On July 7, 2023, Missouri joined over 20 other states in legalizing the use of fentanyl test strips. Congress passed the bill in June, and it was signed in early July (1) and became law on August 28, 2023 (2). Fentanyl test strips are used to detect fentanyl that’s been added to drug products. Prior to their formal legalization, these test strips were classified as drug paraphernalia, and could result in added punitive charges being brought if found on a person. The thought process was people who were legally allowed to carry test strips, would be enabled to use substances illegally. Research shows this is NOT true.
Research from organizations like the Centers for Disease Control (CDC), National Institute of Health (NIH), and other health organizations demonstrates that test strips are a necessary harm reduction tool. Harm reduction is an evidence-based practice in which individuals who use drugs are given tools to help them use in a safer manner. Harm reduction is based on the premise that complete abstinence may or may not be a part of recovery for every person, and if a person does continue to use, either for a little while, or indefinitely, safe practices are utilized while doing so (3). For instance, if a person with alcohol use disorder does decide to have a few drinks, they arrange to have another person drive them, rather than driving themself. Or, if a person uses intravenous drugs, new needles are used, not previously used needles.
A 2019 published article demonstrated support of anecdotal data, with individuals given test strips reporting safer drug use practices like discarding fentanyl-laced products rather than using, using another supplier, and keeping naloxone nearby just in case (4).
Test strips are an inexpensive way to provide widespread harm reduction. In April of 2021, Substance Use and Mental Services Administration (SUMHSA; in name transition from Substance Abuse and Mental Services Administration SAMHSA), announced that federal funding could be used to purchase test strips (5).
Narcan, also known as naloxone, is a similar harm reduction tool. Whether or not individuals have access to these tools won’t affect whether they use substances; rather, it determines how safely they can use them. The goal of harm reduction is to keep people alive.
Future Considerations
Where Missouri has taken an important step in harm reduction, more can always be done in this ever-changing landscape of substance use. New adulterants are always being found in drug supplies, and inevitably make their way to our state. Xylazine is a newer sedative that is adding to the complexity, partially due to its dangerous combination with fentanyl and other opioids (6).
Recent Missouri data reported drug products in the St. Louis region and found traces of xylazine in over 20% of the samples (7). Xylazine deaths in Missouri have increased from 39 in 2021 to 109 in 2022 (8).
Xylazine is being added to fentanyl, and is a sedative, like fentanyl, but not an opioid. This means naloxone does not work to counteract an overdose. When used with opioids, like fentanyl or heroin, the effect could be a more drastic (and dangerous) decrease in respiration during overdose. In overdose deaths with xylazine, opioids were present in 99.4% (8).
There are xylazine test strips available, and some states, like Georgia, Kentucky, and Tennessee, have chosen to legalize the use of ALL test strips (2), as this will not be an isolated incidence. There will be more adulterants coming, and in order to stay ahead of the curve and ensure optimal harm reduction tools, having supportive legislation already in place is key, as the development of new drug product adulterants move much more quickly than the legal system. To provide further harm reduction, and ultimately save lives, more supportive measures can be taken.
Individual Impact:
As individuals, we can advocate for legislature that supports harm reduction practices, like expanding the legalization of all drug testing strips. The opioid epidemic and related problems are not political issues, instead they are human issues. Individuals using substances or dealing with addiction every single day include our coworkers, neighbors, family members, and friends.
Something you can do is to have naloxone on you or in your home in case of emergencies and to normalize its use. Naloxone can be located using this tool. Encouraging the use of test strips as a harm reduction strategy is also a way to help. Test strips may be available at your local public health department upon inquiry.
You can also become more educated on harm reduction and other helpful related topics. MU Extension recently published an article “Harm reduction advice for safer holidays.” Missouri has some online training opportunities offered by UMSL’s Addiction Science Team. Many of these trainings are free and can be offered online to individuals or in person to teams of people. Check them out!
More resources:
Training Opportunities: https://www.mimhaddisci.org/training
Find Naloxone resource: https://getmonaloxone.com/pick-up-today-%2B-fts
Find Test Strips: Local Public Health Departments—inquire at your location for details
Fentanyl Test Strips Information
Harm Reduction tips for safer holidays article.
Harm Reduction Laws Map: https://www.astho.org/advocacy/state-health-policy/public-health-legal-mapping-center/?utm_source=informz&utm_medium=email&utm_campaign=asthophw&utm_content=PH&utm_term=LegalMappingCenter
Harm Reduction Coalition: https://harmreduction.org/issues/fentanyl/
References:
- Riley, Jonathan. Fentanyl Test Strips Legalized in Missouri. 15July2023. eMissourian.com. <https://www.emissourian.com/local_news/fentanyl-test-strips-legalized-in-missouri/article_1af99544-228c-11ee-8fef-4f1074d146d9.html#.>
- The Network for Public Health Law. Harm Reduction and Overdose Prevention: 50-State Survey. Legality of Drug Checking Equipment in the United States, August 2023 Update. <https://www.networkforphl.org/wp-content/uploads/2023/11/50-State-DCE-Fact-Sheet-2023-2.pdf>. Accessed 11 December 2023.
- Substance Use and Mental Health Services Administration (SUMHSA). Harm Reduction. 24 April 2023. <https://www.samhsa.gov/find-help/harm-reduction>. Accessed 12 December 2023.
- Goldman JE, Waye KM, Periera KA, Krieger MS, Yedinak JL, Marshall BDL. Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: a qualitative study. Harm Reduct J. 2019 Jan 8;16(1):3. doi: 10.1186/s12954-018-0276-0. PMID: 30621699; PMCID: PMC6325714. <https://pubmed.ncbi.nlm.nih.gov/30621699/>
- Centers for Disease Control. Fentanyl Test Strips: A Harm Reduction Strategy. Sept 2022. <https://www.cdc.gov/stopoverdose/fentanyl/fentanyl-test-strips.html>.
- Centers for Disease Control. What You Should Know About Xylazine. 28 November 2023. <https://www.cdc.gov/drugoverdose/deaths/other-drugs/xylazine/faq.html>. Accessed 11 December 2023.
- American College of Medical Toxicology, Toxicology Investigators Consortium. Challenges of Xylazine.Virtual presentation 17 November 2023. <https://app.box.com/s/mi49kj7gb23244b5aqwpvse6187unxp7/file/1365782495533>
- Department of Health and Senior Services (DHSS). DHSS Health Alert. Xylazine-Involved Drug Overdoses in Missouri, 2019- 2022. 11 May 2023. Website: <https://ruralhealthinfocenter.health.mo.gov/xylazine-involved-fatal-drug-overdoses-in-missouri-2019-2022/> PDF: <https://health.mo.gov/emergencies/ert/alertsadvisories/pdf/alert051123.pdf>. Accessed 11 December 2023.