This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.harmreductionjournal.com The latest articles from Harm Reduction Journal (ISSN 1477-7517) published by BioMed Central Nearly 400 years after Galileo Galilei of Florence was arraigned and convicted of suspected heresy by the ten member Congregation of the Holy Office (Inquisition), the International Narcotic Control Board (INCB) is similarly inserting itself into matters pertaining to innovations in healthcare and the public health response to addiction throughout the world. Like that earlier Inquisition of 1633 that convicted Galileo of heresy for holding that the sun is the centre of the universe with the earth revolving around it (in contradiction to church doctrine of the time) the INCB and its thirteen-member panel, now rails against any evidence out of sync with the established doctrine of the war on drugs - particularly those innovations in public health called harm reduction. The latest healthcare and harm reduction practices to attract the ire of the INCB Inquisition are elements of Canada's most effective and innovative measures to minimize the harms of drugs in Vancouver - supervised injection facilities and, recently, the potential establishment of supervised inhalation rooms - along with the long established practice of providing safer mouthpieces for pulmonary inhalation in British Columbia. This is particularly significant as it comes in the midst of a crucial battle between municipal and provincial authorities in BC with the federal government in Ottawa, which seems determined to undermine all the most effective HR programs that are the result of years of steady local and governmental support in Vancouver and now threatens to derail all these programs and spread doubt about their usefulness despite the overwhelmingly positive findings of serous research. The Grand Inquisitor of the INCB Board, Chairman Dr. Philip Emafo, makes it his practice to issue stern warnings to Canada and all progressive countries that make HR their national policy and innovate HR practices. On behalf of the INCB Inquisition, Emafo pronounces that all countries must abandon the defense and practice of the dark arts of harm reduction and (like Galileo) must also publicly recant, condemning their leading population health initiatives in addiction work. If they do not, then the countries in question are accused of drug policy heresy. Ironically, while the INCB was proclaiming its newest round of objections to evidenced based approaches to addiction in the first week of March 2008, at the very same time the Pontifical Academy of Sciences, with its headquarters in the Holy See under the direct protection of the Supreme Pontiff was helping to disavow the Inquisitions of Galileo four centuries ago, momentously announcing its plans to erect a statue of Galileo in Vatican City. Will the INCB likewise see the error of its ways and recant its own betrayal of the health and human rights of people with serious addictions? Today we are at a cross roads in Canada--will we defend the truth of evidence-based approaches to the pandemic of addiction, by the light of the lessons learned from this history, or return to the darkness of a time we thought long past? http://www.harmreductionjournal.com/content/5/1/16 Dan Small and Ernest Drucker Harm Reduction Journal 2008, 5:16 2008-05-07 doi:10.1186/1477-7517-5-16 Harm Reduction Journal 1477-7517 5 16 2008-05-07 Background: Methadone is a synthetic, narcotic analgesic used in the treatment of drug misuse. Tragedies involving children being poisoned by the accidental ingestion of methadone are no longer a rare occurrence. Following an audit of the effectiveness of the provision and recall of information to patients attending an NHS Methadone Clinic a protocol was introduced to ensure that staff documented the provision of such information and patients gave a written confirmation that they had received the information. Methods: The study was undertaken in the setting of an NHS methadone clinic with the aim of re- auditing the storage of methadone at home following the introduction of the new protocols. 174 patients completed an anonymous questionnaire regarding where they store methadone at home and whether they recall being given advice about safe storage. Community pharmacists were contacted by telephone to assess the level of advice given to methadone patients regarding safety. Results: Only 49 (28.2%) patients recalled being given advice about safe storage, 24 (13.8%) recalled that information was provided by clinic staff. 170 (97.7%) patients regard methadone as being dangerous. (28.2%). Methadone is most commonly stored in a cupboard (37.9%). All methadone is dispensed in a bottle with a child resistant cap on it. All patients reported they stored their methadone in the original bottle provided by the pharmacist. Conclusion: Recall of information on safety issues is very poor. Provision of written as well as verbal information is needed. The use of printed safety information cards which patients can take away for future reference may be of use. It is the responsibility of health professionals to ensure they provide information and advice to methadone users on the safe storage of their methadone at home. http://www.harmreductionjournal.com/content/5/1/15 Annemarie Mullin, Rosanna J McAuley, Derrett J Watts, Ilana B Crome and Roger N Bloor Harm Reduction Journal 2008, 5:15 2008-04-30 doi:10.1186/1477-7517-5-15 Harm Reduction Journal 1477-7517 5 15 2008-04-30 Injection drug users (IDUs) in San Juan, Puerto Rico are characterized by high rates of daily injecting, injection of shared drugs, re-use of injection syringes, and use of shooting galleries. They lack adequate access to new injection syringes and drug preparation equipment, and experience elevated rates of HIV and HCV infection. Between April and August, 2006, researchers and active IDUs collaborated in the development of an experimental HIV/HCV intervention aimed at identifying drug preparation items and practices that will enable IDUs to make drug solutions without potentially contaminated injection syringes contacting materials used to prepare drugs. The collaboration involved discussing and testing a variety of drug preparation items and practices in office and community settings. The process was repeated until concerns that had been raised were resolved, and a tentative set of intervention items and practices to be evaluated in a community field trial was identified. Throughout, a strong emphasis was placed on the capacity of an item or practice to address common problems confronted by IDUs (blunted needles, clogged syringes, injected particles) in addition to the core aim of reducing contamination of preparation materials by blood in injection syringes.This report describes the final selection of items and practices: 1) A small water bottle that permits IDUs to add approximately .05 cc water drops directly to drug powder in cookers; 2) A preparation syringe (a type of ancillary equipment not used for injecting) that permits IDUs to pull up a measurable amount of water to add to drug powder, an alternative to producing water drops; 3) A filtering device, the Sterifilt filter, attached to a preparation syringe, which eliminates the need for cotton or cigarette filters; 4) Use of a preparation syringe to distribute drug solution by backloading to injection syringe(s); 5) A small water bottle enabling IDUs to clean injection syringes by backload rinsing. The overarching aim of this experimental HIV/HCV intervention was to promote the safe re-use of drug preparation and injection items, and to impact the large number of IDUs in San Juan who maintain personal injection syringes, but currently use communal ancillary equipment in shooting galleries and inject drug solutions prepared with other IDUs' injection syringes. http://www.harmreductionjournal.com/content/5/1/14 H Ann Finlinson, Héctor M Colón, Juan Negrón and Rafaela R Robles Harm Reduction Journal 2008, 5:14 2008-04-28 doi:10.1186/1477-7517-5-14 Harm Reduction Journal 1477-7517 5 14 2008-04-28 Background: Early exit (drop-out) from drug treatment can mean that drug users do not derive the full benefits that treatment potentially offers. Additionally, it may mean that scarce treatment resources are used inefficiently. Understanding the factors that lead to early exit from treatment should enable services to operate more effectively and better reduce drug related harm. To date, few studies have focused on drop-out during the initial, engagement phase of treatment. This paper describes a mixed method study of early exit from English drug treatment services. Methods: Quantitative data (n=2,624) was derived from three English drug action team areas; two metropolitan and one provincial. Hierarchical linear modelling (HLM) was used to investigate predictors of early-exit while controlling for differences between agencies. Qualitative interviews were conducted with 53 ex-clients and 16 members of staff from 10 agencies in these areas to explore their perspectives on early exit, its determinants and, how services could be improved Results: Almost a quarter of the quantitative sample (24.5%) dropped out between assessment and 30 days in treatment. Predictors of early exit were: being younger; being homeless; and not being a current injector. Age and injection status were both consistently associated with exit between assessment and treatment entry. Those who were not in substitution treatment were significantly more likely to leave treatment at this stage. There were substantial variations between agencies, which point to the importance of system factors. Qualitative analysis identified several potential ways to improve services. Perceived problems included: opening hours; the service setting; under-utilisation of motivational enhancement techniques; lack of clarity about expectations; lengthy, repetitive assessment procedures; constrained treatment choices; low initial dosing of opioid substitution treatment; and the routine requirement of supervised consumption of methadone. Conclusions: Early exit diminishes the contribution that treatment may make to the reduction of drug related harm. This paper identifies characteristics of people most likely to drop out of treatment prematurely in English drug treatment services and highlights a range of possibilities for improving services. http://www.harmreductionjournal.com/content/5/1/13 Alex Stevens, Polly Radcliffe, Melony Sanders and Neil Hunt Harm Reduction Journal 2008, 5:13 2008-04-25 doi:10.1186/1477-7517-5-13 Harm Reduction Journal 1477-7517 5 13 2008-04-25 Background: The hepatitis C virus (HCV) is a major cause of drug-related morbidity and mortality, with incidence data implicating a wide range of HCV transmission risk practices. The Blood-Borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ) is a content valid instrument that comprehensively assesses HCV risk practices. This study examines the properties of a new weighted BBV-TRAQ designed to quantify HCV transmission risk among injecting drug users (IDU). Methods: Analyses of cross-sectional surveys of Australian IDU (N=450) were used to generate normative data and explore the properties of a weighted BBV-TRAQ. Items weights were assigned according to expert key informant ratings of HCV risk practices performed during the development stages of the BBV-TRAQ. A range of item weights was tested and psychometric properties explored. A weighting scheme was recommended based on the plausibility of normative subscale data in relation to research evidence and the ability of BBV-TRAQ scores to discriminate between HCV positive and negative participants. Results: While retaining the psychometric properties of the unweighted scale and demonstrating good internal reliability. By taking into account the relative transmission risk of a broad range of putative HCV practices, the weighted BBV-TRAQ produced promising predictive validity results among IDU based on self-report HCV status, particularly among young and less experienced injectors. Conclusions: Brief, easy to administer and score, and inexpensive to apply, the utility of the BBV-TRAQ for community based education and prevention is enhanced by the application of item weights, potentially offering a valid surrogate measure for HCV infection among IDU. http://www.harmreductionjournal.com/content/5/1/12 Mark A Stoove, Craig L Fry and Nicholas Lintzeris Harm Reduction Journal 2008, 5:12 2008-04-23 doi:10.1186/1477-7517-5-12 Harm Reduction Journal 1477-7517 5 12 2008-04-23 Background: Few studies of the prevalence of hepatitis C virus (HCV) infection have focussed on women who work as street sex workers to finance their drug use. Methods: The investigators report the survey findings of such a population in Glasgow. All women attending the health and social care drop-in centre, situated in Glasgow's "Red Light Area", during a four-week period in 1999 were invited to participate in a survey involving the provision of a saliva sample for anonymous HCV testing and the self-completion of a questionnaire seeking demographic, sexual and injecting practice data. Results: Of the 223 women who attended, 51% agreed to participate. Of the 98 women who provided a sufficient saliva sample, 64% (95% CI: 54%–74%) tested HCV antibody positive; 98% of those who tested positive had ever injected drugs. Adjusting for the 85% sensitivity of the saliva test, the HCV antibody prevalence among IDU sex workers sampled was 81%; a rate which is considerably higher than those recorded, contemporaneously, among Glasgow IDUs generally. Two factors were independently associated with HCV antibody positivity in saliva: ever shared needles and syringes (adjusted OR 5.7, 95% CI 2–16) and number of times imprisoned (adjusted OR 7.3, 95% CI 1.4–39, for more than five times compared to zero times). Conclusion: Women who engage in street sex work to finance their drug habit are a particularly desperate, chaotic and vulnerable population. This study demonstrates that their HCV infection risk may be greater than that for other IDUs. Those responsible for designing interventions to prevent HCV infection among IDUs should consider the special needs of this group. http://www.harmreductionjournal.com/content/5/1/11 Avril Taylor, Sharon J Hutchinson, Gail Gilchrist, Sheila Cameron, Susan Carr and David J Goldberg Harm Reduction Journal 2008, 5:11 2008-03-20 doi:10.1186/1477-7517-5-11 Harm Reduction Journal 1477-7517 5 11 2008-03-20 Background: Smoking rates in methadone-maintained patients are almost three times higher than in the general population and remain elevated and stable. Due to the various negative health effects of smoking, nicotine dependence contributes to the high mortality in this patient group. The purpose of the current study was to investigate Swiss methadone and buprenorphine-maintained patients' willingness to stop smoking and to clarify further smoking cessation procedures. Methods: Substance abuse history, nicotine dependence, and readiness to stop smoking were assessed in a sample of 103 opiate-dependent patients in the metropolitan area of Zurich, Switzerland. Patients were asked to document their smoking patterns and readiness to quit. Results: Only a small number of patients were willing to quit smoking cigarettes (10.7%) and, even though bupropione or nicotine replacement therapy was included in the fixed daily treatment care, only one patient received nicotine replacement therapy for smoking cessation. A diagnosis of depression in patients' clinical records was associated with readiness to stop smoking. No significant associations were found between readiness to quit smoking and age, methadone treatment characteristics, and presence of co-dependencies. Conclusion: The current prescription level of best medicine for nicotine dependence in Swiss methadone and buprenorphine-maintained patients is far from adequate. Possible explanations and treatment-relevant implications are discussed. http://www.harmreductionjournal.com/content/5/1/10 Victoria Wapf, Michael Schaub, Beat Klaeusler, Lukas Boesch, Rudolf Stohler and Dominique Eich Harm Reduction Journal 2008, 5:10 2008-03-18 doi:10.1186/1477-7517-5-10 Harm Reduction Journal 1477-7517 5 10 2008-03-18 Swedish snus is a medium/high nicotine delivery, low-nitrosamine moist smokeless tobacco product that has been estimated to be at least 90% less harmful than smoked tobacco. More men use snus than smoke cigarettes in Sweden, and a quarter of male former smokers quit by switching to snus. Leading multinational cigarette manufacturers have begun test-marketing snus-like products in the United States and other countries. The version of Philip Morris' Marlboro snus currently being marketed in the United States differs from Swedish snus in many ways; it has lower moisture content and pH, but most puzzling is its very low nicotine delivery. Philip Morris, the market-leader in United States cigarette sales, may have designed the product so that it does not satisfy nicotine cravings and fails to enable smokers to switch. In this paper we compare and contrast Swedish snus and Marlboro snus, and speculate as to why Philip Morris may have intentionally designed a product that delivers very low levels of nicotine. We recommend that Philip Morris cease using the term "snus" to refer to dry tobacco products with low nicotine delivery, so that the term be reserved for moist, low-toxin, medium/high nicotine delivery smokeless tobacco products that are qualitatively similar to the leading brands in Sweden. http://www.harmreductionjournal.com/content/5/1/9 Jonathan Foulds and Helena Furberg Harm Reduction Journal 2008, 5:9 2008-02-27 doi:10.1186/1477-7517-5-9 Harm Reduction Journal 1477-7517 5 9 2008-02-27 Hepatitis C is the most common blood borne virus in Australia affecting over 200 000 people. Effective treatment for hepatitis C has only become accessible in Australia since the late 1990's, although active injecting drug use (IDU) remained an exclusion criteria for government-funded treatment until 2001. Treatment uptake has been slow, particularly among injecting drug users, the largest affected group. We developed a peer-based integrated model of hepatitis C care at a community drug and alcohol clinic. Clients interested and eligible for hepatitis C treatment had their substance use, mental health and other psychosocial comorbidities co-managed onsite at the clinic prior to and during treatment. In a qualitative preliminary evaluation of the project, nine current patients of the clinic were interviewed, as was the clinic peer worker. A high level of patient acceptability of the peer-based model and an endorsement the integrated model of care was found. This paper describes the acceptability of a peer-based integrated model of hepatitis C care by the clients using the service. http://www.harmreductionjournal.com/content/5/1/8 Josephine Norman, Nick M Walsh, Janette Mugavin, Mark A Stoové, Jenny Kelsall, Kirk Austin and Nick Lintzeris Harm Reduction Journal 2008, 5:8 2008-02-25 doi:10.1186/1477-7517-5-8 Harm Reduction Journal 1477-7517 5 8 2008-02-25 Background: Skin and soft-tissue infections are very common among persons who inject drugs. They occur when microbes pass under the protective layer of the skin and proliferate. This happens when harm reduction recommendations such as skin aseptia before injection and sterile injection equipment usage are not properly followed. Methods: A group of active drug users involved in a health promotion project as peer educators were asked about their formation needs. To address their inquiries concerning skin and soft-tissue infections, we devised with them a series of workshops touching upon common infections, the microflora, and microbial transmission. Results: Participants learned to identify common infections and how to properly react in case of an abscess, cellulitis or phlebitis. They saw microscopic objects, found out about the high prevalence of microbes in their environment and on their skin, and could appreciate the efficiency of different washing and disinfection techniques. They visualized how easily microbes can spread from person to person and from contaminated objects to persons. Conclusion: In the weeks following this activity, some participants demonstrated and reported healthy behavioural changes regarding their own injection practices. Furthermore, they shared their newfound knowledge and began enforcing its application among people they inject drugs with. Most participants greatly appreciated this activity and valued it as being highly efficient and tangible. Note: A French version of this paper is available on the Journal's web site [see Additional file 1].Additional File 1Article en Français (article in French). Une version française de l'article a été préparée par les auteurs. Elle est disponible à partir du site Web du Harm Reduction Journal.Click here for file http://www.harmreductionjournal.com/content/5/1/7 Sarah-Amelie Mercure, Isabelle Tetu, Steeve Lamonde, Francoise Cote and Guides de rue working group Harm Reduction Journal 2008, 5:7 2008-02-12 doi:10.1186/1477-7517-5-7 Harm Reduction Journal 1477-7517 5 7 2008-02-12