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"Harm reduction"
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Solution focused harm reduction : working effectively with people who misuse substances
Explains the many synergies between solution focused brief therapy (SFBT) and harm reduction (HR). Seán Foy discusses how these two approaches are complementary and when used in conjunction, create a novel way of approaching addiction work. The book covers several detailed case studies examining how the concepts and theories of both approaches are intertwined to enhance and deepen the work undertaken with people who misuse and abuse substances. It will be of great interest to scholars of psychotherapy, social work, social care, addiction, nursing and health care, as well as to practitioners seeking a clearer understanding of solution focused brief therapy and harm reduction and how to apply these to case work with problematic drinkers and drug users.
Book
“Let me hear what you’re needing”: exploring how HIV providers conceptualize patient-provider interactions with people with HIV who use drugs using a harm reduction framework
Background: In addition to structural interventions such as syringe services and naloxone distribution, harm reduction (HR) is also a relational approach to care encompassing principles such as patient autonomy and pragmatism that can be implemented in healthcare teams to improve outcomes for people with HIV (PWH) who use drugs. Evidence suggests that using a relational HR framework to operationalize care for PWH who use drugs may improve the patient-provider relationship, thus positively impacting HIV outcomes. We previously found that negative attitudes toward people who use drugs are negatively associated with acceptance of HR; however, little is known about how HIV providers conceptualize the patient-provider relationship with PWH who use drugs. Objectives: The aim of this study was to describe the ways healthcare workers (HCWs) characterize interactions with PWH who use drugs and if these characterizations reflect relational HR or missed opportunities to improve the patient-provider relationship. Design: We used a qualitative descriptive design to characterize HCWs’ descriptions of their interactions with PWH who use drugs. Methods: We interviewed providers ( n = 23) working at three HIV clinics in the United States to assess their interactions with patients. Providers included anyone who had worked at their respective clinic for ⩾1 year and who had face-to-face contact with patients (e.g., front desk staff, nurses, physicians, and social workers). Data were coded thematically via Dedoose. Results: We discovered that HCWs characterize positive patient-provider interactions that both reflect HR principles and may not align with the principles of HR. Examples include when patients appear comfortable with and trusting of their provider, when patients feel heard by their provider, and when providers feel they are responsive to patient needs. However, other HCWs described positive interactions as counter to relational HR. Conclusion: HCW descriptions of positive interactions in line with relational HR in their conceptualization of patient-provider interactions with PWH who use drugs have the potential to guide efforts in increasing the acceptability of HR in HIV care. Given evidence showing HR improves outcomes for those who use substances, findings suggest missed opportunities to incorporate relational HR into the patient-provider relationship in HIV primary care settings. Registration: NCT05404750.
Journal Article
The problem of harm in world politics : theoretical investigations
\"The need to control violent and non-violent harm has been central to human existence since societies first emerged. This book analyses the problem of harm in world politics which stems from the fact that societies require the power to harm in order to defend themselves from internal and external threats, but must also control the capacity to harm so that people cannot kill, injure, humiliate or exploit others as they please. Andrew Linklater analyses writings in moral and legal philosophy that define and classify forms of harm, and discusses the ways in which different theories of international relations suggest the power to harm can be controlled so that societies can co-exist with the minimum of violent and non-violent harm. Linklater argues for new connections between the English School study of international society and Norbert Elias's analysis of civilizing process in order to advance the study of harm in world politics\"-- Provided by publisher.
Book
Harm reduction self-efficacy and motivations for contactless supply access among a sample of syringe services program participants
Background
Contactless harm reduction supply methods (e.g., vending machines, mail order, mobile delivery) have become prevalent in the United States. However, this approach has faced some criticisms, including the notion that, unlike staffed syringe services programs, contactless methods do not provide face-to-face support, education, or referrals to treatment, potentially limiting their overall impact.
Methods
We collected self-reported data from a sample of people who inject drugs who accessed a syringe services program (N = 50), including their demographics, harm reduction self-efficacy (i.e., confidence to employ specific health-preserving coping skills in high-risk drug using situations), and motivations for contactless harm reduction supply access via vending machine. We explored differences in the participants' demographics and harm reduction self-efficacy by usual method of harm reduction supply access (in-person vs. vending machine).
Results
Participants accessed the harm reduction supply vending machine primarily out of convenience (66%) and limited syringe services program hours (56%). Fear of being seen by someone they knew (28%), law enforcement (34%), and social services (22%) were also motivators. Overall, harm reduction self-efficacy was highest for safer injection practices but lowest for reducing drug use. We did not find any significant differences in participants’ demographics or harm reduction self-efficacy by access method.
Conclusions
People who access harm reduction supplies in person and through contactless methods may not meaningfully differ in terms of their demographics and harm reduction self-efficacy, and contactless harm reduction supply methods are more convenient than in-person services. Findings support continued reductions to barriers of harm reduction services.
Journal Article
Over the influence : the harm reduction guide to controlling your drug and alcohol use
\"Just say no\" just doesn't work for everyone. Presenting a powerful alternate to abstinence-only addictions treatments, this empathic, nonjudgmental resource has already helped thousands set and meet their own goals for gaining control over alcohol and drugs. The science of harm reduction is translated into step-by-step strategies that readers can use to figure out which aspects of their habits may be harmful, what they would like to change, and how to put their intentions into action. Updated to reflect a decade's worth of research, the fully revised second edition is even more practical and reader friendly. It features additional concrete examples, engaging graphics, new worksheets (which can be downloaded and printed for repeated use), \"Self-Reflection\" boxes, and more.-- Source other than Library of Congress.
Book
Estimation of the global number of e-cigarette users in 2020
Background
The combustion of tobacco is the main cause of tobacco-related morbidity and mortality. E-cigarettes are potentially disruptive innovations with considerable potential for population health. A key question is whether e-cigarettes are replacing tobacco cigarettes, which requires mapping their prevalence. Collecting information on nicotine use is difficult for many countries due to cost. The objective of this study was to derive a global estimate of e-cigarette use (vaping).
Methods
Since 2018 we have collected information on the prevalence of e-cigarette use. To estimate the prevalence of vaping in countries lacking information, we used the method of assumed similarity between countries in the same region and economic condition. Based on surveys, we calculated the average prevalence of vaping for each WHO region, World Bank income classification group, and the legal status of e-cigarettes in each country. For each of these groups the average prevalence of vaping was calculated. These values were used as substitutes for the prevalence figures in the countries with absent data. The number of vapers was calculated by taking as the denominator the adult population.
Results
Survey data on e-cigarette users were available for 49 countries covering 2.8 b of the adult population in 2018 and unavailable for 2.9 b. Information on vaping was lacking for half of the world's population. We estimated a total of 58.1 m vapers worldwide in 2018. By reference to market growth the data were adjusted to arrive at estimates for 2020. Results were fitted to revenue data at the 2018. For the year 2020, the projection is for 68 m vapers globally.
Conclusions
Many global epidemiological studies use the method of assumed similarity between countries with shared characteristics in order to estimate missing data. The methodological limitations are likely to overestimate the global number of vapers. Our estimate of 68 m vapers indicates considerable uptake given that: e-cigarettes have been available on most markets for only a decade; there is either no support, or there is opposition to vaping in many countries; and countries which regulate e-cigarettes have controls over advertising and promotion. However, given the global scale of tobacco smoking (at 1.1 billion people), progress in adoption of alternative products is slow. Those using e-cigarettes are still a small fraction of those who smoke.
Journal Article
Effectiveness of needle and syringe Programmes in people who inject drugs – An overview of systematic reviews
Background
Needle and syringe programmes (NSP) are a critical component of harm reduction interventions among people who inject drugs (PWID). Our primary objective was to summarize the evidence on the effectiveness of NSP for PWID in reducing blood-borne infection transmission and injecting risk behaviours (IRB).
Methods
We conducted an overview of systematic reviews that included PWID (excluding prisons and consumption rooms), addressed community-based NSP, and provided estimates of the effect regarding incidence/prevalence of Human Immunodeficiency Virus (HIV), Hepatitis C virus (HCV), Hepatitis B virus (HBV) and bacteremia/sepsis, and/or measures of IRB. Systematic literature searches were undertaken on relevant databases, including EMBASE, MEDLINE, and PsychINFO (up to May 2015). For each review we identified relevant studies and extracted data on methods, and findings, including risk of bias and quality of evidence assessed by review authors. We evaluated the risk of bias of each systematic review using the ROBIS tool. We categorized reviews by reported outcomes and use of meta-analysis; no additional statistical analysis was performed.
Results
We included thirteen systematic reviews with 133 relevant unique studies published between 1989 and 2012. Reported outcomes related to HIV (
n
= 9), HCV (
n
= 8) and IRB (
n
= 6). Methods used varied at all levels of design and conduct, with four reviews performing meta-analysis. Only two reviews were considered to have low risk of bias using the ROBIS tool, and most included studies were evaluated as having low methodological quality by review authors. We found that NSP was effective in reducing HIV transmission and IRB among PWID, while there were mixed results regarding a reduction of HCV infection. Full harm reduction interventions provided at structural level and in multi-component programmes, as well as high level of coverage, were more beneficial.
Conclusions
The heterogeneity and the overall low quality of evidence highlights the need for future community-level studies of adequate design to support these results.
Trial registration
The protocol of this systematic review was registered in Prospective Register of Systematic Reviews (PROSPERO 2015:
CRD42015026145
).
Journal Article
Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study
To capture pandemic experiences of people with opioid use disorder (OUD) to better inform the programs that serve them.
We designed, conducted, and analyzed semi-structured qualitative interviews using grounded theory. We conducted interviews until theme saturation was reached and we iteratively developed a codebook of emerging themes. Individuals with lived experience of substance use provided feedback at all steps of the study.
We conducted phone or in-person interviews in compliance with physical distancing and public health regulations in outdoor Vancouver parks or well-ventilated indoor spaces between June to September 2020.
Using purposive sampling, we recruited participants (n = 19) who were individuals with OUD enrolled in an intensive community outreach program, had visited one of two emergency departments, were over 18, lived within catchment, and were not already receiving opioid agonist therapy.
We audio-recorded interviews, which were later transcribed verbatim and checked for accuracy while removing all identifiers. Interviews explored participants' knowledge of COVID-19 and related safety measures, changes to drug use and healthcare services, and community impacts of COVID-19.
One third of participants were women, approximately two thirds had stable housing, and ages ranged between 23 and 59 years old. Participants were knowledgeable on COVID-19 public health measures. Some participants noted that fear decreased social connection and reluctance to help reverse overdoses; others expressed pride in community cohesion during crisis. Several participants mentioned decreased access to housing, harm reduction, and medical care services. Several participants reported using drugs alone more frequently, consuming different or fewer drugs because of supply shortages, or using more drugs to replace lost activities.
COVID-19 had profound effects on the social lives, access to services, and risk-taking behaviour of people with opioid use disorder. Pandemic public health measures must include risk mitigation strategies to maintain access to critical opioid-related services.
Journal Article
Supervised injection facilities in Canada: past, present, and future
Canada has long contended with harms arising from injection drug use. In response to epidemics of HIV infection and overdose in Vancouver in the mid-1990s, a range of actors advocated for the creation of supervised injection facilities (SIFs), and after several unsanctioned SIFs operated briefly and closed, Canada’s first sanctioned SIF opened in 2003. However, while a large body of evidence highlights the successes of this SIF in reducing the health and social harms associated with injection drug use, extraordinary efforts were needed to preserve it, and continued activism by local people who inject drugs (PWID) and healthcare providers was needed to promote further innovation and address gaps in SIF service delivery. A growing acceptance of SIFs and increasing concern about overdose have since prompted a rapid escalation in efforts to establish SIFs in cities across Canada. While much progress has been made in that regard, there is a pressing need to create a more enabling environment for SIFs through amendment of federal legislation. Further innovation in SIF programming should also be encouraged through the creation of SIFs that accommodate assisted injecting, the inhalation of drugs. As well, peer-run, mobile, and hospital-based SIFs also constitute next steps needed to optimize the impact of this form of harm reduction intervention.
Journal Article
Evidence for harm reduction in COPD smokers who switch to electronic cigarettes
Background
Electronic cigarettes (ECs) are battery-operated devices designed to vaporise nicotine, which may help smokers quitting or reducing their tobacco consumption. There is a lack of data on the health effects of EC use among smokers with COPD and whether regular use results in improvement in subjective and objective COPD outcomes.
We investigated long-term changes in objective and subjective respiratory outcomes in smokers with a diagnosis of COPD who quit or reduced substantially their tobacco consumption by supplementing with or converting only to ECs use.
Methods
We conducted a retrospective chart review of patients with COPD to identify those reporting regular daily use of ECs on at least two follow-up visits at 12- (F/up1) and 24-months (F/up2). Regularly smoking COPD patients were included as a reference group.
Results
A marked reduction in cigarette consumption was observed in ECs users. A significant reduction in COPD exacerbations was reported in the COPD EC user group, their mean (±SD) decreasing from 2.3 (±1) at baseline to 1.8 (±1;
p
= 0.002) and 1.4 (±0.9;
p
< 0.001) at F/up1 and F/up2 respectively. A significant reduction in COPD exacerbations was also observed in ECs users who also smoked conventional cigarettes (i.e. ‘dual users’). COPD symptoms and ability to perform physical activities improved statistically in the EC group at both visits, with no change in the control group.
Conclusions
These findings suggest that ECs use may aid smokers with COPD reduce their cigarette consumption or remain abstinent, which results in marked improvements in annual exacerbation rate as well as subjective and objective COPD outcomes.
Journal Article