Urinalysis and Self-Reporting

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 process involves analyzing urine samples for metabolites of substances after people consume them and compare these with information from a survey that asks what people intended to consume. Compared to drug checking, this process avoids storing and transporting illegal substances for testing and does not require that participants sacrifice drug samples for testing.

CCSA coordinates the Community Urinalysis and Self-Report Project (CUSP), which collects anonymous surveys of recent drug use from people accessing harm reduction services and compares them with urine toxicology results. The survey also includes questions about drug use patterns and needs that can inform local services and supports.

As part of CCSA’s continuing efforts, CUSP is collaborating with project partners to develop guidelines, tools and templates that make implementing urinalysis and self-reporting easy for harm reduction sites and that standardize data collection and reporting across sites. Please contact us if you are interested in implementing this “research project in a box” (see Participation tab). Our goal is to build the capacity of harm reduction sites across Canada to generate information useful for local service delivery as well as for monitoring national substance use trends.

Project Overview and History

The standardized system used by the Community Urinalysis and Self-Report Project (CUSP) for monitoring the content of illegal drugs was originally developed by the B.C. Centre for Disease Control (BCCDC) and the 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 now collaborating with BCDCC and CCSMTL to expand this system to a national scale through a grant from Health Canada’s Substance Use and Addictions Program titled, “Developing National Surveillance of Illicit Drug Content.”

The system uses urine screening to determine the contents of drugs taken. This method avoids storing and transporting illegal substances; does not require that participants sacrifice drug samples for testing; avoids exposing testers to violence associated with the drug trade; and is more reflective of the street-level products available than testing of products seized by police.

The system also includes a survey that participants complete when they submit their urine for testing, indicating what drugs they think they took. The combination of survey data with the urine screening results shows any substances that participants took unintentionally or unknowingly, and any substances they think they took that were in fact not present. The survey can be adapted to include questions about emerging local or national issues to capture the changing preferences and needs of people who use drugs.

The project will lead to local reporting and national 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.

Timeline

The Community Urinalysis and Self-Report Project (CUSP) was developed and is being rolled out in multiple phases:

Phase 1 (2018–2019): Development of a pilot system for combining a survey with urine drug testing at three sites (British Columbia, Montreal and Edmonton);
Phase 2 (2019–2021): Development of a standardized project toolkit and expansion to additional sites (Manitoba, Laval, Newfoundland and Labrador, Nova Scotia and Thunder Bay);
Phase 3 (2021–present): Continued expansion across Canada and development of additional toolkit materials (e.g., support for qualitative data collection).

For more information, please see the detailed timeline below.

If you are interested in participating in Phase 3, please see the “Participation” tab.

Detailed Timeline

Phase 1 (2018–2019)

Built a pilot system based on earlier work in British Columbia 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).
Sites in British Columbia, Montreal and Edmonton tested the pilot system and collected data from 858 participants.
Publications describing the pilot project and results:
- Biggar, E., Papamihali, K., Leclerc, P., Hyshka, E., Graham, B., Taylor, M., Payer, D., Maloney-Hall, B., & Buxton, J. (2021). Towards cross-Canada monitoring of the unregulated Street Drug Supply. BMC Public Health, 21, 1678.
- Slide presentation: Leclerc, P., Graham. B., Papamihali, K., Hyshka, E., Taylor, M., Tremblay, C., Carron, N., Morissette, C., & Buxton, J. (2019, Nov.). Towards a Cross-Canada Surveillance of Illicit Drug Content. Presentation at Issues of Substance conference, Ottawa. For a copy of the slides, please contact cusp-pcua@ccsa.ca.
BCCDC resources, reports, and knowledge translation outputs are available on the BCCDC Harm Reduction Client Survey page.

Phase 2 (2019–2021)

Phase 2 project toolkit:

Developed English and French project toolkit materials in collaboration with British Columbia, Montreal and Edmonton study teams to facilitate implementation at additional locations.
- Project manual
- Standardized long- and short-form surveys
- Survey and urine collection instructions
- Verbal consent form
- Ethics review board materials
- Template spreadsheet for inputting and analyzing data
- Suggested template for local reports

Expanded the system to five new sites in Manitoba, Thunder Bay, Laval, Nova Scotia, and Newfoundland and Labrador (see Partners and Collaborators tab) and collected additional data from existing sites (B.C., Montreal). This resulted in data from more than 2,000 participants in Phase 2.
Local project reports:
- Manitoba Harm Reduction Network. (2021). Community Urinalysis and Self-Report Project: Summary of Findings for Manitoba.
- Project reports and additional resources from B.C. are available on the BCCDC Harm Reduction Client Survey page.

Phase 3 (2021–present)

Continuing to expand the project across Canada by recruiting additional sites and repeating data collection at existing sites.
Developing additional toolkit materials. The additional materials currently include support for integrating an optional qualitative interview alongside the survey and urine testing.
Toolkit materials are available upon request (see Participation).

Participation

CCSA is recruiting new sites interested in implementing the Community Urinalysis and Self-Report Project (CUSP) at a harm reduction site in their region. Funds are available for participant honoraria, urinalysis costs and research assistance.

Participation entails:

Identifying local data collection sites such as harm reduction supply distribution sites or observed consumption sites;
Obtaining local research ethics board approval;
Recruiting interested clients and collecting survey responses and urine samples to be sent to Lifelabs, Ontario, for analysis;
Analyzing and interpreting survey and urinalysis results;
Communicating results back to harm reduction site clients and staff; and
Contributing to cross-Canada reporting on drug use trends by sharing results with CCSA.

CCSA supports participating sites throughout these stages. CCSA has also created project toolkit materials for each stage to make implementation easy and comparable across sites.

The project toolkit includes:

A project manual: a step-by-step guide for project implementation
Standardized short- and long-form surveys: the short-form survey contains core questions on drug use in the past three days. The long-form survey includes additional questions that sites can choose to include based on local needs and emerging issues.
Instructions for collecting survey data and urine samples: a step-by-step guide for participant recruitment and data collection
Verbal consent form: a template for obtaining informed consent from participants that allows participants to stay anonymous
Ethics review board materials: a template study protocol and information to complete research ethics review board application forms
Electronic survey file: an online form that allows for online survey administration or for online data entry if participants completed surveys on paper
Template data analysis spreadsheet: a tool to assist with cleaning, linking and analyzing survey and urinalysis data
Template for local reports: a template to assist sharing results with harm reduction site staff, clients and community

If you are interested in participating or would like more information about CUSP or the project toolkit materials, please email cusp-pcua@ccsa.ca.

Partners and Collaborators

CCSA would like to acknowledge and thank the following partners for developing and implementing the Community Urinalysis and Self-Report Project (CUSP).

Partners that contributed to the development of CUSP:

Site Location	Organization	Local Study Leads
Alberta (Edmonton)	University of Alberta StreetWorks, Edmonton	Elaine Hyshka Marliss Taylor and Richard Herrick
British Columbia	B.C. Centre for Disease Control, Vancouver In-kind support from: Regional Harm Reduction Coordinators, B.C. Ministry of Health and Vancouver Area Network of Drug Users	Jane Buxton, Brittany Graham, Kristi Papamihali
Quebec (Montreal)	Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Ile-de-Montréal, Quebec Toxicology Centre	Pascale Leclerc, Carole Morissette Nicolas Caron

Site Location

Organization

Local Study Leads

Alberta (Edmonton)

University of Alberta
StreetWorks, Edmonton

Elaine Hyshka
Marliss Taylor and Richard Herrick

British Columbia

B.C. Centre for Disease Control, Vancouver

In-kind support from: Regional Harm Reduction Coordinators, B.C. Ministry of Health and Vancouver Area Network of Drug Users

Jane Buxton, Brittany Graham, Kristi Papamihali

Quebec (Montreal)

Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Ile-de-Montréal,
Quebec Toxicology Centre

Pascale Leclerc, Carole Morissette

Nicolas Caron

Additional partners that have implemented CUSP:

Site Location	Organization	Local Study Leads
Manitoba	Manitoba Harm Reduction Network Winnipeg Regional Health Authority	Veda Koncan Paula Migliardi
Newfoundland and Labrador	Eastern Health AIDS Committee of Newfoundland and Labrador	Jane Henderson Emily Wadden, Alexe Morgan
Nova Scotia	Nova Scotia Health Authority Direction 180	Patryk Simon Cindy McIsaac
Ontario (Thunder Bay)	Lakehead University NorWest Community Health Centres	Abigale Sprakes Juanita Lawson
Quebec (Laval)	Centre intégré de santé et de services sociaux de Laval	Catherine Boucher-Rodriguez

Reports

New research shows that the contents of drugs from the unregulated supply remain unpredictable. In fact, there’s often a difference between what drugs people think they are taking and what they are actually consuming. This increases the risk of harm for people who use drugs.

To better understand substance use trends and how expected substance use contents compares with actual substance use contents across Canada, data was collected from 2,634 participants at harm reduction sites in seven regions between January 2021 and April 2023. The reporting sites are in British Columbia, Edmonton, Regina, Ottawa, Peel, Quebec and Nova Scotia. The data has been compiled into Community Urinalysis and Self-Report Project (CUSP) Cross-Canada Report 2021–2023 series. Reports will be released between February and April 2024 and made available on this page.

The CUSP project was led by the Canadian Centre on Substance Use and Addiction (CCSA) in collaboration with BC Centre for Disease Control, the Institut national de santé publique du Québec, and sites who partnered directly with CCSA to collect data locally.

CUSP is a monitoring system that compares the drugs people think they are using (via self-report) with the actual drug contents (via urinalysis). The goal is to collect standardized information about drugs from the unregulated supply, including discrepancies between expected and actual use. The project also examines which substances people used together (intentionally or not), and how people administer their drugs.