Harm Reduction Journal最新文献

Background: Substance use disorder is a persistent public-health challenge in Iran, where multiple treatment settings operate in parallel. This study assessed within-modality changes over 12 months among clients in Methadone Maintenance Treatment (MMT), Drop-in Centers (DICs), Therapeutic Communities (TCs), compulsory (Article 16) treatment.

Methods: A prospective, naturalistic cohort was conducted across 15 routine-care centers in Kerman Province (May 2023-May 2024). Of 493 enrolled, 470 completed follow-up (MMT/DIC at 12 months; TC/compulsory at end-of-treatment [EOT]). MMT/DIC were assessed at baseline, 2 months, and 12 months; TC/Article 16 at baseline and EOT. Outcomes were assessed using the Maudsley Addiction Profile (MAP). Within-modality changes from baseline were estimated with mixed-effects models in Stata 15, using two-sided tests (α = 0.05).

Results: MMT was associated with reductions in alcohol, opium, and heroin use, lower odds of interpersonal conflicts, fewer physical/psychological problems, and fewer days of illness-related unemployment. DIC showed decreases in physical/psychological problems, drug-related harms (e.g., dealing), and fighting; changes in spouse/relative/friend-conflict indicators were not statistically significant. TC showed short-term reductions in several substances; employment decreased during the residential phase (a programmatic constraint rather than a change in employability). Article 16 showed declines in selected substances and health problems during observation; durability post-discharge remains uncertain.

Conclusions: Findings indicate domain-specific, within-modality changes rather than comparative effectiveness between settings. In TCs, short-term within-modality declines were observed in alcohol and selected illicit opioids at EOT alongside limited employment opportunities during residence due to programmatic restrictions. Within MMT, improvements were observed in selected psychosocial indicators at follow-up, consistent with stabilization during ongoing care. Within DICs, reductions were observed in health problems and certain risk behaviors, aligning with their harm-reduction and linkage role. Within Article 16, short-term declines were observed in selected substances and health problems during observation; durability after discharge is uncertain without structured aftercare. Overall, no single modality appears universally superior; matching clients to treatment according to target outcomes, and implementing stepped-care or blended pathways with robust post-treatment supports-particularly following compulsory programs-may optimize long-term impact.

Illicitly manufactured fentanyl (IMF) and amphetamine-type stimulants (ATS) are driving the fourth wave of the opioid crisis in the United States and Canada. Accordingly, the aim of this paper was to determine the presence of heroin, fentanyl, ATS, xylazine, and other substances in Tijuana and Mexicali, Baja California, two cities on the US-Mexico border. We also tested the positive predictive value of fentanyl and ATS test strips. To do this, we randomly selected 300 drug residues from syringe plungers provided by two non-governmental organizations (NGOs) with harm reduction programs (one in each city) and from community samples obtained at shooting galleries and meeting places for people who inject drugs. We then analyzed them with GC-MS and BTNX test strips for amphetamine-type stimulants (ATS) and fentanyl and its analogs. Test strips showed a high positive predictive value of 81% when compared with GC-MS. Most residues had fentanyl, followed by methamphetamine, heroin, and xylazine. Fentanyl and methamphetamine co-occurrence were the norm rather than the exception in drug residues. Xylazine was more prevalent in fentanyl-containing samples in Mexicali, whereas the combination of fentanyl and methamphetamine was more common in Tijuana. Benzodiazepines were not detected in any of our samples. In conclusion, in two key Mexican northern border cities, most heroin samples contained fentanyl. Opioid and ATS use was common in Tijuana and Mexicali, while xylazine emerged as a significant adulterant in Mexicali and was subsequently detected in Tijuana. The evolving drug market demands continuous drug testing while public health policies are required to address the challenges raised by this scenario.

Background: Rural communities often face higher rates of opioid-related harm but fewer resources to address risk. Pharmacies in these areas are critical for opioid overdose prevention and treatment for opioid use disorder (OUD) as they may serve as patients' only healthcare access point. Pharmacists in these communities can provide opioid overdose-related education, counseling for OUD, and follow-up care. However, little is known about pharmacists' knowledge and practices regarding the delivery of these services. It remains unclear to what extent rurality or pharmacist years of practice experience influence knowledge and practices related to opioid overdose treatment and prevention.

Methods: A cross-sectional survey was disseminated to 150 pharmacists in the Rural Research Alliance of Community Pharmacies (RURAL-CP). The survey contained 20 items, which included demographic, knowledge-based, and practice-based questions.

Results: The survey had a 52% response rate (n = 78). Participating pharmacists demonstrated strong baseline knowledge related to naloxone and buprenorphine. Regarding rurality, no significant difference in pharmacists' composite knowledge scores based on RUCA code was found ((p = 0.12). Neither rurality nor years of practice experience were significantly associated with the offering of naloxone, overdose counseling, or the dispensing of buprenorphine and naloxone. Only 10.3% of pharmacists always provided overdose counseling and only 1% of pharmacists always offered naloxone to patients filing an opioid prescription.

Conclusion: This is the first multi-state study to provide a comprehensive look at the knowledge and practices related to opioid overdose prevention and treatment services for OUD across rural community pharmacists in the Southeastern United States. While no major differences in knowledge based on rurality or practice experience were found, there was low implementation of key overdose prevention practices in these pharmacies, particularly overdose counseling and naloxone offering. These findings highlight that the barriers are not related to pharmacist knowledge, but rather service implementation.

Background: As interest in human enhancement continues to rise in Europe, kratom (Mitragyna speciosa) products have raised significant public health concerns. Kratom, which is used for its dose-dependent stimulant and sedative effects, has grown in popularity to enhance mood and self-manage pain or opioid withdrawal symptoms. This study aimed to assess the East-Central European online kratom market, evaluate product quality, and analyze potential toxicological risks to inform evidence-based harm reduction strategies.

Methods: A comprehensive approach was employed, including online market surveillance, detailed content analysis of vendor websites, test purchase of products, followed by chemical analysis. Google search engine results were used to identify vendors shipping to Hungary. A total of 59 web shops were identified, and 25 distributors were selected for further analysis. Eight online sellers were included in test purchases. Mitragynine content was analyzed using supercritical fluid chromatography coupled with tandem mass spectrometry (SFC-MS/MS) and high-performance liquid chromatography with diode-array detection (HPLC-DAD). Toxicovigilance data were extracted from the United States Food and Drug Administration Adverse Event Reporting System (FAERS) and the Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS).

Results: The online kratom market in East-Central Europe is extensive and accessible, with many sellers identified in Hungary, the Czech Republic, Slovakia, and the Netherlands. While 68% (n/N = 17/25) of the evaluated web shops promoted enhancement effects, only 32% (n/N = 8/25) presented any information on potential adverse effects. Analysis of the products revealed highly variable mitragynine content, with mean concentrations ranging between 14.16 and 18.41 mg/g in powder form, and 42.60-210.20 µg/mL in prepared teas. Vigilance databases revealed 1090 cases in FAERS and 630 in CAERS associated with kratom use, with high rates of serious outcomes, including 592 deaths reported in FAERS.

Conclusions: The online kratom market in East-Central Europe poses a significant public health threat, particularly to individuals seeking its enhancement effects. The significant variability in the mitragynine content, combined with the lack of safety information creates a high-risk environment. Toxicological data revealed a high incidence of serious adverse reactions, particularly in cases of polysubstance use. These findings highlight the urgent need for regulatory oversight and harm reduction strategies.

The United States' legal responses to substance use and addiction have led to frequent interactions between people who use drugs (PWUD) and criminal-legal systems. Interactions with policing, courts, detention facilities, and community supervision can shape health risk and disrupt access to services. Behavioral health and harm reduction organizations also frequently experience law enforcement interference on the program level. To better understand this structural determinant of PWUD health, we developed survey measures that assess PWUD's contact with criminal-legal systems across 10 harm reduction studies. Using input from experts and leveraging the National Institutes of Health Research on Interventions for Stability & Engagement network, the survey captures a broad range of legal interactions. The resulting measures enhance comparability across studies, informing policies that address the complex relationship between criminal-legal involvement and health outcomes for PWUD, particularly in overdose prevention efforts.

Background: Flavored e-cigarettes remain a controversial public health topic, with disagreement on their potential benefits and harms. In this study we compared patterns of flavor use in e-cigarettes at the time of quitting smoking between young adults (18-24 years old) with older adults (> 24 years old).

Methods: A convenience sample of US adults who formerly smoked and reported consuming e-cigarettes every day or some days during the period of quitting smoking were included in the study (N = 51,641) and responded to an online questionnaire. Participants were divided into young adults (n = 9895) and older adults (n = 41746).

Results: The most popular flavors used regularly by young adults and older adults were fruit (92.3% and 81.3%, P < 0.001), followed by dessert/pastry/bakery (67.3% and 68.1%, P = 0.054) and candy/chocolate/sweet (49.7% and 43.3%, P < 0.001). Fruit was the most prevalent single most often used flavor for both groups but was more prevalent in young adults (63.4% vs. 46.0% in older adults, P < 0.001), followed by dessert/pastry/bakery which was more prevalent in older adults (32.1% vs. 22.7% in young adults, P < 0.001). Menthol and mint/wintergreen flavors, while the fourth and fifth most popular flavors used regularly, were the single most often used flavors by only a small minority in both groups. Tobacco flavor was the single most often used flavor by 1.1% of young and 6.0% of older adults (P < 0.001). From logistic regression analysis, being a young adult was positively associated with the use of fruit (OR: 1.65, 95% CI 1.16-2.35), menthol (OR: 1.58, 95% CI 1.09-2.30), mint/wintergreen (OR: 1.51, 95% CI 1.00-2.28) and non-alcoholic/non-coffee drink (OR: 1.83, 95% CI 1.18-2.83) flavors, and negatively associated with the use of tobacco (OR: 0.52, 95% CI 0.34-0.78) flavor at the time of quitting smoking.

Conclusion: Non-tobacco flavors were popular among the US adult former-smoking e-cigarette consumers at the time of quitting smoking, but different flavor preferences exist between young and older adults. Tobacco flavor use prevalence was low, as were menthol and mint/wintergreen, particularly as the single most often used flavors. Future studies should explore patterns of e-cigarette flavor use in young adults who smoke or used to smoke, in addition to those with no smoking history.

Background: As the use of psychedelics increases in both therapeutic and non-clinical settings, reports of extended post-experience difficulties have also emerged. While many individuals integrate their experiences effectively, others face persistent challenges. Despite growing recognition of these issues, there is limited research on best practices for mitigating and addressing prolonged post-psychedelic difficulties. This study explores expert perspectives on the nature of these challenges and optimal support strategies.

Methods: A qualitative survey study was conducted with 28 professionals who support individuals navigating post-psychedelic distress, including psychiatrists, psychotherapists, psychedelic integration coaches, and retreat facilitators. Structured Tabular Thematic Analysis (ST-TA) was applied to identify high-consensus themes related to extended difficulties and effective integration practices.

Results: Practitioners consistently reported six key post-psychedelic difficulties: (1) existential struggle and ontological shock, (2) anxiety and panic, (3) self-perception issues, (4) dissociative symptoms, (5) resurfacing of repressed material and trauma, and (6) disappointment due to unmet expectations. The most frequently recommended support strategies included (1) individual psychotherapy, particularly trauma-informed approaches, (2) grounding and mindfulness techniques, (3) peer and community support, (4) meaning-making and narrative reconstruction, and (5) in some cases, short-term psychiatric medication. While psychiatrists emphasized medical stabilization and symptom management, psychotherapists and integration coaches focused on existential meaning-making, emotional processing, and community-based support.

Conclusions: Our findings highlight the need for trauma-informed, cross-disciplinary approaches to psychedelic integration. Ensuring access to ethical, evidence-based support-both clinical and community-based-is important for further developing harm reduction strategies as psychedelic use expands in the western world. Future research should explore culturally diverse integration practices and inform therapeutic protocols for mitigating post-psychedelic distress.

Background: A collective identity is a set of shared values and value propositions that an investigator network projects as they deliver data and knowledge generated through their studies to community partners, policymakers, research participants, public health authorities, and prospective end users. The strategic process of identifying common values and establishing procedures to ensure the consistent communication of a collective identity across a diverse network of research teams is often not considered in research networks' dissemination of results. This paper describes how the HEAL Research on Interventions for Stability and Engagement (RISE) network co-created communication pillars that embody a set of common values and shared research imperatives to frame dissemination activities.

Methods: Early in the development of RISE, project teams participated in an in-person workshop to identify attributes and core values that they believed to be representative of their individual research programs. Dissemination coordinators analyzed and synthesized themes from workshop material, including presentations and posterboard illustrations, and used Mural whiteboarding software to distill these themes into core values and value propositions to collectively share across the research sites.

Results: The four communication pillars, which encompass our collective identity and are the foundation of our dissemination program, are (1) Doing Research with Communities, (2) Centering on the Lives and Experiences of People Who Use Drugs, (3) Emphasizing Scientific Rigor and Integrity; and (4) Focusing on Social Determinants. We present examples of how project teams are demonstrating the pillars throughout the research process and outline how the communication pillars inform the planning and dissemination of RISE-produced evidence to end users.

Conclusions: Applying concepts from strategic communication and social marketing, we demonstrate how a research network of independent investigators can create a collective identity, formulate a cogent narrative communicating their contributions to a field of practice, and establish a foundation for a successful research dissemination program.

Background: Nitrous oxide (N₂O), colloquially known as "laughing gas", is a dissociative anaesthetic that has become increasingly popular among young people as a recreational drug. Social media and messaging platforms have made N₂O more accessible. As avid users of social media, young people are well-positioned to contribute to the development of digitalised harm reduction resources. This study draws on young people with N₂O experience to develop harm reduction resources for dissemination on social media.

Methods: This study comprised four stages, utilising a co-creation approach with young people (aged 18-25) with N₂O experience. Stage 1 involved two focus groups (n = 22) to co-create harm reduction messages with participants. Stage 2 involved the development of harm reduction resources (video clips and posts) using the participants' insights collected in stage 1. Stage 3 included two focus groups with participants (n = 13) to review and refine the draft resources. Stage 4 involved the final production of the resources. This article reports the findings of the focus groups we held in stages 1 and 3, answering the research question, "What strategies are most effective in engaging young people with N₂O experience in harm reduction messaging on social media?" Data were analysed using thematic analysis, involving semantic and latent coding to develop key strategies for effective harm reduction messaging.

Results: Three strategies were developed through thematic analysis: (1) Set your message apart from the crowd-participants emphasised the importance of visually appealing, sharply framed content with direct taglines to capture attention quickly on social media; (2) Use realistic social settings-harm reduction messages were more engaging when they reflected authentic environments and social dynamics in which N₂O is typically consumed, including peer influence and support and (3) Prioritise practical harm reduction advice over recommendations for abstinence-participants preferred actionable harm reduction tips (e.g., dosage control, safe administration techniques) over abstinence-based messaging, valuing autonomy and lived experience.

Conclusions: Effective reach to young people on social media requires harm reduction information to be visually appealing, immediately comprehensible and contextually relevant to young people's social environments.