Harm Reduction Journal最新文献

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.

Background: As in much of the United States, there have been significant increases in overdose deaths among non-Hispanic Black and Hispanic/Latinx populations in Rhode Island over the past decade. Given the shifting dynamics of the overdose epidemic, there is an urgent need for focused interventions that address the specific needs of diverse communities. This study explores differences in drug use patterns, harm reduction behaviors and types and barriers to treatment by race and ethnicity.

Methods: This study utilized baseline data from the Rhode Island Prescription and Illicit Drug Study (RAPIDS). We assessed sociodemographic characteristics, drug use patterns, harm reduction practices, treatment type, and barriers to treatment in a cross-sectional analysis of people who use drugs (PWUD), stratified by race and ethnicity (non-Hispanic white, non-Hispanic Black, non-Hispanic other race, and Hispanic). Chi-square tests of independence and ANOVA tests were used to identify statistically significant differences by race and ethnicity.

Results: Among 509 participants, the median age was 43, and the majority were men (64%). Non-Hispanic Black participants reported significantly less regular use of unregulated opioids, such as heroin (10%) and fentanyl (12%), as compared to non-Hispanic white participants (39% and 33%, respectively). Non-Hispanic Black participants reported significantly less experience responding to overdoses: only 39% had ever administered naloxone and 34% had ever performed rescue breathing, as compared to 67% and 57% among non-Hispanic white participants, respectively. Despite significant differences in drug use patterns, there were few differences in harm reduction practices by race and ethnicity. Current treatment enrollment was highest among those who were non-Hispanic white (38%) and lowest among those who were non-Hispanic Black (7%).

Conclusions: These findings suggest that there are differences in overdose response experience and treatment exposure between non-Hispanic Black PWUD and those belonging to other racial and ethnic groups, indicating a need for enhanced investment in overdose response education, naloxone distribution and treatment access for non-Hispanic Black PWUD.

Objectives: This project sought to contribute to healthy, safe organizational cultures within Vancouver's hospital system healthcare system as one method to address indirect harms of the province's drug toxicity and housing syndemic. A tertiary care inner-city hospital in western Canada partnered with the Eastside Illicit Drinkers Group for Education and Vancouver Area Network of Drug Users to convene a participatory action research project to identify systemic and personal barriers to safe, non-stigmatizing, and effective care at a local health care setting and to propose ways of responding to these conditions.

Methods: We convened semi-structured Listening Circles held in October 2023 with people who have sought care at the urban health care setting, and frontline healthcare workers who respond to them. The Listening Circles included a graphic recorder who illustrated themes as participants spoke about their experiences, perceived barriers to safety and comfort in health care settings, and challenges faced by service providers and service users when interacting with one another.

Results: Common themes identified by a graphic recorder included: (1) the importance of time and in the absence of time, relational space between healthcare workers and people who use drugs, (2) shared desire to scale approaches like peer navigation which consider the wellbeing of both service recipients and providers, and (3) the role of systemic forces and organizational practices that obstruct both quality of care and healthcare worker wellbeing.

Conclusions: Healthcare workers and people who use drugs and alcohol report an urgent need for resourced, relational care spaces and peer advocates within their area hospital systems. We will use these themes to inform our next steps in an investigation-as-action effort to improve respect, safety, and equity for all stakeholders across multiple stages of care.

Background: Overdose prevention centres (OPCs) are spaces where people can consume previously obtained illicit drugs under the supervision of staff who can intervene to prevent and manage overdose. They have been provided in Europe and elsewhere for nearly 40 years, initially in response to the epidemic of HIV/AIDS. We can learn from their operation history to inform future developments in harm reduction services.

Methods: We carried out a realist review of 391 documents, reported according to the RAMESES I guidelines, and carried out realist synthesis of these documents.

Results: We present a full realist programme theory of OPCs, with a diagrammatic logic model, of how the contexts and mechanisms of OPCs combine to produce various outcomes for service users and their communities in different settings. Three specific causal pathways were evidenced through which OPCs produce their outcomes for particular groups in specific contexts of housing status, gender identity and ethnicity, and local drug markets, with frequency of use, legal and political contexts, and stigma as overlapping contextual factors. Key OPC interventions include the provision of a safe and hygienic consumption space, safe consumption education, timely overdose response, and protection from drug scene and gender-based violence. These can trigger the underlying mechanisms of safety, trust, social inclusion, engagement, autonomy, and empowerment when supported with health care and other services, including detoxification and opioid agonist treatment. The combinations of these contexts and mechanisms create important outcomes for individual service users, for the communities they live in, and for wider society. We also describe causal pathways that can lead to unintended, adverse outcomes.

Conclusion: This review provides useful information for policy makers, practitioners, and researchers on how to implement and evaluate OPCs in future to maximise their benefits; an important task in the context of the ongoing public health crises of drug poisoning deaths in North America and the UK, and the possibility of increasing deaths from synthetic opioids in Europe and elsewhere.

Background: Pharmacies often restrict access to over the counter (OTC) syringes. The objective of this study was to quantify the frequency that patients experience barriers when seeking to purchase a 10-pack of OTC syringes from community pharmacies in Oregon.

Methods: To ascertain the availability of a 10-pack of OTC syringes, we conducted a telephone audit ("secret shopper") study of Oregon community pharmacies. Descriptive statistics and binomial logistic regressions were then performed to identify factors associated with willingness to sell a syringe 10-pack OTC. Factors included in the analysis were related to pharmacy type (chain vs. independent) and county characteristics (rurality, syringe service program presence, overdose rate).

Results: We contacted 425 pharmacies (361 chain, 64 independent) between December 2023 and March 2024; of those, 62.8% were in urban counties. Staff at 184 (43.3%) pharmacies reported that they would not sell a syringe 10-pack OTC. Urban pharmacies were more likely to restrict OTC syringe sales compared to rural pharmacies (adjusted odds ratio [2.11]; 95% CI [1.22-3.65]). No significant differences existed between chain and independent pharmacies.

Conclusions: Community pharmacies are well positioned to ensure access to sterile syringes, but our findings show that they are unreliable access points as nearly half of Oregon community pharmacies restrict patient access to OTC syringes. Unwillingness to sell OTC syringes was most pronounced in urban counties. Pharmacy-directed efforts are needed to ensure access to sterile syringes and address unmet health needs for people who inject drugs.