法学最新文献

Background: People who inject drugs (PWID) face premature mortality, particularly from opioid overdose. In Sweden, harm reduction has expanded, including increased access to opioid agonist therapy (OAT) and the 2018 introduction of Take-Home Naloxone (THN). This study aimed to examine trends in all-cause and cause-specific mortality and to estimate predictors of all-cause and opioid overdose mortality among PWID in Stockholm.

Methods: We conducted a retrospective cohort study from April 2013 to March 2023. Data from the national Cause of Death Register were linked to Stockholm Needle and Syringe Program (NSP) records. Causes of death were categorised as opioid overdoses, external causes, internal/natural causes, or other/unknown. Crude mortality rates and age- and sex-standardised mortality ratios were calculated. Time-dependent Cox regression models estimated risk of all-cause death, and Fine and Gray subdistribution hazard models estimated opioid overdose mortality, accounting for competing risks. Person-time began at first NSP visit and ended at death, study end or censoring (> 365 days without a visit).

Results: Among 4192 participants, 685 (16%) died. The crude mortality rate declined from 36.75 to 27.04 deaths per 1,000 person-years and the standardised mortality ratio from 17.24 to 10.94. In multivariable models, reporting opioids as the latest injected drug was the strongest driver for both all-cause and opioid mortality. Other significant predictors included infrequent injecting and current contact with social services, psychiatry or addiction care, while OAT participation was associated with a lower risk. Male sex and age over 56 at enrolment were associated with a higher risk of all-cause mortality. Opioid overdose was the most common cause of death (53%). However, the opioid overdose mortality rate declined from 29.40 to 5.88 deaths per 1,000 person-years over the study period, coinciding with the 2018 introduction of THN and declining reported opioid injecting drug use among NSP clients.

Conclusions: All-cause mortality among PWID in Stockholm declined over the study period, alongside significant reductions in opioid overdose deaths, during a period of broadened harm reduction and reduced reporting of opioid injecting drug use. Our findings support continued scale-up of OAT and THN and consideration of supervised consumption sites to further reduce preventable deaths.

Despite growing investment in age-friendly models and social prescribing, many older adults remain disconnected from services, even when those services align with identified needs. Findings from the Age-Friendly Integrative Mobile Services (AIMS) pilot indicate that this engagement gap (motivational barriers, relational mistrust, and value misalignment) is as limiting as access or infrastructure. Motivational engagement - defined as aligning care with a person's values, readiness, and trust - emerged as a critical yet overlooked driver of uptake. Centering trust, values alignment, and relational support within implementation strategies may enhance service uptake, sustain engagement, and improve equity in aging-in-place outcomes by ensuring care is both accessible and meaningful.

Background: The veterinary sedative xylazine is increasingly found in illicit fentanyl and has been associated with numerous health harms. Xylazine test strips (XTS) are an emerging technology that can theoretically assist consumers in avoiding xylazine, but they require real-world validation. We leverage community-based drug checking program data to compare real-world XTS performance to 'gold standard' methods.

Methods: Samples were initially assessed by dissolving 1 mg of drug product in 1 mL water and dipping an XTS ("first generation" Wisebatch™) in the sample. Subsequently, confirmatory testing was performed by sending samples to the National Institute of Standards and Technology for qualitative analysis using direct analysis in real-time mass spectrometry (DART-MS). A subset was analyzed quantitatively with liquid chromatography gas spectrometry (LC-MS) to quantify xylazine, fentanyl, and other compounds.

Results: A total of n = 1570 drug samples were analyzed between June 2023 and May 2025, and a total of n = 801 XTS were used. N = 715 comparisons between xylazine test strips and mass spectrometry results could be made, including n = 333 among samples that tested positive for fentanyl. Of these, n = 63 samples were confirmed to contain xylazine by mass spectrometry, of which the majority contained low concentrations (average concentration 2.3%; 78% of samples contained less than < 1% xylazine by weight). Of the 63, n = 34 were correctly identified as positive by XTS, yielding sensitivity of 54.0 %. Of n =  270 xylazine negative samples, n = 235 were correctly categorized (specificity = 87.0%). Most false positives occurred with lidocaine present.

Conclusions: In our sample, with a large percentage of low concentration xylazine samples, "first generation" Wisebatch XTS had a relatively low sensitivity, but higher specificity. This highlights the value of confirmatory testing and the complicated and often confusing nature of point-of-care test strips for novel substance detection. Lot testing and validation studies are needed to improve quality control in this area.

Drug-checking services (DCS) provide people who use drugs (PWUD) with crucial information concerning the substances they may consume. The intent of DCS is to reduce harms potentially associated with those substances, by providing evidence-based information about the contents of said substances and possibly influencing PWUD consumption-related behaviors. This pilot project reports on a network of 10 dedicated Raman spectroscopy drug-checking devices, located at various organizations throughout the province of Ontario, Canada. The spectrometers were specifically developed for drug-checking analysis and use machine learning (ML) enabled software to provide participants with automated, real-time results. The same software was also used to collect participants' demographic data and self-reported consumption-related behavior changes. In this work, we report on the results provided by this network over a 14-months period from July 2023 to August 2024 on 7752 samples provided by 5083 participants. On select samples, high-performance liquid chromatography-mass spectrometry (HPLC-MS) measurements were also collected to probe the accuracy of the results and quantify variations between the two techniques. Voluntary feedback was also collected from a limited number of participants concerning the potential impact the drug-checking process may have on their consumption-related behaviors.

Emotional risks are ubiquitous in social work practice and pose significant threats to the health and well-being of practitioners and clients. Emotional skills are recognized as the best practice approach for coping with these risks. However, existing research on emotional skills is almost all from the fields of medicine, education, and psychology, and little attention is paid to it in the social work literature. To address this gap, the study explored Chinese social workers' experiences and perceptions of using emotional skills in practice through semistructured interviews (N = 28). The study suggests that emotion can be used as a practical skill for social workers, who have developed two patterns of practice for emotional skills: "self-directed" emotion management and "other-directed" emotion management. In the practice of coping with emotional risk in oneself and others, social workers navigated three stages of identification, understanding, and management and employed relevant professional skills (such as body scanning, empathy, and communicating emotions to others). The study results are pragmatic, and the action plan model of emotional skills has significant implications for social work practice and education.

Background: Chemsex, a form of sexualized drug use, is a growing public health concern among men who have sex with men (MSM) in Malaysia. It is associated with an increased likelihood of HIV transmission and other adverse health outcomes, such as overdose. Although harm-reduction services are proven to be efficacious in mitigating these outcomes, they often remain inaccessible because of stigma, criminalization, and limited availability of the service. This study examines the barriers MSM face in such services and explores how a mobile smartphone app with tailored features could help overcome these barriers.

Methods: From February to August 2022, six virtual focus groups were conducted with 22 MSM participants who had engaged in chemsex in the past six months. Participants were recruited through geosocial networking (GSN) applications and Facebook advertisements. The focus group sessions were recorded, transcribed, translated into English, and analyzed using thematic analysis.

Results: Participants described multiple barriers to practicing chemsex harm reduction, including limited knowledge of safer drug use, peer pressure, fear of legal consequences, and stigma from healthcare providers. They emphasized the need for a mobile app that provides reliable educational resources, peer support groups, discreet ordering of harm-reduction supplies (e.g., condoms, lubricants, sterile injection equipment), and access to emergency assistance during adverse events. Privacy protection and a simple, familiar user interface were identified as essential for building trust and encouraging sustained use of the mobile app and uptake of harm reduction services among MSM.

Conclusions: This study underscores the persistent structural and social barriers to harm reduction among MSM who engage in chemsex in Malaysia. A mobile app tailored to their lived experiences and privacy needs may offer a confidential pathway to harm-reduction information, community support, and linkage to services that MSM trust.