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... level of review evidence that supported or discounted the effect of an intervention was classified as: (i) sufficient; (ii) tentative; (iii) insufficient; or (iv) no evidence from reviews. These classifications are based on a framework ( Table 5.1) that considers the quality of the reviews, the reviewers' conclusions and the designs/findings of the primary studies ( Ellis et al., 2003). Consistent with an evidence-based medicine approach ( Glaziou and Heneghan, 2009;Sackett et al., 1996), study designs considered to provide more 'robust' evidence of effect were controlled trials, longitudinal cohort and case-control designs, while ecological, serial cross-sectional and cross-sectional designs were considered to provide 'weaker' evidence of effect. ...

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Background As the opioid overdose crisis persists and take-home naloxone (THN) programmes expand, it is important that the intervention is targeted towards those most likely to use it. We examined THN program participants to 1) describe those that return for refills, specifically those that reported multiple use (super-savers) and 2) to determine w...
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Research Question How concentrated is the total harm of offences with detected offenders (identified suspects) among the complete list of all detected offenders in a given year in an English police agency, and how consistent is the list of highest-harm “felonious few” offenders from one year to the next? Data Characteristics of 327,566 crimes and...
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Introduction: Cocaine users often present with repetitive events of cocaine-associated chest pain (CACP), clinically resembling acute coronary syndromes. The aim of the study is to describe the specific risk factors for CACP. Method: Cocaine users (n = 316) were recruited for a multicenter cross-sectional study. Lifetime CACP history, sociodemograp...
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Background Since 2003, a harm reduction program for injecting drug users has been rolled out countrywide in China. It entails services for condom promotion, a needle and syringe program (NSP), and methadone maintenance treatment (MMT). However, it remains unknown if and to what extent the coverage of these services at city level is related to a red...
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The COVID-19 pandemic has aggravated the obstacles for HIV/AIDS programs in limited-resource countries like Vietnam to achieve the HIV/AIDS-related Sustainable Development target. The paper aims to evaluate the impact of the COVID-19 pandemic on the provision of HIV/AIDS services-a pathway to achieving universal health coverage for key populations...

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... Harm reduction (HR) interventions traditionally focused on adults who engage in "problem" drug use (Kimber et al. 2010). This approach misses people who engage in "recreational" drug use and do not fit this profile, for example, young festival attendees. ...
Article
Drug-checking services (DCS) provide people who use drugs (PWUD) the opportunity to have their substances tested before consumption. Though some suggest they may have adverse consequences, DCS have been introduced as a harm reduction (HR) strategy. A systematized review of the literature regarding drug checking (DC) methods and testing locations, advantages and disadvantages, and legal frameworks with an emphasis on HR was conducted referencing PRISMA guidelines. The primary search of PsychInfo, PubMed, Medline, CINHAL, CORE, and Web of Science was conducted between the 4th and 10th of September 2020, and 51 literature pieces were included in the final article. Most of the literature focuses on the benefits of currently available DCS. The services identified varied significantly in terms of testing methods, location of operation, primary goal, and the surrounding legal framework. The results suggest using multiple DC methods to be most beneficial. Further, DCS and the personalized interventions they provide can positively influence behavior change, minimize harm, and reduce mortality. DCS are a viable public health intervention that requires cross-sector support beyond the legal frameworks and testing methods. Services will need to be tailored to meet the needs of their chosen setting, local drug market, and target audience.
... To date, the research published in SIFs is extensive and their benefits have been well summarised in numerous reviews. 9,[17][18][19][20][21][22][23][24] The evidence supports positive impacts on both public health and order 15,25,26 and improvements in individual health outcomes. 27,28 Despite the growing evidence demonstrating the benefits of SIFs, the movement to establish and operate these facilities has often faced significant challenges. ...
... The breadth of our search may also have been limited as we considered only peer-reviewed papers indexed on either Medline or Embase. However, the bulk of research identified in other reviews was drawn from the medical literature, 3,9,17,[19][20][21][22][23][24] making these two databases the most relevant. Further, we were interested in only considering the most robust research findings, and therefore peer-reviewed literature was the most appropriate. ...
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Background: Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) provide a safe environment in which people who inject drugs (PWIDs) can inject under hygienic and supervised conditions. Numerous reviews have documented the benefits of these facilities; however, there is a lack of clarity surrounding their long-term effects. Purpose: To conduct, with a systematic approach, a literature review, of published peer-reviewed literature assessing the long-term impacts of DCRs/SIFs. Methods: A systematic search of the PubMed and Embase database was performed using the keywords: ("SUPERVISED" OR "SAFE*") AND ("CONSUMPTION" OR "INJECT*" OR "SHOOTING") AND ("FACILITY*" OR "ROOM*" OR "GALLERY*" OR "CENTRE*" OR "CENTER*" OR "SITE*"). Included studies were original articles reporting outcomes for five or more years and addressed at least one of the following client or community outcomes; (i) drug-related harms; (ii) access to substance use treatment and other health services; (iii) impact on local PWID population; (iv) impact on public drug use, drug-related crime and violence; and (v) local community attitudes to DCRs. Results: Four publications met our inclusion criteria, addressing four of the five outcomes. Long-term data suggested that while the health of PWID naturally declined over time, DCRs/SIFs helped reduce injecting-related harms. The studies showed that DCRs/SIFs facilitate drug treatment, access to health services and cessation of drug injecting. Local residents and business owners reported less public drug use and public syringe disposal following the opening of a DCR/SIF. Conclusion: Long-term evidence on DCRs/SIFs is consistent with established short-term research demonstrating the benefits of these facilities. A relative paucity of studies was identified, with most evidence originating from Sydney and Vancouver. The overall body of evidence would be improved by future studies following outcomes over longer periods and being undertaken in a variety of jurisdictions and models of DCRs/SIFs.
... Opioid agonist treatment (OAT) is the most effective evidence-based treatment strategy for opioid dependence, and contributes to outcomes like psychosocial stabilization, reintegration into society and reduction of drug related mortality [1][2][3][4][5]. Other well-documented outcomes of OAT include reduction of high-risk drug use, reduction of criminal activities and prevention of drug related infectious diseases [6][7][8]. ...
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Background Retention in care is a prerequisite for successful recovery, especially for a chronic condition like opioid dependence. Though retention varies greatly depending on the different substitution medication and treatment model, treatment retention is used as an indicator of treatment quality and effectiveness of care on a system and individual level. To monitor the overall quality of the Austrian opioid agonist treatment (OAT) system and to monitor patient satisfaction within the system, a new online-based registry called “eSuchmittel” was introduced in Austria at the beginning of 2011. The objective of this study is to analyze retention rates within the Austrian treatment system and to identify patient characteristics associated with retention, using data collected by the substitution registry. Methods The complete Austrian sample of 4778 registered patients starting treatment between 1.1.2011 to 31.12.2012 were included in the prospective cohort study using data from the Austrian substitution registry. For the statistical analysis, multivariate Cox Regression and Kaplan–Meier survival analysis were used to evaluate retention in treatment. Results The retention rate of the total cohort after two years was around 61%. Retention rates were significantly lower for men (exp(B) = .806, 95% CI 0.714–0.908) and significantly higher for patients aged 30 and older (exp(B) = 1.155, 95% CI 1.044–1.279), among patients located in Vienna (exp(B) = 1.439, 95% CI 1.273–1.626) and among patients prescribed oral slow-release morphine (SROM) (exp(B) = 2.141, 95% CI 1.885–2.430). Conclusions Average retention in the Austrian system is high in comparison to international retention rates. Nationally, SROM demonstrates higher treatment retention when compared to other available substitution medications. Sociodemographic and regional indicators also contribute to higher retention in care. A systematic monitoring of retention rates within a national registry is an important tool helping to evaluate the quality of care. In this study, the Austrian OAT system proves very high retention in care, an important success criterion.
... In mid-2011, hundreds of sites were providing needles and syringes, as well as condoms, and in 1 year, millions of syringes were distributed [30][31][32]. Although there is sufficient evidence on the effectiveness of NSP and OST in the reduction in self-reported injecting risky behavior [32][33][34], evidence regarding the effectiveness of these programs in the containment of HCV epidemics is inadequate in Iran [32,33]. ...
... In mid-2011, hundreds of sites were providing needles and syringes, as well as condoms, and in 1 year, millions of syringes were distributed [30][31][32]. Although there is sufficient evidence on the effectiveness of NSP and OST in the reduction in self-reported injecting risky behavior [32][33][34], evidence regarding the effectiveness of these programs in the containment of HCV epidemics is inadequate in Iran [32,33]. ...
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Background Prevalence of hepatitis C virus (HCV) infection among people who inject drugs (PWID) in Iran is high. Since 2005, the Iranian government has implemented a harm reduction program to control HCV. We aimed to describe the prevalence of HCV antibody (Ab) in Iranian PWID before and after the implementation of harm reduction with cumulative meta-analysis. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the seroprevalence of HCV among PWID. We systematically reviewed the literature to identify eligible studies up to December 2018 in international and national databases. Pooled prevalence and 95% confidence intervals were calculated using Der Simonian and Laird method, taking into account conceptual heterogeneity. Subgroup analyses were performed by harm reduction implementation and studies’ characteristics to assess the sources of heterogeneity. We used Cochran–Armitage test for the linear trend of the prevalence of HCV Ab among PWID. Results We reviewed 5966 papers and reports and extracted data from 62 eligible records. The pooled HCV Ab prevalence among PWID in Iran was 46.5% (95% confidence interval [95% CI] 41.1–52.0%). Overall, the Cochran–Armitage test for trend indicated a significant decreasing trend of HCV Ab prevalence (P = 0.04). The cumulative meta-analysis showed a slight decline in the prevalence of HCV Ab between the years 2005 and 2018. Conclusions The HCV Ab prevalence among PWID in Iran is high, with a considerable geographical variation. The prevalence of HCV Ab among PWID in Iran slightly decreased after 2005 which could be, at least to some extent, related to the implementation of extensive harm reduction programs in the country.
... It would allow governments to introduce "safe supply" programs for cannabis, opioids such as heroin, stimulants such as cocaine and crystal meth, empathogens such as MDMA, and psychedelics such as psilocybin and LSD in order to curtail the harms associated with illegal markets, end the stigmatization of drug use and drug users, and increase the benefits of responsible drug use and treatment options for substance use disorders (CAPUD 2019). If the drug industry were a regulated business, governments could provide drug safety-and-hygiene regulations, expanding upon those measures already known to be cost-effective and efficient at reducing harms associated with drug use, such as needle exchange programs (in combination with medication-assisted therapy where appropriate) (Rhodes and Hedrich 2010;Kimber et al. 2010). Accordingly, they would be able to tax drugs according to proper assessment of their respective harms (e.g. ...
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Historically, laws and policies to criminalize drug use or possession were rooted in explicit racism, and they continue to wreak havoc on certain racialized communities. We are a group of bioethicists, drug experts, legal scholars, criminal justice researchers, sociologists, psychologists, and other allied professionals who have come together in support of a policy proposal that is evidence-based and ethically recommended. We call for the immediate decriminalization of all so-called recreational drugs and, ultimately, for their timely and appropriate legal regulation. We also call for criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs to be expunged, and for those currently serving time for these offenses to be released. In effect, we call for an end to the "war on drugs." KEYWORDS race and culture/ethnicity; health policy; regulatory issues
... The evidence to support harm reduction as an approach to the care of people who use illicit substances has been well established to prevent overdoses, transmission of bloodborne diseases and other harms (Degenhardt et al., 2019). Research supports the use of harm reduction services to increase access to health care services and facilitate the development of therapeutic relationships between people who use illicit substances and health care providers (Hilton et al., 2009;Kimber, 2010;McNeil & Small, 2014;Pauly, 2008a). Many argue that harm reduction as a guiding philosophy can promote ethical nursing practice and increase access to health care for people who use illicit substances because it is consistent with professional ethical standards of nursing practice and evidence-based practice; it has the potential to improve the ethical climate of nursing practice; and it provides a context to enhance trust and access to health care (CNA, 2017;Lightfoot et al., 2009;Kulikowski & Linder, 2018;Pauly et al., 2009). ...
Article
People who use illicit substances and experience socioeconomic disadvantage experience poor health as a result of structural vulnerabilities made worse by barriers to health care. In particular, stigma and discrimination often act as a barrier to health care for people who use illicit substances. Lack of respect for persons and judgements based on discrimination are in violation of core ethical principles of nursing practice. Harm reduction, as a guiding philosophy, is proposed as a way to promote respectful and non-judgmental care and minimize the harms associated with illicit substance use in alignment with principles of ethical nursing practice. Utilizing McLeroy’s Ecological Model of Health Promotion as the guiding framework, we conducted an integrated review of relevant literature to identify recommendations for implementing harm reduction in nursing practice at the intrapersonal, interpersonal, and institutional levels. The search yielded 20 primary research articles published from 2008 until 2020 to identify the actions necessary to implement harm reduction in nursing practice. This integrative review summarizes evidence-based actions necessary from the micro- to meso-level to support the implementation of harm reduction as a guiding philosophy to enhance ethical practice in nursing.
... 3 Needle-exchange programs (NEPs) improve access to kits with sterile drug-injecting equipment and condoms, reducing drug-related harms by decreasing transmission of infections among PWID. [4][5][6][7] NEPs are available in 90 countries around the world, 8 using different forms of distribution, ranging from mobile vans to home visits. Community pharmacies play an important role in these programs, mainly due to their accessibility in terms of opening hours and broad geographical distribution. ...
Article
Background Needle-exchange programs (NEPs) reduce infections in people who inject drugs. This study assesses the impact community pharmacies have had in the Needle-Exchange Program in Portugal since 2015. Methods Health gains were measured by the number of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections averted, which were estimated, in each scenario, based on a standard model in the literature, calibrated to national data. The costs per infection were taken from national literature; costs of manufacturing, logistics and incineration of injection materials were also considered. The results were presented as net costs (i.e., incremental costs of the program with community pharmacies less the costs of additional infections avoided). Results Considering a 5-year horizon, the Needle Exchange Program with community pharmacies would account for a 6.8% ( n = 25) and a 6.5% reduction ( n = 22) of HCV and HIV infections, respectively. The present value of net savings generated by the participation of community pharmacies in the program was estimated at €2,073,347. The average discounted net benefit per syringe exchanged is €3.01, already taking into account a payment to community pharmacies per needle exchanged. Interpretation We estimate that the participation of community pharmacies in the Needle Exchange Program will lead to a reduction of HIV and HCV infections and will generate over €2 million in savings for the health system. Conclusions The intervention is estimated to generate better health outcomes at lower costs, contributing to improving the efficiency of the public health system in Portugal.
... Fourteen literature reviews of DCR/SIF research have been published to date [20][21][22][23][24][25][26][27][28][29][30][31][32][33], of them, five were book chapters or reports [20][21][22]25,33], two were doctoral theses [27,32] and seven were published in scientific journals [23,24,26,[28][29][30][31]. According to the scientific journal papers, eight types of DCRs/SIF outcomes were documented: (i) attracting high-risk, marginalised users; (ii) management of overdose and decreased mortality; (iii) enhancement of safe injecting practices; (iv) decreased public drug use and improve public amenity; (v) increased uptake to treatment and other healthcare and social services; (vi) prevention of transmission of blood-borne diseases and the associated economic benefits from it; (vii) no increase in crime; and (viii) no increase in drug use or related risks (Table 1). ...
... Fourteen literature reviews of DCR/SIF research have been published to date [20][21][22][23][24][25][26][27][28][29][30][31][32][33], of them, five were book chapters or reports [20][21][22]25,33], two were doctoral theses [27,32] and seven were published in scientific journals [23,24,26,[28][29][30][31]. According to the scientific journal papers, eight types of DCRs/SIF outcomes were documented: (i) attracting high-risk, marginalised users; (ii) management of overdose and decreased mortality; (iii) enhancement of safe injecting practices; (iv) decreased public drug use and improve public amenity; (v) increased uptake to treatment and other healthcare and social services; (vi) prevention of transmission of blood-borne diseases and the associated economic benefits from it; (vii) no increase in crime; and (viii) no increase in drug use or related risks (Table 1). ...
Article
Issues Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. Approach Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF ‘exposure’ were recorded. Key Findings Two hundred and nineteen eligible peer‐reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty‐six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood‐borne diseases, overdose deaths and costs. Papers using individual‐level data included four prospective cohorts (n = 28), cross‐sectional surveys (n = 7) and service records (n = 5). Individual‐level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service ‘exposure’. Implications Research around DCRs/SIFs has used ecological, modelling, cross‐sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self‐reported proportion of injections at SIFs or a stepped‐wedge or a cluster trial comparing localities. Conclusions Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted.
... Durch zeitreihenanalytische Verfahren wurde jedoch nachgewiesen, dass die Einführung von DKR in deutschen Städten statistisch signifikant zur Senkung der Anzahl Drogentoter beitragen konnte [4]. Vergleichbare Ergebnisse liegen auch für andere europäische Städte vor [5,6]. ...
Article
Zusammenfassung Eine im Jahr 2005 von der Senatsverwaltung Berlin in Auftrag gegebene Evaluation der Berliner Drogenkonsumräume ergab, dass ein großer Teil der Drogengebrauchenden in Berlin die niedrigschwelligen Angebote der Drogenkonsumräume (DKR) nicht regelmäßig oder nur selten nutzte. Die Studie „Evaluation der Nutzungsprofile der Drogenkonsumraumnutzer im Land Berlin“, die 2015 vom Institut für Suchtforschung Frankfurt durchgeführt wurde, analysiert daher die Gründe für die Nutzung bzw. Nicht-/Nicht-mehr-Nutzung von DKR in Berlin. Dieser Artikel stellt die wichtigsten Ergebnisse des Berichts vor und vergleicht diese im Anschluss mit Ergebnissen aus DKR in Frankfurt und NRW. Im Zentrum steht dabei die Frage, wie sich existierende niedrigschwellige Angebote in Berlin im Sinne der Qualitätssicherung bedarfsgerecht ausbauen lassen. Die Untersuchung zeigt, dass die DKR die definierte Zielgruppe (Opioidkonsumierende außerhalb von Substitutionsbehandlungen) überwiegend erreicht. Jedoch zeigt die Studie auch existierende Problemlagen auf und weist auf Verbesserungsbedarfe hin. So werden sowohl von den Nicht-/Nicht-mehr-Nutzenden, als auch seitens der befragten Fachkräfte die knapp bemessenen Öffnungszeiten sowie das Nutzungsverbot für Substituierte thematisiert.
... Health officials estimated that the 78 cases diagnosed in Glasgow between 2015 and 2017 alone could potentially create lifetime costs to the health service of £29.64m. However, whether DCRs do reduce incidents of HIV is unclear and hard to estimate (Hedrich et al., 2010;Kimber et al., 2010), due to the DCR facilities limited coverage of the target population and also to methodological problems with isolating their effect from other interventions' (EMCDDA, 2017:5). In presenting the case for a DCR, the Glasgow Integrated Joint Board estimated the annual cost of each 'problem drug user' at £31,438. ...
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