Do you want to avoid the hassle of traveling with your printed poster? IAPHS2026 is pleased to make poster printing available to you through our supplier PosterSessionOnline. Your poster will be professionally reviewed, printed and shipped directly to Portland and you will be able to pick it up from the Poster desk. Click here to learn more.
Primary Submission Category: Policy
Fentanyl Test Strip Policy in US and Overdose Deaths, 2016–2023
Authors: Shutong Huo,
Presenting Author: Shutong Huo*
Background: The U.S. overdose crisis accelerated with the spread of illicitly manufactured fentanyl. Fentanyl test strips (FTS) offer a low-cost drug-checking tool that can prompt safer decisions. In recent years, many states have moved to legalize FTS. However, evidence linking FTS legalization to population-level mortality remains limited. We evaluate whether decriminalization of FTS coincides with decrease in overdose deaths and whether effects differ among different domains of policy, as well as before versus after COVID-19.
Methods: We constructed a state-month panel from National Vital Statistics System Multiple Cause-of-Death micro-records, 2016–2023. Outcomes included age-adjusted deaths per 100,000 for any drug, any opioid, and synthetic opioids, coded via ICD-10. We ARIMA-detrended each state outcome series to reduce confounding from nonstationary trends. We coded policies monthly for first enforceable month in domains, possession, sale, and free distribution. Causal effects used Callaway–Sant’Anna difference-in-differences.
Results: Before COVID-19, legalization that created distribution or retail channels aligned with lower mortality. For any-opioid deaths, sale and free distribution reduced rates by about 3.4 per 100,000 (sale −3.40; free −3.47), while possession showed no detectable change (−1.64). Synthetic-opioid results mirrored this pattern (sale −3.16; free −3.21; possession −1.89). Any-drug deaths declined modestly (sale −1.84; free −1.93). After COVID-19, estimates clustered near zero across domains. Full-period averages therefore appeared null, reflecting opposing pre- and post-COVID dynamics. Analyses on unfitted age-adjusted rates produced the same directions and domain rankings.
Discussion: Findings indicate that legal pathways that expand access, sale authorization and funded free distribution, coincided with mortality declines during the late-2010s surge, whereas possession alone did little. Post-COVID attenuation likely reflects service disruptions, market shifts, and broader stressors that muted policy leverage. Policy implications include pairing FTS legalization with financed distribution through syringe services and community partners, retail clarity for pharmacies and vendors.