This program brings real-time on-site drug checking services to three “low-threshold” Harm Reduction Housing (HRH) sites in Boston, Massachusetts. These sites adhere to Housing First principles, which do not require abstinence or treatment before the provision of housing. The drug checking program was created to provide residents with real-time information about the contents of their drugs, allowing them to potentially avoid unwanted additives or adapt their use. A study found that offering real-time drug checking services within low-barrier housing is a valuable intervention for people who use drugs who are navigating an unreliable drug supply.
Program description
HRH sites provide low-threshold housing which offer harm reduction services to residents. The specific types of harm reduction services available vary by site; they can include the provision of safer use supplies, HIV testing and care, naloxone distribution and other supports. As part of the program in Boston, in May 2024 three HRH sites integrated on-site, real-time drug checking services into their existing service models:
- Site 1 was a communal men’s shelter, where drug checking was performed in a common room.
- Site 2 was a tiny house community, where drug checking was performed in a common-space trailer on the grounds.
- Site 3 was a repurposed hotel, where drug checking was performed in a common lobby area.
At first the sites offered drug checking on a trial basis, on irregular dates at particular times. The program transitioned to offering drug checking at consistent times on recurring monthly dates that are advertised at the HRH sites. Staff encourage participation by demonstrating how the testing works, emphasizing what can be learned from results and leveraging trust already established with residents in the HRH.
Participants provide samples for analysis, such as baggies with residue, used cookers with or without filters, pipes, straws or any other materials containing drug remnants. Staff record what the person believes the substance to be, whether they experienced any adverse health events after consuming it, and any other notable information. Real-time sample analysis is performed using a Bruker Alpha II Fourier-transform infrared (FTIR) spectrometer, along with fentanyl, xylazine and benzodiazepine immunoassay test strips, depending on the suspected substance. On-site analysis generally takes 15 minutes. Once the analysis is completed, the results are communicated to the participant. Participants receive a $5 gift card for each substance sample they provide.
Real-time results are posted anonymously on a board at each site, along with information about future program dates and additional community resources.
Samples are also sent for more detailed analysis to the Massachusetts StreetCheck drug analysis program. These samples take four to six weeks for analysis. Participants are provided business cards with a unique web link to the StreetCheck website where their laboratory testing results are posted once available.
Results
Before the implementation of the drug checking program (from September 2023 to February 2024), 106 HRH residents who reported illicit substance use in the past 30 days completed a baseline survey. This survey collected an array of information, including residents’ interest in harm reduction services.
From September 2023 to March 2025, 28 qualitative interviews with HRH residents were conducted as part of a larger study. These qualitative interviews were analyzed to explore experiences with the real-time drug checking program which began in May 2024. Interview themes were analyzed alongside researchers’ field observations collected during program operation, including quotes from residents and 55 real-time drug checking results collected from May 2024 to September 2025.
Interest
Before the implementation of the program, many residents expressed interest in using an on-site drug checking service. Survey results found that 49% reported they would be “very likely” to use drug checking services if provided on-site, with an additional 25% reporting they were “somewhat likely” to use these services.
The strong level of resident interest demonstrated a clear demand for an on-site drug checking program and supported the implementation of the program at HRH sites by indicating that it would address an identified need.
Engagement
The real-time drug checking service saw strong engagement among residents, with participation increasing over time as the service became a more consistent offering. During interviews and field observations, residents frequently indicated that even though another drug checking program was available to them, they engaged with the program at their residence because of convenience.
Presence of contaminants and protective use behaviours
When submitting a sample, residents were asked to report what they believed the drug contained. The majority (72%) of 55 submitted samples contained at least one substance that residents had not suspected was present. One of the primary reasons residents used the drug checking service was to determine whether their sample contained xylazine (sometimes this was specifically to try to determine the reason for a new wound). While only 9% of submitted samples were suspected to contain xylazine, real-time drug checking found that nearly one-third did. In addition, many of the samples suspected to contain xylazine were found not to contain it.
Residents also reported they wanted their drugs checked to help them prevent drug-related harms. Some described how drug checking results informed their use and purchasing decisions. For example, for some people the results sparked outrage and resulted in a decision to switch suppliers or dispose of the substance.
Community engagement and peer recruitment
There were strong collective and community-based desires among residents to engage with drug checking services. As residents developed trusting relationships with staff, recruitment was aided by word of mouth and community promotion. Participants described how they shared their drug checking results with other people in their community with the goal of increasing community safety and well-being. Residents reported that the drug checking service fostered deeper community discussions about how they could safely navigate the unstable local drug market.
“When you guys did it [tested] before, everyone was like, ‘holy shit.’ Nobody knew that all that dope had xylazine and everyone was kind of like, 'oh my God, we gotta readjust here. We have to figure out how to get it [dope] without it [xylazine].’”
What does this mean for service providers?
Residents engaged with the drug checking service for their own knowledge and individual health and wellness, as well as to promote safer use knowledge and practices in their communities. Locating drug checking services where they are convenient and accessible, such as in supportive housing, can support these individual- and community-level goals. Thoughtfully working to develop trust and offering drug checking services that meet people’s needs can strengthen relationships between service providers and people who use substances. These strengthened relationships can in turn foster deeper engagement with the services, which can help realize potential community-level benefits of drug checking services.
Related resources
The Pit Stop: Harm reduction drop-in centre
Drug checking services at a supervised consumption site
A transitional housing program for people facing mental health or substance use challenges
Reference
Summers C, Silcox J, Zaragoza S et al. Real time, on-site drug checking in low-threshold housing communities. Harm Reduction Journal. 2026;23:33. Available from: https://doi.org/10.1186/s12954-026-WQh01397-y