Fentanyl Test Strips for Harm Reduction: A Scoping Review

Abstract

Background: High potency synthetic opioids like fentanyl have continued to replace or contaminate the supply of illicit drugs in North America, with fentanyl test strips (FTSs) often used as a harm reduction tool for overdose prevention. The available evidence to support FTS for harm reduction has yet to be summarized.

Methods: A search of PubMed, Ovid Embase, and Web of Science was conducted in March 2023. A 2-stage review was conducted to screen by title and abstract and then by full text by 2 reviewers. Data were extracted from each study using a standardized template.

Results: A total of 91 articles were included, mostly from North America, predominantly reporting on FTS along with other harm reduction tools, and all conducted after 2016. No randomized controlled trials are reported. Robust evidence exists supporting the sensitivity and specificity of FTS, along with their acceptability and feasibility of use for people who use drugs and as a public health intervention. However, limited research is available on the efficacy of FTS as a harm reduction tool for behavior change, engagement in care, or overdose prevention.

Conclusions: Though FTSs are highly sensitive and specific for point of care testing, further research is needed to assess the association of FTS use with overdose prevention. Differences in FTS efficacy likely exist between people who use opioids and nonopioid drugs, with additional investigation strongly needed. As drug testing with point-of-care immunoassays is embraced for nonfentanyl contaminants such as xylazine and benzodiazepines, increased investment in examining overdose prevention is necessary.

Figure 1.

PRISMA Flow Sheet

Figure 2.

Barriers to the Feasibility of FTS for Harm Reduction

Figure 3.

Facilitators to the Feasibility of FTS for Harm Reduction * Lowenstein M, Abrams M, Shimamoto K. Exploring Patient Perspectives on Low-Threshold Treatment for Opioid Use Disorder. J Gen Intern Med. 2022;37(Supplement 2):S271. doi:10.1007/s11606-022-07653-8 ^ Shin SS, LaForge K, Stack E, et al. “It wasn’t here, and now it is. It’s everywhere”: fentanyl’s rising presence in Oregon’s drug supply. Harm Reduct J. 2022;19(1):76. doi:10.1186/s12954-022-00659-9