Harm Reduction Journal最新文献

Background: Understanding the hepatitis C virus (HCV) cascade of care (CoC) and factors associated with engagement is crucial for designing interventions for achieving HCV elimination. However, data on engagement in the HCV CoC among people who inject drugs (PWID) in the Middle East and North Africa remains limited. We examined the HCV CoC and factors associated with testing among Iranian PWID.

Methods: We recruited PWID in 14 cities using respondent-driven sampling. PWID completed structured interviews capturing measures on socio-demographics, behaviors, and HCV CoC. We examined the self-reported numbers and proportions of individuals who ever tested for HCV, tested positive for HCV antibody, were diagnosed with HCV, initiated HCV treatment, and achieved sustained virologic response (SVR). Multivariable logistic regression models were built to assess factors associated with HCV antibody testing.

Results: Of 2308 PWID, 23.1% had ever received an HCV antibody test, 13.9% received the HCV antibody test in the last year, 3.4% had tested positive for HCV antibodies, and 2.5% had received an HCV diagnosis. Of those diagnosed, 54.4% reported initiating treatment, and 31.6% had achieved SVR. HCV antibody testing was significantly associated with having knowledge about HCV transmission through sharing needle/syringe (adjusted odds ratio [aOR] 8.09; 95% confidence intervals [CI] 5.25, 12.48), living with HIV (aOR 4.15; 1.58, 10.92), no previous history of homelessness (aOR 1.89; 1.31, 2.72), history of arrest/incarceration (aOR 1.83; 1.26, 2.64), history of being diagnosed with any mental health problems (aOR 2.88; 1.79, 4.61), history of non-fatal overdose (aOR 1.51; 1.08, 2.10), receiving needle exchange programs in the last 12 months (aOR 6.20; 3.86, 9.93), opioid agonist treatment in the last six months (aOR 2.10; 1.39, 3.18), and having ever received HBV vaccine (aOR 2.31; 1.59, 3.35).

Conclusions: We found a considerably low engagement in HCV CoC among PWID in Iran. Enhancing access to testing services for PWID, especially those with limited awareness of HCV transmission and those encountering structural challenges, is essential as the initial step in the HCV CoC. This improvement is vital for strengthening HCV elimination efforts in Iran.

Background: Reversing trends in substance use-related health inequities among Indigenous Peoples requires investments in epidemiological research anchored in community-based participatory research (CBPR) methodologies. There is scarce literature that describes how to implement population estimation methods on American Indian reservation lands.

Objective: This research describes how we leveraged CBPR throughout the implementation of a population estimation study conducted in collaboration with a Tribal Nation in the southern plains to quantify the size and characteristics of persons with histories of illicit substance use on reservation lands.

Methods: We used the capture and recapture population estimation methodology in April-May 2023 to estimate the size of the population of people who used illicit substances in the past six months in a county within the collaborating tribe's jurisdiction. Participant recruitment occurred in areas where people who use drugs were known to congregate. Participants completed a survey that included measures pertaining to sociodemographics, substance use, harm reduction, overdose, sexual health, and cultural factors.

Results: In total, N = 501 surveys were completed by unique persons who had used illicit substances in their lifetime. A large proportion had injected drugs in the past six months or greater than six months ago (19.6% and 31.7%, respectively). There were N = 210 persons who reported having used illicit substances by at least one route of administration within the last six months. We estimated that there were 419 (95% confidence interval = 277, 562) adults who had recently used an illicit substance in the county where the study occurred.

Conclusions: This study demonstrates that population estimation methodologies can be integrated with community-based participatory research approaches to quantify the size of populations of people who use drugs. Future work should be conducted to understand the degree to which population-level needs evolve over time and in response to local initiatives.

Background: Opioid agonist treatment (OAT) is a highly effective treatment option for people with opioid use disorder. The potent medications used create dilemmas regarding low or high thresholds to access treatment, patient autonomy and regulations. OAT in Scania County in the south of Sweden has seen the implementation of regulatory changes resulting in liberalization through a patient choice model and increased access to treatment. In this setting, in which OAT has developed from high threshold to low threshold because of policy changes at both national and local levels, we aimed to analyze how patients and staff view the risks and benefits of OAT.

Methods: We conducted qualitative interviews with 32 OAT patients and 15 OAT staff in Malmö, Sweden. We analyzed the data with a thematic analysis approach.

Results: Patients reported that OAT helped them to "stabilize" their lives although many felt a sense of being locked into treatment, which acted as a barrier to normalization. A significant risk was being offered illicit drugs by patients and dealers when visiting the clinic. Patients who had enrolled in OAT before liberalization found current guidelines too lenient and expressed worry that persons being enrolled were too young. Staff viewed liberalization with some ambivalence, with a positive view of increased access to OAT, although they had worries about the enrollment of young patients and difficulties supporting patients with ongoing drug use. Staff also viewed the sale of drugs in and outside of clinics as a significant problem. Some staff viewed medicines as the most important aspect of OAT, while others positioned the social support as most important.

Conclusions: Patient and staff perspectives were relatively congruent as they highlighted substantial risks regarding drug dealing at OAT clinics and were ambivalent toward the liberalization of OAT guidelines and the increased access to OAT. Liberalization impacted both patients and staff in their everyday lives and in professional practice, in a setting where OAT is both a desirable treatment and sometimes the basis of a problematic drug scene.

Background: Polysubstance use is common at electronic dance music (EDM) events and hazards associated with polysubstance use may be exacerbated when people who use drugs are unaware of the contents of their drug sample. Reagent test kits (RTK) and fentanyl test strips (FTS) are two efficacious drug checking tools that people who use drugs might use to protect themselves from risks associated with contamination, adulteration, and misrepresentation of unregulated substances. In the current study, we aimed to (1) characterize the use of RTK and FTS among attendees of a 4-day music festival in Colorado and (2) qualitatively capture perceived barriers to using RTK and FTS within festival settings.

Methods: We surveyed 227 music festival attendees on their use of drug checking tools (i.e., RTK and FTS) and behavior in response to drug checking. We also collected qualitative data on perceived barriers of using RTK and FTS within a festival setting using survey-based open-ended text response questions.

Results: The percentage of participants having ever used RTK and FTS was 75.3% and 66.5% respectively. When asked how often participants ensure their drugs are tested prior to consumption, participants responding "always" or "most of the time" was 54.4% for use of RTK and 59.4% for use of FTS. Additionally, 60.8% of participants reported that they had never consumed a drug that reagent tested differently than expected and 87.9% of participants reported that they had never consumed a drug that tested positive for fentanyl. Perceived barriers to using RTK and FTS within a festival setting encompassed the following themes: (1) accessing testing materials (2) environmental or ecological barriers (3) legal concerns (4) social dynamics (5) lack of education/training and (6) limits of individual drug checking tools.

Conclusions: RTK and FTS appear to empower festival attendees in the U.S. to make informed decisions related to their substance use. However, there is a critical need to reduce barriers associated with drug checking for this at-risk population.

Background: Reliable epidemiological data are limited on the lung cancer risk of groups using e-cigarettes (ECIGs) and groups using heated tobacco products (HTPs).

Aim: We describe a methodology to estimate the lung cancer risk of these groups according to their levels of biomarkers of exposure (BOEs) and of potential harm (BOPHs).

Methods: Using 28 search terms for BOEs and 82 for BOPHs we sought publications reporting biomarker-specific data from North America and Europe comparing individuals who smoke cigarettes and individuals who use other established products (ETPs; cigars, pipes, smokeless tobacco (ST) and/or snuff/snus). Publications were selected using defined inclusion/exclusion criteria. Additionally using lung cancer relative risk (RR) estimates for users of specific ETPs derived from recent meta-analyses of epidemiological studies in these regions, we derived a regression model predicting the lung cancer RR by level of each specific biomarker. Separately for groups using ECIGs and using HTPs the lung cancer risk was then estimated by combining RR estimates for selected biomarkers. Our primary estimates only considered biomarkers statistically significantly (p < 0.01) related to lung cancer risk which showed no significant (p < 0.01) misfit to the RR of 1.0 for non-users-those with no use of ETPs, ECIGs or HTPs.

Results: Based on 38 available publications, we extracted biomarker-specific data for ETPs for 56 BOEs within 21 of the 28 search terms considered and for 54 BOPHs within 29 of the 82. The regression slope fitted to the lung cancer risk was significant (p < 0.01) for 22 BOEs and six BOPHs. However, the predicted RR for non-users significantly (p < 0.01) differed from 1.0 for 16 of these biomarkers. We estimated the lung cancer RR for using ECIGs, derived from 30 estimates for 10 biomarkers, as 1.88 (95% CI 1.60-2.22), the excess risk (ER = RR - 1) being 6.8% of that for smokers of cigarettes. The RR estimate varied little in most sensitivity analyses conducted, but increased markedly after removing the restriction to significant model fit. We estimated the lung cancer RR for using HTPs, combining estimates for four BOEs, as 1.44 (0.41-5.08), the ER being 3.4% of that for smokers of cigarettes.

Conclusions: Despite some methodological limitations, our approach estimates risk when reliable epidemiological data are unavailable. Using the biomarkers considered here, the model indicates that the lung cancer risk for individuals using ECIGs is much lower than for smokers of cigarettes, and suggests that the risk for those using HTPs is also low. Research using additional data could add precision to these findings.

Background: The increasing implementation of harm reduction strategies such as take-home naloxone has placed people who use drugs (PWUD) in the position of overdose responders during overdose events, but the perspectives of PWUD are underrepresented in public health policy and practice concerning overdose response. We conducted this study to examine PWUD's perspectives on first response services for overdose and to learn how PWUD can be supported more effectively when they respond to overdoses.

Methods: The Research with Expert Advisors on Drug Use (READU) team, a community-based research team that includes academically trained researchers and people with lived and living experience conducted 13 semistructured interviews with PWUD in King County. The data were analyzed via thematic analysis. The Consolidated Framework for Implementation Research (CFIR) was used to guide the development of the interview protocol and as a framework for qualitative codebook development.

Results: Participants were asked to describe their experiences with EMS, including police, during overdose response. Most had reversed an overdose themselves and demonstrated commitment to their role as overdose responders. Participants had mixed feelings about EMS involvement in overdose response, citing concerns about stigma and coercion. Police response was described as negatively impacting peer overdose response, with participants stating that past experiences of arrest and harassment by police during overdose response contributed to their reluctance to call 911 during an overdose.

Conclusion: The findings from this study demonstrate the important role of PWUD in overdose response and suggest that improving interactions between EMS and PWUD could positively impact future responses, including increasing PWUD's willingness to call 911 during overdose events.

Background: Since July 2022, the Australian government has required online wagering operators to send all active customers activity statements as part of the National Consumer Protection Framework in an effort to reduce gambling harms. Having access to clear and accurate gambling expenditure data is intended to facilitate awareness and reflection and enhance consumer self-awareness for their spending, which can consequently enable informed and considered decisions regarding future gambling spend. This study aimed to explore Australian wagering customers' use of activity statements and their impact on gambling behaviour.

Methods: Data was gathered through surveys distributed via two online gambling operators to assess problem gambling severity, self-reported use and impact of activity statements, and ability to recall gambling spend. The operators provided matched customer account data for each participant, which was de-identified but enabled gambling behaviour to be objectively assessed and the accuracy of self-reported spending to be determined. The final sample comprised 1647 participants (85% male) with a mean age of 44 years.

Results: Our results suggest that 57.2% of participants opened their statements at least "sometimes", indicating consumer interest in activity statements. Of the customers who opened statements, 17.6% reported that the statements decreased their gambling, and a very small proportion (0.8%) reported a subsequent increase in their gambling. There was some evidence of a dose-dependent relationship whereby the more people engaged with statements, the more effective they were perceived to be. Reading statements more often and more recently was not associated with improved recall of recent gambling spend or net outcome. There were no significant changes in gambling behaviour (betting frequency and deposit amount) observed around the time when statements were sent.

Conclusions: A notable proportion of online wagering customers are using activity statements and many feel these are useful in tracking their gambling spending and may help them to reduce their gambling. Importantly, there was minimal evidence of negative unintended consequences observed in self-report and objective behavioural data. Efforts to enhance engagement with activity statements would likely result in further benefits. These findings contribute to the evaluation of a national policy regarding consumer protection tools designed to reduce gambling harm.

This commentary examines Australia's intensified regulatory approach toward nicotine control, revealing a shift that increasingly resembles a de facto War on Nicotine. While traditional tobacco control measures have achieved commendable declines in smoking rates, recent policies- including increased tobacco taxation and a ban on consumer vapes- have inadvertently fuelled a burgeoning nicotine black market. This has resulted in serious unintended consequences, including increased criminal activity, systemic violence, and health risks associated with the proliferation of unregulated nicotine products. By analysing the relationship between nicotine control policies and these outcomes, this paper argues that Australia's current strategy may be creating more harm than it mitigates, mirroring many of the unintended consequences historically associated with drug prohibition. We contend that a recalibration toward a harm reduction model, coupled with a re-evaluation of tax and improved access to less harmful nicotine products, could achieve a more balanced approach to nicotine control, aligning public health objectives with sustainable, effective policy.

Background: A welfare-first approach to harm reduction at UK festivals is emerging as a critical strategy for enhancing festival safety. In particular, the implementation of anonymous, non-punitive drug-checking services is posited as essential for reducing drug-related harm by enabling informed decision-making. This empirical study examines the limitations of punitive drug policies and the associated risks to public health and explores the potential benefits of decriminalisation in fostering safer festival environments.

Methods: The study employed qualitative methodologies, including semi-structured interviews and questionnaires with festival attendees at three major UK festivals. This empirical data was supplemented by a review of recent studies (Ivers et al. in Ir J Med Sci 191(4):1701-1710, 2022. https://doi.org/10.1007/s11845-021-02765-2 ; Palmer Maynard in Harm Reduc J 19(1):81, 2022. https://doi.org/10.1186/s12954-022-00662-0 ; Cooney and Measham. in Drug Sci Policy Law 9, 2023. https://doi.org/10.1177/20503245231211444 ) and relevant policy documents, in order to evaluate current harm reduction practices and identify key barriers, such as stigma, social control, and criminalisation.

Results: Analysis revealed that integrated harm reduction measures, comprising drug-checking services, welfare support, and early intervention initiatives, significantly enhance safety by empowering individuals with timely, accurate substance information. A majority of participants expressed a clear preference for drug-checking services, underscoring their willingness to engage when these services are provided in a supportive, non-punitive environment. However, persistent challenges related to punitive drug policies and gaps in public education about harm reduction continue to impede optimal service delivery. Evidence further suggests that a shift towards decriminalisation and welfare-based approaches could mitigate these risks and foster more trusting engagement with harm reduction initiatives.

Conclusions: The findings indicate that prioritising welfare-first harm reduction strategies, particularly the implementation of anonymous drug-checking services, can create safer festival environments and inform broader public health policies. The study underscores the need for policy reforms that move away from punitive approaches, suggesting that festival-based interventions can serve as scalable models for reducing drug-related harm across diverse community settings.

Background: Interventions aimed to mitigate drug-related harm include drug checking, which invloves a chemical analysis of a drug sample alongside personalized harm reduction advise. The Drug Information and Monitoring System (DIMS) represents a network of Drug Checking Services (DCS) in the Netherlands, which people who use drugs (PWUD) may visit before consumption, though not consistently. This paper describes the characteristics and experienced effects of PWUD who have their drugs tested after use, in relation to the analysis results of the submitted drug sample and the setting of use.

Methods: Data was collected between 2018 until 2022 encompassing a range of characteristics provided by the visitors. Statistical analyses were performed to find associations between the type of effects the visitor experienced and the (mis)match with the expected content of the drug sample or setting in which the sample was used.

Results: 14% (N = 9472) of all samples submitted to DIMS (N = 66150) were used prior to attending a DCS. The majority of samples were sold as ecstasy (41%, N = 3460) and cocaine (17%, N = 1407). Most visitors were male (75%, N = 6359), purchased their drugs offline (96%, N = 8081), and reported having used the sample at a party/festival (43%, N = 3614), while 27% (N = 2320) used it in a home setting. Half of the visitors (49%, N = 4109) declared not having used the sample in combination with other psychoactive substances. Positive mental effects were less likely to be experienced when the detected drug content did not match the expected content, while negative mental effects were more likely. Moreover, visitors consuming their sample at a party/festival were more likely to experience positive mental and physical effects and less likely to experience negative mental and physical effects compared to people consuming their sample at home.

Conclusions: By identifying the characteristics of PWUD who have their drugs tested after use and by demonstrating that not only a (mis)match with the expected drug content, but also the setting in which the substance was used was associated with the drug experience, improved strategies can be developed to encourage individuals to visit a DCS before consumption, thereby reducing drug-related harm.