Harm Reduction Journal最新文献

Background: Lower risk gambling guidelines provide clear, actionable advice for reducing the risk associated with gambling by specifying behaviour associated with non-harmful use. Here we aimed to develop lower-risk guidelines specific to online sports and race betting in Australia that Currie (Addiction 112:2011-20, 2017) captured behaviours unique to this activity associated with high risk of experiencing gambling harms (e.g., depositing frequency, number of sports & races bet on) and Currie (Health Promot 34:1207-17, 2019) were based on objective behavioural data from a gambling operator not subject to self-report inaccuracies.

Methods: Customers from two large online wagering sites in Australia owned by the same parent company were invited to take part in a survey including the Problem Gambling Severity Index (PGSI) and the Gambling Harm Measure (GHM). Survey responses were matched to customer's account data provided by the operator, including all bets and transactions placed six months before and after the survey. The final sample consisted of 1,647 participants (84.6% male; mean age = 44.1).

Results: Receiver Operating Characteristic curve analyses were used to identify optimal threshold values for PGSI and GHM harm separately across eight behavioural indicators: frequency, spend, percentage of household income spent, number of different sports/races bet on, deposit frequency, deposit amount, percentage of household income deposited, and number of active wagering accounts (self-reported). All indicators had acceptable Area Under the Curve values (AUC; ≥ 0.6) except gambling frequency. Optimal threshold values were higher for GHM than PGSI harm, and higher than those established in studies using self-report data (e.g., ≤ 6% vs. ≤ 1% of monthly income spent) irrespective of the measure of harm. A dose-response relationship was observed, whereby surpassing more limits was generally associated with greater odds of reporting harm.

Conclusions: Our findings provide preliminary support for the following Lower-Risk Guidelines for Online Sports and Race Betting in Australia: Currie (Addiction 112:2011-20, 2017) make no more than four deposits per month, Currie (Health Promot 34:1207-17, 2019) deposit no more than 2% of your pre-tax household income per month, Rockloff (J Gambl Stud 28: 207-16, 2012) bet with no more than two different sites or apps, and as reported by National Health and Medical Research Council (Australian guidelines to reduce health risks from drinking alcohol, Commonwealth of Australia Canberra, 2020) stick to betting on four or fewer different types of sports or races. We strongly encourage further evaluation and testing of these guidelines to confirm their value across samples and over time.

Background: Syringe services programs (SSPs) provide evidence-based services to prevent the spread of disease and reduce overdose mortality among people who use drugs. To address unacceptably high levels of overdose, some SSPs have implemented advanced drug checking services (DCS) to identify illicitly manufactured fentanyl, xylazine, and other unexpected substances in local drug supplies. Advanced DCS improve people's knowledge of the illicit drug market and can support widescale dissemination of information for monitoring and evaluation of drug supply trends.

Objective: To investigate the barriers and facilitators to implementing advanced DCS at SSPs across the United States.

Methods: We conducted semi-structured interviews between May 31st and July 2nd 2023 with 23 SSP representatives in the United States. We used purposive sampling methods to include programs covering a variety of perspectives and experiences, varying by region, program type, and legal status. We used a deductive analytic approach to code transcripts and met weekly to refine codes and capture emerging themes. After identifying barriers and facilitators as key themes, we further coded the data using domains and constructs from the Consolidated Framework for Implementation Research.

Results: Eight of 23 SSPs provided advanced DCS. Most of these collaborated with external partners that hosted and maintained drug checking equipment, analyzed samples, and provided results. Five of these SSPs partnered with laboratories that offered mail-based services-through which participants could mail in their sample, and results would be sent back to SSPs for dissemination. The cost of machines and limited organizational capacity (e.g., staff, physical space) were key reasons that programs required partnerships to provide advanced DCS. Similarly, SSPs that were interested in but had not implemented advanced DCS noted cost and organizational capacity as primary barriers. Supportive laws and buy-in from law enforcement also impacted the implementation of advanced DCS.

Conclusion: The cost and organizational barriers SSPs face implementing advanced DCS can be addressed through collaboration with well-resourced partners. Advanced DCS through SSPs may first require supportive laws and law enforcement buy-in. Additional research on partnerships and other implementation strategies to support advanced DCS may provide a useful roadmap for SSPs interested in offering these services.

Background: People who inject drugs (PWID) face premature mortality, particularly from opioid overdose. In Sweden, harm reduction has expanded, including increased access to opioid agonist therapy (OAT) and the 2018 introduction of Take-Home Naloxone (THN). This study aimed to examine trends in all-cause and cause-specific mortality and to estimate predictors of all-cause and opioid overdose mortality among PWID in Stockholm.

Methods: We conducted a retrospective cohort study from April 2013 to March 2023. Data from the national Cause of Death Register were linked to Stockholm Needle and Syringe Program (NSP) records. Causes of death were categorised as opioid overdoses, external causes, internal/natural causes, or other/unknown. Crude mortality rates and age- and sex-standardised mortality ratios were calculated. Time-dependent Cox regression models estimated risk of all-cause death, and Fine and Gray subdistribution hazard models estimated opioid overdose mortality, accounting for competing risks. Person-time began at first NSP visit and ended at death, study end or censoring (> 365 days without a visit).

Results: Among 4192 participants, 685 (16%) died. The crude mortality rate declined from 36.75 to 27.04 deaths per 1,000 person-years and the standardised mortality ratio from 17.24 to 10.94. In multivariable models, reporting opioids as the latest injected drug was the strongest driver for both all-cause and opioid mortality. Other significant predictors included infrequent injecting and current contact with social services, psychiatry or addiction care, while OAT participation was associated with a lower risk. Male sex and age over 56 at enrolment were associated with a higher risk of all-cause mortality. Opioid overdose was the most common cause of death (53%). However, the opioid overdose mortality rate declined from 29.40 to 5.88 deaths per 1,000 person-years over the study period, coinciding with the 2018 introduction of THN and declining reported opioid injecting drug use among NSP clients.

Conclusions: All-cause mortality among PWID in Stockholm declined over the study period, alongside significant reductions in opioid overdose deaths, during a period of broadened harm reduction and reduced reporting of opioid injecting drug use. Our findings support continued scale-up of OAT and THN and consideration of supervised consumption sites to further reduce preventable deaths.

Background: The veterinary sedative xylazine is increasingly found in illicit fentanyl and has been associated with numerous health harms. Xylazine test strips (XTS) are an emerging technology that can theoretically assist consumers in avoiding xylazine, but they require real-world validation. We leverage community-based drug checking program data to compare real-world XTS performance to 'gold standard' methods.

Methods: Samples were initially assessed by dissolving 1 mg of drug product in 1 mL water and dipping an XTS ("first generation" Wisebatch™) in the sample. Subsequently, confirmatory testing was performed by sending samples to the National Institute of Standards and Technology for qualitative analysis using direct analysis in real-time mass spectrometry (DART-MS). A subset was analyzed quantitatively with liquid chromatography gas spectrometry (LC-MS) to quantify xylazine, fentanyl, and other compounds.

Results: A total of n = 1570 drug samples were analyzed between June 2023 and May 2025, and a total of n = 801 XTS were used. N = 715 comparisons between xylazine test strips and mass spectrometry results could be made, including n = 333 among samples that tested positive for fentanyl. Of these, n = 63 samples were confirmed to contain xylazine by mass spectrometry, of which the majority contained low concentrations (average concentration 2.3%; 78% of samples contained less than < 1% xylazine by weight). Of the 63, n = 34 were correctly identified as positive by XTS, yielding sensitivity of 54.0 %. Of n =  270 xylazine negative samples, n = 235 were correctly categorized (specificity = 87.0%). Most false positives occurred with lidocaine present.

Conclusions: In our sample, with a large percentage of low concentration xylazine samples, "first generation" Wisebatch XTS had a relatively low sensitivity, but higher specificity. This highlights the value of confirmatory testing and the complicated and often confusing nature of point-of-care test strips for novel substance detection. Lot testing and validation studies are needed to improve quality control in this area.

Drug-checking services (DCS) provide people who use drugs (PWUD) with crucial information concerning the substances they may consume. The intent of DCS is to reduce harms potentially associated with those substances, by providing evidence-based information about the contents of said substances and possibly influencing PWUD consumption-related behaviors. This pilot project reports on a network of 10 dedicated Raman spectroscopy drug-checking devices, located at various organizations throughout the province of Ontario, Canada. The spectrometers were specifically developed for drug-checking analysis and use machine learning (ML) enabled software to provide participants with automated, real-time results. The same software was also used to collect participants' demographic data and self-reported consumption-related behavior changes. In this work, we report on the results provided by this network over a 14-months period from July 2023 to August 2024 on 7752 samples provided by 5083 participants. On select samples, high-performance liquid chromatography-mass spectrometry (HPLC-MS) measurements were also collected to probe the accuracy of the results and quantify variations between the two techniques. Voluntary feedback was also collected from a limited number of participants concerning the potential impact the drug-checking process may have on their consumption-related behaviors.

Background: Chemsex, a form of sexualized drug use, is a growing public health concern among men who have sex with men (MSM) in Malaysia. It is associated with an increased likelihood of HIV transmission and other adverse health outcomes, such as overdose. Although harm-reduction services are proven to be efficacious in mitigating these outcomes, they often remain inaccessible because of stigma, criminalization, and limited availability of the service. This study examines the barriers MSM face in such services and explores how a mobile smartphone app with tailored features could help overcome these barriers.

Methods: From February to August 2022, six virtual focus groups were conducted with 22 MSM participants who had engaged in chemsex in the past six months. Participants were recruited through geosocial networking (GSN) applications and Facebook advertisements. The focus group sessions were recorded, transcribed, translated into English, and analyzed using thematic analysis.

Results: Participants described multiple barriers to practicing chemsex harm reduction, including limited knowledge of safer drug use, peer pressure, fear of legal consequences, and stigma from healthcare providers. They emphasized the need for a mobile app that provides reliable educational resources, peer support groups, discreet ordering of harm-reduction supplies (e.g., condoms, lubricants, sterile injection equipment), and access to emergency assistance during adverse events. Privacy protection and a simple, familiar user interface were identified as essential for building trust and encouraging sustained use of the mobile app and uptake of harm reduction services among MSM.

Conclusions: This study underscores the persistent structural and social barriers to harm reduction among MSM who engage in chemsex in Malaysia. A mobile app tailored to their lived experiences and privacy needs may offer a confidential pathway to harm-reduction information, community support, and linkage to services that MSM trust.

Introduction: In response to the overdose epidemic, novel strategies including Overdose Response Hotlines and Applications (ORHAs) have been introduced to help mitigate the crisis. These technologies enable individuals with a phone to access harm reduction support via smartphones and applications. Such supports include overdose monitoring, access to social services, mental health referrals, and more. This study analyzed data from the Canadian National Questionnaire on Overdose Monitoring (CNQOM), a large bilingual national survey, to evaluate the perspectives of people who use unregulated substances currently (PWUS-C), people who used unregulated substances previously (PWUS-P), and addiction service provider (ASP) on the importance of specific ORHA features.

Methods: One component of the CNQOM pertained to the importance of specific ORHA service elements. Examined categories included accessibility and technological features, overdose response functionality, data privacy and philosophies of care, additional support services, and substance usage. Each group responded to 33 questions on a 5-point Likert scale, and the data was analyzed using descriptive statistics involving percentages and ordinal logistical regression analysis.

Results: The study involved 971 participants: 840 PWUS-C, 298 PWUS-P, and 169 ASP. The majority of respondents from the key groups considered all ORHA elements important. Generally, the groups ranked the elements in a similar order of importance, with only minor variations. The highest-ranked elements in each element category with regards to importance were: 24/7 availability (84% of PWUS-C, 88% of PWUS-P, and 90% of ASP), the ability of EMS to resuscitate individuals during an overdose (81% of PWUS-C, 83% of PWUS-P, 85% ASP), non-judgmental support (87% of PWUS-C, 87% of PWUS-P, and 91% of ASP), access to mental health support (82% of PWUS-C, 84% of PWUS-P, and 90% of ASP), and feeling safer when using substances (80% of PWUS-C, 81% of PWUS-P, and 88% of ASP).

Conclusion: This paper highlights the importance multiple groups place on various elements of ORHAs, reflecting critical elements that should be considered when standardizing these virtual harm reduction technologies. The results of this study provide insight into opportunities to enhance virtual platforms, making them more responsive, accessible, and trusted as harm reduction resources.

Background: Prescribed safer supply consists of the provision of pharmaceutical alternatives to people who use drugs to reduce reliance on the highly toxic unregulated supply and mitigate risk of overdose. Prescribed safer supply programs (SSP) have recently been scaled-up in some Canadian jurisdictions, including Ontario, showing demonstratable individual and population level benefits. Differences between prior experiences of opioid agonist therapy (OAT) among clients enrolled in the SSP are not well described, including how safer supply programs differ from existing approaches to OAT provision.

Methods: Drawing on qualitative interviews (n=22) with participants of a safer supply program in Kitchener-Waterloo, a mid-sized southwestern Ontario city, we use thematic analysis to examine contrasting experiences of safer supply and OAT among SSP clients.

Results: There were several key differences identified between OAT and safer supply program models on key programmatic elements, particularly the medical management of withdrawal, tolerance, and medication side effects. Additionally, differences in the program model and philosophy of care impacted therapeutic rapport and provided greater autonomy for SSP clients. The greater autonomy for clients within SSP aligned strongly with client goals and helped maximize program retention, which is key to the public health goal of reducing overdose related mortality.

Conclusion: The findings underscore the benefits of - and urgent need for - collaborative decision-making and comprehensive models of care for substance use, including individualized dosing in both OAT and safer supply programs to improve their public health impact. Participants' experiences provide a window into reorienting to substance use care that offers potential solutions to longstanding challenges within existing OAT models that undermine retention and therapeutic benefit.

Chemsex is defined as the use of psychoactive substances - most commonly methamphetamine, synthetic cathinones, and Gamma-hydroxybutyrate/Gamma butyrolactone (GHB/GBL) - to enhance sexual activity primarily among gay, bisexual, and other men who have sex with men (GBM). It is associated with higher rates of sexually transmitted infections, HIV, and mental health conditions. However, despite substantial public health concerns regarding rising overdose deaths, the relationship between chemsex and overdose remains poorly studied. In this perspective, we synthesize the current evidence, identify critical knowledge gaps regarding the association between chemsex and overdose risk among GBM, and outline harm reduction and behavioral interventions. Assessing chemsex-related overdose deaths among GBM is challenging due to the limited documentation of sexual practices and sexual orientation in medical or legal records. Stigma further reduces disclosure, and chemsex involvement is rarely identifiable posthumously. Chemsex frequency and perceptions of harm also obscure problematic use. Effective pharmacologic treatments for stimulant dependence remain limited. In contrast, contingency management (CM) has been proven effective in reducing stimulant use, yet remains underutilized. Integrated harm reduction approaches are essential to mitigate the potential risks of chemsex. Key interventions include HIV testing, needle exchange, sexual health screenings, psychosocial interventions, and vaccinations. There is an urgent need for targeted research, improved data collection, and tailored harm reduction strategies to better understand and reduce overdose risk within chemsex contexts. Addressing these gaps is essential for reducing preventable deaths and improving health outcomes in this population.