Cannabis use as harm reduction in the Eastern Caribbean

Purpose The purpose of this paper is to present evidence of the therapeutic value of cannabis as a harm reduction intervention with people who smoke crack cocaine. Design/methodology/approach A desk study of published peer-reviewed material supporting the use of cannabis as therapeutic in mitigating some of the harms associated with crack cocaine smoking. Findings The use of cannabis as a harm reduction strategy for crack cocaine use has been commented on in the scientific literature since the 1980s. The officially scheduling of cannabis as having no medicinal value hampered further study despite the reporting of positive findings and numerous calls for more research. Practical implications There are currently no approved pharmaceutical substitutions for crack cocaine. Cannabis has shown itself effective in mitigating harms for 30–40 per cent of people. Cannabis is inexpensive and readily available and should be allowed for those people who want to use it. Originality/value Poly drug use is often framed in a negative context. In this paper, the author shows that with cannabis and crack, the poly drug use is actually a valid harm reduction strategy.

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Harm Reduction: An Emerging New Paradigm for Drug Education

Journal of Drug Education ◽

10.2190/087g-b4et-08jy-t08y ◽

1994 ◽

Vol 24 (4) ◽

pp. 281-290 ◽

Cited By ~ 36

Author(s):

David F. Duncan ◽

Thomas Nicholson ◽

Patrick Clifford ◽

Wesley Hawkins ◽

Rick Petosa

Keyword(s):

Drug Use ◽

Harm Reduction ◽

Needs Assessment ◽

Drug Education ◽

New Paradigm ◽

Reduction Strategy ◽

Harm Reduction Strategy

Harm reduction is a new paradigm now emerging in the field of drug education. This strategy recognizes that people always have and always will use drugs and, therefore, attempts to minimize the potential hazards associated with drug use rather than the use itself. The rationale for a harm reduction strategy is presented, followed by an example of the kind of needs assessment which may be needed for planning a harm reduction strategy.

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Erratum for “Misoprostol in women's hands: a harm reduction strategy for unsafe abortion" Contraception 2013 Feb; 87(2): 128–130

Contraception ◽

10.1016/j.contraception.2015.08.011 ◽

2016 ◽

Vol 93 (1) ◽

pp. 87

Author(s):

Alyson Hyman ◽

Kelly Blanchard ◽

Francine Coeytaux ◽

Daniel Grossman ◽

Alexandra Teixeira

Keyword(s):

Harm Reduction ◽

Unsafe Abortion ◽

Reduction Strategy ◽

Harm Reduction Strategy

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Public Health Implications of Smokeless Tobacco Use as a Harm Reduction Strategy

American Journal of Public Health ◽

10.2105/ajph.2005.075499 ◽

2006 ◽

Vol 96 (11) ◽

pp. 1934-1939 ◽

Cited By ~ 38

Author(s):

David A. Savitz ◽

Roger E. Meyer ◽

Jason M. Tanzer ◽

Sidney S. Mirvish ◽

Freddi Lewin

Keyword(s):

Public Health ◽

Harm Reduction ◽

Tobacco Use ◽

Smokeless Tobacco ◽

Reduction Strategy ◽

Health Implications ◽

Harm Reduction Strategy ◽

Smokeless Tobacco Use

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Examining a migration-based phenomenon of heroin use in an urban drug scene in Sao Paulo, Brazil

International Journal of Migration Health and Social Care ◽

10.1108/ijmhsc-06-2020-0065 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Marcelo Ribeiro ◽

Rosana Frajzinger ◽

Luciane Ogata Perrenoud ◽

Benedikt Fischer

Keyword(s):

Drug Use ◽

Crack Cocaine ◽

Methadone Treatment ◽

Rapid Test ◽

Sao Paulo ◽

Therapeutic Interventions ◽

São Paulo ◽

Heroin Use ◽

Heroin Users ◽

Content Type

Purpose Brazil’s street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service availability. Recently, an influx of multi-ethnic migrants within an urban drug scene in Sao Paulo was associated with heroin use, a drug normatively absent from Brazil. The purpose of this paper is to characterize and compare heroin use-related characteristics and outcomes for an attending sub-sample of clients from a large community-based treatment centre (“CRATOD”) serving Sao Paulo’s local urban drug scene. Design/methodology/approach All non-Brazilian patients (n = 109) receiving services at CRATOD for 2013–2016 were identified from patient files, divided into heroin users (n = 40) and non-heroin users (n = 69). Based on chart reviews, select socio-demographic, drug use and health status (including blood-borne-virus and other infections per rapid test methods) were examined and bi-variately compared. Multi-variate analyses examined factors independently associated with heroin use. Findings Most participants were male and middle-aged, poly-drug users and socio-economically marginalized. While heroin users primarily originated from Africa, they reported significantly more criminal histories, drug (e.g. injection) and sex-risk behaviors and elevated rates of BBV (e.g. Hepatitis C Virus and HIV). A minority of heroin users attending the clinic was provided methadone treatment, mostly for detoxification. Originality/value This study documented information on a distinct sample of mostly migration-based heroin users in Sao Paulo, Brazil. Based on the local experience, global migration dynamics can bring changes to established drug use cultures and services, including new challenges for drug use-related related behaviors and therapeutic interventions that require effective understanding and addressing.

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Performance-Enhancing Substances in Sports

10.1093/oso/9780190130640.003.0019 ◽

2021 ◽

pp. 266-275

Author(s):

Kaveri Prakash

Keyword(s):

Harm Reduction ◽

Level Playing Field ◽

New Approach ◽

Reduction Strategy ◽

Playing Field ◽

Ethical Frameworks ◽

Harm Reduction Strategy ◽

Practice Of Medicine ◽

Performance Enhancing Substances ◽

Performance Enhancing

Given that the current strategies focusing on deterrence and punishment are increasingly ineffective worldwide, is there a radically different approach to ensuring a level playing field? This essay explores the growing discourse on alternate approaches to controlling the use of performance enhancing substances (PES) in sports and reflects on the fact that social and cultural behaviour patterns, plus a lack of ethics in the practice of medicine are the issues that need to be tackled urgently in this eagerness to ensure a level playing field in sports. Kaveri Prakash cautiously argues for adopting a relatively new approach, under wide discussion, centring on a harm reduction strategy, that would allow performance enhancing substances to be administered under supervision. However, this will only be successful if regulatory and ethical frameworks in related areas are strengthened and current practices are systematically reviewed and either discarded or reformed. Moreover, India needs to pay serious attention to its sporting population, on and off the field, in order to gauge its response to regulation.

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PrEP in Prisons: HIV prevention in incarcerated populations

International Journal of Prisoner Health ◽

10.1108/ijph-09-2019-0053 ◽

2019 ◽

Vol 16 (2) ◽

pp. 199-206

Author(s):

Jordan Parsons ◽

Chelsea Cox

Keyword(s):

Hiv Prevention ◽

Harm Reduction ◽

New Approach ◽

Content Type ◽

Harm Reduction Intervention ◽

Access To Health ◽

Prevention Interventions ◽

High Risk Populations ◽

Sex With Men ◽

Exposure Prophylaxis

Purpose The purpose of this paper is to discuss the possibility of using pre-exposure prophylaxis (PrEP) as an HIV harm reduction intervention in prisons. PrEP is primarily discussed in relation to men who have sex with men (MSM), meaning other high-risk populations, such as prisoners, are often side-lined. The authors wanted to consider how it could prove beneficial beyond the MSM community. Design/methodology/approach First, the authors discuss whether the common objections to existing HIV harm reduction interventions in prisons, such as needle exchanges, are applicable to PrEP. The authors then apply common objections to the provision of PrEP in the general population to the provision of PrEP in a prison context in order to assess their strength. Finally, the authors discuss what the authors anticipate to be a key objection to PrEP in prisons: post-incarceration access. Findings The authors argue that both sets of common objections considered are easily refuted in the case of PrEP in prisons. The unique setting and nature of the intervention are such that it is without immediately apparent flaws. In addressing post-incarceration access, the authors suggest that a longitudinal consideration of a prisoner’s HIV risk undermines the objection. Originality/value This discussion is of importance due to the significantly heightened risk of HIV infection prisoners are subject to. Not only do effective HIV prevention interventions in prisons contribute to fair access to health for incarcerated individuals, but also to the wider fight against HIV. The authors demonstrate that PrEP has potential as a new approach and call for further research in this area.

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

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa198 ◽

2020 ◽

Cited By ~ 1

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.

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