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Keijzer L. Reducing harm through the development of good preparation practices for the injection of slow release morphine sulphate capsules. Harm Reduct J 2020; 17:48. [PMID: 32677966 PMCID: PMC7367403 DOI: 10.1186/s12954-020-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is not always easy to advise people who inject drugs (PWID) on how to prepare their drugs in a way that is associated with reduced harm. This is particularly true for pharmaceutical drugs that are not meant to be injected. Our objective was to find "good preparation practices" for slow release morphine sulphate capsules, namely preparation methods that reduce harm, that are evidence-based and acceptable to PWID. METHODS In the laboratory, morphine sulphate capsules were prepared using both a cold and lukewarm preparation technique, two contact and stirring durations (1 min and 20 s) and 4 different filters (cotton filter, Sterifilt, Sterifilt+ and a wheel filter). The following outcomes were compared: particle reduction and morphine content in the filtrate, as well as filtration ease and time. RESULTS The lukewarm method and a stirring and contact time of 1 min were associated with a considerably higher morphine yield than both the cold method and the stirring time of only 20 s. Moreover, the suspension obtained was easy to filter using membrane filters. Particle reduction was important with all three membrane filters tested. Using the lukewarm method, morphine recovery was 86% for the wheel filter, 89% for the Sterifilt and 99% for the Sterifilt+. CONCLUSIONS The provision of a method that is easy to use, reduces harms associated to the injection of insoluble particles and recovers virtually all the active drug has a large chance to be adopted by people who use drugs. This type of "best practices" can be provided by drug workers and by people who use drugs to actively promote harm reduction.
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Affiliation(s)
- Lenneke Keijzer
- Research and Prevention Fund Apothicom "know more, risk less", 52 Avenue Edison, 75013, Paris, France.
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Lefrancois E, Belackova V, Silins E, Latimer J, Jauncey M, Shimmon R, Mozaner Bordin D, Augsburger M, Esseiva P, Roux C, Morelato M. Substances injected at the Sydney supervised injecting facility: A chemical analysis of used injecting equipment and comparison with self-reported drug type. Drug Alcohol Depend 2020; 209:107909. [PMID: 32145660 DOI: 10.1016/j.drugalcdep.2020.107909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 01/07/2023]
Abstract
Providing information about substances injected can reduce the negative impact of illicit drug consumption and support people who inject drugs to make informed decisions. In Australia, information about drugs injected relies largely on periodic self-report surveys. For the first time, the analysis of the residual content of used injecting equipment was conducted in a supervised injecting facility (SIF) located in Sydney, Australia. The aim was to gain a better understanding of the substances injected by clients through: (1) chemical analyses of the content of used syringes; (2) comparison of these results with clients' self-reported drug use; and (3) assessing the usefulness of analysing other injecting equipment to detect substances used. During one week in February 2019, syringes and other injecting equipment were collected at the Sydney SIF. Their residual content was analysed by gas-chromatography/mass-spectrometry. Heroin was the most commonly detected substance (present in 51% of syringes), followed by methamphetamine (22%) and oxycodone (10%). In addition to the main psychoactive substance, cutting agents reported in the literature were also detected in used syringes. The main psychoactive substance identified by laboratory analysis reliably corresponded with users' self-reported drug type. Analytical confirmation of substances injected allows for the provision of better targeted harm reduction messaging based on timely and objective data. The approach used is amenable to clients and feasible in the Australian SIF context. Upscaling and wider implementation could be done through Needle and Syringe Programs, and would support the early detection of harmful substances entering drug markets and better inform harm reduction strategies.
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Affiliation(s)
- Elodie Lefrancois
- School of Criminal Justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Avenue Forel 15, CH-1015 Lausanne, Switzerland; Centre for Forensic Science, School of Mathematical and Physical Sciences, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia.
| | - Vendula Belackova
- Uniting Medically Supervised Injecting Centre, 66 Darlinghurst Rd, Potts Point, NSW 2011, Australia; Social Policy Research Centre, Faculty of Arts and Social Sciences, University of New South Wales
| | - Edmund Silins
- Uniting Medically Supervised Injecting Centre, 66 Darlinghurst Rd, Potts Point, NSW 2011, Australia; National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia
| | - Julie Latimer
- Uniting Medically Supervised Injecting Centre, 66 Darlinghurst Rd, Potts Point, NSW 2011, Australia
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, 66 Darlinghurst Rd, Potts Point, NSW 2011, Australia
| | - Ronald Shimmon
- Centre for Forensic Science, School of Mathematical and Physical Sciences, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Dayanne Mozaner Bordin
- Centre for Forensic Science, School of Mathematical and Physical Sciences, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Marc Augsburger
- University Centre of Legal Medicine (CURML), Chemin de la Vulliette 4, CH-1000 Lausanne, Switzerland
| | - Pierre Esseiva
- School of Criminal Justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Avenue Forel 15, CH-1015 Lausanne, Switzerland
| | - Claude Roux
- Centre for Forensic Science, School of Mathematical and Physical Sciences, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Marie Morelato
- Centre for Forensic Science, School of Mathematical and Physical Sciences, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
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Belackova V, Salmon AM, Day CA, Ritter A, Shanahan M, Hedrich D, Kerr T, Jauncey M. Drug consumption rooms: A systematic review of evaluation methodologies. Drug Alcohol Rev 2019; 38:406-422. [PMID: 30938025 DOI: 10.1111/dar.12919] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 01/27/2023]
Abstract
ISSUES Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. APPROACH Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. KEY FINDINGS Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood-borne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. IMPLICATIONS Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. CONCLUSIONS Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted.
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Affiliation(s)
| | - Allison M Salmon
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Carolyn A Day
- Central Clinical School, Addiction Medicine, University of Sydney, Royal Prince Albert Hospital, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, UNSW Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Geddes L, Iversen J, Memedovic S, Maher L. Intravenous fentanyl use among people who inject drugs in Australia. Drug Alcohol Rev 2018; 37 Suppl 1:S314-S322. [PMID: 29405465 DOI: 10.1111/dar.12668] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/15/2017] [Accepted: 01/09/2018] [Indexed: 01/30/2023]
Abstract
INTRODUCTION AND AIMS There is a current epidemic of pharmaceutical opioid (PO) misuse, particularly fentanyl and fentanyl analogues, globally. Fentanyl is a highly potent synthetic opioid with rapid onset and significantly higher risk of overdose compared with other opioids. Contexts and correlates of fentanyl use among people who inject drugs (PWID) in Australia are under-researched. DESIGN AND METHODS The Australian Needle Syringe Program Survey is conducted annually. Consenting PWID complete a self-administered questionnaire and provide a capillary dried blood spot for human immunodeficiency virus and hepatitis C virus antibody testing. Bivariate and multivariate logistic regressions determined correlates of recent (last 6 months) fentanyl injection in 2014. RESULTS Recent fentanyl injection was reported by 8% (n = 193) of the total sample. Among the 848 PWID who recently injected POs, 23% injected fentanyl. Compared with PO injectors who had not injected fentanyl, those who had injected fentanyl were significantly more likely to identify as Indigenous Australian [adjusted odds ratio (AOR) 1.61; 95% confidence interval (CI) 1.04, 2.51; P = 0.034], inject daily or more frequently (AOR 1.92; 95% CI 1.30, 2.83; P = 0.005), inject in public (AOR 1.43; 95% CI 1.01, 2.02; P = 0.042) and to have overdosed in the past year (AOR 2.16; 95% CI 1.48, 3.13; P < 0.001), but were significantly less likely to receptively share syringes (AOR 0.56; 95% CI 0.36, 0.87; P = 0.010). DISCUSSION AND CONCLUSIONS Fentanyl injectors in Australia are significantly more likely to identify as Indigenous, report frequent injection, inject in public and experience overdose. Increased access to harm reduction interventions, including naloxone distribution, wheel filters and supervised injection facilities, are likely to benefit this population.
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Affiliation(s)
- Louise Geddes
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute for Immunity and Infection, UNSW Sydney, Sydney, Australia
| | - Jenny Iversen
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute for Immunity and Infection, UNSW Sydney, Sydney, Australia
| | - Sonja Memedovic
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute for Immunity and Infection, UNSW Sydney, Sydney, Australia
| | - Lisa Maher
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute for Immunity and Infection, UNSW Sydney, Sydney, Australia
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