Fentanyl test strips highlight rift in struggle to combat drug deaths
nytimes.com
nytimes.com
There are many categories of drug users, not just "addicts" and "party" people.
Some people have chronic pain issues and are subject to medically-imposed restrictions on their consumption of lawful drugs -- to the point where they seek out illegal "drugs" hoping to get something to alleviate their pain.
Some people are self-medicating other issues than addiction -- like anxiety. Maybe not a good idea from your point of view and mine, but there they are.
(I put "drugs" in quotes because they aren't really -- they are powders and pills sold with fraudulent claims they might contain the substances desired by the customer. And, perhaps, not contain poisons or toxic overdoses.)
Few street drugs contain what is advertised -- the Vancouver market is stuck with variable mixes of meth, oxy, sugar, fentanyl, methadone, occasionally some actual heroin, cocaine, benzodiazepine, even carfentanil.
Steet buyers receive the same crap regardless of what they want. It's a serious game of russian roulette when ingesting this stuff. Nalaxone is a common upsell for street "drugs" -- buy your stuff and your opioid antagonist in case the stuff is poison. (Nalaxone is free in BC).
Harm Reduction is a difficult proposition when governments have decades-old policies and international treaties enforcing prohibition. Putting addicts on lawful drugs draws easy political fire ("subsidizing fiends"). And how does a pharmaceutical company even get close to trying to develop and market a "smokable" lawful opioid (because that is what the customers want)?
Over 10,000 dead people in British Columbia (population about 5 million) due to opioid overdoses. Since 2016.
Imagine that you're with a friend or loved one who is overdosing, when you might not be that far yourself from overdosing, and choosing whether to let them die there and cover up all evidence that you were in the room, or spend 10 years in prison if you take them to the hospital and they still die. The worse off they look, the less sensible it is to call for help. It's a sick society.
> Two friends share drugs. One overdoses and dies. The other survives. Is that murder? Amid the deadliest drug crisis in history, America is often answering "yes" to that question. Prosecutors are increasingly treating overdose deaths as homicides, locking up drug dealers who sell fentanyl to people living with addiction — people who are often addicted themselves. Some see justice and accountability in convictions under so-called "death resulting" laws. Some see a new and widening front in America's failed War on Drugs. In Death Resulting, we hone in on one of these homicide cases and meet a young man facing a 20-year mandatory minimum sentence in federal prison for his friend's death. Along the way we examine the forces that shape that case — from a cycle of generational trauma and addiction to the racist origins and current impacts of these prosecutions. So... an accident — or a homicide? Our answer could shape how we address the deadliest overdose crisis in American history
People that look up to someone are always like "Noooo, my role model wouldn't be doing cocaine to begin with, how dare you suggest that!" and unless you know how common that actually is, you don't see how the rest unfolds. People wanted to believe that this married woman, whose husband was out of town that weekend, was out with her girlfriend and they were both roofied at a party and a predatory man took them to their house and did all these heinous things. Most of that narrative disintegrated over time but there are still issues that the public doesn't understand and justice system don't really reveal. Especially around what you said about the host.
It's more clear that they went to the afterparty to do cocaine (which even w/o fentanyl is often not coke, hence the toxicology reports), it was tainted by the supplier leading to another fentanyl overdose, the hosts panicked. The hosts concocted that ghost car hospital plan, eventually got caught, various women with varying degrees of scorn over their whole life come out of the woodwork solidifying people's disdain, and off to prison they go!
The hosts though had exact the choice you mentioned... they waited 12 hours on this issue with their overdosed popular guests. But they also had to weigh the issue of snitching on their drug dealer! Potentially even worse than taking the full force of being a social pariah and prison time!
All of this occurring because we can't have an honest discussion about what commonly occurs! Because people don't have test strips on the ready, or don't have Narcan and don't know how to use it even if they know to suggest it. Because we don't address drug supply by fixing the supply chain.
There may indeed be no "safe" recreational use, but there's certainly relatively safer use and relatively more dangerous use of opiates. And not knowing exactly how pure and how much of what you're taking makes it decidedly less safe.
One relatively safer option is to only dispense less than what would be a fatal dose for the person's tolerance, and dispense regularly. This is often how opioid maintenance programs are run. In countries like Germany, Canada, the UK, Netherlands, Switzerland, etc. they prescribe opioids to severe opioid addicts so they can get high more safely and avoid withdrawal and stabilize. These programs generally drastically reduce the rate of overdose, use of other street drugs, and improve functioning and life expectancy. A lot of participants once given an effective regular daily supply, end up slowly weaning themselves off voluntarily (over 30% after 2 years in the initial German program).
The wild west going on with fentanyl is certainly worse, but I don't think legalizing what is likely the most addictive drug on the planet would improve things. Even if you cut down on contamination and improper doses, just the sheer increase in users would cause a ton of deaths.
This is just naiv. You can already see the effects of the marijuana industry speeding up adoption and innovation.
But it would certainly be interesting to see what happens in a world with big heroine and cocaine industry.
- I rarely give out fentanyl test strips on street outreach (lower east side). Everyone knows that everything here is fentanyl and has been for years. It's mostly taken by people who will trade/give them to non sophisticated dealers who want a little more insight into what they are getting. (fent strips only show positive or negative, do not show amounts) - Older users don't like fentanyl, for many reasons, but the main thing I hear is that it doesn't "have legs". it hits very hard all at once so you cant just do a bag and go about your chores so easily. There are all sorts of drug users who have varying levels of abilities to "maintain" the other aspects of their life. - Most of the test strips that get used from my supplies these days are from people in bars and parties (testing molly, coke, ketamine etc) - People mention the fentanyl in cannabis(and k2) thing constantly to me. I've yet to be presented with any real proof. As of now I'm still convinced this is propaganda. You can guess who might be incentivized to spread these types of rumors. People don't like to share their drug habits, so it's likely they took a bad pill and blamed it on a blunt at a party. - Here is a video of how to actually use a fentanyl test strip https://www.instagram.com/tv/CaDE8XblaKy/?igshid=YmMyMTA2M2Y...
If you want to support Harm Reduction outreach and education (narcan trainings, drug testing etc) where all of the money goes DIRECTLY to supplies you can support us at https://opencollective.com/dont-forget-the-streets. I've been funding these things for about 4 years solely out of my own income, and now need to start taking donations as my work life has dramatically changed.
If you live outside of NYC and want access to supplies anywhere in the USA. Checkout https://nextdistro.org/ they mail supplies for FREE everywhere, in discrete packaging.
All because everyone else self-censors.
Abstinence only education isn't working. A lot of people are dying, people that aren't seeking fentanyl.
As the article says even marijuana has fentanyl in it these days. And I’ve heard reports in Mexico that pharmacy drugs have had it as well.
Various indictments and warnings over some variation of this in Mexico: https://www.google.com/search?q=mexico+pharmacy+fentanyl&ie=...
Until people can talk about it as a real thing that happens, nothing is going to change.
Abstinence based apathy is contributed to lots of people dying and no realistic measures taken.
Okay, in that case though, that's purely a Mexico failing to regulate problem. FDA requires audits, certs, testing, and tracking of all stages of drug production and delivery specifically so that tainted or contaminated batches can have things like recalls or advisories released about them.
I'd be interested to know more about the producers of the pharmaceuticals in question, or whether compounding pharmacies are unable to sufficiently control their environment given the potency of fentanyl such that what little contamination is making it past their attempts to prevent cross contamination are leading to lethal complications.
It can be handled. Whether or not you enforce the requirements for it to be handled is a political question.
The point was more of a pointing out the prevalence and the realism of the danger, many Americans do medical tourism, alongside the issue with the street drug issue in the USA.
If you're relying on a "it can't happen here" approach to that specific issue, I think that is also naive.
It is the number one killer 18-45 in US right now. All aspects need to be addressed simultaneously. The accuracy of your observation I think is a football punted in the wrong direction.
Street labs, by their nature, are unencumbered by the same systems and incentive structures that result in generally safe dispensaries.
Part of medical tourism is the risk taking inherent thereto. Part of being an FDA approved drug is regular audits and compliance of your supply chain, plus regular mandatory inventory QC, with enforceable consequences for failure to comply. It's expensive, but it means (generally) a high quality product with known behavior at the condumer end.
That goes out the door if you aren't regularly looking for failure states because your regulator takes a "hands off" or paper pusher approach.
I'm not saying failure can't happen in the U.S. it certsinly can. Just that there are relatively fewer sources where we don't have the capability to tighten down amongst law abiding dispensaries. Black Market sources are purely an at your own risk affair.
Is this actually true? It makes absolutely no sense at all, unless the goal of whoever is doing it actually is to kill people.
Cutting heroin or other opiates with Fentanyl can make sense (from a dealer's point of view), because it is extremely potent but not much more expensive than the desired drug -- so you can mix a tiny amount of fentanyl with loads of fillers and then cut that into the actual drug, and your buyer will probably never know. Until you screw up and put a tiny bit too much fentanyl in and then lots of your customers die. But this model, however fucked up, makes sense.
Cutting things like weed with fentanyl truly makes no sense to me at all except as a fucked up way to murder people.
This is an issue with fentanyl because it's so potent that a small amount which would be a non-issue for opiate users can easily kill a person with no tolerance for the drug.
It's also dangerous because, when mixed with stimulants like cocaine, the overdose doesn't necessarily happen immediately - the stimulants will briefly mask the effects of the opiates, raising the heart rate, but then they'll wear off and the opiates will suppress breathing to the point of death. Because the effects aren't always immediate, the drug user (or those around them) don't connect the person's behavior to the drug use, so they don't always recognize it as an opiate overdose requiring immediate emergency attention and Narcan.
Source: used to work for a nonprofit that conducted harm reduction education training
You would think that dealers would be more careful than that -- killing your customers is bad for business -- but it makes way more sense than intentionally cutting fentanyl into pot.
The supposed reason is dealers trying to get their weed users addicted, but that doesn't make a ton of sense as they'd have to either fess up or be the only weed dealer someone knows.
Plus, I'm not positive the temperature of burning marijuana would do anything to fentanyl or if the temps would destroy it.
>> Which is not how you smoke marijuana.
People don't use a pipe to smoke marijuana?
Here's a NIH paper on less people injecting fentanyl and other opiods in favor of smoking fentanyl. I think you can conclude that smoking it is an adequate delivery system and doesn't destroy it, just like freebasing cocaine.
Different pipes/heating methods. I'm not saying there's no way to smoke fentanyl, I'm unsure if sprinkling it on marijuana is one of them.
This isn't to say that fentanyl (and opiates in general) isn't a huge problem in the US (I couldn't possibly count the number of legit narcan wakeups I've done over the years), but fentanyl in particular is really prone to exaggerated claims by law enforcement that don't pass the sniff (or snort?) test.
You need a very precise scale to measure those quantities...
[1] https://www.nytimes.com/2022/07/13/magazine/police-fentanyl-...
That said there's been a lot of fentanyl deaths and it ain't making any communities better off having it. It's cheap, easy to get and the cartels can easily justify losing people to selling large batches.
Only way they can stop the cartels continue to get more of a foothold is by decreasing demand of the product. Not saying their approach is a good approach but I understand why they would try it.
When you accused Havana Syndrome sufferers of mass hysteria, Authorities would start explaining to you like you were a child how very important and very professional the sufferers are, and how it's just like not believing women when you don't believe that they were brain damaged by secret, very quiet, commie sound ray guns. You could reply with a video of a fentanyl cop.
In other words, poisoning.
We really just need to get going with legalizing and making safe drugs accessible. I don't know why it isn't obvious how much of a mess this is.
The test strips aren't even great. Better then nothing but if weed is really getting contaminated you cant even test that. Unless there's ways of testing lately don't require putting the whole thing in water?
None of these things really works, just do damage control to other people.
https://www.nytimes.com/2022/10/01/health/fantanyl-test-stri...