Drug Policy

New Study Finds Heroin Users Less Likely to Overdose If They Know What Drugs They're Actually Taking

Heroin user take smaller doses if they know they're also taking fentanyl.

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A reagent test used by Afghan police. Photo credit: https://www.flickr.com/photos/jackofspades

Drug users are 10 times more likely to reduce their doses if they know the drug they're consuming contains fentanyl, according to a new study from Vancouver's supervised injection site. Designed as a safe place where drug users can get high under the supervision of medical professionals, Insite found that providing fentanyl test kits reduced the odds of an overdose by 25 percent.

According to the Globe and Mail, Insite offers a simple reagent test, in which a small amount of the drug is tested using a solution and a strip. Other reagent tests use just a solution and the drug itself, mixed together on a white surface. While reagent testing won't tell you every compound present, it's an effective way to identify substances you definitely don't want to take.

Reagent testing has been popular among synthetic drug users for two decades now, particularly the MDMA/ecstasy crowd. But there are limits, one of them being that reagent testing reveals presence, not dosing. And at least one reagent vendor says it's difficult to distinguish between fentanyl and other synthetic opioids, which could lead to false positives.

According to the data gathered by Insite, 1,000 different reagent tests revealed fentanyl in 83 percent of drugs thought to be heroin, 82 percent of drugs thought to be meth, and 40 percent of drugs thought to be cocaine. A recent Washington Post investigation found cases across the U.S. of cocaine contaminated with fentanyl, including 12 emergency department admissions at a Connecticut hospital in just eight hours.

Supervised injection sites and easy reagent testing are good ideas. But you know what would work even better? Letting people buy the drugs they want in a legal market where drug producers have an incentive to create safe products. Because as helpful as reagent testing is, it's not good enough just to know that you're taking what you think you're taking; it's also important to know how much you're taking. Britain is witnessing an increase in MDMA-related deaths. Is it because of contaminants? No, it's because the MDMA is more pure than ever, with larger doses in smaller packages.

Reagent testing won't tell you whether a given MDMA pill contains 25 mg or 100 mg, or whether your heroin contains a little fentanyl or a lot. That kind of knowledge requires a regulatory regime in which heroin (and MDMA and cocaine) is produced with the same attention to detail and accuracy as Tylenol. Or cannabis! As the marijuana market has turned from black to grey, consumers can now choose the ratio of THC to CBD and talk with retailers about optimal dosing based on their tolerance, experience, and desired effect.

In the short term, America needs harm reduction strategies like the kind offered at Incite. In the long term, we need to surrender to reality.

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  1. It’s a noble project to keep trying to remind people of this, but this information is hardly new. This has been known since the early 70s at least.

    1. As a matter of fact, the Netherlands has offered this type of testing for decades, with great success.

        1. ?

            1. Ah.

              1. Drugs. Bad. Think. Children.

                1. Children. Bad. Think. Drugs.

                  1. I think drugging children who are bad is an idea whose time has come.

  2. No shit. I’ve had a few friends spend some time as junkies and they tend to know a fair bit about what they are doing.

    In NH we get a lot of “opioid epidemic” panic coverage. There has been a pretty big bump in (reported) ODs this year. And almost all of the fatal ones are from fentanyl or other super potent synthetic opioids, either alone or mixed with heroin.

    1. I haven’t had a chance to dig into the details on this “epidemic,” but I can say that during the cocaine panic of the 80s, there was a rash of “cocaine-related deaths” where the vast majority either involved people who also happened to have fatal gunshot and stab wounds, or who were smuggling and had a balloon burst in their rectum. They were all “cocaine-related deaths” as long as the dead person had cocaine in their system.

      1. I’m pretty sure the ODs are legit. Murder is pretty rare, so that would get more attention.

        1. It does seem to have more legitimacy in the sense that there doesn’t seem to be a concurrent wave of violence to enhance the death numbers. But on the other hand, the government and the media have both shown strong tendencies to over-count such statistics. I wonder how many of these people had severely compromised health in the first place – a lot of these addictions seem to have their origins in medical treatment.

      2. My belief is ultimately that people can take their risks and make their choices. Its fucked up that the government actively makes it more dangerous for them though. The inherent risk of the action is all on them, but making it worse is on us.

        1. I agree completely.

          And in the end, the guy who wants to risk his life on heroin is going to do it anyway. The only thing we can do is have an effect on the price and quality of the heroin he can get, and only for the negative.

          1. People who want to do heroin are going to find ways to do heroin. It’s the government’s job to ensure that they bankrupt their family and die in the process.

  3. “In the short term, America needs harm reduction strategies like the kind offered at Incite. In the long term, we need to surrender to reality.”

    Ah, yes, the classic Reason Libertarian philosophy that loves nanny state regimes solely to keep their drugs safe. Ban the FDA, Ban the USDA, Ban health inspections, but dammit I want my refined and regulated Heroin!

    Nice.

    1. I’m curious about the meaning of “regulatory regime” as well. Does he really mean a governmental system in place, or is he referring to the self-regulation of a legal marketplace? The latter would tend to be the libertarian stance but I feel that very few would use “regulatory regime” in that way.

    2. “Ah, yes, the classic Reason Libertarian philosophy that loves nanny state regimes solely to keep their drugs safe. Ban the FDA, Ban the USDA, Ban health inspections, but dammit I want my refined and regulated Heroin!”

      Perfect, the thread stops here.

    3. Ah, yes, the classic Reason Libertarian philosophy that loves nanny state regimes solely to keep their drugs safe. Ban the FDA, Ban the USDA, Ban health inspections, but dammit I want my refined and regulated Heroin!

      Nice.

      Yup;

      While reagent testing won’t tell you every compound present, it’s an effective way to identify substances you definitely don’t want to take.

      Because reagent testing won’t tell you every compound present, it’s also dead simple to overcome with cutting agents, carriers, and adjuvants. So a does with 5X heroine equivalent of fentanyl can be made to look like a 1X. Not that Incite shouldn’t be allowed to sell but, you know, caveat emptor.

  4. Drug users are 10 times more likely to reduce their doses if they know the drug they’re consuming contains fentanyl

    ’10 times’ is a weird euphemism for ‘unanimously’. That or a good number of heroine users are given a compound they know to be 10X more potent/deadly than heroine and don’t flinch with regard to the dosage. Which would be impressive if they hadn’t drugged themselves into that state in the first place.

    1. Both 10x and ‘reduced by 25%’ require some base numbers for us to extrapolate from. And this article and the Globe and Mail article do not actually link to the original study so I don’t know the information.

      Really that number seems understated to me. If only a 25% reduction happens that actually seems to go against the narrative that fentanyl and other mixins are the driving reason for these overdoses. I probably just misunderstood something here though. Please correct me if I am wrong.

      Ultimately, more information is better for the consumer though, that includes these consumer of drugs and so making this available is a step-forward.

      Safe injection sites I feel more mixed about. What I wish is that they could just make it legal, and my guess is that charities and boutiques or whatever would pop up that served the same purpose without the oddness of government labs doing it alone.

      1. And another pernicious effect of prohibition is that a lot of opioid deaths are 100% preventable, but people are too scared to report overdoses, since the laws will implicate the owner of the location where the overdose happened as well as anyone else who was present.

        I once worked with a guy whose brother OD’d on heroin at a party, and out of fear of prosecution rather than call 911, they simply tossed him out the window and he died in the alleyway.

        Have no doubt that was billed as a heroin death.

      2. If only a 25% reduction happens that actually seems to go against the narrative that fentanyl and other mixins are the driving reason for these overdoses. I probably just misunderstood something here though. Please correct me if I am wrong.

        Nope, that whole free will thing. Fucks up causality ever time.

  5. “In the long term, we need to surrender to reality.”

    Word.

    1. 10/10

      Poetic and poignant, just like what I strive for in my own writing.

  6. Another great reason to legalize all drugs.

    War on Drug zealots hardest hit!

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