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High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips
BACKGROUND: The opioid epidemic has caused an increase in overdose deaths which can be attributed to fentanyl combined with various illicit substances. Drug checking programs have been started by many harm reduction groups to provide tools for users to determine the composition of their street drugs...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941948/ https://www.ncbi.nlm.nih.gov/pubmed/33750405 http://dx.doi.org/10.1186/s12954-021-00478-4 |
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author | Lockwood, Tracy-Lynn E. Vervoordt, Alexandra Lieberman, Marya |
author_facet | Lockwood, Tracy-Lynn E. Vervoordt, Alexandra Lieberman, Marya |
author_sort | Lockwood, Tracy-Lynn E. |
collection | PubMed |
description | BACKGROUND: The opioid epidemic has caused an increase in overdose deaths which can be attributed to fentanyl combined with various illicit substances. Drug checking programs have been started by many harm reduction groups to provide tools for users to determine the composition of their street drugs. Immunoassay fentanyl test strips (FTS) allow users to test drugs for fentanyl by either filling a baggie or cooker with water to dissolve the sample and test. The antibody used in FTS is very selective for fentanyl at high dilutions, a characteristic of the traditional use of urine testing. These street sample preparation methods can lead to mg/mL concentrations of several potential interferents. We tested whether these concentrated samples could cause false positive results on a FTS. METHODS: 20 ng/mL Rapid Response FTS were obtained from BTNX Inc. and tested against 4 different pharmaceuticals (diphenhydramine, alprazolam, gabapentin, and naloxone buprenorphine) and 3 illicit stimulants [cocaine HCl, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA)] in concentrations from 20 to 0.2 mg/mL. The FTS testing pad is divided into 2 sections: the control area and the test area. Control and test area signal intensities were quantified by ImageJ from photographs of the test strips and compared to a threshold set by fentanyl at the FTS limit of detection. RESULTS: False positive results indicating the presence of fentanyl were obtained from samples of methamphetamine, MDMA, and diphenhydramine at concentrations at or above 1 mg/mL. Diphenhydramine is a common cutting agent in heroin. The street sample preparation protocols for FTS use suggested by many online resources would produce such concentrations of these materials. Street samples need to be diluted more significantly to avoid interference from potential cutting agents and stimulants. CONCLUSIONS: Fentanyl test strips are commercially available, successful at detecting fentanyl to the specified limit of detection and can be a valuable tool for harm reduction efforts. Users should be aware that when drugs and adulterants are in high concentrations, FTS can give a false positive result. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12954-021-00478-4. |
format | Online Article Text |
id | pubmed-7941948 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-79419482021-03-09 High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips Lockwood, Tracy-Lynn E. Vervoordt, Alexandra Lieberman, Marya Harm Reduct J Research BACKGROUND: The opioid epidemic has caused an increase in overdose deaths which can be attributed to fentanyl combined with various illicit substances. Drug checking programs have been started by many harm reduction groups to provide tools for users to determine the composition of their street drugs. Immunoassay fentanyl test strips (FTS) allow users to test drugs for fentanyl by either filling a baggie or cooker with water to dissolve the sample and test. The antibody used in FTS is very selective for fentanyl at high dilutions, a characteristic of the traditional use of urine testing. These street sample preparation methods can lead to mg/mL concentrations of several potential interferents. We tested whether these concentrated samples could cause false positive results on a FTS. METHODS: 20 ng/mL Rapid Response FTS were obtained from BTNX Inc. and tested against 4 different pharmaceuticals (diphenhydramine, alprazolam, gabapentin, and naloxone buprenorphine) and 3 illicit stimulants [cocaine HCl, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA)] in concentrations from 20 to 0.2 mg/mL. The FTS testing pad is divided into 2 sections: the control area and the test area. Control and test area signal intensities were quantified by ImageJ from photographs of the test strips and compared to a threshold set by fentanyl at the FTS limit of detection. RESULTS: False positive results indicating the presence of fentanyl were obtained from samples of methamphetamine, MDMA, and diphenhydramine at concentrations at or above 1 mg/mL. Diphenhydramine is a common cutting agent in heroin. The street sample preparation protocols for FTS use suggested by many online resources would produce such concentrations of these materials. Street samples need to be diluted more significantly to avoid interference from potential cutting agents and stimulants. CONCLUSIONS: Fentanyl test strips are commercially available, successful at detecting fentanyl to the specified limit of detection and can be a valuable tool for harm reduction efforts. Users should be aware that when drugs and adulterants are in high concentrations, FTS can give a false positive result. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12954-021-00478-4. BioMed Central 2021-03-09 /pmc/articles/PMC7941948/ /pubmed/33750405 http://dx.doi.org/10.1186/s12954-021-00478-4 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Lockwood, Tracy-Lynn E. Vervoordt, Alexandra Lieberman, Marya High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips |
title | High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips |
title_full | High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips |
title_fullStr | High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips |
title_full_unstemmed | High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips |
title_short | High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips |
title_sort | high concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941948/ https://www.ncbi.nlm.nih.gov/pubmed/33750405 http://dx.doi.org/10.1186/s12954-021-00478-4 |
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