The 5 Senses Framework-People Who Use Drugs Were and Are the First Drug Checkers.

BACKGROUND: The unregulated drug supply in the United States has become largely unpredictable, with novel substances emerging and impacting the health and wellbeing of people who use drugs (PWUD). In response to this, harm reduction programs have increased funding for community-based drug checking to empower PWUD to learn about their drug supply. However, important implementation questions must be answered to ensure benefits are maximized. Thus, we aimed to create a conceptual framework to help community partners understand the imperative for including PWUD's input on drug checking implementation. FINDINGS: The 5 Senses Framework describes how PWUD use their sensory data (ie, sight, taste, smell, touch, hearing) and embodied sensations to evaluate their drug supply, allowing them to create informal mental archives of drug use experiences and adjust decision-making as needed to keep themselves safe in the future. PWUD's intimate understanding of the drug supply makes them the first drug checkers, and thus important members of drug checking programs. The creation of a structured intake process that reflects the sensory experiences of PWUD may help engage individuals while recognizing their autonomy and foundational knowledge in the drug checking space. Understanding that PWUD are checking their drugs through sensory input and embodied sensations may help programs assess why some people may be hesitant to engage with drug checking more formally. Recognizing that PWUD may have expectations that differ from what existing programs provide is imperative for implementation, access and success. Additionally, PWUD often are part of communities that already share sensory knowledge about drugs. Building upon such networks may expand drug checking programs' community benefit. CONCLUSION: Community-based drug checking programs would be wise to incorporate decision-making from PWUD, as they were, and are, the first drug checkers. Including sensory data during drug checking intake would position PWUD as integral team members.