Harm Reduction Practices Research Articles

Impact of harm reduction practice on the use of non-prescribed performance and image-enhancing drugs (PIEDs): The PUSH! Audit

The PUSH! Audit was a cross-sectional study performed from May 2019 to May 2021. With each audit submitted, general practitioners (GPs) were asked about the impact of their engagement with their patients. In all, 144 audit responses were collected, with 81.6% ofaudits showing a change in behaviour. The changes noted were better monitoring (71.3%), treatment of adverse effects (64.4%), modified use (44.4%) and stopped use (12.2%). This study asking GPs about outcomes with each of theirpatients using non-prescribed PIEDs has shown significant changes in behaviour. There has been no previous work done to evaluate the potential impact of such engagement. The findings of this exploratory study of the PUSH! Audit suggest harm reduction for people who use non-prescribed PIEDs when engaged with GPclinics.

Young Adults’ Pathways of Negating Harms and Pleasure Related to Recreational Poly-Drug Use: A Complex Balancing Act

Background: This paper examines the drug use and harm reduction practices of a subset of young adults in the Greater London area who engage in recreational poly-drug use. It traces their complex relationships with three popular party drugs – MDMA/ ecstasy, cocaine, and alcohol – and explores the difficulties of balancing the harms and benefits within the context of situated poly-drug use practices. Method: Longitudinal qualitative interviews with 31 young adults, aged 22 to 25. Three phases of thematic, semi-structured interviews were conducted from February 2018 to April 2019. Results: This paper describes participants’ relationships to both MDMA and cocaine and the various ways they balance the risks and pleasures associated with these drugs. Participants appeared to succeed in balancing the two with MDMA, based largely on effective harm reduction messaging. With their cocaine use, however, we see a rise in challenges complicating this balancing act. Framed by ‘harm reduction from below,’ this paper shows that participants generally see cocaine’s adverse effects as less physically and mentally harmful than those of MDMA and this is reflected in their drug use choices. But the perception of cocaine’s relative safety has consequences, particularly when we consider the drug’s normalization and acceptability in spaces where it is frequently co-consumed with alcohol. In light of their consistent co-consumption of cocaine and alcohol, this pathway analysis suggests that participants’ efforts to reduce harm in one instance could create more harm and long-term negative effects in another. And as a result, participants struggle to bring the risk and pleasure of this co-consumption into balance. Conclusion: Further exploration on both young peoples’ evolving motivations of drug choice and use and on how young people navigate the nuances of balancing acts within their poly-drug use would be a helpful contribution to advancing field of harm reduction. An emphasis on the psychological and physical risks of the prevalent practice of co-consuming cocaine and alcohol are also encouraged.

Consultório de Rua: cuidado no território na interface entre HIV/Aids, drogas e Redução de Danos

ABSTRACT This article aims to present the experience of implementing ‘Street Outreach Teams’ in the city of Recife-PE as a strategy for HIV/AIDS prevention and Harm Reduction (HR) associated with the use of alcohol, crack, and other drugs. Although the review of the history of this process reveals tensions, volatility, and alternations in the care models implemented by the city management, the analysis points out the importance of reaffirming, in the current context, the practices and experiences in that field, anchored in HR and in the defense of civil and human rights. Street outreach teams have been found to help strengthen the practice of HR in the Unified Health System, as a public health strategy to reduce vulnerabilities to Sexually Transmitted Infections (STI) and AIDS associated with the use of alcohol, crack, and other drugs. The experience has expanded the promotion of the line of care for people who use alcohol, crack, and other drugs and reduced the vulnerabilities of STI/AIDS associated with such use. However, it seems that it is necessary to invest and maintain permanent training processes, in addition to epidemiological studies and research demonstrating the results achieved in different contexts.

Puff, Puff, Don’t Pass: harm reduction for cannabis use during a viral respiratory pandemic

BackgroundPrior to the COVID-19 pandemic, cannabis use social practices often involved sharing prepared cannabis (joints/blunts/cigarettes) and cannabis-related paraphernalia. Previous studies have demonstrated that sharing paraphernalia for cannabis, tobacco, and crack cocaine is a risk factor for respiratory viral and bacterial infections. Although COVID-19 is a respiratory viral infection that spreads through droplets and airborne transmission, it is unclear if many individuals adopted harm reduction practices around sharing cannabis. This study: quantifies the prevalence of sharing prepared non-medical cannabis and cannabis-related paraphernalia reported before and during the pandemic; assesses changes in sharing of non-medical cannabis from before to during the pandemic; assess the association between frequency of non-medical cannabis use and sharing of cannabis during the pandemic; and describes how respondents obtained their cannabis and the reasons for changing their cannabis use during the pandemic to explain differences in sharing patterns.MethodsThis cross-sectional study used data collected from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020 (n = 1833). Participants were included if they reported using a mode of inhalation for non-medical cannabis consumption. We calculated proportional changes in sharing cannabis before/during the COVID-19 pandemic. Associations between frequency of cannabis use and cannabis sharing during the COVID-19 pandemic were assessed using logistic regression analysis.ResultsOverall, 1,112 participants reported non-medical cannabis use; 925 (83.2%) reported a mode of cannabis inhalation. More respondents reported no sharing during (24.9%) than before the pandemic (12.4%; p < 0.01); less respondents shared most of the time (19.5% before; 11.2% during; p < 0.01) and always during the pandemic (5.2% before; 3.1% during; p < 0.01). After adjusting for covariates, the odds of any sharing during the pandemic for those who reported ≥ weekly cannabis use was 0.53 (95% CI 0.38, 0.75) compared to those who reported ≤ monthly.ConclusionsSharing of prepared cannabis and cannabis-related paraphernalia decreased during the COVID-19 pandemic compared to before the pandemic. This finding suggests potential risk mitigation strategies taken by participants for COVID-19 prevention either directly through behavior change or indirectly through adherence to COVID-19 prevention recommendations. Harm reduction messaging around sharing of cannabis during surges of COVID-19 or other respiratory infections may provide benefit in reducing infection among those who use cannabis, especially as cannabis use in the USA continues to increase.

Motives for alcohol use, risky drinking patterns and harm reduction practices among people who experience homelessness and alcohol dependence in Montreal

BackgroundPeople experiencing homelessness are disproportionately affected by harms related to alcohol use. Indeed, their alcohol dependence is associated with numerous physical and mental health problems along with strikingly high rates of alcohol-related mortality. Recent research has extensively examined alcohol use patterns among people experiencing homelessness in an effort to develop interventions and treatments for this problem. However, only a few studies have incorporated the perspectives of the individuals under study about their drinking or examined the ways in which they manage the associated harms. To bridge this gap, we conducted a qualitative study exploring the relation between the drinking motives, risky drinking patterns and harm reduction practices of a group of people (n = 34) experiencing homelessness in Montreal, Canada.MethodsThe qualitative methods we used consisted of semi-structured interviews (n = 12) and focus groups (n = 2, with a total of 22 participants). The content of the collected data was then analyzed.ResultsParticipants identified their various motives for alcohol use (coping with painful memories, dealing with harsh living conditions, socializing/seeking a sense of belonging, enjoying themselves/having fun); their risky drinking patterns (binge drinking, mixing alcohol with drugs, non-beverage alcohol drinking, failing to keep sufficient alcohol on hand to prevent acute withdrawal, drinking in public settings); their harm reduction practices (planning how much to drink, keeping a supply of alcohol to prevent acute withdrawal, hiding to drink, concealing alcohol, drinking alone, drinking/hanging out with others, drinking non-beverage alcohol, and taking benzodiazepines, cocaine or other stimulant drugs); and the rationales underpinning their alcohol use and harm reduction practices.ConclusionAssociating the drinking motives of a group of study participants with their risky drinking patterns and harm reduction practices shed light on their rationales for alcohol use, yielding insights that could be used to better tailor policies and interventions to their needs.

Acute hepatitis C virus infection: clinical update and remaining challenges.

Acute hepatitis C virus (HCV) infection is a global health concern with substantial geographical variation in the incidence rate. People who have received unsafe medical procedures, used injection drugs, and lived with human immunodeficiency virus are reported to be most susceptible to acute HCV infection. The diagnosis of acute HCV infection is particularly challenging in immunocompromised, reinfected, and superinfected patients due to difficulty in detecting anti-HCV antibody seroconversion and HCV ribonucleic acid from a previously negative antibody response. With an excellent treatment effect on chronic HCV infection, recently, clinical trials investigating the benefit of direct-acting antivirals (DAAs) treatment for acute HCV infection have been conducted. Based on the results of cost-effectiveness analysis, DAAs should be initiated early in acute HCV infection prior to spontaneous viral clearance. Compared to the standard 8-12 week-course of DAAs for chronic HCV infection, DAAs treatment duration may be shortened to 6-8 weeks in acute HCV infection without compromising the efficacy. Standard DAA regimens provide comparable efficacy in treating HCV-reinfected patients and DAA-naïve ones. For cases contracting acute HCV infection from HCV-viremic liver transplant, a 12-week course of pangenotypic DAAs is suggested. While for cases contracting acute HCV infection from HCV-viremic non-liver solid organ transplants, a short course of prophylactic or pre-emptive DAAs is suggested. Currently, prophylactic HCV vaccines are unavailable. In addition to treatment scale-up for acute HCV infection, practice of universal precaution, harm reduction, safe sex, and vigilant surveillance after viral clearance remain critical in reducing HCV transmission.

Implementing the White House’s Strategic Plan to Save Lives Amid the Opioid Crisis

This Viewpoint discusses the goals of the inaugural National Drug Control Strategy, which as the ambitious agenda of emphasizing harm reduction practices, medications for treating opioid use disorder, and criminal justice reform, as well as supporting long-term recovery and interrupting illicit drug trafficking.

Attitudes towards people who use substances: a survey of mental health clinicians from an urban hospital in British Columbia

Stigma and other barriers limit harm reduction practice integration by clinicians within acute psychiatric settings. The objective of our study was to explore mental health clinician attitudes towards substance use and associations with clinical experience and education level. The Brief Substance Abuse Attitudes Survey was completed among a convenience sample of mental health clinicians in Vancouver, British Columbia. Five predefined attitude subgroups were evaluated. Respondents’ attitudes towards substance use were associated with level of education on questions from two (non-stereotyping [p = 0.012] and treatment optimism [p = 0.008]) subscales. In pairwise comparisons, postgraduate education was associated with more positive attitudes towards relapse risk (p = 0.004) when compared to diploma-educated respondents. No significant associations were observed between years of clinical experience and participant responses. Our findings highlight important aspects of clinician attitudes that could improve harm reduction education and integration into clinical practice.

Psychedelic integration challenges: Participant experiences after a psilocybin truffle retreat in the Netherlands

AbstractThis article reports on integration challenges that were experienced by nine individuals who attended a three-day legal psilocybin truffle retreat in the Netherlands. The study employed a qualitative phenomenological approach, using semi-structured interviews to gain an understanding of participants' (n = 30) psilocybin experiences and their after-effects. While the study did not actively seek to measure integration issues or unexpected side effects, nine out of thirty participants (30%) spontaneously reported a post-experience integration challenge. These challenges included: mood fluctuations, ‘post-ecstatic blues’, disconnection from community, re-experiencing symptoms, spiritual bypass and perceived lack of support. Integration challenges were transient; they occurred immediately after the psilocybin experience (once the main psychedelic effects had worn off) and in the days and weeks following the retreat, and resolved with time. Integration challenges were also correlated with positive after-effects including long-term remission of significant health conditions. The experiences related in this article align with existing literature that describes the ‘spiritual emergency’ phenomenon; that is, the potential challenges that can arise after ecstatic experiences and how these challenges may be integral to the transformative potential of such experiences. We discuss the implications for psychedelic integration and harm reduction practices and for future psychedelic research.

A Content Analysis of Social Media Discussions on THC-O-Acetate.

Novel cannabinoids require systematic research to inform policies and practices. There is a growing interest in semi-synthetic cannabinoids by consumers, manufacturers, and regulators. However, there is a scarcity of research on these substances. Online discussion forums can provide guidance for research questions when current knowledge is scarce. The current project investigates the topics and issues covered in a social media forum devoted to THC-O-acetate (THCO), a semi-synthetic cannabinoid with rapidly rising popularity. Reddit comments posted on the THCO subreddit from June 2021 through November 2021 were coded for major and minor themes by a team of five coders and a supervisor. Major themes were established and clarified through group discussions. A second round of coding confirmed major themes and identified minor themes. The analysis identified several future research topics for THC-O-acetate, including the extent of variation in product composition, the characteristics of user experiences and comparisons with other substances, whether THC-O-acetate produces psychedelic effects, concerns and adverse experiences, and user harm reduction practices. As an acetate ester, THC-O-acetate may break down when heated and release toxic ketene gas. Although several users expressed safety concerns regarding THC-O-acetate, some explicitly mentioning ketene risk, the most common administration method reported was heated inhalation.

1535. Harm Reduction: A Missing Piece in Holistic ID Care for Patients Who Inject Drugs

Abstract Background The rise in injection drug use (IDU) has led to an increase in drug-related infections and hospitalizations. Harm reduction is an important strategy for preventing infections among people who inject drugs (PWID). We set out to evaluate how infectious disease physicians counsel PWID with serious injection-related infections on harm reduction practices. Methods An electronic survey was distributed to 1,510 physician members of the Emerging Infectious Network (EIN) to determine which harm reduction principles ID physicians recommend to PWID to reduce infection risks. EIN members who do not care for PWID were excluded. Two weekly reminders were sent to increase the response rate. Results Three hundred ninety-nine (26%, still in progress) ID physicians responded to the survey. Practice settings included: university (37%), community (27%), non-university teaching (23%), or other (14%) hospital settings. Of those, 279 (70%) reported routinely caring for PWID. 274 (98%) performed screening for HIV and hepatitis, and 239 (86%) discussed the risk of these viral infections. 65% prescribed immunization against hepatitis and 44% discussed HIV PrEP. 57% (n=159) reported not counseling patients on safer injection strategies. Common reasons for not counseling included limited time and a desire to emphasize antibiotic therapy/medical issues (33%, n=91), lack of training (30%, n=85), and believing that it would be better addressed by other services (27%, n=75). Among physicians who reported counseling PWID, they recommended abstinence from IDU (38%, n=105), handwashing &amp; skin cleansing prior to injection (33%, n=92), avoiding injecting areas of skin breakdown (27%, n=76), and cleaning needles between use (26%, n= 73). Finally, 17% (N=47) reported no access to any addiction services. Conclusion Almost all ID physicians screen PWID for HIV and viral hepatitis and discuss the risks of these infections. Despite frequently encountering PWID, less than half of ID physicians provide safer injection advice. Opportunities exist to standardize education of PWID on harm reduction, emphasizing safer injection practices in conjunction with other strategies (e.g. HIV PrEP, HAV/HBV vaccination) to prevent infections. Disclosures All Authors: No reported disclosures.

PWUD Experiences of Criminal Justice Reform: Enduring Tensions Between Policing and Harm Reduction in Baltimore, MD

In this paper we explore people who use drugs (PWUD) perceptions and experiences of drug-related law enforcement in a major U.S. city. Maryland recently implemented several harm reduction policies/interventions aiming to improve PWUD-police relationships, such as the Good Samaritan Law (GSL), intended to avoid criminalizing police encounters with PWUD in cases of overdose. PWUD, though most impacted by these efforts, are seldom included in the decision making process. Data collection occurred in Baltimore City, a majority-Black city with a history of structural racism, where high overdose fatalities necessitate collaborative interventions, but where over-policing and abusive practices have generated widespread community mistrust of police. Between October 2018 and December 2019, we conducted in-depth interviews with 20 PWUD in Baltimore City to understand their perspectives of policing and its impact on harm reduction practices (specifically willingness to seek overdose assistance) in the context of the GSL. PWUD reported ongoing police mistrust, which impacted their harm reduction practices and experiences of laws such as the GSL. Results question whether police, as first responders to overdose, can ever avoid criminalizing the encounter. Findings intend to guide future public health-law enforcement collaboration efforts in the context of the current de-policing debate.

An Assessment of Psychedelic Knowledge Among People Using Psychedelics Naturalistically

ABSTRACT Identifying gaps and strengths in psychedelic-related knowledge is key to developing effective, evidence-based education to inform appropriate use of and harm reduction practices for psychedelics in the naturalistic use landscape. The current study piloted an assessment instrument with questions on legal status, therapeutic potential, and side effects of psychedelics among people reporting current psychedelic use. We recruited participants (N = 1435) at a psychedelic advocacy event and through psychedelic interest groups on social media. Respondents completed a brief survey of psychedelic use and psychedelic knowledge. Items assessed basic knowledge of various topics surrounding psychedelics, such as legal status, active compounds, and known therapeutic efficacy based on the clinical trial literature. Respondents who had used greater numbers of different psychedelics, with higher levels of education, lower age, greater frequency of psychedelic use, identifying as male, used high doses (vs. microdosing only), identifying as Caucasian/White, and with greater annual household income answered more questions correctly. Most respondents exhibited high knowledge of psychedelics, though there is also a demonstrated need for education and outreach, especially in under-represented communities.

Harm reduction innovation: Abstinence, move over

Earlier this year, signs of a growing acceptance of harm reduction practices emerged in Washington, D. C. The Biden administration identified harm reduction as a policy priority and followed up with $30 million in grants to treatment programs to institute limited harm reduction strategies. I term this innovation limited or “harm reduction lite” (see “Treatment and recovery discover harm reduction: Now what?,” ADAW July 18; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33500) because treatment programs can qualify by only conducting community presentations and Narcan distribution. Altering treatment protocols to “meet clients where they are,” including people who do not want to pursue abstinence, is another matter.

Exploring Harm Reduction in Supportive Housing for Formerly Homeless Older Adults.

BackgroundExclusionary care policy contributes to the growing number of older adults experiencing homelessness and complex health challenges including substance misuse. The aim of this study was to examine how harm reduction policy and practices are experienced and enacted for older adults with homeless histories and care staff in congregate supportive housing.MethodsDrawing on harm reduction (HR) principles, Rhodes’ risk environment framework, and 15 semi-structured interviews (six residents, nine staff) at a 70-bed supportive housing facility in Western Canada, this qualitative constructivist grounded theory study aimed to determine: How is harm reduction experienced and enacted from the perspectives of older adults and their care staff?ResultsHR policy and practices helped residents to feel respected and a sense of belonging, due largely to staff’s understanding of structural vulnerability related to homelessness and their efforts to earn and maintain residents’ trust. Physical and program structures in the facility combined with the social environment to mitigate harms due to substance- and nonsubstance-related risk behaviours.ConclusionHR policy and practices in supportive living empower care providers and older adults to work together to improve housing and health stability. Wider adoption of HR approaches is needed to meet the needs of a growing number of older people experiencing homelessness and substance use challenges.

Drug use behaviors, trauma, and emotional affect following the overdose of a social network member: A qualitative investigation.

Scant research has examined the influence of overdoses occurring in social networks (i.e., knowing someone who has overdosed) on individual overdose risk. We sought to characterize drug use behaviors of individuals following the overdose of someone in their social network. We conducted semi-structured interviews with 25 people who use drugs and knew someone who overdosed in the prior 90 days. All interviews were conducted in person in Rhode Island from July to October 2021. Data were stratified by drug use behaviors following the overdose of a network member (i.e., risk behaviors, protective behaviors, no change; selected a priori) and analyzed using a thematic analysis variation to identify salient themes. We identified variation in the effect of knowing someone who overdosed on subsequent drug use behaviors and emotional affect. Several participants described increasing their drug use or using more types of drugs than usual to manage feelings of bereavement and trauma, and a subset of these participants described increased drug use with suicidal intention and increased suicidal ideations following the overdose event. Other participants described reducing their drug use and engaging in protective behaviors in response to heightened perceived overdose risk, protection motivation (i.e., increased motivation to protect oneself), and concern for others. Additionally, some participants reported no change in drug use behaviors, and these participants described already engaging in harm reduction practices, feeling desensitized due to frequent or repeated exposure to overdose, and ambivalence about living. Findings suggest a need for enhanced investment in network-based overdose prevention interventions, as well as more robust integration of bereavement support and mental health services in settings that serve people who use drugs. The findings also suggest a need for future research to identify mediators of the effect of overdose occurring in social networks on individual overdose risk.

Impact of harm reduction care in HIV clinical settings on stigma and health outcomes for people with HIV who use drugs: study protocol for a mixed-methods, multisite, observational study

IntroductionOur previous pilot work suggests relational harm reduction strengthens relationships between people with HIV (PWH) who use drugs and their healthcare providers and improves HIV health outcomes. However, there is...

The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research.

Background: Although Africa has long borne the brunt of the human immunodeficiency virus (HIV) epidemic, until recently, the continent has been considered largely free of illicit drug use and injection drug use in particular. In Uganda, the number of people who use or inject drugs (PWUD and PWID, respectively) has increased, and PWID are a key population at high risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. However, harm reduction practices, including providing clean injection equipment and medication-assisted treatment (MAT), have only recently been piloted in the country. This project aims to integrate buprenorphine into a harm reduction drop-in center (DIC). Methods: The Consolidated Framework for Implementation Research was used to guide our preparations to integrate buprenorphine into existing practices at a harm reduction DIC. We conducted key informant interviews with members of a community advisory board and DIC staff to document this process, its successes, and its failures. Results: Results indicate that criminalization of drug use and stigmatization of PWUD challenged efforts to provide buprenorphine treatment in less regulated community settings. Conclusions: DIC staff and their commitment to harm reduction and advocacy facilitated the process of obtaining necessary approvals.

Knowledge, attitudes, and behaviors related to the fentanyl-adulterated drug supply among people who use drugs in Oregon

IntroductionNonpharmaceutical fentanyl has reconfigured the U.S. illicit drug market, contributing to a drastic increase in overdose drug deaths. While illicit fentanyl has subsumed the drug supply in the Northeast and Midwest, it has more recently reached the West. For this study, we explored knowledge, attitudes, and behaviors among people who use drugs in Oregon in the context of the emergence of fentanyl in the drug supply. MethodsWe conducted in-depth interviews by phone with 34 people who use drugs in Oregon from May to June 2021. We used thematic analysis to analyze transcripts and construct themes. ResultsPeople who use drugs knew about fentanyl, expressed doubt that fentanyl could be found in methamphetamine; believed those who were younger or less experienced were at higher risk for harm; and received information about fentanyl from drug dealers, syringe service programs, or peers (other people who use drugs). Preference for fentanyl's presence in drugs like heroin or methamphetamine was mixed. Some felt that their preference was irrelevant since fentanyl was unavoidable. Participants reported engaging in harm reduction practices, including communicating about fentanyl with dealers and peers, testing for fentanyl, using smaller quantities of drugs, switching from injecting to smoking, and using naloxone. ConclusionPeople who use drugs are responding to the rise of fentanyl on the West Coast and are concerned about the increasing uncertainty and hazards of the drug supply. They are willing and motivated to adopt harm reduction behaviors. Harm reduction promotion from syringe service programs and public health agencies is essential to reduce injury and death from nonpharmaceutical fentanyl.

Are you tripping comfortably? Investigating the relationship between harm reduction and the psychedelic experience

BackgroundAlongside a recent revival in the use of psychedelics in clinical settings, there have been increases in the prevalence of recreational use, with many using psychedelics to deal with difficult emotions or to improve well-being. While clinical research is conducted in carefully controlled settings, this is not necessarily the case for recreational use. In this mixed methods online survey study, we aimed to develop an understanding of frequently used psychedelic harm reduction practices in recreational settings and how their use relates to the psychedelic experience. We also aimed to characterise users’ first and most recent psychedelic trips to understand how harm reduction changes with experience.MethodsParticipants (n = 163) recounted their first and most recent psychedelic experience by providing details about the harm reduction practices they employed and completing the Challenging Experience Questionnaire (CEQ) and Emotional Breakthrough Inventory (EBI). We also asked open-ended questions for a more in-depth qualitative understanding of their views on psychedelic harm reduction.ResultsUsing ANOVA, we observe greater use of harm reduction practices for participants’ most recent versus first psychedelic experience and that use of these practices is positively associated with EBI scores and negatively associated with CEQ scores (particularly for the first experience). Participants engaged in a wide range of harm reduction practices and we provide details of those which are most commonly used and those which are deemed most important by experienced users. Our qualitative analysis indicated that participants were largely positive about psychedelics and many recounted profound positive experiences. While specifics of the drug they were taking was important for aspects of harm reduction, participants largely focused on the importance of ensuring a good “set and setting” for enhancing positive effects.ConclusionsOur research helps us understand how engagement in harm reduction may increase with experience. Our mixed methods data shed light on the perceived importance of different harm reduction practices and examine their association with the psychedelic experience itself. Together, our research has important implications for the development of psychedelic harm reduction advice and provides opportunities for future research to explore the importance of these different practices in more detail.