A tube with white powder arrived by FedEx at the University of North Carolina at Chapel Hill, with the words, "quick OD, half bag, weirdly lethargic after,” on a slip of paper. The user had a hunch that there was fentanyl in the powder but feared the presence of xylazine, a dangerous animal tranquilizer that can leave oozing wounds on limbs. Erin Tracy, a university chemist, began searching for the answer. She loaded the sample into a $600,000 refrigerator-size device known as a gas chromatograph-mass spectrometer. A nearby computer displayed the results in a line graph with a dramatic peak, the signal for fentanyl. There was only a trace of xylazine. In a state increasingly besieged by the drug in the street supply, the results from the test amounted to partial relief. The work at the North Carolina lab is part of a strategy known as harm reduction, which aims not to lead users to abstinence but to give them the tools to use drugs safely, keeping them from infections, injuries and death, the New York Times reports. President Biden is the first president to endorse the strategy, lending it a federal imprimatur that health experts say could transform how the U.S. contends with drug use. The testing of drug samples in a growing number of cities is delivering new insight into what is in the local drug supply. Drug users can learn what is in a substance before they use it, alert other users to possible dangers in the supply or find out why a drug led to an overdose or some other reaction.
The Chapel Hill team has examined samples of drugs that caused fatal overdoses and relayed the results to harm reduction groups. The testing work, known as drug checking, has become especially critical to recognizing fentanyl, a synthetic opioid and a chief culprit in many overdose deaths. Other drugs, such as cocaine and heroin, are often mixed with fentanyl. Dr. Nora Volkow, director of the National Institute on Drug Abuse, noted that people who were fatally overdosing from drugs were not just dying from fentanyl, but also from other contaminants. There are dozens of health departments, academic laboratories or harm reduction groups using machines for drug checking, including in cities such as New York and Chicago. The work needs more funding. While test strips that can check for the presence of fentanyl in a sample typically cost $1, drug checking machines have a price tag in the tens or even hundreds of thousands of dollars. The Biden administration’s 2022 national drug strategy aims to increase drug checking services at harm reduction programs by 25 percent within three years. Drug checking has long been a feature of harm reduction efforts in Canada, Australia and Europe, including in settings such as nightclubs and music festivals. The practice has picked up in the U.S. only in recent years, a reflection of the nation’s slow adoption of harm reduction measures. In more than a dozen states, even the basic tools of drug checking, such as fentanyl test strips, are outlawed as drug paraphernalia; conservatives criticize the practice as permissive of drug use.