California To Drug Users: We’ll Pay For You To Test Your Dope

30 to 50 times more potent than heroin — said Marquesen, whose group runs a mobile needle exchange out of a white van, serving drug users all over the city.

A lethal dose of heroin compared to a lethal dose of fentanyl (Bruce A. Taylor-Criminalist II/NH State Police Forensic Lab)

The deadly fentanyl wave sweeping the East Coast and the Midwest has arrived in California. The number of deaths from fentanyl in the state, though still a fraction of those seen in some other states, has spiked in recent years. And state health officials have responded with a proactive but experimental policy: Since last May, they have supplied needle exchanges with rapid-response test strips that allow drug users to determine if their next high is contaminated with the potentially fatal opioid.

It’s hard for drug users to know exactly what is mixed into their supply, because dealers don’t tell them — and often don’t know themselves. Needle exchange workers say the strips have revealed the presence of fentanyl not only in white powder form but also as an additive to black-tar heroin and even in such non-opioids as methamphetamine and crack/cocaine.

Officials hope that if people know the dangers lurking in their stash, they’ll be more careful to protect themselves from accidental overdoses.

The idea of using the strips to test for fentanyl started at a publicly funded needle exchange in Vancouver, British Columbia. The state of New York also makes public money available for needle exchanges to buy the test strips. Eight New York exchanges, a third of the total, supply them to drug users, according to the state’s public health agency.

Last fall, Marquesen’s needle exchange started handing them out from the white van, along with a brief lesson on how to use them. Eleven California needle exchanges, from Eureka to Santa Barbara, have ordered the strips so far, state officials said.

over 1,100 deaths were fentanyl-related in 2016, more than triple the number of the previous year, according to that state’s health department.

In Ohio, nearly 2,500 died from fentanyl and related opioids in 2016, double the number of the year before.

Accidental overdoses involving fentanyl were blamed in the deaths of both Prince in 2016 and Tom Petty in October.

Eliza Wheeler (left), an overdose response strategist with the Harm Reduction Coalition, helps run a syringe exchange for intravenous drug users on a Thursday night in San Francisco’s Mission District. (Pauline Bartolone/KHN)

Wheeler says drug users are more likely to take precautions because of the test strips. Needle exchange participants report using less of the drug or getting high with others, she says. (Pauline Bartolone/KHN)

In San Francisco, needle exchange workers and users say the ability to test drugs has changed behavior.

“People are much more cautious if they know there’s fentanyl in it,” said Patty, who didn’t want to give her last name because of her heroin and crack use. “Honestly, nobody wants to die.”

But some experts urge caution in using test strips, noting the strategy is still experimental.

Sold for a dollar apiece by BTNX Inc., a Canadian company, .they are designed to test urine and have not been approved by the U.S. Food and Drug Administration for use on drug samples, a BTNX spokesman said.

Dr. Karen Mark, chief of the California public health department’s Office of AIDS, said all the evidence suggests that the strips effectively detect fentanyl.

But Dr. Dan Ciccarone, a professor at the University of California-San Francisco who researches drug abuse, noted that the strips show only whether a sample contains fentanyl, not how much — so there’s no way to know if it’s a deadly dose. The strips are also too sensitive and could be yielding false positives, he said. That may not be such a bad thing per se, he said, but drug users might stop using them after a series of positives.

Despite reservations, many experts say the severity of the opioid epidemic justifies California’s unproven approach.

“The crisis situation that we find ourselves in … definitely calls for a lot of nimble and innovative responses,” said Leo Beletsky, associate professor of law and health sciences at Northeastern University in Boston. “We’re going to see more fentanyl in our drug supply in coming years.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

pbartolo[email protected], @pbartolone

Related Topics

Mental Health Public Health Opioids Substance Abuse

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