Drug checking use and interest among people who inject drugs in Toronto, Canada

Rammohan, Indhu; Bouck, Zachary; Fusigboye, Sufiat; Bowles, Jeanette M.; McDonald, Karen; Maghsoudi, Nazlee; Scheim, Ayden I.; Werb, Dan

doi:10.1016/j.drugpo.2022.103781

Cited by 10 publications

(7 citation statements)

References 26 publications

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“…Instead, settings need to be tailored to local context and needs, the different groups of people who might be accessing the services, their previous experiences and preconceptions, and current service provision, with local needs assessments and drug trends/toxicology data being used to help inform decision making on the most suitable model. These findings align with other studies regarding the accessibility of DCS: whilst community-based services receive multiple samples of drugs, they reach a relatively small proportion of people who use drugs [ 34 , 49 – 51 ]. Participants in our study did not identify one approach as being the most appropriate but, instead, talked about a range of different options, including a combination of different approaches, service types and staffing.…”

Section: Discussionsupporting

confidence: 90%

'It’s not going to be a one size fits all': a qualitative exploration of the potential utility of three drug checking service models in Scotland

Carver,

Falzon,

Masterton

et al. 2023

Harm Reduct J

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Background Scotland currently has the highest rates of drug-related deaths in Europe, so drug checking services are being explored due to their potential role in reducing these deaths and related harms. Drug checking services allow individuals to submit presumed psychoactive drug samples for analysis, and then receive individualised feedback and counselling. This paper explores participants’ views on the advantages and challenges of three hypothetical service models, to inform future service delivery in Scotland. Methods Semi-structured interviews were conducted with 43 people: 27 professional stakeholders, 11 people with experience of drug use, and five family members across three cities. Vignettes were used to provide short descriptions of three hypothetical service models during the interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Results Participants identified advantages and challenges for each of the three potential service models. The third sector (not-for-profit) model was favoured overall by participants, and the NHS substance use treatment service was the least popular. Participants also noted that multiple drug checking sites within one city, along with outreach models would be advantageous, to meet the diverse needs of different groups of people who use drugs. Conclusions Drug checking services need to be tailored to local context and needs, with a range of service models being possible, in order to meet the needs of a heterogeneous group of people who use drugs. Addressing issues around stigma, accessibility, and concerns about the potential impact of accessing drug checking on access to and outcomes of drug treatment, are essential for successful service delivery.

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Section: Discussionsupporting

confidence: 90%

'It’s not going to be a one size fits all': a qualitative exploration of the potential utility of three drug checking service models in Scotland

Carver,

Falzon,

Masterton

et al. 2023

Harm Reduct J

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“…In Canada, for example, federal exemptions have been granted to implement drug checking services, but the process is time-consuming and fraught with logistical difficulties. Such uncertainty makes providers wary and, for structurally vulnerable communities, may reduce the likelihood of use [48,50,51,64].…”

Section: Discussionmentioning

confidence: 99%

“…Drug checking may provide additional channels to spread warnings about contaminants by word of mouth among communities of PWUDs [11,12,14,15]. Willingness to use services is complicated by social factors, including trust, stigma, and fears of police [48,50,51]. Research has also highlighted that people using drugs alone or in economically deprived conditions may have far fewer options to avoid risks post-test, e.g., they may not be in a position to not use drugs that have been confirmed to entail increased risk by drug checking analysis [41,48].…”

Section: Introductionmentioning

confidence: 99%

Insights from Drug Checking Programs: Practicing Bootstrap Public Health Whilst Tailoring to Local Drug User Needs

Ondocsin

Ciccarone

Moran

et al. 2023

IJERPH

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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.

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“…[30][31][32][33] Willingness to use FTS is reported in 5 studies, ranging from 43%-85% of study participants. [33][34][35][36][37] Notably, interest in FTS use is not always motivated by avoiding fentanyl, as the proliferation of fentanyl into the drug market has led some PWUD preferring fentanyl as their drug of choice. 2,30,34,38,39 Participants in many studies agreed that testing should occur when obtaining a new batch of drugs, purchasing from a new seller, purchasing a large amount, using drugs that look different than prior, using what has been described as a "strong" batch, purchasing from an area with high levels of overdose, or selling to others.…”

Section: Acceptability Of Fts Use By Communitymentioning

confidence: 99%

Fentanyl Test Strips for Harm Reduction: A Scoping Review

Kutscher,

Barber Grossi,

LaPolla

et al. 2024

J Addict Med

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Background High potency synthetic opioids like fentanyl have continued to replace or contaminate the supply of illicit drugs in North America, with fentanyl test strips (FTSs) often used as a harm reduction tool for overdose prevention. The available evidence to support FTS for harm reduction has yet to be summarized. Methods A search of PubMed, Ovid Embase, and Web of Science was conducted in March 2023. A 2-stage review was conducted to screen by title and abstract and then by full text by 2 reviewers. Data were extracted from each study using a standardized template. Results A total of 91 articles were included, mostly from North America, predominantly reporting on FTS along with other harm reduction tools, and all conducted after 2016. No randomized controlled trials are reported. Robust evidence exists supporting the sensitivity and specificity of FTS, along with their acceptability and feasibility of use for people who use drugs and as a public health intervention. However, limited research is available on the efficacy of FTS as a harm reduction tool for behavior change, engagement in care, or overdose prevention. Conclusions Though FTSs are highly sensitive and specific for point of care testing, further research is needed to assess the association of FTS use with overdose prevention. Differences in FTS efficacy likely exist between people who use opioids and nonopioid drugs, with additional investigation strongly needed. As drug testing with point-of-care immunoassays is embraced for nonfentanyl contaminants such as xylazine and benzodiazepines, increased investment in examining overdose prevention is necessary.

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Drug checking use and interest among people who inject drugs in Toronto, Canada

Cited by 10 publications

References 26 publications

'It’s not going to be a one size fits all': a qualitative exploration of the potential utility of three drug checking service models in Scotland

'It’s not going to be a one size fits all': a qualitative exploration of the potential utility of three drug checking service models in Scotland

Insights from Drug Checking Programs: Practicing Bootstrap Public Health Whilst Tailoring to Local Drug User Needs

Fentanyl Test Strips for Harm Reduction: A Scoping Review

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