Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation.

BACKGROUND: Within North America and worldwide, drug related overdoses have increased dramatically over the past decade. COVID-19 escalated the need for a safer supply to replace unregulated substances and to reduce toxicity and overdoses. Service providers play an integral role in the delivery of safer supply but there is little empirical evidence that conceptualizes effective safer supply from their perspectives. This study explored early implementation and impacts of a safer supply program, capturing the perspectives of an interdisciplinary team of service providers on tensions and issues encountered in the development of the SAFER program. METHODS: Using a community-based participatory approach, we conducted individual interviews with program providers (n = 9). The research team was composed of researchers from a local drug user organization, a local harm reduction organization, and academic researchers. The Consolidated Framework for Implementation Research (CFIR) informed the interview guide. Data was analyzed using thematic analysis. RESULTS: There are six themes describing early implementation: (1) risk mitigation prescribing as context for early implementation; (2) developing SAFER specific clinical protocols; (3) accessibility challenges and program innovations; (4) interdisciplinary team and wraparound care; (5) program tensions between addiction medicine and harm reduction; (6) the successes of safer supply and future visions. CONCLUSION: Early implementation issues and tensions included prescriber concerns about safer supply prescribing in a highly politicized environment, accessibility challenges for service users such as stigma, encampment displacement, OAT requirements, program capacity and costs, and tensions between addiction medicine and harm reduction. Navigating these tensions included development of clinical protocols, innovations to reduce accessibility challenges such as outreach, wraparound care, program coverage of medication costs and prescribing safer supply with/without OAT. These findings contribute important insights for the development of prescribed safer supply programs.

Interrupting the social processes linked with initiation of injection drug use: results from a pilot study.

BACKGROUND: Injection drug use is a skill learned in social settings. Change the Cycle (CTC), a peer-delivered, one-session intervention, is designed to reduce among people who inject drugs (PIDs) injection initiation-related behaviours (i.e., speaking positively about injecting to non-injectors, injecting in front of non-injectors, explaining or showing a non-injector how to inject) and initiation of non-injectors. We hypothesized that participation in CTC would lead to reductions in initiation-related behaviours six months later. METHODS: Using respondent driven sampling (RDS), 98 PIDs were recruited in Toronto, Canada to participate in pilot testing of CTC. The baseline session consisted of a structured interview, the peer-delivered CTC intervention, instructions regarding RDS coupon distribution, and an invitation to return in six months for a follow-up interview. For the 84 PIDs completing the six-month interview, we compared initiation-related behaviours at baseline with six-month follow-up. RESULTS: The proportion of PIDs offering to initiate a non-injector was reduced from 8.4% (95% CI: 2.5, 15.9) at baseline to 1.59% (95% CI: 0.4, 3.7) at 6-month follow-up. The prevalence of speaking positively about injection to non-injectors also decreased significantly. The proportion of PIDs who helped a non-injector with a first injection at baseline was 6.2% (95% CI: 2.1, 11.3) and at follow-up was 3.5% (95% CI: 0.8, 7.1). Paired analyses of initiator baseline versus follow-up data showed a 72.7% reduction in initiation (95%CI: 47.7, 83.1). CONCLUSIONS: While further refinements remain to be tested, pilot study results suggest that CTC holds promise as a prevention intervention.

[Structural basis for the regulation of the neuronal sensitivity]. / Strukturnye osnovy reguliatsii chuvstvitel'nosti neironov.

Using light and electron microscopy structural bases for intracellular, extracellular and integrative regulation of synaptic efficiency and neuron sensitivity were established in rat sensomotor cortex. Intracellular regulation is realized basically through modulation of postsynaptic components of the synapse, while extracellular one is provided by synaptic endings of "recurrent" axons on GABA-ergic relay and interneurons. Integrative regulation is realized by means of concentration of similar axonal terminals in restricted cortical area and arrangement of "neuromediatory" pool.

Modules of cortical neurons and their "self-assembly".

The data we have by now accumulated on the cytoarchitectonics of the cerebral cortex, as well as published data, suggest that some of the neurons are structurally combined into compact clusters (ensembles, blocks), and that the majority of them participate in the construction of these clusters by directing the terminal branches of their axons to them. The collaterals of projection, associative, and callosal nerve cells, as well as the axons of interneurons which accomplish local interneuronal closures, can combine individual elements of the ensembles into a unified morphofunctional system. The collaterals of the axons of a block of neurons spread divergently to neurons disposed along the perimeter, while the axons of the latter converge reciprocally to the neurons of the cluster, forming a maximum (focus) of the arborization of the axonal terminals there; this makes it possible actively to isolate modules of nerve cells by accomplishing their self-assembly.

[Cortical neuronal modules and their "self-assembly"]. / Moduli korkovykh neironov i ikh "samosborka".

The light and electron-microscopy original data and other morphological and physiological findings reveal that a population of cortical neurones is gathered in compact cell clusters (blocks, ensembles, modules) and most of neurones participate in maintaining such modules by their axonal ramifications. Some elements of cell clusters may be joined by associative, callosal and projectional thalamic afferents. Authors' new findings are discussed in relation with corresponding literature data. The main attention is given to the self-organization of cortical modules.