Defining and organizing drug checking implementation in France using a Delphi method : the Checknow project
Context : Drug checking (DC) is a harm reduction (HR) service accessible in many countries. It provides people who use drugs (PWUD) with the opportunity to have the composition of a drug sample analyzed, so that they can make an informed decision about whether or not to consume it. In France, DC interventions are proposed within HR programs in several contexts and using various techniques. However, there is no consensus on how DC should be implemented. We used the Delphi consensus element of the Checknow project to understand DC experts’ perceptions and opinions of how DC should be implemented in France.
Methods : Between July and November 2022, we conducted a three-round Delphi study based on a preliminary sociological study (face-to-face interviews with 15 DC experts) and a literature review. A steering committee including PWUD, toxicologists, healthcare providers and academics, was created to discuss generated statements on the following categories: i) DC definitions and impact, ii) organizational aspects of DC implementation, and iii) DC content/proceedings.
Results : Forty-eight experts providing DC services indicated their agreement or disagreement with 121 statements. At the end of the third round, consensus was still missing for 48 statements (<75% consensus). In terms of the three categories, (i) experts agreed that DC is an attractive proposition in order to reduce PWUD health complications, to improve their drug knowledge and HR strategies, and to increase field workers’ awareness and knowledge about drug use. However, discrepancies emerged regarding the perceived impact of DC according to the type of technique (qualitative versus quantitative) used to analyze the sample, and to the types of PWUD sub-populations targeted (PWUD from HR programs, party settings, chemsexers, etc.); ii) experts did not agree that partnerships between HR programs and toxicology laboratories were essential to implement or validate DC techniques, independently of the type of technique used. Neither did they reach agreement on PWUD and field worker protection regarding law enforcement; iii) with regard to pre-DC analysis counselling, the analysis of the sample, and the sharing of results, consensus was reached that DC training that should be opened up to PWUD themselves and community organizations (except for HPLC/GC-MS technique), that training on HR, drug effects, and drug composition is necessary for DC providers, and that the sharing of results should be accompanied by HR advice. However, no consensus was reached on the necessity of a standardized protocol for the sharing of results, on providing results via an app or a 3-day maximum waiting period for results.
Conclusions : Implementing DC is a challenge for HR programs and policy makers. While the main finding of our Delphi study showed consensus on the value and benefits of DC for PWUD, several questions remain concerning the way DC should be implemented and associated constraints and consequences.
