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Grace Rose C, Kulbokas V, Carkovic E, Lee TA, Pickard AS. Contextual factors affecting the implementation of drug checking for harm reduction: a scoping literature review from a North American perspective. Harm Reduct J 2023; 20:124. [PMID: 37667312 PMCID: PMC10478363 DOI: 10.1186/s12954-023-00856-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The opioid epidemic continues to be a significant cause of morbidity and mortality in the US. In 2020, 83% of opioid-related overdose deaths were due to synthetic opioids, such as fentanyl. Drug checking services have been widely implemented as a harm reduction intervention to facilitate the identification of substances in a drug sample. There is a need to inform decision-making on drug checking technologies and service implementation. This research aims to outline contextual considerations for the implementation of a drug checking service. METHODS A scoping review was conducted using a structured search strategy in PubMed and EMBASE. Articles were independently screened by two reviewers, and included if they were primary literature and reported on an actionable consideration(s) for drug checking services. Data elements were extracted using a standardized form, and included study design, study population, drug checking technology utilized or discussed, and main findings. RESULTS Twenty-nine articles were selected for inclusion, and four primary areas of consideration were identified: drug checking technologies, venue of a drug checking service, legality, and privacy. Technological considerations include the need for highly accurate, quantitative results which appeal to both populations of people with drug use disorder and recreational users. Accessibility of services was identified as an important factor that may be impacted by the location, integration with other services, how the service is provided (mobile vs. fixed), and the hours of operation. Maintaining plausible deniability and building trust were seen as important facilitators to service use and engagement. Issues surrounding legality were the most frequently cited barrier by patrons, including fear of criminalization, policing, and surveillance. Patrons and stakeholders identified a need for supportive policies that offer protections. Maintaining anonymity for patrons is crucial to addressing privacy-related barriers. CONCLUSION This review highlights the need to understand the local population and climate for drug checking to implement a drug checking service successfully. Common themes identified in the literature included considerations related to the choice of technology, the type of venue, and the impact of legality and privacy. We intend to utilize these considerations in future research to help guide discussions with US-based stakeholders.
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Affiliation(s)
- Chloe Grace Rose
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Emir Carkovic
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, 833 S Wood St, Chicago, IL, 60612, USA.
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Ji J, Zhang Y, Zhang Y, Chang J, Wang A, Zhou H, Liu Y, Wang J. Direct analysis in real-time tandem mass spectrometry method for the rapid screening of 11 new psychoactive substances in blood and urine. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2023; 37 Suppl 1:e9515. [PMID: 37013363 DOI: 10.1002/rcm.9515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/05/2023] [Accepted: 03/29/2023] [Indexed: 05/26/2023]
Abstract
RATIONALE With the continuous renewal of new psychoactive substances (NPS), the abuse of NPS has seriously harmed social security and public safety. The number of deaths from the abuse of NPS is increasing year by year. Therefore, there is an immediate need to develop an effective method for detecting NPS. METHODS Direct analysis in real-time tandem mass spectrometry (DART-MS/MS) was used to detect 11 NPS in blood and urine. The temperature of the ion source was optimized and set to 400°C. The mixture solvent of acetonitrile/methanol (4:1, v/v) was used as the precipitant. SKF-525 (2-(diethylamino)ethyl 2,2-diphenylpentanoate) was selected as the internal standard for quantification. After the pretreatment of the analytes in blood or urine, the supernatant was prepared for instrumental analysis. RESULTS The results indicated that the correlation coefficients (r2 ) of all analytes ranged from 0.99 to 1 in the linear range. The recoveries of 11 analytes at three spiked levels ranged between 83.4% and 110.4% in blood and between 81.7% and 108.5% in urine. The matrix effects of 11 analytes ranged between 79.5% and 109.5% in blood and between 85.0% and 109.4% in urine. The relative standard deviations of intra-day and inter-day precisions and repeatability were lower than 12.4%, 14.1%, and 14.3% in blood and lower than 11.4%, 13.9%, and 14.3% in urine, respectively. CONCLUSION The method established for the detection of 11 NPS could meet the needs for the rapid screening of NPS samples. The DART-MS/MS method has the advantages of being efficient, fast, and green. Therefore, it may become a promising technology for the detection of NPS in the future.
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Affiliation(s)
- Jiahua Ji
- School of Criminal Investigation, People's Public Security University of China, Beijing, China
- Institute of Forensic Science, Ministry of Public Security, Beijing, China
| | - Yunfeng Zhang
- Institute of Forensic Science, Ministry of Public Security, Beijing, China
- State Key Laboratory of Precision Measurement Technology and Instruments, Department of Precision Instrument, Tsinghua University, Beijing, China
| | - Ying Zhang
- Forensic Science Service of Beijing Public Security Bureau, Key Laboratory of Forensic Toxicology, Ministry of Public Security, Beijing, China
| | - Jing Chang
- Institute of Forensic Science, Ministry of Public Security, Beijing, China
| | - Aihua Wang
- Institute of Forensic Science, Ministry of Public Security, Beijing, China
| | - Hong Zhou
- Institute of Forensic Science, Ministry of Public Security, Beijing, China
| | - Yao Liu
- Institute of Forensic Science, Ministry of Public Security, Beijing, China
| | - Jifen Wang
- School of Criminal Investigation, People's Public Security University of China, Beijing, China
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Affiliation(s)
- David Love
- United States Drug Enforcement Administration, Special Testing and Research Laboratory, USA
| | - Nicole S. Jones
- RTI International, Applied Justice Research Division, Center for Forensic Sciences, 3040 E. Cornwallis Road, Research Triangle Park, NC, 22709-2194, USA,70113th Street, N.W., Suite 750, Washington, DC, 20005-3967, USA,Corresponding author. RTI International, Applied Justice Research Division, Center for Forensic Sciences, 3040 E. Cornwallis Road, Research Triangle Park, NC, 22709-2194, USA.
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4
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Virmani I, Oteo A, Dunn M, Vidler D, Roper C, Officer J, Hardy G, Dargan PI, Eddleston M, Cooper JG, Hill SL, Macfarlane R, Keating L, Haden M, Hudson S, Thomas SHL. Accuracy of substance exposure history in patients attending emergency departments after substance misuse; a comparison with biological sample analysis. Clin Toxicol (Phila) 2023; 61:39-46. [PMID: 36322622 DOI: 10.1080/15563650.2022.2131566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Acute toxicity caused by illicit substance use is a common reason for emergency department (ED) presentation. Knowledge of the substances involved is helpful for predicting and managing potential toxicity, but limited information is available about the accuracy of patient-reported substance exposure. This study assessed the accuracy of the history of exposure in those reporting use of a single substance by comparison with those identified by detailed toxicological analysis, focusing on synthetic cannabinoid receptor agonists (SCRA). METHODS Adults (≥16 years) presenting between March 2015 and July 2021 to participating UK hospitals with toxicity after reporting use of a single illicit substance were included. Exposure details were documented from medical records and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry (HRAM LCMS). Sensitivity, specificity, and positive and negative predictive values of the exposure history were calculated by comparison with biological sample analysis ("gold standard"). RESULTS Single substance exposure was reported for 474 (median age 33 years, IQR: 18 range 16-75, 80% males) patients. Analysis commonly identified multiple substances (Median 3, IQR 2-5). A history of exposure was documented for 121 of 151 patients where a SCRA or metabolite was detected on analysis (sensitivity 80.1%, 95% CI 72.9, 86.2%). Corresponding proportions were lower for 3,4-methylenedioxymethamphetamine (MDMA, 44/70, 62.9%., 95% CI 50.5%, 74.1%), heroin 41/108 (38.0% 95% CI 28.8-47.8%) and cocaine (22/56, 31.3%, 95% CI 20.9, 43.6%). CONCLUSIONS Multiple undeclared substances were detected analytically in most patients reporting single substance use. Clinicians should be alert to the potential presence and toxicity of unreported substances when managing patients presenting after substance misuse.
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Affiliation(s)
- Ishita Virmani
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Alberto Oteo
- Addictions and Inclusion Directorate, Department of Health and Social Care, Office for Health Improvement & Disparities, London, UK
| | - Michael Dunn
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Daniel Vidler
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Clair Roper
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Jane Officer
- Scottish Police Authority Forensic Services, Edinburgh, UK
| | - Gareth Hardy
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Paul I Dargan
- Clinical Toxicology, Guys & St Thomas' NHS Foundation Trust, London and Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michael Eddleston
- Pharmacology, Toxicology & Therapeutics, University of Edinburgh, Edinburgh, UK
| | | | - Simon L Hill
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
| | | | - Liza Keating
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Mark Haden
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Simon Hudson
- LGC Sport and Specialised Analytical Services, Fordham, UK
| | - Simon H L Thomas
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
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5
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Delaney SR, Konforte D, Stefan C, Palaty J, Sun D, McDonald K, Thompson H, Werb D, Beriault DR. Drug checking services as a surveillance tool for clinical laboratories: Examining trends in the unregulated fentanyl supply. Clin Biochem 2023; 111:11-16. [PMID: 36379241 DOI: 10.1016/j.clinbiochem.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Timely assessment and understanding of drug trends is essential for clinical laboratories to effectively respond to the overdose epidemic. In this proof-of-concept study, we sought to determine whether information obtained through Toronto's Drug Checking Services (DCS) and cross-provincial urine drug testing (UDT) data can be used as a surveillance tool for clinical laboratories and discuss the value of collaboration between the clinical laboratory, clinicians, and community partners to optimize patient care. DESIGN & METHODS Mass spectrometry-based UDT data from LifeLabs Ontario (n = 127,529) and British Columbia (n = 14,848), and drug checking data from Toronto DCS (n = 3,308 drugs or used paraphernalia) was collected between August 2020 and October 2021. Fentanyl co-positivity with toxic adulterants such as benzodiazepine-related drugs and fentanyl analogues were examined. RESULTS The percent co-positivity of fentanyl with etizolam, flualprazolam, flubromazolam, carfentanil, and acetylfentanyl in both Ontario UDT and DCS drugs/used paraphernalia showed similar trends. Regional differences in co-positivity with etizolam and fentanyl analogues were noted between Ontario and British Columbia UDT with patterns consistent over the entire 15-month collection period. CONCLUSIONS Clinical laboratories should connect with their local DCS, if available, to understand and monitor unregulated drug trends. These data can be used as an important tool to help clinical laboratories tailor their UDT menus and thereby provide a community-focused service to improve patient care.
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Affiliation(s)
- Sarah R Delaney
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine, St. Michael's Hospital, Toronto, ON, Canada; Toronto's Drug Checking Service, Canada.
| | | | - Cristiana Stefan
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada; Toronto's Drug Checking Service, Canada; Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Karen McDonald
- Toronto's Drug Checking Service, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Hayley Thompson
- Toronto's Drug Checking Service, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Dan Werb
- Toronto's Drug Checking Service, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Daniel R Beriault
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine, St. Michael's Hospital, Toronto, ON, Canada; Toronto's Drug Checking Service, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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6
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Implementation and Uptake of the Massachusetts Drug Supply Data Stream: A Statewide Public Health-Public Safety Partnership Drug Checking Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:S347-S354. [PMID: 36194805 PMCID: PMC9531987 DOI: 10.1097/phh.0000000000001581] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT The illicit drug supply is rapidly evolving. Equally important to gathering drug supply data for monitoring is timely sharing of information with people who use drugs, the providers who care for them, law enforcement partners, and public health stakeholders so that efforts to avoid harmful substances, take preventive actions, and better target interventions can occur. PROGRAM The Massachusetts Drug Supply Data Stream (MADDS) is the country's first statewide community drug checking program. Founded on public health-public safety partnerships, MADDS collects remnant drug packaging and paraphernalia with residue from people who use drugs and noncriminal samples from partnering police departments. MADDS tests samples using simultaneous immunoassay fentanyl test strips, Fourier-transform infrared spectrometry (FTIR), and off-site laboratory testing by gas chromatography-mass spectrometry (GC/MS). Results are accessible to community programs and municipalities, while trend analyses inform public health for cross-site alerts and informational bulletins. IMPLEMENTATION MADDS was launched statewide in 2020 and rapidly expanded to a multisite program. Program staff approached communities and met with municipal police and community partners to secure written agreements to host drug checking. Community partners designed sample collection consistent with their pandemic era workflows. Consultations with stakeholders gathered feedback on design and deliverables. EVALUATION The program tests sample donations on-site from community agencies and police departments, incorporates review by a medical toxicologist for health and safety concerns, crafts stakeholder-specific communications, and disseminates English, Spanish, and Portuguese language materials. For 2020, a total of 427 samples were tested, of which 47.1% were positive for fentanyl. By early 2021, MADDS detected shifts in cocaine purity, alerted communities of a new toxic fentanyl analogue and a synthetic cannabinoid contaminant, and confirmed the increase of xylazine (a veterinary sedative) in Massachusetts. DISCUSSION Community drug checking programs can be collaboratively designed with public health and public safety to generate critical health and safety information for people who use drugs and the communities where they live.
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Masterton W, Falzon D, Burton G, Carver H, Wallace B, Aston EV, Sumnall H, Measham F, Gittins R, Craik V, Schofield J, Little S, Parkes T. A Realist Review of How Community-Based Drug Checking Services Could Be Designed and Implemented to Promote Engagement of People Who Use Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911960. [PMID: 36231262 PMCID: PMC9564958 DOI: 10.3390/ijerph191911960] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 05/06/2023]
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 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.
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Affiliation(s)
- Wendy Masterton
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
- Correspondence:
| | - Danilo Falzon
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Gillian Burton
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Hannah Carver
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Elizabeth V. Aston
- School of Applied Sciences, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool L2 2QP, UK
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool L69 7ZR, UK
- The Loop, Unclassified Community Interest Company, Manchester M13 9PL, UK
| | | | | | - Joe Schofield
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Simon Little
- Kinbank Social Research Consultancy, Tayport DD6 9AP, UK
| | - Tessa Parkes
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
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8
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Detection of the Synthetic Cannabinoids AB-CHMINACA, ADB-CHMINACA, MDMB-CHMICA, and 5F-MDMB-PINACA in Biological Matrices: A Systematic Review. BIOLOGY 2022; 11:biology11050796. [PMID: 35625524 PMCID: PMC9139075 DOI: 10.3390/biology11050796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
Simple Summary Synthetic cannabinoids were originally developed for scientific research and potential therapeutic agents. However, clandestine laboratories synthesize them and circumvent legal barriers by falsely marketing them as incense or herbal products. They have serious adverse effects, and new derivatives are continuously found in the market, making their detection difficult due to the lack of comparative standards. Human matrices are used to identify the type of synthetic cannabinoid and the time of its consumption. This review discusses the use of hair, oral fluid, blood, and urine in the detection and quantification of some of the major synthetic cannabinoids. Based on the results, some recommendations can be followed, for example, the use of hair to detect chronic and retrospective consumption (although sensitive to external contamination) and oral fluid or blood for the simultaneous detection of the parent compounds and their metabolites. If longer detection times than blood or oral fluid are needed, urine is the matrix of choice, although its pH may intervene in the analysis. This work highlights the use of new techniques, such as high-resolution mass spectrometry, to avoid the use of previous standards and to monitor new trends in the drug market. Abstract New synthetic cannabinoids (SCs) are emerging rapidly and continuously. Biological matrices are key for their precise detection to link toxicity and symptoms to each compound and concentration and ascertain consumption trends. The objective of this study was to determine the best human biological matrices to detect the risk-assessed compounds provided by The European Monitoring Centre for Drugs and Drug Addiction: AB-CHMINACA, ADB-CHMNACA, MDMB-CHMICA, and 5F-MDMB-PINACA. We carried out a systematic review covering 2015 up to the present date, including original articles assessing detection in antemortem human biological matrices with detailed validation information of the technique. In oral fluid and blood, SC parent compounds were found in oral fluid and blood at low concentrations and usually with other substances; thus, the correlation between SCs concentrations and severity of symptoms could rarely be established. When hair is used as the biological matrix, there are difficulties in excluding passive contamination when evaluating chronic consumption. Detection of metabolites in urine is complex because it requires prior identification studies. LC-MS/MS assays were the most widely used approaches for the selective identification of SCs, although the lack of standard references and the need for revalidation with the continuous emergence of new SCs are limiting factors of this technique. A potential solution is high-resolution mass spectrometry screening, which allows for non-targeted detection and retrospective data interrogation.
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9
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Scarfone KM, Maghsoudi N, McDonald K, Thompson H, Stefan C, Beriault DR, Werb D, Bowles JM. Emerging synthetic cannabinoids detected by a drug checking service in Toronto, Canada. Clin Toxicol (Phila) 2022; 60:979-984. [PMID: 35546568 DOI: 10.1080/15563650.2022.2069575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Toronto's Drug Checking Service (DCS) provides people who use drugs with information on the chemical composition of their substances and conducts real-time monitoring of the unregulated drug supply. Presented are first known data of three newly detected synthetic cannabinoids (SCs) in Toronto, Ontario. METHODS The present data are from samples analyzed between April and November 2020. Samples were collected at partnering harm reduction agencies in Toronto and analyzed using gas or liquid chromatography-mass spectrometry. An intake survey queried about the sample characteristics on submission, including expected drug(s). RESULTS Samples were analyzed between 1 April and 20 November 2020 (N = 19), which marks the period immediately following imposed COVID-19 border and movement restrictions in Canada. The newly detected, unexpected SCs were ACHMINACA (n = 15), AB-FUBINACA (n = 3), and 4-fluoro-MDMB-BUTINACA (n = 1). Fentanyl was expected in 74% (n = 14). Most SCs were detected in samples containing fentanyl or related analogues (n = 18; 95%), or benzodiazepine-related drugs (i.e., etizolam and flualprazolam) (n = 15; 79%). CONCLUSIONS This information can inform overdose prevention efforts and drug market monitoring of SCs in Toronto and regions served by the same drug trafficking routes. The detection of SCs during a period marked by COVID-19-related restrictions can contribute to efforts to identify global drug market trends during this time.
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Affiliation(s)
- K M Scarfone
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - N Maghsoudi
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - K McDonald
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - H Thompson
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - C Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Canada
| | - D R Beriault
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - D Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - J M Bowles
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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10
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McNeil R, Fleming T, Mayer S, Barker A, Mansoor M, Betsos A, Austin T, Parusel S, Ivsins A, Boyd J. Implementation of Safe Supply Alternatives During Intersecting COVID-19 and Overdose Health Emergencies in British Columbia, Canada, 2021. Am J Public Health 2022; 112:S151-S158. [PMID: 35262376 PMCID: PMC8965179 DOI: 10.2105/ajph.2021.306692] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To explore the implementation and effectiveness of the British Columbia, Canada, risk mitigation guidelines among people who use drugs, focusing on how experiences with the illicit drug supply shaped motivations to seek prescription alternatives and the subsequent impacts on overdose vulnerability. Methods. From February to July 2021, we conducted qualitative interviews with 40 people who use drugs in British Columbia, Canada, and who accessed prescription opioids or stimulants under the risk mitigation guidelines. Results. COVID-19 disrupted British Columbia's illicit drug market. Concerns about overdose because of drug supply changes, and deepening socioeconomic marginalization, motivated participants to access no-cost prescription alternatives. Reliable access to prescription alternatives addressed overdose vulnerability by reducing engagement with the illicit drug market while allowing greater agency over drug use. Because prescriptions were primarily intended to manage withdrawal, participants supplemented with illicit drugs to experience enjoyment and manage pain. Conclusions. Providing prescription alternatives to illicit drugs is a critical harm reduction approach that reduces exposure to an increasingly toxic drug supply, yet further optimizations are needed. (Am J Public Health. 2022;112(S2):S151-S158. https://doi.org/10.2105/AJPH.2021.306692).
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Affiliation(s)
- Ryan McNeil
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Taylor Fleming
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Samara Mayer
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Allison Barker
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Manal Mansoor
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Alex Betsos
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Tamar Austin
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Sylvia Parusel
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Andrew Ivsins
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Jade Boyd
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
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Maghsoudi N, Tanguay J, Scarfone K, Rammohan I, Ziegler C, Werb D, Scheim AI. Drug checking services for people who use drugs: a systematic review. Addiction 2022; 117:532-544. [PMID: 34729849 PMCID: PMC9299873 DOI: 10.1111/add.15734] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/14/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Drug checking services provide people who use drugs with chemical analysis results of their drug samples while simultaneously monitoring the unregulated drug market. We sought to identify and synthesize literature on the following domains: (a) the influence of drug checking services on the behaviour of people who use drugs; (b) monitoring of drug markets by drug checking services; and (c) outcomes related to models of drug checking services. METHODS Systematic review. A systematic literature search was conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Scopus, Web of Science and Dissertations and Theses Global. Eligible studies were peer-reviewed articles and conference abstracts or grey literature, published in any language since 1990 and including original data on the domains. We assessed risk of bias for quantitative peer-reviewed articles reporting on behaviour or models of drug checking services using National Institutes of Health tools. RESULTS We screened 2463 titles and abstracts and 156 full texts, with 90 studies meeting inclusion criteria. Most (n = 65, 72.2%) were from Europe and used cross-sectional designs (n = 79, 87.7%). Monitoring of drug markets by drug checking services (n = 63, 70%) was the most reported domain, followed by the influence of drug checking services on behaviour (n = 31, 34.4%), including intent to use, actual use and disposal of the drug, and outcomes related to models of drug checking services (n = 17, 18.9%). The most common outcome measures were detection of unexpected substances (n = 50, 55.6%), expected substances (n = 44, 48.9%), new psychoactive substances (n = 40, 44.4%) and drugs of concern (n = 32, 36.5%) by drug checking services. CONCLUSIONS Drug checking services appear to influence behavioural intentions and the behaviour of people who use drugs, particularly when results from drug checking services are unexpected or drugs of concern. Monitoring of drug markets by drug checking services is well established in Europe, and increasingly in North America. Concerns about drug contents and negative health consequences facilitate the use of drug checking services; lack of concern; trust in drug sellers; lack of accessibility of drug checking services; and legal and privacy concerns are barriers to use.
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Affiliation(s)
- Nazlee Maghsoudi
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
| | - Justine Tanguay
- Munk School of Global Affairs and Public PolicyUniversity of TorontoTorontoONCanada
| | - Kristy Scarfone
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoONCanada
| | - Indhu Rammohan
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
| | | | - Dan Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Division of Infectious Diseases and Global Public Health, School of MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Ayden I. Scheim
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPAUSA
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Tobias S, Grant CJ, Laing R, Arredondo J, Lysyshyn M, Buxton J, Tupper KW, Wood E, Ti L. Time-Series Analysis of Fentanyl Concentration in the Unregulated Opioid Drug Supply in a Canadian Setting. Am J Epidemiol 2022; 191:241-247. [PMID: 33977304 DOI: 10.1093/aje/kwab129] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
North America has been contending with an unregulated street drug supply in which opioids are often adulterated with illicitly manufactured fentanyl. The unpredictability of composition may result in an increased risk of overdose due to unexpected elevated concentrations of the high-potency drug. Using data from a community-based drug-checking project, we evaluated trends in fentanyl concentration of illicit opioids in the context of an overdose epidemic. Using a quantification model for fentanyl hydrochloride, historical Fourier-transform infrared spectra from opioid drug-checking samples were analyzed to determine fentanyl concentrations. Median monthly fentanyl concentrations were plotted, and polynomial and autoregressive time-series analyses were performed to examine trends over time. A total of 3,621 fentanyl-positive samples were included in the study, spanning November 2017 to December 2019. Monthly median fentanyl concentrations ranged from 4.5% to 10.4%. Time-series analyses indicated that a third-degree polynomial model fit the data well (R2 = 0.639), suggesting a cyclical pattern in median concentration over time. Notably, absolute variance in fentanyl concentration decreased by an average 0.1% per month (P < 0.001). Future research should explore the relationship between fentanyl concentration and overdose to identify potential targeted harm-reduction interventions that can respond to changes in observed fentanyl concentration.
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Dasgupta N, Figgatt MC. Invited Commentary: Drug Checking for Novel Insights Into the Unregulated Drug Supply. Am J Epidemiol 2022; 191:248-252. [PMID: 34528056 PMCID: PMC8824693 DOI: 10.1093/aje/kwab233] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
Tobias et al. (Am J Epidemiol. 2022;191 (2):241–247) present a novel analysis of time trends in fentanyl concentrations in the unregulated drug supply in British Columbia, Canada. The preexisting knowledge about unregulated drugs had come from law-enforcement seizures and postmortem toxicology. As both of these data sources are subject to selection bias, large-scale drug-checking programs are poised to be a crucial component of the public health response to the unrelenting increase in overdose in North America. As programs expand, we offer 2 guiding principles. First, the primary purpose of these programs is to deliver timely results to people who use drugs to mitigate health risks. Second, innovation is needed to go beyond criminal justice paradigms in laboratory analysis for a more nuanced understanding of health concerns. We provide examples of the role adulterants play in our understanding of drug harms. We also describe the applications and limitations of common laboratory assays, with implications for epidemiologic surveillance. While the research and direct service teams in British Columbia have taken groundbreaking steps, there is still a need to establish best practices for communicating results to sample donors in an approachable yet nonalarmist tone.
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Affiliation(s)
- Nabarun Dasgupta
- Correspondence to Dr. Nabarun Dasgupta, University of North Carolina Injury Prevention Research Center, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27514 (e-mail: )
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