Drug Checking as Strategy for Harm Reduction in Recreational Contests: Evaluation of Two Different Drug Analysis Methodologies

Introduction: Drug checking as a part of drug harm-reduction strategies representsan essential aspect of public health policies. It focuses on rapid identification ofdrugs that individuals intend to use during night events, in order to implement health-protective behaviors. Chemical drug analysis techniques vary considerably, from simplecolorimetric reagents to advanced forensic methods such as gas chromatography/massspectrometry (GC/MS).Materials and Methods: In 2019, drug-check services were offered at some nightevents in Umbria (Central Italy). One hundred and twenty attendees directly deliveredunidentified substances to a harm-reduction worker, who collected a few milligrams ofthe substances on ceramic plates and added a drop of colorimetric reagent. Multiplereagents were used to increase the diagnostic capacity of a substance, which may reactwith a specific drug or a few drugs. Later, a fraction of the samples was analyzed byGC/MS. The concordance of the results obtained using these twomethodologies and theintended behaviors of consumers after being informed of the test result was evaluated.Results: We analyzed 120 samples by colorimetric test: 32 MDMA, 25 ketamine, 10amphetamine, 11 cocaine, 8 heroin, and 4 LSD samples. The results were inconclusivefor 29 samples. The GS/MS analysis confirmed MDMA in 84%, ketamine in 78%,amphetamine in 91%, cocaine in 92%, heroin in 88%, and LSD in 100% of the samples.The results of samples with inconclusive results were as follows: 2, MDMA; 7, ketamine;2, amphetamine; 2, cocaine; 2, heroin; 2, mephedrone; 6, mixes; 1, debris; and 5,adulterants as the main component. Twenty-one of 29 participants reported that theyhad no intention of consuming the unidentified substance.he high percentage of individuals who claimed no intention of consuming the unidentifieddrugs indicates that drug checking is viable as a part of drug harm-reduction strategies.Overall, colorimetric reagents showed a good performance with regard to samples beingunadulterated (LSD) or minimal in quantity, but failed to identify mixtures of substancesand the adulterants present in them. Therefore, the use of more discriminatory on-sitemethods such as Raman or infrared spectrometry is strongly recommended.