California provides fentanyl test strips to needle exchanges

As the opioid epidemic continues to sweep the nation, California has taken a new approach to help lower fatalities within its borders.

In May 2017, the Golden State's public health department began paying needle exchanges to provide drug users with test strips that determine if a drug contains fentanyl.

Fentanyl, a synthetic opioid 30 to 50 times stronger than heroin, can be mixed into other drugs without the user knowing (though some users intentionally seek it out for its strength). This is a common practice for drug dealers because fentanyl is inexpensive and easily available.

Because of its potency – as little as two milligrams is a lethal dosage to most people – fentanyl is now responsible for the largest number of overdose deaths in the U.S.

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Fentanyl Citrate, a CLASS II Controlled Substance as classified by the Drug Enforcement Agency in the secure area of a local hospital Friday, July10, 2009.

(Photo By Joe Amon/The Denver Post via Getty Images)

A seized counterfeit hydrocodone tablets in the investigation of a rash of fentanyl overdoses in northern California is shown in this Drug Enforcement Administration (DEA) photo released on April 4, 2016. At least 42 drug overdoses in the past two weeks have been reported in northern California, 10 of them fatal, in what authorities on Monday called the biggest cluster of poisonings linked to the powerful synthetic narcotic fentanyl ever to hit the U.S. West Coast.

(Drug Enforcement Administration/Handout via Reuters)

Fentanyl Citrate, a CLASS II Controlled Substance as classified by the Drug Enforcement Agency in the secure area of a local hospital Friday, July10, 2009.

(Photo By Joe Amon/The Denver Post via Getty Images)

Dory Bauler's unused Fentanyl patch packets. She is one of millions of patients who used the fentanyl patch, which delivers a powerful narcotic through the skin. The patch, brand name Duragesic, was the subject of a recent FDA alert. Patients are overdosing, sometimes they die. Mrs. Bauler came off the patch when she realized the drug was causing her breathing problems, a sign of serious trouble. This photo was taken at her home in Laguna Woods.

(Photo by Glenn Koenig/Los Angeles Times via Getty Images)

A small bag of straight Fentanyl on display at the State Crime Lab at the Ohio Attorney General's headquarters of the Bureau of Criminal Investigation on Wednesday, September 16, 2015 in London, Ohio.

(Photo by Ty Wright for/ For The Washington Post via Getty Images)

'If I don't put these on, it hurts to breathe,' says Smitty Anderson wearing Fentanyl patches to help him deal with the pain caused by multiple myeloma cancer, a blood cancer that affects the bones. Anderson worked at Savannah River Site from 1981 to 1998. The Andersons filed claims to get federal compensation for his disease, which he said came from working at the nuclear site. He had no luck. 'We've been going through so much red tape for years,' he said. 'My wife has to do all the work now. I just don't have the strength anymore.' He died on Nov. 5, 2015.

(Gerry Melendez/The State/TNS via Getty Images)


Since last May, the Los Angeles Times reports that California has invested $57,000 on doling out the test strips, worth $1 each, to half of the state's 45 needle exchanges.

The strips are similar to a pregnancy test: The user can dip the strip into water mixed with a sample of the drug, and the results appear a few minutes later. If the strip develops a single line, fentanyl is present, while two lines means the drug is fentanyl-free.

While proponents want to extend the funding efforts beyond just needle exchanges (since other drugs such as methamphetamine can also be laced with fentanyl), others worry about the accuracy of the strips.

They were created to test urine for pharmaceutical-grade fentanyl, not to test street drugs directly, according to the Los Angeles Times. The U.S. Food and Drug Administration also has not approved their use directly on drugs.

Because they were designed for urine, the strips are very sensitive and seem to detect "minuscule" amounts of fentanyl that wouldn't harm someone, University of California—San Francisco Professor Dr. Daniel Ciccarone told the Times. This could make people eventually start to ignore the results, he added.

Still, a Johns Hopkins study found the strips show a positive result if fentanyl is present 100 percent of the time, so proponents argue that it's better to have false positives than the possibility of a false negative.

But the 100 percent rate might change as illegal labs develop new variations of the drug, beyond the three chemical variations of fentanyl the strips can identify, The Baltimore Sun reported.

Despite this controversy, officials and overdose prevention programs in other states, including New York, Rhode Island and Maryland, have been pushing for the test strips as the drug epidemic shows no signs of abating.

In 2016, the nation saw more than 20,000 fentanyl and other synthetic opioid deaths, with heroin following at more than 15,000 deaths, according to the Centers for Disease Control and Prevention.

The story is no different in California: The number of reported fentanyl-related deaths in the state tripled between 2016 and 2017.

Though some users might still choose to take their drug knowing it is laced with fentanyl, the Johns Hopkins Bloomberg School of Public Health found in a study that 70 percent of people said they would take more precaution if they knew fentanyl was present.

"The point is that it allows people to make choices, to have a little more information," lead researcher Susan Sherman told The Washington Times. "It's not a small thing that people who are drug users feel a sense of autonomy and it gives them a choice."

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