Harm Reduction Journal最新文献

{"title":"Improving hospital care for people who use drugs: deliberative process development of a clinical guideline for opioid withdrawal management.","authors":"Marisha Wickremsinhe, Adam Holland, Jenny Scott, Rosalind Gittins, Michael Brown, Adrian 'Bean' Noctor, Dan Lewer, Vivian Hope, Niamh Eastwood, Magdalena Harris","doi":"10.1186/s12954-024-01127-2","DOIUrl":"10.1186/s12954-024-01127-2","url":null,"abstract":"<p><strong>Background: </strong>Management of opioid withdrawal in hospital settings is crucial to improve treatment completion and health outcomes among patients who use opioids, such as heroin. Evidence-based clinical guidelines can support responsive provision of opioid substitution therapy (OST). In England there is no standardised application of guidance for substance dependence management across National Health Service (NHS) Hospitals. A recent review of NHS hospital policies identified varying approaches to managing opioid withdrawal and procedural barriers to timely medication.</p><p><strong>Objective: </strong>To develop a clinical guideline for opioid withdrawal management in acute NHS hospital trusts to be tested and evaluated as part of the iHOST (Improving Hospital Opioid Substitution Therapy) research intervention.</p><p><strong>Methods: </strong>We undertook a deliberative guideline development process. The University London College Hospital (UCLH) substance dependence guideline was used as a template, with key points of revision informed by evidence review, consultations with hospital staff and people with opioid dependence. A multidisciplinary working group deliberated evidence statements to develop recommendations. These were reviewed by an oversight committee comprising representatives from key stakeholder organisations. The team authored the guideline with iterative review by the oversight committee, key stakeholders and UCLH clinical governance committees.</p><p><strong>Results: </strong>Deliberation focused on three key domains: (1) identifying opioid dependence and promptly continuing existing OST prescriptions; (2) initiating or re-titrating OST; (3) ensuring safety and continuity of care at discharge. Changes to the UCLH guideline included removal of mandatory urine drug testing prior to OST; increasing initial methadone titration dose; and provision for a higher day-one titration dose when specific safety criteria are met. A new titration schedule for sublingual buprenorphine was incorporated. Discharge planning to ensure continuity of community care and reduce risk of opioid overdose was emphasised, with allowance for bridging prescriptions of OST and naloxone provision on hospital discharge.</p><p><strong>Conclusion: </strong>The iHOST clinical guideline aims to remove procedural barriers to opioid withdrawal management for hospital inpatients. It is intended to be implemented by other NHS hospitals, which could improve access to OST and reduce discrepancies in treatment access and completion.</p><p><strong>Study registration: </strong>ISRCTN47320412 https://doi.org/10.1186/ISRCTN47320412 .</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"201"},"PeriodicalIF":4.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647767","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":"Identifying barriers to hepatitis B and delta screening, prevention, and linkage to care among people who use drugs in Philadelphia, Pennsylvania, USA.","authors":"Beatrice Zovich, Catherine Freeland, Holly Moore, Kara Sapp, Anousha Qureshi, Amy Jessop, Rachel Holbert, Fiona Borondy-Jenkins, Quinn Plunkett, Chari Cohen","doi":"10.1186/s12954-024-01117-4","DOIUrl":"10.1186/s12954-024-01117-4","url":null,"abstract":"<p><strong>Background: </strong>People who use drugs (PWUD) are at increased risk for blood-borne viruses, including hepatitis B (HBV) and delta (HDV). Despite the public health threats both viruses present, awareness remains low among at-risk communities and providers who serve them. This study assessed barriers to HBV and HDV prevention, diagnosis, and linkage to care, evaluated existing levels of knowledge, and identified educational needs and preferences among both PWUD and service providers.</p><p><strong>Methods: </strong>For this mixed-methods study, data were collected through an anonymous online provider-focused survey, and interviews with PWUD, non-medical staff, and healthcare providers at a harm reduction organization in Philadelphia, PA, USA. Convenience sampling was used for recruitment of both key informants and survey respondents. Survey respondents were categorized according to their type of practice. For the interviews, a codebook was created for qualitative analysis. Data were subsequently organized into thematic categories.</p><p><strong>Results: </strong>The top provider-related barriers limiting HBV screening were identified as confusion about insurance coverage (48%) and competing priorities (45%). Barriers to vaccination included patient hesitancy (52%) and challenges with administering multiple doses (39%). Respondents indicated low knowledge of HDV tests (62%) and cited guideline complexity (31%) as barriers to HDV testing. HBV and HDV awareness within the community and among staff was poor. Findings demonstrated that stigma related to drug use and harm reduction posed a significant barrier to care. Participants recommended awareness campaigns tailored for the PWUD community that are non-stigmatizing and non-judgmental, clear, factual, digestible, and interactive, with empowering steps to protect health.</p><p><strong>Conclusion: </strong>This study identified major gaps in HBV and HDV service delivery for PWUD, including poor basic knowledge, the need to address this through culturally appropriate, non-stigmatizing and tailored educational programming, and challenges with access to vaccination and testing. Continued initiatives are needed to close disparities, and to continue to provide financial and political support for harm reduction organizations, a frequently cited facilitator of healthcare access for PWUD. Significant efforts are essential to address lack of vaccination, testing, and linkage to care, and to improve health outcomes among PWUD.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"199"},"PeriodicalIF":4.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643995","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":"Women, gender and drugs: between research and action.","authors":"Anne Coppel, Sarah Perrin","doi":"10.1186/s12954-024-01106-7","DOIUrl":"10.1186/s12954-024-01106-7","url":null,"abstract":"<p><p>This article is part of Harm Reduction Journal's special issue on harm reduction research in the francophone context and specifically the Harm Reduction Network (HARENE). After highlighting the history and current context of harm reduction for women in France, we present the results of four research studies addressing the links between gender and drugs which were presented in the book Espaces genrés des drogues. Parcours dans la fête, l'intimité et la réduction des risques ('Gendered Spaces of Drugs. A journey of intimacy, party and harm reduction'). This article is divided into three parts, each addressing a specific space: the space of institutional care, the intimate marital space, and the urban festive space. We begin by describing gender inequalities within harm reduction and care structures, by demonstrating how single-sex spaces facilitate the care of women, and how care professionals can perpetuate unequal gender norms in their relationship with a woman in a situation of addiction expressing a desire for pregnancy. Concerning the marital space, we highlight the reproduction of gender norms within socially included heterosexual couples who use drugs and are socially included, particularly concerning the choice of the intimate partner, the distribution of tasks linked to the purchase and sale of drugs, and parenthood. Finally, concerning the festive space, the article highlights the differentiated strategies of men and women in urban festive places, and the maintenance of a gendered order of festive places and drug consumption. This leads us to discuss the current issues of stigmatization of women drug users, and the initiatives put in place in the French context to promote harm reduction for women who use drugs.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"200"},"PeriodicalIF":4.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643927","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":"Reaching people who use drugs with sexual and reproductive healthcare through syringe services programs: potential promise and missed opportunities.","authors":"Joy D Scheidell, Teresa Chueng, Katrina Ciraldo, Belén Hervera, Sophia Dakoulas, Muthoni Mahachi, Alex S Bennett, Luther C Elliott","doi":"10.1186/s12954-024-01116-5","DOIUrl":"10.1186/s12954-024-01116-5","url":null,"abstract":"<p><strong>Background: </strong>People who use drugs are at elevated sexual and reproductive health risk but experience barriers to services. Syringe services programs (SSP) are an important venue to provide integrated health services. Few studies have examined SSP use within intersecting gender, racial, and ethnic groups, including by injection drug use (IDU), and differences in sexual and reproductive health among these groups.</p><p><strong>Methods: </strong>Within a cohort study among people who use unprescribed opioids in New York City, we conducted a nested cross-sectional study from November 2021-August 2022 assessing sexual health with a survey (n = 120). The parent study measured baseline characteristics, and the cross-sectional study survey measured self-reported past-year SSP use and sexual and reproductive health. We estimated SSP use within gender, racial, and ethnic groups by IDU, and the prevalence of sexual and reproductive health outcomes by gender, race, ethnicity, and SSP use.</p><p><strong>Results: </strong>Among men (n = 61) and women (n = 54), SSP use was disproportionately low among Black participants irrespective of IDU. Women reporting SSP use had a higher prevalence of multiple, new, sex trade, and/or casual sex partners, history of STI symptoms, and lack of effective STI prevention, although women who did not use SSP had non-negligible levels of risk with variation between racial and ethnic groups. Among men, sexual and reproductive health varied across racial and ethnic groups but not as clearly by SSP use.</p><p><strong>Conclusions: </strong>SSP offer opportunity to address elevated STI risk among people who use drugs but may miss certain intersecting gender, race, and ethnic groups.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"198"},"PeriodicalIF":4.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619052","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":"Correction: Europe must continue to lead on harm reduction.","authors":"Brendan Kahn, Michel Kazatchkine","doi":"10.1186/s12954-024-01124-5","DOIUrl":"10.1186/s12954-024-01124-5","url":null,"abstract":"","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"197"},"PeriodicalIF":4.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619004","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":"Harm reduction techniques among cisgender gay, bisexual, and queer men using anabolic androgenic steroids: a qualitative study.","authors":"Eric Kutscher, Arslaan Arshed, Richard E Greene, Mat Kladney","doi":"10.1186/s12954-024-01121-8","DOIUrl":"10.1186/s12954-024-01121-8","url":null,"abstract":"<p><strong>Background: </strong>Anabolic androgenic steroids (AAS) are synthetic forms of testosterone frequently used as performance enhancing drugs among gay, bisexual, and queer (GBQ) men. Despite widespread use, associated harms, and the likely existence of an AAS use disorder, there is no medical consensus on standards of care for people who use AAS, with most medical providers focusing exclusively on abstinence. Individuals using AAS have developed community-based harm reduction strategies to mitigate these harms.</p><p><strong>Methods: </strong>This paper is a sub-analysis of qualitative data obtained through semi-structured interviews with GBQ men using AAS for 8 or more weeks recruited through convenience and snowball sampling from clinical sites and LGBTQ + venues in New York City as well as through social media. Interviews were coded with themes developed using reflexive thematic analysis. Data related to harm reduction techniques were then re-analyzed through a prevention strategies framework lens of primary, secondary, and tertiary harm prevention.</p><p><strong>Results: </strong>Thematic saturation was reached at twelve interviews in the primary analysis, with men reporting frequent use of multiple harm reduction techniques. For primary prevention, men avoided oral steroids and simultaneous substance use, tried to obtain AAS from reputable sources, used \"cycling\" to dose steroids, and practiced sterile injection techniques. Secondary prevention methods included patient-directed lab testing for hematocrit, liver and kidney function, cholesterol, prostate specific antigen, testosterone, and self-performed blood pressure checks. Tertiary prevention included donating blood and the use of medications without a prescription, including aromatase inhibitors, selective estrogen receptor blockers, aspirin, statins, angiotensin receptor blockers, clomiphene, and human chorionic gonadotropin.</p><p><strong>Conclusions: </strong>Despite many GBQ men experiencing harms from anabolic androgenic steroids, community members have often sought harm reduction techniques in lieu of abstinence. Though many of these techniques embrace clinical reasoning and may be more broadly applicable, additional research is needed to understand the impact of each intervention on the overall health of individuals using AAS.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"196"},"PeriodicalIF":4.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619050","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":"Problematizing content moderation by social media platforms and its impact on digital harm reduction.","authors":"André Belchior Gomes, Aysel Sultan","doi":"10.1186/s12954-024-01104-9","DOIUrl":"10.1186/s12954-024-01104-9","url":null,"abstract":"<p><p>Recent years have marked a shift in selling and buying illicit psychoactive drugs from darknet cryptomarkets to publicly accessible social media and messaging platforms. As more users turn to procuring drugs this way, the role of digital harm reduction has become particularly urgent. However, one of the main obstacles complicating the implementation of digital harm reduction is the increasingly automated content moderation by the social media platforms. While some platforms are less restrictive about harm reduction content (e.g., TikTok), others implement higher degrees of moderation, including the removal of individual content and banning of entire profile pages (e.g., Instagram). This article discusses community guidelines of five popular social media and messaging platforms and their content moderation tools. It aims to highlight how these guidelines may be inadvertently curbing the dissemination of harm reduction and health promotion materials, and erroneously interpreting it as a promotion of drug use and sales. The discussion concludes that digital harm reduction requires transdisciplinary collaboration of professional organizations, researchers, and social media platforms to ensure reliable implementation of digital harm reduction, and help build safer digital communities.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"194"},"PeriodicalIF":4.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619051","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":"A cross-sectional study of stigma towards opioid users among rural law enforcement and community members in tennessee.","authors":"Kahler W Stone, Gabrielle M Chesak, Angela S Bowman, Michael Ayalon, Cynthia Chafin","doi":"10.1186/s12954-024-01114-7","DOIUrl":"10.1186/s12954-024-01114-7","url":null,"abstract":"<p><strong>Background: </strong>The U.S. opioid crisis, resulting in nearly 500,000 deaths from 1999 to 2019, has been exacerbated by persistent stigma, which hinders treatment and recovery efforts. This stigma, whether structural, social, or self-imposed, challenges overdose prevention and recovery. Our study aimed to assess and compare levels of stigma towards opioid users among rural law enforcement officers (LEOs) and community members in Tennessee, highlighting rural community-level attitudes.</p><p><strong>Methods: </strong>Methods involved surveying two groups: LEOs (N=48) and community members (N=393). Utilizing a Likert Scale based on prior research, the survey probed attitudes toward drug use across four stigma domains: dangerousness, blame, social distancing, and fatalism. Analysis employed standardized scoring and ANOVA for evaluating stigma differences by participant characteristics.</p><p><strong>Results: </strong>LEOs (75%) and community members (51.7%) predominantly identify drug users as white, with varied perceptions regarding socioeconomic status and employment. Despite similar perceptions, normalized stigma scores revealed statistical differences between groups across stigma domains. ANOVA found no significant impact of participant type or gender on stigma levels, though race/ethnicity and its interaction with gender suggested potential influences on overall stigma score.</p><p><strong>Conclusions: </strong>Both LEOs and community members in rural Tennessee hold measurable stigma against opioid users, spanning dangerousness, blame, social distancing, and fatalism domains. These insights highlight the need for further research into both professional and public attitudes toward individuals with opioid or other substance use disorders within shared communities. This research should aim to develop specific stigma-reducing interventions that target both providers and community members.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"195"},"PeriodicalIF":4.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619003","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":"Opioid relapse and its predictors among methadone maintenance patients: a multicenter, cross-sectional study in Vietnam.","authors":"Huong Thi Thanh Nguyen, Dai Xuan Dinh","doi":"10.1186/s12954-023-00872-0","DOIUrl":"10.1186/s12954-023-00872-0","url":null,"abstract":"<p><strong>Background: </strong>Opioid relapse, one of the common and severe problems during methadone maintenance treatment, can give rise to poor treatment outcomes. This study measured the opioid relapse rate and its associated factors among methadone maintenance patients in Vietnam.</p><p><strong>Methods: </strong>Information about the demographic characteristics and social support of 655 patients was collected through direct interviews. Medical records were used to gather data on treatment characteristics. Relapse was determined via urine opioid test results.</p><p><strong>Results: </strong>The overall relapse rate of patients during treatment was 13.1%. According to the multivariate logistic regression model, living in mountainous areas (adjusted odds ratio (aOR) = 3.63, 95% CI 1.90-7.46) and long duration of drug use in the past (aOR = 1.06, 95% CI 1.03-1.09) were associated with an increase in the odds of opioid relapse. By contrast, living with many family members (aOR = 0.69, 95% CI 0.55-0.85), having longer treatment time (aOR = 0.80, 95% CI 0.73-0.87), and completely adhering to treatment (aOR = 0.38, 95% CI 0.23-0.64) were protective for opioid relapse. As per the univariate analyses, the odds of opioid relapse declined by 25% for each increase of one close friend or relative (OR = 0.75, 95% CI 0.66-0.86). Regarding social support (range score: 0-100), each additional increase of one score was associated with a 1% decrease in the odds of opioid relapse (OR = 0.99, 95% CI 0.98-0.99). Patient sex, education level, occupation type, patient's monthly income, family's monthly income, the number of previous treatments, daily methadone dose, comorbidity, and received antiretroviral therapy were not associated with opioid relapse among patients (p > 0.05).</p><p><strong>Conclusions: </strong>Residence, the role of family and social support, and treatment adherence should be paid more attention to guarantee and enhance the success of methadone maintenance treatment.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"20 1","pages":"136"},"PeriodicalIF":4.4,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307086","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":"Stigma and level of familiarity with opioid maintenance treatment (OMT) among specialist physicians in Israel.","authors":"Rozner Lihi, Delayahu Yael, Brill Silviu, Sason Anat, Weinstein Marsha, Shoshan Stacy, Schreiber Shaul, Adelson Miriam, Peles Einat","doi":"10.1186/s12954-023-00869-9","DOIUrl":"10.1186/s12954-023-00869-9","url":null,"abstract":"<p><strong>Context: </strong>Opioid use disorder (OUD) poses significant public health problems that have increased dramatically, resulting in high rates of morbidity and mortality.</p><p><strong>Objectives: </strong>To minimize the risk of an opioid epidemic in Israel and be prepared, we evaluated physicians' objective knowledge, level of stigma, and approach to prescribing opioids, risk factors, and identification of patients with substance use disorder (SUD), as well as their knowledge about opioid maintenance treatment (OMT) for OUD.</p><p><strong>Methods: </strong>Anonymous computerized questionnaires were distributed nationally to physicians by the Israel Medical Association. Knowledge, stigma, and approach were scored.</p><p><strong>Results: </strong>Of only 249 responders, 58.6% prescribe opioids, 32.1% prescribe cannabis, and 18.5% daily encounter patients with SUD. Logistic regression found the high knowledge group had daily encounters with SUD (Odds Ratio (OR) = 3.5, 95% CI 1.7-7.1) and were familiar with OMT (OR = 10.1, 95% CI 3.5-29.0). The high stigma group was characterized by physicians who prescribe opioids (OR = 1.7, 95% CI 1.0-2.9), but who self-reported having limited knowledge regarding OMT (OR = 2, 95% CI 1.1-3.7). The high approach group was characterized by those who prescribe opioids (OR = 11.7, 95% CI 4.9-28), prescribe cannabis (OR = 2.1, 95% CI 1.0-4.3), self-report having limited knowledge regarding OMT (OR = 11.2, 95% CI 1.4-89) and self-report identifying SUD (OR = 32.5, 95% CI 4.1-260).</p><p><strong>Conclusion: </strong>High stigma was most evident among physicians who prescribe opioids but, importantly, who had limited knowledge specifically regarding OMT. Gaps in knowledge and approach were observed. An educational intervention is highly recommended to reduce stigma and increase referrals of patients for OMT, the most effective treatment for opioid use disorder.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"20 1","pages":"134"},"PeriodicalIF":4.4,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10287803","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}