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PubMed2005

Controlled gambling for pathological gamblers.

Despite its high prevalence, pathological gambling often remains untreated. It is estimated that only 10% of the pathological gamblers identified in prevalence studies will enter treatment. Within this small proportion, a high percentage will drop out. Despite the facts that some researchers argue against abstinence as the unique treatment goal and that regaining control appears to be possible for some pathological gamblers, abstinence has been the only treatment goal in most problem gambling interventions thus far. This paper examines the avenue of controlled gambling embedded in a harm reduction context as a viable solution for some pathological gamblers.

Adult↗

PubMed2006

HIV behavioral research online.

Internet access has caused a global revolution in the way people of all ages and genders interact. Many have turned to the Internet to seek love, companionship, and sex, prompting researchers to move behavioral studies online. The sexual behavior of men who have sex with men (MSM) has been more closely studied than that of any other group online given the abundance of gay-oriented websites and concerns about increasing transmission of HIV and other sexually transmitted infections. Not only does the Internet provide a new medium for the conduct of behavioral research and for participant recruitment into an array of research studies, it has the as yet unrealized potential to reach huge numbers of MSM with innovative harm reduction and prevention messages tailored to individualized needs, interests, and risk behavior. Internet-based research on sexual behavior has many advantages in rapidity of recruitment of diverse samples which include individuals unreachable through conventional methods (i.e., non-gay identified and geographically and socially isolated MSM, etc.). Internet-based research also presents some new methodologic challenges in study design, participant recruitment, survey implementation, and interpretation of results. In addition, there are ethical issues unique to online research including difficulties in verifying informed consent, obstacles to surveying minors, and the ability to assure anonymity. This paper presents a review of Internet-based research on sexual behavior in MSM, a general discussion of the methodologic and ethical challenges of Internet-based research, and recommendations for future interdisciplinary research.

Ethics, Research↗

PubMed2006

Hospital utilization for injection drug use-related soft tissue infections in urban versus rural counties in California.

Drug related-soft tissue infections (DR-STIs) are a significant source of hospital utilization in inner-city urban areas where injection drug use is common but the magnitude of hospital utilization for DR-STIs outside of inner-city urban areas is not known. We described the magnitude and characteristics of hospital utilization for DR-STIs in urban versus rural counties in California. All discharges from all nonfederal hospitals in California in 2000 with ICD-9 codes for a soft tissue infection and for drug dependence/abuse were abstracted from the California Office of Statewide Health Planning and Development discharge database. There were 4,152 DR-STI discharges in 2000 from hospitals in 49 of California's 58 counties. Residents of 12 large metropolitan counties accounted for 3,598 discharges (87% of total). The majority of DR-STI discharges were from urban safety net hospitals with county indigent programs and Medicaid as the expected payment source and opiate related discharge diagnoses. Hospital utilization for DR-STIs in California is highest in large urban metropolitan counties, although DR-STI discharges are widespread. Increased access to harm reduction services and drug treatment may reduce government health care expenditures by preventing unnecessary hospital utilization for DR-STIs.

Adolescent↗

PubMed2004

Recent advances in the treatment of opiate addiction.

Although addiction to heroin and other opiates is a major public health issue in the United States and many other countries, advances in pharmacologic and nonpharmacologic treatment have been made. Some of these advances represent a major shift from traditional treatment philosophies, whereas others are characterized by more subtle, though important, improvements. This review discusses recent advances in opiate-addiction treatment in the context of three main domains: the use of buprenorphine and buprenorphine/naloxone in an office-based paradigm, psychosocial treatment and the addressing of medical and psychiatric comorbidity, and harm reduction strategies.

Buprenorphine↗

PubMed2004

Staphylococcus aureus infections in injection drug users: risk factors and prevention strategies.

Infections, in particular soft tissue infections (cellulitis, skin abscesses), are the leading cause for emergency department visits and hospital admissions of drug injection users (IDUs). Staphylococcus aureus is the most relevant bacterial pathogen in this population. It is the main cause of soft tissue infections and of severe infections such as endocarditis and bacteremia. Moreover, epidemic spread of methicillin-resistant S. aureus (MRSA) among IDUs has occurred in Europe and North America. Nasal carriage of S. aureus is associated with an increased risk of subsequent S. aureus infections, and it has been shown that active IDUs have a higher rate of colonization with S. aureus than the general population. However, it is still unknown why an individual carries S. aureus. In particular, repeated injections do not appear to be the main predisposing factor for S. aureus carriage. Infections associated with injection drug use are frequently the consequence of the illegal status of street drugs. Harm reduction programs, including needle exchange programs, safer injecting facilities and injection opiate substitution programs can reduce the incidence of infections among severely addicted IDUs.

Humans↗

PubMed1994

Airbag and facebag benefits and costs.

There is debate about the appropriate design of supplementary airbags for passenger car occupants with high levels of seatbelt use. A theoretical analysis was performed to demonstrate the likely costs and benefits of U.S. fullsize driver airbags and the smaller European-style facebag. This study, undertaken for the Federal Office of Road Safety in Australia, builds upon previous work in this area. Benefits were determined using Harm Reductions for front-seat occupants involved in frontal crashes. A sensitivity analysis was undertaken for different benefit scenarios for the facebag, given the lack of available performance data. Likely costs of the components were derived from information provided by the local automobile manufacturers, part suppliers, and vehicle importers, with adjustments made for fitting to Australian vehicles. The results demonstrate the advantage of fullsize airbags over facebags, even when seatbelt wearing rates are high.

Air Bags↗

PubMed1996

Aids, violence and behavioral coding: information theory, risk behavior and dynamic process on core-group sociogeographic networks.

Elsewhere we have presented a traveling-wave analysis of HIV transmission on a tightly self-interactive, geographically-focused core group social network (Wallace R. Soc. Sci. Med. 32, 847, 1991; Soc. Sci. Med. 33, 1155, 1991; Environ. Plan. A. 26, 767, 1994; Wallace R. and Fullilove M. Environ. Plan. A. 23, 1701 1991). Here we reanalyze the problem in probability space and recover a close analog of the Shannon Coding Theorem of information theory. Subsequent direct application of information-theoretic methods provides striking insight regarding the spread of disease along the sociogeographic networks of marginalized subgroups, suggesting that 'risk behaviors' for infection may constitute essential components of a behavioral code for the transmission of information within the noisy channel of a marginalized community's social networks. The code's form, including the incorporation of risk behaviors, arises as a direct consequence of the external oppressive forces which structure marginalization. This viewpoint suggests an explanation of the sometime-observed rapid transmission of both infection and of control strategies for infection along the same network, but suggests further that if risk behaviors are indeed parts of a behavioral code for the transmission of group norms, statements of individual worth or resource sharing, then high rates of relapse are inevitable, given the persistence of the external oppression which gives those behaviors symbolic value. We suggest that violent acts in particular may emerge as key behavioral symbols for 'sending a message' in socially disorganized communities, implying that school-based or other individual-oriented harm reduction strategies for violence prevention, in the absence of a comprehensive, multifactorial reform program, cannot significantly reverse the effects of continuing economic and social constraints or of public policies of planned shrinkage and benign neglect, factors primarily responsible for the disorganization of urban minority communities within the United States.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Preventing the spread of HIV among Australian injecting drug users.

Control of HIV infection among and from injecting drug users is critical for the long-term control of HIV infection in Australia. There is now consistent and strong evidence that the prevalence of HIV infection among Australian injecting drug users is still low. Recent evidence suggests that Australian injecting drug users are reducing injecting behaviour associated with HIV infection. Australian adopted harm reduction policies early and implemented a comprehensive range of programmes vigorously. These were designed to reduce the spread of HIV infection in this population. The most plausible explanation for the low prevalence of HIV infection in Australia is the adoption and implementation of these policies and programmes, although it is unrealistic to expect that this can be proved in a definitive way. Control of HIV infection in Australian injecting drug users represents one of the major public health triumphs in this country in the past decade and probably reduced the present cumulative number of AIDS cases by 1200, AIDS deaths by 800 and expenditure on AIDS by at least $60 million. However, recent international experience in this area is alarming. The prevalence of HIV infection in injecting drug users in Australia will probably rise in the future. Complacency, failure to implement HIV prevention in prisons (including especially bleach distribution), continued emphasis on supply reduction drug policy and a failure to foster a research capability will ensure that this happens sooner rather than later.

Australia↗

PubMed1994

The extent of injecting and syringe sharing in prison reported by Edinburgh drug clinic attenders.

68 outpatient attenders at Edinburgh's Community Drug Problem Service who reported a history of drug injecting and who had spent 1 week or more in prison between March 1987-March 1990 were interviewed about drug injecting behaviour and syringe sharing before and during each prison episode they reported. One-third of those injecting prior to prison continued to do so in prison, most doing so twice weekly or more. 80% of prison injectors shared syringes in prison. No subjects commenced their injecting career in prison, and being imprisoned did not cause past injectors who had stopped to resume injecting in custody. Being imprisoned tended to cause non-sharing injectors to resume sharing in prison. Prison injectors tended to have started both their oral and their injecting drug use careers at an earlier age, and to have been sharing syringes in the community prior to custody. Half of prison sharers used unofficially acquired bleach or disinfectant to sterilise injecting equipment. Continuing involvement with the courts and thus risk of reimprisonment was common. The findings support the case for harm reduction policies in Scottish prisons, and diversion from custody and into treatment for this high risk group.

Journal Article↗

PubMed2005

Ecstasy and the concomitant use of pharmaceuticals.

Recent anecdotal evidence suggests that it is becoming increasingly popular among ecstasy users to attempt to negate certain side-effects or enhance the drug experience through the concomitant use of pharmaceutical drugs or supplements. This study was designed to explore the practice of deliberately using pharmaceuticals for any reason in association with ecstasy and related drug (ERD) use. A cross sectional survey was conducted with 216 adults who had used ecstasy at least once in the previous 6 months. Generally, this sample was young, well educated, and likely to be in some form of paid employment. Males were slightly overrepresented within the sample. About one quarter of the sample had deliberately taken a pharmaceutical substance for its putative effects on the euphoric effects of, or recovery from, ecstasy use. Those who reported using pharmaceuticals were significantly more likely to be male, had more 'apparent' years of use, and were more likely to have injected ERDs. As a result, there appears to be a need for harm reduction information for ecstasy users regarding the risks associated with the mixture of ERDs with pharmaceuticals and supplements. Particular attention should be paid to informing users of the potentially fatal serotonin syndrome that is likely to arise from combining serotonin-enhancing substances, such as ecstasy or SSRI and MAOI groups of antidepressants.

Adult↗

PubMed2005

The potential impact of a low-nitrosamine smokeless tobacco product on cigarette smoking in the United States: estimates of a panel of experts.

OBJECTIVE: To predict the impact on tobacco use in the US of a "harm reduction" policy that requires that the smokeless tobacco product meet low nitrosamine standards, but could be marketed with a warning label consistent with the evidence of relative health risks. METHODS: Low nitrosamine smokeless tobacco (LN-SLT) and cigarette use are predicted by a panel of experts using a modified Delphi approach. We specify a thought experiment to isolate the changes that would occur after the new LN-SLT policy was implemented. RESULTS: The panel predicted that the new policy would accelerate a decrease in smoking prevalence from 1.3 to 3.1 percentage points over 5 years compared to the current SLT product policy, with greater effects on males than females. Introduction of the new product was also predicted to result in modest additional use of SLT overall, with the greatest increases among males who initiated tobacco use under the new policy. CONCLUSION: An overall consensus was reached that the introduction of a new LN-SLT product under strict regulations would increase SLT use, but reduce overall smoking prevalence. This reduction would likely yield substantial health benefits, but uncertainties surround the role of marketing and other tobacco control policies.

Adolescent↗

PubMed2026

Patterns and implications of co-use between vaping and hallucinogens: a systematic review and meta-analysis.

BACKGROUND: The co-occurrence use of e-cigarettes and hallucinogens has become increasingly common, particularly among youth and young adults. However, evidence regarding the association between these behaviors remains limited and fragmented. This systematic review and meta-analysis aimed to synthesize current evidence, examining the correlation between hallucinogen use and the likelihood of being an e-cigarette user. METHODS: A comprehensive search was conducted in PubMed, Scopus, Web of Science, EMBASE, and Cochrane CENTRAL up to June 2025. Eligible studies measured both hallucinogen and e-cigarette use and reported quantitative associations between these behaviors. Data extraction and risk-of-bias assessments were performed independently by three reviewers using the Newcastle-Ottawa Scale. Pooled effect sizes were calculated using a random-effects model (REML). Certainty of evidence was evaluated with the GRADE approach. RESULTS: Eleven studies met the inclusion criteria (n = 247,904), and seven were included in the meta-analysis (n = 217,478). The pooled analysis demonstrated that hallucinogen users had 4.47 times higher odds of being e-cigarette users (OR: 4.47, 95% CI 2.72 to 7.34; p < 0.001; I2 = 95.7%, n = 7). The certainty of evidence was rated as low. CONCLUSIONS: Hallucinogen use is directionally and strongly associated with e-cigarette use across diverse populations. Although the direction of association was consistent across studies, the magnitude of effect was heterogeneous. These behaviors likely share psychosocial and environmental determinants, although alternative explanations, including shared genetic liability, recall bias, and residual confounding, cannot be excluded. Further longitudinal studies are needed to clarify the underlying mechanisms of this association and establish temporality. The findings also support integrating hallucinogen-use screening into e-cigarette prevention and harm-reduction programs targeting youth and young adults.

Humans↗

PubMed2003

The bioavailability of intranasal and smoked methamphetamine.

BACKGROUND: Patients in harm-reduction treatment programs are switching from intravenous to other routes of methamphetamine (INN, metamfetamine) administration to avoid risks associated with needle use. Relatively little has been reported about the bioavailability of methamphetamine when smoked or used intranasally. METHODS: Eight experienced methamphetamine users were administered smoked or intranasal methamphetamine concurrently with an intravenous dose of deuterium-labeled methamphetamine. Plasma and urine concentrations were measured for calculation of bioavailability and other pharmacokinetic parameters by noncompartmental methods. RESULTS: Methamphetamine was well absorbed after smoking or intranasal administration, with bioavailabilities of 79% after intranasal administration and 67% of the estimated delivered dose or 37.4% of the absolute (pipe) dose after smoking. Maximum methamphetamine concentrations occurred at 2.7 and 2.5 hours after intranasal and smoked doses. The elimination half-life was similar for intravenous (11.4 hours), intranasal (10.7 hours), and smoked (10.7 hours) methamphetamine. Clearance (272 mL x h(-1) x kg(-1)), steady-state volume of distribution (4.2 L/kg), and mean residence time (16 hours) of the intravenous dose were similar to previously reported values. Dextroamphetamine (INN, dexamfetamine) half-life (all routes) was 16.2 hours. Methamphetamine and dextroamphetamine renal clearances (all routes) were about 100 and 1100 mL x h(-1) x kg(-1), respectively. CONCLUSIONS: Intranasal and smoked methamphetamine are well absorbed. Although intranasal or smoked routes may decrease the risk of transmission of blood-borne diseases, exposure to methamphetamine and the possibility of drug-related complications remain substantial.

Administration, Inhalation↗

PubMed2004

Prevalence of psychiatric and substance use disorders in opioid abusers in a community syringe exchange program.

The present study evaluates the prevalence of psychiatric and substance use disorders in male and female intravenous opioid abusers participating at a community needle exchange program (NEP). All participants (n = 422) were administered the Structured Clinical Interview for the DSM-IV (SCID) for Axis I disorders and antisocial personality disorder (APD). Psychiatric and substance abuse comorbidity were highly prevalent. Major depression was the most common current and lifetime Axis I non-substance use disorder (6 and 21% of the sample, respectively); 37% were diagnosed with APD. Over 50% of the sample was diagnosed with at least one non-substance use Axis I disorder or APD. In addition to opioid dependence, cocaine dependence was the most prevalent current and lifetime substance use disorder (68 and 78% of the sample, respectively), followed by alcohol and cannabis dependence. Overall, participants reported a mean of over one current and over three lifetime substance use disorders in addition to opioid dependence. Women reported higher rates of post-traumatic stress disorder (PTSD), while men were more likely diagnosed with APD. Presence of a psychiatric disorder was associated with increased prevalence of substance use disorder for all drug classes. The high rates of comorbidity observed in this sample suggest that the harm reduction efforts of NEPs can be significantly enhanced through referral of participants to programs that treat substance use and/or other psychiatric disorders.

Adult↗

PubMed2004

HIV infection among female drug users in Northern Thailand.

Reports on HIV infection and risk behaviors among female drug users in developing countries, particularly in Asia, are limited. In this study, we investigated HIV prevalence and risk factors for HIV infection among 200 women admitted for 21-day inpatient drug detoxification in Chiang Mai, Thailand. Volunteers completed a face-to-face interview using a structured interview, HIV pre-test counseling, specimen collection for HIV and STD tests, and were provided test results and HIV post-test counseling 1 week later. Two-third of participants (68%) were ethnic minorities with no formal education. Overall, 14 (7%) were HIV positive: 25% among 28 heroin injectors and 4.1% among 172 opium or methamphetamine smokers (p<0.001). History of drug injection and sexual abuse were associated with HIV infection. HIV prevention strategies for drug-using women in Thailand should consider both harm reduction strategies for drug use and promoting safer sex measures in a culturally appropriate context.

Adult↗

PubMed2026

Influencer-driven lifestyle and wellness framing of intoxicating hemp products may normalize youth cannabis use.

Hemp-derived intoxicating cannabis products (DICPs) have rapidly expanded across the U.S. marketplace and are increasingly promoted on social media platforms popular among youth. This commentary highlights emerging concerns about influencer-driven DICP promotion on Instagram, where intoxicating hemp and cannabis products are embedded within lifestyle, wellness, fitness, sobriety, harm-reduction, and entertainment narratives. In ongoing monitoring of Instagram posts from leading DICP brands, we observed influencer posts that featured young-looking creators, aspirational wellness imagery, humor, slang, fast-cut editing, mocktail-making scenes, and claims positioning DICPs as "hangover-free," safer, or substitutes for alcohol or other drug use. Such content may reduce perceived risk, increase product appeal, and normalize cannabis use, particularly when promotional posts resemble organic (non-promotional) peer-culture content rather than advertising. Existing platform guidelines and regulatory approaches may inadequately address this form of influencer marketing. Enforcement is more actionable when sponsorship is clearly disclosed; however, influencers often omit brand sponsorship disclosures entirely or use vague disclosures. The absence of a disclosure does not necessarily mean that a post is non-promotional. Platforms should develop policies and algorithm-assisted surveillance approaches that identify DICP influencer content using youth-oriented cues, lifestyle and wellness framing, brand tags or links, and unverified reduced-risk or therapeutic claims.

Humans↗

PubMed2006

Carboxyhemoglobin and thiocyanate as biomarkers of exposure to carbon monoxide and hydrogen cyanide in tobacco smoke.

The determination of biomarkers in human body fluids is a useful tool, which allows the quantitative assessment of the exposure to chemicals or complex mixtures of chemicals and of early biological effects as a result of the exposure. Biomarkers require validation before their successful application in human studies. This review describes some general purposes of human biomonitoring and biomarkers including the requirements for validation. Risk assessment and harm reduction of smoking and tobacco products, respectively, is a very suitable field for the application of biomarkers. A brief historical review shows that the application of biomarkers of exposure and effect in human smoking goes back more than 150 years. Two 'classical' biomarkers of exposure to tobacco, namely carboxyhemoglobin (COHb and its equivalent carbon monoxide in exhalate, COex) and thiocyanate (SCN) in body fluids are discussed in terms of sources of exposure, metabolism, disposition kinetics and influencing host factors. Data on COHb/COex and SCN in nonsmokers and smokers as well as the power to discriminate between smokers and nonsmokers are presented. Both biomarkers are significantly correlated with the daily cigarette consumption. Smoking machine-derived yields of the precursors carbon monoxide and hydrogen cyanide were not correlated with COHb/COex and SCN, respectively. It is concluded that, while COHb/COex is a useful biomarker for assessing the smoke inhalation, preferably in controlled studies, the application of SCN in body fluids as a biomarker for smoking is limited, mainly due to the abundance of other sources for SCN.

Biomarkers↗

PubMed2005

Patterns of illicit drug use of prisoners in police custody in London, UK.

AIMS AND METHODS: The aims of the study were to explore the current characteristics of drug misusers seen in police custody and identify trends or changes that have taken place in the last decade. A prospective, anonymised, structured questionnaire survey was undertaken of consenting consecutive, self-admitted illicit drug users seen by forensic physicians in police custody within the Metropolitan Police Service in London, UK in 2003. RESULTS: 30% of detainees were dependent on heroin or crack cocaine. Drug users (n=113) were studied in 2003. 95.4% completed the questionnaire. 82% were male, 18% female. Mean age was 28.5 y (range 18-49). 80% were unemployed; significant mental health issues (e.g., schizophrenia) were present in 18%; 15% had alcohol dependence; heroin was the most frequently used drug (93%); crack cocaine -- 87%; mean daily cost of drugs -- heroin GBP 76 (range 20-240), crack GBP 81 (range 20-300). >50% users inject crack and heroin simultaneously. 56% used the intravenous route; 25% had shared needles; 100% had accessible sources of clean needles; 6.4% were hepatitis B positive; 42% were aware of hepatitis prophylaxis; hepatitis C positive -- 20.2%; 3.6% were HIV positive. Mean length of time of drug use was 7.5 y (range 1 month -- 20 years); 82% had served a previous prison sentence; 54% had used drugs in prison; 11% had used needles in prison; 3% of users stated they had started using in prison. 38% had been on rehabilitation programs; 11% had been on Drug Treatment and Testing; Orders (DTTO); 32% had used the services of Drug Arrest Referral Teams in police stations; 10% were in contact with Drug Teams at the time of assessment. CONCLUSIONS: In the last decade, there appears to be a substantial increase in the prevalence of drug use in this population -- particularly of crack cocaine. Treatment interventions are either not readily available, or not followed through. In very general terms, the illicit drug use problem appears to have significantly worsened in the population seen in police custody in London, UK, in the last decade although there is evidence that health education and harm reduction messages appear to have had some positive effects.

Adolescent↗