Harm Reduction Journal最新文献

Background: The overdose epidemic is presently driven by polydrug use, sparking renewed interest in why people initiate use of certain drugs or drug combinations. Current research privileges the physiological ends of consumption, often ignoring the social and environmental context of use. Framed by social cognitive theory, the purpose of this study was to characterize factors precipitating substance initiation, transition, and combination beyond the immediate effects of the substance(s).

Methods: We conducted 30 semi-structured interviews with people who use drugs across North Carolina, exploring substance use history and risk and protective factors of polydrug use. Participants also completed a visual timeline activity. We used a staged analytic approach, beginning with deductive Structural Coding and ending with inductive Reflexive Thematic Analysis at both the transcript and excerpt levels.

Results: We conceptualized substance transitions as pragmatic responses to environments of constraints and opportunities. Socially, transitions facilitated interpersonal closeness, aligned use with network norms, and responded to ubiquitous drug availability. Transitions also reflected navigation of material constraints, including which substances were locally available, logistically accessible, and financially sustainable.

Conclusions: Beyond the desire for new or enhanced physiological effects, substance transitions serve social and practical functions, like facilitating emotional closeness and responding to market conditions. Interventions to reduce the risks of use should expand viable options by addressing structural barriers and promoting safe, affordable, and accessible supply.

Background: The use of psychedelics is currently increasing in the United States. Awareness of clinical trials investigating the therapeutic applications of psychedelics may result in a record number of people who use psychedelics for the first-time. This study aimed to develop a harm-reduction resource to facilitate safe and successful psychedelic experiences outside of regulated clinical and research settings. We employed a community-based approach to crowdsource practical recommendations for first-time psychedelic experiences from the psychedelic community.

Methods: We conducted an online survey with 581 individuals who reported psychedelic use (N = 581) on recommendations for people using psychedelics for the first-time, following the principles of community-based collaborative research. The survey assessed recommendations for and against specific psychedelics for first-time experiences, recommendations for and against combinations of psychedelics, and other advice for first-time experiences. Open-ended follow-up questions were included to understand participants' reasons for their recommendations. An experienced qualitative researcher and two qualitative coders analyzed responses to open-ended items.

Results: Most participants recommended psilocybin for first-time psychedelic experiences, approximately half recommended cannabis, and a third recommended MDMA/MDA (3,4-methylenedioxymethamphetamine/3,4-methylenedioxyamphetamine, ecstasy, molly). These substances were favored for their moderate intensity, dose-dependent effects, precise dosing, and relatively short duration of effects. Conversely, substances such as ayahuasca, DMT (N,N-dimethyltryptamine), 5-MeO-DMT (5-methoxy-N,N-dimethyltryptamine), and Salvia divinorum or salvinorin A were not recommended due to their intensity, mental and physical health risks, and safety concerns. Participants advised against mixing psychedelics with alcohol, stimulants, antidepressants, and narcotics/opiates. Additional recommendations included embracing the experience, learning about the substance and its effects, and setting intentions for the experience.

Conclusions: Given the growing interest in psychedelics despite limited legal access and systematic education available, it is crucial to inform the public about practices that minimize risks. This project compiled recommendations from individuals who self-identified being experienced with psychedelics. The active involvement of the psychedelic community may enhance research quality and public trust in the findings.

Background: Impulsivity is a key contributor to substance use disorder, with previous research consistently demonstrating its role in the initiation, continuation and severity of drug use. Less is known about its association with injection-related risk behaviours, including injection equipment sharing and public injection, important drivers of HCV and HIV epidemics among people who inject drugs (PWID).

Methods: Data were drawn from HEPCO, an ongoing community-based cohort study of PWID in Montreal, Canada. We used the first observation from participants who reported injecting drugs in the past three months and were administered the Cambridge Neuropsychological Test Automated Battery (CANTAB) (August 2017-March 2020). The Stop Signal Task was administered to measure "response inhibition," i.e., an individual's ability to inhibit a prepotent or automatic response when presented with a stop signal or cue. Stop-signal reaction time (range: 50-1000 ms) was analyzed as a continuous indicator of impulsivity. Univariate and multivariable logistic regression were utilized to estimate associations between impulsivity and i) sharing injection equipment and ii) injection in public places, and identify other correlates of the study outcomes.

Results: Of 156 PWID included in the study, 26 (17%) and 42 (27%) reported sharing injection equipment and injecting in public, respectively. The majority of participants were men (85%) and the mean age was 45 years. In multivariable analysis, impulsivity was significantly associated with injecting in public places (aOR = 1.26 per each 100-unit increase, 95% CI = 1.01, 1.60). Other correlates of injecting in public were: age (0.93 [0.88, 0.97] and unstable housing (3.51 [1.43, 8.61]). There was no evidence for an association between impulsivity and injection equipment sharing (0.85 [0.65, 1.10]).

Conclusion: This study underscores the importance of impulsivity in public injection, a behaviour strongly associated with HIV and HCV transmission among PWID. These findings highlight the need for public health interventions that both mitigate impulsivity, such as behavioural or pharmacological therapies, and accommodate it through expanding low-threshold harm-reduction services, including access to supervised consumption sites and sterile injecting equipment.

Background: The COVID-19 lockdown prompted changes in accessing opioid agonist therapy in England, but the lockdown and further adaptations could exacerbate inequalities in opioid agonist therapy availability across practices with different socioeconomic statuses. This study aimed to evaluate the impact of the COVID-19 lockdown on the prescribing of methadone and buprenorphine and how general practices located within areas with differing socioeconomic status responded to these policies in England.

Methods: This quasi-experimental study used a health administrative practice-level dispensing database from March 2019 to February 2022 and socioeconomic deprivation from the Office for National Statistics in England. General practices that prescribed methadone or buprenorphine were included. The monthly number of Defined Daily Doses (DDDs) and dispensed items were quantified. The monthly changes in DDDs and dispensed items during the COVID-19 lockdown were also calculated. Interrupted time series analysis was used to evaluate the impact of the COVID-19 lockdown in March 2020. For practices with consistent prescribing (any OAT prescribing from December 2019 to February 2020 and 6 months during the lockdown), a group-based trajectory model explored the variability between practices.

Results: A significant level elevation (β₂ = 473,678.3, p = 0.002) and slope decrease (β₃ = - 46,396.6, p = 0.03) in DDDs of methadone, and a level elevation (β₂ = 114,041.9, p = 0.002) in DDDs of buprenorphine were found after COVID-19 lockdown. Practices located in the more deprived areas were more likely to prescribe OAT consistently, and 16.8% of practices were categorised into decreasing methadone dispensing during the COVID-19 lockdown, and 5.4% of practices were classified as increasing dispensing of buprenorphine. There was a tendency for practices located in deprived areas to be grouped into the trajectory of decreasing methadone dispensing, but not with buprenorphine.

Conclusions: The COVID-19 lockdown limited the prescribing of methadone and increased the prescribing of buprenorphine in England. Further studies should adopt individual patient data to investigate the potential reasons for limiting the prescribing of methadone.

Background: Illicit anabolic-androgenic steroid (AAS) use poses physical and psychosocial risks. These issues are exacerbated by inadequate public health responses and well-meaning yet inadequately trained health workers. This study presents the development of a collaboratively designed health conversation tool, which equips health workers' with a number of questions and strategic information to promote well-informed use for people who use AAS.

Methods: This qualitative, multi-stage study co-produced a health conversation, a guided conversation tool that aims to incorporate a brief assessment, knowledge provision, sharing of harm reduction strategies and advice for health workers engaging with people who use AAS in community settings. The iterative co-design process followed a five-stage pedagogical approach (ideation, planning, creation, programming and sharing), guided by semi-structured interviews with 25 people who use AAS and a workshop focus group of 6 experienced AAS peers for further refinement. Guided discussion included exploration or harms, health enhancement and required resources. Qualitative responses were synthesised via inductive analysis to identify key themes, from which the conversation was developed and then tested with the AAS peer group.

Results: There were two core findings from this research. Firstly, insights gained from people who use AAS in the key current practices related to safer use of these drugs. Secondly, based on these insights, a health conversation tool was co-produced, which encompasses a brief assessment, gauging people's experiences with AAS, confidence in their knowledge, and support systems. The tool provides health workers with a suite of harm reduction strategies to offer to people who use AAS, such as proper injection techniques, considerations regarding their usage strategy, and suggestions for health monitoring.

Conclusions: The collaborative design process ensured the health conversation tool reflected the lived-living experiences and priorities of people who use AAS, specifically fostering trust and engagement. This peer-driven approach filled gaps in harm reduction services, promoting informed decisions regarding AAS use as well as some health strategies. Expanding the peer workforce and integrating digital platforms can enhance the reach and sustainability of tailored harm reduction interventions for AAS and other communities.

Background: Chemsex, involving substances like methamphetamine, GHB/GBL, and mephedrone among gay, bisexual, and other men who have sex with men (GBMSM), poses HIV and health concerns. Despite existing integrated care programs, uptake remains low, highlighting a missed opportunity for self-help harm-reduction digital strategies. This study employs a collaborative design approach, integrating insights from the community on the app prototype and assessed usability to guide future interventions.

Methods: The app prototype was built on two design principles: recovery as a continuum with evolving goals like harm reduction and temporarily not using, and harm reduction dimensions on drug-, sex-, and HIV-related harms. Features were integrated into UPrEPU, a user-centered app supporting HIV PrEP adherence through flexible dosing and personalized reminders. Users could set goals, such as reducing chemsex frequency, supported by tailored feedback. The app includes an emergency alert system, local resources for clean needles and HIV testing, and myth-busting for the chemsex community. GBMSM with recent chemsex experience tested the app between January-December 2024. A one-month evaluation followed using the mHealth App Usability Questionnaire (1-7 scale, lower score indicates higher usability) and an interview to assess usability and impact. Interview transcripts were analyzed based on design themes to gather users' reflections and suggestions for enhancing harm reduction features.

Results: Twenty GBMSM aged 23-46 in Taiwan reported a positive perception of usability (mean = 2.14, SD = 1.15). However, users indicated that HIV PrEP functions were utilized more frequently than drug-related functions. Dynamic goal setting should be more intuitive and tied to lived experiences, reflecting one's physical and mental state. Inadequate social support led individuals to adopt self-reliance strategies, such as tracking HIV PrEP uptake, setting hydration reminders, and prioritizing self-care. This extended to managing cravings, adhering to dosage limits, and achieving control over their health. Users emphasized the need for tools to go beyond drug-related features, focusing instead on helping them plan their time and set broader life goals, supporting a more holistic approach to well-being.

Conclusions: A collaborative, user-centered approach to app design shows promise for digital solutions addressing chemsex-related harms, including HIV prevention, with functions closely tied to lived experiences.

Background: Despite Scotland's commitment to patient-centred substance use care, little is known about how individuals learn of residential rehabilitation. This study explores whether national policy goals of informed decision-making translate into on-the-ground practice.

Methods: This paper presents a secondary analysis of data generated during a larger mixed-methods evaluation of residential rehabilitation. Participants (n = 197 people who reported a drug problem in the previous 12 months) were recruited from 29 Scottish Local Authority areas and completed structured face-to-face interviews. Peer researchers with lived experience conducted interviews. Qualitative data were thematically examined according to macro-level (systemic), meso-level (community), and micro-level (individual) influences.

Results: Many participants reported never being informed of residential rehabilitation by healthcare providers. In response, peers, family, and community support groups filled information gaps, though their accounts were inconsistent or contradictory. Consequently, individuals resorted to micro-level strategies, such as internet searches and repeated questioning of key workers, to piece together essential details. Participants frequently expressed frustration with missed opportunities to explore alternative treatment pathways, compounding a sense of systemic neglect and disempowerment. This dynamic interplay between macro, meso, and micro factors often hindered genuinely informed decision-making and undermined policy ambitions for accessible, rights-based care.

Conclusions: Findings highlight pervasive communication gaps, echoing other contexts where new or less-familiar treatment options remain poorly signposted. Mandated communication protocols, formal peer collaboration, and reduced burdens on individuals could strengthen the alignment between practice and Scotland's National Mission. By closing these knowledge gaps, services can better support people with problem substance use to make truly informed decisions about residential rehabilitation and broader treatment pathways.

Background: We report investigating effectiveness and medical necessity of urine drug testing in a real-world setting comparing near-real-time definitive chromatography/mass spectrometry to real-time presumptive immunoassay for guiding evidence-based harm reduction in a buprenorphine medication for opioid use disorder clinic during the initial swell of the opioid epidemic's fourth wave.

Methods: Our exploratory case series included all opioid use disorder patients, most of whom exhibited co-occurring polysubstance use, treated with buprenorphine for one year in a single outpatient clinic. Interventions entailed split-sample urine drug testing comparing "gold standard" definitive laboratory chromatography/mass spectrometry testing to less-costly presumptive point-of-care immunoassay testing, which is more susceptible to false-positive and false-negative results. Analysis evaluated changes to clinical decision-making (i.e., escalation to outpatient crisis management) based on head-to-head definitive chromatography/mass spectrometry vs. presumptive immunoassay testing.

Results: Comparison of chromatography/mass spectrometry vs. immunoassay testing in 883 patients eliminated 1847 (14.6%) false-positive results in 458 (51.9%) patients. Mass spectrometry further identified an additional 7086 (69.1%) test results warranting reconsideration of clinical decision-making in 767 (86.9%, p < 0.001) patients. Most false-negative and the additional positive results detected solely by definitive chromatography/mass spectrometry testing comprised substances often associated with polysubstance use in overdose deaths, including methamphetamine, fentanyl, benzodiazepines, heroin and cocaine.

Conclusions: Mass spectrometry urine drug testing for patients with opioid use disorder and co-occurring polysubstance use provided evidence-based criteria substantiating the notable superiority of definitive testing at nominal additional cost by identifying significant additional instances of risky substance use necessitating harm reduction interventions for substances that would have remained undetected and untreated if testing were limited to presumptive immunoassay testing.

Introduction: Despite reductions in overdose deaths reported nationally in 2025, overdose remains a leading cause of death in Michigan and the broader United States. Naloxone is a safe and highly effective opioid antagonist that can reverse opioid overdose, and community-based distribution to people at highest risk of overdose is a key overdose death prevention strategy.

Methods: In 2021, Harm Reduction Michigan (HRMI) launched an innovative naloxone box model to boost community-based naloxone distribution through publicly accessible, unlocked, outdoor naloxone boxes. To evaluate HRMI's naloxone box model, we conducted stakeholder interviews and analyzed secondary quantitative data about naloxone box stocking and placement.

Results: As of December 2024, HRMI has placed 184 naloxone boxes in 85 jurisdictions within 47 Michigan counties, resulting in 24,428 doses of naloxone distributed from 2023 to 2024 alone. Naloxone boxes are prevalent in some, but not all, counties with high overdose death rates, suggesting the need for data-driven placement to support equitable access. However, stakeholders universally perceived the naloxone box model as impactful and crucial to saving lives, noting that naloxone boxes democratize naloxone distribution through their low-barrier, 24/7 availability and relative anonymity. They noted that amid persistent drug-related stigma, naloxone boxes create opportunities for productive conversations about overdose, drug use, and harm reduction in communities.

Conclusion: These models are strengthened by partnership with non-traditional partners (such as restaurants or retail stores) who request to host boxes, along with meaningful involvement of people with lived experience of drug use, overdose, and interrelated conditions in box planning, implementation, and maintenance.