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

Abstract

Purpose The purpose of this paper is to present some of the continued resistance and challenges faced by drug checking services (DCS) and review how the existing literature and the contributions to the special issue address them, with a view to making recommendations. Design/methodology/approach The existing literature and the contributions to the special issue are reviewed. Findings Drug checking cannot be equated with quality control. With the appropriate equipment and chemistry staff, DCS can provide quantitative analysis and reliable results. When the product does not match expectations, service users discard the tested substance of concern. To more easily compare the results of different studies and better evaluate drug checking, standardisation of measures is desirable. Uptake of drug checking, notably in festivals, is low and depends in part on the capacity of DCS. Drug checking has added value in monitoring drug markets and is complementary with chemical (forensic) analysis. Originality/value This paper interrogates in a relatively comprehensive way the continued resistance to drug checking in light of theoretical and empirical research to derive recommendations that are specific to drug checking and that are addressed to health professionals, researchers and also to policymakers.

Planning and implementing community-based drug checking services in Scotland: a qualitative exploration using the consolidated framework for implementation research

“…This is the case both for impact-based research (considering the harm reduction impacts of DCS) and process-based research (considering issues such as service design, implementation challenges, and levels of engagement in DCS). Although research on both is growing as the number and profile of DCS increase globally [ 4 , 12 , 19 , 22 , 23 , 31 , 48 ], there is a need for ongoing exploration of DCS implementation and delivery across a range of contexts. The current paper highlights initial considerations for Scotland, using the CFIR framework to conduct pre-implementation research and identify key issues for planning and service delivery, requiring further exploration and research.…”

“…DCS can present a challenge to the prohibitionist logics which have formed the basis of policy responses to drug use in many countries [ 10 , 11 ]. As such, they typically operate in a legal grey area with varying degrees of funding and government sanctioning [ 1 , 3 , 12 , 13 ]. Such factors shape the delivery of services, contributing to wide diversity in the: sophistication of their operation; scale of the service provided; extent to which services need to operate under the radar of law enforcement; and comprehensiveness of results provided to individuals [ 2 – 4 , 12 – 18 ].…”

“…As such, they typically operate in a legal grey area with varying degrees of funding and government sanctioning [ 1 , 3 , 12 , 13 ]. Such factors shape the delivery of services, contributing to wide diversity in the: sophistication of their operation; scale of the service provided; extent to which services need to operate under the radar of law enforcement; and comprehensiveness of results provided to individuals [ 2 – 4 , 12 – 18 ]. Although DCS have historically operated on the periphery of public health responses to drug-related harms (with some notable exceptions such as the Drug Information and Monitoring System in the Netherlands), there is evidence that this dynamic is shifting.…”

“…A further recent example of the integration of drug checking into mainstream public health structures and government policy is in Australia where the government of Queensland has announced support for the introduction of DCS [ 22 ]. Despite these developments, DCS largely continue to exist within complex social, legal, and political spaces on a continuum between unsanctioned grassroots activism and sanctioned public health response [ 1 , 3 , 12 , 13 , 15 , 23 – 27 ].…”

“…Work in North America has highlighted important considerations when delivering DCS to marginalised populations during the ongoing overdose crisis [ 5 – 8 , 16 – 18 , 20 , 23 , 31 – 39 ]. Further, reviews of the literature have identified important factors for implementation of community-based DCS including: integration into existing harm reduction services which are perceived as non-authoritative and trusted; involvement of those with lived/living experience in the design and delivery of services; supportive legislation; adequate funding for service delivery and evaluation; and capacity to engage in continuous development of drug checking equipment and methods [ 12 , 19 , 40 ]. Despite these cited sources, there is a need for further exploration of implementation contexts and service design and how these differ across countries and regions.…”