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Do you know what’s in your pill? In Mass. there’s a way to find out
Editor's Note: This is an excerpt from WBUR's weekly health newsletter, CommonHealth. If you like what you read and want it in your inbox, sign up here.
There's a trend few people are talking about when it comes to overdose deaths. They rose in some Massachusetts communities last year — even as they plummeted statewide and across the U.S.
Part of the reason might be differences in the drug supply.
The illegal drug supply varies quite a bit from city to city. When xylazine, the animal tranquilizer, dominates — rather than the opioid fentanyl — there tend to be fewer fatal overdoses.
One possible explanation is fentanyl wears off quickly, so people addicted to fentanyl often use it six or more times a day to avoid going into withdrawal and feeling deathly ill. Xylazine, by contrast, can knock a person out for eight hours or longer. A lot of things can go wrong if you don’t move for many hours and are unprotected outside in the sun or cold. But if a person uses drugs twice a day instead of six times, their risk of a fatal overdose drops.
I heard this theory from Traci Green, who runs the Opioid Policy Research Collaborative in the Heller School at Brandeis University. She speaks with unique authority. In 2019, Green started the first statewide community drug-checking program in the U.S. So far this year, her team has tested more than a thousand samples from 20 communities using a combination of low-tech test strips and 12 high-tech spectrometers. The testing equipment is housed in harm reduction programs from Hyannis to Pittsfield.
Program participants share test results with the person who supplied the sample, so they can make more informed choices. They also post the results online, so outreach workers, family members, prevention programs, emergency medical personnel and treatment providers can adjust what they do based on facts.
“We take for granted that we know what’s in the drugs,” said Green. “Perhaps that was a safe assumption 20 years ago, but it is not a safe assumption now.”
Here’s one example: Tinuvin (or BTMPS), a chemical used in manufacturing to protect plastics, was in at least 21% of drug samples tested in Massachusetts so far this year. The effect in humans is lower blood pressure, according to a public health alert reviewed by the state Department of Public Health. Green said Tinuvin is used to create ingredients for fentanyl, so it may signal there's a new fentanyl recipe in the works.
It’s hard to know what local or global forces are behind shifts in the drug supply, Green said, but they're happening all the time. Local testing can, at least, track the results.
On the ground, drug checkers are finding lots of otherwise hidden clues about how the illegal drug market works, and what people with an addiction are looking for. Traces of methadone or similar drugs might indicate people want a street version of the addiction treatment drug that works but is not widely available. Caffeine, a common substance found in samples with xylazine or opioids, may help offset the heavy sedation. Some samples show the generic version of Benadryl which might offset itching that sometimes comes with opioid use, and acetaminophen which might relieve pain from injecting. Some dealers color code their xylazine, cocaine or opioids.
Community-based drug checking is expanding. Some programs are using spectrometers to test other kinds of drugs that are moving from the legal to illegal market, like hormones transgender patients take that are now banned for minors in many states.
The website Street Check shows test results from 11 states. Massachusetts is part of a New England coalition of programs that launched last year to try new drug checking technologies.
"Drug checking gives us real time information about the drug supply," said Jamie Davis, who managed harm reduction programs at the Opioid Policy Research Collaborative until a recent job change. "We can respond proactively rather than waiting for overdose death counts to rise without knowing what's changed or why."
