As overdoses hit crisis point, groups respond with free tests, Narcan and other life-saving help
Jesse Foley-Tapia and Andrew Lopez
As the sun set on a November day, Blue and her friend Seb prepared to go to a Mission district club in San Francisco. Blue had bought some ketamine and they agreed to bring it with them. Knowing there might be fentanyl in the drug, they decided to stop at Seb’s home in Oakland to use a fentanyl test strip.
They mixed a pinch of ketamine with an ounce of water, stuck the detection end of the strip into the solution and waited five minutes. The test came back negative.
“Nobody is immune to getting an unlucky dose of drugs,” said Blue, who asked not to use her real name.
Blue told the tragic story of a friend and his roommate who bought cocaine that was laced with fentanyl, a deadly synthetic opioid, last year.
“He was like a casual partier. I mean, I would not identify him as an addict or anything,” Blue said. “Both of them died in their living room, probably before even going out anywhere,” Blue said.
Drug overdose deaths in the U.S. have reached an all-time high. In California, during a 12-month period ending in April, there were 10,010 drug overdose deaths, according to the Centers for Disease Control and Prevention.
There were 144 opioid-related deaths in Alameda County in 2020, the majority of them in Oakland. The number has nearly tripled in the last decade, according to the California Department of Public Health. During the first nine months of 2021, there were 99 drug overdose deaths involving Alameda County residents. Of those, 78 mention fentanyl as an underlying cause.
The pandemic has exacerbated the risks of overdosing, according to Dr. Aaron Chapman, the chief medical officer at Alameda County Behavioral Health. People taking drugs in isolation could not get help from others in the event of an accidental overdose, and there were fewer options for in-person treatment.
Opioid-related deaths in recent years are in large part because of drugs being laced with fentanyl, which can be up to 50 times more powerful than heroin and 100 times stronger than morphine, according to the U.S. Drug Enforcement Administration. Illicit drug producers are cutting substances like heroin and counterfeit pills with fentanyl to make them more potent and cost effective.
According to DEA research, a kilogram of heroin can be bought for roughly $6,000 and sold “wholesale” for $80,000. A kilogram of pure fentanyl can be purchased for less than $5,000, and after it is stretched thin and cut with other agents, can produce 16 to 24 kilograms worth over $1.6 million.
Fentanyl is a heavy-duty pain medication that has historically been used with other medications as an anesthetic. It takes as little as 2 milligrams to kill someone, according to the DEA. Some signs of potential overdose include: dizziness, a decrease in motor functions, nausea, slurred speech, and becoming unconscious.
In response to the uptick in fentanyl-related overdoses and deaths in Oakland, some community organizations have taken action to protect and inform drug users. FentCheck, a local nonprofit, distributes potentially life-saving tools like fentanyl test strips and doses of Narcan to bars and other community spaces in Oakland. FentCheck and its volunteers consider it unrealistic to expect people to abstain from drug use and instead, freely give recreational drug users the proper tools to stay safe.
FentCheck co-founder Alison Heller drew inspiration from the condom fishbowl initiative, a movement to provide bar patrons with condoms for free during the AIDS crisis. She said giving people access to safe-sex tools is synonymous with giving them harm-reduction tools. It keeps them safe.
“We really love that vision and we’re doing that with fentanyl test strips, so we work with bars and tattoo parlors and book stores and thrift stores all around the Bay Area,” Heller said.
Nearly two dozen businesses in Oakland offer fentanyl test strips and Narcan for free, thanks to FentCheck. Narcan, a brand of naloxone, is used to treat opioid overdoses and can be easily administered in a nasal spray.
The test strips are a single-use detection system originally engineered to test for the synthetic opiate in urine. When used correctly, they can also accurately detect traces of fentanyl in other substances.
The presence of fentanyl in drugs, both illicit and those posing as prescriptions but purchased on the street, is becoming increasingly common, according to Heller.
“We see it in ketamine. Molly. Adderall. It’ll show up in weed if people aren’t cleaning their scales,” Heller says.
FentCheck’s target demographic isn’t really those with drug addiction, she says, but rather those who use recreationally and aren’t seeking things like clean needles or other harm-reduction services at syringe exchanges.
Heller and her partner, Dean Shold, began street-based harm reduction in 2017 and added FentCheck in response to the damage fentanyl did to the West Oakland communities they worked in. The nonprofit gained 501(c)(3) status in late 2019 and began partnering with The Avenue, Eli’s Mile High Club and other bars in Oakland.
Many of these venues closed temporarily due to the pandemic, but as they began to reopen this summer, FentCheck volunteers organized to have their resources readily available.
Heller says that volunteers usually leave 20-25 strips depending on the venue. Some businesses require refills every other day and daily refills on the weekends. Around holidays like Halloween, Heller said that demand skyrockets.
“It was amazing. Almost all of our venues reported that people were calling and asking if they had the fentanyl test strips,” said Heller. “We had to refill some of our venues every day.”
To cover the cost of strips and delivery, Heller says businesses can either make monthly donations of a few hundred dollars to the nonprofit, have a monthly fundraiser for FentCheck or be sponsored by an individual or a business.
Dana Bushouse has had FentCheck’s strips in her cider tap room in Downtown Oakland, Crooked City Cider, for the last three months.
“One of our customers did test some molly that was positive for fentanyl, so they were able to go back to their dealer and provide that feedback to them,” Bushouse said. “I don’t know how that ended up, but I know that it potentially saved their life because they tested it and it tested positive.”
FentCheck has approached close to 100 businesses, and only a third have agreed to partner with the organization. Heller understands that some businesses don’t want to be seen as ‘the coke bar’ or as a space that ‘invites drug use.’
FentCheck has also focused on supplying the test strips to places in Downtown Oakland and North Oakland. Between West and East Oakland, there are only two establishments with FentCheck’s strips, though those are the neighborhoods that have historically been ravaged by opioid-related deaths and overdoses according to the state Public Health Department.
Data collected from January 2018 to last December showed an average opioid-related death rate of 31 per 100,000 people of East Oakland neighborhoods under the 94621 ZIP code, double the state average of 13 per 100,000, and the highest average in the city. The second highest death statistic is in West Oakland’s 94607 ZIP code.
West Oakland’s racial demographics are nearly 28% Black and close to 14% Latino. East Oakland is 29% Black and the Latino population makes up 60% of the 94621 ZIP code.
“Individuals who are growing up in more challenged communities, who are more often to be Black and brown, will experience more chronic and ongoing trauma,” Chapman, the Alameda County medical officer, says. “Opiate use is often seen as more common, or perhaps even as a response to ongoing trauma and the consequences of that.”
Heller said FenCheck has focused on North and Downtown Oakland because that’s where they have the most volunteers.
“There’s no rhyme or reason to any of the neighborhoods, except for proximity,” she said.
Heller is planning on expanding FentCheck’s coverage in East Bay neighborhoods and is in the process of getting fentanyl test strips to other cities nationwide.