How the criminalization of fentanyl test strips could intensify the opioid crisis

By Jules Murtha | Fact-checked by Jessica Wrubel
Published October 25, 2022

Key Takeaways

  • Research shows that the rate of fentanyl-related overdoses in the US has steadily increased prior to and during the COVID-19 pandemic.

  • Despite their potential to reduce such overdoses, fentanyl test strips have been outlawed in many states due to the argument that instruments used to test for substances condone drug use.

  • To decrease opioid-related overdoses, the AMA suggests public health officials provide widespread, community-level distribution of naloxone and fentanyl test strips. Further research suggests clinicians may treat opioid use disorder with medications.

To address the intensifying opioid epidemic, doctors across the US have cut opioid prescriptions by 50%—yet opioid-related overdoses continue to rise. The culprit? Fentanyl.

To avoid using unwanted fentanyl, many individuals rely on fentanyl test strips, which detect the drug’s presence in illicit opioids—and are illegal in 19 states.

Reduction of opioid-related overdoses will require public health officials to support the distribution of fentanyl test strips and other overdose reduction strategies, as physicians treat patients accordingly.

Fentanyl-related overdoses rising

According to an article published by Current Opinion in Psychiatry, the US is seeing what researchers are calling the “fourth wave” of the opioid crisis, denoted by heightened rates of overdose and mortality among those who use opiates.[]

A major cause of opioid deaths and stimulant-related overdoses is illicit fentanyl.

Manufactured fentanyl has become almost impossible to avoid in illicit opioids, according to a article.[]

Between December 2018 and December 2019, there were 50,178 known opioid-related overdoses, amounting to a 6.5% increase from the prior year. Synthetic opioid-related overdoses (which include those involving fentanyl) rose to 36,603—a 16.1% increase. Heroin and prescription opioid-related overdoses, however, fell.

The author of the article asserted that fentanyl’s infiltration of the drug supply is the reason why the opioid epidemic is as lethal as it is. Heroin, amphetamines, MDMA, and other substances are commonly laced with fentanyl.

Patients who use heroin regularly—or other drugs recreationally—may rely on fentanyl test strips to rule out fentanyl's presence in their supply. However, these test strips are legal only in some of the US.

Fentanyl test strips controversy

Tools designed to check drugs have long been contested by conservative lawmakers, who argue that products such as fentanyl test strips are paraphernalia and that legalizing them condones drug use.

As a result, 19 states—mostly in the south—have outlawed fentanyl test strips, according to

But evidence shows that fentanyl test strips could be a valuable harm-reduction tool.

A study published by Harm Reduction Journal looked at a sample of 93 adults in Rhode Island who’d reported they used drugs in the past 30 days.[] Each participant was given fentanyl test strips and asked to return within 2–4 weeks for a follow-up interview.

The study results showed that 87% of participants who were interviewed had used at least one strip. Of those who had positive test results, a number of participants changed their approach to substance use. Some discarded their supply, used it in the presence of another person, or made sure to have naloxone (which reverses opioid overdoses) on hand.

These findings support the argument that fentanyl test strips are a valuable harm-reduction tool—and advocates agree, voicing their discontent with the legislation that bans them.

“It’s really frustrating that in 2022, we still have these laws on the books,” Corey Davis, an attorney and director of the Harm Reduction Legal Project, told “Everybody agrees they have the result of reducing the health of people who use drugs.”

"It leads to preventable blood-borne disease, endocarditis, which we all end up paying for—it ends up being a very destructive and expensive way of punishing people."

Corey Davis

Addressing the opioid epidemic

As political flames fan the controversy surrounding fentanyl test strips, prominent medical organizations openly support their widespread availability and use.

An article published by the AMA recommended that health officials make naloxone and fentanyl test strips accessible to communities that need these products, in addition to supporting comprehensive syringe services programs.[]

Clinicians, on the other hand, can continue doing what they do best: caring for patients.

If you have a patient who struggles with opioid use disorder (OUD), consider different treatment options. One is to employ drugs like methadone and buprenorphine, which evidence shows have strong levels of efficacy for treating OUD.

What this means for you

Opioid-related overdoses continue to climb, largely due to an uptick in synthetic fentanyl use. Although fentanyl test strips have potential to save lives—especially for those who may not know how pervasive fentanyl is in illicit drugs—they’re illegal in 19 states. To slow the rate of opioid-related overdoses, the AMA is calling on public health officials to make fentanyl test strips and naloxone widely available. In the meantime, clinicians may treat patients with OUD using medications.

Read Next: Nonfatal opioid overdose rates are climbing. Here's what you can do to help.
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