Harm Reduction Research Articles

Psychedelic-related deaths in England, Wales and Northern Ireland (1997–2022)

BackgroundPsychedelic drugs are increasingly visible in society once more, but their risks and adverse effects have received less attention than perhaps they should. While fatalities associated with psychedelics appear rare, a systematic approach to characterising their aetiology is required to inform harm minimisation efforts. AimsThis study aimed to analyse prevalence and characteristics of psychedelic-related deaths in England, Wales, and Northern Ireland, between 1997 and 2022. MethodsWe analysed coroner reports submitted to the National Programme on Substance Use Mortality where psychedelic serotonergic agonist drugs were involved in the death, and conducted a thematic framework analysis to explore potential factors associated with their occurrence. ResultsWe identified 28 cases where psychedelics were implicated (75 %, N = 21) or potentially implicated (25 %, N = 7) in the death; 19 of these involving psychedelic tryptamines (LSD 39 %, N = 11; Psilocybin 21 %, N = 6; DMT 7 %, N = 2), and 9 psychedelic phenethylamines (incl. NBOMes 18 %, N = 5). Most deaths were deemed accidental by the coroner (86 %, N = 24), including both traumatic injuries and drug toxicities; most cases involved multiple implicated drugs (68 %, N = 19); and most of the deceased were under 30 years of age (82 %, N = 23). Thematic framework analysis identified nine themes in the deaths across three categories. ‘Polysubstance use’ was the most common theme (82 % of cases, N = 23/28), followed by a suboptimal ‘physical environment’ (70 % of cases where this information was available, N = 14/20). ConclusionsThe profound and often unpredictable effects of psychedelics pose a unique profile of risks and adverse reactions. Nevertheless, psychedelic-related deaths remain very rare in comparison to other recreational drugs, and frequently involve polydrug use. Implications for harm reduction and policy are discussed.

Virtual/Mobile Overdose Response in Canada: A Social Return on Investment Analysis

The overdose epidemic continues to be one of the leading causes of death in North America and continues to contribute to high healthcare costs. While harm reduction initiatives have significantly reduced the aforementioned costs, there is a dearth of evidence regarding overdose response hotlines and applications. We aim to evaluate the social return on investment (SROI) from a payer perspective of one such overdose response hotline, Canada's National Overdose Response Service, and its implications for service users, service operators, the Canadian healthcare system, and program funders. Outcome variables determined from theory of change models were developed in consultation with the aforementioned vested interest groups. Proxy values were attributed to each variable identified through values present within existing literature and databases. These values were then compared to operational costs accounting for deadweight, attribution, and displacement to determine a final SROI ratio. A discount rate was then applied based on the influence of risk on the outcome achieved. The ratio illustrating the value created for all stakeholders, resulting from the $1,592,00 investment made over two years, is $15.84 per single dollar invested. The value generated stems primarily from overdose prevention, mental health support, staff employment, reductions in emergency service utilization, service referrals, and volunteer well-being, which outweigh costs including operational funding, work-related stressors, compassion fatigue, and false calls. The results of our study demonstrate that the National Overdose Response Service provides a social value that far outweighs the costs attributed to the program's operation.

The Opioid Crisis, Preventing and Managing Substance Abuse in India: A Systematic Review.

The opioid crisis has emerged as a significant public health concern globally, with India facing unique challenges in preventing and managing substance abuse. This systematic review aims to analyze the current state of the opioid crisis in India, evaluate existing prevention and management strategies, and propose evidence-based recommendations for addressing this complex issue. A comprehensive literature search was conducted across multiple databases, resulting in the inclusion of 30 studies meeting the predefined criteria. The review highlights the multifaceted nature of the opioid crisis in India, influenced by factors such as socioeconomic conditions, cultural norms, and healthcare accessibility. Key findings include the need for comprehensive prevention programs, improved access to evidence-based treatments, and integration of harm reduction strategies. The review also emphasizes the importance of addressing co-occurring mental health disorders and the potential of community-based interventions in managing substance abuse. Challenges identified include stigma, limited access to treatment, inadequate healthcare infrastructure, regulatory barriers, and lack of comprehensive policies. Recommendations for future directions include developing culturally appropriate prevention programs, assessing the long-term effectiveness of treatment modalities, exploring innovative approaches to reduce stigma, and investigating the role of technology in improving access to care. By implementing a multifaceted approach that considers the unique sociocultural context of India (including factors such as family structures, religious beliefs, economic disparities, and regional variations in drug use patterns), there is potential to significantly reduce the burden of opioid abuse and improve outcomes for affected individuals and communities.

Prediction of typical gas components in cigarette smoke based on transformer

Abstract Harm reduction of cigarette products has become one of the primary objectives of the entire tobacco industry. The prediction of typical gas components (TGC) and dynamic adjustment of process parameters are crucial for cigarette coke reduction and harm reduction. In this study, a deep learning (DL)-assisted TGC prediction framework is proposed to predict CO and NI simultaneously. Firstly, a large number of experimental and simulation parameters of cigarette process are collected as the data base for subsequent model construction. Then, the feature importance analysis of the process parameters was carried out by combining the mechanism of the combustion process through the mutual information method. Finally, DL models based on Multilayer Perceptron, One-Dimension Convolutional Neural Network and Transformer (TF) was developed as data-driven surrogate models to establish the mapping relationship between process parameters and TGC. The results show that TF model generalizes best and can predict TGC quickly and accurately with R2 over 0.99. This work will provide a valuable predictive and decision-making tool for cigarette harm reduction.

AI Governance: A Challenge for Public Health.

The rapid evolution of artificial intelligence (AI) is structuralizing social, political, and economic determinants of health into the invisible algorithms that shape all facets of modern life. Nevertheless, AI holds immense potential as a public health tool, enabling beneficial objectives such as precision public health and medicine. Developing an AI governance framework that can maximize the benefits and minimize the risks of AI is a significant challenge. The benefits of public health engagement in AI governance could be extensive. Here, we describe how several public health concepts can enhance AI governance. Specifically, we explain how (1) harm reduction can provide a framework for navigating the governance debate between traditional regulation and "soft law" approaches; (2) a public health understanding of social determinants of health is crucial to optimally weigh the potential risks and benefits of AI; (3) public health ethics provides a toolset for guiding governance decisions where individual interests intersect with collective interests; and (4) a One Health approach can improve AI governance effectiveness while advancing public health outcomes. Public health theories, perspectives, and innovations could substantially enrich and improve AI governance, creating a more equitable and socially beneficial path for AI development.

A Model of Alcohol Consumption with Semi-Markov Variable Coefficients

This paper focuses on the in-depth study of a stochastic approximation methodology involving semi-Markov switches in an averaging scheme with a minor parameter. We present a model where perceived objects are impacted by noise variables dependent on the semi-Markov process. The emphasis is on analyzing the convergence and stability of the stochastic approximation process within this context. Theoretical results are presented alongside numeric simulations, demonstrating the practical applications in managing complex stochastic systems. This work opens promising paths for the use of stochastic approximation approaches in the wider field of semi-Markov processes. Recognizing the mutable nature of alcohol consumption and its dependency on a variety of factors, we propose encoding such dynamism within a semi-Markov parameter structure. This model handles the patterns of individual alcohol consumption as a semi-Markov process; the transition probabilities between different states of alcohol consumption are directed by sociodemographic variables that change over time. Our approach, thus, bridges the gap between the realities of ever-changing alcohol consumption trends and static traditional Markov-chain models. By integrating real-world variables into our innovative model, we offer a cutting-edge analytical tool that lays down new paths for understanding and addressing the challenges with alcohol consumption patterns. Further, our insights have the potential to significantly impact the formulation of effective strategies and public health interventions aimed at alcohol-related harm reduction

Comparative evaluation of cigarette smoke and a heated tobacco product on microglial toxicity, oxidative stress and inflammatory response

BackgroundTobacco smoking is the leading cause of preventable death and disease worldwide, with over 8 million annual deaths attributed to cigarette smoking. This study investigates the impact of cigarette smoke and heated tobacco products (HTPs) on microglial function, focusing on toxicological profiles, inflammatory responses, and oxidative stress using ISO standard and clinically relevant conditions of exposure.MethodsWe assessed cell viability, reactive oxygen species (ROS) production, lipid peroxidation, mitochondrial function, unfolded protein response, and inflammation in human microglial cells (HMC3) exposed to cigarette smoke, HTP aerosol or nicotine.ResultsOur findings show that cigarette smoke significantly reduces microglial viability, increases ROS formation, induces lipid peroxidation, and reduces intracellular glutathione levels. Cigarette smoke also alters the expression of genes involved in mitochondrial dynamics and biogenesis, leading to mitochondrial dysfunction. Additionally, cigarette smoke impairs the unfolded protein response, activates the NF-κB pathway, and induces a pro-inflammatory state characterized by increased TNF and IL-18 expression. Furthermore, cigarette smoke causes DNA damage and decreases the expression of the aging marker Klotho β. In contrast, HTP, exhibited a lesser degree of microglial toxicity, with reduced ROS production, lipid peroxidation, and mitochondrial dysfunction compared to conventional cigarettes.ConclusionThese results highlight the differential toxicological profile of cigarette smoke and HTP on microglial cells, suggesting a potential harm reduction strategy for neurodegenerative disease for smokers unwilling or unable to quit.

"Like an umbrella, protecting me from the rain until I get to my destination": Evaluating the implementation of a tailored primary care model for urban marginalized populations.

Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework. Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis. Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20. The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.

Personal Experiences With Xylazine and Behavior Change: A Qualitative Content Analysis of Reddit Posts.

Xylazine is a rapidly spreading adulterant in the United States' drug supply and is increasingly associated with overdoses and severe wounds, but there is a dearth of information about the clinical presentation or means of treatment for human xylazine exposure. The objective of this study was to explore personal attitudes about xylazine in the drug supply and experiences with xylazine-related use among people who reported using drugs and contributed content to social media site Reddit. To conduct a retrospective qualitative content analysis, the study team extracted all posts and comments from Reddit, which mentioned the terms "xylazine" or "tranq." Content was extracted from 10 Reddit forums, or subreddits, specific to drug use, and included content created on or before the extraction date of January 2023. In total, 3284 posts were identified and 1803 were qualitatively coded using an inductive approach until meaning saturation was reached. Three themes emerged across comments and posts: (1) personal experiences with xylazine, including a negative impact on overdose, withdrawal, and wounds; (2) behavior changes in response to xylazine in the drug supply, including devising and sharing new harm reduction and detection tips, and reducing or abstaining from drug use altogether; (3) a perceived lack of treatment options for xylazine withdrawal and information sharing to help others self-treat withdrawal symptoms, most often with clonidine. This study of people who reported using drugs with xylazine provides new insights into how xylazine is perceived, possible treatment modalities, and potential clinical research approaches.

Switching from Cigarettes to Heated Tobacco Products in Japan-Potential Impact on Health Outcomes and Associated Health Care Costs.

Japan's rising health expenditure, driven by an aging population, coincides with growing demands for increased spending. Reducing smoking-related costs could alleviate the burden on the health care system. Despite efforts to promote smoking cessation, success has been limited, indicating a need for strategies beyond cessation. Using a status quo simulation based on hospital resource data from the Japanese Ministry of Health, Labor, and Welfare, we examine the impact of heated tobacco products (HTPs) on the prevalence of four smoking-attributable diseases (chronic obstructive pulmonary disease, ischemic heart disease, stroke, and lung cancer) and the related direct health care costs. The baseline scenario assumes a 50% switch from combustible cigarettes to HTPs, with a 70% risk reduction. A sensitivity analysis was conducted to assess the effects of parameter variations. If 50% of smokers replaced combustible tobacco products with HTPs, 12 million patients could be averted equivalent to JPY 454 billion in health care savings. Prefectures located in the north and south of Japan would benefit the most. Considering the heterogeneous prevalence rates, a one-size-fits-all tobacco control approach is ineffective. Japan should prioritize cost-efficient measures that promote public health and economic benefits. Encouraging smokers to switch to reduced-risk products, raising awareness of health risks, and adopting a harm-based taxation model can drive positive change. Public-private partnerships can further enhance harm reduction efforts. With a combination of tax reforms, revised regulations, collaborations, and ongoing research, Japan can create a more effective and comprehensive approach to tobacco control.

“Give me the reigns of taking care of myself with a home”: Healing environments in an Indigenous-led alcohol harm reduction program

BackgroundDistinct from western Managed Alcohol Programs (MAPs), Indigenous-led alcohol harm reduction programs can be defined by both ‘culture as healing’ and decolonized harm reduction philosophies. We sought to explore experiences of Indigenous ‘family members’ (participants) in an Indigenous-led alcohol harm reduction program and culturally supportive housing to identify appropriate supports according to family member perspectives, and to inform delivery of the program.MethodsSituated within an Indigenous-western research partnership, we completed semi-structured interviews with seven family members of an Indigenous-led alcohol harm reduction and culturally supportive housing program. Community-guided protocols informed relational knowledge gathering practices including semi-structured in-depth interviews, qualitative thematic analysis, collaborative interpretation of findings, and development of knowledge products.ResultsFamily members highlighted the importance of tailored Indigenous-led alcohol harm reduction in shifting their relationships to alcohol from survival to having choice and control of their drinking (It’s a choice I’m making right now). The provision of varied and incremental culture-based opportunities (Multiple pathways for connecting to culture) facilitated engagement with culture as healing. Policies that honour respect and autonomy were identified as supportive to healing and harm reduction, countering family members’ experiences in western spaces (Give me the reigns of taking care of myself with a home).ConclusionsAn Indigenous-led alcohol harm reduction program within a model of culture as healing facilitated shifts in relationships to alcohol, providing a space where family members could explore long term goals of healing and connection to culture. Family members’ experiences and recommendations offer key considerations for the design of Indigenous-led harm reduction and culture as healing models. Recommendations emphasize the provision of tailored alcohol harm reduction plans in parallel to multiple and accessible opportunities for connection to culture as healing in order to meet diverse participant goals and relationships to alcohol and culture.

Joint HIV and hepatitis C virus phylogenetic analyses signal network overlap among women engaged in sex work and men who purchase sex.

Transmission of HIV and hepatitis C virus (HCV) are heavily influenced by complex interactions within sexual or injecting networks where risk behaviors occur. In Ukraine, women engaged in sex work (WSW) and men who purchase sex (MWPS) are disproportionately affected by both viruses. The aim of our study was to the investigate the influence of underlying networks on transmission of HIV and HCV. A cross-sectional integrated bio-behavioural survey was implemented among 560 WSW and 370 MWPS representative of sex work hotspots in Dnipro, Ukraine (December 2017 to March 2018). A portion of the HIV reverse transcriptase gene (n = 13; 62% WSW, 38% MWPS) and HCV NS5B gene (n = 46; 70% WSW, 30% MWPS) were sequenced from dried blood spot specimens. Tip-to-tip distances on phylogenetic trees were used to infer phylogenetic clusters for identifying potential transmission clusters. Phylogenetic analyses identified two HIV clusters containing four sequences (50% WSW; 50% MWPS) and 11 HCV clusters containing 31 sequences - the majority comprising infections in WSW (83.9%). Nearly half (45.4%) of HCV clusters contained at least one WSW with a history of injecting drugs. Joint analyses of HIV and HCV signal overlap in sex work and injecting networks in Ukraine, suggesting implications for the comprehensive coverage of prevention programs for WSW including harm reduction services. Conducting phylogenetic analyses with HCV may provide a more complete appraisal of underlying transmission networks than HIV alone, particularly in the context of high HIV treatment coverage yielding viral suppression.

Use of cannabis for mental health in the Canadian territories: a cross-sectional study

Background Population prevalence and patterns of cannabis use for mental health (CUMH) are underexplored. This is important to understand in the Canadian territories which has the highest prevalence of cannabis use in Canada. This study aimed to examine socio-demographic factors associated with CUMH in the territories and associations between CUMH and cannabis use outcomes. Methods This study is a cross-sectional analysis of survey data from the 2022 Cannabis Policy Study in the Territories, including 2431 respondents aged 16+. Multivariable logistic regression models were used to examine socio-demographic characteristics associated with CUMH. Among past 12-month cannabis consumers, multivariable logistic regression models were used to examine whether CUMH was associated with daily/near-daily use, cannabis product type, healthcare interactions, and self-reported impacts on mental health, controlling for socio-demographic characteristics. Results Overall, 29.6% of all participants, and 55.5% of past 12-month cannabis consumers reported ever using cannabis for mental health. Use for mental health was higher among those with lower education, lower perceived income adequacy, and younger ages. Those reporting CUMH were more likely to report daily/near-daily use (ORadj = 3.00, 95%CI: 2.01–4.49), potent product types like solid concentrates (ORadj = 2.76, 1.62–4.70), and perceived positive impacts on mental health (ORadj = 3.71, 2.49–5.52). Conclusion Due to the high prevalence of CUMH, more research is needed to examine its long-term impacts and effectiveness. Future research is also needed to understand the social context underlying socioeconomic inequalities in CUMH, including access to mental healthcare and harm reduction measures for mitigating adverse mental health impacts.

The environmental effects of non-invasive cardiac imaging

The healthcare sector is a major contributor to the universal climate footprint, of this a significant proportion is attributable to medical imaging and further to dedicated cardiac imaging. The increasing availability and utility of cardiac imaging techniques for prognosis, diagnosis and management raises concerns for the impact of these investigations on the environment.Our objective was to review the published literature assessing the environmental impact of non-invasive imaging modalities within cardiology, subsequently helping guide physicians toward a more sustainable approach to cardiac imaging and improved awareness of the environmental impact of healthcare within this field.We conducted a systematic review of studies measuring the environmental impact of non-invasive cardiac imaging. A total of 8 studies were included in the final analysis.Cardiac imaging has a significant environmental impact, which varies by modality: lowest for echocardiography and highest for MRI. As a whole this field represents a significant contributor to climate-related threats to human health, which we should strive toward harm minimisation. This may be mitigated through the conscious utilisation of energy consumption and contrast media, as well as healthcare worker education and quality improvement to guide imaging choice based on environmental impact alongside conventional determinants such as patient characteristics, clinical guidelines and cost (visual abstract).

Slippery Slopes and Russian Roulettes: Abjection and Drug User (Self-)Governance in an Online Harm Reduction Forum

Slippery Slopes and Russian Roulettes: Abjection and Drug User (Self-)Governance in an Online Harm Reduction Forum

Harm Reduction as a Form of ‘Wrap‐Around’ Care: The Nursing Role

ABSTRACTIn addiction treatment, harm reduction is a philosophy that aims to reduce the harms from ongoing alcohol and other drug use. Although abstinence may be the ‘gold standard’ in reducing harm from ongoing alcohol and other drug use, harm reduction recognises that abstinence may not be achievable for certain individuals. Accordingly, harm reduction is used to enable medical or mental health treatment for individuals who continue to use alcohol and other drugs, providing a form of care which meets individuals where they present to healthcare facilities. Harm reduction accepts ongoing alcohol and other drug use, while providing a traditionally marginalised cohort of individuals access to healthcare services. In this perspective paper, we argue that the role of nurses in promoting and utilising harm reduction as part of their regular practice is essential to both reducing harm from alcohol and other drug use, engaging individuals who use alcohol and other drugs in healthcare services, and providing a means to accept individuals as they are to build trust and rapport for engagement in addiction treatment when they are ready, and at their own pace. Nurses, by virtue of their role and number in the healthcare landscape (approximately 28 million globally), are ideally placed to implement harm reduction in their practice to achieve better outcomes for individuals who use alcohol and other drugs.

Health harms, climate harms and the regenerative potential of policing

ABSTRACT Policing, public health, and climate change are interconnected. Police respond to health harms, from pandemics to mental distress. They also respond to climate harms, such as floods and fires. In combination, changing ‘harmscapes’ – or landscapes of harm – place new demands and strains on policing, but they can also serve as ‘portals’ to new imaginings of policing functions. In this essay, we examine the potential for policing to serve a regenerative function, working not only to protect life, but to act as a glue that binds local harm reduction efforts together and stimulate their growth. We offer examples of two developments aimed at improving the policing of health harms (COVID-19 and mental distress respectively) to illustrate the potential of regenerative policing and distil its nascent features. This essay concludes that intentional efforts to advance regenerative policing should be considered in view of new and compounding harms to planetary and human health.

Is smokeless tobacco a healthier option in patients with AUD? A follow-up study during treatment

IntroductionSmoking is negatively related to mental health, but there is a paucity of research on the relationship between the use of smokeless tobacco, such as snus, and mental health outcomes, especially in people with alcohol use disorders (AUD). The aim of the present study was to examine the development of mental distress and quality of life (QoL) among AUD patients in treatment who did or did not use snus.MethodThe study included 128 AUD patients (27% female) from three rehabilitation clinics in Eastern Norway who were interviewed at admission, at 6 weeks, and after 6 months. Patients were asked about their mental health-related problems, alcohol, and substance use, QoL, and physical activity. Information about tobacco use was gathered with the questions “Do you smoke cigarettes?” and “Do you use snus?”, with follow-up questions “How often?”.ResultThere were 39 current snus users (31%), of which 20 were also current smokers (dual users). Seventy-five patients (59%) were smokers only, and only 14 (11%) patients were abstainers. Those who used snus only had a lower severity of dependence score than the other groups (p < 0.05). The dual use group reported lower QoL than the no tobacco use group. In a regression model adjusted for sex and age, smokers and dual users, but not users of snus, had higher levels of mental distress and poorer QoL compared to nontobacco users (p < 0.05). There were no differences between tobacco groups at follow-ups.ConclusionIn this study, among AUD patients, snus users reported QoL and mental distress close to that of non-smokers, indicating a lower problem load among snus users compared to smokers.ImplicationsPrevious studies have shown conflicting results regarding the potential harm reduction effect of snus use among patients with AUD who smoke regarding their tobacco use, quality of life and mental health problems. This study suggests that snus use could also be a viable alternative to smoking for patients with addictions.

Opioid-specific harm reduction in the emergency department: how staff provide harm reduction and contextual factors that impact their capacity to engage in harm reduction practice

BackgroundEmergency Departments (ED) staff, including nurses and physicians, are most directly involved in the care of people who use unregulated substances, and are ideally positioned to provide harm reduction interventions. Conceptualizing the ED as a complex adaptive system, this paper examines how ED staff experience opioid-specific harm reduction provision and engage in harm reduction practice, including potential facilitators and barriers to engagement.MethodsUsing a mixed methods approach, ED nurses and physicians completed a self-administered staff survey (n = 99) and one-on-one semi-structured interviews (n = 15). Five additional interviews were completed with clinical leaders. Survey data were analyzed to generate descriptive statistics and to compute scale scores. De-identified interview data were analyzed using a reflexive thematic analysis approach, which was informed by the theory of complex adaptive systems, as well as understandings of harm reduction as both a technical solution and a contextualized social practice. The final analysis involved mixed analysis through integrating both quantitative and qualitative data to generate overarching analytical themes.ResultsStudy findings illustrated that, within the context of the ED as a complex adaptive system, three interrelated contextual factors shape the capacity of staff to engage in harm reduction practice, and to implement the full range of opioid-specific harm reduction interventions available. These factors include opportunities to leverage benefits afforded by working collaboratively with colleagues, adequate preparation through receiving the necessary education and training, and support in helping patients establish connections for ongoing care.ConclusionsThere is a need for harm reduction provision across all health and social care settings where people who use unregulated opioids access public sector services. In the context of the ED, attention to contextual factors including teamwork, preparedness, and connections is warranted to support that ED staff engage in harm reduction practice.

A call for compassionate opioid overdose response

High dose and long-acting opioid overdose reversal drugs can precipitate withdrawal in people who are opioid dependent. Products recently brought to market for community use in the United States (US) have drawn international concern because of their increased risk of withdrawal. At the March 18–19, 2024, Compassionate Overdose Response Summit & Naloxone Dosing Meeting, a panel of harm reduction experts issued the following call to action: 1) people who use drugs should be directly involved in decisions regarding the research, development, selection, and distribution of opioid overdose reversal products; 2) regulatory agencies and pharmaceutical manufacturers should carefully consider and communicate the risk and duration of withdrawal associated with higher dose and longer-acting opioid antagonists; 3) take-home naloxone kits should include at least two doses of an intramuscular (IM) product containing 0.4 mg or an intranasal (IN) product containing ≤4 mg; 4) At this time, high dose and long-acting opioid antagonists have no use in acute opioid overdose response; and, 5) overdose response educational materials, instructions on overdose response, and training should emphasize the restoration of breathing, avoiding withdrawal, and compassionate post-overdose support and care. High dose and long-acting opioid overdose reversal drugs were approved without testing for withdrawal and are often aggressively marketed despite decades of evidence from naloxone distribution programs worldwide that the ideal dose of naloxone is one that restores breathing without inducing withdrawal. Government agencies should direct resources to harm reduction programs to make standard dose take-home naloxone products widely available among people who use drugs. Lay bystanders, people who use drugs, their families, and professional first responders can learn and apply a compassionate approach to opioid overdose response.