The Promise and Pitfalls of Consumer Drug Detectors. Okay, Mostly Pitfalls. (Part 2 of 2)

What’s in Your Drugs? Summer Drug Testing Roundup, part 2 of 2:

Read Part 1 here

On the heels of a bar drugging scare this past summer in Seattle, some local bars in the Capitol Hill section of that city are supplying test strips for bar patrons. These easy-to-use reagent strips can typically test for GHB, and in some cases Ketamine. The problems, though, with such devices are legion. Where to begin? I’ll get there in a roundabout way by first talking about the state of easily deployed drug identification technology.

Given the recent attention to contamination and tampering of both street and prescribed drugs, along with the drug counterfeiting problem, there’s clearly a general demand for light, reasonably precise, and portable field and home test technology for consumers to use. For reasons of legal sanction, privacy, expense, and convenience, commercial lab testing on-demand still leaves behind a big unmet need.

After-ingestion drug kits already exist – worried parents can get their kid to pee in a cup and test for any number of illicit substances, which they can then mail into a lab for confirmation. But the unmet need – or perceived need – is for before-you-consume products.  For instance, while the press loves entrepreneurs who come up with yet another “revolutionary” spiked drink detector (test cards, straws, cups, coasters, even a nail polish that you can stick in your drink) – funders … not so much. Though things may change, press fanfare is usually followed by failure on the venture capital and the crowdsourced funding circuit.

People seem to feel ambivalent, at best, about using these items anyway. I’d love to think this had something to do with clarity about the real nature of a variety of inter-related problems – drug use, alcohol use, and sexual assault – but I suspect there’s more to it.

In studying the date rape drugs scare, I noticed that the uptake for these detection items is low.  Campus public safety departments and bars, for a while in the 2000s, bought bulk lots to hand out only to find enthusiasm for the products’ use to be weak. The industry also lacks success testimonials – the natural one being “I foiled a spiker!” – for two reasons: one, the testing products aren’t used much, and two: because spiking in public venues, among strangers, is much lower than the hype would suggest. Once a particular scare dies down, demand from the nightlife industry tends to wane, suggesting that patrons aren’t particularly clamoring for even more reactive coasters or drink sealers.

There’s also a third problem: many of these reagent testing devices manage to lack both specificity and sensitivity – enough so that both false positives and false negatives are fairly common in lab settings. The test cards and strips for GHB, for instance, are based on a simple Ph test. Pour some mineral water on it – or any number of other liquids that are common in drinks and in bars – and you can get a positive result. (Fun bonus error: some wines have GHB in them.) Yet, as a 2010 article in Maclean’s suggests, in addition to missing about a third of tampered samples (that is, producing false negatives), the most widely distributed products “would still finger 12 innocents as toxic creeps for every 1 guilty man it identified.” A great deal of mayhem could ensue in the wake of a false positive before the 12 inculpated spikers (at a sensitivity level of 88%, according to the UK lab study by Caryl Beynon and associates of some similar spike-detecting products) could be cleared of wrongdoing. (Here are some other studies that examine the problems with this technology.)

Newly deployed handheld mass spectrometers are much more precise, but they still aren’t the kind of thing that a layperson interested in their personal safety will be able to use and understand well. Technicians and scientists have to be trained to interpret (and not over-interpret) results; the rest of us might well end up in the same guessing-game position both before and after the field test.

Yet, to be fair, while the date rape drug detection industry lacks testimonials of success, false positive scandals seem to be lacking as well.  I haven’t read of any calamities associated with the big error rates of these products. The Maclean’s article came out after a spate of new products hit the market, but the lackluster interest and scientific problems with the devices were reported on in the press as early as 2002, in an article by Margie Mason via the Associated Press. This is another indirect – though fairly convincing — indication that such devices, which are still employing the same technology, are celebrated without being actually used much. They’re neither foiling drink spikers nor falsely implicating our bar mates. In all likelihood, they get ordered, deployed near the lemons and swizzle sticks, and then get mothballed.

Next up in this blog: a third entry in the Summer Drug Testing Roundup. More pitfalls of light and portable drug testing, but I promise a bit more promise also.

Advertisements

What’s in Your Drugs? And Does it Matter if it isn’t what you think? (Part 1 of 2)

Summer Drug Testing Roundup, part 1 of 2: 

In mid-July in Yorkshire, England, ITV and other news sources reported that purchasers of “street Valium” got more than they bargained for and a number of them had sought medical attention. The first odd thing was that the drug had turned their tongues blue, and the second was that the drugs’ effects were much heavier than expected. Within weeks, police made an arrest and recovered about 40 more of the suspect tablets.

It appears that the underground compounder making the drugs mixed diazepam (known by one of its commercial names, Valium) with flunitrazepam (known as Rohypnol) or “roofies.” Swiss pharmaceutical giant Roche began blue-dye tagging Rohypnol tabs in response to spiked-drink reports in the United States in the late 1990s. Both Valium and Rohypnol are benzodiazepines, but Rohypnol is stronger. Roche makes both of the name brands, but generic versions are around, as well. Valium is mostly used as an anti-anxiety drug, whereas Rohypnol treats insomnia. (Roche was never all that aggressive in seeking to swim upstream against the negative publicity as it marketed the drug in the US. Rohypnol was too similar to other insomnia drugs anyway, and Roche focused mainly on countering the negative publicity.)

No doubt the purchasers of the illicit drug had expected a Valium-high, but experienced something more anvil-like and presumably suffered some of Rohypnol’s known side effects, such as amnesia.

The recent incident in Yorkshire points up the strangeness of continuing to use the term “date rape drugs” in any meaningful way. References to Rohypnol assume, often without sources or reference, that it is widely implicated in drugging and drink-spiking cases. In fact, Rohypnol is available by prescription in Europe and elsewhere, and it is rarely implicated in predatory drugging incidents. In the handful of cases where anything other than high blood-alcohol levels has been found, none of the commonly labeled “date rape drugs” are among the top substances. Instead, the usual street substances are found, including stimulants. But the moniker “roofie” leapt clear of its origins and took on a meaning of its own.

The Yorkshire Street Valium incident points to a more common problem — adulterated drugs in the illicit market. Up until recently, consumers of illegal or restricted substances had no way to verify that what they were buying was what they thought they were buying. Underground mid-level distributors and wholesalers sometimes employed chemists for verification of samples from larger lots they were negotiating to buy, but the street user was more or less on his or her own. In the US, there have been a number of cases in which seekers of heroin were sold heroin-fentanyl combinations, with sometimes fatal results. Fentanyl is a powerful synthetic opiate, and by weight or volume tends to be considerably stronger than heroin. Also this July, law enforcement in Long Island, NY arrested 24 people in connection with heroin and fentanyl distribution. At least one of the combinations they were distributing seems to have provoked an uptick in overdoses.

But in describing a street preparation as a deadly dose, you have to consider not only the objective effects of a particular dose, but the expectations that the buyer and user bring to the anticipated high. Fentanyl itself is now sought out, on its own or in combinations, by illicit users. Heroin users often expect their purchases to be cut with other things; toxicologists note that most of the time, the adulterants buffer rather than strengthen the effects of the drug. But the haphazard and after-the-fact investigation of the content of illicit substances, as well as a non-transparent supply chain, means that it is difficult to separate effects of the drugs themselves and the drugs’ potential substitutions and additives.

In my book on drugs associated with the “date rape drugs” scare, I noted that there was really no factual basis to label certain popular club drugs like GHB as the preferred weapons of predators. GHB, Ketamine, and Rohypnol – like many central nervous system depressants – have been implicated in specific cases, but any CNS depressant can work, and the labeled drugs are found less often than other widely available drugs (and, of course, alcohol). GHB also presents an interesting conundrum in that it is often not clear whether people who had some in their system were dosed by someone else with ill intent, or whether the GHB was a part of a popular mix of MDMA and GHB sometimes sought out in club settings.

Just to add to the confusion, GHB’s street names are myriad, including Liquid Ecstasy and Cherry Meth. and its effects are seemingly subjective enough to be mistaken for any number of knowingly ingested substances.  The underground compounder often finds that GHB is a cheap substitute for other drugs. GHB is also sought out by recreational users for its reputation as a calorie-free buzz mimicking moderate alcohol ingestion. It can be very dangerous, however, in combination with alcohol.

Voluntary drug users clearly might benefit by being able to quickly and easily test the content and potency of their drugs, but for many reasons the market hasn’t reached this potential public yet.  In my next blog, I discuss the problems with validity and reliability of home and field drug test kits, and the products that come to market to purportedly fix this problem. Depending on context, testing technology can either aid well-being and safety or undermine it.