"You can't go wrong being safe": Motivations, patterns, and context surrounding use of fentanyl test strips for heroin and other drugs.

Background: Unintentional drug overdose fatalities due to fentanyl contamination continue to increase. Fentanyl test strip (FTS) use has emerged as a valuable harm reduction strategy to detect the presence of fentanyl in drugs. However, motivation for FTS uptake and context surrounding use have not been well characterized in the literature. This study aimed to capture people who use drugs' (PWUD) lived experiences to understand motivations underlying FTS uptake, ongoing use, and actions after testing.

Methods: We conducted qualitative interviews with PWUD at a harm reduction organization in Philadelphia, PA. Interviews asked about experiences with using FTS. Interviews were audio-recorded, professionally transcribed, and reviewed. Data were analyzed through a conventional content analysis approach and organized into broader categories via team consensus.

Results: Twenty-nine PWUD with experience using FTS were interviewed between January and May 2021. Interviews were organized into three thematic categories: first time use of FTS, patterns of FTS use, and contextual factors of FTS use. Motivations to use FTS among PWUD varied, but were largely driven by factors related to knowledge, access, neighborhood, and drug market trends. Frequency of use was characterized by number of FTS, ongoing FTS access, and drug purchasing location and amount. Participants reported few logistical barriers to testing.

Conclusion: This research supports the current literature that states FTS are an accepted and effective harm reduction strategy for the PWUD community. To support increased use of FTS, distribution campaigns should be widespread geographically and provide enough strips to ensure availability for PWUD to test more frequently.