Harm Reduction Methods Research Articles

Take Care of the Patient: Pharmacists Should Advocate for Overdose Prevention Centers (OPC) as Harm Reduction.

Overdose prevention centers (OPCs) are places where people can bring previously obtained substances to use under the supervision of trained healthcare professionals who are prepared to intervene in the event of an overdose. Healthcare professionals, counselors and peer support provide services including naloxone distribution, provision of sterile injection equipment, counseling services, referrals to necessary providers, and above all, a safe and compassionate space for people to get the care they need. This is a method of harm reduction that has been used globally for decades and is now gaining traction in the United States. Pharmacists play a vital role in harm reduction for patients, and they should support the legalization and establishment of overdose prevention centers across the country to extend this essential service. A compelling body of evidence shows that overdose prevention centers reduce overdose deaths, emergency department visits for overdoses, wounds relating to injection drug use and reduce emergency medical service utilization in the area surrounding the centers. They also reduce drug use and discarded hazardous drug paraphernalia in public areas. Overdose prevention centers also provide wrap-around services that aid in holistic care of the person, including referrals to inpatient substance use treatment, detoxification, primary care, transportation and housing. It is the responsibility of pharmacists to advocate for the needs of patients, and overdose prevention centers will provide an effective avenue for pharmacists to deliver counseling and medication management services as part of care of the individual.

Harm reduction for addictive consumption: When does it improve health and when does it backfire?

Some harm reduction strategies encourage individuals to switch from a harmful addictive good to a less harmful addictive good; examples include e-cigarettes (substitutes for combustible cigarettes) and methadone and buprenorphine (substitutes for opioids). These have proven to be controversial. Advocates argue that people struggling with addiction benefit because they can switch to a less harmful substance, but opponents argue that this could encourage abstainers to begin using the harm-reduction method or even, eventually, the original addictive good. This paper builds on theories of addiction to model the introduction of a harm reduction method, and demonstrates the conditions under which each side is correct.

High concordance between urine toxicology results and self-reported fentanyl use in Nevada and New Mexico

Background Co-use of stimulants and opioids is often deliberate. However, the possibility remains that some people are unintentionally consuming fentanyl. To advance understanding of overdose risk, we examined the rate of concordance between self-reported fentanyl use and corresponding urine toxicology screen results. Methods Between August 2022–August 2023, 411 participants (adults who reported any non-medical drug use in the past three months) in Nevada and New Mexico completed a cross-sectional survey, of whom 64% (n = 270; the analytical sample) also completed a urine toxicology screen, which detects fentanyl use in the past three days. Positive predictive value, negative predictive value, sensitivity, and specificity were calculated using self-reported past three-day fentanyl use (yes/no) and urine toxicology screen results for the presence of fentanyl (positive/negative). Results Of the 270 participants who provided a urine sample, 268 are included in the descriptive statistics (two with inconclusive urine toxicology screen results were excluded). Of the 268 participants, 146 (54.5%) had a fentanyl-positive urine toxicology screen result, 122 (45.5%) had a fentanyl-negative urine toxicology screen result, 137 (51.1%) reported past three-day fentanyl use, and 130 (48.5%) reported no past three-day fentanyl use. Only 6.9% of those with a fentanyl-positive urine toxicology screen did not report recent fentanyl use. The sensitivity of self-reported fentanyl use was 93%, specificity was 97%, positive predictive value was 97%, and negative predictive value was 92%. Discussion The rate of unanticipated exposure to fentanyl (that is, positive urine screen and negative self-report) in this sample was low, at 6.9%. This runs counter to the national narrative that there is widespread unknown contamination of fentanyl in the drug supply. Conclusion Future research is needed to further explore how people who use multiple substances interpret their overdose risk and what harm reduction methods they employ.

Perspectives of key interest groups regarding supervised Consumption sites (SCS) and novel virtual harm reduction services / overdose response hotlines and applications: a qualitative Canadian study

BackgroundSupervised consumption sites (SCS) and overdose prevention sites (OPS) have been implemented across Canada to mitigate harms associated with illicit substance use. Despite their successes, they still contend with challenges that limit their accessibility and uptake. Overdose response hotlines and apps are novel virtual technologies reminiscent of informal “spotting” methods that may address some of the limitations. Here, we strove to qualitatively examine the factors that may encourage or deter utilization of these virtual services and SCS.MethodsA total of 52 participants across Canada were recruited using convenience and snowball sampling methods. These included people with lived and living experience of substance use, family members of people with lived experience, healthcare providers, community harm reduction workers, and virtual harm reduction operators. Semi-structured telephone interviews were conducted and inductive thematic analysis was performed to identify the themes pertaining to SCS and virtual harm reduction.ResultsParticipants viewed overdose response hotline and apps as an opportunity to consume substances without being hindered by logistical barriers (e.g., wait times), fear of law enforcement, invasion of privacy, and more. They also noted that these virtual services provided more flexibility for clients who opt for routes of consumption that are not supported by SCS, such as smoking. Overall, SCS was perceived to be better than virtual services at facilitating social connection, providing additional resources/referrals, as well as prompt response to overdose.ConclusionIn sum, participants viewed SCS and virtual services as filling different needs and gaps. This study adds to a growing body of literature which informs how virtual harm reduction services can serve as useful adjunct to more standard harm reduction methods.

Dreaming of an abolitionist drama therapy

Despite long standing activist and academic calls for prison and police abolition and the need to consider how carceral logics are embedded in mental health practices, no known drama therapy scholarship currently focuses on these topics. We explain the problems with using policing, prisons, and punitive responses to systemic problems, articulating the ways in which these practices are deeply rooted in settler colonialism, anti-Black racism, ableism, capitalism, cis-heteronormativity, and other systems of oppression. We then offer an introduction to carceral logics and abolition, situating our work as not only about the absence of these punitive systems and ways of thinking, but also about imagining and building another kind of world. Approaches to behavioral escalation and suicidality are articulated as examples of sites of practice where drama therapists are often complicit in harmful practices and offer anti-carceral alternatives as harm reduction methods. We conclude with a call to action to drama therapists to engage in abolitionist practices in their work and to be part of the larger visioning process for a more just world.

Health information-seeking on Reddit, by people who use opioids

Introduction. In the most recent year that data is available, 101,035 people died from drug overdoses in the United States. For people who use drugs, obtaining treatment remains a significant barrier due to issues of fear, stigmatisation, and illegality. Some people turn to the anonymous social media site, Reddit, for obtaining health and harm reduction information. Method. In this study we analysed 2,748 health-related posts on the subreddit r/opiates over a three-month period. Analysis. Using a thematic analysis grounded in social constructivism, we categorised the data to determine the most frequent types of health questions asked by people who use opioids. We then used the text analysis software Linguistic Inquiry and Word Count to determine the emotional content of the posts. Results. Most of the posts were asking about harm reduction strategies and methods to reduce or quit opioid use. Conclusion. The text analysis demonstrated evidence of Foucault’s discourse theory. People who use opioids need more information on harm reduction strategies, and especially safely administering and withdrawing from them.

Exploring Anabolic Androgenic Steroid Use Among Cisgender Gay, Bisexual, and Queer Men

Anabolic androgenic steroids (AAS) are disproportionately used by sexual minority men, with the physical and mental health implications of AAS use incompletely understood. To understand the reasons for use and health care needs of gay, bisexual, and queer cisgender men using AAS. This qualitative study was conducted from November 2021 to May 2023 using self-administered questionnaires and semistructured interviews that were transcribed and coded using reflexive thematic analysis. Participants were recruited through convenience and snowball sampling from lesbian, gay, bisexual, transgender, and queer clinical centers in New York, New York, as well as through online platforms. All patients self-identified as cisgender and gay, bisexual, or queer. History of nonprescribed AAS use for a minimum of 8 consecutive weeks was required. The primary outcomes were reasons for and health implications of AAS use and interactions with health care practitioners, as determined through interviews. Interview transcripts were collected and analyzed. Thematic saturation was reached after interviews with 12 male participants (mean [SD] age, 44 [11] years), with the majority of participants identifying as gay (10 participants [83%]), White non-Hispanic (9 participants [75%]), being in their 30s and 40s (9 participants [75%]), holding a bachelor's degree or higher (11 participants [92%]), and having used steroids for a mean (SD) of 7.5 (7.1) years. One participant (8%) self-identified as Black, and 2 (17%) identified as Hispanic. Seven men (58%) met the criteria for muscle dysmorphia on screening. Nine overarching themes were found, including internal and external motivators for initial use, continued use because of effectiveness or fear of losses, intensive personal research, physical and emotional harms experienced from use, using community-based harm reduction techniques, frustration with interactions with the medical community focused on AAS cessation, and concerns around the illegality of AAS. In this qualitative study, AAS use among cisgender gay, bisexual, and queer men was found to be associated with multifactorial motivators, including a likely AAS use disorder and muscle dysmorphia. Despite all participants experiencing harms from use, men seeking medical help found insufficient support with practitioners insistent on AAS cessation and, thus, developed their own harm reduction techniques. Further research is needed to assess the utility of practitioner education efforts, the safety and efficacy of community-developed harm reduction methods, and the impact of AAS decriminalization on health care outcomes for this patient population.

Synthetic Cathinones: Epidemiology, Toxicity, Potential for Abuse, and Current Public Health Perspective.

Synthetic cathinones, derived from cathinone found in the plant Catha edulis, represent the second largest and most frequently seized group of new psychoactive substances. They are considered as β-keto analogs of amphetamine, sharing pharmacological effects with amphetamine and cocaine. This review describes the neurotoxic properties of synthetic cathinones, encompassing their capacity to induce neuroinflammation, dysregulate neurotransmitter systems, and alter monoamine transporters and receptors. Additionally, it discusses the rewarding and abuse potential of synthetic cathinones drawing from findings obtained through various preclinical animal models, contextualized with other classical psychostimulants. The review also offers an overview of current abuse trends of synthetic cathinones on the illicit drug market, specifying the aspects covered, and underscores the risks they pose to public health. Finally, the review discusses public health initiatives and efforts to reduce the hazards of synthetic cathinones, including harm reduction methods, education, and current clinical management strategies.

Identifying Provider Barriers to the Implementation of Opioid Harm Reduction Methods: An Initial Narrative Review.

According to the Centers for Disease Control and Prevention, the opioid epidemic remains a major issue in the United States, with over 80,000 deaths attributed to opioids in 2021. This public health crisis continues to impact communities across the country, highlighting the need for intervention and reflecting the nation's failed attempts at prohibition through criminalization to reduce opioid use. Harm reduction methodshave proven to be effective in preventing adverse health outcomes and promoting the overall well-being of individuals with opioid use disorders. However, significant gaps remain in the universal implementation by healthcare providers. This review evaluated the PICOT question: What barriers exist among providers in implementing evidence-based harm reduction methods for adults aged 18 years and older, with and without opioid use disorders? A literature search was conducted across databases using key words which included: "Health care provider," "Physician," "Pharmacist," "Harm reduction," "Harm reduction programs," "Naloxone," "Buprenorphine-naloxone induction," "Methadone," "Naloxone take home kits," "Stigma," "Barriers," "Negative perception," "Refusal." The inclusion criteria focused on identifying provider barriers, specifically regarding opioid use. . The review revealed 3 major barriers that exist among providers to prevent harm reduction: stigma, lack of education and knowledge, and lack of access to resources for long-term management. Recognizing these barriers among providers can help organizations develop targeted interventions to overcome them, leading to widespread adoption of opioid harm reduction methods. The results provide an initial narrative review of the current evidence at the time of the authors search to inform practice, policy, and future research.

Are Health Care Providers Caring for Pregnant and Postpartum Women Ready to Confront the Perinatal Cannabis Use Challenge?

The purpose of this study was to assess health care providers' knowledge and practices related to cannabis use among pregnant and postpartum women. A survey of health care providers (n = 75 responders) was conducted across four main regions in the state of Virginia to assess knowledge of adverse health effects associated with perinatal cannabis use, screening tools, follow-up for positive screening, barriers to having discussions about cannabis use, and treatment among pregnant and postpartum women. An astonishing 34.7% of the providers surveyed responded as not being aware of the impacts of cannabis use on the health of the mother and infant, and 66.7% of them reported that they would like some training on feeling comfortable with their knowledge about the impact of perinatal cannabis use on the population they are serving. When asked about providing resources and/or patient education related to cannabis use during pregnancy and/or breastfeeding, 62.7% reported they did not but they would be interested in providing both resources and education. Over one-third of the providers did not have a follow-up process for positive screening. In addition, numerous barriers to asking/screening and/or discussing cannabis use and potential harm reduction methods for the pregnant and postpartum populations emerged such as inadequate or lack of resources for positive screening, lack of knowledge on the topic, unsure about the policies of reporting a positive screening, etc. CONCLUSION: The findings of this study indicate that health care providers caring for pregnant and postpartum women are not equipped to make appropriate recommendations to patients and guide them through decision-making. Health care providers caring for pregnant and postpartum women need to be knowledgeable on how to best support patients with cannabis use for effective counseling and guidance due to health risks. State policies and resources are needed to ensure training for clinicians on perinatal cannabis. · Providers are not knowledgeable about perinatal cannabis.. · Providers lack resources and do not have a follow-up process.. · Providers would like to receive training on the impact of perinatal cannabis on health outcomes..

Making Harm Reduction More Accessible: Fentanyl Test Strip Awareness and Attitudes among Emergency Department Patients Who Use Drugs

Background Fentanyl test strips (FTS) are a harm reduction method for people to test their drugs for fentanyl. Ideal points for FTS distribution have not been identified. Many people who use drugs have frequent contact with the Emergency Department (ED). We piloted FTS distribution in two urban hospital EDs. Methods Between June-December 2021 in Philadelphia, PA, patients with past 30-day drug use completed a survey about drug use, fentanyl attitudes, and FTS; then offered FTS and a brief training. Survey data were analyzed using SPSS for bivariate statistics. Results Patients (n = 135) were primarily White (68.1%) and male (72.6%). Participants regularly interacted with substance use (57.8%) and benefits coordination (49.6%) services. The most common drugs used were heroin/fentanyl (68.9%), crack cocaine (45.2%) and cannabis (40.0%). Most (98.5%) had heard of fentanyl though few (18.5%) had ever used FTS. Across most drug types, participants were concerned about fentanyl. All accepted FTS training and distribution. Few (9.6%) were somewhat or very concerned about having FTS if stopped by police and this number varied by race (7.6% of White people were somewhat or very concerned, compared to 12.8% of Black people). Most participants were already engaged in risk reduction practices. Discussion FTS are a widely desired harm reduction tool to facilitate informed decision-making, and non-harm reduction locations are potentially feasible and acceptable distribution sites. Given regular contact with EDs and social services across the sample, FTS should be offered at non-harm reduction locations that come into frequent contact with people who use drugs.

Changing Harm Reduction Approaches Is Not a Choice; It Is Necessary to Survive

: Service providers have tried to reduce harm reduction and objectively improve health and infectious indicators caused by the consumption of illegal drugs for years. However, some disappointment has happened to these people. On the other hand, policymakers and society still need to remember the efforts of harm reduction service providers or have more and higher expectations in this regard. This article looks at the services and achievements of harm reduction from the past to the present. Also, it discusses the new harm reduction methods that align with today's needs of the global community. Today, a new mission is needed for harm reduction and other goals, such as mediation and human rights issues related to disease and addiction. The undeniable success of harm reduction in curbing and controlling many infectious aspects has caused policymakers and harm reduction service providers to become weak and need clarification. It has plunged harm reduction into a halo of uncertainty. There is a need to give new life to this dynamic thinking by redefining harm reduction.

Perspectives on cannabis risks and harm reduction among youth in Early Psychosis Intervention programs: a qualitative study

Purpose The Canadian government legalized cannabis in 2018 and funded harm reduction campaigns to educate youth about the risks. Cannabis can contribute to psychosis in vulnerable populations, and consumption is common among youth in Early Psychosis Intervention (EPI) programs. The purpose of this study is to understand the views of youth in EPI programs on the risks related to cannabis and methods to reduce those risks. Design/methodology/approach A qualitative design and thematic analysis were used to understand the perspectives of youth in EPI programs (n = 15) towards cannabis risks and harm reduction. Findings Participants associated Δ−9 tetrahydrocannabinol (THC) with problems related to cognition, psychosis, respiration, addiction, motivation, finances, relationships and anxiety. Cannabidiol (CBD) was believed to be safe and risk-free. To reduce the risks associated with THC, participants suggested using in moderation, delaying use, using CBD over THC, accessing legal sources, avoiding high THC dosages and using non-combustible methods. Research limitations/implications Participants self-selected to participate, were psychiatrically stable and may not represent youth in EPI programs with more severe psychotic symptoms. Practical implications Assessing risk perceptions, motives for use and perspectives towards the cannabis and psychosis connection can reveal educational needs. CBD may offer a harm reduction option for EPI clients wanting to decrease THC intake, though more research is needed and adverse effects should be explained. Educational campaigns should disseminate the connection between cannabis and psychosis to facilitate early intervention. Originality/value This study adds to the literature by highlighting knowledge of harm reduction methods and gaps in risk awareness among EPI program youth.

Knowledge, Attitude, and Perception of Tobacco Harm Reduction Strategies Among Medical Students in Southwest, Nigeria

Background: The rate of tobacco use is on a steady increase worldwide and is associated with over 7 million deaths per year, three-quarters of which occur in low-and middle-income countries. Inadequate cessation programs/interventions, difficulties quitting tobacco, and a lack of information about tobacco health risks and tobacco harm reduction methods, have all contributed to the rapid rise of tobacco use in Nigeria, with the country's smoking rate increasing at a rate of approximately 4% each year. Tobacco harm reduction (THR) methods are alternatives to cigarette smoking that have been shown to assist in smoking cessation and reduce the mortality and morbidity associated with tobacco and nicotine use, however, these methods are still controversial and have drawn some criticism in recent times. Due to the prevalence of THR methods among young people and the growing health debate around them, medical students are likely to have a direct or indirect encounter with THR methods. A greater grasp of their viewpoint is beneficial while training them. Therefore, this study aims to determine the knowledge, attitude, and perception of THR strategies among medical students in southwest, Nigeria. Methods: A cross-sectional study was carried out among clinical medical students in 6 medical schools in southwest, Nigeria, and data was collected via an online semi-structured based questionnaire. Descriptive analysis was done and a chi-square test was used to test the association between the level of knowledge of tobacco health risks and the socio-demographic variables. Results: 199 participants’ data were fully collected, 105(53%) were male while 94(47%) were female. Most (79%) of the respondents were of the age group 21-25. The majority (99.5%) of them never smoked. The majority of the participants 190(95%) have good knowledge about the health risks of tobacco and a Chi-square test showed only age as a significant socio-demographic variable, with participants between the 16-20 age group having a higher frequency of poor knowledge. Only 83(42%) understood what THR means. Also, 185(93%) do not know about THR methods regulation in Nigeria. 179(90%) have an interest in knowing about THR and 147(74%) said they will recommend it to smokers as a future doctor. 60.3% of participants perceived THR products to be less harmful than conventional cigarettes and 23% perceived THR products to be harmful to people in the vicinity of the users. 50.8% of participants see THR products to be a “gateway” to conventional cigarette use in the future. Conclusion: From this result, most medical students have good knowledge about tobacco harm risks, therefore, they will be able to confidently discuss this topic with patients and the public. However, there is poor knowledge of THR methods among medical students. This highlights the critical need to further educate medical students as well as give evidence-based recommendations at all levels to assist in advising patients who enquire or are interested in THR products and regulating their usage in the general community, as our study found out that most medical students are interested in knowing about THR method.

A qualitative study: harm reduction and opioid overdose strategies for Black and Latinx opioid overdose survivors

ABSTRACT The United States (US) is amidst an opioid epidemic. In New York City (NYC), there are disparate rates of opioid overdose deaths among communities of color. Many harm reduction methods are being implemented to curb the opioid crisis. Little is known about which strategies people of color use to reduce their risk of a subsequent overdose. This qualitative phenomenological study highlights the lived experiences of 11 NYC Black and Latinx opioid overdose survivors and their strategies to reduce the likelihood of another overdose. ts . A thematic analysis was utilized to identify three significant themes: volition and control; risk factors for overdose; and risk reduction, services, and interventions. The sample’s mean (±SD) age was 40.54 (±13.84); 54.55% identified as Latinx and 45.45% identified as Black. Social workers and other health professionals need continued education and training about harm reduction methods and overdose prevention strategies. Implications for social work practice, education, policy, and research are delineated.

Understanding Community Perceptions of the St. Kitts’ “Monkey Problem” by Adapting Harm Reduction Concepts and Methods

Wicked problems in One Health are associated with dynamicity and uncertainty that require experts, authorities and community members to reach for innovative means of collective inquiry, and collaborative interventions to address the deep social issues at the root of interspecies problems. In this study we explore the value of harm reduction concepts to understand a hundreds of year old issue, the St. Kitts’ “monkey problem,” which involves the invasive African green monkey (Chlorocebus sabaeus) as the cause of deleterious effects on agriculture, but concurrent positive effects on tourism and biomedical research. The harm reduction approach, a systems and settings-based approach with decades of success in public health, can serve as a framework to produce action on persistent societal problems. Harm reduction concepts and methods and participatory epidemiology were used to uncover local perceptions about human-monkey interactions and “meet people where they are” by asking the research question: Are there commonalities in perceptions and values linked to the St. Kitts’ “monkey problem” that are shared across diverse representatives of society that can act as a common starting place to launch collaborative responses to this invasive species? Through a series of focus group activities and interviews we found that the Kittitian “monkey problem” is a contentious and dichotomous problem pervasive in most of society that has no single stakeholders nor one solution. Harm reduction helped to map the island’s human-monkey system and elucidated an entry point toward tackling this problem through the identification of shared values, and also provided a model for incremental gains that may be achieved. Likening the St. Kitts “monkey problem” to a wicked problem enabled stakeholders to seek more options to manage the problem rather than to conclusively solve it. Frequently mentioned shared values including the protection of farmer crops and backyard harvests likely represent strong entry points to this problem and a jumping-off point to begin collective action toward future improvements.

CPNP 2022 Annual Meeting Poster Abstracts

CPNP 2022 Annual Meeting Poster Abstracts

Breaking it down: Review and management of sialendoscopy device malfunctions

PurposeThe present study was aimed at determining common causes of sialendoscopy device malfunctions and identifying a uniform algorithm to manage device failures. Materials and methodsThe FDA Manufacturer and User Facility Device Experience (MAUDE) database was searched for various keywords related to sialendoscopy. Reports between the dates of December 1, 2009 to March 31, 2020 were downloaded for review and included in the study. Variables such as: device, the iatrogenic injury type, and subsequent surgical or medical intervention were collected and details of the malfunction were categorized based on the type of malfunction. Results206 medical device reports were identified; 47 of them which met inclusion criteria (106 were duplicate cases and 53 were irrelevant to the present study). The majority of device malfunctions involved salivary stone extractor baskets (SSEBs), (40/47; 85.1%), followed by malfunctions of balloon dilators (3/47; 6.4%) and sialendoscopes (2/47; 4.3%). Retention of the SSEB was noted in 85% of the SSEB malfunctions. ConclusionsGiven that sialendoscopy is an increasingly popular technique that relies on devices, it is inevitable that device failures will occur for a multitude of reasons. Working to prevent these malfunctions from occurring is the most effective method of harm reduction. Though it is important that sialendoscopists have a discrete, algorithmic approach to manage them when they occur.

Mental Health and Benzodiazepine Use Among Patients on Chronic Opioid Therapy.

Higher daily doses of opioids as well as co-prescription of benzodiazepines have been associated with risk of overdose. The current study characterizes prescribing patterns in a family medicine practice with regard to patient mental health diagnoses, benzodiazepine prescriptions, morphine milligram equivalent opioid dose, and patient demographics. Patients on chronic opioid therapy were studied in 2018 and 2019. Mental health diagnoses, opioid dose, benzodiazepine prescriptions and demographic characteristics were extracted from the electronic health record. Data were compared between years and logistic regression was used to determine which patient characteristics were associated with likelihood of decreased opioid dose. A total of 387 patients were prescribed chronic opioid therapy in 2018, and 231 in 2019. In 2018, 49.9% of patients prescribed chronic opioids had mental health diagnoses. In 2019, this proportion rose to 92.2%. In 2019, 205 of the original 387 patients were still with the practice but were not prescribed chronic opioids. Among the factors studied, psychiatric diagnosis and higher opioid dose were associated with a significantly lower likelihood of tapering doses. As practices taper or de-prescribe opioids, or implement harm reduction methods such as de-prescribing benzodiazepines, it is important to understand patient characteristics and their relationship to success with tapering. This study adds to the evidence that odds of successfully tapering opioids may be significantly impacted by patients' mental health diagnosis and opioid dose.

Risk perception of cigarette and e-cigarette use during pregnancy: A qualitative postpartum perspective

AimThe aim of this exploratory qualitative analysis is to assess the perceptions of risks of cigarette and e-cigarette use during pregnancy. BackgroundAn important public health aim is a reduction of smoking at time of delivery (SATOD) from 10.6% to less than 6% by 2022 in the United Kingdom (UK). In order to successfully meet this target, we need to have a better understanding of the perceived risks associated with cigarette smoking. Additionally, the use of e-cigarettes is increasing in the general population, with pregnant women being supported to use such products if it helps them remain smoke free. However, in contrast to cigarette smoking, there is little definitive research assessing the safety of e-cigarette use during pregnancy, with most information disregarding the health of the growing fetus. E-cigarettes are of special interest, given they are an unlicensed product for use during pregnancy, yet women are being supported to use them as a method of harm reduction. A better understanding of perceived risks is essential. MethodFourteen interviews were conducted one month postpartum with women who smoked during pregnancy and continued to smoke after the birth. Thematic analysis was conducted. FindingsTwo themes emerged for cigarette smoking; health and justifications. Six themes were identified for e-cigarette use; the unknown, experience, comparison to cigarettes, the product, advice and healthier option. A range of subthemes are discussed. ConclusionWomen provided a range of justifications for continuing to smoke during pregnancy. Women felt e-cigarettes were a riskier option than continuing to smoke.