Harm Reduction Journal最新文献

Background: As the first EU country to enact laws regulating the non-medical use of cannabis and with established legislation for the cultivation and production of cannabis for medical purposes and scientific research, Malta is at the forefront of cannabis regulation and research initiatives. Despite this context, healthcare professionals' attitudes, beliefs, and knowledge regarding medicinal cannabis remain variable. We assess these constructs and examine perceived barriers to clinical integration.

Methods: A cross-sectional survey was distributed to doctors and pharmacists across Malta (n = 198). Data analysis included independent samples t-tests, Pearson correlation analyses, and hierarchical regression to examine demographic influences, professional comparisons, and predictors of prescription attitudes.

Results: Most professionals acknowledged medicinal cannabis's therapeutic benefits but exhibited notable hesitancy in clinical practice, largely due to insufficient formal guidelines and inadequate education. No significant gender differences were observed, and only a weak correlation emerged between age and attitudes among male doctors. The strongest predictor of willingness to prescribe medicinal cannabis was doctors' attitudes, outweighing formal education or knowledge.

Conclusions: Despite broad acknowledgment of potential therapeutic benefits, Maltese healthcare professionals remain cautious due to insufficient training and unclear guidelines. Enhancing evidence-based education and providing clear prescribing frameworks may significantly boost clinicians' confidence and willingness to integrate medicinal cannabis into clinical practice.

This article examines women's accounts of using performance and image-enhancing drugs in the context of fitness and strength-training. It explicitly engages in a mode of feminist knowledge production to rethink the harms women experience as a feature of epistemic injustice and gendered discrimination rather than personal inability, consumption or drug effects alone. Drawing on theorisations of epistemic agency and injustice (Fricker, 2007; Haraway, 1988) alongside 10 qualitative interviews with women who use substances for strength-training in Melbourne, Australia, we attend to the social and political features of drug consumption, and women's accounts of bodily transformation and harms. Women overwhelmingly described consumption in relation to enhanced autonomy, with substances functioning as technologies of self-realisation within domestic and work responsibilities and gendered relations of power, as well as a route to enhanced social lives. In contrast to epistemically authoritative discourses in which women have little knowledge of the substances they are consuming and knowingly downplay the potential for side effects, our participants possessed detailed forms of knowledge and skill, and actively sought to monitor and prevent side effects, including virilisation, in the absence of reliable, gender-sensitive health information and healthcare. The most pressing forms of harm women experienced were gender-related stigma and discrimination, and insufficient gender-specific healthcare, related, in part, to epistemic exclusion and injustice in research and healthcare. By prioritising women's accounts and attending to embodiment and social practices, our analysis complicates normative knowledge claims about women's risk, coercion and pathologies, and suggests new epistemic resources for understanding women's consumption as socially and materially meaningful, and enhancement harm reduction more broadly.

Introduction: The Spruce Bough is the first supportive living facility in Yellowknife, Northwest Territories, and hosts the first long-term residential managed alcohol program (MAP) in northern Canada. The program accepts individuals who have at least two co-morbid mental health, physical health, substance use, and/or mobility concerns. This study sought to hear from residents about their experiences in the program.

Method: This study utilized a community-based participatory approach including the residents of the Spruce Bough in development, design, and data analysis, with the aim of generating results that would improve the lives of residents. Resident co-researchers used inductive coding to draw themes from statements gathered through focus groups and interviews and used these to develop recommendations to improve resident wellness for Spruce Bough leadership.

Results: Residents reported that life was good at Spruce Bough, they had what they needed, and that staff were supportive and helpful. Concerns included unmet needs for special meals for individuals with specific health-related dietary needs; the disruptive behaviour of individuals drinking outside the MAP; and disrespect felt by residents through actions or comments by staff.

Conclusion: The Spruce Bough supportive living model is seen as successful by residents; however, they identified potential areas of improvement. Community-based participatory research allowed residents to provide recommendations to be shared with service providers and funders for continued quality improvement. The insights provided and the interest in participation shown by residents indicate that the program would benefit from creating an ongoing mechanism to include resident feedback in decision making.

Background: People who use drugs (PWUD) and Indigenous-PWUD in rural and remote communities are met with considerable barriers in access to opioid agonist treatments (OAT) in comparison to their urban counterparts. OAT is met with low rates of uptake and retention owing to clinic policies limiting access to take-home doses. Digital technologies may improve access to OAT for PWUD in rural and remote communities. The objective of this study was to understand willingness to use an asynchronous witnessed-dosing phone application among rural and remote PWUD.

Methods: Qualitative semi-structured interviews were conducted with PWUD in rural and small communities in British Colombia, Canada (n = 32). Participants had to be ≥ 19 years old and have been on a prescribed OAT program within the 1-year of when the study began. A content analysis was completed on interview transcripts based on categories identified by the research team.

Results: Participants described access barriers to OAT medications, which was contingent upon housing-related factors. Regardless of living in town, in coastal communities, or on Tla'amin Nation treaty lands, participants described accessing OAT medications as restricting, impractical, and stigmatizing. When presented with a potential alternative delivery method via an asynchronous virtual application, participants described potential improvements in not only access to their OAT medications, but overall quality of life through, independence and increased opportunities to engage in day-to-day activities. Participants noted potential difficulties in keeping mobile devices.

Conclusions: Our findings help illustrate how current OAT prescribing practices and the challenges with requiring in-person witnessed doses for people living in rural and remote communities, exercising control over OAT patients, ultimately limiting the autonomy of PWUD. There is a clear need to implement virtual OAT programs to improve access to OAT medications.

Objective: To synthesise original research on the distinct challenges of regulating the online sector, and the efficacy of public health legal interventions aimed at reducing online gambling harm.

Background: Both legal and public health scholars increasingly view gambling as a public health concern. Gambling puts individuals at risk of a range of harms, including related to finances, relationships, mental health, physical health, employment/education, and criminal activity. Harmful gambling can extend beyond the realms of individual harm to affect others including wider society. Online gambling is growing in many countries-e.g. it accounts for 44% of gambling turnover in the UK-and it is seen as especially harmful compared to land-based gambling due to the accessibility, and fast-paced nature of the products available. In addition, there are distinct harms associated with the overlap between gaming and gambling, most prominently through the challenges that exist in the regulation of loot boxes. Legal and public health scholars recommend legal interventions to reduce the harms of gambling, including online gambling.

Methods: Following a PICOST inclusion/exclusion criteria, we completed a comprehensive scoping review of scientific and legal data sources to ascertain the efficacy of legal interventions on reducing online gambling harms. A narrative synthesis of the included studies was completed.

Results: We include 27 data sources which either described distinct challenges of regulating online gambling or evaluated the efficacy of laws and regulations. Current gambling harm reduction research is heavily focused on using an individual approach, rather than a systems approach. When a systems approach is taken, it often prioritises tackling unlicensed gambling and blocking mechanics, which require a comprehensive delivery strategy to be effective. Significant gaps exist in examining the effectiveness of interventions on subgroups of the population.

Conclusions: Inadequate legal and regulatory frameworks have played a crucial role in the proliferation of online gambling harms; studies vary in their explanation for this inadequacy. There is an urgent need for more robust research on law, regulation, and online gambling harms to critically explore the implications of technology, ongoing innovation, and the intervention generated inequalities of regulating online gambling.

Background: Benzodiazepines are widely prescribed but are associated with significant risks, particularly when used long-term. The anxiolytic and hypnotic properties of these medications increase their risk of dependence, which can lead to nonmedical and illicit use. Illicit use further compounds these harms, particularly with the emergence of potent novel benzodiazepines on the unregulated market. While tapering remains the standard treatment, not all individuals seek discontinuation. In such cases, harm reduction becomes a key approach to minimise associated risks. This review aimed to identify and synthesise existing harm reduction approaches for people using benzodiazepines.

Method: A systematic search was conducted across four databases, PsycINFO (n = 183), MEDLINE (n = 345), Web of Science (n = 382), and Embase (n = 940), following the PRISMA guidelines. Searches were carried out between February 14 and March 30, 2024, using terms related to harm reduction and benzodiazepines. The search was re-run on July 7, 2025, using the same strategy across all four databases.

Results: Thirty-five studies were included and grouped into the following themes: direct interventions (n = 16), policy approaches (n = 9), and population-specific approaches (n = 10). Among direct interventions, drug checking was the most frequently reported approach, with advanced techniques improving the detection of novel benzodiazepines and prompting safer use practices. Benzodiazepine agonist prescribing during the COVID-19 pandemic has yielded positive outcomes; conversely, policy responses such as rescheduling and prescribing changes indicated mixed results. While some studies reported reduced use and improved treatment engagement, others highlighted unintended consequences that may displace or exacerbate harm. Specific populations, such as young people, those who inject benzodiazepines, and members of online communities, highlight the diverse demographics of people who use benzodiazepines and emphasise the importance of developing tailored responses to address unique needs.

Conclusion: Drug checking emerged as the most widely reported harm reduction approach for benzodiazepine use, with consistent positive outcomes across studies. Prescribing and policy interventions demonstrated variable impacts, often influenced by broader systemic factors. Critically, a clear gap remains in harm reduction approaches for those not seeking treatment, highlighting a need for inclusive, flexible and pragmatic responses. There is also a need for more robust evaluation of harm reduction interventions to strengthen the evidence base and inform practice.

Background: Harm reduction techniques such as supervised injection facilities and drug checking are evidence-based strategies for reducing fatal overdoses. Despite the evidence in support of these interventions, Irish drug policy experienced delays in implementation of these strategies. This study considers the perceived impacts of delayed implementation of the supervised injection facility and drug checking in Ireland.

Methods: A purposive sample of people who use drugs and people from the substance use workforce were recruited for a total of 34 semi-structured interviews. Data were analysed using Braun and Clarke's reflexive thematic analysis.

Results: Our results show perceived direct and secondary impacts of delayed implementation of the supervised injection facility and drug checking. Direct impacts of delays include the absence of evidence-based practices forcing people who use drugs to adopt make-shift safety responses and compounding the inequalities they experience. Participants expressed concern for the lives that could have been saved if the supervised injection facility and drug checking had been implemented, and the unknown scope of health consequences due to delays. Secondary impacts of delays noted the difficulties to respond to current issues or new challenges in the drug markets. Over the period of waiting for these interventions, participants reported changes in the drug market and drug use which may have implications for the existing policies. Participants described navigating frustration with bureaucracy and concern for moving forward with harm reduction.

Conclusion: Changes in drug use and drug markets occurred over a period of waiting for interventions to be implemented. Policymakers must consider adapting plans for a supervised injection facility to include inhalation space to meet the current needs of people who use drugs. Drug policy interventions must consider the populations most at risk, and should consider drug checking services outside of the festival setting. This study highlights that the nature of change in drug markets requires timely policy response and implementation. As drug markets become riskier, policymakers should consider framing overdose as a matter of public health urgency to facilitate timely harm reduction implementation.

Background: Homelessness results from, and exacerbates, various social determinants of health, including poverty, racism, and inadequate healthcare access, which are further compounded by physical and mental health challenges. The street medicine movement seeks to address these disparities by providing direct medical care and harm reduction services to unsheltered homeless in low-barrier settings. The development of trust is critical to providing this form of care. Few studies have sought to understand the factors influencing trust development in street medicine encounters.

Methods: This case study of Street Medicine St. Louis aims to explore the factors that influence trust and how trust development impacts unhoused individuals' perceptions and utilization of services and education provided by Street Medicine St. Louis. Qualitative semi-structured interviews were conducted with 19 participants who receive harm reduction services from Street Medicine St. Louis. Participants were selected via purposive sampling from shelters, encampments, and street locations to ensure a diversity of experiences.

Results: Findings highlight that trust, built through consistent outreach, respectful interactions, and non-judgmental care, directly shaped participants' perceptions and utilization of harm reduction resources, including sterile syringes, fentanyl test strips, and naloxone. Trust facilitated greater receptivity to education and increased willingness to apply harm reduction practices.

Conclusion: Building trust through consistent, respectful, and person-centered outreach is essential for effective harm reduction interventions. Street medicine programs should prioritize relational approaches to enhance uptake and impact of harm reduction services among unhoused populations.

Psychedelic use in naturalistic settings in Australia is increasing. Although the risks and harms of psychedelics from a physical perspective are low, psychedelic drugs carry a unique psychological risk profile which is increased in uncontrolled settings. Harm reduction support services align with the Australian Government's Federal Drug strategy, which includes harm reduction as the third pillar in the overall harm minimisation approach to drug use for the period of 2017-2026. This study examined the harm reduction behaviours which users of psychedelics in naturalistic settings currently use, and any harm reduction interventions which have been developed for this population. A scoping review was undertaken using online databases, Psychinfo, Medline, CINAHL and Scopus. Articles were included if they explored or informed harm reduction practices for users of psychedelic drugs in naturalistic settings, which included articles that investigated motivations for psychedelic use. Twenty-seven papers were included, which contained only four intervention-based studies. Harm reduction or benefit enhancing strategies were categorised into three themes: before psychedelic use, during psychedelic experience and after the experience (integration). The review found that users of psychedelic drugs in naturalistic settings employ several different harm minimisation strategies, predominantly before and during use. Motivation for use, social setting and dosage amount were all found to influence the strategies used. There were a limited number of evaluated interventions for users of psychedelics in naturalistic settings, identifying the need for further research in this area. Challenges for harm reduction campaigns such as low uptake of drug checking services and low trust in government institutions were identified. Further research needs to consider the differing motivations of psychedelic users and recognise strategies that promote benefit enhancement and reduce risk.

Background: E-cigarettes have emerged as an alternative to combustible cigarettes, yet their comparative impact on respiratory symptoms remains uncertain. We investigated cross-sectional differences in self-reported wheezing between current exclusive e-cigarette users, current exclusive cigarette smokers, and never-users of either product.

Methods: We analysed data from 9000 adults aged ≥ 16 years in the 2017-2019 Scottish Health Survey. The exposure was current nicotine use status (exclusive cigarette smoking, exclusive e-cigarette use, or never-use), and the outcome was self-reported wheezing in the past 12 months. Binary multivariable logistic regression estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs), controlling for age, sex, area-level socioeconomic deprivation, longstanding illness, doctor-diagnosed asthma and COPD, self-rated general health, alcohol consumption, age of smoking initiation, and exposure to second-hand smoke.

Results: Compared to exclusive e-cigarette users, exclusive cigarette smokers had significantly higher odds of wheezing (adjusted OR = 1.80, 95% CI: 1.33-2.42, p < 0.001). Never-users had lower odds of wheezing than exclusive e-cigarette users, though the difference was not significant (adjusted OR = 0.66, 95% CI: 0.31-1.40, p = 0.275). Among exclusive cigarette smokers, the odds of wheezing increased with smoking intensity relative to exclusive e-cigarette users, indicating a dose-response relationship (χ² = 5.91, p = 0.018). Specifically, light smokers (< 10 cigarettes/day) had elevated but not significant odds (adjusted OR = 1.32, 95% CI: 0.92-1.89, p = 0.133), while moderate smokers (10-19 cigarettes/day) showed higher odds (adjusted OR = 1.85, 95% CI: 1.33-2.59, p < 0.001), and heavy smokers (≥ 20 cigarettes/day) had the greatest odds (adjusted OR = 2.27, 95% CI: 1.57-3.28, p < 0.001). Adjusted predicted probabilities of wheezing mirrored this pattern: compared with exclusive e-cigarette users, probabilities were significantly higher for moderate smokers (+ 7.2%, p = 0.002) and heavy smokers (+ 10.0%, p < 0.001), but not for light smokers (+ 3.0%, p = 0.152) or never-users (-3.9%, p = 0.306).

Conclusions: Exclusive e-cigarette use was not associated with higher odds of wheezing compared with never-use, and it was linked to substantially lower odds than exclusive cigarette smoking. These findings suggest that, while complete abstinence remains the lowest-risk option, e-cigarette use may pose fewer respiratory symptoms than smoking, particularly for moderate-to-heavy smokers.