Drug checking

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 empowers users to make safer choices: to avoid more dangerous substances, to use smaller quantities, and to avoid dangerous combinations.^[1]

Drug checking services have developed over the last twenty-five years in twenty countries and are being considered in more.^[2] They 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 service is the Drug Information and Monitoring System^[5] 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^[6], TechnoPlus in France founded in 1995^[7], 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 The Loop^[8] founded in the UK in 2013 and KnowYourStuffNZ in New Zealand in 2015.

Attempts to set up drug checking in some countries have been hindered by local laws. Trials of testing in Australia were cancelled in 2017 due to legal pressure^[9] but are set to go ahead in 2018.^[10]

Analysis technologies

A range of analysis techniques are in use by drug checking service. The most common are reagent testing, Fourier transform infrared spectroscopy, ultraviolet-visible spectroscopy, Raman spectroscopy, and gas chromatography mass spectroscopy. Developing technologies include nuclear magnetic resonance spectroscopy and ion-trap mass spectroscopy.

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.^[11]

The presence of specific drugs can also be detected through immunoassy 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.^[12]

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.

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

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. 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.^[13] 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.^[14] Drug checking services also reach drug users who are not reached by existing services. Interactions with The Loop account for the first contact with drug workers for 90% of service users.

References