David Frank

People who use drugs (PWUD) in the U.S. often face barriers to accessing harm reduction, social, and medical services, including fragmented systems and limited access to locally relevant, usable information. A digital harm reduction support tool (DHRST) that identifies clients' needs and matches them to available community resources may help address these barriers. We examined the feasibility and acceptability of a DHRST among PWUD, as well as its potential role in supporting safer practices and improving engagement with services. We recruited a convenience sample of 37 clients from a community-based harm reduction organization to participate in semi-structured interviews. Participants were ≥ 18 years old, English-speaking, and able to provide informed consent. Interviews explored perceptions of the feasibility, acceptability, and potential uses of a DHRST. Data were analyzed using thematic analysis. Four primary themes emerged from our data: (1) participants viewed a DHRST as a valuable tool for navigating fragmented and locally specific information about harm reduction, social, and healthcare services; (2) participants perceived the tool as a means of enhancing safety in an increasingly unpredictable drug supply through access to real-time, peer-generated information and alerts; (3) participants expressed concerns about privacy, surveillance, and the potential unintended consequences of sharing sensitive information; and (4) participants emphasized that feasibility would depend on accessibility, including device access, digital literacy, and the availability of multiple platforms for engagement. Overall, participants expressed strong enthusiasm for the potential value of a DHRST despite concerns regarding implementation and information security. Findings suggest that a DHRST is both acceptable and potentially valuable for supporting harm reduction among PWUD, particularly as a means of improving access to locally relevant information. However, its effectiveness will depend on careful attention to structural constraints, privacy and data governance, and the broader risk environment in which information-sharing occurs. These findings support continued development of DHRSTs while emphasizing the need for user-centered and context-sensitive design.

Despite the growing relevance of rural areas in the overdose crisis, research on rural people who inject drugs and their experiences with law enforcement remains limited. This research examines how rural policing and stigma uniquely shape the lives of people who inject drugs. Forty-one semi-structured qualitative interviews were conducted with people who inject drugs in southern Illinois. For this analysis, we focused on participants who mentioned police in response to the question, "Have you ever been treated differently because you used drugs?" We identified three interrelated manifestations of stigma in rural people who inject drugs' interactions with police-verbal degradation and discrediting, unwarranted searches, and dehumanization-that align with Earnshaw's (2020) model distinguishing between stigma components (stereotypes, prejudice, discrimination) and health impact pathways. This study emphasizes the impact of stigma on people who use drugs, particularly in their interactions with law enforcement.

Methadone maintenance treatment (MMT) is among the best strategies for reducing harms associated with illegal opioid use, yet it is hindered by low rates of treatment initiation and retention that limit its impact. There has been a lack of studies that describe how people who use illegal opioids use methadone-both from opioid treatment programs, and bought illegally-over time, or what factors correlate with long-term participation in MMT. We collected monthly survey data from N = 412 people who use illicit opioids in New York City from April 2019-2022. We used bivariate analyses to estimate the distribution of baseline sociodemographic and background characteristics. Multinomial logistic regression was then used to estimate the association between those characteristics and methadone use over time. Findings show that people who are older, who used heroin for longer amounts of time, and who had multiple episodes of substance use disorder treatment other than medication for opioid use disorder are more likely to use MMT consistently over time. Our findings may be related to the many barriers to long-term participation in MMT, such as travel distance, the need for regular attendance, and patients' dissatisfaction with opioid treatment programs. Consistent participation in MMT may become acceptable only when the difficulties and burdens of criminalized drug use begin to outweigh those of MMT participation, and after non-medication-using treatments have already been tried. Efforts to make MMT less burdensome could reduce the tendency to avoid MMT until later in life and improve people's consistency of participation over time.

Background: In 2021, NYC implemented overdose prevention center (OPC) services at two existing syringe exchange programs, allowing people to use pre-obtained drugs on-site. Although OPCs in Canada, Western Europe, and Australia have demonstrated their feasibility and benefits towards reducing overdose risk and drug-related harm, there is less data on how people who use drugs (PWUD) conceptualize the benefits and any potential drawbacks of using OPCs. Methods: In June–August 2022, we conducted 26 semistructured interviews with people in New York City who used unprescribed opioids. Interviews lasted 30–60 min and were conducted remotely using Zoom and later transcribed by a professional service. Data were then coded, using AtlasTi, into meaningful categories using a thematic approach based on the aims of the study and existing literature. Results: Most participants had heard of OnPoint and reported a willingness to use it. They described the ability of OnPoint staff to reverse an overdose quickly and the presence of naloxone, oxygen, and other supplies as the primary benefits. Yet, many also noted that OPCs provide PWUD with a place to escape from the weather and/or avoid law enforcement. Participants also reported concerns about how far PWUD would be willing to travel or wait to use an OPC and for the autonomy of PWUD in the context of formal, sanctioned OPCs. Conclusions: Results suggest that many PWUD in NYC are well-informed about OnPoint and are willing to use OPCs. Yet, to fulfil their potential, OPCs must be located near to where PWUD live, and should be made as low-threshold as possible. However, since it is unlikely that OPCs will be expanded enough to meet the need and because some PWUD will never choose to use in sanctioned OPCs, expanding the reach of alternative strategies, such as Mobile Overdose Response Services, is recommended.

Background: Access to methadone treatment can reduce opioid overdose death by up to 60%, but US patient outcomes are suboptimal. Federally allowed methadone treatment accommodations during the COVID-19 public health emergency were not widely adopted. It is likely that staff-level characteristics such as trauma symptoms influence the adoption of treatment innovation. Objective: Methadone Patient Access to Collaborative Treatment (MPACT) is a 2-phased project (pilot and field trial) to develop and test a staff-level, multimodal intervention to increase staff adoption of low-barrier, patient-centered methadone treatment practices and ultimately improve treatment retention and patient outcomes. Methods: A pilot and national trial will measure implementation feasibility, acceptability, and effects of the MPACT intervention on treatment practice change, clinic culture, patient retention, and patient posttraumatic stress symptoms (PTSS). The pilot will be a single-arm 5.5-month pilot study of MPACT conducted in 2 Arizona methadone treatment clinics (rural and urban) among 100 patients and 22 staff. The national trial will be a 20-month cluster randomized trial conducted among 30 clinics, 600 patients (20 per clinic), and 480 staff (18 per clinic). Data will be gathered by staff and patient surveys and patient chart review. The primary study outcome is increased patient methadone treatment retention measured as (1) time to first treatment interruption from study enrollment; (2) active in treatment at enrollment, day 30, 60, 90, and 120; and (3) continuous days in treatment during the study period. Secondary study outcomes include reductions in vicarious trauma and PTSS among enrolled opioid treatment program staff and PTSS among enrolled patients. Results: The pilot study was funded by the National Institute on Drug Abuse (award R61DA059889, funded September 2023), and the field trial will be funded under the associated R33 mechanism in September 2025. The pilot study was completed in March 2025. The randomized controlled trial will begin in December 2025. Both the pilot and trial have been approved by the University of Arizona Human Subjects Protection Program and have been registered with the clinical trials network. Conclusions: The MPACT study will provide a foundation for an evidence-based, staff-level intervention aimed at improving patient retention in methadone treatment. Future studies should examine the individual components of MPACT to determine their differential contributions to the primary outcome of patient methadone treatment retention and to secondary outcomes of staff and patient reduction in stress symptoms. Trial Registration: ClinicalTrials.gov NCT06513728; https://clinicaltrials.gov/study/NCT06513728 and ClinicalTrials.gov NCT06556602; https://clinicaltrials.gov/study/NCT06556602 International Registered Report Identifier (IRRID): DERR1-10.2196/69829

BACKGROUND Access to methadone treatment can reduce opioid overdose death by up to 60%, but US patient outcomes are suboptimal. Federally allowed methadone treatment accommodations during the COVID-19 public health emergency were not widely adopted. It is likely that staff-level characteristics such as trauma symptoms influence the adoption of treatment innovation. OBJECTIVE Methadone Patient Access to Collaborative Treatment (MPACT) is a 2-phased project (pilot and field trial) to develop and test a staff-level, multimodal intervention to increase staff adoption of low-barrier, patient-centered methadone treatment practices and ultimately improve treatment retention and patient outcomes. METHODS A pilot and national trial will measure implementation feasibility, acceptability, and effects of the MPACT intervention on treatment practice change, clinic culture, patient retention, and patient posttraumatic stress symptoms (PTSS). The pilot will be a single-arm 5.5-month pilot study of MPACT conducted in 2 Arizona methadone treatment clinics (rural and urban) among 100 patients and 22 staff. The national trial will be a 20-month cluster randomized trial conducted among 30 clinics, 600 patients (20 per clinic), and 480 staff (18 per clinic). Data will be gathered by staff and patient surveys and patient chart review. The primary study outcome is increased patient methadone treatment retention measured as (1) time to first treatment interruption from study enrollment; (2) active in treatment at enrollment, day 30, 60, 90, and 120; and (3) continuous days in treatment during the study period. Secondary study outcomes include reductions in vicarious trauma and PTSS among enrolled opioid treatment program staff and PTSS among enrolled patients. RESULTS The pilot study was funded by the National Institute on Drug Abuse (award R61DA059889, funded September 2023), and the field trial will be funded under the associated R33 mechanism in September 2025. The pilot study was completed in March 2025. The randomized controlled trial will begin in December 2025. Both the pilot and trial have been approved by the University of Arizona Human Subjects Protection Program and have been registered with the clinical trials network. CONCLUSIONS The MPACT study will provide a foundation for an evidence-based, staff-level intervention aimed at improving patient retention in methadone treatment. Future studies should examine the individual components of MPACT to determine their differential contributions to the primary outcome of patient methadone treatment retention and to secondary outcomes of staff and patient reduction in stress symptoms. CLINICALTRIAL ClinicalTrials.gov NCT06513728; https://clinicaltrials.gov/study/NCT06513728 and ClinicalTrials.gov NCT06556602; https://clinicaltrials.gov/study/NCT06556602 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/69829