Gaining Access to Essential Harm Reduction Tools

The opioid epidemic has gripped the United States for decades, resulting in the rise of severe addictions and overdoses around the country. In recent years, an even deadlier threat has emerged in the crisis. Fentanyl is a synthetic opioid that is responsible for the growing amount of accidental overdoses. According to the National Coalition Against Prescription Drug Abuse, more than 67 percent of drug overdoses now involve fentanyl. 

At this time, the significance of harm reduction strategies, specifically the use of tools like fentanyl test strips and naloxone, cannot be overstated. As communities in the US continue to face suffering and loss amid this crisis, we must amplify the discourse surrounding the accessibility, legality, and widespread adoption of these prevention tools. 

Rather than relying on abstinence-based policies as we have for so long, harm reduction recognizes the reality that people will continue to use drugs. These crucial tools seek to minimize the negative impacts of that drug use. 

In this article, we will discuss the significance of harm reduction tools and explore the vital role that fentanyl test strips and naloxone play in reducing overdoses and saving lives. We also aim to answer the question of what we need to do as a society to prevent overdose deaths in every part of the country. 

The battle against opioid overdoses is far from over, but these harm reduction tools can make significant strides in saving lives and offering hope to those struggling. 

Understanding Fentanyl 

If you are unfamiliar with fentanyl, it is a synthetic opioid that is 50-100 times more potent than morphine or heroin. Fentanyl is generally prescribed by a medical professional in the form of transdermal patches, tablets, or injections when undergoing surgery or suffering from chronic pain from conditions like cancer. 

Unfortunately, illicitly produced fentanyl has contributed to the growing rise of overdoses. This fentanyl typically comes in the form of white powder, which is often laced into other drugs like cocaine or heroin. Most times, these drugs are laced without the knowledge of the user and, due to their high potency, can result in respiratory depression, coma, and even death.  

The Rise of Counterfeit Pills

Fentanyl is also known to be laced in pills like oxycodone or Xanax that have not been obtained legally from pharmacies. These counterfeit pills are often produced in laboratories with little regard for safety or quality control. They are designed to mimic the appearance of actual prescription medications like opioid painkillers or anti-anxiety meds. A report from the CDC has found that the number of people who overdose and die from counterfeit prescription drugs has doubled from 2 percent to 4.7 percent from 2019 to 2021. 

These counterfeit pills have become a growing issue on college campuses around the country. Fentanyl was involved in the majority of teen overdose deaths in 2021, and nearly three-fourths of these deaths were because of counterfeit pills like oxycodone, Xanax, or Vicodin that have been laced. 

Because of this, college campuses like UNC are educating students about harm reduction and encouraging students to carry test strips and naloxone and even began handing them out at events. 

What are Fentanyl Test Strips?

Fentanyl test strips are a crucial harm reduction tool in the opioid epidemic, particularly for individuals who regularly use drugs. A fentanyl test strip is a small and portable device that can detect the presence of fentanyl in the sample you provide. This quick and accessible information about a particular substance allows users to make more informed decisions about their drug use and take necessary precautions to avoid accidental overdoses.

As fentanyl continues to rapidly contribute to the overdose crisis in the US, the availability and use of these strips have become vital in reducing the risks of drug use. 

How to Use

To use a fentanyl test strip, follow the instructions below:

• Get a small sample of the substance. This can be a portion of the drug or the residue from it.
• Dip the test strip into the sample, ensuring that the reactive pad is fully submerged for a couple of seconds.
• After about a minute or two, remove the strip and place it on a surface that is dry and clean.
• Wait for the designated time in the instructions, then look at the result. A positive result is often indicated by lines or symbols on the strip. A negative result implies the absence of Fentanyl. 

What is important to remember about fentanyl test strips is that while these test strips can detect the presence of fentanyl, they may not be able to identify other dangerous substances that could be present.

What is Naloxone Used For?

While fentanyl test strips are used to test if a substance is laced, naloxone is used to reverse an overdose after an individual uses a laced drug. Naloxone is an opioid antagonist that works by binding to the same receptors in the brain that opioids bind to, which displaces the opioid and reverses its effects. This will quickly restore normal respiration to the individual. 

Naloxone is typically administered through intramuscular injection, though it can also be delivered intravenously or as a nasal spray, depending on the specific formulation. While it is often used in emergency medical settings by first responders, it is becoming more common for communities to educate themselves to recognize and respond to overdoses. The accessibility and distribution of naloxone have become essential components of harm reduction strategies aimed at preventing overdose deaths, providing individuals with a second chance at life and recovery.

How to Use

To administer Naloxone to someone experiencing an overdose, follow these instructions.

• Look for signs of opioid overdose in the individual, like unconsciousness, slow or absent breaths, and pinpoint pupils. 
• If possible, call for emergency medical assistance before getting started. (Ideally, have somebody else call while you are administering the Naloxone.)
• If you are using a Naloxone injection, inject the medication into the muscle of the individual’s upper arm or thigh, following the specific instructions of the kit you are using. Always dispose of any needles or syringes safely after use.
• If you are using a nasal spray instead, place the individual on their back and gently insert the tip of the spray into one nostril, making sure to follow specific instructions on the nasal spray. 
• It is important to monitor the individual’s breathing and responsiveness and be ready to provide additional doses if needed. 
• Always follow up with medical care, even if they have appeared to recover. 

Accessibility Challenges

Despite the benefits of increasing education and accessibility of harm reduction tools in response to the rapidly growing opioid and overdose epidemic, fentanyl test strips are still illegal in some stages under the 70’s era war on drugs law. States such as Idaho, Iowa, and Texas still classify test strips as drug paraphernalia under these laws that were established long before fentanyl showed up in the nation’s drug supply.

Addressing the opioid crisis with the angle of harm reduction rather than drug abstinence is believed by many to increase the likelihood of overdose despite research proving otherwise. Fortunately, with the rise of overdoses,  states are beginning to change these laws, with Ohio decriminalizing test strips earlier this year. 

Addressing these challenges in accessibility requires an approach involving policy reforms, destigmatization efforts, increased funding for harm reduction programs, expanded training and education initiatives, and the establishment of equitable distribution networks to ensure that fentanyl test strips and naloxone are readily available to those who need them most.

What Can We Do to Prevent Overdose Deaths in the US?

Continuing to prevent overdose in the United States requires a proactive approach that can address all factors contributing to the opioid crisis. This can include increased access to naloxone, the expansion of harm reduction services, enhanced Prescription Drug Monitoring Programs (PDMPs), comprehensive substance use disorder treatment, public awareness and education campaigns, legislative reforms and policy initiatives, integrated healthcare and community support services, and dedicated research and innovation efforts.

Below are some key measures that an individual can take to prevent overdose death for themselves and those around them:

• Educate yourself and others:  Get started by educating yourself and those around you about the risks of drug misuse as well as the signs of an overdose to watch out for. Inform others about the risks associated with combining substances and the importance of never using drugs alone.
• Carrying fentanyl test strips and naloxone: Create a habit of carrying harm reduction tools like fentanyl test strips and naloxone to have in the case of an overdose. Encourage others to do the same.
• Supporting harm reduction programs: Support harm reduction programs that work to provide clean needles and syringes, safe injection sites, and opioid substitution therapy. These types of programs can prevent overdoses and provide avenues for addiction treatment.
• Community support: Creating or involving yourself in a community environment that encourages people to seek help without the fear of judgment can play a huge role in reducing addiction and preventing overdose. Communities can organize support groups, outreach programs, and peer support networks to create a sense of belonging and reduce social isolation.
• Advocate for policy changes: Advocate for policy changes that prioritize public health, harm reduction, and evidence-based approaches to substance use disorders. This can involve decriminalization, diversion programs, and increased funding for substance use disorder treatment and prevention.

By implementing a combination of these strategies, communities can work towards preventing overdose deaths and providing support for individuals struggling with substance use disorders.