Checking Services Research Articles

Governing Access to Nationality Through Paperwork: The Discretionary Uses of Documentation for Naturalisation in Belgium, France and the United Kingdom

ABSTRACTIn this paper, we examine the discretionary uses of documentation in the implementation of naturalisation through a comparative perspective focusing on Belgium, France and the United Kingdom. We investigate the organisational and professional factors that are likely to impact variation in the uses of discretion based on documentation. Belgium, France and the United Kingdom represent three interesting case studies involving different actors with different mandates. In Belgium, municipal agents are responsible for a mandatory check of applicants' documents before transferring the naturalisation application to public prosecutors. While only the latter have the mandate to check that the legal requirements are met, most municipal agents are involved in the examination of the requirements. In France, before the digitisation of nationality acquisition in 2023, the initial acceptance of an application involved prefectural agents who had the power to refuse application registration if the documentation was deemed insufficient or ‘non‐compliant’. In the United Kingdom, ‘Nationality Checking Services’ (NCS) were available until 2019 in local register offices for an optional check of the application before the transfer to the Home Office, which remains the decision‐making body on nationality applications. As United Kingdom law regulates strictly immigration advice, NCSs were often unwilling to express themselves on the chances of an application. Drawing on ethnographic fieldwork consisting of interviews with implementation agents in the three countries and observations of their interactions with applicants, this paper contributes to shedding light on what drives variations in the governance of access to nationality through paperwork.

Implementation of a community-based LC-UV drug checking service: promising preliminary findings on feasibility and validity

BackgroundThe increasing diversity of psychoactive substances on the unregulated drug market poses significant health, psychological, and social risks to people who use drugs (PWUD). To address these risks, various harm reduction (HR) policies have been implemented, including drug checking services (DCS). Many analytical methods are used for DCS. While qualitative methods (e.g., thin layer chromatography, spectroscopy) are easier to implement, they are not as accurate as quantitative methods (e.g., LC-UV, LC-MS). Some HR programmes have implemented high-performance liquid chromatography coupled with UV detection (LC-UV). This article presents the cross-validation of this quantitative method with a reference liquid chromatography coupled with high resolution mass spectrometry (LC-HRMS) method.MethodsDrug samples were provided by PWUD to a DCS called DrugLab in Marseille, France. The samples were weighed and prepared through dissolution in methanol, followed by ultrasonic bathing. Samples were analysed onsite using LC-UV analysis. They were then subsequently analysed with the reference LC-HRMS method. The LC-UV instrument in DrugLab was calibrated after being purchased; analysis of standard solutions was routinely performed once a month and after maintenance operations. For the LC-HRMS instrument, calibration and quality control procedures followed European Medicines Agency (EMA) guidelines. Statistical analyses were conducted including Spearman correlation tests using IBM® SPSS® Statistics version 20.ResultsA total of 102 samples representing different product classes and cutting agents were cross-validated. Differences between both analyses methods for each molecule analysed were ≤ 20%, with significant correlations between both methods’ results for most substances. Notably, LC-HRMS provided lower concentration values for cocaine and acetaminophen, whereas it provided higher values for other substances. Correlations were significant for cocaine, ketamine, MDMA, heroin, amphetamine, caffeine, acetaminophen, and levamisole.ConclusionsThis study demonstrates that the results provided by DrugLab were accurate and reliable, making LC-UV an adaptable, stable, and suitable analytical method for simple matrices like drugs in a DCS context. However, this cross validation does not guarantee accuracy over time. A proficiency test project in HR laboratories across France is currently under development in order to address potential drifts in LC-UV accuracy.

‘I will not use it because the results are bad’ – understanding the influence of the drug checking service on changing consumption behavior

Background Based on the theories of reasoned action and planned behavior, this study aimed to investigate the impact of drug checking services (DCS) on clients’ consumption behavior and to assess the intention to use drugs based on DC results, underlying motives and the consistency between intention and actual behavior. Methods Two anonymous questionnaires were sent to the clients of a Slovenian integrated DCS (No = 364), the first when the DC results were returned by e-mail – including closed and open questions – and the second after 10–14 days to check whether the first intention was maintained. Results The results show that the information provided by the DCS fosters the intention to avoid the use when the substance tested is not the one expected (65.5% of cases), with a strong correlation between the level of health risk of the sample (adulterations, substance other than the one purchased) and attitudes towards drug use. Conclusion Although the results should be strengthened by including larger samples, the study has demonstrated the potential of DCS to reduce health risks, particularly among PWUD and provides an example of how the impact of DCS on behavioral choices can be investigated.

Misrepresentation of MDMA in the United States, 1999–2023

Background and AimsThe misrepresentation of illicit drugs in unregulated markets increases the risk of adverse health events. This study analyzed drug checking data to compare represented, expected, and actual content of alleged MDMA samples, estimate trends in the quality of the MDMA supply, document the presence of adulterants, compare patterns of adulteration, and validate drug checking against law enforcement data.Methods: The study analyzed 4,719 alleged MDMA samples submitted to the DrugsData drug checking service between 1999–2023. Measures captured characteristics and quality of the MDMA supply, including represented content, expected and actual content, sample form, and specific adulterants. Tests of association were conducted using Pearson’s chi-square or Spearman’s rho, and tests for trends were performed using joinpoint regression. Findings. Most samples (75%) were expected to contain MDMA, but this varied significantly by represented content (p<0.001). About half the samples (48%) contained MDMA-only, which also varied significantly by represented content (p<0.001). MDMA-only prevalence declined from 1999–2009 (57.4% to 15.2%, p<0.05), recovered from 2009–2017 (15.2% to 56.0%, p<0.05), and increases more moderately from 2017–2023 (56.0% to 74.1%, p<0.05). Overall, 199 unique adulterants were detected in the MDMA supply across 25 years. We confirmed robust correlations in adulterant prevalence trends between drug checking and law enforcement seizure data. Conclusions. While users typically expected alleged MDMA samples to contain only MDMA, more than half of the submitted MDMA samples were misrepresented in some manner. Despite high levels of misrepresentation, MDMA quality has stabilized at relatively high levels in recent years.

Opportunities and challenges for implementing drug checking services in British Columbia, Canada: A qualitative study

BackgroundAmidst the ongoing drug poisoning crisis across North America, drug checking services (DCS) are increasingly being implemented as an intervention intended to reduce drug-related harms. This study sought to identify key opportunities and challenges influencing the implementation of DCS in British Columbia (BC), Canada. MethodsBetween January 2020 and July 2021, semi-structured, in-depth interviews were conducted with 21 individuals involved in the implementation of DCS across BC (i.e., policymakers, health authority personnel, community organization representatives and service providers). The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis of the interviews. ResultsBy bringing in a wealth of knowledge about community needs and concerns, in addition to a passion and energy for social justice and health equity, community members and organizations with a dedication for harm reduction played a critical role in the successful implementation of DCS in BC. Other significant facilitators to implementation included the preventive benefits of DCS that made the intervention compelling to policy influencers and decision makers, the provincial public health emergency regarding overdose that shifted the regulatory environment of DCS, the adaptability of DCS to meet concerns and needs in various contexts, including via ongoing processes of reflection and evaluation. Barriers to implementation included criminalization and stigmatization of drug use and people who use drugs and lack of funding for community-led implementation actions. ConclusionsAlongside structural reforms that address the underlying contextual factors that influence implementation (e.g., decriminalization of drugs, increased funding for DCS), centering community expertise throughout implementation is critical to the success of DCS. Our findings provide important insights into how BC can successfully implement systems-level harm reduction interventions and offer insights for other jurisdictions in their implementation of DCS.

"The compounds for females are really commonly faked!": Women's challenges in anabolic steroid acquisition and the place of drug checking interventions.

Women who use drugs, particularly those using anabolic-androgenic steroids (AAS), encounter heightened social risks influenced by the legal status of AAS, varying regionally. In jurisdictions where AAS are legal, medical guidance and prescription are common, while in illegal regions, there are challenges associated with acquisition and safer usage. Therefore, we aimed to explore the experiences of women who use AAS in Australia, where these substances are criminalised, with a focus on the challenges they encounter in acquiring and using these drugs. We focused on data from six women in a broader study interviewing 15 AAS users. The data were subjected to iterative inductive analysis, resulting in two theme-categories. Women who use AAS face distinct challenges in accessing reliable suppliers, with men seemingly having 'easier' access. Women experience this disparity as increasing their vulnerability to unsafe products, further compounded by their lack of knowledge regarding these substances. Moreover, mislabelling and counterfeiting of female-specific AAS substances is described to further compound these risks, reflecting the participants' expressed need for enhanced intervention and quality control in the AAS market. Ensuring product reliability, transparency and accountability are perceived as essential for the health and safety of women who use AAS. To address these issues, interventions should provide women with comprehensive drug checking services tailored to their health needs. 'Steroid literacy' must be an integral component, equipping women with knowledge to make informed decisions in the gendered AAS market.

Detection of N-desethyl etonitazene in a drug checking sample: Chemical analysis and pharmacological characterization of a recent member of the 2-benzylbenzimidazole “nitazene” class

The emergence of 2-benzylbenzimidazole “nitazene” opioids is stirring up the recreational synthetic opioid market. Many nitazene analogues act as potent agonists at the µ‑opioid receptor (MOR), as demonstrated in various in vitro and in vivo studies. Severe intoxication and overdose deaths associated with nitazene analogues are increasingly being reported. Nitazene opioids are classified as a public health threat, stressing the need for close monitoring of new developments on the recreational drug market. This study reports on the detection of N-desethyl etonitazene in a sample handed in by a recreational drug user at a Swiss drug checking service in August 2023. The person bought the sample through an internet source where it was stated to contain isotonitazene. Chemical analyses were conducted to characterize the sample, i.e. nuclear magnetic resonance (NMR), capillary electrophoresis (CE), and high-resolution mass spectrometry (HRMS). The sample was additionally investigated using two different in vitro MOR activation assays. NMR and high-performance liquid chromatography (HPLC) coupled to HRMS confirmed the presence of N-desethyl etonitazene at a high purity and in the absence of isotonitazene and etonitazene. N-Desethyl nitazene analogues have been detected before as metabolites of isotonitazene and etonitazene. However, as first seen with N-desethyl isotonitazene, they are now emerging as standalone drugs. The applied bioassays demonstrated increased efficacy and approximately 6–9-fold higher potency of N-desethyl etonitazene at MOR compared to fentanyl. N-Desethyl etonitazene showed EC50 values of 3.35 nM and 0.500 nM in the β-arrestin 2 recruitment and Aequoscreen® assays, respectively. The opioid activity present in the collected sample was additionally evaluated using the bioassays and showed good overlap with the reference standard, in line with the analytical purity assessment. This demonstrates the potential of these bioassays to provide a rapid opioid activity assessment of authentic samples. The emergence of other N-desethyl nitazene analogues must be considered during forensic and clinical toxicology casework, to avoid misclassification of intake of such analogues as metabolites. Finally, drug checking services enable the close monitoring of market developments and trends and are of great value for early warning and harm reduction purposes.

Trace Detection of Adulterants in Illicit Opioid Samples Using Surface-Enhanced Raman Scattering and Random Forest Classification.

The detection of trace adulterants in opioid samples is an important aspect of drug checking, a harm reduction measure that is required as a result of the variability and unpredictability of the illicit drug supply. While many analytical methods are suitable for such analysis, community-based approaches require techniques that are amenable to point-of-care applications with minimal sample preparation and automated analysis. We demonstrate that surface-enhanced Raman spectroscopy (SERS), combined with a random forest classifier, is able to detect the presence of two common sedatives, bromazolam (0.32-36% w/w) and xylazine (0.15-15% w/w), found in street opioid samples collected as a part of a community drug checking service. The Raman predictions, benchmarked against mass spectrometry results, exhibited high specificity (88% for bromazolam, 96% for xylazine) and sensitivity (88% for bromazolam, 92% for xylazine) for the compounds of interest. We additionally provide evidence that this exceeds the performance of a more conventional approach using infrared spectral data acquired on the same samples. This demonstrates the feasibility of SERS for point-of-care analysis of challenging multicomponent samples containing trace adulterants.

Xylazine awareness, desire, use and exposure: Preliminary findings from the Rhode Island community-based drug checking cohort study

BackgroundXylazine is an ⍺2 adrenergic receptor agonist and a veterinary sedative that can cause severe health complications yet interventions to detect and treat human exposure remain underdeveloped. Community-based drug checking services (DCS) involve the testing of small amounts of drugs to increase community knowledge of unregulated supplies and decrease harms. This study characterized xylazine awareness, desire, use and exposure among people who use drugs (PWUD) in Rhode Island, US. MethodsWe analyzed data from an ongoing PWUD cohort study. In 2023, 125 PWUD were enrolled and surveyed. Using point-of-care Fourier Transform infrared spectroscopy (FTIR-S), we tested a drug sample from each participant onsite and confirmed the results offsite at a laboratory. Results were conveyed in real-time, along with harm reduction education, referrals to resources and care. ResultsVirtually all participants (99.2 %) wanted to avoid xylazine exposure. Half (51.2 %) knew what xylazine was, and a quarter (26.1 %) suspected previous exposure. Xylazine exposure was primarily surmised through sedating (45.2 %) and ulcerative (29.0 %) effects. Only 8.8 % of participants submitted a sample that they expected to contain xylazine. Xylazine was detected in 14.5 % of samples using FTIR-S and in 21.4 % of samples using a dual laboratory approach of gas chromatography mass spectrometry (GC-MS) and liquid chromatography quadrupole-time-of-flight mass spectrometry (LC-QTOF-MS). Participants thought that these xylazine-positive samples were fentanyl (78.3 %), heroin (13.0 %), or Percocet® (8.7 %). ConclusionImplementing point-of-care DCS at harm reduction organizations could be useful in rapidly increasing xylazine awareness and engaging at-risk individuals in prevention, harm reduction, treatment, and rapid care for xylazine-related wounds.

Responsibility, Care and Trust Among People Using Drug Checking Services at a Music Festival

Drug checking services (DCS) allow people who use drugs to submit substances of concern for chemical analysis and then provide results and specialized counselling when needed. DCS intersect risk management, from a public health perspective, with an activist take that provides people who use drugs with agency over their use by helping them detect and avoid unwanted substances. This paper presents data from an exploratory study of people's motivations for using the Boom Festival DCS and the meanings attributed to their interactions with the service. Semi-structured interviews ( n = 22; mean age 29 years, range 24–43; 68% cisgender men) were conducted, and an inductive approach was applied informed by Iterative Categorization and reflexive thematic analysis. Participant narratives were organized around three themes: “Drug Checking as a Responsible Practice”, “Drug Checking as a Care Practice,” and “Drug Checking as a (Mis)trust Practice”. Through these themes, the analysis focuses on the concepts of risk and the ideals of responsibility, care and trust among people using the DCS. Our findings expand the current literature that demonstrates the usefulness of DCS as an intervention to mitigate individual risks of drug use by demonstrating the more communitarian potential of this type of intervention as a means to expand the social networks of people who use drugs and support a “culture of care” among partygoers. Our participants relied on friends and trusted suppliers to get information about drugs and make informed decisions. Hence, there is a potential for those involved in drug use and supply to actively participate in harm reduction services, particularly DCS, as a way to disseminate information to a broader audience that does not want or cannot access the service.

Contribution to the harm assessment of darknet markets: topic modelling drug reviews on Dark0de Reborn

Amid the global opioid crisis, the volume of drug trade via darknet markets has risen to an all-time high. The steady increase can be explained by the reliable operation of darknet markets, affected by community-building trust factors reducing the risks during the process of the darknet drug trade. This study was designed to explore the risk reduction efforts of the community of a selected darknet market and therefore contribute to the harm assessment of darknet markets. We performed Latent Dirichlet Allocation topic modelling on customer reviews of drug products (n = 25,107) scraped from the darknet market Dark0de Reborn in 2021. We obtained a model resulting in 4 topics (coherence score = 0.57): (1) feedback on satisfaction with the transaction; (2) report on order not received; (3) information on the quality of the product; and (4) feedback on vendor reliability. These topics identified in the customer reviews suggest that the community of the selected darknet market implemented a safer form of drug supply, reducing risks at the payment and delivery stages and the potential harms of drug use. However, the pitfalls of this form of community-initiated safer supply support the need for universally available and professional harm reduction and drug checking services. These findings, and our methodological remarks on applying text mining, can enhance future research to further examine risk and harm reduction efforts across darknet markets.

The impact of the COVID-19 pandemic on people who use drugs in three Canadian cities: a cross-sectional analysis

BackgroundThe COVID-19 pandemic had a disproportionate impact on the health and wellbeing of people who use drugs (PWUD) in Canada. However less is known about jurisdictional commonalities and differences in COVID-19 exposure and impacts of pandemic-related restrictions on competing health and social risks among PWUD living in large urban centres.MethodsBetween May 2020 and March 2021, leveraging infrastructure from ongoing cohorts of PWUD, we surveyed 1,025 participants from Vancouver (n = 640), Toronto (n = 158), and Montreal (n = 227), Canada to describe the impacts of pandemic-related restrictions on basic, health, and harm reduction needs.ResultsAmong participants, awareness of COVID-19 protective measures was high; however, between 10 and 24% of participants in each city-specific sample reported being unable to self-isolate. Overall, 3–19% of participants reported experiencing homelessness after the onset of the pandemic, while 20–41% reported that they went hungry more often than usual. Furthermore, 8–33% of participants reported experiencing an overdose during the pandemic, though most indicated no change in overdose frequency compared the pre-pandemic period. Most participants receiving opioid agonist therapy in the past six months reported treatment continuity during the pandemic (87–93%), however, 32% and 22% of participants in Toronto and Montreal reported missing doses due to service disruptions. There were some reports of difficulty accessing supervised consumption sites in all three sites, and drug checking services in Vancouver.ConclusionFindings suggest PWUD in Canada experienced difficulties meeting essential needs and accessing some harm reduction services during the COVID-19 pandemic. These findings can inform preparedness planning for future public health emergencies.

How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives

BackgroundMortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered.MethodsWe conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: “clients” (individuals who use drugs and receive harm reduction services) and “providers” (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis.ResultsWe found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.ConclusionThis study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.

Pilot findings on the real-world performance of xylazine test strips for drug residue testing and the importance of secondary testing methods

BackgroundXylazine is a sedative found increasingly in the illicit fentanyl supply that can cause hypotension, bradycardia, necrosis and death. This pilot examined the real-world performance of BTNX xylazine test strips (XTS) in drug residue samples. MethodsThis study was nested within a drug checking service in Rhode Island. We tested unmeasured drug residue dissolved in 5mL of distilled water using XTS and Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometry (LC-QTOF-MS). Analyses compared XTS and LC-QTOF-MS results to calculate XTS detection of xylazine in residue. ResultsAmong 41 residue samples, xylazine was detected in 11% by the XTS and 44 % by the laboratory. The LC-QTOF-MS detected xylazine in 18 samples: 4 major, 9 minor, 5 trace by volume relative to the whole sample. The XTS disagreed with the LC-QTOF-MS by indicating a negative result in 77.8 % (N=14) of the samples but never indicated a positive when the LC-QTOF-MS reported xylazine’s absence. The XTS correctly detected xylazine 22 % of the time, however, this increased to 100 % of the time if xylazine was a major active component. ConclusionsIn this study, the BTNX XTS often disagreed with LC-QTOF-MS by indicating a negative result, likely due to the dilution levels used and sample composition. The XTS may not be accurate in detecting residual amounts of xylazine, especially if xylazine is not a dominant component of the tested sample. Given the novelty of BTNX’s XTS products, we recommend XTS only be used in conjunction with other advanced drug checking modalities for residue testing.

Implementation opportunities and challenges to piloting a community-based drug-checking intervention for sexual and gender minority men in Vancouver, Canada: a qualitative study

BackgroundIn response to the overdose crisis, a collaborative group of two community-based organizations, a health authority and a research institute in Vancouver, Canada, implemented a pilot community-based drug checking (CBDC) intervention for sexual and gender minority (SGM) men. This study identified key factors that influenced the implementation of the CBDC intervention, including opportunities and challenges.MethodsWe conducted semi-structured interviews with seven pertinent parties involved in the CBDC, including policymakers, researchers and representatives from community-based organizations. These interviews were coded and analyzed using domains and constructs of the Consolidated Framework for Implementation Research.ResultsWhile drug-related stigma was identified as a challenge to deliver drug checking services, participants described the context of the overdose crisis as a key facilitator to engage collaboration between relevant organizations (e.g., health authorities, medical health officers, community organizations) to design, resource and implement the CBDC intervention. The implementation of the CBDC intervention was also influenced by SGM-specific needs and resources (e.g., lack of information about the drug supply). The high level of interest of SGM organizations in providing harm reduction services combined with the need to expand drug checking into community spaces represented two key opportunities for the CBDC intervention. Here, SGM organizations were recognized as valued partners that fostered a broader culture of harm reduction. Participants’ emphasis that knowing the composition of one’s drugs is a “right to know”, particularly in the context of a highly contaminated illicit drug market, emerged as a key implementation factor. Lastly, participants emphasized the importance of involving SGM community groups at all stages of the implementation process to ensure that the CBDC intervention is appropriately tailored to SGM men.ConclusionsThe context of the overdose crisis and the involvement of SGM organizations were key facilitators to the implementation of a drug checking intervention in SGM community spaces. This study offers contextualized understandings about how SGM knowledge and experiences can contribute to implement tailored drug checking interventions.

Substance use patterns, sociodemographics, and health profiles of harm reduction service recipients in Burlington, Vermont

BackgroundUnderstanding current substance use practices is critical to reduce and prevent overdose deaths among individuals at increased risk including persons who use and inject drugs. Because individuals participating in harm reduction and syringe service programs are actively using drugs and vary in treatment participation, information on their current drug use and preferred drugs provides a unique window into the drug use ecology of communities that can inform future intervention services and treatment provision.MethodsBetween March and June 2023, 150 participants in a harm reduction program in Burlington, Vermont completed a survey examining sociodemographics; treatment and medication for opioid use disorder (MOUD) status; substance use; injection information; overdose information; and mental health, medical, and health information. Descriptive analyses assessed overall findings. Comparisons between primary drug subgroups (stimulants, opioids, stimulants-opioids) of past-three-month drug use and treatment participation were analyzed using chi-square and Fisher’s exact test.ResultsMost participants reported being unhoused or unstable housing (80.7%) and unemployed (64.0%) or on disability (21.3%). The drug with the greatest proportion of participants reporting past three-month use was crack cocaine (83.3%). Fentanyl use was reported by 69.3% of participants and xylazine by 38.0% of participants. High rates of stimulant use were reported across all participants independent of whether stimulants were a participant’s primary drug. Fentanyl, heroin, and xylazine use was less common in the stimulants subgroup compared to opioid-containing subgroups (p < .001). Current- and past-year MOUD treatment was reported by 58.0% and 77.3% of participants. Emergency rooms were the most common past-year medical treatment location (48.7%; M = 2.72 visits).ConclusionsFindings indicate high rates of polysubstance use and the underrecognized effects of stimulant use among people who use drugs—including its notable and increasing role in drug-overdose deaths. Crack cocaine was the most used stimulant, a geographical difference from much of the US where methamphetamine is most common. With the increasing prevalence of fentanyl-adulterated stimulants and differences in opioid use observed between subgroups, these findings highlight the importance and necessity of harm reduction interventions (e.g., drug checking services, fentanyl test strips) and effective treatment for individuals using stimulants alongside MOUD treatment.

Safe beats down under: investigating the support of drug checking at a regional festival in the Northern Territory, Australia

Background In the context of Australian music festivals, including those in the Northern Territory (NT), drug-related harms persist. This study focused on gathering local insights into drug-related behaviours and attitudes, particularly regarding drug checking, among NT festival attendees. Methods In May 2022, attendees (aged 16+) at a single-day multi-genre music festival in the NT were surveyed onsite about their drug use and harm reduction behaviours. Logistic regression was employed to explore factors influencing attitudes and preferences toward drug checking. Results Out of 539 participants, 40% reported recent drug use in the past month. About 12% planned drug use at the festival. Notably, 73% supported drug checking, with 81% approval among people who use drugs. Older participants (>25 years) had 2.6 times (p = .001) greater odds of supporting drug checking. Participants with recent drug use had 2.1 times (p = .006) greater odds of supporting it. Among those opting for drug checking (n = 270), people who have recently used drugs had 5.5 times (p <.001) greater odds of preferring an onsite service. Additionally, 67% believed any drug checking service increased their safety. Conclusions The study reveals NT festivalgoers’ widespread support for drug checking and suggests the need for on-site drug checking services in the NT.

Harm reduction behaviours and harm experiences of people who use 3,4-methylenedioxymethamphetamine (MDMA) in Aotearoa New Zealand

Background3,4-Methylenedioxymethamphetamine (MDMA) is drug of high prevalence in Aotearoa New Zealand and is the primary drug analysed by legal drug checking services. We aimed to address the gap in literature pertaining to MDMA-related harm reduction behaviour and harm experiences within the country.MethodsAn online survey was used to assess the harm reduction behaviours (e.g., limiting consumption, planning use, seeking information) of people who use MDMA, in addition to their use of reagent testing and the major national drug checking and harm reduction service, KnowYourStuffNZ.ResultsIn total, 915 people completed the survey (60.7% females, aged 18–65, median = 24, IQR = 20–28). Frequency of various MDMA-related harm reduction behaviours differed, although these were carried out relatively frequently by most participants. Those who reported experiencing harm (physical, psychological, spiritual, social) from MDMA, or another drug presumed to be MDMA, reported less frequent harm reduction behaviours than non-harmed consumers. Reagent testing of MDMA had been conducted by 42.3% of the sample. Approximately 27% of the sample had used KnowYourStuffNZ services. Of KnowYourStuffNZ clients, 95.9% reported learning about harm reduction, and 53.3% reported changing their behaviour because of the service. Reasons for not using the KnowYourStuffNZ service were primarily lack of availability in local area (32.8%) or at relevant events (51.8%), and lack of concern with substance quality (29.8%). MDMA harm was reported by 14.4% of the sample, whilst reported harm was more common from consumption of presumably non-MDMA substances, self-reported as being mistaken for MDMA. Harm was primarily physical or psychological. Potential MDMA dependence was apparent in 6.9% of the sample.ConclusionsThe findings highlight potential targets for harm reduction education and interventions and emphasize the need for greater availability of readily accessible drug checking services in Aotearoa New Zealand.

Beyond a spec: assessing heterogeneity in the unregulated opioid supply

BackgroundDrug 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.MethodsThis study assesses the consequence of drug heterogeneity and sampling of consumer level opioid purchased in Victoria, British Columbia (n=21\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$n=21$$\\end{document}, 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.ConclusionsThis 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.

Adulteration and substitution of drugs purchased in Australia from cryptomarkets: An analysis of Test4Pay.

Prohibited drugs in unregulated markets may be adulterated, resulting in increased risks for people who use drugs. This study investigated levels of drug adulteration and substitution of drugs purchased in Australia from cryptomarkets. Data were collected from a darknet forum called Test4Pay from 1 September 2022 to 23 August 2023. Posts were included if they reported the results of drug samples submitted by post to the Vancouver-based Get Your Drugs Tested service, which uses Fourier-transform infrared spectroscopy with immunoassay strip tests (fentanyl and benzodiazepines). Of 103 samples, 65% contained only the advertised substance, 14% contained the advertised substance in combination with other psychoactive and/or potentially harmful substances and for 21%, the advertised substance was absent. Substances sold as MDMA, methamphetamine or heroin were consistently found to contain only the advertised substance, while substances sold as 2C-B, alprazolam or ketamine were the most likely to be completely substituted. Only 4 samples sold as cocaine contained solely the advertised substance, with 13 containing cocaine with adulterants like lidocaine, creatine, levamisole and boric acid (n = 19). No fentanyl contamination was detected. Novel dissociatives and novel benzodiazepines were detected, as well as a nitazene compound. Drug markets under prohibition continue to contain numerous unexpected substances, some of which can elevate risk of harm. Cryptomarkets are not immune to this problem, despite review systems, which should, in theory, make vendors more accountable for the quality of their stock. These findings demonstrate a need for expansion of local drug checking services in Australia.