Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States.
Drug Alcohol Depend. 2024 Jun 1;259:111293. doi: 10.1016/j.drugalcdep.2024.111293. Epub 2024 Apr 15.
We introduce the concept of harm reduction capital (HRCap) as the combination of knowledge, resources, and skills related to substance use risk reduction, which we hypothesize to predict MOUD use and opioid overdose. In this study, we explored the interrelationships between ethnicity, HRCap, nonfatal overdose, and MOUD use among PWUD.
Between 2017 and 2019, people who currently or in the past used opioids and who lived in Massachusetts completed a one-time survey on substance use history, treatment experiences, and use of harm reduction services. We fit first-order measurement constructs for positive and negative HRCap (facilitators and barriers). We used generalized structural equation models to examine the inter-relationships of the latent constructs with LatinX self-identification, past year overdose, and current use of MOUD.
HRCap barriers were positively associated with past-year overdose (b=2.6, p<0.05), and LatinX self-identification was inversely associated with HRCap facilitators (b=-0.49, p<0.05). There was no association between overdose in the past year and the current use of MOUD. LatinX self-identification was positively associated with last year methadone treatment (b=0.89, p<0.05) but negatively associated with last year buprenorphine treatment (b=-0.68, p<0.07). Latinx PWUD reported lower positive HRCap than white non-LatinX PWUD and had differential utilization of MOUD.
Our findings indicate that a recent overdose was not associated with the current use of MOUD, highlighting a severe gap in treatment utilization among individuals at the highest risk. The concept of HRCap and its use in the model highlight substance use treatment differences, opportunities for intervention, and empowerment.
我们引入了减少伤害资本（HRCap）的概念，即与减少物质使用风险相关的知识、资源和技能的组合，我们假设它可以预测美沙酮使用和阿片类药物过量。在这项研究中，我们探讨了在吸毒者中族裔、HRCap、非致命性过量和美沙酮使用之间的相互关系。
在 2017 年至 2019 年期间，目前或过去使用过阿片类药物并居住在马萨诸塞州的人完成了一次关于药物使用史、治疗经历和减少伤害服务使用情况的调查。我们拟合了正性和负性 HRCap（促进因素和障碍）的一阶测量结构。我们使用广义结构方程模型来检验潜在结构与拉丁裔自我认同、过去一年的过量用药和当前美沙酮使用之间的相互关系。
HRCap 障碍与过去一年的过量用药呈正相关（b=2.6，p<0.05），拉丁裔自我认同与 HRCap 促进因素呈负相关（b=-0.49，p<0.05）。过去一年的过量用药与当前美沙酮的使用之间没有关联。拉丁裔自我认同与去年美沙酮治疗呈正相关（b=0.89，p<0.05），但与去年丁丙诺啡治疗呈负相关（b=-0.68，p<0.07）。拉丁裔吸毒者报告的正性 HRCap 低于白人非拉丁裔吸毒者，且对美沙酮的使用存在差异。
我们的研究结果表明，最近的过量用药与当前美沙酮的使用无关，这突显了高危人群在治疗利用方面存在严重差距。HRCap 的概念及其在模型中的应用突出了药物使用治疗的差异、干预机会和赋权。
