Table 2 Recommendations and considerations for developing drug checking programs
Staffing | Leverage the relationships already built between harm reduction agencies and communities of PWUD. Agencies with established trust and experience should operate drug checking programs. This is an important determinant of the success of a program, especially for clients who may feel ambivalent about drug checking. Operating programs successfully will require long-established trust within the community due to needing to hand over a sample of an illicit drug to staff to complete FTIR analysis. It is also helpful to have this trust established among participants who may be skeptical about drug checking technology or the results being produced |
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Hire people with lived experience of drug use and/or people with clinical medical experience | |
Safety | Work with leadership at the city, county, or state level to anticipate potential legal challenges to drug checking work. When state laws do not allow drug checking, consider working with local government to issue protections (e.g., a Mayoral Order) to allow drug checking locally |
Information given to participants should not be able to be linked back to individuals. If necessary, participants in the program should be identified through the use of a unique identifier similar to the one they use for a syringe exchange program yet be separate. The use of a unique identifier should be explored to allow participants to access results at a later date, track engagement with the program, and for other program evaluation activities | |
Logistics | When feasible, operate multiple drug checking sites. Consider ways to make sites responsive to the diverse needs of PWUD to offer a spectrum of sites. Those preferring a more clinical environment could access programs with clinicians on staff with or without lived experience of drug use to answer questions about medical implications of drug components. Others who want on-demand access to a program staffed by people with lived experience could visit a “brick and mortar” site and interact directly with peers |
Situate a drug checking service within a larger suite of harm reduction services. The service should offer fentanyl test strips, naloxone, wound care, and safer injection equipment. It is critical that linkages to detoxification and other drug treatment programs be available given the high number of people who indicated they would want to cease drug use upon receiving results | |
Participants should be offered printed materials after testing, but many will prefer to have a verbal conversation about results. Handouts should include terms of service stating what the drug checking program can and cannot tell them and a list of standard precautions to take when using drugs. A pre-determined fact sheet for each of the most common adulterants/diluents (e.g., xylazine, levamisole) that contains information on potential health consequences of use and harm reduction options can be given out with this information when those substances are detected | |
Aggregate all test results and publish them as community reports using both health alerts during “surge” events and as general information for PWUD | |
Cultural competency | Most participants engaged in polysubstance use. Programs should expect a diverse range of drugs to be brought in and should be familiar with all illicit drugs and their most common adulterants and diluents |
Establish and meaningfully engage a community advisory board to provide program feedback and make recommendations for changes | |
Consider the use of a participant fact sheet about the program prior to implementation to address and allay concerns related to the transparency of the process, amount of drug needed for the test, etc | |
To build trust, programs may be more likely to succeed if they are not viewed as partnering with police. There should be legal protections for people using the service and there should be no police presence while the service is operating |