(83) Drug Supply Monitoring: Feedback from People Who Use Drugs

Background & Introduction: The overdose crisis is a critical public health crisis in the U.S., with significant impacts in Rhode Island. In 2022, there were 107,941 drug overdose deaths nationwide, including 434 in Rhode Island. The emergence of potent synthetic opioids like fentanyl and novel psychoactive substances (NPS) such as xylazine and nitazenes poses additional challenges. Understanding drug supply dynamics and their influence on use and health outcomes is crucial for developing effective public health interventions. This study aims to assess feedback from people who use drugs (PWUD) regarding dissemination of information, drug supply surveillance, and testing services. By evaluating PWUD feedback, this study seeks to improve drug checking services and inform public health responses.

Methods: The testRI project is a two-year initiative to monitor the evolving opioid crisis at the street level in Rhode Island. The testRI project employed a multidisciplinary approach, integrating ethnographic, epidemiological, and toxicological methods to gain a comprehensive understanding of the local drug supply and its implications for people who use drugs (PWUD). Survey participants were recruited through outreach efforts with community partners. For inclusion in the survey participants had to report active or recent drug use, defined as drug use within the last six months. The surveys included questions on drug use practices, interest in drug testing or checking in various forms, and feedback on study materials, including presentation, content, and dissemination strategies. Additionally, participants were queried on perceptions of supply safety, preferences related to drug testing services, how results from drug testing might impact them, and preferences for receiving information about the local drug supply. A total of 158 individuals completed the survey.

Results: A total of 203 drug samples were collected for testing via donation from May 2022-January 2024. Donated drug sample testing results were incorporated into monthly or bimonthly “Supply Updates”. “Spotlights” were developed to provide focused information on new substances or substances of specific concern, e.g., xylazine, nitazenes, novel benzodiazepines, synthetic cannabinoids

Overall, the majority of participants (88%) were either very or mostly satisfied with the information. A significant portion of respondents (81%) expressed a likelihood (either “yes, definitely” or “yes, I think so”) of checking the website for future updates, underscoring the importance of maintaining and promoting this resource. Participants showed a strong inclination to recommend the resource to others, with 81% indicating that they would do so. The survey results indicate a high level of concern among participants regarding drug supply safety with 71% of participants responding that they were either “concerned” or “very concerned” about supply safety. Regarding the use of xylazine or benzodiazepine test strips, 115 participants expressed interest in using both types of strips, while five participants were interested in xylazine test strips only. When considering the availability of drug checking services, 95 participants indicated that they would be "very interested" in checking their drugs prior to use, while 28 were "interested." Participants had varied preferences for receiving future drug supply information. The most preferred formats were drop-in centers (49%), websites (47%), and paper printouts (47%). Other popular options included outreach workers (44%), email (42%), and social media platforms such as Twitter, Instagram, and Facebook (33%). Some participants preferred receiving information through healthcare provider offices (30%), links with results texted directly to them (31%), and visual methods like drawings or posters (28%).

Participants were given the opportunity to provide additional feedback or suggestions. The feedback from participants highlighted eight key themes: strong appreciation for the clarity and life-saving potential of the information and services, a desire for more accessible and extensive harm reduction services, an emphasis on providing essential tools like test strips and needle exchanges, suggestions for improving communication through visual aids, requests for additional support addressing the psycho-social aspects of addiction, recognition of the positive impact and effectiveness of community outreach, diverse attitudes toward drug use interventions, and a call for expanding these vital resources to better meet the needs of the community.

Conclusion & Discussion: The survey results indicate that there is a significant concern among respondents regarding drug supply safety, with a majority expressing a high level of interest in using drug-checking services and test strips for substances like fentanyl and xylazine. We observed an unmet demand for more drop-in centers and printed educational materials. This suggests a gap in the current harm reduction infrastructure, where more physical spaces and resources are needed to meet the evolving needs of this community. In summary, this project underscores the importance of a multifaceted approach that goes beyond drug testing to include robust community engagement, clear and comprehensive educational materials, and ongoing dialogue with those most affected by drug use. Future initiatives should integrate these elements to maximize their impact and address the broader concerns of the community regarding health and safety.

References: 1. Spencer MR, Garnett MF, Miniño AM. Drug overdose deaths in the United States, 2002–2022. NCHS Data Brief, no 491. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc:135849
2. Rhode Island Department of Health. (2023, June 14). Rhode Island 2022 fatal drug overdose data released. RI.gov. https://www.ri.gov/press/view/45859
3. Amanda L A Mohr, Barry K Logan, Melissa F Fogarty, Alex J Krotulski, Donna M Papsun, Sherri L Kacinko, Marilyn A Huestis, Jeri D Ropero-Miller, Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, 2017–2020: A Review, Journal of Analytical Toxicology, Volume 46, Issue 6, July 2022, Pages e116–e185, https://doi.org/10.1093/jat/bkac023