Opportunities to Offer Harm Reduction to People who Inject…

The clinical trial led by a King’s College London academic followed patients who had been injected with tezepelumab every four weeks for a year. More than half of the participants who had received the injection were able to stop their daily steroid tablets entirely, without any impact on their symptoms. This compassionate, non-judgmental approach can empower individuals, reduce stigma, and ultimately, foster healthier communities.

IDENTIFYING TECHNIQUES TO REDUCE ID COMPLICATIONS

From Western PA to our Columbus, Ohio location, Central Outreach Wellness Center is committed to providing a comprehensive array of additional resources and services that are crucial in reinforcing these strategies. Here’s what everyone should know about harm reduction, along with five basic guidelines to follow in order to keep yourself and others healthy. Shannon N. Ogden was involved in most aspects of the systematic review and publication. Melissa J. Davoust was involved in most aspects of the systematic review and publication. Grace H. Yoon was involved in all aspects of the systematic review and publication. Timothy W. Levengood was involved in all aspects of the systematic review and publication.

Crime and Drug Use-Related Public Nuisance

Following these steps carefully can help ensure that injections are performed safely and effectively, whether they’re for vaccinations, medications, or other treatments. Proper drug injection technique is crucial for ensuring the medication’s effectiveness, minimizing pain, and reducing the risk of complications such as infections or tissue damage. The consequences are dire and far-reaching, contributing to a staggering 13% of new HIV infections worldwide being attributed to needle sharing among people who inject drugs (PWID).

RESOURCES

There has been a concurrent increase in infectious complications of IDU, including outbreaks of human immunodeficiency virus (HIV) infection 3–5, viral hepatitis 6–8, and bacterial infections . Common reasons for not counseling included limited time and a desire to emphasize antibiotic therapy/medical issues (62%), lack of training (55%), and believing that it would be better addressed by other services (47%). AThis is not a comprehensive list of resources, but rather a starter guide for accessing additional training or support. Lastly, there Reducing injection harm is an extensive body of literature associating MOUD with reduced risk of HIV and HCV transmission in addition to improved viral suppression 86–95. As such, access is largely restricted by the limited number of clinicians who have obtained the DATA waiver to prescribe buprenorphine . For MOUD, there are 3 FDA-approved medications including opioid agonist treatment options, methadone, and buprenorphine, in addition to an opioid antagonist treatment option, extended-release naltrexone .

Substantial resources will be needed to effectively implement low-barrier and nontraditional models of care for PWID. Integrated care teams have been successful in both inpatient and outpatient settings and provide a model for hospitals looking to improve the care of PWID 38–40. Other allied health professionals, such as peer recovery specialists, nurse educators, and pharmacists, may also be able to provide counseling, education, and vaccinations.

Evaluators should advocate for more empirically rigorous study designs whenever possible. Review authors also found that most effectiveness studies had the “least” suitable quality of design (e.g., they were cross-sectional studies, before–after studies, or were prospective cohort studies analyzed in a cross-sectional manner). One study by Kral et al.56 published after the search period ended examined an unsanctioned SIF at an undisclosed U.S. location.

Evidence Acquisition

Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. The findings of the WAYFINDER study will be presented at the British Thoracic Society Winter Meeting 2025 on Thursday 27th November 2025. “As tezepelumab also suppresses allergy related symptoms and improves chronic rhinosinusitis as well, the results are particularly exciting for patients with severe asthma who suffer with both upper and lower airway symptoms.” Last year, another team at King’s discovered that another antibody, benralizamab, could be injected during some asthma and COPD attacks to reduce the need for further treatment. The WAYFINDER study, published in The Lancet Respiratory Medicine today, is among long-standing research into severe asthma at King’s College London.

The following is a noncomprehensive list of strategies that ID clinicians could familiarize themselves with and incorporate into a harm reduction–informed service within their practice. To expand access to services provided by SSPs and SCS, ID clinicians are uniquely positioned to provide resources and patient education to PWID. Many of the harm reduction services provided by SSPs and SCS can be incorporated into an ID setting to leverage the role of ID specialists to positively impact the opioid crisis. It has been estimated that eliminating nonsterile injection techniques can prevent 43% of incident HCV infections between 2018 and 2030 . Follow-up studies in the same settings, conducted after addressing the aforementioned concerns, found no such increase in risk or decrease in HIV prevalence . This belief stems from many sources, including 2 landmark prospective cohort studies in the 1990s that found an association between SSP and higher risk of HIV seroconversion 19, 20.

• Counseling strategies to prevent overdoses are summarized in Table 4.
• Although many harm reduction services are delivered in the community, outpatient and inpatient settings represent other important opportunities to use these strategies.
• Finally, to avoid further heterogeneity, the review authors did not include overdose prevention sites; future work should consider these related harm reduction interventions.
• Some of the challenges in patients with substance use disorder face include undertreated pain, undertreated withdrawal symptoms, movement and visitor restrictions, and feeling stigmatized by hospital staff.
• Most of the folks we see come in specifically hoping to get started on medication for opioid use disorder (MOUD), and then they realize there are other services they are open to receiving.

We’re seeing different types of synthetic substances being cut into the drug supply. That can be life-threatening, particularly for people who are opioid-naive. Evidence-based treatments look different for different substances.

Health and Social Impacts

Many harm reduction services take place in community settings, through mobile outreach and brick-and-mortar locations that can reach PWUS more readily. These harm reduction strategies are easier to isolate and study for effectiveness and are more likely to be setting-specific. Harm reduction also includes specific strategies, such as syringe service programs to reduce injection-related infections. For example, harm reduction includes using non-stigmatizing and non-judgmental language when working with PWUS and utilizing principles of trauma-informed care and motivational interviewing to overcome the stigma commonly felt by PWUS in healthcare and society at large.

Reduce cost

Embedding these harm reduction principles into treatment does not mean that abstinence has no place. It’s not a one-size-fits-all approach, and we don’t discharge people from treatment if they continue to show symptoms of their substance use disorder. In addiction treatment, harm reduction aims to be welcoming and patient centered. People may feel that treatment, with its deep connections to the legal system, is not welcoming, patient-centered, or safe. In my clinical experience, many people have been mandated to treatment in the past, often through the legal system.

However, areas with less robust resources may need to seek creative solutions to gaps in care, such as telehealth or the creation of localized treatment algorithms or electronic medical record bundles. Creating standard pathways of care for PWID admitted with complications of drug use allows patients to benefit from integrated, interprofessional care aimed at serving their holistic needs. Traditional care pathways, such as patients presenting to the hospital for acute illnesses and then following up in primary care settings for vaccination and health counseling, may not be effective. ” Of these responses, we found several predominant concerns, including limitations in resources, difficulty in accessing medications for treatment of addiction, and concern of medicolegal ramifications when offering best practice care. Percentage of infectious diseases (ID) physicians offering routine counseling for safe injection strategies, stratified by years of practice. When asked to rate their agreement with specific statements, only a minority believed that recommending needle exchanges and/or safe injection practices enabled drug use (9.7%), while most either disagreed (28.7%) or strongly disagreed (51.7%) with that sentiment.

Brandon D.L. Marshall made a substantial contribution to the conception of the study and to data interpretation; revised the article for important intellectual content; and read and approved the final version of the submitted manuscript. She made a substantial contribution to the conception and design of the study, data acquisition, abstraction of articles, data analysis and interpretation; revised the article for important intellectual content; and read and approved the final version of the submitted manuscript. He led the conception and design of the study, data acquisition, abstraction of all articles, data analysis and interpretation; wrote the article and revised the article for important intellectual content; and read and approved the final version of the submitted manuscript. Brandon D.L. Marshall was supported by the National Institute on Drug Abuse (R01-DA046620) and the National Institute of General Medical Sciences (P20-GM125507) during the conduct of this study. The findings and conclusions in this study have not been formally determined by the Community Preventive Services Task Force or disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any Community Preventive Services Task Force or agency determination or policy. Third, the heterogeneity of comparisons (SIF versus various controls) in these studies (Appendix) and outcome measures makes synthesis difficult.

• Two review authors (combinations of TL, GY, MD, SO) independently abstracted each study using a standardized data collection form that was designed and approved by all authors.
• However, the test strips are inexpensive, early studies show the tests are accurate,19 and PWUS have a very favorable opinion of them,20,21 which has promoted significant uptake among harm reduction programs across the country.
• Lastly, to further expand treatment access and reduce harm, ID clinicians should offer naloxone and become waivered to initiate buprenorphine for those interested in this treatment pathway.
• Hospitalizations for substance use-related infections cost the U.S. over $700 million annually.

Common Risks of Unsafe Injection Practices

Using Community Guide methods,23,24 review authors assessed each study for threats to internal and external validity and suitability of study design. Finally, review authors considered all included studies from the Potier et al.22 review for a second round of full-text screening using additional criteria. For completeness, review authors also extracted and screened the references of the studies included after the first round of screening (“snowball screen”). At the individual level, this review considered studies comparing PWID who use SIFs to PWID who do not or studies comparing frequent SIF users to infrequent users (control).

Harm Reduction Services to Prevent and Treat Infectious Diseases in People Who Use Drugs

On average, two thirds of clients of the SIFs in included studies were men; a quarter of clients were experiencing homelessness. Table 1 synthesizes demographic characteristics from included studies with individual-level data. The most common limitation was related to poor description of methods or poor reporting of demographic data among 10 of the 22 studies29,31,33,36,40,42–45,53 (Appendix). Of the 14 studies with fair quality of execution, 6 studies29,35,43,44,47,52 received 2 limitations and 8 studies28,31,33,34,36,42,45,53 received 3 limitations. Of the 22 included studies.28,29,31,33–36,39–49,51,53–55 8 studies39–41,46,48,49,51,54 had good quality of execution (1 or no limitation); the other 14 had fair quality of execution (2–4 limitations).