The impact of Taiwan’s implementation of a nationwide harm reduction program in 2006 on the use of various illicit drugs: trend analysis of first-time offenders from 2001 to 2017

Background After implementing a nationwide harm reduction program in 2006, a dramatic decline in the incidence of human immunodeficiency virus (HIV) infection among people with injection drug use (IDU) was observed in Taiwan. The harm reduction program might have sent out the message discouraging the choice of IDU among illicit drug users in early stage. Based on the yearly first-time offense rates from 2001 to 2017, this study aimed to examine (1) whether the nationwide implementation of the harm reduction program in 2006 led to changes in first-time offenders’ use of heroin; (2) whether the intervention had a similar effect on the use of other illicit drugs; and (3) whether the effect of the intervention was limited to the first-time offenders of young age groups. Methods Yearly first-time illicit-drug offense rates from 2001 to 2017 in Taiwan were derived from two national databases for drug arrests that were verified using urine tests: the Criminal Record Processing System on Schedule I/II Drugs and the Administrative Penalty System for Schedule III/IV Substances. A hierarchy of mutually exclusive categories of drug uses was defined by the drug with the highest schedule level among those tested positive in an arrest. Segmented regression analyses of interrupted time series were used to test for the impact of the 2006 intervention. Results There was a decrease of 22.37 per 100,000 in the rate for heroin but no detectable level changes in that for methamphetamine or ecstasy after the 2006 intervention in Taiwan. There were baseline decreasing trends in the first-time offense rate from 2001 to 2017 for heroin and ecstasy and an increasing trend for methamphetamine, with the slopes not altered by the 2006 intervention. The postintervention decrease in the first-time offense rate for heroin was detectable among offenders less than 40 years old. Conclusions Our results indicate a diffusion effect of the 2006 intervention on decreasing heroin use among young offenders and have policy implications for better prevention and treatment for different age groups.

Helping Behavior among People Who Use Drugs: Altruism and Mutual Aid in a Harm Reduction Program

People who use drugs, and particularly people experiencing addiction, are rarely afforded the opportunity to have their voices heard when it comes to drug treatment or drug policy or even when attempting to define themselves and their life experiences. Of course, there is much more to a person than one area of their behaviour. The current study seeks to capture and understand the lived experiences of people who use drugs, with a focus on their relationships and helping behaviour. We interviewed 32 participants in a harm reduction program seeking to provide understanding beyond stigmatizing and criminalizing drug narratives, by exploring their motivation and context for helping behav- iours. Grounded theory methodology was used to under- stand the patterns of helping behaviour, along with the contexts in which help is or is not given. We particularly focus on participants' distribution of syringes and carrying medicine to reverse overdose (naloxone). Participants shared stories of altruism and mutual aid, along with barriers and disincentives to helping others. We situate these behaviours within contrasting environments of a free harm reduction program and the competitive market system of the U.S. society. Implications for practice and public pol- icy are discussed.

NEXT Harm Reduction: An Online, Mail-Based Naloxone Distribution and Harm-Reduction Program

Needle EXchange Technology (NEXT) Harm Reduction is an online, mail-based platform designed for sending (1) naloxone kits to people at risk for overdose and (2) sterile syringes and other equipment directly to people who otherwise cannot access safe supplies. From its inception in 2017 through the end of 2019, NEXT Harm Reduction sent naloxone kits to 3609 individuals and 1230 packages of sterile syringes and supplies and received 335 reports of overdose reversals using naloxone provided by NEXT Harm Reduction and its affiliates. (Am J Public Health. Published online ahead of print February 18, 2021: e1–e5. https://doi.org/10.2105/AJPH.2020.306124 )

Harm reduction program and hepatitis C prevalence in people who inject drugs (PWID) in Iran: an updated systematic review and cumulative meta-analysis

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.

DIFERENCIAS DE ALTERACIONES PSICOMOTRICES ENTRE EL USO DE COCAÍNA Y DE COCAÍNA-HEROÍNA EN UNA SALA DE VENOPUNCIÓN

INTRODUCCIÓN El uso de cocaína puede generar alteraciones psicomotrices (1). Sin embargo, hay pocos estudios sobre el uso conjunto de cocaína-heroína (speedball) y las alteraciones psicomotrices inducidas de forma aguda en una sala de reducción de daños (2,3). OBJETIVOS Analizar las diferencias psicopatológicas psicomotrices entre el uso agudo de cocaína y de cocaína-heroína en una sala de venopunción. MÉTODOS Este es un estudio observacional realizado en una sala de venopunción entre el 01/01/2009 y 31/05/2021. Se analizaron las diferencias sociodemográficas básicas y variables psicomotrices en función del uso agudo de cocaína o cocaína-heroína intravenosa. Análisis univariantes y bivariantes fueron realizados por cada consumo y no por información individual. RESULTADOS De 3707 episodios de venopunción asistida en la sala, 1079 correspondían a uso de cocaína y 77 a cocaína –heroína (el resto eran usos de heroína). Hay diferencias sociodemográficas y psicopatológicas de carácter motriz entre el uso de cocaína y cocaína-heroína (Tabla 1). CONCLUSIONES El uso concomitante de heroína en usuarios de cocaína podría generar diferencias a nivel psicopatológico. REFERENCIAS 1. Maremmani AG et al. Substance abuse and psychosis. The strange case of opioids. Eur Rev Med Pharmacol Sci. 2014;18(3):287-302. 2. Leri F, Bruneau J, Stewart J. Understanding polydrug use: review of heroin and cocaine co-use. Addiction. 2003 Jan;98(1):7-22. doi: 10.1046/j.1360-0443.2003.00236.x. 3. Roncero C et al. Psychotic symptoms of cocaine self-injectors in a harm reduction program. Subst Abus. 2013;34(2):118-21. doi: 10.1080/08897077.2012.691446.

HaRePo (Harm Reduction by Post): An innovative and effective harm reduction program for people who use drugs using email, telephone and post-service.

Background: Despite multiple Harm Reduction (HR) programs worldwide, there are still an important number of people who use drugs (PWUD) who do not access those services. Their difficulties to obtain HR tools are due to their inability to reach such services (remoteness and/or limited customer service hours), costs, quantitative restrictions, fear of judgment, lack of confidentiality in pharmacy and unfamiliarity with HR programs. We tested an innovative approach using the power of remote online communication and the national postal distribution network to improve HR tools access and counselling. Methods: Based on these observations, SAFE association created HaRePo in 2011, a free and confidential program designed for people who have difficulties accessing HR tools and counselling. PWUD can access the program by phone and/or email. An HR professional delivers HR counselling, HR tools and connects PWUD to other HR services, medical, and social workers. HR tools are prepared and sent according to the person’s needs through the French postal service to consumers across Metropolitan France and overseas territories. Results: Since 2011, 1920 PWUD have benefited from HaRePo: 10,450 parcels were sent accounting for more than 1.7 million syringes and 6 million HR related items. HaRePo receives positive feedback from PWUD who have improved their practices through remote but trusted communication. The percentage of people that, after joining the program, never reuse and/or share HR tools have significantly increased. On average 71.5% of beneficiaries never reuse syringes and 81% do not reuse needles. And they are 98.5% consumers who never share syringes and 99% needles any longer. Between 44% and 80% HaRePo beneficiaries have reported that their drug-related practices (injection, inhalation and snorting) are now safer. Finally, between 39% and 53% HaRePo consumers declared that their overall physical state has improved (e.g., venous condition, the appearance of point of injection, swelling of arms, legs, and hands). Conclusion: HaRePo is an innovative HR program efficient for hard-to-reach PWUD. It shows evidence of a positive feedback loop for PWUD in improving their practices. Finally, HaRePo represents a clear benefit for health authorities in France, who decided to expand the program in 2016.

HaRePo (Harm Reduction by Post): An Innovative and Effective Harm Reduction Program for People Who Use Drugs Using Email, Telephone and Post-Service.

BackgroundDespite multiple Harm Reduction (HR) programs worldwide, there are still an important number of people who use drugs (PWUD) who do not access those services. Their difficulties to obtain HR tools are due to their inability to reach such services (remoteness and/or limited customer service hours), costs, quantitative restrictions, fear of judgment, lack of confidentiality in pharmacy and unfamiliarity with HR programs. We tested an innovative approach using the power of remote online communication and the national postal distribution network to improve HR tools access and counselling.MethodsBased on these observations, SAFE association created HaRePo in 2011, a free and confidential program designed for people who have difficulties accessing HR tools and counselling. PWUD can access the program by phone and/or email. An HR professional answers any questions, delivers HR counselling, and connects the PWUD to other HR services, medical, and social workers. HR tools are prepared and sent according to the person’s needs through the French postal service to users across Metropolitan France and overseas territories.ResultsSince 2011, 1920 PWUD have benefited from HaRePo: 10,450 parcels were sent accounting for more than 1.7 million syringes and 6 million HR related items. HaRePo receives positive feedback from PWUD who have improved their practices through remote but trusted communication. The percentage of people that, after joining the program, never reuse and/or share HR tools have significantly increased. On average 71.5% of beneficiaries never reuse syringes and 81% do not reuse needles. And they are 98.5% users who never share syringes and 99% needles any longer. Between 44% and 80% HaRePo beneficiaries have reported that their drug-related practices (injection, inhalation and snorting) are now safer. Finally, between 39% and 53% HaRePo users declared that their overall physical state has improved (e.g., venous condition, the appearance of point of injection, swelling of arms, legs, and hands).ConclusionHaRePo is an innovative HR program efficient for hard-to-reach PWUD. It shows evidence of a positive feedback loop for PWUD in improving their practices. Finally, HaRePo represents a clear benefit for health authorities in France, who decided to expand the program in 2016.

Implementation of the Methadone Maintenance Therapy Program for Highrisk Drug Prisoners

<p>The harm reduction program is a program that aims to assist inmates who use syringes (IDU's) in overcoming dependence on narcotics medically and to prevent the adverse effects caused by narcotics abuse. Where in general the use of heroin is done by injecting using a syringe alternately, or known as "For Wet" This can cause a new problem that is greater that the outbreak of the HIV/AIDS virus. Most prisoners use injecting narcotics before entering prison and have been infected with the HIV virus, so the risk of transmitting HIV/AIDS to other prisoners is very high. The tendency of the number of relapses (reuse) by prisoners who are in the period of coaching is quite high despite the efforts of strict supervision in the security sector, but in fact in several prisons/detention there is narcotics smuggling in various modes. For this reason, the Indonesian Ministry of Law and Human Rights through the Directorate General of Corrections organizes the P4GN program (Prevention of Eradication of Narcotics Abuse and Circulation) in prisons and detention environments by promoting the principle of "Total Abstinence" meaning that no use of any type of narcotics during coaching in prisons and prisons. But for the type of metadone, which is a type II narcotics can be tolerated because it is used for the purpose of treatment/healing of narcotics dependence and is also a government program implemented by the Ministry of Health as the leading sector.</p>