Harm Reduction Journal最新文献

{"title":"Behavioral phenotypes associated with cannabis and alcohol substitution.","authors":"Claire L Pince, Cianna J Piercey, Vanessa T Stallsmith, Katelyn Weldon, Jesse Ruehrmund, Gregory Dooley, Hollis C Karoly","doi":"10.1186/s12954-026-01432-y","DOIUrl":"10.1186/s12954-026-01432-y","url":null,"abstract":"<p><strong>Objective: </strong>Alcohol and cannabis co-use is the most common form of polysubstance use in the U.S. Some evidence suggests that there is an association between cannabis use and reduced alcohol consumption, however data on this topic are mixed. Further research is needed to elucidate the individual factors that determine whether cannabis substitutes for alcohol.</p><p><strong>Method: </strong>This study is an exploratory analysis of data from a within-subjects, crossover laboratory study on alcohol and cannabis co-administration. Participants completed two sessions: one in which they self-administered alcohol after using cannabis, and one in which they self-administered alcohol but did not use cannabis. We aim to compare behavioral phenotypes of individuals who self-administered less alcohol after cannabis (\"substituters\"; n = 23), more alcohol after cannabis (\"complementers\"; n = 7), or the same amount of alcohol regardless of whether cannabis was used (\"non-substituters\"; n = 16). We utilized Welch's ANOVAs and Kruskal-Wallis tests to compare baseline group differences, drawing on domains from the Addictions Neuroclinical Assessment (ANA) framework. Wilcoxon tests were employed to test differences in laboratory self-administration measures between sessions for each group.</p><p><strong>Results: </strong>Substituters had significantly lower scores on measures corresponding to ANA domains of negative emotionality (BDI-II, DASS-Depression) and executive function (UPPS-P Lack of Premeditation) than non-substituters. Substituters endorsed higher positive cannabis expectancies than non-substituters, though expectancy differences did not reach significance.</p><p><strong>Conclusions: </strong>Individuals who use cannabis and alcohol and have lower levels of negative emotionality and impulsivity may be more likely to substitute cannabis for alcohol. Future research is needed to explore long-term outcomes of cannabis substitution.</p><p><strong>Clinical trials registration number: </strong>NCT04998006.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369556","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":"Risk reduction behaviours following the detection of unexpected drugs through community drug checking: a cross-sectional study.","authors":"Samuel Tobias, Cameron Grant, Mark Lysyshyn, Perrine Roux, Evan Wood, Thomas Kerr, Lianping Ti","doi":"10.1186/s12954-025-01374-x","DOIUrl":"10.1186/s12954-025-01374-x","url":null,"abstract":"<p><strong>Background: </strong>Community-based drug checking services have scaled up in response to the unregulated drug toxicity crisis across North America. We sought to assess the relationship between the detection of unexpected active drugs in a drug checking sample and subsequent engagement in risk reduction practices.</p><p><strong>Methods: </strong>We used data from a cross-sectional study of people who used community-based drug checking services in British Columbia, Canada (March 2020-July 2024). We constructed multivariable logistic regression models to examine the relationship between the detection of unexpected active drugs (i.e., compounds that have psychoactive properties) in samples brought for analysis (using combination Fourier-transform infrared spectroscopy and immunoassay strips) and engagement in subsequent risk reduction practices (e.g., dose reduction, disposal of the drug).</p><p><strong>Results: </strong>In total, 447 individuals were included: 174 (38.9%) reported detection of unexpected active drugs in their drug checking sample with the most common being benzodiazepines in expected opioid samples. The most common risk reduction behaviours were to dispose of the drug without using it (n = 24) and taking a smaller dose (n = 11). Through multivariable logistic regression, we found a positive association between detection of unexpected active drugs and engagement in risk reduction practices (adjusted odds ratio = 2.24; 95% confidence interval: 1.30-3.87).</p><p><strong>Conclusion: </strong>Individuals who detected unexpected active drugs in their sample had higher odds of engaging in risk reduction practices. These findings highlight the potential of drug checking services as a harm reduction tool within a suite of services offered to combat the unpredictable and unregulated drug supply.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365004","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 lab-based drug checking services on syringe service program engagement in Maryland, USA.","authors":"Caitlin M Berry, David Newton, Margaret Rybak, Gregory Malik Burnett, Marcela Najarro, Edward Sisco, Jasmine Lopes, Dennis Leber","doi":"10.1186/s12954-025-01380-z","DOIUrl":"10.1186/s12954-025-01380-z","url":null,"abstract":"<p><strong>Purpose: </strong>The introduction of synthetic substances into the unregulated drug supply has driven a surge in overdose deaths, posing significant public health challenges in timely substance identification, engagement with people who use drugs (PWUD), and access to treatment. Maryland's rapid analysis of drugs (RAD) program, piloted through syringe service programs (SSPs), provides a proactive harm reduction strategy by integrating mail-in, laboratory based drug checking with broader public health services to enhance surveillance and improve engagement with PWUD. We aim to investigate the association of offering RAD drug checking with SSP metrics such as encounters with PWUD and access to wound care.</p><p><strong>Methods: </strong>To investigate the association of RAD affiliation with SSP engagement and service metrics, a hierarchical linear model was employed to estimate percent changes in metrics such as encounters, naloxone distribution, and instances of overdose education. Metrics were analyzed on a log scale to account for skewness and variability across sites, with site-specific effects and random variation modeled to capture both baseline differences and the impact of RAD affiliation.</p><p><strong>Results: </strong>Sites that became RAD affiliated saw an increase in many of the recorded metrics, such as wound care services per quarter (131%) and the number of participants per quarter (74%) while other metrics, such as testing, showed smaller changes. When adjusting for baseline trends of non-RAD affiliated behavior, most of the metrics still trend towards a positive association with RAD affiliation, but only Wound Care and Counseling reach statistical significance given the small number of sites remaining non-RAD affiliated for the full duration of data collection.</p><p><strong>Conclusion: </strong>Participation in the RAD program shows a positive association with an increase in engagement and service delivery within Maryland's SSPs, suggesting it may be considered as a valuable public health intervention for improving outcomes for PWUD. However, further research is needed to explore causality and influence of factors like broader public health initiatives.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365002","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":"Association between venlafaxine use and the risk of withdrawal from nonopioid substances: a nationwide, population-based study.","authors":"Shyh-Yuh Wei, Brian Meng-Hsun Li, Daniel Hsiang-Te Tsai, Hsuan-Yun Hu, Szu-Yu Lin, Swu-Jane Lin, Chien-Chou Su, Chih-Hsin Pan, Edward Chia-Cheng Lai","doi":"10.1186/s12954-026-01427-9","DOIUrl":"10.1186/s12954-026-01427-9","url":null,"abstract":"<p><strong>Background: </strong>Appropriate treatments for nonopioid substance use are currently unavailable. Venlafaxine may reduce withdrawal from nonopioid substances, but the effects have not been evaluated. We aimed to investigate the association between venlafaxine use and the risk of withdrawal from nonopioid substances.</p><p><strong>Methods: </strong>We linked Taiwan's National Health Insurance Research Database and the Taiwan Illicit Drug Issue Database from January 2012 to December 2019. We used a case-case-time-control study involving a case-crossover analysis and a control-crossover analysis consisting of future cases. The outcomes were withdrawal from substances and all-cause mortality. For each individual, venlafaxine use during the hazard period (day - 8 to - 67 before the outcome) was compared with that during the 60-day reference period (between days - 248 and - 307). Conditional logistic regression was used to determine odds ratios with 95% confidence intervals to evaluate the associations between outcome events and the use of venlafaxine.</p><p><strong>Results: </strong>The participants' average age on the index date was 39.5 years (standard deviation 8.7), with 84.1% men and 88.3% having low income. Venlafaxine was significantly associated with a lower risk of withdrawal from substances (odds ratio 0.35, 95% confidence interval 0.13 to 0.96). However, we found no association between the recent use of venlafaxine and all-cause mortality (1.08, 0.55 to 2.14). The point estimates were similar in a series of sensitivity analyses, though not all analyses statistical significance.</p><p><strong>Conclusions: </strong>This study provides strong ground for clinicians to consider the use of venlafaxine to reduce patient experiencing withdrawal symptoms from substances.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343994","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":"Characteristics of adverse reactions to kratom and implementation of harm reduction strategies in a sample of ethnobotanical tea bar patrons in Colorado.","authors":"Cianna J Piercey, Joseph Cameron, Riley Ahern, Isabella Packwood, Carter Bruning, Devin Henry, Jesse Ruehrmund, Katelyn Weldon, Kirsten E Smith, Hollis C Karoly","doi":"10.1186/s12954-025-01382-x","DOIUrl":"10.1186/s12954-025-01382-x","url":null,"abstract":"<p><strong>Background: </strong>Kratom is a psychoactive botanical that is increasingly popular in the United States. While potential risks of kratom use have been identified, research on harm reduction strategies and contextual factors contributing to adverse reactions is limited. Given that kratom is federally unregulated at present, and a variety of kratom products are widely available on the commercial market, more data are needed to inform harm reduction efforts and public health messaging.</p><p><strong>Methods: </strong>102 participants (mean age = 22.34 years, 39.2% women) were recruited from ethnobotanical tea bars in Northern Colorado to complete a survey on kratom use, which included questions pertaining to adverse experiences.</p><p><strong>Results: </strong>Most participants (75.5%) reported experiencing an adverse reaction to kratom at least once in the past, with a wide range of kratom doses reportedly consumed during these experiences. Adverse reactions were most commonly reported to occur in the context of consuming kratom on an empty stomach, consuming alongside certain foods, lack of hydration, and combining kratom with other substances. Participants employed a variety of strategies in attempt to mitigate adverse reactions, such as stopping or pacing their use of kratom and other substances, modulating hydration and food intake, and engaging in rest and recovery behaviors.</p><p><strong>Conclusions: </strong>Adverse reactions to kratom may be associated with certain contextual factors. Several techniques are reportedly used to mitigate adverse reactions, but the efficacy of these techniques is unknown. More data are needed to understand the causes and consequences of adverse reactions to kratom, and to better understand potential harm reduction strategies for reducing adverse experiences. More research could also shed light on the extent to which kratom serving size and various product formulations (e.g. whole leaf vs. extracts) are predictive of adverse effects.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343997","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":"Barriers and facilitators of implementation of liver screening in an outreach-based care pathway for people experiencing homelessness and substance use disorders: a qualitative study of clinicians' and stakeholders' perspectives.","authors":"Nikolaos Mylonas, Laura Hazeldine, Maria Walsh, Chris Daly, Martin Prince, Stephen J Kaar","doi":"10.1186/s12954-025-01375-w","DOIUrl":"10.1186/s12954-025-01375-w","url":null,"abstract":"<p><strong>Background: </strong>People experiencing homelessness face disproportionate rates of liver disease, yet are often excluded from mainstream healthcare services. Vibration-Controlled Transient Elastography (VCTE) is a non-invasive method for liver screening increasingly used in community settings. However, evidence on implementing such screening pathways in outreach services remains limited. This study explored the views of clinicians and stakeholders on the barriers and facilitators to implementing a VCTE liver screening pathway within an assertive outreach drug and alcohol service in North West England.</p><p><strong>Methods: </strong>A qualitative design involving semi-structured interviews was used to explore the implementation of the pathway. Twenty participants, including frontline clinicians and stakeholders involved in service design, commissioning, and delivery, were interviewed. Data were analysed using Framework Analysis guided by the Consolidated Framework for Implementation Research (CFIR). Both deductive coding using CFIR domains and inductive coding were applied.</p><p><strong>Results: </strong>Key barriers included training costs, capacity within hepatology services, patients' difficulties in accessing healthcare, and uncertainties around continuity of funding. Facilitators included the immediate feedback provided by VCTE supporting harm reduction advice, targeted initial funding for services supporting people experiencing homelessness, a strong team culture of person-centred care, staff motivation, and the flexibility of the outreach delivery model. Challenges around interpreting results and navigating referral processes highlighted the need for stronger cross-sector collaboration and workforce development.</p><p><strong>Conclusions: </strong>Integrating liver screening into outreach-based drug and alcohol services was considered acceptable by staff and stakeholders when supported by interagency partnerships, targeted funding, and motivated staff. Future implementation efforts should prioritise keyworker training and enhanced communication between drug and alcohol and hepatology services.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13020038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344069","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":"ZIP code-level alcohol outlet density and nonfatal overdose among people who inject drugs in 22 US metropolitan statistical areas: a multilevel modeling analysis.","authors":"Snigdha R Peddireddy, Stephanie Beane, Courtney Yarbrough, Umedjon Ibragimov, Janet R Cummings, Danielle F Haley, Sabriya L Linton, Hannah L F Cooper","doi":"10.1186/s12954-026-01414-0","DOIUrl":"10.1186/s12954-026-01414-0","url":null,"abstract":"<p><p>BACKGROUND: Alcohol outlet density (AOD) is associated with drinking behaviors and related harms across several populations. As alcohol consumption compounds the depressive effects of opioids to increase overdose risk among people who inject drugs (PWID), this study investigated (1) whether off-premise AOD is associated with the risk of nonfatal overdose among a large sample of PWID, and (2) whether this relationship varies by individual race/ethnicity. METHODS: We linked individual-level 2018 National HIV Behavioral Surveillance (NHBS) data with ZIP code-level data on off-premise AOD in 2016 from the US Census Bureau’s ZIP Code Business Pattern survey. NHBS surveys PWID across 22 metropolitan statistical areas (i.e., urban cores and surrounding counties with ≥ 50,000 residents, defined by commuting patterns) using respondent-driven sampling. Hierarchical generalized linear models quantified the association between AOD and nonfatal overdose, overall and by PWID race/ethnicity. RESULTS: The sample comprised 9,764 PWID who used opioids, 45% of whom were non-Hispanic/Latine White, 38% non-Hispanic/Latine Black, and 18% Hispanic/Latine. Over a quarter (28%) experienced an overdose in the past year. The median outlet density was 4.0 outlets per square mile. The adjusted model did not show a significant relationship between AOD and odds of overdose (OR: 1.01, 95% CI 1.00–1.02), and the relationship remained null in the race/ethnicity interaction model. CONCLUSIONS: Regulating AOD alone may not effectively mitigate overdose risk among PWID. Future research should explore why overdoses among PWID are not sensitive to changes in AOD. Possible explanations to consider are whether (1) AOD is unassociated with alcohol consumption among PWID, or (2) PWID stagger the timing of their alcohol consumption so it does not coincide with opioid consumption.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13020277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344049","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":"Celebrating each success: proportion of remission as a measure of recovery from polysubstance use disorder proportion of remission; a recovery measure.","authors":"Fatima Quddos, Rafaela M Fontes, Candice L Craft, Allison N Tegge, Warren K Bickel","doi":"10.1186/s12954-025-01370-1","DOIUrl":"10.1186/s12954-025-01370-1","url":null,"abstract":"<p><strong>Background and aims: </strong>History of multiple substance use disorders (SUDs) or polysubstance use is highly prevalent, associated with worse treatment outcomes and higher mortality rates compared to single substance use. Although a few longitudinal studies have measured recovery progress over time, no metric explicitly quantifying recovery from polysubstance use is available. Here, we introduce the concept of proportion of remission (PrR) that provides a more granular and nuanced measure of recovery in individuals with polysubstance use and investigate its association with various Quality of Life (QoL) domains. We also report on individual SUD's contribution to QoL.</p><p><strong>Design: </strong>Cross-sectional study design.</p><p><strong>Setting: </strong>Remote study.</p><p><strong>Participants: </strong>2,406 participants with polysubstance use (polySUD; i.e., a history of two or more substance use disorders).</p><p><strong>Measurements: </strong>Participants completed DSM-5 questionnaires regarding their lifetime and past 12-month substance use, Quality of Life measures, and demographics. Remission status was determined for each SUD based on meeting the DSM-5 criteria (excluding craving) in the past 12 months. Proportion of remission was quantified as the number of SUDs in 12-month remission divided by the total number of lifetime SUDs.</p><p><strong>Results: </strong>PrR was significantly positively associated with environmental (B = 12.13, 95% CI: [9.68, 14.59], f = 0.2), physical (B = 10.75, 95% CI: [8.23, 13.26], f = 0.17), psychological (B = 7.73, 95% CI: [5.93, 9.52], f = 0.17), and social (B = 6.69, 95% CI: [3.45, 9.93], f = 0.08) QoL, after adjusting for covariates. Across SUDs, individuals not in remission exhibited significantly lower QoL compared to those in remission, with stimulants having the largest effect sizes (f = 0.39-0.42).</p><p><strong>Conclusions: </strong>We propose a novel construct of polySUD recovery: proportion of remission. Our results indicate the potential of PrR to capture gradual improvements in quality of life and reflect recovery progress.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321532","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":"Hi-fun, homepas and incidental sex with drugs: a qualitative study developing a locally grounded definition of hi-fun (chemsex) compared to other sexualised drug use types practiced by gay, bisexual and other men who have sex with men in Thailand.","authors":"T Charles Witzel, Worawalan Waratworawan, Nattharat Samoh, Alison J Rodger, Harry Prabowo, Gloria Lai, Pongsri Bootsan, Ittiphol Chaicharoen, Thissadee Sawangying, Ratachayapornthawee Thanawattewakul, Siriporn Nonenoy, Sudarat Thongsuksangcharoen, Nittaya Phanuphak, Siripong Srichau, Verapun Ngamee, Adam Bourne, Thomas E Guadamuz","doi":"10.1186/s12954-026-01426-w","DOIUrl":"10.1186/s12954-026-01426-w","url":null,"abstract":"<p><strong>Background: </strong>Gay, bisexual and other men who have sex with men's (GBMSM) sexualised drug use, defined as taking psychoactive drugs before or during sex, is the focus of public health concern globally. 'Hi-fun' in Thailand (similar to the practice of 'chemsex' in Western settings) is a subset of sexualised drug use. Much harm reduction programming relies on Western chemsex definitions, obscuring critical variation related to local cultures, drug markets and legislative contexts. We aimed to develop, informed by transnational queer sociology, a locally grounded definition of hi-fun compared to other sexualised drug use types practiced among GBMSM in Thailand.</p><p><strong>Methods: </strong>To delineate sexualised drug use types and explore structural and social influences on how hi-fun is practiced and organised, focus groups and in-depth interviews (May-Sept 2024) were conducted with GBMSM (with sexualised drug use experience within prior 12-months) recruited from community organisations in Bangkok, Khon Kaen and Pattaya. Data were transcribed, translated where necessary and analysed with a thematic framework.</p><p><strong>Results: </strong>Participants (n = 30) were aged 25-47 years, 25 gay, ten living with HIV, seven born outside Thailand. Most (n = 23) used crystal methamphetamine (ice) before/during sex in preceding 12-months, with fewer taking other drugs (ecstasy/MDMA= 14, ketamine = 12, cocaine = 10, GHB/GBL = 5). Participants' accounts coalesced around three main sexualised drug use types: hi-fun, sex at homepas (medium to large parties where men socialise, usually while wearing only underwear) and incidental sex with drugs (spontaneous and situational combining sex with drugs, often after a night out). Hi-fun was delineated from other sexualised drug use types based on participant motivations to increase wellbeing through pleasure and intimacy, in contrast to homepas and incidental sex with drugs which were linked more to socialising. Crystal methamphetamine (ice) was considered foundational to hi-fun, whereas other drugs (e.g. cocaine, ecstasy/MDMA, ketamine and GHB/GBL) were more common in homepas and incidental sex with drugs. Technology, especially geolocation social/sexual networking apps, were central to hi-fun organisation, but potentially less important for other sexualised drug use types. Both hi-fun and homepas primarily took place in private settings, whereas incidental sex with drugs happened in a wider range of venues.</p><p><strong>Conclusions: </strong>Hi-fun in Thailand can be defined as the intentional combination of sex and crystal methamphetamine (ice) to enhance intimacy and pleasure with one or more other man/men, facilitated by technology and usually in a private setting. This definition will be useful for those supporting GBMSM in Thailand through policy, research and service provision.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147305101","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":"Convenience, rapport and skill: effective rural hepatitis C treatment, qualitative findings from a mobile harm reduction-informed tele-medicine intervention in Northern New England, 2022-2024.","authors":"K Nolte, L Del Toro-Mejias, E Bianchet, S Tarplin, R Hoskinson, P D Friedmann, T J Stopka","doi":"10.1186/s12954-026-01421-1","DOIUrl":"10.1186/s12954-026-01421-1","url":null,"abstract":"<p><strong>Background: </strong>People who inject drugs (PWID) are at high risk for acquiring and transmitting the hepatitis C virus (HCV). Access to HCV testing and treatment remains limited in rural communities. Mobile healthcare interventions are promising models to reach underserved populations like rural PWID. Understanding the characteristics of effective interventions to engage rural PWID in HCV care can guide design strategies for HCV treatment and elimination in rural areas.</p><p><strong>Methods: </strong>The Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) study randomized 150 participants with chronic HCV to examine Mobile Tele-HCV Care (MTC) versus Enhanced Usual Care (EUC). On-the-spot qualitative interviews (n = 34) were conducted with study participants, community providers, and study van staff to understand the context for protocol implementation. For this study, qualitative coding and thematic analyses identified the characteristics of successful HCV treatment engagement among PWID in rural areas.</p><p><strong>Results: </strong>This successful HCV treatment engagement intervention with out-of-treatment rural PWID had three essential characteristics: convenience, effective rapport, and skilled staff. Convenience factors included dependable and easily accessible locations with drop-in availability that made it easy to make HCV treatment a priority. Rapport with participants through a harm reduction approach engendered respect for autonomy and tailoring the protocol to accommodate the complexities of daily life that PWID face. Skilled staff were flexible across multiple roles including on-site phlebotomy, a notable barrier to rural PWID obtaining HCV treatment, and were competent in caring for PWID.</p><p><strong>Conclusions: </strong>We identified salient characteristics that contributed to high trust and treatment adherence among a marginalized population of rural PWIDs. Tailored, flexible approaches and specialized skills are required to engage and retain PWID in rural areas.</p><p><strong>Trial registration: </strong>NCT05466331.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13041415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147305155","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}