A mixed methods examination of organizational approaches to fentanyl test strip distribution and training across multiple states

Background: Fentanyl test strips (FTS) have become a critical harm reduction tool, allowing people who use drugs (PWUD) to detect fentanyl in their drug supply and make informed decisions about their drug use. While FTS distribution is increasingly common, there is limited understanding of distribution strategies used by community organizations, and the education and training provided around FTS use. Given the proliferation of fentanyl in the drug supply, and the diverse motivations of PWUD, research is needed to better understand FTS distribution and training practices. This study examines FTS distribution strategies, training approaches, and the facilitators and barriers faced by harm reduction organizations in Kentucky, Ohio, and New York. Methods: We conducted a mixed-methods study as part of the Stay Safe Study, using a quantitative survey and qualitative interviews with organizations distributing FTS. Organizations included syringe service programs, mobile outreach units, recovery centers, and public health departments. Survey data were used to describe organizational characteristics and distribution practices, while interview data were coded and analyzed for themes related to distribution practices, training, and facilitators and barriers of FTS distribution. Results: Twenty-eight organizations completed the organizational survey, and staff from 21 organizations participated in interviews. FTS distribution settings varied widely. Most organizations distributed between 100 and 500 FTS monthly, primarily on an “as needed” basis. Legalization of FTS was identified as a key facilitator, and innovative distribution methods included vending machines and mail distribution. Partnerships within the community expanded the reach and accessibility of FTS. Training approaches for both staff and PWUD varied substantially, and organizations faced barriers related to securing buy-in and the time required for training. Conclusions: This study highlights organizational practices related to FTS distribution and training. Participants viewed FTS as a gateway to providing broader harm reduction services, fostering trust and engagement with PWUD. To maximize the impact of FTS as an overdose prevention tool, it is important to address persistent barriers through tailored distribution and training strategies, sustainable funding, and scalable implementation models.