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Fentanyl test strips a behavior-changing tool, but not widely used, experts say



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Fentanyl test strips a behavior-changing tool, but not widely used, experts say

March 11th 2020

FentanylWiki test strips are billed as a tool used to save lives and change habits when it comes to battling deadly drug overdose. But addiction treatment experts acknowledge they're not widely utilized in the U.S. as a way to fight the opioid epidemic because of suspected disagreement of opinions on their use.

The synthetic opioid fentanyl is approved for treating severe pain. But the Centers for Disease Control and Prevention (CDC) explains that the most recent cases of fentanyl-related harm, overdose, and death in the U.S. are linked to illegally-made fentanyl. It is often mixed with heroin and/or cocaine as a combination product, with or without the user’s knowledge, to increase its euphoric effects, CDC officials said on their website.

In 2016, synthetic opioids, primarily illegal fentanyl, passed prescription opioids as the most common drugs involved in overdose deaths in the United States, according to the National Institute on Drug Abuse.

It's a huge reason why Haven Wheelock, a syringe exchange coordinator in the Outside In Harm Reduction programs, hands out free fentanyl test strips to any client who wants them.

"They're not a nuanced test at all. They are a 'yes' or 'no' on whether or not fentanyl is present or not. They can't tell you how much fentanyl is in your supply. They can't tell you what type of fentanyl is in your supply. So they do give you some information that can be helpful in changing how you choose to use. But they're not going to give you a full picture the way that some other testing devices could," Wheelock told KATU News. "Knowing anything is better than knowing nothing. The pros are that people do change their behaviors. We've seen, in research, that people choose to use in safer ways when they know fentanyl is present."

In fact, a study by the Johns Hopkins Bloomberg School of Public Health showed that 70 percent of people who use drugs would modify their drug use behaviors if their drugs tested positive for fentanyl.

"This could include not using the drugs, using the drugs more slowly, or using the drugs with others who have naloxone. It could also include changing their purchasing behaviors," the study explained.

Wheelock explained that a drug user is able to mix a little bit of drug residue with water, dip in a fentanyl test strip, and wait 30 seconds for a reveal from the fentanyl test strip as to whether or not the synthetic substance is present.

A harm reduction expert demonstrates the use of a fentanyl test strip to determine the presence of the highly potent and deadly synthetic opioid. (Photo: KATU)

ut Dr. John McIlveen, the State Opioid Treatment Authority with the Oregon Health Authority, says that there's a disconnect on the effectiveness of harm reduction tools - such as fentanyl test strips - at the federal level.

"Harm reduction methodology has been seen, traditionally, as enabling drug users. That is very much different than the way harm reduction folks see it -- which is that they are protecting health and extending health, and actually, using the position that the longer I keep [someone] alive and keep them from not acquiring a very serious infectious disease that could kill them, that will give them more time to maybe think about doing some behavior change," Dr. McIlveen explained. "I could see a time where they do become more widely used. But it has a lot more to do with - I think - stigma and just a suspicion, in general."

In a public blog post posted on the Substance Abuse and Mental Health Services Administration's website, the federal agency's Assistant Secretary for Mental Health and Substance Use writes that she has a "fundamental problem in the justification" for using fentanyl test strips.

"On the surface, given the trends in deaths, this seems like a valid step to take," Dr. Elinore McCance-Katz writes. "However there’s one significant problem. The entire approach is based on the premise that a drug user poised to use a drug is making rational choices, is weighing pros and cons, and is thinking completely logically about his or her drug use. Based on my clinical experience, I know this could not be further from the truth."

Dr. McCance-Katz goes on to write that the goal of medical professionals should be more solely ending deaths; that it, "should also be to facilitate the opportunity to recover to safe, healthy and productive lives," she writes in the blog post headlined, "For Beating The Opioid Crisis, America Has Better Weapons Than Fentanyl Test Strips."

Dr. McIlveen argues that harm reduction services, such as the use of fentanyl test strips, can be an excellent tool for, "a portal for folks to actually receive more sustained help in getting into recovery."

Despite the fundamental disagreement with Dr. McCance-Katz on the effectiveness of harm reduction services in helping people battling substance use disorder, Wheelock agrees that, in part, more steps need to be taken to keep addicts alive.

"It's not going to end the overdose crisis. It's not going to change our systemic issues with lack of access to treatment and things like that," Wheelock said. "But it is going to allow people to have a little more autonomy and a little more education about what they do."


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