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Participants explained that learning their drugs contained fentanyl may make them more likely to engage in overdose risk reduction behaviors, such as using less, doing tester shots, and not using the drugs entirely. Conclusion Among our sample of rural PWID in Appalachia, most were unaware of FTS but expressed high willingness to utilize the technology. Participants described how receiving a positive FTS result may lead them to engage in overdose risk reduction behaviors. Augmenting existing overdose prevention initiatives in rural Appa