Piloting the UK’s First Home-Office-Licensed Pharmacist-Led Drug Checking Service at a Community Substance Misuse Service

Abstract

(1) Introduction: Drug-related deaths in the UK are at concerning high levels. The unknown content and purity of illicit substances can cause unpredictable adverse effects and thus a public health risk with no sign of abating. On-site drug checking is a public health strategy that has previously been implemented, predominantly in festival settings, but without Home Office licensing. (2) Aims: The aim of this study was to pilot the UK’s first pharmacist-led, Home Office-licensed community drug checking service. (3) Methods: A bespoke protocol incorporating legally, professionally and ethically binding documents was implemented. This free, confidential service ran between February and March 2019, was available to anyone over 18 who were purposefully recruited, gave informed consent and agreed to relinquish their drug sample. Samples were checked on-site within an established Substance Misuse Service (SMS) using a handheld Raman spectrometer to determine likely drug content and adulterants. In parallel, participants completed a questionnaire about their substance use and the drug sample(s) being tested. A pharmacist-led multidisciplinary approach was adopted to discuss the analytical findings. Informed by the results of the analysis and the questionnaire, people who used the service received tailored harm reduction advice. (4) Results and Discussion: The pilot operated for a total of four days over four weeks. Eleven people visited and relinquished a total of thirteen samples. Half of the participants had previously overdosed and were known to the SMS. Seventy per cent were male, all were White British individuals, 30% were employed and two people disclosed visiting from another nearby town. Samples included what was thought to be heroin, synthetic cannabinoids, stimulants, benzodiazepines and LSD and none required activation of the “alerts cascade” process. Most participants drank alcohol regularly and the concomitant use of traditional illicit drugs and prescribed medication (including opioids, anxiolytics and antidepressants) with sedating profiles was common. Given some of the ethical decisions and interpretation of the results, specialist pharmacist involvement was deemed essential. (5) Conclusions: This pilot demonstrated the proof-of-concept that a pharmacist-led Home Office-licensed drug checking service can be successfully implemented in community SMSs.

Invited Commentary: Drug Checking for Novel Insights Into the Unregulated Drug Supply

“…First and foremost, the program’s primary purpose should be to deliver results in a timely manner to people who use drugs to empower behavior change. At a music festival in the United Kingdom ( 29 ), 1 in 5 users disposed of their substances after receiving unfavorable test results. In another study, two-thirds disposed of drugs after learning that they were sold something other than what was expected ( 30 ).…”

Challenges for drug checking services in Scotland: a qualitative exploration of police perceptions

“…The first relates to the legality of the service itself, and the legal protection afforded to staff. Services operate with different levels of protection in this regard, ranging from explicit legislation or 'legal exemptions' protecting their operation, to varying degrees of informal, tacit acceptance by local police forces [5][6][7][8][9][10][11]. The second relates to the protection of clients from being charged for drug offences by police when entering, leaving, and travelling to services [12].…”

“…The second relates to the protection of clients from being charged for drug offences by police when entering, leaving, and travelling to services [12]. Whilst DCS have received legal exemptions protecting their operation in some countries, such as Canada and the UK [10,13], such exemptions relate to the operation of the service and its staff, providing no explicit protection to clients attempting to access such services. Indeed, few DCS operate in contexts providing explicit legal protection for clients [1,5,9,13,14].…”

“…In contrast to England, where local policing divisions retain a higher degree of operational autonomy over local policing arrangements [38,48], policing in Scotland was centralised in 2013 through the creation of a unified police service, Police Scotland. In England, divisional autonomy over policing has facilitated the development of localised diversion schemes [24], vocal support for harm reduction approaches from high-level local police officials in some areas [47,53], and examples of local divisions working collaboratively with harm reduction services such as drug checking [1,10]. In Scotland there are concerns that the centralisation of policing may limit divisional autonomy in relation to local policing practices (e.g., the policing of drugs).…”

Drug Checking as Strategy for Harm Reduction in Recreational Contests: Evaluation of Two Different Drug Analysis Methodologies

“…They are aimed at ensuring a pragmatic manner of dealing with drug use through a hierarchy of intervention goals that emphasizes on reducing the health-related harms of continued drug use, offering, for example, opioid substitution treatment and needle and syringe programs to prevent death due to overdose and reduce the spread of infectious diseases ( 1 , 17 ). Since the 1960s, harm-reduction services are occasionally available at various types of nightly musical events to inform users about the risks of drug use and ways of risk minimization ( 18 ). Such services are called “street drug analysis,” “pill testing,” “drug checking,” “adulterant screening,” “drug testing,” and “multi-agency safety testing ( 19 ).” Their main purpose is to provide individual drug users free testing services to identify the drugs that they intend to use during an event and all possible information on substance purity.…”