Harm Reduction Journal最新文献

{"title":"Exploring perceived quality of life in long-term methadone-dependent patients: a qualitative study.","authors":"Seyed Hamzeh Hosseini, Farnaz Fendereski, Fereshteh Yazdani, Zeinab Hamzehgardeshi","doi":"10.1186/s12954-024-01140-5","DOIUrl":"https://doi.org/10.1186/s12954-024-01140-5","url":null,"abstract":"<p><strong>Background and aim: </strong>Considering opioid use disorder (OUD) as one of the major global concerns, methadone maintenance treatment (MMT) has been documented the core treatment for such dependence in the affected individuals. With regard to the significant role of quality of life (QoL) in evaluating the outcomes of various treatment methods in this line, the present study was to explore perceived QoL in long-term methadone-dependent patients (MDPs).</p><p><strong>Materials and methods: </strong>Applying a qualitative research design, this study was performed on 25 long-term MDPs, selected by purposive sampling with maximum variation. The data were also collected through semi-structured, in-depth interviews until data saturation was reached, and then analyzed via the MAXQDA10 software program and conventional content analysis.</p><p><strong>Results: </strong>The themes mined from the qualitative data were (i) satisfaction with improvements of physical-mental deterioration, with two main categories, viz. (a) improved physical efficiency and (b) improved mental efficiency; (ii) satisfaction with having a meaning in life, comprised of two categories, i.e., (a) hope for the future and (b) new beginnings in life; (iii) positive self-perception, made up of four main categories of (a) Increased Confidence and Self-Acceptance, (b) Positive Self-Acceptance and Improved Self-Image, (c) Improved Decision-Making Abilities, and (d) More Effective Coping with Stressful Situations; (iv) satisfaction with perceived social capital, consisting of two categories, namely, (a) strong social support and (b) no worry of the stigma of substance use; (v) growth in marital satisfaction, with two main categories of (a) increased libido and (b) effective communication with one's spouse; and (vi) physical-mental exhaustion caused by MMT, containing three categories, i.e., (a) fear of physical harm induced by MMT, (b) stigma and discrimination due to MMT, and (c) financial hardship following MMT.</p><p><strong>Conclusion: </strong>The study results revealed that QoL in MDPs was associated with their satisfaction with improvements of physical-mental deterioration, satisfaction with having a meaning in life, positive self-perception, satisfaction with perceived social capital, growth in marital satisfaction, and physical-mental exhaustion caused by MMT. Accordingly, it was suggested to reduce the negative impacts of MMT, such as stigma and discrimination due to MMT and the related treatments, on QoL in opioid-dependent patients (ODPs) and boost its benefits in their daily life.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"225"},"PeriodicalIF":4.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871927","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":"Relational anonymity in reducing the harms of illicit drug use: accounts of users of dark web- and street-based services in Finland.","authors":"Johanna Ranta, Teemu Kaskela, Juha Nurmi, Teemu Ruokolainen, Gillian W Shorter","doi":"10.1186/s12954-024-01139-y","DOIUrl":"https://doi.org/10.1186/s12954-024-01139-y","url":null,"abstract":"<p><strong>Background: </strong>Protecting individual anonymity is a common practice in harm reduction (HR), as it can mitigate the fears that may prevent people from accessing services. Protecting anonymity usually means applying for services with a pseudonym. However, anonymity protection practices have diversified in current HR environments, for example, on the streets or in the Tor network, which relies on technology to guarantee exceptionally strong anonymity. Despite its importance, the individual's need for anonymity when seeking help to reduce drug-related harm has been underexplored.</p><p><strong>Methods: </strong>The research contexts included four street- and dark web-based HR services in Finland. The data consisted of service user interviews and naturally occurring conversations in the Tor network. We focused on service users' accounts of their need for anonymity and applied the concept of relational anonymity, acknowledging that wider contextual relations intertwine with situational needs for anonymity. We asked: What kinds of needs for anonymity do service users express when discussing seeking help to reduce drug-related harm? How do service users account for their need for anonymity when seeking such help? To which kinds of contextual relations are these accounts attached?</p><p><strong>Results: </strong>We identified connections between the accounts of the need for anonymity and various contextual relations: (1) excusing the need for anonymity by referring to societal relations: blaming Finnish society for stigmatising attitudes and exclusionary practices; (2) excusing the need for anonymity by referring to service system relations: blaming the service system for the risk of negative consequences from recording the use of illicit drugs; (3) justifying and excusing the need for anonymity by referring to personal relations: appealing to personal situation, feelings and experiences.</p><p><strong>Conclusions: </strong>The need for anonymity reflects problematic societal relations, in which the stigma towards drug use is strong. The service users' accounts were motivated by rational actions to avoid possible sanctions and the perceived abuse of power in Finnish society and services, which the service users deemed to have various negative consequences in their lives. Societies should promote cultural atmospheres and information sharing practices where anonymity is not needed, but services that protect anonymity are crucial in the current societal conditions.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"224"},"PeriodicalIF":4.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871930","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":"The theory of preloading: A cognitive-behavioural motivational model.","authors":"Jacob G Sorbello, Grant J Devilly","doi":"10.1186/s12954-024-01122-7","DOIUrl":"https://doi.org/10.1186/s12954-024-01122-7","url":null,"abstract":"<p><p>Preloading of alcohol and/or drugs before an event has been examined in the research literature for the past two decades. Despite the considerable interest and scrutiny on the behaviour, there are limited, if any, attempts to conceptualise a theoretical understanding of why people preload before an event. Here we propose a Theory of Preloading (TOP)-a general cognitive-behavioural motivational model for alcohol and drug preloading. This conceptualisation reviewed and borrowed relevant cognitive, motivational and behavioural constructs from previous models-i.e., the Motivational Model of Alcohol Use, (Cox & Klinger, 2011), PRIME theory (West, 2007); SORCK analysis (Kanfer & Sanslow, 1965)-applied to the target behaviour of preloading with alcohol and/or drugs. The TOP proposed that a central construct of affective management-guided by distal and cognitive factors-contributes to decisional factors for preloading. Consequential reinforcers and punishers create a reinforcement loop that feeds back into distal and immediate environmental factors for preloading, increasing the likelihood of future occurrences of preloading behaviours. Our proposed theoretical formulation concludes with practical and clinical implications, along with future directions for testing the model.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"226"},"PeriodicalIF":4.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871931","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":"Practical solutions to resolve social barriers to hepatitis C treatment initiation among people who inject drugs: a qualitative study.","authors":"Phyo Aung, Margaret Hellard, Paul Dietze, Bek Petrovic, Peter Higgs, Mark Stoové","doi":"10.1186/s12954-024-01136-1","DOIUrl":"https://doi.org/10.1186/s12954-024-01136-1","url":null,"abstract":"<p><strong>Background: </strong>We aimed to identify motivators for people who inject drugs to pursue treatment for hepatitis C virus (HCV) infection and uncover opportunities that could make treatment more appealing.</p><p><strong>Methods: </strong>Between November 2023 and January 2024, we conducted semi-structured interviews with 15 HCV RNA-positive individuals with a history of injecting drug use and self-reported as either untreated or treated but delayed treatment for more than 6 months. Thematic and framework data analysis was employed and interpreted using the Capability, Opportunity and Motivation (COM-B) framework of behaviour change.</p><p><strong>Results: </strong>The findings suggest that a combination of stability through secure housing, mental readiness and overcoming drug dependence supported by OAT (Capability), accessible and convenient healthcare like mobile outreach services coupled with financial incentives (Opportunity), and supportive relationships (Motivation) could serve to help people who inject drugs take up HCV treatment.</p><p><strong>Conclusion: </strong>Alcohol and other drug and primary care services for people who use drugs should adopt person-centred approaches and recognise the gradual nature of behavioural change to foster empathy and supportive relationships to promote engagement in HCV care. Additionally, integrating HCV treatment with mobile outreach services and providing practical assistance, such as housing and financial incentives, are critical to ensuring that individuals remain engaged in HCV care.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"221"},"PeriodicalIF":4.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871928","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":"Understanding the financial barriers to treatment among individuals with opioid use disorder: a focus group study.","authors":"Precious Anyanwu, Olajumoke A Olateju, Vaishnavi Tata, Tyler Varisco, Lauren R Gilbert, Motolani E Ogunsanya, E James Essien, Michael L Johnson, J Douglas Thornton","doi":"10.1186/s12954-024-01133-4","DOIUrl":"https://doi.org/10.1186/s12954-024-01133-4","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the established effectiveness and relatively widespread availability of Medications for Opioid Use Disorder, individuals seeking treatment frequently encounter various structural and social barriers, including costs of treatment. This study aimed to understand the financial barriers that affect treatment continuation in individuals with opioid use disorder (OUD).</p><p><strong>Methods: </strong>In this qualitative study, seven semi-structured in-depth focus group interviews were conducted among 28 participants in treatment for OUD. Basic demographic information were collected in a pre-focus group survey. Focus group interviews were conducted from December 2021 to February 2022. A moderator guide was used to facilitate the discussion. Transcripts were managed using ATLAS.ti© v7. Data collected from the focus groups underwent deductive thematic analysis.</p><p><strong>Results: </strong>Data saturation was reached in 7 focus groups with a total of 28 participants (17 [60.7%] women; 27 [96.4%] white; 24 [85.7%] non-Hispanic). All three medications for OUD were represented (18 [64.3%] buprenorphine and naloxone, 5 [17.9%] methadone, 3 [10.7%] naltrexone, and 2 [7.1%] buprenorphine) and the time in treatment ranged from 1 month to over 36 months. Nearly all participants (27 [96.4%]) indicated a financial barrier that led to delayed treatment initiation and treatment retention. Two themes were identified from the focus group interviews: (1) OUD treatment-related financial burden- the direct and indirect cost associated with the treatment, and (2) psychosocial effects associated with the cost of OUD treatment -the mental, emotional, and social effects of the disease.</p><p><strong>Conclusions: </strong>Most participants described the desire and need for resources to offset the unaffordable cost that inhibits treatment initiation and retention. Further work is required to help identify individuals susceptible to financial barriers that can lead to early discontinuation in treatment.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"220"},"PeriodicalIF":4.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871932","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":"Developing an ethical framework for the recruitment of people who inject drugs experiencing incarceration in HIV prevention research: a qualitative study.","authors":"Matthew Murphy, Nyx Gomes, Kimberly Kane, Josiah D Rich, Lloyd Goldsamt, Jasjit S Ahluwalia, Kate M Guthrie, Susan E Ramsey, Sara Vargas","doi":"10.1186/s12954-024-01138-z","DOIUrl":"https://doi.org/10.1186/s12954-024-01138-z","url":null,"abstract":"<p><strong>Background: </strong>HIV disproportionately impacts people who experience incarceration. Incarceration represents an opportunity to engage in HIV prevention care for individuals who often experience a number of barriers accessing health services in the community. The development of evidence-based practices promoting pre-exposure prophylaxis for HIV prevention (PrEP) is crucial for ending the HIV epidemic within this highly marginalized population. However, PrEP research within carceral facilities has been limited and is hampered in part by the lack of ethical guidance on conducting HIV prevention research in this unique setting where incarcerated individuals are categorized as a vulnerable population requiring specific protections. This lack of knowledge is particularly striking when considering the lack of input from incarcerated individuals themselves on the responsible conduct of research, which is critical to understanding ways to ensure participant autonomy while avoiding coercive practices in research activities.</p><p><strong>Methods: </strong>In order to gain a better understanding of ethical approaches to the conduct of HIV prevention research among incarcerated individuals, we conducted qualitative interviews with 21 incarcerated men who reported injecting drugs and met clinical criteria for PrEP use. The interview topics included HIV knowledge, PrEP knowledge, stigma, and perceptions related to ethical research practices.</p><p><strong>Results: </strong>Themes identified included how forced abstinence during incarceration can negatively affect research participation, the importance of participant comfort as it relates to ensuring autonomy in decision making, a desire for person centred approaches in research activities, study staff characteristics impacting participant experience, and perceptions of carceral staff as members of research teams.</p><p><strong>Conclusions: </strong>The results of this study indicate that conducting research focused on improving PrEP use in a carceral environment has support among those experiencing incarceration. However, researchers should place the participant experience at the center of research protocol development.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"223"},"PeriodicalIF":4.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871926","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":"Progress and challenges in the elimination of hepatitis C among people who inject drugs in Germany: results of a pilot study for a national monitoring system, 10 years after the first data collection.","authors":"Gyde Steffen, Amrei Krings, Sarah Guttmann, Nadine Lübke, Kristin Meyer-Schlinkmann, Carsten Tiemann, Jörg Timm, Andreas Walker, Ruth Zimmermann","doi":"10.1186/s12954-024-01119-2","DOIUrl":"https://doi.org/10.1186/s12954-024-01119-2","url":null,"abstract":"<p><strong>Background: </strong>People who inject drugs (PWID) are at high risk of blood-borne infections, and injection drug use contributes significantly to hepatitis C virus (HCV) transmission. The WHO has therefore set targets of reducing HCV incidence and prevalence among PWID and increasing treatment coverage to eliminate HCV by 2030. The DRUCK study (2011-2014) found high HCV prevalence and low treatment coverage among PWID in Germany. To assess progress in the elimination of HCV among PWID, we conducted a cross-sectional study in two German federal states that piloted a future monitoring.</p><p><strong>Methods: </strong>PWID aged 16 + who injected drugs (previous 12 months) were recruited in low-threshold drug services and opioid agonist treatment (OAT) practices in Berlin and Bavaria between June 2021 and April 2022. Participants completed a questionnaire on sociodemographics, behaviours and access to care, and were tested for hepatitis B virus (HBV) and HCV, and HIV. Data was analysed regarding HCV prevalence, history of treatment, and risk and prevention behaviours. Results were compared with the DRUCK study.</p><p><strong>Results: </strong>A total of 588 PWID, with a median age of 39 (range: 17-66) years and 68% (399/587) male, were included in the analysis. Of the participants, 61% (353/574) reported receiving OAT and 14% (66/469) recent use of shared needles/syringes during the last 30 days. History of imprisonment was reported by 77% (444/577) and history of homelessness by 75% (428/569) of participants. Among anti-HCV positive participants, viraemic HCV infections decreased by 44% from 66% (904/1361) in 2011-2014 to 37% (160/432) in 2021-2022, while those with cleared HCV infection and treatment history increased from 20% (266/1361) to 34% (148/432).</p><p><strong>Conclusions: </strong>Despite a decrease since 2011-2014, viraemic HCV prevalence among PWID in Germany remains high, and treatment coverage is still insufficient. To achieve the WHO targets, universal health coverage and targeted integrated testing and treatment for PWID are needed. PWID receiving OAT and people in prison should be offered testing and treatment at any contact with the medical system. A nationwide monitoring system will help assess successes and remaining gaps, and track progress towards elimination of HCV among PWID in Germany.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"222"},"PeriodicalIF":4.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871929","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":"Harm reduction and its monitoring in Europe, from EMCDDA to EUDA.","authors":"Alexis Goosdeel","doi":"10.1186/s12954-024-01130-7","DOIUrl":"https://doi.org/10.1186/s12954-024-01130-7","url":null,"abstract":"<p><strong>Background: </strong>Harm Reduction, conceptualized by Russell Newcombe in the late 1980s, has revolutionized how drug use, individuals who use drugs, and drug policies are understood globally. Emerging from the HIV/AIDS crisis, Harm Reduction sought to address the dire rates of drug-related infections and the overwhelming burden on healthcare providers. Early initiatives, such as Opioid Substitution Treatment (OST) and needle exchange programs, were met with resistance but gradually established new standards of care, transforming attitudes toward people who use drugs and prioritizing human-centered, rather than solely medical, approaches.</p><p><strong>Main body: </strong>This paper explores the evolution and expansion of Harm Reduction from an HIV/AIDS prevention strategy to a broader framework adopted across Europe. Although ideological barriers initially slowed adoption, Harm Reduction principles have gained acceptance, notably through EU policies promoting drug-related harm reduction and the United Nations' 2024 resolution. Through initiatives such as OST, needle exchange programs, drug consumption rooms, and drug-checking services, the European Union has demonstrated progressive success in reducing drug-related deaths and infectious diseases. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has supported this evolution by providing extensive data, scientific evidence, and policy recommendations that guide national approaches. More recently, advancements in hepatitis C treatment have created opportunities for improved health outcomes among individuals who use drugs, fostering their role as active partners in healthcare processes.</p><p><strong>Conclusion: </strong>Today's increasingly complex drug landscape, characterized by high substance availability, poly-drug use, and drug-related violence, necessitates a redefined approach to Harm Reduction. With the transformation of the EMCDDA into the European Union Drug Agency (EUDA), the agency's mandate now includes a proactive focus on anticipating, alerting, responding to, and learning from emerging drug-related challenges. Strengthening collaboration with civil society will be crucial in evolving Harm Reduction to meet future needs, ensuring that EU drug policies remain inclusive, adaptive, and aligned with the diverse realities faced by individuals who use drugs.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"219"},"PeriodicalIF":4.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863989","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":"Door-to-door overdose harm reduction: an Illinois case study.","authors":"Maryann Mason, Bruce Johnson, Christorpher Schaffner, Sean Johnston, Ursula Alexander, Oyindamola Ajala, Nia Andrews, Sarah B Welch","doi":"10.1186/s12954-024-01134-3","DOIUrl":"10.1186/s12954-024-01134-3","url":null,"abstract":"<p><strong>Background: </strong>Harm reduction for people who use drugs (PWUD) is an established evidence-based practice that encompasses a wide variety of services, delivery formats, and settings and has been named a priority in US drug policy. Harm reduction is focused on planning with communities and meeting PWUD where they are and encompasses a wide variety of interventions. We describe and report the feasibility, acceptability, and process implementation outcomes for an innovative pilot drug overdose harm reduction intervention, Block-by-Block (BXB), focused on training for and distribution of naloxone and test strips in areas identified as high risk for fatal overdoses.</p><p><strong>Case presentation: </strong>Beginning operations in 2022, BXB operates in five pilot sites in four Illinois counties. Through partnerships with local organizations, BXB delivers harm reduction services in a private setting (home) or in a setting not specifically focused on serving PWUD (businesses, libraries, faith-based organizations, etc.) to reach PWUD and their friends, family and neighbors living in areas disproportionately affected by opioid overdose death. The intervention theory is based on acknowledgement that harm reduction services that require PWUD to visit a mobile unit, van or community organization, may not reach those in need or their friends, neighbors, and family for a variety of reasons including stigma associated with drug use, lack of awareness about these services, or where to locate them. Services delivered include education and training in the use of naloxone and fentanyl, xylazine and benzodiazepine test strips. Leave behind materials include naloxone, test strips and handouts with information on the intervention and local resources.</p><p><strong>Conclusions: </strong>Results to date indicate that this intervention is feasible -over half (55%) of the doors approached were answered. Acceptability of the intervention as delivered is high --people at 75% of doors that were answered were interested in and received training and/or supplies. BXB is flexible in that it has been quickly adapted to changes in community conditions, the drug supply, and shifting high risk areas as they developed. This is a promising intervention that leverages available data and resources and is readily implementable in communities with support from a central program administrator and access to geo-coded data.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"218"},"PeriodicalIF":4.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780163","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":"Challenges for the implementation of injectable opioid agonist treatment: a scoping review.","authors":"Tanja Schwarz, Deniz Akartuna, Martin Busch, R Michael Krausz, Alfred Uhl","doi":"10.1186/s12954-024-01102-x","DOIUrl":"10.1186/s12954-024-01102-x","url":null,"abstract":"<p><strong>Background and aims: </strong>Injectable opioid agonist treatment (iOAT) is a valuable, patient-centred, evidence based intervention. However, limited information exists on contextual factors that may support or hinder iOAT implementation and sustainability. This study aims to examine existing research on iOAT using diacetylmorphine and hydromorphone, focusing on identifying the key barriers and facilitators to its successful implementation.</p><p><strong>Methods: </strong>A systematic search was conducted in the MEDLINE and PsycInfo databases (via Ovid) from inception to February 2024, supplemented by a comprehensive grey literature search. No restrictions were applied regarding publication type, year, or geographic location. Articles were independently screened by two reviewers. Eligible articles described the feasibility, implementation, and/or evaluation of iOAT in one or more countries, presenting perspectives on receiving, administering, or governing iOAT.</p><p><strong>Results: </strong>Forty-four publications were selected for inclusion. Barriers identified through thematic analysis included public acceptance concerns such as medication diversion, increased crime, and the Honey-Pot effect. Legal and ethical challenges identified involved enacting changes in law to make certain substances available as a medically controlled options for treatment, and addressing patient consent issues. Negative media coverage and public controversies were found to undermine acceptance, and high start-up costs especially for security, facility access, and economic feasibility were seen as additional obstacles. Regulatory barriers and stringent protocols were the most frequently cited limiting factors by patients and providers. Facilitators included the integration of trial prescriptions into comprehensive drug policy strategies and publishing data for evidence-based debates, together with ethics committees ensuring compliance with ethical standards. Developing information strategies and addressing opponents' claims improved public perception. Cost-effectiveness evidence was found to support long-term implementation, while flexible treatment protocols, inclusive spaces, and affirming therapeutic relationships were seen as important facilitators to enhance patient engagement and treatment effectiveness.</p><p><strong>Conclusions: </strong>Successful implementation of iOAT requires balancing political and social acceptability with scientific integrity, alongside strategic communication and public outreach. Further research is needed to enhance the transferability of findings across diverse socio-political contexts and address key influencing factors associated with iOAT programs.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"217"},"PeriodicalIF":4.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780159","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}