Peer Support and Overdose Prevention Responses: A Systematic 'State-of-the-Art' Review.

Overdose prevention for people who use illicit drugs is essential during the current overdose crisis. Peer support is a process whereby individuals with lived or living experience of a particular phenomenon provide support to others by explicitly drawing on these experiences. This review provides a systematic search and evidence synthesis of peer support within overdose prevention interventions for people who use illicit drugs. A systematic search of six databases (CINAHL, SocINDEX, PsycINFO, MEDLINE, Scopus, and Web of Knowledge) was conducted in November 2020 for papers published in English between 2000 and 2020. Following screening and full-text review, 46 papers met criteria and were included in this review. A thematic analysis approach was used to synthesize themes. Important findings include: the value of peers in creating trusted services; the diversity of peers' roles; the implications of barriers on peer-involved overdose prevention interventions; and the stress and trauma experienced by peers. Peers play a pivotal role in overdose prevention interventions for people who use illicit drugs and are essential to the acceptability and feasibility of such services. However, peers face considerable challenges within their roles, including trauma and burnout. Future interventions must consider how to support and strengthen peer roles in overdose settings.

What treatment and services are effective for people who are homeless and use drugs? A systematic 'review of reviews'.

BACKGROUND: People who experience homelessness and those vulnerably housed experience disproportionately high rates of drug use and associated harms, yet barriers to services and support are common. We undertook a systematic 'review of reviews' to investigate the effects of interventions for this population on substance use, housing, and related outcomes, as well as on treatment engagement, retention and successful completion. METHODS AND FINDINGS: We searched ten electronic databases from inception to October 2020 for reviews and syntheses, conducted a grey literature search, and hand searched reference lists of included studies. We selected reviews that synthesised evidence on any type of treatment or intervention that reported substance use outcomes for people who reported being homeless. We appraised the quality of included reviews using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and the Scale for the Assessment of Narrative Review Articles. Our search identified 843 citations, and 25 reviews met the inclusion criteria. Regarding substance use outcomes, there was evidence that harm reduction approaches lead to decreases in drug-related risk behaviour and fatal overdoses, and reduce mortality, morbidity, and substance use. Case management interventions were significantly better than treatment as usual in reducing substance use among people who are homeless. The evidence indicates that Housing First does not lead to significant changes in substance use. Evidence regarding housing and other outcomes is mixed. CONCLUSIONS: People who are homeless and use drugs experience many barriers to accessing healthcare and treatment. Evidence regarding interventions designed specifically for this population is limited, but harm reduction and case management approaches can lead to improvements in substance use outcomes, whilst some housing interventions improve housing outcomes and may provide more stability. More research is needed regarding optimal treatment length as well as qualitative insights from people experiencing or at risk of homelessness.

Provision of peer support at the intersection of homelessness and problem substance use services: a systematic 'state of the art' review.

BACKGROUND: Peer support refers to a process whereby individuals with lived experience of a particular phenomenon provide support to others by explicitly drawing on their personal experience. It has been adopted in a variety of service contexts including homelessness, substance use, mental and physical health. Those who experience homelessness have some of the most complex intersecting health and social challenges. This 'state of the art' review provides a systematic search and synthesis of literature examining use of peer support models within services for people impacted by homelessness and problem substance use. METHODS: A systematic search using six databases (CINAHL, SocINDEX, PsycINFO, MEDLINE, Scopus and Web of Knowledge) was conducted in August 2019 and identified 2248 papers published in English after the year 2000. After de-duplication and scanning titles/abstracts, 61 papers were deemed relevant. Three more papers (including one grey literature report) were identified via references, but two papers were later excluded due to relevance. The final 62 papers included studies conducted in five countries. A thematic analysis approach was used to compare and contrast the study findings and provide a synthesis of the main learning points. RESULTS: In recent years there has been a substantial increase in research examining the utility of peer support yet there is significant variation across this field. Alongside profiling the range of settings, aims, populations, and main outcomes of these studies, this paper also provides an overview of overarching themes: the overall effectiveness and impact of peer-staffed or peer-led interventions; and challenges commonly faced in these roles. Five themes relating to the challenges faced by peers were identified: vulnerability, authenticity, boundaries, stigma, and lack of recognition. CONCLUSIONS: While our findings provide support for current efforts to involve individuals with lived experience in providing peer support to those experiencing concurrent problem substance use and homelessness, they also urge caution because of common pitfalls that can leave those providing the support vulnerable. We conclude that peers should be respected, valued, supported, and compensated for their work which is often profoundly challenging. Suggested guidelines for the implementation of peer involvement in research studies and service delivery are presented.

The Value of Providing Smokers with Free E-Cigarettes: Smoking Reduction and Cessation Associated with the Three-Month Provision to Smokers of a Refillable Tank-Style E-Cigarette.

Despite the uptake of tobacco smoking declining in the United Kingdom (UK), smoking is still the leading cause of preventable poor health and premature death. While improved approaches to smoking cessation are necessary, encouraging and assisting smokers to switch by using substantially less toxic non-tobacco nicotine products may be a possible option. To date, few studies have investigated the rates of smoking cessation and smoking reduction that are associated with the provision of free electronic-cigarettes (e-cigarettes) to smokers. In this exploratory study, the Blu Pro e-cigarette was given to a convenience sample of adult smokers (n = 72) to assist them in reducing and quitting over a 90-day period. The rates of smoking abstinence and daily smoking patterns were assessed at baseline, 30 days, 60 days, and 90 days. The response rate was 87%. After 90 days, the complete abstinence rate was 36.5%, up from 0% at baseline. The frequency of daily smoking reduced from 88.7% to 17.5% (p < 0.001), and the median consumption of cigarettes/day reduced from 15 to five (p < 0.001). The median number of days per month that participants smoked also reduced from 30 to 13 after 90 days (p < 0.001). On the basis of these results, there may be value in smoking cessation services and other services ensuring that smokers are provided with e-cigarettes at zero or minimal costs for at least a short period of time.

Resolution of chronic nasal Staphylococcus aureus infection in a non-smoker who started to use glycerine based e-cigarettes: Antibacterial effects of vaping?

BACKGROUND: Smokers who switch to vaping report a decrease in respiratory infections. A previous case report of a non-smoker who started to vape and experienced a resolution of chronic tonsillitis proposed that this could be due to bactericidal effects of propylene glycol. Here were report a similar case where a resolution of chronic nasal infection was associated with using glycerol-based nicotine vaporiser. CASE PRESENTATION: A never-smoker adopted an e-cigarette that his wife was using and after a few weeks of vaping liquids containing vegetable glycerine with low levels of nicotine (3 mg/ml) experienced a complete resolution of chronic nasal Staphylococcus aureus infections. CONCLUSIONS: The improvements cannot be attributed to smoking cessation or bactericidal effects of propylene glycol. The effect could be a coincidence, but it could also be related to bacteriostatic properties of glycerol, or to antimicrobial properties of nicotine and/or the zinc (II) complex of nicotine. Assessments of effects of e-cigarettes with different humectants and nicotine levels in patients with recurrent bacterial respiratory infections could clarify this issue and possibly generate new treatments.

What Proportion of People Who Try One Cigarette Become Daily Smokers? A Meta-Analysis of Representative Surveys.

Introduction: The "conversion rate" from initial experimentation to daily smoking is a potentially important metric of smoking behavior, but estimates of it based on current representative data are lacking. Methods: The Global Health Data Exchange was searched for representative surveys conducted in English speaking, developed countries after the year 2000 that included questions about ever trying a cigarette and ever smoking daily. The initial search identified 2776 surveys that were further screened for language, location, year, sample size, survey structure, and representativeness. Forty-four surveys that passed the screening process were accessed, and their codebooks were examined to see whether the two questions of interest were included. Eight datasets allowed extraction or estimation of relevant information. Survey quality was assessed with regards to response rates, sampling methods, and data collection procedures. PRISMA guidelines were followed, with explicit rules for approaching derived variables and skip patterns. Proportions were pooled using random effects meta-analysis. Results: The eight surveys used representative samples of the general adult population. Response rates varied from 45% to 88%. Survey methods were on par with the best practice in this field. Altogether, 216314 respondents were included of whom 60.3% (95% CI = 51.3 to 69.3) ever tried a cigarette. Among them, 68.9% (95% CI = 60.9 to 76.9%) progressed to daily smoking. Conclusions: Over two-thirds of people who try one cigarette become, at least temporarily, daily smokers. The finding provides strong support for the current efforts to reduce cigarette experimentation among adolescents. Implications: The transition from trying the first cigarette through occasional to daily smoking usually implies that a recreational activity is turning into a compulsive need that has to be satisfied virtually continuously. The "conversion rate" from initial experimentation to daily smoking is thus a potentially important metric of smoking behavior, but estimates of it based on representative data are lacking. The present meta-analysis addressed this gap. Currently, about two-thirds of nonsmokers experimenting with cigarettes progress to daily smoking. The finding supports strongly the current efforts to reduce cigarette experimentation among adolescents.

The Effect of Prefrontal Transcranial Direct Current Stimulation on Attention Network Function in Healthy Volunteers.

OBJECTIVES: The effect of acute transcranial direct current stimulation (tDCS) on cortical attention networks remains unclear. We examined the effect of 20 min of 2 mA dorsolateral prefrontal cortex tDCS (bipolar balanced montage) on the efficiency of alerting, orienting and executive attention networks measured by the attention network test. MATERIALS AND METHODS: A between-subjects stratified randomized design compared active tDCS vs. sham tDCS on attention network function in healthy young adults. RESULTS: Executive attention was greater following active vs. sham stimulation (d = 0.76) in the absence of effects on alerting, orienting, or global RT or error rates. Group differences were not moderated by state-mood. CONCLUSION(S): Twenty minutes of active 2 mA tDCS over left DLPFC is associated with greater executive attention in healthy humans.

Resolution of recurrent tonsillitis in a non-smoker who became a vaper. A case study and new hypothesis.

BACKGROUND: Evidence concerning the impact of vaping on respiratory infections remains contradictory. Cell and animal studies suggested that vaping may increase vulnerability to respiratory infections, but human data do not confirm this concern. CASE PRESENTATION: We present a case of a never-smoker who became a vaper and after a few months of e-cigarette use experienced a complete resolution of chronic tonsillitis and a marked improvement in tonsilloliths. CONCLUSIONS: As this is a never-smoker, the improvements cannot be attributed to smoking cessation. One possible explanation is that the improvement was due to antimicrobial properties of propylene glycol. The hypothesis could be tested by a trial of zero-nicotine e-cigarettes in patients with recurrent bacterial throat infection.