Differences in drug use behaviors that impact overdose risk among individuals who do and do not use fentanyl test strips for drug checking

Background

Opioid-involved overdose continues to rise, largely explained by fentanyl adulteration of the illicit opioid supply. Fentanyl test strips are a novel drug checking tool that can be used by people who use drugs to detect the presence of fentanyl in drug products. However, it is unclear whether fentanyl test strip use can prompt behavior changes that impact risk of overdose.

Methods

In this mixed-methods study involving a structured survey (n = 341) of syringe service program clients in southern Wisconsin, we examined the association between fentanyl test strip use and overdose risk behaviors in scenarios where the presence of fentanyl is confirmed and unknown. Individual items were transformed into summary scales representing the performance of riskier and safer behaviors. Linear regression examined the association of behaviors with FTS use. Models are adjusted for study site, race/ethnicity, age, gender, drug of choice, indicator of polysubstance use, times used per day, and lifetime overdose count.

Results

In response to survey questions before prompting about fentanyl risk, people who used fentanyl test strips reported an increased number of safer (p = 0.001) as well as riskier behaviors (p = 0.018) relative to people who did not use fentanyl test strips. The same held true in situations when fentanyl adulteration was suspected, though fentanyl test strip use lost significance in the fully adjusted model examining safer behaviors (safer: p = 0.143; riskier: p = 0.004). Among people who use fentanyl test strips, in unadjusted models, a positive test result was associated with more safer behaviors and fewer riskier behaviors, but these associations became nonsignificant in fully adjusted models (safer: p = 0.998; riskier: p = 0.171). Loss of significance was largely due to the addition of either polysubstance use or age to the model.

Conclusions

Fentanyl test strip use is associated with behaviors that may impact overdose risk, including safer and riskier behaviors. Specifically, a positive test result may promote more risk reducing behaviors and fewer risk enhancing behaviors than a negative test result. Results suggest that while FTS may promote safer drug use behaviors, outreach and education should emphasize the need for multiple harm reduction techniques in all scenarios.

Intentions, actions and outcomes: A follow up survey on harm reduction practices after using an English festival drug checking service

BACKGROUND

Drug checking is a health service whose behavioural outcomes have been assessed primarily through reported intentions of service users after receiving healthcare consultations or brief interventions (BIs). This study contributes to the evidence base through utilising a follow-up design to compare outcomes of risk communications on risk management and harm reduction practices both at and after attending drug checking services at three English music festivals in 2017.

METHODS

Data were collected and analysed from: (i) 1,482 self-complete questionnaires at sample drop-off; (ii) 1,482 nominated primary service users at 1,482 face-to-face BIs; and (iii) an anonymous online self-report follow-up survey completed by a sub-sample of 130 primary service users (one quarter of legible, functioning email addresses received) followed up three months later. Ten measures (one verified action and nine intentions) were recorded at point of BI and compared with retrospectively reported outcomes and ongoing changes post-BI.

RESULTS

Outcomes at follow-up were correlated with actions and intentions at BI for nine of the ten measures, including over half of service users disposing of samples identified as other than expected and two in five reporting reduced dosage for samples identified as expected. One in five reported alerting their friends to substances of concern.

CONCLUSION

Event-based drug checking services can access and engage productively with young adults earlier in drug taking careers and not in touch with health services, through tailored polydrug BIs. Rapid identification of substances of concern, dissemination of test results and associated risk communications during and after events through friendship networks, support services and early warning systems suggest that the benefits of drug checking can extend beyond service users and point of BI and can increase strategies and behaviours to reduce drug-related harm such as poisoning and overdose.