Fentanyl Test Strips Highlight Rift in Nation’s Struggle to Combat Drug Deaths

Are you a fan of smoking weed? A group of young men are sitting on benches in a public housing courtyard.

There was a soft September air.

Ms. Lopez works for New York University. Fentanyl, a drug that can kill you, is being cut with street drugs. Before you use your supply, you can test it to see if there is any Fentanyl in it. She was giving away items.

She had their attention not just because of her stature but also because of her cascading black hair and bright scarf. One of the highest overdose rates can be found in the neighborhood of Mott Haven. After she told them how to use the kit, they all accepted it. A person asked for another kit.

She said she appreciated him and smiled.

Fentanyl, a cheap synthetic opiate 50 times more lethal than heroin, has led to a record number of fatal overdoses in the US. Fentanyl test strips have become controversial in their use. Drug users can make life-saving decisions, according to supporters. They are accused of facilitating drug use.

Test strips are part of a broader approach called harm reduction, which states that ending the overdose crisis can only be achieved by first ameliorating the deadliest risks of drug use, then taking steps to curb behavior. President Biden is the first president to embrace harm reduction, and he has made fentanyl test strips a key component in his proposed $307 million harm- reduction drug-control strategy. In the last year, Louisiana, Tennessee, Alabama, and Georgia have legalized test strips, making them more available.

In about 20 states, test strips are considered to be drug paraphernalia.

Critics say test strips encourage drug use if the supply is free of the drug. The test strips are more objectionable than other forms of harm reduction due to the fact that they prevent the spread of H.I.V. and other dangerous infections to users and non users.

Legislators in Kansas did not approve of the strips being legalized. Fentanyl strips are not good for saving lives. It is clear that let's be clear. Molly Baumgardner, a Republican state senator, said at the time that there were people who wanted to use the drug.

The drug czar of the Biden administration disagrees. The director of the federal Office of National Drug Control Policy said there was no scientific evidence to support the idea that harm-reduction services like Fentanyl test strips encouraged drug use.

There is not a lot of evidence that test strips save lives. Some studies looked at whether the strips deterred drug use.

The study found that after receiving the strips, 84 percent tested their drugs and 69 percent took precautionary measures, such as asking someone to check on them or using smaller amounts. Users of a supervised drug injection site in British Columbia were asked if they wanted to check their drugs for the drugfentanil. Only 1 percent decided to do so. The majority of the samples tested positive for the drug.

Drug users in Baltimore and Delaware who had been given strips at two needle exchange programs were the subject of a study. In Delaware, 69 percent of people said that they took risk reduction measures when they found out that the drug was positive.

The strips have become accepted by casual drug users. The city of Chicago offered free kits to attendees of the festival. Thousands of strips have been given to college students by TACO. Emergency rooms give overdose patients strips.

Ms. Lopez persuaded some drug sellers to try the strips. I asked how you knew.

The use of strips by dealers could make a difference. He said that if a dealer can say that they have tested it, that would be a good thing. Drug dealers are making sure they don't poison their customers with more dangerous drugs.

The differing messages on test strips get translated into different practices. Drug paraphernalia is considered drug paraphernalia by Kentucky. Target4 is an H.I.V.-prevention and harm-reduction program at the University of Kentucky. In a lot of rural counties, police officers have taken the kits from program participants.

There is a stigma attached to drug use that makes it hard to reduce harm in the Bible Belt.

A lot of people don't see addiction as a problem. It is seen as immoral. I have heard that the best way to solve the drug problem in Kentucky is to gather up all the drug users and lock them up in a big space and let them all overdose and die.

Test strips have limitations even where they are easy to get. The presence of Fentanyl is not measured. In locations where access is difficult or banned, drug treatment programs can be purchased online for about a dollar or two each, a cost that can add up quickly for a regular user.

The effectiveness of the testing, in which a small drug sample is dissolved in barely a capful of water into which a strip is dipped, depends on the user's compliance. Outreach workers like Ms. Lopez try to engage users directly by climbing under bridges to find them.

People who buy fake pills through social media or street dealers need to be extra careful. The drugs are salted with Fentanyl. One pill might not be positive, but others could be. There should be a test for each pill.

Kevin Sabet, a founder of the Foundation for Drug Policy Solutions, said that rigor is antithetical to people who struggle with addiction.

Mr. Sabet thinks the strip's utility is modest. The brain is hijacked by it. The idea that you're going to make a lot of rational choices when you're in active addiction goes against the idea of what addiction is.

Ms. Lopez said she knows people who use heroin who use the strips in moderation because they fear an accidental overdose.

She acknowledged that people who are addicted tend to reject the strips. She said that they wanted the drug because their goal was high. Even if they die in pursuit of that goal, they think it is worth it.

She looks for people who can be persuaded to carry strips in order to save others. Sussing someone out is a blend of observation, intuition and street experience.

The Hub is a Bronx commercial center filled with drug traffic. Men leaned against storefronts and thumbed their money.

She offered inducements as she approached. Men are talking outside a barbershop. What are y'all doing? I need some condoms. Throughout the day, every man, young or old, responded with a question. She pivoted to her pitch.

A woman sits alone at a cafe table. "How are you?" Ms. Lopez pulled out the kit.

A man had a needle in his arm as he headed towards the hub. She turned around. She was angry and said it was crazy to her. People don't feel comfortable shooting up in front of everyone before Covid. Poor people have seen the world change. They were desperate before, but now they are full of desperation.

By the end of the shift, the women had given out about 20 Fentanyl test kits, as well as hygiene kits, condoms and Narcan, which reverses overdoses. The New York City Communities for Health is run by the Silver School of Social Work at the New York University.

A chill breeze kicked up as the sun went down. When the weather turned cold, how would Ms. Lopez find people?

She wasn't intimidated. She wanted to get people while they were waiting for the subway. We would definitely rock it.