Abstract:
:A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear--and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI), now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated) now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify.
journal_name
Harm Reduct Jjournal_title
Harm reduction journalauthors
Small D,Drucker E,Editorial for Harm Reduction Journal.doi
10.1186/1477-7517-3-16subject
Has Abstractpub_date
2006-05-02 00:00:00pages
16issn
1477-7517pii
1477-7517-3-16journal_volume
3pub_type
杂志文章abstract::With a worldwide prevalence of 15.4%, hepatitis C virus (HCV) has been estimated to be the most prevalent major infectious disease in prisons. The exceptionally high prevalence of HCV in prisons is attributable to common risk behaviors including sharing contaminated tattooing equipment and drug paraphernalia, as well ...
journal_title:Harm reduction journal
pub_type: 信件
doi:10.1186/s12954-020-00379-y
更新日期:2020-05-24 00:00:00
abstract:BACKGROUND:The current illicit drug overdose crisis within North America and other countries requires expanded and new responses to address unpredictable and potentially lethal substances, including fentanyl analogues, in the unregulated drug market. Community-wide drug checking is being increasingly explored as one su...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-020-00373-4
更新日期:2020-05-12 00:00:00
abstract::Young people aged 15-24 years account for fifty percent of all new AIDS cases worldwide. Moreover, half of all new HIV infections are associated with injection drug use. The average age for initiation into injecting drug use is 20 years of age. This paper investigates whether HIV prevention programs have reduced risk ...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-2-5
更新日期:2005-03-17 00:00:00
abstract:BACKGROUND:Only July 1, 2017, Nevada became the fifth US state to allow the legal sale of recreational cannabis products for adults ages of 21 and over. This study investigates young adults' cannabis-related attitudes, perceptions, and behaviors in a state where recreational and medical cannabis use was recently legali...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-020-00442-8
更新日期:2020-11-26 00:00:00
abstract:BACKGROUND:We have recently published some work on CEA levels in hookah (also called narghile, shisha elsewhere) and cigarette smokers. Hookah smokers had higher levels of CEA than non-smokers although mean levels were low compared to cigarette smokers. However some of them were also users of other tobacco products (ci...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-5-19
更新日期:2008-05-24 00:00:00
abstract:BACKGROUND:People who smoke crack cocaine experience a wide variety of health-related issues. However, public health programming designed for this population is limited, particularly in comparison with programming for people who inject drugs. Canadian best practice recommendations encourage needle and syringe programs ...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-017-0144-3
更新日期:2017-05-12 00:00:00
abstract:BACKGROUND:There are few studies of mortality amongst people who inject drugs (PWID) in Australia. In this study, we estimate mortality in a cohort of PWID in Melbourne and examine predictors of mortality including health service use, demographic characteristics, drug use and personal wellbeing. FINDINGS:We linked ide...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-015-0089-3
更新日期:2015-12-09 00:00:00
abstract:BACKGROUND:Methadone maintenance treatment is the most widely prescribed treatment for opiate dependence with proven benefits for patients. In naïve users or in case of recreational misuse, methadone can be a source of potentially lethal intoxications, resulting in fatal overdoses. A few cases of infantile intoxication...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-11-20
更新日期:2014-07-02 00:00:00
abstract:BACKGROUND:Patients with substance use disorders grow older thanks to effective treatments. Together with a high prevalence of comorbidities, psychological problems, and low social support, these patients are at high risk for medication non-adherence. Established treatment facilities face challenges to accommodate thes...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-017-0182-x
更新日期:2017-08-16 00:00:00
abstract::This article examines harm reduction from a novel perspective. Its central thesis is that harm reduction is not only a social concept, but also a biological one. More specifically, evolution does not make moral distinctions in the selection process, but utilizes a cannabis-based approach to harm reduction in order to ...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-2-17
更新日期:2005-09-22 00:00:00
abstract:INTRODUCTION:The aim of this study is to identify the profiles of young people who use drugs (YPUD) and their exposure to HIV risks in the 3 main cities of Vietnam, Haiphong, Hanoi, and Ho Chi Minh City (HCMC), in order to design a community-based intervention to prevent HIV. METHODS:A survey using respondent-driven s...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-020-00357-4
更新日期:2020-02-24 00:00:00
abstract:BACKGROUND:This study aimed to investigate the development of opioid tolerance in patients receiving long-term methadone maintenance treatment (MMT). METHODS:A region-wide cross-sectional study was performed focusing on dosage and duration of treatment. Differences between racemic methadone and levomethadone were exam...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-016-0095-0
更新日期:2016-02-16 00:00:00
abstract:BACKGROUND:To understand the limits of HCV screening programs to reach all drug users (DUs). METHOD:The association of the recruitment of a representative sample of a population of DUs in a specific area with the use of a questionnaire that included 250 items allowed the use of uni- and multifactorial analysis to expl...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-018-0264-4
更新日期:2018-12-12 00:00:00
abstract:BACKGROUND:In response to the opioid epidemic, naloxone distribution programs aim to prevent overdose death by making naloxone available and training people to use it. Peers of individuals at risk of opioid overdose are well-positioned to administer naloxone and prevent overdose death. METHODS:We conducted key informa...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-019-0352-0
更新日期:2020-01-09 00:00:00
abstract:BACKGROUND:Condom provision is one of the most effective harm reduction interventions to control sexually transmitted infections (STIs) including HIV/AIDS and viral hepatitis in prisons. Yet, very few countries around the world provide prisoners with condoms. The present study aimed to elucidate principles of effective...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-021-00462-y
更新日期:2021-01-28 00:00:00
abstract:INTRODUCTION:In 2008, one of the oldest fixed site needle exchanges in a large urban city in Canada was closed due to community pressure. This service had been in existence for over 20 years. CASE DESCRIPTION:This case study focuses on the consequences of the switch to mobile needle exchange services immediately after...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-7-11
更新日期:2010-05-25 00:00:00
abstract::Needle exchange programs chase political as well as epidemiological dragons, carrying within them both implicit moral and political goals. In the exchange model of syringe distribution, injection drug users (IDUs) must provide used needles in order to receive new needles. Distribution and retrieval are co-existent in ...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-7-1
更新日期:2010-01-04 00:00:00
abstract:BACKGROUND:People who inject drugs (PWID) are disproportionally affected by the hepatitis C virus (HCV) infection. In the Netherlands, active HCV transmission in PWID has practically been halted but uptake of HCV testing and linkage to care remains insufficient in this risk group. A national HCV in Addiction Care (HAC)...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-019-0316-4
更新日期:2019-07-15 00:00:00
abstract:BACKGROUND:Community pharmacies are important for health access by rural populations and those who do not have optimum access to the health system, because they provide myriad health services and are found in most communities. This includes the sale of non-prescription syringes, a practice that is legal in the USA in a...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-019-0327-1
更新日期:2019-09-18 00:00:00
abstract::The findings of our research show that while police play multiple roles in the fight against drug-related crime, they often perceived their tasks - especially preventing and controlling drug use on the one hand, and supporting harm reduction on the other - as contradictory, and this creates tensions in their work and ...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-9-25
更新日期:2012-07-09 00:00:00
abstract::Whilst unsupervised injectable methadone and diamorphine treatment has been part of the British treatment system for decades, the numbers receiving injectable opioid treatment (IOT) has been steadily diminishing in recent years. In contrast, there has been a recent expansion of supervised injectable diamorphine progra...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-3-28
更新日期:2006-09-27 00:00:00
abstract:AIM:Evidence is emerging that prescription opioid (PO) injection is associated with increased health risks. This mixed-methods study compares the mechanics of PO and heroin injection and examines the demographic and drug-related correlates of lifetime PO injection in a sample of young people who inject drugs (PWID) in ...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-020-00367-2
更新日期:2020-03-30 00:00:00
abstract:BACKGROUND:Smoking cessation treatment service is concerned to be a critical element in methadone maintenance treatment (MMT) in order to diminish the effect of smoke on health outcomes. To implement the smoking cessation services in Vietnam, we examined the stages of change to quit and determined associated factors am...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-015-0085-7
更新日期:2015-10-30 00:00:00
abstract:BACKGROUND:Greece has the highest smoking rates (in the 15-nation bloc) in Europe. The purpose of this study was to investigate Greek smokers' intention and appraisal of capability to quit employing the theoretical frameworks of Decisional Balance (DB) and Cognitive Dissonance (CD). METHODS:A cross-sectional study inc...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-3-13
更新日期:2006-03-29 00:00:00
abstract:BACKGROUND:Illicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher H...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-10-10
更新日期:2013-06-20 00:00:00
abstract:BACKGROUND:Ongoing legal and social discrimination, and stigmatization of people with lived experience of drug use (PWLE) continues to contribute to overdose-related deaths in Canada. The involvement of PWLE working in harm reduction services has proven effective in decreasing drug-related harms among PWLE; however, th...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-020-00453-5
更新日期:2021-01-06 00:00:00
abstract::Alcohol and other drug misuse are significant but neglected public health issues in conflict-affected populations. In this article, we review the literature on the challenges and strategies for implementing substance misuse treatment and prevention services in conflict and post-conflict settings in low- and middle-inc...
journal_title:Harm reduction journal
pub_type: 杂志文章,评审
doi:10.1186/s12954-018-0267-1
更新日期:2018-11-28 00:00:00
abstract:BACKGROUND:Smoking is endemic amongst people accessing homeless services, and they are disproportionately affected by smoking-related diseases. This paper reports on the results of a 3-month small scale intervention which explored the efficacy, challenges and opportunities of using electronic nicotine delivery systems ...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-020-00406-y
更新日期:2020-10-12 00:00:00
abstract:BACKGROUND:Stigma and discrimination may adversely affect the benefits of methadone maintenance treatment (MMT) for drug users, especially in disadvantaged settings. This study assessed stigma and discrimination against MMT patients in the mountainous and rural areas in Vietnam and explored their associated factors to ...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/s12954-016-0127-9
更新日期:2017-01-06 00:00:00
abstract:BACKGROUND:To examine the predictors of continued drug- and sex-related HIV-risk behaviors among drug users in methadone maintenance therapy (MMT) programs in China. METHODS:We followed a sample of 5,035 drug users enrolled for the first time in MMT programs at baseline, 6 months, and 12 months utilizing a longitudina...
journal_title:Harm reduction journal
pub_type: 杂志文章
doi:10.1186/1477-7517-10-23
更新日期:2013-10-10 00:00:00