States Consider Fentanyl Testing Legislation

May 03, 2018|11:54 a.m.| ASTHO Staff

As state public health continues to address the opioid overdose epidemic, it is important to remember that the crisis is driven by the misuse and abuse of a variety of opiate forms, including  prescription opioids, heroin, and synthetic opioids such as fentanyl. Unfortunately, the past few years have witnessed a dramatic rise in synthetic opioid-involved deaths. In 2013, the number of such deaths was around 3,000. However, a recent article in the Morbidity and Mortality Weekly Report reveals that synthetic opioids were involved in 19,413 overdose deaths in 2016—a 100 percent increase when compared to 2015 data. They now account for 45.9 percent of all opioid-involved deaths.

Fentanyl, which is 50-100 times more potent than morphine, is often mixed with heroin but may also be mixed into counterfeit opioid and benzodiazepine pills, as well as cocaine. Often, the person who is using the heroin, pills, or cocaine is unaware that fentanyl is present. Fentanyl can be detected in other substances with low-cost test strips designed for use by hospitals and law enforcement to detect its presence in urine. Several harm reduction organizations now provide these fentanyl test strips to people who use drugs so they can check their drug for fentanyl before use. While a positive result for fentanyl may not deter the person from his or her drug use, it may persuade them to use a lesser amount and reduce the risk of overdosing.

Some have questioned the accuracy of the test strips and expressed concern that if the fentanyl is not evenly distributed throughout the drug, the test strip could give a negative result and a false sense of security to a person about to use a drug. However, a recent study by Johns Hopkins and others, including the Rhode Island Department of Health, examined the accuracy of fentanyl testing technologies and found that testing strips had “the lowest detection limit and the highest sensitivity and specificity for fentanyl of the technologies assessed.” The study also looks at whether people who use drugs would be interested in using the testing technologies. Eighty-five percent of respondents indicated they would like to know whether fentanyl is present, and 70 percent stated that the presence of fentanyl would change their behavior (e.g., not using the drugs, using less or more slowly, using in the company of someone with naloxone).

The issue of fentanyl testing strips is also beginning to show up in state legislatures. In late-April, a bill introduced in the Rhode Island General Assembly would add fentanyl test strips to the state’s Good Samaritan law. The bill, H 8132, would allow anyone to provide or use a “narcotic testing product” (e.g., fentanyl test strip) as a way of helping someone determine whether “a narcotic or substance contains chemicals, toxic substances, or hazardous compounds.” The proposed law would protect the person who helps test for fentanyl from civil liability and criminal prosecution.

Reducing the number of fentanyl-involved overdose deaths continues to be an important public health issue. To counter the rise of these deaths, CDC suggests improving the detection of fentanyl outbreaks and expanding the use of naloxone. Public health law researchers also encourage states to develop fentanyl testing programs to distribute test strips, collect data, and provide safe disposal options. The role and responsibility of state public health in these activities will be key, demonstrating the need for public health to remain involved in the opioid crisis as it continues to evolve.