Fentanyl Test Strip Use and Overdose History among Individuals on Medication for Opioid Use Disorder

Special Article - Health Policy

Austin J Public Health Epidemiol. 2021; 8(6): 1117.

Fentanyl Test Strip Use and Overdose History among Individuals on Medication for Opioid Use Disorder

Mistler CB1,2*, Rosen AO1,2, Eger W3, Copenhaver MM1,2 and Shrestha R1,2

1Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA

2Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, Storrs, CT, USA

3Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT, USA

*Corresponding author: Colleen B Mistler, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269-1101, USA

Received: November 29, 2021; Accepted: December 22, 2021; Published: December 29, 2021

Abstract

Background: The number of deaths from drug overdose in the United States has more than doubled in the past decade. In particular, drug overdose deaths involving fentanyl have doubled every year since 2013. Rapid fentanyl test strips (FTS) are a useful strategy for detecting traces of fentanyl in substances and have received overwhelming support from individuals with opioid-dependence.

Methods: We investigated fentanyl use, knowledge of FTS, willingness to use FTS, and overdose history among a sample of 105 individuals currently on medication for opioid use disorder (MOUD).

Results: Results showed that the majority (63%) of the sample had experienced a non-fatal overdose and that 85% of participants were willing to use FTS. The majority of participants reported concern about fentanyl in their drug supply (70%) and 77% reported likelihood of past unintentional fentanyl use. Of note, only about half (47%) of participants knew of FTS prior to being surveyed, and only 17% reported ever using FTS.

Conclusion: These results expand on previous literature that documents high levels of willingness, yet low uptake of FTS among individuals on MOUD. Widespread education about FTS, in addition to the implementation of the use of FTS, is a highly promising and critical primary prevention alternative to overdose treatment and/or death due to fentanyl.

Keywords: Fentanyl; Fentanyl test strips; Medication for opioid use disorder; Opioid overdose; People who inject drugs

Introduction

Drug overdose deaths in the United States have exponentially increased in the past decade [1], as synthetic opioids such as fentanyl have become increasingly prevalent among populations who use illicit drugs. Synthetic opioids are 50-100 times more potent than heroin, thus are incredibly dangerous when present in drug supplies [2]. Alarmingly, death rates involving fentanyl overdose have doubled each year since 2013, with over 85% of overdose deaths in 2016 involving fentanyl [3]. These trends in overdose deaths prompted the Department of Drug Enforcement Administration to issue a nationwide alert, identifying fentanyl-related overdoses as a threat to public health and safety [4].

As alarming rates of overdose deaths have spread across the country, greater prevention efforts are needed to address the threat. Naloxone is a medication designed to rapidly reverse the effects of an overdose when administered in a timely manner [5], and is a commonly used tertiary prevention strategy that saves lives from opioid overdose. Most recently, the fentanyl test strip (FTS) has emerged as an innovative drug-checking tool to address the opioid overdose crisis [6,7]. Unlike naloxone, it is a primary prevention strategy that can be used to detect traces of fentanyl in substances before ingestion, thus preventing unintentional fentanyl exposure and accidental overdose if used appropriately. FTS provides an opportunity for substance users to test their drug supply for fentanyl in a private setting, allowing them to make their own choices and be in control of their overdose risk [8,9].

Individuals who use illicit opioids have unanimously supported the use of FTS to reduce overdose risk [6-8,10-15]. However, people on medication for opioid use disorder (MOUD) have been underrepresented in these studies. Other studies have indicated that people on MOUD continue to engage in illicit substance use [16-18], yet are more likely to engage in FTS-related harm reduction strategies to prevent overdose [19]. Use of MOUD treatment increased nationally by 65% in recent years, with the New England region providing higher rates of MOUD accessibility than other parts of the United States [20], demanding greater research on the harm reduction behaviors among persons on MOUD in the northeast. With an average of over 130 people dying each day from opioid overdose [21], more knowledge is needed on the prevalence of fentanyl use and use of FTS to aid in reducing overdose rates in high risk groups of individuals on MOUD. In the present study, we investigated willingness to use FTS among a sample of 105 participants on MOUD in New Haven, CT.

Methods

Participants

Participants were recruited between July 2018 and October 2019 from a sample of individuals in treatment for opioid use disorder to study HIV prevention and harm reduction behaviors [22, 23]. Participants were eligible for the study if they were: a) at least 18 years or older; b) self-reported HIV-negative or unaware of HIV status; c) self-reported drug- and/or sex-related HIV risk behaviors (e.g., needle sharing, unprotected sex) in the past 6 months; d) met DSM-V criteria for opioid use disorder (OUD); and e) currently on MOUD treatment. All participants included in the sample were stabilized on methadone.

Study procedures

Participants were recruited from an addiction treatment program (APT Foundation, Inc.) in New Haven, Connecticut. It is the largest addiction treatment center in Connecticut with over 7,000 patients on MOUD. Recruitment methods included snowball sampling by using clinic-based advertisements and flyers, word of mouth, and referrals from counselors. All screening and interviews were conducted privately by trained research assistants. Upon informed consent, participants were asked to complete a survey using audio computer-assisted self-interview (ACASI), which took approximately 45 minutes. Participants were reimbursed $25 for their time. The study protocol was approved by the Institutional Review Board at the University of Connecticut and received board approval from the APT Foundation Inc.

Measures

Participant demographics were collected, including age, selfreported sex, sexual orientation, ethnicity, marital status, education status, housing status, income, and visits with a primary care physician in the past year (Table 1). Substance use characteristics were also measured, including current methadone dose and Alcohol Use Disorder.