Announced on May 28, New York City will soon roll out a public education campaign about fentanyl. Encouragingly, it aims to depart from dominant messaging about the drug—like the Trump administration’s “drug free” rhetoric or the Drug Enforcement Administration’s fear-mongering about “fatal” consequences of “just one touch.”
The NYC Health Department instead seeks to translate evidence-based information—like “Fentanyl is an opioid that can’t be detected by sight, taste, or smell when mixed into other drugs,” and “Anyone using heroin, cocaine or crack, even occasionally, may be at risk of fentanyl-involved overdose”—into popular knowledge.
Posters to be showcased in subways, bus shelters, billboards, LinkNYC kiosks, local businesses and the Staten Island Ferry Terminal will advise people to “Carry naloxone”; “Avoid mixing drugs,” especially since “Mixing opioids with alcohol and Xanax, Valium and Klonopin increases the risk of overdose”; and “Avoid using alone,” but “If you do, have someone check on you.”
But the campaign materials make no mention of checking drugs with fentanyl test strips, an “incredibly important” portable tool that can tell users what’s in their bag.
A Health Department representative explained to Filter that the checking tool is not discussed because the “campaign targets a general audience, not just [syringe service program (SSP)] participants,” so in turn, they’ve used “broadly applicable harm reduction messages.” Some harm reductionists, though, argue that fentanyl test strips are also important for people who recreationally use drugs that are increasingly adulterated with fentanyl, like cocaine and methamphetamine—and who might well not be utilizing SSPs.
Drug checking in general has been included in previous Health Department awareness campaigns. Two years ago, a nearly-identical outreach campaign advised “using a small amount first to see how strong your drugs are.”
Even then, though, the poster’s subject matter was on shaky ground with the city government. Almost six months before it officially launched, Medical Reserve Corps (MRC) volunteers, who were working on the campaign, were set to head out in December 2016 with the exact flier (see above) that would later be officially released in May 2017, when ultimately approximately 20,000 of them would be distributed at 42 locations in 15 neighborhoods across all five boroughs. The flyer continues to be distributed as part of the NYC Health Department’s opioid overdose prevention trainings, community events and naloxone dispensing drives, and through Rapid and Assessment and Response field investigations.
A day before, a Health Department press representative informed MRC volunteers that the two-day long event was cancelled “due to circumstances beyond our control,” according to an email reviewed by Filter.
One of the volunteers believes that “the fentanyl outreach project in 2016 was cancelled because people in the mayor’s office thought the recommendations on the flyer ‘condoned’ drug use,” specifically the “Test Your Drugs” tip.
For the most recent campaign, the Health Department stated that “The campaign messages do not ‘promote’ drug use; rather, we offer safer use strategies for a broad audience of people who use drugs and their friends, families, and social networks. Our primary goal is to protect the health of all New Yorkers, and this includes people who use drugs.”
When asked why drug checking and specifically fentanyl test strips are not discussed in the agency’s latest messaging, a Health Department representative told Filter, “The evidence around fentanyl test strips is still emerging—with no peer-reviewed studies on the sensitivity and specificity of the strips published to date.”
The strips also face staunch opposition from the federal government because they are perceived to enable riskier use. In an October 2018 blog post, for example, Elinore F. McCance-Katz, assistant secretary for the Substance Abuse and Mental Health Administration, speculated that supporters of fentanyl strips assume that a “drug user poised to use a drug…is thinking completely logically about his or her drug use,” and she thinks that “this could not be further from the truth.” McCance-Katz goes on to argue that this drug checking tool would enable some users to seek out more potent batches of illicit opioids.
Though this federal opposition is quite different from the position of the NYC Health Department, the skepticism toward the strips is based in both cases in the idea that potentially unforeseen variables—like the strips’ inability to detect potency and suggested oversensitivity—outweigh their role in giving people better understanding of what is in their drugs.
Despite not mentioning fentanyl test strips in its new awareness campaign, the NYC Health Department has cautiously proceeded with making the strips more available. In July 2018, syringe service programs (SSPs) funded by department were permitted to use a portion of the city money to purchase strips. They are to be used as “an educational tool through SSPs so that people who receive strips can also engage other necessary services and receive safer use education,” said the city representative.
City-backed mainstreaming of harm reduction messaging is surely important. At the same time, skeptical city politics imposes limits on the campaigns’ ability to “keep people who use drugs safe,” as Alyssa Aguilera, co-executive director of VOCAL-NY, put it.
The MRC volunteer told Filter, “I think that New York City has a love-hate relationship with harm reduction.”
Photograph by Terabass via Wikimedia Commons