scholarly journals Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Alyssa M Peckham ◽  
Erika H Young
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Postexposure Prophylaxis ◽  
Treatment Access ◽  
Clinical Encounters ◽  
Exposure Prophylaxis ◽  
Improve Patient ◽  
Major Target

Abstract Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include (1) teaching and distribution of materials related to safer injection practice such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and postexposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.

scholarly journals Harm Reduction Service Utilization Among People Who Inject Drugs in Tajikistan: Prevalence and Precipitating Factors

2020 ◽  
Author(s):  
Mary M. Tate ◽  
Daniel J. Bromberg ◽  
Kamiar Alaei ◽  
Saifuddin Karimov ◽  
Dilshod Saidi ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Methadone Maintenance Therapy ◽  
People Who Use Drugs ◽  
People Living With Hiv ◽  
Opioid Use ◽  
Needle And Syringe Programs

Abstract Tajikistan is in a unique geopolitical location along the global heroin trade route, exacerbating its own opioid use disorder and HIV epidemics. With one of the highest rates of opioid use disorder in the world, and 20,000-30,000 people who inject drugs in the country, Tajikistan’s government and international actors have provided harm reduction measures for people who use drugs, like narcology centers, needle and syringe programs, and methadone maintenance therapy. No implementation science studies have been conducted in Tajikistan and the current implementation gaps in service uptake are unknown. The purpose of this paper is to determine the prevalence of harm reduction service uptake among people who use drugs in Tajikistan, and determine which factors are associated with service uptake. Methods This paper uses data from the National AIDS Registry, subset to patients who use drugs (n=11,029) and cross-sectional data from a bio-behavioral survey conducted in 2017 (n=2,390). Univariate and multivariate logistic regression were used to assess associations between study variables and probably of uptake of narcology center registration, uptake of needle and syringe programs, and registration into methadone maintenance therapy. Results Fewer than half of all people who inject drugs (42.4%) were registered with the narcology center , most people who inject drugs (88.6%) reported always having access to clean syringes, and only 5.3% of PWID had ever engaged in methadone treatment in Tajikistan. There were ethnic differences in service uptake – with ethnic Russians and Uzbeks less likely to use services than ethnic Tajiks. Men who have sex with men and people living with HIV were also more likely to access services than heterosexual or seronegative individuals. Conclusion Narcology center registration and clean needle coverage are high in Tajikistan. Methadone maintenance therapy uptake, however, is low, like in other countries in Eastern Europe and Central Asia. NGO and government initiatives that target risk groups (like LGBTQ+ people and people living with HIV) seem to have been somewhat effective at recruiting their clientele into services. Future research might focus on the “positive deviancy” of these subgroups of people who use drugs to learn how to increase service uptake generally.

scholarly journals Standards for opioid use disorder care: An assessment of Nordic approaches

2019 ◽  
Vol 36 (3) ◽  
pp. 286-298 ◽  
Author(s):  
Charlotte Gedeon ◽  
Mikael Sandell ◽  
Inge Birkemose ◽  
Johan Kakko ◽  
Valgerður Rúnarsdóttir ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Success Factors ◽  
Opioid Use Disorder ◽  
Integrated Treatment ◽  
Nordic Countries ◽  
Standards Of Care ◽  
Easy Access ◽  
Opioid Use ◽  
Treatment Needs ◽  
Treatment Access

Aims: Outcomes in opioid use disorder (OUD) in Nordic countries have improved with integrated treatment and harm-reduction programmes. Approaches and the standard of care are different across the region. Evidence of treatment needs and current approaches are defined from evidence to inform development of a common standard. Method: Evidence of population sizes and treatment approach collected. Common standards for care (harm reduction, pharmacotherapy, psychology/social therapy) defined for each country. Results: Evidence defines number in treatment; potential population needing treatment not defined for all countries. Populations sizes, treatment access (ratio in treatment programme compared to total country population) defined: Sweden 4,000 in OUD care (access ratio 40); Finland 3,000 (55); Norway 8,000 (154); Denmark 7,500 (132). Approach to treatment similar: integrated treatment programmes standard. Care provided by specialists in outpatient clinics/primary care; secondary care/inpatient services are available. Harm reduction is limited in Sweden but available and more accessible elsewhere. Treatment entry criteria: access relatively unlimited in Norway and Denmark, more limited in Finland and Sweden. Standards of care defined: easy access to high-quality services, individual planning, care not limited by time, management of relapse, education for patients, continuous engagement, holistic approach including management of comorbidities, needle equipment programmes without limit, treatment in prisons as community. Conclusion: There are opportunities to improve OUD care in the Nordics. Policy makers and clinicians can advance OUD care and share common success factors. Collaborative work across the Nordic countries is valuable. Further research in clinical practice development can yield important results for the benefit of patients with OUD.

scholarly journals Recurring Severe Injection-related Infections in People Who Inject Drugs and the Need for Safe Injection Sites in Spain

2021 ◽  
Author(s):  
Jorge Valencia ◽  
Jesús Troya ◽  
Jeffrey V Lazarus ◽  
Guillermo Cuevas ◽  
Alejandro Alvaro-Meca ◽  
...  
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Opioid Use Disorder ◽  
Incidence Density ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Complicated Skin ◽  
Safe Injection

Abstract Background and aims: An estimated 68,297 people with opioid use disorder engage in opioid agonist therapy (OAT) in Spain. We aimed to calculate the incidence of severe injection-related infections in people who inject drugs (PWID) engaged in OAT in a harm reduction setting without a safe injection site (SCS).Methods: A retrospective cohort study was performed in PWID engaged in OAT and in a mobile harm reduction unit to identify who was admitted to a referral hospital for any severe injection-related infections between 1 Jan 2016 and 31 Dec 2019. A Cox proportional hazard regression analysis was used to assess factors associated with any severe injection-related infection.Results: 237 PWID engaged in OAT were included. After a median follow-up of 5.5 months (IQR 1.3–22.7), a total of 104 episodes of severe injection-related infections occurred in 56 individuals, and admission for a second event occurred in 35.7% of this same group. The incidence density of any type of severe injection-related infection was 26.8 (20.2–34.8) episodes per 100 PY, and the incidence density of complicated skin and soft tissue infections (SSTIs) that required hospital admission was 20.4 (15.0–27.3) episodes per 100 PY. Fifty-six (53.8%) of all the episodes were patient-directed discharge (PDD), and people who had two or more hospital admissions had a higher PDD frequency.Conclusion: Severe injection-related infections remain highly prevalent among PWID cared for in a harm reduction setting without a SCS. PDD were more frequent in higher-risk individuals who presented two or more hospital readmissions.

Perceived Benefits and Harms of Involuntary Civil Commitment for Opioid Use Disorder

2020 ◽  
Vol 48 (4) ◽  
pp. 718-734
Author(s):  
Elizabeth A. Evans ◽  
Calla Harrington ◽  
Robert Roose ◽  
Susan Lemere ◽  
David Buchanan
Keyword(s):  
Civil Commitment ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Treatment Access ◽  
Evidence Based Treatment ◽  
Ethics Framework ◽  
Vulnerable Patients ◽  
Underserved Patients ◽  
Legal Consequences

Involuntary civil commitment (ICC) to treatment for opioid use disorder (OUD) prevents imminent overdose, but also restricts autonomy and raises other ethical concerns. Using the Kass Public Health Ethics Framework, we identified ICC benefits and harms. Benefits include: protection of vulnerable, underserved patients; reduced legal consequences; resources for families; and “on-demand” treatment access. Harms include: stigmatizing and punitive experiences; heightened family conflict and social isolation; eroded patient self-determination; limited or no provision of OUD medications; and long-term overdose risk. To use ICC ethically, it should be recognized as comprising vulnerable patients worthy of added protections; be a last resort option; utilize consensual, humanizing processes; provide medications and other evidence-based-treatment; integrate with existing healthcare systems; and demonstrate effective outcomes before diffusion. ICC to OUD treatment carries significant potential harms that, if unaddressed, may outweigh its benefits. Findings can inform innovations for ensuring that ICC is used in an ethically responsible way.

scholarly journals Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Noa Krawczyk ◽  
Adetayo Fawole ◽  
Jenny Yang ◽  
Babak Tofighi
Keyword(s):  
Harm Reduction ◽  
Scoping Review ◽  
English Language ◽  
Data Extraction ◽  
Home Delivery ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Policy And Practice ◽  
Patient Centered ◽  
Long Acting

Abstract Background The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. Methods Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. Results Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. Conclusions The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.

scholarly journals Implementing a Low-threshold Audio-only Telehealth Model for Medication-assisted Treatment of Opioid Use Disorder at a Community-based Non-profit Organization in Washington, D.C.

2021 ◽  
Author(s):  
Ellis Jaewon Yeo ◽  
Hannah Kralles ◽  
David Sternberg ◽  
Dana McCullough ◽  
Ajetha Nadanasabesan ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Retention Rates ◽  
People Who Use Drugs ◽  
Opioid Use ◽  
Treatment Access ◽  
Community Based ◽  
Medication Assisted Treatment ◽  
Low Threshold

Abstract BackgroundThe COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the United States, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Case PresentationThis case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. ConclusionsLow-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.

scholarly journals Suboptimal uptake, retention, and adherence of daily oral PrEP among people with OUD receiving HCV treatment

2021 ◽  
Author(s):  
C Brokus ◽  
S Kattakuzhy ◽  
B Gayle ◽  
S Narayanan ◽  
A Davis ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Self Report ◽  
Washington Dc ◽  
Opioid Use ◽  
Hcv Treatment ◽  
Community Based ◽  
Treatment Medication ◽  
Long Acting ◽  
Exposure Prophylaxis ◽  
Hiv Negative

Abstract Introduction Daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) prevents HIV among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use, PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID. Methods The ANCHOR investigation evaluated a community-based care model collocating hepatitis C (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC-Baltimore. PrEP counseling was conducted from HCV treatment Day 0 until Week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried bloodspot TDF analysis. Results 198 participants were enrolled, of whom 185 (93%) were HIV-negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. 116 participants (62.7%) met 2014 CDC PrEP criteria due to IDU (82, 44.3%), sex (9, 4.9%), or both practices (25, 13.5%). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (IQR 28, 276), with 8 participants retained through Week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred. Conclusions This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.

Harm Reduction

2017 ◽  
Author(s):  
Sonal Batra ◽  
Noah Villegas ◽  
Erin Zerbo
Keyword(s):  
Harm Reduction ◽  
Historical Context ◽  
Opioid Use Disorder ◽  
Economic Consequences ◽  
Evidence Based ◽  
Maladaptive Behaviors ◽  
Negative Consequences ◽  
Opioid Use ◽  
Humanistic Approach ◽  
Female Sex Work

Harm reduction is defined as a set of policies, programs, and practices aimed at reducing the negative health, social, and economic consequences associated with various behaviors. Although classically applied to the treatment of substance use disorders, its scope has broadened over time to include high-risk sexual activity, nonadherence to treatment, and other behaviors that may lead to negative consequences. In addition to providing relevant historical context for scenarios encountered, this chapter uses a case to demonstrate how a provider might take a nonjudgmental and humanistic approach to identifying maladaptive behaviors and apply evidence-based, realistic interventions to reduce associated harms. Specific topics discussed include opioid use disorder, tobacco use disorder, female sex work, and nonadherence to psychotropic medications.

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