Strategies for Decreasing Synthetic Opioid Overdose Incidents: guidelines for action and reaction

In a promising development, overdose deaths have been on a steady decline since 2023, with the leading cause of death for Americans ages 18-44 remaining overdose. This trend is attributed to various factors, including changes in the illicit drug supply, widespread distribution of naloxone, improved access to evidence-based treatment for substance use disorders, and the increased use of drug checking equipment (DCE) such as fentanyl test strips.

Jurisdictions worldwide are implementing overdose prevention and response practices, recognising the importance of DCE in combating the ongoing overdose crisis. In the United States, Canada, and Australia, legislative proposals were introduced in 2025 to expand the authorization of devices detecting dangerous substances, including fentanyl, xylazine, and other contaminating compounds.

States are taking proactive measures to ensure the safety of their citizens. Hospitals and emergency departments in certain states are now required to screen for fentanyl in specific circumstances. For instance, Louisiana has enacted legislation for hospitals to specifically screen minors for fentanyl, while Florida and Virginia have legislation requiring emergency departments to include fentanyl in their urine drug screening when ordered.

Moreover, at least seven states have considered legislation to support fentanyl screening in emergency departments, including Arizona, Illinois, Massachusetts, Michigan, North Carolina, New Jersey, and New York. In Arizona, legislation (SB 1209) was considered that not only would have directed fentanyl screening but also explicitly stated that the information could not be used by law enforcement.

Furthermore, at least two states enacted laws expanding the scope of DCE. In Virginia (HB 2319) and Louisiana (SB 78), authorized DCE now includes products or equipment that detect any dangerous substance, chemical compound, or contaminant "that can cause physical harm or death," not just fentanyl. Iowa also considered HF699 that would have authorized not only fentanyl and xylazine test strips, but also other DCE to detect contaminants.

Connecticut requires hospitals treating patients for nonfatal overdose to perform a toxicology screening for a number of controlled substances, including fentanyl. Meanwhile, Massachusetts bill H2457 would authorize the health department to promulgate or review any regulations necessary to implement fentanyl screening in hospital emergency departments.

The Association of State and Territorial Health Officials (ASTHO) will continue to monitor this issue and provide relevant updates. Studies have shown that the use of fentanyl testing equipment reduces the risk of overdose among people who use drugs. As of August 2024, fentanyl testing equipment is authorized in 46 states and Washington, D.C.

However, addressing the overdose crisis will require states and territories to take pragmatic, evidence-based approaches that can adapt to an ever-changing landscape. Provisional data for 2024 shows an even sharper decrease in overdose deaths, offering hope that these efforts are bearing fruit. Synthetic opioids, such as fentanyl, remain a leading cause of overdose deaths overall.

In conclusion, the decline in overdose deaths is a testament to the effectiveness of comprehensive strategies that include the use of fentanyl testing equipment. As the landscape evolves, it is crucial for states to remain vigilant and adapt their approaches to continue saving lives.

Strategies for Decreasing Synthetic Opioid Overdose Incidents: guidelines for action and reaction