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Community Drug Checking to Reduce Harms

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 19158

Special Issue Editors

School of Social Work, University of Victoria, Victoria, BC1700, Canada
Interests: substance use; harm reduction; drug checking; health equity; community-based research
Faculty of Social Sciences, University of Stirling, Scotland FK84LA, UK
Interests: substance use; mental health; homelessness; inclusion health; drug checking; intervention development; policy analysis; peer support
Faculty of Social Sciences, University of Stirling, Scotland FK84LA, UK
Interests: substance use; harm reduction; drug checking; homelessness; qualitative research; peer support; inclusion health

Special Issue Information

Dear Colleagues,

This special issue aims to provide a unique space for researchers and practitioners to publish work on drug checking in community settings. Drug checking services offer people who use drugs and others information on the contents of their drugs to help them to make more informed decisions. While drug checking has often been associated with festival and nightlife settings, there has been a rapid increase in interest and research focused on community drug checking services, often as a response to the unpredictable illicit drug markets and unprecedented rates of overdose. These services seek to respond to a whole region and be more permanent and integrated within overall harm reduction and health services. This special issue will publish research and policy and practice commentaries generated from community drug checking services across the world and provide a ‘go to place’ for those wishing to develop their own services or to share learning. A key advantage of this special edition is that it will help fill an identified knowledge gap in relation to models of community drug checking and questions surrounding implementation, operation, impact and practice-based theory. As guest editors we are keen to hear from anyone that would like to make a contribution so please get in touch. 

Prof. Dr. Bruce B. Wallace
Prof. Dr. Tessa Parkes
Dr. Hannah Carver
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • drug checking
  • fixed-site
  • community based
  • harm reduction
  • point-of-care

Published Papers (6 papers)

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Research

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19 pages, 381 KiB  
Article
Insights from Drug Checking Programs: Practicing Bootstrap Public Health Whilst Tailoring to Local Drug User Needs
Int. J. Environ. Res. Public Health 2023, 20(11), 5999; https://doi.org/10.3390/ijerph20115999 - 30 May 2023
Cited by 5 | Viewed by 1681
Abstract
The year 2021 was the most deadly year for overdose deaths in the USA and Canada. The stress and social isolation stemming from the COVID-19 pandemic coupled with a flood of fentanyl into local drug markets created conditions in which people who use [...] Read more.
The year 2021 was the most deadly year for overdose deaths in the USA and Canada. The stress and social isolation stemming from the COVID-19 pandemic coupled with a flood of fentanyl into local drug markets created conditions in which people who use drugs were more susceptible to accidental overdose. Within territorial, state, and local policy communities, there have been longstanding efforts to reduce morbidity and mortality within this population; however, the current overdose crisis clearly indicates an urgent need for additional, easily accessible, and innovative services. Street-based drug testing programs allow individuals to learn the composition of their substances prior to use, averting unintended overdoses while also creating low threshold opportunities for individuals to connect to other harm reduction services, including substance use treatment programs. We sought to capture perspectives from service providers to document best practices around fielding community-based drug testing programs, including optimizing their position within a constellation of other harm reduction services to best serve local communities. We conducted 11 in-depth interviews from June to November 2022 via Zoom with harm reduction service providers to explore barriers and facilitators around the implementation of drug checking programs, the potential for integration with other health promotion services, and best practices for sustaining these programs, taking the local community and policy landscape into account. Interviews lasted 45–60 min and were recorded and transcribed. Thematic analysis was used to reduce the data, and transcripts were discussed by a team of trained analysts. Several key themes emerged from our interviews: (1) the instability of drug markets amid an inconsistent and dangerous drug supply; (2) implementing drug checking services in dynamic environments in response to the rapidly changing needs of local communities; (3) training and ongoing capacity building needed to create sustainable programs; and (4) the potential for integrating drug checking programs into other services. There are opportunities for this service to make a difference in overdose deaths as the contours of the drug market itself have changed over time, but a number of challenges remain to implement them effectively and sustain the service over time. Drug checking itself represents a paradox within the larger policy context, putting the sustainability of these programs at risk and challenging the potential to scale these programs as the overdose epidemic worsens. Full article
(This article belongs to the Special Issue Community Drug Checking to Reduce Harms)
27 pages, 2480 KiB  
Article
Handheld Raman Spectroscopy in the First UK Home Office Licensed Pharmacist-Led Community Drug Checking Service
Int. J. Environ. Res. Public Health 2023, 20(6), 4793; https://doi.org/10.3390/ijerph20064793 - 08 Mar 2023
Cited by 2 | Viewed by 2301
Abstract
Across the world, the interest in point-of-care drug checking as a harm-reduction intervention is growing. This is an attempt to improve intelligence about current drug trends and reduce drug-related morbidity and mortality. In the UK, drug-related harm is increasing exponentially year after year. [...] Read more.
Across the world, the interest in point-of-care drug checking as a harm-reduction intervention is growing. This is an attempt to improve intelligence about current drug trends and reduce drug-related morbidity and mortality. In the UK, drug-related harm is increasing exponentially year after year. As such, specialist community treatment services are exploring new methods to improve engagement with people who use drugs (PWUD), who may require support for their problematic drug use. This need has driven the requirement to pilot an on-site, time-responsive, readily available drug-checking service at point-of-support centres. In this study, we piloted the UK’s first Home Office-licensed drug-checking service that was embedded into a community substance-misuse service and had all on-site analysis and harm-reduction interventions led and delivered by pharmacists. We report on the laboratory findings from the associated confirmatory analysis (UHPLC-MS, GC-MS, and 1H NMR) to assess the performance of the on-site hand-held Raman spectrometer and outline the challenges of providing real-time analysis of psychoactive substances in a clinical setting. Whilst acknowledging the limitation of the small sample size (n = 13), we demonstrate the potential suitability of using this technology for the purposes of screening substances in community-treatment services. Portability of equipment and timeliness of results are important and only very small samples may be provided by people who use the service. The challenges of accurately identifying substances from complex mixtures were equally found with both point-of-care Raman spectroscopy and laboratory confirmatory-analysis techniques. Further studies are required to confirm these findings. Full article
(This article belongs to the Special Issue Community Drug Checking to Reduce Harms)
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10 pages, 743 KiB  
Article
Challenges in Drug Surveillance: Strengthening the Analysis of New Psychoactive Substances by Harmonizing Drug Checking Services in Proficiency Testing
Int. J. Environ. Res. Public Health 2023, 20(5), 4628; https://doi.org/10.3390/ijerph20054628 - 06 Mar 2023
Cited by 2 | Viewed by 2279
Abstract
Background: Drug checking is a proven harm reduction strategy and provides real-time information on the market of new psychoactive substances (NPS). It combines chemical analysis of samples with direct engagement with people who use drugs (PWUD), giving the ability to increase preparedness and [...] Read more.
Background: Drug checking is a proven harm reduction strategy and provides real-time information on the market of new psychoactive substances (NPS). It combines chemical analysis of samples with direct engagement with people who use drugs (PWUD), giving the ability to increase preparedness and responsiveness towards NPS. Next to that, it supports rapid identification of potential unwitting consumption. However, NPS cause a toxicological battle for the researchers, as factors such as the unpredictability and quick shift of the market complicate the detection. Methods: To evaluate challenges posed towards drug checking services, proficiency testing was set up to evaluate existing analytical techniques and investigate the capability to correctly identify circulating NPS. Twenty blind substances, covering the most common categories of substances, were analyzed according to the existing protocols of the existing drug checking services, including several analytical methods such as gas chromatography–mass spectrometry (GC-MS) and liquid chromatography with diode array detector (LC-DAD). Results: The proficiency test scores range from 80 to 97.5% accuracy. The most common issues and errors are mainly unidentified compounds, presumably due to no up-to-date libraries, and/ or confusion between structural isomers, such as 3- and 4-chloroethcathinone, or structural analogs, such as MIPLA (N-methyl-N-isopropyl lysergamide) and LSD (D-lysergic acid diethylamide). Conclusions: The participating drug checking services have access to adequate analytical tools to provide feedback to drug users and provide up-to-date information on NPS. Full article
(This article belongs to the Special Issue Community Drug Checking to Reduce Harms)
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14 pages, 369 KiB  
Article
Substance Use Stigma and Community Drug Checking: A Qualitative Study Examining Barriers and Possible Responses
Int. J. Environ. Res. Public Health 2022, 19(23), 15978; https://doi.org/10.3390/ijerph192315978 - 30 Nov 2022
Cited by 4 | Viewed by 1929
Abstract
Background: Community drug checking is an emerging response to the overdose crisis. However, stigma has been identified as a potential barrier to service use that requires investigation. Methods: A qualitative study explored how best to implement drug checking services to the wider population [...] Read more.
Background: Community drug checking is an emerging response to the overdose crisis. However, stigma has been identified as a potential barrier to service use that requires investigation. Methods: A qualitative study explored how best to implement drug checking services to the wider population including those at risk of overdose. A secondary analysis of 26 interviews with potential service users examine how stigma may be a barrier to service use and strategies to address this. A Substance Use Stigma Framework was developed to guide analysis. Results: Drug checking is operating in a context of structural stigma produced by criminalization. People fear criminal repercussions, anticipate stigma when accessing services, and internalize stigma resulting in shame and avoidance of services. A perceived hierarchy of substance use creates stigma results in stigma between service users and avoidance of sites associated with certain drugs. Participants frequently recommended drug checking to be located in more public spaces that still maintain privacy. Conclusions: Criminalization and societal views on substance use can deter service use. Strategies to mitigate stigma include employment of people with lived and living experience from diverse backgrounds; public yet private locations that preserve anonymity; and normalization of drug checking while decriminalization could address the root causes of stigma. Full article
(This article belongs to the Special Issue Community Drug Checking to Reduce Harms)

Review

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25 pages, 693 KiB  
Review
A Realist Review of How Community-Based Drug Checking Services Could Be Designed and Implemented to Promote Engagement of People Who Use Drugs
Int. J. Environ. Res. Public Health 2022, 19(19), 11960; https://doi.org/10.3390/ijerph191911960 - 22 Sep 2022
Cited by 12 | Viewed by 8323
Abstract
With rising numbers of drug-related deaths in the UK and globally, exploration of interventions that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people to submit drug samples for chemical analysis and receive feedback about the sample, as well [...] Read more.
With rising numbers of drug-related deaths in the UK and globally, exploration of interventions that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people to submit drug samples for chemical analysis and receive feedback about the sample, as well as harm reduction advice. The use of DCS is often linked to festival and/or nightlife settings and to so-called ‘recreational’ drug use, but research has also shown the potential of community-based DCS as an intervention serving more varied demographics of people who use drugs, including more marginalised individuals and those experiencing drug dependence. Whilst there is a growing evidence base on the effectiveness of drug checking as a harm reduction intervention, there is still limited evidence of the underlying mechanisms and processes within DCS which may aid implementation and subsequent engagement of people who use drugs. This presents a challenge to understanding why engagement differs across types of DCS, and how best to develop and deliver services across different contexts and for different populations. To explore the contexts and mechanisms which impact engagement in community-based DCS, a realist review was undertaken to synthesise the international evidence for the delivery and implementation of DCS. There were 133 sources included in the review. From these sources the underlying contexts, mechanisms, and outcomes relating to DCS implementation and engagement were developed and refined into seven programme theories. The findings of this review are theoretically novel and hold practical relevance for the design of DCS, with implications for optimisation, tailoring, and implementing services to reach individuals in different settings. Full article
(This article belongs to the Special Issue Community Drug Checking to Reduce Harms)
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Other

Jump to: Research, Review

6 pages, 280 KiB  
Opinion
Considerations for Purchasing Drug Checking Technologies: Perspectives from Toronto’s Drug Checking Service
Int. J. Environ. Res. Public Health 2023, 20(15), 6486; https://doi.org/10.3390/ijerph20156486 - 31 Jul 2023
Viewed by 930
Abstract
With the unregulated drug supply—particularly the unregulated opioid supply—becoming increasingly more toxic, more contaminated, and less predictable, drug checking has emerged as an essential public health service: informing individuals who use drugs, as well as those who care and advocate for them, in [...] Read more.
With the unregulated drug supply—particularly the unregulated opioid supply—becoming increasingly more toxic, more contaminated, and less predictable, drug checking has emerged as an essential public health service: informing individuals who use drugs, as well as those who care and advocate for them, in real-time. For those looking to offer drug checking services in community settings, choosing a technology can be an arduous task. With very little regulatory oversight of drug checking technologies, it can be difficult for organizations that specialize in harm reduction to ascertain what questions to ask drug checking technology vendors to ensure they invest in a technology that best suits the needs of their community. Looking to help those that lack drug checking and technical expertise, Toronto’s Drug Checking Service has compiled a list of questions to equip organizations to make informed decisions when it comes to purchasing drug checking technologies. Having developed and operated a drug checking service since 2018, Toronto’s Drug Checking Service is uniquely positioned to share its expertise and insights. Full article
(This article belongs to the Special Issue Community Drug Checking to Reduce Harms)
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