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Can Fentanyl Testing Strips Help Curb the Overdose Epidemic?

As the nation faces an overdose epidemic, more states are looking to legalize harm-reduction measures like at-home fentanyl rapid tests in an effort to curb the surge in fentanyl-related overdose deaths. Synthetic opioids like fentanyl were involved in about two thirds of U.S. drug overdose deaths between November 2020 and November 2021. Often people aren’t aware whether there’s fentanyl in the drugs they’re purchasing, so first-time, casual and long-term drug users alike are at risk for overdose from an amount of drugs they otherwise think to be “safe.” Harm-reduction advocates hope increased access to fentanyl testing strips can help people make informed decisions about the drugs they’re using and avoid overdose if fentanyl is present.

Fentanyl Testing Strips

Fentanyl testing strips (FTS) are small strips that were initially developed to test for fentanyl in a person’s urine, but many harm-reduction programs now distribute them as a resource to test a person’s drug supply. FTS are cheap, easy to use and effective in detecting trace amounts of at least 12 different fentanyl analogs. To use, the tester takes a small amount of the drug, adds water and dips the strip into the solution for 15 seconds. The strips are highly sensitive, so they can detect even small amounts of fentanyl residue and produce results within five minutes. One line on the strip indicates fentanyl is present and two lines indicates it isn’t. The drawback, however, is that these strips only show whether or not fentanyl is present in the batch and provide no indication as to how much. Any misuse of fentanyl (knowingly or unknowingly) has the potential to cause a fatal overdose.

Image copyright: JHU Bloomberg School of Public Health/Bloomberg American Health Initiative

Several studies point to FTS being an effective harm reduction option. For example, a study involving a community-based FTS distribution program in North Carolina found that 81 percent of people with access to test strips routinely tested their drugs before use. And those who received positive test results were five times more likely to change their drug-use behavior to avoid overdose. FTS give people a chance to pause and think about the drugs they are using and empower them to take precautions to prevent overdose if they do decide to use. If a batch tests positive, for example, a person might choose to discard the drugs entirely, use with a trusted person present and a naloxone kit or use less of the drug.

“The increase in drug overdose deaths related to synthetic opioids such as illicitly made fentanyl is a public health crisis that requires immediate action and novel strategies,” CDC Director Rochelle Walensky said. “State and local programs now have another tool to add to their on-the-ground efforts toward reducing and preventing overdoses.”

Legal issues, however, pose a challenge to implementing these kinds of harm reduction programs in many states. Decades ago, drug testing strips were banned under drug paraphernalia laws, thus criminalizing possession and distribution of them. But in recent years, several states have legalized access to FTS in response to the increasing number of overdose deaths. As it stands, possession and distribution of the strips is still illegal in half of the U.S., but there is hope for progress. In 2012, only eight states had legalized access to naloxone. By 2017, all 50 states and the District of Columbia had passed at least one law increasing access to naloxone, which was a historically rapid progression for public health legislation. Additionally, the Biden administration has become the first presidential administration to embrace harm reduction by lifting restrictions on use of federal grant funds for buying FTS.

Making the Case for Harm Reduction

Fentanyl overdose has become so widespread it is now the leading cause of death among Americans age 18 to 45, ahead of suicide, COVID-19 and car accidents. Regardless of why someone might use drugs – addiction, recreationally, experimentation or otherwise – protecting people from overdose is in the interest of public health and all of us. Chances are you or someone you know has been or could be impacted by fentanyl being in their drugs.

Drug use is an incredibly complex issue, but mounting evidence shows that harm reduction tactics can mitigate some of the negative consequences of drug use and save thousands of lives. Instead of demanding complete abstinence from people, harm reduction aims to make drug use safer through initiatives like access to clean needles, medication-assisted treatment, drug disposal kits, naloxone and fentanyl testing strips.

However, harm reduction can be a controversial concept. Many advocates tout its effectiveness in reducing drug-related deaths, injuries and illnesses. Opponents argue that harm reduction facilitates addiction and drug use by providing the tools people need to continue using drugs. Yet data shows that harm reduction works. According to the CDC, people who use syringe programs are five times more likely to start treatment for drug addiction and three times more likely to stop using drugs altogether. No single tactic alone will solve the overdose crisis, but saving any amount of lives is a worthwhile cause.

[Hannah Sabitoni]

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