Rob’s story: Interview with a fentanyl user
Rob is an opioid user who shares his experience and harm reduction advice regarding using the synthetic drug that is up to 100 times stronger than morphine.
User’s News: Where did you get most of your info from about fentanyl? Did you know of its big rep when you first tried it?
Rob: As is the case with most people who experiment with a new substance, I was introduced to fentanyl by a friend during my days of using heroin daily. I had heard about fentanyl in a medical context but had little access to pharmaceutical drugs in my area. I was immediately intrigued by its ultra-potency, strong opioid effects, as well as its (as I found out later) inaccurate street reputation of being the ultimate drug.
UN: Why / how did you first try fentanyl? Did you seek it out or did it come to you?
R: I wouldn’t say I sought it out. However, I certainly would have snapped it up if it were available because of its reputation. In the end a friend shared a fentanyl patch he would trade ice for with a friend of his who had chronic cancer. At a cost of $50 or a point of ice they were extremely economical for a heroin dependent person as you could easily get four decent shots, equivalent to a deal of heroin, although due to the short half-life they wouldn’t stave off withdrawal as effectively.
UN: How long have you been doing fentanyl?
R: I used diverted, pharmaceutical fentanyl periodically for several years. With the advent of the darkweb markets, I switched to illicit fentanyl. The first few markets banned selling the drug due to media hysteria making it too hot to handle, but later markets had no such misgivings. The fentanyl would come in a pre-cut, ready-to-shoot mixture of fentanyl and lactose powder mainly. I never came across the illicit form sold on the street.
UN: Is it a preference or a stopgap? Do you do other drugs as well?
R: I was initially convinced that fentanyl was a superior product, but I would say that the appeal of fentanyl wore off quickly. For me, it lacks the qualities of heroin that makes it so universally sought after. Fentanyl doesn’t have the same warmth and doesn’t last as long — it doesn’t stave of withdrawal for nearly the same period of time.
I used a number of drugs regularly. This included heroin, methamphetamine and crack cocaine when I could afford it. Benzos were and continue to be a particularly dangerous (due to the accumulative effect of respiratory depression) mainstay. Additionally, alcohol was a common stopgap for me.
I have now switched to the Opioid Treatment Program (OTP) and reduced my illicit opioid use to nearly nothing, although I do use a range of drugs from time to time.
UN: How important have the peers around you been in using in general and specifically in managing the risks around using fentanyl? Did you learn how to inject safely from peers? Did you learn anything good from your peer org or peer org resources (like the AIVL fentanyl resource) or peer mags (like User’s News or Whack)?
R: My particular group of peers were highly naïve when it came to drug use. This was no truer than with fentanyl. At the time, the fentanyl issue was coming to a head in America and all my peers bought the line that fentanyl was a killer and practically evil. I knew this wasn’t true and would take special precautions to keep my friends and myself alive. I learnt most of the harm reduction info online because at the time I was using a lot of fentanyl, I had only an inkling that drug user organisations existed in Australia. Happily, I am more connected now and do some peer work at the ACT drug user org, CAHMA and read User’s News regularly!
UN: Fentanyl is a very strong drug. How did you deal with the risk of overdose? Have you ever overdosed and what happened?
R: I tried to keep people educated as best as I could as I don’t think my peers appreciated how dangerous the patches are. Each of those patches is designed to release a strong dose of medicine for opiate naive patients every hour for 7 days, so you can imagine that even small differences in the efficiency of a cook can be disastrous.
To attempt to keep my friends safe while using fentanyl I would offer the best advice I could. I warned them that cooking up patches results in varying potency. I told them that if they suspended the plunger a quarter through the barrel while injecting they could gauge purity. I advised them not to use alone, or to at least ask friends to sit with them on the phone during injection or check on them just afterwards. I suggested they get naloxone (Narcan) and learn how to safely use it.
And yes, I have overdosed on fentanyl — because I ignored all those rules. A fentanyl OD feels like just going to sleep and waking to pain. I ODed in my parent’s bathroom judging my shot to be mild — I had it on the floor with the shower running. My parents found me on the floor, shocked and scared, and they called the ambulance immediately. Luckily, the hospital just held me overnight and I had a lucky break. I never broke those rules again.
UN: Fentanyl doesn’t come in the traditional powder and often not in pill form either — but as a patch. How have you overcome the barriers to injecting? What tips can you pass on to people for safe extraction?
R: Attempts from pharmaceutical companies to produce ‘tamper-proof’ products are misguided and dangerous. For most people who can use drugs, it is laughably easy to overcome the tamper proof ‘barriers’ — but the risks are very high. In my opinion, the extraction process is never safe and remains so problematic that I would warn any against attempting it. If you insist on doing it, it’s important to be as accurate as you possibly can. Check out the measurements on this page. They’re from an AIVL resource that I strongly recommend you connect with.
My best recipe for preparing patches is this:
Ingredients: one soup ladle; a 10ml ampoule of sterile water; a blue wheel filter and sterile equipment of your choice.
Method: Drip some water onto the Ladle and place the patch sticky side down. Drip more water onto the ladle. Cook with slow flame until the water boils and the patch turns transparent. Draw up liquid with a large syringe and filter through the wheel filter.
You should always start with a small amount and go very carefully — keeping your mates in the know all the way.
UN: What’s the best harm reduction ‘trick’ you have in your kit for dealing with fentanyl?
R: There are a clear set of safety processes that apply not only to fentanyl but all opiates, particularly ones that are injected. Firstly, be as precise as possible with dosage knowledge and measurement. Listen to people with more experience and check out that AIVL resource that has been put together by other users. Which brings us to the next point ... Secondly, peer support. Peers are a vital source of information, particularly when it comes to giving warnings about dangerous doses. We can also act as safekeepers to our friends by checking on their wellbeing. You should also pass on your best advice to others to help them out and try and keep your friends safe by sharing info.
If someone may have overdosed, always call 000. Don’t delay — do it fast. Someone’s life may be at stake. The police are legislated to no-show at overdoses — there is no guarantee, but we are talking about a person’s life here. Also, possess and learn how to safely use Narcan (naloxone). You can get it completely FREE of charge from chemists as part of a Commonwealth government trial and from a lot of organisations, too. Call NUAA on 1800 644 413 if you can’t work out how to get it.
[Rob works at CAHMA (Canberra Alliance for Harm Minimisation and Advocacy), the drug user organisation in the ACT. You can call them for peer support if you live in Canberra on 6253 3643.]
Injecting fentanyl: Minimising the Risks
A resource developed by AIVL (our national drug user organisation). Note that NUAA had significant input into this resource.
*This table is a guide only and should be viewed with caution
**Released hourly over 168 hours
How to recognise an overdose
Signs of an opioid (heroin, fentanyl, oxys) overdose
