Harm Reduction Journal最新文献

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.

Drug overdose deaths for low- and no-income women during pregnancy and the postpartum period are on the rise in the United States. Unfortunately, health and social services for pregnant and postpartum women who use drugs (WWUD) are lacking, especially in rural areas. In this qualitative study, we explore provider perspectives on the service provision terrain for pregnant/postpartum women who use illegalized drugs in 17 North Georgia Appalachian counties. We conducted 35 one-on-one semi-structured qualitative interviews between October 2023 and May 2024 with governmental and non-governmental organization employees who held frontline and/or leadership positions in these counties. We used thematic analysis to identify patterns within and across transcripts. Our guiding conceptual framework builds on existing perspectives on the "nonprofit industrial complex," and uses the risk environment model to highlight meso-level obstacles that hinder WWUD from experiencing a healthy pregnancy and postpartum period. Our findings indicated that service providers-most predominantly working in 501(c)3 community nonprofits-struggle to meet the complex needs of pregnant/postpartum WWUD. They reported how the bureaucratic entanglements and fragmentations distinctive of 501(c)3 community nonprofits both impede holistic services and necessitate collaborations to piecemeal vital services together to serve this population. Our findings suggest that the multitude of struggles rural and low-no income pregnant/postpartum WWUD in North Georgia face cannot be addressed adequately through current siloed single-issue community nonprofits, regardless of how well-intentioned. These findings underline the importance of meso-level investigation of the risk environment into institutions like nonprofits tasked with assisting this population.

Background: Fentanyl contamination in illicit drug markets has significantly increased overdose risk in Puerto Rico and other regions. Fentanyl test strips (FTS) have emerged as a promising harm reduction tool. While several studies in the United States have examined FTS willingness and acceptability, research in Puerto Rico remains scarce. This study offers one of the first large-scale epidemiological assessments of willingness to use FTS among street-recruited drug users on the island.

Methods: We conducted a cross-sectional study of 400 street drug users recruited from syringe exchange programs in Puerto Rico between March and June 2024. Participants completed structured interviews assessing sociodemographic characteristics, substance use behaviors, overdose history, and program engagement. Willingness to use FTS was measured through a direct question and coded as a binary variable. Analyses included descriptive statistics, bivariate tests of independence, Bayes factors, logistic regression, and Bayesian Model Averaging (BMA).

Results: Overall willingness to use FTS was high (76.5%). Engagement in substance abuse treatment was strongly associated with willingness (OR = 3.09, 95% CI: 1.81-5.26, p < 0.001; Bayes Factor = 336.17). In contrast, severe substance use disorder (SUD) was negatively associated (OR = 0.36, 95% CI: 0.18-0.73, p = 0.005; Bayes Factor = 1.19). Other variables such as age, overdose history, or homelessness showed inconsistent or weak evidence. BMA confirmed treatment engagement (inclusion probability = 100%) and SUD severity (95.4%) as the most robust predictors, while age and other covariates had low inclusion probabilities, suggesting weaker evidence across models.

Conclusions: Willingness to use FTS is high among Puerto Rican street drug users, especially among those engaged in substance abuse treatment. Lower willingness among individuals with severe SUD aligns with patterns reported in prior research, suggesting that higher levels of dependence may limit the perceived feasibility or utility of FTS. This underscores the need for low-threshold, tailored harm reduction strategies. These findings highlight both the promise and challenges of implementing drug-checking interventions in underserved, high-risk populations. As FTS are not currently available in Puerto Rico, expanding access through harm reduction and treatment programs should be a public health priority.

Background: It is critical that a range of harm reduction supplies are available through Ontario's Public Health Units (PHU) to meet the varying needs of people who use drugs. Therefore, we assessed geographic variation in opioid-related deaths and the distribution of these harm reduction supplies among 34 PHUs in Ontario, Canada.

Methods: We conducted a population-based repeated cross-sectional study using publicly available administrative datasets between January 1, 2019, and December 31, 2022. Rates of opioid-related deaths and the distribution of harm reduction supplies (inhalation supplies, naloxone, and needles provided) were calculated per PHU. Small area rate variation statistics including the extremal quotient (EQ) were used to assess variation across PHUs in 2022.

Results: Over the study period, the quarterly number of opioid-related deaths increased by 40.6% (3.2 to 4.5 per 100,000) in Ontario. The distribution rate of all harm reduction supplies increased, although there was considerable variation by type of supply. For example, the EQ ranged from 34.7 for naloxone to 1,610.6 for foil. In 2022, there were three PHUs with significantly higher rates of opioid-related deaths compared to the provincial average. In general, these PHUs also had significantly higher distribution rates of naloxone, needles, and inhalation supplies.

Conclusions: Across Ontario, there is high variability in harm reduction supply distribution and opioid-related mortality. Regions with elevated opioid-related death rates also had high supply distribution rates, suggesting that efforts are concentrated in regions with particular need. To minimize harms related to substance use, ongoing efforts are needed to ensure a clear understanding of community-based needs for harm reduction services.

Background: Gay, bisexual and other men who have sex with men (GBMSM) who use crystal methamphetamine and gamma hydroxybutyrate (GHB) in sexual contexts (otherwise known as chemsex) report barriers to accessing health services. Peer-led chemsex interventions may reduce barriers to care and provide meaningful therapeutic support, however, there have been few formal evaluations of such programs. M3THOD is a novel peer-led intervention based on the transtheoretical model of behaviour change comprising elements of harm reduction education, motivational interviewing and service navigation. In this formative evaluation we appraise the acceptability, appropriateness, and feasibility of M3THOD.

Methods: M3THOD aimed to support people to reduce chemsex-related harm, manage frequency of chemsex and access specialist services. The acceptability, feasibility and appropriateness of this service were assessed. We collected data from peers' field notes and conducted 33 semi-structured in-depth interviews. These were conducted with intervention clients (n = 15), eligible community members who did not receive an intervention (n = 9), M3THOD peer workers (n = 3) and their managers (n = 2) and partnering clinicians (n = 4). A thematic framework method was used to analyse data.

Results: M3THOD demonstrated acceptability among all stakeholders and was deemed appropriate, with the caveat that peer workers should be supported to operate within a framework of structured flexibility to dually ensure safety and person-centred care. Most participants reported dependence on crystal methamphetamine and desired ongoing rather than one-off peer support. M3THOD's feasibility was contingent on robust support for training, technical support, and pastoral care for peers, and strong clinical partnerships and referral pathways.

Conclusions: M3THOD was valued by participants with unique information and support needs often unmet by sexual health, mental health and drug and alcohol services and reported that peers' personal experiences of chemsex facilitated rapid rapport, validated and mitigated clients' shame around chemsex. Our formative evaluation indicated that a peer intervention addressing chemsex is acceptable, appropriate, and feasible in contexts sufficiently resourced to provide substantial support for peer workers. Hiring a team of peer workers, providing training, ongoing coaching, monthly clinical supervision and establishing supportive relationships with co-located counsellors were said to enable the safe and effective delivery of this peer-led chemsex service.

Background: Much of the existing discourse surrounding the Enhanced Games has focused on its potential to undermine traditional sporting values by permitting and promoting the use of performance-enhancing drugs (PEDs), thereby challenging established anti-doping frameworks. However, as the Enhanced Games continues to expand its brand, a broader agenda has emerged, specifically, the incorporation of telehealth services into its platform.

Aim: This study aims to critically examine the Enhanced Games' role in facilitating access to testosterone replacement therapy (TRT) through its emerging telehealth services.

Method: A qualitative content analysis was conducted of the Enhanced Games' official website, with a specific focus on its telehealth offerings. Drawing on Cooper and Waldby's (2014) concept of the bioeconomy, in which human bodies become sites for pharmaceutical accumulation and capital generation, we examine how the Enhanced Game's seek to exploit this notion.

Results: Findings indicate that the Enhanced Games leverages sport as a vehicle to market TRT. This underscores its ambitions to extend beyond the sporting arena, positioning the organisation as a commercial actor within the broader biomedical, wellness, and longevity sector. Their telehealth advertisments explicitly promote testosterone products, signalling a shift and bluring boundaries between sport (performance enhancement) and society (longevity, wellness, optimisation).

Discussion: In light of the over-prescription of testosterone through telehealth services, the Enhanced Games may serve as a powerful force towards expanding that market. These developments raise important concerns, particularly regarding the risk of physiological dependency resulting from prolonged use of exogenous testosterone. The commodification of TRT under the guise of sport and health optimisation calls for critical reflection on the ethical, medical, and regulatory implications of such practices.

Background: Patient-centered approaches may facilitate retention in opioid agonist treatment (OAT) but are challenging to implement in rigid or stigmatizing service contexts. We evaluate a telemedicine program delivering flexible, patient-centered OAT from a community-based harm reduction setting in Montreal, Canada.

Methods: An OAT clinic was established in a community-based harm reduction setting with hospital-based addiction medicine services delivered remotely via telemedicine. Community workers screened clients, established telemedicine connections, and offered holistic patient follow-up. The medical team offered individualized OAT and other health services. Patients chose between treatment with methadone, buprenorphine/naloxone, or slow-release oral morphine. Hydromorphone co-prescription was also available. Effectiveness was assessed via longitudinal chart review and semi-structured interviews (n = 20). A convergent mixed method design was used to quantify retention rates and blood borne infection care up to 12 month follow up, and to examine patient reported program experiences.

Results: Sixty-nine patients (46 men, 23 women; median age 38) initiated OAT between April 2020-March 2022. Most (96%) were injecting opioids, 56% were unstably housed, and 71% reported prior OAT. Patients typically initiated treatment with methadone (54%) or slow-release oral morphine (35%); 78% also received hydromorphone. Continuous retention in the first OAT episode was 83% at one month, 74% at three months, and 54% at 12 months. Disregarding prior treatment interruptions, 71% of patients were receiving OAT at 12 months. Most patients were assessed for HIV (77%) and HCV (78%), and 13/15 confirmed as HCV-positive initiated antiviral treatment. Trust, respect, and the alignment of practices with patient-centered care and harm reduction principles were critical to success. Integrating treatment within a community-based harm reduction setting enhanced accessibility and care coordination, and created a welcoming service environment. Diverse medication options, collaborative treatment planning, and a non-judgmental/non-punitive approach were key to developing positive therapeutic relationships.

Conclusion: Our community-based telemedicine program presents a novel framework for OAT delivery that efficiently bridges the health and community sectors. Working collaboratively around the patient, program partners leveraged their strengths to improve treatment experiences and promote retention.

Background: People with opioid use disorder (POUD) who are incarcerated are disproportionately impacted by the overdose crisis. We sought to identify overdose policies that allocate resources with maximal efficiency to reduce mortality among POUD in the New Jersey (NJ) Department of Corrections.

Main outcomes/measures: We created a probabilistic state-transition model of a simulated cohort of POUD incarcerated in NJ to simulate maximizing medication for opioid use disorder (MOUD) during incarceration and/or post-release in the community and naloxone in the community. We estimated how maximizing each intervention individually and in combinations compared to current provision would impact five-year overdose deaths (ODDs), life-years (LYs), and quality-adjusted life-years (QALYs) among the simulated cohort, who moved between different modeled settings and opioid use statuses. Inputs were derived from literature reviews and expert opinion. Costs were in 2021 USD, employing a health sector perspective in base-case analyses and a limited societal perspective in sensitivity analyses, a 3% discount rate, cost-effectiveness criterion of ≤ $100,000/QALY, and life-year and lifetime horizons.

Results: At status quo, 141 five-year ODDs will occur in the cohort (n = 2,592), and the cohort will live an average of 17.0 discounted LYs, experiencing 13.3 discounted QALYs. Evaluating interventions individually compared to status quo, maximizing MOUD in incarceration prevents 14 five-year ODDs, adds 0.2 LYs, 0.3 QALYs per-person at a favorable incremental cost-effectiveness ratio (ICER; $34,000/QALY). Maximizing MOUD in the community prevents 40 five-year ODDs, adds 0.9 LYs, 1.1 QALYs at a favorable ICER ($25,000/QALY). Maximizing naloxone prevents 24 five-year ODDs, adds 0.3 LYs, 0.2 QALYs at a favorable ICER ($17,000/QALY). Comparing all combinations of interventions to status quo and each other, the most beneficial combination meeting cost-effectiveness criterion was jointly maximizing community MOUD and naloxone (ICER $25,000/QALY), preventing 56 five-year ODDs, adding 1.2 LYs, 1.3 QALYs. In sensitivity analyses using a limited societal perspective, all interventions were cost-saving. Maximizing all interventions was both most beneficial (42% reduction in death) and cost-saving ($300,000 per capita) over the cohort lifetime.

Conclusion: Maximizing MOUD and community naloxone in New Jersey can reduce five-year ODDs by 40%. Considering societal cost-savings, maximizing all three also saves money.

Background: Drug checking is a harm reduction intervention that combines the identification of the chemical content of a drug with an information-sharing intervention concerning the risks of drug use. Despite growing evidence of the usefulness of this method, legal obstacles in many countries constrain the implementation of drug checking. The purpose of this Finnish study was to evaluate the usefulness of a paraphernalia-based drug-checking protocol.

Methods: A total of 503 drug paraphernalia samples were submitted between April 2022 and July 2024 to 9 different harm reduction services. The samples were analysed monthly via chromatography‒mass spectrometry, and the visitors had the option to return to discuss the results after laboratory analysis. The questionnaire data were collected both during sample submission and the discussion of the results. Additionally, six thematic paired interviews were conducted with staff who performed drug checking at different service locations.

Results: The concordance between the promised and detected contents varied greatly depending on the submitted substance. Over two-thirds of the samples were submitted by visitors who had never used substance use services before. The visitors returned for the laboratory results for only 208 samples. The interviewed staff believed that a long waiting time was the main reason for the low return rate. The staff also identified several advantages. The sample submission as well as the dissemination of the recent results via posters at the service points offered an easy way to approach people and discuss different topics related to drug use, harm reduction, and social and health issues.

Conclusion: The protocol used was too slow for visitors to make preconsumption decisions. However, this shortcoming was not directly connected to the use of paraphernalia samples instead of actual drug samples, as the protocol could be accelerated with sufficient resources. The use of paraphernalia also caused uncertainties related to presubmission contamination. However, the protocol proved to be beneficial for initiating harm reduction discussions during the submission of the samples and the public dissemination of the results at the service locations, and should be considered as a starting point for drug checking when the use of actual drug samples is not possible.

Background: Despite strong evidence supporting medication for opioid use disorder (MOUD), acceptability varies considerably across contexts. This study explored client and provider perspectives on MOUD acceptability among people who inject drugs in Kampala, Uganda.

Methods: We conducted a qualitative descriptive study during November and December 2023 in Kampala Capital City, Uganda. In-depth interviews with 20 people who inject drugs (10 enrolled, 10 not enrolled) and key informant interviews with 10 MOUD service providers were conducted. Data were analysed using thematic analysis, guided by the Theoretical Framework of Acceptability (TFA) and managed with ATLAS.ti software.

Results: MOUD was highly acceptable among providers, enrolled and non-enrolled participants. Facilitators included comprehensive, person-centered services that addressed health and psychosocial needs, supportive family relationships, alignment with personal recovery goals, and the safety and effectiveness of supervised medication therapy. However, participants encountered significant barriers. Structural challenges such as high transport costs, limited clinic operating hours, and strict enrolment criteria impeded access and continuity. Fear of arrest due to drug criminalization and stigma, both societal and within healthcare settings, further discouraged engagement. Additionally, some participants questioned methadone's effectiveness relative to heroin and reported widespread reliance on traditional and spiritual healing practices, often coerced by family members. Social norms promoting mutual drug-sharing as a symbol of trust were disrupted by MOUD enrolment, resulting in peer resistance and social isolation.

Conclusion: MOUD was acceptable to people who inject drugs and providers, offering health and social benefits, but barriers, including transport cost, dialysis attendance, stigma, fears of arrests, clinic rules, side effects, and misconceptions, limited access. Scaling up requires flexible clinic rules and service models, community sensitisation, counselling, and collaboration with private, religious, traditional, and law enforcement actors to promote early initiation and broader acceptability.