The US is facing an overdose epidemic, with 104,671 people losing their lives as a result of a drug overdose in the last year. Astaggering 67% of those deaths involved synthetic opioids. Synthetic opioids such as fentanyl – a powerful central nervous system depressant – are the fastest growing concern with the DEA branding fentanyl “the single deadliest drug our country has ever encountered.”
With overdose deaths among adolescents more than doubling between 2010 to 2021, combined with the ever-growing prescription opioid crisis, the US is scrambling to put in place measures to mitigate the risks of dangerous substances like fentanyl. There are increasing reports of counterfeit pills containing deadly amounts of fentanyl being made to look like prescription opioids. Some solutions include increasing access to fentanyl abuse treatment and introducing fentanyl testing strips to help users identify whether the drugs they are taking contain fentanyl.
Fentanyl is a powerful synthetic opioid between 50 and 100 times stronger than morphine and many times that of heroin. It is used as a prescription painkiller, generally in the form of either a patch or a pill, used to treat severe pain often during or after an operation or a serious injury.
Fentanyl has a sedating effect and depresses the central nervous system (CNS) and respiratory function, meaning it slows breathing and heart rate. When administered or prescribed by a doctor, the dose is carefully monitored as too much drug can slow breathing and heart rate to a dangerously low level, risking death. The exact lethal dose of fentanyl is difficult to measure as all bodies are different, and individuals can build a tolerance to the drug.
Fentanyl testing strips are a form of inexpensive drug testing technology, originally developed for urinalysis to screen for the presence of the drug in a person’s urine. These have shown great success in detecting whether fentanyl and fentanyl-analogs are present in substances. There is hope that these testing strips will allow drug users to screen their drug samples prior to ingestion, and reduce the risk of accidental fentanyl ingestion.
The testing strips are relatively simple to use; testers add water to the substance they wish to test, allowing it to dissolve before dipping the test strip into the liquid for 15 seconds. Testing strips are highly sensitive, so only a very small amount of the substance is required to obtain a result. After the testing strip has been held in water for 15 seconds, it should then be sat on a flat surface until results appear, which will generally take no more than 5 minutes. The testing strips are easy to read, with one line indicating fentanyl is present in the sample and two lines indicating a negative result.
Studies have shown fentanyl testing strips to be accurate and unlikely to produce false negative results. Researchers at Brown University, Boston Medical Center, and Johns Hopkins University in collaboration with law enforcement agencies engaged in a thorough examination of the testing strips to validate their efficacy for use in detecting fentanyl in drug samples. They determined that the testing strips were an effective harm-reduction tool to prevent overdose, stating “everyone deserves to be able to take care of themselves and make informed decisions about their health, whether they use drugs or not. These test strips could be a life-saving intervention for many young adults who use drugs.”
Fentanyl testing strips have shown some limitations, however, as they fail to measure the quantity or potency of fentanyl in the substance. Moreover, because they are so sensitive with such a low detection threshold, there is the chance that they could detect minimal contamination of a drug sample, There is significant chance of this being caused by particular drugs being stored, packaged, or produced in the same area, which is unlikely to represent a quantity of fentanyl in the sample significant enough to cause harm.
Despite the limitations of the testing strips, there is a strong argument for their use as a harm reduction strategy in response to the rising number of fentanyl-related deaths. This is partly driven by accidental fentanyl consumption with most recent overdoses driven by the drug’s presence in imported pills that resemble prescription medication and include other substances such as heroin, oxycodone, or Xanax.
Increasing reports of counterfeit pills being made to look like prescription opioids that in fact contain fentanyl or methamphetamine are of particular concern. The United States Drug Enforcement Administration lab testing discovered that two out of every five pills with fentanyl contain a potentially lethal dose. With the United State’s underlying prescription opioid epidemic driving many people to the streets to source drugs such as Xanax, oxycodone, and other prescription opioids, the danger of prescription opioid abuse becoming fentanyl addiction or overdose is of great concern.
The endorsement and distribution of these testing strips would represent a shift in attitude toward drug users in many parts of the country. Concerns that this kind of approach to drug use encourages as opposed to discourages drug use, and in fact facilitates abuse of dangerous and addictive substances are justifiable. However, at a time when access to adequate mental health and addiction care is not yet available to all, and overdose deaths are a leading cause of death in the US for individuals under 50, a range of solutions needs to be considered. Far from the sole solution to this country’s battle with substance abuse harm, emerging research on fentanyl testing strips suggests they should, in fact, be part of the solution to America’s drug overdose epidemic.