Danielle Nestadt is a social and behavioral scientist whose research focuses on social/structural determinants of health among marginalized populations, particularly women who exchange sex and people who use drugs. Danielle is also the Program Director for Check It, a mobile harm reduction, drug checking, and HIV-prevention intervention in Baltimore.

The proliferation of adulterants and cutting agents in the illicit drug supply in the United States has contributed to a range of harms, including overdose, wounds, and other morbidities. Due to the opacity of the drug supply, people who use drugs (PWUD) often do not know what they are consuming, creating unintended volatility in individual-level drug use. Drug checking is a harm reduction tool designed to empower PWUD by allowing testing of drugs prior to consumption. We report on findings comparing what samples were sold as versus what they were found to contain during the first six months of implementation of a point-of-care drug checking program in Baltimore, Maryland, US.

Check It is a van-based mobile, integrated overdose- and HIV-prevention intervention that provides point-of-care drug checking with a Fourier Transform Infrared spectrometer (FTIR), alongside wound care, infectious disease testing, and HIV pre-exposure prophylaxis (PrEP) provision. A trained drug checking technician analyzes participant-provided drug samples using the FTIR and provides results about sample contents, as well as tailored harm reduction counseling.

Between February and August 2024, 104 samples were tested with Check It’s FTIR. 50% (n=52) were reportedly sold as an illicit opioid, primarily heroin (n=49). Among illicit opioid samples, 6% (n=3) contained heroin, 94% (n=49) contained fentanyl, 60% (n=31) contained xylazine, 8% (n=4) contained cocaine, and 98% (n=51) contained fillers/bulking agents, primarily mannitol and quinine. Two-thirds of samples that contained fentanyl also contained xylazine. Two samples reportedly sold as xylazine contained neither xylazine nor fentanyl. An average of 4 compounds were detected in each illicit opioid sample.

We have found significant discordance between PWUD self-report of drug contents and actual contents. Advanced point-of-care drug checking and associated harm reduction counseling can fill a critical knowledge gap, allowing PWUD to make informed decisions about their drug use and health behaviors.