By Yarelix Estrada, Jeffery Sauer, Leonardo Dominguez, Izza Zaidi, Andrew J. Trinidad, Hannah Helmy, Alex Harocopos

Background: Drug checking is a harm reduction strategy that provides people who use drugs (PWUD) information about the composition of a substance. Drug checking has been identified as a key public health response to the continually evolving overdose crisis.

Methods: The New York City Health Department of Health and Mental Hygiene (DOHMH) partnered with existing syringe programs to launch a drug-checking pilot study. The study offered multiple point-of-care drug-checking technologies including fentanyl test strips (FTS) and Fourier-transformed infrared (FTIR) spectrometry, as well as secondary laboratory testing. Fentanyl positivity in major drug types was assessed for each drug-checking technology.

Results: Between November 2021 and December 2023, a total of N = 397 unique participants and drop-off samples contributed a total of N = 1644 samples for drug checking. The majority of samples were sold as opioids (n = 908), with fewer sold as cocaine (n = 314) and methamphetamine (n = 62). 95.3 % (852/894) of opioid samples produced positive FTS. FTIR and secondary laboratory testing resulted in a similarly high prevalence of fentanyl in opioid samples at 84.7 % (769/908) and 89.3 % (519/581), respectively. We did not observe the unexplained presence of fentanyl in samples sold as cocaine or methamphetamine. Further, we describe instances where discussions between technicians and PWUD provided important context that explained the presence of fentanyl in non-opioid samples.

Conclusion: The majority of opioid samples submitted to DOHMH's drug-checking pilot study contained fentanyl. Comparatively, there was little evidence suggesting fentanyl in samples sold as cocaine and methamphetamine. The drug-checking pilot study's point-of-care service delivery model was effective in providing information to PWUD.

Drug Alcohol Depend 10.1016/j.drugalcdep.2025.112578. Epub 2025 Jan 27, 47 p.

By: Jonathan P. Caulkins, Philippe C. Schicker, H. Brinton Milward & Peter Reuter

Overdose deaths in North America have soared, primarily because of the spread of illegally manufactured fentanyl. This paper uses detailed qualitative and transaction-level data to analyse an early and prominent dark web fentanyl-selling operation. The data record the date, drug, quantity, and selling price for 5,589 transactions comprising 872,659 items sold for a little over $2.8 million through AlphaBay. Findings include that the organisation sustained an impressive sales growth rate of approximately 15% per week, com-pounded. Increasing order sizes by a factor of ten reduced the price per pill by approximately 25% for Oxycodone and 50% for Xanax. Those steep quantity discounts imply large price markups when selling further down the distribution chain. Such high growth rates and price markups suggest that it might be difficult to constrain supply by shutting down individual organisations, since any remain-ing organisations may be able to quickly grow to fill unmet demand.

Glob. Crime 2023