The state of science on including inhalation within supervised consumption services: A scoping review of academic and grey literature

Gehring, Nicole D; Speed, Kelsey A.; Launier, Katherine; O’Brien, Daniel C.; Campbell, Sandy; Hyshka, Elaine

doi:10.1016/j.drugpo.2022.103589

Cited by 12 publications

(10 citation statements)

References 62 publications

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“…Worse, it appears that many PWUD in Canadian settings have actively switched from opioid use by injection to inhalation or alternative use modes as part of intentional efforts for improved health protection amidst the drug‐death‐crisis, while with limited success of achieving these desired benefits [28]. Meanwhile, principal interventions (e.g., supervised consumption services) operating across Canada to provide ‘safer’ drug use environments for overdose death reduction, to a large extent, do not accommodate for drug ‘inhalation’, and so leave tangible prevention opportunities for PWUD especially with non‐injection use limited, despite great and acute need to protect and support their health [29]. While related provisions exist in some supervised consumption service sites, these need to be systematically expanded to accommodate and directly support the risk‐reduction needs of PWUD engaging in non‐injection (e.g., inhalation) use.…”

Section: Resultsmentioning

confidence: 99%

Three noteworthy idiosyncrasies related to Canada's opioid‐death crisis, and implications for public health‐oriented interventions

Fischer,

Robinson,

Jutras‐Aswad

2023

Drug and Alcohol Review

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Canada has been experiencing a prolonged public health‐crisis of high rates of overdose deaths caused by exceptionally potent/toxic, illicit opioid use. While many key features of this drug death epidemic are well‐documented, several idiosyncratic aspects with relevance for public health‐oriented interventions are not adequately recognised. These include: (i) the discrepant opioid patterns pan‐Canada, with large majorities of opioid deaths caused by illicit fentanyl drugs in Western, but not Eastern regions where prescription‐type opioid prevail; (ii) the environments of overdose deaths, where vast majorities occur in ‘residential’ or other shelter‐type settings, presenting barriers for emergency interventions rather than health protection; and (iii) shifting drug use modes, where now majorities of overdose deaths are associated with drug ‘inhalation’ (instead of ‘injection’) in contexts of potent/toxic drug supply. We briefly describe these factors and related implications for intervention programming towards an improved response to the drug death‐crisis.

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Section: Resultsmentioning

confidence: 99%

Three noteworthy idiosyncrasies related to Canada's opioid‐death crisis, and implications for public health‐oriented interventions

Fischer,

Robinson,

Jutras‐Aswad

2023

Drug and Alcohol Review

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“…Dies erleichtert den Wechsel vom injizierendem zum nicht-injizierenden Konsum von Substanzen und reduziert somit die Risiken der Ansteckung mit Infektionskrankheiten (HIV und Hepatitis C) und die Gefahr einer Überdosierung [11]. DKR mit Inhalationsplätzen bieten zudem Konsument*innen von Drogen, die hauptsächlich geraucht werden, sowie Crack einen sicheren Raum für den Konsum [12].…”

Section: Introductionunclassified

“…Auch europaweit wird ein Anstieg von Stimulanzien wie Crack und Methamphetaminen beobachtet [17]. Generell ist wenig über die Nutzung von nicht injizierten Substanzen in Drogenkonsumräumen bekannt [12].…”

Section: Introductionunclassified

Inhalativer Konsum in Drogenkonsumräumen als wichtiges Element von Harm Reduction

Grabski,

Stöver,

Michels

et al. 2024

Suchttherapie

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Zusammenfassung Ziel der Studie Während die schadensminimierende Wirkung von Drogenkonsumräumen (DKR) bei injizierendem Drogengebrauch gut belegt ist, gibt es momentan wenige Nachweise über die schadensminimierende Wirkung bei nicht-injizierendem Drogengebrauch in DKR. Dies ist aber aktuell von großer Wichtigkeit: zum einen bringt die Alterung der DKR-Population mit sich, dass viele Konsument*innen wegen ihrer durch chronischen Konsum von nicht regulierten Drogen geschädigten Venen nicht mehr intravenös Nutzen können. Zum anderen wird europaweit und auch in Deutschland ein Anstieg vom Konsum gerauchter Stimulanzien, wie Crack, beobachtet. Generell gilt der nicht- injizierende Konsum als risikoärmer, aber dies ist im Kontext von DKR bis jetzt nicht untersucht worden. Seit 2011 wird der Konsum von Substanzen in den Inhalationsräumen der vier DKR in Frankfurt am Main systematisch erfasst. Durch sein Volumen und die Länge der systematischen Erfassung ist dieser Datensatz besonders geeignet, die Entwicklungen des nicht- injizierenden Konsums in DKR und die schadensminimierende Wirkung dieser Konsumform zu untersuchen. Methodik Wir untersuchen die Nutzung von Inhalationsplätzen und die Nutzung von nicht -injizierend und injizierend konsumierter Substanzen. Zudem werden Notfalldaten zu injizierendem und nicht- injizierendem Gebrauch verglichen. Ergebnisse Inhalationsplätze werden insgesamt viel und vermehrt genutzt. Nicht- injizierend werden vor allen Dingen Heroin und Crack konsumiert. Heroin ist nach einem sprunghaften Anstieg ab 2015 die am meisten nicht-injizierend genutzte Substanz. Den stärksten Anstieg von nicht-injizierend genutzten Substanzen in den letzten zwei Jahren hatte Crack. Der injizierende Gebrauch nimmt insgesamt ab, es ist aber noch die bei weitem häufigste Konsumform. Notfalldaten zeigen, dass die Nutzung von nicht- injizierenden Methoden zur Drogeneinnahme im Vergleich zu injizierenden Methoden in Verbindung mit deutlich weniger Notfällen steht. Dies ist auch nach statistischer Anpassung für die Häufigkeit der Konsumform der Fall. Schlussfolgerung Die Bereitstellung von Inhalationsplätzen bietet die Möglichkeit zum weniger riskanten Konsum von gerauchten Substanzen und kann den Umstieg vom injizierenden zum weniger riskanten inhalativen oder intranasalen Konsum erleichtern. Sollte der Konsum von Drogen wie Crack weiter ansteigen, könnte die gezielte Ausrichtung von DKR auf die Bedarfe von Konsument*innen eine der wichtigsten gesunderhaltenden Maßnahmen sein.

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“…In Canada, Supervised Consumption Sites (SCS) are federally sanctioned facilities that provide safe and hygienic spaces for people to consume substances in the presence of a staff who is trained in overdose response (3). While the uptake of SCS has gained momentum across the globe with over 130 sites operating in 12 countries (especially in North America, UK, and Europe) due to their researched effectiveness (4), they continue to face signi cant objections and ambivalence from the general public (5).…”

Section: Introductionmentioning

confidence: 99%

Understanding the barriers and facilitators to implementing and sustaining Mobile Overdose Response Services from the perspective of Canadian key interest groups: A qualitative study.

Seo,

Rider,

Rioux

et al. 2023

Preprint

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Introduction: Unregulated supply of fentanyl and adulterants continues to fuel the opioid epidemic across the globe. Mobile Overdose Response Services (MORS) are novel technologies that offer virtual supervised consumption (including hotline and mobile applications) to minimize the risk of fatal overdose for those who are unable to access a physical supervised consumption site. However, as newly implemented services, they are also faced with numerous limitations. The objective of this study was to examine the facilitators and barriers to the adoption and implementation of MORS in the context of the current drug poisoning crisis in Canada. Methods: A total of 64 semi-structured interviews were conducted between November 2021 and April 2022. Participants consisted of individuals with lived or living experience of substance use (i.e. peers), family members, health care providers, harm reduction workers, members of the general public, and MORS operators. Inductive thematic analysis informed by grounded theory was used to identify major themes and subthemes. Results: Respondents revealed that MORS facilitated a safe, trauma-informed environment for PWUS to seek harm reduction and other necessary support. It also created a new sense of purpose for operators to positively contribute to the community. However, barriers to adoption of MORS included uncertainty of funding, lacking marketing strategies, and compassion fatigue amongst the workers. Conclusion: Although MORS were viewed as a useful addition to the currently existing harm reduction toolkit, its barriers to adoption must be continuously examined and monitored in various contexts by engaging the perspectives of key interest groups.

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The state of science on including inhalation within supervised consumption services: A scoping review of academic and grey literature

Cited by 12 publications

References 62 publications

Three noteworthy idiosyncrasies related to Canada's opioid‐death crisis, and implications for public health‐oriented interventions

Three noteworthy idiosyncrasies related to Canada's opioid‐death crisis, and implications for public health‐oriented interventions

Inhalativer Konsum in Drogenkonsumräumen als wichtiges Element von Harm Reduction

Understanding the barriers and facilitators to implementing and sustaining Mobile Overdose Response Services from the perspective of Canadian key interest groups: A qualitative study.

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