Traditional cigarettes (TC) are regarded as more hazardous compared to heated tobacco products (HTPs). However, mainly from ethical reasons, there are no well-designed studies examining the health impact of exposure to HTPs. This study aimed to assess and compare self-reported physical health implications of respondents smoking traditional cigarettes and HTPs. The survey was conducted in 2,500 adults who had smoked TC for at least a year and after quitting them had been using HTPs for a minimum of six months. The questions, between other issues, aimed to determine and compare the opinion of respondents on impact of smoking cigarettes and using HTPs on physical health, physical condition, and physical health symptoms. Comparing TC and HTPs, 54.2% of the respondents indicated that TC were worse for their physical health, in turn 5.2% of respondents pointed to HTPs as worse. Similarly, 61.9% of respondents viewed TCs as more harmful to their physical condition, while 25% believed that more harmful are HTPs. Traditional cigarettes had reportedly more pronounced negative impact on various physical signs and symptoms. Most people who switched from traditional cigarettes to HTPs perceive traditional cigarettes as more harmful to their physical health. Most believe also that traditional cigarettes more negatively affect physical endurance and various physical signs and symptoms. Age appears to be the main demographic factor influencing perceptions, while other variables such as sex, income, and education have only minor effects.

The toxic drug supply and overdose epidemic in North America has led to deaths, reduced quality of life, and emotional burdens, especially for harm reduction workers who experience stress from grief and trauma. This study aims to evaluate the benefits and harms of working in overdose prevention hotlines and to identify strategies to reduce stress and trauma for lived-experience operators in these settings. We conducted a sequential mixed-methods study comprising 11 qualitative interviews and a survey with 15 operators and volunteers with Canada's National Overdose Response Service (NORS). The study explored operator challenges, compassion fatigue, and quality of life with previously validated quality of life surveys (ProQOL), while also assessing the perceived effectiveness of the hotline in reducing overdose deaths, mental health impacts, and emergency medical service call-outs. From our qualitative interviews, 3 major themes emerged including (1) The duality of remote overdose response work including: tension between flexibility, accessibility, and supportive team dynamics, with ethical challenges, lack of physical presence, and complex client interactions. (2) Emotional burden and stress in a remote context and: (3) Meaning, purpose, and peer connection as drivers of fulfilment. Overall, most participants ranked their burnout levels as low (13/15 (86.6%)), compassion satisfaction as high (13/15 (86.6%)), and secondary traumatic stress as low (14/15 (93.3%)). This study reveals that work with overdose prevention hotlines is both rewarding and sustainable, with operators experiencing low burnout, low secondary traumatic stress, and high compassion satisfaction. The flexibility, strong team support, and inclusive approach of NORS make remote harm reduction a viable model for aiding marginalized individuals effectively in the overdose crisis.

There is substantial evidence that many people recover from serious alcohol concerns without treatment and further, return to moderate alcohol consumption. The current study asks what people believe would happen if this evidence was widely disseminated. Participants (N = 3994), sampled to match the demographic characteristics of people in the UK, were recruited through the Prolific website. Participants were asked a series of questions about their current and past alcohol use. All participants were also asked their beliefs as to whether it would be problematic if evidence was disseminated regarding untreated and moderate drinking recoveries from serious alcohol problems. Roughly half of the sample believed that it would make it harder for people to deal with their alcohol concerns if it was widely published that some people with serious alcohol problems can deal with their alcohol concerns without treatment and drink in a moderate/social manner after they have dealt with their concerns. Participants with prior to past year alcohol dependence were less likely to endorse that promulgating this information would be harmful compared to those who were never dependent or had lifetime alcohol dependence with past year symptoms. The results of this study contribute to the question of whether it is possible to promulgate the facts that untreated and moderate drinking recoveries are common without causing unanticipated consequences.

The diversity of student populations and the heightened risk/s for women students, sexuality and gender-diverse students, First Nations students, multicultural students, international students, and students with a disability, highlight the importance of intersectionality in university responses to sexual violence. This paper analyses policy guidance and explores the framing of sexual violence within policies from 35 Australian universities, with respect to considerations of intersectionality. It also examines student perceptions of the inclusiveness of university policies via an anonymous online survey. Although 91% of the policies used language that is inclusive of specific identity attributes, policy guidance fails to acknowledge the importance of intersectionality in addressing sexual violence or to recognise the structural and systemic inequalities that underpin sexual violence. Policy guidance also lacks sufficient information about cultural responsiveness and intersectional support, and these gaps translate to the policies examined. Student victim-survivors perceived policies as inconsistent with respect to inclusivity and sought more specific acknowledgement of vulnerable populations and diverse student needs. Inclusive language broadens the framing of sexual violence, beyond a white, abled, heterosexual, cisgender norm, and can help all students to perceive their experiences as worthy of support. Failures to acknowledge and embed intersectionality and inclusivity within policy and practice can lead toharmful and enduring well-being, safety and human rights-based consequences, and compound systemic issues associated with sexual violence.

We examined fentanyl use and outcomes among people who inject drugs (PWID) in the urban Pacific Northwest (PNW). We conducted secondary analysis of data from the 2022 National HIV Behavioral Surveillance PWID cycle from Seattle, WA and Portland, OR. We calculated proportions of any fentanyl, injection fentanyl, non-injection fentanyl, and street pill use. Next, we compared characteristics, behaviors, and outcomes by any fentanyl use. Finally, we estimated adjusted relative risk (aRR) of overdose outcomes associated with fentanyl use and injecting less associated with type of street pill use. Among 830 PWID, 76% reported any fentanyl use, 47% specifically reported injection fentanyl use, 68% specifically reported non-injection fentanyl use, and 66% reported street pill use. Of those who used pills, 94% smoked them. Fentanyl use was crudely associated with age; race; housing; detainment; usual drug injected; injection frequency; syringe service programs, substance treatment, non-fatal overdose, and naloxone (p < 0.05). With adjustment, any fentanyl use (aRR = 3.20, 95% CI 1.58-6.47), injection fentanyl use (aRR = 3.51, 95% CI 1.63-7.58), and non-injection fentanyl use (aRR = 2.29, 95% CI 1.23-4.28) were associated with higher risk of overdose. Participants who smoked street pills were more likely to report injecting less because of pill use (aRR = 1.82, 95% CI 1.24-2.66). Fentanyl use was highly prevalent among PWID in the urban PNW. Non-injection fentanyl use was most common and street pills were frequently administered by smoking which was associated with injecting less. All fentanyl use was associated with increased risk for overdose. There is ongoing need for access to naloxone for PWID who use fentanyl.

The United States opioid epidemic's reach is expanding. Rapidly scaling opioid overdose education and naloxone distribution (OEND) programs is essential within a multipronged public health response. Universities offer infrastructure with potential to support routine, widespread OEND program implementation among adolescents and young adults nationally, a priority population who could disseminate to broader networks and geographic communities. This important setting is underutilized, and critical gaps remain in understanding university-based OEND program adoption/implementation. We conducted semi-structured, in-depth interviews (n = 21) among a purposively selected national sample of college health administrators to understand their perceptions of barriers/facilitators of implementing OEND programs at their universities and among universities nationally. The Consolidated Framework for Implementation Research guided data collection and inductive-deductive thematic analysis. Unexpected student opioid overdoses and deaths catalyzed university administration to implement OEND programming. Absent the urgency induced by such events and in contrast to the incidental exposure they implicate, administrations perceived the prevalence of opioid misuse within their student population as too low to justify OEND program implementation. For some, this reluctance to proactively implement OEND programming was heightened by a desire to avoid political controversy, related to stigma surrounding harm reduction. Participants described the need for campus partners to collaboratively navigate university administrations' inaction/opposition, and ultimately, spearhead implementation, often with external collaborators. Key roles among campus and external collaborators were identified, including (a) allowing students to access existing OEND programming prior to obtaining administrative approval for university-based implementation; (b) compiling data and anecdotal evidence to understand the campus substance use environment and sharing that information with administration to establish program need; (c) overcoming stigma and legal complexity of harm reduction programming; (d) overcoming funding/resource constraints and building capacity to sustain OEND programming. Our findings underscore complexities of university-based OEND program implementation while providing actionable insights to support its national scale-up. Building on identified distinctions between universities in the process of implementing OEND programming and those without intention to implement, future research should identify OEND programming implementation phase among universities nationally, advance understanding of implementation determinants and strategies distinguishing each phase, and establish best practices for OEND program implementation.

The introduction of synthetic substances into the unregulated drug supply has driven a surge in overdose deaths, posing significant public health challenges in timely substance identification, engagement with people who use drugs (PWUD), and access to treatment. Maryland's rapid analysis of drugs (RAD) program, piloted through syringe service programs (SSPs), provides a proactive harm reduction strategy by integrating mail-in, laboratory based drug checking with broader public health services to enhance surveillance and improve engagement with PWUD. We aim to investigate the association of offering RAD drug checking with SSP metrics such as encounters with PWUD and access to wound care. To investigate the association of RAD affiliation with SSP engagement and service metrics, a hierarchical linear model was employed to estimate percent changes in metrics such as encounters, naloxone distribution, and instances of overdose education. Metrics were analyzed on a log scale to account for skewness and variability across sites, with site-specific effects and random variation modeled to capture both baseline differences and the impact of RAD affiliation. Sites that became RAD affiliated saw an increase in many of the recorded metrics, such as wound care services per quarter (131%) and the number of participants per quarter (74%) while other metrics, such as testing, showed smaller changes. When adjusting for baseline trends of non-RAD affiliated behavior, most of the metrics still trend towards a positive association with RAD affiliation, but only Wound Care and Counseling reach statistical significance given the small number of sites remaining non-RAD affiliated for the full duration of data collection. Participation in the RAD program shows a positive association with an increase in engagement and service delivery within Maryland's SSPs, suggesting it may be considered as a valuable public health intervention for improving outcomes for PWUD. However, further research is needed to explore causality and influence of factors like broader public health initiatives.

Determining health information quality on online drug platforms is crucial for revealing and shaping substance use practices. The study aims to assess the scope and quality of health-related information on the largest Polish drug forum, Hyperreal. Ultimately, the goal was to explore how the case of Hyperreal illustrates user-driven knowledge construction around drug use and its potential implications for harm reduction strategies on similar online platforms. A multimethod approach was employed for the current research. First, the full content of the forum was scraped, and topic modelling was used to pinpoint and analyse posts (N = 159,145) that discussed drugs in a health-related context. From this, 25 posts were selected for expert analysis using specified selection criteria for each topic. As existing standardized tools were found to be unsuitable for the aims of this study, the research team developed a custom questionnaire to evaluate the quality of posts, with psychiatrists serving as expert reviewers. The topic distribution analysis indicated the most frequent and only sporadically discussed themes. Semantic analysis revealed distinct relationships between specific psychoactive substances and health topics, including associations between ketamine and depression/psychotherapy, marijuana and symptom relief and inflammation, amphetamines and cardiovascular issues, and fentanyl and palliative or oncological care. These patterns closely mirrored associations described in the medical literature, indicating knowledge structures grounded in medical rather than purely anecdotal knowledge. However, although the posts largely adhered to evidence-based medicine, the expert evaluation showed that they contained significant informational gaps. Overall, the mean quality of posts was M = 35.67, SD = 6.70, which indicates moderate health information quality. Experts rated factual accuracy and consistency with medical guidelines as moderate, while safety-related aspects—particularly dosage guidance and encouragement to consult specialists—received the lowest scores. Online drug platforms are an important source of knowledge on psychoactive substances. However, the health information quality of posts was average, which is especially crucial as these forums shape discourses that replace professional narratives. The study is relevant in the context of harm reduction strategies and emphasizes the need to improve the quality of drug platforms’ content.

Prescribed safer supply consists of the provision of pharmaceutical alternatives to people who use drugs to reduce reliance on the highly toxic unregulated supply and mitigate risk of overdose. Prescribed safer supply programs (SSP) have recently been scaled-up in some Canadian jurisdictions, including Ontario, showing demonstratable individual and population level benefits. Differences between prior experiences of opioid agonist therapy (OAT) among clients enrolled in the SSP are not well described, including how safer supply programs differ from existing approaches to OAT provision. Drawing on qualitative interviews (n=22) with participants of a safer supply program in Kitchener-Waterloo, a mid-sized southwestern Ontario city, we use thematic analysis to examine contrasting experiences of safer supply and OAT among SSP clients. There were several key differences identified between OAT and safer supply program models on key programmatic elements, particularly the medical management of withdrawal, tolerance, and medication side effects. Additionally, differences in the program model and philosophy of care impacted therapeutic rapport and provided greater autonomy for SSP clients. The greater autonomy for clients within SSP aligned strongly with client goals and helped maximize program retention, which is key to the public health goal of reducing overdose related mortality. The findings underscore the benefits of - and urgent need for - collaborative decision-making and comprehensive models of care for substance use, including individualized dosing in both OAT and safer supply programs to improve their public health impact. Participants' experiences provide a window into reorienting to substance use care that offers potential solutions to longstanding challenges within existing OAT models that undermine retention and therapeutic benefit.