Mason Maryann, Johnson Bruce, Schaffner Christorpher, Johnston Sean, Alexander Ursula, Ajala Oyindamola, Andrews Nia, Welch Sarah B
Buehler Center for Health Policy and Economics, Institute for Public Health and Medicine, Northwestern University, 420 E. Superior St. 9th Floor, Chicago, IL, 60611, USA.
Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 420 E. Superior St. 9th Floor, Chicago, IL, 60611, USA.
Harm Reduct J. 2024 Dec 4;21(1):218. doi: 10.1186/s12954-024-01134-3.
Harm reduction for people who use drugs (PWUD) is an established evidence-based practice that encompasses a wide variety of services, delivery formats, and settings and has been named a priority in US drug policy. Harm reduction is focused on planning with communities and meeting PWUD where they are and encompasses a wide variety of interventions. We describe and report the feasibility, acceptability, and process implementation outcomes for an innovative pilot drug overdose harm reduction intervention, Block-by-Block (BXB), focused on training for and distribution of naloxone and test strips in areas identified as high risk for fatal overdoses.
Beginning operations in 2022, BXB operates in five pilot sites in four Illinois counties. Through partnerships with local organizations, BXB delivers harm reduction services in a private setting (home) or in a setting not specifically focused on serving PWUD (businesses, libraries, faith-based organizations, etc.) to reach PWUD and their friends, family and neighbors living in areas disproportionately affected by opioid overdose death. The intervention theory is based on acknowledgement that harm reduction services that require PWUD to visit a mobile unit, van or community organization, may not reach those in need or their friends, neighbors, and family for a variety of reasons including stigma associated with drug use, lack of awareness about these services, or where to locate them. Services delivered include education and training in the use of naloxone and fentanyl, xylazine and benzodiazepine test strips. Leave behind materials include naloxone, test strips and handouts with information on the intervention and local resources.
Results to date indicate that this intervention is feasible -over half (55%) of the doors approached were answered. Acceptability of the intervention as delivered is high --people at 75% of doors that were answered were interested in and received training and/or supplies. BXB is flexible in that it has been quickly adapted to changes in community conditions, the drug supply, and shifting high risk areas as they developed. This is a promising intervention that leverages available data and resources and is readily implementable in communities with support from a central program administrator and access to geo-coded data.
为吸毒者（PWUD）减少伤害是一项既定的循证实践，涵盖多种服务、提供形式和场所，并且已被列为美国毒品政策的优先事项。减少伤害侧重于与社区共同规划，并在吸毒者所在之处提供服务，涵盖多种干预措施。我们描述并报告了一种创新的药物过量减少伤害试点干预措施——逐街区（BXB）的可行性、可接受性和实施过程结果，该措施专注于在被确定为致命过量用药高风险地区进行纳洛酮和检测试纸的培训与分发。
BXB于2022年开始运作，在伊利诺伊州四个县的五个试点地点开展工作。通过与当地组织合作，BXB在私人场所（家中）或并非专门为吸毒者服务的场所（企业、图书馆、宗教组织等）提供减少伤害服务，以接触吸毒者及其居住在受阿片类药物过量死亡影响尤为严重地区的朋友、家人和邻居。干预理论基于这样的认识，即要求吸毒者前往移动单位、货车或社区组织接受的减少伤害服务，可能由于多种原因无法惠及有需要的人及其朋友、邻居和家人，这些原因包括与吸毒相关的污名、对这些服务缺乏了解或不知何处可获得这些服务。提供的服务包括纳洛酮以及芬太尼、赛拉嗪和苯二氮䓬检测试纸使用方面的教育与培训。留存材料包括纳洛酮、检测试纸以及有关干预措施和当地资源的资料手册。
迄今为止的结果表明，这种干预措施是可行的——超过半数（55%）的敲门访问得到了回应。所提供干预措施的可接受性很高——在75%得到回应的门访中，人们对培训和/或用品感兴趣并接受了相关服务。BXB具有灵活性，因为它已迅速适应社区状况、毒品供应的变化以及随着情况发展而不断变化的高风险地区。这是一项很有前景的干预措施，它利用现有数据和资源，在中央项目管理人员的支持以及获取地理编码数据的情况下，很容易在社区中实施。
