1
|
Gozdzialski L, Louw R, Kielty C, Margolese A, Poarch E, Sherman M, Cameron F, Gill C, Wallace B, Hore D. Beyond a spec: assessing heterogeneity in the unregulated opioid supply. Harm Reduct J 2024; 21:63. [PMID: 38491435 PMCID: PMC10941387 DOI: 10.1186/s12954-024-00980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Drug checking services aim to provide compositional information for the illicit drug supply and are being employed in public health responses to extreme rates of overdose associated with fentanyl within street opioids. The technologies used within these services range from basic qualitative tests, such as immunoassay test strips, to comprehensive quantitative analyses, such as mass spectrometry. In general, there is concern that heterogeneity of a drug mixture adds significant uncertainty when using drug checking results based on a small subsamples. The presence of hot spots of active drug components in this context is often termed the 'chocolate chip cookie effect'. Establishing the limitations of the service are essential for interpretation of the results. METHODS This study assesses the consequence of drug heterogeneity and sampling of consumer level opioid purchased in Victoria, British Columbia ( n = 21 , 50-100 mg each) on quantitative fentanyl results determined from testing with paper spray mass spectrometry. RESULTS Using descriptive statistics, such as relative standard deviation and interquartile range, the results demonstrate varied distributions of fentanyl concentrations within a single drug batch. However, the presence of hot spots, defined as outliers, were relatively rare. CONCLUSIONS This study found that the variability in fentanyl concentration from drug heterogeneity and sampling is greater than that attributed to the analytical technique. On a practical level, this provides data to help guide communication of limitations of drug checking services, supporting the aim of trust and transparency between services and people who use drugs. However, if drug checking services continue to be restricted from fully engaging with the reality of manufacturing, buying, selling, mixing and dosing practices, the accuracy, usefulness, and impact will always be limited.
Collapse
Affiliation(s)
- Lea Gozdzialski
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Rebecca Louw
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Collin Kielty
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Ava Margolese
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Eric Poarch
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Miriam Sherman
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | | | - Chris Gill
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
- Applied Environmental Research Laboratories (AERL), Department of Chemistry, Vancouver Island University, Nanaimo, V9R 5S5, Canada
- Department of Chemistry, Simon Fraser University, Burnaby, V5A 1S6, Canada
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, 98195, USA
| | - Bruce Wallace
- School of Social Work, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Dennis Hore
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada.
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada.
- Department of Computer Science, University of Victoria, Victoria, V8W 3P6, Canada.
| |
Collapse
|
2
|
Reed MK, Borne E, Esteves Camacho T, Kelly M, Rising KL. Recommendations from people who use drugs in Philadelphia, PA about structuring point-of-care drug checking. Harm Reduct J 2024; 21:26. [PMID: 38287409 PMCID: PMC10825997 DOI: 10.1186/s12954-024-00937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/13/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Adulterants, such as fentanyl and xylazine, among others, are present in a high percentage of the illicit drug supply, increasing the risk for overdose and other adverse health events among people who use drugs (PWUD). Point-of-care drug checking identifies components of a drug sample and delivers results consumers. To successfully meet the diverse needs of PWUD, more information is needed about the utility of drug checking, motivations for using services contextualized in broader comments on the drug supply, hypothesized actions to be taken after receiving drug checking results, and the ideal structure of a program. METHODS In December 2021, semi-structured interviews were conducted with 40 PWUD who were accessing harm reduction services in Philadelphia, PA. Participants were asked about opinions and preferences for a future drug checking program. Interviews were audio recorded, transcribed and coded using content analysis to identify themes. RESULTS Participants were primarily White (52.5%) and male (60%). Heroin/fentanyl was the most frequently reported drug used (72.5%, n = 29), followed by crack cocaine (60.0%, n = 24) and powder cocaine (47.5%, n = 19). Emerging themes from potential drug checking consumers included universal interest in using a drug checking program, intentions to change drug use actions based on drug checking results, deep concern about the unpredictability of the drug supply, engaging in multiple harm reduction practices, and concerns about privacy while accessing a service. CONCLUSIONS We offer recommendations for sites considering point-of-care drug checking regarding staffing, safety, logistics, and cultural competency. Programs should leverage pre-existing relationships with organizations serving PWUD and hire people with lived experiences of drug use. They should work with local or state government to issue protections to people accessing drug checking programs and ensure the service is anonymous and that data collection is minimized to keep the program low-threshold. Programs will ideally operate in multiple locations and span "atmosphere" (e.g., from clinical to a drop-in culture), offer in-depth education to participants about results, engage with a community advisory board, and not partner with law enforcement.
Collapse
Affiliation(s)
- Megan K Reed
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Curtis Building, Suite 704, Philadelphia, PA, 19107, USA.
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA, 19107, USA.
- College of Population Health, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Elias Borne
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| | - Tracy Esteves Camacho
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| | - Morgan Kelly
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Curtis Building, Suite 704, Philadelphia, PA, 19107, USA
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| |
Collapse
|
3
|
Falzon D, Carver H, Masterton W, Wallace B, Sumnall H, Measham F, Craik V, Gittins R, Aston EV, Watson K, Hunter C, Priyadarshi S, Parkes T. Planning and implementing community-based drug checking services in Scotland: a qualitative exploration using the consolidated framework for implementation research. Subst Abuse Treat Prev Policy 2024; 19:7. [PMID: 38233933 PMCID: PMC10795311 DOI: 10.1186/s13011-023-00590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Drug checking services (DCS) provide harm reduction support and advice to individuals based on chemical analysis of submitted substances of concern. Whilst there are currently no DCS in Scotland, community-based services are being planned in three cities. METHODS In this paper, we report qualitative findings based on interviews with 43 participants, focused on perceptions of DCS and their implementation. Participants were relevant professionals, those with experience of drug use, and family members of those with experience of drug use. The Consolidated Framework for Implementation Research (CFIR) was used to inform data collection and analysis. We report findings under nine constructs/themes across the five CFIR domains. RESULTS Participants noted the importance of DCS being implemented in low-threshold, trusted services with a harm reduction ethos, and outlined a range of further service design considerations such as speed of testing, and information provided through the analysis process. In relation to the 'inner setting', a key finding related to the potential value of leveraging existing resources in order to expand both reach and effectiveness of drug trend communication. The approach of local and national police to DCS, and the attitudes of the public and local community, were described as important external factors which could influence the success (or otherwise) of implementation. Bringing together a range of stakeholders in dialogue and developing tailored communication strategies were seen as ways to build support for DCS. Overall, we found high levels of support and perceived need for DCS amongst all stakeholder groups. CONCLUSIONS Our findings present initial implementation considerations for Scotland which could be further explored as DCS are operationalised. Further, our focus on implementation contexts is relevant to research on DCS more generally, given the minimal consideration of such issues in the literature.
Collapse
Affiliation(s)
- Danilo Falzon
- Faculty of Social Sciences, University of Stirling, FK9 4LA, Stirling, UK.
| | - Hannah Carver
- Faculty of Social Sciences, University of Stirling, FK9 4LA, Stirling, UK
| | - Wendy Masterton
- Faculty of Social Sciences, University of Stirling, FK9 4LA, Stirling, UK
| | - Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, BCV8P 5C2, Victoria, Canada
| | - Harry Sumnall
- School of Psychology, Faculty of Health, Liverpool John Moores University, L2 2QP, Liverpool, UK
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, L69 7ZR, Liverpool, UK
- The Loop, Registered Charity, M13 9PL, Manchester, UK
| | | | | | - Elizabeth V Aston
- School of Applied Sciences, Edinburgh Napier University, EH11 4BN, Edinburgh, UK
| | - Kira Watson
- Scottish Ambulance Service, EH12 9EB, Edinburgh, UK
| | - Carole Hunter
- Alcohol and Drug Services, NHS Greater Glasgow and Clyde, G51 1DP, Glasgow, UK
| | - Saket Priyadarshi
- Alcohol and Drug Services, NHS Greater Glasgow and Clyde, G51 1DP, Glasgow, UK
| | - Tessa Parkes
- Faculty of Social Sciences, University of Stirling, FK9 4LA, Stirling, UK
| |
Collapse
|