Correction to: Psychedelic Drug Checking: Analytical and Strategic Challenges in Harm Reduction for Classic Psychedelics.

Classic psychedelics such as LSD, psilocybin, and DMT from unregulated markets pose considerable risks through unknown adulterants and potencies. In this chapter, we explore the importance of drug checking in minimizing harm among users of classic psychedelics and examine the opportunities and challenges associated with intervention settings, analytical techniques, and risk communication strategies. Gas chromatography (GC) and liquid chromatography (LC) coupled with mass spectrometry (MS) provide the most reliable and comprehensive analysis results for classic psychedelics. However, they are relatively costly, stationary, and require legal permission to obtain reference standards. Combined presumptive tests, such as thin-layer chromatography (TLC) and reagent testing, offer a time-efficient and cost-effective approach to initial substance screening. For certain compounds, Fourier-transform infrared spectroscopy (FTIR) serves as a valuable complementary technique, although potent psychedelics, such as LSD and NBOMe on blotter paper or in diluted solution, and complex botanical matrices challenge its detection limit, requiring the use of multiple analytical methods to confirm results. Such combination can effectively prevent acute risks, while confirmatory instrumental analysis remains essential for ongoing monitoring and public health efforts. Alongside robust testing procedures, drug checking's consultative component is crucial for clarifying analytical constraints, promoting safer use practices, and offering referrals to health services. By identifying mislabeled samples and ensuring tailored risk communication, drug checking not only protects individual users but also informs the public and health professionals regarding dangerous or novel substances. This chapter situates drug checking as a key public health measure that reduces acute harm from misrepresented psychedelic substances while supporting monitoring efforts.

<div>Abstract</div><div><br></div><div>Background: The issue of drug checking at events such as music festivals has come to the fore in recent years both in New Zealand and other countries such as Australia and the UK. Drug checking, also referred to as pill testing, involves testing a small sample of a particular substance to determine what it contains. Alongside the actual testing drug checking services usually offer advice around how to take the substance more safely e.g. to keep hydrated, not to mix the substances together, and to avoid mixing alcohol and illegal substances. KnowYourStuff (KYSNZ) are a voluntary organisation that have been providing drug checking services at New Zealand festivals for approximately five years. KYSNZ operate in a grey legal area, making it difficult to provide a harm reduction focused service. For example, festival organisers could be prosecuted under s12 of the Misuse of Drugs Act (MODA) for openly having drug checking at their events.</div><div><br></div><div>Globally drug checking is not a new phenomenon and has been in existence in some countries such as the Netherlands since the 1990s. The international evidence so far about drug checking demonstrates that: it does not increase the use of illegal drugs; it does not encourage those who don’t use illegal drugs to start using them; behaviour change is evident when substances are not as sold; harm reduction advice is valued and acted upon by young people. Drug checking services often positively affect people’s behaviour and as such are an important harm reduction service, although drug checking is not just about the test itself - the information offered and advice given are important elements of drug checking services. Further, behaviour change should not be measured solely in terms of drug disposals as other behavioural changes are also important e.g. taking less, not mixing substances tested with other drugs or alcohol, as well as improvements in knowledge about harm reduction for service users. This research was undertaken to provide information and understanding about drug checking as a harm reduction intervention. Further, it aimed to explore both behavioural changes related to drug checking and attitudes towards drug checking services in New Zealand.</div><div>Methods: This mixed methods study gathered data via an online and in-situ survey as well as through structured and semi structured interviews. Four groups of people were interviewed: festival/event organisers; medical personnel who worked at festivals and events; volunteers working for KYSNZ; festival attendees/wider New Zealand public (recruited via the survey). Overall 66 people were interviewed, and 911 surveys were completed, with the final survey sample after cleaning totalling 861. The sample was a purposeful, focused, non-random sample.</div><div>Results - Survey: 68% of those who had used the services of KnowYourStuffNZ (KYSNZ) stated that they had changed their behaviour either through disposing of their substances after checking or through adhering to harm reduction advice. 87% of those who had used KYSNZ drug checking services stated that their knowledge of harm reduction had improved a great deal or a little. The survey results also found that the majority of participants (95%-97%) supported drug checking, thought that it reduced drug related harm, and supported the proposed change to s12 of the 1975 Misuse of Drugs Act (MODA) to give drug checking legal status legal.</div><div><br></div><div>Results – interviews: All of the groups that were interviewed thought that drug checking was an important harm reduction service and that it reduced drug-related harms. The interviewees noted that young people will take drugs regardless of their illegal status and that drug checking services were therefore a crucial harm reduction intervention. Festival organisers wanted to provide as safe an environment as possible for those attending their events and noted illegality as a barrier to providing drug checking services. Festival organisers who invited KYSNZ to their events noted fewer serious incidents related to illicit drug use and emphasised the importance of having drug checking at their events. Medical personnel who were interviewed noted the treatment problems that came with</div><div>festival attendees ingesting unknown substances, and supported drug checking as it enabled clear information about drugs that were circulating at particular events that might be dangerous. All 66 interviewees viewed drug checking as an important harm reduction initiative and believed that it reduced drug related harms.</div><div><br></div><div>Conclusions: The majority of people who had used the services of KnowYourStuffNZ changed their behaviour. This is in line with international evidence. Drug checking was recognised by research participants as an important harm reduction intervention that saved lives and kept young people as safe as possible when using illicit drugs. Drug use was also viewed by the majority of participants as a health issue and that it should be treated as such by supporting harm reduction initiatives such as drug checking. There is a high level of support to amend s.12 of the 1975 MODA to allow drug checking and make services like KYSNZ legal.</div>

<div>Abstract</div><div><br></div><div>Background: The issue of drug checking at events such as music festivals has come to the fore in recent years both in New Zealand and other countries such as Australia and the UK. Drug checking, also referred to as pill testing, involves testing a small sample of a particular substance to determine what it contains. Alongside the actual testing drug checking services usually offer advice around how to take the substance more safely e.g. to keep hydrated, not to mix the substances together, and to avoid mixing alcohol and illegal substances. KnowYourStuff (KYSNZ) are a voluntary organisation that have been providing drug checking services at New Zealand festivals for approximately five years. KYSNZ operate in a grey legal area, making it difficult to provide a harm reduction focused service. For example, festival organisers could be prosecuted under s12 of the Misuse of Drugs Act (MODA) for openly having drug checking at their events.</div><div><br></div><div>Globally drug checking is not a new phenomenon and has been in existence in some countries such as the Netherlands since the 1990s. The international evidence so far about drug checking demonstrates that: it does not increase the use of illegal drugs; it does not encourage those who don’t use illegal drugs to start using them; behaviour change is evident when substances are not as sold; harm reduction advice is valued and acted upon by young people. Drug checking services often positively affect people’s behaviour and as such are an important harm reduction service, although drug checking is not just about the test itself - the information offered and advice given are important elements of drug checking services. Further, behaviour change should not be measured solely in terms of drug disposals as other behavioural changes are also important e.g. taking less, not mixing substances tested with other drugs or alcohol, as well as improvements in knowledge about harm reduction for service users. This research was undertaken to provide information and understanding about drug checking as a harm reduction intervention. Further, it aimed to explore both behavioural changes related to drug checking and attitudes towards drug checking services in New Zealand.</div><div>Methods: This mixed methods study gathered data via an online and in-situ survey as well as through structured and semi structured interviews. Four groups of people were interviewed: festival/event organisers; medical personnel who worked at festivals and events; volunteers working for KYSNZ; festival attendees/wider New Zealand public (recruited via the survey). Overall 66 people were interviewed, and 911 surveys were completed, with the final survey sample after cleaning totalling 861. The sample was a purposeful, focused, non-random sample.</div><div>Results - Survey: 68% of those who had used the services of KnowYourStuffNZ (KYSNZ) stated that they had changed their behaviour either through disposing of their substances after checking or through adhering to harm reduction advice. 87% of those who had used KYSNZ drug checking services stated that their knowledge of harm reduction had improved a great deal or a little. The survey results also found that the majority of participants (95%-97%) supported drug checking, thought that it reduced drug related harm, and supported the proposed change to s12 of the 1975 Misuse of Drugs Act (MODA) to give drug checking legal status legal.</div><div><br></div><div>Results – interviews: All of the groups that were interviewed thought that drug checking was an important harm reduction service and that it reduced drug-related harms. The interviewees noted that young people will take drugs regardless of their illegal status and that drug checking services were therefore a crucial harm reduction intervention. Festival organisers wanted to provide as safe an environment as possible for those attending their events and noted illegality as a barrier to providing drug checking services. Festival organisers who invited KYSNZ to their events noted fewer serious incidents related to illicit drug use and emphasised the importance of having drug checking at their events. Medical personnel who were interviewed noted the treatment problems that came with</div><div>festival attendees ingesting unknown substances, and supported drug checking as it enabled clear information about drugs that were circulating at particular events that might be dangerous. All 66 interviewees viewed drug checking as an important harm reduction initiative and believed that it reduced drug related harms.</div><div><br></div><div>Conclusions: The majority of people who had used the services of KnowYourStuffNZ changed their behaviour. This is in line with international evidence. Drug checking was recognised by research participants as an important harm reduction intervention that saved lives and kept young people as safe as possible when using illicit drugs. Drug use was also viewed by the majority of participants as a health issue and that it should be treated as such by supporting harm reduction initiatives such as drug checking. There is a high level of support to amend s.12 of the 1975 MODA to allow drug checking and make services like KYSNZ legal.</div>

Recently, there have been calls for pill testing to be introduced at music festivals. Advocates say that this would inform consumers and reduce risks. However, there are a number of technical and laboratory limitations of such an intervention that need to be considered. This editorial will highlight these limitations. The recent deaths and hospitalisation of young people from illicit drug use has led to calls for the introduction of on-site testing of tablets and capsules containing illicit drugs (‘pills’) at music festivals and events.1, 2 Pill testing, both on- and off-site, is available in several European countries, with individuals submitting samples for drug identification and purity analysis. These services are aimed at both harm minimisation and providing information on the availability and emergence of new psychoactive substances.3 Death and morbidity data are unavailable to ascertain the effectiveness or harm of this intervention. Advocates for pill testing argue that by providing information on content, the person can reconsider taking the pill.4 To support that, an online survey by the Australian National Council on Drugs reported that most young people supported pill testing being available and wanted access to reliable and balanced information so that they would be more equipped to make informed decisions about the risks of using drugs.5 A field survey of Swiss attendees at dance music events reported that respondents were receptive to harm reduction measures, including pill testing. However, 27.4% responded that they would never use pill testing; 31.1% would use it systematically before taking a pill, and 41.6% would not use unless they did not know the substance, dealer or both.6 The introduction of pill testing is perceived as a way to monitor pill composition and encourage information exchange. However, it is possible that information received from this may also be seen as affirming the quality and purity of the pill.7 The testing of illicit drug formulations does not guarantee the safety of the product or protect the person consuming the drug from harm. In a research report on ecstasy pill testing, the authors concluded that pill testing at best gave an artificial ‘shine of safety’, and other simpler harm reduction mechanisms were more likely to be effective.7 Although some would consider some information better than nothing, false reassurance because of false negative results is a concern. Thus, this editorial focuses on the technical and laboratory limitations of such an intervention. On-site pill testing procedures include pill identification, reagent testing kits and chromatographic techniques. Pill identification relies on visually comparing pills supplied by the consumer with formerly analysed pills. This approach has limited utility if testing is to be performed at different geographically distinct locations. Even if the tablets are similar in appearance, it assumes that each batch contains the same excipients and the same dose and that each tablet in a batch contains a uniform dose or that the same tablet press has not been used to manufacture another batch of tablets containing a different drug. Reagent testing involves mixing a small sample of powder scraped or removed from the illicit drug formulation with chemical reagents to produce a colour change. The class of drug present is identified by the colour produced. Some kits are labelled semi-quantitative and use colour intensity to classify tablet content from very low to very high. Problems with reagent testing include lack of specificity between similar compounds, cross-reactivity with non-related compounds producing incorrect results and the inability to detect other potentially dangerous compounds that may be present. As the distribution of the illicit drug in the tablet may not be uniform, samples taken from multiple scrapings of the same tablet surface may give results varying from little or no drug to high concentration. In terms of actual dose that will be administered, the interpretation of what low or very high means is variable. It may be argued that, given the flaws of pill identification and chemical reagent testing, sophisticated techniques, such as liquid or gas chromatography with mass spectrometry, could be employed for on-site pill testing. These techniques involve expensive and technical equipment and highly trained personnel just to undertake the analytical work. For chromatography to be effectively used, there needs to be a previously determined reference library of drugs, likely contaminants and harmful excipients in a tablet or capsule to which test samples can be matched. Any drug testing method needs to know what drug or chemical it is looking for. Therefore, unknown substances in a preparation may not be detected if the testing method is not set up to detect this. The analysis may find the substance it is looking for but miss a dangerous adulterant or, if a new designer drug is present that is not in the assay library, it could be missed completely. This testing method also suffers from the fact that a scraping or sample of powder from one tablet or capsule will not accurately reflect either the dose in that particular tablet or capsule or indeed the dose in any of the tablets or capsules from the same batch. Commonly used chromatographic testing will also not determine the ratio of isomers present if the drug is a racemic compound. Different processes used to manufacture the illicit drug may influence the ratio of each isomer present. As different isomers can vary significantly in potency and psychoactive effect, quantifying the total amount of drug present will not be a useful guide to pharmacological effect.7 Time taken for analysis is also a factor. A reagent test takes minutes, but how many potential pill takers would be willing to delay consumption for the still incomplete but more comprehensive chromatography testing, which may take hours depending on sample numbers. In comparison, production of tablets and capsules in the pharmaceutical industry is highly regulated and subject to strict quality control and safety guidelines to ensure products are safe for the consumer. Any tablet or capsule may contain diluents, disintegrant, binding agents and glidants in addition to the drug. Diluents are added to increase the powder mass. Tablets may also contain a binding agent to help the tablet maintain its shape after compression and a disintegrant so that the tablet breaks into small fragments when swallowed, aiding absorption. A glidant may be added to help powder flow evenly from the machine hopper into the tablet die or capsule shell. This ensures that each tablet or capsule contains the same amount of powder and therefore the same dose. The active ingredient and the excipients must undergo satisfactory mixing to ensure that every tablet or capsule contains the correct dose of drug. Determining the correct manufacturing procedure is in itself a time-consuming process that is strictly controlled. In registered pharmaceutical products, the active ingredient (drug) undergoes identity and purity testing to ensure that no harmful levels of residual ingredients, by-products or other contaminants are present. Excipients are also tested to ensure no effect on drug stability or the performance of the tablet or capsule when administered. During and post-production, tablets and capsules undergo tests, such as uniformity of content and weight, to ensure that each tablet or capsule produced contains the appropriate dose and dissolution and disintegration testing to ensure that the tablet or capsule will disintegrate, and the drug will dissolve at an appropriate rate to produce the desired effect. The stability of the drug in the dosage form over time is also tested to ensure that the drug does not break down to inactive or toxic products. In distinction, the production of illicit drug formulations is not controlled. Illicit drug dosage forms are not subject to any quality control measures, meaning that whilst a drug may be sold as ‘drug X’, it may in fact contain pure drug, no drug, another drug or a toxic or non-toxic diluent. The stability of an illicit drug in the formulation is not known, and there is less, if any, data on potential toxicity of decomposition products. Even if the product contains the active ingredient, it may also contain dangerous by-products of the drug synthesis process. Mixing of ingredients prior to preparing the tablets and capsules is unlikely to be satisfactory, resulting in uneven distribution of drug through the powder bed. This will result in some tablets from the same batch having very little drug while others have a very high dose. As distribution of drug within a tablet or capsule is usually not uniform, a portion of powder taken from one part of a tablet by scraping the surface of the tablet or by opening the capsule for testing may not be representative of what the entire tablet or capsule contains. The pharmacological effects of illicit drugs or other excipients also appear to have been forgotten. Even if the likely drug and dose is determined, drugs exhibit inter-individual variability in their pharmacokinetics and pharmacodynamics. The same dose of drug administered to different people may produce markedly different responses. Observed differences may be because of any number of factors, including genetic polymorphism, interaction with other co-administered drugs and physiological factors affecting drug distribution and elimination. Formulations may also influence how much of the illicit drug is absorbed. If a tablet disintegrates rapidly, a rapid rise in plasma drug concentration may occur, whereas if the tablet does not disintegrate in the gastrointestinal tract, the drug may not be released from the formulation. A delayed release of the drug resulting in delayed onset of action may result in the consumer taking additional pills, thinking the pills they have are ‘weak’.7 For many illicit drugs, the full pharmacological spectrum of action is not known. The lack of pharmacokinetic data for many illicit drugs also poses a concern in an emergency situation with illicit drug intoxication. Often, the pharmacological and toxicological effects of other excipients, by-products and contaminants are not known, producing an unpredictable spectrum of effect. Even reflecting on the small percentage of potential analytical factors discussed here, it is evident that the consumer considering taking an illicit drug may have a false sense of security, particularly if their decision to take the drug is based only on information provided by quantitative and qualitative on-site pill testing. The failure to detect an agent that could be life-threatening is of great concern. Although the ‘harm reduction’ argument is noted, equally, the many unknown and potentially unidentifiable factors that could cause mortality are noted. On-site testing will thus not solve this problem and could lead to other problems of an unpredictable and tragic nature.

BackgroundAs drug checking becomes more integrated within public health responses to the overdose crisis, and potentially more institutionalized, there is value in critically questioning the impacts of drug checking as a harm reduction response.MethodsAs part of a pilot project to implement community drug checking in Victoria, BC, Canada, in-depth interviews (N = 27) were held with people who use or have used substances, family or friends of people who use substances, and/or people who make or distribute substances. Critical harm reduction and social justice perspectives and a socioecological model guided our analysis to understand the potential role of drug checking within the overdose crisis, from the perspective of prospective service users.ResultsParticipants provided insight into who might benefit from community drug checking and potential benefits. They indicated drug checking addresses a “shared need” that could benefit people who use substances, people who care for people who use substances, and people who sell substances. Using a socioecological model, we identified four overarching themes corresponding to benefits at each level: “drug checking to improve health and wellbeing of people who use substances”, “drug checking to increase quality control in an unregulated market”, “drug checking to create healthier environments”, and “drug checking to mediate policies around substance use”.ConclusionsDrug checking requires a universal approach to meet the needs of diverse populations who use substances, and must not be focused on abstinence based outcomes. As a harm reduction response, community drug checking has potential impacts beyond the individual level. These include increasing power and accountability within the illicit drug market, improving the health of communities, supporting safer supply initiatives and regulation of substances, and mitigating harms of criminalization. Evaluation of drug checking should consider potential impacts that extend beyond individual behaviour change and recognize lived realities and structural conditions.

ObjectivesUnpredictable fluctuations in the illicit drug market increase overdose risk. Drug checking, or the use of technology to provide insight into the contents of illicit drug products, is an overdose prevention strategy with an emerging evidence base. The use of portable spectrometry devices to provide point-of-service analysis of the contents of illicit drugs been adopted by harm reduction organizations internationally but is only emerging in the United States. This study aimed to identify barriers and facilitators of implementing drug checking services with spectrometry devices in an urban harm reduction organization and syringe service program serving economically marginalized people who use drugs in Boston, Massachusetts (USA).MethodsIn-vivo observations and semi-structured interviews with harm reduction staff and participants were conducted between March 2019 and December 2020. We used the consolidated framework for implementation research to identify implementation barriers and facilitators.ResultsThis implementation effort was facilitated by the organization’s shared culture of harm reduction—which fostered shared implementation goals and beliefs about the intervention among staff persons—its horizontal organizational structure, strong identification with the organization among staff, and strong relationships with external funders. Barriers to implementation included the technological complexity of the advanced spectroscopy devices utilized for drug checking. Program staff indicated that commercially available spectroscopy devices are powerful but not always well-suited for drug checking efforts, describing their technological capacities as “the Bronze Age of Drug Checking.” Other significant barriers include the legal ambiguity of drug checking services, disruptive and oppositional police activity, and the responses and programmatic changes demanded by the COVID-19 pandemic.ConclusionsFor harm reduction organizations to be successful in efforts to implement and scale drug checking services, these critical barriers—especially regressive policing policies and prohibitive costs—need to be addressed. Future research on the impact of policy changes to reduce the criminalization of substance use or to provide explicit legal frameworks for the provision of this and other harm reduction services may be merited.

BackgroundDrug checking is a harm reduction strategy which allows users to check the content and purity of illicit drugs. Although drug checking has been trialled internationally, with demonstrated value as a harm reduction and health promotion strategy, the use of such services in Australia remains a contentious issue.This study aimed to investigate the proportion and patterns of illicit drug use among young people, their attitudes towards drug checking at festivals and the potential impact of drug checking on intended drug use behaviour.MethodsThe survey was conducted at a major Australian music festival in 2016. Data was collected from a sample of festival attendees (n = 642) aged between 18 and 30 years. A descriptive analysis of the data was performed.ResultsNearly three-quarters (73.4%) of participants reported that they had used illicit drugs in the past 12 months, most commonly cannabis (63.9%) and ecstasy (59.8%). A large proportion of participants believed ‘somewhat’ or ‘a lot’ that drug checking services could help users seek help to reduce harm (86.5%) and that drug checking services should be combined with harm reduction advice (84.9%). However, two thirds of the participants agreed ‘somewhat’ or ‘a lot’ that drug sellers may use this service as a quality control mechanism (68.6%). Approximately half (54.4%) indicated they would be highly likely and a third (32.7%) would be somewhat likely to utilise free drug checking services should they be available at music festivals. When asked whether the results of drug checking would influence their drug use behaviour, participants reported that they would not take substances shown to contain methamphetamine (65.1%), ketamine (57.5%) or para-methoxyamphetamine (PMA) (58.4%).ConclusionThe majority of festival attendees aged 18–30 participating in this study reported a history of illicit drug use and were in favour of the provision of free drug checking at festivals. A considerable proportion reported that the results of drug checking would influence their drug use behaviour. The findings of this study can contribute to the debate regarding whether drug checking services could potentially play a major role in harm reduction and health promotion programming for young people attending festivals.

Classic psychedelics such as psilocybin and lysergic acid diethylamide are anecdotally associated with the phenomenon of "psychedelic afterglow," a set of predominantly pleasant, temporary psychological effects reported after the acute effects have subsided. Since post-acute effects are crucial for the therapeutic use of psychedelics, an instrument to systematically assess subacute "afterglow" effects is needed. To create and validate a questionnaire to quantify the subacute "afterglow" effects of psychedelics. An international online survey was conducted in English and German. Participants who had consumed a psychedelic (N = 1323) or another non-psychedelic substance (control group, N = 157) within the past 4 weeks were included. An initial list of 97 items was progressively reduced to 24 items. A 5-factor structure best fit the data and showed high internal consistency. The factors included (1) vitality, (2) transpersonal aspects, (3) inspiration/creativity, (4) interpersonal relationships, and (5) relationship to nature. The final 24-item version of the Afterglow Inventory (AGI) effectively differentiated between the psychedelic group and the control group. The overall AGI score positively correlated with the intensity (r = 0.165; p < 0.001) and positive valence (r = 0.251; p < 0.001) of the acute psychedelic effects. The AGI is a novel scale for quantifying positive subacute ("afterglow") effects of psychedelics. The use of the AGI could lead to a better understanding of the interplay between acute, subacute, and long-term effects of psychedelics. Insights could also be gained into how different substances, dosages, and extra-pharmacological factors, such as psychotherapy, might influence outcomes.

Classical psychedelics induce complex visual hallucinations in humans, generating percepts that are co-herent at a low level, but which have surreal, dream-like qualities at a high level. While there are many hypotheses as to how classical psychedelics could induce these effects, there are no concrete mechanistic models that capture the variety of observed effects in humans, while remaining consistent with the known pharmacological effects of classical psychedelics on neural circuits. In this work, we propose the “oneirogen hypothesis”, which posits that the perceptual effects of classical psychedelics are a result of their pharmacological actions inducing neural activity states that truly are more similar to dream-like states. We simulate classical psychedelics’ effects via manipulating neural network models trained on perceptual tasks with the Wake-Sleep algorithm. This established machine learning algorithm leverages two activity phases, a perceptual phase (wake) where sensory inputs are encoded, and a generative phase (dream) where the network internally generates activity consistent with stimulus-evoked responses. We simulate the action of psychedelics by partially shifting the model to the ‘Sleep’ state, which entails a greater influence of top-down connections, in line with the impact of psychedelics on apical dendrites. The effects resulting from this manipulation capture a number of experimentally observed phenomena including the emergence of hallucinations, increases in stimulus-conditioned variability, and large increases in synaptic plasticity. We further provide a number of testable predictions which could be used to validate or invalidate our oneirogen hypothesis.

Classical psychedelics induce complex visual hallucinations in humans, generating percepts that are co-herent at a low level, but which have surreal, dream-like qualities at a high level. While there are many hypotheses as to how classical psychedelics could induce these effects, there are no concrete mechanistic models that capture the variety of observed effects in humans, while remaining consistent with the known pharmacological effects of classical psychedelics on neural circuits. In this work, we propose the “oneirogen hypothesis”, which posits that the perceptual effects of classical psychedelics are a result of their pharmacological actions inducing neural activity states that truly are more similar to dream-like states. We simulate classical psychedelics’ effects via manipulating neural network models trained on perceptual tasks with the Wake-Sleep algorithm. This established machine learning algorithm leverages two activity phases, a perceptual phase (wake) where sensory inputs are encoded, and a generative phase (dream) where the network internally generates activity consistent with stimulus-evoked responses. We simulate the action of psychedelics by partially shifting the model to the ‘Sleep’ state, which entails a greater influence of top-down connections, in line with the impact of psychedelics on apical dendrites. The effects resulting from this manipulation capture a number of experimentally observed phenomena including the emergence of hallucinations, increases in stimulus-conditioned variability, and large increases in synaptic plasticity. We further provide a number of testable predictions which could be used to validate or invalidate our oneirogen hypothesis.

Interest of drug checking supply: Results of 3 years of activity in Geneva

The immunomodulatory effects of classical psychedelics: A systematic review of preclinical studies

BackgroundThe current illicit drug overdose crisis within North America and other countries requires expanded and new responses to address unpredictable and potentially lethal substances, including fentanyl analogues, in the unregulated drug market. Community-wide drug checking is being increasingly explored as one such public health response. We explored how drug checking could be implemented as a potential harm reduction response to the overdose crisis, from the perspective of potential service users.MethodsThe research was guided by the Consolidated Framework for Implementation Research (CFIR). We conducted a qualitative, pre-implementation study to inform development and implementation of drug checking services that are acceptable to people who use substances and meet their needs. University and community researchers conducted 27 in-depth interviews with potential service users at prospective drug checking sites. We inductively developed emerging themes to inform the implementation of drug checking services within the five domains of the CFIR, and identified the most relevant constructs.ResultsImplementing community drug checking faces significant challenges within the current context of criminalization and stigmatization of substance use and people who use/sell drugs, and trauma experienced by potential service users. Participants identified significant risks in accessing drug checking, and that confidential and anonymous services are critical to address these. Engaging people with lived experience in the service can help establish trust. The relative advantage of drug checking needs to outweigh risks through provision of accurate results conveyed in a respectful, non-judgemental way. Drug checking should provide knowledge relevant to using and/or selling drugs and informing one’s own harm reduction.ConclusionsFor service users, the extent to which the implementation of drug checking can respond to and mitigate the risks of being criminalized and stigmatized is critical to the acceptability and success of community drug checking. The culture and compatibility of the service, setting and staff with harm reduction principles and practices is essential.

Canadian harm reduction policies: A comparative content analysis of provincial and territorial documents, 2000–2015

BackgroundWith many drug-related deaths driven by potent synthetic opioids tainting the illicit drug supply, drug checking services are becoming a key harm reduction strategy. Many drug checking technologies are available, ranging from fentanyl test strips to mass spectrometry. This study aimed to identify key considerations when implementing drug checking technologies and services to support harm reduction initiatives.MethodsKey informant interviews were conducted with harm reduction stakeholders throughout Illinois. Participants included members of existing drug checking services and recovery centers. Interviews were recorded, transcribed, and coded by two researchers using the framework method. Findings were contextualized according to micro (client)-, meso (organization)-, and macro (policy)-level themes.ResultsSeven interviews were conducted with ten participants. Fourier transform infrared spectroscopy was consistently identified as a technology of choice given its accuracy, range of substance detection, portability, and usability. Recommendations included the use of confirmatory testing, which can help address the limitations of technologies and provide a mechanism to train technicians. Locations of drug checking services should maximize public health outreach and leverage existing harm reduction agencies and staff with lived experience, who are critical to developing trust and rapport with clients. Criminalization and loss of privacy were major concerns for clients using drug checking services. Additional issues included the need to raise awareness of the legitimacy of services through public support from governing bodies, and funding to ensure the sustainability of drug checking services.ConclusionsThis research facilitated the identification of issues and recommendations from stakeholders around key considerations for the adoption of drug checking technologies, which not only included the cost and technical specifications of instrumentation, but also broader issues such as accessibility, privacy, and well-trained personnel trusted by clients of the service. Successful implementation of drug checking services requires knowledge of local needs and capacity and an in-depth understanding of the target population.