Making Harm Reduction More Accessible: Fentanyl Test Strip Awareness and Attitudes among Emergency Department Patients Who Use Drugs

Abstract

Background

Fentanyl test strips (FTS) are a harm reduction method for people to test their drugs for fentanyl. Ideal points for FTS distribution have not been identified. Many people who use drugs have frequent contact with the Emergency Department (ED). We piloted FTS distribution in two urban hospital EDs.

Methods

Between June-December 2021 in Philadelphia, PA, patients with past 30-day drug use completed a survey about drug use, fentanyl attitudes, and FTS; then offered FTS and a brief training. Survey data were analyzed using SPSS for bivariate statistics.

Results

Patients (n = 135) were primarily White (68.1%) and male (72.6%). Participants regularly interacted with substance use (57.8%) and benefits coordination (49.6%) services. The most common drugs used were heroin/fentanyl (68.9%), crack cocaine (45.2%) and cannabis (40.0%). Most (98.5%) had heard of fentanyl though few (18.5%) had ever used FTS. Across most drug types, participants were concerned about fentanyl. All accepted FTS training and distribution. Few (9.6%) were somewhat or very concerned about having FTS if stopped by police and this number varied by race (7.6% of White people were somewhat or very concerned, compared to 12.8% of Black people). Most participants were already engaged in risk reduction practices.

Discussion

FTS are a widely desired harm reduction tool to facilitate informed decision-making, and non-harm reduction locations are potentially feasible and acceptable distribution sites. Given regular contact with EDs and social services across the sample, FTS should be offered at non-harm reduction locations that come into frequent contact with people who use drugs.

Keywords:

• Emergency department
• fentanyl
• fentanyl test strips
• harm reduction
• drug checking

Acknowledgments

The authors would like to thank the patients who participated in the survey, the research coordinator teams inside both EDs, and the ED staff engaged in patient harm reduction education, including on the use of FTS.

Declaration of interest

The authors report there are no competing interests to declare.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, MKR.

Table 1. Sociodemographic characteristics of patients (n = 135) offered FTS in the emergency department in Philadelphia, PA, June-December 2021.

Additional information

Funding

This work was supported by Vital Strategies through funding from Bloomberg Philanthropies.