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A Realist Review of How Community-Based Drug Checking Services Could Be Designed and Implemented to Promote Engagement of People Who Use Drugs

Masterton, Wendy; Falzon, Danilo; Burton, Gillian; Carver, Hannah; Wallace, Bruce; Aston, Elizabeth V.; Sumnall, Harry; Measham, Fiona; Gittins, Rosalind; Craik, Vicki; Schofield, Joe; Little, Simon; Parkes, Tessa


Wendy Masterton

Danilo Falzon

Gillian Burton

Hannah Carver

Bruce Wallace

Harry Sumnall

Fiona Measham

Rosalind Gittins

Vicki Craik

Joe Schofield

Simon Little

Tessa Parkes


With rising numbers of drug-related deaths in the UK and globally, exploration of interventions that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people to submit drug samples for chemical analysis and receive feedback about the sample, as well as harm reduction advice. The use of DCS is often linked to festival and/or nightlife settings and to so-called ‘recreational’ drug use, but research has also shown the potential of community-based DCS as an intervention serving more varied demographics of people who use drugs, including more marginalised individuals and those experiencing drug dependence. Whilst there is a growing evidence base on the effectiveness of drug checking as a harm reduction intervention, there is still limited evidence of the underlying mechanisms and processes within DCS which may aid implementation and subsequent engagement of people who use drugs. This presents a challenge to understanding why engagement differs across types of DCS, and how best to develop and deliver services across different contexts and for different populations. To explore the contexts and mechanisms which impact engagement in community-based DCS, a realist review was undertaken to synthesise the international evidence for the delivery and implementation of DCS. There were 133 sources included in the review. From these sources the underlying contexts, mechanisms, and outcomes relating to DCS implementation and engagement were developed and refined into seven programme theories. The findings of this review are theoretically novel and hold practical relevance for the design of DCS, with implications for optimisation, tailoring, and implementing services to reach individuals in different settings.

Journal Article Type Article
Acceptance Date Sep 15, 2022
Online Publication Date Sep 22, 2022
Publication Date 2022
Deposit Date Sep 28, 2022
Publicly Available Date Sep 28, 2022
Journal International Journal of Environmental Research and Public Health
Publisher MDPI
Peer Reviewed Peer Reviewed
Volume 19
Issue 19
Article Number 11960
Keywords drug checking; harm reduction; substance use; drug intervention
Public URL


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