Skip to content

Testing street drugs for fentanyl: Does it reduce overdoses?

A pilot project by Insite that allows drug users to check their drugs for the presence of fentanyl has received a lot of publicity. Now, according to this article in the Globe & Mail, the BC government is going to increase the availability of these tests:

British Columbia is set to expand a program to allow people to check their street drugs for fentanyl, the latest harm-reduction initiative to roll out amid skyrocketing overdose deaths.

The most recent figures from the provincial government show 1,103 confirmed deaths from overdoses of illicit drugs in the first nine months of this year. The year-end total is on pace to be around seven times the annual average in the 2000s.

I’m going to take a few moments to explain why this harm-reduction strategy, in its current form, is a bad idea.

First, it is likely that cross-contamination is causing false positives. Insite is not a sterile lab environment, and nor are the drug users who are conducting these tests. Trace amounts of fentanyl and other opiates are likely present on their hands, clothes, etc. Only a very small amount of fentanyl is required to generate a positive test result.

Street drugs are often cut with a buffer, and the result is not a uniform mixture. For example, low-grade heroin cut with fentanyl has not been mixed to pharmaceutical standards. A tiny sample tested at Insite might have no fentanyl, but there could still be enough fentanyl in the remaining dose to kill the user. Also, the tests used by Insite result in false negatives. It’s also worth noting the tests can detect fentanyl, but may not be able to accurately or reliably detect other synthetic drugs such as W-18. The latter is known to be present in British Columbia. W-18 is orders of magnitude more toxic than fentanyl.

As mentioned the test itself, even if used correctly, inherently has a false negative rate. This means the test will sometimes come back negative even through fentanyl is present. Furthermore, the drug test strips were only designed to be used for human urine samples as a preliminary test. I obtained a copy of the BTNX Single Drug Test Strip from Kwan Tse, manager of QA / RA at BTNX Inc.  Excerpts from this product insert include numerous warnings (emphasis added by me).

In the section labeled INTENDED USE:

The Rapid Response Single Drug Test Strip is rapid chromatographic immunoassays for the qualitative and simultaneous detection of one of the following drugs in a variety of combinations in human urine.

This assay provides only a preliminary analytical test result. A more specific alternative chemical method must be used in order to obtain a confirmed analytical result.

In the section labeled QUALITY CONTROL:

Good laboratory practice recommends the use of control materials to ensure proper kit performance. Quality control specimens are available from commercial sources and are recommended to be used daily. Use the same assay procedure as with a urine specimen. Controls should be challenging to the assay cutoff concentration. If control values do not fall within established limits, assay results are invalid. Users should follow the appropriate federal, state, and local guidelines concerning the running of external quality controls.

There is no indication from Insite that control materials were used on a daily basis to ensure the validity of their off-label fentanyl screening tests. As such their test results are unreliable.

In the section labeled LIMITATIONS OF THE TEST:

The assay is designed for use with human urine only.

There is a possibility that technical or procedural error as well other substances as factors not listed may interfere with the test and cause false results. See SPECIFICITY for lists of substances that will produce either positive results, or that do not interfere with test performance.

In the section labeled Specificity:

The Specificity for the Rapid Response Single Drug Test Strip has been tested by adding various drugs, drug metabolites, and other compounds that are likely to be present in drug-free normal human urine. The Rapid Response Single Drug Test Strip performance at cutoff point are not affected when pH range of urine specimens is at 3.0 to 8.5 and specific gravity range of urine specimens is at near 1.005 to 1.03.

The specificity testing for this product was limited as the company was only considering what was likely to be found in drug-free human urine. It should be obvious by now that this product was never designed to be used for the testing of unknown street drugs prior to their consumption by humans.

The pilot project results obtained by Insite are compromised by these limitations. It is likely that various adulterants in street drugs as well as the drugs themselves are causing either false positives or false negatives.

There is also a risk that Insite is simply confirming the presence of fentanyl for drug traffickers whose true intention is to sell fentanyl on the streets. The data from the pilot project hints at this. Here is an excerpt from the abstract presented at the 2017 Harm Reduction International conference:

Of substances checked pre-consumption, compared to receiving a negative result, receiving a positive result did result in more dose reductions (37% vs. 8%) but not in more disposals (9% vs. 8%).

And so even when street drugs tested positive for fentanyl, the users did not get rid of their drugs.  The users said (to Insite staff) that they were reducing their planned dose, but there was no way to verify the truth of those statements. What the data shows is that clients walked out of Insite with their fentanyl-laced dope. Their likely plan was to sell their fentanyl to unsuspecting users, or to keep it for themselves and use it on their own.  Both choices have almost certainly resulted in fatal consequences for people who use drugs in British Columbia.

I have been a public advocate of harm reduction for almost a decade. But harm reduction supporters should not blindly accept every strategy and method put forward as harm reduction. Because the Insite pilot project did not result in users getting rid of their fentanyl, it cannot be said that testing street drugs for fentanyl actually reduces overdoses.

One last point: The data showing that users did not dispose of their fentanyl-laced drugs (once they become aware of the contamination) was never included in the original media release by Vancouver Coastal Health. I think it was an important point for journalists to know. Particularly as that media release generated worldwide coverage. Users and user-dealers were walking out the doors of Insite into the broader community, believing that the dope in their possession was fentanyl. It should have been in the original media release.

Disclaimer: The opinions expressed in this blog post represent my own personal views, and not those of my employer (or any other organization).

CHEK News – Insensitive and Gratuitous

Most journalists work in their profession for noble reasons. Most of them intend to do the right thing. But sometimes – just like some police officers – they become jaded and numb to what they see on a regular basis. Media outlets are uniquely positioned in terms of their ability to inform millions of people. A gratuitous and insensitive decision by a journalist can lead to more grief and trauma, and foster a more cynical society.

The following has been submitted to the Canadian Broadcasting Standards Council in relation to a CHEK News segment that was broadcast on September 11, 2017:

Dear Sir or Ma’am,

I am writing to express my concern and disappointment regarding the decision by CHEK News to broadcast security camera footage of a fatal motorcycle collision.

The news clip even included a close up / enhanced replay showing [graphic description of collision removed].

The clip was broadcast on the 5pm news. No viewer advisory was shown before the clip. The clip currently remains on the CHEK News web site: [link removed]

Following the CHEK News broadcast, the police department investigating the collision took the rare and unusual step of publicly criticizing CHEK News by posting the following message on Twitter:

@Saanich Police: “Can’t believe you obtained the video & then aired the death of someone on your newscast. Insensitive to the #yyj family, friends & coworkers”

I wish to echo the concerns expressed by the Saanich Police Department.  It is one thing to show the aftermath of a collision, it is another matter entirely to broadcast the serious injury or death of a motorcyclist on the air.

I note that in a decision released earlier this year, the Canadian Broadcasting Standards Council determined that a violent sci-fi show should be broadcast at 9pm instead of 8pm. The CBSC also determined that the show required viewer advisories. I would respectfully suggest that the same criteria – at a minimum – should apply to a community television station that wishes to broadcast the death of a real person who lived in that very same community.

I believe that CHEK News violated the following provisions of the Canadian Association of Broadcasters Violence Code (1993):

6.1 Broadcasters shall use appropriate editorial judgment in the reporting of, and the pictorial representation of violence, aggression or destruction within their news and public affairs programming.

6.2 Caution shall be used in the selection of, and repetition of, video which depicts violence.

6.3 Broadcasters shall advise viewers in advance of showing scenes of extra-ordinary violence, or graphic reporting on delicate subject matter such as sexual assault or court action related to sexual crimes, particularly during afternoon or early evening newscasts and updates when children could be viewing.

Please note that I am submitting this complaint as a concerned citizen. These are my own personal views and they do not represent the official views of any organization or employer.

Thank you,

David Bratzer

Using Canadian C-17 Globemaster III’s to fight wildfires

Today I’m thinking about the wildfires raging in British Columbia. And how to increase our capacity to respond. One resource worth considering is that Canada has five C-17 Globemaster III aircraft. This research paper was presented at the 16th Australian International Aerospace Congress, in 2015. It says the C-17 could (in theory) temporarily become a 50,000 litre air tanker. Here’s the abstract:

Australian summers are hot and dry and bushfires are a significant risk to life and property. The worst ever recorded natural disaster were the Victorian Black Saturday Bushfires in 2009, where 173 people lost their lives. To limit bushfire damage, an effective firefighting capability is essential. This project investigated the feasibility of using existing military assets and converting them to firefighting/control capability on an as required basis. This paper presents a conceptual design of a RAAF C-17 Globemaster III conversion to a temporary firefighting platform that provides three support roles: water drop, in-flight refill of standard firefighting aircraft and in-situ surveillance, command and control. Provisions were made for quick conversion with minor structural modifications to allow return to military status.

C17 Cargo Drop, FA2012-1007

In the Canadian Forces, these aircraft are designated as the CC-177 Globemaster III. This plane can travel very long distances and carry extremely heavy payloads. And it can operate from short runways in difficult environments all over the world.

There have been calls to bring the Martin Mars water bomber back into service.  However the Martin Mars “only” holds 27,276 litres of water (compared to 50,000 litres, potentially, for the C-17). The Martin Mars has been in service since 1944.  Over seventy years!  Not a lot of aircraft that have been in operation for that long.  The C-17 Globemaster III entered service in 1995, so that’s a fifty year difference in aircraft technology.

Obviously this is not something that could be used right now, but perhaps it is worth exploring for the future.

Too few police officers in the North

There is short staffed, which every police agency is to various degrees. And then there is short staffed. I never realized how few police officers were in the Yukon until I saw this article:

RCMP workload in Yukon ‘not sustainable’, says superintendent

The Yukon RCMP’s superintendent says he’s thankful for outside help, but says the current situation is “not sustainable” when it comes to the territory’s policing.

The force is dealing with several homicide investigations, and has called for support from other jurisdictions.

Brian Jones, the officer in charge of criminal operations in Yukon, says about ten officers flew in from Alberta last weekend. They provided help sweeping for evidence and conducting interviews.

Now they’ve gone home.

Jones says the help was appreciated especially because rapid response is important in homicide investigations.

“Those investigators that have come up from Alberta and other places — they’re busy with their full-time jobs as well,” he says.

This is not the first time the territory’s police force has called for outside help. And Jones thinks it suggests a larger problem with workload.

Yukon’s seven-person Major Crimes Unit has been involved in eight homicide investigations since last summer.

“Long term, that type of energy and effort isn’t sustainable for our people,” Jones said.

In 2016, the Yukon had 138 police officers to cover 482,443 sq km.

The Northwest Territories had 199 police officers to cover 1,346,106 sq km.

And Nunavut had 131 police officers to cover 2,038,722 sq km.

By comparison, British Columbia had 8761 police officers to cover 944,735 sq km.

When you consider the time required to travel large distances from one call to another, plus the extreme weather, it becomes clear that officers in the North face some big challenges.

Criminal harassment and the word “repeatedly”

A creepy guy stalks the same woman for thirty minutes every day for three days in a row.

A creepy guy stalks a woman for ninety minutes continuously on a single day.

Which scenario – if any – constitutes criminal harassment?  Section 264(1) of the Criminal Code describes a range of harassing behaviour:

264 (1) No person shall, without lawful authority and knowing that another person is harassed or recklessly as to whether the other person is harassed, engage in conduct referred to in subsection (2) that causes that other person reasonably, in all the circumstances, to fear for their safety or the safety of anyone known to them.

Prohibited conduct

(2) The conduct mentioned in subsection (1) consists of
(a) repeatedly following from place to place the other person or anyone known to them;
(b) repeatedly communicating with, either directly or indirectly, the other person or anyone known to them;
(c) besetting or watching the dwelling-house, or place where the other person, or anyone known to them, resides, works, carries on business or happens to be; or
(d) engaging in threatening conduct directed at the other person or any member of their family.

So what does the word “repeatedly” mean in the context of criminal harassment? Does it mean at least twice?  Three times?  Well, in R. v. Venn, 2014 ABPC 284, the Court expressed a more nuanced view:

[26] The Ontario Court of Justice (General Division) in R. v. Belcher (1998 CarswellOnt 192), 50 O.T.C. 189, considered the nature of the ‘following’ that is required to found the charge under the subsection in question. At paragraph 20 the court summarized the authorities stating that the repeated ‘following’ contemplated by the section describes conduct that occurs more than once.

[27] However, the ‘following’ need not occur over and over again separated by any particular amount of time. Rather, the meaning in the criminal law context means “persistently” following. The court stated that focussing on persistent following “which demonstrates resolve to do so”, would help avoid criminalizing innocuously following another person even if annoying or prolonged.

In R. v. Ohenhen, 2005 CanLII 34564 (ON CA), the Court of Appeal for Ontario found that sending two letters over the span of 18 months constituted “repeatedly communicating”. In examining past case law, the Court rejected suggestions that “repeatedly” meant three or more:

[17] I do not interpret these reasons to say anything other than that in the circumstances of that case the three incidents which were the subject of the charge were sufficient to meet the charge of “repeatedly communicating”. The statement that “three communications would seem to be the minimum number sufficient to justify being described as ‘repeatedly'” was nothing more than a Crown submission and was not specifically adopted by the court.

The Court went on to examine Belcher and other cases in a detailed manner, and ultimately reached this conclusion:

[31] In my view, the dictionary definitions of the words “repeat” and “repeated”, from which the adverbial form “repeatedly” is derived, lead me to conclude that conduct which occurs more than once can, depending on the circumstances of the case, constitute “repeated” conduct or conduct which is “repeatedly” done and the section is met. In my view, it is unnecessary that there be a minimum of three events or communications. “Repeatedly” obviously means more than once but not necessarily more than twice.

[32] While one instance of unwanted conduct can be sufficient to satisfy s. 264(2)(c) and (d), it will not be sufficient to satisfy s. 264(2)(b). More than one instance of unwanted conduct will be necessary to meet paragraph (b); however, in my view, there is not and should not be any minimum number of instances of unwanted conduct beyond this to trigger these subsections. Provided the conduct occurs more than once, in my view, the actus reus can be made out. It will be a question of fact for the trier in each case whether there has been repeated conduct. The approach is a contextual one. The trier will consider the conduct that is the subject of the charge against the background of the relationship and/or history between the complainant and accused. It is in this context that a determination will be made as to whether there has been repeated communication. On the facts of this case, it was clear that neither of the communications could be characterized as i nnocuous or accidental. In the context in which they were made, these two communications would be [page581] sufficient to constitute “repeatedly” communicating as set out in s. 264(2) (b). In my view, it was entirely appropriate for the trial judge to use the standard charge language on this point.

[33] Although not in issue on the facts of this case, trial judges should be cautious in using the standard charge language in all cases. It seems to me that defining “repeatedly” as being more than one communication is not always appropriate. In some cases, the jury will have to consider the context in which the communications were made, the intent of the accused and possibly other factors to determine whether the communications were repeatedly made or were innocuous or accidental. Perhaps a more appropriate instruction would be to advise the jury that communication that occurs more than once can constitute repeated communications depending on the context and circumstances in which they were made.

The Court of Appeal for Ontario upheld the conviction for criminal harassment and found the sentence to be appropriate:

[41] Lastly, the appellant requests leave to appeal his sentence and if leave is granted, appeals on the basis that in all the circumstances, his sentence is overly harsh. Counsel advised the court that he has served his sentence.

[42] The appellant was sentenced, in effect, to three years’ imprisonment. After being given credit for the time he spent in pre-trial custody, he was required to serve a further 18 months. The sentence was to be followed by two years’ probation. The appellant has an extensive record dating back to 1990; it includes weapons offences, aggravated assault, assault with a weapon and at least four convictions for uttering threats. In my view, the sentence was manifestly fit in all the circumstances and I would not interfere with it. In view of the fact, however, that the sentence has been served, I would deny leave to appeal sentence.

My takeaway from all of this? There is no magic number of incidents required for criminal harassment to have occurred.  Victims do not have to be followed for a minimum of three separate times. Nor do there have to be a minimum of three separate communications.