As the social service providers handed out fruit snacks and water bottles on Thursday, down the block from a needle exchange on Berkeley’s University Avenue, they asked passers-by an unusual question: Did they want to “check” their drugs?
Naila Vitatoe explained the operation to a middle-aged man. She works for an Oakland nonprofit that analyzes street drugs for unwanted chemicals — a dash of fentanyl in a bag of tar heroin, for instance, or an emerging industrial chemical that sears the veins of users.
Vitatoe and her colleagues take a small sample and test it with a machine that beams infrared light. Within minutes, they return the drug to the user, along with information about its true contents and safety advice — all free of charge.
The man left and reappeared five minutes later with a small shard of methamphetamine for checking.
Drug checking is a public health strategy that California is leaning into more and more as overdose deaths continue to plague the region. The approach is rooted in the principle of harm reduction. Research suggests that drug users make more informed decisions and behave more safely if they’re empowered with knowledge of what is actually in the drugs they’re using. Proponents say this knowledge can be the difference between a user living long enough to reach recovery or becoming another statistic of the overdose crisis.
“I’m a strong believer in them,” Daniel Ciccarone, a professor in the UCSF School of Medicine who studies drug use, said of checking programs. “Knowledge is power.”
The drug supply is constantly evolving at the whims of drug traffickers. Unbeknownst to users, their dealers may add synthetic opiates, research chemicals, additives and adulterants to bags of fentanyl, heroin and cocaine. Xylazine, a tranquilizer used by veterinarians, is appearing on the streets.
“That’s where it really shines for the conscientious consumer,” Ciccarone said, “is to bring their meth in and say, ‘Hey, I felt unusually sleepy when I used this.’ And then, lo and behold, they find that there’s fentanyl in it.”
And in the U.S., which doesn’t have a unified system for monitoring changes in the drug supply, checking programs provide much-needed data. Like others, the Oakland nonprofit sends drug samples for confirmation to a National Institute of Standards and Technology lab in Maryland.
The Oakland-based nonprofit is the HIV Education and Prevention Project of Alameda County. Staff launched their drug checking program in 2023. Similar operations have sprung up in San Francisco and Los Angeles, and in other U.S. cities. In 2024, Gov. Gavin Newsom signed a law that protects workers in drug checking programs from arrest and criminal prosecution. Police associations opposed it, saying it would empower drug dealers to improve their product.
“Our job is to normalize this and standardize it, so that it just becomes a normal thing in the next five years,” said Braunz Courtney, the Oakland nonprofit’s executive director. “If not sooner.”
Courtney said drug checking is “a natural progression for harm reduction.” The organization, based in East Oakland, has long run a syringe exchange. Its staff distribute naloxone — the opioid overdose reversal medication — plus smoking kits and fentanyl test strips. Courtney and his staff are staunch believers in these strategies, which curb disease transmission and overdoses.
He also knows they can spur fierce opposition. For decades, critics have said these practices encourage drug use that is inherently risky.
In 2000, the nonprofit’s Fruitvale offices burned down in an act of arson. The organization had already endured several prosecutions for possessing and distributing drug paraphernalia. But in a sign of changing times, Courtney said the drug checking program isn’t controversial in Oakland, and his staff rolled it out without interference from police or ideological opponents.
On Thursday, the middle-aged man handed his meth to drug checking technician Enzo Dominguez. He placed the pea-sized shard onto a Fourier-transform infrared spectrometer. It’s an unassuming gray device that fits on a desk in the nonprofit’s Winnebago van, which travels throughout Oakland and Berkeley to deliver drug checking services.
Vitatoe and Dominguez are trained and accredited to use the device. Using infrared light, the spectrometer measures how much radiation is absorbed by the sample and how much passes through. The technicians use software to visualize the results, giving clues into the chemistry of the sample.
Dominguez compared the new spectroscopy to a benchmark measurement of meth.
“This is pure meth,” he said. The test showed nothing unexpected, no red flags that it is more dangerous to use.
Dominguez informed the man and handed him back the sample. The man took a cupcake and promised to be back next week.
With testing, staff occasionally discover something unexpected. They’ve revealed that a counterfeit Xanax pill included a benzodiazepine that’s not approved for medical use and helped fuel a wave of overdoses in San Francisco. They’ve found potent fentanyl in heroin, which is of weaker strength. They’ve discovered a dangerous bag of uncut fentanyl — a “crazy” sight, Vitatoe said.
When they make such discoveries, they say they give their clients advice: Don’t use alone, carry Narcan, and start small. Maybe they should change dealers or carry testing strips. Sometimes, users discard their drugs, Dominguez said. Others don’t.
Research suggests that this approach is beneficial to public health. A 2021 meta-analysis of research on 90 drug checking programs internationally, including nine studies in the U.S., found evidence that drug users behave more safely when they know something unexpected is in their drugs.
A 2018 study of drug checking at a supervised injection site in Vancouver, Canada, where heroin was the drug of choice, found that about a third of users planned to reduce their drug dose after testing revealed the presence of fentanyl. About 10% of those users planned to trash their sample. Researchers suggested that the rate wasn’t higher because the users might have sought out fentanyl in the first place, or perhaps they couldn’t find drugs without fentanyl at all.
Keith Humphreys, a Stanford professor of psychiatry and behavioral sciences who is an expert on drug use, noted that dynamic.
The value of drug checking is “pretty small when fentanyl is in almost everything,” he said in an email, “and also a number of people are going to use whatever they have no matter the test result.”
But Ciccarone, of UCSF, threw cold water on that idea. Fentanyl is common in the Bay Area, he said, but it’s a “myth” that the powerful opiate is in every drug. The drug checking technicians agree.
“Our results definitely do confirm that there is not fentanyl in everything,” Dominguez said.