Module Nine: Continuing Education
Resources for ongoing education and support.
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Drug checking is a dynamic field, and our knowledge and understanding of ‘best practices’ is constantly evolving. The drug supply itself is also rapidly changing, and technicians as well as anyone involved with the operation of a drug checking program need to stay updated with information about novel substances, trends in the supply and shifts in how people are using drugs. Turning to the drug checking community to build networks and communities of practice, and to share information with each other will help build this movement and ultimately improve the services offered to people who use drugs. There are several resources that currently exist to help build communities of practice and facilitate continuing education. There are also smaller local or regional networks that you could tap into, or if one doesn’t exist yet, you could start your own!
General Resources for Drug Checking
The Alliance for Collaborative Drug Checking
The Alliance for Collaborative Drug Checking (ACDC) is an online learning community of advocates, policy makers, researchers, technicians, program directors and others involved in harm reduction focused drug checking. ACDC was founded in 2019, and currently has over 600 members from across the globe. There is a listserv where people can share updates and information, as well as ask questions of the whole group. ACDC also hosts a monthly call that focuses on broad updates across the larger drug checking community, and features agenda topics that reflect current challenges in the field of drug checking. There is an immense amount of expertise within ACDC and it is highly recommended that anyone interested in drug checking join the group to learn from the experiences of drug checking pioneers from across the world. ACDC is not open to journalists or people in law enforcement, including HIDTA embedded public health employees. To request access, fill out this form and an admin will add you to the group: https://forms.gle/HwCeMKVDiA7uUm5s8
Remedy Alliance Drug Checking Office Hours
Drug checking requires an immense amount of planning, and it can be confusing and complicated to navigate through the pre-implementation stages. Remedy Alliance offers an “office-hours” style call on the 2nd and 4th Wednesdays of the month as a resource for programs at any stage of building or conceptualizing a drug checking program. These calls are led by program managers and technicians of some of the longest running drug checking programs in the country and focus specifically on drug checking implementation. The floor is open for attendees to ask questions related to the building of a drug checking service; anything from how it should be staffed, to questions about establishing stakeholder support, budgeting, or secondary verification testing. Attendees can attend the entirety of the call or come only to have their specific question answered. For more information, email drugchecking@remedyallianceftp.org.
The British Columbia Centre on Substance Use (BCCSU)
The BCCSU is one of the leading organizations in substance use research, policy work, training and education, and direct practice and have led the roll-out of drug checking with FTIR across British Columbia and have directly inspired much of the drug checking work in the United States. They have a wide variety of resources related to drug checking including an Operational Technician Manual and an online introductory FTIR course, among many others. Visit them at www.bccsu.ca.
The Drug Resource Education Project (DRED Project)
The DRED project is a collaborative effort from several leaders within drug checking in Canada. They provide practical guidance and knowledge on the ever-evolving best practices of harm reduction-based drug checking service implementation and messaging in a variety of settings. They have an incredibly thorough manual as well as a wide breadth of different resources related to drug checking. Check them out at www.dredproject.ca!
Substance Drug Checking at University of Victoria (Substance)
Substance is the drug checking project at the University of Victoria. They provide drug checking services in real time to community members, and are pioneering a number of novel technologies and approaches to drug checking. They are validating the use of a Paper Spray Mass Spectrometer, as well as working towards developing open source analysis software for FTIR instruments. They also have a variety of resources on their website that can be found at https://substance.uvic.ca/.
Opioid Data Lab at the University of North Carolina
The Opioid Data Lab, or the Street Drug Analysis Lab at the University of North Carolina provides analytical laboratory services for harm reduction drug checking programs, as well as public health information and data. Their website has a wealth of information about drug checking, trends and insights into the drug supply, and is a hub for impactful updates from the drug checking field. Take some time to browse their website here: https://opioiddatalab.ghost.io/
Resources for Technicians
Monthly Technician Call
Remedy Alliance hosts a monthly call that is specifically for FTIR technicians. The calls are led by experienced technicians, focus on a different topic every month, and are intended to be a deep dive into the specifics of FTIR operation and direct service provision. Calls typically involve practice scans that are sent to technicians ahead of time to illustrate the concept being discussed. Technicians can also ask questions about difficult scans, problems with the software, or how to navigate complicated drug checking scenarios. For more information, email drugchecking@remedyallianceftp.org.
Technician Slack Channel
Remedy Alliance also offers a Slack channel as a resource to technicians. This allows technicians from across the country to be able to interface with each other, ask questions, and build community. Technicians can upload scans for second opinions, ask questions of the network, and share resources and materials all within the same platform. It’s a one-stop-shop for technicians to receive technical support and feedback in close to real-time. For more information, email drugchecking@remedyallianceftp.org.
Other Resources and Materials
Harm Reduction Hacks
Information, tips, and insights from harm reduction leaders across a wide variety of topics. Harm Reduction Hacks is an invaluable resource to anyone working in harm reduction and highlights many core principles that carry over into drug checking. This is essential reading for anyone looking to implement a harm reduction intervention such as drug checking. Find this resource online at https://www.harmreductionhacks.org/
Cross-Contamination
The unintentional transfer of a compound from one object or place to another.
Needs-Based Syringe Exchange
Needs-based syringe distribution provides people who inject drugs(PWID) access to the number of syringes they need to ensure that a new, sterile syringe is available for each injection. A needs-based approach provides sterile syringes with no restrictions, including no requirement to return used syringes. https://stacks.cdc.gov/view/cdc/112935
Community Advisory Board (CAB)
A community advisory board (CAB) is a collective group of community members and representatives that provide suggestions, feedback, and directives to an organization. They advocate for the preferences and desires of the community, and help to ensure that the services a program is offering actually meets the community's needs.
Drug Users Union
Next Distro Definition of Drug Users Unions:
Drug user unions band together for connection, protection, and to change systems that control and punish people who use drugs. They provide opportunities to make changes on social, legal, and health issues that impact drug users. Similar to labor unions, drug user unions work together to solve a problem that members of the group are facing.They can connect you to resources, provide a space to talk about your use, and opportunities for strengthening the rights of people who use drugs like you. Drug user unions recognize the expertise of people who use drugs and put the power in their hands.
https://nextdistro.org/resources-collection/fight-back-drug-user-unions-how-drug-users-are-working-together-for-their-rights
Sources
Legality of Drug Checking Equipment in the United States
https://www.networkforphl.org/resources/legality-of-drug-checking-equipment-in-the-united-states/
Sources
Characterization of Xylazine Test Strips for Drug Checking
https://www.cfsre.org/images/content/reports/drug_checking/CFSRE_Xylazine_Report-Rev-1-18-23.pdf
Sources
WHP: Drugs of Abuse Testing
https://www.whpm.com/xylazine
DanceSafe Xylazine Test Strips
https://dancesafe.org/xylazine-test-strips/
Sources
Godkhindi, P., Nussey, L. & O’Shea, T. “They're causing more harm than good”: a qualitative study exploring racism in harm reduction through the experiences of racialized people who use drugs. Harm Reduct J19, 96 (2022). https://doi.org/10.1186/s12954-022-00672-y
https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00672-y
Sources
Lopez, A. M., Thomann, M., Dhatt, Z., Ferrera, J., Al-Nassir, M., Ambrose, M., & Sullivan, S. (2022). Understanding racial inequities in the implementation of harm reduction initiatives. American journal of public health, 112(S2), S173-S181.
https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2022.306767
Sources
Dasgupta, N., & Figgatt, M. C. (2022). Invited commentary: drug checking for novel insights into the unregulated drug supply. American Journal of Epidemiology, 191(2), 248-252.
McCrae, K., Tobias, S., Grant, C., Lysyshyn, M., Laing, R., Wood, E., & Ti, L. (2020). Assessing the limit of detection of Fourier‐transform infrared spectroscopy and immunoassay strips for fentanyl in a real‐world setting. Drug and alcohol review, 39(1), 98-102.
Gozdzialski, L., Wallace, B., & Hore, D. (2023). Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations. Harm Reduction Journal, 20(1), 39.
Sources
Brandeis University: Massachusetts Drug Supply Data Stream
https://heller.brandeis.edu/opioid-policy/community-resources/madds/index.html
Washington State Community Drug Checking Network
https://adai.uw.edu/wordpress/wp-content/uploads/THE_DC_Network_Infosheet.pdf
Sources
To Combat the Opioid Crisis, Expand Drug Checking Programs
https://www.wired.com/story/to-combat-the-overdose-crisis-expand-drug-checking-programs/
Sources
New York State Department of Health Announces Drug Checking Programs
https://www.health.ny.gov/press/releases/2023/2023-10-23_drug_checking_programs.htm
Sources
British Columbia Centre on Substance Use: What is Drug Checking
Sources
We Are the Loop: Our History
Sources
Nixon Adviser Admits War on Drugs Was Designed to Criminalize Black People
https://eji.org/news/nixon-war-on-drugs-designed-to-criminalize-black-people/
Race and the War on Drugs
https://www.nacdl.org/Content/Race-and-the-War-on-Drugs
Sources
Otiashvili D, Mgebrishvili T, Beselia A, Vardanashvili I, Dumchev K, Kiriazova T, Kirtadze I. The impact of the COVID-19 pandemic on illicit drug supply, drug-related behaviour of people who use drugs and provision of drug related services in Georgia: results of a mixed methods prospective cohort study. Harm Reduct J. 2022 Mar 9;19(1):25. doi: 10.1186/s12954-022-00601-z. PMID: 35264181; PMCID: PMC8906357.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8906357/
Emerging Drug Trends and Prevention
https://www.carnevaleassociates.com/our-work/emerging-drug-trends-prevention-issue-brief.html
Ray, B., Korzeniewski, S. J., Mohler, G., Carroll, J. J., Del Pozo, B., Victor, G., ... & Hedden, B. J. (2023). Spatiotemporal analysis exploring the effect of law enforcement drug market disruptions on overdose, Indianapolis, Indiana, 2020–2021. American journal of public health, 113(7), 750-758.
https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307291
Sources
CDC Dashboard and Visualizations of Overdose Rates:
https://www.cdc.gov/overdose-prevention/data-research/facts-stats/index.html
SAMHSA Overdose Prevention and Response Toolkit:
https://store.samhsa.gov/sites/default/files/overdose-prevention-response-kit-pep23-03-00-001.pdf
Sources
The War on Drugs Is Built On Racism. It's Time to Decolonise Drug Policies
Race, Mass Incarceration, and the Disastrous War on Drugs
The War on Drugs as Structural Racism
https://ldi.upenn.edu/our-work/research-updates/the-war-on-drugs-as-structural-racism/
Community Based Drug Checking
Also referred to as point-of-care drug checking, community based drug checking refers to drug checking that is cited within overdose prevention centers, SSPs, and other harm reduction or community health settings. Compared to nightlife or pop-up drug checking, community based drug checking is more likely to be accessed by people who are structurally vulnerable to the harms of the War on Drugs and may be experiencing homelessness, complex medical concerns, and more chaotic substance use.
Cross-reactivity
Within the context of drug checking, cross-reactivity refers to when a test responds inappropriately to the presence of a secondary compound that is not the primary target substance. For example, the presence of diphenhydramine (the active ingredient in Benadryl) can cause a false-positive result on a fentanyl test strip.
Memorandum of Understanding
A memorandum of understanding (MOU) is a non-binding agreement between two or more parties that outlines how they will work together. MOUs are also known as letters of intent (LOIs) or memorandums of agreement (MOAs), and sometimes are the first step towards a formal contract.
Immunoassay Strips
Immunoassay strips are used to identify the presence or absence of a particular compound. The use specific antibodies to bind to the compound of interest. Immunoassay strips only give a positive or negative answer and do not indicate anything about how much of a particular compound is present. Examples of immunoassay strips commonly used in drug checking include fentanyl test strips, xylazine test strips, and benzodiazepine test strips, although tests are available for many other types of drugs.
Limit of Detection (LOD)
The lowest concentration that can be confidently detected by an analytical instrument or technique.
Fourier Transform Infrared Spectrometer (FTIR)
An analytical instrument used to identify different compounds. Infrared spectroscopy uses infrared light to scan a sample, and then measures how the infrared light interacts with the various compounds in the sample.
Local Drug Supply
A local drug supply refers to the localized aspects of drug availability within a specific area, encompassing unique variations in available drugs, adulterants, and distribution methods. These are impacted by regional law enforcement dynamics, community relationships, and targeted policies or interventions specific to that area.
Overdose Data to Action
Overdose Data to Action (OD2A) supports jurisdictions in implementing prevention activities and in collecting accurate, comprehensive, and timely data on nonfatal and fatal overdoses and in using those data to enhance programmatic and surveillance efforts. OD2A focuses on understanding and tracking the complex and changing nature of the drug overdose crisis by seamlessly integrating data and prevention strategies.
Opioid Settlement Dollars
Following lawsuits against major pharmaceutical companies such as Perdue Pharma, opioid manufacturers and distributers are paying more than $54 billion in restitution for their role in the opioid overdose crisis. Much of this money has or will be given directly to state, county, or city governments but there is little guidance in how the money is to be spent.
Adulterant
An adulterant is a substance added to a drug to increase the bulk or weight of a drug, or to enhance the effects or the delivery of the drug in some way. Examples of common adulterants include xylazine, caffeine, diphenhydramine, and levamisole.
Colorimetric Analysis
A method of determining the presence or absence of a specific compound using specific chemicals to elicit color changes within a solution. In drug checking, colorimetric analysis, also known as reagent testing, is used to assess for the presence or absence of a specific drug of interest. Results of the test are interpreted based on the observed color changes.