How fentanyl test strips help drug users 'be safe and survive'

With a goal of stopping the recent rise in drug overdose deaths, advocates and health agencies are willing to try anything - even safety strategies targeting people who will continue using illicit drugs.

The latest strategy to come to the suburbs is the issuance of fentanyl test strips so users can determine whether the drugs they plan to take contain the powerful painkilling substance, which is 30 to 50 times stronger than heroin.

Live4Lali in Arlington Heights has doled out more than 600 fentanyl test strips since March, and the Lake County Health Department started providing them for free in August. Test strips also are available through the Chicago Recovery Alliance, and Point to Point, a Kane County-based syringe access program, plans to begin offering them soon.

"We're seeing such an increase in fentanyl deaths, it's almost vital that you test before you use, sad to say," said Bill Gentes, project coordinator of the Lake County Opioid Initiative and the Lake County Underage Drinking and Drug Prevention Task Force.

The increased focus on harm reduction comes as the region marks today as International Overdose Awareness Day, designed to remember those who have died, decrease the negative perception of drug-related deaths and prevent future fatal overdoses.

Groups including Live4Lali, Glueckert Funeral Home in Arlington Heights, LTM Heroin Awareness and Support Foundation and the Addiction Policy Forum's Illinois chapter are promoting events or resources targeted at decreasing the likelihood of overdoses. These include training on how to use overdose reversal agents called naloxone, Narcan or Evzio, and offering an online tool kit with information on naloxone, overdose aftercare and drug use survival.

"If you're going to use, use carefully," said Kelsey Trotter, coordinator of digital marketing and public relations for the Addiction Policy Forum. "We want (users) to be safe and be able to survive."

'You have no idea'

Safety and survival are paramount when powerful opioids like fentanyl are at play, coroners and drug prevention experts say, because even small traces can cause death.

Fentanyl has been a contributing factor in 15 of the 26 opioid-related deaths in McHenry County this year, Coroner Anne Majewski said. Four fatalities came from fentanyl alone, the other 11 from heroin and fentanyl combined.

Advocates hope some of these deaths can be avoided through the use of fentanyl test strips.

Chelsea Laliberte Barnes, founder and executive director of Live4Lali, says the strips are essential, even for people who use street drugs other than heroin, such as synthetic marijuana, amphetamines or "benzo bars" made to act like the class of medications called benzodiazepines - anti-anxiety medications such as Xanax or Klonopin.

"You have no idea what you're getting when you're buying on the street. You have to really be faithful in your dealer to have provided you with what you think is appropriate," she said. "We just can't rest on that."

That's why Live4Lali provides handfuls of fentanyl test strips to anyone who receives services meant to decrease overdose risk. The organization buys the strips from DanceSafe, a harm reduction group within the electronic dance music community.

A video on Live4Lali's Facebook page shows how the thin, blue strips work to test drugs users plan to inject, sniff or swallow.

The key, Live4Lali's McHenry County outreach coordinator, Alex Mathiesen, says in the video, is to combine drug residue with water, insert the strip for about 15 seconds, allow it to dry and wait for one or two stripes to appear. One stripe means the substance contains fentanyl, or one of 37 synthetic analogs made to act like fentanyl. Two stripes means no fentanyl.

"If people are worried about fentanyl and they test and they see that it's fentanyl and they're not going to use it, then it's a great thing," Lake County Coroner Howard Cooper said.

Pill users must dissolve one dose into a full glass of water to test the drugs, Mathiesen says. Injection drug users can put water in the spoon they used to heat their drugs and test from there. Those who sniff or snort can empty the contents of their bag of drugs, fill it with water and insert the test strip.

Some worry drug users won't put in the effort to test, but Laliberte Barnes said knowing the contents is worth it. Others worry about the risk-taking type of user who is simply looking for euphoria.

"The problem is that some people are using fentanyl knowingly because they want to try to get a better high," Cooper said. "They might look for fentanyl because they know that's a lot stronger."

'Keeps you safer'

Even if the test strips aren't realistic for all users, they offer knowledge, says Lyndsay Hartman of Batavia, founder of the Point to Point syringe access program.

Hartman ensures each person who takes syringes also leaves with a dose of naloxone for overdose reversal. She hopes to receive a donated supply of fentanyl test strips soon.

"It's really important (to test) because people don't know what's in their drugs and then they're overdosing," Hartman said. "It keeps you safer to know what you're injecting."

As fentanyl test strips become more widely available, advocates say they could combine with other efforts against the opioid epidemic that have ramped up during the past five years across Cook, DuPage, Kane, Lake, McHenry and Will counties. Efforts include education, widespread availability of naloxone and the willingness of suburban police departments to help users find treatment.

Even if overdose death totals do not yet show it, Laliberte Barnes says these efforts are producing "encouraging" results.

Through Aug. 24 across the six-county region excluding Chicago, 321 people have died from opioid-related overdoses, compared with 689 in all of 2017.

The numbers appear on pace to fall below last year's total, but overdose cases can be pending for more than six weeks as coroners await toxicology results, meaning the total could be dozens of deaths behind.

In Lake County, for example, Cooper is awaiting toxicology on 18 deaths he knows are overdoses, though he does not yet know from which substance or substances.

That's why officials suggest continued vigilance.

"We need to be able to continue implementing more solutions," Laliberte Barnes said, "to really see a dent."