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Observational Study
. 2025 May 1;8(5):e2510077.
doi: 10.1001/jamanetworkopen.2025.10077.

Fentanyl Test Strip Use and Overdose Risk Reduction Behaviors Among People Who Use Drugs

Rachel A Vickers-Smith  1 , Kitty H Gelberg  2 , Janet E Childerhose  3 , Denise C Babineau  4 , Redonna Chandler  5 , James L David  2 , Lauren D'Costa  4 , Megan Dzurec  6 , Barry Eggleston  4 , Amanda Fallin-Bennett  7 , Laura C Fanucchi  8 , Soledad Fernandez  9 , Jace Gilbert  4 , Louisa Gilbert  2 , Megan E Hall  4 , Brooke E Hiltz  10 , Michael W Konstan  11 , Kathryn E Lancaster  12 , Beth Linas  4 , Katherine R Marks  13 , Nichole Michaels  14 , Jennifer Miles  10 , Fernando Montero  15 , Haley J Ramsey Harden  10 , Carter Roeber  16 , Mary R Russo  2 , Rachel Taylor  10   17 , Melissa A Theis  10   18 , Jennifer Villani  5 , Emmanuel Oga  4 , Nabila El-Bassel  2 , Sharon L Walsh  19 , Bridget Freisthler  20
Affiliations
Observational Study

Fentanyl Test Strip Use and Overdose Risk Reduction Behaviors Among People Who Use Drugs

Rachel A Vickers-Smith et al. JAMA Netw Open. .

Abstract

Importance: Illegal fentanyl is driving overdose mortality, and fentanyl test strips (FTS) can be used to test drugs for fentanyl at the point of consumption. Evidence on whether FTS use is associated with overdose risk reduction behaviors is encouraging, but largely limited to smaller, single-site studies.

Objective: To determine whether self-reported baseline FTS use among people who use drugs (PWUD) was associated with overdose risk reduction behaviors and nonfatal overdose over a 28-day follow-up.

Design, setting, and participants: Multisite, observational cohort study of PWUD conducted from May to December 2023 as an ancillary study of the HEALing Communities Study, which consists of fixed and mobile direct service provision sites in 14 community partner organizations distributing FTS. Participants lived in Kentucky, New York, or Ohio and reported using heroin, fentanyl, cocaine, methamphetamine, or nonprescribed opioids, benzodiazepines, or stimulants within 30 days before baseline. Participants were followed up for a maximum of 37 days.

Exposure: Baseline FTS use.

Main outcome and measures: The primary outcome was a composite score measuring the self-reported number and frequency of using 8 overdose risk reduction behaviors. Secondary outcomes included multiple measures (eg, self-reported nonfatal overdose).

Results: The study included 732 participants (median [IQR] age, 41 [34.0-48.0] years; 369 [50.4%] male; 64 [8.9%] Black or African American, 587 [81.3%] White, and 71 [9.8%] other races); 414 reported baseline FTS use and 318 did not. Compared with nonusers, a higher percentage of baseline FTS users were from Ohio and White, while a lower percentage were from New York and Hispanic and/or Black. In adjusted analyses, PWUD who used FTS had a mean daily composite score for overdose risk reduction behaviors that was 0.86 (95% CI, 0.34-1.38) units higher across follow-up compared with nonusers (score for FTS users, 7.37; nonusers, 6.51). There was no difference in self-reported nonfatal overdoses between the 2 groups (mean daily risk for FTS users, 0.02; nonusers, 0.02; risk ratio, 1.20; 95% CI, 0.70-2.06).

Conclusions and relevance: In this cohort study, baseline FTS use was associated with greater engagement in overdose risk reduction behaviors during follow-up, but not with the risk of nonfatal overdose during follow-up, suggesting PWUD who use FTS may also engage in a broader set of harm reduction strategies.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Vickers-Smith reported receiving grants from the National Institutes of Health (NIH) National Institute on Drug Abuse and personal fees from the journal Alcohol: Clinical and Experimental Research outside the submitted work. Dr Fallin-Bennett reported serving as a founder of Voices of Hope, a partner recruitment site in this study; and receiving financial and nonfinancial support from Voices of Hope. Dr Konstan reported receiving personal fees from AbbVie, Cystic Fibrosis Foundation, Digestive Care Inc, First Wave Biopharma, Insmed, Laurent Pharmaceuticals, Sionna, Vertex, and Medicines outside the submitted work. Dr Walsh reported receiving personal fees from Braeburn, Cerevel Therapeutics, Indivior, Opiant, Astra Zeneca, Kinoxis, and Lundbeck outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Flow Diagram of Those Screened, Eligible, Enrolled, and Followed During the Study
aReasons for exclusion from sample are not mutually exclusive. bParticipants withdrawn from the study were lost to follow-up. FTS indicates fentanyl test strip.
See this image and copyright information in PMC

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