Young adults who use drugs find fentanyl test strips useful, residue testing more convenient and testing at home more private, a Brown study found. Fentanyl is a synthetic opioid so potent that a miniscule amount equivalent to several grains of salt can cause a fatal overdose. Yet it's difficult for people who use drugs to detect, which presents a major public health hazard given how commonly fentanyl is used to lace heroin or cocaine. The new findings were published on in Harm Reduction Journal.

"Qualitative interviews allow to explore the feelings of participants" 

"Qualitative interviews allow us to explore the thoughts and feelings of our research participants," said Jacqueline Goldman. "When researching the fentanyl test strips, we wanted to understand why participants did or did not use them. We used these interviews to examine the complex opinions and motivations that our participants experienced."

During the first stage of the study, each participant received 10 fentanyl test strips, which work like an over-the-counter pregnancy test. A single-use strip is dipped into water containing a bit of drug residue (before drug use) or urine (after drug use) and either one or two red lines quickly appear — one line means the liquid contains fentanyl, and two lines means the test did not detect the drug.

A naloxone kit can rapidly reverse an opioid overdose

All participants also received overdose prevention education and a naloxone kit — which can rapidly reverse an opioid overdose — to take home. Two to four weeks later, 81 of the original 93 participants returned and completed a brief survey and a 10- to 20-minute-long interview in which trained research assistants asked numerous open-ended questions.

The questions probed each participant's use of the test strips and any challenges they faced using them. Among other questions, the researchers asked: "Did you use any of the tests?" and "Is there anything that would make it easier to use the test?" The research team identified some key themes from the participant interviews:

1. Participants used the fentanyl test strips as a tool to test suspicious drug supplies. A 23-year-old male participant said: "I contacted a local dealer of mine that I had gone to in the past. I was like questionable of his product, so I told him that I had these strips and that I was going to test, to test his stuff for fentanyl to see if it was good or not and showed him the positive result. With those tests, I was able to do that with a couple other dealers between now and then to root out my chances of getting a tainted product."

 2. Testing drug reside was more convenient than testing urine."If there was a like test strip you know that you could mix a bit of your heroin, or what you think is heroin in water and dip the strip in it, and something like that… to be able to test it before you use it… Afterwards it could be too late, you know," said a 22-year-old male participant from the first group.

3. Participants gave test strips to friends, family members and acquaintances they perceived as having a high overdose risk. "They were not just close friends, but a couple of people I met at the [methadone]clinic and stuff, and they actually were people who really want to know if the fentanyl is actually in the drugs they are using, and they actually use a little bit more than I do. On a daily basis they still use, so I felt like it was very important to have," a 28-year-old female participant said.

4. Participants preferred testing their drugs in private, due to perceived stigma or legal concerns. "Just because it's more private, it's in my house, I wouldn't have to risk getting caught by the police bringing it somewhere. I would just, I don't know, I would never bring it somewhere to get it tested honestly, never," a 25-year-old female participant said.

The researchers said that the interviews support other studies indicating that fentanyl test strips are a feasible and acceptable tool to reduce the harm of fentanyl overdoses. "These results further underscore the benefits of fentanyl testing programs to reduce the risk of overdose from drugs contaminated with fentanyl," Marshall said. "We are grateful to our study participants for sharing their perspectives on fentanyl test strips, which were overwhelmingly positive."