Every couple of weeks a local media outlet does some coverage of fentanyl test strips (FTS) that tells basically the same story: These are simple, life-saving tools that can prevent overdose, but because some states still criminalize them as “drug paraphernalia,” coupled with the myth that they enable drug use, we can’t get them into the hands of the people who need them. Then there are some quotes from someone at a syringe service program (SSP) about the volatility of the drug supply, and how no one knows what they’re using these days.
This isn’t wrong exactly. But it keeps the focus on SSP participants, the group for whom FTS are arguably the least useful, and completely overlooks the groups for whom they’re an obvious fit because the inherent limitations of the technology wouldn’t matter. FTS should be accessible to everyone, but they should be aimed primarily at people who don’t use fentanyl—people who aren’t considered “drug users,” even though they too use drugs.
FTS are rapid-result dipsticks that produce a binary “Yes” or “No”—along the same lines as a COVID-19 test or a pregnancy test. They tell you whether fentanyl is detected in a drug sample, but they don’t tell you how much fentanyl or what else is there besides fentanyl. They detect fentanyl analogs, but it all still just shows up as the same thing.
The problem is that for people who use fentanyl every day, which is the main demographic served by SSP, it doesn’t necessarily change anything to learn that their fentanyl has fentanyl in it. The real game-changing information would be the quantity of fentanyl, and the overall composition of the sample, which requires higher-tech forms of drug-checking that are much less accessible.
This isn’t to say FTS can’t still be useful to SSP participants. They can be handy to check for cross-contamination. They can serve as a reminder to “start low, go slow.” They can provide a natural opportunity to engage participants in conversation. And they can provide confirmation to anyone who just wants the information because they have the right to it.
But the obvious places to stock FTS are school bathrooms and locker rooms. Bars, nightclubs, festivals, dormitories—all the places frequented by people who don’t identify as drug users, but who do use drugs. They could be $1 each, in dispensers next to the tampons.
The original purpose of FTS was urinalysis testing, and so because they’re designed to pick up fentanyl after it’s been metabolized and peed out—rather than dipped into it directly—they’re extraordinarily sensitive. They can pick up trace quantities of fentanyl that even the higher-tech drug-checking technology can’t.
The Drug Enforcement Administration’s “One Pill Can Kill” campaign has very successfully marketed the idea that 2 mg of fentanyl means you die, which invites people to believe that the danger comes from just the presence of fentanyl in and of itself. This isn’t true—no substance is toxic by nature even in trace amounts—but for people who don’t expect and don’t want fentanyl in the drugs they’re about to use, and won’t go into withdrawal if they change their minds based on the results, a “Yes” or “No” fentanyl test is enough.
Obviously the DEA is not going to put FTS on billboards because the point of “One Pill Can Kill” is to prosecute overdose, not prevent it. That’s why rather than describing fentanyl as what’s replaced heroin in the unregulated opioid supply, media and law enforcement describe it as a “Russian roulette” contaminant that’s equally likely to show up in heroin, cocaine, meth, marijuana, vapes and counterfeit pills whether they were sold as Percocet or Adderall or Xanax.
But everyone the agency is trying to scare with these campaigns—everyone who calls fentanyl deaths “poisoning” because “overdose” is just what happens to people who use drugs—is the audience for whom FTS would really make a difference.
The target demographic should be the students the DEA is so fixated on, and their parents who regardless of their views on drugs would probably latch onto FTS immediately if they were rebranded as something that belonged to the “fentanyl poisonings” movement, not just the harm reduction movement. This would also speed things along in the states still trying to decriminalize FTS, with legislation that keeps stalling in committee because it only helps drug users.
Top image via Drug Enforcement Administration. Inset graphic via San Francisco Department of Public Health.
