Guirguis Amira, Gittins Rosalind, Schifano Fabrizio
Swansea University Medical School, Institute of Life Sciences, Swansea University, Swansea SA2-8PP, Wales, UK.
Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield AL10-9AB, UK.
Behav Sci (Basel). 2020 Jul 25;10(8):121. doi: 10.3390/bs10080121.
(1) Introduction: Drug-related deaths in the UK are at concerning high levels. The unknown content and purity of illicit substances can cause unpredictable adverse effects and thus a public health risk with no sign of abating. On-site drug checking is a public health strategy that has previously been implemented, predominantly in festival settings, but without Home Office licensing. (2) Aims: The aim of this study was to pilot the UK's first pharmacist-led, Home Office-licensed community drug checking service. (3) Methods: A bespoke protocol incorporating legally, professionally and ethically binding documents was implemented. This free, confidential service ran between February and March 2019, was available to anyone over 18 who were purposefully recruited, gave informed consent and agreed to relinquish their drug sample. Samples were checked on-site within an established Substance Misuse Service (SMS) using a handheld Raman spectrometer to determine likely drug content and adulterants. In parallel, participants completed a questionnaire about their substance use and the drug sample(s) being tested. A pharmacist-led multidisciplinary approach was adopted to discuss the analytical findings. Informed by the results of the analysis and the questionnaire, people who used the service received tailored harm reduction advice. (4) Results and Discussion: The pilot operated for a total of four days over four weeks. Eleven people visited and relinquished a total of thirteen samples. Half of the participants had previously overdosed and were known to the SMS. Seventy per cent were male, all were White British individuals, 30% were employed and two people disclosed visiting from another nearby town. Samples included what was thought to be heroin, synthetic cannabinoids, stimulants, benzodiazepines and LSD and none required activation of the "alerts cascade" process. Most participants drank alcohol regularly and the concomitant use of traditional illicit drugs and prescribed medication (including opioids, anxiolytics and antidepressants) with sedating profiles was common. Given some of the ethical decisions and interpretation of the results, specialist pharmacist involvement was deemed essential. (5) Conclusions: This pilot demonstrated the proof-of-concept that a pharmacist-led Home Office-licensed drug checking service can be successfully implemented in community SMSs.
(1) 引言：英国与毒品相关的死亡人数处于令人担忧的高水平。非法物质的未知成分和纯度会导致不可预测的不良反应，从而构成公共卫生风险，且毫无缓解迹象。现场毒品检测是一项此前已实施的公共卫生策略，主要在节日场合开展，但未经英国内政部许可。(2) 目的：本研究的目的是试行英国首个由药剂师主导、获英国内政部许可的社区毒品检测服务。(3) 方法：实施了一个包含具有法律、专业和道德约束力文件的定制方案。这项免费、保密的服务于2019年2月至3月期间运行，面向所有18岁以上、经过特意招募、给予知情同意并同意交出其毒品样本的人。样本在既定的药物滥用服务机构（SMS）内使用手持式拉曼光谱仪进行现场检测，以确定可能的毒品成分和掺杂物。与此同时，参与者填写了一份关于其物质使用情况及所检测毒品样本的问卷。采用了由药剂师主导的多学科方法来讨论分析结果。根据分析结果和问卷情况，使用该服务的人获得了量身定制的减少伤害建议。(4) 结果与讨论：试点在四周内共运行了四天。11人前来并交出了总共13个样本。一半的参与者此前曾过量用药，且为SMS所熟知。70%为男性，均为英国白人，30%有工作，两人透露是从附近另一个城镇前来。样本包括疑似海洛因、合成大麻素、兴奋剂、苯二氮䓬类药物和麦角酸二乙胺（LSD），且无一需要启动“警报级联”程序。大多数参与者经常饮酒，同时使用传统非法药物和具有镇静作用的处方药（包括阿片类药物、抗焦虑药和抗抑郁药）的情况较为常见。鉴于一些伦理决策和对结果的解读，专家药剂师的参与被认为至关重要。(5) 结论：该试点证明了由药剂师主导、获英国内政部许可的毒品检测服务可在社区SMS中成功实施的概念验证。
