Expand Drug Testing Options

Introductory Paragraph

Fentanyl is a powerful synthetic opioid used for the treatment of chronic severe pain or severe pain after surgery. It is 100 times more potent than morphine. Fentanyl is also illegally manufactured and found in other illicit substances such as heroin, methamphetamine, and cocaine in order to increase the potency. Not only is Fentanyl extremely potent, but it is also considered to be low cost. For these reasons, illegal drug manufacturers continue to mix fentanyl with drugs to maximize profits despite the extreme risk of death and overdose. Even 2 milligrams of Fentanyl can be added to illicit substances and cause a lethal overdose for some individuals depending on their body size and history of usage or tolerance. It is possible, and very common, for someone to unknowingly take a drug that has been laced with a lethal dose of fentanyl. As a way to reduce the risks and impacts on society of drug overdoses, many health officials, government officials, organizations, and researchers believe that providing fentanyl testing strips (FTS) to individuals could have positive impacts on society and those living with substance use disorders.

Providing fentanyl testing strips could allow users to test for the presence of fentanyl in their drugs prior to using. Testing strips are reliable and highly sensitive, making it easy to detect fentanyl in a minimal amount of drug residue. To use, the individual dips the strip into water containing a small amount of drug residue. After a few minutes, the test will indicate either a positive or negative test. Two lines signify the absence of fentanyl and one line indicates the presence of fentanyl. Along with other harm reduction strategies, treatment, and education, society can begin to reduce the number of deaths due to overdose.

Key Information

Fentanyl in Different Forms Fentanyl is sold in pill form made to look like Oxycodone, Xanax, or other prescription/non-prescription opioids. Lethal amounts of fentanyl in counterfeit pills can be almost impossible to distinguish from legitimate prescriptions obtained from medical providers or pharmacists. It can also be mixed with methamphetamine and cocaine, making users at a higher risk of overdose. Many people who use substances are unaware of the contents of the drug they are taking. This lack of knowledge is responsible for the impact fentanyl has on the increasing number of drug overdoses each year in the United States . In 2017, fentanyl was found in over 50% of all New York City overdose deaths. Fentanyl strips could provide a way for users to detect the presence of fentanyl and give them multiple options to prevent the risk of overdose. Should someone use FTS and have a positive result, they would have the option to discard the batch, use less of the substance, use in the presence of others, or have naloxone on hand when using with others. Although the testing strips do not provide information on the amount of fentanyl added to a drug, it allows the user to gain insight into the trustworthiness of the dealer which may prevent them from buying tainted drugs in the future.

Opposing Viewpoints and Stigmas

Much controversy surrounds harm reduction techniques and fentanyl testing strips are not immune to the stigma that people who use FTS lack a moral compass, can’t be trusted, or have a lack of concern for their wellbeing. Drug users who used FTS reported that a positive fentanyl test resulted in changed behavior and reduced risk of overdose. Research has shown that individuals who use fentanyl testing strips display behaviors consistent with great concern for their wellbeing. More evidence overwhelmingly supports the idea that FTS are safe, easy, affordable (around $1 per strip), and lead to reduced overdose fatalities . Substance use disorders are complex and the development of a SUD can be caused by all too common life events such as trauma, chronic pain, emotional distress, anxiety, depression, and other environmental stressors. These events can be experienced by anyone at any point in time, not just by individuals who lack morals or self-control .

Relevant Research

Fentanyl contamination has only begun to increase with the COVID 19 pandemic. Fentanyl-related deaths increased from 4% to the leading substances involved with drug overdoses in the United States(2). Between October 2019 to October 2020, the increase in fentanyl contamination was responsible for an almost 50% increase in overall overdose deaths(2). The Chief Medical Examiner in San Francisco, California reported more overdose deaths due to fentanyl contamination than COVID 19 deaths from January 2020 to December 2020(2). The Center for Disease Control reported a 13% increase in individuals who reported new or increased use of substances during the pandemic(2). Restrictions, loss of wages, lack of maintenance therapies (MAT treatment, clean needles), and anxiety around virus exposure may have further increased people to use with less discretion than they normally would.

Impactful Federal, State, and Local Policies

In April 2021, the Biden Administration, CDC, and SAMHSA announced that federal funding can be used to purchase FTS (5). The strips were approved for research, distribution to the public, and clinical use.

Minnesota decriminalized FTS in July 2021 and no longer considers them to be “drug paraphernalia” (4).

Available Tools and Resources

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

Promising Practices

Please link to any best practice models or case studies that highlight creative/innovative or successful efforts in support of this strategy. Is there a community that does a really good job in this area that other communities should replicate? Please write a brief description and provide a link.