Table 3 Core and adaptable elements of service design

Integration into trusted service (core element)

Participants generally felt that DCS should be integrated into an existing low-threshold harm reduction service with established trust between service and staff [48].

It needs to ultimately go where people are already at. Where people already have that trust. I think if we are trying to start something from scratch or go somewhere new it’s going to take a hell of a lot of time. (Professional participant 2, third sector)

Confidentiality and discretion (core element)

Participants stressed the importance of DCS being perceived as confidential and discreet.

They will be suspicious of this, ‘who is doing this, who is getting the information, are the police about, am I going to be arrested? Are they going to report back to my worker, am I going to lose my prescription?’ (Family member participant 2)

You’d have to tell them when they first come in with this cup of coffee, ‘listen look, if you come in here, you are under no surveillance at any time and we will not be informing any police.’ (PWEDU participant 6)

Non-judgemental ethos (core element)

Participants noted that staff should be non-judgemental and have a harm reduction ethos.

Relevant quotes provided under construct ‘staff skills, knowledge, and values’ (in the domain ‘individuals’).

Links with wider harm reduction supports and services (core element)

Participants noted that drug checking should be linked with wider interventions and services to provide wrap-around care and support, particularly for those at highest risk of experiencing drug-related harm.

It’s one thing telling them about the risks, but it’s creating that kind of whole package [of support] that will have the greatest impact. (Professional participant 26, third sector)

Information on substance strength/concentration (core element)

Participants, particularly those with experience of drug use, noted that DCS should aim to provide information about substance strength/concentration wherever possible to inform considerations around dosage and risk.

They want to know how strong it is, how powerful it is. (PWEDU participant 11)

See if I knew it was 50%…I’d think ‘oh that’s not going to be strong, or that’s going to be really strong be very careful, take a little’… I’d maybe not take it depending on how strong it was do you know what I mean? (PWEDU participant 7)

[Drug checking] would, aye [yes] still useful [without information on substance strength], but it wouldn’t be as useful. (PWEDU participant 9)

Sample size required for testing (core element)

Participants generally felt that as small an amount of a substance as possible should be required for checking.

I keep going on about this not getting it [the substance] back because I think that’s going to be your biggest bug bear. (PWEDU participant 11)

Turnaround time for results (core element)

Participants noted that quick turnaround time for point of care results was essential, particularly for those at highest risk of experiencing drug-related harm.

Someone like my son, yes, they need it immediately. (Family member participant 1)

It would have to be something that was quite quick because addicts don’t have time to hang around. That’s the thing. Because that is valuable time for their using… [The] needle exchange… if people are in there longer than ten minutes, they just don’t get needles. (PWEDU participant 6)

I’d say about an hour, half an hour. Some people might want it straightaway but obviously it’s going to take a bit of time. (PWEDU participant 8)

Protocols and processes (core element)

Wider project meetings highlight the importance of having well-defined protocols and processes in place, including the provision of a Home Office licence. Some participants, typically in professional strategic positions, also discussed such issues.

I think the [Home Office] licence, well you couldn’t do it without a licence because you can’t employ staff on that basis, they need to have the reassurance that the service supports them and that they are working within a legal framework. (Professional participant 11, NHS)

Protection from criminalisation (core element)

Participants, particularly those with experience of drug use, described the importance of assurances that individuals would not be surveilled, stopped or charged by police when accessing DCS.

Relevant quotes provided under construct ‘Concerns over policing and criminalisation of people who use drugs’ (in the domain ‘outer setting’).

Location (adaptable)

Participants discussed a number of locations which may be suitable for DCS delivery in Scotland and noted that a single site may not be suitable for the wide variety of individuals who may wish to make use of the service. Additionally, the suitability of a site was said to differ according to the demographic/target population which the service aims to attract.

See paper published from the same data set for extensive discussion of such issues [45].

Scale of service (adaptable)

Participants noted that the scale of the service may vary, describing potential for drug checking across numerous sites and outreach checking or sample collection

See paper published from the same data set for extensive discussion of such issues [45].

Confirmatory testing options (adaptable)

Discussions with local implementation groups and key stakeholders highlighted the potential for individuals to be offered more detailed results through confirmatory lab-based testing, meaning these more detailed results would be available within a longer period of time. Participants also highlighted that some individuals may not require quick results, and may wish to have more detailed results over a longer time period (through confirmatory testing).

So, it needs to be… ‘bring one or two in and you will get some information’. So really good reliable you know clinical result, you know information within half an hour and then what we will do is we will send that away to do deeper analysis and you will also get that back after three days. That would be the best for me. (Professional participant 26, third sector)

Method of communicating results (adaptable)

Participants described a range of methods of communicating drug checking results

People would want it all different ways, but aye [yes], if you put email, if you put a text, it could be a phone call, it could be anything. Or some people might want it face to face. (PWEDU participant 8)