Drug Services Research Articles

Evaluation of a pharmacist-led workflow for the FDA Expanded Access Program.

This project aimed to characterize the resources necessary for pharmacists to support the required steps for obtaining and handling investigational drugs outside of a study protocol in the individual patient and intermediate-size population Expanded Access Program (EAP) processes. The second aim was to characterize the types of EAP requests received. This retrospective, single-center, observational study was performed by reviewing EAP requests initiated at Duke University Hospital (DUH) between August 1, 2017, and February 11, 2023. The annualized cost of unreimbursed EAP study services was projected to be approximately $196,500 at DUH for 2023. Of the 168 EAP requests submitted after the institutional policy requiring pharmacy and therapeutics (P&T) committee approval was established, 162 (96.4%) were approved by the P&T committee. Given the lack of published information on a pharmacist-led workflow related to EAP services, this study sought to share DUH's process for managing EAP requests. As there is no mechanism for reimbursement of EAP services, they can be difficult to manage given the labor resources required. Further work is needed to recoup unreimbursed investigational drug service labor costs to ensure compassionate use programs can be implemented in a manner that is financially sustainable for a health system.

Aisyiyah Organization Communication Network In Tuberculosis Prevention In North Sumatra

The purpose of this study was to analyze the communication network built by the Aisyiyah organization in the prevention of Tuberculosis (TB) in North Sumatra. Aisyiyah as Lembaga autonomy Muhammmadiyah who became one of the government fatners in the eradication of tuberculosis. Eradication of tuberculosis is something that must be done in breaking the chain of the spread of tuberculosis that is of concern to the world because the disease is very fast spreading and is the no. 2 deadly disease after HIV Aids. Transmission is through people infected with tuberculosis coughing and removing mycobacterium bacteria. The research methods used are descriptive through qualitative approaches. The informant in this study was the Head of Aisyiyah Region of North Sumatra, TB-HIV Care Aisyiyah Team of North Sumatra. Data collection techniques through interviews, observations, and documentation. The results showed that the communication network built by Aisyiyah North Sumatra in the prevention of Tuberculosis by forming TB-HIV Care Aisyiyah. Cadres as implementers who plunge into the community to the village level in helping to provide services in collaboration with puskesmas services. Cadres in carrying out this humanitarian task always put forward human values by not paying attention to race, religion, or ethnicity. For cadres to be able to carry out tasks in the field are given debriefing that supports competence in the form of knowledge related to TB, effective communication and evaluation, and reporting, in addition, cadres in performing their duties are provided facilities such as jackets of pinaster marks, participant cards as TB cadres. . As for the reporting made by cadres so that sufferers, suspects more easily obtain drug services that can later be obtained from the nearest health center whose treatment is provided by the government for free. The recruitment of these cadres is usually done through Aisyiyah studies or can be done through other channels such as through social media, and in coordination with other organizations or associations such as the PKK Mother

Research on the improvement mechanism of value-based healthcare objectives in pharmaceutical group procurement

Focusing on the research scenario that integrates value-based healthcare objectives with the pharmaceutical group purchasing model, this study delineates value-based healthcare objectives in pharmaceutical group purchasing from three perspectives: drug sales price, drug quality, and service level. We construct a three-level pharmaceutical group purchasing supply chain consisting of drug manufacturers, medical institutions, and non-profit drug group purchasing organisations. Under centralised and decentralised decision-making, we introduce cost-sharing contracts and “cost-sharing-quantity-discount” contracts to analyse the impact of factors such as drug sales price, quality, and sensitivity of the service level. The study found that: (1) Compared with centralised decision-making, the optimal drug quality and service level in decentralised decision-making and the optimal profits of drug manufacturers and medical institutions will decrease. However, the optimal drug sales price in decentralised decision-making always deviates from that in centralised decision-making, leading to higher or lower drug sales prices. (2) The incorporation of value-based healthcare objectives in the pharmaceutical group purchasing through cost-sharing contracts depends on changes in the proportion of drug quality costs borne by medical institutions. If the proportion is too high, medical institutions will suffer greater losses because they bear too much of the cost. (3) Under certain conditions, cost-sharing contracts can improve supply chain efficiency but cannot achieve supply chain coordination, while the combination of “cost-sharing-quantity-discount” contracts can achieve supply chain coordination in pharmaceutical group purchasing.

Standardization of key performance indicators and metrics for investigational drug services: Consensus recommendations among IDS specialists.

There are currently no consensus guidelines on establishing metrics for investigational drug services (IDS). Because of the complexity of research protocols, it remains difficult for sites to track pharmacy productivity and create a baseline for IDS growth within the institution, as well as to perform benchmarking with peer institutions. The goal of this study was to help establish practical guidance for IDS metrics and site utility as applicable. This was a survey-based project conducted by the metrics subgroup of the Hematology/Oncology Pharmacy Association (HOPA) IDS special interest group (SIG), which was formed specifically for this analysis. Three surveys developed by the metrics subgroup were sent to members of the IDS HOPA SIG to gather metrics. The first survey included questions about what metrics IDS sites currently collect. The identified metrics were then condensed into categories. Through a consensus-based approach, standardized definitions were established and applied to future surveys. The 2 subsequent surveys sent to HOPA SIG members helped create a list of top recommended metrics that are recommended for every IDS site to track. A total of 3 surveys were sent to 75 recipients, with the response rate ranging from 24% to 38%. From these surveys and consensus with the metrics subgroup, 5 top recommended metrics were identified: (1) active protocols; (2) dispenses; (3) new clinical trials initiated; (4) patients treated; and (5) clinical interventions. These recommended metrics should serve as guidance and allow for standardization to help ensure adequate resources are available for IDS pharmacy staff. These recommendations should serve as a basis for standardization and benchmarking with peer institutions.

Acceptance and feasibility of a low-threshold and substitution services-based periodical monitoring system for blood-borne and sexuallytransmitted infections among people who inject drugs in Germany: a mixed-methods analysis.

To reach the global elimination goals of viral hepatitis B and C (HBC, HCV), human immunodeficiency virus (HIV) and other sexually transmitted infections as a public health threat by 2030, monitoring is needed. Staff members of drug services and opioid substitution treatment (OST) practices in Berlin and Bavaria recruited clients for a pilot study addressing the respective infections among people who injected drugs (PWID) in Germany, 2021/2022. Participants filled a questionnaire and were tested for HBV, HCV, HIV and syphilis using dried blood spots (DBS). We evaluated the study design to implement a feasible and accepted nationwide periodical monitoring among PWID and serve as an example for the implementation of similar monitoring systems in other countries. A mixed-methods design was used, including focus group discussions with study participants and staff members and a semi-quantitative questionnaire filled by the latter. Aspects covered were the setting for recruitment, study preparation for staff members, willingness of clients to participate, the study questionnaire, blood collection and return of results. The majority (96%) of 668 study participants were recruited in low-threshold services, drug consumption rooms and OST-practices. Flexibility of recruiting study participants during routine work or testing weeks/days was important to the facilities. Collaborations with local AIDS services helped cope with the work load of data collection. The need to train staff for DBS collection was highlighted. Study participants welcomed the testing opportunity in familiar places. Study participants frequently needed assistance to complete the study questionnaire. Return of results was considered as ethically mandatory by staff members but referral to treatment remained challenging. For a successful monitoring time flexibility and adequate training are essential. Individual benefits for study participants by receiving their test results should be ensured and referral networks with infectiology practices may increase number of infected PWID receiving treatment. Overall, the evaluation confirmed that a monitoring through drug services and OST-practices is feasible and well accepted in Germany. Beyond that it shows important lessons learnt for the implementation in other countries.

Evaluation of a remote hybrid staffing model for investigational drug service pharmacists.

This project compared the time to complete investigational prescription drug order verification by investigational drug service (IDS) pharmacists in an onsite vs offsite (hybrid) staffing model, evaluating the impact of remote work on verification time. Parenteral IDS drug orders from August 2019 through June 2022 were analyzed. Electronic medical records were timestamped for each order, first verification, second verification, and medication administration. The project was divided into four 6-month time periods to allow for 2 independent comparisons of onsite vs hybrid staffing models. A survey was given retrospectively to IDS pharmacists for the last hybrid timeframe to assess work satisfaction and burnout. A total of 4,398 orders were evaluated. The time from order entry to first verification was 14 minutes (n = 1,248) during the first onsite time period compared to 13 minutes (n = 1,042) during the first hybrid period (P = 0.003). The time for order verification was similar between the second onsite and hybrid periods (12 minutes [n = 1,041] vs 10 minutes [n = 1,067], respectively; P < 0.0001). The staff satisfaction survey for the hybrid model showed high levels of job satisfaction and no self-reported burnout. The remote hybrid staffing model did not result in a meaningful change in the time from order placement to medication administration within the IDS pharmacy. Hybrid staffing also resulted in greater job satisfaction among IDS pharmacists. This study highlights the benefits of implementing remote work practices in the pharmacy practice setting.

Sign-tracking to non-drug reward is related to severity of alcohol-use problems in a sample of individuals seeking treatment

BackgroundA prominent neuroscientific theory of drug addiction is the incentive sensitization model. Individual differences in the tendency to ascribe motivational salience to cues that predict reward, and involuntary “sign-tracking” (orientation towards) such cues have been identified as potentially important in understanding vulnerability to addiction and relapse. However, to date this behaviour has not been assessed in a treatment-seeking clinical population, who typically represent those most susceptible to alcohol-related harms and episodes of relapse. This highlights a significant gap in the literature pertaining to incentive sensitization and drug dependence. MethodsIndividuals accessing inpatient drug and alcohol services with alcohol as primary drug of concern were recruited to participate in a Cognitive Bias Modification (CBM) intervention. At the baseline assessment, participants completed various self-report measures (including the Alcohol Use Disorders Identification Test; AUDIT) in addition to a visual search task measuring sign-tracking to cues signalling monetary reward. At 3-month follow up, abstinence from alcohol was the primary outcome measure. All analyses and hypotheses were pre-registered. ResultsAt baseline (57 participants), AUDIT scores correlated with sign-tracking to signals of monetary reward. In a subsequent regression analysis sign-tracking, gender and self-reported alcohol craving predicted abstinence at 3-month follow up (41 participants). ConclusionsOur work demonstrates that involuntary sign-tracking to cues signalling non-drug reward is associated with problematic alcohol use and return to use at 3-month follow up, in a treatment-seeking sample. Whether this automatic prioritisation of cues signalling reward is a consequence or vulnerability for problematic alcohol use remains to be investigated.

Volatile drug use and overdose during the first year of the COVID-19 pandemic in the United States

BackgroundOverdose deaths in the United States rose substantially during the COVID-19 pandemic. Disruptions to the drug supply and service provision introduced significant instability into the lives of people who use drugs (PWUD), including volatility in their drug use behaviors. MethodsUsing data from a multistate survey of PWUD, we examined sociodemographic and drug use correlates of volatile drug use during COVID-19 using multivariable linear regression. In a multivariable logistic regression model, we assessed the association between volatile drug use and past month overdose adjusting for sociodemographic and other drug use characteristics. ResultsAmong participants, 52% were male, 50% were white, 29% had less than a high school education, and 25% were experiencing homelessness. Indicators of volatile drug use were prevalent: 53% wanted to use more drugs; 45% used more drugs; 43% reported different triggers for drug use, and 23% used drugs that they did not typically use. 14% experienced a past-month overdose. In adjusted models, hunger (β=0.47, 95% CI: 0.21-0.72), transactional sex (β=0.50, 95% CI: 0.06-0.94), and the number of drugs used (β=0.16, 95% CI: 0.07-0.26) were associated with increased volatile drug use. Volatile drug use was associated with increased overdose risk (aOR=1.42, 95% CI: 1.17-1.71) in the adjusted model. ConclusionsVolatile drug use during the COVID-19 pandemic was common, appeared to be driven by structural vulnerability, and was associated with increased overdose risk. Addressing volatile drug use through interventions that ensure structural stability for PWUD and a safer drug supply is essential for mitigating the ongoing overdose crisis.

Bereavement support after a drug-related death: Professional perspectives

After a drug-related death, the bereaved are at risk of severe social and health consequences, but their need for professional support in their bereavement processes often falls under the radar. The bereaved themselves ask for continued support, and the research shows significant symptoms of prolonged grief for years after the loss. This article explores professionals’ perspectives on providing bereavement support to bereaved clients after a drug-related death. The article builds on focus group interviews with professionals from different health and welfare services in Norway who are likely to encounter the bereaved in their client work. A total of six focus group interviews were conducted, involving 29 professionals from services such as mental health and drug services, residential care, low threshold services, and medical services. The results show that bereavement support for the drug-death bereaved is perceived as demanding relational work that is not part of their primary work tasks. The work is highly individualised because formal organisational structures are lacking, which can impair bereaved peoples’ access to bereavement support. The lack of training, knowledge, and clear responsibility may lead to professionals lacking confidence and withdrawing from support initiatives in order to avoid stress and burnout.

Pelindungan Hukum bagi Bidan Memberikan Pelayanan Obat kepada pasien dalam Praktik Kebidanan di Daerah Terpencil

Providing drug services to patients in midwifery practice in remote areas is regulated in Article 273 of the Health Law which states that: "personnel in carrying out practice have the right to obtain legal protection as long as they carry out their duties in accordance with professional standards, professional service standards, and standard operational procedures and professional ethics, as well as patient's health needs. Likewise, Article 19 of the Minister of Health's Permit and Practice of Midwives also states that "in carrying out practice/work, midwives have the right to obtain legal protection in carrying out practice/work as long as they comply with standards." The purpose of this paper is to analyze the authority of midwives to provide drug services to patients in midwifery practice and examine the form of legal protection for midwives in carrying out practice. The author uses a research method with a normative juridical type and approaches the problem using legislation, a conceptual approach and a comparative approach.&#x0D; &#x0D; Keywords: Medication Administration by Midwives, Legal Protection&#x0D;

Investigating the Critical Period for Alcohol or Other Drug-Related Presentations Following Access to Residential Substance Use Treatment: a Data Linkage Study

AbstractIndividuals who access residential treatment for substance use disorders are at a greater risk of negative health and substance-use outcomes upon exiting treatment. Using linked data, we aimed to identify predictive factors and the critical period for alcohol or other drug (AOD)-related events following discharge. Participants include 1056 individuals admitted to three residential treatment centres in Queensland, Australia from January 1 2014 to December 31 2016. We linked participants’ treatment data with administrative data from hospitals, emergency departments, AOD services, mental health services and the death registry up to December 31 2018. We used survival analysis to examine presentations for AOD-related events within two-years of index discharge. A high proportion of individuals (57%) presented to healthcare services for AOD-related events within 2 year of discharge from residential treatment, with the first 30 days representing a critical period of increased risk. Completing residential treatment (aHR = 0.49 [0.37–0.66], p &lt; .001) and high drug-abstaining self-efficacy (aHR = 0.60 [0.44–0.82], p = .001) were associated with a reduced likelihood of AOD-related events. Individuals with over two previous residential treatment admissions (aHR = 1.31 [1.04–1.64], p = .029), identifying as Indigenous Australian (aHR = 1.34 [1.10–1.63], p &lt; .001), alcohol as a primary substance (aHR = 1.58 [1.30–1.92], p &lt; .001), and receiving a Disability Support Pension (aHR = 1.48 [1.06–2.06], p = 0.022) were at a greater likelihood. The high proportion of individuals that present to health and drug services for AOD-related events, especially in the first 30 days post-discharge, highlights the need for continued support following discharge from substance use treatment.

Hubungan Keikutsertaan Kegiatan Prolanis dengan Kualitas Hidup Lansia di Wilayah Kerja Puskesmas Bangkala

&lt;p align="justify"&gt;&lt;em&gt;Chronic diseases cause disability in sufferers, so the Government, through BPJS Health, collaborates with health facilityservices to design a program known as “Chronic Disease Management Program” which is a system that combines management and communication if health services for participants with certain diseases through efforts to treat the disease independently. This research aims to determine the relationship between participation in Prolanis activitiesand the quality of life of the elderly. The type of research used is an analytical survey method using a Cross Sectional Study. The population in this study were 63 elderly who participated in Prolanis in the Bangkala Community Health Center working area. The sampling technique used was Exhaustive sampling. Data was collected through questionnaires and analysis using univariate and bivariate test, with a confidence level of α = 0.05. The research result show that reminders do not have a significant relationship with the elderly where the p value is 0.229. Monitoring health status has a significant relationship with the quality of life of the elderly where the p value is 0.033. Drug services do not have a significant relationship with the quality of life of the elderly where the p value is 0.214. Club activities have a significant relationship with the quality of life of the elderly where the p value is 0.047 based on the results of the chi-square test. Therefore, Bangkala Health Center Health officers are expected to pay more attention to reminder activities. Participants are also expected to carry out health status monitoring activities, drug services and club activities more regularly.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

The impact of changes in opioid dependency treatment upon COVID-19 transmission in Sydney, Australia: a retrospective longitudinal observational study

BackgroundIn April 2020, in response to the COVID-19 public health emergency, South Eastern Sydney Local Health District (SESLHD) Drug and Alcohol services modified their delivery of opioid dependency treatment (ODT) to reduce spread of COVID-19 and maintain continuity of care by increasing use of takeaway doses (TADs), transferring clients to local community pharmacies for dosing and encouraging the use of long-acting depot buprenorphine (LADB) which enabled once a month dosing.MethodsThis study was a retrospective longitudinal case–control study conducted from August 1st, to November 30th, 2021. Eligible clients were those admitted for treatment with SESLHD ODT Services prior to August 1st,2021 and who remained in treatment beyond November 30th, 2021. COVID-19 diagnoses were determined by a COVID-19 PCR and extracted from the electronic Medical Records (eMR) Discern Reporting Portal. Demographic, clinical and dosing related data were collected from eMR and the Australian Immunisation Register (AIR).ResultsClients attending SESLHD ODT services had significantly greater odds of acquiring COVID-19 than the NSW adult population at large (OR: 13.63, 95%CI: 9.64,18.88). Additionally, amongst SESLHD ODT clients, being of Aboriginal and Torres Strait Islander origin was associated with greater odds of acquiring COVID-19 (OR = 2.18, CI: 1.05,4.53); whilst being employed (OR = 0.06, CI:0.01,0.46), receiving doses at pharmacy (OR = 0.43, CI: 0.21,0.89), and being vaccinated (OR = 0.12, CI: 0.06,0.26) were associated with lower odds. Every additional day of attendance required for dosing was associated with a 5% increase in odds of acquiring COVID-19 (OR = 1.05, CI: 1.02,1.08).ConclusionsClients attending SESLHD ODT services are significantly more likely to acquire COVID-19 than the NSW population at large. Promoting vaccination uptake, transferring clients to pharmacy, and reducing the frequency of dosing (by use of takeaway doses or long-acting depot buprenorphine) are all potential methods to reduce this risk.

Perbedaan Obat Berdasarkan Nama Generik dan Nama Dagang pada Masyarakat Desa Genteng Kulon

Drugs are substances, guide substances, and biological products that are used to influence or investigate physiological systems or pathological states. Medicines can have generic names and trade names. People think that drugs with generic names produce lower therapeutic effects than trade names, as is the case in the Genteng Kulon community. The aim of this community service activity is to provide information regarding the differences between medicines based on generic names and trade names to the Genteng Kulon Village community. The method used was counseling and giving leaflets. Apart from that, people also do pre-test and post-test questions. This community service activity was attended by 50 representatives of posyandu figures in Genteng Kulon Village. The result of community service activities is that representatives of posyandu figures receive information regarding the differences in medicines based on generic names and trade names. People can use drugs with generic names without worrying about efficacy, especially for people who receive drug services from BPJS. There is an increase in the post test score compared to the pre test.

Scoping review: mapping clinical guidelines and policy documents that address the needs of women who are dependent on drugs during the perinatal period

BackgroundWomen who use or are in treatment for drug use during the perinatal period often have complex needs and presenting comorbidity. Women who use opioids during pregnancy, and their infants, experience poor outcomes. Drug use by women during pregnancy is a public health priority.This scoping review aimed to (1) map clinical guidelines, treatment protocols and good practice guidance across the UK for women who use or are in treatment for drug use during the perinatal period, (2) identify recommended best practice across health and social care for optimising outcomes and reducing inequalities for these women and (3) identify potential gaps within guidance.MethodsWe followed the Joanna Briggs International (JBI) guidance on scoping reviews and PRISMA Scr extension. A registered protocol, containing a clear search strategy, inclusion, and exclusion criteria was adhered to. Reviewers double screened 25%, discussing disagreements. Data were extracted using a predefined template and charted in tables. Recommendations for best practice were organised around agreed categories.ResultsOf 968 documents screened, 111 met the inclusion criteria. The documents included UK-wide, national, regional, and organisational policy documents. They varied in the degree they were relevant to women who use or are in treatment for drug use during the perinatal period, the settings to which they applied, and their intended users. Most were created without patient or public involvement and lacked any clear evidence base.Overall, documents recommended an integrated model of care with a lead professional, clear referral pathways and information sharing between agencies. Guidance suggested referrals should be made to specialist midwives, drug, and social care services. A holistic assessment, inclusive of fathers / partners was suggested. Recent documents advocated a trauma-informed care approach. Opioid substitution therapy (OST) was recommended throughout pregnancy where required. Potential gaps were identified around provision of support for women postnatally, especially when their baby is removed from their care.ConclusionsThis synthesis of recommended practice provides key information for practitioners, service providers and policy makers. It also highlights the need for guidelines to be evidence-based, informed by the experiences of women who use or are in treatment for drug use during the perinatal period, and to address the support needs of postnatal women who have their babies removed from their care.

Safe inhalation pipe provision (SIPP): protocol for a mixed-method evaluation of an intervention to improve health outcomes and service engagement among people who use crack cocaine in England

BackgroundOver 180,000 people use crack cocaine in England, yet provision of smoking equipment to support safer crack use is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, leading to pipe sharing and injuries from use of unsafe materials. This increases risk of viral infection and respiratory harm among a marginalised underserved population. International evaluations suggest crack pipe supply leads to sustained reductions in pipe sharing and use of homemade equipment; increased health risk awareness; improved service access; reduction in injecting and crack-related health problems. In this paper, we introduce the protocol for the NIHR-funded SIPP (Safe inhalation pipe provision) project and discuss implications for impact.MethodsThe SIPP study will develop, implement and evaluate a crack smoking equipment and training intervention to be distributed through peer networks and specialist drug services in England. Study components comprise: (1) peer-network capacity building and co-production; (2) a pre- and post-intervention survey at intervention and non-equivalent control sites; (3) a mixed-method process evaluation; and (4) an economic evaluation. Participant eligibility criteria are use of crack within the past 28 days, with a survey sample of ~ 740 for each impact evaluation survey point and ~ 40 for qualitative process evaluation interviews. Our primary outcome measure is pipe sharing within the past 28 days, with secondary outcomes pertaining to use of homemade pipes, service engagement, injecting practice and acute health harms.Anticipated impactSIPP aims to reduce crack use risk practices and associated health harms; including through increasing crack harm reduction awareness among service providers and peers. Implementation has only been possible with local police approvals. Our goal is to generate an evidence base to inform review of the legislation prohibiting crack pipe supply in the UK. This holds potential to transform harm reduction service provision and engagement nationally.ConclusionPeople who smoke crack cocaine in England currently have little reason to engage with harm reduction and drug services. Little is known about this growing population. This study will provide insight into population characteristics, unmet need and the case for legislative reform.Trial registration: ISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454

Crystal balling the drug services sector

Crystal balling the drug services sector

Testing the test strips: laboratory performance of fentanyl test strips

BackgroundThe overdose crisis driven by synthetic opioids continues to escalate in the USA. We evaluated the efficacy of multiple manufacturing lots of a fentanyl test strip (FTS) to detect fentanyl and fentanyl analogs and assessed cross-reactivity with possible interferences.MethodsDrug standards were dissolved in water in a laboratory setting and serially diluted. Drug dilutions were tested using five different manufacturing lots of BTNX Rapid Response (20 ng/mL cutoff) lateral flow chromatographic immunoassay strips to assess lot-to-lot variability for FTS sensitivity and cross-reactivity for the analytes of interest.ResultsAll five manufacturing lots cross-reacted with fentanyl and eleven fentanyl analogs. Diphenhydramine, lidocaine, MDMA, and methamphetamine were found to cause false positives with the strips. There was notable lot-to-lot variability in the sensitivity of the strips for fentanyl, fentanyl analogs, and known interferences.DiscussionFTS remains an important overdose prevention tool, but lot-to-lot variability in performance complicates robust instructions that balance the prevention of false positives and false negatives. Continued lot-to-lot performance assessment is recommended to ensure health education for FTS remains accurate. More sophisticated drug checking technologies and services are needed in the community landscape to augment personal FTS use to facilitate informed consumption and overdose risk mitigation.

Women, Addictions, Mental Health, Dishonesty, and Crime Stigma: Solutions to Reduce the Social Harms of Stigma.

British drug policies could underserve women with treatment needs, and this paper provides evidence that communication through the words and actions of professionals across drug and alcohol services, health and mental health, social work and the criminal justice sector can leave women feeling stigmatised and failed. Women live with the stigma of 'the lying addict'; however, documents and courtroom statements provided by professionals can misrepresent women's experiences, which exacerbates social harm. Data are drawn from feminist participatory action research, where female lived experience experts worked alongside academics to implement a qualitative study using interviews and focus groups with women using treatment services (n = 28) and an online world café with professionals working with these women (n = 9) and further professionals providing support at lived experience data collection events (n = 5). This data set is cross-referenced with one-to-one and small-group interviews with professionals in the field (n = 17) conducted by a third-sector partner. Findings establish that stigma negatively impacts the identification of treatment needs and access to timely and appropriate service delivery. Social harms to women with addictions could be significantly reduced with timely, authentic, honest, gender-informed and trauma-informed practices for girls and women using drugs and alcohol to self-medicate from traumatic experiences.

Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals?

BackgroundIn England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced. MethodsWe analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011–2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs’ (2011–2014), ‘Prioritised DAAs’ (2015–2016) and 'Unrestricted DAAs’ (2017–2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period. ResultsThe proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95–2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45–0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12–0.60), never (vs current, aOR:0.31, 95 %CI:0.13–0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08–0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06–1.54). ConclusionCOC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.