Since 2010, the incidence of acute Hepatitis C Virus (HCV) infections in the U.S. has nearly quadrupled. Re-use and sharing of syringes among people who inject drugs (PWID) is a significant contributor to increased rates of HCV transmission and a risk factor for HIV infection. Community pharmacists are uniquely positioned to offer harm reduction services that lower the transmission of HCV/HIV by providing sterile syringes to PWID. However, legislation on non-prescription syringe dispensing varies by state and differences in individual pharmacists’ interpretation and attitudes regarding these laws may impact their willingness to participate in harm reduction services. Little is known about the impact of these factors on pharmacist engagement with harm reduction services in central Appalachia, a region particularly hard-hit by the opioid epidemic. The objective of this project is to qualitatively evaluate open-ended responses collected as part of a survey administered to community pharmacists in three central Appalachian states in order to determine: 1) pharmacists’ knowledge and attitudes regarding their state’s non-prescription syringe dispensing laws; and 2) the correlation of attitudes about state legislation to pharmacists’ intent to sell syringes to PWID. A telephonic community pharmacist survey on non-prescription syringe attitudes and behaviors was conducted between April and June 2018 in Northeast Tennessee, Western North Carolina, and Southwest Virginia. Survey responses were obtained from pharmacists practicing in 391 community pharmacies (51% response rate) in the study region. Transcribed responses to open-ended survey questions were extracted from the dataset and a qualitative analysis was completed using a generalized inductive approach. A single investigator coded all qualitative data and a second investigator coded data from a random selection of 10% of the respondents in order to develop themes through consensus. Descriptive analysis was conducted using SPSS version 25 to compare syringe law attitude thematic categories to respondents’ intent to sell syringes to PWID. Preliminary analysis identified discrepancies in pharmacists’ non-prescription syringe law knowledge, state-specific differences in pharmacists’ non-prescription syringe law attitudes, and underlying differences in willingness to sell syringes to PWID based on attitudes. The findings may encourage pharmacists to reflect on personal attitudes and interpretation of state-specific legislation as factors that may influence participation in an evidence-based harm reduction strategy for prevention of HCV/HIV transmission. This study offers preliminary results that will serve as a basis for larger studies and interventions aimed at reducing ambiguity in pharmacists’ interpretation of non-prescription syringe dispensing laws and encouraging pharmacists to counter the spread of HCV/HIV in an evidence-based manner.

INTRODUCTION: Drug overdose death is now the leading cause of mortality among homeless adults in Boston, with opioids implicated in a majority of those deaths. Harm reduction interventions help minimize the risks associated with substance use, and are critical in supporting individuals with substance use disorder. Medical monitoring programs are an effective harm reduction strategy that work to prevent fatal drug overdoses and keep people safe while still actively using. METHODS: Visit data from the Supportive Place for Observation and Treatment (SPOT) was compiled and analyzed. The two measures of interest were the count of referrals to substance use disorder treatment and the count of visits prior to the first referral to treatment. Chi-square tests of independence, odds ratios, and binary logistic regression models were used to describe the association between factors of interest and referrals to substance use disorder treatment. RESULTS: Gender and age did not show any significant association to a connection to treatment. Overdose history (Adjusted Odds Ratio 6.59), reported stimulant use (AOR 2.59), and documented health or harm reduction education (AOR 5.14) were all associated with increased odds of being referred to substance use disorder treatment. Heavy sedation (AOR 0.55) was associated with decreased odds of a treatment referral.When examining factors associated with rapid connection to treatment, male gender (OR 1.87) was associated with increased odds, while overdose history (AOR 0.42) was associated with decreased odds. DISCUSSION: The two most impactful factors associated with increased odds of connecting to substance use disorder treatment were reported overdose history and documented education. Both of these factors suggests that a strength of SPOT is its ability to form and maintain meaningful connections with participants. One way that SPOT could improve referral outcomes would be to increase its ability to engage participants, such as through the recruitment of more harm reduction specialists or peer recovery coaches.

Ett begrepp som på senare tid fått större utrymme inom behandling av beroendesjukdom är skadereduktion (Harm reduction). Skadereduktion är metoder och ambitioner syftar till att minska skadeverkningarna av ett beteende utan att nödvändigtvis minska beteendet. Skadereduktion är ett begrepp som under senare år har fått en ökad användning inom sjukvård och socialtjänst men också inom rättsväsende och policyarbete. Trots att det använts i olika kontexter sedan 90-talet så finns det ingen tydlig definition av vad det innebär och olika tolkningar av begreppet kan leda till svårigheter att implementera dessa vårdåtgärder. Syftet är att beskriva skadereduktion som begrepp inom beroendevård med hjälp av begreppsanalys. En begreppsanalys utifrån Segesten modell (2017) har genomförts. Resultatet utgörs av en lexikal del och en litterär del som leder till att definiera meningsbärande attribut som sedan sorterats in i framträdande attribut för skadereduktion. I den litterära analysen presenteras de framträdande attributen som är: Autonomi, delaktighet av personer som tar droger, fokus på skador, folkhälsa, mänskligt värde och praktiskt och pragmatiskt. Tre fallbeskrivningar utformades för att beskriva och förtydliga resultatet. Avslutningsvis diskuteras hur skadereduktion och dess attribut förhåller sig inom kontexten beroendevård. Skadereduktion är mer än bara specifika insatser utan också ett förhållningssätt och ett annat sätt att se på de som brukar droger. Skadereducerande insatser och förhållningssätt flyttar fokus från att bota till att fokusera på att minska skador för dem som brukar droger.

BACKGROUND. Skin cancer represents a significant health threat with over 1.3 million diagnoses, 8000 melanoma deaths, and more than $1 billion spent annually for skin cancer healthcare in the US. Despite findings from laboratory, case-control, and prospective studies that indicate a link between youthful indoor tanning (IT) and skin cancer, IT is increasing among US youth. Appearance-focused interventions represent a promising method to counteract these trends. METHODS. A total of 430 female indoor tanners were randomized into intervention or no intervention control conditions. Intervention participants received an appearance-focused booklet based on decision-theoretical models of health behavior. Outcome variables included self-reports of IT behavior and intentions, as well as measures of cognitive mediating variables. RESULTS. Normative increases in springtime IT rates were significantly lower (ie, over 35%) at 6-month follow-up in intervention versus control participants with similar reductions in future intentions. Mediation analyses revealed 6 cognitive variables (IT attitudes, fashion attitudes, perceived susceptibility to skin cancer and skin damage, subjective norms, and image norms) that significantly mediated change in IT behavior. CONCLUSIONS. The appearance-focused intervention demonstrated strong effects on IT behavior and intentions in young indoor tanners. Appearance-focused approaches to skin cancer prevention need to present alternative behaviors as well as alter IT attitudes. Mediational results provide guides for strengthening future appearance-focused interventions directed at behaviors that increase risk of skin cancer.

Based on the growing importance of community engagement and the recognition of its importance by the American Association of Colleges of Pharmacy (AACP), the committee offers several examples of community engagement activities for consideration and replication by our academy and beyond. These activities, including those of winning institutions of the Lawrence J. Weaver Transformational Community Engagement Award, can be mapped to the core components of community engagement presented in Table 1. The committee, using an implementation readiness framework, provides the reader with insight into the challenges that may impact successful community engagement and encourages our academy to continue its work to support faculty capacity in this area. Toward that end, the committee offers a policy statement that encourages schools and colleges of pharmacy to have an office or designate a faculty member whose focus is specifically on community engagement. The committee also offers a recommendation that the core components be included in the criteria for the Weaver Award.

Current research suggests clear correlation between People Who Inject Drugs (PWID) struggling with Substance Use Disorder (SUD) and increased prevalence of Human Immunodeficient virus (HIV) and Hepatitis C (HCV) when compared to the general population. Current research also suggests clear correlation between decreased rates of HIV and HCV in communities with well supported Harm Reduction Programs such as Syringe Service Programs (SSP). The regions of Northeast Tennessee and East Tennessee have been flagged by the CDC as potential regions for future HIV outbreaks due to disproportionately high HCV rates. Prior to 2021, the incidence in of HIV in PWID in East Tennessee Region held consistent with about 15 new diagnoses per year. In 2021 this region reported 86 new diagnoses of HIV among PWID’s as well as an increase from 19.6% to 59.0% of total percentage of HIV incidence in this region associated with PWID’s. This data suggests a potential rapid HIV transmission event could occur in this region and surrounding areas, especially among PWID, area such as that seen in Scott County Indiana in 2015 that first prompted the CDC review of counties at highest risk of a potential outbreak. While there has not yet been a reported increase in incidence in our region of Northeast Tennessee, there is a high likelihood of our region’s population and health system getting impacted by this event. To further investigate what factors may have contributed to this event we called registered Tennessee and neighboring counties SSP’s within 100 miles radius to survey what their program was seeing in terms of HIV/HCV testing, participation accessibly, and weekly availability including changes since the onset of COVID-19 pandemic. We then reviewed data collected from participants at the region’s one local SSP, Syringe Trade and Education Program of Tennessee (STEP TN), a service provided by a partnership between Cempa Community Care and ETSU Center of Excellence for HIV/AIDS. We askedreviewed participants’ experiences regarding changes in accessibility they encountered over the last year including those contributable to the COVID-19 pandemic, changes in current drug use, barriers to HCV/HIV testing, and accessibility to supplies and healthcare. The goal of this project was to determine associations with the increased HIV incidence in the surrounding regions in hopes of mitigating the impact it might have on our region of Northeast Tennessee’s health system; we are not investigating causation or implying correlation to SSP programs, particularly as there is evidence supporting increased incidence of transmission of infectious disease following SSP closures. We plan to use the results for of this project to reduce barriers to care and increase accessibility and testing among PWID’s in our area.

This study explores frontline support workers’ perspectives on how mothers’ needs and children’s rights are balanced in harm reduction programs in an urban centre in Alberta, Canada. Interviews were conducted with five (5) workers employed at harm reduction programs supporting mothers and/or children facing circumstances related to substance use, domestic violence, mental health, poverty, homelessness, and criminal justice system involvement. The interviews, along with content from publicly available (web-based) program descriptions, were analyzed through a theoretical framework that mobilizes theories of intersectional stigma (both on symbolic/interactional and structural levels). Participants revealed that intersectional stigma emerges from an abstinence-based child welfare system (namely, Children’s Services (CS) in Alberta), which constitutes a major barrier to ensuring the best interests of both mothers and children. Such stigma manifests based on the intersecting identities that women hold as mothers, as substance users, as partners who face violence, as criminalized persons, and more. Experiences of these barriers disproportionately impact mothers who do not meet idealized standards of mothering—standards which seem to be upheld and reproduced by the medicalization of motherhood. These families are more vulnerable to interventions including child apprehensions, which have severe impacts for both mothers and their children. The perspectives of the frontline support workers point to the importance of a harm reduction approach as an alternative to the current harm elimination one, but identified tensions between harm reduction and harm elimination remain a barrier to balancing the best interests of both mothers and children. Despite these tensions, the participants discuss their own practices of self-awareness and reflection and point to relationship building, non-judgment, and client-centering as essential to the role of the frontline worker who adopts a harm reduction approach.

No description available.

The purpose of this study is to critically reflect on what is represented to be the problem in harm reduction interventions directed towards drug users. The study is based on five qualitative, semi-structured interviews with professionals in the social services administration of Stockholm. With assistance from Carol Bacchi's theoretical approach "What's the problem represented to be", we critically assess how the problem is constituted in harm reduction interventions. Four themes are addressed. First, our data indicate that the problem is assumed to be that some drug users fail or neglect to comply with the social services' demand for drugabstinence, despite multiple attempts, and are considered to be untreatable. Second, we show that there is an assumption that drug users who receive harm reduction interventions must change and become stabilized, although they are categorized as untreatable. Third, we show how professionals in our study fail to problematize the conditions and checkups people who are subject to harm reduction interventions must follow. Fourth, we illustrate the effects of the problem and show examples of drug users who dare say that they do not aim for abstinence, in an institutional context where abstinence is still the default.

This thesis uses the four principles of biomedical ethics as put forth by Beauchamp and Childress to address the issue of the criminalization of sex work in contemporary national and international settings. Though a controversial subject, the existence of sex work has been a constant for centuries worldwide. However, the criminalization of sex work in contemporary society has been largely predicated on the conflation of sex work and a number of social ills, particularly human trafficking and sexual exploitation. This uncritical and inappropriate conflation of terms has enabled discourse, legislation, and even health care policy that is unethical, ineffective, and explicitly harmful to both sex workers and victims of human trafficking alike.Medical professionals have a unique set of moral obligations to which they must hold themselves in their practice of medicine, both with their individual patients as well as with the society in which they live. This thesis argues that the criminalization of sex work is fundamentally incompatible with contemporary health care ethics, reviewing each of the four fundamental pillars of biomedical ethics as it applies to policies that criminalize sex work. Each chapter will outline the many ways in which criminalization violates each of these fundamental principles, causing immense and largely preventable harm in the form of human rights violations and poor public health outcomes. At the same time, this thesis will introduce the alternative policy of decriminalization, discussing its features and implications for public health, and highlighting the ways in which the decriminalization of sex work results in improved health, safety, and human rights outcomes for both sex workers and victims of sex trafficking, exemplifying a viable, ethical, and evidenced-based alternative to criminalization. Given the gross bioethical and humans rights violations associated with the criminalization of sex work, this thesis concludes that there exists evidence of a substantial ethical imperative on the part of the medical community and its constituent professional societies to formally condemn policies that criminalize any and all aspects of sex work and issue formal recommendations for its urgent decriminalization, as both a public health issue and an issue of human and patients’ rights. / Urban Bioethics