Search

Against a backdrop of high levels of drug related harms in Scotland, this research aimed to inform training development to aid the upskilling of the workforce to support people who use drugs and are involved in transactional sex. Sixteen qualitative interviews were conducted with participants recruited across four health board areas and a range of services covering sexual health and/or harm reduction. Interviews explored initiation, frequency, and the nature of transactional sex; drug use, and experience of services. A thematic analysis was undertaken. Vulnerability was a key emerging theme when discussing drug use, sexual behavior, and service use. Vulnerability increased risk of a range of harms from sexual assault to injecting harms and overdose. Participants were often, but not always, introduced to drugs and transactional sex by someone who had power over them or was more experienced in drug use and/or sex. High risk drug use was evident in terms of polydrug use, consuming large quantities of drugs, sharing crack pipes/injecting equipment. There is a need for information and services to reduce the risk of harm from drugs, sexual violence, and unprotected sex as well as non-judgmental, trauma aware services. The workforce needs to be skilled to recognize and manage these potentially complex syndemics.

The rapid emergence of novel psychoactive substances (NPS) poses a number of challenges to the professional field, not least because little is known about the extent and trends of use in different populations. This lack of insight means that it is difficult to plan intervention resources or to monitor the effects of policy and drug control. In this chapter, we present an overview of some of the best available international evidence on NPS epidemiology in both general and targeted populations of users. Points of access to high quality data sources are also identified. We identify major surveys and data sources, key findings on the most popular compounds, and discuss the strengths and limitations of different methodological approaches. Overall, we find that earlier findings suggesting that some NPS such as mephedrone and synthetic cannabinoids showed signs of dispersal into the general population have not been sustained. The majority of NPS use still appears to be limited to small groups of people who use drugs and are considered at higher-risk of drug related harm. Traditional methodologies for estimating drug use prevalence, such as general population, school, and household surveys, have generally failed to provide meaningful insights into use of NPS. Emerging environmental sampling methodologies such as waste-water based epidemiology may provide some insights, but currently face technical and interpretative challenges.

BACKGROUND AND AIMS: Income assistance is critical to the health and well-being of socioeconomically marginalized people who use illicit drugs (PWUD). However, past literature paradoxically identifies unintended increases in drug-related harm coinciding with synchronized payments that may magnify signals for drug use. The scope of such harm has not been fully characterized among non-institutionalized populations. This study examined sociodemographic, health and drug use-related correlates of payment-coincident drug-related harm. DESIGN: This observational study using data from prospective community-based longitudinal cohorts of PWUD between December 2013 and May 2018. SETTING: Vancouver, British Columbia, Canada. PARTICIPANTS: A total of 1604 PWUD receiving monthly income assistance. Our sample included 586 (36.5%) women, 861 (53.7%) non-white participants, and 685 (42.7%) people living with HIV. MEASUREMENTS: Primary outcome was a self-reported composite measure of drug-related harm in the past 6 months coinciding with income assistance, including higher frequency substance use, non-fatal overdose, and service barriers or interruptions. Subanalyses disaggregated this outcome. FINDINGS: Payment-coincident drug-related harm was reported among 77.7% of participants during the study period. In multivariable models, key correlates positively and significantly associated with payment-coincident harm included: street-based income generation (Adjusted Odds Ratio [AOR]=1.48, 95% Confidence Interval [CI]=1.26–1.74, P

Since the turn of the millennium, calls for evidence-based drug policy have become increasingly louder. In response, researchers have generated a large body of evidence in support of measures such ...

Research suggests that food insecurity exacerbates the harms experienced by people who use drugs (PWUD). Therefore, improving the food security status can help PWUD reduce drug-related harms. This paper identifies a knowledge gap in public health and harm reduction literatures regarding the relationship between food and harm reduction. We argue that there needs to be a more comprehensive and systematic model of food provision in harm reduction services. Our argument is based on a qualitative case study of 42 people who currently use, or have used drugs in Vancouver, Canada and of staff of 27 programs that provide harm reduction services in the city. The research demonstrates how PWUD experience the effects of drug use on their food consumption, how they access food, and how they practice self-care. It also shows how harm reduction services, while they often provide food, are unable to systematically address the dietary-related harms associated with drug use. This presents an opportunity and a challenge for these organizations and for harm reduction as a public health approach. We call for more research to be done on food as harm reduction and for stable publically funded food provision in harm reduction-oriented services.

This chapter documents the rise of alternative strategies of drug control which aim to reduce drug related harm, rather than drug use per se. It explores the concept of harm reduction, its evolution over time, and its limitations, recommending that harm reduction strategies should also seek to address the harm that is caused by inequality and human rights abuses related harm. The final section address the extent to which harm reduction strategies have already become embedded in global drug policy practice, and suggests that it remains very much of secondary status.

In this article, we analyse the ways in which methamphetamine, its use, and those who consume it are discursively produced in Australian scientific research, drawing on theoretical concepts from th...

This article asserts that anarchist-inspired direct action tactics have played a fundamental role in the development of interventions ostensibly intended to reduce drug-related harm. Drawing from observations collected during the author's participant-observation-based ethnographic fieldwork endeavors in Canada and the U.S., the article interrogates several aspects of harm reduction philosophy and practice, including (1) The establishment of needle and syringe programs, (2) The development of autonomous local, national and international organizations by and for people who use illicit drugs, and (3) Direct drug/service user involvement in harm reduction policies and programs.

In 2010, the International Conference on the Reduction of Drug Related Harm shared its 21st birthday with one of its most constant companions: hepatitis C. The co-occurrence of these significant anniversaries provides an opportunity to reflect critically on the formative role played by hepatitis C, and on our responses to it, in the development of harm reduction. The commentary takes an interdisciplinary approach to analyse the implications of a foundational aspect of harm reduction and the response to hepatitis C: medicalisation. It draws on a range of literature and research disciplines to highlight a set of issues poorly visible from within medical expertise. This commentary highlights two trends, both of which emerge from hepatitis C's place as a thoroughly medicalised object. First, hepatitis C has contributed to an increasing emphasis on individual responsibility in prevention initiatives, and second, it has contributed to the homogenisation of affected individuals in relation to treatment.While ack...

We describe trends in illicit drug use revealed by the Australian Illicit Drug Reporting System (IDRS) between 1996 and 2006. We begin by briefly outlining the rationale, development, and testing of the IDRS, which integrates information from: interviews with a sentinel population of injecting drug users (IDU); key experts in health and law enforcement; and indicators that include information on drug purity and price, plus indicators of drug-related harm, such as fatal and nonfatal overdoses. These sources of information are critically discussed at annual meetings of researchers, policy makers and practitioners in the field. We describe what the IDRS has revealed about the use of heroin, cocaine, methamphetamines, and injected pharmaceutical preparations (opioids and benzodiazepines) over the period 1996–2006. We also illustrate how IDRS data can be combined with pharmaceutical prescription data to evaluate the effectiveness of policies designed to reduce benzodiazepine injecting. We also very briefly describe recent experience with monitoring trends on “dance party” drug use that extends the methods of IDRS by combining data from interviews with party drug users, key experts, and leading indicators of drug use.

Adverse drug events can range from mild to life threatening reactions resulting in inconvenience or serious morbidity and mortality besides being a financial burden on the society. However clinicians often do not recognize this drug related harm. The terms used to describe these events with medication use cause much confusion. Moreover manifestations of adverse drug reactions can be non-specific making it difficult to differentiate from current illness. To determine the likelihood of relationship between the drug and the event assessment of causality is done. The purpose of this article is to review and clarify the terms encompassing the discipline of pharmacovigilance and also to outline the steps in causality assessment with the help of an actual case report.

The impact of alternative drug policy objectives, specifically harm reduction/harm minimisation or prohibition, is unclear. The literature is confusing. This article conceptualises the causal connection between drug consumption and health harm (or reduced health status) then clarifies the implication of 'drug related harm'. By applying some geometrical tools from economics, the choice of policy objective is analysed. The preferences of policy advocates are then incorporated. Policy advocates are conceived as arguing that decision-makers and consumers should adopt their preferences between drugs and health harm. With this approach, the difference between alternative drug policies, in particular prohibition and harm minimisation/reduction, is demonstrated.

Harm reduction coming of age: A summary of the ‘18th International Conference on the Reduction of Drug Related Harm’—Warsaw, Poland: 13–17 May 2007 Jacek Moskalewicz a,∗, Damon Barrett b, Michal Bujalski a, Katarzyna Dąbrowska a, Harald Klingemann c, Justyna Klingemann a, Artur Malczewski d, Marta Struzik d a Institute of Psychiatry and Neurology, Warsaw, Poland b International Harm Reduction Association, London, United Kingdom c University of Zurich, Zurich, Switzerland d National Bureau for Drug Prevention, Warsaw, Poland

Background: Evaluation of the state of play of the 2003 Council Recommendation on the preventionand reduction of health-related harms, associated with drug dependence, in the EU and candidatecountries and elaboration of proposals for new recommendations. Methods: Analysis of epidemiological data available at the European Monitoring Center for Drugsand Drug Addiction (EMCDDA) using statistical modeling, a general literature review on harmreduction measures, four systematic literature reviews (one on peer naloxone pro-grams) andsurveys among decision makers in the field of drug policy and among harm reduc-tion providers(“stakeholders”) using online questionnaires and a gap survey among the na-tional focal points ofEMCDDA in EU-countries and candidate countries. Results: It was possible to decrease the number of HIV-infections among drug users substan-tiallyin most EU countries and candidate countries during the last decade; unfortunately for the numbersof deaths due to overdoses this effect could not be reached. Stakeholders (harm reduction providers)name improvement of needle and syringe exchange and harm reduction in prison as main prioritiesin order to reduce drug related infectious diseases. Concerning re-duction of mortality they prioritisepeer naloxone programs, drug consumption rooms and first aid training of drug users. Conclusions : The increase of coverage of substitution treatment and of the availability of nee-dleexchange programs in most countries can be seen as successes of harm reduction policy although thecoverage especially of the latter still needs improvement. Peer naloxone pro-grams and improvementof harm reduction in (and after) prison are two of 13 recommended actions to improve the situationconcerning mortality of opioid users. Continuous political strengthening of harm reduction is necessary.

Since the late 1980s drug policy and practice within UK has been heavily influenced by the idea of reducing drug related harm. The paradigm of harm reduction, which has shaped drug treatment services grew out of the fear that HIV may spread rapidly and widely amongst injecting drug users. This article looks at the extent to which drug use or HIV have had the greater impact on individual and public health within UK and the extent to which it has been possible to reduce drug related harm in the face of continuing drug use. The article concludes that in the face of the growth in the prevalence of problem drug use over the last 10 years and the persistence of an array of drug related harms including: the extent of Hepatitis-C amongst injecting drug users, the extent of drug related crime and the impact of drugs on communities and families that it may be appropriate now to make drug prevention, rather than harm reduction, the key aim of drug policy and practice.

0 d nly ever possible to glimpse a tiny fraction of what occurred ver the 5 days. The conference handbook listed over 500 apers, presented across 70 sessions. In addition, over 150 osters were also on display (Department of Health, Social ervices and Public Safety, 2005). The theme of this year’s conference was “Widening the genda”, and to a degree, the range and diversity of the onference programme indicated that the agenda was already onsiderably rotund. The programme was subdivided into 0 major pathways, which ranged from law enforcement nd harm reduction, through core harm reduction issues uch as injecting behaviour, HIV/AIDS and hepatitis, harm eduction practice and treatment services, to broader issues uch as young people and education, and the wider social olicy response. As in Melbourne, the Film Fest had a Conference awards

Countries committed to a harm-reduction approach to drugs have exploited the latitude which exists within the UN global drug control regime to implement strategies which deviate from the strict prohibition ethos of the conventions. These nations risk pressure being brought to bear through the UN drug control regime, principally by the United States, determined to prevent what it sees as foreign challenges to its domestic 'zero tolerance' approach and its internationalisation. In this paper, based on his presentation to the International Conference on the Reduction of Drug Related Harm in Melbourne this year, David Bewley-Taylor, describes the conventions and the 'wiggle room' which exists, but also imagines ways like-minded states might together challenge and reform the conventions so that harm reduction can be accepted and hard wired into the UN drug control system itself.

The programme for the 14th International Conference on the Reduction of Drug Related Harm consisted of 139 hours of presentations, discussion and debate. In order just to listen and participate in all this would require four working weeks, and that would not include the time needed to synthesise the information and summarise the key findings and highlights. The task of the conference rapporteur is therefore a difficult undertaking. The method adopted to confront this is very much like the rapid assessment strategy: I attended as many sessions as possible and asked friends and colleagues to act as key informants. Many people have provided impressions of what they considered highlights of this conference. This summary is based on both their and my personal impressions of this conference. This summary is organised into four sections. The first, What we know and how do we find out? addresses the epidemiology of problem drug use and of blood-borne diseases such as HIV/AIDS in different parts of the world. Different research methodologies are briefly discussed. The second section, What do we do? presents examples of responses regarding prevention and treatment and the issue of sustainability and scaling up efforts. The third section, Other drugs and other drug users, briefly discusses the heterogeneity of problems and populations beyond the main focus of the programme on opiate dependence. Finally, the summary concludes with the theme of the conference, Strengthening partnerships for a safer future. Abstract numbers refer to the programme and abstract book (14th ICRDH, 2003).

Background Raves may be considered recreational settings in which drug use and health risks related to polydrug use are higher than in others. Harm reduction behaviors implemented by ravers are of particular relevance in reducing such risks. This study analyzes harm reduction behaviors and their relationship to raver polysubstance use patterns. Methods Cross-sectional study of 248 ravers recruited at underground raves in Andalusia (Spain). A questionnaire was developed to collect information about their sociodemographics, drug use, and harm reduction behaviors. Results The results show that ravers employ harm reduction behaviors for minimizing drug-related harm. Nevertheless, only a small minority of the participants frequently employed harm reduction behavior for polysubstance use as well. Ravers identified as high polysubstance users protected themselves significantly less than those identified as low polysubstance users. Conclusions This study provides empirical information that may be useful for harm reduction intervention in a hidden and hard-to-reach population like rave attendees. The results point to the need to inform and increase harm reduction behavior specifically aimed at polysubstance use by ravers, especially among more frequent users. Future directions for research are also suggested.

a University of California San Diego School of Medicine, San Diego, CA, USA b British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada c CACTUS Montreal, Projet PLAISIIRS, Montreal, Canada d Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rio de Janeiro, Brazil e HIV/AIDS Programme, Laboratory Sciences Division, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh

Background—Higher income is generally associated with better health outcomes; however, among people who inject drugs (IDU) income generation frequently involves activities, such as sex work and drug dealing, which pose significant health risks. Therefore, we sought to examine the relationship between level of income and specific drug use patterns and related health risks. Methods—This study involved IDU participating in a prospective cohort study in Vancouver, Canada. Monthly income was categorized based on non-fixed quartiles at each follow-up with the lowest level serving as the reference category in generalized linear mixed-effects regression. Results—Among our sample of 1,032 IDU, the median average monthly income over the study follow-up was $1050 [Interquartile range=785–2000]. In multivariate analysis, the highest income category was significantly associated with sex work (Adjusted Odds Ratio [AOR]=7.65), drug dealing (AOR=5.06), daily heroin injection (AOR=2.97), daily cocaine injection (AOR=1.65), daily crack smoking (AOR=2.48), binge drug use (AOR=1.57) and unstable housing (AOR=1.67). The high income category was negatively associated with being female (AOR=0.61) andaccessing addiction treatment (AOR=0.64), (all p < 0.05). In addition, higher income was strongly associated with higher monthly expenditure on drugs (>$400) (OR=97.8). Conclusion—Among IDU in Vancouver, average monthly income levels were low and higher total monthly income was linked to high-risk income generation strategies as well as a range of drug use patterns characteristic of higher intensity addiction and HIV risk. These findings underscore the need for interventions that provide economic empowerment and address high intensity addiction, especially for female IDU.

The necessity to ‘do more with less’ poses challenges for policy makers and service providers in the drug and alcohol field. In recent years, some services and research initiatives have been targeted at women in an effort to compensate for their previous neglect. The question now arises that such targeting is no longer appropriate since there are fewer resources, and men constitute the main population suffering drug-related harm. This review proposes other ways of considering the question that go beyond competition over scarce resources. It shows that the present attention to women is raising new questions with potential significance to men, and suggests that research and services to the whole population can be improved by paying attention to the gender of men as well as women.

The article describes the nature, origins and development of Australia's recently announced National Drug Strategy (NDS). The NDS aims to minimize the harmful effects of drugs and drug use in Australian society and covers the period 1993-97. The National Drug Strategic Plan is discussed, and the means by which the NDS will be monitored. The National Campaign Against Drug Abuse (NCADA), the forerunner to the NDS, is reviewed in terms of its major achievements. The Campaign was particularly successful in raising the policy profile of alcohol and tobacco, the drugs causing the most harm in Australian society. The relationship between the latest evaluation of NCADA and the NDS is also described.

In this Harm Reduction Digest, Father Peter Norden of Jesuit Social Services (Australia) summarises the findings of a report of a consultation into how Catholic schools in Australia address substance use by school students. The report showed that while in the past the 'zero tolerance' approach had been the norm, more recently there had been a growing awareness in Catholic schools that it is possible to respond to the needs of drug-using students while being respectful of the duty of care to other students. Moreover, harm reduction was accepted as a serious objective for drug policy and practice in Australian Catholic schools. The paper canvases the key issues that emerged from the consultation and suggests what 'good practice' looks like, providing useful guidance for both Catholic and non-Catholic schools alike. For those of us outside the Catholic school system, the paper provides an enlightening read about how substance use can be best addressed within schools. Simon Lenton Editor, Harm Reduction Digest.

In this paper Moore & Dietze use data from their study of street-based injecting drug users and sex workers in the Melbourne suburb of St Kilda to challenge the dominant emphasis of drug policy in Australia. They remind us that while existing harm reduction strategies that encourage individual behaviour change should be continued, these measures need to be complemented and extended by further attention to the environmental aspects of drug-related harm. This is a timely call. Responses targeting individual behaviour change are relatively easy to implement and less politically challenging. However, if we are really serious about reducing drug-related harm in the Australian community, then broader systemic and structural barriers which undermine these efforts must be addressed.Simon LentonEditor, Harm Reduction Digest.

There are many forms of structural violence in the world and in Brazil. These include the massive brutalities of hunger and starvation, of environmental destruction, of necessity-induced working at...

Als die 1. Konferenz uber die Verringerung drogenbedingter Schaden 1990 in Liverpool stattfand, war viel von einer Aufbruchstimmung unter den Teilnehmern zu spuren. Das Konzept „harm reduction“ wurde erstmals in einem grosen Forum mit Teilnehmern aus der ganzen Welt diskutiert. Die Entwicklung sich grundsatzlich verandernder Drogenhilfe unter dem Eindruck von HIV/AIDS unter Drogenkonsumenten war in vielen Landern zu beobachten und wurde nun weltweit vernetzt. Innovative Ansatze der Drogenhilfe wurden vorgestellt. Methadonbehandlung, Heroinabgabe in Liverpool, needle exchange-Programme, Konsumraume in der Schweiz, weitere Ansatze zur sozialen und gesundheitlichen Stabilisierung fur Drogenkonsumenten, fur die das Ziel der Abstinenz noch in weiter Ferne lag oder fur die ein Leben ohne (diese) Drogen schlicht gar kein Ziel darstellte. Trotz des Titels wurden auch drogenpolitikbedingte Probleme angesprochen. Die volkswirtschaftlichen, sozialen und personlich-gesundheitlichen Kosten und Schaden der Prohibition wurden intensiv diskutiert. Furwahr eine Pionierleistung! Die Teilnehmerliste (immerhin fast 700) von damals umfaste hauptsachlich Wissenschaftler, Praktiker, aber auch Drogenkonsumenten aus der westlichen Welt (Westeuropa, USA, Australien) — der Eiserne Vorhang zwischen Ost und West war noch nicht wirklich verschwunden und die sogenannten „Entwicklungslander“ waren noch nicht vertreten.

Harm-reduction approaches are more easily embedded in policy when drugs are legally regulated.

Effective tobacco control strategies save money for the individual and the state. Inability to create such strategies, without having to spend large amounts of money may reflect a lack of imagination on our part. Not only are there effective measures that can be carried out at relatively little cost, these could even turn out to be more effective than the expensive ones.