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TOPLINE:

The use of fentanyl test strips (FTS) was not associated with a reduction in nonfatal overdose rates compared with nonuse among people who use drugs but was linked to a significant increase in overdose risk reduction behaviors, a new study showed.

METHODOLOGY:

• This multisite, observational cohort study included 732 participants (median age, 41 years; 50% men; 81% White individuals) from Kentucky, New York, and Ohio. Of these, 414 self-reported FTS use, whereas 318 were nonusers.
• Participants reported heroin, fentanyl, cocaine, methamphetamine, nonprescribed opioids, benzodiazepines, or stimulant use within 30 days before baseline. Research was conducted from May to December 2023, with participants followed-up for up to 37 days.
• The primary outcome was a composite score reflecting how many of the eight overdose risk reduction behaviors participants engaged in and how frequently they performed them; secondary outcomes included self-reported nonfatal overdose.
• Covariates included sociodemographic and drug use characteristics.

TAKEAWAY:

• After adjustment, FTS use at baseline was associated with a significantly higher mean daily composite score for overdose risk reduction behaviors than nonusers (increase in score, 0.86; 95% CI, 0.34-1.38).
• After adjustment, the mean daily rate of harm reduction behaviors was 11% higher among baseline FTS users than among nonusers (relative risk [RR], 1.11; 95% CI, 1.04-1.19).
• Baseline FTS users were more likely than nonusers to report having naloxone nearby (RR, 1.10; 95% CI, 1.04-1.18), testing drug strength (RR, 1.41; 95% CI, 1.24-1.61), and asking someone to check on them (RR, 1.26; 95% CI, 1.10-1.45).
• After adjustment, no significant difference was found between groups in self-reported nonfatal overdoses.

IN PRACTICE:

“Illegal fentanyl is driving overdose mortality, and FTS can be used to test drugs for fentanyl at the point of consumption. Our findings provide support for the role of FTS in a comprehensive harm reduction strategy but suggest that FTS use alone may be insufficient to significantly reduce overdose rates, particularly among populations with complex, high-risk drug use patterns. Integrating FTS with other harm reduction strategies like naloxone distribution is critical,” the investigators wrote.

SOURCE:

The study was led by Rachel A. Vickers-Smith, PhD, MPH, College of Public Health, University of Kentucky, Lexington, Kentucky. It was published online on May 13 in JAMA Network Open.

LIMITATIONS:

The study included only individuals already engaged in harm reduction, lacked data on prior engagement, had variable site messaging, and included a predominantly non-Hispanic White sample, limiting generalizability. Behavioral intent was not measured, follow-up was brief, data were self-reported and subject to bias, and participant anonymity prevented assessment of reasons for loss to follow-up or identification of fatal overdoses.

DISCLOSURES:

The study was funded by the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration. Several investigators reported receiving funding from NIH, fees from industry and journals, and support from advocacy groups, all unrelated to the submitted work. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.