A New Approach to Fentanyl Test Strip Distribution

In 2023 more than 73,000 overdose deaths in the United States were linked to synthetic opioids other than methadone, primarily fentanyl.

Bloomberg Fellow JR Westberg and his organization, Hennepin Healthcare, partnered with Susan Sherman, Bloomberg Professor of American Health in the Department of Health, Behavior, and Society, to pilot a new approach to addressing the fentanyl crisis: distributing fentanyl test strips in emergency departments.

Fentanyl is frequently found in methamphetamines, heroin, counterfeit opioids, and benzodiazepines, contributing to the rise in overdose deaths. Fentanyl test strips help detect its presence in drugs people intend to use, giving them critical knowledge that may reduce the risk of overdose.

These test strips are a proven harm reduction tool. Research shows that people who detect fentanyl in their drug supply modify their behavior with 45% reporting using smaller amounts, 42% proceeding more slowly, and 39% ensuring someone else is present during use—significantly lowering overdose risk.

In November 2023, Westberg, and colleagues, Dr. Charles Reznikoff, and Dr. Max Goder-Reiser, from Hennepin Healthcare launched a fentanyl test strip distribution program in its emergency department to assess its impact on changing behavior, compliance challenges, and outcomes in an urban Level 1 trauma center.

During the program’s first three months, structured conversations between clinicians and patients about the risks of fentanyl, coupled with test strip distribution, were offered to 31% of patients who presented to the emergency department with an overdose. Among those who received test strips, only one patient returned with a subsequent overdose within 14 days, compared to eight patients who did not receive test strips.

The program’s success quickly gained attention within the hospital, leading to new partnerships. The Positive Care Clinic (HIV clinic), Coordinated Care Clinic, and Addiction Medicine Clinic—all serving patients who use drugs—adopted the research team’s standard operating procedures and now provide fentanyl test strips. 

Externally, the team also worked with the Steve Rummler Hope Network and California Bridge, a collaborating organization of the Bloomberg American Health Initiative, whose guidance and resources helped make the project possible.

Though still in its early stages, this program demonstrates a promising new approach to integrating harm reduction into emergency departments nationwide.