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      'I t’s not going to be a one size fits all': a qualitative exploration of the potential utility of three drug checking service models in Scotland

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          Abstract

          Background

          Scotland currently has the highest rates of drug-related deaths in Europe, so drug checking services are being explored due to their potential role in reducing these deaths and related harms. Drug checking services allow individuals to submit presumed psychoactive drug samples for analysis, and then receive individualised feedback and counselling. This paper explores participants’ views on the advantages and challenges of three hypothetical service models, to inform future service delivery in Scotland.

          Methods

          Semi-structured interviews were conducted with 43 people: 27 professional stakeholders, 11 people with experience of drug use, and five family members across three cities. Vignettes were used to provide short descriptions of three hypothetical service models during the interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis.

          Results

          Participants identified advantages and challenges for each of the three potential service models. The third sector (not-for-profit) model was favoured overall by participants, and the NHS substance use treatment service was the least popular. Participants also noted that multiple drug checking sites within one city, along with outreach models would be advantageous, to meet the diverse needs of different groups of people who use drugs.

          Conclusions

          Drug checking services need to be tailored to local context and needs, with a range of service models being possible, in order to meet the needs of a heterogeneous group of people who use drugs. Addressing issues around stigma, accessibility, and concerns about the potential impact of accessing drug checking on access to and outcomes of drug treatment, are essential for successful service delivery.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12954-023-00830-w.

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          Most cited references36

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          Using thematic analysis in psychology

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            Evaluation of a fentanyl drug checking service for clients of a supervised injection facility, Vancouver, Canada

            Background British Columbia, Canada, is experiencing a public health emergency related to opioid overdoses driven by consumption of street drugs contaminated with illicitly manufactured fentanyl. This cross-sectional study evaluates a drug checking intervention for the clients of a supervised injection facility (SIF) in Vancouver. Methods Insite is a facility offering supervised injection services in Vancouver’s Downtown East Side, a community with high levels of injection drug use and associated harms, including overdose deaths. During July 7, 2016, to June 21, 2017, Insite clients were offered an opportunity to check their drugs for fentanyl using a test strip designed to test urine for fentanyl. Results of the drug check were recorded along with information including the substance checked, whether the client intended to dispose of the drug or reduce the dose and whether they experienced an overdose. Logistic regression models were constructed to assess the associations between drug checking results and dose reduction or drug disposal. Crude odds ratios (OR) and 95% confidence intervals (CI) were reported. Results About 1% of the visits to Insite during the study resulted in a drug check. Out of 1411 drug checks conducted by clients, 1121 (79.8%) were positive for fentanyl. Although most tests were conducted post-consumption, following a positive pre-consumption drug check, 36.3% (n = 142) of participants reported planning to reduce their drug dose while only 11.4% (n = 50) planned to dispose of their drug. While the odds of intended dose reduction among those with a positive drug check was significantly higher than those with a negative result (OR = 9.36; 95% CI 4.25–20.65), no association was observed between drug check results and intended drug disposal (OR = 1.60; 95% CI 0.79–3.26). Among all participants, intended dose reduction was associated with significantly lower odds of overdose (OR = 0.41; 95% CI 0.18–0.89). Conclusions Although only a small proportion of visits resulted in a drug check, a high proportion (~ 80%) of the drugs checked were contaminated with fentanyl. Drug checking at harm reduction facilities such as SIFs might be a feasible intervention that could contribute to preventing overdoses in the context of the current overdose emergency.
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              An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples

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                Author and article information

                Contributors
                hannah.carver@stir.ac.uk
                Journal
                Harm Reduct J
                Harm Reduct J
                Harm Reduction Journal
                BioMed Central (London )
                1477-7517
                27 July 2023
                27 July 2023
                2023
                : 20
                : 94
                Affiliations
                [1 ]GRID grid.11918.30, ISNI 0000 0001 2248 4331, Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, , University of Stirling, ; Stirling, FK9 4LA UK
                [2 ]GRID grid.143640.4, ISNI 0000 0004 1936 9465, Canadian Institute for Substance Use Research, , University of Victoria, ; Victoria, BC V8P 5C2 Canada
                [3 ]GRID grid.20409.3f, ISNI 000000012348339X, School of Applied Sciences, , Edinburgh Napier University, ; Edinburgh, EH11 4BN UK
                [4 ]GRID grid.10025.36, ISNI 0000 0004 1936 8470, Department of Sociology, Social Policy and Criminology, , University of Liverpool, ; Liverpool, L69 7ZR UK
                [5 ]The Loop, Unclassified Community Interest Company, Manchester, M13 9PL UK
                [6 ]GRID grid.413301.4, ISNI 0000 0001 0523 9342, Alcohol and Drug Services, , NHS Greater Glasgow and Clyde, ; Glasgow, G51 1DP UK
                [7 ]GRID grid.4425.7, ISNI 0000 0004 0368 0654, Public Health Institute, , Liverpool John Moores University, ; Liverpool, L2 2QP UK
                [8 ]Via, London, SW1H 9BL UK
                [9 ]GRID grid.416115.6, ISNI 0000 0004 0624 7813, NHS Grampian, , Royal Cornhill Hospital, ; Cornhill Road, Aberdeen, AB25 2ZH UK
                [10 ]GRID grid.508718.3, Public Health Scotland, ; Glasgow, G2 6QE UK
                [11 ]Crew2000, Edinburgh, EH1 1PB UK
                Article
                830
                10.1186/s12954-023-00830-w
                10373262
                36611167
                c00c230c-49cb-420f-a7da-8268c9e4ead1
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 14 April 2023
                : 16 July 2023
                Funding
                Funded by: Drug Deaths Taskforce/Corra Foundation
                Award ID: 20/5304
                Award ID: 20/5304
                Award ID: 20/5304
                Award ID: 20/5304
                Award ID: 20/5304
                Award ID: 20/5304
                Award ID: 20/5304
                Award ID: 20/5304
                Award ID: 20/5304
                Award Recipient :
                Categories
                Research
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2023

                Health & Social care
                drug checking services,harm reduction,substance use,drug use intervention,drug related deaths,qualitative research,scotland,public health,service delivery

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