Should You Offer Fentanyl Test Strips in Your Office?

Harm reduction approaches support the use of fentanyl test strips for individuals who are taking illicit substances but want to avoid fentanyl.

Nichole Michaels, PhD, a principal investigator in the Center for Injury Research and Policy at Nationwide Children’s, is conducting two studies about the efficacy of offering and educating about fentanyl testing among adults. Project Dawn is focused on distributing naloxone to any user who wants it. The other project involves offering fentanyl test strips for users with criminal justice involvement for substances such as stimulants, cocaine, methamphetamines – things that might be laced with fentanyl.

“In Ohio, more than 85% of fatalities from overdoses involve fentanyl,” she says. “We are working with the courts across the state to help distribute naloxone and fentanyl testing strips as a way to reduce harm among adults with substance use disorder. Most overdoses are polysubstance, and it is possible that users are getting drugs laced with fentanyl when they did not intend it.”

When to offer fentanyl test strips to a patient is a judgment call, says Erin McKnight, MD, adolescent medicine and addiction medicine physician and the medical director of Nationwide Children’s Substance Use Treatment and Recovery Program.

“We know that fentanyl is everywhere and our patients with opioid use disorder who are actively seeking out fentanyl don’t feel they need test strips. However, if you have a teen who is experimenting with drugs at parties, you can counsel them about the dangers, talk about a plan, and maybe offer test strips. If they want to use marijuana but are concerned that it could be laced with fentanyl, it’s about preventing overdose deaths,” she says.

Regardless of whether or not providers distribute fentanyl test strips, Dr. McKnight and her colleagues recommend that all providers prescribe Naloxone/Narcan to patients using substances as they are at risk of being exposed to fentanyl and having an overdose. Naloxone is a big component of harm reduction, and it has been approved by the FDA to be over the counter. As of fall 2023, a limited supply of naloxone has hit drugstore shelves at a cost of about $45 for two doses. This cost may be prohibitive for some consumers. So, Dr. McKnight adds, a prescription still may be needed for some.

In some states, including Ohio, Naloxone is available for free from public health departments and some pharmacies without a prescription.