With one person dying every 11 days on the Big Island from a drug overdose, often involving fentanyl, experts say it’s hard to believe that fentanyl test kits are not readily available at local drug stores, health clinics or nonprofits that serve addicts in Hawaii.

Big Island locator map

The U.S. Centers for Disease Control and Prevention views fentanyl test strips as a low-cost method of helping prevent drug overdoses and reducing harm, and they’re available for purchase online. But the strips are illegal in Hawaii.

Under state law, fentanyl test strips are classified as drug paraphernalia. Anyone possessing a single strip could be subject to a fine of up to $500. And any adult who provides a fentanyl test strip to a minor can be charged with a class B felony.

Kimo Alameda, head of the Big Island Fentanyl Task Force, said he was shocked when he found out. He had been distributing Narcan, a medication that reverses the effects of an opioid overdose, along with fentanyl test strips, when police mentioned he shouldn’t be distributing the strips because they are illegal.

“I’m like, ‘Alright man, this is crazy,’” he said.

Fentanyl test strips are illegal in Hawaii, where they are considered drug paraphernalia. Courtesy: Kimo Alameda

Proponents, including the White House, say fentanyl test strips can save lives and money.

If people knew how to avoid poisoning or killing themselves with fentanyl, county-employed medics would not have to get involved as often. Emergency room beds used by overdose patients who require medical treatment could be freed up as well, said Alameda, a psychologist and vice president of business development at Hawaii Island Community Health Center.

Fentanyl test strips cost about a dollar each and work similar to a Covid test. The user dissolves some of the drug they plan to take in water. After the drug is dissolved, the person dips the test strip into the solution for 15 seconds, places it on a flat surface and waits about two minutes. If a single line appears, no fentanyl is detected. Double lines indicate the presence of fentanyl. The strips don’t measure the amount of fentanyl in the drug.

Kimo Alameda leads the Big Island Fentanyl Task Force. He was shocked when police told him not to distribute fentanyl test strips because they’re illegal in Hawaii. Courtesy: Kimo Alameda

Heather Lusk, executive director of the Hawaii Health & Harm Reduction Center in Honolulu, said she was also surprised to recently learn that fentanyl test strips are illegal in Hawaii. Her organization has been distributing them since 2018 and was poised to launch a statewide program with partner agencies with funding from the Hawaii Department of Health.

Just before the program’s unveiling, a Health Department employee alerted Lusk to consider hitting pause. The employee had recently learned through the Attorney General’s Office that the test strips were illegal.

“We didn’t want to get anyone in trouble,” Lusk said.

While fentanyl test strips can prevent deaths, some opposition to making them widely available exists in Hawaii and around the nation.

When Alameda initially spoke to a few of his colleagues about the test strips some said, “isn’t that like encouraging drug use?”

Anyone who thinks that way doesn’t understand the nature of drug addiction, Alameda said.

Heather Lusk, executive director of the Hawaii Health & Harm Reduction Center, says a DOH employee recently asked her to stop distributing the test strips for legal reasons. Courtesy: Heather Lusk

Withdrawal from street drugs, particularly opioids, can involve painful symptoms so users often stay hooked to avoid the severe discomfort. A tool to test their drugs for fentanyl isn’t going to keep users addicted. It simply allows them to know if their drugs are contaminated, a two-minute step that could save their lives.

Fentanyl is a synthetic opioid that is 50 times more potent than heroin and 100 times stronger than morphine, according to the federal government. Illegal drug manufacturers lace other substances with fentanyl, including heroin, cocaine and methamphetamine, to make the drugs more potent. They also make counterfeit pills resembling prescription medications like oxycodone or Xanax.

Because users tend to be unaware they’re taking drugs containing fentanyl, they often fail to have trained observers or overdose medication like Narcan on hand, or to test their drugs ahead of time.

If fentanyl test strips were legal and easily obtained, it could be a game-changer for Hawaii, public health and addiction experts say.

“If I had those strips, I could pass them out. I know I could save lives,” said Michelle Kobayashi, a former drug user who said she has watched several friends and a nephew die of drug overdoses.

Michelle Kobayashi says she wants to start handing out fentanyl test strips as soon as possible. Courtesy: Michelle Kobayashi

Kobayashi, who lives in Hilo, said she volunteers with various organizations doing street outreach to drug users. She would like to be handing out fentanyl test strips as soon as possible.

“It makes me feel good to help others who are struggling,” Kobayashi said.

Big Island Police Capt. Thomas Shopay, a member of the fentanyl task force, said he would personally like to see fentanyl test strips become decriminalized. The topic is ripe for a community forum and action by the Legislature, he said.

“We’re trying to bring it to light,” said Shopay, who heads criminal investigations for the Hawaii Police Department’s Area 11, which covers West Hawaii island.

Hawaii is one of about 20 states where test strips are considered drug paraphernalia. In the last year, some 10 states have changed their laws to decriminalize the strips.

Sen. Joy San Buenaventura plans to introduce a bill this session to decriminalize fentanyl test strips. Joy San Buenaventura

Sen. Joy San Buenaventura, who represents Puna, plans to introduce a bill to change the law during the next legislative session, which opened Wednesday.

“The more we can reduce addiction hopefully we have less crime and the things that go along with high addiction rates,” San Buenaventura said.

Decriminalizing fentanyl test strips would also make Hawaii more competitive for new federal funding the Biden administration is making available for harm reduction programs, Lusk said.

The administration in September announced some $1.6 billion in funds for communities to address the nation’s addiction and overdose crisis. In a fact sheet, the White House said none of the funding can be used to “purchase or distribute drug paraphernalia.”

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation and the Cooke Foundation.

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