Fuentes is on to something many Americans aren’t aware of. Despite what mainstream coverage would have you believe, at least half of opioid overdose deaths are from illicitly manufactured fentanyl--not prescription painkillers or heroin. This detail matters because our strategies to prevent opioid overdose deaths won’t work if they’re targeted at the wrong problem. But before we start talking about solutions, it’s important to look at the stages of the opioid crisis that got us here in the first place.
Though some may view Fuentes’ approach as a half measure, it saves people’s lives at a time when life expectancy in the United States has dropped for two years in a row.
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It all started with the pain pill epidemic, with the overprescribing and abuse of prescription opioids. As doctors became more wary and new regulations restricted the prescription of opioids, the supply of pain pills diverted to the black market shrank, so they became more expensive on the street. Many users who’d become dependent on opioids switched to cheaper, more readily available heroin.Despite efforts to reduce the supply--such as spraying poppy plants, seizing drugs and arresting traffickers--the heroin supply in the U.S. grew, keeping prices at a historic low. But like any consumer, drug users are looking for most quickly attainable, most cost-effective product--and drug dealers take advantage accordingly. Our failure to recognize drug users as shoppers looking for the best deal--just like the rest of us--is part of the reason that cheap, potent fentanyl is on the rise and driving a big spike in deaths.
Because fentanyl and other cheap analogue drugs are far more potent than heroin, you don’t need as much to get high or, more importantly, to die from an overdose. Because fentanyl has a much smaller footprint, it makes it easier for dealers to evade detection by law enforcement. Dealers can also boost their profits by adding fentanyl to weak batches of heroin and using it to make counterfeit prescription pain pills. Meanwhile, users have no idea what they’re really taking--and the results are lethal.
As the death toll from opioids continues to climb, we must ask ourselves: what can we do now to start saving lives?
In the 1990s, the Dutch government set up a Drugs Information Monitoring System (DIMS), where drug users can anonymously submit their drugs for testing and find out whether they contain fentanyl or other deadly substances. This information gives users the opportunity to adjust their behavior accordingly. DIMS also functions as a monitoring system, issuing national media warnings when especially lethal substances are detected, and shares some of its data with law enforcement agencies--not to prosecute individual users and low-level dealers, but to locate the source of new or deadly drugs.Tino Fuentes is a lot scrappier. As a freelance harm reduction worker, he doesn’t get caught up in red tape. Fuentes buys test strips--originally intended for use by health care providers to check urine for fentanyl--for about a dollar each, and uses them to see if fentanyl or other analogues are present in a user’s drugs. After he tests a batch, Fuentes talks to the user about how to inject drugs more safely: use with a buddy so that someone is available to administer naloxone, call 911 and give mouth-to-mouth if the other person starts to overdose.The American opioid overdose epidemic is unprecedented. If we want to save lives, if we think these lives matter, we’ll need to open ourselves to novel, even radical, solutions. We’ve got to start by arming users with the information and tools they need to protect themselves. A good place to start is by donating to Tino Fuentes’ GoFundMe Campaign or the Harm Reduction Coalition. Free your mind, think big and act.
The American opioid overdose epidemic is unprecedented. If we want to save lives, if we think these lives matter, we’ll need to open ourselves to novel, even radical, solutions.