Enhancing drug checking services for supply monitoring: perspectives on implementation in syringe service programs in the USA

Abstract

Background: Shifts in the US drug supply, including the proliferation of synthetic opioids and emergence of xylazine, have contributed to the worsening toll of the overdose epidemic. Drug checking services offer a critical intervention to promote agency among people who use drugs (PWUD) to reduce overdose risk. Current drug checking methods can be enhanced to contribute to supply-level monitoring in the USA, overcoming the selection bias associated with existing supply monitoring efforts and informing public health interventions.

Methods: As a group of analytical chemists, public health researchers, evaluators, and harm reductionists, we used a semi-structured guide to facilitate discussion of four different approaches for syringe service programs (SSPs) to offer drug checking services for supply-level monitoring. Using thematic analysis, we identified four key principles that SSPs should consider when implementing drug checking programs.

Results: A number of analytical methods exist for drug checking to contribute to supply-level monitoring. While there is likely not a one-size-fits-all approach, SSPs should prioritize methods that can (1) provide immediate utility to PWUD, (2) integrate seamlessly into existing workflows, (3) balance individual- and population-level data needs, and (4) attend to legal concerns for implementation and dissemination.

Conclusions: Enhancing drug checking methods for supply-level monitoring has the potential to detect emerging threats in the drug supply and reduce the toll of the worsening overdose epidemic.

Keywords: Drug checking; Drug supply; Fentanyl test strips; Harm reduction; Immunoassay strips; Implementation research; LC–MS; Overdose prevention; Public health.

Fig. 1

Summary of four low-barrier methods for drug checking services discussed for implementation in SSPs

Fig. 2

Three FTS (two lots manufactured by BTNX, one lot manufactured by DanceSafe) were run following manufacturer guidelines with aqueous solutions of 5000 ng/mL of each of the drugs or drug metabolites. Each strip was dried, stored for a week, then extracted with 5 mL of water/methanol 9:1 with sonication. Analysis of the amount of drug or drug metabolite that was extracted from the strip into the water/methanol solution was performed as previously described [23]

Fig. 3

Mock dashboard of overdose trends overlaid with supply-level monitoring. Data were constructed to provide an example of how drug checking data can be superimposed on overdose dashboards to assess geospatial and temporal trends to better understand associations between supply shifts and overdose risk [46, 47]