Exploratory Analysis of the Characteristics Associated With the Use of Fentanyl Test Strips Among People Who Use Drugs in Rhode Island, 2021-2023

Objectives: Fentanyl overdose deaths are a critical public health issue in the United States. Rhode Island, an early epicenter of the fentanyl crisis, has seen fentanyl overdose deaths increase 30-fold since 2009. In response, harm reduction tools such as fentanyl test strips (FTSs) have been introduced to help people who use drugs (PWUD) detect fentanyl in their substances. We analyzed FTS use among PWUD in Rhode Island from 2021 through 2023 and identified characteristics associated with their use. Methods: We conducted a pooled cross-sectional analysis using aggregate data from the Rhode Island Harm Reduction Surveillance System. We used bivariate Pearson χ 2 tests to assess the relationship between past-month FTS use and demographic and behavioral characteristics. Because analyses were limited to unadjusted comparisons, these findings are exploratory and hypothesis generating. Results: Of 498 survey respondents, most identified as male (n = 328; 65.9%), non-Hispanic White (n = 204; 41.0%), straight (n = 400; 80.3%), and aged 25 to 44 years (n = 288; 57.8%). The most frequently reported substances used were crack (n = 355; 71.3%), cocaine (n = 219; 44.0%), and fentanyl/heroin (n = 196; 39.4%). Only 31.7% of individuals reported FTS use in the past 30 days. FTS use was significantly associated with age, race and ethnicity, witnessing an overdose, possessing naloxone, and recent fentanyl/heroin use (all P < .05). Conclusions: Despite FTS distribution efforts and overdose risk, FTS uptake in Rhode Island was low. Future research should assess barriers to FTS adoption and consider integrating FTS distribution within naloxone programs.