Check, please

This week will mark New Mexico’s two-year anniversary of combating the COVID-19 pandemic: On March 11, 2020, the state announced its first four cases. Since then, the state has amassed more than 513,000.

In addition to the loss of life from the disease itself (the state had just passed 7,000 COVID-19 deaths as of press time), the past two years have also brought a significant uptick in drug overdoses, particularly from the synthetic opioid fentanyl. The Centers for Disease Control and Prevention recently reported overdose deaths had reached a historic high. In New Mexico, the story is the same: A legislative analysis from last summer notes the state continues to have some of the highest death rates from drugs in the country, with overdose deaths increasing by 572% since 1990. In 2020, the state’s drug overdose rate of 39.7 per 100,000 people was close to 34% higher than the national rate, with fentanyl and methamphetamine surpassing heroin and prescription opioids as the leading causes of overdose deaths.

A bill passed by the Legislature and signed into law by Gov. Michelle Lujan Grisham in late February amended the state’s Harm Reduction Act to allow tools to address the changing nature of the overdose epidemic. That evolution reflects longstanding ineffective drug policies and points to the expanding role technology can play in combating the negative health outcomes sometimes associated with substance use. In essence, House Bill 52 acknowledges how much drugs have changed since the program was established in 1997.

“In 1997…heroin was the drug that was causing the most problems, and you had HIV and hepatitis C and then other complications and so the solution to that was clean needles,” Phillip Fiuty, harm reduction program manager for the Mountain Center, says. Fentanyl, a synthetic opioid, is reportedly up to 50 times stronger than heroin and 100 times stronger than morphine, frequently mixed with other drugs, such as heroin, cocaine and methamphetamine, and also made into pills that can resemble prescription opioids.

Fiuty sees the fentanyl crisis as existing on a continuum of drug prohibition policies dating back to 1914.

“It used to be you had marijuana and heroin…and all of those require large volume of organic material, plants and everything to grow them,” he says. The crops and their cultivation were easy to target, he said, making a shift to synthetic drugs a natural outcome. “You used to need millions of acres of poppies to feed this country’s heroin appetite,” he says. “Now you need a garage to do the same job.”

Fentanyl testing strips use the same technology as at-home pregnancy tests and were originally created to detect the presence of fentanyl in urine. The changes made to state law allow the health department to employ drug checking tools, such as fentanyl strips, which otherwise would be considered illegal paraphernalia. The same bill stalled out in 2021, an outcome Department of Health Policy Director Aryan Showers attributes partially to last year’s virtual session. “I think that impeded a lot of progress for a lot of people,” she says, but acknowledges that “this time around, the issue with fentanyl has reached a fevered pitch…the timing was right and we didn’t leave any stone unturned.”

Decriminalizing fentanyl strips and other drug checking supplies has definitely gained traction. The American Medical Association includes decriminalizing drug checking devices in its 2022 state tool kit. Numerous states have moved in similar directions: The Washington, DC-based nonprofit Legislative Analysis and Public Policy Association in May of last year noted 32 states with drug paraphernalia laws that include controlled substances testing equipment, with three specifically allowing the test strips through harm reduction programs and 10 states with pending bills (New Mexico among them at the time) that would exclude fentanyl testing from the definition of drug paraphernalia. The CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) announced last spring that federal funding can now be used to purchase fentanyl test strips.

A 30-year-veteran in providing harm reduction services, Fiuty managed the state’s program 20 years ago. He also didn’t wait for the Legislature to amend state law before he started providing fentanyl testing strips at the Mountain Center.

“I’m a big fan of the state’s program and I have a lot of respect for New Mexico’s approach,” Fiuty says, “but fentanyl showed up in our drug supply at the end of 2019 and then COVID started, and I was like, ‘I can’t wait.’” He bought the test strips and began making them available. “People took to using them right away and, in my opinion, it’s been very successful,” he adds.

The changes to the law, however, don’t specifically name fentanyl testing strips. Rather, they allow for any technology that comes down the line that could help deter overdoses and other negative outcomes from substance use.

Such “drug checking,” as it’s commonly called “is critical,” Emily Kaltenbach, senior director of criminal legal and policing reform at the Drug Policy Alliance, says, “and will continue to be as we see increasing numbers of adulterants. Fentanyl is just one and that’s why it is so important that House Bill 52 was broader in the language.”

Those could include reagents—liquid drops that create a chemical interaction to detect substances, or even certain types of spectrometers that can be used to check drugs for impurities. The technology, Fiuty notes, “has been around forever,” but access can be limited.

“I feel like the technology is really advancing as we see these adulterants emerge,” Kaltenbach says, but adds that they are “only as good as they are used” and, ideally, there needs to be expansion toward community-based, government-endorsed drug-checking centers. She, like Fiuty, points to “prohibition in an unregulated” drug market as fueling the rise in fentanyl overdoses. “For example, as we continue to crack down on trafficking, you see those in the illicit market transporting higher concentrations in smaller dose because it’s easier to go undetected,” Kaltenbach says.

The state health department doesn’t have plans to employ tools beyond fentanyl testing strips in the immediate future, but officials say they are open to doing so.

“It’s something we’re always looking at,” Joshua Swatek, the state health department’s hepatitis and harm reduction program manager, says. “We’ll certainly take a serious look into any future technology that might come out that would help us reduce overdoses or any sort of negative health consequence that’s associated with substances.”

Chances are, that flexibility will be needed. Lisa Raville, executive director of the Harm Reduction Action Center in Denver, tells SFR her organization has been using fentanyl testing strips since 2018 when fentanyl arrived in that city. “We’re seeing it in heroin, meth, cocaine and then the pressed pills,” she says, but also says “we’re not really getting much heroin anymore due to climate change and lack of poppy cultivation. They’re making synthetic opioids in the lab…so that’s definitely the wave of the future.”

Which means at some point, “in the next six months to a year, I’m not even sure I’m going to be giving out strips anymore, because what’s the point?” she says. “Everything’s gonna have fentanyl in it.”