Engagement in Harm Reduction Strategies After Suspected Fentanyl Contamination Among Opioid-Dependent Individuals

Mortality by cause of death during year 1 of the COVID-19 pandemic in a cohort of older adults from Baltimore Maryland who have injected drugs

“…Past research shows HCV infection could be a proxy marker for more frequent drug use over the life course ( Hahn et al, 2002 ; Villano et al, 1997 ), so this is consistent with the hypothesis that people with heavier drug use over the life course who managed to survive up to the start of the pandemic were more able to navigate the risks of the pandemic, for example because they may be more engaged with health or harm reduction services. Other studies suggest people who survive overdoses adopt risk-reduction strategies that they believe have helped them prevent repeat overdoses ( Elliott et al, 2019 ; Mistler et al, 2021 ). However, the data here are insufficient to strongly support any particular hypothesis about why this cohort did not experience increases in drug overdose mortality as observed in the broader U.S., Maryland, and Baltimore populations.…”

A Realist Review of How Community-Based Drug Checking Services Could Be Designed and Implemented to Promote Engagement of People Who Use Drugs

“…Although willingness does not necessarily translate into actual use, it does show potential for increased footfall for people who inject drugs accessing existing integrated services, and this may lead to increased willingness to consider using DCS as well. Further, if individuals are already accessing the service, literature suggests that they may feel less stigmatised, more accepted, and value their pre-existing relationships with staff [56,76,79,88,110].…”

“…However, available evidence in the literature strongly suggests that increased trust due to existing non-judgmental relationships with staff, and increased willingness to consider using a DCS due to accessing multiple interventions in one site, are beneficial mechanisms to engagement [11,15,58,64,82,83]. It appears that this is particularly applicable for those with multiple, intersecting vulnerabilities [19,38,64,110].…”

“…The belief that services are flexible, accessible, and provide a choice of how to engage, has been argued as potentially resulting in a higher number of service users being reached overall, although there is a lack of robust outcome data on this issue [20,38,[76][77][78]108,110]. Outreach sample collection, or testing in particular, may increase engagement amongst those with wider support needs relating to high-risk drug use such as injecting [37,58,77], those who are rough sleeping, and those with more entrenched patterns of use [19,38,54].…”

“…Sub theory 2: Service user expectations of DCS tests As noted, point-of-care drug checking technologies have several limitations which vary by factors such as those listed in the above programme theory [6,11,16,56,62,66,95,96,115]. It is therefore vital for services to communicate these limitations to service users [107,110,124]. The importance of particular testing limitations may vary according to context or service user's substance use.…”