Year of Publication

2022

College

Public Health

Date Available

4-24-2024

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Rachel Vickers-Smith

Committee Member

Dr. April Young

Committee Member

Dr. Amanda Fallin-Bennett

Abstract

Background and aims Fentanyl-related overdoses have largely contributed to the nearly 500,000 opioid overdose deaths in the United States since 1999. Fentanyl test strips (FTS) are a new technology that is designed to help prevent these overdoses. People who use drugs (PWUD) can test their drug supply for fentanyl by placing the strip in a sample of the drug. However, access to FTS varies across the country. This variance is largely due to rural PWUD not having the same access to harm reduction programs, compared to urban settings. This study uses data on PWUD in rural Kentucky to evaluate attitudes and perceptions towards FTS and their ability to reduce overdose risk. Methods Our study sample was made up of 241 PWUD in Appalachian rural Kentucky from the CARE2HOPE study. Participants were deemed eligible if they were 18 or older, lived in one of five rural Kentucky counties, and either used opioids to get high or injected any drug to get high in the past 30 days. We calculated descriptive statistics, conducted bivariate analysis between potential correlates and answering yes or maybe to three survey questions asking whether they were interested in using FTS, believed that FTS could reduce personal overdose risk, and believed that FTS could reduce others’ overdose risk. We performed a multivariable analysis using logistic regression. Results Of those in our sample, 94% were interested in using FTS, 94% believed that FTS could help reduce personal overdose risk, and 95% believed that FTS could help reduce others’ overdose risk. In OUR multivariable model, we found that when adjusting for the other variable in the model, those who have been tested for HIV in the past 6 months have 6.32 (CI=1.45-32.74) odds of not being interested in using fentanyl test strips, compared to those who have not been tested for HIV in the past 6 months. Further, adjusted for being tested for HIV, those who would consider using a mobile MOUD program if it was available in their community have 0.15 (CI=0.03-0.75) times the odds of not being interested in using fentanyl test strips, compared to those who would not consider using a mobile MOUD program. Conclusions Our primary finding is that interest in the community establishing a mobile MOUD program is associated with interest in FTS (OR=6.67 95% CI=1.33-33.33). Rural communities, such as our sample, have limited availability to harm reduction and treatment services. Innovative service delivery models like mobile MOUD programs could be a solution for these communities to gain access to many harm-reduction tools and resources; FTS could also be one of the resources that are provided.

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