Demand for fentanyl test strips booms — but test is not widely available

They aren't the type of calls that Iqbal Sunderani thought he would ever get. Parents who have lost their children to fentanyl overdoses ring up his biotechnology company on a regular basis.

They say they are desperate to get their hands on drug testing strips that can detect the powerful opioid, which could prevent other families from suffering the same loss.

"It's heartbreaking to hear the stories, I am a parent myself, " said Sunderani, CEO of BTNX, which is based in Markham, Ont. 

When they ask to buy the strips, however, Sunderani tells them no. He says he doesn't want to give people a false sense of security and worries about potential liability.

"We have to be cautious in distributing these tests," he said.

"The last thing you want is that someone has overdosed and there is a test on the floor showing negative."

Off-label use

Sunderani says the strips he sells were never meant as a tool to help combat the opioid crisis. They were originally marketed to labs and police agencies.

In 2016, BTNX sold 75,000 of the fentanyl drug tests. So far this year, it has sold more than 200,000 tests, many of them to harm reduction workers in Canada and the United States, who use them off label to test street drugs for fentanyl.

Because the strips are unlicensed in Canada for use as an illicit drug test, they can only legally be used at supervised injection sites and overdose prevention centres.

"We recognize that it isn't available enough," said Dr. Mark Lysyshyn, a medical health officer with Vancouver Coastal Health.

Even though most of B.C.'s overdose deaths are happening in private residences, officials say staff aren't handing out the strips to people to take off site because they want to be able to track how people are using them and what they are finding. 

Lysyshyn says there hasn't been enough research on how the strips would be used by people at home and there are questions how they would interpret the results.

Ideally, he says they would like to offer the testing at community health centres and use the strips alongside an infrared spectrometer that's able to detail a drug's ingredients.

"Before we can offer them in the community, we either need sort of the go-ahead from the provincial government to say yes... or we need to work with Health Canada to get an exemption and we know that process can be very long," Lysyshyn  said.

BTNX is working with health officials in Vancouver to develop a protocol around how the strips should be used.

Pilot project

The strips were part of a study conducted by Vancouver Coastal Health last year at Insite, a supervised injection site in Vancouver.

At the time, officials say they found that about 80 per cent of the drugs tested contained fentanyl, and that people were less likely to overdose after getting their drugs checked. That's because they found that those with a positive result were 10 times more likely to cut back on the amount of drugs they were taking.

In order to do a test, a few granules of the drug are dissolved in water. The strip is then dipped in that solution. At first, there was uncertainty about what the test could detect, but BTNX now says it's capable of finding fentanyl and 10 of its analogs, including the highly toxic carfentanil. 

Still, Lysyshyn says there are limitations. The strips can detect fentanyl, but they don't measure just how much is in the drugs. 

Fear of false negatives

A negative test is also no guarantee. 

"We really don't know what goes into the illicit drugs," Sunderani said. "The analogs they can manufacture synthetically can change just like that."

Health Canada says it conducted a preliminary study on the drug testing strips and compared their accuracy to sophisticated laboratory tests. The department concluded that more research is needed.

Sales stopped

Health Canada and the College of Pharmacists in Manitoba stepped in last year when a Winnipeg pharmacy started selling the test strips. BTNX says the strips are routinely sold to pharmacies that run methadone clinics and they are supposed to be used by the pharmacists to screen their patient's urine for drugs. But in this case, the boxes were stocked on a shelf and being sold to the public. 

"We had them for sale, I think, for a day or two," said Michael Watts, owner of Brothers Pharmacy.

After an investigation by Health Canada, the College of Pharmacists asked Watts to stop selling them. He says that was disappointing.

"We are trying to protect the public and I felt that it was a little short sighted on their behalf, but I understand there were legalities involved," he said.

In the United States, where there are no legal supervised injection sites, some harm-reduction workers hand out the strips like they do clean syringes.

While BTNX says it has some concerns with the strips being dispensed that way, Sunderani says harm reduction workers have assured him they are training people on how to use the strips and outlining the limitations. 

Van Asher, who works at St. Ann's Corner of Harm Reduction in New York City, first heard about about them after reading about the Insite study.

Before handing them out, he created a training video and educational material for users. 

"People keep asking for them. I just ordered another 2,000," he said."We want people to use them, we want people to not die."

About 64,000 people died of drug overdoses in the United States in 2016. Asher says he is willing to try anything to fight an "impossible battle."

High demand

In Massachusetts, harm reduction activist Jess Tilley says she spent thousands of dollars of her own money to purchase and distribute the test strips and recently launched GoFundMe campaigns to continue. She has been doing street outreach for more than 20 years and says she has seen the kind of impact the test strips can have on behaviour. 

"I have people that tell me, 'No way, my heroin would never have fentanyl in it,'" she said. "And then they see it and say, 'Oh, well maybe I should only do half."

Tilley says she has been particularly targeting recreational drug users, especially after a number of college students in the state overdosed on cocaine laced with fentanyl. 

"It seems like every Friday night I have the classic jock boys calling me up, saying can we get some of those fentanyl test strips, because they have cocaine and they don't want to die."