Implications For Harm Reduction Research Articles

Structural stigma within inpatient care for people who inject drugs: implications for harm reduction.

Individuals suffering with addiction have historically experienced disproportionally high levels of stigma. The process of inpatient care for those with substance abuse disorder (SUD) is multifaceted, shaped by the interplay of human interactions within the healthcare team and overarching structural factors like policy. While existing literature predominantly addresses personal and interpersonal stigma, the influence of structural stigma on care delivery practices remains understudied. Our research aims to investigate the impact of structural stigma on care processes for individuals with SUD admitted to acute medicine units. Weconducted a secondary analysis ofobservation notes and interview transcriptsutilizing an analytic framework related to structural stigma adapted from previous research.Data was collected from June 2019 to January 2020 in 2 hospitals.81 participants consented to observation and 25 to interviews.Interviews were conducted with patients (n = 8), healthcare staff (n = 16), and caregivers (n = 1). Each aspect of care for people with SUD is adversely influenced by structural forms of stigma. There was evidence of a gap in accessing care and time pressures which deteriorated care processes. Structural stigma also manifested in the physical spaces designed for care and the lack of adequate resources available for mental health and addictions care. We found that structural stigma perpetuated other forms of implicit and explicit stigma. Structural stigma and other forms of stigma are interconnected. Improving care for people with SUD in hospital settingsmay require addressing structural forms of stigma such as how physical spaces are designed and how mental healthcare is integrated with physical healthcare within inpatient settings.

Acute cardiovascular effects of 4th generation electronic cigarettes and combusted cigarettes: implications for harm reduction.

The health consequences associated with using electronic cigarettes (ECs) are of great public interest because of their potential role in smoking cessation. In 110 participants, including 41 nonusers, 34 people who exclusively use ECs (EC group), and 35 people who smoke tobacco cigarettes (TCs) including 12 dual users (collectively called the TC-D group), the heart rate (HR), blood pressure (BP), and heart rate variability (HRV) were compared at baseline. People in the EC or the TC-D groups were also compared after using a 4th generation EC with or without nicotine, a TC with or without nicotine (TC-D group only), and a straw-control. Baseline HR, BP, and HRV parameters were not different among the EC, the TC-D, and nonuser groups. In people who exclusively use ECs, acute nicotine-EC use increased HR and BP, and produced changes in HRV patterns suggestive of increased cardiac sympathetic influence. In people in the TC-D group, BP increased similarly after acutely smoking a nicotine-TC or a nicotine-EC. However, the increase in HR was significantly greater after smoking a TC compared with the nicotine-EC despite similar acute increases in plasma nicotine. Overall, all exposures containing nicotine significantly increased HR and BP in both cohorts when compared with non-nicotine exposures. Since acute EC use 1) produces an abnormal HRV pattern associated with increased cardiac sympathetic tone in people who chronically use ECs, and 2) similar hemodynamic increases compared with acute TC smoking in people who chronically smoke TCs including dual users, the role of ECs as part of a harm reduction strategy is questioned.NEW & NOTEWORTHY We found that nicotine, not the non-nicotine constituents in tobacco cigarette (TC) or electronic cigarette (EC) emissions, may be the instigator of the acute, potentially adverse, changes in hemodynamics and heart rate variability (HRV) that were recorded several minutes after tobacco product use. Furthermore, acute EC use produced an abnormal HRV pattern associated with increased cardiac risk in people who chronically smoke ECs and produced similar hemodynamic increases compared with acute TC use in people who chronically smoke TCs, including people who are dual users.

Electronic cigarettes prolong ventricular repolarization in people who smoke tobacco cigarettes: implications for harm reduction.

Electronic cigarettes are often used for smoking cessation as a harm reduction strategy, but studies comparing risks of electronic cigarettes (ECs) and tobacco cigarettes (TCs) are scarce. Ventricular repolarization in people who smoke TCs is abnormal. Baseline repolarization was compared among nonusers (people who do not use TCs or ECs) and people who use ECs or TCs. The acute effects of ECs and TCs on metrics of ventricular repolarization were then compared in people who chronically smoke. A total of 110 participants (59 female), including 35 people (21 females) in the TC cohort, 34 people (17 females) in the EC cohort, and 41 people (21 females) in the nonuser cohort, were included. None of the primary outcomes, Tpeak-end (Tp-e), Tp-e/QT, and Tp-e/QTc, were different among the three cohorts at supine baseline, even when adjusted for sex. When compared with the control exposure standing after acutely using the EC but not the TC, significantly prolonged all three primary indices of ventricular repolarization in people who smoke TCs. The major new finding in this study is that in people who smoke TCs, using an EC compared with a TC significantly prolongs ventricular repolarization. Furthermore, in our subgroup analysis by sex, this adverse effect on repolarization is found only in male, not female, smokers. In summary, chronic TC smoking is the most prevalent, modifiable risk factor for cardiovascular death, including sudden cardiac death. If used for smoking cessation, ECs should only be used in the short term since they too carry their own risks; this risk appears to be greatest in males compared with females who smoke.NEW & NOTEWORTHY The major new finding in this study is that in people who smoke tobacco cigarettes, using an electronic cigarette but not a tobacco cigarette acutely and significantly prolongs several metrics of ventricular repolarization, including Tpeak-Tend, Tpeak-Tend/QT, and Tpeak-Tend/QTc. Furthermore, in our subgroup analysis by sex, this adverse effect on repolarization is found only in male, not female, smokers.

The impact of tableside ordering technologies on alcohol sales to the intoxicated.

The impact of tableside ordering technologies on alcohol sales to the intoxicated.

Alcohol and Tobacco Use Among Lesbian, Bisexual, and Queer Identifying Women: A Longitudinal Qualitative Study Protocol

Background: Lesbian, bisexual, and queer (LBQ) women exhibit high rates of alcohol and tobacco use, yet there is limited qualitative research examining why. Previous research has focused on minority stress explanations, linking alcohol and tobacco use to experiences of discrimination. However, other work considers the social contexts and cultural practices associated with alcohol and tobacco consumption. This confirms the need for more in-depth understandings of LBQ women’s lived experiences in a contemporary Australian context. Aims: To address gaps in existing research, this project aims to develop a more nuanced contemporaneous theorising of what alcohol and tobacco mean to LBQ women in Australia. Drawing on feminist and critical drugs studies, this research will examine the complexities of alcohol and tobacco in LBQ women’s lives, including how patterns of use change over time. We will also critically consider how LBQ women understand risk in relation to these substances, including factors leading to harm reduction and help-seeking. Method: We will employ a longitudinal qualitative approach to explore LBQ women’s experiences over time, including three waves of semi-structured interviews and participant photography. We aim to recruit approximately 60 women in Victoria and New South Wales. Interview and visual data will be analysed using a range of narrative and thematic techniques. Conclusion: This study seeks to explore the complexities of individual experiences with alcohol and tobacco use, including pleasure and support-seeking, and to provide a nuanced understanding of the cultural dimensions of use that may change over time. In doing so, we propose a shift from deficit approaches to LBQ women’s substance use towards more meaningful strengths-based engagement with the function of substances for LBQ women. Findings will be significant in their contribution to the current understandings of substance use patterns among LBQ women and the implications for harm reduction and health interventions.

‘People need to know we exist!’: an exploratory study of the labour experiences of transmasculine and non-binary sex workers and implications for harm reduction

This article presents findings demonstrating that transmasculine and non-binary people work in sex industries worldwide. Informed by results from a qualitative study with transmasculine and non-binary sex workers, it provides much-needed demographic information about this population, their clients and workers’ safety concerns. It explores the importance of using an intersectional framework and inclusive methods to gather demographic data regarding gender and sexuality in studies of sex work. Not only is an intersectional framework necessary for empirical studies of sex work, but it is also vital to developing successful harm reduction strategies. Using an intersectional frame in studies of sex work and harm reduction can provide much-needed insight into the development of inclusive services and programmes that help the most marginal. So long as researchers, social service agencies and health providers treat transmasculine and non-binary providers as non-existent, this reduces their ability to meet the needs of all sex workers.

Effects of cannabidiol in cannabis flower: Implications for harm reduction.

Using a federally compatible, naturalistic at-home administration procedure, the present study examined the acute effects of three cannabis flower chemovars with different tetrahydrocannabinol (THC) to cannabidiol (CBD) ratios, in order to test whether chemovars with a higher CBD content produce different effects. Participants were randomly assigned to ad libitum administration of one of three chemovars (THC-dominant: 24% THC, 1% CBD; THC+CBD: 9% THC, 10% CBD; CBD-dominant: 1% THC, 23% CBD); 159 regular cannabis users (male = 94, female = 65) were assessed in a mobile pharmacology lab before, immediately after, and 1h after ad libitum administration of their assigned chemovar. Plasma cannabinoids as well as positive (e.g., high, elation) and negative (e.g., paranoia and anxiety) subjective effects were assessed at each time points. Participants who used the CBD-dominant and THC + CBD chemovars had significantly less THC and more CBD in plasma samples compared to participants who used the THC-dominant chemovar. Further, the THC + CBD chemovar was associated with similar levels of positive subjective effects, but significantly less paranoia and anxiety, as compared to the THC-dominant chemovar. This is one of the first studies to examine the differential effects of various THC to CBD ratios using chemovars that are widely available in state-regulated markets. Individuals using a THC + CBD chemovar had significantly lower plasma THC concentrations and reported less paranoia and anxiety while also reporting similar positive mood effects as compared to individuals using THC only, which is intriguing from a harm reduction perspective. Further research is needed to clarify the harm reduction potential of CBD in cannabis products.

A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction.

PurposeDespite marked progress in the ability to test for, treat, and prevent HIV, the epidemic remains a significant public health concern, especially among key populations including prisoners; sex workers; transgender individuals; gay, bisexual, and other men who have sex with men (MSM); and Black and Latinx MSM. This scoping review was conducted to provide an overview of the current research describing patient preferences for HIVST in the United States to understand what key populations value about HIVST and why they are willing to use it. A targeted search for published literature on patient preferences for HIVST was conducted using Ovid Medline, PsychINFO, and an HIVST research database.ResultsWe reviewed 700 abstracts and 139 full texts. We found 19 articles published between January 2014 and April 2020 that included findings related to HIVST preferences. Overall, HIVST was preferred to more traditional testing. Six primary factors emerged as important HIVST values including: 1) convenience, 2) type of test; 3) cost, 4) stigma reduction, 5) risk reduction, and 6) self-control. Linkage to care was also identified as a key factor when considering HIVST as an option. Much of what makes HIVST attractive to individuals is their ability to self-determine how HIVST can be best integrated into their lives as a harm reduction tool for stigma and sexual risk mitigation.ConclusionWhile there is substantial evidence suggesting HIVST is feasible for use and there are aspects of HIVST that are beneficial and preferred over traditional testing approaches, there is a lack of rigorous implementation studies exploring how best to scale up HIVST in community settings. HIVST has the potential to be a powerful biobehavioral HIV prevention and harm reduction tool to empower individuals to engage with testing on their own terms while providing pathways to prevention and care support.

A qualitative study of diphenhydramine injection in Kyrgyz prisons and implications for harm reduction

BackgroundTo reduce opioid dependence and HIV transmission, Kyrgyzstan has introduced methadone maintenance therapy and needle/syringe programs into prisons. Illicit injection of diphenhydramine, an antihistamine branded as Dimedrol®, has been anecdotally reported as a potential challenge to harm reduction efforts in prisons but has not been studied systematically.MethodsWe conducted qualitative interviews in Kyrgyz or Russian with prisoners (n = 49), former prisoners (n = 19), and stakeholders (n = 18), including prison administrators and prisoner advocates near Bishkek, Kyrgyzstan from October 2016 to September 2018. Interviews explored social–contextual factors influencing methadone utilization in prisons. Transcripts were coded by five researchers using content analysis. Dimedrol injection emerged as an important topic, prompting a dedicated analysis.ResultsAfter drinking methadone, some people in prison inject crushed Dimedrol tablets, a non-prescription antihistamine that is banned but obtainable in prison, to achieve a state of euphoria. From the perspectives of the study participants, Dimedrol injection was associated with devastating physical and mental health consequences, including psychosis and skin infections. Moreover, the visible wounds of Dimedrol injecting contributed to the perception of methadone as a harmful drug and supporting preference for heroin over methadone.ConclusionDimedrol injecting is a potentially serious threat to harm reduction and HIV prevention efforts in Kyrgyzstan and elsewhere in the Eastern European and Central Asian region and requires further investigation.

Estimating the contribution of stimulant injection to HIV and HCV epidemics among people who inject drugs and implications for harm reduction: A modeling analysis

BackgroundStimulants, such as amphetamines and cocaine, are widely injected among people who inject drugs (PWID). Systematic reviews indicate stimulant injection is associated with HIV and HCV among PWID. Using these associations, we estimated the contribution of stimulant injection to HIV and HCV transmission among PWID. MethodsWe modeled HIV and HCV transmission among PWID, incorporating excess injecting and sexual risk among PWID who inject stimulants. We simulated three illustrative settings with different stimulants injected, prevalence of stimulant injecting, and HIV/HCV epidemiology. We estimated one-year population attributable fractions of stimulant injection on new HIV and HCV infections, and impact of scaling up needle-syringe programs (NSP). ResultsIn low prevalence settings of stimulant injection (St. Petersburg-like, where 13 % inject amphetamine), 9% (2.5–97.5 % interval [95 %I]: 6–15 %) and 7% (95 %I 4–11 %) of incident HIV and HCV cases, respectively, could be associated with stimulant injection in the next year. With moderate stimulant injection (Montreal-like, where 34 % inject cocaine), 29 % (95 %I: 19–37 %) and 19 % (95 %I: 16–21 %) of incident HIV and HCV cases, respectively, could be associated with stimulant injection. In high-burden settings like Bangkok where 65 % inject methamphetamine, 23 % (95%I:10–34%) and 20 % (95%I: 9-27%) of incident HIV and HCV cases could be due to stimulant injection. High-coverage NSP (60 %) among PWID who inject stimulants could reduce HIV (by 22–65 %) and HCV incidence (by 7–11 %) in a decade. DiscussionStimulant injection contributes substantially to HIV and HCV among PWID. NSP scale-up and development of novel interventions among PWID who inject stimulants are warranted.

Comparison of the locations where young adults smoke, vape, and eat/drink cannabis: Implications for harm reduction

BackgroundCannabis vaping and edible use are increasingly popular methods of cannabis use. These discreet methods could increase risk of cannabis-related problems by facilitating cannabis use in a wider range of settings. MethodsA sample of 1018 college students were recruited to complete a survey about their health and behavior. Participants who used cannabis in the past year (35.1%, n = 357) answered questions about their cannabis use, including where they were the last time they smoked, vaped, or ate/drank cannabis, and their experience of cannabis-related problems. ResultsCompared with cannabis smoking, participants were more likely to have vaped cannabis (15.8% smoked vs. 24.6% vaped; X2 = 4.59, p = .032), and were slightly, but not statistically significantly, more likely to have used cannabis edibles (17.5% smoked vs. 24.2% used edibles; X2 = 3.57, p = .059), in locations other than a private residence. For example, participants were more likely to have vaped cannabis in a car than to have smoked cannabis in a car (8.8% vaped vs. 3.5% smoked; X2 = 4.26, p = .039). More frequent cannabis vaping was associated with driving while high on cannabis, even after accounting for overall frequency of cannabis use and other covariates (OR = 1.22, p = .047). More frequent cannabis vaping and edible use were associated with various cannabis-related problems, but, in general, these associations became statistically non-significant after accounting for overall frequency of cannabis use. ConclusionsCannabis vaporizers and edibles facilitate cannabis use in locations that require discretion. Increased availability of cannabis vaporizers and edibles could increase risk of cannabis-related problems by enabling use in more settings.

Spore forming bacteria infections and people who inject drugs: Implications for harm reduction

BackgroundThere is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014–July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb–April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks. MethodsThe Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May–August 2015. Multivariate logistic regression was undertaken. Between Oct 2015–January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis. Results38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394–11.349, p < 0.001) or discussed the postcard (aOR = 25.114, CI 3.188–190.550, p < 0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322–4.890, p < 0.001) or discussed the postcard (aOR = 6.707, CI 2.744 16.252, p < 0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR = 3.304 CI 1.425 7.660, p < 0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events. ConclusionMore widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.

Barriers to Access to Sterile Syringes as Perceived by Pharmacists and Injecting Drug Users: Implications for Harm Reduction in Lebanon

ABSTRACTBackground: Access to sterile syringes to injecting drug users (IDU) reduces sharing behavior and prevents the transmission of HIV. Objectives: To describe the barriers to access to sterile syringes for IDUs in Lebanon from the perspectives of pharmacists and IDUs. Methods: in this qualitative study conducted in Lebanon, data were collected from 72 syringe purchase tests at pharmacies, 64 interviewees with pharmacists and 2 focus groups with injecting drug users. Two independent researchers analyzed the verbatim transcripts. Results: Results revealed that pharmacists often deny access to sterile syringes to IDUs who are frequently stigmatized and intimidated at pharmacies. While no large gender differences in pharmacists' attitudes and practices were observed, inequalities in syringe access were noticed with men IDUs more often denied purchase. Pharmacists had several barriers to sell syringes to IDUs including fear of disease spread, increased drug use, inappropriately discarded syringes, staff and customer safety, and business concerns. IDUs had several challenges to purchase syringes including stigmatization, intimidation, physical harassment, concern to reveal identity, fear of arrest and syringe price abuse. Conclusions: Identifying the barriers to and facilitators of access to sterile syringes to IDUs is important to guide the development of efficient policies. Findings implicate the importance of empowering IDUs to purchase syringes at pharmacies through reducing the negative attitude towards IDUs and strengthening pharmacists' role in the promotion of health of IDUs. Findings also suggest that the habit of syringe sharing would decrease if the legal and cultural barriers to access are reduced.

The influence of marketing on the sports betting attitudes and consumption behaviours of young men: implications for harm reduction and prevention strategies

BackgroundGambling can cause significant health and social harms for individuals, their families, and communities. While many studies have explored the individual factors that may lead to and minimise harmful gambling, there is still limited knowledge about the broader range of factors that may contribute to gambling harm. There are significant regulations to prevent the marketing of some forms of gambling but comparatively limited regulations relating to the marketing of newer forms of online gambling such as sports betting. There is a need for better information about how marketing strategies may be shaping betting attitudes and behaviours and the range of policy and regulatory responses that may help to prevent the risky or harmful consumption of these products.MethodsWe conducted qualitative, semi-structured interviews with 50 Australian men (aged 20–37 years) who gambled on sports. We explored their attitudes and opinions regarding sports betting marketing, the embedding of marketing within sports and other non-gambling community environments, and the implications this had for the normalisation of betting.ResultsOur findings indicate that most of the environments in which participants reported seeing or hearing betting advertisements were not in environments specifically designed for betting. Participants described that the saturation of marketing for betting products, including through sports-based commentary and sports programming, normalised betting. Participants described that the inducements offered by the industry were effective marketing strategies in getting themselves and other young men to bet on sports. Inducements were also linked with feelings of greater control over betting outcomes and stimulated some individuals to sign up with more than one betting provider.ConclusionsThis research suggests that marketing plays a strong role in the normalisation of gambling in sports. This has the potential to increase the risks and subsequent harms associated with these products. Legislators must begin to consider the cultural lag between an evolving gambling landscape, which supports sophisticated marketing strategies, and effective policies and practices which aim to reduce and prevent gambling harm.

Young adults' accounts of buying rounds of alcoholic drinks for friends: Implications for harm reduction

Riazi, S., &amp; MacLean, S. (2016). Young adults' accounts of buying rounds of alcoholic drinks for friends: Implications for harm reduction. The International Journal Of Alcohol And Drug Research, 5(3), 125-129. doi:http://dx.doi.org/10.7895/ijadr.v5i3.229Aims: Buying or shouting rounds (purchasing alcoholic drinks for oneself and others at the same time) at on-premise licensed venues, such as nightclubs and bars, is a widespread Australian cultural practice. Our paper aims to provide detailed information on young adults’ attitudes and practices concerning round buying.Methods: Thematic analysis of research interviews involving 60 young adults living in Melbourne was conducted using NVivo 10, yielding three key themes.Findings: (1) Contexts where round buying occurred: young adults considered group size and culture, as well as bar activity, when determining whether they should round buy with their friends. In busy venues, round buying conveniently reduced the number of trips to and time waiting at the bar. Round buying was less likely to occur in groups larger than 4-5 people, as beyond this participants found it difficult to control the reciprocity of round buying, cost, and consumption of alcohol. (2) Sociability: while round buying did not occur within the friendship groups of all participants, it was seen by many as an important way of demonstrating connections with friends. (3) Consumption: overwhelmingly, participants believed that round buying increases their overall alcohol intake through implicit and explicit pressures to consume more.Conclusions: Policies that limit round buying may offer a means to reduce alcohol-related harm. In addition, education that challenges round buying rules and expectations may help alleviate pressure on young adults to consume heavily.

I am just a 'maae' (mother): experiences of mothers injecting drugs in Thailand.

Mothers who use drugs face much discriminatory action as society in general finds female drug users' modes of caring for their children unacceptable. In this article, I explore the ways in which Thai women's injecting practices revolve around the role of mother 'maae' and the ways they employ tactics to challenge the motherhood discourse. This article draws on in-depth interviews with 30 Thai mothers injecting drugs. Thai mothers injecting drugs struggled with stigma and self-blame. They internalise the values of the mother 'maae', that is, what the mother is supposed to be; attempting to combine their drug use with their parental responsibilities. Having a child is treated as a means for many women to manage the hostile social impacts of being an addict mother as well as anxieties about the future of their children. To maintain identity as a mother, as gender norms dictates, the mothers employ several tactics to defend that identity from the threats. In conclusion, the findings have implications for harm reduction and reproductive services for women using drugs in Thailand; health care providers need to appreciate the ramifications of the lived experiences of the women who take drugs.

Prescription opioid misuse and mental health among young injection drug users

Background: Prescription opioid (PO) misuse is a significant concern in the United States. Objectives: This study describes the prevalence and timing of PO misuse, diagnoses of opiate abuse and dependence, and their associations with psychiatric disorders in a sample of young people who inject drugs (PWID). Methods: Participants were 570 young (18–25 years) PWID, primarily heroin users, recruited through outreach and respondent-driven sampling. Trained interviewers administered a semi-structured psychiatric interview. Diagnoses of substance use and mental disorders were based on DSM-IV diagnostic criteria. Results: Estimated rates of lifetime PO abuse and dependence were 19% and 17%, respectively. Past year PO misuse was significantly associated with anti-social personality disorder (ASPD, OR = 2.15, 95% CI 1.43–3.24), past year substance-induced major depression (SIMD, OR = 1.81, 95% CI 1.16–2.83), and prior post-traumatic stress disorder (PTSD, OR = 2.45, 95% CI 1.31–4.60). Among male PO users, PTSD was a significant predictor of PO abuse (prior, OR = 7.62, 95% CI 2.16–26.88; past year, OR = 21.67 95% CI 2.46–190.75), and dependence (prior, OR = 4.82, 95% CI 1.48–15.67; past year, OR = 9.65, 95% CI 1.75–53.32). Conclusion: Among young PWID, PTSD is a significant risk factor for PO misuse for both men and women, and men with PTSD are in addition at increased risk for PO abuse and dependence. These findings have implications for harm reduction and substance abuse prevention efforts.

The ‘do-it-yourself’ New Zealand injecting scene: Implications for harm reduction

The review in this issue of the International Journal of Drug Policy (Grund, Latypov, & Harris, 2013) highlights the disturbing harms caused by the increasing use of ‘krokodil’ by people who inject drugs (PWID) in Eurasia. The growing use of this home produced injectable opiate poses a number of challenges for harm reduction policy, particularly when situated in restrictive regulatory environments where initiatives such as Opioid Substitution Treatment (OST) are prohibited or limited. In such contexts where OST access is restricted, how can these harms be minimised, and what alternatives can be offered? This commentary addresses these questions, by offering the rarely researched case of home produced injectable opioid use in New Zealand as an example.

Mental health among opiate users in Kabul

The number of injecting opiate users in Afghanistan has recently risen dramatically. Through this cross-sectional pilot study, the authors have aimed to assess psychiatric comorbidity and drug use patterns among Afghan opiate users, which might have implications for harm reduction and treatment interventions. The authors conducted semi-structured psychiatric interviews, with a convenience sample of 30 clients of the Medecins du Monde drop-in centre in Kabul. Symptoms were classified according to the WHO International Classification of Diseases, Revision 10. Results show that psychiatric comorbidity is very common, particularly depressive and posttraumatic stress disorders. Ideally, this could be addressed by harm reduction and treatment measures.

Canada’s highest court unchains injection drug users; implications for harm reduction as standard of healthcare

North America’s only supervised injection facility, Insite, opened its doors in September of 2003 with a federal exemption as a three-year scientific study. The results of the study, evaluated by an independent research team, showed it to be successful in engaging the target group in healthcare, preventing overdose death and HIV infections while increasing uptake and retention in detox and treatment. The research, published in peer-reviewed medical and scientific journals, also showed that the program did not increase public disorder, crime or drug use. Despite the substantial evidence showing the effectiveness of the program, the future of Insite came under threat with the election of a conservative federal government in 2006. As a result, the PHS Community Services Society (PHS), the non-profit organization that operates Insite, launched a legal case to protect the program. On 30 September 2011, Supreme Court of Canada ruled in favour of Insite and underscored the rights of people with addictions to the security of their person under section 7 of the Charter of Rights and Freedoms (Charter of Rights). The decision clears the ground for other jurisdictions in Canada, and perhaps North America, to implement supervised injection and harm reduction where it is epidemiologically indicated. The legal case validates the personhood of people with addictions while metaphorically unchaining them from the criminal justice system.