For about half a decade, Terry has been taking his drugs to overdose prevention units in Vancouver’s Downtown Eastside to find out what’s in the powders he’s about to consume. 

It’s not an idle question: earlier this year, Terry lost his girlfriend to fentanyl overdose. The knowledge of whether the drugs have been cut with fentanyl can literally be a matter of life or death. 

The checking process tells him everything he needs to know about what he has on hand, and whether it’s laced with substances like fentanyl. 

Ever since the city began to give out test strips that let him check his drugs at home, Terry has been using those instead.

“You know what you’re going to do. It’s not like you’re going into the situation blind,” Terry said in an interview with Capital Daily. “You know there’s going to be fentanyl, you know what’s going to be in it [when you use] the test strips. 

A drug check at an overdose prevention site might yield more exact information about what is in those drugs, but that process takes much longer.

“It’s hard to get an immediate result. People don’t wanna wait. They want instant results,” said Terry.

For substance users in BC, information is key when it comes to staying alive during the worst year of the province’s overdose crisis. But that information, and its availability in a timely fashion, is not something that is offered on Vancouver Island. 

Most deaths occurring at home

Since January 2020, residents in the Vancouver Coastal and Interior Health regions have been able to take home drug checking kits that they can then use to determine whether or not their drugs are laced with fentanyl.

These take-home drug tests are currently available across 10 locations across Vancouver, Richmond, the North Shore and more. They are also offered at 44 community agencies and shelters in the Interior Health region, which encompasses cities like Kamloops, Kelowna, Vernon as well as a large swath of BC’s rural and remote communities.

But they can’t be found anywhere else in BC, despite an increasingly toxic supply of street drugs that has claimed 1,386 lives just this year. 

According to the latest report from the BC Coroners Service, the vast majority—83 per cent—of people who died of overdose in BC did so inside. Most of the deaths happened in a private residence, while more than a quarter were in shelters or other housing. In the past three years, more than 700 people on Vancouver Island lost their lives to toxic drugs while using inside a residence.

No deaths occurred in overdose prevention units (OPUs) where drug testing and overdose response are readily available. While OPUs across the province offer substance users the ability to get their drugs tested for toxicity, experts have long advocated for the service to be expanded beyond those sites.

“When drug checking is limited to a specific overdose prevention site or supervised injection site, access is going to be limited to those people who are interested and able to access those very specific services,” said Bruce Wallace, scientist at the Canadian Institute for Substance Use Research and associate professor at the University of Victoria, in an interview with Capital Daily.

“Especially when overdose prevention sites are for injection use only and don’t include inhalation, as many are, [they] integrate drug checking only with injection drug use rather than reaching people who might not necessarily be injecting drugs.”

Moreover, Wallace adds that rising numbers of overdose deaths during the COVID-19 pandemic are not just a sign of a more unpredictable street drug supply—they also indicate how self isolation mandates are causing people who may be at risk of overdosing to forgo essential in-person safety services that were available to them pre-pandemic. 

“I think we need to be looking at rolling out service adaptations that respond to the pandemic, and one of them can be providing more resources for people to be able to access at home,” said Wallace.

More than 11,000 testing strips distributed in Vancouver region in 2020

The initial plan to offer take-home test strips to substance users was hatched long before the pandemic, as a response to the overdose crisis itself. Then, and now, most people who die of overdose are found to be using alone.

In early 2019, the British Columbia Centre for Disease Control announced a joint research study with Vancouver Coastal Health and Interior Health authorities to determine whether people could use drug checking kits safely at home.

Each substance user involved in the study was given five free drug checking test strips to take home, along with instructions on how to use them. 

These strips were initially used to check whether fentanyl was present in urine samples, but about four years ago, researchers in Vancouver figured out how to use them to check the drugs themselves for fentanyl.

“To use the strips, the client dilutes a very small (grain of salt) amount of their substance with 30 ml of tap water, dips the test strip in the cup for ten seconds, and then waits for one minute for a red line to appear on the test strip,” said a spokesperson for Vancouver Coastal Health Authority in an emailed statement to Capital Daily.

“One red line is a positive result, two red lines is a negative result. While test strips detect fentanyl, they do not always detect analogues such as carfentanil.”

96 per cent of the clients who received those take-home tests said they would use them again, and 27 per cent of them said they made a safer choice if their drugs had fentanyl in them — like using with a friend, taking less of the substance, using more slowly, or taking their drugs to an overdose or supervised consumption site. 

The results of that 2019 study convinced the two health authorities to start offering take-home drug testing kits in early 2020 across numerous locations. 

In the Vancouver Coastal Health region, over 11,000 take-home fentanyl test strips have been distributed between January and November 30, 2020. 

The program has attained similar levels of popularity in the Interior Health region.

“Since the Take Home Drug Checking service was launched last January, there has been significant interest,” said Dr. Karin Goodison, Interior Health medical health officer, in an emailed statement to Capital Daily.

“There are 44 sites across Interior Health registered to offer Take Home Drug Checking kits and that number is growing – sites include community agencies, shelters/housing, and IH locations.”

There is no indication that any plans are being made to expand the availability of take-home fentanyl test strips to other parts of the province.

“We are monitoring the work underway in Interior and Vancouver Coastal with respect to take-home testing  — the results and outcomes of this initiative will inform our plans going forward,” said an Island Health spokesperson in an emailed statement to Capital Daily.

‍Tests don’t give fentanyl percentage

If the take home program comes to Victoria, Wallace says it would not be difficult to integrate it into the drug testing services already provided by the Canadian Institute of Substance Use Research at several locations throughout the city.

Drug checking is also currently offered at overdose prevention and supervised consumption sites across Vancouver Island.

For all its benefits, a take home fentanyl test strip program would still need to be implemented in conjunction with other forms of harm reduction in order to be truly effective in reducing overdose deaths. One reason is that the tests alone may not be foolproof.

 “These strip tests… have a very high level of detection. What the research on take home tests is trying to figure out is are there going to be results of false negatives? That’s the greatest risk,” said Wallace.

“The fentanyl test strips are fairly simple to use but they are also an off-label use,” he adds, referring to the tests’ original purpose of detecting fentanyl in urine. “The concern is the efficacy of being able to use these with the right amount of water, the right amount of the substance, and [for] the right amount of time.”

Despite these limitations, the same tests have been used for drug checking purposes by provincial authorities and public health services for several years, says Wallace. So it follows that extending their availability for individual use would not dilute their efficacy.

The bigger issue lies in how much information the test strips themselves provide.

“The problem is the strips will tell you what’s in the drugs but they don’t tell you the percentage… so you don’t get any idea of the risk,” said Terry.

Terry and his girlfriend were using test strips when she overdosed and died. He believes her life could have been saved had the test strips been able to detect the percentage of fentanyl she was consuming.

BC Coroners Service post-mortem toxicology reports show that in 2020, there have been more cases of people dying after consuming extreme concentrations of fentanyl (more than 50 micrograms per litre) than ever before. 

Terry himself says he is a heroin addict and does not partake in fentanyl. But the synthetic drug has been used in Vancouver and around BC for several years.

“There’s nothing magic about fentanyl, it’s just a drug. The significant thing is that it’s a synthetic—completely manufactured,” said Karen Ward, an expert drug policy advisor to the City of Vancouver. “It’s very potent, and therefore very profitable.”

Because of its low cost and extreme potency, fentanyl has made its way, often hidden, into everything from heroin to cocaine to MDMA. 

“Opioid users in BC should assume that their medicine purchased from the unregulated market does contain fentanyl analogues,” said Ward.

While many opioid users in Vancouver have built up a tolerance to fentanyl after years of use, Ward says the danger lies in other types of drugs increasingly found to be laced with fentanyl and analogues unbeknownst to substance users.

The role of the take-home tests strips, then, is to inform people using at home whether or not there is fentanyl in their drugs. They can then make an informed decision about how and whether they want to use them. 

When thinking about how these take-home tests can be doled out most effectively, Wallace says we have a lesson or two to learn from how condoms are distributed after the HIV/AIDS crisis.

“It’s important to get condom distribution in so many different places, and not to have it only where people would buy it at a drugstore or only through an AIDS service organization,” he said.

“I think that there’s some lessons to learn [while] looking at some of these other harm reduction measures, such as take-home fentanyl strips distribution.”