How to monitor the illicit drug supply is an evolving science. New tools and technologies are emerging all the time, but these products are usually developed in labs, often tested by marketing teams, and rarely tried on “real-world” drug samples for validity and feasibility testing, let alone handled or reviewed by people who use drugs and programs supporting their health and wellness.

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In the New England region, there is a strong network of community drug checking programs. These programs are supported by state initiatives, community groups, and foundation funding. We brought together  this network of sites–united by a common data collection platform, trained similarly and already gathering regularly in learning collaboratives–to serve as a laboratory for testing out drug-related innovations, tools, and technologies.

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We're working with drug checking sites in four New England states (Massachusetts, Rhode Island, Connecticut, and Vermont) to test new technologies and methods as part of the Network 1 collaboration. The sites will work together, share resources, and help shape the study, ensuring everyone has a say in how things are done. The Network 1 sites all use StreetCheck and host on-site Bruker FTIR, test strip and related technologies. 

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Formed and piloted in 2023 and launched in 2024, Network 1 has considered several protocols to advance the science and practice of drug checking:

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Motivating Project: BTNX XTS Pilot Study

• Who: 10 community drug checking partners across New England 

• Aim: Test the sensitivity, specificity and usefulness of xylazine test strips for the detection of xylazine in the drug supply

• Why: Xylazine is increasing found in the drug supply in the Northeast but there are no test strips that have been used on actual community samples in the New England drug supply to see if they are valid and useful here.

• Findings:  Currently available xylazine test strips are specific (low false positive) but not sensitive (high false negative) and have too high of a level of detection to find the xylazine that is circulating in the New England drug supply. The amount of drug needed to test a sample to detect xylazine is substantially higher than what is needed for fentanyl test strips, which complicates training and distribution of test strips in the community.  If currently available xylazine test strips are to be used by drug checking program technicians, take care to concentrate the sample or use sufficient sample.  Risk of false negative (the test missing a true positive xylazine sample) is substantial and distribution of xylazine test strips should not be done without education on testing process (more drug needed to detect), warning on the probability of a negative result, and referrals for wound care and supports should they experience xylazine-suspected wounds. 

• View: Using Xylazine Test Strips for Drug Checking In The New England Region 

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OPUS 9.0 Beta Project

• Who: 10 community drug checking partners across New England

• Aim: To help gather feedback on the newest version of OPUS while in beta to test software and provide feedback to Bruker to improve utility for FTIR drug checking technicians. The primary enhancement being tested in this version was the Autonomous Component Identifier (AID), which is an expansion upon a current feature called Mixture Analysis. 

• Why: New technology and updated features are not always able to be tested with actual community samples or developed specifically with community drug checking in mind. This provided an opportunity to test AID with "real world" samples and provide technician feedback to directly to Bruker. 

• Findings: Based on feedback conveyed to Bruker developers have incorporated notes on the Custom Result Feature to allow the operator to customize the weights of substances that will auto-adjust to add up to 100% for a composite spectrum. There is an option to increase or decrease the weights in small increments (0.1%), similar to the preexisting Manual Subtraction feature in regular OPUS. In the real-world sample scans we asked the technicians to review as part of this beta testing, it was reported that AID struggled to detect low lying components such as xylazine. These scans were shared with developers so the algorithm could be improved to detect xylazine in a low concentration. Feedback was heard in where seeing results for mixture samples reporting 6 or more substances can be confusing and misleading. This note was taken under consideration and now limits the composite spectra provided immediately to be limited to 5 or fewer component spectra.

• View: OPUS 9.0 for Drug Checking Feedback Report

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Multi-Lab Analysis Project

• Who: 10 lab partners from across U.S. who have been or are preparing to provide secondary testing for community-based drug checking using GC-MS, LC-QTOF-MS and other instruments.

• Aim: Each enrolled lab is sent the same series of 10 drug samples that are theoretically comparable in composition (approx. 10mg each).  Each lab will conduct the maximum level testing according to their regular procedures and report the results to the Network 1 team. The team will then conduct analysis on results between labs to determine their levels of comparability. These results will be used to promote discussion between labs for quality improvement and standardization purposes.

• Why: To assess the comparability of various toxicology labs that analyze unknown drug samples.  The labs will compare results across different testing methodologies to have more uniform testing results for participants and programs. 

• Findings: ​​​​​Laboratories involved in secondary testing for community-based drug checking consistently reported the same Major/Primary components, with newer labs just starting in this field showing the most variation. When examining dope, heroin, and fentanyl samples, the trace-level components can differ significantly. This variation is influenced by challenges and limitations like imperfect subsampling methods and differences in the technology ionization types and analysis methods used. Overall, there isn't a single best instrument or method for drug checking — it's a complex process. The constantly changing drug supply and the need for labs to tailor their sample preparation and analysis methods add to the difficulty. Collaboration between laboratories is crucial, and more research is needed to refine these practices. Future efforts could include another round of multi-laboratory analysis, potentially expanding to include international labs, to improve and standardize the process.   

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Wet Sample Project

• Who: 7 community drug checking partners across New England 

• Aim: To develop best practices to prepare wet samples for FTIR point-of-care testing and for laboratory analysis 

• Why: To expand the range of services provided by drug checking and improve work up procedures for different samples. Through this, there is potential to engage certain groups of people who use drugs who may not otherwise have been engaging in drug checking services. 

• Findings: Project is ongoing, findings to come! 

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Future Project Ideas: 

• We are taking suggestions! 

• Have an idea for a protocol for us to test out?

• What do you want to know about drug checking and the tools for drug checking?

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