Iowa is part of a shrinking club: It’s one of just five states that still does not authorize fentanyl test strips. These tools simply show whether or not fentanyl is present in a substance—information that may be unnecessary for regular opioid users who already assume it’s there, but could be lifesaving for someone who’s not expecting to use fentanyl. Iowa activists, with some allies in the state legislature, are working to legalize fentanyl test strips (FTS).
Current law in Iowa defines drug “paraphernalia” as “all equipment, products, or materials of any kind used or attempted to be used in combination with a controlled substance”, including if it’s used to “Test the strength, effectiveness, or purity of a controlled substance”. A drug paraphernalia violation is a misdemeanor. But do fentanyl test strips fall under that definition?
“They’re not legal but not illegal in Iowa, it’s in a gray area.”
“They’re not legal but not illegal in Iowa, it’s in a gray area,” Deborah Krauss, executive director of the Iowa Harm Reduction Coalition, told Filter. “Because they are not drug-checking equipment they don’t fall under the code for it.” Despite being used with samples of drugs dissolved in water, “FTS are a urine test strip. You’d be hard pressed to find a [district attorney] who would charge someone with drug paraphernalia for a urine test strip.”
At the same time, their ambiguous legal status sends an unnecessarily ambiguous message to people who could benefit from FTS. “We’ve talked to lawmakers trying to educate on what an FTS even is and what the law looks like for us,” Krauss said.
In the legislature, Representative Megan Srinivas (D) led an effort to legalize fentanyl test strips earlier in 2024. She introduced it as an amendment to a larger bill, which sought to increase penalties for fentanyl distribution. But the bid seems to have been killed because of opposition from police: According to the Iowa Capital Dispatch, Rep. Phil Thompson (R), reported that police requested lawmakers block the FTS amendment.
“Almost unanimously, they asked us to pump the brakes on this,” Thompson said. “Their major concern … a lot of times, what we’re seeing in some of these states that have expanded it are getting false negatives on those counterfeit pills.”
According to the Dispatch, Srinivas is looking at reintroducing the measure in the next legislative session beginning January 13, with support from harm reduction advocates.
One of them is Ann Breeding, who lost her 29-year-old son, Daniel, to an overdose.
“My biggest fear became my reality, and I have nothing left,” Breeding told Filter.
“I do whatever it takes,” she said. “I have a big mouth and a lot to say, because I had to be quiet when my son was here, because of the shame and stigma of substance use. He’s no longer here; I will talk to anybody who will listen and share my experience.”
“Even if it’s one out of 10, it’s worth it.”
Breeding co-founded Steps of Hope Iowa, which raises awareness about overdose and harm reduction. And she’s now focusing on what she sees as a simple way to prevent deaths like that of her son.
“If a person has access to test strips, they can test what they’re going to do, and then they’ve got a choice,” she said. If they weren’t intending to use fentanyl, that information “will alter their decision.”
Breeding doesn’t see FTS as a perfect solution, but cited research showing how the strips can change people’s awareness as well as their immediate decisions. For example, a 2019 study published in the International Journal of Drug Policy found that 43 percent of people who used FTS changed their drug-use behaviors.
“Even if it’s one out of 10, it’s worth it,” Breeding said.
According to CDC data, overdose deaths in Iowa have trended upwards over the last decade, reaching a record high in 2021. That year, the state lost 475 people to overdose. Deaths declined just very slightly in 2022, with 469 lives lost that year.
Besides Iowa, only Idaho, Indiana, North Dakota and Texas have not yet legalized FTS. But it’s been a long journey to get to this point. Even very recently, many more states had laws on the books banning or restricting this harm reduction tool. In 2023, a wave of states, including some of those hardest hit by the overdose crisis, moved to decriminalize FTS—among them Ohio, Pennsylvania, South Dakota, Kentucky and Mississippi.
“It’s common sense—if it’s going to potentially alter a decision to ingest a substance that can kill a person, why would that not be fully legalized?”
Breeding fully expects Rep. Srinivas to try again in Iowa. “She is incredible,” she said. “She’s very intelligent because she’s in the medical field, and she knows what a lot of people don’t know. Public health, public safety, lived experience and harm reduction people have to come together. We’ve got [three of those], but it’s the public safety I’m going to call out. There is no justification.”
Breeding is willing to work with either Democrats or Republicans in the state House, but has found that most lawmakers show little interest. “I was very disappointed when I have reached out to other representatives … because we’ve got to get this done,” she said. “It’s common sense—if it’s going to potentially alter a decision to ingest a substance that can kill a person, why would that not be fully legalized?”
Krauss supports efforts to expand access to FTS, though her major current focus is passing a law to authorize syringe service programs. Iowa is also one of a small group of states that still does not allow these programs to operate legally. Despite the obstacles to harm reduction in her state, its community spirit gives her hope.
“We all take care of our people,” she said. “In rural Iowa, if we do a delivery to someone who doesn’t have a vehicle and lives 45 minutes outside of town, we’re dropping off dozens of naloxone kits because they will pass it out to their people and make sure they’re staying alive. Nothing is unique [about Iowa] but we really do love each other in ways that make sure our friends and neighbors aren’t dying.”
Photograph of memorial to overdose victims courtesy of Steps of Hope Iowa