Harm Reduction Journal最新文献

{"title":"A mixed methods examination of organizational approaches to fentanyl test strip distribution and training across multiple states.","authors":"Kitty H Gelberg, Megan E Hall, Janet E Childerhose, Mary R Russo, Fernando Montero, Kaleigh Niles, Jill Oliveri, Haley Ramsey Harden, Rachel A Vickers-Smith, Arnie Aldridge, Sarah G Stenger, Katherine R Marks, Louisa Gilbert, Sharon L Walsh, Nabila El-Bassel, Carter Roeber, Redonna Chandler","doi":"10.1186/s12954-026-01455-5","DOIUrl":"10.1186/s12954-026-01455-5","url":null,"abstract":"<p><strong>Background: </strong>Fentanyl test strips (FTS) have become a critical harm reduction tool, allowing people who use drugs (PWUD) to detect fentanyl in their drug supply and make informed decisions about their drug use. While FTS distribution is increasingly common, there is limited understanding of distribution strategies used by community organizations, and the education and training provided around FTS use. Given the proliferation of fentanyl in the drug supply, and the diverse motivations of PWUD, research is needed to better understand FTS distribution and training practices. This study examines FTS distribution strategies, training approaches, and the facilitators and barriers faced by harm reduction organizations in Kentucky, Ohio, and New York.</p><p><strong>Methods: </strong>We conducted a mixed-methods study as part of the Stay Safe Study, using a quantitative survey and qualitative interviews with organizations distributing FTS. Organizations included syringe service programs, mobile outreach units, recovery centers, and public health departments. Survey data were used to describe organizational characteristics and distribution practices, while interview data were coded and analyzed for themes related to distribution practices, training, and facilitators and barriers of FTS distribution.</p><p><strong>Results: </strong>Twenty-eight organizations completed the organizational survey, and staff from 21 organizations participated in interviews. FTS distribution settings varied widely. Most organizations distributed between 100 and 500 FTS monthly, primarily on an \"as needed\" basis. Legalization of FTS was identified as a key facilitator, and innovative distribution methods included vending machines and mail distribution. Partnerships within the community expanded the reach and accessibility of FTS. Training approaches for both staff and PWUD varied substantially, and organizations faced barriers related to securing buy-in and the time required for training.</p><p><strong>Conclusions: </strong>This study highlights organizational practices related to FTS distribution and training. Participants viewed FTS as a gateway to providing broader harm reduction services, fostering trust and engagement with PWUD. To maximize the impact of FTS as an overdose prevention tool, it is important to address persistent barriers through tailored distribution and training strategies, sustainable funding, and scalable implementation models.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971781","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":"Strengthening harm reduction strategies for boys and men in Australia: thinking differently about dominant discourses on gender-based violence.","authors":"Samantha Burton, James Smith","doi":"10.1186/s12954-026-01429-7","DOIUrl":"10.1186/s12954-026-01429-7","url":null,"abstract":"<p><p>In Australia, discussions concerning domestic violence (DFV) and gender-based violence (GBV) frequently depict women and girls as victims and men as perpetrators. While reflecting the reality, this perspective risks marginalising male victims, particularly boys, and infringing upon their rights to safety, dignity, and support. Media stereotypes exacerbate this issue; for instance, violent mothers are often portrayed as mentally ill, male perpetrators are deemed inherently violent, and boy victims are largely ignored. Such erasure violates international human rights standards, including the Convention on the Rights of the Child (CRC), which affirms everyone's right to protection from violence and discrimination (United Nations [UN], 1998). The concept of the 'ideal victim,' typically portrayed as white, young, and female, obscures complex realities and undermines a rights- based approach to violence. Boys experience marginalisation because societal masculine norms deter vulnerability and help- seeking behaviours, thereby infringing upon their rights to health and support. Although harm reduction strategies are widely employed in public health and suicide prevention, their application remains limited in the context of family violence (FV) and GBV. A human rights approach emphasises that harm reduction initiatives should encompass all victims. This discourse advocates for media and institutional advocacy aimed at shifting narratives from pathology and aggression towards promoting healthy masculinities grounded in empathy and caregiving. Drawing upon feminist theory, masculinity studies, and child welfare research, this proposal presents an inclusive model of masculinity founded on ethical intelligence. Men who challenge traditional masculine norms exemplify positive masculinity through engaged parenting and emotional openness. The study encourages collaborative efforts to incorporate male victimisation into education, media, and prevention strategies. Addressing stereotypes and advancing gender equity as fundamental human rights necessitates concerted efforts across education, media, and policy sectors to acknowledge male victimisation. Despite an Australian Government election commitment of $32 million to boys' and men's health, additional efforts are essential to integrate these issues within human rights frameworks and public discourse, demonstrating that male victimisation supports, rather than threatens, women's rights within an inclusive human rights paradigm concerning GBV.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147928631","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":"Changes in community health worker knowledge and perspectives following opioid overdose prevention and response training.","authors":"Madeline Hooten, Mindy L McEntee","doi":"10.1186/s12954-026-01465-3","DOIUrl":"10.1186/s12954-026-01465-3","url":null,"abstract":"<p><strong>Background: </strong>Community Health Workers (CHWs) are trusted community members well-positioned to address the opioid epidemic from the frontlines through education, stigma reduction, and connection to culturally competent care, yet do not regularly receive training in this area.</p><p><strong>Methods: </strong>This study evaluated changes in CHW knowledge and attitudes toward opioid use before and after a standardized Opioid Overdose Prevention and Response (OOPR) training. CHWs (N = 78) 18 years of age or older who were employed, volunteering, or in CHW training in Arizona between January and February 2024 participated in a 60-min evidence-based OOPR training, completing online surveys pre- and post-training. Elements of training and assessment mirrored the Opioid Overdose Awareness and Reversal training (OOART) by Bascou and colleagues (2022). Paired Sample T-Tests assessed changes related to (1) opioid overdose knowledge, (2) self-confidence in using naloxone and handling overdose situations, (3) Narcan-related risk compensation beliefs, (4) attitudes towards naloxone usage and overdose reversal, and (5) attitudes toward individuals with Opioid Use Disorder (OUD).</p><p><strong>Results: </strong>Participants were predominantly female (72.8%), with nearly half identifying as Hispanic/Latinx/Spanish (46.2%). The mean age was 37.69 (SD 13.4) years; 96.2% were employed full-time, with 60.2% reporting at least six or more years of CHW experience. Overall, training improved knowledge and confidence response, with 74.6% feeling capable of using naloxone effectively post-training.</p><p><strong>Conclusion: </strong>Overall, this intervention increased participants' perceived knowledge of overdose response, though some gaps persisted, including inaccuracies in key areas of factual knowledge. Individual feedback and/or booster training may further enhance both the accuracy and retention of knowledge in this population.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147928618","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 characteristics and experiences of parents accessing prescribed safer supply in BC, 2020-2021.","authors":"Katherine Hogan, Celeste Macevicius, Taija McLuckie, Jenny McDougall, Bernie Pauly, Karen Urbanoski, Brittany Barker","doi":"10.1186/s12954-026-01468-0","DOIUrl":"10.1186/s12954-026-01468-0","url":null,"abstract":"<p><strong>Objectives: </strong>In 2020, British Columbia implemented prescribed safer supply (PSS) to reduce harms associated with the toxic drug supply. Evidence is emerging on these programs; however, no studies to date have focused on exploring the experiences of parents accessing or attempting to access PSS, including differences between parents and non-parents in reported barriers.</p><p><strong>Methods: </strong>This mixed-methods study involved a secondary analysis of data collected for an evaluation of PSS, informed by an ecological model. We conducted descriptive analysis of barriers to care, using data from a cross-sectional survey with people who had received or were seeking PSS (n = 353), and a thematic analysis of data from interviews with a subset of participants who were parenting children under age 19 (n = 16), focused on exploring parents' experiences of PSS.</p><p><strong>Results: </strong>Among 353 recruited, 31.4% of participants reported having a child under age 19. All participants reported barriers to PSS; however, parents were more likely to report being too busy compared to non-parents (41.4% vs. 25.4%, p = 0.003). Ecological themes describing parents' experiences of PSS reflected: (1) unique interpersonal motivations for accessing PSS, such as to participate in children's lives and protect them from potential harms and (2) parenting-associated policy barriers, including fear of child welfare reports and competing time demands.</p><p><strong>Discussion: </strong>Parents reported unique interpersonal motivations and policy challenges when accessing PSS. These findings highlight the need to address stigmatizing, punitive responses to families experiencing substance use and support approaches that are parent-centered and inclusive of the family across a continuum of care.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868190","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":"Innovation, respiration and drug paraphernalia policy: a mixed methods study of crack pipe practice and respiratory harm in England.","authors":"Magdalena Harris, Cedomir Vuckovic, Caitlynne McGaff, Casey Sharpe, Sujit Rathod, Alexandre Piot, Mat Southwell, Jenny Scott, Vivian Hope, Lucy Platt","doi":"10.1186/s12954-026-01470-6","DOIUrl":"10.1186/s12954-026-01470-6","url":null,"abstract":"<p><strong>Background: </strong>Provision of equipment for the purpose of stimulant inhalation is prohibited under UK law. Crack cocaine use is prevalent and rising in England, where the SIPP (safer inhalation pipe provision) study piloted and evaluated a crack equipment and workforce training intervention. We report mixed method findings from the baseline component of the study, prior to intervention implementation. The aim of this paper is to situate quantitative findings regarding respiratory risk through qualitative exploration of crack inhalation practice in a context of stimulant equipment prohibition.</p><p><strong>Methods: </strong>In this paper we report descriptive findings from baseline survey data (n = 727) with a focus on thematic analysis of interview data (n = 33). Participants were recruited through drug treatment services and peer networks in six geographical locations in England, with survey eligibility criteria including crack use (injecting or smoking) in the past 28 days.</p><p><strong>Findings: </strong>Of the 733 participants who completed the baseline questionnaire, 727 (99%) smoked crack in the past month and were included for further analysis. A minority reported crack injection (28%). Over half (55%) used crack daily in the past month. Many (60%) reported respiratory symptoms, with one third experiencing a respiratory-related hospitalisation. Qualitative data illustrate ingenuity of crack equipment practice, with participants fashioning pipes out of materials ranging from umbrella handles, through to tin cans and plastic inhaler cases. Ash and stainless-steel scourer were primarily used as suspension materials. Accounts of practice illustrate connections between materials used and respiratory harms, the latter exacerbated by poor living conditions and limited availability of supports.</p><p><strong>Conclusion: </strong>We evidence a high burden of respiratory harm among people who smoke crack in England. Stimulant inhalation equipment prohibition contributes to a constellation of respiratory risk, with use of unsafe materials and impoverished living environments exacerbating health harms among a highly marginalised population. There is a need to reorientate drug services to support safer crack inhalation practice and reduce respiratory risk. Legislative change can facilitate this process.</p><p><strong>Trial registration: </strong>ISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454 .</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863978","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 continuum of disconnection: the impacts of safer supply program closures on continuity of care, transition, and total loss of service access.","authors":"Farihah Ali, Abigale Sprakes, Jordan Mende-Gibson, Mohammad Karamouzian, Gillian Kolla, Andrew Shaw, Andrzej Celinski, Nat Kaminski, Uppala Chandresekera, Jürgen Rehm","doi":"10.1186/s12954-026-01469-z","DOIUrl":"10.1186/s12954-026-01469-z","url":null,"abstract":"<p><strong>Objective: </strong>In March 2025, the expiration of federal pilot funding for Safer Supply Programs (SSPs), combined with restrictive provincial legislative changes to harm reduction service provision in Ontario, disrupted care for thousands of clients at risk of toxic drug poisoning. This study examines the impacts of these changes on client health, social stability, and overdose risk across a continuum of access.</p><p><strong>Method: </strong>We conducted 30 semi-structured virtual interviews between September and November 2025 with clients who were enrolled in an SSP prior to March 31, 2025. Participants were recruited via purposive and snowball sampling. Data were analyzed using Braun and Clarke's reflexive thematic analysis to explore experiences across three distinct groups: those who maintained continuity with their prescriber or SSP, those who transitioned to a new prescriber or SSP, and those who lost access entirely.</p><p><strong>Results: </strong>Experiences of harm were directly proportional to the degree of service disconnection. Participants who maintained access (n = 10) retained clinical stability, but reported chronic anxiety and \"survivor's guilt\" regarding peers who lost care. Participants who transitioned to an alternative prescriber (n = 13) experienced a \"medicalization of harm reduction\" characterized by increased surveillance (e.g., urine screens, monitored dosing), revoked take-home doses, and the loss of trusted relationships, which undermined their autonomy and stability. Those who lost access entirely (n = 7) experienced significant harms, such as the loss of an entire ecosystem of care (i.e., medication, primary care, and community), an immediate return to the unregulated fentanyl market, and engagement in survival strategies that can lead to criminalization. Notably, 100% (n = 5) of participants who reported an overdose following the policy changes belonged to this group.</p><p><strong>Conclusion: </strong>The loss of federal funding for SSPs in Ontario did not solely reduce medication availability; it severed the structural and relational network that supported participants' reintegration into health care services that they previously felt uncomfortable accessing due to stigma, surveillance and mistreatment. Findings reveal a \"continuum of disconnection\" where the removal of wraparound supports and the reintroduction of punitive clinical practices function as forms of structural violence. Sustainable, low-barrier models are urgently needed to prevent further morbidity and mortality.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13273957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863922","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":"Self-reported physical health among people who switched from traditional cigarettes to heated tobacco products: a large-scale national survey.","authors":"Agnieszka Tuszyńska-Chyży, Magdalena Walicka, Ludomir Tuszyński, Aleksandra Gola-Graczyk, Aleksandra Pohadajło, Iwona Towpik, Dorota Kiedik, Andrzej Fal, Edward Franek, Janusz Sytnik-Czetwertyński","doi":"10.1186/s12954-026-01466-2","DOIUrl":"10.1186/s12954-026-01466-2","url":null,"abstract":"<p><strong>Background: </strong>Traditional cigarettes (TC) are regarded as more hazardous compared to heated tobacco products (HTPs). However, mainly from ethical reasons, there are no well-designed studies examining the health impact of exposure to HTPs. This study aimed to assess and compare self-reported physical health implications of respondents smoking traditional cigarettes and HTPs.</p><p><strong>Methods: </strong>The survey was conducted in 2,500 adults who had smoked TC for at least a year and after quitting them had been using HTPs for a minimum of six months. The questions, between other issues, aimed to determine and compare the opinion of respondents on impact of smoking cigarettes and using HTPs on physical health, physical condition, and physical health symptoms.</p><p><strong>Results: </strong>Comparing TC and HTPs, 54.2% of the respondents indicated that TC were worse for their physical health, in turn 5.2% of respondents pointed to HTPs as worse. Similarly, 61.9% of respondents viewed TCs as more harmful to their physical condition, while 25% believed that more harmful are HTPs. Traditional cigarettes had reportedly more pronounced negative impact on various physical signs and symptoms.</p><p><strong>Conclusions: </strong>Most people who switched from traditional cigarettes to HTPs perceive traditional cigarettes as more harmful to their physical health. Most believe also that traditional cigarettes more negatively affect physical endurance and various physical signs and symptoms. Age appears to be the main demographic factor influencing perceptions, while other variables such as sex, income, and education have only minor effects.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837247","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":"Transitions from first drug use to illicit opioid and injection drug use in a multisite rural U.S. cohort of people who use drugs.","authors":"Rob J Fredericksen, Adams Sibley, Kathryn E Lancaster, Wiley Jenkins, L Sarah Mixson, Bridget M Whitney, Lawrence Ouellet, Peter D Friedmann, Todd Korthuis, Joseph A C Delaney, Judith I Tsui, Heidi M Crane, William Zule, April M Young, David W Seal, Thomas J Stopka","doi":"10.1186/s12954-026-01460-8","DOIUrl":"10.1186/s12954-026-01460-8","url":null,"abstract":"<p><strong>Aim: </strong>To understand circumstances surrounding transitions between initial drug use, non-prescribed opioid use, and injection drug use (IDU) among people who use non-prescribed opioids in the rural U.S.</p><p><strong>Methods: </strong>We interviewed adults who use non-prescribed opioids in 10 states. We coded transcript data regarding age, drug, modality, circumstances for each \"first use\" event and transitions to illicit opioid use/IDU. Transition-related themes were categorized using the Social Ecological Model (SEM) through iterative qualitative memoing. We calculated frequencies and measures of central tendency.</p><p><strong>Results: </strong>Participants (n = 304, mean age [MA] = 36 years, 56% male) reported marijuana or opioid pills as first drug used (60%, reported MA = 13, and 16%, MA = 19, respectively). First opioid use (MA = 20) was typically pills (74%); 43% were initially prescribed opioids for pain. Of participants reporting IDU (92%, MA = 24), first drugs injected were methamphetamine (26%), opioid pills (22%), and heroin (22%). Reasons for first injection of these three substances were recreational (65%, 84%, 66%, respectively) followed by mental health coping (35%, 16%, 33%). Interviews revealed factors influencing transition to illicit opioid use/IDU at environmental, interpersonal, and intrapersonal levels of the SEM, including early household exposure to drugs, and family/peer encouragement to use opioids for coping. Participants described initial use of prescribed opioids following surgery or workplace injury, followed by illicit use of opioids and later IDU for recreational as well as practical goals. IDU was facilitated by intimate partners and friends in the context of diminished local access to illicit opioid pills.</p><p><strong>Conclusion: </strong>Among people who use opioids and inject drugs in the rural U.S., drug use typically started in pre-adolescence, first opioid use in early adulthood, and IDU a few years later, highlighting the need for early intervention. Methamphetamine comprised a substantial proportion of initial IDU raising concerns for polysubstance use. Drug use for coping highlights the need for increased mental health resources in rural areas.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814088","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":"Crack/cocaine use to manage xylazine exposure in fentanyl in Connecticut: findings from a convergent mixed methods study.","authors":"Katherine Hill, Emma T Biegacki, Gabrielle Bogut, Elizabeth Znamierowski, Cameron Breen, River Rose, Corona Zhang, Lauretta E Grau, Jenna L Butner, Robert Heimer, Kimberly L Sue","doi":"10.1186/s12954-026-01459-1","DOIUrl":"10.1186/s12954-026-01459-1","url":null,"abstract":"<p><strong>Background: </strong>In the context of the fourth wave of the opioid overdose crisis, defined by fentanyl and stimulant co-use, we aimed to explore if there might be a relationship between exposure to xylazine in the fentanyl supply and patterns of crack/cocaine use.</p><p><strong>Methods: </strong>This mixed methods study used data from four Connecticut-based sources: (1) the Office of the Chief Medical Examiner for fatal overdoses, 2019-2023, (2) community-based drug checking data, 2023-2024, (3) a structured survey of people who use drugs, 2024, and (4) one-on-one in-depth interviews, 2024.</p><p><strong>Results: </strong>Xylazine was detected in 19.2% of overdose fatalities involving fentanyl or a fentanyl analog (n = 5,849). Those with xylazine detected had a higher proportion of cocaine simultaneously detected, though this was not statistically significant (54.0% vs. 51.1%, p = 0.085). Cocaine detection rose over time in the fatality data, regardless of xylazine detection. There were 1,048 drug samples submitted to harm reduction organizations for drug checking. Using Fourier Transform Infrared Spectroscopy, 573 of the samples submitted tested positive for fentanyl or a fentanyl analog; 45.2% of these also tested positive for xylazine. Of 1048 samples, 276 tested positive for cocaine. Among the survey sample (n = 88), 62.5% of participants self-reported xylazine exposure. Those who reported lifetime xylazine exposure also reported higher past-year crack/cocaine use, though this was not statistically significant (89.1% vs. 81.8%, p = 0.336). Among our interview sample (n = 31), three themes emerged: (1) participants felt there was an inevitability of polysubstance use due to an increasingly volatile drug supply, (2) participants increased their crack/cocaine use in response to perceived exposure to xylazine in their fentanyl supply, and (3) participants' drug patterning changed due to xylazine's presence (e.g., timing, drug sequencing, etc.). Two meta-inferences were identified: (1) overdose fatality data likely underestimate the \"true\" prevalence of xylazine in the street supply, and (2) people who use drugs are using crack/cocaine in response to xylazine in their local fentanyl supply.</p><p><strong>Conclusions: </strong>Xylazine exposure has likely contributed to an adaptive and increasing use of crack/cocaine among people who use drugs in Connecticut. It is imperative that practitioners and policymakers are prepared to manage this triad of opioid-stimulant-sedative polysubstance use.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814096","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 community's memory is timeless\": exploring cultural and community context to inform the public health response to the overdose crisis in black communities.","authors":"Jasmine Barnes, M Holliday Davis, Kathryn Gallagher, Kathryn Morris, Nicole O'Donnell, Gilly Gehri, Jeanmarie Perrone, Margaret Lowenstein","doi":"10.1186/s12954-026-01457-3","DOIUrl":"10.1186/s12954-026-01457-3","url":null,"abstract":"<p><strong>Background: </strong>Substance use treatment and harm reduction strategies are vital tools in addressing the overdose crisis, however, effectiveness depends on access and uptake. Little is known about perceptions of harm reduction and substance use treatment efforts among people who use drugs (PWUD) in minoritized communities and how to enhance acceptability and uptake of evidence-based care. Our aim was to explore perceptions of drug use, PWUD and approaches to harm reduction and treatment in an urban, predominantly Black neighborhood heavily impacted by overdose.</p><p><strong>Methods: </strong>We conducted one-on-one, semi-structured interviews with a purposive sample of participants living or working in West and Southwest Philadelphia, focusing on factors influencing uptake of substance use services. Interviews were recorded, transcribed, and analyzed using thematic analysis.</p><p><strong>Results: </strong>We completed 19 interviews. Mean participant age was 46, 79% of the sample were women; 83% were Black/AA. Half of participants worked with PWUD in health or social service roles (50%), and the majority had lived experience of substance use personally or with a close friend or family member (83%). Participants reported several factors of attitudes toward substance use, PWUD, and addiction care in the community. First, participants frequently referenced the legacy of the punitive drug policies regarding current community apprehension about substance use services. Participants reported a high degree of community stigma towards PWUD, as well as a view of harm reduction as an endorsement of drug use rather than a public health effort. Stigma also shaped cultural norms, limiting acceptability of care-seeking among PWUD. In addition, participants highlighted the toll of systemic racism, noting that it contributed to generational trauma, substance use, and overall vulnerability to addiction and overdose. Finally, participants emphasized the importance of community-driven initiatives, culturally appropriate services, and expanded outreach to actively address and dismantle the structural inequities.</p><p><strong>Conclusion: </strong>Overall, participants from West and Southwest Philadelphia described how the combined impact of the war on drugs, systemic racism, and medical system mistrust has shaped the experiences of Black PWUD and their communities. Participants highlighted the need for equitable, culturally responsive public health policies that safeguard the provision of harm reduction services for Black PWUD.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769690","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}