Evaluation of a novel intervention to prevent polysubstance overdoses involving illicit stimulants

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Project Summary Overdoses involving illicit stimulants are increasing in the United States (US). Many of these overdoses involve fentanyl, which may be added to illicit stimulants with or without the user’s knowledge. Given the potency of fentanyl and its pervasiveness in the illicit drug supply, any meaningful efforts to reduce overdose deaths involving illicit stimulants must also address fentanyl. Rapid fentanyl test strips, designed to test for the presence of fentanyl and some fentanyl analogs in urine samples, are increasingly being used off-label by people who use drugs to test illicit drugs for fentanyl before consumption. This alerts the user that they may wish to perform overdose risk reduction behaviors (e.g., using less of the drug). However, due to the emergent nature of this harm reduction strategy, peer-reviewed published research on this topic is very limited. The proposed study addresses Objective #1 of the NOFO and will test an intervention to prevent overdoses among a high-risk population of drug court clients with a history of illicit stimulant use. The intervention consists of 1) fentanyl test strip education and distribution (FTSED) and 2) opioid overdose education and naloxone distribution (OEND) through drug courts in Ohio. The long-term goal of this research is the reduction of overdose-related morbidity and mortality in Ohio and nationally. The research objectives of this study are: 1) Determine the acceptability and feasibility of providing FTSED and OEND on-site through drug courts (process evaluation – Specific Aim #1); and 2) Evaluate the impact of providing FTSED in combination with OEND to drug court clients who use illicit stimulants or polysubstances including illicit stimulants, compared with providing OEND alone (outcome evaluation – Specific Aims #2 & #3). Using a two-arm group randomized trial design, we will answer the research objectives by testing the following specific aims: 1) Determine the perceived acceptability, barriers, and facilitating factors associated with providing FTSED and OEND on-site in drug courts to clients who use illicit stimulants or polysubstances including illicit stimulants; 2) Test the hypothesis that individuals with a history of illicit stimulant use who receive FTSED and OEND on-site in drug courts will have improved knowledge and self-efficacy regarding how to test drugs for fentanyl and strategies for reducing their risk of an overdose compared to those who receive OEND only; 3) Test the hypothesis that individuals with a history of illicit stimulant use who receive FTSED and OEND on-site in drug courts will have lower non-fatal and fatal overdose rates associated with illicit stimulants or polysubstance use involving illicit stimulants than those who receive OEND only. Given the pervasiveness of fentanyl in the illicit drug supply, even individuals whose preferred drugs are illicit stimulants are likely to encounter fentanyl and/or fentanyl analogues. We will evaluate the feasibility, acceptability, and associated benefits and harms of integrating FTSED into drug court programs in a state with high rates of overdoses involving stimulants.