87 research outputs found
Harm reduction among injecting drug users - evidence of effectiveness
No full textThis chapter synthesises and evaluates the available direct evidence relating to the impact of needle and syringe programmes (NSPs), opioid substitution treatment (OST), drug consumption rooms (DCRs), and peer naloxone distribution (PND) on HIV/hepatitis C (HCV) incidence/prevalence, injecting risk behaviour and overdose-related mortality. To achieve this, we conducted a review of reviews; a systematic and explicit method used to identify, select and critically appraise relevant findings from secondary level research (systematic reviews and/or meta-analyses) into an evidence briefing. In the absence of high-quality reviews, appraisal of the evidence was supplemented with a targeted review of the primary literature. We find that there is sufficient review-level evidence that OST reduces HIV transmission, while the evidence in support of NSPs reducing HIV transmission is more tentative, and for DCRs currently insufficient. There is tentative evidence that OST has limited effectiveness in reducing HCV transmission, and insufficient evidence to support or discount NSPs or DCRs' ability to reduce HCV transmission. There is sufficient review-level evidence that NSPs, OST and DCRs reduce self-reported injecting risk behaviour. There is sufficient review evidence that OST reduces risk of overdose mortality, but insufficient evidence to support or discount the effect of DCRs or PND on overdose deaths at the community level. Our review shows evidence in support of a variety of harm reduction interventions but highlights an uneven presence of high-quality review evidence. Future evaluation of harm reduction programmes should prioritise methodologically robust study designs
If Supply-Oriented Drug Policy is Broken, Can Harm Reduction Help Fix It?—Melding Disciplines and Methods to Advance International Drug Control Policy
Get PDFCritics of the international drug control regime contend that supply-oriented policy interventions are not just ineffective, but they also produce unintended adverse consequences. Research suggests their claims have merit. Lasting local reductions in opium production are possible, albeit rare; but, unless global demand shrinks, production will shift elsewhere, with little or no effect on the aggregate supply of heroin and, potentially, at some expense to exiting and newly emerging suppliers. The net consequences of the international drug control regime and related national policies are as yet unknown. In this paper, we consider whether “harm reduction,” a subject of intense debate in the demand-oriented drug policy community, can provide a unifying foundation for supply-oriented drug policy, one capable of speaking more directly to policy goals. Despite substantial conceptual and technical challenges, we find that harm reduction can provide a basis for assessing the net consequences of supply-oriented drug policy, choosing more rigorously among policy options, and identifying new policy options. In addition, we outline a practical path forward for assessing harms and policy options.
Policy and practice in harm reduction in Australasia
No full textThis chapter has a different format from the other chapters. The author originally commissioned to write the chapter was unable to deliver it late in the process. We asked a number of distinguished experts from Australia and New Zealand to write a brief piece on their perceptions of the current situation of harm reduction in their countries. What we have now are six contributions and a brief commentary. There is a small overlap between some contributions but this is the nature of these individual contributions and as such they have remained as integrated pieces
Van ijstijd tot middeleeuwen: geschiedenis Dinkel in de beekoever
No full textDe Dinkel is een unieke beek die al door Twente stroomt sinds de laatste ijstijd. In de tussentijd is er ontzettend veel veranderd, grotendeels door de mens. Die sporen zijn nog terug te vinden in de beekoever. Historisch landschapsecoloog Harm Smeenge, werkzaam bij Bosgroepen, promoveerde op het landschap van Noordoost-Twente en ontdekte een belangrijke snelweg recht door het water
MRI changes in diaphragmatic motion and curvature in Pompe disease over time
Get PDFOBJECTIVES: To evaluate changes in diaphragmatic function in Pompe disease using MRI over time, both during natural disease course and during treatment with enzyme replacement therapy (ERT). METHODS: In this prospective study, 30 adult Pompe patients and 10 healthy controls underwent pulmonary function tests and spirometry-controlled MRI twice, with an interval of 1 year. In the sagittal view of 3D gradient echo breath-hold acquisitions, diaphragmatic motion (cranial-caudal ratio between end-inspiration and end-expiration) and curvature (diaphragm height and area ratio) were calculated using a machine learning algorithm based on convolutional neural networks. Changes in outcomes after 1 year were compared between Pompe patients and healthy controls using the Mann-Whitney test. RESULTS: Pulmonary function outcomes and cranial-caudal ratio in Pompe patients did not change significantly over time compared to healthy controls. Diaphragm height ratio increased by 0.04 (−0.38 to 1.79) in Pompe patients compared to −0.02 (−0.18 to 0.25) in healthy controls (p = 0.02). An increased diaphragmatic curvature over time was observed in particular in untreated Pompe patients (p = 0.03), in those receiving ERT already for over 3 years (p = 0.03), and when severe diaphragmatic weakness was found on the initial MRI (p = 0.01); no progression was observed in Pompe patients who started ERT less than 3 years ago and in Pompe patients with mild diaphragmatic weakness on their initial MRI. CONCLUSIONS: MRI enables to detect small changes in diaphragmatic curvature over 1-year time in Pompe patients. It also showed that once severe diaphragmatic weakness has occurred, improvement of diaphragmatic muscle function seems unlikely. KEY POINTS: • Changes in diaphragmatic curvature in Pompe patients over time assessed with 3D MRI may serve as an outcome measure to evaluate the effect of treatment on diaphragmatic function. • Diaphragmatic curvature showed a significant deterioration after 1 year in Pompe patients compared to healthy controls, but the curvature seems to remain stable over this period in patients who were treated with enzyme replacement therapy for less than 3 years, possibly indicating a positive effect of ERT. • Improvement of diaphragmatic curvature over time is rarely seen in Pompe patients once diaphragmatic motion shows severe impairment (cranial-caudal inspiratory/expiratory ratio < 1.4). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-022-08940-y
Access to needle and syringe programs by people who inject image and performance enhancing drugs
No full textWe appreciate van Beek and Chronister's concerns regarding the funding of harm reduction interventions in an environment of diminishing resources (van Beek & Chronister, 2015), however we disagree with their conclusion and support the international guidelines for equitable and non-discriminatory NSP provision for all people who inject drugs. van Beek and Chronister outline the response of the Kirketon Road Centre (KRC), an established primary health care facility in Sydney, New South Wales (NSW), to a potential “public policy dilemma” resulting from an increase in the injection of drugs with the primary purpose of enhancing image and/or performance in Australia (van Beek & Chronister, 2015). Using data from surveys of 102 men injecting image and performance enhancing drugs (IPEDs) attending the KRC Needle and Syringe Program (NSP), they assessed the risk of blood-borne viral (BBV) infections in this group to be lower than among people who inject drugs primarily for their psychoactive effects. The KRC subsequently implemented a policy decision to limit the availability of injecting equipment from their NSP to people who inject IPEDs. The authors also encouraged other NSP services to undertake local assessment
The extent of injection site infection in injecting drug users: findings from a national surveillance study.
Get PDFInjection site infections in injecting drug users (IDUs) are associated with serious morbidity and healthcare costs. Factors associated with symptoms of these were examined through annual (2006-2008) unlinked-anonymous survey of IDUs in England, Wales and Northern Ireland. Overall 36% (1863/5209) self-reported having a symptom with no trend over time (35% 2006, 37% 2007, 34% 2008). Symptoms were less common in the North East of England; increased with years injecting; and were higher in women, those recently homeless, those recently using a needle exchange, and those injecting both opiates and stimulants. Of those injecting during the previous 4 weeks (n=3733) symptoms were associated with: injecting daily; injecting >or=10 times a day; injecting into hands, groin, or legs; sharing filters; and reusing water to flush syringes. Symptoms of injection site infections are common in IDUs. Better-targeted preventive interventions are needed, and continued surveillance should assist with assessing the impact of new initiatives
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