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Dasgupta N, Figgatt MC. 
“Drug Checking for Novel Insights into the Unregulated Drug Supply”. 
Am J Epidemiol. 2021 Aug 17.
Abstract
Tobias et al. (Am J Epidemiol. XXXX;XXX(XX):XXXX-XXXX) present a novel analysis of time trends in fentanyl concentrations in the unregulated drug supply in British Columbia, Canada. The pre-existing knowledge about unregulated drugs had previously come from law enforcement seizures and post-mortem toxicology. As both of these data sources are subject to selection bias, large scale drug checking programs are poised to be a crucial component of the public health response to the unrelenting increase in overdose in North America. As programs expand, we offer two guiding principles. First, the primary purpose of these programs is to deliver timely results to people who use drugs to mitigate health risks. Second, innovation is needed to go beyond criminal justice paradigms in laboratory analysis for a more nuanced understanding of health concerns. We provide examples of the role adulterants play in our understanding of drug harms. We also describe the applications and limitations of common laboratory assays, with implications for epidemiologic surveillance. While the research and direct service teams in British Columbia have taken groundbreaking steps, there is still a need to establish best practices for communicating results to sample donors in an approachable yet non-alarmist tone.
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