Fentanyl Test Strips: A Simple Harm Reduction Strategy that Saves Lives

In 2018, almost 70,000 Americans died from a drug overdose, and among those two thirds were associated with opioids. This is higher than deaths from HIV, car crashes and gun violence at their highest levels. Recently, U.S. life expectancy dropped for the third year in a row, which represents the longest sustained decline in expected lifespan since 1915-1918, a time when World War I and the influenza pandemic claimed many lives. The primary cause — illicit fentanyl and other synthetic opioids in the drug supply. 

Synthetic opioids are found in most overdose deaths

Today’s drug supply is heavily tainted, and frequently contains illicit fentanyl (a synthetic, short acting opioid), a drug 50-100 times more potent than morphine. The potency leaves little room for error and makes overdose risk high. Fentanyl and its analogs claimed over 30,000 lives in 2018 (40% of all overdose deaths). In Philadelphia, illicit fentanyl was found in over 85% of overdose deaths in 2018. The reality is that we are dealing with an ongoing fentanyl crisis that supply side strategies can’t fix. What we can do is use smarter approaches to reduce harm and save lives.

Fentanyl test strips are one such public health strategy. Since 2018 Penn Medicine’s Emergency Department has called for greater access to this life saving tool. These strips cost about a dollar each and are being used off-label to detect fentanyl and its analogs (including carfentanil) in illicit drug samples before consumption. The advantages are clear and give the user a choice — if the sample tests positive, people may choose to use less or not use at all, use slowly, have naloxone on hand, and/or use with someone else around.  

Fentanyl test strips reduce harm and deliver many benefits

The unregulated and contaminated drug supply is more dangerous than ever before. Any tool that informs and gives people a chance to improve their health and safety is a positive step. Fentanyl test strips are one tool in the toolbox, and provide important benefits, including: 

  • Improved engagement with people who use drugs (PWUD)
  • Improved ability to deliver information, resources and peer support
  • Improved knowledge leads to improved decision making and behavior change
  • Improved awareness of the drug supply
  • Improved naloxone access, education and distribution
  • Decreased probability of overdose death
  • Increased likelihood of entering treatment and living in long-term recovery 

Fentanyl test strips change people’s behavior and reduce harm

At Brown University’s School of Public Health, our team has examined the use of rapid fentanyl test strips in young adults who use drugs. We’ve found that most young adults who use these strips changed their behavior (using less, with others, or proceeding cautiously), and would like to continue using them in the future. Another recent study looked at fentanyl test strips as an opioid overdose prevention strategy. This study confirmed that a positive fentanyl test strip result led to positive changes in behavior that mitigated risk and put safety first. 

Our team is poised to launch a larger clinical trial that will determine how a harm reduction intervention including fentanyl test strips could reduce fatal and nonfatal overdoses. Recently, Dr. Judith Feinberg and researcher Jon Zibbel at West Virginia University has also asked the National Institute on Drug Abuse to fund research on fentanyl test strips. Their plan is to look at both the positive and negative impact of using these strips, and we’re excited to see the results. Dr. Robin Pollini, the associate director of the Injury Control Research Center at West Virginia University, has said, “There is good evidence that when people use these strips and their drugs test positive for fentanyl, they take steps to use more safely and thus reduce their risk of opioid overdose.”

Fentanyl test strips are saving lives across the country

Many areas of the country have started to distribute fentanyl testing strips with positive results. The Howard Center in Burlington, Vermont distributes these strips to prevent overdose deaths. Catherine Simonson, Chief of Client Services states, “the strips may not stop people from using, but they do change people’s behavior.” In California, the state health department has been paying half of their 45 needles exchanges to distribute these strips. Michael Marquesen, executive director of needle exchange at Los Angeles Community Health Project, states the distribution of fentanyl test strips has an important role in overdose prevention, and allows him to educate people about fentanyl and harm reduction strategies, including naloxone, an opioid receptor antagonist that reverses opioid related overdoses and saves lives. Recently, an article in the Capital Gazette describes a 25% decline in opioid related overdose deaths in Anne Arundel County, Maryland in comparison to 2018. Part of their successful multi-pronged strategy has been the distribution of fentanyl test strips. 

Fentanyl test strips are an important public health strategy that works. Getting this tool into the hands of people who use drugs is critical. It’s a tool that saves lives and improves engagement with a population that is often difficult to engage. With the fentanyl overdose crisis growing in communities across the country, it’s time to implement this and other evidence-based harm reduction interventions that will save lives.

Brandon Marshall, PhD will be a keynote speaker for our Statewide Conference: A Safety first Approach to the Overdose Epidemic. In his keynote address, Putting People Before Politics: Centering Harm Reduction in the US Overdose Response, he will be summarizing the current state of the overdose epidemic in the United States, focusing on the emergence of fentanyl in the illicit drug supply. The session will then discuss how harm reduction programs contribute critically to the broader goal of decreasing overdose deaths. Finally, the session will highlight findings from two evaluations of harm reduction interventions in Canada and the United States, focusing on supervised consumption facilities and fentanyl testing programs. Join us on October for this groundbreaking event by registering here.



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