"The high prevalence of mental health issues among the homeless population has been extensively documented throughout literature, but the consumption of NPS to treat mental health symptoms is of particular concern (Gray et al., 2021; Irving et al., 2015; McLeod et al., 2016; Ralphs et al.,

"The prevalence of homelessness globally is estimated to be roughly 150 million individuals at any given time (Busch-Geertsema et al., 2016). In the UK, recent data from the Shelter organisation estimated that 320,000 people were homeless in 2019/2020 (Bramley & Fitzpatrick, 2018).

"This research sought the perspectives of people involved in the unregulated drug market on how drug checking could be implemented as a market intervention within the current context of a highly unpredictable drug supply and unprecedented rates of overdose. Currently, drug checking is positioned as a public health intervention promoted to people who use drugs within supervised consumption sites while being averse to aiding people who sell or produce drugs.

"The adulteration of illicit drugs is not a new phenomenon, with evidence of it occurring as early as the 1930s (Morgan, 1982).

"Although many checkers mentioned that they had not heard of anyone being prosecuted for possession of test kits, many were more directly affected by party promoter and venue owner reluctance to allow their services due to fear of fines or even prison sentences. Checkers affiliated with formal drug checking organizations in particular expressed concern over potential legal barriers associated with drug checking at festivals or other events. The main concern cited by many formal checkers is the “RAVE Act” (the “Reducing Americans’ Vulnerability to Ecstasy Act”).

"Regardless of what led these individuals to become drug checkers, most appeared to be motivated by altruism and the desire to increase safety and minimize risks associated with others’ drug consumption. We describe their efforts in terms of altruism not only because they act in a selfless manner and donate their time and services, but also because unlike many other volunteers, drug checkers also risk arrest by handling illegal drugs, in order to promote the safety of others. Thus, they essentially place themselves under legal risk to help protect others.

• "In 2019 and 2020, alcoholic liver disease was the most frequent cause of alcohol-induced death, followed by mental and behavioral disorders due to use of alcohol (Figure 5).
   
• "From 2019 to 2020, the largest increases in rates were from alcohol-induced acute pancreatitis (50%), from 0.1 per 100,000 to 0.2, followed by mental and behavioral disorders due to use of alcohol (33%), from 3.0 to 4.0.

• "After annual increases of 7% or less between 2000 and 2018, the overall age-adjusted rate of alcohol-induced deaths increased 26%, from 10.4 per 100,000 in 2019 to 13.1 in 2020 (Figure 1).
   
• "Rates of alcohol-induced deaths for males were stable from 2000 to 2009, increased 30% from 2009 (11.3) to 2018 (14.7), and increased 26% from 2019 (15.2) to 2020 (19.2).

"In February 2023, Mexico's federal government closed the country's only methadone manufacturing plant, Psicofarma, following concerns about quality control.5 In Mexican-U.S. border cities, such as Ciudad Juarez, Mexicali, and Tijuana, where the prevalence of OUD is among the highest in the country, methadone clinics are turning new clients away as they run out of medication, limiting doses, providing doses only on alternate days, or not dosing altogether.

"The number of unintentional poisoning deaths increased from 12,186 in 1999 to 20,950 in 2004. The annual age-adjusted rate increased 62.5%, from 4.4 per 100,000 population in 1999 to 7.1 in 2004. The increase among females, from 2.3 to 4.7 per 100,000 population (103.0%), was twice the increase among males, from 6.5 to 9.5 per 100,000 population (47.1%) (Table 1). Among males, rates among whites, American Indians/Alaska Natives, and Asians/Pacific Islanders all increased approximately 50%.