Comparison of anticipated and detected drug contents in samples submitted to a statewide drug checking program in Maryland, USA.

Abstract

The unregulated drug supply in North America is volatile, with several adulterants emerging following the COVID-19 pandemic. These changes pose significant health risks, including wounds and overdose, to people who use drugs. Understanding discrepancies between perceptions and tested results of drug contents is vital in reducing overdose and other harms associated with the unregulated drug supply. We analyzed data from Maryland's statewide drug checking program, Rapid Analysis of Drugs (RAD), from October 2021 to May 2024 (N = 792). Clients of participating RAD syringe service programs voluntarily provide drug samples and information about samples, including what they intended to buy. Samples were tested at the National Institute of Standards and Technology using DART-MS. We calculated prevalence of drug classes across different categories of what participants indicated they intended to use. Of 792 samples, 22.0 % were concordant. 278 (35.1 %) intended to contain heroin, but only 15 (1.9 %) overall tested positive for heroin. Contrastingly, xylazine appeared in 454 (57.3 %) samples but was only intended in 15 (1.9 %). 192 (24.2 %) samples were positive for cocaine, but some were detected in samples intended to solely contain opioids. Benzodiazepines (n = 13, 1.6 %) were detected in samples intended to solely contain opioids or stimulants. Discrepancies between substances participants intended to use and drug checking results demonstrate significant risks and unpredictability across Maryland's unregulated drug supply. Harm reduction efforts should be inclusive across drug classes, increase awareness of adulterants, and advocate for safer supply and overdose prevention sites.