By LORI KERSEY
A West Virginia University researcher is asking for federal funding to study what effect a tool that detects the presence of fentanyl in other drugs might have on the behavior of drug users.
Dr. Judith Feinberg, a professor at the WVU School of Medicine, and Jon Zibbell, a senior public health analyst at RTI International, are asking the National Institute on Drug Abuse for a grant to study how the strips might change behavior in people at harm reduction programs at two sites: the Milan Puskar Health Right, in Morgantown, and a program in western North Carolina.
"We're going to look at the positive and negative impact because it might be either way," Feinberg said. "People might be safer if they know there's fentanyl in their drugs, or people who are looking for fentanyl may use this as a way to seek out more-dangerous drug doses."
Feinberg said the researchers wrote the grant last fall and it was not funded at first. A revised version of the grant is up for review June 5, Feinberg said.
"We think it's an important step because fentanyl has certainly penetrated the drug supply in many places, not just in West Virginia," she said. "I was still in Ohio when fentanyl surfaced there, and that was sort of the first time that people were aware that there was a significant amount of fentanyl in the drug supply because all of a sudden our drug overdose deaths skyrocketed."
Originally intended for use as urine drug tests, fentanyl testing strips can also be used as a harm reduction tool for people who use injection, according to the Harm Reduction Coalition. So far, the testing strips have mostly been used at harm reduction programs in urban areas, Feinberg said.
The strips detect the absence or presence of fentanyl, a man-made opioid that, according to the Centers for Disease Control and Prevention, is 50 times more potent than heroin and 100 times more potent than morphine.
While an increasing number of drug-related deaths in West Virginia have involved fentanyl over the past few years, in an informal survey of the state's 18 harm reduction programs, only Milan Puskar Health Right, in Morgantown, and the Berkeley-Morgan County Health Department said they offer the strips.
Representatives from 12 other programs said they do not offer fentanyl test strips and four others did not immediately respond to messages.
Dr. Robin Pollini, a harm reduction expert and the associate director of the Injury Control Research Center at West Virginia University, said harm reduction programs in the state should "absolutely provide fentanyl test strips" if there's funding available for them.
"There is good evidence that when people use these strips and their drugs test positive for fentanyl, they take steps to use more safely and thus reduce their risk of opioid overdose," Pollini said.
A spokeswoman for the Department of Health and Human Resources said she was not aware of any program in the state that offers the strips or that requested them as part of their budget.
"However, we do believe if a harm reduction program requested this to be included in their budget, it would likely be approved by the State as long as there was justification," DHHR spokeswoman Allison Adler wrote in an email.
A 2018 study of young adult drug users in Rhode Island found that more than 90 percent of those surveyed indicated they'd be willing to use the testing strips.
Feinberg said she's heard conversationally that the strips are an effective harm reduction tool, but she's wary of anecdotes.
"If you don't look systematically, you might hear the positive things from the people that feel that way about it and you might not hear that people are using it so they can find more fentanyl on the drug market for example," she said. "So I think anecdotes always carry that danger. If you don't look at things systematically, you don't truly know what's happening."
Laura Jones, executive director of the Milan Puskar Health Right, said researchers sent the program 500 of the strips prior to writing the research grant to gauge interest in them.
The program quickly ran out of the original 500 and another 500. The strips were included in the program's budget request to the state, Jones said.
The strips cost $1 each.
Jones said part of the concern about the strips for harm reduction programs is accuracy. A false negative could lead a person to believe their drugs are safer than they are, she said.
Shawn Thorn, crisis response coordinator at the Grafton-Taylor County Health Department, said concern about liability when the tests aren't accurate was one reason his department hasn't offered the strips.
Jones said her research showed the strips are more likely to show false positives.
"We decided that if the problem was mainly false positives, we can live with that because that would just hopefully encourage people to be very cautious," Jones said.
Jones said people use the strips not for every injection, but for every new supply or when they use a drug dealer.
"Ideally, you would check each injection, but fentanyl test strips are able to pick up such a tiny quantity of fentanyl that if you test the first dose that you take out of a new batch and it's negative, it's unlikely that there's any fentanyl in there at all," she said.
Jones said her program includes instructions for the testing strips, though they're relatively easy to use.
If the drugs do have fentanyl, the person can use less of the drug, or do a test of it to see how they feel after, Jones said. They can also make sure there's someone nearby who can administer naloxone and call 911 in the event of an overdose.
"The other thing is to not use that batch at all," Jones said.
Jones said for the most part, it's not believed that drug dealers in the Morgantown area are not spiking other drugs with fentanyl, but they may use the same tools to cut heroin or meth, which contaminates them, she said.
Jones said her program distributes as many strips as people ask for.
Jones said if the funding for Feinberg's research project comes through, the harm reduction program will be collecting information about how well people used the strips and whether it changed their behavior.
"I hope we get funded," Feinberg said. "I hope that we will show that it is by and large a useful thing, because they are not that expensive. They're a dollar a strip. And, you know, a dollar is somebody's life. That isn't even a decision."