Harm Reduction Research Articles

A community-academic partnership to develop an implementation support package for overdose prevention in permanent supportive housing

IntroductionThe overdose crisis in the U.S. disproportionately impacts people experiencing homelessness. Permanent supportive housing (PSH) – permanent, affordable housing with voluntary support services – is an effective, evidence-based intervention to address homelessness. However, overdose risk remains high even after entering PSH for individual and structural reasons. In this study, we aimed to refine a set of evidence-based overdose prevention practices (EBPs) and an associated implementation support package for PSH settings using focus groups with PSH tenants, frontline staff, and leaders. MethodsOur community-academic team identified an initial set of overdose EBPs applicable for PSH through research, public health guidance, and a needs assessment. We adapted these practices based on feedback from focus groups with PSH leaders, staff, and tenants. Focus groups followed semi-structured interview guides developed using the EPIS (Exploration, Preparation, Implementation, Sustainment) framework constructs of inner context, outer context, and bridging factors related to overdose prevention and response. ResultsWe conducted 16 focus groups with 40 unique participants (14 PSH tenants, 15 PSH staff, 11 PSH leaders); focus groups were held in two iterative rounds and individuals could participate in one or both rounds. Participants were diverse in gender, race, and ethnicity. Focus group participants were enthusiastic about the proposed EBPs and implementation strategies, while contributing unique insights and concrete suggestions to improve upon them. The implementation support package contains an iteratively refined PSH Overdose Prevention (POP) Toolkit with 20 EBPs surrounding overdose prevention and response, harm reduction, and support for substance use treatment and additional core implementation strategies including practice facilitation, tenant-staff champion teams, and learning collaboratives. ConclusionsThis manuscript describes how robust community-academic partnerships and input from people with lived experience as tenants and staff in PSH informed adaptation of evidence-based overdose prevention approaches and implementation strategies to improve their fit for PSH settings. This effort can inform similar efforts nationally in other settings serving highly marginalized populations. We are currently conducting a randomized trial of the refined overdose prevention implementation support package in PSH.

Experiences of harm and mental ill-health among gay, bisexual and other men-who-have-sex-with-men who use methamphetamine or GHB/GBL in different combinations: findings from the COMeT study in Taiwan

IntroductionPolydrug use in the context of chemsex is commonplace among gay, bisexual, and other men-who-have-sex-with-men (GBMSM). This study aimed to examine the differences in experiences of physical, social, and psychological harms, as well as mental ill-health among GBMSM who use different combinations of methamphetamine and gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL) during chemsex.MethodAdult GBMSM participants who had experience of chemsex in the past 12 months participated in a cross-sectional online survey in Taiwan and self-reported their sociodemographic background, sexual behaviours, mental health, and experiences of harm following a chemsex session. We used univariable and multivariable logistic regression to assess the different experiences of harm and mental ill-health among GBMSM who engaged in chemsex without using methamphetamine, used methamphetamine but not GHB/GBL, and who used both drugs.ResultsOut of 510 participants who completed all items included in the analysis, 24.1% engaged in chemsex without using methamphetamine, 36.9% used methamphetamine but not GHB/GBL, and 39.0% used both drugs. Eighty five percent of men who used both methamphetamine and GHB/GBL reported at least one kind of social harm after a chemsex session, such as missing dates or appointments, or appearing “high” at work, followed by used methamphetamine but not GHB/GBL (69.7%) and those without using methamphetamine (37.4%). After controlling for polydrug and frequency of drug use in the multivariable logistic regression, those who used methamphetamine but not GHB/GBL and those who used both drugs were more likely to report experiencing physical and psychological harms compared to those who did not use methamphetamine (p < 0.003).ConclusionGBMSM who used both methamphetamine and GHB/GBL in a chemsex context were more likely to report experience of harms than those who only used a single chemsex drug or engaged in chemsex without methamphetamine or GHB/GBL. Harm reduction should focus on both preventing HIV and STI transmission and on minimising psychosocial harm to GBMSM, with varying impacts depending on drug use.

"I drink less and that's no small matter": a qualitative descriptive study of a managed alcohol program evaluation in Barcelona.

Background: The concurrence of homelessness and alcohol use disorder (AUD) has negative consequences in affected individuals. Managed alcohol programs (MAPs), a harm reduction strategy based on providing regular doses of alcohol to individuals with AUD, have emerged as a potential solution to reduce alcohol-related harms.Objectives: This study examined the impact of a MAP implemented in Barcelona on patterns of alcohol and other psychoactive substance use, health, and quality of life among people who use drugs and were experiencing homelessness. The research also incorporated a gender perspective and focused on individuals who had accessed a residential center.Methods: A descriptive qualitative design was used, employing semi-structured interviews with eight participants who were enrolled in the MAP (three women, five men) and four program professionals. Thematic analysis was used to analyze the resulting data.Results: The domains guiding the study appeared as outcome themes: patterns of use of alcohol and other substances, health, quality of life and impact on female-identified participants. Participants reported improved health due to reduced consumption of alcohol and other substances, better anxiety management, and reconnection to health services. The participants reported enhanced quality of life, including feeling safer, and better use of time, which had been spent on meeting their basic needs. Women reported that a key benefit of the program was living in a sexism-free environment.Conclusion: These results appear to demonstrate that harm reduction strategies prioritizing basic needs and adopting a gender-sensitive perspective can positively impact the health and quality of life of people experiencing homelessness with AUD.

A place of encounter: Health and social care workers’ perspectives on public gathering spaces for people using drugs

Background: The use of drugs is an escalating concern, with significant implications for the health and daily functionality for individuals. It has proven challenging to provide accessible health and social services. In the context of addressing substance use issues in urban areas, public gathering places for individuals who use drugs play a multifaceted role, serving as sites of belonging, support and potential illicit activity. This qualitative study explores the experiences of healthcare and social workers regarding a public gathering place, referred to as “the Bench”, in a medium-sized Norwegian city. Methods: A qualitative research design consisting of semi-structured focus group interviews and individual interviews with 13 participants representing various support agencies. Results: The analysis resulted in four thematic areas: (1) belonging and a gateway to support and services; (2) balancing user autonomy at the Bench and systems support; (3) the role of a centralised location; and (4) the preventive role of support workers at the Bench. Conclusion: While the Bench fosters a sense of community and provides access to vital services, concerns about illicit activities persist due to its visibility. Nevertheless, its central location facilitates outreach efforts and ensures easy access to support services. The study underscores the preventive role of healthcare and social workers in stabilising the environment and mitigating conflicts. Furthermore, it highlights the importance of central locations for public gathering places, emphasising the proximity to low-threshold services. The Bench represents a crucial venue for establishing relationships and providing assistance to individuals who use drugs, contributing to harm reduction efforts in the community.

Informing the cannabis policy debate: a cross-sectional study of current and former cannabis users in Ireland

ABSTRACT Background Cannabis is the most widely used illicit drug with considerable international discourse regarding its legal status. This study sought to examine the wellbeing, experiences, and attitudes of adults who have used cannabis to inform policy debates. Methods A national, cross-sectional survey was completed. Data related to demographics and attitudes was collected along with validated questionnaires to measure level of dependence and wellbeing. Results Respondents (n = 732) were primarily males (61%) with a median age of 21. Three-quarters (75%) consumed cannabis more than 100 days with few regretting their cannabis use. Additionally, 60% reported previous use of both cocaine and MDMA and three-quarters currently use tobacco. While strongly in favor of more liberal cannabis policies they were ambivalent about decriminalizing all drugs. Depending on the cutoff used, 14.6% to 32.2% of respondents potentially meet the criteria for cannabis dependence. Wellbeing was overall good; however, women were at significantly higher odds of poor wellbeing (OR = 2.59; 95% CI = 1.78, 3.76). Conclusion Findings suggest unanimity among cannabis users toward more liberal legal policies but have discord regarding other drugs. Harm reduction, particularly in relation to tobacco, other substances, and women is indicated.

Stories for Us, or for Others: Digital Storytelling with a Harm Reduction Organization as Culture-Centered Health Communication

ABSTRACT Digital storytelling is a participatory media creation process. To illustrate how digital storytelling may be used as a method within the culture-centered approach to health communication, this paper presents a case study analysis of two 2-day digital storytelling workshops in collaboration with a local harm reduction organization that supports people who use drugs. Storytellers used the communicative space of digital storytelling to confront stigmatizing cultural and institutional narratives related to substance use. Storytellers also demonstrated how harm reduction work engendered a sense of purpose and an alternative to punitive drug policies. However, storytellers felt that stories produced for the harm reduction community could be misunderstood by outsiders, limiting the potential of the stories for advocacy communication. Overall, we find that digital storytelling as a method within the culture-centered approach has potential to elevate the experiences, understanding, expertise, and goals of communities that have been excluded from health communication. The digital storytelling method will have the most value as a critical narrative intervention if the principles and reflexivity of the culture-centered approach are foundational to the process.

Intersecting structural and psychosocial conditions: investigating injection drug use and HIV among transgender women.

Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women compared to cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women to a general sample of people who inject drugs (PWID). Participants from National HIV Behavioral Surveillance were recruited via respondent-driven sampling, interviewed, and tested for HIV infection in 2019-2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics. Among 1,561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (aPR=1.5, 95%CI=1.2-1.8) than those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (aPR=0.8, 95%CI=0.7-1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%). Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to non-judgmental and culturally competent harm reduction services.

Changes in hospital-supported substance use services across US nonprofit hospitals, 2015-2021.

Substance use remains a timely and important community need to understand and address. Nonprofit hospitals are in a unique position to identify needs and develop programs in response to substance use challenges in their communities. To better understand how nonprofit hospitals do this, we collected data from community health needs assessments and their corresponding implementation strategy (IS) to address these needs for a 20% random sample of hospitals in each state of the United States over 2 periods (2015-2018 and 2019-2021). The sample of nonprofit hospitals came from the American Hospital Association's (AHA) Annual Survey Database. Community health needs assessment and IS documents were coded for the inclusion of substance use programs using a systematic protocol and analyzed quantitatively. We found that the percentage of nonprofit hospitals in our sample with at least 1 substance use program increased from 66.5% in 2015-2018 to 73.6% in 2019-2021. Of the types of programs analyzed, harm reduction approaches saw the greatest increase in implementation in the time period studied, while primary care approaches decreased. This indicates that hospitals are continuing or even increasing their responses to community needs regarding substance use, but there is evidence that their approaches in doing so are shifting over time.

Assessing the Effectiveness of an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Single-Case and Pre-Post Experimental Design Study.

This study focuses on the Budd app, a mobile health intervention designed for gay, bisexual, and other men who have sex with men who participate in chemsex. Chemsex, the use of psychoactive drugs in a sexual context, presents substantial health risks including increased HIV transmission and mental health issues. Addressing these risks requires innovative interventions tailored to the unique needs of this population. This study aims to evaluate the effectiveness of the Budd app in promoting drug harm reduction practices among its users, focusing on knowledge, behavioral intention, risk behavior awareness, and self-efficacy. The study used a mixed methods approach, combining a single-case experimental design and a pre-post study. A total of 10 participants from an outpatient clinic were recruited, and each attended the clinic 3 times. During the first visit, participants installed a restricted version of the Budd app, which allowed them to report daily mood and risk behavior after chemsex sessions. Phase A (baseline) lasted at least 2 weeks depending on chemsex participation. In the second visit, participants gained full access to the Budd app, initiating phase B (intervention). Phase B lasted at least 6 weeks, depending on chemsex participation, with identical data input as phase A. Participants completed pre- and postintervention surveys assessing behavioral determinants during the first and third visit. The study observed an increased knowledge about chemsex substances postintervention, with a mean percentage improvement in knowledge scores of 20.59% (SD 13.3%) among participants. Behavioral intention and self-efficacy showed mixed results, with some participants improving while others experienced a decrease. There was also a variable impact on awareness of risk behavior, with half of the participants reporting a decrease postintervention. Despite these mixed results, the app was generally well-received, with participants engaging with the app's features an average of 50 times during the study. The Budd app showed effectiveness in enhancing knowledge about chemsex substances among gay, bisexual, and other men who have sex with men. However, its impact on safe dosing behavior, behavioral intention, self-efficacy, and risk behavior awareness was inconsistent. These findings suggest that while educational interventions can increase knowledge, translating this into behavioral change is more complex and may require more participants, a longer follow-up period, and additional strategies and support mechanisms.

Risk of opioid-related harms by occupation within a large cohort of formerly injured workers in Ontario, Canada: findings from the Occupational Disease Surveillance System

ObjectiveWorking-age individuals have been disproportionately affected by the opioid crisis, prompting interest in the potential role of occupation as a contributor. This study aimed to estimate the risk of opioid-related...

Aachen smoking cessation and harm reduction (ASCHR) trial study protocol – scientific evaluation of a psychological-telemedical counseling concept for smoking cessation in patients with vascular diseases

BackgroundSmoking is a major risk factor of cardiovascular diseases, notably peripheral arterial disease (PAD). Despite this link, research on smoking cessation interventions in PAD patients remains scarce and inconclusive regarding the efficacy of such interventions.Therefore, elucidating it is crucial and should address both individuals who smoke that are motivated to quit and individuals who smoke heavily lacking the motivation to quit.Methods/DesignThe Aachen Smoking Cessation and Harm Reduction (ASCHR) trial is a prospective randomized controlled study (RCT) on the benefits of telemedical-psychological support for smoking cessation in patients with PAD, funded by the “Innovation Fund” of the Joint Federal Committee in Germany. This trial aims to scientifically assess the efficacy, feasibility, acceptance, and efficiency of a multi-stage smoking cessation program based on the recommendations of the German guideline for smoking cessation tailored to patients with PAD, compared to a control group receiving no intervention. Central to the program is psychological counseling utilizing motivational interviewing techniques, delivered through telemedicine via video consultations. The primary endpoint of the ASCHR trial is the smoking cessation rate after 8 months of intervention, with a secondary endpoint evaluating sustained abstinence at a further 6 months follow-up. Smoking cessation is defined as a carbon monoxide level in exhaled air of less than 6 ppm. We hypothesize that the group receiving the multi-stage cessation program will yield a cessation rate at least 10 percentage points higher than that of usual care. Anticipating a dropout rate of around 35%, the planned sample size is at least N = 1032 study participants.DiscussionShould the trial demonstrate significant positive outcomes, efforts should be made to integrate the program into routine care in Germany, potentially offering a promising base for future smoking cessation support among PAD patients.

B-288 Turning False Positive Screening into True Positive Results

Abstract Background After conducting a retrospective analysis of our laboratory data, we identified a notable disparity between immunoassay screen and mass spectrometry confirmation results for benzodiazepines. This prompted an investigation into whether the prevalence of false negative benzodiazepine results stemmed from the inadequacy of the immunoassay or the absence of new psychoactive substances (NPS) in our mass spectrometry confirmation assay. To determine the latter, we added four NPS benzodiazepines and their metabolites to our confirmation panel. Monitoring drug seizure records as well as reports detailing emerging substances were helpful in guiding which NPS to add. The objective of this study was to determine whether the addition of NPS benzodiazepines to our confirmation panel would increase the agreement between screen and confirmation benzodiazepine results in an opioid dependent population. Methods Urine samples that screened positive for benzodiazepines with immunoassay and confirmed negative by mass spectrometry over a 6-month timeframe were selected for analysis. Four NPS were added to our confirmation panel which included bromazolam, flubromazepam, flubromazolam, flualprazolam as well as their metabolites alpha-OH bromazolam, 3-OH flubromazepam, alpha-OH flubromazolam and alpha-OH flualprazolam. Immunoassay data was obtained using an Olympus AU480 instrument, while mass spectrometry results were acquired through an internally developed dynamic multiple reaction monitoring method on an Agilent 6470 triple quadrupole instrument. Results In the analysis of 476 urine samples using a cut-off value of 50 ng/mL, 55.3% of the samples tested positive for bromazolam, 83.0% for alpha-OH bromazolam, 0% for flubromazepam, 41.8% for 3-OH flubromazepam, 0% for flubromazolam, 0.2% for alpha-OH flubromazolam, 1.3% for flualprazolam and 6.7% for alpha-OH flualprazolam. Using a cut-off value of 10 ng/mL which represents the limit of quantitation, 75.4% tested positive for bromazolam, 89.9% for alpha-OH bromazolam, 2.1% for flubromazepam, 60.5% for 3-OH flubromazepam, 0% for flubromazolam, 0.2% for alpha-OH flubromazolam, 3.4% for flualprazolam and 9.7% for alpha-OH flualprazolam. In total, among the 476 samples that initially screened positive but confirmed negative, 95.8% confirmed positive for benzodiazepines with the inclusion of the four NPS benzodiazepines and their metabolites into our confirmation panel. Of the samples that tested positive for NPS benzodiazepines, 77.1% were also positive for fentanyl, and 95.2% were positive for norfentanyl. Conclusions The incorporation of NPS benzodiazepines into our confirmation panel significantly enhanced the concordance between immunoassay screen and mass spectrometry confirmation results. The discrepancies we observed with benzodiazepines were not predominantly linked to immunoassay challenges. Rather, they were due to the presence of NPS benzodiazepines commonly found in benzo-dope preparations, not accounted for in our mass spectrometry confirmation panel. The inclusion of NPS benzodiazepines into our confirmation panel has improved the reporting of useful diagnostic information which can be used to support harm reduction efforts.

Capturing the context of drug use for college students: A Contextual Behavioural Science informed qualitative Analysis of Harm reduction practices using network feedback loops simulation modelling

Drug use during college can have substantial harm on students’ lives and impacts the institutions’ functioning and local communities. Yet existing interventions for drug use at college poorly address the concurrent dynamic influences of the experiences in earlier developmental periods of young adults and the proximal contextual triggers of college life; both risk factors that contribute to drug use. In answer to this, system dynamic methods and contextual-behavioural science (CBS) approaches can support the development of interventions to address these risk factors. Using Causal Loop Diagram methods (Vensim PLE), we collected qualitative data from college students (n=24, aged 22 years old), during the development phase of MyUse: a contextual behavioural change intervention for harm reduction practices at college students, to generate Network Feedback Loops (NFLs). The findings underscore central nodes (determinants within an intervention) that can support our previous identified three CBS-harm-reduction practices for college students (targeted edges: mindful drug-use decision making, value-based activities, context-sensitive personalized plan of harm reduction). Analyses revealed 4 NFLs for students with previous drug use, consisting of 13 edges (4 positive, 2 negative, and 4 balancing reinforcing relationships) and 3 NFLs for students with no previous drug use, consisting of 4 positives, one negative, and one balancing relationship. All these determinants (manipulable variables) are nested with the three CBS-related targeted outcomes. College students who use drugs need drug-related knowledge about the unpredictable and adverse effects of drugs, presented in a compassionate way and distributed from credible resources (e.g., students’ unions/ club). Students with no previous drug use need education about the effects of drugs and awareness of how drugs can devaluate value-based activities (e.g. sports, friendships, social life). These should be delivered via proxy cue reminders and mobile-text-messages conveying drug use susceptibility, distributed in real-time. Idiosyncratic, dynamic, and contextual-bound factors of lapse risks or preventive practices should account for each person-specific vulnerabilities via personalized harm reduction plans.

Implementation of an EMS-based naloxone distribution program: A qualitative evaluation.

We evaluated a novel leave-behind naloxone (LBN) program that allows Emergency Medical Services (EMS) personnel to distribute naloxone after an opioid overdose. Our objective was to explore EMS engagement and experiences with the program, as well as interest in education on addiction and harm reduction. We also assessed the acceptability of LBN programs among people who use drugs (PWUD). We conducted telephone interviews with EMS personnel and residents of substance use recovery housing between February and September 2023. EMS personnel described their direct experiences with the LBN program and perceived facilitating factors and barriers to naloxone distribution. First responder interactions and support for LBN were explored with PWUD. A rapid assessment method was used to analyze the interview data. Eighteen of the 23 EMS participants had distributed LBN; most agreed EMS agencies should have an LBN program. Barriers included forgetting, patient acuity, patients declining, and perceived liability. Facilitators included having a clear protocol, accessible kits, and minimal documentation burden. The majority expressed interest in harm reduction education. Eight of the 11 PWUD participants reported recent involvement in an opioid overdose. The majority supported LBN and felt comfortable receiving naloxone training from EMS. In this qualitative evaluation, we found broad support for EMS-based naloxone distribution among EMS personnel and PWUD. We identified several modifiable barriers to the success of such programs, which should be the subject of future investigation. EMS and harm reduction communities should support the expansion of LBN programs across the United States.

Assessing challenges and solutions in substance abuse prevention, harm reduction, and treatment services in New York State

Assessing challenges and solutions in substance abuse prevention, harm reduction, and treatment services in New York State

Facilitators of and obstacles to practitioners’ adoption of harm reduction in cannabis use: a scoping review

Abstract Background Cannabis use can generate potential avoidable harms, hence the need for effective preventive measures and treatment. Studies show the efficacy of harm reduction (HR) in minimizing undesirable consequences associated with this use. Despite its proven efficacy, HR in cannabis use remains poorly applied by many health and social services (HSS) practitioners, especially with young people. However, knowledge regarding the underlying reasons for this is limited. To fill this gap, we aimed to identify facilitators of and obstacles to HSS practitioners’ adoption of HR in cannabis use across OECD countries. Methods We conducted a scoping review, guided by Arksey and O’Malley’s model. The search strategy, executed on health databases and in the grey literature, captured 1804 studies, of which 35 were retained. Data from these studies were extracted in summary sheets for qualitative and numerical analysis. Results Facilitators and obstacles were grouped into four themes: stakeholders’ characteristics (e.g., education, practice experience); clients’ characteristics (e.g., personal, medical); factors related to HR (e.g., perceived efficacy, misconceptions); factors related to the workplace (e.g., type of workplace). Data were also extracted to describe the populations recruited in the selected studies: type of population, clientele, workplace. Conclusion Several factors might facilitate or hinder HSS practitioners’ adoption of HR in cannabis use. Taking these into consideration when translating knowledge about HR can improve its acceptability and applicability. Future research and action should focus on this when addressing practitioners’ adoption of HR.

Statistical Analyses Plan for “MAGnItude of cigarette substitutioN after Initiation oF e-cigarettes and its ImpaCt on biomArkers of exposure and potenTial harm in dual users”: MAGNIFICAT trial

BackgroundThe substitution of combustible cigarettes (CC) with non-combustible nicotine alternatives, such as e-cigarettes (EC), significantly lowers exposure to harmful chemicals. However, many individuals who use ECs continue smoking CCs, becoming dual users and remaining at increased risk of toxin exposure. This study will examine how the reduction in cigarettes smoked per day (CPD) after switching to ECs correlates with changes in biomarkers of exposure (BoE) and potential harm (BoPH) to evaluate the extent of harm in dual users. MethodsThe study is a prospective, non-randomised, observational, longitudinal cohort study in which 250 CC smokers will be invited to use EC as part of a smoking reduction/cessation strategy. Participants will be grouped in five dual use categories based on the change from baseline in CPD at 1, 3 and 6 months, based on self-reported use in the preceding 30 days. The primary outcome of interest is the mean absolute urinary 2-cyanoethyl mercapturic acid (2CyEMA), a well-validated BoE, also assessed at 1, 3 and 6 months. Other BoE will be assessed, together with exploration of the association between varying intensities of dual use and BoPH. The association between the dual use category and levels of BoE will be evaluated using analysis of variance (ANOVA), in order to understand which BoE are best suited to identifying different levels of dual use. Exploratory assessment of the value of BoPH will similarly be evaluated, to assess whether their predictive power extends from the binary smoker/non-smoker categorization to a more nuanced dual use categorization. The specific details of the own-brand CC will be available once smokers' enrollment in the study is complete. The EC used in the study will be the KIWI 2 Pen refillable pod system, with participants given the option to choose from three different flavored e-liquids: LEAF, MIDWAY, and GLACIAL, all containing 0.9% nicotine. For specialized equipment used for biomarker analysis please refer our previous publication: https://pubmed.ncbi.nlm.nih.gov/38584934/ ConclusionEC are increasingly adopted as a harm reduction strategy in CC smokers who wish to quit smoking, the outlined Statistical Analysis Plan (SAP) provides a robust approach to understand the impact of EC on CC use and to quantify the impact of dual use on clinical outcomes using BoPH. For statistical calculations we will use R software.The subject of this SAP manuscript – trial research – due to planned medical procedures, is a subject of verification by proper ERB (Ethics Review Board) in Poland and gained required approval prior to the start of the actions. The positive opinion was granted on 22nd February 2024, with the signature number 04/24.

Is naloxone where it needs to be? Using spatial analytics to examine equitable distribution of community-based naloxone sites

BackgroundOne of the most effective harm reduction services for preventing opioid overdose deaths is naloxone. Given the ongoing opioid crisis, which has led to a surge in overdose deaths across the country, expanding access to naloxone is critical. Community-based naloxone distributions sites in Palm Beach County can increase access to naloxone. However, several rural and disadvantaged regions rarely have any type of access to naloxone. The purpose of this descriptive paper is to examine the spatial distribution of and evaluate equitable accessibility to community-based naloxone sites in Palm Beach County. MethodsWe examined health equity in the distribution of community-based naloxone sites using a mixed-methods approach with ArcGIS Pro version 3.0, which is a geographic information system (GIS) software used for mapping, spatial analysis, and data visualization. ResultsThe Belle Glade region was identified as the location most adversely affected with health inequities and limited accessibility to naloxone distribution sites, as it ranked in the 100 % percentile for all social vulnerability index (SVI) themes. The 30-minute drive-time area calculated a county service area of 1885.3 km2 (km2), which covers about 34 % of the 478.0 km2 land area of census tracts. Drive-time areas did not account for periods of heavier traffic such as during rush hour. Maximum distances during heavier traffic may be smaller, thus decreasing accessibility to naloxone distribution sites. ConclusionThere is a need for effective policy-led strategies tailored to expanding our understanding of the challenges that are experienced by the individuals in need of naloxone and encountered by the distribution sites themselves, as accessible naloxone is crucial for preventing nonfatal and fatal overdoses and ensuring timely emergency responses in vulnerable communities.

Ethical concerns in caring for persons with anorexia nervosa: content analysis of a series of documentations from ethics consultations

BackgroundCaring for patients with anorexia nervosa (AN) is associated with high levels of moral distress among healthcare professionals. The main moral conflict has been posited to be between applying coercion to prevent serious complications such as premature death and accepting treatment refusals. However, empirical evidence on this topic is scarce.MethodsWe identified all 19 documentations of ethics consultations (ECs) in the context of AN from one clinical ethics support service in Switzerland. These documentations were coded with a sequential deductive-inductive approach and the code system was interpreted in a case-based manner. Here, we present findings on patient characteristics and ethical concerns.FindingsThe ECs typically concerned an intensely pretreated, extremely underweight AN patient endangering herself by refusing the proposed treatment. In addition to the justifiability of coercion, frequent ethical concerns were whether further coerced treatment aimed at weight gain would be ineffective or even harmful, evidencing uncertainty about beneficence and non-maleficence and a conflict between these principles. Discussed options included harm reduction (e.g. psychotherapy without weight gain requirements) and palliation (e.g. initiating end-of-life care), the appropriateness of which were ethical concerns in themselves. Overall, nine different types of conflicts between or uncertainties regarding ethical principles were identified with a median of eight per case.ConclusionsEthical concerns in caring for persons with AN are diverse and complex. To deal with uncertainty about and conflict between respect for autonomy, beneficence and non-maleficence, healthcare professionals consider non-curative approaches. However, currently, uncertainty around general justifiability, eligibility criteria, and concrete protocols hinders their adoption.

Vaping as a Harm Reduction Strategy: Lessons from the Past

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