Over 100 overdose prevention sites (OPS) operate in various jurisdictions, including Australia, Canada, the United States, and several European countries. However, despite the increasing prevalence of people who use illegal drugs, including those who inject drugs, no such facility currently operates in Africa, Asia, the Middle East, the Caribbean, or Central and South America. Except for Canada and a few sites in the US, no sanctioned facility currently operates in Mexico. This systematic review will identify peer-reviewed studies, reports, and theses that evaluate the cost and benefits of OPS, relying on five electronic databases (ECONLIT, Google Scholar, Medline, PubMed, and Web of Science). A search strategy based on the PRESS approach will guide the initial search for articles. Based on the PRISMA, community researchers will screen titles and abstracts using the specified inclusion criteria in EndNote X20, and the results will be uploaded into Covidence. Community reviewers using Covidence will examine the complete text, including the title and abstract. All articles reported through the initial search will be further screened based on Cheers and Drummond criteria to identify weaknesses in the research while extracting additional information and data related to costs, benefits, programs, or services. The final data analysis will include the range of cumulative benefits, costs, and ratios associated with operating OPS. This review has the potential to provide evidence-based knowledge through a community-based research approach on the cost savings of public health interventions implemented through harm reduction philosophy for underserved populations.
Cardiovascular multimorbidity (CVD MM), defined as two or more cardiovascular conditions, poses a significant public health challenge. Substance use disorders (SUDs) may elevate CVD MM risk, and health insurance disparities could exacerbate this relationship. We examined if insurance type moderates the association between SUDs and CVD MM. We analyzed cross-sectional data from 45,133 US adults in the 2023 National Survey on Drug Use and Health (NSDUH). CVD MM was defined as two or more specific cardiovascular conditions. SUDs included illicit drugs and cannabis, excluding nicotine dependence and alcohol use disorder. Logistic regression models examined the SUDs-CVD MM relationship and tested for an interaction between insurance type and SUDs, adjusting for covariates. Individuals in the representative sample of US adults were 60.8
Prior studies emphasize the impact of anti-tobacco campaigns on tobacco prevention; there needs to be more understanding of the variations across different media channels. This study examines the associations between cigarette use, harm perception of e-cigarettes, and e-cigarette use, and explores how exposure to offline and online anti-tobacco messages is related to these associations. Utilizing data from the HINTS 6 (N = 5,268), this study employs mediation analysis to explore two primary mediating mechanisms: [1] the mediating role of offline and online anti-tobacco message exposure and [2] the sequential mediating effect involving offline and online anti-tobacco messages and harm perception of e-cigarettes. Our findings revealed that cigarette use was positively associated with e-cigarette use (B=0.260, β = 0.256, p<.001). While offline anti-tobacco messages exposure showed no significant mediating effect (B=0.002, β = 0.002, [-0.001, 0.005]) between cigarette use and e-cigarette use, and it became a substantial and negative mediator when introducing harm perception of e-cigarettes (B=-0.001, β=-0.001, [-0.002, − 0.001]). Conversely, online anti-tobacco messages exposure positively mediated the link between cigarette use and e-cigarette use (B=0.004, β = 0.004, [0.001, 0.007]), but was not significantly associated with harm perception of e-cigarettes (B=-0.022, β=-0.007, p>.05). This study reaffirms the prevalence of dual use and reveals the disparities between online and offline anti-tobacco messages exposure. The distinctive roles played by online and offline media channels and the pivotal influence of harm perception of e-cigarettes on e-cigarette use carry significant implications for public health and tobacco control.
This study investigated context-dependent intertemporal decision-making patterns in substance use disorder (SUD) through a comprehensive experimental paradigm examining both gain and loss contexts. Using mixed-effects analysis of 26,144 decisions from 186 participants (100 SUD, 86 controls), we found significant group differences in context-dependent choice patterns (OR = 0.39, p <.001). The SUD group showed enhanced preference for delayed losses (lnk = 4.67 vs. 4.81, p <.001) but only marginally stronger immediate reward preference (lnk = 4.40 vs. 4.37, p =.089). While temporal processing remained intact across groups (OR = 0.98, p =.785), magnitude sensitivity varied significantly by context, particularly in loss scenarios. These findings challenge traditional views of uniformly impaired decision-making in SUD and suggest the need for context-aware intervention strategies that leverage preserved temporal processing abilities.
Pregabalin (a Gabapentinoid) has been shown to have potential for non-medical use. We aimed at exploring the prevalence and clinical correlates of non-medical use of pregabalin and dependence in patients seeking treatment for substance use disorders (SUDs). Patients with ICD-10 diagnosis for various SUDs, in the age range of 18–70 years who consented for participation in this study were evaluated for non-medical use and dependence of pregabalin across three different regions of Punjab and the union territory of Chandigarh. ICD-10 criteria for a dependence syndrome (three or more criteria) were used for defining dependence on pregabalin. Out of a total 974 patients enrolled in this study, 44.6
Housing insecurity, or the inability to afford or maintain residence in a safe and quality place, is a barrier to accessing and staying in substance use treatment and/or recovery support services. There is a gap in knowledge in how housing insecurity influences substance use disorder (SUD) prevalence, and the role housing security plays in SUD treatment initiation and retention. The HEALing Communities Study (HCS) is a large multisite trial aiming to reduce overdose risk through the implementation of evidence-based interventions delivered by community coalitions to reduce overdose deaths among 67 counties in 4 states. This study explored diverse perspectives of HCS community coalition members on housing systems for populations with SUD to better understand how housing insecurity attenuates SUD prevalence and initiation or retention in various drug treatment services. The aim of this study was to explore various mechanisms at multiple levels through which housing insecurity adversely affects individuals with SUD. Semi-structured key informant interviews (n = 85) were conduct with HCS community coalition members in New York State from 2019 to 2020. The transcripts were coded using the PRISM/RE-AIM framework and further subcoded with the following five themes: 1) cost (housing affordability); 2) conditions (housing quality); 3) consistency (residential stability); 4) context (neighborhood opportunity); and 5) considerations (unique aspects affecting substance use-related populations). Findings include housing insecurity driven by cycles of poverty or poor economic reality in NY counties, substandard or poor-quality housing, experiences of stigma or social isolation within the home, a lack of transitional housing for individuals exiting the criminal legal system, housing insecurity associated with a return to use or overdose, neighborhood challenges such as accompanying transportation or food insecurity, or environmental triggers to return to use, and challenges associated with housing insecurity for SUD treatment, such as missed appointments. The results suggest that structural housing interventions are needed to improve the health and quality of life of individuals with SUD directly and that they may also strengthen the effectiveness and sustainability of other interventions with this population. Future research can explore the community co-design of innovative solutions across the continuum of housing security. NCT04111939
Abstract Background Adolescence is a critical period for the initiation of alcohol use. It is uncertain how predictors of alcohol onset, such as Theory of Planned Behavior (TPB) constructs, change in response to alcohol onset. This study tests for longitudinal changes in TPB constructs during adolescents’ onset of alcohol consumption. Method Data were collected longitudinally in three waves (T1, T2, T3) in Norway. Participants (N = 1,548; M age = 13.54, 51% girls, 49% boys) reported alcohol use and TPB constructs (attitudes; subjective norms (SN); Perceived Behavioural Control (PBC); intentions) at each wave. Multilevel modelling was used to test whether the constructs changed over time, and intraclass correlation coefficients were used to assess the total variance explained by differences between individuals and waves. In addition, we tested different lagged versions of the TPB model, to determine whether alcohol use at wave 3 was linked to TPB constructs at earlier waves. Results Alcohol consumption and the TPB constructs varied between waves (58% − 72%). Alcohol use, attitudes and friends-related SN significantly increased from T1 to T2 and from T1 to T3. Intentions and parent-related SN significantly increased only from T1 to T3. PBC significantly decreased only from T1 to T3. Attitudes changed the most, and PBC changed the least over time. Tests of lagged models showed that alcohol use was predicted by constructs measured at earlier waves. Conclusion Adolescent alcohol use was mirrored by changes in attitudes and friends-related SN, whereas changes in intentions, parents-related SN and PBC took longer to manifest. In addition, constructs assessed early in adolescence retained their ability to predict alcohol use later in adolescence, although intentions measured closer to the actual behaviour showed higher accuracy in predicting alcohol use. These findings can be used to determine the optimal timing to intervene in different constructs to delay adolescent drinking onset.
Abstract Background In 2018, the Cannabis Act regulated the production and sale of cannabis for non-medical purposes in Canada. With the aim of continuing to protect the public health and safety of Canadians as the legal cannabis market matures, we conducted a thorough data disaggregation to identify segments of the cannabis consumer base in Canada who are more likely to engage in ‘higher risk’ cannabis use behaviours. The analysis also aligned with the Canadian federal department of health’s Sex- and Gender-Based Analysis Plus Action Plan. Methods Participants were respondents from the 2023 and 2024 cycles of the Canadian Cannabis Survey who reported consuming cannabis in the previous 12 months (n = 7,238). Sixteen higher risk cannabis use outcomes were identified, along with 11 socio-demographic/socio-economic characteristics (herein ‘covariates’). Outcomes were arranged in four categories: heavy cannabis consumption; use of higher risk cannabis products; negative effects of cannabis use on one’s life; and threats to personal or public safety. Prevalence of each outcome was estimated among past 12-month consumers. For each outcome, adjusted logistic regression models tested differences between subgroups for each covariate. After Bonferroni correction for multiple comparisons, a threshold of p < 0.003 was used. Results Over three-quarters (78%) of consumers engaged in at least one higher risk outcome (mean = 2.9, SD = 2.8). After adjustment, models revealed that several subgroups tended to engage in higher risk outcomes. These included younger people, males, those reporting lower education and household income levels, and those who reported having poor/fair mental health. There were also higher rates of certain higher risk outcomes among specific ethnic groups and sexual and gender minorities, but these differences became non-significant in adjusted models. Conclusions Study results may be used to identify subgroups of cannabis consumers in Canada who are more likely to engage in higher risk cannabis behaviours and who may benefit from more targeted public education or harm reduction initiatives.
Despite all Health Maintenance Organizations in Israel having documented an increased use of prescription opioids, a decrease in admissions with positive opioid toxicology was observed in emergency departments (EDs). We hypothesized that following the fentanyl test introduction in 2023 in the largest acute care facility in Israel, opioid detection and naloxone usage would increase, and death rates would decrease. Between 2016 and June 2024, 20,337 ED-admitted individuals were screened for drugs via urine toxicology tests. Opioid trends, their characteristics, the administration of naloxone, and death rates were analyzed. The pre- and since fentanyl testing initiation periods were compared. The proportion of individuals screened via urine toxicology increased from 0.7
Background Healthcare providers working in addiction care often navigate complex clinical, social, and systemic challenges that can affect both care delivery and provider well-being. Yet, despite increasing recognition of the need for specialized addiction services within hospital settings, there remains limited research exploring the perspectives of staff working in these environments. The Addictions Medicine Unit (AMU) in Northern Ontario represents a novel model of inpatient addiction-focused care. This study seeks to explore the lived experiences of staff who work on the AMU to better understand the opportunities and challenges encountered in this novel model of care. The intention is to generate transferable insights relevant to similar inpatient addiction care models, while reducing unnecessary operational detail. Methods A qualitative study was conducted using focus groups between January and June 2024. Fourteen front line staff members (70% of the unit's staff), including social workers, nurses, and addiction workers, participated in three focus groups. Eight guided open-ended questions were used to facilitate in-depth discussions. All sessions were recorded, transcribed, and subjected to thematic analysis to identify recurring patterns and themes. Results The study highlighted both strengths and challenges of the AMU from the staff perspective. Identified challenges included opportunities to improve collaboration with other units in the hospital and community service providers. Focus groups highlighted several strengths, including the patient-centered approach used in the AMU and a genuine commitment to supporting individuals. When staff were asked about their perspectives on contributing factors to substance use they cited trauma, social and familial influences, economic hardship, and barriers to access to treatment or outpatient services. Conclusion Building a healthcare system that effectively supports individuals with Substance Use Disorder (SUD) and the professionals who care for them requires overcoming systemic barriers. The AMU is a step toward patient-centered addiction care, but challenges like health care providers feeling stigmatized and isolated from other providers because they work in addictions care emphasize the need for stronger collaboration, harm reduction integration, and policy-driven solutions to improve care and support both patients and frontline workers.
Background Pregabalin's non-medical use is frequently reported in the literature. However, knowledge related to this non-medical use is scarce, especially from community dwellers of a developing nation. Lacking baseline information, the current study qualitatively explored the motives and reasons for non-medical use of pregabalin among the general population of Islamabad city, Pakistan. Methods By adopting the phenomenological approach, a qualitative study using semi-structured interviews was conducted. Community dwellers approaching pharmacies and purchasing pregabalin without a prescription were approached for face-to-face, in-depth interviews. The interviews were audio-taped, individually transcribed (verbatim), and were then analysed for thematic contents by the standard content analysis framework. Results Most of the participants (10, 66.6%) were in the 18-27 age group. All participants were male and most of them worked in the private sector Islamabad city. Thematic content analysis resulted in five major themes and five subthemes. Peers at the workplace were identified as a major source of information regarding pregabalin use. Being lethargic, easing physical exertion and poor work-life balance were the reasons for pregabalin use among the study respondents. Intriguingly, pregabalin was also reported as a performance enhancer by some of the participants. The participants had no information on clinical use of pregabalin and most of them had the opinion that the drug is safe to use and has no side effects. Conclusion This study highlights the non-medical use of pregabalin in Islamabad, driven by challenges like difficult living conditions, work-related fatigue, fear of the future, and work-life balance. The findings emphasize the need for public awareness campaigns, rigorous regulations on pregabalin sales, and accessible support for those individuals involved in non-medical use of pregabalin.
Background Substance use disorder (SUD) remains a critical public health crisis in the United States, with high prevalence and overdose mortality rates. Despite the availability of effective treatments, including medications that significantly reduce overdose risk, fewer than 20% of Americans with active SUD receive treatment annually. Single State Agencies (SSAs), which oversee federal funding and regulate SUD treatment programs, hold significant authority to impose licensure and reporting requirements intended to promote treatment quality. Methods This study presents findings from a national survey of SSAs across 50 states and the District of Columbia (94% response rate) conducted between 2020 and 2021, examining their roles in licensing SUD programs and setting requirements to promote evidence-based clinical practice. Results Results reveal that 58.3% of SSAs were responsible for licensing SUD treatment programs, with most requiring reporting primarily from publicly funded programs rather than all licensed providers. Staffing and clinical practice requirements varied substantially across treatment settings: opioid treatment programs and inpatient withdrawal management services were most frequently subject to medical staffing and supervision mandates, while outpatient programs were less regulated in these respects. Few SSAs required minimum staffing ratios or mandated medical professionals on staff in outpatient settings, limiting access to medication-based treatments. While patient placement criteria and clinical assessments were commonly required, clinical supervision requirements were inconsistent, and data reporting was often limited. Across treatment settings, treatment and aftercare/discharge planning were commonly required. Conclusions The study findings indicate that agency requirements in many states allow for SUD treatment practices and staffing arrangements that are inconsistent with evidence-based care. Balancing quality improvements with maintaining access to care may necessitate additional resources and technical support for treatment programs to meet higher standards. Enhancing licensure requirements may be a critical step toward closing persistent gaps in SUD treatment quality and expanding access to lifesaving interventions.
Background This study has two objectives: (1) to identify the attitudinal and demographic factors most closely associated with performance-enhancing drugs (PED) use in sports; (2) to propose a new method for estimating PED use prevalence that mitigates the limitations of self-report surveys. Methods We analyse survey data from a sample of 2113 athletes attending ten UK universities, using a two-step approach. First, Bayesian Variable Selection (BVS) is used to identify the factors most closely associated with PED use. Second, these factors are incorporated into a Bayesian Profile Regression (BPR) model to identify clusters of athletes with similar attitudes toward PEDs. The prevalence of PED use is then estimated by linking these clusters with reported PED use via a logit model. Results Four key factors are significantly associated with PED use: being male, believing PED use is necessary to excel in sports, having a perceived estimate of PED use prevalence among elite athletes higher than the sample average, and having a perceived estimate of PED use prevalence among sportspeople in general higher than the sample average. BPR identifies four distinct clusters of athletes: (1) non-users; (2) use-admitters; (3) use-admitters and non-admitters; (4) most likely non-users. Using this new methodology, PED use prevalence is estimated at 13.7%, considerably higher than the 3.4% obtained through direct questioning. Conclusion The proposed method identifies attitudinal and demographic factors associated with PED use and provides a more accurate estimate of its prevalence, which can inform the development of more effective anti-doping programmes.
Artisanal and small-scale gold mining (ASGM) employs many adolescent girls and young women (AGYW) who face distinct vulnerabilities. Work and leisure activities in ASGM often involve substance use. This increases the health, financial, and social burdens of AGYW. This paper examines the prevalence of and factors associated with substance use among AGYW in ASGM in Uganda. This paper uses a cross-sectional survey of 810 females aged 15–24 years who work in the ASGM sector in Central and Eastern Uganda. To assess the prevalence and determinants of substance use, we used frequency distributions, chi-squared tests, and a complementary log-log model at the multivariable level of analysis. Nineteen percent (19
Canada is facing a national opioid crisis, with an average of 20 opioid-related deaths reported daily. Postpartum women who use non-prescription opioids and unregulated substances are at high risk of relapse and overdose. They also face significant health and social challenges that create barriers to successful, long-term recovery. While many women reduce or stop substance use during pregnancy, sustained recovery in the postpartum period remains a challenge. Despite this, little research has explored the personal, social, and structural factors, collectively conceptualized as recovery capital, that sustain motivation for recovery after birth. Therefore, the purpose of this study was to explore the factors that influence motivation for recovery among postpartum women with a history of substance use, with particular attention to the personal, social, and structural dimensions of recovery capital. An exploratory qualitative design was used to capture the experiences of 16 postpartum women in Saskatchewan, Canada, who had given birth within the previous two years and were in recovery from non-prescription opioid or unregulated substance use for at least three months. Participants were recruited through public health and treatment agencies. Semi-structured interviews were conducted in-person or by phone and analyzed using Braun and Clarke’s six-phase thematic analysis. The sample (N = 16) was primarily Indigenous (n = 14), predominantly in their twenties, and single (n = 14), with most participants having a high school education or less, low household income, and limited employment. Thematic analysis identified four themes: (1) the impact of limited accessibility on recovery, (2) parenthood as a motivator, (3) the role of peer, family, and professional support systems, and (4) the transformative power of resilience. Postpartum women with substance use disorders are highly motivated to recover, often driven by their roles as mothers. However, motivation alone is not enough without adequate recovery capital, including access to integrated, trauma-informed, and culturally safe treatment, social supports, and structural resources. Findings highlight the importance of expanding substance use programs that address structural barriers, promote resilience, and include peer, family, and professional supports. Comprehensive, strength-based treatment models are critical to sustaining and supporting long-term recovery for postpartum women.
Abstract Background The COVID-19 pandemic significantly disrupted substance use services, potentially exacerbating existing inequities in access to treatment. This study examines the perspectives of senior managers and decision-makers in Wales regarding equity issues in substance use services during the pandemic. Methods Semi-structured interviews were conducted with fifteen senior managers and decision-makers from various organisations in the substance use field in Wales. Interviews were conducted during autumn 2020. Data were analysed using reflexive thematic analysis to identify key themes related to equity in access to treatment. Results Key findings highlighted significant disparities between third sector and statutory NHS services, particularly in access to PPE, and recognition as essential workers. The rapid shift to digital service provision exposed a digital divide, potentially excluding vulnerable service users. However, the pandemic also accelerated innovations in service delivery, such as the introduction of long-acting injectable buprenorphine and revised take-home medication policies. Long-term concerns included the economic impact on vulnerable populations, potential increases in mental health issues and substance use, and funding uncertainties for third sector services. Conclusions The pandemic exposed and exacerbated existing inequities in substance use services while also driving rapid innovation. Findings suggest a need for greater recognition and support for third sector services, strategies to address the digital divide, and sustained funding to ensure equitable access to treatment. These insights can inform policy and practice to develop more equitable and resilient substance use services in preparation for any future crises.
Abstract Background Substance use among children and adolescents is an emerging public health concern, with studies from some settings reporting substantial levels of alcohol and other substance use among young people. However, in many low- and middle-income countries, including Uganda, the role, feasibility, and implications of routine substance use screening in primary healthcare settings remain poorly understood. Validated tools such as the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening instrument have been used in other contexts, but evidence on their acceptability among children, caregivers, and health workers in African primary care settings is limited. This study assessed the acceptability of the CRAFFT tool among children aged 6–17 years, their caregivers, and health workers in primary healthcare settings in Uganda. Methods A cross-sectional study was conducted with 824 children, their caregivers, and 47 health workers across selected health facilities. Acceptability was measured using Likert-scale questionnaires tailored to each participant group; children, caregivers, and health workers alongside open-ended questions. Quantitative data were analyzed using STATA 18, and qualitative feedback was analyzed thematically. Results The CRAFFT screening tool was generally acceptable across all participant groups. Children found the tool easy to understand and informative, caregivers appreciated its potential for early identification of risky behaviors, and health workers viewed it as useful in identification of substance use. However, several concerns were raised, including long screening durations, lack of privacy, cultural and religious sensitivities, and doubts about the relevance of screening younger children. Conclusion CRAFFT screening was found to be acceptable among children, caregivers, and health workers in Ugandan health facilities. However, successful implementation requires addressing key barriers such as confidentiality, time burden, and cultural appropriateness. Integrating screening into routine care, especially in community and school settings, may enhance uptake and early intervention for substance use among children and adolescents.
Numerous research studies indicate that Native Hawaiian and Pacific Islander (NHPI) youth report disproportionately higher substance use rates than other ethnic groups, as well as higher adverse effects associated with their use. Nonetheless, there has been a historical lack of evidence-based, culturally relevant interventions designed to prevent NHPI substance use. This article describes the trajectory of school-based, culturally grounded substance use prevention research for NHPI youth funded by the National Institute on Drug Abuse over the past two decades. A review and synthesis of published research documenting the development, evaluation, implementation, and adaptation of the Hoʻouna Pono (HP) program is presented. The interconnectedness of separate funded research studies is highlighted. The HP program was developed and evaluated through 5 interconnected studies—a pre-prevention study, a pilot study, an efficacy trial, an implementation study, and an e-cigarette adaptation study. The program was also adapted to different regions through two complementary studies—a Guam adaptation (Fuestan Manhoben) and a Windward Oʻahu hybrid implementation trial (Mohala Na Pua). The life course of the HP program may serve as a model for the development of culturally grounded prevention for under-researched and underserved youth populations. The program is a foundation for future substance use prevention adaptations across Hawaiʻi and the Pacific. Not applicable.
Secondhand smoke (SHS) remains a major global health concern, exposing individuals to toxic compounds that significantly increase the risk of cardiovascular diseases, metabolic disorders, and respiratory illnesses. This study aims to assess the global burden of disease attributable to SHS by analyzing Disability-Adjusted Life Years (DALYs) across Socio-Demographic Index (SDI) regions. This study utilized secondary data from the Global Burden of Disease (GBD 2021) database, analyzing epidemiological metrics across 204 countries. The SDI was applied to assess disparities, and SHS exposure was defined based on household and workplace factors. Statistical analyses estimated the burden of SHS-associated diseases, stratified by demographic and socioeconomic categories, with results mapped globally using ArcGIS. Globally, ischemic heart disease posed a greater burden on males (131.31 DALY) compared to females (96.42 DALY), while diabetes mellitus and stroke affected females more (46.99 and 84.05 DALY, respectively). COPD exhibited the highest DALY rates in low-middle SDI regions (males: 129.85; females: 124.42), whereas high-income regions had the lowest burden. Diabetes mellitus showed a rising trend across SDI regions, with females in middle and high-middle SDI regions experiencing the highest YLDs. The analysis reveals significant disparities in disease burden from secondhand smoke exposure across regions and sexes. The findings highlight the sex-specific and regional variations in disease burden, underscoring the need for targeted health interventions and tobacco control strategies.
As aging is associated with physiological changes, patients in methadone maintenance treatment (MMT) may require an adequate methadone dose adjustment. We aimed to study the relationship between aging and methadone dose and plasma level. Patients with two methadone plasma level results, above one year apart, were included. Methadone dose and plasma levels, as well as their changes over time, were studied by age group. 318 patients, 36.5
