The Role of Drug Checking in Reducing Overdoses and Saving Lives

Between November 2021 and August 2022, the National Institute of Standards and Technology tested nearly 500 deidentified drug paraphernalia samples collected from eight syringe services programs across Maryland. For almost half of these samples, participants also completed a questionnaire about the substances they had intended to purchase. Among the 212 participants who sought to buy an opioid, 87.7% brought in samples that contained fentanyl, fentanyl analogs, or both, while 85.8% contained xylazine.

These findings underscore a major challenge: the unpredictability of other substances unknowingly entering the illicit drug supply. The increasing presence of fentanyl, xylazine, and other additives puts lives at risk. It also presents significant challenges for community organizations, harm reduction providers, and policymakers striving to implement effective interventions.

Recognizing the urgent need for accessible, real-time drug composition data, Danielle Friedman Nestadt, assistant scientist in the Department of Health, Behavior and Society, and Susan G. Sherman, Bloomberg Professor of American Health in the same department, partnered with the Sex Workers Promoting Action, Risk Reduction, and Community Mobilization (SPARC) Center to launch Check It—Maryland’s first point-of-care advanced drug checking intervention. With support from the National Institute on Drug Abuse, the Maryland Department of Health, and the Bloomberg American Health Initiative, Check It is attempting to change the landscape of overdose prevention in Baltimore.

Operating in five Baltimore neighborhoods with high overdose rates, Check It is a mobile, van-based intervention designed to provide rapid drug testing and harm reduction support. Individuals bring a small sample of the substance they want to be tested and, within 20 minutes, receive results about the psychoactive substances and contaminants it contains, along with tailored harm reduction guidance. This empowers them to make informed choices about their drug use, including precautions to avoid overdose.

The impact of Check It extends beyond those who use drugs. Using shared data about local drug samples tested by the program, harm reduction providers and policymakers can gain real-time insights into the evolving local drug supply. These data allow them to anticipate spikes in overdoses and adapt their responses accordingly. Furthermore, researchers working with Check It have deepened their understanding of how best to communicate life-saving information to people who use drugs – as well as how to connect them to key services such as treatment.

As Baltimore and cities nationwide continue to grapple with the ever-changing crisis programs like Check It reflect the need for an innovative response.