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Meert N, Eliaerts J, Van Durme F, Wille SMR, Samyn N. Evaluation of spectroscopic techniques for on-site drug testing of festival seizures. Drug Test Anal 2024. [PMID: 39103284 DOI: 10.1002/dta.3780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
Despite the fact that drugs of abuse are illegal, a drug-free festival still remains an utopia in most settings. For law enforcement purposes, it is necessary to rapidly determine whether controlled substances are involved. On-site testing is a challenging task because drugs appear in different physical forms and concentrations. The aim of this study was to compare the performance of two spectroscopic techniques, Raman and Fourier transform-infrared (FT-IR), for the testing of drug seizures at a dance festival. First, samples were measured through packaging with Raman. Subsequently, homogenized samples were analysed with FT-IR. For MDMA tablets, a chemometric model was applied on the FT-IR spectra for the dose estimation. After the festival, results were confirmed in the forensic laboratory with gas chromatography coupled with mass spectrometry (GC-MS) and gas chromatography with flame ionization detection (GC-FID). In total, 166 samples of which 90 tablets, 53 powders, 16 crystals and 7 liquids were analysed. MDMA, cocaine and ketamine were the top three drugs seized. The Raman technique was suitable for powders and crystals (sensitivity of 100% and 81%, respectively). However, in comparison with FT-IR, Raman performance was lower for the analysis of liquids (sensitivity of 67%) and 'ecstasy'-like tablets (sensitivity of 41%). Overall, sensitivities above 95% were obtained with FT-IR. The MDMA doses of the tablets, determined on-site, ranged between 52 mg and 336 mg MDMA hydrochloride. For a quick identification of a variety of drugs on-site, the combination of Raman and FT-IR is recommended. It should be emphasized that optimized settings, in-house libraries and analysis by trained operators are essential to obtain correct results.
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Affiliation(s)
- N Meert
- Drugs and Toxicology, National Institute for Criminalistics and Criminology, Brussels, Belgium
| | - J Eliaerts
- Drugs and Toxicology, National Institute for Criminalistics and Criminology, Brussels, Belgium
| | - F Van Durme
- Drugs and Toxicology, National Institute for Criminalistics and Criminology, Brussels, Belgium
| | - S M R Wille
- Drugs and Toxicology, National Institute for Criminalistics and Criminology, Brussels, Belgium
| | - N Samyn
- Drugs and Toxicology, National Institute for Criminalistics and Criminology, Brussels, Belgium
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Frinculescu A, Mercer B, Shine T, Ramsey J, Couchman L, Douce D, Frascione N, Abbate V. Assessment of a Single Quadrupole Mass Spectrometer Combined with an Atmospheric Solids Analysis Probe for the On-Site Identification of Amnesty Bin Drugs. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2024; 35:1480-1489. [PMID: 38837752 PMCID: PMC11228975 DOI: 10.1021/jasms.4c00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
The surging number of people who abuse drugs has a great impact on healthcare and law enforcement systems. Amnesty bin drug analysis helps monitor the "street drug market" and tailor the harm reduction advice. Therefore, rapid and accurate drug analysis methods are crucial for on-site work. An analytical method for the rapid identification of five commonly detected drugs ((3,4-methylenedioxymethamphetamine (MDMA), cocaine, ketamine, 4-bromo-2,5-dimethoxyphenethylamine, and chloromethcathinone)) at various summer festivals in the U.K. was developed and validated employing a single quadrupole mass spectrometer combined with an atmospheric pressure solids analysis probe (ASAP-MS). The results were confirmed on a benchtop gas chromatography-mass spectrometry instrument and included all samples that challenged the conventional spectroscopic techniques routinely employed on-site. Although the selectivity/specificity step of the validation assessment of the MS system proved a challenge, it still produced 93% (N = 279) and 92.5% (N = 87) correct results when tested on- and off-site, respectively. A few "partly correct" results showed some discrepancies between the results, with the MS-only unit missing some low intensity active ingredients (N-ethylpentylone, MDMA) and cutting agents (caffeine, paracetamol, and benzocaine) or detecting some when not present. The incorrect results were mainly based on library coverage. The study proved that the ASAP-MS instrument can successfully complement the spectroscopic techniques used for qualitative drug analysis on- and off-site. Although the validation testing highlighted some areas for improvement concerning selectivity/specificity for structurally similar compounds, this method has the potential to be used in trend monitoring and harm reduction.
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Affiliation(s)
- Anca Frinculescu
- Department
of Analytical, Environmental and Forensic Sciences, King’s College London, 150 Stamford Street, London SE1 9NH, United
Kingdom
- TICTAC
Communications Limited, Room 1.159 Jenner Wing, St. George’s University of London, Cranmer Terrace, London SW17 0RE, United
Kingdom
| | - Benjamin Mercer
- Clinical
Pharmacology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Trevor Shine
- TICTAC
Communications Limited, Room 1.159 Jenner Wing, St. George’s University of London, Cranmer Terrace, London SW17 0RE, United
Kingdom
| | - John Ramsey
- TICTAC
Communications Limited, Room 1.159 Jenner Wing, St. George’s University of London, Cranmer Terrace, London SW17 0RE, United
Kingdom
| | - Lewis Couchman
- Department
of Analytical, Environmental and Forensic Sciences, King’s College London, 150 Stamford Street, London SE1 9NH, United
Kingdom
- Analytical
Services International, St. George’s
University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - David Douce
- Waters
Corporation, Stamford
Avenue, Wilmslow SK9 4AX, United Kingdom
| | - Nunzianda Frascione
- Department
of Analytical, Environmental and Forensic Sciences, King’s College London, 150 Stamford Street, London SE1 9NH, United
Kingdom
| | - Vincenzo Abbate
- Department
of Analytical, Environmental and Forensic Sciences, King’s College London, 150 Stamford Street, London SE1 9NH, United
Kingdom
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Falzon D, Parkes T, Carver H, Masterton W, Wallace B, Craik V, Measham F, Sumnall H, Gittins R, Hunter C, Watson K, Mooney JD, Aston EV. "It would really support the wider harm reduction agenda across the board": A qualitative study of the potential impacts of drug checking service delivery in Scotland. PLoS One 2023; 18:e0292812. [PMID: 38096231 PMCID: PMC10721102 DOI: 10.1371/journal.pone.0292812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/28/2023] [Indexed: 12/17/2023] Open
Abstract
Drug checking services (DCS) enable individuals to voluntarily submit a small amount of a substance for analysis, providing information about the content of the substance along with tailored harm reduction support and advice. There is some evidence suggesting that DCS may lead to behaviour and system change, with impacts for people who use drugs, staff and services, and public health structures. The evidence base is still relatively nascent, however, and several evidence gaps persist. This paper reports on qualitative interviews with forty-three participants across three Scottish cities where the implementation of community-based DCS is being planned. Participants were drawn from three groups: professional participants; people with experience of drug use; and affected family members. Findings focus on perceived harm reduction impacts of DCS delivery in Scotland, with participants highlighting the potential for drug checking to impact a number of key groups including: individual service users; harm reduction services and staff; drug market monitoring structures and networks; and wider groups of people who use and sell drugs, in shaping their interactions with the drug market. Whilst continued evaluation of individual health behaviour outcomes is crucial to building the evidence base for DCS, the findings highlight the importance of extending evaluation beyond these outcomes. This would include evaluation of processes such as: information sharing across a range of parties; engagement with harm reduction and treatment services; knowledge building; and increased drug literacy. These broader dynamics may be particularly important for evaluations of community-based DCS serving individuals at higher-risk, given the complex relationship between information provision and health behaviour change which may be mediated by mental and physical health, stigma, criminalisation and the risk environment. This paper is of international relevance and adds to existing literature on the potential impact of DCS on individuals, organisations, and public health structures.
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Affiliation(s)
- Danilo Falzon
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Wendy Masterton
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Vicki Craik
- Public Health Scotland, Glasgow, United Kingdom
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, United Kingdom
- The Loop, Registered Charity, Manchester, United Kingdom
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | | | - Carole Hunter
- Alcohol and Drug Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Kira Watson
- Scottish Ambulance Service, Edinburgh, United Kingdom
| | - John D. Mooney
- Public Health Directorate, NHS Grampian, Aberdeen, United Kingdom
| | - Elizabeth V. Aston
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
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Milshteyn Y, Bensimon M. Exploring the subjective experience of rave party participants in Israel who consume psychedelic drugs: a qualitative inquiry. Harm Reduct J 2023; 20:176. [PMID: 38057811 PMCID: PMC10701949 DOI: 10.1186/s12954-023-00908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Rave music parties (RMP) are a world-wide socio-cultural phenomenon, where people listen to rave music while frequently consuming psychedelic drugs. Epidemiological studies have emphasized the hazardous consequences following the consumption of psychedelic drugs at RMP, and qualitative studies have shown social and psycho-spiritual experiences. Yet, phenomenological inquiry into subjective experiences of attendees is scant. This study aimed to examine physical, emotional, perceptual and social experiences of RMP participants in Israel, and their view on Israel's policy toward rave events. In addition, the study aimed to contribute useful information for policymakers and society on rave music and psychedelic drugs experiences at RMP. METHOD Interpretative phenomenological analysis was used to analyze transcriptions of semi-structured interviews with 27 individuals attending RMP regularly and consume psychedelic drugs. RESULTS Analysis revealed four significant themes: the first theme, the impact of Israel's drug policy on participants' sense of safety, relates to participants' sense of insecurity and anxiety at Israeli RMP due to government drug ban policy. The second theme, the stigma on rave culture, relates to participants' perception regarding the stigma on rave culture in law enforcement agencies and in society in general. The third theme, negative experiences, describes short-term experiences after consuming psychedelics at RMP, including hallucinations and disorientation. The fourth theme, positive experiences, describes positive sensory, emotional and self/world attitudinal aspects after consuming psychedelics at RMP. Sensory experiences included intensified auditory, visual and tactile experiences; emotional experiences included positive feelings toward others, reduced stress and ability to vent difficult emotions; self/world attitudinal aspects included self-acceptance, higher appreciation of life and connectedness to nature. CONCLUSIONS The study highlights RMP participants' sense of insecurity due to Israel's strict drug policy and absence of harm reduction strategies at rave scenes. The study also notes participants' experience of stigmatization as drug addicts by society and law enforcement agencies. Reducing police presence and adopting harm reduction policies at rave scenes in Israel may increase participants' sense of security, reduce stigmatization and decrease overdose risk. Hence, the findings may contribute to new knowledge useful for policymakers and society concerning RMP and the use of psychedelics.
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Affiliation(s)
- Yula Milshteyn
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Moshe Bensimon
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel.
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Piatkowski T, Puljevic C, Francis C, Ferris J, Dunn M. "They sent it away for testing and it was all bunk": Exploring perspectives on drug checking among steroid consumers in Queensland, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104139. [PMID: 37481876 DOI: 10.1016/j.drugpo.2023.104139] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Research supports the feasibility and acceptance of drug checking among nightlife and festival attendees. Interest in expanding drug checking to other groups of people who use drugs, including those who inject drugs, has grown. However, understanding the acceptability and feasibility of drug checking among specific cohorts, like anabolic-androgenic steroids (AAS) consumers, remains a research gap. This study explores AAS consumers' perspectives on drug checking and service preferences, aiding the preparation for drug checking delivery in Queensland, Australia. METHODS A purposive sampling technique was used to recruit 15 AAS consumers (9 males, 6 females; Mage = 36.80 years, SD = 6.12) from Australia. One-on-one semi-structured qualitative interviews were conducted with questions exploring participants' views on drug checking/testing and their preferences for AAS analysis. Thematic analysis was conducted with final themes established through iterative consensus. RESULTS Consumers expressed frustration with the prevailing stereotypes, social stigma, and the perception of criminality associated with the use of AAS. There was a strong dependence on personal connections and trusted suppliers, with coaches exerting significant influence. Participants expressed concerns about the widespread availability of counterfeit products and underground operations. The act of using unknown AAS was likened to a game of Russian roulette, underscoring the importance of obtaining accurate information and access to reliable drug checking services. Consumers expressed a preference for a web-based platform that enables individuals to access their own test results while contributing to a comprehensive database of brand-specific testing outcomes. DISCUSSION AAS consumers recognise the significance of monitoring their AAS use and seek a service that can not only assist them in making informed decisions regarding AAS usage but also potentially contribute to the knowledge of the wider AAS-consuming community. These findings underscore the importance of tailored education, drug checking services, and harm reduction measures to address the diverse needs of AAS consumers.
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Affiliation(s)
- Timothy Piatkowski
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia; The Loop Australia, Australia.
| | - Cheneal Puljevic
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia; The Loop Australia, Australia
| | | | - Jason Ferris
- The Loop Australia, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Matthew Dunn
- The Loop Australia, Australia; School of Health and Social Development/Institute for Health Transformation, Deakin University, Geelong, Australia
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Carver H, Falzon D, Masterton W, Wallace B, Aston EV, Measham F, Hunter C, Sumnall H, Gittins R, Raeburn F, Craik V, Priyadarshi S, Rothney L, Weir K, Parkes T. 'It's not going to be a one size fits all': a qualitative exploration of the potential utility of three drug checking service models in Scotland. Harm Reduct J 2023; 20:94. [PMID: 37501057 PMCID: PMC10373262 DOI: 10.1186/s12954-023-00830-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Scotland currently has the highest rates of drug-related deaths in Europe, so drug checking services are being explored due to their potential role in reducing these deaths and related harms. Drug checking services allow individuals to submit presumed psychoactive drug samples for analysis, and then receive individualised feedback and counselling. This paper explores participants' views on the advantages and challenges of three hypothetical service models, to inform future service delivery in Scotland. METHODS Semi-structured interviews were conducted with 43 people: 27 professional stakeholders, 11 people with experience of drug use, and five family members across three cities. Vignettes were used to provide short descriptions of three hypothetical service models during the interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis. RESULTS Participants identified advantages and challenges for each of the three potential service models. The third sector (not-for-profit) model was favoured overall by participants, and the NHS substance use treatment service was the least popular. Participants also noted that multiple drug checking sites within one city, along with outreach models would be advantageous, to meet the diverse needs of different groups of people who use drugs. CONCLUSIONS Drug checking services need to be tailored to local context and needs, with a range of service models being possible, in order to meet the needs of a heterogeneous group of people who use drugs. Addressing issues around stigma, accessibility, and concerns about the potential impact of accessing drug checking on access to and outcomes of drug treatment, are essential for successful service delivery.
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Affiliation(s)
- Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Danilo Falzon
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Wendy Masterton
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, V8P 5C2, Canada
| | - Elizabeth V Aston
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, L69 7ZR, UK
- The Loop, Unclassified Community Interest Company, Manchester, M13 9PL, UK
| | - Carole Hunter
- Alcohol and Drug Services, NHS Greater Glasgow and Clyde, Glasgow, G51 1DP, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, L2 2QP, UK
| | | | - Fiona Raeburn
- NHS Grampian, Royal Cornhill Hospital, Cornhill Road, Aberdeen, AB25 2ZH, UK
| | | | - Saket Priyadarshi
- Alcohol and Drug Services, NHS Greater Glasgow and Clyde, Glasgow, G51 1DP, UK
| | - Laura Rothney
- NHS Grampian, Royal Cornhill Hospital, Cornhill Road, Aberdeen, AB25 2ZH, UK
| | | | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
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Beckwith D, Ferris LJ, Cruwys T, Hutton A, Hertelendy A, Ranse J. Psychosocial interventions and strategies to support young people at mass gathering events: a scoping review. Public Health 2023; 220:187-195. [PMID: 37392554 DOI: 10.1016/j.puhe.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/19/2023] [Accepted: 05/04/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES To improve health and safety outcomes at mass gathering events (MGEs) for young attendees, it is essential to understand the psychosocial factors that may influence behaviour so that the implementation of support strategies before, during and after MGEs can be developed to enhance outcomes. This review identifies the psychosocial outcomes that may occur at MGEs, including social connection, substance use, risky behaviours and psychological distress and examines what interventions have been implemented to target these outcomes. STUDY DESIGN Scoping review. METHODS This study examined MGE psychosocial interventions with predominantly youth attendees was conducted using the Preferred Reporting Items of Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Papers were collected from the databases CINAHL, MEDLINE, Embase and PsycINFO. Titles and abstracts were scanned for relevance, followed by a full-text screening. Information relevant to the research question was extracted from papers meeting the inclusion criteria. RESULTS Twenty-six papers met the inclusion criteria. The psychosocial factors that were most studied included social influence, social interactions and psychological stressors, which lead to behaviours such as excessive alcohol consumption, drug taking, risky casual sex and risk taking amongst psychological factors of young attendees. Effective interventions implemented before or during MGEs, such as alcohol-free zones, antidrinking campaigns, psychoeducation and disapproval from parents with regard to drinking alcohol, showed promise in reducing harms. CONCLUSION Psychosocial interventions have the potential to reduce harms and enhance well-being for young people attending MGEs. This review has identified gaps and opportunities in the current literature with regard to psychosocial interventions and strategies to support young people at MGEs and makes recommendations to support the development and refinement of evidence-based interventions aimed at young MGE attendees.
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Affiliation(s)
- D Beckwith
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - L J Ferris
- School of Business, The University of Queensland, Australia
| | - T Cruwys
- School of Medicine and Psychology, The Australian National University, Australia
| | - A Hutton
- School of Nursing and Midwifery, University of Newcastle, Australia; School of Nursing and Midwifery, Flinders University, Australia; School of Nursing, Johns Hopkins, USA
| | - A Hertelendy
- Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA; Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, USA
| | - J Ranse
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia.
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Mullin A, Scott M, Vaccaro G, Gittins R, Ferla S, Schifano F, Guirguis A. Handheld Raman Spectroscopy in the First UK Home Office Licensed Pharmacist-Led Community Drug Checking Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4793. [PMID: 36981705 PMCID: PMC10049009 DOI: 10.3390/ijerph20064793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Across the world, the interest in point-of-care drug checking as a harm-reduction intervention is growing. This is an attempt to improve intelligence about current drug trends and reduce drug-related morbidity and mortality. In the UK, drug-related harm is increasing exponentially year after year. As such, specialist community treatment services are exploring new methods to improve engagement with people who use drugs (PWUD), who may require support for their problematic drug use. This need has driven the requirement to pilot an on-site, time-responsive, readily available drug-checking service at point-of-support centres. In this study, we piloted the UK's first Home Office-licensed drug-checking service that was embedded into a community substance-misuse service and had all on-site analysis and harm-reduction interventions led and delivered by pharmacists. We report on the laboratory findings from the associated confirmatory analysis (UHPLC-MS, GC-MS, and 1H NMR) to assess the performance of the on-site hand-held Raman spectrometer and outline the challenges of providing real-time analysis of psychoactive substances in a clinical setting. Whilst acknowledging the limitation of the small sample size (n = 13), we demonstrate the potential suitability of using this technology for the purposes of screening substances in community-treatment services. Portability of equipment and timeliness of results are important and only very small samples may be provided by people who use the service. The challenges of accurately identifying substances from complex mixtures were equally found with both point-of-care Raman spectroscopy and laboratory confirmatory-analysis techniques. Further studies are required to confirm these findings.
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Affiliation(s)
- Anthony Mullin
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Mark Scott
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Giorgia Vaccaro
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Rosalind Gittins
- Clinical Department, WDP-Westminster Drug Project, 18 Dartmouth St., London SW1H 9BL, UK
| | - Salvatore Ferla
- Pharmacy, Medical School, The Grove Extension, Swansea University, Swansea SA2 8PP, UK
| | - Fabrizio Schifano
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Amira Guirguis
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
- Pharmacy, Medical School, The Grove Extension, Swansea University, Swansea SA2 8PP, UK
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Substances from unregulated drug markets - A retrospective data analysis of customer-provided samples from a decade of drug checking service in Zurich (Switzerland). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 114:103972. [PMID: 36841217 DOI: 10.1016/j.drugpo.2023.103972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Drug checking services (DCS) are harm reduction interventions for people who consume illicit substances. Unregulated drug markets lead to samples with unexpected and variable contents. A retrospective data analysis of Zurich's DCS was performed to determine the nature of these samples. METHODS This study aims to investigate the qualitative and quantitative properties of 16,815 customer-provided psychoactive drug samples analyzed chemically through the DCS in Zurich from 1st January 2011 to 31st December 2021. The main analytical method utilized for characterizing these substances was high-performance liquid chromatography and gas chromatography-mass spectrometry. Data sets are summarized using descriptive statistics. RESULTS There was a 2.5-fold increase in the number of tested samples over the past decade. An overall proportion of 57.9% (weighted mean) of samples within our database demonstrates unexpected analytical findings and additional low sample contents during the observation period. Substantial differences in quality and quantity between substance groups were detected and an increase of sample quality and content over time was demonstrated. CONCLUSIONS Chemical analysis reveals that over half of substances acquired from unregulated drug markets analyzed through DCS in Zurich are with low qualitative and quantitative properties, which may expose users to risks. Based on longitudinal analyses over a decade, this study contributes to the body of evidence that DCS may potentially manipulate unregulated drug markets towards providing better quality substances, as well as may stabilize these markets over time. The necessity for drug policy changes to make this service accessible in further settings was highlighted, as DCS still often take place in legal grey zones. FUNDING None to declare.
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10
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Giulini F, Keenan E, Killeen N, Ivers JH. A Systematized Review of Drug-checking and Related Considerations for Implementation as A Harm Reduction Intervention. J Psychoactive Drugs 2023; 55:85-93. [PMID: 35060837 DOI: 10.1080/02791072.2022.2028203] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Drug-checking services (DCS) provide people who use drugs (PWUD) the opportunity to have their substances tested before consumption. Though some suggest they may have adverse consequences, DCS have been introduced as a harm reduction (HR) strategy. A systematized review of the literature regarding drug checking (DC) methods and testing locations, advantages and disadvantages, and legal frameworks with an emphasis on HR was conducted referencing PRISMA guidelines. The primary search of PsychInfo, PubMed, Medline, CINHAL, CORE, and Web of Science was conducted between the 4th and 10th of September 2020, and 51 literature pieces were included in the final article. Most of the literature focuses on the benefits of currently available DCS. The services identified varied significantly in terms of testing methods, location of operation, primary goal, and the surrounding legal framework. The results suggest using multiple DC methods to be most beneficial. Further, DCS and the personalized interventions they provide can positively influence behavior change, minimize harm, and reduce mortality. DCS are a viable public health intervention that requires cross-sector support beyond the legal frameworks and testing methods. Services will need to be tailored to meet the needs of their chosen setting, local drug market, and target audience.
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Affiliation(s)
- Francesca Giulini
- Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, the University of Dublin, Tallaght, Dublin
| | - Eamon Keenan
- Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, the University of Dublin, Tallaght, Dublin.,National Office of Social Inclusion, Health Service Executive, Dublin 20
| | - Nicki Killeen
- National Office of Social Inclusion, Health Service Executive, Dublin 20
| | - Jo-Hanna Ivers
- Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, the University of Dublin, Tallaght, Dublin
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11
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Yang R. Extended QUALIFLEX method for electronic music acoustic quality evaluation based on the picture fuzzy multiple attribute group decision making. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-223377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the past, different useful extensions of fuzzy sets were established by the researchers to manage the vagueness and uncertainty in various practical problems. Usually, the real numbers are utilized to express the decision information, but it is noted that the description of attributes using picture fuzzy sets (PFSs) proves to be more appropriate. As a powerful decision tool, PFSs provides more decision information that requires the application of some specific situations more types of response of human ideas: yes, contain, no, reject. QUALIFLEX (qualitative flexible multiple criteria method), is one of the well-known outranking methods to solve the multiple attribute group decision making (MAGDM) problems with crisp numbers. The QUALIFLEX method can perfectly address the complex MAGDM problems where a lot of attributes are utilized to assess a limited number of alternatives. The electronic music acoustic quality evaluation is a classical MAGDM. This paper proposes and utilizes the QUALIFLEX to develop the picture fuzzy QUALIFLEX(PF-QUALIFLEX) method for MAGDM. The current study is mainly devoted to explore and extend the measurement of alternatives and ranking according to the QUALIFLEX under the background of PFSs. Furthermore, an example to evaluate the electronic music acoustic quality is handled through the proposed method to substantiate the extended approach.
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Affiliation(s)
- Run Yang
- Jiamusi University, Jiamusi, Heilongjiang, China
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12
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Olsen A, Wong G, McDonald D. Music festival drug checking: evaluation of an Australian pilot program. Harm Reduct J 2022; 19:127. [PMID: 36403032 PMCID: PMC9675117 DOI: 10.1186/s12954-022-00708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/01/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This paper explores the feasibility of delivering a music festival-based drug checking service in Australia, evaluating service design and stakeholder acceptability. METHODS Questionnaire and interview data were collected from adult service users and key stakeholders. A mixed methods approach was used to analyse the data on implementation, impact and acceptability. RESULTS The trial service tested 170 substances with more than 230 patrons (including individuals who attended in groups). Adult service users had an average age of 21 years. Voluntary participation in the evaluation resulted in 158 participants completing the pre-service questionnaire, most of whom also completed the post-service (147 participants). Eleven in-depth qualitative interviews were conducted with patrons in the weeks following the drug checking. Concordance between what the patron expected the drug to be and drug checking results occurred in 88 per cent (n = 139) of the sample. Evaluation results show that the experience of testing and the accompanying harm reduction brief interventions positively impacted on patrons' self-reported drug harm reduction knowledge, trust of health providers and stated drug use intentions. The service was received positively by service users. CONCLUSION This is the first independent evaluation of a pilot drug checking service in Australia. Consideration of operational feasibility and self-reported behavioural change suggests that the program was successful, although communication about the interpretation of drug checking results could be improved. Future studies should develop strategies for follow-up and consider the applicability of behavioural change theory.
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Affiliation(s)
- Anna Olsen
- grid.1001.00000 0001 2180 7477Medical School, The Australian National University, Florey Building 54 Mills Road, Canberra, ACT 2601 Australia
| | - Gabriel Wong
- grid.1001.00000 0001 2180 7477Centre for Social Research Methods, The Australian National University, Level 2, Beryl Rawson Building, Canberra, ACT 2601 Australia
| | - David McDonald
- grid.1001.00000 0001 2180 7477National Centre for Epidemiology and Population Health, The Australian National University, Mills Road, Canberra, ACT 2601 Australia
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13
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Masterton W, Falzon D, Burton G, Carver H, Wallace B, Aston EV, Sumnall H, Measham F, Gittins R, Craik V, Schofield J, Little S, Parkes T. A Realist Review of How Community-Based Drug Checking Services Could Be Designed and Implemented to Promote Engagement of People Who Use Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911960. [PMID: 36231262 PMCID: PMC9564958 DOI: 10.3390/ijerph191911960] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 05/06/2023]
Abstract
With rising numbers of drug-related deaths in the UK and globally, exploration of interventions that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people to submit drug samples for chemical analysis and receive feedback about the sample, as well as harm reduction advice. The use of DCS is often linked to festival and/or nightlife settings and to so-called 'recreational' drug use, but research has also shown the potential of community-based DCS as an intervention serving more varied demographics of people who use drugs, including more marginalised individuals and those experiencing drug dependence. Whilst there is a growing evidence base on the effectiveness of drug checking as a harm reduction intervention, there is still limited evidence of the underlying mechanisms and processes within DCS which may aid implementation and subsequent engagement of people who use drugs. This presents a challenge to understanding why engagement differs across types of DCS, and how best to develop and deliver services across different contexts and for different populations. To explore the contexts and mechanisms which impact engagement in community-based DCS, a realist review was undertaken to synthesise the international evidence for the delivery and implementation of DCS. There were 133 sources included in the review. From these sources the underlying contexts, mechanisms, and outcomes relating to DCS implementation and engagement were developed and refined into seven programme theories. The findings of this review are theoretically novel and hold practical relevance for the design of DCS, with implications for optimisation, tailoring, and implementing services to reach individuals in different settings.
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Affiliation(s)
- Wendy Masterton
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
- Correspondence:
| | - Danilo Falzon
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Gillian Burton
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Hannah Carver
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Elizabeth V. Aston
- School of Applied Sciences, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool L2 2QP, UK
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool L69 7ZR, UK
- The Loop, Unclassified Community Interest Company, Manchester M13 9PL, UK
| | | | | | - Joe Schofield
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Simon Little
- Kinbank Social Research Consultancy, Tayport DD6 9AP, UK
| | - Tessa Parkes
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
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14
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Drug checking use and interest among people who inject drugs in Toronto, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103781. [DOI: 10.1016/j.drugpo.2022.103781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/02/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
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15
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Canêdo J, Sedgemore KO, Ebbert K, Anderson H, Dykeman R, Kincaid K, Dias C, Silva D, Charlesworth R, Knight R, Fast D. Harm reduction calls to action from young people who use drugs on the streets of Vancouver and Lisbon. Harm Reduct J 2022; 19:43. [PMID: 35505320 PMCID: PMC9064719 DOI: 10.1186/s12954-022-00607-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/03/2022] [Indexed: 12/02/2022] Open
Abstract
Vancouver, Canada, and Lisbon, Portugal, are both celebrated for their world-leading harm reduction policies and programs and regarded as models for other cities contending with the effects of increasing levels of drug use in the context of growing urban poverty. However, we challenge the notion that internationally celebrated places like Lisbon and Vancouver are meeting the harm reduction needs of young people who use drugs (YPWUD; referring here to individuals between the ages of 14 and 29). In particular, the needs of YPWUD in the context of unstable housing, homelessness, and ongoing poverty—a context which we summarize here as “street involvement”—are not being adequately met. We are a group of community and academic researchers and activists working in Vancouver, Lisbon, and Pittsburgh. Most of us identify as YPWUD and have lived and living experience with the issues described in this comment. We make several calls to action to support the harm reduction needs of YPWUD in the context of street involvement in and beyond our settings.
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Affiliation(s)
- Joana Canêdo
- GAT (Grupo de Ativistas Em Tratamentos), Avenida Paris, 4 - 1º direito, 1000-228, Lisbon, Portugal.,MANAS, Lisbon, Portugal
| | - Kali-Olt Sedgemore
- 'Namgis First Nation, Alert Bay, Canada.,Coalition of Peers Dismantling the Drug War, Vancouver, Canada.,British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | | | - Haleigh Anderson
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | - Rainbow Dykeman
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | - Katey Kincaid
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | - Claudia Dias
- GAT (Grupo de Ativistas Em Tratamentos), Avenida Paris, 4 - 1º direito, 1000-228, Lisbon, Portugal.,MANAS, Lisbon, Portugal
| | | | | | - Reith Charlesworth
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | - Rod Knight
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Danya Fast
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
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16
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Maghsoudi N, Tanguay J, Scarfone K, Rammohan I, Ziegler C, Werb D, Scheim AI. Drug checking services for people who use drugs: a systematic review. Addiction 2022; 117:532-544. [PMID: 34729849 PMCID: PMC9299873 DOI: 10.1111/add.15734] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/14/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Drug checking services provide people who use drugs with chemical analysis results of their drug samples while simultaneously monitoring the unregulated drug market. We sought to identify and synthesize literature on the following domains: (a) the influence of drug checking services on the behaviour of people who use drugs; (b) monitoring of drug markets by drug checking services; and (c) outcomes related to models of drug checking services. METHODS Systematic review. A systematic literature search was conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Scopus, Web of Science and Dissertations and Theses Global. Eligible studies were peer-reviewed articles and conference abstracts or grey literature, published in any language since 1990 and including original data on the domains. We assessed risk of bias for quantitative peer-reviewed articles reporting on behaviour or models of drug checking services using National Institutes of Health tools. RESULTS We screened 2463 titles and abstracts and 156 full texts, with 90 studies meeting inclusion criteria. Most (n = 65, 72.2%) were from Europe and used cross-sectional designs (n = 79, 87.7%). Monitoring of drug markets by drug checking services (n = 63, 70%) was the most reported domain, followed by the influence of drug checking services on behaviour (n = 31, 34.4%), including intent to use, actual use and disposal of the drug, and outcomes related to models of drug checking services (n = 17, 18.9%). The most common outcome measures were detection of unexpected substances (n = 50, 55.6%), expected substances (n = 44, 48.9%), new psychoactive substances (n = 40, 44.4%) and drugs of concern (n = 32, 36.5%) by drug checking services. CONCLUSIONS Drug checking services appear to influence behavioural intentions and the behaviour of people who use drugs, particularly when results from drug checking services are unexpected or drugs of concern. Monitoring of drug markets by drug checking services is well established in Europe, and increasingly in North America. Concerns about drug contents and negative health consequences facilitate the use of drug checking services; lack of concern; trust in drug sellers; lack of accessibility of drug checking services; and legal and privacy concerns are barriers to use.
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Affiliation(s)
- Nazlee Maghsoudi
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
| | - Justine Tanguay
- Munk School of Global Affairs and Public PolicyUniversity of TorontoTorontoONCanada
| | - Kristy Scarfone
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoONCanada
| | - Indhu Rammohan
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
| | | | - Dan Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Division of Infectious Diseases and Global Public Health, School of MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Ayden I. Scheim
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPAUSA
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17
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Carroll JJ, Mackin S, Schmidt C, McKenzie M, Green TC. The Bronze Age of drug checking: barriers and facilitators to implementing advanced drug checking amidst police violence and COVID-19. Harm Reduct J 2022; 19:9. [PMID: 35120531 PMCID: PMC8814788 DOI: 10.1186/s12954-022-00590-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/12/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Unpredictable fluctuations in the illicit drug market increase overdose risk. Drug checking, or the use of technology to provide insight into the contents of illicit drug products, is an overdose prevention strategy with an emerging evidence base. The use of portable spectrometry devices to provide point-of-service analysis of the contents of illicit drugs been adopted by harm reduction organizations internationally but is only emerging in the United States. This study aimed to identify barriers and facilitators of implementing drug checking services with spectrometry devices in an urban harm reduction organization and syringe service program serving economically marginalized people who use drugs in Boston, Massachusetts (USA). METHODS In-vivo observations and semi-structured interviews with harm reduction staff and participants were conducted between March 2019 and December 2020. We used the consolidated framework for implementation research to identify implementation barriers and facilitators. RESULTS This implementation effort was facilitated by the organization's shared culture of harm reduction-which fostered shared implementation goals and beliefs about the intervention among staff persons-its horizontal organizational structure, strong identification with the organization among staff, and strong relationships with external funders. Barriers to implementation included the technological complexity of the advanced spectroscopy devices utilized for drug checking. Program staff indicated that commercially available spectroscopy devices are powerful but not always well-suited for drug checking efforts, describing their technological capacities as "the Bronze Age of Drug Checking." Other significant barriers include the legal ambiguity of drug checking services, disruptive and oppositional police activity, and the responses and programmatic changes demanded by the COVID-19 pandemic. CONCLUSIONS For harm reduction organizations to be successful in efforts to implement and scale drug checking services, these critical barriers-especially regressive policing policies and prohibitive costs-need to be addressed. Future research on the impact of policy changes to reduce the criminalization of substance use or to provide explicit legal frameworks for the provision of this and other harm reduction services may be merited.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology and Anthropology, North Carolina State University, 10 Current Drive, Campus Box 8107, Raleigh, NC, 27695-8107, USA. .,Brown University, Providence, RI, USA.
| | - Sarah Mackin
- Access, Harm Reduction, Overdose Prevention and Education (AHOPE) Syringe Exchange, Boston, MA, USA
| | - Clare Schmidt
- Access, Harm Reduction, Overdose Prevention and Education (AHOPE) Syringe Exchange, Boston, MA, USA
| | - Michelle McKenzie
- Brown University, Providence, RI, USA.,The Miriam Hospital, Providence, RI, USA
| | - Traci C Green
- Brown University, Providence, RI, USA.,Brandeis University, Waltham, MA, USA
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18
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Tobias S, Grant CJ, Laing R, Arredondo J, Lysyshyn M, Buxton J, Tupper KW, Wood E, Ti L. Time-Series Analysis of Fentanyl Concentration in the Unregulated Opioid Drug Supply in a Canadian Setting. Am J Epidemiol 2022; 191:241-247. [PMID: 33977304 DOI: 10.1093/aje/kwab129] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
North America has been contending with an unregulated street drug supply in which opioids are often adulterated with illicitly manufactured fentanyl. The unpredictability of composition may result in an increased risk of overdose due to unexpected elevated concentrations of the high-potency drug. Using data from a community-based drug-checking project, we evaluated trends in fentanyl concentration of illicit opioids in the context of an overdose epidemic. Using a quantification model for fentanyl hydrochloride, historical Fourier-transform infrared spectra from opioid drug-checking samples were analyzed to determine fentanyl concentrations. Median monthly fentanyl concentrations were plotted, and polynomial and autoregressive time-series analyses were performed to examine trends over time. A total of 3,621 fentanyl-positive samples were included in the study, spanning November 2017 to December 2019. Monthly median fentanyl concentrations ranged from 4.5% to 10.4%. Time-series analyses indicated that a third-degree polynomial model fit the data well (R2 = 0.639), suggesting a cyclical pattern in median concentration over time. Notably, absolute variance in fentanyl concentration decreased by an average 0.1% per month (P < 0.001). Future research should explore the relationship between fentanyl concentration and overdose to identify potential targeted harm-reduction interventions that can respond to changes in observed fentanyl concentration.
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19
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Dasgupta N, Figgatt MC. Invited Commentary: Drug Checking for Novel Insights Into the Unregulated Drug Supply. Am J Epidemiol 2022; 191:248-252. [PMID: 34528056 PMCID: PMC8824693 DOI: 10.1093/aje/kwab233] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
Tobias et al. (Am J Epidemiol. 2022;191 (2):241-247) present a novel analysis of time trends in fentanyl concentrations in the unregulated drug supply in British Columbia, Canada. The preexisting knowledge about unregulated drugs had come from law-enforcement seizures and postmortem toxicology. As both of these data sources are subject to selection bias, large-scale drug-checking programs are poised to be a crucial component of the public health response to the unrelenting increase in overdose in North America. As programs expand, we offer 2 guiding principles. First, the primary purpose of these programs is to deliver timely results to people who use drugs to mitigate health risks. Second, innovation is needed to go beyond criminal justice paradigms in laboratory analysis for a more nuanced understanding of health concerns. We provide examples of the role adulterants play in our understanding of drug harms. We also describe the applications and limitations of common laboratory assays, with implications for epidemiologic surveillance. While the research and direct service teams in British Columbia have taken groundbreaking steps, there is still a need to establish best practices for communicating results to sample donors in an approachable yet nonalarmist tone.
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Affiliation(s)
- Nabarun Dasgupta
- Correspondence to Dr. Nabarun Dasgupta, University of North Carolina Injury Prevention Research Center, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27514 (e-mail: )
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20
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Oomen PE, Schori D, Tögel-Lins K, Acreman D, Chenorhokian S, Luf A, Karden A, Paulos C, Fornero E, Gerace E, Koning RPJ, Galindo L, Smit-Rigter LA, Measham F, Ventura M. Cannabis adulterated with the synthetic cannabinoid receptor agonist MDMB-4en-PINACA and the role of European drug checking services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 100:103493. [PMID: 34687992 DOI: 10.1016/j.drugpo.2021.103493] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/27/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND European drug checking services exchange information on drug trends within the Trans European Drug Information (TEDI) network, allowing monitoring and coordination of responses. Starting in Spring 2020, several services detected the synthetic cannabinoid receptor agonist MDMB-4en-PINACA in adulterated low-THC cannabis products. METHODS Cannabis products suspected of adulteration were analyzed for the presence of MDMB-4en-PINACA by 9 services in 8 countries within the TEDI network. If available, phytocannabinoid analysis was also performed. RESULTS 1142 samples sold as cannabis in herbal, resin and e-liquid form were analyzed, of which 270 were found to contain MDMB-4en-PINACA. All cannabis samples contained low THC (<1%), except the e-liquids which contained no phytocannabinoids. Three serious health incidents requiring hospitalization after use of an adulterated cannabis sample were reported. CONCLUSION Adulteration of cannabis with synthetic cannabinoid receptor agonists is a new phenomenon that carries risk for people who use it. Given that cannabis consumers are not a usual target group for drug checking services, services and associated harm reduction interventions could be reconfigured to include them.
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Affiliation(s)
- Pieter E Oomen
- Drugs Information and Monitoring System (DIMS), Drug Monitoring and Policy, Trimbos Institute, Da Costakade 45, 3521 VS, Utrecht, the Netherlands
| | - Dominique Schori
- Saferparty Streetwork (Schadensminderung illegale Substanzen), Wasserwerkstrasse 17, 8006 Zürich, Switzerland.; Trans European Drug Information (TEDI), NEWNet, Paris, France
| | - Karsten Tögel-Lins
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Basis, Heddernheimer Landstrasse 145, Frankfurt am Main, Germany
| | - Dean Acreman
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Substance Misuse Programme, Public Health Wales, 2 Capital Quarter, Tyndall Street, CF10 4BZ, Cardiff, Wales, UK
| | - Sevag Chenorhokian
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Association SIDA Paroles, 10 rue Victor Hugo, 92700 Colombes, France; Association OPPELIA-Charonne, 3 Quai d'Austerlitz, 75013 Paris, France
| | - Anton Luf
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Checkit! laboratory, Clinical Department of Laboratory Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria; Cooperativa Sociale Alice Onlus, Neutravel, Corso Allamano 141, 10095 Grugliasco (TO), Italy
| | - Alexandra Karden
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Checkit!, Vienna Addiction Services, Gumpendorfer Straße 8, 1060, Vienna, Austria
| | - Carlos Paulos
- Trans European Drug Information (TEDI), NEWNet, Paris, France; 4motion asbl. / PIPAPO71-73 rue Adolphe Fischer L-1520 Luxembourg, Luxembourg
| | - Elisa Fornero
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Cooperativa Sociale Alice Onlus, Neutravel, Corso Allamano 141, 10095 Grugliasco (TO), Italy
| | - Enrico Gerace
- Centro Regionale Antidoping e di Tossicologia "A.Bertinaria", Regione Gonzole 10/1, 10043 Orbassano (TO), Italy
| | - Raoul P J Koning
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Jellinek (Prevention), Jacob Obrechtstraat 92, 1071 KR, Amsterdam, the Netherlands
| | - Liliana Galindo
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Department of Psychiatry, University of Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Laura A Smit-Rigter
- Drugs Information and Monitoring System (DIMS), Drug Monitoring and Policy, Trimbos Institute, Da Costakade 45, 3521 VS, Utrecht, the Netherlands; Trans European Drug Information (TEDI), NEWNet, Paris, France
| | - Fiona Measham
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Department of Sociology, Social Policy & Criminology, University of Liverpool, Liverpool, L69 7ZR, United Kingdom
| | - Mireia Ventura
- Trans European Drug Information (TEDI), NEWNet, Paris, France; Energy Control, Asociación Bienestar y Desarrollo, Quevedo 2, Barcelona, Spain.
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21
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Larnder A, Burek P, Wallace B, Hore DK. Third party drug checking: accessing harm reduction services on the behalf of others. Harm Reduct J 2021; 18:99. [PMID: 34535157 PMCID: PMC8447798 DOI: 10.1186/s12954-021-00545-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/02/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Drug checking uses chemical analytical technologies to analyze drugs from the unregulated market to reduce substance use-related risks. We aim to examine the frequency of third party use of a community drug checking service to explore the potential for harm reduction to extend beyond the individual into the community, increase service accessibility, and to contribute to upstream interventions in the supply. METHODS Over 31 months, data were collected from a point-of-care drug checking service operated in Victoria, Canada. Through the implementation of survey questions at the intake of the service, data were collected about whether the drug check was for the individual, to sell, and/or for others. RESULTS Just over half (52%) of service users were checking for reasons that extended beyond individual use. When checking for others, friends were the most common response, representing 52% of responses, and outreach/support workers checking for others was the second most at 32%. Twelve percent of service users reported checking to sell or for a supplier. CONCLUSIONS Third party checking is a frequent, and important aspect of drug checking services, which through facilitating community engagement and increasing accessibility, has expanded the reach of interventions beyond individuals to reduce risks within the unregulated market. Therefore, drug checking as an overdose response should be responsive and accessible for those using the service on the behalf of others.
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Affiliation(s)
- Ashley Larnder
- Department of Chemistry, University of Victoria, Victoria, V8W 3V6, Canada
| | - Piotr Burek
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8W 2Y2, Canada
| | - Bruce Wallace
- School of Social Work, University of Victoria, Victoria, V8W 2Y2, Canada. .,Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8W 2Y2, Canada.
| | - Dennis K Hore
- Department of Chemistry, University of Victoria, Victoria, V8W 3V6, Canada.,Department of Computer Science, University of Victoria, Victoria, V8W 3P6, Canada
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22
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Hirschfeld T, Smit-Rigter L, van der Gouwe D, Reiche S, Stöver H, Majić T. Safer Tripping: Serotonergic Psychedelics and Drug Checking. Submission and Detection Rates, Potential Harms, and Challenges for Drug Analysis. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00385-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
With the continuous emergence of new psychoactive substances, drug checking (DC) services are challenged by an increasingly complex drug market. Considering the resumed scientific and public interest in serotonergic psychedelics (SPs) like LSD, psilocybin, and 2C-B, we present the results of a literature search investigating the presence and proportion of SPs in DC samples.
Recent Findings
In 15 identified reports, submission and detection rates of SPs were comparably low, but increasing. Samples contained considerable amounts of adulterations or analogues, mostly novel SPs with unknown toxicological profiles and in some cases potentially life-threatening effects. The detection of SPs, however, requires advanced analysis techniques currently not available to most DC services.
Summary
Given the substantial proportion of novel SPs in DC samples and the associated risks, DC can be a valuable harm reduction and monitoring tool for SPs if analysis techniques with high sensitivity are employed.
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Peacock A, Gibbs D, Price O, Barratt MJ, Ezard N, Sutherland R, Hill PL, Grigg J, Lenton S, Page R, Salom C, Hughes C, Bruno R. Profile and correlates of colorimetric reagent kit use among people who use ecstasy/MDMA and other illegal stimulants in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103334. [PMID: 34246017 DOI: 10.1016/j.drugpo.2021.103334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Colorimetric reagent kits can provide information about the compounds present in drug samples. This study aimed to identify patterns and correlates of colorimetric reagent kit use, as well as behavioural outcomes of testing, amongst people who use illegal stimulants in a context that lacks permanent government-sanctioned drug checking services. METHODS Australians residing in capital cities who reported regularly using ecstasy/MDMA and/or other illegal stimulants ≥monthly in the past six months were recruited via social media and word-of-mouth from April-July 2019 (N = 792). Participants were asked about testing the contents and/or purity of illegal drugs, and features of last colorimetric reagent kit use. Logistic regression identified correlates of last using a kit (referent: no use of drug checking technology to test drug contents/purity in the past year). RESULTS Over one-third (36%) reported testing drug contents and/or purity; of this group, 86% had last used a colorimetric reagent kit. On the last occasion, 52% reported someone else had conducted testing; 58% said testing occurred <24 h before planned drug use; and 24% reported testing for quantity of a substance. Correlates of drug checking comprised: being younger, male, past six-month use of new psychoactive substances, accessing community-based health services for alcohol or other drug reasons, selling drugs for cash profit, obtaining information from peers who had tried the drug, and searching online for reports of the drug by stamp/appearance. The majority (84%) tested a substance they had been sold and/or given as MDMA; of these, 87% detected MDMA. Of those who expected and detected MDMA, 29% and 11% reported results to their peers and dealer, respectively. CONCLUSION People who use ecstasy/MDMA and/or other illegal stimulants seek out objective information about substance contents. In countries that lack permanent government-sanctioned drug checking services, it is important to acknowledge that people already engage in drug checking but with suboptimal technologies and without tailored specialist advice and education.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia.
| | - Daisy Gibbs
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Olivia Price
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Monica J Barratt
- Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; National Centre for Clinical Research on Emerging Drugs, Sydney, Australia; St Vincent's Hospital, Sydney, Australia
| | - Rachel Sutherland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Penelope L Hill
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; National Centre for Clinical Research on Emerging Drugs, Sydney, Australia; Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jodie Grigg
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Simon Lenton
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Robert Page
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; St Vincent's Hospital, Sydney, Australia
| | - Caroline Salom
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Caitlin Hughes
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; Centre for Crime Policy and Research, Flinders University, Adelaide, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
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Wallace B, van Roode T, Pagan F, Hore D, Pauly B. The potential impacts of community drug checking within the overdose crisis: qualitative study exploring the perspective of prospective service users. BMC Public Health 2021; 21:1156. [PMID: 34134698 PMCID: PMC8207696 DOI: 10.1186/s12889-021-11243-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background As drug checking becomes more integrated within public health responses to the overdose crisis, and potentially more institutionalized, there is value in critically questioning the impacts of drug checking as a harm reduction response. Methods As part of a pilot project to implement community drug checking in Victoria, BC, Canada, in-depth interviews (N = 27) were held with people who use or have used substances, family or friends of people who use substances, and/or people who make or distribute substances. Critical harm reduction and social justice perspectives and a socioecological model guided our analysis to understand the potential role of drug checking within the overdose crisis, from the perspective of prospective service users. Results Participants provided insight into who might benefit from community drug checking and potential benefits. They indicated drug checking addresses a “shared need” that could benefit people who use substances, people who care for people who use substances, and people who sell substances. Using a socioecological model, we identified four overarching themes corresponding to benefits at each level: “drug checking to improve health and wellbeing of people who use substances”, “drug checking to increase quality control in an unregulated market”, “drug checking to create healthier environments”, and “drug checking to mediate policies around substance use”. Conclusions Drug checking requires a universal approach to meet the needs of diverse populations who use substances, and must not be focused on abstinence based outcomes. As a harm reduction response, community drug checking has potential impacts beyond the individual level. These include increasing power and accountability within the illicit drug market, improving the health of communities, supporting safer supply initiatives and regulation of substances, and mitigating harms of criminalization. Evaluation of drug checking should consider potential impacts that extend beyond individual behaviour change and recognize lived realities and structural conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11243-4.
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Affiliation(s)
- Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada. .,School of Social Work, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada.
| | - Thea van Roode
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
| | - Flora Pagan
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
| | - Dennis Hore
- Department of Chemistry, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada.,Department of Computer Science, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada.,School of Nursing, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
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Palamar JJ, Fitzgerald ND, Keyes KM, Cottler LB. Drug checking at dance festivals: A review with recommendations to increase generalizability of findings. Exp Clin Psychopharmacol 2021; 29:229-235. [PMID: 33600199 PMCID: PMC8282667 DOI: 10.1037/pha0000452] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dance festival attendees are at high risk for consuming adulterated drugs. In recent years, drug checking studies have been conducted at various dance festivals to provide valuable harm reduction information to attendees regarding drug content. We conducted a review of the literature to determine the generalizability of findings to the target population of interest-festival attendees at risk for using adulterated drugs. Six published studies involving drug checking at festivals were reviewed. All relied on self-selected samples and male attendees were overrepresented based on previous research. Test methods, drugs tested, definitions of adulteration, and prevalence of adulteration varied across studies. Prevalence of detection of adulterants ranged from 11% to 55%. While the drug checking services described appear to have been beneficial for participants, results have limited generalizability to the target population. We recommend that researchers expand beyond the self-selection model in future studies and utilize recruitment methods that involve random sampling techniques such as systematic random sampling, stratified random sampling, or time-space sampling within festivals. We also recommend that individuals approached are surveyed for demographic characteristics, planned drug use at the festival, and willingness to test their drugs. These methods would help determine how representative the sample is compared to the target population and allow for more generalizable estimates. In conclusion, as these valuable harm reduction services expand, it may be possible to reach a wider portion of the population at risk and to obtain more generalizable estimates of engagement, adulteration, and reactions to learning one possesses adulterated drugs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Joseph J. Palamar
- Department of Population Health, New York University Grossman School of Medicine
| | - Nicole D. Fitzgerald
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida
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Visitors of the Dutch drug checking services: Profile and drug use experience. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103293. [PMID: 34052555 DOI: 10.1016/j.drugpo.2021.103293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Drug checking services (DCS) provide information about drug content and purity, alongside personalized feedback, to people who use drugs; however, the demographic and drug use characteristics of DCS clients are rarely reported. This paper describes these characteristics for clients of the Dutch DCS, the Drug Information and Monitoring System (DIMS). METHODS 1,530 participants completed a pen-and-paper questionnaire at one of eight participating DCS in the Netherlands in 2018. RESULTS The participants were mostly highly educated males in their twenties with no migration background. Experience with drugs prior to coming to the DCS was common. Only 0.7% indicated they had never used any of the twenty drugs studied. 93% of participants reported use of ecstasy or MDMA with an average of 6.3 years since first use. CONCLUSIONS These results indicate that drug checking can be a valuable tool for public health services as it facilitates access to more difficult-to-reach communities who use drugs. It is unlikely that DCS encourage drug initiation, since almost all people who visit the Dutch DCS already report experience with drugs. However, DCS should be aware that their services might not be easily accessible or attractive to all demographic groups.
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Measham F, Turnbull G. Intentions, actions and outcomes: A follow up survey on harm reduction practices after using an English festival drug checking service. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103270. [PMID: 33972157 DOI: 10.1016/j.drugpo.2021.103270] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/27/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Drug checking is a health service whose behavioural outcomes have been assessed primarily through reported intentions of service users after receiving healthcare consultations or brief interventions (BIs). This study contributes to the evidence base through utilising a follow-up design to compare outcomes of risk communications on risk management and harm reduction practices both at and after attending drug checking services at three English music festivals in 2017. METHODS Data were collected and analysed from: (i) 1,482 self-complete questionnaires at sample drop-off; (ii) 1,482 nominated primary service users at 1,482 face-to-face BIs; and (iii) an anonymous online self-report follow-up survey completed by a sub-sample of 130 primary service users (one quarter of legible, functioning email addresses received) followed up three months later. Ten measures (one verified action and nine intentions) were recorded at point of BI and compared with retrospectively reported outcomes and ongoing changes post-BI. RESULTS Outcomes at follow-up were correlated with actions and intentions at BI for nine of the ten measures, including over half of service users disposing of samples identified as other than expected and two in five reporting reduced dosage for samples identified as expected. One in five reported alerting their friends to substances of concern. CONCLUSION Event-based drug checking services can access and engage productively with young adults earlier in drug taking careers and not in touch with health services, through tailored polydrug BIs. Rapid identification of substances of concern, dissemination of test results and associated risk communications during and after events through friendship networks, support services and early warning systems suggest that the benefits of drug checking can extend beyond service users and point of BI and can increase strategies and behaviours to reduce drug-related harm such as poisoning and overdose.
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Affiliation(s)
| | - Gavin Turnbull
- University of Liverpool, Liverpool, United Kingdom & RMIT University, Victoria, Australia
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28
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Scott IA, Scott RJ. Pill testing at music festivals: is it evidence-based harm reduction? Intern Med J 2021; 50:395-402. [PMID: 31908122 DOI: 10.1111/imj.14742] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/19/2019] [Accepted: 12/29/2019] [Indexed: 01/12/2023]
Abstract
Recent pill-related deaths of young people at music festivals in Australia have led to a concerted push for on-site pill testing as a means for preventing such events. However, whether pill testing (also termed 'safety checking') is an effective harm reduction strategy remains uncertain. This narrative review concludes that pill testing currently lacks evidence of efficacy sufficient to justify publicly funded national roll-out of on-site pill-testing programmes. Australian governments, addiction specialists and public health experts should collaborate in conducting properly designed field studies aimed at confirming clear benefits from such programmes in reducing pill-related harm.
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Affiliation(s)
- Ian A Scott
- Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Russ J Scott
- Prison Mental Health Services, Queensland Health, Brisbane, Queensland, Australia
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Betzler F, Helbig J, Viohl L, Ernst F, Roediger L, Gutwinski S, Ströhle A, Köhler S. Drug Checking and Its Potential Impact on Substance Use. Eur Addict Res 2021; 27:25-32. [PMID: 32535605 PMCID: PMC7845440 DOI: 10.1159/000507049] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/14/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Drug checking as a tool for harm reduction is offered in certain cities throughout Europe, the USA, and Australia, but in general, it is internationally still scarcely available and controversially discussed. This study aimed at investigating the potential impact of a drug-checking offer on Berlin nightlife attendees' illicit drug use and at identifying the encouraging and discouraging factors for using or refraining from such an offer. METHODS Using an online questionnaire, we conducted a cross-sectional survey in a Berlin party scene. A total of 719 people participated in the survey that took part in 2019. RESULTS The vast majority of participants (92%) stated that they would use drug checking, if existent. If the test revealed the sample to contain a high amount of active ingredient, 91% indicated to take less of the substance than usual. Two-thirds (66%) would discharge the sample if it contained an unexpected/unwanted agent along with the intended substance. If the sample contained only unexpected/unwanted substances and not the intended substance at all, 93% stated to discharge the sample. Additional brief counseling was stated to be useful. Participants showed a comparatively high substance use. CONCLUSIONS Drug checking as a harm reduction tool was highly accepted in the scene, and the majority of participants stated to align their consumption behavior accordingly, in a reasonable manner. A concomitant consultation would be appreciated, which may be used to direct educational information about harms and risks to users.
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Affiliation(s)
- Felix Betzler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
| | - Jonas Helbig
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Leonard Viohl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felicitas Ernst
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lukas Roediger
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Fregonese M, Albino A, Covino C, Gili A, Bacci M, Nicoletti A, Gambelunghe C. Drug Checking as Strategy for Harm Reduction in Recreational Contests: Evaluation of Two Different Drug Analysis Methodologies. Front Psychiatry 2021; 12:596895. [PMID: 33692707 PMCID: PMC7938318 DOI: 10.3389/fpsyt.2021.596895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Drug checking as a part of drug harm-reduction strategies represents an essential aspect of public health policies. It focuses on rapid identification of drugs that individuals intend to use during night events, in order to implement health-protective behaviors. Chemical drug analysis techniques vary considerably, from simple colorimetric reagents to advanced forensic methods such as gas chromatography/mass spectrometry (GC/MS). Materials and Methods: In 2019, drug-check services were offered at some night events in Umbria (Central Italy). One hundred and twenty attendees directly delivered unidentified substances to a harm-reduction worker, who collected a few milligrams of the substances on ceramic plates and added a drop of colorimetric reagent. Multiple reagents were used to increase the diagnostic capacity of a substance, which may react with a specific drug or a few drugs. Later, a fraction of the samples was analyzed by GC/MS. The concordance of the results obtained using these two methodologies and the intended behaviors of consumers after being informed of the test result was evaluated. Results: We analyzed 120 samples by colorimetric test: 32 MDMA, 25 ketamine, 10 amphetamine, 11 cocaine, 8 heroin, and 4 LSD samples. The results were inconclusive for 29 samples. The GS/MS analysis confirmed MDMA in 84%, ketamine in 78%, amphetamine in 91%, cocaine in 92%, heroin in 88%, and LSD in 100% of the samples. The results of samples with inconclusive results were as follows: 2, MDMA; 7, ketamine; 2, amphetamine; 2, cocaine; 2, heroin; 2, mephedrone; 6, mixes; 1, debris; and 5, adulterants as the main component. Twenty-one of 29 participants reported that they had no intention of consuming the unidentified substance. Discussion: The high percentage of individuals who claimed no intention of consuming the unidentified drugs indicates that drug checking is viable as a part of drug harm-reduction strategies. Overall, colorimetric reagents showed a good performance with regard to samples being unadulterated (LSD) or minimal in quantity, but failed to identify mixtures of substances and the adulterants present in them. Therefore, the use of more discriminatory on-site methods such as Raman or infrared spectrometry is strongly recommended.
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Affiliation(s)
| | - Andrea Albino
- Harm Reduction Services, Cooperative "Borgorete", Perugia, Italy
| | - Claudia Covino
- Local Health Unit, USL Umbria 1, Ser.T Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Alessio Gili
- Hygiene and Public Health Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Mauro Bacci
- Forensic Medicine, Forensic Science and Sports Medicine Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessia Nicoletti
- Forensic Medicine, Forensic Science and Sports Medicine Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Cristiana Gambelunghe
- Forensic Medicine, Forensic Science and Sports Medicine Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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McAllister I, Makkai T. The effect of public opinion and politics on attitudes towards pill testing: Results from the 2019 Australian Election Study. Drug Alcohol Rev 2020; 40:521-529. [PMID: 33222283 DOI: 10.1111/dar.13211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Following several deaths due to drug overdoses at music festivals in Australia, pill testing (or drug checking) has been proposed as a means of reducing the risk to young people. However, pill testing is a politically controversial policy in Australia. This paper examines the political dimension to the debate, its relationship with other social issues and how it divides party supporters. DESIGN AND METHODS The data come from the 2019 Australian Election Study survey-a large (n = 2179), nationally weighted representative probability survey conducted immediately after the federal election. Bivariate and multivariate analyses are used to identify the social groups, attitudes and vote preferences most associated with public views about pill testing. RESULTS Almost two-thirds of the public support pill testing at music festivals. The young and those who do not attend church are most likely to express support. Supporters of other liberal social opinions, such as the legalisation of marijuana, are also strongly supportive of pill testing. Those who vote for one of the two main conservative parties are less likely to support pill testing. DISCUSSION AND CONCLUSIONS While a majority of the public support pill testing, beyond the Australian Capital Territory this has not translated into policy in other jurisdictions. The results show that there is a high level of political polarisation surrounding opinions among both voters and political elites. This issue must be addressed if the policy is to be advanced as part of an overall harm reduction approach to drug use.
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Affiliation(s)
- Ian McAllister
- School of Politics and International Relations, Australian National University, Canberra, Australia
| | - Toni Makkai
- Centre for Social Research and Methods, Australian National University, Canberra, Australia
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Palamar JJ, Salomone A. Shifts in Unintentional Exposure to Drugs Among People Who Use Ecstasy in the Electronic Dance Music Scene, 2016-2019. Am J Addict 2020; 30:49-54. [PMID: 32813326 DOI: 10.1111/ajad.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/19/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Electronic dance music (EDM) party attendees who use ecstasy (3,4-methylenedioxymethamphetamine [MDMA], Molly) are at high risk for ingesting adulterant drugs, but little is known regarding trends in exposure. We sought to determine whether adulteration has shifted in recent years. METHODS Adults entering EDM events at nightclubs and dance festivals in NYC were surveyed in 2016 and 2019. We tested hair samples from a subsample of those reporting past-year ecstasy use using ultra-high performance liquid chromatography-tandem mass spectrometry. Differences in unreported drug exposure and suspected adulteration were compared between 2016 (n = 90) and 2019 (n = 72). RESULTS MDMA detection was stable at 72-74%. We detected decreases in unreported use of methamphetamine (from 22.2% to 5.6% [P = .003], an 74.8% decrease), new psychoactive substances (from 31.1% to 2.8% [P < .001], a 91.0% decrease), and synthetic cathinones in particular (from 27.8% to 2.8% (P < .001, an 89.9% decrease). Unreported ketamine exposure increased from 18.9% to 34.7% (P = .022, an 83.6% increase). We also detected decreases in participants' suspicion of their ecstasy being adulterated with methamphetamine (from 20.0% to 5.6% [P = .010], an 72.0% decrease) and "bath salts" (synthetic cathinones, from 8.9% to 1.4% [P = .044], an 84.3% decrease). DISCUSSION AND CONCLUSIONS Unknown exposure to adulterants among people who use ecstasy in the EDM scene is shifting. Monitoring of exposure to adulterants is needed to inform harm reduction. SCIENTIFIC SIGNIFICANCE This was among the first studies to examine unintentional exposure to drugs over time in this population and unintentional exposure to synthetic cathinones in particular appears to be declining. (Am J Addict 2021;30:49-54).
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Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Alberto Salomone
- Dipartimento di Chimica, Università di Torino, Torino, Italy.,Centro Regionale Antidoping e di Tossicologia, Orbassano (TO), Italy
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Abstract
PURPOSE OF REVIEW Drug checking services invite drug consumers to anonymously submit drug samples for chemical analysis and provide feedback of results. Drugs are tested for strength/dose and/or presence of adulterants. Drug checking appears to be more common in recent years in response to increases in fentanyl-related deaths and the proliferation of new psychoactive substances (NPS). We aim to provide information regarding the current state of drug checking in relation to analysis methods, adulteration rates, and behavioral responses to results. RECENT FINDINGS Various technologies are being used to detect the presence of fentanyl, its analogs, and other NPS in drug samples. Proxy drug checking, which we define as biospecimen testing for drug exposure postconsumption, is also becoming common. However, there appears to a dichotomy between research focusing on populations at high risk for fentanyl exposure and to exposure to NPS such as synthetic cathinones. SUMMARY Drug checking research and services largely focus on opioid consumers and nightclub and dance festival attendees, but more focus may be needed on the general population. Drug checking results can inform surveillance efforts, and more research is needed to overcome barriers to drug checking and to focus on whether test results indeed affect behavior change.
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Frude E, McKay FH, Dunn M. A focused netnographic study exploring experiences associated with counterfeit and contaminated anabolic-androgenic steroids. Harm Reduct J 2020; 17:42. [PMID: 32532347 PMCID: PMC7291737 DOI: 10.1186/s12954-020-00387-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/03/2020] [Indexed: 02/17/2023] Open
Abstract
Background A primary consequence of illicit drug markets and the absence of regulation is the variable quality or purity of the final product. Analysis of anabolic-androgenic steroid seizures shows that these products can contain adulterated products, product not included on the label, or product of unsatisfactory standard. While the potential negative effects of counterfeit anabolic-androgenic steroids (AAS) use is a recognised risk associated with use, no study has explored personal experiences associated with use. The aim of the present study was to use online discussion forums to investigate and explore the experiences associated with the purchase and consumption of counterfeit AAS among consumers. Methods An online search was conducted to identify online forums that discussed counterfeit or contaminated AAS; three were deemed suitable for the study. The primary source of data for this study was the ‘threads’ from these online forums, identified using search terms including ‘counterfeit’, ‘tampered’, and ‘fake’. Threads were thematically analysed for overall content, leading to the identification of themes. Results Data from 134 threads (2743 posts from 875 unique avatars) was included. Two main themes were identified from the analysis: (1) experiences with counterfeit product and (2) harms and benefits associated with counterfeit product. Conclusions The use of counterfeit or contaminated substances represents a public health concern. Those who report using performance and image enhancing drugs such as AAS for non-medical purposes report consuming these substances and experiencing harm as a result. Consumers take steps to limit coming into contact with counterfeit or contaminated product, though recognise that many of these have limitations. The implementation of accessible drug safety checking services may provide an opportunity to provide consumers with information to assist them with making healthier choices.
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Affiliation(s)
- Evelyn Frude
- School of Health and Social Development, Deakin University, Geelong Waterfront Campus, Locked Bag 20000, Geelong, Victoria, 3220, Australia
| | - Fiona H McKay
- School of Health and Social Development, Deakin University, Geelong Waterfront Campus, Locked Bag 20000, Geelong, Victoria, 3220, Australia
| | - Matthew Dunn
- School of Health and Social Development, Deakin University, Geelong Waterfront Campus, Locked Bag 20000, Geelong, Victoria, 3220, Australia. .,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
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Wallace B, van Roode T, Pagan F, Phillips P, Wagner H, Calder S, Aasen J, Pauly B, Hore D. What is needed for implementing drug checking services in the context of the overdose crisis? A qualitative study to explore perspectives of potential service users. Harm Reduct J 2020; 17:29. [PMID: 32398090 PMCID: PMC7216532 DOI: 10.1186/s12954-020-00373-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The current illicit drug overdose crisis within North America and other countries requires expanded and new responses to address unpredictable and potentially lethal substances, including fentanyl analogues, in the unregulated drug market. Community-wide drug checking is being increasingly explored as one such public health response. We explored how drug checking could be implemented as a potential harm reduction response to the overdose crisis, from the perspective of potential service users. METHODS The research was guided by the Consolidated Framework for Implementation Research (CFIR). We conducted a qualitative, pre-implementation study to inform development and implementation of drug checking services that are acceptable to people who use substances and meet their needs. University and community researchers conducted 27 in-depth interviews with potential service users at prospective drug checking sites. We inductively developed emerging themes to inform the implementation of drug checking services within the five domains of the CFIR, and identified the most relevant constructs. RESULTS Implementing community drug checking faces significant challenges within the current context of criminalization and stigmatization of substance use and people who use/sell drugs, and trauma experienced by potential service users. Participants identified significant risks in accessing drug checking, and that confidential and anonymous services are critical to address these. Engaging people with lived experience in the service can help establish trust. The relative advantage of drug checking needs to outweigh risks through provision of accurate results conveyed in a respectful, non-judgemental way. Drug checking should provide knowledge relevant to using and/or selling drugs and informing one's own harm reduction. CONCLUSIONS For service users, the extent to which the implementation of drug checking can respond to and mitigate the risks of being criminalized and stigmatized is critical to the acceptability and success of community drug checking. The culture and compatibility of the service, setting and staff with harm reduction principles and practices is essential.
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Affiliation(s)
- Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada. .,School of Social Work, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada.
| | - Thea van Roode
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
| | - Flora Pagan
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
| | - Paige Phillips
- SOLID Outreach Society, 1056 North Park St, Victoria, BC, Canada
| | - Hailly Wagner
- SOLID Outreach Society, 1056 North Park St, Victoria, BC, Canada
| | - Shane Calder
- AVI Health & Community Services, 3rd Floor - Access Health Centre 713 Johnson St, Victoria, BC, Canada
| | - Jarred Aasen
- Lantern Services, 820 Cormorant St, Victoria, BC, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada.,School of Nursing, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
| | - Dennis Hore
- Department of Chemistry, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada.,Department of Computer Science, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
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Measham F. City checking: Piloting the UK's first community-based drug safety testing (drug checking) service in 2 city centres. Br J Clin Pharmacol 2020; 86:420-428. [PMID: 32030770 DOI: 10.1111/bcp.14231] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/05/2020] [Accepted: 01/12/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS To explore the feasibility of delivering community-based drug safety testing (drug checking), to trial service design characteristics and to compare with festival-based testing. METHODS In total, 171 substances of concern were submitted on 5 dates at 3 venues in 2 UK cities and tested using up to 6 analytical techniques. Test results and harm reduction advice were distributed directly to over 200 service users through 144 tailored healthcare consultations, to stakeholders, and through early warning systems, media and social media alerts. RESULTS The 171 samples were submitted and identified as MDMA (43.3%), cocaine (12.9%), ketamine (12.9%), various psychedelics submitted by students, and heroin and a synthetic cannabinoid submitted by rough sleeping communities, with 76% of samples' test results as expected. The 144 primary service users identified as 91.7% white, 68.1% male, with an average age of 26.7 years. Reported harm reduction intentions included alerting friends and acquaintances (37.5%), being more careful mixing that substance (35.4%), lowered dosage (27.8%), disposal of further substances (6.9%) and additionally 2.8% handed over further substances for verified destruction. CONCLUSION Community-based drug safety testing (drug checking) was piloted for the first time in the UK-within a drugs service, a community centre and a church-with consideration given to meso-level operational feasibility and micro-level behavioural outcomes. Service design characteristics such as venue, day of week, prior publicity, service provider, and direct and indirect dissemination of results all may impact on outcomes. Future studies should consider cost-benefit analyses of community and event-based testing and context-appropriate macro, meso and micro-level evaluations.
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Affiliation(s)
- Fiona Measham
- Chair in Criminology, Department of Sociology, Social Policy and Criminology, University of Liverpool, UK, and Honorary Professor, RMIT, Australia
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