实现对加拿大各地不受监管的街头毒品供应情况的跨地区监测。
Towards cross-Canada monitoring of the unregulated street drug supply.
机构信息
Canadian Centre on Substance Use and Addiction, 500-75 Albert Street, Ottawa, ON, K1P 5E7, Canada.
British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
出版信息
BMC Public Health. 2021 Sep 15;21(1):1678. doi: 10.1186/s12889-021-11757-x.
BACKGROUND
The well-being of people who use drugs (PWUD) continues to be threatened by substances of unknown type or quantity in the unregulated street drug supply. Current efforts to monitor the drug supply are limited in population reach and comparability. This restricts capacity to identify and develop measures that safeguard the health of PWUD. This study describes the development of a low-barrier system for monitoring the contents of drugs in the unregulated street supply. Early results for pilot sites are presented and compared across regions.
METHODS
The drug content monitoring system integrates a low-barrier survey and broad spectrum urine toxicology screening to compare substances expected to be consumed and those actually in the drug supply. The system prototype was developed by harm reduction pilot projects in British Columbia (BC) and Montreal with participation of PWUD. Data were collected from harm reduction supply distribution site clients in BC, Edmonton and Montreal between May 2018-March 2019. Survey and urine toxicology data were linked via anonymous codes and analyzed descriptively by region for trends in self-reported and detected use.
RESULTS
The sample consisted of 878 participants from 40 sites across 3 regions. Reported use of substances, their detection, and concordance between the two varied across regions. Methamphetamine use was reported and detected most frequently in BC (reported: 62.8%; detected: 72.2%) and Edmonton (58.3%; 68.8%). In Montreal, high concordance was also observed between reported (74.5%) and detected (86.5%) cocaine/crack use. Among those with fentanyl detected, the percentage of participants who used fentanyl unintentionally ranged from 36.1% in BC, 78.6% in Edmonton and 90.9% in Montreal.
CONCLUSIONS
This study is the first to describe a feasible, scalable monitoring system for the unregulated drug supply that can contrast expected and actual drug use and compare trends across regions. The system used principles of flexibility, capacity-building and community participation in its design. Results are well-suited to meet the needs of PWUD and inform the local harm reduction services they rely on. Further standardization of the survey tool and knowledge mobilization is needed to expand the system to new jurisdictions.
背景
在不受监管的街头毒品供应中，未知类型或数量的物质继续威胁着吸毒者（PWUD）的健康。目前监测毒品供应的工作在人口覆盖范围和可比性方面受到限制。这限制了识别和制定措施以保障 PWUD 健康的能力。本研究描述了一种用于监测不受监管的街头供应中药物含量的低门槛系统的开发。介绍了试点站点的早期结果，并在各地区进行了比较。
方法
药物含量监测系统结合了低门槛调查和广谱尿液毒物筛查，以比较预期消耗的物质和实际供应中的物质。该系统原型由不列颠哥伦比亚省（BC）和蒙特利尔的减少伤害试点项目开发，有 PWUD 参与。2018 年 5 月至 2019 年 3 月，在 BC、埃德蒙顿和蒙特利尔的减少伤害供应分发点客户中收集了数据。通过匿名代码将调查和尿液毒物学数据联系起来，并按地区进行描述性分析，以了解自我报告和检测到的使用趋势。
结果
该样本由来自三个地区 40 个地点的 878 名参与者组成。报告的物质使用、检测以及两者之间的一致性在各地区有所不同。在 BC（报告：62.8%；检测：72.2%）和埃德蒙顿（58.3%；68.8%），甲基苯丙胺的使用报告和检测最为频繁。在蒙特利尔，报告（74.5%）和检测（86.5%）可卡因/快克的一致性也很高。在检测到芬太尼的参与者中，无意使用芬太尼的参与者比例在 BC 为 36.1%，埃德蒙顿为 78.6%，蒙特利尔为 90.9%。
结论
本研究首次描述了一种可行的、可扩展的不受监管的毒品供应监测系统，该系统可以对比预期和实际的药物使用情况，并比较各地区的趋势。该系统在设计中采用了灵活性、能力建设和社区参与的原则。结果非常适合满足 PWUD 的需求，并为他们所依赖的当地减少伤害服务提供信息。需要进一步标准化调查工具并调动知识，以将该系统扩展到新的司法管辖区。
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