The value of harm reduction for injection drug use: A clinical and public health ethics analysis

2019 ◽  
Vol 65 (5) ◽  
pp. 119-141 ◽  
Author(s):  
Laura Vearrier
Keyword(s):  
Public Health ◽  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Public Health Ethics ◽  
Injection Drug ◽  
Health Ethics

scholarly journals The Ethics of Tobacco Harm Reduction: An Analysis of E-Cigarette Availability From the Perspectives of Utilitarianism, Bioethics, and Public Health Ethics

2020 ◽  
Author(s):  
Rebecca Thomas ◽  
Lisa S Parker ◽  
Saul Shiffman
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Biomedical Ethics ◽  
Public Health Ethics ◽  
Individual Autonomy ◽  
Tobacco Harm Reduction ◽  
Reduction Strategy ◽  
Ethics Framework ◽  
Health Ethics ◽  
Harm Reduction Strategy

Abstract Much evidence suggests e-cigarettes are substantially less harmful than combustible cigarettes. Assuming this is true, we analyze the ethical case for a policy of e-cigarette availability (ECA) as a tobacco harm reduction strategy. ECA involves making e-cigarettes available to allow smokers to switch to them, and informing smokers of the lower risks of e-cigarettes vis-à-vis smoking. After suggesting that utilitarian/consequentialist considerations do not provide an adequate ethical analysis, we analyze ECA using two other ethical frameworks. First, ECA is supported by a public health ethics framework. ECA is a population-level intervention consistent with respecting individual autonomy by using the least restrictive means to accomplish public health goals, and it supports equity and justice. Second, ECA is supported by four principles that form a biomedical ethics framework. By reducing smokers’ health risks and not harming them, ECA fulfills principles of beneficence and non-maleficence. Because ECA allows smokers to make informed health decisions for themselves, it fulfills the principle requiring respect for persons and their autonomy. Here, we consider whether nicotine addiction and thus ECA undermine autonomy, and also discuss the ethical warrant for special protections for youth. Finally, ECA can also advance justice by providing a harm reduction alternative for disadvantaged groups that disproportionately bear the devastating consequences of smoking. Policies of differential taxation of cigarettes and e-cigarettes can facilitate adoption of less harmful alternatives by those economically disadvantaged. We conclude that public health and biomedical ethics frameworks are mutually reinforcing and supportive of ECA as a tobacco harm reduction strategy. Implications Making e-cigarettes and information about them available is supported as ethical from multiple ethical perspectives.

scholarly journals Harm reduction via online platforms for people who use drugs in Russia: a qualitative analysis of web outreach work

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Arsen Davitadze ◽  
Peter Meylakhs ◽  
Aleksey Lakhov ◽  
Elizabeth J. King
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Injection Drug ◽  
People Who Use Drugs ◽  
Structured Interviews ◽  
Advantages And Disadvantages ◽  
Online Platforms ◽  
Outreach Work ◽  
Outreach Workers

Abstract Background Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Several organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO “Humanitarian Action,” we explored web outreach work in Telegram instant messenger. Methods Our data were comprised of 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD. We used thematic analysis to study the process of web outreach, harm reduction service provision, and needs of PWUD. Results Three stages of the process of web outreach work were identified: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded in group chat or direct messages. Challenges in addressing clients’ needs happened when clients turned for help after hours, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. The needs of PWUD were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services. Conclusions Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and for recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). Harm reduction organizations should consider incorporating online harm reduction services into their activities. However, further research is needed to explore relative advantages and disadvantages of online harm reduction services.

scholarly journals The hepatitis C epidemic in Canada: An overview of recent trends in surveillance, injection drug use, harm reduction and treatment

2021 ◽  
Vol 47 (12) ◽  
pp. 505-514
Author(s):  
Lillian Lourenço ◽  
Marian Kelly ◽  
Jill Tarasuk ◽  
Kyla Stairs ◽  
Maggie Bryson ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Health Concern ◽  
Prescription Opioid ◽  
Direct Acting Antiviral ◽  
Life Years ◽  
Hcv Transmission

Hepatitis C continues to be a significant public health concern in Canada, with the hepatitis C virus (HCV) responsible for more life-years lost than all other infectious diseases in Canada. An increase in reported hepatitis C infections was observed between 2014 and 2018. Here, we present changing epidemiological trends and discuss risk factors for hepatitis C acquisition in Canada that may have contributed to this increase in reported hepatitis C infections, focusing on injection drug use. We describe a decrease in the use of borrowed needles or syringes coupled with an increase in using other used injection drug use equipment. Also, an increased prevalence of injection drug use and use of prescription opioid and methamphetamine injection by people who inject drugs (PWID) may be increasing the risk of HCV acquisition. At the same time, while harm reduction coverage appears to have increased in Canada in recent years, gaps in access and coverage remain. We also consider how direct-acting antiviral (DAA) eligibility expansion may have affected hepatitis C rates from 2014 to 2018. Finally, we present new surveillance trends observed in 2019 and discuss how the coronavirus disease 2019 (COVID-19) pandemic may affect hepatitis C case counts from 2020 onwards. Continual efforts to i) enhance hepatitis C surveillance and ii) strengthen the reach, effectiveness, and adoption of hepatitis C prevention and treatment services across Canada are vital to reducing HCV transmission among PWID and achieving Canada’s HCV elimination targets by 2030.

Between Emergency Department Visits: The Role of Harm Reduction Programs in Mitigating the Harms Associated With Injection Drug Use

2021 ◽  
Author(s):  
Wendy Macias-Konstantopoulos ◽  
Alan Heins ◽  
Carolyn J. Sachs ◽  
Paula J. Whiteman ◽  
Neil-Jeremy G. Wingkun ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Emergency Department Visits ◽  
Injection Drug

scholarly journals A qualitative assessment of injection drug use and harm reduction programmes in Kabul, Afghanistan: 2006–2007

2009 ◽  
Vol 20 (2) ◽  
pp. 111-120 ◽  
Author(s):  
Catherine S. Todd ◽  
Mark A. Stibich ◽  
M. Raza Stanekzai ◽  
M. Zafar Rasuli ◽  
Shairshah Bayan ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Qualitative Assessment

Insights on Prison Needle and Syringe Programs: Research With Former Prisoners in Canada

2017 ◽  
Vol 97 (5) ◽  
pp. 628-643 ◽  
Author(s):  
Emily van der Meulen ◽  
Tara Marie Watson ◽  
Ann De Shalit
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Qualitative Data ◽  
Injection Drug ◽  
Injection Equipment ◽  
Federal Prisons ◽  
Former Prisoners ◽  
Reduction Measure ◽  
Needle And Syringe Programs

Although injection drug use occurs inside Canadian federal prisons, the correctional service does not allow prisoners access to sterile injection equipment as a harm reduction measure. International evaluations have shown that prison-based needle and syringe programs (PNSPs) lead to many beneficial health and other outcomes, and contribute to safer environments for prisoners and staff. This article presents qualitative data from a community-driven study with 30 former prisoners in Ontario, Canada. Participants shared insights that are highly valuable for understanding the prison context in relation to the need for PNSPs, both in Canada and in other jurisdictions.

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