Drug Checking Equipment Can Lead to Healthier Decisions, Saving Lives

Strong and dangerous substances such as fentanyl have become increasingly common in the illicit drug supply but often go undetected, causing overdoses. Drug checking equipment—namely test strips or spectroscopy machines such as the Fourier-Transform Infrared (FTIR) spectrometer—are tools that can identify harmful substances and reduce the risk of an overdose by providing valuable, potentially lifesaving information to people who use drugs.

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Pew spoke with Dr. Megan Reed, a research assistant professor in emergency medicine at Philadelphia’s Thomas Jefferson University, about the role of this technology in addressing the overdose crisis. Reed’s areas of study include overdose prevention, barriers for engaging in risk reduction strategies, community-based participatory research, and drug checking. She received her Ph.D. from Drexel University in community health and prevention.

This interview has been edited for length and clarity.

How can drug checking equipment help the overdose crisis?

Our drug supply isn’t regulated. If I order a cocktail, I can be pretty certain that what I order is what’s actually going to be there, because alcohol is regulated. For many reasons, that’s not the case with [illicit] drugs, so users may not know what’s in them. In fact, they almost certainly don’t.

Drug checking can give people a clearer idea of what is in the drug they’re using. And when people have information, they’re naturally going to make healthier decisions that can reduce their risk for overdose and benefit their health. They may use smaller quantities of a drug, consume it more slowly, or use drugs around those who can administer naloxone or call for help in case of an overdose.

Why is this equipment necessary?

Substances in the drug supply have become more potent and much easier to manufacture. We’ve seen the intrusion of veterinary tranquilizers like xylazine and medetomidine, which are not approved for human use, and other more potent sedatives. This can make use riskier and complicate how to respond to an overdose. These substances can pop up and enter the drug supply, sometimes going away and other times becoming entrenched very quickly.

The drug supply is hyper-regional, hyper-local. Philadelphia, Delaware, Baltimore, New York City—they all have different drug supplies that change quickly. This is part of what makes drug checking equipment so critical. It can give people lifesaving information on what can be an unpredictable product.

What would you say to someone who argues that drug checking equipment normalizes drug use and shouldn’t be used?

No evaluations have ever shown that these interventions cause the initiation of drug use, an increase in drug use, or a riskier way of using drugs. All evidence shows the opposite: that people decrease their substance use or they use drugs in a less risky way.

At the end of the day, the interventions mean people are alive. And when you talk to people in a very person-centered way, it gives them agency. When people have agency, they make rational decisions that are good for their health.

Describe the different types of equipment.

First are test strips—which can be available in a variety of settings depending on the state and can be used whenever a person has space and time and privacy. If used correctly, fentanyl test strips give reliable results. On the other hand, xylazine tests may be less reliable because they can’t easily pick up on low concentrations of this substance, but they’re still a valuable tool.

How easy are the strips to use?

They’re not as simple as they may look. Public education, awareness, and training are key parts of the success of test strips. Testing has a lot of steps and nuance.

What else?

There’s spectroscopy equipment like the FTIR, which would be run by someone, perhaps in a local health program. An FTIR can identify multiple substances in a drug sample, while test strips are used to detect one substance at a time, like fentanyl or xylazine.

How accurate is FTIR?

This technology has limitations. Each sample takes about 10 to 20 minutes to run on the FTIR, and if the substance of concern is less than 5% of the sample, the machine can’t pick it up. And some of these substances are extremely potent and may even be deadly in very small amounts. We have to tell people that.

A trained technician should have a conversation about what the tests can tell, what they can’t, and the possible impact. Then have a conversation about options.

In a way, a conversation is part of the tool.

Yes. If I’m a person who uses drugs, that’s deeply empowering to me to talk about some of the tools and tricks I can use and about what I can do to stay safer.

What can policymakers do to support the wider use of drug checking equipment?

First, drug paraphernalia laws in states need to be written broadly to cover new technology as it emerges. For example, many laws legalizing fentanyl test strips didn’t apply to xylazine test strips when they came out. Policymakers had to go back and change the paraphernalia laws to include them.

Second, laws also need to protect not only the person who is operating the equipment but the person providing the sample. Until you have that layer of protection, policies won’t have the intended effect of reducing overdose deaths. 

What about funding for the tests themselves?

Yes, not only funding for the test strips and the purchase of FTIRs for community-based organizations, but also the training and education on drug checking equipment would also make a big impact. In addition, if a substance can’t be identified by the FTIR, we need money in the budget to send off the sample for confirmatory testing at a lab that uses mass spectrometry, which can give a much more granular breakdown of what’s in it.

What else should people know?

A major benefit of drug checking is that policymakers and the public will have a better understanding of the drug supply, because we can aggregate results. So much of what we know about the drug supply in Philadelphia now is because the health department has been testing the supply.

When used correctly, these drug checking tools can provide incredibly useful information not only for individuals but for everyone. We ought to approach it as one of the many interventions that are available in the prevention and treatment ecosystem that can be used to keep people alive and healthy.