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Published in Viyaasan Mahalingasivam, Marc A Gladman, Manoj Ramachandran, Secrets of Success: Getting into Medical School, 2020
Veena Naganathar, Asil Tahir, Pairaw Kader, Omar Chehab
The spread of HIV via blood products is a particular problem in intravenous drug users who share needles to administer recreational drugs. In doing so, the virus is passed from one person to another. This is why HIV has higher rates in recreational drug users. It is important to identify drug users so that they can be advised of the risks, which is no easy task, because people do not readily disclose their drug habits. It requires the development of a strong doctor-patient relationship based on trust, honesty and professionalism. It remains important to promote safe and responsible drug use, advocating the use of clean needles and safe injection sites, which are clean and away from areas that may lead to serious infections, such as the neck. Some local authorities have needle exchange programmes to promote the use of clean needles and healthier lifestyles.
Informal Social Controls and the Liberalization of Drug Laws and Policies
Published in Ross Coomber, The Control of Drugs and Drug Users, 2020
As drug controls are liberalized, there will be an increased need for secondary prevention programs that aim to reduce harm to and by drug-takers. Alcohol users, for example, should be encouraged to use designated drivers (Apsler, Harding & Goldfein, 1987). Drinkers who become too intoxicated to drive safely and cannot or will not use a designated driver, can be given a free “safe ride” home by taxi or another conveyance (Harding, Apsler & Goldfein, 1988). Sports stadiums and other public assembly facilities can stop serving alcohol well before events end, and they can also use on site advertising to reduce impaired driving (Apsler & Harding, 1989). Similar harm reduction programs should be applied to illicit drug use. Safe ride services, which are now offered exclusively to drinkers, could be offered to users of other drugs. Needle exchange programs, intended to reduce the transmission of HIV/AIDS, should be disseminated beyond the few sites in which they now are available. Furthermore, the rationale for needle exchange programs should be to prevent the transmission of disease, not just HIV/AIDS. Programs should be offered that test drug samples anonymously submitted by users and provide them with accurate reports about the purity and potency of the sample.
Challenges to the implementation of the international drug control system 1
Published in Daniel Wisehart, Drug Control and International Law, 2018
Needle exchange programmes deviate from the limitation of drugs to medical and scientific purposes. Albeit that they do not involve the provision of drugs for individuals for other than medical or scientific purposes, they facilitate non-medical and non-scientific drug use. An individual will use these sterile syringes for intravenous drug use occurring outside the control of an individual exercising medical functions; this cannot be considered as medical drug use.194 It is the purpose of these programmes to protect the individual using drugs for such purposes from being inflicted with blood-transmittable diseases. Such practices, nevertheless, are legal under the UN Drug Conventions because they are contained within the recommendations of WHO’s Technical Guide and thereby are a viable form of treatment as outlined by Art. 14 (4) 1988 Convention.195
Management of opioid withdrawal and initiation of medications for opioid use disorder in the hospital setting
Published in Hospital Practice, 2022
Nico Carswell, Giselle Angermaier, Christopher Castaneda, Fabrizzio Delgado
It is important to include harm reduction in the management of patients with OUD. Since infections are a common complication of OUD, patients should be counseled on cleaning the injection site with alcohol, boiling the drug, and the use of clean, new needles and supplies with every use if they continue to use after discharge [52]. If needle exchange programs exist in the community, it can be helpful to provide this information to the patient, as these programs can help decrease the risk of infection [53,54]. Additionally, patients with OUD should be screened for common infections such as HIV, tuberculosis, sexually transmitted infections (STIs), and hepatitis A, B, and C. Vaccinations for hepatitis A and B, pneumococcus, tetanus, and influenza should also be provided if the patient is not up to date [52]. Given the higher risk of COVID-19 and its adverse outcomes in individuals with OUD [55], it is also important to ensure COVID-19 vaccination is up to date. HIV prophylaxis should be provided to all patients who inject drugs and either have shared use of drug injection equipment or have a high risk of sexual acquisition of HIV [56].
Perceptions diverge on aspects related to substance use disorder: An analysis of individuals in recovery, physicians, nurses, and medical students
Published in Substance Abuse, 2021
Jacob Shreffler, Isaac Shaw, Suzanne McGee, Campbell Bishop, Selena Thé, Daniel O’Brien, Tim Price, Martin Huecker
Medical students and physicians had higher agreement on items regarding needle exchange and safe injection sites. Needle exchange programs can allow persons with SUD to reduce risk of infection and overdose from unsafe injection practices, while providing a low barrier entry point to treatment and recovery.23 Safe injection sites afford a place for individuals to use high risk recreational drugs in a supervised environment. Persons who inject drugs (PWID) are not provided with drugs to inject, but are offered access to sterile supplies, overdose reversal treatment, and referral to treatment if desired.24 Despite purported benefits, a 2018 study revealed less than a third of Americans supported safe consumption sites.25 Importantly, as new initiatives and policies continue to emerge, we should systematically and routinely seek feedback directly from individuals in recovery.
Significant decrease in injection risk behaviours among participants in a needle exchange programme
Published in Infectious Diseases, 2020
Martin Kåberg, Niklas Karlsson, Andrea Discacciati, Katarina Widgren, Ola Weiland, Anna Mia Ekström, Anders Hammarberg
Several reviews have concluded that needle exchange programmes (NEP) are effective in reducing injection risk behaviours, HIV and HCV among PWID [9–14]. Sweden has historically been slow to introduce NEP for political reasons; however, the country is currently noticing a fast expansion with 17 of 21 regions providing NEP with the Stockholm NEP as the largest programme [4]. There is still a lack of knowledge on predictors for favourable long-term outcomes following initiation and participation in a NEP [15]. Factors such as early drug debut, being a woman and being homeless are associated with a higher degree of injection risk behaviours but less is known about the impact of NEP for different PWID subgroups over time [7]. Most studies investigating NEP have used cross-sectional study designs, which does not allow for studying changes in risk behaviours over time [16]. Cohort studies using a longitudinal design have shown a general reduction in self-reported injection risk behaviours among PWID but have seldom been designed to study subgroup variations in outcomes [13,14]. Furthermore, these studies mostly included participants with previous experience of NEP at baseline, compared change in injection risk behaviours between street-based PWID with and without access to NEP and often had a limited follow-up time [17–30].