An estimated 2,104 Massachusetts residents died from opioid-related fatal overdose during 2020- the city of Boston alone lost an estimated 245 residents.(see here) For the duration of 2020 I bore witness to this loss firsthand as a front line worker, first as a street outreach worker at the Cambridge needle exchange, and then as a harm reduction coordinator in Gloucester. I lost three people I love to fatal overdose this past year alone. Losing someone you love to overdose is a specific type of grief, grief that leaves me wondering if there was something more I could have done, better words that I could have said, signs I might have missed that would have clued me in that a friend had picked up again. The lack of closure and unanswered questions can be haunting, but in my experience the anger stemming from the fact that overdose deaths are completely preventable is the heaviest weight to carry. Until a safe drug supply exists, it is up to each of us to keep ourselves and our communities as safe as possible while using drugs. One harm reduction method that saves lives is the utilization of fentanyl test strips.
Testing Your Drugs
If you’re a person who uses drugs (even if it’s just occasionally), it is incredibly important for you to test what you’re using. Anything you’re buying off the street can be contaminated with fentanyl. Over the past year there have been community reports of pressed Perc 30s, Xanny bars, Adderall IR 30s, cocaine, methamphetamine, and crack cocaine all being contaminated with fentanyl. I will save my thoughts about the War on Drugs for another time, but in short our current drug policies and punitive approach towards drug use is what facilitates an unregulated street supply. Because of this, it is impossible to know what’s actually in your drugs as well as their potency. In our current climate, we are experiencing a poisoning in the drug supply like we’ve never seen before. What makes the presence of fentanyl in the street supply so alarming is that it is around 100 times stronger than morphine. Its numerous and ever-evolving analogues have the potential to be even stronger. This isn’t to say that fentanyl isn’t used by folks daily; in fact, it is the drug of choice for many. That being said, if you’re an individual who has zero tolerance to opioids and you happen to consume contaminated drugs, you are at extremely high risk for overdose. Even if opioids are your drug of choice and you decide to take a few days off, be aware that your tolerance drops significantly within 72 hours. If you pick back up and use the same dose that you were before you took a break, you are at greater risk for overdose.
As I said before, because of drug prohibition, there is no surefire way to know what is in your drugs. For example, my drug of choice cocaine is almost always cut with lidocaine, levamisole (a cattle de-wormer), and other amphetamines. Does knowing all of this prevent me from indulging when the opportunity presents itself? To be completely honest no, not at all. Obviously I would prefer to not have this garbage cut into the cocaine supply, but until people who use drugs are given access to a safe supply we have to look after one another and keep each other safe. Utilizing fentanyl test strips to test your substances before you consume them is a great way to ensure that you are using more safely. These strips are very basic and won’t tell you the amount of fentanyl in your drug or anything about the rest of the cut, but they are such an important tool when it comes to keeping yourself and the people you love safe. Test strips are straightforward and easy to use, and the coolest part about them is that you don’t need to waste any of your drug for testing! The fentanyl test strips that are widely available and offered at most harm reduction programs were originally designed to test urine, not drugs, so diluting your substance is necessary for checking.
If you’re someone that injects, you can just add more water (1ml) to your spoon or cooker and test the rinse. If you enjoy sniffing, smoking, or orally ingesting your substances your method of testing your stuff is just as easy. Best practice is to test every bit of the drug that you intend to consume because fentanyl is never distributed evenly within a bag. The powder on one side of your baggie might just be “cocaine” or whatever you’re trying to use, but a tiny bit of powder in the bottom corner could contain a lethal dose of fentanyl. This applies to pills as well, and is often referred to as the chocolate chip cookie effect. I’m going to guess that most of us don’t want to dilute and drink every bump we want to consume (no judgement if you do though), so how can we minimize our risks as non-injection drug users? Answer: test your baggie residue.
When it comes to dilution, there are testing specifics for some substances which I will get into below, but prepping for residue testing is the same across the board. Put your powder/crystals/pills on a sterile surface like a plate, and chop/crush your drugs into the finest powder you can manage. Spoons and hose clamps are great for breaking down pills, and razor blades come in handy for chopping. If you’re going to use your bank card or driver’s license, it’s a really good idea to sanitize it before it contacts substances you plan on ingesting. Once you’ve broken everything down to a fine powder, you’re going to want to pour it back into the baggie it came in. Yes this is a pain in the ass, but it’s important! You can put a piece of paper down on the plate before you add your drugs so you can use it as a funnel tool for this step; straws cut at an angle can be used as scoops as an alternative. Once your powder is safely stashed inside of its baggie, seal it up and shake. Do this for a few seconds and then dump your powder back onto the plate or into another baggie if you have one. You should have a solid residue inside the initial baggie that you can now add water to.
Opioids/Cocaine/Crack: Transfer your powder into another baggie or put it on a sterile surface where you intend to consume your drugs. Next, add 2.5ml of water (roughly half a teaspoon) to the inside of the initial baggie, making sure that all of the residue dissolves. Dip your test strip into the solution holding the blue end, sing happy birthday (or count to 15 your choice), and then lay the test strip on a flat surface for at least 2 minutes to process the sample.
Amphetamines/Methamphetamine/MDMA: These substances have the potential to read as false-positives if they are diluted incorrectly. If they aren’t diluted enough, you could see a false-positive pop on your test strip. If you overdilute it, you run the risk of getting a false-negative result as the strip won’t be able to detect fentanyl and its analogs. The recommended dilution for these substances is 2mg/ml. It’s safe to assume that at most you will have 10mg of residue in your baggie, so a dilution of 5ml (1 teaspoon) is a sufficient amount of water to test with.
Fentanyl test strips aren’t foolproof , but they are a valuable asset that can help you make safer, more informed choices about the drugs that you are using. If you are using drugs or you have folks in your life that are, I strongly urge you to carry Narcan. There are multiple harm reduction programs in Massachusetts that offer free and confidential harm reduction services like naloxone (Narcan) distribution, overdose prevention and response training, safer use supplies like fentanyl test strips, safe injection supplies, HIV/HepC/STI testing, and safe sharps disposal.
AHOPE (Boston Public Health Commission)
774 Albany Street Boston, MA 02118 (617) 534-3976
Access: Drug User Health Program
359 Green Street Cambridge, MA 02139 (617) 470-0994 (confidential call/text)
100 Willow Street (2nd Floor) Lynn, MA 01901 (339) 440-5633
ONESTOP Harm Reduction Center
9 Center Street Gloucester, MA 01930 (978) 381-3170 (confidential call/text)
Never Use Alone Hotline (800) 484-3731
24hr. hotline run by harm reductionists that can keep you safe while using alone. No judgment, no shaming, no preaching, just love!
I can be reached via email at [email protected] or via Instagram @_teee.na I am here for any questions, to help you access harm reduction supplies, and to just be a friend to anyone that needs someone to talk to. I am also available for in-person or virtual overdose prevention and response trainings and fentanyl test strip demos- please reach out! Stay safe out there y’all and remember- start low, go slow. You can always do more, but you can’t do less!