Vickers-Smith Rachel A, Gelberg Kitty H, Childerhose Janet E, Babineau Denise C, Chandler Redonna, David James L, D'Costa Lauren, Dzurec Megan, Eggleston Barry, Fallin-Bennett Amanda, Fanucchi Laura C, Fernandez Soledad, Gilbert Jace, Gilbert Louisa, Hall Megan E, Hiltz Brooke E, Konstan Michael W, Lancaster Kathryn E, Linas Beth, Marks Katherine R, Michaels Nichole, Miles Jennifer, Montero Fernando, Ramsey Harden Haley J, Roeber Carter, Russo Mary R, Taylor Rachel, Theis Melissa A, Villani Jennifer, Oga Emmanuel, El-Bassel Nabila, Walsh Sharon L, Freisthler Bridget
College of Public Health, University of Kentucky, Lexington.
School of Social Work, Columbia University, New York, New York.
JAMA Netw Open. 2025 May 1;8(5):e2510077. doi: 10.1001/jamanetworkopen.2025.10077.
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.
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.
Baseline FTS use.
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).
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).
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.
非法芬太尼导致过量用药死亡率上升，而芬太尼检测试纸（FTS）可用于在消费点检测毒品中是否含有芬太尼。关于使用FTS是否与降低过量用药风险行为相关的证据令人鼓舞，但主要限于规模较小的单中心研究。
确定吸毒者（PWUD）自我报告的基线FTS使用情况是否与28天随访期间的过量用药风险降低行为及非致命过量用药相关。
设计、地点和参与者：2023年5月至12月对PWUD进行的多中心观察性队列研究，作为“治愈社区研究”的一项辅助研究，该研究由14个社区伙伴组织中的固定和移动直接服务提供点组成，这些组织分发FTS。参与者居住在肯塔基州、纽约州或俄亥俄州，报告在基线前30天内使用过海洛因、芬太尼、可卡因、甲基苯丙胺或非处方类阿片、苯二氮卓类药物或兴奋剂。对参与者进行了最长37天的随访。
基线FTS使用情况。
主要结局是一个综合评分，用于衡量自我报告的8种降低过量用药风险行为的使用次数和频率。次要结局包括多项指标（如自我报告的非致命过量用药情况）。
该研究纳入了732名参与者（年龄中位数[四分位间距]为41[34.0 - 48.0]岁；369名[50.4%]为男性；64名[8.9%]为黑人或非裔美国人，587名[81.3%]为白人，71名[9.8%]为其他种族）；414名报告基线使用FTS，318名未使用。与未使用者相比，基线FTS使用者中来自俄亥俄州和白人的比例更高，而来自纽约州以及西班牙裔和/或黑人的比例更低。在调整分析中，使用FTS的PWUD在随访期间降低过量用药风险行为的每日平均综合评分比未使用者高0.86（95%置信区间，0.34 - 1.38）分（FTS使用者评分为7.37；未使用者评分为6.51）。两组之间自我报告的非致命过量用药情况无差异（FTS使用者的每日平均风险为0.02；未使用者为0.02；风险比为1.20；95%置信区间，0.70 - 2.06）。
在这项队列研究中，基线FTS使用与随访期间更多地参与降低过量用药风险行为相关，但与随访期间非致命过量用药风险无关，这表明使用FTS的PWUD可能也参与了更广泛的减少伤害策略。
