Supplement: Kentucky CAN HEAL: Impact of Fentanyl Test Strip Use on Overdose Risk Reduction Behavior

Abstract The emerging evidence on the acceptability and preliminary effects of using fentanyl test strips (FTS) on reducing overdose risk behaviors is promising, yet there remain significant gaps in understanding whether use of FTS actually reduces the risk behaviors of people who use drugs (PWUD). We lack sufficient data about how PWUD use FTS and how use impacts consumption practices and overdose. There are mixed findings on whether PWUD who obtain a positive FTS result modify their drug consumption practices, suggesting the need to look more closely at the impact of FTS use, risk perception, and behavior change. Gaining such an understanding is critical for informing intervention strategies on how to promote and optimize FTS as an overdose prevention strategy for opioid users. Further, it is unclear how FTS are distributed by harm reduction organizations, the reach of different distribution approaches, and how geographic region within the state (urban, rural, remote) as well as distribution location within municipalities (retail, residential, dense core, suburbs) shape FTS reach and uptake. This supplement aims to address these significant gaps by conducting a mixed methods observational study to evaluate the feasibility, acceptability, safety and positive and negative health consequences of FTS overdose prevention strategies that are currently being used by organizations within the HEALing Communities Study (HCS) in both Wave 1 and Wave 2 communities through the following aims: Aim 1. Examine the relationship between engagement in overdose risk reduction behaviors and use of FTS. Aim 1a. Conduct qualitative interviews with Aim 1 participants to examine perspectives of and experiences of using FTS. Aim 1b. Collect oral drug tests from Aim 1 participants to compare stated knowledge of drugs being used to biomarker results. Aim 2. Assess the impact of characteristics of organizations distributing FTS on facilitators and barriers to FTS distribution. Aim 2a. Estimate the cost of FTS distribution strategies employed by partner organizations.