Publications by authors named "Susan G Sherman"

Background: The COVID-19 pandemic highlighted the salience of material needs and financial precarity on mental health and distress. Women who use drugs (WWUD) experienced significant mental distress and multiple material need insecurities before the pandemic. However, research is limited on the nature of these insecurities during the pandemic despite both material scarcity and mental distress placing WWUD at greater risk of drug-related harms such as overdose.

View Article and Find Full Text PDF

Harm reduction programs provide tools that enable people who use drugs to do so more safely in a nonstigmatizing environment without the goal of them necessarily seeking treatment or abstinence. Most harm reduction programs in the United States distribute sterile syringes and naloxone and safely dispose of used syringes and other drug use supplies. Many also provide drug checking services, and other safer use supplies.

View Article and Find Full Text PDF

Background: While the unregulated drug market has seen dramatic increases in fentanyl adulteration in the past decade, other adulterants have impacted the recent volatility of the drug supply. There has been recent documentation related to the presence of wound-associated substances; however, there is a lack of data showing the prevalence of these substances across unregulated drug market samples over time. The aim of this paper is to examine known and potential wound-associated agents' (xylazine, levamisole, medetomidine) prevalence in Maryland's unregulated drug supply.

View Article and Find Full Text PDF

Background: Perceived HIV risk may impact willingness to initiate PrEP among people who inject drugs (PWID).

Methods: We analyzed baseline data from PrEP eligible PWID in Baltimore, MD. Risk perception was assessed by PWID relative to the average risk of their age group categorized as: higher-than, lower-than, or about average.

View Article and Find Full Text PDF

Background: Longitudinal studies of future overdose risk among people who inject drugs (PWID) are needed to inform planning of targeted overdose preventions in the United States.

Methods: The Integrating Services to Improve Treatment and Engagement (INSITE) study followed 720 PWID between June 2018 and August 2019 to evaluate the delivery of mobilized healthcare services in Baltimore, Maryland. The present analyses used logistic regression to identify baseline characteristics predictive of non-fatal or fatal overdose during the 6-month follow-up among 507 participants with overdose information.

View Article and Find Full Text PDF

Introduction: Psychological resilience has emerged as a key construct of interest in the study of substance use. However, very few studies have examined resilience among individuals who are actively using drugs. Furthermore, many studies of psychological resilience have focused on individual-level factors.

View Article and Find Full Text PDF

Background: Hepatitis C virus (HCV) infection and hazardous alcohol use are both preventable causes of morbidity and mortality among people who inject drugs (PWID). In the general population, hazardous alcohol is associated with a reduced likelihood of HCV treatment initiation. Less is known about the prevalence and impact of hazardous alcohol use on direct-acting antiviral (DAA) therapy initiation among PWID with active injection drug use.

View Article and Find Full Text PDF

Background: Over 107,000 people died in the United States (U.S.) from drug overdose in 2022, with over one million overdose deaths since 1999.

View Article and Find Full Text PDF

Background: Despite the widespread use of the phrase "harm reduction" and the proliferation of programs based on its principles during the current opioid epidemic, what it means in practice is not universally agreed upon. Harm reduction strategies have expanded from syringe and needle exchange programs that emerged in the mid-1980s primarily in response to the HIV epidemic, to include medication for opioid use disorder, supervised consumption rooms, naloxone distribution, and drug checking technologies such as fentanyl test strips. Harm reduction can often be in tension with abstinence and recovery models to address substance use, and people who use drugs may also hold competing views of what harm reduction means in practice.

View Article and Find Full Text PDF

As in much of the United States, there have been significant increases in overdose deaths among non-Hispanic Black and Hispanic/Latinx populations in Rhode Island over the past decade. Given the shifting dynamics of the overdose epidemic, there is an urgent need for focused interventions that address the specific needs of diverse communities. This study explores differences in drug use patterns, harm reduction behaviors and types and barriers to treatment by race and ethnicity.

View Article and Find Full Text PDF

Objective: People who use opioids are vulnerable to sleep disturbances due to a range of factors, including the substances they use and the various structural vulnerabilities they face. We aimed to understand the burden of sleep-related impairment and problems pertaining to sleep context and schedule among people who use opioids.

Methods: We explored sleep quality and problems among a suburban sample of people who use opioids experiencing extensive structural vulnerabilities (N = 170).

View Article and Find Full Text PDF

Background: Prosecutorial discretion to pursue or decline criminal charges is a powerful mechanism determining criminal justice outcomes among people who use drugs (PWUD). In the US, prosecutors are increasingly employing this tool to prevent arrest, incarceration, and subsequent health and social harms among PWUD. Many cite harm reduction as a basis for these reforms; however, the extent of prosecutors' knowledge and understanding of harm reduction principles, and how they are operationalized in the policy process, remains unclear.

View Article and Find Full Text PDF

Background: Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via prosecutorial discretion-or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD).

View Article and Find Full Text PDF

We assessed acceptability of nonoral HIV pre-exposure prophylaxis (PrEP) formulations among transgender women (TW) engaged in street-based sex work in Baltimore, Maryland. In a -means cluster analysis, TW (=36) were partitioned into groups characterized by high interest in long-acting injectable PrEP only (, 36%), high interest in injectables and subdermal implants (, 36%), and low interest across PrEP formulations (, 28%). TW's interest in novel PrEP agents varied widely across formulations (range: 22-66%) and clustered around numerous relational, occupational, and structural factors, highlighting the importance of availing multiple PrEP formulations for this impacted population.

View Article and Find Full Text PDF

Background And Aims: People who inject drugs (PWID) are at risk for adverse outcomes across multiple dimensions. While evidence-based interventions are available, services are often fragmented and difficult to access. We measured the effectiveness of an integrated care van (ICV) that offered services for PWID.

View Article and Find Full Text PDF

Objective: To examine experiences of intimate partner violence (IPV) screening among women who sell sex.

Design: A qualitative descriptive study.

Setting: Telephone interviews during the COVID-19 pandemic (June 2020 to October 2020).

View Article and Find Full Text PDF

Background: Overdose deaths in the United States rose substantially during the COVID-19 pandemic. Disruptions to the drug supply and service provision introduced significant instability into the lives of people who use drugs (PWUD), including volatility in their drug use behaviors.

Methods: Using data from a multistate survey of PWUD, we examined sociodemographic and drug use correlates of volatile drug use during COVID-19 using multivariable linear regression.

View Article and Find Full Text PDF

Background: The legal enforcement of drug possession is associated with a host of negative consequences for people who use drugs (PWUD), has demonstrated little effectiveness at curbing drug use, and has contributed to lasting financial, social, and health-related racial disparities in Black and Brown communities in the United States (U.S.).

View Article and Find Full Text PDF

Background: Overdose prevention centers (OPCs) are being implemented in the United States as a strategy to reduce drug-related mortality and morbidity. Previous studies have suggested that people who use drugs (PWUD) with a history of criminal legal system (CLS) involvement (e.g.

View Article and Find Full Text PDF

Background: Sex workers, those who trade sex for monetary or nonmonetary items, experience high rates of HIV transmission but have not been adequately included in HIV prevention and Pre-Exposure Prophylaxis (PrEP) adherence program development research. Community-empowered (C.E.

View Article and Find Full Text PDF

The continued prevalence of xylazine in the illicit drug market has necessitated development of quick and simple methods for identification, including lateral flow immunoassays (also known as "test strips"), like those frequently used to detect fentanyl. This study explored the drug checking applicability of the first publicly available xylazine test strips (XTS) using four sub-studies: reproducibility (i.e.

View Article and Find Full Text PDF

Background: The national overdose crisis is often quantified by overdose deaths, but understanding the traumatic impact for those who witness and respond to overdoses can help elucidate mental health needs and opportunities for intervention for this population. Many who respond to overdoses are people who use drugs. This study adds to the literature on how people who use drugs qualitatively experience trauma resulting from witnessing and responding to overdose, through the lens of the Trauma-Informed Theory of Individual Health Behavior.

View Article and Find Full Text PDF

Harm reduction and opioid treatment programs (OTPs) modified service delivery based on rapid changes to state and federal regulations during the COVID-19 pandemic. There is little evidence on how these regulations changed the delivery of medication for opioid use disorder and harm reduction services and whether certain regulations should be made permanent. This study explores how harm reduction OTPs across the United States leveraged changes in regulations and responded to impacts of COVID-19 to continue providing services and perspectives on future legislation that regulates their practice and practice sites.

View Article and Find Full Text PDF

Introduction: Overdose prevention sites (OPS) are evidence-based interventions to improve public health, yet implementation has been limited in the USA due to a variety of legal impediments. Studies in various US settings have shown a high willingness to use OPS among urban and rural people who inject drugs, but data among people who use drugs (PWUD) via non-injection routes of administration in suburban areas are lacking.

Methods: We utilized cross-sectional data from a sample of suburban PWUD who have not injected drugs in the past 3 months (N = 126) in Anne Arundel County, Maryland.

View Article and Find Full Text PDF