Drug Checking Research Articles

The insanity of addiction treatment in America

Confirming early fears of accelerated drug overdose deaths in 2020, over 93,000 Americans died last year of a drug overdose—the greatest overdose-involved loss of life in a single year. National survey results reveal that 40% of people with a substance use disorder who do not receive treatment report that they are ‘not ready to stop using’ and 42% do not receive treatment due to stigma, underscoring the need for greater adoption of harm reduction strategies. In the face of surging drug overdose deaths, American policymakers and treatment professionals continue to stand by the same approaches while expecting different results. Evidence-based, life-saving interventions include medications for opioid use disorder, low-threshold bridge clinics in emergency crisis settings, co-prescription and community distribution of naloxone anti-overdose kits, drug checking services (fentanyl test strips), syringe services programs, and overdose prevention sites. Despite strong research support and national lip-service to ‘evidence-based’ and ‘patient-centered’ approaches, harm reduction remains highly underutilized and widely unaccepted by the treatment community. Fortunately, the American government has taken several steps in recent months in terms of increased funding and the elimination of many strict, often arbitrary federal regulations, signaling the beginning of a potential shift in federal drug policy. This paper reviews available evidence with an eye toward the current state of affairs and offers actionable steps for researchers, treatment administrators, clinicians, and policymakers to make the case for greater adoption of harm reduction to address the drug overdose crisis.

Portable gas chromatography-mass spectrometry in drug checking: Detection of carfentanil and etizolam in expected opioid samples.

There has been a recent increase in adulteration of opioids with low concentration actives such as fentanyl analogues and benzodiazepines. As drug checking projects using vibrational spectroscopy continue to seek confirmatory lab-based testing, the concern and reality of missing these potentially harmful substances in point-of-care testing is prevalent. A portable GC-MS was used to analyze select opioid samples acquired at a drug checking service in Victoria, Canada (n=59). Certified reference standards of several fentanyl analogues and benzodiazepines were measured to guide targeted analysis of these samples. Results were compared with those obtained using a lab-based paper spray mass spectrometer. Portable GC-MS was able to identify 62% of samples containing carfentanil and 36% of samples containing etizolam. In the case of etizolam, the success rate was higher for more potent samples: 78% of etizolam-containing samples were identified when the etizolam concentration was above 3% by weight. In comparison, infrared spectroscopy was able to detect etizolam in only 9% of the etizolam-containing samples, and is not sensitive enough to detect carfentanil at relevant concentrations. Portable GC-MS has potential in identifying low concentration substances in a point-of-care setting, without relying on subsequent off-site confirmatory testing.

Profile and correlates of colorimetric reagent kit use among people who use ecstasy/MDMA and other illegal stimulants in Australia.

Colorimetric reagent kits can provide information about the compounds present in drug samples. This study aimed to identify patterns and correlates of colorimetric reagent kit use, as well as behavioural outcomes of testing, amongst people who use illegal stimulants in a context that lacks permanent government-sanctioned drug checking services. Australians residing in capital cities who reported regularly using ecstasy/MDMA and/or other illegal stimulants ≥monthly in the past six months were recruited via social media and word-of-mouth from April-July 2019 (N=792). Participants were asked about testing the contents and/or purity of illegal drugs, and features of last colorimetric reagent kit use. Logistic regression identified correlates of last using a kit (referent: no use of drug checking technology to test drug contents/purity in the past year). Over one-third (36%) reported testing drug contents and/or purity; of this group, 86% had last used a colorimetric reagent kit. On the last occasion, 52% reported someone else had conducted testing; 58% said testing occurred <24h before planned drug use; and 24% reported testing for quantity of a substance. Correlates of drug checking comprised: being younger, male, past six-month use of new psychoactive substances, accessing community-based health services for alcohol or other drug reasons, selling drugs for cash profit, obtaining information from peers who had tried the drug, and searching online for reports of the drug by stamp/appearance. The majority (84%) tested a substance they had been sold and/or given as MDMA; of these, 87% detected MDMA. Of those who expected and detected MDMA, 29% and 11% reported results to their peers and dealer, respectively. People who use ecstasy/MDMA and/or other illegal stimulants seek out objective information about substance contents. In countries that lack permanent government-sanctioned drug checking services, it is important to acknowledge that people already engage in drug checking but with suboptimal technologies and without tailored specialist advice and education.

The utility of visual appearance in predicting the composition of street opioids

Background: With the emergence of unregulated fentanyl, people who use unregulated opioids are increasingly relying on appearance in an effort to ascertain the presence of fentanyl and level of drug potency. However, the utility of visual inspection to identify drug composition in the fentanyl era has not been assessed. Methods: We assessed client expectation, appearance, and composition of street drug samples being presented for drug checking. Results of a visual screening test were compared to fentanyl immunoassay strip testing. We calculated sensitivity, specificity and likelihood ratios (LR) to assess the accuracy of the common assumption that samples with a “pebbles” appearance contain fentanyl. Results: In total, of the 2502 unregulated opioid samples tested, 1820 (73.5%) appeared as “pebbles”, of which 1729 (95.0%) tested positive for fentanyl for a sensitivity of 75.9% (95% Confidence Interval [CI]: 74.2–77.6) and specificity of 59.4% (95%CI: 57.5–61.3). Although, the odds of samples containing fentanyl was 4.60 (95%CI: 3.47−6.11) times higher among pebbles samples compared to non-pebble samples, the positive LR for pebbles to contain fentanyl was only 1.87 (CI: 1.59–2.19). The negative LR was more useful at 0.41 (95% CI: 0.36−0.46). Conclusions: A positive screening test for pebbles is not strongly enough associated to be used as a proxy for detecting fentanyl. While the absence of the appearance of pebbles does somewhat reduce the likelihood of fentanyl being present in a given sample, the high prevalence of fentanyl and fentanyl analogues in the drug supply and the risks of consumption are such that public health providers should routinely advise people who use unregulated opioids against solely relying on visual characteristics of drugs as a harm reduction strategy.

Drug use, harm-reduction practices and attitudes toward the utilisation of drug safety testing services in an Irish cohort of festival-goers

BackgroundFestival drug-related deaths are a growing public health concern.AimTo examine drug use and related harm-reduction practices and attitudes towards utilisation of drug safety testing services.MethodsData collection took place over the 2019 festival season (June–October). The questionnaire was self-reported. Data was gathered via the online survey, which was promoted through online and social media platforms and outlets. Social media communication methods were used to reach the targeted population more effectively.ResultsA total of 1193 Irish festival attendees over the age of 18 completed an anonymous online survey. Alcohol, MDMA powder/crystals, ecstasy pills and cocaine were the highest reported drugs used by Irish festival attendees. The vast majority of participants reported polysubstance use (86.8%/n = 1036). Forty percent of participants (39.98%/n = 477) reported having had sex following the use of a drug at a festival; of these, 66% (n = 316) said that the sex was unprotected. Most participants (84.0%/n = 1003) engaged in some form of harm reduction when taking drugs at festivals.Overwhelmingly, participants reported a willingness to engage with drug-checking services. The vast majority (96.3%; n = 1149) and would use drug checking services more than three-quarters (75.1%/n = 897) reported that they would use an ‘amnesty bin’ for drugs if it were part of an alert system to notify if dangerous drugs are in circulation. A chi-square test of Independence was conducted to examine whether age and utilisation of drug safety testing service a festival were independent. Moreover, when all cases are taken together, the difference between testing modalities (onsite, offsite and amnesty bin) shows a significant difference p < 001 between those who would use onsite and offsite drug testing facilities.ConclusionThe evidence from this survey indicates that those young people who use drugs at festivals would be prepared to utilise drug checking services and amnesty bins should help inform the public health response to this important area.

Wastewater analysis for psychoactive substances at music festivals across New South Wales, Australia in 2019–2020

Introduction Implementation of wastewater surveillance at music festivals has been limited to date. We aimed to use wastewater analysis and a self-report survey to determine the range of psychoactive substances being used during a music festival season in New South Wales, Australia. Methods We sampled six single-day music festivals requiring a music festival license in New South Wales from March 2019 to March 2020; between 15% and 100% of portaloos (temporary, un-fixed toilet facilities) were sampled at each festival. Samples were screened for 98 psychoactive substances and/or their metabolites with results qualitatively expressed as detection frequencies for each substance at each festival and across all festivals. We compared these data with the results of surveys of self-reported drug use at four of the six festivals. Results Festival attendance ranged from 6200 to 14,975 people. Amphetamine, cocaine, ketamine, methylone, MDMA, MDA, alprazolam, diazepam, etizolam, oxazepam and temazepam were found in almost all samples from all festivals. Ethylone, mephedrone and methcathinone were also found in over 50% of festivals. A norfentanyl (a fentanyl metabolite) and n-ethylpentylone were found at 2/6 and 1/6 festivals. No festival survey participant reported intentionally taking cathinones. Discussion The detection frequency for cathinones was higher than expected relative to recent other data sources and this may represent adulteration or substitution. Similarly, the appearance of etizolam may be related to the use of counterfeit alprazolam. The detection of highly toxic substances such as N-ethylpentylone and norfentanyl may warrant public health alerts. Conclusion If provided close to real time, wastewater analysis at festivals could be complemented with information sources such as drug checking, on-site surveys, medical presentations and intelligence from peer networks to feed into early warning systems, public health alerts and peer-based harm reduction education during the festival season.

Invited Commentary: Drug Checking for Novel Insights Into the Unregulated Drug Supply.

Tobias et al. (Am J Epidemiol. 2022;191 (2):241–247) present a novel analysis of time trends in fentanyl concentrations in the unregulated drug supply in British Columbia, Canada. The preexisting knowledge about unregulated drugs had come from law-enforcement seizures and postmortem toxicology. As both of these data sources are subject to selection bias, large-scale drug-checking programs are poised to be a crucial component of the public health response to the unrelenting increase in overdose in North America. As programs expand, we offer 2 guiding principles. First, the primary purpose of these programs is to deliver timely results to people who use drugs to mitigate health risks. Second, innovation is needed to go beyond criminal justice paradigms in laboratory analysis for a more nuanced understanding of health concerns. We provide examples of the role adulterants play in our understanding of drug harms. We also describe the applications and limitations of common laboratory assays, with implications for epidemiologic surveillance. While the research and direct service teams in British Columbia have taken groundbreaking steps, there is still a need to establish best practices for communicating results to sample donors in an approachable yet nonalarmist tone.

Results from a mobile drug checking pilot program using three technologies in Chicago, IL, USA

BackgroundOpioid overdose deaths in the United States continue to rise, with the majority of deaths involving fentanyl. Drug checking has been used in Europe and Canada to assess adulteration of the illegal drug supply, but faces legal barriers in the United States. We are presenting information from a pilot mobile program offering drug checking services to participants of a harm reduction program in Chicago, Illinois, USA. MethodsDrug checking services were provided at five mobile outreach and one fixed-point drop-in location in Chicago, IL, between March 2019 and August 2020. Three technologies were used: a Fourier transform infrared spectroscopy (FTIR) spectrometer, a handheld high-pressure mass spectrometer (HPMS), and immunoassay fentanyl test strips (FTS). We report on results generated by this combination of technology during the study period. ResultsDuring the study period, 422 total samples were tested, the majority of which were sold as dope/heroin (66.7 %). Of the 282 samples sold as dope/heroin, 12.8 % matched to fentanyl on the FTIR, 47.5 % had fentanyl identified on the HPMS, and 57.8 % produced a positive FTS. ConclusionsThis pilot program demonstrated the feasibility of using three technologies to assess for the presence of fentanyl in user-submitted samples, revealed discordant results from the technologies, and provided information on the local drug market.

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.

A new quantitative drug checking technology for harm reduction: Pilot study in Vancouver, Canada using paper spray mass spectrometry.

IntroductionDrug checking services for harm reduction and overdose prevention have been implemented in many jurisdictions as a public health intervention in response to the opioid overdose crisis. This study demonstrates the first on‐site use of paper spray mass spectrometry for quantitative drug checking to address the limitations of current on‐site drug testing technologies.MethodsPaper spray mass spectrometry was used to provide on‐site drug checking services at a supervised consumption site in the Downtown Eastside of Vancouver, British Columbia, Canada during a 2‐day pilot test in August 2019. The method included the targeted quantitative measurement of 49 drugs and an untargeted full scan to assist in identifying unknown/unexpected components.ResultsDuring the pilot, 113 samples were submitted for analysis, with 88 (78%) containing the client expected substance. Fentanyl was detected in 45 of 59 expected fentanyl samples, and in 50 (44%) samples overall at a median concentration of 3.6% (w/w%). The synthetic precursor of fentanyl, 4‐anilino‐N‐phenethyl‐piperidine (4‐ANPP), was found in 74.0% of all fentanyl samples at a median concentration of 2.2%, suggesting widespread poor manufacturing practices. Etizolam was detected in 10 submitted samples anticipated to be fentanyl at a median concentration of 2.5%. No clients submitting these samples expected etizolam or a benzodiazepine in their sample. In three instances, it was co‐measured with fentanyl, and in seven cases it was detected alone.Discussion and ConclusionsThe quantitative capabilities and low detection limits demonstrated by paper spray mass spectrometry offer distinct benefits over existing on‐site drug checking methods and harm reduction services.

Pill testing policy: A comparative analysis using the Advocacy Coalition Framework.

Pill testing is regarded as a controversial harm reduction intervention and provides an ideal case study for examining how policy change comes about. Two Australian jurisdictions were analysed to explore factors that may account for policy change by comparing the ACT which allowed a pill testing trial, and NSW where pill testing has not been permitted. The analysis was conducted using the Advocacy Coalition Framework (ACF). Data sources were first coded to establish the subsystem actors beliefs and advocacy coalitions; then coded using a deductive approach and classified against core dimensions of the ACF. An inductive approach was then applied to generate and link themes in the data. A dominant and minority coalition was identified in each jurisdictions' policy subsystem. The results show how in the ACT a dominant 'harm reduction' coalition shifted their secondary beliefs and introduced a pill testing policy. Whereas in NSW, a shift in both the secondary and policy core beliefs of the dominant 'law enforcement' coalition was required, something which rarely occurs according to the ACF. The analysis supports the ACF's assertion that advocacy coalitions will respond to pressures for change by restricting change to secondary beliefs, while keeping policy core beliefs intact. It also demonstrates that secondary and policy core beliefs matter in the context of minority and dominant coalitions. Further research is needed to explore whether a minority coalition's strategic re-framing of an issue to align with the policy core beliefs of their opponents would have more success than advocating from their own belief paradigm.

A clinical research priority setting study for issues related to the use of methamphetamine and emerging drugs of concern in Australia.

IntroductionThis study aimed to gather a range of opinions, including those of affected people (consumers, concerned others) to identify clinical research priorities for methamphetamine and emerging drugs of concern in Australia, to guide the work of the National Centre for Clinical Research on Emerging Drugs (NCCRED).MethodsA priority setting study was conducted (February–March 2019) in four phases: online stakeholder survey, thematic analysis of responses, rapid literature review, expert panel ranking of priorities against predetermined criteria.ResultsForty‐seven respondents completed the survey, including people identifying as one or more of: researcher (53%, n = 25), clinician (45%; n = 21), family/friend/caregiver of someone who uses methamphetamine/emerging drugs (15%, n = 7) and consumer of methamphetamine/emerging drugs (13%, n = 6). Expert panel, evidence‐informed top‐ranked clinical research priorities for methamphetamine were: strategies to overcome barriers to intervention uptake, pilot medication trials for adults seeking treatment, and communication strategies regarding evidence‐based treatments. For emerging drugs of concern, top‐ranked priorities were: piloting community‐located drug checking, feasibility of social media/other opportunities to alert consumers of emerging risks, GHB overdose and withdrawal management, and impacts of an early warning information system on reducing harms.Discussion and ConclusionsWe demonstrate feasibility of a structured, collaborative clinical research priority setting process. Results have informed the establishment of NCCRED; using the identified priorities to guide seed funding, fellowships/scholarships and research programs. Broader uptake of this methodology by policymakers/research funders would assist to embed areas of concern identified by affected communities and other stakeholders in research prioritisation.

SISTEM INFORMASI PENJUALAN DAN PEMBELIAN OBAT PADA APOTEK DIKA FARMA PONTIANAK BERBASIS WEB

ABSTRACT Pharmacies play a very important role in health services. Pharmacy as a form of business that has a high complexity also requires an information system in its business activities. All forms of recording, starting from recording incoming drug data, purchasing transactions, selling, searching for drug data and checking stocks to making reports are still done manually. This designed system aims to produce a drug sales and purchase information system at a web-based pharmacy in which it is integrated with an expired drug notification system, computerized recording of sales and purchase transactions, purchase and sales reports, assisting drug data management, and providing information to the public. regarding the availability of stock and the price of the drug sought at the Dika Farma Pontianak Pharmacy only through the web. This application is made using the stages of the Waterfall model which can produce data that is easily accessible, accurate, and fast in the report generation process.

Commentary on Andersen et al.: Time for drug checking for heroin users?

Commentary on Andersen et al.: Time for drug checking for heroin users?

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

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.

Drug checking at dance festivals: A review with recommendations to increase generalizability of findings.

Dance festival attendees are at high risk for consuming adulterated drugs. In recent years, drug checking studies have been conducted at various dance festivals to provide valuable harm reduction information to attendees regarding drug content. We conducted a review of the literature to determine the generalizability of findings to the target population of interest-festival attendees at risk for using adulterated drugs. Six published studies involving drug checking at festivals were reviewed. All relied on self-selected samples and male attendees were overrepresented based on previous research. Test methods, drugs tested, definitions of adulteration, and prevalence of adulteration varied across studies. Prevalence of detection of adulterants ranged from 11% to 55%. While the drug checking services described appear to have been beneficial for participants, results have limited generalizability to the target population. We recommend that researchers expand beyond the self-selection model in future studies and utilize recruitment methods that involve random sampling techniques such as systematic random sampling, stratified random sampling, or time-space sampling within festivals. We also recommend that individuals approached are surveyed for demographic characteristics, planned drug use at the festival, and willingness to test their drugs. These methods would help determine how representative the sample is compared to the target population and allow for more generalizable estimates. In conclusion, as these valuable harm reduction services expand, it may be possible to reach a wider portion of the population at risk and to obtain more generalizable estimates of engagement, adulteration, and reactions to learning one possesses adulterated drugs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The discounting of death: Probability discounting of heroin use by fatal overdose likelihood and drug purity.

As fatal overdoses from synthetic opioids continue to rise, we need to understand decision-making processes underlying heroin and synthetic opioid use. This study evaluated the influence of sample impurity and fatal overdose risk on hypothetical heroin use. Individuals who currently use heroin (n = 69) were recruited online. Participants completed two probability-discounting tasks evaluating the likelihood of using a sample of heroin based on the likelihood of sample impurity and likelihood of fatal overdose, where greater discounting represented reduced use likelihood. Prior to completing the probability-discounting tasks, participants were randomized to read one of four prompts varying by the presence of information on heroin effects and active (e.g., fentanyl) or inert impurities. Influence of prompts on discounting processes and associations among probability-discounting measures, opioid use behaviors, and dependence severity were evaluated. Heroin use likelihood decreased with increased impurity or overdose risk and in a generally orderly fashion. Discounting was greater (i.e., reduced heroin use likelihood) when overdose risk, compared to sample impurity, was manipulated. Less discounting was associated with more severe opioid dependence. Discounting did not differ among prompts for either task. Individuals might adjust their heroin-use behavior to reduce harm with risk-related information. Greater discounting elicited by overdose relative to impurity risk suggests that equating adulteration and overdose risk is essential for harm reduction. Expanded access to drug checking services, which inform impurity and overdose risk, can reduce fatal overdoses. Due to fear of legal sanctions for these services, legislation and judicial decisions should explicitly protect these services. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Visitors of the Dutch drug checking services: Profile and drug use experience

BackgroundDrug checking services (DCS) provide information about drug content and purity, alongside personalized feedback, to people who use drugs; however, the demographic and drug use characteristics of DCS clients are rarely reported. This paper describes these characteristics for clients of the Dutch DCS, the Drug Information and Monitoring System (DIMS). Methods1,530 participants completed a pen-and-paper questionnaire at one of eight participating DCS in the Netherlands in 2018. ResultsThe participants were mostly highly educated males in their twenties with no migration background. Experience with drugs prior to coming to the DCS was common. Only 0.7% indicated they had never used any of the twenty drugs studied. 93% of participants reported use of ecstasy or MDMA with an average of 6.3 years since first use. ConclusionsThese results indicate that drug checking can be a valuable tool for public health services as it facilitates access to more difficult-to-reach communities who use drugs. It is unlikely that DCS encourage drug initiation, since almost all people who visit the Dutch DCS already report experience with drugs. However, DCS should be aware that their services might not be easily accessible or attractive to all demographic groups.

Public support for harm reduction: A population survey of Canadian adults.

We described public views toward harm reduction among Canadian adults and tested a social exposure model predicting support for these contentious services, drawing on theories in the morality policy, intergroup relations, addiction, and media communication literatures. A quota sample of 4645 adults (18+ years), randomly drawn from an online research panel and stratified to match age and sex distributions of adults within and across Canadian provinces, was recruited in June 2018. Participants completed survey items assessing support for harm reduction for people who use drugs (PWUD) and for seven harm reduction interventions. Additional items assessed exposure to media coverage on harm reduction, and scales assessing stigma toward PWUD (α = .72), personal familiarity with PWUD (α = .84), and disease model beliefs about addiction (α = .79). Most (64%) Canadians supported harm reduction (provincial estimates = 60% - 73%). Five of seven interventions received majority support, including: outreach (79%), naloxone (72%), drug checking (70%), needle distribution (60%) and supervised drug consumption (55%). Low-threshold opioid agonist treatment and safe inhalation interventions received less support (49% and 44%). Our social exposure model, adjusted for respondent sex, household income, political views, and education, exhibited good fit and accounted for 17% of variance in public support for harm reduction. Personal familiarity with PWUD and disease model beliefs about addiction were directly associated with support (βs = .07 and -0.10, respectively), and indirectly influenced public support via stigmatized attitudes toward PWUD (βs = 0.01 and -0.01, respectively). Strategies to increase support for harm reduction could problematize certain disease model beliefs (e.g., “There are only two possibilities for an alcoholic or drug addict–permanent abstinence or death”) and creating opportunities to reduce social distance between PWUD, the public, and policy makers.

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.