(9) A Drug Identification Program as a Harm Reduction Initiative

Background & Introduction: Adulterants in the illicit drug supply remain a primary concern. People who use drugs are being exposed to drugs without their knowledge that may cause unintended effects. Drug checking had been recognized as an important harm reduction technique especially after the increasing prevalence of illicit fentanyl. In 2023, Hamilton County Public Health (HCPH) partnered with the Centers for Disease Control and Prevention, the University of North Carolina (UNC) Street Drug Analysis Lab, and community-based organizations to pilot a drug checking program. The primary purpose of this study was to describe drugs identified in participant submitted samples.

Methods: Participants could voluntarily submit samples of drug at three different community sites. This study included samples collected from 1/24 -12/24. Samples included drug residues, power, or used paraphernalia. All samples were submitted anonymously but included a questionnaire. Participants identified what they thought the substance was. The samples were then sent to the UNC Drug Analysis lab that performed gas chromatography/mass spectrometry. Participants could then access their results directly from a UNC website. A medical toxicologist classified the drug results.

Results: 79 samples were submitted for identification. In addition to fentanyl, heroin, cocaine, and methamphetamine, 47 other substances were identified. 18 of these were substances with potential psychoactive activity but were not a known metabolite (eg. 6-monoacetylmorphine). The most common were xylazine (42), medetomidine (17), p-fluorofentanyl (11), N-desethyl etonitazene (6), and N-pyrrolidino-etonitazene (4). 5 distinct benzimidazole opioids were identified. 16 substances were likely cutting agents, 6 were likely metabolites of other illicit agents, and 7 were likely precursors or byproducts (eg. 4-anilino-N-phenethylpiperidine) in the manufacture of other illicit agents. 3 samples had no substances of any kind identified. All potentially psychoactive adulterants were found only in samples submitted that were believed to contain an opioid. Only 1 sample believed to be an opioid contained only the opioid (fentanyl and heroin and precursors). 15 samples were submitted believed to contain methamphetamine. 12 contained only methamphetamine and 3 contained methamphetamine with a likely cutting agent (dimethyl sulfone or quinidine). 3 samples were submitted believed to contain only cocaine and all 3 only had cocaine identified with no adulterants identified. Methamphetamine and cocaine were also frequently identified in samples believed to be an opioid. Only 1 sample was submitted believed to be a benzodiazepine (alprazolam) but contained only bromazolam.

Conclusion & Discussion: In this sample of drug samples submitted in Hamilton County, OH, the majority of samples believed to be an opioid were adulterated with other substances with potentially harmful effects. Alpha-2 agonists, fentanyl analogs, and benzimidazole opioids were common. Information given to participants may aid in harm reduction. In addition, knowledge of the composition of the local drug supply may aid health care providers. Furthermore, we may be able to identify temporal trends. For example, there were 9 of 17 samples identified with medetomidine were submitted after September. In addition, ortho-methylfentanyl was first identified in a sample in September and has been identified 2 more times.
Limitations of the study include the following: The participants in this study may not reflect people who use drugs in the overall larger community of Cincinnati and Hamilton County. The drug identifications are largely qualitative (some were identified as trace amounts).

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