"If I had them, I would use them every time": Perspectives on fentanyl test strip use from people who use drugs

Fentanyl contamination in the illicit drug supply has contributed to a significant increase in overdose deaths in the United States. Fentanyl test strips (FTS), which can detect the presence of fentanyl in drugs, are increasingly given to people who use drugs (PWUD) as an overdose prevention intervention. No studies to date have described PWUD's perspectives from a real-world setting about ideal FTS program characteristics. These perspectives, specifically any identified facilitators, barriers, and suggestions for use, are crucial to informing scalability and implementation of FTS.

The study team conducted qualitative interviews between January and May 2021 with PWUD in Philadelphia, PA, who had used FTS on a variety of substances. The study recruited participants outside of a harm reduction agency and provided informed consent. The team conducted interviews utilizing a semi-structured interview guide, and audio-recorded and transcribed them. The research team analyzed interviews with a conventional content analysis approach.

A total of 29 PWUD participated in an interview. Participants were predominantly cisgender male (n = 21, 72.4%) and White (n = 18, 62.1%). Participants reported previously using FTS on heroin (65.5%), crack cocaine (55.2%), powder cocaine (48.3%), synthetic cannabinoids (31.0%), and benzodiazepines (24.1%). Eighty-six percent of participants learned about FTS through harm reduction or other social service organizations. Most participants incorporated FTS into their daily lives and found them easy to use. Participants identified key barriers, including lack of necessary supplies needed to test, not having an ideal testing location, and confusion reading test results. Suggestions included adding supplies needed for using FTS to distribution packets, ensuring that each PWUD receives enough FTS per distribution, and expanding the types of programs distributing FTS.

While most participants reported FTS as practical and easy to use, participants identified a few key barriers to use that should be addressed to optimize FTS use across a broader population. These barriers include expanding training materials and distributing additional testing materials (e.g., water, cookers) with FTS. Findings can inform sustainable and effective FTS distribution practices, such as distributing FTS in packs of 20 and distributing at other locations that regularly interact with PWUD (e.g., emergency departments, housing shelters, and food banks).