Drug quality assessment practices and communication of drug alerts among people who use drugs

•Drug quality information was primarily from a reputable dealer or peer networks.•Most drug users do not discuss drug quality with health service providers.•Participants provided improvements to drug alerts including new language.•Enhanced drug alert communication may mitigate drug adulteration practices.

BackgroundRegional health bodies in British Columbia (BC) issue drug alerts to the public when health risks associated with drug quality are identified, such as increased illicit drug deaths, overdoses or other harms. There is a lack of evidence-based guidelines for producing timely, effective public health alerts to mitigate these harms. This study sought to understand (1) the practices used by people who use drugs (PWUD) to assess the quality of street drugs and reduce harms from adulterants and (2) how drug alerts could be better communicated to PWUD.MethodsGuided by interpretive and descriptive methodology, this study consisted of brief questionnaires and in-depth focus groups with 32 PWUD.ResultsFindings suggest the most effective and trusted information about drug quality was primarily from: (a) trusted, reputable dealers or (b) peer-based social networks. Most PWUD thought information received through health service providers was not timely and did not discuss drug quality with them. A number of concrete guidelines were suggested by participants to improve the effectiveness of drug alert modes and methods of communication in the community, including the use of language on drug alert postings that implies harm, indicates what drug effects to look for, and suggests appropriate responses to overdose, such as the use of naloxone. Participants also emphasized the need to date posters and remove them in a timely manner so as to not desensitize the community to such alerts.ConclusionSince it is difficult to control adulteration practices in an unregulated drug market, this study suggests methods of effectively producing and communicating drug alerts among PWUD to mitigate harms associated with drug use.