What’s New in Harm Reduction Research (September 2024)

A review of recently published research on harm reduction topics – September 2024.

Need help getting copies of any of these articles? Email Meg Brunner, MLIS (meganw@uw.edu). Free articles have “(open access)” after the titles; all other articles require a subscription to access.

FROM LOCAL AUTHORS

Harm Reduction in the Field: First Responders’ Perceptions of Opioid Overdose Interventions (open access)
Elswick Fockele C, Frohe T, McBride O, Perlmutter DL, Goh B, Williams G, Wettemann C, Holland N, Finegood B, Oliphant-Wells T, Williams EC, van Draanen J. West J Emerg Med. 2024 Jul;25(4):490-499. doi: 10.5811/westjem.18033.

*Authors are from the University of Washington, Research with Expert Advisors on Drug Use, and Public Health-Seattle & King County.

First responders have not historically offered harm reduction services that are known to reduce overdose death and increase access to care for people who use drugs. In partnership with the Research with Expert Advisors on Drug Use team, semi-structured interviews were conducted with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February–May 2022. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff.

Financial barriers, facilitators, and strategies among syringe services programs in the U.S., and their impact on implementation and health outcomes. (open access)
Akiba CF, Smith J, Wenger LD, Morris T, Patel SV, Bluthenthal RN, Tookes HE, LaKosky P*, Kral AH, Lambdin BH. SSM Qual Res Health. 2024 Jun;5:100421. doi: 10.1016/j.ssmqr.2024.100421.

*Dr. Paul LaKosky, Dave Purchase Project, Tacoma

Semi-structured interviews were conducted with 20 leaders of U.S. syringe services programs (SSPs) to document how the current funding landscape impacted SSP implementation, particularly financial and staffing barriers, facilitators, and proposed strategies. Participants described how structural stigma against people who use drugs led to insufficient and restrictive funding and burdensome reporting for SSPs. Inadequate funding also led to insufficient staffing and staff stress, burnout, and turnover. These barriers limited the implementation of evidence-based interventions at SSPs to effectively address health outcomes.

Comparing harm reduction and overdose response services between community-based and public health department syringe service programmes using a national cross-sectional survey. (open access)
Ray BR, Humphrey JL, Patel SV, Akiba CF, Bluthenthal RN, Tookes H, LaKosky PA*, Wenger LD, Kral AH, Lambdin BH. Lancet Reg Health Am. 2024 May 6;34:100757. doi: 10.1016/j.lana.2024.100757.

*Dr Paul LaKosky, Dave Purchase Project, Tacoma

Using results from the National Survey of Syringe Services Programs (SSPs),this study examined four outcomes: syringe distribution, naloxone distribution, fentanyl test strip (FTS) availability, and buprenorphine implementation across three organizational categories of SSPs: those operated by public health departments (DPH), community-based organizations (CBOs) with government funding, and CBOs without government funding.

Adjusting for community-level differences, CBO SSPs with government funding had significantly higher provision of all four syringe and overdose response services as compared to DPH SSPs and across three of the four services as compared to CBO SSPs without government funding. CBO SSPs without government funding still had significantly higher provision of three of the four services as compared to programs maintained by the DPH. CBO SSPs have strong potential to expand overdose response.

The July 2024 issue of the American Medical Association Journal of Ethics is dedicated to “Harm Reduction and Opioid Use Disorder.”  All articles are open access and include:

• Why Harm Reduction and Equity Are Ethical Imperatives in Opioid Use Disorder Care
• When Are “Paraphernalia” Critical Medical Supplies?
• How Should Harm Reduction Be Included in Care Continua for Patients With Opioid Use Disorder?
• What Would Equitable Harm Reduction Look Like?
• Street Health Care as Harm Reduction
• Drawing on Black and Queer Communities’ Harm Reduction Histories to Improve Overdose Prevention Strategies and Policies.
• How Should Harm Reduction Strategies Differ for Adolescents and Adults?
• Opioid Epidemic Grief and Characterological Harm Reduction

OTHER HARM REDUCTION TOPICS

“If everyone knew about this, how many lives could we save?”: Do drug suppliers have a role in reducing overdose risk? (open access)
Hedden-Clayton B, Cochran J, Carroll JJ, Kral AH, Victor G, Comartin E, Ray B. Drug Alcohol Depend Rep. 2024 Jun 24;12:100250. doi: 10.1016/j.dadr.2024.100250.

In-person interviews with people who use drugs were conducted in 2022 in Indianapolis, Indiana, with thematic analysis of data from six interviews with people who were either primarily or secondarily trained through a harm reduction training for people who supply drugs. People who supply drugs were regularly identified as key actors capable of widely reducing risk across drug networks. Participants described being motivated by a moral imperative to protect community members, tying the previous loss of friends and loved ones to overdose to their commitments to the safety of others. Providing people who supply drugs with harm reduction training and access to harm reduction resources may help to reduce drug-related harms.

Health risks associated with smoking versus injecting fentanyl among people who use drugs in California.
Megerian CE, Bair L, Smith J, Browne EN, Wenger LD, Guzman L, Kral AH, Lambdin BH.
Drug Alcohol Depend. 2024;255:111053. doi: 10.1016/j.drugalcdep.2023.111053.

This study of 999 people who use drugs from 34 syringe services programs across California compared health and healthcare utilization outcomes among people who injected fentanyl (78% of whom also smoked) to people who solely smoked fentanyl. Of the 563 participants, 41% injected fentanyl and 59% only smoked fentanyl. People who injected fentanyl were 40% more likely to have experienced a non-fatal overdose in the past 3 months and 253% more likely to have had a skin and soft tissue infection in the past 3 months compared to people who only smoked fentanyl. The average number of nights spent in the hospital was higher among people who injected fentanyl. There were non-significant associations between mode of fentanyl administration and number of emergency department visits and probability of hospitalization. These data suggest that people who injected fentanyl were at higher risk for overdose and skin and soft tissue infections than people who only smoked fentanyl. Distribution of safe smoking supplies may facilitate transitions from injecting to smoking fentanyl, thereby reducing health risks associated with fentanyl use.

Unmet needs and harm reduction preferences of syringe services program participants: differences by co-use of illicit opioids and methamphetamine. (open access)
Sun R, Sauda TH, Hoopsick RA. Harm Reduct J. 2024;21(1):119. doi: 10.1186/s12954-024-01038-2.

This survey of 50 participants of a small, midwestern syringe services program (SSP) examined differences in basic needs and harm reduction preferences between SSP participants who do and do not co-use illicit opioids and methamphetamine. Co-use was defined as reporting the use of both drugs, which may or may not have been used simultaneously. The mean level of need was highest for bus passes or other transportation, a person who can help you get the services you need, medication for opioid use disorder, and a job or job training. Additionally, all participants reported being either interested or very interested in fentanyl test strips, safe consumption sites, delivery of syringe service supplies, and delivery of naloxone. Those who endorsed co-use had a greater need for food, healthcare, substance use disorder treatment, a support person to help them access needed services, and bus passes or transportation.