A prospective cohort of treatment-seeking patients with problematic use of prescription narcotic drugs: study protocol and baseline characteristics.

Background: There is limited knowledge on long-term outcomes of tapering treatment for individuals with problematic use of prescription narcotics, including opioids and benzodiazepines. The overall aim of the study is to investigate clinical trajectories and treatment outcomes of patients seeking treatment in addiction care.

Methods: This paper presents the study protocol and baseline characteristics of a cohort of patients seeking treatment for problematic use of prescription narcotic drugs at specialized outpatient addiction services.

Antibiotic prophylaxis reduced broad-spectrum antibiotics and length of stay in ICU patients with alcohol withdrawal induced refractory delirium tremens.

Background: Pneumonia is a well-known complication in patients with severe alcohol withdrawal syndrome (SAWS). Antibiotic prophylaxis in ICU treated SAWS patients may be beneficial but data is lacking. The aims of this study were to investigate the effect of introduction of trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, on use of broad-spectrum antibiotics and ICU length of stay (LOS) in SAWS patients with refractory delirium tremens (rDT).

At the tipping point: Patient experiences of addiction to benzodiazepines and motivation to seek treatment.

Introduction: Addiction to benzodiazepines is a serious problem, and it is important to better understand how individuals can be motivated to quit. Few studies have investigated patients' perceptions and experiences of addiction to benzodiazepines and there is a need to better understand the influence of motivational factors on treatment seeking.

Methods: In this qualitative study, nineteen adults undergoing treatment for addiction to benzodiazepines participated in semi-structured individual interviews which were analyzed using reflexive thematic analysis.

'Before, we ended up in conflicts, now we can provide support'-Experiences of Community Reinforcement and Family Training (CRAFT) for parents of young adults with hazardous substance use.

Background: The prevalence of hazardous substance use is highest in the age between 18 and 25, but few young adults enter treatment. Community Reinforcement and Family Training (CRAFT) is a support program for concerned significant others (CSOs) of individuals with diverse substance use disorders and is proven efficacious in promoting treatment entry. The aim of the current study was to investigate the experiences of CRAFT among parents of substance using young adults.

Changes in hepatitis C virus prevalence and incidence among people who inject drugs in the direct acting antiviral era.

Background: The World Health Organization (WHO) has set a goal to eliminate hepatitis C virus (HCV) infection by 2030, including a 90% reduction of HCV incidence. With the introduction of a needle syringe program (NSP) in Stockholm, Sweden, and unrestricted availability of direct acting antiviral (DAA) treatment, we investigate the change of prevalence and incidence of HCV infection among people who inject drugs (PWID) over time.

Methods: All persons attending the Stockholm NSP 2013-2021 (n=4,138) were included.

A study protocol for a European, mixed methods, prospective, cohort study of the effectiveness of naloxone administration by community members, in reversing opioid overdose: NalPORS.

Background: Worldwide, opioid use causes more than 100,000 overdose deaths annually. Naloxone has proven efficacy in reversing opioid overdoses and is approved as an emergency antidote to opioid overdose. Take home naloxone (THN) programmes have been introduced to provide 'community members', who are likely to observe opioid overdoses, with naloxone kits and train them to recognise an overdose and administer naloxone.

Legal Minors Who Inject: Differences in Socio-Demographics and Treatment Needs Compared to Adults in a Swedish National Sample of People with Injecting Drug Use.

Background: Injection drug use among legal minors is under-researched. Although the population may be small in absolute terms, treatment needs may be greater than for those who began injecting as adults. Such knowledge may help tailor services more effectively.

Real-world hepatitis C treatment outcomes and reinfections among people who inject drugs at a needle and syringe program in Stockholm, Sweden.

Background: People who inject drugs (PWID) represent a population with an increased prevalence of hepatitis C (HCV) infections. HCV treatment among PWID is essential to reach the WHO goal of eliminating HCV as a major public health threat by 2030. Despite better understanding of PWID subgroups and changes in risk behaviors over time, more knowledge about HCV treatment outcomes in different HCV prevalence populations and settings is warranted to enhance the continuum of care.

Sweden's first Take-Home Naloxone program: participant characteristics, dose endpoints and predictors for overdose reversals.

Background: Opioid overdoses are a growing concern, particularly among people who inject drugs. Sweden, with a comparatively high proportion of drug-related mortality, introduced its first Take-Home Naloxone (THN) program in 2018, at the Stockholm needle and syringe program (NSP). In this study we compare THN participant characteristics regarding refills and overdose reversals as well as investigate predictors associated with number of reversals.

Take-Home Naloxone and risk management from the perspective of people who survived an opioid overdose in Stockholm - An analysis informed by drug, set and setting.

Background: Take-Home Naloxone (THN) programs were introduced in Sweden in 2018 - a country with one of the highest rates of overdose mortality in the EU and a severe stigmatisation of people who inject drugs. This qualitative study builds on the international research that has expanded a previously narrow and medical focus on overdose deaths. It uses Zinberg's framework to look beyond the role of the "drug" to include the attitudes and personality of the person ("set") and contextual factors ("setting").

A shift in focus: Mothers' descriptions of sharing a child with a co-parent with unhealthy alcohol use after participating in a support program.

Background: Unhealthy alcohol use (UAU) affects not only the drinking individual, but also significant others (SOs), such as partners and children. Most of the harm to others caused by alcohol can be attributed to common, moderate drinking patterns, but existing studies have mainly included SOs of individuals with severe UAU. There is a need for increased knowledge regarding SOs of individuals in an earlier stage of UAU and efficacious support programs for this group.

Psychometric evaluation of a Swedish version of the Impaired Control Scale for individuals with alcohol use disorder.

The aim of this study was to evaluate the psychometric properties of a Swedish version of the Impaired Control Scale. Impaired control (IC) over alcohol consumption is a core symptom of alcohol use disorder and a predictor of treatment outcome, but measures of IC are not well utilised in clinical practice. The study comprised 250 individuals from a randomised controlled trial conducted at an adult outpatient addiction clinic in Sweden.

Alcohol as a risk factor for mortality in liver transplant patients in Sweden.

Objectives: Liver transplantation (LT) is the only available cure for end-stage liver disease and one of the best treatment options for hepatocellular carcinomas (HCC). Patients with known alcohol-associated cirrhosis (AC) are routinely assessed for alcohol dependence or abuse before LT. Patients with other liver diseases than AC may consume alcohol both before and after LT.

An online self-directed program combining Community Reinforcement Approach and Family Training and parenting training for concerned significant others sharing a child with a person with problematic alcohol consumption: a randomized controlled trial.

Background: There is an urgent need for interventions helping children affected by parental problematic alcohol consumption (PAC). Such interventions could target partners to individuals with PAC, partners who often themselves show impaired quality of life and mental health. The aim of this study was to investigate the efficacy of an online self-directed intervention combining components from Community Reinforcement Approach and Family Training (CRAFT) with a parenting training program for concerned significant others (CSOs) sharing a child with a co-parent with PAC.

Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden.

Purpose: Needle syringe programs (NSP) significantly reduce risk behavior and HIV and hepatitis transmission in people who inject drugs (PWID). However, PWID are underrepresented in studies on health-related quality of life (HRQoL), representing a barrier to evaluate effects of public health and preventive measures related to injecting drug use. In this study, we investigate how well the two questionnaires EQ-5D-3L and SF-6D measure health in PWID.

A rapid assessment of take-home naloxone provision during COVID-19 in Europe.

Background: In March 2020, the World Health Organization declared COVID-19 a global pandemic. In the following weeks, most European countries implemented national lockdowns to mitigate viral spread. Services for people who use drugs had to quickly revise their operating procedures to rearrange service provision while adhering to lockdown requirements.

Univariable associations between a history of incarceration and HIV and HCV prevalence among people who inject drugs across 17 countries in Europe 2006 to 2020 - is the precautionary principle applicable?

BackgroundPeople who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes.AimWe aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe.MethodsAggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006-2020; n = 52,368 HIV+/-; n = 47,268 HCV+/-).

Hepatitis C elimination in Sweden: Progress, challenges and opportunities for growth in the time of COVID-19.

Background & Aims: In 2014, the burden of hepatitis C virus (HCV) in Sweden was evaluated, to establish a baseline and inform public health interventions. Considering the changing landscape of HCV treatment, prevention, and care, and in light of the COVID-19 pandemic, this analysis seeks to evaluate Sweden's progress towards the World Health Organization (WHO) elimination targets and identify remaining barriers.

Methods: The data used for modelling HCV transmission and disease burden in Sweden were obtained through literature review, unpublished sources and expert input.

Absence of interferon-λ 4 enhances spontaneous clearance of acute hepatitis C virus genotypes 1-3 infection.

Objectives: Absence of a functional interferon-λ 4 (IFN-λ4) gene () predicts spontaneous resolution of acute hepatitis C virus (HCV) infections in regions with a predominance of genotype 1, whereas variants of the inosine triphosphate pyrophosphatase (ITPase) gene () entailing reduced activity associate with increased sustained virologic response rates following some therapeutic regimens. This study aimed at investigating the impact of on acute HCV genotype 2 or 3 infections, and whether ITPase activity influenced outcome.

Materials And Methods: Two hundred and seven people who injected drugs (PWID) with documented anti-HCV seroconversion, and 57 PWID with reinfection with HCV were analyzed regarding (rs368234815 and rs12979860) and (rs1127354 and rs7270101), and longitudinally followed regarding HCV RNA.

Alcohol and illicit and non-medical prescription drug use before and during pregnancy in Stockholm, Sweden: A cross-sectional study.

Objectives: To provide current estimates of alcohol and drug use among pregnant women attending antenatal care lectures in preparation for childbirth in Stockholm, Sweden.

Study Design: A cross-sectional study. Data was collected anonymously among women attending lectures in preparation for childbirth.

Health literacy and changes in pattern of drug use among participants at the Stockholm Needle Exchange Program during the COVID-19 pandemic.

Background And Aims: People who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden's initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown.

Not Enough Money and Too Many Thoughts: Exploring Perceptions of Mental Health in Two Ugandan Districts Through the Mental Health Literacy Framework.

Mental health disorders account for a heavy disease burden in Uganda. In order to provide culturally appropriate mental health prevention and treatment approaches, it is necessary to understand how mental health is conceptualized in the population. Three focus group discussions (FGDs) and 31 in-depth interviews (IDIs) were conducted with men and women aged 14 to 62 years residing in rural, urban, and semi-urban low-income communities in central and western Uganda to explore perceptions and knowledge of mental health.

A prospective cohort study of risk behaviours, retention and loss to follow-up over 5 years among women and men in a needle exchange program in Stockholm, Sweden.

Background: Needle exchange programs (NEP) are important in reducing risk behaviours among people who inject drugs (PWID), also exposed to HIV and hepatitis C (HCV) through injecting drug use (IDU). Women (WWID) compared to men who inject drugs (MWID), are particularly vulnerable with complex needs, however less is known about their risk determinants and NEP outcomes.

Methods: In an open prospective NEP cohort, 697 WWID and 2122 MWID were followed, 2013-2018.