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Piatkowski T, Benn S, Ayurzana L, King M, McMillan S, Hattingh L. Exploring the role of community pharmacies as a harm reduction environment for anabolic-androgenic steroid consumers: triangulating the perspectives of consumers and pharmacists. Harm Reduct J 2024; 21:59. [PMID: 38481218 PMCID: PMC10935940 DOI: 10.1186/s12954-024-00972-5] [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: 07/31/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic-androgenic steroid (AAS) consumers. OBJECTIVE This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist's regarding AAS harm reduction. METHODS Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis. RESULTS While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively. CONCLUSIONS Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers.
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Affiliation(s)
- Timothy Piatkowski
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia.
- Griffith Centre for Mental Health, Griffith University, Brisbane, QLD, Australia.
| | - Sarah Benn
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Lkhagvadulam Ayurzana
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Michelle King
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Sara McMillan
- Griffith Centre for Mental Health, Griffith University, Brisbane, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Laetitia Hattingh
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Pharmacy Department, Gold Coast Health, Southport, QLD, 4215, Australia
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Hayes MJ, Beavon E, Traeger MW, Dillon JF, Radley A, Nielsen S, Byrne CJ, Richmond J, Higgs P, Hellard ME, Doyle JS. Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102489. [PMID: 38440399 PMCID: PMC10909633 DOI: 10.1016/j.eclinm.2024.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Background The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies. Methods Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218). Findings Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was 16.6% (95% CI 11.0%-23.0%; heterogeneity I2 = 96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2 = 82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2 = 83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2 = 72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2 = 92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2 = 75.1%). This did not differ significantly between pharmacy and non-pharmacy settings. Interpretation These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research. Funding None.
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Affiliation(s)
| | | | - Michael W. Traeger
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
| | - John F. Dillon
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | - Suzanne Nielsen
- Burnet Institute, Melbourne, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher J. Byrne
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | | | - Peter Higgs
- Burnet Institute, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Margaret E. Hellard
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
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Pope E, McCullough M, Smith JG, Kim B. Knowledge, practice and attitudes regarding substance use disorder treatment and harm reduction strategies among pharmacists: a scoping review protocol. BMJ Open 2024; 14:e080338. [PMID: 38418243 PMCID: PMC10910657 DOI: 10.1136/bmjopen-2023-080338] [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] [Received: 09/27/2023] [Accepted: 01/22/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Pharmacists provide a spectrum of services and comprehensive medication management for patients with substance use disorders (SUDs) with many providing timely and increased access to care for patients. Prior studies have evaluated other healthcare professionals' attitudes, knowledge and practice in regard to SUD treatment and harm reduction services. However, no reviews to date summarise the available literature on the attitudes, knowledge and practice in regard to SUD treatment and harm reduction services from the pharmacist perspective. This scoping review aims to systematically map the extent, range and nature of available evidence and identify and describe gaps in knowledge, practice and attitudes towards SUD treatment among pharmacists with the goal of providing information for meaningful integration of pharmacists into SUD care. METHODS AND ANALYSIS We will use the framework proposed by Arksey and O'Malley (2005) updated with recommendations by Levac et al (2010) and the Joanna Briggs Institute (2020). The protocol is registered via Open Science Framework (https://osf.io/92dek). We will search for peer-reviewed literature containing empirical evidence investigating SUD treatment or harm reduction with outcomes pertaining to the knowledge, practice or attitudes of pharmacists. Findings will be guided and assessed by research objectives and summarised using descriptive statistics and thematically for quantitative and qualitative findings, respectively. This review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. ETHICS AND DISSEMINATION Our findings will provide crucial information and support for future interventions and programmes which aim to meaningfully integrate pharmacists into SUD care. We will disseminate findings at conferences and publish in a peer-reviewed journal. In addition, we will integrate feedback on search strategy, data extraction and our dissemination approach from multidisciplinary collaborators including those within our team's institution and outside experts with clinical or administrative knowledge in SUD care.
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Affiliation(s)
- Elle Pope
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Megan McCullough
- VA Bedford Healthcare System, Bedford, Massachusetts, USA, Bedford, MA, USA
- University of Massachusetts-Lowell, Lowell, MA, USA
| | - Jason G Smith
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Bo Kim
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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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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Turi E, McMenamin AL, Martsolf G, Hasin D, Han BH, Liu J, Poghosyan L. Primary care nurse practitioner work environments and emergency department utilization among older adults with substance use disorders in rural areas. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209285. [PMID: 38159910 PMCID: PMC10922346 DOI: 10.1016/j.josat.2023.209285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The prevalence of substance use disorders (SUDs) is growing among older adults, and older adults in rural areas face disparities in access to SUD care. Rural older adults with SUDs commonly have comorbid chronic conditions that puts them at risk for frequent acute healthcare utilization. In rural areas, primary care for patients with SUDs are increasingly provided by nurse practitioners (NPs), and quality primary care services may decrease ED visits in this population. Yet, NP-delivered primary care for rural older adults with SUDs may be limited by work environment barriers, which include lack of support, autonomy, and visibility. This study assessed the relationship between the NP work environment and ED utilization among rural older adults with SUDs. METHODS This was a secondary analysis of cross-sectional data from a large survey of NPs in six U.S. states merged with Medicare claims. The study measured the NP work environment by the four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), which measure 1) independent practice and support, 2) NP-physician relations, 3) NP-administration, and 4) professional visibility. Multilevel logistic regression models, adjusted for practice and patient covariates, assess the relationship between the NP work environment and all-cause ED use. RESULTS The sample included 1152 older adults with SUDs who received care at 126 rural NP primary care practices. NP independent practice and support at the practice was associated with 49 % lower odds of all-cause ED visits among older adults with SUDs. There were no relationships between the other NP-PCOCQ subscales and all-cause ED visits. CONCLUSIONS Organizational support for NP independent practice is associated with lower odds of all-cause ED utilization among rural older adults with SUDs. Practice administrators should ensure that NPs have access to support and resources to enhance their ability to care for rural older adults with SUDs. Ultimately, these practice changes could reduce ED utilization and health disparities in this population.
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Affiliation(s)
- Eleanor Turi
- University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104, United States of America.
| | - Amy L McMenamin
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America
| | - Grant Martsolf
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15213, United States of America
| | - Deborah Hasin
- Columbia University Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University Mailman School of Public Health; 722 West 168th Street, New York, NY 10032, United States of America
| | - Benjamin H Han
- University of California San Diego Department of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, United States of America
| | - Jianfang Liu
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America
| | - Lusine Poghosyan
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America; Columbia University Mailman School of Public Health; 722 West 168th Street, New York, NY 10032, United States of America
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Smith KR, Shah NK, Adamczyk AL, Weinstein LC, Kelly EL. Harm reduction in undergraduate and graduate medical education: a systematic scoping review. BMC MEDICAL EDUCATION 2023; 23:986. [PMID: 38129846 PMCID: PMC10734177 DOI: 10.1186/s12909-023-04931-9] [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: 08/15/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration. METHODS PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm reduction within UME or GME in the United States or Canada from 1993 until Nov 22, 2021. Two authors independently reviewed and screened records for data extraction. Data were analyzed on trainee population, curricula objectives, format, content, and evaluation. RESULTS Twenty-three articles describing 19 distinct educational programs across the United States were included in the final sample, most of which created their own curricula (n = 17). Data on educational content were categorized by content and approach. Most programs (85%) focused on introductory substance use knowledge and skills without an understanding of harm reduction principles. Based on our synthesis of the educational content in these curricula, we iteratively developed a Harm Reduction Educational Spectrum (HRES) framework to describe curricula and identified 17 discrete content topics grouped into 6 themes based on their reliance on harm reduction principles. CONCLUSIONS Harm reduction is under-represented in published medical curricula. Because the drug supply market changes rapidly, the content of medical curricula may be quickly outmoded thus curricula that include foundational knowledge of harm reduction principles may be more enduring. Students should be grounded in harm reduction principles to develop the advanced skills necessary to reduce the physical harm associated with drugs while still simultaneously recognizing the possibility of patients' ongoing substance use. We present the Harm Reduction Educational Spectrum as a new framework to guide future healthcare workforce development and to ultimately provide the highest-quality care for patients who use drugs.
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Affiliation(s)
- Kelsey R Smith
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA.
| | - Nina K Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, #100, Philadelphia, PA, 19107, USA
| | - Abby L Adamczyk
- Scott Memorial Library, Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA, 19107, USA
| | - Lara C Weinstein
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
| | - Erin L Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
- Center for Social Medicine and Humanities, University of California Los Angeles, B7-435, Semel Institute, Los Angeles, CA, 90095-1759, USA
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Justen M, Edelman EJ, Chawarski M, Coupet E, Cowan E, Lyons M, Owens P, Martel S, Richardson L, Rothman R, Whiteside L, O'Connor PG, Zahn E, D'Onofrio G, Fiellin DA, Hawk KF. Perspectives on and experiences of emergency department-initiated buprenorphine among clinical pharmacists: A multi-site qualitative study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209058. [PMID: 37149149 DOI: 10.1016/j.josat.2023.209058] [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: 09/09/2022] [Revised: 01/05/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Clinical pharmacists are well positioned to enhance efforts to promote emergency department (ED)-initiated buprenorphine to treat opioid use disorder (OUD). Among clinical pharmacists in urban EDs, we sought to characterize barriers and facilitators for ED-initiated buprenorphine to inform future implementation efforts and enhance access to this highly effective OUD treatment. METHODS This study was conducted as a part of Project ED Health (CTN-0069, NCT03023930), a multisite effectiveness-implementation study aimed at promoting ED-initiated buprenorphine that was conducted between April 2017 and July 2020. Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) framework to assess perspectives on the relationship between 3 elements: evidence for buprenorphine, the ED context, and facilitation needs to promote ED-initiated buprenorphine. The study used an iterative coding process to identify overlapping themes within these 3 domains. RESULTS The study conducted eight focus groups/interviews across four geographically disparate EDs with 15 pharmacist participants. We identified six themes. Themes related to evidence included (1) varied levels of comfort and experience among pharmacists with ED-initiated buprenorphine that increased over time and (2) a perception that patients with OUD have unique challenges that require guidance to optimize ED care. With regards to context, clinical pharmacists identified: (3) their ability to clarify scope of ED care in the context of unique pharmacology, formulations, and regulations of buprenorphine to ED staff, and that (4) their presence promotes successful program implementation and quality improvement. Participants identified facilitation needs including: (5) training to promote practice change and (6) ways to leverage already existing pharmacy resources outside of the ED. CONCLUSION Clinical pharmacists play a unique and critical role in the efforts to promote ED-initiated buprenorphine. We identified 6 themes that can inform pharmacist-specific interventions that could aid in the successful implementation of this practice.
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Affiliation(s)
- Marissa Justen
- Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, United States of America.
| | - E Jennifer Edelman
- Yale School of Medicine, Department of Internal Medicine, Edward S. Harkness, Building A, 4th floor 367 Cedar Street, New Haven, CT 06510, United States of America
| | - Marek Chawarski
- Yale School of Medicine, Department of Psychiatry, 300 George St #901, New Haven, CT 06511, United States of America
| | - Edouard Coupet
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Ethan Cowan
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
| | - Michael Lyons
- University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, United States of America
| | - Patricia Owens
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Shara Martel
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Lynne Richardson
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
| | - Richard Rothman
- John Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States of America
| | - Lauren Whiteside
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States of America
| | - Patrick G O'Connor
- Yale School of Medicine, Department of Internal Medicine, Edward S. Harkness, Building A, 4th floor 367 Cedar Street, New Haven, CT 06510, United States of America
| | - Evan Zahn
- Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, United States of America
| | - Gail D'Onofrio
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - David A Fiellin
- Yale School of Medicine, Department of Internal Medicine, Edward S. Harkness, Building A, 4th floor 367 Cedar Street, New Haven, CT 06510, United States of America; Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Kathryn F Hawk
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
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Yeh PT, Yang X, Kennedy CE, Armstrong KA, Fonner VA, Sherryn, O'Reilly KR, Sweat MD. The Impact of Needle and Syringe Exchange Programs on HIV-Related Risk Behaviors in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis Examining Individual- Versus Community-Level Effects. AIDS Behav 2023; 27:3306-3331. [PMID: 37046029 PMCID: PMC10524190 DOI: 10.1007/s10461-023-04051-x] [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] [Accepted: 03/14/2023] [Indexed: 04/14/2023]
Abstract
We conducted a systematic review and meta-analysis of the impact of needle and syringe exchange programs (NSP) on both individual- and community-level needle-sharing behaviors and other HIV-related outcomes in low- and middle-income countries (LMIC). A search of five databases for peer-reviewed trial or quasi-experimental studies reported through July 2021 identified 42 interventions delivered in 35 studies, with a total of 56,751 participants meeting inclusion criteria. Random-effects meta-analysis showed a significant protective association between NSP exposure and needle-sharing behaviors at the individual-level (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.16-0.39, 8 trials, n = 3947) and community-level (OR 0.39, CI 0.22-0.69, 12 trials, n = 6850), although with significant heterogeneity. When stratified by needle-sharing directionality, NSP exposure remained associated with reduced receptive sharing, but not distributive sharing. NSP exposure was also associated with reduced HIV incidence and increased HIV testing but there were no consistent associations with prevalence of bloodborne infections. Current evidence suggests positive impacts of NSPs in LMICs.
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Xuhao Yang
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Caitlin E Kennedy
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Kevin A Armstrong
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Virginia A Fonner
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
- FHI 360, Health Services Research Division, Durham, NC, 27701, USA
| | - Sherryn
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Kevin R O'Reilly
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Michael D Sweat
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
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Roberts HH, Stone M, Isac AJ. Syringe Services Programs to Reduce Intravenous Disease Transmission in Substance Use Disorders. Nurs Clin North Am 2023; 58:243-256. [PMID: 37105658 DOI: 10.1016/j.cnur.2023.01.004] [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: 03/09/2023]
Abstract
Syringe services programs (SSPs) are evidence-based programs. SSPs are integral in preventing bloodborne diseases while increasing access to care and reducing drug overdose deaths. SSPs are often the only source of health care for people who use drugs. Several states in the United States support and offer community-based SPPs; however, US prisons do not offer such programs to those incarcerated. Nurses are bridging the gap in support of SSPs and are being backed by organizations such as the American Nurses Association and the Association of Nurses in AIDS Care.
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Affiliation(s)
| | - Misty Stone
- Faculty, School of Nursing, Fayetteville State University
| | - Amanda J Isac
- Division of Public Health, Injury, and Violence Prevention Branch, North Carolina Department of Health and Human Services
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Fockele CE, Morse SC, van Draanen J, Leyde S, Banta-Green C, Huynh LN, Zatzick A, Whiteside LK. "That Line Just Kept Moving": Motivations and Experiences of People Who Use Methamphetamine. West J Emerg Med 2023; 24:218-227. [PMID: 36976607 PMCID: PMC10047723 DOI: 10.5811/westjem.2022.12.58396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/16/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Methamphetamine use is on the rise with increasing emergency department (ED) visits, behavioral health crises, and deaths associated with use and overdose. Emergency clinicians describe methamphetamine use as a significant problem with high resource utilization and violence against staff, but little is known about the patient's perspective. In this study our objective was to identify the motivations for initiation and continued methamphetamine use among people who use methamphetamine and their experiences in the ED to guide future ED-based approaches. METHODS This was a qualitative study of adults residing in the state of Washington in 2020, who used methamphetamine in the prior 30 days, met criteria for moderate- to high-risk use, reported recently receiving care in the ED, and had phone access. Twenty individuals were recruited to complete a brief survey and semi-structured interview, which was recorded and transcribed prior to being coded. Modified grounded theory guided the analysis, and the interview guide and codebook were iteratively refined. Three investigators coded the interviews until consensus was reached. Data was collected until thematic saturation. RESULTS Participants described a shifting line that separates the positive attributes from the negative consequences of using methamphetamine. Many initially used methamphetamine to enhance social interactions, combat boredom, and escape difficult circumstances by numbing the senses. However, continued use regularly led to isolation, ED visits for the medical and psychological sequelae of methamphetamine use, and engagement in increasingly risky behaviors. Because of their overwhelmingly frustrating experiences in the past, interviewees anticipated difficult interactions with healthcare clinicians, leading to combativeness in the ED, avoidance of the ED at all costs, and downstream medical complications. Participants desired a non-judgmental conversation and linkage to outpatient social resources and addiction treatment. CONCLUSION Methamphetamine use can lead patients to seek care in the ED, where they often feel stigmatized and are provided little assistance. Emergency clinicians should acknowledge addiction as a chronic condition, address acute medical and psychiatric symptoms adequately, and provide positive connections to addiction and medical resources. Future work should incorporate the perspectives of people who use methamphetamine into ED-based programs and interventions.
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Affiliation(s)
- Callan Elswick Fockele
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Sophie C Morse
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Jenna van Draanen
- University of Washington School of Public Health, Department of Health Systems and Population Health, Seattle, Washington
- University of Washington, Department of Child, Family, and Population Health Nursing, Seattle, Washington
| | - Sarah Leyde
- Harborview Medical Center, University of Washington, Department of Medicine, Seattle, Washington
| | - Caleb Banta-Green
- School of Public Health, University of Washington, Department of Health Services and Population Health, Seattle, Washington
- University of Washington School of Medicine, Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, Washington
| | - Ly Ngoc Huynh
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Alina Zatzick
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Lauren K Whiteside
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
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Marley GT, Ostrach B, Carpenter D. North Carolina pharmacists' willingness to sell fentanyl test strips: a survey study. Harm Reduct J 2023; 20:10. [PMID: 36694186 PMCID: PMC9875410 DOI: 10.1186/s12954-023-00739-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although fentanyl test strips (FTS) can accurately determine the presence of fentanyl in unregulated substances, access to FTS remains limited. This study aimed to examine North Carolina community pharmacists' attitudes and willingness to engage in various behaviors related to FTS sales and distribution. METHODS A convenience sample of community pharmacists completed an online survey that assessed: (1) comfort initiating an FTS conversation; (2) willingness to sell FTS, distribute FTS instructions, counsel on FTS, refer patients to harm reduction organizations, and advertise FTS; (3) perceived barriers and benefits of selling FTS; and (4) interest in FTS training. Data were collected from March to May 2022. Descriptive statistics were calculated. RESULTS Of the 592 pharmacists who participated, most were somewhat or very willing to refer patients to harm reduction organizations for FTS (514, 86.9%), counsel on FTS (485, 81.9%), distribute FTS instructions (475, 80.2%), sell FTS (470, 79.3%), and advertise FTS for sale (372, 62.9%). The most commonly reported benefits of selling FTS were reducing overdose deaths in the community (n = 482, 81.4%) and participating in community harm reduction efforts (n = 455; 76.9%). Barriers commonly reported to selling FTS were: not knowing where to order FTS (n = 295, 49.8%) and discomfort initiating a conversation about FTS (n = 266, 44.9%). Most respondents (88.3%) were interested in FTS training. CONCLUSION North Carolina community pharmacists are willing to engage in various behaviors related to FTS sales and distribution. Most pharmacists were interested in receiving FTS training, which should be created to address pharmacist-reported barriers to FTS sales. Pharmacist distribution of FTS could increase access to FTS at the community level and has the potential to change drug use behavior and reduce overdose deaths.
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Affiliation(s)
- Grace T. Marley
- grid.10698.360000000122483208School of Pharmacy, UNC Eshelman, 201 Pharmacy Lane, CB 7355, Chapel Hill, NC 27599-7355 USA
| | - Bayla Ostrach
- grid.189504.10000 0004 1936 7558School of Medicine, Fruit of Labor Action Research and Technical Assistance, Boston University, LLC 85 E. Newton St., Boston, MA 02118 USA
| | - Delesha Carpenter
- grid.10698.360000000122483208UNC Eshelman School of Pharmacy, 220 Campus Drive CPO 2125, Asheville, NC 28804 USA
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12
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Floyd AS, Silcox J, Cousin E, Irwin AN, Gray M, Bolivar D, Bratberg J, Arnold J, Al-Jammali Z, Hansen RN, Hartung DM, Green TC. Readiness of community pharmacies to implement an opioid safety intervention. J Am Pharm Assoc (2003) 2023; 63:275-283.e1. [PMID: 36496310 PMCID: PMC9870924 DOI: 10.1016/j.japh.2022.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND We report on efforts to measure readiness to adopt opioid safety initiatives in community pharmacies within 2 large chains. Previous studies identified lack of knowledge, confidence, or enthusiasm in addressing harm reduction efforts. We implemented an intervention that provided training to improve opioid safety. The goal was to increase naloxone prescribing and nonprescription syringe sales, reduce stigma, and decrease opioid overdoses among patients and customers. OBJECTIVES To assess pharmacy readiness for intervention delivery, by characterizing pharmacy culture around opioid safety; describing current practices and challenges interacting with patients and customers on naloxone, nonprescription syringe sales, and buprenorphine; and determining pharmacy defined goals for implementing the intervention. METHODS The sample included pharmacy managers and staff pharmacists from 2 large chains who completed a brief phone interview. Interviews consisted of Likert-scale and open-ended, theoretically driven questions. Questions focused on workplace culture, patient engagement, naloxone and buprenorphine prescribing, nonprescription syringe sales, and intervention goals. Coding categories for the open-ended questions were derived using a thematic review of responses. RESULTS A total of 163 respondents described both workplace culture and how they encourage patient opioid safety as including public health awareness, patient engagement, and naloxone prescribing. Sale of nonprescription syringes exhibited high variability: no sales barriers (53.9%), sales with barriers (21.5%), and no sales (20.9%). Half of pharmacists (50.3%) interacted with buprenorphine prescribers outside of medication fills. Most respondents (68.7%) endorsed being ready to promote the intervention. Pharmacists named goals in adopting the intervention of wanting more knowledge and educational materials, talking points with patients, and best practices for offering naloxone. CONCLUSION Community pharmacists, before implementation, described awareness of and receptiveness to opioid safety initiatives, with substantial barriers around nonprescription syringe sales. Assessed knowledge level, culture, and identified barriers that emerged in the readiness assessments can be used to tailor future pharmacy-specific programming.
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13
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Romo E, Rudolph AE, Stopka TJ, Wang B, Jesdale BM, Friedmann PD. HCV serostatus and injection sharing practices among those who obtain syringes from pharmacies and directly and indirectly from syringe services programs in rural New England. Addict Sci Clin Pract 2023; 18:2. [PMID: 36597153 PMCID: PMC9809047 DOI: 10.1186/s13722-022-00358-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Among people who inject drugs (PWID), obtaining syringes via syringe services programs (SSPs) and pharmacies reduces injection sharing practices associated with hepatitis C virus (HCV). Whether indirect use of SSPs via secondary exchange confers a similar benefit remains unknown, particularly in rural settings. We compared HCV serostatus and injection sharing practices by primary syringe source among a sample of rural PWID. METHODS Data are from a cross-sectional study of adults who use drugs recruited from eleven rural counties in New Hampshire, Vermont, and Massachusetts using respondent-driven sampling (2018-2019). Study staff performed HCV antibody testing. An audio computer-assisted self-interview assessed sociodemographic characteristics, past 30-day injection practices, and past 30-day primary syringe source. Primary syringe source was classified as direct SSP, pharmacy, indirect SSP (secondary exchange), or "other" (friend/acquaintance, street seller, partner/relative, found them). Mixed effects modified Poisson models assessed the association of primary syringe source with HCV seroprevalence and injection sharing practices. RESULTS Among 397 PWID, the most common primary syringe source was "other" (33%), then pharmacies (27%), SSPs (22%), and secondary exchange (18%). In multivariable models, compared with those obtaining most syringes from "other" sources, those obtaining most syringes from pharmacies had a lower HCV seroprevalence [adjusted prevalence ratio (APR):0.85, 95% confidence interval (CI) 0.73-0.9985]; however, the upper bound of the 95% CI was close to 1.0. Compared with those obtaining most syringes from other sources, PWID obtaining most syringes directly from SSPs or pharmacies were less likely to report borrowing used syringes [APR(SSP):0.60, 95% CI 0.43-0.85 and APR(Pharmacies):0.70, 95% CI 0.52-0.93], borrowing used injection equipment [APR(SSP):0.59, 95% CI 0.50-0.69 and APR (Pharmacies):0.81, 95% CI 0.68-0.98], and backloading [APR(SSP):0.65, 95% CI 0.48-0.88 and APR(Pharmacies):0.78, 95% CI 0.67-0.91]. Potential inverse associations between obtaining most syringes via secondary exchange and injection sharing practices did not reach the threshold for statistical significance. CONCLUSIONS PWID in rural New England largely relied on informal syringe sources (i.e., secondary exchange or sources besides SSPs/pharmacies). Those obtaining most syringes from an SSP or pharmacy were less likely to share injection equipment/syringes and had a lower HCV seroprevalence, which suggests using these sources reduces the risk of new HCV infections or serves as proxy for past injection behavior.
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Affiliation(s)
- Eric Romo
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Abby E. Rudolph
- grid.264727.20000 0001 2248 3398Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA USA
| | - Thomas J. Stopka
- grid.67033.310000 0000 8934 4045Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Bo Wang
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Bill M. Jesdale
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Peter D. Friedmann
- grid.266683.f0000 0001 2166 5835Office of Research, University of Massachusetts Chan Medical School-Baystate, Springfield, MA USA
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Balayssac D, Pereira B, Julien E, Chennell P, Brousse G, Laporte C, Authier N, Vennat B. Attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco), estimation of harmfulness and knowledge of these substances, and continuing education: A pilot cross-sectional study. ANNALES PHARMACEUTIQUES FRANÇAISES 2022; 80:897-905. [PMID: 35667462 DOI: 10.1016/j.pharma.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco). MATERIAL AND METHODS The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded. RESULTS Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01). CONCLUSION Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.
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Affiliation(s)
- D Balayssac
- Inserm U1107, NEURO-DOL, direction de la recherche clinique et de l'innovation, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France.
| | - B Pereira
- Direction de la recherche clinique et de l'innovation, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - E Julien
- Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - P Chennell
- Service de pharmacie, CNRS, Sigma Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - G Brousse
- EA7280, service de psychiatrie B et d'addictologie, UFR de médicine, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - C Laporte
- Département de médecine générale, EA7280, UFR de médicine, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - N Authier
- Inserm U1107, NEURO-DOL, service de pharmacologie médicale, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - B Vennat
- ACCePPT, UFR de pharmacie, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
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15
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Interventions to prevent HIV and Hepatitis C among people who inject drugs: Latest evidence of effectiveness from a systematic review (2011 to 2020). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103872. [PMID: 36202039 DOI: 10.1016/j.drugpo.2022.103872] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) and HIV remain prevalent among people who inject drugs (PWID) and transmission is usually associated with injecting risk behaviour (IRB). We update a 2011 review of reviews (RoR) to assess the latest evidence on the effectiveness of harm reduction interventions - drug treatment (including opioid agonist therapy [OAT]), needle and syringe programmes (NSP) and other interventions - in the prevention of HCV and HIV transmission, and related measures of infection risk (IRB and injecting frequency [IF]), among PWID. METHODS We undertook an initial search for systematic reviews (i.e. an Overview of Reviews [OoR]) and subsequent systematic searches for primary studies where required. Where there was sufficient evidence based on synthesis of multiple robust studies for an intervention effect in the 2011 RoR, new evidence was not sought. Medline, CINAHL, The Cochrane Library, EMBASE, PsycINFO and Web of Science were searched (2011-2020). Two reviewers screened papers, extracted data, and graded reviews/studies. We classified evidence as 'sufficient', 'tentative', 'insufficient', or 'no evidence'. RESULTS We screened 8513 reviews and 7133 studies, with 27 and 61 identified as relevant, respectively. The level of evidence increased since the 2011 RoR and is now 'sufficient' for OAT (regarding all outcomes), NSP (for reducing HIV transmission and IRB), and combination OAT/NSP (for reducing HCV transmission). There is also now sufficient evidence for in-prison OAT, psychosocial interventions, pharmacy-based NSP and provision of sterile drug preparation equipment for reducing IRB. CONCLUSION There is now a strong body of empirical evidence for the effectiveness of OAT and NSP, alone and in combination, in reducing IRB, and HCV and HIV transmission. However, there is still a relative lack of evidence for other interventions, including heroin-assisted treatment, pharmacological treatment for stimulant dependence, contingency management, technology-based interventions, low dead space syringes and drug consumption rooms on HCV or HIV risk.
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Advances in Pharmacy Practice: A Look towards the Future. PHARMACY 2022; 10:pharmacy10050125. [PMID: 36287446 PMCID: PMC9608826 DOI: 10.3390/pharmacy10050125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
This review looks at the factors that may influence practice in the future. Transformation could occur at 3 levels. Firstly, the traditional profession of the pharmacist as a dispenser of medicines is expanding. Secondly, the pharmacist’s activities are progressing into new healthcare fields. Thirdly, other changes are stimulated by global developments. This review may be helpful for pharmacy and healthcare leaders looking at the future configuration and aims of their pharmacy services.
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Kay ES, Creasy S, Batey DS, Coulter R, Egan JE, Fisk S, Friedman MR, Kinsky S, Krier S, Noble V, Turan B, Turan JM, Yu L, Hawk M. Impact of harm reduction care in HIV clinical settings on stigma and health outcomes for people with HIV who use drugs: study protocol for a mixed-methods, multisite, observational study. BMJ Open 2022; 12:e067219. [PMID: 36113946 PMCID: PMC9486355 DOI: 10.1136/bmjopen-2022-067219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Our previous pilot work suggests relational harm reduction strengthens relationships between people with HIV (PWH) who use drugs and their healthcare providers and improves HIV health outcomes. However, there is limited research examining ways that structural (eg, strategies like syringe service programmes) and/or relational (patient-provider relationship) harm reduction approaches in HIV clinical settings can mitigate experiences of stigma, affect patient-provider relationships and improve outcomes for PWH who use drugs. Our mixed methods, multisite, observational study aims to fill this knowledge gap and develop an intervention to operationalise harm reduction care for PWH who use drugs in HIV clinical settings. METHODS AND ANALYSIS Aim 1 will explore the relationship between healthcare providers' stigmatising attitudes towards working with PWH who use drugs and providers' acceptance and practice of structural and relational harm reduction through surveys (n=125) and interviews (n=20) with providers. Aim 2 will explore the interplay between patient-perceived harm reduction, intersectional stigma and clinical outcomes related to HIV, hepatitis C (if applicable) and substance use-related outcomes through surveys (n=500) and focus groups (k=6, total n=36) with PWH who use drugs. We will also psychometrically evaluate a 25-item scale we previously developed to assess relational harm reduction, the Patient Assessment of Provider Harm Reduction Scale. Aim 3 will use human-centred design approaches to develop and pretest an intervention to operationalise harm reduction care for PWH who use drugs in HIV clinical settings. ETHICS AND DISSEMINATION This study was approved via expedited review by the University of Pittsburgh Institutional Review Board (STUDY21090002). Study findings will be presented in peer-reviewed journals and public health conferences as well as shared with patient participants, community advisory boards and harm reduction organisations. TRIAL REGISTRATION NUMBER NCT05404750.
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Affiliation(s)
- Emma Sophia Kay
- Magic City Research Institute, Birmingham AIDS Outreach, Birmingham, Alabama, USA
| | - Stephanie Creasy
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stuart Fisk
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Mackey Reuel Friedman
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sarah Krier
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Victor Noble
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Bulent Turan
- Department of Psychology, Koc Universitesi, Istanbul, Turkey
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lan Yu
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Harm reduction interventions as a potential solution to managing cannabis use in people with psychosis: A call for a paradigm shift. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103814. [PMID: 35926338 DOI: 10.1016/j.drugpo.2022.103814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022]
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Sahibzada KI, Ganova-Raeva L, Dimitrova Z, Ramachandran S, Lin Y, Longmire G, Arthur L, Xia GL, Khudyakov Y, Khan I, Sadaf S. Hepatitis C virus transmission cluster among injection drug users in Pakistan. PLoS One 2022; 17:e0270910. [PMID: 35839216 PMCID: PMC9286280 DOI: 10.1371/journal.pone.0270910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
Hepatitis C virus (HCV) infections are public health problem across the globe, particularly in developing countries. Pakistan has the second highest prevalence of HCV infection worldwide. Limited data exist from Pakistan about persons who inject drugs (PWID) and are at significant risk of exposure to HCV infection and transmission. Serum specimens (n = 110) collected from PWID residing in four provinces were tested for molecular markers of HCV infection. Next generation sequencing (NGS) of the hypervariable region (HVR1) of HCV and Global Hepatitis Outbreak and Surveillance Technology (GHOST) were used to determine HCV genotype, genetic heterogeneity, and construct transmission networks. Among tested specimens, 47.3% were found anti-HCV positive and 34.6% were HCV RNA-positive and belonged to four genotypes, with 3a most prevalent followed by 1a, 1b and 4a. Variants sampled from five cases formed phylogenetic cluster and a transmission network. One case harbored infection with two different genotypes. High prevalence of infections and presence of various genotypes indicate frequent introduction and transmission of HCV among PWID in Pakistan. Identification of a transmission cluster across three provinces, involving 20% of all cases, suggests the existence of a countrywide transmission network among PWIDs. Understanding the structure of this network should assist in devising effective public health strategies to eliminate HCV infection in Pakistan.
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Affiliation(s)
- Kashif Iqbal Sahibzada
- School of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan
- Division of Viral Hepatitis, Center of Disease Control and Prevention, Molecular Epidemiology and Bioinformatics, Atlanta, GA, United States of America
| | - Lilia Ganova-Raeva
- Division of Viral Hepatitis, Center of Disease Control and Prevention, Molecular Epidemiology and Bioinformatics, Atlanta, GA, United States of America
| | - Zoya Dimitrova
- Division of Viral Hepatitis, Center of Disease Control and Prevention, Molecular Epidemiology and Bioinformatics, Atlanta, GA, United States of America
| | - Sumathi Ramachandran
- Division of Viral Hepatitis, Center of Disease Control and Prevention, Molecular Epidemiology and Bioinformatics, Atlanta, GA, United States of America
| | - Yulin Lin
- Division of Viral Hepatitis, Center of Disease Control and Prevention, Molecular Epidemiology and Bioinformatics, Atlanta, GA, United States of America
| | - Garrett Longmire
- Division of Viral Hepatitis, Center of Disease Control and Prevention, Molecular Epidemiology and Bioinformatics, Atlanta, GA, United States of America
| | - Leonard Arthur
- Division of Viral Hepatitis, Center of Disease Control and Prevention, Molecular Epidemiology and Bioinformatics, Atlanta, GA, United States of America
| | - Guo-liang Xia
- Division of Viral Hepatitis, Center of Disease Control and Prevention, Molecular Epidemiology and Bioinformatics, Atlanta, GA, United States of America
| | - Yury Khudyakov
- Division of Viral Hepatitis, Center of Disease Control and Prevention, Molecular Epidemiology and Bioinformatics, Atlanta, GA, United States of America
| | - Idrees Khan
- University of Peshawar, Peshawar, KPK, Pakistan
| | - Saima Sadaf
- School of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan
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Puzhko S, Eisenberg MJ, Filion KB, Windle SB, Hébert-Losier A, Gore G, Paraskevopoulos E, Martel MO, Kudrina I. Effectiveness of Interventions for Prevention of Common Infections Among Opioid Users: A Systematic Review of Systematic Reviews. Front Public Health 2022; 10:749033. [PMID: 35273933 PMCID: PMC8901608 DOI: 10.3389/fpubh.2022.749033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The North American opioid crisis is marked by high opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs). Users of pharmaceutical and non-pharmaceutical opioids are at an increased risk of acquiring hepatitis C (HCV), human immunodeficiency virus (HIV), and other infections. No high-level evidence, however, has been synthesized regarding effectiveness of interventions to prevent OUAIs in legal, and illegal/mixed opioid users. The aim of the study is to synthesize available systematic review (SR)-level evidence on the scope and effectiveness of interventions to prevent OUAIs among opioid users. Methods A SR of SRs approach was applied. We searched PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos and Google Scholar from inception to September 2020. Data selection and extraction were performed independently by three researchers. Risk of bias and quality of evidence were assessed using the AMSTAR2 tool. Results were narratively synthesized. Strength of evidence for each category was reported. Results Eleven of twelve identified SRs included interventions to prevent HCV/HIV transmission in persons who inject drugs (PWID), including opioids. One SR evaluated interventions to prevent recurrent infectious endocarditis. There was sufficient and tentative SR of SRs-level evidence for the effectiveness of opioid substitution therapy (OST) in preventing HIV and HCV, respectively. We found tentative evidence to support effectiveness of needle/syringe exchange programs (NSP) in HIV prevention, and sufficient evidence to support effectiveness of the combined OST and NSP in HCV prevention. There was insufficient SR-level evidence to support or discount effectiveness of other interventions to prevent OUAIs. No SR focused on non-PWID populations. Conclusion SR-level evidence supports the use of OST, NSP, and combined interventions for the reduction of HCV and HIV transmission in PWID. More research on prevention of other OUAIs and on prevention of OUAIs in non-PWID populations is urgently needed. Systematic Review Registration Registered in PROSPERO on July 30, 2020. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195929, identifier: #195929.
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Affiliation(s)
- Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Mark J Eisenberg
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kristian B Filion
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Medicine, Faculty of Medicine and Health Sciences, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Sarah B Windle
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andréa Hébert-Losier
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | | | - Marc O Martel
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montréal, QC, Canada
| | - Irina Kudrina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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21
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Community pharmacist engagement in HIV and HCV prevention: Current practices and potential for service uptake. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100088. [PMID: 35479840 PMCID: PMC9029914 DOI: 10.1016/j.rcsop.2021.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
Background Objective Methods Results Conclusions Pharmacists are largely willing to help people who need HIV/HCV prevention services. Perception of HIV/HCV prevention fit with pharmacist professional identity varies. Cognitive HIV/HCV prevention services are preferred over hands-on clinical services. Pharmacists often engage in gatekeeping to limit sales of non-prescription syringes. Willingness to sell syringes potentially hinges on minimal contact with requestors.
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22
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Improved syringe disposal practices associated with unsanctioned safe consumption site use: A cohort study of people who inject drugs in the United States. Drug Alcohol Depend 2021; 229:109075. [PMID: 34654588 DOI: 10.1016/j.drugalcdep.2021.109075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Community opposition to safe consumption sites often centers around improper syringe disposal. People are concerned these sites might attract people who inject drugs to the neighborhood, which might in turn lead to more used syringes left in public settings. METHODS We evaluated an unsanctioned safe consumption site in an undisclosed United States city in 2018-2020 to assess whether use of the site was associated with improper syringe disposal practices. We recruited people who inject drugs (N=494) using targeted sampling methods, and interviewed participants at baseline, 6 months, and 12 months. We employed a quasi-experimental design involving inverse probability of treatment weighting using propensity scores. We used generalized estimating equations and Poisson models to calculate relative risk and incidence rate ratios of improper syringe disposal. RESULTS The risk of any improper syringe disposal was comparable among people who used and did not use the unsanctioned safe consumption site in prior 30 days (relative risk 1.03; 95% confidence interval=0.53, 1.17). The rate of improperly disposed syringes per number of injections in prior 30 days was significantly lower among people who had used the unsanctioned safe consumption site during the same period (incident rate ratio 0.42; 95% confidence interval=0.18, 0.88). CONCLUSION When people used this unsanctioned safe consumption site, they disposed of significantly fewer syringes in public places, including streets, sidewalks, parks, or parking lots, than people not using the site. This study helps allay concerns that implementing safe consumption sites in the US would lead to increases in improperly disposed syringes.
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23
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Marotta PL, Stringer K, Beletsky L, West BS, Goddard-Eckrich D, Gilbert L, Hunt T, Wu E, El-Bassel N. Assessing the relationship between syringe exchange, pharmacy, and street sources of accessing syringes and injection drug use behavior in a pooled nationally representative sample of people who inject drugs in the United States from 2002 to 2019. Harm Reduct J 2021; 18:115. [PMID: 34789270 PMCID: PMC8600731 DOI: 10.1186/s12954-021-00565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Provision of sterile syringes is an evidence-based strategy of reducing syringe sharing and reusing and yet, access to sterile syringes through pharmacies and syringe exchange programs (SEPs) in the United States remains inadequate. This nationally representative study examined associations between obtaining syringes from pharmacies, SEPs, and sterilizing syringes with bleach and risk of syringe borrowing, lending and reusing syringes in a pooled cross-sectional dataset of 1737 PWID from the 2002-2019 National Survey on Drug Use and Health. Logistic regression was used to produce odds ratios (OR) of the odds of injection drug behaviors after adjusting for obtaining syringes from SEPs, pharmacies, the street, and other sources and potential confounders of race, ethnicity, sex, education, and insurance coverage. Obtaining syringes through SEPs was associated with lower odds of borrowing (OR = .4, CI95% = .2, .9, p = .022) and reusing syringes (OR = .3, CI95% = .2, .6, < .001) compared to obtaining syringes on the street. Obtaining syringes from pharmacies was associated with lower odds of borrowing (OR = .5, CI95% = .3, .9, p = .037) and lending (OR = .5 CI95% = .3, .9, p = .020) syringes. Using bleach to clean syringes was associated with increased odds of borrowing (OR = 2.0, CI95% = 1.3, 3.0, p = .002), lending (OR = 2.0, CI95% = 1.3, 3.0, p = .002) and reusing syringes (OR = 2.4, CI95% = 1.6, 3.6, p < .001). Our findings support provision of syringes through pharmacies and SEPs as a gold-standard strategy of reducing sharing and reuse of syringes in the US.
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Affiliation(s)
- Phillip L Marotta
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
- School of Social Work, Columbia University, New York, NY, 10027, USA.
- Northeastern University, Boston, MA, 02115, USA.
| | - Kristi Stringer
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Leo Beletsky
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Brooke S West
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Dawn Goddard-Eckrich
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Louisa Gilbert
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Tim Hunt
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Elwin Wu
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Nabila El-Bassel
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
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24
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Broz D, Carnes N, Chapin-Bardales J, Des Jarlais DC, Handanagic S, Jones CM, McClung RP, Asher AK. Syringe Services Programs' Role in Ending the HIV Epidemic in the U.S.: Why We Cannot Do It Without Them. Am J Prev Med 2021; 61:S118-S129. [PMID: 34686281 DOI: 10.1016/j.amepre.2021.05.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
Diagnoses of HIV among people who inject drugs have increased in the U.S. during 2014-2018 for the first time in 2 decades, and multiple HIV outbreaks have been detected among people who inject drugs since 2015. These epidemiologic trends pose a significant concern for achieving goals of the federal initiative for Ending the HIV Epidemic in the U.S. Syringe services programs are cost effective, safe, and highly effective in reducing HIV transmission and are an essential component of a comprehensive, integrated approach to addressing these concerns. Yet, geographic coverage of these programs remains limited in the U.S., and many jurisdictions continue to have laws and policies that limit or disallow syringe services programs. An in-depth literature review was conducted on the role of syringe services programs in the Ending the HIV Epidemic initiative. Empirical and model-based evidence consistently shows that syringe services programs have the highest impact in HIV prevention when combined with access to medications for substance use disorder and antiretroviral therapy. Their effectiveness is further maximized when they provide services without restrictions and include proven and innovative strategies to expand access to harm-reduction and clinical services (e.g., peer outreach, telehealth). Increasing geographic and service coverage of syringe services programs requires strong and sustainable policy, funding, and community support and will need to address new challenges related to the COVID-19 pandemic. Syringe services programs have a key role in all 4 Ending the HIV Epidemic initiative strategies-Prevent, Diagnose, Treat, and Respond-and thus are instrumental to its success in preventing disease and saving lives.
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Affiliation(s)
- Dita Broz
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Neal Carnes
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Johanna Chapin-Bardales
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Don C Des Jarlais
- Department of Epidemiology, School of Global Health, New York University, New York, New York
| | - Senad Handanagic
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - R Paul McClung
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - Alice K Asher
- Office of Policy, Planning and Partnerships, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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25
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Sanchez DP, Tookes H, Pastar I, Lev-Tov H. Wounds and Skin and Soft Tissue Infections in People Who Inject Drugs and the Utility of Syringe Service Programs in Their Management. Adv Wound Care (New Rochelle) 2021; 10:571-582. [PMID: 33913781 PMCID: PMC8312019 DOI: 10.1089/wound.2020.1243] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Opioid use disorder and transition to injection drug use (IDU) are an urgent, nationwide public health crisis. Wounds and skin and soft tissue infections (SSTIs) are common complications of IDU that disproportionately affect people who inject drugs (PWID) and are a major source of morbidity and mortality for this population. Critical Issues: Injections in a nonsterile environment and reusing or sharing needles facilitates bacterial inoculation, with subsequent risk of serious complications such as sepsis, gangrene, amputation, and death. PWID are susceptible to infections with a wide spectrum of organisms beyond common culprits of SSTI, including Clostridium and Bacillus spp., as well as Candida. Recent Advances: Syringe services programs (SSPs) are cost-effective and successful in reducing harms associated with IDU. SSPs provide new equipment to PWID and aid in discarding used equipment. SSPs aim to reduce the risks of unhygienic injecting practices, which are associated with transmission of infections and blood-borne pathogens. Future Directions: Concurrently run SSPs and wound care clinics are uniquely positioned to facilitate care to PWID. Providing new, sterile equipment as well as early wound care intervention can reduce morbidity and mortality as well as health care expenditures by reducing the number of SSTI and injection-related wounds that require hospital admission. Establishment of wound care clinics as part of an SSP represents an untapped potential to reduce harm.
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Affiliation(s)
- Daniela P. Sanchez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hansel Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Irena Pastar
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
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26
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Ijioma SC, Pontinha VM, Holdford DA, Carroll NV. Cost-effectiveness of syringe service programs, medications for opioid use disorder, and combination programs in hepatitis C harm reduction among opioid injection drug users: a public payer perspective using a decision tree. J Manag Care Spec Pharm 2021; 27:137-146. [PMID: 33506729 PMCID: PMC10391166 DOI: 10.18553/jmcp.2021.27.2.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: The hepatitis C virus (HCV) prevalence rate among injection drug users (IDUs) in North America is 55.2%, with 1.41 million individuals estimated to be HCV-antibody positive. Studies have shown the effectiveness of syringe service programs (SSPs) alone, medications for opioid use disorder (MOUD) alone, or SSP+MOUD combination in reducing HCV transmission among opioid IDUs. OBJECTIVE: To evaluate the cost-effectiveness of SSP alone, MOUD alone, and SSP + MOUD combination in preventing HCV cases among opioid IDUs in the United States. METHODS: We used a decision tree analysis model based on published literature and publicly available data. Effectiveness was presented as the number of HCV cases avoided per 100 opioid IDUs. A micro-costing approach was undertaken and included both direct medical and nonmedical costs. Cost-effectiveness was assessed from a public payer perspective over a 1-year time horizon. It was expressed as an incremental cost-effectiveness ratio (ICER) and an incremental cost savings per HCV case avoided per 100 opioid IDUs compared with cost savings with "no intervention." Costs were standardized to 2019 U.S. dollars. RESULTS: The incremental cost savings per HCV case avoided per 100 opioid IDUs compared with no intervention were as follows: SSP + MOUD combination = $347,573; SSP alone = $363,821; MOUD alone = $317,428. The ICER for the combined strategy was $4,699 compared with the ICER for the SSP group. Sensitivity analysis showed that the results of the base-case cost-effectiveness analysis were sensitive to variations in the probabilities of injection-risk behavior for the SSP and SSP + MOUD combination groups, probability of no HCV with no intervention, and costs of MOUD and HCV antiviral medications. CONCLUSIONS: The SSP + MOUD combination and SSP alone strategies dominate MOUD alone and no intervention strategies. SSP had the largest incremental cost savings per HCV case avoided per 100 opioid IDUs compared with the no intervention strategy. Public payers adopting the SSP + MOUD combination harm-reduction strategy instead of SSP alone would have to pay an additional $4,699 to avoid an additional HCV case among opioid IDUs. Although these harm-reduction programs will provide benefits in a 1-year time frame, the largest benefit may become evident in the years ahead. DISCLOSURES: This research had no external funding. The authors declare no financial interests in this article. Ijioma is a Health Economics and Outcomes Research (HEOR) postdoctoral Fellow with Virginia Commonwealth University and Indivior. Indivior is a pharmaceutical manufacturer of opioid addiction treatment drugs but was not involved in the design, analysis, or write-up of the manuscript.
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Affiliation(s)
- Stephen C Ijioma
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Vasco M Pontinha
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - David A Holdford
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Norman V Carroll
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
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27
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Patel EU, Solomon SS, Lucas GM, McFall AM, Tomori C, Srikrishnan AK, Kumar MS, Laeyendecker O, Celentano DD, Thomas DL, Quinn TC, Mehta SH. Drug use stigma and its association with active hepatitis C virus infection and injection drug use behaviors among community-based people who inject drugs in India. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103354. [PMID: 34247900 DOI: 10.1016/j.drugpo.2021.103354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although drug use stigma is globally pervasive, quantitative evidence of its role in hepatitis C virus (HCV) transmission is limited. We evaluated the psychometric properties of a drug use stigma scale and examined the association between drug use stigma and active HCV infection among a community-based sample of people who inject drugs (PWID) in India. METHODS Between 8/2016 and 5/2017, a cross-sectional sample of PWID was recruited from 12 Indian cities (~1000/city) using respondent-driven sampling. Participants were ≥18 years old and reported injection drug use (IDU) in the past 2 years. Multivariable logistic regression with a random-intercept for each city was used to estimate adjusted odds ratios (aOR) of active HCV infection (RNA>30 IU/mL). Analyses incorporated RDS-II weights. RESULTS Of 11,663 participants, 73.1% reported IDU in the past 6 months and 33.8% had active HCV infection. Exploratory factor analysis yielded a four-factor solution of enacted, vicarious, felt normative and internalized drug use stigma with high internal consistency (Cronbach's α: 0.85-0.92). In analyses adjusted for age, gender, northeast region, education, homelessness, incarceration, alcohol dependence, HIV status, frequency of IDU, and ever sharing needles/syringes, PWID reporting any enacted stigma had greater odds of active HCV infection (aOR = 1.27 [95% CI = 1.13-1.43]) as did PWID with internalized stigma scores in the highest quartile (vs. lowest quartile; aOR = 1.69 [95% CI = 1.11-2.56]). Among PWID who reported IDU in the past 6 months, multiple forms of stigma were associated with higher frequency of IDU, sharing needles/syringes, having multiple injection partners, and IDU in public spaces. CONCLUSION Using a multidimensional drug use stigma scale, various forms of stigma were significantly associated with active HCV infection and injection drug use-related risk behaviors. Collectively, these data suggest that drug use stigma may play a role in HCV transmission and impede efforts to achieve HCV elimination. Strategies to diminish drug use stigma are warranted.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cecília Tomori
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Oliver Laeyendecker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore MD, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David L Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas C Quinn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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28
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Ibragimov U, Cooper KE, Batty E, Ballard AM, Fadanelli M, Gross SB, Klein EM, Lockard S, Young AM, Cooper HLF. Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky. Harm Reduct J 2021; 18:68. [PMID: 34193165 PMCID: PMC8244225 DOI: 10.1186/s12954-021-00518-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study's purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. METHODS We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017-2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. RESULTS Stigma, a feature of IREF's meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID's individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. CONCLUSIONS Features of the social and healthcare environments operating at the meso-level, as well as PWID's individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.
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Affiliation(s)
| | | | - Evan Batty
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - April M Ballard
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Monica Fadanelli
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Skylar B Gross
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Emma M Klein
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Scott Lockard
- Kentucky River District Health Department, Hazard, KY, USA
| | - April M Young
- University of Kentucky College of Public Health, Lexington, KY, USA
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29
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Hagemeier NE, Dowling-McClay K, Baladezaei M, Curtis SJ, Spence M. Pharmacists' nonprescription syringe dispensing perceptions and behaviors: A three-state descriptive analysis. Drug Alcohol Depend 2021; 221:108597. [PMID: 33631542 DOI: 10.1016/j.drugalcdep.2021.108597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND One approach to increasing the reach of syringe programs in rural areas could be through provision of syringes at community pharmacies. This study evaluated relationships between state-specific syringe policies, pharmacy, and pharmacist characteristics and pharmacists' nonprescription syringe dispensing behaviors in a 3- state Appalachian region at high risk for HIV and HCV transmission. METHODS We conducted a telephone census of community pharmacies in the Appalachian counties of North Carolina, Tennessee, and Virginia from April-June 2018. Behaviors studied included having ever sold syringes without a prescription, quantity of individuals to whom nonprescription syringes were dispensed in the past 30 days, having ever denied a request for nonprescription syringes, and past 30-day denial of nonprescription syringe requests. Behavioral intention and perceptions of legality were elicited. RESULTS A response rate of 52.3 % was achieved (N = 391). North Carolina pharmacists reported increased past 30-day dispensing, less denial of nonprescription syringe requests, and decreased justification for syringe dispensing (proof of medical need) as compared to Tennessee and Virginia pharmacists. Behavioral intention to dispense did not vary by state but did vary by political affiliation. Perceptions of syringe dispensing legality in NC were significantly different from those in TN and VA. CONCLUSIONS Significant differences in pharmacists' perceptions and behaviors were noted across state lines with North Carolina pharmacists reporting more engagement in syringe dispensing as compared to pharmacists in Tennessee and Virginia. Policy allowing pharmacists to dispense syringes to people who inject drugs appears to foster some but not all pharmacist engagement in this harm reduction intervention.
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Affiliation(s)
- Nicholas E Hagemeier
- East Tennessee State University Gatton College of Pharmacy, Box 70657, City, TN, 37614, United States.
| | - KariLynn Dowling-McClay
- East Tennessee State University Gatton College of Pharmacy, Box 70657, City, TN, 37614, United States
| | - Mahnaz Baladezaei
- East Tennessee State University Gatton College of Pharmacy, Box 70657, City, TN, 37614, United States
| | - Sabrina J Curtis
- East Tennessee State University Gatton College of Pharmacy, Box 70657, City, TN, 37614, United States
| | - Matthew Spence
- East Tennessee State University Gatton College of Pharmacy, Box 70657, City, TN, 37614, United States
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30
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Johnson WD, Rivadeneira N, Adegbite AH, Neumann MS, Mullins MM, Rooks-Peck C, Wichser ME, McDonald CM, Higa DH, Sipe TA. Human Immunodeficiency Virus Prevention for People Who Use Drugs: Overview of Reviews and the ICOS of PICOS. J Infect Dis 2021; 222:S278-S300. [PMID: 32877540 DOI: 10.1093/infdis/jiaa008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This article summarizes the results from systematic reviews of human immunodeficiency virus (HIV) prevention interventions for people who use drugs (PWUD). We performed an overview of reviews, meta-analysis, meta-epidemiology, and PROSPERO Registration CRD42017070117. METHODS We conducted a comprehensive systematic literature search using the Centers for Disease Control and Prevention HIV/AIDS Prevention Research Synthesis Project database to identify quantitative systematic reviews of HIV public heath interventions with PWUD published during 2002-2017. We recombined results of US studies across reviews to quantify effects on HIV infections, continuum of HIV care, sexual risk, and 5 drug-related outcomes (sharing injection equipment, injection frequency, opioid use, general drug use, and participation in drug treatment). We conducted summary meta-analyses separately for reviews of randomized controlled trials (RCTs) and quasi-experiments. We stratified effects by 5 intervention types: behavioral-psychosocial (BPS), syringe service programs (SSP), opioid agonist therapy (OAT), financial and scheduling incentives (FSI), and case management (CM). RESULTS We identified 16 eligible reviews including >140 US studies with >55 000 participants. Summary effects among US studies were significant and favorable for 4 of 5 outcomes measured under RCT (eg, reduced opioid use; odds ratio [OR] = 0.70, confidence interval [CI] = 0.56-0.89) and all 6 outcomes under quasi-experiments (eg, reduced HIV infection [OR = 0.42, CI = 0.27-0.63]; favorable continuum of HIV care [OR = 0.68, CI = 0.53-0.88]). Each intervention type showed effectiveness on 1-6 outcomes. Heterogeneity was moderate to none for RCT but moderate to high for quasi-experiments. CONCLUSIONS Behavioral-psychosocial, SSP, OAT, FSI, and CM interventions are effective in reducing risk of HIV and sequelae of injection and other drug use, and they have a continuing role in addressing the opioid crisis and Ending the HIV Epidemic.
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Affiliation(s)
- Wayne D Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie Rivadeneira
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Emory Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Mary S Neumann
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary M Mullins
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cherie Rooks-Peck
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Christina M McDonald
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Darrel H Higa
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Theresa Ann Sipe
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
Persons who inject drugs are at high risk for skin and soft tissue infections. Infections range from simple abscesses and uncomplicated cellulitis to life-threatening and limb-threatening infections. These infections are predominantly caused by gram-positive organisms with Staphylococcus aureus, Streptococcus pyogenes, and other streptococcal species being most common. Although antimicrobial therapy has an important role in treatment of these infections, surgical incision, drainage, and debridement of devitalized tissue are primary. Strategies that decrease the frequency of injection drug use, needle sharing, use of contaminated equipment, and other risk behaviors may be effective in preventing these infections in persons who inject drugs.
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Affiliation(s)
- Henry F Chambers
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Building 30, Room 3400, San Francisco, CA 94110, USA.
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32
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Olives T, Willhite LA, Lee SC, Evans DK, Jensen A, Regelman HT, McGillis ES. Point-of-sale Naloxone: Novel Community-based Research to Identify Naloxone Availability. West J Emerg Med 2020; 21:1188-1194. [PMID: 32970574 PMCID: PMC7514389 DOI: 10.5811/westjem.7.2020.47252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/09/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Expanding naloxone availability is important to reduce opioid-related deaths. Recent data suggest low, variable urban naloxone availability. No reports describe naloxone availability at the point of sale (POSN). We characterize POSN without prescription across a Midwestern metropolitan area, via a unique poison center-based study. Methods Pharmacies were randomly sampled within a seven-county metropolitan area, geospatially mapped, and distributed among seven investigators, who visited pharmacies and asked, “May I purchase naloxone here without a prescription from my doctor?” Following “No,” investigators asked, “Are you aware of the state statute that allows you to dispense naloxone to the public under a standing order?” Materials describing statutory support for POSN were provided. Responses were uploaded to REDCap in real time. We excluded specialty (veterinary, mail order, or infusion) pharmacies a priori. POSN availability is presented as descriptive statistics; characteristics of individual sites associated with POSN availability are reported. Results In total, 150 pharmacies were prospectively randomized, with 52 subsequently excluded or unavailable for survey. Thus, 98 were included in the final analysis. POSN was available at 71 (72.5%) of 98 pharmacies. POSN availability was more likely at chain than independent pharmacies (84.7% vs 38.5%, p<0.001); rural areas were more commonly served by independent than chain pharmacies (47.4% vs 21.5%, p = 0.022). Five chain and five independent pharmacies (18.5% each) were unaware of state statutory support for collaborative POSN agreements. Statutory awareness was similar between independent and chain pharmacies (68.8% vs 54.6%, p = 0.453). Rationale for no POSN varied. Conclusion POSN is widely available in this metropolitan area. Variability exists between chain and independent pharmacies, and among pharmacies of the same chain; awareness of statutory guidance does not. Poison centers can act to define local POSN availability via direct inquiry in their communities.
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Affiliation(s)
- Travis Olives
- Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota.,Minnesota Poison Control System, Minneapolis, Minnesota
| | - Laurie A Willhite
- Hennepin Healthcare, Minneapolis, Minnesota.,Minnesota Poison Control System, Minneapolis, Minnesota
| | | | - Danika K Evans
- Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Ashley Jensen
- Minnesota Poison Control System, Minneapolis, Minnesota
| | | | - Eric S McGillis
- University of Calgary, Department of Emergency Medicine, Calgary, Alberta, Canada
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33
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Bratberg JP, Kubicsko D. Meeting people where they're at: A focus on pharmacist harm reduction roles in the opioid crisis. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jeffrey P. Bratberg
- Department of Pharmacy Practice; University of Rhode Island College of Pharmacy; Kingston Rhode Island
| | - Danielle Kubicsko
- Department of Pharmacy Practice; University of Rhode Island College of Pharmacy; Kingston Rhode Island
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34
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Alho H, Dematteis M, Lembo D, Maremmani I, Roncero C, Somaini L. Opioid-related deaths in Europe: Strategies for a comprehensive approach to address a major public health concern. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102616. [PMID: 31855706 DOI: 10.1016/j.drugpo.2019.102616] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 11/07/2019] [Accepted: 12/03/2019] [Indexed: 12/28/2022]
Abstract
Use of illicit opioids and misuse of prescription opioids are the main causes of drug-related deaths across the world, and the continuing rise in opioid-related mortality, especially affecting North America, Australia and Europe, is a public health challenge. Strategies that may help to decrease the high levels of opioid-related mortality and morbidity and improve care across Europe include risk assessment and interventions to improve the use of opioid analgesics, e.g. prescription drug-monitoring programmes, education on pain management to reduce opioid prescribing, and the implementation of evidence-based primary prevention programmes to reduce the demand for opioids. For patients who develop opioid use disorder (a chronic and relapsing problematic use of opioids that causes clinical impairment or distress), treatment combining opiate receptor full or partial agonist medications for opioid-use disorder (MOUD) with psychosocial interventions is essential. However, in Europe a substantial proportion of the 1.3 million high-risk opioid users (defined as injecting drug use or regular use of opioids, mainly heroin) remain outside of dedicated treatment programmes. More widespread and easier access to MOUD could reduce mortality levels; via approaches such as primary care-led treatment models, and efforts to improve patient retention and adherence to treatment programmes. Other harm-reduction strategies, such as the use of MOUD at optimal doses, the provision of take-home naloxone, the introduction of supervised drug-consumption facilities, and patient education to reduce the risk of overdose may also be beneficial.
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Affiliation(s)
- Hannu Alho
- Department of Public Health Solutions, The Alcohol, Drugs and Addictions Unit, National Institute of Health and Welfare, Mannerheimintie 166, Helsinki, Finland.
| | - Maurice Dematteis
- Department of Addiction Medicine, Grenoble Alpes University Hospital and Faculty of Medicine, Grenoble Alpes University, France.
| | | | - Icro Maremmani
- Vincent P. Dole Dual Disorder Unit, Santa Chiara University Hospital, University of Pisa, Italy.
| | - Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex and Psychiatric Department, University of Salamanca, Salamanca, Spain.
| | - Lorenzo Somaini
- Addiction Treatment Centre, Local Health Unit, Biella, Italy.
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35
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Wang SC, Maher B. Substance Use Disorder, Intravenous Injection, and HIV Infection: A Review. Cell Transplant 2019; 28:1465-1471. [PMID: 31547679 PMCID: PMC6923556 DOI: 10.1177/0963689719878380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 11/16/2022] Open
Abstract
DSM-V-defined substance use disorder comprises four groups of symptoms: impaired control, social impairment, risky use, and pharmacological reactions. Behavioral patterns of impaired control, including impulsivity and risk taking, are associated with HIV risk behaviors. Substance users with stronger craving symptoms are more likely to use drugs via intravenous injection than other routes because of the faster drug effect and the higher bioavailability; thus, they are at high risk of HIV infection. HIV risk behaviors such as unprotected sex and intravenous injection facilitate HIV disease spread. Public health policies such as Needle and Syringe Exchange Programs and medication-assisted treatment are proven to reduce HIV risk behaviors such as the frequency of intravenous injection and even the incidence of HIV infection, but both of them have limitations. While intravenous injection is a frequently discussed issue in public policies and the HIV-related literature, it is a much less frequent topic in the addiction literature. We believed that understanding the mental substrate behind impulsivity/risk taking and the possible biological mechanism of intravenous injection may help in creating more effective strategies to slow down HIV infection.
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Affiliation(s)
- Shao-Cheng Wang
- Jianan Psychiatric Center Ministry of Health and Welfare, Tainan,
Taiwan
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Brion Maher
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
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36
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Bach P, Hartung D. Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders. Addict Sci Clin Pract 2019; 14:30. [PMID: 31474225 PMCID: PMC6717996 DOI: 10.1186/s13722-019-0158-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022] Open
Abstract
The global rise in opioid-related harms has impacted the United States severely. Current efforts to manage the opioid crisis have prompted a re-evaluation of many of the existing roles in the healthcare system, in order to maximize their individual effects on reducing opioid-associated morbidity and preventing overdose deaths. As one of the most accessible healthcare professionals in the US, pharmacists are well-positioned to participate in such activities. Historically, US pharmacists have had a limited role in the surveillance and treatment of substance use disorders. This narrative review explores the literature describing novel programs designed to capitalize on the role of the community pharmacist in helping to reduce opioid-related harms, as well as evaluations of existing practices already in place in the US and elsewhere around the world. Specific approaches examined include strategies to facilitate pharmacist monitoring for problematic opioid use, to increase pharmacy-based harm reduction efforts (including naloxone distribution and needle exchange programs), and to involve community pharmacists in the dispensation of opioid agonist therapy (OAT). Each of these activities present a potential means to further engage pharmacists in the identification and treatment of opioid use disorders (OUDs). Through a careful examination of these approaches, we hope that new strategies can be adopted to leverage the unique role of the community pharmacist to help reduce opioid-related harms in the US.
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Affiliation(s)
- Paxton Bach
- British Columbia Centre on Substance Use, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Daniel Hartung
- College of Pharmacy, Oregon State University/Oregon Health and Science University, Robertson Collaborative Life Science Building, 2730 SW Moody Ave, CL5CP, Portland, OR, 97201-5042, USA
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37
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Bratberg JP, Smothers ZPW, Collins K, Erstad B, Ruiz Veve J, Muzyk AJ. Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1171] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jeffrey P. Bratberg
- Department of Pharmacy Practice; University of Rhode Island College of Pharmacy; Kingston Rhode Island
| | | | - Kathryn Collins
- Doctor of Pharmacy Program; Campbell University College of Pharmacy and Health Sciences; Buies Creek North Carolina
| | - Brian Erstad
- Department of Pharmacy Practice and Science; University of Arizona College of Pharmacy; Tucson Arizona
| | - Jennifer Ruiz Veve
- Doctor of Pharmacy Program; Campbell University College of Pharmacy and Health Sciences; Buies Creek North Carolina
| | - Andrew J. Muzyk
- Department of Pharmacy Practice; Campbell University College of Pharmacy and Health Sciences; Buies Creek North Carolina
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38
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Hadland SE. How Clinicians Caring for Youth Can Address the Opioid-Related Overdose Crisis. J Adolesc Health 2019; 65:177-180. [PMID: 31331540 PMCID: PMC6658108 DOI: 10.1016/j.jadohealth.2019.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Scott E Hadland
- Grayken Center for Addiction, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
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39
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The effects of community pharmacy-delivered public health interventions on population health and health inequalities: A review of reviews. Prev Med 2019; 124:98-109. [PMID: 30959070 DOI: 10.1016/j.ypmed.2019.04.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/13/2019] [Accepted: 04/03/2019] [Indexed: 01/08/2023]
Abstract
Community pharmacies have great potential to deliver services aimed at promoting health and preventing disease, and are well placed in deprived communities. This review of reviews aimed to assess the effectiveness of community pharmacy-delivered public health services and assess how they impact on inequalities in health using PROGRESS-Plus characteristics. Twenty databases were searched from their start date until January 2018. The quality of the included articles was determined using the Assessment of Multiple Systematic Reviews tool (AMSTAR 2). Fifteen systematic reviews were identified reporting 157 unique primary studies. There were a number of community pharmacy initiatives with positive intervention effects on health outcomes. These services were predominantly focused on primary disease prevention, and included smoking cessation, weight management programmes, syringe exchange programmes, and inoculation services. This review supports the development of some community pharmacy public health services. At present, little is known how community pharmacy-delivered public health interventions impact on health inequalities. It would be prudent for future studies to address this by explicitly reporting outcomes according to the PROGRESS-Plus framework. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42017056264.
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40
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Kinner SA, Young JT. Understanding and Improving the Health of People Who Experience Incarceration: An Overview and Synthesis. Epidemiol Rev 2018; 40:4-11. [PMID: 29860342 PMCID: PMC5982728 DOI: 10.1093/epirev/mxx018] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 01/04/2023] Open
Abstract
The world prison population is growing at a rate that exceeds the rate of population growth. This issue of Epidemiologic Reviews comprises articles in which researchers summarize what is known about some of the key health issues facing people in prison, particularly in relation to human immunodeficiency virus and other blood-borne viral infections. A key recurring theme is that addressing the health needs of people in prison is important to reducing health inequalities at the population level—that prisoner health is public health. The reviews also highlight some critical evidence gaps, notably the lack of evidence from low- and middle-income countries, and the limited number of longitudinal studies in which health behaviors, health outcomes, or health service experiences after release from prison are documented. Despite growing evidence of the poor health of detained adolescents, none of the included reviews considered this population. Further research on the health of young people who cycle through juvenile detention should be a priority. Despite a rapidly growing literature on the health of people who experience incarceration, some critical health issues remain poorly understood, and there has been insufficient attention devoted to co-occurring health conditions and the consequent need for coordinated care. Key populations in custodial settings remain understudied, limiting capacity to develop targeted, evidence-based responses to their health needs. The quality of many studies is suboptimal, and although rigorous, independent research in correctional settings can be challenging, it is not impossible and is critical to laying the groundwork for evidence-based reform.
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Affiliation(s)
- Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne Australia
- Mater Research Institute-UQ, University of Queensland, Brisbane Australia
- Griffith Criminology Institute, Griffith University, Brisbane Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
- Correspondence to Stuart A. Kinner, Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville VIC 3052 Australia (e-mail: )
| | - Jesse T Young
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth Australia
- National Drug Research Institute, Curtin University, Perth Australia
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41
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Samuels EA, D'Onofrio G, Huntley K, Levin S, Schuur JD, Bart G, Hawk K, Tai B, Campbell CI, Venkatesh AK. A Quality Framework for Emergency Department Treatment of Opioid Use Disorder. Ann Emerg Med 2018; 73:237-247. [PMID: 30318376 DOI: 10.1016/j.annemergmed.2018.08.439] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022]
Abstract
Emergency clinicians are on the front lines of responding to the opioid epidemic and are leading innovations to reduce opioid overdose deaths through safer prescribing, harm reduction, and improved linkage to outpatient treatment. Currently, there are no nationally recognized quality measures or best practices to guide emergency department quality improvement efforts, implementation science researchers, or policymakers seeking to reduce opioid-associated morbidity and mortality. To address this gap, in May 2017, the National Institute on Drug Abuse's Center for the Clinical Trials Network convened experts in quality measurement from the American College of Emergency Physicians' (ACEP's) Clinical Emergency Data Registry, researchers in emergency and addiction medicine, and representatives from federal agencies, including the National Institute on Drug Abuse and the Centers for Medicare & Medicaid Services. Drawing from discussions at this meeting and with experts in opioid use disorder treatment and quality measure development, we developed a multistakeholder quality improvement framework with specific structural, process, and outcome measures to guide an emergency medicine agenda for opioid use disorder policy, research, and clinical quality improvement.
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Affiliation(s)
- Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT. https://twitter.com/LizSamuels
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Kristen Huntley
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Scott Levin
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD
| | - Jeremiah D Schuur
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gavin Bart
- Addiction Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - Kathryn Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Betty Tai
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
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Okoro O, Hillman L. HIV pre-exposure prophylaxis: Exploring the potential for expanding the role of pharmacists in public health. J Am Pharm Assoc (2003) 2018; 58:412-420.e3. [PMID: 29789257 DOI: 10.1016/j.japh.2018.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/05/2018] [Accepted: 04/03/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The study objectives were to a) assess knowledge and experience; b) describe perceptions and attitudes; and c) identify training needs of community-based pharmacists regarding HIV pre-exposure prophylaxis (PrEP). DESIGN This was a cross-sectional survey study. SETTING AND PARTICIPANTS The survey was administered online to pharmacists practicing in a community setting in the state of Minnesota. OUTCOME MEASURES Measures included knowledge of and experience with HIV PrEP, perceptions and attitudes towards pharmacists' involvement, and HIV PrEP-specific training needs for pharmacists. RESULTS With a survey response rate of approximately 13% (n = 347), most respondents (76.4%) agreed that HIV PrEP can be beneficial in high-risk populations. Forty-six percent of respondents were not aware of U.S. Food and Drug Administration approval of emtricitabine and tenofovir disoproxil fumarate for PrEP. Most respondents (71.1%) were "not at all familiar" with Centers for Disease Control and Prevention guidelines for PrEP. Twenty-one percent of respondents had sufficient knowledge to counsel patients on PrEP. Experience with counseling on PrEP (21.8%), having dispensed PrEP in the last 2 years (33.1%), fewer years in practice (≤10 years), location of practice site (urban or suburban), and having received HIV continuing education in the last 2 years (33.0%) were associated with more knowledge of HIV PrEP. Top concerns with counseling were knowledge about the medication and behavior modification. The most frequently indicated primary concerns with implementing PrEP initiatives were identifying appropriate candidates and patient adherence. CONCLUSION As pharmacists' roles continue to expand, relevant content in pharmacy education and requisite training (including continuing education) are critical to addressing knowledge gaps and competencies that will enable pharmacists engage more effectively in public health efforts such as HIV prevention.
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Christensen S, Buggisch P, Mauss S, Böker KHW, Schott E, Klinker H, Zimmermann T, Weber B, Reimer J, Serfert Y, Wedemeyer H. Direct-acting antiviral treatment of chronic HCV-infected patients on opioid substitution therapy: Still a concern in clinical practice? Addiction 2018; 113:868-882. [PMID: 29359361 DOI: 10.1111/add.14128] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/15/2017] [Accepted: 12/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS There is limited real-world information on the effectiveness of antiviral treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals (DAA) in people on opioid substitution therapy (OST). This study compared sustained virological response (SVR) rates and proportion of lost to follow-up (LTFU) between OST and non-OST patients in the German Hepatitis C-Registry (DHC-R). DESIGN National multi-centre prospective real-world registry (German Hepatitis C-Registry, DHC-R). Non-OST patients comprised patients with former/current drug use (non-OST/DU) and patients never consuming drugs (non-OST/NDU). SETTING A total of 254 medical centres in Germany, including 123 centres providing OST. PARTICIPANTS A total of 7747 chronic HCV patients started DAA therapy (739 OST and 7008 non-OST; 1500 non-OST/DU; 5508 non-OST/NDU) patients. Five hundred and twenty-eight OST and 5582 non-OST patients had completed antiviral therapy and at least one follow-up documentation [intention-to-treat (ITT) population]. MEASUREMENTS Study outcomes were SVR, proportion of LTFU and safety of treatment. FINDINGS SVR (ITT) was documented in 85% (450 of 528) OST patients versus 86% (969 of 1126) in non-OST/DU (P = 0.651) and 92% (4113 of 4456) non-OST/NDU (P < 0.001) patients. Independent predictors for SVR (P < 0.01 in multivariate analysis) included HCV genotype non-3 [adjusted odds ratio (aOR) = 1.11; 95% confidence interval (CI) = 1.07-1.15], female sex (aOR = 1.59; CI = 1.30-1.94), platelet counts >90 × 109/l (aOR = 1.51, CI = 1.14-2.01), cirrhosis (aOR = 0.77; CI = 0.62-0.96) and patient group (OST/DI (aOR = 0.58; CI = 0.42-0.78); non-OST/DU (OR: 0.63; CI = 0.50-0.78). In per-protocol analysis (PP), SVR rates were ≥ 94% in all patient groups. In OST the proportion of LTFU was higher (10.2%) than in non-OST/DU (8.5%) and non-OST/NDU (3.2%, P < 0.001) patients. Independent factors for LTFU (P < 0.01) were HCV genotype non-3 (aOR = 0.92; CI = 0.88-0.96), female sex (aOR: 0.7; CI = 0.53-0.92), pre-treatment (aOR = 0.64; CI = 0.50-0.82), OST/DI (aOR = 3.35; CI = 2.35-4.78) and non-OST/DU (aOR = 2.38; CI = 1.80-3.14). CONCLUSIONS In Germany, direct-acting antiviral treatment of former or current drug users with or without opioid substitution therapy can achieve equally high sustained virological response rates as in patients with no history of drug use.
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Affiliation(s)
| | - Peter Buggisch
- ifi-Institute for Interdisciplinary Medicine, Hamburg, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | | | - Eckart Schott
- Charité Campus Virchow-Klinikum (CVK), Berlin, Germany
| | | | - Tim Zimmermann
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bernd Weber
- Praxiszentrum Friedrichsplatz/Competence Center Addiction, Kassel, Germany
| | - Jens Reimer
- Gesundheit Nord-Bremen Hospital Group, Bremen, Germany
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D'Couto HT, Robbins GK, Ard KL, Wakeman SE, Alves J, Nelson SB. Outcomes According to Discharge Location for Persons Who Inject Drugs Receiving Outpatient Parenteral Antimicrobial Therapy. Open Forum Infect Dis 2018; 5:ofy056. [PMID: 29766017 PMCID: PMC5941140 DOI: 10.1093/ofid/ofy056] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/20/2018] [Indexed: 11/14/2022] Open
Abstract
Background Opioid use disorder poses a significant public health risk. Persons who inject drugs (PWID) suffer from high mortality and morbidity secondary to serious infectious diseases, often requiring prolonged courses of outpatient parenteral antibiotics. The goal of this study was to determine the outcomes of PWID discharged to home or to a skilled nursing or rehabilitation facility (SNF/rehab) with parenteral antibiotic treatment under an outpatient parenteral antimicrobial therapy (OPAT) program. Methods This is a retrospective observational study. The study population was identified via hospital and OPAT databases using substance use disorder diagnoses and confirmed through chart review. The study population included hospitalized PWID with injection drug use in the preceding 2 years who were discharged between 2010 and 2015 to complete at least 2 weeks of parenteral antibiotics and monitored by the OPAT program. Retrospective chart review was used to describe patient characteristics and outcomes. Results Fifty-two patients met inclusion criteria, 21 of whom were discharged to home and 31 were discharged to a SNF/rehab. Of the patients discharged to home, 17 (81%) completed their planned antibiotic courses without complication. Twenty (64%) patients discharged to a SNF/rehab completed the antibiotic courses without complication. Six (11%) patients had line infections, 6 (11%) had injection drug use relapse, and 12 (23%) required readmission. Conclusions Persons who inject drugs discharged home were not more likely to have complications than those discharged to a SNF/rehab. Home OPAT may be a safe discharge option in carefully selected patients.
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Affiliation(s)
- Helen T D'Couto
- Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital, Boston
| | - Gregory K Robbins
- Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston.,Department of Medicine, Massachusetts General Hospital, Boston
| | - Kevin L Ard
- Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston.,Department of Medicine, Massachusetts General Hospital, Boston
| | - Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Justin Alves
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | - Sandra B Nelson
- Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston.,Department of Medicine, Massachusetts General Hospital, Boston
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Goodin A, Fallin-Bennett A, Green T, Freeman PR. Pharmacists' role in harm reduction: a survey assessment of Kentucky community pharmacists' willingness to participate in syringe/needle exchange. Harm Reduct J 2018; 15:4. [PMID: 29370808 PMCID: PMC5785823 DOI: 10.1186/s12954-018-0211-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/19/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pharmacists' role in harm reduction is expanding in many states, yet there are limited data on pharmacists' willingness to participate in harm reduction activities. This study assessed community pharmacists' willingness to participate in one harm reduction initiative: syringe/needle exchange. METHODS In 2015, all Kentucky pharmacists with active licenses were emailed a survey that examined attitudes towards participation in syringe/needle exchange. Response frequencies were calculated for community pharmacist respondents. Ordinal logistic regression estimated the impact of community pharmacist characteristics and attitudes on willingness to provide clean needles/syringes to people who inject drugs and to dispose of used syringes/needles, where both dependent variables were defined as Likert-type questions on a scale of 1 (not at all willing) to 6 (very willing). RESULTS Of 4699 practicing Kentucky pharmacists, 1282 pharmacists responded (response rate = 27.3%); the majority (n = 827) were community pharmacists. Community pharmacists were divided on willingness to provide clean needles/syringes, with 39.1% not willing (score 1 or 2 of 6) and 30% very willing (score 5 or 6 of 6). Few were willing to dispose of used needles/syringes, with only 18.7% willing. Community pharmacists who agreed that pharmacists could have significant public health impact by providing access to clean needles expressed 3.56 times more willingness to provide clean needles (95% CI 3.06-4.15), and 2.04 times more willingness to dispose of used needles (95% CI 1.77-2.35). Chain/supermarket pharmacists (n = 485, 58.6% of community pharmacies) were 39% less likely to express willingness to dispose of used needles (95% CI 0.43-0.87) when compared with independent community pharmacists (n = 342, 41.4% of community pharmacies). Independent pharmacists reported different barriers (workflow) than their chain/supermarket pharmacist colleagues (concerns of clientele). CONCLUSIONS Kentucky community pharmacists were more willing to provide clean needles than to dispose of used needles. Strategies to mitigate barriers to participation in syringe/needle exchange are warranted.
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Affiliation(s)
- Amie Goodin
- College of Pharmacy, Pharmaceutical Outcomes and Policy, University of Florida, 1225 Center Drive, HPNP 2320, Gainesville, FL, 32610, USA.
| | | | - Traci Green
- Emergency Medicine, Injury Prevention Research Center, College of Medicine, Brown University, Providence, RI, USA
| | - Patricia R Freeman
- Pharmacy Practice and Science, Center for the Advancement of Pharmacy Practice, College of Pharmacy, University of Kentucky, Lexington, KY, USA
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Davis SM, Daily S, Kristjansson AL, Kelley GA, Zullig K, Baus A, Davidov D, Fisher M. Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis. Harm Reduct J 2017; 14:25. [PMID: 28514954 PMCID: PMC5436422 DOI: 10.1186/s12954-017-0156-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/08/2017] [Indexed: 12/16/2022] Open
Abstract
Background Previous research on the effectiveness of needle exchange programs (NEP) in preventing hepatitis C virus (HCV) in people who inject drugs (PWID) has shown mixed findings. The purpose of this study was to use the meta-analytic approach to examine the association between NEP use and HCV prevention in PWIDs. Methods Study inclusion criteria were (1) observational studies, (2) PWIDs, (3) NEP use, (4) HCV status ascertained by serological testing, (5) studies published in any language since January 1, 1989, and (6) data available for measures of association. Studies were located by searching four electronic databases and cross-referencing. Study quality was assessed using the Newcastle Ottawa (NOS) scale. A ratio measure of association was calculated for each result from cohort or case–control studies and pooled using a random effects model. Odds ratio (OR) and hazard ratio (HR) models were analyzed separately. Results were considered statistically significant if the 95% confidence interval (CI) did not cross 1. Heterogeneity was estimated using Q and I2 with alpha values for Q ≤ 0.10 considered statistically significant. Results Of the 555 citations reviewed, 6 studies containing 2437 participants were included. Studies had an average NOS score of 7 out of 9 (77.8%) stars. Concerns over participant representativeness, unclear adjustments for confounders, and bias from participant nonresponse and loss to follow-up were noted. Results were mixed with the odds ratio model indicating no consistent association (OR, 0.51, 95% CI, 0.05–5.15), and the hazard ratio model indicating a harmful effect (HR, 2.05, 95% CI, 1.39–3.03). Substantial heterogeneity (p ≤ 0.10) and moderate to large inconsistency (I2 ≥ 66%) were observed for both models. Conclusions The impact of NEPs on HCV prevention in PWIDs remains unclear. There is a need for well-designed research studies employing standardized criteria and measurements to clarify this issue. Trial registration PROSPERO CRD42016035315 Electronic supplementary material The online version of this article (doi:10.1186/s12954-017-0156-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen M Davis
- School of Medicine, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9149, Morgantown, WV, 26506-9149, USA.
| | - Shay Daily
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Alfgeir L Kristjansson
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - George A Kelley
- Department of Biostatistics, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Keith Zullig
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Adam Baus
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Danielle Davidov
- School of Medicine, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9149, Morgantown, WV, 26506-9149, USA.,Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Melanie Fisher
- Department of Medicine, Section of Infectious Diseases, West Virginia University, PO Box 9163, Morgantown, WV, 26506, USA
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Scott J. Commentary on Sawangjit et al. (2017): There is still much to be determined before policy makers can choose pharmacy needle and syringe programmes (NSP) confidently over other models of NSP provision. Addiction 2017; 112:248-249. [PMID: 28078701 DOI: 10.1111/add.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jenny Scott
- Department of Pharmacy and Pharmacology, University of Bath, Somerset, UK
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