FENTANYL TEST STRIPS: HARM PREVENTION STRATEGIES AS AN ALTERNATIVE APPROACH TO THE OPIOID EPIDEMIC
Author: Carissa Coy, Associate Editor
In 2021 more than 107,000 people died from a drug-related overdose in the United States.[i] A synthetic opioid, fentanyl, was responsible for 71,238 of those deaths.[ii] Fentanyl is 50 to 100 times more potent than morphine and heroin; even a minute dose of the opioid can prove fatal.[iii] Fentanyl is now the leading cause of death for adults ages 18-45 in the United States.[iv] This data makes it evident that the opioid epidemic has impacted the lives of countless families across the country and something must be done. One initiative that has been developed to decrease fatal opioid overdose focuses on harm reduction strategies.
Harm reduction strategies are a set of policies, programs, and practices that strive to minimize the negative health, social, and legal impacts that are often associated with drug use and drug laws.[v] For example, these strategies involve safer use, managed use, abstinence, and addressing conditions of use and the use itself.[vi] Harm reduction strategies play a significant role in preventing drug-related deaths and offering access to healthcare, social services, and treatment.[vii] These strategies decrease overdose fatalities and infections related to unsterile drug injection.[viii]
Fentanyl test strips are an inexpensive and relatively easy-to-use form of drug testing technology that can detect the presence of fentanyl in drug samples prior to ingestion.[ix] Each test strip cost approximately $1.[x] The test strip functions much like a COVID-19 test, where the user mixes a small sample of the substance with water and then dips the strip into the mixture.[xi] Since fentanyl is often mixed with heroin or pressed into counterfeit prescription drugs and then sold to unknowing customers, the test strips allow users to proactively test a small sample of their drug substance for any unwanted fentanyl and possibly save their lives.[xii] A 2018 study from Brown University found that a positive test strip result was associated with positive risk reduction behavior, indicating that fentanyl test strips could promote engagement in risk reduction practices, which could then reduce rates of overdose.[xiii] While clearly the test strips will not save everyone, as some users would still choose to use fentanyl, they would prevent a significant number of users from fatally overdosing. Yet, despite their low cost of production and positive health outcomes, the test strips are illegal in almost half of the states.[xiv]
Harm reduction does not endorse drug use, rather it accepts drug use as a reality, with a focal point on reducing the harmful consequences such as death, hepatitis C, and HIV.[xv] The tragic reality of drug addiction is that, in most instances, there is little that anyone can do to make a user seek treatment. However, many harm reduction strategies can effectively minimize the high death rate associated with opioid abuse.[xvi] For example, some states have created initiatives to distribute naloxone and fentanyl test strips to the community.[xvii]
In those states that have outlawed fentanyl testing strips, they are often classified under state law as drug paraphernalia.[xviii] For example, in Kentucky drug paraphernalia includes testing equipment used, intended for use, or designed for use in identifying or analyzing the strength, effectiveness, or purity of controlled substances.[xix] Violation of this Kentucky statute would result in a Class A misdemeanor, which comes with a maximum jail sentence of twelve months and/or a maximum fine of $500.[xx] Florida uses the same definition for drug paraphernalia as Kentucky in terms of testing equipment, however, Florida law classifies the delivery of drug paraphernalia as a felony in the third degree.[xxi] A third-degree felony in Florida is punishable by up to 5 years in prison.[xxii] States like Florida continue to lag behind the times and refuse to sign into law new legislation that adopts a harm-reduction model. For example, in the 2022 legislative session, the Florida legislature failed to approve a measure that would have legalized fentanyl test strips.[xxiii]
More states are welcoming the idea of harm reduction strategies as a solution to the opioid epidemic, with New Mexico, Wisconsin, Tennessee, and Alabama all recently enacting legislation legalizing fentanyl test strips.[xxiv] Several states, such as Louisiana and Georgia, currently have legislation pending that would decriminalize fentanyl test strips, allowing for their distribution.[xxv] Some states such as Pennsylvania, still have laws that make the test strips illegal but have allowed initiatives to distribute the test strips regardless.[xxvi] An evaluation of fentanyl test strip use in California found that they promote increased fentanyl awareness and lead people to take safety precautions to prevent overdose if fentanyl is detected.[xxvii] Additionally, a study in Rhode Island found that receiving a positive fentanyl result was significantly associated with reporting a positive change in overdose risk behavior in young adults who reported using heroin, cocaine, or prescription pills.[xxviii] Harm reduction strategies save lives by being readily available and accessible in a matter that emphasizes the need for humility and compassion toward those who use drugs.[xxix]
The law needs to be changed in the states that still classify fentanyl test strips as drug paraphernalia. If the test strips have the potential to save even just one life and give that person the chance to live another day and possibly seek treatment, then they are well worth the small cost.
[i] AMA, Issue Brief: Nation’s drug-related overdose and death epidemic continues to worsen, American Medical Association Advocacy Resource Center (May 12, 2022), https://www.ama-assn.org/system/files/issue-brief-increases-in-opioid-related-overdose.pdf (last updated May 12, 2022).
[ii] CDC National Center for Health Statistics, U.S. Overdose Deaths in 2021 Increased Half as Much as in 2020 – But Are Still Up 15%, Centers for Disease Control and Prevention (May 11, 2022), https://www.cdc.gov/nchs_press_releases/2022/
202205.htm (last reviewed May 11, 2022).
[iii] NIDA, Fentanyl DrugFacts, National Institute on Drug Abuse (June 1, 2021), https://nida.nih.gov/publications/
drugfacts/fentanyl.
[iv] F.B. Ahmad, et al., Provisional Drug Overdose Death Counts, Centers for Disease Control and Prevention (July 13, 2022), https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm (last reviewed July 13, 2022).
[v] HRI, What is harm reduction?, Harm Reduction International, https://www.hri.global/what-is-harm-reduction.
[vi] NHRC, Foundational Principles Central to Harm Reduction, National Harm Reduction Coalition, https://harmreduction.org/about-us/principles-of-harm-reduction/.
[vii] SAMHSA, Harm Reduction, Substance Abuse and Mental Health Services Administration, https://www.samhsa.gov/find-help/harm-reduction.
[viii] Id.
[ix] CDPH, Fentanyl Testing to Prevent Overdose, California Department of Public Health, https://www.cdph.ca.gov/
Programs/CID/DOA/CDPH%20Document%20Library/Fact_Sheet_Fentanyl_Testing_Approved_ADA.pdf?TSPD_101_R0=087ed344cfab2000367bc5dc8e7865a2511d68c890360e64aca39a698323e7203a2aa51843844675087981fc02143000c44e24fa448d8ce2acd7abd2787305eff87aab6e9593b0e93f48a81095c4ed1ee13f6012bb4eebf2f95d334197747bc8 (last visited Aug. 7, 2022).
[x] Addiction Resource Editorial Staff, Fentanyl Test Strips: Why Are They Illegal?, AddictionResource.net, (Jan. 13, 2022), https://www.addictionresource.net/blog/fentanyl-test-strips/.
[xi] CDPH, Fentanyl Testing to Prevent Overdose, California Department of Public Health, https://www.cdph.ca.gov/
Programs/CID/DOA/CDPH%20Document%20Library/Fact_Sheet_Fentanyl_Testing_Approved_ADA.pdf?TSPD_101_R0=087ed344cfab2000367bc5dc8e7865a2511d68c890360e64aca39a698323e7203a2aa51843844675087981fc02143000c44e24fa448d8ce2acd7abd2787305eff87aab6e9593b0e93f48a81095c4ed1ee13f6012bb4eebf2f95d334197747bc8 (last visited Aug. 7, 2022).
[xii] Nicholas C. Peiper, et al., Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States, 63 Int’l. J. Drug Pol’y. 122, 123 (2019).
[xiii] Maxwell S. Krieger, et al., Use of rapid fentanyl test strips among young adults who use drugs, 61 Int’l. J. Drug Pol’y. 52, 57 (2018).
[xiv] AMA, Fentanyl Test Strips, American Medical Association, https://www.ama-assn.org/topics/fentanyl-test-strips (last visited Aug. 7, 2022).
[xv] Kathryn F. Hawk, et al., Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies, 88 Yale J. Biol. Med. 235, 239 (2015).
[xvi] Id.
[xvii] Ian Richardson, Iowa Attorney General Tom Miller calls to legalize fentanyl test strips as overdoses rise, Des Moines Register, July 21, 2022. – According to Rule 16 there should be the first page the story started on at the end. I assume you found this online, but you need to cite to the print version if available. If not, disregard comment.
[xviii] Addiction Resource Editorial Staff, Fentanyl Test Strips: Why Are They Illegal?, AddictionResource.net, (Jan. 13, 2022), https://www.addictionresource.net/blog/fentanyl-test-strips/.
[xix] Ky. Rev. Stat. § 218A500(1)(d) (2022).
[xx] Ky. Rev. Stat. § 218A500(8) (2022).
[xxi] Fla. Stat. § 893.145(4) (2022).
[xxii] Fla. Stat. § 775.082(3)(e) (2022). – Under T1.3 if West or Lexis was used for looking these up, it should have ‘Ann’ in small caps along with the Ky/Fla Rev Stat, and then West or LexisNexis in the parenthesis with the year
[xxiii] Brent Schilliinger, Fentanyl detection strips save lives, The Palm Beach Post, Mar. 24, 2022. Page number or web address?
[xxiv] Andy Miller, As Overdoses Soar More States Decriminalize Fentanyl Testing Strips, Kaiser Health News, May 5, 2022. Page number or web address?
[xxv] Andy Miller, As Overdoses Soar More States Decriminalize Fentanyl Testing Strips, Kaiser Health News, May 5, 2022. Page number or web address?
[xxvi] Id.
[xxvii] CDPH, Fentanyl Testing to Prevent Overdose, California Department of Public Health, https://www.cdph.ca.gov/
Programs/CID/DOA/CDPH%20Document%20Library/Fact_Sheet_Fentanyl_Testing_Approved_ADA.pdf?TSPD_101_R0=087ed344cfab2000367bc5dc8e7865a2511d68c890360e64aca39a698323e7203a2aa51843844675087981fc02143000c44e24fa448d8ce2acd7abd2787305eff87aab6e9593b0e93f48a81095c4ed1ee13f6012bb4eebf2f95d334197747bc8 (last visited Aug. 7, 2022).
[xxviii] Id.
[xxix] SAMHSA, Harm Reduction, Substance Abuse and Mental Health Services Administration, https://www.samhsa.gov/find-help/harm-reduction.