Ryan Greenstein is a staff writer for Brief Policy Perspectives and a first-year MPA student.

In October 2017, the Acting Health and Human Services Secretary declared the opioid epidemic in the United States to be a public health emergency. The move was widely applauded as a savvy method for combating stigma and increasing awareness of opioid use disorder while also making additional federal funds available. After a consistent increase since 1999, drug overdose deaths fell by 4.1% from 2017 to 2018. Just a few years later, however, the COVID-19 pandemic has exacerbated the opioid epidemic to a previously unseen level as lockdowns limited access to treatment for the millions of Americans living with substance use disorder. All but four states saw an increase in overdose deaths of at least 6% between March 2020 and March 2021, with the national average being slightly over a 30% rise. As state governments have rushed to address the sharp rise in overdose deaths, the federal government and many states have begun reconsidering their approach to certain harm reduction tools, such as fentanyl test strips. 

Background

Fentanyl is a synthetic opioid that is significantly more potent than morphine and has been increasingly responsible for causing fatal overdoses, especially in individuals who do not realize they are consuming it. Synthetic opioids, like fentanyl, are the most common drug that results in overdose deaths and are often mixed in with other substances, though the individual consuming the drugs may not be aware of everything being consumed as illicit drug sales are not regulated by any government agency. With a design like an at-home pregnancy test, a fentanyl test strip can be used to confirm whether a drug contains any fentanyl. Fentanyl strips have been praised by harm reduction advocates as a tool to easily allow individuals to be more aware of what substances they may be considering consuming. Though fentanyl test strips do not measure potency, simply being aware fentanyl is present in a substance can prevent an overdose.

Challenges with Promoting the Use of Test Strips

In most states however, fentanyl test strips are illegal under state laws prohibiting ownership or use of drug paraphernalia. Though the exact definition of “paraphernalia” varies within the thirty-two states with drug paraphernalia laws, almost all of them include controlled substance testing equipment, which encompasses fentanyl testing strips. The initial goal of drug paraphernalia laws was to prevent the ownership of anything that could be used to produce, conceal, or consume a controlled substance such as a pipe, bong, or syringes intended to be used to inject illicit drugs. 

Potential Solutions and Where To Go From Here

As more academics and advocacy groups amplify support for harm reduction techniques, government officials have begun endorsing those techniques as well. Pennsylvania Mayor Jim Kenney signed an executive order in August directing local police not to arrest anyone using or distributing fentanyl test strips following failed attempts in the state legislature to legalize the practice. In September, Nevada amended its drug paraphernalia laws to allow the use and distribution of testing products such as fentanyl test strips. Most significantly, the Centers for Disease Control and Prevention (CDC) and Substance Abuse and Mental Health Services Administrations (SAMHSA) are now allowing federal grant funds to be used to purchase fentanyl test strips and the newly unveiled Health and Human Services’ Overdose Prevention Strategy as embraced harm reduction as a key pillar in reducing drug overdose deaths in America. 

    No one tool will solve the opioid crisis. Lawmakers and agency officials accepting harm reduction tools and techniques, such as fentanyl test strips, reveals both the amount of progress that advocates have achieved but also how dire the crisis has become. As more legislatures increase access to these tools and the federal government continues to embrace previously unused strategies, the results will dictate the future of how the government approaches substance use issues and will hopefully save lives.