Current Attitudes Toward Drug Checking Services and a Comparison of Expected with Actual Drugs Present in Street Drug Samples Collected from Opioid Users

Abstract

Background: The opioid epidemic continues to cause high numbers of fatalities in the US and other countries, driven mainly by the inclusion of potent synthetic opioids in street drugs. Drug checking by means of various technologies is being increasingly implemented as a harm reduction strategy to inform users about constituent drugs in their street samples. We assessed how valued drug checking services (DCS) would be for opioid street drug users given the ubiquity of fentanyl and related analogs in the drug supply, the information they would most value from drug checking, and compared expected versus actual constituent drugs in collected samples. Methods: A convenience sample of opioid street drug users (N = 118) was recruited from two syringe service exchange programs in Chicago between 2021-2022. We administered brief surveys asking about overdose history, fentanyl preference, and interest in DCS. We also collected drug samples and asked participants what drug(s) they expected were in the sample. Provided samples were analyzed using LC-MS technology and the results compared to their expected drugs. Results: Participants reported an average of 4.4 lifetime ODs (SD=4.8, range=0-20) and 1.1 (SD=1.8, range=0-10) past-year ODs. A majority (92.1%) believed they had recently used drugs containing fentanyl. Opinions about the desirability of fentanyl were mixed with 56.1% indicating they did not and 38.0 % indicating they did prefer fentanyl. Attitudes towards DCS indicated a general but not uniform receptiveness with a majority indicating interest in DCS though sizeable minorities believed DCS was ”too much trouble” (25.2%) or there was “no point” in testing (35.4%). Participants were especially poor at identifying common cutting agents and potentiating drugs such as diphenhydramine in their samples. They reported having quantitative information on drug concentrations and identification of all constituent drugs present in a sample would be especially valuable. Conclusions: Results affirmed street drug users remain interested in using DCS to monitor their drugs and such services should be more widely available. Advanced checking technologies that provide information on the relative quantities and the different drugs present in a given sample available at point-of-care, would be most valuable but remain challenging to implement.

How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives

“…Increasingly, however, pockets of consumers are preferring fentanyl, as seen in our San Francisco client sample and within populations reflected in recent drug checking studies. Our data echo the broader finding that drug checking technologies are likely to be used differently by fentanyl-seeking opioid users versus fentanyl-avoiding opioid users, and differently still among those using stimulants, psychedelics, or other non-opioid drugs [22,62].…”

“…Though not mainstream or broadly implemented, studies from North America indicate that DCS are generally acceptable among people who use drugs [19,20], and report that both service users and providers have expressed desire for better access to DCS, legal protections for those providing and using drug checking, and advanced technologies that provide information on drug concentrations-not just drugs present-at the point of care [21][22][23][24]. Several studies explore the potential impact of drug checking when used at various points along the supply chain [25,26], with findings that suggest feasibility, acceptability, and uptake of DCS among drug sellers [27], noting particular importance to drug sellers who are embedded in their community and hold long-term trusted relationships with customers [28,29].…”

Associations among Drug Acquisition and Use Behaviors, Psychosocial Attributes, and Opioid-Involved Overdoses: A SEM Analysis

“…Additional details on both study protocols are available elsewhere (33)(34)(35). The rst study had two components: assessing street-drug users' current attitudes towards drug-checking services and testing the feasibility of using ecological momentary assessment (EMA) to collect data.…”

“…All participants were also required to provide information on behaviors increasing overdose risk. However, demographic information was not available for twenty participants who opted out of taking a longer survey that included the demographic questions and which was administered to the group participating in the attitudes survey component (34).…”

Feasibility Study of Using Mobile Phone-Based Experience Sampling to Assess Drug Checking by Opioid Street Drug Users

“…Feasibility study data were collected during the third phase of a three-phase research project that also included phases to assess current attitudes towards drug checking and develop a novel take-home drug-checking method -the illegal drug Paper Analytic Device (idPAD). (39)(40)(41) Recruitment for each phase was conducted independently to obtain a unique sample. The study protocol was reviewed and approved by the UIC institutional review board.…”