חיפוש מאמרים

Harm Reduction or Psychedelic Support? Caring for Drug-Related Crises at Transformational Festivals
Ruane, D. Weekend Societies: Electronic Dance Music Festivals and Event-Cultures (2017): 115.
Many of the EDM events known as “transformational festivals” provide psychedelic support spaces: volunteer projects caring for festivalgoers undergoing difficult drugRead More...

Many of the EDM events known as “transformational festivals” provide psychedelic support spaces: volunteer projects caring for festivalgoers undergoing difficult drug experiences. Mostly drawn from the festival community, many volunteer carers (“sitters”) subscribe to psychedelic culture discourse which frames these substances as aids to personal growth if handled appropriately. However, within the dominant paradigm of international drug

prohibition, support projects must employ the contrasting discourse of harm reduction in order to gain access to events, visibility to festivalgoers, and integration with other support staff. Harm reduction, a paradigm for the care of drug users which began as a grassroots heroin addict advocacy movement, has since become associated with neoliberal, medicalised views of drugs, drug users and the self. This article considers how psychedelic support workers negotiate this discourse dichotomy in the course of caregiving, within differing national and local drug policy climates. Early findings are presented from ethnographic fieldwork as a psychedelic support volunteer with three organisations at seven festivals, combining participant observation and in-depth interviews with nineteen support workers. Events in the UK, the US and Portugal were studied due to these countries’ contrasting policy regimes. Points of conflict between the psychedelic and harm reduction discourses were found to create tensions both within the support organisations and in their relations with on-site medics, security guards, festival organisers and police. The findings suggest that mainstream harm reduction discourses may be a poor fit for psychedelics and that risks inhere in their adoption by festival support spaces, such as abjection of drug users in difficulty which may create a trust-damaging divide between users and workers.

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Prevalence of Hepatitis C Among Injection Drug Users in England and Wales: Is Harm Reduction Working?
Hope, V. D., Judd, A., Hickman, M., Lamagni, T., Hunter, G., Stimson, G. V., & Gill, O. N. American Journal of Public Health 91.1 (2001): 38.
OBJECTIVES: This study sought to establish the prevalence of hepatitis C antibodies (anti-HCV) and hepatitis B antibodies (anti-HBc) among injectionRead More...

OBJECTIVES: This study sought to establish the prevalence of hepatitis C antibodies (anti-HCV) and hepatitis B antibodies (anti-HBc) among injection drug users in England and Wales. METHODS: A voluntary cross-sectional survey collected oral fluid samples and behavioral information; 2203 injectors were recruited through drug agencies, and 758 were recruited in the community. RESULTS: Prevalence was 30% for anti-HCV, 21% for anti-HBc, and 0.9% for HIV antibodies. Anti-HCV prevalence rates were significantly greater among those with longer injecting careers, those in older age groups, those residing in London, those recruited in drug agencies, those positive for anti-HBc, and those with a previous voluntary HIV test. CONCLUSIONS: Anti-HCV prevalence rates among injectors in England and Wales, where comprehensive harm reduction programs exist, are lower than rates in other industrialized countries.

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Expanding Harm Reduction Services Through a Wound and Abscess Clinic
Grau, L. E., Arevalo, S., Catchpool, C., & Heimer, R. American Journal of Public Health 92.12 (2002): 1915-1917.
A wound and abscess clinic, held concurrently with a syringe exchange, provided economical treatment and aftercare for injection-associated soft tissueRead More...

A wound and abscess clinic, held concurrently with a syringe exchange, provided economical treatment and aftercare for injection-associated soft tissue infections. During 20 two-hour clinic sessions, 173 treatment episodes were logged, and the visit cost was estimated at $5 per patient.

Increased patient–clinician interactions provided opportunities beyond those afforded by the syringe exchange for patients to obtain resources and referrals to services such as HIV counseling and testing, medical care, and drug treatment.

Distribution of cards advertising the clinic was substantially less effective than word of mouth in increasing community awareness of the clinic.

INJECTION-RELATED SOFT tissue infections are common among injection drug users. In a 1997 sample of injection drug users from one San Francisco neighborhood, the prevalence of soft tissue infections was 32%.1 These infections place injection drug users at risk for serious medical problems, including cellulitis, septicemia, and necrotizing fasciitis.

Although soft tissue infections can be treated in outpatient settings, most community-based clinics do not perform incision and drainage procedures. Hence, treatment is typically hospital based, and estimated costs range from $185 to $360 (excluding medications and physician fees). Many injection drug users are reluctant to seek hospital-based treatment because they lack financial resources or are concerned about negative or punitive interactions with health care providers.

Syringe exchange programs have been demonstrated to improve public health.Injection drug users have grown to trust syringe exchange and affiliated programs because they espouse a non–abstinence-based harm reduction philosophy while encouraging customers to adopt healthier habits (e.g., hygienic injection practices, vein care, nutrition) to reduce their health risks. Syringe exchange programs that treat injectionassociated wounds and soft tissue infections have the potential to expand their effectiveness by reducing negative sequelae of infections and providing injectors with access to needed health care resources and social services.

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The impact of harm-reduction-based methadone treatment on mortality among heroin users
Langendam, M. W., Van Brussel, G. H., Coutinho, R. A., & Van Ameijden, E. J. American journal of public health 91.5 (2001): 774.
OBJECTIVES: The purpose of this study was to investigate the impact of harm-reduction-based methadone programs on mortality among heroin users.Read More...

OBJECTIVES: The purpose of this study was to investigate the impact of harm-reduction-based methadone programs on mortality among heroin users. METHODS: A prospective cohort investigation was conducted among 827 participants in the Amsterdam Cohort Study. Poisson regression was used to identify methadone maintenance treatment characteristics (dosage, frequency of program attendance, and type of program) that are significantly and independently associated with mortality due to natural causes and overdose. RESULTS: From 1985 to 1996, 89 participants died of natural causes, and 31 died as a result of an overdose. After adjustment for HIV and underweight status, there was an increase in natural-cause mortality among subjects who left methadone treatment (relative risk [RR] = 2.38, 95% confidence interval [CI] = 1.28, 4.55). Leaving treatment was also related to higher overdose mortality, but only among injection drug users (RR = 4.55, 95% CI = 1.89, 10.00). CONCLUSIONS: Harm-reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdoses. Provision of methadone in itself, together with social-medical care, appears more important than the actual methadone dosage.

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Provision of syringes: the cutting edge of harm reduction in prison?
Nelles, J., Fuhrer, A., Hirsbrunner, H. P., & Harding, T. W. Bmj 317.7153 (1998): 270-273.
When, in the summer of 1994, a pilot project on prevention of drug use and transmission of HIV was launchedRead More...

When, in the summer of 1994, a pilot project on prevention of drug use and transmission of HIV was launched in Hindelbank, a Swiss prison for women, not many outsiders paid attention to it. Yet only a few months later, the prison director received repeated calls from television stations, newspapers, and drug experts asking how the project was developing. We describe how this high level of public interest in a small prison (around 85 inmates, 100 entries and releases per year) came about.

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E-Cigarettes and the Harm-Reduction Continuum
Fairchild, A. L., Lee, J. S., Bayer, R., & Curran, J. The New England journal of medicine 378.3 (2018): 216.
n recent years, there has been a trend of acknowledging the importance of a harm-reduction approach in policy discussions aboutRead More...

n recent years, there has been a trend of acknowledging the importance of a harm-reduction approach in policy discussions about e-cigarettes. But some proposed strategies might well limit, if not entirely undermine, the population benefits associated with e-cigarettes.

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Brief Intervention for Harm Reduction With Alcohol-Positive Older Adolescents in a Hospital Emergency Department
Monti, P. M., Colby, S. M., Barnett, N. P., Spirito, A., Rohsenow, D. J., Myers, M., & Lewander, W. Journal of consulting and clinical psychology 67.6 (1999): 989.
This study evaluated the use of a brief motivational interview (MI) to reduce alcohol-related consequences and use among adolescents treatedRead More...

This study evaluated the use of a brief motivational interview (MI) to reduce alcohol-related consequences and use among adolescents treated in an emergency room (ER) following an alcohol-related event. Patients aged 18 to 19 years (N = 94) were randomly assigned to receive either MI or standard care (SC). Assessment and intervention were conducted in the ER during or after the patient’s treatment. Follow-up assessments showed that patients who received the MI had a significantly lower incidence of drinking and driving, traffic violations, alcohol-related injuries, and alcohol-related problems than patients who received SC. Both conditions showed reduced alcohol consumption. The harm-reduction focus of the MI was evident in that MI reduced negative outcomes related to drinking, beyond what was produced by the precipitating event plus SC alone.

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Drug Decriminalization in Portugal – Lessons for Creating Fair and Successful Drug Policies
Greenwald, G. Cato Institute Whitepaper Series (2009).
On July 1, 2001, a nationwide law in Portugal took effect that decriminalized all drugs, including cocaine and heroin. UnderRead More...

On July 1, 2001, a nationwide law in Portugal took effect that decriminalized all drugs, including cocaine and heroin. Under the new legal framework, all drugs were "decriminalized," not "legalized." Thus, drug possession for personal use and drug usage itself are still legally prohibited, but violations of those prohibitions are deemed to be exclusively administrative violations and are removed completely from the criminal realm. Drug trafficking continues to be prosecuted as a criminal offense. While other states in the European Union have developed various forms of de facto decriminalization — whereby substances perceived to be less serious (such as cannabis) rarely lead to criminal prosecution — Portugal remains the only EU member state with a law explicitly declaring drugs to be "decriminalized." Because more than seven years have now elapsed since enactment of Portugal's decriminalization system, there are ample data enabling its effects to be assessed. Notably, decriminalization has become increasingly popular in Portugal since 2001. Except for some far-right politicians, very few domestic political factions are agitating for a repeal of the 2001 law. And while there is a widespread perception that bureaucratic changes need to be made to Portugal's decriminalization framework to make it more efficient and effective, there is no real debate about whether drugs should once again be criminalized. More significantly, none of the nightmare scenarios touted by preenactment decriminalization opponents — from rampant increases in drug usage among the young to the transformation of Lisbon into a haven for "drug tourists" — has occurred. The political consensus in favor of decriminalization is unsurprising in light of the relevant empirical data. Those data indicate that decriminalization has had no adverse effect on drug usage rates in Portugal, which, in numerous categories, are now among the lowest in the EU, particularly when compared with states with stringent criminalization regimes. Although postdecriminalization usage rates have remained roughly the same or even decreased slightly when compared with other EU states, drug-related pathologies — such as sexually transmitted diseases and deaths due to drug usage — have decreased dramatically. Drug policy experts attribute those positive trends to the enhanced ability of the Portuguese government to offer treatment programs to its citizens — enhancements made possible, for numerous reasons, by decriminalization. This report will begin with an examination of the Portuguese decriminalization framework as set forth in law and in terms of how it functions in practice. Also examined is the political climate in Portugal both pre- and postdecriminalization with regard to drug policy, and the impetus that led that nation to adopt decriminalization. The report then assesses Portuguese drug policy in the context of the EU's approach to drugs. The varying legal frameworks, as well as the overall trend toward liberalization, are examined to enable a meaningful comparative assessment between Portuguese data and data from other EU states. The report also sets forth the data concerning drug-related trends in Portugal both pre- and postdecriminalization. The effects of decriminalization in Portugal are examined both in absolute terms and in comparisons with other states that continue to criminalize drugs, particularly within the EU. The data show that, judged by virtually every metric, the Portuguese decriminalization framework has been a resounding success. Within this success lie self-evident lessons that should guide drug policy debates around the world.

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Heroin-assisted treatment as a response to the public health problem of opiate dependence
Fischer, B., Rehm, J., Kirst, M., Casas, M., Hall, W., Krausz, M., & Van Ree, J. M. The European Journal of Public Health 12.3 (2002): 228-234.
Injection drug use (involving the injection of illicit opiates) poses serious public health problems in many countries. Research has indicatedRead More...

Injection drug use (involving the injection of illicit opiates) poses serious public health problems in many countries. Research has indicated that injection drug users are at higher risk for morbidity in the form of HIV/AIDS and Hepatitis B and C, and drug‐related mortality, as well as increased criminal activity. Methadone maintenance treatment is the most prominent form of pharmacotherapy treatment for illicit opiate dependence in several countries, and its application varies internationally with respect to treatment regulations and delivery modes. In order to effectively treat those patients who have previously been resistant to methadone maintenance treatment, several countries have been studying and/or considering heroin‐assisted treatment as a complementary form of opiate pharmacotherapy treatment. This paper provides an overview of the prevalence of injection drug use and the opiate dependence problem internationally, the current opiate dependence treatment landscape in several countries, and the status of ongoing or planned heroin‐assisted treatment trials in Australia, Canada and certain European countries.

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Strategies for preventing heroin overdose
Sporer, K. A. Bmj 326.7386 (2003): 442-444.‏
Making naloxone available in addicts' homes is one of several official or unofficial ways that are being tried out toRead More...

Making naloxone available in addicts' homes is one of several official or unofficial ways that are being tried out to reduce the rising toll of fatalities from heroin overdose.

The recent “heroin epidemic” has led to a dramatic increase in the incidence of fatal and non-fatal heroin overdose in many countries. Deaths from opioid overdose increased 55-fold in Australia between 1964 and 1997, and heroin overdose was the leading cause of death among men aged 25-54 in Portland, Oregon, in 1999.

In 1999, the Drug Abuse Warning Network recorded 4820 heroin related deaths in the United States, as well as 16 646 non-fatal cases of heroin overdose in patients presenting to emergency departments. Every year about 2% of people who inject heroin die, which is six to 20 times the rate expected in peer controls who do not use drugs. This epidemic of deaths among injecting heroin users has led many organisations to develop strategies other than simple abstinence to prevent this tragedy. Several underground and government programmes to this end have recently been implemented in several countries, but their effectiveness and community acceptance needs evaluation.

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ABC of smoking cessation – Harm reduction
McNeill, A. BMJ: British Medical Journal 328.7444 (2004): 885.
Although the ideal for all smokers is to quit completely, a substantial proportion of smokers either do not want toRead More...

Although the ideal for all smokers is to quit completely, a substantial proportion of smokers either do not want to stop smoking or have been unable to do so despite many attempts. Harm reduction strategies are aimed at reducing the adverse health effects of tobacco use in these individuals.

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Prevention, early intervention, harm reduction, and treatment of substance use in young people
Stockings, E., Hall, W. D., Lynskey, M., Morley, K. I., Reavley, N., Strang, J., & Degenhardt, L. The Lancet Psychiatry 3.3 (2016): 280-296.
We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use inRead More...

We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use in young people for tobacco, alcohol, and illicit drugs (eg, cannabis, opioids, amphetamines, or cocaine). Taxation, public consumption bans, advertising restrictions, and minimum legal age are effective measures to reduce alcohol and tobacco use, but are not available to target illicit drugs. Interpretation of the available evidence for school-based prevention is affected by methodological issues; interventions that incorporate skills training are more likely to be effective than information provision—which is ineffective. Social normsand brief interventions to reduce substance use in young people do not have strong evidence of effectiveness. Roadside drug testing and interventions to reduce injection-related harms have a moderate-to-large effect, but additional research with young people is needed. Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people. Existing evidence is from high-income countries, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status. Concerted efforts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people.

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Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems
Larimer, M. E., Malone, D. K., Garner, M. D., Atkins, D. C., Burlingham, B., Lonczak, H. S., & Marlatt, G. A. Jama 301.13 (2009): 1349-1357.
Objective To evaluate association of a “Housing First” intervention for chronically homeless individuals with severe alcohol problems with health care useRead More...

Objective To evaluate association of a “Housing First” intervention for chronically homeless individuals with severe alcohol problems with health care use and costs.

Design, Setting, and Participants Quasi-experimental design comparing 95 housed participants (with drinking permitted) with 39 wait-list control participants enrolled between November 2005 and March 2007 in Seattle, Washington.

Main Outcome Measures Use and cost of services (jail bookings, days incarcerated, shelter and sobering center use, hospital-based medical services, publicly funded alcohol and drug detoxification and treatment, emergency medical services, and Medicaid-funded services) for Housing First participants relative to wait-list controls.

Results Housing First participants had total costs of $8 175 922 in the year prior to the study, or median costs of $4066 per person per month (interquartile range [IQR], $2067-$8264). Median monthly costs decreased to $1492 (IQR, $337-$5709) and $958 (IQR, $98-$3200) after 6 and 12 months in housing, respectively. Poisson generalized estimating equation regressions using propensity score adjustments showed total cost rate reduction of 53% for housed participants relative to wait-list controls (rate ratio, 0.47; 95% confidence interval, 0.25-0.88) over the first 6 months. Total cost offsets for Housing First participants relative to controls averaged $2449 per person per month after accounting for housing program costs.

Conclusions In this population of chronically homeless individuals with high service use and costs, a Housing First program was associated with a relative decrease in costs after 6 months. These benefits increased to the extent that participants were retained in housing longer.

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Interventions to reduce harm associated with adolescent substance use
Toumbourou, J. W., Stockwell, T., Neighbors, C., Marlatt, G. A., Sturge, J., & Rehm, J. The Lancet 369.9570 (2007): 1391-1401.
A major proportion of the disease burden and deaths for young people in developed nations is attributable to misuse ofRead More...

A major proportion of the disease burden and deaths for young people in developed nations is attributable to misuse of alcohol and illicit drugs. Patterns of substance use established in adolescence are quite stable and predict chronic patterns of use, mortality, and morbidity later in life. We integrated findings of systematic reviews to summarise evidence for interventions aimed at prevention and reduction of harms related to adolescent substance use. Evidence of efficacy was available for developmental prevention interventions that aim to prevent onset of harmful patterns in settings such as vulnerable families, schools, and communities, and universal strategies to reduce attractiveness of substance use. Regulatory interventions aim to increase perceived costs and reduce availability and accessibility of substances. Increasing price, restricting settings of use, and raising legal purchase age are effective in reducing use of alcohol and tobacco and related harms. Screening and brief intervention are efficacious, but efficacy of a range of treatment approaches has not been reliably established. Harm-reduction interventions are effective in young people involved in risky and injecting substance use.

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Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment
Marlatt, G. A., & Witkiewitz, K. Addictive behaviors 27.6 (2002): 867-886.
Harm reduction approaches to alcohol problems have endured a controversial history in both the research literature and the popular media.Read More...

Harm reduction approaches to alcohol problems have endured a controversial history in both the research literature and the popular media. Although several studies have demonstrated that controlled drinking is possible and that moderation-based treatments may be preferred over abstinence-only approaches, the public and institutional views of alcohol treatment still support zero-tolerance. After describing the problems with zero-tolerance and the benefits of moderate drinking, the research literature describing prevention and intervention approaches consistent with a harm reduction philosophy are presented. Literature is reviewed on universal prevention programs for young adolescents, selective and indicated prevention for college students, moderation-based self-help approaches, prevention and interventions in primary care settings, pharmacological treatments, and psychosocial approaches with moderation goals. Overall, empirical studies have demonstrated that harm reduction approaches to alcohol problems are at least as effective as abstinence-oriented approaches at reducing alcohol consumption and alcohol-related consequences. Based on these findings, we discuss the importance of individualizing alcohol prevention and intervention to accommodate the preferences and needs of the targeted person or population. In recognizing the multifaceted nature of behavior change, harm reduction efforts seek to meet the individual where he or she is at and assist that person in the direction of positive behavior change, whether that change involves abstinence, moderate drinking, or the reduction of alcohol-related harm. The limitations of harm reduction and recommendations for future research are discussed.

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