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ROCHESTER — They call it overdose, but the correct term for accidental fentanyl ingestion might be closer to poisoning.

A powerful narcotic 80 to 100 times stronger than morphine, the synthetic opioid was originally developed for the treatment of cancer via transdermal patch. Illicit suppliers have adulterated a variety of street drugs with fentanyl, however, and it has driven an unprecedented explosion in opioid deaths.

The Drug Enforcement Agency reporting says fentanyl is being added to cocaine, methamphetamine, heroin, and counterfeit opioids. The narcotic is laced into illicit drugs because it is cheap, potent and plentiful, but at unknown doses, thereby increasing its lethal potential.

According to Minnesota state health officials , opioid-involved deaths in Minnesota jumped from 412 to 654 between 2019 and 2020, with synthetic opioids responsible for 82% of that total. While the greatest number of fentanyl poisonings have occurred in the Twin Cities, no part of the state has been spared.

In Olmsted County, for example, in 2020, with the number of nonfatal overdoses in Olmsted emergency rooms having more than doubled from 21 to 48. During this same period, opioid prescriptions continued a five-year decline, decreasing almost 10%.

In the past, the notion of helping drug users test their substance for adulterants would have been rejected as enabling. Now it is at the forefront of public health.

Since July 2021, it has been not only legal within Minnesota to distribute strips for testing the safety of illicit drugs, the distribution of fentanyl test strips has benefited from a coordinated effort to save lives.

The strips, which act much like test kits used to detect COVID-19, pregnancy, or chemicals, were included as part of a public safety bill passed in a special legislative session last year. The test strips were elevated from contraband status, along with clean syringes, as part of so-called "harm reduction" efforts to increase HIV prevention.

"I had a woman come up to me at an event and say a fentanyl test strip saved her life," says Alicia House, executive director of the , an opioid-focused recovery group based in the Twin Cities. "She was going to use a substance but she tested it, and it ended up having fentanyl. She said it changed the way she used."

Steve Rummler is one of three organizations in the state which receives Centers for Disease Control and Prevention funds managed by the state and allocated for harm reduction. The network packages the test strips four to a kit, along with a user survey, contact information, and advice for those who may encounter fentanyl.

"When the law changed (last summer) I bought 53,000 strips," House said. "I probably have about 20,000 left. I will be buying another 30,000 in the next month or two."

Each kit costs her organization $5. Steve Rummler has distributed the kits to more than 450 organizations around the state so far, including jails, hospitals, walk-in clinics and drug outreach workers on the street. Some users have begun receiving test strip kits via the mail.

The strips can be dipped into a small amount of water added to drug residue. The strips will show two lines if the drug is negative, one line if it is adulterated with fentanyl.

The instructions are detailed.

House says, for example, that it is necessary to crush an entire pill into testing liquid, given that a counterfeit opioid can contain fentanyl in one part of the pill, while the rest is uncontaminated.

"For state-level efforts, it's been a very good thing to have this law changed," said Sam Robertson, community overdose prevention coordinator at MDH. "Now we can officially and financially support fentanyl test strip distribution efforts to prevent overdose."

Robertson says demand for the strips shows that people with opioid dependency disorder care greatly about their safety.

"If you look at the history of harm reduction practices, a lot of these strategies have been implemented and promoted by people who use substances. They have a long history of taking care of each other ... they really care about their lives and each other."

Is providing access to the strips enabling?

"It's a question that comes up less frequently, fortunately, as the science around harm reduction becomes more common knowledge," Roberston said, citing research showing that clean needle programs increase participation in recovery.

"Not only do harm reduction services not enable drug use," he said. "I think they can be the stepping stone toward accessing treatment and recovery if that's something the individual desires or needs."

"If you are allowing people to die," House said, "there is no hope of recovery."

CORRECTION JAN. 31: The test strips described in this story and video will show two lines if the drug is negative, one line if it is adulterated with fentanyl. The indicators were wrong in an earlier version of this story. It has been corrected.