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Fentanyl addictive prescription drug bottle with warning labels beside a few pills from an open, fallen vial.
Drug-detecting tools have the potential to save lives and serve as a critical part of harm reduction toolkits but often remain inaccessible because of various barriers.
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More Research, Less Barriers Needed to Implement Drug-Checking Tools

Tools such as fentanyl test strips hold promise to reduce drug-related harms and save lives amid the overdose epidemic

National Institutes of Health
Published:Jun 14, 2023
|2 min read
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In a new commentary in The New England Journal of Medicine, leaders at the National Institutes of Health and the U.S. Food and Drug Administration highlight the urgent need to address current gaps in the research, development, and implementation of fentanyl test strips and other rapid drug-detecting tools that could help prevent overdose deaths. These tools have the potential to save lives and serve as an important part of harm-reduction toolkits but often remain inaccessible because of various barriers like state or legal prohibitions. 

This call to action encourages new collaborations among researchers and agencies to ensure the effectiveness of fentanyl test strips and promote the development of additional drug-checking technologies. It also encourages the reduction of barriers that inhibit the use of these technologies where not prohibited by law.

In 2021, more than 60,000 people in the US ages 15 to 54 died from opioid-involved overdose—more than COVID-19 fatalities for this age group—and many of these deaths were driven by the extremely potent opioid fentanyl, which is difficult to detect unaided. 

Illicit fentanyl is often mixed in counterfeit pills and with other drugs like heroin, cocaine, methamphetamine, and xylazine, leaving many people unaware of the specific substances they are consuming. Expanding access to innovative, inexpensive, and easy-to-use drug-checking technologies where not prohibited by law may be able to play a pivotal role to help keep people safe, whether at home or in public.

Fentanyl test strips and drug-checking tools

Fentanyl test strips are among the most well-known and easily distributable drug-checking tools to date, yet few studies have evaluated their performance and impact on public health. In general, the FDA does not regulate test products when intended solely for use to detect substances or adulterants in illicit drugs. It is critical for researchers and developers of these drug-detecting products to evaluate their accuracy to assure quality and performance in each instance of use.

Research is also needed to determine whether other drug-checking strategies are feasible and effective in community and clinical settings and to develop techniques for detecting other emerging substances. Models for implementing drug-checking strategies should ensure that they are deployed in an equitable and culturally appropriate way, tailored to unique community needs where not prohibited by law.

The NIH welcomes research proposals on fentanyl test strips and other drug-checking and screening tools. The FDA has provided premarket clearance for laboratory-based tests to detect fentanyl in urine and hair and welcomes the opportunity to work with manufacturers on point-of-care devices intended for testing human specimens. This would be particularly valuable in clinical settings to help monitor critical trends and outcomes and aid in clinical evaluations of substance use.

- This press release was originally published on the National Institutes of Health website