Harm Reduction Journal最新文献

Purpose: The introduction of synthetic substances into the unregulated drug supply has driven a surge in overdose deaths, posing significant public health challenges in timely substance identification, engagement with people who use drugs (PWUD), and access to treatment. Maryland's rapid analysis of drugs (RAD) program, piloted through syringe service programs (SSPs), provides a proactive harm reduction strategy by integrating mail-in, laboratory based drug checking with broader public health services to enhance surveillance and improve engagement with PWUD. We aim to investigate the association of offering RAD drug checking with SSP metrics such as encounters with PWUD and access to wound care.

Methods: To investigate the association of RAD affiliation with SSP engagement and service metrics, a hierarchical linear model was employed to estimate percent changes in metrics such as encounters, naloxone distribution, and instances of overdose education. Metrics were analyzed on a log scale to account for skewness and variability across sites, with site-specific effects and random variation modeled to capture both baseline differences and the impact of RAD affiliation.

Results: Sites that became RAD affiliated saw an increase in many of the recorded metrics, such as wound care services per quarter (131%) and the number of participants per quarter (74%) while other metrics, such as testing, showed smaller changes. When adjusting for baseline trends of non-RAD affiliated behavior, most of the metrics still trend towards a positive association with RAD affiliation, but only Wound Care and Counseling reach statistical significance given the small number of sites remaining non-RAD affiliated for the full duration of data collection.

Conclusion: Participation in the RAD program shows a positive association with an increase in engagement and service delivery within Maryland's SSPs, suggesting it may be considered as a valuable public health intervention for improving outcomes for PWUD. However, further research is needed to explore causality and influence of factors like broader public health initiatives.

Background: Appropriate treatments for nonopioid substance use are currently unavailable. Venlafaxine may reduce withdrawal from nonopioid substances, but the effects have not been evaluated. We aimed to investigate the association between venlafaxine use and the risk of withdrawal from nonopioid substances.

Methods: We linked Taiwan's National Health Insurance Research Database and the Taiwan Illicit Drug Issue Database from January 2012 to December 2019. We used a case-case-time-control study involving a case-crossover analysis and a control-crossover analysis consisting of future cases. The outcomes were withdrawal from substances and all-cause mortality. For each individual, venlafaxine use during the hazard period (day - 8 to - 67 before the outcome) was compared with that during the 60-day reference period (between days - 248 and - 307). Conditional logistic regression was used to determine odds ratios with 95% confidence intervals to evaluate the associations between outcome events and the use of venlafaxine.

Results: The participants' average age on the index date was 39.5 years (standard deviation 8.7), with 84.1% men and 88.3% having low income. Venlafaxine was significantly associated with a lower risk of withdrawal from substances (odds ratio 0.35, 95% confidence interval 0.13 to 0.96). However, we found no association between the recent use of venlafaxine and all-cause mortality (1.08, 0.55 to 2.14). The point estimates were similar in a series of sensitivity analyses, though not all analyses statistical significance.

Conclusions: This study provides strong ground for clinicians to consider the use of venlafaxine to reduce patient experiencing withdrawal symptoms from substances.

Background: Kratom is a psychoactive botanical that is increasingly popular in the United States. While potential risks of kratom use have been identified, research on harm reduction strategies and contextual factors contributing to adverse reactions is limited. Given that kratom is federally unregulated at present, and a variety of kratom products are widely available on the commercial market, more data are needed to inform harm reduction efforts and public health messaging.

Methods: 102 participants (mean age = 22.34 years, 39.2% women) were recruited from ethnobotanical tea bars in Northern Colorado to complete a survey on kratom use, which included questions pertaining to adverse experiences.

Results: Most participants (75.5%) reported experiencing an adverse reaction to kratom at least once in the past, with a wide range of kratom doses reportedly consumed during these experiences. Adverse reactions were most commonly reported to occur in the context of consuming kratom on an empty stomach, consuming alongside certain foods, lack of hydration, and combining kratom with other substances. Participants employed a variety of strategies in attempt to mitigate adverse reactions, such as stopping or pacing their use of kratom and other substances, modulating hydration and food intake, and engaging in rest and recovery behaviors.

Conclusions: Adverse reactions to kratom may be associated with certain contextual factors. Several techniques are reportedly used to mitigate adverse reactions, but the efficacy of these techniques is unknown. More data are needed to understand the causes and consequences of adverse reactions to kratom, and to better understand potential harm reduction strategies for reducing adverse experiences. More research could also shed light on the extent to which kratom serving size and various product formulations (e.g. whole leaf vs. extracts) are predictive of adverse effects.

Background: People experiencing homelessness face disproportionate rates of liver disease, yet are often excluded from mainstream healthcare services. Vibration-Controlled Transient Elastography (VCTE) is a non-invasive method for liver screening increasingly used in community settings. However, evidence on implementing such screening pathways in outreach services remains limited. This study explored the views of clinicians and stakeholders on the barriers and facilitators to implementing a VCTE liver screening pathway within an assertive outreach drug and alcohol service in North West England.

Methods: A qualitative design involving semi-structured interviews was used to explore the implementation of the pathway. Twenty participants, including frontline clinicians and stakeholders involved in service design, commissioning, and delivery, were interviewed. Data were analysed using Framework Analysis guided by the Consolidated Framework for Implementation Research (CFIR). Both deductive coding using CFIR domains and inductive coding were applied.

Results: Key barriers included training costs, capacity within hepatology services, patients' difficulties in accessing healthcare, and uncertainties around continuity of funding. Facilitators included the immediate feedback provided by VCTE supporting harm reduction advice, targeted initial funding for services supporting people experiencing homelessness, a strong team culture of person-centred care, staff motivation, and the flexibility of the outreach delivery model. Challenges around interpreting results and navigating referral processes highlighted the need for stronger cross-sector collaboration and workforce development.

Conclusions: Integrating liver screening into outreach-based drug and alcohol services was considered acceptable by staff and stakeholders when supported by interagency partnerships, targeted funding, and motivated staff. Future implementation efforts should prioritise keyworker training and enhanced communication between drug and alcohol and hepatology services.

Background and aims: History of multiple substance use disorders (SUDs) or polysubstance use is highly prevalent, associated with worse treatment outcomes and higher mortality rates compared to single substance use. Although a few longitudinal studies have measured recovery progress over time, no metric explicitly quantifying recovery from polysubstance use is available. Here, we introduce the concept of proportion of remission (PrR) that provides a more granular and nuanced measure of recovery in individuals with polysubstance use and investigate its association with various Quality of Life (QoL) domains. We also report on individual SUD's contribution to QoL.

Design: Cross-sectional study design.

Setting: Remote study.

Participants: 2,406 participants with polysubstance use (polySUD; i.e., a history of two or more substance use disorders).

Measurements: Participants completed DSM-5 questionnaires regarding their lifetime and past 12-month substance use, Quality of Life measures, and demographics. Remission status was determined for each SUD based on meeting the DSM-5 criteria (excluding craving) in the past 12 months. Proportion of remission was quantified as the number of SUDs in 12-month remission divided by the total number of lifetime SUDs.

Results: PrR was significantly positively associated with environmental (B = 12.13, 95% CI: [9.68, 14.59], f = 0.2), physical (B = 10.75, 95% CI: [8.23, 13.26], f = 0.17), psychological (B = 7.73, 95% CI: [5.93, 9.52], f = 0.17), and social (B = 6.69, 95% CI: [3.45, 9.93], f = 0.08) QoL, after adjusting for covariates. Across SUDs, individuals not in remission exhibited significantly lower QoL compared to those in remission, with stimulants having the largest effect sizes (f = 0.39-0.42).

Conclusions: We propose a novel construct of polySUD recovery: proportion of remission. Our results indicate the potential of PrR to capture gradual improvements in quality of life and reflect recovery progress.

Background: Gay, bisexual and other men who have sex with men's (GBMSM) sexualised drug use, defined as taking psychoactive drugs before or during sex, is the focus of public health concern globally. 'Hi-fun' in Thailand (similar to the practice of 'chemsex' in Western settings) is a subset of sexualised drug use. Much harm reduction programming relies on Western chemsex definitions, obscuring critical variation related to local cultures, drug markets and legislative contexts. We aimed to develop, informed by transnational queer sociology, a locally grounded definition of hi-fun compared to other sexualised drug use types practiced among GBMSM in Thailand.

Methods: To delineate sexualised drug use types and explore structural and social influences on how hi-fun is practiced and organised, focus groups and in-depth interviews (April-Sept 2024) were conducted with GBMSM (with sexualised drug use experience within prior 12-months) recruited from community organisations in Bangkok, Khon Kaen and Pattaya. Data were transcribed, translated where necessary and analysed with a thematic framework.

Results: Participants (n = 30) were aged 25-47 years, 25 gay, ten living with HIV, seven born outside Thailand. Most (n = 23) used crystal methamphetamine (ice) before/during sex in preceding 12-months, with fewer taking other drugs (ecstasy/MDMA= 14, ketamine = 12, cocaine = 10, GHB/GBL = 5). Participants' accounts coalesced around three main sexualised drug use types: hi-fun, sex at homepas (medium to large parties where men socialise, usually while wearing only underwear) and incidental sex with drugs (spontaneous and situational combining sex with drugs, often after a night out). Hi-fun was delineated from other sexualised drug use types based on participant motivations to increase wellbeing through pleasure and intimacy, in contrast to homepas and incidental sex with drugs which were linked more to socialising. Crystal methamphetamine (ice) was considered foundational to hi-fun, whereas other drugs (e.g. cocaine, ecstasy/MDMA, ketamine and GHB/GBL) were more common in homepas and incidental sex with drugs. Technology, especially geolocation social/sexual networking apps, were central to hi-fun organisation, but potentially less important for other sexualised drug use types. Both hi-fun and homepas primarily took place in private settings, whereas incidental sex with drugs happened in a wider range of venues.

Conclusions: Hi-fun in Thailand can be defined as the intentional combination of sex and crystal methamphetamine (ice) to enhance intimacy and pleasure with one or more other man/men, facilitated by technology and usually in a private setting. This definition will be useful for those supporting GBMSM in Thailand through policy, research and service provision.

Background: People who inject drugs (PWID) are at high risk for acquiring and transmitting the hepatitis C virus (HCV). Access to HCV testing and treatment remains limited in rural communities. Mobile healthcare interventions are promising models to reach underserved populations like rural PWID. Understanding the characteristics of effective interventions to engage rural PWID in HCV care can guide design strategies for HCV treatment and elimination in rural areas.

Methods: The Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) study randomized 150 participants with chronic HCV to examine Mobile Tele-HCV Care (MTC) versus Enhanced Usual Care (EUC). On-the-spot qualitative interviews (n = 34) were conducted with study participants, community providers, and study van staff to understand the context for protocol implementation. For this study, qualitative coding and thematic analyses identified the characteristics of successful HCV treatment engagement among PWID in rural areas.

Results: This successful HCV treatment engagement intervention with out-of-treatment rural PWID had three essential characteristics: convenience, effective rapport, and skilled staff. Convenience factors included dependable and easily accessible locations with drop-in availability that made it easy to make HCV treatment a priority. Rapport with participants through a harm reduction approach engendered respect for autonomy and tailoring the protocol to accommodate the complexities of daily life that PWID face. Skilled staff were flexible across multiple roles including on-site phlebotomy, a notable barrier to rural PWID obtaining HCV treatment, and were competent in caring for PWID.

Conclusions: We identified salient characteristics that contributed to high trust and treatment adherence among a marginalized population of rural PWIDs. Tailored, flexible approaches and specialized skills are required to engage and retain PWID in rural areas.

Trial registration: NCT05466331.

Background: Synthetic cathinones that are primarily smoked-such as pyrovalerone-type compounds, including MDPV, MDPHP, α-PHP, and α-PHiP, often referred to as "Monkey Dust"-have raised growing concern in clinical and harm reduction contexts due to their association with severe adverse psychological and behavioral effects. To date, detailed empirical user-level data on patterns of use and related aspects are absent. To address this gap, the present study aims to integrate first-hand perspectives and key characteristics of individuals using smokable synthetic cathinones to examine patterns of use and experiences associated with these substances.

Methods: As part of a large cross-sectional online survey on synthetic cathinone use in general, this study investigated the use of smokable synthetic cathinones in Germany (March-May 2025). A sample of 107 participants who reported use within the past 12 months was analyzed in detail. Quantitative measures-combined with content analysis of open-text responses-captured sociodemographics, patterns, settings, and motives of use, mental and physical health, adverse effects, reduction efforts, and support needs.

Results: The majority of individuals who used smokable synthetic cathinones matched typical chemsex profiles (male, homosexual, urban, highly educated), yet non-chemsex use populations were also identified. One quarter reported using at least once a week and had high rates of problematic or dependent use indicators. One third reported a current mental disorder and symptoms of depression and anxiety were common. Frequently reported adverse effects included psychotic symptoms, anxiety, and panic attacks-consistent with the clinical profiles (e.g., sympathomimetic characteristics) typical of smokable synthetic cathinones-and were particularly prevalent among those reporting frequent use. Around one third reported applying safer use strategies, and nearly half had initiated reduction or cessation efforts.

Conclusions: This study provides the first systematic user-centered insights into the use of smokable synthetic cathinones, revealing heterogeneous populations with varying use patterns and risks. The findings highlight the need for targeted prevention and support strategies that address both chemsex-related and other emerging use profiles and settings.

Clinical trial registration: The study was prospectively preregistered with the German Clinical Trials Register (DRKS; drks.de/search/en/trial/DRKS00035946) in February 2025.

Background: Disparities in nonmedical opioid (NMO) mortality reflect a shifting geography of risk that presents urgent public health challenges. This study uses a socio-built environment (SBE) framework to investigate how place-based conditions shape NMO-related risks across urban, suburban, and rural municipalities in New Jersey.

Methods: Six SBE domains with multiple indicators were analyzed. Generalized linear models with a negative binomial distribution examined associations with NMO mortality, estimating incidence rate ratios with 95% confidence intervals. Domain-level contributions were assessed using log-likelihood ratio chi-square tests, with models stratified by geographies.

Results: The quality of residential, commercial, and community economic engagement domains contributed significantly to NMO mortality across all municipalities. The physical environment, community participation, and spatial access to opioid health programs domains were more influential in urban settings, with weaker or inconsistent effects in suburban and rural areas. Foreclosure rates, vacant storefronts, liquor license density, and indicators of economic distress were positively associated with mortality risk, while housing stability, business density, and higher per capita income were protective. Suburban and rural municipalities showed the largest disparities in mortality risk, with distances to naloxone sites nearly eight times greater than in urban areas (IRR = 7.88, p = 0.003). Urban municipalities benefited from closer proximity to syringe access programs, which was associated with reduced mortality risk (IRR = 0.92, p = 0.011).

Conclusion: Disparities in NMO mortality are shaped by SBEs that vary across urban, suburban, and rural municipalities. Housing instability, economic distress, and spatial access gaps in opioid health programs consistently contributed to elevated mortality, while stronger local economies and more stable housing were protective. These findings underscore that the risk of overdose mortality emerges through place-based conditions and call for strategies responsive to local SBEs, expanding affordable housing, strengthening community economies, and improving spatial access to harm reduction and treatment services across diverse geographic settings, as demonstrated in New Jersey.