NWT launches fentanyl test strips in response to drug poisonings

A pilot drug-checking program is under way to help increase awareness of drug contamination in the Northwest Territories.

The Department of Health and Social Services said a fentanyl test strip project began in December in response to several opioid-related deaths in the territory. The department said the aim is to “increase safety and reduce the harm to those who use drugs by giving them another tool to test their drugs for fentanyl.”

Fentanyl is extremely toxic and can be lethal. Dealers sometimes add it to other drugs to increase the package’s overall potency, but buyers often don’t know that has happened.

Where the tests have been distributed remains unclear. The department said they had been targeted toward “areas of highest reported need.”

Test strips have been made available at health centres in multiple communities, a nurses’ expo in Yellowknife, the NWT Association of Communities annual general meeting in Hay River, and using “direct contact in areas with concern.”

If there is greater demand, the department said, distribution may be expanded to more communities and agencies. Communities can request access through the department’s health promotion unit.

The program began with 5,000 tests. The department said it has since purchased an additional 10,000 to be distributed in the coming days. The project has cost around $27,000 to date, including $15,000 for the strips and $12,000 for additional packaging and instructions.

Last month, chief public health officer Dr Kami Kandola warned residents following a suspected overdose death related to contaminated cocaine.

In January 2023, Dr Kandola and chief coroner Garth Eggenberger raised the alarm following six drug poisoning deaths in Hay River in 2022. Kandola said five of those deaths involved fentanyl or carfentanil. Eggenberger said most cases involved crack cocaine that people did not know was contaminated.

Kandola declined an interview request about the drug checking pilot, stating it is still in a preliminary stage.

How the tests work

The rapid response test strips require a drug sample of at least 10mg mixed with about a teaspoon of water. A paper test strip is placed in the mixture for about 15 seconds and can produce a result in two to five minutes.

The territorial government cautioned the tests are “not a guarantee of safety.” While they can indicate whether a drug sample contains fentanyl or something similar, the tests do not indicate exactly what the opioid is, nor how much is present.

Similar substances include synthetic opioids with a chemical structure like that of fentanyl. These are called fentanyl analogs and include carfentanil, which is 100 times more potent than fentanyl.

This kind of test strip is considered a consumer product in Canada and is not assessed by Health Canada before being authorized for sale.

In June 2018, Health Canada said some strips may not be able to detect some fentanyl analogs. The federal agency also said the tests could produce false negatives if illegal drugs are mixed with other substances unevenly, different substances interfere with the accuracy of a test, or a sample is too small to detect a specific substance.

A 2017 study by the BC Centre on Substance Use, or BCCSU, found the tests correctly detected fentanyl in 88 percent of relevant samples – and correctly came back negative 95 percent of the time when there was no fentanyl in a sample.

Another study published in 2022 suggests the strips may have difficulty detecting trace amounts of fentanyl analogs, finding they failed to detect carfentanil or furanyl-fentanyl at or below 1,000 nanograms per millilitre.

Treat all illicit drugs as though they could be contaminated, governments have warned.

Officials including Kandola have told people who use drugs not to consume alone, “start low and go slow,” carry a naloxone kit, and make sure they and others around them know how to use it.

Call 9-1-1 if you think someone is having a drug overdose. The federal Good Samaritan Drug Overdose Act prevents people involved in an overdose from being charged for drug possession, with the aim of encouraging people to call for help if they witness or experience an overdose. 

Naloxone kits are available at all hospitals, health centres and pharmacies in the NWT.

‘We’re in a drug poisoning crisis’

Drug testing has been used as a harm reduction tool in other jurisdictions across Canada.

A mobile drug checking service launched in Calgary in 2023, while Blood Ties Four Directions began offering drug checking in Whitehorse in 2018.

The Aids Network Outreach and Support Society has offered real-time drug-checking at the annual Shambhala music festival, in BC, for more than two decades.

Across BC, the BCCSU drug checking project uses strips that can test for fentanyl and benzodiazepine. The project also uses devices that can identify substances by shining infrared light at a drug sample and measuring how that light is absorbed. The project publishes data about drug testing results online.

Among the technologies available, BCCSU drug checking implementation lead Jennifer Matthews said test strips are relatively cheap and easy to distribute.

“They’re really good for reaching large areas where it’s hard to get equipment to places,” she said.

“Test strips are incredibly important for getting into rural and remote communities, particularly up north, to give people more information about what is actually in their drug supply.”

Matthews said while test strips may have limitations, drug checking tools can help people make more informed decisions.

“We’re in a drug poisoning crisis across this country,” she said.

“Things like drug checking give everybody more information, and that can only be helpful for people and making decisions around their health.”

Drug checking ‘can affect behaviour’

Karen McDonald is the executive director of Toronto’s Drug Checking Service, which launched in 2019. Through the service, people can bring drug samples or used drug equipment to five safe-consumption sites for lab testing.

“What we’ve learned during our pilot period is that drug checking is hugely important,” McDonald said. “We learned that drug checking is associated with intent to change behaviour.”

According to a report published in May 2023, 34 percent of surveyed service users said they planned to do something different based on drug sampling results. That included giving feedback to their seller, using at a supervised consumption site, using with a friend rather than alone, having a naloxone kit handy, starting with a small test dose, or not using a drug at all.

The study also found drug checking was a gateway to other harm reduction services, which in turn could lead to treatment referrals and connection to other health and social services.

McDonald said the NWT’s fentanyl test strip project is a step in the right direction.

“It’s really hopeful to hear that the government is starting to turn their attention to drug checking,” she said. “Hopefully this kind-of evolves into something bigger.”

NWT residents can access mental wellness and addiction recovery supports through the community counselling program, online and by calling 8-1-1.