A Realist Synthesis of How Drug Checking Services are Designed and Implemented for People Who Use Drugs.

Author: Wendy Masterton Danilo Falzon Gill Burton Hannah Carver Tessa Parkes Bruce Wallace Joe Schofield Vicki Craik Liz Aston Harry Sumnall Fiona Measham Roz Gittins Liz

Theme: Models of Care Year: 2022

Background: With rising numbers of drug-related deaths in Scotland, exploration of interventions
that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people who
use drugs to submit drug samples for chemical analysis and receive feedback about their sample as
well as harm reduction advice. The use of DCS is often linked to festival and/or nightlife settings, but
research has also shown the potential of DCS as a community-based intervention. However, there is
still limited understanding of the underlying mechanisms and processes within DCS which aid
implementation and subsequent engagement. Without this knowledge, it is impossible to
understand why DCS work or do not work, and how best to develop and deliver them in different
contexts and for different populations. It is unclear, for example, how implementing community based DCS might differ from festival-based DCS and why. To explore this, a realist synthesis was
undertaken to review the international evidence for the delivery and implementation of DCS. There
were 135 sources included in the synthesis comprising of full text articles, project meeting notes,
and conference notes. From the sources, the underlying contexts, mechanisms, and outcomes of
DCS were extracted and refined into macro-, meso-, and micro-level programme theories showing
what works, for whom, why, and in what contexts. The findings of this synthesis are theoretically
novel and hold practical relevance for those involved in the design of DCS with implications for
optimisation, tailoring, and implementing services to reach client groups in different settings. In
particular, identifying how DCS could best be integrated into community-based services may inform
future developments in harm reduction for people who use drugs more regularly and may be at
higher risk of drug-related harm.
Disclosure of Interest Statement: No conflicts of interest.

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