Even as the spread of synthetic opioids such as fentanyl has brought a stunning rise in drug overdose deaths, a simple, cheap test for the drug's presence is illegal.
Fentanyl test devices — prohibited under drug paraphernalia laws adopted decades ago — remain illegal in about half of states, including Missouri. A House bill to establish a fentanyl testing strip pilot program got a second reading in January but didn't make it onto the legislative calendar for further action.
Ironically, the Missouri Department of Health and Senior Services offers this advice to users of illegal drugs such as heroin, methamphetamine and cocaine: "Test drugs with a fentanyl test strip, when possible."
Although the state hasn't decriminalized the strips, people who possess the papers aren't being prosecuted.
Current drug paraphernalia laws may discourage states or organizations from applying for grants to buy test strips or creating programs to distribute them, said Jon Woodruff, senior legislative attorney for the Legislative Analysis and Public Policy Association.
Public health and addiction experts promote the rapid testing devices as what's known as a "harm reduction" tactic to help prevent overdose deaths from illicit drugs that users may not know are laced with fentanyl.
"We hope all the states would come to realize the dangers of contamination are so high and that fentanyl test strips empower a person taking drugs to know whether they have fentanyl," said Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.
Street versions of fentanyl, an approved painkiller that's being produced illegally, largely come into the U.S. from Mexico. Fentanyl is up to 100 times as powerful as morphine. It is commonly found in what is sold as heroin — often taking its place entirely. It also can be mixed into cocaine, methamphetamine, and counterfeit street pills sold as opioid medications — substances that many buyers are not expecting to contain fentanyl.
Synthetic opioids — including fentanyl — were involved in about two-thirds of U.S. drug overdose deaths in the 12-month period that ended in November 2021. And three-quarters of overdose deaths from cocaine last year were associated with fentanyl, Volkow said.
"Fentanyl is so potent that it can stop your breathing at very low doses," she said.
The fentanyl epidemic also "has exacerbated racial inequities," Volkow added. From 2019 to 2021, fentanyl overdose deaths more than tripled among teenagers — and surged fivefold among Black teens, according to an analysis of Centers for Disease Control and Prevention data produced by the advocacy group Families Against Fentanyl.
Last month, the Drug Enforcement Administration sent a letter to federal, state, and local law enforcement officials warning of a nationwide spike in fentanyl-related mass-overdose events.
"Fentanyl is killing Americans at an unprecedented rate," said DEA Administrator Anne Milgram. "Already this year, numerous mass-overdose events have resulted in dozens of overdoses and deaths."
The testing strips are inexpensive, costing about $1. A drug user can take a small quantity of the substance, add water, and dip a strip briefly into the solution. If one red stripe appears on the strip, fentanyl is present; two stripes mean none of that drug is found.
A downside is that the test strips don't gauge the amount of fentanyl in the drug.
Still, the strips are effective in detecting "very small amounts of fentanyl," said Brown University epidemiologist Brandon Marshall, part of a team that has studied illicit drug users and the devices in Rhode Island. Many of the participants who tried the strips, Marshall said, discarded the substance if fentanyl was present, used the drug with someone else present, or had naloxone available during use.
A similar study of North Carolina intravenous drug users found 3 in 4 people indicated that fentanyl strips made them feel better able to protect themselves from overdose.
In South Carolina, which has made fentanyl test strips available, the state sends an anonymous survey to anyone who receives them. Sara Goldsby, director of the South Carolina Department of Alcohol and Other Drug Abuse Services, said survey responses indicate that people who use the strips report using fewer drugs, with some choosing not to use the drugs altogether, and that they feel safer in preventing overdoses.
The testing strips, Brown's Marshall added, "are not going to be a silver bullet to address the overdose crisis, but they can be an important tool to help people stay safe."
Kaiser Health News contributed to this report.
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