Harm Reduction Journal最新文献

Background: Testing street drugs for the presence of active adulterants such as fentanyl and xylazine can provide the user some confidence as to the safety of their drugs.

Methods: We obtained 3 different commercially available xylazine and 3 different commercially available fentanyl test strips and evaluated them for analytical sensitivity using drug standards. The specificity of the fentanyl strips against fentanyl analogues was also assessed. Powdered fentanyl, xylazine, and fentanyl analogue standards were dissolved in water and serially diluted to bracket the manufacturer's stated test strip sensitivity. Each dilution was tested in duplicate until a negative result was obtained. The ability to discern positive from negative results under different lighting conditions was also assessed for one of the strips (two lots of reagents).

Results: All three xylazine test strips detected the drug at concentrations below the manufacturer's stated limits, however one strip was substantially more sensitive (at 50 ng/mL) than the other two (at 250 ng/mL). One of the fentanyl strips had the best sensitivity (at 3.5 ng/mL), well below the stated sensitivity of 20 ng/mL. The other two were less sensitive (at 7 and 250 ng/mL). For specificity against fentanyl analogues, all of the strips tested positive for all of the analogues tested, but at different levels. The visual endpoints for all of the strips were acceptable under normal lighting conditions, but cannot be read when the ambient light is low.

Conclusion: Based on these results, we selected one xylazine (Shanghai Accurature Diagnostics) and one fentanyl strip (W.P.H.M.) based on the best analytical sensitivity. The fentanyl strip chosen had varying degrees of specificity against the other manufacturers.

Background: Two-thirds of adults in the United States (U.S.) find recreational and medical cannabis use acceptable. Evidence shows that cannabis use is an effective treatment for pain, and as a harm reducing therapeutic for Substance Use Disorder (SUD). In contrast to most SUD treatment models, some models allow illegal substance use as a harm reduction strategy, which is the case for the SUD treatment program examined in this study. Little is known about veterans with SUD and their perspectives on cannabis use to treat pain. This study characterizes veteran perspectives on cannabis use to manage chronic pain, and pain-related anxiety and poor sleep, during treatment for non-cannabis SUD.

Methods: Thirty-three U.S. military veterans with a diagnosis of chronic pain, who were receiving care from a Veterans Affairs (VA) SUD treatment program were eligible to participate. Patients with polysubstance use could continue to use substances, as long as they committed to a goal of abstaining from the substance that was the primary focus of their SUD treatment. Most patients had a primary diagnosis of alcohol use disorder (70%), followed by opioid use disorder (18%), and stimulant use disorder (12%). Patients with a primary cannabis SUD were excluded. Patients completed a semi-structured interview. Content analysis identified key narrative themes.

Results: Approximately one-third of patients reported cannabis use during SUD treatment. Motivations for cannabis use were to alleviate pain, pain-related anxiety and poor sleep quality, and viewing cannabis as a harm reducing therapeutic. Approximately half of patients abstained from cannabis due to negative physical and mental effects experienced in the past, fear of returning to use their primary SUD substance, and to avoid the violation of policies or laws prohibiting cannabis use. Some patients who did not use cannabis showed interest in future cannabis use for pain based on recent cannabis science, laymen's knowledge and curiosity.

Conclusions: Patients with non-cannabis SUD may choose to use cannabis to alleviate chronic pain, pain-related anxiety and poor sleep quality, and as a harm reducing therapeutic during SUD treatment. VA and other federally employed clinicians, particularly in states where cannabis is legal, should prepare to educate patients on the medical evidence, gaps, policies and laws related to cannabis to help patients make more informed healthcare decisions related to cannabis use.

Introduction: People experiencing homelessness and alcohol dependence are vulnerable to a range of harms, and existing treatment options, which are often abstinence-based, are inadequate for this group because they may be unavailable, unsuitable, or not aligned with goals. Abstinence-based treatment programmes also rarely address underlying social and health issues faced by this population. Instead, alcohol harm reduction approaches provide individuals with support to reduce the harms associated with their drinking, without the need to stop drinking. Managed alcohol programmes (MAPs) are one harm reduction approach specifically designed for this group. MAPs provide alcohol in regulated doses through the day, alongside wider support for housing, physical and mental health, welfare, and social connections.

Methods: A realist review was conducted to explore the current evidence base for MAPs. Realist reviews aim to synthesise existing evidence to examine the contexts, mechanisms, and outcomes of complex interventions, on the assumption that the outcomes of these interventions are directly caused by underlying mechanisms which have been activated in particular contexts. Twenty-four initial programme theories were developed and then tested using international evidence and refined to 11 programme theories.

Results: A total of 60 sources were included in this review, highlighting a range of contexts, mechanisms, and outcomes relating to MAPs. The 11 programme theories demonstrate the need for MAPs in a context where abstinence-based treatment is the norm but is often unsuitable for this population. For MAPs to be successful for this population they need to enable autonomy, address clients' needs, create a sense of hope and purpose, and provide access to healthcare and other activities. MAPs can lead to a range of positive outcomes for those who access them.

Conclusions: Our theoretically informed exploration of service implementation can inform the design, development, and optimisation of future MAPs internationally. At a time when homelessness and alcohol deaths are increasing, innovative harm reduction approaches like MAPs are required to improve wellbeing and support health contextualised by the complex lives faced by some individuals.

A fentanyl vaccine would serve as a passive model of overdose prevention and a harm reduction strategy that could save the lives of those at risk of fentanyl overdose. Implementation of this innovation has the potential to be impeded by concerns for safety, efficacy, and risk of unintended harms, as well as resistance to change from clinical, programmatic, and public sectors. The Human Papillomavirus (HPV) vaccine also faced barriers to its implementation, with a lower acceptance rate than other standard vaccines. Concerted efforts to increase uptake of the HPV vaccine have been successful and contributed to the significant declines in HPV infections and associated precancers documented since its introduction. This report summarizes parallels between factors that negatively affected the acceptability of the HPV vaccine which may similarly impact acceptability of a fentanyl vaccine and summarizes potential strategies to mitigate barriers in the potential future implementation of a fentanyl vaccine.

Background: Harm Reduction (HR) approaches applied to substance use aim to decrease the toxic consequences of overdose. The addition of xylazine and benzodiazepines to fentanyl, the primary opioid in the US drug supply, increases the likelihood of overdose. Likewise, adding fentanyl to other popular substances, such as cocaine and methamphetamine, has further driven the exponential increase in opioid and stimulant overdoses. Engaging lay community members in HR efforts may help to combat the overdose crisis. Substance use is common in live music settings, and working musicians may be uniquely positioned within "the scene" - individuals who populate specific cultural niches within live entertainment - making them attractive candidates to assist with and/or lead lay HR promotion. Therefore, this study aimed to gather perspectives to inform a tailored needs assessment among working musicians in South Carolina using Community-Based Participatory Research (CBPR) methods to ascertain local patterns and impacts of substance use.

Methods: Using a CBPR framework, a three-person community leadership team and the academic research team collaboratively developed a semi-structured interview to guide focus groups with working musicians. A total of 19 working musicians participated in focus groups, followed by HR and naloxone administration training. The focus groups were audio-recorded, transcribed, verified for accuracy, and coded by a team of researchers using rapid qualitative analysis to identify themes and exemplar quotes.

Results: Participants reported observing a variety of legal and illegal substances used within the South Carolina music "scene" and broader community. Concerns reported by musicians included venue practices of over-selling to promote over-consumption of alcohol, using substances to "self-medicate", and recreational drug use misidentified as dependence. Although musicians suggested HR efforts are necessary, many lacked knowledge and awareness of HR tools and were unfamiliar with local HR initiatives. Barriers and facilitators include a lack of overdose knowledge and a close-knit community, respectively.

Conclusions: Using CBPR methods, we found that HR efforts are necessary in "the scene" of central South Carolina to leverage strengths to combat the national opioid crisis at the community level.

Background: HIV testing is critical for HIV prevention and treatment among PWID and their social networks. This study aimed to examine the trend of HIV testing among PWID in Iran. We also assessed the factors associated with HIV testing in 2020.

Methods: This study used data from three consecutive nationwide bio-behavioral surveillance surveys (BBSS) of PWID conducted between 2010 and 2020. The primary outcome variable was a history of HIV testing and having received the results within the past 12 months. Cochran-Armitage trend test was used to assess the trend of HIV testing over the years. Bivariable and multivariable logistic regression models were used to investigate factors associated with HIV testing in 2020.

Results: A total of 6887 HIV-negative PWID (2206 in 2010, 2092 in 2014, and 2589 in 2020) were included in the analysis. The uptake of HIV testing increased significantly from 25.1% (95% CI 23.9%, 27.6%) in 2010 to 30.0% (95% CI 28.0%, 32.0%) in 2014, and 39.3% (95% CI 37.4%, 41.2%) in 2020 (p < 0.001). In 2020, people with unstable employment (adjusted odds ratio [AOR] = 2.35, 95% CI 1.70, 3.25) had higher odds of HIV testing than those with stable employment. Also, the age at first drug use ≥ 18 years (AOR = 1.42, 95% CI 1.13, 1.80), and sufficient HIV knowledge (AOR = 1.71, 95% CI 1.37, 2.14) were significantly associated with higher odds of HIV testing.

Conclusions: Despite the increasing trend, HIV testing among PWID in Iran remains considerably low. Policies and strategies, such as HIV self-testing, expansion of harm reduction services to include HIV testing, and encouraging HIV testing among PWID, are required to increase HIV testing uptake in this population. Targeted interventions focusing on raising knowledge about the importance of HIV testing may contribute to further increased testing uptake among PWID.

Background: The unique challenges faced by vulnerable drug users highlight the urgent need for accessible, immediate digital interventions which people can access anywhere and at any time. This study explores the impact of the Here4UScotland virtual supervised consumption app, examining relationships between service users and providers, their separate relationships with harm reduction digital solutions and the app's effects on personal and collaborative service engagement.

Methods: The "Here4UScotland" app was piloted in Aberdeen, Scotland between May 2022 to Aug 2023, which incorporates its gestational inception to front-end live engagement. This qualitative study employed two focus groups (n = 8)). These were conducted independent of semi-structured interviews (n = 21) which individually investigated the various experiences of service users, supporters, and stakeholders. In total 26 people provided data which was thematically analysed using NVivo 12 to look for associated and relevant codes and themes using the Technology, People, Organisational, and Macro-environmental (TPOM) framework.

Results: Main technology themes were video calling, location and privacy and usability/connection. Under 'people' positive relationships, finding identify and enhanced digital safety were described. Organisational themes covered ways to cultivating trust, supporter's responsibility, and associated training for services and supporters. Key concerns emerged regarding the absence of crucial visual cues for staff and the potential for police involvement.

Conclusions: Digital interventions like Here4UScotland offer significant benefits in enhancing harm reduction engagement and access, fostering new connections and community among vulnerable populations. Digital access beyond virtual consumption was considered. For successful integration of this technology, it appears crucial to balance technological advantages with ensuring privacy, providing adequate training for staff, and integrating these solutions with existing services, rather than replacing essential human interaction.

Background: The health risks for people who use drugs (PWUD) in Chile are exacerbated by evolving drug markets, unpredictable supplies, and the limited availability of harm reduction services. Community-based drug-checking programs have shown effectiveness in reducing some of these risks; however, regional evidence remains limited.

Case presentation: In 2024, Reduciendo Daño (RD), a Chilean non-profit organization, conducted a peer-led drug-checking program, attending 22 electronic music events in Santiago. Event attendees interested in testing their substances placed small samples on the designated testing surface, after which staff conducted rapid colorimetric analysis and recorded the samples' characteristics and test results. RD staff analyzed 992 samples; most of the samples, according to the event attendees, were MDMA (78%), followed by ketamine (9%), cocaine (6%), tusi (5%), and other substances (2%). The analysis showed that more than 80% of the samples purported MDMA contained MDMA. 10% of the samples expected to be MDMA contained MDA instead, and the most common adulterant in MDMA samples was methamphetamine (8%). Cocaine was found in all samples expected to be cocaine (n = 62), but more than two-thirds of the samples (71%) were adulterated. Tusi samples (n = 48) were heterogeneous. Ketamine was the only substance detected in 42% of all the ketamine samples: 33% had a combination of ketamine and MDMA, 15% contained ketamine plus other substances, and 10% had no detectable substances. Excluding tusi, about 70% of the samples matched the attendees' expectations, 14% were adulterated, and 16% lacked the expected drug.

Conclusions: This peer-led harm reduction intervention provided timely and practical information to PWUD. The findings indicate that MDMA was the most common substance tested among attendees of electronic music events, that tusi showed considerable variability in its composition, and that cocaine was frequently adulterated with other substances. Together, these results underscore the need to strengthen and expand harm reduction initiatives in Chile, such as community-based drug checking programs, that provide information about substances and education on safer drug use.