Harm Reduction Journal最新文献

{"title":"Channelling and taxation in European online gambling markets: evolution and policy implications.","authors":"Virve Marionneau, Nicola Matteucci, Sabrina Vieira Lima, Janne Nikkinen, Jani Selin","doi":"10.1186/s12954-024-01145-0","DOIUrl":"10.1186/s12954-024-01145-0","url":null,"abstract":"<p><strong>Background: </strong>Taxation can be used to direct consumption and provision of harmful commodities. Prior research on gambling taxation has nevertheless been inconclusive on whether this can also apply to gambling. In gambling policy, optimal taxation rates have particularly been debated from the perspective of channelling consumption from offshore markets to regulated markets. Prior industry-sponsored reports have suggested that lower tax rates may be correlated with higher channelling rates.</p><p><strong>Methods: </strong>We analyse data on two cross-sections (2018; 2021) derived from 29 European countries. The data consist of estimated channelling rates, information on taxation levels, and controls including blocking policies. We produce a descriptive overview of the recent evolution of market channelling and taxation for online gambling products across Europe. We also produce a multivariate regression analysis on the extent that market channelling is correlated with taxation of online gambling.</p><p><strong>Results: </strong>Our results show important divergence in taxation of online gambling markets in Europe. We also found that over time, the market share of offshore markets has declined in relative terms. However, this decline is explained by a more rapid growth in the regulated market in absolute terms. The regression analysis found no evidence of a negative correlation between that taxation rates and channelling rates within Europe.</p><p><strong>Conclusions: </strong>Gambling policy needs to be based on empirical, impartial evidence. Misleading estimates may result in increased harms to societies. Channelling objectives are important for better regulation and harm reduction, but taxation levels do not appear to be correlated to the success of channelling policies.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"1"},"PeriodicalIF":4.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927226","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":"\"It's a delicate balance\": clinicians' experiences of providing heroin-assisted treatment.","authors":"Rune Ellefsen, Silvana De Pirro, Vegard Haukland, Linda Elise Couëssurel Wüsthoff, Espen Ajo Arnevik","doi":"10.1186/s12954-024-01135-2","DOIUrl":"10.1186/s12954-024-01135-2","url":null,"abstract":"<p><strong>Background: </strong>Little attention has been paid to the experiences of clinicians and health personnel who provide heroin-assisted treatment (HAT). This study provides the first empirical findings about the clinicians' experiences of providing HAT in the Norwegian context.</p><p><strong>Methods: </strong>23 qualitative interviews were conducted with 31 clinicians shortly after HAT clinics opened in Norway's two largest cities: Oslo and Bergen. By inductive thematic analysis of interview transcripts, we identified what research participants experienced and viewed as the chief rewards and challenges of providing HAT. The study aimed to offer an overview of these key rewards and challenges, with insights potentially transferable to HAT programs internationally.</p><p><strong>Results: </strong>Participants experienced three aspects of providing HAT as particularly rewarding, and three as most challenging. The rewarding aspects were observing harm reduction outcomes; providing holistic care; and having a positive clinic milieu and patient-clinician relationships. The challenging aspects were dosing and overdose risk; rule enforcement and aggression management; and the difficulty of initiating treatments beyond medication and harm reduction. The rewarding and challenging aspects of providing HAT overlapped and were at times contradictory, thus reflecting the duality and tensions in clinicians' work to provide HAT. The challenges were reported to vary between patient subgroups, according to their degree of instability. The most unstable patients were seen as involving more difficulties as regards the challenging aspects of HAT. Participants expressed uncertainty about HAT's utility for a small group of the most unstable patients.</p><p><strong>Conclusion: </strong>While studies about clinical experiences of HAT have usually examined individual or limited aspects of treatment provision, this study provided an overview of the main aspects of the rewards and challenges of providing HAT. Importantly, it also showed the tensions between these overlapping and sometimes contradictory aspects of HAT provision. Because a positive patient-clinician relationship is crucial to patient satisfaction and treatment outcomes in HAT, the provision of training for clinicians on navigating the inherent tensions of HAT provision, nurturing therapeutic alliances with patients, and managing their role as gatekeepers to medical heroin and valuable services, seem particularly important for ensuring that care is patient-centered and staff are adequately supported.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"230"},"PeriodicalIF":4.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909054","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":"Oral health risks in adults who use electronic nicotine delivery systems and oral nicotine pouches: a critical review of the literature and qualitative synthesis of the available evidence.","authors":"Gerhard Scherer, Nikola Pluym, Max Scherer","doi":"10.1186/s12954-024-01147-y","DOIUrl":"10.1186/s12954-024-01147-y","url":null,"abstract":"<p><strong>Background: </strong>Use of combustible cigarettes (CCs) and smokeless oral tobacco products are well documented risk factors for a variety of oral diseases. However, the potential oral health risks of using recently introduced (since about 2000) non-combustible tobacco/nicotine products (NCPs: electronic cigarettes (ECs), heated tobacco products (HTPs) and oral nicotine pouches (ONPs), remain poorly established.</p><p><strong>Methods: </strong>This review evaluates published human studies on detrimental oral health effects in people who use NCPs compared to those smoking cigarettes and those not using any tobacco/nicotine product (NU). We identified 52 studies, predominantly focusing on adults who used electronic cigarettes as an NCP. The studies exhibited significant heterogeneity regarding design, populations, endpoints and quality. Reported outcomes, based on both single and grouped endpoints were qualitatively evaluated by comparing people who use NCPs with NU and with people smoking CCs. Significant increases (indicating a worsening in oral health), significant decreases (indicating a lower level of detrimental effects) and no significant difference between groups were assigned scores of + 1, -1 and 0, respectively. Scores from studies belonging to the same single or grouped endpoints were averaged to a summary score ranging from - 1 to + 1.</p><p><strong>Results: </strong>The qualitative meta-analysis revealed that comparisons of EC versus NU groups yielded mean scores of 0.29 for pre-cancerous lesions (N = 14 observations), 0.27 for inflammatory processes (N = 83), 0.43 for oral clinical parameters (N = 93) and 0.70 for shifts in the oral microbiome (N = 10). The corresponding values for the EC versus CC group comparisons amounted to -0.33 (N = 15), -0.14 (N = 76), -0.27 (N = 78) and 0.57 (N = 7). Most studies had significant limitations regarding group sizes, duration of NCP use (mostly only a few years) and validity of self-reported exclusive NCP use. Notably, the implications of dual use (EC + CC) and prior CC use were often not adequately considered.</p><p><strong>Conclusions: </strong>The evaluated studies suggest that use of ECs is associated with relatively fewer detrimental oral health effects compared to smoking, yet oral health status remains poorer compared to not using any tobacco/nicotine products. These results have to be interpreted with caution due to a number of limitations and uncertainties in the underlying studies, particularly the potential biases and confounding factors inherent in cross-sectional study designs.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"229"},"PeriodicalIF":4.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906732","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":"Identifying the facilitators of Iran's alcoholic beverage black market and presenting solutions for harm reduction: a qualitative document analysis.","authors":"Fawzieh Ghammari, Rahim Khodayari-Zarnaq","doi":"10.1186/s12954-024-01146-z","DOIUrl":"10.1186/s12954-024-01146-z","url":null,"abstract":"<p><strong>Background: </strong>Despite Iran's prohibition politics regarding alcoholic beverages consumption, marketing, and trading, there is a flourishing black market. Often, alcohol producers on this black market do not adhere alcohol production standards, resulting in a lot of deaths and significant consequences each year. Accordingly, this study was carried out to identify facilitators for the growth of the black market for alcoholic beverages in Iran and provide solutions for harm reduction.</p><p><strong>Methods: </strong>This study was a qualitative document publicly available analysis, in which online newspapers and Persian news websites about alcoholic beverages black market in Iran were reviewed. Documents were analyzed using thematic analysis.</p><p><strong>Results: </strong>After the completion of the analysis, 21 final codes, seven subthemes, and four themes were developed. Four themes are (1) political factors, including governance, regulatory rules and regulations, and awareness sub-themes (2) sociocultural factors, including culture change sub-theme (3) economic factors, including attractive market sub-theme, and (4) business factors, including manufacturing and marketing sub-themes.</p><p><strong>Conclusions: </strong>As a result of alcohol prohibition politics in Iran and a socioeconomically supportive environment, black market has developed. Several policies can be implemented to reduce alcohol black market harm. It is possible to reduce the demand for homemade alcohol by educating the public about its risks. The government should enforce stricter policies on trading and advertising alcohol to reduce the availability of homemade alcohol and shrink alcohol black market. To implement these solutions, clerics should be convinced that the alcohol black market poses a serious public health threat.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"228"},"PeriodicalIF":4.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894077","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":"Assessing healthcare cost changes associated with transitioning away from cigarette smoking using healthcare claims data: an exploratory study among adult male patients with COPD.","authors":"Mingda Zhang, Hui G Cheng, Brendan Noggle, Jud C Janak, Megan Richards, David Smith","doi":"10.1186/s12954-024-01141-4","DOIUrl":"10.1186/s12954-024-01141-4","url":null,"abstract":"<p><strong>Background: </strong>The assessment of potential health effects of switching from cigarette smoking to non-combustible tobacco products has important implications for public health and regulatory decisions. Robust epidemiological evidence requires long-term follow-up of a large number of individuals. Real-world evidence derived from health records has the potential to help fill the gap in the interim. To our knowledge, this is the first study using individual-level healthcare claims data to assess the potential impact of transitioning from cigarette smoking to smokeless tobacco on short-term direct healthcare costs.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult male patients with COPD who smoked cigarettes at baseline using the MarketScan^® Databases. We compared changes in direct healthcare costs between the 12-month periods before (baseline) and after the index date (follow-up) across three cohorts: continued smoking (CS), quit all tobacco (QT), or switched to smokeless tobacco (SW), using a non-linear difference-in-differences model with average marginal effects.</p><p><strong>Results: </strong>A total of 23,427 COPD patients were included (CS: 11,167; QT: 12,013; SW: 247). At baseline, the QT cohort had the highest total average healthcare costs ($43,771), followed by SW ($38,419), and CS ($27,149). The unadjusted difference-in-differences model revealed no statistically significant differences in total healthcare cost changes when comparing the QT or SW cohorts to the CS cohort (-$1,532 [95% CI: -$3,671, $608] for the QT cohort, and -$452 [95% CI: -$15,415, $14,511] for the SW cohort). After adjusting for Deyo-Charlson Comorbidity Index and COPD exacerbation, assuming patients had two comorbidities and exacerbations, the QT cohort had greater reduction in total healthcare costs compared to the CS cohort (-$2,910 dollars [95% CI: -$4,485, $-1,335]). The same trend was observed for the SW cohort, although the estimate was not statistically significant (-$5,312 [95%CI: -$11,067, $442], p = 0.08).</p><p><strong>Conclusions: </strong>This study demonstrated the feasibility of using administrative claims to conduct real-world evidence studies on the harm-reduction potential of non-combustible tobacco products and found evidence suggesting reductions in direct healthcare costs after quitting tobacco or switching to smokeless tobacco among patients with COPD. Based on the learnings and limitations identified during the study, we propose concrete recommendations to improve future observational studies by integrating additional real-world healthcare data from multiple data sources.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"21 1","pages":"227"},"PeriodicalIF":4.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881948","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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662500/pdf/","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":"OA","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662733/pdf/","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":"OA","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662552/pdf/","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":"OA","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660820/pdf/","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":"OA","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660775/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}