It’s not just people who use drugs making use of drug test kits and machines—people who also sell the substances can, and often do, check their wares for purity and potency. While the near-ubiquity of fentanyl in opioid supplies (besides others) has changed the drug-checking landscape, there’s still much value in accessing the harm reduction strategy, experts say.
New research out of Victoria, British Columbia examines the implications and benefits of drug checking conducted by people who sell. The work began in 2019 alongside the formation of the Vancouver Island Drug Checking Project, which has set up checking stations at various encampments for unhoused people, harm reduction facilities and other venues.
Bruce Wallace is a scientist with the Canadian Institute for Substance Use Research (CISUR), and an associate professor with the University of Victoria’s School of Social Work. He and his team began asking service users at project venues about the implications of drug checking in their lives, and how they would like to see such services implemented. Later, they also began speaking with service users’ friends and families.
“There’s a real right to that information, and there’s real value in people being able to verify that substance.”
From the resulting 27 qualitative interviews, they found people felt that drug checking using the various strips, kits and machines could increase accountability and consumer power in the unregulated market. Additionally, it could potentially change attitudes surrounding drugs and the people who use them, and might increase interest in harm reduction.
Wallace acknowledged the potential benefits of having people who sell drugs check the contents of their wares prior to sale, while noting the overlap between people who use and those who sell. “There is interest in drug checking as a market intervention—interest from people who buy and sell,” he told Filter.
Wallace said that it’s unlikely that a person who sells drugs would toss a batch of, say, heroin that came up positive with unexpected fentanyl. But the unpredictability of the contents of drugs contributes to overdoses, while removing that unpredictability empowers everyone. Knowing the composition of a batch of drugs—and the concentrations of the substances within it—can let the sellers inform their buyers and, in turn, let the buyers make safer, more informed decisions.
“There’s a real right to that information, and there’s real value in people being able to verify that substance,” he said.
Ryan McNeil, director of the Harm Reduction Research program at the Yale Program in Addiction Medicine, produced work with similar findings. Last January, he and his team published a paper using 26 semi-structured interviews with people who checked their drugs at an overdose prevention site (or safe consumption site) in Vancouver.
From these interviews, the team found that people selling drugs—who may, of course, also be people who use them—would get their batches checked because they didn’t want to hurt people in their community. In some cases, the people selling drugs, once alerted to a batch’s high potency, would avoid selling it to people they knew had lower levels of tolerance.
“One of the core constituencies of folks accessing drug checking were people who were selling,” said McNeil, who was also involved in the original evaluation of fentanyl test strips at Insite in Vancouver, as part of a separate study. “They wanted to know [what was in the drugs] so they wouldn’t kill anyone in their community.”
“To put it really bluntly, the drug supply is fucked. It’s just absolutely fucked at this point,” he told Filter.
“People actively wanted to keep the people they were selling to safe.”
Like Wallace’s work, McNeil’s didn’t try to quantify how many people who sell drugs use drug checking. However, anecdotally, McNeil estimates that around 30 percent of the people he’s seen accessing the service are people who sell.
It’s “many more than you’d anticipate,” he said. “People actively wanted to keep the people they were selling to safe—they were friends, they were people in their social network. They just didn’t want that on their conscience.”
Research like Wallace’s and McNeil’s importantly adds to a wealth of knowledge already held by people who use and sell drugs and their allies about drug sellers’ harm reduction efforts. Even the FBI has acknowledged this phenomenon in a leaked report.
However, drug checking might be applicable differently in places where fentanyl is the norm, according to Gillian Kolla, a postdoctoral research fellow with CISUR who was not involved with Wallace’s research. Kolla noted that, back when fentanyl was something of a rarity, checking for it was always the highest priority.
People are now knowingly buying and selling fentanyl, meaning that, for example, a person who sells drugs, simply knowing it’s there might not mean as much as it used to even just five years ago. If that’s the situation, “It loses a bit of relevance in a market that’s dominated by fentanyl, versus one where it’s just one of the drugs out there on the market,” she told Filter.
But as McNeil pointed out, testing for fentanyl remains particularly valuable in cases where it would be less expected—for example in batches of what’s believed to be cocaine and methamphetamine.
Additionally, as Kolla noted, drug checking is key in monitoring developing illicit-market trends and their implications for drug-user health. For example, in the past few months in Ontario and BC, benzodiazepines such as etizolam have become increasingly common in unregulated supplies of opioids and other drugs. Once again, having that knowledge can help people make more informed choices about both consumption and sales.
It’s also not just about the presence of different substances in a particular batch. Drug checking can also allow people to test the concentration of, say, fentanyl. Being able to tell that a batch is 50 percent fentanyl, rather than simply that fentanyl is there, could be all-important.
Some checking methods—such as Fourier-transform infrared spectroscopy, which Wallace and his team’s project makes use of—can provide this. Others, like the standard fentanyl test strip, will not. Kolla added that drug checking can identify other substances that might increase the chance of an overdose occuring—like carfentanil, or unexpected illicit benzodiazepines. The downside of the more thorough methods is that they take longer—a day or more—on top of being more expensive.
Kolla said that we need both structural societal changes and a regulated supply.
The benefits of involving people who sell drugs in harm reduction can stretch beyond the immediate safety opportunity of drug checking, Kolla said. But drug checking—whether performed by people who use drugs, and/or the people who sell them—could of course be seen as a stop-gap measure.
Kolla said that drug checking takes a kind of “buyer beware” approach, which simply tells a person the contents of their drugs, rather than offering them a safer alternative. She said that we need both structural societal changes and a regulated supply of drugs of known dosage and contents to adequately combat climbing rates of overdose deaths.
McNeil agreed that policies surrounding drugs need to shift towards efforts like safe supply, but that drug testing can help in the meantime. “That way people can—as much as possible within the context of drug criminalization and all the other structural oppression—maintain safety to the greatest extent possible.”