Background: The opioid crisis is a significant public health issue in Canada, with prairie provinces like Saskatchewan facing high levels of opioid-related harm. Factors driving this crisis include a volatile drug supply, limited access to harm reduction services, and systemic challenges like poverty and housing instability. The increasing prevalence of fentanyl has further exacerbated overdose risks for individuals who use drugs. Harm reduction initiatives such as opioid overdose education and naloxone distribution programs have demonstrated efficacy in reducing overdose fatalities and improving community health. Geospatial analysis is increasingly being used to target harm reduction efforts by mapping high-need areas, but its application into harm reduction strategies remains underexplored.

Methods: This study utilized data from 44 participants who completed pop-up naloxone trainings in Regina, Saskatchewan, between August 2023 and September 2024. Data sources include geospatial information on discarded needle locations from ReportNeedles.ca and survey responses using a modified Opioid Overdose Knowledge Scale. Naloxone trainings targeted areas with high needle counts. Geospatial analyses used ArcGIS to map needle prevalence and assess harm reduction service accessibility based on walk-time buffers..

Results: Between August 2023 and August 2024, 315 reports of discarded needles were made on ReportNeedles.ca leading to the disposal of 2,836 needles. Geospatial analysis revealed clustering of discarded needles in Regina's city center, with some seasonal variation. Pop-up trainings expanded the accessibility of naloxone services, with 70% of participants reporting living within a 15-minute walk to pop-up Naloxone trainings. However, geospatial analysis revealed gaps in service accessibility specifically in suburban areas. After trainings participants demonstrated strong knowledge of overdose recognition and naloxone administration.

Conclusions: This study demonstrates promise to the integration of geospatial analysis with harm reduction interventions to address the opioid crisis. By identifying needle prevalence hotspots having pop-up naloxone training can improve service accessibility.

Background: High coverage prison-based harm reduction services, including needle and syringe programs, are needed to prevent transmission of HIV and hepatitis C virus (HCV). Canada launched a Prison Needle Exchange Program (PNEP) in nine federal prisons in 2018; however, uptake among people who inject drugs in prison remains low. We aimed to explore barriers and facilitators to improving PNEP uptake among key carceral stakeholder groups.

Methods: Participants from nine federal prisons with PNEP completed focus groups using nominal group technique, a rapid mixed-method consensus strategy. Responses were generated, rank-ordered, and prioritized by each stakeholder group (correctional officers, healthcare workers, and people in prison). We identified the highest-ranking responses (>10% of the overall votes per stakeholder group) to questions about barriers and solutions to PNEP uptake and described them using the six levels of the Socio-Ecological Model: individual, peers, healthcare workers, correctional officers, prison leadership, and structural.

Results: Between September 2023 and February 2024, 34 focus groups were conducted with 215 participants (n=51 correctional officers; 67 healthcare workers; n=97 people in prison). The top three barriers were lack of confidentiality/privacy (all levels), fear of being targeted (individual), and fear of repercussion from drug use (individual). The top three solutions were the provision of education (all levels), supervised/safe injection sites (structural), and external program delivery, including by peers (structural). While there was significant overlap in identified barriers and solutions between stakeholder groups, important differences in ranking emerged.

Conclusion: Several multi-level modifiable barriers to improving PNEP uptake in Canadian federal prisons were shared among all key stakeholders. Structural changes to PNEP delivery including supervised/safe injecting sites and a peer-led program were proposed as solution-driven enablers to increasing PNEP uptake among people who inject drugs in prison. These data will inform Canadian efforts to expand PNEP provision and contribute to Canada’s HIV/HCV elimination efforts.

Background:
North America is experiencing an overdose crisis which is disproportionately affecting structurally vulnerable people living with HIV (PLHIV) who use drugs. In response, innovative programs providing prescribed “safer supply” medications (e.g., diacetylmorphine, tablet hydromorphone) as alternatives to the unregulated drug supply have been established to reduce overdose risk. Program models vary, with some involving coordinated daily dispensed or witnessed consumption of safer supply and other medications (e.g., antiretroviral therapy; ART), positioning them to support the management of HIV care. We explored how engagement with safer supply interventions influence the management of HIV and other comorbid conditions.

Methods:
We conducted baseline, semi-structured interviews from April-November 2023 with 53 PLHIV who were receiving safer supply medications. One-year follow-up interview were conducted with 36 participants in 2024. Using a team-based approach, data were analysed thematically to identify experiences and impacts of receiving safer supply medications on HIV and other healthcare.

Results:
Most participants received daily coordinated dispensing (home delivery or program-based witnessed consumption) of ART with safer supply. Thirty-two participants were receiving tablet hydromorphone, thirteen a fentanyl formulation (powder, transdermal, or sublingual fentanyl), and eight diacetylmorphine. Positive impacts of receiving safer supply included: reduced unregulated drug use, financial improvements, and positive impacts to health and wellbeing. While some participants described daily dispensing, and especially witnessed consumption, as onerous and stigmatizing, coordinated dispensing facilitated HIV treatment adherence and supported efforts to reduce overdose risk.

Conclusions:
Our study demonstrates how innovations in harm reduction and drug treatment can potentially enhance HIV treatment and care. Integrating safer supply and HIV care has significant potential to impact treatment engagement and the management of other health concerns including overdose risk, and improve the lives of PLHIV who use drugs.

Background: There is an important intersection between pain and substance use in people with HIV (PWH). While cocaine use and cocaine and alcohol co-use are prevalent in this population, the effects of cocaine use on pain in PWH are unknown, as are the effects of cocaethylene, the by-product of cocaine and alcohol co-use.
Objective: In this study, we aimed to investigate the impact of cocaine use and co-use of cocaine and alcohol on pain among PWH.
Methods: We completed a secondary analysis of data from the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) study, a longitudinal cohort study including PWH who use substances. The primary outcome was self-reported pain interference, defined as the extent to which pain impairs daily activities. Primary exposures were self-reported (a) cocaine use in the past 30 days, and (b) unhealthy alcohol use in the past 14 days. Adjusted generalized Estimating Equation (GEE) ordinal logistic regression models were employed.

Results: Among 251 participants, 22.3% reported unhealthy alcohol use only, 11.1% reported cocaine use only, and 13.2% reported use of both. More than half the sample (55.4%) reported some degree of pain interference in the last seven days. In adjusted regression models, greater pain interference was associated with cocaine use alone (aOR 1.73, 95% confidence interval [CI] 1.15-2.60) but not with unhealthy alcohol use alone. Participants reporting both cocaine and unhealthy alcohol use had greater pain interference than participants reporting neither (aOR: 2.27, 95%CI: 1.35-3.79).

Conclusions: Pain interference was common among this sample of PWH who use substances. Greater pain interference was associated with cocaine use, and with cocaine and unhealthy alcohol use, but not with unhealthy alcohol use alone. Cocaine may worsen pain interference or PWH may use cocaine for pain interference.

Background: Understanding the risks and long-term health impacts of overdose among People Living with HIV (PLWH) is critical, as this population faces compounded vulnerabilities. Additionally, women who use drugs (WWUD) experience disproportionately high risks of overdose driven by socio-structural factors (e.g., gender norms, drug policies, criminalization, stigma, and gender-based violence). This study explored the risks and health outcomes of overdose among PLWH and those without HIV in Vancouver, British Columbia, during COVID-19, with a particular focus on the experiences of WWUD and Women Living with HIV (WLWH).

Approach: We conducted semi-structured focus groups and one-on-one interviews with 74 people who use drugs (PWUD), including 38 (51.4%) PLWH, and 19 healthcare providers representing diverse professional backgrounds. This analysis focuses on three focus groups that were exclusive to people who identified as women and gender-diverse (n=18, 24%). Participants were recruited from organizations and care centers in Vancouver supporting PLWH and PWUD. Based on community consultation, we omitted demographic data collection, making participant gender breakdown indeterminate. Sessions were audio-recorded, transcribed verbatim, and analyzed using NVivo 14.0.

Findings: Themes of feeling unsafe and anxious were pervasive in the women-only focus groups. Pandemic-related public health guidance to self-isolate intensified overdose risks, as women often already used drugs in isolation to avoid violence and predation. Participants emphasized the critical need for women-only spaces, such as change rooms, showers, housing, clinics, and a standalone women’s AIDS organization. They also expressed the need for more advocates and outreach workers to assist with securing housing, and access to skills training to improve employment opportunities.

Conclusion: Despite wide-spread recognition of the unique risk environment WWUD navigate, significant service gaps persist, further increasing overdose risks among this population. These findings highlight the urgent need for gender-specific and trauma-informed policies and services, as well as dedicated safer spaces for WWUD, including WLWH.