Fentanyl self-testing in a community-based sample of people who inject drugs, San Francisco.

ABSTRACT

BACKGROUND: Fentanyl test strips (FTS) can prevent overdose by identifying unknown fentanyl-laced drugs. We measured FTS use amongst people who inject drugs (PWID) in San Francisco. METHODS: Data were from a cross-sectional survey of PWID in 2018, recruited by respondent-driven sampling. Participants were asked about FTS use in the last 12 months. RESULTS: Of 458 PWID surveyed, 45.4% had used an FTS in the last 12 months. FTS use was higher among PWID younger in age (adjusted odds ratio [AOR] 0.97 per year, 95% confidence interval [CI] 0.95-0.98), witnessing overdose (AOR 2.40, 95% CI 1.36-4.23), currently owning naloxone (AOR 2.92, 95% CI 1.76-4.87), and receiving overdose training (AOR 1.62, 95% CI 1.04-2.51). FTS use was lower among Black/African Americans (AOR 0.56, 95% CI 0.34-0.93). Amongst FTS users, 80.2% had a positive result, of whom 43.4% did not change their use of the drug, 26.5% abstained from using it, and 30.1% used a lower dose. CONCLUSION: Efforts to promote the use of FTS may have reached under half of PWID in San Francisco. Avenues need to be found to increase the role of FTS as a harm reduction approach to prevent overdose, particularly for older and Black/African American PWID.