Characteristics of take-home fentanyl test strip use and support for drug checking services among people who use heroin in Australia: learnings for an increasingly complex drug market.

Background: This paper examines: (i) the acceptability of, and behavioural outcomes associated with, take-home fentanyl test strips (FTS), and (ii) support for, and preferences regarding, drug checking services among people who use heroin.

Methods: Data were obtained from 78 people who had used heroin in the past 6 months, recruited from treatment and harm reduction services in Sydney, Australia in 2020-21. Participants were provided with 10 BTNX Rapid Response™ single-use immunoassay FTS and surveyed 4 weeks later.

Results: Among those who completed the follow-up survey (n = 72), 81% (n = 58) had used at least one FTS by the time of follow-up (median 6 strips). Participants reported high confidence in their ability to use FTS at both baseline (immediately post training) and follow-up. Of those who self-reported a positive FTS result (n = 25), 48% (n = 12) reported using less than they otherwise would have or starting with a smaller amount, and 60% (n = 15) shared this information with peers and/or health professionals. Of those who used FTS and responded, 95% (n = 54/57) reported that they would continue using FTS if they were free to access, and 97% (n = 56/58) would recommend them to their peers. Among those who completed the follow-up survey, the majority (93%; n = 67) reported that they would like to be able to access a drug checking service, preferably via a supervised injecting facility or Needle and Syringe Program.

Conclusions: Acceptability of FTS and support for drug checking were high among our sample. Multi-instrument approaches to drug checking may form one component of an effective response to the emerging threat of illicitly manufactured synthetic opioids.