Department of Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Int J Drug Policy. 2018 Dec;62:59-66. doi: 10.1016/j.drugpo.2018.10.001. Epub 2018 Oct 22.
Adulteration of illicit drug supplies with synthetic opioids such as fentanyl has contributed to a dramatic rise in overdose morbidity and mortality in North America. One promising response to this crisis is the implementation of "drug checking" services. Drug checking encompasses a range of interventions used to assess the constituents of illicit drug samples, such as colour-spot testing, gas or liquid chromatography, and various methods of spectroscopy. Testing may be performed on-site at events or harm reduction service locales, performed independently by consumers, or sent to a centralized lab for analysis. This information may then serve to inform individual decision-making, enhance harm reduction efforts and strengthen public health surveillance and response strategies to prevent harms associated with illicit drug use. Historical examples of drug checking services that emerged with the 1990s synthetic "party drug" movement in Europe provide a theoretical and practical basis for the adaptation of these services for use in context of the current opioid overdose crisis. Potential harm reduction benefits of drug checking for synthetic opioid adulterants include individuals being more likely to use drugs more safely or to dispose of drugs found to contain harmful adulterants. Public health benefits of drug checking may also include negative feedback on the illicit drug supply with decreased availability or consumption of drugs from sources adulterated with synthetic opioids following public health warning campaigns. As part of the response to the current synthetic opioid epidemic in BC, pilot efforts are being undertaken in Vancouver to determine the feasibility and effectiveness of drug checking as an overdose response strategy. Models of drug checking service delivery and comparison of differing technologies, including unique challenges and potential solutions related to access to these services, legal obstacles, and sensitivity and specificity of testing technologies, are explored, alongside suggestions for future research and directions.
非法药物供应中掺入合成阿片类药物（如芬太尼）导致北美地区药物过量发病率和死亡率急剧上升。应对这一危机的一个有希望的措施是实施“药物检测”服务。药物检测包括一系列用于评估非法药物样本成分的干预措施，例如颜色斑点测试、气体或液体色谱法以及各种光谱方法。测试可以在活动现场或减少伤害服务场所进行，也可以由消费者独立进行，或者送到集中的实验室进行分析。然后，这些信息可以为个人决策提供依据，加强减少伤害的努力，并加强公共卫生监测和应对策略，以防止与非法药物使用相关的危害。90 年代欧洲出现的与合成“派对药物”运动相关的药物检测服务的历史实例为这些服务在当前阿片类药物过量危机背景下的应用提供了理论和实践基础。药物检测对合成阿片类药物掺杂物的潜在减少伤害益处包括个人更有可能更安全地使用药物或丢弃发现含有有害掺杂物的药物。药物检测的公共卫生益处还可能包括通过公共卫生警告运动减少对含有合成阿片类药物的掺假药物供应的可用性或消费，从而对非法药物供应产生负面影响。作为对卑诗省当前合成阿片类药物流行的应对措施的一部分，温哥华正在进行试点工作，以确定药物检测作为应对药物过量的策略的可行性和有效性。正在探讨药物检测服务提供模式以及不同技术的比较，包括与获取这些服务相关的独特挑战和潜在解决方案、法律障碍以及测试技术的敏感性和特异性，并提出了未来研究和发展方向的建议。
