Fentanyl test strip use and homelessness among people who use drugs in Rhode Island

People experiencing homelessness have been disproportionately affected by the overdose crisis in the United States. We assessed whether an association exists between homelessness and fentanyl test strip (FTS) use to avoid drug overdose among people who use drugs in Rhode Island.

We recruited 505 participants aged 18-65 from September 2020 to February 2023 as part of the Rhode Island Prescription Illicit Drug Study (RAPIDS). Baseline data assessed correlates of past-month FTS use through bivariate and multivariable analyses. We used generalized estimating equations (GEE) to estimate the longitudinal association between past-month homelessness and FTS use over 12 months.

At baseline, 19.3 % of the sample reported having used FTS in the past month, which was more commonly reported by those who were experiencing homelessness (22.6 %) compared to those who were housed (14.4 %), p = 0.021. In bivariable GEE analysis, past month homelessness was not associated with past-month FTS use (OR=1.22, 95 %CI: 0.95--1.56, p = 0.117). In multivariable GEE analysis, homelessness was not associated with FTS use, but regular use of crystal methamphetamine was (aOR = 2.13, 95 %CI: 1.42-3.19; p < 0.001). The odds of FTS use among persons recruited in 2023 increased by 165 % (aOR=2.65, 95 %CI: 1.22-5.76; p < 0.001) compared to those recruited in 2020.

We found that housing status was not independently and longitudinally associated with FTS use; however, people who used crystal methamphetamine were more than twice as likely to have used FTS in the past month. Future research exploring how differential housing situations may affect uptake of harm reduction services is needed to prevent fentanyl overdose.