"All it's gonna tell you is if it has fentanyl or not:" Perceptions of fentanyl and drug checking among first responders and people who use drugs.
Journal of Substance Use and Addiction Treatment · 2025-06-25 · Qualitative study
Abstract
INTRODUCTION: Fentanyl contamination in the unregulated drug supply contributes to high rates of opioid overdose among people who use drugs (PWUD). Drug checking is a harm reduction strategy that provides PWUD with information about the contents of their substances. Although drug checking has broad utility, this study focused specifically on drug checking to test for fentanyl, with a particular emphasis on fentanyl test strips (FTS) and point-of-care testing at community service organizations. This study assessed first responders and PWUDs' perceptions of fentanyl, drug checking, and associated implementation suggestions. METHODS: The risk environment framework and community-engaged methods guided the study. First responders and PWUD were recruited using convenience sampling from first responder agencies and community service locations, respectively, in King County, WA. The study conducted semi-structured interviews with first responders (n = 32; law enforcement officers, paramedics, emergency medical services, firefighters, etc.) and PWUD (n = 13) until data saturation. A group of academically trained and peer-based researchers with lived experiences of substance use analyzed the data using a thematic analysis approach. RESULTS: First responders and PWUD discussed the fentanyl-saturated drug use landscape and the amplification of PWUDs' overdose risk. Preferences for fentanyl among PWUD varied, ranging from a preference for it, to willingness to use it, to strong aversion. Most first responders expressed concerns about post-overdose FTS distribution, viewing it as ineffective in promoting safer use behaviors and inconsistent with their workflow and provider role. People who use fentanyl perceived drug checking to be of low relevance due to fentanyl's ubiquity, while PWUD who were trying to avoid it cited numerous barriers, including low availability, trust in sellers, limitations of FTS, and lack of information or connections. CONCLUSIONS: The study found low support for drug checking for fentanyl and first responders' distribution of FTS. Drug checking may have the most utility for PWUD who were trying to avoid fentanyl; however, its potential benefits may not be fully realized until structural barriers to access and use are addressed. Caution should be exercised to not promote drug checking as a universal tool and place the onus of addressing fentanyl contamination on PWUD.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Analgesics · Clinician perspective · Fentanyl · Implementation · Fire service & police
Related articles
- "You can see those concentric rings going out": Emergency personnel's experiences treating overdose and perspectives on policy-level responses to the opioid crisis in New Hampshire. (Drug Alcohol Depend, 2019)
- Harm Reduction in the Field: First Responders' Perceptions of Opioid Overdose Interventions. (West J Emerg Med, 2024)
- Epidemiology of 911 Calls for Opioid Overdose in Nogales, Arizona. (West J Emerg Med, 2025)
- 'I'm not going to leave someone to die': carriage of naloxone by police in Scotland within a public health framework: a qualitative study of acceptability and experiences. (Harm Reduct J, 2023)
- Narcan and Narcan't: Implementation factors influencing police officer use of Narcan. (Soc Sci Med, 2021)
- Lessons from the Introduction of Oral Transmucosal Fentanyl Citrate as Pre-Hospital Analgesia in the Mountain Rescue Service of England and Wales. (Wilderness Environ Med, 2026)