Harm Reduction Journal最新文献

Background: Androgens from the black market are often produced in clandestine laboratories without adherence to hygienic manufacturing processes. Consequently, users may face an increased risk of developing injection-related infections caused by microbiological contamination. This study aimed to determine the presence of microbiological contamination in androgens from the black market.

Methods: Characteristics of submitted androgen product were registered. Androgen products were submitted to aerobic and anaerobic bacterial culture using direct inoculation of agar plates and enrichment using BD BACTEC™ Peds Plus Medium blood culture bottles. Participants who submitted products were monitored for injection-related infections.

Results: Bacterial contamination was detected in two of 22 used multidose vials (9%) and one of 41 unused ampules and multidose vials (2%). Identified species included Bacillus spp., Staphylococcus epidermidis, Staphylococcus warneri, Staphylococcus saprophyticus and Micrococcus luteus. None of the participants developed injection-related infections linked to contaminated products.

Conclusion: Both used and unused androgens from the black market can contain bacteria. This can put users at risk for serious injection-related health problems such as abscesses. This study underlines the importance of warning androgen users about these underrecognized injection-related risks.

Trial registration: Study number: NL77191.028.21. Registration date: 2 June 2021.

Background: Engagement with the illicit street tablet market in Middlesbrough, North-East England, has been shown to impact treatment engagement, and the area appears to have a unique z-drug market, potentially not observed in other areas. When combined with high levels of injecting opioid and polydrug usage, this context may account for the steep increases in drug-related deaths reported locally. However, little is known about the volume, dosage, frequency, drivers, and dislikes of street tablet usage from the perspective of those who use drugs. In areas of high drug-related harm, local drug market intelligence is crucial to co-developing acceptable harm reduction and treatment offers that are attractive to those most at risk from a drug-related death.

Methods: This project used a peer research model. The peer researcher engaged a group of high-risk individuals (traditionally underserved by standard research processes) in a survey regarding street tablet usage, drivers, dislikes, and desired treatment options.

Results: A small but notable sample of 38 individuals engaged with the survey, the majority of whom (60%) were not involved in drug treatment, with a high proportion of street homelessness (38%). Street tablets were perceived as a multifunctional remedy to achieve a range of perceived mental and physical effects or for pragmatic purposes, such as cost. Most (89% and 87%, respectively) respondents [with current or historical use] (n = 38) reported extensive illicit pregabalin and zopiclone usage. When only looking at those currently using street tablets (n = 32), 100% were using zopiclone, with nearly all reporting this in combination with pregabalin (n = 31, 96%). Reported drivers of tablet usage included attempts to self-medicate due to untreated mental health conditions. Self-dosage rates were substantially higher than the recommended therapeutic dose rates.

Conclusions: Collaborating with the peer workforce in areas of high need relating to drug harms was an acceptable way of engaging some of the most vulnerable individuals at risk from mortality and morbidity in the research process. Our data highlights this population's complex, high-dose, polydrug use. There was an appetite to develop harm reduction interventions for illicit street tablet usage amongst the population sampled. Further work should develop tailored harm reduction advice for complex issues such as street tablets and opioid co-use.

Background: Accountability for gambling-related harms remains a contested issue, with debates centering on who should be responsible and how interventions should be structured. While Responsible Gambling (RG) frameworks have traditionally emphasized individual responsibility through voluntary tools, growing concerns have led regulators to introduce more robust, operator-focused duty of care requirements. This study analyzes Action Plans (APs) submitted by 52 licensed Swedish gambling operators to examine how duty of care obligations are interpreted and implemented.

Method: The study employed a mixed-methods approach to analyze the APs, combining qualitative and quantitative methods. The process involved a conceptual literature review, the development of a purpose-built critique instrument, rubric-based scoring, and thematic content analysis. Each AP was individually coded and scored using a five-point Likert scale (i.e., 0 - 4) across key duty of care themes. This approach enabled a comprehensive evaluation of how operators interpret, articulate, and operationalize duty of care responsibilities within the Swedish gambling regulatory framework.

Results: The overall alignment scores were generally low, with a median of 1.94 and 50% of documents falling within a moderately spread range of 1.15 to 2.75; only 10% scored above 3.25. While operators performed relatively well in monitoring and risk identification (mean = 2.67), their lower scores in proactive engagement (mean = 1.62) point to a reactive, response-driven focus rather than a preventive strategy. Additionally, a prevailing narrative across the APs frames harmful gambling as affecting only a vulnerable group, thereby subtly justifying minimal and narrowly targeted interventions.

Conclusions: The findings highlight the influence of RG frameworks, with many operators emphasizing individual responsibility rather than systemic harm reduction. In addition, there is a need for clearer, more robust guidelines, as higher compliance was linked to well-defined requirements. Instrumental templates, such as the critique tool developed in this study, can support designing measurable requirements and evaluating their implementation. Finally, duty of care directives can play a dual role: establishing harm reduction specifications and reshaping the narratives that define gambling. Framing them as both regulatory tools and narrative-making platforms can provide policymakers with a powerful means to reorient the discourse around gambling and enhance harm reduction outcomes.

Approximately 4.8 million people in the United States had opioid use disorder in 2024, with more than one hundred thousand experiencing an overdose death. Despite the established benefits of buprenorphine on morbidity and mortality, many patients may express an interest in discontinuing their medications for various reasons, including stigma surrounding addiction. There are limited studies describing how to navigate buprenorphine discontinuation. This commentary provides a practical approach to navigating buprenorphine discontinuation, using two case studies. Ideally, clinicians will develop a deep understanding of the patient's substance use journey, allowing them to understand both the internal and external factors driving their decision. Through this understanding, a clinician can develop a plan based on their well-being, safety, and risk factors for return to use. It is vital to reinforce that buprenorphine is a life-saving medication, can be continued life-long, and is a tool for recovery, not a barrier.

Alcohol-related harms constitute a major global public health challenge. Despite similar consumption levels to their more affluent counterparts, alcohol-related morbidity and mortality is disproportionately higher in socioeconomically deprived populations. People living in social precarity face multiple barriers to accessing traditional treatment services, making alcohol harm reduction (AHR) practices particularly relevant for them. This qualitative study, conducted in the Greater Paris region, described and analyzed AHR practices adopted by health, social, and community professionals working in different types of care facilities with people living in social precarity who consume alcohol. Semi-structured interviews were conducted with 31 professionals in 11 different facilities, including addiction care centers, harm reduction centers, and housing facilities. A thematic analysis of the data revealed three AHR practices: (i) authorizing the consumption of alcohol on the premises, (ii) managing users' level of alcohol consumption, and (iii) providing prevention interventions and information on alcohol consumption. Not all three practices were implemented by all 11 facilities. Specifically, the practices implemented depended on (i) whether alcohol cessation was the primary goal of the professional and the facility, and (b) the specific needs of the facility's users. All 11 facilities shared a common focus of building trust and adapting their practices to their user profile. In contrast, the level of patient engagement varied according to facility type from passive to active involvement. A consensual definition of the concept of AHR for people living in social precarity is essential to standardize related practices, with a view to objectively assessing their effects.

Background: Harm reduction approaches to student drug use have been developing in a number of UK universities. Little is known about how to build consensus and effect normative change towards harm reduction in these settings. The aim of this paper is to identify key factors relevant to achieving organisational change and effecting a shift towards the adoption of harm reduction policies and practices.

Methods: The study included twelve UK universities and employed a qualitative research design which included semi-structured interviews with university policy makers (n = 12) and focus groups with students (4 groups with an overall total of 24 students). The universities were at different points in the process of implementing a harm reduction approach.

Results: There was strong support for harm reduction approaches by both university staff and student participants, but there was confusion and misunderstanding around the concept of harm reduction. Some students were unsure about whether or not their university had a harm reduction policy. This highlights the need for clearer communication and education around harm reduction. A number of challenges in developing and implementing harm reduction strategies were identified including securing resources and gaining institutional support and leadership 'buy-in'. Fears of stakeholders around the reputational risks to universities in advocating for harm reduction needed to be countered. Policy change often relied on committed individuals or 'champions' in the institutions to drive strategy development; however, there was also evidence of a 'community of practice' emerging amongst the network of institutions that had implemented harm reduction strategies which provided support and shared knowledge and experiences. Co-production strategies involving students, staff and external stakeholders were vital in gaining consensus and fostering ownership.

Conclusions: The study has highlighted that there is strong support for a shift away from zero-tolerance approaches to student drug use, although this needs to be accomplished incrementally and in ways that address stakeholder concerns and safeguard university reputations. Working with a 'whole system' philosophy was identified as good practice whereby university policy was embedded within a local or city-wide approach which helped to facilitate the acceptance and development of harm reduction.

Background: Research has explored barriers and facilitators to supervised consumption sites (SCS) in Canadian settings. Despite this, little is known about what factors drive individuals to initiate and repeatedly attend specific SCS where multiple SCS options are available, such as in Vancouver's Downtown Eastside (DTES). The aim of this study was to understand the structural, contextual, and operational determinants of regular SCS attendance during Canada's ongoing overdose crisis.

Methods: Rapid-ethnographic fieldwork was conducted over a six-week period at an integrated SCS in Vancouver's DTES. This comprised an initial five-week period of non-participant observation (≈200 h) followed by a community consultation regarding the research design and question protocols. Qualitative data were then collected through five focus groups (n = 25) and 20 semi-structured interviews with regular service attendees with data analysed using thematic analysis.

Results: Our findings highlight four important factors related to regular service attendance. The service had a regular clientele who described their attendance as routinized, which they attributed to four distinct factors: (1) the accessible location, (2) the on-site auxiliary health and support services, (3) the diversity of harm reduction provision, and (4) the atmosphere. Exploring the concept of atmosphere in more depth showed that it was characterized by the safety, familiarity, and inclusivity experienced within the service. Together, these factors facilitated a strong sense of belonging among attendees regarding the service and its community of staff and clients.

Conclusion: Within the context of an ongoing overdose crisis, our findings highlight SCS service characteristics which facilitate routinized engagement including accessibility, wrap-around support, comprehensive and tailored harm reduction, and an inclusive welcoming atmosphere. These insights can inform policy makers and service providers in scaling and developing effective, client-centred SCSs to reduce harm and promote wellbeing.

Background: Opioid dependence is highly prevalent within incarcerated populations, with one-fifth of all drug overdose deaths occurring among formerly incarcerated individuals. Opioid antagonists are promising in reversing overdoses, with naloxone widely recognised as a rapid and safe treatment for opioid toxicity. While community-based evidence demonstrates the efficacy of naloxone in reducing overdose deaths, its implementation in carceral settings is neither standardised nor embedded.

Objective: This scoping review aims to systematically assess the acceptability, feasibility, and effectiveness of naloxone interventions in prisons and other detention settings globally, with the explicit goal of identifying research gaps and generating evidence to inform global prison policy, practice and future implementation research.

Methods: A scoping review was conducted following Arksey and O'Malley's framework. Literature searches were performed in PubMed, Scopus, and Embase for English-language records published between 2000 and 2025, in line with the PRISMA Extension for Scoping Reviews guidelines. Data were analysed using narrative synthesis as informed by Popay et al. RESULTS: Of the 1764 records initially identified, 24 records met the inclusion criteria. Three themes and associated sub-themes were identified. They were (a) current provision (naloxone distribution and benefits; Take-Home Naloxone programmes on community release; naloxone (intranasal) within carceral settings; rollout of naloxone vending machines), (b) population satisfaction (acceptability and feasibility; implementation readiness) and (c) organisational factors (barriers and challenges; facilitators and suggestions).

Conclusion: Naloxone provision in carceral settings is acceptable, feasible, and effective in preventing opioid overdoses during incarceration and after release. Strong support exists among prisoners and staff, yet significant gaps remain, particularly regarding use in vulnerable populations such as women, younger individuals, and immigration detainees. Integrating naloxone into prison health systems, alongside staff training and peer engagement, is a critical step in reducing preventable overdose deaths and enhancing continuity of care post-release.

Background: This study investigates the impact of addiction history on interpersonal trust and access to social support. Specifically, it explores whether people exhibit decreased trust toward individuals with addiction histories, explores the extent to which positive portrayals can mitigate such distrust, and evaluates whether those with addiction histories receive reduced social support from their closest social networks, including friends and family.

Methods: Two complementary studies were conducted. Study 1 employed hypothetical scenarios to assess trust in both property-related and personal risk situations and examined whether counter-stereotypical information could reduce distrust. Study 2 used vignettes depicting individuals seeking assistance in differing relational contexts (friends versus family) to evaluate responses and types of support provided. Ordinary Least Squares (OLS) regression was applied to estimate the effects of experimental manipulations on trust and social support.

Results: Participants exhibited significantly reduced trust toward individuals with a history of substance abuse across both scenarios. Providing counter-stereotypical information significantly reduced distrust in the property risk scenario, but had no measurable effect on trust in personal risk contexts. Regarding social support, individuals with substance use histories received less informational support when assistance was requested by family members.

Conclusions: This research highlights the role of addiction stigma in shaping interpersonal dynamics, particularly in trust and social support. The findings suggest that targeted interventions addressing trust deficits, such as counter-stereotypical portrayals or trust-building programs, could play a role in reducing stigma and enhancing interpersonal relationships. Additionally, mentoring programs and improved access to informational resources may help bridge gaps in social support, especially where family support is limited. These insights have significant implications for rehabilitation programs, family support services, and community-based initiatives aimed at promoting successful recovery and reintegration.

Background: Since 2016, over 50,928 people have died of an opioid-related overdose in Canada. The unregulated supply of drugs is increasingly toxic and volatile, and fentanyl from unregulated, street-based markets is driving this epidemic. Concerns that existing overdose prevention approaches were insufficient to address the rising number of overdoses led to the implementation of safer supply programs (SSPs) in Canada. SSPs provide prescribed medications to people who use drugs and are designed for individuals at high risk of overdose for whom existing care options have been ineffective or inappropriate. Evidence of SSP impact is growing but implementation processes, including admissions, are not well understood nor well-described in practice guidelines. Our purpose was to describe how the admission processes of four Ontario SSPs evolved and how these changes influenced program reach and perceived effectiveness.

Methods: During 2021, we conducted short demographic and semi-structured interviews with healthcare providers (n = 21) from four SSPs in Ontario about implementation processes, challenges, and impacts. Thematic analysis of data concerning admission processes was conducted in MAXQDA and descriptive statistics in SPSSv28.

Results: Although the desire was for SSPs to have a broad reach, programs quickly realized they needed to develop strategies to manage the high demand for their programs. To manage this demand, strategies were implemented like waitlists, which were later replaced by points-based admission criteria. These admission criteria evolved over time, leading to a client population with high medical and social needs. The combination of high-acuity clients, limited capacity, and funding constraints, exacerbated by COVID-19, caused significant distress and burnout among service providers, prompting further changes to the SSPs.

Discussion: The implementation of SSPs in Ontario highlights the challenges of addressing intersecting public health emergencies in a resource-constrained healthcare system. SSPs, were adaptive and evolved in real time; while these adaptations addressed significant equity gaps, they also underscored the limitations of operating within an under-funded primary care model. The narrowing of admission criteria, necessitated by overwhelming demand and limited resources, ultimately constrained their reach and potential population-level impact.