Drug checking services: barriers and facilitators to implementation by U.S. syringe services programs

Syringe services programs (SSPs) provide evidence-based services to prevent the spread of disease and reduce overdose mortality among people who use drugs. To address unacceptably high levels of overdose, some SSPs have implemented advanced drug checking services (DCS) to identify illicitly manufactured fentanyl, xylazine, and other unexpected substances in local drug supplies. Advanced DCS improve people's knowledge of the illicit drug market and can support widescale dissemination of information for monitoring and evaluation of drug supply trends.

To investigate the barriers and facilitators to implementing advanced DCS at SSPs across the United States.

We conducted semi-structured interviews between May 31st and July 2nd 2023 with 23 SSP representatives in the United States. We used purposive sampling methods to include programs covering a variety of perspectives and experiences, varying by region, program type, and legal status. We used a deductive analytic approach to code transcripts and met weekly to refine codes and capture emerging themes. After identifying barriers and facilitators as key themes, we further coded the data using domains and constructs from the Consolidated Framework for Implementation Research.

Eight of 23 SSPs provided advanced DCS. Most of these collaborated with external partners that hosted and maintained drug checking equipment, analyzed samples, and provided results. Five of these SSPs partnered with laboratories that offered mail-based services-through which participants could mail in their sample, and results would be sent back to SSPs for dissemination. The cost of machines and limited organizational capacity (e.g., staff, physical space) were key reasons that programs required partnerships to provide advanced DCS. Similarly, SSPs that were interested in but had not implemented advanced DCS noted cost and organizational capacity as primary barriers. Supportive laws and buy-in from law enforcement also impacted the implementation of advanced DCS.

The cost and organizational barriers SSPs face implementing advanced DCS can be addressed through collaboration with well-resourced partners. Advanced DCS through SSPs may first require supportive laws and law enforcement buy-in. Additional research on partnerships and other implementation strategies to support advanced DCS may provide a useful roadmap for SSPs interested in offering these services.