Expand Fentanyl Testing Options

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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[1]. 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[2]. To use, the individual dips the strip into water containing a small amount of drug residue[3]. 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[4]. 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 [5]. In 2017, fentanyl was found in over 50% of all New York City overdose deaths[6]. 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[7] . 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[8]. These events can be experienced by anyone at any point in time, not just by individuals who lack morals or self-control [9].

Relevant Research

Fentanyl contamination has only begun to increase with the COVID 19 pandemic. Fentanyl-related deaths increased from 4% to the leading substance involved with drug overdoses in the United States[10]. Between October 2019 to October 2020, the increase in fentanyl contamination was responsible for an almost 50% increase in overall overdose deaths[11]. 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[12]. When compared to COVID-19 deaths and suicide, Fentanyl deaths accounted for tens of thousands more in 2020[13]. The Center for Disease Control reported a 13% increase in individuals who reported new or increased use of substances during the pandemic[14]. 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. The total number of fentanyl deaths nearly doubled from 2020 to 2021. Fentanyl overdose is now the leading cause of death in Americans ages 18 to 45[15].

In a study conducted by Johns Hopkins School of Public Health, researchers tested the ability of three technologies used to assess the presence of fentanyl in street drugs. Johns Hopkins researchers reported “Fentanyl testing strips were among the three types of technologies. Fentanyl testing strips had the lowest detection limit and the highest sensitivity and specificity for fentanyl of the technologies assessed[16].” Additionally, researchers gathered valuable information from people who use drugs about their overdose history, experiences with fentanyl, and other related topics. Among the individuals who completed the interview and surveys, 84% expressed concern about fentanyl presence in the drugs they use[17]. Out of the 256 respondents, 85% said they wished they had known beforehand that drugs they have used in the past contained fentanyl[18]. The vast majority of people who use drugs are concerned about fentanyl exposure and are interested in a product that tests for its presence. The study also found that a majority of the respondents said they would modify their drug use if their drugs tested positive for fentanyl[19]. This information is contrary to the stigmatized belief that drug users actively seek out fentanyl, do not wish to change their drug habits, and are not concerned about overdose due to fentanyl contamination.

Many public health officials, family members of people who use drugs, and drug users themselves agree that the availability of fentanyl testing strips could have a positive impact on society by reducing overdose fatalities due to fentanyl contamination. John Hopkins researchers have provided valuable recommendations for implementing harm reduction techniques such as increasing the availability of FTS, increasing access to information and education about fentanyl exposure, and providing counseling/substance use treatment where FTS are provided[20].

Impactful Federal, State, and Local Policies

The Biden Administration, CDC, and SAMHSA announced that federal funding can be used to purchase FTS[21]. 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”[22].

Families Against Fentanyl (FAF)[23] is a non-profit organization established by family members of an individual who died of a fentanyl overdose. In May of 2022, FAF wrote a letter to the Biden Administration, the Department of Health and Human Services (HHS), and the Center for Disease Control (CDC)asking that the tracking of fentanyl fatality data be published within six weeks of death opposed to the current six month time frame(7). This would allow experts to gather information on trends and respond with appropriate action in a timely manner. The organization requested that the COVID-19 death tracking system be used as a framework for fentanyl fatality reporting. More specifically, FAF is requesting that the department of HHS and the CDC provide weekly updates on synthetic opioid fatalities with information including state deaths, ages of deceased, and their race[24].

Washington State approved over $100,000 for the distribution of Fentanyl test strips. The Washington Syringe Service Programs (SSPs) distributed 40,000 testing strips to participants. This resulted in participants taking precautionary steps in preventing overdose if fentanyl was detected in their drugs[25].

Available Tools and Resources

HarmReduction.Org[26]has valuable information about the use of Fentanyl Testing Strips and other harm reduction strategies. The website also has information about locating Naloxone and clean syringes.

DoseTest.Org [27] manufactures and ships FTS from California in discrete boxes at $1.25 per strip.

PreventOverdoseRI.org[28] is a website based in Rhode Island that has videos and instructions on how to properly use fentanyl testing strips. There is valuable information about receiving FTS in the mail for individuals not located in Rhode Island.

Promising Practices

See "Impactful Federal, State, and Local Policies" and "Available Tools and Resources" sections.

Sources

  1. https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/Fact_Sheet_Fentanyl_Testing_Approved_ADA.pdf?TSPD_101_R0=087ed344cfab20000fac25b9e57d75c2a99df36db39f7ba1100a076d3484d2c2c90ef22061f105220840f6b68b14300061fd5968947d493ea4029838e187e89116cfdff349f37e059202f8585d20f8971c5d734d886e85eed3a7676ad529528c
  2. https://www.health.state.mn.us/communities/opioids/documents/ftsforpwud.pdf
  3. https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/
  4. https://www.health.state.mn.us/communities/opioids/basics/fentanyl.html
  5. https://www.health.state.mn.us/communities/opioids/documents/ftsforpwud.pdf
  6. https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/
  7. https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/
  8. https://medlineplus.gov/ency/article/001522.htm
  9. https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/
  10. https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/
  11. https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/
  12. https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/
  13. https://www.familiesagainstfentanyl.org/research/byage
  14. https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/
  15. https://www.familiesagainstfentanyl.org/research/byage
  16. https://americanhealth.jhu.edu/fentanyl
  17. https://americanhealth.jhu.edu/fentanyl
  18. https://americanhealth.jhu.edu/fentanyl
  19. https://americanhealth.jhu.edu/fentanyl
  20. https://americanhealth.jhu.edu/fentanyl
  21. https://www.cdc.gov/media/releases/2021/p0407-Fentanyl-Test-Strips.html
  22. https://www.health.state.mn.us/communities/opioids/basics/fentanyl.html
  23. https://www.familiesagainstfentanyl.org/research/byage
  24. https://www.foxnews.com/us/families-against-fentanyl-biden-admin-overdose-deaths-covid-19?fbclid=IwAR09SEAZxhGVDQtZZCmGqeacRaFeLM7uIx2sXzKt_nCrs9kghKkW_tQSLU8
  25. https://doh.wa.gov/you-and-your-family/drug-user-health/overdose-education-naloxone-distribution/fentanyl-test-strip-project
  26. https://harmreduction.org/issues/fentanyl/
  27. https://dosetest.com/faq-contact/
  28. https://preventoverdoseri.org/fentanyl-test-strips/