Key Takeaways
Fentanyl typically comes as a white powder, which can be mixed with other drugs—like methamphetamine and cocaine—and stamped onto pills.
Increasingly, drugs being sold on the street as OxyContin, Xanax, Adderall, or other prescription drugs, are laced with fentanyl.A restaurant worker who uses stimulants to stay active for a 10-hour shift might consume fentanyl unwittingly. So might a college student who purchases Adderall to stay alert while studying.
Because fentanyl is so potent, a slight difference in dosing can spell the difference between life and death, especially for people with no tolerance for opioids.
Fentanyl was involved in abouttwo-thirds of the drug overdose deathslast year—double the proportion from 2019.Perhaps due to the pervasiveness of fentanyl in the drug market in recent years and the destabilizing effects of COVID-19, 2021 saw a 15% increase in overdose deaths from 2020, following an even steeper rise of 30% the year before.
To address the crisis, the Biden Administration sent its firstNational Drug Control Strategyto Congress last month. It maps out the Administration’s plan for tackling untreated addiction and drug trafficking.
This Administration is the first to embrace harm reduction as a tool for minimizing overdose deaths. Rather than urging abstinence, supporters of harm reduction aim to improve access to tools that can prevent or revert overdoses. Fentanyl test strips are among one of the most useful methods to detect the deadly substance in drugs.
History of Harm Reduction
The term “harm reduction” was long associated with an underground movement to provide drug users with clean injecting supplies, said Nancy Campbell, PhD, historian of drug science, policy and treatment, and professor at the Rensselaer Polytechnic Institute in New York. As recently as 2000, she said an executive director of the National Institute of Drug Abuse told her harm reduction “was a dirty word in the federal research apparatus.”
Increasing Community Access to Harm Reduction Tools
Though the White House touts fentanyl test strips to be a key harm reduction tool, they remain illegal in about half of U.S. states due to decades-old laws classifying the tests as “drug paraphernalia.”
Some states—including New Mexico, Wisconsin, and Tennessee—have recently passed laws allowing the sale of the test strips. In New York City, city council membersintroduced a billto require health officials to provide overdose care training to bars and nightclubs. Still, in some states, like Florida,lawmakers rejectedattempts to legalize the tests.
“Fentanyl test strips or drug checking overall needs to be easy and more accepted,” Shold said. “If we can change people’s perspective on that, you should be able to go to a drugstore and buy these.”
How to Use Fentanyl StripsTo test a drug for fentanyl, you can dilute a small portion of it in water, dip a test strip in the solution, and get a result in about five minutes. If you’re not able to test for fentanyl, Shold said to assume it’s there and proceed with caution.
How to Use Fentanyl Strips
To test a drug for fentanyl, you can dilute a small portion of it in water, dip a test strip in the solution, and get a result in about five minutes. If you’re not able to test for fentanyl, Shold said to assume it’s there and proceed with caution.
Shold said that while the Drug Control Strategy rightly emphasizes the need for better support services for people with substance use disorders, it fails to address the crisis among recreational drug users who may suffer an accidental overdose.
“There’s this whole kind of lost community of people who are vulnerable because they don’t have the tolerance [to opioids]. They don’t have all the support capabilities, and that’s what we’re trying to help with,” Shold said. “We’re trying to put harm reduction into the hands of people where they need it when they need it.”
Tackling Accidental Overdoses
Quickly administering naloxone is the most effective way to reverse the effects of an opioid-related overdose. But there are several barriers to having the drug on-hand in emergency situations.
Though the Food and Drug Administration hasencourageddrug makers to develop over-the-counter naloxone, the currently available versions of the drug require a prescription orstanding orderfrom a pharmacist.
Community outreach programs like FentCheck can distribute naloxone in some states, and recipients must undergo training on how to administer it.
“There aren’t enough fentanyl test strips, and there isn’t enough Naloxone to really make a dent in the opioid overdose death rate in this country,” she added. “These are harm reduction strategies that are simply insufficient for dealing with the oversupply of fentanyl in the U.S.”
For one, she said, even with the knowledge that a drug is laced with fentanyl, an individual may still choose to use it. And once someone is addicted to opioids, more intensive treatment services are typically necessary to support them.
As of now, few people with substance use disorders are getting access to the treatment they need. According to the 2020National Survey on Drug Use and Health, only about 6.5% of people who needed treatment for a substance use disorder received such care at a specialty treatment facility in the past year.
“That number is very telling and it shouldn’t be so low—we should be able to serve more people than we actually do,” Campbell said. “What can we do to expand and not just treatment capacity, but effective treatment capacity?”
Looking Beyond Harm Reduction
To adequately affect change, the White House emphasized the need for research on consumption patterns, prevention, treatment, recovery, drug production and distribution, and more. Bolstering data collection systems, Campbell said, can also help experts to understand the effects of new psychoactive drugs to create meaningful interventions and treatments.
During the pandemic, substance use has increased, and treatment became harder to access in some ways. For many people, the pandemic exacerbated feelings of social isolation, helplessness, and stress—emotions thatmay increaseone’s dependence on substances. And it deepened many existing inequalities in our health system. In 2020, for instance, the rate of overdose deaths among Black Americans eclipsed that of White Americans for the first time since 1999.
The White House strategy aims to address disparities in treatment for people of color and better management of addiction in the criminal justice system. It also calls for early intervention to prevent young people from developing a dependence on drugs.
But notably, the plan leaves out mention ofsafe injection sites, where people may consume drugs in a supervised area with health providers who can administer naloxone in case of an overdose. Some oppose these sites, saying they enable drug users. Proponents say that they are important for de-stigmatizing drug use and minimizing the associated health risks.
“If we don’t go to safe injection sites—if cities and states don’t move in that direction—I don’t see how we’re going to affect the overdose death rate,” Campbell said.
What This Means For YouFor the first time, the White House is embracing harm reduction as an important tool for the overdose epidemic. But experts say prevention, treatment, and more safe injection sites are needed to make a real difference.
What This Means For You
For the first time, the White House is embracing harm reduction as an important tool for the overdose epidemic. But experts say prevention, treatment, and more safe injection sites are needed to make a real difference.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Wilson N, Kariisa M, Seth P, et al.Drug and opioid-involved overdose deaths — United States, 2017–2018.MMWR Morb Mortal Wkly Rep2020;69:290–297. doi:10.15585/mmwr.mm6911a4
Palamar JJ, Ciccarone D, Rutherford C, Keyes KM, Carr TH, Cottler LB.Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021.Drug Alcohol Depend. 2022;234:109398. doi:10.1016/j.drugalcdep.2022.109398
Centers for Disease Control and Prevention.Provisional drug overdose death count.
Centers for Disease Control and Prevention.U.S. overdose deaths in 2021 increased half as much as in 2020 – but are still up 15%.
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