Papers by Ricky Bluthenthal
Harm Reduction Journal, Feb 28, 2023
Background Naloxone is a medication that can quickly reverse an opioid overdose. Syringe service ... more Background Naloxone is a medication that can quickly reverse an opioid overdose. Syringe service programs (SSPs) are community-based prevention programs that provide a range of evidence-based interventions in the USA, including naloxone distribution. Attributes of SSPs make them ideal settings for naloxone distribution-they have staff and delivery models that are designed to reach people who use drugs where they are. We assessed which outer and inner setting factors of SSPs were associated with naloxone distribution in the USA. We surveyed SSPs in the USA known to the North American Syringe Exchange Network in 2019. Using the exploration, preparation, implementation and maintenance framework, we assessed inner and outer contextual factors associated with naloxone distribution among SSPs (n = 263 or 77% of SSPs). We utilized negative binomial regression to assess which factors were associated with the number of naloxone doses distributed and people receiving naloxone. Results SSPs reported distributing 710,232 naloxone doses to 230,506 people in the prior year. Regarding outer setting, SSPs located in areas with high levels of community support had a higher level of naloxone distribution (aIRR = 3.07; 95% confidence interval (CI): 2.09-4.51; p < 0.001) and 110% (p = 0.022) higher rate of people receiving naloxone (aIRR = 2.10; 95% CI 1.46-3.02; p < 0.001) in the past 12 months. The legal status of SSPs and the level of need was not significantly associated with naloxone distribution. Regarding inner setting, SSPs with proactive refill systems (aIRR = 2.08; 95% CI 1.27-3.41; p = 0.004), greater number of distribution days (aIRR = 1.09 per day; 95% CI 1.06-1.11; p < 0.001) and older programs (aIRR = 1.06 per year; 95% CI 1.02-1.11; p = 0.004) were associated with higher levels of naloxone distribution. Also, SSPs with proactive refill systems (aIRR = 2.23; 95% CI 1.38-3.58; p = 0.001); greater number of distribution days (aIRR = 1.04; 95% CI 1.02-1.07; p < 0.001) and older programs (aIRR = 1.11; 95% CI 1.05-1.17; p < 0.001) were associated with a higher number of people receiving naloxone. We identified outer and inner setting factors of SSPs that were associated with greater naloxone distribution. It is critical to ensure SSPs are adequately resourced to build community support for services and develop service delivery models that maximize naloxone distribution to address the nation's opioid overdose crisis.
JMIR Formative Research
Background Increased preexposure prophylaxis (PrEP) initiation is needed to substantially decreas... more Background Increased preexposure prophylaxis (PrEP) initiation is needed to substantially decrease HIV incidence among Black sexual minority men (BSMM). However, BSMM perceive others as PrEP candidates instead of themselves and are less likely than other groups to use PrEP if prescribed. Peers and smartphone apps are popular HIV prevention intervention tools typically used independently. However, they could be useful together in a multicomponent strategy to improve perceived HIV risk and PrEP initiation for this group. Information regarding attitudes and preferences toward this multicomponent strategy is limited. Objective The goal of this study is to obtain attitudes and perspectives regarding the design of a multicomponent intervention that uses a smartphone app and a peer change agent (PCA) to increase perceived HIV risk and PrEP initiation. The intervention will be refined based on thematic findings for a culturally responsive approach. Methods Data were obtained guided by life ...
Addiction Science & Clinical Practice, Dec 30, 2020
Nicotine & Tobacco Research, 2021
Introduction Young adult never-smokers who vape are at elevated risk of initiating cigarettes, wh... more Introduction Young adult never-smokers who vape are at elevated risk of initiating cigarettes, while young adults who smoke often begin vaping to substitute or reduce cigarette use. Reasons underlying different use patterns of tobacco products are not well-understood. Aims and Methods We conducted 1-on-1 qualitative interviews with young adults (N = 62) who vape in Los Angeles, California from June 2018 to June 2019. Participants were 18–25 years old (79% male; racially/ethnically diverse) and self-reported vaping ≥1x/week. We used a semi-structured interview guide and applied thematic analysis method to analyze data. Results Young adults initiated vaping due to peer socialization and e-liquid flavor novelty. They often reported vaping (after first smoking) due to a belief that e-cigarettes are healthier, social pressure to quit smoking, and convenience of use. Participants reported smoking (after first vaping) when traveling outside of the United States where vaping products were l...
RTI International. P.O. Box 12194, Research Triangle Park, NC 27709-2194. Tel: 919-541-6000; e-mail: [email protected]; Web site: http://www.rti.org, May 19, 2021
Second National Harm Reduction Conference, Oct 1, 1998
The American Journal on Addictions, 2022
Background and ObjectivesWhile inadequate nutrition can weaken the immune system and lead to nega... more Background and ObjectivesWhile inadequate nutrition can weaken the immune system and lead to negative health sequelae for vulnerable populations, little is known about nutritional intake among people who inject drugs (PWID). We aimed to quantify nutritional intake among PWID and to explore associations between protein intake and drug use.MethodsA cross‐sectional design was used to analyze self‐reported participant data. PWID were recruited from community settings in California in 2016/2017. Participants reported on food consumption per day for a 30‐day period, from which a continuous protein intake variable was created.ResultsModal characteristics of participants (N = 937) were: white (42.5%), male (75.3%), healthy body mass index (BMI) (56.6%), and unhoused (82.9%). Less than 1% of participants met or exceeded recommended guidelines for protein intake (0.80 g/day/1 kg body weight). The final multiple regression model found protein intake to be significantly positively associated wi...
Journal of Urban Health, 2021
Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exch... more Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011–2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86–14.27; GB with illegal income AOR = 13.55, CI = 4.57–40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94–70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13–4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18–0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00–4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.
Public Health Nursing, 2021
PurposeThis study explored potentially underreported healthcare contexts, clinical experiences, a... more PurposeThis study explored potentially underreported healthcare contexts, clinical experiences, and motivations for adherence in care among virally suppressed Black sexual minority men (BSMM) living with HIV (LWHIV) in Baltimore, MD.MethodsGo‐alongs with two virally suppressed BSMM LWHIV supplemented 27 in‐depth interviews of a larger qualitative study guided by Positive Deviance and Life Course Theory. The go‐alongs involved accompanying participants’ follow‐up HIV care visit to obtain a better account of contextual healthcare factors. Observations focused on (1) clinic location and resources, (2) sources of HIV and sexuality stigma or support in the clinic, and (3) patient‐provider interactions.ResultsWe found that facilitators and barriers to viral suppression for BSMM LWHIV included structural factors (i.e., healthcare setting, facility, and services), quality of patient‐provider interactions, and personal motivations to achieve viral suppression.ConclusionClinic accessibility, ...
The Cambridge Handbook of Substance and Behavioral Addictions, 2020
Nicotine & Tobacco Research, 2021
Introduction Previous studies suggest that young adults who vape nicotine experience difficulty w... more Introduction Previous studies suggest that young adults who vape nicotine experience difficulty when answering survey items assessing the quantity of vaping. The current study asked young adults who vape to provide suggestions for improving the scientific measurement of vaping. Aims and Methods We conducted semi-structured qualitative interviews with 62 young adults who vape in Los Angeles, California between June 2018 and June 2019. We analyzed participants' responses to the following question: “What do you think is the best way for us to understand how much people vape?” using thematic content analysis. Results We identified two major themes: (1) challenges stemming from differences between the way researchers query about vaping and how individuals self-monitor vaping frequency, and (2) insights for future measurement of vaping. Participants reported that challenges of accurately quantifying vaping were due to inherently hard-to-answer questions (eg, puffs per day), lack of aw...
International Journal of Drug Policy, 2021
OBJECTIVE Prior research has associated assisted injection with risk behaviors, but other risks s... more OBJECTIVE Prior research has associated assisted injection with risk behaviors, but other risks such as injury, missed veins, and incidental exposures to blood-borne infections during an injection episode have not been assessed. In the following, we present the frequency of these other risks and determine factors associated with missing a vein and incidental blood exposure among people who inject drugs (PWID). METHODS We conducted a cross-sectional analysis of data from PWID who were recruited using targeted sampling in Los Angeles and San Francisco, California, during 2016 and 2017. The analytic sample consist of 336 participants who reported providing injection assistance in the last 6 months. Multivariate logistic regression models were developed for reporting the following risks: missing a vein; getting the recipient's blood on the injection provider; and getting blood on clothes or surfaces. RESULTS In the last 6 months, the most common negative consequences were getting blood on clothes or surfaces (40%), getting the recipient's blood on the injection provider (23%), and missing a vein (17%). In multivariate logistic regression analysis, missing the vein was significantly associated with higher odds of assisting a leg injection while getting the injection recipient's blood on the provider or getting blood on clothes or nearby surfaces was associated with higher odds of assisting a groin injection injecting in the groin. CONCLUSION Providing injection assistance can result in incidental blood exposures and injury, particularly when injecting in sensitive locations on the body. Harm reduction interventions to reduce risks associated with this practice are essential to improving the well-being of PWID.
Journal of the Association of Nurses in AIDS Care, 2021
The goals and strategies of Black sexual minority men living with HIV (BSMMLWH) who achieve viral... more The goals and strategies of Black sexual minority men living with HIV (BSMMLWH) who achieve viral suppression require further investigation. This study explored treatment adherence strategies among BSMMLWH with sustained viral suppression. We conducted 27 in-depth qualitative interviews with BSMMLWH in Baltimore, Maryland, and Los Angeles, California, between December 2018 and May 2019. Interviews included questions guided by Positive Deviance and Life Course theoretical frameworks regarding multilevel factors and explicit strategies for antiretroviral therapy adherence. Themes regarding intentional, age group–specific strategies such as using technology (among younger men) and taking HIV medications with other daily pills (among older men) were identified. Participants also reported symbiotic goals and values that encouraged adherence, such as having a desire to live, strong familial relationships with clinicians, and support networks. Identifying personal goals and having supporti...
Translational Research, 2021
As COVID-19 accelerated throughout 2020, syringe service programs (SSPs) faced challenges necessi... more As COVID-19 accelerated throughout 2020, syringe service programs (SSPs) faced challenges necessitating programmatic adaptations to prevent overdose deaths while simultaneously keeping workers and participants safe from COVID-19. We used qualitative methods to gain an understanding of the social context within which SSPs are operating during the COVID-19 pandemic. We conducted 36 in-depth interviews with program representatives from 18 programs and used the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation framework to guide data analysis. We focused on 3 of the 4 EPIS constructs: Outer context, inner context, and innovation factors. Our data indicate that responding to the pandemic led to innovations in service delivery such as secondary and mail-based distribution, adoption of telemedicine for enrolling participants in medications for opioid use disorder (MOUD) and use of virtual training platforms for overdose prevention. We found high levels of staff and volunteer commitment, which was a cornerstone to the success of these innovations. We observed that many SSPs were short-staffed because of their commitment to safety, and some lost current funding as well as opportunities for future funding. Despite minimal staffing and diminished funding, SSPs innovated at an accelerated pace. To ensure the sustainability of these new approaches, a supportive external context (federal, state, and local policies and funding) is needed to support the development of SSPs’ inner contexts (organizational characteristics, characteristics of individuals) and sustainment of the innovations achieved regarding delivery of naloxone and MOUD.
Drug and Alcohol Dependence, 2021
Objective: Cannabis motivations have been studied extensively among patients of medicinal cannabi... more Objective: Cannabis motivations have been studied extensively among patients of medicinal cannabis dispensaries, but less is known about motivations in community samples of opioid-using people who inject drugs. Our objective is to describe cannabis use motivations associated with self-treatment of physical pain, emotional issues, and as an opioid substitute. Methods: Data come from 6-month follow-up interviews with people who inject drugs who participated in a study on the efficacy of an injection initiation prevention intervention in Los Angeles and San Francisco, California from 2016-18. The analytic sample consists of 387 people who inject drugs who reported past-month cannabis use. We developed multivariable logistic regression models by reported cannabis use motivations: physical pain relief, emotional problems, and opioid substitute. Results: The most common cannabis use motivations reported by people who inject drugs was to "get high," relieve physical pain and emotional problems, and reduce opioid use. In separate multivariate models, using cannabis for physical pain relief was associated with higher odds of using cannabis as a substitute for opioids; cannabis for emotional problems was associated with being diagnosed with depression; and cannabis as a substitute for opioids was associated with non-prescribed, non-injection methadone use. Conclusion: People who inject drugs reported using cannabis for health-related motivations. This motivation aligns with health needs and suggests the acceptability of cannabis use for health reasons in this population. Studies to determine the medical effectiveness of cannabis products for these common health and mental health needs among people who inject drugs are needed.
International Journal of Drug Policy, 2020
Protein kinase C signals thromboxane induced increases in fibronectin synthesis and TGF.p bioacti... more Protein kinase C signals thromboxane induced increases in fibronectin synthesis and TGF.p bioactivity in mesangial cells. Previous studies have demonstrated that thromboxane (TX) stimulates matrix protein synthesis in mesangial cells (MC), and that this action is signalled by receptor mediated activation of protein kinase C (PKC). In the present study, we examined the hypothesis that activation of PKC by TX signals increases in transforming growth factor /3 (TGF-/3) bioactivity, which in turn induces enhanced matrix protein synthesis. In cultured rat MC, the TXAJ prostaglandin endoperoxide analogue U-46619, but not exogenous human platelet TGF-/31, activated PKC as reflected by enhanced in situ phosphorylation of MARCKS protein, an endogenous substrate of PKC. U-46619 and TGF-/31 stimulated fibronectin (Fn) synthesis in MC, as shown by [35S]methionine incorporation into immunoprecipitable Fn. Pan-specific rabbit anti-TGF-f3 antibody blocked the increases in Fn synthesis induced by exogenous TGF-/3 and those induced by U-46619 at 24 to 72 hours after addition. Anti-TGF-/3 antibody did not block the small increases in Fn synthesis observed six hours after addition of U-46619, suggesting that this acute response was not dependent on TGF-/3. Anti-TGF-13 antibody also failed to block activation of PKC by U-46619. U-46619 and 50 n of the PKC agonist phorbol dibutyrate (PDBu) significantly increased both the active fraction and total (latent plus active) TGF-/3 in MC culture media, as assayed with the mink lung epithelial cell bioassay system. PKC inhibition with bisindolylmaleimide GF 109203X (GFX) or down-regulation of PKC in MC by prior exposure to a high concentration (0.5 j.tM) of phorbol myristate acetate (PMA) blocked increases in TGF-/3 bioactivity induced by either U-46619 or PDBu. PKC down-regulation in MC also blocked increases in Fn synthesis induced by U-46619. By contrast, exogenous TGF-/3 stimulated Fn synthesis in both intact MC and in MC with down-regulated PKC. The findings indicate that activation of PKC by U-46619 signals an increase in TGF-j3 bioactivity, which in turn stimulates Fn synthesis in MC by processes not dependent on PKC. examined the possibility that TX activation of PKC is a signal to increase TGF-/3 bioactivity in MC, which in turn mediates the sustained increases in Fn synthesis observed in response to TX. Rat MC culture
Annals of Emergency Medicine, 2020
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Drug and Alcohol Dependence, 2020
Injection drug initiation usually requires assistance by someone who already injects drugs. To de... more Injection drug initiation usually requires assistance by someone who already injects drugs. To develop interventions that prevent people from starting to inject drugs, it is imperative to understand why people who inject drugs (PWID) assist with injection initiation. Methods: Injection initiation history and motives for initiating others were collected from 978 PWID in Los Angeles and San Francisco, CA, from 2016-17. This article documents motivations for providing injection initiation assistance and examines demographic, economic, and health-related factors associated with these motivations using multivariable logistic regression modeling. Results: Among the 405 PWID who ever facilitated injection initiation, motivations for initiating were: injury prevention (66%), skilled at injecting others (65%), to avoid being pestered (41%), in exchange for drugs/money (45%), and for food/shelter/transportation (15%). High frequency initiation (> 5 lifetime injection initiations) was associated with all motivations except for being pestered. Initiation to prevent injury was associated with being female. Initiation due to pestering was associated with recycling income and sex work. Being skilled was associated with age and HIV status, while initiation for money or drugs was associated with age, race, education, social security income, and substance use treatment. Lastly, initiation for food, shelter, or transportation was associated with age, sexual orientation and education level. Conclusion: Diverse factors were associated with reported motivations for assisting someone to initiate injection for the first time. Our analysis underscores the need for prevention strategies focused on improving economic and housing conditions along with implementing drug consumption rooms to disrupt the social processes of injection initiation.
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Papers by Ricky Bluthenthal