Police-led Fentanyl Test Strip Distribution Program in Maine and Massachusetts: An Evaluation

Abstract

Background: The increase of illicitly manufactured fentanyl in the drug supply and the lack of a reliable fentanyl detection method have led to a public health innovation: the community distribution and use of fentanyl test strips (FTS) to detect presence of fentanyl in drugs. The One2One project, based on a 2020 six-site pilot project, was a police-driven project spearheaded in Massachusetts and Maine in 2021 that consisted of police and community collaborators using FTS distribution as a low barrier tool to engage with people who use drugs and connect them to harm reduction supplies, services and referrals. Methods: Implementation and evaluation of the program occurred over 8-months. Policeofficers and program staff were trained on community use of FTS and were provided technical and logistical supports to encourage broad-scale local distribution of FTS kits to people who use drugs. The structure of the program encouraged departments to be innovative around FTS distribution and to use test strips as tools to support PWUDs with referrals, direct services and other harm reduction resources. The evaluation included site observations, interviews of staff and recipients, a community stakeholder survey, and analysis of administrative and demographic data to measure uptake and reach (engagement ratio and kit distribution impact rate) of the project as well as catalog implementation successes and challenges across participating police departments.Results: Twenty-one police departments and their collaborators distributed 2,556 FTS kits and reported a combined 3,703 referrals or direct services, yielding an engagement ratio of 1.44 (one referral or service per FTS kit distributed) and a kit distribution impact rate (kits distributed per overdose mortality rate) of 4.37 conveying substantial public health reach of FTS in high overdose burden communities. Qualitative data analysis captured the nuances across police departments of FTS kit distribution approaches, engagement methodologies, and the shift in willingness to embrace harm reduction principles through police-led efforts. Conclusion: FTS distribution through the One2One program exemplifies new and evolving shifts in public health and harm reduction policing roles and strategies. Further research should investigate how FTS distribution can be integrated across more geographies and implemented by other institutions.