Category: Substance Use

Categories : Substance UseTags :

Family Dinners May Reduce Substance Use Risk for Many Adolescents

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Regular bonding over meals may help prevent kids from using alcohol, cannabis, and e-cigarettes, but those with significant stress or trauma need additional support

Photo by Vanessa Loring on Pexels

Anew study from researchers at Tufts University School of Medicine finds that regular family dinners may help prevent substance use for a majority of US adolescents, but suggests that the strategy is not effective for youth who have experienced significant childhood adversity.

The findings provide important insights for practitioners looking to help families prevent substance use, as well as for researchers aiming to develop interventions that better account for adolescents’ unique experiences.  

For the study, published January 19 in the Journal of Aggression, Maltreatment & Trauma, researchers analysed online survey data from 2090 US adolescents ages 12 to 17 and their parents. Participants from around the country were asked about the quality of their family meals – including communication, enjoyment, digital distractions, and logistics – as well as adolescents’ alcohol, e-cigarette, and cannabis use in the previous six months.

The researchers then examined how these patterns differed based on adolescents’ experiences of household stressors and exposure to violence, as reported by both the children and parents. Instead of counting each adverse experience equally, the researchers created a weighted score based on how strongly the different experiences are linked to substance use in prior research and this national sample.

Higher family dinner quality was associated with a 22% to 34% lower prevalence of substance use among adolescents who had either no or low to moderate levels of adverse childhood experiences. 

“These findings build on what we already knew about the value of family meals as a practical and widely accessible way to reduce the risk of adolescent substance use,” said Margie Skeer, the study’s lead author, professor and chair of the Department of Public Health and Community Medicine at the School of Medicine.  

“Routinely connecting over meals – which can be as simple as a caregiver and child standing at a counter having a snack together – can help establish open and routine parent-child communication and parental monitoring to support more positive long-term outcomes for the majority of children,” added Skeer. “It’s not about the food, timing, or setting; it’s the parent-child relationship and interactions it helps cultivate that matter.”

Adverse childhood experiences reported by participants in the study included parents being divorced; a family member being diagnosed with a substance-use disorder; someone in the family having a mental-health disorder; the adolescent witnessing violence; the adolescent often being teased about their weight; a parent using non-prescribed drugs daily; or the adolescent experiencing sexual or physical dating violence.  

The study found that family meals offered little protection for adolescents whose adversity score reached the equivalent of four or more experiences – a population that encompasses nearly one in five U.S. high school students younger than 18, according to a study of the most recent Youth Risk Behavior Survey data.  

“While our research suggests that adolescents who have experienced more severe stressors may not see the same benefits from family meals, they may benefit from more targeted and trauma-informed approaches, such as mental health support and alternative forms of family engagement,” said Skeer.  

She added that future research should explore whether other supportive routines – beyond shared meals or outside the family environment – can help protect adolescents exposed to highly stressful or traumatic childhood experiences. 

Source: Tufts University

Categories : Mental Health Substance UseTags :

Study: Adolescent Cannabis Use Linked to Doubling Risk of Psychotic and Bipolar Disorders

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Adolescents who use cannabis could face a significantly higher risk of developing serious psychiatric disorders by young adulthood, according to a large new study published in JAMA Health Forum. The longitudinal study followed nearly half a million adolescents ages 13 to 17 through age 26 and found that past-year cannabis use during adolescence was associated with a significantly higher risk of incident psychotic (doubled), bipolar (doubled), depressive and anxiety disorders.

The study was conducted by researchers from Kaiser Permanente, the Public Health Institute’s Getting it Right from the Start, the University of California, San Francisco and the University of Southern California, and was funded by a grant from NIH’s National Institute on Drug Abuse (R01DA0531920).

The study analysed electronic health record data from routine paediatric visits between 2016 and 2023. Cannabis use preceded psychiatric diagnoses by an average of 1.7 to 2.3 years. The study’s longitudinal design strengthens evidence that adolescent cannabis exposure is a potential risk factor for developing mental illness.

“As cannabis becomes more potent and aggressively marketed, this study indicates that adolescent cannabis use is associated with double the risk of incident psychotic and bipolar disorders, two of the most serious mental health conditions,” said Lynn Silver, MD, program director of the Getting it Right from the Start, a program of the Public Health Institute, and a study co-author.

The evidence increasingly points to the need for an urgent public health response — one that reduces product potency, prioritises prevention, limits youth exposure and marketing and treats adolescent cannabis use as a serious health issue, not a benign behaviour. 

Lynn Silver, MD, Program Director, PHI’s Getting it Right from the Start

Cannabis is the most used illicit drug among U.S. adolescents. The Monitoring the Future study shows use rising with grade level — from about 8% in 8th grade to 26% in 12th grade — and according to the 2024 National Survey on Drug Use and Health, more than 10% of all U.S. teens aged 12 to 17 report past-year use. At the same time, average THC levels in California cannabis flower now exceed 20%, far higher than in previous decades, and concentrates can exceed 95% THC.

Unlike many prior studies, the research examined any self-reported past-year cannabis use, with universal screening of teens during standard pediatric care, rather than focusing only on heavy use or cannabis use disorder.

“Even after accounting for prior mental health conditions and other substance use, adolescents who reported cannabis use had a substantially higher risk of developing psychiatric disorders — particularly psychotic and bipolar disorders,” said Kelly Young-Wolff, PhD, lead author of the study and senior research scientist at the Kaiser Permanente Division of Research.

This study adds to the growing body of evidence that cannabis use during adolescence could have potentially detrimental, long-term health effects. It’s imperative that parents and their children have accurate, trusted, and evidence-based information about the risks of adolescent cannabis use.

Kelly Young-Wolff, PhD, Lead Study Author and Senior Research Scientist, Kaiser Permanente Division of Research

The study also found that cannabis use was more common among adolescents enrolled in Medicaid and those living in more socioeconomically deprived neighbourhoods, raising concerns that expanding cannabis commercialisation could exacerbate existing mental health disparities.

Source: Public Health Institute

Categories : Substance Use UrogenitalTags :

Ketamine is Giving More Young People Bladder Problems – An Expert Explains

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A growing number of people in the UK are using ketamine recreationally. Photo by Colin Davis on Unsplash

Heba Ghazal, Kingston University

Urology departments in England and Wales have reported seeing an increase in the number of 16- to 24-year-olds being admitted for bladder inflammation associated with ketamine use.

This appears to coincide with an increase in ketamine use – with the number of adults and teens entering treatment for ketamine abuse last year jumping substantially compared to even just a few years previously.

Ketamine abuse can have many affects on the bladder, causing frequent urination, night-time urination, sudden urges, leakage, inflammation, pain in the bladder or lower back and blood in the urine. These symptoms can be severe, make daily life very difficult and may even be permanent in some cases.

Ketamine was first approved in 1970 for human use as an anaesthetic. More recently, studies have suggested that ketamine used at low doses may have antidepressant effects.

But a growing number of people are now using ketamine recreationally. It acts as a dissociative drug, causing users to feel detached from themselves and their surroundings. It can produce hallucinogenic, stimulant and pain-relieving effects, which last one to two hours.

Users typically snort or smoke powdered ketamine, or inject liquid ketamine or mix it into drinks in order to experience the drug’s effects. Snorting usually produces stronger effects and more noticeable symptoms than swallowing it.

Ketamine users can develop tolerance to the drug quickly, needing higher doses to get the same effects. This is probably due to the body and brain adapting to become more efficient at breaking down the drug. Frequent users often need to take twice the amount of occasional users to get the same effect.

Bladder damage

Frequent, high-dose ketamine use can cause serious damage to the bladder, urinary tract and kidneys. In severe cases, the bladder may need to be removed.

The first recorded cases of ketamine affecting the bladder were reported in Canada in 2007, where nine people who used ketamine recreationally had severe bladder problems and blood in their urine. Later, a bigger study in Hong Kong found the same issues in 59 people who had used ketamine for more than three months.

Ketamine, as with any other drug, is metabolised in the body where it’s broken down and excreted in urine.

When ketamine is broken down, it turns into chemicals that can seriously harm the bladder. When these by-products stay in contact with the urinary tract for a long time, they irritate and damage the tissue.

The bladder is damaged first, because it holds urine the longest. Later, the ureters (tubes connecting the kidney to the bladder) and the kidneys can also be affected.

Over time, the bladder can shrink and become stiff, causing strong urinary symptoms. The ureters can become narrow and bent, sometimes described as looking like a “walking stick.” This can lead to backed-up urine in the kidneys (hydronephrosis).

Ketamine also increases oxidative stress, which damages cells and causes bladder cells to die. This breaks the protective bladder lining, making it leaky and overly sensitive.

All these changes can make the bladder overactive, extremely sensitive and painful, often causing severe urges to urinate and incontinence.

Bladder damage from ketamine use happens in stages.

In the first stage, the bladder becomes inflamed. This can often be reversed by stopping ketamine and taking certain medication – such as anti-inflammatory drugs, pain relievers or prescription drugs that reduce bladder urgency and help the bladder lining heal.

In the second stage, the bladder can shrink or become stiff. In this stage, treatment is similar to stage one, but a bladder wash may also be required. This is where a catheter is used to put liquid medication directly into the bladder. The drug coats the bladder’s inner lining, helping to restore its protective layer and reduce inflammation.

Botulinum toxin injections may also be used to relax the bladder and reduce pain and urgency. Stopping ketamine remains essential to prevent further damage.

In the final stage, permanent damage occurs to the bladder and kidneys. Over time, if the kidneys are affected, it can lead to kidney failure. Dialysis (a treatment where waste products and excess fluid are filtered from the blood) or even surgery may be required to repair kidney function and the urinary system.

Although ketamine has been a class B drug since 2014, it’s unfortunately affordable and accessible – costing as little as £3 per gram in some parts of the UK. Raising awareness about the risks of ketamine use is essential to prevent these serious health problems.

Heba Ghazal, Senior Lecturer, Pharmacy, Kingston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : Obstetrics & Gynaecology Substance UseTags :

Effectiveness of Common Treatments for Opioid Use Disorder in Mothers and Infants

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Photo by Alina Matveycheva

Over the last 20 years, substance use-related deaths have more than doubled for women of reproductive age. Overdose deaths are now a leading cause of maternal mortality in the US, and in some states, the leading cause.

Still, substantial gaps remain in understanding how different treatment approaches influence the short- and long-term health of mothers and infants, as well as their broader economic impacts over time.  

New research published this month in the journal JAMA Pediatrics found that while established medications for opioid use disorder in mothers – buprenorphine and methadone – are both superior and cost saving compared to alternative treatment pathways (naltrexone, medication-assisted withdrawal or no treatment), buprenorphine produced the greatest health gains and cost savings for mothers and infants.

Using a mathematical simulation model, the study projected the health and cost outcomes for pregnant individuals with opioid use disorder and their infants over their lifetime. The economic model captured how treatment decisions during pregnancy can have lasting health and economic consequences, such as risks of preterm birth, that extend from infancy through adulthood and drive substantial downstream health effects and costs. Outpatient buprenorphine emerged as the optimal treatment in most scenarios tested (58%-100%) and in nearly every lifetime scenario that incorporated both mother and infant trajectories (99%). In other words, across thousands of simulations, buprenorphine consistently produced the best health outcomes and lower costs compared to alternative strategies. 

The study, led by Ashley Leech, PhD, assistant professor of Health Policy at Vanderbilt University Medical Center, and Stephen Patrick, MD, MPH, O. Wayne Rollins Distinguished Professor of Health Policy and chair of the Department of Health Policy and Management at Emory University, is among the first to compare the short- and long-term health benefits and costs of opioid use disorder treatment for mothers and infants, examining outcomes during pregnancy, postpartum and beyond the infant’s first year of life using simulation modeling.

Existing studies have not examined outcomes beyond the infant’s first year of life. The study used a hypothetical treatment group modeled on known demographic and other social factors to estimate differences in outcomes and cost savings over time for each treatment and population group. The paper found that, although neonatal opioid withdrawal syndrome (NOWS) has received much of the clinical attention as a marker of poor infant health after opioid exposure during pregnancy, preterm birth and low birth weight carry greater morbidity and mortality and played a more significant role in shaping long-term infant outcomes. Notably, buprenorphine, despite its direct association with NOWS, was protective against these critical outcomes. 

“Nationwide, we have seen a significant growth of pregnant women with opioid use disorder, but there have not been comprehensive models that evaluate trade-offs of different medications and strategies,” said Patrick. “This study evaluated the trade-offs we face as clinicians – How will medications affect moms and babies? With the evidence we have available, what can we expect years from now? Bottom line, we found that buprenorphine treatment in pregnancy was cost saving and improved outcomes for mothers with opioid use disorder and their babies.”

The researchers emphasised, however, that patient-centred care and patient choice remain essential to sustaining treatment. “While we found that buprenorphine yielded the greatest health gains and was cost saving across all model variations, methadone could still be a viable option for mothers, and at the individual level, it might work better for some,” said Leech, the lead author of the study. “Buprenorphine shows clear benefits for long-term infant outcomes, but it can be more difficult for patients to start and stay on this treatment because, as a partial agonist, it may not feel as strong to those dependent on drugs like heroin or fentanyl. Methadone, by contrast, is often easier for patients to initiate and sustain.

“This is an opportunity to make sure buprenorphine works as well as possible – by ensuring pregnant individuals receive effective doses across trimesters (since they often need higher and increasing amounts for effectiveness compared to nonpregnant patients) and by removing unnecessary Medicaid restrictions.”

The study estimated substantial cost savings to public insurance programmes like Medicaid, finding that treating pregnant individuals this year could save roughly $4 billion in infant-related lifetime costs alone.  

“Medicaid is the largest payer for pregnant individuals and those with substance use disorders. Our research shows that treatment is not only effective but also has the potential to generate significant savings for Medicaid, benefiting both mothers and their children’s long-term health,” Leech said.

Source: Vanderbilt University Medical Center

Categories : Substance UseTags :

Study Untangles the Complex Relationship Between Cannabis and Binge Drinking

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Photo by Pavel Danilyuk on Pexels

Binge drinking is most common among younger adults, and using cannabis during late adolescence or early adulthood is known to increase the risk of engaging in binge drinking. Now, new research from the Arizona State University Department of Psychology shows that this increase in risk of binge drinking from cannabis use varies with age, peaking around age 20.

“We found that during ages 18 to 20, cannabis motivates people to binge drink more often, while later in adulthood, around age 24, it motivates them to binge drink less. This dichotomy has consequences for prevention and treatment efforts,” said Jack Waddell, assistant professor of psychology at ASU and first author on the study.

The study used cannabis use and alcohol consumption data from the National Consortium on Alcohol and Neurodevelopment in Adolescence, a long-term study of over 500 participants with sites in California, Oregon, North Carolina and Pennsylvania. The work was published in Alcohol Clinical and Experimental Research.

Not just one substance

Waddell described the interaction of cannabis use and alcohol consumption as a complex relationship. 

He has previously found that individuals who use both alcohol and cannabis report higher rates of substance use disorder than those who use just one. Yet, he has also found that many individuals who use both alcohol and cannabis perceive using them together as being protective against some of the negative consequences of excessive drinking.

In the current study, he and his collaborators expected using cannabis to consistently increase the likelihood of the study participants engaging in binge drinking, not for it to flip from enabling excessive drinking in late teens and early 20s to blunting it around age 24.

“People are reducing their binge drinking but they’re switching to cannabis. This can be viewed positively from a harm-reduction standpoint, but it is important to understand that there are still a lot of risks associated with cannabis use,” Waddell said.

Digging into the dynamics of substance use

Waddell wants to understand how people end up using more than one substance, and to do this, he plans to study how people think about and use substances on a day-to-day basis.

“What is it that motivates the transition from using one substance to more than one? Is it someone’s affective experiences – their emotions and moods – whenever they’re using alcohol or cannabis that makes them want to add the other? Is it the social environment?” he asked.

Going forward, Waddell plans to use technology-enhanced momentary assessments, which are questionnaires or check-ins delivered by push notification on an app or text message, to study people’s behavior in the moment. 

Having a finer-grained level of access to how different kinds of substance use interact with and influence each other will lead to better treatment and prevention strategies.

Categories : Cardiovascular Disease Substance UseTags :

Even Low-intensity Smoking Increases Risk of Heart Attack and Death

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Study of 300 000 people finds just two to five cigarettes per day increases risk of death by 60%

Photo by lil artsy

An analysis of data from almost two dozen long-term studies finds that even low-intensity smokers have a substantially higher risk of heart disease and death compared to people who never smoked, even years after they quit. Michael Blaha of the Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, USA, and colleagues report these findings November 18th in the open-access journal PLOS Medicine.

Previous research has shown that smoking cigarettes increases a person’s risk of developing cardiovascular disease, but the exact relationship between how heavily a person smokes and their risks is still unclear, especially for low-intensity smokers. Today, more people are smoking fewer cigarettes, but it’s still important to understand the cardiovascular risks and long-term benefits of quitting, even for individuals who aren’t smoking a pack a day.

Blaha’s team analysed data from more than 300 000 adults enrolled in 22 longitudinal studies – which involve following groups of individuals over time – for up to 19.9 years. In that time, they documented more than 125 000 deaths and 54 000 cardiovascular events, such as heart attacks, strokes and heart failure. The analysis showed that even very low-intensity smoking, defined as two to five cigarettes per day, was associated with a 50% higher risk of heart failure and a 60% higher risk of death from any cause, compared to never smoking. A person’s risk of cardiovascular events dropped most substantially in the first decade after quitting smoking and continued to decrease over time. However, even up to three decades later, former smokers may still exhibit higher risk compared to those who never smoked.

Considering that even occasional or very low-intensity smoking significantly increases a person’s risk of cardiovascular disease and death, the researchers conclude that quitting smoking at younger ages is the best way to decrease your risk, rather than reducing the number of cigarettes smoked each day. These findings reinforce established public health guidelines – that smokers should quit as early as possible instead of just cutting back – and emphasize the importance of smoking prevention programs.

The authors add, “This is one of the largest studies of cigarette smoking to date using the highest quality data in the cardiovascular epidemiology literature. It is remarkable how harmful smoking is – even low doses of smoking confer large cardiovascular risks. As far as behaviour change, it is imperative to quit smoking as early in life as possible, as the among of time passed since complete cessation from cigarettes is more important prolonged exposure to a lower quantity of cigarettes each day.”

Provided by PLOS

Press preview: https://plos.io/4nES58Z

In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: https://plos.io/4nIQAXN

Contact: Michael Blaha, mblaha1@jhmi.edu

Image caption: Researchers assess the impact of when one quits smoking and their health outcomes later on.

Image credit: lil artsy, Pexels (CC0, https://creativecommons.org/publicdomain/zero/1.0/)

High-resolution image link: https://plos.io/3VIPLCA

Citation: Tasdighi E, Yao Z, Dardari ZA, Jha KK, Osuji N, Rajan T, et al. (2025) Association between cigarette smoking status, intensity, and cessation duration with long-term incidence of nine cardiovascular and mortality outcomes: The Cross-Cohort Collaboration (CCC). PLoS Med 22(11): e1004561. https://doi.org/10.1371/journal.pmed.1004561

Categories : Obstetrics & Gynaecology Substance UseTags :

Study Explores How Prenatal Cannabis Exposure May Affect Foetal Brain Development

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Source: Pixabay CC0

Researchers at UTHealth Houston are examining the biological effects of prenatal cannabis exposure and its potential impact on foetal brain development. Supported by a $3.7 million grant from the National Institutes of Health and the National Institute on Drug Abuse, the study aims to improve screening tools, public health guidance, and prenatal care strategies for pregnant people who use cannabis.

Led by Laura Goetzl, MD, MPH, a professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at McGovern Medical School at UTHealth Houston, the five-year grant will fund the study, “Foetal neuronal extracellular vesicle biomarkers of in-utero effects of maternal cannabinoid use and human foetal brain development and neurobehavioral outcomes.”

“In recent years, cannabis use among pregnant women has increased, either recreationally or to help relieve nausea and vomiting during pregnancy,” Goetzl said. “Despite this rise, the effects on a baby’s brain are not well understood. Our hope through this research is that we can better identify risk factors and help health care providers give expecting mothers the best possible guidance.

The study will explore early biological signs, or biomarkers, to show how cannabis exposure influences a baby’s developing brain.

“During pregnancy, small bubbles called neuronal extracellular vesicles travel from the foetus into the mother’s bloodstream,” Goetzl said. “Through studying these small particles, we hope to gain valuable insight into foetal brain development without invasive testing.”

In collaboration with the University of Colorado, the research study will focus on how prenatal cannabis exposure may influence brain growth and neurobehavioral outcomes in children, including their potential for developing attention-deficit/hyperactivity disorder (ADHD) or autism later in life.

The project is supported by the National Institute on Drug Abuse of the National Institutes of Health under award number R01DA060319.

Source: UTHealth Houston

Categories : Pain Management Substance UseTags :

Teens More Likely to Use Opioids when Parents Have Prescriptions

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Norwegian study of more than 21 000 young people found that those whose parents had persistent opioid prescriptions faced more than double the risk of persistent opioid use

Photo by Danilo Alvesd on Unsplash

If a parent has persistent opioid prescriptions, their adolescent or young adult offspring has more than double the risk of persistent opioid use, according to a new study published October 23rd in the open-access journal PLOS Medicine by Anna Marcuzzi of the Norwegian University of Science and Technology, Norway, and colleagues.

The prescription of strong analgesics such as opioids is not recommended for young people. However, despite potential adverse long-term consequences, opioids are often prescribed for non-malignant pain in this population.

In the new study, researchers analysed data from 21 470 adolescents and young adults aged 13-29 years who participated in the population-based Young-HUNT or HUNT Study in Norway in 2006-2008 or 2017-2019. Each participant was linked with at least one parent who also participated in the HUNT study, and opioid prescription data were obtained from the Norwegian Prescription Database.

24.4% of young people had at least one opioid prescription during the seven-year follow-up period, while 1.3% had persistent opioid prescriptions, defined as prescriptions in at least three out of four quarters of a year. When a mother had persistent opioid prescriptions over a five-year period (two years before and three years after offspring participation), their offspring had 2.60 times the risk of persistent opioid use compared to those whose mothers had no prescriptions. When a father had persistent opioid prescriptions, their offspring had 2.37 times the risk of persistent opioid use. The association was also present but weaker for non-persistent opioid prescription – offspring whose mothers had two or more prescriptions had 1.34 times the risk of receiving any opioid prescription, while those whose fathers had two or more prescriptions had 1.19 times the risk, compared to offspring whose parents had no prescriptions. There was no clear evidence that parental chronic musculoskeletal pain status influenced these associations.

The authors note that because parental opioid prescriptions were measured both before and after offspring HUNT participation, some parental opioid prescriptions could have begun after offspring opioid use. However, they conclude that there is an association between parental and offspring opioid prescriptions.

“The study findings suggest that family-based strategies should be considered when managing pain conditions in adolescents and young adults to avoid potentially unnecessary opioid use,” they say.

The authors add, “Despite restrictive opioid policies, one in four adolescents and young adults received an opioid prescription during the seven years follow-up.”

“Adolescents whose parents had two or more opioid prescriptions had a more than two-fold higher risk of persistent opioid use (ie, multiple prescriptions in a year) than if the parents had no opioid prescriptions.”

Provided by PLOS

Categories : Ethics and Law Substance UseTags :

INHSU 2025: Global Drug Policy and Harm Reduction Leaders Meet in Cape Town

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With drug use projected to rise 40% in Africa by 2030, a global conference will amplify pioneering policy responses and proven health interventions from across Africa and beyond.

14–17 October 2025 | Century City Conference Centre, Cape Town

By 2030, the number of people who use drugs in Africa is projected to rise by 40%, according to the United Nations Office on Drugs and Crime (UNODC). Without stronger drug policy and harm reduction responses, the region faces escalating rates of overdose, HIV, hepatitis C, and other harms.

The warning signs are already here: around 11% of the estimated 1.26 million people who inject drugs across sub-Saharan Africa are living with HIV and an estimated 15% currently have hepatitis C, a liver condition that can cause liver cancer and death.

New research also shows that more than 40% of people who inject drugs in sub-Saharan Africa have experienced a recent non-fatal overdose – more than double the global average of 18.5%.

“While the scale of the challenge is undeniable, pioneering efforts by a few African governments show what harm reduction leadership can look like,” says Angela McBride, Executive Director of the South African Network of People Who Use Drugs (SANPUD), INHSU board member, and co-convener of INHSU 2025. “Harm reduction means putting health and human rights before punishment – shifting away from criminalisation and towards evidence-based, rights-affirming policies.”

These evidence-based policies include decriminalising drug use, expanding needle and syringe programs (NSP) to provide sterile equipment to prevent the spread of blood-borne viruses, increasing access to opioid agonist therapy (OAT) – medication to treat opioid dependence and reduce cravings and withdrawal from opioids like heroin – and ensuring access to HIV and hepatitis B and C testing and treatment.

Africa responds to the crisis

Across the continent, examples of this leadership are starting to emerge – from new legislation in Kenya to large-scale service delivery in Mauritius.

  • In South Africa, the Central Drug Authority is implementing the National Drug Master Plan, acknowledging that the country’s drug crisis is worsening and calling for stronger cross-sector responses. The plan recognises harm reduction and OAT must be expanded if HIV and hepatitis C are to be contained. Ms Nandi Mayathula-Khoza, Chairperson of the Central Drug Authority, will be presenting on the new plan during the conference.
  • In Kenya, parliament is currently debating a Harm Reduction Bill. If passed, it would be a landmark move, embedding access to NSP, HIV-related healthcare services, and other evidence-based services into national law for the first time.
  • Finally, in Mauritius, government-backed harm reduction has already achieved coverage levels rarely seen in the region. More than half of people who inject drugs are receiving OAT, supported by a pioneering “social contracting” model that channels government funds directly to NGOs to deliver NSP and other services on the ground.

Learning both ways

These policy shifts will be a focus of INHSU 2025’s Policy Day, which will bring together decisionmakers from across Africa to debate and share reform strategies. The wider conference will then welcome more than 600 global experts – including researchers, clinicians, policymakers, and people with lived experience of drug use – to showcase African-led harm reduction successes alongside international innovations such as long-acting depot buprenorphine (LADB), a monthly treatment for opioid dependence, and community-led hepatitis C testing and treatment programs that are transforming outcomes worldwide.

“The evidence consistently shows that harm reduction works – what we need now is political will,” says Dr Andrew Scheibe, medical doctor and technical advisor with TB HIV Care in Cape Town, INHSU board member, and fellow co-convener of INHSU 2025. “Harm reduction reduces infections, prevents overdose, and connects people to healthcare, yet access across Africa remains the exception rather than the rule. INHSU 2025 will showcase how we can bridge that gap and deliver the services people urgently need.”

Funding, prisons, and women’s health

Beyond drug policy reform and harm reduction, the conference will focus on other areas with profound impacts on the lives of people who use drugs, including incarceration, gender specific health disparities, and shifts in funding.

Prisons and detention settings will feature prominently, with Professor Louisa Degenhardt (National Drug & Alcohol Research Centre, Australia) presenting a multistage systematic review on the global epidemiology of injecting drug use, HIV, viral hepatitis, and tuberculosis among people who are incarcerated.

Women face extreme stigmatisation and complex barriers to healthcare, especially during pregnancy. Women who use drugs will also be a core focus, with multiple presentations from speakers across Africa and globally. Neliswa Gogela (Groote Schuur Hospital/University of Cape Town, South Africa) will present on HIV and HCV Care for Women Who Use Drugs with other presentations from Tanzania and Kenya.Finally, Kennedy Kipkoech (University of Cape Town and University of Bristol, UK) will present new modelling on the potential impact of the suspension of US PEPFAR funding for OAT on HIV and hepatitis C transmission among people who inject drugs. PEPFAR has saved an estimated 26 million lives, prevented 7.8 million babies from being born with HIV, and supported millions of orphans and vulnerable children across sub-Saharan Africa (Lancet EClinicalMedicine, 2025).

“These issues go to the heart of what drives health inequities for people who use drugs,” says Emma Day, Executive Director of INHSU. “Incarceration increases risk of acquiring HCV, HIV and other infectious diseases. Women who use drugs are among the most stigmatised populations and gender responsive models are needed to appropriately support them. And without sustainable funding, harm reduction progress across Africa is at risk. INHSU 2025 is about confronting these systemic challenges head-on and building a stronger, more equitable response.”

View the full program here

Categories : Gender Substance UseTags :

Care for Women and Harm Reduction Services Under the Spotlight

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Facing off a dual burden of high disease risk and low service access

Photo by Sydney Sims on Unsplash

CAPE TOWN, 08 OCTOBER 2025: South African and international leaders in public health will gather on Friday, 10 October 2025 at the University of Cape Town to convene an in-person scientific seminar: Agents of change and women who use drugs. Women who use drugs (WWUD) in South Africa face compounded health and social vulnerabilities that leave them disproportionately excluded from essential health services. Compared to men, women experience heightened stigma, intimate partner violence, reproductive health challenges, and structural barriers such as childcare responsibilities and lack of women-centred care.1,2 Scientific discussions among academics will focus on how women can be supported through access to harm reduction programming and drug policy reform.  

 Seminar: Agents of change and women who use drugs

·        Date    : 10 October 2025

·        Time    : 13:30 – 15:30 (SAST)

·        Venue  : Neurosciences Institute Auditorium, UCT/Groote Schuur Hospital, Cape Town

·        Registration

Recent evidence highlights both the scale of drug use and the urgent need for tailored harm reduction. National estimates suggest there are approximately 82 500 people who inject drugs (PWID) in South Africa, with women comprising between 16% and 27% of this population.3 Led by TB HIV Care, a 2023 bio-behavioural survey across four South African sites documented extremely high HIV prevalence among PWID: 72.1% in Tshwane, 49.3% in eThekwini, 45.4% in Mashishing, and 30.3% in Mbombela. Hepatitis C (HCV) prevalence was similarly alarming, reaching 89% in Tshwane and over 75% in multiple sites.3

“The evidence consistently shows that harm reduction works,” says Dr Andrew Scheibe, medical doctor and technical advisor with TB HIV Care in Cape Town, INHSU board member, and fellow co-convener of the upcoming INHSU 2025 conference. “Harm reduction reduces infections, prevents overdose, and connects people to healthcare, yet access across Africa remains the exception rather than the rule.”

Sex-based disparities are stark. While HIV prevalence among PWID overall has ranged from 14% to over 70%, women consistently show higher prevalence rates than men. One multi-city study found 18% HIV prevalence among female PWID, compared to 13% among males.4 More recent research in Durban confirmed that women face greater barriers to accessing sexual and reproductive health, harm reduction, and HIV services, often due to fear of arrest, intimate partner control, and lack of programming designed for women.5

“Everyone in our communities deserve health, dignity, and care,” says Mfezi Mcingana, Programme Director: Key Populations at TB HIV Care. “People who use drugs are part of our communities and supporting their access to healthcare, not punishment, builds a safer, healthier society for all”, Mcingana concludes.

Despite the magnitude of risk, women remain underrepresented in harm reduction programmes. In opioid agonist therapy (OAT), fewer than 10% of participants are women.6 Needle and syringe programmes (NSPs) and OAT are limited in coverage, mostly urban-based, and not designed with women’s needs in mind. The absence of services aimed at women perpetuates cycles of preventable morbidity, mortality, and infectious disease transmission.

“While the scale of the challenge is undeniable, pioneering efforts by a few African governments show what harm reduction leadership can look like,” says Angela McBride, Executive Director of the South African Network of People Who Use Drugs (SANPUD), INHSU board member, and co-convener of INHSU 2025. “Harm reduction means putting health and human rights before punishment, shifting away from criminalisation and towards evidence-based, rights-affirming policies.”

To address this gap, investment in women-centred harm reduction is essential. Priorities include scaling up OAT and NSPs with women-specific entry points, integrating sexual and reproductive health services into harm reduction sites, providing childcare support, and ensuring protection from intimate partner violence. Without these interventions, WWUD in South Africa will continue to be excluded from public health progress and national HIV/HCV response goals.

References:

  1. Shirley-Beavan, S., Roig, A., Burke-Shyne, N., Daniels, C. and Csak, R. (2020). Women and barriers to harm reduction services: a literature review. Harm Reduction Journal, 17(74). Available here.
  2. Harm Reduction International & South African Network of People Who Use Drugs (SANPUD) (2020). Barriers to harm reduction for women who use drugs in South Africa. London: Harm Reduction International. Available here.
  3. SANPUD (2023). South African bio-behavioural survey and population size estimation among people who inject drugs. Johannesburg: South African Network of People Who Use Drugs. Available here.
  4. Scheibe, A., Young, K., Moses, L., Basson, R., Versfeld, A., Spearman, C.W. and Sonderup, M.W. (2016). HIV prevalence and risk among people who inject drugs in South Africa. International Journal of Drug Policy, 30, pp.107–113. Available here.
  5. Milford, C., Cavanagh, T., Bosman, S., Chetty, T. and Rambally, G. (2024). Access to and acceptability of sexual and reproductive health, harm reduction and other essential health services among people who inject drugs in Durban, South Africa. Harm Reduction Journal, 21(123). Available here.
  6. INHSU (2021). Gender and opioid substitution therapy access in Tshwane, South Africa. International Network on Health and Hepatitis in Substance Users. Available here.