Highlighting variability in fentanyl test strip instructions using thematic content analysis.

Background: Fentanyl test strips (FTS) are a harm reduction tool used by individuals seeking to avoid unintentional fentanyl exposure while consuming other illicit substances (e.g., heroin, cocaine). While evidence speaks to the efficacy and acceptability of FTS, there are currently no standardized instructions for the use of FTS as a drug checking tool, and little is known about potential variability across instructions.

Methods: We sought to investigate variability in content across FTS instructions (N = 16) through conducting a thematic content analysis of instructions listed in the first three pages of a Google search. The search was conducted in May of 2024, with "fentanyl test strip instructions" entered as the search term. To be included in the present analysis, the information listed in the search result must have contained explicit instructions for how to use FTS and have been printed in English.

Results: Thematic content analysis of FTS instructions yielded 26 codes and 4 themes. Themes included (1) Information about FTS (2) Testing Methods (3) Test Results and (4) Additional Resources. Overall, results indicated considerable variability across the 16 instructions examined, with the greatest variability observed within the testing methods theme.

Conclusion: Inconsistencies in online FTS instructions, such as those identified in the current study, could lead to distrust among people who use drugs and disengagement with this drug checking practice. Standardized and accessible instructions are critical to optimizing the efficacy of FTS as a harm reduction tool and reducing accidental fentanyl exposure.