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Amid overdose epidemic, researchers say users should be allowed to test their drugs for fentanyl

A lab technician demonstrates the use of fentanyl testing strips at the Rhode Island Department of Health Laboratory in Providence. Allison Shelley/Bloomberg American Health Initiative

A new study recommends that a simple, low-cost test should be distributed to help drug users detect whether the deadly substance fentanyl is in the drugs they buy on the street.

Researchers from The Johns Hopkins School of Public Health and Rhode Island Hospital worked in partnership with the Bloomberg American Health Initiative on a study on the concept of “drug checking.”

They found promise in a testing strip device, similar to a home pregnancy test, that can detect fentanyl.

“Most service agencies should be able to distribute or deploy fentanyl testing strips, using them in a supervised setting or providing access to these materials for people who use drugs in an outreach context. Fentanyl testing strips require minimal training to use properly and can be worked into drug preparation rituals and processes,” the study said.


The recommendation comes as the United States is suffering through a drug overdose epidemic that killed more than 64,000 people in 2016. Fentanyl, a potent synthetic opioid that is up to 50 times more powerful than heroin and is often mixed with it, has played a major role in the rise of overdose deaths.

Drug checking can be done a variety of ways, including testing the drug and providing immediate results to users; having users drop off drugs and retrieve results by phone or online by a code; or by handing out testing materials to users so they can test on their own, the study said.

It hasn’t been done much in the United States. But “the inconsistency of the drug supply and the lethality of fentanyl have increased interest in drug checking,” the study said.

“We feel really comfortable with getting behind the strategy of drug checking as a critical component” of battling the opioid epidemic, said one of the study’s authors, Dr. Traci Green, associate professor of emergency medicine and epidemiology at Brown University and a senior researcher at Rhode Island Hospital.


To evaluate various available testing technologies, the researchers used drug samples from the Baltimore and Providence police. In addition to evaluating BTNX Fentanyl Testing Strips, the researchers looked at a machine the size of a small cash register called a Bruker Alpha, saying it could be used at a fixed or mobile location with trained people on hand to assist drug users with operating it.

The researchers also looked at a third, handheld device called a TruNarc. “All three have enormous promise,” Green said.

Would drug users take advantage of such tests?

As part of the study, researchers also interviewed 335 people who use drugs in Baltimore, Boston, and Providence.

Dr. Traci Green, associate professor of emergency medicine and epidemiology at Brown University, was one of the study’s authors.Allison Shelley/Bloomberg American Health Initiative

The study found that the vast majority of drug users were highly concerned about fentanyl in the drug supply. The vast majority were also interested in being able to check their drugs. Seventy percent also said they would modify their behavior if they knew their drugs contained fentanyl, including avoiding the drugs, using them more slowly, or using them with others who have the antioverdose medication naloxone.

“People who use drugs are just like anybody else. They don’t want to get sick and hurt, and they want to keep themselves and their community safe from harm,” Green said.

It’s critical that those who participate in drug checking services be aware that tests can still produce false negatives and false positives and that other toxic contaminants may not be detected, the study said.


The study’s other recommendations included: offering counseling and education in connection with drug checking services; continuing private sector research on mobile drug checking tests; and using data collected from the testing to learn more about the drug supply circulating on the streets.

“It would be incredible to provide additional support and harm reduction” to drug users, Green said.

“As the rest of the world acknowledges that this is a supply problem, we need to come to that, too, and have the tools to address it,” Green said. “We have to think about the fact that this is not going away anytime soon.”