Shifting the paradigm: physician-authorized, student-led efforts to provide harm reduction services amidst legislative opposition

Harm reduction in undergraduate and graduate medical education: a systematic scoping review

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.

The Integration of Legal Education and Mental Health Education of College Students in the Contemporary Network Environment Facing the Cultivation of Civic Awareness

Since the world entered the era of network information, the influence of the Internet has been expanding day by day, and today's college students are deeply affected by the network environment, which has also brought unprecedented challenges to the moral education work of colleges and universities. The rule of law education for college students is a key point for the comprehensive implementation of the strategy of governing the country by law. How to enhance the effectiveness and recognition of the rule of law education for college students has become an important task of higher education. Therefore, strengthening the legal education of college students is not only an inevitable choice to fully implement the rule of law but also a realistic requirement to improve the level of higher education and realize the all-round development of college students. College students' mental health education is an important part of the talent training system of colleges and universities, and in-depth exploration of the ideological and political laws of college students' mental health education courses is an inevitable requirement for implementing the fundamental task of Lide Shuren. College students' mental health education courses must be integrated into the ideological and political concepts of the curriculum, reflect the political orientation of ideological and political work, embody the law of educating people with morality as the first, and embody the practical purpose of psychology to pay attention to personality improvement. It is necessary to optimize the content of education and teaching, excavate the elements of ideological politics in the curriculum, enrich the resources of ideological politics in the curriculum, and explore a new way of reforming the ideological and political education curriculum for college students from the aspects of deeply planting family and national feelings, enhancing political identity, strengthening cultural self-confidence, cultivating Chinese temperament, clarifying the meaning of life, strengthening mission responsibility, enhancing civic awareness, and developing law-abiding habits. Strictly regulate the behavior of contemporary college students in the online environment, give full play to the role of legal education, and reduce the incidence of online incidents such as online fraud and cyber violence. This paper puts forward some problems in the current legal education of college students in China and points out the root causes of these problems. Methods for structural reform and advanced cultural construction based on social development are proposed. From a strategic point of view, it is believed that only by managing the reform of legal education and cultivating civic awareness can we completely solve various contradictions and problems among college students in the network environment and pave the way for the development of college students.

Cardiac surgeons' perspectives and practices regarding people who use drugs: A scoping review

BACKGROUND AND AIM OF STUDY

The rising rates of drug use and associated cardiovascular complications, particularly infective endocarditis, have led to poorer health outcomes for people who use drugs (PWUD). The objectives of this scoping review were to identify (1) attitudes of cardiac surgeons toward PWUD and (2) challenges faced in the surgical treatment of drug use-related disease.

METHODS

A comprehensive literature search of three databases was performed with this assistance of a medical librarian. Articles were screened and analyzed for common themes by two independent authors. After literature review, a scoping review was conducted according to preferred reporting items for systematic reviews and meta-analyses and Joanna Briggs Institute guidelines, summarizing existing evidence.

RESULTS

Analysis of 35 qualified articles revealed eight themes regarding the perspectives and practices of cardiac surgeons toward PWUD: (1) need for multidisciplinary care teams (45.7%); (2) insufficient resources for treatment of underlying substanceuse disorders (40.0%); (3) stigma toward PWUD (37.1%); (4) willingness of surgeons to operate (31.4%); (5) incomplete guidelines for surgical management of drug-use related infective endocarditis (17.1%); (6) recognizing the importance of psychosocial factors (14.3%); (7) use of drug abstinence contracts (14.3%); and (8) use of stigmatizing language to describe PWUD and/or sterile injection (40.0%).

CONCLUSIONS

Provision of equitable care for PWUD requires effort from multiple disciplines including cardiothoracic surgeons, infectious disease specialists, addiction medicine specialists, and social workers. Additionally, further research is needed to gather sufficient data for evidence-based guidelines in the treatment of cardiac complications in PWUD.

Improved syringe disposal practices associated with unsanctioned safe consumption site use: A cohort study of people who inject drugs in the United States

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.