Drug use and harm reduction in Afghanistan

Opium has been cultivated in Afghanistan since 1100 A.D., although production has steadily increased since 1979. Currently, Afghanistan produces three-quarters of the global opium supply, with injection drug use and HIV currently following the opium trade route through Central Asia. Although systematic studies are lacking, heroin use appears to be on the rise in Afghanistan. The purpose of this paper is to briefly provide historical background and current statistics for drug production and use in Afghanistan, to discuss the new government's policies towards problem drug use and available rehabilitation programs, and to assess Afghan harm reduction needs with consideration of regional trends.     

Responsible use to responsible harm: illicit drug use and peer harm reduction in a darknet cryptomarket

Sale of illicit drugs through online ‘cryptomarkets’ is a notable innovation in the illicit drug market. Cryptomarkets present new ways of configuring risk and harm in relation to drug use. I examine the kinds of knowledge and discourses users employed to do this. I argue that the lay/expert divide that creates a hierarchy of knowledge around drug use and harms is increasingly undermined by the creation of knowledge communities by drug users who make drug use work effectively for them. I draw on the discussion forum of a now defunct English language focused cryptomarket, anonymised as ‘Merkat’, collected between 2015 and 2016. Typically, vendors in the major cryptomarkets are based in the USA, UK, China, the Netherlands and Australia. Buyers were mainly located in the USA, UK, Australia and Western Europe. I scraped the market forum threads and coded on emergent themes. I found that risk worked along four axes, cultural normalisation/pathologisation, chemical potency, legal/policy and market, each of which required a set of practices and orientations to manage successfully. Users indicated that they had adapted many harm reduction practices, while also promoting a ‘responsible harm’ orientation where they sought to own and take charge of harm. The support infrastructure drew on knowledge from drug users, vendors and interested professionals. I conclude that cryptomarkets can provide a community infrastructure that supports the exchange of drugs and configures them as risky but manageable objects.     

Tobacco harm reduction and the evolution of nicotine dependence

In recent years, a renewed debate has developed around the potential for modified tobacco products to play a role in reducing tobacco-related harm. During the 1960s and 1970s medical experts recommended to smokers who could not quit that they switch to cigarettes with lower tar and nicotine content. At the time, survey data suggested that smokers who switched did not compensate for the reduction in nicotine by increasing their intake. However, public health scientists were hindered in their ability to evaluate the population impact of the reduced tar strategy by a limited understanding of nicotine addiction. Smoking dependence was seen as primarily psychological and social, rather than pharmacological or biological, until the late 1970s, when addiction researchers began to apply experimental techniques from other forms of drug abuse to study smoking behavior. This history has important lessons for current discussions about tobacco harm reduction and regulation of nicotine delivery.     

Early mortality experience in a large military cohort and a comparison of mortality data sources

Background  

Complete and accurate ascertainment of mortality is critically important in any longitudinal study. Tracking of mortality is particularly essential among US military members because of unique occupational exposures (e.g., worldwide deployments as well as combat experiences). Our study objectives were to describe the early mortality experience of Panel 1 of the Millennium Cohort, consisting of participants in a 21-year prospective study of US military service members, and to assess data sources used to ascertain mortality.     

Tobacco harm reduction: an alternative cessation strategy for inveterate smokers

According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases.     

Drugs, prisons, and harm reduction

The use of drugs in society raises important considerations for health and social policy. Critical health and social care issues arise when drugs are used inside prisons. This paper argues that there is an urgent need for prison drug policies to adopt the principles of harm reduction. However, current policy orthodoxy emphasises the control of drugs and punishment for drug taking. Key components of harm reduction are operationalised in this article by exploring the potential for harm reduction in prison within the context of English drug policy. Whilst the focus is on English policy debates, the discussion will have wider international resonance.     

Public health implications of smokeless tobacco use as a harm reduction strategy

Harm reduction strategies involve promoting a product that has adverse health consequences as a substitute for one that has more severe adverse health consequences. Smokeless tobacco low in nitrosamine content offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the potential for such products to serve as a gateway to more harmful tobacco products, public misinterpretation of "less harmful" as "safe," distraction from the public health goal of tobacco elimination, and ethical issues involved in advising those marketing these harmful products. We offer a research agenda to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.     

Assessing pharmacy student experience with,knowledge of and attitudes towards harm reduction: illuminating barriers to pharmacist-led harm reduction

Background

As the burden from the opioid epidemic continues to increase in the state of Minnesota and across the nation, the University of Minnesota College of Pharmacy seeks to design an innovative, comprehensive harm reduction curriculum in order to better train student pharmacists to serve the varied needs of the greater community. This study examines incoming individuals’ baseline knowledge of and attitudes toward harm reduction in order to better inform curriculum planning and to ultimately produce pharmacists capable of impacting the devastating effects of the opioid crisis.

Methods

Incoming first-year pharmacy students took a survey focused on their knowledge of opioid overdose and the drug naloxone and also provided written reflections on their perceptions of harm reduction. Data was coded using consensual qualitative research (CQR) into appropriate domains.

Results

Pharmacy students beginning their professional education revealed a lack of knowledge of proper response to an overdose situation, with 18.56% unfamiliar with the opioid antagonist drug naloxone. Close to 10% (9.58%) of students expressed unwillingness to do anything other than call an ambulance during an overdose event, while 8.98% were either unsure or felt that they would not feel compelled to do something to help. Qualitative coding revealed many barriers to students’ becoming capable harm reductionists, including lack of knowledge of substance use, addiction, and harm reduction, in addition to the presence of bias and stigma.

Conclusion

In order to interrupt the cycle of misinformation and stigma within the larger community and the subgroup of medical providers, gaps in student knowledge must be addressed in meaningful, specific ways over the course of their pharmacy education. Evaluating baseline knowledge and beliefs informs the design of a flexible, action-oriented curriculum to produce well-trained pharmacists ready to engage in finding solutions to the opioid crisis.

     

Smoking reduction in a population-based cohort

OBJECTIVE: To describe the factors associated with smoking reduction in a population-based cohort study in Cornella de Llobregat (Barcelona, Spain). MATERIAL AND METHODS: We used data from the Cornella Health Interview Survey Follow-up Study (n = 2,500). We included for the analysis those subjects who declared to be daily smokers at baseline (1994) and continued smoking after eight years of follow-up (n = 234). We considered as operational definition of reduction to reduce > or = 10 cigarettes/day. We calculated the relative risk (RR) of smoking reduction vs. maintain or increase tobacco consumption and 95% confidence intervals (CI) by means of a Breslow-Cox regression model. RESULTS: The average reduction on number of cigarettes among subjects who reduced their tobacco consumption was similar in men and women (13 cigarettes/day). The consumption intensity and self-perceived health are the characteristics associated with reduction: smoking reduction was associated with being a smoker > 20 cigarettes/day (RR = 3.25; 95% CI: 1.69-6.25) and individuals who declared having a suboptimal health showed a 3-fold risk of reducing smoking (RR = 3.13; 95% CI: 1.52-6.43). CONCLUSION: Heavy smokers and smokers with poor health are those smokers more likely to reduce their tobacco consumption. Specific actions targeting them could lead to increase reduction and even smoking cessation.     

Snuff use and smoking in U.S. men: implications for harm reduction

BACKGROUND: Encouraging smokers to switch to snuff may have unintended public health implications. This study examined the associations between snuff use and smoking in a representative sample of U.S. men. METHODS: Subjects were males aged >or=18 years in the National Health Interview Survey (N=13,865). The data analysis was conducted between August 2001 and April 2002. Multiple logistic regression modeling was used to examine the association between using snuff and quitting smoking. RESULTS: In 1998, 26.4% of U.S. men smoked, 3.6% used snuff, and 1.1% used both products. Adjusting for age and race/ethnicity, current smoking was most prevalent among males who used snuff on some days (38.9%) and lowest among those who used snuff every day (19.2%). Daily snuff users were significantly more likely than never-users to have quit smoking in the preceding 12 months (odds ratio [OR]=4.23; 95% confidence interval [CI]=2.16-8.28). However, U.S. men were more likely to be former snuff users who currently smoked (2.5%) than to be former smokers who currently used snuff (1.0%). Occasional snuff users (some day users) were more likely than never users to have tried to quit smoking in the preceding year (OR=1.69; 95% CI=1.04-2.76) but tended to be less likely to succeed (OR=0.50; 95% CI=0.19-1.33). CONCLUSIONS: Some men may use snuff to quit smoking, but U.S. men more commonly switch from snuff use to smoking. Some smokers may use snuff to supplement their nicotine intake, and smokers who also use snuff are more likely than nonusers to try to quit smoking but tend to have less success.     

Expanding harm reduction services through a wound and abscess clinic

A wound and abscess clinic, held concurrently with a syringe exchange, provided economical treatment and aftercare for injection-associated soft tissue infections. During 20 two-hour clinic sessions, 173 treatment episodes were logged, and the visit cost was estimated at $5 per patient. Increased patient-clinician interactions provided opportunities beyond those afforded by the syringe exchange for patients to obtain resources and referrals to services such as HIV counseling and testing, medical care, and drug treatment. Distribution of cards advertising the clinic was substantially less effective than word of mouth in increasing community awareness of the clinic.     

Food as harm reduction: barriers,strategies, and opportunities at the intersection of nutrition and drug-related harm

Research suggests that food insecurity exacerbates the harms experienced by people who use drugs (PWUD). Therefore, improving the food security status can help PWUD reduce drug-related harms. This paper identifies a knowledge gap in public health and harm reduction literatures regarding the relationship between food and harm reduction. We argue that there needs to be a more comprehensive and systematic model of food provision in harm reduction services. Our argument is based on a qualitative case study of 42 people who currently use, or have used drugs in Vancouver, Canada and of staff of 27 programs that provide harm reduction services in the city. The research demonstrates how PWUD experience the effects of drug use on their food consumption, how they access food, and how they practice self-care. It also shows how harm reduction services, while they often provide food, are unable to systematically address the dietary-related harms associated with drug use. This presents an opportunity and a challenge for these organizations and for harm reduction as a public health approach. We call for more research to be done on food as harm reduction and for stable publically funded food provision in harm reduction-oriented services.     

遏制艾滋病流行,履行减少危害策略

艾滋病(AIDS)是严重危害人民群众身体健康和生命安全的重大传染病,已成为全球的严重公共卫生问题和社会问题。但AIDS与常见的急性传染病,如流感、SARS、霍乱不同,人感染艾滋病病毒(HIV)后,在急性期会出现一些如发热、皮疹、淋巴结肿大等易被忽略的症状,这些症状很快就会消失。感染HIV 2周至6个月后,进行血液检测才会呈HIV抗体阳性。此后临床上会经历一个2~10年无症状潜伏期。但在这段时间,感染了HIV的人可将HIV传染给他人而自己没有任何病征,而成为HIV的传染源;这样随着HIV的流行,在社会上会积累越来越多的未被发现的传染源,…