Drug checking to save lives in California

In a recent opinion article published by the Los Angeles Times, the author Emily Alpert Reyes examined the increasingly contaminated drug supply and drug checking services in California.

The U.S. Centers for Disease Control and Prevention (CDC) has estimated that there were 107,000 overdose-related deaths across the United States in 2021, amid calls by health experts and advocates to increase access to drug testing. According to data released by the public health department of Los Angeles County, there has been an exponential increase in the percentage of deadly overdoses among homeless people linked to two or more drugs, with multi-drug deaths rising to 60.2% from 37.4% between 2014 and 2020.

Fentanyl is a powerful synthetic opioid that is 50 to 100 times more potent than morphine. In 2019, nearly half of all U.S. deadly overdoses involved a combination of fentanyl, cocaine, heroin or methamphetamine. Data released by the National Institute on Drug Abuse (NIDA) has shown that methamphetamine has been increasingly mixed with opioids, with deadly results: as of 2020, more than 60% of overdose deaths involving methamphetamine also involved an opioid.

Benzodiazepines are prescription sedative medications that are increasingly detected in illicit drug samples across North America. Since opioids are nervous system depressants and suppress breathing, consuming them together with benzodiazepines significantly increases the risk of death.

“There are different kinds of opioids, benzodiazepines, stimulants and cannabinoids being synthesized and invented and mixed into the drug supply all over the place — and for the most part we don’t know about them,” said Joseph Friedman, the UCLA addiction researcher.

Notably, across the U.S., drug checking has been impeded by legislature prohibiting drug paraphernalia, since drug testing equipment such as fentanyl testing strips is also considered as such in some states.

California legislature states that individuals operating syringe programs, as well as program participants, should not be prosecuted for possession or dispensing tools deemed necessary by state or local health departments to prevent overdoses. While the California Department of Public Health has named fentanyl test strips as a necessary prevention tool, it has not specifically designated Fourier transform infrared (FITR) machines or their analysis that way, although it “has begun a review of public health literature examining its efficacy as an overdose prevention strategy,” the department said.

Equipment cost has also been demonstrated to act as a barrier to accurate and quick drug sample testing, with FTIR equipment and associated supplies costing around $45,000; the high-resolution instrument at the university lab can run upwards of $600,000, according to UNC research chemist Erin Tracy.

In San Diego, California, researchers at the University of California San Diego (UCSD) have been working with the Harm Reduction Coalition of San Diego and other partners to develop a new program that will test drug samples using an FTIR machine, producing a detailed report of their drug makeup in 15 minutes. The program has two aims : to inform individuals about the contents of their samples, and to help the community publicly monitor the potential adulterants in the broader supply through an online dashboard. The machine, was funded by a foundation named after Josh Gaffen, a UC Berkeley graduate who died from an overdose.

“The goal of harm reduction is to meet drug users where they are,” said his sister, Shayna Gaffen, “so they can live long enough to start to imagine a different reality.”

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