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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.
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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.
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Moon KJ, Whitehead HD, Trinh A, Hasenstab KA, Hayes KL, Stanley D, Carter B, Barclay R, Lieberman M, Nawaz S. Enhancing drug checking services for supply monitoring: perspectives on implementation in syringe service programs in the USA. Harm Reduct J 2024; 21:11. [PMID: 38218980 PMCID: PMC10788002 DOI: 10.1186/s12954-023-00924-5] [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: 05/17/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
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.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heather D Whitehead
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Anne Trinh
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Kathleen L Hayes
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | | | | | | | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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