Harm Reduction Behaviors Research Articles

Exploring Risk Prevention and Harm Reduction Behaviours among Snorted Cocaine Users

Introduction: cocaine use presents significant public health challenges. A promising approach to address this global health problem is to identify protective behaviors that can mitigate use, prevent risks, and minimize negative consequences for people who use snorted cocaine. Objective: this study aims to explore risk prevention and harm reduction behaviours among people who use snorted cocaine in order to contribute to the development and evaluation of harm reduction interventions in the future. Method: qualitative, exploratory study, based on in-depth interviews. Protective behavioral strategies were identified through in-depth semi-structured interviews from 10 cocaine users from Latin America. Results: we identified a range of strategies that people who use snorted cocaine employ in order to avoid cocaine use, prepare for its use, assess substance quality, minimize risks during consumption (including those related to poly-drug use), control dosage, protect routes of administration, mitigate potential adverse effects, reduce sexual risks, avoid legal problems, and recovering. Discussion and conclusions: this is the first study to explore protective behavioral strategies in experienced snorted cocaine users. Such insights into users' self-regulatory practices and care strategies can inform the development of future interventions.

Differences by race and ethnicity in drug use patterns, harm reduction practices and barriers to treatment among people who use drugs in Rhode Island.

As in much of the United States, there have been significant increases in overdose deaths among non-Hispanic Black and Hispanic/Latinx populations in Rhode Island over the past decade. Given the shifting dynamics of the overdose epidemic, there is an urgent need for focused interventions that address the specific needs of diverse communities. This study explores differences in drug use patterns, harm reduction behaviors and types and barriers to treatment by race and ethnicity. This study utilized baseline data from the Rhode Island Prescription and Illicit Drug Study (RAPIDS). We assessed sociodemographic characteristics, drug use patterns, harm reduction practices, treatment type, and barriers to treatment in a cross-sectional analysis of people who use drugs (PWUD), stratified by race and ethnicity (non-Hispanic white, non-Hispanic Black, non-Hispanic other race, and Hispanic). Chi-square tests of independence and ANOVA tests were used to identify statistically significant differences by race and ethnicity. Among 509 participants, the median age was 43, and the majority were men (64%). Non-Hispanic Black participants reported significantly less regular use of unregulated opioids, such as heroin (10%) and fentanyl (12%), as compared to non-Hispanic white participants (39% and 33%, respectively). Non-Hispanic Black participants reported significantly less experience responding to overdoses: only 39% had ever administered naloxone and 34% had ever performed rescue breathing, as compared to 67% and 57% among non-Hispanic white participants, respectively. Despite significant differences in drug use patterns, there were few differences in harm reduction practices by race and ethnicity. Current treatment enrollment was highest among those who were non-Hispanic white (38%) and lowest among those who were non-Hispanic Black (7%). These findings suggest that there are differences in overdose response experience and treatment exposure between non-Hispanic Black PWUD and those belonging to other racial and ethnic groups, indicating a need for enhanced investment in overdose response education, naloxone distribution and treatment access for non-Hispanic Black PWUD.

W134 - Pandemic Era Changes in Drug Use and Harm Reduction Behavior Among People who Use Drugs in Rural Illinois

W134 - Pandemic Era Changes in Drug Use and Harm Reduction Behavior Among People who Use Drugs in Rural Illinois

Tripping into the unknown: Exploring the experiences of first-time LSD users through global drug survey insights.

The recreational use of LSD, a synthetic psychedelic drug, has surged in recent years, coinciding with a renewed research focus on its potential psychotherapeutic properties. This study aims to describe the experiences and perceptions of individuals engaging in LSD use for the first time, derived from a large international sample. This study utilised 2018 Global Drug Survey data collected from 6 November 2017 to 10 January 2018. Participants who initiated LSD use in the preceding 12 months answered questions on their experiences, social settings, harm-reduction behaviours, and demographics. Descriptive statistics were employed, and characteristics of those seeking emergency medical treatment (EMT) and those not planning further LSD use were compared with other respondents. Among 3340 respondents who used LSD in the past year, their first-time experiences generally exceeded expectations, with 97.7% expressing excitement. Adverse and unwanted side effects were rarely reported, and only 17 individuals needed EMT. Feelings of fear were reported by most (64.1%), but only very mildly and not enough to put them off from wanting to use LSD again. Although the occurrence of unwanted side effects seems low and the LSD experience is generally pleasurable, vigilance amid the rising illicit use of LSD through harm-reduction education is still important in preventing possible risks.

Safety strategies and harm reduction for methamphetamine users in the era of fentanyl contamination: A qualitative analysis

IntroductionIn the United States, methamphetamine use is increasing and the context of its use has changed, with reports of illicitly manufactured fentanyl being mixed with methamphetamine (either deliberately or inadvertently). We explore risk-mitigating actions taken by people who use drugs to protect their health when using methamphetamine in that context. MethodsWe conducted qualitative interviews with 48 adults (18+) who used methamphetamine in the past three months at two sites in Nevada, USA and two sites in New Mexico, USA. Interviews were recorded, transcribed, and analyzed using thematic analysis. ResultsRespondents described two rationales for employing harm reduction strategies. First, to prevent harm from methamphetamine containing illicit fentanyl, and second, to maintain their general wellbeing while using methamphetamine. Regarding methamphetamine containing illicit fentanyl, our findings highlight how respondents employ primary strategies like buying from trusted sources and secondary strategies such as spotting and selective use of harm reduction tools (i.e., fentanyl test strips) to reduce risks. To maintain their general wellbeing, participants reduced their use of methamphetamine as reasonably as possible, and used other substances like marijuana and alcohol alongside methamphetamine to counter the unwanted side effects of methamphetamine (i.e., hallucinations and paranoia). Use of these harm reduction strategies varied within situational and social contexts, and respondents usually developed these strategies based on their lived experiences. ConclusionOur findings uniquely demonstrate that people who use methamphetamine prioritize community driven, trust-based strategies within their social networks to mitigate risks in a fentanyl-contaminated drug environment. Additionally, our results indicate that harm reduction behaviors are influenced by multilevel risk environments, which include social, physical, economic, and political factors. Overall, these results highlight the potential for targeted interventions at the network level, which are responsive to complexities and shifts in drug market dynamics- such as illicit fentanyl in methamphetamine.

Measurement of the self-determination continuum of motivation for engaging in alcohol-related harm reduction behaviors: Improved content coverage of the Treatment Self-Regulation Questionnaire.

Self-determination theory (SDT) proposes that people are more likely to engage in behaviors that reduce the harms associated with alcohol use if they do so for more self-determined reasons. There is growing support for this proposal, but the Treatment Self-Regulation Questionnaire (TSRQ), which assesses the self-determination continuum of motivation for engaging in alcohol-related harm reduction behaviors, lacks content coverage. We generated additional items to improve the content coverage of the TSRQ and evaluated its psychometric properties. We also compared two randomly assigned instruction sets that referenced "responsible drinking" or "protective behavioral strategies" (PBS). Participants (n = 2,236) were college students from psychology departments at 10 universities in eight U.S. states who reported past-month alcohol use and completed the revised TSRQ; the online survey was completed for partial course credit. Exploratory factor analysis supported a three-factor structure representing autonomous motivation, controlled motivation, and amotivation for the PBS version. This factor structure was confirmed using exploratory structural equation modeling for both the PBS and responsible drinking versions. Scalar invariance was achieved across instruction sets. Latent mean differences showed that those who received the PBS version had lower autonomous and controlled motivation scores, but higher amotivation scores. Associations of the three TSRQ factors with alcohol-related outcomes were consistent with SDT, and the magnitude of these associations did not differ across instruction sets. More accurate assessment of the self-determination continuum of motivation for alcohol-related harm reduction behaviors will improve research on this topic which has promising implications for alcohol interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Measurement of the Self-Determination Continuum of Motivation for Engaging in Alcohol-Related Harm Reduction Behaviors: Improved Content Coverage of the Treatment Self-Regulation Questionnaire

Supplemental Material for Measurement of the Self-Determination Continuum of Motivation for Engaging in Alcohol-Related Harm Reduction Behaviors: Improved Content Coverage of the Treatment Self-Regulation Questionnaire

Safe beats down under: investigating the support of drug checking at a regional festival in the Northern Territory, Australia

Background In the context of Australian music festivals, including those in the Northern Territory (NT), drug-related harms persist. This study focused on gathering local insights into drug-related behaviours and attitudes, particularly regarding drug checking, among NT festival attendees. Methods In May 2022, attendees (aged 16+) at a single-day multi-genre music festival in the NT were surveyed onsite about their drug use and harm reduction behaviours. Logistic regression was employed to explore factors influencing attitudes and preferences toward drug checking. Results Out of 539 participants, 40% reported recent drug use in the past month. About 12% planned drug use at the festival. Notably, 73% supported drug checking, with 81% approval among people who use drugs. Older participants (>25 years) had 2.6 times (p = .001) greater odds of supporting drug checking. Participants with recent drug use had 2.1 times (p = .006) greater odds of supporting it. Among those opting for drug checking (n = 270), people who have recently used drugs had 5.5 times (p <.001) greater odds of preferring an onsite service. Additionally, 67% believed any drug checking service increased their safety. Conclusions The study reveals NT festivalgoers’ widespread support for drug checking and suggests the need for on-site drug checking services in the NT.

Harm reduction behaviours and harm experiences of people who use 3,4-methylenedioxymethamphetamine (MDMA) in Aotearoa New Zealand

Background3,4-Methylenedioxymethamphetamine (MDMA) is drug of high prevalence in Aotearoa New Zealand and is the primary drug analysed by legal drug checking services. We aimed to address the gap in literature pertaining to MDMA-related harm reduction behaviour and harm experiences within the country.MethodsAn online survey was used to assess the harm reduction behaviours (e.g., limiting consumption, planning use, seeking information) of people who use MDMA, in addition to their use of reagent testing and the major national drug checking and harm reduction service, KnowYourStuffNZ.ResultsIn total, 915 people completed the survey (60.7% females, aged 18–65, median = 24, IQR = 20–28). Frequency of various MDMA-related harm reduction behaviours differed, although these were carried out relatively frequently by most participants. Those who reported experiencing harm (physical, psychological, spiritual, social) from MDMA, or another drug presumed to be MDMA, reported less frequent harm reduction behaviours than non-harmed consumers. Reagent testing of MDMA had been conducted by 42.3% of the sample. Approximately 27% of the sample had used KnowYourStuffNZ services. Of KnowYourStuffNZ clients, 95.9% reported learning about harm reduction, and 53.3% reported changing their behaviour because of the service. Reasons for not using the KnowYourStuffNZ service were primarily lack of availability in local area (32.8%) or at relevant events (51.8%), and lack of concern with substance quality (29.8%). MDMA harm was reported by 14.4% of the sample, whilst reported harm was more common from consumption of presumably non-MDMA substances, self-reported as being mistaken for MDMA. Harm was primarily physical or psychological. Potential MDMA dependence was apparent in 6.9% of the sample.ConclusionsThe findings highlight potential targets for harm reduction education and interventions and emphasize the need for greater availability of readily accessible drug checking services in Aotearoa New Zealand.

“When people who use drugs can’t differentiate between medical care and cops, it’s a problem.” Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies

BackgroundCommunity-based harm reduction programming is widely recognized as an effective strategy for reducing the increased risks for and spread of HIV, HCV, and for reducing the growing rate of overdose deaths among people who use drugs (PWUD). PWUD in the United States (US) are a highly justice-involved population, also at increased risk for law enforcement interaction, arrest, and incarceration. These risks compound and interact in the context of criminalization and law enforcement surveillance. Justice involvement increases risks for overdose and for riskier injecting behavior among PWUD, in turn increasing HCV and HIV risks. In Central and Southern Appalachia specifically, PWUD have identified fear of law enforcement harassment and arrest as a barrier to engaging in harm reduction behavior, and a deterrent to seeking help at the scene of an overdose. Moreover, stigmatizing and punitive treatment in healthcare settings can deter PWUD from seeking care, with life or death consequences. This evaluation research study assessing the successes and impacts of a grant-funded project to increase access to safer drug consumption supplies and overdose prevention education for PWUD, including justice-involved participants of a syringe access program (SAP), in public housing and beyond in a South-Central Appalachian setting used key informant and opportunistic sampling. Mixed-methods data were compiled and collected including secondary program data; primary interview and participant-observation data.ResultsThe evaluation research identified that grant deliverables were largely achieved, despite challenges presented by the COVID-19 pandemic. In addition, SAP participants and staff reported larger themes surrounding grant-funded activities, in which they perceived that widespread local law enforcement harassment of PWUD increased participants’ risks for overdose death and infectious disease risks and that punitive local healthcare settings and policies acted as deterrents to care-seeking for many PWUD.ConclusionsOverall, the evaluation research found that participants’ experiences with and perceptions of local law enforcement harassment combined with their understandings and experiences of local punitive healthcare settings and policies; together compounding and increasing overdose risks and negative health consequences for local justice-involved PWUD.

Motivators of and barriers to drug checking engagement in British Columbia, Canada: Findings from a cross-sectional study

ObjectiveResponding to increasing rates of illicit drug toxicity mortality in British Columbia, regional health authorities introduced various types and models of drug checking services starting in 2016. Uptake has been gradual yet consistent, but motivators and barriers of service use have not been well-described. MethodsThe British Columbia Harm Reduction Client Survey is a cross-sectional survey conducted at harm reduction sites across British Columbia. Data for the present findings were collected between March 2021 and January 2022. Participants (n = 537) were asked about their use of drug checking services and what prevented them from using available services. Responses were analyzed with descriptive statistics and multivariable logistic regression. ResultsOf all participants, 519 (96.6 %) answered the survey question on drug checking with 144 (27.7 %) reporting having used services within six months. Participants highlighted barriers such as not knowing where to access services (21.0 %), or not having services in their area (10.0 %). Among people who did not report recent use of fentanyl, 49.6 % stated they would not use their drugs if they tested positive for fentanyl. Other harm reduction behaviors were positively associated with drug checking, such as use of overdose prevention sites (adjusted odds ratio [AOR]: 2.75, 95 % confidence interval [CI]: 1.65, 4.59) and having a naloxone kit (AOR: 2.67, 95 %CI: 1.14, 6.28). Receipt of opioid agonist therapy in the previous six months was also positively associated with drug checking (AOR: 1.72, 95 %CI: 1.05, 2.83). DiscussionDrug checking uptake remains low in British Columbia, however this study identified desire for services among participants, suggesting a need for expanded drug checking services. Behavioral change was reported among a high proportion of people who said they would not use their drugs if they tested positive for fentanyl, meaning that immunoassay strips alone have utility in the context of a pervasive fentanyl supply.

Alcohol protective behavioral strategies for young adults: a content analysis across drinking contexts and gender

ABSTRACTBackground: Protective behavioral strategies (PBS) are specific harm reduction behaviors which mitigate alcohol-related consequences among young adults. Prior work indicates PBS utilization varies according to drinking context and gender, suggesting a need for further research assessing whether young adults employ unidentified PBS according to such factors.Objectives: This study examined alcohol PBS young adults suggest using across drinking contexts and gender to inform alcohol-related harm reduction interventions.Methods: An online survey with 514 young adult heavy drinkers (n = 269 female, Mage = 22.36 years) assessed PBS use generally, and across 12 physical and social contexts. We utilized qualitative content analysis methods to code and derive themes from open-ended responses from a prompt asking participants to state additional PBS used per context. The frequency of each theme’s appearance was calculated across the overall sample, by gender, and within each context.Results: PBS endorsement varied across context and gender within each theme. Young adults who reported PBS use most frequently endorsed utilizing strategies related to drink content (18.30%), social support (12.36%), and engaging in other activities (10.34%). Participants infrequently endorsed strategies related to awareness of time (0.23%), standards of behavior (0.78%) and avoiding environments (0.87%).Conclusions: Young adults endorse utilizing additional PBS in varying frequency according to drinking context and gender. Given PBS are often a key component of alcohol harm reduction interventions, monitoring trends in young adult PBS use is crucial to ensure continued relevance and efficacy of such interventions to minimize harms associated with young adult heavy alcohol use.

75 Examining the Role of Executive Functions on the Intention-Behavior Gap of Alcohol Harm Reduction Strategy Use

Objective:The Temporal Self-Regulation Theory (Hall and Fong, 2007) proposes that initiation and maintenance of effortful health behaviors relies on executive functions (EF: cognitive abilities associated with goal-directed behavior). Alcohol harm reduction strategies are health behaviors that aim to minimize the likelihood or severity of consequences associated with alcohol use. Some drinkers have the intention to drink safely but lack the ability to effectively initiate and execute the harm reduction behaviors. Executive functions may be one mechanism that helps explain the gap between safe drinking intentions and behavior. Specific components of EF may be differentially associated with alcohol harm reduction strategy use; working memory and set-shifting may be especially important in planning and following through with alcohol harm reduction strategies, and individuals with greater working memory capacity and set-shifting abilities may be more successful in implementing strategies that require preplanning and have a focus on altering typical the manner of drinking (e.g., not mixing types of alcohol). Inhibition may be important for resisting temptations that are inconsistent with safe drinking goals, and those with stronger inhibitory control may be more likely to follow through with strategies that require withholding responses despite desire to engage in the behavior, such as stopping or limiting drinking (e.g., not exceeding a predetermined number of drinks).Participants and Methods:Using ecological momentary assessment, the current study explored the extent to which an intention-behavior gap in harm reduction strategy use exists among college student drinkers (n=77), and investigated how potential individual differences in EF (i.e., working memory, set-shifting, and inhibition) were associated with translating intentions of drinking safely into action. Daily monitoring assessments contained brief measures of intention to use harm reduction strategies, actual strategy use, and alcohol-related behaviors, and were assessed daily for twenty-one days.Results:Multilevel model analyses revealed that although intention to use strategies predicted actual strategy use, measures of EF did not significantly moderate the relationship. Exploratory analyses indicated that set-shifting significantly moderated the intention-behavior gap for a subset of harm reduction strategies that relies more heavily on modifying behavior during a drinking event. Set-shifting did not significantly moderate the intention-behavior gap for a subset of strategies that relies more heavily on pre-planning before the drinking event.Conclusions:Findings from the current study suggests that those who plan to use strategies typically follow through regardless of individual differences in EF. Efforts to increase intention to drink safely can be incorporated into existing alcohol prevention and intervention programs, which would likely lead to increased use of harm reduction strategies and decreased alcohol-related consequences.

The Effectiveness of a Novel Public Health Campaign to Reduce Parental Provision of Alcohol

Abstract Background Parental provision of alcohol to children is common despite being associated with negative outcomes, including earlier initiation of alcohol use and riskier drinking behaviours. Parental provision can be particularly problematic because it suggests to children that their parents have permissive attitudes to underage alcohol use. This study evaluated the ‘I need you to say no’ mass media public health campaign implemented by the Mental Health Commission in Western Australia (Nov 2018 - Feb 2022). The campaign adopted a novel approach by depicting adolescent children asking their parents to say ‘no’ if they ask for alcohol, alongside information challenging beliefs that provision behaviours are safe and commonplace. Methods Parents in Western Australia (n = 297) were surveyed in March 2022 to examine campaign recognition, perceptions of the campaign, and behaviours enacted due to seeing the campaign. Descriptive analyses were conducted. Two generalised linear models were also run to identify variables associated with positive campaign perceptions and behaviours enacted due to the campaign. Results The campaign was recognised by 4 in 5 parents and was rated by 70+% as being clear, memorable, and believable. Two-thirds of parents reported that the campaign made them concerned about underage drinking and less likely to supply alcohol to minors. Half the sample reported talking to their children about alcohol as a result of seeing the campaign. Perceptions of the campaign did not differ according to demographic characteristics, suggesting the campaign achieved widespread approval across demographic subgroups. Positive perceptions of the campaign were associated with enacting more of the examined harm reduction behaviours (B = .43, p = .002). Conclusions A novel campaign discouraging parental provision of alcohol resonated with parents and motivated harm reduction behaviours. Such campaigns have the potential to reduce alcohol-related harms among underage people. Key messages • A campaign advising parents to not provide alcohol to children was well received. • Such campaigns can challenge permissive attitudes to parental alcohol provision and promote harm-reduction behaviours.

Substance use, harm reduction attitudes and behaviors among attendees of nature rave parties in Israel

BackgroundFew studies have analyzed harm reduction behaviors and attitudes among rave party attendees. Since the late 1980s, there has been a large Israeli rave scene, also known as 'Nature Parties'. However, only a few studies have been conducted among nature party attendees and almost all of them are from a qualitative perspective. This study's aim was to fill the gap and conduct quantitative research to investigate the patterns of substance use, harm reduction attitudes and behaviors among Israeli nature rave party attendees.MethodsA cross-sectional online survey recruited 1,206 people who reported having attended nature rave parties. All of the participants were aged 18–60 years (M = 29.9; SD = 7.4), and 770 (64%) were male.ResultsThe most common illicit substances used at Israeli nature rave parties in the past year were cannabis (62.2%), followed by LSD (41.4%), MDMA (31.7%), mushrooms/psilocybin (23.9%), ketamine (19.6%) and cocaine (17.2%). A significant but weak association was found between harm reduction behaviors and attitudes toward harm reduction interventions (r = .26, p < .001) and attitudes toward drug testing kits (r = .33, p < .001). It seems that although we found higher positive harm reduction attitudes, it is harder to implement harm reduction behaviors. Logistic regressions demonstrated stronger associations with high harm reduction behaviors and higher levels of positive attitudes toward drug testing kits (OR = 4.53; CI 2.97–6.90; p < .001), higher levels of positive attitudes toward harm reduction interventions (OR = 4.06; CI 2.62–6.29; p < .001), marital status of widower/divorced (OR = 2.22; CI 1.49–3.32; p < .001), using MDMA (OR = 1.63; CI 1.19–2.23; p < = .01) and using LSD (OR = 1.41; CI 1.03–1.94; p < = .05).ConclusionsFormal harm reduction policies and interventions are needed for Israeli nature rave parties in addition to prevention and information programs, which are also very rare. Future studies should examine the subjects of harm reduction attitudes and behaviors among the public, policy makers and professionals.

Social Supply and the Potential for Harm Reduction in Social Media Drug Markets

Background Existing studies have highlighted the potential for increased drug market risks from buying drugs via social media involving strangers, such as receiving adulterated drugs or being robbed. However, social supply-driven social media drug markets may also offer enhanced social dealing and harm reduction opportunities. Aim To explore how social media platform features that enable expanded social networking may also support safer social drug dealing and other harm-reduction behaviors. Method Thematic analysis of anonymous online interviews with 33 people who buy and sell drugs via social media in New Zealand. Results Participants (median age 24; 22 male, 10 female, 1 gender diverse) accessing drugs via social media mostly utilized established social networks. These personal networks offered many benefits commonly associated with social media drug trading (i.e., safer and secure drug purchasing). Benefits included reducing the risk of receiving adulterated substances and being victimized. Social media affordances, which participants used to expand their everyday social networks, could also increase participants’ ability to leverage a broader social drug supply network and access related harm reduction benefits. Some participants used darknet markets to buy drugs, which they then resold to “friends” via social media platforms, facilitating supply channels that were largely “separated” from local physical drug markets and associated problems of fraud, violence, and organized crime. Conclusion Social media drug markets offer a range of harm reduction benefits that contribute to a lower-risk local drug market. We suggest this may reflect a closer alignment between social media platform affordances and their adaptation to social supply drug trading.

Evaluating an alcohol harm-reduction campaign advising drinkers of the alcohol-cancer link

IntroductionPublic awareness of the alcohol-cancer link is low. Provision of this information could reduce alcohol consumption and related harms. The Spread campaign is a multi-media education campaign implemented in Western Australia to inform people about the carcinogenic properties of alcohol and associated harms. The aims of the present study were to (i) examine attitudinal and behavioural outcomes of the Spread campaign and (ii) identify demographic and drinking status factors associated with enactment of harm-reduction behaviours resulting from exposure. MethodA cross sectional survey of Western Australian drinkers (consumed alcohol at least a few times in the previous 12 months, n = 760) examined campaign recognition, campaign perceptions, and behaviours resulting from campaign exposure. Chi-square analyses and a generalised linear model were used to identify demographic and alcohol-related factors associated with behavioural outcomes. ResultsAround two-thirds of respondents recognised the campaign (65%), and of these, 22% reported successfully reducing how often or how much they drank due to seeing the campaign. Three quarters (73%) of all respondents considered the campaign message about the alcohol-cancer link to be believable. Respondents drinking at levels above the Australian guideline were less likely to have positive perceptions of the campaign than those complying with the guideline, but were more likely to report enacting the assessed harm-reduction behaviours as a result of campaign exposure. Discussion and ConclusionThe results suggest that provision of information about the alcohol-cancer link has the potential to motivate reduced alcohol consumption. Implementing such campaigns could constitute an effective alcohol harm-reduction strategy.

Harm reduction behaviors are associated with carrying naloxone among patients on methadone treatment

BackgroundDespite the widespread availability of naloxone, US opioid overdose rates continue to rise. The “Cascade of Care” (CoC) is a public health approach that identifies steps in achieving specific outcomes and has been used to identify gaps in naloxone carriage among individuals with opioid use disorder (OUD). We sought to apply this framework to a treatment-seeking population with OUD that may be more inclined to engage in harm reduction behaviors.MethodsPatients were recruited from an urban methadone program to complete a survey. We assessed naloxone familiarity, availability, obtainability, training, and possession, as well as naloxone carriage rates, demographics, and harm reduction behaviors. A multivariable logistic regression examined associations between naloxone carriage and individual-level factors.ResultsParticipants (n = 97) were majority male (59%), with a mean age of 48 (SD = 12), 27% had college education or higher, 64% indicated injection drug use, and 84% reported past naloxone training. All participants endorsed familiarity with naloxone, but only 42% regularly carried naloxone. The following variables were associated with carrying naloxone: White race (aOR = 2.94, 95% CI 1.02–8.52), college education (aOR = 8.11, 95% CI 1.76–37.47), and total number of self-reported harm reduction behaviors (aOR = 1.45, 95% CI 1.00–2.11).ConclusionWe found low rates of naloxone carriage among methadone-treated patients. Methadone programs provide opportunities for naloxone interventions and should target racial/ethnic minorities and individuals with lower education. The spectrum of harm reduction behaviors should be encouraged among these populations to enhance naloxone carriage.

School-based harm reduction with adolescents: a pilot study

A pilot study of Safety First: Real Drug Education for Teens showed significant results pre to post curriculum with high school freshmen. Negative outcomes of drug education are linked to a failure to engage students because of developmentally inappropriate materials that include activities that have no relevance to real experiences of young people. The few harm reduction studies showed increased student drug related knowledge. Students were less likely to consume substances, and less likely to consume to harmful levels. More studies are necessary to evidence harm reduction efficacy in the classroom. The goal of this study was to measure harm reduction knowledge and behaviors, including drug policy advocacy, before and after Safety First. Data were analyzed using McNemar’s test, ANOVA, linear regression, t-tests and thematic coding. Survey results, corroborated by the qualitative findings, showed a significant increase (p < .05) in high school freshmen harm reduction knowledge and behaviors in relationship to substance use pre to post Safety First. This increase related to a decrease in overall substance use. Harm reduction is often perceived as a controversial approach to substance use. These findings have implications for further study of what could be a promising harm reduction-based substance use intervention with teens.

Network-level HIV risk norms are associated with individual-level HIV risk and harm reduction behaviors among people who inject drugs: a latent profile analysis.

The COVID-19 related U.S.-Mexico border-crossing restrictions disrupted social networks and HIV harm reduction services among people who inject drugs (PWID) in San Diego and Tijuana. We assessed associations of descriptive network norms on PWID’s HIV vulnerability during this period. Between 10/2020 and 10/2021, 399 PWID completed a behavioral and egocentric questionnaire. We used Latent Profile Analysis to categorize PWID into network norm risk profiles based on proportions of their network (n = 924 drug use alters) who injected drugs and engaged in cross-border drug use (CBDU), among other vulnerabilities. We used logistic and linear regressions to assess network profile associations with individual-level index of HIV vulnerability and harm reduction behaviors. Fit indices specified a 4-latent profile solution of descriptive network risk norms: lower (n = 178), moderate with (n = 34) and without (n = 94) CBDU and obtainment, and higher (n = 93). Participants in higher risk profiles reported more HIV vulnerability behaviors and fewer harm reduction behaviors. PWID’s gradient of HIV risk was associated with network norms, warranting intervention on high-vulnerability networks when services are limited.