Commentary: VA must adapt to stay ahead of opioid crisis

Virginia is at a crossroads in its efforts to reduce opioid overdose deaths. Thanks to actions taken over several years — from expanding access to overdose reversal medication, naloxone, to allowing possession of drug-checking equipment for fentanyl, a powerful synthetic opioid — the Old Dominion has experienced a 15% decrease in the number of overdose fatalities over the past year. Harm reduction, which mitigates the hazards associated with certain behaviors, including drug use, as opposed to insisting on prohibitionist policies or abstention, has proven to be a key strategy in the fight.

Illicit opioids like heroin are dangerous. But adulterants or contaminants — which are harmful substances often added to drugs without the user’s knowledge — like the powerful synthetic opioid fentanyl can make them even deadlier and complicate overdose responses.

Virginia’s current law only authorizes tools that check drugs for “fentanyl” and “fentanyl analog(s),” but should be expanded as the opioid epidemic continues to evolve. Broadening the drug checking law to test for the presence of any substance that can cause physical harm or death would help Virginia stay ahead of the constantly changing overdose crisis, save lives and eliminate the need to update the law every time a new contaminant appears in the illicit market.

Research shows that 81% of people who inject drugs do use fentanyl test strips. Drug checking helps them consume more safely by reducing doses or using with others who can administer naloxone or contact emergency services in case of an overdose — decreasing fatality risk. In some cases, users will discard their supply if testing shows it was contaminated.

But simply adding new contaminants to Virginia’s drug-checking law each year would create a reactive “whack-a-mole” approach, necessitating constant updates from lawmakers. This hampers harm-reduction efforts and limits access to needed tools for identifying emerging adulterants in the illicit opioid supply. To save lives, lawmakers should adopt broader language clarifying that drug paraphernalia laws don’t apply to equipment that checks for any potential contaminant that could cause physical harm or death.

Critics assert drug checking equipment, like fentanyl test strips, encourages drug use by giving users a false sense of safety. But this claim is unsupported. In fact, Dr. Ruhal Gupta, who directs the Office of National Drug Control Policy, has pointed out that “(t)here is no scientific evidence to support this notion that harm-reduction services like fentanyl test strips somehow encourage drug use.”

Moreover, the American Medical Association has thrown its support behind “harm reduction policies that provide civil and criminal immunity for the possession, distribution, and use of ‘drug paraphernalia’ designed for harm reduction from drug use, including but not limited to drug-contamination testing.”

Virginia has achieved significant progress in combating the opioid crisis through harm reduction initiatives like naloxone access and fentanyl testing. By working to update the drug-checking law to include tools capable of identifying a wider array of adulterants, lawmakers can equip public health officials and individuals with the necessary resources to reduce risks, prevent overdose deaths and stay ahead of this evolving crisis.