Traci C Green

Background: In recent years, Boston has attempted to increase housing options and reduce overdose risk through the implementation of harm reduction housing (HRH) sites. Despite numerous harm reduction resources available to HRH residents, drug checking services are noticeably absent. Studies suggest that drug checking may influence individuals' intentions to use, sell, or buy drugs, potentially preventing negative experiences associated with unexpected adulterants. Drug checking offers a window into concerning supply shifts, such as the introduction of the veterinary sedative xylazine, and helps monitor disruptions in the supply due to environmental changes, such as encampment clearings. Few studies have explored drug checking’s application in housing programs. The establishment of the Massachusetts Drug Supply Data Stream (MADDS), a statewide community drug checking program, afforded us the opportunity to pilot real-time drug checking at HRH sites.

Methods: We implemented real-time drug checking services at three HRH sites. Residents were asked to provide approximately 5mg of their remnant substance in order to receive immediate test results using FTIR spectroscopy and immunoassay test strips. Samples were logged into the web-based data collection platform StreetCheck, then mailed to partnering laboratories for additional testing. Survey questions about drug checking were administered to 106 HRH residents. Survey responses and testing results were analyzed using descriptive and bivariate statistics. Field notes and longitudinal interviews from a subset of 28 HRH residents were also analyzed to better understand experiences with drug checking.

Results: Resident engagement with drug checking services was considerable, with fifty-five drug samples collected across nine site visits over three months. The services generated an increase in xylazine awareness among residents and provided chances to address concerns about the changing drug market amid heavy policing. Engagement with residents confirmed the need for on-site drug checking alongside other provided harm reduction services, and a consensus vocalized concerns with the local drug supply.

Conclusions: Real-time, on-site drug checking in low-barrier housing programs is a promising harm reduction approach for detecting shifts in the drug supply and can complement transitional housing interventions. Residents engage with these services with the intention of intervening upon personal, community, and market-level norms.