Harm reduction in Asia and the Pacific: an evolving public health response

Purpose The purpose of this paper is to compare the response to HIV/AIDS and drug use (drugs harm reduction) with tobacco harm reduction. Design/methodology/approach Analysis of historical and contemporary sources, combined with personal knowledge of key stakeholders in the history and development of both fields. Findings Both drugs harm reduction and tobacco harm reduction share a similar objective – to reduce health risks for people who are unwilling or unable to stop using their drug of choice. Both also share a broader public health aim of helping people to make healthier decisions. Drugs harm reduction – as a response to HIV/AIDS – included the adoption of a wide range of radical harm reduction interventions and was a public health success. It became an established part of the professional Public Health agenda. In contrast the Public Health response to e-cigarettes and tobacco harm reduction has ranged from the negative to the cautious. A recent Public Health England report is exceptional for its endorsement of e-cigarettes. Originality/value Highlights contradictions in Public Health responses to drugs and tobacco; and that public health interventions can be implemented without and despite the contribution of professional Public Health.

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Looking Beyond the Provision of Injecting Equipment to People Who Use Anabolic Androgenic Steroids: Harm Reduction and Behavior Change Goals for UK Policy

Contemporary Drug Problems ◽

10.1177/0091450921998701 ◽

2021 ◽

pp. 009145092199870

Author(s):

Geoff Bates ◽

Jim McVeigh ◽

Conan Leavey

Keyword(s):

Public Health ◽

Harm Reduction ◽

Public Health Intervention ◽

Anabolic Androgenic Steroids ◽

Public Health Response ◽

Health Response ◽

Wide Range ◽

Reduction Strategies ◽

The Uk ◽

Androgenic Steroids

Understanding of the choices and motivations of people who use anabolic androgenic steroids (AAS) for muscular enhancement has increased greatly in the past thirty years, along with understanding of a wide range of health harms associated with this form of drug use in the community. During this period the predominant public health intervention for this population in the UK has consistently remained the provision of injecting equipment to prevent blood borne virus (BBV) transmission. The study explored the health professionals’ and other stakeholders’ perceptions on: whether the current UK public health response is sufficient to address the needs of people who use AAS, and if not, what other needs they might have. This included an exploration of whether there were gaps in harm reduction strategies or other behavioral outcomes and interventions that were needed. Interviews with 27 stakeholders who provide support to people who use AAS in a variety of roles established consensus on the need for a range of interventions to reduce harm and risk in those that choose to use AAS, to prevent initiation, to motivate and support cessation, and to prevent relapse. Study findings indicate that while providing sterile injecting equipment remains essential, it should be considered a bare minimum. The challenge is to develop and deliver a range of harm reduction interventions that look beyond BBV prevention to provide appropriate support to who choose to use AAS at all points in their cycles of use and ultimately for those choosing the temporary or permanent cessation of use.

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Using Surveillance With Near–Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019

Public Health Reports ◽

10.1177/00333549211015662 ◽

2021 ◽

Vol 136 (1_suppl) ◽

pp. 18S-23S

Author(s):

Peter Canning ◽

Suzanne Doyon ◽

Sarah Ali ◽

Susan B. Logan ◽

Aliese Alter ◽

...

Keyword(s):

Public Health ◽

Harm Reduction ◽

Real Time ◽

Crack Cocaine ◽

State Department ◽

Poison Control ◽

Opioid Overdose ◽

Public Health Response ◽

Mapping Tool ◽

Health Response

In 2019, Connecticut launched an opioid overdose–monitoring program to provide rapid intervention and limit opioid overdose–related harms. The Connecticut Statewide Opioid Response Directive (SWORD)—a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups—required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients’ status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD’s near–real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.

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