Substance use & misuse
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Substance use & misuse · Jan 2011
Access to sterile syringes for injecting drug users in New York City: politics and perception (1984-2010).
In the United States, political and social environments have shaped public health response to injecting drug use, and New York City represents a salient example. The history of "harm reduction" in New York City is characterized within changing historical periods and in relation to the actions of stakeholders. The expansion is traced over four periods: (i) 1984-1989: emergence, activism, and science; (ii) 1990-1994 reckoning: syringe exchange legislation and consolidation; (iii) 1995-1999: bureaucratization, opposition, and challenges to institutional control; and (iv) 2000-2010 revitalization: expansion of syringe access and harm reduction. ⋯ Without this "push," it is unlikely that New York City would have experienced the dramatic decline in HIV infection among drug injectors in the 1990s. Second, successful arguments for expanding syringe access in New York City were based on the high HIV/AIDS infection rates. Thus, program developments were advocated as HIV prevention interventions, rather than as expanded services for addressing broader health and social issues of injecting drug use.
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Substance use & misuse · Jan 2011
Randomized Controlled TrialSwitching from methadone to diamorphine: 2-year results of the german heroin-assisted treatment trial.
Several international clinical studies have found diamorphine treatment for opioid-dependent patients to show significantly better effects compared with methadone maintenance treatment. ⋯ The results of the course of methadone-diamorphine switchers are a methodologically independent contribution toward confirming the positive effects of diamorphine treatment for difficult-to-treat opioid-dependent patients. This study supports the hypothesis that changing from optimized methadone treatment under the conditions of the clinical trial to diamorphine treatment is associated with improvements in health and drug use behavior. The study's limitations are noted.