Drug checking programs provide people with more information about what is in their drugs. They can also be used to monitor the unregulated market and inform broader policy and program initiatives. Various technologies are used in drug checking (e.g., testing strips, mass spectrometry machines) and the services can be provided in a variety of settings (e.g., supervised consumption sites, music festivals, mobile units).
We talked to three drug checking programs in British Columbia and Quebec to learn more about the services that they provide, how they do it and what benefits and opportunities drug checking provides.
- Amelia Martzke, Drug Checking Program Coordinator, ANKORS, Nelson, British Columbia
- Carlin Patterson, Clinical Nurse Leader, St. Paul’s Hospital Overdose Prevention Site, Vancouver, British Columbia
- Alexane Langevin, Substance Testing Service Coordination, Magali Boudon, Management, Kathryn Balind, Research and Development at GRIP (Groupe de recherche et d’intervention psychosociale), Montreal, Quebec
Amelia Martzke, Drug Checking Program Coordinator, ANKORS, Nelson, British Columbia
Can you provide a brief overview of how drug checking works in your program/organization?
At ANKORS, we offer drug checking in a variety of settings. On an ongoing basis, we offer point-of-care drug checking from our main office in Nelson, BC, from Monday to Thursday, 9:30 a.m. to 4:30 p.m. Service users can come by anytime within these hours to drop off a sample for testing. If our technician is on site when the service user comes in, testing can be done immediately, with the service user in the room, and results are usually given within 5–15 minutes, depending on the complexity of the sample (if there are many samples the testing time will be longer). The service user is present during the analysis and has the opportunity to ask questions, discuss limitations of the testing and receive harm reduction supplies and suggestions.
We also offer drug checking in other communities on a biweekly or monthly basis. This drug checking operates with the same format as our on-site drug checking in Nelson but is offered less frequently because our drug checking technician has to travel to the other communities (Trail, Grand Forks and Castlegar). When our technician is doing drug checking in another community, there is no on-demand testing available at our Nelson office. However, service users can drop a sample off at any time, and if our technician is away, the sample will be tested as soon as they return and the results will be provided to the service user in the way that best suits them (text, phone, email, etc.).
Our point-of-care drug checking in Nelson and surrounding communities is conducted by the ANKORS Drug Checking Program Coordinator, who is trained through online learning and shadowing as a drug checking technician.
We also offer drug checking at local festivals, notably the Shambhala Music Festival. This testing is conducted on site at the festival and involves a large team of technicians, volunteers and supervisors. Results are provided on demand at the time of testing to folks who wish to use the service.
All of our drug checking services use a combination of Fourier-transform infrared (FTIR) spectroscopy and immunoassay test strips. This combination offers the perfect balance: it is a fast, user-friendly and portable method that people can relatively easily become competent at using, and it also provides precise, accurate and reliable results.
ANKORS also has a connection with a confirmatory testing laboratory in Vancouver, which allows for further testing on samples that are ambiguous, confusing or particularly concerning. Samples can be sent for confirmatory testing after preliminary testing at ANKORS, and then more detailed results can be provided to the service user after about one to three weeks.
How are the drug checking results used in your program/organization and in the wider community?
The results from our drug checking program serve a dual purpose: (1) to inform service users and help them make decisions about how to use their drugs more safely and (2) to help us to understand trends in the drug supply and identify trends or samples of concern that necessitate wider reporting or alerting to the community, region or province.
At the individual level, our drug checking services allow us to engage with service users. They serve as a point of entry through which our service users can get connected to other services or support that they might need (such as peer support or advocacy, social work support, housing, harm reduction supplies, safe supply). Drug checking at the point of care enables us to have a conversation with the service user about their substance use patterns and to recommend tips for safer drug use that are tailored to the results of their drug tests. Our drug checking gives users information that they can use to make appropriate decisions to use more safely.
At the community, regional or provincial level, our drug checking results enable us to identify trends and substances of note that provide insight into changes in the drug supply in the community, region, province or beyond. Drug checking allows us to contribute to and learn from a body of knowledge about trends in the local, regional, provincial and national drug supply. When needed, we share notable results with our community and region in a weekly report. For particularly concerning results, we coordinate with Interior Health to send out widespread regional alerts. These alerts can help drug users and the community be aware of and respond to changes in the toxic drug supply and support them to use drugs in a safer way.
Additionally, all of our drug checking results are logged in a database that is analyzed and monitored by the British Columbia Centre on Substance Use (BCCSU). The information in this database is used to understand trends in the drug supply, which can be used in reports and as evidence to support policy and practice changes relating to the illicit street drug supply and to improve drug checking services across the province.
What are the benefits/opportunities that drug checking services provide? What is the main challenge you’ve experienced in providing drug checking services?
Drug checking provides multiple benefits and opportunities, at the individual, community and regional or provincial levels. At the individual level, it enables people who use drugs to make better decisions about their drug use and to engage in practices to reduce the harms associated with drug use. Drug checking also offers a safe space to engage in conversation with people who use drugs as well as a pathway for referral to other social services or support that they may need.
At the community level, drug checking helps to reduce the stigma associated with drug use. It facilitates conversation about drug use and increases positive and supportive messaging about how to use safely and reduce harm. Drug alerts help to warn the community when particularly harmful substances are circulating, so that individuals can alter their drug use patterns and behaviours to use more safely at a time of increased risk.
One of the main challenges we have experienced with drug checking is the ability to offer detailed and precise results to service users. Owing to the limitations of the drug checking technology that we use (FTIR spectrometry and immunoassay test strips), and the increasing complexity and toxicity of the illicit drug supply, it is becoming more and more difficult to give results with a level of detail that is significant to our service users. This is particularly the case for down (drugs that are expected to be fentanyl or fentanyl-related analogues) samples; it is much less of a concern for crystal meth, cocaine, MDMA, ketamine and psychedelics. As down is becoming increasingly adulterated with benzodiazepines and carfentanil, the results we are able to provide onsite are becoming less and less relevant to service users. We are usually unable to determine the presence of carfentanil in down samples and are often unable to determine the type of benzodiazepine that is present. Our ability to quantify fentanyl and benzodiazepines in a sample is also limited. This means that for service users who are testing down samples, we are often only able to notify them about the presence, not the amount, of fentanyl, benzodiazepines and any cuts or buffs.* Luckily, access to confirmatory testing laboratories in Vancouver has allowed us to provide more detailed results to service users, although these results are less timely, as they usually take about one or two weeks to be reported.
Carlin Patterson, Clinical Nurse Leader, St. Paul’s Hospital Overdose Prevention Site, Vancouver, British Columbia
Can you provide a brief overview of how drug checking works in your program/organization?
When a client arrives at the St. Paul’s Hospital Overdose Prevention Site, they are offered benzodiazepine and fentanyl testing strips. Testing is done on the spot by one of the licensed practical nurses. Testing is normally completed using the wash (i.e., when water is added to the drug residue that can remain in the cooker and filter after a person has injected), or the mixture leftover after a client has prepared their substances. Results are available almost immediately.
How are the drug checking results used in your program/organization and in the wider community?
The results of the drug checking are disclosed on the spot to clients. Clients can use the information to make a more informed decision around their substance use. Some clients opt to use fewer drugs or to use them more slowly.
The results also help to alert staff to possible complications when responding to a potential overdose. It can be particularly helpful to know if the substances used contained benzodiazepines, as benzodiazepines do not respond to naloxone.
The findings are reported on a standardized data form, and sent to the Vancouver Coastal Health (VCH) central database. These results are collected from various overdose prevention sites and supervised consumption sites in the VCH catchment area. This information can be used to track regional trends in the current drug supply.
What are the benefits/opportunities that drug checking services provide? What is the main challenge you’ve experienced in providing drug checking services?
Drug checking empowers clients to make an informed decision about their drug use and gives them a sense of control. This information can keep clients safer by giving them information that may prompt them to use less or more slowly. The test may also prompt clients to not use alone if they are at greater risk for an overdose.
The main limitation is the information that the test can provide. Benzodiazepines and fentanyl test strips only provide a “positive” or “not positive” result. The test strips do not provide information on the quantity or concentration of fentanyl/benzodiazepines in the sample. Additionally, we cannot say that a result is truly negative, because the tests do not pick up on all of the drug analogues.
Alexane Langevin, Substance Testing Service Coordination, Magali Boudon, Management, Kathryn Balind, Research and Development at GRIP (Groupe de recherche et d’intervention psychosociale), Quebec
Can you provide a brief overview of how drug checking works in your program/organization?
GRIP provides a weekly drug checking service in a park in Montreal’s Plateau Mont-Royal area. It has been operating for 3 to 6 hours every Tuesday and Thursday evening for the past few months. This setting was chosen because parks were being used for recreational gatherings as a result of COVID-19 health restrictions in Montreal. The program is also building partnerships with community partners such as shelters, day centres, supervised injection services and festive venues to provide drug checking services. These partnerships will continue through the winter of 2022.
Drug checking is currently used by GRIP clients and members of the community. The service is promoted through word of mouth, community organizations and social media. Testing takes about 15 to 20 minutes, with additional time required if someone has multiple samples to be tested. There are three methods for drug checking available: colorimetry, two types of testing strips (for benzodiazepines and fentanyl) and FTIR spectroscopy. Colorimetry typically involves substance loss. When strips are used, samples can be returned but will be diluted in water. With FTIR, the entire sample can be returned to the user, unless grinding and mixing are required for the test. The three different methods of drug checking are discussed with clients, so people can make an informed decision in selecting the testing options that are most suitable for their situation and substance(s).
How are the drug checking results used in your program/organization and in the wider community?
Our program works from the standpoint that all test results belong to the person. The objective is to provide people with as much information as possible about the substance they have or plan to take, so they can make an informed decision about their use. GRIP also publishes and shares anonymous information on substances that pose a particular danger for our community through our social media networks. We are currently developing a platform that combines drug checking results from various Quebec organizations in an attempt to provide a province-wide overview. We take care to ensure that the results we share are correct so that we do not inadvertently provide a false sense of security to community members.
What are the benefits/opportunities that drug checking services provide? What is the main challenge you’ve experienced in providing drug checking services?
Our mobile drug checking service provides access to drug checking in organizations that do not have their own testing service. We have had many partnership requests, however, setting up and financing this kind of service can be challenging. We also offer training to organizations wishing to set up their own drug checking service, allowing them to set up faster, and we make ourselves available to answer any questions.
The benefit to people using the service is that they can test an illicit drug so they have a better idea of what they are planning to consume. The person can reflect on the drug checking results and take steps to prevent harm. Additionally, making the drug checking results available to the community can help people understand the contents of drugs in the community if they cannot use the drug checking service themselves.
One of the main challenges is community support for this innovative practice. We need to raise awareness about drug checking to successfully build trust in the service. Another challenge is to successfully convey all the limitations and nuances of drug checking technologies. We usually offer other harm reduction interventions alongside the drug checking, as there are limitations to the drug checking technologies and some people might experience a false sense of security if they make decisions solely on the basis of the drug checking results.
Although our testing technologies have limitations (e.g., fentanyl test strips that cannot detect all fentanyl analogues if the sample is improperly mixed), these technologies are critical for harm reduction intervention services because they are better than having no information. We could offer more accurate test results if we could use certain technologies (e.g., laboratory technologies) that can be difficult to access and operate.
A number of testing programs are in the process of being set up for marginalized communities (e.g., services for people who are homeless), but a challenge for GRIP is creating an onsite drug checking service dedicated to a population of recreational substance users at festive venues. This population also needs this service, but there is little acknowledgement of their needs, since they are either marginalized by being less “visible” or have a more privileged social status, even though the risk is the same. In response, GRIP would like to provide drug checking services at festive venues in the province (especially where prevention programs are already in place in these settings); however, the current Health Canada exemption is limited to the Greater Montreal Area. A future goal of the program will be to seek a province wide exemption from Health Canada for this service.
* Cuts and buffs are normally less expensive substances and/or fillers that are added to a substance to increase the amount of drug without significantly altering its effects. They may or may not have psychoactive properties (e.g., caffeine or sugars).