Harm Reduction Journal最新文献

{"title":"A qualitative study of benzodiazepine/z-drug and opioid co-use patterns and overdose risk.","authors":"Hannah E Family, Gabriele Vojt, Hannah Poulter, Chris P Bailey, Ana Paula Abdala Sheikh, Damiana Cavallo, Sara Karimi, Nick Booth, Peter Da Silva, Louise Aitken, Samantha Stewart, Matthew Hickman, Graeme Henderson, Jenny Scott, Joanna M Kesten","doi":"10.1186/s12954-025-01153-8","DOIUrl":"https://doi.org/10.1186/s12954-025-01153-8","url":null,"abstract":"<p><strong>Background: </strong>Co-use of benzodiazepines and/or 'z-drugs' along with opioids is linked to the rise in drug related deaths (DRD) in the UK. Understanding patterns of co-use could inform harm reduction strategies for reducing DRDs. This study explored how people co-use, including dosages, timings, methods of administration, use of other substances and desired effects sought.</p><p><strong>Methods: </strong>Forty-eight semi-structured interviews across Glasgow in Scotland (n = 28), Bristol (n = 10) and Teesside (n = 10) in England with individuals who co-use illicit and/or prescribed opioids and benzodiazepines/z-drugs were conducted. Eighteen interviews were co-facilitated with qualitatively trained local peer researchers. Interviews were analysed using the Framework method.</p><p><strong>Results: </strong>Six co-use patterns were generated: (1) co-use to aid sleep or come down, (2) curated co-use, opioid agonist therapy (OAT) only (3) morning and evening benzodiazepine doses with opioids throughout the day (4) co-use binges (5) co-use throughout the day, (6) benzodiazepine use throughout the day plus OAT. Patterns one to three reflected more controlled co-use with a focus on self-medicating to give confidence, manage anxiety, promote sleep and come-down from cocaine/ketamine. Patterns four to six involved greater poly-drug use, and less controlled co-use with a focus on seeking euphoria (\"warm glow\", \"gouching out\") or oblivion (to escape untreated mental health conditions and trauma). Patterns two, three, five and six involved daily co-use. People switched between patterns depending on available resources (e.g. finances) or changes to prescriptions (opioids or benzodiazepines). Near-fatal overdoses were reported by participants across all co-use patterns. Patterns four to six were conceptualised as presenting greater overdose risk due to less controlled co-use and more extensive polydrug use.</p><p><strong>Conclusions: </strong>The patterns identified provide opportunities for future harm reduction strategies, tailoring advice to patterns of use, updated prescribing guidance and policies, and the need for better access to mental health care, for people who co-use benzodiazepines and opioids to reduce DRDs.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"24"},"PeriodicalIF":4.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"For a renewed harm reduction model.","authors":"Pierre Chappard, Fabienne Pourchon","doi":"10.1186/s12954-025-01165-4","DOIUrl":"10.1186/s12954-025-01165-4","url":null,"abstract":"<p><p>In the early 1990s, the spread of HIV among heroin injectors prompted a shift in drug policy internationally, including in France. This led to the emergence of a new policy known as Harm Reduction (HR) and related tools, including needle exchange programmes, opioid substitution therapy programmes to manage illicit opiate consumption, as well as reception facilities and support systems for the most precarious People Who Use Drugs (PWUDs). This new policy is based on the assertion that drugs have always been there and will always be a part of society, and that we have to live with them and not try to eradicate them. Promising PWUD emancipation, the advent of HR was accompanied by the birth of peer-support groups for unrepentant PWUDs, who decided to speak out in the public arena for the first time. Thirty years on, the authors assert that this promise has not lived up to expectations. More specifically, the cohabitation of an institutionalized, bureaucratized HR with the criminalization and stigmatization of drug use has worked against PWUD emancipation. As PWUDs, users of the addiction care system, peer workers and managers of addiction and HR facilities, the authors discuss the tensions between HR and the continued criminalisation and stigmatisation of drug use in France. Using the PWUD internet platform Psychoactif and the related peer-support group, both of which they created, the authors share their experiences and reflect on their practices to propose a renewed model of HR which reconnects with the civic and emancipatory roots of HR: a rights-based model that enables PWUDs to regain their power to act and escape the alienation caused by the stigma of drug use.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"23"},"PeriodicalIF":4.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Switching behavior and changes in smoking behavior by menthol cigarette preference and menthol heated tobacco product use among adults in the United States who smoke cigarettes: an actual use study.","authors":"Joshua L Karelitz, Yisha He, Elizabeth Becker, Andrea Vansickel","doi":"10.1186/s12954-025-01170-7","DOIUrl":"10.1186/s12954-025-01170-7","url":null,"abstract":"<p><strong>Background: </strong>Heated tobacco products (HTPs) deliver nicotine with significantly lower toxicant exposure relative to combustible cigarettes. HTPs may serve as viable tobacco harm reduction options for adults who smoke but are not able or interested in stopping consuming nicotine-containing products. There is limited information on the degree to which adults in the United States who smoke will switch away from or reduce combusted cigarette consumption when provided with HTPs, and none assessing differences due to menthol cigarette preference or menthol HTP use.</p><p><strong>Methods: </strong>In a six-week actual use study of an HTP (IQOS®), adults in the United States, ages 21-64 (n = 615), who smoke combustible cigarettes and were not planning to quit were offered free choice of HTPs (one non-menthol and two menthol varieties) to use ad libitum. Preference for smoking menthol or non-menthol cigarettes was assessed upon study entry (374 menthol; 241 non-menthol). The number of HTP sticks and combusted cigarettes consumed were assessed via daily diary administered through smartphone application. Complete switching was defined on a seven-day point prevalence basis-reporting consuming zero combusted cigarettes while continuing to use the HTP research product in Week 6.</p><p><strong>Results: </strong>Overall, 247 participants completely switched to HTP, corresponding to 21.1% of all those enrolled at baseline (n = 1173) or 40.2% of those included in primary analyses (n = 615). Among individuals included in primary analyses, we observed greater switching among those who preferred menthol versus non-menthol cigarettes (46.8% vs 29.9%). Probability of switching increased with greater proportional use of menthol versus non-menthol HTPs. Non-menthol cigarette-preferring participants had greater increases in switching when using proportionally more menthol than non-menthol HTPs; switching remained consistently high among menthol-preferring participants. Among participants who did not switch and continued smoking at Week 6, preference for menthol cigarettes and use of proportionally greater menthol versus non-menthol HTPs were each associated with greater reductions in cigarette consumption.</p><p><strong>Conclusion: </strong>HTP use facilitated switching away from or reducing consumption of combusted cigarettes among adults who smoke, especially when using menthol HTPs. Most participants used menthol HTPs, regardless of their incoming preference for smoking menthol or non-menthol cigarettes. Availability of HTPs in menthol and non-menthol varieties offers an increased tobacco harm reduction opportunity over solely non-menthol by providing adults who smoke with smoke-free alternatives that they find appealing.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"19"},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of UNODC/WHO S-O-S (stop-overdose-safely) training on opioid overdose knowledge and attitudes among people at high or low risk of opioid overdose in Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine.","authors":"Paul Dietze, Samantha Colledge-Frisby, Gilberto Gerra, Vladimir Poznyak, Giovanna Campello, Wataru Kashino, Dzhonbek Dzhonbekov, Tetiana Kiriazova, Danil Nikitin, Assel Terlikbayeva, Kirsten Horsburgh, Anja Busse, Dzmitry Krupchanka","doi":"10.1186/s12954-025-01167-2","DOIUrl":"10.1186/s12954-025-01167-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Opioid overdose education and naloxone distribution (OEND) is an evidence-based strategy to reduce opioid overdose deaths in line with guidance provided by the World Health Organization (WHO) and United Nations Office on Drugs and Crime (UNODC). However, OEND effectiveness has rarely been examined in low- and middle-income countries (LMICs). The WHO/UNODC Stop Overdose Safely (S-O-S) project involved training of &gt; 14,000 potential opioid overdose witnesses in opioid overdose response (including the administration of naloxone) in Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine. We examined the impact of training using the S-O-S training package, developed within the framework of the S-O-S project, on knowledge of and attitudes towards, opioid overdose as well as effective opioid overdose response amongst participants stratified by high and low personal risk of opioid overdose.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and methods: &lt;/strong&gt;A sample of S-O-S project participants were recruited into a cohort study to evaluate the effects of training using the S-O-S training package. Of these participants, 1481 at high or low personal risk of opioid overdose completed pre- and post-S-O-S training questionnaires that incorporated sections of the Brief Opioid Overdose Knowledge (BOOK) and Opioid Overdose Attitudes Scale (OOAS) instruments. Outcomes examined included overall scale scores as well as scores on instrument sub-scales. Mean change scores, stratified by personal risk of opioid overdose, were calculated and compared using repeated measures t-tests. Variation in overall change scores according to select participant characteristics (e.g., age, sex) was also examined using multivariable linear regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After training there were increases in overall BOOK and OOAS mean scores with a similar pattern evident in mean scores for all instrument subscales. Observed changes were larger for participants at low personal risk of opioid overdose (between 11% and 112%, depending on measure) compared to those who were at high personal risk of overdose (between 5% and 33% depending on measure), reflecting higher baseline scores for those at high personal risk of opioid overdose. We observed few variations in change scores across other participant characteristics. However, amongst those at high personal risk of opioid overdose, no personal experience of an overdose (β=-0.3; 95%CI=-0.5-0) and not currently being in drug treatment (β=-0.6; 95%CI=-0.4-0.8) was associated with a higher BOOK change score. Reporting not having witnessed an overdose previously was associated with higher BOOK change scores amongst those at low personal opioid overdose risk (β = 0.5; 95%CI = 0.2-0.8). Not currently being in drug treatment (β=-1.3; 95%CI=-0.1-2.4) was associated with a higher OOAS change score amongst those at high personal risk of opioid overdose.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;OEND training using the S-O-S training packa","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"20"},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandatory verses voluntary self-tests for new online casino customers: effect on engagement, quality, gambling behavior and use of responsible gambling measures.","authors":"Jakob Jonsson, Nathan Lakew, Philip Lindner","doi":"10.1186/s12954-025-01173-4","DOIUrl":"10.1186/s12954-025-01173-4","url":null,"abstract":"<p><strong>Background: </strong>To combat the public health concern that is problem gambling, gambling operators are increasingly being required by legislation to exercise a duty of care obligation, including the provision of Responsible Gambling (RG) tools. Self-test assessments have long been a popular RG tool implemented by many operators, yet there has been scant empirical research on self-tests, including on how the method of delivery impacts engagement, quality, and subsequent gambling behavior. The main objective of the current study was to examine if the level of voluntariness to perform a self-test moderated these key outcomes.</p><p><strong>Method: </strong>Participants in the study, 1800 new online customers at a leading Swedish gambling company, were randomized to one of three arms: No message (control), up to four messages inviting them to do a self-test, and one message with a mandatory (but technically possible to circumvent) self-test. The interventions were presented when the customer logged in.</p><p><strong>Results: </strong>The results showed that 38.9% in the mandatory group and 4.8% in the voluntary group completed the self-test, with indications of a somewhat lower quality of the test by the mandatory group. There was no difference in customer churn or gambling behavior, and only minor differences in use of RG-measures post intervention.</p><p><strong>Conclusions: </strong>We conclude that presentation format matters and can affect the use and quality of tests: gambling operators should exercise caution when interpreting non-risk assessment results derived solely from self-test tools, particularly mandatory ones, as it can result in inaccurate risk assessments that may mislead duty of care obligations. The balance between achieving high participation and maintaining quality (and thereby meaningfulness) is discussed.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"22"},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and predictors of condom use among people who inject drugs in Georgia.","authors":"Maia Kajaia, Maia Butsashvili, Jack A DeHovitz, George Kamkamidze, Lasha Gulbiani, Tinatin Abzianidze, Mamuka Djibuti","doi":"10.1186/s12954-025-01171-6","DOIUrl":"10.1186/s12954-025-01171-6","url":null,"abstract":"<p><strong>Background: </strong>People who inject drugs (PWID) are more likely to engage in unsafe sexual behavior placing them at high risk of acquiring HIV and other STIs. This study aims to assess the prevalence and predictors of inconsistent condom use with casual and/or paid sexual partners among PWID in Georgia.</p><p><strong>Methods: </strong>Integrated Bio-Behavioral Surveillance Survey was conducted among PWID in seven major cities of Georgia. Study design was cross-sectional with respondent-driven sampling (RDS) methodology. Data collection was carried out through individual face-to-face interviews. Of the 2005 PWID who participated in the study, we analyzed a subsample of 619 (30.9%) who reported having casual and/or paid sexual partners during the last 12 months and described prevalence and predictors of consistent condom use.</p><p><strong>Results: </strong>Consistent condom use during casual and/or paid sex in past 12 months was reported by 49.4% of respondents. The likelihood of consistent use with casual and/or paid sexual partners was statistically significantly associated with residence, family income, drug use frequency, drug dependence and HIV risk self-perceptions. In multivariable analysis independent predictors of always using condom at casual/paid sex during the last 12 months were place of residence (aOR = 6.4; 95% CI: 3.2-12.7), family income (aOR = 2.1; 95% CI:1.3-3.5) and drug use frequency (aOR = 0.6; 95% CI: 0.4-0.9).</p><p><strong>Conclusion: </strong>The study revealed low prevalence of consistent condom use with casual and/or paid sexual partners among PWID in Georgia. Integration of safe sex educational interventions in harm reduction services may improve the rates of condom use among PWID and should focus PWID with lower socio-economic status and residing outside capital city.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"21"},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of resilience and coping to intersectional HIV prevention and drug-use stigma among people who inject drugs in rural Appalachian Ohio.","authors":"Stacy Endres-Dighe, Ana D Sucaldito, Renee McDowell, Anyssa Wright, Ashleigh LoVette, William C Miller, Vivian Go, Nisha Gottfredson O'Shea, Kathryn E Lancaster","doi":"10.1186/s12954-025-01160-9","DOIUrl":"10.1186/s12954-025-01160-9","url":null,"abstract":"<p><strong>Background: </strong>Intersectional stigma of drug-use and HIV hinders provision and utilization of HIV prevention services for people who inject drugs (PWID), particularly within rural US communities. Resilience and coping may be critical for PWID to counter pervasive stigma.</p><p><strong>Methods: </strong>Between October 2021 and July 2022, 35 in-depth interviews were conducted in Appalachian Ohio to understand the intersection of drug-use and HIV prevention stigma and how resilience and coping processes are displayed, shared, and enacted. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted, guided by Harper et al.'s four key resilience processes: (a) engaging in health-promoting cognitive processes, (b) enacting in health behavioral practices, (c) exchanging social support, and (d) empowering other PWID to engage in health behavior practices.</p><p><strong>Results: </strong>Resilience processes aligned with the Harper framework with additional coping processes identified, including anticipation strategies and maladaptive coping. Empowering other PWID emerged as a prominent resiliency process, often supported by systems of support like syringe service programs (SSPs), which provided resources and helped reduce stigma. However, bidirectional social support was constrained, as PWID frequently acted as providers of resources and referrals for peers despite limited knowledge of HIV prevention strategies and feeling unsupported themselves. Anticipation strategies were employed to manage anticipated stigma, including accessing support or, conversely, avoiding healthcare and refraining from disclosing drug use. Maladaptive coping included behaviors such as social isolation and self-administered medical care, highlighting critical gaps in opportunities to foster resilience.</p><p><strong>Conclusions: </strong>Findings highlight that empowering peers and anticipation strategies can be key resilience processes, while maladaptive coping and limited bidirectional social support underscore the need for resilience-building and stigma-reduction interventions. Tailored systems of support for PWID in rural communities are critical to fostering adaptive coping and enhancing engagement with HIV prevention services.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"18"},"PeriodicalIF":4.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of drug checking services in Austria: a cross-sectional online survey.","authors":"Alexandra Karden, Tobias Fragner, Cornelia Feichtinger, Julian Strizek, Daragh T McDermott, Igor Grabovac","doi":"10.1186/s12954-025-01168-1","DOIUrl":"10.1186/s12954-025-01168-1","url":null,"abstract":"<p><strong>Background: </strong>The use of psychoactive substances is a key public health issue due to its impact on mental, physical, and social health. Integrated drug checking is a well-known harm reduction and addiction prevention measure and is currently implemented in four federal states in Austria. The aim of this study is to investigate the prevalence of drug checking use among a web-survey sample of people who use drugs (PWUD) in Austria and to examine differences in socio-demographic and substance use characteristics between individuals with and without drug checking experience. In addition, reasons for not using these services are explored.</p><p><strong>Methods: </strong>A secondary data analysis of the Austrian data from the European Web Survey on Drugs (EWSD), a targeted survey conducted between March and May 2021 was performed. Based on reported drug checking experience, the data set was divided into two groups - those with and without drug checking experience - and compared.</p><p><strong>Results: </strong>In this web-survey sample of PWUD (n = 1113), 20.1% reported prior use of a drug checking service in Austria. The groups with drug checking experience (n = 224) and those without (n = 889) differed significantly in both univariate and multivariate analyses. Univariate analysis revealed significant differences in terms of age, household composition, highest level of education, employment status, region of residence, substance use prevalences and treatment experience. Participants who used cannabis only had significantly less experience with drug checking. No significant differences were found regarding gender and income. While logistic regression analysis showed a significant relationship between sociodemographic predictors and drug checking experience, this relationship was relatively weak. The main reasons for not having used the services yet included a high level of trust in the source of supply (68%), confidence in receiving high quality of substances (64%), and a lack of service availability near the place of residence (62%).</p><p><strong>Conclusions: </strong>The results indicate that drug checking services are well-accepted and trusted but not equally accessed by and accessible to all PWUD. Specifically, people who use only cannabis and those residing with parents or in rural or small-town areas access services less. In conclusion, there is considerable potential for expanding the availability and accessibility of drug checking services in Austria, particularly to reach underserved groups of PWUD who could benefit from this intervention.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"17"},"PeriodicalIF":4.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing viral hepatitis C reinfections in a low-threshold programme for people who inject drugs in Slovenia.","authors":"Jasna Černoša, Jelka Meglič Volkar, Mario Poljak, Maja Pohar Perme, Jeffrey Victor Lazarus, Mojca Matičič","doi":"10.1186/s12954-025-01164-5","DOIUrl":"10.1186/s12954-025-01164-5","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis C virus (HCV) infection remains a public health threat. Although therapy with direct-acting antivirals made its elimination possible, major challenges remain in treating vulnerable populations, such as people who inject drugs (PWID) enrolled in low-threshold programmes (LTPs). This study analysed the outcome of HCV management focused on HCV reinfection in a specifically designed model-of-care (MoC) for PWID in Slovenia, where treatment is prescribed without limitations, though only by specialist physicians.</p><p><strong>Methods: </strong>All HCV antibody (anti-HCV) positive users of a MoC, combining HCV management at Clinic for Infectious Diseases at the University Medical Centre in Ljubljana and LTP for PWID in 100 km distanced civil society organisation (CSO) Svit Koper, between January 2017 to December 2022, were included. The MoC enabled regular transportation of PWID between LTP and the Clinic, where specifically assigned services for individually tailored HCV management in cooperation with CSO were available. Data on participants´ demographic, epidemiological, and clinical characteristics were collected partly retrospectively and prospectively, with a particular focus on HCV treatment outcome and reinfection status, and analysed accordingly.</p><p><strong>Results: </strong>The study included 49 anti-HCV positive PWID with a mean age of 38.7 (standard deviation (SD) = 7.6) years at first visit. The majority was male (40/49, 81.6%); 16/49 (32.7%) experienced previous incarceration, 14/49 (28.6%) were experiencing homelessness, and 42/49 (85.7%) were receiving opioid agonist therapy. A total of 42/49 (83.7%) were HCV RNA-positive. Of them 36/42 (85.7%) started HCV treatment at a mean age of 42.7 (SD = 5.7) years and 33/36 (91.7%) completed treatment. Six (14.3%) HCV RNA-positive PWID died. Among 28/33 (84.9%) who achieved a sustained virological response 12 weeks post treatment, 6/28 (21.4%) presented with reinfection. The HCV reinfection rate was 13.3 per 100 - PY (95% confidence interval (CI) [6.0, 29.7]), the rate of positive HCV RNA re-test was 12.2 per 100 - PY (95%CI [7.7-16.7]), while hazard of reinfection in our cohort increased with time, with the estimated reinfection probability exceeding 0.5 at 4 years.</p><p><strong>Conclusions: </strong>In marginalised population of PWID attending LTP, a sustainable HCV RNA re-screening and follow-up after HCV cure are necessary, as the risk of reinfection remains high.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"16"},"PeriodicalIF":4.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limit-setting in online gambling: a comparative policy review of European approaches.","authors":"Virve Marionneau, Elli Luoma, Tobias Turowski, Tobias Hayer","doi":"10.1186/s12954-024-01150-3","DOIUrl":"10.1186/s12954-024-01150-3","url":null,"abstract":"<p><strong>Background: </strong>Online gambling products involve a heightened risk of harm, but there are some possibilities to prevent and reduce these harms. Notably, mandatory identification in online gambling environments allows for a range of pre-commitment tools such as limit-setting. Previous research has found that limit-setting tools can be helpful, but effectiveness depends on how policies are outlined and implemented. Limits can be financial or temporal, voluntary or mandatory, and system-level or operator-based. The current paper presents a policy review of European approaches to limit-setting in online environments.</p><p><strong>Methods: </strong>We first compared legal provisions on pre-commitment and limit-setting in N = 30 European countries (27 European Union Member States, Great Britain, Norway, and Switzerland). Data were retrieved from Vixio Gambling Compliance country reports and verified against original legal texts. The analysis focused on financial, temporal, maximum wager limits, and any other limits pertaining to online gambling. Second, based on the policy review, we produced a more in-depth analysis of limit-setting provisions in countries with system-level pre-commitment (Finland, Norway, Germany).</p><p><strong>Results: </strong>Results show important divergence in terms of limit-setting across Europe. While almost all countries (n = 27) have some form of limit-setting, implementation details vary. Financial limits can include loss limits (n = 15 countries), deposit limits (n = 18), and wagering limits (n = 14), with the majority of countries providing several types of financial limits. Temporal limits were available in ten countries. Eleven countries had some mandatory limits, in other countries operators were expected to provide the option to set limits. Statutory maximum limits and lower limits for young adults were not common, but available in some countries. Germany was the only country with a system-level limit-setting scheme that covered multiple licensed operators.</p><p><strong>Conclusions: </strong>Contextual variations in pre-commitment and limit-setting policies are likely to impact effectiveness in terms of preventing and reducing harm. Our review shows some promising practices, including system-level regimes, mandatory policies, reasonable maximum caps on limits and wagers, the possibility to set limits for various time periods, lower limits for young adults, and coupling limit-setting with other duty-of-care obligations. Learning from other jurisdictions can constitute good practice for future policies on pre-commitment.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"15"},"PeriodicalIF":4.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}