Tags

Type your tag names separated by a space and hit enter

High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips.
Harm Reduct J. 2021 03 09; 18(1):30.HR

Abstract

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.

Authors+Show Affiliations

Department of Chemistry and Biochemistry, University of Notre Dame, 251 Stepan Hall of Chemistry, Notre Dame, IN, 46556, USA. tlockwood@nd.edu.Department of Chemistry and Biochemistry, University of Notre Dame, 251 Stepan Hall of Chemistry, Notre Dame, IN, 46556, USA.Department of Chemistry and Biochemistry, University of Notre Dame, 251 Stepan Hall of Chemistry, Notre Dame, IN, 46556, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33750405

Citation

Lockwood, Tracy-Lynn E., et al. "High Concentrations of Illicit Stimulants and Cutting Agents Cause False Positives On Fentanyl Test Strips." Harm Reduction Journal, vol. 18, no. 1, 2021, p. 30.
Lockwood TE, Vervoordt A, Lieberman M. High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips. Harm Reduct J. 2021;18(1):30.
Lockwood, T. E., Vervoordt, A., & Lieberman, M. (2021). High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips. Harm Reduction Journal, 18(1), 30. https://doi.org/10.1186/s12954-021-00478-4
Lockwood TE, Vervoordt A, Lieberman M. High Concentrations of Illicit Stimulants and Cutting Agents Cause False Positives On Fentanyl Test Strips. Harm Reduct J. 2021 03 9;18(1):30. PubMed PMID: 33750405.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips. AU - Lockwood,Tracy-Lynn E, AU - Vervoordt,Alexandra, AU - Lieberman,Marya, Y1 - 2021/03/09/ PY - 2020/10/09/received PY - 2021/02/26/accepted PY - 2021/3/22/entrez PY - 2021/3/23/pubmed PY - 2021/9/30/medline KW - Drug testing KW - False positives KW - Fentanyl KW - Fentanyl test strip (FTS) KW - Harm reduction KW - Opioid KW - Stimulant SP - 30 EP - 30 JF - Harm reduction journal JO - Harm Reduct J VL - 18 IS - 1 N2 - 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. SN - 1477-7517 UR - https://www.unboundmedicine.com/medline/citation/33750405/High_concentrations_of_illicit_stimulants_and_cutting_agents_cause_false_positives_on_fentanyl_test_strips_ L2 - https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00478-4 DB - PRIME DP - Unbound Medicine ER -