Harm Reduction Journal最新文献

{"title":"Facilitators and Barriers to adherence to antiretroviral therapy among incarcerated people living with HIV in Iran: insights from a qualitative study.","authors":"Azam Bazrafshan, Ali Ahmad Rafiei-Rad, Maliheh Sadat Bazrafshan, Nima Ghalekhani, Soheil Mehmandoost, SeyedAhmad SeyedAlinaghi, Fatemeh Mehrabi, Mehrdad Khezri, Gelareh Mostashari, Mohammad Karamouzian, Hamid Sharifi","doi":"10.1186/s12954-024-01151-2","DOIUrl":"https://doi.org/10.1186/s12954-024-01151-2","url":null,"abstract":"<p><strong>Background: </strong>Ensuring consistent adherence to antiretroviral therapy (ART) is crucial for effective HIV treatment and achieving viral suppression. Within prisons, the prevalence of HIV is notably high, and incarcerated individuals face an increased risk of transmitting the virus both during and after incarceration. However, facilitators and barriers to ART adherence among these individuals in low- and middle-income countries remain inadequately explored. This study applied the Social Ecological Model (SEM) to investigate how various individual, interpersonal, organizational, community and policy-level factors impact ART adherence among incarcerated populations in Iran during and post-incarceration.</p><p><strong>Methods: </strong>This study employed a phenomenological qualitative approach using semi-structured interviews to gather insights. The research population consisted of people living with HIV (PLHIV) who had experienced incarceration and had been prescribed ART during their latest incarceration. Eleven PLHIV from two prisons located in Kerman and Tehran, Iran, formed the study group. Qualitative findings from the interviews were analyzed using a thematic approach. The findings were organized within the SEM framework to highlight key themes influencing ART adherence during and after incarceration.</p><p><strong>Results: </strong>Participants had an average age of 45.1 years (± 5.6). Various factors influence ART adherence during and post-incarceration. Participants highlighted the individual (e.g., HIV knowledge, previous treatment history, mental and physical health), interpersonal (e.g., family, friends, other incarcerated people, and prison health staff), organizational (e.g., ART treatment interventions, methadone maintenance therapy, and other health protocols), community (e.g., stigma, social isolation, discrimination and lack of access to community health services), and policy (e.g., financial interventions, and providing shelters) level factors influence ART adherence during and post-incarceration.</p><p><strong>Conclusions: </strong>This study provides insights into the multi-level approach to ART adherence among PLHIV during and post-incarceration. It recommends implementing public health activities at the proposed multi-levels to maximize the synergies of intervention for the greatest impact.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"4"},"PeriodicalIF":4.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947692","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 impact of Covid-19 on harm reduction policies in Iran: an interrupted time series analysis.","authors":"Siavash Beiranvand, Meysam Behzadifar, Aidin Aryankhesal, Seyed Jafar Ehsanzadeh, Masoud Behzadifar","doi":"10.1186/s12954-024-01137-0","DOIUrl":"https://doi.org/10.1186/s12954-024-01137-0","url":null,"abstract":"<p><strong>Background: </strong>The global emergence of the Covid-19 pandemic in 2019 posed unprecedented challenges to healthcare systems, disrupting routine services and necessitating swift adaptations. Harm reduction programs, vital for addressing substance use-related health risks, faced unique challenges during the pandemic, impacting vulnerable populations. This study focuses on the repercussions of Covid-19 on harm reduction policies in Iran, specifically examining the distribution of condoms, syringes, and methadone to high-risk individuals attending Triangle Centers.</p><p><strong>Aim: </strong>The study aims to assess the impact of the Covid-19 pandemic on harm reduction services in Iran and provide evidence-based insights for policy adjustments. Using Interrupted Time Series Analysis (ITSA), the research analyzes trends in the distribution of condoms, syringes, and methadone before and after the official declaration of the pandemic in February 2020.</p><p><strong>Method: </strong>ITSA, a valuable tool for evaluating program impacts, was employed to analyze data collected from Triangle Centers in Lorestan Province, Iran. Monthly records of harm reduction services (condoms, syringes, methadone) from January 2017 to February 2023 were extracted. The pre-intervention period spanned January 2017 to January 2020, with the post-intervention period extending from February 2020 to February 2023. Statistical analyses were conducted using the Newey-West technique, Combi-Huizinga autocorrelation test, and Ordinary Least Squares (OLS) regression, with a significance threshold set at P-value < 0.05.</p><p><strong>Results: </strong>Following the onset of Covid-19, the level change in condom distribution to high-risk individuals showed a significant decline, decreasing by 2,168.87 units per month (95% CI: -2,405.57 to -1,932.15). Methadone dispensation, crucial for opioid harm reduction, also witnessed a substantial level change, decreasing by 5,007.60 cc per month (95% CI: -6,251.75 to -3,763.45). Additionally, the provision of syringes decreased significantly, with a level change of -601.01 units per month (95% CI: -706.39 to -495.62).</p><p><strong>Conclusion: </strong>This study reveals significant disruptions in harm reduction services in Iran post-Covid-19, emphasizing the need for targeted interventions. Factors such as fear, stigma, resource reallocation, and logistical challenges contribute to the observed decreases. Policymakers must prioritize sustaining harm reduction services during pandemics, ensuring continuity for vulnerable populations. The findings underscore the importance of proactive policy development and preparedness to prevent delays and inequalities in accessing essential services for individuals with high-risk behaviors. Overall, integrating harm reduction into pandemic planning is crucial for a resilient and equitable health system.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"3"},"PeriodicalIF":4.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947706","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":"Managing xylazine-involved overdoses in a community harm reduction setting: lessons from Tijuana, Mexico.","authors":"Lilia Pacheco Bufanda, Alejando González Montoya, Brenda Torres Carrillo, Mariana Alejandra Gonzalez Tejeda, Luis A Segovia, Alhelí Calderón-Villarreal, Joseph R Friedman","doi":"10.1186/s12954-024-01143-2","DOIUrl":"10.1186/s12954-024-01143-2","url":null,"abstract":"<p><strong>Background: </strong>Xylazine is a α2-adrenergic receptor agonist, used for sedation in veterinary contexts. Although it is increasingly found in overdose deaths across North America, the clinical management of xylazine-involved overdoses has not been extensively studied, especially in community-based harm reduction settings. Here we present a clinical series of xylazine-involved overdose and share the clinical approach and lessons learned by a community overdose response team in Tijuana, Mexico amidst the arrival of xylazine.</p><p><strong>Case presentation: </strong>We present three cases describing the clinical management of patients with xylazine-involved overdoses that occurred in close proximity to the Prevencasa community harm reduction clinic. The long period of post-naloxone sedation in xylazine overdoses is a unique clinical feature. The first case is a 61-year-old man with longstanding opioid and methamphetamine use disorder found hypoxic, who received 4.0 mg of intranasal naloxone, and quickly began respirating well. He remained unconscious for 20 min, and upon awakening, experienced withdrawal symptoms, agitation and confusion, and exposed himself to considerable physical danger by entering a local roadway. The second is a 28-year-old man who primarily uses stimulants, who overdosed while trying \"China White\". His oxygen saturation improved from 81 to 100% with supplemental oxygen and field management, and he did not require naloxone administration. He recovered consciousness after 40 min. The third patient is a 36-year-old male who was found down, saturating at 20%, who received 0.4 mg intramuscular naloxone, was placed in recovery position, and remained unconscious for 12 min before making a complete recovery. The first and third patients provided urine and drug samples that tested positive for xylazine and fentanyl.</p><p><strong>Conclusions: </strong>We describe insights about the clinical management of combined xylazine-fentanyl involved overdoses in the field, from a community harm reduction context where xylazine arrived suddenly spurring a large number of overdoses. In response to the long period of post-naloxone sedation inherent to xylazine overdoses, the clinical team learned to center oxygenation-not consciousness-as the key parameter of interest for the titration of naloxone, increase emphasis on field airway management, portable oxygen administration, and scene safety, and employ xylazine testing strips for urine and direct substance analysis to educate the patient population about health risks.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"2"},"PeriodicalIF":4.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927229","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":"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}