Harm Reduction Programs Research Articles

Between Care and Control: Examining Surveillance Practices in Harm Reduction.

As harm reduction programs and services proliferate, people who use drugs (PWUD) are increasingly subjected to surveillance through the collection of their personal information, systematic observation, and other means. The data generated from these practices are frequently repurposed across various institutional sites for clinical, evaluative, epidemiological, and administrative uses. Rationales provided for increased surveillance include the more effective provision of care, service optimization, risk stratification, and efficiency in resource allocation. With this in mind, our reflective essay draws on empirical analysis of work within harm reduction services and movements to reflect critically on the impacts and implications of surveillance expansion. While we argue that many surveillance practices are not inherently problematic or harmful, the unchecked expansion of surveillance under a banner of health and harm reduction may contribute to decreased uptake of services, rationing and conditionalities tied to service access, the potential deepening of health disparities amongst some PWUD, and an overlay of health and criminal-legal systems. In this context, surveillance relies on the enlistment of a range of therapeutic actors and reflects the permeable boundary between care and control. We thus call for a broader critical dialogue within harm reduction on the problems and potential impacts posed by surveillance in service settings, the end to data sharing of health information with law enforcement and other criminal legal actors, and deference to the stated need among PWUD for meaningful anonymity when accessing harm reduction and health services.

Patient and health-care provider experience of a person-centred, multidisciplinary, psychosocial support and harm reduction programme for patients with harmful use of alcohol and drug-resistant tuberculosis in Minsk, Belarus

BackgroundTuberculosis (TB) often concentrates in groups of people with complex health and social issues, including alcohol use disorders (AUD). Risk of TB, and poor TB treatment outcomes, are substantially elevated in people who have AUD. Médecins sans Frontières and the Belarus Ministry of Health have worked to improve treatment adherence in patients with multi-drug or rifampicin resistant (MDR/RR)-TB and harmful use of alcohol. In 2016, a person-centred, multidisciplinary, psychosocial support and harm reduction programme delivered by TB doctors, counsellors, psychiatrists, health-educators, and social workers was initiated. In 2020, we described patient and provider experiences within the programme as part of a wider evaluation.MethodsWe recruited 12 patients and 20 health-care workers, using purposive sampling, for in-depth individual interviews and focus group discussions. We used a participant-led, flexible, exploratory approach, enabling participants and the interviewer to shape topics of conversation. Qualitative data were coded manually and analysed thematically. As part of the analysis process, identified themes were shared with health-care worker participants to enable their reflections to be incorporated into the findings.ResultsKey themes related to the patients’ and practitioners experience of having and treating MDRTB with associated complex health and social issues were: fragility and despair and guidance, trust and health. Prejudice and marginalisation were global to both themes. Counsellors and other health workers built a trusting relationship with patients, enabling guidance through a multi-disciplinary approach, which supported patients to achieve their vision of health. This guidance was achieved by a team of social workers, counsellors, doctors and health-educators who provided professional and individualised help for patients’ illnesses, personal or interpersonal problems, administrative tasks, and job searches.ConclusionsPatients with MDR/RR-TB and harmful use of alcohol faced complex issues during treatment. Our findings describe how person-centred, multi-disciplinary, psychosocial support helped patients in this setting to cope with these challenges and complete the treatment programme. We recommend that these findings are used to: i) inform programmatic changes to further boost the person-centred care nature of this program; and ii) advocate for this type of person-centred care approach to be rolled out across Belarus, and in contexts that face similar challenges.

A qualitative analysis of rural syringe service program fidelity in Appalachian Kentucky: Staff and participant perspectives.

As drug-related epidemics have expanded from cities to rural areas, syringe service programs (SSPs) and other harm reduction programs have been slow to follow. The recent implementation of SSPs in rural areas demands attention to program fidelity based on core components of SSP success. Semistructured interviews conducted with clients and staff at 5 SSPs in 5 counties within 2 Central Appalachian health districts. Interviews covered fidelity of SSP implementation to 6 core components: (1) meet needs for harm reduction supplies; (2) education and counseling for sexual, injection, and overdose risks; (3) cooperation between SSPs and local law enforcement; (4) provide other health and social services; (5) ensure low threshold access to services; and (6) promote dignity, the impact of poor fidelity on vulnerability to drug-related harms, and the risk environment's influence on program fidelity. We applied thematic methods to analyze the data. Rural SSPs were mostly faithful to the 6 core components. Deviations from core components can be attributed to certain characteristics of the local rural risk environment outlined in the risk environment model, including geographic remoteness, lack of resources and underdeveloped infrastructure, and stigma against people who inject drugs (PWID) CONCLUSIONS: As drug-related epidemics continue to expand outside cities, scaling up SSPs to serve rural PWID is essential. Future research should explore whether the risk environment features identified also influence SSP fidelity in other rural areas and develop and test strategies to strengthen core components in these vulnerable areas.

What is the global prevalence of depression among men who have sex with men? A systematic review and meta-analysis

BackgroundDepression due to stigma resulting from their sexual identity, isolation, social exclusion, and insufficient access to care and counseling services has become a health problem among men who have sex with men (MSM).ObjectivesThis study aimed to determine the global prevalence of depression among MSM as a systematic review and meta-analysis.MethodsThis study was a systematic review and meta-analysis performed in five steps of search strategy, screening and selecting articles, data extraction, evaluation of the risk of bias, and meta-analysis. In this study, the determined keywords were searched in the databases of PubMed, Scopus, Embase, and Web of Science from January 1913 to July 2021 to find the initial articles, from which data were extracted according to the set checklist in the data extraction stage. Finally, the studies were included in the present meta-analysis according to the inclusion and exclusion criteria, to be evaluated using the Newcastle Ottawa scale checklist. I Square and Q Cochrane were also used to assess the degree of heterogeneity. The analyses were performed using the random-effects model in STATA 16.ResultsThe results showed the quality score of the majority of cross-sectional studies included in the meta-analysis (62 studies) was equal to six or seven (moderate), and five ones had a high-quality score. After combining these studies, the pooled prevalence of depression among MSM in the world was 35% (95% CI 31%–39%, I square; 98.95%, P-value < 0.001). Population subgroup analysis showed the pooled prevalence of depression among MSM living with HIV was 47% (95% CI 39%-55%, I square; 95.76%, P-value < 0.001). Continent subgroup analysis showed the highest pooled prevalence of depression among Asian MSM at 37% (95% CI 31%-43%, I square; 99.07%, P-value < 0.001). Also, in the subgroup analysis of the sampling method, the pooled prevalence in the studies which used the respondent-driven sampling method was equal to 34% (95% CI 25%-43%, I square; 99.32%, P-value < 0.001). Sensitivity analysis revealed the pooled prevalence of depression in studies included in the meta-analysis was near or around the pooled estimate.ConclusionThe pooled prevalence of depression among MSM was almost three times higher than the general male population. Therefore, particular and therapeutic interventions such as screening, and harm reduction programs for mental disorders, especially depression, are suggested to be considered in service packages.

Promoting harm reduction in rural South Dakota using an interdisciplinary consortium

BackgroundDeaths from drug-related overdoses are increasing. Rural areas continue to have fewer accessible resources than urban areas. The START-SD (Stigma, Treatment, Avoidance, and Recover in Time – South Dakota) project is funded by the Health Resources and Services Administration and aims to address needs surrounding substance use disorder (SUD) in South Dakota. Pharmacists can play a key role in these efforts. ObjectiveDescribe harm reduction and prevention activities implemented through START-SD to reduce the impact of SUD in South Dakota. Practice descriptionThe interdisciplinary team at South Dakota State University, including pharmacists and student pharmacist researchers, partnered with collaborating organizations to provide improved access to prevention, treatment, and recovery services for those impacted by SUD. Practice innovationGiven the rural and conservative nature of the state, the START-SD team used an innovative framework to implement harm reduction and prevention programs that other states could adopt. Evaluation methodsBecause the START-SD project uses evidence-based programs, evaluation focuses on the number of programs implemented and the number of people subsequently served. Data are collected and reported biannually by the team. ResultsThe core team established and expanded an interdisciplinary consortium and advisory board. A variety of harm reduction and prevention strategies were implemented: establishing and developing partnerships with key organizations, working to increase access to harm reduction programs, facilitating educational activities and trainings, and working to reduce stigma related to SUD and harm reduction. DiscussionReducing the impact of SUD requires a broad, multifaceted approach, as well as overcoming many environmental barriers. Pharmacists and pharmacy staff are uniquely positioned to positively affect harm reduction for patients. ConclusionMore work to decrease the impact of SUD is needed, particularly in rural areas. Pharmacists can play a key role in projects to increase the reach and impact of prevention, treatment, and recovery efforts.

Perceptions and Experiences With Evidence-based Treatments Among People Who Use Opioids.

Even where treatment is available, people who use drugs (PWUD) may not seek help. Few published studies examine beliefs, experiences, and perceptions of evidence-based treatment among PWUD who are not actively engaged in care. This study aimed to explore the experiences of PWUD in considering or accessing treatment and gauge receptiveness to low-threshold treatment models. A purposeful sample of participants actively using opioids and with previous interest in or experience with treatment was recruited from a harm reduction program in Chicago. Semistructured interviews were conducted to explore key phenomena while allowing for unanticipated themes. The instrument included questions about historical drug use, treatment experience, and perceptions of how to improve treatment access and services. Private interviews were audio recorded, transcribed, and double coded by 2 analysts. Queries of coded data were analyzed using issue-focused analysis to identify themes. The sample (N = 40) approximated groups at highest risk of fatal overdose in Chicago, with more than 80% between the ages of 45 to 64 years, 65% African American, and 62% male identified. The majority had prior treatment experience, although all resumed use after completing or leaving treatment. The most prevalent barriers to treatment included structural barriers related to social determinants, lack of readiness for abstinence, burdensome intake procedures, and regulatory/programmatic requirements. Most participants expressed interest in low-threshold treatment. Existing treatment barriers may be addressed by shifting to lower-threshold intake processes and/or outreach-based delivery of opioid agonist treatment. Engaging PWUD in efforts to create lower-threshold treatment programs is necessary to ensure that needs are met.

Sources of knowledge and truth related to anabolic/androgenic steroid use among two-spirit, gay, bisexual, queer, and other men who have sex with men.

ObjectivesThis study sought to explore how two-spirit, gay, bisexual, and queer cisgender and transgender (2SGBQ+) men engage with information related to non-prescribed anabolic/androgenic steroid (AAS) use, and how discourses of risk surrounding AASs influence their AAS use practices. Two objectives were achieved: (1) Sources of information that 2SGBQ+ men consulted when considering using AASs were identified and (2) the ways in which discourses of risk shaped 2SGBQ+ men’s experiences of using AASs were revealed.MethodsParticipants were recruited for semi-structured interviews online and through word of mouth. A critical poststructural methodology and theories of risk discourse and biopolitics were used to identify themes and interpret data.ResultsSeventeen interviews were conducted with adult 2SGBQ+ cis and trans men. Three themes emerged: (1) Unauthoritative sources of knowledge and truth sought by current and prospective AAS users were inconsistent and difficult to evaluate; (2) Authoritative sources, including health care providers, reacted inconsistently; and (3) 2SGBQ+ men generated and shared lay knowledges as a form of community-led harm reduction.ConclusionThe complexities of seeking and evaluating information highlight the privileged nature of trustworthy, accurate information on the topic. Risk—as a discursive regime—places 2SGBQ+ male AAS users in the position to produce lay knowledge and cultivate their own “truths” on the topic, which can lead to preventable harm. Public health needs to address these biopolitical effects by considering these lay forms of knowledge as an untapped resource and design accessible and judgement-free AAS use harm reduction programs for 2SGBQ+ AAS users.

Dealing With the Epidemic of Endocarditis in People Who Inject Drugs.

North America is facing an opioid epidemic and growing illicit drug supply, contributing to growing numbers of injection drug use-related infective endocarditis (IDU-IE). Patients with IDU-IE have high early and late mortality. Patients with IDU-IE more commonly present with right-side IE compared with those with non-IDU IE, and a majority are a result of Streptococcus aureus. Although most patients can be successfully managed with intravenous antibiotic treatment, surgery is often required in part owing to high relapse rates, potential treatment biases, and more aggressive pathophysiology in some. Multidisciplinary management as endocarditis teams, including not only cardiologists and cardiac surgeons, but also infectious disease specialists, drug addiction experts, social workers, neurologists, and neurosurgeons, is essential to best manage substance use disorder and facilitate safe discharge to home and society. Structural and population-level interventions, such as harm-reduction programs, are necessary to reduce IDU-IE relapse rates in the community and other IDU-related health concerns, such as overdoses. In this review, we describe the pathophysiologic, clinical, surgical, social, and ethical characteristics of IDU-IE and their management. We present the most recent clinical guidelines for this condition and discuss existing gaps in knowledge to guide future research, practice changes, and policy interventions.

Perception of Resource Allocations to Address the Opioid Epidemic.

Despite billions of dollars spent on opioid policy initiatives, public knowledge of evidence-based policies to reduce opioid-related morbidity remain low. Consequences of this knowledge gap for support of initiatives remains understudied. Our objective was to evaluate how participants with and without lived experience allocate funding for initiatives to address the opioid epidemic. A secondary objective was to collect proof-of-concept data of an informational intervention designed to improve support for evidence-based policies. Participants (N = 284; 57.2% female) without lifetime nonmedical opioid use (n = 98) and those with lifetime use (past year [n = 81] or nonpast year [n = 105]) of nonmedical opioids were recruited. All participants reported how they would allocate funds to demand reduction, supply reduction, harm reduction, and treatment policies. Half of all participants were then randomized to a brief informational intervention designed to emphasize evidence-based harm reduction and treatment programs. Funding allocations were highest for policies related to community services and treatment and lowest for those related to harm reduction. Participants with lived experience allocated less to supply reduction policies. Participants (12%) who reallocated funds after information exposure increased funding to supervised consumption sites, dz = 0.77, naloxone distribution, dz = 0.85, syringe exchange programs, dz = 0.63, and medications for opioid use disorder access, dz = 0.70. This study illustrates how people with and without lived experience prioritize various policies to address the opioid epidemic and emphasize comparably low support for harm reduction policies. Proof-of-concept data suggest that brief informational interventions may increase funding support for harm reduction strategies, at least in a subset of people.

Behavioural Risk for HIV, Hepatitis B, and Hepatitis C Infections among a Population of Drug Users and Injectors across Four Regions in Ghana.

Background Blood borne infections such as HIV, Hepatitis B (HBV), and Hepatitis C (HCV) are of great importance to governments and their implementing partners, especially among people who use drugs (PWUD) and people who inject drugs (PWID). Prevalence and determinants of HIV, HBV, and HCV among PWUD and PWID in Ghana are not well established, the significance of this study. Method This assessment was a cross-sectional study implemented via the respondent driven sampling approach. A team of community advisory boards that comprised former users, current users, and civil society organizations were constituted to help in the implementation of the study. The study was conducted in four regions in Ghana. The assessment was based on a representation of populations of PWID and PWUD from the four regions. Efforts were made by the team to ensure adequate representation of women where feasible. A quantitative questionnaire was developed and used to obtain information on the respondents' sociodemographics, sexual behavior, substance use, and biological characteristics. The prevalence of HIV, HBV, and HCV among PWID and PWUD was determined using blood samples. First response and oral quick test for confirmation of HIV positivity were carried out, while SD bioline was used to test for the presence of HBV and HBC. Data were analyzed using the Bayesian generalized linear model via the binomial family of distributions under the logit link function with weak Cauchy and Normal distribution as prior. Results A total of 323 PWUD and PWID participants were interviewed across four regions of Ghana. The overall median age of the respondents was 36 (28, 43) years. The prevalence of HIV, HBV, and HCV infection in the study was 2.5%, 4.6%, and 5.9%, respectively. The prevalence of HIV, HBV, and HCV among drug users was 2.5% (95% CI: 0.7%–4.2%), 4.1% (95% CI: 1.8%–6.2%), and 6.7% (95% CI: 3.9%–9.4%), respectively. Most drug injectors and users started using and injecting drugs at ages less than 20 years and between 20 and 29 years, respectively. Drug users who identified themselves as part of the general population were 66% less likely to be tested HIV positive (POR = 0.34, CrI: 0.12–0.81) compared to sex workers. Part time employment respondents had fivefold odds (POR = 5.50, CrI: 1.20–16.16) of being HBV positive as against full-time employment. Conclusion Most of the injectors and users started drugs at an early age. Drug users and injectors are at higher risk of these infections because of associated risky sexual behaviors and risky injection practices. Harm reduction programs to help addicts who are willing to quit the practice are recommended.

Bibliometric Analysis and Visualization Harm Reduction in Indonesia Indexed in Scopus

Harm Reduction is a program to reduce the harm of narcotics for injecting drug users. The Harm Reduction (HR) program in Indonesia was initiated in 1999 with assistance and financial support from international donor agencies that lead to policy or program implementation. 9 components of Harm Reduction are still being implemented in Indonesia. The current study was conducted to analyze the bibliometric characteristics and trends of articles on Harm Reduction in Indonesia. This study uses VOSviewer affiliate analysis to visualize and analyze trends in the form of bibliometric maps. VOSviewer can also create publication maps, country maps, or journal maps based on shared citation networks or create keyword maps based on their networks. All data is taken from the Scopus database. Articles from 1999 to 2021 in 41 journals indexed by Scopus with a total of 67 documents. Research on Harm Reduction in Indonesia in the last five years has only one significant increase, namely in 2019 with 10 article documents.Harm Reduction is a program to reduce the harm of narcotics for injecting drug users. The Harm Reduction (HR) program in Indonesia was initiated in 1999 with assistance and financial support from international donor agencies that lead to policy or program implementation. 9 components of Harm Reduction are still being implemented in Indonesia. The current study was conducted to analyze the bibliometric characteristics and trends of articles on Harm Reduction in Indonesia. This study uses VOSviewer affiliate analysis to visualize and analyze trends in the form of bibliometric maps. VOSviewer can also create publication maps, country maps, or journal maps based on shared citation networks or create keyword maps based on their networks. All data is taken from the Scopus database. Articles from 1999 to 2021 in 41 journals indexed by Scopus with a total of 67 documents. Research on Harm Reduction in Indonesia in the last five years has only one significant increase, namely in 2019 with 10 article documents.

Public injecting and its association with mental health and other drug-related outcomes among people who inject drugs in Iran

BackgroundInjecting in public places may increase the risk of drug and health-related harms among people who inject drugs (PWID). We examined the prevalence of public injecting and associations with non–fatal overdose, needle/syringe sharing, sexual health, and mental health among PWID in Iran. MethodsUsing respondent-driven sampling, we recruited 2684 PWID from 11 major cities between July 2019 and March 2020. We defined public injecting as injecting primarily in public places, such as streets, parks, or abandoned buildings. Multivariable logistic regression models assessed public injecting and its associated factors, as well as the association of public injecting with certain health outcomes. ResultsOf 2388 respondents, 69.6 % reported public injecting in the previous year. Self-identifying as men (adjusted odds ratio [aOR] = 4.21; 95 % confidence intervals [95 % CI]: 2.31, 7.65), homelessness (aOR = 6.81; 95 % CI: 5.10, 9.10), high injection frequency (aOR = 1.58; 95 % CI: 1.03, 2.44), and free needle/syringe uptake (aOR = 1.47; 95 % CI: 1.04, 2.07) were significantly associated with public injecting. Compared to PWID who primarily inject in non–public places, PWID who mostly used public places had significantly greater odds of reporting non–fatal overdose (aOR = 2.02; 95 % CI: 1.01, 4.02), needle/syringe sharing (aOR = 1.77; 95 % CI: 1.08, 2.90), unsafe sexual practices with casual sexual partners (aOR = 2.16; 95 % CI: 1.03, 4.55), suicidal ideation (aOR = 1.50; 95 % CI: 1.02, 2.21), and self-harm (aOR = 1.78; 95 % CI: 1.24, 2.54) in the last three months. ConclusionThese results suggest the potential utility of a safer injecting environment to mitigate the multiple harms associated with public injecting in Iran. Optimizing health and well-being of PWID necessitates integrating supervised injection facilities into the current harm reduction programs and services in Iran. Future studies should also consider the experiences of additional mental health harms associated with public injecting when exploring adverse health outcomes among PWID.

Interest of drug checking supply: Results of 3 years of activity in Geneva

Swiss drug policy aims to reduce recreational drug consumption and its negative consequences. The strategy is based on a four pillars concept: prevention, therapy, harm reduction and repression. Among harm reduction programs drug checking (DC) facilities have emerged, allowing drug users to check the presence of adulterants or other non-expected substances, and to gain information concerning the purity of the product, without encouraging drug consumption. In 2019, one DC opened in Geneva (Switzerland) after receiving an authorization from the Federal Office of Public Health, and the results of 3 years of activity are presented. Drug users brought samples anonymously to DC. Samples were send to the laboratory for analyses, and results are transmitted to DC, where drug users could obtained and discussed the results. Samples were dissolved in methanol, and a general unknown screening was performed by using gas chromatography coupled to mass spectrometry (GC-MS) directly and after acetylation. Depending of the substances, quantitative analyses were performed by using GC-MS, liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS), or liquid chromatography coupled to diode array detector (LC-DAD). A total of 883 samples were analyzed from June 2019 to April 2022. The majority of samples were powders (67%), tablets (11%), plants (8%), and blotting papers (6%). For 71 samples (8%) the detected substances did not correspond to those announced by consumers, and in 23 samples (3%), no psychoactive substances were detected. Cocaine was detected in 290 samples (33%), with a median purity of 75%. In these samples, 11% contained also levamisole, 11% caffeine, and 7% phenacetin. Sympathomimetics were detected in 278 samples (31%). MDMA (16%), amphetamine (4.8%), 3-MMC (3.3%), 2C-B (2.6%), and 4-MMC (1.4%) were the most detected substances in this group of substances. MDMA was detected in powder specimen with a median purity of 85%, and in tablet form with a median amount of 133 mg (range: 3–320 mg). More rarely, methamphetamine, MDEA, 6-APB, 2C-D, 2C-E, BOD, 2-Br-4,5-DMPEA, DOB, DOC, DOM, MBDB, 3-FA, 5-MMPA, 5-MAPB, and 4-CMC were observed. Cannabinoids were detected in 84 samples (9.5%), and among these samples, 11 contained synthetic cannabinoids [5-Fluoro-MDMB-PINACA (3 cases); MDMB-4en-PINACA (8 cases)]. LSD and other hallucinogenic substances (1cP-LSD, psilocin, DMT, 4-ACO-DMT, 4-HO-MET) were detected in 85 samples (9.6%). Ketamine was detected in 68 cases (7.7%), with a median purity of 76%. Heroin was detected in 64 cases (7.2%), with a median purity of 20%. Benzodiazepines (alprazolam or etizolam) were detected in 7 cases (0.8%). The DC activity reached out to consumers who were not yet connected to prevention structures. The prevalence of the detected substances in the DC samples analyzed confirmed roughly what was known about the local market for illicit substances. However, some unexpected results were observed, such as the number of samples containing ketamine, or some new psychoactive substances. Interestingly, a couple of months after the beginning of COVID pandemic, 2 synthetic cannabinoids never detected before in Western Switzerland were observed, showing the interest of the DC facility in a harm reduction strategy, and more generally for public health prevention. Knowledge concerning the market of illicit psychoactive substances is complex and often difficult to assess. In this context, the analyses carried out for the Geneva DC have demonstrated a definite interest in better knowing and understanding the dynamics of the illicit substance market, complementing other information from police and customs seizures, wastewater analyses, used needle analyses, suspected DUID case analyses, clinical toxicology case analyses and postmortem case analyses.

The impact of a 24‐hour syringe dispensing machine on a face‐to‐face needle and syringe program and targeted primary healthcare clinic

ObjectiveAutomatic syringe dispensing machines (ADM) have become an important adjunct to Australia's needle and syringe programs (NSP). However, concerns that they reduce face‐to‐face contact with health staff and other health interventions remain. We examined changes in the number of needle/syringes dispensed at an ADM and occasions of service at a co‐located face‐to‐face NSP and targeted primary healthcare clinic during the first wave of COVID‐19 restrictions. MethodsWe reviewed data from an inner‐city harm reduction program during the study period of April 2020 to March 2021 compared to the previous year. Multivariable linear regression models were used to estimate the association between occasions of service and equipment distribution. ResultsADM‐dispensed equipment increased significantly by 41.1%, while face‐to‐face NSP occasions decreased by 16.2%. Occasions provided by the targeted primary healthcare clinic increased by 59.7% per month. ConclusionWe have shown that 24‐hour ADM access did not adversely affect the number of people using targeted primary healthcare when provided within close proximity. Implication for public healthThese findings reinforce the demand for 24‐hour needle/syringe access and can be used to support the expanded access to ADMs, especially where people who inject drugs (PWID) have access to appropriate healthcare.

Application of machine learning algorithms for localized syringe services program policy implementation – Florida, 2017

Background People who inject drugs (PWID) are at an amplified vulnerability for experiencing a multitude of harms related to their substance use, including viral (e.g. HIV, Hepatitis C) and bacterial infections (e.g. endocarditis). Implementation of evidence-based interventions, such as syringe services programs (SSPs), remains imperative, particularly in locations at an increased risk of HIV outbreaks. This study aims to identify communities in Florida that are high-priority locations for SSP implementation by examining state-level data related to the substance use and overdose crises. Methods State-level surveillance data were aggregated at the ZIP Code Tabulation Area (ZCTA) (n = 983) for 2017. We used confirmed cases of acute HCV infection as a proxy of injection drug use. Least Absolute Selection and Shrinkage Operator (LASSO) regression was used to develop a machine learning model to identify significant indicators of acute HCV infection and high-priority areas for SSP implementation due to their increased vulnerability to an HIV outbreak. Results The final model retained three variables of importance: (1) the number of drug-associated skin and soft tissue infection hospitalizations, (2) the number of chronic HCV infections in people aged 18–39, and 3) the number of drug-associated endocarditis hospitalizations. High-priority SSP implementation locations were identified in both urban and rural communities outside of current Ending the HIV Epidemic counties. Conclusion SSPs are long researched, safe, and effective evidence-based programs that offer a variety of services that reduce disease transmission and assist with combating the overdose crisis. Opportunities to increase services in needed regions across the state now exist in Florida as supported by the expansion of the Infectious Disease Elimination Act of 2019. This study provides details where potential areas of concern may be and highlights regions where future evidence-based harm reduction programs, such as SSPs, would be useful to reduce opioid overdoses and disease transmission among PWID. Key messages The rate of acute HCV in Florida in 2017 was 1.9 per 100,000, nearly twice the national average. Serious injection related infections among PWID are significant indicators of acute HCV infection. High-priority SSP implementation locations in Florida were identified in both urban and rural communities, including those outside of current Ending the HIV Epidemic counties.

A qualitative examination of naloxone access in three states: Connecticut, Kentucky, and Wisconsin

BackgroundPrevention of opioid-involved overdose deaths remains a public health priority in the United States. While expanding access to naloxone is a national public health strategy, it is largely implemented at the state and local level, where significant variability in policies, resources, and norms exist. The aims of the current study were to examine the social context of naloxone access in three different states (Connecticut, Kentucky, Wisconsin) from the perspectives of key informants (first responders, harm reduction personnel, and pharmacists), who play some role in dispensing or administering naloxone within their communities.MethodsInterviews were conducted with key informants who were in different local areas (urban, suburban, rural) across Connecticut, Kentucky, and Wisconsin. Interview guides explored the key informants’ experiences with administering or dispensing naloxone, and their perspectives on opioid overdose prevention efforts in their areas. Data analysis was conducted using multistage inductive coding and comparative methods to identify dominant themes within the data.ResultsKey informants in each of the three states noted progress toward expanding naloxone access, especially among people who use opioids, but also described inequities. The key role of harm reduction programs in distributing naloxone within their communities was also highlighted by participants, as well as barriers to increasing naloxone access through pharmacies. Although there was general consensus regarding the effectiveness of expanding naloxone access to prevent overdose deaths, the results indicate that communities are still grappling with stigma associated with drug use and a harm reduction approach.ConclusionFindings suggest that public health interventions that target naloxone distribution through harm reduction programs can enhance access within local communities. Strategies that address stigmatizing attitudes toward people who use drugs and harm reduction may also facilitate naloxone expansion efforts, overall, as well as policies that improve the affordability and awareness of naloxone through the pharmacy.

Fake anabolic androgenic steroids on the black market – a systematic review and meta-analysis on qualitative and quantitative analytical results found within the literature

ObjectiveSupraphysiologic doses of anabolic androgenic steroids (AAS) are widely used to improve body image and sport performance goals. These substances can easily be acquired over the internet, leading to a substantial black market. We reviewed literature that assessed the quality and quantity of AAS found on the black market.MethodsWe searched PubMed/Medline, Embase and Google Scholar for articles published before March 2022. Additional hand searches were conducted to obtain studies not found in the primary literature search. Studies were included if they report on qualitative and/or quantitative analytical findings of AAS from the black market. Primary outcomes were proportions of counterfeit or substandard AAS. Eligible articles were extracted; quality appraisal was done using the ToxRTool for in-vitro studies. We used random-effects models to calculate the overall mean estimates for outcomes. The review protocol has been published and registered in INPLASY.ResultsOverall, 19 studies, which in total comprised 5,413 anabolic samples, met the inclusion criteria, and passed the quality appraisal from two WHO world regions that reported findings, the Americas and Europe. Most studies were nonclinical laboratory studies (95%) and provided samples seized by authorities (74%). In 18 articles, proportions of counterfeit substances and in eight articles, proportions of substandard substances were presented. The overall mean estimate for counterfeit anabolic steroids found on the black market was 36% (95% CI = 29, 43). An additional 37% (95% CI = 17, 63) were of substandard quality. We also demonstrate that these drugs could contain no active ingredient, or in another amount than that labeled, a wrong active ingredient, as well as not all or more active ingredients than were labeled. High heterogeneity among all analyses and significant differences between geographical subgroups were found.ConclusionWith this systematic review and meta-analysis, we demonstrate that substantial mean proportions of black-market AAS are counterfeit and of substandard quality. These products pose a considerable individual and public health threat, and the very wide range in proportions of fake black-market AAS puts the user in a situation of unpredictable uncertainty. There is a great need for future prevention and harm-reduction programs to protect users from these substances.

Harm Reduction and War on Drugs in Indonesia During Joko Widodo Era

Narcotics is a form of transnational crime. From the practice of narcotics crime, many victims of the nation's generation. Circulation and abuse of narcotics are some of the problems facing the world, including Indonesia. Estimated data on narcotics users in Indonesia is between 3.7-4 million people (National Narcotics Agency). Various efforts have been made by the Indonesian government to break the chain of narcotics trafficking and abuse through international collaboration with the Harm Reduction (HR) program. The era of President Joko Widodo (Jokowi) of the Indonesian government was more towards the "War on Drugs" policy. The success of the Harm Reduction program by the previous government, namely reducing the number of HIV/AIDS transmission among narcotics users. The rejection of the declaration of the War on Drugs against the Jokowi regime which failed in the first period. In this study, the theory of international regimes and the concept of human security will be used as well as bibliometric analysis methods with VOSviewer software.

Illicit Drug Use among Commercial ‘Boda Boda’ Motorcyclists in Uganda

Background: Illicit drug use is a global public health problem with grave health and socio-economic consequences. Related intoxication has been associated with accidental injuries and fatalities. In Uganda, 67% of road traffic accidents are attributed to motorcyclists. Methods: This study assessed the prevalence and determinants of illicit drug use among commercial motorcyclists in Uganda, using a cross-sectional survey research design. We interviewed 785 commercial motorcyclists in the divisions of Nakawa, Rubaga, Makindye, and Kawempe of Kampala district. We used an on-spot saliva drug test kit to screen and detect the presence of illicit drugs. Data were analyzed using frequency distributions, cross tabulations and multi variable logistic regression. Results: Findings show that 11% of the cyclists used illicit drugs. The use of illicit drugs was associated with division of operation, religiosity, and whether a cyclist resided with a family. The odds of use of illicit drugs were higher among cyclists from Nakawa division compared to cyclists from Kawempe. Cyclists who went to places of worship on a weekly basis compared to those who were less frequent, and cyclists who lived with their families compared to those who did not, had reduced odds of use of illicit drugs. There are variations in the distribution of cyclists that use illicit drugs in Kampala. Religious commitment and residence with families had a mitigating influence on illicit drug use among commercial cyclists. Conclusion: Illicit drug use prevention, treatment, and harm reduction programs among cyclists should collaborate with faith-based organizations and other key stakeholders, and promote stable family relations.

Frequency of fatal and non-fatal overdoses and response to grief and loss among people who inject drugs: An unexplored dimension of the opioid overdose crisis

BackgroundWe investigated the relationship between overdose events and grief and loss responses among people who inject drugs. MethodsWe conducted a cross-sectional, tablet-based survey with a convenience sample of people who inject drugs (n = 249) from four community-based harm reduction programs in Toronto in 2019. We examined the association between frequency and types of overdose events (own, witnessed, death of significant person) in the last 6 months with grief and loss responses, identified using latent class analysis. ResultsAmong respondents, 70 (48.6 %) reported 2 or more personal overdoses, 173 (79.5 %) witnessed 2 or more overdoses, and 69 (41.4 %) experienced overdose deaths of 2 or more significant persons in the last 6 months. We identified 2 latent classes with probability of membership of 38.6 % (95 % confidence interval [CI]=31.0, 46.7) for medium/low intensity of responses to grief/loss and 61.4 % (95 % CI= 53.3, 69.0) for severe responses to grief/loss. In adjusted Poisson regression models with robust standard error estimators, severe responses to grief/loss were associated with exposure to two or more own overdoses (prevalence ratio [PR] = 1.44; 95 % CI=1.12, 1.84, p-value=0.004), and having witnessed one (PR=2.09; 95 % CI=1.05, 4.15, p-value=0.04) or witnessed two or more overdoses (PR=2.25; 95 % CI=1.24, 4.09, p-value=0.008). Severe grief/loss responses were also more common in individuals exposed to all three types of overdose events (PR=2.42; 95 % CI=1.08, 5.41, p-value=0.03). ConclusionsCumulative overdose events were associated with severe responses to grief and loss. Bereavement interventions should consider the complex nature of grief and loss following overdoses.