A qualitative evaluation of the implementation of a statewide drug checking program using the Consolidated Framework...

Drug checking programs have emerged to monitor and address risks associated with the increasingly opaque and volatile drug supply. Implementation research can elaborate factors that facilitate uptake and success of these programs.

We conducted 19 qualitative interviews with staff at syringe services programs that did (n = 14) or did not (n = 5) participate in Maryland's Rapid Analysis of Drugs (RAD) program. Through the RAD program, syringe services program staff across the state collected residue samples from items submitted by participants (e.g., baggies, syringes, foils) and then mailed these samples into a central laboratory for analysis. Interviews explored staff experiences implementing and delivering the RAD program, as well as successes and challenges encountered. We used deductive content analysis to map staff experiences and insights onto Consolidated Framework for Implementation Research constructs.

Successful implementation of RAD was facilitated by the program's simplicity and flexibility, allowing individual programs to adapt it to their specific needs. However, legal environments and local attitudes that were hostile towards harm reduction created significant implementation barriers. Trusted staff-participant relationships, especially among staff with lived experience, enhanced uptake of RAD, while staffing capacity and turnover threatened its sustainability.

These findings can meaningfully inform how to adapt the implementation of similar drug checking interventions across settings to be responsive to unique contextual and organizational factors. Centering lived experience and being flexible and responsive to participant concerns are critical for implementation success.