February 08, 2024
Courtenay Harris Bond/PhillyVoice
Fentanyl and xylazine test strips are used to check a sample of opioids bought in Philadelphia last year. The drugs are increasingly showing up in stimulants like cocaine and methamphetamines, but health officials say users may be unaware.
People who may think they are using just cocaine or other illegal stimulants are starting to overdose in larger numbers, as the deadly opioid fentanyl increasingly invades the illicit drug supply – highlighting the need for drug testing strips, health officials say.
Fatal drug overdoses reached a record 112,000 nationwide last year, preliminary data from the U.S. Centers for Disease Control and Prevention shows. Philadelphia had a record 1,413 overdose deaths in 2022, the most recent data available, with 83% involving opioids. Nearly all of those fatal overdoses involved fentanyl – a synthetic opioid 50 to 100 times more potent than heroin – according to the Philadelphia Department of Public Health.
Xylazine, a veterinary tranquilizer known as "tranq," also is permeating the illicit drug supply throughout the city and the country, because it is unscheduled, cheap and sedating like opioids. Dealers cut fentanyl with xylazine, also known as "tranq dope," to increase profits. Xylazine can cause respiratory distress and death, as well as hard-to-heal ulcers that can lead to amputation.
Earlier this month, the deputy secretary from the U.S. Department of Health and Human Services visited Philadelphia to discuss the next steps in the national Overdose Prevention Strategy, including news that certain grant funds now may be used to buy xylazine test strips. Federal grant money has been available since 2021 for fentanyl test strips.
People in acute addiction, and those who serve them, know that fentanyl and xylazine have largely overtaken the Philadelphia heroin market in recent years – so testing local bags of opioids for these substances usually comes up positive. But what people may not realize is that fentanyl and xylazine are also tainting cocaine and crack, as well as methamphetamine – which has been sweeping the nation from west to east – making test strips critical for those using illicit stimulants, health officials say.
The Kensington-based nonprofit Prevention Point Philadelphia, which provides a syringe exchange and other services for substance users, distributes xylazine and fentanyl test strips. Using test strips can help educate people about the risk of overdose and safer practices, such as carrying the opioid overdose reversal medication Narcan, also known as naloxone, said Silvana Mazzella, Prevention Point's interim executive director.
Test strips also can help people who are using what they think are stimulants avoid opioid overdoses.
"We're hoping to empower people to be aware of their risk for overdose – that includes people who knew they were at risk and people who didn't know they were at risk," Mazzella said.
The U.S. Drug Enforcement Administration also is warning that international and domestic drug networks are pressing fentanyl and methamphetamine into fake prescription pills bought outside of legal pharmacies. Fake prescription pills sold on the street, social media or e-commerce platforms – sometimes marketed as prescription opioids, such as OxyContin – may contain lethal doses of fentanyl, further accentuating the need for using fentanyl and other drug test strips.
Using test strips is important for anyone who uses drugs "no matter where they fall on the spectrum," said Dr. Andrew Best Jr., director of Substance Use Prevention and Harm Reduction, a division of Philadelphia's health department. "People immediately think of people who may be dependent on substances, but we also have to think of people who use drugs recreationally."
Test strips may help people make "informed decisions'' about their drug use, Best said.
Christopher Moraff, a journalist and drug checking pioneer, founded a nonprofit called PA Groundhogs that uses mass spectrometry technology in partnership with the Center for Forensic Science Research and Education in Willow Grove, Montgomery County.
The goal is to inform outreach groups and nonprofits, those in the medical community and individual users about what is in the local drug supply, how it shifts over time and what new psychoactive substances may appear. This data may help harm reduction efforts, improve health care outcomes for drug users and reduce drug overdose deaths.
Using free PA Groundhog kits containing test strips for xylazine, fentanyl and benzodiazepines, the Pennsylvania Harm Reduction Network, local outreach groups, nonprofits and grassroots organizations collect drug samples from the street that Moraff then sends to CFSRE. The lab can determine, for instance, what a sample from a $5 bag of "fentanyl" bought on the streets of Kensington actually contains.
Through lab results and anecdotal evidence, Moraff is finding that bags being sold as fentanyl in the city are containing increasingly higher concentrations of xylazine. Some samples are mostly xylazine, he said.
"People are just scrambling for anything that doesn't have tranq in it," Moraff said.
Methamphetamine is also popping up more frequently in Philadelphia, especially with the nationwide shortage of medications for attention-deficit/hyperactivity disorder, such as Adderall and Ritalin, Moraff said. People sometimes abuse ADHD medications as stimulant party drugs.
Ultimately, Moraff hopes to create a statewide data bank to track in real time the purity and makeup of regional drug supplies in order to forecast where tainted batches of drugs – and therefore overdoses – may likely next appear.
SUPHR distributed 186,470 free fentanyl test strips and 44,475 free xylazine test strips in 2023.
Individuals and organizations can access test strips and training about how to use them through SUPHR's website. NEXT Distro, an online and mail-based harm reduction program, offers free resources, training, naloxone and test strips. Visit NEXT Distro's website to find out more. To find substance use treatment and help, call the Substance Abuse and Mental Health Services national helpline: 1-800-662-4357.
