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Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States.
Int J Drug Policy. 2019 01; 63:122-128.IJ

Abstract

BACKGROUND

In 2016, the number of overdose deaths involving illicitly-manufactured fentanyl (IMF) surpassed heroin and prescription opioid deaths in the United States for the first time, with IMF-involved overdose deaths increasing more than 500% across 10 states from 2013 to 2016. IMF is an extremely potent synthetic opioid that is regularly mixed with heroin and often sold to unwitting consumers. Community-based organizations have started to distribute fentanyl test strips (FTS) as a strategy to identify IMF in street purchased products. We investigated the association between FTS use and changes in drug use behavior and perceived overdose safety among a community-based sample of people who inject drugs (PWID) in the United States.

METHODS

Between September-October 2017, a total of 125 PWID completed an online survey about their most recent FTS use in Greensboro, North Carolina. Our first outcome of interest included whether PWID engaged in any of the following changes in drug use behavior after using FTS: used less than usual, administered tester shot, pushed syringe plunger slower than usual, and snorted instead of injected. Our second outcome of interest was whether PWID felt that FTS use made them feel better able to protect themselves from overdose. We conducted bivariate and multivariate analyses to determine the association between FTS use and these two outcomes.

RESULTS

Overall, 63% of the sample reported a positive FTS test result and 81% reported using FTS prior to consuming their drugs. For the outcomes, 43% reported a change in drug use behavior and 77% indicated increased perceived overdose safety by using FTS. In multivariable models adjusting for demographic and FTS correlates, PWID with a positive FTS test result had five times the odds of reporting changes in drug use behavior compared to those with a negative result. PWID who used the FTS after drug consumption were 70% less likely to report behavioral changes at subsequent drug consumption compared to those who used it before consumption. PWID who were not existing clients of the syringe services program had four times higher odds than existing clients to report increased overdose safety from using FTS.

CONCLUSIONS

We found that using FTS and receiving a positive test result was associated with changes in drug use behavior and perceptions of overdose safety. FTS may represent an effective addition to current overdose prevention efforts when included with other evidence-based strategies to prevent opioid overdose and related harm.

Authors+Show Affiliations

Behavioral Health Research Division, RTI International, Research Triangle Park, NC, United States.Behavioral Health Research Division, RTI International, Research Triangle Park, NC, United States.Urban Survivors Union, Piedmont Chapter, Greensboro, NC, United States.Department of Family and Community Medicine, University of California, San Francisco, CA, United States.Behavioral Health Research Division, RTI International, Research Triangle Park, NC, United States.Behavioral Health Research Division, RTI International, Research Triangle Park, NC, United States. Electronic address: jzibbell@rti.org.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30292493

Citation

Peiper, Nicholas C., et al. "Fentanyl Test Strips as an Opioid Overdose Prevention Strategy: Findings From a Syringe Services Program in the Southeastern United States." The International Journal On Drug Policy, vol. 63, 2019, pp. 122-128.
Peiper NC, Clarke SD, Vincent LB, et al. Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States. Int J Drug Policy. 2019;63:122-128.
Peiper, N. C., Clarke, S. D., Vincent, L. B., Ciccarone, D., Kral, A. H., & Zibbell, J. E. (2019). Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States. The International Journal On Drug Policy, 63, 122-128. https://doi.org/10.1016/j.drugpo.2018.08.007
Peiper NC, et al. Fentanyl Test Strips as an Opioid Overdose Prevention Strategy: Findings From a Syringe Services Program in the Southeastern United States. Int J Drug Policy. 2019;63:122-128. PubMed PMID: 30292493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States. AU - Peiper,Nicholas C, AU - Clarke,Sarah Duhart, AU - Vincent,Louise B, AU - Ciccarone,Dan, AU - Kral,Alex H, AU - Zibbell,Jon E, Y1 - 2018/10/03/ PY - 2018/04/17/received PY - 2018/07/25/revised PY - 2018/08/09/accepted PY - 2018/10/8/pubmed PY - 2020/2/14/medline PY - 2018/10/8/entrez KW - Drug checking KW - Epidemiology KW - Illicitly-manufactured fentanyl KW - Opioid overdose KW - Overdose prevention SP - 122 EP - 128 JF - The International journal on drug policy JO - Int J Drug Policy VL - 63 N2 - BACKGROUND: In 2016, the number of overdose deaths involving illicitly-manufactured fentanyl (IMF) surpassed heroin and prescription opioid deaths in the United States for the first time, with IMF-involved overdose deaths increasing more than 500% across 10 states from 2013 to 2016. IMF is an extremely potent synthetic opioid that is regularly mixed with heroin and often sold to unwitting consumers. Community-based organizations have started to distribute fentanyl test strips (FTS) as a strategy to identify IMF in street purchased products. We investigated the association between FTS use and changes in drug use behavior and perceived overdose safety among a community-based sample of people who inject drugs (PWID) in the United States. METHODS: Between September-October 2017, a total of 125 PWID completed an online survey about their most recent FTS use in Greensboro, North Carolina. Our first outcome of interest included whether PWID engaged in any of the following changes in drug use behavior after using FTS: used less than usual, administered tester shot, pushed syringe plunger slower than usual, and snorted instead of injected. Our second outcome of interest was whether PWID felt that FTS use made them feel better able to protect themselves from overdose. We conducted bivariate and multivariate analyses to determine the association between FTS use and these two outcomes. RESULTS: Overall, 63% of the sample reported a positive FTS test result and 81% reported using FTS prior to consuming their drugs. For the outcomes, 43% reported a change in drug use behavior and 77% indicated increased perceived overdose safety by using FTS. In multivariable models adjusting for demographic and FTS correlates, PWID with a positive FTS test result had five times the odds of reporting changes in drug use behavior compared to those with a negative result. PWID who used the FTS after drug consumption were 70% less likely to report behavioral changes at subsequent drug consumption compared to those who used it before consumption. PWID who were not existing clients of the syringe services program had four times higher odds than existing clients to report increased overdose safety from using FTS. CONCLUSIONS: We found that using FTS and receiving a positive test result was associated with changes in drug use behavior and perceptions of overdose safety. FTS may represent an effective addition to current overdose prevention efforts when included with other evidence-based strategies to prevent opioid overdose and related harm. SN - 1873-4758 UR - https://www.unboundmedicine.com/medline/citation/30292493/Fentanyl_test_strips_as_an_opioid_overdose_prevention_strategy:_Findings_from_a_syringe_services_program_in_the_Southeastern_United_States_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0955-3959(18)30213-5 DB - PRIME DP - Unbound Medicine ER -