Exploring public preferences for limiting or expanding harm reduction policies in Florida, USA

Background: The U.S. is undergoing an opioid overdose crisis. Harm reduction (HR) policies are associated with decreased overdose deaths and incidence of communicable diseases, yet legality of HR policies differs across U.S. jurisdictions. College student perceptions of HR policies are underexplored, even though their voting behavior has increased in recent years. We sought to compare their support of different HR policies and to explore relationships between demographic characteristics and support for HR policies. Methods: We collected cross-sectional, convenience sample survey data from undergraduate students at two large public universities, one in the Midwest and one in the Southeast, during Fall 2018/Spring 2019. We analyzed data using descriptive statistics and logistic regressions. Results: The final sample included 1,263 respondents. Good Samaritan laws (n = 833, 66%) and naloxone distribution (n = 476, 37.7%) were most commonly supported, while heroin maintenance treatment (n = 232, 18.4%) and heroin decriminalization (n = 208, 16.5%) were least supported. Democrat/liberal or less religious/spiritual respondents supported HR policies more than their Republican/conservative or religious/spiritual counterparts. Midwestern students were more likely to support syringe services programs. Conclusion: HR education initiatives could target religious and/or Republican/conservative students, as they have lower HR support. Among HR policies, Good Samaritan policies may be easiest to pass in college communities.

Prison's second death row

Youth and young adult knowledge of and access to opioid harm reduction policies and interventions in North Carolina

168 Impact of Connecticut’s Good Samaritan Laws in Preventing Opioid Overdose Deaths – An Applied System Dynamics Approach

BackgroundGood Samaritan Laws are a harm reduction policy intended to facilitate a reduction in fatal opioid overdoses by enabling bystanders, first responders, and health care providers to assist individuals experiencing an overdose without facing civil or criminal liability. However, Good Samaritan Laws may not be reaching their full impact in many communities due to a lack of knowledge of protections under these laws, distrust in law enforcement, and fear of legal consequences among potential bystanders. The purpose of this study was to develop a systems-level understanding of the factors influencing bystander responses to opioid overdose in the context of Connecticut’s Good Samaritan Laws and identify high-leverage policies for improving opioid-related outcomes and implementation of these laws in Connecticut (CT).MethodsWe conducted six group model building (GMB) workshops that engaged a diverse set of participants with medical and community expertise and lived bystander experience. Through an iterative, stakeholder-engaged process, we developed, refined, and validated a qualitative system dynamics (SD) model in the form of a causal loop diagram (CLD).ResultsOur resulting qualitative SD model captures our GMB participants’ collective understanding of the dynamics driving bystander behavior and other factors influencing the effectiveness of Good Samaritan Laws in the state of CT. In this model, we identified seven balancing (B) and eight reinforcing (R) feedback loops within four narrative domains: Narrative 1 - Overdose, Calling 911, and First Responder Burnout; Narrative 2 - Naloxone Use, Acceptability, and Linking Patients to Services; Narrative 3 - Drug Arrests, Belief in Good Samaritan Laws, and Community Trust in Police; and Narrative 4 - Bystander Naloxone Use, Community Participation in Harm Reduction, and Cultural Change Towards Carrying Naloxone.ConclusionsOur qualitative SD model brings a nuanced systems perspective to the literature on bystander behavior in the context of Good Samaritan Laws. Our model, grounded in local knowledge and experience, shows how the hypothesized non-linear interdependencies of the social, structural, and policy determinants of bystander behavior collectively form endogenous feedback loops that can be leveraged to design policies to advance and sustain systems change.

Delivering and receiving prompt medical care during an overdose are imperative to ensure survival. Good Samaritan laws encourage people to call 911 during an overdose by providing immunity from selected drug arrests (eg, low-level possession). However, it is unclear whether persons who inject drugs (PWID) are aware of and understand these laws and their implications. We examined awareness among PWID of the 2015 Good Samaritan law in Maryland and their beliefs about whether they could be arrested for calling 911 or having an overdose. We surveyed 298 PWID in Baltimore, Maryland. We estimated the proportion who knew what the Good Samaritan law addressed and who believed they could be arrested for calling 911 or overdosing. We used a multivariate model to assess the association between harm-reduction services and knowledge of the Good Samaritan law or beliefs about getting arrested for calling 911 or overdosing. Of PWID, 56 of 298 (18.8%) knew what the Good Samaritan law addressed, 43 of 267 (16.1%) believed they could be arrested for calling 911, and 32 of 272 (11.8%) believed they could be arrested for having an overdose. After adjusting for demographic characteristics, accessing the syringe services program was associated with accurate knowledge and the belief that PWID could be arrested for calling 911; however, training in overdose reversal was not associated. Most PWID were unaware of the Good Samaritan law; this lack of awareness is a barrier to preventing overdose deaths. Educating PWID about Good Samaritan laws is essential, and such education should include police to ensure that law enforcement is congruent with Good Samaritan laws and does not perpetuate mistrust between police and PWID.

In the United States, the rising prevalence of opioid addiction has led to an increase in opioid-related overdose deaths and transmission of infectious disease. This resulted in the declaration of a national public health emergency and the need for harm reduction strategies such as syringe exchange. Florida has seen increases in blood-borne diseases and fatal/nonfatal opioid overdoses, yet harm reduction policy integration has been historically limited. To inform policy change, this study explores the perspectives of community members in Manatee County, Florida, on harm reduction services. Six focus groups were conducted with findings centralized around three emergent themes related to the implementation of a syringe exchange program: (a) awareness and acceptability; (b) facilitating factors; and (c) perceived barriers. The results of this qualitative research helped to inform the successful adoption of a local syringe exchange ordinance. Recommendations for community education and engagement regarding harm reduction policy are discussed.

Harm reduction is an approach that aims to reduce harms related to using drugs. Harm reduction services often fail to consider the needs of women who inject drugs or minimise responses to women’s needs in service design and implementation (Bennett et al., 2000; Brown et al., 2005; EMCDDA, 2006; Levy, 2014a; Pinkham, Stoicesu and Myers, 2012; UNODC et al., 2014). It is therefore crucial to understand the experiences of women who inject drugs from their own perspectives, as well as those of harm reduction workers, in order to develop and implement effective responses to injecting drug use. This thesis explores how ‘harm’ and ‘harm reduction’ are conceptualised by workers and clients at a women-only day syringe exchange programme. It answers the following questions: In what ways do participants’ broader understandings of ‘harm’ and ‘harm reduction’ go beyond the traditional public health model of harm reduction in response to illicit injectable drug use? How are clients and workers’ understandings gendered? These questions were explored empirically through fieldwork in 2013 and 2014 at a harm reduction centre which featured a women-only day syringe exchange programme in Budapest, Hungary. This women-only day was the only gender sensitive harm reduction programme in the country, and the first study undertaken with Roma women who inject drugs in Hungary and female harm reduction workers. In addition, this first research project to use photovoice within a harm reduction context in Hungary. Data were co-produced with respondents according to the principles of Feminist- informed Participatory Action Research, using the method of ‘photovoice’. This method involved providing cameras for clients and employees of the women-only day to photograph their experiences and understandings of harm, harm production, and harm reduction. A significant portion of the data collected for this study was created by female harm reduction workers who worked at the women-only syringe exchange programme. Employees and clients’ images guided the research observations, interviews, and analysis. This meant collaboration between the participants and the researcher through the fieldwork, including the development and implementation of a research output in the form of a public photo exhibition and fundraiser event. The event was called ‘Chicks on the Corner’, and is the source of the thesis title as well as the title of the research project. The theoretical frameworks of zemiology (the study of harm) and black and multiracial feminist thought informed the ontological and epistemological grounding of the Chicks on the Corner project. These frameworks, coupled with the empirical data, produced an argument for the development of a feminist zemiology. The analytical themes that emerged from the Chicks on the Corner project were produced and categorised primarily using participant generated photographs. These images depict the multiple intersecting, overlapping, and mutually reinforcing sources of harm production and attempts at harm reduction in participants’ lives. Analysis of the photographs affirm that women who inject drugs experience an array of harms in addition to physical harms related to their drug use. Harms identified by research participants were categorised using Hillyard and Tombs (2004; 2005) zemiological typology. This typology consists of: physical harms, emotional harms, economic harms, and cultural harms (also known as lack of cultural safety). In addition, a new fifth category of harm was created based on participants’ responses, and is called institutional and political harms. The data from the Chicks on the Corner project show how institutional and political harms contributed to the production of the other four categories of harm. Furthermore, the analysis outlines the numerous challenges workers faced in attempting to provide adequate harm reduction responses while experiencing multiple social harms as well. These novel findings suggest the need for expanded definitions of ‘harm’ in harm reduction theory and practices. The findings from the Chicks on the Corner project complement existing literature on harm reduction theory and practice while also adding to the limited body of research on gender- sensitive approaches to harm reduction. This thesis contributes to an expansion of theoretical understandings of harm and harm reduction in relation to women who inject drugs and harm reduction workers, as well as discussing implications for gender sensitive harm reduction practices. Based on this analysis, I propose the development of feminist zemiology as a way to better understanding harm.

Dimension reduction of 911 Good Samaritan Laws: Drawing inferences from policy surveillance

Background Substance abuse continues to be on the rise in the U.S. driven by the proliferation of fentanyl laced street drugs. Per the CDC, during May 2020 - April 2021, a 29% increase in over dose deaths was observed compared to the previous year. Harm reduction services play a major role in reducing overdose deaths, life-threatening infections and chronic diseases. Syringe service programs (SSPs) have proven to be an essential component of a broader focus on harm reduction; however, gaps remain in engaging Veterans into these programs. Figure 1.Contents of Standard SSP Kit Distributed to Veterans at the Orlando VA Methods A multimodal strategy was implemented to engage Veterans and VA staff into harm reduction services. A harm reduction short video series was developed and posted on social media channels. ICD-10 codes were utilized to identify Veterans with polysubstance use and harm reduction letters were mailed. A pre and post survey was developed to assess provider’s familiarity and level of comfort with SSPs before and after in-service education was provided by ID physicians. An ID pharmacy consult was developed for providers to request patient education or harm reduction kit dispensing. Upon completion of the quality improvement project, we expect to see an increase in the number of Veterans utilizing SSP. Figure 2.Orlando VA SSP Process MapFigure 3.Harm Reduction Letter Results Upon implementation of outreach strategies total SSP visits increased by 72%. A total of 2040 syringes and 24 Naloxone kits have been dispensed through the SSP. Survey data shows that employees' knowledge on SSPs have increased by 48%, their comfort on working with Veterans who inject drugs increased by 6%, providers confidence in the tools available to them to successfully help veterans with alcohol and substance use recovery increased by 17%, misconception that SSPs increase drug use decreased by 6%, and support of placing consults for medication assisted therapy increased by 4%. Data is notable given limitations like post survey participation. Figure 4.Pre and Post Education Survey Data Collection ComparisonFigure 5.Pre and Post Education Survey Data Collection ComparisonFigure 6.Pre and Post Education Survey Data Collection Comparison Conclusion The implementation of multimodal strategies to engage Veterans and VA staff has resulted in an increase of SSP utilization. Sustained efforts to continue to identify target patients and bring them into care will be undertaken in an effort to increase and normalize SSP utilization. The steps already taken can serve as a model for programs currently in development and moves us closer to ending the HIV epidemic by 2030. Figure 7.Outreach Strategies Summary Disclosures All Authors: No reported disclosures.

Pathways to racial disparities in the effects of Good Samaritan Laws: A mixed methods pilot study

At a two-day private meeting in Tokyo in June 2005, some of Japan's most senior politicians and powerbrokers met to consider the steadily expanding HIV/AIDS epidemic. AIDS has recently become a matter of increasing concern in Japan following an HIV epidemic in several major Japanese cities among Japanese men having sex with men at sex-on-premises venues. The Japanese elites at the Tokyo meeting were shocked to learn that the United States has by far the highest annual AIDS incidence among OECD countries at 15/100,000 [1]. Spain, with an annual AIDS incidence of 3.3/100,000, has the second highest rate among industrialized countries, while Australia was well down the ranking with an incidence only one tenth that of the United States at 1.5/100,000 [1].

BackgroundUS chiefs of police hold significant influence over the perceived acceptability and appropriateness of interventions for opioid use disorder (OUD) among the public, elected officials, and subordinate officers. This study assessed whether police chiefs’ support for such interventions was sensitive to framing an intervention’s benefits in terms that emphasize public health and harm reduction outcomes, versus terms typically indicative of public safety outcomes.MethodsA two-armed survey utilizing a randomized, between-subjects design tested framing-based variance in support among US chiefs of police for overdose prevention centers, syringe service programs (SSPs), Good Samaritan laws, police naloxone distribution, trustworthiness of officers in recovery from OUD, and related propositions. Of 1,200 invitations, 276 chiefs participated (23%). The two experimental arms (n = 133, n = 143) were demographically balanced between both each other and non-respondents.ResultsChiefs were more likely to agree that their mission was protecting public safety than protecting public health, even when both were defined using public health outcomes. Chiefs expressed significantly greater support for “overdose prevention sites” than “safe injection sites” (p = .018), low levels of support for SSPs regardless of framing (18% safety; 19% health), and comparably more support for Good Samaritan laws based on framing (62% safety vs. 54% health). Respondents voiced low levels of trust in officers recovering from OUD generally (31%), and significantly lower levels of trust when recovery involved the medication buprenorphine (10%; p < .001). Senior chiefs were significantly more likely to support SSPs (aOR 1.05; CI 1.01, 1.09) and overdose prevention sites (aOR 2.45; CI 1.13, 5.28) than less senior chiefs.ConclusionsIn this cross-sectional survey experiment, support for some interventions for OUD was greater among US chiefs of police when framed to emphasize positive public safety outcomes. Research is required to better understand low support for SSPs, mistrust of officers in recovery for OUD, and greater support for OUD interventions among senior chiefs.

Harm reduction drug policy

Intervenciones de reducción de daños en usuarios de drogas: situación actual y recomendaciones