Drug Checking Policies – Safe Supply and Drug Checking

Not every municipality currently offers drug checking services to residents. Drug checking programs operated in Canada have not been federally standardized, creating some variation between programs across the country. Two drug checking services offered in Canada, and the procedures and policies surrounding these operations, are outlined below; Toronto and Vancouver.

TORONTO

Toronto Drug Checking services were launched in October of 2019. This service is free, anonymous, and available to anyone. Currently, there are five different harm reduction facilities within Toronto where drug checking samples can be collected and supervised consumption services are available. These services are offered at the following locations:

Types of Samples Collected

~ 10 mg powders

~ 10 mg pills

~ 10 mg liquids

~ 10 mg blotters

leftover syringe liquids

used cookers/filters

Receiving Results

Once a sample is collected it is transported from the harm reduction facility to laboratories at either St. Michael Hospital or the Centre for Addiction and Mental Health.

All samples collected through Toronto Drug Checking services are analyzed using gas and/or liquid mass spectrometry detectors.

Results are made available to clients within two business days, either via phone or in person by the staff at harm reduction facilities.

VANCOUVER

Vancouver also offers anonymous drug checking services to its residents. Every overdose and supervised consumption site in Vancouver offers drug checking collection services. In addition to this, Vancouver Coastal Health also promotes the use of mail in drug checking through www.getyourgrugstested.com.

Fentanyl Test Strips

Unique to Vancouver, clients can access on-site Fentanyl testing strips at all overdose prevention and supervised consumption sites in the city. These test strips can also be obtained at various community health centres.

Each strip comes with an instructional sticker similar to the image below:

Fentanyl test strips, testing non-injected drugs. It is recommended to test everything you intend to consume. It is not recommended to test only the residue inside the baggie. 1. Place all of the drug you intend to consume into a small glass. 2. Add water. Testing methamphetamine: add 1 teaspoon of water (5 ml) for each 10 mg of crystal or powder. Testing cocaine, MDMA or any other drug: add 2 teaspoon of water (10 ml) for each 100mg of powder. 3. Stir the contents until thoroughly dissolved. 4. Hold blue end of the strip, and insert other end into the liquid for 15 seconds, no higher than the blue line. 5. Set the strip down on a flat surface. Wait 2 minutes to interpret the results.
Testing injected drugs: 1. Prepare shot, and set the needle aside. Wait to inject. 2. Add 1 ml (1/4 of a teaspoon) of clean water into the spoon or cooker. 3. Hold blue end of the strip,, and insert other end into the liquid for 15 seconds, no higher than the blue line. 4. Set the strip down on a flat surface. Wait 2 minutes to interpret the results. Interpreting the results: One red line towards the top end is a POSITIVE result (fentanyl detected). Two red lines is a NEGATIVE result (fentanyl not detected). One red line towards the bottom end OR no red lines is an INVALID result. Developed by: Deval Mehta, PharmD Candidate, Reviewed by: Michael Beazely, BScPhm, PhD. University of Waterloo, Faculty of Science, School of Pharmacy. "

Fourier-Transform Infrared Spectrometer (FTIR)

Vancouver was the first Canadian city to use FTIR as a drug checking analytical methodology.

FTIR is a portable drug checking machine that provides greater access to drug checking services than standard spectrometry checking methods.

Compounds FTIR can test:

– opioids (such as heroin)

– stimulants (such as cocaine)

– psychoactives (such as MDMA)

Another benefit of FTIR is the ability for the machine to test for multiple compounds at once, run contrast to fentanyl strips that only test for one compound (fentanyl).

Using FTIR allows clients to receive results within minutes.

Safe Injection Site Policies

An infographic saying "Saving lives. Changing lives. What influence has TOPS had on people who use the site? Provides a safe, clean & secure space. Clients are less worried of... overdosing, other people taking their drugs, getting caught using in public or in shelters. 'The staff just have big hearts. Even when I see them outside they help me. They are like a friend in my pocket!' [Data Source: Client Interview]. Staff are... warm, friendly, caring, non-judgmental, knowledgeable, skilled at de-escalation. Improves safer drug use practices. 74% of clients agreed that they have learned tips at the site to use drugs more safely. Increased knowledge of how to use drugs more safely. 72% of clients indicated that they are reusing gear less often since using the site. Increased access to free, clean gear. Reduced illness. 76% of clients reported injecting less in public spaces since using the site. Less public drug use and discarded gear. Builds relationships & connections. 95% of clients feel accepted at the site. Having someone trusted to talk to and who listens. Increased feelings of acceptance. Increased feelings of being valued and cared for. Increased sense of community and belonging. Not feeling judged, not feeling stigmatized. "I feel that I belong somewhere... I do not feel like an outcast. I walk in here and it's a family. For once in my life. I feel like I belong." [Data Source: Client Survey]. Having someone to talk to and who listens, increased feelings of acceptance, increased feelings of being valued and cared for, increased sense of community and belonging. Not feeling judged or stigmatized. TOPS Evaluation conducted Summer of 2018. Customer Satisfaction Surveys (n = 105), Client Interviews (n = 26), TOPS Staff/Lead (n = 17), Stakeholders (n = 9). For more information: health@mlhu.on.ca
Burreau De Sante De, Middlesex-London Health Unit, www.healthunit.com — Temporary Injection Site Ontario.

Supervised injection services are a type of health service that provides a safe and hygienic environment for individuals to inject drugs under supervision of trained professionals. These sites are exempt under Section 56 of the Controlled Drug and Substances Act (CDSA), so people seeking these services do not have to worry about prosecution from the law.

Individuals are first assessed by staff to make sure they are eligible for this program. Once they are found eligible, there are precautionary measures taken:

Person who already has drugs in their possession are assessed by the nurse and then taken into a separate room before administration of the drug.
Staff will check for any alterations in the drug that can effect the strength.
Client is given clean needle and will self administer the drug.
Following administration, they are moved to a waiting room and monitored for any adverse reactions.

Individuals who use this service are also provided with more than just sterile injection supplies. These services also must provide:

Education on safe injecting
Prevention services
Overdose intervention
Referrals to drug treatment and rehabilitation
Mental health and health services
House services
Needle exchange

An infographic that says "Safe injection sites. What are the benefits? With 39 sites currently in operation across Canada and around 3000 unique visits each day, safe injection sites are proven to provide a range of benefits at three levels:
1. Benefits to the individual. More likely to pursue avenues of rehabilitation or detoxification. Receive destigmatized and judgement-free medical care. Access to housing, counselling and employment services. Safety and stability provided leads to decreased risk-taking and criminality.
2. Benefits to the Community. Reduced public drug usage. Reduced publicly discarded drug-taking paraphernalia. Reduced spread of infectious diseases like HIV and Hepatitis C.
3. Benefits to Healthcare. Reduced strain on hospitals and clinics, making them better equipped to handle other emergencies. Specially trained medical staff at safe injection sites provide higher quality of care to individuals in need. Preventatively funding safe injection sites is more cost-effective than funding hospitals during a drug crisis. For more information, please visit wgdrugstrategy.ca" — Sourced from: University of Guelph, Medical Toxicology Students, 2020

British Colombia Ministry of Mental Health and Addictions. (2018). Services in Response to Overdose. Retrieved from: https://www.stopoverdose.gov.bc.ca/theweekly/overdose-prevention-sites-supervised-consumption-services-drug-checking

Centre on Drug Policy Evaluation. (2020). Toronto’s Drug Checking Service. Retrieved from: https://cdpe.org/project/drug-checking-services/

Gems-Inclusions. (2020). FTIR Spectroscopy. Retrieved from: https://www.gems-inclusions.com/inclusions-studies/analytical-methods/ftir-spectroscopy/

Supervised Injection Services. (2020). City of Toronto. Retrieved: https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/supervised-injection-services/

Temporary Overdose Prevention Site (TOPS). (2019). The Middlesex-London Health Unit. Retrieved: https://www.healthunit.com/temporary-overdose-prevention-site

Vancouver Coastal Health. (2020). Drug Checking. Retrieved from: http://www.vch.ca/public-health/harm-reduction/overdose-prevention-response/drug-checking