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.

     

An invisible barrier to integrating HIV primary care with harm reduction services: philosophical clashes between the harm reduction and medical models

Overall AIDS mortality in the United States has declined in recent years, but declines have not been consistent across all populations. Due to an array of barriers to care, minorities and poor people who are active substance users have not benefited as others have from advances in the treatment of HIV disease. One way to address this problem is to integrate HIV primary care into harm reduction programs that already effectively serve this population. Such collaborations, however, are difficult to initiate and sustain. Philosophical differences between the medical model and the harm reduction model, which often remain invisible to the parties involved, underlie these difficulties. This article addresses the issue by describing a partnership in the Bronx, NY, between CitiWide Harm Reduction Inc. (CitiWideHR) and the Montefiore Medical Center. It focuses specifically on the sources of philosophical differences between models, and briefly assesses the potential for successful collaborations of this sort.     

Access to harm reduction services in Atlantic Canada: implications for non-urban residents who inject drugs

Awareness of drug use in rural communities and small towns has been growing, but we know relatively little about the challenges injection drug users (IDUs) living in such places face in accessing harm reduction services. Semi-structured interviews were conducted with 115 IDUs in urban and non-urban areas of Atlantic Canada. In many instances, geographic distance to a needle exchange program (NEP) meant that individuals living outside of urban areas and who were not provided services through an NEP's outreach program were at a disadvantage in terms of an array of supports offered through many NEPs. These include access to free clean injecting equipment, and such ancillary services as clothing, food, referrals, information and social support. The integration of the services and approaches provided by NEPs into mainstream health services in non-urban places is one possible model for improving such access.     

Assessing the impact of harm reduction programs on law enforcement in Southeast Asia: a description of a regional research methodology

ABSTRACT: For over 15?years the Australian Agency for International Development (AusAID) has been a leading donor for harm reduction projects in Southeast Asia. The recent AusAID-supported harm reduction projects of greatest significance have included the Asia Regional HIV/AIDS Project (AHRP), from 2002 until 2007,1 and the HIV/AIDS Asia Regional Program (HAARP), from 2007 until 2015.2 Both projects included in their design specific strategies for engaging with law enforcement agencies at country level. The main focus of these strategies has been to develop law enforcement harm reduction policy and curriculum, and the design and implementation of specific harm reduction training for law enforcement officers.In July 2008, the Australian Development Research Awards (ADRA) funded the Nossal Institute for Global Health at the University of Melbourne to establish a research project created to assess the influence of harm reduction programs on the policy and operational practices of law enforcement agencies in Southeast Asia, known as the LEHRN Project (Law Enforcement, Harm Reduction, Nossal Institute Project). The ADRA is a unique grant research mechanism that specifically funds development research to improve the understanding and informed decision making of the implementation of Australian aid effectiveness.While the need to engage law enforcement when establishing harm reduction programs was well documented, little was known about the impact or influence of harm reduction programs on policy and practices of law enforcement agencies. The LEHRN Project provided the opportunity to assess the impact of harm reduction programs on law enforcement in Southeast Asia, with a focus on Vietnam, Cambodia and Lao PDR.     

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.     

Vietnamese-speaking injecting drug users in Melbourne: the need for harm reduction programs

While research on aspects of injecting drug use (IDU), including injecting and sexual risks for HIV transmission, has been progressing in 'mainstream' Australian populations, there has been little among non-English speaking background (NESB) communities in Australia, particularly the South-East Asian communities, of which the Vietnamese is the largest. This exploratory study employed and trained peer workers to recruit and interview IDUs of Vietnamese origin in Melbourne on a wide range of subjects related to risks associated with their drug using, as an initial assessment of risk-taking behaviours for blood-borne viruses among Vietnamese-speaking IDUs. A finger-prick blood sample was taken where possible to measure antibody status to HIV, HBV and HCV.
The profile which emerged was not dissimilar to that of their English-speaking counterparts prior to the benefit of currently available harm-reduction programs. A relatively isolated group whose social world often related only to other Vietnamese-speaking drug users, they were engaging in unsafe sex and unsafe injecting and were unfamiliar with procedures for cleaning injecting equipment and where they could seek out information and services, including needle exchanges. This study has identified an urgent need not only to promote currently available information and services to this group, but also to provide culturally relevant education and other harm-reduction measures needed to prevent transmission of HIV, other BBVs and STDs. The study has highlighted the lack of responsiveness of mainstream health services to the needs of Vietnamese-speaking IDUs.     

Assessing the feasibility of retrospective cohort studies

While most epidemiologic cohort studies are preceded by some sort of feasibility study, details of such prior investigations are rarely reported. Yet it is during such feasibility studies that critical decisions are made, such as site selection and definition of exposure. Here we present the details on one such feasibility study, conducted to determine the possibility of a cohort mortality study of workers exposed to ethylene oxide. Issues discussed include methods for estimating sample size and power, for estimating levels of exposure, and for assessing the adequacy of personnel records.     

Assessing management training needs: a study in the Punjab health services,Pakistan

Pakistan's public sector is organized in a federal system with many management and planning functions devolved to the 4 provincial governments. Provincial health secretariats lead on most policy and planning decisions for health services. The provinces employ health personnel, although the national Public Service Commission controls some key aspects of human resources management. Reporting the findings of a training needs assessment (TNA) for health personnel in the provincial health services of Punjab, the authors show how TNA can be used systematically to improve the quality of health professional training. They also discuss the extent to which better training could contribute to improved health management capacity in Pakistan, and describe the context and problems of Pakistan's health services, focusing upon management capacity, and the methods and results of a training needs assessment conducted to address the problems. A final section covers the usefulness of the TNA method in Pakistan and its applicability to other countries. Moreover, the implications of decentralization and the problems of preparing training plans in the absence of decentralized structures are discussed.     

Introducing oral tobacco for tobacco harm reduction: what are the main obstacles?

With the number of smokers worldwide currently on the rise, the regular failure of smokers to give up their tobacco addiction, the direct role of smoke (and, to a much lesser extent, nicotine) in most tobacco-related diseases, and the availability of less toxic (but still addictive) oral tobacco products, the use of oral tobacco in lieu of smoking for tobacco harm reduction (HR) merits assessment.     

Delivery of Internet-based cancer genetic counselling services to patients' homes: a feasibility study

We examined the feasibility of home videoconferencing for providing cancer genetic education and risk information to people at risk. Adults with possible hereditary colon or breast and ovarian cancer syndromes were offered Internet-based counselling. Participants were sent web cameras and software to install on their home PCs. They watched a prerecorded educational video and then took part in a live counselling session with a genetic counsellor. A total of 31 participants took part in Internet counselling sessions. Satisfaction with counselling was high in all domains studied, including technical (mean 4.3 on a 1-5 scale), education (mean 4.7), communication (mean 4.8), psychosocial (mean 4.1) and overall (mean 4.2). Qualitative data identified technical aspects that could be improved. All participants reported that they would recommend Internet-based counselling to others. Internet-based genetic counselling is feasible and associated with a high level of satisfaction among participants.     

Characteristics of physically active smokers and implications for harm reduction

Objectives. We sought to establish the prevalence of physical activity among smokers, whether or not physically active smokers were more likely to attempt cessation, and who these physically active smokers were.Methods. We used logistic regression to contrast physically active and inactive smokers in a secondary data analysis of the Canadian Community Health Survey Cycle 1.1.Results. Physically active smokers represented almost one quarter of the smoking population. Compared with physically inactive smokers, physically active smokers were more likely to have attempted cessation in the past year. Physically active smokers were more likely to be young, single, and men compared with their inactive counterparts. Income had no influence in distinguishing physically active and inactive smokers.Conclusions. Skepticism persists regarding the practicality and potential risks of promoting physical activity as a harm-reduction strategy for tobacco use. We found that a modest proportion of the daily smoking population was physically active and that engagement in this behavior was related to greater cessation attempts. Interventions could be developed that target smokers who are likely to adopt physical activity.Recent evidence has suggested that physical activity could act as a potential tobacco harm-reduction strategy for smokers.1 Although we have shown in previous work that physical activity fulfills several criteria that guide the development of potential tobacco harm-reduction strategies, skepticism remains regarding its practicality.1 The majority of the North American population does not fulfill the current public health recommendations for physical activity.2^,3 Because smokers have a tendency to participate in less physical activity compared with nonsmokers,4^–6 it is unclear how practical it would be to promote physical activity as a harm-reduction strategy.An additional concern associated with the adoption of physical activity as a potential harm-reduction strategy is the possibility that physical activity may unintentionally result in a delay in cessation. If smokers perceive physical activity as an effective strategy for reducing smoking-related morbidity and mortality, cessation attempts could be deferred or neglected.7 This would undermine the long-term goal of harm reduction: complete smoking cessation.8To maximize the effectiveness of physical activity as a tobacco harm-reduction strategy, physical activity must be promoted and advocated to those smokers most likely to adopt and maintain it. If smokers have no interest in becoming physically active, any effort to promote physical activity would be ineffective. The success of public health interventions that promote physical activity among smokers will be dependent upon the ability of health professionals to identify and target those smokers likely to participate in physical activity on a regular basis.If physical activity is to be regarded as an effective tobacco harm-reduction strategy, these concerns need to be addressed. Therefore, we sought to answer 3 specific questions: (1) What is the prevalence of physically active smokers within the smoking and general population? (2) Are physically active smokers more likely to attempt smoking cessation? (3) Which demographic characteristics differentiate physically active smokers from physically inactive smokers? Some answers to these questions were provided by Ward et al.,9 who examined characteristics of highly physically active and less physically active smokers in a sample of military recruits. They concluded that highly physically active smokers were more likely to be young men who earned higher family incomes, consumed more fruits and vegetables, were less dependent on nicotine, and were more likely to achieve cessation for a minimum of 24 hours compared with less physically active smokers.However, several limitations were identified in the study conducted by Ward et al. that may have influenced the results. Reliance on a sample of military recruits may have limited the generalizability of the results.9 Also, the assessment of physical activity levels by a single question may not have been as accurate as measuring frequency, duration, and intensity of specific physical activities. Thus, misclassification of physical activity levels may have occurred.9 We addressed these limitations by comparing physically active and inactive smokers with a more detailed measure of physical activity and a nationally representative sample of Canadians to provide further insight into the role of physical activity as a tobacco harm-reduction strategy.     

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,…     

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.     

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.