drug checking

• Overdose


  Drug poisoning
• Opioid epidemic


  Toxic drug epidemic/supply
• Drug testing


  Drug checking (checking substances to see drug makeup)
• Safe consumption site (SCS)

  Might include other resources like drug substitution, outreach open health, reduce harm and pathogens, provide harm reduction tools (naloxone, needles)
• Overdose prevention site (OPS)


  Popup site that comes about due to specific need in a specific area, reduce harm and pathogens, provide harm reduction tools (naloxone, needles)
• Harm reduction


  Aims to reduce the negative effects or harms of a behaviour without requiring you to stop the behaviour (i.e., hand washing, PPE, seatbelts, earplugs)
• Harm Reduction [movement] vs harm reduction [the public health framework]

  • Swap program - bring needle back for fresh one
  • Needle distribution - giving out clean sterile equipment (pipes, needles, tubing for pipes, tourniquets, alcohol swabs, cookers, straws for snorting)
  • Substitution - cannabis substitution for harder drugs [new approach], more recently, methadone & suboxone for opioids
  • SCS and OPS
  • Take home naloxone kits
• 7 tenets of harm reduction

  • Focus on harms - the drug use is secondary to the harms, first priority is to reduce the negative harms of drug use to the individual
  • The involvement of people who use drugs - important for creating policy/organizations to reduce harm, involve those who are using drugs or have used them
  • Alignment with human rights - don't need to forfeit their human rights (to life, to social services)
  • Alignment with public health aims
  • Value neutrality and nonjudgement - meet people where they are without judgement
  • Being practical and pragmatic - we want something that the demographic you're targeting will want to engage with
• Public health emergency declared in 2016 CANADA
• Fentanyl detected in 84% of unregulated drug deaths (2023)
• Rise in illicit benzodiazepines - 29.7% (2022) -> 44.8% (2023), no benzo antagonist available yet for consumers (only accessible in hospital), naloxone doesn't work on benzos
• BC lost 2539 people in 2023 (6% increase from 2022; 7 people per day (ages 30-59), 77% males, First nations 6x rate (Jan-June 2023), 11.9x first nations women, 4.6x for first nations men
• Why Drug Checking?


  • Opportunities for conversation and connection
  • Public health - reducing risks
  • Consumers feel empowered
  • Market regulation of the drug market (people will get their drugs checked and bring back to their dealer for accountability)
  • Enhanced community and individual well-being
  • Reduces stigma
  • Track evolution of the drug supply over time, allowing the organization to adapt to the changing supply to provide better resources to those using them
• Drug checking


  Free, confidential HR service that provides users with info about what's in their drugs, PWUD (people who use drugs) are empowered to make more informed decisions about the drugs they intend to use
• Section 56 exemption of the federal Controlled Drugs & Substances Act


  BC center for substance abuse is allowed to legally Collect, storage, transportation, and dispose of drugs
• June 2021 - BC implemented a specific designation for drug checking services = distributed model of drug checking
• Previously, someone could be arrested on their way to drug checking
• Drug Checking Technologies


  • Tier 1 - Immunoassay test strips (cost effective and accessible, low detection threshold, result: either yes/no (binary))
  • Tier 2 - FTIR (portable, can identify 4-5 ingredients, ~5% detection by threshold, doesn't destroy the sample, sometimes able to give % of ingredients)
  • Tier 3 - PS-MS, HPLC-MS, GC-MS (high precision, very sensitive, where drugs are sent if the previous methods cannot determine)
• Drug checking process only needs to be a rice sized sample
• Myths and facts about Naloxone

  • It encourages substance use - myth
  • Naloxone does not get you high - fact
  • If you admin it wrong, person can be injured - myth
  • It can be safely administered multiple times - fact
• Opioid poisoning signs


  • Shallow breathing
  • Cold, clammy skin, may be discoloured (loss of red colour due to lack of oxygen)
  • Tiny pupils (not a good indicator when drug is mixed)
• Opioid poisoning response


  • Stimulate (talk to them, stimulate sternum; call 911 immediately)
  • Airway (see if blocked)
  • Ventilate
  • Evaluate (give naloxone; it can be administered 2x in a row with no bad outcomes)
  • Medication