From trash to results: shortcomings and benefits of paraphernalia-based drug checking in Finland.

BACKGROUND: Drug checking is a harm reduction intervention that combines the identification of the chemical content of a drug with an information-sharing intervention concerning the risks of drug use. Despite growing evidence of the usefulness of this method, legal obstacles in many countries constrain the implementation of drug checking. The purpose of this Finnish study was to evaluate the usefulness of a paraphernalia-based drug-checking protocol. METHODS: A total of 503 drug paraphernalia samples were submitted between April 2022 and July 2024 to 9 different harm reduction services. The samples were analysed monthly via chromatography‒mass spectrometry, and the visitors had the option to return to discuss the results after laboratory analysis. The questionnaire data were collected both during sample submission and the discussion of the results. Additionally, six thematic paired interviews were conducted with staff who performed drug checking at different service locations. RESULTS: The concordance between the promised and detected contents varied greatly depending on the submitted substance. Over two-thirds of the samples were submitted by visitors who had never used substance use services before. The visitors returned for the laboratory results for only 208 samples. The interviewed staff believed that a long waiting time was the main reason for the low return rate. The staff also identified several advantages. The sample submission as well as the dissemination of the recent results via posters at the service points offered an easy way to approach people and discuss different topics related to drug use, harm reduction, and social and health issues. CONCLUSION: The protocol used was too slow for visitors to make preconsumption decisions. However, this shortcoming was not directly connected to the use of paraphernalia samples instead of actual drug samples, as the protocol could be accelerated with sufficient resources. The use of paraphernalia also caused uncertainties related to presubmission contamination. However, the protocol proved to be beneficial for initiating harm reduction discussions during the submission of the samples and the public dissemination of the results at the service locations, and should be considered as a starting point for drug checking when the use of actual drug samples is not possible.