If the opioid epidemic is a war, fentanyl is a lethal weapon. The synthetic drug was involved in 71 percent of all unintentional overdose deaths in Ohio last year, according to preliminary data but, experts say, hope lies in fentanyl test strips. The cost? Just $1 per strip.
They’re currently handed out free of charge at the needle exchange van parked on Cleveland’s west side 5 days a week. At the van, operated by Circle Health Services, people who use drugs can exchange used needles for clean ones.
The needle exchange service is a controversial method of reducing the harm drug users do to their bodies—and one that’s only recently gained acceptance in Ohio, with the passing of House Bill 92.
“You’re giving needles to people to inject drugs, but you’re doing it to keep them clean from HIV and other diseases, and from sharing needles,” said Roger Lowe, an outreach worker for Circle Health Services.
Lowe and fellow outreach worker, Chico Lewis, operate the needle exchange van, and they use their short interactions with their clients to build relationships, which can help serve as a catalyst to get them into recovery.
But keeping people alive long enough to seek treatment became far more challenging when common street drugs like heroin, cocaine, and even meth, started getting laced with more powerful and dangerous drugs like fentanyl. This synthetic is up to 50 times more potent than heroin.
“We never had this many overdoses like we’re experiencing now,” said Lewis.
So Chico and Roger added the fentanyl test strips to their arsenal. Produced by the Canadian company BTNX, the strips are not currently FDA approved, but were shown in studies to accurately detect the presence of fentanyl even better than more costly methods. The strips can also detect many different fentanyl analogues, including carfentanil—although they do not currently differentiate between the analogues.
“It’s almost like a pregnancy test,” said Lisa Fair, the Associate Director of HIV Prevention and Outreach at Circle Health Services. “You just put the strip into the solution, and you just test the residue with the strip. Two lines means it’s negative, one line means it’s positive.”
“We haven’t seen a negative yet,” said Lowe, who has been asking his clients who used the strips a series of follow-up questions.
“The test strip program has become more popular, and a lot more clients are starting to ask for the strips when they come in to exchange syringes,” said Fair, who runs the needle exchange service, which also includes an in-house exchange at Circle Health Services’ east side clinic.
Although some people who use drugs seek out fentanyl for a stronger hit, a Johns Hopkins study revealed that most users were concerned about fentanyl in the drug supply. And detecting it would cause 70% of drug users to modify their behavior.
According to Fair, "Once a client draws up a shot, the chances of them not using that shot is almost zero, but if the test comes back positive for fentanyl, they may use slower, they may use less, or they may not go to that same drug dealer.”
“We’re not trying to help people use drugs, we’re trying to help people stay alive,” she added.
Greg McNeil has a personal stake in fighting the opioid epidemic. McNeil lost his son, Sam, to an overdose in 2015.
“Sam went through two rounds of rehab and, by all accounts, he was doing fantastic,” said McNeil. “But October 23, 2015, for whatever reason, that day he decided to go out, and he got hooked up with some dope that was heavily laced with fentanyl. They found him the next day in his game room and he was gone.”
“When you lose a son or daughter your life changes forever. I think you either crawl into a hole some place or you have to go out, and you have to do something to make a difference,” said McNeil.
McNeil founded a nonprofit organization called Cover2 Resources, which funded Circle Health Service’s test strip pilot program. The test strips are now funded by the ADAMHS Board of Cuyahoga County.
“These things cost a buck,” said McNeil. “So you have a dollar that you’re investing in the program—that one dollar, hopefully, it’s going to keep them from killing themselves, keep them a little safer, and give you just that one more day, one more chance, to maybe get them the treatment that they need.”
“I don’t know if Sam knew that the stuff that he used on October 23, 2015 was tainted with fentanyl. I suspect that he probably didn’t,” McNeil added, “So if he would have had one of these little one dollar test strips who knows what would have happened.”