The Carroll County Health Department is poised to introduce a new harm reduction tool in the public health battle with opioid addiction: fentanyl test strips.
Fentanyl is a synthetic opioid drug many times more powerful than morphine or heroin, which has increasingly been blamed for driving up the number of fatal drug overdoses in Carroll County and across Maryland — when drug dealers mix fentanyl in with heroin, it’s possible to get a wildly more powerful dose than the user was bargaining for.
Putting fentanyl test strips in the hands of users who are not yet able or willing to stop using could be a strategy to mitigate that, according to Cathy Baker, deputy local behavioral health authority at the Health Department.
“We know the user is going to use one way or the other,” she said. “The majority of our overdoses already this year alone are fentanyl overdoses.”
There were nine deaths in the first six months of 2019 blamed on fentanyl, four on heroin and one death on other illicit drugs, according to statistics compiled by the Carroll County Sheriff’s Office. Another 19 deaths in that period of time are still unattributed awaiting review by the Office of the Chief Medical Examiner.
The test strips are actually urine test strips, according to Baker, and will be simple to use and fit in with the ritual heroin users go through before injecting their drug.
“They would add sterile water to the powdered heroin and then they cook it on the spoon,” she said. “Then prior to injecting, they are encouraged to dip the strip in and let it process for 30 seconds or a minute or whatever, and either turn up positive or negative for fentanyl.”
A line showing up indicates the presence of fentanyl, “Like a pregnancy test,” said Lisa Pollard, care coordination manager at the health department. But the recommended course of action is a bit different, she notes, beginning with users using less than they would normally use at one time, and having the opioid antidote naloxone, also known as Narcan, on hand.
“We always encourage the users to not use alone, to use with somebody where if you got into trouble somebody could rescue you," Pollard said. “Have someone available with Narcan.”
The Health Department will have 3,000 of the test strips available, at least initially, according to Pollard. Those are Carroll’s portion of 58,020 distributed to 27 organizations around Maryland, according to Maryland Department of Health Spokeswoman Deidre McCabe, and it is a pilot program.
“Made a one-time purchase of fentanyl test strips with $67,000 in federal grant funds,” McCabe wrote in an email. “There is no ongoing budget for this program.”
But it is a program housed within the newly formed — as of February — Center for Harm Reduction Services within the Maryland Department of Health’s Public Health Services Administration, according to McCabe, which has a $20 million budget.
“Maryland is one of four states with an office dedicated to establishing and improving services for people who use drugs,” she wrote in an email.
Distribution of fentantyl test strips to the public likely will not begin in Carroll County until late August at the soonest, according to Pollard, as the Carroll County Health Department develops a plan for distributing the test strips to those that need them most and making use of the department’s partnership with Carroll Hospital and both organizations peer recovery specialists, people in long term recovery that can help counsel those seeking help.
“We’re just not going to hand them out at the front window, we’re going to want to try and get some engagement with them to find out where they are, is there anything else we can help them with,” Pollard said. “We’re going to want to have a conversation.”
And conversations are part of the evidence that fentanyl test strips will actually affect behavior in a positive way, and keep people alive. That’s according to Heather Asbury, one of the peer recovery specialists at the health department, who has already been discussing the forthcoming test strips with the people she works with.
“A lot of people are very interested in them and I have asked what kinds of harm reductions skills they would practice,” Asbury said. “They said they would not use alone, they would make sure they have their Narcan and probably use a lot less than they normally would if they didn’t know there was fentanyl.”
Asbury speaks from experience. Being a peer, she can recall her own long struggle with heroin addiction, and how despite her being unable to quite using for a long time, she was not oblivious to the dangers.
“Unfortunately, not everybody is ready to completely stop just yet,” she said. “But I wasn’t suicidal.”
Asbury points to years of messaging about the dangers of using alone with fentanyl in the drug supply, and the availability of naloxone to the public — Asbury helps train people in its use — as a possible driver behind reduced numbers of overdoses for the first half of 2019.
According to Pollard, the Health Department distributed 1,352 doses of naloxone from January though June.
“I believe Narcan is a huge contributor to the number trends,” Asbury said.
And fentanyl test strips could be an effective next step, according to Baker.
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“It’s a harm reduction — it saves people’s lives,” she said. “It’s just another tool in the tool kit.”