Carter Graves regularly used meth in 2014 and wanted to be able to test their drugs for fentanyl, an extremely strong and addictive opioid that can be laced into various drugs. But fentanyl test strips, when they could be found, seemed to be unreliable. Friends said the strips often produced false positives.
“I would have been safer in my use. A lot safer,” if strips were available and reliable, Graves said. “I would have taken better steps to protect myself because I had the tools available. I’ve always been an advocate for drug-checking, but I was failed by the product.”
A decade ago, fentanyl started to become more prevalent in the drug market, but use and distribution of test strips was highly stigmatized and illegal.
Now that the strips have become more accepted and legal, Graves is able to distribute new, more reliable tests to people who use drugs in their work for the Pittsburgh chapter of DanceSafe and their own organization, KMFK Safety Services.
“We’ve had a lot of people self-reporting that, ‘Hey, I was able to hand these to my sister, and it tested positive, and … my sister’s still here because of the stuff that you gave me at your table, so thank you,’” Graves said. “I had somebody recently grab two strips and a set of directions and say, ‘Hey, you might be saving my life tonight,’ and then scurried away. It’s stuff like that we know are helping people.”
Pittsburgh-area researchers and harm reduction specialists support legislation implemented this year that legalizes fentanyl test strips and believe it will be helpful. Because fentanyl is so common, it’s not unlikely that a given non-prescribed drug has fentanyl in it. This leaves experts wondering just how helpful this legislation will be. Its most impactful provision, in fact, may be one legalizing future tests for other substances that have not yet become as prevalent.
In November, former Gov. Tom Wolf signed legislation that legalized fentanyl test strips across the state, and it went into effect in January. Other states and parts of Pennsylvania had already made similar moves – in 2021, former Pittsburgh Mayor Bill Peduto signed an executive order that decriminalized fentanyl test strips in the city.
The test strips are inexpensive, one-time-use devices that detect whether fentanyl is in a drug. The devices cannot detect how much fentanyl is in a drug; they only produce a yes or no answer.
Fentanyl has become incredibly common in the national and local drug market. In 2021, 80% of overdose deaths in Allegheny County involved fentanyl, an increase from 62% in 2016 and just 2% in 2011, according to the county’s overdose dashboard. Preliminary numbers for 2022, which are still being finalized, show 86% of overdose deaths involved fentanyl.
‘I don’t think they understood it’
In 2014, state Rep. James Struzzi lost his younger brother to a drug overdose. This personal connection to the drug epidemic inspired the Republican lawmaker, largely representing Indiana County, to support legislation aimed at preventing overdose deaths. Struzzi has collaborated with progressive Pittsburgh-area Democrats, including Pittsburgh Mayor Ed Gainey when he was a state representative, on drug-related legislation, sometimes diverging from the mainstream of his party.
He first introduced a bill to legalize fentanyl test strips in 2019, during his first term; then, it faced steep opposition. He said he began sending articles about fentanyl overdoses related to colleagues every day to make his case that this pressing issue needed to be addressed.
“They weren’t really arguing against it. I don’t think they understood it,” Struzzi said. “Unless you know someone who’s addicted or you’ve lost someone to an overdose, it’s hard to understand.”
During hearings, experts explained that new substances are constantly being introduced into the market, and argued that it would be helpful for the law to be broad and proactive. Because of this testimony, lawmakers amended the bill to legalize not only fentanyl test strips, but all future drug test strips for any other substances.
Now that the law has passed and gone into effect, it will start to become clearer whether test strips can still help, years after the introduction of fentanyl to the drug market.
“I would have liked to have seen it done several years ago as well. We could have definitely saved lives. It will still save lives,” Struzzi said. “I know that fentanyl is more and more prevalent today, but I think that gives all the more credence to having these strips available.”
‘Pretty much everything they had had fentanyl in it’
Alice Bell has worked with Prevention Point Pittsburgh for more than 20 years, primarily helping people in the community access harm reduction materials. She appreciates fentanyl test strip legalization but is skeptical of how much it will help.
“If they would have been legal 10 years ago, we could have saved a lot of lives. … People want to see this as, ‘Yay, now we have fentanyl test strips, it’s gonna save all these lives, it’s gonna save the day,’” Bell said. “It’s sort of too late for it to have that dramatic effect.”
Prevention Point has been distributing fentanyl test strips since 2019, even when it was at odds with state law, and Bell has heard mixed feedback from people who have used them.
“Early on, people were avid, wanted them. ‘Yes, yes, yes, gimme those, gimme those, gimme those.’ And then they realized that pretty much everything they had had fentanyl in it,” Bell said. “And now they’re like, ‘Yeah, I don’t really need those, because I just assume it’s fentanyl, I know it’s fentanyl, that’s all we could get.’”
Jane Liebschutz, a UPMC physician and University of Pittsburgh professor and researcher focused on the opioid epidemic, agrees that the benefit will be limited, in part because so many regular drug users have already become used to fentanyl.
“Because they’re already used to it, then having the fentanyl test strip doesn’t really change it, for people who use drugs regularly,” Liebschutz said.
Immediately following legalization of test strips, the Allegheny County Health Department [ACHD] ordered 3,000 strips using leftover funding from a grant primarily for purchasing the overdose reversal drug naloxone (known commonly by the brand Narcan) for first responders. It cost the county about one dollar per strip, according to Otis Pitts, deputy director of ACHD. Next fall, ACHD plans to purchase another 10,000 test strips.
ACHD works with a variety of organizations such as the Homewood group Ukombozi, and visits various communities to distribute test strips. The department focuses on areas with “high foot traffic,” including homeless encampments and people leaving the Allegheny County Jail, according to Pitts. Anyone who wants test strips can also contact the county to get them.
“From the staff, I have heard that, for whatever reason, these test strips are, at least for right now, a better conversation starter with the public compared to Narcan,” Pitts said in late February. “Maybe it’s just the newness around the legality of test strips, but the public response has been stronger for whatever reason. … They’re taking us up on offers for test strips.”
‘A Band-Aid on the larger problem’
Several experts told PublicSource that they are concerned about xylazine, a veterinary tranquilizer and a newer substance in the drug market. About 26% of 2020 overdose deaths in Pennsylvania involved xylazine, sometimes in combination with other drugs, compared to just 2% in 2015, according to the National Institute on Drug Abuse. In the Pittsburgh area, there is growing awareness and news coverage of this drug.
Test strips for xylazine are still being developed and, therefore, are not yet widely available for use by the public, but if they are available in the future, they will automatically be legal in Pennsylvania, as would new test strips for any other substance.
Still, even xylazine has become so widespread that it’s unclear how much testing could help. At the end of the day, folks who work closely on these issues like Graves see testing as a bandage for a larger problem: a drug policy focused on criminalization rather than rehabilitation.
“This stuff is deadly and has spread. It’s already becoming very prevalent in Pittsburgh,” Graves said. “The technology isn’t keeping up with the rapid changes that occur in the drug market. So while I like seeing that these preventative measures and giving the power back to drug users are being developed, I guess I don’t see it solving the problem.”
Matt Petras is a freelance reporter and adjunct professor based in the Pittsburgh area. He can be reached at firstname.lastname@example.org or on Twitter @mattApetras.
This story was fact-checked by Abigail Nemec-Merwede.
- The Pennsylvania Harm Reduction Network assembled a resource guide to help people connect with services for overdose prevention, safer substance use and recovery.
- Prevention Point Pittsburgh provides syringe services, wound care and management for people using substances. Call 412-247-3404 or email email@example.com.
- The Never Use Alone Hotline is run by volunteers who have lived experience with substance use disorders. The volunteers stay on the phone with callers as they use substances and contact emergency medical services if the caller becomes unresponsive. Call 1-800-484-3731.
- Pennsylvania’s Acting Secretary of Health and Physician General issued a standing order that allows anyone at risk of experiencing an opioid-related overdose — and their family and friends — to obtain naloxone at their local pharmacy. People can also have naloxone mailed to them for free.
- Pathway to Care and Recovery provides Allegheny County residents with services including peer support and linkage to recovery programs. Call 412-325-7550 or email firstname.lastname@example.org.
- The Pennsylvania Get Help Now Hotline assists people in finding nearby providers of treatment for substance use disorders. Call 1-800-662-4357.
- Onala Recovery Center offers services for recovery including connections to certified recovery specialists, daily group meetings and free Narcan and monthly trainings. Call 412-471-8797 or email email@example.com.
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