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St. Anne's Harm Reduction Corner is located in a busy area of Westchester Avenue, in the Bronx, in the shadow of an elevated railroad. Inside, guests can come home from the cold, have a hot meal and sit in a reclining chair to watch TV or chat with friends. In a corner, people can pump iron or do push-ups in an improvised gym.
The organization also offers a non-judgmental space for people who use drugs to collect sterile syringes, alcohol swabs, doses of naloxone, an anti-opioid drug to reverse the overdose. and other products that help reduce the risks of intravenous drug use.
St. Ann's operates on the harm reduction model, which advocates believe is a pragmatic approach to overdose prevention and the spread of disease, by accepting that some people take drugs, and it is better to to keep them alive and healthy than to demand them. "Just say no." Harm reduction is not a quick fix, and it is not meant to be. Instead, he is committed to meeting drug users wherever they are and trying to keep them as safe as possible, according to Van Asher, program manager at St. Ann's.
"Just say no" did not work, "Asher said." It did not work in the '80s, and it does not work anymore. "
Needle syringes and other sterile products distributed by St. Ann have long been at the heart of harm reduction activities. While the Bronx and the rest of the country began to experience an upsurge in deaths from fentanyl, a potent synthetic opioid 50 to 100 times more potent than morphine, St. Ann's was at the forefront of a new way to help those who consume drugs try to avoid overdoses.
In early 2017, Asher heard about a pilot project at Insite – a safe drinking site located in Vancouver, Canada, which allows people to inject drugs in the presence of qualified personnel – suggesting that a brand of urine test strips designed to test the Fentanyl in hospitalized patients could also be used for its presence in addictive drug samples, including heroin and cocaine. Intrigued by the prospect of a new tool to add to his arsenal of harm reduction tactics, he ordered strips of paper worth approximately US $ 1 from the Canadian company BTNX.
Asher is one of many street level activists leading the fight against the death of fentanyl across the country. It has three objectives: to collect data on the spread of fentanyl, to give people the opportunity to test their own medicines and to take the necessary precautions, and to open a dialogue with drug users to help them develop the means to stay. as safe. as possible.
"We need to start talking to people about how to safely use something that contains fentanyl," he said.
"We need all the tools in the toolbox"
Two recent scientific studies seem to corroborate Insite's findings suggesting that urine strips would be useful for detecting fentanyl and helping people make safer choices. In February, a team of researchers from Johns Hopkins University published the summary of a study BTNX urinary strips had the lowest detection limit and the highest sensitivity, which means that they are extremely accurate traces of fentanyl. The team is still trying to publish its study in a medical journal, but it first published the summary because of the urgency of the problem, according to what has been reported. Susan Sherman, a professor of Johns Hopkins and one of the principal investigators of the study.
The study also consulted drug users and found them very receptive to testing their drugs. 86% of respondents said they would use the tests and 70% would likely change their behavior if the drugs tested positive.
While the bands are over immediately useful to those who use drugs more than machines, they simply answer "yes" or "no" to the question of whether the drugs contain fentanyl or any of its three badogues. Bands can not indicate how much or how much of these substances may be present.
Nevertheless, said Sherman, gangs are a positive step towards more informed consumption, one of many services to keep drug users alive, at a time when overdose deaths continue to claim victims in communities across the country. .
"What more is needed to understand that there is a crisis and that we must react with all the tools in the toolbox," she said in an interview. "It takes a lot of contact points for drug users, engaging them at different points in the trajectory before they can be stable enough or have the will to stop using drugs."
Another study, published in October by the North Carolina-based Research Triangle Institute, was even more encouraging. The study found that people who consume street opioids are five times more likely to practice safer injection practices if their drugs give a positive result to fentanyl.
"The bottom line is that fentanyl test strips could be a new technique for preventing opioid overdose because they would allow people to control the presence of fentanyl on the street and change their drinking behavior." Wrote Jon Zibbell, public health researcher at RTI. .
The strips are still not officially approved for use outside the clinical setting, but BTNX has played its role as a leading provider of harm reduction clinics. The company sent representatives to a recent conference in New Orleans organized by the Harm Reduction Coalition. Its website contains information on harm reduction, including: brochure extolling the results of recent studies by Johns Hopkins and RTI.
"It was in every bag, and people prefer it"
Although fentanyl leaked a lot of ink in the press, its presence in illicit drugs has increased dramatically and it has played a role in celebrity deathsit's not particularly new. A lot of heroin labeled "Tango and Cash"Who was badly cut with foolish fentanyl and killed many people in New York in 1991. He again raised his head from 2005 to 2007, when fentanyl contamination killed more than 1,000 people in Illinois, New York and several other states.
Overdoses have become the number one cause of death among people under 50 in the United States, and the number of deaths attributed to fentanyl has risen sharply. In 2017, 72,000 people death in America of all drugs. Fentanyl and its badogues were present about 30,000 of them, according to preliminary data from National Institute for Combating Drug Abuse.
In New York, fentanyl represents an even greater threat. In 2017, where 1,487 drug overdose deaths were reported in the city, fentanyl was badociated with 57% of these deaths, making it the most common substance, according to one report published in September.
According to the Drug Enforcement Administration, illicit fentanyl – which is now largely produced in laboratories in Mexico – has probably been introduced into the supply of heroin because it is easier to manufacture than heroin and increases the power of the product. The amount of fentanyl contained in a given bag is not always the same. A person who is used to a certain dose may be mistaken if they buy a dose with just a touch of more fentanyl than they can handle.
But the supply of illicit drugs is not regulated and fentanyl is much more potent than heroin. It is almost impossible to identify one or the other by looking at it: a bag sold in the street could be much more powerful than the next, which can contribute to a potentially fatal overdose.
For someone who uses drugs, having an idea of what they contain can make the difference between life and death. Heroin and fentanyl are opioids that, when taken in large enough doses, inhibit heart rate and respiration. This can deprive the brain of oxygen, which can kill the person or cause serious damage to the brain. An overdose is a race against the clock to administer naloxone, designed to revive the victim by preventing opioid receptors in the brain from absorbing drugs.
fentanyl absorbs into the person's system faster than morphine or heroin and, as a result, people who overdose are stunned much faster. This makes it all the more urgent that anyone could use fentanyl to take precautions such as using a friend and naloxone, according to Shawn Westfahl, a risk reduction specialist who works with vulnerable populations. Philadelphia.
Westfahl was trained as a street nurse in 2011 and said he had performed his first overdose reversal at Zuccotti Park, New York, during the Occupy Wall Street live action. Since then, he claims to have received naloxone dozens of times, which allowed him to appreciate the spread of fentanyl in the Northeast. Westfahl said he first heard about fentanyl in 2016 as a dangerous adulterer to avoid. But as the drug began to dominate the local street opioid market, it has changed
"At the time, it was like" beware, there is fentanyl here and he's chasing people, "he said. "But eventually, fentanyl was everywhere, it was in every bag and people prefer it."
According to several people familiar with the use of opioids in the Northeast, fentanyl has become so prevalent that many people are looking for it, including some who have started injecting drugs well. after fentanyl began to replace or greatly increase the heroin sold on the street. But even if someone prefers the more intense and intense heroin of fentanyl, the mechanism of an overdose remains the same and the ability to know if the most potent drug is present can make the difference between life and death for people like James. James showed Microphone how he usually prepares a heroin shot and tests the drugs before consuming.
Taking a slightly wider glbad envelope than a postage stamp, James, who asked that his surname not be published, poured a small pile of off-white powder into a stove, a sterile container used to mix drugs that look like a soda. James measured about 15 cubic centimeters of water in a sterile syringe, injected it into the stove and briefly mixed the heroin over a flame before placing a filter in mix it, tuck it into the syringe and close the needle use it later, privately.
Then James dipped the tape in the water and waited about 15 or 20 seconds before a small bluish color began to creep into the surface of the strip. Slowly, only one line appears, indicating the presence of fentanyl.
The result is not a surprise for James. In New York, at least, each tested bag is fentanyl positive, a prevalence corroborated by Asher's results testing drugs in the Bronx. Nevertheless, knowing for sure that the drug he will shoot in a few minutes contains fentanyl, James said he could take precautions to avoid an overdose. It can inject it more slowly
James said he had never experienced an overdose, in part because he was able to test the drugs as long as he injected them, which he started doing just a few months ago.
"You're just going slowly, because a certain amount will probably kill you," he said.
"With every reform, we get closer to the end goal"
At about the same time Asher started experimenting with fentanyl test strips, other players in the world of harm reduction have also begun to do so. Tino Fuentes, who had previously sold drugs and consumed heroin, and now works as an independent advocate for harm reduction, has worked to bring his daily lives closer to the Bronx drug users. He gained a good reputation for drug testing so that other harm reduction sites in the country began to bring him to train him on the use of bandages.
Christopher Moraff, a journalist and former opioid user who began covering the drug scene in Philadelphia as a continuation of his focus on criminal justice, discovered the Fuentes Bands and began to perform extensive testing of samples from the outdoor drug markets. the Kensington district. Over time, he has also started using morphine strips, which can detect the presence of heroin, and could tell him how to determine if a sample contained both heroin and fentanyl or only one or the other. Over time, as fentanyl appeared in almost all drug samples, he began to focus on crack cocaine vials to check for rumors that fentanyl would be present in the coke stocks of the drug. city. No dice up to now, he says Microphone.
However, as bands began to gain ground across the country, organizations such as St. Ann's were largely prevented from using public funds to pay for them. This began to change in 2018, however, with city governments in Philadelphia cream, San Francisco and Burlington, Vermont, giving the green light to the groups funded by the city and interested in the distribution of the bands.
"Philly is doing a really good job," Moraff said. "With every reform, we are getting closer to the ultimate goal of safer use for all."
Until June, St. Anne, funded in part by New York City, did not have the right to use public funds to buy test strips. Asher bought them with other grants and resources, he said. But this summer, the city quietly gave green light to the 14 syringe programs it funds, including St. Ann's, to begin buying and distributing the tapes, a department spokeswoman said. Microphone.
Officials from the Ministry of Health and Mental Hygiene have initially been reluctant to indulge in inappropriate use of labels. But while other cities were beginning to see their potential, and more particularly after reading the growing scientific support of the bands as an additional way to encourage safer use, the agency said: Denise Paone, who oversees research and monitoring at the Bureau of Alcohol and Drug Use, said in an interview.
"We were concerned that we were supporting and funding test strips, that there was not enough scientific evidence," Paone said. "We encourage organizations to use them as a mobilization tool."
"The best 'you screw' '"
Like many of those working in harm reduction, Asher has his own drug history. A young punk living in a squat on the Lower East Side, he said he lived a wild life, fighting against cops and landowners and taking drugs a lot. He's never been a big opioid lover, but his experiences with "a lot of crack and a lot of methamphetamine" and his frustration with what he's described as the apathy of the Government in the face of deaths caused by overdoses and HIV in marginalized communities have led to harm reduction. job.
"It bothered me enough that a group of people who had never met me had said that my death would have died," he said, as he was traveling from St. Ann to Patterson Park, where his team was doing outreach work on the new day of the week. "So it was the best job I could do for a group of people who said that
With the exception of a few years spent in motorcycle racing, Asher says that since 1992, he has been working through needle exchange programs and other harm reduction providers.
"I will keep myself and my friends, family and loved ones alive, healthy and against you," he said.
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