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PubMed1998

Vietnamese-speaking injecting drug users in Melbourne: the need for harm reduction programs.

While research on aspects of injecting drug use (IDU), including injecting and sexual risks for HIV transmission, has been progressing in 'mainstream' Australian populations, there has been little among non-English speaking background (NESB) communities in Australia, particularly the South-East Asian communities, of which the Vietnamese is the largest. This exploratory study employed and trained peer workers to recruit and interview IDUs of Vietnamese origin in Melbourne on a wide range of subjects related to risks associated with their drug using, as an initial assessment of risk-taking behaviours for blood-borne viruses among Vietnamese-speaking IDUs. A finger-prick blood sample was taken where possible to measure antibody status to HIV, HBV and HCV. The profile which emerged was not dissimilar to that of their English-speaking counterparts prior to the benefit of currently available harm-reduction programs. A relatively isolated group whose social world often related only to other Vietnamese-speaking drug users, they were engaging in unsafe sex and unsafe injecting and were unfamiliar with procedures for cleaning injecting equipment and where they could seek out information and services, including needle exchanges. This study has identified an urgent need not only to promote currently available information and services to this group, but also to provide culturally relevant education and other harm-reduction measures needed to prevent transmission of HIV, other BBVs and STDs. The study has highlighted the lack of responsiveness of mainstream health services to the needs of Vietnamese-speaking IDUs.

Adolescent↗
PubMed2006

Injecting and HIV prevalence among young heroin users in three Spanish cities and their association with the delayed implementation of harm reduction programmes.

OBJECTIVES: To evaluate changes in the prevalence of HIV infection among young heroin users in three Spanish cities, and their association with harm reduction programmes (HRPs). METHODS: Two cross sectional studies. The 1995 study included 596 users; half were street recruited and half were recruited at drug treatment centres. The 2001-03 study included 981 street recruited users. Face to face interviews were conducted using a structured questionnaire. Samples for HIV testing (saliva in 1995 and dried blood spot in 2001-03) were collected. RESULTS: The proportion who had ever injected (IDUs) decreased in all three cities. HIV prevalence in IDUs decreased by half in Barcelona (44.1% to 20.8%) and Seville (44.2% to 22.2%), but remained constant in Madrid (36.8% and 34.9%). This difference was attributable to a decrease in HIV prevalence in long term IDUs in Barcelona and Seville, but not in Madrid. The crude odds ratio for HIV prevalence in Madrid compared with Barcelona in long term IDUs was 2.3 (95%CI 1.4 to 3.7), increasing to 3.1 (95%CI 1.5 to 6.2) after adjusting for sociodemographic and risk factors. HIV prevalence in short term IDUs was similar in all cities. In 1992 Barcelona already had 20 heroin users in methadone maintenance programmes (MMPs) per 10 000 population aged 15-49 years; Seville reached this rate in 1994, and Madrid, not until 1998. CONCLUSIONS: The prevalence of HIV infection did not decrease in long term injectors in Madrid. The delayed implementation of HRPs, especially MMPs, may be the most plausible hypothesis. This finding should shed light on decision making in countries in a similar epidemiological and sociological situation.

Adolescent↗
PubMed2002

Patients' views on smoking cessation and tobacco harm reduction during drug treatment.

Efforts to help smokers in drug treatment quit smoking have met with little success. To explore barriers to quitting and interest in tobacco harm reduction we conducted focus groups and interviews among 78 patients from five Methadone Maintenance Treatment (MMT) sites. Measures included a written survey and open-ended questions on (a) motivation for quitting, (b) what quit methods worked and what didn't work, and (c) interest in smoking reduction and nicotine maintenance as an alternative to complete cessation. Discussions were audiotaped, transcribed, and coded using computer-based qualitative software; our interobserver reliability was 83%. Successful quitters used in general a combination of quit methods such as prayer, nicotine gum, keeping busy, quitting 'one day at a time,' nicotine patches, deep breathing, and avoidance of triggers. Nicotine craving, rather than withdrawal, was cited as the biggest challenge to staying quit. Some current smokers feared quitting smoking would divert them from their goal of quitting illicit drug use or tapering off MMT. Current smokers were interested in smoking reduction as an alternative to quitting; however, those who had tried but failed to reduce smoking preferred complete cessation. Nicotine maintenance was favored by only a few participants with major health problems who didn't hold out hope for quitting. Findings suggest combination pharmacotherapy could help patients control withdrawal and acute episodes of craving. Patients have a number of skills from coping with illicit drug dependence that are useful in combating nicotine dependence. Behavioral methods and short-term pharmacotherapy to help patients reduce tobacco exposure should be explored.

Adult↗
PubMed2003

Acceptability and availability of harm-reduction interventions for drug abuse in American substance abuse treatment agencies.

This study assessed acceptability, availability, and reasons for nonavailability of interventions designed to prevent drug use related harm by substituting pharmaceuticals for illicit drugs; facilitating detoxification; and reducing the occurrence of HIV transmission, relapse, and opiate overdose. A survey was mailed to a sample of 500 randomly selected American substance abuse treatment agencies. Of 435 potentially eligible respondents, 222 (51%) returned usable data. A subset of interventions--including harm reduction education, cue exposure therapy, needle exchange, substitute opiate prescribing, various detoxification regimes, and complementary therapies--were rated as somewhat or completely acceptable by 50% or more of the respondents. Regardless of their acceptability, listed interventions were generally not available from responding agencies; respondents typically attributed unavailability to lack of resources and inconsistency of an intervention with agency philosophy.

Attitude of Health Personnel↗
PubMed1996

What does mathematical modeling tell us about harm reduction?

This paper argues, primarily by example, that mathematical modeling can contribute to harm reduction-orientated drug policy making in three ways: by contributing to quantitative evaluations of effectiveness, by improving data and understanding of the underlying drug-related phenomena, and by encouraging precise thinking about the goals and objectives of harm reduction.

Journal Article↗
PubMed2004

The prevalence of injecting drug use in a Russian city: implications for harm reduction and coverage.

AIM: This study sought to estimate the prevalence of injecting drug users (IDU) in Togliatti city and to examine the implications of these estimates for HIV prevalence and harm reduction. DESIGN: Routine data sources of IDUs were identified. Covariate capture-recapture techniques were used on the individuals identified on the three data sources and used to estimate the number of IDU 'not observed' by the data sources, and thereby estimate the prevalence of IDU. SETTING: Togliatti City, Samara Oblast, Russian Federation. PARTICIPANTS: IDUs recorded on three data sources (narcology records, HIV positive test results and police arrest data) during 2001. MEASUREMENTS: Poisson regression models were fitted to the observed data, with interactions between data sources fitted to replicate 'dependencies' between those data sources. To select the best model the goodness of fit was approximated by chi2 distribution and the best-fitting model was selected on the basis of standard information criteria and log likelihood ratio tests. FINDINGS: The total estimated population of IDUs is 20 226 [95% confidence interval (CI): 16 971-24 749] giving a population prevalence of 5.4% (95% CI: 4.5-6.6%) of the registered population and 2.7% (95% CI: 2.4-3.5%) of the population (including migrants) aged 15-44 years. For every one IDU in contact with a service there were three out of contact. CONCLUSIONS: There is a high prevalence of IDU which, in the context of a fast-emerging IDU-associated HIV epidemic, will have serious public health implications.

Adolescent↗
PubMed2001

Natural helpers: a community approach to harm reduction.

This paper, by Jennifer Taylor and Theresa Jasperson, looks at a successful harm-reduction initiative developed by Streetworks, a needle exchange program in Edmonton, Alberta. The Natural Helpers initiative provides and enhances the skills, knowledge, resources, and support that people who use injection drugs need in order to take care of others in their community. The evolution of the project, from its inception to the present situation, is described.

Canada↗
PubMed2006

Heroin-related attentional bias and monthly frequency of heroin use are positively associated in attenders of a harm reduction service.

The relationship between heroin-related attentional bias (AB) and a proxy for dependence severity (monthly frequency of heroin use-injecting or inhaling) was measured in individuals attending a heroin harm reduction service. A flicker change blindness paradigm was employed in which change detection latencies were measured to either a heroin-related or to a neutral change made to a stimulus array containing an equal number of heroin-related and neutral words. Individuals given the heroin-related change to detect showed a positive relationship between heroin-related AB and the proxy for dependence severity; those given the neutral change showed a negative relationship. Both findings complement each other--and are consistent with the sending of more attention to heroin-related stimuli than neutral, the more severe is the dependence.

Adult↗
PubMed2004

Smokeless tobacco use: harm reduction or induction approach?

BACKGROUND: Smokeless tobacco (ST) substitution for cigarettes as a method to reduce harm has been actively debated. Use of ST as a smoking cessation method or as a means to reduce cigarettes has been proposed. The impact of using ST in these ways is relatively unknown. METHODS: A review of the different issues and studies related to using smokeless tobacco as a method to reduce tobacco toxin exposure and harm is presented. RESULTS: The toxicity of the product itself varies by brand of ST and across countries. Of the existing studies, comparisons of consequences between cigarettes and ST show that cigarette smoking produces more negative health effects, is likely to have a higher addiction potential and more severe withdrawal, and leads to a higher rate of relapse than ST use. On the other hand, ST use facilitates the use of cigarettes, which is a deadly tobacco product. Additionally, ST is not a harmless product, and a less harmful product, medicinal nicotine, is available as an effective treatment approach. Furthermore, ST products are not under the same regulatory scrutiny as medicinal nicotine products. CONCLUSIONS: Considerably more research and product regulation is necessary prior to considering smokeless tobacco as a harm reduction method.

Humans↗
PubMed2003

Harm reduction and alternative development in the Golden Triangle.

The authors of this Digest are anthropologists from Macquarie University, Sydney Australia. At the invitation of the German aid agency GTZ, they have been monitoring opium use and the impact of drug rehabilitation in Muang Sing Laos over the past 3 years. Their role is to provide analyses of how development projects alter the social make-up of their target communities and contribute to ways in which substance use/abuse is understood, practiced and controlled or reconfigured. In their consideration of development projects they take the perspective that harm reduction can and should include pre-emptive concern with factors that promote damaging drug use in the first place and furthermore, that these factors are at times the products of the distinct drug reduction strategies themselves.

China↗
PubMed2005

[Methadone maintenance: adoption of a new harm reduction approach in Hungary].

Methadone with its favourable physiological effects in comparison to heroin has been the most well-known and widely used tool of substitution treatment in heroinism. Research on efficiency has produced evidence of the fact that methadone maintenance as a model method of harm reduction is an efficient treatment of heroin dependent patients if used in the appropriate dose and indication. Due to its addictive effects, there has been some resistance against its worldwide spreading, especially in Central Eastern Europe. Methadone maintenance became a legal medical method in Hungary during the last ten years with approved classified protocol and manual owing to the consistent efforts of addiction-professionals, who were convinced of the treatment's efficacy. The process involved numerous conflicts, police provisions and media scandals. Professional legitimacy of methadone maintenance may hopefully be proved by research on efficiency in the near future.

Confidentiality↗
PubMed1997

Alcohol, tobacco and cannabis use among Nova Scotia adolescents: implications for prevention and harm reduction.

OBJECTIVE: To characterize adolescent drug use in terms of a risk continuum and to explore the rationale for harm reduction as a potential approach for school-based drug prevention. DESIGN: Self-reported surveys, in 1991 and 1996, of adolescent students concerning their use of drugs, especially alcohol, tobacco and cannabis, and the harmful consequences of such use. SETTING: Nova Scotia. PARTICIPANTS: A total of 3452 (in 1991) and 3790 (in 1996) junior and high school students in randomly selected classes in the public school system. OUTCOME MEASURES: Prevalence of drug use and patterns of multiple drug use and of alcohol- and drug-related problems; independent risk factors for multiple drug use. The risk continuum for the response to alcohol problems was used as a policy framework. RESULTS: The prevalence of cigarette smoking and the use of hallucinogens and stimulants was markedly higher in 1996 than in 1991. Over one-fifth (21.9%) of the students reported multiple drug use of alcohol and tobacco and cannabis in the 12 months before the 1996 survey. The 3 main subgroups--nonusers, users of alcohol only and users of multiple drugs--had distinct patterns of use, numbers of problems and risk factors. In all, 27.1% of the students had experienced at least 1 alcohol-related problem and 6% had experienced at least 1 drug-related problem in the 12 months before the 1996 survey. CONCLUSION: There is a need for integrated school- and community-based drug prevention programs, with goals, strategies and outcome measures capturing the full spectrum of patterns of use and levels of risk among subgroups of the adolescent student population.

Adolescent↗
PubMed2001

[Changes in pharmacists practices (1996 - 2000) related to harm reduction policy (condoms, injecting equipment, methylmorphine) and maintenance therapy delivery (buprenorphine, methadone)].

AIMS: To measure pharmacists involvement in harm reduction programs and in delivery of maintenance therapies in order to estimate their contribution to the new public health policy. METHOD: A longitudinal study was conducted among 327 pharmacies located in the southern suburban area of Paris (28 communities) using a standardized questionnaire. RESULTS: The response rate was 95% in 1996 and 92% in 2000. The number of condoms offered to intravenous drug users (IDU) decreased dramatically from 99% to 24% while delivered units decreased from 857 to 566 per day for needles and from 1200 to 760 per month per pharmacy for methylmorphine tablets (14.93 mg/tablet). Pharmacists delivered injecting equipment to some of their patients under opiate treatment: methylmorphine 19%, buprenorphine 35%, methadone 14%. Their contribution to the local healthcare network on addiction decreased from 38% to 20%. Nevertheless, the pharmacists attitude towards the IDU and public health policy was found to be improving with problems being mentioned for 62% of the cases in 1996 and for 16% in 2000. CONCLUSION: Pharmacists are rapidly and intensively changing their practices and are discovering a new comprehensive relationship with IDU. Better pharmacist involvement is associated with a shift in local healthcare network concentration, reinforcing the general practitioner-pharmacist partnership.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Histories of harm reduction: illicit drugs, tobacco, and nicotine.

This paper traces the different historical routes which the public health concept of "harm reduction" has taken for illicit drugs and for tobacco and nicotine. It locates these different recent histories, not just in degrees of dangerousness or risk, but rather in the ways in which those concepts have been mediated through intervening factors. It identifies institutional and cultural/conceptual planes for discussion. Key issues include different routes of medicalization; the role of differing policy communities; changing cultural and class positioning; and the shifting of boundaries between categories of "substance," "drug," and "medicine." [Translations are provided in the International Abstracts Section of this issue.]

Canada↗
PubMed2004

Drug use and harm reduction policy: alternative perspectives on the California proposal.

On October, 12, 2003, then California Governor Gray Davis vetoed legislation which would have created a trial period for evaluating nonprescription pharmacy access to needles and syringes for adults in California. An analysis of California Senate Bill 774 provides a case study to examine the struggle for clean syringe and needle access as a component of disease prevention along with the community fear of tacit approval for illicit drug use. Reflecting upon the empirically-supported research and community concerns for this specific type of harm reduction policy is an important step towards forming common political ground. This article underscores the relevance of syringe deregulation and its relevance as an ethical and political issue for social workers.

Adult↗
PubMed2004

Latinas and HIV/AIDS risk factors: implications for harm reduction strategies.

OBJECTIVES: We examined risk factors for HIV infection among Puerto Rican and Mexican American women aged 15 through 44 years. METHODS: We used data from the 1995 National Survey of Family Growth. Analyses focused on the relation between sex role attitudes, sex education, anxiety, and consistent condom use. RESULTS: Nearly 60% of Puerto Rican and Mexican American women received no sex education from parents. Twenty-one percent of Puerto Rican and 38.3% of Mexican American women reported no sex education in schools. Women with some sex education in school, less than 13 years of education, or higher sex role attitude scores were more likely than other women to have partners who consistently used condoms. CONCLUSIONS: Harm reduction interventions must be designed to reach multiple Latino audiences by age, gender, and subgroup

Adolescent↗