Harm Reduction Journal最新文献

Background: There are increasing calls for cross-cutting approaches to reducing stigma in health systems that do not silo specific identities, conditions, or practices. In our previous work, we proposed a 'universal precautions' approach to addressing stigma and its negative effects (Treloar et al. in Harm Reduct J 19(1):74, 2022), whereby health systems assume that all people who enter a health service might be concerned about being treated negatively or excluded in some way. This paper explores the possibilities and limitations of such an approach to stigma reduction by canvassing key stakeholder perspectives.

Methods: Qualitative interviews were conducted with 20 key stakeholders with extensive experience working within the alcohol and other drugs, blood-borne viruses, and sexually transmissible infections sectors. Participants were asked to reflect on the concept of a universal precautions approach to stigma reduction, including its acceptability, feasibility, utility in practice, and key challenges.

Results: Although interview participants strongly advocated for a need to address all stigma within health care, there were mixed attitudes towards the use of the term, 'universal precautions'. Some participants believed it would be useful to draw on a lexicon more familiar to health workers, while others expressed ambivalence and confusion about the term. Participants reflected on the possibilities of universality, in treating everyone with respect and providing non-judgemental care, while also emphasising that different client populations have specific needs that must be addressed. Many participants emphasised strongly that such an approach would need to be embedded at a systemic level, including having support from executive leadership, to address the structural forces that (re)produce stigma. Participants emphasised that centring the voices and perspectives of people with lived experience of stigma is integral to any approach to reducing stigma in health systems.

Conclusions: Findings highlight the various possibilities of adopting a universal approach that recognises the diversity and intersections in experiences of stigma. This research informs the development and implementation of novel stigma reduction initiatives in health care settings.

Background: In recent years, Boston has attempted to increase housing options and reduce overdose risk through the implementation of harm reduction housing (HRH) sites. Despite numerous harm reduction resources available to HRH residents, drug checking services are absent. Studies suggest that drug checking may prevent negative experiences associated with unexpected adulterants. Drug checking offers a window into concerning supply shiftsand helps monitor disruptions in the supply due to environmental changes, such as encampment clearings. Few studies have explored drug checking's application in housing programs. The establishment of the Massachusetts Drug Supply Data Stream, a statewide community drug checking program, allowed us to pilot real-time drug checking at HRH sites.

Methods: From September 2023 to February 2024, we administered surveys to 106 HRH residents. From September 2023 to March 2025, we conducted longitudinal interviews (baseline, 3-month, 6-month) with a subset of 28 survey respondents. In response to drug supply shifts and resident demand, starting on May 20, 2024, we implemented real-time drug checking services at three HRH sites located in Boston. Residents were asked to provide approximately 5 mg of their remnant substance in order to receive immediate test results using FTIR spectroscopy and immunoassay test strips. Survey responses pertaining to drug checking provision and real-time, on-site drug checking sample results were analyzed using descriptive and bivariate statistics. Longitudinal interviews and field notes collected during real-time, on-site service provision were analyzed to further contextualize resident experiences.

Results: Resident engagement with drug checking services was considerable, with fifty-five drug samples collected across nine site visits over three months. The services generated an increase in xylazine awareness among residents and provided chances to address concerns about the changing drug market amid heavy policing. Engagement with residents confirmed the need for on-site drug checking alongside other provided harm reduction services, and a consensus vocalized concerns with the local drug supply.

Conclusions: Real-time, on-site drug checking in low-barrier housing programs is a promising harm reduction approach for detecting shifts in the drug supply and can complement transitional housing interventions. Residents engage with these services with the intention of intervening upon personal, community, and market-level norms.

Background: People who co-use opioids and methamphetamine have high rates of incarceration. The criminal legal system is therefore increasingly tasked with providing substance use disorder treatment, including medications for opioid use disorder (MOUD). Unfortunately, treatment in carceral settings remains inconsistent and little is known about how people who co-use experience these treatment pathways. This qualitative study addresses this gap by analyzing how people navigate these overlapping systems of punishment and care.

Methods: We conducted in-depth, semi-structured interviews with 20 hospitalized patients in Washington State initiating MOUD with recent methamphetamine use and past-year criminal legal involvement. Interviews explored substance use trajectories, legal system contact, and treatment experiences. Using thematic analysis grounded in ethnographic principles, we identified common strategies and challenges participants faced in accessing and engaging with treatment.

Results: Participants described legal system involvement as stigmatizing, unpredictable, and difficult to escape. Metaphors like "entrapment" and "contagious" were used to make sense of the legal system's disruptive role and to show how social and structural factors increased people's vulnerability to the legal system itself, sometimes in substance-dependent ways. To navigate this legal environment, participants adopted strategies of both compliance and non-compliance, toggling between them to minimize risk of harm and maintain autonomy. These same strategies were carried over into carceral treatment, which was often experienced as an extension of punishment and ill equipped to meaningfully capture polysubstance use.

Conclusions: This study contributes to the literature on carceral treatment, detailing the lived experience of people who co-use opioids and methamphetamine with treatment access and legal system involvement as the two become more tightly linked. Mandated treatment often replicates carceral control and fails to accommodate the realities of polysubstance use. People who co-use developed adaptive strategies to navigate these systems, reflecting the need for treatment models that respect autonomy and reduce harm rather than criminalize. Our findings thus support the need for policies that provide consistent access to care and disentangle treatment from coercive legal oversight.

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.