Bruce Wallace

The emergence of nitazene compounds in the illicit drug supply is a significant and increasing concern due to their high potency and rapid evolution in several parts of the world. Nitazenes create challenges for harm reduction drug checking services, where there is a need to provide relevant information about the composition of drug samples to people who use drugs. While targeted paper spray mass spectrometry has demonstrated abilities for drug checking, it is difficult to keep analysis methods up to date for the rapidly evolving drug supply. We have developed a precursor ion scan method that monitors four common nitazene product ions paired with tooling to streamline data interpretation. Twenty‐five control samples received at a community‐level drug checking service were used in method development and evaluation to ensure direct applicability to illicit drug samples. Using the developed method, three nitazene compounds, ‐pyrrolidino protonitazene, ‐desethyl etonitazene, and ‐pyrrolidino ethylene isotonitazene, were detected across 18 samples where a nitazene was not previously detected upon preliminary targeted analysis. This approach demonstrates rapid, nontargeted screening for the detection of emerging nitazenes, ultimately allowing more complete information about the composition of drug samples to be provided to people who use drugs, as well as public health monitoring and epidemiology. Data collected through drug checking service delivery found that nitazene compounds were most commonly detected in place of expected pharmaceutical opioids, combined with benzodiazepines, and in complex opioid mixtures alongside fentanyl. These findings highlight the wide‐ranging presence of nitazene compounds in the illicit drug supply.

The ongoing overdose crisis is largely fueled by unregulated opioids; therefore, harm reduction measures like drug checking are forced to adapt to the changing supply. Even at low concentrations, fentanyl and its analogues can induce potent effects, particularly when present together. We found that the three most common fentanyl analogues occur individually and in mixtures of each other, and most often below 5% w/w, under the limit of consistent detection by Fourier transform infrared spectroscopy. Using surface-enhanced Raman scattering and random forest binary classifiers, we detected fentanyl (0.2–29.4% w/w), para -fluorofentanyl (0.2–20.0% w/w), and ortho -methyl fentanyl (0.8–27.4% w/w) in real-world samples with high accuracy (0.93, 0.85, 0.93) and precision (0.96, 0.90, 0.96), an improvement over Fourier transform infrared spectroscopy paired with random forest. However, while the surface-enhanced Raman scattering-based model performed exceptionally well for samples with only one target analyte, mixtures of analogues resulted in the suppression of signals from analytes at lower concentrations, complicating their identification. Overall, this demonstrates the need for the detection and distinction of fentanyl analogues below 5% w/w, the applicability of surface-enhanced Raman scattering and random forest classification for real-world samples involving one fentanyl analogue, and the need for future research in competitive binding of fentanyl analogues in mixtures.

Harm reduction drug checking utilizing paper spray mass spectrometry (PS-MS) has been the focus of ongoing research since 2017 and has seen many refinements. The presented work is the result of this research and has led to the public-facing PS-MS use for on-site drug checking in Victoria, BC. Included are the improved methods and approaches required to develop and implement PS-MS as an on-site drug checking technology. Critical details regarding appropriate direct mass spectrometry tune and calibration suites required to avoid isobaric interferences, calibration details, quality control strategies, detailed MS scan approaches to implement rapid drug tests, as well as future work considerations are presented. The PS-MS method presented currently directly quantifies 107 targeted drugs in a two-minute measurement, and can be easily adapted to include additional new targets that appear in the unregulated drug supply that are detected by either low or high resolution PS-MS. The presented methodologies provide a framework to assist those interested in implementing PS-MS to reduce harms from the toxic drug supply, but will have value for those developing rapid, quantitative drug testing for other applications.

Objectives: Research shows that in countries around the world, unregulated drug use and disorders are more prevalent amongst youth and young adults compared to general adult populations. Further, youth and young adults, including those in post-secondary settings, are increasingly experiencing harms from the global unregulated drug supply. Yet, population-specific harm reduction strategies are limited. This implementation science study explored the reach, effectiveness, adoption, implementation, and maintenance of a post-secondary campus-based drug checking service that was facilitated through intersectoral partnerships and run by students. Methods: This study used critical social theory and integrated knowledge translation. Data were collected from June to December 2023 through interviews and surveys that utilized the RE-AIM implementation science framework. One-time, individual semi-structured interviews were conducted with students (n = 4) who used drugs and/or the campus drug checking service and with program decision makers (n = 7) while student drug checking technicians (n = 6) completed online surveys. Data were analyzed using constant comparison. Results: Service reach was enhanced by a motivation to avoid consuming harmful substances but inhibited by stigma and fears of criminalization, particularly amidst uncertain academic repercussions. Participants reported that the presence and use of student-run drug checking services effectively reduced stigma on campus and the risk of harm for service users and their social networks. Adoption and implementation were facilitated by intersectoral partnerships and associated network expansion and resource sharing opportunities but challenged by inadequate infrastructure. The service was maintained through partnership agreements and individual commitments to engaging with drug checking services. Conclusion: This study contributes valuable insights regarding drug checking in post-secondary settings. These contributions are discussed in the context of young adult health and post-secondary environments, demonstrating how post-secondary institutions might help to overcome challenges in the implementation and delivery of campus drug checking services. The sustainability of such services requires supportive policies, enhanced accessibility, and related evaluations.

Impacts of the toxic unregulated drug supply are experienced across all geographic regions in Canada, with high rates of fatal and non-fatal overdoses nation-wide. In British Columbia, rates of overdose fatalities are often higher within smaller urban and rural communities than in larger urban cities. Community drug checking is increasingly explored as a harm reduction intervention; however, these services are typically limited to larger cities. In this study, we explored the contextual factors that service users and implementers consider to be important for context specific drug checking services within smaller communities. Data collection involved 39 semi-structured interviews with prospective drug checking service users and service implementers from six harm reduction services in four smaller communities on Vancouver Island, BC. Interviews explored perspectives on the contextual factors that may impact the implementation and accessibility of drug checking services within smaller communities. Through inductive thematic analysis, we developed themes that reflected the overarching contextual factors discussed by participants. Participants described four overarching contextual factors important for accessing and implementing drug checking in smaller communities: community and political climate; close social groups and personal relationships; resource availability; and geographic profile. While many of the contextual factors are similar to those operating in larger urban contexts, they can manifest differently in smaller communities. For example, lack of anonymity and confidentiality are intensified in small and rural communities where “everybody knows everybody”. Geographic distance to service and transportation were identified as barriers, with outreach and transportation to services suggested as potential mitigating strategies. As community drug checking services are established as a response to the toxic unregulated drug market, factors that support equitable access to services beyond inner-city and urban areas are critical. Factors identified as potential barriers offer targets for service adaptation and tailored implementation to enable greater access. With rural communities experiencing high rates of overdose, implementing drug checking services that are contextually relevant and equity-oriented is critical.

Illicit opioids, including fentanyl, are linked to unprecedented levels of overdose in Canada and elsewhere. The risks associated with illicit opioids can include high potency, unpredictable concentration and the unexpected presence in other drugs. Within this context, we examine drug checking data to better understand the presence of illicit opioids such as fentanyl in other drugs and possible ways to interpret these results. Three years (2021–2023) of data (18,474 samples) from Substance Drug Checking in British Columbia, Canada were examined to investigate the risks associated with the detection of opioids in other drugs such as cocaine and methamphetamine, as well as in other drug categories. Samples were tested by paper spray mass spectrometry (PS-MS), fentanyl test strips and Fourier-Transform infrared spectroscopy (FTIR). We examine the 8889 samples not expected to include fentanyl to confirm; if the expected drug was detected, if unexpected opioids were detected, and when the unexpected opioids are in trace concentration. Unexpected opioids were rarely detected (2%) in other drugs (189 of 8889 samples) with most (61.4%) detected at trace concentration levels. Unexpected opioids are far more likely to be found in samples that did not contain the expected drug than in samples that were confirmed to contain the expected drug. The least common scenario (below 1%) were substances that included the expected drug plus unexpected opioid above trace concentration. These findings raise questions on how to interpret and communicate the detection of fentanyl and related opioids in other drugs. We present three potential interpretations: (1) mistaken and misrepresented samples where the expected drug was never detected, (2) cross contamination when opioids were at trace concentration levels, or (3) adulteration as the least frequent scenario where opioids were detected above trace concentrations in combination with the expected drug. In a region where fentanyl is associated with extreme rates of overdose, it remains rare to find such opioids in other drugs. However, the risk of fentanyl in other drugs remains an ongoing threat that warrants responses by individuals and public health. We provide possible interpretations to inform such responses. Our data raises questions on how to interpret and communicate the detection of fentanyl and other opioids in other drugs.