PROJECT SUMMARY This application requests funding for the rigorous scientific evaluation of a provincial drug checking program in a Canadian setting where drug checking is legal. Drug checking—the analysis of illicit drug samples and provision of drug composition information back to people who use drugs (PWUD)—is a highly innovative public health intervention that can equip PWUD with crucial information and potentially contribute to life-saving behavior change. This is particularly relevant in light of the most serious drug overdose crisis in North American history. Evidence indicates that fentanyl and fentanyl analogues are increasingly found as adulterants in the street opioid supply across much of the continent, and may also be found in the stimulant and psychedelic street drug supply. While various drug checking technologies have been used in some European jurisdictions to reduce the risks of using illicit recreational drugs (e.g., MDMA, ecstasy) in the electronic dance music scene, drug checking of other street drugs is still nascent in North America and remains largely illegal in the U.S. In the Canadian province of British Columbia, governments at all levels have supported drug checking programs as part of their opioid overdose emergency response and have invested in technology and operational funding for drug checking services, including both rapid point-of-care and laboratory-based confirmatory testing. This represents a significant opportunity to study this intervention and its impacts on opioid overdose risk. Accordingly, this application seeks to fund a rigorous scientific evaluation that aims to evaluate and describe the rate and patterns of uptake of point-of-care drug checking technologies by various drug market actors (e.g., opioid users, stimulant users, drug dealers). It further aims to behavioral impacts and overdose risk reduction practices (e.g., using less) associated with receipt of quantitative and qualitative drug checking results among different drug market actors. Lastly, it aims to examine the impact of drug checking service utilization on non-fatal and fatal overdose events. This highly innovative and significant program of research involves the use of three complementary sources of data: 1) baseline questionnaire data, which captures information on demographics, drug use patterns and behaviors, and social-structural and environmental exposures; 2) longitudinal data on street drug contents using point-of-care and established laboratory techniques as well as data on intended behaviors following receipt of drug checking results; and 3) detailed longitudinal administrative public health data available on overdose outcomes through Canada’s universal health care system. Collectively, these data will be confidentially linked and used to evaluate how such information can be integrated into addiction treatment and substance use focused public health programming. Investigating innovative solutions to the opioid crisis is perfectly aligned with NIDA’s plans to highlight research on synthetic psychoactive drugs, as well as with the broad behavioral intervention goals identified by NIH’s HEAL and Opioid Initiatives, which include research dedicated to preventing and reversing overdoses.

PROJECT NARRATIVE The emergence of toxic fentanyl analogues in the street drug supply across much of North America is contributing to the most severe overdose crisis in North American history. Drug checking is a highly innovative and promising public health intervention that provides quantitative and qualitative information from chemical analyses of street drug samples back to people who use drugs and which has the potential to positively contribute to improved health outcomes. This application seeks to take advantage of the unique legal and policy landscape in the Canadian province of British Columbia to rigorously: 1) evaluate rates and characteristics that shape use of drug checking services; 2) assess changes in overdose risk behaviors following results of a drug check; and 3) examine how this information could be used to predict overdoses from a province-wide registry.