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Operational Technician Manual Authors Drug Checking Operational Technician Manual Authors Karen McCrae, MA Project Manager, Implementation & Partnerships, British Columbia Centre on Substance Use Samuel Tobias, MSc Senior Drug Checking Operational Technician, British Columbia Centre on Substance Use Chelsea Stunden, MPH Project Coordinator, Drug Checking, British Columbia Centre on Substance Use Acknowledgements The authors would like to thank Josey Ross, Emily Wagner, Jill Fikowski, Jaime Arredondo, Jeremy Kalicum, Nicole Esligar, Kenneth Tupper, Ian Garber, The Loop, and Bruker Ltd. for research, writing, and editorial support. This report was made possible through funding from Health Canada’s Substance Use and Addictions Program Version 1, March 2019 PAGE 2 · Drug Checking | Operational Technician Manual Table of Contents 1.0 GLOSSARY OF ACRONYMS AND OTHER FREQUENTLY USED TERMS ...................................... 4 2.0 INTRODUCTION ..................................................................................................................................... 5 2.1 About the BCCSU ...............................................................................................................................5 2.2 About Drug Checking .........................................................................................................................5 2.3 History of Drug Checking in British Columbia ........................................................................................6 2.4 About this Manual .............................................................................................................................7 3.0 PRIMARY DRUG CHECKING TECHNOLOGIES .................................................................................. 8 3.1 Fourier Transform Infrared Spectroscopy .............................................................................................8 3.2 Fentanyl Test Strips ............................................................................................................................8 4.0 DRUG CHECKING PROTOCOL ............................................................................................................ 11 4.1 General Site Setup ........................................................................................................................... 11 4.2 Drug Checking at Supervised Consumption and Overdose Prevention Sites ............................................ 11 4.2.1 Supplies and Equipment Checklist ....................................................................................... 11 4.2.2 Drug Checking Procedure ................................................................................................... 12 4.3 Drug Checking at Festivals and Events ................................................................................................ 17 4.4 Procedures Following Drug Checks .................................................................................................... 19 4.5 Safe Substance Handling and Disposal ............................................................................................... 20 5.0 PROCEDURES FOR OPERATING DRUG CHECKING TECHNOLOGIES ........................................ 21 5.1 Fourier Transform Infrared (FTIR) Spectrometer .................................................................................. 21 5.1.1 FTIR Spectrometer Setup and Storage .................................................................................. 21 5.1.2 FTIR Spectrometer Drug Checking Procedure ........................................................................ 25 5.1.3 Measuring Spectra with the OPUS Software ......................................................................... 26 5.1.4 Performing a Spectrum Search ............................................................................................ 30 5.1.5 Troubleshooting: How to Recover a Spectrum After Saving a Subtraction ................................33 5.1.6 How to export the spectrum files for sharing and safe data storage ........................................ 35 5.1.7 FTIR support information ................................................................................................... 37 5.2 Fentanyl Test Strips Procedure .......................................................................................................... 37 5.3 Benzodiazepine Test Strip Procedure ................................................................................................. 39 5.4 LSD Immunoassay and Ehrlich Reagent Test Procedure ........................................................................ 39 5.5 Confirmatory Testing Procedure ........................................................................................................ 40 5.5.1 Sample Confirmatory Testing Protocol ................................................................................. 42 6.0 HARM REDUCTION MESSAGING ..................................................................................................... 43 7.0 GLOSSARY OF ACRONYMS AND OTHER FREQUENTLY USED TERMS ..................................... 45 7.1 Drug Checking Disclaimer ................................................................................................................. 45 7.2 Harm Reduction, Drug Information, and Other Resources .................................................................... 46 7.3 Deterra Pouch Technology ................................................................................................................ 48 7.4 Drug Checking Procedural Posters ..................................................................................................... 49 7.5 Drug Checking Results Slips .............................................................................................................. 51 7.6 Sample Logging Template ................................................................................................................. 53 7.7 Data Reporting Sheet ....................................................................................................................... 54 8.0 REFERENCES ........................................................................................................................................ 55 Drug Checking Program | Operational Technician Manual · PAGE 3 1.0 Glossary of Acronyms and Other Frequently Used Terms Amnesty bin: a disposal bin where visitors can dispose of unwanted drugs ANKORS: AIDS Network Kootenay Outreach and Support Society ATR: attenuated total reflectance BCCSU: British Columbia Centre on Substance Use EDC: electronic data capture FTIR: Fourier transform infrared (spectroscopy) Fentanyl immunoassay strips: also referred to as fentanyl test strip GC-MS: gas chromatography-mass spectrometry LSD: lysergic acid diethylamide, also known as “acid” MDMA: 3,4-methylenedioxymethamphetamine OPS: overdose prevention site OQ: operational qualification PQ: performance qualification PWUD: people who use drugs qNMR: quantitative nuclear magnetic resonance RSC: reference single channel SCS: supervised consumption site SSC: sample single channel SWGDRUG: Scientific Working Group for the Analysis of Seized Drugs PAGE 4 · Drug Checking | Operational Technician Manual 2.0 Introduction 2.1 About the BCCSU The British Columbia Centre on Substance Use (BCCSU) is a provincially networked organization with a mandate to develop, implement, and evaluate evidence-based approaches to substance use and addiction. The BCCSU’s vision is to transform substance use policies and care in British Columbia by translating research into education and evidence-based care guidance. By supporting the collaborative development of policies, guidelines and standards, the BCCSU seeks to improve the integration of best practices and care across the continuum of substance use, thereby serving all British Columbians. The BCCSU seeks to achieve these goals through the integrated activities of its three core functions: Research —Leading an innovative multidisciplinary program of research, monitoring, evaluation and quality improvement activities to guide health system improvements in the area of substance use. Education and Training—Strengthening addiction medicine education activities across disciplines, academic institutions and health authorities, and training the next generation of interdisciplinary leaders in addiction medicine. Clinical Care Guidance—Developing and helping implement evidence-based clinical practice guidelines, treatment pathways and other practice support documents. 2.2 About Drug Checking British Columbia (BC) is in the midst of the most serious drug overdose crisis in its history. In 2017 alone, 1,487 individuals died of an illicit drug overdose (nearly as many as the previous two years combined).1 The overdose crisis is largely attributable to the emergence of highly potent, illegally manufactured synthetic opioids, which has created a toxic illegal drug supply.2 In 2017, fentanyl was detected in 84% of all illicit drug overdose deaths, up from 4% five years earlier, in 2012.1 This influx of highly toxic substances into the illegal drug supply necessitates the incorporation of all possible harm reduction measures into a comprehensive, multi-sectoral strategy to prevent overdose deaths.2 Drug Checking Program | Operational Technician Manual · PAGE 5 Drug checking is a harm reduction service that allows individuals to anonymously submit drug samples for analysis and to receive individualized and fact-based consultation
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