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Sarah Mackin runs a Q-tip-type swab around the inside of a tiny plastic baggie that appears to be empty. She spreads whatever the swab picked up onto a test strip that resembles a Band-Aid. Mackin slides the test strip into a buzzing machine about the size of a boxed take-home pie.
Meet the MX908. This mass spectrometer -- initially marketed to the military and hazmat crews fighting bioterrorism or explosions — may help in the fight against one of Boston's top killers: fentanyl.
But can a machine designed to detect agents of chemical warfare help save lives in the opioid epidemic? That's the question Mackin, director of harm reduction services, and her colleagues at the Boston Public Health Commission aim to answer.
Mackin looks down at a screen that spans the top of the MX908 and taps an icon labeled "drug hunter."
"This is something that was sold as heroin," Mackin says, dangling the baggie as the machine whirs into action. It can identify 70 specific types of fentanyl and alert users about the presence of more than 2,000 not-yet-named fentanyl analogs.
It also detects stimulants including cocaine and meth — all based on what’s left at the tip of a needle or wiped onto a cotton ball. About 30 seconds after starting the test, Mackin watches red and yellow warning symbols flash across the screen.
"Oh yeah," Mackin says, nodding her head. "So, there’s multiple kinds of opioid analgesics and multiple kinds of synthetic fentanyls in this sample that was sold as heroin. It’s kind of an example of what the drug landscape looks like here."
The drugs for sale today in Boston may have crossed many borders. They may have been cut and remixed countless times along the supply chain. Drug users rarely know for sure what they are buying.
Take the experience of a woman named Bri. (We’re only using Bri’s first name because she uses illegal drugs.) She tested the residue from some of her drugs one day last July when the machine was set up in downtown Boston. On that day, she had three samples. Bri overdosed on a hit from one of the bags.
"That’s why I wanted it tested," Bri says. "I thought there was carfentanil in it."
Carfentanil, sometimes called the elephant tranquilizer, shows up in Boston sporadically, along with other increasingly powerful and deadly forms of fentanyl.
In Bri’s case, one sample showed no trace of drugs at all, one tested positive for a medical-grade fentanyl, and the third showed traces of something Bri learned is in the range of carfentanil.
"Now, I’m going to be honest. If I was sick and I had one bag of dope on me and you told me there’s carfentanil in there, I’m not going to lie and say I wouldn't use it," Bri says. "But I would know to not put the entire thing in."
Bri says she knows doing that would still be a very risky move. But trying to moderate that risk is the first way research shows drug checking helps save lives.
Here’s the second way: Drug checking offers an evidence-based warning for drug users, a warning that the Boston Public Health Commission can help spread.
"Now, they can tell people, 'just to let you know, there’s some really strong, killer stuff that’s coming out of,' let’s say, 'Copley,' " Bri says.
That warning may draw people seeking an ever more powerful high. But Traci Green, who is a researcher in emergency medicine at Rhode Island Hospital and Brown University, says her own work and studies out of Europe show that when drug users can test what they buy, they seek dealers with the safest supply.
"So this improvement in consumer knowledge and confidence in what they’re getting, and how to use it can improve the safety of the larger supply," Green says.
Green will evaluate this Boston trial run of the MX908. She says she’s especially interested in whether it brings drug users who avoid institutions and medical care into a setting where they might begin talking about treatment.
The Price Tag, And 'A Legal Gray Area'
One other city, Chicago, is testing the MX908 as a harm reduction tool during the opioid crisis. There are two reasons it may not be widely adopted. One is the price tag: $65,000.
For Boston, the device was purchased through a grant from RIZE Massachusetts, a foundation focused on combating the opioid epidemic.
"Cost is one concern," says RIZE CEO Julie Burns, "but what is the value of a human life? If we decide through the evaluation that this is something that is reducing overdoses, I believe it is worth the investment."
There are much cheaper ways to find out if a baggie contains fentanyl.
Street outreach workers have been distributing fentanyl test strips, that cost about $1 apiece, for more than two years. The current Massachusetts state budget includes $150,000 to expand access to these test strips. They, like the MX908, show the presence or absence of fentanyl. The MX908 offers much greater detail as well as information about several types of stimulants. It does not yet detect benzodiazepines or some of the other drugs often used in combination with fentanyl.
Greg Scott, executive director at the Chicago Recovery Alliance (CRA), says harm reduction programs will have to decide what's cost effective based on their goals and budget. The CRA rolled out an extensive drug-checking program in March that includes two MX908s. He says none of the high-end devices "produce iron-clad results." Scott mentions an antihistamine commonly used as a cutting agent in the Chicago area that he says often triggers a false read.
Scott says so far, the MX908 is delivering on two goals: helping people use drugs more safely and offering real-time information about the drug supply in Chicago. Scott says he doesn't think drug checking will help clean up the drug supply unless it becomes much more widespread.
"Getting to that scale and that level of impact is a very costly endeavor," Scott says.
The second reason public health workers may hesitate to use the MX908 is that doing so may be illegal.
"Drug checking is a legal gray area," says Northeastern University law professor Leo Beletsky. "There are provisions in Massachusetts law and the laws of pretty much every other state that might be interpreted to consider drug checking devices as drug paraphernalia."
That includes fentanyl test strips. Illinois enacted legislation in August that exempts people who test their drugs from prosecution. A bill that would add drug checking to Massachusetts' Good Samaritan law is pending.
In the meantime, this trial run of the MX908 in Boston is on hold. Devin Larkin, who runs recovery services at the Boston Public Health Commission, says she wants to be sure that use of the machine is on firm legal ground.
"We are awaiting guidance from the state on the best next steps to make sure that if we were to roll this out as a permanent project that we’re doing so in the safest way possible," Larkin says.
Boston police say they aren’t involved in the MX908 pilot and referred questions to the city’s public health commission. The U.S. attorney's office in Massachusetts declined a request for their perspective on the use of this device for public health purposes.
The company that developed the MX908 is in Boston's Seaport District, less than a mile from some of the sidewalks where people who use drugs waited this summer to find out what they were taking. CEO and co-founder of 908 Devices Kevin Knopp says his team is working closely with the Boston Public Health Commission on improvements, given the many additives and shifting combinations of drugs.
"That's where really our technology has an advantage," Knopp says. "It can find the different constituents of such a mixture at very low levels."
Knopp says there have been many surprises already as the machine finds new varieties of fentanyl. It's the first time drug users have been able to see for themselves proof of more than one drug in a single bag.
The MX908 is also in more traditional use by police, fire and hazmat teams across Massachusetts. Even there the leading enemy agent is fentanyl, says David DiGregorio, who directs the hazardous materials emergency response division at the Massachusetts Department of Fire Services. His department has about a dozen of the machines.
"If you had asked me if I was going to be involved in drugs five years ago I would have said, 'No, it's not my job.' It's become my job," DiGregorio says. "Hazmat calls are up in the last two years, exponentially, and a lot of that has to do with drug calls because we can identify these powders in the field."
Correction: An earlier version of this post spelled Knopp's surname incorrectly. The post has been updated. We regret the error.
This article was originally published on October 10, 2019.
This segment aired on October 10, 2019.
- Fentanyl-Linked Deaths: The U.S. Opioid Epidemic's Third Wave Begins
- Meth Use Is Rising In Boston, Intensifying The Opioid Crisis
- Fentanyl Test Strips Reduce Risk Of Overdose In Small Study
- Opioid Addiction Crisis
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