A urine test could become another tool in the fight to reduce opioid overdose deaths in Maine. The test screens for fentanyl, a synthetic opioid that caused more than half of the 418 drug overdose deaths in the state last year. Some health advocates say the test can be used to check drugs before they’re injected, but others say it’s an unscientific method that could actually cause harm.
With fentanyl responsible for an increasing number of overdose deaths in the state, the highly potent synthetic opioid is a concern for people like Maddy Magnuson, the director of harm reduction at the Health Equity Alliance, which has locations in northern Maine. Magnuson says drugs like heroin and cocaine are often laced with fentanyl because it’s cheap, but the people who buy these drugs can be unaware.
“They wouldn’t necessarily know that, unless they were testing their supply,” she says.
That’s why the Health Equity Alliance is considering distributing tests that would allow people to check before they use. They’re called Rapid Response Fentanyl Test Strips. They’re designed to screen urine for fentanyl, but Magnuson says they can also be used to screen drugs.
“You would draw up the drugs that you’re going to inject, and then with the residue that’s in the cooker, you would add more water and then insert the test strip for a certain amount of time. And then it will show one line or two that tell you whether or not there is fentanyl in the drug supply,” she says.
It’s a tool already in use by some harm reduction advocates outside the state. Jess Tilley, director of the New England Drug Users Union, says over the past two years, she has distributed thousands of the fentanyl test strips to organizations and individuals, and has witnessed positive results.
“When the actual, tangible, physical evidence is in front of them, there is such a change in behavior,” she says.
Tilley says people who use drugs recreationally usually opt out if they get a batch with fentanyl. Those who are addicted, she says, do tester shots and they’re less likely to use alone, so that a friend can call 911 or administer the opioid overdose reversal drug Narcan, if necessary.
“At this point, when we are losing more people than we did at the height of the AIDS epidemic, any tool is positive and something that we should investigate and use at this point,” she says.
“Flatly, it makes no sense whatsoever,” says Dr. Mark Publicker, an addiction medicine specialist in Portland.
Publicker says the test is not being used for its purpose, and it’s unclear how sensitive or effective it is.
“We’re talking about something that is untried, untested, and can give a false sense of security,” he says.
Zoe Brokos at the India Street Public Health Center in Portland says she’s also concerned that the test could give a false sense of security. If people split a batch of contaminated drugs, some portions may be fentanyl-free while others have a concentrated amount.
Beyond that, Brokos says, most of the health center’s clients already assume that every batch of drugs they encounter has fentanyl.
“Our harm reduction messages and the education we give to our clients always include things like being careful, making sure you have naloxone, using with friends, doing tester amounts. And is that message really going to change if people know there’s fentanyl in their product?” she says.
Even though the health center has testing strips, it’s holding off on distributing them for now. Brokos says she’ll continue to consider it as she checks in with colleagues across the country about best practices.
As harm reduction organizations weigh the benefits and drawbacks, Dr. Noah Nesin of Penobscot Community Health Care says the debate likely wouldn’t be necessary if the state took other actions to help reduce drug overdose deaths.
“The other side of this equation is we have to keep working to make Narcan as widely available as it can be, and to offer treatment programs that have very low barriers,” he says.
Magnuson of the Health Equity Alliance says they’ll hold a community meeting this month for clients to decide whether the organization should distribute the testing strips.