You can’t see it, smell it, or taste it and usually there was never an intention to buy it. Since 2013 fentanyl became the driving force behind drug overdoses, and now most street drugs are laced with it. 

The problem so big, Ohio decriminalized fentanyl test strips this year so people could check to see if their drugs were tainted.

But it’s still not stopping the overdoses and usually the person never has a clue they were exposed. 

“It might come as a surprise to many people that when somebody goes to a hospital for an overdose in the United States, only about 5% of them are actually tested for fentanyl,” said Cleveland Clinic Addiction Specialist, Brian Barnett, MD.

The reason is that fentanyl requires a different type of drug test, that many hospitals don’t have.

Dr. Barnett co-wrote a perspective piece in the New England Journal of Medicine calling for easier fentanyl testing.  

“Many people are using things like methamphetamine, cocaine, and they have an overdose and they don’t understand why. There are good fentanyl tests out there, but the problem is you have to send them out to a lab to get them analyzed, so it can be 24 hours or even several days before the results come back. and so that’s not really useful to us clinically,” Dr. Barnett said. 

Last year the FDA approved the Superbio Fentanyl Urine Detection Kit, Superbio Immunofluorescence Analyzer. A device that can test for fentanyl in minutes.  But Barnett says it’s not widely known about.  

In his perspective he states:

Although fentanyl is now the dominant driver of the opioid epidemic,

our health care system has struggled to adapt toxicology screening practices

to this reality. Routine fentanyl immunoassay screening has not been fully

adopted in clinical practice, in part because of the costs of implementation and

maintenance of laboratory instrumentation, as well as interpretation challenges

related to false positive results from “designer fentanyls” and cutting agents.

There is also no reliable Food and Drug Administration (FDA)–approved selftesting

kit that people who use drugs can deploy for harm-reduction purposes.

Some health care facilities may not have fentanyl immunoassays available. For

those that do, turnaround times may be long, and given the varying chemical

structures of illicit fentanyls, results may be difficult to interpret in the clinical

context. Though hospitals can create their own point-of-care (POC) fentanyl

tests to reduce turnaround time, such laboratory-developed tests are classified

as “high complexity” under the Clinical Laboratory Improvement Amendments

of 1988 (CLIA), the federal standards that govern testing of specimens from

humans for purposes of clinical care. Such tests must therefore be processed in

laboratories whose technologists can perform high-complexity testing, which

severely limits feasibility for many facilities. 

But Dr. Barnett says a simpler option may already be on the street.

“There are actually good urine dipstick tests for fentanyl that already exist, you can buy these in the U.S. and people use them to test their own drug supplies. The problem is they have not gone through testing with the FDA to be approved as a laboratory technique,” Dr. Barnett says.

Many fentanyl overdoses are unintentional, but not being able to quickly tell someone they were exposed loses an opportunity to get them help.

“From a public health perspective, it’s behooves us to let those patients know that they’ve been exposed so that they can think about, whether they would want to use that substance again or wouldn’t want to get it from the same source, they got it from before,” Dr. Barnett says.

It may also help someone realize they need help for their addiction.

Can test strips make a difference? Currently there is a study underway. 

Watch the full 3News story here.

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