State bill to legalize test strips advances
Fentanyl heightens the overdose crisis
Massachusetts could soon become the latest state to legalize small strips of paper for detecting whether street drugs contain fentanyl, the fast-acting and highly potent synthetic opioid driving the overdose crisis.
For years, those who carried or distributed fentanyl test strips could be arrested and charged with possession of drug paraphernalia, which state law defined as equipment of any kind used to test or analyze controlled substances.
Now, those thin strips — no more than a few inches long — have emerged as a critical tool in state and local efforts to prevent fatal drug overdoses, which remain near record highs and continue to claim more than 2,000 lives a year in Massachusetts.
On Thursday, the state Senate voted unanimously to approve legislation that would legalize the test strips by amending state law to exclude them from the state’s legal definition of drug paraphernalia. The bill still needs to pass a House vote and needs Governor Maura Healey’s signature before going into effect. So far, 36 states plus the District of Columbia have legalized the strips, reflecting a broad shift in attitudes toward harm-reduction strategies that prioritize saving lives over abstinence and criminal sanctions.
“This could be a life changer, particularly for our young people,” said Senate majority leader Cynthia Stone Creem, the lead sponsor of the legislation. “Drug users are less likely to engage in risky behavior if they have the knowledge that fentanyl is present.”
Fentanyl test strips have been used by harm-reduction nonprofits and public health agencies in Massachusetts for at least the past five years and are available on Amazon for about $1 a strip. Yet some police departments and community organizations have been reluctant to distribute them due to their legal status as drug paraphernalia, Creem said.
Newton Police Chief John Carmichael said he’s kept a box of about 500 fentanyl test strips tucked away in his office for more than a year. Yet he and other Newton city officials have held off on dispersing them to drug users. “Any municipality or police department or health agency is going to refrain from distributing something that’s essentially illegal,” said Carmichael, who is legislative chair of the Massachusetts Chiefs of Police Association.
The paper strips work much like over-the-counter pregnancy tests. Each strip is dipped into a small amount of water containing a bit of drug residue. After a couple of minutes, either one or two pink lines appear on the strip. One line means the liquid contains fentanyl; two lines mean the test did not detect the drug. The strips can detect fentanyl in all types of drugs, including heroin, cocaine, methamphetamine, and counterfeit pain pills.
The test strips have been shown to be highly accurate in detecting fentanyl and in changing user behavior. Study after study has shown that people who discover fentanyl in their drugs will take steps to reduce the risks of a deadly overdose. A 2018 study by researchers at Brown University found that nearly half of young adults who detected fentanyl using the strips reported using smaller amounts, while more than a third used more slowly or used with someone else present.
“They are great facilitators of behavior change,” said Allyson Pinkhover, director of substance use services at the Brockton Neighborhood Health Center, which has been distributing the strips to its patients since 2018.
Their illegality dates back to a model law from the Nixon administration, which classified as illegal anything linked to taking or testing banned substances.
The legislation that passed the Senate on Thursday also contains a so-called Good Samaritan provision that protects people who administer fentanyl testing tools from criminal or civil liability.
“At the most basic level, this bill expands access to a lifesaving tool at a time when our drug supply today is more contaminated than ever,” said Senator John Velis, a Westfield Democrat who spoke in favor of the bill on the Senate floor Thursday. “We all know the old adage ‘you can’t treat someone who is dead.’”
The rapid spread of fentanyl, which is lethal in even tiny amounts, has been the primary cause of an unrelenting wave of overdose deaths across Massachusetts and the nation. The substance is mixed with most street drugs and last year was present in 93 percent of fatal opioid-related overdoses in which a toxicology screen was done, according to the state Department
of Public Health. In 2022, overdose fatalities statewide reached 2,359 — the highest on record and more than triple the number from a decade ago.
“Anything that removes barriers to getting tools in people’s hands that are low cost and low barrier and proven to save lives — is something that we should be considering in all and every opportunity,” said Julie Burns, president and chief executive of RIZE Massachusetts, a Bostonbased nonprofit working to end the state’s overdose crisis.
Yet the strips are no silver bullet. They cannot detect how much fentanyl is present in a drug sample, and there may be some fentanyl analogues that the strips do not pick up.
And some harm-reduction specialists think legalizing fentanyl strips does not go far enough. The illicit drug supply is changing rapidly, with new and increasingly dangerous substances being mixed into street drugs. One of these is xylazine, a veterinary sedative known as “tranq,” which is particularly dangerous because it prolongs highs and is resistant to overdose-reversal drugs such as Narcan. Xylazine can cause people to stop breathing and often causes severe flesh wounds when injected.
New test strips for detecting xylazine hit the market last March, and some harm-reduction nonprofits in Massachusetts have started to distribute them. Yet their legal status is murky. The proposed law only applies to fentanyl and its analogues.
Some public health advocates have been pushing for broader legislation that would legalize all drug-testing equipment and materials, and not just fentanyl test strips, to better protect users from the evolving and increasingly toxic nature of the illicit drug supply.
“Focusing on fentanyl test strips alone is myopic and a decade too late,” said Traci Green, an epidemiologist and director of the Opioid Policy Research Collaborative at Brandeis University. “We need to make drugchecking tools readily available to cities and towns all over the Commonwealth, and not be so focused on fentanyl alone but have a broader understanding of what’s in the drug supply.”