Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2024 Aug 1;7(8):e2427241. doi: 10.1001/jamanetworkopen.2024.27241.
Rates of overdose deaths involving synthetic opioids remain high, increasingly involve stimulants combined with opioids, and are increasing rapidly in racially and ethnically minoritized communities, yet little is known about access to harm reduction and treatment services in these groups.
To characterize access and barriers to harm reduction and treatment in a racially and ethnically diverse population of people who use drugs.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional telephone survey of people recruited from 39 treatment, harm reduction, and social service organizations in Milwaukee County, Wisconsin; Flint and Detroit, Michigan; and statewide in New Jersey was conducted from January 30 to July 28, 2023. Adults who used cocaine, methamphetamine, or opioids in the past 30 days called a study hotline and completed an interview in English or Spanish.
Overdose experience, drug types used (opioids only, stimulants only, and polysubstance), and social risk factors (eg, financial instability and criminal legal involvement).
Recent use of any harm reduction services, fentanyl test strips, naloxone possession, treatment, and self-reported barriers to services.
Of the total sample of 1240 adults, 486 (39.2%) were Black non-Hispanic, 183 (14.8%) were Hispanic, and 464 (37.4%) were White non-Hispanic. In the past 30 days, 826 individuals (66.6%) were polysubstance users, 135 (10.9%) used only opioids, and 279 (22.5%) used only stimulants. A total of 349 respondents (28.1%) experienced a prior-year overdose. Compared with those without a prior-year overdose, people with overdose were more likely to possess naloxone (80.7% vs 68.2%; P < .001), possess fentanyl test strips (36.8% vs 23.5%; P < .001), and use harm reduction services (63.4% vs 53.0%; P = .003), while differences in treatment use were nonsignificant (52.0% vs 46.6%; P = .24). Among stimulant-only users, 51.4% possessed naloxone compared with 77.3% of opioid-only users (P < .001) and 77.6% of polysubstance users (P < .001), with similar disparities in fentanyl test strip possession.
In this cross-sectional study of people who used drugs in the past 30 days, findings highlighted low use of harm reduction and treatment services among people who use stimulants. Additional communication regarding their importance may help increase the use of the services amidst a rapidly changing drug supply.
涉及合成阿片类药物的过量死亡人数仍然很高，越来越多地涉及与阿片类药物混合使用的兴奋剂，并且在种族和民族少数群体中迅速增加，但关于这些群体获得减少伤害和治疗服务的情况知之甚少。
描述在使用毒品的种族和民族多样化人群中获得减少伤害和治疗服务的情况和障碍。
设计、地点和参与者：2023 年 1 月 30 日至 7 月 28 日，对来自威斯康星州密尔沃基县、密歇根州弗林特和底特律以及新泽西州全州的 39 个治疗、减少伤害和社会服务组织招募的参与者进行了一项横断面电话调查。过去 30 天内使用可卡因、冰毒或阿片类药物的成年人拨打研究热线并以英语或西班牙语完成了访谈。
经历过过量用药、使用的药物类型（仅阿片类药物、仅兴奋剂和多药物）和社会风险因素（例如财务不稳定和刑事法律涉入）。
最近使用任何减少伤害服务、芬太尼检测条、纳洛酮拥有、治疗和自我报告的服务障碍。
在总共 1240 名成年人中，486 人（39.2%）是非西班牙裔黑人，183 人（14.8%）是西班牙裔，464 人（37.4%）是非西班牙裔白人。在过去 30 天内，826 名个体（66.6%）是多药物使用者，135 名（10.9%）仅使用阿片类药物，279 名（22.5%）仅使用兴奋剂。共有 349 名受访者（28.1%）在过去一年中经历过过量用药。与没有过去一年过量用药的人相比，有过过量用药经历的人更有可能拥有纳洛酮（80.7%对 68.2%；P<0.001）、拥有芬太尼检测条（36.8%对 23.5%；P<0.001）和使用减少伤害服务（63.4%对 53.0%；P=0.003），而在治疗使用方面的差异无统计学意义（52.0%对 46.6%；P=0.24）。在仅使用兴奋剂的人群中，51.4%的人拥有纳洛酮，而仅使用阿片类药物的人拥有纳洛酮的比例为 77.3%（P<0.001），仅使用多药物的人拥有纳洛酮的比例为 77.6%（P<0.001），在芬太尼检测条拥有方面也存在类似的差异。
在这项对过去 30 天内使用毒品的人的横断面研究中，研究结果突出了在使用兴奋剂的人群中减少伤害和治疗服务的低使用率。关于其重要性的额外沟通可能有助于在快速变化的毒品供应环境中增加这些服务的使用。
