BOSTON — Her T-shirt bears the words NO MORE DRUG WAR.
It’s an indication that Aubri Esters is somewhat at peace with her occasional drug use. Over a nearly 20-year span, the Boston resident has even injected heroin, but several years ago, Esters noticed something sinister creeping into Boston’s heroin supply: fentanyl -- a synthetic opioid used medically for severe pain.
"It was becoming more common," Esters said. "People were overdosing a lot harder... a lot faster."
No wonder. Fentanyl is about 50 times more potent than heroin and it’s become a major factor in overdose deaths in Massachusetts. According to the Massachusetts Department of Public Health, almost 10,000 people have died of overdoses statewide since fentanyl made its way into the local drug supply.
Esters, a member of the Boston Users Union, a group that lobbies to make drug use safer, had heard about the use of fentanyl test strips in Canada. These gave users a simple way to check for the presence of fentanyl in whatever drug they planned to take. Esters was eventually able to help bring the strips to Boston.
"People knowing what's in their drugs is important," she said. "We all deserve to be healthy and safe and be able to know what we're putting into our bodies."
That may be truer now than ever, suggests Andrew Musgrave, senior director of Legal Services and Special Projects at the Fenway Health Center in Boston.
That’s because fentanyl is now showing up in many more places than heroin, and that could have deadly consequences to the unsuspecting drug user.
"Fentanyl has been found in methamphetamine, cocaine, MDMA. It's been found in pressed pills," Musgrave said. "It basically continues to spread."
The Fenway Health Center is one of many spots in Massachusetts that distributes fentanyl test strips free of charge.
“The test strip program is very effective in informing people about what they’re using,” Musgrave said. “At that point, they can make a choice about what to do.”
Locally, Musgrave has seen positive changes in behavior as a result. So did researchers at Johns Hopkins University. That study found 70 percent of drug users interviewed changed plans if their drug tested positive for fentanyl -- either forgoing the drug altogether or reducing the amount used.
“Nothing is 100 percent,” Musgrave said. “But any impact you can make to change someone’s behavior to use in a safer manner means someone’s going to live.”
The test strips do have limitations because they have not been able to keep up with the many variants, or analogs, of fentanyl that has been popping up in Boston’s drug supply.
The strips only give a yes or no on the presence of fentanyl but it could be any kind of fentanyl, and there are some critical, life-and-death distinctions. Carfentanil, for example, is 10,000 times more potent than morphine and is legally used as a sedative for animals as large as elephants. Perhaps a few grains of carfentanil could be enough to kill a human.
"One analog could spell disaster," Aubri Esters said. "Another could be something a person is used to."
But for about a year now, drug users in Boston have been able to get a more detailed read on what they’re about to take through a pilot program run through AHOPE, a Harm Reduction program that also offers such services as clean needle exchanges.
Located behind Boston Medical Center, AHOPE is equipped with two, high-tech machines that go far beyond the ‘yes’ or ‘no’ of the fentanyl test strips.
"We like to start with this machine because it doesn't destroy the substance," said Dr. Traci Green from Brandeis University, who is working with AHOPE on the project. "We put a very small quantity on this plate and then secure it with this arm."
The machine she is referring to uses infrared technology to look at the light emitted by a substance. Green said the machine is useful to give ‘the anatomy’ of the drug supply -- that is, what the drug’s been ‘cut’ with -- whether that be an inactive ingredient like lactose or something with pharmacological activity, such as caffeine.
“Without any information, we’re in this big black box of great unknowns and huge risk,” Green said. “We’ve had an enormous health crisis and it’s a tragedy beyond words.”
Machine number two can delineate the type of fentanyl present in a sample.
"The device that we use is called the MX908," said Clare Schmidt, a program coordinator for AHOPE. "It's a high-pressure mass spectrometer. It heats up the samples to the point the molecules fracture apart and then looks at the weight of those molecules."
"Most people bring in, like, empty Baggies," Schmidt said, as she swabbed drug residue from plastic to three test strips. Within minutes, the tests were done. "So this came back as meth," she said.
Had the sample come back as a potent form of fentanyl, an AHOPE counselor would have dispensed life-preserving advice, such as recommending reducing the amount of the drug taken or not taking it at all.
AHOPE Program Director Sarah Mackin said the point is not to tell drug users what to do, but give information.
“So we’re losing 70,000 people a year from opiate overdose and the idea that people can’t have access to information that might be life saving or might help them change their behaviors around the drug that they’re using, regardless of whether it’s legal or illegal I mean that’s been something that harm reductionists have been wanting to do for a very long time.”
To those who would suggest it’s a waste of time and money to try and change a drug user’s behavior, Mackin said this, “Every person that comes through this door has value Every human. Every human life has value. So that’s sort of what we’re about.”