As fentanyl overdoses rise in Georgia, Kemp OK awaits bill to ease access to lifesaving tests

Georgians are suffering from a rise in fentanyl overdoses as the synthetic opioid finds its way into a growing number of illicit substances across the state.

“We unpack clean syringes and take the dirty ones. We also distribute naloxone (a drug that can reverse the effects of an opioid overdose) and train people in its use. We pretty much cover all the bases from a harm reduction perspective and we’re probably keeping pace with Atlanta,” said Christian Frazier, executive director of Focus on Recovery Augusta. “Nevertheless, we created this program, A because it was necessary, B because it helps us keep our finger on the pulse of the still-using opioid community, and it’s bad.”

The number of fentanyl overdose-related deaths has increased since the pandemic began, increasing more than 106% between May 2020 and April 2021, according to the Georgia Department of Public Health.

Two fentanyl test strips with a positive result. Photo courtesy of Riley Kirkpatrick/Access Point of Georgia Inc. via Georgia Recorder

The department also reported at least 66 visits to the emergency room involving fentanyl-laced drugs nationwide between February and mid-March. In some cases, patients were admitted with a suspected stimulant overdose, but responded when given naloxone. Cocaine, methamphetamine and counterfeit pills are the most common, but other laced drugs, including cannabis products, have prompted emergency room visits, DPH said.

“It seems like there’s just fentanyl in almost everything,” said Mona Bennett, co-founder of the Atlanta Harm Reduction Coalition. “Over the past summer there have been a number of overdose deaths from fentanyl-laced cocaine and fentanyl-laced stimulants.

“We’ve had a few naloxone distribution events at Little Five Points, East Atlanta Village, and a few other locations, and in the past I’ve had to ask stimulant users to please take some Narcan (a brand of naloxone), but now that fentanyl is at Common to stimulants, it is easier to sell.”

Manufacturers mix fentanyl into their medications to increase potency and lower costs, but if users are unaware their supply contains fentanyl, the dose they are used to can be deadly.

There are test strips that can be used to quickly determine if a substance contains fentanyl, but they’re in a legal gray area — you can buy them online at Amazon, among others, but a police officer could consider them a drug-related item.

A bill on Gov. Brian Kemp’s desk seeks to remove strips that test for fentanyl from the drug paraphernalia list to make them more accessible. The governor has until May 14 to sign the law into law, veto it, or do nothing and let it go into effect.

Atlanta Democratic state Senator Jen Jordan, who introduced the idea, said she’s heard from voters who have lost loved ones to fentanyl-laced drugs. She compared the idea to measures the state has already taken to reduce the harm of opioid overdoses, like making naloxone available and enacting a shield law that protects people who call 911 to report an overdose.

“It’s one of those things where it’s hard to acknowledge that people are taking these drugs, right? It’s not great,” she said. “But at the same time, we have such a problem that if we don’t acknowledge it and try to do something to mitigate the damage, we’re going to lose so many more people.”

The test strip policy change took a strange path to passage — it was attached to a bill designed to legalize the sale of raw milk.

Jordan said she nearly abandoned her test strip plan when she realized the section of the state law that dealt with adulterated foods like milk also dealt with adulterated medicines, so she felt a change around test strip language was objectionable would withstand.

Republican supporters of the bill in both houses agreed, and it passed the Senate 42-10 and the House 110-55.

Effective but expensive

The strips work great if you can get your hands on them, Bennett said.

They usually require such a small amount of the substance that users can test it against the residue on the container that the drugs came in, she said.

“It literally takes a few seconds to get a result,” Bennett said. “It’s kind of the opposite of a pregnancy test, where one strip means fentanyl is present in the substance test and two strips say it’s not in the substance. And there are always new analogues, but the test strip recognizes many of them.”

Bennett urges users to reduce their dose if their supply shows the presence of fentanyl. No matter what the strip says, she tells them to always have a friend with Narcan nearby and gives them a hotline to call if they need alone.

She said Atlanta Harm Reduction’s current supply of test strips is limited and comes from donations, but she hopes the rule change means more vendors will carry them and the price will come down.

Right now, a box of 100 single-use test strips averages between $125 and $150, she said.

When you’re serving a large number of daily users, a dollar and a half per strip can quickly add up, especially for a nonprofit organization, Frazier said.

“We get requests for it every day. We explain to them every day why we don’t carry it because it’s expensive,” he said. “We just tell them listen, assume your dope has fentanyl in it and use it accordingly or you’ll be back here tomorrow asking for more narcan. If the price was lower I would definitely stock more of this because I think it has a wide variety of uses not only for the active user community but also for family members and allies, spouses. I wish it was cheaper.”

Fentanyl ubiquitous for addicts

Telling heroin users to expect their drugs to contain fentanyl is not an exaggeration, said Riley Kirkpatrick, program director at the Access Point of Georgia in Athens. A study using spectrometers to analyze substances sold as heroin in Georgia found that 100% of the samples contained fentanyl, he said.

“There’s literally no heroin empty down here,” he said. “People’s heroin is far more likely to contain fentanyl than it actually contains heroin.”

It’s harder to justify allocating resources to test strips for heroin users when a negative test would come as a surprise, but the strips can be useful for people who use other substances, Kirkpatrick said.

“We really only give the fentanyl test strips to people who are using other things they aren’t sure about, like pressed pills now, and there are a lot of pills that people don’t know are pressed” , he said.

Some pills bought from strangers or through social media can be marketed as prescription opioids and molded to actually contain fentanyl.

“Those are the things where it helps even more, like the fentanyl test strips actually help them see if fent is in their stash or not, and sometimes with cocaine,” Kirkpatrick added.

Kirkpatrick said he was encouraged by a group of students who stopped by around New Year’s Eve who were planning to take ecstasy but wanted to make sure their pills didn’t contain fentanyl.

“We had college kids show up and get Fent test strips because they wanted to roll on E, do Ecstasy and MDMA, and that made me really happy,” he said, laughing. “Because we could supply them and they could test their stuff and make an informed decision about what they were doing. As harm reducers, we know people will consume it no matter what, but we can help them be safe.”

Jordan said she hopes that more widespread use of test strips will help inform those who are not regular opioid users that fentanyl may be making its way into their drug of choice.

“I think what we’re seeing in particular is a spike in terms of younger users, free time, maybe a girls’ weekend, whatever it is,” she said. “We’re not even talking about regular users here. So there is an opportunity for enlightenment here, even when talking about these stripes.”

Georgia Recorder is part of States Newsroom, a network of news outlets supported by grants and a coalition of donors as a 501c(3) public charity.