CHICAGO — The steps are simple: Mix a few grains of the drug sample with a ketchup cup’s worth of water, dip a tiny strip of paper and wait.
Within minutes, the strip displays results: One line means there is fentanyl, and two lines mean there isn’t.
That paper, which can detect any presence of fentanyl in a substance, is one of the latest tools Chicago officials and social service organizations are using against the deadly opioid that has infiltrated the city’s illicit drug supply and is responsible for most of its fatal overdoses in recent years. The Chicago Department of Public Health began offering these fentanyl test strips to the public for the first time in October.
The free kits include the strips, ketchup cups, a stirrer and sterile water, along with instructions and information on how to seek treatment. Interested people can email OSU.CDPH@cityofchicago.org to request them for pickup or mail delivery.
So far, more than 7,000 strips have gone out, mostly to groups that tackle substance abuse, said CDPH behavioral health Medical Director Dr. Wilnise Jasmin. She said the names of individuals requesting a kit are protected and the city does not track who requests them.
“The drug supply content has changed so much,” Jasmin said. “Normal drug tests may test for heroin or related morphine products. But they don’t necessarily detect fentanyl specifically, and so that’s why we are trying to encourage the fentanyl test strips.”
The Cook County Department of Public Health also has a supply of fentanyl test strips that it distributes to community partners in the city and suburbs. A training video and other material on using the strips is at bit.ly/FTStraining.
Fentanyl is a highly addictive synthetic opioid that is manufactured by pharmaceutical companies primarily for patients suffering from severe pain. But in recent years it has been illegally mass-produced and cut with other street drugs like heroin, cocaine, MDMA or even counterfeit supplies of prescription pills such as Xanax.
Its appeal in the black market stems from it being 50 times stronger than heroin and 100 times stronger than morphine. That means illegal drug manufacturers can use less of it to deliver the same high to its users — but with often deadly consequences.
Fentanyl is now the leading cause of fatal opioid overdoses in Chicago, a crisis exacerbated when the COVID-19 pandemic isolated drug users and closed U.S. borders to the usual heroin and cocaine supplies, experts say.
But Taylor Wood, a drug-checking technician with the Chicago Recovery Alliance, said this latest drug epidemic stretches further back, to when pharmaceutical companies peddled highly addictive opioids to doctors, only for their patients to be cut off upon further scrutiny of the drugs. That left a population still substance-dependent turning to the streets for relief.
“It’s kind of an unfortunate, perfect storm for why fentanyl is so prevalent right now,” Wood said.
Cook County registered a record number of opioid-related deaths in 2020, according to the medical examiner, which found many cases originated from Chicago’s West Side. Although so far this year the city’s opioid deaths have decreased compared with this point in time in 2020, the share that stems from fentanyl use continues climbing. About 88% of all fatal opioid overdoses in Chicago this year are related to fentanyl, according to the medical examiner, compared with 83% in all of 2020 and 74% in 2019.
Nationwide from April 2020 to April 2021, fatal drug overdoses topped 100,000, a 28.5% increase from the same period a year earlier, according to the Centers for Disease Control and Prevention. The CDC approved federal funding for fentanyl test strip purchases in April, which allowed CDPH to begin distributing them in October.
Robert Banks, a social worker with the University of Illinois at Chicago’s Community Outreach Intervention Projects, knows the dangers of fentanyl personally. His grandson fatally overdosed on the opioid a couple of years ago while in Michigan, Banks said. He was 22.
The specter of fentanyl is ever-present in his job too.
“It’s a whole different ballgame out here now with this fentanyl,” Banks said. “It seems like every other week I’m injecting somebody with (the overdose-reversing medication) naloxone to bring them back.”
Banks, who began distributing fentanyl test strips for his job about six months ago, said he doesn’t know if his grandson would have benefited from them because he hid his drug use from his parents and may not have been receptive to help.
Still, Banks said the strips are useful as one tool among several in the fight against the opioid epidemic. Beyond offering the testing kits, outreach groups like Banks’ work to offer access to recovery treatment and education on how to minimize risks for those who will still do the drug.
Then there are those who have built tolerance to fentanyl and do not fear ingesting it. Wood, the drug technician, said it’s still important they get information on what’s in their drugs so they can adjust their dose, pace themselves and make sure someone else is present in case of an overdose.
“Most of our dope users will use regardless,” Wood said. “It’s more so just providing them with the information so they can maybe use less.”
The Chicago Recovery Alliance has distributed the strips for years now, Wood said. Though some who believe in drug abstinence may balk at such an invention, Wood said that’s not realistic from a public health standpoint given how powerful addiction is.
Harm reduction tools such as fentanyl strips have proved effective in shifting attitudes on drug use, Jasmin, the CDPH medical director, said. A 2019 study by Brown University researchers found about half of young adults who recently used drugs and were given fentanyl test strips changed their behavior after detecting the opioid’s presence.
“The whole concept of harm reduction is to allow the person who uses drugs the opportunity to have another chance of staying alive,” Jasmin said. “If a person is alive, that will be the opportunity to talk to them about their options when it comes to going into recovery.”