Fentanyl Test Strips

Fentanyl is a synthetic opioid that’s up to 50 times stronger than heroin and has become increasingly common in the illicit drug supply according to the Centers for Disease Control and Prevention (CDC). Many of the fatal and nonfatal overdoses in the United States involve fentanyl. Over the last few years, overdoses involving fentanyl have continued to rise.

“Even in small doses, fentanyl can be deadly, especially for a person who doesn’t regularly use opioids,” says Sarah Wakeman, MD, senior medical director for substance use disorder at Mass General Brigham. “One way we can keep people safe is to help them understand what they’re using. Fentanyl test strips allow a person to check if fentanyl is present or not in their drug to help prevent overdose. This is important because the illicit drug supply in this country is unregulated, contaminated, and dangerous.”

Using a fentanyl test strip to prevent overdose can be the difference between life and death. Learn why fentanyl is so dangerous, how fentanyl strips work, where you can get them, and how to understand test results.

Why is fentanyl so deadly?

There are two types of fentanyl and both are made in a lab:

1. Pharmaceutical fentanyl. Doctors prescribe this type to treat severe pain, especially after surgery and for advanced-stage cancer. Health care providers help ensure patients receive the right amount of fentanyl to relieve pain safely.

2. Illicitly manufactured fentanyl (IMF). People share this type of fentanyl through illegal drug markets because of its heroin-like effect. It’s often added to other drugs and makes them cheaper and more powerful. This is why fentanyl is so dangerous. Most recent cases of fentanyl-related overdose are linked to IMF.

Illicitly manufactured fentanyl is available as a powder or it can be pressed into pills. Powdered fentanyl looks just like many other drugs. It’s commonly sold as heroin and may be an accidental contaminant in drugs like cocaine. It can also be made into pills that are made to resemble other prescription opioids.

For a person who uses opioids, fentanyl has made the risks of overdose even greater than when people were using prescription opioids or heroin. This is because a person has no way of knowing how much fentanyl or what type of fentanyl is in their drug. The risks of fentanyl are even greater for people using cocaine, methamphetamine, or other drugs because their bodies are not used to using opioids and even a small amount of fentanyl can be deadly. Many people may be unaware that their non-opioid drugs like cocaine contain fentanyl.

How do fentanyl test strips work?

Fentanyl test strips are small strips of paper that can detect the presence of fentanyl in different kinds of drugs (cocaine, methamphetamine, heroin, etc.) and drug forms (pills, powder, and injectables). A drug may contain deadly levels of fentanyl, but you wouldn't be able to see it, taste it, or smell it. It’s almost impossible to tell if drugs have been mixed with fentanyl unless you test your drugs with fentanyl test strips.

Test strips to detect fentanyl are low-cost and typically give results within 5 minutes.

Although fentanyl testing strips are an important tool to help reduce overdose risk, it’s important to note they may not work in all cases. For example, they can’t distinguish what type of fentanyl analog is the drug. Fentanyl analogs include acetylfentanyl, butyrfentanyl, carfentanil, alfentanil, sufentanil, and remifentanil. Testing strips may not detect the presence of some analogs, like alfentanil or carfentanil. The testing strips also may not work as well in the presence of large amounts of methamphetamine, MDMA, or diphenhydramine. Fentanyl testing strips don’t tell you how much fentanyl is in a sample; they just show if the sample contains fentanyl.

In areas of the country where nearly all of the heroin has been replaced by fentanyl, fentanyl test strips are less helpful and more advanced drug checking techniques are needed. However, fentanyl test strips are incredibly helpful for people who primarily use drugs other than fentanyl to test their cocaine or other non-fentanyl drug.

How to use fentanyl testing strips

Depending on the types of drug you’re testing, the steps may be slightly different. Here’s how fentanyl test strips are used:

1. Put a small amount (at least 10 mg) of the drug out aside in a clean, dry container.

2. Add water to the container and mix together. For most drugs, ½ teaspoon of water is needed. For methamphetamines, MDMA, or ecstasy, 1 full teaspoon for every 10 mg of crystal or powder is needed.

3. Place the wavy end of the test strip down in the water. The strip absorbs the water for about 15 seconds.

4. Take the strip is taken out of the water and place on a flat surface for 2 to 5 minutes. Similar to pregnancy test or COVID-19 test, results appear within minutes.

5. Read the results.

Opioid use disorder treatment saves lives.

Mass General Brigham Substance Use Disorder Program Bridge Clinics are transitional outpatient addiction clinics for patients in need of rapid access to substance use disorder care. Four regional Bridge Clinic hubs serve patients from any Mass General Brigham location and community members through both in-person and virtual care. Any provider can prescribe buprenorphine, a lifesaving medication that has been shown to reduce the risk of dying from overdose by more than 50%.

People can also find evidence-based treatment and service options by visiting findtreatment.gov or by calling the 24/7, National Helpline at 800-662-HELP (4357).