In Providence and Pawtucket, harm-reduction organization Project Weber/RENEW regularly hands out test strips that can detect whether a drug sample contains fentanyl, a highly potent opioid that can cause an overdose, even at trace amounts.
While the organization makes it easier for individuals to access the test strips, figuring out how to use the strips can be more complicated, says Amy Qu, a recent graduate of the Rhode Island School of Design.
Qu, who graduated in May with an industrial design degree, hopes to change that. In the spring, she visited Project Weber/RENEW’s Kennedy Plaza booth as part of a studio course, Design Beyond Crisis, centered around using design principles to develop new ways to combat the opioid epidemic.
With the test strips, Qu says, the problem is in the design, which does not cater to the average individual.
“On the test strips, it literally says ‘for forensic use only,’ ” Qu said. “There were no instructions anywhere on the packet on how to use them.”
Additionally, the strips are flimsy and require different pieces – which aren’t included – to prepare the samples for testing, such as a container to mix part of the drug sample with water.
To demystify this process and actually reduce harm, Qu created a redesigned version of the test strips that focuses on a user-friendly, intuitive interface, with features such as printed instructions, a visual aid and a physically sturdier product that fits in a wallet.
“My goal is to make it so that anyone who encounters this [kit] immediately knows how to use it or can immediately learn,” Qu said, “because with the ones distributed by the harm-reduction centers, you wouldn’t know how to use it if someone wasn’t there to teach you.”
Qu was one of eight students to participate in the course, which was developed in partnership with the Center of Biomedical Research Excellence at Rhode Island Hospital. Projects ranged from Qu’s user-friendly test strips to proposed layouts and locations for the state’s planned harm-reduction centers and harm-reduction manuals.
“The idea of the studio was to reimagine a system of care that’s not based on criminalization and incarceration but is based on a more humanistic perception,” said Justin Cook, executive director of the RISD Center for Complexity.
Already at crisis levels prior to the emergence of COVID-19, opioid-related deaths have spiked, with confirmed accidental drug overdoses in Rhode Island jumping from 308 in 2019 to 435 in 2021, according to R.I. Department of Health data.
With front-line workers inundated, Cook says designers can play a key role in finding innovative methods for harm reduction.
“People on the front lines of these issues don’t have a lot of time to step back and look at the big picture, and that’s the kind of strategic support we provide,” he said.
The Design Beyond Crisis studio was launched after Rhode Island became the first state in the U.S. to approve safe-injection sites on a pilot basis. The facilities allow people to use drugs in a supervised setting, with medical help available in case of an overdose.
Cook saw this legislation as “an opportunity on the policy side to do some research,” he said.
In areas that have established safe-injection sites, the facilities “are put in remote locations; they’re kind of hidden, they’re not well-resourced, so they end up being stigmatized spaces,” Cook said.
“So we thought, let’s take RISD’s incredible creative talent to the design of harm-reduction centers,” he added.
Rhode Island’s pilot program, which legislators approved in 2021, gives the state until March 2026 to establish the harm-reduction centers and evaluate if the sites should be permanent.
The health department began accepting applications for safe-injection sites in mid-February but hasn’t received any, RIDOH spokesperson Joseph Wendelken says. No sites have been designed as of late July.
The organizations that eventually receive a license will likely consider different design approaches, Wendelken says.
Safe-injection sites have met opposition in some communities, but Cook and other advocates point to New York City’s two overdose-prevention centers – opened in December 2021 – as examples of the centers’ ability to save lives.
According to a Journal of the American Medical Association Network report, 613 individuals visited the New York City centers almost 6,000 times in their first two months of operation, with trained staff members responding to a possible overdose 125 times. No deaths have occurred.
The Design Beyond Crisis participants and partnering organizations hope that these initial results, combined with designs that emphasize a destigmatized view of substance use disorders, will allow the harm-reduction centers to remain in Rhode Island.
The studio concluded at the end of the spring semester in May, but Cook and several students are continuing to advance their ideas from an academic project to a real-world application.
For Qu, that means seeking collaborators to help get the redesigned test kits into the hands of people who need them, and then moving forward to secure manufacturing contracts.
For the test strips and in general, Qu believes that designers have a natural role to play in harm-reduction efforts.
“Designers understand the relationship between human behavior and human thinking, and physically-built environments, experience and products,” Qu said. “We have the understanding of how to implement design decisions into that changed behavior.”
