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Fentanyl tests strips could prevent overdoses, but they’re often not allowed to

Several packaged fentanyl test strips are placed on a table next to a card with instructions on how to use them.
Gustavo Sagrero
Boise State Public Radio
Packages of fentanyl test strips lie next to a card that explains how to use them. The tests, themselves, look like little strips of blue, red and white paper.

Black market fentanyl is a growing problem across the West and the nation. The synthetic opioid is useful for pain management in hospitals, but when used without any quality control, it can kill.

Crime labs often take the burden of analyzing drugs found by police, deciphering what has fentanyl and what doesn’t. Forensic scientist Kerry Hogan works at an Idaho crime lab in Meridian, Idaho. She says it can take longer to analyze fentanyl than other drugs because they have to use machines like gas chromatograph mass spectrometers.

“My most generic way to explain it is the reverse of baking," she said. "So if you put a chocolate chip cookie into our mass spectrometer every time you put a chocolate chip cookie into there, it would break apart into flour, sugar, butter, eggs and chocolate chips.”

Hogan said Idaho’s crime lab chemists have been working hard to process an increasing amount of fentanyl, often coming in the form of little blue counterfeit pills.

“They are designed to look like oxycodone tablets, so they’re round, light blue to green in color, and they have an imprint of an 'M' on one side and a '30' on the other,” she said.

Part of a gas chromatograph mass spectrometer machine is in view. Several small vials are placed into the machine in a circular-shaped configuration. A testing mechanism with a needle-like point appears above the configuration of vials.
Madelyn Beck
Mountain West News Bureau
This is part of the gas chromatograph mass spectrometer machine at the crime lab in Meridian, Idaho. This GC/MS can break substances down into basic parts and measure their levels, which can show what a substance is.

But individuals don't necessarily need a fancy machine to check their own drugs for the potent synthetic opioid. They could use relatively inexpensive fentanyl test strips to detect the drug – but those are illegal in Idaho and many other states.

The strips act like a pregnancy or a COVID-19 test: they show one line if there’s fentanyl in a drug’s residue, two if there isn’t. They’re not perfect. With meth, they can show a false positive.

Fentanyl also tends to glob together, so it’s possible to test a portion of a drug that simply wasn’t touching the fentanyl.

However,early research shows that young people who have them use more caution. That can save lives.

Health experts say some people might use the strips to seek out fentanyl, but add that's unlikely for a few reasons. Most want to avoid overdoses the drug can easily cause, and people with substance use disorders often have to use fentanyl again sooner to avoid getting sick from withdrawal.

Still, Idaho health officials aren’t pressuring lawmakers to make test strips legal this year.

“Our stance right now as a department is to really focus on providing some education to our partners about what that legislative change would mean,” said Caroline Messerschmidt, health program manager with Idaho’s Drug Overdose Prevention Program.

Messerschmidt points to states like Pennsylvania, where a bill to legalize test strips failed last year.

“They just didn't put the effort behind it that they needed to because there was this other thing called COVID happening at the same time,” she said.

Even if the strips were legal, she said she’s not “naive” enough to think they’ll get strips into everyone’s hands.

"And so I think it's more important getting the message out that drugs can be really risky and deadly.”

As of last May, drug tests (like fentanyl test strips) were considered illegal paraphernalia in more than half of U.S. states, according to data from the nonprofit Legislative Analysis and Public Policy Association, or LAPPA.

A tray with 12 cavities. One cavity has clear liquid in it that has developed an orange-like hue with some areas more vivid in color than others.
Madelyn Beck
Mountain West News Bureau
A bit of suspected meth was put into a solution at a crime lab in Meridian, Idaho. It turns orange in response, though fentanyl turns a similar color. Because of this, more tests are generally needed to confirm a substance is fentanyl.

So why are they illegal?

Well, LAPPA attorney Jon Woodruff found that in the late 70s many states copied and pasted the DEA’s definition of illegal drug paraphernalia into their own laws. And that definition includes individual tests for illicit drugs.

So the drug tests have been technically illegal for decades.

“The question is how do you get the inertia of having a law that's been in place for so long changed enough to sort of clearly make it allowable,” he said.

Woodruff said LAPPA writes and researches legislation on health, substance use disorders, and criminal justice. It does so largely through funding by the federal Office of National Drug Control Policy. Woodruff said LAPPA will put out more research on test strip laws in the coming months, and the association plans to draft new model legislation for states to use to change drug paraphernalia laws and allow tests.

But some states already changed their laws, like Nevada. And others, like New Mexico, don’t want to wait any longer.

Aryan Showers is the policy director for the New Mexico Department of Health. She said that if a bill legalizing the strip would have passed last year, “around 250 people would have likely been saved ... so we’re too late.”

That state health department drafted another bill this year, and it goes beyond fentanyl test strips, legalizing tests for potential new drugs that could come along.

“Fentanyl probably isn't going anywhere soon, but we're already seeing analogs to fentanyl that are popping up in the drug supply that are actually not being detected by fentanyl test strips,” she said.

Showers said the current law, if left unchanged, could even apply to tests young women carry to make sure their drinks aren’t “roofied,” or contain date-rape drugs like Rohypnol.

“Many of those devices would fall under that criminal statute, under the definition of paraphernalia,” she said.

Showers says if they legalize tests now, they can take advantage of help being offered by the federal government. Last April, officials made it legal for states to use federal grant funds to buy fentanyl test strips.

And until February 7, states can apply for a chunk of $30 million specifically aimed at overdose prevention tools, including test strips.

“If we can get this bill passed, it's really going to enable us to intervene quickly, immediately, and to really start trying to solve this problem,” Showers said.

Just legalizing the test strips doesn’t mean states will use them, though. The tests aren’t listed as drug paraphernalia in Wyoming, but the state health department said it doesn’t plan on buying test strips yet, citing limited fentanyl overdose data.

Jason Svare coordinates the University of Wyoming’s AWARE program, which stands for Alcohol Wellness Alternatives, Research, & Education. The program talks with university students about safety measures they can use with substance abuse.

He says he has a few fentanyl test strips to show people who ask, but doesn’t have enough to give out. Those few strips he does have just came from a colleague. He said he would like more available, even if Wyoming isn’t a hot-spot for overdose deaths yet.

“AWARE is a harm reduction program, and so yes, I would want them to be available,” he said about the test strips. “Why not?”

While the state may have limited data on fentanyl overdoses, the drug is moving through the state. Last summer, Wyoming Highway Patrol seized an estimated $150 million worth of fentanyl.

All this comes as the U.S. recognizes a grim milestone. In the 12 months leading up to April 2021, more than 100,000 people died from drug overdoses, a record and an increase of 28.5% over the prior year.

For more information on fentanyl in the Mountain West, check out our series. If you are a person who uses drugs or are concerned about loved ones overdosing on opioids, you can find Narcan and Naloxone resources on nextdistro.org or by contacting your state health department.

This story was produced by the Mountain West News Bureau, a collaboration between Nevada Public Radio, Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.
Copyright 2022 Boise State Public Radio News. To see more, visit Boise State Public Radio News.

Madelyn Beck is a regional Illinois reporter, based in Galesburg. On top of her work for Harvest Public Media, she also contributes to WVIK, Tri-States Public Radio and the Illinois Newsroom collaborative.
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