Harm Reduction Journal最新文献

Background: Gambling Disorder (GD) is associated with significant personal and social harms, yet most individuals, especially those with mild to moderate symptoms, do not seek treatment. Online interventions offer an accessible and resource-efficient approach, but their cultural fit and feasibility across contexts remain unclear. This study examined the feasibility, engagement, and perceived cultural compatibility of a brief (1-week) Canadian self-directed gambling intervention among Israeli individuals with mild and moderate GD who were not actively seeking treatment.

Method: A sample of 102 participants (age range 19-74, 83.3% men) were recruited via a social networks campaign; 92 eligible participants were randomly assigned to either an interactive website online gambling intervention or to a static information-based control condition, with each condition including 1 week of participation. GD was assessed using the Problem Gambling Severity Index (PGSI) for screening and the Structured Clinical Interview for DSM-5 (SCID) for diagnostic classification. Participants completed daily self-report measures of interest, enjoyment, perceived benefit, and overall evaluation over seven days. Forty-five participants also participated in focus groups exploring user experience, engagement factors, and cultural relevance.

Results: Quantitative analyses showed that participants with mild GD in the website condition reported increasing levels of interest, perceived benefit, and task evaluation over time (ps < 0.01), while enjoyment remained stable. Participants with moderate GD in the control condition showed decreasing engagement across these variables (ps < 0.001). Thematic analysis revealed that engagement was supported by practical tools, privacy, accessibility, and perceived cultural fit, with participants emphasizing the value of autonomy and confidentiality in addressing gambling behavior.

Conclusions: Findings indicate that a brief self-directed online intervention is feasible and engaging for individuals with mild GD and shows high perceived acceptability and cultural compatibility among Israeli users. These results provide preliminary support for the cross-cultural scalability of evidence-based digital harm reduction tools and identify areas for future localization and long-term evaluation.

Background: Stimulant-affected drivers are overrepresented in global road trauma statistics, however, studies to date have not accurately defined how drug consumption contributes to increased risk of road trauma. This study examined whether attitudes toward drug driving predicts dangerous driving behaviour among people who currently use methamphetamine, and whether this differs to individuals with no history of any drug use.

Method: Three attitude factors (favourable attitudes toward risks, unfavourable attitudes toward sanctions, and favourable peer attitudes) were explored using an adapted version of attitudes towards drug driving scale and dangerous driving was measured using the Dula Dangerous Driving Index.

Results: A multigroup structural equation model indicated that individuals who use methamphetamine report more favourable attitudes toward drug driving compared to those who have never used drugs. Among people who use methamphetamine, a favourable attitude towards drug driving risks predicted higher dangerous driving behaviour scores, while more unfavourable attitudes toward sanctions for drug driving predicted lower scores. Among those with no history of substance use, favourable peer attitudes toward drug driving predicted dangerous driving behaviour.

Conclusions: Attitudes towards drug-driving, and their relationship to dangerous driving behaviour differs between those who use methamphetamine and those who do not have a history of substance usage. Targeted campaigns aimed specifically at reducing methamphetamine-related road trauma should challenge general underlying beliefs and attitudes about drug driving, rather than simply the impact of potential sanctions or influence of peers.

Background: Sex workers who use drugs are disproportionately impacted by the current overdose crisis and face many structural barriers to health and harm reduction services. Delivered in either community (e.g., embedded in supportive housing) or clinic (e.g., hospitals) settings, overdose prevention services are crucial harm reduction interventions. Gaining insight into which services sex workers use, and whether sex worker-specific programs impact this use, is key to identifying targeted prevention strategies and enhancing the continuum of overdose care for this population.

Methods: Data were derived from An Evaluation of Sex workers' Health Access (AESHA), a prospective, community-based cohort of women (trans-inclusive) sex workers in Vancouver, Canada (March 2017-March 2024). We plotted biannual trends in use of overdose prevention services, comparing community-based and clinic-based services (Aim 1), and used generalized linear mixed models to characterize uptake of overdose prevention services, including potential differences between community and clinic-based services (Aim 2). Finally, we evaluated the association between use of sex worker-specific programs and uptake of overdose prevention services, including potential differences between community or clinic-based services over the 7-year study period (Aim 3).

Results: Among 503 sex workers who used drugs, 82.1% (N = 413) used any overdose prevention services over the seven-year study. Uptake of community-based versus clinic-based overdose prevention services was 70.2% (N = 353) and 60.2% (N = 303), respectively. Use of sex worker-specific programs was positively associated with use of overdose prevention services (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI] 1.82-2.62), and this association was strongest for community-based services (AOR 2.66, 95% CI 2.21-3.20) as opposed to clinic-based services (AOR 1.73, 95%CI 1.41-2.13).

Conclusion: Uptake of overdose prevention services among sex workers is relatively high, but faced concerning declines over the study period, highlighting the need for additional interventions to scale-up access. Use of sex worker-specific programs facilitated wider access to overdose prevention services. Findings underscore the importance of expanding sex worker-specific and peer-led programs as part of scaling up overdose prevention efforts.

Background: The COVID-19 pandemic presented significant new needs and challenges for people experiencing homelessness (PEH) and people with substance use disorders (SUDs). In response, program leaders modified existing programs and developed new ones to meet these needs during a unique policy and public health environment. This study aimed to examine how these innovations unfolded and what lessons can be learned from their implementation.

Methods: We performed in-depth, semi-structured qualitative interviews with key informants (n = 37 informants) from programs serving PEH and addressing substance use created or adapted during the COVID-19 pandemic in the United States (U.S.) and Canada. Informants spanned a wide range of backgrounds, program types, and geographic locations. We completed rapid sequence qualitative analysis using templated summaries for each interview, which we compiled into a summary matrix. We reviewed the summary matrix to identify key topics and develop a code list that was applied to transcripts using line-by-line coding. Results from rapid analysis and line-by-line coding were discussed iteratively to develop and refine key themes.

Results: Key informants described innovations including SUD treatment and harm reduction interventions via telemedicine, hotel shelters, and street outreach. Interviews revealed four overarching themes related to innovation implementation: (1) Removal of usual bureaucratic barriers and easing of regulations facilitated action, (2) Individuals stepped up and said, "We're gonna do it," (3) Stigma and mixed attitudes about harm reduction impacted the implementation of pandemic innovations, and (4) Innovations in shelter and SUD care delivery for PEH during the COVID-19 pandemic resulted in durable lessons and new program models.

Conclusions: A combination of individual action and systemic changes produced new innovations to address the intersecting issues of homelessness and substance use during the COVID-19 pandemic. Lessons from these innovations can inform sustained improvements in SUD care for PEH.

Background: In April 2022, a new Drug Consumption Room (DCR) opened in Athens' city centre. To date, no qualitative research has evaluated the operational strengths and weaknesses of the site from the viewpoint of people who use drugs locally, including those who use the DCR and those who use in street-based settings who do not access the DCR.

Methods: Rapid-ethnographic fieldwork was conducted over a seven-week period. 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 with 24 regular DCR clients and 25 street-based interviews with non-DCR clients who consume drugs in street-based settings.

Results: Regular DCR clients reported increased physical, structural, and emotional safety and increased connection with auxiliary health and social services and staff and peers. Those who did not use the facility could see potential benefits but noted several operational and contextual barriers including anticipated stigma within the service and contextual and operational barriers.

Conclusion: Addressing DCR barriers could increase service access, reduce the presence and visibility of street-based drug use, and improve public health outcomes for people who use drugs in Athens. Indeed, some of these barriers have been addressed since the research was conducted (e.g. by expanding operating hours, increasing the number of staff with lived experience, offering on-site drug checking), illustrating the value of evaluating DCRs and subsequently adapting design and delivery based on the perspectives of actual and potential clients.

Background: There are increasing accounts of benzodiazepine adulteration and contamination in the unregulated drug supply in Canada and internationally. In some Canadian settings, drug checking services (DCS) are available for people to identify the constituents of their drugs. This study examines the relationship between suspected, unintentional benzodiazepine consumption and DCS utilization frequency, and whether gender modifies this relationship. We hypothesized that suspected unintentional benzodiazepine consumption would predict frequent DCS utilization, particularly for women, who may be at heightened risk for pertinent harms related to benzodiazepine use.

Methods: Data were drawn from a cross-sectional study (2021-2023) evaluating DCS that used spectroscopy and immunoassay strips in British Columbia, Canada. Multivariable ordinal logistic regression was used to examine the relationship between suspected unintentional benzodiazepine consumption and DCS utilization frequency, categorized as: once, > once and < once/month, once/month, > once/month and < three times/month, weekly, and > weekly. Potential confounders included age, population centre size, and frequent unregulated opioid use (≥ weekly). In planned exploratory analyses, gender was included as a possible effect modifier.

Results: Of 220 participants, 73 (33.2%) were women and 143 (65.0%) believed they had unintentionally consumed benzodiazepines in the previous six months. Bivariable ordinal regression showed a significant relationship between suspected unintentional benzodiazepine consumption and DCS utilization frequency (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.22-3.69). However, after adjusting for confounders, particularly frequent unregulated opioid use, this association was no longer statistically significant (adjusted OR: 1.49; 95%CI: 0.75-2.99). We also failed to find that gender modified the relationship between suspected unintentional benzodiazepine consumption and DCS utilization.

Conclusions: Findings suggest that frequent unregulated opioid use may best explain the frequency of DCS utilization. Although gender did not significantly modify the association between suspected unintentional benzodiazepine consumption and frequency of DCS utilization, continued research should explore the role and context of gender in this relationship.

Background: There are increasing calls for cross-cutting approaches to reducing stigma in health systems that do not silo specific identities, conditions, or practices. In our previous work, we proposed a 'universal precautions' approach to addressing stigma and its negative effects (Treloar et al. in Harm Reduct J 19(1):74, 2022), whereby health systems assume that all people who enter a health service might be concerned about being treated negatively or excluded in some way. This paper explores the possibilities and limitations of such an approach to stigma reduction by canvassing key stakeholder perspectives.

Methods: Qualitative interviews were conducted with 20 key stakeholders with extensive experience working within the alcohol and other drugs, blood-borne viruses, and sexually transmissible infections sectors. Participants were asked to reflect on the concept of a universal precautions approach to stigma reduction, including its acceptability, feasibility, utility in practice, and key challenges.

Results: Although interview participants strongly advocated for a need to address all stigma within health care, there were mixed attitudes towards the use of the term, 'universal precautions'. Some participants believed it would be useful to draw on a lexicon more familiar to health workers, while others expressed ambivalence and confusion about the term. Participants reflected on the possibilities of universality, in treating everyone with respect and providing non-judgemental care, while also emphasising that different client populations have specific needs that must be addressed. Many participants emphasised strongly that such an approach would need to be embedded at a systemic level, including having support from executive leadership, to address the structural forces that (re)produce stigma. Participants emphasised that centring the voices and perspectives of people with lived experience of stigma is integral to any approach to reducing stigma in health systems.

Conclusions: Findings highlight the various possibilities of adopting a universal approach that recognises the diversity and intersections in experiences of stigma. This research informs the development and implementation of novel stigma reduction initiatives in health care settings.

Background: In recent years, Boston has attempted to increase housing options and reduce overdose risk through the implementation of harm reduction housing (HRH) sites. Despite numerous harm reduction resources available to HRH residents, drug checking services are absent. Studies suggest that drug checking may prevent negative experiences associated with unexpected adulterants. Drug checking offers a window into concerning supply shiftsand helps monitor disruptions in the supply due to environmental changes, such as encampment clearings. Few studies have explored drug checking's application in housing programs. The establishment of the Massachusetts Drug Supply Data Stream, a statewide community drug checking program, allowed us to pilot real-time drug checking at HRH sites.

Methods: From September 2023 to February 2024, we administered surveys to 106 HRH residents. From September 2023 to March 2025, we conducted longitudinal interviews (baseline, 3-month, 6-month) with a subset of 28 survey respondents. In response to drug supply shifts and resident demand, starting on May 20, 2024, we implemented real-time drug checking services at three HRH sites located in Boston. Residents were asked to provide approximately 5 mg of their remnant substance in order to receive immediate test results using FTIR spectroscopy and immunoassay test strips. Survey responses pertaining to drug checking provision and real-time, on-site drug checking sample results were analyzed using descriptive and bivariate statistics. Longitudinal interviews and field notes collected during real-time, on-site service provision were analyzed to further contextualize resident experiences.

Results: Resident engagement with drug checking services was considerable, with fifty-five drug samples collected across nine site visits over three months. The services generated an increase in xylazine awareness among residents and provided chances to address concerns about the changing drug market amid heavy policing. Engagement with residents confirmed the need for on-site drug checking alongside other provided harm reduction services, and a consensus vocalized concerns with the local drug supply.

Conclusions: Real-time, on-site drug checking in low-barrier housing programs is a promising harm reduction approach for detecting shifts in the drug supply and can complement transitional housing interventions. Residents engage with these services with the intention of intervening upon personal, community, and market-level norms.

Background: People who co-use opioids and methamphetamine have high rates of incarceration. The criminal legal system is therefore increasingly tasked with providing substance use disorder treatment, including medications for opioid use disorder (MOUD). Unfortunately, treatment in carceral settings remains inconsistent and little is known about how people who co-use experience these treatment pathways. This qualitative study addresses this gap by analyzing how people navigate these overlapping systems of punishment and care.

Methods: We conducted in-depth, semi-structured interviews with 20 hospitalized patients in Washington State initiating MOUD with recent methamphetamine use and past-year criminal legal involvement. Interviews explored substance use trajectories, legal system contact, and treatment experiences. Using thematic analysis grounded in ethnographic principles, we identified common strategies and challenges participants faced in accessing and engaging with treatment.

Results: Participants described legal system involvement as stigmatizing, unpredictable, and difficult to escape. Metaphors like "entrapment" and "contagious" were used to make sense of the legal system's disruptive role and to show how social and structural factors increased people's vulnerability to the legal system itself, sometimes in substance-dependent ways. To navigate this legal environment, participants adopted strategies of both compliance and non-compliance, toggling between them to minimize risk of harm and maintain autonomy. These same strategies were carried over into carceral treatment, which was often experienced as an extension of punishment and ill equipped to meaningfully capture polysubstance use.

Conclusions: This study contributes to the literature on carceral treatment, detailing the lived experience of people who co-use opioids and methamphetamine with treatment access and legal system involvement as the two become more tightly linked. Mandated treatment often replicates carceral control and fails to accommodate the realities of polysubstance use. People who co-use developed adaptive strategies to navigate these systems, reflecting the need for treatment models that respect autonomy and reduce harm rather than criminalize. Our findings thus support the need for policies that provide consistent access to care and disentangle treatment from coercive legal oversight.