Urinalysis and self-reporting allow us to monitor drugs on the illegal market for the substances they contain and compare this to what people who use those drugs expect them to contain. The research section summarizes a project currently being done on drug content monitoring using urinalysis and self-reporting in Canada.
The Community Urinalysis and Self-Report Project (CUSP) is developing a standardized national system for monitoring the content of illegal drugs. This system was originally developed by the B.C. Centre for Disease Control (BCCDC) and Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Ile-de-Montréal (CCSMTL). It was developed with feedback from individuals who use drugs. CCSA is collaborating with BCDCC and CCSMTL to expand this system to a national scale.
The system, as developed by BCCDS and CCSMTL, uses urine screening to determine the contents of drugs taken. Testing of actual illegal drugs is one potential route of learning their contents, but comes with legal, ethical and practical barriers. Using urine samples has the following advantages:
- It avoids issues around storing and transporting illegal substances.
- It does not require that participants sacrifice some drugs for testing.
- It avoids exposing testers to violence associated with the drug trade when buying products for testing.
- It is more reflective of the street-level products available than testing of products seized by police.
- It is a comprehensive strategy that can rely on laboratory systems for testing.
The system also includes a survey that participants complete when they submit their urine for testing, indicating what drugs they think they took.
Advantages of using a survey include:
- The survey data when compared with the urine screening results allow for comparison of what substances people think they are consuming with what they are actually consuming.
- It captures the preferences and needs of people who use drugs.
- The survey can be adapted to include questions about emerging local or national issues.
The project will lead to local reporting and national-level comparisons and publications outlining the findings of drug-use trends and emerging issues. The long-term goal for the project is that people who use drugs can receive better harm reduction and health services based on the data the project collects.
CCSA is working with project partners to implement the Community Urinalysis and Self-Report Project system at multiple sites across Canada, using a multi-phase approach. This project is funded by a grant from Health Canada’s Substance Use and Addictions Program under the project name, “Developing National Surveillance of Illicit Drug Content.”
Phase 1 (2018–2019)
Developed and implemented a pilot system that combines a survey with urine drug testing.
- Built a system based on previous work in B.C. and Montreal, including an annual B.C. Harm Reduction Client Survey (2012–2015) and a fentanyl urine screening study (2015), and a Montreal drug-testing project (2017).
- Three sites tested the pilot system:
- British Columbia (summer 2018, 486 participants)
- Montreal (summer 2018, 343 participants)
- Edmonton (March 2019, 49 participants)
- Results were presented at CCSA’s Issues of Substance conference (November 2019), in a presentation called, Towards a Cross-Canada Surveillance of Illicit Drug Content. For a copy of the slides, please contact email@example.com.
Phase 2 (2019–2020)
Expanding the surveillance system and begin implementing it on a national level. Key steps in the process include:
- Additional data collection: Survey and urine testing completed by 400 participants across 10 sites in Montreal in September 2019, and approximately 750 participants across 25 sites in British Columbia in fall 2019.
- In collaboration with B.C., Montreal and Edmonton study teams, CCSA developed materials in English and French to facilitate implementation at additional locations:
- Standardized long- and short-form surveys
- Technical specifications for standardized urine drug testing
- A project manual
- Ethics review board materials
- A template spreadsheet for inputting and analyzing data
- Suggested template for local reports
- CCSA is centrally coordinating new sites, including four new sites for 2020 (see Partners and Collaboration page):
- Manitoba Harm Reduction Network (including five sub-sites across Manitoba)
- Eastern Health (including two sites in Newfoundland)
- Nova Scotia Health and Direction180, Nova Scotia
- Centre intégré de santé et de services sociaux (CISSS) de Laval
- Project implementation materials are available to interested sites by request to firstname.lastname@example.org.
- Local and project-wide surveillance reports will present the findings in a practical format.
Phase 3 (2020–2021)
Continue to expand the project on a national level by repeating steps from Phase 2 in the four sites that joined for 2020 and recruiting two to three additional sites.