Implementing community drug checking in smaller urban communities: a qualitative study exploring contextual factors to consider.

Background: Impacts of the toxic unregulated drug supply are experienced across all geographic regions in Canada, with high rates of fatal and non-fatal overdoses nation-wide. In British Columbia, rates of overdose fatalities are often higher within smaller urban and rural communities than in larger urban cities. Community drug checking is increasingly explored as a harm reduction intervention; however, these services are typically limited to larger cities. In this study, we explored the contextual factors that service users and implementers consider to be important for context specific drug checking services within smaller communities.

Methods: Data collection involved 39 semi-structured interviews with prospective drug checking service users and service implementers from six harm reduction services in four smaller communities on Vancouver Island, BC. Interviews explored perspectives on the contextual factors that may impact the implementation and accessibility of drug checking services within smaller communities. Through inductive thematic analysis, we developed themes that reflected the overarching contextual factors discussed by participants.

Results: Participants described four overarching contextual factors important for accessing and implementing drug checking in smaller communities: community and political climate; close social groups and personal relationships; resource availability; and geographic profile. While many of the contextual factors are similar to those operating in larger urban contexts, they can manifest differently in smaller communities. For example, lack of anonymity and confidentiality are intensified in small and rural communities where "everybody knows everybody". Geographic distance to service and transportation were identified as barriers, with outreach and transportation to services suggested as potential mitigating strategies.

Conclusion: As community drug checking services are established as a response to the toxic unregulated drug market, factors that support equitable access to services beyond inner-city and urban areas are critical. Factors identified as potential barriers offer targets for service adaptation and tailored implementation to enable greater access. With rural communities experiencing high rates of overdose, implementing drug checking services that are contextually relevant and equity-oriented is critical.