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Page R, Jauncey M, Brett J, Wood W, Roxburgh A. The role of on-site drug analysis within supervised injecting facilities: A case presentation of an adverse event highlighting need. Drug Alcohol Rev 2024. [PMID: 39031451 DOI: 10.1111/dar.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/02/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION The Sydney Medically Supervised Injecting Centre provides a safe, non-judgemental space where people can inject pre-obtained substances under the supervision of trained staff. This article describes an unusual incident occurring at the Medically Supervised Injecting Centre in January 2023. CASE PRESENTATION Two regular male clients attending the Medically Supervised Injecting Centre injected a substance they believed to be cocaine. Both clients experienced adverse reactions; one was transported to hospital, while the other became extremely distressed and agitated. Paraphernalia sent for testing returned a result of tiletamine (a dissociative used in veterinary medicine) and no cocaine, 30 h after the incident. DISCUSSION AND CONCLUSIONS Where substances are novel or unknown, adverse events are often unexpected and may be more difficult to prepare for. Substance-induced acute agitation can be alarming and hazardous for people consuming drugs and those around them and may pose challenges for staff. There is a substantial evidence base for the benefits of on-site drug analysis and drug checking in reducing harms related to drug use, and in enhancing drug market monitoring. This incident was successfully managed by Medically Supervised Injecting Centre and hospital staff, with no major consequence, however clinical management could have been improved using point of care drug testing.
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Affiliation(s)
- Robert Page
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
- Discipline of Addiction Medicine, the Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jonathan Brett
- Drug Health Service, St Vincent's Hospital Sydney, Sydney, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Will Wood
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Amanda Roxburgh
- Discipline of Addiction Medicine, the Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Harm and Risk Reduction, Burnet Institute, Melbourne, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
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Bear D, Hosker-Field A, Westall K, D'Alessio H, Cresswell M. Harm reduction isn't enough: Introducing the concept of Mindful Consumption and Benefit Maximization (MCBM). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104514. [PMID: 39030084 DOI: 10.1016/j.drugpo.2024.104514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/21/2024]
Abstract
The concept of harm reduction was a radical departure from a century of stigmatizing demand reduction initiatives targeted at people who use drugs. In fact, since the early 1980's Harm Reduction has been used with great success to protect the lives and wellbeing of these individuals. When employed with people who use opioids, the relevancy and importance of harm reduction are easy to grasp because the potential dangers are both quite visible and profound. However, promoting harm reduction practices to people consuming cannabis is a more difficult challenge. Cannabis cannot cause death due to overconsumption, is not associated with the spread of communicable diseases, and is overall a relatively harmless drug both to the individual and society when compared with other legal substances such as tobacco and alcohol. Harm reduction campaigns targeted at cannabis consumers run the risk of sounding overly fearful and stigmatizing, ultimately being ignored like many of the old demand reduction initiatives. Cannabis does have potential harms, and teaching people to mitigate those harms is an important public health goal. This commentary argues that cannabis education targeted at young people should employ mindful consumption and benefit maximization (MCBM) language that promotes harm reduction practices but does not focus on harm as the primary issue related to cannabis use. We define what we mean by mindful consumption and benefit maximization, identify their convergence with harm reduction principles, and argue for their use to both promote knowledge and normalize cannabis consumption that incorporates harm reduction practices.
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Affiliation(s)
- Daniel Bear
- Humber College, 2 Colonel Samuel Smith Park Drive, Toronto, Ontario M8V 1K8, Canada.
| | - Ashley Hosker-Field
- Humber College, 2 Colonel Samuel Smith Park Drive, Toronto, Ontario M8V 1K8, Canada
| | - Kelsey Westall
- Humber College, 2 Colonel Samuel Smith Park Drive, Toronto, Ontario M8V 1K8, Canada
| | - Heath D'Alessio
- Humber College, 2 Colonel Samuel Smith Park Drive, Toronto, Ontario M8V 1K8, Canada
| | - Marilyn Cresswell
- Humber College, 2 Colonel Samuel Smith Park Drive, Toronto, Ontario M8V 1K8, Canada
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Heinz A, Gutwinski S, Krausz M, Ernst G, Vogel M, Scherbaum N. [Challenges in the treatment of opioid dependence]. DER NERVENARZT 2024:10.1007/s00115-024-01691-9. [PMID: 39008087 DOI: 10.1007/s00115-024-01691-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The number of persons using opioids has increased worldwide in the last decade, particularly the use of opioid analgesics in North America and Africa. In Germany, the prevalence of heroin addiction has remained relatively stable. METHOD Narrative review of the literature. RESULTS Opioid-assisted maintenance treatment (OMT) with the established substances methadone, levomethadone, slow-release morphine and buprenorphine is recommended as the first-line treatment for heroin dependence. The OMT reduces the use of heroin, mortality and individual suffering and improves the quality of life and physical health. A diamorphine and heroine-assisted treatment is an option for people who do not benefit from conventional OMT. An alternative to the use of diamorphine could be treatment with hydromorphone hydrochloride. The regulations on carrying out maintenance treatment in the Controlled Substances Prescription Act and the guidelines of the Federal Medical Association in Germany have been loosened based on the experiences of the COVID-19 pandemic, for example with respect to take-home prescriptions. There is an ongoing intensive discussion on how to deal with the decreasing number of outpatient clinics offering OMT. CONCLUSION The first-line treatment for opioid addiction is opioid-assisted substitution treatment, including diamorphine and heroin-assisted treatment. Long-acting depot medications and implants still play a subordinate role.
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Affiliation(s)
- Andreas Heinz
- Department of Psychiatry and Neurosciences, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Department of Psychiatry, University Hospital Charité, St. Hedwig Hospital Berlin, Berlin, Deutschland.
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Berlin-Potsdam, Deutschland.
| | - Stefan Gutwinski
- Department of Psychiatry and Neurosciences, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Department of Psychiatry, University Hospital Charité, St. Hedwig Hospital Berlin, Berlin, Deutschland
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Kanada
| | - Gernot Ernst
- Psychological Institute, University of Oslo, Oslo, Norwegen
- Kongsberg Hospital, Anesthesiology, Vestre Viken Hospital Trust, Kongsberg, Norwegen
| | - Marc Vogel
- Department of Addictive Disorders, Psychiatric University Clinic Basel, Basel, Schweiz
| | - Norbert Scherbaum
- LVR-Universitätsklinik Essen, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
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Sweileh WM. Analysis and mapping of harm reduction research in the context of injectable drug use: identifying research hotspots, gaps and future directions. Harm Reduct J 2024; 21:131. [PMID: 38987762 PMCID: PMC11234666 DOI: 10.1186/s12954-024-01048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Harm reduction is a crucial approach in addressing the multifaceted challenges of injectable drug use. This paper presents an analysis and mapping of the existing literature on harm reduction research in the context of injectable drug use. By reviewing a comprehensive set of scholarly articles, this study identifies research hotspots, knowledge gaps, and future directions in the field. The findings provide valuable insights for researchers, policymakers, and practitioners to guide future research efforts and inform evidence-based harm reduction interventions. METHODS Data for the study was obtained from the Scopus database, using keywords and phrases related to harm reduction and injectable drug use. Validation methods were employed to verify the accuracy and comprehensiveness of the search strategy. Data analysis involved identifying growth patterns, key contributors, mapping frequent terms, identifying research hotspots, and identifying emerging research directions. RESULTS A total of 971 articles were found, with a notable increase from 2015 to 2022. The International Journal of Drug Policy (n = 172, 17.7%) and the Harm Reduction Journal (n = 104, 10.7%) were the most prolific journals, and the United States (n = 558, 57.5%) had the highest number of publications. The Johns Hopkins University (n = 80, 8.5%) was the most prolific institution. Mapping of frequent author keywords revealed the main keywords, including harm reduction, HIV, hepatitis C, and opioid overdose. The highly cited articles cover a broad time span and focus on topics like naloxone distribution, HIV and hepatitis C transmission, while recent articles concentrate on emerging issues such as the impact of the COVID-19 pandemic, fentanyl-related concerns, stigma reduction, and needle and syringe programs. Both sets of articles share a common focus on harm reduction strategies, but recent publications highlight current challenges and developments in the field. CONCLUSIONS This study provides insights into research landscape on harm reduction in injectable drug use. Research is concentrated in high-income countries, emphasizing the need for more research in low- and middle-income countries. Recent publications focus on emerging challenges like COVID-19 and fentanyl. Research gaps highlight the need for studies in diverse populations, social determinants, program evaluation, and implementation strategies to enhance harm reduction interventions.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology and Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Mazzeo SE, Weinstock M, Vashro TN, Henning T, Derrigo K. Mitigating Harms of Social Media for Adolescent Body Image and Eating Disorders: A Review. Psychol Res Behav Manag 2024; 17:2587-2601. [PMID: 38978847 PMCID: PMC11229793 DOI: 10.2147/prbm.s410600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/22/2024] [Indexed: 07/10/2024] Open
Abstract
Social media has negative effects on adolescent body image and disordered eating behaviors, yet adolescents are unlikely to discontinue engaging with these platforms. Thus, it is important to identify strategies that can reduce the harms of social media on adolescent mental health. This article reviews research on social media and adolescent body image, and discusses strategies to reduce risks associated with social media use. Topics covered include interventions aimed at mitigating social media's negative impacts, the body-positivity movement, and policies regulating adolescents' social media use. Overall, this review highlights specific factors (such as staffing, duration, modality, facilitator training, and cultural sensitivity) to consider when designing and implementing social media interventions targeting adolescents. This review also discusses psychosocial outcomes associated with body positivity on social media. Finally, policy efforts to reduce the negative impact of social media on adolescents' body image and eating behaviors are described. In sum, there is a strong need to conduct further research identifying optimal approaches to reduce the harms of social media for adolescent body image and eating behavior.
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Affiliation(s)
- Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Madison Weinstock
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Taryn Henning
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Karly Derrigo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Ciatti JL, Vazquez-Guardado A, Brings VE, Park J, Ruyle B, Ober RA, McLuckie AJ, Talcott MR, Carter EA, Burrell AR, Sponenburg RA, Trueb J, Gupta P, Kim J, Avila R, Seong M, Slivicki RA, Kaplan MA, Villalpando-Hernandez B, Massaly N, Montana MC, Pet M, Huang Y, Morón JA, Gereau RW, Rogers JA. An Autonomous Implantable Device for the Prevention of Death from Opioid Overdose. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.27.600919. [PMID: 39005313 PMCID: PMC11244915 DOI: 10.1101/2024.06.27.600919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Opioid overdose accounts for nearly 75,000 deaths per year in the United States, representing a leading cause of mortality amongst the prime working age population (25-54 years). At overdose levels, opioid-induced respiratory depression becomes fatal without timely administration of the rescue drug naloxone. Currently, overdose survival relies entirely on bystander intervention, requiring a nearby person to discover and identify the overdosed individual, and have immediate access to naloxone to administer. Government efforts have focused on providing naloxone in abundance but do not address the equally critical component for overdose rescue: a willing and informed bystander. To address this unmet need, we developed the Naloximeter: a class of life-saving implantable devices that autonomously detect and treat overdose, with the ability to simultaneously contact first-responders. We present three Naloximeter platforms, for both fundamental research and clinical translation, all equipped with optical sensors, drug delivery mechanisms, and a supporting ecosystem of technology to counteract opioid-induced respiratory depression. In small and large animal studies, the Naloximeter rescues from otherwise fatal opioid overdose within minutes. This work introduces life-changing, clinically translatable technologies that broadly benefit a susceptible population recovering from opioid use disorder.
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Karthikeyan N, Xia T, Nielsen S, Picco L. Stocking and supplying naloxone: Findings from a representative sample of community pharmacies in Victoria, Australia. Drug Alcohol Rev 2024; 43:1305-1312. [PMID: 38691509 DOI: 10.1111/dar.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Naloxone is an opioid receptor antagonist, which can rapidly reverse the effects of an opioid overdose. Community pharmacists may experience several barriers to stocking and supplying naloxone including a lack of confidence or knowledge and time constraints. The current study aimed to examine the extent to which Victorian community pharmacies stock and supply naloxone and determine specific characteristics associated with stocking naloxone. METHODS A representative sample of community pharmacists (n = 558) in Victoria, Australia, were contacted between October and November 2020 and invited to participate in an online survey. Data related to pharmacy- and pharmacist-related characteristics, including stocking and frequency of supplying naloxone in the past year. Multivariate logistic regression analysis was performed to examine the effect of various covariates on stocking naloxone. RESULTS The sample comprised 265 pharmacists (response rate 47%). Most pharmacies were located in Melbourne (the capital city of Victoria, 59.6%) and were part of a pharmacy chain (61.5%). In total, 100 (38%) pharmacies stocked naloxone, a third of whom did not supply it in the past year. Pharmacies that provided opioid agonist treatment had 2.4 times higher odds of stocking naloxone (95% confidence interval 1.425-4.136; p = 0.001). DISCUSSION AND CONCLUSION Less than half of Victorian community pharmacies stock naloxone, with even fewer actually supplying it in the past year. Future efforts are needed to increase the number of pharmacies that stock naloxone and the frequency in which it is supplied, while also addressing possible barriers to stocking and supplying naloxone among community pharmacists.
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Affiliation(s)
- Nandini Karthikeyan
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- School of Medicine, Monash University, Melbourne, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Yangchen T, Rodriguez M, Baird J, Hallowell BD, Daly MM, Berk J, Gaither R, Wightman RS, Beaudoin FL, Chambers LC. Trends in recurrent overdose and treatment initiation following emergency department visits for opioid overdose between 2016 and 2021. Drug Alcohol Depend 2024; 262:111379. [PMID: 38968835 DOI: 10.1016/j.drugalcdep.2024.111379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/30/2024] [Accepted: 06/09/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Overdose remains a pressing public health concern in the United States, particularly with the emergence of fentanyl and other potent synthetic opioids in the drug supply. We evaluated trends in recurrent overdose and opioid use disorder (OUD) treatment initiation following emergency department (ED) visits for opioid overdose to inform response efforts. METHODS This retrospective cohort study used electronic health record and statewide administrative data from Rhode Island residents who visited EDs for opioid overdose between July 1, 2016, and June 30, 2021, a period with fentanyl predominance in the local drug supply. The primary outcome was recurrent overdose in the 365 days following the initial ED visit. OUD treatment initiation within 180 days following the initial ED visit was considered as a secondary outcome. Trends in study outcomes were summarized by year of the initial ED visit. RESULTS Among 1745 patients attending EDs for opioid overdose, 20 % (n=352) experienced a recurrent overdose within 365 days, and this percentage was similar by year (p=0.12). Among patients who experienced any recurrent overdose, the median time to first recurrent overdose was 88 days (interquartile range=23-208), with 85 % (n=299/352) being non-fatal. Among patients not engaged in OUD treatment at their initial ED visit, 33 % (n=448/1370) initiated treatment within 180 days; this was similar by year (p=0.98). CONCLUSIONS Following ED visits for opioid overdose in Rhode Island from 2016-2021, the one-year risk of recurrent overdose and six-month treatment initiation rate remained stable over time. Innovative prevention strategies and improved treatment access are needed.
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Affiliation(s)
- Tenzin Yangchen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - McClaren Rodriguez
- Substance Use Epidemiology Program, Rhode Island Department of Health, Providence, RI, USA
| | - Janette Baird
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Benjamin D Hallowell
- Substance Use Epidemiology Program, Rhode Island Department of Health, Providence, RI, USA
| | - Mackenzie M Daly
- Research, Data Evaluation, and Compliance Unit, Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, Providence, RI, USA
| | - Justin Berk
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel Gaither
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Rachel S Wightman
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Laura C Chambers
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
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LEVENGOOD TIMOTHYW, CONTI RENAM, CAHILL SEAN, COLE MEGANB. Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer-Reviewed Literature. Milbank Q 2024; 102:429-462. [PMID: 38282421 PMCID: PMC11176403 DOI: 10.1111/1468-0009.12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/11/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024] Open
Abstract
Policy Points The 340B Drug Pricing Program accounts for roughly 1 out of every 100 dollars spent in the $4.3 trillion US health care industry. Decisions affecting the program will have wide-ranging consequences throughout the US safety net. Our scoping review provides a roadmap of the questions being asked about the 340B program and an initial synthesis of the answers. The highest-quality evidence indicates that nonprofit, disproportionate share hospitals may be using the 340B program in margin-motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. CONTEXT Despite remarkable growth and relevance of the 340B Drug Pricing Program to current health care practice and policy debate, academic literature examining 340B has lagged. The objectives of this scoping review were to summarize i) common research questions published about 340B, ii) what is empirically known about 340B and its implications, and iii) remaining knowledge gaps, all organized in a way that is informative to practitioners, researchers, and decision makers. METHODS We conducted a scoping review of the peer-reviewed, empirical 340B literature (database inception to March 2023). We categorized studies by suitability of their design for internal validity, type of covered entity studied, and motivation-by-scope category. FINDINGS The final yield included 44 peer-reviewed, empirical studies published between 2003 and 2023. We identified 15 frequently asked research questions in the literature, across 6 categories of inquiry-motivation (margin or mission) and scope (external, covered entity, and care delivery interface). Literature with greatest internal validity leaned toward evidence of margin-motivated behavior at the external environment and covered entity levels, with inconsistent findings supporting mission-motivated behavior at these levels; this was particularly the case among participating disproportionate share hospitals (DSHs). However, included case studies were unanimous in demonstrating positive effects of the 340B program for carrying out a provider's safety net mission. CONCLUSIONS In our scoping review of the 340B program, the highest-quality evidence indicates nonprofit, DSHs may be using the 340B program in margin-motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. Future studies should examine heterogeneity by covered entity types (i.e., hospitals vs. public health clinics), characteristics, and time period of 340B enrollment. Our findings provide additional context to current health policy discussion regarding the 340B program.
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Affiliation(s)
| | | | - SEAN CAHILL
- Boston University School of Public Health
- The Fenway Institute
- Northeastern University
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Mocanu V, Viste D, Rioux W, Ghosh SM. Accessibility gaps of physical supervised consumption sites in Canada motivating the use of overdose response technology/phone based virtual overdose response services: a retrospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100770. [PMID: 38798948 PMCID: PMC11127238 DOI: 10.1016/j.lana.2024.100770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Background Overdose response technology or virtual overdose response services are an evolving complementary harm reduction intervention which may overcome certain accessibility barriers of physical supervised consumption sites (SCS) and overdose prevention sites (OPS). We sought to characterize SCS/OPS accessibility barriers among clients accessing a nationwide overdose response phone-based hotline in Canada. Methods We performed a retrospective cohort analysis using anonymized call logs of the National Overdose Response Service (NORS) between December 2020 to July 2023. De-identified caller locations were cross-referenced with the locations, policies and operational hours of existing physical SCS/OPS. The primary outcome was accessibility of physical SCS/OPS defined hierarchically according to alignment with caller postal code, substance use routes reported, and calling times. Findings Our cohort comprised 4501 calls from 331 unique clients. Despite always having nearby SCS/OPS open and supporting substance use routes of choice, 100 clients (30.2%) preferentially utilized NORS. Among 191 clients (57.7%) who never had access to physical SCS/OPS at time of calling, 92 (27.8%) lacked a nearby site, 58 (17.5%) called outside of operational hours, and 41 (12.4%) would not be permitted to smoke on premises. Secondary analyses identified correlations between accessibility and the urbanicity and geographical region of callers within Canada. Interpretation Overdose response technology or virtual overdose response services are a novel complementary harm reduction strategy both for clients with access barriers to physical SCS/OPS and those who prefer virtual services. System-level correlates of client location urbanicity and inter-provincial variation indicate actionable targets for expanding harm reduction services both physical and virtual to better engage with people who use drugs. Funding Health Canada Substance Use and Addictions Program, Canadian Institutes of Health Research, and Grenfell Ministries.
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Affiliation(s)
- Victor Mocanu
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Dylan Viste
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta T6G 2R7, Canada
| | - S. Monty Ghosh
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta T6G 2R7, Canada
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Schaefer M, Panagiotoglou D. Evaluating the effects of supervised consumption sites on housing prices in Montreal, Canada using interrupted time series and hedonic price models. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100242. [PMID: 38948426 PMCID: PMC11214419 DOI: 10.1016/j.dadr.2024.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 07/02/2024]
Abstract
Background In 2017, three brick and mortar supervised consumption sites (SCS) opened in Montreal, Canada. Opponents argued the sites would attract people who use drugs and reduce local real estate prices. Methods We used interrupted time series and hedonic price models to evaluate the effects of Montreal's SCS on local real estate prices. We linked the Quebec Professional Association of Real Estate Brokers' housing sales data provided by Centris Inc. with census tract data and gentrification scores. Homes sold within 200 m of the SCS locations between 1 January 2014 and 31 December 2021 were included. We adjusted for internal (e.g., number of bed/bathrooms, unit size) and external attributes (e.g., neighbourhood demographics), and included a spatio-temporal lag to account for correlation between sales. For sensitivity analysis we used site-specific dummy variables to better account for unmeasured neighbourhood differences, and repeated analyses using 500 m and 1000 m radii. Results We observed a price shock after the opening of the first two SCS in June 2017 (level effect: -10.5%, 95% CI: -19.1%, -1.1%) but prices rose faster month-to-month (trend effect: 1.1%, 95% CI: 0.7%, 1.6%) after implementation. Following the implementation of the third site in November 2017 there was no immediate impact (level effect: 2.4%, 95% CI: -10.4%, 17.0%) but once more prices roses faster (0.9%, 95% CI: 0.4%, 1.5%) thereafter. When we replaced neighbourhood attributes with a site-specific dummy variable, we observed the same pattern. Sales' prices dropped (level effect: -9.6%, 95% CI: -15.0%, -3.8%) but rose faster month-to-month (trend effect: 0.9%, 95% CI: 0.6%, 1.2%) following June 2017's SCS implementations, with no level effect (4.9%, 95% CI: -7.3%, 18.6%) and a positive trend (0.9%, 95% CI: 0.5%, 1.3%) after November 2017's SCS opening. In most 500 m and 1000 m radii models, there were no immediate shocks following SCS opening, however, positive trend effects persisted in all models. Conclusion Our models suggest homes sold near SCS may experience a price shock immediately post-implementation, with evidence of market recovery in the months that follow.
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Affiliation(s)
- Maximilian Schaefer
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Côté-Lussier C, Rodrigues P. The public health impacts of supervised injection sites in Canada: Moving beyond social acceptability and impacts on crime. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:468-471. [PMID: 38602661 PMCID: PMC11151887 DOI: 10.17269/s41997-024-00874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/28/2024] [Indexed: 04/12/2024]
Abstract
Canada has been a pioneer in adopting a harm reduction approach to address risks associated with drug use for people who inject drugs. Today, Canada is home to 39 supervised injection sites spread throughout the country. The scientific literature demonstrates, unequivocally, that these sites have numerous health benefits for people who inject drugs, namely by decreasing risks of blood-borne diseases, overdose, and mortality. Yet, a lack of clear guidelines on optimal locations for the implementation of such sites and NIMBYISM ("Not In My Back Yard") have been stumbling blocks for planned and operating sites. Various Canadian governments have introduced their own policies to overcome the lack of national public health guidelines on community planning. Namely, policies aim to limit the exposure to sites and drug use for vulnerable populations, such as children. However, there is a veritable lack of research on the public health impacts of supervised injection sites for local communities, who tend to be disadvantaged. The existing literature fails to address the broader and differential impacts of such sites for local vulnerable and disadvantaged populations, including use of active transportation, psychological distress, perceived safety, and social cohesion. Moreover, existing research, largely focusing on assessing pre-implementation social acceptability and post-implementation impacts on crime, faces important methodological limitations. The following commentary reviews the existing literature and makes recommendations for future public health research on the impacts of supervised injection sites.
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Affiliation(s)
- Carolyn Côté-Lussier
- Centre Urbanisation Culture Société, Institut national de la recherche scientifique, Montréal, Québec, Canada.
- Centre international de criminologie comparée (CICC), Université de Montréal, Montréal, Québec, Canada.
- Regroupement intersectoriel de recherche en santé de l'Université du Québec (RISUQ), Montréal, Québec, Canada.
| | - Paul Rodrigues
- Centre Urbanisation Culture Société, Institut national de la recherche scientifique, Montréal, Québec, Canada
- Centre international de criminologie comparée (CICC), Université de Montréal, Montréal, Québec, Canada
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Moran L, Ondocsin J, Outram S, Ciccarone D, Werb D, Holm N, Arnold EA. How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives. Harm Reduct J 2024; 21:92. [PMID: 38734643 PMCID: PMC11088080 DOI: 10.1186/s12954-024-01014-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Mortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered. METHODS We conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: "clients" (individuals who use drugs and receive harm reduction services) and "providers" (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis. RESULTS We found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels. CONCLUSION This study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.
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Affiliation(s)
- Lissa Moran
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, 94143, USA.
| | - Jeff Ondocsin
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, 94143, USA
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Simon Outram
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Daniel Ciccarone
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Daniel Werb
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
- Division of Infectious Diseases & Global Public Health, UC San Diego School of Medicine, University of California, San Diego, CA, 92093, USA
| | - Nicole Holm
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Emily A Arnold
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, 94143, USA
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Cattell C, Hyshka E, Leier B, Mack C. Capacity, Rationality, and the Promotion of Autonomy: A Trauma-Informed Approach to Refusals of Care After Opioid Poisoning. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:48-51. [PMID: 38635442 DOI: 10.1080/15265161.2024.2327285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
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Grisamore SP, DeMatteo D. Overcoming stigma: Community support for overdose prevention sites. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104415. [PMID: 38593517 DOI: 10.1016/j.drugpo.2024.104415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
Overdose prevention sites (OPS) are beginning to be examined for their feasibility of implementation in the United States to curb the fatality of overdoses. Support for these sites varies greatly and can impact local policy, implementation, and the long-term viability of such programs. This study examined two communications strategies - research and anecdotal evidence - and their effect on public support for an OPS. One group (n= 106) was presented with a summary of research evidence for the efficacy of implementing an OPS in their community. The other group (n= 109) received similar information framed as personal anecdotes from people who use drugs (PWUD), people who work with PWUD, and community members of neighborhoods with an OPS. Communicating the efficacy of OPS as research evidence was associated with increased support for implementation and a decreased belief that an OPS will attract crime. Lower stigma towards PWUD was also associated with increased support. However, neither condition was associated with changes in stigma towards PWUD. Jurisdictions implementing OPS should utilize research evidence in communicating the program proposal to the public. Further research is needed regarding best practices for reducing stigma towards PWUD and the subsequent support for the implementation of an OPS.
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Affiliation(s)
- Simone P Grisamore
- Department of Psychological and Brain Sciences, Drexel University, United States.
| | - David DeMatteo
- Department of Psychological and Brain Sciences, Drexel University, United States; Thomas R. Kline School of Law, Drexel University, United States
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Collins AB, Macon EC, Levin S, Wunsch C, Wightman RS. "It gets you high as a kite but not unsick": Characterizations of and responses to a changing local drug supply by people who use drugs in Rhode Island. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104391. [PMID: 38490014 PMCID: PMC11127783 DOI: 10.1016/j.drugpo.2024.104391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The North American overdose crisis has continued at unprecedented rates with more than 100,000 overdose deaths occurring in the United States (US) in 2022. Overdose deaths have increasingly been polysubstance-involved, with novel substances (e.g., xylazine) complicating overdose risk and health outcomes. Understanding the effects of-and responses to-a changing drug supply among people who use drugs is critical to modifying harm reduction strategies to be more responsive to people's needs. METHODS This qualitative study draws on data collected from May to December 2022 in Rhode Island. Data include in-depth interviews with 50 people who use drugs and observational fieldwork in spaces frequented by participants (e.g., encampments, drop-in centers). Qualitative data were analyzed thematically drawing on concepts of situated rationality. RESULTS Participants described significant changes in the drug supply, with many attributing these transitions to COVID-19. Most participants characterized the local supply as "synthetic" with textures, color, and taste evolving. Notably, participants emphasized adverse outcomes related to available supplies, including during use (e.g., intense burning sensations) and post-consumption (e.g., heavy sedation, ongoing withdrawal, necrosis). Given the complex supply, participants highlighted the increased risk of overdose and shared how they altered their use practices to manage evolving health risks. CONCLUSION Our results underscore how people who use drugs characterized the local drug supply, including perceived changes to supply contents. Implementing and scaling up harm reduction interventions that reduce risk and reinforce the agency of people who use drugs are urgently needed to effectively address the overdose crisis.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA.
| | - E Claire Macon
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA
| | - Stacey Levin
- Parent Support Network of Rhode Island, Warwick, RI, USA
| | - Caroline Wunsch
- Lifespan Department of Psychiatry and Behavioral Health Services, Division of Addiction Medicine, Providence, RI, USA
| | - Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Ellis JD, Dunn KE, Huhn AS. Harm Reduction for Opioid Use Disorder: Strategies and Outcome Metrics. Am J Psychiatry 2024; 181:372-380. [PMID: 38706335 DOI: 10.1176/appi.ajp.20230918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Tweet: The authors discuss harm reduction strategies and associated outcome metrics in relation to the ongoing opioid crisis.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
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Havlik JL, Rhee TG, Rosenheck RA. Association of mental health related quality of life and other factors with treatment seeking for substance use disorders: A comparison of SUDs rooted in legal, partially legal, and illegal substances. PLoS One 2024; 19:e0302544. [PMID: 38683850 PMCID: PMC11057773 DOI: 10.1371/journal.pone.0302544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
The association of subjective mental health-related quality of life (MHRQOL) and treatment use among people experiencing common substance use disorders (SUDs) is not known. Furthermore, the association of a given substance's legal status with treatment use has not been studied. This work aims determine the association of MHRQOL with SUD treatment use, and how substance legal status modulates this relationship. Our analysis used nationally-representative data from the NESARC-III database of those experiencing past-year SUDs (n = 5,808) to compare rates of treatment use and its correlates among three groups: those with illicit substance use disorders (ISUDs); those with partially legal substance use disorders, i.e., cannabis use disorder (CUD); and those with fully legal substance use disorders, i.e., alcohol use disorder (AUD). Survey-weighted multiple regression analysis was used to assess the association of MHRQOL with likelihood of treatment use among these three groups, both unadjusted and adjusted for sociodemographic, behavioral, and diagnostic factors. Adults with past-year ISUDs were significantly more likely to use treatment than those with CUD and AUD. Among those with ISUDs, MHRQOL had no significant association with likelihood of treatment use. Those with past-year CUD saw significant negative association of MHRQOL with treatment use in unadjusted analysis, but not after controlling for diagnostic and other behavioral health factors. Those with past-year AUD had significant negative association of MHRQOL with treatment use in both unadjusted and adjusted analysis. If legalization and decriminalization continue, there may be a greater need for effective public education and harm reduction services to address this changing SUD landscape.
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Affiliation(s)
- John L. Havlik
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Taeho G. Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
- Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Robert A. Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States of America
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Wenger LD, Morris T, Knight KR, Megerian CE, Davidson PJ, Suen LW, Majano V, Lambdin BH, Kral AH. Radical hospitality: Innovative programming to build community and meet the needs of people who use drugs at a government-sanctioned overdose prevention site in San Francisco, California. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104366. [PMID: 38492432 PMCID: PMC11160962 DOI: 10.1016/j.drugpo.2024.104366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The Tenderloin Center (TLC), a multi-service center where people could receive or be connected to basic needs, behavioral health care, housing, and medical services, was open in San Francisco for 46 weeks in 2022. Within a week of operation, services expanded to include an overdose prevention site (OPS), also known as safe consumption site. OPSs have operated internationally for over three decades, but government-sanctioned OPSs have only recently been implemented in the United States. We used ethnographic methods to understand the ways in which a sanctioned OPS, situated in a multi-service center, impacts the lives of people who use drugs (PWUD). METHODS We conducted participant observation and in-depth interviews June-December 2022. Extensive field notes and 39 in-depth interviews with 24 TLC guests and 15 TLC staff were analyzed using an inductive analysis approach. Interviewees were asked detailed questions about their experiences using and working at the TLC. RESULTS TLC guests and staff described an atmosphere where radical hospitality-welcoming guests with extraordinary warmth, generosity, and unconditional acceptance-was central to the culture. We found that the co-location of an OPS within a multi-service agency (1) allowed for the culture of radical hospitality to flourish, (2) yielded a convenient one-stop shop model, (3) created a space for community building, and (4) offered safety and respite to guests. CONCLUSIONS The co-location of an OPS within a multi-service drop-in center is an important example of how such an organization can build positive sociality among PWUD while protecting autonomy and reducing overdose mortality. Overdose response and reversal is an act of relational accountability in which friends, peers, and even strangers intervene to protect and revive one another. This powerful intervention was operationalized as an anti-oppressive, horizontal activity through radical hospitality with a built environment that allowed PWUD to be both social and safe.
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Affiliation(s)
- Lynn D Wenger
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States.
| | - Terry Morris
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Kelly R Knight
- University of California, San Francisco, San Francisco, CA, United States
| | - Cariné E Megerian
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Peter J Davidson
- Univerity of California, San Diego, San Francisco, CA, United States
| | - Leslie W Suen
- University of California, San Francisco, San Francisco, CA, United States
| | - Veronica Majano
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Barrot H Lambdin
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Alex H Kral
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
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20
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Lee-Pii K, DeBeck K, Choi J, Sedgemore KO, Kerr T, Kennedy MC. Characterizing Use of Supervised Consumption Services among Street-involved Youth and Young Adults in the Context of an Overdose Crisis. J Urban Health 2024; 101:233-244. [PMID: 38536600 PMCID: PMC11052733 DOI: 10.1007/s11524-024-00849-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/28/2024]
Abstract
In response to an increase in overdose deaths, there was a rapid scale-up of supervised consumption services (SCS), including federally sanctioned SCS and low-barrier SCS known as overdose prevention sites (OPS), in Vancouver, Canada, beginning in December 2016. However, little is known about the use of such services among adolescents and young adults (AYA) in this context. We therefore sought to characterize factors associated with the use of federally sanctioned SCS and OPS among street-involved AYA who inject drugs in Vancouver during an overdose crisis. From December 2016 to March 2020, data were collected from a prospective cohort of street-involved AYA aged 14 to 26 at baseline. Using multivariable generalized estimating equation analyses, we identified factors associated with recent use of federally sanctioned SCS and OPS, respectively. Among 298 AYA who inject drugs, 172 (57.8%) and 149 (50.0%) reported using federally sanctioned SCS and OPS during the study period, respectively. In multivariable analyses, public injecting, negative police interactions, and residing or spending time ≥ weekly in the Downtown Eastside neighborhood were all positively associated with the use of federally sanctioned SCS and OPS, respectively. Additionally, ≥ daily unregulated opioid use and residential eviction were positively associated with federally sanctioned SCS use, while requiring help injecting was inversely associated. Self-identified female or non-binary gender was also positively associated with OPS use (all p < 0.05). Both federally sanctioned SCS and OPS successfully engaged AYA at heightened risk of adverse health outcomes. However, the lack of accommodation of AYA who require manual assistance with injecting at federally sanctioned SCS may be inhibiting service engagement.
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Affiliation(s)
- Kiera Lee-Pii
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC, V6B 5K3, Canada
| | - JinCheol Choi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Kali-Olt Sedgemore
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- 'Namgis First Nation, Alert Bay, BC, Canada
- Coalition of Peers Dismantling the Drug War, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- School of Social Work, University of British Columbia - Okanagan, 611-1628 Dickson Ave, Kelowna, BC, V1Y 9X1, Canada.
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21
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Young AM, Havens JR, Cooper HLF, Fallin-Bennett A, Fanucchi L, Freeman PR, Knudsen H, Livingston MD, McCollister KE, Stone J, Vickerman P, Freeman E, Jahangir T, Larimore E, White CR, Cheatom C, Community Staff K, Design Team K. Kentucky Outreach Service Kiosk (KyOSK) Study protocol: a community-level, controlled quasi-experimental, type 1 hybrid effectiveness study to assess implementation, effectiveness and cost-effectiveness of a community-tailored harm reduction kiosk on HIV, HCV and overdose risk in rural Appalachia. BMJ Open 2024; 14:e083983. [PMID: 38431295 PMCID: PMC10910671 DOI: 10.1136/bmjopen-2024-083983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Many rural communities bear a disproportionate share of drug-related harms. Innovative harm reduction service models, such as vending machines or kiosks, can expand access to services that reduce drug-related harms. However, few kiosks operate in the USA, and their implementation, impact and cost-effectiveness have not been adequately evaluated in rural settings. This paper describes the Kentucky Outreach Service Kiosk (KyOSK) Study protocol to test the effectiveness, implementation outcomes and cost-effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C and overdose risk in rural Appalachia. METHODS AND ANALYSIS KyOSK is a community-level, controlled quasi-experimental, non-randomised trial. KyOSK involves two cohorts of people who use drugs, one in an intervention county (n=425) and one in a control county (n=325). People who are 18 years or older, are community-dwelling residents in the target counties and have used drugs to get high in the past 6 months are eligible. The trial compares the effectiveness of a fixed-site, staffed syringe service programme (standard of care) with the standard of care supplemented with a kiosk. The kiosk will contain various harm reduction supplies accessible to participants upon valid code entry, allowing dispensing data to be linked to participant survey data. The kiosk will include a call-back feature that allows participants to select needed services and receive linkage-to-care services from a peer recovery coach. The cohorts complete follow-up surveys every 6 months for 36 months (three preceding kiosk implementation and four post-implementation). The study will test the effectiveness of the kiosk on reducing risk behaviours associated with overdose, HIV and hepatitis C, as well as implementation outcomes and cost-effectiveness. ETHICS AND DISSEMINATION The University of Kentucky Institutional Review Board approved the protocol. Results will be disseminated in academic conferences and peer-reviewed journals, online and print media, and community meetings. TRIAL REGISTRATION NUMBER NCT05657106.
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Affiliation(s)
- April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah L F Cooper
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Laura Fanucchi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Patricia R Freeman
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah Knudsen
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Melvin D Livingston
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Kathryn E McCollister
- Division of Health Services Research and Policy, University of Miami, Coral Gables, Florida, USA
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Edward Freeman
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | - Tasfia Jahangir
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Elizabeth Larimore
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Carol R White
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | | | - KyOSK Community Staff
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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22
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Lu A, Kim C, Rosen JG, Thompson E, Tardif J, Welwean R, Park JN. Supervised Inhalation Sites: Preventing Overdose and Reducing Health Inequities among People Who Use Drugs. Subst Use Misuse 2024; 59:520-526. [PMID: 38044494 PMCID: PMC10922979 DOI: 10.1080/10826084.2023.2287195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Policy and research on the implementation of services for people who inhale drugs lag behind similar efforts for people who inject drugs, limiting access to adequate harm reduction resources for people who inhale drugs. This commentary considers why supervised inhalation sites (SIS) are needed, highlights operational characteristics of four existing services, and advocates for future SIS research. Our hope is to encourage the expansion of SIS worldwide for overdose prevention and reduction of health inequities. Given the limited literature regarding SIS, more extensive study of these programs is warranted to incorporate inhalation into the implementation of supervised consumption sites to provide fair opportunities for all people who use drugs to do so safely without fear of stigma and overdose.
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Affiliation(s)
- Alison Lu
- School of Public Health, Brown University, Providence, Rhode Island
- Department of Neuroscience, Brown University, Providence, Rhode Island
| | - Claire Kim
- Department of Neuroscience, Brown University, Providence, Rhode Island
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
| | - Joseph G. Rosen
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
| | - Erin Thompson
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
| | - Jessica Tardif
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
| | - Ralph Welwean
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ju Nyeong Park
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
- Division of General Internal Medicine, The Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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23
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Tonin FS, Alves da Costa F, Fernandez-Llimos F. Impact of harm minimization interventions on reducing blood-borne infection transmission and some injecting behaviors among people who inject drugs: an overview and evidence gap mapping. Addict Sci Clin Pract 2024; 19:9. [PMID: 38310293 PMCID: PMC10838443 DOI: 10.1186/s13722-024-00439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND This study aimed to synthetize the evidence on the effectiveness of harm minimization interventions on reducing blood-borne infection transmission and injecting behaviors among people who inject drugs (PWID) through a comprehensive overview of systematic reviews and evidence gap mapping. METHODS A systematic review was conducted with searches in PubMed and Scopus to identify systematic reviews assessing the impact of interventions aimed at reducing the harms associated with injectable drug use. The overall characteristics of the studies were extracted and their methodological quality was assessed using AMSTAR-2. An evidence gap map was constructed, highlighting the most frequently reported outcomes by intervention (CRD42023387713). RESULTS Thirty-three systematic reviews were included. Of these, 14 (42.2%) assessed the impact of needle/syringe exchange programs (NSEP) and 11 (33.3%) examined opioid agonist therapy (OAT). These interventions are likely to be associated with reductions of HIV/HCV incidence (10-40% risk reduction for NSEP; 50-60% for OAT) and sharing injecting paraphernalia (50% for NSEP, 25-85% for OAT), particularly when combined (moderate evidence). Behavioral/educational interventions were assessed in 12 reviews (36.4%) with most authors in favor/partially in favor of the use of these approaches (moderate evidence). Take-home naloxone programs and supervised-injection facilities were each assessed in two studies (6.1%), which reported inconclusive results (limited/inconsistent evidence). Most authors reported high levels of heterogeneity and risk of bias. Other interventions and outcomes were inadequately reported. Most systematic reviews presented low or critically low quality. CONCLUSION The evidence is sufficient to support the effectiveness of OAT, NSEP and their combination in reducing blood-borne infection transmission and certain injecting behaviors among PWID. However, evidence of other harm minimizations interventions in different settings and for some outcomes remain insufficient.
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Affiliation(s)
- Fernanda S Tonin
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, Lisbon, Portugal.
| | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit, (UCIBIO-i4HB) Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Park JW, Wilson-Barthes MG, Dulin AJ, Hogan JW, Mugavero MJ, Napravnik S, Carey MP, Fava JL, Dale SK, Earnshaw VA, Johnson B, Dougherty-Sheff S, Agil D, Howe CJ. Multilevel Resilience and HIV Virologic Suppression Among African American/Black Adults in the Southeastern United States. J Racial Ethn Health Disparities 2024; 11:313-325. [PMID: 37043167 PMCID: PMC10092932 DOI: 10.1007/s40615-023-01520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To assess overall and by neighborhood risk environments whether multilevel resilience resources were associated with HIV virologic suppression among African American/Black adults in the Southeastern United States. SETTING AND METHODS This clinical cohort sub-study included 436 African American/Black participants enrolled in two parent HIV clinical cohorts. Resilience was assessed using the Multilevel Resilience Resource Measure (MRM) for African American/Black adults living with HIV, where endorsement of a MRM statement indicated agreement that a resilience resource helped a participant continue HIV care despite challenges or was present in a participant's neighborhood. Modified Poisson regression models estimated adjusted prevalence ratios (aPRs) for virologic suppression as a function of categorical MRM scores, controlling for demographic, clinical, and behavioral characteristics at or prior to sub-study enrollment. We assessed for effect measure modification (EMM) by neighborhood risk environments. RESULTS Compared to participants with lesser endorsement of multilevel resilience resources, aPRs for virologic suppression among those with greater or moderate endorsement were 1.03 (95% confidence interval: 0.96-1.11) and 1.03 (0.96-1.11), respectively. Regarding multilevel resilience resource endorsement, there was no strong evidence for EMM by levels of neighborhood risk environments. CONCLUSIONS Modest positive associations between higher multilevel resilience resource endorsement and virologic suppression were at times most compatible with the data. However, null findings were also compatible. There was no strong evidence for EMM concerning multilevel resilience resource endorsement, which could have been due to random error. Prospective studies assessing EMM by levels of the neighborhood risk environment with larger sample sizes are needed.
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Affiliation(s)
- Jee Won Park
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
- Program in Epidemiology, University of Delaware, Newark, DE, USA
| | - Marta G Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
| | - Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Joseph W Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA.
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Fowle MZ, Routhier G. Mortal Systemic Exclusion Yielded Steep Mortality-Rate Increases In People Experiencing Homelessness, 2011-20. Health Aff (Millwood) 2024; 43:226-233. [PMID: 38315931 DOI: 10.1377/hlthaff.2023.01039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The number and percentage of people in the US dying while homeless has increased in recent years. However, information about the causes of death most prevalent among this population, and about how cause-specific mortality rates may be shifting over time, has been limited to locally specific data. Using a unique data set of 22,143 homeless decedents in twenty-two localities across ten states and Washington, D.C., from the period 2011-20, we found large increases in all-cause and cause-specific homeless mortality rates. The largest increases in cause-specific homeless mortality rates in the ten-year period were for deaths related to drug and alcohol overdose, diabetes, infection, cancer, homicide, and traffic injury. We discuss implications of these results and posit that people experiencing homelessness are systematically excluded from the life-affirming institutions of housing and health care, in an example of mortal systemic exclusion. The findings have important implications for existing local and federal policy approaches to homelessness.
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Affiliation(s)
- Matthew Z Fowle
- Matthew Z. Fowle, University of Pennsylvania, Philadelphia, Pennsylvania
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26
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Fixler AL, Jacobs LA, Jones DB, Arnold A, Underwood EE. There goes the neighborhood? The public safety enhancing effects of a mobile harm reduction intervention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104329. [PMID: 38232437 DOI: 10.1016/j.drugpo.2024.104329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/10/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Buprenorphine is a gold-standard treatment for opioid use disorders, but most people with these disorders do not access it. Barriers to treatment access may be diminished by low-threshold mobile treatment programs but concern regarding their impact on local public safety challenges their adoption. METHODS This quasi-experimental study uses difference-in-differences analyses to measure the impact of four mobile buprenorphine clinics in Pittsburgh on neighborhood arrest rates. The study period spans 2018 to 2022, with a pre-intervention period of 11 to 12 quarters and a post-intervention period of 7 to 8 quarters (dependent on neighborhood). A treatment group of 84 census block groups in the areas surrounding clinics during the time period after their establishment were compared to a control group of city census blocks not within one mile of a clinic plus treated block groups in the two years prior to clinic establishment. Outcome variables include drug, non-drug, and total arrests, measured quarterly per 100 in population. RESULTS Compared to block groups further than 1 mile from a clinic, arrests fell by 34.13 % (b = -0.358, 95 % CI = -0.557, -0.158), drug arrests by 33.85 % (b = -0.087, 95 % CI = -0.151, -0.023), and non-drug related arrests by 22.29 % (b = -0.179, 95 % CI = -0.302, -0.057). Drug arrests declined significantly on days when the clinics were not present (b = -0.015, 95 % CI = -0.025, -0.006), with no significant change on clinic operational days (b = -0.002, 95 % CI = -0.016, -0.013). Total arrests declined significantly on days when clinics were and were not present (b = -0.045, 95 % CI = -0.078, -0.012; and b = -0.052, CI = -0.082, -0.023, respectively). CONCLUSIONS Mobile clinics providing medication for opioid use disorders were associated with reduced neighborhood arrest rates. Expansion of mobile services could promote health equity and public safety.
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Affiliation(s)
- Alex L Fixler
- School of Social Work, University of Pittsburgh. 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States.
| | - Leah A Jacobs
- School of Social Work, University of Pittsburgh. 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States
| | - Daniel B Jones
- Graduate School of Public and International Affairs, University of Pittsburgh, 3424 Wesley W. Posvar Hall, 230 South Bouquet Street, Pittsburgh, PA 15260, United States
| | - Aaron Arnold
- Prevention Point Pittsburgh, 5913 Penn Avenue, Pittsburgh, PA 15206, United States
| | - Emily E Underwood
- School of Social Work, University of Pittsburgh. 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States
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27
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Mayer M, Mejia Urieta Y, Martinez LS, Komaromy M, Hughes U, Chatterjee A. Encampment Clearings And Transitional Housing: A Qualitative Analysis Of Resident Perspectives. Health Aff (Millwood) 2024; 43:218-225. [PMID: 38315933 DOI: 10.1377/hlthaff.2023.01040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The number of people experiencing homelessness in tent encampments in the US has increased significantly. Citing concerns over health and safety, many cities have pursued highly visible encampment removals. In January 2022, a major tent encampment in Boston, Massachusetts, was cleared using a unique approach: Most encampment residents were placed in transitional harm reduction housing. We conducted interviews between July 2022 and February 2023 with thirty former encampment residents to explore how the encampment clearing affected their health and sense of safety. We also explored participants' perspectives on harm reduction housing. Of those interviewed, fourteen people had been placed in such housing. Among those not placed, the encampment clearing tended to exacerbate health and safety concerns, especially those related to mental health conditions and risk for violence. Among people successfully placed, harm reduction housing improved health and safety and allowed participants to make meaningful progress toward long-term goals such as addiction recovery, management of chronic health conditions, and permanent housing. Our findings suggest that encampments can have safety-promoting characteristics, but if encampment removal is pursued, offering harm reduction housing after removal can be beneficial.
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Affiliation(s)
- Michael Mayer
- Michael Mayer , Boston Medical Center, Boston, Massachusetts
| | | | | | | | - Ursel Hughes
- Ursel Hughes, Dimmock Community Health Center, Boston, Massachusetts
| | - Avik Chatterjee
- Avik Chatterjee, Boston Medical Center and Boston University
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28
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Rammohan I, Gaines T, Scheim A, Bayoumi A, Werb D. Overdose mortality incidence and supervised consumption services in Toronto, Canada: an ecological study and spatial analysis. Lancet Public Health 2024; 9:e79-e87. [PMID: 38307685 DOI: 10.1016/s2468-2667(23)00300-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Supervised consumption services (SCS) prevent overdose deaths onsite; however, less is known about their effect on population-level overdose mortality. We aimed to characterise overdose mortality in Toronto, ON, Canada, and to establish the spatial association between SCS locations and overdose mortality events. METHODS For this ecological study and spatial analysis, we compared crude overdose mortality rates before and after the implementation of nine SCS in Toronto in 2017. Data were obtained from the Office of the Chief Coroner of Ontario on cases of accidental death within the City of Toronto for which the cause of death involved the use of an opiate, synthetic or semi-synthetic opioid, or other psychoactive substance. We assessed overdose incident data for global spatial autocorrelation and local clustering, then used geographically weighted regression to model the association between SCS proximity and overdose mortality incidence in 2018 and 2019. FINDINGS We included 787 overdose mortality events in Toronto between May 1, 2017, and Dec 31, 2019. The overdose mortality rate decreased significantly in neighbourhoods that implemented SCS (8·10 deaths per 100 000 people for May 1-July 31, 2017, vs 2·70 deaths per 100 000 people for May 1-July 31, 2019; p=0·037), but not in other neighbourhoods. In a geographically weighted regression analysis that adjusted for the availability of substance-use-related services and overdose-related sociodemographic factors by neighbourhood, the strongest local regression coefficients of the association between SCS and overdose mortality location ranged from -0·60 to -0·64 per mile in 2018 and from -1·68 to -1·96 per mile in 2019, suggesting an inverse association. INTERPRETATION We found that the period during which SCS were implemented in Toronto was associated with a reduced overdose mortality in surrounding neighbourhoods. The magnitude of this inverse association increased from 2018 to 2019, equalling approximately two overdose fatalities per 100 000 people averted in the square mile surrounding SCS in 2019. Policy makers should consider implementing and sustaining SCS across neighbourhoods where overdose mortality is high. FUNDING The Canadian Institutes of Health Research.
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Affiliation(s)
- Indhu Rammohan
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, ON, Canada
| | - Tommi Gaines
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ayden Scheim
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ahmed Bayoumi
- MAP Centre on Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, ON, Canada; MAP Centre on Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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29
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Brown L, Rishel Brakey H, Page K. Voices of the unhoused from Santa Fe, New Mexico: A mixed methods study of health status, substance use, and community harm reduction program perspectives. J Prev Interv Community 2024; 52:73-97. [PMID: 38757899 DOI: 10.1080/10852352.2024.2352266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
No published studies have examined the community service priorities and harm reduction perspectives of unhoused people in Santa Fe, New Mexico. We conducted a mixed methods pilot study of 56 unhoused people at community locations in Santa Fe to: (1) assess the current prevalence of chronic medical conditions and substance use; (2) highlight community service priorities; and (3) explore views of innovative community harm reduction programs. Our first hypothesis was there would be high prevalence of chronic medical conditions, for which we found high prevalence of post-traumatic stress disorder, major depression, substance use disorders, chronic pain, and hypertension. Our second hypothesis was that we would find top community service priorities of housing, food, and health care. We found long- and short-term housing and food, but not healthcare, top priorities. Our third hypothesis was that we would find mixed support for community harm reduction initiatives like managed alcohol programs and overdose prevention centers. We found positive, not mixed, support for these community harm reduction programs among Santa Fe's unhoused. Unhoused study participants ranged in age 27-77 years, with lifetime years unhoused from less than one year to 63 years. Study limitations included small sample size, convenience sampling, and descriptive results. Policies and program initiatives supporting additional Housing First options, managed alcohol programs, and overdose prevention centers in the Santa Fe community are clearly indicated to increase engagement with this vulnerable population. Future research should focus on inclusion of the perspectives of the unhoused in the design, conduct, evaluation, and dissemination of community programs to meet the needs of the unhoused, with re-defined outcomes to include changes in quality of life, program engagement, demarginalization, and future goals and plans, beyond currently utilized health and social service program outcome measures.
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Affiliation(s)
- Laura Brown
- Center for Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Heidi Rishel Brakey
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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30
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Collins AB, Kaplowitz E, Bastani P, McKee H, Whitaker D, Hallowell BD, McKenzie M. "I Don't Go Overboard": Perceptions of Overdose Risk and Risk Reduction Strategies among People Who Use Drugs in Rhode Island. Subst Use Misuse 2023; 59:673-679. [PMID: 38124349 PMCID: PMC10922331 DOI: 10.1080/10826084.2023.2294968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background: North America experiencing an unprecedented overdose epidemic, with data estimating almost 110,000 overdose deaths occurring in 2022 in the United States (US). To address fatal overdoses in the US, community organizations and local health departments in some jurisdictions have expanded community distribution of naloxone, and increased overdose prevention education, and other harm reduction supplies and services (e.g., fentanyl test strips, drug checking programs) to reduce harm for people who use drugs (PWUD). Objectives: Understanding how PWUD manage overdose risk within the context of these expanded services is important for ensuring public health services are meeting their needs. Semi-structured qualitative interviews were conducted with 25 PWUD who were accessing harm reduction services in Rhode Island. Data were imported into NVivo where they were coded and analyzed thematically. Results: Our findings demonstrate the complexity of managing overdose risk in the context of a fentanyl drug supply. While most participants were concerned about overdosing, they sought to manage overdose risk through their own harm reduction practices (e.g., testing their drugs, going slow) and drug purchasing dynamics, even when using alone. Conclusions: Study findings point to the need to implement and scale-up community-level interventions to better support PWUD within the context of the current US overdose crisis.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Eliana Kaplowitz
- Center for Health and Justice Transformation, Providence, Rhode Island, USA
| | - Parsa Bastani
- Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Haley McKee
- The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Delaney Whitaker
- Center for Health and Justice Transformation, Providence, Rhode Island, USA
| | - Benjamin D Hallowell
- Center For Health Data and Analysis, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Michelle McKenzie
- The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Salvalaggio G, Brooks H, Caine V, Gagnon M, Godley J, Houston S, Kennedy MC, Kosteniuk B, Livingston J, Saah R, Speed K, Urbanoski K, Werb D, Hyshka E. Flawed reports can harm: the case of supervised consumption services in Alberta. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:928-933. [PMID: 37930628 PMCID: PMC10661131 DOI: 10.17269/s41997-023-00825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
Supervised consumption services have been scaled up within Canada and internationally as an ethical imperative in the context of a public health emergency. A large body of peer-reviewed evidence demonstrates that these services prevent poisoning deaths, reduce infectious disease transmission risk behaviour, and facilitate clients' connections to other health and social services. In 2019, the Alberta government commissioned a review of the socioeconomic impacts of seven supervised consumption services in the province. The report is formatted to appear as an objective, scientifically credible evaluation of these services; however, it is fundamentally methodologically flawed, with a high risk of biases that critically undermine its authors' assessment of the scientific evidence. The report's findings have been used to justify decisions that jeopardize the health and well-being of people who use drugs both in Canada and internationally. Governments must ensure that future assessments of supervised consumption services and other public health measures to address drug poisoning deaths are scientifically sound and methodologically rigorous. Health policy must be based on the best available evidence, protect the right of structurally vulnerable populations to access healthcare, and not be contingent on favourable public opinion or prevailing political ideology.
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Affiliation(s)
- Ginetta Salvalaggio
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Hannah Brooks
- School of Public Health, University of Alberta, Nashville, TN, USA
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Jenny Godley
- Department of Sociology, University of Calgary, Calgary, AB, Canada
| | - Stan Houston
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mary Clare Kennedy
- British Columbia Centre On Substance Use, University of British Columbia - Okanagan School of Social Work, Vancouver, BC, Canada
| | - Brynn Kosteniuk
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jamie Livingston
- Department of Criminology, Saint Mary's University, Halifax, NS, Canada
| | - Rebecca Saah
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kelsey Speed
- School of Public Health, University of Alberta, Vancouver, BC, Canada
| | - Karen Urbanoski
- School of Public Health & Social Policy, University of Victoria, Victoria, BC, Canada
| | - Dan Werb
- Centre On Drug Policy Evaluation, MAP Centre On Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Division of Infectious Disease & Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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32
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Rider N, Safi F, Marshall T, Jones S, Seo B, Viste D, Taplay PE, Rioux W, Ghosh SM. Investigating uses of peer-operated Virtual Overdose Monitoring Services (VOMS) beyond overdose response: a qualitative study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:809-817. [PMID: 37956211 DOI: 10.1080/00952990.2023.2271642] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Abstract
Background: Virtual overdose monitoring services (VOMS) are novel technologies that allow remote monitoring of individuals while they use substances (especially those who use alone) electronically.Objectives: The authors explored key partner perspectives regarding services offered by VOMS beyond overdose response with the aim of understanding the breadth and perception of the services amongst those that use these services and are impacted by them.Methods: Forty-seven participants from six key partner groups [peers who had used VOMS (25%), peers who had not used VOMS (17%), family members of peers (11%), health professionals (21%), harm reduction sector employees (15%), and VOMS operators (15%)] underwent 20-to-60-minute semi-structured telephone interviews. Of peer and family groups, thirteen participants identified as female, eleven as male and one as non-binary, gender data was not recorded for other key partner groups. Interview guides were developed and interviews were conducted until saturation was reached across all participants. Themes and subthemes were identified and member checked with partner groups.Results: Participants indicated that uses of VOMS beyond overdose monitoring included: (1) providing mental health support and community referral; (2) methamphetamine agitation de-escalation; (3) advice on self-care and harm reduction; and (4) a sense of community and peer support. Respondents were divided on how VOMS might affect emergency services (5).Conclusions: VOMS are currently being used for purposes beyond drug poisoning prevention, including community methamphetamine psychosis de-escalation, mental health support, and community peer support. VOMS are capable of delivering a broad suite of harm reduction services and referring clients to recovery-oriented services.
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Affiliation(s)
- Nathan Rider
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Fahad Safi
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tyler Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Boogyung Seo
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dylan Viste
- Three Hive Consulting, Edmonton, Alberta, Canada
| | | | - William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Pennington ML, Dupree J, Hoffman K, Beattie EH, Coe E, Ostiguy W, Kimbrel NA, Meyer EC, Gulliver SB. First Responder Attitudes Regarding Working Near a Supervised Injection Facility: Relationship to Burnout, Secondary Traumatic Stress, and Compassion Satisfaction. Workplace Health Saf 2023; 71:543-550. [PMID: 37530030 DOI: 10.1177/21650799231188364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Emergency responders are the most frequent overdose responders, however, little is known about the impact of supervised injection facility (SIF) location on first responders. The purpose of this study was to determine whether firefighter/paramedic attitudes about being stationed near an SIF were related to burnout, secondary traumatic stress, and compassion satisfaction. METHODS Firefighter/paramedics from Vancouver Fire and Rescue Services (n = 54) completed an online survey. General linear models were used to assess differences in burnout, secondary traumatic stress, and compassion satisfaction based on attitudes regarding being stationed near an SIF while controlling for occupational stress. FINDINGS Firefighters with negative attitudes regarding station placement near an SIF experienced more burnout compared with those with neutral/mixed attitudes and less compassion satisfaction compared with those with positive attitudes. There were no differences between those with positive and neutral/mixed attitudes. CONCLUSIONS These findings have implications for education and training of emergency responders stationed near SIFs. They also highlight the need for more research into the effects of and possible clinical opportunities needed to support first responders' work near an SIF. APPLICATION TO PRACTICE While these findings represent early exploratory evidence, increased burnout and reduced compassion satisfaction may be common reactions among first responders who experience negative attitudes toward SIFs. Prevention efforts could incorporate programs to enhance health and well-being of first responders and education regarding substance use and harm reduction, while workforce surveillance for signs of distress or burnout could be implemented to trigger additional mental health services and interventions. while policymakers should remain aware of SIF-related impacts on all stakeholders, including first responders.
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Affiliation(s)
| | | | - Kristy Hoffman
- Baylor Scott & White Research Institute
- Baylor University
| | | | | | | | - Nathan A Kimbrel
- Durham Veterans Affairs (VA) Health Care System
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center
- Duke University School of Medicine
| | | | - Suzy B Gulliver
- Baylor Scott & White Research Institute
- Texas A&M University Health Science Center
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Tapper A, Ahern C, Graveline-Long Z, Newberger NG, Hughto JMW. The utilization and delivery of safer smoking practices and services: a narrative synthesis of the literature. Harm Reduct J 2023; 20:160. [PMID: 37891658 PMCID: PMC10612300 DOI: 10.1186/s12954-023-00875-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Providing sterile drug smoking materials to people who use drugs can prevent the acquisition of infectious diseases and reduce overdose risk. However, there is a lack of understanding of how these practices are being implemented and received by people who use drugs globally. METHODS A systematic review of safer smoking practices was conducted by searching PubMed, PsycInfo, Embase for relevant peer-reviewed, English-language publications from inception or the availability of online manuscripts through December 2022. RESULTS Overall, 32 peer-reviewed papers from six countries were included. 30 studies exclusively included people who use drugs as participants (n = 11 people who use drugs; generally, n = 17 people who smoke drugs, n = 2 people who inject drugs). One study included program staff serving people who use drugs, and one study included staff and people who use drugs. Sharing smoking equipment (e.g., pipes) was reported in 25 studies. People who use drugs in several studies reported that pipe sharing occurred for multiple reasons, including wanting to accumulate crack resin and protect themselves from social harms, such as police harassment. Across studies, smoking drugs, as opposed to injecting drugs, were described as a crucial method to reduce the risk of overdose, disease acquisition, and societal harms such as police violence. Ten studies found that when people who use drugs were provided with safer smoking materials, they engaged in fewer risky drug use behaviors (e.g., pipe sharing, using broken pipes) and showed improved health outcomes. However, participants across 11 studies reported barriers to accessing safer smoking services. Solutions to overcoming safer smoking access barriers were described in 17 studies and included utilizing peer workers and providing safer smoking materials to those who asked. CONCLUSION This global review found that safer smoking practices are essential forms of harm reduction. International policies must be amended to help increase access to these essential tools. Additional research is also needed to evaluate the efficacy of and access to safer smoking services, particularly in the U.S. and other similar countries, where such practices are being implemented but have not been empirically studied in the literature.
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Affiliation(s)
| | | | | | - Noam G Newberger
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02903, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, 02903, USA
- The Fenway Institute, Fenway Health, Boston, MA, 02215, USA
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Ali F, Russell C, Kaura A, Leslie P, Bayoumi AM, Hopkins S, Wells S. Client experiences using a new supervised consumption service in Sudbury, Ontario: A qualitative study. PLoS One 2023; 18:e0292862. [PMID: 37844109 PMCID: PMC10578573 DOI: 10.1371/journal.pone.0292862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
Overdoses are increasing in the province of Ontario, Canada, where northern communities such as Sudbury have witnessed disproportionately elevated rates, with opioid-related deaths double that of the provincial average. To address this issue, governments have implemented supervised consumption services (SCS) where people who use drugs (PWUD) can use their pre-obtained substances onsite under trained supervision. In September 2022, the city of Sudbury opened its first SCS, 'The Spot', but the site's sustainability is contingent on demonstrating benefit to PWUD and the neighboring community. We undertook a qualitative study exploring experiences among clients who used the consumption service inside The Spot. In December 2022, clients of The Spot were invited to participate in a brief survey which collected socio-demographic information and substance use profiles, followed by an in-person semi-structured qualitative interview. Participant survey and interview data were combined with administrative site utilization data provided by site staff of all clients who accessed the consumption service from September 2022 to August 2023 to examine overall service utilization and uptake. Qualitative data were analyzed using iterative thematic analysis techniques, and results were informed by common responses to research questions. The responses were narratively presented. Administrative site utilization data highlighted a relatively stable increase in uptake and utilization of the site since its inception. A total of 20 clients participated in the survey and semi-structured interviews. Participants described the importance of the site in preventing and responding to overdoses, providing a safe and comfortable environment to consume their drugs, and decreasing public drug use, which they suggested may potentially reduce stigmatization in the community. However, clients also suggested challenges, including issues regarding site operational policies that hindered consumption room utilization. Service suggestions made by clients to improve site utilization include the addition of inhalation services, relocating the site to a location in downtown Sudbury where PWUD commonly congregate, and extending operational hours. Positive impacts and recommendations can be drawn on and considered by other northern or rural communities interested in implementing similar harm reduction services.
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Affiliation(s)
- Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Toronto, Ontario, Canada
| | - Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Toronto, Ontario, Canada
| | - Ashima Kaura
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Toronto, Ontario, Canada
| | - Peter Leslie
- Harm Reduction Worker, Co-chair Street Health Board of Directors, Founding Member of Toronto Overdose Prevention Society, Moss Park OPS and Toronto Harm Reduction Alliance, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Shaun Hopkins
- The Works, Toronto Public Health, Toronto, Ontario, Canada
| | - Samantha Wells
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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Feder KA, Patel EU, Buresh M, Kirk GD, Mehta SH, Genberg BL. Trends in self-reported non-fatal overdose and patterns of substance use before and during the COVID-19 pandemic in a prospective cohort of adults who have injected drugs - Baltimore, Maryland, 2014-2022. Drug Alcohol Depend 2023; 251:110954. [PMID: 37716287 PMCID: PMC10538370 DOI: 10.1016/j.drugalcdep.2023.110954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/25/2023] [Accepted: 08/26/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Overdose deaths increased during the COVID-19 pandemic in the United States. Less is known about drug use behavior changes during the same time period. We examined differences in non-fatal overdose and drug use behaviors before and after the start of the COVID-19 pandemic in a community-recruited cohort of adults who have injected drugs. METHODS 721 participants attended 7401 visits between Jan 2014 and Mar 2022. Outcomes (non-fatal overdose, drug route of administration, type of drugs used) were assessed via self-report in the last six months. We compared pre-pandemic (Jan 2014-Mar 2020) to inter-pandemic (Dec 2020-Mar 2022) prevalence of each outcome using Cohcrane-Maentel-Haeszel odds ratios (CMH-OR). We then estimated probabilities for transitioning between specific behaviors from participants' last pre-pandemic visit to their first inter-pandemic visit. RESULTS Comparing pre-pandemic visits to inter-pandemic visits, the prevalence of non-fatal overdose did not change (CMH-OR 1.06, 95% CI 0.75-1.50); the prevalence of injection (CMH-OR 0.13, 95% CI 0.1-0.17) and non-injection (CMH-OR 0.51, 95% CI 0.42-0.61) drug use declined. More than a third (35.7%) of persons using both injection and non-injection drugs pre-pandemic transitioned to exclusive non-injection use during the pandemic. By contrast, few (4.0%) persons using non-injection drugs exclusively pre-pandemic transitioned to injecting during the pandemic. CONCLUSION Among adults who have injected drugs, the start of the COVID-19 pandemic was associated with a reduced drug use prevalence and transitions from injection to non-injection use. Average overdose prevalence was unchanged, but these behavior changes may have helped mitigate overdose harm.
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Affiliation(s)
- Kenneth A Feder
- Department of Mental Health, Bloomberg School of Public Health, USA.
| | - Eshan U Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Megan Buresh
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
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Crossin R, Cleland L, Wilkins C, Rychert M, Adamson S, Potiki T, Pomerleau AC, MacDonald B, Faletanoai D, Hutton F, Noller G, Lambie I, Sheridan JL, George J, Mercier K, Maynard K, Leonard L, Walsh P, Ponton R, Bagshaw S, Muthukumaraswamy S, McIntosh T, Poot E, Gordon P, Sharry P, Nutt D, Boden J. The New Zealand drug harms ranking study: A multi-criteria decision analysis. J Psychopharmacol 2023; 37:891-903. [PMID: 37353972 PMCID: PMC10481626 DOI: 10.1177/02698811231182012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
AIMS The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth. METHODS Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software. RESULTS When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others. CONCLUSIONS The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.
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Affiliation(s)
- Rose Crossin
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Lana Cleland
- Department of Population Health, University of Otago, Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Chris Wilkins
- SHORE & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Marta Rychert
- SHORE & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Simon Adamson
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Tuari Potiki
- Office of Māori Development, University of Otago, Dunedin, New Zealand
| | - Adam C Pomerleau
- National Poisons Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Blair MacDonald
- National Drug Intelligence Bureau, New Zealand Police, Wellington, New Zealand
| | - Dwaine Faletanoai
- Pacific Mental Health and Addictions Services (Takanga a Fohe), Waitemata District Health Board, Takapuna, New Zealand
| | - Fiona Hutton
- Institute of Criminology, Victoria University of Wellington, Wellington, New Zealand
| | - Geoff Noller
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
- New Zealand Needle Exchange Programme, National Office, Christchurch, New Zealand
| | - Ian Lambie
- Department of Psychology, University of Auckland, Auckland, New Zealand
| | - Jane L Sheridan
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jason George
- New Zealand Needle Exchange Programme, National Office, Christchurch, New Zealand
| | - Kali Mercier
- New Zealand Drug Foundation, Wellington, New Zealand
| | | | - Louise Leonard
- Community and Other Drug Service, Waikato District Health Board, Waikato, New Zealand
| | | | - Rhys Ponton
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sue Bagshaw
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Suresh Muthukumaraswamy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tracey McIntosh
- School of Māori Studies and Pacific Studies, Faculty of Arts, University of Auckland, Auckland, New Zealand
- Ministry of Social Development, Wellington, New Zealand
| | | | | | - Patrick Sharry
- People and Decisions, Sydney, Australia
- Australian Graduate School of Management, University of New South Wales, Sydney, Australia
| | - David Nutt
- Centre for Neuropsychopharmacology, Imperial College, London, UK
| | - Joseph Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Rioux W, Marshall T, Ghosh SM. Virtual overdose monitoring services and overdose prevention technologies: Opportunities, limitations, and future directions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104121. [PMID: 37453373 DOI: 10.1016/j.drugpo.2023.104121] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Overdose mortality has continued to rise in North America and across the globe in people who use drugs. Current harm reduction strategies such as supervised consumption sites and naloxone kit distribution have been important public health strategies implemented to decrease the harms associated with illicit drug use however have key limitations which prevent their scalability. This is represented in statistics which indicate that the vast majority of overdose mortality occur in individuals who use drugs by themselves. To address this, virtual overdose monitoring services and overdose detection technologies have emerged as an adjunct solution that may help improve access to harm reduction services for those that cannot or choose not to access current in-person services. This article outlines the current limitations of harm reduction services, the opportunities, challenges, and controversies of these technologies and services, and suggests avenues for additional research and policy development.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tyler Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of General Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Guise A, Harris M, McCusker M, McNeil R, Werb D. Stigma is stopping an evidence based response to drug overdose deaths in the UK. BMJ 2023; 382:e074934. [PMID: 37558236 DOI: 10.1136/bmj-2023-074934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
| | | | | | - Ryan McNeil
- University of Yale, New Haven, Connecticut, USA
| | - Dan Werb
- University of Toronto. Toronto, Canada
- University of California San Diego, San Diego, USA
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van Draanen J, Hamilton J, Morgan J, Maxwell S, Taylor T, Richardson L, Nolan S. Supervised smoking facility access, harm reduction practices, and substance use changes during the COVID-19 pandemic: a community-engaged cross-sectional study. Harm Reduct J 2023; 20:101. [PMID: 37525168 PMCID: PMC10388471 DOI: 10.1186/s12954-023-00825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The potential public health benefits of supervised smoking facilities (SSFs) are considerable, and yet implementation of SSFs in North America has been slow. We conducted this study to respond to significant knowledge gaps surrounding SSF utilization and to characterize substance use, harm reduction practices, and service utilization following the onset of the COVID-19 pandemic. METHODS A questionnaire was self-administered at a single site by 175 clients using an outdoor SSF in Vancouver, Canada, between October-December 2020. Questionnaire responses were summarized using descriptive statistics. Multinomial logistic regression techniques were used to examine factors associated with increased SSF utilization. RESULTS Almost all respondents reported daily substance use (93% daily use of opioids; 74% stimulants). Most used opioids (85%) and/or methamphetamine (66%) on the day of their visit to the SSF. Respondents reported drug use practice changes at the onset of COVID-19 to reduce harm, including using supervised consumption sites, not sharing equipment, accessing medically prescribed alternatives, cleaning supplies and surfaces, and stocking up on harm reduction supplies. Importantly, 45% of SSF clients reported using the SSF more often since the start of COVID-19 with 65.2% reporting daily use of the site. Increased substance use was associated with increased use of the SSF, after controlling for covariates. CONCLUSIONS Clients of the SSF reported increasing not only their substance use, but also their SSF utilization and harm reduction practices following the onset of COVID-19. Increased scope and scale of SSF services to meet these needs are necessary.
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Affiliation(s)
- Jenna van Draanen
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Child, Family, and Population Health Nursing, Health Sciences Building, University of Washington, Box 357262, Seattle, WA, 98195-0005, USA.
| | - Jonah Hamilton
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Jeffrey Morgan
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott Maxwell
- Overdose Prevention Participatory Research Assistant Program, Overdose Prevention Society, 58 E Hastings St, Vancouver, BC, V6A 1N1, Canada
| | - Tara Taylor
- Overdose Prevention Participatory Research Assistant Program, Overdose Prevention Society, 58 E Hastings St, Vancouver, BC, V6A 1N1, Canada
- Spencer Creo Foundation, 500-610 Main St, Vancouver, BC, V6A 2V3, Canada
| | - Lindsey Richardson
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Sociology, Faculty of Arts, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Seonaid Nolan
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Tabanelli R, Brogi S, Calderone V. Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going? Int J Mol Sci 2023; 24:10888. [PMID: 37446064 DOI: 10.3390/ijms241310888] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
This review article offers an outlook on the use of opioids as therapeutics for treating several diseases, including cancer and non-cancer pain, and focuses the analysis on the opportunity to target opioid receptors for treating opioid use disorder (OUD), drug withdrawal, and addiction. Unfortunately, as has been well established, the use of opioids presents a plethora of side effects, such as tolerance and physical and physiological dependence. Accordingly, considering the great pharmacological potential in targeting opioid receptors, the identification of opioid receptor ligands devoid of most of the adverse effects exhibited by current therapeutic agents is highly necessary. To this end, herein, we analyze some interesting molecules that could potentially be useful for treating OUD, with an in-depth analysis regarding in vivo studies and clinical trials.
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Affiliation(s)
- Rita Tabanelli
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Simone Brogi
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
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Kyzar EJ, Novick AM, Ross DA. The Hidden Side of Addiction: Allostatic Load, Health Disparities, and Opioids in the Time of COVID. Biol Psychiatry 2023; 93:e57-e59. [PMID: 37257984 PMCID: PMC10578313 DOI: 10.1016/j.biopsych.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/09/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Evan J Kyzar
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York.
| | - Andrew M Novick
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David A Ross
- Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Miller NM, Campbell C, Shorter GW. Barriers and facilitators of naloxone and safe injection facility interventions to reduce opioid drug-related deaths: A qualitative analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104049. [PMID: 37247475 DOI: 10.1016/j.drugpo.2023.104049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Opioid drug-related deaths continue to be a significant public health concern in the Republic of Ireland (ROI) and Northern Ireland (NI). While both regions have implemented naloxone to reduce drug related deaths, there remains a gap in the implementation of a supervised injection facility (SIF). This study aimed to identify barriers and facilitators to implementing naloxone and a SIF to reduce opioid drug-related deaths in ROI and NI. METHODS Semi-structured interviews (n=23) were conducted in ROI and NI with experts by experience (n=8), staff from low threshold services (n=9), and individuals involved in policy making (n= 6). Data were analyzed using coding reliability Thematic Analysis and were informed by the Risk Environmental Framework. RESULTS The findings illustrated that stigma within the media, health centers, and the community was a significant barrier to naloxone distribution and SIF implementation. Policing and community intimidation were reported to hinder naloxone carriage in both the ROI and NI, while threats of paramilitary violence towards people who use drugs were unique to NI. Municipal government delays and policy maker apathy were reported to hinder SIF implementation in the ROI. Participants suggested peer-to-peer naloxone delivery and amending legislation to facilitate non-prescription naloxone would increase naloxone uptake. Participants recommended using webinars, Town Halls, and a Citizens' Assembly as tools to advocate for SIF implementation. CONCLUSION Local and regional stigma reduction campaigns are needed in conjunction with policy changes to advance naloxone and a SIF. Tailoring stigma campaigns to incorporate the lived experience of people who use drugs, their family members, and the general community can aid in educating the public and change negative perceptions. This study highlights the need for ongoing efforts to reduce stigma and increase accessibility to evidence-based interventions to address opioid drug-related deaths in the ROI, NI, and internationally.
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Affiliation(s)
| | | | - Gillian W Shorter
- Drug and Alcohol Research Network & Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
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44
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Giglio RE, Mantha S, Harocopos A, Saha N, Reilly J, Cipriano C, Kennelly M, Landau L, McRae M, Chokshi DA. The Nation's First Publicly Recognized Overdose Prevention Centers: Lessons Learned in New York City. J Urban Health 2023; 100:245-254. [PMID: 37016269 PMCID: PMC10072795 DOI: 10.1007/s11524-023-00717-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 04/06/2023]
Abstract
In November of 2021, multiple factors converged to create a window of opportunity to open overdose prevention centers (OPCs) at two existing syringe service programs (SSPs) in New York City (NYC). Political will exists in NYC, particularly toward the end of the de Blasio administration's term, and the NYC Health Department worked to garner additional support from local and state elected officials given the dire need to address the overdose crisis. This coincided with readiness on the part of one of the NYC SSP providers, OnPoint NYC, to open and operate OPC services. Legal risks were assessed by both the city and the provider. This case study outlines the sequence of events that resulted in NYC supporting OnPoint to open the first two publicly recognized OPCs in the nation, including lessons learned to inform other jurisdictions considering offering such services.
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Affiliation(s)
- Rebecca E Giglio
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA.
| | - Shivani Mantha
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Alex Harocopos
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Nilova Saha
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Jacqueline Reilly
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Chelsea Cipriano
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Maura Kennelly
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Lisa Landau
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Michael McRae
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Dave A Chokshi
- New York Health Foundation, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
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Gubskaya E, Kennedy MC, Hayashi K, Cui Z, Milloy MJ, Kerr T. The impact of the COVID-19 pandemic on access to supervised consumption programs. Subst Abuse Treat Prev Policy 2023; 18:16. [PMID: 36899417 PMCID: PMC9999333 DOI: 10.1186/s13011-023-00521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/02/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Supervised consumption sites (SCS) and overdose prevention sites (OPS) have been increasingly implemented in response to the ongoing overdose epidemic in Canada. Although there has been a dramatic increase in overdose deaths since the start of the SARS-CoV 2 (COVID-19) pandemic, little is known about how SCS access may have been affected by this pandemic. Therefore, we sought to characterize potential changes in access to SCS during the COVID-19 pandemic among people who use drugs (PWUD) in Vancouver, Canada. METHODS Between June and December 2020, data were collected through the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS), two cohort studies involving people who use drugs. Multivariable logistic regression was used to examine individual, social and structural factors associated with self-reported reduced frequency of SCS/OPS use since COVID-19. RESULTS Among 428 participants, 223 (54.7%) self-identified as male. Among all individuals surveyed, 63 (14.8%) reported a decreased frequency of use of SCS/OPS since COVID-19. However, 281 (66%) reported that they "did not want to" access SCS in the last 6 months. In multivariable analyses, younger age, self-reported fentanyl contamination of drugs used and reduced ease of access to SCS/OPS since COVID-19 were positively associated with a decreased frequency of use of SCS/OPS since COVID-19 (all p < 0.05). CONCLUSIONS Approximately 15% of PWUD who accessed SCS/OPS reported reduced use of these programs during the COVID-19 pandemic, including those at heightened risk of overdose due to fentanyl exposure. Given the ongoing overdose epidemic, efforts must be made to remove barriers to SCS access throughout public health crises.
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Affiliation(s)
- Emili Gubskaya
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- School of Social Work, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Faculty of Health Sciences, Simon Fraser University, 888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Rich KM, Solomon DA. Medical Complications of Injection Drug Use - Part II. NEJM EVIDENCE 2023; 2:EVIDra2300019. [PMID: 38320028 DOI: 10.1056/evidra2300019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Medical Complications of Injection Drug Use - Part IIDuring the past 2 decades, the risk of death, as well as the prevalence of hospitalizations in the United States, has increased substantially among people who inject drugs, mainly because of the opioid epidemic. In Part Two of this two-part review, the authors review complications observed in people who inject drugs and strategies to reduce harm.
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Affiliation(s)
| | - Daniel A Solomon
- Harvard Medical School, Boston
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston
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Victor G, Hedden BJ, Lister J, Lee G, Huynh P, Ray B. Community overdose surveillance: Fentanyl involvement in overdose deaths in rural Michigan. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100150. [PMID: 37069960 PMCID: PMC10105480 DOI: 10.1016/j.dadr.2023.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
Purpose Examine fatal overdose toxicology trends to contribute toward understanding the outreach and treatment needs of people who use drugs in rural areas. Methods We describe toxicology results from overdose deaths that occurred between January 1, 2018, and December 31, 2020, in 11 rural counties in Michigan, a state with relatively high rates of overdose mortality. One-way ANOVA with Tukey's HSD posthoc tests were used to test statistically significant differences in the frequency of substances detected between years. Findings Decedents (N = 107) were male (72.9%), White (96.3%), non-military (96.3%), unemployed (71.0%), married (73.9%), and had a mean age of 47 years old. The number of observed overdose deaths increased considerably from 2019 to 2020, with an increase of 72.4%. Fentanyl was the most common substance detected and had a 94% increase during the three-year period to present in 70% of all the deaths in these counties in 2020. Among the deaths we examined where cocaine was detected, 69% also contained fentanyl, and in deaths where methamphetamine was detected, 77% also contained fentanyl. Conclusion Findings could inform rural health and outreach initiatives aimed at reducing overdose risks by providing education on the risks of stimulant and opioid couse but also the widespread saturation of illicit drugs that contain fentanyl. Lowthreshold harm reduction interventions are discussed amid limited prevention and treatment resources in rural communities.
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Stewart RE, Cardamone NC, Loscalzo E, French R, Lovelace C, Mowenn WK, Tarhini A, Lalley-Chareczko L, Brady KA, Mandell DS. "There's absolutely no downside to this, I mean, except community opposition:" A qualitative study of the acceptability of vending machines for harm reduction. Harm Reduct J 2023; 20:25. [PMID: 36855064 PMCID: PMC9971672 DOI: 10.1186/s12954-023-00747-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/02/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Vending machines for harm reduction (VMHR) are an innovative approach to deliver life-saving materials, information, and treatment for hard-to-reach populations, particularly for persons who inject drugs. The current study explores stakeholders' perspectives on the feasibility and acceptability of VMHR in Philadelphia. METHODS From October 2021 to February 2022, we conducted 31 semi-structured interviews with potential end users, staff, and leadership at a local federally qualified health center, and community members. Trained coders extracted themes from interview transcripts across four key domains: materials and logistics, location, access, and community introduction. RESULTS Interviewees from all stakeholder groups endorsed using VMHR to provide supplies for wound care, fentanyl test strips, naloxone, and materials to connect individuals to treatment and other services. Dispensing syringes and medications for opioid use disorder were commonly endorsed by health center staff but were more controversial among potential end users. Even within stakeholder groups, views varied with respect to where to locate the machines, but most agreed that the machine should be placed in the highest drug use areas. Across stakeholder groups, interviewees suggested several strategies to introduce and gain community acceptance of VMHR, including community education, one-on-one conversations with community members, and coupling the machine with safe disposal of syringes and information to link individuals to treatment. CONCLUSIONS Stakeholders were generally receptive to VMHR. The current study findings are consistent with qualitative analyses from outside of the USA and contribute new ideas regarding the anticipated community response and best methods for introducing these machines to a community. With thoughtful planning and design, VMHR could be a feasible and acceptable modality to reduce death and disease transmission associated with the opioid and HIV epidemics in cities like Philadelphia.
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Affiliation(s)
- Rebecca E Stewart
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Nicholas C Cardamone
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily Loscalzo
- Philadelphia FIGHT Community Health Centers, Philadelphia, Pennsylvania, USA
| | - Rachel French
- University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
| | - Collin Lovelace
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Winna Koe Mowenn
- Philadelphia FIGHT Community Health Centers, Philadelphia, Pennsylvania, USA
| | - Ali Tarhini
- Philadelphia FIGHT Community Health Centers, Philadelphia, Pennsylvania, USA
| | | | - Kathleen A Brady
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - David S Mandell
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Stoltman JJK, Marra A, Uppercue K, Terplan M. Reporting on addiction: countering misinformation about addiction, harm reduction, treatment, and recovery. J Am Pharm Assoc (2003) 2023; 63:230-233. [PMID: 36224048 DOI: 10.1016/j.japh.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023]
Abstract
Misinformation, or the spread of false information, can affect policy and individual health behaviors. Harm reduction practitioners and researchers have seen their work misrepresented in the media to the detriment of people in their community. Media coverage affects both public opinion and policy, which necessitates that it be informed by the current science and carefully platforms people who can speak to the science. Reporting on Addiction was formed to understand issues with media coverage and the consequences of this uninformed media coverage and propose solutions to these issues. Our "three-legged stool" approach defines this work (academic experts, researchers, community members, and the media) by identifying the problems and guiding our solutions. By working collaboratively with the media to improve their knowledge about addiction science, we aim to reduce misinformation and improve the lives of people with an addiction, in treatment, and during recovery.
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Abstract
LEARNING OBJECTIVES After completing this activity, practitioners will be better able to:• Discuss the growing body literature emphasizing moderation and harm-reduction in patients with severe and enduring anorexia nervosa (SE-AN)• Outline and discuss the legal, ethical, and medical challenges inpatient providers face when treating patients with SE-AN. ABSTRACT Patients with severe and enduring anorexia nervosa (SE-AN) present numerous clinical and ethical challenges for the hospital psychiatrist. Patients typically come to the hospital in a state of severe medical compromise. Common difficulties in the period of acute medical stabilization include assessment of decision-making capacity and the right to decline treatment, as well as legally complex decisions pertaining to administering artificial nutrition over the patient's objection. Following acute medical stabilization, the psychiatric consultant must decide whether psychiatric hospitalization for continued treatment is indicated, and if so, whether involuntary hospitalization is indicated. The standard of care in these situations is unclear. Pragmatic issues such as lack of appropriate facilities for specialized treatment are common. If involuntary hospitalization is not approved or not pursued, there may be difficulty in determining whether, when, and how to involve palliative care consultants to guide further management. These cases are complex and largely reside in a medico-legal and ethical gray area. This article discusses the difficulties associated with these cases and supports a growing body of literature emphasizing moderation and harm-reduction in patients with SE-AN. Physician-assisted dying (PAD) is also discussed.
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