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A tall and slender woman with sunken cheeks scooped up 70 dirty needles and stepped inside an RV — home to Louisville’s controversial roaming syringe-exchange program.

She paused to cough while chatting with a worker, who offered her polite words of encouragement and several clean needles to prevent the spread of HIV, hepatitis C and hepatitis A.

Her addiction to crystal methamphetamine has cost her most of her teeth and a collapsed lung. She’s only 31.

But she’s one of the lucky ones. She hasn’t died from a batch of meth cut with fentanyl, a man-made opioid that has emerged as the deadliest drug in Louisville, Kentucky and the nation.

To safeguard drug users, Louisville is taking a pioneering step by handing out fentanyl test strips — the first known initiative of its kind in the commonwealth, said Beth Crace Fisher, a spokeswoman for the Kentucky Cabinet for Health and Family Services. The strips allow users to quickly test what they’re about to take.

Fentanyl and its derivatives present a growing danger — blamed in two-thirds of the 313 overdose deaths last year in Jefferson County, according to a Courier Journal analysis of preliminary coroner data.

Initially targeted at heroin users, fentanyl increasingly is hidden in many other drugs. It was detected along with meth in at least 64 Louisville deaths last year, according to the analysis.

Read this: Fentanyl is now the deadliest drug in Louisville, Kentucky and the US

Fentanyl test strips are controversial, yet a growing number of states are using them, including California, Rhode Island, Massachusetts, Delaware and Maryland.

Similar to an at-home pregnancy test, a slender strip of paper will show if a batch of drugs tests positive for fentanyl, which is up to 50 times stronger than heroin.

The test kits are simple. The user just needs water to dilute a small amount of drug residue from a cooker or baggie, then dip the strip in the mix for 30 seconds.

One red line indicates the presence of fentanyl. Two red lines means no fentanyl.

“It’s just enough time where someone wouldn’t be impatient and go ahead and use,” said Takeisha Nunez, supervisor of the health department’s syringe exchange program,which hands out the test strips.

Some fear strips will foster drug use

However, fentanyl test strips have their detractors.

Three veteran police officers told the Courier Journal that the test strips endorse illegal drug use, just like syringe exchanges. They asked not to be named because of a feared backlash.

An outspoken critic, Dr. Elinore F. McCance-Katz, assistant secretary for Mental Health and Substance Use at the U.S. Department of Health and Human Services, cautioned against the trend in an October blog titled: “For beating the opioid crisis, America has better weapons than fentanyl test strips.”

“The entire approach is based on the premise that a drug user poised to use a drug is making rational choices, is weighing pros and cons, and is thinking completely logically,” Katz wrote, noting that her experience working with patients indicated the opposite. 

“It is not inconceivable to think that people who are severely addicted will actually use the test strips to seek fentanyl, which might be able to give them the high that their current opioid no longer gives them — and which will place them at risk for overdose and death.”

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See also: A drug caused mass overdoses. How DEA chemists solved the mystery

Strips cost less than $1 each

Some Louisville and Lexington men and women who have suffered from addiction told the Courier Journal that they have sought out fentanyl hoping for a stronger high.

Others said they switched from heroin to other drugs to avoid fentanyl, not wanting to die like some of their friends.

Dr. Sarah Moyer, Louisville’s chief health strategist, said she researched the use of test strips in other states before deciding to use them here at the health department’s syringe exchange site downtown and on the roaming RV.

The Louisville Metro Department of Public Health and Wellness recently ordered 2,000 strips — paying 80 cents per strip — and will gauge how they are being received.

For now, Moyer said the department is targeting “high-risk” participants, including those just leaving jail or rehab, who are vulnerable to relapse.

“Fentanyl test strips and naloxone don’t increase drug use,” Moyer said. “They reduce the harms and deaths from substance-use disorder.”

Surveys of participants who used test strips showed that more than 70 percent decided to change their behavior with the knowledge gained from the test, the health director said. 

For some, that means not using because the risks are too high. For those who are addicted, it means using a smaller dose, buying from a different dealer or ensuring that a friend is nearby with naloxone, a heroin and opioid antidote.

Related: Drugs aren’t what they used to be, DEA warns. What parents need to know

Retired police officer and current state Sen. John Schickel, R-Union, has been an outspoken critic of clean syringe programs and co-sponsored a failed Senate bill to limit drug users to a one-for-one needle exchange.

Schickel views fentanyl test strips differently.

By handing out syringes, “You’re providing a product to help someone possibly kill themselves,” he said. “There’s nothing illegal about test strips.

“I think anytime you can save a life, you should save a life.”

CLOSE

In the battle against the opioid crisis, Louisville’s syringe exchange program is now adding test strips so drug users can test for deadly fentanyl.
Marty Pearl/Special to Courier Journal, Louisville Courier Journal

Fentanyl found in many drugs

While overdose deaths in Jefferson County dropped last year to 313 from 426 the previous year, a 27 percent decrease, fentanyl continued to pose the biggest threat, according to preliminary data from the coroner’s office.

Fentanyl and its derivatives were found in 210 of the deaths, compared with 46 victims who ingested heroin, the data shows. If you add in all morphine deaths, since some of those victims likely ingested heroin that metabolized over time, it would total 85 — still a fraction of deaths blamed on fentanyl.

Yet some frequent drug users have told the Courier Journal they believed fentanyl is mainly used to cut heroin, so other drugs are safer. 

Toxicology results from drug overdose victims deflate that myth.

Twenty-one people died last year from heroin that hadn’t been cut with fentanyl. But 184 victims died from fentanyl that didn’t contain heroin.

Some of those users may have thought they were getting pharmaceuticals, but drug traffickers increasingly are pressing fentanyl into pills that are dyed and stamped to mimic legal drugs.

“It concerns me there’s not more awareness for how widespread fentanyl is in more than just heroin,” said Tamara Reif, associate vice president of program services for Volunteers of America Mid-States, which has a contract with the Louisville health department to operate the mobile syringe exchange program.

“The risk is just too high,” she said. “We don’t want people to die.”

Read this: Deal drugs or die: Grandpa says he sold meth to save son from cartel

CLOSE

The newest tool in the fight against opioid overdoses is an inexpensive test strip that can detect the presence of a potentially deadly painkiller. (Sept 17)
AP

Test strips give drug users more chances to quit

The fentanyl test strips also detect derivatives of fentanyl, including norfentanyl, methyl fentanyl and acetyl fentanyl — which were detected in a handful of fatal overdoses last year, according to preliminary coroner data.

Fentanyl test strips were first handed out in the commonwealth in September by volunteers with the Kentucky Harm Reduction Coalition, said co-founder Russ Read. They are ordering more.

“When we first started handing out naloxone, we were called enablers,” Read said. “We’re enabling someone to live so they can make a decision to get treatment and get better — the same reason we’re handing out the test strips.” 

The test kits have been used in New York for two years, said Daniel Raymond, deputy director of planning and policy for the Harm Reduction Coalition, based in New York City.

“It helped people recognize that fentanyl wasn’t just some scary story they saw on TV or at a press conference,” he said. “This was a way to make the presence of fentanyl in the drug supply tangible.” 

He said he has talked to several drug users who overdosed on fentanyl, then used the test strips to protect themselves before eventually ending up in treatment.

“Like for people who have heart attacks, they don’t automatically start exercising or eating right,” Raymond said.

Related: Fentanyl may be to blame for increased Southern Indiana overdoses

It can take time for people who are addicted to believe in the possibility of recovery, he said.

Positive encounters with harm-reduction workers are a good start, Reif, of Volunteers of America, said.

“If and when they decide they want to get treatment, they can get a referral from someone who is nonjudgmental and cares about them.”

Jesse Hazel contributed to this report. 

Reporter Beth Warren: bwarren@courier-journal.com; 502-582-7164; Twitter @BethWarrenCJ. Support strong local journalism by subscribing today: courier-journal.com/bethw.

FIND HELP NOW

The health department offers syringe exchange and fentanyl tests strips at its main site, 400 E. Gray St. For a list of hours, go to louisvilleky.gov and click on “Health & Wellness” under Departments, then click on “Syringe Exchange.” Another tab provides addiction help. 

Anyone who finds a dirty needle or needs to dispose of one safety can drop it off in the health department’s safe disposal kiosk, installed this month. It looks like a red mailbox and is located at the intersection of East Jacob and Brook streets.

For a list of the RV’s roaming syringe exchange sites and locations, go to voamid.org.

For more information about treatment programs in Louisville and beyond, go to findhelpnowky.org.

Read or Share this story: https://www.courier-journal.com/story/news/crime/2019/03/27/kentucky-opioid-crisis-louisville-fentanyl-test-helps-save-drug-users/2702648002/