Can Fentanyl Test Strips Modify How People Use Drugs?

To the Editor: The market for illicit substances is constantly expanding and changing faster than clinicians can keep up, especially with distribution through the “dark web.”¹ In the latest wave of this epidemic, the emergence of internet markets provides a new venue for adulteration of drugs with illicitly manufactured fentanyl (IMF), such as carfentanil and ocfentanil.¹ Fentanyl can be up to 100 times more potent than morphine, increasing the risk for fatal overdose.² These adulterants can be found in counterfeit pills that mimic prescription drugs such as benzodiazepines and oxycodone.²

A commentary about the increasing prevalence of nonprescription fentanyl in counterfeit oxycodone recently published in the PCC suggests that buyers are often unsuspecting of IMF contamination.² There were 79,770 reported fentanyl contaminated fatal heroin overdoses in 2022.³ To decrease mortality, we need to improve harm-reduction initiatives to identify contaminated substances for people who use drugs.

Current tactics for harm reduction include opioid agonist treatment, proper injection techniques, sterile syringe distribution, and naloxone use.^4,5 The distribution of fentanyl test strips to conveniently test the drug supply in the community has garnered recent attention.^4,5 Fentanyl test strips have been widely used in Europe for several years and are recently expanding into Canada.⁵ A study⁵ was conducted at a drug-checking site wherein drugs can be injected under supervision with no questions asked. In this case, they asked 1 question: whether or not clients wanted their drugs tested for fentanyl.⁵ Although only 1% of visits resulted in a drug check, about 80% of these 1,411 drug checks were fentanyl positive.⁵ These clients received a menu of harm reduction strategies such as dose modifications, drug use with others, take-home naloxone, and connection with addiction services.⁵ Among persons with a fentanyl-positive test, about 11% planned to discard the contaminated drug, while 36% planned to decrease their drug dose.⁵ In this sample, dose-reduction intention was significantly associated with decreased overdose risk.⁵

Subsequently, harm-reduction organizations in the United States started exploring distribution of fentanyl test strips as a tool to decrease overdose risk in drug users.^5–7 In a report from Rhode Island, about 90% of people who use drugs were receptive to using home rapid fentanyl test strips.⁸ Another study⁷ performed in Philadelphia found that 75.9% of participants used fentanyl test strips because they had experienced an overdose in the past. Participants who had positive fentanyl-containing drugs were inclined to lower the dose or inject slowly to prevent overdose.⁷

Although pilot trials in the United States support the distribution of fentanyl test strips to drug users, they have limited use.^7,8 Fentanyl test strips are not US Food and Drug Administration approved and are considered illegal paraphernalia in many states.⁴ Additionally, fentanyl test strips cannot measure the quantity of IMF present, and there is potential for false results.⁷ Further research and empirical validation are needed before fentanyl test strips can make a meaningful public health impact on the opioid overdose crisis.

Article Information

Published Online: May 14, 2024. https://doi.org/10.4088/PCC.23lr03681
© 2024 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2024;26(3):23lr03681
Submitted: December 13, 2023; accepted January 22, 2024.
To Cite: Modesto-Lowe V, Roznitsky R, Tan KC. Can fentanyl test strips modify how people use drugs? Prim Care Companion CNS Disord. 2024;26(3):23lr03681.
Author Affiliations: Hartford Behavioral Health, Hartford, Connecticut (Modesto-Lowe); Department of Psychiatry, University of Connecticut, Farmington, Connecticut (Modesto-Lowe); School of Health Sciences, Quinnipiac University, Hamden, Connecticut (Modesto-Lowe, Roznitsky, Tan).
Corresponding Author: Vania Modesto-Lowe, MD, MPH, Hartford Behavioral Health, 2550 Main St, Hartford, CT 06120 ([email protected]).
Relevant Financial Relationships: None.
Funding/Support: None.
ORCID: Vania Modesto-Lowe: https://orcid.org/0000-0003-3036-2566