Substance use and destigmatization: SDG 3 and Me interview with Paige Lemen, PhD candidate

Paige M. Lemen is a PhD candidate at the University of Tennessee Health Science Center, studying the neurobiology and genetics of drug use and substance use disorder (SUD).
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Substance use and destigmatization: SDG 3 and Me interview with Paige Lemen, PhD candidate
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BioMed Central
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High-dose naloxone formulations are not as essential as we thought - Harm Reduction Journal

Naloxone is an effective FDA-approved opioid antagonist for reversing opioid overdoses. Naloxone is available to the public and can be administered through intramuscular (IM), intravenous (IV), and intranasal spray (IN) routes. Our literature review investigates the adequacy of two doses of standard IM or IN naloxone in reversing fentanyl overdoses compared to newer high-dose naloxone formulations. Moreover, our initiative incorporates the experiences of people who use drugs, enabling a more practical and contextually-grounded analysis. The evidence indicates that the vast majority of fentanyl overdoses can be successfully reversed using two standard IM or IN dosages. Exceptions include cases of carfentanil overdose, which necessitates ≥ 3 doses for reversal. Multiple studies documented the risk of precipitated withdrawal using ≥ 2 doses of naloxone, notably including the possibility of recurring overdose symptoms after resuscitation, contingent upon the half-life of the specific opioid involved. We recommend distributing multiple doses of standard IM or IN naloxone to bystanders and educating individuals on the adequacy of two doses in reversing fentanyl overdoses. Individuals should continue administration until the recipient is revived, ensuring appropriate intervals between each dose along with rescue breaths, and calling emergency medical services if the individual is unresponsive after two doses. We do not recommend high-dose naloxone formulations as a substitute for four doses of IM or IN naloxone due to the higher cost, risk of precipitated withdrawal, and limited evidence compared to standard doses. Future research must take into consideration lived and living experience, scientific evidence, conflicts of interest, and the bodily autonomy of people who use drugs.

  • What SDG3 target(s) is your work and the work of the organization most closely aligned with?

Among the targets listed, we are most aligned with the mission to “Strengthen the prevention and treatment of substance abuse,” however, we also focus on reducing the stigma of drug use as well. Not all of those who use drugs, including opioids, have a substance use disorder. Not all who use opioids outside of doctor’s orders are “abusing” the drug. Who determines what is considered abuse anyways?

Substance use disorder is a spectrum. It can range from healthy and responsible drug use to uncontrolled and chaotic drug use to a full disorder. Oftentimes, this depends on the individual’s quality of life. For example, someone who has all their needs met and can pay all of their bills is more likely to be able to control their drug use compared to someone who is experiencing homelessness, abuse and trauma, exploitation or some other issue that many of our most vulnerable people in our society experience.

Instead of policing drug use and taking a “punish and control” approach, we need to be focusing on the underlying causes that lead to people using drugs in a risky way in the first place.

  • Do you feel there is something missing from the specific SDG 3 targets of the areas you are most interested in?

We want to show the importance of including the experiences and voices of those who use drugs. As our paper mentions, “Those with lived and living experience have unique insight into the complexities of overdose and the effectiveness of naloxone. They can provide valuable information on how a higher dose formulation may impact their ability to respond to an overdose. Additionally, they can offer insight into other factors that may contribute to overdose, such as polysubstance use or lack of access to harm reduction services. By listening to those with lived and living experience, we can gain a better understanding of the challenges and barriers faced by PWUD [people who use drugs] and make more informed decisions about how to address overdose in a way that is effective, equitable, and inclusive.”

Another important target for us is to bridge the gap between researchers and those working “on the ground,” as in directly with drug users and those with substance use disorder (SUD), or drug users themselves. From personal experience, I have worked with scientists who struggle to design studies that provide results that could be translated to treatment and prevention in humans, especially within our current society and policy landscape. This is because they lack the knowledge of how drug use and SUD occur in real life.

I’ve also worked with harm reductionists and drug users who could benefit, either in their work or personally, from understanding the science of drugs and SUD, or even how the scientific process itself, research, and funding works.

  • Who (or what groups) would you like to work with, or would like to be in contact with, to push forward your ideas/projects?

As a PhD candidate, I’ll soon be Dr. Lemen and want to use my training in biomedical sciences to improve the lives of those who use drugs and those with SUD. However, I’m not sure in which way I’d like to go about that; scientific advisor, post-doc (continue doing the research I do now in academia), industry, or maybe even scientific journalism.

Academia needs SUD researchers with real world experience and have undergone the unlearning process of all the drug war propaganda that many scientists don’t even recognize they’ve fallen for as well. In that case, I’d love to work with like-minded researchers that have funding for post-docs.

I’m also interested in getting more involved with policy work or journalism in this same field. In that case, I’d love to connect with the Drug Policy Alliance and the Harm Reduction Coalition. However, it is possible to do both and one does compliment the other!

 

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  • Harm Reduction Journal Harm Reduction Journal

    This journal publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues, as well as rebuking the de facto criminalization of marginalized and stigmatized communities.

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Harm reduction online and for online gambling

With more aspects of our lives taking place on mobile devices connected to the internet, online gambling has increased considerably over the past decade. This has resulted in the emergence of new gambling activities, difficult-to-regulate gambling products, and unlimited access through personal devices. Governments, researchers and service providers globally are now faced with unprecedented challenges to address gambling harm in the rapidly changing digital environment. Better understanding of the negative consequences of online gambling is necessary to guide global efforts to reduce gambling harm, including regulation and public health interventions. In addition to the changing regulatory environment, online gambling yields vast amounts of digital data that constitutes considerable commercial value, but can be also harnessed for innovative ways to reduce gambling harm. More effective harm reduction can benefit from the current technology including comprehensive online harm reduction approaches and tools to monitor play patterns. Such approaches may be particularly impactful for Indigenous groups that are historically more geographically isolated and economically marginalized. The online environment also enables new forms of self-help and therapeutic interventions with significant developments during COVID-19 related social restrictions. Another emerging area of research and policy regarding online gambling are gambling-like features in video games. This convergence of gambling and gaming involves gaming elements in gambling, games incorporating gambling elements, gambling on games, free simulated online gambling, and social media games and gambling. Gambling-like features in video games are of particular concern for parents and children, as underaged players are the main market and often aggressively targeted by the gambling industry. Regulating and controlling the gambling industry, its affiliates and beneficiaries effectively also in the online arena is thus crucial in gambling harm reduction. We invite submissions around but not limited to the following themes: - Experiences and types of online gambling harm - Harm minimization tools specifically targeting online gambling - The collection and use of online gambling data - Gambling regulation as a harm reduction tool - Online gambling therapy and self-help platforms on the Internet - Harm reduction with a focus on Indigenous and minority groups - Convergence of gambling and gaming

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HARENE: Fostering Francophone Community-based Participatory Harm Reduction Research

Producing scientific knowledge on harm reduction means including people who use drugs (PWUD) in ‘participatory and community-based research’ (CBPR), a validated and demonstrated scientific approach. Harm reduction advocates a more central contribution of PWUD in CBPR. Specifically, by sharing their lay knowledge and living experiences, PWUD can improve other stakeholders’ understanding of their realities and needs, thereby informing the design of suitable interventions. Ensuring that scientific knowledge can be disseminated, accessed, and communicated in different languages is one way to encourage communities to participate in research. However, for many non-native academic researchers, publishing in English (the scientific world’s primary language) is not possible without extra funding for copyediting/translation services. For community-based associations with a non-academic background who desire to participate in CBPR, this linguistic and financial barrier is even greater. The CBPR-based harm reduction network HARENE wishes to reduce this barrier by helping associations in France to publish their work in English, with a view to increasing the diversity of science and knowledge and reducing the production of ignorance and undone science. Publishing a France-specific collection in Harm Reduction Journal would not only promote this endeavor, it would encourage other non-academic CBPR stakeholders in harm reduction to follow suit.

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