Harm Reduction Research Articles

Opioid consumption frequency and its associations with potential life problems during opioid agonist treatment in individuals with prescription-type opioid use disorder: exploratory results from the OPTIMA Study

BackgroundTraditional treatment approaches for prescription-type opioid use disorder (POUD), centered on abstinence, have limitations and hinder the development of interventions that meet the needs of people with POUD. Reduction in use without complete abstinence presents a promising avenue for intervention enhancement, but supporting data is scarce regarding its translation into positive patient outcomes. This study explores whether reducing opioid use frequency (OUF) during opioid agonist treatment correlates with reduced potential life problems in individuals with POUD, including those using fentanyl.MethodsThis study is an exploratory analysis of the OPTIMA trial, a pragmatic, open-label, randomized controlled study comparing the effectiveness of flexible take-home dosing of buprenorphine/naloxone and supervised methadone in reducing opioid use amongst individuals with POUD. OUF was assessed every two weeks for 24 weeks after treatment initiation using the Timeline Followback. Potential life problems were evaluated at baseline and study completion using the Addiction Severity Index Self-Report. The 114 participants who completed both baseline and end-of-study questionnaires were included. A repeated-measures generalized linear mixed model (GLMM) was used to evaluate the influence of OUF on potential life problems.ResultsReducing OUF was significantly associated with fewer problems related to medical status (p = 0.049), psychiatric status (p = 0.019), and alcohol problem severity (p = 0.001). The interaction was non-significant for employment (p = 0.264), family status (p = 0.352) and legal status (p = 0.050). Life improvements emerged with ≤ 21 days of opioid use per 28-day period.ConclusionFindings underscore the significance of harm reduction goals focusing on opioid use reduction, which translated in improvements across many life domains.Trial registrationStudy was registered with ClinicalTrials.gov (NCT03033732) prior to participant enrollment.

Harm reduction of tobacco: Mith or reality?

Harm reduction of tobacco: Mith or reality?

Poppers use, adherence to antiretroviral therapy and risky sexual behaviors among HIV-positive men who have sex with men in Chongqing, China

BackgroundHigh prevalence of poppers use was observed among men who have sex with men (MSM) and the use of poppers was associated with risky sexual behaviors and increased risk for human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) infection. To assess the risks for HIV/STDs transmission following poppers use, this study described the prevalence of poppers use and its associations with adherence to antiretroviral therapy (ART) and risky sexual behaviors among HIV-positive MSM.MethodsBetween June 2022 to June 2023, 1501 HIV-positive MSM enrolled in the study and data on sociodemographic characteristics, substances use, depressive and anxiety symptoms, perceived HIV-related stigma, adherence to ART and sexual behaviors were collected using an online questionnaire. Multivariate logistic regression models were constructed to identify factors associated with poppers use, as well as its relationship with adherence to ART and risky sexual behaviors.ResultsAmong the 1501 participants, 32.4% reported poppers use in the past 6 months, of whom 99.6% reported that poppers were used before or during anal intercourse. Multivariate logistic analysis indicated that MSM who used poppers were more likely to report ART non-adherence (aOR = 3.92, 95% CI: 2.36–6.53), have multiple sex partners (aOR = 7.70, 95% CI: 5.61–10.57), participate in group sex (aOR = 18.30, 95% CI: 9.72–34.43), practice condomless anal intercourse with regular sex partners (aOR = 5.49, 95% CI: 3.93–7.68) and non-regular sex partners (aOR = 2.95, 95% CI: 1.97–4.43) and engage in condomless insertive anal intercourse (aOR = 5.32, 95% CI: 3.72–7.60) and condomless receptive anal intercourse (aOR = 3.72, 95% CI: 2.62–5.29).ConclusionsThis study indicated that HIV-positive MSM commonly used poppers in the context of anal intercourse and participants who used poppers were at increased odds of reporting ART non-adherence and risky sexual behaviors. Further research is needed to explore the mechanisms through which poppers use may influence these outcomes. Tailored harm reduction programs and counseling should be implemented to mitigate the use of poppers and address their potential risks.

Towards environmentally just supply chains: from harm reduction to transformative sustainability actions

Towards environmentally just supply chains: from harm reduction to transformative sustainability actions

Substance Use Disorder and Harm Reduction Curriculum in United States and Canadian Undergraduate Medical Education: An Online Survey.

Substance use disorders (SUD) are a significant public health challenge, necessitating that clinicians are trained in SUD treatment and harm reduction (HR) strategies. Despite this, no studies have assessed the extent of SUD and HR training across all medical schools. This study assesses the current state of SUD and HR curriculum among medical students in the United States and Canada. From May to July 2023, we conducted an anonymous online survey via email invitation to student affairs' offices of all 220 accredited US and Canadian medical schools. The survey assessed the curricula students were exposed to related to SUD treatment, HR, and stigmatizing attitudes. A sample of 568 students from 52 medical schools (23.6% of all US and Canadian medical schools) completed the survey. Participants reported that in their medical school they were taught about: recognition of an opioid overdose (80.0%), identifying and treating opioid withdrawal (68.2%), principles and practices of HR (60.6%), administering naloxone (56.6%), the importance of syringe service programs (51.8%), prescribing methadone and/or buprenorphine (29.5%), and counseling patients on safe injection practices (11.4%). In addition, participants reported that they were taught: how to identify drug-seeking behavior (36.4%), that people who use heroin are "drug abusers" (24.4%), to withhold opioid pain medication from patients who are known or suspected to use drugs (15.9%), and that medication for opioid use disorder is another form of addiction (12.6%). We found large curricular gaps related to the administration of medications for opioid use disorder and treating opioid overdose and withdrawal, as well as a significant prevalence of stigmatizing attitudes. Renewed efforts are needed to implement comprehensive and destigmatizing SUD curricula. The study is limited by response bias and is expected to overestimate the extent of HR related curriculum, indicating the true gap is likely higher than reported.

The world's first anabolic-androgenic steroid testing trial: A two-phase pilot combining chemical analysis, results dissemination and community feedback.

The clandestine production and distribution of anabolic-androgenic steroids (AAS) poses health risks due to the uncertainty of their contents. This study aimed to test the chemical content of AAS samples and provide aggregate results back to the community, exploring how these results influenced usage decisions and risk management. A mixed-methods approach was used, combining chemical analysis of AAS samples with qualitative interviews. Participants submitted samples for testing, and the results were later shared with them. Semi-structured interviews explored participants' perceptions of AAS risks and the impact of testing results on their behaviour. The study was conducted at CheQpoint drug checking service in Brisbane, Australia. Thirty-two samples were submitted for testing between 19 April and 7 June 2024, with 23 samples analysed. A total of 25 active AAS users participated in interviews. Chemical analyses identified substances present and assessed active ingredient concentrations. Qualitative interviews gathered participants' perceptions, and these data were analysed through iterative categorisation, guided by the Health Belief Model. Chemical analysis identified that 13% of samples contained substances different from what was expected. Concentrations of active ingredients were close to expected levels [e.g. testosterone propionate at 96.2mg/mL (range = 91.39-101.01 mg/mL)]. Interviews identified four key theme categories. Participants sought testing primarily for substance verification, expressing concerns about contamination and dosage. Barriers to testing included limited access and fear of disclosure. While testing was seen as a valuable harm reduction tool, gaps in health guidance and follow-up support were identified as areas for improvement. Thirteen percent of 23 anabolic-androgenic steroid (AAS) samples analysed contained substances different from what was expected. Interviews with active AAS users highlighted the need for reliable information, accessible testing services and tailored health approaches for AAS use.

Using the ADAPT guidance to culturally adapt a brief intervention to reduce alcohol use among injury patients in Tanzania.

Harmful alcohol use is a leading risk factor for injury-related death and disability in low- and middle-income countries (LMICs). Brief negotiational interventions (BNIs) in emergency departments (EDs) effectively reduce alcohol intake and re-injury rates. However, most BNIs are developed in high-income countries, with limited evidence of their effectiveness in LMICs. To address this gap, we culturally adapted a BNI for alcohol-related injury patients at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital in Tanzania. Our study followed the ADAPT guidance to culturally adapt an existing high-income country BNI for use in the KCMC, a tertiary hospital in Tanzania. The adaptation included: 1) a systematic review of effective alcohol harm reduction interventions in similar settings; 2) consultations with local and international healthcare professionals experienced in counseling and substance abuse treatment; 3) group discussions to refine goals and finalize adaptations. The adapted BNI protocol and assessment scales ensured intervention fidelity. At KCMC, 30% of injury patients screened positive for alcohol use disorder (AUD), with a five-fold increased risk of injury, primarily from road traffic accidents and violence. A systematic review highlighted limited data on patient-level interventions in low-resource settings. Our adapted BNI, 'Punguza Pombe Kwa Afya Yako (PPKAY)', based on the FRAMES model, showed high feasibility and acceptability, with 84% of interventions achieving ≥80% adherence and 98% patient satisfaction. PPKAY is the first culturally adapted alcohol BNI for injury patients in an African ED. Our study demonstrates our approach to adapting substance use interventions for use in low resource settings and shows that cultural adaptation of alcohol use interventions is feasible, beneficial and empowering for our team. Our study lays a framework and method for other low resourced settings to integrate cultural adaptation into the implementation of a BNI in low resource EDs.

SMOKING AS A CAUSE OF INCREASED CARDIOVASCULAR PREMATURE AGEING AND MORTALITY

Background. The article deals with the influence of modifiable risk factors, namely tobacco smoking on morbidity and mortality. The concept of reducing the influence of risk factors (harm reduction) was first widely recognized in work with people who are dependent on smoking. According to the WHO Report on the Global Tobacco Epidemic, tobacco kills more than 8 million people each year, including an estimated 1.3 million non-smokers who are exposed to secondhand smoke. Purpose of the study: To study the impact of tobacco smoking on public health and the international experience of measures to reduce the harmful effects of this risk factor at the present stage. Materials and methods. The research and publications on the topic of the study were analyzed using sources indexed in eLibrary, Google Academic, PubMed, Web of Science and Scopus databases. The results of a literature review aimed at studying the effectiveness and features of the organization of smoking cessation interventions are presented. Results of the study. A comprehensive approach to reducing the effects of harmful risk factors is yielding positive results. The group of non-communicable diseases (NCDs) remains the No. 1 deadly disease category, with alcohol, smoking, unbalanced diet and physical inactivity as the main risk factors. According to the latest data, tobacco smoke is one of the deadliest risk factors for deaths worldwide. While smoking cessation is the best option for reducing the risk of smoking-related diseases, tobacco harm reduction is a complementary approach to existing tobacco control interventions. Conclusion. Perspectives on tobacco harm reduction should focus on reducing the negative health effects of smoking. ‘Tobacco control’ refers to a range of supply, demand and harm reduction strategies aimed at improving public health by eliminating or reducing their use of tobacco products and exposure to tobacco smoke.

Co-occurrence of depression, anxiety and increased alcohol use during the late stage of the COVID-19 pandemic in Saskatchewan, Canada: a cross-sectional survey

BackgroundImpact of the COVID-19 pandemic on mental health and substance use is well recognised. COVID-19 impacted Saskatchewan particularly hard as it has a higher prevalence of alcohol consumption than the...

Barriers to uptake of harm reduction techniques for GBMSM who use drugs in night-clubs and sex-on-premises venues in London and the Southeast: a mixed-methods, qualitative study

BackgroundDrug-related harm is a significant public health concern in the UK, particularly among underserved groups such as gay, bisexual, and other men who have sex with men (GBMSM). This study explores the role of night-time venues (for example night clubs or sex-on-premises venues) in promoting harm reduction strategies for GBMSM who use drugs, highlighting unique challenges within these spaces.MethodsThe study used a mixed-methods approach, including an online survey (n = 53) and semi-structured interviews (n = 8). Participants included GBMSM with lived experience of substance use in night-time venues, as well as those providing support to this population. Data was collected through a Likert-scale survey and thematic analysis of qualitative responses.ResultsFindings reveal dissatisfaction among survey respondents about the level of support for harm reduction provided by night-time venues, which are perceived as inconsistent in their approach towards substance use. The study also identifies economic and legal barriers faced by venues that prevent the endorsement of harm reduction techniques.ConclusionsAddressing these barriers could transform night-time venues into effective sites for harm reduction, particularly by targeting “afters” culture (the phenomenon where club-goers will return to a residential setting and continue substance use for prolonged periods ‘after’ the night-time venue closes or the event ends) and promoting safer practices. This research suggests that coordinated efforts with local government and policy reform are crucial to fostering safer environments for GBMSM.

The Commercial Determinants of Nonalcoholic Beer: Redemption, Revenue, or Men's Harm Reduction?

Public awareness about the connections between men's alcohol use and poor health outcomes, including increased male suicide risk, has led to reduced consumption and increased use of nonalcoholic beverages-most prominently nonalcoholic beer (NAB). Marketed as a healthy substitution option (i.e., periodically switching to an NAB rather than abstaining from alcoholic beer), the rapidly growing NAB sector might be somewhat redemptive, wherein the alcoholic beer industry (as the predominant producers of NAB) is selling harm reduction to men, albeit for profit. The commercial determinants of NAB are, however, complex and have significant implications for legislation and policy. For example, in Canada, NAB is exempt from alcoholic beer excise duty but considered beer for the goods and services and harmonized sales taxes. Coupled with industry production costs and profit margins, these taxes contribute to NAB and alcoholic beer retail price parity. From a public health perspective, there are also concerns about increasing alcoholic beer brand recognition and sales revenue by extending NAB visibility in more places (e.g., supermarkets), contexts (e.g., taking medication), and activities (e.g., driving). The current article highlights (1) the connections between men's alcohol use and health risks, ahead of discussing, (2) the rise of NAB, and mapping (3) NAB legislation and policy implications. We conclude with a discussion about the redemption, revenue, and men's harm reduction potentials, pragmatically arguing the need to both regulate and incentivize NAB. Proposed are promising directions for future research with the goal of reducing men's alcohol use and associated harms.

Harm Reduction and Substance Use Disorder Treatment Program Relations: Perspectives of Syringe Services Program Operators in Michigan

Harm Reduction and Substance Use Disorder Treatment Program Relations: Perspectives of Syringe Services Program Operators in Michigan

Journey Mapping Drug Market Disruptions Among Law enforcement, Public health, Harm reduction, and People who Use Drugs

Journey Mapping Drug Market Disruptions Among Law enforcement, Public health, Harm reduction, and People who Use Drugs

The System Isn’t Broken; How do we fix it? The Need for Workplace Education About Harm Reduction

The System Isn’t Broken; How do we fix it? The Need for Workplace Education About Harm Reduction

Harm Reduction Is Nursing Practice.

Barriers remain to applying this approach with people who use drugs.

'Zombie drugs': Dehumanising news frames and public stigma towards people who use drugs.

News media is an important determinant of public understanding of drug policy topics. Recent media reporting around the use of synthetic drugs such as xylazine makes frequent use of non-human metaphors, including reference to the effects of 'zombie drugs'. We investigated whether presentation of news stories which included such dehumanising frames were associated with i) increased stigmatising attitudes towards people who use drugs; and ii) lower support for relevant harm reduction programmes. We undertook a cross-sectional online experimental study with a randomised factorial design, using a nationally representative sample (UK). Participants (N = 1417) were randomly presented with one of six simulated news stories based on recent reports of the identification of xylazine in the drug market. Stories differed with respect to text (neutral or referred to either a 'zombie drug', or a drug that 'turns people into zombies'); and accompanying imagery (neutral or depicting immobile people under the influence of drugs). Stigmatising attitudes and support for harm reduction were assessed using instruments including an adapted version of the Attribution Questionnaire-Substance Use Disorders (AQ-SUD) and analysed using MANOVA. Data were obtained for 1235 participants (52 % female; mean age 47 ± 16). Attitudes towards people who use drugs were more stigmatising amongst participants presented with either of the dehumanising text conditions (both p < 0.001). There was no main effect of imagery and no interaction between text and imagery on stigma scores. Support for harm reduction programmes did not differ between conditions. Our study is the first to show that dehumanising 'zombie' framing frequently used in news reporting is associated with higher public stigma towards people who use drugs. News media is an important source of public education on drugs, so to avoid reinforcing stigma the use of dehumanising language and framing, such as 'zombie' metaphors, should be avoided. Organisations working to reduce stigma towards people who use drugs should encourage news outputs and journalists to avoid this type of representation.

Self-care interventions for legal and safe abortions: lessons learned from a woman-centered approach to sexual and reproductive healthcare in Uruguay.

In the 1990s, almost 40% of maternal deaths in Uruguay were caused by unsafe abortions. A harm reduction model implemented in Uruguay, which addressed the risks associated with unsafe abortion practices by promoting and supporting the self-management of medical abortions by women in their homes, encouraged women's autonomy. Since 2005, an accelerated decrease in maternal mortality has been recorded in Uruguay, coinciding with the implementation of two major actions: a harm reduction approach with active promotion of self-care through self-management of medical abortions; and in 2012, a change in legislation, which made abortion legal within sexual and reproductive health facilities when requested by women up to 12 weeks of pregnancy or later for specific indications. This example demonstrates that progress in public policies is possible through the combined efforts of civil society, healthcare professionals and policy makers. The initiative expanded the entry points to the healthcare system while strengthening women's autonomy. Increased access to self-care interventions for SRH contributed to advancing achievement of universal health coverage and the highest, most attainable standards of health. The authors have no financial relationships relevant to this article to disclose.

Implementation of risk mitigation prescribing during dual public health emergencies: A qualitative study among Indigenous people who use drugs and health planners in Northern British Columbia, Canada.

In response to the dual public health emergencies of COVID-19 and the overdose crisis, the Government of British Columbia (BC) introduced risk mitigation prescribing, or prescribed safer supply. In the context of colonialism and racism, Indigenous people are disproportionately impacted by substance use harms and experience significant barriers to receiving care, particularly those living in rural and remote communities. As part of a larger provincial evaluation, we sought to assess the implementation of risk mitigation prescribing as experienced by Indigenous people who use drugs (IPWUD) in Northern BC. We used the Consolidated Framework for Implementation Research and the First Nations Perspective on Health and Wellness as conceptual frameworks to guide the study. In partnership with people with lived/living experience, we conducted 20 qualitative interviews with IPWUD. Data were supplemented by four interviews with health planners and analyzed thematically. Participants reported limited implementation of risk mitigation prescribing in Northern BC, with unique regional challenges and innovative facilitators to access. Analysis of supplementary health planner data was consistent with the experiences of IPWUD and together provided a comprehensive picture of implementation in Northern BC. Four themes emerged: 1) Northern socio-politico-cultural barriers to implementation (outer setting), 2) rural and remote healthcare delivery challenges (inner setting), 3) adaptability of risk mitigation prescribing on Northern wellness (intervention characteristics), and 4) Northern ingenuity, relationality and champions facilitating access (implementation process). Implementation and access to risk mitigation prescribing in Northern BC was limited, with region-specific applicability challenges and a health service delivery model that was not able to sufficiently meet the unique service needs of IPWUD. Demonstrating Northern ingenuity, peer groups, harm reduction community champions, and telehealth services were identified as stopgap measures that promoted access and reduced inequitable implementation within the region.

Developing a Comprehensive Inventory to Define Harm Reduction Housing

Developing a Comprehensive Inventory to Define Harm Reduction Housing

Intersecting Structural and Psychosocial Conditions: Investigating Injection Drug Use and HIV Among Transgender Women.

Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women than among cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women with a general sample of persons who inject drugs. Participants from the National HIV Behavioral Surveillance were recruited through respondent-driven sampling, interviewed, and tested for HIV infection in 2019-2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics. Among 1561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (adjusted prevalence ratio = 1.5, 95% confidence interval: 1.2 to 1.8) than among those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (adjusted prevalence ratio = 0.8, 95% confidence interval: 0.7 to 1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%). Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to nonjudgmental and culturally competent harm reduction services.