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There has been increasing interest in using low dose initiation (LDI) strategies to reduce this withdrawal risk. As there are limited data on withdrawal symptoms during LDI, we characterize withdrawal symptoms in people with daily fentanyl use who underwent initiation using these strategies as outpatients.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Methods\u003C\u002Fjats:title>\n                \u003Cjats:p>We conducted a retrospective chart review of patients with OUD using daily fentanyl who were prescribed 7-day or 4-day LDI at 2 substance use disorder treatment clinics in San Francisco. Two addiction medicine experts assessed extracted chart documentation for withdrawal severity and precipitated withdrawal, defined as acute worsening of withdrawal symptoms immediately after taking buprenorphine. A third expert adjudicated disagreements. Data were analyzed using descriptive statistics.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Results\u003C\u002Fjats:title>\n                \u003Cjats:p>There were 175 initiations in 126 patients. The mean age was 37 (SD 10 years). 71% were men, 26% women, and 2% non-binary. 21% identified as Black, 16% Latine, and 52% white. 60% were unstably housed and 75% had Medicaid insurance. Substance co-use included 74% who used amphetamines, 29% cocaine, 22% benzodiazepines, and 19% alcohol. Follow up was available for 118 (67%) initiations. There was deviation from protocol instructions in 22% of these initiations with follow up. 31% had any withdrawal, including 21% with mild symptoms, 8% moderate and 2% severe. Precipitated withdrawal occurred in 10 cases, or 8% of initiations with follow up. Of these, 7 had deviation from protocol instructions; thus, there were 3 cases with follow up (3%) in which precipitated withdrawal occurred without protocol deviation.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Conclusions\u003C\u002Fjats:title>\n                \u003Cjats:p>Withdrawal was relatively common in our cohort but was mostly mild, and precipitated withdrawal was rare. Deviation from instructions, structural barriers, and varying fentanyl use characteristics may contribute to withdrawal. Clinicians should counsel patients who use fentanyl that mild withdrawal symptoms are likely during LDI, and there is still a low risk for precipitated withdrawal. Future studies should compare withdrawal across initiation types, seek ways to support patients in initiating buprenorphine, and qualitatively elicit patients’ withdrawal experiences.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>",{"EN":145,"VI":146},"Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: a retrospective cohort study","Hội chứng cai trong quá trình khởi trị buprenorphine liều thấp ngoại trú ở người sử dụng fentanyl: Nghiên cứu đoàn hệ hồi cứu",{"VOID":148},"38594721",{"VOID":150},"10.1186\u002Fs12954-024-00998-9","PUBLICATION","VERIFIED","2024-12-18T06:13:44.352+00:00","Auto Verify",[156],"EN",[158],"VI","https:\u002F\u002Fharmreductionjournal.biomedcentral.com\u002Farticles\u002F10.1186\u002Fs12954-024-00998-9",[161,180,200,219,244,262,288,308],{"id":162,"sortIndex":21,"researcher":20,"roles":163,"affiliations":164,"properties":173,"displayName":177,"givenName":20,"familyName":20},"2f59de3f-7d2f-46ab-87bf-a1c53be378f0",[],[165],{"id":166,"sortIndex":21,"affiliation":167,"properties":20},"704b1e69-5cf0-472c-9f89-0768c8f28a45",{"id":166,"createTime":20,"updateTime":20,"relativeEntities":168,"slug":20,"properties":169,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":172,"statistic":20},[],{"title":170},{"EN":171},"Medical Student Center, UCSF School of Medicine, 533 Parnassus Avenue, S-245, San Francisco, CA, 94143, USA. benjamin.jones@ucsf.edu.",[],{"orcid":174,"title":176,"openalex":178},{"VOID":175},"https:\u002F\u002Forcid.org\u002F0000-0002-6058-9692",{"EN":177},"Benjamin L. 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J Addict Med. 2022;16(4):399–406.",{"doi":425},"10.1097\u002FADM.0000000000000945",{"id":20,"text":427,"url":20,"identifiers":428},"Dunn KE, Bird HE, Bergeria CL, Ware OD, Strain EC, Huhn AS. Operational definition of precipitated opioid withdrawal. Front Psychiatry. 2023;14:1141980.",{"doi":429},"10.3389\u002Ffpsyt.2023.1141980",{"id":20,"text":431,"url":20,"identifiers":432},"Ahmed S, Bhivandkar S, Lonergan BB, Suzuki J. Microinduction of Buprenorphine\u002FNaloxone: a review of the literature. Am J Addict. 2021;30(4):305–15.",{"doi":433},"10.1111\u002Fajad.13135",{"id":20,"text":435,"url":20,"identifiers":436},"Sue KL, Cohen S, Tilley J, Yocheved A. A Plea from people who use drugs to clinicians: New ways to initiate Buprenorphine are urgently needed in the Fentanyl era. J Addict Med. 2022;16(4):389–91.",{"doi":437},"10.1097\u002FADM.0000000000000952",{"id":20,"text":439,"url":20,"identifiers":440},"Bhatraju EP, Klein JW, Hall AN, Chen DR, Iles-Shih M, Tsui JI, et al. Low dose buprenorphine induction with full agonist overlap in hospitalized patients with opioid use disorder: a retrospective cohort study. J Addict Med. 2022;16(4):461–5.",{"doi":441},"10.1097\u002FADM.0000000000000947",{"id":20,"text":443,"url":20,"identifiers":444},"Whitley SD, Sohler NL, Kunins HV, Giovanniello A, Li X, Sacajiu G, et al. Factors associated with complicated buprenorphine inductions. J Subst Abuse Treat. 2010;39(1):51–7.",{"doi":445},"10.1016\u002Fj.jsat.2010.04.001",{"id":20,"text":447,"url":20,"identifiers":448},"Pilarinos A, Bingham B, Kwa Y, Joe R, Grant C, Fast D, et al. Interest in using buprenorphine-naloxone among a prospective cohort of street-involved young people in Vancouver, Canada. J Subst Use Addict Treat. 2023;148:209005.",{"doi":449},"10.1016\u002Fj.josat.2023.209005",{"id":20,"text":451,"url":20,"identifiers":452},"Silverstein SM, Daniulaityte R, Martins SS, Miller SC, Carlson RG. Everything is not right anymore: buprenorphine experiences in an era of illicit fentanyl. Int J Drug Policy. 2019;74:76–83.",{"doi":453},"10.1016\u002Fj.drugpo.2019.09.003",{"id":20,"text":455,"url":20,"identifiers":456},"Spadaro A, Sarker A, Hogg-Bremer W, Love JS, O’Donnell N, Nelson LS, et al. Reddit discussions about buprenorphine associated precipitated withdrawal in the era of fentanyl. Clin Toxicol Phila Pa. 2022;60(6):694–701.",{"doi":457},"10.1080\u002F15563650.2022.2032730",{"id":20,"text":459,"url":20,"identifiers":460},"Shearer D, Young S, Fairbairn N, Brar R. Challenges with buprenorphine inductions in the context of the fentanyl overdose crisis: a case series. Drug Alcohol Rev. 2022;41(2):444–8.",{"doi":461},"10.1111\u002Fdar.13394",{"id":20,"text":463,"url":20,"identifiers":464},"Antoine D, Huhn AS, Strain EC, Turner G, Jardot J, Hammond AS, et al. Method for successfully inducting individuals who use Illicit Fentanyl onto Buprenorphine\u002FNaloxone. Am J Addict. 2021;30(1):83–7.",{"doi":465},"10.1111\u002Fajad.13069",{"id":20,"text":467,"url":20,"identifiers":468},"Bird HE, Huhn AS, Dunn KE, Fentanyl Absorption. Distribution, metabolism, and excretion: Narrative Review and clinical significance related to illicitly manufactured fentanyl. J Addict Med. 2023.",{"doi":469},"10.1097\u002FADM.0000000000001185",{"id":20,"text":471,"url":20,"identifiers":472},"Spadaro A, Faude S, Perrone J, Thakrar AP, Lowenstein M, Delgado MK, et al. Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: a case series. J Am Coll Emerg Physicians Open. 2023;4(1):e12880.",{"doi":473},"10.1002\u002Femp2.12880",{"id":20,"text":475,"url":20,"identifiers":476},"Varshneya NB, Thakrar AP, Hobelmann JG, Dunn KE, Huhn AS. Evidence of buprenorphine-precipitated withdrawal in persons who use Fentanyl. J Addict Med. 2022;16(4):e265–8.",{"doi":477},"10.1097\u002FADM.0000000000000922",{"id":20,"text":479,"url":20,"identifiers":480},"D’Onofrio G, Hawk KF, Perrone J, Walsh SL, Lofwall MR, Fiellin DA, et al. Incidence of precipitated Withdrawal during a Multisite Emergency Department–Initiated Buprenorphine Clinical Trial in the era of Fentanyl. JAMA Netw Open. 2023;6(3):e236108.",{"doi":481},"10.1001\u002Fjamanetworkopen.2023.6108",{"id":20,"text":483,"url":20,"identifiers":484},"Hämmig R, Kemter A, Strasser J, von Bardeleben U, Gugger B, Walter M, et al. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method. Subst Abuse Rehabil. 2016;7:99–105.",{"doi":485},"10.2147\u002FSAR.S109919",{"id":20,"text":487,"url":20,"identifiers":488},"Suen LW, Lee TG, Silva M, Walton P, Coffin PO, Geier M, et al. Rapid Overlap initiation protocol using low dose buprenorphine for opioid use disorder treatment in an outpatient setting: a Case Series. J Addict Med. 2022;16(5):534–40.",{"doi":489},"10.1097\u002FADM.0000000000000961",{"id":20,"text":491,"url":20,"identifiers":492},"Varshneya NB, Thakrar AP, Lambert E, Huhn AS. Opioid use disorder treatment in the Fentanyl era. J Addict Med. 2023;17(1):118–9.",{"doi":493},"10.1097\u002FADM.0000000000001013",{"id":20,"text":495,"url":20,"identifiers":496},"Noel M, Abbs E, Suen L, Samuel L, Dobbins S, Geier M et al. The Howard Street Method: A Community Pharmacy-Led low dose overlap buprenorphine initiation protocol for individuals using fentanyl. J Addict Med. 2023.",{"doi":497},"10.1097\u002FADM.0000000000001154",{"id":20,"text":499,"url":20,"identifiers":500},"Handelsman L, Cochrane KJ, Aronson MJ, Ness R, Rubinstein KJ, Kanof PD. Two new rating scales for opiate withdrawal. Am J Drug Alcohol Abuse. 1987;13(3):293–308.",{"doi":501},"10.3109\u002F00952998709001515",{"id":20,"text":503,"url":20,"identifiers":504},"Wesson DR, Ling W. The clinical opiate Withdrawal Scale (COWS). J Psychoact Drugs. 2003;35(2):253–9.",{"doi":505},"10.1080\u002F02791072.2003.10400007",{"id":20,"text":507,"url":20,"identifiers":508},"Stata Corp. Stata Statistical Software: Release 17. College Station. Texas, USA: StataCorp LLC; 2021.",{},{"id":20,"text":510,"url":20,"identifiers":511},"Jablonski LA, Bodnar AR, Stewart RW. Development of an intravenous low-dose buprenorphine initiation protocol. Drug Alcohol Depend. 2022;237:109541.",{"doi":512},"10.1016\u002Fj.drugalcdep.2022.109541",{"id":20,"text":514,"url":20,"identifiers":515},"Brar R, Fairbairn N, Sutherland C, Nolan S. Use of a novel prescribing approach for the treatment of opioid use disorder: Buprenorphine\u002Fnaloxone micro-dosing - a case series. Drug Alcohol Rev. 2020;39(5):588–94.",{"doi":516},"10.1111\u002Fdar.13113",{"id":20,"text":518,"url":20,"identifiers":519},"Kaliamurthy S, Jegede O, Hermes G. Community based buprenorphine micro-induction in the context of methadone maintenance treatment and fentanyl - case report. J Addict Dis. 2023;41(2):175–80.",{"doi":520},"10.1080\u002F10550887.2022.2051985",{"id":20,"text":522,"url":20,"identifiers":523},"Coish R, Hardial J. Successful Buprenorphine\u002FNaloxone low-dose induction in pregnancy: a Case Report. J Addict Med. 2023;17(1):114–6.",{"doi":524},"10.1097\u002FADM.0000000000001042",{"id":20,"text":526,"url":20,"identifiers":527},"Kilaru A, Perrone J, Lowenstein M, Nelson L, Spadaro A, Faude S, et al. Incidence of Buprenorphine-precipitated withdrawal in Emergency Department patients with Opioid Use Disorder in Philadelphia. Ann Emerg Med. 2023;82(4):S132.",{"doi":528},"10.1016\u002Fj.annemergmed.2023.08.327",{"id":20,"text":530,"url":20,"identifiers":531},"Mumba MN, Brantley SG, Cross A. Social and structural determinants of recovery: the impact of race. J Nurs Scholarsh off Publ Sigma Theta Tau Int Honor Soc Nurs. 2023;55(3):553–5.",{},false,{"id":534,"createTime":535,"updateTime":536,"relativeEntities":537,"slug":538,"properties":539,"entityType":151,"verifyStatus":152,"verifyTime":551,"verifyNote":154,"languages":552,"translateLanguages":553,"viewCount":21,"primaryUrl":554,"fullTextUrl":20,"authors":555,"publicationType":331,"publisherRelationship":660,"citationCount":98,"citationInfo":715,"publishDate":20,"publishYear":20,"citationAnalyzeStatus":19,"lastCitationAnalyze":20,"indexDatabases":717,"openAccess":20,"references":718,"isForceReanalyzing":532},"c43ca2f3-654f-481a-ac2d-664582cafb2f","2024-04-19T08:02:02.112+00:00","2026-09-05T03:11:54.904+00:00",[],"Differences-in-drug-use-behaviors-that-impact-overdose-risk-among-individuals-who-do-and-do-not-use-fentanyl-test-strips-for-drug-checking",{"openalex":540,"abstract":542,"title":544,"pm":547,"doi":549},{"VOID":541},"W4361224100",{"EN":543},"\u003Cjats:title>Abstract\u003C\u002Fjats:title>\u003Cjats:sec>\n                \u003Cjats:title>Background\u003C\u002Fjats:title>\n                \u003Cjats:p>Opioid-involved overdose continues to rise, largely explained by fentanyl adulteration of the illicit opioid supply. Fentanyl test strips are a novel drug checking tool that can be used by people who use drugs to detect the presence of fentanyl in drug products. However, it is unclear whether fentanyl test strip use can prompt behavior changes that impact risk of overdose.\n\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Methods\u003C\u002Fjats:title>\n                \u003Cjats:p>In this mixed-methods study involving a structured survey (\u003Cjats:italic>n\u003C\u002Fjats:italic> = 341) of syringe service program clients in southern Wisconsin, we examined the association between fentanyl test strip use and overdose risk behaviors in scenarios where the presence of fentanyl is confirmed and unknown. Individual items were transformed into summary scales representing the performance of riskier and safer behaviors. Linear regression examined the association of behaviors with FTS use. Models are adjusted for study site, race\u002Fethnicity, age, gender, drug of choice, indicator of polysubstance use, times used per day, and lifetime overdose count.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Results\u003C\u002Fjats:title>\n                \u003Cjats:p>In response to survey questions before prompting about fentanyl risk, people who used fentanyl test strips reported an increased number of safer (\u003Cjats:italic>p\u003C\u002Fjats:italic> = 0.001) as well as riskier behaviors (\u003Cjats:italic>p\u003C\u002Fjats:italic> = 0.018) relative to people who did not use fentanyl test strips. The same held true in situations when fentanyl adulteration was suspected, though fentanyl test strip use lost significance in the fully adjusted model examining safer behaviors (safer: \u003Cjats:italic>p\u003C\u002Fjats:italic> = 0.143; riskier: \u003Cjats:italic>p\u003C\u002Fjats:italic> = 0.004). Among people who use fentanyl test strips, in unadjusted models, a positive test result was associated with more safer behaviors and fewer riskier behaviors, but these associations became nonsignificant in fully adjusted models (safer: \u003Cjats:italic>p\u003C\u002Fjats:italic> = 0.998; riskier: \u003Cjats:italic>p\u003C\u002Fjats:italic> = 0.171). Loss of significance was largely due to the addition of either polysubstance use or age to the model.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Conclusions\u003C\u002Fjats:title>\n                \u003Cjats:p>Fentanyl test strip use is associated with behaviors that may impact overdose risk, including safer and riskier behaviors. Specifically, a positive test result may promote more risk reducing behaviors and fewer risk enhancing behaviors than a negative test result. Results suggest that while FTS may promote safer drug use behaviors, outreach and education should emphasize the need for multiple harm reduction techniques in all scenarios.\n\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>",{"EN":545,"VI":546},"Differences in drug use behaviors that impact overdose risk among individuals who do and do not use fentanyl test strips for drug checking","Sự khác biệt trong hành vi sử dụng ma túy ảnh hưởng đến nguy cơ quá liều giữa những người có và không sử dụng que thử fentanyl để kiểm tra ma 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J, Radley D. The Drug Overdose Toll in 2020 and Near-Term Actions for Addressing It [Internet]. The Commonwealth Fund; 2021 Aug [cited 2021 Oct 17]. (Improving Health Care Quality). Available from: https:\u002F\u002Fwww.commonwealthfund.org\u002Fblog\u002F2021\u002Fdrug-overdose-toll-2020-and-near-term-actions-addressing-it",{},{"id":20,"text":723,"url":20,"identifiers":724},"National Center for Health Statistics. U.S. Overdose Deaths In 2021 Increased Half as Much as in 2020 - But Are Still Up 15% [Internet]. Centers for Disease Control and Prevention",{},{"id":20,"text":726,"url":20,"identifiers":727},"2022 May [cited 2022 Sep 22]. Available from: https:\u002F\u002Fwww.cdc.gov\u002Fnchs\u002Fpressroom\u002Fnchs_press_releases\u002F2022\u002F202205.htm#:~:text=Provisional%20data%20from%20CDC's%20National,93%2C655%20deaths%20estimated%20in%202020.",{},{"id":20,"text":729,"url":20,"identifiers":730},"Korthuis PT, Cook RR, Foot CA, Leichtling G, Tsui JI, Stopka TJ, et al. Association of methamphetamine and opioid use with nonfatal overdose in rural communities. JAMA Netw Open. 2022;5(8):e2226544–e2226544.",{"doi":731},"10.1001\u002Fjamanetworkopen.2022.26544",{"id":20,"text":733,"url":20,"identifiers":734},"National Institute on Drug Abuse. Overdose Death Rates [Internet]. [cited 2020 Mar 27]. Available from: https:\u002F\u002Fwww.drugabuse.gov\u002Frelated-topics\u002Ftrends-statistics\u002Foverdose-death-rates",{},{"id":20,"text":736,"url":20,"identifiers":737},"Coffin PO, McMahan VM, Murphy C. Evidence of Pre-mortem Opioid Use among Fentanyl Overdose Decedents in a Safety Net Healthcare System. J Urban Health. 2022;1–8.",{"doi":738},"10.1007\u002Fs11524-022-00663-1",{"id":20,"text":740,"url":20,"identifiers":741},"Maghsoudi N, Tanguay J, Scarfone K, Rammohan I, Ziegler C, Werb D, et al. Drug checking Services for People who use Drugs: a systematic review. Addiction. 2021;",{"doi":742},"10.32388\u002FTXE86U",{"id":20,"text":744,"url":20,"identifiers":745},"Karch L, Tobias S, Schmidt C, Doe-Simkins M, Carter N, Salisbury-Afshar E, et al. Results from a mobile drug checking pilot program using three technologies in Chicago, IL, USA. Drug Alcohol Depend. 2021;228: 108976.",{"doi":746},"10.1016\u002Fj.drugalcdep.2021.108976",{"id":20,"text":748,"url":20,"identifiers":749},"Green TC, Park JN, Gilbert M, McKenzie M, Struth E, Lucas R, et al. An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples. Int J Drug Policy. 2020;77:102661.",{"doi":750},"10.1016\u002Fj.drugpo.2020.102661",{"id":20,"text":752,"url":20,"identifiers":753},"Peiper NC, Clarke SD, Vincent LB, Ciccarone D, Kral AH, Zibbell JE. Fentanyl test strips as an opioid overdose prevention strategy: findings from a syringe services program in the Southeastern United States. Int J Drug Policy. 2019;63:122–8.",{"doi":754},"10.1016\u002Fj.drugpo.2018.08.007",{"id":20,"text":756,"url":20,"identifiers":757},"Sherman SG, Park JN, Glick J, McKenzie M, Morales K, Christensen T, et al. FORECAST Study Summary Report [Internet]. Johns Hopkins Bloomberg School of Public Health; 2018. Available from: https:\u002F\u002Famericanhealth.jhu.edu\u002Fsites\u002Fdefault\u002Ffiles\u002Finline-files\u002FFentanyl_Executive_Summary_032018.pdf",{},{"id":20,"text":759,"url":20,"identifiers":760},"Bergh MSS, Øiestad ÅML, Baumann MH, Bogen IL. Selectivity and sensitivity of urine fentanyl test strips to detect fentanyl analogues in illicit drugs. Int J Drug Policy. 2021;90:103065.",{"doi":761},"10.1016\u002Fj.drugpo.2020.103065",{"id":20,"text":763,"url":20,"identifiers":764},"Sherman SG, Morales KB, Park JN, McKenzie M, Marshall BD, Green TC. Acceptability of implementing community-based drug checking services for people who use drugs in three United States cities: Baltimore, Boston and Providence. Int J Drug Policy. 2019;68:46–53.",{"doi":765},"10.1016\u002Fj.drugpo.2019.03.003",{"id":20,"text":767,"url":20,"identifiers":768},"Krieger MS, Yedinak JL, Buxton JA, Lysyshyn M, Bernstein E, Rich JD, et al. High willingness to use rapid fentanyl test strips among young adults who use drugs. Harm Reduct J. 2018;15(1):1–9.",{"doi":769},"10.1186\u002Fs12954-018-0213-2",{"id":20,"text":771,"url":20,"identifiers":772},"Goldman JE, Waye KM, Periera KA, Krieger MS, Yedinak JL, Marshall BD. Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: a qualitative study. Harm Reduct J. 2019;16(1):1–11.",{"doi":773},"10.1186\u002Fs12954-018-0276-0",{"id":20,"text":775,"url":20,"identifiers":776},"Krieger MS, Goedel WC, Buxton JA, Lysyshyn M, Bernstein E, Sherman SG, et al. Use of rapid fentanyl test strips among young adults who use drugs. Int J Drug Policy. 2018;61:52–8.",{"doi":777},"10.1016\u002Fj.drugpo.2018.09.009",{"id":20,"text":779,"url":20,"identifiers":780},"Weicker NP, Owczarzak J, Urquhart G, Park JN, Rouhani S, Ling R, et al. Agency in the fentanyl era: exploring the utility of fentanyl test strips in an opaque drug market. Int J Drug Policy. 2020;84:102900.",{"doi":781},"10.1016\u002Fj.drugpo.2020.102900",{"id":20,"text":783,"url":20,"identifiers":784},"Park JN, Frankel S, Morris M, Dieni O, Fahey-Morrison L, Luta M, et al. Evaluation of fentanyl test strip distribution in two Mid-Atlantic syringe services programs. Int J Drug Policy. 2021;94:103196.",{"doi":785},"10.1016\u002Fj.drugpo.2021.103196",{"id":20,"text":787,"url":20,"identifiers":788},"Reed MK, Roth AM, Tabb LP, Groves AK, Lankenau SE. “I probably got a minute”: perceptions of fentanyl test strip use among people who use stimulants. Int J Drug Policy. 2021;92:103147.",{"doi":789},"10.1016\u002Fj.drugpo.2021.103147",{"id":20,"text":791,"url":20,"identifiers":792},"Goodman-Meza D, Arredondo J, Slim S, Angulo L, Gonzalez-Nieto P, Loera A, et al. Behavior change after fentanyl testing at a safe consumption space for women in Northern Mexico: a pilot study. Int J Drug Policy. 2022;106:103745.",{"doi":793},"10.1016\u002Fj.drugpo.2022.103745",{"id":20,"text":795,"url":20,"identifiers":796},"Tilhou AS, Birstler J, Baltes A, Salisbury-Afshar E, Malicki J, Chen G, et al. Characteristics and context of fentanyl test strip use among syringe service clients in southern Wisconsin. Harm Reduct J. 2022;19(1):1–11.",{"doi":797},"10.1186\u002Fs12954-022-00720-7",{"id":20,"text":799,"url":20,"identifiers":800},"Weller S, Romney A. Defining a domain and free listing. In: Systematic data collection. Newbury Park, London, New Delhi: Sage Publications, Inc.; 1988. (Qualitative Research Methods; vol. 10).",{"doi":801},"10.4135\u002F9781412986069.n2",{"id":20,"text":803,"url":20,"identifiers":804},"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.",{"doi":805},"10.1016\u002Fj.jbi.2008.08.010",{"id":20,"text":807,"url":20,"identifiers":808},"Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.",{"doi":809},"10.1016\u002Fj.jbi.2019.103208",{"id":20,"text":811,"url":20,"identifiers":812},"Wisconsin Network for Research Support. CARDS [Internet]. [cited 2022 Mar 4]. Available from: https:\u002F\u002Fwinrs.nursing.wisc.edu\u002Fservices\u002Fcards\u002F",{},{"id":20,"text":814,"url":20,"identifiers":815},"Revelle WR. psych: Procedures for personality and psychological research [Internet]. Evanston, Illinois: Northwestern University; 2017 [cited 2022 Oct 5]. Report No.: R package version 2.2.9. Available from: https:\u002F\u002Fcran.r-project.org\u002Fpackage=psych",{},{"id":20,"text":817,"url":20,"identifiers":818},"National Institute on Drug Abuse. What is drug addiction? [Internet]. 2022. Available from: https:\u002F\u002Fnida.nih.gov\u002Fpublications\u002Fdrugs-brains-behavior-science-addiction\u002Fdrug-misuse-addiction",{},{"id":20,"text":820,"url":20,"identifiers":821},"Jones JD, Campbell A, Metz VE, Comer SD. No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone. Addict Behav. 2017;71:104–6.",{"doi":822},"10.1016\u002Fj.addbeh.2017.03.008",{"id":20,"text":824,"url":20,"identifiers":825},"Zapata J, Tran P. Public Health Advisory: Fentanyl Increasingly Present in Overdose Deaths in Wisconsin [Internet]. Wisconsin: Wisconsin Department of Health Services; 2022 Sep [cited 2023 Jan 4]. (Public Health Advisory). Available from: https:\u002F\u002Fwww.dhs.wisconsin.gov\u002Fopioids\u002Fph-advisory.htm",{},{"id":20,"text":827,"url":20,"identifiers":828},"A field assessment of Fourier-Transform Infrared Spectroscopy (FTIR) and fentanyl immunoassay strips as point of care drug checking technologies [Internet]. British Columbia Centre on Substance Use; 2019 [cited 2022 Oct 5]. Available from: https:\u002F\u002Fwww.bccsu.ca\u002Fwp-content\u002Fuploads\u002F2020\u002F08\u002FFTIR_TestStrip_Field_Assessment-Sept2019.pdf",{},{"id":20,"text":830,"url":20,"identifiers":831},"Carroll JJ, Mackin S, Schmidt C, McKenzie M, Green TC. The Bronze Age of drug checking: barriers and facilitators to implementing advanced drug checking amidst police violence and COVID-19. Harm Reduct J. 2022;19(1):1–13.",{"doi":832},"10.1186\u002Fs12954-022-00590-z",{"id":834,"createTime":835,"updateTime":836,"relativeEntities":837,"slug":838,"properties":839,"entityType":151,"verifyStatus":152,"verifyTime":850,"verifyNote":154,"languages":20,"translateLanguages":20,"viewCount":21,"primaryUrl":851,"fullTextUrl":20,"authors":852,"publicationType":331,"publisherRelationship":895,"citationCount":20,"citationInfo":20,"publishDate":950,"publishYear":951,"citationAnalyzeStatus":952,"lastCitationAnalyze":953,"indexDatabases":954,"openAccess":20,"references":20,"isForceReanalyzing":532},"af2830d8-8f3d-42c3-815c-d6bb276fddbd","2024-01-10T22:49:25.850+00:00","2026-07-22T16:36:41.181+00:00",[],"A-qualitative-study-of-referring-agents-perceptions-of-access-barriers-to-inpatient-substance-abuse-treatment-centres-in-the-Western-Cape",{"abstract":840,"title":842,"gsPaper":844,"references":846,"doi":848},{"EN":841},"Despite empirical support for the individual and public health benefits of treating substance use disorders (SUDs) , access to these services is impeded by several barriers. Although many studies on access barriers have been put forward in the literature, few have explored the barriers to accessing state-funded inpatient substance abuse treatment or the views of referral agents. A qualitative study was conducted to explore referring agents’ perceptions of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape Province of South Africa. Six individual in-depth interviews were conducted and analysed using theoretical thematic analysis. The key barriers to emerge from the analysis pertained to referring agents’ perceptions of the following: service users, the substance abuse referral and treatment system and community dynamics. Recommendations are made for interventions to address the identified barriers.",{"EN":843},"A qualitative study of referring agents’ perceptions of access barriers to inpatient substance abuse treatment centres in the Western Cape",{"VOID":845},"[]",{"VOID":847},"South African Community Epidemiology Network on Drug Use (SACENDU). Monitoring alcohol and drug abuse treatment admissions in South Africa. Phase 34, January to July 2013. Cape Town: SACENDU; 2014.\nMyers B, Louw J, Fakier N. Access to substance abuse treatment in the Cape Town Metropole; 2007.\nNational Institute on Drug Abuse. Principles of drug addiction treatment: a research-based guide (3rd ed.), 2012. [http:\u002F\u002Fwww.drugabuse.gov\u002Fsites\u002Fdefault\u002Ffiles\u002Fpodat_1.pdf]\nCarr CJA, Xu J, Redko C, Lane DT, Rapp RC, Goris J, et al. Individual and system influences on waiting time for substance abuse treatment. J Subst Abuse Treat. 2008;34(2):192–201.\nMyers B, Parry C. Access to substance abuse treatment services for black South Africans: findings from audits of specialist treatment facilities in Cape Town and Gauteng. S Afr Psychiatry Rev. 2005;8:15–9.\nMyers B, Fakier N, Louw J. Stigma, treatment beliefs, and substance abuse treatment use in historically disadvantaged communities. Afr J Psychiatry. 2009;12:218–22.\nShapiro B, Coffa D, McCance-Katz EF. A primary care approach to substance misuse. Am Fam Physician. 2013;88(2):113–21.\nWHO Regional Office for South-East Asia. Referral and network development. 2004. [http:\u002F\u002Fwww.who.int\u002Fmanagement\u002Ffacility\u002FReferralRationale.pdf]\nCenter for Substance Abuse Treatment. Integrating Substance Abuse Treatment and Vocational Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2000. (Treatment Improvement Protocol (TIP) Series, No. 38.) Chapter 5—Effective Referrals and Collaborations. Available from:http:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fbooks\u002FNBK64299\u002F].\nJindal SK. Promotion of standard treatment guidelines and building referral system for management of common non-communicable diseases in India. IJCM. 2011;36(5):38–42.\nMyers B, Louw J, Fakier N. Alcohol and drug abuse: removing structural barriers to treatment for historically disadvantaged communities in Cape Town. Int J Soc Welf. 2008;17(2):156–65.\nXu J, Wang J, Rapp RC, Carlson RG. The multidimensional structure of internal barriers to substance abuse treatment and its invariance across gender, ethnicity, and age. J Drug Issues. 2007;37(2):321–40.\nWisdom JP, Cavaleri M, Gogel L, Nacht M. Barriers and facilitators to adolescent drug treatment: youth, family, and staff reports. Addict Res Theory. 2009;19(2):179–88.\nBronfenbrenner U, Morris PA. The bio-ecological model of human development. Handb Child Psychol. 2007, I:14.\nBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.\nBrady TM, Ashley OS. Women in substance abuse treatment: results from the alcohol and drug services study (ADSS) (DHHS Publication No. SMA 04- 3968, Analytic Series A-26). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2005.\nJackson A, Shannon L. Barriers to receiving substance abuse treatment among rural pregnant women in Kentucky. Matern Child Healt J. 2011, doi:10.1007\u002Fs10995-011-0923-5.\nGreen CA. Gender and use of substance abuse treatment services. National Institute on Alcohol Abuse and Alcoholism. [http:\u002F\u002Fpubs.niaaa.nih.gov\u002Fpublications\u002Farh291\u002F55-62.htm]\nCenter for Substance Abuse Treatment. Substance use disorder treatment for people with physical and cognitive disabilities. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). Treatment Improvement Protocol (TIP) Series, No. 29. Chapter 1- Overview of treatment issues. 1998. [http:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fbooks\u002FNBK64885\u002F]\nCenter for Substance Abuse Treatment. Screening for infectious diseases among substance abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). Treatment Improvement Protocol (TIP) Series, No. 6. Chapter 3- Legal and ethical issues. 1993. [http:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fbooks\u002FNBK64720\u002F]\nRedko C, Rapp RC, Carlson, RG. Waiting time as a barrier to treatment entry: perceptions of substance users. J of Drug Issues. 2006. 0022-0426\u002F06\u002F04 831-852: 831-851.\nMyers BJ, Louw J, Pasche SC. Inequitable access to substance abuse treatment services in Cape Town, South Africa. Subst Abuse Treat Prev Policy. 2010;5:28.\nAnderson C. Presenting and evaluating qualitative research. Am J Pharm Educ. 2010;74(8):1–7.",{"VOID":849},"10.1186\u002Fs12954-015-0064-z","2024-06-25T17:34:51.650+00:00","https:\u002F\u002Fharmreductionjournal.biomedcentral.com\u002Farticles\u002F10.1186\u002Fs12954-015-0064-z",[853,869,882],{"id":854,"sortIndex":21,"researcher":20,"roles":855,"affiliations":857,"properties":866,"displayName":868,"givenName":20,"familyName":20},"0827e582-c5ba-429b-9569-4314af2d095b",[856],"AUTHOR",[858],{"id":859,"sortIndex":21,"affiliation":860,"properties":20},"b9a415ad-ecc7-42e7-880f-374a69e55d4e",{"id":859,"createTime":20,"updateTime":20,"relativeEntities":861,"slug":20,"properties":862,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":865,"statistic":20},[],{"title":863},{"VI":864},"Psychology Department, University of the Western Cape, Cape Town, South Africa",[],{"title":867},{"VI":868},"Deborah Isobell",{"id":870,"sortIndex":182,"researcher":20,"roles":871,"affiliations":872,"properties":879,"displayName":881,"givenName":20,"familyName":20},"8cec3e09-eb6d-491c-9727-3140ebc646af",[856],[873],{"id":859,"sortIndex":21,"affiliation":874,"properties":20},{"id":859,"createTime":20,"updateTime":20,"relativeEntities":875,"slug":20,"properties":876,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":878,"statistic":20},[],{"title":877},{"VI":864},[],{"title":880},{"VI":881},"Kamal Kamaloodien",{"id":883,"sortIndex":99,"researcher":20,"roles":884,"affiliations":885,"properties":892,"displayName":894,"givenName":20,"familyName":20},"48cc98af-4806-4d49-9e59-98519f04984f",[856],[886],{"id":859,"sortIndex":21,"affiliation":887,"properties":20},{"id":859,"createTime":20,"updateTime":20,"relativeEntities":888,"slug":20,"properties":889,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":891,"statistic":20},[],{"title":890},{"VI":864},[],{"title":893},{"VI":894},"Shazly Savahl",{"url":851,"publisher":896,"properties":945},{"id":6,"createTime":7,"updateTime":8,"relativeEntities":897,"slug":10,"properties":898,"entityType":18,"verifyStatus":19,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":21,"subjectFields":901,"manageAffiliations":914,"indexDatabases":925,"url":20,"thumbnailPath":20,"statistic":940,"gsStatistic":20,"type":128,"analyzePriority":20},[],{"issn":899,"title":900},{"VOID":13},{"EN":15},[902,906,910],{"id":24,"createTime":20,"updateTime":20,"relativeEntities":903,"label":904,"description":905,"parentId":20,"standard":20,"scholarHubFieldId":20},[],{"EN":27},{},{"id":30,"createTime":20,"updateTime":20,"relativeEntities":907,"label":908,"description":909,"parentId":20,"standard":20,"scholarHubFieldId":20},[],{"EN":33},{},{"id":36,"createTime":20,"updateTime":20,"relativeEntities":911,"label":912,"description":913,"parentId":20,"standard":20,"scholarHubFieldId":20},[],{"EN":39},{},[915,920],{"id":43,"createTime":20,"updateTime":20,"relativeEntities":916,"slug":20,"properties":917,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":919,"statistic":20},[],{"title":918},{"EN":47},[],{"id":50,"createTime":20,"updateTime":20,"relativeEntities":921,"slug":20,"properties":922,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":924,"statistic":20},[],{"title":923},{"EN":54},[],[926,933],{"id":58,"indexDatabase":927,"url":71,"indexYears":20,"academicFieldIds":932,"indexDatabaseRanking":20},{"id":60,"createTime":20,"updateTime":20,"relativeEntities":928,"label":929,"description":930,"key":67,"publicationTags":931,"standard":20},[],{"EN":63,"VI":63},{"EN":65,"VI":66},[69,70],[73],{"id":75,"indexDatabase":934,"url":86,"indexYears":87,"academicFieldIds":939,"indexDatabaseRanking":92},{"id":77,"createTime":20,"updateTime":20,"relativeEntities":935,"label":936,"description":937,"key":83,"publicationTags":938,"standard":20},[],{"EN":80,"VI":80},{"EN":80,"VI":82},[85],[89,90,91],{"impactFactor":21,"impactFactorByYear":941,"i10Index":98,"i10IndexLast5Year":99,"totalPublication":100,"totalPublicationByYear":942,"totalCitation":121,"totalCitationByYear":943,"totalCitationPerPublication":96,"totalCitationPerPublicationByYear":944,"hindexLast5Year":98,"hindex":98},{"2019":95,"2020":96,"2021":97,"2022":96},{"2004":102,"2005":103,"2006":104,"2007":105,"2008":103,"2009":106,"2010":107,"2011":108,"2012":106,"2013":109,"2014":110,"2015":111,"2016":112,"2017":113,"2018":114,"2019":115,"2020":116,"2021":117,"2022":118,"2023":119,"2024":120},{"2018":123,"2020":124},{"2018":126,"2020":127},{"pages":946,"volume":948},{"VOID":947},"1-14",{"VOID":949},"12","2015-09-26",2015,"ERROR_IN_GET_PLATFORM_ID","2026-07-22T16:36:41.180+00:00",[69,92],{"id":956,"createTime":957,"updateTime":958,"relativeEntities":959,"slug":960,"properties":961,"entityType":151,"verifyStatus":152,"verifyTime":978,"verifyNote":154,"languages":979,"translateLanguages":20,"viewCount":21,"primaryUrl":980,"fullTextUrl":20,"authors":981,"publicationType":331,"publisherRelationship":1200,"citationCount":182,"citationInfo":1254,"publishDate":1257,"publishYear":1255,"citationAnalyzeStatus":19,"lastCitationAnalyze":1258,"indexDatabases":1259,"openAccess":20,"references":1260,"isForceReanalyzing":532},"44ed86e3-11d7-4423-8153-bed3320d0e8b","2024-04-17T17:05:57.994+00:00","2026-07-15T17:33:29.725+00:00",[],"Relationship-between-benzodiazepine-prescription-aggressive-behavior-and-behavioral-disinhibition-a-retrospective-study-in-a-Swiss-prison",{"mag":962,"gsPaper":964,"pmc":966,"openalex":968,"abstract":970,"title":972,"pm":974,"doi":976},{"VOID":963},"3108623351",{"VOID":965},"[\"1850456634439966035\"]",{"VOID":967},"8139037",{"VOID":969},"W3108623351",{"EN":971},"\u003Cjats:title>Abstract\u003C\u002Fjats:title>\u003Cjats:sec>\n                \u003Cjats:title>Background\u003C\u002Fjats:title>\n                \u003Cjats:p>Benzodiazepines are commonly prescribed in prisons amidst the controversies surrounding their potential role in causing behavioral disinhibition and aggressive behavior and their association with use and trafficking of illicit and addictive substances. The present study aimed to (1) ascertain the relationship between benzodiazepine prescription (including their dosage and duration of use) and aggressive behavior and behavioral disinhibition in prison and (2) investigate whether there was an association between benzodiazepine prescription, (including their dosage and duration of use) and using and trafficking illicit and addictive substances during imprisonment.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Methods\u003C\u002Fjats:title>\n                \u003Cjats:p>Data were extracted from the electronic database of an “open” Swiss prison (\u003Cjats:italic>n\u003C\u002Fjats:italic> = 1206, 1379 measures) over a 5-year period (2010–2015). Measures included benzodiazepine prescription, duration of benzodiazepine use and mean dosage, and punishable behaviors (physical and verbal aggression, disinhibited but not directly aggressive behaviors, property damage or theft, substance-related offenses, and rule transgression). We assessed the relationship between benzodiazepine prescription and punishable behaviors after propensity score matching. Logistic regressions were also used to test the relationship of benzodiazepine use duration and dosage with punishable behaviors among participants who received benzodiazepines.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Results\u003C\u002Fjats:title>\n                \u003Cjats:p>After propensity score matching, benzodiazepine prescription was not significantly associated with any punishable behavior. Among detained persons who took benzodiazepines, there was no significant association of dosage and duration of use with offenses involving illicit or addictive substance use or trafficking.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Conclusions\u003C\u002Fjats:title>\n                \u003Cjats:p>Our study did not empirically support the occurrence of increased aggressive or disinhibited behaviors or increased risk of substance abuse in detained persons who received benzodiazepines in prison. This suggests a need to reconsider restrictions in prescribing benzodiazepines in the prison setting.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>",{"EN":973},"Relationship between benzodiazepine prescription, aggressive behavior, and behavioral disinhibition: a retrospective study in a Swiss 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Guideline, education, and peer comparison to reduce prescriptions of benzodiazepines and low-dose Quetiapine in prison. J Correct Health Care. 2012;18:45–52.",{"doi":1346},"10.1177\u002F1078345811421591",{"id":20,"text":1348,"url":20,"identifiers":1349},"Elger BS. Prisoners’ insomnia: to treat or not to treat? Medical decision-making in places of detention. Med Sci Law. 2008;48:307–16.",{"doi":1350},"10.1258\u002Frsmmsl.48.4.307",{"id":20,"text":1352,"url":20,"identifiers":1353},"Lekka NP, Paschalis C, Papadourakis A, Beratis S. Characteristics of inmates receiving prescribed benzodiazepines in a high-security greek prison. Compr Psychiatry. 2003;44:409–14.",{"doi":1354},"10.1016\u002FS0010-440X(03)00112-3",{"id":20,"text":1356,"url":20,"identifiers":1357},"Watson TM. Prisoners’ access to psychoactive medications: the need for research and improved policy. Int J Drug Policy. 2016;29:98–9.",{"doi":1358},"10.1016\u002Fj.drugpo.2015.12.007",{"id":20,"text":1360,"url":20,"identifiers":1361},"Liebrenz M, Schneider M, Buadze A, Gehring M-T, Dube A, Caflisch C. High-dose benzodiazepine users’ perceptions and experiences of anterograde amnesia. J Am Acad Psychiatry Law. 2016;44:328–37.",{},{"id":20,"text":1363,"url":20,"identifiers":1364},"Lundholm L, Haggård U, Möller J, Hallqvist J, Thiblin I. The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study. Drug Alcohol Depend. 2013;129:110–5.",{"doi":1365},"10.1016\u002Fj.drugalcdep.2012.09.019",{"id":20,"text":1367,"url":20,"identifiers":1368},"Reynolds B, Richards JB, Dassinger M, de Wit H. Therapeutic doses of diazepam do not alter impulsive behavior in humans. Pharmacol Biochem Behav. 2004;79:17–24.",{"doi":1369},"10.1016\u002Fj.pbb.2004.06.011",{"id":20,"text":1371,"url":20,"identifiers":1372},"Albrecht B, Staiger PK, Best D, Hall K, Nielsen S, Lubman DI, Miller P. Benzodiazepine use of community-based violent offenders: a preliminary investigation. J Subst Use. 2017;22:295–303.",{"doi":1373},"10.1080\u002F14659891.2016.1195893",{"id":20,"text":1375,"url":20,"identifiers":1376},"Bartlett A, Dholakia N, England R, Hales H, Ev H, McGeorge T, Moss B, Ovaisi S, Tukmachi E, Patel S. Prison prescribing practice: practitioners’ perspectives on why prison is different. Int J Clin Pract. 2014;68:413–7.",{"doi":1377},"10.1111\u002Fijcp.12362",{"id":1379,"createTime":1380,"updateTime":1381,"relativeEntities":1382,"slug":1383,"properties":1384,"entityType":151,"verifyStatus":152,"verifyTime":1395,"verifyNote":154,"languages":20,"translateLanguages":20,"viewCount":21,"primaryUrl":1396,"fullTextUrl":20,"authors":1397,"publicationType":331,"publisherRelationship":1445,"citationCount":20,"citationInfo":20,"publishDate":1499,"publishYear":1500,"citationAnalyzeStatus":19,"lastCitationAnalyze":1501,"indexDatabases":1502,"openAccess":20,"references":20,"isForceReanalyzing":532},"92e68ce0-d0e4-43b5-811b-122b837d7453","2024-02-11T03:15:37.377+00:00","2026-07-14T07:55:54.371+00:00",[],"Telling-our-stories-heroin-assisted-treatment-and-SNAP-activism-in-the-Downtown-Eastside-of-Vancouver",{"abstract":1385,"title":1387,"gsPaper":1389,"references":1391,"doi":1393},{"EN":1386},"This article highlights the experiences of a peer-run group, SALOME\u002FNAOMI Association of Patients (SNAP), that meets weekly in the Downtown Eastside of Vancouver, British Columbia, Canada. SNAP is a unique independent peer- run drug user group that formed in 2011 following Canada’s first heroin-assisted treatment trial (HAT), North America Opiate Medication Initiative (NAOMI). SNAP’s members are now made up of former research participants who participated in two heroin-assisted trials in Vancouver. This article highlights SNAP members’ experiences as research subjects in Canada’s second clinical trial conducted in Vancouver, Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), that began recruitment of research participants in 2011. This paper draws on one brainstorming session, three focus groups, and field notes, with the SALOME\u002FNAOMI Association of Patients (SNAP) in late 2013 about their experiences as research subjects in Canada’s second clinical trial, SALOME in the DTES of Vancouver, and fieldwork from a 6-year period (March 2011 to February 2017) with SNAP members. SNAP’s research draws on research principles developed by drug user groups and critical methodological frameworks on community-based research for social justice. The results illuminate how participating in the SALOME clinical trial impacted the lives of SNAP members. In addition, the findings reveal how SNAP member’s advocacy for HAT impacts the group in positive ways. Seven major themes emerged from the analysis of the brainstorming and focus groups: life prior to SALOME, the clinic setting and routine, stability, 6-month transition, support, exiting the trial and ethics, and collective action, including their participation in a constitutional challenge in the Supreme Court of BC to continue receiving HAT once the SALOME trial ended. HAT benefits SNAP members. They argue that permanent HAT programs should be established in Canada because they are an effective harm reduction initiative, one that also reduces opioid overdose deaths.",{"EN":1388},"Telling our stories: heroin-assisted treatment and SNAP activism in the Downtown Eastside of Vancouver",{"VOID":1390},"[\"10365461376516750412\"]",{"VOID":1392},"Coroners Service of British Columbia. Fentanyl-detected illicit drug overdose deaths (2012 to 2016). Burnaby: Coroners Service of British Columbia; 2016. http:\u002F\u002Fwww2.gov.bc.ca\u002Fgov\u002Fcontent\u002Fsafety\u002Fpublic-safety\u002Fdeath-investigation\u002Fstatistical-reports. Accessed 5 Jan 2017.\nCoroners Service of British Columbia. Illicit drug overdose deaths in BC, January 1, 2007–March 31, 2017. Burnaby: Coroners Service of British Columbia; 2017. http:\u002F\u002Fwww2.gov.bc.ca\u002Fgov\u002Fcontent\u002Fsafety\u002Fpublic-safety\u002Fdeath-investigation\u002Fstatistical\u002Fillicit-drug.pdf. Accessed 5 May 2017.\nWoo A. Ottawa mulls unconventional B.C.—style therapies for opioid addiction. Globe and Mail. 2017. http:\u002F\u002Fwww.theglobeandmail.com\u002Fnews\u002Fbritish-columbia\u002Fottawa-mulls-bc-style-therapies-for-opioid-addiction\u002Farticle33681601\u002F. Accessed 19 Jan 2017.\nBoyd S, NAOMI Patients Association. Yet they failed to do so: recommendations based on the experiences of NAOMI research survivors and a call for action. Harm Reduction J. 2013;10(6):1–13.\nPaulus I, Halliday R. Rehabilitation and the narcotic addict: results of a comparative methadone withdrawal program. Can Med Assoc J. 1967;96:655–9.\nCommission of Inquiry into the Non-Medical Use of Drugs. Final report. Ottawa: Information Canada; 1973.\nGiffen P, Endicott S, Lambert S. Panic and indifference: the politics of Canada’s drug laws. Ottawa: Canadian Centre on Substance Abuse; 1991.\nCity of Vancouver. Downtown Eastside (DTES) local area profile 2012. 2012. p. 21. April 2017. http:\u002F\u002Fwww.vancouver.ca\u002Fdtesplan.\nBoyd S, MacPherson D, Osborn B. Raise shit! Social action saving lives. Fernwood: Halifax; 2009.\nCampbell L, Boyd N, Culbert L. A thousand dreams: Vancouver’s Downtown Eastside and the fight for its future. Vancouver: Greystone Books; 2009.\nCain V. The report of the task force into illicit narcotic overdose deaths in British Columbia. British Columbia Office of the Chief Coroners. Ministry of Attorney General.: Burnaby; 1994.\nHaysom B. NDP MP is backing free-heroin proposal. Vancouver Sun. 12 Aug 1998. In: Boyd S, MacPherson D, Osborn B, editors. Raise shit! Social action saving lives. Fernwood: Halifax; 2009. p. 98.\nMacPherson D. A framework for action: a four-pillar approach to drug problems in Vancouver. Vancouver: City of Vancouver; 2001. http:\u002F\u002Fdonaldmacpherson.ca\u002Fpublications\u002Ffour-pillars-drug-strategy. Accessed 10 Jan 2017.\nBlanken P, et al. Heroin-assisted treatment in the Netherlands: history, findings, and international context. Eur Neuropsychopharmacol. 2010;20 Suppl 2:105–58.\nNAOMI Study Team. Reaching the hardest to reach—treating the hardest-to-treat. Vancouver: NAOMI Study Team; 2008. http:\u002F\u002Fwww.chumontreal.qc.ca\u002Fsites\u002Fdefault\u002Ffiles\u002F\u002Fdocuments\u002FMedia\u002FPDF\u002F081017-resume-resultats-etude.pdf. Accessed 25 Sept 2015.\nWorld Medical Association. Declaration of Helsinki—ethical principles for medical research involving human subjects (and subsequent amendments). 1964. http:\u002F\u002Fwww.wma.net\u002Fen\u002F30publications\u002F10policies\u002Fb3\u002F. Accessed 27 Jan 2017.\nWorld Health Organization & UNAIDS. Ethical engagement of people who inject drugs in HIV prevention trial. 2011. http:\u002F\u002Fwww.unaids.org\u002Fsites\u002Fdefault\u002Ffiles\u002Fmedia_asset\u002F20110429-Ethical-engagement-people-inject-drugs-HIV-prevention-trials_en_0.pdf. Accessed 25 Sept 2014.\nSmall D, Drucker E. Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment. Harm Reduction J. 2006;3(16):1–14.\nOviedo-Joekes E, et al. Hydromorphone compared with diacetylmorphine for long-term opioid dependence: a randomized clinical trial. JAMA Psychiatry. 2016; doi:10.1001\u002Fjamapsychiatry.2016.0109.\nCanadian HIV\u002FAIDS Legal Network. “Nothing about us without us.” Greater, meaningful involvement of people who use illegal drugs: a public health, ethical, and human rights imperative. 2005. http:\u002F\u002Fwww.aidslaw.ca\u002FMaincontent\u002Fissues\u002Fdruglaws\u002Fgreater_involvement.htm. Accessed January 7, 2017.\nCarroll W, editor. Critical strategies for social research. Toronto: Canadian Scholars Press; 2004.\nCulhane D. Stories and plays: ethnography, performance and ethical engagements. Anthropologica. 2011;53:257–74.\nVancouver Area Network of Drug Users (VANDU). http:\u002F\u002Fwww.vandu.org\u002F. Accessed 7 Jan 2017.\nCameron S. Telling stories. n.d. http:\u002F\u002Fsandycameron.vcn.bc.ca\u002Fcategory\u002Fpoems\u002F. Accessed 19 Aug 2013.\nMillion D. Therapeutic nations: healing in an age of Indigenous human rights. Tucson: University of Arizona Press; 2013.\nAmnesty International. Stolen sisters: discrimination and violence against Indigenous women in Canada. 2004. http:\u002F\u002Fwww.amnesty.ca\u002Fresearch\u002Freports\u002Fstolen-sisters-a-human-rights-response-to-discrimination-and-violence-against-indig. Accessed 25 Jan 2017.\nBoyd J, Cunningham D, Anderson S, Kerr T. Supportive housing and surveillance. Int J Drug Policy. 2016;34:72–9.\nProvidence Health Care. SALOME Clinical Trial Questions and Answers. 2017. http:\u002F\u002Fwww.providencehealthcare.org\u002Fsalome\u002Ffaqs.html. Accessed 20 Jan 2017.\nPivot Legal Society. n.d. About. http:\u002F\u002Fwww.pivotlegal.org\u002Fabout. Accessed 27 Jan 2017.\nStrang J, Groshkova T, Metrebian N. New heroin-assisted treatment: recent evidence and current supervised injectable heroin treatment in Europe and beyond. Luxemburg: Insights, European Monitoring Centre for Drugs and Drug Addiction; 2012.\nRoom R, Reuter P. How well do international drug conventions protect public health? Lancet. 2012;379:84–91.\nConservative Party of Canada. Stop giving heroin to addicts. http:\u002F\u002Fwww.conservative.ca\u002F?page_id=3488. Accessed 22 Sept 2013. (link no longer active).\nProvidence Health Care Society [PHCS] et al. v. Canada (Attorney General) (2014) BCSC 936.\nMacDonald S. Injectable opioids homegrown solution to fix fentanyl crisis. Canadian Broadcasting Corporation. 2017. http:\u002F\u002Fwww.cbc.ca\u002Fnews\u002Fcanada\u002Fbritish-columbia\u002Fb-c-fentanyl-fix-1.3959208. Accessed 31 Jan 2017.\nCanadian Press. n.d. B.C. overdose inquest recommends better access to addictions treatment. Vancouver Sun. 2017. http:\u002F\u002Fvancouversun.com\u002Fnews\u002Flocal-news\u002Fb-c-overdose-inquest-recommends-better-access-to-addictions-treatment. Accessed 26 Jan 2017.",{"VOID":1394},"10.1186\u002Fs12954-017-0152-3","2024-06-23T13:03:27.078+00:00","https:\u002F\u002Fharmreductionjournal.biomedcentral.com\u002Farticles\u002F10.1186\u002Fs12954-017-0152-3",[1398,1413,1430],{"id":1399,"sortIndex":21,"researcher":20,"roles":1400,"affiliations":1401,"properties":1410,"displayName":1412,"givenName":20,"familyName":20},"5b8a0d55-5c76-47fb-b578-33c9816678b4",[856],[1402],{"id":1403,"sortIndex":21,"affiliation":1404,"properties":20},"8dba5a82-e787-413e-87c8-f88e960f721f",{"id":1403,"createTime":20,"updateTime":20,"relativeEntities":1405,"slug":20,"properties":1406,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":1409,"statistic":20},[],{"title":1407},{"VI":1408},"Faculty of Human and Social Development, University of Victoria, Victoria, Canada",[],{"title":1411},{"VI":1412},"Susan Boyd",{"id":1414,"sortIndex":182,"researcher":20,"roles":1415,"affiliations":1416,"properties":1425,"displayName":1427,"givenName":20,"familyName":20},"edc7ea7f-a3c2-4217-be70-56b26bad4cfa",[856],[1417],{"id":1418,"sortIndex":21,"affiliation":1419,"properties":20},"0c149d80-d93c-4a59-a070-c3749419adee",{"id":1418,"createTime":20,"updateTime":20,"relativeEntities":1420,"slug":20,"properties":1421,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":1424,"statistic":20},[],{"title":1422},{"VI":1423},"c\u002Fo VANDU, Vancouver, Canada",[],{"title":1426,"gsAuthor":1428},{"VI":1427},"Dave Murray",{"VOID":1429},"[\"Zt4sm8oAAAAJ\"]",{"id":1431,"sortIndex":99,"researcher":20,"roles":1432,"affiliations":1433,"properties":1442,"displayName":1444,"givenName":20,"familyName":20},"646eb3a9-3046-4584-aad2-f134624328ab",[856],[1434],{"id":1435,"sortIndex":21,"affiliation":1436,"properties":20},"b3dc37f2-732c-4cbe-a819-afd0986b94e8",{"id":1435,"createTime":20,"updateTime":20,"relativeEntities":1437,"slug":20,"properties":1438,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":1441,"statistic":20},[],{"title":1439},{"VI":1440},"Canadian Drug Policy Coalition, Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, Vancouver, Canada",[],{"title":1443},{"VI":1444},"Donald MacPherson",{"url":1396,"publisher":1446,"properties":1495},{"id":6,"createTime":7,"updateTime":8,"relativeEntities":1447,"slug":10,"properties":1448,"entityType":18,"verifyStatus":19,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":21,"subjectFields":1451,"manageAffiliations":1464,"indexDatabases":1475,"url":20,"thumbnailPath":20,"statistic":1490,"gsStatistic":20,"type":128,"analyzePriority":20},[],{"issn":1449,"title":1450},{"VOID":13},{"EN":15},[1452,1456,1460],{"id":24,"createTime":20,"updateTime":20,"relativeEntities":1453,"label":1454,"description":1455,"parentId":20,"standard":20,"scholarHubFieldId":20},[],{"EN":27},{},{"id":30,"createTime":20,"updateTime":20,"relativeEntities":1457,"label":1458,"description":1459,"parentId":20,"standard":20,"scholarHubFieldId":20},[],{"EN":33},{},{"id":36,"createTime":20,"updateTime":20,"relativeEntities":1461,"label":1462,"description":1463,"parentId":20,"standard":20,"scholarHubFieldId":20},[],{"EN":39},{},[1465,1470],{"id":43,"createTime":20,"updateTime":20,"relativeEntities":1466,"slug":20,"properties":1467,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":1469,"statistic":20},[],{"title":1468},{"EN":47},[],{"id":50,"createTime":20,"updateTime":20,"relativeEntities":1471,"slug":20,"properties":1472,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":1474,"statistic":20},[],{"title":1473},{"EN":54},[],[1476,1483],{"id":58,"indexDatabase":1477,"url":71,"indexYears":20,"academicFieldIds":1482,"indexDatabaseRanking":20},{"id":60,"createTime":20,"updateTime":20,"relativeEntities":1478,"label":1479,"description":1480,"key":67,"publicationTags":1481,"standard":20},[],{"EN":63,"VI":63},{"EN":65,"VI":66},[69,70],[73],{"id":75,"indexDatabase":1484,"url":86,"indexYears":87,"academicFieldIds":1489,"indexDatabaseRanking":92},{"id":77,"createTime":20,"updateTime":20,"relativeEntities":1485,"label":1486,"description":1487,"key":83,"publicationTags":1488,"standard":20},[],{"EN":80,"VI":80},{"EN":80,"VI":82},[85],[89,90,91],{"impactFactor":21,"impactFactorByYear":1491,"i10Index":98,"i10IndexLast5Year":99,"totalPublication":100,"totalPublicationByYear":1492,"totalCitation":121,"totalCitationByYear":1493,"totalCitationPerPublication":96,"totalCitationPerPublicationByYear":1494,"hindexLast5Year":98,"hindex":98},{"2019":95,"2020":96,"2021":97,"2022":96},{"2004":102,"2005":103,"2006":104,"2007":105,"2008":103,"2009":106,"2010":107,"2011":108,"2012":106,"2013":109,"2014":110,"2015":111,"2016":112,"2017":113,"2018":114,"2019":115,"2020":116,"2021":117,"2022":118,"2023":119,"2024":120},{"2018":123,"2020":124},{"2018":126,"2020":127},{"pages":1496,"volume":1497},{"VOID":947},{"VOID":1498},"14","2017-05-18",2017,"2026-07-14T07:55:54.370+00:00",[69,92],{"id":1504,"createTime":1505,"updateTime":1506,"relativeEntities":1507,"slug":1508,"properties":1509,"entityType":151,"verifyStatus":152,"verifyTime":1517,"verifyNote":154,"languages":20,"translateLanguages":20,"viewCount":21,"primaryUrl":1518,"fullTextUrl":20,"authors":1519,"publicationType":331,"publisherRelationship":1548,"citationCount":20,"citationInfo":20,"publishDate":1603,"publishYear":1604,"citationAnalyzeStatus":952,"lastCitationAnalyze":1506,"indexDatabases":1605,"openAccess":20,"references":20,"isForceReanalyzing":532},"2fb602fd-6eca-4119-8130-722a960bbc40","2024-02-17T01:45:29.587+00:00","2026-06-12T12:21:55.374+00:00",[],"Global-and-local-perspectives-on-tobacco-harm-reduction-what-are-the-issues-and-where-do-we-go-from-here-",{"title":1510,"gsPaper":1512,"references":1513,"doi":1515},{"EN":1511},"Global and local perspectives on tobacco harm reduction: what are the issues and where do we go from here?",{"VOID":845},{"VOID":1514},"Jha P. Avoidable deaths from smoking: a global perspective. Public Health Rev. 2012;33:569–600.\nRussell MJ. Low-tar medium nicotine cigarettes: a new approach to safer smoking. BMJ. 1976;1:1430–3.\nWest R, Raw M, McNeill A, Stead L, Aveyard P, Bitton J, Stapleton J, McRobbie H, Pokhrel S, Lester-George A, Borland R. Health-care interventions to promote and assist tobacco cessation: a review of the efficacy, effectiveness and affordability for use in national guideline development. Addiction. 2015;110(9):1388–03.\nWest, R., Beard, E. & Brown, J. Smoking toolkit study: electronic cigarettes in England—latest trends STS140122. 2016. http:\u002F\u002Fwww.smokinginengland.info\u002Flatest-statistics\u002F. Accessed 14 May 2018.\nBullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013;382(9905):1629–37.\nOffice for National Statistics (ONS). Adult smoking habits in Great Britain: 2014. 2016. http:\u002F\u002Fwww.ons.gov.uk\u002Fpeoplepopulationandcommunity\u002Fhealthandsocialcare\u002Fhealthandlifeexpectancies\u002Fbulletins\u002Fadultsmokinghabitsingreatbritain\u002F2014. Accessed 14 May 2018.\nASH. Fact sheet 33. Use of electronic cigarettes (vapourisers) among adults in great Britain. 2016b. http:\u002F\u002Fwww.ash.org.uk\u002Ffiles\u002Fdocuments\u002FASH_891.pdf. Accessed 14 May 2018.\nFarsalinos, KE., Poulas, K., Voudris, V. & Le Houezec, J. Electronic cigarette use in the European Union: analysis of a representative sample of 27,460 Europeans from 28 countries. 2016. Addiction Jun 24 (Epub ahead of print). doi: https:\u002F\u002Fdoi.org\u002F10.1111\u002Fadd.13506.\nFarsalinos KE, Siakas G, Poulas K, Voudris V, Merakou K, Barbouni A. Electronic cigarette use in Greece: an analysis of a representative population sample in Attica prefecture. Harm Reduction J. 2018;15(1):20.\nPechacek TF, Nayak P, Gregory KR, Weaver SR, Eriksen MP. The potential that electronic nicotine delivery systems can be a disruptive technology: results from a national survey. Nicotine Tob Res. 2016;18(10):1989–97.\nCookson C, Strang J, Ratschen E, Sutherland G, Finch E, McNeill A. Smoking and its treatment in addiction services: clients’ and staff behaviour and attitudes. BMC Health Serv Res. 2014;14(1):304.\nKozlowski LT. Origins in the USA in the 1980s of the warning that smokeless tobacco is not a safe alternative to cigarettes: a historical, documents-based assessment with implications for comparative warnings on less harmful tobacco\u002Fnicotine products. 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Quantitative outcomes relating to participants’ substance use, physical and mental health, and quality of the Peer Navigator relationship, were measured via a ‘holistic health check’ with six questionnaires completed at two time-points. The intervention was found to be acceptable to, and feasible and accessible for, participants, Peer Navigators, and service staff. Participants reported improvements to service engagement, and feeling more equipped to access services independently. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling trusting, authentic, and meaningful relationships to be developed. Some challenges were experienced in relation to the ‘fit’ of the intervention within some settings. Among participants there were reductions in drug use and risky injecting practices. There were increases in the number of participants receiving opioid substitution therapy. 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Soc Sci Med. 2008;67(7):1065–73.","https:\u002F\u002Fwww.sciencedirect.com\u002Fscience\u002Farticle\u002Fpii\u002FS0277953608002980",{"doi":2254},"10.1016\u002Fj.socscimed.2008.06.004",{"id":20,"text":2256,"url":2257,"identifiers":2258},"Bramley EG, Fitzpatrick S, Edwards J, Ford D, Johnsen S, Sosenko F, et al. Hard edges: mapping severe and multiple disadvantage. Lankelly Chase: London; 2015. https:\u002F\u002Flankellychase.org.uk\u002Fwp-content\u002Fuploads\u002F2015\u002F07\u002FHard-Edges-Mapping-SMD-2015.pdf.","https:\u002F\u002Flankellychase.org.uk\u002Fwp-content\u002Fuploads\u002F2015\u002F07\u002FHard-Edges-Mapping-SMD-2015.pdf",{},{"id":20,"text":2260,"url":2261,"identifiers":2262},"Bramley G, Fitzpatrick S, Wood J, Sosenko F, Blenkinsopp J, Littlewood M, et al. Hard edges Scotland. 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BMC Health Serv Res. 2021;21(1):1–10.","https:\u002F\u002Fbmchealthservres.biomedcentral.com\u002Farticles\u002F10.1186\u002Fs12913-020-06013-8",{"doi":2271},"10.1186\u002Fs12913-020-06013-8",{"id":1911,"text":2273,"url":1913,"identifiers":2274},"Matheson C, Liddell D, Hamilton E, Wallace J. Older people with drug problems in Scotland: a mixed methods study exploring health and social support needs. Scottish Drugs Forum: Glasgow; 2017. https:\u002F\u002Fwww.sdf.org.uk\u002Fresource\u002Folder-people-drug-problems-scotland-mixed-methods-study-exploring-health-social-support-needs\u002F.",{"doi":1915},{"id":2276,"text":2277,"url":2278,"identifiers":2279},"beac535f-cb94-42fd-816f-998a57ce8438","Mercer SW, Fitzpatrick B, Guthrie B, Fenwick E, Grieve E, Lawson K, et al. 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Clin Med (Northfield Il). 2016;16(3):223–9.",{"doi":1915},{"id":1911,"text":2288,"url":1913,"identifiers":2289},"Svendsen TS, Veseth M, McKay JR, Bjornestad J, Erga AH, Moltu C, et al. Securing participant engagement in longitudinal substance use disorder recovery research: a qualitative exploration of key retention factors. J Psychosoc Rehabil Ment Heal. 2021;8:247–59.",{"doi":1915},{"id":2291,"createTime":2292,"updateTime":2293,"relativeEntities":2294,"slug":2295,"properties":2296,"entityType":151,"verifyStatus":152,"verifyTime":2307,"verifyNote":154,"languages":20,"translateLanguages":20,"viewCount":21,"primaryUrl":2308,"fullTextUrl":20,"authors":2309,"publicationType":331,"publisherRelationship":2422,"citationCount":20,"citationInfo":20,"publishDate":2476,"publishYear":1500,"citationAnalyzeStatus":19,"lastCitationAnalyze":2477,"indexDatabases":2478,"openAccess":20,"references":20,"isForceReanalyzing":532},"c85450cb-7ee1-488d-8109-8c6ad4ca843a","2024-02-20T15:21:11.347+00:00","2026-04-22T21:10:13.498+00:00",[],"The-impact-of-benzodiazepine-use-in-patients-enrolled-in-opioid-agonist-therapy-in-Northern-and-rural-Ontario",{"abstract":2297,"title":2299,"gsPaper":2301,"references":2303,"doi":2305},{"EN":2298},"Benzodiazepine use is common among patients in opioid agonist therapy; this puts patients at an increased risk of overdose and death. In this study, we examine the impact of baseline and ongoing benzodiazepine use, and whether patients are more likely to terminate treatment with increasing proportion of benzodiazepine positive urine samples. We also study whether benzodiazepine use differs by geographic location. We conducted a retrospective cohort study using anonymized electronic medical records from 58 clinics offering opioid agonist therapy in Ontario. One-year treatment retention was the primary outcome of interest and was measured for patients who did and did not have a benzodiazepine positive urine sample in their first month of treatment, and as a function of the proportion of benzodiazepine-positive urine samples throughout treatment. Cox proportional hazard model was used to characterize one-year retention. Our cohort consisted of 3850 patients, with the average retention rate of 43.4%. Baseline benzodiazepine users had a retention rate of 39.9% and non-users had a retention rate of 44%. Patients who were benzodiazepine negative on admission benefited from an increased median days retained of 265 vs. 215 days. Patients with more than 75% of urines positive for benzodiazepines were 175% more likely to drop out of treatment than those patients with little or no benzodiazepine use. Baseline benzodiazepine use is predictive of decreased retention. Patients who have a higher proportion of benzodiazepine-positive urine samples are more likely to drop out of treatment compared to those who have little or no benzodiazepine detection in their urine.",{"EN":2300},"The impact of benzodiazepine use in patients enrolled in opioid agonist therapy in Northern and rural Ontario",{"VOID":2302},"[\"8456832160809722116\"]",{"VOID":2304},"Dhalla IA, et al. Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. Cmaj. 2009;181(12):891–6.\nGomes T, et al. The burden of premature opioid-related mortality. 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Benzodiazepine use among opiate-dependent subjects in buprenorphine maintenance treatment: correlates of use, abuse and dependence. Drug Alcohol Depend. 2009;99(1-3):338–44.\nBrands B, et al. The impact of benzodiazepine use on methadone maintenance treatment outcomes. J Addict Dis. 2008;27(3):37–48.\nMikolaenko I, Robinson Jr CA, Davis GG. A review of methadone deaths in Jefferson County, Alabama. Am J Forensic Med Pathol. 2002;23(3):299–304.\nKellogg S, et al. Adolescent and young adult heroin patients: drug use and success in methadone maintenance treatment. J Addict Dis. 2006;25(3):15–25.\nSchiff M, Levit S, Moreno RC. Retention and illicit drug use among methadone patients in Israel: a gender comparison. Addict Behav. 2007;32(10):2108–19.\nAdamson S, S.R., Sheridan J, New Zealand Addiction Treatment Research Monograph. Research Proceedings from the Cutting Edge Conference, September 2010, 2012.\nUhlenhuth EH, et al. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: IV. Therapeutic dose dependence and abuse liability of benzodiazepines in the long-term treatment of anxiety disorders. J Clin Psychopharmacol. 1999;19(6 Suppl 2):23s–9s.\nNielsen S, et al. Benzodiazepine use among chronic pain patients prescribed opioids: associations with pain, physical and mental health, and health service utilization. Pain Med. 2015;16(2):356–66.\nAnthierens S, et al. The lesser evil? Initiating a benzodiazepine prescription in general practice: a qualitative study on GPs' perspectives. Scand J Prim Health Care. 2007;25(4):214–9.\nEibl JK, et al. Evaluating the Effectiveness of First-Time Methadone Maintenance Therapy Across Northern, Rural, and Urban Regions of Ontario, Canada. J Addict Med. 2015;9(6):440–6.\nHandford CKM, Srivastava A, Cirone S, Sanghera S, Palda V. Buprenorphine\u002FNaloxone for Opioid Dependence: Clinical Practice Guideline. 2011. Available from: https:\u002F\u002Fwww.cpso.on.ca\u002FuploadedFiles\u002Fpolicies\u002Fguidelines\u002Foffice\u002Fbuprenorphine_naloxone_gdlns2011.pdf. Accessed July 2016.\nProctor SL, Copeland AL, Kopak AM, Hoffmann NG, Herschman PL, Polukhina N. Predictors of Patient Retention in Methadone Maintenance Treatment. Journal of the Society of Psychologists in Addictive Behaviors. Psychol Addict Behav. 2015;29(4):906–17.\nRawson RA, et al. A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Arch Gen Psychiatry. 2002;59(9):817–24.\nEiroa-Orosa FJ, et al. Benzodiazepine use among patients in heroin-assisted vs. methadone maintenance treatment: findings of the German randomized controlled trial. Drug Alcohol Depend. 2010;112(3):226–33.\nBackmund M, et al. Co-consumption of benzodiazepines in heroin users, methadone-substituted and codeine-substituted patients. J Addict Dis. 2005;24(4):17–29.\nLeece P, et al. Predictors of opioid-related death during methadone therapy. J Subst Abuse Treat. 2015;57:30–5.\nChen KW, et al. Benzodiazepine use and misuse among patients in a methadone program. BMC Psychiatry. 2011;11:90.\nMcCabe SE, et al. Medical and nonmedical use of prescription opioids among high school seniors in the United States. Arch Pediatr Adolesc Med. 2012;166(9):797–802.\nWinklbaur B, et al. Quality of life in patients receiving opioid maintenance therapy. A comparative study of slow-release morphine versus methadone treatment. Eur Addict Res. 2008;14(2):99–105.\nNunes EV, et al. Treating opioid dependence with injectable extended-release naltrexone (XR-NTX): who will respond? J Addict Med. 2015;9(3):238–43.\nBramness JG, Kornor H. Benzodiazepine prescription for patients in opioid maintenance treatment in Norway. 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Psychiatric and medical comorbidities, associated pain, and health care utilization of patients prescribed buprenorphine. J Subst Abuse Treat. 2013;44(5):481–7.\nJones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012;125(1-2):8–18.\nCPSO, methadone maintenance treatment program standards and clinical guidelines m. program, Editor. 2011, The College of Physicians and Surgeons of Ontario: Toronto, Ontario.\nWhite WL, et al. Patterns of abstinence or continued drug use among methadone maintenance patients and their relation to treatment retention. J Psychoactive Drugs. 2014;46(2):114–22.\nPeles E, et al. One-year and cumulative retention as predictors of success in methadone maintenance treatment: a comparison of two clinics in the United States and Israel. J Addict Dis. 2008;27(4):11–25.\nNosyk B, et al. Trends in methadone maintenance treatment participation, retention, and compliance to dosing guidelines in British Columbia, Canada: 1996-2006. J Subst Abuse Treat. 2010;39(1):22–31.",{"VOID":2306},"10.1186\u002Fs12954-017-0134-5","2024-05-16T22:32:06.916+00:00","https:\u002F\u002Fharmreductionjournal.biomedcentral.com\u002Farticles\u002F10.1186\u002Fs12954-017-0134-5",[2310,2334,2354,2367,2380,2393],{"id":2311,"sortIndex":21,"researcher":20,"roles":2312,"affiliations":2313,"properties":2331,"displayName":2333,"givenName":20,"familyName":20},"63ecc36f-ffe5-4ff5-b2b6-ac3c9562482f",[856],[2314,2322],{"id":2315,"sortIndex":21,"affiliation":2316,"properties":20},"2ec8438e-b359-493d-9709-6e9136a746be",{"id":2315,"createTime":20,"updateTime":20,"relativeEntities":2317,"slug":20,"properties":2318,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":2321,"statistic":20},[],{"title":2319},{"VI":2320},"Northern Ontario School of Medicine, Sudbury, Canada",[],{"id":2323,"sortIndex":182,"affiliation":2324,"properties":2330},"4ee87e34-1347-4d31-b472-99f775b912e4",{"id":2323,"createTime":20,"updateTime":20,"relativeEntities":2325,"slug":20,"properties":2326,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":2329,"statistic":20},[],{"title":2327},{"VI":2328},"School of Rural and Northern Health,Laurentian University, Sudbury, Canada",[],{},{"title":2332},{"VI":2333},"Alexandra M. 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Take-home naloxone is an effective strategy for preventing opioid-related overdose death, but its widespread use is particularly challenging in smaller cities, towns, and rural areas where it may be stigmatized and\u002For poorly understood.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Methods\u003C\u002Fjats:title>\n                \u003Cjats:p>We analyzed data on knowledge and beliefs about drug use and naloxone among the general public in Nebraska, a largely rural state in the Great Plains region of the U.S., drawing on the 2020 Nebraska Annual Social Indicators Survey.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Results\u003C\u002Fjats:title>\n                \u003Cjats:p>Respondents reported negative beliefs about people who use drugs (PWUD) and little knowledge of naloxone. Over half reported that members of their community view PWUD as blameworthy, untrustworthy, and dangerous. Approximately 31% reported being unaware of naloxone. Only 15% reported knowing where to obtain naloxone and less than a quarter reported knowing how to use it. Knowing where to obtain naloxone is associated with access to opioids and knowing someone who has recently overdosed, but having ever used opioids or being close to someone who uses opioids is not associated with naloxone knowledge. Finally, almost a quarter of respondents endorsed the belief that people who use opioids will use more if they have access to naloxone.\u003C\u002Fjats:p>\n              \u003C\u002Fjats:sec>\u003Cjats:sec>\n                \u003Cjats:title>Conclusion\u003C\u002Fjats:title>\n                \u003Cjats:p>Our findings highlight stigmatizing beliefs about PWUD and underscore the need for further education on naloxone as an effective strategy to reduce opioid-related overdose death. 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Nebraska: opioid-involved deaths and related harms. https:\u002F\u002Fwww.drugabuse.gov\u002Fdrug-topics\u002Fopioids\u002Fopioid-summaries-by-state\u002Fnebraska-opioid-involved-deaths-related-harms. Accessed 12 Aug 2021.",{},{"id":20,"text":2650,"url":20,"identifiers":2651},"National Center for Health Statistics [Internet]. Provisional drug overdose death surveillance. National Center for Health Statistics. 2021. https:\u002F\u002Fwww.cdc.gov\u002Fnchs\u002Fnvss\u002Fvsrr\u002Fprovisional-drug-overdose.htm. Accessed 3 May 2021.",{},{"id":20,"text":2653,"url":20,"identifiers":2654},"Nebraska Legislature [Internet]. Nebraska revised statute 28–470. https:\u002F\u002Fnebraskalegislature.gov\u002Flaws\u002Fstatutes.php?statute=28-470. Accessed 3 May 2021.",{},{"id":20,"text":2656,"url":20,"identifiers":2657},"Guy GP, Haegerich TM, Evans ME, Losby JL, Young R, Jones CM. Vital signs: pharmacy-based naloxone dispensing—United States, 2012–2018. MMWR. 2019;68:679–86. https:\u002F\u002Fdoi.org\u002F10.15585\u002Fmmwr.mm6831e1.",{"doi":2658},"10.15585\u002Fmmwr.mm6831e1",{"id":20,"text":2660,"url":20,"identifiers":2661},"Bureau of Sociological Research [BOSR] [Internet]. 2020 NASIS methodology report. https:\u002F\u002Fbosr.unl.edu\u002Fnasis-methodology-reports. Accessed 3 May 2021.",{},{"id":20,"text":2663,"url":20,"identifiers":2664},"Lambdin BH, Bluthenthal RN, Wenger LD, et al. Overdose education and naloxone distribution within syringe service programs—United States, 2019. MMWR. 2020;69(33):1117–21. https:\u002F\u002Fdoi.org\u002F10.15585\u002Fmmwr.mm6933a2.",{"doi":2665},"10.15585\u002Fmmwr.mm6933a2",{"id":20,"text":2667,"url":20,"identifiers":2668},"Fernández-Viña MH, Prood NE, Herpolsheimer A, Waimberg J, Burris S. State laws governing syringe services programs and participant syringe possession, 2014–2019. Public Health Rep. 2020;135(1_suppl):128S-137S. https:\u002F\u002Fdoi.org\u002F10.1177\u002F0033354920921817.",{"doi":2669},"10.1177\u002F0033354920921817",{"id":20,"text":2671,"url":20,"identifiers":2672},"Bachhuber MA, McGinty EE, Kennedy-Hendricks A, Niederdeppe J, Barry CL. Messaging to increase public support for naloxone distribution policies in the United States: results from a randomized survey experiment. PLoS ONE. 2015;10(7):e0130050. https:\u002F\u002Fdoi.org\u002F10.1371\u002Fjournal.pone.0130050.",{"doi":2673},"10.1371\u002Fjournal.pone.0130050",{"id":20,"text":2675,"url":20,"identifiers":2676},"Linas BP, Savinkina A, Madushani RW, Wang J, Eftekhari G, Chatterjee A, et al. Projected estimates of opioid mortality after community-level interventions. JAMA Netw Open. 2021;4(2):e2037259. https:\u002F\u002Fdoi.org\u002F10.1001\u002Fjamanetworkopen.2020.37259.",{"doi":2677},"10.1001\u002Fjamanetworkopen.2020.37259",{"id":20,"text":2679,"url":20,"identifiers":2680},"U.S. Census Bureau [Internet]. QuickFacts selected: Nebraska. https:\u002F\u002Fwww.census.gov\u002Fquickfacts\u002Ffact\u002Ftable\u002FNE,US\u002FPST045219. Accessed 1 July 2021.",{},{"id":2682,"createTime":2683,"updateTime":2684,"relativeEntities":2685,"slug":2686,"properties":2687,"entityType":151,"verifyStatus":152,"verifyTime":2698,"verifyNote":154,"languages":20,"translateLanguages":20,"viewCount":21,"primaryUrl":2699,"fullTextUrl":20,"authors":2700,"publicationType":331,"publisherRelationship":2831,"citationCount":20,"citationInfo":20,"publishDate":2886,"publishYear":2887,"citationAnalyzeStatus":19,"lastCitationAnalyze":2684,"indexDatabases":2888,"openAccess":20,"references":20,"isForceReanalyzing":532},"c60ef595-5d4a-41bc-80f9-fa039851b4e4","2023-12-17T13:27:16.020+00:00","2026-03-26T13:35:29.367+00:00",[],"Chasing-the-dragon-characterizing-cases-of-leukoencephalopathy-associated-with-heroin-inhalation-in-British-Columbia",{"abstract":2688,"title":2690,"gsPaper":2692,"references":2694,"doi":2696},{"EN":2689},"An association between leukoencephalopathy, a disease of the white matter of the brain, and smoking heroin is well recognized. This paper describes 27 cases of leukoencephalopathy identified in two cities in British Columbia, Canada 2001-2006; the largest number of geographically and temporally defined reported cases in North America. Twenty cases of leukoencephalopathy were identified in and around Vancouver with onset dates December 2001 to July 2003; seven further cases were identified in Victoria September 2005-August 2006. Twenty (74%) of all cases were male, two couples were reported and eleven cases (55%) had Asian ethnicity. One case reported smoking heroin on a single occasion and developed mild symptoms; all other cases were hospitalized. Thirteen (48%) cases died; all had smoked heroin for a minimum of 3 years. Testing of one available heroin sample identified no substance other than common cutting agents. Although a specific etiology was not identified our study supports the theory of an intermittent exposure to a toxic agent added to the heroin or a combustion by-product. It also suggests a dose response effect rather than genetic predisposition. Collaboration with public health, health professionals, law enforcement and persons who use illegal drugs, will facilitate the early identification of cases to enable timely and complete follow-up including obtaining samples. Testing of implicated heroin samples may allow identification of the contaminant and therefore prevent further cases. It is therefore important to ensure key stakeholders are aware of our findings.",{"EN":2691},"Chasing the dragon - characterizing cases of leukoencephalopathy associated with heroin inhalation in British Columbia",{"VOID":2693},"[\"3856677629776070516\"]",{"VOID":2695},"Filley CM, Kleinschmidt-DeMasters BK: Toxic leukoencephalopathy. N Engl J Med. 2001, 345: 425-432. 10.1056\u002FNEJM200108093450606.\nKeogh CF, Andrews GT, Spacey SD, Forkheim KE, Graeb DA: Neuroimaging features of heroin inhalation toxicity: \"chasing the dragon\". AJR Am J Roentgenol. 2003, 180: 847-850.\nKriegstein AR, Armitage BA, Kim PY: Heroin inhalation and progressive spongiform leukoencephalopathy. N Engl J Med. 1997, 336: 589-590. 10.1056\u002FNEJM199702203360818.\nTan TP, Algra PR, Valk J, Wolters EC: Toxic leukoencephalopathy after inhalation of poisoned heroin: MR findings. AJNR Am J Neuroradiol. 1994, 15: 175-178.\nWeber W, Henkes H, Moller P, Bade K, Kuhne D: Toxic spongiform leucoencephalopathy after inhaling heroin vapour. Eur Radiol. 1998, 8: 749-755. 10.1007\u002Fs003300050467.\nWolters EC: \"Heroin\" leukoencephalopathy. Ned Tijdschr Geneeskd. 1982, 126: 111-112.\nChen CY, Lee KW, Lee CC, Chin SC, Chung HW, Zimmerman RA: Heroin-induced spongiform leukoencephalopathy: value of diffusion MR imaging. J Comput Assist Tomogr. 2000, 24: 735-737. 10.1097\u002F00004728-200009000-00013.\nChang YJ, Tsai CH, Chen CJ: Leukoencephalopathy after inhalation of heroin vapor. J Formos Med Assoc. 1997, 96: 758-760.\nAu-Yeung K, Lai C: Toxic leucoencephalopathy after heroin inhalation. Australas Radiol. 2002, 46: 306-308. 10.1046\u002Fj.1440-1673.2002.01066.x.\nRyan A, Molloy FM, Farrell MA, Hutchinson M: Fatal toxic leukoencephalopathy: clinical, radiological, and necropsy findings in two patients. J Neurol Neurosurg Psychiatry. 2005, 76: 1014-1016. 10.1136\u002Fjnnp.2004.047134.\nGacouin A, Lavoue S, Signouret T, Person A, Dinard MD, Shpak N, Thomas R: Reversible spongiform leucoencephalopathy after inhalation of heated heroin. Intensive Care Med. 2003, 29: 1012-1015.\nVella S, Kreis R, Lovblad KO, Steinlin M: Acute leukoencephalopathy after inhalation of a single dose of heroin. Neuropediatrics. 2003, 34: 100-104. 10.1055\u002Fs-2003-39604.\nCelius EG, Andersson S: Leucoencephalopathy after inhalation of heroin: a case report. J Neurol Neurosurg Psychiatry. 1996, 60: 694-695. 10.1136\u002Fjnnp.60.6.694.\nHalloran O, Ifthikharuddin S, Samkoff L: Leukoencephalopathy from \"chasing the dragon\". Neurology. 2005, 64: 1755-10.1212\u002F01.WNL.0000149907.63410.DA.\nLong H, Deore K, Hoffman RS, Nelson LS: A fatal case of spongiform leukoencephalopathy linked to \"chasing the dragon\". J Toxicol Clin Toxicol. 2003, 41: 887-891. 10.1081\u002FCLT-120025358.\nHill MD, Cooper PW, Perry JR: Chasing the dragon--neurological toxicity associated with inhalation of heroin vapour: case report. CMAJ. 2000, 162: 236-238.\nZhou L, Lu BX, Yin J, Luo YF, Wang Q, Liu XJ: [Glucocortioid treatment for heroin-induced spongiform leucoencephalopathy: a clinical controlled study]. Di Yi Jun Yi Da Xue Xue Bao. 2003, 23: 172-174.\nWang Q, Lu BX: Single photon emission computerized tomography of spongiform leukoencephalopathy heroin addicts: analysis of 10 cases. Di Yi Jun Yi Da Xue Xue Bao. 2002, 22: 659-660.\nLu B, Zhou L, Pan S: Clinical and pathological characteristics of heroin spongiform leukoencephalopathy in China. Zhonghua Nei Ke Za Zhi. 2001, 40: 753-756.\nZheng W, Zhang X: Characteristics of spongiform leukoencephalopathy induced by heroin: MRI detection. Chin Med J (Engl). 2001, 114: 1193-1195.\nNeiman J, Haapaniemi HM, Hillbom M: Neurological complications of drug abuse: pathophysiological mechanisms. Eur J Neurol. 2000, 7: 595-606. 10.1046\u002Fj.1468-1331.2000.00045.x.\nBrenneisen R, Hasler F: GC\u002FMS determination of pyrolysis products from diacetylmorphine and adulterants of street heroin samples. J Forensic Sci. 2002, 47: 885-888.\nBrunt TM, Rigter S, Hoek J, Vogels N, van Dijk P, Niesink RJ: An analysis of cocaine powder in the Netherlands: content and health hazards due to adulterants. Addiction. 2009, 104: 798-805. 10.1111\u002Fj.1360-0443.2009.02532.x.\nCoomber R: Dangerous drug adulteration - an international survey of drug dealers using the internet and the world wide web (WWW). International Journal of Drug Policy. 1997, 8: 18-28.\nUnited Nations Office on Drugs and Crime. World Drug Report 2009. 2009, Vienna Austria, http:\u002F\u002Fwww.unodc.org\u002Funodc\u002Fen\u002Fdata-and-analysis\u002FWDR-2009.html\nBuxton JA: Vancouver drug use epidemiology. Site Report for the Canadian Community Epidemiology Network on Drug Use. Vancouver. 2005, http:\u002F\u002Fvancouver.ca\u002Ffourpillars\u002Fpdf\u002Freport_vancouver_2005.pdf\nHuizer H: Analytical studies on illicit heroin. V. Efficacy of volatilization during heroin smoking. Pharm Weekbl Sci. 1987, 9: 203-211.\nGriffiths P, Gossop M, Strang J: Chasing the dragon: the development of heroin smoking in the United Kingdom. Heroin Addiction and Drug Policy: The British System. 1997, Oxford: Oxford Universtiy Press\nGossop M, Griffiths P, Strang J: Chasing the dragon: characteristics of heroin chasers. Br J Addict. 1988, 83: 1159-1162. 10.1111\u002Fj.1360-0443.1988.tb03022.x.\nRizzuto N, Morbin M, Ferrari S, Cavallaro T, Sparaco M, Boso G, Gaetti L: Delayed spongiform leukoencephalopathy after heroin abuse. Acta Neuropathol. 1997, 94: 87-90. 10.1007\u002Fs004010050676.\nBarnett MH, Miller LA, Reddel SW, Davies L: Reversible delayed leukoencephalopathy following intravenous heroin overdose. J Clin Neurosci. 2001, 8: 165-167. 10.1054\u002Fjocn.2000.0769.\nMaschke M, Fehlings T, Kastrup O, Wilhelm HW, Leonhardt G: Toxic leukoencephalopathy after intravenous consumption of heroin and cocaine with unexpected clinical recovery. J Neurol. 1999, 246: 850-851. 10.1007\u002Fs004150050469.\nPerez ER, Maeder P, Riovier L, Deonna T: Toxic leukoencephalopathy after heroin ingestion in a 2.5 year old child [letter]. Lancet. 1992, 340: 729-\nKriegstein AR, Shungu DC, Millar WS, Armitage BA, Brust JC, Chillrud S, Goldman J, Lynch T: Leukoencephalopathy and raised brain lactate from heroin vapor inhalation (\"chasing the dragon\"). Neurology. 1999, 53: 1765-1773.",{"VOID":2697},"10.1186\u002F1477-7517-8-3","2024-05-14T08:53:06.778+00:00","http:\u002F\u002Fharmreductionjournal.biomedcentral.com\u002Farticles\u002F10.1186\u002F1477-7517-8-3",[2701,2726,2748,2761,2783,2803,2816],{"id":2702,"sortIndex":21,"researcher":20,"roles":2703,"affiliations":2704,"properties":2721,"displayName":2723,"givenName":20,"familyName":20},"4168769a-71d6-4312-a083-c094d11632ff",[856],[2705,2713],{"id":2706,"sortIndex":21,"affiliation":2707,"properties":20},"dae6cf61-a21c-44db-9f89-8efa84b7a93d",{"id":2706,"createTime":20,"updateTime":20,"relativeEntities":2708,"slug":20,"properties":2709,"entityType":20,"verifyStatus":20,"verifyTime":20,"verifyNote":20,"languages":20,"translateLanguages":20,"viewCount":20,"url":20,"parentIds":2712,"statistic":20},[],{"title":2710},{"VI":2711},"Epidemiology Services, British Columbia Centre for Disease Control, Vancouver, 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