对无家可归者或弱势住房者使用兴奋剂的干预措施:包括创伤知情方法在内的证据范围审查。

IF 4 2区 社会学 Q1 SUBSTANCE ABUSE
Nicole E Edgar, Housam Taha, Valentina Ly, Simon Hatcher
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引用次数: 0

摘要

背景:在过去十年中,兴奋剂的使用在全球范围内呈上升趋势。现在使用毒品的人通常同时使用阿片类药物和兴奋剂。在加拿大,从2020年到2024年,68%的过量死亡与兴奋剂有关。过量用药危机对无家可归者的影响尤为严重。无家可归的人更有可能过量服用兴奋剂,而兴奋剂更有可能直接导致这一人群的过量死亡。尽管需求不断增长,但对于使用兴奋剂的无家可归者来说,没有一个全面而有效的治疗方案,也没有考虑到创伤和安全供应的选择。我们进行了范围审查,以确定可用于解决无家可归者兴奋剂使用问题的循证治疗类型;这些服务是否有创伤信息;并找出知识差距。方法:采用同行评议的检索策略,在MEDLINE、Embase、PsychInfo(通过OVID)、CINAHL、Global Health(通过EBSCOhost)和Scopus进行检索。手工搜索灰色文献来源。我们纳入了所有没有语言或日期限制的初级研究。报告遵循系统审查的首选报告项目和范围审查的元分析扩展(PRISMA-ScR)清单。结果:共筛选到2914篇标题和摘要,51篇转入全文筛选。其中31项研究符合入选标准,纳入数据提取。论文研究了应急管理干预措施(n = 20)、住院治疗方案(n = 5)、更安全的供应(n = 1)和其他类型的干预措施(n = 4)。在31篇论文中,没有研究报告使用创伤知情护理方法,尽管有7篇论文纳入了创伤知情护理的某些组成部分。研究中有效性的证据参差不齐,基于奖励的应急管理通常是有效的,并且为参与者所接受。讨论:关于对无家可归者使用兴奋剂治疗的证据有限,大多数研究都集中在应急管理上。研究在干预或研究设计中大都没有考虑创伤的影响。需要进一步研究减少危害的干预措施,如兴奋剂更安全的供应或监督消费服务,以及可能对这一人群重要的禁欲以外的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Interventions for stimulant use in people who are homeless or vulnerably housed: a scoping review of the evidence including trauma-informed approaches.

Background: Stimulant use has been increasing globally over the past decade. People using drugs are now most often using both opioids and stimulants. In Canada, stimulants were involved in 68% of overdose deaths from 2020 to 2024. The overdose crisis has disproportionately impacted people experiencing homelessness. People experiencing homelessness are more likely to experience an overdose and stimulants are more likely to contribute directly to an overdose death in this population. Despite the growing need, a comprehensive and effective treatment program for people experiencing homelessness who use stimulants, that also considers trauma and safe supply options, is non-existent. We conducted a scoping review to identify the types of evidence-based treatments available to address stimulant use in people experiencing homelessness; whether any of these services were trauma-informed; and to identify knowledge gaps.

Methods: Using a peer-reviewed search strategy, we conducted searches in MEDLINE, Embase, PsychInfo via OVID, CINAHL, Global Health via EBSCOhost, and Scopus. Grey literature sources were hand searched. We included any primary research study with no restrictions on language or date. Reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

Results: After de-duplication, 2914 titles and abstracts were screened, and 51 papers were moved to full text screening. Of this, 31 studies met eligibility criteria and were included for data extraction. Papers examined contingency management interventions (n = 20), residential treatment programs (n = 5), safer supply (n = 1), and other types of interventions (n = 4). Of the 31 papers, no studies reported using trauma-informed care approaches, although, seven incorporated some components of trauma-informed care. There was mixed evidence of effectiveness among studies, with rewards-based contingency management being generally effective and acceptable to participants.

Discussion: There is limited evidence available regarding stimulant use treatments for people experiencing homelessness, with most studies focusing on contingency management. Studies largely do not consider the effects of trauma in their intervention or study design. Further research is needed on harm reduction interventions such as stimulant safer supply or supervised consumption services, as well as outcomes other than abstinence that may be important to this population.

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来源期刊
Harm Reduction Journal
Harm Reduction Journal Medicine-Public Health, Environmental and Occupational Health
CiteScore
5.90
自引率
9.10%
发文量
126
审稿时长
26 weeks
期刊介绍: Harm Reduction Journal is an Open Access, peer-reviewed, online journal whose focus is on the prevalent patterns of psychoactive drug use, the public policies meant to control them, and the search for effective methods of reducing the adverse medical, public health, and social consequences associated with both drugs and drug policies. We define "harm reduction" as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use without necessarily reducing drug consumption". We are especially interested in studies of the evolving patterns of drug use around the world, their implications for the spread of HIV/AIDS and other blood-borne pathogens.
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