It's noon at the Outside In needle exchange program in downtown Portland and a half dozen people are waiting for the doors to open. Outside In is one of Portland's largest programs for homeless youth, offering a range of services from health care to education and employment assistance.
The people visiting on this day have come to exchange used needles for clean ones — so they can inject drugs without fear of contracting diseases like hepatitis or HIV. Some are also here to test their own supply.
"Cause there were a lot of people in downtown that overdosed within like a couple of days radius of each other. And everyone was like, obviously it had something to do with the dope,” said a 28-year-old woman, who OPB is only identifying as Sarah because of her illegal drug use.
She said she recently checked her heroin.
“I just decided I should bring some in and get it tested to find out exactly what was in it and how strong it was,” she said.
She said many heroin users have been using for years, have a job and somewhere to live. So it’s not surprising they’d want to protect their health by checking their drugs.
“People need to have a brighter idea of that because they could be your next door neighbor, watching your kids, addicted to heroin. And you would have no idea,” she said.
Outside In's Haven Wheelock runs the program that checks illegal drugs for fentanyl, an opioid up to 100 times stronger than morphine. Wheelock said people are overdosing because the cheap and powerful synthetic opioid is being mixed-in with the local drug supply.
She said checking for fentanyl is really quite simple.
“So people can bring in a residue from mixing their drugs, typically in like a little mixer, or a spoon or a baggie. And they can bring those into us. We put a little bit of water into that residue. You just dip the white end into the water, hold it there for about 30 seconds and then you’ll see if it has one line it’s positive and two lines it’s negative,” said Wheelock, describing a process similar to using a home pregnancy test.
They were originally designed for doctors to test patient urine for fentanyl.
Wheelock said Outside In started the program two years ago, after a study out of Johns Hopkins showed test strips could detect fentanyl in all kinds of drugs – and that people would change their behavior if they found fentanyl.
“We decided at that point that it was a tool that we could afford to give out and that we should be giving out,” she said.
The strips cost Outside In about $1 each and they hand out about 100 month, for free.
Wheelock said people ask for the strips if they’ve found a new supplier they don’t trust, if they’ve recently heard of someone overdosing, or if their drugs just don’t look right. Heroin tends to be yellowish, while fentanyl is white.
The Centers for Disease Control and Prevention are predicting a four percent increase in overdose deaths in Oregon this year – to about 560 people.
Wheelock said Outside In hasn’t done a study to prove the test strips are reducing overdoses. But she’s heard of people reducing their dose when fentanyl is found — and throwing the drugs away.
Meanwhile, drug possession remains strictly illegal. But Portland Police Sergeant Brad Yakots said they’re not making it a priority to bust people for drug possession while they're waiting to test their heroin.
“We would prefer that our homeless youth, they don’t use. But we understand that the reality is that they do. We are happy that there’s a message getting out that fentanyl is very dangerous and that you need to have a plan if you decide to use heroin,” said Yakots.
The Oregon Health Authority takes a similar view. A spokeswoman described Outside In's work as being in-line with the state's core values of protecting health.
Michael Gilbert, an epidemiologist and a national expert on drug use, said drug checking is becoming increasingly common. For example, a program called DanceSafe tests drugs at festivals and concerts. And there's a website called Ecstasydata.org that will check samples sent in anonymously through the mail.
“So the submission is anonymous, but they know what’s theirs,” explained Gilbert.
The site has a long list with a picture, a code and description like: Codeine from Colorado. LSD from Switzerland, or Ketamine and Caffeine from Austria. Gilbert thinks drug checking can only help.
“We’ve been testing people’s bodies for drugs for years. What we haven’t done effectively is test their baggies before the products go into their bodies,” Gilbert said.
More broadly, Gilbert thinks extensive testing could change a marketplace. It’s likely to make drugs purer, as people learn not to buy from dealers who mix-in unwanted compounds. Gilbert said that’s good because it means people are more likely to know what they’re putting into their bodies. He draws a parallel with beer, wine and spirits, where alcohol percentages are listed on the labels.
Back on the street, Sarah said she lives in a tent on the side of the highway and is trying to return to her family back east. Contrary to the belief of some, she said, drug checking doesn’t make people take more drugs.
“It’s not really facilitating it because people are going to do it regardless. So it’s kind of more a safe haven and a safe way for us to do it,” she said.