A new survey of people who inject illicit drugs in the state of Washington yields positive and important findings for policy makers as the world struggles to deal with the COVID-19 pandemic, said authors of the survey by the 天美影视传媒 and Public Health-Seattle & King County.

Most people 鈥� 82% 颅鈥� who inject heroin and roughly half of methamphetamine users are interested in reducing or stopping their use and are open to a broad array of services to help them manage their substance use, according to the led by 鲍奥鈥檚 and Public Health-Seattle & King County.

The latest results of the survey, which has been conducted every two years since 2015, also show that possession of naloxone 鈥� a drug that rapidly reverses opioid overdose 鈥� has increased substantially. Researchers found that nearly 80% of respondents in King County and outside the county who use opioids possessed a naloxone kit in 2019, compared to when only 47% in King County and 24% outside the county possessed naloxone.

鈥淭hese surveys provide important insights into the complex lives of people who use drugs in our state and can be used to inform our health care, public health, social service, public policy and criminal legal system responses, particularly during and after the COVID-19 pandemic,鈥� said study co-author , principal research scientist at the institute.

During the COVID-19 crisis, syringe exchanges continue to operate across Washington state, although programs have had to substantially modify how they deliver services, including distributing prepackaged supplies, moving outdoors and providing mobile and delivery services.

Public Health-Seattle & King County is also offering screening and COVID-19 testing at the , Downtown Public Health, Monday through Friday from 1 to 4 p.m. (one of the sites participating in the survey). At other syringe-services program , providers are asking COVID-19 screening questions and providing information about testing locations and other resources, public health officials said.

鈥淧eople who inject drugs, and also smoke them, are at high risk for contracting and having serious consequences of COVID-19 and already use emergency health care resources at high rates,鈥� said Banta-Green.

Consequently, access to syringe services 鈥� which distribute clean syringes and help to reduce the risk of contracting or transmitting infectious diseases 鈥� during this crisis can help alleviate pressure for emergency medical care while also helping this at-risk population get treatment to reduce or stop their drug use.

鈥淭his report confirms that the majority of persons who inject drugs are interested in reducing or stopping their drug use and improving their health,鈥� said Dr. Jeff Duchin, Health Officer at Public Health-Seattle & King County. 鈥淭he syringe exchange provides an important entry point and ongoing resources to help connect people to treatment when they are ready.鈥�

For instance, programs such as Public Health-Seattle & King County鈥檚听听provides access to treatment co-located with needle exchange. The program lowers barriers to treatment safely and successfully.

Another important finding in the survey, Banta-Green pointed out, is that 68% of participants who have been diagnosed with hepatitis C remain untreated and were interested in treatment for that disease, which is good news since hepatitis C with a three-month course of medication.

鈥淲e are honored to work with our syringe-services partners across Washington state to better understand how we can best serve people who use drugs,鈥� said Banta-Green. 鈥淚t鈥檚 so important to understand that people are very interested in getting help, and that syringe exchanges provide an incredible array of life-saving services. They also provide ongoing personal relationships with members of our communities who are often in personal crisis and poor health.鈥�

The new Syringe Exchange Health Survey, on the Alcohol & Drug Abuse Institute鈥檚 website, consists of responses from 1,269 participants from most of the more than 30 fixed and mobile syringe services programs in 23 Washington counties.

Co-authors include Alison Newman, continuing education specialist, and Susan Kingston, project coordinator, UW Alcohol & Drug Abuse Institute; Sara Glick, research assistant professor, UW School of Medicine, Division of Allergy & Infectious Diseases; and Joe Tinsley, needle exchange coordinator, Public Health-Seattle & King County. This research was funded by the Washington State Health Care Authority, Division of Behavioral Health and Recovery.

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For more information, contact Banta-Green at calebbg@uw.edu.

Learn more about the 鲍奥鈥檚 Population Health Initiative: a 25-year, interdisciplinary effort to bring understanding and solutions to the biggest challenges facing communities.

A new article published by researchers from University of Puget Sound and 天美影视传媒 reports that, based on analysis of public wastewater samples in at least one Western Washington population center, cannabis use both increased and substantially shifted from the illicit market since retail sales began in 2014.

Led by chemist Dan Burgard, the research team analyzed wastewater samples collected from 2013-2016 from two treatment plants that service a community of two hundred thousand听in Western Washington.

鈥淲e set out to perform a wastewater-based analysis that explored the impact of newly legalized retail cannabis sales on its use, and to determine if this approach could estimate the size of the legal market place,鈥� says Burgard, who chairs the chemistry department at Puget Sound.

The researchers estimate that THC-COOH (the metabolite of psychoactive THC in cannabis created within the human body) found in wastewater has increased by 9% per quarter, on average, from December 2013 to December 2016. During this time, cannabis sales increased at nearly 70% per quarter, on average, for stores operating from August 2014 to December 2016.

鈥淕iven that wastewater represents a total population measure, these findings suggest that many established users switched very quickly from the illegal to the legal market,鈥� says Burgard. 鈥淭his is the strongest statement possible regarding displacement of the illegal market.鈥�

Caleb Banta-Green, interim director and principal research scientist at 天美影视传媒鈥檚 Alcohol and Drug Abuse Institute, is a co-author of the article and was a key researcher on the project.

鈥淭his project was designed to aid the understanding of how the sales of adult recreational cannabis impact its total consumption within a population,鈥� says Banta-Green. 鈥淲e believe this will be a valuable tool for local, state, national and international policy makers as they assess and consider Washington鈥檚 recreational cannabis law.鈥�

In the past six years nine U.S. states (Colorado, Washington, Alaska, Oregon, Nevada, California, Maine, Massachusetts, Vermont, Michigan, and the District of Columbia), as well as the countries of Uruguay and recently Canada, have legalized the adult use of recreational cannabis.

鈥淓xisting measures, particularly surveys are subject to important biases and limitations, including potential changes in self-report as social norms change as well as very limited information on the amount of THC actually consumed,鈥� Banta-Green notes. 鈥淲astewater based estimates help address these limitations.鈥�

The researchers note that their findings suggest that legalization is, in part, achieving one of its primary objectives which was to eliminate black market sales.

Funded in part by a grant from the National Institute on Drug Abuse, the research process included testing samples from 387 days spread over three years. The team utilized a new method that enables a complementary and potentially more timely and objective assessment of illicit drug consumption compared to existing measures.

Raw wastewater samples representing a full day are collected at a treatment plant and analyzed for drugs and their metabolites at extremely low concentrations (part per billion or part per trillion levels).听 These data can be used to track drug consumption trends, both legal and illegal, but not individual users. In some instances, the concentration of the metabolites can be used to 鈥渂ack calculate鈥� to the actual number of doses of drug used in a particular area.

When this research project was announced in 2015 and throughout its duration it has earned national and international press from media like , , , and .

The report, titled “Using Wastewater-Based Analysis to Monitor the Effects of Legalized Retail Sales on Cannabis Consumption in Washington State, USA,” was published in , a journal published by the Society for the Study of Addiction.

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For more information, contact Banta-Green at calebbg@uw.edu.

听

The grant was presented by Attorney General Bob Ferguson in an event at the UW’s Oct. 17.

The grant, to , research scientist, and her colleagues at the Institute, will assess and address gaps in science-based training and education for a number of groups: staff of community organizations that provide information to individuals suffering from chronic pain, health care providers and the general public.

“Chronic pain is a major public health issue,” Carlini said. “This project will offer non-judgmental, science-based information to clinicians and to the general public on the role of medical marijuana as an option in alleviating intractable pain in our state.”

The ultimate goal of the project is to increase awareness of the options available to treat pain and other medical conditions, and to decrease unnecessary suffering among people living with chronic pain. The project will provide and information and education about medical conditions and populations for whom cannabis is recommended, and for whom it is not recommended, as well as possible side effects and risks.

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It’s gonna happen!

But according to at least a third of us can’t keep these resolutions through the end of January, never mind an entire year, and four out of five of us will break them eventually.

“I don’t make them,” said of New Year’s resolutions. He’s the director of the at the 天美影视传媒 and has spent decades helping people, usually those in recovery for alcohol and substance use problems, stick to their resolutions.

“New Year’s is a time to reflect, see things differently or for the first time. People have the best of intentions around the holidays, but it often dissipates quickly,” he said. “The lastingness of a resolution depends on the initial level of commitment and degree to which it’s made public and implemented rapidly.”

Donovan suggests some steps to help overcome the holiday afterglow and make headway on life improvements long after you finish muddling through “Auld Lang Syne.”

Are you really ready to change? According to behavioral models of change, often people start in a “pre-contemplation” stage during which they don’t see or aren’t aware of a problem. It’s also called denial. “If you don’t consider a behavior as problematic, then you won’t see a need to change,” Donovan said. So be honest and realistic with yourself: If you don’t think you’re that overweight or out of shape, a gym membership probably won’t help you get fit. But if you begin contemplating the potential need to change and the pros and cons involved, that could be a signal that you’re ready.

Weigh the pros and cons. To drink less or to not to drink less, that is the question. Donovan said that you have to think through the good and the bad consequences of change, a strategy known as decisional balance. For instance, cutting back on your drinking will improve your health, but what will you do if it damages your relationship with your drinking buddies? If your drinking helps with your depression, how else can you cope that doesn’t involve alcohol? The point is to “become aware of the benefits of changing but also know the cons because those could be the barriers to following through,” Donovan said.

Spread the word. You’re more likely to stick to a resolution if you let people know your intentions. Then you’ll have witnesses to support you and remind you not to drink, smoke or whatever else you resolve to do.

Don’t dawdle. The longer you delay in making the resolution and then acting on it, the more likely you’ll let it fall by the wayside. “Many of us are procrastinators and we’re good at talking ourselves out of things,” Donovan said. So buy that exercise bike during New Year’s Day sales.

Change could take a while. There’s no magical answer to how long it will take for a new behavior to become permanent, but there are some predicting factors. “How firmly committed the person is and how well he or she has prepared to implement change probably contributes to the length and success of change,” Donovan said. In the meantime, it’s important to stay away from “slippery places” 鈥� or high-risk relapse situations 鈥� and have emotional and behavioral copings skills and social support. People often relapse, or break their resolutions and commitment to change. Likelihood of relapse among alcohol-dependent individuals who stop drinking through treatment or on their own is greatest in the first 90 days, Donovan said.

If you plan ahead, it’s just possible the old acquaintance of some bad habits will be, if not forgotten completely, perhaps at least greatly diminished.

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For more information, contact Donovan at 206-543-0937 or ddonovan@uw.edu.

Oh, the slippery slope. And it’s not just when snow is falling.

The omnipresence of alcohol at holiday gatherings and the social ease that a little buzz provides make it hard to limit ourselves. Risk of relapse among alcoholics is greater this time of year, when stress and negative emotions may mix at gatherings where alcohol has a central role.

, director of the at the 天美影视传媒, says that alcohol is a major issue around the holidays for both social drinkers and those recovering from alcoholism. He’s spent more than three decades treating people with alcohol and other addictions. He has advice for how to drink moderately, and treatment approaches he’s used with people recovering from alcohol problems.

So perhaps we can strive to be home, but not hammered, for the holidays.

For social drinkers and people hoping to curb their alcohol consumption, Donovan suggests following these guidelines.

• Count your drinks. In many cases, people lose track of how much they’ve had. This is especially true when they’re sharing a pitcher of beer and someone refills their glass 鈥� it’s easy for drinkers to not notice or say “yes” to more than they want to drink.
• Know a standard serving size. Large wine glasses, higher alcohol content in some beers and generous liquor pours in mixed drinks make the “I only had one!” claim questionable. There are online showing standard serving sizes for alcohol.
• One drink, one hour. Most people’s bodies can process about one drink per hour. “It’s like a funnel, you might take in lots of alcohol but the body cannot process it any faster,” Donovan said. Pace yourself to one drink an hour or so, and every hour or two you might take a drink “off” and have water or another non-alcoholic beverage instead. Also, make sure to have eaten something.
• Ginger ale looks like a cocktail. Teetotalers not wanting to attract attention or questions can stick to ginger ale or other non-alcoholic drinks that look like cocktails.
• Get support. is a support group that helps social drinkers who are not alcohol dependent achieve and maintain a goal of staying within safe drinking limits.

For people struggling with alcohol use or in recovery, Donovan advises:

• Say no. Firmly, confidently turn down drinks and become resistant to social pressure and arm-twisting. It’s a learned skill that takes practice. “It’s like a play. You need to rehearse your lines and convince the audience,” Donovan said. Some lines to try: “No, I’ve reached my limit” or “I’m not drinking tonight”. Donovan added that the drink refusal approach requires a commitment to yourself to abstain or have a drink limit. “If you’re not committed, it won’t help,” he said.
• 听Ride out cravings. Using a treatment strategy known as mindfulness, let yourself be aware of a desire, impulse or craving, then wait it out. Distract yourself 鈥� take a walk, strike up a conversation, move away from the liquor cabinet. Think of it as “urge surfing,” Donovan said, where you imagine your craving as a wave. The wave increases in intensity, heightens and then crests. As a surfer, you ride it out. Once the wave is gone, the power behind it dissipates.
• 听Look out for stinking thinking. In 12-step programs, stinking thinking is when you notice you’re beginning to think in a way that leads to drinking. It usually starts with a seemingly small decision, like running an errand that brings you close to a favorite bar or stopping by a holiday party. “It seemed to come out of nowhere” is how many people in treatment describe their relapses to Donovan. Think through the consequences of small decisions 鈥� “If I go to the party, what will I say if someone offers me a drink?”
• 听Support groups. Like Pavlov’s dogs salivating to the sound of a bell, people with alcohol problems are conditioned to crave alcohol in response to social and emotional cues. These cues, such as family conflicts, become more prominent around the holidays, Donovan said. Support and camaraderie of other people trying to stay sober and clean can help you get through this high-stress time. He suggests 12-step or mutual support programs like , or , and notes that people don’t have to be sober to join 鈥� they just have to have a desire to stop drinking.

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For more information, contact Donovan at 206-543-0937 or ddonovan@uw.edu.