Tammy Hogan said she was grateful for OnPoint NYC when her husband began to overdose in the Bronx. She dragged him onto the subway down to Harlem, where she ran into the overdose prevention center to alert staff. Trained health specialists quickly leaped into action, rushing through the crowded lounge. Outside, they found the 65-year-old still conscious, but holding onto a streetlight and struggling to move.
They got him inside and settled in a comfortable chair with an oxygen mask. Hogan, still visibly shaken, lamented the state of the drug supply. She said her husband had been “doing dope since he was a kid,” implying that he had some tolerance for opioids.
Hogan wanted to know exactly what her husband had taken — and how much. Thanks to a sophisticated new drug checking program the city health department is piloting at OnPoint NYC and other centers that serve drug users, that was easy to find out.
“It's not heroin no more,” Hogan said. “It's something else that they're cutting these drugs with. And I don't understand why they're doing that to people. ‘Cause this is people's lives, man.”
The city’s program uses a scanner that you’d typically find in a graduate school chemistry lab. Known as a Fourier-transform infrared spectroscopy machine, or FTIR for short, it can detect what substances are in a baggie of drugs — without destroying the drugs themselves. That’s an incentive for users to participate.
Drugs tested through the program often contain fentanyl — which, at this point, may not seem particularly shocking. The cheap, synthetic opioid, which is up to 50 times stronger than heroin, is largely responsible for the record-breaking numbers of drug overdose deaths New York City has seen in recent years. If someone wants to find out whether their drugs contain any fentanyl at all, a simple test strip will do the trick.
But for opioid users, fentanyl can be difficult to avoid altogether. The amount of fentanyl that’s present can make a big difference in how they react — and that can’t be determined by a strip. FTIR machines have the added benefit of being able to detect other dangerous substances in the drug supply — such as the powerful animal sedative xylazine — as they arise.
Because of the training required to use the FTIR machines – which the city health department says cost about $40,000 apiece – New York City is rolling out its drug checking pilot slowly. About 400 samples have been tested across three pilot sites in Harlem, the Lower East Side and the South Bronx since the city-funded program quietly launched in November 2021. But the practice is already yielding valuable insights.
The program recently confirmed the presence of xylazine, or “tranq,” in New York City, after it had already been detected in other parts of the country. Xylazine is dangerous because it can make people more heavily sedated than opioids — but may not respond to the opioid overdose reversal medication naloxone because it is in a different class of drugs.
That discovery led the city health department to send an alert about xylazine to organizations working with drug users last month, so they would be able to recognize the signs that someone had taken it – such as the severe skin ulcerations it can cause – and know how to respond to a potential overdose.
Those involved with drug checking programs in New York and other cities say they have the potential to create some amount of accountability in otherwise unregulated underground drug markets – not only by informing consumers about what they’re getting, but also by allowing dealers to test their products.
“Drug dealers are trying to get money,” said Terrell Jones, the advocacy and community engagement manager at OnPoint NYC. “They ain't trying to go to jail for homicide.”
Hogan passed the baggie her husband had purchased in the Bronx to Yarelix Estrada, a special projects coordinator with the city health department, who was hunkered down in a tiny room off the side of the lounge at the Harlem site. There, she was able to confirm that the drugs he purchased contained a high concentration of fentanyl.
Estrada said drug checking is typically accompanied by a conversation about how to use substances more safely. She recalled one participant in the city who was experiencing kidney problems and discovered that the cocaine they were using contained phenacetin, a pain reliever that has been banned from use in the U.S. and other countries because it is associated with kidney disease.
Even if the client wasn’t ready to stop using cocaine, Estrada said, it was an opportunity to “have a more in-depth conversation about their long-term health goals and potentially changing their supply.”
Monitoring the drug supply
Using an FTIR machine, Estrada is able to visualize the chemical makeup of a substance on her computer screen. The concept has its roots in Nobel Prize-winning devices invented more than a century ago and mathematical equations conceived around the 1950s as part of a Ph.D thesis.
But the basic idea is that every chemical has a visual fingerprint that can be revealed by shining laser light on it. FTIR machines measure those fingerprints.
Estrada often finds that drugs sold ambiguously as “dope” contain a range of other substances people may not be expecting. One sample she tested contained caffeine, sugar and quinine – a substance she said can mimic the taste and itchy feel of heroin.
“There's a lot of folks who are buying things off the street under the assumption that they know what's in it,” Estrada said. “But they actually don't know and then have adverse reactions because of it in some situations.”
Drug checking services allowing people to submit illegal substances for testing aren’t new, although they are more established and widely used in Europe. These programs — which employ a range of different technologies – gained popularity in the 1990s, largely driven by concerns about young people using drugs such as ecstasy in the dance music scene.
In the U.S., a nonprofit called Dance Safe has been testing drugs at music festivals since 1998, and sells basic home test kits for a range of substances online. Public data about the drug supply here often comes from law enforcement — such as the U.S. Drug Enforcement Administration and local agencies like the NYPD — which have long used lab testing to determine the contents of seized drugs after arrests.
But the city health department’s drug checking pilot is part of a recent shift in the U.S. toward more sophisticated monitoring of the drug supply at the community level.
That creates a means of reducing the acute harms of drugs — with a focus on users at high risk for overdose and health complications.
Instead of using [this technology] to put people in prison, we're using it to inform public health ...
“Instead of using [this technology] to put people in prison, we're using it to inform public health and help people have more autonomy over what they put into their bodies,” said Dr. Nabarun Dasgupta, a drug researcher at the University of North Carolina.
Dasgupta’s lab accepts drug samples from harm reduction programs in North Carolina and other states around the country. They are tested using technology such as gas chromatography/mass spectrometry, which can provide details beyond what can be gleaned from an FTIR machine, such as any fentanyl spinoffs entering the supply.
Dasgupta and his colleagues are collaborating with those working on similar efforts at Brandeis University in Massachusetts. Together, they are piloting an app called Street Check that aims to standardize and streamline the process of checking drugs and sharing data for other groups that want to do it. The study is supported by funding from the U.S. Centers for Disease Control and Prevention and the Massachusetts Department of Public Health.
Brandeis has also worked with the state health department and local governments to develop the Massachusetts Drug Supply Data Stream, which provides insights into trends in local drug markets.
The Canadian government is wading into drug checking as well, with a five-year pilot that launched in three cities in 2018.
The limits of drug checking
These programs are still figuring out how they can be most useful — and require time and money to get up and running. In New York City’s pilot program, trainees using the FTIR machine at each site initially have to send every sample they test to an official lab to confirm their results. Once they can demonstrate a consistent level of accuracy, they can operate independently.
Even then, there are limitations. FTIR machines typically cannot detect chemicals if they make up less than 5% of a sample — meaning more basic technologies like test strips, which can detect trace amounts, still come in handy.
Those working on these programs say the current volatility of the illicit drug supply has made this type of monitoring more urgent. But it has also made it more difficult to draw broad conclusions that can inform public health guidance on a large scale.
“The things I see here change every two weeks,” Estrada said of the drug checking program at OnPoint NYC.
She added that the drug supply in one part of the city can look very different than in another. “There are certain sites I work at where we see a lot more xylazine than others,” she said.
In some cases, hyperlocal, real-time warnings are warranted. Estrada said drug checking can enable organizations like OnPoint NYC to warn clients about a batch of drugs that’s branded with a particular stamp, for instance.
She and others doing this work said their first priority is to inform individuals about what’s in their drugs in a timely manner.
How drug users respond to drug checking
Research on past drug checking programs shows that people can have a range of reactions when they find out their drugs contain something dangerous or unexpected. Some may throw the drugs out, but several studies show that, more often, participants vow to change their behavior given the close call.
A 2018 study of a drug checking program at a supervised injection facility in Canada, for example, found that only 11% of participants said they would get rid of their drugs, while 36% said they would use less.
Karen McDonald leads Toronto’s Drug Checking Service. “When we were originally funded, governments thought, ‘We're going to show people what's in their drugs and they're going to turn around and decide not to use those drugs or throw those drugs out,” McDonald said. “That is not the reality of the situation. People work very hard for these drugs. Also, people are physically dependent on these drugs.”
But she said at least a third of those who get their drugs checked through her program say they intend to change their behavior — for instance, by using at a supervised consumption site (which are more common in Canada) or by vowing to use with a friend who has naloxone handy. Naloxone is a medication that helps reverse opioid overdoses.
The main thing she said people do after finding out what’s in their drugs is go back to their dealers and “provide feedback or advocate for themselves.”
“We see this as really huge because it’s almost like a form of grassroots regulation that's happening,” McDonald said. “If you can start putting pressure on people from the bottom up, we could possibly start to see changes in the drug supply that way.”
An uphill battle in an unregulated market
McDonald said Toronto’s drug checking service doesn’t ask people who submit samples whether they are selling drugs but said she knows some dealers are using it. “That is something that we encourage,” McDonald said.
Jones, the OnPoint NYC employee, said that after finding out about overdose deaths in nearby Marcus Garvey Park, he and other outreach workers spoke to local drug dealers, notifying them they risked being brought up on homicide charges if they were responsible and informing them about the testing service.
Jones said one of them brought in a sample that was about 80% fentanyl, which he said could “definitely cause an overdose and a death.” According to Jones, the dealer said he wouldn’t sell it. After publication, health department spokesperson Patrick Gallahue stated that Jones' comment was word-of-mouth and that "high concentrations" of fentanyl typically range around 20%.
It’s unclear to what extent this anecdote could be replicated to impact the safety of the illegal drug supply. But Dr. Traci Green, director of Brandeis University’s Opioid Policy Research Collaborative, argued that it makes sense to encourage testing whenever possible.
“This is way better than using human guinea pigs to know how strong something is,” she said.
This story was updated with comments from health department spokesperson Patrick Gallahue.