Tracking a changing drug supply

Understanding the local drug supply can help public health professionals respond to emerging risks. A pilot drug checking program in Cuyahoga County is providing valuable insight, with researchers at the Begun Center for Violence Prevention Research and Education at Case Western Reserve University’s Jack, Joseph and Morton Mandel School of Applied Social Sciences helping evaluate the program and its data.

Funded through a CDC OD2A-LOCAL grant awarded to the Cuyahoga County Board of Health (CCBH) in 2023, the program provides a closer look at what substances are present in the local drug supply and how those findings compare with what people expect to be present.

“The goals of this program are to understand the local drug supply, including emerging drugs and inform local surveillance in near-real time,” said Vaishali S. Deo, MD (MED ’19), a research associate at the Begun Center. “We also want to understand the gap between drug users’ expectations and perceptions versus what was found in their paraphernalia. This information is very important and helpful in designing local interventions and creating awareness among users.”

Evaluating results

The program initially collected used syringes from clients at The Centers and MetroHealth System’s Syringe Service Programs. It has since expanded to include other drug paraphernalia, including pipes and cookers. About 20 samples are tested weekly at the Cuyahoga County Medical Examiner’s Office to identify drugs, drug residues and adulterants.

Before a sample is tested, participants are asked what substances they expect to be present. Results are then shared with participants and syringe service program sites, while aggregate findings are made available through a public dashboard.

The Begun Center serves as a data analysis and evaluation partner, collaborating with CCBH and the Medical Examiner’s Office. One notable finding is the gap between what people expect to be in their drugs and what is actually there. Samples frequently contain adulterants alongside major drugs such as fentanyl, heroin and cocaine—information that can be surprising to participants.

The data has also shown that substances such as medetomidine, which may not appear as frequently among the major drugs involved in fatal overdoses, are also showing up regularly in drug checking results.

These findings can help public health professionals develop targeted education and overdose prevention efforts. For example, information about medetomidine’s presence in the fentanyl supply can inform educational materials and awareness campaigns, while test strips can help people identify its presence before using a drug product.

“As the drug landscape is constantly changing, such programs are very important to understand emerging trends to design overdose prevention initiatives,” said Deo.

Building a more informed response

The grant-funded program is currently scheduled to continue through 2028. Begun Center researchers have presented their findings at national, state and local conferences and meetings, reaching people who use drugs and their families and friends, public health professionals, treatment providers and other stakeholders. The team also collaborates with other drug checking programs throughout Ohio.

The program is one tool for providing timely information about a rapidly changing drug supply and translating that information into education and prevention strategies. Because the project tests fewer than 5% of the roughly 15,000 syringes collected each week by syringe service programs, its findings may not represent all drug use in Cuyahoga County. Still, the data provides a valuable snapshot of emerging trends that can help inform local public health responses.