What is Fentanyl? & How to Use Fentanyl Test Strips
- maxsmission
- 4 days ago
- 10 min read
What is Fentanyl?
Fentanyl is a highly potent, synthetic (lab-made) opioid, produced legally as a pharmaceutical with legitimate medical applications and also illegally by criminal organizations. In medical settings, fentanyl is primarily used to treat severe and complex pain conditions as well as surgical anesthesia. Due to its potency, fentanyl is associated with a high risk of overdose, especially when used without professional, medical supervision. Illicitly manufactured fentanyl has become increasingly more common in the United States due to it's high-potency and low cost production. The vast majority of fentanyl overdoses are from illicit/street fentanyl.
Table of Contents
In this article we're going to discuss fentanyl - why it's so dangerous, how fentanyl contamination in other substances can lead to overdoses (often referred to as poisonings), how to identify and respond to a fentanyl overdose and how to use fentanyl test strips to reduce your risk of overdose.
(Click any of the headings to quick-jump to a specific topic).
Is Fentanyl an Opioid?
Yes. Fentanyl is a fast-acting, highly potent opioid. Fentanyl is 50-100 times more potent than morphine and about 30-50 times stronger than heroin.
Why is Fentanyl so Dangerous?
According to the Drug Enforcement Administration (DEA), "...illicit fentanyl is primarily manufactured in foreign clandestine labs," and "is being mixed in with other illicit drugs to increase the potency of the drug(s) and increasingly pressed into pills made to look like legitimate prescription opioids." As a result of their being no official oversight or quality control, many counterfeit pills contain lethal doses of fentanyl.
Fentanyl Contamination and Poisoning
Beyond intentional mixing or "cutting" of fentanyl into the existing drug supply, there is also significant risk of unintentional, cross-contamination of fentanyl with other drugs. Fentanyl is found regularly in heroin, cocaine, methamphetamine, counterfeit pills and even cannabis. As a result, many people do not know if they've used fentanyl, leading to accidental overdose (often referred to as poisonings) and can result in death. According to the National Institute of Health (NIH), illicitly manufactured fentanyl-contamination has been the primary driver of overdose deaths involving not only opioids, but methamphetamine and cocaine, since at least 2016.
What are the Fentanyl Overdose Symptoms?
Anyone using legal or illicit drugs is at risk of overdose. It's important to learn the signs of an overdose so you can take action when needed. When someone overdoses on fentanyl, their breathing slows or stops completely. This decreases the amount of oxygen reaching their brain - a condition called hypoxia. Hypoxia can lead to coma, permanent brain damage, and death. Due to its extreme potency and fast-action, a fentanyl overdose can sometimes happen immediately after consuming fentanyl, skipping the traditional signs of an opioid overdose, leading straight into unconsciousness and hypoxia.
The signs and symptoms of an opioid overdose, including fentanyl, are as follows:
Being non-responsive, unable to wake up
Slowed breathing or no breathing
Gurgling or snoring sounds
Blue, gray or ashen lips, fingernails and skin.
For lighter-skinned people, the skin turns blueish/grayish.
For darker-skinned people, the skin turns gray/ashen.
For lighter-skinned people, the skin turns blue/gray
Cold, clammy skin
An individual experiencing a fentanyl overdose may appear to be okay immediately after consuming fentanyl, only to collapse seconds later. Because a fentanyl overdose can progress much faster than other opioid overdoses, it's important to be prepared and understand how to administer naloxone. Quickly treating someone experiencing an overdose with naloxone greatly increases their chances of survival. If it looks like someone is overdosing, even if you are unsure of what substances they have taken, give them naloxone. Naloxone is harmless when used on someone without opioids in their system. There is no risk in trying.
How to Respond to a Fentanyl Overdose
Responding to an fentanyl overdose is a fairly intuitive process, however there are certain actions you can take to significantly increase the likelihood of someone surviving an overdose event. Time is a significant factor in reversing a fentanyl overdose and it's important to act quickly and deliberately while remaining calm.
Check for responsiveness.
Yell, speak or call their name assertively, to get their attention or wake them up.
Give a firm sternum rub: Make a fist and rake your knuckles up and down the front of the person's sternum (breast bone). This is physically harmless, but feels uncomfortable and is enough to wake someone.
Try a collarbone hook: Hook their collarbone with your finger and pull gently, this is also physically harmless but uncomfortable enough to wake someone.
Check for breathing. See if the person's chest rises and falls and put your ear near the person's face to listen and feel for breaths. If the person does not respond or is not breathing, proceed with following steps.
Call emergency services.
If you call police or 911 to get help for someone having a drug overdose, Oregon's Good Samaritan Law protects you from being arrested or prosecuted for drug-related charges or probation/parole violations based on information provided to emergency responders.
Tell the emergency operator that someone is unresponsive and indicate whether or not they are breathing.
Provide address and any relevant identifying information.
Be aware that complications may arise in overdose cases. Naloxone only works on opioids and the person may have overdosed on a different substance, or multiple substances, e.g., alcohol and benzodiazepines. Emergency services are critical in overdose situations.
Start rescue breathing.
Check the person's airway and remove any obstructions that can be seen.
Tilt the person's forehead back and lift their chin.
Pinch the person's nose and give normal breaths - giving one breath every 5 seconds.
Continue rescue breathing for approximately 30 seconds.
(If you are CPR trained you may use it also).
In an unfortunate scenario where you don't have naloxone on-hand, rescue breathing and CPR are still essential and can help keep someone alive until emergency services can arrive.
Administer naloxone (nasal or IM injection)
If the person has been using opioids regularly, giving them naloxone may result in temporary withdrawal symptoms. This response can include abrupt waking, vomiting, diarrhea, sweating and agitated behavior. While these symptoms can be dramatic and unpleasant, they are not life threatening and will only last until the naloxone has worn off, 30-45 minutes after administration.
How to use naloxone nasal spray kit:
Peel off the back of the package to remove nasal spray device.
Tilt the person's head back and support their neck with your hand.
Holding the nozzle between two fingers and place the tip of the nozzle in either nostril until your fingers touch the bottom of the patients nose.
Press the plunger firmly with your thumb to release the entire dose into the patients nose. (Do not try testing the nasal spray by partially pressing the plunger or lightly pressing the plunger. Naloxone nasal spray is intended to be single use and will not be effective if incorrectly tested before using).
Continue rescue breathing or CPR. (Max's Mission naloxone nasal spray kits include face shields to make rescue breathing more sanitary).
If minimal or no response within 1.5 - 2 minutes, give a second naloxone dose.
How to use naloxone intramuscular injection kit:
Remove cap of naloxone vial.
Draw up 1ml of naloxone into the syringe provided in the naloxone IM kit.
If possible, quickly clean injection area with an alcohol prep pad. Inject naloxone into upper arm, thigh or buttocks, do not try to inject into a vein.
Where to inject intramuscular (IM) naloxone. Insert needle at a 90-degree angle (straight up and down) to the skin and push in the plunger completely. With the provided syringe you can inject through light or medium weight clothing.
Continue rescue breathing or CPR. (Many naloxone IM injection kits include face shields to make rescue breathing more sanitary.)
If minimal or no response within 1.5-2 minutes, give a second naloxone dose.
Resume rescue breathing.
Resume rescue breathing if the person has not yet started breathing.
Brain damage can occur after 3-5 minutes without oxygen. The naloxone may not kick in that quickly. You may have to breathe for the person until the naloxone takes effect or until the emergency medical services arrive.
Wait for emergency services.
It's recommended that you monitor the person for at least an hour or until emergency medical services arrive, as the person may fall back into overdose as the naloxone wears off. Naloxone can take several minutes to kick in and wears off in 30-45 minutes.
If you must leave the person at any point, put them in the recovery position.
You may need use multiple doses of naloxone. Give an additional dose if the person does not respond within 1.5-2 minutes of the previous dose. Repeat this process as many times as necessary, there is no danger in giving someone too much naloxone.
When the person overdosing revives, keep them calm. Tell the person that they have overdosed on opioids and that you have given them naloxone, which wears off in 30-45 minutes.
Do not let the person use more opioids. Explain that the naloxone will block any effects immediately and that once it wears off they could fall back into an overdose. Taking more opioids exacerbates an already life-threatening situation.
Why Should You Test Your Drugs for Fentanyl?
Fentanyl is a very powerful and fast-acting opioid that dramatically increases the risk of an overdose.
Fentanyl is commonly found in counterfeit opioid pills made to look like legitimate prescription opioids. It has also been found in heroin cocaine, methamphetamine, ketamine, pills from nonmedical sources, and in some cases, cannabis products.
You're not going to know whether a pill or powder contains fentanyl from sight, taste, smell, or touch.
Being aware of whether the drugs you intend to use contain fentanyl significantly reduces your risk of overdose.
What are Fentanyl Test Strips?
Fentanyl test strips are small, single-use strips of paper that can detect the presence of fentanyl in different types of drugs, such as pills, powders, and liquids (injectables). When used correctly and alongside other harm reduction strategies, fentanyl test strips help prevent overdose.
(Fentanyl test strips only detect the presence of fentanyl, they can't determine the potency or volume of fentanyl contained within a sample.)
How to Use Fentanyl Test Strips - Instructions
Below you will find detailed, step-by-step instructions for using fentanyl test strips. If you prefer concise, easy-to-use video instructions on how to use fentanyl test strips, check out this great video by End Overdose.
1. Prepare the Testing Area
Make sure you have a clean, flat surface to work on.
Gather the following materials:
Fentanyl drug testing strip
A sample to test (liquid, powder, or pill)
A clean container
Clean water (for dissolving the substance, if necessary)
2. Read the Instructions
Always refer to the manufacturer's instructions that come with the fentanyl testing strips. There may be slight differences depending on the brand.
Each testing strip can have specific details for handling or sample preparation.
3. Prepare the Sample
If you are testing a powdered substance: Place a small amount (typically 10mg, or a grain of rice-sized portion) of the substance in a clean container.
If testing a pill, the safest and most effective method is to dissolve all the drugs you plan to use in water by following the instructions in Step 4. This is the most accurate way to test your drugs, because fentanyl is rarely mixed evenly throughout counterfeit pills - referred to as the "Chocolate Chip Cookie effect." After testing your drugs this way, you can drink them, snort them using a clean nasal spray device, or wait until the water evaporates to use them.
If you cannot test your drugs this way, instead crush your pill into a powder, mix the powder thoroughly to more-evenly distribute any potential fentanyl "chips" and then separate a small sample of the thoroughly mixed powder for testing.
Fentanyl is not always mixed evenly throughout contaminated pills, so make sure to crush each pill into a fine powder and mix thoroughly. This has been referred to as the Chocolate Chip Cookie effect. (Image Credit: CDC) If testing a liquid substance: Make sure it is ready for testing (e.g., if it is from a solution or liquid form, you may need to dilute it slightly with water).
4. Add Sample to Water (if needed)
Fentanyl test strips work best with the substance dissolved in a small amount of water.
Add a few drops (5ml for every 10mg of testing substance) of clean water to the sample in the container, ensuring that the substance dissolves completely.
5. Dip the Fentanyl Test Strip
Hold the fentanyl testing strip by the top end (it will usually have a "handle" or non-test area).
Immerse the test strip into the sample solution (water with the dissolved substance).
Ensure that only the “test area” of the strip (usually the bottom portion) is submerged in the liquid. Do not immerse the entire strip into the solution.
Keep the strip in the sample solution for the time indicated in the instructions, usually between 15-30 seconds.
6. Wait for Results
Remove the strip from the sample.
Lay it flat on a clean surface and wait for the results. Typically, you should wait for about 5 minutes, although accurate results can usually be read after only 1-2 minutes.
The test strip will show a series of lines or symbols that indicate whether fentanyl is present.
7. Interpret the Results
Negative result: A single line will appear in the control region of the test strip (usually labeled "C").
Positive result: Two lines will appear. One line will appear in the control region, and one will appear in the test region (usually labeled "T"). A positive result means that fentanyl is detected in the sample.
Invalid result: If no lines appear, or only the test line appears and not the control line, the test is invalid. You will need to repeat the test with a new strip.
8. Dispose of the Test Strip
Once you have interpreted the result, dispose of the fentanyl test strip properly in a safe manner (preferably in a waste container meant for hazardous materials if needed).
Additional Tips:
If the sample is particularly difficult to dissolve, you can add more water, but always follow the instructions specific to the brand of test strip you're using.
Avoid touching the test area of the strip to prevent contamination.
