Harm Reduction Journal最新文献

Background: The diversity of student populations and the heightened risk/s for women students, sexuality and gender-diverse students, First Nations students, multicultural students, international students, and students with a disability, highlight the importance of intersectionality in university responses to sexual violence.

Methods: This paper analyses policy guidance and explores the framing of sexual violence within policies from 35 Australian universities, with respect to considerations of intersectionality. It also examines student perceptions of the inclusiveness of university policies via an anonymous online survey.

Results: Although 91% of the policies used language that is inclusive of specific identity attributes, policy guidance fails to acknowledge the importance of intersectionality in addressing sexual violence or to recognise the structural and systemic inequalities that underpin sexual violence. Policy guidance also lacks sufficient information about cultural responsiveness and intersectional support, and these gaps translate to the policies examined. Student victim-survivors perceived policies as inconsistent with respect to inclusivity and sought more specific acknowledgement of vulnerable populations and diverse student needs.

Conclusions: Inclusive language broadens the framing of sexual violence, beyond a white, abled, heterosexual, cisgender norm, and can help all students to perceive their experiences as worthy of support. Failures to acknowledge and embed intersectionality and inclusivity within policy and practice can lead to harmful and enduring well-being, safety and human rights-based consequences, and compound systemic issues associated with sexual violence.

Background: Our study examines how harm reduction service providers (providers) throughout North Carolina (NC) provide services to people who use opioids (PWUO), how these service provision strategies align with PWUO preferences, and implications for care.

Methods: We conducted semi-structured in-depth interviews and used a thematic analytic strategy to identify common approaches to service delivery among providers (n = 10), rationales for taking these approaches, and how approaches were received by PWUO (n = 30). To be included in the study, service providers had to provide direct care to PWUO, while PWUO had to be 18 + and be in active opioid use (not as prescribed by a doctor); providers and PWUO had to live in NC.

Results: Providers often allowed PWUO to take the lead in service delivery interactions, asked limited questions about what/how participants use drugs, and rarely offered unsolicited information. Providers believed questioning could feel invasive or stigmatizing to PWUO. They also thought questions were unnecessary, assuming PWUO understood the risks that come with drug use. Providers reported that they would take the lead in interactions to correct PWUO's misconceptions that could make their use more dangerous, and would, occasionally, offer unsolicited information related to upcoming events or new services, or if PWUO appeared open to receiving more information. PWUO varied in desired approach by providers, based on the established rapport between providers and PWUO, and whether PWUO were in withdrawal during the interaction. Still, PWUO generally felt syringe service programs were a safe space, and many wanted to be asked more about their use so providers could provide tailored information about risks, trends, and safe use.

Conclusion: Providers offer valuable services and safe spaces for PWUO in NC, but should ask program participants' preferences regarding interaction style to ensure the services provided are aligned with the desires of PWUO to have the maximum possible impact.

Introduction: Despite being disproportionately affected by the COVID-19 pandemic, people who inject drugs (PWID) have markedly lower and more variable rates of COVID-19 vaccine uptake-ranging from 10% to 81%-compared to 79% of all US adults. Multiple implementation adaptations have been proposed to address this gap, including offering the vaccines at syringe service programs (SSPs). To inform their implementation at an SSP in Miami, Florida, this study aimed to identify predictors of COVID-19 vaccine uptake and preferences for service delivery among PWID in our context.

Methods: Between June 2022 and July 2023, we administered a cross-sectional survey based on the Health Belief Model with PWID accessing services at an SSP in Miami, FL (n = 135). Bivariate analysis was used to identify factors associated with COVID-19 vaccination status (vaccinated vs. not vaccinated).

Results: Only 65% of participants had received at least one dose of the COVID-19 vaccine series. Factors associated with COVID-19 vaccination included older age (42 vs. 38 years, p = 0.0287), requiring medical care for previous COVID-19 infections (p = 0.0173), being confident in the US healthcare system (p = 0.0023), and not believing multiple COVID-19 misconceptions (p < 0.05). Among the Health Belief Model domains, perceived benefit, self-efficacy, and one cue to action item were significantly associated with COVID-19 vaccination status: vaccinated participants were more likely to believe in the vaccines' benefits (p = 0.0045-0.0213), report it was easy to get vaccinated (p = 0.0159), and know where to obtain accurate vaccine information (p = 0.0477). Most participants (86%) preferred to receive the COVID-19 vaccine at the SSP, and suggestions for increasing uptake included offering compensation, utilizing peer outreach systems, providing information and reminders, and allowing for accelerated vaccination schedules.

Discussion: Our findings reiterate the potential of SSPs to increase COVID-19 and other vaccination rates among PWID and provide insight into implementation adaptations to optimize vaccine uptake, including emphasizing the benefit of vaccines in communication efforts, offering compensation, and leveraging the trusted relationship with SSP staff, particularly peer navigators. Together, this evidence reinforces SSPs' unique ability to increase engagement with and utilization of preventative care services among PWID, within and beyond the COVID-19 pandemic.

Background: We examined fentanyl use and outcomes among people who inject drugs (PWID) in the urban Pacific Northwest (PNW).

Methods: We conducted secondary analysis of data from the 2022 National HIV Behavioral Surveillance PWID cycle from Seattle, WA and Portland, OR. We calculated proportions of any fentanyl, injection fentanyl, non-injection fentanyl, and street pill use. Next, we compared characteristics, behaviors, and outcomes by any fentanyl use. Finally, we estimated adjusted relative risk (aRR) of overdose outcomes associated with fentanyl use and injecting less associated with type of street pill use.

Results: Among 830 PWID, 76% reported any fentanyl use, 47% specifically reported injection fentanyl use, 68% specifically reported non-injection fentanyl use, and 66% reported street pill use. Of those who used pills, 94% smoked them. Fentanyl use was crudely associated with age; race; housing; detainment; usual drug injected; injection frequency; syringe service programs, substance treatment, non-fatal overdose, and naloxone (p < 0.05). With adjustment, any fentanyl use (aRR = 3.20, 95% CI 1.58-6.47), injection fentanyl use (aRR = 3.51, 95% CI 1.63-7.58), and non-injection fentanyl use (aRR = 2.29, 95% CI 1.23-4.28) were associated with higher risk of overdose. Participants who smoked street pills were more likely to report injecting less because of pill use (aRR = 1.82, 95% CI 1.24-2.66).

Conclusions: Fentanyl use was highly prevalent among PWID in the urban PNW. Non-injection fentanyl use was most common and street pills were frequently administered by smoking which was associated with injecting less. All fentanyl use was associated with increased risk for overdose. There is ongoing need for access to naloxone for PWID who use fentanyl.

Situated between two of the world's largest opium-producing regions, South Asia faces significant public health threats associated with drug trafficking and injecting drug use. People who inject drugs (PWID) in South Asia experience disproportionately high rates of bloodborne viruses (BBVs), including human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). These high rates are driven by factors such as drug trafficking routes, socioeconomic marginalization, poor surveillance, and inadequate harm reduction services. Pakistan has the highest reported prevalence rates, with HIV and HCV rates exceeding 30% and 50%, respectively, while India, Bangladesh, and Afghanistan report localized epidemics in urban and border areas. Co-infections, particularly HIV/HCV, further complicate clinical management and public health responses. Despite the implementation of needle-syringe programs and opioid substitution therapy in several countries, service coverage remains below recommended levels due to legal, financial, and structural barriers. Marginalized subgroups, including women and incarcerated individuals, remain underserved and often overlooked. In this review, we discuss the burden of these infections among PWID in South Asia, current control strategies, and the precarious future given the recent instability to the USAID, PEPFAR, WHO, and the Global Fund by the Trump administration.

Background: Overdose is a significant cause of mortality in the United States. People who inject drugs (PWID) are uniquely positioned to witness and reverse overdoses. This study assesses overdose responses and factors associated with witnessing overdose among PWID.

Methods: Data originate from baseline surveys for a longitudinal study of PWID in Oakland and San Francisco, California, collected between April 2024 and March 2025. Multivariable logistic regression identified factors associated with witnessing overdoses.

Results: Of 597 PWID, 464 (77.7%) witnessed at least one overdose in the past 3 months, with an average of 13.4 (SD = 28.2) and a median of 6 (IQR = 3-15) overdoses. Among those, 30 (6.5%) reported only calling 911, 50 (10.8%) reported taking no action, 172 (37.2%) reported only using naloxone to reverse overdoses, and 210 (45.5%) used naloxone in conjunction with calling 911. The adjusted odds of witnessing overdoses were 2.2 times higher among unsheltered PWID (vs. sheltered, p < 0.001), 3.1 times higher among those in San Francisco (vs. Oakland, p < 0.001), 4.6 times higher among those who experienced non-fatal overdose themselves (vs. not, p = 0.002), 2.8 times higher among those sharing needles (vs. not, p = 0.015), and 1.9 times higher among those injecting fentanyl (vs. did not, p = 0.006) in the past 3 months.

Conclusions: Nearly four in five PWID in Oakland and San Francisco recently witnessed an overdose. Witnesses are at greater risk of non-fatal overdose and may be the first to respond when those they inject with overdose. Targeting naloxone distributions to PWID who are characteristically more likely to witness overdoses may prevent additional drug-related deaths.

Background: The uptake of e-cigarettes has been associated with reduced smoking in the UK, and British public health policy has sought to leverage e-cigarettes' potential to encourage cessation. Smoking harms are concentrated in disadvantaged communities in the UK. If e-cigarette use were similarly concentrated in these groups, that could help redress the inequity. On the other hand, disadvantaged communities may be slower to adopt e-cigarettes, and this could perpetuate or exacerbate smoking-related disparities.

Methods: This study examines the association between community-level e-cigarette prevalence and disparities in smoking between those employed in routine and manual occupations (R&M) and those employed in professional, managerial, intermediate, and other (PMI) occupations in England between 2013 and 2019. Using observational data, a small area estimation model is employed to form synthetic estimates of e-cigarette prevalence at the local level. The local socioeconomic gap in smoking (or smoking prevalence by occupation group) is then nonparametrically regressed on the estimated local e-cigarette prevalence.

Results: The uptake of e-cigarettes is negatively associated with smoking rates in both occupational groups, affirming the role of e-cigarettes as an opportunity for harm reduction. However, the decrease in smoking is smaller for R&M workers. Thus, the uptake of e-cigarettes may have slightly increased the disparity between the two groups.

Conclusions: Small area estimation provides a useful way to synthesize local estimates of e-cigarette use when direct estimation is impossible. The analysis suggests that the uptake of e-cigarettes, while associated with cessation from smoking for both types of workers, may not immediately reduce smoking-related disparities. Additional investigation should examine why the uptake of e-cigarettes may have a less marked effect on smoking cessation among R&M workers and whether these results change as the e-cigarette market matures. The analysis highlights the need to ensure that cessation interventions delivering net benefits reach the communities whose need is greatest.

Background: The United States opioid epidemic's reach is expanding. Rapidly scaling opioid overdose education and naloxone distribution (OEND) programs is essential within a multipronged public health response. Universities offer infrastructure with potential to support routine, widespread OEND program implementation among adolescents and young adults nationally, a priority population who could disseminate to broader networks and geographic communities. This important setting is underutilized, and critical gaps remain in understanding university-based OEND program adoption/implementation.

Methods: We conducted semi-structured, in-depth interviews (n = 21) among a purposively selected national sample of college health administrators to understand their perceptions of barriers/facilitators of implementing OEND programs at their universities and among universities nationally. The Consolidated Framework for Implementation Research guided data collection and inductive-deductive thematic analysis.

Results: Unexpected student opioid overdoses and deaths catalyzed university administration to implement OEND programming. Absent the urgency induced by such events and in contrast to the incidental exposure they implicate, administrations perceived the prevalence of opioid misuse within their student population as too low to justify OEND program implementation. For some, this reluctance to proactively implement OEND programming was heightened by a desire to avoid political controversy, related to stigma surrounding harm reduction. Participants described the need for campus partners to collaboratively navigate university administrations' inaction/opposition, and ultimately, spearhead implementation, often with external collaborators. Key roles among campus and external collaborators were identified, including (a) allowing students to access existing OEND programming prior to obtaining administrative approval for university-based implementation; (b) compiling data and anecdotal evidence to understand the campus substance use environment and sharing that information with administration to establish program need; (c) overcoming stigma and legal complexity of harm reduction programming; (d) overcoming funding/resource constraints and building capacity to sustain OEND programming.

Conclusions: Our findings underscore complexities of university-based OEND program implementation while providing actionable insights to support its national scale-up. Building on identified distinctions between universities in the process of implementing OEND programming and those without intention to implement, future research should identify OEND programming implementation phase among universities nationally, advance understanding of implementation determinants and strategies distinguishing each phase, and establish best practices for OEND program implementation.

Objective: Alcohol and cannabis co-use is the most common form of polysubstance use in the U.S. Some evidence suggests that there is an association between cannabis use and reduced alcohol consumption, however data on this topic are mixed. Further research is needed to elucidate the individual factors that determine whether cannabis substitutes for alcohol.

Method: This study is an exploratory analysis of data from a within-subjects, crossover laboratory study on alcohol and cannabis co-administration. Participants completed two sessions: one in which they self-administered alcohol after using cannabis, and one in which they self-administered alcohol but did not use cannabis. We aim to compare behavioral phenotypes of individuals who self-administered less alcohol after cannabis ("substituters"; n = 23), more alcohol after cannabis ("complementers"; n = 7), or the same amount of alcohol regardless of whether cannabis was used ("non-substituters"; n = 16). We utilized Welch's ANOVAs and Kruskal-Wallis tests to compare baseline group differences, drawing on domains from the Addictions Neuroclinical Assessment (ANA) framework. Wilcoxon tests were employed to test differences in laboratory self-administration measures between sessions for each group.

Results: Substituters had significantly lower scores on measures corresponding to ANA domains of negative emotionality (BDI-II, DASS-Depression) and executive function (UPPS-P Lack of Premeditation) than non-substituters. Substituters endorsed higher positive cannabis expectancies than non-substituters, though expectancy differences did not reach significance.

Conclusions: Individuals who use cannabis and alcohol and have lower levels of negative emotionality and impulsivity may be more likely to substitute cannabis for alcohol. Future research is needed to explore long-term outcomes of cannabis substitution.

Clinical trials registration number: NCT04998006.

Background: Community-based drug checking services have scaled up in response to the unregulated drug toxicity crisis across North America. We sought to assess the relationship between the detection of unexpected active drugs in a drug checking sample and subsequent engagement in risk reduction practices.

Methods: We used data from a cross-sectional study of people who used community-based drug checking services in British Columbia, Canada (March 2020-July 2024). We constructed multivariable logistic regression models to examine the relationship between the detection of unexpected active drugs (i.e., compounds that have psychoactive properties) in samples brought for analysis (using combination Fourier-transform infrared spectroscopy and immunoassay strips) and engagement in subsequent risk reduction practices (e.g., dose reduction, disposal of the drug).

Results: In total, 447 individuals were included: 174 (38.9%) reported detection of unexpected active drugs in their drug checking sample with the most common being benzodiazepines in expected opioid samples. The most common risk reduction behaviours were to dispose of the drug without using it (n = 24) and taking a smaller dose (n = 11). Through multivariable logistic regression, we found a positive association between detection of unexpected active drugs and engagement in risk reduction practices (adjusted odds ratio = 2.24; 95% confidence interval: 1.30-3.87).

Conclusion: Individuals who detected unexpected active drugs in their sample had higher odds of engaging in risk reduction practices. These findings highlight the potential of drug checking services as a harm reduction tool within a suite of services offered to combat the unpredictable and unregulated drug supply.