Agency in the fentanyl era: Exploring the utility of fentanyl test strips in an opaque drug market

Weicker, Noelle P.; Owczarzak, Jill; Urquhart, Glenna J.; Park, Ju Nyeong; Rouhani, Saba; Ling, Rui; Morris, Miles; Sherman, Susan G.

doi:10.1016/j.drugpo.2020.102900

Cited by 52 publications

(45 citation statements)

References 22 publications

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“…Given this smaller sample size in AAC, it was not possible to conduct a comparative analysis; instead, data were pooled and AAC was entered into the model as a confounder. Another limitation is that self-reported fentanyl use may not be accurate given the uncertainties inherent to illicit drug supplies, particularly in the era of fentanyl [ 30 , 31 , 39 – 41 ]. In the current legal context, it is also plausible that PWID are underreporting fentanyl use given the climate of fear exacerbated by laws that encourage police crackdowns of those involved in the sale, distribution, or sharing of fentanyl.…”

Section: Discussionmentioning

confidence: 99%

HIV Risk Among Urban and Suburban People Who Inject Drugs: Elevated Risk Among Fentanyl and Cocaine Injectors in Maryland

et al. 2021

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Drug overdose remains a leading cause of death in the US, with growing rates attributable to illicit fentanyl use. Recent HIV outbreaks among people who inject drugs (PWID) and service disruptions from COVID-19 have renewed concerns on HIV resurgence. We examined the relationship between fentanyl use and three injection-related HIV risk behaviors among PWID in Baltimore City (BC) and Anne Arundel Country (AAC), Maryland. PWID (N = 283) were recruited to the study through targeted sampling at street-based locations in BC and AAC from July 2018 to March 2020. Receptive syringe sharing (RSS) [adjusted odds ratio (AOR): 2.8, 95% confidence interval (CI): 1.2-6.3] and daily injecting (AOR: 1.9, 95% CI: 1.0-3.6) were associated with injecting fentanyl and cocaine together. Fentanyl availability and COVID-19 bring new HIV prevention challenges, particularly among those who inject fentanyl with cocaine, highlighting the importance to expand and sustain harm reduction, prevention, and treatment services for PWID to reduce HIV and overdose burden.

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Section: Discussionmentioning

confidence: 99%

HIV Risk Among Urban and Suburban People Who Inject Drugs: Elevated Risk Among Fentanyl and Cocaine Injectors in Maryland

et al. 2021

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“…Fentanyl kills—really—but it has also been demonized in the exaggerated form of a “killer opioid” (Bracken, 2016) and mischaracterized as a complexly racialized “chemical bogeyman” (Reinarman & Levine, 1989, p. 98). 7 As arti facts that detach the “bogeyman” semiotics from the socio-material pragmatics of harm reduction, FTS have been presented as if they are neutral tools for “savvier consumers” (Weicker et al, 2020). Lessening the deadly uncertainties and ignorances generated by the interpenetrated structures of licit and illicit opioid markets, FTS serve as “protective adaptations” beyond overdose prevention, helping PWUDs moderate use, avoid incarceration, and promote awareness.…”

Section: Off-label Use: the Symbolics Of The “Right Tool” For The “Right” Jobmentioning

confidence: 99%

“…Lessening the deadly uncertainties and ignorances generated by the interpenetrated structures of licit and illicit opioid markets, FTS serve as “protective adaptations” beyond overdose prevention, helping PWUDs moderate use, avoid incarceration, and promote awareness. FTS are a “tangible and reliable tool (Weicker et al, 2020),” an arti fact that counters what we might call a “futility narrative” that casts PWUDs as victims at the mercy of unpredictable and uncertain markets in which they have little control or agency. With artisanal flair, harm reduction organizations have produced brightly colored, attention-grabbing materials that speak plainly to practical interests in staying alive oneself and keeping others alive.…”

Section: Off-label Use: the Symbolics Of The “Right Tool” For The “Right” Jobmentioning

confidence: 99%

Enacting Fentanyl Tests Strips for Overdose Prevention: The Socio-Material Transformation of “Suspect Technologies” into “Technologies of Solidarity”

Campbell

2021

Contemporary Drug Problems

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Fentanyl Test Strips (FTS) make possible rapid visual determinations of whether or not fentanyl is present in a given drug supply. This article places FTS within the historical contexts of drug-checking for drug control, overdose prevention, and harm reduction in North America. Following Fentanyl Test Strips (FTS) as artifacts made to signify and enact possibilities other than those for which they were developed and licensed, this article contributes to socio-material theorization of drug control, overdose prevention, and harm reduction in relation to the agency, empowerment, and liveliness of drug users through enactment of the policy and practice of off-label use. The socio-materialities of FTS co-constitute their semiotics and their interpretive flexibility within prevailing forms of evidence-based reasoning that have transformed clinical practice over past decades. They offer new renderings of facticity and artifactuality, which I connect to Ludwik Fleck’s work on the Wasserman test in Genesis and Structure of a Scientific Fact. Reading both the materiality and the semiotics of FTS as artifacts provides a hybrid concept of socio-materiality attentive to the social and material relations embedded in and embodied by FTS, and those who use them in both intended and unintended ways. Such uses differ from individualized expertise and evaluation taken as contributory to the evidence base of the global North. The political work of articulating between different grounds of struggle is underway among those seeking to distribute FTS more widely. But it is their sociomaterial flexibility that makes these artifacts move into new relations that sustains the more affective and artisanal forms of political and cultural recognition characterized in this article as “artifactual” use for an alterbiopolitics.

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“…(15,16) In order to help prevent overdoses, lateral ow immunoassay test strips originally designed for monitoring traces of fentanyl and its analogs in urine are being explored as a drug checking technology in harm reduction contexts. (17)(18)(19)(20) One commonly used fentanyl test strip or "FTS" (BTNX Inc., Markham, ON, Canada) is a lateral ow chromatographic immunoassay for the qualitative detection of fentanyl in urine at the cutoff concentration of 20 ng/ml. A positive result on this test strip gives one line, a negative result gives two lines, and an invalid test gives either no line or no control line.…”

Section: Introductionmentioning

confidence: 99%

High Concentrations of Illicit Stimulants and Cutting Agents Cause False Positives on Fentanyl Test Strips

Lockwood

Vervoordt

Lieberman

2020

Preprint

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Background:The opioid epidemic has caused an increase of overdose deaths which can be attributed to fentanyl combined with various illicit substances. Drug checking programs have been started by many harm reduction groups to provide tools for users to determine the composition of their street drugs. Immunoassay fentanyl test strips (FTS) allow users to test drugs for fentanyl by either filling a baggie or cooker with water to dissolve the sample and test. The antibody used in FTS is very selective for fentanyl at high dilutions, a characteristic of the traditional use of urine testing. These street sample preparation methods can lead to mg/mL concentrations of several potential interference. We tested whether these concentrated samples could cause false positive results on a FTS. Methods:20 ng/mL Rapid Response immunoassay Fentanyl Test Strips (FTS) were obtained from BTNX Inc. and tested against 4 different pharmaceuticals (diphenhydramine, alprazolam, gabapentin, and naloxone buprenorphine) and 3 illicit stimulants (cocaine HCl, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA)) in concentrations from 20 mg/mL to 0.2 mg/mL. The FTS testing pad is divided into 2 sections: the control area and the test area. Control and test area signal intensities were quantified by ImageJ from photographs of the test strips and compared to a threshold set by fentanyl at the FTS limit of detection. Results: False positive results indicating the presence of fentanyl were obtained from samples of methamphetamine, MDMA, and diphenhydramine at concentrations at or above 1 mg/mL. Diphenhydramine is a common cutting agent in heroin. The street sample preparation protocols for FTS use suggested by many online resources would produce such concentrations of these materials. Street samples need to be diluted more significantly to avoid interference from potential cutting agents and stimulants. Conclusions:Fentanyl test strips are commercially available, successful at detecting fentanyl to the specified limit of detection and can be a valuable tool for harm reduction efforts. Users should be aware that when drug adulterants are in high concentrations, FTS can give a false positive result.

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Agency in the fentanyl era: Exploring the utility of fentanyl test strips in an opaque drug market

Cited by 52 publications

References 22 publications

HIV Risk Among Urban and Suburban People Who Inject Drugs: Elevated Risk Among Fentanyl and Cocaine Injectors in Maryland

HIV Risk Among Urban and Suburban People Who Inject Drugs: Elevated Risk Among Fentanyl and Cocaine Injectors in Maryland

Enacting Fentanyl Tests Strips for Overdose Prevention: The Socio-Material Transformation of “Suspect Technologies” into “Technologies of Solidarity”

High Concentrations of Illicit Stimulants and Cutting Agents Cause False Positives on Fentanyl Test Strips

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