Harm Reduction Journal最新文献

{"title":"Highlighting variability in fentanyl test strip instructions using thematic content analysis.","authors":"Cianna J Piercey, Claire L Pince, Hollis C Karoly","doi":"10.1186/s12954-025-01252-6","DOIUrl":"10.1186/s12954-025-01252-6","url":null,"abstract":"<p><strong>Background: </strong>Fentanyl test strips (FTS) are a harm reduction tool used by individuals seeking to avoid unintentional fentanyl exposure while consuming other illicit substances (e.g., heroin, cocaine). While evidence speaks to the efficacy and acceptability of FTS, there are currently no standardized instructions for the use of FTS as a drug checking tool, and little is known about potential variability across instructions.</p><p><strong>Methods: </strong>We sought to investigate variability in content across FTS instructions (N = 16) through conducting a thematic content analysis of instructions listed in the first three pages of a Google search. The search was conducted in May of 2024, with \"fentanyl test strip instructions\" entered as the search term. To be included in the present analysis, the information listed in the search result must have contained explicit instructions for how to use FTS and have been printed in English.</p><p><strong>Results: </strong>Thematic content analysis of FTS instructions yielded 26 codes and 4 themes. Themes included (1) Information about FTS (2) Testing Methods (3) Test Results and (4) Additional Resources. Overall, results indicated considerable variability across the 16 instructions examined, with the greatest variability observed within the testing methods theme.</p><p><strong>Conclusion: </strong>Inconsistencies in online FTS instructions, such as those identified in the current study, could lead to distrust among people who use drugs and disengagement with this drug checking practice. Standardized and accessible instructions are critical to optimizing the efficacy of FTS as a harm reduction tool and reducing accidental fentanyl exposure.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"110"},"PeriodicalIF":4.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474971","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":"\"To not feel fake, it can't be fake\": co-creation of a harm reduction, peer-delivered, health-system intervention for people who use drugs.","authors":"J Deanna Wilson, Stephanie P Klipp, Kelsey Leon, Jane M Liebschutz, Jessica Merlin, Cristina Murray-Krezan, Sommer Nolette, Kristina T Phillips, Michael Stein, Nate Weinstock, Megan Hamm","doi":"10.1186/s12954-025-01210-2","DOIUrl":"10.1186/s12954-025-01210-2","url":null,"abstract":"<p><strong>Background: </strong>People who use drugs (PWUD) continue to experience not only high overdose rates but also growing infectious complications. In response, there has been a growing focus on increasing access to harm reduction resources, particularly among hospitalized PWUD. However, there is limited data on how best to integrate harm reduction into hospital settings. We describe using a Design Sprint, a human-centered design process, to co-create an intervention with people who have lived experience (PWLE) focused on improving access and adoption of harm reduction behaviors for hospitalized PWUD.</p><p><strong>Methods: </strong>We recruited a sample of PWLE from Pittsburgh, Pennsylvania. We recruited a total of 14 participants over a 3-week period from March to April 2024. There were four Design Sprint sessions, two-hours in length, delivered via HIPAA-compliant zoom. Participants identified intervention components, sketched the intervention, and prototyped the planned intervention process. Sessions were recorded and transcribed verbatim. The team identified intervention components and key themes using thematic analysis.</p><p><strong>Results: </strong>There were 14 PWLE (mean age 40.4 years; majority white) who participated in at least one Design Sprint session. Participants conceptualized an intervention delivered by a THRIVE navigator who establishes rapport, identifies what if any goals the participant may have, offers information from a menu of harm reduction topics, and helps participants create a Wellness Plan focused on achieving their goals and overcoming likely barriers. The THRIVE navigator will then follow-up via weekly text messages. There were four additional themes that informed intervention content and implementation. These were related to the hospital being experienced as a hostile environment to PWUD; the value of health information being delivered by PWLE who can speak authentically; the importance of creating a flexible participant-led intervention offering a range of content; and the importance of neutrality to building authenticity and attaining participant buy-in.</p><p><strong>Conclusions: </strong>The Design Sprint process allowed for rich input from PWLE on the design, scope, content, and implementation of the THRIVE intervention. Findings highlight the importance of a peer navigator role to embody relational harm reduction and guide THRIVE participants in education and goal setting around a host of wellness-related behaviors.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 Suppl 1","pages":"108"},"PeriodicalIF":4.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325480","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 Spanish gambling regulations on online gambling behavior and marketing strategies.","authors":"Gema Aonso-Diego, Ángel García-Pérez, Andrea Krotter","doi":"10.1186/s12954-025-01219-7","DOIUrl":"10.1186/s12954-025-01219-7","url":null,"abstract":"<p><strong>Background: </strong>A large body of research has pointed out that advertising has an impact on gambling behavior. However, little is known about how actual gambling marketing regulations impact online gambling behavior and marketing expenditure. Recently, a Spanish law-the Royal Decree 958/2020-came into force, which, in general terms, limits the marketing of gambling products. The current study aimed to examine the effect of the Spanish Royal Decree 958/2020 on gambling behavior (i.e., new accounts, active accounts, deposits, and total money bet) and marketing expenditure (i.e., advertising, bonuses, affiliation, and sponsorship) based on data from the Directorate General for Regulation of Gambling.</p><p><strong>Methods: </strong>We used Seasonal Autoregressive Integrated Moving Average (SARIMA) models to examine the impact of the implementation of Royal Decree 958/2020 on both online gambling behavior and marketing expenditure.</p><p><strong>Results: </strong>The entry into force of the Spanish Royal Decree (applied between November 2020 and August 2021) led to a permanent decrease in gambling behavior, in particular new accounts (-263k; p = .003) and total money bet (-€216M; p = .034). Additionally, regulatory measures had an impact on marketing strategies, specifically, reducing money earmarked for advertising (-€20M; p = .004), bonuses (-€2.6M; p = .048), and sponsorship (-€5.3M; p < .001).</p><p><strong>Conclusion: </strong>These findings demonstrate that regulatory measures aimed at limiting gambling advertising, bonuses, and sponsorships impact new accounts (i.e., new gamblers) and total money gambled, but hardly active accounts (i.e., regular gamblers). This study can serve as a model for countries where gambling advertisements have not yet been regulated.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"107"},"PeriodicalIF":4.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293658","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":"Using RE-AIM to evaluate the implementation of a social marketing and free product distribution project for fentanyl and xylazine test strips in New York State.","authors":"Hilary M Kirk, Joshua J Lynch, Kimberly A Bernosky, Orian B Painter, Shelby Arena, Mia Dickinson, Lyudmila Pakhomova, Brian M Clemency","doi":"10.1186/s12954-025-01259-z","DOIUrl":"10.1186/s12954-025-01259-z","url":null,"abstract":"","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"105"},"PeriodicalIF":4.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283553","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":"Informed implementation practice - formative research of a mobile drug consumption room in Brno, Czech Republic.","authors":"Viktor Mravčík, Barbara Janíková, Danica Thanki, Daniela Nováková, Petr Matoušek, Simona Psárska, Martin Matušák, Žofie Buchalová, Lenka Dospiviová, Lucie Mašková, Petr Blažek","doi":"10.1186/s12954-025-01246-4","DOIUrl":"10.1186/s12954-025-01246-4","url":null,"abstract":"<p><strong>Background: </strong>Drug consumption rooms (DCRs) are harm reduction facilities providing safer and hygienic setting for supervised administration of drugs aimed at decreasing negative health and social consequences of drug use. The first DCR in Czechia was opened in September 2023 in city of Brno in a mobile form operating in a socially excluded area (SEA). A research project informed the implementation of the DCR.</p><p><strong>Methods: </strong>A mixed methods design was applied in the following phases: desk review, research before and after the launch of the mobile DCR, and routine monitoring of programme performance. Two cross-sectional questionnaire surveys among PWUDs (n = 131 and 135), ethnographic observation, focus group (n = 19), interviews with PWUDs (n = 26 and 19), with personnel of addiction services and local officials (n = 16 and 12), and residents (n = 7 and 6) were performed prior to and after the launch of the DCR. Thematic analysis of qualitative data, descriptive and regression analyses of quantitative data were performed.</p><p><strong>Results: </strong>There was a need and high willingness to use the DCR among potential clients. The significant predictors were opioid use (adjusted odds ratio, AOR = 3.4 in survey 1 and 3.9 in survey 2), drug injection in the last 30 days (AOR 4.3 in survey 1), being in the probationary period during the previous 30 days (AOR 10.0 in survey 1), witnessing an overdose in the past 30 days (AOR 8.5 in survey 2), HCV positivity ever in life (AOR 2.9 in survey 2), living in SEA (AOR 2.7 in survey 2) and Roma ethnicity (AOR 2.8 in survey 2). The beginnings of the DCR were relatively slow with low initial number of clients and drug administrations. However, with time, and programme adjustments following research results, the attendance at the facility has grown.</p><p><strong>Conclusions: </strong>Research was instrumental in shaping the DCR in Brno before and during its implementation. The DCR showed a potential to attract the most vulnerable PWUDs from SEA. Despite a slow start, the DCR has become an integral part of low-threshold services for PWUDs in Brno and has proven its feasibility in the Czech settings.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"106"},"PeriodicalIF":4.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283552","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 nothing personal\": understanding barriers to relational harm reduction practices during inpatient hospitalization.","authors":"Kelsey Leon, Rachel Weger, Nate Weinstock, Raagini Jawa, J Deanna Wilson","doi":"10.1186/s12954-025-01240-w","DOIUrl":"10.1186/s12954-025-01240-w","url":null,"abstract":"<p><strong>Background: </strong>People who use drugs (PWUD) have a higher incidence of infectious complications that require medical interventions only available in hospital settings. Hospitalizations for PWUD are also more likely to result in patient directed discharge (PDD) before completing medical treatment. Stigma directed at PWUD pressurizes and shapes clinical encounters, leading to poor communication between patient and provider. We explore how the relational philosophy of harm reduction - the premise that building relationships rooted in compassion and respect, as opposed to a transactional encounter - can redress the harms and communication barriers between PWUD and healthcare providers in the hospital setting.</p><p><strong>Methods: </strong>We recruited sixteen patients (achieving thematic saturation) with substance use disorder during their hospital stay at a large academic medical center with an urban, suburban, and rural referral base. Interviews were semi-structured, and focused on assessing patient knowledge and experiences of accessing harm reduction services and medical care. Interviews were transcribed verbatim and analyzed using content and thematic analysis.</p><p><strong>Findings: </strong>When discussing patient experiences accessing medical care, three key themes emerged from our interviews about their hospital experiences: 1) providers disregard for social contexts of PWUD, 2) providers withholding care because of patient's substance use, 3) patients viewed in negative or pejorative ways because of their addiction. All participants reported experienced or anticipated stigma related to drug use. Our participants described avoiding seeking medical care and developing strategies to deal with anticipated and experienced stigma; some reported their minimization of physical complaints due to providers' focus on their substance use as well as medical care being withheld because of their substance use. Three themes emerged around experiences of care that conferred dignity and autonomy: 1) experience dignity in and through use and access of harm reduction services, 2) peer support as a tool to model for relational harm reduction 3) harm reduction as community care (leveraging a responsibility to look out for others). Participants identified these social supports as giving them hope and motivation around their own health goals.</p><p><strong>Conclusion: </strong>Our findings emphasize that healthcare settings remain challenging for PWUD. Patients describe how stigmatizing beliefs impact clinical reasoning and bleed into negative healthcare experiences and lower quality of care. The foundational principles of harm reduction - appreciating the social contexts in which individuals use drugs and the dignity in survival strategies - offer pathways for therapeutic communication between patients and providers.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"104"},"PeriodicalIF":4.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274743","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 institutionalization on the effectiveness of harm reduction: a qualitative study using drug users' representations.","authors":"Nicolas Khatmi, Lionel Dany, Perrine Roux","doi":"10.1186/s12954-025-01254-4","DOIUrl":"10.1186/s12954-025-01254-4","url":null,"abstract":"<p><strong>Context: </strong>The French harm reduction (HR) model has been incorporated into health policies at the institutional level since 2004. To assess the effectiveness of this process, this article examines the representations of people who inject drugs (PWID) treated in care centers in France. In particular, it focuses on how they perceive themselves and their drug injection practices.</p><p><strong>Methodology: </strong>We conducted a qualitative study using semi-structured interviews with 24 PWID attending both low- and high-threshold care centers. Lexical analysis and advanced statistical methods, including hierarchical clustering and correspondence analysis, were employed to elucidate the intricate relationships between the language utilized, the characteristics of the participants, and the care context.</p><p><strong>Results: </strong>The analysis identified four lexical classes, which collectively represented 96.9% of the corpus. These were: economic aspects (C1), social relationships and stigma (C2), therapeutic and medical care (C3), and technical skills (C4) related to drug injection practices. Two principal factors of variability significantly influenced these classes. Factor 1 primarily distinguished the discourse of PWID according to their socio-economic status, forming a gradient from those in more precarious situations-who accessed low-threshold care centers-to those with greater social stability-who accessed high-threshold care centers. Factor 2 highlighted the influence of temporal markers on discourse, particularly the period of drug injection initiation. This factor reveals a pronounced contrast between participants who initiated injection prior to the 2000s and those who began during or after the 2000s.</p><p><strong>Conclusion: </strong>Our results demonstrate that PWID's experiences and perceptions were shaped not only by their socio-demographic characteristics but also by their social context, particularly the type of care center they attended. This study's findings reveal the limitations of the institutionalized HR model in the French healthcare system and advocate the development of a community-based approach to HR that aligns with its original principles.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"103"},"PeriodicalIF":4.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266132","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 novel naloxone distribution intervention among persons experiencing unsheltered homelessness: acceptability of naloxone training and distribution during an annual point-in-time count.","authors":"Ashleigh Herrera, Kael Rios","doi":"10.1186/s12954-025-01250-8","DOIUrl":"10.1186/s12954-025-01250-8","url":null,"abstract":"<p><strong>Background: </strong>The United States is experiencing an intersecting crisis of structural inequities, record levels of homelessness, and a surging fourth wave of the opioid epidemic. People experiencing unsheltered homelessness (PEUH) are at particularly high risk of opioid-related death. Although naloxone is a key tool for preventing overdose fatalities, PEUH face significant barriers to accessing and retaining it. This study examined the acceptability of a novel overdose education and naloxone distribution (OEND) intervention implemented during Kern County's 2024 Point-in-Time (PIT) unsheltered count. As part of the initiative, volunteers were offered optional OEND training prior to distributing naloxone to PEUH during the annual PIT Count.</p><p><strong>Methods: </strong>Naloxone distribution was tracked, and PIT Count volunteers were recruited via convenience sampling to complete a post-intervention electronic survey. The survey assessed acceptability using domains from the Theoretical Framework of Acceptability. Descriptive statistics and thematic analysis were used to evaluate responses related to OEND training and naloxone distribution.</p><p><strong>Results: </strong>Of 111 survey initiators, 94 met eligibility criteria. Most respondents (71.3%) participated in the OEND training, and nearly two-thirds (64.9%) distributed naloxone. Among those with prior overdose experience (n = 26), 88.5% had taken bystander action, most often administering naloxone or calling 911. Training participants reported positive affective attitudes (mean = 1.57), high perceived effectiveness (mean = 1.58), low burden (mean = 1.89), and low opportunity cost (mean = 4.40 on a reverse scale), with slightly lower self-efficacy (mean = 2.23). Overall acceptability was high (mean = 1.45). Among naloxone distributors, responses indicated strong comfort (mean = 1.6), confidence (mean = 1.7), coherence (mean = 1.6), and acceptability (mean = 1.8), along with low burden (mean = 1.9) and opportunity cost (mean = 4.5). Over 87% expressed willingness to distribute naloxone in future PIT Counts. Non-distributors cited reasons such as lack of opportunity, participant refusal, and discomfort. Open-ended responses suggested improvements in training availability, logistics, and messaging for PEUH.</p><p><strong>Conclusions: </strong>Naloxone training and distribution during the PIT Count was feasible and highly acceptable. These findings support broader implementation to improve naloxone access and reduce overdose deaths among PEUH, and they provide a foundation for future effectiveness studies.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"102"},"PeriodicalIF":4.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257968","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":"Evaluation of implementing drug checking services for anabolic androgenic steroids in Switzerland: a pilot study.","authors":"Raphael Magnolini, Michel Kaeppeli, Dominique Schori, Philip Bruggmann, Oliver Senn","doi":"10.1186/s12954-025-01242-8","DOIUrl":"10.1186/s12954-025-01242-8","url":null,"abstract":"<p><strong>Background: </strong>The use of anabolic androgenic steroids (AAS) among male recreational gym users has become a global substance use concern. A substantial black market for these substances exists with possibly extensive counterfeiting. Drug checking services (DCS) are established harm reduction services for people who consume illicit substances. To evaluate the feasibility of implementing a novel specialized DCS for AAS, a pilot study was conducted within a pre-existing DCS in Zurich (Switzerland).</p><p><strong>Methods: </strong>The reporting of this pilot study follows an adapted CONSORT statement. Further aims were to characterize AAS use as well as the chemical properties of customer-provided substance samples analysed through the DCS in a Swiss context. Customers could access DCS in Zurich from August 2023 onwards by providing a voluntary user questionnaire and dispense samples of AAS. Primary feasibility outcomes for this study were customer satisfaction metrics with the DCS received (i.e., customer satisfaction score (CSAT); net promoter score (NPS)). The chemical analytical method utilized was gas chromatography-mass spectrometry (GC-MS). Descriptive statistics were used.</p><p><strong>Results: </strong>Overall, 52 clients accessed DCS over the pilot period and 71 samples were chemically assessed. Excellent results regarding customer satisfaction metrics towards DCS for AAS were achieved (NPS: 97 (integer); CSAT: 93%). The typical clients were males partaking in recreational sports, between 22 and 40 years old, working, and with a higher education. The main motivation for using AAS was for aesthetic purposes. Patterns of AAS use were complex with frequent extensive concomitant substances use. Most AAS in this sample were acquired from non-medical sources. The sample analysis revealed that over half (52%) of the user-provided samples of AAS were fake.</p><p><strong>Conclusions: </strong>We demonstrate that the implementation of DCS for AAS was feasible with high acceptance among clients. Those clients may engage in many high-risk behaviors and the use of substances with low chemical properties may expose them to additional unexpected health risks. As a harm reduction tool, DCS for these clients and substances appears to be feasible and it may further serve as monitoring tool for public health purposes. Upon the initial study results, DCS for AAS were continued with close monitoring.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"100"},"PeriodicalIF":4.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247558","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":"U.S. substance use harm reduction efforts: a review of the current state of policy, policy barriers, and recommendations.","authors":"Bailey E Pridgen, Andrew P Bontemps, Audrey R Lloyd, William P Wagner, Emma S Kay, Ellen F Eaton, Karen L Cropsey","doi":"10.1186/s12954-025-01238-4","DOIUrl":"10.1186/s12954-025-01238-4","url":null,"abstract":"<p><p>A wealth of research demonstrates that harm reduction interventions for substance use (SU) save lives and reduce risk for serious infectious diseases such as HIV, hepatitis C, and other SU-related health conditions. The U.S. has adopted several harm reduction interventions at federal and state levels to combat SU-related harm. While several policy changes on the federal and state levels decriminalized interventions and further support their use, other policies limit the reach of these interventions by delaying or restricting care, leaving access to life-saving interventions inconsistent across the U.S. Federal and state policies in the U.S. that restrict access to medications for opioid use disorder (MOUD), criminalize possession of drug paraphernalia, prevent syringe service programs and overdose prevention centers from operating, and limit prescribing of pre-exposure prophylaxis (PrEP) pose significant barriers to harm reduction access and implementation. This paper aims to bridge publications and reports on current state and federal harm reduction intervention policies and discuss policy recommendations. Federally, the DEA and SAMHSA should expand certification for methadone dispensing to settings beyond dedicated opioid treatment programs and non-OTP prescribers. Congress can decriminalize items currently categorized as paraphernalia, permit purchasing of syringes and all drug checking equipment using federal funds, amend the Controlled Substances Act to allow for expansion of overdose prevention centers, protect Medicaid coverage of PrEP, and expand Medicaid to cover residential SU treatment. At the state level, states can reduce regulations for prescribing MOUD and PrEP, decriminalize drug paraphernalia, codify Good Samaritan laws, and remove restrictions for syringe service program and overdose prevention center implementation. Lastly, states should expand Medicaid to allow broader access to treatment for SU and oppose Medicaid lock-outs based on current SU. These changes are needed as overdose deaths and serious infectious disease rates from SU continue to climb and impact American lives.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"101"},"PeriodicalIF":4.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247559","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}