Harm Reduction Journal最新文献

{"title":"Anonymous Opt-Out HIV and hepatitis C screening at a syringe services program in Florida.","authors":"Heather Henderson, Jason Wilson, Bernice McCoy, Megan Sarmento, Asa Oxner","doi":"10.1186/s12954-025-01182-3","DOIUrl":"10.1186/s12954-025-01182-3","url":null,"abstract":"<p><p>This paper outlines the implementation of opt-out HIV and Hepatitis C (HCV) screening at a syringe services program (SSP) in Florida, highlighting its effectiveness in reducing the transmission of these infectious diseases. Historically, many SSPs have utilized opt-in testing models, which require participants to actively choose testing and often result in low participation rates. Recognizing the need for a more effective approach and to comply with Florida's regulatory requirements under the Infectious Disease Elimination Act, we transitioned to an opt-out testing model at our SSP. This model integrates routine, anonymous, and voluntary testing into standard care, normalizing the process and reducing stigma associated with infectious disease screening. Initially, our policy tied testing to access to specific services, including syringe exchange, to meet compliance with Florida Department of Health mandates. However, after feedback from participants, staff, and community members, we revised our approach to allow all participants to access all services, regardless of their decision to participate in testing. Importantly, this policy change did not decrease testing rates, with only 6 out of 226 new enrollments (3%) opting out since the implementation of opt-out screening. By fostering a trusting, non-coercive environment and normalizing screening as part of routine care, we achieved high rates of participation while maintaining participant autonomy. Since transitioning to an opt-out model, we have conducted nearly 3,000 HIV and HCV tests, with seropositivity rates of 3.8% and 54%, respectively. These efforts have facilitated early detection, rapid linkage to care, and reduced transmission within the community. Our findings underscore the importance of comprehensive, repeat testing in high-risk populations and demonstrate the potential for opt-out models to serve as a scalable framework for SSPs nationwide. This approach not only fulfills regulatory and public health objectives but also strengthens the role of SSPs as critical interventions in combating HIV and HCV transmission.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"30"},"PeriodicalIF":4.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614688","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":"Is fentanyl in everything? Examining the unexpected occurrence of illicit opioids in British Columbia's drug supply.","authors":"Bruce Wallace, Irene Shkolnikov, Collin Kielty, Derek Robinson, Lea Gozdzialski, Jai Joshua, Ava Margolese, Pablo Gonzalez-Nieto, Armin Saatchi, Lucas Abruzzi, Taelor Zarkovic, Chris Gill, Dennis Hore","doi":"10.1186/s12954-025-01189-w","DOIUrl":"10.1186/s12954-025-01189-w","url":null,"abstract":"<p><strong>Background: </strong>Illicit opioids, including fentanyl, are linked to unprecedented levels of overdose in Canada and elsewhere. The risks associated with illicit opioids can include high potency, unpredictable concentration and the unexpected presence in other drugs. Within this context, we examine drug checking data to better understand the presence of illicit opioids such as fentanyl in other drugs and possible ways to interpret these results.</p><p><strong>Methods: </strong>Three years (2021-2023) of data (18,474 samples) from Substance Drug Checking in British Columbia, Canada were examined to investigate the risks associated with the detection of opioids in other drugs such as cocaine and methamphetamine, as well as in other drug categories. Samples were tested by paper spray mass spectrometry (PS-MS), fentanyl test strips and Fourier-Transform infrared spectroscopy (FTIR). We examine the 8889 samples not expected to include fentanyl to confirm; if the expected drug was detected, if unexpected opioids were detected, and when the unexpected opioids are in trace concentration.</p><p><strong>Results: </strong>Unexpected opioids were rarely detected (2%) in other drugs (189 of 8889 samples) with most (61.4%) detected at trace concentration levels. Unexpected opioids are far more likely to be found in samples that did not contain the expected drug than in samples that were confirmed to contain the expected drug. The least common scenario (below 1%) were substances that included the expected drug plus unexpected opioid above trace concentration. These findings raise questions on how to interpret and communicate the detection of fentanyl and related opioids in other drugs. We present three potential interpretations: (1) mistaken and misrepresented samples where the expected drug was never detected, (2) cross contamination when opioids were at trace concentration levels, or (3) adulteration as the least frequent scenario where opioids were detected above trace concentrations in combination with the expected drug.</p><p><strong>Conclusions: </strong>In a region where fentanyl is associated with extreme rates of overdose, it remains rare to find such opioids in other drugs. However, the risk of fentanyl in other drugs remains an ongoing threat that warrants responses by individuals and public health. We provide possible interpretations to inform such responses. Our data raises questions on how to interpret and communicate the detection of fentanyl and other opioids in other drugs.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"28"},"PeriodicalIF":4.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596840","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":"Breaking the vicious cycle of delayed healthcare seeking for people who use drugs.","authors":"Zoi Papalamprakopoulou, Elisavet Ntagianta, Vasiliki Triantafyllou, George Kalamitsis, Arpan Dharia, Suzanne S Dickerson, Angelos Hatzakis, Andrew H Talal","doi":"10.1186/s12954-025-01166-3","DOIUrl":"10.1186/s12954-025-01166-3","url":null,"abstract":"<p><strong>Background: </strong>People who use drugs (PWUD) are at increased mortality risk, yet they typically avoid healthcare settings due to stigma and shunning. Understanding the healthcare journey from the viewpoint of PWUD has been understudied, although it is essential for informing solutions to increase healthcare access to improve their healthcare outcomes. We aimed to understand the process of accessing healthcare for PWUD, including perceived barriers and facilitators, by exploring their experiences, attitudes, and beliefs.</p><p><strong>Methods: </strong>We employed purposive sampling to recruit PWUD to participate in nine focus group discussions (FGDs) (N = 57) in Athens, Greece. Inclusion criteria required a history of injection drug use, internet access, and Greek verbal fluency. The FGDs were audio-recorded, transcribed, translated into English, and de-identified. We analyzed FGD transcripts using modified grounded theory.</p><p><strong>Results: </strong>Participants' mean (standard deviation) age was 47.9 (8.9) years, 89.5% (51/57) were male, 91.2% (52/57) were of Greek origin, and 61.4% (35/57) had attended at least 10 years of school. We identified three key themes from the FGD transcript analysis: (1) seeking care after an individual's rapid health decline, (2) facing barriers in accessing healthcare, and (3) building trust to improve access to healthcare for PWUD. Participants disclosed that they tended to seek healthcare after a rapid deterioration in their health. They experienced multiple barriers to healthcare access such as stigma, healthcare system mistrust, unresponsive emergency medical services and competing priorities such as homelessness, mental health challenges, and ongoing manifestations of substance use disorder (SUD). Participants' recommendations to build patient-provider trust and improve healthcare access include stigma minimization, promotion of empathy in the patient-provider relationship, and engaging community organizations that serve PWUD to build bridges with healthcare providers and institutions.</p><p><strong>Conclusions: </strong>PWUD in Athens, Greece demonstrate delayed health-seeking behaviors and report multifaceted healthcare access barriers including stigma, delays in emergency care, poor mental health, homelessness, and SUD manifestations. Key trust-building processes to expand healthcare access include minimizing stigma and promoting empathy in healthcare encounters, enhancing healthcare staff education on SUD, improving the responsiveness of emergency medical services, engaging community organizations, and exploring telehealth's role in improving healthcare access for PWUD.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"27"},"PeriodicalIF":4.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566925","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":"Prevalence of HIV and Hepatitis C and access to opioid substitution treatment among people who inject drugs in three cities in Croatia: findings from the second wave of respondent-driven sampling surveys.","authors":"Sandra Šević, Goran Koletić, Tatjana Nemeth Blažić, Mirjana Lana Kosanović Ličina, Josipa-Lovorka Andreić, Senad Handanagić, Magda Pletikosa Pavić, Ivana Božičević","doi":"10.1186/s12954-025-01174-3","DOIUrl":"10.1186/s12954-025-01174-3","url":null,"abstract":"<p><strong>Background: </strong>The second wave of integrated bio-behavioural surveys was conducted among people who inject drugs (PWID) in the cities of Zagreb, Split, and Rijeka in Croatia to estimate the prevalence of HIV and hepatitis C virus (HCV) antibodies and sexual and injecting risk behaviours.</p><p><strong>Methods: </strong>Respondent-driven sampling (RDS) was used to recruit a total of 301 PWID in Split, 130 in Rijeka, and 86 in Zagreb from March to July 2022. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire. RDS-Analyst software was used to calculate weighted population estimates with 95% confidence intervals (95% CI).</p><p><strong>Results: </strong>Approximately one in four PWID were women (range from 24.3% in Zagreb to 29.9% in Rijeka). Overall, HIV prevalence was low, with no cases identified in Zagreb, and 0.6% and 0.8% in Split and Rijeka, respectively. HCV antibody prevalence was 37.2% among PWID in Zagreb and Rijeka, and as high as 59.5% in Split. Testing for HIV and HCV in the 12 months before the survey was reported by 11.3-19.8% and 17.3-21.6% of PWID across the cities, respectively. Use of needles and syringes in the past 30 days that had already been used by someone else was reported by 8.9-26.5% across the cities. A large proportion of PWID-54.0% in Zagreb, 31.0% in Rijeka and 29.9% in Split-never used needle and syringe exchange programmes. Being in drug addiction treatment at the time of the survey was reported by 50.8% in Split, 57.3% in Rijeka and 73.3% in Zagreb. Injecting cocaine in 30 days before the survey was common, ranging from 12.7 to 32.1% across the cities.</p><p><strong>Conclusion: </strong>HIV prevalence continues to be low among PWID in Croatia, whereas HCV prevalence is substantial. Due to low coverage of HIV and HCV testing and insufficient use of harm reduction services, there is a potential for further spread of drug-related infectious diseases in this population.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"26"},"PeriodicalIF":4.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556653","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":"Perspectives of syringe services program operators in Michigan on their relationship with substance use treatment: a qualitative study.","authors":"Molly C Reid, Samantha J Harris, Suzanne M Grieb, Sabrina Gattine, Zekiye Lukco, Brandon Hool, Mary Aguirre, Fernanda Alonso Aranda, Catherine Tomko, Sara Whaley, Brendan Saloner, Sean T Allen","doi":"10.1186/s12954-025-01172-5","DOIUrl":"10.1186/s12954-025-01172-5","url":null,"abstract":"<p><strong>Background: </strong>Substance use treatment (SUT) and harm reduction are often perceived as having distinct goals despite people who use drugs routinely having needs that encompass both services. The co-occurring SUT and harm reduction needs of people who use drugs warrant collaboration between service providers. However, little work has explored such collaborations, or lack thereof. This research explores how SUT providers responded to expanded harm reduction programming from the perspectives of syringe services program (SSP) operators in Michigan.</p><p><strong>Methods: </strong>We conducted in-depth, semi-structured interviews with a geographically diverse sample of SSP operators (n = 19) in Michigan during October and November 2021. The interview guide broadly explored the contributing factors to SSP implementation, including SSP relationships with SUT providers. Analyses of transcribed interviews were conducted using an iterative, thematic constant comparison process informed by grounded theory.</p><p><strong>Results: </strong>Participants described a range of responses to SSP implementation from SUT providers. Many SSP operators identified significant barriers to effective collaboration with SUT providers due to lack of awareness about harm reduction approaches and stigmatization of drug use. For example, SUT providers were often reluctant to accept free harm reduction supplies (e.g., sterile syringes, naloxone) to offer their clients. Participants also reported difficulties connecting their clients to evidence-based SUT providers. Incremental relationship building and education about the role of harm reduction in recovery were required for effective collaboration between SUT providers and SSPs.</p><p><strong>Conclusions: </strong>Tensions between SUT and harm reduction providers may create challenges that impede recovery among people who use drugs. Ensuring SUT and harm reduction providers understand the unique and complementary roles of each approach is necessary to advance the health of people who use drugs.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"25"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study of benzodiazepine/z-drug and opioid co-use patterns and overdose risk.","authors":"Hannah E Family, Gabriele Vojt, Hannah Poulter, Chris P Bailey, Ana Paula Abdala Sheikh, Damiana Cavallo, Sara Karimi, Nick Booth, Peter Da Silva, Louise Aitken, Samantha Stewart, Matthew Hickman, Graeme Henderson, Jenny Scott, Joanna M Kesten","doi":"10.1186/s12954-025-01153-8","DOIUrl":"10.1186/s12954-025-01153-8","url":null,"abstract":"<p><strong>Background: </strong>Co-use of benzodiazepines and/or 'z-drugs' along with opioids is linked to the rise in drug related deaths (DRD) in the UK. Understanding patterns of co-use could inform harm reduction strategies for reducing DRDs. This study explored how people co-use, including dosages, timings, methods of administration, use of other substances and desired effects sought.</p><p><strong>Methods: </strong>Forty-eight semi-structured interviews across Glasgow in Scotland (n = 28), Bristol (n = 10) and Teesside (n = 10) in England with individuals who co-use illicit and/or prescribed opioids and benzodiazepines/z-drugs were conducted. Eighteen interviews were co-facilitated with qualitatively trained local peer researchers. Interviews were analysed using the Framework method.</p><p><strong>Results: </strong>Six co-use patterns were generated: (1) co-use to aid sleep or come down, (2) curated co-use, opioid agonist therapy (OAT) only (3) morning and evening benzodiazepine doses with opioids throughout the day (4) co-use binges (5) co-use throughout the day, (6) benzodiazepine use throughout the day plus OAT. Patterns one to three reflected more controlled co-use with a focus on self-medicating to give confidence, manage anxiety, promote sleep and come-down from cocaine/ketamine. Patterns four to six involved greater poly-drug use, and less controlled co-use with a focus on seeking euphoria (\"warm glow\", \"gouching out\") or oblivion (to escape untreated mental health conditions and trauma). Patterns two, three, five and six involved daily co-use. People switched between patterns depending on available resources (e.g. finances) or changes to prescriptions (opioids or benzodiazepines). Near-fatal overdoses were reported by participants across all co-use patterns. Patterns four to six were conceptualised as presenting greater overdose risk due to less controlled co-use and more extensive polydrug use.</p><p><strong>Conclusions: </strong>The patterns identified provide opportunities for future harm reduction strategies, tailoring advice to patterns of use, updated prescribing guidance and policies, and the need for better access to mental health care, for people who co-use benzodiazepines and opioids to reduce DRDs.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"24"},"PeriodicalIF":4.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523310","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":"For a renewed harm reduction model.","authors":"Pierre Chappard, Fabienne Pourchon","doi":"10.1186/s12954-025-01165-4","DOIUrl":"10.1186/s12954-025-01165-4","url":null,"abstract":"<p><p>In the early 1990s, the spread of HIV among heroin injectors prompted a shift in drug policy internationally, including in France. This led to the emergence of a new policy known as Harm Reduction (HR) and related tools, including needle exchange programmes, opioid substitution therapy programmes to manage illicit opiate consumption, as well as reception facilities and support systems for the most precarious People Who Use Drugs (PWUDs). This new policy is based on the assertion that drugs have always been there and will always be a part of society, and that we have to live with them and not try to eradicate them. Promising PWUD emancipation, the advent of HR was accompanied by the birth of peer-support groups for unrepentant PWUDs, who decided to speak out in the public arena for the first time. Thirty years on, the authors assert that this promise has not lived up to expectations. More specifically, the cohabitation of an institutionalized, bureaucratized HR with the criminalization and stigmatization of drug use has worked against PWUD emancipation. As PWUDs, users of the addiction care system, peer workers and managers of addiction and HR facilities, the authors discuss the tensions between HR and the continued criminalisation and stigmatisation of drug use in France. Using the PWUD internet platform Psychoactif and the related peer-support group, both of which they created, the authors share their experiences and reflect on their practices to propose a renewed model of HR which reconnects with the civic and emancipatory roots of HR: a rights-based model that enables PWUDs to regain their power to act and escape the alienation caused by the stigma of drug use.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"23"},"PeriodicalIF":4.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476480","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":"Switching behavior and changes in smoking behavior by menthol cigarette preference and menthol heated tobacco product use among adults in the United States who smoke cigarettes: an actual use study.","authors":"Joshua L Karelitz, Yisha He, Elizabeth Becker, Andrea Vansickel","doi":"10.1186/s12954-025-01170-7","DOIUrl":"10.1186/s12954-025-01170-7","url":null,"abstract":"<p><strong>Background: </strong>Heated tobacco products (HTPs) deliver nicotine with significantly lower toxicant exposure relative to combustible cigarettes. HTPs may serve as viable tobacco harm reduction options for adults who smoke but are not able or interested in stopping consuming nicotine-containing products. There is limited information on the degree to which adults in the United States who smoke will switch away from or reduce combusted cigarette consumption when provided with HTPs, and none assessing differences due to menthol cigarette preference or menthol HTP use.</p><p><strong>Methods: </strong>In a six-week actual use study of an HTP (IQOS®), adults in the United States, ages 21-64 (n = 615), who smoke combustible cigarettes and were not planning to quit were offered free choice of HTPs (one non-menthol and two menthol varieties) to use ad libitum. Preference for smoking menthol or non-menthol cigarettes was assessed upon study entry (374 menthol; 241 non-menthol). The number of HTP sticks and combusted cigarettes consumed were assessed via daily diary administered through smartphone application. Complete switching was defined on a seven-day point prevalence basis-reporting consuming zero combusted cigarettes while continuing to use the HTP research product in Week 6.</p><p><strong>Results: </strong>Overall, 247 participants completely switched to HTP, corresponding to 21.1% of all those enrolled at baseline (n = 1173) or 40.2% of those included in primary analyses (n = 615). Among individuals included in primary analyses, we observed greater switching among those who preferred menthol versus non-menthol cigarettes (46.8% vs 29.9%). Probability of switching increased with greater proportional use of menthol versus non-menthol HTPs. Non-menthol cigarette-preferring participants had greater increases in switching when using proportionally more menthol than non-menthol HTPs; switching remained consistently high among menthol-preferring participants. Among participants who did not switch and continued smoking at Week 6, preference for menthol cigarettes and use of proportionally greater menthol versus non-menthol HTPs were each associated with greater reductions in cigarette consumption.</p><p><strong>Conclusion: </strong>HTP use facilitated switching away from or reducing consumption of combusted cigarettes among adults who smoke, especially when using menthol HTPs. Most participants used menthol HTPs, regardless of their incoming preference for smoking menthol or non-menthol cigarettes. Availability of HTPs in menthol and non-menthol varieties offers an increased tobacco harm reduction opportunity over solely non-menthol by providing adults who smoke with smoke-free alternatives that they find appealing.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"19"},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467876","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":"Mandatory verses voluntary self-tests for new online casino customers: effect on engagement, quality, gambling behavior and use of responsible gambling measures.","authors":"Jakob Jonsson, Nathan Lakew, Philip Lindner","doi":"10.1186/s12954-025-01173-4","DOIUrl":"10.1186/s12954-025-01173-4","url":null,"abstract":"<p><strong>Background: </strong>To combat the public health concern that is problem gambling, gambling operators are increasingly being required by legislation to exercise a duty of care obligation, including the provision of Responsible Gambling (RG) tools. Self-test assessments have long been a popular RG tool implemented by many operators, yet there has been scant empirical research on self-tests, including on how the method of delivery impacts engagement, quality, and subsequent gambling behavior. The main objective of the current study was to examine if the level of voluntariness to perform a self-test moderated these key outcomes.</p><p><strong>Method: </strong>Participants in the study, 1800 new online customers at a leading Swedish gambling company, were randomized to one of three arms: No message (control), up to four messages inviting them to do a self-test, and one message with a mandatory (but technically possible to circumvent) self-test. The interventions were presented when the customer logged in.</p><p><strong>Results: </strong>The results showed that 38.9% in the mandatory group and 4.8% in the voluntary group completed the self-test, with indications of a somewhat lower quality of the test by the mandatory group. There was no difference in customer churn or gambling behavior, and only minor differences in use of RG-measures post intervention.</p><p><strong>Conclusions: </strong>We conclude that presentation format matters and can affect the use and quality of tests: gambling operators should exercise caution when interpreting non-risk assessment results derived solely from self-test tools, particularly mandatory ones, as it can result in inaccurate risk assessments that may mislead duty of care obligations. The balance between achieving high participation and maintaining quality (and thereby meaningfulness) is discussed.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"22"},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467874","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 UNODC/WHO S-O-S (stop-overdose-safely) training on opioid overdose knowledge and attitudes among people at high or low risk of opioid overdose in Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine.","authors":"Paul Dietze, Samantha Colledge-Frisby, Gilberto Gerra, Vladimir Poznyak, Giovanna Campello, Wataru Kashino, Dzhonbek Dzhonbekov, Tetiana Kiriazova, Danil Nikitin, Assel Terlikbayeva, Kirsten Horsburgh, Anja Busse, Dzmitry Krupchanka","doi":"10.1186/s12954-025-01167-2","DOIUrl":"10.1186/s12954-025-01167-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Opioid overdose education and naloxone distribution (OEND) is an evidence-based strategy to reduce opioid overdose deaths in line with guidance provided by the World Health Organization (WHO) and United Nations Office on Drugs and Crime (UNODC). However, OEND effectiveness has rarely been examined in low- and middle-income countries (LMICs). The WHO/UNODC Stop Overdose Safely (S-O-S) project involved training of &gt; 14,000 potential opioid overdose witnesses in opioid overdose response (including the administration of naloxone) in Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine. We examined the impact of training using the S-O-S training package, developed within the framework of the S-O-S project, on knowledge of and attitudes towards, opioid overdose as well as effective opioid overdose response amongst participants stratified by high and low personal risk of opioid overdose.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and methods: &lt;/strong&gt;A sample of S-O-S project participants were recruited into a cohort study to evaluate the effects of training using the S-O-S training package. Of these participants, 1481 at high or low personal risk of opioid overdose completed pre- and post-S-O-S training questionnaires that incorporated sections of the Brief Opioid Overdose Knowledge (BOOK) and Opioid Overdose Attitudes Scale (OOAS) instruments. Outcomes examined included overall scale scores as well as scores on instrument sub-scales. Mean change scores, stratified by personal risk of opioid overdose, were calculated and compared using repeated measures t-tests. Variation in overall change scores according to select participant characteristics (e.g., age, sex) was also examined using multivariable linear regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After training there were increases in overall BOOK and OOAS mean scores with a similar pattern evident in mean scores for all instrument subscales. Observed changes were larger for participants at low personal risk of opioid overdose (between 11% and 112%, depending on measure) compared to those who were at high personal risk of overdose (between 5% and 33% depending on measure), reflecting higher baseline scores for those at high personal risk of opioid overdose. We observed few variations in change scores across other participant characteristics. However, amongst those at high personal risk of opioid overdose, no personal experience of an overdose (β=-0.3; 95%CI=-0.5-0) and not currently being in drug treatment (β=-0.6; 95%CI=-0.4-0.8) was associated with a higher BOOK change score. Reporting not having witnessed an overdose previously was associated with higher BOOK change scores amongst those at low personal opioid overdose risk (β = 0.5; 95%CI = 0.2-0.8). Not currently being in drug treatment (β=-1.3; 95%CI=-0.1-2.4) was associated with a higher OOAS change score amongst those at high personal risk of opioid overdose.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;OEND training using the S-O-S training packa","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"20"},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467873","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}