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'Informed Consent': To Reduce Harm, Some Bay Area Venues Are Providing Fentanyl Testing Strips to Patrons

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Fentanyl testing strips on a bathroom shelf, next to other health-safety products.
A shelf in the restroom of Crisis Club Art Gallery in Oakland, which offers free fentanyl testing strips among other harm reduction supplies. (Annelise Finney/KQED)

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Almost a year has passed since Crisis Club Gallery, a community space in Oakland, opened its doors, something that makes co-owner Niko Nada very proud.

"It took a few months of getting a bunch of kids who didn't know about construction to do construction," Nada said. "We built all these walls, we laid everything."

Among other things, the group set up a shelf in the bathroom with a supply of fentanyl testing strips — small pieces of paper that can be used to identify whether a substance contains fentanyl. Anyone who comes into the gallery can take as many strips as they need.

On the shelf are also safe snorting and injection kits, and other products meant to help people who use drugs do so in the safest way possible.

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Having this available at the gallery was nonnegotiable, said Nada, who uses "they/them" pronouns.

"Some places don't want to stock these things because they think that is promoting drug use in their establishment," they explained.

But Nada acknowledges that drug use is a part of many people's lives, and has seen how lack of access to clean supplies or information can make the experience much more dangerous.

A person stands leaning their shoulder against the plate-glass storefront of an art gallery, ankles crossed.
Niko Nada stands outside Crisis Club Gallery in Oakland. Nada believes in a harm-reduction approach to help those who use drugs stay as safe as possible. (Annelise Finney/KQED)

The highly addictive synthetic opioid fentanyl is about 50 to 100 times more potent than morphine. It is often mixed with other drugs, like ketamine, ecstasy, cocaine and heroin to increase potency.

Nada also knows there is now much more fentanyl circulating throughout the Bay Area and the country than there used to be, resulting in an exponential spike in overdoses in recent years.

NPR recently reported a rise in the use of drugs that are mixed with fentanyl, with users often consuming it unknowingly, creating a serious health risk. The spike in availability is particularly pronounced in Northern California, where local Drug Enforcement Administration agents already have seized roughly 163 pounds of fentanyl in pill and powder form so far this year — a 155% increase over last year, the agency said.

The Bay Area, in particular, has been hit hard by the drug. In Alameda County, fentanyl overdoses jumped from 14 to 62 in just two years. Santa Clara County saw the region's biggest fentanyl overdose rate increase, from just 11 cases in 2018 to 72 in 2020.

And in San Francisco, 396 overdoses from the drug were reported in 2020, a sixfold increase over those reported two years earlier. According to the county's medical examiner, just over two-thirds of the city's total overdose deaths this year have involved fentanyl.

Fentanyl testing strips are easy to use and effective, explained Dr. Hannah Snyder, an assistant professor at UCSF and director of the California Bridge program, which focuses on providing health care for people who use drugs.

When people want to use fentanyl testing strips, she said, "they can take a tiny amount out of whatever their drug is. Maybe it's the edge off of a pill or residue." That residue can then be mixed with a small amount of water and dipped in the testing strip. After a few minutes of drying, if two lines appear, that signifies a negative result. Just one line, however, means there is likely some trace of fentanyl in the other drug.

"It's not a perfect test," Snyder said, "but that's really important so a person can say, 'This is a drug that I think is too high-risk for me to take,' or 'This is a drug that I want to take with other people around me to make sure I'm safe.'"

Testing also allows people to make the decisions that can help reduce harm, she added.

Hospitals, health clinics and emergency departments are making these supplies available, too. But according to Nada, venues like galleries and bars can play a big role in increasing the rate of testing.

"[Business owners] have the resources to have a space that can be an influence," said Nada, whose gallery receives testing supplies through a network of friends.

"In places like bars or clubs where drugs are around, whether we are acknowledging [it] or not, [we can be] the nudge in someone's mental shoulder to be like, 'Hey, take care of this.'"

Along with helping to run the gallery, Nada works a few days a week at Telegraph Beer Garden in Oakland, which also offers fentanyl testing strips. The bar receives the strips from FentCheck, an organization run by volunteers that supplies them to around 30 establishments in San Francisco and the East Bay.

"We're trying to normalize. If you're going to do drugs, test them first so you can have some informed consent before you ingest, and then you can make a plan," said Alison Heller, an Oakland resident who launched the project last year after months of extensive community outreach.

Heller said people who occasionally use party drugs like ecstasy or ketamine "don’t think this applies to them. Fentanyl feels to them very much like a heroin issue or cocaine issue."

But those occasional users are especially vulnerable to unknowingly consuming fentanyl, she said.

And although fentanyl testing strips are usually available at harm-reduction clinics, not everybody knows about those sites, or feels comfortable going to them, Heller added. Providing them at clubs, bars and other nighttime venues, she said, is a way of offering them "where the community goes, and destigmatizing the process."

Heller said she hopes making test strips easily accessible in social venues will have as much of a positive impact as did offering condoms in bars during the AIDS crisis in the 1980s.

"[Condoms do] not incentivize having sex in the bar bathroom, nor do fentanyl tests incentivize drug use in the venue," she said.

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Where can you find testing strips in the Bay Area?

The following is a list of some of the establishments that offer fentanyl testing strips through FentCheck. The complete list is available on the FentCheck website:

  • Beauty Bar: 2299 Mission Street, San Francisco
  • The Sycamore: 2140 Mission Street, San Francisco
  • Royal Cuckoo Market: 3368 19th Street, San Francisco
  • Bender's Bar & Grill: 806 South Van Ness Avenue, San Francisco
  • Crisis Club Gallery: 5887 San Pablo Avenue, Oakland
  • Telegraph Beer Garden: 2318 Telegraph Avenue, Oakland
  • Ghost Town: 1960 Adeline Street, Oakland
  • King Kog Bicycle Shop: 327 17th Street, Oakland
  • Oakland Glow Studio: 4454 Piedmont Avenue, Unit A, Oakland
  • The Avenue: 4822 Telegraph Avenue, Oakland

What can be done to prevent an overdose from turning fatal?

Fatal opioid overdoses can be prevented with a drug called naloxone (also known by the brand name Narcan), which temporarily attaches to opioid receptors and reverses and blocks the effects of other opioids. According to the National Institutes of Health, naloxone very rarely causes any serious side effects.

A number of Bay Area counties, including San Francisco and Santa Clara, provide free naloxone/Narcan kits and training for how to use them and for how to recognize signs of an overdose.

Pharmacists in California also are permitted to provide naloxone without a doctor’s prescription.

Additionally, medication-assisted treatment for opioid addiction is widely available. Emergency doctors can prescribe FDA-approved drugs that treat opioid dependence and can arrange for patients to follow up at outpatient centers.

What are common signs of an overdose?

Someone may be overdosing if they're acting groggy and lethargic or are barely able to stand, and if slow breathing grows irregular or even stops altogether. Very constricted pupils in someone's eyes — known as “pinpoint pupils” — that don't expand when exposed to light also are a common sign of an overdose.

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This post includes reporting from Mohar Chatterjee and KQED's Julie Small.

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