The United States federal government has taken a step to make good on its late 2020 endorsement of fentanyl testing strips (FTS), which came came after years of effective opposition to the drug-checking technology.
On April 7, two public health agencies—the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA)—announced that certain federal funding can now be used to purchase FTS.
The strips are simple drug-checking tools that promote the bodily autonomy of people who use drugs. They inform people of the presence of fentanyl, the potent synthetic opioid that’s come to be nearly ubiquitous in the street supply of heroin, and increasingly in other drugs including cocaine, meth and pills marked as Xanax.
In particular, grantees of CDC’s Overdose Data to Action and SAMHSA’s State Opioid Response programs are subject to the policy change. The former is primarily concerned with surveilling overdose trends, while the latter—recently found to squander funds—mostly addresses substance use disorders.
Although the Biden Administration has said harm reduction is one of its priorities, as Filter first reported, the policy change seems to have been brewing before he took office in January. The CDC endorsed drug checking as an overdose prevention strategy on December 17, 2020, in the lame duck period of Trump’s presidency. The former head of SAMHSA during that administration was opposed to FTS.
Changes on the Ground
The longstanding ban, similar to the ongoing one criminalizing syringes, has forced syringe service programs (SSP) to secure other funding, rely on donations or go without FTS. “Until now, we have not been able to purchase fentanyl test strips using federal funds,” the Alliance LES Harm Reduction Center, an SSP in New York City, said in a statement shared with Filter.
“Our supply has been bolstered with fentanyl test strips generously donated by volunteers, however a limited supply means that we often are forced to ration or limit the amount of test strips that we can give out. This is certainly not ideal with a potentially life-saving tool that gives people who use drugs information that they can use to stay safe.”
The policy change will likely allow Alliance LES and other SSP to step up their own drug-checking services. “The ability to purchase test strips with federal funds will improve our supply, and means that people can test multiple batches and substances,” the organization added. “Fentanyl is out there in the opioid supply, and it is being found in other substances, so the ability to test for it shouldn’t be limited.”
For years, grassroots harm reductionists have been distributing FTS without governmental support. One such activist is Tino Fuentes, who resigned in 2016 from his position at a nonprofit SSP in New York City to pursue an independent effort to provide FTS to people who use as well as people who supply drugs—the latter of which he said would have been difficult if he had stayed in his organizational role.
“I believe in asking for forgiveness, instead of permission. That’s the best way I’ve found,” Fuentes told Filter in 2019. “I’m going to do what I have to do. If I get caught and I go before a judge, I’ll say, ‘People are dying.’”
The new funding will be no silver bullet for ending preventable overdoses. Instead, it appears to be a small policy step toward embracing evidence-based harm reduction policies—after years of rising fentanyl-involved death tolls.
FTS are still criminalized as drug paraphernalia in many parts of the US. Some jurisdictions, however, have exempted the strips, including Maryland, Rhode Island, North Carolina and the District of Columbia. The Delaware state legislature may soon follow suit.
Supply-side crackdowns on the unregulated drug economy appear to have driven the introduction of fentanyl analogs as an adulterant into heroin and pressed-pill supplies. Research has shown how efforts by law enforcement to reduce the drug supply have incentivized suppliers to shrink the volume of product by introducing higher-potency substances.
One potential vision for addressing the structural issues driving fentanyl-involved overdoses include drug-possession decriminalization and a safe supply, as North American harm reductionists and drug-user activists have been demanding. Canada is considering a promising model, while the state of Oregon approved decriminalization at the ballot box last November. The Seattle Supreme Court also struck down the state’s felony drug possession law as unconstitutional. Some Canadian provincial governments have medicalized safe supply programs, while grassroots advocates call for a “community-led compassion club” model.
Photograph by Kastalia Medrano