Fentanyl Test Strips Highlight Rift in Nation’s Struggle to Combat Drug Deaths

Fentanyl Test Strips Highlight Rift in Nation’s Struggle to Combat Drug Deaths

Proponents say the ability to check drugs for the presence of lethal fentanyl may save lives. But critics say the strips enable drug use.

“You smoke weed?” Eufamia Lopez asked the half-dozen young men lounging on benches in a public housing courtyard in the South Bronx.

Ms. Lopez, who works for a New York University health support program, plunged into her spiel. Street drugs — meth, coke, molly, Xanax, heroin and even marijuana — are being cut with fentanyl these days, she said, which can kill you. But you can test your supply before using it to see whether there’s any fentanyl in it. She was giving out free kits.

She had their attention, and not just because she is 5-foot-10, frank but ebullient, with cascading black curls scarcely held in check by a brightly colored scarf. The neighborhood, Mott Haven, has one of New York City’s highest overdose rates. After she recited the simple instructions, each man readily accepted a kit with three fentanyl test strips. One asked for a second kit.

The spread of fentanyl, a cheap synthetic opioid 50 times as lethal as heroin, into most kinds of illicit drugs has pushed fatal overdoses to record highs in the United States. Fentanyl test strips have become a popular but contentious tool in response. Supporters say they help drug users make lifesaving decisions. Opponents contend that they facilitate drug use.

Critics say test strips encourage drug use by giving users the green light if the supply is free of fentanyl. To some opponents, the test strips are even more objectionable than other forms of harm reduction, like distributions of clean syringes, because those at least prevent the spread of H.I.V., hepatitis and other dangerous infections to users and nonusers.

In May, Kansas legislators blocked a proposal to legalize the strips. “Fentanyl strips don’t save lives. Let’s be clear. There are individuals that want fentanyl in the drug that they’ve purchased or acquired,” Molly Baumgardner, a Republican state senator, said at the time, according to the Kansas Reflector, which reports on state government.

The Biden administration’s drug czar refutes such criticism. “There is no scientific evidence to support this notion that harm-reduction services like fentanyl test strips somehow encourage drug use, but there is significant evidence to support the fact that these tools can save lives,” said Dr. Rahul Gupta, director of the federal Office of National Drug Control Policy.

Fentanyl is a potent and fast-acting drug, two qualities that also make it highly addictive. A small quantity goes a long way, so it’s easy to suffer an overdose. With fentanyl, there is only a short window of time to intervene and save a person’s life during an overdose.Prescription drugs sold online or by unlicensed dealers marketed as OxyContin, Vicodin and Xanax are often laced with fentanyl. Only take pills that were prescribed by your doctor and came from a licensed pharmacy.The best way to prevent fentanyl use is to educate your loved ones, including teens, about it. Explain what fentanyl is and that it can be found in pills bought online or from friends. Aim to establish an ongoing dialogue in short spurts rather than one long, formal conversation.When someone overdoses from fentanyl, breathing slows and their skin often turns a bluish hue. If you think someone is overdosing, call 911 right away. If you’re concerned that a loved one could be exposed to fentanyl, you may want to buy naloxone, a medicine that can rapidly reverse an opioid overdose and is often available at local pharmacies without prescription.

In fact, there is not yet a substantial body of evidence that directly shows test strips have saved lives. Results have been mixed from a handful of relatively small studies looking at whether the strips deter sustained drug use.

In a 2021 study, researchers at the Johns Hopkins Bloomberg School of Public Health, among others, surveyed 225 drug users in Baltimore and Delaware who had been given strips at two syringe distribution programs. About three-quarters reported having used them. In Delaware, 69 percent said that when results were positive for fentanyl, they subsequently took risk-reduction measures; in Baltimore, just 23 percent did so.

Ms. Lopez said she had even persuaded some drug sellers to try the strips.“I’ve had drug dealers tell me, ‘I don’t have any fentanyl in my stuff!’” she said. “And I say, ‘Well, how do you know?’”

The divergent messaging on fentanyl test strips gets translated into inconsistent practices even within the same state. Kentucky considers them drug paraphernalia but gives decision-making authority to local health departments. So in cities like Lexington and Louisville, mobile units or clinics readily hand out the strips, said Jim Thacker, project director of Target4, an H.I.V.-prevention and harm-reduction program at the University of Kentucky. But in many rural counties, he said, police officers have detained program participants and confiscated the kits.

Mr. Thacker said that particularly in the Bible Belt, resistance to harm reduction springs from a stigma that still attaches to drug use.

“Addiction is not seen by a lot of people as an illness,” he said. “It is seen as a moral failure. I’ve heard multiple times that ‘the best way to solve the drug problem in Kentucky is to gather up all the drug users and lock them in a big space and supply all the drugs they could possibly want and let them all overdose and die.’ ”

Even where test strips are easily obtained, they have limitations. They measure the presence of fentanyl, but not its concentration. While many clinics, pharmacies and drug treatment programs provide them free, in locations where access is difficult or banned, they must be purchased online for about a dollar or two each, a cost that can add up quickly for a regular user.

The effectiveness of the testing, in which a small drug sample is dissolved in scarcely a capful of water into which a strip is then dipped, relies completely on the user’s compliance. That’s why outreach workers like Ms. Lopez try to engage users directly, clambering under bridges to find them and perusing parks near high schools.

The tests require even more diligence from people who buy counterfeit versions of pills like Xanax, OxyContin or Percocet through social media or street dealers. Cartels that press the pills salt them haphazardly with fentanyl filler. So while one pill might test negative, others could be contaminated. Each pill should be tested.

From powerful pharmaceuticals to illegally made synthetics, opioids are fueling a deadly drug crisis in America.

But such rigor is antithetical to young people looking to party, or to people who struggle with addiction, said Kevin Sabet who, with former congressman Patrick Kennedy, is a founder of the Foundation for Drug Policy Solutions.

“Addiction is chaotic and disturbing,” said Mr. Sabet, who thinks the strips’ utility is modest. “It hijacks the brain. So the idea that while you are in active addiction you are going to make a lot of rational choices with regard to your drugs sort of goes against the very notion of what addiction is.”

Ms. Lopez disagreed with that broad-brush view, saying she knows functioning heroin users who use the strips responsibly because they fear an inadvertent fentanyl overdose.

But she acknowledged that people who are deeply in addiction tend to reject the strips. “They want fentanyl,” she said, “because their goal is being high. Their lives have become so empty that they figure that even if they die in the pursuit of that goal, it’s worth it to them.”

So she looks for people who can be at least persuaded to carry strips for the sake of saving others. Sussing out who might be receptive is a subtle skill, a blend of observation, intuition and street-wise experience.

Ms. Lopez and her co-worker Stephanie Llivichuzhca walked along 149th Street toward the Hub, a Bronx commercial center dense with drug traffic. Clusters of men leaned against storefronts, casually thumbing wads of cash.

As Ms. Lopez approached, she offered icebreaker inducements. To men chatting outside a barbershop: “Papi! How y’all doing? Need some condoms?” (Throughout the day, every man, young or old, responded: “You got Magnums?”) Then she would pivot to her test-strip pitch.

A thin, worn-looking woman sat alone at a cafe table, staring vacantly. “How you doing, Mama?” Ms. Lopez called, pulling out a hygiene kit from her bag.

As she headed toward the bustling spoke of the Hub, a man plunged a needle in his arm. She swerved away. “This is crazy to me!” she sputtered angrily. “Before Covid I don’t remember people feeling comfortable enough to shoot up in front of everybody. The world has definitely changed for poor people. They were borderline desperate before, but now they’re full-on desperate. ”

By the end of the shift, the women had distributed about 20 fentanyl test kits in addition to hygiene kits, condoms and Narcan, which reverses overdoses. Their program, New York City Communities for Health, run by the Silver School of Social Work at N.Y.U., also distributes kits in other neighborhoods in the Bronx and Manhattan.

The late-afternoon sun ducked behind clouds, and a chill breeze kicked up. How would Ms. Lopez find recipients when the weather turned wintry?

She was not daunted. “We should try to get people while they’re waiting for the subway,” she said to Ms. Llivichuzhca. “We would totally rock it!”