International Journal of Drug Policy最新文献_第8页

Regressive policing, a return to the war on drugs, and the need for qualitative and ethnographic policy evaluations 倒退的警务、毒品战争的回归以及定性和人种学政策评估的必要性

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-03 DOI: 10.1016/j.drugpo.2024.104565

Shoshana V. Aronowitz , Megan K. Reed

引用次数: 0

Evidence that intergenerational income mobility is the strongest predictor of drug overdose deaths in U. S. Midwest counties 有证据表明，代际收入流动性是预测美国中西部地区吸毒过量死亡的最有力因素。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-03 DOI: 10.1016/j.drugpo.2024.104558

Gene M. Heyman, Ehri Ryu, Hiram Brownell

Background

Our goal in this report was to quantify the degree to which opioid prescription rates and socioeconomic correlates of income inequality predicted overdose deaths in the 1055 U.S. Midwest counties. The study follows up a state-level analysis which reported that opioid prescription rates, social capital and unemployment explained much of the variance in opioid overdose death rates (Heyman, McVicar, & Brownell, 2019).

Methods

We created a data set that included drug overdose death rates, opioid prescription rates, and correlates of income inequality. Given that the variables of interest varied at the state and county level, multilevel regression was our statistical approach.

Results

From 2006 to 2021, Midwest overdose drug deaths increased according to an exponential equation that closely approximated the equation that describes the increases in overdose deaths for the entire U.S. from 1978 to 2016 (e.g., Jalal et al., 2018). Retail opioid prescription sales increased from 2006 to 2012, but then declined so that by 2017 they were lower than in 2006. The regression analyses revealed that intergenerational income mobility was the strongest predictor of overdose deaths. The other consistently statistically significant predictors were opioid prescription rates, social capital, and unemployment rates. Together these predictors, plus pupil teacher ratios, single parent families, and attending college accounted for approximately 47 % of the variance in overdose death rates each year. In keeping with the decline in opioid prescription rates, the explanatory power of opioid prescription rates weakened over the course of the study.

Conclusions

Overdose deaths increased at a constant exponential rate for the years that it was possible to apply our regression model. This occurred even though access to legal opioids decreased. What remained invariant was the predictive strength of intergenerational income mobility; each year it was the predictor that explained the most variance in overdose deaths.

背景：本报告的目标是量化阿片类药物处方率和收入不平等的社会经济相关因素对美国中西部 1055 个县药物过量死亡的预测程度。这项研究是对一项州级分析的跟进，该分析报告称，阿片类药物处方率、社会资本和失业率在很大程度上解释了阿片类药物过量致死率的差异（Heyman, McVicar, & Brownell, 2019）：我们创建了一个数据集，其中包括吸毒过量死亡率、阿片类药物处方率以及收入不平等的相关因素。鉴于相关变量在州和县一级存在差异，我们采用了多层次回归的统计方法：从 2006 年到 2021 年，中西部吸毒过量死亡人数的增长与 1978 年到 2016 年全美吸毒过量死亡人数增长的指数方程非常接近（例如，Jalal 等人，2018 年）。阿片类处方药的零售额在 2006 年至 2012 年期间有所增加，但随后有所下降，到 2017 年已低于 2006 年的水平。回归分析表明，代际收入流动性是吸毒过量死亡的最强预测因素。其他持续具有统计意义的预测因素包括阿片类药物处方率、社会资本和失业率。这些预测因素加上师生比、单亲家庭和上大学等因素，每年约占吸毒过量死亡率差异的 47%。随着阿片类药物处方率的下降，阿片类药物处方率的解释力在研究过程中逐渐减弱：结论：在可以应用我们的回归模型的年份里，过量死亡人数以恒定的指数速度增长。尽管获得合法阿片类药物的机会减少了，但这一现象依然存在。保持不变的是代际收入流动性的预测强度；每年，它都是解释过量死亡差异最大的预测因素。

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引用次数: 0

Making sense of drug use and dependence—A scoping review of mass media interventions intended to reduce stigma towards people who use drugs 了解吸毒和药物依赖--对旨在减少对吸毒者污名化的大众传媒干预措施的范围界定综述。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-03 DOI: 10.1016/j.drugpo.2024.104543

Adam Holland , Tom P Freeman , James Nicholls , Chloe Burke , Joshua Howkins , Magdalena Harris , Matthew Hickman , Angela Attwood , Vicky Carlisle , Peter Krykant , Olivia M Maynard

Background

People who use drugs face entrenched stigma, which fosters shame, restricts service access, and exacerbates inequalities. The use of mass media in anti-stigma interventions offers an opportunity to challenge stigmatising attitudes at scale. There are, however, inconsistencies in messaging approaches used in mass media anti-stigma interventions, and how authors conceptualise and measure ‘stigma’.

Methods

This scoping review maps literature on the development and/or evaluation of mass media interventions intended to reduce stigma towards people who use drugs. We systematically searched seven databases for reports about: (i) people who use drugs, (ii) stigma, (iii) mass media. We charted data about intervention (i) subjects and recipients, (ii) format, (iii) authors, (iv) content; and (v) conceptualisation and measurement of stigma. We narratively synthesised findings with qualitative content analyses.

Results

From 14,256 records, we included 49 reports about 35 interventions. 25/35 were from the last five years and 19/35 were from the United States. Intended recipients included the public and/or specified sub-populations, often including healthcare workers. Most interventions were intended to reduce stigma towards people with patterns of drug use perceived to be problematic, as opposed to people who use drugs in general. Interventions ranged from single pieces of media to complex multi-format campaigns. People who use(d) drugs contributed to 22/35 interventions. Professionals working in medical disciplines co-authored 29/35 interventions. Intervention content often had a medical focus, describing dependence as a ‘disease’ or medical issue, and emphasised the benefits of recovery. Other interventions, however, criticised medical framings. In some interventions drug use and people who use drugs were described in markedly negative terms. ‘Stigma’ was often under-theorised, and measurement approaches were inconsistent, with 42 instruments used to measure phenomena associated with stigma across 19 quantitative evaluations.

Conclusion

We found inconsistencies in approaches to reduce and measure stigma, potentially reflecting different motivations for intervention development. The primary motivation of many interventions was seemingly to promote drug service engagement and recovery.

背景：吸毒者面临着根深蒂固的耻辱感，这种耻辱感助长了羞耻感，限制了获得服务的机会，加剧了不平等现象。在反污名化干预措施中使用大众媒体为大规模挑战污名化态度提供了机会。然而，在大众媒体反污名化干预措施中使用的信息传递方法以及作者对 "污名化 "的概念和测量方法并不一致：本范围界定综述对旨在减少对吸毒者的污名化的大众媒体干预措施的开发和/或评估文献进行了梳理。我们系统地搜索了七个数据库中有关以下内容的报告：(i) 吸毒者，(ii) 成见，(iii) 大众媒体。我们绘制了有关干预的数据图表：(i) 对象和接受者，(ii) 形式，(iii) 作者，(iv) 内容，以及 (v) 成见的概念化和测量。我们通过定性内容分析对研究结果进行了叙述性综合：在 14256 条记录中，我们收录了关于 35 项干预措施的 49 份报告。其中 25/35 来自过去五年，19/35 来自美国。目标受众包括公众和/或特定亚人群，通常包括医护人员。大多数干预措施的目的是减少对吸毒模式被认为有问题的人的污名化，而不是对一般吸毒者的污名化。干预措施从单一媒体到复杂的多形式运动不等。吸毒者参与了 22/35 项干预活动。医疗学科的专业人员共同撰写了 29/35 项干预措施。干预内容通常以医学为重点，将药物依赖描述为一种 "疾病 "或医学问题，并强调康复的益处。然而，其他干预措施则对医学框架提出了批评。在一些干预措施中，吸毒和吸毒者被以明显负面的措辞描述。成见 "往往没有被充分理论化，测量方法也不一致，19 项定量评估中使用了 42 种工具来测量与成见相关的现象：我们发现，减少和衡量成见的方法并不一致，这可能反映了制定干预措施的不同动机。许多干预措施的主要动机似乎是促进戒毒服务的参与和康复。

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引用次数: 0

The ‘ban’ for public health that wasn't? Views and impressions on cannabis retail promotion/advertising realities amidst legalization policy in Canada 对公共健康的 "禁令 "不是禁令？对加拿大合法化政策下大麻零售促销/广告现实情况的看法和印象

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-01 DOI: 10.1016/j.drugpo.2023.104294

引用次数: 0

Modeling the impact of the COVID-19 pandemic on achieving HCV elimination amongst young and unstably housed people who inject drugs in San Francisco 模拟 COVID-19 大流行对在旧金山年轻且无稳定住所的注射吸毒者中消除 HCV 的影响。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-01 DOI: 10.1016/j.drugpo.2024.104452

Background

Young adult (18–30 years) people who inject drugs (PWID) face high hepatitis C virus (HCV) prevalence. In San Francisco, where >60% of PWID lack stable housing, barriers hinder HCV treatment access. We assessed progress towards the World Health Organization's (WHO) HCV elimination goal of an 80% reduction in incidence over 2015–2030, focusing on young (YPWID) and unstably housed PWID in San Francisco.

Methods

We developed a dynamic HCV transmission model among PWID, parameterized and calibrated using bio-behavioural survey datasets from San Francisco. This included 2018 estimates for the antibody-prevalence among PWID (77%) and care cascade estimates for HCV for YPWID (72% aware of their status and 33% ever initiating treatment). Based on programmatic data, we assumed a 53.8% reduction in testing and 40.7% decrease in treatment from 2020 due to the COVID-19 pandemic, which partially rebounded from April 2021 with testing rates then being 31.1% lower than pre-pandemic rates and treatment numbers being 19.5% lower. We simulated different scenarios of how services changed after the pandemic to project whether elimination goals would be met.

Results

Continuing post-pandemic rates of testing and treatment, the model projects an 83.3% (95% credibility interval [95% CrI]:60.6–96.9%) decrease in incidence among PWID over 2015–2030 to 1.5/100pyrs (95% CrI:0.3–4.4) in 2030. The probability of achieving the elimination goal by 2030 is 62.0%. Among YPWID and unstably housed PWID, the probability of achieving the elimination goal by 2030 is 54.8 and 67.6%, respectively. Importantly, further increasing testing and treatment rates to pre-pandemic levels by 2025 only results in a small increase in the probability (67.5%) of the elimination goal being achieved among all PWID by 2030, while increased coverage of medication for opioid use disorder among YPWID and/or housing interventions results in the probability of achieving elimination increasing to over 75%.

Conclusion

The COVID-19 pandemic impeded progress toward achieving HCV elimination. Our findings indicate that existing partial rebounds in HCV testing and treatment may achieve the elimination goal by 2030, with an additional scale-up of interventions aimed at YPWID or unstably housed PWID ensuring San Francisco is likely to achieve elimination by 2030.

背景：年轻的成年（18-30 岁）注射吸毒者（PWID）面临着丙型肝炎病毒（HCV）高流行率的问题。在旧金山，超过 60% 的注射吸毒者没有稳定的住所，这阻碍了他们获得丙型肝炎病毒（HCV）治疗。世界卫生组织（WHO）提出了在 2015-2030 年间将丙型肝炎病毒感染率降低 80% 的目标，我们以旧金山的年轻吸毒者（YPWID）和无稳定住所的吸毒者为重点，评估了实现这一目标的进展情况：我们开发了一个动态的艾滋病病毒在吸毒者中传播模型，并利用旧金山的生物行为调查数据集进行了参数化和校准。其中包括 2018 年艾滋病病毒抗体流行率估计值（77%）和青年艾滋病病毒感染者护理级联估计值（72% 意识到自己的感染状况，33% 曾经开始治疗）。根据计划数据，我们假设由于 COVID-19 大流行，检测率从 2020 年开始下降了 53.8%，治疗率下降了 40.7%，从 2021 年 4 月开始部分反弹，检测率比大流行前下降了 31.1%，治疗人数下降了 19.5%。我们模拟了大流行后服务变化的不同情况，以预测是否能实现消除目标：按照大流行后的检测率和治疗率，模型预测 2015-2030 年间吸毒者发病率将下降 83.3%（95% 可信区间 [95%CrI]：60.6-96.9%），到 2030 年降至 1.5/100pyrs（95% CrI：0.3-4.4）。到 2030 年实现消除目标的概率为 62.0%。在青少年吸毒者和无固定住所的吸毒者中，到 2030 年实现消除目标的概率分别为 54.8% 和 67.6%。重要的是，如果到 2025 年将检测和治疗率进一步提高到大流行前的水平，到 2030 年在所有感染者中实现根除目标的概率（67.5%）仅会略有增加，而在青少年感染者和/或住房干预中增加阿片类药物使用障碍的药物治疗覆盖率，则实现根除目标的概率会增加到 75% 以上：结论：COVID-19 大流行阻碍了消除 HCV 的进程。我们的研究结果表明，HCV 检测和治疗方面现有的部分反弹可能会在 2030 年前实现根除目标，而针对青年妇女吸毒者或无稳定居所的吸毒者的干预措施的进一步扩大将确保旧金山有可能在 2030 年前实现根除目标。

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引用次数: 0

National increase in the community supply of take‐home naloxone associated with a mass media campaign in Scotland: a segmented time series analysis 与苏格兰大众媒体宣传活动相关的全国社区带回家纳洛酮供应量的增加：分段时间序列分析。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-01 DOI: 10.1016/j.drugpo.2023.104106

Background

Take-home naloxone (THN) programmes have been associated with reductions in opioid-related mortality. In response to high rates of drug-related deaths in Scotland, the Scottish Government commissioned the ‘How to save a life’ (HTSAL) mass media campaign to: (1) increase awareness of drug-related deaths and how to respond to an overdose, and (2) increase the supply of THN. The aim of this study was to assess the effect of the campaign on the supply of THN.

Methods

We used an interrupted time series design to assess the effect of the HTSAL mass media campaign on the national community supply of THN. The study time period was August 2020–December 2021. We modelled two key dates: the start of the campaign (week beginning (w/b) 30th of August 2021) and after the end of the main campaign (w/b 25th of October 2021).

Results

The total number of THN kits distributed in the community in Scotland during the study period was 27,064. The mean number of THN kits distributed per week (relative to the pre-campaign period), increased by 126% during the campaign and 57% post-campaign. In segmented regression analyses, the pre-campaign trend in the number of THN kits supplied was increasing by an average of 1% each week (RR=1.01, 95% CI 1.01 to 1.01, p<0.001). Once the campaign started, a significant change in level was observed, and the number of kits increased by 75% (RR=1.75, 95% CI 1.29 to 2.40, p<0.001). The trend during the campaign was stable (i.e. not increasing or decreasing) but a significant change in level was observed when the campaign ended, and the number of THN kits supplied decreased by 32% (RR=0.68, 95% CI 0.46 to 0.98, p = 0.042). The trend during the post-campaign period was stable.

Conclusions

The HTSAL campaign had a short term, but large and significant impact, on the community supply of THN in Scotland. Mass media campaigns could be combined with other interventions and strategies to maintain the increased uptake of THN outside of campaign periods.

背景：居家纳洛酮（THN）计划与降低阿片类药物相关死亡率有关。为应对苏格兰与毒品有关的高死亡率，苏格兰政府委托开展了 "如何拯救生命"（HTSAL）大众媒体宣传活动，以达到以下目的：(1) 提高人们对毒品相关死亡以及如何应对用药过量的认识，以及 (2) 增加 THN 的供应。本研究旨在评估该活动对 THN 供应量的影响：我们采用间断时间序列设计来评估 HTSAL 大众媒体宣传活动对全国社区 THN 供应量的影响。研究时间段为 2020 年 8 月至 2021 年 12 月。我们模拟了两个关键日期：活动开始（2021 年 8 月 30 日开始的一周）和主要活动结束后（2021 年 10 月 25 日开始的一周）：研究期间在苏格兰社区分发的 THN 工具包总数为 27,064 个。与运动前相比，运动期间每周分发的 THN 工具包平均数量增加了 126%，运动后增加了 57%。在分段回归分析中，活动前供应的 THN 工具包数量呈平均每周增加 1%的趋势（RR=1.01，95% CI 1.01 至 1.01，p 结论：HTSAL 运动对苏格兰 THN 的社区供应产生了短期但巨大的影响。大众媒体宣传活动可与其他干预措施和战略相结合，以保持在宣传活动期间之外增加 THN 的摄入量。

{"title":"National increase in the community supply of take‐home naloxone associated with a mass media campaign in Scotland: a segmented time series analysis","authors":"","doi":"10.1016/j.drugpo.2023.104106","DOIUrl":"10.1016/j.drugpo.2023.104106","url":null,"abstract":"<div><h3>Background</h3><p>Take-home naloxone (THN) programmes have been associated with reductions in opioid-related mortality. In response to high rates of drug-related deaths in Scotland, the Scottish Government commissioned the ‘How to save a life’ (HTSAL) mass media campaign to: (1) increase awareness of drug-related deaths and how to respond to an overdose, and (2) increase the supply of THN. The aim of this study was to assess the effect of the campaign on the supply of THN.</p></div><div><h3>Methods</h3><p>We used an interrupted time series design to assess the effect of the HTSAL mass media campaign on the national community supply of THN. The study time period was August 2020–December 2021. We modelled two key dates: the start of the campaign (week beginning (w/b) 30th of August 2021) and after the end of the main campaign (w/b 25th of October 2021).</p></div><div><h3>Results</h3><p>The total number of THN kits distributed in the community in Scotland during the study period was 27,064. The mean number of THN kits distributed per week (relative to the pre-campaign period), increased by 126% during the campaign and 57% post-campaign. In segmented regression analyses, the pre-campaign trend in the number of THN kits supplied was increasing by an average of 1% each week (RR=1.01, 95% CI 1.01 to 1.01, <em>p</em><0.001). Once the campaign started, a significant change in level was observed, and the number of kits increased by 75% (RR=1.75, 95% CI 1.29 to 2.40, <em>p</em><0.001). The trend during the campaign was stable (i.e. not increasing or decreasing) but a significant change in level was observed when the campaign ended, and the number of THN kits supplied decreased by 32% (RR=0.68, 95% CI 0.46 to 0.98, <em>p</em> = 0.042). The trend during the post-campaign period was stable.</p></div><div><h3>Conclusions</h3><p>The HTSAL campaign had a short term, but large and significant impact, on the community supply of THN in Scotland. Mass media campaigns could be combined with other interventions and strategies to maintain the increased uptake of THN outside of campaign periods.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104106"},"PeriodicalIF":4.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9964745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How to save a life: Public awareness of a national mass media take home naloxone campaign, and effects of exposure to campaign components on overdose knowledge and responses. 如何拯救生命：公众对全国性大众媒体带回家纳洛酮活动的认识，以及接触活动内容对用药过量知识和反应的影响。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-01 DOI: 10.1016/j.drugpo.2023.104111

Background

Take home naloxone (THN) programmes are effective at reducing opioid related mortality, but require high levels of distribution, including to the general public. Mass media campaigns can be effective in improving public understanding of a topic and encouraging behavior change. Whilst mass media campaigns focusing on naloxone have been developed internationally, there is a lack of research on their potential impact. We investigated the effects of components of a recent national mass media campaign (Scotland, UK) designed to improve public awareness of drug related deaths, and readiness to intervene.

Methods

We undertook a cross-sectional online experimental study with a randomized design, conducted with a nationally representative sample. Participants (N = 1551; 52.6% female; age 46.1±16.5 years) were assessed on overdose knowledge and readiness to intervene after presentation of eight combinations of campaign components.

Results

Compared to a basic campaign description, exposure to all types of campaign component were associated with higher overdose knowledge (p < .001), but not knowledge of what to do in response to an overdose (p = .374), or readiness to intervene (p= .286). The greatest effects were associated with a media rich audio-visual resource (animated video with a popular song on the soundtrack, and narrated by a well-known actor).

Conclusion

Our data suggest that harm reduction is an appropriate topic for large-scale mass media campaigns. However, effects may be limited to knowledge and awareness raising in the general public, and may be related to the types of media used. Audience segmentation is important and more general messaging about drug related deaths may be more appropriate for the majority of audiences.

背景：带回家的纳洛酮（THN）方案可有效降低与阿片类药物相关的死亡率，但需要大量分发，包括向公众分发。大众媒体宣传可以有效提高公众对某一主题的理解，并鼓励行为改变。虽然国际上已经开展了以纳洛酮为重点的大众媒体宣传活动，但缺乏对其潜在影响的研究。我们调查了最近一次全国性大众媒体宣传活动（英国苏格兰）的效果，该活动旨在提高公众对毒品相关死亡事件的认识，并做好干预准备：我们进行了一项横断面在线实验研究，采用随机设计，以具有全国代表性的样本为研究对象。参与者（N = 1551；52.6% 为女性；年龄为 46.1±16.5 岁）在接受了八种宣传内容组合的介绍后，接受了用药过量知识和干预意愿的评估：与基本的宣传说明相比，接触所有类型的宣传内容都会增加用药过量知识（p < .001），但不会增加对用药过量时该如何应对的知识（p = .374），也不会增加干预意愿（p= .286）。效果最大的是富媒体视听资源（动画视频，配乐为一首流行歌曲，由知名演员解说）：我们的数据表明，减少危害是大规模大众媒体宣传活动的一个合适主题。然而，效果可能仅限于提高公众的知识和意识，而且可能与所使用的媒体类型有关。对受众进行细分非常重要，对于大多数受众来说，更多关于毒品相关死亡的一般性信息可能更合适。

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引用次数: 0

The impact of an unsanctioned compassion club on non-fatal overdose 未经批准的同情俱乐部对非致命性用药过量的影响。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-01 DOI: 10.1016/j.drugpo.2024.104330

Objectives

In 2022, the Drug User Liberation Front opened an unsanctioned compassion club in Vancouver where members could purchase illicit drugs that had been rigorously tested to ensure quality and a lack of potentially fatal contaminants. We sought to evaluate the impact of access to this novel safer supply intervention on non-fatal overdose.

Methods

Data were obtained from 47 club members via surveys completed at 3-month intervals between August 2022 and October 2023. We conducted multivariable generalized estimating equations (GEE) analyses to examine the association between club enrolment and the outcomes of: (1) any non-fatal overdose; and (2) any non-fatal overdose involving naloxone administration.

Results

The final sample, including 47 study participants, contributed a total of 225 observations and 44.4 person-years of follow-up during the study, and a median follow-up duration of 12.2 months (quartile 1 - 3: 10.4 – 14.7) per participant. In multivariable GEE analyses, enrolment in the compassion club was associated with reduced likelihood of non-fatal overdose (Adjusted Odds Ratio [AOR] = 0.51, 95% Confidence Interval (CI): 0.26 – 0.99) and non-fatal overdose involving naloxone administration (AOR = 0.37, 95% CI: 0.16 – 0.84) after adjusting for potential confounders.

Discussion

In this study, enrolment in an unsanctioned compassion club was found to be associated with reductions in any type of non-fatal overdose and non-fatal overdose involving naloxone administration. These findings highlight the need for ongoing research on safer supply interventions, as well as the potential of non-medicalized compassion clubs to complement existing safer supply programming and reduce overdose events.

目标：2022 年，"吸毒者解放阵线 "在温哥华开设了一家未经批准的慈善俱乐部，会员可以在那里购买经过严格检测的非法药物，以确保质量和不含潜在的致命污染物。我们试图评估获得这种新型安全供应干预措施对非致命性用药过量的影响：在 2022 年 8 月至 2023 年 10 月期间，我们通过每隔 3 个月完成一次的调查从 47 名俱乐部成员处获得了数据。我们进行了多变量广义估计方程 (GEE) 分析，以研究加入俱乐部与以下结果之间的关联：(结果：最终样本包括 47 名研究参与者，在研究期间共进行了 225 次观察和 44.4 人年的随访，每位参与者的中位随访时间为 12.2 个月（四分位数 1 - 3：10.4 - 14.7）。在多变量 GEE 分析中，在调整了潜在的混杂因素后，参加同情俱乐部与降低非致命性用药过量的可能性相关（调整后比值比 [AOR] = 0.51，95% 置信区间 (CI)：0.26 - 0.99），以及与使用纳洛酮相关的非致命性用药过量的可能性相关（AOR = 0.37，95% CI：0.16 - 0.84）：本研究发现，参加未经批准的爱心俱乐部与减少任何类型的非致命性用药过量和涉及纳洛酮给药的非致命性用药过量有关。这些发现凸显了对更安全供应干预措施进行持续研究的必要性，以及非医疗化同情俱乐部补充现有更安全供应计划和减少用药过量事件的潜力。

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引用次数: 0

Pilot model of hepatitis C virus micro-elimination in high-risk populations in Hong Kong: Barriers and facilitators 在香港高危人群中微量消除丙型肝炎病毒的试点模式：障碍与促进因素

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-08-31 DOI: 10.1016/j.drugpo.2024.104568

Lung-Yi Mak , Wai-Pan To , Vivien Tsui , Matthew Shing-Hin Chung , Ka-Yin Hui , Trevor Kwan-Hung Wu , Anthony Kwok , Kwan-Lung Ko , Danny Ka-Ho Wong , Siu-Yin Wong , Kevin Sze-Hang Liu , Wai-Kay Seto , Man-Fung Yuen

Background

Although the general seroprevalence of hepatitis C virus (HCV) infection in Hong Kong is <0.5 %, Hong Kong is still striving for HCV elimination owing to barriers in care cascade encompassing linkage-to-care (LTC), treatment initiation and adherence. We aimed to evaluate the feasibility of a pilot model of micro-elimination to strengthen the HCV care cascade for high-risk groups in Hong Kong.

Methods

We initiated the pilot Conquering Hepatitis vIa Micro-Elimination (CHIME) program which adopts an integrated care approach involving outreach visits to halfway house or drug rehabilitation centers run by non-governmental organizations. Participants with history of injection drug use (PWID), recreational drug use, or imprisonment were included. We performed point-of-care test for anti-HCV with reflex HCV RNA testing. LTC with government-subsidized direct acting antiviral was provided to viremic participants. We compared the impact on the care cascade with a cohort of HCV patients (17.8 % PWID) under usual care.

Results

396 participants (62.9 % PWID) were screened and 187 (47.2 %) were viremic, of which 29.8 % had cirrhosis. Proportion with LTC, treatment initiation and adherence were 76.5 % and 63.7 %, 90.9 % and 85.8 %, and 90.0 % and 92.2 %, for the CHIME program and usual care, respectively. The CHIME program was significantly associated with higher odds of LTC (OR 1.797, 95 % CI 1.221–2.644). Non-engagement in care (affecting 37.9 % participants with HCV viremia) was associated with unemployment (OR 2.165, 95 % CI 1.118–4.190).

Conclusion

The pilot CHIME program demonstrated feasibility of an integrated approach to consolidate the HCV care cascade in high-risk populations in Hong Kong.

背景虽然香港丙型肝炎病毒（HCV）感染的血清阳性率为0.5%，但由于护理流程（包括联系到护理（LTC）、开始治疗和坚持治疗）中的障碍，香港仍在努力消除HCV。我们发起了 "战胜 VIa 型肝炎微观治疗"（CHIME）试点项目，该项目采用综合治疗方法，对非政府组织开办的中途宿舍或戒毒康复中心进行外展探访。有注射吸毒史（PWID）、娱乐性吸毒史或服刑史的参与者也被纳入其中。我们通过反射性 HCV RNA 测试对患者进行抗-HCV 检测。对有病毒感染的参与者提供了由政府补贴的直接作用抗病毒药物的长期治疗。结果 396 名参与者（62.9% PWID）接受了筛查，187 人（47.2%）为病毒携带者，其中 29.8% 为肝硬化患者。在CHIME项目和常规护理中，LTC、开始治疗和坚持治疗的比例分别为76.5%和63.7%、90.9%和85.8%、90.0%和92.2%。CHIME项目与较高的长期护理几率有明显关联（OR 1.797，95% CI 1.221-2.644）。结论CHIME试点项目证明了在香港高危人群中采用综合方法巩固HCV护理级联的可行性。

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引用次数: 0

Opportunities and challenges for implementing drug checking services in British Columbia, Canada: A qualitative study 在加拿大不列颠哥伦比亚省实施药物检查服务的机遇与挑战：定性研究

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-08-31 DOI: 10.1016/j.drugpo.2024.104560

Koharu Loulou Chayama , Lianping Ti , Jaime Arredondo Sanchez Lira , Pierre-julien Coulaud , Geoff Bardwell , Rod Knight

Background

Amidst the ongoing drug poisoning crisis across North America, drug checking services (DCS) are increasingly being implemented as an intervention intended to reduce drug-related harms. This study sought to identify key opportunities and challenges influencing the implementation of DCS in British Columbia (BC), Canada.

Methods

Between January 2020 and July 2021, semi-structured, in-depth interviews were conducted with 21 individuals involved in the implementation of DCS across BC (i.e., policymakers, health authority personnel, community organization representatives and service providers). The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis of the interviews.

Results

By bringing in a wealth of knowledge about community needs and concerns, in addition to a passion and energy for social justice and health equity, community members and organizations with a dedication for harm reduction played a critical role in the successful implementation of DCS in BC. Other significant facilitators to implementation included the preventive benefits of DCS that made the intervention compelling to policy influencers and decision makers, the provincial public health emergency regarding overdose that shifted the regulatory environment of DCS, the adaptability of DCS to meet concerns and needs in various contexts, including via ongoing processes of reflection and evaluation. Barriers to implementation included criminalization and stigmatization of drug use and people who use drugs and lack of funding for community-led implementation actions.

Conclusions

Alongside structural reforms that address the underlying contextual factors that influence implementation (e.g., decriminalization of drugs, increased funding for DCS), centering community expertise throughout implementation is critical to the success of DCS. Our findings provide important insights into how BC can successfully implement systems-level harm reduction interventions and offer insights for other jurisdictions in their implementation of DCS.

背景在整个北美地区持续不断的药物中毒危机中，毒品检查服务（DCS）作为一种旨在减少毒品相关危害的干预措施正越来越多地得到实施。本研究旨在确定影响加拿大不列颠哥伦比亚省（BC省）实施DCS的主要机遇和挑战。方法在2020年1月至2021年7月期间，对参与不列颠哥伦比亚省各地DCS实施工作的21名个人（即政策制定者、卫生当局人员、社区组织代表和服务提供者）进行了半结构化深入访谈。结果通过引入有关社区需求和关切的丰富知识，以及对社会正义和健康公平的热情和精力，致力于减少伤害的社区成员和组织在不列颠哥伦比亚省成功实施 DCS 的过程中发挥了至关重要的作用。促进实施的其他重要因素包括：DCS 的预防性益处使干预措施对政策影响者和决策者具有说服力；关于用药过量的省级公共卫生紧急状况改变了 DCS 的监管环境；DCS 具有适应性，能够满足各种情况下的关切和需求，包括通过持续的反思和评估过程。实施的障碍包括对吸毒和吸毒者的定罪和污名化，以及社区主导的实施行动缺乏资金。结论除了进行结构性改革以解决影响实施的基本环境因素（如毒品非刑罪化、增加对社区安保服务的资金投入），在整个实施过程中以社区专业知识为中心对社区安保服务的成功至关重要。我们的研究结果为不列颠哥伦比亚省如何成功实施系统层面的减低伤害干预措施提供了重要启示，并为其他辖区实施减低伤害战略提供了借鉴。

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