As clinicians, many of us have been touched personally as well as professionally by the opioid crisis and overdose deaths. According to the CDC, over 107,000 people in the U.S. died of drug overdoses from January 2021-January 2022, and 67% of those deaths involved synthetic opioids such as fentanyl. Fentanyl is especially terrifying because many people who overdose on it may have had no intention of using it at all.
Within the last 7 years, my husband’s family has lost 4 family members to the opioid epidemic. The most recent and most tragic was my brother-in-law, Christopher. After losing his son to an opioid overdose and his mother to COPD, Chris ended up unhoused and relapsed on methamphetamines. In 2022, Chris was found dead in his truck. The toxicology report showed methamphetamine and fentanyl. I truly believe that Chris’s death was unintentional and a consequence of fentanyl contamination in the drug supply.
Many drugs are contaminated with fentanyl due to its potency and low cost. As an analgesic, fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. We know that heroin, cocaine, methamphetamine, and counterfeit pills designed to look like benzodiazepines or oxycodone have all been laced with fentanyl.
We often feel helpless when faced with these realities, but harm reduction strategies can help. One strategy is educating our patients about naloxone (Narcan) and encouraging everyone to carry it and know how to use it. Another strategy is education around fentanyl test strips.
Fentanyl test strips can help drug users identify fentanyl in their drug supply in order to avoid unintentional overdose. Fentanyl test strips are available for free from many health departments.
Knowing how to properly use fentanyl test strips, and sharing that information with your patients, is critical – and not that simple. YouTube has useful videos on the subject, and state and city health departments provide helpful handouts, such as this one from the NYC Department of Health.
The CDC gives the following basic steps:
Here’s the tricky part: on a fentanyl test strip 2 lines means NEGATIVE (the opposite of many covid or pregnancy test strips we are used to reading). Think “N-O” has 2 letters.
What if a drug supply is contaminated with fentanyl? We want our patients to avoid using fentanyl completely, but that is not always realistic. Harm reduction strategies include encouraging people to use the drug slower, or to use less; to use the drug only with someone they trust; to use it somewhere visible to street traffic; and to always have naloxone with them and easily accessible.
Hear more about this topic in Eli’s Story: The Fentanyl Crisis and What Clinicians Can Do About It, which aired August 2023 on Primary Care RAP and Peds RAP. Learn more about the new DEA requirements here.