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An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples.
Int J Drug Policy. 2020 03; 77:102661.IJ

Abstract

BACKGROUND

Fentanyl has caused rapid increases in US and Canadian overdose deaths, yet its presence in illicit drugs is often unknown to consumers. This study examined the validity in identifying the presence of fentanyl of three portable devices that could be used in providing drug checking services and drug supply surveillance: fentanyl test strips, a hand-held Raman Spectrometer, and a desktop Fourier-Transform Infrared Spectrometer.

METHODS

In Fall 2017, we first undertook an assessment of the limits of detection for fentanyl, then tested the three devices' sensitivity and specificity in distinguishing fentanyl in street-acquired drug samples. Utilizing test replicates of standard fentanyl reference material over a range of increasingly lower concentrations, we determined the lowest concentration reliably detected. To establish the sensitivity and specificity for fentanyl, 210 samples (106 fentanyl-positive, 104 fentanyl-negative) previously submitted by law enforcement entities to forensic laboratories in Baltimore, Maryland, and Providence, Rhode Island, were tested using the devices. All sample testing followed parallel and standardized protocols in the two labs.

RESULTS

The lowest limit of detection (0.100 mcg/mL), false negative (3.7%), and false positive rate (9.6%) was found for fentanyl test strips, which also correctly detected two fentanyl analogs (acetyl fentanyl and furanyl fentanyl) alone or in the presence of another drug, in both powder and pill forms. While less sensitive and specific for fentanyl, the other devices conveyed additional relevant information including the percentage of fentanyl and presence of cutting agents and other drugs.

CONCLUSION

Devices for fentanyl drug checking are available and valid. Drug checking services and drug supply surveillance should be considered and researched as part of public health responses to the opioid overdose crisis.

Authors+Show Affiliations

Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, USA; Department of Epidemiology, Brown University School of Public Health, 55 Claverick St., 2nd floor, Providence, RI 02903, USA. Electronic address: traci.c.green@brown.edu.Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: ju.park@jhu.edu.Independent, Portland, OR, USA.Department of Immunology, The Miriam Hospital, Center for Prisoner Health and Human Rights, Providence, RI, USA. Electronic address: mmckenzie@lifespan.org.Department of Emergency Medicine, Rhode Island Hospital, 55 Claverick St., 2nd floor, Providence, RI 02903 USA.Baltimore Police Department Forensic Laboratory, Baltimore, MD, USA. Electronic address: rachel.lucas@baltimorepolice.org.Department of Pathology, Johns Hopkins Bloomberg School of Medicine, Baltimore, MD, USA. Electronic address: wclarke@jhmi.edu.Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: ssherman@jhu.edu.

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31951925

Citation

Green, Traci C., et al. "An Assessment of the Limits of Detection, Sensitivity and Specificity of Three Devices for Public Health-based Drug Checking of Fentanyl in Street-acquired Samples." The International Journal On Drug Policy, vol. 77, 2020, p. 102661.
Green TC, Park JN, Gilbert M, et al. An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples. Int J Drug Policy. 2020;77:102661.
Green, T. C., Park, J. N., Gilbert, M., McKenzie, M., Struth, E., Lucas, R., Clarke, W., & Sherman, S. G. (2020). An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples. The International Journal On Drug Policy, 77, 102661. https://doi.org/10.1016/j.drugpo.2020.102661
Green TC, et al. An Assessment of the Limits of Detection, Sensitivity and Specificity of Three Devices for Public Health-based Drug Checking of Fentanyl in Street-acquired Samples. Int J Drug Policy. 2020;77:102661. PubMed PMID: 31951925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples. AU - Green,Traci C, AU - Park,Ju Nyeong, AU - Gilbert,Michael, AU - McKenzie,Michelle, AU - Struth,Eric, AU - Lucas,Rachel, AU - Clarke,William, AU - Sherman,Susan G, Y1 - 2020/01/14/ PY - 2019/03/19/received PY - 2019/12/31/revised PY - 2020/01/02/accepted PY - 2020/1/18/pubmed PY - 2021/5/5/medline PY - 2020/1/18/entrez KW - Drug checking KW - Fentanyl KW - Harm reduction KW - Overdose KW - Public health KW - Surveillance SP - 102661 EP - 102661 JF - The International journal on drug policy JO - Int J Drug Policy VL - 77 N2 - BACKGROUND: Fentanyl has caused rapid increases in US and Canadian overdose deaths, yet its presence in illicit drugs is often unknown to consumers. This study examined the validity in identifying the presence of fentanyl of three portable devices that could be used in providing drug checking services and drug supply surveillance: fentanyl test strips, a hand-held Raman Spectrometer, and a desktop Fourier-Transform Infrared Spectrometer. METHODS: In Fall 2017, we first undertook an assessment of the limits of detection for fentanyl, then tested the three devices' sensitivity and specificity in distinguishing fentanyl in street-acquired drug samples. Utilizing test replicates of standard fentanyl reference material over a range of increasingly lower concentrations, we determined the lowest concentration reliably detected. To establish the sensitivity and specificity for fentanyl, 210 samples (106 fentanyl-positive, 104 fentanyl-negative) previously submitted by law enforcement entities to forensic laboratories in Baltimore, Maryland, and Providence, Rhode Island, were tested using the devices. All sample testing followed parallel and standardized protocols in the two labs. RESULTS: The lowest limit of detection (0.100 mcg/mL), false negative (3.7%), and false positive rate (9.6%) was found for fentanyl test strips, which also correctly detected two fentanyl analogs (acetyl fentanyl and furanyl fentanyl) alone or in the presence of another drug, in both powder and pill forms. While less sensitive and specific for fentanyl, the other devices conveyed additional relevant information including the percentage of fentanyl and presence of cutting agents and other drugs. CONCLUSION: Devices for fentanyl drug checking are available and valid. Drug checking services and drug supply surveillance should be considered and researched as part of public health responses to the opioid overdose crisis. SN - 1873-4758 UR - https://www.unboundmedicine.com/medline/citation/31951925/An_assessment_of_the_limits_of_detection_sensitivity_and_specificity_of_three_devices_for_public_health_based_drug_checking_of_fentanyl_in_street_acquired_samples_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0955-3959(20)30002-5 DB - PRIME DP - Unbound Medicine ER -