Evaluating networked drug checking services in Toronto, Ontario: study protocol and rationale

N Maghsoudi,L Barnaby,D R Beriault,T M Watson,J Altenberg,L Kufner,C Stefan,D Werb,K Mcdonald,J Caldwell,K W Tupper,R Nisenbaum,A I Scheim,R D Macdonald,P Leece,K Mason

doi:10.1186/s12954-019-0336-0

Abstract

BackgroundThe increasing incidence of fatal opioid overdose is a public health crisis in Canada. Given growing consensus that this crisis is related to the presence of highly potent opioid adulterants (e.g., fentanyl) in the unregulated drug supply, drug checking services (DCS) have emerged as part of a comprehensive approach to overdose prevention. In Canada’s largest city, Toronto, a network of DCS launched in 2019 to prevent overdose and overdose-related risk behaviors. This network employs mass spectrometry technologies, with intake sites co-located with supervised consumption services (SCS) at three frontline harm reduction agencies. The protocol and rationale for assessing the impact of this multi-site DCS network in Toronto is described herein. The aims of this study are to (1) evaluate the impact of DCS access on changes in and factors influencing overdose and related risk behaviors, (2) investigate the perceived capacity of DCS to prevent overdose, and (3) identify composition (qualitative and quantitative) trends in Toronto’s unregulated drug supply.MethodsWe will use a parallel-mixed-methods design with complementary data sources (including data from chemical analysis of drug samples, quantitative intake and post-test surveys, SCS, coroners, paramedic services, and qualitative interviews), followed by a meta-inference process wherein results from analyses are synthesized.ResultsWhereas most DCS globally target “recreational drug users,” in Toronto, this networked DCS will primarily target marginalized people who use drugs accessing frontline services, many of whom use drugs regularly and by injection. This evolution in the application of DCS poses important questions that have not yet been explored, including optimal service delivery models and technologies, as well as unique barriers for this population. Increasing information on the unregulated drug supply may modify the risk environment for this population of people who use drugs.ConclusionsThis study addresses evidence gaps on the emerging continuum of overdose prevention responses and will generate critical evidence on a novel approach to reducing the ongoing high incidence of drug-related morbidity and mortality in Canada and elsewhere.

Highlights

The increasing incidence of fatal opioid overdose is a public health crisis in Canada
drug checking services (DCS) are intended to provide people who use drugs with critical information so they can make informed decisions and take action prior to their use of unregulated drugs, thereby possibly preventing overdose from occurring in the first place. This is important given that an examination of the current risk environment experienced by people who use drugs in Toronto suggests that, while the emergence of fentanyl and fentanyl analogs in the unregulated drug supply is a macro-level factor in the increased incidence of fatal overdose and drug-related harm, social, economic, and policy barriers constrain the capacity of individuals to avoid overdose risk [34, 35]
DCS have only targeted “recreational drug users,” and no DCS colocated with SCS and using Liquid chromatography (LC)- or Gas chromatography (GC)-Mass spectrometry (MS) have been scientifically evaluated

Summary

Introduction

The increasing incidence of fatal opioid overdose is a public health crisis in Canada. Given growing consensus that this crisis is related to the presence of highly potent opioid adulterants (e.g., fentanyl) in the unregulated drug supply, drug checking services (DCS) have emerged as part of a comprehensive approach to overdose prevention. In Canada’s largest city, Toronto, a network of DCS launched in 2019 to prevent overdose and overdose-related risk behaviors. This network employs mass spectrometry technologies, with intake sites co-located with supervised consumption services (SCS) at three frontline harm reduction agencies. With 308 opioid-related deaths in 2017, the country’s largest city, Toronto, Ontario, has experienced a 125% increase in deaths compared to 2015 [4].

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