In a recent HRSA-hosted webinar, speaker Rithvik Kondai of the Missouri Institute of Mental Health presented on the value of fentanyl test strips as harm reduction tools. Fentanyl is a synthetic opioid that has become an increasingly lethal threat as it contaminates the illegal drug supply, contributing to rising overdose rates. Synthetic opioids are already the most common drugs involved in overdose deaths, and at 50 times greater potency than heroin and 100 times greater potency than morphine, just a small amount of fentanyl can be extremely dangerous. Many drug users have no way of knowing if their drugs have been contaminated, and a wide variety of drugs, including increasingly popular stimulants, are susceptible to contamination.

Fentanyl test strips are a way of detecting fentanyl in certain substances. If the test strip shows two lines, no fentanyl was detected, and if it shows one line, it detected fentanyl (or an analog) in the sample. Though different strips exist, many of the most common models operate by testing for fentanyl in liquid. The FDA-approved use of the popular BTNX rapid response test strip, for example, is to test for the presence of fentanyl in urine samples, although there is scientific literature in support of the off-label use of fentanyl test strips to check drug supply directly. Kondai stressed that the results of fentanyl test strips are only accurate if the tests are conducted correctly. Careful measuring to ensure correct dilution and concentration is crucial.

Because these tests can be used to check drug supply, fentanyl test strips are a key tool for harm reduction. Though the tests do not indicate how much fentanyl is in a substance, and can be susceptible to false positives and negatives when used incorrectly, the ability to detect the presence of fentanyl is critical for drug users to avoid lethal overdoses and reduce serious health risks to themselves.

“There is a well-documented history and rich literature pointing to the support of fentanyl test strip use to effect positive behavior change in people who use drugs,” said Kondai. “This is merely a tool that provides a certain kind of information that people who use drugs deserve to know, especially in this age of an unstable supply. It’s crucial that they have this information.”

Kondai gave examples of how a person could use the test strips to determine whether or not there was fentanyl in their drug supply. For post-consumption use, if a person observed that they felt different than usual while they were under the influence of their drug, they could run a urine test the next morning to see if the strips indicate fentanyl. “If it does, then maybe they get to understand a little bit of why they felt differently. They have that context. Next time, they might use a little less, or they might get rid of the supply entirely, or they might share that information with their dealer or other people they know that bought from this same supplier,” said Kondai.

For pre-consumption use, the person would check their supply before they used. Kondai recommended DanceSafe as a resource that provides quality instructions about how to test supply. Having the knowledge that their drug supply is contaminated with fentanyl before using allows the person to make choices about what to do with that information to take safety precautions and avoid potentially lethal situations.

Though fentanyl test strips are critical harm reduction tools, some barriers impede their distribution in Missouri, among other states. Many people are reluctant to take strips for themselves or their loved ones out of concern that owning the strips may be illegal. While it is true that drug paraphernalia is illegal, fentanyl test strips are not illegal to own. Distributing them for the express purpose of checking drug supply is illegal, but distributing to test urine, or to own, is legal. It is not illegal to own fentanyl test strips. “Fentanyl test strips are not illegal in the same way that a syringe itself is not illegal,” Kondai explained. “The messaging and the language around this is super important. Though we’re distributing for urine testing, we acknowledge that people will use the fentanyl test strips to check their drugs. That’s one of the core harm reduction principles: acknowledge the reality.”

“As we need to stay within the legal landscape of Missouri, we cannot encourage people to use the fentanyl test strips to check their drugs. But as harm reductionists, we recognize that it’s important to share the safe way to use fentanyl test strips so they can be an effective tool.”

To learn more about harm reduction organizations in Missouri and fentanyl, visit the links below.