Harm Reduction Journal via MedWorm.com

Pharmacological interventions in the treatment of the acute effects of Cannabis: a systematic review of literature

Harm Reduction Journal — Wed, 25 Jan 2012 05:00:00 +0100

Conclusion: Although scarce, the evidence on pharmacological interventions for the management of cannabis intoxication suggests that propanolol and rimonabant are the most effective compounds currently available to treat the physiological and subjective effects of the drug. Further studies are necessary to establish the real effectiveness of these two medications, as well as the effectiveness of other candidate compounds to counteract the effects of cannabis intoxication, such as cannabidiol and flumazenil. (Source: Harm Reduction Journal)

Sex work involvement among women with long-term opioid injection drug dependence who enter opioid agonist treatment

Harm Reduction Journal — Wed, 25 Jan 2012 05:00:00 +0100

Conclusions: After entering OAT, women using injection drugs and engaging in sex work represent a particularly vulnerable group showing poorer psychological health and a higher use of heroin and cocaine compared to women not engaging in sex work. These factors must be taken into consideration in the planning and provision of OAT in order to improve treatment outcomes.Trial Registration: NCT00175357 (Source: Harm Reduction Journal)

Injecting drug use via femoral vein puncture: Preliminary findings of a point-of-care ultrasound service for opioid-dependent groin injectors in treatment

Harm Reduction Journal — Fri, 20 Jan 2012 05:00:00 +0100

Conclusions: Modern, portable ultrasound scanners make it possible to examine the venous health of GIs in community treatment settings. Ultrasound scanning identified extensive FV damage, much hitherto-unrecognised in this population. These findings should further alert clinicians, policy-makers and patients to the urgent need for effective harm reduction responses to GI behaviour. Images of damaged FV in this paper might prove to be a useful resource for discussions about GI risks. (Source: Harm Reduction Journal)

Implementation and Evaluation of a Harm-Reduction Model for Clinical Care of Substance Using Pregnant Women

Harm Reduction Journal — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion: Methamphetamine use during pregnancy doesn't exist is isolation. It is often combined with a multitude of other adverse circumstances, including poverty, interpersonal violence, psychiatric comorbidity, polysubstance use, nutritional deficiencies, inadequate health care and stressful life experiences. A comprehensive harm reduction model of perinatal care, which aims to ameliorate some of these difficulties for substance-using women without mandating abstinence, provides exceptional birth outcomes and can be implemented with limited resources. (Source: Harm Reduction Journal)

Psychoactive substances and the political ecology of mental distress

Harm Reduction Journal — Wed, 18 Jan 2012 05:00:00 +0100

The goal of this paper is to both understand and depathologize clinically significant mental distress related to criminalized contact with psychoactive biotic substances by employing a framework known as critical political ecology of health and disease from the subdiscipline of medical geography. The political ecology of disease framework joins disease ecology with the power-calculus of political economy and calls for situating health-related phenomena in their broad social and economic context, demonstrating how large-scale global processes are at work at the local level, and giving due attention to historical analysis in understanding the relevant human-environment relations. Critical approaches to the political ecology of health and disease have the potential to incorporate ever-broaden...

The Nature of Methadone Diversion in England: A Merseyside case study

Harm Reduction Journal — Fri, 13 Jan 2012 05:00:00 +0100

Conclusion: Methadone diversion is widespread although drug users generally do not make use of illicit methadone regularly (every month). The degree of altruism involved in the exchange of methadone does not negate the potential role of this action in overdose or the possibility of criminal justice action against individuals. Treatment agencies need to emphasise these risks whilst ensuring that treatment aims are effectively shared with clients to ensure adherence to treatment. (Source: Harm Reduction Journal)

It Can't Hurt to Ask; A Patient-Centered Quality of Service Assessment of Health Canada's Medical Cannabis Policy and Program

Harm Reduction Journal — Tue, 03 Jan 2012 05:00:00 +0100

This study is an attempt to learn more about patient needs, challenges and experiences with the MMAD. Methods: Launched in the spring of 2007, Quality of Service Assessment of Health Canada's Medical Cannabis Policy and Program pairs a 50 question online survey addressing the personal experiences of patients in the federal cannabis program with 25 semi-guided interviews. Data gathering for this study took place from April 2007 to Jan. 2008, eventually garnering survey responses from 100 federally-authorized users, which at the time represented about 5% of the patients enrolled in Health Canada's program. This paper presents the results of the survey portion of the study. Results: 8% of respondents report getting their cannabis from Health Canada, while 66% grow it for themselves. >50% repo...

Prescribing Cannabis for Harm Reduction

Harm Reduction Journal — Sun, 01 Jan 2012 05:00:00 +0100

Neuropathic pain affects between 5% and 10% of the US population and can be refractory to treatment. Opioids may be recommended as a second-line pharmacotherapy but have risks including overdose and death. Cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning. The author suggests that physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. This harm reduction strategy may reduce the morbidity and mortality rates associated with prescription pain medications. (Source: Harm Reduction Journal)

The Soviet doctor and the treatment of drug addiction: "A difficult and most ungracious task"

Harm Reduction Journal — Fri, 30 Dec 2011 05:00:00 +0100

This paper reviews the development of early Soviet drug treatment approaches by focusing on the struggle for disciplinary power between leading social and mental hygienists and clinical psychiatrists as a defining moment for Soviet drug treatment speciality that became known as "narcology." From this vantage point, I engage in the examination of the rise and fall of various treatment methods and conceptualizations of addiction in Russian metropolitan centres and look at how they were imported (or not) to other Soviet republics. As clinical psychiatrists appeared as undisputed victors from the battle with social and mental hygienists, the entire narcological arsenal was subdued in order to serve the needs of mainstream psychiatry. However, what that 'mainstream' would be, was not entirely c...

Non-medical use of opioids among HIV-infected opioid dependent individuals on opioid maintenance treatment: the need for a more comprehensive approach

Harm Reduction Journal — Mon, 28 Nov 2011 05:00:00 +0100

Conclusions: Non-medical use of opioids was found to be comparable in OMT patients receiving methadone or buprenorphine. The presence of opioid withdrawal symptoms was a determinant of non-medical use of opioids and may serve as a clinical indicator of inadequate dosage, medication, or type of follow-up. Sustainability and continuity of care with adequate monitoring of withdrawal symptoms and polydrug use may contribute to reduced harms from ongoing non-medical use of opioids. (Source: Harm Reduction Journal)

Selling sex in unsafe spaces: Sex work risk environments in Phnom Penh, Cambodia

Harm Reduction Journal — Sun, 20 Nov 2011 05:00:00 +0100

Conclusions: Entertainment venues may also provide a high risk environment for sex work. Our results indicate that strategies designed to address HIV prevention among brothel-based FSWs in Cambodia have not translated well to street and entertainment-based sex work venues in which increasing numbers of women are working. There is an urgent need for targeted interventions, supported by legal and policy reforms, designed to reduce the environmental risks of sex work in these settings. Future research should seek to investigate sex work venues as risk environments, explore the role of different business models in mediating these environments, and identify and quantify exposure to risk in different occupational settings. (Source: Harm Reduction Journal)

Abuse risks and routes of administration of different prescription opioid compounds and formulations

Harm Reduction Journal — Wed, 19 Oct 2011 04:00:00 +0100

Conclusions: Unadjusted risks observed here were consistent with rankings of prescription opioid abuse obtained by others using different populations/methods. Adjusted risk estimates suggest that some, less widely prescribed analgesics are more often abused than prescription volume would predict. The compounds/formulations investigated evidenced unique ROA patterns. Baseline abuse patterns will be important for future evaluations of TRFs and REMS. (Source: Harm Reduction Journal)

Sexual and Injection-Related Risks in Puerto Rican-Born Injection Drug Users Living in New York City: A Mixed-Methods Analysis

Harm Reduction Journal — Mon, 17 Oct 2011 04:00:00 +0100

Conclusions: : Poor material conditions (especially homelessness) may be key in triggering risky sexual practices. Cultural norms (ingrained while using drugs in PR) around injection drug use are perpetuated in their new setting following an almost natural flow. These norms may have a particular stronghold over risky drug injection practices. These results indicate that culturally appropriate HIV and HCV prevention and education services are needed. In addition, homelessness should be addressed to reduce risky sexual practices. (Source: Harm Reduction Journal)

The acceptability of nicotine containing products as alternatives to cigarettes: Findings from two pilot studies

Harm Reduction Journal — Wed, 12 Oct 2011 04:00:00 +0100

Conclusions: These studies indicate an untapped interest in the use of substitutes to reduce the harmfulness of smoking. Studies of this sort do not inhibit interest in quitting nicotine altogether, and may facilitate it. The greater the range of products on offer, the more smokers are likely to try a product to quit. (Source: Harm Reduction Journal)

Yulu Shequ - a unique rehabilitation program for illicit drug users in Kaiyuan in southwest China

Harm Reduction Journal — Tue, 20 Sep 2011 04:00:00 +0100

Conclusions: The Yulu Shequ program is an interesting model for drug rehabilitation that could lead the way for a new Chinese national policy away from compulsory rehabilitation towards a more collaborative and effective approach. Caution is needed when interpreting relapse rates as Yulu Shequ participants need to have completed compulsory rehabilitation before entering the program. A more comprehensive evaluation of this program would be desirable before implementation in other parts of China or in other countries facing similar problems. (Source: Harm Reduction Journal)

Randomized, placebo-controlled, double-blind trial of Swedish snus for smoking reduction and cessation

Harm Reduction Journal — Tue, 13 Sep 2011 04:00:00 +0100

Background: Epidemiological studies suggest that smokeless tobacco in the form of Swedish snus has been used by many smokers in Scandinavia to quit smoking, but the efficacy of snus has so far not been evaluated in controlled clinical trials. Methods: We conducted a randomized, double-blind, placebo-controlled, clinical trial aimed at assessing the efficacy of snus to help adult cigarette smokers in Serbia to substantially reduce, and, eventually, completely stop smoking. The study enrolled 319 healthy smokers aged 20-65 years at two occupational health centers in Belgrade, Serbia. Most of them (81%) expressed an interest to quit rather than just reduce their smoking. Study products were used ad libitum throughout the 48-week study period. The main study objective during the first 24 weeks...

The changing trends in tobacco smoking for young Arab women; narghile, an old habit with a liberal attitude

Harm Reduction Journal — Mon, 29 Aug 2011 23:00:00 +0100

Narghile smoking by young females is becoming more acceptable than cigarettes in the conservative societies of Arab countries. Lack of social constraints on narghile smoking has resulted in an increased prevalence of narghile smoking among young Arab females and an earlier age of onset of this habit when compared to cigarette smoking.Documented health hazards of narghile smoking including pulmonary, cardiovascular and neoplastic ailments are consequently expected to affect this vulnerable sector of the population together with their offspring. In this commentary, we shed some light on the changing trend of tobacco use among young Arabic women as shown by an increasing number of studies investigating habits of tobacco use in young people. (Source: Harm Reduction Journal)

Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?

Harm Reduction Journal — Thu, 25 Aug 2011 23:00:00 +0100

Conclusions: MMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves. (Source: Harm Reduction Journal)

Prevalence and correlates of HIV, syphilis, and hepatitis B and C infection and harm reduction program use among male injecting drug users in Kabul, Afghanistan: A cross-sectional assessment

Harm Reduction Journal — Wed, 24 Aug 2011 23:00:00 +0100

Conclusions: HIV and HCV prevalence appear stable among Kabul IDUs, though the substantial number having recently initiated injecting raises concern that transmission risk may increase over time. Harm reduction programming appears to be reaching high-risk drug user populations; however, monitoring is warranted to determine efficacy of prevention programming in this dynamic environment. (Source: Harm Reduction Journal)

Trends in beliefs about the harmfulness and use of stop-smoking medications and smokeless tobacco products among cigarettes smokers: Findings from the ITC four-country survey.

Harm Reduction Journal — Mon, 22 Aug 2011 23:00:00 +0100

Conclusions: Many smokers continue to be misinformed about the relative safety of nicotine and alternatives to smoked tobacco, especially in the US and Canada. Concerted efforts to educate UK smokers have probably improved their knowledge. Further research is required to assess whether misinformation deters smokers from appropriate use of alternative forms of nicotine. (Source: Harm Reduction Journal)

The filter of choice: filtration method preference among injecting drug users

Harm Reduction Journal — Sun, 21 Aug 2011 23:00:00 +0100

Conclusion: It was concluded that the factors influencing filter preference are in favour of change; a shift towards the use of more efficient filters can be made through increased availability, information and demonstrations. (Source: Harm Reduction Journal)

The Scientific Foundation for Tobacco Harm Reduction, 2006-2011

Harm Reduction Journal — Thu, 28 Jul 2011 23:00:00 +0100

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The relationship between self-reported substance use and psychiatric symptoms in low-threshold methadone maintenance treatment clients

Harm Reduction Journal — Wed, 27 Jul 2011 23:00:00 +0100

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Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: An intersectional lens in the Canadian context

Harm Reduction Journal — Wed, 29 Jun 2011 23:00:00 +0100

Conclusions: Harm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. An intersectional lens elucidates the need for harm reduction approaches that reflect an understanding of and commitment to addressing the historical, socio-cultural and political forces that shape responses to mental illness/health, addictions, including harm reduction and methadone maintenance treatment. (Source: Harm Reduction Journal)

Bioethical differences between drug addiction treatment professionals inside and outside the Russian Federation

Harm Reduction Journal — Thu, 09 Jun 2011 23:00:00 +0100

This article provides an overview of a sociological study of the views of 338 drug addiction treatment professionals. A comparison is drawn between the bioethical approaches of Russian and foreign experts from 18 countries. It is concluded that the bioethical priorities of Russian and foreign experts differ significantly. Differences involve attitudes toward confidentiality, informed consent, compulsory treatment, opioid agonist therapy, mandatory testing of students for psychoactive substances, the prevention of mental patients from having children, harm reduction programs (needle and syringe exchange), euthanasia, and abortion. It is proposed that the cardinal dissimilarity between models for providing drug treatment in the Russian Federation and in the majority of the countries of the w...

Drug Checking: A prevention measure for a heterogeneous group with high consumption frequency and polydrug use. Evaluation of Zurich's Drug Checking services.

Harm Reduction Journal — Thu, 09 Jun 2011 23:00:00 +0100

Conclusions: Drug Checking combined with a consultation appears to be an important harm reduction and prevention measure that reaches a group of consumers with high consumption frequency and polydrug use. Because of the heterogeneity of the target group, different prevention measures must be offered and embedded in an overall local concept. (Source: Harm Reduction Journal)

Rapid assessment response (RAR) study: drug use and health risk - Pretoria, South Africa

Harm Reduction Journal — Tue, 31 May 2011 23:00:00 +0100

Conclusions: The implementation of pragmatic harm-reduction and other evidence-based public health care policies that are designed to reduce the harmful consequences associated with substance use and HIV/AIDS should be considered. HIV testing and treatment services also need to be made available in places accessed by drug users. (Source: Harm Reduction Journal)

Not Sold Here: Limited Access to Legally Available Syringes at Pharmacies in Tijuana, Mexico

Harm Reduction Journal — Mon, 23 May 2011 23:00:00 +0100

Conclusions: IDUs in Tijuana have limited access to syringes through retail pharmacies and policies and practices regarding syringe sales are inconsistent. Reasons for these restrictive and inconsistent practices must be identified and addressed to expand syringe access, reduce syringe sharing and prevent HIV transmission. (Source: Harm Reduction Journal)

If the data contradict the theory, throw out the data: Nicotine addiction in the 2010 report of the Surgeon General

Harm Reduction Journal — Wed, 18 May 2011 23:00:00 +0100

The reports of US Surgeon General on smoking are considered the authoritative statement on the scientific state of the art in this field. The previous report on nicotine addiction published in 1988 is one of the most cited references in scientific articles on smoking and often the only citation provided for specific statements of facts regarding nicotine addiction. In this commentary we review the chapter on nicotine addiction presented in the recent report of the Surgeon General. We show that the nicotine addiction model presented in this chapter, which closely resembles it's 22 years old predecessor, could only be sustained by systematically ignoring all contradictory evidence. As a result, the present SG's chapter on nicotine addiction, which purportedly "documents how nicotine compares...

Swedish snus and the GothiaTek standard

Harm Reduction Journal — Sun, 15 May 2011 23:00:00 +0100

Some smokeless tobacco products, such as Swedish snus, are today considered to be associated with substantially fewer health hazards than cigarettes. This risk differential has contributed to the scientific debate about the possibilities of harm reduction within the tobacco area. Although current manufacturing methods for snus build on those that were introduced more than a century ago, the low levels of unwanted substances in modern Swedish snus are largely due to improvements in production techniques and selection of raw materials in combination with several programs for quality assurance and quality control that have been successively introduced during the past 30-40 years. In the late 1990s these developments formed the basis for a voluntary quality standard for Swedish snus named Goth...

Retail Promotions and Perceptions of R.J. Reynold's Novel Dissolvable Tobacco in a U.S. Test Market.

Harm Reduction Journal — Sat, 14 May 2011 23:00:00 +0100

This study assessed the availability, price and point-of-purchase promotional strategies for Camel Dissolvables, and investigated consumer awareness, interest and perception of these products in the Indiana test market. Methods: A retail audit of point-of-purchase promotions was conducted in a random sample of retailers from 6 store categories (n=81) in the test market area. Data included: store type, location, product placement, forms / flavors carried, price, types and locations of advertisements and promotions, and ad messages. An Awareness-Attitude-Usage (AAU) survey was used to gauge consumer awareness and knowledge of tobacco products including Camel Dissolvables. Respondents were shown promotional materials from a package onsert and perceptions and interest in the Camel Dissolvables...

Social-structural contexts of needle and syringe sharing behaviours of HIV-positive injecting drug users in Manipur, India: a mixed methods investigation

Harm Reduction Journal — Thu, 12 May 2011 23:00:00 +0100

Conclusions: Effective HIV prevention and care programmes for IDUs in Northeast India may hinge on several enabling contexts: supportive government policy on harm reduction programmes, including in prisons; an end to harassment by the police, army, and anti-drug groups, with education of these entities regarding harm reduction, creation of partnerships with the public health sector, and accountability to government policies that protect IDUs' human rights; adequate and sustained funding for NSPs to cover all IDU populations, including prisoners; and non-discriminatory access by IDUs to affordable needles/syringes in pharmacies. (Source: Harm Reduction Journal)

A qualitative exploration of travel-related risk behaviours of injection drug users from two Slovene regions

Harm Reduction Journal — Sat, 16 Apr 2011 23:00:00 +0100

Conclusion: This qualitative study provides insight into potential travel-related risk behaviour of injection drug users from two Slovene regions - central and coastal. The potential value of this qualitative study is primarily in the identification of potential risk behaviour of Slovene injection drug users travelling abroad. The study shows that injection drug users' experiences can contribute to better and more efficient treatment of drug addiction in Slovenia. (Source: Harm Reduction Journal)

Factors associated with drug-related harms related to policing in Tijuana, Mexico

Harm Reduction Journal — Thu, 07 Apr 2011 23:00:00 +0100

Conclusions: IDUs who experienced drug-related harms related to policing were those who were most affected by other micro and macro influences in the physical risk environment. Police education programs are needed to ensure that policing practices do not exacerbate risky behaviors or discourage protective behaviors such as needle exchange program use, which undermines the right to health for people who inject drugs. (Source: Harm Reduction Journal)

Are smokers rational addicts? Empirical evidence from the Indonesian Family Life Survey

Harm Reduction Journal — Wed, 23 Feb 2011 00:00:00 +0100

This study provides an empirical test of a rational addiction (henceforth RA) hypothesis of cigarette demand in Indonesia. Methods: Four estimators (OLS, 2SLS, GMM, and System-GMM) were explored to test the RA hypothesis. The author adopted several diagnostics tests to select the best estimator to overcome econometric problems faced in presence of the past and future cigarette consumption (suspected endogenous variables). A short-run and long-run price elasticities of cigarettes demand was then calculated. The model was applied to individuals pooled data derived from three-waves a panel of the Indonesian Family Life Survey spanning the period 1993-2000. Results: The past cigarette consumption coefficients turned out to be a positive with a p-value (Source: Harm Reduction Journal)

Knowledge of AIDS and HIV transmission among drug users in Rio de Janeiro, Brazil

Harm Reduction Journal — Tue, 15 Feb 2011 00:00:00 +0100

Conclusions: Drug users have an increased HIV infection vulnerability compared to the general population, this specific population expressed relevant doubts about HIV transmission, as well as high levels of risky behavior. Moreover, the findings suggest that possessing inaccurate HIV/AIDS knowledge may be a barrier to timely HIV testing. Interventions should be tailored to such specific characteristics. (Source: Harm Reduction Journal)

Uncovering high rates of unsafe injection equipment reuse in rural Cameroon: validation of a survey instrument that probes for specific misconceptions

Harm Reduction Journal — Mon, 07 Feb 2011 00:00:00 +0100

Conclusions: Injection safety assessments that probe for indirect reuse may be more effective than observational assessments. The auto-disable syringe may be an appropriate solution to injection safety problems in some hospitals in Cameroon. Advocacy for injection safety interventions should be a public health priority. (Source: Harm Reduction Journal)

Chasing the dragon - Characterizing cases of leukoencephalopathy associated with heroin inhalation in British Columbia

Harm Reduction Journal — Fri, 21 Jan 2011 00:00:00 +0100

An association between leukoencephalopathy, a disease of the white matter of the brain, and smoking heroin is well recognized. This paper describes 27 cases of leukoencephalopathy identified in two cities in British Columbia, Canada 2001-2006; the largest number of geographically and temporally defined reported cases in North America.Twenty cases of leukoencephalopathy were identified in and around Vancouver with onset dates December 2001 to July 2003; seven further cases were identified in Victoria September 2005-August 2006. Twenty (74%) of all cases were male, two couples were reported and eleven cases (55%) had Asian ethnicity. One case reported smoking heroin on a single occasion and developed mild symptoms; all other cases were hospitalized. Thirteen (48%) cases died; all had smoked ...

Changes in time-use and drug use by young adults in poor neighbourhoods of Greater Buenos Aires, Argentina, after the political transitions of 2001-2002: results of a survey

Harm Reduction Journal — Thu, 20 Jan 2011 00:00:00 +0100

Conclusions: Time use methods are useful to study changes in drug use and their relationships to every day life activities. In these previously-drug-impacted neighbourhoods, the Argentinean crisis did not lead to an increase in drug use, which somewhat contradicts our initial expectations. Nevertheless, those for whom the crises led to decreased work time, increased time looking for work, and increased time spent in indoor or outdoor neighbourhood environments, were likely to spend more time using drugs. These data suggest that young adults in traditionally less-impoverished neighbourhoods may be more vulnerable to Big Events than those in previously drug-impacted impoverished neighbourhoods. Since Big Events will continue to occur, research on the pathways that determine their sequelae is...

US smokers' reactions to a brief trial of oral nicotine products

Harm Reduction Journal — Mon, 10 Jan 2011 00:00:00 +0100

This study examines smokers' interest in using a smokeless tobacco or a nicotine replacement product as a substitute for their cigarettes. Methods: The study included 67 adult cigarette smokers, not currently interested in quitting, who were given an opportunity to sample four alternative oral nicotine products: 1) Camel Snus, 2) Marlboro Snus, 3) Stonewall dissolvable tobacco tablets, and 4) Commit nicotine lozenges. At visit 1, subjects were presented information about the relative benefits/risks of oral nicotine delivery compared to cigarettes. At visit 2, subjects were given a supply of each of the four products to sample at home for a week. At visit 3, subjects received a one-week supply of their preferred product to see if using such products reduced or eliminated cigarette use. Resu...

Better retention of Malaysian opiate dependents treated with high dose methadone in methadone maintenance therapy

Harm Reduction Journal — Fri, 17 Dec 2010 00:00:00 +0100

This study has the objective of determining the utility of daily methadone dose to predict retention rates and re-injecting behaviour among opiate dependents. Methods: Subjects comprised opiate dependent individuals who met study criteria. They took methadone based on the Malaysian guidelines and were monitored according to the study protocols. At six months, data was collected for analyses. The sensitivity and specificity daily methadone doses to predict retention rates and re-injecting behaviour was evaluated. Results: Sixty-four patients volunteered to participate but only 35 (54.69%) remained active and 29 (45.31%) were inactive at 6 months of treatment. Higher doses were significantly correlated with retention rate (p (Source: Harm Reduction Journal)

Can one puff really make an adolescent addicted to nicotine? A critical review of the literature

Harm Reduction Journal — Wed, 10 Nov 2010 00:00:00 +0100

DiscussionThe conceptual and methodological problems detailed in this review invalidate many of the claims made by the "hooked on nicotine" research program and undermine its contribution to the understanding of the nature and development of tobacco smoking in adolescents. (Source: Harm Reduction Journal)

Smoked cocaine in socially-depressed areas

Harm Reduction Journal — Tue, 09 Nov 2010 00:00:00 +0100

Conclusions: We can conclude that the research, focused on achieving greater knowledge of the smoked cocaine user's profile, their usage of smoking crack, consumption patterns and acute effects, should be incorporated into substance misuse interventions. (Source: Harm Reduction Journal)

Thwarting science by protecting the received wisdom on tobacco addiction from the scientific method

Harm Reduction Journal — Thu, 04 Nov 2010 00:00:00 +0100

In their commentary, Dar and Frenk call into question the validity of all published data that describe the onset of nicotine addiction. They argue that the data that describe the early onset of nicotine addiction is so different from the conventional wisdom that it is irrelevant. In this rebuttal, the author argues that the conventional wisdom cannot withstand an application of the scientific method that requires that theories be tested and discarded when they are contradicted by data. The author examines the origins of the threshold theory that has represented the conventional wisdom concerning the onset of nicotine addiction for 4 decades. The major tenets of the threshold theory are presented as hypotheses followed by an examination of the relevant literature. Every tenet of the thresho...

Seroprevalence of HIV, hepatitis B, and hepatitis C among opioid drug users on methadone treatment in the Netherlands

Harm Reduction Journal — Mon, 25 Oct 2010 23:00:00 +0100

Conclusion: Annual screening for infectious diseases in all ODUs in methadone care is not fully implemented in the Netherlands. On average, more than half of the ODUs in methadone care in Heerlen and Amsterdam were screened for HIV, HBV and HCV. In addition, screening data indicate that HBV vaccination uptake was rather high. While the HIV prevalence among these ODUs was relatively low compared to other drug-using populations, the high HCV prevalence among this group underscores the need to expand annual screening and interventions to monitor HIV, HBV and HCV in the opioid drug-using population. (Source: Harm Reduction Journal)

Route of administration for illicit prescription opioids: A comparison of rural and urban drug users

Harm Reduction Journal — Thu, 14 Oct 2010 23:00:00 +0100

Conclusions: Alternative ROA are common among rural drug users. This finding has implications for rural substance abuse treatment and harm reduction, in which interventions should incorporate methods to prevent and reduce route-specific health complications of drug use. (Source: Harm Reduction Journal)

An appeal to humanity: legal victory in favour of North America's only supervised injection facility: Insite

Harm Reduction Journal — Fri, 08 Oct 2010 23:00:00 +0100

Canada's federal government has once again failed to shut North America's only authorized supervised injection facility, Insite. A majority ruling issued by the BC Court of Appeal on 15 January 2010 upheld an earlier British Columbia Supreme Court ruling in 2008 that protected the rights of injection drug users (IDUs) to access Insite as a health facility as per the Charter of Rights and Freedoms component of the Constitution of Canada. The majority decision from Honourable Madam Justices Rowles, Huddart and Smith also established a jurisdictional victory safeguarding Insite as most appropriately run under the authority of the province of British Columbia rather than the federal Government of Canada. The Federal Government has appealed the case to the Supreme Court of Canada. A hearing dat...

Do patients think cannabis causes schizophrenia? - A qualitative study on the causal beliefs of cannabis using patients with schizophrenia

Harm Reduction Journal — Mon, 27 Sep 2010 23:00:00 +0100

Conclusions: Patients with schizophrenia did not establish a causal link between schizophrenia and the use of cannabis. We suggest that clinicians consider our findings in their work with patients suffering from these co-occurring disorders. Withholding treatment or excluding patients from certain treatment settings like day-care facilities or in patient care because of their use of cannabis, may cause additional harm to this already heavily burdened patient group. (Source: Harm Reduction Journal)

Innocent parties or devious drug users: the views of primary healthcare practitioners with respect to those who misuse prescription drugs

Harm Reduction Journal — Sat, 25 Sep 2010 23:00:00 +0100

Conclusions: A binary view of PDM may not be helpful in understanding the issues surrounding PDM, nor in providing appropriate interventions. There is a need for further exploration of 'over users' whose needs may not be being met by mainstream drug services, and issues of stigma in relation to 'abusers'. (Source: Harm Reduction Journal)

Services used by perinatal substance-users with child welfare involvement: a descriptive study

Harm Reduction Journal — Mon, 30 Aug 2010 23:00:00 +0100

Conclusions: Findings from this study suggest services that address basic family needs were related to positive child welfare outcomes. The provision of basic services, such as health care and financial assistance through entitlement benefits and tangible donations, may help to establish a foundation so mothers can concentrate on recovery and parenting skills. Identification of services for perinatal substance users that are associated with more successful child welfare outcomes has implications for the child welfare system, treatment providers, courts and families. (Source: Harm Reduction Journal)

Social structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: a qualitative study

Harm Reduction Journal — Mon, 30 Aug 2010 23:00:00 +0100

Conclusions: This study documents numerous severe harms that arise from assisted injecting. Social structural factors that shape the risks related to assisted injection in the Vancouver context included intimate partner relations and social conventions requiring an exchange of goods for provision of injecting assistance. Health services for IDU who need help injecting should include targeted interventions, and supervised injection facilities should attempt to accommodate individuals who require assistance with injecting. (Source: Harm Reduction Journal)

Retailers' knowledge of tobacco harm reduction following the introduction of a new brand of smokeless tobacco

Harm Reduction Journal — Wed, 28 Jul 2010 23:00:00 +0100

Conclusion: Tobacco retailers are potentially important sources of information about THR, particularly since there are restrictions on the promotion of all tobacco products (regardless of the actual health risks) in Canada. This study found that many retailers in Edmonton do not know the relative health risks of different tobacco products and are therefore unable to pass on accurate information to smokers. (Source: Harm Reduction Journal)

Increased risk for hepatitis C associated with solvent use among Canadian Aboriginal injection drug users

Harm Reduction Journal — Sun, 18 Jul 2010 23:00:00 +0100

Background: Solvent abuse is a particularly serious issue affecting Aboriginal people. Here we examine the association between solvent use and socio-demographic variables, drug-related risk factors, and pathogen prevalence in Aboriginal injection drug users (IDU) in Manitoba, Canada. Methods: Data originated from a cross-sectional survey of IDU from December 2003 to September 2004. Associations between solvent use and variables of interest were assessed by multiple logistic regression. Results: A total of 266 Aboriginal IDU were included in the analysis of which 44 self-reported recent solvent use. Hepatitis C infection was 81% in solvent-users, compared to 55% in those reporting no solvent use. In multivariable models, solvent-users were younger and more likely to be infected with hepati...

Drug use and opioid substitution treatment for prisoners

Harm Reduction Journal — Sun, 18 Jul 2010 23:00:00 +0100

This article discusses drug use by inmates and its associated harms. In addition, this article provides a survey of studies conducted in prisons of opioid substitution therapy (OST), a clinically effective and cost-effective drug treatment strategy. The findings from this overview indicate why treatment efforts for drug users in prison are often poorer than those available for drug users in the non-prison community and demonstrate how the implementation of OST programmes benefits not only prisoners but also prison staff and the community at large. Finally, the article outlines strategies that have been found effective for implementing OST in prisons and offers suggestions for applying these strategies more broadly. (Source: Harm Reduction Journal)

Whither RDS? An investigation of Respondent Driven Sampling as a method of recruiting mainstream marijuana users

Harm Reduction Journal — Thu, 08 Jul 2010 23:00:00 +0100

Conclusions: Research on marijuana use, and other forms of drug use hidden in the general population of adults, is important for informing and extending harm reduction beyond its current emphasis on 'at-risk' populations. Expanding harm reduction in a normalizing context, through innovative research on users often overlooked, further challenges assumptions about reducing harm through prohibition of drug use and urges consideration of alternative policies such as decriminalization and legal regulation. (Source: Harm Reduction Journal)

Assessing the spatial distribution of methadone clinic clients and their access to treatment

Harm Reduction Journal — Sun, 04 Jul 2010 23:00:00 +0100

Using Geographic Information System (GIS), the spatial distribution of methadone clinic clients and their utilization of a treatment service in Hong Kong was analysed. A majority (93.7%) of the 63 methadone users recruited were residing in the same district, of which 84.1% spent not more than 15 minutes for traveling. Walking (55.6%) was the commonest transport mode followed by cycling (30.2%). There was no distance decay effect on traveling time, but an association between distance and transport selection could be demonstrated. The residence locations displayed a compact distribution, merging with the general population without any evidence of clustering. Though the distribution of methadone users could have been shaped by the location of clinic, it can also be concluded that methadone cl...

Coerced addiction treatment: Client perspectives and the implications of their neglect

Harm Reduction Journal — Sat, 19 Jun 2010 23:00:00 +0100

Recent work has criticized the evidence base for the effectiveness of addiction treatment under social controls and coercion, suggesting that the development of sound policies and treatment practices has been hampered by numerous limitations of the research conducted to date. Implicit assumptions of the effectiveness of coerced treatment are evident in the organization and evolution of treatment, legal, and social service systems, as well as in related legislative practices. This review builds upon previous work by focusing in greater detail on the potential value of incorporating client perspectives on coercion and the implications for interpreting and applying existing research findings. Reviewing the existing empirical and theoretical literature, a case is made for greater accuracy in r...

Risk behaviours among HIV positive injecting drug users in Myanmar: a case control study

Harm Reduction Journal — Tue, 01 Jun 2010 23:00:00 +0100

Conclusions: Prudent measures such as access to sterile syringes and continuous health education programmes among IDUs and their sexual partners are required to reduce high risk behaviours of IDUs in Myanmar. (Source: Harm Reduction Journal)

Impact: a case study examining the closure of a large urban fixed site needle exchange in Canada

Harm Reduction Journal — Mon, 24 May 2010 23:00:00 +0100

Conclusion: Closing the fixed site needle exchange had an adverse effect on already vulnerable clients and reduced access to effective comprehensive harm reduction services. While offical public policy supports a fixed site, politicization of the issue has meant a significant setback for harm reduction with reduced potential to meet public health targets related to reducing the the spread of blood borne diseases. This situation is unacceptable from a public health perspective. (Source: Harm Reduction Journal)

Narghile (water pipe) smoking among university students in Jordan: prevalence, pattern and beliefs

Harm Reduction Journal — Sun, 23 May 2010 23:00:00 +0100

Conclusion: This study confirmed the spreading narghile epidemic among young people in Jordan like the neighboring countries of the Eastern Mediterranean region. Alarming signs were the poor oral health awareness among students particularly smokers. (Source: Harm Reduction Journal)

Overdose experiences among injection drug users in Bangkok, Thailand

Harm Reduction Journal — Wed, 12 May 2010 23:00:00 +0100

Conclusions: Experiencing and witnessing an overdose were common in this sample of Thai IDU. These findings support the need for increased provision of evidence-based responses to overdose including peer-based overdose interventions. (Source: Harm Reduction Journal)

Lessons learned from a peri-urban needle exchange

Harm Reduction Journal — Wed, 28 Apr 2010 23:00:00 +0100

Conclusions: The limited data presented here suggest that a NEP can be an effective method of harm reduction even in low-volume, non-urban settings and are an important venue for intervention in peri-urban areas. (Source: Harm Reduction Journal)

High rates of midazolam injection among drug users in Bangkok, Thailand

Harm Reduction Journal — Fri, 26 Mar 2010 00:00:00 +0100

Conclusion: We observed a high rate of midazolam injection among Thai IDU. Midazolam injection was strongly associated with polysubstance use and binge drug use, and was most commonly used in combination with both opiates and methamphetamines. Our findings suggest that midazolam injection has become increasingly common within Thailand. Evidence-based approaches for reducing harms associated with midazolam injection are needed. (Source: Harm Reduction Journal)

Assisted injection in outdoor venues: an observational study of risks and implications for service delivery and harm reduction programming

Harm Reduction Journal — Fri, 19 Mar 2010 00:00:00 +0100

Conclusions: Our findings indicate that a substantial proportion of local IDU engage in assisted injecting in outdoor settings and that the practice is associated with other markers of drug-related harm, including being female, daily cocaine injection, and sex trade involvement. These findings suggest that novel interventions are needed to address the needs of this subpopulation of IDU. (Source: Harm Reduction Journal)

Methamphetamine use and malnutrition among street-involved youth

Harm Reduction Journal — Mon, 08 Mar 2010 00:00:00 +0100

We sought to explore the effect of crystal methamphetamine use on the risk of experiencing malnutrition among street-involved youth in Vancouver, Canada. Risk of malnutrition was defined as being hungry but not having enough money to buy food. Socio-demographic and drug use factors associated with risk of malnutrition were investigated using univariate and multivariate analysis among a prospective cohort of street-involved youth known as the At-Risk Youth Study (ARYS). Between September 2005 and December 2006, 509 street-involved youth were enrolled in ARYS, among whom 21% reported being at risk of malnutrition as defined above in the previous six months. In multivariate analysis, only non-injection crystal methamphetamine was significantly associated with being at risk of malnutrition amo...

The Chinese government's response to drug use and HIV/AIDS: A review of policies and programs

Harm Reduction Journal — Fri, 05 Mar 2010 00:00:00 +0100

This study reviews the current policies on drug use and assesses the harm reduction interventions among drug users in China. The review documents that the new policies on drug use provide a variety of choices of detoxification treatment for drug users. The methadone maintenance treatment and needle exchange programs have been adopted as harm reduction models in China. Most of the reviewed harm reduction programs have been successfully implemented and yielded positive effects in reducing drug-related risk behaviors among drug users. Although there remain barriers to the effective implementation of policies on drug use and harm reduction programs, the Chinese government has shown their commitment to support the expansion of harm reduction interventions for drug users throughout the country. ...

Medical marijuana users in substance abuse treatment

Harm Reduction Journal — Fri, 05 Mar 2010 00:00:00 +0100

Conclusions: This exploratory study suggests that medical marijuana is consistent with participation in other forms of drug treatment and may not adversely affect positive treatment outcomes. These findings call for more extensive sampling in future research to allow for more rigorous research on the growing population of medical marijuana users and non-marijuana users who are engaged in substance abuse treatment. (Source: Harm Reduction Journal)

Giving away used injection equipment: missed prevention message?

Harm Reduction Journal — Tue, 09 Feb 2010 00:00:00 +0100

Conclusions: Our findings show that more IDUs give away cookers than needles or other injection equipment. While the results showed that correlates of sharing differed by piece of equipment, each point to distributive sharing by the most marginalized IDUs. Targeting prevention efforts to reduce equipment sharing in general, and cookers in particular is warranted to reduce use of contaminated equipment and viral transmission. (Source: Harm Reduction Journal)

The Washington Needle Depot: fitting healthcare to injection drug users rather than injection drug users to healthcare: moving from a syringe exchange to syringe distribution model

Harm Reduction Journal — Mon, 04 Jan 2010 00:00:00 +0100

Needle exchange programs chase political as well as epidemiological dragons, carrying within them both implicit moral and political goals. In the exchange model of syringe distribution, injection drug users (IDUs) must provide used needles in order to receive new needles. Distribution and retrieval are co-existent in the exchange model. Likewise, limitations on how many needles can be received at a time compel addicts to have multiple points of contact with professionals where the virtues of treatment and detox are impressed upon them. The centre of gravity for syringe distribution programs needs to shift from needle exchange to needle distribution, which provides unlimited access to syringes. This paper provides a case study of the Washington Needle Depot, a program operating under the sy...

Effect of filtration on morphine and particle content of injections prepared from slow-release oral morphine tablets

Harm Reduction Journal — Tue, 22 Dec 2009 00:00:00 +0100

Conclusions: Apart from overdose and addiction itself, the harmful consequences of injecting morphine tablets come from the insoluble particles from the tablets and microbial contamination. These harmful components can be substantially reduced by passing the injection through a sterilizing (0.22 um) filter. To prevent the filter from blocking, a preliminary coarse filter (such as a cigarette filter) should be used first. The filters retain some of the dose, but this can be recovered by following filtration with one or two rinses with 1 ml water. Although filtration can reduce the non-pharmacological harmful consequences of injecting tablets, this remains an unsafe practice due to skin and environmental contamination by particles and microorganisms, and the risks of blood-borne infections f...

Getting the message straight: effects of a brief hepatitis prevention intervention among injection drug users

Harm Reduction Journal — Tue, 15 Dec 2009 00:00:00 +0100

To redress gaps in injection drug users' (IDUs) knowledge about hepatitis risk and prevention, we developed a brief intervention to be delivered to IDUs at syringe exchange programs (SEPs) in three US cities. Following a month-long campaign in which intervention packets containing novel injection hygiene supplies and written materials were distributed to every client at each visit, intervention effectiveness was evaluated by comparing exposed and unexposed participants' self-reported injection practices. Over one-quarter of the exposed group began using the novel hygiene supplies which included an absorbent pad ("Safety Square") to stanch blood flow post-injection. Compared to those unexposed to the intervention, a smaller but still substantial number of exposed participants continued to i...

Cannabis as a substitute for alcohol and other drugs

Harm Reduction Journal — Thu, 03 Dec 2009 00:00:00 +0100

Conclusions: The substitution of one psychoactive substance for another with the goal of reducing negative outcomes can be included within the framework of harm reduction. Medical cannabis patients have been engaging in substitution by using cannabis as an alternative to alcohol, prescription and illicit drugs. (Source: Harm Reduction Journal)

Love as harm reduction: Fighting AIDS and stigma in Vietnam

Harm Reduction Journal — Thu, 03 Dec 2009 00:00:00 +0100

In the summer of 2009, I visited a humble orphanage for children with HIV/AIDS in Vietnam. Here, like many parts in the world, the very existence of marginalized people with stigmatized illness is hidden away. Relegated to the shadows of society, these children lacked something more fundamental than housing, shelter, nutrition and medications. They lacked families to love and care for them unconditionally. One might think it self-evident that a visit to an orphanage for children with HIV would be profound, but the profundity wasn't where I expected to find it. It was in how the children had created their own family, loving each other like brothers and sisters, and the way the priest who operated the shelter was more than a Father, he was a dad to dozens of children. This is an account of l...

Commentary on Vorobjov et al., "Comparison of injection drug users who obtain syringes from pharmacies and syringe exchange programs in Tallinn, Estonia"

Harm Reduction Journal — Fri, 27 Nov 2009 00:00:00 +0100

Recent data suggest that globally, between 5% and 10% of all new HIV cases are the result of unsafe injecting practices, and experts agree that reducing these practices is key to tackling the spread of HIV. And yet, despite the overwhelming evidence that providing sterile syringes to injection drug users (IDU) through syringe exchange programs (SEPs) or other means is an effective way of reducing HIV transmission among high-risk subpopulations, IDU in most settings still do not have access to sterile injecting equipment or if they do, access remains too restricted to effectively reduce the risk of HIV transmission. Vorobjov and colleagues have presented in this journal an interesting and timely study from Estonia comparing individuals who obtain syringes from SEPs and those who obtain syri...

Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes

Harm Reduction Journal — Fri, 20 Nov 2009 00:00:00 +0100

Conclusions: A number of distinct but interconnected processes emerged as being important to women's addiction recovery. Women experienced individual growth and transformative learning that led to a higher quality of life and improved interactions with their children. The findings support the need for programs to adopt practices that focus on improving maternal health and social functioning in an environment characterized by empowerment, safety, and connections. Women's relationships with their children require particular attention as positive parenting practices and family relationships can alter predispositions toward substance use later in life, thereby impacting favourably on the cycle of addiction and dysfunctional parenting. (Source: Harm Reduction Journal)

Curbing the menace of antimicrobial resistance in developing countries

Harm Reduction Journal — Thu, 19 Nov 2009 00:00:00 +0100

Several reports suggest that antimicrobial resistance is an increasing global problem; but like most pandemics, the greatest toll is in the less developed countries. The dismally low rate of discovery of antimicrobials compared to the rate of development of antimicrobial resistance places humanity on a very dangerous precipice. Since antimicrobial resistance is part of an organism's natural survival instinct, total eradication might be unachievable; however, it can be reduced to a level that it no longer poses a threat to humanity. While inappropriate antimicrobial consumption contributes to the development of antimicrobial resistance, other complex political, social, economic and biomedical factors are equally important. Tackling the menace therefore should go beyond the conventional sens...

Levamisole tainted cocaine causing severe neutropenia in Alberta and British Columbia

Harm Reduction Journal — Tue, 17 Nov 2009 00:00:00 +0100

Background: Five cases of severe neutropenia (neutrophil counts < 0.5 per 109 cells/L) associated with exposure to cocaine and levamisole, an antihelimithic agent no longer available in Canada, were identified in Alberta in 2008. Alberta and British Columbia (BC) public health officials issued an advisory and urged health care professionals to report cases to public health. This paper presents the findings of the public health investigations. Methods: Cases were identified prospectively through reporting by clinicians and a retrospective review of laboratory and medical examiners data from January 1, 2006 to March 31, 2009. Cases were categorized as confirmed, probable or suspect. Only the confirmed and probable cases are included in this paper. Results: We compare cases of severe neutrope...

Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments

Harm Reduction Journal — Tue, 03 Nov 2009 00:00:00 +0100

Nicotine is so desirable to many people that when they are given only the options of consuming nicotine by smoking, with its high health costs, and not consuming nicotine at all, many opt for the former. Few smokers realize that there is a third choice: non-combustion nicotine sources, such as smokeless tobacco, electronic cigarettes, or pharmaceutical nicotine, which eliminate almost all the risk while still allowing consumption of nicotine. Widespread dissemination of misleading health claims is used to prevent smokers from learning about this lifesaving option, and to discourage opinion leaders from telling smokers the truth. One common misleading claim is a risk-risk comparison that has not before been quantified: A smoker who would have eventually quit nicotine entirely, but learns th...

Survey of abuses against injecting drug users in Indonesia

Harm Reduction Journal — Fri, 23 Oct 2009 23:00:00 +0100

In Indonesia, an ongoing government "war on drugs" has resulted in numerous arrests and anecdotal reports of abuse in detention, but to date there has been little documentation or analysis of this issue. JANGKAR (also known in English as the Indonesian Harm Reduction Network), a nongovernmental organization (NGO) based in Jakarta, surveyed 1106 injecting drug users in 13 cities about their experiences of police abuse. Of those interviewed, 667 or 60% reported physical abuse by police. These findings indicate the importance of continuing efforts to promote police reform and harm reduction in Indonesia. (Source: Harm Reduction Journal)

Surveillance indicators for potential reduced exposure products (PREPs): developing survey items to measure awareness

Harm Reduction Journal — Sun, 18 Oct 2009 23:00:00 +0100

Conclusions: After evaluating new measures with cognitive interviews, we conclude that as of winter 2006, awareness of reduced exposure products among U.S. smokers was likely to be between 1% and 8%, with the higher estimates for some products occurring in test markets. Recommended measurement strategies for future surveys are presented. (Source: Harm Reduction Journal)

Can we prevent drug related deaths by training opioid users to recognise and manage overdoses?

Harm Reduction Journal — Thu, 24 Sep 2009 23:00:00 +0100

Conclusions: Our findings confirm that training of bystanders constitutes a valuable resource in the assessment and management of opiate overdoses that may not otherwise be recognised or addressed. Obstacles have been identified at individual (transportability, stigma) and at a systems level (police involvement, prescription laws). Training individuals does not seem to be sufficient for these programmes to succeed and a more applied approach is necessary. (Source: Harm Reduction Journal)

Efficacy of pharmacotherapies for short-term smoking abstinence: A systematic review and meta-analysis.

Harm Reduction Journal — Thu, 17 Sep 2009 23:00:00 +0100

Background: Smoking cessation has important immediate health benefits. The comparative short-term effectiveness of smoking cessation interventions is not well known. We aimed to determine the relative effectiveness of nicotine replacement therapy (NRT), bupropion and varenicline at 4 weeks post-target quit date. Methods: We searched 10 electronic medical databases (inception to October 2008). We selected randomized clinical trials [RCTs] evaluating interventions for our primary outcome of abstinence from smoking at at-least 4 weeks post-target quit date, with biochemical confirmation. We conducted random-effects odds ratio (OR) meta-analysis and meta-regression. We compared treatment effects across interventions using head-to-head trials and calculated indirect comparisons. Results: We com...

Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review

Harm Reduction Journal — Thu, 27 Aug 2009 23:00:00 +0100

The reuse of injecting equipment in clinical settings is well documented in Africa and appears to play a substantial role in generalized HIV epidemics. The U.S. and the WHO have begun to support large scale injection safety interventions, increased professional education and training programs, and the development and wider dissemination of infection control guidelines. Several African governments have also taken steps to control injecting equipment, including banning syringes that can be reused.However injection drug use (IDU), of heroin and stimulants, is a growing risk factor for acquiring HIV in the region. IDU is increasingly common among young adults in sub-Saharan Africa and is associated with high risk sex, thus linking IDU to the already well established and concentrated generalize...

HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey

Harm Reduction Journal — Sat, 22 Aug 2009 23:00:00 +0100

Conclusions: Harm reduction, addiction treatment and HIV prevention programs should address risk factors to stop further spread of both HIV and HCV among IDUs and to the general population in central Ukraine. (Source: Harm Reduction Journal)

Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia

Harm Reduction Journal — Thu, 30 Jul 2009 23:00:00 +0100

Conclusions: The type of drug injected was associated with distinct behavioral risks. Risks specific to Stimulant Only Users appeared related to direct syringe sharing. The risks specific to the other two groups are common to the process of sharing drugs in preparation to injecting. Across the board, IDUs could profit from prevention education that emphasizes both access to clean syringes and preparing and apportioning drug with these clean syringes. However, attention to neighborhood differences might improve the intervention impact for injectors who favor different drugs. (Source: Harm Reduction Journal)

Needle and syringe sharing among Iranian drug injectors

Harm Reduction Journal — Wed, 29 Jul 2009 23:00:00 +0100

Conclusion: However this data has been extracted from cross-sectional design and we can not conclude causation, some of the introduced variables with association with needle and syringe sharing may be used in HIV prevention programs which target reducing syringe sharing among IDUs. (Source: Harm Reduction Journal)

Worry as a window into the lives of people who use injection drugs: a factor analysis approach

Harm Reduction Journal — Tue, 28 Jul 2009 23:00:00 +0100

Conclusions: PWUID in this study first and foremost worry about stressful factors in their daily life which have been linked to both increased HIV/AIDS risk behaviour and decreased anti-retroviral treatment adherence. The importance PWUID give to these concerns emphasizes the need to place HIV/AIDS intervention and /or treatment programs within a broader harm-reduction framework that incorporates their perspectives on both worry and risk. (Source: Harm Reduction Journal)

Harm reduction in hospitals: is it time?

Harm Reduction Journal — Tue, 28 Jul 2009 23:00:00 +0100

This article describes harm reduction activities within hospitals and areas for future investigation. (Source: Harm Reduction Journal)

Safe using messages may not be enough to promote behaviour change amongst injecting drug users who are ambivalent or indifferent towards death

Harm Reduction Journal — Fri, 24 Jul 2009 23:00:00 +0100

Conclusions: Most of the interviewees in this study were indifferent towards heroin-related death. Whilst interviewees were well aware of the possible consequences of their actions, these consequences were not seen as important as achieving their desired state of mind. Safe using messages are an important part of reducing drug-related harm, but people working with IDUs must consider the context in which risk behaviours occur and efforts to reduce said behaviours must include attempts to reduce environmental risk factors at the same time. (Source: Harm Reduction Journal)

Psychosocial and contextual correlates of opioid overdose risk among drug users in St. Petersburg, Russia

Harm Reduction Journal — Thu, 23 Jul 2009 23:00:00 +0100

Conclusions: Opioid overdose experience is very common among drug users in St. Petersburg, Russia, and interest in receiving training for overdose recognition and prevention was high. Future research should target the development of effective overdose recognition and prevention interventions, especially ones that include naloxone distribution and involve drug users' families. (Source: Harm Reduction Journal)

Bundling occupational safety with harm reduction information as a feasible method for improving police receptiveness to syringe access programs: evidence from three U.S. cities

Harm Reduction Journal — Mon, 13 Jul 2009 23:00:00 +0100

Conclusion: The experience in these three cities suggests that a harm reduction training curriculum that bundles strategies for increasing officer occupational safety with information about the legality and public health benefits of SAPs can be well received by law enforcement personnel and can lead to better communication and collaboration between law enforcement and harm reduction actors. Further study is indicated to assess whether such a bundled curriculum is effective in changing officer attitudes and beliefs and reducing health risks to officers and injection drug users, as well as broader benefits to the community at large. (Source: Harm Reduction Journal)

Characteristics of inmates witnessing overdose events in prison: implications for prevention in the correctional setting

Harm Reduction Journal — Wed, 08 Jul 2009 23:00:00 +0100

Conclusions: Witnessing a drug overdose is a frequent occurrence within the prison system. The likelihood of witnessing an overdose is greater with being male, polydrug use and drug injection in prison. Findings signal an urgent public health challenge that requires prompt interventions to reduce this drug related harm within the correctional system, including adequate access to medication with opiate agonists. (Source: Harm Reduction Journal)

Survey of smokers' reasons for not switching to safer sources of nicotine and their willingness to do so in the future

Harm Reduction Journal — Wed, 01 Jul 2009 23:00:00 +0100

Despite the well-known risks of smoking, policy, social pressure, and accessible cessation programs, tens of millions of North American adults continue smoking rather than quitting or switching to less harmful non-combustion nicotine products. We surveyed people smoking in public in Edmonton, Canada (n=242, year=2007) to investigate smokers' reasons for resisting switching to low-risk nicotine sources. 43% had used low-risk products (mostly pharmaceutical nicotine). 75% indicated willingness to consider switching to low-risk products. Smokers cited similar reasons for not switching to smokeless tobacco and pharmaceutical nicotine, largely based on misinformation. Accurate risk information may lead many to try low-risk nicotine products. (Source: Harm Reduction Journal)

Large sharing networks and unusual injection practices explain the rapid rise in HIV among IDUs in Sargodha, Pakistan

Harm Reduction Journal — Thu, 25 Jun 2009 23:00:00 +0100

DiscussionUse of an unprecedented method of injecting drugs that largely bypasses fresh syringes, larger size of sharing networks, higher injection frequency and near universal use of street injectors likely explain for the rapid rise in HIV prevalence among IDUs in Sargodha despite high level provision of fresh syringes. This had been missed by us and the national surveillance, which is quantitative. We have addressed this by hiring injectors as peer outreach workers and increasing syringe supply. Our findings highlight both the importance of qualitative research and operations research to enrich the quality of HIV prevention programs. (Source: Harm Reduction Journal)

Review of "The Globalisation Of Addiction: A Study In Poverty Of The Spirit" By Bruce K. Alexander

Harm Reduction Journal — Mon, 22 Jun 2009 23:00:00 +0100

Book review of "The Globalisation Of Addiction: A Study In Poverty Of The Spirit"by Bruce K. Alexander (Source: Harm Reduction Journal)

Prevalence of khat chewing in students of Jazan region

Harm Reduction Journal — Fri, 19 Jun 2009 23:00:00 +0100

This study was conducted to assess the prevalence and associated risk factors of khat chewing among college and secondary school students in Jazan region. Methods: The study was conducted in May 2006 in the colleges and secondary schools in Jazan region. A sample of 10,000 students aged between 15 and 25 years was randomly selected. Students in each year of study were selected by systematic random sampling technique. Self-administered questionnaire was used for data collection. Results: The overall prevalence of khat chewing in all the studied population was 21.4 % (colleges 15.2% versus schools 21.5%). There were 3.8% female khat chewers and 37.70 % male Khat chewers. Significant differences were found between khat chewers according to age, gender and residence (p (Source: Harm Reduction ...

Improving introspection to inform free will regarding the choice by healthy individuals to use or not use cognitive enhancing drugs

Harm Reduction Journal — Tue, 16 Jun 2009 04:00:00 +0100

A commentary in Nature entitled "Towards responsible use of cognitive-enhancing drugs by the healthy" (Greely et al 2008 Nature 456: 702-705) offers an opportunity to move toward a humane societal appreciation of mind-altering drugs. Using cognitive enhancing drugs as an exemplar, this article presents a series of hypotheses concerning how an individual might learn optimal use. The essence of the proposal is that individuals can cultivate sensitivity to the effects of ever-smaller amounts of psychoactive drugs thereby making harm less likely and benign effects more probable. Four interrelated hypotheses are presented and briefly discussed. 1. Humans can learn to discriminate ever-smaller doses of at least some mind-altering drugs; a learning program can be designed or discovered that will...

Can abuse deterrent formulations make a difference? Expectation and speculation.

Harm Reduction Journal — Fri, 29 May 2009 04:00:00 +0100

It is critical that issues surrounding the abuse and misuse of prescription opioids be balanced with the need for these medications for the treatment of pain. One way to decrease the abuse of prescription opioid medications is to develop formulations (abuse deterrent formulations or ADFs) that in some way prevent drug abusers from extracting out the active ingredient in order to employ alternate routes of administration, such as injection, snorting, and smoking. Several factors including the pharmacokinetic profile of the drug, the features of the drug formulation that make it attractive or unattractive for abuse, the type of drug abuser, the progression of one's addiction pathway, and one's social environment may all play a role in the abuse of prescription opioids and what methods are us...

The context of illicit drug overdose deaths in British Columbia, 2006

Harm Reduction Journal — Fri, 29 May 2009 04:00:00 +0100

The objective of this study was to examine IDD in 2006 in BC by place of residence, injury and death, decedents' age and sex and substances identified. Methods: IDD data was obtained through the BC Coroners Office and entered into SPSS (version 14). Fisher's exact and Pearson's chi2 were used for categorical data; Mann-Whitney U-test for continuous variables. Rates were calculated using 2006 population estimates. Results: We identified 223 IDD in BC; 54 (24%) occurred in Vancouver. Vancouver decedents (compared to those occurring outside Vancouver) were older (mean age 43.9 vs. 39.2 years; p (Source: Harm Reduction Journal)

Moving beyond non-engagement on regulated needle-syringe exchange programs in Australian prisons

Harm Reduction Journal — Mon, 04 May 2009 04:00:00 +0100

Conclusions: Psychology, peace studies and social marketing all agree people's views must be carefully collected and analysed if people are going to be convinced to consider and discuss the issue. By understanding the views and their underlying motivations of those who oppose NSPs, it will be far easier to influence these views. Furthermore, involving all stakeholders, especially prison authorities, will help create a sense of ownership of a solution and therefore increase the chances of that solution succeeding. (Source: Harm Reduction Journal)

Overdose beliefs and management practices among ethnic Vietnamese heroin users in Sydney, Australia

Harm Reduction Journal — Mon, 27 Apr 2009 04:00:00 +0100

Conclusions: The explanatory model of overdose employed by ethnic Vietnamese IDUs privileges traditional beliefs about the circulatory, rather than the respiratory, system. This paper explores participants' beliefs about blood, the effects of drugs on blood and the causes of heroin overdose in order to document the explanatory model of overdose used by ethnic Vietnamese IDUs. Implications for overdose prevention, treatment and management are identified and discussed. (Source: Harm Reduction Journal)

HIV/AIDS in Vancouver, British Columbia: A growing epidemic

Harm Reduction Journal — Thu, 05 Mar 2009 05:00:00 +0100

The prevalence of HIV in Vancouver, British Columbia was subject to two distinct periods of rapid increase. The first occurred in the 1980s due to high incidence among men who have sex with men (MSM), and the second occurred in the 1990s due to high incidence among injection drug users (IDU). The purpose of this study was to estimate and model the trends in HIV prevalence in Vancouver from 1980 to 2006. HIV prevalence data were entered into the UNAIDS/WHO Estimation and Projection Package (EPP) where prevalence trends were estimated by fitting an epidemiological model to the data. Epidemic curves were fit for IDU, MSM, female sex trade workers (FSW), and the general population. Using EPP, these curves were then aggregated to produce a model of Vancouver's overall HIV prevalence. Of the 505...

High prevalence of HIV infection among homeless and street-involved Aboriginal youth in a Canadian setting

Harm Reduction Journal — Wed, 19 Nov 2008 05:00:00 +0100

We examined HIV seroprevalence and risk factors among a cohort of 529 street-involved youth in Vancouver, Canada. At baseline, 15 (2.8%) were HIV positive, of whom 7 (46.7%) were Aboriginal. Aboriginal ethnicity was a significant correlate of HIV infection (odds ratio = 2.87, 95%CI: 1.02 – 8.09). Of the HIV positive participants, 2 (28.6%) Aboriginals and 6 (75.0%) non-Aboriginals reported injection drug use; furthermore, hepatitis C co-infection was significantly less common among Aboriginal participants (p = 0.041). These findings suggest that factors other than injection drug use may promote HIV transmission among street-involved Aboriginal youth, and provide further evidence that culturally appropriate and evidence-based interventions for HIV prevention among Aboriginal young people ...

Predictors of HIV infection and prevalence for syphilis infection among injection drug users in China: Community-based surveys along major drug trafficking routes

Harm Reduction Journal — Mon, 25 Aug 2008 04:00:00 +0100

Conclusions: Prevalence rates of HIV among IDUs in China are more than two out of three in some venues. Risk factors include longer duration of IDU and needle sharing. Also associated with HIV were factors that may indicate some success in education in higher risk persons, such as higher knowledge. A systemic community-level intervention with respect to evidenced-based, population-level interventions to stem the spread of HIV from IDU in China should include needle exchange, opiate agonist-based drug treatment, condom distribution along with promotion, and advocacy for community-based VCT with bridges to HIV preventive services and care. (Source: Harm Reduction Journal)

Distributing foil from needle and syringe programmes (NSPs) to promote transitions from heroin injecting to chasing: an evaluation

Harm Reduction Journal — Mon, 21 Jul 2008 04:00:00 +0100

Conclusions These findings suggest that distributing foil packs can be a useful means of engaging NSP attenders in discussions about ways of reducing injecting risks and can reduce injecting in settings where there is a pre-existing culture of heroin chasing. Further research should see whether these findings can be reproduced in other cultural contexts and evaluate whether the observed behavioural changes are sustained and lead to reductions in harm including blood-borne infections and overdose. (Source: Harm Reduction Journal)

Half a gram – a thousand lives

Harm Reduction Journal — Tue, 24 Jun 2008 04:00:00 +0100

The article presents information on the latest drug policy change in the Russian Criminal Code: a decrease of the drug threshold amounts for which possession can lead to a criminal liability. Also, the article presents an assessment of the 2003–2004 liberal revisions in the Criminal Code, and an analysis of the background/premise for the 2006 counter-reform. The author examines the new criteria for establishing criminal liability and possible consequences of these changes for people who use illicit psycho-active substances for non-medical purposes. (Source: Harm Reduction Journal)

Half a gram - a thousand lives

Harm Reduction Journal — Tue, 24 Jun 2008 04:00:00 +0100

The article presents information on the latest drug policy change in the Russian Criminal Code: a decrease of the drug threshold amounts for which possession can lead to a criminal liability. Also, the article presents an assessment of the 2003-2004 liberal revisions in the Criminal Code, and an analysis of the background/premise for the 2006 counter-reform. The author examines the new criteria for establishing criminal liability and possible consequences of these changes for people who use illicit psycho-active substances for non-medical purposes. (Source: Harm Reduction Journal)

On drug treatment and social control: Russian narcology's great leap backwards

Harm Reduction Journal — Tue, 24 Jun 2008 04:00:00 +0100

The medical discipline of narcology in Russia is a subspecialty of psychiatry from the Soviet era and it is given warrant to define the scope of health activities with regard to alcohol and other drug use, drug users, and related problems. Narcological practice is in turn constrained by the State. The emergence of widespread injection opiate use and associated HIV morbidities and mortalities during the first decade following the collapse of the Soviet Union has brought the contradictions in Russian narcological discourse into high relief. Narcology officials in the Russian Federation have consistently opposed substitution treatment for opiate dependence-- the replacement of a short-acting illegal substance with a longer acting prescribed drug with similar pharmacological action but lower d...

How high? Quantity as a predictor of cannabis-related problems

Harm Reduction Journal — Thu, 29 May 2008 04:00:00 +0100

Conclusions: These findings indicate that quantity is an important predictor of cannabis-related outcomes, and that the three quantity measures convey useful information about use. (Source: Harm Reduction Journal)

Switching to smokeless tobacco as a smoking cessation method: evidence from the 2000 National Health Interview Survey

Harm Reduction Journal — Fri, 23 May 2008 04:00:00 +0100

Conclusions: Switching to ST compares very favorably with pharmaceutical nicotine as a quit-smoking aid among American men, despite the fact that few smokers know that the switch provides almost all of the health benefits of complete tobacco abstinence. The results of this study show that tobacco harm reduction is a viable cessation option for American smokers. (Source: Harm Reduction Journal)

Return to Galileo? The Inquisition of the International Narcotic Control Board

Harm Reduction Journal — Wed, 07 May 2008 04:00:00 +0100

Nearly 400 years after Galileo Galilei of Florence was arraigned and convicted of suspected heresy by the ten member Congregation of the Holy Office (Inquisition), the International Narcotic Control Board (INCB) is similarly inserting itself into matters pertaining to innovations in healthcare and the public health response to addiction throughout the world. Like that earlier Inquisition of 1633 that convicted Galileo of heresy for holding that the sun is the centre of the universe with the earth revolving around it (in contradiction to church doctrine of the time) the INCB and its thirteen-member panel, now rails against any evidence out of sync with the established doctrine of the war on drugs - particularly those innovations in public health called harm reduction. The latest healthcare...

Awareness of the need for safe storage of Methadone at home is not improved by the use of protocols on recording information giving.

Harm Reduction Journal — Wed, 30 Apr 2008 04:00:00 +0100

Conclusion: Recall of information on safety issues is very poor. Provision of written as well as verbal information is needed. The use of printed safety information cards which patients can take away for future reference may be of use. It is the responsibility of health professionals to ensure they provide information and advice to methadone users on the safe storage of their methadone at home. (Source: Harm Reduction Journal)

Designing an experimental HIV/HCV intervention to promote the safe re-use of drug preparation materials by injection drug users in Puerto Rico

Harm Reduction Journal — Mon, 28 Apr 2008 04:00:00 +0100

This report describes the final selection of items and practices: 1) A small water bottle that permits IDUs to add approximately .05cc water drops directly to drug powder in cookers; 2) A preparation syringe (a type of ancillary equipment not used for injecting) that permits IDUs to pull up a measurable amount of water to add to drug powder, an alternative to producing water drops; 3) A filtering device, the Sterifilt filter, attached to a preparation syringe, which eliminates the need for cotton or cigarette filters; 4) Use of a preparation syringe to distribute drug solution by backloading to injection syringe(s); 5) A small water bottle enabling IDUs to clean injection syringes by backload rinsing. The overarching aim of this experimental HIV/HCV intervention was to promote the safe re-...

Early exit: estimating and explaining early exit from drug treatment

Harm Reduction Journal — Fri, 25 Apr 2008 04:00:00 +0100

Conclusions: Early exit diminishes the contribution that treatment may make to the reduction of drug related harm. This paper identifies characteristics of people most likely to drop out of treatment prematurely in English drug treatment services and highlights a range of possibilities for improving services. (Source: Harm Reduction Journal)

Quantifying hepatitis C transmission risk using a new weighted scoring system for the Blood-Borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ): Applications for community-based HCV surveillance, education and prevention

Harm Reduction Journal — Wed, 23 Apr 2008 04:00:00 +0100

Conclusions: Brief, easy to administer and score, and inexpensive to apply, the utility of the BBV-TRAQ for community based education and prevention is enhanced by the application of item weights, potentially offering a valid surrogate measure for HCV infection among IDU. (Source: Harm Reduction Journal)

Prevalence and determinants of hepatitis C virus infection among female drug injecting sex workers in Glasgow

Harm Reduction Journal — Thu, 20 Mar 2008 04:00:00 +0100

Conclusions: Women who engage in street sex work to finance their drug habit are a particularly desperate, chaotic and vulnerable population. This study demonstrates that their HCV infection risk may be greater than that for other IDUs. Those responsible for designing interventions to prevent HCV infection among IDUs should consider the special needs of this group. (Source: Harm Reduction Journal)

Is low-nicotine Marlboro snus really snus?

Harm Reduction Journal — Wed, 27 Feb 2008 05:00:00 +0100

Swedish snus is a medium/high nicotine delivery, low-nitrosamine moist smokeless tobacco product that has been estimated to be at least 90% less harmful than smoked tobacco. More men use snus than smoke cigarettes in Sweden, and a quarter of male former smokers quit by switching to snus. Leading multinational cigarette manufacturers have begun test-marketing snus-like products in the United States and other countries. The version of Philip Morris Marlboro snus currently being marketed in the United States differs from Swedish snus in many ways; it has lower moisture content and pH, but most puzzling is its very low nicotine delivery. Philip Morris, the market-leader in United States cigarette sales, may have designed the product so that it does not satisfy nicotine cravings and fails to en...

The acceptability and feasibility of peer worker support role in community based HCV treatment for injecting drug users

Harm Reduction Journal — Mon, 25 Feb 2008 05:00:00 +0100

Hepatitis C is the most common blood borne virus in Australia affecting over 200 000 people. Effective treatment for hepatitis C has only become accessible in Australia since the late 1990as, although active injecting drug use (IDU) remained an exclusion criteria for government-funded treatment until 2001. Treatment uptake has been slow, particularly among injecting drug users, the largest affected group. We developed a peer-based integrated model of hepatitis C care at a community drug and alcohol clinic. Clients interested and eligible for hepatitis C treatment had their substance use, mental health and other psychosocial comorbidities co-managed onsite at the clinic prior to and during treatment. In a qualitative preliminary evaluation of the project, nine current patients of the clinic...

Seeing is believing: an educational outreach activity on disinfection practices

Harm Reduction Journal — Tue, 12 Feb 2008 05:00:00 +0100

Conclusions: In the weeks following this activity, some participants demonstrated and reported healthy behavioural changes regarding their own injection practices. Furthermore, they shared their newfound knowledge and began enforcing its application among people they inject drugs with. Most participants greatly appreciated this activity and valued it as being highly efficient and tangible. (Source: Harm Reduction Journal)

Mother-infant consultation during drug treatment: research and innovative clinical practice

Harm Reduction Journal — Wed, 06 Feb 2008 05:00:00 +0100

Conclusions: The implications for NNNS consultation in drug treatment programs is outlined. The importance of prevention/intervention to establish satisfactory mother-infant interaction in recovery programs which include a central parenting component is indicated (Source: Harm Reduction Journal)

Regulating compassion: an overview of Canada's federal medical cannabis policy and practice

Harm Reduction Journal — Mon, 28 Jan 2008 05:00:00 +0100

Conclusion: Any future success will depend on the government's ability to better assess and address the needs and legitimate concerns of end-users of this program, to promote and fund an expanded clinical research agenda, and to work in cooperation with community-based medical cannabis dispensaries in order to address the ongoing issue of safe and timely access to this herbal medicine. (Source: Harm Reduction Journal)

Years of life lost to prison: racial and gender gradients in the United States of America

Harm Reduction Journal — Fri, 25 Jan 2008 05:00:00 +0100

Conclusion: There are clear gender and racial gradients in life expectancy spent in prison in the United States. Future research needs to examine how current imprisonment practice in the United States may influence population health and health disparities. (Source: Harm Reduction Journal)

A qualitative study of overdose responses among Chicago IDUs

Harm Reduction Journal — Thu, 24 Jan 2008 05:00:00 +0100

Conclusions: Overall, our small study found that the overdose prevention efforts build on extensive knowledge possessed by IDUs. Teaching IDUs how to use naloxone is an effective risk reduction strategy. (Source: Harm Reduction Journal)

Amazing grace: Vancouver's supervised injection facility granted six-month lease on life

Harm Reduction Journal — Thu, 24 Jan 2008 05:00:00 +0100

Addiction should be a matter, primarily, for the Chief of Medicine rather than the Chief of Police. While internationally renowned for its social kindness, Canada has not been without its share of disgraceful political mistakes in the not too distant past. Regrettably, there are many shameful events in Canada that have unfolded in the name of public policy including the banishment without medical treatment of Chinese Canadians living with leprosy to die on D'Arcy and Bentinck Islands in British Columbia while European Canadians stricken similarly enjoyed healthcare on the mainland as well as the eternally haunting treatment of people of aboriginal ancestry who were without full voting privileges in some parts of Canada until 1965 and abandoned to encampments, reserves, that paralleled Sou...

Controlling illegal stimulants: a regulated market model

Harm Reduction Journal — Wed, 23 Jan 2008 05:00:00 +0100

Prohibition of illegal drugs is a failed social policy and new models of regulation of these substances are needed. This paper explores a proposal for a post-prohibition, public health based model for the regulation of the most problematic drugs, the smokable and injectable stimulants. The literature on stimulant maintenance is explored. Seven foundational principles are suggested that could support this regulatory model of drug control that would reduce both health and social problems related to illegal stimulants. Some details of this model are examined and the paper concludes that drug policies need to be subject to research and based on evidence. (Source: Harm Reduction Journal)

My first time: initiation into injecting drug use in Manipur and Nagaland, north-east India

Harm Reduction Journal — Wed, 05 Dec 2007 05:00:00 +0100

Conclusions: Targeting harm reduction messages to (non-injecting) drug users and capitalising on existing IDU social networks to promote safe injecting and deter initiation of others are possible strategies for reducing the impact of injecting drug use and the HIV epidemic in north-east India. (Source: Harm Reduction Journal)

Introducing oral tobacco for tobacco harm reduction: what are the main obstacles?

Harm Reduction Journal — Wed, 07 Nov 2007 05:00:00 +0100

With the number of smokers worldwide currently on the rise, the regular failure of smokers to give up their tobacco addiction, the direct role of smoke (and, to a much lesser extent, nicotine) in most tobacco-related diseases, and the availability of less toxic (but still addictive) oral tobacco products, the use of oral tobacco in lieu of smoking for tobacco harm reduction (HR) merits assessment. Instead of focusing on the activity itself, HR focuses on the risks related to the activity. Currently, tobacco HR is controversial, generally not discussed, and consequently, poorly evaluated. In this paper, we try to pinpoint some of the main reasons for this lack of interest or reluctance to carry out or fund this type of research. In this paper we deal with the following issues: the status of...

Tampering by office-based methadone maintenance patients with methadone take home privileges: a pilot study

Harm Reduction Journal — Tue, 30 Oct 2007 04:00:00 +0100

Methadone Maintenance Treatment (MMT) is among the most widely studied treatments for opiate dependence with proven benefits for patients and society. When misused, however, methadone can also be lethal. The issue of methadone diversion is a major concern for all MMT programs. A potential source for such diversion is from those MMT patients who receive daily take home methadone doses. Using a reverse phase high performance liquid chromatography method, seven of the nine patients who were randomly selected to have all of their remaining methadone take home doses (within a 24 hour period) analyzed, returned lower than expected quantities of methadone. This finding suggests the possibility of such patients tampering with their daily take home doses. Larger prospective observational studies ar...

Assessing the role of syringe dispensing machines and mobile van outlets in reaching hard-to-reach and high-risk groups of injecting drug users (IDUs): a review

Harm Reduction Journal — Wed, 24 Oct 2007 04:00:00 +0100

Reaching hard-to-reach and high-risk injecting drug users (IDUs) is one of the most important challenges for contemporary needle syringe programs (NSPs). The aim of this review is to examine, based upon the available international experience, the effectiveness of syringe vending machines and mobile van/bus based NSPs in making services more accessible to these hard-to-reach and high-risk groups of IDUs. A literature search revealed 40 papers/reports, of which 18 were on dispensing machines (including vending and exchange machines) and 22 on mobile vans. The findings demonstrate that syringe dispensing machines and mobile vans are promising modalities of NSPs, which can make services more accessible to the target group and in particular to the harder-to-reach and higher-risk groups of IDUs....

Impact of welfare cheque issue days on a service for those intoxicated in public

Harm Reduction Journal — Thu, 26 Apr 2007 04:00:00 +0100

The objective of this analysis was to rigorously examine the impact of welfare cheque issue dates on admission to the Sobering Unit (SU), a service for the publicly intoxicated, in Vancouver, Canada. Data on 1234 consecutive admissions to the SU over a 7-month period were assessed, and the average number of daily admissions on each of the 7 days of the welfare cheque issue week and similar weekdays in other weeks were compared. A Wilcoxon rank-sum test was performed for the comparisons. Our results showed that there were significant increases in the number of admissions on the 3 days starting with Welfare Wednesday compared to the similar weekdays in other weeks (Welfare Wednesday vs. other Wednesdays: 8.7 vs. 5.1, p =0.02; Welfare Thursdays vs. other Thursdays: 9.6 vs. 5.3, p =0.02; Welfa...

It is time for Canadian community early warning systems for illicit drug overdoses

Harm Reduction Journal — Wed, 28 Mar 2007 04:00:00 +0100

Although fatal and non-fatal overdoses represent a significant source of morbidity and mortality, current systems of surveillance and communication in Canada provide inadequate measurement of drug trends and lack a timely response to drug-related hazards. In order for an effective early warning system for illicit drug overdoses to become a reality, a number of elements will be required: real-time epidemiologic surveillance systems for illicit drug trends and overdoses, inter-agency networks for gathering data and disseminating alerts, and mechanisms for effectively and respectfully engaging with members of drug using communities. An overdose warning system in an urban area like Vancouver would ideally be imbedded within a system that monitors drug trends and overdoses by incorporating qual...

Public health the leading force of the Indonesian response to the HIV/AIDS crisis among people who inject drugs

Harm Reduction Journal — Sat, 17 Feb 2007 07:00:00 +0100

Issue: Indonesia has an explosive HIV/AIDS epidemic from the beginning of this century and it is in process to build its response. Reported AIDS cases doubled from 2003 - 2004, and around 54% of the AIDS cases are among people who inject drugs. Setting: Indonesia is the 4th in population in the world, a predominantly Muslim country with strong views towards drug users and people living with HIV/AIDS. Globally speaking has one of the main explosive epidemics in recent years. The Project: IHPCP (Indonesia HIV/AIDS Prevention and Care Project) is a support joint project (AusAID based mainly) that works in partnership with the Government of Indonesia. IHPCP has been a key player of countys response, particularly pioneering NSP; stimulating and supporting methadone programs, and being key to pr...

Achieving a high coverage – the challenge of controlling HIV spread in heroin users

Harm Reduction Journal — Thu, 15 Feb 2007 05:00:00 +0100

In China, the national plan to open 1000 methadone clinics over a five-year period provides a unique opportunity to assess the impacts of harm reduction in a country with concentrated HIV epidemic amongst heroin users. To track the progress of this public health response, data were collected from the first methadone clinic in Liuzhou, Guangxi, a province with a high HIV prevalence. In the first 15 months of its operation, a cumulative total of 488 heroin users, 86% of which male, had joined the programme. The first dose of methadone was given efficiently at a median of 2 days after registration. Of the 240 heroin users attending the clinic in August 2006, 61% took methadone for four days or more each week. The number of active methadone users, however, leveled off at around 170 after the f...

Achieving a high coverage - the challenge of controlling HIV spread in heroin users

Harm Reduction Journal — Thu, 15 Feb 2007 05:00:00 +0100

In China, the national plan to open 1000 methadone clinics over a five-year period provides a unique opportunity to assess the impacts of harm reduction in a country with concentrated HIV epidemic amongst heroin users. To track the progress of this public health response, data were collected from the first methadone clinic in Liuzhou, Guangxi, a province with a high HIV prevalence. In the first 15 months of its operation, a cumulative total of 488 heroin users, 86% of which male, had joined the programme. The first dose of methadone was given efficiently at a median of 2 days after registration. Of the 240 heroin users attending the clinic in August 2006, 61% took methadone for four days each week. The number of active methadone users, however, leveled off at around 170 after the first two...

Roadside sobriety tests and attitudes toward a regulated cannabis market

Harm Reduction Journal — Wed, 31 Jan 2007 07:00:00 +0100

Conclusions: Increased awareness and use of roadside sobriety tests that detect recent cannabis use could increase support for a regulated cannabis market. Identifying concerns of voters who are not Caucasian or Democrats could help alter cannabis policy. (Source: Harm Reduction Journal)

Overdose prevention for injection drug users: Lessons learned from naloxone training and distribution programs in New York City

Harm Reduction Journal — Thu, 25 Jan 2007 07:00:00 +0100

Conclusions: Other naloxone distribution programs may anticipate similar challenges to SKOOP and we identify mechanisms to address them. Strategies include being flexible in program planning and implementation, developing evaluation instruments for feasibility and simplicity, and responding to and incorporating feedback from participants. (Source: Harm Reduction Journal)

Rates of inappropriate antiretroviral prescription among injection drug users

Harm Reduction Journal — Thu, 04 Jan 2007 07:00:00 +0100

Conclusion: The present study identified measurable rates of guideline-inappropriate ART prescription for patients who were injection drug users. Rates were highest in the era of dual therapy, although high rates persisted into the triple-therapy era. As therapeutic guidelines continue to evolve, it is critical that mechanisms be put in place to ensure prescription of ART combinations for IDU that are consistent with current expert recommendations. (Source: Harm Reduction Journal)

Tobacco harm reduction: an alternative cessation strategy for inveterate smokers

Harm Reduction Journal — Thu, 21 Dec 2006 07:00:00 +0100

This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations.The American Council on Science and Health beli...

HIV seroprevalence among participants at a Supervised Injection Facility in Vancouver, Canada: implications for prevention, care and treatment

Harm Reduction Journal — Mon, 18 Dec 2006 07:00:00 +0100

North America's first government sanctioned medically supervised injection facility (SIF) was opened during September 2003 in Vancouver, Canada. This was in response to a large open public drug scene, high rates of HIV and hepatitis C transmission, fatal drug overdoses, and poor health outcomes among the city's injection drug users. Between December 2003 and April 2005, a representative sample of 1,035 SIF participants were enrolled in a prospective cohort that required completing an interviewer-administered questionnaire and providing a blood sample for HIV testing. HIV infection was detected in 170/1007 (17%) participants and was associated with Aboriginal ethnicity (adjusted Odds Ratio [aOR], 2.70, 95% Confidence Interval [95% CI], 1.84–3.97), a history of borrowing used needles/syrin...

Barriers to the dissemination of four harm reduction strategies: a survey of addiction treatment providers in Ontario

Harm Reduction Journal — Thu, 14 Dec 2006 07:00:00 +0100

A sample of service providers at addictions agencies' in Ontario were interviewed by telephone to assess attitudes toward, anticipated internal and external barriers to implementing, and expected benefits of four harm reduction strategies: needle exchange, moderate drinking goals, methadone treatment, and provision of free condoms to clients. Respondents were also asked to define harm reduction, list its most important elements, and describe what they find most troubling and most appealing about harm reduction. Attitudes toward harm reduction in general and the services provided at each agency were also assessed. Results indicated that the service providers surveyed had positive attitudes toward each of the four harm reduction strategies and harm reduction in general, and the majority of r...

Evaluation of herbal cannabis characteristics by medical users: a randomized trial

Harm Reduction Journal — Mon, 13 Nov 2006 07:00:00 +0100

DiscussionWhile the small size of the study precludes broad conclusions, the study shows that medical cannabis users can appreciate differences in herbal product. A more acceptable cannabis product may increase recruitment and retention in clinical studies of medical cannabis. (Source: Harm Reduction Journal)

Therapeutic challenges in hepatitis C-infected injection drug using patients

Harm Reduction Journal — Fri, 10 Nov 2006 07:00:00 +0100

This article discusses HCV antiviral treatment issues relevant to IDUs chronically infected with this virus. The effect of non-injected substances of abuse on treatment outcome is considered. Priority issues requiring research are discussed. (Source: Harm Reduction Journal)