Harm Reduction Journal最新文献

{"title":"Relative affordability of heated tobacco products and cigarettes: a cross-country comparative analysis of 55 countries.","authors":"Giorgi Mzhavanadze","doi":"10.1186/s12954-026-01509-8","DOIUrl":"10.1186/s12954-026-01509-8","url":null,"abstract":"<p><strong>Background: </strong>Since their introduction in 2014, heated tobacco products (HTPs) have entered a growing number of countries. However, few studies have systematically compared their affordability with that of cigarettes or examined differences in access across income groups. This study assessed the affordability of HTPs relative to combustible cigarettes with a focus on socioeconomic disparities.</p><p><strong>Methods: </strong>Using publicly available data from the World Health Organization, World Bank, and industry sources, we compared retail prices, affordability, and tax shares across 55 countries with complete analytical data. Affordability was measured as the share of GDP per capita required to purchase 100 packs. Income distribution data were used to assess affordability across income quintiles.</p><p><strong>Results: </strong>HTP sticks were more expensive than the most-sold cigarette brand in 23 countries and more expensive than the cheapest cigarette brand in 44 countries. In all 9 lower-middle-income countries and 10 of 16 upper-middle-income countries, HTPs were more expensive than the most-sold cigarette brand; in 24 of 30 high-income countries, they were cheaper. HTPs were not marketed in low-income countries. In lower-middle-income countries, purchasing 100 packs required 7.9% of GDP per capita for HTP sticks, compared with 5.3% for the most-sold cigarette brand and 3.5% for the cheapest brand. In high-income countries, the corresponding values were 1.6%, 1.9%, and 1.5%, respectively. For the lowest-income quintile across countries, purchasing 100 packs of HTPs required 9.1% of annual income, compared with 7.9% for the most-sold cigarette brand; for the highest-income quintile, the figures were 1.4% and 1.3%. Including device costs increased annual HTP use costs by 9.2-35.3%.</p><p><strong>Conclusions: </strong>HTPs were often less affordable than cigarettes, particularly in lower-income countries and among lower-income population groups. This pattern was not explained by higher taxes on HTP sticks; in most countries, HTPs had lower tax shares than cigarettes, but this did not consistently translate into lower retail prices. Assessments of HTP affordability should therefore consider observed consumer prices, upfront device costs, and within-country income differences, rather than tax rates alone.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030436","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 among refugees and displaced populations in Lebanon: a systematic review.","authors":"Zeinab Abbas, Aline Hajj, Hala Sacre, Samah Tawil, Marwan Akel, Pascale Salameh, Michele Cherfane","doi":"10.1186/s12954-026-01453-7","DOIUrl":"10.1186/s12954-026-01453-7","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the comprehensiveness of existing policies, strategies, and research regarding harm reduction services for refugees and displaced populations in Lebanon, evaluating service availability, access barriers, and policy gaps to inform targeted and evidence-based interventions and improve health outcomes for this vulnerable group.</p><p><strong>Method: </strong>A systematic review was conducted to examine substance use and harm reduction among refugees in accordance with PRISMA guidelines. The study protocol was registered in PROSPERO. PubMed, EMBASE, and Google Scholar databases were searched using free-text words and MeSH terms, including substance use, drug use, harm reduction, hepatitis C virus (HCV) screening, hepatitis B virus (HBV) screening, refugees, treatment access, and displaced population. Grey literature from the Lebanese Ministry of Public Health, World Health Organization, and other global reports was reviewed separately and included in the PRISMA flowchart, alongside peer-reviewed studies. The risk for bias in included research papers was evaluated using the Joanna Briggs Institute Critical Appraisal Tools.</p><p><strong>Results: </strong>A total of 387 papers (369 peer-reviewed studies and 18 grey literature reports on harm reduction and substance use) were retrieved, and 29 were included in the review after screening and full-text evaluation (17peer reviewed articles and 12 grey literature reports). The results revealed a lack of structured harm reduction policies specifically targeting refugees. The identified barriers include legal restrictions, stigma, and poor integration of harm reduction services into healthcare programs. Of the 12 grey literature documents, only four mentioned harm reduction provision, and none offered a comprehensive strategy to enhance access for this vulnerable group. Many studies were general and lacked focused insights into substance use or harm reduction in refugee settings.</p><p><strong>Conclusion: </strong>The findings suggest that current policies require adaptation, as they inadequately address the specific vulnerabilities and barriers faced by refugee populations. Priority actions include adapting policies to refugee contexts, expanding mobile harm reduction clinics to improve accessibility, and integrating HCV screening into refugee healthcare services. Further targeted research is urgently required to characterize substance use patterns among refugees and develop evidence-informed interventions.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220089","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":"Timing of intimate partner violence and alcohol and cigarette use across the perinatal period among American Indian and Alaska Native women.","authors":"Stefanie Gillson, Ariel Richer, Maureen Canavan, Caroline Sloper, Katie Edwards","doi":"10.1186/s12954-026-01506-x","DOIUrl":"10.1186/s12954-026-01506-x","url":null,"abstract":"<p><strong>Background: </strong>Intimate partner violence (IPV) and substance use are closely linked and pose significant risks during the perinatal period. American Indian and Alaska Native (AI/AN) women experience disproportionately high rates of IPV and inequities related to perinatal substance use outcomes, yet research is limited regarding timing of IPV exposure and how it relates to perinatal substance use. This study examined associations between IPV exposure before and during pregnancy and patterns of alcohol use and cigarette smoking across the perinatal and postpartum periods among AI/AN women.</p><p><strong>Methods: </strong>We analyzed pregnancy risk assessment monitoring system (PRAMS) data from 2016 to 2022 in a cross-sectional design. IPV exposure was categorized as occurring before pregnancy, during pregnancy, or both. Outcomes included alcohol use frequency, heavy drinking (≥ 8 drinks per week), and cigarette smoking before pregnancy, during pregnancy, and postpartum. Survey-weighted ordinal logistic and logistic regression models were used, adjusting for sociodemographic and pregnancy-related factors. Predicted probabilities were calculated. Exploratory analyses examined associations between partner race and IPV.</p><p><strong>Results: </strong>AI/AN women reported higher prevalence of IPV before and during pregnancy (p < 0.001). In adjusted models, IPV before pregnancy was not associated with alcohol use frequency but was associated with higher odds of heavy drinking (aOR = 1.75, 95% CI 1.07-2.85). AI/AN women had higher odds of heavy drinking compared with Non-Hispanic White (NHW) women (aOR = 1.80, 95% CI 1.31-2.46), with the highest predicted probabilities observed among AI/AN women experiencing IPV (12.1%). IPV before pregnancy was also associated with higher odds of cigarette smoking before pregnancy, during late pregnancy, and postpartum (aORs 1.45-1.89), while IPV during pregnancy was associated with postpartum smoking (aOR = 2.82, 95% CI 1.23-6.44). Predicted probabilities indicated higher smoking across periods among those with IPV exposure, particularly among AI/AN women. In exploratory analyses, partner racial concordance was associated with lower odds of reported IPV among AI/AN women.</p><p><strong>Conclusions: </strong>IPV exposure was associated with more severe and persistent patterns of perinatal substance use, with the highest predicted probabilities of heavy drinking and persistent smoking observed among AI/AN women experiencing IPV. These findings underscore the importance of trauma-informed, culturally grounded harm reduction approaches that address both IPV and substance use across the perinatal period. Efforts should be situated within the broader context of structural and historical inequities while recognizing Indigenous communities strengths and resilience.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535685","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":"Peer‑led harm reduction in Brazil: gender‑based violence, intersectionality, and decolonial perspectives of community-based care.","authors":"Delia Da Mosto, Ueslei Solaterrar","doi":"10.1186/s12954-026-01499-7","DOIUrl":"10.1186/s12954-026-01499-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Gender-based violence (GBV) and substance use are closely linked in the lives of trans women and travestis. However, mainstream harm reduction frameworks rarely address these issues or focus on community-based practices that emerge in response. In Brazil, trans women and travestis-who are disproportionately Black, engaged in sex work and exposed to lethal violence-navigate health systems marked by transphobia, racism, and the dismantling of harm reduction policies. This study examines how GBV and substance use intersect in their lives, and the role of peer-led harm reduction practices as technologies of care and life-sustaining strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This article draws on two multisited ethnographic studies conducted in Brazil between 2018 and 2023. The first (2018-2020) examined suffering, self-care, and community-based support among trans women and travestis in Rio de Janeiro, combining life history and semi-structured interviews. The second (2022-2023) explored sex work, violence, resistance, and practices of care among cis and trans women sex workers, through participant observation, semi-structured interviews, and rodas de conversa (collective conversation circles). The two studies were placed in dialogue and analysed using thematic analysis supported by the Framework Method, through an intersectional and socio-anthropological lens.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Four interrelated themes emerged: (1) GBV was enacted across families, schools, health services, labour markets, and sex work spaces, producing cumulative trajectories of exclusion shaped by racism, cisnormativity, and class inequality; (2) substance use was inseparable from trauma, social suffering, and the labour conditions of sex work-embedded in an economy of survival rather than reducible to individual pathology; (3) despite structural exclusion, participants generated situated harm reduction practices-peer-led outreach, informal knowledge networks, collective care, and mutual protection-functioning as counter-hegemonic forms of health knowledge; (4) participants re-signified marginality as a site of agency, transforming exclusion into professional expertise, chosen kinship, and political activism.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study advances a conception of harm reduction that is intersectional, decolonial, and politically grounded. It demonstrates that GBV is not peripheral to substance use but constitutive of it, and that lived experience-generated knowledge, forged in structural oppression, is a legitimate foundation for harm reduction practices. These findings call for frameworks that move beyond individual risk reduction toward a social determination of health perspective-locating harm in intersecting systems of racism, transphobia, patriarchy, and criminalisation of sex work. Trans women and travestis must be recognised not only as populations exposed to harm, but as producers of care, knowledge, and politi","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497556","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":"Strategies to increase attendance in substance use disorder group treatment: results from a randomized controlled trial.","authors":"Liliane Cambraia Windsor, Heather A Jones, Carla Ellis, Kennya Hooper, Andrea Rucker, Salma Musaad, Moses Okumu","doi":"10.1186/s12954-026-01425-x","DOIUrl":"10.1186/s12954-026-01425-x","url":null,"abstract":"<p><strong>Background: </strong>Attendance in substance-use-disorder group-treatment is challenging with only 32% of patients attending at least one session [16]. The present study tested a set of strategies to increase group session attendance in Community Wise, an innovative evidence-based group-intervention delivered in harm-reduction-community-based agencies and, Community Wise was designed to reduce alcohol and substance use among people with: a history of substance-use-disorders living in predominantly Black and disinvested communities. We examined: (1) if strategies to increase attendance stratified by surveillance status (participation in mandatory programs that use urine screens regularly) would result in a clinically and statistically significant increase in intervention session attendance, with a goal of at least 50% of participants attending at least half of sessions; and (2) the effects of group session attendance and strategies to increase attendance on alcohol and substance use frequency in the past 30 days at three-months-follow-up.</p><p><strong>Methods: </strong>We conducted a 2² stratified full factorial experiment with 164 adults with substance-use-disorder in East St. Louis, IL. Participants were randomized to combinations of two strategies to increase attendance: Financial incentives (receiving $20 to attend group sessions) and group type (open versus closed groups). Surveillance status was treated as a fixed factor in the analytical model. Logistic and multiple regression models, using effect coding, tested main and interaction effects on number of sessions attended and alcohol and substance use. Analyses followed an intent-to-treat approach, adjusting for demographic covariates, using SAS 9.4.</p><p><strong>Results: </strong>Of 164 participants, 29% attended ≥ 50% of Community Wise sessions. Paying participants increased odds of attending at least 50% of sessions (OR = 1.97, p = 0.004), while being under surveillance reduced odds by 39% (OR = 0.61, p = 0.036). No main effects were found for group type. Yet, a significant interaction showed financial incentives were more effective in closed versus open groups (OR = 0.58, p = 0.021). Higher attendance predicted reduced percent alcohol and substance use at follow-up (p = 0.011).</p><p><strong>Conclusions: </strong>Financial incentives effectively improved intervention attendance, while being under surveillance reduced participation. Higher attendance was associated with decreased alcohol and substance use. The Community Wise intervention should be further tested for effectiveness in harm reduction community-based-organizations among people who are disengaged from treatment and experiencing vulnerabilities such as poverty and houselessness.</p><p><strong>Trial registration: </strong>Clinical Trials: NCT05934591.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455742","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":"Evaluating demographic variation in no-cost naloxone distribution in North Carolina: a cross-sectional survey study.","authors":"Grace Marley, Caroline Shubel, Izabela E Annis, Paul L Delamater, Carolyn T Thorpe, Bhoomi Parikh, Bayla Ostrach, Delesha Carpenter","doi":"10.1186/s12954-026-01505-y","DOIUrl":"10.1186/s12954-026-01505-y","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to identify naloxone distribution resources, as well as to evaluate potential differences in naloxone distribution by demographic population utilizing a naloxone distribution score.</p><p><strong>Methods: </strong>We utilized a cross-sectional online survey of potential no-cost naloxone distributors in North Carolina (NC) to identify their program type, where programs distribute no-cost naloxone, and to whom no-cost naloxone distribution was distributed in 2023. This information was utilized to create a naloxone distribution measure at the ZIP code level.</p><p><strong>Results: </strong>A total of 241 survey responses for programs were identified as distributors of no-cost naloxone to community members in NC. At least one no-cost naloxone distributor served all demographic populations in over 92% of NC ZIP codes. The Non-Hispanic (NH) White group had the highest mean naloxone distribution score of 30.2 (SD = 8.9) across all ZIP codes, suggesting greater distribution to this demographic. After adjusting for the size of the race/ethnicity population in GEE models, all minority race/ethnicity groups had significantly lower naloxone distribution than the NH White group.</p><p><strong>Conclusions: </strong>The naloxone distribution score calculated suggests NH White populations may be served by no-cost naloxone distributors more frequently when compared to other populations.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420622","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":"Scoping evidence review on the prevention and treatment of opioid overdose.","authors":"Abhishek Ghosh, Shinjini Choudhury, Tathagata Mahintamani, Nicolas Clark, Dzmitry Krupchanka","doi":"10.1186/s12954-025-01372-z","DOIUrl":"10.1186/s12954-025-01372-z","url":null,"abstract":"<p><strong>Background and aim: </strong>Opioid overdose is a public health crisis. Globally, ~ 600,000 deaths each year are attributable to drug use, and roughly three-quarters are linked to opioids. The rising prevalence of high-potency synthetic opioids like fentanyl necessitates comprehensive prevention and treatment strategies. This scoping review aims to map the published literature on the early detection and community management of opioid overdose and post-overdose care and identify research gaps. The aim was also to inform the potential research questions for updating the WHO and other international guidelines.</p><p><strong>Methods: </strong>We systematically searched PubMed, EMBASE, PROSPERO, and the Cochrane Database for systematic reviews for studies published between January 2014 and March 2024. Inclusion criteria encompassed systematic reviews and review protocols, randomized clinical trials, and their secondary analysis, and guidelines published in those databases, addressing opioid overdose early detection and treatment strategies.</p><p><strong>Results: </strong>A total of 3,057 unique records were screened, resulting in 105 studies meeting the inclusion criteria. Thirty studies examined the effects of the acute opioid overdose treatment. Among the preventive strategies, 46 studies focused on \"Take Home Naloxone\" strategies, reflecting a significant emphasis on naloxone distribution as a primary intervention. However, 11 studies examined post-overdose care, highlighting a notable gap in the literature. Additionally, research predominantly concentrated in the Americas (70 studies) and Europe (27 studies), with limited representation from Africa and Southeast Asia. There was a marked absence of studies on polysubstance use and ultrapotent opioids, with one systematic review addressing the treatment of fentanyl overdose.</p><p><strong>Conclusion: </strong>Findings support future international guidelines, such as those of the WHO, to examine the effectiveness of take-home naloxone, peer training, and community-based distribution models, higher-dose naloxone protocols for ultrapotent opioids, and digital delivery models. This review identifies gaps in post-overdose care, fentanyl and polysubstance overdose management, and research from low-resource settings.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420627","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":"Moral foundations and attitudes towards supervised consumption services: a regional moderation study.","authors":"Robert P Dryden, Em M Pijl","doi":"10.1186/s12954-026-01500-3","DOIUrl":"10.1186/s12954-026-01500-3","url":null,"abstract":"<p><strong>Background: </strong>Research shows consistent links between supervised consumption services (SCS) and positive health outcomes for people who use drugs, as well as reductions in the economic burdens associated with illicit substance use. However, SCS often face considerable opposition and resistance from political figures and local community members. This opposition to SCS appears to be driven, in part, by perceived violations of individuals' moral foundations.</p><p><strong>Purpose: </strong>We sought to interrogate a recently published and unexpected finding indicating that Manitobans' had the highest levels of support for SCS among the Prairie Provinces, despite being the only Prairie Province without a currently operating SCS. The Prairie Provinces refer to Alberta, Manitoba, and Saskatchewan, and comprise a region of Western Canada characterized by grasslands and lowlands. We hypothesized that differences in the predictive strength of moral foundations on attitudes towards SCS between residents of provinces with (Alberta and Saskatchewan) and without (Manitoba) an operating SCS might help to clarify this phenomenon.</p><p><strong>Method: </strong>We recruited a sample of 2116 adult participants from the three Prairie Provinces in Canada through online research panels (Manitoba, n = 716; Saskatchewan, n = 700; and Alberta, n = 700). We tested Province × Moral Foundations interactions through a series of moderated multiple logistic regression models.</p><p><strong>Results: </strong>We found consistent interaction effects indicating that binding moral foundations (authority, loyalty, purity) were stronger predictors of opposition towards SCS for residents of Manitoba compared to residents of Alberta and Saskatchewan.</p><p><strong>Conclusions: </strong>These findings help to clarify how Manitobans' slightly lower levels of binding moral foundations may have translated into relatively large differences in support for SCS compared to individuals living in Alberta and Saskatchewan. This study extends past research in being the first, to date, to show that associations between moral foundations and attitudes towards SCS may depend on regional factors such as proximity to an extant SCS. Our results point to the strategic value of framing arguments that appeal to individuals' binding moral foundations for overcoming opposition to SCS, especially the first SCS to be introduced in a province, state, or region.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411452","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":"Integrating harm reduction interventions for older adults in opioid treatment programs: a qualitative study of patient and provider perspectives.","authors":"Wayne Kepner, Benjamin H Han, Annie L Nguyen, Raúl Bejarano-Romero, Nora Satybaldiyeva, Alison A Moore, Angela R Bazzi","doi":"10.1186/s12954-026-01503-0","DOIUrl":"10.1186/s12954-026-01503-0","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of opioid use disorder (OUD) among older adults has increased rapidly, yet this population faces unique challenges in accessing harm reduction services within opioid treatment programs (OTPs). The objective of this study was to explore patient and provider perspectives on the acceptability and feasibility of delivering harm reduction interventions to older adults within OTPs.</p><p><strong>Methods: </strong>From June 2023 to February 2024, we conducted a qualitative study with two OTPs in San Diego County, California. Participants included 25 patients aged 55 and older receiving medications for OUD, and 15 OTP providers. Semi-structured interviews and thematic analysis focused exploring participants' beliefs, attitudes, and experiences with harm reduction interventions.</p><p><strong>Results: </strong>Both patients and providers expressed broad acceptability and perceived need for harm reduction services within OTPs. Key barriers identified included intersectional stigma related to age and substance use, lack of age-appropriate interventions, transportation challenges, and technological barriers. Strong patient-provider relationships were viewed as critical for successful implementation; patients emphasized the value of providers with lived experience. Providers highlighted implementation challenges, including resource constraints, sustainability concerns, and the need for integrated care models addressing complex medical and social needs. While providers viewed the frequent contact inherent in OTP settings as an opportunity for relationship building and service delivery, cognitive changes among some patients and multiple chronic conditions could complicate care provision.</p><p><strong>Conclusion: </strong>Patients and providers report high acceptability for integrating harm reduction services within OTPs tailored to older adults, but significant barriers exist. Addressing these barriers through tailored interventions, improved accessibility, and efforts to reduce stigma may improve care for this vulnerable population. Implementation strategies should focus on establishing sustainable funding mechanisms, strong community partnerships, and ongoing provider training. Finally, harm reduction services may require regular review to ensure they accommodate the unique needs of older adults with OUD.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411468","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":"Community-based interventions for hepatitis C virus elimination among people who use drugs in Shanghai, China.","authors":"Xiaoxiao Yu, Yingqiu Shen, Jiayi Wang, Guichun Ji, Qiuli Xu, Yumeng Gao, Zhenglan Zhang, Xingyi Chen, Xin Xin, Lihong Qu","doi":"10.1186/s12954-026-01498-8","DOIUrl":"10.1186/s12954-026-01498-8","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of hepatitis C virus (HCV) infection among people who use drugs (PWUD) in China remains high, yet diagnosis and treatment rates are low. Strategies are urgently needed to achieve the World Health Organization's goal of eliminating HCV as a public health threat by 2030.</p><p><strong>Aim: </strong>To improve HCV diagnosis and treatment rates among PWUD in Pudong New Area, Shanghai, China.</p><p><strong>Methods: </strong>A non-randomized controlled intervention study was implemented among individuals with a substance addiction history in Pudong New Area, Shanghai, China. Three models were explored in our study. In the Self-Referral (SR) model, HCV antibody-positive individuals relied on their own initiative to seek medical services. In the Standard Intensive Referral (SIR) model, managerial supervision was strengthened. The Active Intensive Referral (AIR) model placed greater emphasis on managerial proactivity, enhancing screening and treatment for high-risk populations.</p><p><strong>Results: </strong>A total of 3926 PWUD from 36 communities in Pudong New Area underwent rapid HCV antibody testing in the SR model. These numbers were 1973 and 191, respectively, in the SIR and AIR models. Only 18.9% population completed HCV RNA testing in the SR model compared with 100.0% in both the SIR and AIR models (P < 0.001). Overall, 70/146(47.9%) PWUD in the SR model were identified with HCV RNA, consistent with the SIR and AIR models [339/916(37.0%) and 74/191(38.7%), P > 0.05]. In terms of treatment, 47/74(63.5%) of patients in the AIR model initiated treatment, significantly higher than the 15/70 (21.4%) in the SR model and 73/339 (21.5%) in the SIR model (P < 0.001). Genotype 3, particularly subtype 3b, was the most prevalent genotype among PWUD in our study, respectively accounting for 23/38 [60.5%] in the AIR model and 112/166 [67.5%] in the SIR model. In the AIR model, all participants received a liver stiffness test. Fifty-two (27.2%) patients had a liver stiffness of more than 12.5 kPa. One hundred and eighty-one persons completed the questionnaire in the AIR model. The results revealed that few people had high educational attainment. More than half (52.5%) of the population had no stable marital relationship.</p><p><strong>Conclusions: </strong>A multidisciplinary community-based approach significantly improved HCV diagnosis and treatment among PWUD. Despite limitations, the AIR model may represent a promising approach to improving the HCV care cascade among PWUD and could potentially contribute to China's efforts to optimize cascade management for hepatitis C elimination among specific high-risk populations.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411498","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}