A Realist Review of How Community-Based Drug Checking Services Could Be Designed and Implemented to Promote Engagement of People Who Use Drugs

Abstract

With rising numbers of drug-related deaths in the UK and globally, exploration of interventions that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people to submit drug samples for chemical analysis and receive feedback about the sample, as well as harm reduction advice. The use of DCS is often linked to festival and/or nightlife settings and to so-called ‘recreational’ drug use, but research has also shown the potential of community-based DCS as an intervention serving more varied demographics of people who use drugs, including more marginalised individuals and those experiencing drug dependence. Whilst there is a growing evidence base on the effectiveness of drug checking as a harm reduction intervention, there is still limited evidence of the underlying mechanisms and processes within DCS which may aid implementation and subsequent engagement of people who use drugs. This presents a challenge to understanding why engagement differs across types of DCS, and how best to develop and deliver services across different contexts and for different populations. To explore the contexts and mechanisms which impact engagement in community-based DCS, a realist review was undertaken to synthesise the international evidence for the delivery and implementation of DCS. There were 133 sources included in the review. From these sources the underlying contexts, mechanisms, and outcomes relating to DCS implementation and engagement were developed and refined into seven programme theories. The findings of this review are theoretically novel and hold practical relevance for the design of DCS, with implications for optimisation, tailoring, and implementing services to reach individuals in different settings.

Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations

“…As a harm reduction intervention, we argue that drug checking holds potential for impact beyond an individual level, on the unregulated drug market as well as at the community and policy level [ 2 , 121 ]. However, public health and harm reduction organizations lack clear guidance to inform decisions on which instruments to purchase [ 122 ]. They currently do not have sufficient opportunities to assess what the operation of such instruments would actually look like in practice, with numerous potential benefits and limitations to consider.…”

“…Regardless of what instrument is employed, the recognition and understanding of the sources of uncertainty and limitations is at the forefront of providing a safe and reliable service model. Pragmatic knowledge translation is vital to establishing a trustworthy service [ 122 ]. For many service providers the reality is that current out-of-the-box technology is not meeting their needs [ 29 ], particularly in the level of nuance and expertise required for the interpretation of the data.…”

Challenges, policy and politics in drug checking: reflections of the TEDItorial team

“…Test results alone are a source of information which can be used for a multitude of purposes aside from harm reduction and dissemination of test results does not necessarily in itself result in the reduction of drug-related harm. Regardless of the model chosen, organisations wishing to get started can use operational guidelines (Masterton et al , 2022; Trans European Drug Information, 2022). In addition to being evidence-based, we suggest here that drug checking should be evidence-making (Trans European Drug Information, 2022; Wallace et al , 2022).…”

Handheld Raman Spectroscopy in the First UK Home Office Licensed Pharmacist-Led Community Drug Checking Service

“…Trials in this field have reported numerous models (e.g., employing spectroscopic and chromatographic techniques as well as presumptive tests) and improved developments in the detection and identification of illicit and novel drugs, although they are often associated with mixed opportunities and challenges [ 3 , 29 , 30 ]. Portable in-field techniques with their screening ability are usually easy to use and beneficial in providing a low-cost rapid identification of the content of the sample and informing on decisions accordingly (e.g., advice on harm, providing intelligence information, preparing for possible threats from high-risk drugs) [ 31 , 32 ].…”