Setting Shambhala is a 5-day electronic dance music (EDM) festival held in rural British Columbia that annually hosts between 15,000 and 18,000 people on a 500-acre ranch. The AIDS Network Outreach & Support Society (ANKORS) has provided harm reduction services throughout the duration of the festival since 2003, including point-of-care drug checking, which allows realtime testing of illicit substances to assess their composition. Drug checking results are provided directly to clients and displayed in aggregate on a screen for all attendees to see. Intervention In 2017, ANKORS added fentanyl checking to their repertoire of drug checking technologies for festivalgoers. Volunteers used a brief survey to collect information on what clients expected the samples to contain. Volunteers carried out drug checks and subsequently logged test results. ANKORS provided an amnesty bin at the tent for clients who chose to discard their substances. Outcomes Of the 2683 surveys, 2387 included data on both the client's belief and the actual test result. Clients were more likely to discard when the test result differed from their belief (5.16%) than when their belief was confirmed (0.69%). Discarding increased to 15.54% when the test could not clearly identify a substance and to 30.77% if the client did not have a prior belief of the substance. Of 1971 samples tested for fentanyl, 31 tested positive and 16.13% of clients discarded compared to 2.63% in the negative group. Implications Drug checking services appeal to festivalgoers who, when faced with uncertainty, may discard their substances. This innovative harm reduction service allows for a personalized risk discussion, potentially reaching others via word-of-mouth and early warning systems. Résumé Contexte Shambhala est un festival de musique électronique qui se déroule sur cinq jours dans un ranch de 500 acres en campagne britanno-colombienne et qui accueille de 15 000 à 18 000 personnes. L'AIDS Network Outreach & Support Society (ANKORS) offre des services de réduction des méfaits pour toute la durée du festival depuis 2003, notamment sous forme d'analyses en temps réel de la composition de substances illicites dans des points de service. Les résultats sont remis directement aux clients et affichés sous leur forme brute dans un tableau général que peuvent voir tous les festivaliers.

BackgroundHarm reduction has been at the forefront of the response to the opioid overdose public health emergency in British Columbia (BC). The unprecedented number of opioid overdose deaths in the province calls for an expansion of harm reduction services. The purpose of this study was to determine the acceptability of a fentanyl urine drug test among people who use drugs (PWUD) and explore whether testing introduced any changes in participants’ attitudes and behaviors towards their drug use.MethodsA pilot of fentanyl urine testing was implemented in partnership with an outreach harm reduction program in rural BC. Participants were PWUD who had consumed within the last 3 days prior to the test. Participants filled out a semi-structured questionnaire at the time of the test and were invited for a follow-up interview 2 to 4 weeks after the test. Urine samples were tested with BNTX Rapid Response™ fentanyl urine strip test at a detection level of 20 ng/ml norfentanyl.ResultsOf the 24 participants who completed the urine test and first interview, 4 had a positive fentanyl urine test. Fifteen clients completed the second questionnaire, 10 of whom reported introducing a behavior change after testing and the remaining 5 indicated being already engaged in harm reduction practices. All four clients who tested positive completed the second questionnaire; all but one indicated adopting behaviors towards overdose prevention.DiscussionFentanyl urine testing appealed to illicit opioid users and may have contributed to adopting behaviors towards safer drug use. A relationship of trust between tester and client seemed important for clients who expressed concerns with privacy of the urine test results. Post-consumption urine testing could complement the use of pre-consumption drug checking in the context of harm reduction services.Electronic supplementary materialThe online version of this article (10.1186/s12954-018-0224-z) contains supplementary material, which is available to authorized users.