Amidst an ever turbulent political environment in North America that has all but written off harm reduction and drug checking efforts from rural Western Canada to New Jersey, the Alliance for Collaborative Drug Checking (ACDC) summit was a music-filled and optimistic step in the right direction.
The goal of the annual summit is to bring together people from across the world to discuss strategies, lessons and trends in drug checking. Across four days, blending perspectives from harm-reduction leaders, researchers and drug-checking experts, a sense of the strength of the harm-reduction community emerged above all. This was particularly evident in discussions on the practical aspects of drug-checking technologies and procedures, which often have to work alongside and around legal restrictions to make people feel safe testing their drugs.
The summit brought together organisations differing enormously in size, capacity and legal environment. Integración Social Verter, in Baja California, Mexico, is a community-led organisation that opened one of the first unsanctioned safe consumption sites in Latin America, called La Sala.
Its representative, a physician, described supervising a consumption space he characterised as clean, safe, police-free and government-independent, for injecting and snorting. Naloxone and oxygen are on hand at La Sala, and he believes that the room is an opening for further intervention, given that drug checking is often raised in conversations around overdose risk. Beyond the site, he runs scheduled visits to neighbourhoods offering drug checking and needle exchange, collecting used needles and handing out sterile ones.
Verter should be the clearest case of an organisation severely limited by legal restriction. Mexican law does not permit possession so much as decline to prosecute it: the General Health Law sets out maximum doses for strictly personal and immediate consumption. While it does not authorise possession of those amounts, it shields a person from prosecution only where the state accepts the drugs were for personal use. Anything above the threshold but below trafficking quantities is considered possession, carrying up to three years.
Harm reduction services have no place in this framework at all. Verter is registered as a mental health facility despite the fact that its work falls under harm reduction, drug checking included. Most jarringly, police are stationed outside the building, and confiscate sealed, unused needles from participants who are simultaneously receiving hepatitis C treatment inside.
Despite restrictions, Verter is lauded as a successful effort.
Finding workarounds
The strictest statutory environment among the panellists at the ACDC came from New Brunswick, New Jersey. Unlike in Mexico, the restrictions in New Jersey are codified and enforced, despite the fact that the state actively works with harm reduction organisations. Sterile syringe access was illegal there until 2006, and, until 2022, the statute that legalised it required municipal authorisation for every new programme, which is a barrier applied to no other health service.
Mexico’s problem is that there is no framework beyond the local level that Verter operates at, which is largely justified by pointing outward to international guidelines, and to what the United States and Canada already do. Meanwhile in New Jersey, the problem is a dense statutory framework around syringe access and paraphernalia, within which drug checking is not mentioned.
Different legal environments result in different workarounds by harm reduction organisations, leading to a surprising homogeneity in quality of care, a point that the panellists kept returning to. Their shared experiences, which offered the summit a sense of connection that extended far beyond a professional networking event, demonstrated that practice converges where law does not.
The panellists work in vastly different legal environments, ranging from full legalisation in Aotearoa, New Zealand, case-by-case exemption in Canada, state protection with hostile local enforcement in California, restrictive statute in New Jersey, to no framework at all in Mexico. Yet their accounts of the work were nearly interchangeable. Every panellist described the same job: analysis of drug samples, but also a much longer conversation about physical care, referrals, and the client’s needs and future plans.
This demonstrates how the harm reduction community has adapted and evolved around a variety of political and social environments that vary in their hostility towards people who use drugs and the people who help them.
In some cases, this means getting creative to circumvent restrictions: at Verter, this takes the form of improvising legal forms and self-signed statements asserting that sterile unused needles are not illegal to avoid confiscation while a New Jersey technician described selective non-reporting of data that in police hands would result in arrests.
Increasing hostility
This matters more now than it did a year ago. In April 2026, the US Substance Abuse and Mental Health Services Administration barred its grant funds from supporting several harm reduction interventions, sterile syringes and rapid test strips among them. This continued a shift announced the previous July in response to a Trump executive order on crime and disorder claiming that such interventions merely facilitate illegal drug use.
Just weeks later, the White House Office of National Drug Control Policy published a national strategy identifying drug checking as an important tool and stating that test strips should not be treated as paraphernalia. A reauthorisation act signed in December 2025 authorises federal grant money for drug checking supplies. American programmes are left to reconcile the two, amid a rapidly shifting set of policies under which their existence is threatened.
What is the cost of this adaptability, amid decreasing public and legislative support for harm reduction initiatives? The panellists agreed that it is paid in information. What New Jersey gives up is statewide alerting about harmful substances in the drug supply, a loss a panellist working there considers worth making, since local stamp markings mean little across a whole state.
New Zealand, the first country to fully legalise drug checking, is barred by that same statute from collecting any personal or demographic data, which removes ID checks but makes following up on results structurally impossible.
In Ontario, closures of consumption sites disrupted the flow of samples to the province’s analysis service. The state’s power over drug checking is exercised at the point of data, not the point of care.
From the ground up
This raises the question of what a collaborative arrangement between local, state and individual interests looks like in practice. New York City’s health department runs its drug checking programme through six of the city’s fourteen harm reduction organisations, and its coordinator, who was present at the summit, explained that this was a matter of legitimacy rather than logistics: the department has poor standing with the populations the service needs to reach, while its partners have decades of direct service, community organising and advocacy behind them.
A department-run programme, she said, would have failed. What the department contributes is money and administrative load in terms of providing funding, hiring, training, equipment, repairs, and laboratory analysis.
A further constraint is technical rather than political. One presenter showed three samples analysed by the same technician, on the same day, on the same instrument, where the portable estimates diverged from laboratory values by a factor of two to three in both directions. Confirmatory quantification exists, but it requires several milligrams of product a participant may not be willing to surrender, and returns results a day or two later.
The field’s response is best exemplified in a metaphor that circulated across panels: drug checking is a flashlight; it shows the obstacles immediately ahead, rather than the whole forest.
Ultimately, the summit was a reminder that what holds the field together is an enduring commitment to serving people who use drugs beyond what drug checking can offer, in terms of mental health support, providing a community, and sharing information about harm reduction.
