Harm Reduction Services

Abstract Background People who inject drugs (PWID) are disproportionately affected by hepatitis C (HCV) but often do not receive treatment. HCV treatment in partnership with syringe service programs (SSPs) is one way to address this disparity. We implemented telehealth-based HCV treatment programs at 3 SSPs in Colorado and evaluated the effect of the programs on annual treatment rates for PWID with HCV in our safety net healthcare system.Figure 1.Hepatitis C Care Continuum for SSP-based Telehealth HCV Treatment Program Methods In November 2022, we began offering telehealth video consultations for SSP clients in Denver with self-reported HCV, along with on-site phlebotomy and medication storage. A pre-post analysis was completed to compare the proportion of individuals with evidence of HCV and injection drug use that received HCV treatment in our healthcare system in the year prior to the program (clinic-based treatment only) versus during the first year of the program (clinic-based plus SSP-based treatment). After the first year of program implementation, the program was expanded to 2 additional SSPs in Colorado (Boulder and Pueblo). Progression along the HCV care continuum was followed for all SSP program participants enrolled through April 2025. Results SSP-based telehealth for HCV treatment offered in addition to standard clinic-based treatment resulted in a higher proportion PWID treated for HCV throughout our healthcare system in the first year of program implementation compared to the year prior to implementation (30.1% [47/156] vs 20.1% [30/149], difference: 10.0%, 95% CI: 3.4% to 19.7%, p=0.04). To date, the SSP-based HCV telehealth program has been operating continuously for 30 months and has enrolled 117 individuals through April 2025. 64% of SSP HCV program participants (75/117) had HCV RNA detected, 88% (66/75) of those with +HCV RNA started treatment, 69% (52/75) completed treatment or were on treatment at the end of the study period, 43% (32/75) had evidence of sustained virologic response 4 weeks after the end of treatment (SVR4) (Figure). One individual experienced treatment failure and was retreated with a second-line regimen. Conclusion Telehealth-based HCV treatment at SSPs is a feasible approach to offering HCV treatment and may increase the proportion of PWID who receive HCV treatment in a safety net healthcare system. Disclosures All Authors: No reported disclosures

To examine how persons using different methamphetamine-opioid combinations differ with respect to social, risk, and health characteristics, and to identify patterns of vulnerability across simultaneous, sequential, and independent use. 414 people who use illicit drugs were surveyed, 384 of whom reported polydrug use involving methamphetamine, in Nevada and New Mexico between June 2022 and August 2023. Participants were classified into three mutually exclusive groups based on self-reported methamphetamine and opioid use patterns: simultaneous use (deliberately using both drugs together), sequential use (using both drugs but not deliberately using simultaneously), and independent use (using methamphetamine alone or with non-opioid drugs). Prevalence ratios were calculated to examine associations between use patterns and social, economic, health, and drug use characteristics. We identified three distinct use patterns: simultaneous (53.1%), sequential (17.7%), and independent (29.2%). Individuals in these risk groups exhibited differential social, economic, carceral, and health-related risk: those engaged in simultaneous showed higher vulnerability relative to people who use independently and sequentially. Healthcare engagement was associated with lower simultaneous use. These findings suggest the need to support development of strategies to support transition from higher to lower-risk drug use patterns.

Benzodiazepine adulteration of the unregulated opioid supply presents significant clinical challenges, whereby patients can develop physical dependence to benzodiazepines inadvertently. Currently, clinicians lack evidence to guide care of patients potentially experiencing benzodiazepine withdrawal when ceasing use of unregulated opioids. We used a Delphi technique to build consensus around assessment and management of people at risk for benzodiazepine dependence due to the use of unregulated opioids. We administered a Delphi Technique with 12 clinicians (physicians, nurses, nurse practitioners, pharmacists) with expertise in substance use disorders, from a Canadian province with a high prevalence of benzodiazepine-adulterated unregulated opioids. The technique involved 4 rounds of consensus building and resulted in 122 consensus statements related to direct clinical care. Final consensus statements include approaches to risk stratification, diagnosis, and management of benzodiazepine withdrawal secondary to use of benzodiazepine-adulterated opioids. At-risk groups include daily/high-volume opioid users, those who intentionally seek benzodiazepine-contaminated opioids, and those who abruptly cease using unregulated opioids. Common co-opioid and benzodiazepine withdrawal symptoms include anxiety, agitation, gastrointestinal upset, insomnia, and confusion, usually peaking around 72 hours from the time of last use. Experts formed consensus on tracking benzodiazepine withdrawal using vitals, CIWA-B, and treatment response to benzodiazepines administered in inpatient settings. As benzodiazepines become more prevalent in the unregulated drug supply, there is an urgent need for evidence-based care. Key future priorities should focus on developing evidence-based clinical guidance, creating decision-support tools, and advancing research efforts.

Stunting remains a critical public health challenge in Indonesia, impacting child growth, cognitive development, and long-term productivity. The government has prioritized interventions targeting families at risk of stunting to reduce its prevalence. This study examines the relationship between families at risk of stunting and stunting prevalence in Indonesia by an ecological study design. Data were analyzed at the district/city level using correlation analysis to assess key risk factors. The findings indicate that inadequate access to safe drinking water, poor sanitation, substandard housing, and reproductive health risks among women of reproductive age are significantly correlated with higher stunting prevalence (p<0.05). The correlation coefficients for these factors are 0.14, 0.19, 0.17, and 0.33, respectively. Furthermore, a one percent reduction in families at risk of stunting is associated with a 0.19 percent decrease in stunting prevalence (R² = 16%). These results highlight the need for comprehensive interventions addressing environmental, socio-economic, and maternal health factors. Strengthening policies that improve access to clean water, sanitation, and maternal health services is crucial to accelerating stunting reduction efforts in Indonesia. Prioritizing families at risk can enhance the effectiveness of government strategies in achieving national stunting decrease targets.

The number of meth/amphetamine related deaths in Australia has quadrupled in the last 20 years, primarily due to drug toxicity and suicide among individuals in their 30s and 40s. Previous analysis of Australian meth/amphetamine-related deaths covered limited timeframes and causes, and there has been no exploration of the effects of changing cohorts on meth/amphetamine mortality. This paper provides comprehensive insights across 20 years into the evolving cohort trends in meth/amphetamine-related deaths in Australia. An age-period-cohort-interaction (APC-I) analysis of Australian meth/amphetamine-related deaths (2001-2020) by cause extracted from the National Coronial Information System, a database of all deaths reported to the coroner in Australia and New Zealand. APC-I analyses revealed that unintentional drug toxicity deaths peaked at ages 35-38 [Coefficient (Coef) = 0.92; 95% confidence interval (CI) = 1.0-0.8], intentional self-harm deaths peaked at ages 31-34 (Coef = 1.2; 95% CI = 1.4-1.0), unintentional injury deaths peaked at ages 23-26 (Coef = 1.02; 95% CI = 1.2-0.8) and natural cause deaths at 39-42 (Coef = 1.15; 95% CI = 1.4-0.9). Period effects were consistent across all causes, with a mean 29.3% increase in estimated mortality rate from 2001 to 2012, followed by a mean 103.3% increase in estimated mortality rate to 2016, at which time period effects stabilised. Cohort effects revealed that individuals born between 1962 and 1982 (mainly Generation X) faced a higher-than-average mortality risk across all four causes, with risk decreasing in later generations. Despite different age profiles across the various causes of death, cohort effects suggest a single generation (Generation X: people born between 1962 and 1982) is predominantly experiencing the increase in meth/amphetamine-related mortality observed in Australia over the past 20 years. As Generation X ages, the risk of meth/amphetamine-related natural deaths, especially from cardiovascular disease, is likely to increase.

Abstract Accurate, user-friendly drug checking tools are critical in reducing overdose risks, especially in settings where people test substances without professional guidance. This study examined whether a small design change—a 10mg micro scoop—could improve how users interact with fentanyl test kits. During a multi-day music festival, 50 participants were randomly assigned to use one of two test kits: one with the scoop (Version A) and one without it (Version B). Each person used written instructions only and completed a survey afterward. Participants using the scoop-equipped kit achieved 100% accuracy when interpreting results, compared to 84% accuracy in the group without the scoop. They also rated the instructions as clearer—91% versus 73%—and reported feeling more confident and less confused during testing. Many described the scoop as helpful in measuring and mixing the sample. These findings show that even simple, user-centered design improvements can make drug checking more effective and accessible in real-world environments. Improving ease of use may increase the reliability and impact of harm reduction tools in preventing overdose. Subject Classification Codes: Health and Safety (e.g., 62P10, 62M30); Public Health (e.g., 91C44); Addiction and Substance Use (e.g., 92E70); Human Factors and Ergonomics (e.g., 94C37).

The Risk Environment Framework is widely utilized theoretical framework for understanding the landscape of harm for people who use drugs (PWUD). This study sought to understand factors contributing to risk of overdose for PWUD in New Jersey. Understanding these factors can lead to improved policy interventions, programmatic targets, and a shared understanding that overdose risk is impacted by larger societal forces influencing PWUD. Using a community based participatory design model, this study conducted 30 semi-structured, in-depth interviews with PWUD and naloxone distributors in New Brunswick and Newark, New Jersey from February to November of 2022. Thematic analysis was performed using a collaborative analytical approach. Risk factors for overdose fell into all four categories of Rhodes's Risk Environment Framework - physical, social, economic, and policy. Many factors overlapped in multiple categories, and most factors had elements existing at both the macro and micro levels. Interventions supporting PWUD should see overdose risk as an environmental, structural consideration, and be constructed to address comprehensive risks, rather than directing themselves exclusively at the individual level. Factors contributing to risk at the macro level included systemic and institutional concerns and stigma toward PWUD. At the micro level, mental health, substance use behaviors, treatment and recovery, and trauma were cited as potential risk factors.