Charlie Summers (they/them) is a medical anthropologist and researcher at the Opioid Policy Research Collaborative at Brandeis University.

Background: Like many U.S. cities, Boston struggles with housing instability and an overdose crisis, recently implementing harm reduction housing (HRH) sites as a response. While other harm reduction resources are available to residents, drug checking services are noticeably absent. 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 changes such as encampment clearings. Real-time drug checking services have been implemented successfully at music festivals, but few studies have explored their application in housing programs.

Methods : Starting December 2023, we implemented real-time drug checking at four HRH sites. Residents were asked to provide 5mg of their substance or residue from used materials to receive immediate test results for xylazine and other contaminants. Samples were logged into the web-based collection platform StreetCheck, then mailed to laboratories for confirmatory testing. On-site boards posted anonymized results. Drug sample results and 104 resident surveys about the service were analyzed using descriptive and bivariate statistics. Transcribed interviews with 28 residents were coded thematically and researchers transcribed field notes at each site.

Results: Resident engagement with drug checking services was considerable, with 56 samples collected across 9 visits over 3 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 coupled with access to other harm reduction supplies and services, and a consensus vocalized safety 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, providing information to people who use drugs about the contents of their supply, and can complement transitional housing interventions.