People who sell used needles at the Anchorage Isolated Syringe Exchange are more worried than ever of dying from a drug overdose.
Staff at the nonprofit hear about it anecdotally in brief conversations with clients who return old needles for clean new ones, and in the frequency of anti-overdose drug requests.
“Do the guys have Narcan?” Asked a man, who later declined to speak to a reporter, as did several others on a recent weekday afternoon.
The Alaska AIDS Assistance Association, or Four A’s, the organization that runs the exchange, also distributes Narcan, an easy-to-use nasal spray that can stop an overdose of opioid pain relievers and heroin. A member of staff working in a white van parked outside the group’s office near Spenard Road asked the man a few brief follow-up questions before handing a kit containing two doses of the drug into a brown paper bag, along with some syringes, alcohol wipes, and other supplies to help reduce the risk of illness or infection for people who will inject drugs. In two months, Four A distributed 500 kits.
“This is something we hear now is that people are scared, they are losing their friends, Narcan is saving lives,” said Venus Woods, who oversees the needle exchange program. “There is a lot of fentanyl on the streets. “
Fentanyl is the chemical culprit in a growing share of fatal and non-fatal overdoses in the ongoing opioid epidemic, both in Alaska and across the country. It mimics the effects of conventional opiates like heroin, but is much more potent and can be made relatively inexpensively in industrial laboratories. In recent years, it has become more ubiquitous in the US drug supply, most recently with an explosion of counterfeit prescription pills – a problem so alarming that it prompted the DEA to issue its first official public safety alert. in six years.
This week’s alert described “a significant nationwide increase in counterfeit pills that are mass-produced by criminal drug rings in laboratories, deceptively marketed as legitimate prescription pills, and kill unsuspecting Americans at an unprecedented rate “.
Transnational pharmaceutical organizations are combining low but extremely high doses of fentanyl and similar compounds into pills designed to resemble widely consumed opioid pain relievers and anti-anxiety medications, according to the DEA. Without supervision, the potency of these pills can vary widely. The result, according to several public health and law enforcement entities, is that people buy what they believe to be doses of pharmaceutical grade drugs like Oxycontin, Vicodin, or Xanax, but are actually counterfeits with life-threatening levels of fentanyl.
“It is such a crisis, in our opinion, that we must take extreme measures,” said Frank Tarentino, the special agent in charge of DEA operations in the Pacific Northwest, which includes Alaska. .
In an interview from his office in Seattle, Tarantino said the agency saw a 275% increase in the number of counterfeit pills seized in the region. According to the DEA, in its laboratory analyzes of the pills seized, two out of five of these pills contain enough fentanyl to potentially kill a person.
“There is no quality control in these pills,” Tarentino said.
[With overdose deaths soaring, federal regulators warn of fentanyl-laced painkillers sold online]
According to the DEA, as well as recent reports from the NPR and the Center for Advanced Defense Studies, the counterfeit pills come from Chinese companies that ship precursor chemicals to industrial laboratories in Mexico operated by criminal organizations. Once the active ingredients are squeezed into pills almost identical to those dispensed by a conventional pharmacist, they are distributed through the same networks that have spent years getting heroin and methamphetamine to markets in American cities.
A growing concern
Anchorage police say counterfeit pills are a growing problem.
“They’ve always been there,” said Sgt. Gregory Witte of the Vice Unit of the Anchorage Police Department, “but the counterfeit side, I would say, is becoming more and more common.”
Witte said that while investigating drugs with APD, he saw counterfeit pills play a suspected role in overdoses among residents between the ages of 14 and 70, in part because they could not be distinguished from their counterparts. legally manufactured.
“Kind of buyer, beware. You don’t really know what you’re going to get,” Witte said.
According to the APD and DEA, many of these pills are bought and sold on social media apps and platforms like Facebook, Instagram and Snapchat. One of Witte’s main concerns is that teens or inexperienced drug addicts might think they are experimenting with relatively safe pharmaceuticals like Xanax, a strong but widely prescribed benzodiazepine that has been romanticized in popular music for years, and ingest a lethal dose of fentanyl instead.
“The biggest concern I have is the age of some of the victims and the mechanism by which they bought their pills,” Witte said. “These are all mobile apps.
State and local health officials who track overdoses have not seen a significant increase in overdoses in recent years, although the number of drug-related deaths continues to rise year on year in Alaska. Nationally, deaths attributed to opioid overdoses continue to rise, hitting a grim average of 254 per day in 2020. That same year, 146 Alaskans were determined to die of drug overdose.
“Fentanyl-related overdoses have increased dramatically,” said Elana Habib, public health specialist in the state office for the prevention of drug addiction and substance abuse. “Fentanyl is driving this right now.”
Alaska saw a brief and significant increase in the number of overdose cases in hospitals this spring. Maybe it’s because of a bad batch of heroin or opiates, but researchers say it’s hard to find a single clear explanation.
[From June: Alaska is in the midst of a statewide surge in heroin-related overdoses]
Accurate and timely public health data on drug addiction is difficult to obtain. The overdose numbers recorded by paramedics, hospital emergency departments and morgues give an extreme little glimpse into what’s going on with the drug epidemic.
“We only know the events that we can see,” said Anna Frick, of the Alaska Epidemiology Section.
Those who work closest to the day-to-day realities of drug and opioid addiction understand that there are big lags between drug supply trends and the data generated by law enforcement and public health officials. . And one of their strategies to fill these gaps is an abundance of preventative measures, such as the free distribution of Narcan and other tools for safer drug use.
Byron Kim began volunteering with Four A during the Syringe Exchange in 2017, and has since become a staff member, regularly parked inside the white van for hours.
“I have heard a lot of people report their friends overdose dying, possibly from fentanyl,” Kim said.
As these worries grew, so did Narcan’s ubiquity. Kim said there are a lot of customers who are constantly asking for new kits, “sometimes several times a week.”
As he spoke, his boss, Woods, took information from a client who asked for Narcan. Woods took the opportunity to inquire about his general situation and eventually sent him back with additional medicine kits and a bag full of supplies.
“He’s camping and he said he’s gathering supplies for at least five other people,” she explained.
Along with the Narcan and the needles, Woods included a bunch of fentanyl test strips, a relatively new item in the syringe exchange quiver. The thin, bright green wrappers are the size of a tooth whitening strip. The strips can be soaked in a small, liquefied sample of heroin, methamphetamine, pain relievers, or other substances, and they change color if they detect fentanyl.
What they can’t tell a user is how much fentanyl is in that sample. And according to Woods, for people who are deeply addicted, the mere presence of the potent substance will not be enough to stop them from using it.
“When you’re out there and your daily goal is to get high, you don’t really care if there’s fentanyl in it,” Woods said. “Nine times out of 10, if the substance contains fentanyl, they’ll use it anyway. So what we’re trying to let people know is that there are other ways to use it.
Customers have told him that the strips alert them to the fentanyl in a product before they use it, so they inject less as a precaution, or smoke it instead.
With more precariousness in the supply of drugs, these kinds of precautions reported by clients who remain alive constitute small victories for his team.