State health officials expect that when the final numbers are accounted for, more than 2000 Marylanders will have died from opioid overdoses in 2018. And the number one opioid killer is fentanyl.
In the past two years, fentanyl-related fatal overdoses have doubled in Maryland, according to the state health department.
Fentanyl looks just like heroin, but it’s cheaper - and deadlier. A typically lethal dose of heroin is 30 milligrams. A lethal dose of fentanyl is only two to three milligrams.
And it’s often mixed with heroin or cocaine. So, scientists and public health experts have begun distributing fentanyl test strips, thinking they’d help those with opioid addictions check their drugs and avoid the ones with the extremely lethal drug.
But they’re learning that’s not how it’s working out on the street.
On a frigid morning in early March, health workers had set up a card table with kits of the test strips, condoms and Narcan--all tools to reduce the risk of disease or overdose in the world of drug use –near a busy alley in Southwest Baltimore where drugs were being sold.
Roichelle Johnson, one of the health workers, had been in that alley. Or, as she put it, “in the hole.”
“They up there purchasing, doing what they do,” she said. “And we waiting for them to come out to give them a kit with the fentanyl strips."
Johnson works for Bmore POWER, part of Behavioral Health Systems of Baltimore, a non-profit connected to the city health department. She says she handed out more than a dozen kits that morning.
Darryl Burrell, who leads this outreach team, says dealers, like the ones up in the hole, give out free samples, called testers. And that’s where the problems lie.
“Once they give out the tester, you have a lot of overdoses happening,” he explained. “You might have 60 testers. It might have fentanyl in it. You might have 4 or 5 overdoses at that time.”
But many with opioid addictions want the drugs laced with fentanyl when they hear somebody overdosed on them, says Takeya Brittingham, Burrell’s partner at the card table.
"That’s what they chase,” she says. “They want it because somebody overdosed on it. That means it’s good.”
She and Burrell say those addicted ask dealers for the drug by name, using the street slang, “fit.”
So, rather than serving as a deterrent, a positive fentanyl test strip becomes an enticement to many of the people addicted to opioids, they say. It shows their drugs will give them the highest high they can get.
But that’s not everybody, Burrell adds.
“Some people don’t want the fentanyl. I’m not saying they gonna throw it away. It’s hard for someone to throw drugs away because they addicted.”
For years, scientists and experts studied whether drug users would avoid drugs they knew were laced with fentanyl.
Unfortunately, say Burrell and Brittingham, a positive test strip does not guarantee those drugs won't be used. But, says Burrell, users might change their behavior in another way.
“We seeing and hearing that people aren’t slamming it anymore,” he said. “If you shooting take it slow, don’t slam it. You know – don’t shoot it all at once.”
That could at least reduce the risk of overdose a little bit.
Counselors call that “harm reduction.” It’s meant to promote safer drug use, which, the theory goes, will keep those addicted alive and available to the options for recovery.
“I don’t know if just telling people to stop using drugs, they gonna stop using drugs,” Burrell says. “It don’t work like that.”
Experts say a person addicted to opioids who finds a successful path to recovery will have tried treatment numerous times.
One outreach worker – himself once addicted, said the road to recovery is a “continuous pursuit”.
That’s why Burrell and his team are out here, trying to get their kits with the condoms, the narcan and the fentanyl test strips into the hands of as many people as they can.
“We trying to get the information out,” he says. “We give them the narcan and the strips – but we also give them information about recovery, too.”
Some walk out of the alley where drugs are being sold and brush past them. Others quickly cross the street, avoiding the card table. And some take the kits. They know they need it.
“We trying to offer them hope because there’s a lot of despair out here,” says Burrell.
Whether that hope translates to treatment is tomorrow's story.