The opioid epidemic has claimed many lives and harm reduction strategies have been implemented to reduce overdose mortality and improve health outcomes. Supervised consumption sites (SCS) and their virtual counterparts, overdose response hotlines and apps (ORHAs), are interventions to reduce overdose harms. In this study, we explore the business community's perspectives with commercial space near SCS on these harm reduction strategies and virtual services. Twenty-three business owners and staff within 1 km of an SCS were recruited across Canada. Inductive thematic analysis using grounded theory was employed to identify themes. Five themes were identified: (1) access to bathrooms has been a common source of conflict; (2) substance use and associated disruptions have been on the rise since the COVID-19 pandemic with litter around the businesses; (3) many businesses feel compassion fatigue when interacting with people who use substances; (4) harm reduction services were positively viewed by most participants, with some expressing concerns; (5) virtual harm reduction services were seen as necessary and an additional tool in the toolkit with disadvantages being lack of access to a phone and no immediate help available in case of an overdose. This study provides important business insights on harm reduction strategies to understand their viewpoint on SCS and ORHAs. We identified areas for potential improvement in both overdose prevention interventions and identified improvements. Virtual services have the potential to expand within communities and improve health outcomes.
Harm reduction has gained international policy traction and increasing recognition as essential for health equity, while punitive drug control approaches have re-emerged. This study examines Sweden, known for its restrictive drug policy, to explain why harm reduction measures have gained greater acceptance alongside increasingly severe penal responses to drug offences. Furthermore, it explores the role of stakeholders in shaping these policy processes. We analyzed three data sets 2015-2025 (media texts, key informant interviews, stakeholder comments to two commissions of inquiry) by using the Multiple Streams Framework. Two main problem constructions were identified: drug-related mortality and organized criminality controlling illicit drug markets. Both were related to the opening of two policy windows; however, only one led to policy change (stricter penalties), while the other did not, despite broad stakeholder support (evaluating drug use criminalization). The results highlight the role of specific stakeholders as policy entrepreneurs and indicate growing acceptance of harm reduction, although measures perceived as challenging the control-oriented track remain controversial. The results support previous findings of Sweden adopting a dual-track policy structure. However, the control-oriented policy track continues to dominate drug policy formation. This study suggests that harm reduction is likely to remain subordinate to control-oriented approaches, when the policy tracks remain institutionally separate, and when control institutions, conventions, and key stakeholders hold greater authority than human rights frameworks and may act as status quo entrepreneurs. Furthermore, focusing on control measures due to criminal networks and drug trafficking may hinder harm reduction development.
Injection-related bacterial infections represent a major but under-recognised health issue among people who inject drugs (PWID). Harm reduction interventions (HRIs) like needle and syringe programmes (NSP) and opioid agonist treatment (OAT) could mitigate their burden. This review aimed to identify and synthesise evidence on the effectiveness of HRIs in preventing bacterial infections among PWID. Systematic review with meta-analysis of studies with more than 40 participants from Medline, Embase, Cochrane Library and Web of Science, published between 1990 and 2023 in English or French. We included interventional and observational studies that reported a quantitative effect measure for an HRI conducted in community, harm reduction, healthcare and outreach settings, targeting bacterial infections among PWID, defined as individuals who had injected drugs at least once within the previous year. Twelve studies met the inclusion criteria, for a total of n = 11 611 participants. The primary outcome was the impact of HRI on the prevalence or incidence of bacterial infections, measured as a risk difference, relative risk, number needed to treat, relative risk reduction, odds ratio, incidence rate ratio, hazard ratio or preventable fraction among the unexposed. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane RoB 2 tool for randomised trials. Meta-analysis was performed when at least 3 comparable estimates were available. Overall, the available evidence was sparse and heterogeneous, with substantial variability in study design, intervention definitions and outcome measurement across the 12 included studies. Sterile injecting equipment provision was found protective in 2/6 studies (n = 1938), 1/6 (n = 5209) found increased risk and 3/6 (n = 1323) reported no statistically significant association. OAT was protective in 2 studies (n = 2934) when comparing current PWID or those who had never used OAT to past PWID. Only 1 study (n = 1876) evaluated a combination of these interventions, showing a statistically significant reduction in skin and soft tissue infections. Among hygiene interventions, 1 of 2 studies (n = 59) reported a statistically significant protective effect, and the same for drug consumption rooms (n = 665). Overall, 8/10 studies assessed were judged to be at high risk of bias. A random-effect meta-analysis of crude odds-ratios (ORs) associated with NSPs yielded a pooled OR of 1.25 (95% confidence interval = 1.07-1.47). Evidence on the effectiveness of harm reduction interventions in preventing bacterial infections among people who inject drugs is limited and inconsistent, as most studies are observational, focus on skin and soft tissue infections and present substantial methodological limitations.
Continued cannabis use among young people with first-episode psychosis (FEP) has been linked to poorer clinical and functional outcomes (eg, increased symptom severity and higher relapse rates). Digital harm-reduction interventions may represent a promising, person-centered approach to reduce at-risk cannabis use behaviors in this population. However, evidence remains limited regarding which subgroups are more likely to engage with these interventions and whether specific levels of engagement are required to achieve more favorable cannabis-related outcomes. This exploratory, hypothesis-generating analysis of the CHAMPS (Cannabis Harm-Reducing App to Manage Practices Safely) pilot randomized controlled trial (RCT) evaluated a cannabis harm-reduction mobile app for youth with FEP in early intervention services (EIS). The objectives of this study were to assess engagement by examining associations between selected sociodemographic factors and module completion and to determine whether achieving specific completion thresholds was associated with improvements in cannabis-related outcomes. Cannabis-related outcomes (Marijuana Problems Scale [MPS], Protective Behavioral Strategies for Marijuana [PBSM] scores, and days of cannabis use) were self-assessed at baseline and at week 6 (primary end point), week 12, and week 18 (postrandomization). Participants were categorized into low to moderate (0-4 modules) and high (5-6 modules) completion groups, and selected sociodemographic factors were compared between groups using bivariate analyses. Mixed-effects models, adjusted for baseline values and the covariates sex and cannabis use disorder (CUD) status, were fitted to evaluate whether module thresholds were associated with improvements in cannabis-related outcomes. Data from 96 participants, including 46 in the CHAMPS+EIS arm and 50 in the EIS-only arm (1:1 ratio), were analyzed under a modified intention-to-treat principle. Individuals in the high-engagement group reported higher baseline social support and higher educational level (P=.005 and P=.01). No statistically significant associations were observed between specific module completion thresholds and cannabis-related outcomes in adjusted mixed-effects models. Participants with higher social support and higher education were more likely to engage with CHAMPS. Although descriptive analyses suggested a potential gradient of improvement with increasing module completion, no specific completion threshold was robustly associated with improvements in outcomes. Given the multifactorial nature of engagement, supporting subgroups at risk of lower app use and examining metrics beyond module completion may enhance the impact of CHAMPS. These findings are hypothesis-generating, given their exploratory nature, and require replication in a future efficacy trial.
Harmful alcohol use is a major modifiable risk factor for self-harm. We aimed to examine associations between minimum unit pricing for alcohol, introduced in Scotland in 2018, and rates of hospital-admitted self-harm. Data were obtained from Public Health Scotland and English Hospital Episode Statistics. Interrupted time series (ITS) analysis compared pre- and post-intervention self-harm admission rates per 100 000 population, including controlled comparisons with England. The before-after slope reduction in Scotland corresponded to -5.6 (95% CI -7.5 to -3.7) admissions per quarter, per 100 000 population, over the intervention period. Using controlled ITS, a greater slope reduction was observed in Scotland relative to England: -3.5, CI -6.4 to -0.6. No differences in slope change were observed when examining only pre-pandemic study quarters. Findings were consistent with a possible postintervention rate reduction in the two most deprived population quintiles, while no between-nation slope difference was observed in the three least deprived quintiles. Findings were consistent with possible postintervention reductions in hospital-admitted self-harm in Scotland compared to England, with reductions concentrated in more deprived populations. Population-level alcohol pricing policies may contribute to reducing self-harm frequency, although causal interpretation is limited by the observational, quasi-experimental study design and differing between-nation pre-intervention trajectories.
Deep brain stimulation (DBS) is a promising intervention for obsessive-compulsive disorder (OCD) refractory to conventional therapies. However, preoperative factors that reliably predict treatment response are not well established. Among patients with contamination OCD, some are concerned with substances potentially causing harm to themselves or others ("harm-avoidant"), while others are viscerally repulsed by them ("disgust"). Disgust-oriented OCD is associated with attenuated psychotherapy outcomes; relationship with DBS outcome has yet to be examined. Here, we compare clinical outcomes following DBS between harm-avoidant and disgust OCD subtypes. We conducted a retrospective cohort study of 14 contamination OCD patients (7 female, 7 male) undergoing DBS between 2019 and 2024 and categorized them as harm-avoidant or disgust based on clinical features. We assessed demographics and Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II) scores preoperatively and longitudinally. Among 14 patients with contamination OCD, the harm-avoidant (n=10) and disgust (n=4) groups had similar demographic characteristics and baseline Y-BOCS-II scores (harm-avoidant: 40.4 ± 4.2, disgust: 40.0 ± 6.9, p =0.92, Welch's t-test). At the latest follow-up, harm-avoidant patients achieved significantly lower Y-BOCS-II scores (harm-avoidant: 13.8 ± 11.1, disgust: 30.5 ± 3.1; p =0.001, Welch's t-test). Nine of ten harm-avoidant patients achieved response status (≥35% score reduction) compared to only one of four disgust patients ( p =0.04, Fisher's exact test). Disgust OCD patients experienced attenuated improvement following DBS compared to harm-avoidant OCD patients. If confirmed in larger cohorts, these findings could motivate preoperative phenotypic stratification, inform decision-making about DBS candidacy, and guide alternative therapeutic strategies for disgust patients.
Instant delivery crashes (IDCs) pose a growing public health challenge. Standard crash databases rarely capture the fine-grained variables necessary to model severe pedestrian disability. To address this gap, we analyzed a sample of 732 adjudicated court verdicts involving pedestrian-IDC collisions. This specific data source captures a highly selected subset of litigated, severe events rather than the broader crash population. We applied a Hierarchical Generalized Ordered Probit (HGOP) model. This framework accommodates the ordinal nature of disability grades and unobserved age-related heterogeneity. To achieve model convergence, we consolidated fatalities and severe disabilities into a single highest-severity category. Our modeling reveals that older pedestrian age (65-74 years) and motorbike involvement strongly predict higher-grade disability. Conversely, female pedestrians and winter conditions correlate with lower injury severity. We also identified a negative monotonic association between rider liability and pedestrian injury grade. As legal rider responsibility increased, the predicted severity of pedestrian injuries systematically decreased. Lacking direct kinematic data, we hypothesize this liability association reflects distinct conflict typologies rather than direct physical causation. Translating these findings into effective harm reduction requires a two-tiered approach. Our statistical estimates directly support physical interventions, including age-proofed infrastructure and targeted motorbike regulations. Simultaneously, our descriptive behavioral data align with existing literature to advocate for platform governance reforms addressing algorithmic deadlines. Ultimately, these observational findings carry strict inferential boundaries. They apply exclusively to litigated crash populations and highlight the critical need for integrated clinical and kinetic data in future research.
Xylazine, a veterinary sedative not approved for human use, has emerged as a dangerous adulterant in the illicit opioid supply and is now linked to severe, progressive necrotic wounds. These lesions often occur at noninjection sites, exhibit atypical healing patterns, and are commonly complicated by infection, osteomyelitis, and delayed presentation. This study characterizes the clinical features, management strategies, and outcomes of xylazine-associated wounds to inform triage and harm-reduction efforts. A systematic review was conducted in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines and registered with PROSPERO (CRD420251000303). Searches of PubMed, Embase, and Web of Science were completed through April 2025. Nineteen studies comprising 92 patients were included. Descriptive statistics and Fisher exact tests were used to evaluate associations between clinical variables. Among 27 patients with detailed case-level data, all had extremity involvement (100%), with bone or tendon exposure in 56% and osteomyelitis in 30%. Surgical management occurred in 78% of patients, including grafting (41%), free flap reconstruction (11%), and amputation (26%). Algorithm-guided care, documented in 56%, was significantly associated with both bone or tendon exposure (P = 0.007) and amputation (P = 0.008). At the study level, algorithm use was more common in studies that described bone or tendon exposure (P = 0.048). Xylazine-associated wounds are a distinct and increasingly prevalent condition. These findings support early surgical triage and structured, harm-reduction care models to improve outcomes for medically and socially vulnerable patients.
Electronic cigarettes (ECs) have gained substantial popularity, yet misperceptions that ECs are equally or more harmful than combustible cigarettes are increasing. In Israel, where smoking prevalence remains high, particularly among lower socioeconomic groups and the Arab minority, population-level perceptions of EC harms are unknown. Data were drawn from the International Tobacco Control (ITC) Israel Survey, a nationally representative survey of 659 adults conducted in March-June 2022. The study assessed perceptions of (1) the relative harmfulness of ECs compared with cigarettes, (2) the health effects of completely switching from cigarettes to ECs, and (3) the relative harm of EC vapour compared with cigarette smoke. Associations with sociodemographic characteristics and smoking status were examined. Overall, 29.3% of Israeli adults perceived ECs as less harmful than cigarettes, 51.5% as equally or more harmful, and 19.0% did not know. Smokers were more likely to believe that ECs were more harmful. Regarding completely switching, 30.0% believed health would improve, 17.8% worsen, 33.2% no effect, and 19.1% did not know. Arab respondents were more likely than Jewish respondents to perceive ECs as equally or more harmful than cigarettes. Younger adults (<40 years) were less likely than older adults to perceive switching to ECs as harmful. Misperceptions about the relative harms of ECs are widespread among Israeli adults, including those who smoke, suggesting a failure of risk communication. Clear, evidence-based communication is needed to support informed decision-making among adult smokers, while maintaining strong protections against EC uptake among non-smoking youth.
People who use drugs (PWUD) interact with hospital and emergency departments at higher rates than the general population. PWUD have unique needs when receiving hospital-based care and often face challenges receiving care in hospital-based environments. Programs such as Hospital at Home provide the opportunity to deliver hospital-level care outside of traditional hospital-based environments through the use of in-person outreach and virtual care, however have traditionally faced challenges providing this care to people actively using substances and to those who are unhoused or unsafely housed. In Vancouver, Canada a novel partnership was formed between Hospital at Home and a community-based, harm reduction site in order to provide hospital-level care for PWUD who are unhoused or precariously housed. Baseline demographic data as well as substance use disorder diagnoses, admitting diagnoses and admission outcome were collected. During the first 3 months of the program, 17 patients were admitted, with 94% (n = 16) of patients admitted for an infectious disease. There was a high preponderance of opioid use disorder (n = 15, 88%) and stimulant use disorder (n = 14, 82%). There was 1 patient-initiated discharge and 2 patients required transfer back to hospital to receive a higher level of care. All other patients completed treatment and were discharged to community. Median length of stay was 31 days (standard deviation 26 days). Early program findings suggest that providing hospital-level of care in a community based harm reduction setting may be an acceptable alternative to traditional hospital admission in appropriately selected patients who use drugs.
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In a previous study, an opioid reduction tool was designed to reduce inappropriate opioid treatment in patients with chronic noncancer pain. This study aimed to assess whether the tool facilitated opioid tapering in patients with chronic noncancer pain and long-term opioid treatment in primary care. In addition, it evaluated the impact on pain-related outcome measures. In a cohort study, 55 general practices and 30 collaborating pharmacies were recruited to implement the tool containing six reduction measures. Patients on long-term opioid treatment (>3 months) for chronic noncancer pain received a tailored taper programme from their healthcare provider and were monitored via questionnaires. The primary outcome was reduction in oral morphine equivalent daily dose over 3 months retrieved through pharmacy dispensing data. Secondary outcomes included trends in opioid use over 9 months, pain severity, pain interference, well-being, withdrawal symptoms, discontinuation rate, and nonopioid analgesic use. Of the 366 patients approached, 116 agreed to taper, of whom 27 were included in our cohort. The median oral morphine equivalent daily dose decreased significantly from 40.0 mg (interquartile range (IQR), 16.5-120.0) at baseline to 15.2 mg (IQR, 0.0-60.0) at 3 months. Opioid dose continued to decrease over 9 months, with 12 participants discontinuing completely. Pain-related outcome measures remained stable throughout the study period. With a significant decrease in opioid dose without negative impact on pain, this study showed promising results for an opioid reduction tool tapering long-term opioid treatment in primary care. A larger controlled trial is needed to assess the effectiveness of the tool.
Prenatal cannabis use is increasing in prevalence and associated with potential harm to maternal-fetal health. Pregnant individuals who use cannabis seek information about prenatal cannabis use informally (e.g., online) and adopt practices perceived to reduce harm. However, no evidence-based harm reduction interventions address prenatal cannabis use. Cannabis protective behavioral strategies (PBS) are associated with less cannabis use and fewer cannabis-related negative consequences among non-pregnant populations. There is a lack of research exploring PBS during pregnancy. This study combined two samples of pregnant individuals who use cannabis (N = 48; Mage = 30.33; 2% American Indian or Alaska Native, 2% Asian, 19% Black, 15% multiracial, 58% White). Participants completed the Protective Behavioral Strategies for Marijuana scale (PBSM; Pedersen et al., 2017), adapted for pregnancy, and an open-ended question about prenatal PBS. We examined relationships between prenatal cannabis use, PBS, consequences, and perceived harm of prenatal cannabis use. Participants reported using PBS (M = 4.07, SD = 0.93) and experiencing consequences in the past 30 days (M = 3.77, SD = 3.30). Higher perceived harm of cannabis to fetal health (B = 0.02, p = .010) and use in later trimesters (second: B = 0.69, p = .011; third: B = 0.82, p = .013) were positively associated with PBS. PBS was associated with lower weekly (IRR = 0.79, 95% CI [0.69, 0.90], p < .001) and daily prenatal cannabis use frequency (IRR = 0.41, 95% CI [0.33, 0.51], p = .001) but was not significantly associated with consequences. Open-ended responses revealed pregnancy-specific practices perceived to reduce harm (e.g., "I had a date set to quit and slowly decreased the amount I was smoking"). Results underscore the need for harm reduction research and validation of PBS and consequence measures for prenatal cannabis use to support informed decision-making among pregnant individuals who use cannabis.
Health care organizations face pressure to advance environmental sustainability. Core challenges include pursuing distant-future goals (e.g., climate neutrality by 2050), leading sustainability initiatives beyond formal authority, and making mitigation decisions whose benefits accrue in the future and outside the organization. Dominant management theories tend to treat the future as a strategic context or planning horizon rather than as an object of sustained organizational work. Long-term orientation is often assumed rather than explained. Leadership is conceptualized as hierarchical or professionally anchored, leaving distributed and extra-professional leadership weakly theorized. Moreover, prevailing theories assume alignment between decision-makers and beneficiaries, privileging value creation and capture while inadequately addressing harm reduction and externalized and future-oriented environmental benefits and costs. We suggest a shift from treating the future as a given condition to be anticipated or adapted to, toward actively pursuing distant futures as ongoing organizational work. We conceptualize sustainability leadership as distributed across fragmented authority structures and reframe environmental sustainability as a governance challenge of managing asymmetric costs and benefits alongside clinical priorities. Reframing of sustainability leadership provides opportunities for healthcare management research to advance environmentally sustainable health care through managerial work. We highlight the need for health care managers to actively sustain future-oriented goals over time, lead sustainability initiatives without relying solely on formal authority, and develop decision and performance frameworks capable of integrating temporally and spatially uneven payoffs.
To provide evidence-informed recommendations for the screening, management, and cessation of nicotine use during pregnancy and the postpartum period. Women who are pregnant or planning a pregnancy who use nicotine-containing products, including combustible tobacco, electronic cigarettes and smokeless tobacco. Screening approaches, behavioural counselling interventions, pharmacologic therapies, harm-reduction strategies, and health system interventions for nicotine cessation. Improved maternal and neonatal outcomes, reduced nicotine exposure during pregnancy, improved cessation rates for nicotine-containing products, and prevention of postpartum relapse. Implementation of these recommendations may improve smoking cessation rates during pregnancy and reduce adverse maternal and neonatal outcomes. Potential harms include increased clinical time requirements and resource utilization for cessation programs. Evidence was identified through comprehensive literature reviews addressing key clinical questions related to nicotine exposure, screening, cessation interventions, electronic cigarettes, and postpartum relapse prevention. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). This guideline is intended for health care professionals involved in the care of pregnant individuals and those planning pregnancy, including obstetricians, family physicians, midwives, nurses, nurse practitioners, and other health professionals providing prenatal and postpartum care. It may also be relevant to public health practitioners, smoking cessation specialists, and policy makers involved in maternal and child health. Nicotine use in pregnancy remains a major preventable cause of adverse maternal and neonatal outcomes. This SOGC guideline recommends routine screening, behavioural counselling as first-line therapy, cautious use of NRT or other pharmacotherapy when needed, and continued postpartum support to reduce relapse. RECOMMENDATIONS.
Gambling consumers show low uptake and engagement with tools designed to support safer gambling practices and reduce the risk of experiencing gambling-related harms. We used co-design principles to design and develop a digital tool for safer gambling (BetWell) to overcome known barriers to tool uptake, including a focus on gambling problems. BetWell aims to increase awareness of personal gambling expenditure and knowledge of how gambling products function to support informed decision-making about gambling. It was designed based on behavioral change theories and presents a personalized amalgamation of gambling expenditure relative to alternative spend options, and psychoeducational information via a quiz. This exploratory study assessed the perceived acceptability and usefulness of the newly designed digital tool and gathered end-user feedback to improve future prototypes. The study explored whether usability, gambling severity, financial well-being, gambling frequency, spend tracking, activity statement use, and the number of accounts held impacted acceptability and perceived usefulness, and the extent to which these factors independently predicted acceptability and perceived usefulness when controlling for life satisfaction, gambling satisfaction, and demographic variables. This cross-sectional study recruited 140 gambling consumers (mean 41.3, SD 10.9 years) via the market research panel CRNRSTONE. Participants accessed and engaged with BetWell and completed an online survey to share their perceptions towards the tool. The overall acceptability (mean 32/40, SD 5.2) and perceived usefulness (mean 20/25, SD 3.9) of the tool were considered "good" and "useful," respectively by participants. Individuals with higher gambling severity scores were more likely to perceive the tool as useful than those of the lower risk categories. Individuals with higher financial well-being were more likely to perceive the tool as useful and acceptable compared to those in lower financial well-being categories. Higher usability scores corresponded with higher tool acceptability. Previous efforts to monitor and track gambling spend was associated with acceptability and perceived usefulness. Gambling frequency and the number of gambling accounts held were not related to acceptability and perceived usefulness. Qualitative feedback included participant identified suggestions for improvements such as a need for interactive elements, a more detailed view of gambling expenditure, automation of activity statement upload functionality, more challenging and positively framed quiz content, and an emphasis on data security. The study provides preliminary support for the acceptability and perceived usefulness of a newly developed tool to increase awareness of gambling expenditure and knowledge on how gambling products function, providing directions for future improvements to the tool.
Polysubstance use is rising and linked to heightened overdose rates and increased treatment challenges, further exacerbated by increasing detection of adulterants (e.g., xylazine) in the street drug supply. Harm reduction groups provide sterile syringes in exchange for used ones, creating a unique opportunity to characterize prevalent polysubstance combinations and inform translational and preclinical research We analyzed residues from used syringes (N=3,168) obtained from several harm reduction organizations in Jefferson County, KY (Jan-Dec 2025) for the presence of substances using gas chromatography mass spectrometry (GC-MS). We classified compounds as adulterants (e.g., diphenhydramine [DPH]/Benadryl), byproducts/precursors of synthesis (e.g., 4-ANPP), and recreational drugs (e.g., meth). We excluded byproducts/precursors and determined the most frequent substance and pairs/trios containing one or more recreational substance. Results. Of 3,168 syringes, 2,522 (79.61%) tested positive for substances. Out of those positive, the top recreational substances were meth (n=1,387; 54.99%), fentanyl (n=1,220; 48.37%), and heroin (n=653; 25.89%). Top adulterants were DPH (n=1021; 40.48%), dimethyl sulfone (n=749; 29.69%), and lidocaine (n=736; 29.18%). The most common pairs were DPH+fentanyl (n=670; 26.57%), lidocaine+fentanyl (n=659; 26.13%), dimethyl sulfone+meth (n=621; 24.62%), and fentanyl+heroin (n=484; 19.19%). The most common trios were DPH+lidocaine+fentanyl (n=369; 14.63%), DPH+fentanyl+heroin (n=327; 12.97%), lidocaine+fentanyl+heroin (n=297; 11.77%), diphenhydramine+xylazine+fentanyl (n=273; 10.82%), and meth+lidocaine+fentanyl (n=262; 10.39%). Our findings highlight evolving patterns of multiple-opioid and opioid-stimulant polysubstance use, generating insights that can be rapidly applied to strengthen clinical, preclinical, and translational polysubstance research. These insights allow for investigations into biobehavioral mechanisms and consequences of emerging use patterns, accelerating development of novel therapeutics.
This article explores the mental health concerns of transgender and gender diverse (TGD) individuals within a mutual aid and harm reduction framework. Despite historical strides toward equity and care in the public health sector, TGD people face structural discrimination, polyvictimization, and worsening political hostility that heighten mental health disparities. The authors critique medical and nursing practices shaped by carceral logic and call for new approaches rooted in equity and care. Clinical recommendations emphasize affirming, trauma-informed, and community-based care, while highlighting harm reduction and mutual aid as essential, evidence-based strategies for collective healing, resilience, and a move toward communal care.
Cigarette smoking, maintained predominantly by nicotine dependence, is a long-term and relapsing behavior that continues to be a leading cause of preventable death and disease worldwide. E-cigarettes with nicotine are less harmful than cigarettes and have been shown to be more effective for smoking cessation than US Food and Drug Administration-approved nicotine replacement therapies. However, misperceptions of the harms of e-cigarettes are common, even among clinicians. This Special Communication is a position manuscript developed by a working group within the Treatment Research Network of the international Society for Research on Nicotine and Tobacco. The aims of the manuscript were to summarize the evidence on the use of e-cigarettes for smoking cessation and to provide recommendations for clinicians on how to engage in conversations with adult patients who currently smoke cigarettes. Specifically, advice is provided on (1) integration of e-cigarettes into patient-centered shared decision-making conversations on the risks and benefits of various pharmacologic smoking cessation treatments; and (2) practical guidance on the use of e-cigarettes for smoking cessation. This Special Communication includes one overarching recommendation: integrate e-cigarettes into conversations on the risks and benefits of all evidence-based pharmacologic treatments for smoking cessation. In support of this recommendation, specific guidance is provided regarding how to discuss potential misperceptions and suggests questions to guide patient conversations. Finally, evidence-based best practices are provided for using e-cigarettes to quit smoking, which can be shared with patients. The significant burden of cigarette smoking, coupled with scientific evidence supporting e-cigarettes for smoking cessation, clearly indicates that it is appropriate to include e-cigarettes in discussions of evidence-based pharmacologic treatment for smoking cessation to reduce the harms of cigarette smoking. These recommendations are intended to provide evidence-informed guidance to clinicians regarding use of e-cigarettes for smoking cessation.