Harm Reduction Journal最新文献

{"title":"Implementing public health vending machines on the reservation lands of the Bois Forte Band of Chippewa (United States).","authors":"Sean T Allen, Kristin E Schneider, Maisie Conrad, Pam Hughes, Allison O'Rourke, Molly C Reid, Cathy Chavers, Christopher G Kemp, Melissa Walls","doi":"10.1186/s12954-025-01244-6","DOIUrl":"10.1186/s12954-025-01244-6","url":null,"abstract":"<p><strong>Background: </strong>Public health vending machines (PHVMs) have been shown to improve access to numerous health-promoting supplies. However, they are understudied in the United States and no study of which we are aware has examined their implementation on American Indian reservation lands.</p><p><strong>Objective: </strong>This study describes how PHVMs were implemented on the Bois Forte Band of Chippewa Reservation lands in Minnesota (United States) and associated costs during the first 24 weeks of operations.</p><p><strong>Methods: </strong>We summarize the steps undertaken to implement PHVMs on reservation lands. We describe formative research in which we assessed willingness to use a PHVM among a sample of people who use drugs. Then, we describe how we worked with community members to ensure the appropriateness of a PHVM initiative. Finally, we present utilization data from the first 24 weeks of PHVM operations and describe associated implementation costs.</p><p><strong>Results: </strong>In May 2022, the academic research team presented to the Bois Forte Reservation Tribal Council about PHVMs and requested a Resolution that authorized their implementation on Reservation lands. The Resolution was unanimously approved, and the team began working with a local Community Research Council to determine the most appropriate way to implement the PHVMs. Prior to implementation, we conducted a survey among people who used drugs (N = 227) on Reservation lands and found that most (56%) reported willingness to use PHVMs if they were available. In October 2023, two PHVMs were installed. During the first 24 weeks of operations, there were 2,534 successful dispensations at the PHVMs. Items dispensed through the PHVMs included COVID-19 test kits, naloxone, drug test strip kits, menstrual supply kits, wound care kits, sterile injection equipment kits, pregnancy tests, safer sex kits, and HIV self-test kits. In total, the PHVM initiative cost approximately $30,406.75 (USD) during its initial 24-week implementation period.</p><p><strong>Conclusions: </strong>The Bois Forte Band of Chippewa took swift action upon learning about the potential public health benefits of PHVMs and immediately authorized their implementation, catalyzing a collaborative effort between local community members and academic partners. Thousands of life-sustaining supplies were dispensed at the PHVMs, supporting the prevention and treatment needs of the community.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"90"},"PeriodicalIF":4.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173601","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":"Vending machines for reducing harm associated with substance use and use disorders, and co-occurring conditions: a systematic review.","authors":"Alice Zhang, Matthew Carrillo, Ryan Liu, Sarah M Ballard, Alexis Reedy-Cooper, Aleksandra E Zgierska","doi":"10.1186/s12954-025-01236-6","DOIUrl":"10.1186/s12954-025-01236-6","url":null,"abstract":"<p><strong>Background: </strong>To stem rising fatal overdoses and other substance use/use disorder (SUD)-related harms, communities are turning to low-barrier harm reduction strategies, such as harm reduction-focused vending machines (VMs) that distribute naloxone, fentanyl test strips, and other harm reduction-related items. This systematic review aims to synthesize literature on VMs for SUD-related harm reduction.</p><p><strong>Methods: </strong>Four databases (Embase, Cochrane, PubMed, MEDLINE) were searched from their inception through November 29, 2023. References of identified eligible articles and pertinent prior reviews were also searched for relevant eligible research articles describing VM's feasibility, acceptability, reach, and/or impact when used for SUD-related harm reduction. Data from eligible articles were systematically extracted and summarized.</p><p><strong>Results: </strong>The search found 45 eligible articles covering 30 separate studies involving 191,242 participants (190,576 VM users; 666 non-users). Most studies were conducted outside of the U.S. (n = 20), focused on individuals who injected drugs (n = 18), and evaluated syringe-dispensing VMs (n = 12). Of the 45 articles, the majority evaluated feasibility (n = 35), followed by acceptability (n = 21), impact (n = 17), and reach (n = 14). The feasibility-assessing articles noted high demand for VM-dispensed items, with usage mostly occurring outside of traditional business hours, and more syringes and HIV self-tests being dispensed compared to some in-person programs. The VMs were generally accepted by target populations, regardless of the items dispensed, and reached high-risk populations. Impact evaluation was limited and based on item dispensed. Seven articles examined the impact of syringe-dispensing VMs and described reductions in syringe sharing (n = 4) and drug use (n = 2), as well as stable or declining rates in drug use-related crime (n = 1). Articles evaluating the impact of HIV self-test-dispensing VMs (n = 3) described HIV detection rates ranging from 1.9% to 17.7%. Two articles reported reduced fatal overdoses after naloxone-dispensing VMs were implemented.</p><p><strong>Discussion: </strong>VMs show promise as a low-barrier method for reducing SUD-related harm, decreasing health disparities, and engaging hard-to-reach populations. Future implementation science-based research is needed to assess VMs' impact on individual and community health outcomes, including overdose.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"89"},"PeriodicalIF":4.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173605","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":"Discreet but accessible: a qualitative study with people who use drugs and service staff about the optimal design of a harm reduction vending machine in rural Kentucky.","authors":"Rachel M Marschke, April M Young, Hannah K Knudsen, Chelsi N Cheatom, Hannah L F Cooper","doi":"10.1186/s12954-025-01222-y","DOIUrl":"10.1186/s12954-025-01222-y","url":null,"abstract":"<p><strong>Background: </strong>Rural Appalachia has been significantly affected by drug-related harms (Hepatitis C, HIV, overdose deaths) over the past two decades, but harm reduction responses still lag behind other regions. Harm reduction vending machines (HRVMs) are an effective intervention for preventing overdose and the spread of infection, though they are newer to the US and have rarely scaled out to rural areas. Here, we report on guidance from people who use drugs (PWUD) and health department staff on how to adapt HRVMs to suit local needs in rural Appalachian Kentucky.</p><p><strong>Methods: </strong>Focus groups were conducted with local health department and syringe service program (SSP) staff, PWUD who use the SSP, and PWUD who do not use the SSP. The interview guide covered key HRVM features including identification for access, contents, location, and appearance. Focus groups were recorded and transcribed, and data thematically analyzed.</p><p><strong>Results: </strong>The results yielded 3 major themes: participants sought an HRVM that was discreet and nonjudgmental, accessible and equitable, and holistic. These themes informed their decisions when ranking features of the machine's location, content, appearance, etc. Focus groups favored discreet machines that were out of plain sight; placing the machine somewhere walkable to ensure it is accessible; and including items that address needs beyond harm reduction to give participants more holistic help.</p><p><strong>Conclusions: </strong>HRVM scale out in this rural area should be guided by discreet and non-judgmental approaches that create an accessible and equitable machine that responds holistically to community needs. Future efforts to scale out HRVMs into rural areas could use this guidance as a starting point for exploring local priorities, to help ensure successful implementation in under-served rural areas.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"88"},"PeriodicalIF":4.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158251","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 pilot evaluation of managed alcohol programs operating in the context of the COVID-19 pandemic.","authors":"Sybil Goulet-Stock, Tim Stockwell, Meaghan Brown, Deidre Rautenberg, Bernie Pauly","doi":"10.1186/s12954-025-01232-w","DOIUrl":"10.1186/s12954-025-01232-w","url":null,"abstract":"<p><strong>Background: </strong>Managed Alcohol Programs (MAPs) are a harm reduction strategy designed for individuals with severe AUD, unstable housing, and previous unsuccessful treatment attempts. MAPs provide access to individualized doses of beverage alcohol alongside other social supports and are effective for stabilizing alcohol consumption and reducing alcohol-related harms. In Canada, MAP models (scattered site outreach or fixed site) were developed in response to the COVID-19 pandemic to reduce harms associated with severe AUD, high-risk drinking, and unstable housing as means of supporting physical isolation and distancing. This study provides a description of novel program models and practices and an in-depth description of nine MAP participants in British Columbia in the context of the COVID-19 pandemic.</p><p><strong>Methods: </strong>This research used a longitudinal mixed methods design. Participants included nine individuals enrolled in MAPs in British Columbia during the COVID-19 pandemic. Quantitative interviews assessing mental and physical health, safety, service usage, substance use, quality of life, well-being, physical distancing and risk behaviours, and alcohol-related harms were collected every 2 weeks for up to 3 months (n = 9). Qualitative interviews about experiences, goals, and expectations related to the MAP were conducted (n = 5). MAP records, including alcohol administration, liver function tests, and healthcare records were collected (n = 8).</p><p><strong>Results: </strong>Clinician-scattered site outreach or fixed-site MAP models were the most common during the COVID-19 pandemic. The individual findings suggest that MAPs may enhance housing stability, improve health, safety, and well-being, reduce alcohol-related harms, and help participants improve their ability to follow COVID-19 guidelines.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic accelerated the development of novel MAP models and approaches to alcohol distribution. The findings of this pilot evaluation illustrate the potential role for outreach models in the development of future MAPs.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"87"},"PeriodicalIF":4.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142354","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":"Sociodemographic and clinical characteristics associated with overdose among patients with a substance-related diagnosis in the emergency department of Southern California.","authors":"Brian Maila, María Luisa Zúñiga, Carla Marienfeld","doi":"10.1186/s12954-025-01233-9","DOIUrl":"10.1186/s12954-025-01233-9","url":null,"abstract":"<p><strong>Background: </strong>Drug overdoses are a significant public health concern, but there is limited research on the associated factors among patients presenting to the Emergency Department (ED). We investigated the sociodemographic and clinical characteristics associated with drug overdoses among patients with substance-related diagnoses (SRD) in a Southern California healthcare system's ED.</p><p><strong>Methods: </strong>A cross-sectional study employed EPIC electronic medical records from a sample of 13,477 adults (18-90 years of age) diagnosed with an SRD ICD-10 classification and had an ED encounter within the UCSD Health system in Southern California during the period from January 1, 2020, to December 31, 2023. Bivariate and multiple logistic regression analyses were utilized to ascertain sociodemographic and clinical characteristics correlated with overdoses.</p><p><strong>Results: </strong>The odds of experiencing an overdose were higher among individuals with a cannabis-related diagnosis (aOR = 1.21, p < 0.05) in comparison to those lacking such a diagnosis, among individuals with an Opioid-related diagnosis (aOR = 1.14, p < 0.05) when compared to those without an Opioid-related diagnosis. Individuals aged 40-54 had higher odds (aOR = 1.37, p < 0.05) of experiencing an overdose compared to those aged 18-24. Additionally, the odds were more pronounced among Black or African American (aOR = 1.31, p < 0.001) individuals compared to whites, among individuals of Hispanic/Latinx origin (aOR = 1.22, p < 0.001) compared to those of non-Hispanic/Latinx origin, among those with public health insurance (aOR = 1.40, p < 0.001) compared to those with commercial health insurance, and among individuals with any mental health diagnosis (aOR = 1.13, p < 0.05) compared to those without such a diagnosis. In contrast, individuals experiencing overdose were less likely to be female (aOR = 0.78, p < 0.001) compared to male, and less likely to be married/living as married/having a significant other (aOR = 0.69, p < 0.001) compared to those who were single.</p><p><strong>Conclusion: </strong>Our research showed that individuals with cannabis or Opioid-related diagnoses had higher odds of experiencing an overdose. Patients with an overdose were typically middle-aged, Black or African American, and Hispanic/Latinx, had public health insurance, and had comorbid mental health diagnoses. They were less likely to be female, married, or in a significant relationship. These findings highlight the importance of sociodemographic and clinical factors in identifying at-risk individuals for targeted interventions.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"86"},"PeriodicalIF":4.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132256","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":"Dispensing hope: leveraging distribution boxes to enhance low-barrier access to naloxone in healthcare settings.","authors":"Nycole Kothe, Angela Gray, Sarah Guthrie, Michael Londner","doi":"10.1186/s12954-025-01229-5","DOIUrl":"10.1186/s12954-025-01229-5","url":null,"abstract":"<p><strong>Background: </strong>West Virginia, often regarded as the epicenter of the opioid epidemic, has consistently recorded the nation's highest rates of opioid overdose deaths. The Eastern Panhandle, which includes Berkeley, Morgan, and Jefferson counties, mirrors this trend, with Berkeley County's overdose death rate in 2020 exceeding triple the national average. Recent data, however, indicates a promising 37% decrease in overdose deaths in Berkeley County over a 12-month period ending August 2024, and a statewide decrease of 27.9%. This decline is suspected to be attributed to enhanced access to naloxone and medications for opioid use disorder, supported by community collaboration. Despite these gains, barriers persist for at-risk populations, necessitating strategies such as over-the-counter naloxone availability.</p><p><strong>Methods: </strong>The implementation of naloxone distribution boxes in healthcare settings, initiated in Berkeley Medical Center's emergency department, marks a significant advancement. These boxes, accessible at all times and stocked with OTC (over the counter) naloxone kits, were placed in visible areas of the building vestibule to increase community access to naloxone.</p><p><strong>Results: </strong>Over a six-month period, these boxes distributed 2,383 naloxone kits, significantly surpassing physician-ordered distributions of 17 kits over the same period.</p><p><strong>Conclusion: </strong>Distribution boxes allowed for delivery of large quantities of naloxone compared to the physician-ordered distributions. Future efforts aim to expand naloxone availability in community settings to sustain and further reduce overdose fatalities.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"85"},"PeriodicalIF":4.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119365","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":"Scaling up low barrier wound care for people who use drugs: a mixed methods study.","authors":"Eleanor Turi, Shoshana V Aronowitz, Amanda Bettencourt, Allison Li, Jessica Lin, Rachel McFadden, David Mandell, Courtney Benjamin Wolk","doi":"10.1186/s12954-025-01241-9","DOIUrl":"10.1186/s12954-025-01241-9","url":null,"abstract":"<p><strong>Background: </strong>People who use drugs (PWUD) have long required wound care-a need that has become more urgent with the rise of xylazine, an animal tranquilizer in the street opioid supply associated with necrotic wounds. When PWUD visit the hospital for wound care, they often face discrimination from healthcare staff and leave the hospital before treatment completion. Low barrier wound care, community-based wound care that is grounded in harm reduction, is promising for meeting PWUD where they are and providing trustworthy, high quality care. Yet, access to low barrier wound care remains limited. This study explored determinants of and strategies for scaling up low barrier wound care for PWUD.</p><p><strong>Methods: </strong>We utilized a prospective sequential exploratory mixed methods design, including semi-structured 1:1 interviews, community advisory board (CAB) meetings, and an online survey. The study was conducted from April 2024-September 2024 in Philadelphia, Pennsylvania and surrounding regions. We included wound care providers, administrators, and recovery specialists of low barrier sites with walk-in, flexible services and harm reduction approaches. The interviews identified determinants of scaling up low barrier wound care, guided by the Consolidated Framework for Implementation Research. We then facilitated CAB meetings and conducted a survey of CAB members to identify community-generated implementation strategies and assess acceptability, feasibility, and appropriateness of CAB-generated strategies. We also generated evidence-based implementation strategies using the Expert Recommendations for Implementing Change compilation.</p><p><strong>Results: </strong>Participants identified many barriers, including stigma, social needs, local policies, unstable funding, lack of specialized knowledge, and unstandardized evidence. Promising implementation strategies include using mass media to address stigma, developing resource sharing agreements between sites, revising professional roles to spread knowledge, and building academic partnerships to develop evidence. The most acceptable, feasible, and appropriate strategy rated by the CAB was offering social needs services (e.g., food, showers) within low barrier wound care sites.</p><p><strong>Conclusions: </strong>Many factors at different levels influence the availability and quality of low barrier wound care for PWUD. Our results suggest that communities would benefit from a local needs assessment to identify and tailor strategies for scaling up care. Future work will test the effectiveness and implementation of identified strategies.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"84"},"PeriodicalIF":4.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110255","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":"\"You don't have the right resources to let it hurt\": How structural vulnerabilities shape opioid withdrawal experiences among a community sample of people who inject drugs in Los Angeles, California.","authors":"Siddhi S Ganesh, Erin E Gould, Rebecca P Smeltzer, Jesse L Goldshear, Jimi Huh, Rachel Carmen Ceasar, Ricky N Bluthenthal","doi":"10.1186/s12954-025-01223-x","DOIUrl":"10.1186/s12954-025-01223-x","url":null,"abstract":"<p><p>Among people who inject drugs and use opioids, the vast majority have reported experiencing opioid withdrawal symptoms during the past six months. People who use opioids experience significant impediments from withdrawal symptoms, including increased risk behaviors associated with overdose, bloodborne infection, and other negative health outcomes. We undertook this analysis to understand how social and structural forces shaped experiences of withdrawal risk, navigation, and management among a community sample of people who use opioids and inject drugs in Los Angeles, California. We conducted 30 semi-structured, in-depth interviews at community sites in Los Angeles. Qualitative data were analyzed using constructivist grounded theory. Our findings indicate that: 1) when people who use opioids experienced overlapping structural conditions (such as unsheltered houselessness and material difficulty) withdrawal becamea vulnerability and was prioritized first 2) severe material hardships necessitated that participants prioritized withdrawal to engage in their daily income generation activities, 3) participants engaged in higher risk behaviors in order to manage intense and urgent withdrawal symptoms, which led to shifts towards stigmatized and criminalized identities and negative self-appraisal. Overlapping structural vulnerabilities such as housing insecurity, material hardship, experiencing theft, and financial precarity compress risks associated with withdrawal while simultaneously constricting ways in which individuals can manage symptoms. Our findings point to ways in which existing withdrawal management options may be made more effective and accessible via structural support such as housing, income, and basic needs support. MOUD expansion may empower people who actively use opioids to navigate complex structural vulnerabilities from a place of assurance rather than urgency and fear; thereby serving as a harm reduction tool that disrupts the cycle of withdrawal management and material precarity.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"82"},"PeriodicalIF":4.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101780","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":"Exploration of novel harm reduction approaches to increase client engagement (ENHANCE): protocol for a prospective cohort study.","authors":"Rachel E Gicquelais, Caitlin J Conway, Mikaela Becker, Erika J Bailey, Cullen Bosworth, Rebecca Miller, Katy Mijal, Emmie Curran, Bianca Barredo, Sydney Taylor, Elizabeth Salisbury-Afshar, David W Seal, Marguerite Burns, Ryan P Westergaard","doi":"10.1186/s12954-025-01212-0","DOIUrl":"10.1186/s12954-025-01212-0","url":null,"abstract":"<p><strong>Background: </strong>Syringe services programs (SSPs) reduce the risk of overdose by distributing supplies like naloxone. SSPs also support clients in meeting their basic needs via referrals to organizations providing food, housing, and healthcare. This paper describes the Exploration of Novel Harm Reduction Approaches to Increase Client Engagement (ENHANCE) Project, a prospective cohort study developed in partnership with people who use drugs that aims to characterize the influence of longitudinal engagement in SSPs on overdose risk behaviors.</p><p><strong>Methods: </strong>The ENHANCE Project protocol was developed with a community leadership team of 16 people with living experience of drug use who were clients from four SSPs in Wisconsin that serve as study recruitment sites. The community leadership team met five times to conceptualize the study priorities, protocol, recruitment strategies, and measures. ENHANCE will enroll 400 people who use opioids and/or stimulants via recruitment of clients from study sites and peer referrals. Clients will report on primary outcomes (overdose experiences and risk behaviors) and other covariates (substance use history and behaviors, mental and physical health, satisfaction of basic needs, stigma, and others) over a 2-year follow-up period. At enrollment, clients select a self-generated identification code that is documented in all subsequent harm reduction services received from ten SSPs in Wisconsin. These data will be linked to study survey data using probabilistic methods and used for the primary exposure variable, frequency of using SSP services. ENHANCE will test the primary hypothesis that more frequently using SSP services is associated with reduced overdose risk behavior frequency.</p><p><strong>Preliminary results: </strong>Among the first 125 clients enrolled, 22.4% (N = 28) reported personally experiencing an opioid overdose in the 6 months before enrollment and 38.4% (N = 48) experienced adverse effects after using stimulants. The most common overdose risk behaviors reported in the past 30 days were using opioids while alone (mean: 9.9 days [standard deviation: 10.7]) and injecting heroin (mean: 9.3 days [standard deviation: 12.8]).</p><p><strong>Conclusions: </strong>This study will identify aspects of harm reduction services that are most effective in reducing overdose risk to inform future service provision, funding, and policy efforts.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 Suppl 1","pages":"81"},"PeriodicalIF":4.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101782","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":"Implementing community drug checking in smaller urban communities: a qualitative study exploring contextual factors to consider.","authors":"Abby Hutchison, Karen Urbanoski, Dennis Hore, Bruce Wallace","doi":"10.1186/s12954-025-01234-8","DOIUrl":"10.1186/s12954-025-01234-8","url":null,"abstract":"<p><strong>Background: </strong>Impacts of the toxic unregulated drug supply are experienced across all geographic regions in Canada, with high rates of fatal and non-fatal overdoses nation-wide. In British Columbia, rates of overdose fatalities are often higher within smaller urban and rural communities than in larger urban cities. Community drug checking is increasingly explored as a harm reduction intervention; however, these services are typically limited to larger cities. In this study, we explored the contextual factors that service users and implementers consider to be important for context specific drug checking services within smaller communities.</p><p><strong>Methods: </strong>Data collection involved 39 semi-structured interviews with prospective drug checking service users and service implementers from six harm reduction services in four smaller communities on Vancouver Island, BC. Interviews explored perspectives on the contextual factors that may impact the implementation and accessibility of drug checking services within smaller communities. Through inductive thematic analysis, we developed themes that reflected the overarching contextual factors discussed by participants.</p><p><strong>Results: </strong>Participants described four overarching contextual factors important for accessing and implementing drug checking in smaller communities: community and political climate; close social groups and personal relationships; resource availability; and geographic profile. While many of the contextual factors are similar to those operating in larger urban contexts, they can manifest differently in smaller communities. For example, lack of anonymity and confidentiality are intensified in small and rural communities where \"everybody knows everybody\". Geographic distance to service and transportation were identified as barriers, with outreach and transportation to services suggested as potential mitigating strategies.</p><p><strong>Conclusion: </strong>As community drug checking services are established as a response to the toxic unregulated drug market, factors that support equitable access to services beyond inner-city and urban areas are critical. Factors identified as potential barriers offer targets for service adaptation and tailored implementation to enable greater access. With rural communities experiencing high rates of overdose, implementing drug checking services that are contextually relevant and equity-oriented is critical.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"22 1","pages":"83"},"PeriodicalIF":4.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101781","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}