Exploring drug checking services for people who use drugs: Pre-implementation study

The growing proportion of adulterants in the street drug supply has increased overdose risk and other negative health outcomes for people who used drugs (PWUD). Though useful, single-item test strips (ie fentanyl), are limited in their ability to identify multiple drugs in one drug sample. Thus, community-based drug checking services (DCS) using fourier transform infrared spectroscopy (FTIR) are being adopted as an overdose prevention strategy. To inform the pre-implementation of Michigan's first DCS using FTIR, we sought to understand facilitators and barriers to FTIR among potential participants at a local harm reduction agency.

Potential DCS participants were recruited (n = 25) into three focus groups (n = 8-9) and one individual interview. Semi-structured interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were used. Focus groups were audio-recorded, transcribed and rapid thematic qualitative analysis was conducted. Themes were developed to inform DCS implementation within CFIR domains with relevant constructs displayed in summary matrices.

Participants' main concern was being targeted by police when utilizing FTIR. Additional barriers included concerns about confidentiality, testing wait time, and negative community perceptions. Key facilitators were trusted staff, sharing FTIR information via PWUD social networks, and efforts to increase participant service access with extended hours. Participants felt FTIR would be a valuable resource to support safer drug use, increase autonomy, and help prevent overdose by providing information about drug contents.

DCS can inform PWUD and the public of dangerous analogues in the drug supply, increase autonomy to make informed decisions, and reduce overdose risk.