Towards cross-Canada monitoring of the unregulated street drug supply

Emily Biggar,Kristi Papamihali,Jane A Buxton,Doris Payer,Bridget Maloney-Hall,Brittany Graham,Marliss Taylor,Pascale Leclerc,Elaine Hyshka

doi:10.1186/s12889-021-11757-x

Abstract

BackgroundThe well-being of people who use drugs (PWUD) continues to be threatened by substances of unknown type or quantity in the unregulated street drug supply. Current efforts to monitor the drug supply are limited in population reach and comparability. This restricts capacity to identify and develop measures that safeguard the health of PWUD. This study describes the development of a low-barrier system for monitoring the contents of drugs in the unregulated street supply. Early results for pilot sites are presented and compared across regions.MethodsThe drug content monitoring system integrates a low-barrier survey and broad spectrum urine toxicology screening to compare substances expected to be consumed and those actually in the drug supply. The system prototype was developed by harm reduction pilot projects in British Columbia (BC) and Montreal with participation of PWUD. Data were collected from harm reduction supply distribution site clients in BC, Edmonton and Montreal between May 2018–March 2019. Survey and urine toxicology data were linked via anonymous codes and analyzed descriptively by region for trends in self-reported and detected use.ResultsThe sample consisted of 878 participants from 40 sites across 3 regions. Reported use of substances, their detection, and concordance between the two varied across regions. Methamphetamine use was reported and detected most frequently in BC (reported: 62.8%; detected: 72.2%) and Edmonton (58.3%; 68.8%). In Montreal, high concordance was also observed between reported (74.5%) and detected (86.5%) cocaine/crack use. Among those with fentanyl detected, the percentage of participants who used fentanyl unintentionally ranged from 36.1% in BC, 78.6% in Edmonton and 90.9% in Montreal.ConclusionsThis study is the first to describe a feasible, scalable monitoring system for the unregulated drug supply that can contrast expected and actual drug use and compare trends across regions. The system used principles of flexibility, capacity-building and community participation in its design. Results are well-suited to meet the needs of PWUD and inform the local harm reduction services they rely on. Further standardization of the survey tool and knowledge mobilization is needed to expand the system to new jurisdictions.

Highlights

Harms related to the unregulated street drug supply threaten the well-being of people who use drugs (PWUD)
Deaths are largely due to contamination of the unregulated drug supply with psychoactive substances of unknown type or quantity, such as fentanyl and its analogues [1] and benzodiazepines [2]
This study demonstrated the feasibility of using broad spectrum urine toxicology tests to examine contents of urine samples submitted by participants

Summary

Introduction

Harms related to the unregulated street drug supply threaten the well-being of people who use drugs (PWUD). Deaths are largely due to contamination of the unregulated drug supply with psychoactive substances of unknown type or quantity, such as fentanyl and its analogues [1] and benzodiazepines [2]. The well-being of people who use drugs (PWUD) continues to be threatened by substances of unknown type or quantity in the unregulated street drug supply. Current efforts to monitor the drug supply are limited in population reach and comparability. This restricts capacity to identify and develop measures that safeguard the health of PWUD. This study describes the development of a low-barrier system for monitoring the contents of drugs in the unregulated street supply. Results for pilot sites are presented and compared across regions

Methods

Results

Conclusion