Harm Reduction Journal最新文献

Background: Research has explored barriers and facilitators to supervised consumption sites (SCS) in Canadian settings. Despite this, little is known about what factors drive individuals to initiate and repeatedly attend specific SCS where multiple SCS options are available, such as in Vancouver's Downtown Eastside (DTES). The aim of this study was to understand the structural, contextual, and operational determinants of regular SCS attendance during Canada's ongoing overdose crisis.

Methods: Rapid-ethnographic fieldwork was conducted over a six-week period at an integrated SCS in Vancouver's DTES. This comprised an initial five-week period of non-participant observation (≈200 h) followed by a community consultation regarding the research design and question protocols. Qualitative data were then collected through five focus groups (n = 25) and 20 semi-structured interviews with regular service attendees with data analysed using thematic analysis.

Results: Our findings highlight four important factors related to regular service attendance. The service had a regular clientele who described their attendance as routinized, which they attributed to four distinct factors: (1) the accessible location, (2) the on-site auxiliary health and support services, (3) the diversity of harm reduction provision, and (4) the atmosphere. Exploring the concept of atmosphere in more depth showed that it was characterized by the safety, familiarity, and inclusivity experienced within the service. Together, these factors facilitated a strong sense of belonging among attendees regarding the service and its community of staff and clients.

Conclusion: Within the context of an ongoing overdose crisis, our findings highlight SCS service characteristics which facilitate routinized engagement including accessibility, wrap-around support, comprehensive and tailored harm reduction, and an inclusive welcoming atmosphere. These insights can inform policy makers and service providers in scaling and developing effective, client-centred SCSs to reduce harm and promote wellbeing.

Background: This study investigates the impact of addiction history on interpersonal trust and access to social support. Specifically, it explores whether people exhibit decreased trust toward individuals with addiction histories, explores the extent to which positive portrayals can mitigate such distrust, and evaluates whether those with addiction histories receive reduced social support from their closest social networks, including friends and family.

Methods: Two complementary studies were conducted. Study 1 employed hypothetical scenarios to assess trust in both property-related and personal risk situations and examined whether counter-stereotypical information could reduce distrust. Study 2 used vignettes depicting individuals seeking assistance in differing relational contexts (friends versus family) to evaluate responses and types of support provided. Ordinary Least Squares (OLS) regression was applied to estimate the effects of experimental manipulations on trust and social support.

Results: Participants exhibited significantly reduced trust toward individuals with a history of substance abuse across both scenarios. Providing counter-stereotypical information significantly reduced distrust in the property risk scenario, but had no measurable effect on trust in personal risk contexts. Regarding social support, individuals with substance use histories received less informational support when assistance was requested by family members.

Conclusions: This research highlights the role of addiction stigma in shaping interpersonal dynamics, particularly in trust and social support. The findings suggest that targeted interventions addressing trust deficits, such as counter-stereotypical portrayals or trust-building programs, could play a role in reducing stigma and enhancing interpersonal relationships. Additionally, mentoring programs and improved access to informational resources may help bridge gaps in social support, especially where family support is limited. These insights have significant implications for rehabilitation programs, family support services, and community-based initiatives aimed at promoting successful recovery and reintegration.

Background: Since 2016, over 50,928 people have died of an opioid-related overdose in Canada. The unregulated supply of drugs is increasingly toxic and volatile, and fentanyl from unregulated, street-based markets is driving this epidemic. Concerns that existing overdose prevention approaches were insufficient to address the rising number of overdoses led to the implementation of safer supply programs (SSPs) in Canada. SSPs provide prescribed medications to people who use drugs and are designed for individuals at high risk of overdose for whom existing care options have been ineffective or inappropriate. Evidence of SSP impact is growing but implementation processes, including admissions, are not well understood nor well-described in practice guidelines. Our purpose was to describe how the admission processes of four Ontario SSPs evolved and how these changes influenced program reach and perceived effectiveness.

Methods: During 2021, we conducted short demographic and semi-structured interviews with healthcare providers (n = 21) from four SSPs in Ontario about implementation processes, challenges, and impacts. Thematic analysis of data concerning admission processes was conducted in MAXQDA and descriptive statistics in SPSSv28.

Results: Although the desire was for SSPs to have a broad reach, programs quickly realized they needed to develop strategies to manage the high demand for their programs. To manage this demand, strategies were implemented like waitlists, which were later replaced by points-based admission criteria. These admission criteria evolved over time, leading to a client population with high medical and social needs. The combination of high-acuity clients, limited capacity, and funding constraints, exacerbated by COVID-19, caused significant distress and burnout among service providers, prompting further changes to the SSPs.

Discussion: The implementation of SSPs in Ontario highlights the challenges of addressing intersecting public health emergencies in a resource-constrained healthcare system. SSPs, were adaptive and evolved in real time; while these adaptations addressed significant equity gaps, they also underscored the limitations of operating within an under-funded primary care model. The narrowing of admission criteria, necessitated by overwhelming demand and limited resources, ultimately constrained their reach and potential population-level impact.

Background: The overdose epidemic is presently driven by polydrug use, sparking renewed interest in why people initiate use of certain drugs or drug combinations. Current research privileges the physiological ends of consumption, often ignoring the social and environmental context of use. Framed by social cognitive theory, the purpose of this study was to characterize factors precipitating substance initiation, transition, and combination beyond the immediate effects of the substance(s).

Methods: We conducted 30 semi-structured interviews with people who use drugs across North Carolina, exploring substance use history and risk and protective factors of polydrug use. Participants also completed a visual timeline activity. We used a staged analytic approach, beginning with deductive Structural Coding and ending with inductive Reflexive Thematic Analysis at both the transcript and excerpt levels.

Results: We conceptualized substance transitions as pragmatic responses to environments of constraints and opportunities. Socially, transitions facilitated interpersonal closeness, aligned use with network norms, and responded to ubiquitous drug availability. Transitions also reflected navigation of material constraints, including which substances were locally available, logistically accessible, and financially sustainable.

Conclusions: Beyond the desire for new or enhanced physiological effects, substance transitions serve social and practical functions, like facilitating emotional closeness and responding to market conditions. Interventions to reduce the risks of use should expand viable options by addressing structural barriers and promoting safe, affordable, and accessible supply.

Background: The use of psychedelics is currently increasing in the United States. Awareness of clinical trials investigating the therapeutic applications of psychedelics may result in a record number of people who use psychedelics for the first-time. This study aimed to develop a harm-reduction resource to facilitate safe and successful psychedelic experiences outside of regulated clinical and research settings. We employed a community-based approach to crowdsource practical recommendations for first-time psychedelic experiences from the psychedelic community.

Methods: We conducted an online survey with 581 individuals who reported psychedelic use (N = 581) on recommendations for people using psychedelics for the first-time, following the principles of community-based collaborative research. The survey assessed recommendations for and against specific psychedelics for first-time experiences, recommendations for and against combinations of psychedelics, and other advice for first-time experiences. Open-ended follow-up questions were included to understand participants' reasons for their recommendations. An experienced qualitative researcher and two qualitative coders analyzed responses to open-ended items.

Results: Most participants recommended psilocybin for first-time psychedelic experiences, approximately half recommended cannabis, and a third recommended MDMA/MDA (3,4-methylenedioxymethamphetamine/3,4-methylenedioxyamphetamine, ecstasy, molly). These substances were favored for their moderate intensity, dose-dependent effects, precise dosing, and relatively short duration of effects. Conversely, substances such as ayahuasca, DMT (N,N-dimethyltryptamine), 5-MeO-DMT (5-methoxy-N,N-dimethyltryptamine), and Salvia divinorum or salvinorin A were not recommended due to their intensity, mental and physical health risks, and safety concerns. Participants advised against mixing psychedelics with alcohol, stimulants, antidepressants, and narcotics/opiates. Additional recommendations included embracing the experience, learning about the substance and its effects, and setting intentions for the experience.

Conclusions: Given the growing interest in psychedelics despite limited legal access and systematic education available, it is crucial to inform the public about practices that minimize risks. This project compiled recommendations from individuals who self-identified being experienced with psychedelics. The active involvement of the psychedelic community may enhance research quality and public trust in the findings.

Background: Impulsivity is a key contributor to substance use disorder, with previous research consistently demonstrating its role in the initiation, continuation and severity of drug use. Less is known about its association with injection-related risk behaviours, including injection equipment sharing and public injection, important drivers of HCV and HIV epidemics among people who inject drugs (PWID).

Methods: Data were drawn from HEPCO, an ongoing community-based cohort study of PWID in Montreal, Canada. We used the first observation from participants who reported injecting drugs in the past three months and were administered the Cambridge Neuropsychological Test Automated Battery (CANTAB) (August 2017-March 2020). The Stop Signal Task was administered to measure "response inhibition," i.e., an individual's ability to inhibit a prepotent or automatic response when presented with a stop signal or cue. Stop-signal reaction time (range: 50-1000 ms) was analyzed as a continuous indicator of impulsivity. Univariate and multivariable logistic regression were utilized to estimate associations between impulsivity and i) sharing injection equipment and ii) injection in public places, and identify other correlates of the study outcomes.

Results: Of 156 PWID included in the study, 26 (17%) and 42 (27%) reported sharing injection equipment and injecting in public, respectively. The majority of participants were men (85%) and the mean age was 45 years. In multivariable analysis, impulsivity was significantly associated with injecting in public places (aOR = 1.26 per each 100-unit increase, 95% CI = 1.01, 1.60). Other correlates of injecting in public were: age (0.93 [0.88, 0.97] and unstable housing (3.51 [1.43, 8.61]). There was no evidence for an association between impulsivity and injection equipment sharing (0.85 [0.65, 1.10]).

Conclusion: This study underscores the importance of impulsivity in public injection, a behaviour strongly associated with HIV and HCV transmission among PWID. These findings highlight the need for public health interventions that both mitigate impulsivity, such as behavioural or pharmacological therapies, and accommodate it through expanding low-threshold harm-reduction services, including access to supervised consumption sites and sterile injecting equipment.

Background: The COVID-19 lockdown prompted changes in accessing opioid agonist therapy in England, but the lockdown and further adaptations could exacerbate inequalities in opioid agonist therapy availability across practices with different socioeconomic statuses. This study aimed to evaluate the impact of the COVID-19 lockdown on the prescribing of methadone and buprenorphine and how general practices located within areas with differing socioeconomic status responded to these policies in England.

Methods: This quasi-experimental study used a health administrative practice-level dispensing database from March 2019 to February 2022 and socioeconomic deprivation from the Office for National Statistics in England. General practices that prescribed methadone or buprenorphine were included. The monthly number of Defined Daily Doses (DDDs) and dispensed items were quantified. The monthly changes in DDDs and dispensed items during the COVID-19 lockdown were also calculated. Interrupted time series analysis was used to evaluate the impact of the COVID-19 lockdown in March 2020. For practices with consistent prescribing (any OAT prescribing from December 2019 to February 2020 and 6 months during the lockdown), a group-based trajectory model explored the variability between practices.

Results: A significant level elevation (β₂ = 473,678.3, p = 0.002) and slope decrease (β₃ = - 46,396.6, p = 0.03) in DDDs of methadone, and a level elevation (β₂ = 114,041.9, p = 0.002) in DDDs of buprenorphine were found after COVID-19 lockdown. Practices located in the more deprived areas were more likely to prescribe OAT consistently, and 16.8% of practices were categorised into decreasing methadone dispensing during the COVID-19 lockdown, and 5.4% of practices were classified as increasing dispensing of buprenorphine. There was a tendency for practices located in deprived areas to be grouped into the trajectory of decreasing methadone dispensing, but not with buprenorphine.

Conclusions: The COVID-19 lockdown limited the prescribing of methadone and increased the prescribing of buprenorphine in England. Further studies should adopt individual patient data to investigate the potential reasons for limiting the prescribing of methadone.

Background: Illicit anabolic-androgenic steroid (AAS) use poses physical and psychosocial risks. These issues are exacerbated by inadequate public health responses and well-meaning yet inadequately trained health workers. This study presents the development of a collaboratively designed health conversation tool, which equips health workers' with a number of questions and strategic information to promote well-informed use for people who use AAS.

Methods: This qualitative, multi-stage study co-produced a health conversation, a guided conversation tool that aims to incorporate a brief assessment, knowledge provision, sharing of harm reduction strategies and advice for health workers engaging with people who use AAS in community settings. The iterative co-design process followed a five-stage pedagogical approach (ideation, planning, creation, programming and sharing), guided by semi-structured interviews with 25 people who use AAS and a workshop focus group of 6 experienced AAS peers for further refinement. Guided discussion included exploration or harms, health enhancement and required resources. Qualitative responses were synthesised via inductive analysis to identify key themes, from which the conversation was developed and then tested with the AAS peer group.

Results: There were two core findings from this research. Firstly, insights gained from people who use AAS in the key current practices related to safer use of these drugs. Secondly, based on these insights, a health conversation tool was co-produced, which encompasses a brief assessment, gauging people's experiences with AAS, confidence in their knowledge, and support systems. The tool provides health workers with a suite of harm reduction strategies to offer to people who use AAS, such as proper injection techniques, considerations regarding their usage strategy, and suggestions for health monitoring.

Conclusions: The collaborative design process ensured the health conversation tool reflected the lived-living experiences and priorities of people who use AAS, specifically fostering trust and engagement. This peer-driven approach filled gaps in harm reduction services, promoting informed decisions regarding AAS use as well as some health strategies. Expanding the peer workforce and integrating digital platforms can enhance the reach and sustainability of tailored harm reduction interventions for AAS and other communities.

Background: Chemsex, involving substances like methamphetamine, GHB/GBL, and mephedrone among gay, bisexual, and other men who have sex with men (GBMSM), poses HIV and health concerns. Despite existing integrated care programs, uptake remains low, highlighting a missed opportunity for self-help harm-reduction digital strategies. This study employs a collaborative design approach, integrating insights from the community on the app prototype and assessed usability to guide future interventions.

Methods: The app prototype was built on two design principles: recovery as a continuum with evolving goals like harm reduction and temporarily not using, and harm reduction dimensions on drug-, sex-, and HIV-related harms. Features were integrated into UPrEPU, a user-centered app supporting HIV PrEP adherence through flexible dosing and personalized reminders. Users could set goals, such as reducing chemsex frequency, supported by tailored feedback. The app includes an emergency alert system, local resources for clean needles and HIV testing, and myth-busting for the chemsex community. GBMSM with recent chemsex experience tested the app between January-December 2024. A one-month evaluation followed using the mHealth App Usability Questionnaire (1-7 scale, lower score indicates higher usability) and an interview to assess usability and impact. Interview transcripts were analyzed based on design themes to gather users' reflections and suggestions for enhancing harm reduction features.

Results: Twenty GBMSM aged 23-46 in Taiwan reported a positive perception of usability (mean = 2.14, SD = 1.15). However, users indicated that HIV PrEP functions were utilized more frequently than drug-related functions. Dynamic goal setting should be more intuitive and tied to lived experiences, reflecting one's physical and mental state. Inadequate social support led individuals to adopt self-reliance strategies, such as tracking HIV PrEP uptake, setting hydration reminders, and prioritizing self-care. This extended to managing cravings, adhering to dosage limits, and achieving control over their health. Users emphasized the need for tools to go beyond drug-related features, focusing instead on helping them plan their time and set broader life goals, supporting a more holistic approach to well-being.

Conclusions: A collaborative, user-centered approach to app design shows promise for digital solutions addressing chemsex-related harms, including HIV prevention, with functions closely tied to lived experiences.