PMID- 33750405
OWN - NLM
STAT- MEDLINE
DCOM- 20210929
LR  - 20210929
IS  - 1477-7517 (Electronic)
IS  - 1477-7517 (Linking)
VI  - 18
IP  - 1
DP  - 2021 Mar 9
TI  - High concentrations of illicit stimulants and cutting agents cause false 
      positives on fentanyl test strips.
PG  - 30
LID - 10.1186/s12954-021-00478-4 [doi]
LID - 30
AB  - BACKGROUND: The opioid epidemic has caused an increase in overdose deaths which 
      can be attributed to fentanyl combined with various illicit substances. Drug 
      checking programs have been started by many harm reduction groups to provide 
      tools for users to determine the composition of their street drugs. Immunoassay 
      fentanyl test strips (FTS) allow users to test drugs for fentanyl by either 
      filling a baggie or cooker with water to dissolve the sample and test. The 
      antibody used in FTS is very selective for fentanyl at high dilutions, a 
      characteristic of the traditional use of urine testing. These street sample 
      preparation methods can lead to mg/mL concentrations of several potential 
      interferents. We tested whether these concentrated samples could cause false 
      positive results on a FTS. METHODS: 20 ng/mL Rapid Response FTS were obtained 
      from BTNX Inc. and tested against 4 different pharmaceuticals (diphenhydramine, 
      alprazolam, gabapentin, and naloxone buprenorphine) and 3 illicit stimulants 
      [cocaine HCl, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA)] in 
      concentrations from 20 to 0.2 mg/mL. The FTS testing pad is divided into 2 
      sections: the control area and the test area. Control and test area signal 
      intensities were quantified by ImageJ from photographs of the test strips and 
      compared to a threshold set by fentanyl at the FTS limit of detection. RESULTS: 
      False positive results indicating the presence of fentanyl were obtained from 
      samples of methamphetamine, MDMA, and diphenhydramine at concentrations at or 
      above 1 mg/mL. Diphenhydramine is a common cutting agent in heroin. The street 
      sample preparation protocols for FTS use suggested by many online resources would 
      produce such concentrations of these materials. Street samples need to be diluted 
      more significantly to avoid interference from potential cutting agents and 
      stimulants. CONCLUSIONS: Fentanyl test strips are commercially available, 
      successful at detecting fentanyl to the specified limit of detection and can be a 
      valuable tool for harm reduction efforts. Users should be aware that when drugs 
      and adulterants are in high concentrations, FTS can give a false positive result.
FAU - Lockwood, Tracy-Lynn E
AU  - Lockwood TE
AUID- ORCID: 0000-0002-8988-7810
AD  - Department of Chemistry and Biochemistry, University of Notre Dame, 251 Stepan 
      Hall of Chemistry, Notre Dame, IN, 46556, USA. tlockwood@nd.edu.
FAU - Vervoordt, Alexandra
AU  - Vervoordt A
AUID- ORCID: 0000-0002-8893-9500
AD  - Department of Chemistry and Biochemistry, University of Notre Dame, 251 Stepan 
      Hall of Chemistry, Notre Dame, IN, 46556, USA.
FAU - Lieberman, Marya
AU  - Lieberman M
AUID- ORCID: 0000-0003-3968-8044
AD  - Department of Chemistry and Biochemistry, University of Notre Dame, 251 Stepan 
      Hall of Chemistry, Notre Dame, IN, 46556, USA.
LA  - eng
GR  - UL1TR002529/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20210309
PL  - England
TA  - Harm Reduct J
JT  - Harm reduction journal
JID - 101153624
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Illicit Drugs)
RN  - 70D95007SX (Heroin)
RN  - UF599785JZ (Fentanyl)
SB  - IM
MH  - Analgesics, Opioid/*adverse effects
MH  - Drug Contamination
MH  - Drug Overdose/*prevention & control
MH  - False Positive Reactions
MH  - Fentanyl/analysis/*poisoning
MH  - Heroin/*adverse effects
MH  - Humans
MH  - Illicit Drugs/adverse effects/*poisoning
MH  - Opioid-Related Disorders/*prevention & control
PMC - PMC7941948
OTO - NOTNLM
OT  - Drug testing
OT  - False positives
OT  - Fentanyl
OT  - Fentanyl test strip (FTS)
OT  - Harm reduction
OT  - Opioid
OT  - Stimulant
COIS- The authors declare that they have no competing interests.
EDAT- 2021/03/23 06:00
MHDA- 2021/09/30 06:00
PMCR- 2021/03/09
CRDT- 2021/03/22 18:07
PHST- 2020/10/09 00:00 [received]
PHST- 2021/02/26 00:00 [accepted]
PHST- 2021/03/22 18:07 [entrez]
PHST- 2021/03/23 06:00 [pubmed]
PHST- 2021/09/30 06:00 [medline]
PHST- 2021/03/09 00:00 [pmc-release]
AID - 10.1186/s12954-021-00478-4 [pii]
AID - 478 [pii]
AID - 10.1186/s12954-021-00478-4 [doi]
PST - epublish
SO  - Harm Reduct J. 2021 Mar 9;18(1):30. doi: 10.1186/s12954-021-00478-4.