A percepção dos trabalhadores de saúde mental sobre a atuação do redutor de danos / The perception of mental health workers about the performance of the damage reducer / La percepción de los trabajadores de salud mental sobre la actuación de reductor de daños

OBJETIVO: conhecer a percepção dos trabalhadores sobre a atuação do redutor de danos em um Centro de Atenção Psicossocial de Álcool e outras drogas (CAPSad), assim colaborando com a problematização e transformação da realidade do cuidado aos usuários de álcool e outras drogas. MÉTODO: trata-se de uma pesquisa qualitativa e exploratória, de caráter descritivo, realizada com profissionais de um CAPSad da cidade de Sant'Ana do Livramento por meio da técnica de Grupo Focal Narrativo (GFN). Para realizar a análise dos dados, o conteúdo foi transformado em narrativa de grupo. RESULTADOS: apontou-se a discussão frente à percepção da figura do redutor de danos e sua inter-relação no cotidiano da clínica em saúde mental, apresentando potências e desafios. CONCLUSÃO: evidencia-se a importância do papel que a redução de danos ocupa no âmbito da Reforma Psiquiátrica Brasileira. A figura do redutor de danos no serviço é de que este profissional tem como capacidade a criação de vínculos, realização de um acolhimento efetivo e que pode auxiliar na desconstrução do estigma que o usuário de substâncias sofre perante a sociedade, sendo uma ferramenta potente para a construção e transmutação na vida das pessoas.

OBJECTIVE: to know the workers' perception about the performance of the damage reducer in a Psychosocial Care Center for Alcohol and other drugs (PSCCad), thus collaborating with the problematization and transformation of the reality of the care for users of alcohol and other drugs. METHOD: this is a qualitative and exploratory research, of a descriptive nature, carried out with professionals from a PSCCad in the city of Sant'Ana do Livramento using the Narrative Focus Group (NFG) technique. In order to perform the data analysis, the content was transformed into group narrative. RESULTS: the discussion was pointed out in the face of the perception of the figure of the damage reducer and its interrelation in the daily routine of the mental health clinic, presenting strengths and challenges. CONCLUSION: it is evident the importance of the role that damage reduction plays in the scope of the Brazilian Psychiatric Reform. The figure of the damage reducer in the service is that this professional has the capacity to create bonds, perform an effective welcoming and that can assist in deconstructing the stigma that the substance user suffers in society, being a powerful tool for construction and transmutation in people's lives.

OBJETIVO: comprender la percepción de los trabajadores sobre el papel de la reducción de daños en un Centro de Atención Psicosocial para el Alcohol y otras Drogas (CAPSad), colaborando con la problematización y transformación de la realidad de la atención a los consumidores de alcohol. y otras drogas. MÉTODO: investigación descriptiva, cualitativa y exploratoria, realizada con profesionales de un CAPSad en la ciudad de Sant'Ana do Livramento, utilizando la técnica del Narrative Focus Group (GFN). Para realizar análisis de datos, el contenido se transformó en una narración grupal. RESULTADOS: la discusión se señaló frente a la percepción de la figura del reductor de daños y su interrelación en la rutina diaria de la clínica de salud mental, presentando fortalezas y desafíos. CONCLUSIÓN: la importancia del papel que juega la reducción de daños en el contexto de la Reforma Psiquiátrica brasileña es evidente. La figura del reductor de daños en el servicio es que este profesional tiene la capacidad de crear vínculos, realizar una bienvenida efectiva y que puede ayudar a deconstruir el estigma que sufre el usuario de sustancias en la sociedad, siendo una herramienta poderosa para la construcción y transmutación en la vida de las personas.

Between Emergency Department Visits: The Role of Harm Reduction Programs in Mitigating the Harms Associated With Injection Drug Use.

Injection drug use is a major public health problem in the United States. Cocaine, heroin, and methamphetamine are the most commonly injected illicit drugs, whereas opioids are responsible for the majority of overdose fatalities. Although recent emergency department (ED) efforts have focused on expanding capacity for buprenorphine induction for opioid use disorder treatment, the injection of illicit drugs carries specific health risks that require acknowledgment and management, particularly for patients who decline substance use treatment. Harm reduction is a public health approach that aims to reduce the harms associated with a health risk behavior, short of eliminating the behavior itself. Harm-reduction strategies fundamental to emergency medicine include naloxone distribution for opioid overdose. This clinical Review Article examines the specific health complications of injection drug use and reviews the evidence base for 2 interventions effective in reducing morbidity and mortality related to drug injection, irrespective of the specific drug used, that are less well known and infrequently leveraged by emergency medicine clinicians: syringe service programs and supervised injection facilities. In accordance with the recommendations of health authorities such as the Centers for Disease Control and Prevention, emergency clinicians can promote the use of harm-reduction programs in the community to reduce viral transmission and other risks of injection drug use by providing patients with information about and referrals to these programs after injection drug use-related ED visits.

Oficinas profissionalizantes para reinserção de internos de um centro terapêutico de toxicômanos no mercado de trabalho / Professional workshops for reinsertion of internal staff from a drug rehabilitation center in the labor market / Cursos profesionales para la reinserción de internos de un centro terapéutico de toxicómanos en el mercado laboral

Objetivo: desenvolver atividades a fim de facilitar a reinserção social e no mercado de trabalho de dependentes químicos residentes da comunidade terapêutica Fazenda Paraíso, um centro de recuperação de toxicômanose alcoólatras do noroeste do estado do Rio Grande do Sul. Método: trata-se de um estudo de abordagem qualiquantitativa, com caráter descritivo. Quinze internos com idade entre 16 e 49 anos participaram de oficinas com cunho teórico/prático ministradas por docentes e acadêmicos do curso de graduação de Farmácia. Resultados: a maioria dos participantes estava com idade acima dos 30 anos, e 80% tinham somente formação em educação básica. Constatou-se que o emprego é capaz de gerar estabilidade financeira, além de proporcionar dignidade e trazer reconhecimento por parte da sociedade, sendo então importante para o toxicômano. Conclusão: o profissional farmacêutico pode ser um grande aliado na reinserção do dependente químico na sociedade, seja pela ministração de oficinas ou palestras de educação em saúde

Objective: to develop activities that facilitate social and labor market reintegration of drug addicts residing in Fazenda Paraíso, a drug and alcohol rehabilitation center in the northwest of Rio Grande do Sul, Brazil. Methods: this qualitative/quantitative study of descriptive character included 15 interns aged 16 to 49 years who participated in workshops of theoretical/practical nature taught by educators of the Pharmacy graduation course. Results: most participants were over 30 years old, and 80% had only basic education. Employment was shown to allow for financial stability, as well as to provide dignity and recognition by society, and it is considered important for drug addicts. Conclusion: pharmacy professionals can be great allies in the reintegration of drug addicts in society by providing workshops or lectures on health education

Objetivo: desarrollar actividades para facilitar la reinserción social y laboral de los toxicómanos que residen en la comunidad terapêutica Fazenda Paraíso, un centro para la recuperación de toxicómanos y alcohólicos en el noroeste del estado de Rio Grande do Sul. Método: estudio cualitativo y cuantitativo con carácter descriptivo. 15 pasantes de entre 16 y 49 años participaron en talleres teórico-prácticos impartidos por profesores y académicos del curso de graduación de Farmacia. Resultados: la mayoría de los participantes tenían más de 30 años, y el 80% solo tenían la educación básica. Se observó que el empleo es capaz de generar estabilidad financiera, además de proporcionar dignidad y reconocimiento por parte de la sociedad, lo cual es importante para el toxicómano. Conclusión: el profesional farmacéutico puede ayudar en la reintegración del toxicómano en la sociedad, por medio de la impartición de cursos o conferencias sobre la educación para la salud

Health outcomes and cost-effectiveness of diversion programs for low-level drug offenders: A model-based analysis.

BACKGROUND: Cycles of incarceration, drug abuse, and poverty undermine ongoing public health efforts to reduce overdose deaths and the spread of infectious disease in vulnerable populations. Jail diversion programs aim to divert low-level drug offenders toward community care resources, avoiding criminal justice costs and disruptions in treatment for HIV, hepatitis C virus (HCV), and drug abuse. We sought to assess the health benefits and cost-effectiveness of a jail diversion program for low-level drug offenders. METHODS AND FINDINGS: We developed a microsimulation model, calibrated to King County, Washington, that captured the spread of HIV and HCV infections and incarceration and treatment systems as well as preexisting interventions such as needle and syringe programs and opiate agonist therapy. We considered an adult population of people who inject drugs (PWID), people who use drugs but do not inject (PWUD), men who have sex with men, and lower-risk heterosexuals. We projected discounted lifetime costs and quality-adjusted life years (QALYs) over a 10-year time horizon with and without a jail diversion program and calculated resulting incremental cost-effectiveness ratios (ICERs) from the health system and societal perspectives. We also tracked HIV and HCV infections, overdose deaths, and jail population size. Over 10 years, the program was estimated to reduce HIV and HCV incidence by 3.4% (95% CI 2.7%-4.0%) and 3.3% (95% CI 3.1%-3.4%), respectively, overdose deaths among PWID by 10.0% (95% CI 9.8%-10.8%), and jail population size by 6.3% (95% CI 5.9%-6.7%). When considering healthcare costs only, the program cost $25,500/QALY gained (95% CI $12,600-$48,600). Including savings from reduced incarceration (societal perspective) improved the ICER to $6,200/QALY gained (95% CI, cost-saving $24,300). Sensitivity analysis indicated that cost-effectiveness depends on diversion program participants accessing community programs such as needle and syringe programs, treatment for substance use disorder, and HIV and HCV treatment, as well as diversion program cost. A limitation of the analysis is data availability, as fewer data are available for diversion programs than for more established interventions aimed at people with substance use disorder. Additionally, like any model of a complex system, our model relies on simplifying assumptions: For example, we simplified pathways in the healthcare and criminal justice systems, modeled an average efficacy for substance use disorder treatment, and did not include costs associated with homelessness, unemployment, and breakdown in family structure. CONCLUSIONS: We found that diversion programs for low-level drug offenders are likely to be cost-effective, generating savings in the criminal justice system while only moderately increasing healthcare costs. Such programs can reduce incarceration and its associated costs, and also avert overdose deaths and improve quality of life for PWID, PWUD, and the broader population (through reduced HIV and HCV transmission).

Harm Reduction Services in Ottawa: The Culture of Drug Use.

Between January 2016 and June 2019, there were over 13,900 apparent opioid-related deaths in Canada, solidifying the need for appropriate and effective services for people who use drugs (PWUD). Within government initiatives and policies, PWUD are often inappropriately considered a homogeneous group of individuals, with implementation of services nationally often being guided by these governmental bodies without meaningful consultation and collaboration with PWUD. However, recent harm reduction research and best practice guidelines have emphasized the importance of tailoring services to local drug scenes. Despite this, very little research on the cultural norms of PWUD exists in the literature. In an attempt to explore the local culture of drug use in Ottawa, a literature review ultimately uncovered very few articles on this topic. However, by expanding the search beyond Ottawa and using a social determinants of health framework, the factors of culture, income and social status, physical environment, and access to services were revealed as unique experiences for PWUD. Further, through four in-depth interviews with current harm reduction providers in Ottawa, the themes of (1) uncertainty and concerns surrounding the overdose crisis; (2) lack of flexibility in resources and access issues; and (3) diversity in the culture of drug use in Ottawa were explored. Recommendations surrounding partnering with PWUD, policy changes, and a safer supply were subsequently discussed. These findings helped to validate the reality of the unique drug-use culture in Ottawa, and the requirement for harm reduction services to be adapted to the local needs of PWUD.

Atitudes dos profissionais da atenção primária frente à assistência aos usuários de álcool / Attitudes of primary care professionals towards assistance to alcohol users

O álcool é a substância mais usada por diversos grupos da população e o seu consumo abusivo pode levar a diversas consequências para a saúde física, mental e se estende à família e a problemas sociais o que configura um problema de saúde pública. Estratégias de identificação e intervenção para os problemas relacionados ao uso de álcool têm sido lentamente implementadas nos serviços da atenção primária à saúde, tendo em vista a amplitude e complexidade dos problemas e as barreiras que comprometem a oferta e a boa qualidade do cuidado. Entender o fenômeno do uso de álcool em sua multifatorialidade torna-se uma questão relevante para o manejo das barreiras e a oferta de abordagem apropriada. Entende-se como um componente crucial para proporcionar educação e treinamento a esses profissionais que atuam em cuidados aos usuários de álcool na atenção primária à saúde. O estudo teve por objetivo: a) avaliar conhecimentos teórico-práticos, percepções, sentimentos e atitudes de profissionais de saúde da atenção primária, sobre a assistência aos usuários com problemas relacionados ao uso de álcool; b) realizar um treinamento sobre esse tema e c) avaliar os conhecimentos, percepções, sentimentos e atitudes dos profissionais antes e após a aplicação do treinamento aos agentes comunitários da saúde. Método: trata-se de estudo quase-experimental, que envolve avaliação pré e pós-treinamento, e com abordagem quantitativa. O estudo foi realizado nas unidades de atenção primária em Pitangueiras, São Paulo, Brasil. Informações sociodemográficas e relacionadas a conhecimentos teórico-práticos sobre os problemas referentes ao uso de álcool na assistência aos usuários de álcool na atenção primária, a escala de Seaman & Manello: Nurse's Attitudes Toward Alcohol and Alcoholism Scale e o Short Alcohol and Alcohol Problems Perception Questionnaire foram utilizados. Na primeira etapa do estudo, foram entrevistados 89 profissionais de saúde da atenção primária. Posteriormente, participaram 31 agentes comunitários de saúde, que receberam treinamento sobre os problemas relacionados ao uso de álcool e foram avaliados antes e após o treinamento. Resultados: esses profissionais eram adultos jovens (33,8 anos), a maioria do sexo feminino, metade era casado, professava a religião católica e 64,5% possuía o ensino médio. Em relação às percepções sobre a assistência e sua importância, os agentes comunitários de saúde apresentaram melhores percepções sobre "como ajudar os usuários de álcool na atenção primária" - no pós-treinamento, no entanto, assinalaram que, mesmo com o treinamento, ainda apresentavam dificuldades em realizar tais cuidados junto a essa clientela. Obtiveram melhores níveis de conhecimento sobre sinais e sintomas do uso, abuso e dependência de álcool, houve mudança também em relação aos conhecimentos, habilidades específicas e necessárias para realizar assistência adequada aos usuários de álcool. Para um grupo de atitudes, foram relacionadas habilidades para ajudar os pacientes usuários de álcool e não foram observadas mudanças após a realização do treinamento. Conclusão: o treinamento é uma ferramenta que possibilita mudanças das práticas de saúde para a assistência integral ao paciente, que deve ser incorporado nas rotinas das unidades de saúde de forma contínua e permanente

Alcohol is the substance most used by various groups of the population, its abuse can lead to several diverse consequences for physical and mental health and extends to family and social problems which configured a public health problem. Identification and intervention strategies for alcohol-related problems have been slowly implemented in primary health care services, given the breadth and complexity of the problems and the barriers that compromise the provision and good quality of care. Understanding the phenomenon of alcohol use in its multifactorialities becomes a relevant issue for the management of barriers and offering an appropriate approach. It is understood as a crucial component to provide education and training to these professionals who work in the care of drug users. alcohol in primary health care. The study aims to: a) evaluate the theoretical and practical knowledge, perceptions, feelings and attitudes of primary care health professionals, about the assistance to users with problems related to alcohol use; b) conduct training on this topic; and c) evaluate the knowledge, perceptions, feelings and attitudes of professionals before and after the application of training to community health agents. Method: this is a quasi-experimental study, involving pre and post training evaluation, with a quantitative approach. The study was conducted in primary care units of a municipality in the interior of São Paulo: Pitangueiras. The data collection instrument contains: sociodemographic information, theoretical and practical information on problems related to alcohol use in assisting alcohol users in primary care, Seaman & Manello Scale: "Nurse's Attitudes Toward Alcohol and Alcoholism Scale" and Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). In the first stage of the study, 89 primary care health professionals were interviewed. Participated in the training on problems related to alcohol use, 31 community health agent. Results: the final sample consisted of professionals with an average age of 33.8 years, most were female 83.9%, half were married, 54.8% professed the Catholic religion and 64.5% had high school. Regarding perceptions about care and its importance, community health agents presented better perceptions about "how to help alcohol users in primary care" - however, after training, they pointed out that even with training, they still had difficulties. in performing such care with this clientele, obtained better levels of knowledge about signs and symptoms of alcohol use, abuse and dependence. There was also a change in the knowledge, specific skills needed to provide appropriate assistance to alcohol users. There were no changes in CHA attitudes after training, skills-related attitudes to help alcohol users. Conclusion: it is concluded that the training provided enables changes in health practices for comprehensive patient care, but should be incorporated into the routines of health units on a continuous and permanent basis

Álcool, drogas e inclusão social pelo trabalho: potencialidades e dificuldades de uma prática baseada na Economia Solidária / Alcohol, drugs and social inclusion by labor: potentialities and difficulties of a practice based on Solidarity Economy

O capitalismo, cujo modelo de organização do trabalho não permite que as populações mais vulneráveis (tais como a população em sofrimento pelo uso/abuso de álcool ou outras drogas) consiga acesso a uma colocação empregatícia formal, acaba por excluí-los para atividades laborais extremante precárias. A Economia Solidária, como outra perspectiva de atividade econômica, tem se mostrado uma alternativa para orientar projetos de inclusão social pelo trabalho. O objetivo deste estudo foi analisar as potencialidades e dificuldades vivenciadas por uma iniciativa de inclusão social pelo trabalho em Economia Solidária, desenvolvido por usuários de um CAPS-ad II (Centro de Atenção Psicossocial Álcool e Ouras Drogas), incubado por uma Incubadora Tecnológica de Empreendimentos Solidários, a Co-Labora ITES, da Universidade de São Paulo. A pesquisa se caracterizou como um estudo de caso de abordagem qualitativa e teve como instrumentos e técnicas de coleta de dados: (a) questionário de caracterização socioeconômico em forma adaptada do modelo elaborado e validado por Mesquita (2012), a partir do referencial teórico de Robert Castel e sua descrição das zonas de vulnerabilidade social (2005); (b) observação participante; (c) diário de campo e (d) entrevistas semiestruturadas. A pesquisa ocorreu na sede do CAPS-ad II, situado na cidade de Ribeirão Preto (SP). Os sujeitos foram: (a) associados da iniciativa de inclusão social pelo trabalho do CAPS-ad II (08 membros); (b) a coordenadora da iniciativa (01 membro) e (c) membros da Co-Labora ITES (04 membros). Mediante análise dos dados das tabelas de caracterização socioeconômica dos membros da iniciativa, inferiu-se que estavam todos desempregados, dependiam de benefícios de proteção social, possuíam renda insuficiente para as despesas domésticas e pessoais, além de uma rede social de apoio frágil. De acordo com as entrevistas semiestruturadas e observação participante, pode-se descrever o processo de implementação e desenvolvimento da iniciativa de inclusão social pelo trabalho do CAPS-ad II. As dificuldades encontradas através da análise das entrevistas semiestruturadas se concentraram na rotatividade de participantes na iniciativa, somada aos diferentes perfis e momentos do tratamento para uso problemático de álcool e outras drogas, às recaídas no uso dessas substâncias, as dificuldades manuais e cognitivas, a dificuldade com transporte, recursos humanos e financeiros, a existência deste Empreendimento Econômico Solidário (EES) dentro da unidade de serviços de saúde mental, o tempo escasso dedicado às atividades produtivas e o manejo do dinheiro por parte dos membros associados. As potencialidades dizem respeito à formação de lideranças, à construção de identidades e representatividades dos associados, ao investimento pessoal na iniciativa de inclusão social, à ocupação como meio de ressignificação para o trabalho, à bagagem técnica dos membros da Co-Labora sobre Economia Solidária, à conquista do trabalho como direito e não meio terapêutico, à conquista da Lei Municipal e consequentemente dos Fóruns, Feiras e assembleias sobre Economia Solidária, à criação da Associação Pólvora, à atuação da participante coordenadora da iniciativa como meio de promoção de autonomia e à formação em Economia Solidária através da incubadora. As redes sociais de suporte identificados foram os programas assistenciais do governo, a Lei Municipal, os Fóruns, as Feiras de Economia Solidária e assembleias. Os grupos sociais de suporte são o próprio CAPS-ad II, os membros familiares e a profissional coordenadora. Conclui-se que devemos olhar para as potencialidades, pois elas representam a força do empreendimento e as conquistas que o próprio grupo alcançou. As dificuldades devem ser enfrentadas com a união do próprio grupo, com o apoio da instituição do CAPS-ad II, da sociedade, da Co-Labora e das políticas públicas

The capitalism system, whose work organization model does not allow the most vulnerable populations (such as population suffering from the use/abuse of alcohol or other drugs) to achieve access to a formal employment position, it ends up excluding them for extremely precarious labor activities. The Solidarity Economy as another perspective of economic activity has shown itself to be an alternative to guide projects of social inclusion by means of working. The purpose of this study was to analyze the potentialities and difficulties experienced by an initiative of social inclusion through the work in Solidarity Economy, developed by users of a CAPS-ad II (Psychosocial Care Center for Alcohol and Drugs), grounded by a Technological Incubator of Solidarity Enterprises, the ITES Co-Labora, of the University of São Paulo. The research was characterized as a case of study of qualitative approach and it had as instruments and techniques of data collection: (a) questionnaire of sociodemographic characterization in adapted form of the model developed and validated by Mesquita (2012), based on the theoretical framework of Robert Castell and his description of the areas of social vulnerability (2005); (b) participant observation; (c) field diary and (d) semi-structured interviews. The research occurred at the head office of CAPS-ad II, placed in the city Ribeirão Preto (SP). The subjects were: (a) members of the social inclusion initiative by working of CAPS-ad II (8 members); (b) the coordinator of the initiative (1 member) and (c) members of the ITES Co-Labora (4 members). By means of analysis of the data from the socioeconomic characterization tables of members of the initiative, it was inferred that they were all unemployed, they depended on social protection benefits, they had insufficient income for domestic and personal expenses, and they had a fragile social support network. According to the semi-structured interviews and participant observation, the process implementation and development of the social inclusion initiative through the work of CAPS-ad II can be described. The difficulties encountered through the analysis of semi-structured interviews focused on the turnover of participants in the initiative, added to the different profiles and moments of treatment for problematic use of alcohol and other drugs; the relapses in the use of these substances, the manual and cognitive difficulties, the difficulty with transportation, human and financial resources, the existence of this Solidarity Economic Enterprise (SEE) within the unit mental services, the sparse time dedicated to productive activities and the management of money by the partners members. The potentialities involve the formation of leaders, the construction of identities and representations of the partners who are members of the initiative of social inclusion, the occupation as a means of re-signification for the work, the technical knowledge of the members of the Co-Labora on Solidarity Economy, the achievement of the work as right and not as a therapeutic way, the conquest of the Municipal Law and consequently of the Forums, Fairs and assemblies on Solidarity Economy, the creation of the Pólvora Association, the performance of the coordinator participant of the initiative as means of promoting autonomy and the formation in Solidarity Economy through the Incubator. The social support networks identified were the government`s assistance programs, the Municipal Law, the Forums, the Solidarity Economy Fairs and assemblies. The social support groups are CAPS-ad II itself, the family members and the professional coordinator. We conclude that we must look at the potentialities, because they represent the strength of the enterprise and the achievements that own group has achieved. The difficulties should be faced with the union of the group itself, with the support of the institution of CAPS-ad II, of society, of the Co-Labora, and the public politics

DOES IT WORK? -a randomized controlled trial to test the efficacy of HCV and HIV-related education on drug users in MMT, China.

BACKGROUND: HCV (Hepatitis C virus) is a prevalent chronic disease with potentially deadly consequences, especially for drug users. However, there are no special HCV or HIV (human immunodeficiency virus)-related intervention programs that are tailored for drug users in China; to fill this gap, the purpose of this study was to explore HCV and HIV-related knowledge among drug users in MMT (methadone maintenance treatment) sites of China and to investigate the effectiveness of HCV and HIV-related education for improving the knowledge of IDUs (injection drug users) and their awareness of infection. METHODS: The study was a randomized cluster controlled trial that compared a usual care group to a usual care plus HCV/HIV-REP (HCV/HIV-Reduction Education Program) group with a 24-week follow-up. The self-designed questionnaires, the HCV- and HIV-related knowledge questionnaire and the HIV/HCV infection awareness questionnaire, were used to collect the data. Four MMT clinics were selected for this project; two MMT clinics were randomly assigned to the research group, with subjects receiving their usual care plus HCV/HIV-REP, and the remaining two MMT clinics were the control group, with subjects receiving their usual care over 12 weeks. Sixty patients were recruited from each MMT clinic. A total of 240 patients were recruited. Follow-up studies were conducted at the end of the 12th week and the 24th week after the intervention. RESULTS: At baseline, the mean score (out of 20 possible correct answers) for HCV knowledge among the patients in the group receiving the intervention was 6.51 (SD = 3.5), and it was 20.57 (SD = 6.54) for HIV knowledge (out of 45 correct answers) and 8.35 (SD = 2.8) for HIV/HCV infection awareness (out of 20 correct answers). At the 12-week and 24-week follow-up assessments, the research group showed a greater increase in HCV-/HIV-related knowledge (group × time effect, F = 37.444/11.281, P < 0.05) but no difference in their HIV/HCV infection awareness (group × time effect, F = 2.056, P > 0.05). CONCLUSION: An MMT-based HCV/HIV intervention program could be used to improve patient knowledge of HCV and HIV prevention, but more effort should be devoted to HIV/HCV infection awareness. TRIAL REGISTRATION: Protocols for this study were approved by institution review board (IRB) of Shanghai Mental Health Center (IRB:2009036), and registered in U.S national institutes of health (http://www.clinicaltrials.gov, NCT01647191 ). Registered 23 July 2012.

Randomized comparison of two web-based interventions on immediate and 30-day opioid overdose knowledge in three unique risk groups.

BACKGROUND: In response to the opioid overdose epidemic, scalable interventions that instruct at-risk populations how to prevent and respond to overdose scenarios are needed. METHOD: The following groups of at-risk individuals were recruited online: (1) Acute Pain patients with an opioid prescription, (2) Chronic Pain patients with an opioid prescription, and (3) persons without pain who use Illicit Opioids. Participants were tested on their opioid overdose knowledge using the Brief Opioid Overdose Knowledge (BOOK) questionnaire and randomized to one of two web-based interventions that contained 25 educational content slides. One intervention consisted of embedded questions with corrective feedback (Presentation + Mastery, n = 58), the other did not (Presentation, n = 61). Participants completed the BOOK again at the end of the intervention and 30 days later. Overdose risk behaviors were assessed at baseline and 30-days. RESULTS: Relative to baseline, both Presentation and Presentation + Mastery interventions increased total BOOK scores immediately and 30 days later. There was a significant effect of Group on BOOK Knowledge, whereby those with Acute Pain had lower scores across time, regardless of intervention, relative to those with Chronic Pain and Illicit Opioid Use. Compared to baseline, all three groups reported fewer instances of using opioids alone or concurrently with alcohol at the 30-day follow-up. CONCLUSIONS: A web-based intervention increased opioid overdose knowledge and decreased overdose risk behavior immediately and at a one-month follow-up, suggesting that this brief, practical, and scalable program could have utility in several populations who are at-risk of opioid overdose.

Engaging people who inject drugs in hepatitis C virus testing and prevention through community-based outreach, in Sydney, Australia.

INTRODUCTION AND AIMS: Increasing treatment uptake among people who inject drugs (PWID) with chronic hepatitis C virus (HCV) infection is integral to eliminating viral hepatitis. This study explored the role of community-based outreach in engaging and retaining Australian PWID in the testing component of the HCV care cascade. DESIGN AND METHODS: Semi-structured interviews were conducted with 28 PWID, including new initiates to injecting and those from culturally and linguistically diverse (CALD) backgrounds, who acquired HCV infection while enrolled in a community-based prospective observational study of hepatitis C vaccine preparedness in Sydney. Participants were interviewed at diagnosis and 12 months later. Transcripts were thematically analysed using constant comparative techniques. RESULTS: Community-based outreach was effective in engaging newly infected participants in HCV monitoring and decision-making about seeking interferon-based treatment. Key factors in the acceptability of outreach were privacy and discretion, and opportunities to build trust with non-judgmental staff. Retaining participants in the HCV cascade of care required more than a one-off session of post-test counselling. Ongoing discussions with staff enabled paced and tailored delivery of information about HCV prevention, testing and treatment. Increased understanding of the role of HCV ribonucleic acid viremia in determining the need for treatment, and access to this testing, was pivotal in making HCV monitoring salient for participants. DISCUSSION AND CONCLUSIONS: Outreach is an effective strategy for engaging new initiates to injecting and CALD PWID in HCV testing and decision-making about treatment. Findings highlight the need to increase availability and access to HCV ribonucleic acid testing for PWID.

Community-consumerism: negotiating risk in online drug communities.

This study explores the social organisation of risk within online drug-related communities. Drawing on in-depth interviews with participants from two Norwegian Internet drug forums, the paper illustrates how participation in such forums influenced notions of risk, and how it supported notions of participants as being informed, responsible and empowered. First, the forums facilitated an easy exchange of user-generated drug information, which helped members present themselves as informed and competent. Second, members used the communal resources on the forums to negotiate their drug-using identities, in which they resisted stigma and argued for a responsible drug-using identity. Third, the social inclusion and sense of community within the forums formed the basis for collective support, which helped empower those involved. Conceptualised as community-consumerism, these findings highlight the social mechanisms involved in the information self-sufficiency and decentralisation of authority on the Internet, in which members created an alternative frame of reference for drug use and associated health. The concept of community-consumerism offers a perspective on the social organisation of risk within online communities and ought to be of relevance for future studies on online health-related discourses, not only those related to drugs.

Evaluation of a Computer-Based Training Program to Teach Adults at Risk for HIV About Pre-Exposure Prophylaxis.

This study developed a computer-based program to teach HIV prevention behaviors and raise awareness of pre-exposure prophylaxis (PrEP) among individuals at risk for HIV. The program was divided into modules containing educational material and multiple-choice questions. Participants received immediate feedback for responses and incentives for correct responses to multiple-choice questions. Participants trained on each module until they met speed and accuracy criteria. The modules were divided into: Course 1 (HIV), Course 2 (PrEP), and Course 3 (HIV risk behaviors). Tests of content from all three courses were delivered before and after participants completed each course. Test scores on the content delivered in the courses improved only after participants completed training on each course. HIV and PrEP knowledge was initially low and increased following completion of each part of the program. Computer-based training offers a convenient and effective approach to promoting HIV prevention knowledge, including use of PrEP.

Reducing substance use and risky sexual behaviour among drug users in Durban, South Africa: Assessing the impact of community-level risk-reduction interventions.

Alcohol and other drug (AOD) use is increasingly recognised as having a direct and indirect effect on the transmission of human immunodeficiency virus (HIV). However, there is evidence to suggest that drug- and sex-related HIV risk-reduction interventions targeted at drug users within drug treatment centres or via community outreach efforts can lead to positive health outcomes. This study aimed to test whether a community-level intervention aimed at AOD users has an impact on risky AOD use and sexual risk behaviour. In 2007, in collaboration with a local non-governmental organisation (NGO) in Durban, an initiative was begun to implement a number of harm reduction strategies for injection and non-injection drug users. The NGO recruited peer outreach workers who received intensive initial training, which was followed by six-monthly monitoring and evaluation of their performance. Participants had to be 16 years of age or older, and self-reported alcohol and/or drug users. Peer outreach workers completed a face-to-face baseline questionnaire with participants which recorded risk behaviours and a risk-reduction plan was developed with participants which consisted of reducing injection (if applicable) and non-injection drug use and sex-related risks. Other components of the intervention included distribution of condoms, risk-reduction counselling, expanded access to HIV Testing Services, HIV/sexually transmitted infection care and treatment, and referrals to substance abuse treatment and social services. At follow-up, the baseline questionnaire was completed again and participants were also asked the frequency of reducing identified risk behaviours. Baseline information was collected from 138 drug users recruited into the study through community-based outreach, and who were subsequently followed up between 2010 and 2012. No injection drug users were reached. The data presented here are for first contact (baseline) and the final follow-up contact with the participants. There were no decreases in drug use practices such as use of cannabis, heroin, cocaine and Ecstasy after the intervention with drug users; however, there was a significant reduction in alcohol use following the intervention. While there was a substantial increase in the proportion of participants using drugs daily as opposed to more often, the reduction in the frequency of drug use was not statistically significant. Following the intervention, drug users had significantly fewer sexual partners, but there were no significant differences following the intervention with regard to frequency of sex or use of condoms. Substance use in general and during sex was, however, decreased. While the findings were mixed, the study shows that it is possible to provide HIV risk-reduction services to a population of substance users who are less likely to receive services through community outreach, and provide risk-reduction information, condoms and condom demonstration and other services. More intensive interventions might be needed to have a substantial impact on substance use and substance use-related HIV risk behaviours.

Consequências do uso de drogas: a ótica de adolescentes pertencentes ao meio rural / Consecuencias del abuso de substancias: la perspectiva de adolescentes pertenecientes a las zonas rurales / Consequences of drug use: perspective of the adolescent in rural areas

Objetivo: conhecer a ótica de adolescentes rurais sobre as consequências do uso de drogas. Método: Trata-se de uma pesquisa qualitativa, realizada pela metodologia criativo-sensível, com adolescentes do oitavo ano de uma escola rural. Resultado: Durante as produções artísticas e depoimentos, os adolescentes do meio rural expressaram que o uso de drogas gera consequências de saúde e sociais, destacando a exposição ao sexo inseguro (gravidez precoce e doenças sexualmente transmissíveis – DSTs), a violência física e sexual (estupro e atentado ao pudor) e os acidentes de trânsito. Conclusão: Os adolescentes pertencentes ao meio rural têm um olhar ampliado a respeito das consequências do uso de drogas. Contudo, isso não significa que estão protegidos diante dessa problemática. Nesse caso, os setores saúde e escolar precisam manter/realizar ações de prevenção ao uso e abuso de drogas junto aos adolescentes.

Objective: to know the perspective of rural teenagers on drug use consequences. Method: This is a qualitative research, carried out by creative - sensitive method, with teenagers in the eighth year of a rural school. Result: During artistic productions and testimonials, the teenagers from rural areas expressed that the use of drugs generates health and social consequences, highlighting the exposure to unsafe sex (early pregnancy and STD), physical and sexual violence (rape and indecent assault) and car accidents. Conclusion: Adolescents from the rural area have an extending look about the consequences of drug use. However, this does not mean that they are protected against this problem. In this case, the health sector and school need to keep/take actions to prevent drug use and abuse among adolescents.

Objetivo: conocer la perspectiva de los adolescentes rurales sobre las consecuencias del consumo de drogas. Método: Se trata de uma investigación cualitativa, llevada a cabo por el método creativo - sensible, con los adolescentes octavo año en una escuela rural. Resultado: Durante las producciones artísticas y testimonios, los adolescentes de las zonas rurales expresaron que el uso de drogas genera consecuencias sociales y de salud, destacando la exposición a relaciones sexuales sin protección (el embarazo precoz y enfermedades de transmisión sexual), la violencia física y sexual (violación y exposición indecente) y accidentes de tráfico. Conclusión: Adolescentes del área rural tienen una mirada ampliada sobre las consecuencias del consumo de drogas. Sin embargo, esto no quiere decir que están protegidos contra este problema. En este caso, El sector de la salud y la escuela necesitan mantener/adoptar medidas para prevenir el uso y abuso de drogas entre los adolescentes.

Category 3 and 4 Controlled Drugs Users' Perceptions of Participating in Drug-Abuse-Health Prevention Lectures in Taiwan.

This study was designed to explore Category 3 and 4 controlled drug users' perceptions of participating in health-prevention lectures. A phenomenological approach was used. Twelve participants were interviewed after completing the lectures. Findings revealed five themes (1) mixed emotions; (2) self-development; (3) finding the lectures lacked practicality and relevance; (4) highlighting three stages for discontinuing drug-usage; and, (5) suggesting tips for the advancement of lectures. These findings could be used as a map to help health professionals understand drug users' perceptions of attending health prevention lectures and provide insight into how young people might stop using drugs.

The social logic of naloxone: Peer administration, harm reduction, and the transformation of social policy.

This paper examines overdose prevention programs based on peer administration of the opioid antagonist naloxone. The data for this study consist of 40 interviews and participant observation of 10 overdose prevention training sessions at harm reduction agencies in the Bronx, New York, conducted between 2010 and 2012. This paper contends that the social logic of peer administration is as central to the success of overdose prevention as is naloxone's pharmacological potency. Whereas prohibitionist drug policies seek to isolate drug users from the spaces and cultures of drug use, harm reduction strategies like peer-administered naloxone treat the social contexts of drug use as crucial resources for intervention. Such programs utilize the expertise, experience, and social connections gained by users in their careers as users. In revaluing the experience of drug users, naloxone facilitates a number of harm reduction goals. But it also raises complex questions about responsibility and risk. This paper concludes with a discussion of how naloxone's social logic illustrates the contradictions within broader neoliberal trends in social policy.

The impact of an HIV/AIDS adult integrated health program on leaving hospital against medical advice among HIV-positive people who use illicit drugs.

Background: Leaving hospital against medical advice (AMA) is a major source of avoidable morbidity, mortality and healthcare expenditure. The objective of this study was to assess the impact of an innovative HIV/AIDS adult integrated health program on leaving hospital AMA among HIV-positive people who use illicit drugs (PWUD). Methods: Using generalized estimating equations, we examined the relationship between being a participant of the Dr. Peter Centre (DPC), a specialty HIV/AIDS-focused adult integrated health program, and leaving hospital AMA among a cohort of HIV-positive PWUD patients. Results: Between July 2005 and July 2011, 181 HIV-positive PWUD who experienced ≥1 hospitalization were recruited into the study. Of the 406 hospital admissions among these individuals, 73 (39.9%) participants left the hospital AMA. In a multivariable model adjusted for confounders, being a participant of the DPC was independently associated with lower odds of leaving hospital AMA (adjusted odds ratio = 0.42; 95% confidence interval: 0.19-0.89). Conclusions: Our findings suggest that the provision of a broad range of clinical, harm reduction and support services through an innovative HIV/AIDS-focused adult integrated health program operating in proximity to a hospital may curb the rate at which individuals leave hospital prematurely.

Willingness to Use Pre-Exposure Prophylaxis (PrEP): An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model among High-Risk Drug Users in Treatment.

Evidence from recent pre-exposure prophylaxis (PrEP) trials has demonstrated its safety and efficacy in significantly reducing the risk of HIV acquisition for those who are at considerable risk of acquiring HIV infection. With a rapid increase in the amount of research on the efficacy of PrEP for HIV prevention, complementary research on the willingness to use PrEP has grown, especially among MSM, but limited research has been focused among people who use drugs (PWUD). As part of the formative process, we utilized the information-motivation-behavioral skills (IMB) model of health behavior change to characterize and guide intervention development for promoting willingness to use PrEP among high-risk PWUD. The analysis included 400 HIV-negative high-risk PWUD enrolled in a community-based methadone maintenance treatment who reported drug- and/or sex-related HIV risk behaviors in the past 6-months. Analyses revealed support for the IMB model as PrEP-related behavioral skills were found to mediate the influence of PrEP-related information and motivation on willingness to use PrEP. The results provide evidence as to the utility of the IMB model to increase willingness to use PrEP among high-risk PWUD. It therefore makes an important contribution to our understanding of the applicability of theoretically-grounded models of willingness to use PrEP among high-risk PWUD, who are one of the key risk populations who could benefit from the use of PrEP.

Improvements in HCV-related Knowledge Among Substance Users on Opioid Agonist Therapy After an Educational Intervention.

OBJECTIVES: Lack of knowledge about hepatitis C virus (HCV) is a principal barrier to substance users' engagement into care for the infection. As a step toward their increased engagement into HCV care, the objective of this study was to deliver an HCV-related educational intervention to substance users on opioid agonist therapy and to assess the change in HCV-related knowledge after the intervention. METHODS: We designed a comprehensive and interactive hepatitis C-related educational intervention, composed of two 30 to 60-minute sessions conducted during 2 consecutive weeks. Patients' knowledge about hepatitis C was assessed immediately before and after the intervention using a 7-item questionnaire. RESULTS: A total of 110 patients completed both educational sessions. Patients' mean age was 54.7 ±â€Š7.8 years, 58.7% were men, 70.4% African American, and 30% were Hispanic. We observed a significant increase in HCV-related knowledge after completion of the educational intervention. Whereas 65.45% of patients answered 5 or more questions correctly before the intervention, 83.64% had 5 or more questions answered correctly on the posteducational quiz (P < 0.001). Male sex, ever receiving an HCV diagnostic test before the educational intervention, and a higher level of HCV knowledge on the preeducational quiz were found to be significantly associated with HCV-related knowledge after the educational intervention. CONCLUSIONS: Patients' knowledge about hepatitis C was found to be significantly improved after the educational intervention. Therefore, HCV-related education could be the first step toward effective enrollment of patients on opioid agonist therapy into hepatitis C care.