Harm Reduction Research Articles

Two decades of electronic nicotine delivery systems discussions in Türkiye: AI-driven text analysis

Abstract Background As Turkiye ranks second in cigarette consumption in Europe, the increasing shift to Electronic Nicotine Delivery Systems (ENDS) presents emerging public health concerns. This study aims to introduce a hybrid approach by combining AI-driven large language models (LLM) with traditional thematic analysis to explore 20 years of ENDS discourse on Eksisozluk, a popular Turkish social media platform, using the Health Belief Model (HBM). Methods This mixed-methods study, analyzed 5,907 comments about ENDS from 2003 to 2023, sourced from a renowned online user-generated forum in Turkiye. Utilizing an LLM, comments were first categorized according to the HBM. Subsequently, the LLM’s generative capabilities were employed to identify sub-themes through thematic analysis. A temporal analysis was then conducted to examine the evolving trends over the 20-year span. Results ENDS popularity peaked in 2017, dipped during the COVID-19 pandemic, and later rebounded. Using an LLM with 70% accuracy, validated by a manually labeled sample, we discerned two main themes: perceived benefits (40.5%) - primarily using ENDS as for harm reduction (32.8%) and smoking cessation tools (21.6%)- and perceived barriers (27.7%), with cost and accessibility (21.9%) being the most significant throughout the period. Initially, the focus was on cessation, but shifted to harm reduction post-pandemic. Conclusions Our study indicates that consumers in Turkiye initially used ENDS for cessation but recognized their ineffectiveness over time. During the COVID-19 pandemic, usage shifted towards harm reduction, likely influenced by the rhetoric of the Tobacco Industry. Despite a national ban, ENDS remain widely used in Turkiye. Key messages • Turkiye should develop a social marketing strategy to raise awareness that ENDS is not a valid tool for harm reduction. • Although the sale of ENDS is prohibited in Turkiye, enforcement of bans should be strengthened as part of an effective control strategy.

Navigating transitions into, through, and beyond peer worker roles: insider insights from the Supporting Harm Reduction through Peer Support (SHARPS) study

BackgroundPeer workers are individuals who draw on their personal experiences in a professional capacity to support clients. Existing research on the role of peer workers in mental health, homelessness, and substance use services has primarily focused on their impact on client outcomes. This paper describes the development of peer workers as they transition into, through, and beyond this role. Utilising data from the Supporting Harm Reduction through Peer Support (SHARPS) study, where Peer Navigators supported people experiencing homelessness and substance use challenges, this paper explores the sense-making involved in an intensive peer support worker role, adaptation to organisational culture, and engagement with opportunities for professional advancement.MethodsSemi-structured interviews with three Peer Navigators were conducted by two SHARPS study researchers at four time points in 2018 and 2019 corresponding with the beginning, middle, and end of the intervention. These data were analysed along with entries from the three Peer Navigators’ reflective diaries. Analysis followed a multi-stage approach to thematic analysis utilising both inductive and deductive processes. The Peer Navigators’ personal reflections have also been incorporated into the recommendations.ResultsThe foundational training provided to the Peer Navigators before taking up their role helped to ensure readiness and build confidence. This training illuminated the dynamics of supporting individuals with complex health and social challenges. Integrating into diverse organisational environments, the Peer Navigators adapted to new professional expectations and consistently advocated for harm reduction and psychologically informed approaches, sometimes encountering resistance from other professionals. Establishing effective relationships with participants and professionals was essential and involved dealing with challenges such as overcoming personal biases and navigating systemic obstacles. the Peer Navigators benefitted from the specially designed training to support career progress with personal and professional development opportunities which enabled successful transitions beyond the SHARPS study.ConclusionsPre-work training, coupled with support and adherence to key principles, enabled the Peer Navigators to integrate effectively into diverse organisations. Quality relationships were vital in achieving client outcomes and supporting the professional growth of the Peer Navigators. These findings are important for services employing peer workers and underscore the importance of a commitment to training and continuing professional development.

Alcohol policy and alcohol-attributed disease burden in Finland and the Baltic countries 1995-2019

Abstract Introduction Alcohol remains a significant contributor to mortality and morbidity in Finland and the Baltic countries, particularly among men. This study aimed to assess alcohol policy restrictiveness in this region from 1995 to 2019 using a modified version of the Bridging the Gap (BtG-M) policy scale and examine its association with alcohol-related disease burden. Methods The study utilised national statutory laws to score policy restrictiveness (higher BtG-M scores mean stricter policies) and age-standardised rates of disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) and deaths per 100,000 from the 2019 Global Burden of Disease Study (GBD). Spearman correlation tests and panel data regression models were applied to assess the association between policy scores and burden of disease. Results Finland maintained a high BtG-M score, while the Baltic countries experienced recent increases from initially lower scores. Alcohol-related disease burden showed an inverse association with policy changes in these countries. Strongest association was seen between the BtG-M score and DALY rates attributed to injuries. Premature mortality among men constituted the largest proportion of disease burden. Discussion and Conclusions Despite challenges in accessing and comparing policy data over time, we showed a strong association between alcohol policy and alcohol-related harm in Finland and the Baltic countries. This study is one of the first to use the BtG-M scale to monitor changes in alcohol policies over time and their relationship to alcohol-related harm using GBD methodology. The study highlights the effects of national alcohol policies on levels of alcohol-related harm. Key messages • This study stands out due to its longitudinal study design, which quantitatively compares the level of alcohol policy restrictiveness in Finland and the Baltic countries from 1995 to 2019. • Our study suggests that shifts towards more restrictive alcohol policies are linked to reduction in alcohol-related harm in Finland and the Baltic countries.

Co-use of psychedelics with other substances: Findings from the global psychedelic survey.

While most psychedelic substances are considered to carry a relatively low risk of acute or long-term harm, co-use with other psychoactive substances may increase health and social harm. Using a large international survey of adults who use psychedelics, we sought to comprehensively characterize psychedelic co-use. We used data from the 2023 Global Psychedelic Survey, a web-based survey of adults ⩾21 with lifetime use of psychedelics. We explored patterns of co-use (prevalence, secondary substances used, timing, and motives of co-use) and examined sociodemographic and psychedelic use-related characteristics associated with co-use overall and by specific psychedelics. In total, 5370 respondents were included in this analysis, of whom 3228 (56.3%) reported typically co-using at least one of the 11 psychedelic substances of interest, with co-use lowest for ayahuasca (14.8%) and highest for nitrous oxide (54.5%). Cannabis and alcohol were the most common secondary substances. Depressants were the only secondary substance class that increased in use following psychedelic experiences. Greater experience with psychedelics was significantly associated with co-use, as was using for recreational purposes or to reduce/substitute the use of other substances. Personal exploration and therapeutic purposes for psychedelic use were negatively associated with co-use. In this detailed analysis of psychedelic co-use, we observed high rates of co-use with certain psychedelics, specifically when used recreationally. Our findings highlight psychedelic-specific consumers for whom harm reduction messaging around co-use practices may be best tailored. Further research is justified to assess whether specific patterns of co-use might reduce or increase potential harms.

Severity and Number of Substances Used are Independently Associated with Antiretroviral Therapy Adherence Over Time among People with HIV in the Current Treatment Era.

Substance use is associated with decreased antiretroviral therapy (ART) adherence among people with HIV (PWH). Adherence plays a significant role in mediating the negative effects of substance use on HIV suppression and is a principal modifiable patient-level factor in improving HIV suppression and reducing ART drug resistance. Understanding substance use and ART adherence, particularly with rapidly changing substance use epidemiology and ART regimens, is vital to improving HIV care. Among 10,557 PWH (2010-2021) from 8 academic clinical sites nationally we examined longitudinal associations of substance use severity and number of substances used (measured using AUDIT-C and modified ASSIST) with patient-reported ART adherence (visual analog scale). Alcohol (68% any use, 18% unhealthy use [AUDIT-C > 4 men, > 3 women]), marijuana (33%), and methamphetamine (9%) use were most reported. Polysubstance use was common (32%). Both higher severity substance use and higher number of substances used were associated with lower ART adherence. Severity of methamphetamine use had the strongest dose-response association with ART adherence (low severity [ASSIST 1-3]: -3.05%, 95% CI: -4.23%, -1.87%; moderate [ASSIST 4-26]: -6.20%, 95% CI: -7.08%, -5.33%; high [ASSIST > 26]: -10.77%, 95% CI: -12.76%, -8.78%). Severe substance use, especially methamphetamine, and higher number of illicit drugs used were associated with declines in adherence at levels that were likely clinically meaningful in the modern era of ART. Findings support integrating substance use care with HIV care and potential benefits of harm reduction strategies for improving adherence such as encouraging lower levels of substance use and fewer number of substances used.

Substance use and risk behaviour patterns among people who inject drugs

Abstract Background Substance use and injecting drug use in particular are related to health damages, reduced quality of life and life expectancy. Injecting drug use is a risk factor for acquiring infectious diseases among people who inject drugs (PWID). The aim of the study was to assess the risk behavior related to the use of intravenous psychoactive substances among PWID in Lithuania. Methods In 2023 a cross sectional study using respondent driven sampling (RDS) of active intravenous drug users (n = 370) was conducted in 5 different sites across Lithuania. RDS is a sampling methodology based on peer-referral in underserved populations that cannot be sampled randomly. Descriptive statistical and regression analyses were conducted using SPSS 23.0. Results 78% of the sample were males, 22% - females. Age mean is 40.6 years, SD-7.7. The first injecting drug was used at the age of 18 (mode). 69% of PWID received drug dependance treatment at least once in life. 70% of the PWID in harm reduction services are also in the substitution therapy programmes. Fentanyl is the main substance for every second respondent which is injected 3 times a day and commonly used with alcohol (64%). 79% of PWID during the last injection used sterile needles and syringes. 45% of respondents reported overdosing during the last 12 months and half of all PWID had naloxone for death prevention. Nearly 70% were tested for TB and syphilis during the last 12 months. Conclusions PWID are mainly males who began injecting drugs at 18 years. Unsafe injecting behaviour (frequency and mode), using alcohol were related to lower participation in health care services for PWID. Main messages • Lower participation in health care services is related to behavioural risk factors. • Ongoing research is needed to assess the factors determining engagement into healthcare of PWID.

Parent perspectives on sports betting and its effects on children

Abstract Background Gambling-related harm is a global challenge. Sports betting is a rapidly growing form of gambling, facilitated by access to online wagering platforms and increased advertising. Most public health initiatives target ‘problem’ gamblers, ignoring socio-cultural influences. Within this context, we examine what parents think about sports betting, the potential impacts on their children, and whether they participate in sports betting around their children. Methods Using a survey of 3,481 Australian adult sports fans with dependent children, we analyse parental attitudes to sports betting and their concerns about possible effects on children. ANOVA and regression methods are used to test for differences in attitudes to sports betting between parents who are gamblers (sports and non-sports) and non-gamblers. Results Compared to non-gambling parents, sports-betting parents are much more permissive (by up to 0.9 standard deviations) of sports betting around and by children, and less concerned (by up to 0.6 standard deviations) about any harmful effects of sports betting on children. Sports betting parents place less importance on discussing the risks of sports betting with their children, and the more often a parent bets on sports, the less confident they are about having these discussions. Parents who bet on sports are 5.8 percentage points less likely than non-gambling parents to have had such conversations. Conclusions The strong influence of parent modelling and normalisation, combined with policy initiatives that recommend parents discuss potential sports betting risks with their children, implies that having a better understanding of attitudes will facilitate improved educational and harm minimisation policy initiatives. The findings of our study are important for public health policy and should inform interventions aimed at gambling harm reduction. Targeting sports betting parents with better tailored educational campaigns is warranted. Key messages • Children of parents who bet on sports are less likely to receive messages about the risks of sports betting, in addition to being exposed to role modelling that reinforces sports betting. • Compared to non-gambling parents, those who bet on sports have more permissive attitudes towards sports betting, suggesting targeted messaging and interventions are warranted.

A netnographic study of anabolic-androgenic steroid initiation videos on YouTube.

YouTube personalities (YP) have amassed significant followings by distributing health information. There is concern that YP involved in anabolic androgenic steroid (AAS) communities are sharing information on how people should approach initiating AAS use. This research sought to explore how YP are using their platform to distribute information on AAS initiation, what information is being presented and how people are responding. This mixed methods research utilised a netnographic approach, a method adapted from traditional ethnographic techniques for the study of online sociocultural phenomena. The research included a selection of YouTube videos (n = 37) and user comments replying to the videos (n = 584). YP addressed the positives and negatives of AAS initiation (76%; n = 28 and 76%; n = 28 respectively), provided harm reduction strategies (76%; n = 28), and advice on which AAS people should use (97%; n = 36). A qualitative thematic analysis of the comments found two overarching themes: 'Authenticity, capital and the influence of the YP on their audiences' and 'The evolving landscape of enhancement and health'. Viewers engaged with the videos due to the YPs lived experience using AAS, and YP influenced the health behaviours of viewers. Many believed that the videos were useful for health and lifestyle enhancement purposes. YP are disseminating diverse information on AAS initiation which is derived from their lived experience using AAS. Harm reduction is a key component of the YPs' message and viewers responded positively to a balanced and honest assessment of AAS initiation which is perceived to respect their personal autonomy.

Psychosocial Impact of Suspected Xylazine-Associated Skin Wounds Among People Using Fentanyl, Philadelphia, 2022 to 2023.

The United States opioid crisis has been worsened by the emergence of fentanyl adulterated or associated with the veterinary sedative xylazine. Designated by the White House as an "emerging threat to the US" in 2023, xylazine use is associated with severe skin wounds. This research explored beliefs, concerns, and treatment behaviors for skin wounds among 93 participants recruited outside of a Philadelphia, Pennsylvania harm reduction agency who reported past-6-month history of a skin wound via a cross-sectional survey administered August-September 2022 (group 1; n = 33). Following a December 2022 Philadelphia Department of Public Health Report that indicated xylazine was becoming more prevalent in the Philadelphian drug supply, additional data was collected with new participants from February-March 2023 (group 2; n = 60) using the same survey. Participants were ≥18 years old, reported past-year fentanyl use, and spoke English. Our 17-item tool measured skin wound-related beliefs, concerns, treatment behaviors, and treatment sources. An open-response item explored why participants self-treat skin wounds. Participants averaged 41 years old (SD = 9), slightly more than half were men (n = 54, 58%), 31% (n = 29) were non-White, and most (n = 66, 71%) were unhoused. Overall, 79% of participants self-treated skin wounds. Participants endorsed worry about limb loss (n = 77; 83%), wound shame (n = 76; 82%), and appearance changes (n = 80; 86%). Sixty participants (65%) reported waiting to see wound severity before seeking care. Forty-one participants (44%) delayed wound care because of withdrawal fears. People with probable xylazine-associated skin wounds have psychosocial concerns about and self-treat these wounds. Findings may be a harbinger of skin wound harm in other regions of the United States and internationally where xylazine is increasing.

Harm reduction for addictive consumption: When does it improve health and when does it backfire?

Some harm reduction strategies encourage individuals to switch from a harmful addictive good to a less harmful addictive good; examples include e-cigarettes (substitutes for combustible cigarettes) and methadone and buprenorphine (substitutes for opioids). These have proven to be controversial. Advocates argue that people struggling with addiction benefit because they can switch to a less harmful substance, but opponents argue that this could encourage abstainers to begin using the harm-reduction method or even, eventually, the original addictive good. This paper builds on theories of addiction to model the introduction of a harm reduction method, and demonstrates the conditions under which each side is correct.

"We're Not Gonna Aid You in Shooting Up": Stigma's Relationship to Harm Reduction in People Who Inject Drugs.

Harm reduction, when applied to drug use, prioritizes improving patient-centered health outcomes and reducing drug-related harm. In order for harm reduction strategies to be adopted by people who inject drugs (PWID), they need to be promoted, accessible, and accepted in that population and the community-at-large. While PWID face stigma at multiple levels, less is known about how stigma influences uptake and acceptance of harm reduction services and strategies among PWID. We aim to characterize the stigmatizing experiences PWID have had related to harm reduction and the role of stigma in influencing their acceptance and adoption of harm reduction services and strategies. A qualitative study using in-person, semi-structured interviews. We recruited hospitalized participants, age 18 and over, with a history of injection drug use. We developed an interview guide asking about various aspects of stigma and participants' experiences with naloxone, syringe service programs, fentanyl test strips, HIV and hepatitis C testing, and any other harm reduction strategies. Key themes were generated using a thematic analysis. We reached thematic saturation at 16 participants. PWID reported multi-level stigma related to harm reduction from themselves, the public, the healthcare system, and the legal and carceral systems. Themes were grouped into four main categories: internalized, interpersonal, intervention, and structural stigma. Stigma across all of these domains negatively impacted the ability of PWID to access harm reduction resources. Positive, non-stigmatizing experiences from others, such as syringe service programs and peer navigators, countered historically negative experiences and promoted greater education and comfort about using harm reduction resources among PWID. To expand the reach of harm reduction services, it is critical to develop interventions that can reduce the stigma against PWID and harm reduction.

Transforming public health and economic outcomes by reducing risky behaviors: the potential for South Korea

South Korea faces a diminishing workforce driven by the world's lowest fertility rate, restrictive immigration, and low female labor participation. This paper explores reducing non-communicable diseases from risky behaviors as a solution. We investigate how many cases could be prevented if South Koreans changed risky consumption patterns, and the associated economic healthcare burden impact. Utilizing the Preventable Risk Integrated Model (PRIME), we model hypothetical 2022 reductions in tobacco, alcohol, and unhealthy diet risks to estimate disease case and economic cost impacts. We contrast actual 2022 consumption against a moderate harm reduction scenario. Findings reveal potentially preventing approximately 73,400 new non-communicable disease cases, 69% among working-age Koreans, benefiting the workforce. This reduction could save $13 billion from avoided treatment costs, absenteeism, and premature deaths, including $3.7 billion in 2022 and $9.3 billion in future economic losses. The study emphasizes needing a harm reduction regulatory approach balancing public health and societal realities. We advocate risk-proportionate taxation policies incentivizing consumers toward less harmful alternatives. Given government responsibilities preserving both public health and productivity, smart regulation of risky consumption is critical. This timely research quantifies the significant potential gains from strategic interventions on key risk factors, informing policymakers navigating health promotion and economic objectives.

Predictors of treatment outcomes for Hepatitis C infection in a nationwide elimination program in Iceland: The treatment as prevention for Hepatitis C (TraP HepC) study

BackgroundLimited data exists about treatment outcomes in nationwide hepatitis C virus (HCV) elimination programs where injection drug use (IDU) is the main mode of transmission. In 2016 Iceland initiated the HCV elimination program known as Treatment as Prevention for Hepatitis C (TraP HepC). Factors associated with HCV cure in this population are examined. MethodsUnrestricted access was offered to direct acting antiviral agents (DAAs). Testing and harm reduction was scaled up and re-treatments were offered for those who did not attain cure. Cure rates for the first 36 months were assessed and factors associated with failure to achieve cure analysed using multivariable logistic regression. ResultsTreatment was initiated for 718; 705 consented for the study. Median age was 44 years (IQR 35–56), history of IDU reported by 593 (84.1 %), recent IDU by 234 (33.2 %); 48 (6.8 %) were homeless. Of 705 patients, 635 achieved cure (90.1 %) during the first treatment. A total of 70 (9.9 %) patients initiated two or more treatments, resulting in 673 participants cured (95.5 %). By multivariable analysis, homelessness was the only statistically significant independent factor associated with not achieving cure (OR 2.67, 95 % CI 1.32–5.41) after first treatment attempt. ConclusionBy reengagement in care and prompt retreatment when needed, a cure rate of 95.5 % was achieved. Unstable housing, a potentially actionable factor is associated with poor outcome.

Towards the fair regulation of all coca leaf derivatives in Colombia

Purpose The purpose of this study is to envision the possible path to regulation of the coca leaf and its derivatives. There are a range of possible coca derivatives that could be considered for the broader market and which could be conceived of as risk and harm reduction interventions, as well as have other nutritional and industrial uses. Design/methodology/approach The methodology consists of a historical analysis of the advances in alternative uses of the coca leaf within a commercial market in Colombia as a means of providing greater economic capacity to communities that cultivate the plant, while exploring the nutritional and industrial benefits of the plant. Findings Low-risk products, such as coca leaf and coca tea, could be regulated under the same criteria as coffee or other caffeinated beverages. With a more diverse range of products on the market, consumers can make more informed decisions about their consumption, particularly regarding the associated risks and the effects they desire. Practical implications The legal regulation of coca leaf products implies the creation of a regulatory government agency specialized in the subject, as well as monitor and evaluate the cultivation and processing of products. The production of the coca leaf would still be in the hands of the cultivating communities but would fall under the control and monitoring of the government. Social implications The legal regulation of the coca leaf could have strong impacts on cultivating communities to guarantee their human rights and provide greater protection. Various industries have expressed an interest in using coca leaf derivatives and could represent economic opportunities for communities that cultivate. Originality/value Minimal work has been done on the regulation of coca leaf although there are some international examples that could be relevant in Bolivia and Perú. There is a need to continue exploring the multiple uses of the leaf to reach greater international consensus on its rescheduling.

“Everyone Does Cocaine”: The Impact of Normalization on Practices of Club Drug Use and Risk Management

Background: While many have argued that recreational drug use is becoming increasingly normalized within youth culture, little has been done to explore what this means for risk management. Methods: Drawing on 2 years of ethnographic research with people who use club drugs in the Toronto Electronic Dance Music scene, this study explores how normalization impacts risk-taking and risk management practices of club drug use. Results: It finds that the relationship is complex, as normalization both facilitates and hinders the adoption of risk management practices. The nuances of this relationship are explored by focusing on three key themes: expectation of use, moderation of use, and sharing of risk information and advice. Conclusion: The findings are interpreted with reference to Rhodes’ “risk environment” framework and with particular attention to the need for harm reduction interventions that consider how risk behaviors are shaped by broader social and cultural contexts.

A scoping review on barriers and facilitators to harm reduction care among youth in British Columbia, Canada

BackgroundProgressive harm reduction policies have been implemented in British Columbia, Canada. However, youth who use drugs face barriers to receiving harm reduction care, resulting in increasing opioid-related hospitalizations and drug toxicity deaths. This scoping review collates peer-reviewed evidence to understand the barriers and facilitators faced by youth who use drugs when accessing harm reduction programming in British Columbia, Canada.MethodsThis scoping review entailed conducting a systematic search of relevant databases to identify relevant articles. Articles were included if they: (i) contained youth falling between the ages of 12 and 26 years old; (ii) explored accessibility, barriers, and/or facilitators to harm reduction care or related topics; (iii) were empirical research articles using primary data (i.e., reviews, grey literature, theoretical or conceptual papers, books, etc. were excluded); and (iv) were available in the English language, given the geographic focus on British Columbia.ResultsA total of 398 sources were identified and ultimately, data from 13 sources were charted and extracted. When investigating barriers to harm reduction care among youth, four themes emerged: self-stigma, service navigation, service delivery, and negative provider interactions. Furthermore, in exploring factors that facilitate harm reduction care for youth, four themes surfaced: ability to meet basic needs, positive provider interactions, social networks, and risk mitigation guidance.ConclusionsThe expansion of harm reduction services in 2016 did not fully address accessibility challenges faced by youth who use drugs. Barriers continue to hinder harm reduction engagement, while supportive networks, positive provider interactions, and the ability to meet basic needs facilitated sustained access. Tailored policy interventions rooted in equity are crucial to improving access to harm reduction services for youth who use drugs.

Police Officers’ Perspectives of Harm Reduction Programs in West Virginia

Background As the United States’ drug epidemic continues and resources dwindle, some police agencies are searching for alternatives to combat drug use in their communities. Some police agencies are interacting with harm reduction programs (HRPs) more frequently. Few studies have documented polices’ perspectives of these programs in rural areas. The purpose of this study was to garner police officers’ perspectives of HRPs and how these programs may influence their work in a rural state. Methods Semistructured interviews were conducted with police officers from January to February 2023. Participants had to be ≥18 years of age and be currently employed as an officer within the state of West Virginia. Participants were recruited across the state using non-probability sampling techniques. The interviews were conducted using a standardized script, audio recorded, and transcribed. Two researchers partook in a thematic analysis with inductive coding to determine themes using NVIVO v11 software. Results Participants ( N = 11) were mainly ≥45 years of age (55%) with ≥25 years of enforcement experience (55%). Five themes transpired: (1) nature of police work, (2) perceived benefits of HRPs, (3) perceived detriments of HRPs, (4) need for education, and (5) programmatic effectiveness and accessibility. Many officers felt HRPs could serve as an alternative to arrest for people who use drugs (PWUD) and decrease their drug use, crime, and infectious disease (i.e., improve safety) overtime. Conversely, officers felt HRPs could be detrimental if they were ineffectual as they could draw more PWUD into a community which could increase crime. Officers also discussed how harm reduction principles often conflict with their training. Conclusions From law enforcements’ perspective, HRPs can positively and negatively impact their work. Officers want more education and data on HRP effectiveness and accessibility. These findings may inform future HRP implementation in rural states such as West Virginia.

Social forces shaping evidence production: A study of the swiss cannabis pilot trials

AimThe evidence-based policy paradigm has been criticized for poorly representing drug and other health policy processes, with evidence showing various social forces influencing knowledge translation. However, less research has examined the social forces influencing knowledge production. Applying a social constructivist lens, this study investigates how politics, power, economics, philosophy, and discourse influence the evidence generating processes related to drug policy. MethodsUsing Swiss cannabis pilot trials as a case study, thematic content analysis was conducted on qualitative interview data from 18 stakeholders, including scientists, policy makers, pharmacists, physicians, cannabis producers, and current and former employees of the Swiss Federal Office of Public Health. ResultsThe study reveals how social forces collectively shape scientific evidence generating processes, with political imperatives and stakeholder interests often taking precedence over purely scientific considerations. Contrary to the presumed opposition between positivist and interpretivist stances, informants demonstrated a commitment to both, dedicating themselves to positivist research agendas while highlighting the influence of harm reduction discourse on the pilot trials. ConclusionsThe Swiss cannabis pilot trials illustrate how social forces can shape the production of policy-relevant evidence, transforming evidence-based policy into policy-based evidence. Asymmetries in actor resources and power, along with the adjustment of evidence production to align with contextual realities, play significant roles in this process. Recognizing the complex social dimensions of evidence generating processes is crucial for a more reflexive and power-sensitive understanding of drug policymaking.

Integrated Online-to-Offline Model of Care for HIV Prevention and Treatment Among Men Who Have Sex With Men in Malaysia: Protocol for an Intervention Development and a Multiphase Trial.

HIV continues to have a disproportionate impact on specific populations in Malaysia, particularly men who have sex with men (MSM). HIV self-testing (HIVST) is a strategy that has been shown to scale up HIV testing rates. However, it faces shortcomings because of concerns about self-efficacy, result interpretation, and lack of counseling and linkage to care. This underscores the need for an innovative approach that integrates HIVST with timely counseling, expert guidance, and referrals to enhance engagement in relevant HIV prevention or treatment. This study aims to describe the protocol used in developing and testing a web-based platform (ie, CINTAI) providing an HIVST kit and real-time e-counseling to support online-to-offline linkage to HIV care services for MSM in Malaysia. The methods are reported according to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 guidelines. In phase I, we will adapt existing HIVST web-based platforms to create a new online-to-offline HIVST and counseling platform called "CINTAI" for Malaysian MSM. In phase II, we will use a type 1 hybrid implementation trial design to determine the feasibility, acceptability, and preliminary efficacy of "CINTAI" compared with treatment as usual among Malaysian MSM, with assessments conducted over 6 months. Multilevel implementation factors will also be collected to guide future adoption and scale-up. We will enroll 78 MSM in the pilot randomized controlled trial. Baseline characteristics will be tested for homogeneity between groups using appropriate statistical tests. A generalized linear mixed model with random subject effects will account for within-subject correlation. Treatment assignment, time, interaction, and confounders will be included. The proportion of MSM tested for HIV over 6 months and other outcomes (pre-exposure prophylaxis for HIV or antiretroviral therapy linkage, HIV risk behaviors, and chemsex harm reduction) will be compared using linear contrasts. We completed phase I of the proposed study in April 2024 and started phase II in May 2024, with 15 participants recruited (7 in the CINTAI and 8 in the treatment-as-usual groups). On the basis of a series of formative works completed during phase I, we developed a fully functional, web-based platform that provides a digital platform for MSM in Malaysia to order HIVST kits for free and to receive HIV counseling, followed by offline linkage to HIV prevention services (if HIV negative) or HIV treatment services (if HIV positive). Despite being at high risk for HIV transmission, MSM in Malaysia have alarmingly low testing and linkage to HIV care services, prompting the need for innovative approaches to support HIV prevention efforts. If found to be feasible and acceptable, CINTAI can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries. DERR1-10.2196/60962.

Stigma and Public Support for Treatment and Harm Reduction Policy in Response to the US Overdose Crisis

Stigma and Public Support for Treatment and Harm Reduction Policy in Response to the US Overdose Crisis