Drug checking

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Drug checking or pill testing is a way to reduce the harm from drug consumption by allowing users to find out the content and purity of substances that they intend to consume. This enables users to make safer choices: to avoid more dangerous substances, to use smaller quantities, and to avoid dangerous combinations. [1]

Contents

Drug checking services have developed over the last twenty-five years in twenty countries and are being considered in more countries, [2] although attempts to implement them in some countries have been hindered by local laws. Drug checking initially focused on MDMA users in electronic dance music events but the services have broadened as drug use has become more complex. These developments have been strongly affected by local laws and culture, resulting in a diverse range of services, both for mobile services that attend events and festivals and fixed sites in town centres and entertainment districts. For instance, staff may or may not be able to handle illegal substances, which limits the use of testing techniques to those where the staff are not legally in possession of those substances.

People intending to take drugs provide a small sample to the testing service (often less than a single dose). Test results may be provided immediately, after a short waiting period, or later. Drug checking services use this time to discuss health risks and safe behaviour with the service users. [3] The services also provide public health information about drug use, new psychoactive substances and trends at a national level. [4]

History

The earliest reported drug checking activity began in Amsterdam in November 1970 with a group from the University Hospital of Amsterdam and samples obtained through psychiatrists working with people who used drugs. [5]

The earliest reported drug checking service is the Drug Information and Monitoring System (DIMS) [6] in the Netherlands supported by the Ministry of Health, Welfare and Sport. Since 1992 the service has tested over 100,000 drug samples at a national network of twenty-three testing facilities. Service users receive results within a week via phone or email and the service publishes aggregated results describing what substances are in use.

European countries have led the introduction of drug checking services, with Asociación Hegoak Elkartea founded in Spain in 1994, [7] TechnoPlus in France founded in 1995, [8] and Modus Fiesta in Belgium in 1996. DanceSafe have operated in the USA since 1998 providing reagent testing and harm reduction advice.

More recent services include Neutravel [9] founded in Italy in 2007, The Loop [10] founded in the UK in 2013 and KnowYourStuffNZ [11] in New Zealand in 2015 with Pill Testing Australia [12] launching after a successful trial in 2018.

In 2008, the Trans-European Drug Information network (TEDI) was created, a database compiling information from different non-profit drug checking services located in different European countries.

On March 31, 2017, a coalition of drug safety organisations hosted the first-ever International Drug Checking Day to raise awareness of safer drug use. [13] [14] [15] [16] The initiative was aimed at recreational users, with a particular emphasis on the nightlife community, and aims to promote harm reduction—accepting that people will choose to take drugs, and providing them with tools to minimise the risks.

In November 2021 New Zealand became the first country to make drug checking fully legal after previously allowing this under temporary legislation. Other countries like the Netherlands allow drug checking but do not have legislation to protect the clients or testers, and the practice exists in a legal grey area in countries like the US and UK. [17]

Approaches to drug checking

Front-of-house testing

Front-of-house testing [18] provides testing services to clients at events. It provides real-time, as-you-wait results. An example is the testing at BOOM festival in Portugal where drug testers are legally allowed to handle samples. Where testers are not allowed to handle samples, for fear of breaking laws around possession, clients themselves must handle the substance to be tested. Examples of this model are KnowYourStuffNZ [11] in New Zealand.

Back-of-house testing

Back-of-house testing [18] is more restrictive. The substances tested do not come directly from event participants. Instead, they may come from samples confiscated by police or event security or samples that are disposed of via drug amnesty bins. The results may not be available to event attendees.

Middle-of-house testing

Middle-of-house testing [18] is a new development, started by The Loop in the UK. Testing happens on-site, but without face-to-face interaction with the public. Samples from medical incidents are tested and alerts can be issued after multiple incidents with a trend are identified.

Testing outside events

Static testing sites provide testing services to clients at fixed locations away from events. Often these are in the entertainment districts of cities. Energy Control [19] in Barcelona and DIMS [6] in the Netherlands provide such services.

Off-site testing occurs away from events and away from clients. Clients submit samples by post or at drop-off locations. Those samples are analysed and then the results are publicised. Examples of this model include WEDINOS [20] (the Welsh Emerging Drugs & Identification of Novel Substances Project) and DIMS in the Netherlands.

The UK's first trial of community-based drug safety testing was carried out in Bristol and Durham in 2018 in a church, a drugs service, and a youth and community centre. Users reported that they intended to carry out a range of harm reduction actions such as alerting friends and acquaintances, being more careful mixing substances, consuming lowered dosage, and disposing of substances. [21]

Drug Checking Programs have been emerging across the Americas in recent years. A directory of these programs can be found at the Harm Reduction Innovation Lab's website. [22]

Analysis technologies

A fentanyl test strip. Fentanyl-test-strip.jpg
A fentanyl test strip.

A range of analysis techniques are in use by drug checking services. The most common are reagent testing, fourier transform infrared spectroscopy, ultraviolet-visible spectroscopy, raman spectroscopy, mass spectrometry and gas chromatography mass spectrometry.

Reagent testing uses chemical indicators that show a colour change in the presence of particular drugs. These tests are widely available and affordable. The use of several reagents is generally necessary to positively identify a substance with Marquis, Mandelin, and Mecke reagents being used to detect MDMA and Ehrlich's reagent common for detecting LSD. However, reagent testing only indicates the presence of a substance, not the absence of contaminants or other substances. This can provide a false sense of security when illicit drugs are deliberately adulterated to fool reagent tests. [23]

The presence of specific drugs can also be detected through immunoassay testing strips. Testing strips for fentanyl can detect a few tens of nanograms of the substance at a price of a few dollars per test. [24] Recent increased demand for immunoassay test strips, lack of regulation, and approval to use federal funding for test strip purchasing in the US have led to a boom in test strip manufacturers creating concern in drug checking programs and harm reduction organizations about the lack of validation, consistency, and accuracy of results.

Fourier transform infrared spectroscopy is a rapid test using robust hardware that can be carried out in the field. It provides sample identification and mixture analysis, allowing the detection of impurities and adulterants. It is highly sensitive and can carry out analysis using only a few milligrams of a sample. It is semi-quantitative and can provide an indication of purity. For these reasons, it is widely used by both fixed and mobile testing services and considered the best technology to use. [25]

Gas chromatography mass spectrometry provides very sensitive and quantified information about substances. However, the high price and delicate equipment generally limit the use of this technique to fixed sites.

The RADIAN ASAP is a novel, dedicated direct analysis system specifically designed for rapid, easy and low-cost analysis of liquids and solids. Engineered using proven and robust single quadrupole mass spectrometry technology combined with the Atmospheric Pressure Solids Analysis Probe (ASAP), the RADIAN ASAP delivers quality and ease of use in a compact footprint. RADIAN ASAP screens samples in less than 5 minutes against a library of known compounds for rapid, confident identification of illicit drugs. The sensitivity and selectivity of mass spectrometry provides confidence in detecting drugs with an easy, efficient triage workflow.

Development

Developing technologies include:

Effectiveness of drug checking

Drug checking has been shown to be an effective way to reduce the harm from drug use through informing safer use, limiting use, and helping users avoid the most dangerous substances. [28] [29] The services also provide monitoring and detection of new psychoactive substances to inform public health interventions. The Loop have stated that 20% of samples are handed in for disposal and 40% of service users reduce intake. [30] KnowYourStuffNZ have found that, when substances are not as expected, half of service users state they will not take that substance and a quarter say they will take a smaller quantity. [31] Drug checking services also reach drug users who are not reached by existing services. Evidence from research conducted by Austrian pill testing service CheckIt! found 58% of people who use the service would not otherwise seek out harm reduction information, and about 75% are more likely to access harm reduction services if pill testing is included. [32]

Academic research from the UK has found that one in five substances were not what they were expected to be and two-thirds of misrepresented samples were disposed of. Such on-site testing accesses otherwise hard-to-reach user groups to reduce the harms associated with drug use. [33]

Research that followed-up people who had used drug checking services in the UK revealed that those people acted upon the harm reduction advice that they received from the service. Those people disposed of unwanted substances, reduced their dosage of wanted substances, and reduced their risk of overdose. People also followed those risk management practices after attending festivals, alterted friends to the risks of drug use, and continued to follow that advice. [28]

In a peer-reviewed study published in Journal of Psychopharmacology, researchers at Johns Hopkins found that people were about half as likely (relative risk = 0.56) to report intent to use a product if testing did not identify the substance as MDMA, and this was a statistically significant reduction. [34]

See also

Related Research Articles

<span class="mw-page-title-main">MDMA</span> Psychoactive drug, often called ecstasy

3,4-Methyl​enedioxy​methamphetamine (MDMA), commonly known as ecstasy, and molly or mandy, is a potent empathogen–entactogen with stimulant and minor psychedelic properties primarily used for recreational purposes. The purported pharmacological effects that may be prosocial include altered sensations, increased energy, empathy, and pleasure. When taken by mouth, effects begin in 30 to 45 minutes and last three to six hours.

<span class="mw-page-title-main">Club drug</span> Category of recreational drugs

Club drugs, also called rave drugs or party drugs, are a loosely defined category of recreational drugs which are associated with discothèques in the 1970s and nightclubs, dance clubs, electronic dance music (EDM) parties, and raves in the 1980s to today. Unlike many other categories, such as opiates and benzodiazepines, which are established according to pharmaceutical or chemical properties, club drugs are a "category of convenience", in which drugs are included due to the locations they are consumed and/or where the user goes while under the influence of the drugs. Club drugs are generally used by adolescents and young adults.

<span class="mw-page-title-main">DanceSafe</span>

DanceSafe is a Berkeley, California based nonprofit organization founded in 1998 by then 30 year old Emanuel Sferios. They have 17 local chapters in the US and Canada. DanceSafe youth volunteers set up tables at music festivals, raves, and other events to distribute non-biased educational literature focused on harm reduction for safe and responsible drug use, including testing kits so that users may obtain more information about the contents of their pills. They also offer on site peer counseling, health and safety tools and patrols for events that assist in keeping patrons safe.

<span class="mw-page-title-main">Gas chromatography–mass spectrometry</span> Analytical method

Gas chromatography–mass spectrometry (GC–MS) is an analytical method that combines the features of gas-chromatography and mass spectrometry to identify different substances within a test sample. Applications of GC–MS include drug detection, fire investigation, environmental analysis, explosives investigation, food and flavor analysis, and identification of unknown samples, including that of material samples obtained from planet Mars during probe missions as early as the 1970s. GC–MS can also be used in airport security to detect substances in luggage or on human beings. Additionally, it can identify trace elements in materials that were previously thought to have disintegrated beyond identification. Like liquid chromatography–mass spectrometry, it allows analysis and detection even of tiny amounts of a substance.

<i>para</i>-Methoxyamphetamine Chemical compound

para-Methoxyamphetamine (PMA), also known as 4-methoxyamphetamine (4-MA), is a designer drug of the amphetamine class with serotonergic effects. Unlike other similar drugs of this family, PMA does not produce stimulant, euphoriant, or entactogen effects, and behaves more like an antidepressant in comparison, though it does have some psychedelic properties.

A drug test is a technical analysis of a biological specimen, for example urine, hair, blood, breath, sweat, or oral fluid/saliva—to determine the presence or absence of specified parent drugs or their metabolites. Major applications of drug testing include detection of the presence of performance enhancing steroids in sport, employers and parole/probation officers screening for drugs prohibited by law and police officers testing for the presence and concentration of alcohol (ethanol) in the blood commonly referred to as BAC. BAC tests are typically administered via a breathalyzer while urinalysis is used for the vast majority of drug testing in sports and the workplace. Numerous other methods with varying degrees of accuracy, sensitivity, and detection periods exist.

<span class="mw-page-title-main">Forensic toxicology</span> Use of toxicology for investigations

Forensic toxicology is the use of toxicology and disciplines such as analytical chemistry, pharmacology and clinical chemistry to aid medical or legal investigation of death, poisoning, and drug use. The primary concern for forensic toxicology is not the legal outcome of the toxicological investigation or the technology utilized, but rather the obtention and interpretation of results. A toxicological analysis can be done to various kinds of samples. A forensic toxicologist must consider the context of an investigation, in particular any physical symptoms recorded, and any evidence collected at a crime scene that may narrow the search, such as pill bottles, powders, trace residue, and any available chemicals. Provided with this information and samples with which to work, the forensic toxicologist must determine which toxic substances are present, in what concentrations, and the probable effect of those chemicals on the person.

<span class="mw-page-title-main">Forensic chemistry</span> Forensic application of the study of chemistry

Forensic chemistry is the application of chemistry and its subfield, forensic toxicology, in a legal setting. A forensic chemist can assist in the identification of unknown materials found at a crime scene. Specialists in this field have a wide array of methods and instruments to help identify unknown substances. These include high-performance liquid chromatography, gas chromatography-mass spectrometry, atomic absorption spectroscopy, Fourier transform infrared spectroscopy, and thin layer chromatography. The range of different methods is important due to the destructive nature of some instruments and the number of possible unknown substances that can be found at a scene. Forensic chemists prefer using nondestructive methods first, to preserve evidence and to determine which destructive methods will produce the best results.

Lacing or cutting, in drug culture, refer to the act of using a substance to adulterate substances independent of the reason. The resulting substance is laced or cut.

<span class="mw-page-title-main">Reagent testing</span> Tests for authentication of psychoactive drugs, and detection of adulterants

Reagent testing is one of the processes used to identify substances contained within a pill, usually illicit substances. With the increased prevalence of drugs being available in their pure forms, the terms "drug checking" or "pill testing" may also be used, although these terms usually refer to testing with a wider variety of techniques covered by drug checking.

Illicit drug use in Australia is the recreational use of prohibited drugs in Australia. Illicit drugs include illegal drugs, pharmaceutical drugs when used for non-medical purposes, and other substances used inappropriately. According to government and community organisations, the use and abuse, and the illegality, of illicit drugs is a social, health and legal issue that creates an annual illegal market estimated to be worth A$6.7 billion. Estimates made in 2022 place the figure at A$11.3 billion per year.

<span class="mw-page-title-main">Mephedrone</span> Synthetic stimulant drug

Mephedrone, also known as 4-methylmethcathinone, 4-MMC, and 4-methylephedrone, is a synthetic stimulant drug of the amphetamine and cathinone classes. Slang names include drone, M-CAT, White Magic, meow meow and bubble. It is chemically similar to the cathinone compounds found in the khat plant of eastern Africa. It comes in the form of tablets or crystals, which users can swallow, snort or inject, producing effects similar to those of MDMA, amphetamines and cocaine.

DrugScience or Drug Science (originally called the Independent Scientific Committee on Drugs (ISCD)) is a UK-based drugs advisory committee proposed and initially funded by hedge fund manager Toby Jackson. It is chaired by Professor David Nutt and was officially launched on 15 January 2010 with the help of the Centre for Crime and Justice Studies. The primary aim of the committee is to review and investigate the scientific evidence of drug harms without the political interference that could result from government affiliation.

<span class="mw-page-title-main">4-Methylethcathinone</span> Stimulant designer drug

4-Methylethcathinone or 4-MEC is a chemical that bears a chemical resemblance to mephedrone. Due to its similarity to mephedrone, it is thought to be a stimulant and entactogen drug of the phenethylamine, amphetamine, and cathinone chemical classes. It has been marketed alone or in mixtures with other substituted cathinones under the name "NRG-2", although other blends such as "NRG-1" may have been more ambiguous with their ingredients.

Low-threshold treatment programs are harm reduction-based health care centers targeted towards people who use substances. "Low-threshold" programs are programs that make minimal demands on the patient, offering services without attempting to control their intake of drugs, and providing counselling only if requested. Low-threshold programs may be contrasted with "high-threshold" programs, which require the user to accept a certain level of control and which demand that the patient accept counselling and cease all drug use as a precondition of support.

Responsible drug use maximizes the benefits and reduces the risk of negative impact psychoactive drugs cause on the lives of the user. For illegal psychoactive drugs that are not diverted prescription controlled substances, some critics believe that illegal recreational drug use is inherently irresponsible, due to the unpredictable and unmonitored strength and purity of the drugs and the risks of addiction, infection, and other side effects.

<span class="mw-page-title-main">N-t-BOC-MDMA</span> Chemical compound

N-t-BOC-MDMA is a chemical compound which can be both a synthetic precursor to, or a prodrug of the empathogenic drug MDMA. It was first identified in Australia in 2015 as a seizure by customs, and has subsequently been found in China, the Netherlands and other European countries. Originally it was thought to be intended as a non-illegal form of MDMA which could be easily converted into the prohibited final product after importation, however one seizure by police found N-t-BOC-MDMA in the process of being pressed into pills, and experiments with simulated gastric fluid confirmed that it can be broken down to MDMA by human stomach acid. Similar N-protected compounds such as N-t-BOC-methamphetamine, N-p-tosyl-methamphetamine, N-t-BOC-ketamine, N-t-BOC-norketamine and N-methoxycarbonyl-MDA have also been encountered by law enforcement.

Get Your Drugs Tested is a free public drug checking service located in Vancouver, Canada. It was founded by Dana Larsen in May 2019, accepting samples in person at their storefront and by mail from all across Canada. Dana Larsen said: "I want to help save lives, I want people to be informed and I wish they could buy clean, pre-tested drugs" since "the whole war on drug users is a genocide of the poor."

The Trans-European Drug Information (TEDI) project is a European database compiling information from different drug checking services located on the European continent. The non-governmental organizations feeding into the database are referred to as the TEDI network.

References

  1. ↑ "Bulletin no. 24: Global review of drug checking services operating in 2017 | NDARC - National Drug and Alcohol Research Centre". ndarc.med.unsw.edu.au. Retrieved 2018-04-28.
  2. ↑ Inquiry into Drug Law Reform. Law Reform, Road and Community Safety Committee, Parliament of Victoria. 2018. pp.  https://www.parliament.vic.gov.au/lrrcsc/inquiries/inquiry/421.
  3. ↑ "Keeping safer under summer skies | NZ Drug Foundation - At the heart of the matter". www.drugfoundation.org.nz. Retrieved 2018-04-28.
  4. ↑ Giné, Claudio Vidal; Vilamala, Mireia Ventura; Measham, Fiona; Brunt, Tibor M.; Bücheli, Alexander; Paulos, Carlos; Valente, Helena; Martins, Daniel; Libois, Bérénice; Tögel-Lins, Karsten; Jones, Guy; Karden, Alexandra; Barratt, Monica J. (2017-07-01). "The utility of drug checking services as monitoring tools and more: A response to Pirona et al". International Journal of Drug Policy. 45: 46–47. doi:10.1016/j.drugpo.2017.05.018. ISSN   0955-3959. PMID   28582668.
  5. ↑ KOK, J. C. FILEDT (22 May 1971). "Letter: Analysis of Illicit Drugs". The Lancet. Letters to the Editor: 1065–1066.
  6. 1 2 Netherlands, Trimbos-instituut, The. "drugs-test.nl | Home". www.drugs-test.nl. Retrieved 2018-04-28.{{cite web}}: CS1 maint: multiple names: authors list (link)
  7. ↑ "Asociación Hegoak Elkartea". www.facebook.com. Retrieved 2018-04-28.
  8. ↑ "Accueil - Techno+". Techno+ (in French). Retrieved 2018-04-28.
  9. ↑ "Home". Neutravel. Retrieved 2022-10-05.
  10. ↑ "Home". The Loop. Retrieved 2018-04-28.
  11. 1 2 "Our Service". knowyourstuff.nz. 2017-06-30. Retrieved 2019-02-16.
  12. ↑ "Pill Testing Australia". pilltestingaustralia.org.au. Retrieved 2019-01-18.
  13. ↑ "First-Ever International Drug Checking Day to be Held This Friday". VICE. 2017-03-31. Retrieved 2018-11-24.
  14. ↑ "MARCH 31 IS THE FIRST EVER INTERNATIONAL DRUG CHECKING DAY". MIXMAG. 2017-03-31. Retrieved 2018-11-24.
  15. ↑ "Happy International Day of Drug Checking! Are Your Drugs Laced?". Westword. 2017-03-31. Retrieved 2018-11-24.
  16. ↑ "Drug safety testing, disposals and dealing in an English field: Exploring the outcomes of the UK's first onsite drug checking service". drugscience.org.uk. 2018-12-11. Retrieved 2019-01-15.
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  21. ↑ Measham, Fiona (2020). "City checking: Piloting the UK's first community-based drug safety testing (drug checking) service in 2 city centres". British Journal of Clinical Pharmacology. 86 (3): 420–428. doi: 10.1111/bcp.14231 . ISSN   1365-2125. PMC   7080630 . PMID   32030770.
  22. ↑ "Harm Reduction Innovation Lab". Harm Reduction Innovation Lab.
  23. ↑ "Deliberately Deceptive Drug Mixtures Found This Summer". knowyourstuff.nz. 2018-03-13. Retrieved 2018-04-28.
  24. ↑ Serrano, Alfonso. "$1 Fentanyl Test Strip Could Be a Major Weapon against Opioid ODs". Scientific American. Retrieved 2018-04-28.
  25. ↑ "Fentanyl Overdose Reduction Checking Analysis Study" (PDF). Archived from the original (PDF) on 2019-01-01. Retrieved 2019-01-17.
  26. ↑ Paul, Martin; Tannenberg, Robert; Tscheuschner, Georg; Ponader, Marco; Weller, Michael G. (September 2021). "Cocaine Detection by a Laser-Induced Immunofluorometric Biosensor". Biosensors. 11 (9): 313. doi: 10.3390/bios11090313 . PMC   8466613 . PMID   34562903.
  27. ↑ Abrahamsson, Christoffer K.; Nagarkar, Amit; Fink, Michael J.; Preston, Daniel J.; Ge, Shencheng; Bozenko, Joseph S.; Whitesides, George M. (2020). "Analysis of Powders Containing Illicit Drugs Using Magnetic Levitation". Angewandte Chemie International Edition. 59 (2): 874–881. doi:10.1002/anie.201910177. OSTI   1800028. PMID   31714663. S2CID   207947721.
  28. 1 2 Measham, Fiona; Turnbull, Gavin (8 May 2021). "Intentions, actions and outcomes: A follow up survey on harm reduction practices after using an English festival drug checking service". International Journal of Drug Policy. 95: 103270. doi: 10.1016/j.drugpo.2021.103270 . PMID   33972157.
  29. ↑ Maghsoudi, Nazlee; Tanguay, Justine; Scarfone, Kristy; Rammohan, Indhu; Ziegler, Carolyn; Werb, Dan; Scheim, Ayden I. (2021). "Drug checking services for people who use drugs: a systematic review". Addiction. 117 (3): 532–544. doi:10.1111/add.15734. ISSN   1360-0443. PMC   9299873 . PMID   34729849. S2CID   241108417.
  30. ↑ "The Loop on Twitter". Twitter. Retrieved 2018-04-28.
  31. ↑ "Why it works". knowyourstuff.nz. 2017-06-30. Retrieved 2018-04-28.
  32. ↑ Benschop, Annemieke; Rabes, Manfred; Korf, Dirk (11 September 2022). "Pill Testing, Ecstasy and Prevention: A Scientific Evaluation in Three European Cities" (PDF).
  33. ↑ Measham, Fiona Catherine (December 2018). "Drug safety testing, disposals and dealing in an English field: Exploring the operational and behavioural outcomes of the UK's first onsite 'drug checking' service" (PDF). International Journal of Drug Policy. 67: 102–107. doi:10.1016/j.drugpo.2018.11.001. PMID   30541674. S2CID   56141116.
  34. ↑ Saleemi, Sarah; Pennybaker, Steven J; Wooldridge, Missi; Johnson, Matthew W (10 July 2017). "Who is 'Molly'? MDMA adulterants by product name and the impact of harm-reduction services at raves". Journal of Psychopharmacology. 31 (8): 1056–1060. doi:10.1177/0269881117715596. PMID   28693371. S2CID   206493011.
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