In the U.S. federal system, states have adopted a wide array of opioid-related policies over the past thirty years to address the ongoing overdose crisis. The underlying factors driving this variation remain unclear. Understanding what influences states to adopt more comprehensive policies-and whether they prioritize harm reduction or opioid use disorder (OUD) treatment-has important implications for public health strategy and policymaking. This study develops state-level indexes using dozens of policy indicators to measure the comprehensiveness of opioid-related policies across two dimensions: harm reduction and treatment. Feature rank analysis and multilevel mixed effects regression are employed to assess the influence of various political, epidemiological, and socioeconomic factors. We find that decreases in conservative citizen ideology, increases in the severity of the overdose crisis, and increases in states' economic resources are the most consistent factors influencing adoptions of more comprehensive policies. These factors shaped not only the overall robustness of state responses but also the emphasis on specific policy dimensions. The study highlights key drivers behind the variation in state-level opioid policy comprehensiveness, offering a clearer picture of how political and contextual factors influence public health policymaking. These insights can guide future research on state-level health policy adoption.

ABSTRACT Background: Stimulant use and overdose (known as overamping) are rising across the United States, placing strain on the healthcare system. Harm reduction strategies and behavioral interventions for overamping are more effectively implemented in ambulatory settings, which also prevents costly emergency room utilization for this vulnerable population. However, clinical guidance for ambulatory overamping management is lacking. Objective: To address this gap, we developed a protocol for patient-centered ambulatory care and present two cases demonstrating its implementation. Methods: The protocol was developed by substance use disorder clinician and pharmacy experts. We incorporated evidence for the management of acute stimulant intoxication, clinical expertise, and implementation considerations in protocol development. The protocol was reviewed by a third-party pharmacist with expertise in psychosis treatment and stimulant use disorders. We describe protocol implementation and outcomes for two cases. Results: The protocol was implemented in patients that presented with signs of overamping and consented to treatment. First-line treatment was behavioral intervention, including environmental modifications to reduce external stimuli, remaining present, addressing acute needs, and verbal de-escalation. Second-line treatment was pharmacotherapy, including benzodiazepines followed by antipsychotics. Two cases are presented, both treated initially with behavioral measures and later pharmacotherapy. Long-term follow-up demonstrates continued care and management of stimulant use. Conclusion: Protocol-driven ambulatory care of overamping has the potential to provide patient-centered compassionate care that ensures patient follow-up and promotes continued treatment.

Indigenous communities in Canada, including First Nations, Inuit, and Métis peoples, are frequently impacted by disasters such as floods, wildfires, and endemics. A lack of adequate and culturally appropriate emergency management can lead to trauma. The healthcare sector has addressed similar issues in responses to adverse health conditions through harm reduction, which aims to mitigate negative effects and promote recovery. This conceptual narrative examines how a harm reduction model can enhance emergency management to mitigate negative experiences and trauma and better address the emotional and psychological needs of Indigenous disaster survivors.

The ongoing drug poisoning crisis continues to cause significant mortality, with a disproportionate number of overdose deaths occurring when individuals use drugs alone. While supervised consumption sites (SCS) have proven effective in reducing overdose fatalities, their impact is limited by geographic, social, and systemic barriers. In response, overdose response technologies have emerged to expand access to life-saving interventions beyond the reach of traditional harm reduction infrastructure. Overdose response technologies (e.g., National Overdose Response Service (NORS)) and applications (e.g., Lifeguard App, UnityPhilly) offer real-time monitoring during solitary substance use. Hotlines provide peer-operated support and activate emergency responses if a caller becomes unresponsive, while apps use timers and geolocation to trigger automatic emergency services dispatch. Despite promising early outcomes, these services operate in a fragmented policy landscape without formalized regulatory guidance or implementation best practices. Preliminary data show that services like NORS have successfully prevented overdose deaths; however, published outcomes for most services remain limited. Key areas of priority for standards include the following: ensuring privacy for service, balancing data usage for quality improvement and research, building capacity to further equity of access to healthcare and harm reduction using the virtual platform, standardizing overdose response, and providing appropriate education around the efficacy of services. To enhance the effectiveness and sustainability of overdose response technologies, a comprehensive policy or standards framework is needed. This includes guidance on data privacy, service equity, public education, capacity-building, and outcome evaluation, laying the groundwork for safer, scalable, and more accessible overdose prevention interventions.

To explore how nurse practitioners and physicians providing primary care for LGBTQ+ people experience and make sense of their practice. Qualitative study using Interpretative Phenomenological Analysis. In-depth, semi-structured interviews were conducted with 12 clinicians (four nurse practitioners, eight physicians) working in LGBTQ+-focused primary care across diverse U.S. regions. Interviews were online, audio-recorded via Zoom, and lasted 50-90 min. Reflexive notes were maintained. Analysis followed Smith and Nizza's six-stage Interpretive Phenomenological Analysis (IPA) process from close reading to experiential statements, clustering to personal experiential themes, development of group experiential themes, and synthesis, supported by memoing and peer debriefing. Four Group Experiential Themes: (1) Belonging, Affirmation, and the Power of LGBTQ+-Centred Spaces: clinicians practised as their full selves and modelled culturally safe care; (2) Personal Pain as Professional Purpose: personal histories of marginalisation informed a reparative ethic that fostered empathy, trust, and safety; (3) Expanding the Boundaries of Health Work: care routinely extended beyond clinic walls to advocacy, harm reduction, administrative support, and navigation of social determinants amid political precarity; (4) Resistance Within Broken Systems: persistent, invisible labour was required to navigate heteronormative and cisnormative infrastructures. LGBTQ+-focused primary care operates as clinical practice and social justice work. Clinicians translate lived experience into reparative, relational care while constantly negotiating systemic constraints and policy volatility. Embed LGBTQ+-affirming competencies and reflexivity in education; redesign digital/administrative systems for affirmed names/pronouns and streamlined access; resource and protect services and staff wellbeing in hostile policy climates. Problem: Persistent inequities and under-recognised experiential labour in LGBTQ+ primary care. Belonging and affirmation; reparative ethic; expanded health work; daily systemic workarounds. Impact Audience: Nurses, physicians, educators, leaders, and policymakers. Reporting Method: COREQ. No Patient or Public Contribution.

Ethiopia, with a population exceeding 130 million, presents a complex landscape for understanding substance use disorders. The country's diverse cultural heritage, varying regional practices, and evolving socioeconomic conditions create unique factors of substance use that differ markedly from global trends. Traditional substances like khat and locally brewed alcohols exist alongside emerging threats from cannabis, injecting drug use, and other illicit substances. This paper describes the epidemiology, societal impact, and policy responses to alcohol, tobacco, khat, and other psychoactive substances in Ethiopia. The interplay between economic interests, cultural practices, and public health imperatives creates a complex drug policy environment requiring nuanced, evidence-based approaches that balance harm reduction with sociocultural realities.

This study examined the prevalence and patterns of polydrug use among a national sample of civilians aged 12 years or older, with a focus on polydrug use involving opioids, assessing the influence of the first drug used on these behaviors. Using 2020 National Survey on Drug Use and Health (NSDUH) data, five mutually exclusive drug groups were identified in a hierarchical order: opioid use, stimulant or psychoactive drug use, non-opioid prescription drug misuse, marijuana use, and legal substance use. Polydrug use was defined as the use of drugs from two or more groups. Among 32,893 participants, the prevalence of past-month polydrug use (but not within the past year) was 11.4%, while past-year use (but not past month) was 2.8%. Among participants who used opioids in the past month, 89.2% engaged in polydrug use; among those with past-year opioid use, 48.0% engaged in polydrug use. Of those engaging in past-month and past-year polydrug use, 7.0% and 32.5% used opioids, respectively. Participants who identified as female and Hispanic had lower odds of polydrug use than their respective counterparts. Respondents who initiated drug use with opioids had over five times higher odds of past-month (odds ratio [OR] = 5.45, 95% confidence interval (CI): 2.61–11.37) and past-year (OR = 5.58, 95% CI: 2.76–11.29) polydrug use than those whose first use involved legal substance use. Their odds of opioid-involved polydrug use were 15.56 times higher for past-month use (95% CI: 4.92–49.18) and 54.66 times higher for past-year use (95% CI: 23.80–125.55). While opioid use in the general population is low, it is highly prevalent among those engaging in polydrug use with opioids as their first drug. Efforts to prevent polydrug use should prioritize those who identify as male or whose first drug was opioids, using targeted education, harm reduction, and other prevention strategies.

"This tough love sh*t is just not love": Exploring harm reduction in Massachusetts homeless shelters.

Harm reduction services fulfill a critical need in reducing the negative consequences associated with the overdose crisis. However, many current evidence-based harm reduction services-such as syringe service programs-have access barriers including limited hours or the need for face-to-face interactions to help serve people who use drugs (PWUD). To complement such traditional services, overcome barriers, and bridge gaps, harm reduction vending machines (HRVMs) are increasingly being used to offer PWUD low-barrier, 24-hour access to harm reduction supplies, such as naloxone, drug-checking strips, condoms, and more. Evidence from around the world, and more recently in the United States, demonstrates that HRVMs not only provide anonymous no- or low-cost supplies to PWUD, but also do so in ways that overcome key barriers such as stigma, cost, and transportation, while also increasing accessibility and acceptability among PWUD. Perhaps most notably, HRVMs can do all of this while remaining cost-efficient, highly accessible, and adaptable to community needs. Accordingly, the Association for Multidisciplinary Education and Research in Substance Use and Addiction supports funding and research for the broader application of HRVMs, alongside the creation of national implementation guidance and federal and state policy alignment, to ensure that communities across the United States can access these crucial harm reduction services.

The geriatric gap: the absence of geriatric medicine in postgraduate medical training in Poland.

Our study examines how harm reduction service providers (providers) throughout North Carolina (NC) provide services to people who use opioids (PWUO), how these service provision strategies align with PWUO preferences, and implications for care. We conducted semi-structured in-depth interviews and used a thematic analytic strategy to identify common approaches to service delivery among providers (n = 10), rationales for taking these approaches, and how approaches were received by PWUO (n = 30). To be included in the study, service providers had to provide direct care to PWUO, while PWUO had to be 18 + and be in active opioid use (not as prescribed by a doctor); providers and PWUO had to live in NC. Providers often allowed PWUO to take the lead in service delivery interactions, asked limited questions about what/how participants use drugs, and rarely offered unsolicited information. Providers believed questioning could feel invasive or stigmatizing to PWUO. They also thought questions were unnecessary, assuming PWUO understood the risks that come with drug use. Providers reported that they would take the lead in interactions to correct PWUO's misconceptions that could make their use more dangerous, and would, occasionally, offer unsolicited information related to upcoming events or new services, or if PWUO appeared open to receiving more information. PWUO varied in desired approach by providers, based on the established rapport between providers and PWUO, and whether PWUO were in withdrawal during the interaction. Still, PWUO generally felt syringe service programs were a safe space, and many wanted to be asked more about their use so providers could provide tailored information about risks, trends, and safe use. Providers offer valuable services and safe spaces for PWUO in NC, but should ask program participants' preferences regarding interaction style to ensure the services provided are aligned with the desires of PWUO to have the maximum possible impact.

To describe COVID-19 pandemic experiences among people who use drugs (PWUD) in rural southeastern Ohio in varying geographies and time since start of pandemic. We used two cross-sections of data from the Ohio Opioid Project to describe shifts in PWUD's service accessibility and perceived trustworthiness of COVID-19-related information sources. Participants in the cross-section "Rural2020-22" were surveyed from September 2020 to January 2022 in a rural area. Participants in the cross-section "Micropolitan2022-23" were surveyed from January 2022 to February 2023 in a micropolitan area. Our total sample included 408 participants (50% male). Early in the COVID-19 pandemic, 36% of participants reported increased drug use. Rural2020-22 participants reported services were at least "a little harder" to access than before the pandemic more commonly than Micropolitan2022-23 (local harm reduction services: 34% versus 30%; substance use treatment programs: 49% versus 26%). Most participants reported news media as a source of COVID-19 information in both samples (Rural2020-22: 75%; Micropolitan2022-23: 51%). Local harm reduction programs and health authorities had the highest level of trust for information among participants (Rural2020-22: 46%, 22%; Micropolitan2022-23: 37%, 30%, respectively, trusted them "a lot"). In the context of the COVID-19 pandemic, many PWUD reported increased substance use, yet struggled to access services. Local harm reduction programs, health authorities, and news media may be valuable outlets through which to disseminate timely health information, such as program changes and availability, to PWUD during a future emergency.

Abstract Social media increasingly serves as important spaces for mental health information seeking and peer support, especially for individuals facing barriers to traditional care. Although nonsuicidal self-injury is frequently discussed on social media, there is limited understanding of the factors that influence the visibility of this discourse. We analyzed 973 videos related to nonsuicidal self-injury on TikTok to examine the prevalence and characteristics of posts that become unavailable (i.e., ephemeral) over time, whether due to user deletion or platform removal. Videos that used addiction-related language, included trigger warnings, or depicted scars were significantly associated with ephemerality. These findings highlight how anticipated stigma (user deletion) and enacted stigma (platform moderation) contribute to the disappearance of nonsuicidal self-injury discourse. By identifying which expressions are most vulnerable to ephemerality, this study extends stigma theory to algorithmic contexts and underscores the consequences for recovery-oriented and harm reduction–focused support online.

Intervention about addictive behaviours, especially in substance use, has been advancing from traditional therapeutic communities and drug-free programs to comprehensive care networks and harm reduction programs. Addiction recovery is based on the development of capabilities, skills, and competencies that allow the person who has had an addiction problem to generate an alternative lifestyle to the use of substances (or other addictive behaviours) and not only approach treatment from the presence or absence of the main substance. During the 21st century, the so-called Recovery Science has been developed, identifying the theoretical and practical aspects, concepts and constructs of addiction recovery. This article presented a narrative review of the main theories, aspects, and strengths of Recovery Science, as well as its limitations and applications. The main findings are that recovery-based programs are highly effective for the individuals for whom they are designed, but are more difficult for specific groups (women, especially those with children; young people with conduct disorders; users of new psychoactive substances). In conclusion, it is necessary to strengthen experimental and quasi-experimental studies that allow for a better understanding of what works and what doesn't in Recovery Science.

ABSTRACT Research has established that life stress may elevate the likelihood of challenging experiences with psychedelics, which may be linked to poorer outcomes from psychedelic use. Studies have highlighted the importance of therapeutic support, but questions remain about the type of effective support and its specific contribution. We examined the contribution of therapeutic-like contexts and support on the relationship between life stress and challenging psychedelic experiences and between challenging experiences and psychological outcomes. An online survey was conducted in an international sample (N = 1,867) of psychedelic users. Statistical analyses were conducted to examine the moderating roles of therapeutic-like context and support on presumed links between life stress and challenging psychedelic experiences and between challenging experiences and outcomes. Data generally supported theorized associations among stressful life events, challenging psychedelic experiences, therapeutic-like context/support, and psychological outcomes. Therapeutic-like context mitigated the association of stressful life events with challenging experiences and the association of challenging experiences with coping, but not other associations. Interaction effects indicated that the degree of therapeutic-like support moderated the association of challenging experiences with valence, impact on coping, and impact on well-being. In other regression models, therapeutic-like support maintained significant independent effects, but interaction effects were not found. Therapeutic-like context and support were found to moderate links between life stress and challenging psychedelic experiences and between challenging experiences and outcomes. These findings may be relevant to clinical uses of psychedelics in therapeutic contexts and harm reduction practices in naturalistic contexts.

The use of public health vending machines (PHVMs) is an emerging strategy implemented to mitigate drug-related harms via the dispensation of supplies like naloxone and sterile syringes from vending machines that have been documented to reduce transmission of blood borne viruses, support hygiene and basic personal health needs, and prevent overdose. To inform future applications of this technology and performed initially as part of a technical assistance request, we sought to examine PHVM adoption and implementation by conducting semi-structured interviews with 26 individuals from diverse roles and organizations/agencies across the United States in March 2023 about their experiences launching and optimizing PHVMs. We engaged in a secondary thematic analysis of the interview data using both deduction and induction. Using the interview guide as the frame, we broadly organized our findings into themes that are pertinent to consider prior to PHVM implementation ("Pre-implementation") and those that are relevant during implementation ("Implementation and maintenance"). Pre-implementation themes included (1) Motivating factors influencing implementation, (2) Intended PHVM uptake population, (3) Partnership cultivation, (4) Responsiveness to community needs and concerns, and (5) Factors influencing placement of PHVMs. Implementation and maintenance themes included: (1) Operational components of implementation and (2) Tracking consumer use of machines and supply flow. We found that PHVMs have emerged as versatile and central tools to expand and extend critical, life-saving supplies and services to PWUD and other groups within communities throughout the United States, especially to underserved and high-risk populations, such as people of color, young people, rural residents, individuals leaving incarceration, and veterans. We also found that the planning phases of implementation were shaped by local needs, funding opportunities, collaboration, and community engagement, with PHVM placement most often determined by feasibility and willingness of host sites, as well as the perceptions and needs of the community. Operational challenges included unanticipated costs related to maintenance and supply stocking of the PHVMs. Our findings elucidate the local, ground-up, and bold approaches and innovations undertaken by many organizations, agencies, and programs throughout the country in PHVM implementation. Policymakers and government officials should consider passing local ordinances or granting permissions in support of placing PHVMs and securing access to life saving materials.

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.

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.