BackgroundDespite the rise of stimulant use, most harm reduction programs still focus on people who inject opioids, leaving many people who use methamphetamine (PWUM) underserviced. In Asia, especially, where methamphetamine prevalence has overtaken opioids prevalence, harm reduction programs assisting PWUM are rare. The few existing innovative practices focusing on methamphetamine use lie underreported. Understanding how these programs moved their focus from opiates to methamphetamine could help inspire new harm reduction responses. Hence, this paper analyzes a newly implemented outreach program assisting methamphetamine users in Jakarta, Indonesia. It addresses the program’s critical learning points when making the transition to respond to stimulant use.MethodsThis case study is part of a more extensive research on good practices of harm reduction for stimulant use. For this case study, data was collected through Indonesian contextual documents and documents from the program, structured questionnaire, in-depth interviews with service staff and service users, a focus group discussion with service users, and in-loco observations of activities. For this paper, data was reinterpreted to focus on the key topics that needed to be addressed when the program transitioned from working with people who use opioids to PWUM.ResultsFour key topics were found: (1) getting in touch with different types of PWUM and building trust relationships; (2) adapting safer smoking kits to local circumstances; (3) reframing partnerships while finding ways to address mental health issues; and (4) responding to local law enforcement practices.ConclusionsThe meaningful involvement of PWUM was essential in the development and evaluation of outreach work, the planning, and the adaptation of safer smoking kits to local circumstances. Also, it helped to gain understanding of the broader needs of PWUM, including mental health care and their difficulties related to law enforcement activities. Operating under a broad harm reduction definition and addressing a broad spectrum of individual and social needs are preferable to focusing solely on specific interventions and supplies for safer drug use. Since many PWUM smoke rather than inject, securing funding for harm reduction focused on people who do not inject drugs and/or who do not use opioids is fundamental in keeping programs sustainable.

Twelve methadone-maintained patients were randomized into a controlled crossover study with active and placebo yohimbine 20 mg once a day (n = 4), 5mg three times a day (n = 4) or 10 mg three times a day (n = 4) for seven days to evaluate the effect of yohimbine on naloxone precipitated opiate withdrawal. The yohimbine dose of 10 mg TID was well tolerated and was associated with an average decrease of 30% in precipitated withdrawal symptoms.

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Other investigators have reported clinical improvement from psychostimulant drugs in patients with HIV-1-related cognitive impairment. However, no previous research has substantiated this claim by using a controlled study design. We examined the efficacy of sustained-release methylphenidate (MSR) in a sample of substance abusers with HIV-1-related cognitive impairment. Eight HIV-1-infected methadone patients with impaired neuropsychological test performance participated in an inpatient double-blind placebo-controlled crossover trial of MSR 20-40 mg/day. On a composite neuropsychological measure, patients improved significantly from baseline during MSR but not placebo treatment. Nevertheless, MSR performance did not differ significantly from placebo performance. Patients appeared to improve as a function of time, regardless of sequence, with somewhat more improvement during MSR than placebo treatment.