More States Legalize Fentanyl Test Strips

by J.Adderton J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education. Has 29 years experience.

Tennessee and New Mexico have joined a growing number of states legalizing the use of fentanyl test strips (FTS).  Read on to learn how the strips are being used to prevent deaths caused by overdose.

Harm reduction approach to prevent fentanyl overdoses

More States Legalize Fentanyl Test Strips

Overdose deaths from illegally manufactured fentanyl (IMF) have skyrocketed all across America.  Statistics reported by the CDC’s National Center for Injury Prevention and Control in New Orleans paint a grim picture, with IMF overdose deaths increasing between 2019 to 2020 by:

  • Nearly 50% in the west
  • 65% in the south
  • 33% in the mid-west

New Mexico and Tennessee join a growing list of states that have added fentanyl test strips as a harm reduction tool, joining such programs as needle exchanges and distribution of naloxone kits to lay individuals. 

Fentanyl Facts

Fentanyl is a scheduled II synthetic opioid that is around 100x more powerful than morphine.  It is used legitimately in the medical treatment of severe chronic pain and post-surgical pain.  Illicitly manufactured fentanyl (IMF) is produced in underground labs, unregulated and usually smuggled into the U.S. through Mexico to sell on the black market.   Fentanyl can be mixed with other illicit drugs to increase the effects making it even more lethal.  In fact, 2mg of fentanyl can be deadly for certain individuals.  According to DEA analysis, 42% of counterfeit pills contained at least 2mg of the drug.

Fentanyl Test Strips

Fentanyl test strips were created in 2011 by BNTX, a Canadian biotech company.  Initially, the strips were used by doctors to check clients' urine for prescription fentanyl.  However, the tests eventually began being used “off-label” in harm reduction initiatives to lower overdose risk.  The strips are able to identify the presence of fentanyl in unregulated drugs, including injectables, powders and pills.

According to experts, the test strips are also helpful to people who use other illicit drugs, such as cocaine, methamphetamine and other stimulants.  The number of illicit drugs being “laced”, or contaminated, with fentanyl is increasing at alarming rates.

How FTS Are Used

FTS are usually distributed at harm-reduction centers (such as needle exchange programs), distribution websites and even some dollar stores.  The strips cost around $1.00, are easy to use and small enough to carry discreetly.  The Prevent Overdose Rhode Island website provides specific instructions on how to use the test depending on how someone is taking the drugs, such as by injection, snorting or swallowing pills.  The tests are quick, taking only a couple of minutes to result. Click here to read the "How To Test Your Drugs Using Fentanyl Test Strips" brochure available on

Are They Accurate?

The reliability of FTS are backed by a 2018 research study conducted by Brown University, Boston Medical Center, and Johns Hopkins University.  Researchers used the test strips on samples of street drugs provided by law enforcement and the strips did accurately detect fentanyl in the samples.  In addition, the study found FTS were unlikely to provide a false positive result.  You can read more about the study here.


There are limitations associated with FTS, including:

  • When a strip results positive, the test doesn’t measure how much or how strong the fentanyl is in the drug.
  • The strip may detect an incidental contamination of a drug sample that isn’t a clinically significant amount.

Impact on Safe Behaviors

A 2018 study found drug users provided with FTS that recieved a positive result made safer behavioral changes, such as using with another person present, throwing the drug away, using less or using more slowly.  You can read about additional research and studies related to the impact of FTS on safer behavior here.

Let Us Hear From You

Do you live in a state that has legalized fentanyl test strips?  If so, what impact are FTS having in your community?


Experienced nurse specializing in clinical leadership, staff development and nursing education.

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4 Comment(s)


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,185 Posts

Unaware of Fentanyl test strips.... consider this a good idea for EMT/Paramedics/Police to use....along with needle exchange programs.

Just searched PA usage -- they are considered drug paraphernalia; bill introduced in PA to permit them.  Law was introduced by my state Senator Tim Kearney (pleasantly supprised!); Just might pass our legislature to decrease OD deaths here. 

Fentanyl test strips, currently a crime in Pennsylvania, could soon be legalized

Pa. Senate Judiciary Committee moves fentanyl test strip bill to full senate

I was working Hospice in early 90's when Durageic (Fentanyl) patches introduced and used for our Cancer patients when morphine doses ineffective.  Unreal that its being cut into street drugs today.


gere7404, BSN, RN, EMT-B

Specializes in Emergency Services, Cardiac Step-Down. Has 5 years experience. 633 Posts

Fentanyl is HUGE on the west coast, especially along the I5 corridor. Majority of unintentional ODs I see in the ER in the SeaTac are involving “blues,” which are counterfeit oxy pills that are actually fentanyl or carfentanil. They’re cheap, and everywhere. Don’t really see too many people injecting crushed blues, PO and smoking are the most common routes, but other drugs people do shoot like meth and heroin are cut with it sometimes. 

UrbanHealthRN, BSN, RN

Specializes in Community and Public Health, Addictions Nursing. Has 12 years experience. 230 Posts

Here in my part of New England, the only opiate on the street is Fentanyl, to the point where Fentanyl test strips don't make sense anymore for opiate users- they already know what they're getting. The test strips have been super helpful for testing other substances like cocaine, benzodiazepines, and meth- that's where a lot of our ODs are coming from now. My states law does allow for things like Narcan and test strips, but unfortunately the risk of arrest for paraphernalia is still present. Great article!


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,185 Posts

Ran across this article today

Philadelphia Inquirer  5/11/22

What is fentanyl and why is it behind the deadly surge in US drug overdoses? A medical toxicologist explains

From Xanax to cocaine, drugs or counterfeit pills purchased in nonmedical settings may contain life-threatening amounts of fentanyl, which is deadly in even small amounts.



...Fentanyl is a synthetic opioid that was originally developed as an analgesic — or painkiller — for surgery. It has a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency.

For example, carfentanil, a fentanyl analog formed by substituting one chemical group for another, is 100 times more potent than its parent structure. Another analog, acetylfentanyl, is approximately three times less potent than fentanyl, but has still led to clusters of overdoses in several states...

...Other strategies to prevent overdose deaths include lowering the entry barrier to addiction treatment, fentanyl test strips, supervised consumption sites and even prescription diamorphine (heroin)...