Top health officials call for more research to support fentanyl test strips

The government’s top addiction scientists and key public health officials are calling for more research into fentanyl test strips.

Amid a devastating overdose epidemic, the U.S. must ensure that test strips are legal and widely available, the officials wrote in a New England Journal of Medicine perspective published Saturday. Additionally, they argued, the U.S. should work to develop new products and technologies that facilitate drug-checking.

The article’s authors included Nora Volkow, the director of the National Institute on Drug Abuse; Robert Califf, the commissioner of the Food and Drug Administration; and Lawrence Tabak, the acting director of the National Institutes of Health.

Drug-checking, an increasingly common harm-reduction tactic, involves testing a supply of illicit drugs to determine its contents. In recent years, as fentanyl has come to contaminate much of the illicit drug supply in the U.S., the strategy has become a critical component of overdose-prevention efforts.

While most states once classified drug testing strips as illegal paraphernalia, fentanyl test strips are now legal in a large majority of states. More recently, BTNX, a Canadian company that sells fentanyl test strips, also introduced strips used to test for xylazine, a veterinary tranquilizer that is increasingly present in the U.S. opioid supply.

While fentanyl test strips are highly effective and seen as a key component of U.S. harm-reduction efforts, the authors wrote, there has been little research on how to maximize their potential uses. They also called for using test strips not just for prevention, but for clinical purposes, too.

Currently, test strips are mainly used to test drug samples to determine whether they contain fentanyl, allowing drug users to make informed decisions about whether, and how much, to consume. The researchers, however, also called for developing rapid fentanyl testing products that could be used on urine and hair, arguing that “the ability to use fentanyl test strips on human specimens in clinical settings would be valuable for supporting on-site clinical decision making.”

Overall acceptance of drug-checking is on the rise. Beyond fentanyl test strips, a number of cities and local health departments have begun to employ more advanced technologies, like spectrometers, not just to detect whether fentanyl is present but also to measure exactly how much.

Separately, the Biden administration issued guidance in 2021 clarifying that grants issued by the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration can be used to purchase test strips, among other harm-reduction tools.

“With new reports about additional harmful contaminants, such as xylazine, in illicit drugs, it has become clear that drug-checking practices require careful consideration,” the authors wrote. “It is critical to encourage implementation of such promising practices while supporting research on implementation and expansion of additional drug-checking approaches.”

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