Selectivity and sensitivity of urine fentanyl test strips to detect fentanyl analogues in illicit drugs

Background: Urine fentanyl test strips have been employed to check street drugs for fentanyl and fentanyl analogue contamination, but there is limited evidence for the applicability of fentanyl strips for this purpose. We examined the ability of four commercially-available fentanyl test strips to detect fentanyl and a range of fentanyl analogues currently on the recreational drug market. Methods: Four brands of fentanyl test strips (Rapid Response, One Step, Nal van Minden, and Rapid Self Test) were examined using single-component drug solutions containing fentanyl, 28 fentanyl analogues, four non-fentanyl synthetic opioids, or eight traditional drugs of abuse. The effect of co-presence of heroin or ascorbic acid on test results was also examined. Results: All test strips detected fentanyl as well as 21-24 of the 28 fentanyl analogues tested. One of the test strip brands gave false positive results in the presence of ascorbic acid. Conclusions: Fentanyl test strips successfully detected the majority of fentanyl analogues tested. Drug solutions for testing should not be overly dilute, since the test results are highly concentration dependent. Fentanyl test strips have utility as a harm reduction tool, but they are no panacea for overdose since certain fentanyl analogues are not detected.