WTF: Fentanyl test strips

In October, the Buncombe County Board of Commissioners heard that the county’s rate of overdoses has exceeded the North Carolina average every year since 2016. And in 2021, the latest year for which data is available, Buncombe saw 45 overdose deaths per 100,000 people, compared with 36 overdose deaths per 100,000 people statewide.

But the root of the problem isn’t unique to the county, says Ginger Clough, health promotions supervisor for the Buncombe County Department of Health and Human Services. Fentanyl, a synthetic opioid, is “the driver behind overdose deaths locally in Buncombe, in North Carolina and in the country,” she explains.

That’s the reason fentanyl test strips, which check for the presence of fentanyl in other substances, are “a significant piece of an overall harm reduction approach,” Clough continues.

In a medical setting, fentanyl is used for sedation, like during wisdom teeth removal, or prescribed as a pain medication for individuals requiring around-the-clock relief. It’s highly powerful — 50-100 more potent than morphine, according to the NCDHHS.

But fentanyl can also be manufactured cheaply and illicitly, and it’s added as a filler, also known as an adulterant, to other drugs such as methamphetamine, MDMA, heroin and cocaine. The added cheap fentanyl can make those drugs — which are of more expensive street value — stronger than a user expects, potentially leading to an overdose.

“By testing, people can make a plan of care around safer use to reduce the risk of an unintentional overdose,” says Clough.

The latest edition of Xpress’s WTF — “Want the Facts?” — series looks at the history, legality and use of fentanyl test strips in the Asheville area.

When did Buncombe County start distributing test strips?

In 2019, Gov. Roy Cooper signed the Opioid Epidemic Response Act, which legalized the distribution of fentanyl test strips. Buncombe County’s Safe Syringe Program began that year, which distributes fentanyl test strips along with sterile syringes, the overdose reversal drug naloxone, sharps containers and alcohol wipes.

During fiscal year 2021-22, BCDHHS distributed 1,637 fentanyl test strips, according to Clough. The department has distributed 969 from October through Jan. 27. (The strips cost roughly $1 each, according to the Legislative Analysis and Public Policy Association.)

Free test strips are available on demand at the Buncombe County Health and Human Services office, 40 Coxe Ave., weekdays 1- 4 p.m.

How do test strips help?

Distributing fentanyl test strips is part of an evidence-based strategy to reduce overdoses. The strips let individuals test their drugs for a potent substance that could kill them, explains Lance Karner, harm reduction coordinator for Sunrise Community for Recovery and Wellness.

“If somebody is partying on the weekends, using cocaine at the bar, and they want to make sure that their supply is safe to use, that’s when you would [use a test strip],” he says.

Karner likens supplying fentanyl test strips to “having a condom bowl” at a bar or club, in the sense that the materials make the safety measure more accessible to people.

“Let’s be real — people are using drugs in the bathroom at a bar,” he says. “Being able to test it before you use it, because you just bought it from a random person at the bar, is really beneficial for people who might just be trying to indulge on the weekends.”

What’s the legal status of test strips?

Many states, including North Carolina, criminalize the possession of drug-testing equipment as drug paraphernalia. The state defines paraphernalia as “all equipment, products and materials of any kind that are used … [for] testing, analyzing … or otherwise introducing controlled substances in the human body.”

But North Carolina does exempt the possession of fentanyl test strips “for personal use,” according to an assessment of drug-checking equipment laws nationwide compiled by the Network for Public Health Law.

“I’m not aware of any charges from the Asheville Police Department for possession of fentanyl test strips,” says Capt. Joe Silberman of the APD. “And I don’t really see that as something we would pursue … because we don’t want to persecute somebody solely for their addiction.”

The amount of fentanyl test strips delineating “for personal use” is unclear, Silberman says. But generally speaking, a police officer’s interpretation of a “user amount” versus an amount signifying an intent to sell drugs depends on the amount of the illicit substances and the specific drug paraphernalia present.

For example, “a syringe, a tourniquet, a spoon and they had a handful of test strips — that to me is a user amount,” Silberman explains. “If you caught somebody with an amount [of test strips] with other items like a blender and an amount of fentanyl that exceeds a gram — maybe exceeds 5 grams — you’re into the ‘possession with intent to distribute’ area,” he continues.

But it’s not common to find strips for testing drug purity on those who are selling drugs, Silberman says. “We don’t find fentanyl test strips on drug dealers. We find guns.”

Are test strips becoming more common?

Asheville’s reputation as a party destination means fentanyl test strips are in demand. “Lately, we’ve seen an increase in bars and restaurants in Asheville express an interest [in receiving harm reduction materials],” Karner from Sunrise says.

Some establishments may put the test strips in the bathroom, he says, while others might keep them behind the bar. “The test strips have been almost a bigger hit for [establishments] than the Narcan,” a brand name for naloxone.

“Most of our harm reduction community partners have test strips supplies,” adds Clough with Buncombe County. “The opioid settlement funds are making [it possible] that the county can give out more supplies to our partners.”

The county’s partners include Sunrise Community for Recovery and Wellness, Western North Carolina AIDS Project, Steady Collective and Holler Harm Reduction, she says.

What should test strip users keep in mind?

Silberman from the APD cautions that people who use illicit drugs shouldn’t believe their substances are completely safe because they’ve tested for the presence of fentanyl.

“On the one hand, I’m not going to tell somebody not to use [test strips],” he tells Xpress. “But on the other hand, we’re deeply concerned that it might give [drug users] a sense of false security.

Silberman notes that fentanyl test strips only detect the presence of fentanyl, not the amount. That amount matters, because users can develop a tolerance to small quantities. And the strips don’t identify other adulterants, such as sugar or the anesthetic lidocaine, that may have been put in the substance.

“If they just tell you [the drug] is or isn’t fentanyl, I worry,” Silberman explains. “My concern with the strips is, would it give somebody who’s suffering from addiction a false sense of security?”