Embracing Harm Reduction Tools as the First Step in Reducing Overdose Deaths

fentanyl test strip

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Key Takeaways

  • Overdose deaths surpassed 100,000 in a calendar year for the first time, fueled largely by fentanyl, a super-potent opioid.
  • Harm reduction tools, like fentanyl test strips and naloxone, can help reduce the risk of overdose from fentanyl and other drugs.
  • The White House presented its National Drug Control Strategy last month—the first to emphasize harm reduction as a tool for minimizing overdoses.

The overdose epidemic continues to grow, spurred largely by the proliferation of fentanyl, an extremely potent synthetic opioid that is up to 50 times stronger than heroin.

Fentanyl typically comes as a white powder, which can be mixed with other drugs—like methamphetamine and cocaine—and stamped onto pills.

Increasingly, drugs being sold on the street as OxyContin, Xanax, Adderall, or other prescription drugs, are laced with fentanyl. A restaurant worker who uses stimulants to stay active for a 10-hour shift might consume fentanyl unwittingly. So might a college student who purchases Adderall to stay alert while studying. 

Because fentanyl is so potent, a slight difference in dosing can spell the difference between life and death, especially for people with no tolerance for opioids.

“You don’t know if your boss or a colleague or somebody walking by on the street is going to go out and do cocaine on Friday night. You don’t know about the kids who are watching Euphoria and getting ideas,” said Dean Shold, co-founder of FentCheck, a nonprofit that aims to reduce accidental overdoses.

Drug overdose deaths rose to nearly 108,000 in 2021—an increase that topped the already staggering number of deaths reported in 2020, according to preliminary data published by the Centers for Disease Control and Prevention on Wednesday.

Fentanyl was involved in about two-thirds of the drug overdose deaths last year—double the proportion from 2019. Perhaps due to the pervasiveness of fentanyl in the drug market in recent years and the destabilizing effects of COVID-19, 2021 saw a 15% increase in overdose deaths from 2020, following an even steeper rise of 30% the year before.

To address the crisis, the Biden Administration sent its first National Drug Control Strategy to Congress last month. It maps out the Administration’s plan for tackling untreated addiction and drug trafficking.

This Administration is the first to embrace harm reduction as a tool for minimizing overdose deaths. Rather than urging abstinence, supporters of harm reduction aim to improve access to tools that can prevent or revert overdoses. Fentanyl test strips are among one of the most useful methods to detect the deadly substance in drugs.

History of Harm Reduction

The term “harm reduction” was long associated with an underground movement to provide drug users with clean injecting supplies, said Nancy Campbell, PhD, historian of drug science, policy and treatment, and professor at the Rensselaer Polytechnic Institute in New York. As recently as 2000, she said an executive director of the National Institute of Drug Abuse told her harm reduction “was a dirty word in the federal research apparatus.”

But the new drug control strategy aims to embrace harm reduction by expanding safe syringe programs, rather than criminalizing and stigmatizing drug use.

Increasing Community Access to Harm Reduction Tools

Though the White House touts fentanyl test strips to be a key harm reduction tool, they remain illegal in about half of U.S. states due to decades-old laws classifying the tests as “drug paraphernalia.”

Some states—including New Mexico, Wisconsin, and Tennessee—have recently passed laws allowing the sale of the test strips. In New York City, city council members introduced a bill to require health officials to provide overdose care training to bars and nightclubs. Still, in some states, like Florida, lawmakers rejected attempts to legalize the tests. 

“Fentanyl test strips or drug checking overall needs to be easy and more accepted,” Shold said. “If we can change people’s perspective on that, you should be able to go to a drugstore and buy these.”

How to Use Fentanyl Strips

To test a drug for fentanyl, you can dilute a small portion of it in water, dip a test strip in the solution, and get a result in about five minutes. If you’re not able to test for fentanyl, Shold said to assume it’s there and proceed with caution.

In the meantime, Shold and his colleagues are attempting to make fentanyl testing and overdose first aid kits accessible in spaces where people may already be using drugs, such as bars, restaurants, and other establishments. FentCheck’s approach is modeled after the 1980s movement to increase condom use by making them available in fishbowls in spaces like bars and student health centers.

Shold said that while the Drug Control Strategy rightly emphasizes the need for better support services for people with substance use disorders, it fails to address the crisis among recreational drug users who may suffer an accidental overdose.

“There’s this whole kind of lost community of people who are vulnerable because they don’t have the tolerance [to opioids]. They don’t have all the support capabilities, and that’s what we’re trying to help with,” Shold said. “We’re trying to put harm reduction into the hands of people where they need it when they need it.”

Tackling Accidental Overdoses

Quickly administering naloxone is the most effective way to reverse the effects of an opioid-related overdose. But there are several barriers to having the drug on-hand in emergency situations.

Though the Food and Drug Administration has encouraged drug makers to develop over-the-counter naloxone, the currently available versions of the drug require a prescription or standing order from a pharmacist.

Community outreach programs like FentCheck can distribute naloxone in some states, and recipients must undergo training on how to administer it.

Campbell said that fentanyl test strips and naloxone, which are made by for-profit companies, need should be more widely available at a lower cost. Still, given the massive scope of the overdose epidemic, she said these strategies merely act as a “Band-Aid for a much bigger problem.”

“There aren’t enough fentanyl test strips, and there isn’t enough Naloxone to really make a dent in the opioid overdose death rate in this country,” she added. “These are harm reduction strategies that are simply insufficient for dealing with the oversupply of fentanyl in the U.S.”

For one, she said, even with the knowledge that a drug is laced with fentanyl, an individual may still choose to use it. And once someone is addicted to opioids, more intensive treatment services are typically necessary to support them.

As of now, few people with substance use disorders are getting access to the treatment they need. According to the 2020 National Survey on Drug Use and Health, only about 6.5% of people who needed treatment for a substance use disorder received such care at a specialty treatment facility in the past year.

“That number is very telling and it shouldn’t be so low—we should be able to serve more people than we actually do,” Campbell said. “What can we do to expand and not just treatment capacity, but effective treatment capacity?”

Looking Beyond Harm Reduction

To adequately affect change, the White House emphasized the need for research on consumption patterns, prevention, treatment, recovery, drug production and distribution, and more. Bolstering data collection systems, Campbell said, can also help experts to understand the effects of new psychoactive drugs to create meaningful interventions and treatments.

During the pandemic, substance use has increased, and treatment became harder to access in some ways. For many people, the pandemic exacerbated feelings of social isolation, helplessness, and stress—emotions that may increase one’s dependence on substances. And it deepened many existing inequalities in our health system. In 2020, for instance, the rate of overdose deaths among Black Americans eclipsed that of White Americans for the first time since 1999.

The White House strategy aims to address disparities in treatment for people of color and better management of addiction in the criminal justice system. It also calls for early intervention to prevent young people from developing a dependence on drugs.

But notably, the plan leaves out mention of safe injection sites, where people may consume drugs in a supervised area with health providers who can administer naloxone in case of an overdose. Some oppose these sites, saying they enable drug users. Proponents say that they are important for de-stigmatizing drug use and minimizing the associated health risks.

“If we don’t go to safe injection sites—if cities and states don’t move in that direction—I don’t see how we’re going to affect the overdose death rate,” Campbell said.

What This Means For You

For the first time, the White House is embracing harm reduction as an important tool for the overdose epidemic. But experts say prevention, treatment, and more safe injection sites are needed to make a real difference.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Wilson N, Kariisa M, Seth P, et al. Drug and opioid-involved overdose deaths — United States, 2017–2018MMWR Morb Mortal Wkly Rep 2020;69:290–297. doi:10.15585/mmwr.mm6911a4

  2. Palamar JJ, Ciccarone D, Rutherford C, Keyes KM, Carr TH, Cottler LB. Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021. Drug Alcohol Depend. 2022;234:109398. doi:10.1016/j.drugalcdep.2022.109398

  3. Centers for Disease Control and Prevention. Provisional drug overdose death count.

  4. Centers for Disease Control and Prevention. U.S. overdose deaths in 2021 increased half as much as in 2020 – but are still up 15%.

  5. Friedman JR, Hansen H. Evaluation of increases in drug overdose mortality rates in the US by race and ethnicity before and during the COVID-19 pandemic. JAMA Psychiatry. 2022;79(4):379–381. doi:10.1001/jamapsychiatry.2022.0004

By Claire Bugos
Claire Bugos is a health and science reporter and writer and a 2020 National Association of Science Writers travel fellow.