The opioid overdose crisis is a multi-layered and complex problem, and one that won’t be solved by any single solution. In addition to efforts that support naloxone and syringe access, as well as expansion of on-demand treatment, a new tool that deserves more attention is emerging: drug checking.
“Drug checking,” or testing a substance in order to provide information about contents and purity, is a crucial and potentially life-saving harm reduction intervention already well known in nightlife and festival settings. But until very recently, those trying to keep people who use heroin and other opioids safe didn’t consider it one of their top tools. That may be starting to change.
The main reason why? Fentanyl.
Fentanyl has changed the landscape of opioid, and particularly heroin, use. Although approved and used as a pain-reliever in many settings, when produced illicitly, this highly potent whitish powder can be cut into heroin (as long as it’s also powder form and not tar) or even added to counterfeit pills made to look like Oxycontin and other prescription opioids. And because it takes far less fentanyl than it does heroin or other opioid to trigger an overdose, it has caused deaths to surge in several areas all over the U.S. and Canada.
The proliferation of fentanyl has pushed those in the opioid-using community to think far more urgently about how they might test a substance. But it hasn’t been easy – fentanyl doesn’t show up on reagent drug tests, the most common drug checking method available to the public, and those used most often by people in nightlife or festival settings.
They say necessity is the mother of invention: it was the Canadian supervised injection facility, Insite that first began experimenting with repurposing fentanyl test strips designed for urine testing and instead using them to test heroin before use. The idea has since spread to syringe exchanges and drop-in centers in the U.S.
The worry has crossed over between communities. The western Canadian festival Shambhala, known for its long-running onsite drug checking, recently found alarming results showing fentanyl in substances they checked at their event. Reflecting this growing concern that fentanyl could show up in any substance, the festival-oriented harm reduction organization DanceSafe is now selling these test strips as well as reagent kits on their website.
Questions remain about the efficacy of the fentanyl test strips, how realistic it is to expect heroin and other opioid users to use them, and what resources exist to support expanded distribution of the strips in any case. Despite these questions, the underlying promise of drug checking’s role in reversing the overdose crisis is growing clearer to both the opioid and nightlife harm reduction communities.
Interested in hearing more about this issue? The conversation will continue at DPA’s Reform Conference in Atlanta this year, on a roundtable sessionChecking Out Drug Checking: Can It Solve the Overdose Crisis? to be held on Friday, October 13 from 4:30 – 6 p.m.
If you haven’t yet, consider joining other reformers from around the world at this meeting. Early bird registration ends on Friday, September 8.
And if you can’t join, keep in mind that although drug checking won’t solve the overdose crisis on its own, we should be loudly advocating for everything that has a chance of helping reduce the number of these tragic and often preventable deaths.
This piece first appeared on the Drug Policy Alliance Blog