In England and Wales, drug use and related harms among young adults aged 18-25 remain high. They are neglected in existing service provision. Drawing on evaluation findings of a multi-component drug outreach service in England and informed by the concept of 'emerging adulthood', this paper explores the possibilities for the development of bespoke interventions for young adults. This paper draws on semi-structured interviews (n=19) conducted with managers and practitioners within the outreach service, regional leads for young people's services, and strategic stakeholders in public health, police and education. The co-produced outreach model was found to be agile, innovative and responsive to local drug trends. It was able to reach groups vulnerable to drug-related harms, by employing a different conceptualisation of 'harm reduction' centered on safety. Outreach interactions were limited in scope at some transition points to adulthood, with contact often lost when individuals reached age 18. Onward referral for those who need more intensive interventions was often difficult from ad hoc interactions, and existing adult treatment services were deemed unsuitable for young adult needs. Emerging adults aged 18-25 are a diverse group with distinct substance use profiles. Outreach activities are effective for education, harm reduction messaging, and signposting for further support. However, there is a need for the development of bespoke young adult service provision with skilled, specialist staff who can help young adults navigate these transitions without harm.

Prison needle exchange programs (PNEPs) reduce bloodborne virus transmission among people who inject drugs, yet global implementation remains limited. Canada introduced PNEPs in 2018, but uptake is low, and barriers to implementation persist. While perspectives of correctional officers, healthcare workers, and incarcerated individuals have been examined, little is known about how prison leadership shapes program delivery. Drawing on interviews informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we sought to identify the organisational, system, and structural/policy-level barriers to PNEP implementation from the perspectives of prison administrators. Between January and March 2025, 27 prison leaders from custodial and medical services from nine Canadian federal prisons with operational PNEPs participated in semi-structured interviews. Data were thematically analysed using the EPIS framework. Implementation was shaped by structural tensions between harm reduction goals and "zero tolerance" custodial mandates. Outer context factors, especially union resistance, lack of policy clarity, and federal directives, created misalignment and ambiguity in program ownership. Prison climate, staff turnover, and leadership engagement influenced shifts in attitudes toward PNEPs over time. Healthcare personnel, though central to delivery, were often tasked with communicating custodial decisions, undermining trust. Intervention fit was shaped by security classification and perceived drug use patterns, with PNEPs viewed as ill-suited for minimum-security settings. Sites that streamlined approval processes and designated leadership roles were better positioned to support program uptake. Time, experiential exposure, and tailored education were key facilitators of cultural change and implementation readiness. Addressing outer context barriers and clarifying responsibilities between health and corrections are critical to PNEP sustainability. Leadership engagement is essential to enabling system-wide adoption.

Temporal and regional associations between fentanyl concentrations in the unregulated drug supply and drug-related mortality in British Columbia, Canada.

Risk behaviors and prevalence of hepatitis B and C among people who inject drugs in Georgia: integrated bio-behavioral survey (IBBS).

An Investigation of Young Adults' Psychophysiological and Self-Report Responses to Paid Partnership Disclosures in Pro-Oral Nicotine Pouch Videos.

Although trust in addiction treatment providers and trust in treatment services are related yet distinct constructs, the latter remains underexplored. In Vietnam, where addiction treatment is transitioning from punitive models to community-based harm reduction, research on trust in treatment systems is particularly limited. Baseline data were drawn from an ongoing randomized controlled trial conducted across three provinces in Vietnam, involving 690 people who use drugs (PWUD). Data were collected through face-to-face, computer-assisted interviews using validated and adapted measures in addiction treatment services, depressive symptoms, perceived care support, and internalized stigma related to methadone maintenance treatment (MMT). A linear mixed-effects regression model with commune-level random-effects was used to assess associations between trust in addiction treatment services and the measures of interest, including demographic characteristics. Higher levels of internalized MMT stigma and depressive symptoms were both significantly associated with a decreased trust in addiction treatment services in the adjusted analysis. Demographic characteristics and current MMT status were not significantly associated with trust. Although trust in addition services was associated with perceived care support in bivariate analysis, this relationship was no longer significant after adjusting for other factors. These findings suggest trust in addiction treatment could be understood not only as a function of provider-patient relationships but also in broader institutional and systemic contexts. Addressing treatment-related stigma and integrating mental health services in addiction services may be promising strategies to improve PWUD's trust in addiction services.

Borderline personality disorder (BPD) is widely presented as an objective psychiatric diagnosis describing emotional and relational distress. However, feminist, decolonial, neurodiversity and lived experience-led scholarship demonstrates that BPD emerged within colonial, cisheteronormative, misogynist and neuronormative epistemologies that moralise distress and regulate identity, self-expression and access to care. This paper critically examines BPD as a diagnostic construct and governance technology that produces iatrogenic harm through epistemic injustice, structural exclusion and moralised interpretations of need. It explores how the diagnosis discredits lived experience knowledge, justifies care withdrawal and obscures sensory, cultural and structural determinants of distress and considers the implications for mental health nursing practice. A critical discourse analysis was conducted across psychiatric literature, policy documents, historical diagnostic texts and lived experience scholarship, treating psychiatric language and categorisation as technologies of power shaping credibility and clinical response. The analysis shows that BPD operates less as a clinical description than as a regulatory framework maintained through gendered, colonial and cisheteronormative norms. Dominant narratives of dependence, attachment theory and emotional expression obscure trauma, sensory differences and structural violence, while legitimising coercive and exclusionary practices. Mental health nurses are positioned at the frontline of enacting these logics, often experiencing moral distress. The BPD diagnosis lacks epistemic, cultural and ethical legitimacy. Its continued use undermines therapeutic safety and trust. A harm reduction transition away from the BPD construct is required, prioritising relational safety, sensory-informed and culturally responsive care, epistemic humility and lived experience leadership.

Hepatitis C virus (HCV) remains a major public health concern worldwide. Spain has implemented large-scale direct-acting antiviral (DAA) treatment programs, yet the prevalence of active HCV infection (aHCV) and its trends over time remain incompletely characterised. We applied Bayesian multiparameter evidence synthesis (MPES) to estimate the prevalence of aHCV in Spain in 2022 and its change from 2019 to 2022. The Spanish population aged 15-79 years was stratified into four non-overlapping risk groups: current people who inject drugs (PWID), ex-PWID, gay-bisexual and other men who have sex with men (GBMSM) engaging in chemsex (GBMSMchem), and the general population. Data sources included, among others, national seroprevalence surveys, behavioural studies, national databases, and clinical records on DAA treatment outcomes. The estimated overall aHCV prevalence in Spain in 2022 was 0.14% (95% Credible Interval: 0.05%-0.27%), corresponding to approximately 54,500 individuals. Prevalence was highest among current PWID (12.5%) and GBMSMchem (8.4%). Compared to 2019, the total number of aHCV cases declined by ~20,000, largely attributable to DAA treatment. Among the general population, 29.4% of aHCV cases remained undiagnosed, with the highest prevalence in individuals aged 50-59 (0.25%) and 60-69 (0.16%) years. Spain has made substantial progress towards HCV elimination, but key populations such as PWID and GBMSMchem remain at high risk. Targeted interventions, including expanded harm reduction services and accessible HCV testing and treatment, are essential to achieving the World Health Organization (WHO) elimination targets by 2030.

Housing First provides immediate, permanent, supportive housing with consumer choice, harm reduction, and separation of housing and services. This descriptive, cross-sectional study surveyed five Housing First programs that operate in Brazil and represent all known initiatives during data collection. Although programs adhered to Housing First's core principles, substantial variation existed across sites in governance, funding, staffing, and public service integration. Key implementation barriers included food insecurity and neighborhood safety concerns. National policy momentum provides a pathway for coordinated scale-up; however, funding mechanisms, integration with local services, and monitoring structures remain underdeveloped. Additionally, operational guidance was lacking.

Undocumented migrants in Germany face significant challenges in accessing healthcare. Although they are entitled to limited health services under the Asylum Seekers' Benefits Act, they cannot utilize these services without risking detection and deportation due to reporting obligations of social authorities. This study systematically reviews the existing research on healthcare access in this population in Germany for the first time. The literature research was conducted following the PRISMA-ScR standard in the databases Medline, CINAHL, PSYNDEX, SocINDEX, and Juris, with additional information gathered through supplementary email inquiries and manual searches. Studies from the years 2005-2024 were included. The data were analyzed regarding legal, structural, and practical access barriers and treatment gaps as well as recommended measures. Atotal of 88studies were included, most of which are based on quantitative data collection. The studies reveal that access to healthcare for people without valid residence permits is usually limited to emergency care and is characterized by treatment interruptions and alack of continuity in care. Humanitarian healthcare provision and anonymous healthcare vouchers partially compensate for existing gaps, but do not offer an adequate alternative to regular care. Despite civil society initiatives, undocumented migrants are underserved, and the right to health is not implemented. Future research should be aligned with the research ethics principles of care, harm minimization, and the self-determination of those affected.

Using drug checking data to model the relationship between the prevalence of fentanyl and xylazine to drug overdose deaths in New York City.

ABSTRACT Objectives Commercial fishing is among the most hazardous occupations in the United States, with high rates of injury, chronic pain, and opioid-related overdose deaths. Washington’s fishing community has expressed concern about substance use, highlighting the need for practical, industry-specific training. Methods This project applied the Knowledge to Action (KTA) framework to adapt and implement an overdose response training within the Fishermen First Aid and Safety Training (FFAST) program in Washington state. Training combined a didactic presentation, hands-on naloxone (NARCAN®) administration practice, and distribution of harm reduction materials. Results There were 25 commercial fishermen who participated, primarily shellfish harvesters. In pre-training, 54% reported knowledge of naloxone (NARCAN®) administration, yet 91% did not carry naloxone (NARCAN®) on their vessels, revealing a gap between knowledge and practical application. Post-training, 100% reported increased knowledge and confidence, and 70% indicated plans to include naloxone (NARCAN®) in their first aid kits. Participants emphasized the value of hands-on practice and identified several barriers, including occupational isolation, limited access to healthcare, and stigma. Conclusions Integrating overdose response into established safety programs provides a feasible, community-driven strategy to address opioid risk among fishermen. This training improves emergency preparedness and highlights the importance of translating theoretical knowledge into action within high-risk, remote occupational settings such as commercial fishing vessels.

Harm reduction has largely been shaped by responses to psychoactive drug use where the most urgent harms are acute. These models focus on overdose, blood-borne viruses, and rapid-onset toxicity related harms. When applied wholesale to anabolic-androgenic steroids (AAS), they obscure the distinctive pharmacology, consumer typologies, and slow-developing physiological risks that define people who use AAS. AAS use is often chronic, patterned, and long-term. Harms are often cumulative and organ-based rather than event-based. Routes of administration carry different risk profiles, with oral formulations being more hepatotoxic and commonly falsified through mislabelling or adulteration than injectable products. Despite this, most health services position injecting as inherently higher risk, applying paradigms developed for opioids and stimulants that have not been adapted for AAS use. Using evidence across pharmacology, delivery routes, dependence trajectories, and consumer types, this paper argues for expanding harm reduction models to consider the unique needs of different populations of people who use drugs, including AAS. We draw critically on lessons from other substances as well as multiple existing approaches including structured dosing frameworks, and supply-checking infrastructures, provide practical templates for expanding adaptation to AAS. To remain evidence-based, harm reduction must evolve to be contextually relevant. We have used AAS as an example of this evolution, attempting to highlight cross-substance learnings which integrate consumer-focused tools, workforce development, and peer-led support.

ABSTRACT This article examines the contested politics surrounding the supervised consumption site (SCS) in River City, highlighting how harm reduction spaces have become flashpoints of settler-colonial anxieties about Indigeneity, visibility, and urban governance. Despite clear life-saving benefits, local political and business elites framed the SCS as a threat to the city’s moral and economic order rather than a site of care, which underlines how settler colonial logics impose conditions on Indigenous urban presence, demanding sobriety, compliance, and invisibility, and how these demands undermine inclusion efforts. By analyzing elite discourse on the SCS, this article explains why harm reduction policies in settler-colonial urban settings must move beyond narrow health and expansive public safety frameworks and engage with the ethical and political realities of colonial histories.

Hepatitis C virus (HCV) infection remains a critical public health issue worldwide. Direct-acting antivirals (DAAs) have revolutionized the treatment of hepatitis C. However, real-world elimination efforts are hindered by barriers in diagnosis, treatment access, and follow-up. Embedding patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) into routine care may improve service delivery. This study evaluates clinical and patient-reported outcomes in the HCV care cascade in Tuscany (Italy), offering insights into how health service organization affects effectiveness, equity, and patient experience. We conducted a multicenter, longitudinal, prospective study on 953 adults with HCV chronic infection. These adults were treated between 2021 and 2023 in seven prescribing centers in Tuscany. Clinical data included demographics, comorbidities, fibrosis staging, virological response (SVR12), and loss to follow-up (LTFU). PROMs and PREMs were collected at baseline (T0), 3 months post-treatment (T1), and 6 months after T1 (T2). We used the SF-12 tool and custom surveys. Patients were stratified by referral source (GPs, harm reduction services/prison, specialists). Clinical and questionnaire data were analyzed separately. Statistical analyses included ANOVA, Chi-square, Kruskal-Wallis, Cochran's Q, Friedman, and repeated measures ANOVA with Bonferroni corrections. Significance was set at p ≤ 0.05. DAA therapy achieved high clinical efficacy: SVR12 was reached in 93.4% of patients. The rate rose to 98.6% when excluding those lost to follow-up. Patients referred by harm reduction/prison services were younger and mostly male. They had higher psychiatric comorbidities and risk behaviors. PROMs demonstrated significant improvements in perceived physical and emotional health following treatment, particularly among individuals referred by GPs and specialists. PREMs revealed increasing satisfaction with referring doctors over time. Satisfaction with specialist care remained high and stable. Referral pathways markedly influenced patient profiles and reported outcomes. There were notable disparities in experience and quality-of-life indicators. This study highlights the importance of integrating clinical and patient-reported data in monitoring HCV care. High SVR rates confirm the effectiveness of DAAs, while PROMs and PREMs provide valuable insight into patient engagement and equity of access. Stratified analyses reveal the need for tailored approaches across care pathways, and high-risk populations require special attention. Embedding patient voice in evaluation fosters a more responsive, people-centered health system, advancing progress toward HCV elimination.

Fentanyl overdose deaths are a critical public health issue in the United States. Rhode Island, an early epicenter of the fentanyl crisis, has seen fentanyl overdose deaths increase 30-fold since 2009. In response, harm reduction tools such as fentanyl test strips (FTSs) have been introduced to help people who use drugs (PWUD) detect fentanyl in their substances. We analyzed FTS use among PWUD in Rhode Island from 2021 through 2023 and identified characteristics associated with their use. We conducted a pooled cross-sectional analysis using aggregate data from the Rhode Island Harm Reduction Surveillance System. We used bivariate Pearson χ2 tests to assess the relationship between past-month FTS use and demographic and behavioral characteristics. Because analyses were limited to unadjusted comparisons, these findings are exploratory and hypothesis generating. Of 498 survey respondents, most identified as male (n = 328; 65.9%), non-Hispanic White (n = 204; 41.0%), straight (n = 400; 80.3%), and aged 25 to 44 years (n = 288; 57.8%). The most frequently reported substances used were crack (n = 355; 71.3%), cocaine (n = 219; 44.0%), and fentanyl/heroin (n = 196; 39.4%). Only 31.7% of individuals reported FTS use in the past 30 days. FTS use was significantly associated with age, race and ethnicity, witnessing an overdose, possessing naloxone, and recent fentanyl/heroin use (all P < .05). Despite FTS distribution efforts and overdose risk, FTS uptake in Rhode Island was low. Future research should assess barriers to FTS adoption and consider integrating FTS distribution within naloxone programs.

Addressing the limited generalizability of previous research on nightlife and substance use, which mostly relied on convenience or venue-based samples, this study used nationally representative data from Croatian residents aged 15–64 (N = 4,988) to: (1) examine the extent and patterns of substance use among nightclub attendees, (2) identify subgroups based on nightlife attendance and illicit and new psychoactive substance use in the last year, and (3) assess predictors of cannabis dependence severity. Cannabis, cocaine, amphetamines, and ecstasy were most commonly used substances among nightclub attendees. Latent class analysis identified three distinct classes: a non-attendance/abstinent class, an occasional-attendance/cannabis-use class, and an occasional-attendance/polysubstance-use class. Class membership, together with coping and enhancement motives, significantly predicted cannabis dependence severity. Findings demonstrate substantial heterogeneity of substance use patterns among nightclub attendees and highlight the need for targeted, subgroup-specific harm reduction strategies, focusing on polysubstance use and cannabis-related risks in nightclub settings.

Situated between two of the world's largest opium-producing regions, South Asia faces significant public health threats associated with drug trafficking and injecting drug use. People who inject drugs (PWID) in South Asia experience disproportionately high rates of bloodborne viruses (BBVs), including human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). These high rates are driven by factors such as drug trafficking routes, socioeconomic marginalization, poor surveillance, and inadequate harm reduction services. Pakistan has the highest reported prevalence rates, with HIV and HCV rates exceeding 30% and 50%, respectively, while India, Bangladesh, and Afghanistan report localized epidemics in urban and border areas. Co-infections, particularly HIV/HCV, further complicate clinical management and public health responses. Despite the implementation of needle-syringe programs and opioid substitution therapy in several countries, service coverage remains below recommended levels due to legal, financial, and structural barriers. Marginalized subgroups, including women and incarcerated individuals, remain underserved and often overlooked. In this review, we discuss the burden of these infections among PWID in South Asia, current control strategies, and the precarious future given the recent instability to the USAID, PEPFAR, WHO, and the Global Fund by the Trump administration.

How I do it: How to care for the patient with methamphetamine-associated PAH.

Abstract Background and aims Psychedelic use among college students and young adults has been increasing, but there continues to be a shortage of research on usage among college students. The purpose of this study is to identify risk factors for psychedelics use and understand how they interact with attitudes towards psychedelic usage. Methods Data were collected on 466 liberal arts college students. Using exploratory and confirmatory factor analyses, we validated a new and brief instrument that assessed attitudes toward psychedelics called the Psychedelic Attitudes Scale (PAS). Results The PAS evidenced good psychometric properties and structural equation modeling was used to investigate factors associated with use. Demographic variables, lifetime substance use, and mental health status were used as predictors, and PAS was used as a mediator, explaining 85.6% of the variance in lifetime use. Males, sexual minorities, older students, those who were not religious, and those who used other substances evidenced more positive attitudes toward psychedelics, which in turn led to a higher likelihood of actual usage. Lifetime usage was also found to be directly associated with better mental health. Conclusions College is a time when many students experiment with psychedelics. Understanding risk and protective factors are important for identifying those at great risk and provides critical information for designing harm reduction programs. Moreover, the PAS fills a gap in the literature and provides a brief assessment tool that can be readily implemented with the general population and in future research studies to better understand how attitudes influence actual behaviors.