Impact of Lab-Based Drug Checking Services on Syringe Service Program Engagement in Maryland

Purpose: The introduction of synthetic substances into the unregulated drug supply has driven a surge in overdose deaths, posing significant public health challenges in timely substance identification, engagement with people who use drugs (PWUD), and access to treatment. Maryland's Rapid Analysis of Drugs (RAD) program, piloted through Syringe Service Programs (SSPs), provides a proactive harm reduction strategy by integrating mail-in, laboratory based drug checking with broader public health services to enhance surveillance and improve engagement with PWUD. We aim to investigate the effect of offering RAD drug checking on SSP metrics such as encounters with PWUD and access to wound care. Methods: To evaluate the impact of RAD affiliation on SSP engagement and service metrics, a hierarchical linear model was employed to estimate percent changes in metrics such as encounters, naloxone distribution, and instances of overdose education. Metrics were analyzed on a log scale to account for skewness and variability across sites, with site-specific effects and random variation modeled to capture both baseline differences and the impact of RAD affiliation. Results: RAD affiliation was associated with significant increases across most metrics, including a 131% rise in wound care services and a 74% increase in participant encounters per quarter, though some metrics, such as counseling, showed minimal changes. Even when accounting for SSP maturity, we still see statistically significant increases in metrics. Conclusion: The RAD program has significantly enhanced engagement and service delivery within Maryland's SSPs, suggesting it as a valuable public health intervention for improving outcomes for PWUD, though further research is needed to explore causality and influence of factors like broader public health initiatives.