1. Implementing community-based drug checking services in two Canadian provinces: lessons learned and ways forward

In Canada, there have been rapid shifts towards illicitly-manufactured fentanyl and adulterated opioids in unregulated drug markets across the country. This is a primary contributor to a national overdose crisis. In response, drug checking has emerged as an important harm reduction intervention, providing individuals with chemical analysis of their drugs, which can then facilitate overdose risk reduction. There are a range of technologies and approaches to implementation, offering both benefits and challenges. Two examples of pilot drug checking models in drug consumption sites (DCS) in British Columbia and Ontario will be presented.

In British Columbia, many sites provide point-of-care drug checking using combination Fouriertransform infrared spectroscopy (FTIR) and immunoassay strips with immediate results. In Ontario, samples are collected at DCS and analyzed 'offsite' at laboratories using gas chromatographyand/or liquid chromatography-mass spectrometry, with results in 24 hours. In both settings, results are anonymized and centralized for monitoring and ensuring data quality.

OR Results British Columbia has been operating drug checking since 2017 with over 35,000 samples checked. Ontario’s drug checking service launched in 2019, with over 5,000 samples checked. While FTIR and immunoassay strips provide information in a timely manner at minimal cost, there are limitations in terms of accuracy compared to laboratory-based methods. Additionally, the increased adulteration of the unregulated opioid market proves challenging when developing drug checking solutions.

Drug checking service technologies and delivery models need to adapt to the unregulated drug supply. Centralization of data is critical for monitoring drug markets and ensuring rapid dissemination of information to public health and the community.