As the nation grapples with a deadly overdose crisis, mostly driven by illicit fentanyl, a consensus is developing — from the Biden White House to political leaders in conservative states like Texas, Georgia and Alabama — that widespread distribution of fentanyl test strips can be an effective, if limited, way to reduce the drug’s destructive impact. Test strips are now legal in about half the states and bills to legalize them are pending in almost every remaining state where they are still barred as a form of drug paraphernalia, the New York Times reports. The strips, which retail for about a dollar, are emerging as a sliver of common ground in a bitter debate over the overdose epidemic, in which one side prioritizes law enforcement as a way to prevent drug use, and the other emphasizes safer use and treatment. “There is just this sense that fentanyl has really changed the game,” said Corey Davis, the director of the Harm Reduction Legal Project at the Network for Public Health Law, which tracks state laws on testing drugs. “There are not that many specific things you can do to fight it.”
More than 67,000 deaths nationwide in 2021 were attributed to accidental overdoses of fentanyl, which often is mixed with other drugs. Fentanyl is now present throughout much of the illicit drug supply, in unpredictable quantities. For people who use pills, ketamine, cocaine or MDMA, for example, fentanyl strips can be particularly important because people without an opioid tolerance are at a higher risk of a fentanyl overdose. Other users, including many who previously used heroin, have become dependent on fentanyl, and a positive result is unlikely to stop them from using. But it can act as a reminder to use more cautiously. “The whole thing is, know your drug,” said Jose Martinez, who participates in street outreach with the National Harm Reduction Coalition in the Bronx. For people who now seek out fentanyl, a new kind of strip may be more useful: one that tests for xylazine, a veterinary tranquilizer that can cause horrific skin wounds. Known on the street as tranq, xylazine extends a fentanyl high and is already found in more than 90 percent of the fentanyl supply in Philadelphia. It has also started to turn up in New York and elsewhere. Sales of the fentanyl test strips have soared since the start of the pandemic, as knowledge of them has grown, said Iqbal Sunderani, the chief executive of BTNX, a Canadian company that created the xylazine test strips and is also the main maker of fentanyl strips. The company sold eight million tests in 2022, up from about 1.5 million in 2020, almost all of them to harm reduction organizations. A flood of Chinese-made strips is also entering the market. But finding the strips can still be hard, even in places where they're already legal. So in New York, the ASAP Foundation has placed boxes in dozens of bars, restaurants and galleries with fentanyl test kits — a tactic inspired by free distribution of condoms during the 1980s AIDS crisis.