A deadly dose of fentanyl.

Fentanyl has had a deadly impact on Pennsylvania, and state Auditor General Eugene A. DePasquale on Wednesday said more needs to be done to prevent overdoses and save lives.

DePasquale released a report outlining the financial cost of the drug’s impact on Pennsylvania, and the devastation the drug can cause in communities.

He also listed recommendations for legislators to consider, one of which is controversial, legalizing an item now considered as drug paraphernalia — fentanyl test strips.

“They are currently illegal in Pennsylvania,” he said in a press conference Wednesday afternoon. “That needs to change and the General Assembly has the power to make it happen.

“There are bipartisan bills pending to legalize fentanyl test strips,” he said, adding that he is calling on the Legislature to pass the bills.

The controversy revolves around the fact that these strips would be given to users of illegal drugs to test whatever drug they are ingesting to make sure it isn’t laced with fentanyl.

Angela Eckstrom, executive director of Alcohol & Drug Abuse Services Inc. for Cameron, McKean and Elk counties, said she would support legalizing the test strips.

“I am in favor of any preventive measure that could be life-saving,” she said.

Other officials are less enthusiastic, including a federal official and a state legislator.

Dr. Elinore McCance-Katz, the U.S. assistant secretary of health and human services for mental health and substance use, has voiced her disapproval in a blog post for the Substance Abuse and Mental Health Services Administration.

While she acknowledged that the rise in deaths by fentanyl overdose are alarming, she noted “is encouraging people who use drugs to test them first for ‘safety’ the answer? Can’t the nation do better?

“As a physician who has spent most of my career treating opioid use disorder, I find a fundamental problem in the justification for using such strips,” she wrote. “If fentanyl is detected, the idea is, either the individual will not use or will change the way he or she uses (e.g., will use the more potent drug at a slower rate to try to avoid overdose). On the surface, given the trends in deaths, this seems like a valid step to take.”

However, she noted, drug users are not necessarily making positive choices.

“The entire approach is based on the premise that a drug user poised to use a drug is making rational choices, is weighing pros and cons, and is thinking completely logically about his or her drug use. Based on my clinical experience, I know this could not be further from the truth,” McCance-Katz wrote.

“People who are addicted to opioids are not making a rational choice to continue their drug use. Addicted individuals whose bodies demand that they find their next opioid to stave off withdrawal symptoms are not in positions to weigh all options and to choose to not use the only opioid at their disposal,” she noted. “Even if we accept the premise that an individual is making a rational choice, we must consider these types of unintended consequences. Similarly, we cannot guarantee that the strips will always have 100 percent accuracy. We can’t afford to create a false sense of security.”

State Rep. Marty Causer, R-Turtlepoint, said he would not be backing legislation to legalize test strips.

“Enabling people to use illegal drugs is not a solution to the Commonwealth’s drug problem,” said Causer. “I would not support any legislation to legalize what is essentially drug paraphernalia. Our focus must remain on education, prevention and treatment.”