High levels of interest in access to free safer smoking equipment to reduce injection frequency among people who inject drugs in Seattle, Washington

Differences in Substance Use and Harm Reduction Practices by Race and Ethnicity: Rhode Island Harm Reduction Surveillance System, 2021-2022

CONTEXT

In the United States, minority populations are disproportionately affected by the overdose epidemic, have higher mortality rates, and unequal access to harm reduction and treatment services.

OBJECTIVE

This analysis aims to better understand harm reduction utilization and substance use patterns among minority populations to improve overdose outreach and prevention initiatives in Rhode Island.

DESIGN

The present analysis used data from the Harm Reduction Surveillance System from January 2021 to December 2022 (N = 393). Chi-square tests and multivariable regression models were used to investigate differences in substance use behaviors by race and ethnicity.

SETTING

Rhode Island.

PARTICIPANTS

Participants include individuals who self-reported the use of illicit drugs, currently reside in Rhode Island, and were older than 18 years.

MAIN OUTCOME MEASURES

Methods of drug use and uptake of harm reduction practices.

RESULTS

Among survey participants, 41% were non-Hispanic White, 57% were aged 25 to 44 years, 62% identified as male, and 95% had health insurance coverage. Most participants reported smoking as their method of drug use (90%) and harm reduction practices were underutilized by all race and ethnicity groups. Fewer non-Hispanic Black participants reported carrying naloxone compared to the other race and ethnicity groups. Non-Hispanic Black and Hispanic participants were significantly less likely to inject drugs compared with non-Hispanic White participants (adjusted odds ratio [AOR] = 0.14; 95% confidence interval [CI], 0.04-0.45) (AOR = 0.40; 95% CI, 0.18-0.90).

CONCLUSIONS

Smoking was the most common self-reported method of substance administration for all participants, whereas injection was more prevalent among non-Hispanic White participants. There is a continued need for minority-led and culturally informed harm reduction and treatment services for minority populations.

The utilization and delivery of safer smoking practices and services: a narrative synthesis of the literature

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.

Use of safer smoking facilities within a supervised consumption service shaped by socio-structural factors: A qualitative study

BACKGROUND

Safer smoking facilities provide an important alternative for supervised consumption service (SCS) clients who wish to lower certain health risks associated with injecting or who wish to smoke in the safety of the SCS rather than on the street. In 2018, the first regulated safer smoking facility in North America opened as part of a new supervised consumption site in a Western Canadian city. The purpose of this research project was to understand the interplay of factors in SCS clients choosing to use safer smoking rooms instead of injecting in booths.

METHOD

Using a phenomenological approach, this research was guided by the question, "What personal, social and environmental factors influence SCS clients' consumption methods?" To answer this question we interviewed both clients and staff at the SCS. Participants were recruited through purposive sampling. Data was analysed using thematic analysis.

RESULTS

The findings of this study suggest that the mode of consumption is affected by personal (personal history and preference that clients had previously pre-contemplated and established pertaining to the substances of choice), social (the desire to be with friends) and environmental (space limitations in the SCS) factors.

CONCLUSIONS

While many clients described self-determined rules around how they will consume various substances, these rules were fluid and changing depending on personal, social and environmental factors. Ensuring sufficient capacity of smoking rooms is a critical consideration in SCS and an important potential site of harm reduction.