Introduction

Welcome to Drug Checking: An Implementation Workbook by Drug Checking For The People. This resource is intended for harm reduction advocates, administrators, program directors, and anyone who wants to start building a point-of-care and community-based drug checking service using an infrared spectrometer. This workbook will walk through the steps required to start a drug checking service: from conceptualizing the program, incorporating community feedback, purchasing equipment, and hiring staff, through the implementation of the service and continuing education. Questions and space for reflection are included throughout to help navigate the complicated and intricate nuances of building a drug checking program from the ground up. Example materials and resources are incorporated to provide a solid foundation from which to build. This workbook is not intended as a technician training resource and should not replace any part of the technician training process (contact Remedy Alliance for more information about technician training). This workbook will focus on community based drug checking, or drug checking embedded within programs or services that are frequently accessed by people who use opioids and are at a high risk of overdose, such as syringe service programs (SSPs), safe consumption sites (SCS) and overdose prevention centers (OPCs), or other harm reduction programs. Though there is a significant amount of overlap between drug checking in opioid dominant contexts and other festival, nightlife, or pop-up event drug checking, there are other unique characteristics and considerations for those other settings that are beyond the scope of this workbook. 

We hope that this workbook will give programs a solid foundation from which to build, but drug checking is a complicated intervention and many concepts, topics, and details simply cannot be taught through a workbook. We hope that alongside this resource, programs will be in regular  dialogue with experts in the field as well as with people who use drugs in their community. Remedy Alliance offers drug checking drop-in hours on the 2nd and 4th Wednesday of the month and there are many complementary resources available from leaders in the drug checking field to guide the implementation of a drug checking service. See Continuing Education for more information.

We also want to highlight that drug checking is a new intervention and there is still much that we don’t know. Involving people who use drugs in every facet of program design will always be best practice, but we hesitate to claim a monopoly on operational 'best practices'. The resources and guidelines we explore here are what we consider 'effective practices that are continually being improved upon as we gain experience and learn more.' It's a mouthful, but it's import to understand that any new drug checking program will be entering the fray to collectively iterate these 'effective practices' into 'best practices'. We encourage you to be creative and innovative, to think outside the box and, most importantly, to prioritize the voices and ideas of people who use drugs.

What is Drug Checking?

Drug checking at its most distilled is analyzing the drugs a person plans to consume (or has already consumed) to give them information about the contents of their substance. Drug checking helps to identify unexpected or unwanted components in someone’s drugs, as well as expected components in unexpected amounts. With better information about what is in their drugs, people can choose whether or not they want to consume it, and if they choose to consume it, they can receive harm reduction strategies specific to the contents of their drugs and their personal context. Most importantly, drug checking validates the human right to self-determination, bodily autonomy, and the pursuit of pleasure—a major motivator for engaging in drug use.

Drug checking employs a variety of different technologies. Reagent testing, immunoassay (test) strips, and spectrometers such as a Fourier Transform Infrared (FTIR) spectrometer are all used in point-of-care settings. More advanced laboratory equipment like gas chromatography mass spectrometers (GC/MS), liquid chromatography mass spectrometers (LC/MS), and others are accessed through mail-in services, either as a stand-alone service or in partnership with a community-based drug checking program. Each technology has strengths and limitations and the types of technologies a drug checking program uses will be based on that program’s unique circumstances and needs. This workbook focuses specifically on the implementation of FTIR spectrometers in a point-of-care setting, coupled with immunoassay strips and secondary verification at an off-site laboratory.

Why Do We Need It?

Within the context of drug prohibition and criminalization, the unregulated drug supply has become increasingly erratic and unpredictable. This unpredictability is a major driver of drug-related harms, leading to unimaginable increases in the number of overdose deaths, non-fatal overdoses, soft tissue damage and infection, and other adverse physical and mental health effects¹. The drug supply responds to countless factors such as changes in demand, the availability, legality, and cost of ingredients, arrests and drug busts, and both foreign and domestic policy². The North American opioid supply, for example, is currently shifting between combinations of substances such as xylazine, nitazenes, benzodiazepines, heroin, fentanyl analogs and other novel substances. This parallels the challenges experienced by psychedelics enthusiasts with the emergence of novel psychoactive substances, the resurgence of lesser-known psychedelics, and the nuances between different drugs within the same family (e.g., 2C-B, 2C-I, 2C-P). This perpetual evolution of the drug supply necessitates constant education and learning by community members who use these substances.  By adding drug checking to the suite of harm reduction tools and resources already available, programs can start to gain insight into their regional drug supply and work towards reducing the unpredictability of the drug supply. 

Historically, misinformation about drugs and the drug supply have been used to stigmatize and marginalize communities of color, specifically Black and brown communities within the United States³. This intentional misinformation and criminalization of drugs, based not on their actual risk but on who was perceived to be using that drug, was used to justify over-policing and mass-incarceration of communities of color. This played out in the 1960s with the Nixon administration; heavily criminalizing crack cocaine was an intentional political move intended to disrupt black communities⁴. Misinformation about the effects of crack cocaine were circulated to justify the extreme policies and punishments related to crack use. Today, we still live in a world that is full of uncertainties and misinformation about drugs and the drug supply.  Often the information we do have is not accessible to the communities most impacted by the unregulated and erratic drug supply. Without drug checking programs, the information we have about the drug supply comes from sources such as Medical Examiners offices, toxicology screens, and the Drug Enforcement Agency (DEA) and drug seizure data. These data are rarely if ever translated in a way that is relevant, timely, and understandable to people who use drugs, much less made accessible. Even as drug checking becomes more available, this intervention is at risk of being co-opted by academic institutions, healthcare conglomerates, health departments, and other entities that have a track record of gatekeeping information or prioritizing surveillance over service provision. Through this resource, we hope to make drug checking more accessible and available to grassroots organizations, harm reduction programs, and people who use drugs. We believe that drug checking should live within the community and that the best drug checking programs are those that are built by or co-created with people who use drugs. Through our work, we affirm the expertise of people who use drugs, people of color, and grassroots harm reduction programs by investing in their leadership within the drug checking space. Our goal is nothing less than drug checking by the people and drug checking for the people.

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