Drogas

Abstract

Introdução: São consideradas drogas psicoativas as substâncias capazes de modificar as funções do sistema nervoso central produzindo euforia ou alterando estados de consciência e vigília. Metodologia: levantamento bibliográfico e por uma abordagem de cunho qualitativo, pois a opção por tal baseia-se na utilização de fontes estabelecidas por material já elaborado, construído basicamente por revistas científicas, artigos e livros. Resultados e Discussão: No Brasil, a história de criação das políticas públicas direcionadas aos usuários de drogas e à prevenção de seu uso é relativamente recente. As discussões a respeito da proibição e liberação das drogas não deve ser pautada na defesa de posições extremista de liberação ou proibição. Foi somente depois da Lei Federal nº 10.216/2001, que legitimou o movimento da reforma psiquiátrica na área da saúde mental, e trouxe os usuários de álcool e drogas para o contexto de discussão da saúde mental na Atenção Básica da Saúde (ABS). Considerações Finais: A literatura mostra que existe uma lacuna sobre às problemáticas relacionadas ao uso das drogas, sendo então necessário buscar um foco diferente de discussão a esta questão e realizar estudos que investiguem e aprofundem esta realidade, visto a importância e urgência que ela demanda.

Keywords: redução de danos, saúde pública, saúde mental

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Abstract

Background: Youth substance use programming and educational strategies are frequently informed by prevention approaches that emphasize abstinence goals, which often do not resonate with youth in their lack of acknowledgment of young people’s social context and how young people perceive positive effects of substance use. Further, approaches to drug prevention have been critiqued as adopting a one-size-fits-all approach and therefore inadequate in addressing substance use in the context of population variation and inequities. In response to the limitations of current approaches to prevention, programming informed by harm reduction principles that aims to minimize harms without requiring abstinence is emergent in school settings. However, youth perspectives informing harm reduction are limited in both research and program development.

Methods: This paper draws on data from the Researching Adolescent Distress and Resilience (RADAR) study, which utilized an ethnographic approach to bring youth voice to the literature on mental health and substance use. Qualitative data collection included individual interviews (n = 86) with young people aged 13-18 across three communities-representing urban, suburban, and rural geographies-in British Columbia, Canada. A multi-site qualitative analysis of interview data was conducted to identify themes across and within each research site.

Results: Across all three sites, young people’s individual experiences of substance use were shaped by geographic, socio-cultural, and political contexts, with youth describing their use in relation to the nature of substance use in peer groups and in the broader community. To manage their own substance use and reduce related harms, youth employed a variety of ad hoc harm minimization strategies that were reflective of their respective contexts.

Conclusions: The findings from this study suggest the importance of harm reduction approaches that are contextually relevant and responsive to the lived experiences of youth. Youth perspectives in the development of harm reduction programming are needed to ensure that approaches are relatable and meaningful to young people, and effective for promoting the minimization of substance-related harms.

Keywords: Drug prevention; Harm minimization; Harm reduction; Multi-site qualitative research; Social context; Substance use; Youth.

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Abstract

Context: Regular alcohol use is a predominant risk factor for disease, injury, and social harm. While robust evidence is advocating for implementing interventions to reduce the harms of illegal substance use, less literature is dedicated to identifying and understanding interventions aiming at reducing the various harms associated with alcohol.

Objectives: This review describes how alcohol harm reduction (AHR) interventions are currently conducted and analyzes the facilitators and barriers identified by the studies on their efficacy.

Method: This scoping review with evidence appraisal included articles published between 2011 and 2022, addressing one or more AHR interventions for population of at least 18 years (including alcohol user who have an addiction but also alcohol user with harmful drinking), conducted in North industrialized countries (Europe, Nort America, Australia).

Results: Among the 61 articles selected, we identified several forms of support (face-to-face or remote, support in residential settings, structural interventions, and interventions created upon spontaneous initiatives), and strategies of intervention were also analyzed (the ones based upon learning and skill development, the ones based upon psychological support, the ones focusing upon socio-economic conditions, strategies focusing on the coordination and adaptation of the care system, and those strategies based on peer support). The facilitators linked to fundamental characteristics of the interventions were the promotion of empowerment and autonomy of beneficiaries, setting objectives tailored to individual needs, professionals harmonizing their values, Evidence-Based interventions taking into account cultural contexts, and comprehensive and holistic support. Practical facilitators from the intervention process consist of increasing the number of sessions, involvement, and formation of members of staff, disposing of the necessary resources, and using technological tools.

Discussion: The sheer variety of AHR interventions demonstrates that this is a fertile field in terms of intervention design and innovation. This work illustrates the importance of designing effective, adapted harm reduction interventions, prioritizing interventions that make support more accessible to more people. This also prompts us to consider the potential benefits of invoking proportionate universalism in the design of AHR interventions in order to operationalize alcohol harm reduction philosophy. accessible to more people.

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Introduction: In Latin America and the Caribbean (LAC) the response to substance use has primarily been abstinence-based, acute-care-oriented treatments. While harm reduction services (HRS) and interventions have expanded in LAC over the last decade, the research evidence on such programs has been sparse and disjointed.

Objective: This scoping review will map peer-reviewed literature on HRS and interventions in LAC, and synthesize gaps and opportunities for policy, practice, and research.

Inclusion criteria: Studies conducted in LAC. The HRS that will be included in the search are opioid agonist therapy, syringe services programs, drug consumption facilities, safer consumption kits, managed alcohol programs, and drug-checking services. The scoping review will consider peer-reviewed original research, including qualitative, quantitative, and mixed-methods designs. We will exclude studies addressing harms associated with nicotine or tobacco use. We included original research written in English, Spanish, Portuguese, or French published between January 2013 and December 2024.

Methods: We will conduct literature searches in English (PubMed, Scopus, Web of Science), Spanish, Portuguese (SciELO and BIREME), and French (BIREME). Two reviewers will independently screen the literature. Extraction of characteristics of the studies using a template in Covidence. Data on the HRS and interventions studied and implemented in LAC will be summarized and presented in tables, graphs, and a narrative summary. We will use a narrative synthesis approach to summarize implications for policy, research, and practice identified in the literature. The review was registered in Open Science Framework (https://osf.io/qya7c/).

Discussion: The proposed scoping review will provide valuable information regarding the current state of HRS and interventions for PWUD in LAC. This in return can help guide future research for evaluating services that are already being implemented or unveil services needed in the region. To our knowledge, this is the first scoping review to map HRS in LAC using a systematic approach. Furthermore, among the strengths of this review are: the broad number of services, countries, and time, as well as the consultation with experts and knowledge users.

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Background: People who use drugs (PWUD) frequently seek care in the emergency department (ED). Little is known about ED physician perspectives and experiences integrating a harm reduction approach into care, including interventions that reduce the health, social and legal consequences of drug use without requiring a reduction in drug use.

Objective: This study aimed to describe the experiences of Canadian emergency physicians caring for PWUD, and facilitators and barriers to implementing harm reduction interventions in the ED.

Methods: Purposive sampling, using an existing national network, and snowball sampling techniques were used to recruit practicing emergency physicians. Semi-structured, one-on-one telephone interviews were conducted until theoretical data saturation was achieved. Interview recordings were transcribed and analyzed using latent content analysis. Interviews took place between June 2019 and February 2020. This work is a secondary analysis specifically focused on harm reduction approaches to care.

Results: 32 physician interviews were included. Participants had a median of 10 years of experience (range 1-33) and most (29/32) worked in urban EDs. Participants highlighted the complexities of caring for PWUD, including the intersection of structural vulnerability with substance use. The ED environment varied across Canada and either facilitated or hindered the adoption of harm reduction interventions. Additional barriers included a lack of training and experience; lack of community follow-up care; insufficient ED funding and staffing resources; and, tensions over the appropriate scope of emergency medicine practice. Facilitators included tailored education and training; specialized multidisciplinary teams; ED harm reduction champions; and standardized protocols.

Conclusions: Though variability existed in the adoption and practice of harm reduction in Canadian EDs, most interviewed physicians supported a harm reduction approach to care. To facilitate widespread ED adoption of harm reduction interventions, there is a need for standardized guidance, supplemental resources, facilitated culture change, and sufficient community-based services.

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Background: People who inject drugs (PWID) experience high risk for HIV and HCV infection, which can be mitigated by harm reduction strategies, including syringe service programs (SSP). Understanding individuals’ patterns of substance use and SSP utilization is important for optimizing harm reduction strategies and disease prevention for PWID.

Methods: We evaluated demographic characteristics and service utilization from the New Haven Syringe Services Program (NHSSP), a low-threshold service delivery site in New Haven, Connecticut that provides fully integrated harm reduction and primary healthcare services to PWID. Site-specific data were extracted from the e2ctprevention database, managed by the Connecticut Department of Public Health, and Evaluation Web from January 2017 to October 2023. We conducted a descriptive analysis of basic demographic and social characteristics of SSP clients, transaction characteristics, and service utilization. Statistical analyses were conducted using STATA v 16.1 and IBM SPSS Statistics (v 29.0.2.0).

Results: Among 1,189 unique individuals utilizing SSP during the observation period, most (65.2%) identified as men and white (73.3%), consistent with SSP clients regionally and nationally. The mean age of clients was 41 years (SD = 9.8); approximately half of participants were unstably housed and 80% were unemployed at intake. From June 2020 to October 2023, there were 7,238 transactions, which increased throughout the COVID-19 pandemic period. During this period, the program dispensed 1,860,621 syringes, in addition to other materials, including overdose education and naloxone distribution (OEND), and provided patient education on safer injecting techniques and wound care.

Conclusion: In this first comprehensive analysis of a large SSP since its inception and through the COVID-19 pandemic, we described important client characteristics and utilization of an array of syringe services from an integrated SSP. Findings suggest the SSP attracts a high volume of clients, provides on-demand services, and reaches a wide range of clients. Future research is needed to evaluate the impact of the program’s home-delivery service and increased outreach efforts. Despite limitations, the program’s success demonstrates the SSP can serve as a model for other harm reduction programs nationally.

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Importance: Rates of overdose deaths involving synthetic opioids remain high, increasingly involve stimulants combined with opioids, and are increasing rapidly in racially and ethnically minoritized communities, yet little is known about access to harm reduction and treatment services in these groups.

Objective: To characterize access and barriers to harm reduction and treatment in a racially and ethnically diverse population of people who use drugs.

Design, setting, and participants: A cross-sectional telephone survey of people recruited from 39 treatment, harm reduction, and social service organizations in Milwaukee County, Wisconsin; Flint and Detroit, Michigan; and statewide in New Jersey was conducted from January 30 to July 28, 2023. Adults who used cocaine, methamphetamine, or opioids in the past 30 days called a study hotline and completed an interview in English or Spanish.

Exposures: Overdose experience, drug types used (opioids only, stimulants only, and polysubstance), and social risk factors (eg, financial instability and criminal legal involvement).

Main outcomes and measures: Recent use of any harm reduction services, fentanyl test strips, naloxone possession, treatment, and self-reported barriers to services.

Results: Of the total sample of 1240 adults, 486 (39.2%) were Black non-Hispanic, 183 (14.8%) were Hispanic, and 464 (37.4%) were White non-Hispanic. In the past 30 days, 826 individuals (66.6%) were polysubstance users, 135 (10.9%) used only opioids, and 279 (22.5%) used only stimulants. A total of 349 respondents (28.1%) experienced a prior-year overdose. Compared with those without a prior-year overdose, people with overdose were more likely to possess naloxone (80.7% vs 68.2%; P < .001), possess fentanyl test strips (36.8% vs 23.5%; P < .001), and use harm reduction services (63.4% vs 53.0%; P = .003), while differences in treatment use were nonsignificant (52.0% vs 46.6%; P = .24). Among stimulant-only users, 51.4% possessed naloxone compared with 77.3% of opioid-only users (P < .001) and 77.6% of polysubstance users (P < .001), with similar disparities in fentanyl test strip possession.

Conclusions and relevance: In this cross-sectional study of people who used drugs in the past 30 days, findings highlighted low use of harm reduction and treatment services among people who use stimulants. Additional communication regarding their importance may help increase the use of the services amidst a rapidly changing drug supply.

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Abstract

Psychedelic use in naturalistic settings in Australia is increasing. Although the risks and harms of psychedelics from a physical perspective are low, psychedelic drugs carry a unique psychological risk profile which is increased in uncontrolled settings. Harm reduction support services align with the Australian Government’s Federal Drug strategy, which includes harm reduction as the third pillar in the overall harm minimisation approach to drug use for the period of 2017-2026. This study examined the harm reduction behaviours which users of psychedelics in naturalistic settings currently use, and any harm reduction interventions which have been developed for this population. A scoping review was undertaken using online databases, Psychinfo, Medline, CINAHL and Scopus. Articles were included if they explored or informed harm reduction practices for users of psychedelic drugs in naturalistic settings, which included articles that investigated motivations for psychedelic use. Twenty-seven papers were included, which contained only four intervention-based studies. Harm reduction or benefit enhancing strategies were categorized into three themes: before psychedelic use, during psychedelic experience and after the experience (integration). The review found that users of psychedelic drugs in naturalistic settings employ several different harm minimization strategies, predominantly before and during use. Motivation for use, social setting and dosage amount were all found to influence the strategies used. There were a limited number of evaluated interventions for users of psychedelics in naturalistic settings, identifying the need for further research in this area. Challenges for harm reduction campaigns such as low uptake of drug checking services and low trust in government institutions were identified. Further research needs to consider the differing motivations of psychedelic users and recognize strategies that promote benefit enhancement and reduce risk.

Keywords: Benefit enhancement; Hallucinogens; Harm reduction strategies; Naturalistic use; Psilocybin; Risks.

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Abstract

Background

Benzodiazepines are widely prescribed but are associated with significant risks, particularly when used long-term. The anxiolytic and hypnotic properties of these medications increase their risk of dependence, which can lead to nonmedical and illicit use. Illicit uses further compound these harms, particularly with the emergence of potent novel benzodiazepines on the unregulated market. While tapering remains the standard treatment, not all individuals seek discontinuation. In such cases, harm reduction becomes a key approach to minimizing associated risks. This review aimed to identify and synthesize existing harm reduction approaches for people using benzodiazepines.

Method: A systematic search was conducted across four databases, PsycINFO (n = 183), MEDLINE (n = 345), Web of Science (n = 382), and Embase (n = 940), following the PRISMA guidelines. Searches were carried out between February 14 and March 30, 2024, using terms related to harm reduction and benzodiazepines. The search was re-run on July 7, 2025, using the same strategy across all four databases.

Results: Thirty-five studies were included and grouped into the following themes: direct interventions (n = 16), policy approaches (n = 9), and population-specific approaches (n = 10). Among direct interventions, drug checking was the most frequently reported approach, with advanced techniques improving the detection of novel benzodiazepines and prompting safer use practices. Benzodiazepine agonist prescribing during the COVID-19 pandemic has yielded positive outcomes; conversely, policy responses such as rescheduling and prescribing changes indicated mixed results. While some studies reported reduced use and improved treatment engagement, others highlighted unintended consequences that may displace or exacerbate harm. Specific populations, such as young people, those who inject benzodiazepines, and members of online communities, highlight the diverse demographics of people who use benzodiazepines and emphasize the importance of developing tailored responses to address unique needs.

Conclusion: Drug checking emerged as the most widely reported harm reduction approach for benzodiazepine use, with consistent positive outcomes across studies. Prescribing and policy interventions demonstrated variable impacts, often influenced by broader systemic factors. Critically, a clear gap remains in harm reduction approaches for those not seeking treatment, highlighting a need for inclusive, flexible and pragmatic responses. There is also a need for more robust evaluation of harm reduction interventions to strengthen the evidence base and inform practice.

Keywords: Benzodiazepines, Novel psychoactive substances (NPS), Novel benzodiazepines, Harm reduction.

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The opioid overdose crisis has continued to affect women who use drugs (WWUD), particularly in urban cities such as Baltimore, Maryland, where fatal overdose rates rank among the highest in the nation. Despite evidence demonstrating the impact of mobile health services in serving underserved populations, few interventions are specifically tailored to meet the unique needs of WWUD. The Sustained Harm Reduction OUTreach (SHOUT) study evaluates the effectiveness and implementation of a harm reduction-based mobile outreach service operated by a community-based organization serving WWUD in Southwest Baltimore. The “intervention group” consists of WWUD recruited within the organization’s catchment area, while the “control group” comprises those recruited from neighborhoods outside of the organization’s catchment area. The study’s three aims are: (1) to conduct in-depth interviews with WWUD (N=12) to assess the feasibility of using a modified respondent-driven sampling (RDS) method; (2) to conduct a prospective cohort study comparing intervention (N=250) and control (N=150) groups over 18 months to assess nonfatal overdose and healthcare access outcomes; and (3) to evaluate intervention implementation using the RE-AIM framework. The study is guided by Andersen’s Behavioral Model for Vulnerable Populations and Rhodes’s Risk Environment Framework. Preliminary findings suggest that a modified RDS approach is both feasible and acceptable among WWUD. Aim 2 will examine the effect of mobile services on reducing nonfatal overdoses by promoting harm reduction practices within participants’ social and physical environments. Aim 3 will incorporate qualitative and cost-effectiveness analyses to contextualize the program’s impact and sustainability. This study addresses critical service gaps for WWUD by integrating and providing low-barrier harm reduction services offered on an accessible mobile van. Findings will inform scalable, community-driven strategies to reduce overdose mortality and improve health equity among structurally vulnerable populations. Strengths, limitations, and plans for results dissemination are discussed.

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