Assessment of two brands of fentanyl test strips with 251 synthetic opioids reveals "blind spots" in detection capabilities

Abstract

Background: Fentanyl test strips (FTS) are a commonly deployed tool in drug checking, used to test for the presence of fentanyl in street drug samples prior to consumption. Previous reports indicate that in addition to fentanyl, FTS can also detect fentanyl analogs like acetyl fentanyl and butyryl fentanyl, with conflicting reports on their ability to detect fentanyl analogs like Carfentanil and furanyl fentanyl. Yet with hundreds of known fentanyl analogs, there has been no large-scale study rationalizing FTS reactivity to different fentanyl analogs.

Methods: In this study, 251 synthetic opioids-including 214 fentanyl analogs-were screened on two brands of fentanyl test strips to (1) assess the differences in the ability of two brands of fentanyl test strips to detect fentanyl-related compounds and (2) determine which moieties in fentanyl analog chemical structures are most crucial for FTS detection. Two FTS brands were assessed in this study: BTNX Rapid Response and WHPM DanceSafe.

Results: Of 251 screened compounds assessed, 121 compounds were detectable at or below 20,000 ng/mL by both BTNX and DanceSafe FTS, 50 were not detectable by either brand, and 80 were detectable by one brand but not the other (n = 52 BTNX, n = 28 DanceSafe). A structural analysis of fentanyl analogs screened revealed that in general, bulky modifications to the phenethyl moiety inhibit detection by BTNX FTS while bulky modifications to the carbonyl moiety inhibit detection by DanceSafe FTS.

Conclusions: The different "blind spots" are caused by different haptens used to elicit the antibodies for these different strips. By utilizing both brands of FTS in routine drug checking, users could increase the chances of detecting fentanyl analogs in the "blind spot" of one brand.

Keywords: Drug checking; Fentanyl; Fentanyl analogs; Fentanyl test strips; Harm reduction; Lateral flow immunoassays.

Fig. 1

Fentanyl structure with labeled moieties and carbons (A) and fentanyl haptens reported by Barrientos [21, 22] (B), Raleigh [23] (C), and Haile [24] (D)

Fig. 2

Summary of BTNX and DanceSafe detection of 251 screened compounds at 20,000 ng/mL

Fig. 3

Sensitivity of BTNX and DanceSafe FTS to 251 screened compounds at 20,000, 2,000, and 200 ng/mL

Fig. 4

UpSet plot detailing co-occurrence of moiety modifications

Fig. 5

Structures of selected compounds detected and not detected by both brands