Testing for Fentanyl to Avoid Overdoses

Tino Fuentes demonstrates how to test heroin for fentanyl, in the Bronx. (Photo by Michael O’Brien for Voices of NY)

Tino Fuentes and his comrades huddled under a tarp on an infamous drug corner in the South Bronx. Drug paraphernalia was spread out on a flimsy table.

Fuentes picked up a syringe and went through the set of motions that IV drug users are intimately familiar with. He dipped the needle into the liquid-filled aluminum cap, or cooker, and pulled the plunger back to draw up the shot. But instead of tapping a vein, Fuentes took out a thin, short piece of cardboard – a pH strip. His audience looked on as he dipped the paper in the liquid left in the cooker.

“It has to be in there for about 10 seconds. Let it soak up that water,” he said to them.

Fuentes, 54, grew up in East New York, where he started selling heroin in the 1980s. But he stepped away from the drug trade years ago. On this day, he’s out on the streets with St. Ann’s Corner of Harm Reduction – a nonprofit that offers clean needles, overdose reversal kits, and a community for drug users. As a director of outreach, he’s teaching staff a technique to test street drugs for deadly fentanyl. [Editor’s note: Fuentes recently resigned from his position, citing the need to “take a break.” He remains on good terms with St. Ann’s.]

After the pH strip has soaked up the residue in the cap, it should change color if there’s any trace of fentanyl.

“You want to emphasize that if it has that one line, then it’s a positive,” Fuentes told his team. “And that’s when you gotta be careful with it.”

Fentanyl is a cheap synthetic opioid, up to 100 times stronger than morphine. Doctors use it to treat patients in extreme pain. On the streets, it’s now being cut with heroin and driving an increase in overdose deaths.

The South Bronx has long been battered by drug-related deaths. And St. Ann’s has been in the trenches since 1990. But this rise in overdoses is something its staffers have never seen before.

Before 2015, fentanyl was found in only 3 percent of the city’s overdoses, according to the New York City Department of Health and Mental Hygiene. But now fentanyl is detected in more than half of opioid-related overdose deaths. And those deaths have almost doubled in 2016 – totaling over a thousand.

“People aren’t prepared for this,” said Fuentes.

Fuentes is telling drug users that if their drugs test positive for fentanyl, take precautions – shoot or snort a much smaller amount.

“Because nobody’s gonna throw their bag of dope away,” said Fuentes.

Van Asher is the data manager at St. Ann’s Corner and he’s been working with IV drug users for decades.

“[If] shooting drugs is like Russian roulette,” said Asher, “[now] it’s like playing Russian roulette when there’s more than one bullet in the chamber.”

Asher first ordered the fentanyl testing strips in January, after he’d heard they were being used with some success at a safe injections site in Vancouver, Canada. They were designed to detect fentanyl in urine, though, and aren’t FDA approved. But according to a study done by Vancouver Coastal Health, which operates a safe injecting site, the strips help prevent overdose.

The strips cost about a dollar each, and St. Ann’s has given out about 500 of them since January. They keep a list of which “brands” of heroin test positive for fentanyl, then pass that information on when people come in for clean needles.

Fuentes goes beyond educating his staff. He has helped users directly test their drugs, placing himself at risk. Fuentes isn’t authorized to handle illegal substances.

“You can’t wait for the law to change for you,” said Fuentes. “I’d rather get arrested than see somebody dead.”

He’s been reaching out to the street dealers, showing them how to use the strips and offering to test their drugs for them. The low-level dealer isn’t usually the one cutting the drugs, but he hopes they can pass the word on.

“Only [they] are the ones that can go back to [their] suppliers and tell them, ‘This is deadly, I don’t want this,’” said Fuentes.

So far, the results of that effort have been mixed. One dealer told Fuentes that after his batch tested positive, he told people that it was “really potent” and that “people were overdosing – so be careful.” But the dealer didn’t tell his customers that it contained fentanyl.

Another dealer found his batch to be tainted, but when he passed the word on, his supplier ignored him.

Still, both Fuentes and Asher are confident that the strips can save lives. According to Asher, 80 percent of the heroin tested in the South Bronx contains fentanyl.

Clearly, not all bags containing traces of fentanyl are deadly. But because it is so concentrated, it is hard to evenly mix throughout a batch of heroin. And the bag of heroin that gets an extra milligram of fentanyl can be deadly – literally – as three milligrams of fentanyl can be fatal. Never the less fentanyl could be a deadly substance if missed used, with many looking to home drug testing sits ( similar to https://www.countrywidetesting.com/collections/home-drug-test) to help test fentanyl and other types of over the counter drugs.

Fentanyl is being mixed in with heroin because it delivers a similar, sharp high. And, Fuentes said, by the time heroin makes it to the United States it is diluted.

Fentanyl is only taking off now because, according to the Harm Reduction Coalition, the illegal manufacture of the drug didn’t start until 2013. Facilities in Mexico, Canada, and the United States order the ingredients online, from China.

Fuentes said that a kilogram of fentanyl costs between $1,200 to $4,000, while a kilogram of heroin can cost up to $50,000. Add a little bit to a weak batch of heroin and “you’ve just expanded your profit margin.”

St. Ann’s has even seen bags of cocaine test positive for fentanyl. The city put out a press release warning of this development last week.

But as to why someone would add a high-octane opioid like fentanyl to cocaine, Fuentes is at a loss.

“Fentanyl and coke – it doesn’t make sense,“ he said.

Fuentes wonders if it’s actually cross-contamination. If fentanyl and heroin are now being processed in the same places where coke is being processed, in Mexico or Colombia, it could be accidental, he said.

”As someone who was in [that] business since a very young age, for a very long time, I can’t figure out any reason whatsoever for that mix to be done purposely,” said Fuentes.

The strips have yet to catch on with the whole harm reduction community. Only three out of twelve needle exchanges in New York City use them, according to the Harm Reduction Coalition.

“I can’t tell you 100 percent that they work,” said Mark Townsend.

Townsend is at Washington Heights Corner Project, which does pass out strips. Previously, Townsend ran the site in Vancouver that inspired Van Asher to purchase the strips. Still, he isn’t convinced that they’re the best way to monitor the local drug supply.

Not all drug injectors are going to be able to use them correctly and relay the information back to the Corner Project, he said. He keeps in mind that they were developed for urine testing, and that they may be prone to false positives.

He’s not even comfortable disclosing the percentage of tainted heroin they’re seeing, believing the numbers to be inaccurate.

“It is so random,” said Townsend. It is less than up in the Bronx, though.

The city, while it is warning about fentanyl’s role in overdose deaths, has not weighed in on the usefulness of the strips. The Department of Health and Mental Hygiene has been conducting tests to map fentanyl in the drug supply and results will be available mid-June. Meanwhile, it has been putting the word out about fentanyl’s danger with a health alert poster that states: Fentanyl is Killing New Yorkers. The DOH notes that it is showing up in heroin, cocaine and counterfeit pills marked as Xanax.

Townsend sees a role for the strips, even if they don’t work 100 percent. He’s had clients tell him that after their bags tested positive, they made sure to use less of the drug.

“The sad truth is, it’s better than nothing,” he said.

Townsend describes fentanyl as “a wave of death.”

Since fentanyl hit Vancouver five years ago, overdose deaths have tripled.

“The storm is coming here for sure,” said Townsend. “It’s going to come and New York is in no way ready for it.”

Multimedia reporter Michael O’Brien is a 2016 graduate of the CUNY Graduate School of Journalism. This report is part of a series of Voices of NY stories looking at health equity issues in the NYC area. Support for the series has been provided by the New York State Nurses Association.

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