Substance Use
Fentanyl Test Strip Use and Homelessness among People Who Use Drugs in Rhode Island Leah Shaw* Julia Noguchi Yu Li Carolyn J. Park Jacqueline Goldman Leah C. Shaw Jane A. Buxton Scott E. Hadland Susan G. Sherman Katie B. Biello Brandon D.L. Marshall
Background
People experiencing homelessness (PEH) have been disproportionately affected by the overdose crisis in the United States. Housing insecurity and associated structural factors have been shown to pose barriers to engaging in harm reduction practices. Fentanyl test strips (FTS) can help people who use drugs (PWUD) avoid accidental overdose. This analysis assessed the association between recent homelessness and FTS use over 12 months among a cohort of PWUD who were part of the The Rhode Island Prescription Illicit Drug Study (RAPIDS).
Methods
We recruited 505 participants from September 2020-February 2023. Baseline data assessed correlates of past-month FTS use through bivariable and multivariable analyses. We used generalized estimating equations (GEE) to estimate the longitudinal association between past-month homelessness and FTS use at six time points.
Results
At baseline, 297 (59%) participants had experienced past-month homelessness. Of those, 67 (22.6%) reported recent FTS use compared to 30 (14.4%) of those who were housed. In bivariable analysis, homelessness was positively associated with FTS use (p<0.05). A sensitivity analysis showed that people living in homeless shelters had consistently lower rates of FTS use across all four years. In multivariable GEE analysis, homelessness was not associated with FTS use, but regular use of crystal meth was positively associated with FTS use (aOR=2.12, 95% CI 1.43–3.13; p <0.001). The odds of FTS use in the entire sample in 2023 increased by 158% (aOR=2.58, 95% CI 1.27-5.25; p<0.001) compared to 2020.
Conclusions
We found that FTS use was feasible and acceptable among PEH, and that FTS use was positively associated with crystal meth use. Increased FTS use over time may be due to ongoing community-based education about FTS, improved access to harm reduction tools, and increased awareness of the proliferation of synthetic drugs in the illicit drug supply. Interventions tailored to people who are unstably housed, particularly those staying in shelters, and people who use stimulants are needed to help prevent fentanyl-involved overdoses.
