Michael Marquesen first observed a few 12 months in the past that fentanyl, a harmful artificial opioid, had hit the streets of Los Angeles. People abruptly began overdosing after they shot up a brand new white powder that sellers promised would give them a robust excessive.
“In Hollywood, they’re like ‘Everybody’s dropping … everybody’s overdosing!’” mentioned Marquesen, director of the Los Angeles Community Health Project, which offers help companies for folks coping with drug habit.
The white powder was simply distinguishable from the black, tar-like heroin that’s widespread in California, and customers initially believed it was high-end heroin. But it was fentanyl — 30 to 50 times more potent than heroin — mentioned Marquesen, whose group runs a cell needle change out of a white van, serving drug customers everywhere in the metropolis.
A deadly dose of heroin in comparison with a deadly dose of fentanyl (Bruce A. Taylor-Criminalist II/NH State Police Forensic Lab)
The lethal fentanyl wave sweeping the East Coast and the Midwest has arrived in California. The variety of deaths from fentanyl within the state, although nonetheless a fraction of these seen in another states, has spiked lately. And state well being officers have responded with a proactive however experimental coverage: Since final May, they’ve provided needle exchanges with rapid-response check strips that permit drug customers to find out if their subsequent excessive is contaminated with the possibly deadly opioid.
It’s exhausting for drug customers to know precisely what’s combined into their provide, as a result of sellers don’t inform them — and sometimes don’t know themselves. Needle change employees say the strips have revealed the presence of fentanyl not solely in white powder type but additionally as an additive to black-tar heroin and even in such non-opioids as methamphetamine and crack/cocaine.
Officials hope that if folks know the hazards lurking of their stash, they’ll be extra cautious to guard themselves from unintentional overdoses.
The thought of using the strips to check for fentanyl began at a publicly funded needle change in Vancouver, British Columbia. The state of New York additionally makes public cash accessible for needle exchanges to purchase the check strips. Eight New York exchanges, a 3rd of the overall, provide them to drug customers, in response to the state’s public well being company.
Last fall, Marquesen’s needle change began handing them out from the white van, together with a quick lesson on the right way to use them. Eleven California needle exchanges, from Eureka to Santa Barbara, have ordered the strips to this point, state officers mentioned.
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Kelly, a 44-year-old heroin person in Los Angeles who withheld her final title as a result of her household doesn’t find out about her habit, helps the usage of check strips. She practically died from an overdose of heroin, which she later discovered had been spiked with fentanyl.
“There’s dealers who are trying to make their stuff better because it’s garbage,” mentioned Kelly. Those sellers don’t inform their clients in regards to the fentanyl of their medication, she mentioned, and that places them at grave danger.
Fentanyl and different artificial opioids killed 324 folks in California in 2016, a leap of practically 50 p.c from 2015 and greater than double the toll of 5 years earlier, in response to preliminary information from the California Department of Public Health. The most up-to-date spike is attributable to fentanyl, which accounted for nearly three-quarters of these 2016 deaths, the division mentioned.
The California figures nonetheless pale as compared with different states. In New York, virtually 1,100 folks misplaced their lives to fentanyl and different artificial opioids in 2016, twice as many as a 12 months earlier, in response to the U.S. Centers for Disease Control and Prevention. In the a lot smaller state of Maryland, over 1,100 deaths have been fentanyl-related in 2016, greater than triple the variety of the earlier 12 months, in response to that state’s well being division.
In Ohio, practically 2,500 died from fentanyl and associated opioids in 2016, double the variety of the 12 months earlier than.
Accidental overdoses involving fentanyl have been blamed within the deaths of each Prince in 2016 and Tom Petty in October.
Eliza Wheeler (left), an overdose response strategist with the Harm Reduction Coalition, helps run a syringe change for intravenous drug customers on a Thursday evening in San Francisco’s Mission District. (Pauline Bartolone/KHN)
Wheeler says drug customers usually tend to take precautions due to the check strips. Needle change members report utilizing much less of the drug or getting excessive with others, she says. (Pauline Bartolone/KHN)
In San Francisco, needle change employees and customers say the flexibility to check medication has modified habits.
“People are much more cautious if they know there’s fentanyl in it,” mentioned Patty, who didn’t wish to give her final title due to her heroin and crack use. “Honestly, nobody wants to die.”
But some specialists urge warning in utilizing check strips, noting the technique continues to be experimental.
Sold for a greenback apiece by BTNX Inc., a Canadian firm, .they’re designed to check urine and haven’t been authorised by the U.S. Food and Drug Administration to be used on drug samples, a BTNX spokesman mentioned.
Dr. Karen Mark, chief of the California public well being division’s Office of AIDS, mentioned all of the proof means that the strips successfully detect fentanyl.
But Dr. Dan Ciccarone, a professor on the University of California-San Francisco who researches drug abuse, famous that the strips present solely whether or not a pattern accommodates fentanyl, not how a lot — so there’s no method to know if it’s a lethal dose. The strips are additionally too delicate and might be yielding false positives, he mentioned. That is probably not such a foul factor per se, he mentioned, however drug customers would possibly cease utilizing them after a sequence of positives.
Despite reservations, many specialists say the severity of the opioid epidemic justifies California’s unproven strategy.
“The crisis situation that we find ourselves in … definitely calls for a lot of nimble and innovative responses,” mentioned Leo Beletsky, affiliate professor of legislation and well being 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.
Pauline Bartolone: pbartolone@kff.org”>pbartolone@kff.org, @pbartolone
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