Fentanyl test strip (FTS) programs are designed to promote fentanyl awareness and reduce overdose risk by providing people who use drugs (PWUD) with a method of testing drugs for the presence of fentanyl prior to use. In 2018, two large syringe services programs (SSP) in the U.S. Mid-Atlantic-one in Baltimore City, Maryland and one in the state of Delaware-began distributing FTS. We evaluated the implementation of these programs.
A convenience sample of SSP clients was surveyed in Baltimore City (urban) and Delaware (urban, suburban and rural) to assess FTS utilization patterns and drug use behaviors. Data were collected and analyzed in 2019.
We surveyed N = 123 PWUD in Baltimore and N = 102 in Delaware. Collectively, 20,000 strips were distributed over six months. In both locations, high FTS utilization was reported (70% in Baltimore; 77% in Delaware) and clients reported testing a range of drugs including heroin, fentanyl and cocaine. Following utilization, 23% and 69% of respondents in Baltimore and Delaware adopted risk reduction behaviors (e.g., using less than intended, going slower, doing tester shot, asking someone to check on them). When asked about their level of interest in future FTS use, 49% and 74% reported being interested or very interested, respectively.
Our findings demonstrate that FTS programs could be helpful in promoting fentanyl awareness and risk reduction among PWUD and in monitoring the evolving drug supply in areas where comprehensive community-based drug checking programs have not been established.

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