Enhancing drug checking services for supply monitoring: perspectives on implementation in syringe service programs in the USA.
Drug checking
Drug supply
Fentanyl test strips
Harm reduction
Immunoassay strips
Implementation research
LC–MS
Overdose prevention
Public health
Journal
Harm reduction journal
ISSN: 1477-7517
Titre abrégé: Harm Reduct J
Pays: England
ID NLM: 101153624
Informations de publication
Date de publication:
13 Jan 2024
13 Jan 2024
Historique:
received:
17
05
2023
accepted:
29
12
2023
medline:
14
1
2024
pubmed:
14
1
2024
entrez:
13
1
2024
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 38218980
doi: 10.1186/s12954-023-00924-5
pii: 10.1186/s12954-023-00924-5
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
11Subventions
Organisme : Berthiaume Institute for Precision Health at the University of Notre Dame
ID : Substance Abuse Fund
Organisme : Berthiaume Institute for Precision Health at the University of Notre Dame
ID : Substance Abuse Fund
Organisme : Berthiaume Institute for Precision Health at the University of Notre Dame
ID : Substance Abuse Fund
Organisme : Indiana Clinical and Translational Sciences Institute
ID : UL1TR002529
Organisme : Indiana Clinical and Translational Sciences Institute
ID : UL1TR002529
Organisme : Indiana Clinical and Translational Sciences Institute
ID : UL1TR002529
Organisme : National Science Foundation
ID : IIP-2016516
Organisme : National Science Foundation
ID : IIP-2016516
Organisme : National Science Foundation
ID : IIP-2016516
Informations de copyright
© 2024. The Author(s).
Références
Kariisa M, Seth P, Jones CM. Increases in disparities in US drug overdose deaths by race and ethnicity: opportunities for clinicians and health systems. JAMA. 2022;328:421–2.
pubmed: 35853029
doi: 10.1001/jama.2022.12240
Lee H, Singh GK. Estimating the impact of the COVID-19 pandemic on rising trends in drug overdose mortality in the United States, 2018–2021. Ann Epidemiol. 2023;77:85–9.
pubmed: 36455852
doi: 10.1016/j.annepidem.2022.11.007
Ciccarone D. Fentanyl in the US heroin supply: a rapidly changing risk environment. Int J Drug Policy. 2017;46:107–11.
pubmed: 28735776
pmcid: 5742018
doi: 10.1016/j.drugpo.2017.06.010
Tanz LJ, Dinwiddie AT, Mattson CL, O’Donnell J, Davis NL. Drug overdose deaths among persons aged 10–19 years—United States, July 2019–December 2021. Morb Mortal Wkly Rep. 2022;71:1576–82.
doi: 10.15585/mmwr.mm7150a2
Palamar JJ. Awareness that cocaine can contain fentanyl among nightclub and festival attendees in New York City, 2018–2022. Public Health Nurs. 2023;40:1–6.
doi: 10.1111/phn.13193
Arya S, Nagappala S, Krawczyk N, Gi Y, Meacham MC, Bunting AM. Fentanyl in pressed oxycodone pills: a qualitative analysis of online community experiences with an emerging drug trend. Subst Use Misuse. 2022;57:1940–5.
pubmed: 36106770
pmcid: 9909751
doi: 10.1080/10826084.2022.2120365
Friedman J, Montero F, Bourgois P, Wahbi R, Dye D, Goodman-Meza D, et al. Xylazine spreads across the US: a growing component of the increasingly synthetic and polysubstance overdose crisis. Drug Alcohol Depend. 2022;233:109380.
pubmed: 35247724
pmcid: 9128597
doi: 10.1016/j.drugalcdep.2022.109380
Alexander RS, Canver BR, Sue KL, Morford KL. Xylazine and overdoses: trends, concerns, and recommendations. Am J Public Health. 2022;112:1212–6.
pubmed: 35830662
doi: 10.2105/AJPH.2022.306881
Laing MK, Ti L, Marmel A, Tobias S, Shapiro AM, Laing R, et al. An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: preliminary results from a community drug checking program using point-of-care and confirmatory methods. Int J Drug Policy. 2021;93:103169.
pubmed: 33627302
doi: 10.1016/j.drugpo.2021.103169
Aldy K, Mustaquim D, Campleman S, Meyn A, Abston S, Krotulski A, et al. Illicit benzodiazepines detected in patients evaluated in emergency departments for suspected opioid overdose—four states, October 6, 2020–March 9, 2021. MMWR Morb Mortal Wkly Rep. 2021;70:1177–9.
pubmed: 34437520
pmcid: 8389390
doi: 10.15585/mmwr.mm7034a4
Frank D, Krawczyk N, Arshonsky J, Bragg MA, Friedman SR, Bunting AM. Covid-19-related changes to drug-selling networks and their effects on people who use illicit opioids. J Stud Alcohol Drugs. 2022;84:222–9.
pubmed: 36971722
Cerdá M, Krawczyk N, Keyes K. The future of the united states overdose crisis: challenges and opportunities. Milbank Q. 2023;101:1–29.
doi: 10.1111/1468-0009.12602
Dasgupta N, Figgatt MC. Drug checking for novel insights into the unregulated drug supply. Am J Epidemiol. 2022;191:248–52.
pubmed: 34528056
doi: 10.1093/aje/kwab233
Palamar JJ, Salomone A, Barratt MJ. Drug checking to detect fentanyl and new psychoactive substances. Curr Opin Psychiatry. 2020;33:301–5.
pubmed: 32187173
pmcid: 7255931
doi: 10.1097/YCO.0000000000000607
Laing MK, Tupper KW, Fairbairn N. Drug checking as a potential strategic overdose response in the fentanyl era. Int J Drug Policy. 2018;62:59–66.
pubmed: 30359874
doi: 10.1016/j.drugpo.2018.10.001
Peiper NC, Clarke SD, Vincent LB, Ciccarone D, Kral AH, Zibbell JE. Fentanyl test strips as an opioid overdose prevention strategy: findings from a syringe services program in the Southeastern United States. Int J Drug Policy. 2019;63:122–8.
pubmed: 30292493
doi: 10.1016/j.drugpo.2018.08.007
Carroll JJ, Mackin S, Schmidt C, McKenzie M, Green TC. The Bronze Age of drug checking: barriers and facilitators to implementing advanced drug checking amidst police violence and COVID-19. Harm Reduct J. 2022;19:1–13.
doi: 10.1186/s12954-022-00590-z
Weicker NP, Owczarzak J, Urquhart G, Park JN, Rouhani S, Ling R, et al. Agency in the fentanyl era: exploring the utility of fentanyl test strips in an opaque drug market. Int J Drug Policy. 2020;84:102900.
pubmed: 32769054
doi: 10.1016/j.drugpo.2020.102900
Davis CS, Lieberman AJ, O’Kelley-Bangsberg M. Legality of drug checking equipment in the United States: a systematic legal analysis. Drug Alcohol Depend. 2022;234:109425.
pubmed: 35344879
doi: 10.1016/j.drugalcdep.2022.109425
Park JN, Frankel S, Morris M, Dieni O, Fahey-Morrison L, Luta M, et al. Evaluation of fentanyl test strip distribution in two Mid-Atlantic syringe services programs. Int J Drug Policy. 2021;94:103196.
pubmed: 33713964
doi: 10.1016/j.drugpo.2021.103196
Maghsoudi N, Tanguay J, Scarfone K, Rammohan I, Ziegler C, Werb D, et al. Drug checking services for people who use drugs: a systematic review. Addiction. 2022;117:532–44.
pubmed: 34729849
doi: 10.1111/add.15734
Karamouzian M, Dohoo C, Forsting S, McNeil R, Kerr T, Lysyshyn M. Evaluation of a fentanyl drug checking service for clients of a supervised injection facility, Vancouver, Canada. Harm Reduct J. 2018;15:46.
pubmed: 30200991
pmcid: 6131768
doi: 10.1186/s12954-018-0252-8
Whitehead HD, Hayes KL, Swartz JA, Prete E, Robison-Taylor L, Ellen Mackesy-Amiti M, et al. Validated method for the analysis of 22 illicit drugs and their metabolites via liquid chromatography tandem mass spectrometry (LC–MS/MS) in illicit drug samples collected in Chicago, IL. Forensic Chem. 2023;33:100475.
pubmed: 36910306
doi: 10.1016/j.forc.2023.100475
Reed MK, Imperato NS, Bowles JM, Salcedo VJ, Guth A, Rising KL. Perspectives of people in Philadelphia who use fentanyl/heroin adulterated with the animal tranquilizer xylazine; making a case for xylazine test strips. Drug Alcohol Depend Rep. 2022;4:100074.
pubmed: 36846574
pmcid: 9949306
doi: 10.1016/j.dadr.2022.100074
Glick JL, Christensen T, Nyeong Park J, McKenzie M, Green TC, Sherman SG. Stakeholder perspectives on implementing fentanyl drug checking: results from a multi-site study. Drug Alcohol Depend. 2019;194:527–32.
pubmed: 30551090
doi: 10.1016/j.drugalcdep.2018.10.017
Green TC, Park JN, Gilbert M, McKenzie M, Struth E, Lucas R, et al. An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples. Int J Drug Policy. 2020;77:102661.
pubmed: 31951925
doi: 10.1016/j.drugpo.2020.102661
Gozdzialski L, Wallace B, Hore D. Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations. Harm Reduct J. 2023;20:39.
pubmed: 36966319
pmcid: 10039693
doi: 10.1186/s12954-023-00764-3
Ti L, Tobias S, Lysyshyn M, Laing R, Nosova E, Choi J, et al. Detecting fentanyl using point-of-care drug checking technologies: a validation study. Drug Alcohol Depend. 2020;212:108006.
pubmed: 32438280
doi: 10.1016/j.drugalcdep.2020.108006
Perri M, Khorasheh T, Poon D-O, Kaminski N, LeBlanc S, Mizon L, et al. A rapid review of current engagement strategies with people who use drugs in monitoring and reporting on substance use-related harms. Harm Reduct J. 2023;20:169.
pubmed: 37964286
pmcid: 10648706
doi: 10.1186/s12954-023-00902-x
Tobias S, Shapiro AM, Wu H, Ti L. Xylazine identified in the unregulated drug supply in British Columbia, Canada. Can J Addict. 2020;11:28–32.
doi: 10.1097/CXA.0000000000000089
Bowles JM, McDonald K, Maghsoudi N, Thompson H, Stefan C, Beriault DR, et al. Xylazine detected in unregulated opioids and drug administration equipment in Toronto, Canada: clinical and social implications. Harm Reduct J. 2021;18:104.
pubmed: 34645480
pmcid: 8511847
doi: 10.1186/s12954-021-00546-9
Betzler F, Helbig J, Viohl L, Ernst F, Roediger L, Gutwinski S, et al. Drug checking and its potential impact on substance use. Eur Addict Res. 2021;27:25–32.
pubmed: 32535605
doi: 10.1159/000507049
Brunt TM, Niesink RJM. The drug information and monitoring system (DIMS) in the Netherlands: implementation, results, and international comparison. Drug Test Anal. 2011;3:621–34.
pubmed: 21898860
doi: 10.1002/dta.323
Lockwood TLE, Leong TX, Bliese SL, Helmke A, Richard A, Merga G, et al. idPAD: paper analytical device for presumptive identification of illicit drugs. J Forensic Sci. 2020;65:1289–97.
pubmed: 32227600
pmcid: 7332374
doi: 10.1111/1556-4029.14318
Hayes KL, Lieberman M. Considerations for the design and implementation of point-of-care technology for use in low- and middle-income countries. Nat Rev Methods Primers. 2023;3:8–9.
doi: 10.1038/s43586-023-00197-z
Whitehead HD. Development of analytical methods for highly selective and sensitive analysis of compounds relevant to human health and the environment. Notre Dame: University of Notre Dame; 2023.
Austin EJ, Corcorran MA, Briggs ES, Frost MC, Behrends CN, Juarez AM, et al. Barriers to engaging people who use drugs in harm reduction services during the COVID-19 pandemic: a mixed methods study of syringe services program perspectives. Int J Drug Policy. 2022;109:103825.
pubmed: 35977459
pmcid: 9364718
doi: 10.1016/j.drugpo.2022.103825
Kimergård A, McVeigh J. Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study. Harm Reduct J. 2014;11:1–13.
doi: 10.1186/1477-7517-11-19
Allen ST, O’Rourke A, Johnson JA, Cheatom C, Zhang Y, Delise B, et al. Evaluating the impact of naloxone dispensation at public health vending machines in Clark County, Nevada. Ann Med. 2022;54:2692–700.
pubmed: 36168975
pmcid: 9542801
doi: 10.1080/07853890.2022.2121418
Lockwood T-LE, Huynh P, Richard A, Sightes E, Bailey K, Ray B, et al. Community overdose surveillance: comparing substances collected from the death scene investigation to toxicology results. Drug Alcohol Depend. 2021;224:108722.
pubmed: 33932743
pmcid: 8180509
doi: 10.1016/j.drugalcdep.2021.108722
Duhart Clarke SE, Kral AH, Zibbell JE. Consuming illicit opioids during a drug overdose epidemic: Illicit fentanyls, drug discernment, and the radical transformation of the illicit opioid market. Int J Drug Policy. 2022;99:103467.
pubmed: 34662847
doi: 10.1016/j.drugpo.2021.103467
O’Donnell J, Tanz LJ, Gladden RM, Davis NL, Bitting J. Trends in and characteristics of drug overdose deaths involving illicitly manufactured fentanyls—United States, 2019–2020. MMWR Morb Mortal Wkly Rep. 2021;70:1740–6.
pubmed: 34914673
pmcid: 8675656
doi: 10.15585/mmwr.mm7050e3
McLean K, Monnat SM, Rigg K, Sterner GE, Verdery A. “You never know what you’re getting”: opioid users’ perceptions of fentanyl in Southwest Pennsylvania. Subst Use Misuse. 2019;54:955–66.
pubmed: 30676198
pmcid: 6476660
doi: 10.1080/10826084.2018.1552303
Dun C, Allen ST, Latkin C, Knowlton A, Weir BW. The changing epidemiology of opioid overdose in Baltimore, Maryland, 2012–2017: insights from emergency medical services. Ann Med. 2022;54:1738–48.
pubmed: 35775468
pmcid: 9255214
doi: 10.1080/07853890.2022.2079149
Gilbert M. Transparency and corruption: a general analysis. Univ Chicago Legal Forum. 2019;2018:117–38.
State of Ohio Integrated Behavioral Health Dashboard [Internet]. Data Ohio. 2023. Available from: https://data.ohio.gov/wps/portal/gov/data/view/ohio-ibhd .
The Columbus & Franklin County Addiction Plan [Internet]. Columbus Public Health. 2023. Available from: https://cfcap-columbus.hub.arcgis.com/ .
Dasgupta N. History and future of harm reduction in North Carolina: pragmatism and innovation. N Carol Med J. 2022;83:257–60.
Allen B, Feldman JM, Paone D. Public health and police: building ethical and equitable opioid responses. Proc Natl Acad Sci USA. 2021;118:e2118235118.
pubmed: 34732582
pmcid: 8609228
doi: 10.1073/pnas.2118235118
Dickinson T. Non-violent threats and promises among closed-market drug dealers. Int J Drug Policy. 2017;42:7–14.
pubmed: 28104571
doi: 10.1016/j.drugpo.2016.12.005
Latimore AD, Bergstein RS. “Caught with a body” yet protected by law? Calling 911 for opioid overdose in the context of the Good Samaritan Law. Int J Drug Policy. 2017;50:82–9.
pubmed: 29040841
doi: 10.1016/j.drugpo.2017.09.010
Rudolph AE, Young AM, Havens JR. A rural/urban comparison of privacy and confidentiality concerns associated with providing sensitive location information in epidemiologic research involving persons who use drugs. Addict Behav. 2017;74:106–11.
pubmed: 28609723
pmcid: 5544525
doi: 10.1016/j.addbeh.2017.06.006
Davis CS, Carr DH, Samuels EA. Paraphernalia laws, criminalizing possession and distribution of items used to consume illicit drugs, and injection-related harm. Am J Public Health. 2019;109:1564–7.
pubmed: 31536408
pmcid: 6775926
doi: 10.2105/AJPH.2019.305268
Palamar JJ, Acosta P, Sutherland R, Shedlin MG, Barratt MJ. Adulterants and altruism: a qualitative investigation of “drug checkers” in North America. Int J Drug Policy. 2019;74:160–9.
pubmed: 31610451
pmcid: 6893085
doi: 10.1016/j.drugpo.2019.09.017
Papp DM, Maki SA. S.B. 288. Columbus: State of Ohio Legislature; 2023.
Davis CS, Beletsky L. Bundling occupational safety with harm reduction information as a feasible method for improving police receptiveness to syringe access programs: evidence from three U.S. cities. Harm Reduct J. 2009;6:1–8.
doi: 10.1186/1477-7517-6-16
Beletsky L, Cochrane J, Sawyer AL, Serio-Chapman C, Smelyanskaya M, Han J, et al. Police encounters among needle exchange clients in Baltimore: drug law enforcement as a structural determinant of health. Am J Public Health. 2015;105:1872–9.
pubmed: 26180948
pmcid: 4539845
doi: 10.2105/AJPH.2015.302681
Greer A, Zakimi N, Butler A, Ferencz S. Simple possession as a ‘tool’: drug law enforcement practices among police officers in the context of depenalization in British Columbia, Canada. Int J Drug Policy. 2022;99:103471.
pubmed: 34600414
doi: 10.1016/j.drugpo.2021.103471
Smiley-McDonald HM, Attaway PR, Richardson NJ, Davidson PJ, Kral AH. Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone. Health Justice. 2022;10:1–13.
doi: 10.1186/s40352-022-00172-y
Maher L, Dixon D. Policing and public health. Br J Criminol. 1999;39:488–512.
doi: 10.1093/bjc/39.4.488
Krawczyk N, Jordan A, Cerdá M. Optimizing opioid settlement funds to save lives: investing in equitable solutions. Health Affairs Forefront. 2023;1–10.