Drug Checking Technologies Research Articles

A qualitative exploration of harm reduction in practice by street-based peer outreach workers

BackgroundDespite the widespread use of the phrase “harm reduction” and the proliferation of programs based on its principles during the current opioid epidemic, what it means in practice is not universally agreed upon. Harm reduction strategies have expanded from syringe and needle exchange programs that emerged in the mid-1980s primarily in response to the HIV epidemic, to include medication for opioid use disorder, supervised consumption rooms, naloxone distribution, and drug checking technologies such as fentanyl test strips. Harm reduction can often be in tension with abstinence and recovery models to address substance use, and people who use drugs may also hold competing views of what harm reduction means in practice. Street-based outreach workers are increasingly incorporated into harm reduction programs as part of efforts to engage with people more fully in various stages of drug use and nonuse.MethodThis paper explores how peer outreach workers, called “members,” in a street-based naloxone distribution program define and practice harm reduction. We interviewed 15 members of a street-based harm reduction organization in an urban center characterized by an enduring opioid epidemic. Inductive data analysis explored harm reduction as both a set of principles and a set of practices to understand how frontline providers define and enact them.ResultsAnalysis revealed that when members talked about their work, they often conceptualized harm reduction as a collection of ways members and others can “save lives” and support people who use drugs. They also framed harm reduction as part of a “path toward recovery.” This path was complicated and nonlinear but pursued a common goal of life without drug use and its residual effects. These findings suggest the need to develop harm reduction programs that incorporate both harm reduction and recovery to best meet the needs of people who use drugs and align with the value systems of implementers.

Providers’ knowledge and perception of xylazine in the unregulated drug supply: a sequential explanatory mixed-methods study

BackgroundXylazine is increasingly prevalent in the unregulated opioid supply in the United States. Exposure to this adulterant can lead to significant harm, including prolonged sedation and necrotic wounds. In the absence of literature describing healthcare providers’ experiences with treating patients who have been exposed to xylazine, we aimed to explore what gaps must be addressed to improve healthcare education and best practices.MethodsFrom October 2023 to February 2024, we conducted a sequential explanatory mixed-methods study, with (1) a quantitative survey phase utilizing convenience sampling of healthcare providers treating patients in Connecticut and (2) a qualitative semi-structured interview phase utilizing purposive sampling of providers with experience treating patients with xylazine exposure. Summary statistics from the survey were tabulated; interview transcripts were analyzed using thematic analysis.ResultsSeventy-eight eligible healthcare providers participated in our survey. Most participants had heard of xylazine (n = 69, 95.8%) and had some knowledge about this adulterant; however, fewer reported seeing one or more patients exposed to xylazine (n = 46, 59.8%). After sampling from this subgroup, we conducted fifteen in-depth interviews. This qualitative phase revealed five themes: (1) while xylazine is novel and of concern, this is not necessarily exceptional (i.e., there are other emerging issues for patients who use drugs); (2) participants perceived that xylazine was increasingly prevalent in the drug supply, even if they were not necessarily seeing more patients with xylazine-related outcomes (XROs); (3) patients primarily presented with non-XROs, making it difficult to know when conversations about xylazine were appropriate; (4) patients with XROs may experience issues accessing healthcare; (5) providers and their patients are learning together about how to minimize XROs and reduce the sense of helplessness in the face of a novel adulterant.ConclusionsXylazine-specific education for healthcare providers is currently insufficient. Improving this education, as well as resources (e.g., drug checking technologies) and data (e.g., research on prevention and treatment of XROs), is crucial to improve care for patients who use drugs.

Testing the test strips: laboratory performance of fentanyl test strips

BackgroundThe overdose crisis driven by synthetic opioids continues to escalate in the USA. We evaluated the efficacy of multiple manufacturing lots of a fentanyl test strip (FTS) to detect fentanyl and fentanyl analogs and assessed cross-reactivity with possible interferences.MethodsDrug standards were dissolved in water in a laboratory setting and serially diluted. Drug dilutions were tested using five different manufacturing lots of BTNX Rapid Response (20 ng/mL cutoff) lateral flow chromatographic immunoassay strips to assess lot-to-lot variability for FTS sensitivity and cross-reactivity for the analytes of interest.ResultsAll five manufacturing lots cross-reacted with fentanyl and eleven fentanyl analogs. Diphenhydramine, lidocaine, MDMA, and methamphetamine were found to cause false positives with the strips. There was notable lot-to-lot variability in the sensitivity of the strips for fentanyl, fentanyl analogs, and known interferences.DiscussionFTS remains an important overdose prevention tool, but lot-to-lot variability in performance complicates robust instructions that balance the prevention of false positives and false negatives. Continued lot-to-lot performance assessment is recommended to ensure health education for FTS remains accurate. More sophisticated drug checking technologies and services are needed in the community landscape to augment personal FTS use to facilitate informed consumption and overdose risk mitigation.

A qualitative assessment of key considerations for drug checking service implementation

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.

Considerations for Purchasing Drug Checking Technologies: Perspectives from Toronto's Drug Checking Service.

With the unregulated drug supply-particularly the unregulated opioid supply-becoming increasingly more toxic, more contaminated, and less predictable, drug checking has emerged as an essential public health service: informing individuals who use drugs, as well as those who care and advocate for them, in real-time. For those looking to offer drug checking services in community settings, choosing a technology can be an arduous task. With very little regulatory oversight of drug checking technologies, it can be difficult for organizations that specialize in harm reduction to ascertain what questions to ask drug checking technology vendors to ensure they invest in a technology that best suits the needs of their community. Looking to help those that lack drug checking and technical expertise, Toronto's Drug Checking Service has compiled a list of questions to equip organizations to make informed decisions when it comes to purchasing drug checking technologies. Having developed and operated a drug checking service since 2018, Toronto's Drug Checking Service is uniquely positioned to share its expertise and insights.

Examining fentanyl and its analogues in the unregulated drug supply of British Columbia, Canada using drug checking technologies.

The emergence of fentanyl and its analogues have contributed to a drastic rise in overdose-related mortality in recent years. The objective of this study was to determine the number of drug checking samples containing fentanyl and fentanyl analogues using both point of care and confirmatory drug checking technologies. Point-of-care drug checking data, using a combination of fentanyl immunoassay strips and Fourier-transform infrared spectroscopy (FTIR), were collected at harm reduction sites in Vancouver and Surrey, British Columbia. Based on current recommendations from the British Columbia Centre on Substance Use Drug Checking Project, a subset of these samples was sent for confirmatory analysis using quantitative nuclear resonance spectroscopy, gas chromatography-mass spectrometry and/or liquid chromatography-mass spectrometry. A total of 22,916 samples were tested using FTIR and fentanyl immunoassay strips, of which 6125 (29%) were positive for fentanyl and/or fentanyl analogues. FTIR identified a fentanyl analogue in five samples (all carfentanil). Of the 1467 samples sent for confirmatory analysis, fentanyl was identified in 855 (58%) and fentanyl analogues in 85 (6%), including: carfentanil (n=56), acetyl fentanyl (n=15), furanyl fentanyl (n=9) and cyclopropyl fentanyl (n=5). Our research found that FTIR does not consistently distinguish between fentanyl and its analogues at point of care and that highly sensitive confirmatory drug checking technologies are needed to identify fentanyl analogues. These findings underscore the limitations of current drug checking technologies and the importance of using both point of care and confirmatory drug checking initiatives for monitoring changes in the drug supply.

Evaluation and improvement of a miniature mass spectrometry system for quantitative harm reduction drug checking

The increasing variability of the illicit drug market has imposed serious health risks for people who use drugs (PWUD), particularly due to the increasing co-occurrence of opioids and etizolam (or other benzodiazepines) in some jurisdictions. A miniature mass spectrometer (MS) equipped with paper capillary spray ionization was evaluated for its ability to quantify fentanyl, fluorofentanyl, carfentanil, and etizolam in illicit drug samples. Prior to testing actual drug samples, inter- and intra-day reproducibility, calibration linearity, and analytical sensitivity were assessed. The development of a continuous spray solvent delivery system improved MS/MS quantitation by prolonging ionization stability. A simple, rapid and quantitative tandem mass spectrometry method was developed and employed for the analysis of real-world illicit drug samples provided by PWUD at a harm reduction site in Victoria, British Columbia, Canada. Limits of detection ranged from 0.001 to 0.24% w/w of illicit analyte in the original solid drug samples. Target analytes were detected and quantified via the miniature MS system for samples where conventional on-site drug checking technologies were not always effective. These promising results demonstrate the potential role for miniature mass spectrometer systems for on-site drug checking services that can be both sensitive to trace, toxic levels as well as adaptable/selective for new drug threats as they appear in the illicit drug supply.

Overdose Experiences among People Who Inject Drugs in West Virginia: Personal Loss, Psychological Distress, Naloxone, and Fentanyl

Background: As overdose remains a major public health concern in the United States, it is important to understand the experiences people who inject drugs (PWID) have with overdose. Past experiences during such emergencies are an important determinant of future behavior, including help seeking, which can be lifesaving. Methods: We explored experiences with overdose, using data from 21 in-depth interviews collected from PWID in a rural county in West Virginia (Cabell County). We used an iterative, modified constant comparison approach to synthesize resulting interview data. Results: Participants reported pervasive experiences with overdose, including through their own personal overdose experiences, witnessing others overdose, and losing loved ones to overdose fatalities. Experiencing emotional distress when witnessing an overdose was common among our participants. Many participants reported regularly carrying naloxone and using it to reverse overdoses. Multiple participants described believing the myth that people grow immune to naloxone over time. Concerns about the presence of fentanyl in drugs were also common, with many participants attributing their own and others’ overdoses to fentanyl. Conclusions: Our findings have important implications for naloxone access and education, as well as policies and practices to encourage help seeking during overdose events among rural PWID. Participant concerns about fentanyl in the drug supply highlight the need for access to drug checking technologies.

A distributed model to expand the reach of drug checking

Purpose While there is increasing interest in implementing drug checking within overdose prevention, we must also consider how to scale-up these responses so that they have significant reach and impact for people navigating the unpredictable and increasingly complex drug supplies linked to overdose. The purpose of this paper is to present a distributed model of community drug checking that addresses multiple barriers to increasing the reach of drug checking as a response to the illicit drug overdose crisis. Design/methodology/approach A detailed description of the key components of a distributed model of community drug checking is provided. This includes an integrated software platform that links a multi-instrument, multi-site service design with online service options, a foundational database that provides storage and reporting functions and a community of practice to facilitate engagement and capacity building. Findings The distributed model diminishes the need for technicians at multiple sites while still providing point-of-care results with local harm reduction engagement and access to confirmatory testing online and in localized reporting. It also reduces the need for training in the technical components of drug checking (e.g. interpreting spectra) for harm reduction workers. Moreover, its real-time reporting capability keeps communities informed about the crisis. Sites are additionally supported by a community of practice. Originality/value This paper presents innovations in drug checking technologies and service design that attempt to overcome current financial and technical barriers towards scaling-up services to a more equitable and impactful level and effectively linking multiple urban and rural communities to report concentration levels for substances most linked to overdose.

Implementing drug checking as an illicit drug market intervention within the supply chain in a Canadian setting

This research explored drug checking as a market intervention with a potential role in supporting a safer supply within the overdose crisis. We sought the perspectives of potential service users, including those who sell substances. Twenty-six semi-structured interviews were conducted in Victoria, British Columbia (BC), Canada with research guided by the Consolidated Framework for Implementation Research (CFIR). We identified five overarching themes for implementation: ‘Understanding the role of conflicting policies and market pressures,’ ‘Increasing relative advantage of drug checking through quality results and written reports,’ ‘Establishing safe, discrete locations without the risk of arrest or public knowledge,’ ‘Partnering peers with drug knowledge and skilled technicians,’ and ‘Engaging peers and word of mouth to ensure trust and reputation.’ We heard that criminalization and being responsive to market pressures are the most critical factors in implementing drug checking as a market intervention. To operate within this context, drug checking services need to ensure the provision of high-quality services and products, provided by peers and scientists, with established trust and safety. Promotion of drug checking to facilitate quality products and novel strategies were identified, but pose challenges. Continued development of drug checking technologies and methods is required to be relevant and responsive.

Rapid and accurate etizolam detection using surface-enhanced Raman spectroscopy for community drug checking.

In British Columbia, Canada, illicit opioids have been increasingly combined with etizolam, a benzodiazepine analog, that continues to challenge popular portable drug checking technologies as it is often present in low concentrations as a result of its high potency. An unknown combination of opioids and benzodiazepines may have dangerous consequences due to unpredictable dosing, increased respiratory depression, and complicated overdose response measures. Surface-enhanced Raman spectroscopy (SERS) using a portable Raman spectrometer is used to establish a univariate model for the detection of etizolam in opioid drug mixtures (n=100) obtained from the Vancouver Island Drug Checking Project, where the presence of etizolam has been determined using paper-spray mass spectrometry. Benzodiazepine immunoassay test strips are also performed on all samples for comparison. SERS is shown to detect etizolam with high sensitivity (96%) and specificity (86%). In contrast, benzodiazepine test strips demonstrate a low sensitivity (8%) for the detection of etizolam of the same samples (n=100), with only small improvements when studied over a larger subset of samples (n=506, sensitivity = 29%). We have demonstrated the potential of SERS for trace detection of etizolam within complex sample matrices. Since SERS is one of the few portable technologies capable of trace detection, further studies on its ability for quantification and discrimination of trace adulterants in street samples is of significant interest for point-of-care applications.

Auras of Detection: Power and Knowledge in Drug Prohibition

Drug checking is an evidence-based strategy for overdose prevention that continues to operate (where it operates) in a legal “gray zone” due to the legal classification of some drug checking tools as drug paraphernalia—the purview of law enforcement, not public health. This article takes the emergence of fentanyl in the U.S. drug supply as a starting point for examining two closely related questions about drug checking and drug market expertise. First, how is the epistemic authority of law enforcement over the material realities of the drug market produced? Second, in the context of that authority, what are the socio-political implications of technologically advanced drug checking instruments in the hands of people who use drugs? The expertise that people who use drugs maintain about the nature of illicit drug market and how to navigate the illicit drug supply has long been discounted as untrustworthy, irrational, or otherwise invalid. Yet, increased access to drug checking tools has the potential to afford the knowledge produced by people who use drugs a technological validity it has never before enjoyed. In this article, I engage with theories of knowledge production and ontological standpoint from the field of science, technology, and society studies to examine how law enforcement produces and maintains epistemic authority over the illicit drug market and to explore how drug checking technologies enable new forms of knowledge production. I argue that drug checking be viewed as a form of social resistance against law enforcement’s epistemological authority and as a refuge against the harms produced by drug criminalization.

Fentanyl detection and quantification using portable Raman spectroscopy in community drug checking

AbstractCommunity‐based drug checking has emerged as a harm reduction practice aimed at people who use drugs. Using a portable Raman spectrometer and the statistical method of partial least squares regression, a model was developed to quantify fentanyl in both powder binary mixtures and more complex ternary mixtures. The model was then applied to samples collected over a 2‐year period while operating the drug checking service. As an unpredictable drug supply will always pose a risk for quantification with portable drug checking technologies, we implement check steps that guide the harm reduction decisions and conversations surrounding quantitative results.

Implementing an integrated multi-technology platform for drug checking: Social, scientific, and technological considerations.

The illicit drug overdose crisis in North America continues to devastate communities with fentanyl detected in the majority of illicit drug overdose deaths. The COVID-19 pandemic has heightened concerns of even greater unpredictability in the drug supplies and unprecedented rates of overdoses. Portable drug-checking technologies are increasingly being integrated within overdose prevention strategies. These emerging responses are raising new questions about which technologies to pursue and what service models can respond to the current risks and contexts. In what has been referred to as the epicenter of the overdose crisis in Canada, a multi-technology platform for drug checking is being piloted in community settings using a suite of chemical analytical methods to provide real-time harm reduction. These include infrared absorption, Raman scattering, gas chromatography with mass spectrometry, and antibody-based test strips. In this Perspective, we illustrate some advantages and challenges of using multiple techniques for the analysis of the same sample, and provide an example of a data analysis and visualization platform that can unify the presentation of the results and enable deeper analysis of the results. We also highlight the implementation of a various service models that co-exist in a research setting, with particular emphasis on the way that drug checking technicians and harm reduction workers interact with service users. Finally, we provide a description of the challenges associated with data interpretation and the communication of results to a diverse audience.

An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: Preliminary results from a community drug checking program using point-of-care and confirmatory methods.

From mid-2018, an increase in novel psychoactive substance (NPS) benzodiazepines was noted on surveillance of the unregulated drug market around Vancouver, British Columbia, Canada. The rise was concordant with an outbreak of atypical overdoses suspicious for benzodiazepine adulteration of unregulated opioids. This study sought to describe the number and type of NPS benzodiazepines in a sample drawn from a community drug checking program during this period, and to explore accuracy of point-of-care drug checking technologies when compared to confirmatory methods in this sample. Point-of-care drug checking data using fentanyl and benzodiazepine test strips as well as Fourier transform infrared spectroscopy were gathered at harm reduction sites in the Vancouver area from October 2018 to January 2020. A convenience subsample underwent confirmatory testing with gas chromatography-mass spectrometry, liquid chromatography-mass spectrometry, or quantitative nuclear magnetic resonance spectroscopy. Of 159 samples with both point-of-care and confirmatory results, 24 (15.1%) contained at least one NPS benzodiazepine, including etizolam (n=18), flubromazolam (n=3), flualprazolam (4), and flubromazepam (n=1). Of 114 confirmatory samples expected by participants on self-report to contain opioids, 18 (15.8%) contained some NPS benzodiazepine, with 16 (14.0%) containing both an NPS benzodiazepine and an opioid, always fentanyl. False positive and negative rates were 15.5% and 37.5% for test strips, and 3.9% and 91.7% for FTIR, respectively. Combined together, false positive and negative rates of point-of-care methods were 17.8% and 29.2%. NPS benzodiazepine adulteration in an unregulated drug supply sample reveals new risks compounding ongoing harms associated with the synthetic opioid epidemic. Given substantial false positive and false negative rates noted in our sample for point-of-care detection methods, cautious use of combined point-of-care methods, routinely paired with confirmatory drug checking may aid in early detection and monitoring of unregulated drug markets and inform targeted harm reduction strategies and health policy approaches.

Portable identification of fentanyl analogues in drugs using surface-enhanced Raman scattering

North America's opioid epidemic has created a need for drug checking technologies (DCT) that can detect potent opioids such as fentanyl and its analogues in drugs, and thus reduce the risk of accidental overdose. Here, a novel silver surface-enhanced Raman scattering (SERS) substrate is evaluated on its suitability for use as a DCT in point-of-care harm reduction applications. These substrates are assembled by electrochemically reducing silver (Ag) ions onto a silicon (Si) chip imprinted with gold (Au) microelectrodes, forming SERS-active Ag nanostructures. SERS analysis of lab-grade fentanyl analogues found that the substrates produced spectra of fentanyl, furanylfentanyl, and carfentanil that could be distinguished using principal component analysis (PCA). The limit of detection of fentanyl on the substrates was determined to be within a practical range, however estimations of fentanyl concentrations to an order of magnitude were achieved with 70% accuracy. The substrates also demonstrated the ability to detect trace fentanyl in high concentrations of heroin and caffeine, respectively. Notably, the substrates are compatible with handheld Raman spectrometers, allowing for powerful chemical detection on a compact, portable device. The performance and usability demonstrated by these SERS substrates validates their potential for use as DCTs that could be vital to the safety of people who use drugs.

“I couldn't live with killing one of my friends or anybody”: A rapid ethnographic study of drug sellers’ use of drug checking

IntroductionDrug sellers are often represented as morally bereft actors and as being, in part, responsible for North America's overdose crisis. In Canada and the United States, drug sellers selling fentanyl and fentanyl-adulterated drugs have been charged with manslaughter when their clients fatally overdose, representing a retrenchment of drug war tactics. However, targeting drug sellers for drug checking interventions may have potential for reducing fentanyl-related harms. This study explores drug sellers’ negotiation of and engagement with drug checking technologies in Vancouver, Canada. MethodsRapid ethnographic fieldwork was conducted from November 2018 to January 2019, including 26 semi-structured interviews with people who tested their drugs at an overdose prevention site to examine perceptions of the efficacy of drug checking. As drug sellers were also using the drug checking services, we specifically examined their perceptions of drug checking and the market aspects of the overdose crisis. Data were analyzed using Nvivo 12 and interpreted drawing on the concept of structural vulnerability. FindingsDrug sellers accessing drug checking services were concerned about the safety of their customers, and drug checking was one way of reducing the likelihood of harm. Drug sellers were embedded in the community, thereby, enmeshing practices of community care and ethics with the selling of drugs. When they had access to drug checking knowledge, sellers were able to modify risks related to the fentanyl market, including tailoring drugs sold to clients, returning dangerous batches and modifying fentanyl in order to make it safer to consume. ConclusionsOur findings reposition drug sellers as embedded within their communities and demonstrate their potential role in alleviating the dangers of the volatile fentanyl market. Policies that target people who sell drugs, particularly murder or manslaughter charges, are likely to make the crisis worse, and serious consideration should be put into harm reduction approaches with drug sellers.

Decriminalize Drug-Checking Technologies in Pennsylvania to Prevent Overdose Deaths

Drug-checking technologies (DCTs), such as fentanyl test strips, prevent fatal overdoses caused by the adulteration of drugs. DCTs are currently classified as illegal drug paraphernalia in Pennsylvania (PA), but the recent and significant rise in fentanyl-related overdoses has prompted the PA House and Senate to propose exempting fentanyl test strips from the definition of drug paraphernalia. While fentanyl is currently the leading drug adulterant, other substances may be used to alter drugs. Therefore, we argue that broader reform is required to protect Pennsylvanians against all potential drug adulterants. We recommend that the PA House and Senate Judiciary Committees work to amend the PA Controlled Substance, Drug, Device, and Cosmetic Act to exempt all DCTs from the definition of drug paraphernalia. This proactive intervention will save countless lives by preventing adulterant-related overdoses.

Detecting fentanyl using point-of-care drug checking technologies: A validation study

ObjectivesPoint-of-care drug checking services, wherein individuals can check the content and purity of their drugs, have emerged as a public health intervention to address the fentanyl crisis; however, there have been no rigorous evaluations of the technologies against reference standard laboratory techniques. MethodsTwo point-of-care technologies, fentanyl immunoassay strips and Fourier-Transform Infrared (FTIR) spectroscopy, were implemented at two supervised injection sites in Vancouver, Canada. We calculated sensitivity, specificity, and false negative rate for both testing methods as compared to a laboratory reference standard. ResultsBetween October 2017 and 2018, 331 samples were sent for confirmatory testing. Immunoassay strips had a sensitivity of 87.5% and specificity of 95.2%, with a false negative rate of 12.5%. FTIR spectroscopy had a sensitivity of 72.1% and specificity of 99.0%, with a false negative rate of 27.9%. ConclusionAs expected, while FTIR spectroscopy can quantify concentrations on a wide array of compounds, it can only do so above the detection limit. Using FTIR spectroscopy and immunoassay strips in combination has the potential to offset the limitations of each technology when used alone.

\u201cAm I gonna get in trouble for acknowledging my will to be safe?\u201d: Identifying the experiences of young sexual minority men and substance use in the context of an opioid overdose crisis

BackgroundNorth America and other parts of the globe are in the midst of a public health emergency related to opioid overdoses and a highly contaminated illicit drug supply. Unfortunately, there is a substantial gap in our understandings about how this crisis affects key populations not conventionally identified within overdose-related surveillance data. This gap is particularly pronounced for gay, bisexual, and other men who have sex with men (sexual minority men)—a population that experiences substance use-related inequities across adolescence and young adulthood.MethodsWe draw on in-depth semi-structured interviews conducted in 2018 with a diverse sample (N = 50) of sexual minority men ages 15–30 who use substances and live in Vancouver, Canada, to identify how patterns and contexts of substance use are occurring in the context of the opioid overdose crisis.ResultsOur analysis revealed three themes: awareness, perceptions, and experiences of risk; strategies to mitigate risk; and barriers to safer substance use. First, participants described how they are deeply impacted by the contaminated illicit drug supply, and how there is growing apprehension that fatal and non-fatal overdose risk is high and rising. Second, participants described how procuring substances from “trustworthy” drug suppliers and other harm reduction strategies (e.g., drug checking technologies, Naloxone kits, not using alone) could reduce overdose risk. Third, participants described how interpersonal, service-related, and socio-structural barriers (e.g., drug criminalization and the lack of a regulated drug supply) limit opportunities for safer substance use.ConclusionsEquity-oriented policies and programming that can facilitate opportunities for safer substance use among young sexual minority men are critically needed, including community- and peer-led initiatives, access to low-barrier harm reduction services within commonly frequented social spaces (e.g., Pride, night clubs, bathhouses), nonjudgmental and inclusive substance use-related health services, the decriminalization of drug use, and the provision of a safe drug supply.