HONDA CARWAN

The literature on the long-term cost-effectiveness of these programs, particularly in community-based settings, remains heterogenous and somewhat inconclusive, which may be a barrier to program implementation and participant enrollment 83, 86. Implementation of harm minimization may face external barriers (e.g., low political prioritization, inadequate coordination and integration, limited advocacy, and conflicting intersectoral policies). Additionally, stigma, ethical issues, and changes in drug consumption patterns pose challenges in participant engagement/acceptance, and program evaluation in real-world settings 87, 88.

• The FORECAST study, conducted in 2017, found that the vast majority of people who use drugs would modify their behavior, abstaining from use, slowing down consumption, or using with others who have naloxone, if they were made aware that their drugs contained fentanyl 75, 76.
• A separate study revealed that, after using FTS, participants reduced their injection frequency, avoided solitary drug use, and decreased benzodiazepine use 51.
• Although it can be challenging to study the effect of SSPs in the real-world setting, SSPs have clearly reduced high-risk injection behaviors such as equipment sharing, reuse, and high injection frequency.15 This risk reduction can extend beyond SSP users to their peer network.
• It is noteworthy that while ID physicians have been strong proponents of vaccinations, many did not report routinely incorporating immunizations for hepatitis A, hepatitis B, or tetanus into their routine clinical care for PWID.

Notably, benzodiazepine agonist treatment during the COVID-19 pandemic has shown positive outcomes, such as successful isolation completion and improved health outcomes, with minimal adverse events 56. These results reflect the broader trend of flexible harm reduction approaches during the pandemic 81. Three linked studies from Victoria, Australia, form a comprehensive toxicosurveillance project monitoring illicit drug signals among patients with drug-related toxicity 66,67,68. The first study detailed the Emerging Drugs Network of Australia—Victoria (EDNAV) 68, a coordinated toxicosurveillance system integrating clinical and toxicological data across emergency departments, laboratories, and public health agencies. Using a risk-based framework, EDNAV facilitates timely detection of concerning drug signals and supports rapid harm reduction responses, including dissemination of alerts to the community.

Other Preventative Measures: Vaccinations and Pre-exposure Prophylaxis for Human Immunodeficiency Virus Infection

The study with the greatest suitability of study design that examined crime as an outcome observed a sustained decrease in crime following the opening of a SIF; the reduction was only observed in the vicinity of the SIF and was not observed in the rest of the city. For “Overdose-induced mortality and morbidity”, “Injection behaviors and harm reduction”, and “Crime and public nuisance” a decrease or lower value is favorable; for “Access to addiction treatment programs” an increase or higher value is favorable. They were identified by exporting the retrieved articles from Scopus to Microsoft Excel, sorted, and presented. In the current study, the term “active” refers to the those with highest number of publications. Journals that published the highest number of articles (active journals) were examined to assess their relevance and standing within the field of substance use.

Five Guidelines for Safer Injection Drug Use

Most authors (75.0%) were in favor of the use of behavioral interventions for reducing at least one injecting behavior in PWID. Harm reduction offers practical HIV prevention options for those who inject drugs, such as clean needle exchanges and access to safe injection sites. By reducing needle sharing, these strategies play a crucial role in disease control, helping to prevent the transmission of HIV, hepatitis C, and other blood-borne diseases. Individuals can bring preowned drugs to supervised injection facilities (SIFs), which are safe environments to inject drugs. SIFs are also sometimes referred to as medically supervised injection centers, safe injection facilities, supervised consumption facilities, drug consumption rooms, or overdose prevention sites.

The World Health Organization (WHO) recommends targets for harm minimization interventions, including the distribution of 300 needles per PWID per year, the provision of OAT to more than 40 people per 100 PWID and viral hepatitis vaccination. However, these targets may fall short for meeting the needs of Reducing injection harm PWID daily or more frequently, estimated to correspond to 68.1% (95% CI 64.5–71.6%) on a global scale 67. Moreover, 18% of PWID engage in receptive needle/syringe sharing at their last injection 68, 69. A multinational study pointed to 33 (uncertainty interval UI, 21–50) needle-syringes distributed via NSEP per PWID annually and 16 (UI, 10–24) OAT recipients per 100 PWID, significantly below recommendations 15, 68.

Review mindheal

ID clinicians play an important role in the healthcare system, interacting with patients who often do not have the benefit of continuity of care. Despite the above limitations, there is an important opportunity for ID clinicians to improve the care of PWID. With the removal of barriers to prescribing buprenorphine, clinicians in many disciplines can feel empowered to prescribe this medication. Naloxone, which for many can be lifesaving, was recently approved by the Food and Drug Administration to be over the counter and in most of the United States is available for purchase without a prescription, which means it could easily be incorporated into routine recommendations and counseling for PWID.

Active journals within the field

McKnight et al.42 (a cross-sectional study) found that public injecting was significantly less likely when the SIF did not have a wait time (i.e., the SIF was readily available). Folch and colleagues31 (a cross-sectional study in 2018) found that frequent SIF attendees were significantly less likely to inject in public and significantly more likely to dispose of used syringes safely. In this study, the VOSviewer technique was utilized to generate a map of author keywords that appeared at least 10 times in the collected literature.

Other benefits such as number of diagnostics and immunization, referrals to detoxification, and decreased use of medical services, should be explored 48. As we look to the future of harm reduction, it’s clear that innovation, policy reform, and community engagement will be key drivers in expanding and enhancing the impact of these crucial strategies. The evolving landscape of drug use and public health challenges calls for adaptive approaches that leverage new technologies and foster supportive legal and social environments.

• We collected standard participant demographics and report descriptive statistics from the survey.
• One study evaluated a ‘no benzodiazepine’ policy that was implemented across six outpatient mental health clinics in 2016 in the United States 62.
• In these areas, HIV outbreaks among PWID were identified with high rates of HCV co-infection which, in just a few years, blossomed to a few hundred cases in total.
• The risk of IDU-related outbreaks can be significantly reduced with sterile injection equipment, safer injection technique, PrEP, PEP, and OUD treatment.
• In cities and towns around the world, countless individuals, much like Alex, engage in unsafe injection practices, a decision often made out of necessity rather than choice.

The team then met to discuss the results, and any discrepancies were resolved through discussion to ensure consistency in the application of eligibility criteria. This calibration process was completed before continuing with the full screening of all identified records. All remaining discrepancies were resolved through discussion, with RML providing the final vote where required. Benzodiazepines are a commonly prescribed class of depressant medications 1 and are considered essential medicines by the World Health Organisation 2.

Though currently considered illegal under U.S. federal law, several U.S. cities are considering implementing supervised injection facilities anyway as a response to the escalating overdose crisis. The objective of this review is to determine the effectiveness of supervised injection facilities, compared with control conditions, for harm reduction and community outcomes. Harm reduction serves as an important vehicle to mobilize response to not only the opioid crisis, but also the other aforementioned epidemics, such as HIV/AIDs, viral hepatitis, and various infections. The clinical overlap between SUD and ID suggests that integration of harm reduction strategies within ID would improve health outcomes.

Among the six high-quality systematic reviews, five reported at least one benefit in favor of the interventions, either NSEP 23, OAT 35, 52–54 or behavioral and psychosocial interventions 39. Previous studies have suggested that weak evidence, including studies with methodological flaws and high risk of bias, along with misleading and conflicting reports, can lead to biased recommendations and potentially distort decision-making. We advocate for the development of a core outcome set (COS), which entails a consensus-derived collection of outcomes and instruments to enable consistent measurement and reporting of harm minimization interventions 65, 66. Among the six high-quality systematic reviews, five reported at least one benefit in favor of the interventions, either NSEP 23, OAT 35, 52,53,54 or behavioral and psychosocial interventions 39.

This review determined papers to be “linked” if multiple papers investigated the same underlying cohort of individuals in an overlapping study period and measured the same or similar outcomes. An example of a “linked” study would be papers from the same authors—a paper reporting the initial outcomes of the study, and a second paper reporting the same outcomes measured in the same way several years later. To identify the current research topics and potential future research directions, analysis of the recently published 50 articles was conducted. To identify research hotspots, the ones with high influence and impact in the field, the top 50 cited articles were screened to identify the top main five research topics. Technological and analytical limitations remain a challenge, especially when detecting novel benzodiazepines at low concentrations. Low-cost tools such as FTS (~ $1 USD) provide rapid, albeit less specific, results 51, whereas more sophisticated methods such as PS-MS offer higher sensitivity at greater expense and complexity 44.