Are drug-checking services useful to people who use drugs?

Among the many dangers of opioid use is that street drugs purporting to be one drug often contain other drugs, such as fentanyl, or cutting agents. Drug-checking services — various types of tests that can determine what, truly, is in a drug — can help users understand what they are about to put in their bodies.

A team of UIC researchers from the Jane Addams College of Social Work and the School of Public Health and colleagues wondered what attitudes people who use drugs have toward these services. They were particularly interested in attitudes toward testing for fentanyl, which has become more common in street drugs, both as a hidden ingredient and an intentionally sought-out drug. If most opioid users expect their heroin to contain fentanyl, is it worth it to test the drugs to know for sure?

To find out, the researchers conducted a study with 118 people who participated in two needle exchange programs in Chicago. Each participant gave the researchers a sample of their recently purchased drugs and answered survey questions about their drug use and overdose histories, their attitudes toward drug-checking services and what they believed was actually in the samples they provided to the researchers. The study is published in Harm Reduction Journal.

The researchers found that more than 90% of participants believed they had recently used fentanyl either deliberately or because it was mixed in with something else, yet only 38% of participants said they prefer fentanyl or drug mixtures containing it.

Participants were generally receptive to the idea of using drug-checking services, with 83% saying they would be interested in testing for fentanyl and more than half disagreeing with the statement, “as most heroin has fentanyl, there is no point in testing.” However, the researchers point out that about 25%, said drug testing was “too much trouble.”

Participants often did not anticipate what was mixed in with their drugs. They underestimated how frequently the antihistamine diphenhydramine was present and overestimated how often the drugs contained benzodiazepines, like Valium and Xanax.

The researchers also found that interest in drug checking did not vary depending on the number of times a participant had overdosed.

Taken together, the researchers say the study shows an interest in drug-checking services among people who use street drugs.

“We thought the street opioid users would see drug checking as a waste of time. But this is not what the data showed,” explained lead author James Swartz from the Jane Addams College of Social Work.

Based on their study, the researchers believe these tests could be most beneficial if they showed the concentration of different drugs in a sample, and if they identified a number of potential drugs, not just fentanyl. Testing for fentanyl, however, would be particularly useful for drugs that are not sold as opioids, such as cocaine or methamphetamines. For those users, who may not have a tolerance for opioids, fentanyl is particularly dangerous.

The research team also included A. David Jimenez and Mary Ellen Mackesy-Amiti, from the School of Public Health, as well as colleagues from Notre Dame, Chestnut Health Systems and Thresholds Homeless Outreach Program.

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