Harm Reduction Tool Research Articles

Effects of E-Cigarettes on Combustible Cigarette Smoking Among Adults with Opioid Use Disorder on Buprenorphine: Single Arm ERASER Pilot Trial.

People with opioid use disorder (OUD) on buprenorphine smoke at high rates and have low cessation rates, even with evidence-based medications. Electronic cigarettes (EC) are a promising harm reduction strategy for combusted cigarette (CC) smokers unable to quit. Unfortunately, people with OUD are underrepresented in EC research. A pilot study assessed the feasibility, acceptability, and preliminary effectiveness of EC as a harm reduction tool among CC smokers with OUD on buprenorphine (N=30). Participants were provided with an EC and freebase nicotine liquid (6mg/mL) with a choice of flavor, and a brief training session. Research visits were scheduled in-person at baseline, week 4, and week 8 (follow-up). Daily diary assessments were completed during the 4-week EC period. Most visits (>74%) and 61.4% of daily diary assessments were completed. During the 4-week study period, 90% of participants used the EC at least one day, 66.7% used the EC for at least 16 days, and 43.3% used the EC every day. Significant reductions were observed between baseline and both weeks 4 and 8 in cigarettes smoked per day (CPDbaseline=16.2(8.3), CPDweek4=9.6(9.3), CPDweek8=8.4(8.3)) carbon monoxide (CO) levels (CObaseline=21.5(15.0), COweek4=16.9(9.6), COweek8=15.7(10.0)), and nicotine dependence measured using the Fagerström Test for Nicotine Dependence (FTNDbaseline=5.4(2.5), FTNDweek4=4.2(2.6), FTNDweek8=4.4(2.6))), with all p-values<.05. Implementing an EC protocol in outpatient maintenance treatment programs is feasible and acceptable. Preliminary results suggest that ECs may facilitate reductions in CPD, CO levels, and nicotine dependence. Future research should explore the effect of prolonged EC use on harm reduction and cessation milestones. EC are a potentially promising harm reduction strategy for adult CC smokers with OUD on buprenorphine who are unable to quit using evidence-based medications. However, previous studies have largely overlooked people with OUD on buprenorphine with recent drug use. This study addresses this gap through a pilot trial investigating the feasibility, acceptability, and preliminary effects of EC on CC behavior. The brief and standardized nature of the protocol and its implementation in outpatient settings highlights its potential for widespread implementation in facilities providing care to people with OUD on buprenorphine.

Two decades of electronic nicotine delivery systems discussions in Türkiye: AI-driven text analysis

Abstract Background As Turkiye ranks second in cigarette consumption in Europe, the increasing shift to Electronic Nicotine Delivery Systems (ENDS) presents emerging public health concerns. This study aims to introduce a hybrid approach by combining AI-driven large language models (LLM) with traditional thematic analysis to explore 20 years of ENDS discourse on Eksisozluk, a popular Turkish social media platform, using the Health Belief Model (HBM). Methods This mixed-methods study, analyzed 5,907 comments about ENDS from 2003 to 2023, sourced from a renowned online user-generated forum in Turkiye. Utilizing an LLM, comments were first categorized according to the HBM. Subsequently, the LLM’s generative capabilities were employed to identify sub-themes through thematic analysis. A temporal analysis was then conducted to examine the evolving trends over the 20-year span. Results ENDS popularity peaked in 2017, dipped during the COVID-19 pandemic, and later rebounded. Using an LLM with 70% accuracy, validated by a manually labeled sample, we discerned two main themes: perceived benefits (40.5%) - primarily using ENDS as for harm reduction (32.8%) and smoking cessation tools (21.6%)- and perceived barriers (27.7%), with cost and accessibility (21.9%) being the most significant throughout the period. Initially, the focus was on cessation, but shifted to harm reduction post-pandemic. Conclusions Our study indicates that consumers in Turkiye initially used ENDS for cessation but recognized their ineffectiveness over time. During the COVID-19 pandemic, usage shifted towards harm reduction, likely influenced by the rhetoric of the Tobacco Industry. Despite a national ban, ENDS remain widely used in Turkiye. Key messages • Turkiye should develop a social marketing strategy to raise awareness that ENDS is not a valid tool for harm reduction. • Although the sale of ENDS is prohibited in Turkiye, enforcement of bans should be strengthened as part of an effective control strategy.

Cost-effectiveness analysis of e-cigarettes compared to nicotine replacement therapy for smoking cessation among Medicaid users in California.

Smoking is the leading preventable cause of death and disability in the United States (US). A 2019 randomized controlled trial found e-cigarettes are more effective than nicotine replacement therapy (NRT) in achieving abstinence when both are combined with behavioral counselling. Few cost-effectiveness studies have been performed regarding e-cigarettes as an adjunct to cessation efforts, and none in a US context. This study evaluated the cost-effectiveness of e-cigarettes compared to NRT, both with counselling, as cessation aids for Medicaid smokers in California. A cost-effectiveness analysis from a US societal perspective comparing e-cigarettes with NRT was constructed. Using a lifetime horizon, smokers were followed to different health states to their expected lifespan. Costs were expressed in 2020 US dollars and health outcomes in quality-adjusted life years. All costs and outcomes were discounted at a 3% annual rate and model findings were assessed with a series of sensitivity analyses. Using US willingness-to-pay thresholds, e-cigarettes were more cost-effective than NRT, with an incremental cost-effectiveness ratio of $11,454 per additional QALY gained over smokers' lifetimes. Results were sensitive to smokers' healthcare costs, model start ages, discount rate, and QALY weights. E-cigarettes used as a cessation treatment by smokers are more cost-effective relative to NRT. However, e-cigarettes as a treatment are currently unapproved by the Food and Drug Administration (FDA). Despite lack of FDA approval, e-cigarettes are a popular choice among smokers trying to quit. Policymakers should consider whether providing financial support for e-cigarettes as a harm reduction strategy is worth pursuing. As e-cigarettes grow in popularity and are an increasingly preferred choice of smoking cessation aid among smokers attempting to quit, it is important to examine the inclusion of these products in tobacco policy, research, and practice. Several countries have now adopted or are in the process of adopting e-cigarettes as a medically licensed and regulated smoking cessation aid. Future smoking cessation strategies by US policymakers may consider the adoption of e-cigarettes as a cost-effective harm reduction tool for use by current smokers seeking to quit.

Strategies used to reduce harms associated with fentanyl exposure among rural people who use drugs: multi-site qualitative findings from the rural opioid initiative

AimIllicitly manufactured fentanyl and its analogs are the primary drivers of opioid overdose deaths in the United States (U.S.). People who use drugs may be exposed to fentanyl or its analogs intentionally or unintentionally. This study sought to identify strategies used by rural people who use drugs to reduce harms associated with unintentional fentanyl exposure.MethodsThis analysis focused on 349 semi-structured qualitative interviews across 10 states and 58 rural counties in the U.S conducted between 2018 and 2020. Interview guides were collaboratively standardized across sites and included questions about drug use history (including drugs currently used, frequency of use, mode of administration) and questions specific to fentanyl. Deductive coding was used to code all data, then inductive coding of overdose and fentanyl codes was conducted by an interdisciplinary writing team.ResultsParticipants described being concerned that fentanyl had saturated the drug market, in both stimulant and opioid supplies. Participants utilized strategies including: (1) avoiding drugs that were perceived to contain fentanyl, (2) buying drugs from trusted sources, (3) using fentanyl test strips, 4) using small doses and non-injection routes, (5) using with other people, (6) tasting, smelling, and looking at drugs before use, and (7) carrying and using naloxone. Most people who used drugs used a combination of these strategies as there was an overwhelming fear of fatal overdose.ConclusionPeople who use drugs living in rural areas of the U.S. are aware that fentanyl is in their drug supply and use several strategies to prevent associated harms, including fatal overdose. Increasing access to harm reduction tools (e.g., fentanyl test strips, naloxone) and services (e.g., community drug checking, syringe services programs, overdose prevention centers) should be prioritized to address the polysubstance-involved overdose crisis. These efforts should target persons who use opioids and other drugs that may contain fentanyl.

Challenges and recommendations for overdose prevention and harm reduction in an era of fentanyl and xylazine: Perspectives of women with opioid use disorder and professionals.

The current qualitative study examines the perspectives of women with opioid use disorder (OUD) and professionals that serve them on barriers to engaging in overdose prevention and harm reduction practices and recommendations for improving engagement. Semistructured interviews (N = 42) were conducted with women with a history of OUD (n = 20), substance use disorder treatment professionals (n = 12), and criminal legal professionals (n = 10). The interviews were inductively coded to identify themes and subthemes regarding experiences with overdose and harm reduction practices. Themes included heightened vulnerability to overdose, harm reduction challenges faced by women with OUD, and recommendations for overdose prevention and harm reduction practices. Heightened vulnerability to overdose included concerns about toxic supply and concerns about women's drug use behaviors. Challenges to women's harm reduction engagement included lack of knowledge and education about harm reduction tools and strategies and continued stigma toward harm reduction practices. Finally, recommendations for improving harm reduction engagement included increasing accessibility of harm reduction tools, expanding harm reduction education, and shifting away from "abstinence-only" paradigms. Finding ways to teach women with OUD about harm reduction, more effectively distribute harm reduction tools to them, and reduce stigma among providers and professionals is essential to reduce overdose risk for women with OUD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Suspected Counterfeit M-30 Oxycodone Pill Exposures and Acute Withdrawals Reported from a Single Hospital - Toxicology Investigators Consortium Core Registry, U.S. Census Bureau Western Region, 2017-2022.

Availability of counterfeit prescription pills (counterfeit pills) containing illegally made fentanyl, including counterfeit M-30 oxycodone (counterfeit M-30) pills, has risen sharply in the United States and has been increasingly linked to overdose deaths. In 2023, approximately 115 million counterfeit pills were seized in U.S. High Intensity Drug Trafficking Areas. However, clinical data on counterfeit pill-related overdoses are limited. Medical toxicology consultations during 2017-2022 from one U.S. Census Bureau Western Region hospital participating in the Toxicology Investigators Consortium Core Registry were analyzed. A total of 352 cases suspected to involve counterfeit M-30 pills, including 143 (40.6%) cases of fentanyl exposure and 209 (59.4%) cases of acute withdrawal were identified; consultations increased from three in 2017, to 209 in 2022. Patients aged 15-34 years accounted for 95 (67.4%) exposure cases. Among all patients with exposures, 81.1% were hospitalized, 69.0% of whom were admitted to an intensive care unit. Additional substances were detected in 131 (91.6%) exposures. Providing outreach to younger persons misusing prescription pills, improving access to and distribution of harm reduction tools including fentanyl test strips and naloxone, and promoting linkage of persons treated for overdose in hospitals to harm reduction and substance use treatment services are strategies to reduce morbidity associated with use of counterfeit M-30.

Fentanyl Test Strips for Harm Reduction: A Scoping Review.

High potency synthetic opioids like fentanyl have continued to replace or contaminate the supply of illicit drugs in North America, with fentanyl test strips (FTSs) often used as a harm reduction tool for overdose prevention. The available evidence to support FTS for harm reduction has yet to be summarized. A search of PubMed, Ovid Embase, and Web of Science was conducted in March 2023. A 2-stage review was conducted to screen by title and abstract and then by full text by 2 reviewers. Data were extracted from each study using a standardized template. A total of 91 articles were included, mostly from North America, predominantly reporting on FTS along with other harm reduction tools, and all conducted after 2016. No randomized controlled trials are reported. Robust evidence exists supporting the sensitivity and specificity of FTS, along with their acceptability and feasibility of use for people who use drugs and as a public health intervention. However, limited research is available on the efficacy of FTS as a harm reduction tool for behavior change, engagement in care, or overdose prevention. Though FTSs are highly sensitive and specific for point of care testing, further research is needed to assess the association of FTS use with overdose prevention. Differences in FTS efficacy likely exist between people who use opioids and nonopioid drugs, with additional investigation strongly needed. As drug testing with point-of-care immunoassays is embraced for nonfentanyl contaminants such as xylazine and benzodiazepines, increased investment in examining overdose prevention is necessary.

Safety strategies and harm reduction for methamphetamine users in the era of fentanyl contamination: A qualitative analysis

IntroductionIn the United States, methamphetamine use is increasing and the context of its use has changed, with reports of illicitly manufactured fentanyl being mixed with methamphetamine (either deliberately or inadvertently). We explore risk-mitigating actions taken by people who use drugs to protect their health when using methamphetamine in that context. MethodsWe conducted qualitative interviews with 48 adults (18+) who used methamphetamine in the past three months at two sites in Nevada, USA and two sites in New Mexico, USA. Interviews were recorded, transcribed, and analyzed using thematic analysis. ResultsRespondents described two rationales for employing harm reduction strategies. First, to prevent harm from methamphetamine containing illicit fentanyl, and second, to maintain their general wellbeing while using methamphetamine. Regarding methamphetamine containing illicit fentanyl, our findings highlight how respondents employ primary strategies like buying from trusted sources and secondary strategies such as spotting and selective use of harm reduction tools (i.e., fentanyl test strips) to reduce risks. To maintain their general wellbeing, participants reduced their use of methamphetamine as reasonably as possible, and used other substances like marijuana and alcohol alongside methamphetamine to counter the unwanted side effects of methamphetamine (i.e., hallucinations and paranoia). Use of these harm reduction strategies varied within situational and social contexts, and respondents usually developed these strategies based on their lived experiences. ConclusionOur findings uniquely demonstrate that people who use methamphetamine prioritize community driven, trust-based strategies within their social networks to mitigate risks in a fentanyl-contaminated drug environment. Additionally, our results indicate that harm reduction behaviors are influenced by multilevel risk environments, which include social, physical, economic, and political factors. Overall, these results highlight the potential for targeted interventions at the network level, which are responsive to complexities and shifts in drug market dynamics- such as illicit fentanyl in methamphetamine.

Algorithmic Doors to Community and the Trap of Visibility: TikTok for Harm Reduction Activism in the U.S. Overdose Crisis

Opioid-related overdose death continues to be a public health crisis in the United States, reaching a new peak in 2021 with more than 100,000 people dying of drug overdose; 75% of these deaths involved an opioid. Naloxone, often known by the brand name Narcan®, can be easily administered to prevent opioid overdose death. While naloxone is a central harm reduction tool, it has generated controversy as discussions of its use have been framed by longstanding stigmas associated with drug use. Critics have framed it as a “moral hazard” that encourages drug use, stigmatizing its distribution and uptake. Harm reductionists have responded by countering misinformation about drug use and harm reduction and humanizing people who use drugs. Social media platforms have become key sites for these debates. These are digital social spaces in which individuals may fuel stigma and/or build community with others by enacting identities, exchanging knowledge, and bonding over shared experiences. TikTok, a video-based platform, has become an active space for community-building around harm reduction. This article examines the experiences of people who post about naloxone on TikTok. We draw on thematic analyses of semistructured, open-ended interviews with 13 TikTok users who tagged posts with #naloxonesaveslives or #narcansaveslives hashtags from June 2020 to April 2023. Specifically, we explore how these individuals understand and leverage TikTok's association, creative, and interactive affordances as “doors” to build harm reduction community and to educate others about drug use and harm reduction. We also explore how they navigate the “traps” of visibility on TikTok that pose challenges to using the platform for harm reduction activism: stigma, burnout, mental distress, and digital silencing. Finally, we consider the implications of our findings for future research and practice related to digital harm reduction activism.

The paradox of the safer cigarette: understanding the pulmonary effects of electronic cigarettes.

Electronic cigarette (e-cigarette) use continues to rise globally. E-cigarettes have been presented as safer alternatives to combustion cigarettes that can mitigate the harm associated with tobacco products; however, the degree to which e-cigarette use itself can lead to morbidity and mortality is not fully defined. Herein we describe how e-cigarettes function; discuss the current knowledge of the effects of e-cigarette aerosol on lung cell cytotoxicity, inflammation, anti-pathogen immune response, mucociliary clearance, oxidative stress, DNA damage, carcinogenesis, matrix remodeling, and airway hyperresponsiveness; and summarize the impact on lung diseases, including COPD, respiratory infection, lung cancer, and asthma. We highlight how the inclusion of nicotine or flavoring compounds in e-liquids can impact lung toxicity. Finally, we consider the paradox of the safer cigarette - the toxicities of e-cigarettes that can mitigate their potential to serve as a harm reduction tool in the fight against traditional cigarettes, and we summarize the research needed in this under-investigated area.

Abstract LB086: Measuring oral DNA damage to evaluate electronic cigarette use as a tobacco harmreduction strategy

Abstract Background: Smokers increase their risk of numerous types of diseases, including lung and oral cancer. Despite this knowledge, approximately 18.7% of U.S. adults are smokers, and millions of smokers across the U.S. struggle to quit tobacco every day. Although difficult due to nicotine addiction, you can increase your chances of quitting with the tools available, and help is an important part of any quitting plan. The prevalence of electronic cigarette (e-cigarette) use has increased as users perceive them to be safer than traditional tobacco smoke. Studies have shown that e-cigarettes contain fewer chemicals than tobacco smoke. Therefore, addressing the effectiveness of e-cigarette use in reducing tobacco harm is essential and is currently a priority for the FDA. Aim: To determine whether combustible tobacco users who are provided with free e-cigarettes and free e-liquids reduce the levels of DNA damage in their oral epithelial cells. Methods: Adult smokers who smoked at least 5 cigarettes per day over the past year and did not plan to quit smoking in the next 3 months were enrolled in a randomized 3-arm clinical trial (NCT03113136): “Usual Brand Cigarettes” (UBC), Low Wattage e-cigarettes (LWe), and High Wattage e-cigarettes (HWe). Free combustible cigarettes or e-cigarettes plus e-liquid were provided during the first 12 weeks according to assigned group. Tobacco product use details, CO level, and oral mucosa samples were collected at 0, 4, and 12 weeks. DNA was extracted from oral cells and damage was quantified by q-PADDA, at three time points (Week 0, 4, 12). Data analysis was performed using ANOVA model. Results: Participants who provided samples at all time points were included in this DNA damage study. 201 complete data sets (UBC=77, LWe=61 and HWe=66) were available for DNA damage quantification at the time of this report. At enrolment (week 0), there were no significant differences in age, sex or tobacco product use across groups. At 12 weeks, combustible tobacco use was significantly reduced in smokers also using LWe or HWe (dual users). At 4 and 12 weeks, the CO levels were reduced in dual users of combustible tobacco and e-cigarettes (LWe or HWe), compared to exclusive combustible tobacco users. Compared to combustible tobacco users, dual users of combustible tobacco and LWe or HWe showed a significant reduction in the levels of oral mucosa DNA damage at 4 and 12 weeks (3 to 5 fold). Conclusion: Our study shows that when provided with free e-cigarette devices and e-liquids, smokers who were dual users or completely switched to LWe or HWe significantly reduced the levels of DNA damage in their oral mucosa compared with exclusive combustible tobacco users. These data suggest that LW and HW e-cigarette devices are an effective harm reduction tool and might help to reduce tobacco-associated health effects. Funding: NIH/NCI (R01CA204891, Wagener; R01CA242168, Queimado). Citation Format: Vengatesh Ganapathy, Mayilvanan Chinnaiyan, Daniel Brobst, Balaji Sadhasivam, Jean D. Nshimiyimana, Yan Zhao, Theodore Wagener, Lurdes Queimado. Measuring oral DNA damage to evaluate electronic cigarette use as a tobacco harmreduction strategy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB086.

Using Pod Based e-Cigarettes and Nicotine Pouches to Reduce Harm for Adults With Low Socioeconomic Status Who Smoke: A Pilot Randomized Controlled Trial.

Alternative Nicotine Delivery Systems (ANDS) such as e-cigarettes (EC) and oral nicotine pouches (ONP) may facilitate the substitution of smoking for those unwilling to quit. This pilot study assesses the harm-reduction potential of EC and ONP among smokers with low socioeconomic status (SES). Adults who smoked daily in the past 6 months, had a household income < 250% federal poverty level and had no intention of quitting smoking in the next 30 days were randomized 2:2:1 to 8 weeks of 5% nicotine EC; 4 mg ONP or assessment-only control (CC). The primary outcome was a within-group change in cigarettes per day (CPD) from Baseline to week 8. Forty-five individuals were randomized (EC: N = 18; ONP: N = 18; CC: N = 9). Analyses included 33 participants who completed the week 8 visit. The mean age was 50.1 years (SD: 10.7) and the average CPD at baseline was 13.9 (SD: 10.1). For those randomized to EC, the average CPD decreased from 14.7 (95% CI: 10.3 to 19.1) at the Baseline to 2.9 (95% CI: .1 to 5.8) at week 8 (p-value < .001). For those randomized to ONP, average CPD decreased from 15.0 (95% CI: 5.0 to 24.9) to 8.3 (95% CI: 1.3 to 15.2) by week 8 (p-value = .01). In the EC and ONP groups, respectively, 4 (28.6%) and 1 (8.3%) participant fully switched from smoking to the ANDS product by week 8. Individuals with low SES who smoke had lower CPD after switching to EC or ONP. These findings show the potential of ANDS in helping smokers switch to less harmful devices. This study provides novel evidence that e-cigarettes and nicotine pouches can be a harm-reduction tool for individuals with lower SES who smoke and are not willing to quit smoking, contributing to reducing tobacco-related disparities in this population.Clinical Trials Identifier: NCT05327439.

Clinical Application of Cannabis Vaporization: Examining Safety and Best Practices.

Introduction: Cannabis vaporization is useful for individuals requiring fast-acting method of cannabis administration and for individuals using smoked cannabis as a harm reduction tool. There is a need for guidance on how to assess if a patient is a vaporization candidate and how to safely initiate and monitor cannabis vaporization. Methods: An overview of safe cannabis vaporization, including practical guidance and tactics to promote the lowest-risk use, is provided. This review was developed through a combination of expert clinical opinion and reviewing the available literature. Results: Dried cannabis vaporizers and metered-dose inhalers are recommended to be used over other vaporization devices. Assessing the benefit versus risks of vaporized cannabis and providing guidance for choosing a vaporization device, choosing a cannabis chemovar, and employing a mindful vaping technique are important steps in the safe utilization of vaporized cannabis. Dosing optimization and monitoring to limit adverse events and improve symptom control are essential. Discussion: The utilization of cannabis vaporization presents an important opportunity for clinicians and other health professionals to help facilitate safer cannabis administration and reduce the prevalence of smoked cannabis.

Direct health implications of e-cigarette use: a systematic scoping review with evidence assessment.

E-cigarettes are often marketed as a less harmful alternative to traditional tobacco cigarettes. Despite their popularity, the evidence regarding their effects on human health remains unclear and is filled with complexities. This systematic review aims to elucidate the direct effects of electronic cigarette use on human health, carefully distinguishing between the specific characteristics of the populations studied. Adhering to the PRISMA guidelines, we conducted a comprehensive search in PubMed/Medline, Web of Science, Scopus, and Google Scholar databases without date restrictions, including articles in both Spanish and English. This approach enabled the identification and analysis of primary studies to understand the direct effect of electronic cigarettes on human health. A total of 33 studies were included that evaluated cardiovascular, pulmonary, renal, weight and fertility effects. Only five studies analyzed e-cigarettes in healthy populations and seven studies compared healthy individuals against smokers. The effects evaluated on smokers or former tobacco smokers were apparently positive, however, among healthy individuals, increased heart rate, mean arterial pressure, oxidative stress, alteration of respiratory epithelial cells and increased airflow resistance were found. Smokers or former smokers who switch to e-cigarettes may reduce their exposure to carcinogens and lower their risk of developing severe health issues associated with conventional smoking. However, in healthy individuals who have never smoked traditional cigarettes, the use of e-cigarettes introduces several cardiovascular and respiratory adverse effects. These findings suggest that while e-cigarettes can be a strategic harm reduction tool for smokers, they are not a safe option for non-smokers.

Is heated tobacco a harm reduction tool?

Heated tobacco (HT), a new tobacco product, is presented by the tobacco industry as an effective and safe alternative to cigarettes. Even if the quantities of harmful compounds emitted by HT are lower than those found in cigarette smoke, this reduction in exposure cannot be equated with a reduction in risk. No study has provided evidence that switching from cigarettes to HT reduces the risk of tobacco-related diseases. HT cannot be considered as a cigarette cessation product and was even designed as a product to initiate or return to tobacco consumption. To promote this product, the tobacco industry essentially exploits the concept of harm reduction and, as such, tries in its commercial communication to create confusion between HT and electronic cigarettes, despite these two products having nothing in common. This promotion is based, on the one hand, on the data of internal studies in contradiction with those of independent studies, and, on the other, illegally, on social networks and communication in contradiction with the statements of regulation authorities. HT is a new lure offered by the tobacco industry, intended to maintain its profits in a world that is moving away from "traditional" cigarettes. It should be strictly advised against for both non-smokers and smokers.

Examining acute psychopharmacological effects of nicotine vaping versus heated tobacco products in a randomised crossover study of product naïve adult smokers

Nicotine vaping products (NVPs) and heated tobacco products (HTPs) are designed to replicate the sensory and behavioural aspects of smoking cigarettes while avoiding combustion. The success of these products as harm reduction tools will partially depend on their ability to satisfy smokers and alleviate nicotine-related withdrawal symptoms. This study aims to compare short-term effects of NVPs (Juul and Aspire PockeX) versus HTPs (IQOS) on smoking-related withdrawal relief, product satisfaction, intention to switch to NVP/HTP, perceptions and attitudes in UK adult cigarette smokers naïve to these products. In a randomized cross-over study, 45 participants visited the lab twice, at each visit trying one of the two products (NVP/HTP) and completing a questionnaire. Responses were normalized on a 0–100% scale and mean differences (MD) between NVP and HTP scores computed, with positive and negative MD values indicating greater endorsement for NVP and HTP, respectively. Cigarette cravings were reduced similarly (~ 20.0%) by both products (MD = 4.5%, 95%Confidence Interval (CI) − 4.8, 13.8). Direct positive effects (MD = − 3.5%, 95%CI − 7.2, 0.2) and adverse side effects (MD = 1.8%, 95%CI − 0.3, 3.8) were comparable after each product use, though marginally favouring HTPs. HTPs were perceived as more satisfying overall (MD = − 13.2%, 95%CI − 20.3 − 6.1) than NVPs but both were perceived as similarly addictive (MD = 3.6%, 95%CI − 4.6, 11.8), relative to cigarettes. Intention to switch to either product was comparable (MD = 4.0%, 95%CI − 5.7, 13.8). Comparison of acute use of NVP versus HTP in a sample of UK smokers naïve to these products suggests that HTPs are perceived as more satisfying than NVPs, though still less satisfying than cigarettes.Registration: The analysis plan was pre-registered, and it is available at https://osf.io/6ymdu

Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial.

Cannabis use is highly prevalent in young people with first-episode psychosis (FEP). Most report cannabis use and are often diagnosed with a cannabis use disorder upon admission to specialized services for psychosis. Cannabis use in this population is associated with worse clinical and psychosocial outcomes, rendering it an important clinical target. Despite this, few cannabis-specific interventions have been developed for FEP and empirically evaluated through randomized controlled trials. Most evaluated interventions have targeted cannabis abstinence, with limited efficacy, but none have centered on harm reduction outcomes for people with FEP who use cannabis. Early intervention services (EIS), the standard of care for FEP, have not successfully addressed problematic cannabis use in people with FEP either. Clinical trials are needed to explore the potential of harm reduction strategies, although these should be preceded by robust pilot studies to establish optimal design and approaches. Recognizing the need for harm reduction strategies for individuals with FEP who use cannabis and based on research on patients' preferences supporting harm reduction interventions, we developed a mobile app-based cannabis harm reduction intervention for this population. This intervention is called Cannabis Harm-reducing Application to Manage Practices Safely (CHAMPS). Here, we describe the protocol for a multicenter, 2-arm, parallel group, randomized pilot trial evaluating the acceptability of CHAMPS for people with FEP who use cannabis and the feasibility of conducting a full-scale trial in this population using CHAMPS. The impact on key clinical outcomes will also be explored. This pilot trial aims to recruit 100 young people with FEP using cannabis from 6 Canadian EIS clinics. Participants will be randomized in a 1:1 ratio to CHAMPS+EIS or EIS-only. CHAMPS acceptability will be assessed using completion rates for the intervention arm. Trial feasibility will be assessed using a retention rate for randomized participants. Secondary outcomes will explore tendencies of change in the use of protective behavioral strategies and in motivation to change strategies. Exploratory outcomes include cannabis use-related problems, other substance use, the severity of dependence, psychotic symptoms, and health care service use. Recruitment began in December 2021. Data collection and analysis are expected to be completed in early 2024. Study results describing CHAMPS acceptability and trial feasibility will then be submitted for publication in a peer-reviewed journal. CHAMPS uniquely combines evidence-based approaches, patient perspectives, and mobile health technology to support harm reduction in people with FEP who use cannabis. Attaining adequate acceptability and feasibility through this trial may justify further exploration of harm reduction tools, particularly within the context of conducting a larger-scale randomized controlled trial. This pilot trial has the potential to advance knowledge for researchers and clinicians regarding a feasible and user-acceptable research design in the cannabis and early psychosis fields. ClinicalTrials.gov NCT04968275, https://clinicaltrials.gov/ct2/show/NCT04968275. DERR1-10.2196/53094.

1793. Pipes as a Harm Reduction Tool: Insights from People Who Use Methamphetamine in Rural Illinois

Abstract Background Methamphetamine (meth) use is disproportionately high in rural settings and increased during COVID-19. While sterile syringes services are an evidence-based measure to reduce infectious disease transmission, little research exists around the value of smoking equipment, specifically pipes, in minimizing harms associated with rural drug use in the US. Methods Between March and June 2022, we conducted structured interviews with people who use methamphetamine (PWUM) living in rural Illinois who were at least 15 years old and used meth by any route in the past 30 days. Interview guides explored attitudes and behaviors regarding meth use routes, meth pipe use practice, and pipe access, and were refined by a peer-led Community Advisory Board. Interviews were audio recorded, transcribed, and coded in MAXQDA. The data were then analyzed for emergent themes using modified grounded theory. Results Nineteen participants, average age 37.1 (SD+8.7), were interviewed. Of these, 53% were women, and 89% were white. All reported smoking meth, and 84% injected meth. Participants reported that they often chose to smoke rather than inject to mitigate health concerns like wounds, pain, and infections. Smoking enabled them to use around others as opposed to using alone (as was typical when they injected). Participants expressed interest in pipe distribution through a harm reduction agency, e.g. according to one participant (a 31-year-old white male), “I’ve asked specifically if they had a pipe because I was trying to lay off the syringes.” They related that access to a harm reduction agency distributing pipes would connect people to other services such as HIV testing, naloxone, and safer sex supplies. Conclusion Distribution of meth pipes through harm reduction agencies represents a means for decreasing harm through circumvention of injection, decreased solitary drug use, and linkage to additional services related to overdose and disease prevention. Given increased rates of meth use in rural regions, this intervention could specifically address drug-related harms that impact rural PWUM. Future work should quantitatively explore the health impacts of pipe use as a harm reduction intervention. Disclosures All Authors: No reported disclosures

Effects and Limitations of a Unique, Nationwide, Self-Exclusion Service for Gambling Disorder and Its Self-Perceived Effects and Harms in Gamblers: Protocol for a Qualitative Interview Study.

Voluntary self-exclusion from gambling is a common but underdeveloped harm reduction tool in the management of gambling problems or gambling disorders. Large-scale, multi-operator, and operator-independent self-exclusion services are needed. A recent nationwide multi-operator self-exclusion service in Sweden (Spelpaus), involving both land- and web-based gambling sites, is promising, but recent data have revealed limitations to this system and possibilities to breach one's self-exclusion through overseas web-based gambling. More knowledge is needed about the benefits and challenges of such an extensive self-exclusion service, and its effects as perceived by gamblers. This study protocol describes the rationale and design of a qualitative interview study addressing the effects and limitations perceived by individuals with gambling problems and their concerned significant others. The study aims to provide an in-depth experience of this novel self-exclusion service and to inform stakeholders and policymakers in order to further improve harm reduction tools against gambling problems. Individuals with gambling problems will be recruited primarily through social media and also from a treatment unit, if needed, for a qualitative interview study. Recorded interview material will be analyzed through content analysis, and recruitment will continue until saturation in the material is reached. This study will provide in-depth information about a harm reduction tool that is promising and commonly used, but which has proven to be breached by a significant number of users, potentially limiting its efficiency. The aim is to interview a sufficient number of gamblers until saturation has been obtained in the interview material. Saturation will be considered through a continuous analysis, comparing recently collected data to previously collected data. Results will be reported as the themes and subthemes identified after the thorough analysis and coding of the transcribed text material and will be accompanied by citations representing relevant themes and subthemes. Results are planned to be provided before the end of 2023. This study will likely provide new insights into user perspectives on a multi-operator self-exclusion service that involves both web- and land-based gambling operators, and which according to previous literature attracts many gamblers but also appears to have limitations and challenges in the target group of individuals with gambling problems. Policy and legislation implications, as well as clinical implications for treatment providers, will be discussed. Results and conclusions will be disseminated to policy makers in Sweden and internationally, as well as to peer organizations, treatment providers, and the research community. ClinicalTrials.gov NCT05693155; https://clinicaltrials.gov/study/NCT05693155. PRR1-10.2196/47528.

Adolescents and Electronic Vapor Product Use: A Dangerous Unknown

Electronic vapor products (EVPs) are non-conventional tobacco products that use a battery to heat liquid, generating an aerosol to be inhaled by the user. Despite being initially proposed as a harm reduction tool for adults looking to quit conventional tobacco cigarettes, EVP usage has grown significantly in the adolescent population over the past decade. Data from the 2021 Youth Risk Behavior Survey (YRBS) show that currently, in the United States, 36% of adolescents have ever used an EVP, 18% currently use an EVP, and 5% use EVPs daily. Initial studies have raised concerns about the health effects on multiple organ systems (e.g., respiratory, cardiovascular, and neurodevelopmental), and little information is known about the long-term effects, as well as the impacts specific to the still-developing adolescent body. EVP usage in the adolescent population is a public health crisis. The purpose of this narrative review is to address what is known thus far and to advise areas of focus for future research and advocacy.