Leveraging fourier-transform infrared spectroscopy for community drug checking to bridge clinical care and harm reduction services: case report

Abstract Background The opioid overdose crisis parallels the rise of numerous adulterants in the unregulated drug supply. Harm reduction programs have responded by expanding drug checking services, which chemically analyze street-based drugs. Using a clinical report, we demonstrate the utility of Fourier-transform infrared spectroscopy (FTIR) for engaging people who use drugs in simultaneous, tailored harm reduction and clinical services based on their drug-checking results. Case presentation A woman with a history of fentanyl use (primarily fentanyl via inhalation) was found to be tachycardic during a follow-up visit at an addiction recovery clinic. The patient’s provider suggested she utilize local FTIR drug checking, which revealed that her substance contained a large amount of caffeine, and several other active components. Over the next month, the patient submitted six suspected fentanyl drug samples for testing. The patient shared the information with her partner and ultimately requested different drugs from her supplier. Additionally, FTIR results were communicated with the clinical team at the addiction recovery clinic and incorporated into ongoing discussions around the patient’s treatment plan. Conclusions This case study suggests that low-barrier FTIR drug analysis serves as a valuable tool at the intersection of harm reduction and clinical care. Point-of-care drug checking allows clinicians to engage patients in discussion around etiology of wounds, complications of polysubstance use, and more. By equipping individuals who use drugs with real-time information regarding their substance(s), FTIR restores individual decision-making agency and autonomy. Additionally, drug checking fosters peer knowledge sharing-potentially leading to upstream changes to the unregulated drug supply.