Harm Reduction Journal最新文献

The study examines whether tetrahydrocannabinol (THC) use alone affected sustainability of weekly take-home methadone medication among a small sample of 33 patients attending a single opioid treatment program, under special exception by state and federal governments during the Covid-19 pandemic. Kaplan Meier analyses of survival rates in months of eligibility for take-home methadone showed that the majority of patients with continuing THC use remained eligible for 10 months despite continued THC use. Majority were employed, insured, and housed stably, but Log Rank Tests on these predictor variables showed no statistical significance. The socioeconomic stability of the cohort may indicate THC use alone may be less important in restricting take-home methadone and warrants further research.

Alabama, like other states in the Deep South, lacks comprehensive testing for novel psychoactive substances (NPS) and adulterants like xylazine, leaving gaps in the detection of drug supply changes. From August 2024 to July 2025, we implemented an active testing approach at an emergency department (ED) in central Alabama among people with active illicit fentanyl use. Testing residual biological specimens collected as part of health care offers a potentially useful window into the prevalence of NPS in the drug supply, particularly in communities where traditional drug checking services might be impermissible or difficult to resource. In this study, we used liquid chromatography-quadrupole time of flight mass spectrometry (LC-QTOF-MS) to test the participants' residual biological specimens (blood, urine) coupled with a survey focused on demographics and drug use. We enrolled 37 participants who completed surveys, and 31 who completed LC-QTOF-MS testing. 84% of participants were white (n = 31), 51.4% were male (n = 19), 54.1% were homeless (n = 20), and 45.9% resided in rural areas (n = 17). In participants with comprehensive toxicology testing (n = 31, 83.8%), we detected xylazine in 25 (80.6%). We identified the first confirmed case of medetomidine exposure in the state of Alabama. We also identified a high proportion of samples with the NPS o-methylfentanyl (n = 9, 29.0%), the first published identification of this substance in the region to our knowledge. Among participants with toxicology testing, 59.3% (n = 16) had previously heard of xylazine and 41.9% (n = 13) had knowingly used it in the past. This pilot study demonstrated the feasibility and practical utility of ED-based residual biological specimen illicit drug surveillance. This approach has the potential to identify new emerging substances in the unregulated drug supply.

Background: Substance use disorder (SUD) is highly stigmatized with pregnant individuals experiencing substance-related stigma at greater levels than the general population due to perceived deviance from societal norms. Pregnant individuals experiencing stigma may be more likely to delay or receive inadequate prenatal care. The purpose of this cross-sectional study was to understand self-reported enacted, anticipated, and internalized stigma of pregnant individuals experiencing SUD receiving prenatal care at Magdalene Clinic, a collaborative, trauma-informed OB-GYN clinic.

Methods: The Substance Use Stigma Mechanism Scale was administered to 226 individuals to measure past, present, and anticipated future experiences of substance use related stigma from family, healthcare providers, and self. Participant demographics and SUD diagnosis were abstracted from the participant's electronic medical record. One-way ANOVAs with Tukey's post hoc tests were conducted in January 2025 using SAS version 9.4 to analyze the relationships between stigma and all study variables. Additionally, Welch's ANOVAs with Games-Howell post hoc tests were run where Levene's tests indicated a variance of homogeneity.

Results: Significantly higher internalized stigma scores (n = 226) were associated with initiation of prenatal care in the second (M = 3.28, 95% CI [3.06, 3.50]) or third trimester (M = 3.73, 95% CI [3.32, 4.15]), compared to the first trimester. Individuals who used opioids/stimulants (M = 2.10, 95% CI [1.85, 2.34]) reported significantly higher stigma from healthcare providers than those using other substances. Individuals using stimulants (M = 2.77, 95% CI [2.51, 3.03]) reported higher levels of stigma from their family compared to those using other substances. Those with higher educational attainment reported significantly higher levels of stigma from healthcare providers than those with less than a high school diploma/GED (M = 1.64, 95% CI [1.42, 1.87]).

Conclusions: These findings suggest that higher internalized and source-specific stigma, particularly for opioid and stimulant use, may contribute to delayed prenatal care and highlight the need for stigma-reducing interventions for pregnant individuals with SUD. Additionally, these findings suggest that pregnant individuals with social advantages like higher educational attainment may face unique substance-related stigma. These results inform the need for supportive, empathetic healthcare that is need specific and responsive to the diverse experiences of those experiencing pregnancy and SUD.

Background: People who smoke crack cocaine face significant health risks, including communicable diseases and damage to respiratory health, particularly when using shared or homemade equipment. Despite this, there are currently no targeted harm reduction interventions in Wales for this population. This unique study demonstrates how Health Impact Assessment (HIA) can be used as a process to highlight the wider impacts of a proposed harm reduction pilot of the provision of safer inhalation devices (SIDs) in Wales, and how it has informed future actions and implementation of the scheme.

Methods: A participatory HIA was conducted using a structured process facilitated by the Wales Health Impact Assessment Support Unit (WHIASU). Stakeholder engagement included a workshop involving service providers, public health professionals, and individuals with lived experience of crack cocaine use. The process utilised HIA checklists to systematically assess the potential health, social, and economic impacts of implementing a SIDs pilot, as well as unintended consequences.

Results: The HIA identified a range of positive impacts associated with SIDs, including reduced risk of infections, decreased use of unsafe inhalation equipment, and increased service engagement. Participants emphasised the intervention's potential to reduce stigma and enhance trust, particularly for women, parents, and individuals with a history of adverse childhood experiences. Challenges were also recognised, including potential service strain, funding sustainability, and access barriers for rural populations. Suggested mitigations included mobile outreach and home delivery models. The HIA also highlighted the importance of including lived and living experience to inform future monitoring and service design.

Conclusion: This HIA underscores the potential value of an SID pilot in Wales as a means of addressing a critical service gap and reducing health inequalities among people who smoke crack cocaine. It demonstrates the utility of HIA in identifying both potential positive and negative impacts, and in shaping harm reduction strategies that are inclusive, and evidence informed. The findings provide a foundation for pilot implementation and evaluation, as well as a model for integrating HIA into broader public health initiatives and holistic harm reduction services.

Background: In March 2020, federal regulations were updated to improve access to methadone for people with opioid use disorder (OUD) during COVID-19, and in February 2024, these COVID-19 flexibilities were further updated and made permanent. During the same time, high rates of fentanyl use and opioid overdose persisted in Vermont and New Hampshire. It was not well known how opioid treatment programs (OTPs) were meeting the needs of patients who continued to use fentanyl while on methadone. This study explored the experiences of patients who used fentanyl while on methadone for OUD and their suggestions to improve care.

Methods: Semi-structured one-hour interviews and a brief survey were conducted with 30 patients who continued to use fentanyl while on methadone from 5 OTPs within 3 healthcare facilities in Vermont (n = 14) and New Hampshire (n = 16) from March 2023 to November 2024. Interviews focused on patient experiences with medication induction, dosing, fentanyl use, access to harm reduction materials, and recommendations to improve care. Interviews were audio recorded, transcribed, and analyzed using general thematic analysis.

Results: Most participants identified as White (90%; n = 27), male (53%; n = 16), and were unemployed (73%; n = 22). Patients' current daily methadone dose ranged from 35 to 220 mg, with commuting times from 10 to over 60 min. Six major themes were identified. Patients reported continuing fentanyl until reaching a sufficient methadone dose, after which fentanyl use decreased or stopped. Discomfort or withdrawal during induction was common, often triggering continued fentanyl use. Access to take-home doses was restricted and varied by state and OTP. Split dosing helped some manage cravings and reduce over-sedation for others. Naloxone and fentanyl test strips were highly accessible. Participants suggested structural changes to lower barriers to care, such as extending OTP hours and dosing windows. Three sub-theme patient recommendations to improve care also emerged including: (1) implementing a faster induction process, (2) increased access to take-home doses, and (3) expanded split dosing in OTPs.

Conclusions: This study highlights the importance of leveraging the expertise of patients who use fentanyl while on methadone to co-produce methadone treatment delivery. Findings may help inform the development of interventions to reduce barriers to treatment access and success within rural areas which may be slow to implement policy change.

Globally, young sex workers who use drugs (YSWUD) are at the intersection of laws and policies that criminalize and stigmatize both drug use and sex work which, when compounded by age, leads to increased state targeting and surveillance. Such punitive responses create significant barriers for YSWUD in accessing health, social, and harm reduction services, while also increasing exposure to structural and everyday violence (e.g., overdose risk, increased workplace violence, police targeting, etc.). In order to better highlight the global realities and priorities of YSWUD, this commentary brings together YSWUD from across the world to speak to their unique experiences and expertise with the aim of providing guidance around how service providers and policy makers can move beyond the logics of criminalization to best engage with YSWUD.

Background: Treatment for substance use disorders in Spain has traditionally been abstinence-focused and developed from an androcentric perspective, failing to address the specific needs of women who use drugs. Although abstinence-based models continue to predominate, cities such as Madrid and Barcelona now offer a broader range of services, including harm reduction approaches. The intersection between substance use and gender-based violence remains largely overlooked, especially in research and service provision, thereby reinforcing systemic inequalities and limiting access to appropriate resources. This article explores the intersection between drug use and gender-based violence among women, emphasizing harm reduction as a gender-sensitive approach.

Method: A qualitative study was conducted based on seventeen semi-structured interviews with women who have used or are currently using psychoactive substances in two major Spanish cities. The sample included women of diverse ages, nationalities, socio-economic backgrounds, and substance use profiles. Recruitment was carried out through a combination of strategies, including social media, snowball sampling, and engagement with a harm reduction center. Data were analyzed thematically using NVivo 14 to identify the types of gender-based violence experienced and the strategies employed to confront it.

Results: All participants experienced gender-based violence, including institutional, familial, intimate partner, and sexual violence. Structural violence and stigma further restrict their access to health, social, and legal resources, thereby increasing their vulnerability. Many women used substances as a coping mechanism in response to gender-based violence.

Conclusions: The study highlights the complex intersection between substance use and gender-based violence among women, emphasizing the need for tailored, intersectional harm reduction interventions and strategies to support women in safely and effectively reporting violence.

Background: Energy drinks are stimulant-containing beverages, primarily formulated with caffeine and marketed to enhance mental and physical performance. Unlike coffee, tea, or caffeinated soft drinks, these products are specifically designed as functional stimulants.

Purpose: This study aimed to assess university students' awareness of energy drinks and evaluate their consumption patterns, associated side effects, and reasons for use.

Methods: This cross-sectional observational study was conducted from April to August 2023 at three major universities in Kabul, Afghanistan: Kabul University of Medical Sciences, Kabul Education University, and Kabul University. We distributed 401 questionnaires to students across these institutions, achieving a response rate of 96.76% (n = 379 completed questionnaires). Thirteen students (3.24%) did not return their questionnaires. All collected data were entered and analyzed using SPSS software (version 21).

Results: All participants were male, with ages ranging from 17 to 29 years (mean = 21.1 years; SD = 3.9). Energy drink consumption was reported by 89.97% of participants, of whom 41.34% were occasional users (less than one drink per week) and 56.59% were habitual consumers (3-4 drinks per week). Higher consumption (more than one can) was significantly associated with living alone (P = 0.000) and daily coffee intake (P = 0.005). The primary reasons for consumption included needing energy (33.66%, n = 169), enjoying the taste (24.90%, n = 125), and increased use during exams to improve alertness (12.35%, n = 62). There were no significant differences in energy drink consumption across academic years (P > 0.05). Most students recognized caffeine (86.8%) and sugar (89.97%) as key ingredients. Habitual consumers reported reducing sleep hours more frequently than occasional consumers (34.89% vs. 18.18%; P < 0.05) and were more likely to use it to aid studying/major projects (83.28% vs. 14.66%; P < 0.05). Adverse effects were reported by 67.44% (n = 230), primarily palpitations (44.54%) and insomnia (21.56%).

Conclusion: This study identifies frequent energy drink consumption among university students, driven primarily by the desire to boost energy, enjoy the taste, and enhance exam-time alertness. Over half of participants reported adverse effects, such as palpitations and insomnia. These results suggest a role for targeted educational programs to increase awareness of health risks. Further, policymakers may need to evaluate existing regulations on energy drink marketing and availability to address potential public health concerns.

Background: People who inject drugs (PWID) are at increased risk for viral hepatitis, yet hepatitis A virus (HAV) and hepatitis B virus (HBV) screening and immunization rates remain low. Although offering HAV and HBV services at syringe services programs (SSPs) is effective, few U.S. SSPs currently offer them. Limited qualitative research exists on the advantages and optimization of these services at SSPs. This study explored PWID and SSP staff perspectives regarding barriers to HAV and HBV prevention and care services in traditional healthcare, facilitators for SSP-based provision, and opportunities to improve service delivery.

Methods: This study was conducted at an SSP in Miami, Florida serving over 2500 PWID annually. Quantitative data on vaccine administration from August 2023 to May 2025 were abstracted from the SSP database. Prior to implementation, in May 2022, we conducted in-depth interviews with 15 PWID and 11 SSP staff. Transcripts were analyzed using codebook thematic analysis in Dedoose.

Results: From August 2023 to May 2025, the SSP administered 114 HAV and 176 HBV vaccine doses. Qualitative interviews from May 2022 revealed several key findings. Barriers included limited knowledge, stigma and discrimination, resource and transportation challenges, navigation difficulties, and limited prioritization. Facilitators for SSP-based services included the benefits of co-located, on-demand care, and non-stigmatizing and supportive environment. Opportunities for improvement included offering incentives, expanding outreach, and increasing communication.

Conclusion: PWID face significant barriers to HAV and HBV services in traditional healthcare, including stigma, logistical challenges, and limited awareness of viral hepatitis. Integrating these services into SSPs enhanced accessibility and uptake by leveraging trust, convenience, and harm reduction principles.