Harm Reduction: Checking Street Drugs for Fentanyl
Tino Fuentes, a former heroin user and dealer from New York, might not be the most obvious advocate for drug testing.
But there he is, standing in a Station North warehouse apartment in Baltimore, holding several packets of the single-use Rapid Response drug-testing strips that are supposed to be used to test people’s urine for the presence for drugs. But Fuentes puts them to a different use—one that may save lives.
“After you suck it dry, put your shot to the side, add water to the cooker. All you’re looking for is the residue,” he says to a number of users or former users who are still involved in Baltimore’s opiate community. “You don’t have to waste the drugs at all. Just the residue. . . . I’d be pissed off if you took some of my shot, you know what I’m saying?”
Instead of using the strip to monitor the activities of employees or parolees, Fuentes and others use the strips to test street drugs for fentanyl. Drug checking rather than drug testing.
As the death toll associated with fentanyl, a synthetic opiate 50 times as potent as heroin, rises, users desperately need a way to know just what they’re putting in their veins.
In October, Donald Trump declared the opioid crisis a public health emergency, claiming that more than 64,000 Americans had died from opioid overdoses the previous year. Fentanyl is responsible for a large part of that number. In Maryland alone, fentanyl killed 1,100 people in 2016—with close to that number dying in just the first half of 2017 (numbers for the entire year have not yet been made publicly available).
Saving those lives is what it’s all about for Fuentes, who ran heroin houses in the Lower East Side in the ‘80s and now spends his time traveling, preaching harm reduction. When he comes to a city like Baltimore, he usually finds some street drugs and tests them. Fentanyl, which can be easily manufactured in makeshift labs and does not require poppy fields like heroin, is everywhere.
It is technically illegal for Fuentes to check the drugs in Baltimore—when he is testing he is legally in possession of the drugs; in some places the strips themselves are considered paraphernalia—but the weathered and grizzled old New York Puerto Rican with a leather jacket, flat old-man golf hat, and glasses perched on his nose like Ben Franklin doesn’t give a fuck. That’s why, although he consults with some cities, he doesn’t operate as a 501(c)3 or any other legal entity.
Sometimes ethics—saving lives—is more important than the law. But there are places that recognize the need for these harm-reduction strategies.
“I’m not going to sit back and wait for the law to change or the government to help, because they ain’t never helped me and the law ain’t either,” he says to the group. “That’s why I do what I do.”
Insite, a safe injection facility in Vancouver, first developed the technique of using drug testing strips to test for fentanyl.
“It was just trying to find a solution because there are other drug checking methods that are used—primarily actually in communities like nightlife and festival communities—but the kind of tests used in that community are not sensitive enough to pick up fentanyl, which is really active in small doses,” said Stefanie Jones of the Drug Policy Alliance (DPA). “That’s why using those test strips came about. It was a process of trial and error of how to get it to work most effectively.”
A study conducted at Insite showed that 86 percent of the drugs and 90 percent of the heroin they checked had fentanyl in it. Users who knew fentanyl was in their dope changed their behavior—they were more than 10 times more likely to reduce their dose.
Washington D.C’s City Council has adopted emergency legislation that would allow organizations to distribute the strips and allow individuals to use them without fear of legal consequences.
The Baltimore City Health Department did not respond to repeated requests, made by telephone and email, for comment.
In absence of safe injection spaces and emergency legislation, you need someone like Fuentes, who knows how to talk to users. He knows what it is like and he doesn’t judge. And he looks for other people like himself, who may have some sway in the community. Today, a group of five met him first at a nearby cafe, where he explained who he was and what he was trying to do. Then they all walked, slowly, to a nearby apartment where he would demonstrate the testing.
“We take it and dip it in there for 15 seconds, right,” he says dipping the strip into a small tin votive candle holder that some people use to cook their opiates. “Then you put it up like that, as you see it start getting pink, that’s sucking up the water.”
In a few seconds, lines start to stand out on the strip. If there’s one line, then your dope has fentanyl in it. And if there are two lines, it probably doesn’t. The test only covers 12 fentanyl analogues, including the even stronger carfentanil—but new varieties are developed nearly every day. And the tests can’t check the strength of a drug, only its presence. So even if it tests positive, it may not kill you.
Baltimore has a long culture of heroin use, with an estimated 25,000 users.
“We have to recognize here in Baltimore people have been addicted to heroin and opioids for decades,” the city’s Health Commissioner Leana Wen told the Baltimore Sun. “Individuals have not had access to treatment for many years, and many of these individuals are using drugs when we now have fentanyl.”
In some ways, Baltimore is built on opiates. John O’Donnell named his property Canton, now a yuppie neighborhood, after the region of China because of the money he made there. And a Baltimore-based ship named the Eutaw delivered the first opium from Turkey to China in 1805, some decades before the first of the Opium Wars.
In the post-World War II period, heroin was a boutique affair in Baltimore. But according to David Simon in “The Corner,” his deep study of addiction, the ‘60s changed all of that. “Overnight, the money got serious,” he wrote. “The users, an army unto themselves, were serviced daily in back alleys and housing project stairwells by men who were, on some level, careerists.”
These men worked for people like “Little Melvin, Big Lucille, Gangster Webster, Kid Henderson, Liddie Jones, Snyder Blanchard,” legendary figures who, according to Simon, “became success stories for an increasingly alienated ghetto world, bona fide gangster caricatures with territories and soldiers and reputations.” Still, he writes, they were “serious, cautious.”
It was in this world that William Miller Sr., one of the old-heads gathered in this apartment to learn about the strips, started shooting up, back in the 1960s.
Miller is a dark-skinned man with a long slow drawl and a fierce authoritative intelligence. He has acquired skills and wisdom—he’s had to in order to survive for half a century of dope in Baltimore. He rode the wave of the ‘60s. In the ‘70s, Little Melvin and all the other big names had fallen to Nixon’s war on drugs.
And then in the ‘80s coke came and wreaked havoc on the drug world—and ramped up the war against it. “The heroin trade was limited to the hardcore, but the arrival of cheap, plentiful cocaine in the early and mid-’80s broke down all the barriers and let everyone play,” Simon wrote in his 1997 classic on a Baltimore drug corner.
At almost the same time Simon was writing “The Corner,” drug companies such as Pfizer and Purdue were heavily advertising a new generation of synthetic opiates like Oxycontin. This, along with a revolution in thinking about pain management, made opiates available to a greater public than ever before, leading to a national “opioid crisis,” where addiction and overdose have hit every strata of society.
Fentanyl was developed in the late 1950s and was marketed under the name Sublimaze, but it first came to public consciousness when Michael Jackson overdosed in 2009. Prince died of a fentanyl overdose in 2016 and Tom Petty in 2017. It is considered so dangerous that when Baltimore police raided a corner store where they thought they found 16 pounds of fentanyl, they sent in a hazmat team with gas masks and apocalyptic-looking suits. And, perhaps in a nod to how useful the test strips could be, it took the department a month to realize that they had, in fact, confiscated pounds of Viagra and Cialis, not fentanyl.
Miller has seen it all. But he hasn’t seen anything like fentanyl. “This thing just all of a sudden happened in Baltimore because there wasn’t no fentanyl,” Miller says. “The most deadly drug we had at one time was some China White and I don’t know whether fentanyl was mixed in it or not but that at that time was killing people and that was like the ‘90s.”
But this is different. Miller can’t even begin to count the number of people he’s known who died because of the drug.
“No matter how you feel about people that use, people are gonna get high and this fentanyl thing, man, it is killing people,” Miller said.
Because of the deaths, rumors start to swirl and drug-scare stories sweep the streets and social media. One of the younger men with Miller starts to ask about weed laced with fentanyl, a story that went around the web in the last year or so.
“You can’t put fire to fentanyl,” Fuentes says. “You can’t burn it that way.”
If it was on weed and you smoked it, it wouldn’t do anything. Fact-checking site Snopes.com and Vice have shown the fentanyl-laced weed stories to be false. Other stories circulated that you can die just by touching a speck of fentanyl—they also proved false. But the dangers are real, and real information saves lives.
So now Miller is here with a few of his younger friends to learn about using these strips from Fuentes, who took a bus down from New York City with about 20 strips. After he showed them how to use the strips, he’d leave them with the rest to spread around their community.
They’ve got to do something. The simple economics of it mean fentanyl is here to stay. A kilogram of heroin can cost as much as $60,000. But a kilogram of fentanyl, which is 50 times stronger, costs as little as $2,500.
The logic is similar to the capitalist paradigm that led to the aggressive marketing of opiates over the last decades. Forty-one Attorneys General are investigating the drug companies’ role in the opioid overdose crisis.
“And look, the profit these guys are making, they’re not going to stop pushing their thing. They’re not going to stop eating and taking care of their family,” Miller said of the street dealers and underground chemists who are the heirs of the pharmaceutical companies and their reps, hitting the street to hype their dope.
The street money is what makes what Fuentes does dangerous.
“When I was a dealer, if I thought something was talking shit about my product, I’d put a bullet in them,” he says.
It’s for this same reason that Miller did not want his younger friends to go out and give their friends the strips on the streets. He knows that you have to play it carefully when you are messing with a man’s money. So he took most of the 20 strips that Fuentes was able to bring down and would help introduce the concept to his peers.
“It is some limitations to the strip, but guess what? This is better than not having anything at all,” Miller says. “I do think they can be one of the tools in the toolbox of a harm-reduction method because it will at least let people know what’s happening.”
Fuentes, who approaches the drug problem from the harm-reduction perspective, also sees testing drugs as only one part of a “tool box” of safe use.
“Always, always have naloxone and always use with somebody else because [fentanyl] is not heroin and this, within a couple minutes, can kill you.”
He turns to Miller.
“As old timers, you know, old heroin overdose we’ll be sitting down, nodding out, little by little and then you stop breathing,” he said. Both of the men laughed. “With fentanyl you don’t have that privilege.”
Within two minutes, you can be out.
It’s more difficult to mix fentanyl in the black tar heroin that comes up from Mexico, but Miller has only seen that in Baltimore once. A new study published in the Journal of Psychoactive Drugs on heroin in the city shows that in Baltimore, heroin is powder—“either raw (Colombian in origin and relatively pure) and scramble (raw heroin traditionally blended with quinine and lactose)” and that as scramble becomes more common, so does fentanyl, with which it is increasingly cut. Some of what is sold as heroin is nothing but fentanyl. And Baltimore is not alone.
“When I went to Ohio I didn’t find anything, anything at all with heroin in it. Everything I bought was fentanyl,” Fuentes says.
And it’s not only heroin. Fuentes has found fentanyl in cocaine, crystal meth, and even Xanax.
“I’ve tested 11 Xanax pills that look just like a bar, like it came from a pharmacy. They were pressed illegally and they were positive for fentanyl. I tested MDMA, positive for fentanyl. In Atlanta, crystal meth, positive for fentanyl,” he says.
“Always test every batch,” Fuentes says. “Don’t assume because the last batch.”
He calls it the “chocolate chip” effect when the drugs aren’t cut well and the fentanyl is not well distributed. And he says it is going to get worse: “For as long as I’ve been doing this, and the type of work I did before, I tell you we’re at like 25 percent of where it is going to get.”
While fentanyl is clearly a problem, the solutions being proposed by law enforcement and government officials are not likely to be effective. Twenty states have passed “drug-induced homicide” laws and many others prosecute drug providers for overdoses, even when they do not have a specific law. DPA and other groups vehemently oppose this return to drug war thinking.
But now white kids are dying too.
“It’s not just us dying anymore,” Fuentes says. “I’m Puerto Rican so when I say ‘us’ I mean people of color. It’s not just us anymore so it’s shifting from a war on drugs to a public health issue.”
The goal is that if Miller and his peers take the technique and spread it in their community, then they can get agencies or nonprofits to start buying the strips.
“It has to come from the community, because that’s who it affected and we’re going to benefit greatly when it comes to this if it’s applied correctly. And we will be hoping the health department adopts it,” Miller says. “Doing it like this, it spreads out among communities. You guys either take it and run with it or you don’t. If you do, so now you’re doing it. If you don’t, that’s fine. I’ll leave some strips, do what you do on your own. Figure it out, go into your neighborhoods or wherever you think it’s deemed necessary and see how it works for you.”
Fuentes tells a story about reversing a fentanyl overdose with three or four doses of naloxone. After the guy got out of the hospital, he bought three bags of heroin. Fuentes tested them for him. They all had fentanyl.
“He threw them out and said call the detox,” Fuentes says. “That’s not the norm and that’s not what I’m looking for because I don’t want people to think he’s trying to push me to get off. No I don’t. I used to get high as shit. Probably if there was no fentanyl, maybe I’d be getting high right now.”
Fuentes, who has been working in harm reduction for 15 years, is half joking. But after a half century of heroin use, the fentanyl deaths helped push Miller to give it up.
“Everything combined pushed me to the state that I’m in at this point. Law enforcement, prison sentences, stigma, the way people treat you, discrimination, all of these things combined, got me to where I’m at now—but most of all the repeated deaths from overdoses, man.”