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Substance Use Disorder (SUD) Fentanyl Risk

Fentanyl is a synthetic opioid that is at least 50-100 times stronger than heroin and morphine. Depending on how it is made, it can be even stronger than that. When prescribed by a doctor and used as a medication, fentanyl is approved for treating severe pain, like advanced stage cancer pain. But, fentanyl can be made or sold illegally, and can put people at risk for opioid overdose.

Illegally made and distributed fentanyl has been on the rise in many state across America. Nearly half of all overdose deaths in New York State now involve fentanyl or a form of fentanyl. Drugs that have been mixed with fentanyl, even in very small amounts, hugely increase the risk of overdose and death. Just 3 milligrams of fentanyl can be fatal, compared to 30 milligrams of heroin.

If you use other drugs, you may be at risk of an overdose from fentanyl. You may not know if fentanyl is in your drugs. Fentanyl is often disguised or mixed into other drugs, such as heroin, methamphetamine, cocaine (both powder and crack), MDMA and fake pain, and benzodiazepine pills. This disguising or mixing can happen without the dealers’ or users' knowledge. Fentanyl is undetectable by sight, smell, or taste.

When made and used illegally or recreationally, fentanyl is often:

  • A liquid, or a white or brown powder;
  • Pressed into a pill, often mislabeled as an actual medication, such as ‘OxyContin’ or ‘Xanax’;
  • Mixed in with other illicit drugs, including heroin, methamphetamine, and cocaine (both powder and crack)

If you think you see an overdose, it is important to act fast. Call 911 and wait with the person until emergency services arrives. Emergency services will give the person medical care and watch their breathing.

If you have naloxone (NARCAN®) nasal spray, use it. Even if you don’t know if they have used an opioid or a drug with fentanyl, use naloxone. Naloxone (NARCAN®) has no bad effects on the body if the person has not used opioids. To learn how to use naloxone (NARCAN®), nasal spray, see our naloxone page.

Yes, you can test for fentanyl in your drugs using fentanyl test strips.

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. People who use drugs may not be ready to enter treatment, or stop their use. Harm reduction strategies recognize this, and support people to make changes, when they are ready, to reduce their health and safety risks.

If you are going to use drugs, there are a few different steps you can take to reduce your risk of opioid overdose. These harm reduction steps include:

  • CARRY NALOXONE (NARCAN®): Show others where it is and how to use it. More than one dose may be needed.
  • NEVER USE ALONE: If you overdose, it's important to have someone around to help.
  • TAKE TURNS USING: Be prepared with naloxone (NARCAN®) and have a phone on hand in case you need to call 911.
  • TEST YOUR DRUGS: A small amount of fentanyl can cause an overdose. Use fentanyl test strips to see if fentanyl is in your drugs. This can help you make safer use decisions.
  • USE SLOW AND USE LESS: Use a small amount first to see how strong your drugs are.
  • AVOID MIXING DRUGS: Mixing drugs - including alcohol - increases your risk of overdose.

Along with these harm reduction strategies, like carrying naloxone (NARCAN®), another tool you can use is fentanyl test strips (FTS). In the unregulated, illegal drug supply, you will not always know what is in your drugs. Fentanyl test strips can be used to test your drugs for the presence of fentanyl, before you use them. You can test most drugs for the presence of fentanyl using fentanyl test strips. FTS can be used with most drugs that are in liquid, powder, or pill form, such as cocaine, methamphetamine, heroin, or street pills stamped as Xanax or Adderall.

Fentanyl test strips will only tell you if your drugs contain fentanyl, but WILL NOT tell you how much fentanyl there is, or how strong it is. Because you do not know if there is a little, or a lot, of fentanyl mixed into your drug, it is important to follow the harm reduction practices described. There may be times when the test strips may not be able to detect certain forms of fentanyl, which is another reason to use the harm reduction strategies. Fentanyl test strips do not guarantee that your drugs are safe to use, but the results can help you to make an informed decision about what to do next, to help keep you safer if you use drugs.

Using fentanyl test trips to know if fentanyl is mixed with your drugs is simple. To use a fentanyl test strip, you will need:

  • A sealed, unused test strip
  • 1-2 teaspoons of water
  • A mixing vessel like a clean cup, cooker, or large bottle cap
  • The drug you need to test

The general steps to test a drug are to take a small sample of your drug and mix it with water, dip in the test strip, and read the results. The exact steps you will take depends on if you are testing a powder, pill, or liquid.

Fentanyl Test Results

POWDER:

  1. STEP ONE: PREPARE THE SAMPLE - Empty the powdered drug from the baggie. The residue left behind can be enough to test. Or, add 10mg of your drug to a small cup or cap. 10mg is enough to cover Abraham Lincoln’s hair on a penny.
  2. STEP TWO: ADD WATER - Add ½ - 1 teaspoon of water (3-5 milliliters) to the baggie or small container. NOTE: If you are testing MDMA, Ecstasy, Methamphetamine or if you suspect it may be cut with Benadryl, DOUBLE the amount of water.
  3. STEP THREE: DIP & SWISH THE STRIP - With clean hands, take the fentanyl test strip out of the package. Pick up the strip by the large, dark blue end. Then, dip the strip into the baggie/ container with the water and drug mixture, up to the blue line. Then, stir and swirl the end in the water for 15 seconds. Remove the test strip and lay on a clean, dry surface, and wait 5 minutes.

PILL:

  1. STEP ONE: PREPARE THE SAMPLE – Crush the pill into a fine powder, and mix it well. If there is fentanyl in the pill, it may not be evenly distributed throughout the pill. It may form little clumps inside the pill, like chocolate chips in a cookie. Crushing the whole pill and mixing it makes sure you are getting a good sample to test. Add 10mg of your drug to a small cup or cap. 10mg is enough to cover Abraham Lincoln’s hair on a penny.
  2. STEP TWO: ADD WATER - Add ½ - 1 teaspoon of water (3-5 milliliters) to the small container. NOTE: If you are testing MDMA, Ecstasy, Methamphetamine or if you suspect it may be cut with Benadryl, DOUBLE the amount of water.
  3. STEP THREE: DIP & SWISH THE STRIP - With clean hands, take the fentanyl test strip out of the package. Pick up the strip by the large, dark blue end. Then, dip the strip into the baggie/ container with the water and drug mixture, up to the blue line. Then, stir and swirl the end in the water for 15 seconds. Remove the test strip and lay on a clean, dry surface, and wait 5 minutes.

LIQUID:

  1. STEP ONE: PREPARE THE SAMPLE – Add a few drops of the drug to a small cap or cooker.
  2. STEP TWO: ADD WATER - Add ½ - 1 teaspoon of water (3-5 milliliters) to the small cap or cooker. NOTE: If you are testing MDMA, Ecstasy, Methamphetamine or if you suspect it may be cut with Benadryl, DOUBLE the amount of water.
  3. STEP THREE: DIP & SWISH THE STRIP - With clean hands, take the fentanyl test strip out of the package. Pick up the strip by the large, dark blue end. Then, dip the strip into the small cap or cooker with the water and drug mixture, up to the blue line. Then, stir and swirl the end in the water for 15 seconds. Remove the test strip and lay on a clean, dry surface, and wait 5 minutes.

If there is ONE red line on the strip, the test is positive. That means that there IS fentanyl in the drug. If there are TWO red lines on the strip, the test is negative. That means that the strip did not detect fentanyl in the drug. If there are no red lines on the strip, the test was invalid. That means that something went wrong with the test, and you need to try again with a NEW strip. Fentanyl test strips can only be used ONCE.

Fentanyl Test Results

Remember, fentanyl test strips will only tell you if your drugs contain fentanyl, but WILL NOT tell you how much fentanyl there is, or how strong it is. Because you do not know if there is a little, or a lot, of fentanyl mixed into your drug, it is important to follow the harm reduction practices like carrying naloxone, and never using drugs alone. There may be times when the test strips may not be able to detect certain forms of fentanyl, which is another reason to use the harm reduction strategies. Fentanyl test strips do not guarantee that your drugs are safe to use, but the results can help you to make an informed decision about what to do next, to help keep you safer if you use drugs.

There are many resources for no-cost fentanyl test strips available to you! If you, or someone you know, is using drugs, use these resources below to get and use FTS. You can get FTS mailed directly to you, or meet with local programs to get them in person.

  1. In-Person: Local Opioid Overdose Prevention Programs and Providers - The New York State Department of Health created an Opioid Overdose Prevention Program (OOPP) designation for agencies around the state to provide no-cost naloxone (NARCAN®) and opioid overdose prevention education and programming. These OOPPs can also provide no-cost fentanyl test strips upon request. For more information about OOPP program, please visit the New York State Department of Health’s website at https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/ To find an OOPP in Suffolk County, use the Suffolk Stop Addiction website:
    1. Follow the https://suffolkstopaddiction.org/SUD/Naloxone link to naloxone (NARCAN®) page on the Suffolk Stop Addiction website
    2. Scroll toward the bottom of the page until you reach the naloxone provider chart. You can contact these agencies to request fentanyl test strips and naloxone, at no cost to you. Look for the check boxes!
  2. In- Person: Drug User Health Hub & Syringe Exchange Program (SEP) - The New York State Department of Health has organized Drug User Health Hubs in each region of the State to improve the availability and accessibility of physical health, mental health, and medication for addiction treatment (MAT) services for people who use drugs, especially people use inject drugs. Drug User Health Hubs focus their work around harm reduction, with a special emphasis on preventing and responding to opioid overdose.
    1. On Long Island, our Drug User Health Hub is called Community Action for Social Justice (CASJ): https://casj.org/
    2. You can contact CASJ via email at info@nysocialjustice.org, or call 1-866-599-7260
  3. By Mail: New York State Office of Addiction Services and Supports - In an effort to curb the overdose epidemic in NYS, the NYS Office of Addiction Services and Supports (OASAS) is making test strips available to all New Yorkers. No-cost test strips and naloxone (NARCAN®) can be mailed directly to you.
    1. Follow the https://oasas.ny.gov/harm-reduction link to the Harm Reduction page on the OASAS website.
    2. Near the top of the page, click on the "order now" button.
    3. Answer the following questions about what supplies you need, and where to ship them, and then complete your order.
    4. You can learn more about fentanyl and xylazine by using this link to access the OASAS Community Overdose Prevention Education page: https://oasas.ny.gov/projectcope
  4. By Mail: NY MATTERS - NY MATTERS is working with the New York State Department of Health to make xylazine test strips more available. No-cost xylazine test strips can be mailed directly to you.
    1. Follow the https://mattersnetwork.org/request-test-strips/ link to the test strip order page on the NY MATTERS website
    2. Click the large “I am an Individual” box on the left side of the page
    3. Answer the following questions about what supplies you need, and where to ship them, and then complete your order.

Important Numbers:

If you are experiencing a mental health or substance use crisis, call for help!

  • Call Family Service League’s Diagnostic, Assessment, and Stabilization Hub (DASH) Program at (631) 952–3333 for 24/7 services for mental health, substance use, and crisis care for children and adults in Suffolk County

  • 988 Suicide and Crisis Lifeline: If you are feeling suicidal, are in need of support or rescue, or are in crisis, call or text 988. Help is available 24/7

    • For local support, call the Response of Suffolk 24/7 Crisis Hotline (631) 751-7500

  • For a medical emergency, call 911