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St. Ann's Corner of Harm Reduction on a busy section of Westchester Avenue in the Bronx, in the shadow of an elevated train track. Inside the facility, bosses can come in from the cold, get a hot meal, and sit in a recliner watching TV or chatting with friends. In one corner, people can pump iron or do pull-ups in a makeshift gym.
Drugs, alcohol swabs, doses of the opioid-overdose-reversal drug naloxone, and other goods to help reduce the risk of intravenous drug use.
St. Ann's operates on the model of harm reduction, which advocates argue is a pragmatic approach to preventing overdose and the spread of diseases by accepting that some people are going to do drugs, and it's better to keep them alive "Just say no." It's not a silver bullet, and it's not supposed to be. Instead, it focuses on meeting the needs of the world, where they are at least as possible, according to Van Asher, a program manager at St. Ann's.
"'Just say no' has not worked," Asher said. "It did not work in the '80s, and it's not working now."
The sterile syringes and other products of St. Ann's have been made to be a staple of harm reduction work. As the Bronx and much of the country begins to see a generation of fentanyl, a potent synthetic opioid 50 to 100 times more potent than morphine, St. Ann's has been on the cutting edge who use drugs try to avoid overdoses.
In early 2017, Asher heard about a pilot project at Insite – a so-called safe-consumption site in Vancouver, Canada, which suggests that a brand of urine test strips should be used to test patients for fentanyl for its presence in samples of addictive drugs including heroin and cocaine. Intrigued by the prospect of a new tool to add to his arsenal of harm reduction tactics, which he ordered some strips, which retail for $ 1 a pop, from Canadian company BTNX.
Asher is one of several street-level activists leading the fight against fentanyl deaths across the country. He has three goals: gathering data on the spread of fentanyl, giving people the ability to test their own drugs and taking care of them, and opening a dialogue with people who use drugs in an effort to help them as possible.
"We need to start having conversations with people about how you are doing something right now there's fentanyl in it," he said.
"We need all the tools in the toolbox"
A pair of recent scientific studies appear to support the idea that urine strips would be useful in detecting fentanyl and helping people make safer choices. In February, a team of Johns Hopkins University researchers released executive summary to a study That's what it was, compared to two types of more sophisticated equipment – which would be of little use to an everyday layperson – the urine strips from BTNX traces of fentanyl. The team is still trying to publish their study in a medical journal, but they released the summary Susan Sherman, a Johns Hopkins professor and one of the lead researchers on the study.
The study also reviews people who use drugs, who are highly sensitive to the idea of testing their drugs, with 86% of them saying they are using the tests, and 70% saying they are likely to change their behavior if the drugs tested positive.
While the strips are more immediately useful to those who use drugs that the machines, they only give a simple "yes" or "no" answer for whether the drugs contain fentanyl or any of three analogues. The strips can not indicate which of these substances may be present.
Still, Sherman said, the strips represent a positive step towards a more effective consumption, one among the array of services to help keep people alive.
"What more do we need to understand that there is a crisis and we need to respond to the tools in the toolbox," she said in an interview. "It takes a lot of different points for people who use drugs.
Another study, published in October by the North Carolina-based Research Triangle Institute, was even more encouraging. It found that people who use drugs in their test if they test positive for fentanyl.
"The bottom line is that fentanyl test strips may represent a new technique to prevent opioid overdose," Jon Zibbell, a public health researcher at RTI who worked on the study, wrote .
The strips are still not approved for clinical use, but BTNX has a major role in the role of a major provider of harm reduction clinics. The company is in charge of a recent conference in New Orleans organized by the Harm Reduction Coalition, and its website features lampoon Johns Hopkins and RTI studies.
"It was in every bag, and people prefer it"
While Fentanyl has gotten a lot of help in the past celebrity Deaths, it is not particularly new. A batch of heroin labeled "Tango and Cash"That was improperly cut with fentanyl sickened and killed many people in New York City in 1991. It reads its head again from 2005 to 2007, when fentanyl contamination killed more than 1,000 people in Illinois, New York, and several other states.
As overdoses have become the leading killer of people in the United States, the number of deaths attributed to fentanyl has risen sharply. In 2017, 72,000 people died in America from all drugs. Fentanyl and its analogues were present in nearly 30,000 of those, according to National Institute on Drug Abuse.
In New York, fentanyl represents an even greater threat. In 2017, which saw 1,487 drug overdose deaths in the city, it was connected to 57% of those deaths, making it the most common substance, according to a postponement released in September.
Illicit fentanyl – which is now more widely produced in Mexico, according to the Drug Enforcement Administration – it is easier to make it easier because it increases the potency of the product. The amount of fentanyl in a given bag is not always the same, so somebody accustomed to a certain dose might accidentally misjudge if they happened to buy a dose of fentanyl than they can handle.
Purpose illicit drug supplies are not regulated, and fentanyl is much stronger than heroin. It is essentially impossible to identify by eyeballing them – one bag can be significantly more powerful than the next one, which can be a factor contributing to a potentially fatal overdose.
For a person with drugs, having an idea of what's in your drugs can make the difference between life and death. Heroin and fentanyl are both opioids, which when taken in large enough doses, suppress heart rate and breathing. This can starve the brain of oxygen, killing the person or cause severe brain damage. An overdose is a race against time to administer naloxone, which is designed to revive the victim by blocking the brain's opioid receptors from absorbing the drugs.
fentanyl absorbs into a person's system faster than morphine or heroin, and a result, people who overdose are knocked flat far quicker. That makes it all the more urgent that anyone who can use fentanyl to take care of themselves, according to Shawn Westfahl, a harm reductionist who works with vulnerable populations in Philadelphia.
Westfahl first trained as a street medic in 2011, and said he performed his first overdose reversal in Zuccotti Park in New York City during the Occupy Wall Street live action. Since then, he says he's a naloxon of dozens of times, which has given him a close-up view of the spread of fentanyl in the Northeast. Westfahl said in 2016, first ad a dangerous adulterant to be avoided. But as the drug began to dominate the local street opioid market, that changed
"At the time, it was like 'watch out, there's fentanyl here and it's putting people out,'" he said. "But eventually it came to the point where it was everywhere, it was in every bag, and people prefer it."
According to many people familiar with opioid use in the Northeast, fentanyl has become so prevalent that many people now seek it out, including those who have started to inject drugs, or who have been trying to get rid of them. But even if someone prefers the quick, more intense of fentanyl to heroin, the mechanics of an overdose remain the same, and the ability to know if the more powerful drug is present can mean the difference between life and death for people like James. James showed Mic how he typically prepares a shot of heroin and tests the drugs before using.
Taking a glassine paper slightly larger than a postage stamp, James, who has asked for a small amount of paper, which is a small amount of water. James measured out about 15 cubic centimeters of water in a sterile syringe, and it was mixed up in the mix, use it later, in private.
Next, James is on the water and waited about 15 or 20 seconds to a small blueish coloring to the front of the strip. Slowly, showing the presence of fentanyl.
The result is not a surprise to James. In New York, at least, every bag that has been tested has come up positive for fentanyl, a prevalence that is backed up by Asher's findings testing drugs in the Bronx. Still, knowing that the dope is going to shoot in a fe minutes contains fentanyl, James said he is able to take precautions to avoid an overdose. He can inject it more slowly
James said he's never experienced an overdose, because he's been injecting them, which he has been doing for several months.
"You just go slow, cause some amount will probably kill you," he said.
"With every reform we get closer to the end goal"
Around the time Asher began experimenting with fentanyl test strips, others in the world. Tino Fuentes, who formally dealt with drugs and used heroin, and now works as an independent harm-reduction advocate, rolled up the strips into his daily outreach with people who use drugs in the Bronx. He has been developing a relationship with other people in the world.
Christopher Moraff, a journalist and educator opioid user who has been covering the drug scene in Philadelphia as an extension of his focus on the crime of criminal justice. the Kensington neighborhood. Over time, he also began using morphine strips, which test for the presence of heroin, and could tell him or her an ability to identify whether the sample was both heroin and fentanyl or just one or the other. Over time, he began to focus on the subject of cocaine, in a quest to verify rumors that he was showing up in the city's coke supply. No dice so far, he told Mic.
But even though the strikes were started, the organizations like St. Ann's were largely outlawed. That's going to change in 2018, however, with city governments in Philadelphia, San Francisco and Burlington, Vermontdistributing the strips.
"Philly is doing a really good job," Moraff said. "With every reform we get closer to the end goal, which is safer use for everyone."
Until June, St. Ann's, which is funded by New York City, has been used as a tool for public funding, so he said. But this summer, the city is quietly rumored to be one of the biggest markets in the country. Mic.
Officials with the Department of Health and Mental Hygiene have been in charge of giving thumbs up for an off-label use of the strips. But as other cities began to see their potential, and particularly after the growing scientific support of the stratum, the agency relented, Denise Paone, who oversees research and monitoring in the department's Bureau of Alcohol and Drug Use, said in an interview.
"Paone said," We had a concern in the context of the support and funding test. "We encourage the organizations to use them as an engagement tool."
"The best possible 'screw you'"
Like many others, Asher has his own history with drugs. As a young punk living in a squat on the Lower East Side, he said he lived a wild life, fighting cops and landlords and doing a lot of drugs. He was never big in opioids, but his experiences with "a lot of crack and a lot of meth," and his frustration at what he describes as the government's apathy toward the deaths work.
"I would have been okay if I died," he said, as he drove from St. Ann's to Patterson Park, where his team was doing outreach work on a recent weekday. "So doing this work was the best possible 'screw you' I could come up with a group of people who said that
With the exception of some years of motorcycle racing, Asher has been saying that even when it does so, it has to be done in the past.
"I'm going to keep myself, my friends, my family, my loved ones alive, healthy and fighting you," he said.
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