Piloting a Point-of-Care Drug-Checking Service at Syringe Service Programs in New York City

Abstract

Background:

Drug checking is an evidence-based harm reduction strategy that can contribute to safer use by providing people who use drugs (PWUD) with actionable information about the contents of the drugs they are using and ways to reduce harm. In response to persistently high overdose rates largely driven by adulteration and volatility of the unregulated drug supply, the New York City Department of Health & Mental Hygiene (NYC DOHMH) initiated a point-of-care drug-checking pilot study in partnership with syringe service programs.

Methods:

Drug-checking services were piloted at 6 sites over the study period. DOHMH staff were trained to use immunoassay test strips and Fourier-transform Infrared Spectrometers, analyze and interpret drug-checking results, and provide tailored harm reduction education to participants. Samples were sent for secondary testing to support technician training and quality assurance. Participant demographics, information about the drug sample, and how individuals planned to use the results were collected and entered into a REDCap database.

Results:

From November 2021 through December 2023, more than 1600 samples were submitted for analysis. Over half of the samples were sold as opioids (55%; n = 903). The presence of fentanyl in samples sold as opioids was very high (95%; n = 859). Xylazine was detected in 35.0% (n = 201) of opioid samples for which secondary laboratory results were available. 51.5% of participants indicated that they planned to employ a harm reduction strategy or take some other action following receipt of their drug-checking results.

Conclusion:

Findings from the pilot study demonstrate that it is feasible and acceptable for local health departments to implement point-of-care drug-checking services in partnership with programs that serve PWUD. For some participants, drug-checking interactions may support behavioral intention changes about the drugs they use. Key implementation considerations include the importance of a robust technician training model, selection of appropriate and complementary drug-checking technologies, and availability of secondary lab testing.