The potential impacts of community drug checking within the overdose crisis: qualitative study exploring the perspective of prospective service users

Dennis Hore,Flora Pagan,Bernadette Pauly,Bruce Wallace,Thea Van Roode

doi:10.1186/s12889-021-11243-4

Abstract

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.

Highlights

As 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 within this context [6]
Groves (2018) [7] argues that most evaluations of drug checking have focused on individual behaviour change, asking “what would people do?” Here, effectiveness is often measured in abstinence terms such as individuals’ disposal or nonuse of their tested substances
The principal investigator (BW) and two research associates (TvD & FP) reviewed, coded and compared initial themes that inductively emerged on a small subset of transcripts. Based on this and feedback from community interviewers on any themes that they detected from the interviews, we developed an initial coding structure to understand potential impacts of drug checking services, from the perspective of prospective service users

Summary

Introduction

As 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. As 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 within this context [6]. Groves (2018) [7] argues that most evaluations of drug checking have focused on individual behaviour change, asking “what would people do?” Here, effectiveness is often measured in abstinence terms such as individuals’ disposal or nonuse of their tested substances He argues that a more pragmatic approach to drug checking is required, stating “abstinence is a goal that displays ignorance of reality”. It is critical to better understand the potential role of community-wide drug checking within this context of inequities, stigmatization and criminalization and rapidly changing technologies

Methods

Results

Discussion

Conclusion