White House Loosens Funding Restrictions on Fentanyl Test Strips to Curb Overdose Epidemic

The opioid crisis has become a severe problem in the United States, largely due to the high levels of synthetic opioids introduced in the drug market. Fentanyl is a specific synthetic opioid that can be 50 times stronger than heroin and 100 times stronger than morphine. These drugs played a part in approximately two-thirds of overdose deaths from November 2020 to November 2021. Harm reduction techniques have attempted to curb overdoses and deaths from fentanyl, but there are social and logistical hurdles to implementing these tools. Fentanyl test strips (FTS) have been promoted by many harm reduction organizations as an easy way to start lowering the risk of fentanyl overdoses, but these test strips remain illegal in many states.

In April, the Biden Administration introduced the 2022 National Drug Control Strategy, outlining the steps that the White House and other government agencies will take regarding the state of public health related to drug use. There is a section dedicated to harm reduction techniques where fentanyl test strips are explicitly mentioned and encouraged. While the administration allows funding to be used for FTS and outlines plans for better promotion and distribution, some states still criminalize the possession and use of these tests.

In the 1970s, the Drug Enforcement Agency (DEA) urged states to pass a bill restricting and criminalizing drug paraphernalia. By mid-1981, 20 states had passed the Model Drug Paraphernalia Act, which “made the possession of paraphernalia, with the intent to use it with illicit drugs, a crime.” This bill, due to technicalities with the definitions of paraphernalia and intent to use, also applied to any tool that tests the contents of illegal drugs. Consequently, when FTS were introduced as a harm reduction device, some states included them in the outlawed paraphernalia.

In response to this, the Biden Administration, as the first administration to explicitly mention harm reduction, has taken steps to fund these techniques to curb the number of opioid overdoses that have steadily increased in past years. In the current policy plan, the White House outlines the importance of harm reduction, and specifically FTS, saying that the funding from the American Rescue Plan can continue to be used for the tests. They also call for continued encouragement to use the tests and ask government and private agencies to distribute the tests in communities.

In the introduction to the National Drug Control Strategy, the Biden Administration proclaims that “saving lives is our North Star.” The White House and connected agencies say they want to do everything in their power to prioritize the wellbeing and safety of community members relating to their health and drug use, and ultimately the economic and social benefit in society.

They introduced their seven drug policy priorities during the first year in office and expanded upon those with clear objectives in their second year. Priority three of the plan is “enhancing evidence-based harm reduction efforts,” which the strategy expands upon saying they will increase Syringe Service Programs (SSP) and ensure that at least 25% of SSP will offer some kind of drug safety checking tool, including FTS, by 2025.

The policy explicitly calls on states to update their drug paraphernalia laws to allow for the distribution and use of FTS, as this is a major hurdle in getting the tools to those who need them. Right now, there is a disconnect between nearly 30 states and the federal government when it comes to the legality of drug content testing equipment, specifically FTS. States that implemented the Model Drug Paraphernalia Act in the 1980s and others have either refused or not taken the initiative to change existing laws, leading to harmful outcomes for members of their communities. Without this cooperation, the Biden Administration’s policy cannot serve those who need harm reduction tools to its full intention.

While harm reduction techniques are needed to improve short-term outcomes for people who use drugs, longer term solutions are also necessary. These solutions include further research on tools to test drugs, programs to better assist those struggling with addiction, and well-funded social programs to improve people’s current situations. The policy addresses all of these strategies and more, with the caveat that state and local governments must assist in the funding, connection, and maintenance of these programs and services. States that are resistant to updating outdated laws are also unlikely to put full attention into these efforts.

Biden’s policy also promises to further research on testing and community engagement. They are committed to using the power from their agencies to make progress on this issue. However, since this is a strategy, rather than a binding agreement, there is not much that is guaranteed. Many agencies, states, and people are required to work together to make this happen, and it will take time and compromises to see real results. A first step toward equity is for states to update their laws and ensure that all who need it have access to FTS and other harm reduction tools.

Currently, FTS are not a perfect solution, as they only determine whether fentanyl is present, not the amount of fentanyl that the drug contains. States choosing to prohibit the use of the test strips lessens the incentive for better ones to be developed – strips that could indicate an amount of fentanyl in a drug or that are lower cost. This policy will hopefully allow for full access to Americans, and therefore increased awareness and acceptance of these tools and better ones to come in the future.

This policy, and harm reduction techniques, also create positive social and economic outcomes for society. First, access to the test strips might influence someone to not use a drug if there is an indication it is laced with fentanyl. This extra step of caution could help both routine and casual drug users, as they might be deterred from using the drug, therefore mitigating the risk of overdose. Additionally, many studies of programs that use harm reduction techniques and help with addiction show a favorable benefit-to-cost ratio, higher graduation rates among youth, and lower stigma to seeking help or drug content tests. All of these are positive outcomes to society, and it starts with allowing people to access the resources they need.

In order to see long-term positive change in the community surrounding drug use, there need to be short-term interventions for those who use drugs. FTS provide a safe, inexpensive, and quick way for people who use drugs to check their supply and mitigate their risk of fentanyl overdose. States that continue to ban these testing tools are not stopping drug use from occurring; they are simply taking away an easy and effective way for people to stay safer while using. Longer-term interventions to help those suffering from addiction is the ultimate goal, but until then, harm reduction tools like FTS are needed. The federal government has already opened the door for the funding and distribution, and states must take advantage of this new policy and implement the solution immediately.

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