What is needed for implementing drug checking services in the context of the overdose crisis? A qualitative study to explore perspectives of potential service users

Abstract

Background: The current illicit drug overdose crisis within North America and other countries requires expanded and new responses to address unpredictable and potentially lethal substances, including fentanyl analogues, in the unregulated drug market. Community-wide drug checking is being increasingly explored as one such public health response. We explored how drug checking could be implemented as a potential harm reduction response to the overdose crisis, from the perspective of potential service users. Methods: The research was guided by the Consolidated Framework for Implementation Research (CFIR). We conducted a qualitative, pre-implementation study to inform development and implementation of drug checking services that are acceptable to people who use substances and meet their needs. University and community researchers conducted 27 in-depth interviews with potential service users at prospective drug checking sites. We inductively developed emerging themes to inform the implementation of drug checking services within the five domains of the CFIR, and identified the most relevant constructs. Results: Implementing community drug checking faces significant challenges within the current context of criminalization and stigmatization of substance use and people who use/sell drugs, and trauma experienced by potential service users. Participants identified significant risks in accessing drug checking, and that confidential and anonymous services are critical to address these. Engaging people with lived experience in the service can help establish trust. The relative advantage of drug checking needs to outweigh risks through provision of accurate results conveyed in a respectful, non-judgemental way. Drug checking should provide knowledge relevant to using and/or selling drugs and informing one's own harm reduction.

Substance Use in Pregnancy: Identifying Stigma and Improving Care

“… 49 Much of this synthetic opioid exposure is not known to the substance-using population, who may rely on harm reduction organizations and community drug testing to determine its presence. 50 New contaminants, such as xylazine and designer benzodiazepines, are also increasing the rate of substance-related deaths. Stigma against PWUD limits policy changes that would greatly ameliorate these harms, such as decriminalization and legalization of all substances, universal drug testing, and availability of safe consumption sites.…”

Sustainable Harm Reduction Needle and Syringe Programs for People Who Inject Drugs: A Scoping Review of Their Implementation Qualities

“…Partners in sustainable NSP implementation would commit, if they perceived evidence of quality, affordability, acceptability, and accessibility [6]. We aim to apply a theory driven framework to aggregate the emerging research evidence on NSP program implementation qualities with PWID using the Consolidated Framework for Implementation Research (CFIR) [20].…”

Implementing an integrated multi‐technology platform for drug checking: Social, scientific, and technological considerations

“…COVID‐19 is potentially intensifying risk factors as harm reduction services are limited, people who use drugs are more isolated, and due to possible disruptions in the drug supply that may limit availability and increase variability and uncertainty 5–7 . It is within this context that drug checking has been emerging as a potential harm reduction measure to be included within the overall response to the public health crises 8,9 …”

“…context that drug checking has been emerging as a potential harm reduction measure to be included within the overall response to the public health crises. 8,9 Drug checking is a harm reduction approach that provides a chemical analysis of substances to describe the composition of a sample and inform individuals about the contents of drugs that they may use, share or sell. While street drug analysis is not new, 10 as a harm reduction service, drug checking is often associated with pill-checking services among the dance festival and nightlife settings.…”

“…More recently, early reports from community drug checking are describing the unique challenges to implementing drug checking outside of festivals and nightlife 11,[18][19][20] and specifically within communities facing multiple forms of structural violence including criminalization, stigmatization, trauma, poverty, racism and colonialism among others. 9,[20][21][22][23] Initially, the reports were limited to piloting of fentanyl immunoassay test strips. 22,[24][25][26][27][28][29][30] Now, there are reports of developing community drug checking projects that also utilize spectroscopy.…”