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The Harm Reduction Unit (HRU) in Santo André (São Paulo State) was created to improve the health of people who either live or work on the streets: drug users, commercial sex workers (male and female), men who have sex with men, sexually exploited adolescents, transsexuals, transvestites, lesbians, and women working in brothels. This project was undertaken to evaluate the HRU from the perspective of its users. A semi-structured interview was administered to nineteen users from different segments of the populations served by the unit. The major weaknesses of the HRU were felt to be its inconsistent presence in some areas and the absence of psychologists to provide follow-up care. The unit was seen as promoting better health, increased use of condoms, reduction in drug usage, increased access and use of health care services, and less sharing of equipment used in drug consumption. Users see the HRU as a sympathetic presence whose ongoing work provides them with a sense of security and protection. The impact of the HRU went beyond harm reduction; users reported transformative changes such as increased awareness of their social rights and knowledge about how those rights can be demanded. Users had been given new tools to face their problems and seek access to education, work, and housing. Key words: harm reduction, illegal drugs, health service evaluation, social problems

This report advances our global understanding of drug policy by focusing on two key components: a bibliometric analysis and the creation of preliminary country profiles. We aim to identify trends, challenges, and opportunities within drug policy globally, emphasizing how these aspects can be better aligned with humanitarian principles, Rome Consensus 2.0, and Sustainable Development. Importantly, as the world has recognized the inability of the War on Drugs as a strategy to reduce drug use or drug-related crime, which is to say, to make us more safe and healthier (the two aims of the War on Drugs), this Project provides a new vision for where nations can go next that achieves the desired public safety and public health aspects all peoples want to see in their own communities and countries. Drawing from the preliminary insights, the report advocates for a more holistic and evidence-driven approach to drug policy. This entails broadening support for harm reduction, improving treatment services and the professional workforce, encouraging international collaboration to address the challenges of the transnational illicit drug trade, and reassessing policies that perpetuate stigma. Serving as an overview for the upcoming Global Policy Review (GPR), this report emphasizes the importance of drug policy frameworks that respect human dignity and contribute to achieving Sustainable Development Goals, with intentions to expand the review to more UN member states and provide bi-annual updates.

Context: People experiencing homelessness and alcohol dependence are highly marginalized as they struggle to access various health and social services. This study is part of a broader feasibility study on the implementation of "wet services" in Montréal, Canada. Methods: Four focus groups were conducted with 20 participants working in the field of homelessness. The objectives of this study were to gather their perspectives on the need for wet services in Montréal, define the main purpose of such services, and identify the key factors promoting their success. Results: All participants felt that wet services could meet several critical needs of many people experiencing homelessness in Montréal, and most argued that they should also be implemented without delay. According to most participants, these services should be grounded in a harm reduction philosophy, take a low-threshold approach and be accessible to the target population at all times. Participants argued that wet services should primarily aim to offer a safe place to consume alcohol whilst also serving as a place where people experiencing homelessness could meet their basic needs, reconnect socially, and access various health and social services. However, participants cited a number of financial, logistical, and organizational constraints, such as control-related mechanisms (e.g., eligibility criteria, rigid bylaws, or the institutionalization and medicalization of services), which they feared could stand in the way of achieving the objectives of wet services or perpetuate the exclusion of people experiencing homelessness. To avoid these potential problems, most participants felt that wet services should be delivered by well-established and well-funded community-based organizations, accompanied by a variety of partnership arrangements, including those with health services. Conclusion: This qualitative study contributes to the growing body of evidence on alcohol-related harm reduction services. Its findings may serve to inform the eventual implementation of wet services in Montréal and in other locations.

Background and Objective: Direct-acting antivirals have greatly simplified the treatment of hepatitis C virus (HCV), yet circuits that bring diagnosis and treatment closer to people who inject drugs (PWID) are needed to achieve the elimination targets of the WHO. With this purpose we have established an externalised nurse-driven circuit among former and active PWID in an addiction centre (AC) and a harm reduction centre (HRC)., Methods and Settings: The nursing staff offered HCV screening, diagnosis and treatment to the AC and HRC users, administered medication after the hepatologist's remote prescription to those with an active infection who accepted being treated, and implemented educational and harm reduction interventions. Participants and results: Between October 2018 and March 2021, 566 users accepted screening. 134 (24%) had an active infection, with a higher prevalence among HRC users (42% vs 17%; p<0.001), who were more frequently foreigners, homeless and reported active drug use and syringe sharing. Treatment initiation was similar between groups. Overall sustained viral response (SVR) for intention-to-treat (ITT) and per protocol (PP) was 70% and 88% respectively. Overall adherence was good in both groups; however, SVR was higher in AC users compared to HRC users (ITT-SVR 81% vs 55%). All reinfections (6% by ITT) occurred in the HRC group. Overall loss to follow-up rate was 21%., Conclusions: This patient-centred nurse-driven circuit demonstrates that HCV treatment can be successfully delivered to PWID even with active drug use and socio-economic complexity. User-specific characteristics need to be considered when setting up these interventions to maximise success., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Resumen: En la última década la aparición de los cigarrillos electrónicos y nuevos productos del tabaco (tabaco calentado o tabaco sin humo) ha generado un interés creciente en los métodos de reducción del daño, que se definen como mecanismos que buscan reducir las consecuencias nocivas del tabaco sin renunciar a los efectos placenteros del mismo, sustituyendo este por estos nuevos dispositivos electrónicos. Sin embargo, estos productos son adictivos, ya que contienen nicotina y no son seguros. La reducción del daño es una falsa solución, al representar una estrategia comercial de la industria tabaquera para incrementar sus ventas dificultando el control del tabaquismo, ya que retiene a los fumadores en el consumo de tabaco e impide que estos hagan intentos serios de abandono. Además, estos productos son una puerta de acceso a los adolescentes en el tabaco. Abstract: In the last decade, the appearance of electronic cigarettes and new tobacco products (heated tobacco or smokeless tobacco) has generated a growing interest in harm reduction methods that are defined as mechanisms that seek to reduce the harmful consequences of tobacco without give up the pleasant effects of it by replacing it with these new electronic devices. However, these products are addictive and not safe as they contain nicotine. Harm reduction is a false solution as it represents a commercial strategy of the tobacco industry to increase its sales, making it difficult to control smoking, since it keeps smokers from consuming tobacco and prevents them from making serious attempts to quit. In addition, these products are a gateway to adolescents in tobacco.

ABSTRACT Objective: To analyze the production of meanings on interventions considered as Harm Reduction in the discourses of nursing professionals working in Primary Health Care. Method: Qualitative study based on the theoretical-methodological framework of French Discourse Analysis. Semi-structured interviews were conducted with 14 nursing professionals working in Primary Health Care, from February to October 2019. Results: Most Harm Reduction practices performed by nursing professionals aim to minimize risks and physical damage. Harm Reduction actions that require welcoming, non-judgment and qualified listening were observed. Some nursing professionals perform Harm Reduction actions, but do not recognize them as such. Conclusion: The production of meanings in the discourses of nursing professionals presented evidence of biomedical and/or disease discursive formations, health prevention, interpersonal relationships and health promotion.

Abstract Introduction There are gaps in the available knowledge about substance use and risky practices among prison inmates witch we proposed to clarify in order to improve interventions. Material and method We conducted a specifically adapted survey with 178 potential users imprisoned in the Brians 1 Prison of Barcelona. We applied a snowball sampling method, with peers as privileged access interviewers, which is particularly recommended to bring out hidden information. Results 74.7% of participants admitted to excessive use of addictive substances throughout their life. In the last 6 months in prison, 75.8% accepted that they had used drugs, while 18.5% injected them. 36.4% of the latter group participated in the needle exchange program (NEP) of the facility and 54.5% acknowledged that they shared the needles. Spanish people (adjusted odds ratio (AOR = 4,79), recidivists (AOR = 2.67), penalised individuals (AOR = 2.70) and those involved in serious transgressions of prison regulations (AOR = 3.01) showed greater probability of substance use in prison. A longer sentence (AOR = 1.13), having undergone treatment for drug problems (AOR = 3.84) and being a carrier of blood-borne infections (AOR = 3.95) were linked to intravenous drug use. Injectors in the NEP were predominantly women (66.7%) and were more interested in caring for their health (90.9%). Discussion The study reveals use of addictive substances and health risk practices among inmates in Catalonian prisons, despite their exposure to prevention policies mainly focused on abstinence; relates health risk behaviours to marginalization processes within the institution, and then consider the need to extend the scope of harm reduction interventions and to reinforce its appeal by incorporating the users’ perspectives on the issue.

ABSTRACT Introduction and objectives: In the last twenty years, sociological changes and actions aimed at improving the health of inmates have contributed to decrease the prevalence of infectious diseases and overdoses among prison population. Currently, however, drug addictions treatment penitentiary programs are questioned for lacking of innovation and deficiencies in coverage. In order to investigate this issue we analyzed the discourses of imprisonned people regarding drug use and drug addiction programs. Materials and methods: We applied a qualitative phenomenological method. We carried out four discussion groups with 29 encarcerated drug users and made an analysis of the discourse about different possitionings towards drug use and drug addiction treatment programs. Results: From the combination of positions regarding drug use and drug addiction treatment programs emerged three kind of discourses respectively called: a) “reckless”, characteristic of people implied in risk practices without taking preventive measures; b) “adventourous”, tipical of those that take drugs both keeping the benefits of these practices and controls its negative consequences using prevention measures; c) “prudent”, of abstainers or occasionally users that minimize risks and damages. Discussion: Encarcerated population accept drug use practices based on three risk discourses. The present study shows out that, in order to increase the effectiveness of drug policies in prison, drug treatement programs goals must be adapted to drug users particular economization of risk strategies.

Heat-not-burn products (HNBs) are efficient nicotine delivery devices that heat tobacco instead of burning it, as conventional cigarettes do. Since heating yields less carbon monoxide and other tobacco pyrolysis–derived toxicants, tobacco companies claim that HNBs are less harmful than conventional cigarettes are. Although this hypothesis is plausible, no long-term clinical trials and/or observational studies are available to corroborate it. To overcome barriers to the entry of tobacco products to the market, manufacturers of HNBs argue that they are a new wave of harm reduction alternatives. Nonetheless, even if HNBs were in fact less harmful than conventional cigarettes, they would still have the potential to cause nicotine addiction (a major health hazard) and other harms to smokers’ health. HNBs deliver nicotine, provide users a tobacco aroma and flavor and some rituals of smoking, and are supposedly safer than conventional cigarettes. Owing to these features, HNBs are likely to enhance smoking appeal and initiation among young persons and discourage smokers’ attempts to quit. In other words, if HNBs were freely available on the market, they would increase the prevalence of smoking. However, HNBs may constitute a harm reduction alternative for nicotine-dependent smokers who are unable or unwilling to quit smoking. Given these facts, approval of HNBs for use under medical supervision (prescription only), along with strict restrictions on advertising, is a balanced regulatory option that would reconcile the therapeutic needs of nicotine-addicted patients with the public heath goal of achieving a smoke-free generation in the near future.

This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights.

Harm reduction is a classic Public Health concept to refer to the reduction of the negative effect of drug use/abuse with a focus on justice and human rights, but the tobacco industry has been perverting this concept for years and using it as a tool for its own marketing. This publication details what real harm reduction action on tobacco use would be, when it should be implemented, and what pillars it should be based on. Different methods of reducing the harmful effects of tobacco and nicotine have been tried and tested over time, but the results have been poor; therefore, smoking cessation by the various officially recognised methods is recommended as a priority objective, using the tools that are truly supported by science. In contrast, it also explains the strategies developed by the industry to manipulate consumers and make them dependent on products that can eventually kill them: from the development of filtered cigarettes to light cigarettes, and from menthol to flavoured vapes. In all cases, they have falsely led people to believe that they were developing less toxic products when they were not. Nowadays, both light and menthol cigarettes are banned in Spain, filters have not reduced risk but increased the use, and vapes try to replace cigarettes with their attractive flavours and their false legend of healthier products when what they are really doing is maintaining the same addiction by changing the object, encouraging dual use, and attracting younger and younger non-smokers. At the same time, a strategy of dividing the opinion of health professionals has been developed, using medical doctors and researchers with recognised conflicts of interest but who manage to confuse consumers. In conclusion, we consider that, although nicotine releasing devices may be useful elements in some particular cases, they are not recommended at the population level as they can promote onset, prevent cessation, as well as maintaining the addictive capacity. The only nicotine products that are recommended are those of pharmacological use approved for the case and provided they are used as a transitional tool to complete cessation., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Abstract Objective: To analyze the evidence available in the literature on harm reduction actions developed by primary healthcare. Method: Integrative literature review carried out in the databases MEDLINE, CINAHL, SCOPUS, Web of ScienceTM and LILACS. Results: Seventeen (17) primary studies published from 2008 to 2017 were included in this review. Care strategies for harm reduction included maintenance treatment with methadone, therapy with opioid agonists, needle and syringe distribution programs and the creation of rooms for supervised drug consumption. Health professionals were essential for consolidating inclusion strategies, possessing skills to listen without judgment and prejudice. Conclusion: Harm reduction care strategies have been disseminated in different countries and healthcare levels, aiming toward safe practice and quality, effective and risk-free care actions.

Abstract This is a theoretical essay which aims to reflect on the reasons for and why adolescents use drugs and their implications for clinical nursing care. It used the referential of social phenomenology of Alfred Schutz. The main reasons identified were: to attenuate existential crisis, form social bonds and to have fun. The reasons for this are related to the characteristics of adolescence, a breakdown in social and family ties and the conditions of programmatic vulnerability. Motivations provide important information for developing person-centered, not drug-abuse-centered care strategies. Nurses’ caregiving action is based on emancipatory health education strategies grounded on the strategy of reducing harm and risks related to drug use and the possibility to help adolescents become aware of their biographical situation in a face-to-face relationship, so that they can (in knowing yourself) act to promote their health.

Harm reduction is suggested as a paradigm shift in addressing problematic drug use, the goal of the model is to lessen the consequences of dependence. The World Health Organization emphasizes harm reduction services such as syringe programs and opioid substitution therapy and human rights protection. Nurses, as they are frequently the first contact with the healthy and / or sick client, besides acting as an important axis in the multidisciplinary work, within the interventions it is possible to participate in strategies of communication between pairs, provision of services that improve consumer safety, support in substitution medical treatment for opiate dependency and support groups. In Mexico, there is a lack of training in human resources, a lack of economic resources for programs to prevent and treat addictions, the lack of development of government programs under the harm reduction model, the persistence of stigma and discrimination in the use and abuse of substances, the above, offers a field of training, updating and intervention for the profession developing activities of early detection, promotion and education for health.

This paper is organized into four parts of discussion. Firstly, we present the Portuguese decriminalization law and the central role of harm reduction within this framework. The second section discusses the mainstream meanings ascribed to the ‘HR double’ mainly anchored in problematic drug uses. The third section highlights the need to take into account the specificities of recreational drug uses, users and environments. Thus, the paper highlights the experience of the Kosmicare Project at the Boom Festival, which combines principles of harm reduction, crisis intervention and Grof’s approach. The fourth section draws upon the project’s experience itself and in the idea of the normalization of drug uses to acknowledge and to discuss the potentialities, tensions and limitations of these contributions when it comes to analyzing and constructing a strong version of the ‘HR double’.

An updated bibliographic review was carried out using the resources available in Infomed, specifically Ebsco, PubMed and Scielo, by means of which the following databases were accessed: MEDLINE, Academic Search Premier, MedicLatina and Scopus. The aim was to assess, from a bioethical viewpoint, aspects related to the diagnosis and therapeutic treatment of the drug dependent patient. Of the total consulted bibliography, 26 were chosen to be quoted in the article, 77 % belonging to the last five years. Qualitative research methods were used. It was concluded that the addict must be considered above all a sick person. In the field of drug dependences there are conflicts, from the ethical viewpoint, in the diagnosis due to the stigmatization suffered by these patients, and in the treatment as there are two programs with opposite objectives, one based on the total suppression of the drug and another one on the maintenance of the addition with another similar one, both with advantages and disadvantages without reaching a consensus on this subject.

Resumo OBJETIVO Analisar o grau de responsabilização e participação do usuário em tratamento no Centro de Atenção Psicossocial Álcool e Drogas (CAPS-ad) sob a perspectiva da política de redução de danos. MÉTODOS Trata-se de uma pesquisa de abordagem qualitativa, do tipo estudo de caso, com 12 usuários e quatro profissionais do CAPS-ad de um município de Minas Gerais. Os dados foram coletados entre abril e setembro/2017 por meio de entrevista semi-estruturada, observação participante e análise documental. RESULTADOS A partir da análise de conteúdo, as informações foram organizadas em duas categorias temáticas: objetivos do tratamento e motivação para o tratamento. Conclusões: os achados da pesquisa revelaram que os usuários devem ser mais responsabilizados e empoderados em relação ao seu tratamento. CONCLUSÕES Sugere-se maior escuta profissional, favorecendo a construção de metas condizentes com os interesses dos usuários, na forma de contratos.

Resumen Las benzodiacepinas son fármacos ampliamente utilizados en atención primaria de salud. Su uso prolongado se ha convertido en un problema relevante dadas las consecuencias médicas que ocasionan, especialmente en adultos mayores. Entre otras, estas son: dependencia, deterioro cognitivo y riesgo de caídas. Además, los médicos que trabajan en atención primaria cuentan con pocas herramientas para ayudar al paciente en su deshabituación. Se realizó una búsqueda y revisión de la mejor evidencia disponible sobre estrategias prácticas para el médico no especialista en adicciones, para evitar la dependencia al momento de la prescripción inicial y en el paciente con uso prolongado y probablemente dependiente. Se encontraron 10 revisiones sistemáticas relevantes que mostraron evidencia a favor del uso de estrategias multifacéticas en la prescripción, disminución progresiva, cartas y consejería estandarizadas, farmacoterapia y psicoterapia cognitiva conductual. Una estrategia sencilla, eficaz y duradera para prescribir benzodiacepinas es informar al paciente de la necesidad de reducir su consumo, dándole por escrito la pauta de retirada, señalando sus posibles efectos y su solución. Debido a la evidencia disponible, se propone un modelo integrado y escalonado para el manejo del paciente usuario de benzodiacepinas, desde su prescripción hasta su descontinuación.

This article aims to undertake a reflection on the Harm Reduction model in drug use as opposed to the ‘war on drugs’ model. Through analysis of texts which discuss the topic, it is ascertained that Harm Reduction, although it arose in the early years of the last century in the United Kingdom, was only consolidated as a health strategy for drug users with the advent of the HIV/AIDS epidemic in the beginning of the 1980s, related to the use of injectable drugs, with its actions being focused on syringe exchange. However, at the present time its perspective of minimizing harm in other situations of drug use has expanded, and it is now configured as a more viable alternative in the light of the confirmed failure of the hegemonic model of the war on drugs.

Introducción: España es de los pocos países que ha implementado generalizadamente tratamientos con sustitutivos opioides (TSO) y programas de intercambio de jeringas (PIJ) para los consumidores de drogas en prisión. Se analiza la evolución de la necesidad, cobertura y oportunidad temporal de estas intervenciones en España durante 1992-2009. Material y métodos: La provisión de intervenciones procede de publicaciones oficiales. La necesidad se estimó aplicando métodos multiplicativos a datos secundarios de varias fuentes. La cobertura se estimó mediante el cociente entre provisión y necesidad, y la diferencia entre dichas magnitudes. La oportunidad temporal se estimó observando el decalaje entre el acmé de incidencia de consumo, de infección por VIH o de necesidad y las curvas de provisión. Resultados: Los TSO comenzaron en 1992. Su máxima cobertura se alcanzó en 2002 (63.8%), y posteriormente se estabilizó. Los PIJ comenzaron en 1997. Su máxima cobertura se alcanzó en 2006 (20.7%), pero disminuyó a la mitad en dos años. El retraso entre el acmé de las epidemias o de la necesidad y la máxima cobertura de las intervenciones fue de 8-25 años. Conclusiones: La implementación de TSO y PIJ en las prisiones españolas supuso un enorme avance de salud pública, pero el retraso en su implementación y la baja cobertura de los PIJ pueden haber limitado mucho su impacto potencial en la mejora de la salud de los consumidores de drogas en prisión. El descenso de la cobertura de los PIJ a la mitad en los últimos años es especialmente preocupante para la evolución de las epidemias de VIH y hepatitis C.Introduction: Spain is one of the few countries to have widely implemented opioid substitution treatments (OST) and needle exchange programmes (NEP) for drug users in prison. We analyze the evolution of the need, coverage and the timelinessof these interventions in Spain between 1992 and 2009. Methods: Data on the provision of interventions is taken from official publications. The need was calculated by applying multiplicative methods to secondary data from several sources. Coverage was estimated as the quotient between provision and need. Temporal opportunity was estimated by observing the gap between the acme of the incidence of consumption, of HIV infection or need and the curve of provision. Results: OST's began to be implemented in 1992. In 2002 they reached their maximum coverage (63.8%) and subsequently stabilized. NEP's started in 1997. Their maximum coverage reached 20.7% in 2006, but halved in a period of two years. The delay between the epidemic acme and the need and maximum intervention coverage was of 8-25 years. Conclusions: OST and NEP introduction in Spanish prisons was a great advance, but the delay in their implementation and the low level of NEP coverage could have limited their potential impact on the improvement of the health of incarcerated drug users. The decline of NEP coverage in recent years is a cause of major concern for the evolution of HIV and Hepatitis C epidemics.

Introducción: El objetivo del presente artículo es subsanar el sesgo incluido en nuestro anterior original presentando una estimación corregida de la necesidad y cobertura de jeringuillas en las prisiones españolas en el período 1992-2009. Material y Métodos: La provisión de jeringuillas procede de publicaciones oficiales. La necesidad se estimó aplicando métodos multiplicativos a datos secundarios de varias fuentes. La cobertura se estimó mediante el cociente entre provisión y necesidad, y la diferencia entre dichas magnitudes. Se corrigió el sesgo de estimación de necesidad detectado en el estudio original. Resultados: Los programas de intercambio de jeringuillas en prisión comenzaron en 1997. Su máxima cobertura se alcanzó en 2005, con un 36%, valor muy superior al estimado inicialmente, aunque disminuyó a la mitad en los cuatro años siguientes, con un 17.4% en 2009. Conclusiones: Debe valorarse la notable cobertura que se alcanzó con estos programas en España, pero su evolución más reciente nos lleva a enfatizar la necesidad de ser imaginativos para que las nuevas condiciones epidemiológicas y económicas no lleven a la desaparición de los mismos.Introduction: The objective of this paper is to amend the bias included in our previous work, presenting a corrected estimation of the need and coverage of syringes/needles in Spanish prisons between 1992 and 2009. Methods: Data on the provision of the needles exchange programs (NEPs) in prison is taken from official publications. The need was calculated by applying multiplicative methods to secondary data from several sources. Coverage was estimated as the quotient between provision and need and the difference between these magnitudes. The detected need estimate bias has been corrected. Results: NEP's in prisons started in 1997. Their maximum coverage reached 36% in 2005, which is much higher than the initially estimated value. However, it decreased by half in the next four years, reaching 17.4% in 2009. Conclusion: The remarkable coverage reached by these programmes must be valued, but more recent evolution leads us to emphasize the need to be imaginative so that new epidemiological and economic circumstances do not lead to their disappearance.

Este texto reflete sobre as trajetórias de sujeitos, das mais diversas idades, que passaram a ocupar regiões específicas do centro histórico da cidade de São Paulo, no Brasil, em torno do uso do crack. A partir da observação etnográfica feita nos últimos cinco anos na “Cracolândia” e dos relatos de algumas destas pessoas em situação de rua que fazem intenso uso de crack, buscamos compreender as trajetórias dos usuários até “tornar-se noia” e os agenciamentos que utilizam para a manutenção e sobrevivência cotidiana nos espaços de uso e para lidar com o sofrimento social decorrente dessa condição.This text reflects on the trajectories of subjects of different ages who have come to occupy specific areas of the historic city center of São Paulo, in Brazil, around the use of crack. From the ethnographic observation made in the last five years in “Cracolândia” and from reports of some of these homeless people who make heavy use of crack, we intend to understand the trajectories of users in the process of “becoming noia” and the agency devices they use in their daily life seeking preservation and survival in the places where drug use occurs, and dealing with the social suffering resulting from this condition.

O presente artigo tem por objetivo caracterizar os modelos de atenção à saúde de usuários de álcool e outras drogas existentes no contexto brasileiro. Para tanto, realizou-se uma análise do discurso de políticas públicas de drogas no Brasil a partir da década de 1970. Tal análise foi contextualizada por uma breve digressão sobre os principais posicionamentos políticos identificados entre países do mundo para o enfrentamento de questões relacionadas ao consumo de substâncias psicoativas. As políticas públicas brasileiras de drogas apresentam-se, a partir da presente década, permeáveis ao enfoque da redução de danos, repercutindo na reorientação do modelo de atenção à saúde. Conclui-se que a estruturação e o fortalecimento de uma rede de atenção integral aos usuários de álcool e outras drogas e às suas famílias, centrada na atenção comunitária, orientada pela concepção ampliada de redução de danos e articulada com outras redes de serviços sociais e de saúde constitui, na atualidade, um importante desafio à saúde pública.This article aims to characterize health care models for users of alcohol and other drugs in the Brazilian context. Discourse analysis was performed on public drug policy in Brazil from the 1970s. This analysis was contextualized by a brief digression on the main political positions identified in several countries of the world in relation to drug use problems. Beginning in the current decade, drug policies in Brazil have been receptive to harm reduction approaches, resulting in reorientation of the health care model. In conclusion, the structuring and strengthening of a network of care for users of alcohol and other drugs and their families, based on community care and the harm reduction approach and combined with other social and health services, is now a key public health challenge for the country.

Neste estudo mapeamos e descrevemos 11 programas/ações em redução de danos vigentes nos anos de 2004 a 2006, na Região Metropolitana de Porto Alegre, Rio Grande do Sul, Brasil. A descrição e análise se construíram por meio de entrevistas com as coordenações dos programas, de análise documental e da comparação com um mapeamento realizado em 2003. Buscou-se discutir a sustentabilidade (política, financeira e administrativa) e as características de funcionamento dos programas. A análise utilizou as seguintes categorias: tipo de vínculo do programa/ação; formas de inserção nos municípios; histórico, financiamento; ações típicas; forma de contratação da equipe; existência de trabalho voluntário; recursos (humanos e financeiros); parcerias; existência de legislação municipal; e participação em espaços de representação política. Apesar da diversidade de vínculos e formas de organização dos locais analisados, algumas características são comuns, como: inserção profissional precária; dependência do trabalho voluntário para a execução das atividades; influência das mudanças de gestão municipal e estadual para a continuidade de projetos e de parcerias, assim como para a manutenção de recursos humanos e financeiros dos programas. Concluímos que estes elementos geram descontinuidade no atendimento à população.This study mapped and described 11 harm reduction interventions/programs in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil, in 2004-2006. Mapping was based on interviews and analysis of available documents and comparison with a previous study with data from 2003. We aimed to discuss the programs' sustainability (political, financial, and administrative) and operational characteristics, based on the following categories: type of links in the program or intervention; forms of inclusion in the municipalities; background, financing; typical activities; team hiring practices; volunteer work, if any; resources (human and financial); partnerships; municipal legislation, if any; and participation in forums for political representation. Despite the diversity of links and organizational formats, there were some common characteristics: precarious professional status; dependence on volunteer work to implement activities; influence of turnover in Municipal and State administration on the continuity of projects and partnerships, as well as on the maintenance of human and financial resources. We conclude that such factors lead to lack of continuity in the services provided to the target population.

Este artigo é uma análise reflexiva sobre o uso e abuso de substâncias psicoativas, definido como farmacodependência, e o mundo do trabalho contemporâneo. Tem como objetivo contribuir para que o enfermeiro do trabalho construa uma estratégia prática que possibilite a avaliação dos níveis de dificuldades do usuário de drogas para o exercício pleno de atividades laborais, permitindo a elaboração de intervenções adaptativas para a reinserção deste usuário no mundo do trabalho atual, globalizado, dinâmico e ágil, baseado no paradigma da redução de danos para a promoção da saúde e resgate da cidadania.Este artículo es una análisis reflexiva sobre el uso y abuso de sustancia psicoactivas, definido como dependencia farmacológica, y el mundo del trabajo contemporáneo. Tiene como objetivo contribuir para que el enfermero del trabajo construya una estrategia práctica que posibilite la evaluación de los niveles de dificultades del usuario de drogas para el ejercicio lleno de las actividades del trabajo, permitiendo la elaboración de intervenciones de adaptación para la reinserción del usuario en el lugar de trabajo actual, globalizado, dinámico y ágil, basado en el paradigma de la reducción de daños para la promoción de la salud y rescate de la ciudadanía.This article is a reflexive analysis about psychoactive drugs addiction, defined as substance-related disorders, and the contemporaneous workplace. Its objective is to contribute that the nurse of occupational health nursing build a practical strategy to make possible the evaluation of the drug addicts' problems level related to workplace, in order to adapt interventions to put back addicts in current workplace, which is globalized, dynamic and agile, based in harm reduction paradigm to the promotion of health and citizenship rescue.

O artigo avalia como a descentralização dos recursos e ações do Programa Nacional de DST e AIDS influenciou as transferências de recursos para os programas de prevenção ao HIV/AIDS entre usuários de drogas injetáveis no Rio de Janeiro, Brasil (1999-2006). Foram avaliados os efeitos da política de descentralização sobre as transferências de recursos para os Programas de Redução de Danos (PRD) no Rio de Janeiro. A descentralização das transferências para os PRD no Rio de Janeiro se efetivou em 2006, com a virtual supressão do financiamento federal direto, obrigando estes programas a buscarem fontes alternativas de financiamento. Constata-se uma fragilidade dos PRD no Estado, agravada pela redução recente do volume de recursos. Dos 22 programas, existentes em 2002, o Estado passou a contar, em 2006, com apenas dois programas, financiados pelo Estado e por um município. A descontinuidade dessas ações pode vir a favorecer a reemergência da epidemia de AIDS nesta população, o que reclama um processo de descentralização mais gradual e melhor pactuado dessas iniciativas.This paper assesses how decentralization of resources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Programs (SEPs) are assessed in detail. Decentralization effectively took place in Rio de Janeiro in 2006, with the virtual elimination of any direct transfer from the Federal government. The elimination of direct transfers forced SEPs to seek alternative funding sources. The structure of local SEPs appears to be weak and has been further undermined by current funding constraints. Of 22 SEPs operating in 2002, only two are still operational in 2006, basically funded by the State Health Secretariat and one municipal government. The current discontinuity of SEP operations may favor the resurgence of AIDS in the IDU population. A more uniform, regulated decentralization process is thus needed.

The study focused in sexual behaviour among socially excluded heroin users, identifying factors associated with inconsistent condom use. Data was collected in the cities of Granada and Seville between July and October 2000, through a structured questionnaire, to 391 participants. Twenty two and 15% of participants have made consistent use of condoms in vaginal sex in the last year with occasional and regular partners respectively. There is a greater likelihood of inconsistent condom use with occasional partners among users who had had oral sex, and who does not know if their partner(s) inject or injected drugs. For regular partners those who have an injecting partner and do not speak with their sexual partners about AIDS have a higher probability to do not use always a condom. For both groups, when always the partner is who propose the use of condoms (when used) and not themselves, the risk not to use it is near 4 times more than when thems elves propose to use it. Speaking about condoms and AIDS with mate, partners and family, and learning to negotiate the use of condoms seems to be the most important strategies to be approached for this sample, from the social and health care system in order to promote a protected sex.El objetivo del presente trabajo es analizar las conductas sexuales entre los usuarios de heroína, en situación de exclusión social, y conocer los factores asociados al uso inconsistente del condón en sus relaciones sexuales (coito vaginal) con parejas ocasionales y estables. Los datos fueron recogidos en las ciudades de Granada y de Sevilla entre julio y octubre de 2000, a través de un cuestionario estructurado, a 391 participantes. El 22 y el 15% de los participantes han hecho un uso consistente del condón durante el último año con sus parejas ocasionales y estables, respectivamente. Se ha encontrado una mayor probabilidad de un uso inconsistente del condón con las parejas ocasionales entre usuarios que habían practicado el sexo oral, y que desconocen si su(s) pareja(s) se inyecta drogas. En cuanto a las parejas estables, las que se inyectan y no hablan de sida entre ellos mostraron una probabilidad más alta de no utilizar consistentemente el condón. Para ambos grupos, cuando la pareja es quien siempre propone el uso del condón, el riesgo de no utilizarlo es de 4 veces más que cuando son ellos mismos quienes proponen su uso. Hablar sobre condones y sida con los amigos, las parejas y la familia, así como aprender a negociar el uso del condón, parecen ser las estrategias más apropiadas para el abordaje de esta población, de cara a promover un sexo protegido dentro del sistema sociosanitario.

To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on "high coverage sites", adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services) should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage.Para prevenir ou mitigar uma epidemia de AIDS entre usuários de drogas injetáveis (UDI), atividades eficazes devem ser implementadas numa escala suficiente para atingir e ajudar um número suficiente de usuários e, portanto, modificar seus comportamentos de risco em relação ao uso de drogas e práticas sexuais. Um estudo recente do UNAIDS sobre "locais de cobertura alta", ao adotar as estratégias propostas acima, demonstrou que um dos elementos centrais para atingir uma cobertura alta é a advocacy permanente e bem-elaborada. Locais de redução de danos que apresentavam altas taxas de cobertura foram estudados através de uma revisão bibliográfica e visitas aos locais de maior cobertura, incluindo entrevistas com informantes principais, revisão de dados estatísticos dos serviços e análise de dados para poder documentar os passos que levaram à ampliação do alcance dos projetos, à definição da cobertura dos programas e às lições aprendidas. Os programas de redução de danos podem alcançar uma ampla cobertura de UDI. Além da coleta de dados rotineiros, os programas devem monitorar os projetos para definir o alcance sistemático (ou seja, dos UDI que estão em contato permanente com os serviços de redução de danos). A advocacy é fundamental para alcançar taxas de cobertura altas.

This article discusses the changes in injecting drug use from 1998 to 2003 in Buenos Aires, Argentina. The Rapid Situation Assessment and Response methodology was used to obtain the information. Quantitative and qualitative techniques were triangulated: 140 current IDUs and 35 sex partners of injection drug users (IDUs) were surveyed; 17 in-depth interviews with the surveyed IDUs and 2 focus groups were held, as well as ethnographic observations. The way in which risk and care practices among injecting drug users changed and the influence of the HIV/ AIDS epidemic on this process are described. In recent years, the frequency of injection practices and sharing of injecting equipment has decreased, while injecting drug use is a more hidden practice in a context of increasing impact of the disease in the injecting drug use social networks and changes in the price and quality of drugs. Knowledge about these changes helps build harm reduction activities oriented to IDUs in their particular social context.Este artículo refleja los cambios en el uso inyectable de drogas producidos entre 1998 y 2003 en Buenos Aires, Argentina. Para obtener la información se empleó la metodología de Evaluación y Respuesta Rápida, triangulando técnicas cuantitativas y cualitativas. Durante 2003-2004 se realizaron encuestas a 140 usuarios de drogas inyectables (UDIs) actuales y a 35 parejas sexuales de UDIs. De este universo, 17 UDIs fueron entrevistados en profundidad; se formaron dos grupos de discusión y observaciones etnográficas. Se describe el modo en que cambiaron las prácticas de cuidado y riesgo en el uso inyectable y la influencia de la epidemia de VIH/SIDA en este proceso. En los últimos años disminuyó la frecuencia de uso y del uso compartido de material de inyección, se incrementó el ocultamiento del uso inyectable; en un contexto de fuerte impacto de la enfermedad en el entorno cercano a los UDIs y de un cambio en la relación precio-calidad de las drogas. Conocer estos cambios permite intervenir más adecuadamente en la reducción de los daños asociados al uso inyectable de drogas en el contexto particular en que estas prácticas se desarrollan.

Desde mayo de 1999 hasta mayo de 2001, hemos contactado en el SAPS (Servicio de Atención Social y Sanitaria) de Barcelona con usuarios de drogas de países del este de Europa. Acuden a centros terapéuticos gratuitos, aunque pagan por la organización del viaje unos 500 euros. Son jóvenes entre 18 y 30 años y mantienen el contacto con sus familiares. Conocen los riesgos de transmisión de enfermedades, pero suelen reutilizar las jeringas. Es alta la prevalencia de hepatitis C (92%) y B (62%) y menor la de infección por el VIH (19%). Si no abandonan las drogas, el retorno es un fracaso y tienen dificultades para proseguir los tratamientos con metadona o antirretrovirales. La respuesta asistencial ha de adecuarse a sus necesidades. Se debe procurar la mediación cultural y la información en los lugares de origen, supervisar los centros terapéuticos y diseñar alternativas a los abandonos. Hay que desarrollar la colaboración internacional, estimular programas de disminución de riesgos derivados del consumo y evitar que del tratamiento se haga un comercio.From May 1999 to May 2001, we made contact with injecting drug users from Eastern Europe in the healthcare and prevention service of the Red Cross (servicio de atención y prevención sociosanitaria [SAPS]) in Barcelona (Spain). The users attended free therapeutic centers, but paid approximately 500 € for the trip. The users were aged between 18 and 30 years old and maintained family contact. The knew the risk of disease transmission, but often exchanged needles. The prevalence of hepatitis C (92%) and B (62%) was high but less than that of HIV (19%). If they did not stop taking drugs their return would be a failure and they would have difficulties in following methadone and antiretroviral treatments in their countries of origin. The healthcare provided in these centers should respond to user' needs: cultural mediation should be sought, as well as information from users' countries of origin. Centers receiving users from other countries should be supervised and alternatives should be designed for users who abandon treatment. International cooperation and programs to reduce the risk of drug consumption should be developed. Treatment should be prevented from becoming a business.

In the last decade, the appearance of electronic cigarettes and new tobacco products (heated tobacco or smokeless tobacco) has generated a growing interest in harm reduction methods that are defined as mechanisms that seek to reduce the harmful consequences of tobacco without give up the pleasant effects of it by replacing it with these new electronic devices. However, these products are addictive and not safe as they contain nicotine. Harm reduction is a false solution as it represents a commercial strategy of the tobacco industry to increase its sales, making it difficult to control smoking, since it keeps smokers from consuming tobacco and prevents them from making serious attempts to quit. In addition, these products are a gateway to adolescents in tobacco., (© 2022 Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Published by Elsevier España, S.L.U.)

In response to the mounting number of HIV/AIDS and overdose deaths directly attributable to intravenous drug use during the 1980 and 1990’s, governments across the world began considering alternatives to traditional prohibitionist drug policies. These alternatives, generally described as harm reduction strategies involving needle exchange programs and safe injection sites, rapidly gained acceptance across Europe. By contrast, they encountered significant opposition in North America. This thesis summarily traces the history of Canadian drug law, describing the development and impact of the harm reduction movement in Canada and the establishment of the first and only safe injection site (SIS) in North America (Insite). Employing a repressive formalist analysis of the application of federal drug laws, I then examine the role of the current Conservative government in contesting harm reduction strategies and refusing full legalization of Insite. I illustrate that through the strategic manipulation and discriminatory enforcement of drug laws and political gamesmanship relating to the criteria grounding Insite’s exemption from current drug laws, the government has failed to fulfill a set of fundamental social values with respect to Insite’s users and members of the downtown eastside of Vancouver. Interviews with injection drug users, workers at Insite and residents of the local community provide empirical support for the beneficial effects of safe injection sites, and expose the politics of the struggle for Insite’s continued existence. I also show how the Conservative anti-drug ideologues have led a resistance against classifying drug addiction as a health-related rather than criminal problem, despite significant scientific evidence to the contrary, and how this resistance has resulted in the further marginalization of injection drug users.

Spain is the Western European country with the highest prevalence of Human Immunodeficiency Virus among people who inject drugs. The Hepatitis-C Virus affects over fifty per cent of this population. At the same time, the World Health Organization considers that the average coverage of injection material for drug user per year is low. Harm reduction programs and services have been deployed for over thirty years, and these could now incorporate the advantages of eHealth and mHealth to improve harm reduction. The aim of this qualitative and descriptive study is to analyze how people who inject drugs perceive an application for mobile devices. Fifty-one such drug users participated actively in five focus groups. The main results of the thematic content analysis indicated that the application was welcomed as easy and useful. Participants reported that the application contributed to improving access to injection material, reducing the stigma of drug-dependence and optimizing the organization of the ritual of injection. Excessive preventive information and problems downloading the web app were identified as aspects for improvement. In conclusion, the application was seen as a useful eHealth tool that complements the normal intervention of needle exchange programs.

This study aims to analyse the use of an instant messaging app (WhatsApp®) as a means of communication for reaching people who inject drugs. An eight-week prospective longitudinal and observational study with three observations was designed for five addiction centres in Catalonia. The participants were 105 people who inject drugs, distributed in five intervention groups. The results of the Risk Assessment Battery (RAB) were compared in the three levels of analysis pre-test, post intervention and one month after the intervention. The main results indicate a significative reduction in RAB scores after the intervention. The main conclusion was that the WhatsApp® intervention has great potential for developing harm reduction interventions and to reduce the HIV contagion risk.

This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights.

Drug consumption rooms (DCR) aim to facilitate consumption in hygienic and safe conditions. However, users also consume drugs in public spaces and homes generating incremental risk for health. To strengthen our understanding of consumption practices, we conducted an ethnographic study in different consumption locations in Barcelona, including DCRs, public spaces, and homes. Focusing on consumption practices and narratives, we conducted participant observation and interviewed 16 DCR users. Our findings show that different consumption spaces allow users to experiment different types of pleasures. In addition, consumption in each type of location is associated with various types of harms, which are managed by users by self-regulating their practices. These aspects, therefore, must be taken into account to design harm reduction action aligned with users' practices.

From the analysis of a specific conjuncture, "Cracolândia" in São Paulo, Brazil, and the "De Braços Abertos" program, this article discusses the complex relationships between drug use and the formulation of public policies directed to the care of users. In methodological terms, this work is based on the qualitative research by using semi-structured interviews with thirteen key informants. The empirical material was analyzed from the content thematic analysis and the intersectionality perspective, especially from the theoretical contributions of the "difference" category. The results point out that "differences" are marked by gender, race and social position in the society, reinforcing stigmas and their different impacts on social relations. This paper contributes to the debate on the need to formulate different approaches to the specific needs and demands of populations or social classification categories regarding drug public policy.