The utility of a new point-of-care test for synthetic cannabinoids: a mixed-methods study in people who use synthetic cannabinoids and stakeholders

Background: Synthetic cannabinoids (SCs) are prevalent in prisons and among people who experience homelessness in the UK and can cause serious harms to people who use them. While it is currently not possible to test for SCs at the point of care (POC), a new method for doing so using fluorescence spectral fingerprinting has recently been developed. In this study, we aimed to outline the potential utility of POC SC testing in settings where SCs and SC use occur. Methods: This is a mixed-methods study. Professional stakeholders (n = 449) working or volunteering in healthcare, homeless, police, or prison services were invited to give their views on POC SC testing in an online survey with both quantitative and qualitative (free text) questions. Follow-up interviews were conducted with 35 survey participants and additionally with 25 people who use synthetic cannabinoids (PWUSC). Quantitative survey responses on the overall view of saliva- or drug-based detection of SCs were compared between the four groups using Kruskal-Wallis tests. Qualitative survey responses were analysed using content analysis and interviews were analysed using thematic analysis. Results: SCs were perceived as prevalent in UK prisons and homeless communities, but stakeholders felt poorly equipped to tackle SC use and harms. The quantitative analyses revealed that all groups rated both saliva- and drug-based detection positively, but police and prison services were more positive towards both types of testing than healthcare and homeless services (all p’s < 0.001). The thematic and content analyses outlined several potential benefits of POC SC testing across all four settings, with the strongest support for use in prisons, particularly to reduce the ingress of SCs. Both PWUSC and professional stakeholders raised concerns that testing would be used in a punitive manner and highlighted the lack of treatment options for SC dependence and overdose as a major barrier to reducing harms. Conclusions: POC SC testing has the potential to support healthcare, homeless, police, and prison services in reducing the prevalence of SCs and improving the care of PWUSC. However, ethical application of the technology must be carefully considered to avoid causing undue harm to PWUSC, such as criminalisation and stigma.