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No drug has fueled the current spike in overdose deaths more than fentanyl. The synthetic opioid claimed two thirds of the record 64,000 such fatalities in the U.S. in 2016.

Up to 100 times more potent than morphine, this compound has played a significant role in reducing Americans’ life expectancy for the second straight year. In three states—Rhode Island, New Hampshire and Massachusetts—the drug was found responsible for at least 70 percent of opioid-related deaths, in what drug-harm reduction specialists have described as “slow-motion slaughter.”

Jess Tilley, a harm-reduction veteran in Northampton, Mass., deploys several outreach teams to rural areas. They pass out clean syringes and the overdose-reversal drug naloxone—and refer people to detox programs. But Tilley’s most in-demand item is a $1 testing strip that accurately detects the presence of fentanyl, which dealers sometimes add to boost the strength of illicit drugs.

In 2016, when the overdose rate in western Massachusetts doubled in a year, Tilley bought a thousand fentanyl testing strips—a low-tech device that resembles a pregnancy test—from a Canadian company, and began distributing them to drug users. She says the response was immediate. As demand skyrocketed, she also began asking low-level drug dealers to test their supplies for fentanyl. Tilley says they began regularly pulling tainted supplies from the market. “When people get a tangible result, it changes behavior,” says Tilley, executive director of the nonprofit New England User’s Union. “I’ve been able to track behavior trends. People say when they get results [from the strips], they’re cutting back half of what they’re doing, or they’re making sure they have someone with them when they get high.”

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Scientific American

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