“They should be easier to use”: Expanding fentanyl test strip access through health vending machines amid policy constraints
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Fentanyl test strips (FTS) are an increasingly important overdose prevention tool, yet high acceptability has not consistently translated into sustained use. Limited access, particularly among people who use stimulants and populations experiencing structural barriers to harm reduction services, may contribute to uneven uptake. Health vending machines (HVMs) offer a low-barrier approach to expanding FTS availability, but little is known about how people engage with FTS when they are available through HVMs. Methods We conducted a mixed-methods study of 200 community members newly registered to an HVM program in Kern County, California. Quantitative analyses integrated cross-sectional survey data with longitudinal HVM dispensing records to examine prior FTS use, elective uptake of FTS at enrollment, and subsequent FTS dispensation. Semi-structured interviews with 17 HVM users explored experiences with fentanyl exposure, drug checking, FTS access and usability, and HVM use. Quantitative and qualitative findings were integrated to characterize patterns of engagement with FTS. Results Most participants (93.8%) had never previously used FTS, and only 2.8% possessed FTS at enrollment. However, 44.6% electively accepted FTS when offered by the research team. Only 5% subsequently dispensed FTS from the HVM, although these participants returned for FTS an average of 3.6 times. Previous FTS use was associated with lifetime opioid use and witnessing an overdose, while psychostimulant use was associated with subsequent HVM FTS dispensation. Qualitative findings identified a drug-checking cascade comprising awareness, access, training and practical instruction, possession, use, and re-engagement/diffusion. Participants described HVMs as expanding low-barrier access to FTS, while inadequate practical instruction and product-level usability barriers disrupted progression from access to sustained use. Among participants who continued to obtain FTS from the HVM, peer distribution of testing supplies and drug-checking knowledge extended overdose-prevention resources beyond individual HVM users to others at risk of unintended fentanyl exposure. Conclusions FTS engagement is better understood as a cascade than as a single measure of uptake. HVMs may provide adaptable, low-barrier infrastructure for entry and continued engagement in drug checking, including among people who use stimulants. However, access alone may be insufficient: sustained engagement requires usable technologies, practical instruction, and policies that support continued engagement and adaptation as the illicit drug supply evolves.
Source: Research Square
Language: English
Topic: HIV, Drug Use, Sexual Risk
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7213450072