Pennsylvania Latest State to Decriminalize Fentanyl Test Strips

Alicia Ault

November 21, 2022

Pennsylvania Gov. Tom Wolf has signed a law legalizing the sale and distribution of test strips designed to detect whether fentanyl is in an illicit drug.

Harm-reduction advocates welcomed the action, saying that it has the potential to help reduce overdoses.

The Pennsylvania Department of Health reported that 78% of the 5343 overdose deaths state-wide in 2021 involved fentanyl.

"Because fentanyl is so prevalent, especially in the heroin supply, it's hard to actually find heroin anymore. But people still want to avoid [fentanyl]," James Latronica, DO, a Pittsburgh-based addiction specialist, told Medscape Medical News.

Having the test strips available, however, is "likely more critical for people using other drugs, who have no opioid tolerance," such as those who are casual users of cocaine, methamphetamine, alprazolam (Xanax), and MDMA (Ecstasy, Molly), said Latronica, who is the public policy chair for the Pennsylvania Society of Addiction Medicine.

Pennsylvania joins some 30 other states — including, in 2022, Alabama, Georgia, Illinois, Louisiana, Tennessee, and Wisconsin — that decriminalized or legalized fentanyl test strips, said Latronica.

"Drug Paraphernalia"

The immunoassays, which cost around $1 each and give a simple positive or negative indication that fentanyl is in a powder, pill, or injectable, have been considered illegal drug paraphernalia by the Drug Enforcement Administration (DEA). Most states had followed the DEA prohibition.

The Pennsylvania law, signed by Wolf on November 15, had bipartisan, unanimous support in the state legislature — an encouraging sign, said Tracy Pugh, MHS, states director of the Overdose Prevention Program at Vital Strategies, a global health nonprofit.

"The unanimous support for fentanyl test strips in the legislature is a welcome sign of the growing momentum in support of harm reduction as a tool to address the overdose epidemic," said Pugh, in a statement.

The Wolf administration has prioritized harm reduction, which may have contributed to a small 4% decrease in Pennsylvania overdose deaths for the fiscal year that ended in June, as reported by the US Centers for Disease Control and Prevention (CDC) earlier this month. The report is based on provisional data.

Latronica notes that while fentanyl is most prevalent in the heroin supply, it is not the only dangerous substance being added to opioids and other illicit drugs. These include xylazine and levamisole, both veterinary medications. Neither is easily detectable with rapid point-of-care assays.

The Pennsylvania law smartly legalized testing for any substance that might be found in the drug supply, said Latronica. That means that when test strips or other modes of detection are developed for other contaminants, they will be freely available for harm reduction.

"Allowing that scope of testing will lead to a lot less morbidity and mortality," he said.

Latronica reports no relevant financial relationships.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in publications including JAMA and You can find her on Twitter @aliciaault.

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