CHICAGO ACDC-RT

1 Acknowledgements

Lieberman Laboratory at Notre Dame, Tracy-Lynn Lockwood and Dr. Marya Lieberman CDPH IDPH CDC Foundation ACDC-RT Collaborative

2 Background Why an entire presentation on drug checking? And where did this all start?

3 DIMS In 1992 the Ministry of Health in the Netherlands funded Europe’s first drug- checking system, the Drug Information and Monitoring System (DIMS). This program was started in response to concern about fake or tainted ecstasy. DIMS is a nationwide program with both office-based drug checking and laboratory-based testing. Office-based testing is available in 29 different cities, with both a tester and a peer educator available to discuss results with participants. Lab-based testing is done using a variety of technologies, and results are posted in an online based, which can be accessed by the office-based testing facilities. Red Alerts are also issued when extra hazardous drugs are found, and users who download the Red Alert app can get a push message about these drugs immediately.

4 ChEckiT! Tent Other countries in Europe saw what DIMS was doing and also started similar services. ChEckiT! Started mobile onsite drug-checking in 1998 in Vienna, supported by the municipality of Vienna and the Austrian government.

5 Energy Control In 1997 Spain established and partially funded a stationary testing facility with advanced chemical analysis techniques called Energy Control. Samples may be submitted from around the world for testing, for a fee (70-120 euros, depending on the type of reporting you want).

6 Safer Party and The Loop Zurich established a similar program to ChEckiT! Called Safer Party in 2001, and even more recently in 2013 a not for profit Community Interest Company called The Loop was established in the UK to “provide drug safety testing, welfare, and harm reduction services at nightclubs, festivals, and other leisure events.”

7 Source: T. Brunt. Drug checking as a harm reduction tool for recreational drug users: opportunities and challenges. Commissioned by the European Monitoring Center for Drugs and Drug Addiction (EMCDDA). http://www.emcdda.europa.eu/system/files/attachments/6339/EuropeanResponsesGuide2017_BackgroundPaper-Drug-checking-harm-reduction_0.pdf. Updated 30 October 2017.

Map of Europe Western Europe has more than a handful of drug checking services, many of them with partial or significant government funding.

8 Now for the US! DanceSafe, founded in the Bay Area in 1998, provides reagent testing at festivals and other events. DanceSafe chapters can be found across the country.

9 Erowid DrugsData, launched in 2001 by the Erowid Center, is an DEA-licensed independent laboratory drug analysis program. Samples are submitted anonymously by mail, analyzed using Gas Chromatography/Mass Spectrometer (GC/MS) testing plus 4 reagent tests, and then published publicly and anonymously on the drugsdata.org website along with photos. Erowid and Energy Control are the only lab programs that accept submissions by mail. DrugsData information is published very quickly, although their DEA license does not allow for quantitative results to be published. There is a fee for analysis, anywhere between $40 and $150 to cover the $150 per sample testing cost.

10 Law Enforcement United States law enforcement agencies are becoming more and more interested in field drug checking equipment, ostensibly for the purpose of protecting officers from fentanyl exposure. We will be returning to this topic later.

11 12 Definitions Chromatography – separation of a mixture by dissolving it in a fluid and passing it through a structure to cause the various constituents of the mixture to separate Spectroscopy – the study of how radiated energy and matter interact, on any portion of the electromagnetic spectrum – traditionally involved the visible spectrum of light, but now includes x-ray, gamma, and UV spectroscopy. Involves any interaction between light and matter, including absorption, emission, scattering, etc. Spectrometry – the measurement of electromagnetic radiation to obtain information about a system – kind of the a method of studying spectra Immunoassay – biochemical test that measures the presence or concentration of a macromolecule or a small molecule in a solution through the use of an antibody or an antigen

13 Source: T. Brunt. Drug checking as a harm reduction tool for recreational drug users: opportunities and challenges. Commissioned by the European Monitoring Center for Drugs and Drug Addiction (EMCDDA). http://www.emcdda.europa.eu/system/files/attachments/6339/EuropeanResponsesGuide2017_BackgroundPaper-Drug-checking-harm-reduction_0.pdf. Updated 30 October 2017.

Ways in which drug checking services can vary Discuss how this will impact the technology you choose

14 Heterogenous vs. homogenous & cookie problem Major challenge of testing street drugs, especially heroin

15 Step 1: FTIR

Fourier-Transform Infrared spectroscopy (FTIR) FTIR Analysis measures the infrared region of the electromagnetic radiation spectrum, which has a longer wavelength and a lower frequency than visible light, and is measurable in a sample when submitted to infrared radiation (IR). The basic theory at work is that the bonds between different elements absorb light at different frequencies.

The light is measured using an infrared spectrometer which produces the output of an infrared spectrum. The IR spectrum is a graph of infrared light absorbance by the substance on the vertical axis and the frequency (wavelength) on the horizontal axis.

16 17 Archive #9 – Lactose (also had mannitol and heroin)

18 Step 2: HPMS

High pressure mass spectrometry (HPMS) Mass spectrometry measures the mass of charged molecules, and uses the mass to charge ratio to distinguish between different molecules.

19 Police & spectrometry

20 VIDEO

21 Screenshots of Archive #9 – Fentanyl 2x – MX also got an amphetamine hit (we’ll be back to this…)

22 Step 3: Test Strips

Fentanyl test strips The Rapid ResponseTM Fentanyl (FYL) Forensic Test Kit is a lateral flow chromatographic immunoassay for the qualitative detection of Fentanyl/Norfentanyl in liquid and powder substances at the cut-off concentration of 200 ng/mL.

23 Note known potential for false positives, and missing analogs Archive #9 – positive, both analogs on this list

24 Step 4 (sometimes): LC/MS

Liquid chromatography tandem mass spectrometry (LC/MS) Waters TQD Acquity Triple Quadrupole at Notre Dame Mass range up to 2048 on m/z scale Advanced LC/MS and LC/MS/MS hardware and software capabilities for a variety of qualitative and quantitative applications

25 LC/MS explained Combining liquid chromatography and mass spectrometry reduces the possibility of error, as it is extremely unlikely that two different molecules will behave in the same way in both a liquid chromatograph and a mass spectrometer

26 Diphenhydramine

Fentanyl

Heroin

Quetiapine

Archive 9 sample Diphenhydramine (6.56), Fentanyl (6.33), Heroin (5.25), Quetiapine (6.21) Things past 8-9 min are when the conditions in the mass spec are changing so its washing everything off the column 0.69 peak is the solvent front – when the liquid reaches the detector Bottom graph is all of them Each of the examples above corresponds to a specific mass Will not identify mannitol or lactose – don’t stick to the column, will be in the 0.69 peak or solvent front – would need to change conditions to test for them, and not necessary with FTIR spectra

27 28 Chicago OD rates increased dramatically Slides from presentation by Tamara Rushovich, formerly an epidemiologist at CDPH 2017 data is most recent available from the city

29 Chicago has a much higher OD death rate than Illinois and the US as a whole

30 Fentanyl and heroin OD rates are much higher than opioid pain reliever overdose death rates

31 Chicago has an unusual epidemic in terms of racial disparities

32 May be setting the trend for the country – non-Hispanic whites have the highest rates nationally, but non-Hispanic black death rates are rising the fastest

33 Because of systemic racism, this translates into overdoses being concentrated in high economic hardship neighborhoods in Chicago

34 Luckily, CRA has extensive experience working in these neighborhoods over the past few decades

35 Results 124 samples 48% heroin 15% heroin + fentanyl 48% fentanyl 1% cocaine 19% amphetamine 4% Novel Synthetic Opioids (AH-7921 & U-47700)

Now let’s dig into the data… Heroin Talk about amphetamine/diphenhydramine Also talk about NSOs

36 Results 18 samples 100% cocaine 11% amphetamine

7 samples 100% cocaine base 71% amphetamine

Cocaine – amphetamine hit again, what does this mean? Crack – amphetamine hit again!

37 Results 1 sample 1 fentanyl

5 samples 1 heroin 2 cocaine 2 fentanyl

Fentanyl – only 1 sample that was reportedly sold as fentanyl N/A - either turned in by someone who didn’t know, or the dreaded ground sample

38 Results

2 samples 2 ketamine

6 samples 1 amphetamine 5 MDMA 1 fentanyl 1 methamphetamine

Ketamine MDMA – the meth example, the fentanyl false positive w/negative test strip

39 Results

1 sample 1 methamphetamine

1 sample 1 PCP

PCP Meth

40 Collaborative examples – AHOPE in Boston

41 Collaborative examples – DOPE in San Francisco

42 Forward – what’s next? Improving our understanding of machine gaps, working with companies to improve libraries and algorithms BENZOS

43 44