The people trading in used needles at Anchorage’s lone syringe exchange are more worried than ever about dying from a drug overdose.
The nonprofit’s staff hear about it anecdotally in short conversations with clients returning old needles for clean new ones, and in the frequency of requests for overdose-reversing medication.
“Guys got Narcan?” asked one man, who later declined to speak with a reporter, as did several others on a recent weekday afternoon.
The Alaska AIDS Assistance Association, or Four A’s, the organization that runs the exchange, also dispenses Narcan, an easy-to-use nasal spray that can halt an overdose from opioid painkillers and heroin. A staffer working out of a white van parked in front of the group’s office near Spenard Road asked the man a few short follow-up questions before handing over a kit with two doses of the medication in a brown paper bag, along with syringes, alcohol wipes and other supplies to help cut down the risks of disease or infection for people who are going to inject drugs. In a two-month period, Four A’s gave out 500 of the kits.
“That is something we’re hearing now, is that people are scared, they’re losing their friends, Narcan saves lives,” said Venus Woods, who oversees the syringe exchange program. “There is a lot of fentanyl in the streets.”
Fentanyl is the chemical culprit behind a growing share of fatal and non-fatal overdoses in the ongoing opioid epidemic, both in Alaska and nationwide. It mimics the effects of conventional opiates like heroin, but is far more potent and can be manufactured relatively inexpensively in industrial labs. In the last several years, it has become more ubiquitous in the American drug supply, most recently in an explosion of counterfeit prescription pills — an issue so alarming it prompted the DEA to issue its first official public safety alert in six years.
The alert this week described “a significant nationwide surge in counterfeit pills that are mass-produced by criminal drug networks in labs, deceptively marketed as legitimate prescription pills, and are killing unsuspecting Americans at an unprecedented rate.”
According to the DEA, transnational drug organizations are combining small but extremely strong doses of fentanyl and similar compounds into pills made to resemble widely abused opioid painkillers and anti-anxiety medications. With no oversight, the potency of such pills can vary widely. The result, according to multiple public health and law enforcement entities, is that people purchase what they believe are pharmaceutical-grade doses of drugs like Oxycontin, Vicodin or Xanax, but are actually counterfeits with potentially lethal levels of fentanyl.
“This is such a crisis, in our opinion, that we need to take some extreme measures,” said Frank Tarentino, the special agent in charge of DEA’s operations in the Pacific Northwest, which includes Alaska.
In an interview from his office in Seattle, Tarantino said the agency had seen a 275% increase in the number of counterfeit pills seized in the region. According to the DEA, in its lab analyses of seized pills, two out of every five of those pills contain enough fentanyl to potentially kill a person.
“There’s no quality control in these pills,” Tarentino said.
According to the DEA, as well as recent reporting by NPR and the Center For Advanced Defense Studies, the counterfeit pills originate with Chinese companies shipping precursor chemicals to industrial labs in Mexico operated by criminal organizations. After the active ingredients are pressed into nearly identical pills to those dispensed from a conventional pharmacist, they are distributed through the same networks that have spent years moving heroin and methamphetamine to markets in American cities and towns.
A growing concern
Police in Anchorage say the knockoff pills are a worsening problem.
“They’ve always been there,” said Sgt. Gregory Witte with the Anchorage Police Department’s Vice unit, “but the counterfeit side of it, I would say, is becoming more common.”
Witte said in his time investigating drugs with APD, he has seen counterfeit pills play a suspected role in overdoses among residents ranging in age from 14 to 70, in part because they are indistinguishable from their legally manufactured counterparts.
“Kind of buyer beware. You don’t know actually what you’re gonna get,” Witte said.
According to APD and the DEA, many of these pills are bought and sold over apps and social media platforms like Facebook, Instagram and Snapchat. One of Witte’s main concerns is that teens or inexperienced drug users might think they are experimenting with relatively safe pharmaceutical products like Xanax, a strong but widely prescribed benzodiazepine that has been romanticized in popular music for years, and instead ingest a lethal dose of fentanyl.
“The greatest concern that I have is the age of some of the victims and the mechanism with which they were purchasing their pills,” Witte said. “It’s all mobile applications.”
State and local health officials who track overdoses have not seen a significant rise in overdoses in the last few years, although the number of drug-related deaths continues nudging upward year over year in Alaska. Nationwide, deaths attributed to opioid overdoses continue to rise, reaching a grim average of 254 a day in 2020. The same year, 146 Alaskans were determined to have died from drug overdose.
“Fentanyl-involved overdoses have increased substantially,” said Elana Habib, a public health specialist with the state’s Office of Substance Misuse and Abuse Prevention. “Fentanyl is driving this right now.”
Alaska saw a brief, significant spike in the number of overdose cases in hospitals this spring. That may have been because of a bad batch of heroin or opiates, but researchers say it’s hard to pin down a single, clear explanation.
Accurate and timely public health data on substance abuse is hard to come by. The numbers of drug overdoses catalogued by ambulance crews, hospital emergency departments and morgues provide a small, extreme glimpse of what’s happening with the drug epidemic.
“We only know about the events that we can see,” said Anna Frick, with the Alaska Section of Epidemiology.
Those working closest to the day-to-day realities of opiate and drug addiction understand there are big delays between trends in the drug supply and data generated by law enforcement and public health officials. And one of their strategies for dealing with those gaps is an abundance of preventive measures, such as giving out free Narcan and other tools for safer drug use.
Byron Kim started volunteering with Four A’s at the needle exchange in 2017, and has since become a staffer, regularly stationed inside the white van for hours at a time.
“I’ve heard a lot of people report deaths of their friends due to overdose, most likely because of fentanyl,” Kim said.
As those concerns have risen, so has the ubiquity of Narcan. Kim said there are plenty of clients who consistently ask for new kits, “sometimes multiple times a week.”
As he spoke, his boss, Woods, took information from a client who asked for Narcan. Woods used it as an opportunity to ask after his overall situation and ultimately sent him away with extra kits of the medication and a bag full of materials.
“He’s camping, and he said he gathers supplies for at least five other people,” she explained.
Along with the Narcan and needles, Woods included a bunch of fentanyl test strips, a relatively new fixture in the syringe exchange’s quiver. The thin, bright green packages are the size of a dental whitening strip. The strips can be dipped in a small, liquefied sample of heroin, methamphetamine, pain pills or other substances, and they change color if they detect any fentanyl.
What they cannot tell a user is how much fentanyl is in that sample. And according to Woods, for people deep in addiction, the mere presence of the powerful substance won’t be enough to keep them from using it.
“When you’re out there and your daily goal is to get high, you don’t really care that there’s fentanyl in it,” Woods said. “Nine times out of 10, if the substance has fentanyl in it, they’re gonna use it anyway. So what we’re trying to make sure people know is that there’s other ways you can use it.”
She’s had clients tell her the strips alerted them to fentanyl in a product before they used, so they injected less of it as a precaution, or smoked it instead.
With more precarity in the drug supply, those kinds of precautions reported back by clients who remain alive constitute little victories for her team.