Young, Black/African American, and Latino communities are left behind despite legislative efforts in California to reduce HIV/STI disparities

ObjectivesSexually transmitted infections (STI) have been on the rise in the United States with racial/ethnic minority groups, gay and bisexual men, and youth experiencing the highest STI and HIV infection rates. In 2022, California became the first state in the nation to pass legislation, Senate Bill 306 (SB 306), requiring health care plans to cover the costs of home test kits for STIs, including HIV. This study examines provisions within SB 306 and its potential to reduce STI and HIV disparities among key demographic groups and geographic regions within California.Study designEcological cross-sectional study involving 58 California counties.MethodsDescriptive statistics and choropleth maps compared HIV/STI prevalence rates, uninsured rates, demographic composition, and healthcare provider coverage across California counties. Three geographically weighted Poisson regression analyses were conducted to separately examine the association between proportion of uninsured and HIV, gonorrhea, and chlamydia prevalence rates.ResultsHIV/STI rates were significantly and positively associated with the proportion of uninsured residents in Central and Southern California counties. These counties had a higher proportion of demographic groups vulnerable to HIV/STI including a large Latino, Black/African American, and younger (age 15–24) population but had a lower rate of healthcare providers with prescription authority for home testing kits, which is a requirement under SB 306.ConclusionsCutting-edge solutions are needed to stem the rising tide of new STI and HIV infections. While SB 306 is novel and innovative in intent, its coverage gaps will increase disparities and inequities among historically underserved populations

What’s in Toronto’s drug supply? Results from samples checked by Toronto’s drug checking service October 10, 2019 - March 31, 2020.

On 22 August 2018 amendments to the Northern Territory Liquor Act 1978 (the Act) were passed in the NT Legislative Assembly, introducing a minimum alcohol unit price MUP, commonly referred to as a minimum floor price. On 1 October 2018 the MUP was set at $1.30 per standard drink contained in the alcohol product, where the meaning of 'a standard drink is the volume of a liquor product that contains 10g of ethyl alcohol when measured at 20°C'. The legislative amendment prohibits selling alcohol below the price of$1.30 per standard drink (as compared to the $1.50 recommended by the Riley Review), and imposes the minimum price as an automatic condition of a liquor licence

Securing Safe Supply During COVID-19 and Beyond: Scoping Review and Knowledge Mobilization

Background Safe supply is defined as the legal and regulated provision of drugs with mind and/or body altering properties that have been typically accessible only through the illegal drug market. In response to the coronavirus disease 2019 (COVID-19) pandemic and related social/physical distancing measures, efforts have been made to scale up and increase access to safe supply programs in an effort to reduce overdose and other drug- and drug policy-related risks. However, it remains unclear whether these efforts taken thus far have meaningfully mitigated the barriers to safe supply experienced by People Who Use Drugs (PWUD), both during and beyond the context of COVID-19. We thus undertook a scoping review to identify key concepts, strategies and gaps in evidence with respect to the provision of safe supply during pandemics and other emergencies. Methods We conducted three searches across Scopus, Medline, Embase, CINAHL, and The Cochrane Central Register of Controlled Trials (CENTRAL) for peer-reviewed and grey literature articles to understand barriers/facilitators to both accessing and prescribing legal, pharmaceutical-grade drugs, including opioids, benzodiazepines, and/or stimulants during public health emergencies from January 1 2002 to June 30 2020. We also included opioid agonist therapies (OAT) during emergency conditions. All potential sources underwent title/abstract screening and duplicate full- text review to determine eligibility for inclusion. Three reviewers extracted characteristics and barriers/facilitators to accessing or prescribing drugs for each study, and these were then inductively analyzed to identify common themes. Key stakeholders (PWUD, prescribers, and policymakers/regulators) informed the search strategy and validated findings and interpretations. Input from PWUD and prescribers was gathered through Advisory Committee meetings and one-on-one consultations, respectively. Results We screened 9,839 references and included 169 studies (135 peer-reviewed articles and 36 grey literature reports). From 119 articles, we identified 35 themes related to barriers/facilitators to prescribing safe supply or OAT. Few studies (n=24) focused on emergency or pandemic contexts. Among the most frequently reported barriers were restrictive laws or policies (n= 33; 28%). The most frequently cited facilitator was temporary legal or regulatory exemptions (n= 16; 13%). Further stakeholder consultation identified barriers/facilitators to safe supply absent in the reviewed literature: PWUD reported barriers including lack of access to desired substances, concerns about child apprehension, and a lack of cultural competency within safe supply/OAT programs; prescribers reported barriers including regional differences in service delivery, colleague support, and a lack of, or disagreement between, clinical guidance documents. Conclusion We identified multiple barriers and facilitators to accessing and/or prescribing safe supply or OAT. With few peer-reviewed studies on safe supply models, particularly in the context of emergencies, input from PWUD and other stakeholders offered crucial insights not reflected in the existing literature. To address the overdose epidemic stemming from the criminalization of an unregulated drug supply, prescribers, regulators, and public health authorities should focus on scaling up, and then evaluating, diverse safe supply frameworks that address the facilitators and barriers we have identified

Heroin Prescription, HIV, and Drug Policy: Emerging Regulatory Frameworks

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Injection career trajectories among illicit drug users in Vancouver, Canada

Background: Though vast resources have been allocated toward the prevention of illicit drug use, the prevalence of injection drug use remains high globally. This thesis therefore sought to identify factors that influence the natural history of injection drug use by: systematically reviewing the epidemiologic literature on the prevention of injecting initiation; identifying the role of drug-related and personality-based risk factors in increasing the risk of injecting initiation; and evaluating the role of harm reduction interventions in potentially modifying the likelihood of injecting cessation among injection drug users (IDU). Methods: Street-involved youth and IDU participating in ongoing prospective observational cohorts in Vancouver, Canada, completed semi-annual interviewer-administered questionnaires. Longitudinal epidemiologic methods were applied to assess the association between selected drug-related, personality-based (e.g., sensation seeking level), and structural factors on the outcomes of interest, while controlling for a variety of potential sociodemographic and behavioural confounders. Results: The systematic review found that a limited set of interventions to prevent injecting has been scientifically evaluated and implemented. A longitudinal analysis of injecting initiation found that non-injection crystal methamphetamine use was significantly associated with injecting initiation among street-involved youth. The adaptation of a sensation seeking scale for use in a related longitudinal analysis found that higher sensation seeking was associated with injecting and risk factors for injection initiation. Finally, in a longitudinal analysis conducted over a span of 15 years, rates of injecting cessation among a cohort of IDU increased significantly despite a substantial expansion in needle and syringe program (NSP) implementation. Conclusions: This thesis identified gaps in current responses to preventing injection drug use. A set of drug-related and personality-based factors associated with increased risk of injecting initiation among street-involved youth was also identified, including non-injection crystal methamphetamine use and higher sensation seeking. Further, an increase in the rate of injecting cessation among IDU occurred during a period of substantial expansion of NSP sites in Vancouver. These results suggest that resources should be allocated towards the development of interventions to prevent injection initiation, and that harm reduction interventions should be considered complementary to broader efforts to reduce both injection drug use and related harms.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Commentary on Vorobjov et al., "Comparison of injection drug users who obtain syringes from pharmacies and syringe exchange programs in Tallinn, Estonia"

Recent data suggest that globally, between 5% and 10% of all new HIV cases are the result of unsafe injecting practices, and experts agree that reducing these practices is key to tackling the spread of HIV. And yet, despite the overwhelming evidence that providing sterile syringes to injection drug users (IDU) through syringe exchange programs (SEPs) or other means is an effective way of reducing HIV transmission among high-risk subpopulations, IDU in most settings still do not have access to sterile injecting equipment or if they do, access remains too restricted to effectively reduce the risk of HIV transmission. Vorobjov and colleagues have presented in this journal an interesting and timely study from Estonia comparing individuals who obtain syringes from SEPs and those who obtain syringes from pharmacies. As the authors point out, Estonia faces an unacceptably high HIV incidence rate of 50 new HIV cases per 100,000, this rate driven primarily by injection drug use. As such, the authors argue that Estonia's SEP network does not have the capacity to serve a growing IDU population at risk of transmitting HIV and pharmacy dispensation of clean syringes may be one potential approach to decreasing syringe sharing among high-risk injectors. It may be overly optimistic to consider the impact of higher threshold interventions such as pharmacy-based SEPs, given that IDU populations that engage in HIV risk behaviours such as syringe sharing are often hidden or hard to reach. Despite the need for a cautious approach, however, the findings presented by Vorobjov et al. may chart one potential course towards a more comprehensive societal response to reducing the health harms associated with injection drug use.Population and Public Health (SPPH), School ofNon UBCMedicine, Faculty ofReviewedFacult