The Bronze Age of drug checking: barriers and facilitators to implementing advanced drug checking amidst police violence and COVID-19

Abstract

Objectives Unpredictable fluctuations in the illicit drug market increase overdose risk. Drug checking, or the use of technology to provide insight into the contents of illicit drug products, is an overdose prevention strategy with an emerging evidence base. The use of portable spectrometry devices to provide point-of-service analysis of the contents of illicit drugs been adopted by harm reduction organizations internationally but is only emerging in the United States. This study aimed to identify barriers and facilitators of implementing drug checking services with spectrometry devices in an urban harm reduction organization and syringe service program serving economically marginalized people who use drugs in Boston, Massachusetts (USA). Methods In-vivo observations and semi-structured interviews with harm reduction staff and participants were conducted between March 2019 and December 2020. We used the consolidated framework for implementation research to identify implementation barriers and facilitators. Results This implementation effort was facilitated by the organization’s shared culture of harm reduction—which fostered shared implementation goals and beliefs about the intervention among staff persons—its horizontal organizational structure, strong identification with the organization among staff, and strong relationships with external funders. Barriers to implementation included the technological complexity of the advanced spectroscopy devices utilized for drug checking. Program staff indicated that commercially available spectroscopy devices are powerful but not always well-suited for drug checking efforts, describing their technological capacities as “the Bronze Age of Drug Checking.” Other significant barriers include the legal ambiguity of drug checking services, disruptive and oppositional police activity, and the responses and programmatic changes demanded by the COVID-19 pandemic. Conclusions For harm reduction organizations to be successful in efforts to implement and scale drug checking services, these critical barriers—especially regressive policing policies and prohibitive costs—need to be addressed. Future research on the impact of policy changes to reduce the criminalization of substance use or to provide explicit legal frameworks for the provision of this and other harm reduction services may be merited.

Effect of police action on low-barrier substance use disorder service utilization

“…While our study was not designed to elucidate the specific mechanisms by which OCS led to decreased bridge clinic utilization, in authors’ experience patients reported that incarceration and leaving the area due to fear of incarceration were important factors. Displacement of people from the neighborhood by police, via frequent directives to not to loiter, also likely played a large role [ 13 ].…”

“…They result in more dispersed and less safe disposal of used injection equipment [ 12 ]. The fear and threat of arrest and searches by police can have a chilling effect on the implementation of emerging harm reduction innovations like drug checking [ 13 ]. Though rationalized as public safety actions, sweeps and crackdowns focused on people who use drugs, experience poverty, have marginal housing, and are out in public result in more harm than good [ 14 ].…”

“…These clinics serve a population at high risk of overdose and infectious complications of injection drug use [ 16 , 20 ]. While police presence can reduce PWUD’s access to harm reduction services, less is known about how this presence affects utilization of low-barrier SUD treatment services [ 13 , 21 ].…”

“…City officials reported that OCS was a response to the unsafe conditions that had developed in the temporary encampments in the neighborhood, where people who use drugs and experience homelessness had been increasingly concentrated due to criminalization of substance use and limited availability of services in other areas [ 22 ]. A violent encounter between an off-duty corrections officer and a community member was cited as an immediate and primary driver of OCS [ 13 ]. However, political pressure from residents and businesses in the surrounding neighborhoods had been mounting for months to remove individuals who were experiencing homelessness or congregating in the area, including, but not limited to, people who were intoxicated or using drugs in public [ 23 ].…”

“…OCS led to thirty-four arrests in its first 2 days, nearly half due to prior warrants and a quarter due to active drug possession [ 24 ]. People who use drugs and harm reduction staff reported verbal abuse and physical violence by police officers in addition to consistent requirements to disperse, which displaced people from the neighborhood and resulted in disengagement from social services [ 13 ]. Local news reports showed images of personal belongings and wheelchairs being crushed in garbage trucks [ 25 ].…”