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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.

Background: “Drug checking” has become a common harm reduction method used to test illicit substances, such as ecstasy, for purity and/or the presence of adulterants. Formal drug-checking services have been operating for decades, and the use of personal reagent test kits appears to be relatively common; however, little attention has been devoted to understanding the role and broader experiences of ‘drug-checkers’ (i.e., people who test their own and/or other people's substances). As such, it remains unknown who is engaging in this practice, their motivations for drug-checking, and what barriers they may experience. We addressed this research gap by interviewing people who check drugs about their experiences, with a goal of better understanding drug checking practices. Methods: We conducted in-depth interviews with 32 adults in North America who reported testing drugs. Coding was conducted in an inductive manner and thematic analysis was used to identify relevant themes. Results: Over half (56.2%) of our sample was affiliated with a drug checking organization. Among non-affiliated checkers (43.8%), the majority (57.1%) tested for friends, 21.4% tested only for themselves, and 21.4% were people who sold drugs and tested for their clients. Motivations were driven largely by altruism, described by checkers as wanting to protect their peers from exposure to adulterants. People interviewed who sold drugs were altruistic in the same manner. Barriers to checking—particularly at nightclubs and festivals—included perceived illegality of test kits and denied approval to test drugs at venues, although many checkers circumvented this barrier by checking drugs without such approval. Conclusions: Drug checkers in North America seek to educate people who use drugs about the risk of exposure to unexpected substance types, but they face various barriers. Policy change could help ensure that these potentially life-saving services can be provided without fear of fines and/or criminal p

Introduction and Aims: Ecstasy users in the electronic dance music scene are at high risk for using ecstasy adulterated with new psychoactive substances and/or methamphetamine. We examined self-reported testing of ecstasy among users in this scene. Design and Methods: We surveyed individuals (aged 18–40 years) entering electronic dance music parties in New York City in 2017. Past-year ecstasy users (n = 351) were asked if they had tested their ecstasy in the past year. We estimated prevalence and correlates of having tested one's ecstasy. Results: 23.1% reported having tested their ecstasy in the past year. Those with some college (adjusted prevalence ratio [aPR] = 0.49, P = 0.014) or a college degree (aPR = 0.41, P = 0.025) were less likely to test their ecstasy than those with a high school diploma or less. Using ecstasy pills (aPR = 1.89, P = 0.036) or crystals (aPR = 1.90, P = 0.006) ≥3 times in the past year was associated with increased likelihood of testing one's ecstasy, and purchasing from an unknown or untrustworthy dealer was associated with decreased likelihood (aPR = 0.63, P = 0.034) of testing one's ecstasy. Half (51.1%) of ecstasy users reported finding out or suspecting their ecstasy had contained a drug other than MDMA. Of these, 49.2% reported finding out their ecstasy contained methamphetamine or speed/amphetamine. Most ecstasy users reported that they would be less likely to use again upon learning their ecstasy contained ‘bath salts’ (54.8%) or methamphetamine (54.3%). Discussion and Conclusions: Drug testing appears to help ecstasy users detect adulterants and results can help inform harm reduction efforts. Less frequent users in particular may require education about adulteration and drug-testing.

Introduction and Aims: Polysubstance users are a high-risk population for negative health-related consequences. Although some studies have described harm reduction strategies adopted by polysubstance users, studies have not examined their effectiveness in minimising health-related consequences. We aimed to identify dosing-related harm reduction strategies in a sample of polysubstance-using dance festival attendees, and explore the relationship between harm reduction strategies and self-reported adverse health consequences. Design and Methods: Data were examined for 1226 past-year dance festival attendees who self-identified as past-year multiple drug users. We conducted bivariable and multivariable analyses to explore relationships between six dosing-related harm reduction strategies and 13 self-reported adverse consequences. Results: Self-reported use of dosing-related harm reduction strategies was prevalent, mainly avoidance of mixing depressants (69.2%) and setting limits on quantity (62.2%). Frequent users of harm reduction strategies reported experiencing fewer adverse health consequences (P values < 0.05). Those who reportedly set limits on quantity were at decreased odds of experiencing a bad mood after drug use, sexual difficulties while under drug influence, injuries or fractures while under drug influence, and involvement in fights or being attacked while under drug influence (P values < 0.05). Moreover, those who report frequently avoid mixing depressants were at decreased odds of experiencing headache, loss of consciousness, drop in blood pressure, injuries of fractures, and fights or attacks (P values < 0.05). Discussion and Conclusions: Adoption of dosing-related harm reduction strategies appears to be associated with less drug-related harm among polysubstance-using festival attendees. Findings may inform organisations and policymakers in the designing of harm reduction interventions with this population.

OBJECTIVES: In this study, we examined the prevalence and correlates of current synthetic cannabinoid (SC) use among high school seniors in the United States. METHODS: Monitoring the Future, an annual nationally representative survey of high school seniors, began querying current (30-day) SC use in 2014. Data were examined from the 2 most recent cohorts (2014-2015; N = 7805). Prevalence of self-reported use was examined and differences in demographics and recency and frequency of other drug use was compared between current marijuana-only users and current SC (plus marijuana) users using X2 and generalized linear model using Poisson. RESULTS: We found that 2.9% of students reported current SC use; 1.4% of students (49.7% of users) reported using SCs on ≥3 days in the past month. SC users were more likely to report more recent (and often more frequent) use of lysergic acid diethylamide, cocaine, heroin, and/or nonmedical use of opioids compared with marijuana-only users. Compared with current marijuana-only users, SC users were more likely to report lower parent education (P < .05) and current use of a higher number of illegal drugs other than marijuana (Ps < .001). Students using SCs ≥10 times in the past month were more likely to be boys, frequent marijuana users (Ps < .01), African American, and users of multiple other illegal drugs (Ps < .001). CONCLUSIONS: SC use is typically part of a repertoire of polydrug use, and polydrug use is less prevalent among marijuana-only users. Current SC users are at risk for poisoning from use of the newest generation of SCs and from concurrent drug use.

A decline in response rates in traditional household surveys, combined with increased internet coverage and decreased research budgets, has resulted in increased attractiveness of web survey research designs based on purposive and voluntary opt-in sampling strategies. In the study of hidden or stigmatised behaviours, such as cannabis use, web survey methods are increasingly common. However, opt-in web surveys are often heavily criticised due to their lack of sampling frame and unknown representativeness. In this article, we outline the current state of the debate about the relevance of pursuing representativeness, the state of probability sampling methods, and the utility of non-probability, web survey methods especially for accessing hidden or minority populations. Our article has two aims: (1) to present a comprehensive description of the methodology we use at Global Drug Survey (GDS), an annual cross-sectional web survey and (2) to compare the age and sex distributions of cannabis users who voluntarily completed (a) a household survey or (b) a large web-based purposive survey (GDS), across three countries: Australia, the United States, and Switzerland. We find that within each set of country comparisons, the demographic distributions among recent cannabis users are broadly similar, demonstrating that the age and sex distributions of those who volunteer to be surveyed are not vastly different between these non-probability and probability methods. We conclude that opt-in web surveys of hard-to-reach populations are an efficient way of gaining in-depth understanding of stigmatised behaviours and are appropriate, as long as they are not used to estimate drug use prevalence of the general population.

Background and Objectives: Although new psychoactive substances (NPS) continue to emerge at a rapid rate, US national surveys only measure the use of non-specific categories of NPS and are not designed to access high-risk populations. In this paper we report lifetime use of specific NPS (of 58) and examine correlates of use among a high-risk population: nightlife attendees. Methods: The self-selected sample from the Global Drug Survey (2013) consisted of 2,282 respondents in the US, aged 16–60 years, who reported nightclub attendance in the last year. Multivariable logistic regression models determined unique predictors of lifetime use. Results: Lifetime use of a wide range of NPS was reported (any NPS; 46.4%), including synthetic cannabinoids (24.8%), tryptamines (eg, 4-AcO-DMT, 23.0%), psychedelic phenethylamines (eg, 2C-B, 25I-NBOMe; 21.7%), euphoric stimulants (eg, BenzoFury; 16.2%), and synthetic cathinones (eg, methylone; 10.5%). Females (AOR = 0.49 [.41,.60]) and older respondents (age 22–60; AOR =.73 [.59,.89]) were at lower odds of reporting any lifetime NPS use. Frequent nightclub attendance was associated with increased odds of reporting lifetime NPS use overall (eg, weekly compared with less than once a month, AOR = 2.33 [1.70,3.19]), but not specifically with synthetic cannabinoid use. Discussion and Conclusions: Among a self-selected sample of nightclub attendees, a large range of novel substances were reported, and young attendees, males, and those who attended more frequently were at increased odds of reporting use. Scientific Significance: Harm reduction initiatives are needed to reduce risk of harm in this population, where environmental characteristics may augment risks associated with consuming lesser-known psychoactive substances. (Am J Addict 2016;25:400–407).