Stamp bags are small wax packets that contain mixtures of illicit drugs, most commonly heroin. These bags are packaged for sale and sometimes stamped with a graphic logo by drug dealers to market their contents.
A new University of Pittsburgh study suggests that analyzing these stamp bags on a regular basis can serve as an early warning system in the current opioid crisis by alerting local officials to new lethal drugs that have come into the community.
“The face of the current opioid overdose epidemic changes quickly from month to month. The ability to rapidly analyze drugs causing these overdoses, and make that knowledge available to all stakeholders, is critical to efforts to deal with the crisis,” said co-author Karl E. Williams, M.D., M.P.H., Allegheny County Medical Examiner.
For example, in just two years, the deadly drug fentanyl — an opioid that is 20 to 50 times more potent than heroin — went from nonexistent to detected in more than one in seven stamp bags analyzed by the Allegheny County Office of the Medical Examiner, according to an analysis led by the University of Pittsburgh Graduate School of Public Health.
“We believe this way of examining drug evidence could be expanded upon for use in public health surveillance and monitoring in other regions,” said lead author Kathleen Creppage, M.P.H., C.P.H., a doctoral candidate in Pitt Public Health’s Department of Epidemiology.
“It could be used to inform educational campaigns, allocate limited resources, and devise prevention strategies. First responders also could benefit from knowing what drugs are in circulation so they can take proper precautions to protect themselves and be prepared with overdose reversal medications, such as naloxone.”
In the last decade, fatal heroin overdoses have increased by 300 percent in the U.S., with fentanyl and its analogs acting as major contributors to these deaths. Fentanyl is often implicated in clusters of overdose deaths when it is mixed with heroin, primarily because users do not realize what they are taking is more powerful than usual.
In Allegheny County, stamp bags seized as evidence by law enforcement authorities are submitted to the county’s Office of the Medical Examiner for testing. The drugs are sorted into batches based on similar characteristics, such as the stamp and color of the drug, and a single bag is randomly chosen from each batch to be tested.
For the study, the researchers compiled the medical examiner’s drug chemistry laboratory test results of stamp bag contents from 2010 through 2016. A total of 16,594 stamp bags were tested by the lab during that period.
Before 2014, fentanyl was nonexistent in these tested bags. By 2016 it was found in 15.5 percent of the tested stamp bags, with 4.1 percent containing fentanyl as the only controlled substance present.
Toxicology results from overdose victims take weeks or months, and state and national mortality data lag by about 18 months. Drug evidence testing is usually available much more quickly — in Allegheny County, for example, it is available for the current month.
Stamp bag testing and monitoring should not replace other drug surveillance systems, such as overdose mortality data and toxicology reports, said Creppage. “But it can be a powerful complement to these surveillance systems,” she said. “The data are available, and we need to identify and explore these different data sources as part of our efforts in understanding and combating the opioid epidemic.”
Senior author Anthony Fabio, Ph.D., M.P.H., associate professor of epidemiology at Pitt Public Health, added that the work “is an important step in developing multi-disciplinary tools to quickly identify current and future sources of new drugs that enter the illegal market.”
The findings are published in the journal Public Health Reports.