The potential impacts of community drug checking within the overdose crisis: qualitative study exploring the perspective of prospective service users

Abstract

Background As drug checking becomes more integrated within public health responses to the overdose crisis, and potentially more institutionalized, there is value in critically questioning the impacts of drug checking as a harm reduction response. Methods As part of a pilot project to implement community drug checking in Victoria, BC, Canada, in-depth interviews (N = 27) were held with people who use or have used substances, family or friends of people who use substances, and/or people who make or distribute substances. Critical harm reduction and social justice perspectives and a socioecological model guided our analysis to understand the potential role of drug checking within the overdose crisis, from the perspective of prospective service users. Results Participants provided insight into who might benefit from community drug checking and potential benefits. They indicated drug checking addresses a “shared need” that could benefit people who use substances, people who care for people who use substances, and people who sell substances. Using a socioecological model, we identified four overarching themes corresponding to benefits at each level: “drug checking to improve health and wellbeing of people who use substances”, “drug checking to increase quality control in an unregulated market”, “drug checking to create healthier environments”, and “drug checking to mediate policies around substance use”. Conclusions Drug checking requires a universal approach to meet the needs of diverse populations who use substances, and must not be focused on abstinence based outcomes. As a harm reduction response, community drug checking has potential impacts beyond the individual level. These include increasing power and accountability within the illicit drug market, improving the health of communities, supporting safer supply initiatives and regulation of substances, and mitigating harms of criminalization. Evaluation of drug checking should consider potential impacts that extend beyond individual behaviour change and recognize lived realities and structural conditions.

Drug checking services for people who use drugs: a systematic review

“…Assessment of study quality was conducted for 13 articles meeting a priori criteria (Supporting information, Tables S1 and S3). Among the quality of the unregulated drug supply [32,98], this was not borne out in the evidence and remains a gap in the literature. Our primary domain-the influence of DCS on behaviour of PWUD-was measured in a third of studies, while behavioural intention in response to analysis results from DCS was assessed most often (24.4%).…”

A distributed model to expand the reach of drug checking

“…Based on all of the technologies that have been evaluated over the past decade, it appears that the ideal instrument for drug checking has yet to be determined, and this is in part because of the compromise between cost, ease of use, sensitivity and utility of the results. In the near future, community drug checking will likely continue to engage multiple instruments when seeking to report on the synthetic opioids often associated with overdose and the frequent combinations of active ingredients such as "so-called benzo-dope" (Wallace et al, 2021a(Wallace et al, , 2021b(Wallace et al, , 2021c. j DRUGS, HABITS AND SOCIAL POLICY j Overall, there is a need to address the implementation barriers that are hindering its scale and reach (Wallace et al, 2021a).…”

Co-Designing High-Risk Drug Alerts for Health and Community Service Practitioners

“…Information or advice that is perceived to be dated, inaccurate, unrelatable, irrelevant, or impractical can undermine trust and engagement with alert systems (33,56,57). It is therefore recommended that alert systems carefully prioritize the values, interests, needs, and concerns of target audiences to maximize reach, engagement, and information-sharing (33,34,42,55).…”

“…Systems that provide close to realtime detection of sample composition can differentiate from people's expectations about the substance of concern, and are better-placed to provide evidence-based insights about potentially adulterated, contaminated, or substituted supplies (37,38). Systematic, cross-jurisdictional detection and reporting that coordinates multidisciplinary responses (e.g., xed and mobile drug checking services, screening medical presentations, peerled intelligence, research activities, and wastewater analyses in substance use 'hotspots') can help to ensure more proactive and timely detection, evaluation, and reporting of emerging threat (41)(42)(43). Elements of these coordinated systems could even be 'scaled-up' to feed into EWS, public health alerts, and targeted harm reduction interventions during high-risk periods (e.g., festival 'seasons') when drug-related harms have been known to spike (16,46,47).…”

“…When signi cant threats are identi ed, information can be translated into targeted interventions and universal approaches can rapidly translate information into purposeful public health communications (e.g., warnings, alerts, or advisories) to promote riskawareness and prompt individual or community action (39,40). Drug checking may even help to stabilize local drug markets by reducing the purchase/sale of adulterated or contaminated supplies; and data can be fed into early warning systems (EWS) for systematic and cross-jurisdictional reporting and coordination of local, national, and international responses to perceived threat (41)(42)(43). More broadly, policy-sanctioned drug checking and associated risk communications may help to address some of the social and structural determinants of drugrelated harm (i.e., stigma) by in uencing community attitudes towards people who use drugs through 'normalizing' harm reduction approaches and modelling pragmatic, health-and wellbeing-focused responses to preventing drug-related harm before acute adverse events happen (42).…”