Spokane site begins checking drugs to reduce overdoses

By Treva Lind

A downtown Spokane site has joined a statewide drug-checking network aimed at reducing overdoses. It’s also a glimpse into what’s new in the illicit drugs circulating throughout the area.

In recent months, the testing has found fentanyl in powder form, another troubling development as the powder is even more potent than fentanyl pills. Fentanyl overdoses are rampant throughout the city, with the Spokane County Medical Examiner investigating 49% more deaths from 2019 to 2022, many attributed to overdoses.

And there were hints last summer of the powerful sedative xylazine, known colloquially as “Tranq” and approved only for veterinary use but sometimes mixed with illegal fentanyl.

Compassionate Addiction Treatment became involved with the project about a year ago, testing small drug samples provided anonymously by people who want to check ingredients. A few tests show unexpected results.

“I know people will look at this as enabling, but we’re saving lives,” said Bobbie Lee Moskaloff, who is trained to use a specialized machine at the treatment center to scan samples and compare to known chemical signatures of drugs.

In January, a woman in her late 20s to early 30s came into the Spokane center to begin treatment. She was curious about the machine, then offered to test her “fetty powder.” Moskaloff said that testing found carfentanil, a synthetic opioid 10,000 times more potent than morphine and 100 times more potent than fentanyl. The drug is so powerful that it’s used to sedate massive creatures like elephants.

“She wasn’t aware it had carfentanil in it, and it scared her; she thought it was fentanyl powder,” Moskaloff said. The woman then warned another family member and discarded her needles.

Moskaloff also checks substances with drug test strips. The statewide community drug-checking network is led by the Addictions, Drug & Alcohol Institute at the University of Washington.

The institute has contracted with the Compassionate site along with five other locations in the testing program. They include Walla Walla, three in the Seattle area and one in Tacoma. More sites are expected to join.

Moskaloff said she’s done 150 drug checks, most showing as fentanyl or methamphetamine.

About six months ago, xylazine popped up but hasn’t seemed as apparent since, she said. She saw it once in a voluntary test and twice from urinalysis for people in treatment.

Xylazine and fentanyl drug mixtures bring a higher risk of fatal drug poisoning. The tranquilizer slows breathing and it isn’t an opioid, so Narcan doesn’t reverse that effect.

Hallie Burchinal, the treatment center’s executive director, said that while the drug-testing project had a slow rollout, there are plans to soon share regularly compiled reports.

“We then will be able to share with the health district, the fire department and EMS teams, local police departments and the hospital emergency room systems – so they know when they’re responding to an overdose, what they might be facing,” Burchinal said. “So they can respond in a way that could save a person’s life.”

Drug-checking has two main goals, said Caleb Banta-Green, an addictions scientist who leads the UW institute.

“First and foremost, the goal is really for people who are using drugs to have more complete information about what’s in their drugs,” he said. “It’s really a harm reduction goal, a public health goal of reducing overdoses.

“There are other goals around, let’s understand more about the drug supply and share this information with our clinical partners locally so they know what’s going on and how to respond. Let’s share it with public health partners at the local and state levels. But we definitely need more street-level and rapid information. This is a way to get that.”

The state Health Care Authority is funding the project at about $1 million a year, he said.

Each project site does onsite testing, then samples are sent to a University of North Carolina lab for further confirmation. Banta-Green said people offering samples are told the results as the best information available but are cautioned that further testing will be done.

“We definitely never tell people it’s safe.”

Statewide, testing has largely found three drugs: Methamphetamine, fentanyl M/30 pills and fentanyl powder that can appear in pressed form, as a rock or a small crystal, he said. The powder can be smoked or injected, but researchers have been told it’s mostly smoked.

Banta-Green said fentanyl pills generally are 100-milligram tablets, containing about 2 milligrams or 2% fentanyl. The remaining ingredient is largely acetaminophen, he said.

Even the 2% fentanyl is considered potent and potentially fatal if someone doesn’t have an opioid tolerance, he added.

But fentanyl powder holds greater potency, and possibly other unexpected ingredients. The institute also analyzes King County medical examiner reports in compiling information.

“On the powder side, we’re generally seeing fentanyl, but with widely varying purity,” Banta-Green said. “It could be 10% fentanyl; it could be 80% fentanyl. There is often other stuff in there.”

“In the last quarter, about 5% of the pills appear to have xylazine in them and about 12% of the powder appears to have xylazine in it. There was a point last year on the East Coast where about 70% of the fentanyl had xylazine, and we’ve been monitoring this for about nine months. We can see maybe slight increases.”

Researchers believe xylazine is added to fentanyl potentially to lengthen opioid effect, Banta-Green said.

“A person who is using fentanyl might use it 10, 15 times a day because it’s so short-acting, and we believe that xylazine sort of extends the time of feeling the effect.”

As another health risk, xylazine often causes harmful body sores. He said a couple in Walla Walla had fentanyl tested, and xylazine was detected. After being warned about potential wounds, they returned a week or so later to get medical care.

Drug-checking might find benzodiazepines Valium or Xanax. Withdrawal from “benzos” must be medically supervised, Banta-Green said.

Burchinal and Moskaloff said Spokane overdoses spiked this past summer, then again in the past several weeks. A peer counselor, Moskaloff leads the center’s medication-assisted treatment program and has heard from people that it’s mainly fentanyl powder affecting recent overdoses.

Drug-checking can help educate people, she said.

“To me, harm reduction is really important, because there are other things that can happen before people don’t want drugs anymore,” Moskaloff said.

At least two people recently were within days of getting into treatment and died after one fentanyl hit, she added.

“New drugs are going to come out,” she said.

“When this fentanyl came out in the blue pill, we had a lot of people dying because they were thinking they were taking an (Oxycodone). If we had something like this then, and people were keeping up with the drug supply, we may not have had so many fatalities.”

https://www.spokesman.com/stories/2024/feb/23/spokane-site-begins-checking-drugs-to-reduce-overd/