Health Leaders Urge More Be Done to Prevent Overdose Deaths

WASHINGTON — Top officials at the National Institutes of Health and the Food and Drug Administration are urging that more be done to advance the development of rapid drug-testing tools to stem the rising tide of overdose deaths in the United States.

In the current edition of the New England Journal of Medicine, Dr. Nora Volkow, director of the National Institute on Drug Abuse, Lawrence Tabak, acting director of the National Institutes of Health, FDA Commissioner Dr. Robert Califf and others write that there is an urgent need for a variety of lifesaving tools that remain inaccessible due to gaps in research and various other barriers, including state or legal prohibitions. 

Specifically, they seek to encourage new collaborations among researchers and agencies to ensure the effectiveness of fentanyl test strips and promote the development of additional drug-checking technologies. 

They are also calling for the wholesale reduction of barriers that inhibit use of these technologies where not prohibited by law.

In 2021, more than 60,000 people in the U.S. ages 15-54 died from opioid-involved overdose — more than COVID-19 fatalities for this age group — and many of these deaths were driven by the extremely potent opioid fentanyl, which is difficult to detect unaided.

The health officials note that illicit fentanyl is being mixed with other drugs like heroin, cocaine, methamphetamine, xylazine and in counterfeit pills, leaving many people unaware of the specific substances they are consuming. 

Expanding access to innovative, inexpensive and easy-to-use drug-checking technologies where not prohibited by law may play a pivotal role in keeping people safe, whether at home or in public, they write.

Fentanyl test strips are among the most well-known and easily distributable drug-checking tools to date, yet few studies have evaluated their performance and impact on public health. 

In general, the FDA does not regulate test products when intended solely for use to detect substances or adulterants in illicit drugs. 

It is critical for researchers and developers of these drug-detecting products to evaluate their accuracy to assure quality and performance in each instance of use, the authors write. 

Research is also needed to determine whether other drug-checking strategies are feasible and effective in community and clinical settings and to develop techniques for detecting other emerging substances, they state, adding that models for implementing drug-checking strategies should ensure that they are deployed in an equitable and culturally appropriate way, tailored to unique community needs where not prohibited by law.

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