A recent study found that so-called “drug check” programs have unexpected benefits, allowing public health programs to reach and work with people who use drugs who would not otherwise have access to services like HIV testing.
Drug checking refers to the analysis of illegal or prescription drugs not purchased from a pharmacy that people have used or will use. Various drug control technologies are available, but the ultimate goal is to reduce overdoses and other health risks associated with an increasingly contaminated illicit drug supply.
We already knew that the use of fentanyl test strips in the United States reduces overdoses – these are used to determine if fentanyl is present in other medications. We also knew that drug control using advanced technologies such as spectrometers was very effective in preventing drug overdoses in other countries such as Canada and the UK.
However, we are only seeing the adoption of drug-checking technologies in the US. This research focused on an organization in the US that began using commercially available spectrometers for drug checking to learn what would need to be done to implement similar programs aimed at reducing overdose and other harms associated with drug use .”
jennifer carroll, first author, Assistant Professor of Anthropology, North Carolina State University
In particular, the researchers wanted to identify the barriers to implementing a drug-checking program, as well as document the individual and community health benefits associated with implementing the program.
The researchers worked with an organization called Access, Harm Reduction, Overdose Prevention and Education Syringe Exchange (AHOPE), based in Boston, Massachusetts, which launched a drug screening service using fentanyl test strips and two mobile spectrometers. People using the AHOPE program did not bring their drugs with them per se. Instead, participants brought empty bags or other containers so that program staff could conduct tests for trace amounts and residues of drugs found in the containers.
Over the course of 22 months, researchers observed the program first-hand and conducted in-depth interviews with program staff and syringe exchange participants who benefited from the service.
The study results have relevance for public health, public order and the implementation of drug-checking programs.
“In addition to reducing drug overdoses, we found that there are other public health benefits as well,” says Carroll. “First, we found that demand for drug checking services was very high. People not normally exposed to syringe exchanges, such as middle-class drug users, began coming to AHOPE to get their drugs screened. We also found that drug distributors came to the program to review their medications. In some cases, when high levels of fentanyl were detected, distributors again cut their drugs to reduce potency to better protect their customers. In at least one instance, a supplier discarded a batch of drugs due to the presence of unexpected contaminants.
“We also found that as the number of people coming to AHOPE increased, so did the number of people seeking other services, such as HIV testing and opioid use disorder treatment. In other words, our study suggests that drug checking has a large and positive knock-on effect on other areas of public health.”
From a public policy perspective, the researchers found that the success of the drug-checking program came about in spite of, rather than thanks to, Massachusetts drug policies. In other words, drug policy in this case was actively working against public health.
“The main reason is that working with illegal drugs is illegal,” says Carroll. “Although the program worked with trace amounts of drugs to implement a scientifically proven overdose prevention strategy, law enforcement officials made it clear that the operation of the Drug Control Service gave police a probable cause to arrest AHOPE personnel. Essentially in a program designed to improve public health and safety, we found several instances where law enforcement, at its discretion, prioritized criminal drug possession enforcement, even when it interfered with important overdose prevention efforts. Even a switch to impartiality towards program staff would be a step in the right direction.”
Finally, the researchers determined that there is significant room for improvement in drug-checking technology.
“Portable spectrometers are simply not designed to work under the conditions that apply to drug-checking programs,” says Carroll. “There are countless small changes that could make the technology more effective for working in this area. BTNX, a company that manufactures fentanyl test strips, has been actively working with harm reduction organizations across the United States to ensure its product meets the unique specifications required for It would be nice to see other manufacturers share the same enthusiasm for would take on this exciting new application of their products.
“Looking ahead, we know that community drug-checking programs are becoming more common in the United States, such as at the NC Survivors Union in Greensboro, North Carolina, and several programs directed by the state Department of Health and Human Services. We also know that these programs can save lives. Hopefully, our findings will feed into the development of policies that will allow these programs to work. In North Carolina, for example, we have laws that allow the use of fentanyl test strips, but that protection does not specifically extend to the use of spectrometers for the drug control. There’s no reason to treat these tools any differently. They do the same job – spectrometers just do it more effectively.”
“RIZE Massachusetts’ forward-thinking has helped support leading innovators like AHOPE to set new standards in overdose prevention and public health response,” said Traci Green, study co-author, of the Center of Biomedical Research Excellence (COBRE) for Opioids and Overdose at Rhode Island Hospital. “Lessons learned from this project will help chart a new course for research and policy using evidence-based tools to manage an unpredictable drug supply.”
North Carolina State University
Caroll, JJ, et al. (2022) The Bronze Age of Drug Control: Obstacles and Intermediaries to Implementing Advanced Drug Controls Amid Police Brutality and COVID-19. Harm Reduction Journal. doi.org/10.1186/s12954-022-00590-z.