Europe must continue to lead on harm reduction.

Europe has been at the forefront of harm reduction since its inception. These important early steps were in large part a response to the dramatically expanding HIV epidemic, and investing in these innovative interventions early and robustly had a transformative effect. This brought about not just pioneering services but also pioneering policy changes. However, while Western Europe and Member States in the European Union often have been at the vanguard of harm reduction innovation and vocal advocates for public health and human rights-based drug policy reform, the situation has been much different in the "wider" WHO European region, which also includes Eastern and Southeastern Europe as well as Central Asia. This is a result not just of limited budgets for health, but also of punitive laws and policies and persistent stigma and discrimination. Even as harm reduction has demonstrated huge successes in Europe, there is a need to move forward a wider array of services to respond to an evolving and increasingly complex drug situation in Europe. Instead, it is a lack of political will and of political courage that is holding back the establishment, expansion, and deepening of these essential, lifesaving interventions. Responding proactively and effectively to this changing drug situation will require redoubled investment in public health and harm reduction approaches.

Colocation of COVID-19 Vaccination Services at Syringe Service Programs for People Who Inject Drugs and People Experiencing Houselessness in Oregon.

OBJECTIVES: Integrating vaccination services with other essential health services could increase vaccination rates among socially marginalized populations. We examined the associations between colocation of vaccines at syringe service programs and COVID-19 vaccination status among people who inject drugs and people experiencing houselessness. METHODS: This study included 1891 participants aged ≥18 years at 9 sites in Oregon from July 2021 through March 2022. Participants self-reported whether they had ever received ≥1 dose of a COVID-19 vaccine. We calculated site-level COVID-19 vaccine availability and overall vaccination rates. We compared site-level vaccination rates and analyzed the association between vaccine availability and vaccination status. RESULTS: We found no significant difference in vaccination rates between sites that did and did not offer COVID-19 vaccines (t7 = -0.33; P = .75). We also found no significant association between vaccine availability and vaccination status. However, the odds of having received a COVID-19 vaccine were 2.79 times higher for each additional site visit during which COVID-19 vaccines were available (odds ratio [OR] = 2.79; 95% CI, 2.18-3.58; P < .001). The association between vaccine availability and vaccine status was not moderated by participant age (OR = 1.03; 95% CI, 0.99-1.07; P = .13) or housing instability (OR = 0.59; 95% CI, 0.13-2.60; P = .48). CONCLUSIONS: Colocating COVID-19 vaccines at syringe service programs was only positively associated with vaccination status if vaccines were offered frequently on-site. Future work should examine whether the frequency of offering vaccination services increases willingness to engage in vaccination and examine trust and convenience as potential mechanisms.

MULA, an affordable framework for multifunctional liquid automation in natural- and life sciences with a focus on hardware design, setup, modularity and validation.

The implementation of automation has already had a considerable impact on chemical and pharmaceutical industrial laboratories. However, academic laboratories have often been more reluctant to adopt such technology due to the high cost of commercial liquid handling systems, although, in many instances, there would be a huge potential to automate repetitive tasks, resulting in elevated productivity. We present here a detailed description of the setup, validation, and utilization of a multifunctional liquid automation (MULA) system that can be used to automate various chemical and biological tasks. Considering that such a setup must be highly customizable, we also designed MULA with respect to modularity, providing detailed insight as far as possible. Including all 3D-printed parts and the used Hamilton gastight micro syringe, the total construction cost is approximately 700 €. This allows us to achieve a highly reliable and accurate system that exceeds the precision of a classical air displacement pipette while still retaining the ability to use closed vial (septa) setups. To encourage other groups to adopt this setup, detailed instructions and tips for every step of the process are provided, along with the complete CAD design of MULA and control code, which are freely available for download under the CC BY NC 3.0 license.

Update on Retinal Drug Safety: Proceedings of the ASRS ReST Committee Webinar Part 1.

Purpose: To review the first Research and Safety in Therapeutics (ReST) Committee webinar and summarize the most current recommendations regarding diagnosis and management. Methods: The ReST Committee is comprised of members of the American Society of Retina Surgeons (ASRS). At regular internal meetings, safety issue reports from the website are reviewed. A webinar series was started in 2021 to update members on multiple relevant potential safety events. Results: Topics reviewed in the webinar included pentosan polysulfate sodium (Elmiron) maculopathy, intraocular pressure elevation reported with the aflibercept prefilled syringe (PFS), and brolucizumab-associated inflammation with occlusive retinal vasculitis. Retinal toxicity related to intraoperative medications was reviewed, including hemorrhagic occlusive retinal vasculitis after intraocular vancomycin, dilution errors with intravitreal aminoglycosides, inadvertent overdoses of cefuroxime after cataract surgery, and toxic posterior segment syndrome after dropless cataract surgery using compounded triamcinolone-moxifloxacin. Indocyanine green toxicity has been reported after its use as an adjuvant during macular hole surgery. Conclusions: The past decade has seen advances in retinal pharmaceuticals and drug-delivery devices. The ASRS ReST Committee collects data from its website reporting system to inform members about up-to-date pharmaceutical and device safety concerns. Recently, a webinar was used to inform members of pigmentary maculopathy associated with pentosan polysulfate sodium, safety regarding the aflibercept PFS, intraocular inflammation and occlusive retinal vasculitis secondary to brolucizumab, and retinal toxicity from intraoperative ocular medications.

Intravitreal Silicone Oil with a Silicone-free vs a Siliconized Syringe.

This randomized controlled trial compares incidence and quantity of presumed intravitreal silicone oil in diabetic patients receiving intravitreal injections using a silicone oil-free versus a siliconized syringe, highlighting the reduced contamination with silicone oil-free options.

Rapid green analytical methodology for simultaneous monitoring of nitrosamines and semi-volatile organic compounds in water and human urine samples.

Nitrosamines and semi-volatile organic compounds (SVOCs) are carcinogenic contaminants in water and biological matrices. Conventional analytical methods often struggle to detect trace concentrations due to poor extraction efficacies. This study presents a novel, low-cost, in-syringe-assisted fast extraction cum cleanup technique coupled with GC-FID for monitoring four nitrosamines and two SVOCs in drinking water and human urine samples to measure the contamination and exposure levels. This extraction protocol combines a novel green in-syringe liquid-liquid extraction step using dimethyl carbonate as the green extraction solvent, coupled with a semi-automated solid-phase extraction cleanup process. Then, the final extractant is analyzed using gas chromatography-flame ionization detection (GC-FID) for monitoring. The method demonstrated excellent linearity (R2 > 0.998) between 1.5 and 500 ng mL⁻1 for all six target compounds. Detection limits ranged from 1.0 to 2.0 ng mL⁻1. Extraction recoveries were between 87 and 105% for both urine samples and water samples. Intra-day and inter-day precision were below 9% RSD. The blue applicability grade index evaluation scored 70.0, indicating good practical applicability. The developed analytical protocol offers a sensitive, accurate, low-cost, rapid, and environmentally friendly method for simultaneously quantifying multiple nitrosamines and SVOCs in environmental and human samples. Its performance characteristics and sustainability metrics suggest the potential for broad application in monitoring and exposure studies.

Pharmacokinetics of Subcutaneous Itepekimab Injection With an Autoinjector Device and Prefilled Syringe in Healthy Participants.

Itepekimab, a monoclonal antibody against interleukin-33, has demonstrated clinical utility in previous studies in patients with asthma and chronic obstructive pulmonary disease. An autoinjector (AI) has been developed for administering itepekimab to facilitate further development. This study compared pharmacokinetics of single 300-mg itepekimab subcutaneous administration via an AI versus a prefilled syringe (PFS). Of 90 healthy volunteers enrolled in this Phase 1, parallel-design, randomized study and stratified by body weight (50 to <70 kg, ≥70 to <80 kg, ≥80 to 100 kg) and injection site (abdomen, thigh, or arm), 84 completed the study. Systemic exposure of itepekimab was similar for both groups. Point estimates for geometric mean ratios of pharmacokinetic parameters for AI versus PFS groups were 1.01 for maximum serum concentration, 1.06 for area under the serum concentration-time curve to the last quantifiable concentration, and 1.04 for area under the serum concentration-time curve extrapolated to infinity. The exposure was similar for both devices in each body weight and injection site subgroup. Overall, systemic exposure of 300-mg single-dose itepekimab in healthy participants was comparable when administered subcutaneously via an AI device and PFS, with an acceptable safety profile in both device groups.

Effect of exogenous lipids contamination on blood gas analysis.

Objectives: The purpose of this study was to investigate the effects of contamination of venous blood with a lipid-containing solution on parameters measured by a modern blood gas analyzer. Methods: We collected venous blood from 17 healthcare workers (46 ± 11 years; 53 % women) into three blood gas syringes containing 0 , 5 and 10 % lipid-containing solution. Blood gas analysis was performed within 15 min from sample collection on GEM Premier 5000, while triglycerides and serum indices were assays on Roche COBAS C702. Results: Triglycerides concentration increased from 1.0 ± 0.3 mmol/L in the uncontaminated blood gas syringe, to 39.4 ± 7.8 and 65.3 ± 14.4 mmol/L (both p<0.001) in syringes with 5 and 10 % final lipid contamination. The lipemic and hemolysis indices increased accordingly. Statistically significant variation was noted for all analytes except hematocrit and COHb in the syringe with 5 % lipids, while only COHb did not vary in the syringe with 10 % lipids. Significant increases were observed from 5 % lipid contamination for pO2, SO2 and lactate, while the values of pH, pCO2, sodium, potassium, chloride, ionized calcium, glucose, hematocrit (10 % contamination), hemoglobin and MetHB decreased. All these changes except lactate and CoHb exceeded their relative performance specifications. Conclusions: Artifactual hyperlipidemia caused by contamination with exogenous lipids can have a clinically significant impact on blood gas analysis. Manufacturers of blood gas analyzers must be persuaded to develop new instruments equipped with serum indices.

Racialized environments and syringe services program implementation: County-level factors.

OBJECTIVE: Racialized health inequities in substance use-related harms might emerge from differential access to syringe service programs (SSPs). To explore this, we examined the association between county-level racialized environments, other factors, and (1) SSP presence, and (2) per capita syringe and (3) naloxone distribution. METHODS: 2021 US National Survey of SSP data (n=295/412;72 % response rate) was used to identify SSP presence and the sum of syringes and naloxone doses distributed in 2020 by county. Study measures included racial residential segregation (RRS; i.e., divergence and dissimilarity indexes for Black:Non-Hispanic White & Hispanic:Non-Hispanic White) and covariates (i.e., demographic proportions, urban/suburban/rural classifications, 2020 US presidential Republican vote share, and overdose mortality from 2019). We used logit Generalized Estimating Equations to determine factors associated with county-level SSP presence, and zero inflated negative binomial regression models to determine factors associated with per capita syringe and naloxone distribution. RESULTS: SSPs were reported in 9 % (283/3106) of US counties. SSP presence was associated with higher divergence and dissimilarity indexes, urban and suburban counties, higher opioid overdose mortality, and lower 2020 Republican presidential vote share. Per capita syringes distributed was associated with lower RRS (divergence and Hispanic:White dissimilarity), lower racially minoritized population proportions and rural counties, while per capita naloxone distribution was associated with lower Hispanic and "other" population proportions, and rural counties. CONCLUSIONS: Racialized environments are associated with SSP presence but not the scope of those programs. Preventing HIV and HCV outbreaks, and overdose deaths requires addressing community level factors that influence SSP implementation and accessibility.

Compatibility of medication admixtures in continuous subcutaneous infusions: prioritizing laboratory testing for common combinations.

OBJECTIVES: Continuous subcutaneous infusions (CSCIs) are indicated as an alternative therapy when the oral route is not viable. However, despite their widespread use in palliative care, the evidence for admixture compatibility remains a limitation. It is estimated that a significant number of admixtures used in practice are not supported by laboratory studies, which may lead to suboptimal clinical outcomes. The study aimed to determine the frequency of admixtures used in clinical practice without compatibility data generated by laboratory studies, and thereby identifying the most commonly prescribed admixtures that require laboratory data, which can help to guide the prioritization of future testing. METHODS: This study was conducted across five palliative care services (three inpatients and two communities) in Victoria, Australia between May and July 2021. Electronic or paper medication charts of CSCIs were reviewed across all participating sites for all infusions administered. Data collected included medication combinations, dose, diluent, final volume, duration of infusion, reports of infusion-related reactions, and observed incompatibility. KEY FINDINGS: A total of 616 infusions containing two to three medications were assessed. Only 60% of these infusions were validated by laboratory data. Eleven most commonly prescribed admixtures with no laboratory compatibility data were identified over the 3-month period. CONCLUSION: Laboratory testing for the identified admixtures should be advocated to promote the safe and effective use of these medications.

Analysis of factors affecting the accuracy of low-dose insulin dosage using syringes and vials: a cross-sectional study in a Japanese regional hospital.

While several studies have shown that insulin pens are more convenient and accurate than conventional administration with syringes and vials (syringes/vials), there is a frequent need for low-dose insulin injections administered by nurses using syringes/vials in hospital settings, particularly for critically ill patients. However, there is a lack of research investigating factors related to the accuracy of low-dose insulin administration using syringes/vials, particularly in hospital settings. We therefore performed a cross-sectional study to assess the accuracy of low-dose insulin administration by registered nurses using syringes/vials and to determine whether time of day, years of experience and adherence to proper injection procedures (vertical insertion/drawing and air bubble checking) affected the accuracy. The participants were 33 registered nurses working in the diabetes ward, and a total of 198 trials were analyzed. Using syringes/vials, the median errors converted to insulin units were found to be 0.6 units for the 2- and 6-unit target doses, and 0.7 units for the 10-unit target dose. In cases with the largest error, errors for the 2-, 6-, and 10-unit target doses were observed to be 2.3, 4.0, and 3.3 units, respectively. In our study, time of day, years of experience and vertical insertion/drawing did not correlate with errors, but errors were significant in the participants who did not check for air bubbles. Nurses can make non-negligible dosage errors when administering low-dose insulin using syringes/vials, and this is particularly likely when air bubble checks are missed. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-024-00726-5.

Use of Syringe Service Programs in Rural vs Urban Maine: A Harm-Reduction Study.

Introduction: Syringe service programs (SSPs) reduce HIV and viral hepatitis transmission, as well as the prevalence of improperly disposed needles and needle stick injuries among first responders. Infections associated with injection drug use are rising in rural areas, including Maine, leading to concerns that SSP services are difficult to access for rural residents. Methods: A cross-sectional survey of 101 participants hospitalized with infections associated with injection drug use at 4 hospitals in Maine was collected over a 15-month period. Descriptive analyses were performed. Statistical analyses were completed using Fisher's exact tests, Pearson's chi-squared tests, and Student's t tests. Results: Of 101 participants, 66 (65%) lived in urban areas, and 35 (35%) lived rurally. Participants living in rural areas reported less SSP use in the past 3 months (76% urban vs 43% rural). Rural participants also had a higher prevalence of injecting buprenorphine than urban participants (6% urban vs 12% rural). Rural participants were also more likely to obtain needles from pharmacies than urban participants (40% urban vs 71% rural). Discussion: SSP programs are underrepresented and accessed less in rural areas of Maine. Rural populations of people who inject drugs have unique health characteristics and syringe-use practices. Conclusions: These findings highlight the need to develop rural SSP programs that address the unique needs of rural populations.

The Perry project: A versatile low-cost syringe pump for dispensing in automated synthesis systems.

Syringe pumps are used in applications such as chemistry, medicine, or microbiology offering high-precision dosing or a way to ease the workload of tedious tasks. Further, high-performance syringe pumps are crucial to automating laboratory tasks. The Perry Pump is demonstrated with syringe sizes ranging from 1-20 mL and includes a reservoir, which enables larger volumes to be used. The lowest volume demonstrated is 20 µ L at 5.5 µ L/s, while the largest is 20 mL at 0.145 mL/s. The Perry Pump is designed with the intention of easy to 3D-print, limited metal parts, and a high versatility and tolerance to chemicals.

Facilitators and barriers to monitoring and evaluation at syringe service programs.

BACKGROUND: Syringe services programs (SSPs) provide harm reduction supplies and services to people who use drugs and are often required by funders or partners to collect data from program participants. SSPs can use these data during monitoring and evaluation (M&E) to inform programmatic decision making, however little is known about facilitators and barriers to collecting and using data at SSPs. METHODS: Using the Consolidated Framework for Implementation Research (CFIR), we conducted 12 key informant interviews with SSP staff to describe the overall landscape of data systems at SSPs, understand facilitators and barriers to data collection and use at SSPs, and generate recommendations for best practices for data collection at SSPs. We used 30 CFIR constructs to develop individual interview guides, guide data analysis, and interpret study findings. RESULTS: Four main themes emerged from our analysis: SSP M&E systems are primarily designed to be responsive to perceived SSP client needs and preferences; SSP staffing capacity influences the likelihood of modifying M&E systems; external funding frequently forces changes to M&E systems; and strong M&E systems are often a necessary precursor for accessing funding. CONCLUSIONS: Our findings highlight that SSPs are not resistant to data collection and M&E, but face substantial barriers to implementation, including lack of funding and disjointed data reporting requirements. There is a need to expand M&E-focused funding opportunities, harmonize quantitative indicators collected across funders, and minimize data collection to essential data points for SSPs.

Effectively engaging faith-based leaders on syringe services programs: U.S. pastors' knowledge, perceptions, and questions.

OBJECTIVE: To identify faith-based leaders' (FBLs') knowledge, perceptions, and questions about syringe services programs (SSPs). METHODS: We conducted a one-time, national online survey of 461 Christian FBLs August-September 2022. RESULTS: 56% of FBLs agreed they support having SSPs in their communities; only 7% strongly disagreed. We identified 15 main questions FBLs have about SSPs. We found statistically significant differences based on FBL Protestant affiliations. Mainline FBLs are more knowledgeable about SSPs, likely to believe a larger number of SSP services would benefit their community, supportive of SSPs, interested in data related to SSPs, and likely to look to local public health officials to shape their opinions on SSPs compared with non-mainline FBLs. CONCLUSIONS: SSP advocates can address questions that FBLs have about SSPs before beginning outreach. By understanding common Protestant denominational affiliations, advocates can focus initial engagement efforts on FBLs in their communities who are more likely to support SSPs. Our findings suggest that local public health officials can influence FBLs' opinions about SSPs.

Open-source spring-driven syringe pump with 3D-printed components for microfluidic applications.

The operation of microfluidic devices requires precise and constant fluid flow. Microfluidic systems in low-resource settings require a portable, inexpensive, and electricity-free pumping approach due to the rising demand for microfluidics in point-of-care testing (POCT). Open-source alternatives, employing 3D printing and motors, offer affordability. However, using motors require electrical power, which often relies on external sources, hindering the on-site use of open-source pumps. This study introduces a spring-driven, 3D-printed syringe pump, eliminating the need for an external power source. The syringe pump is operated by the flat spiral spring's torque. By manually winding up the mainspring, the syringe pump can be operated without electricity. Various flow rates can be achieved by utilizing different syringe sizes and choosing the right gear combinations. All the parts of the syringe pump can be fabricated by 3D printing, requiring no additional components that require electricity. It operates by winding a mainspring and is user-friendly, allowing flow rate adjustments by assembling gears that modulate syringe plunger pushing velocity. The fabrication cost is $25-30 and can be assembled easily by following the instructions. We expect that the proposed syringe pump will enable the utilization of microfluidic technologies in resource-limited settings, promoting the adoption of microfluidics. Detailed information and results are available in the original research paper (https://doi.org/10.1016/j.snb.2024.135289).

Soft Fibrous Syringe Architecture for Electricity-Free and Motorless Control of Flexible Robotic Systems.

Flexible robotic systems (FRSs) and wearable user interfaces (WUIs) have been widely used in medical fields, offering lower infection risk and shorter recovery, and supporting amiable human-machine interactions (HMIs). Recently, soft electric, thermal, magnetic, and fluidic actuators with enhanced safety and compliance have innovatively boosted the use of FRSs and WUIs across many sectors. Among them, soft hydraulic actuators offer great speed, low noise, and high force density. However, they currently require bulky electric motors/pumps, pistons, valves, rigid accessories, and complex controllers, which inherently result in high cost, low adaptation, and complex setups. This paper introduces a novel soft fibrous syringe architecture (SFSA) consisting of two or more hydraulically connected soft artificial muscles that enable electricity-free actuation, motorless control, and built-in sensing ability for use in FRSs and WUIs. Its capabilities are experimentally demonstrated with various robotic applications including teleoperated flexible catheters, cable-driven continuum robotic arms, and WUIs. In addition, its sensing abilities to detect passive and active touch, surface texture, and object stiffness are also proven. These excellent results demonstrate a high feasibility of using a current-free and motor-less control approach for the FRSs and WUIs, enabling new methods of sensing and actuation across the robotic field.

Impact of dimensional variability of primary packaging materials on the break-loose and gliding forces of prefilled syringes.

A prefilled syringe (PFS) should be able to be adequately and consistently extruded during injection for optimal safe drug delivery and accurate dosing. To facilitate appropriate break-loose and gliding forces (BLGF) required during injection, certain primary packaging materials (PPM) such as the syringe barrel and plunger are usually coated with silicone oil, which acts as a lubricant. Due to its direct contact with drug, silicone oil can increase the number of particles in the syringe, which could lead to adverse interactions. Compliance with regulatory defined silicone oil quantities in certain drug products, such as ophthalmic, presents a trade-off with the necessity for desirable low and consistent BLGF. In addition to its siliconization, the dimensional accuracy of PPM has an important role in controlling BLGF. The dimensions of PPM are individualized depending on the product and its design and have certain tolerances that must be met during manufacturing. Most studies on ophthalmic focused on the adverse interactions between silicone oil and the drug. To the authors' knowledge, there have been no public studies so far that have investigated the impact of the dimensional variability of PPM on the BLGF in ophthalmic PFS. In this study, we applied advanced optical shaft and tactile measuring technologies to investigate this impact. The syringes investigated, were first sampled during aseptic production, and tested for BLGF. Subsequently, defined dimensions of PPM were measured individually. The results showed that the dimensional variability of PPM can have a negative impact on the BLGF, despite their conformity to specifications, which indicates that the currently available market quality of PPM is improvable for critical drug products such as ophthalmic. This study could serve as an approach to define product-specific requirements for primary packaging combinations and thus appropriate specifications based on data during the development stage of drug products.

A novel syringe tube combined guide-wire technique for repositioning a nasobiliary catheter in endoscopic nasobiliary drainage.

BACKGROUND: In endoscopic nasobiliary drainage (ENBD), it is complicated to reposition the catheter from the mouth to nostril. We developed a new technique using an 1-mL syringe tube combined with guide-wire when repositioning an ENBD tube from mouth to nose. The aim of this study was to verify its utility. METHODS: A single-center, prospective, randomized, controlled study was conducted between January 2021 and December 2022. Compared to traditional guide-wire technique, the new technique added a 1-mL syringe tube readily available in clinical work. The primary outcome was the ENBD repositioning time.The secondary outcomes included number of ENBD repositioning operations and technical success rate. RESULTS: A total of 253 patients who underwent ENBD during the study period. Among them, 241 patients were enrolled in this study. The procedure time was significantly shorter in the new technique group than in the conventional group (60.7 vs. 98.7, p < 0.001). The median number of operations was 2 in both new technique and conventional technique groups(p = 0.36). Technical success was achieved in 95.0 %(113/119) of the new technique group and 98.4 % (120/122) of the conventional technique group(p = 0.14). Multiple linear regression analysis demonstrated that the new technique group (B = 36.9, 95%CI: 21.6 to 52.3, p < 0.001) was independent factor that reduce the ENBD repositioning time. CONCLUSIONS: The 1-mL syringe tube combined guide-wire technique for repositioning ENBD tube could improve the efficiency and shorten the procedure time than the guide-wire technique. Meanwhile, It is easy to obtain for popularization and application.

Policies, adaptations, and ongoing challenges to naloxone, buprenorphine and nonprescription syringe access across four-states: Findings from an environmental scan and key informant interviews.

Background: As the US opioid-involved morbidity and mortality increase, uptake and implementation of evidence-based interventions remain key policy responses. Respond to Prevent was a multi-component, randomized trial implemented in four states and two large pharmacy chains with the aim of improving the pharmacy's capacity to provide naloxone, dispense buprenorphine, and sell nonprescription syringes (NPS). We sought to provide context and assess how policies and organizational practices affect communities and pharmacies across the study states. Methods: Using a multi-method approach we: 1) conducted an environmental scan of published literature and online materials spanning January 2015 to June 2021, 2) created timelines of key events pertaining to those policies and practices and 3) conducted semi-structured interviews with stakeholders (key informants) at the state and local levels (N=36) to provide further context for the policies and practices we discovered. Results: Key informants discussed state policies, pharmacy policies and local practices that facilitated access to naloxone, buprenorphine and NPSs. Interviewees from all states spoke about the impact of naloxone standing orders, active partnerships with community-based harm reduction organizations, and some federal and state policies like Medicaid coverage for naloxone and buprenorphine, and buprenorphine telehealth permissions as key facilitators. They also discussed patient stigma, access in rural settings, and high cost of medications as barriers. Conclusion: Findings underscore the important role harm reduction-related policies play in boosting and institutionalizing interventions in communities and pharmacies while also identifying structural barriers where more focused state and local attention is needed.