselves, reliably, especially in the environments where they might be using and testing drugs, which might be quite contaminated themselves."
BTNX Inc. president and CEO Iqbal Sunderani said that while having the option to test is better than nothing, he is worried that a drug user could misinterpret the result, or not take appropriate precautions if the test turns up negative for fentanyl.
"It's a difficult question. It's one that is, ethically, very difficult to answer," he said. "I personally don't think we should be handing these out like Smarties to everybody, and giving them a false sense of security. It should be handled with care, responsibility, by the right professionals."
Michael Watts, owner and manager of Brothers Pharmacy in Winnipeg, ordered the tests with the intention of selling them to the public but was told by the College of Pharmacists of Manitoba this week not to.
"I think it's important for the community, especially with fentanyl having exploded in the past couple of years," he said. "We're not going to stop people from using illicit drugs and I strongly believe in harm reduction. If we can allow them to make informed decisions, if we can give them any information … then I feel I am doing a service to the public."
Todd Mereniuk, deputy registrar for the college, was unavailable for an interview on Thursday. In a statement, he said the college is seeking additional information from BTNX, Health Canada and VCH on the test kit and has asked Brothers Pharmacy not to sell the tests in the meantime.
"Our motivation is in keeping with our legislative mandate," he said. "We will move forward without delay to resolve this question. Until then, we believe caution is appropriate."
The pilot project at Insite continues. In addition to keeping track of fentanyl-positive tests, physicians are noting whether clients dispose of their drugs when they turn up fentanyl-positive – to date, largely no – whether they lower their doses, and whether they overdose.
Updated figures show the total percentage of drugs that tested positive for fentanyl has dropped slightly – but remains high – at about 80 per cent.
Meanwhile, Alberta is inching toward opening a supervised-injection site of its own. Associate Health Minister Brandy Payne said Thursday that the provincial government will give a $230,000 grant to an Edmonton agency to apply to open a site.
Another $500,000 will go to six other Alberta communities to assess the need for consumption sites.