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Harm Reduct J. 2020 Jan 28;17(1):9. doi: 10.1186/s12954-019-0336-0.

Evaluating networked drug checking services in Toronto, Ontario: study protocol and rationale.

Author information

1
Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada.
2
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
3
Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
4
Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
5
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
6
South Riverdale Community Health Centre, Toronto, Ontario, Canada.
7
Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada.
8
Toronto Paramedic Services, Toronto, Ontario, Canada.
9
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
10
Toronto Public Health, Toronto, Ontario, Canada.
11
MAP Centre for Urban Health Solutions and Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
12
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
13
Public Health Ontario, Toronto, Ontario, Canada.
14
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
15
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
16
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
17
Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA.
18
Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada. dwerb@ucsd.ed.
19
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. dwerb@ucsd.ed.
20
Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA. dwerb@ucsd.ed.

Abstract

BACKGROUND:

The increasing incidence of fatal opioid overdose is a public health crisis in Canada. Given growing consensus that this crisis is related to the presence of highly potent opioid adulterants (e.g., fentanyl) in the unregulated drug supply, drug checking services (DCS) have emerged as part of a comprehensive approach to overdose prevention. In Canada's largest city, Toronto, a network of DCS launched in 2019 to prevent overdose and overdose-related risk behaviors. This network employs mass spectrometry technologies, with intake sites co-located with supervised consumption services (SCS) at three frontline harm reduction agencies. The protocol and rationale for assessing the impact of this multi-site DCS network in Toronto is described herein. The aims of this study are to (1) evaluate the impact of DCS access on changes in and factors influencing overdose and related risk behaviors, (2) investigate the perceived capacity of DCS to prevent overdose, and (3) identify composition (qualitative and quantitative) trends in Toronto's unregulated drug supply.

METHODS:

We will use a parallel-mixed-methods design with complementary data sources (including data from chemical analysis of drug samples, quantitative intake and post-test surveys, SCS, coroners, paramedic services, and qualitative interviews), followed by a meta-inference process wherein results from analyses are synthesized.

RESULTS:

Whereas most DCS globally target "recreational drug users," in Toronto, this networked DCS will primarily target marginalized people who use drugs accessing frontline services, many of whom use drugs regularly and by injection. This evolution in the application of DCS poses important questions that have not yet been explored, including optimal service delivery models and technologies, as well as unique barriers for this population. Increasing information on the unregulated drug supply may modify the risk environment for this population of people who use drugs.

CONCLUSIONS:

This study addresses evidence gaps on the emerging continuum of overdose prevention responses and will generate critical evidence on a novel approach to reducing the ongoing high incidence of drug-related morbidity and mortality in Canada and elsewhere.

KEYWORDS:

Drug checking services; Drug market monitoring; Harm reduction; Overdose

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