Fentanyl test strips show rift in fight against drug deaths

NEW YORK >> “You smoke weed?” Eufamia Lopez asked the half-dozen young men lounging on benches in a public housing courtyard in the South Bronx.

The soft September air reeked of the obvious answer.

Lopez, who works for a New York University health support program, plunged into her spiel. Street drugs — meth, coke, molly, Xanax, heroin and even marijuana — are being cut with fentanyl these days, she said, which can kill you. But you can test your supply before using it to see whether there’s any fentanyl in it. She was giving out free kits.

She had their attention, and not just because she is 5-foot-10, frank but ebullient. The neighborhood, Mott Haven, has one of New York City’s highest overdose rates. After she recited the simple instructions, each man readily accepted a kit with three fentanyl test strips. One asked for a second kit.

“I appreciate you,” she said, rewarding him with a smile.

Record high toll

The spread of fentanyl, a cheap synthetic opioid 50 times as lethal as heroin, into most kinds of illicit drugs has pushed fatal overdoses to record highs in the United States. Fentanyl test strips have become a popular but contentious tool in response. Supporters say they help drug users make lifesaving decisions. Opponents contend that they facilitate drug use.

Test strips are a part of a broader approach called harm reduction, which holds that ending the overdose crisis can be achieved only by first ameliorating the deadliest risks of drug use, then taking steps to curb behavior, such as addiction treatment. President Joe Biden is the first president to embrace harm reduction, and he has made fentanyl test strips a key component in his proposed $307 million harm reduction drug control strategy. Within the past year, about 10 states — including Louisiana, Tennessee, Alabama and Georgia, where hardline abstinence views are more typically favored — have legalized test strips and made them more available.

Illegal in 20 states

But test strips are illegal in about 20 states — including Florida, Texas, Kansas and Kentucky — classified as “drug paraphernalia.”

Critics say test strips encourage drug use by giving users the green light if the supply is free of fentanyl. To some opponents, the test strips are even more objectionable than other forms of harm reduction, like distributions of clean syringes, because those at least prevent the spread of HIV, hepatitis and other dangerous infections to users and nonusers.

In May, Kansas legislators blocked a proposal to legalize the strips. “Fentanyl strips don’t save lives. Let’s be clear. There are individuals that want fentanyl in the drug that they’ve purchased or acquired,” Molly Baumgardner, a Republican state senator, said at the time, according to the Kansas Reflector, which reports on state government.

The Biden administration’s drug czar refutes such criticism. “There is no scientific evidence to support this notion that harm reduction services like fentanyl test strips somehow encourage drug use, but there is significant evidence to support the fact that these tools can save lives,” said Dr. Rahul Gupta, director of the federal Office of National Drug Control Policy.

In fact, there is not yet a substantial body of evidence that directly shows test strips have saved lives. Results have been mixed from a handful of relatively small studies looking at whether the strips deter sustained drug use.

A 2020 study of 68 female sex workers in Baltimore found that after receiving the strips, 84% tested their drugs and 69% subsequently took precautionary measures, such as asking someone to check on them or using smaller amounts. But a 2018 study looked at a supervised drug injection site in Vancouver, British Columbia, where users were asked whether they wanted to check their drugs (usually heroin) for fentanyl. Scarcely 1% chose to do so. Nearly 80% of those samples indeed tested positive for fentanyl.

In a 2021 study, researchers at the Johns Hopkins Bloomberg School of Public Health, among others, surveyed 225 drug users in Baltimore and Delaware who had been given strips at two syringe distribution programs. About threequarters reported having used them. In Delaware, 69% said that when results were positive for fentanyl, they subsequently took riskreduction measures; in Baltimore, just 23% did so.

Certainly acceptance of the strips has soared among casual drug users. This summer, Chicago officials urged people attending the Lollapalooza music festival to pick up free kits from the city. The nonprofit TACO (Team Awareness Combating Overdose) has given away thousands of strips to students on at least a dozen college campuses. Many emergency rooms provide strips to overdose patients upon discharge.

Lopez said she had even persuaded some drug sellers to try the strips. “I’ve had drug dealers tell me, ‘I don’t have any fentanyl in my stuff!’ ” she said. “And I say, ‘Well, how do you know?’ ”

Regular use of strips by dealers could make a difference, said Corey S. Davis, who directs the Harm Reduction Legal Project at the Network for Public Health Law. “People are already there to buy heroin, so if a dealer can say, ‘Hey, I’ve tested it, and I’m actually selling you what you think you’re buying.’ ”