Fentanyl Test Strips Are Saving Lives, but They’re Just the Start

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Feb. 15, 2023 — In December, Texas Gov. Greg Abbott did an about-face on a problem that has been a flash level within the debate over decriminalization of drug paraphernalia: the usage of take a look at strips that may detect fentanyl, the artificial opioid. Abbott had beforehand opposed laws legalizing the take a look at strips, however he cited a surprising 89% enhance in fentanyl deaths in Texas the prior 12 months. 

“It is a very lethal drawback,” Abbott stated in a press convention the place he defined his change of coronary heart.

Greater than 100,000 individuals died of drug overdoses in the US from September 2021 to September 2022, according to the CDC. Nearly 70% of these had been from fentanyl and different artificial opioids. Now, the demise toll is inflicting lawmakers throughout the nation to alter their tune.

A Coverage Shift

Fentanyl take a look at strips had been developed in 2011 to check for the drug in urine by legislation enforcement, for folks eager to know what their youngsters had been taking, and for customers eager to know what was within the medication they beforehand took. A Johns Hopkins University study in 2018 discovered that the strips might precisely detect fentanyl in drug residue. Quickly after, California and Oregon had been among the many first states to supply their public well being departments with free strips to distribute at needle exchanges.

The strips are easy to make use of and efficient. When dipped in water that comprises dissolved drug residue, the strips point out instantly whether or not hint components are contained in a substance, equivalent to heroin, cocaine, or ecstasy. As little as 2 milligrams of fentanyl may be lethal relying on an individual’s weight, tolerance, and previous utilization. 

States throughout the nation have been legalizing fentanyl strips within the hopes of saving lives. Georgia handed a invoice in July. Alabama, Tennessee, Pennsylvania, Wisconsin, South Carolina, and New Mexico all did the identical. An identical invoice has been launched in Florida’s legislature. These states be a part of some 30 others which have decriminalized the strips and made them obtainable to drug customers.

When the strips first got here on the scene, they had been used to take away fentanyl totally from the drug provide. However at this time that is not as true because it as soon as was as a result of fentanyl is now so prevalent, says Aaron Ferguson of Austin, TX, who advocates for safer drug use by means of the City Survivors Union. The group arms out strips to people who find themselves regarded as extra seemingly to make use of some sort of precaution to forestall towards fentanyl overdose. For instance, he lately distributed the strips and naloxone, a drugs generally used to reverse opioid overdoses, to a mom who knew her son was utilizing opioids and wished him to be secure.  

A Poisoned Provide

“We’re in a drug poisoning disaster,” says Jacqueline Goldman, a analysis assistant on the Brown College Faculty of Public Well being. The disaster has deepened not essentially as a result of extra persons are utilizing medication, Goldman says, however quite “extra persons are dying from them as a result of they’re so potent.”

In comparison with different Western nations, the US has all the time had a “puritanical” view of hurt discount methods to deal with drug use and abuse, says John McIlveen, PhD, the prime opioid therapy official for the Oregon Well being Authority. “Now is a superb alternative to alter the narrative,” he says, “as a result of the drug provide is now not simply contaminated with fentanyl, it’s fentanyl.”

As a result of fentanyl is available and so potent, individuals from all walks of life are susceptible to overdose. “If there’s any silver lining, it is that views are shifting and we’re lastly seeing extra acceptance of the take a look at strips and different hurt discount strategies that save lives,” he says. 

Dropping the Battle

 Even because the strips turn into extra broadly decriminalized, they continue to be an imperfect resolution. Whereas the strips are correct at  detecting fentanyl and its analogues, they do not inform you ways a lot the substance comprises. 

In accordance with Ferguson, the excessive expense of medication and the authorized danger of acquiring them implies that customers could also be unlikely to toss out a provide of medication even when a take a look at strip exhibits indicators of fentanyl. And there is additionally the danger of a false constructive end result. A Might 2020 research printed within the International Journal of Drug Policy discovered that the strips returned a false constructive 10% of the time. Which means that the take a look at reads constructive when it comprises no fentanyl. 

Extra regarding is the danger of false damaging outcomes, particularly in pressed capsules. The CDC calls it the “chocolate chip cookie effect.” Fentanyl clumps in capsule type so while you lower into the capsule to check the drug, it is doable {that a} portion is freed from fentanyl when the capsule comprises it. The Worldwide Journal of Drug Coverage research discovered that false negatives happen in 3.7% of instances. 

What’s extra, fentanyl’s efficiency implies that some customers are hooked on the excessive it offers and could also be in search of it out quite than avoiding it, says McIlveen. The extra the drug provide comprises fentanyl, the extra customers turn into hooked on it as a result of it is 50 instances extra highly effective than heroin 

The drug provide can also be always altering and it is laborious for the strips to maintain up. New contaminants like xylazine, a robust sedative utilized in cattle and horses, have lately overtaken the opioid market. Xylazine cannot be detected utilizing the strips.

Nora D. Volkow, MD, director of the Nationwide Institute on Drug Abuse, says fentanyl take a look at strips have to be obtainable without cost all through the nation together with a gentle stream of different hurt discount instruments, particularly naloxone. 

“Presently, an opioid consumer may even see somebody overdosing they usually haven’t got sufficient naloxone readily available to cease it from occurring,” she says. 

Different drugs like buprenorphine and methadone assist wean sufferers off fentanyl and different opioids, however they are not obtainable in lots of elements of the nation. Sufferers might get a prescription from their physician, however the pharmacy of their space cannot fill it as a result of they do not have the medicine. 

There are some efficient remedies for saving individuals, such fentanyl take a look at strips, naxolone, syringe service applications, buprenorphine, and methadone, however states will not be offering them persistently. In West Virginia, for instance, 62% of convictions had been for medication and the state additionally had the highest number of drug overdose deaths within the nation. The hope is that sooner or later, extra assets will level towards hurt discount quite than incarceration. 

“Discrimination and stigma have resulted in legal guidelines which might be interfering with the survival of people that take medication,” Volkow says. 



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