A different kind of drug test
When do harm reduction measures go too far?
Josh Loiola became addicted to opioids before he graduated high school. The cravings drove him from his Greenwich, Conn., neighborhood to dealers in New York City to get his next fix. Sometimes it was heroin. Sometimes fentanyl.
Loiola’s parents made the 18-year-old sign up for Brooklyn Teen Challenge, a year-long New York City rehabilitation program. But Loiola almost didn’t make it to the program. His father found him unconscious one morning at 3 a.m. after he overdosed on fentanyl. Paramedics administered multiple doses of the anti-overdose medication naloxone to save his life.
Loiola is one of tens of thousands of Americans who overdose on fentanyl every year. Record-breaking deaths due to the drug are fueling a bipartisan push to decriminalize fentanyl test strips in a growing number of states. The strips could save lives by enabling users to test their drugs for the dangerous opioid. But the push reopens questions about harm reduction strategies: When do drug safety measures end up feeding addiction?
Over 100,000 Americans died from drug overdoses between April 2020 and April 2021, with about 75 percent overdosing on opioids. Overdose deaths increased by 649 percent from 1999 to 2020, jumping by 34 percent between 2019 and 2020 alone.
Developed in 1959, fentanyl is legally manufactured and prescribed in the United States to ease chronic or severe pain following surgery. The use of illicit fentanyl exploded during the past several years, fueled by an influx of the drug from China and Mexico. The synthetic opioid accounted for two-thirds of overdose deaths during the 12-month period that ended last April.
The drug produces similar effects as heroin and is about 100 times stronger than morphine. Even a 2-milligram dose can be fatal. It’s also dangerously cheap. Dealers often mix fentanyl with other illegal drugs to increase their potency. They also press it into pills resembling legitimate prescription opioids.
People risk unintentionally consuming the drug in other drugs like heroin, methamphetamine, and cocaine. Users can only know if an illicit drug contains fentanyl by dipping a paper test strip into drug residue dissolved in water. If a red stripe appears, the deadly drug is present.
Laws in many states classify the strips as illegal drug paraphernalia. In Texas, possession of a strip is a Class C misdemeanor punishable by a $500 fine. But Republican Gov. Greg Abbott wants the new legislature to change that. “There’s going to be a movement across the state to make sure we do everything that we can to protect people from dying from fentanyl,” he said in December. “I think test strips will be one of those ways.”
Former Arizona Gov. Doug Ducey, also a Republican, signed a bill legalizing the strips in 2021. The state supplied the strips to several counties. Arizona confiscated about 1,200 pounds of illegal fentanyl by October last year—most at or near the southern border. In Georgia, legislators passed a bill with an amendment legalizing the test strips last April.
In Pennsylvania, former Gov. Tom Wolf, a Democrat, signed a bipartisan bill reclassifying the strips in November. Fentanyl accounted for 78 percent of the state’s 5,343 overdose deaths in 2021. With the strips no longer considered drug paraphernalia, the Pennsylvania Department of Drug and Alcohol Programs encouraged residents to equip themselves with the strips as well as doses of the anti-overdose medication naloxone.
Dr. Jeffrey Singer, a senior fellow at the Cato Institute, said fentanyl test strips are a step in the right direction. But he argued that harm reduction should include providing clean needles and syringes, clean smoking equipment, and safe consumption sites to reduce the spread of HIV and hepatitis. “Harm reduction is … realistic,” he said. “It says, look, if you think you’re going to reach a drug free society, you’re dreaming, so let’s do what we can to make fewer [people] arrive in our emergency rooms.”
Critics argue that harm reduction strategies make illicit drugs more socially acceptable and aren’t likely to get addicts into rehab. In December, San Francisco closed its controversial Tenderloin Center, a safe-consumption site aimed at preventing overdoses and connecting addicts to rehab. Staff reversed more than 300 overdoses during the center’s run, but fewer than 1 percent of visits resulted in an addict entering treatment.
Paul Burke, a former addict and current pastor, cautions that harm reduction strategies, including fentanyl test strips, may not be as effective as people hope. Burke used methamphetamines and other drugs for 18 years and now serves as executive director for Brooklyn Teen Challenge. “I’m not minimizing a saved life,” he said. But he isn’t sure users will throw out their next high just because a test strip detects fentanyl, and he worries the strips will encourage users to experiment with more drugs.
Addiction psychiatrist Dr. Mark Duncan doesn’t put fentanyl test strips in the same category as other harm reduction strategies. As fentanyl grows in popularity in his home state of Washington, he thinks the strips are essential, but draws the line at directly dispensing pharmaceutical versions of opiates in an attempt to protect against street contamination.
The effectiveness of safe consumption sites is less clear, he said. “A lot of these people that go there are not going to be interacting with any kind of treatment provider,” Duncan said.
Dr. Kurt Bravata also works in addiction medicine. He argued that Christians should separate harm reduction strategies from affirming harmful behavior. “You are attempting to reduce the risk of life-threatening injury or death so that individuals struggling with substance dependence and addiction can eventually get the help they desperately need, when they are ready,” he said in an email. “I see this as grace.”
Total life transformation is crucial to successful rehab, said Burke of Teen Challenge. It can’t just be about getting sober. After paramedics revived Loiola with naloxone, he started the yearlong program at Brooklyn Teen Challenge. It wasn’t easy, but his parents refused to let him quit. About six months into the program, Loiola became a Christian.
Loiola, now 27, graduated from the men’s residential program in 2015 and now works as the program director. He graduated college and married Cassie, another program graduate. The couple is expecting a baby girl. Burke and his wife plan to give the couple a framed picture of their first sonogram. “It’s so remarkable,” Burke said, “that God can take a life like that, two lives, and change them.”
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