Gicquelais Rachel E, Conway Caitlin J, Becker Mikaela, Bailey Erika J, Bosworth Cullen, Miller Rebecca, Mijal Katy, Curran Emmie, Barredo Bianca, Taylor Sydney, Salisbury-Afshar Elizabeth, Seal David W, Burns Marguerite, Westergaard Ryan P
Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut Street, Madison, WI, 53726, USA.
Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut St, Madison, WI, 53726, USA.
Harm Reduct J. 2025 May 19;22(Suppl 1):81. doi: 10.1186/s12954-025-01212-0.
Syringe services programs (SSPs) reduce the risk of overdose by distributing supplies like naloxone. SSPs also support clients in meeting their basic needs via referrals to organizations providing food, housing, and healthcare. This paper describes the Exploration of Novel Harm Reduction Approaches to Increase Client Engagement (ENHANCE) Project, a prospective cohort study developed in partnership with people who use drugs that aims to characterize the influence of longitudinal engagement in SSPs on overdose risk behaviors.
The ENHANCE Project protocol was developed with a community leadership team of 16 people with living experience of drug use who were clients from four SSPs in Wisconsin that serve as study recruitment sites. The community leadership team met five times to conceptualize the study priorities, protocol, recruitment strategies, and measures. ENHANCE will enroll 400 people who use opioids and/or stimulants via recruitment of clients from study sites and peer referrals. Clients will report on primary outcomes (overdose experiences and risk behaviors) and other covariates (substance use history and behaviors, mental and physical health, satisfaction of basic needs, stigma, and others) over a 2-year follow-up period. At enrollment, clients select a self-generated identification code that is documented in all subsequent harm reduction services received from ten SSPs in Wisconsin. These data will be linked to study survey data using probabilistic methods and used for the primary exposure variable, frequency of using SSP services. ENHANCE will test the primary hypothesis that more frequently using SSP services is associated with reduced overdose risk behavior frequency.
Among the first 125 clients enrolled, 22.4% (N = 28) reported personally experiencing an opioid overdose in the 6 months before enrollment and 38.4% (N = 48) experienced adverse effects after using stimulants. The most common overdose risk behaviors reported in the past 30 days were using opioids while alone (mean: 9.9 days [standard deviation: 10.7]) and injecting heroin (mean: 9.3 days [standard deviation: 12.8]).
This study will identify aspects of harm reduction services that are most effective in reducing overdose risk to inform future service provision, funding, and policy efforts.
注射器服务项目（SSP）通过分发纳洛酮等用品来降低过量用药风险。SSP还通过转介客户到提供食品、住房和医疗保健的组织来支持他们满足基本需求。本文介绍了探索新型减少伤害方法以提高客户参与度（ENHANCE）项目，这是一项与吸毒者合作开展的前瞻性队列研究，旨在描述长期参与SSP对过量用药风险行为的影响。
ENHANCE项目方案是与一个由16名有吸毒生活经历的人组成的社区领导团队共同制定的，他们是威斯康星州四个作为研究招募地点的SSP的客户。社区领导团队共开会五次，以确定研究重点、方案、招募策略和测量方法。ENHANCE将通过从研究地点招募客户和同伴推荐的方式，招募400名使用阿片类药物和/或兴奋剂的人。客户将在2年的随访期内报告主要结果（过量用药经历和风险行为）以及其他协变量（物质使用史和行为、身心健康、基本需求满意度、耻辱感等）。在入组时，客户选择一个自己生成的识别码，该识别码将记录在他们从威斯康星州的10个SSP获得的所有后续减少伤害服务中。这些数据将使用概率方法与研究调查数据相链接，并用于主要暴露变量，即使用SSP服务的频率。ENHANCE将检验主要假设，即更频繁地使用SSP服务与降低过量用药风险行为频率相关。
在最初招募的125名客户中，22.4%（N = 28）报告在入组前6个月内个人经历过阿片类药物过量用药，38.4%（N = 48）在使用兴奋剂后出现了不良反应。在过去30天内报告的最常见的过量用药风险行为是独自使用阿片类药物（平均：9.9天[标准差：10.7]）和注射海洛因（平均：9.3天[标准差：12.8]）。
本研究将确定减少伤害服务中最有效地降低过量用药风险的方面，为未来的服务提供、资金投入和政策努力提供信息。
