Background: Drug use is a public health problem associated with increased mortality, morbidity and lack of contact with healthcare. Stigmatization and discrimination surround drug use. Harm reduction aims to improve health without coercive measures to become drug-free in collaboration with people who inject drugs. Harm reduction is evidence-based, cost-effective and reduces the spread of infectious diseases. Needle exchanges provide information about drug-related risks and offer protection against this.  Aim: The aim was to describe experiences of harm reduction in needle exchanges in people who inject drugs.  Method: A qualitative literature study was carried out according to Polit and Beck's nine-step model. 11 articles were included and analyzed thematically according to the model of Braun and Clarke.  Results: The main finding is that people who inject drugs experience that needle exchanges offer knowledge and enable harm reduction. Needle exchanges are a place of health promotion for people who inject drugs.  Conclusion: How people who inject drugs experience the services and what makes them return is important knowledge for harm reduction to reach more people. Continued research is needed on how needle exchanges can reach more people who inject drugs. / Bakgrund: Drogbruk är ett folkhälsoproblem förenat med ökad dödlighet, sjuklighet och bristande kontakt med hälso- och sjukvård. Stigmatisering och diskriminering omgärdar drogbruk. Skadereduktion syftar till att förbättra hälsan utan tvingande åtgärder rörande drogfrihet. Skadereduktion är evidensbaserat, kostnadseffektivt och minskar spridningen av smittsamma sjukdomar. Sprututbyten ger information om drogrelaterade risker och erbjuder skydd mot dessa.  Syftet: Att beskriva erfarenheter av skadereduktion vid sprututbyten hos personer som injicerar droger. Metod: En kvalitativ litteraturstudie enligt Polit och Becks niostegsmodell. Elva artiklar inkluderades och analyserades tematiskt enligt modell av Braun och Clarke. Resultat: Huvudfynd är att personer som injicerar droger upplever att sprututbyten erbjuder kunskap och möjliggör skadereduktion. Sprututbyten är en plats för hälsopromotion för personer som injicerar droger.  Slutsats: Hur personer som injicerar droger upplever erbjuden skadereduktion vid sprututbyten och vad som får dem att återkomma är betydelsefull kunskap för att skadereduktion ska nå fler. Fortsatt forskning behövs om hur sprututbyten kan nå fler personer som injicerar droger.

With the rise of accidental fentanyl overdoses and recreational opioid use in college-aged populations, the need for campus-based overdose prevention and harm reduction measures is at an all-time high. Naloxone, an opioid antagonist, is an FDA-approved, lifesaving, medication which can be intranasally delivered by laypersons. Naloxone reverses opioid overdose, essentially buying time until an overdosing individual receives emergency medical attention. While some previous studies have examined access to naloxone on college campuses, to my knowledge no study has explored distribution of naloxone in residential college areas, such as dormitories and within Greek housing. Therefore, the purpose of this thesis was to identify themes in student perception surrounding naloxone, as well as potential processes and barriers/facilitators to naloxone distribution within residential areas (e.g., dormitories, sorority housing, and fraternity housing.) This study addresses these issues through qualitative, semi-structured, interviews with a convenience sample of students at the University of Central Florida, with questions informed by the Consolidated Framework for Implementation Research and Proctor et al. implementation outcomes. Seven students (n = 7) participated in the interview, all of whom either had personal experience with substance use disorder (SUD) or were close to someone with SUD. I analyzed data for themes using a mixed deductive-inductive template analysis approach in Dedoose software. Resulting themes relating to barriers to distribution within residential areas were as follows: lack of knowledge; fear of negative consequences from external parties; desire of administrators to maintain image of a “drug free campus”; lack of funding for distribution; student desire to avoid stigmatization. Resulting themes relating to facilitators to distribution in residential areas included the following: active involvement of peers; providing free naloxone; educating students about where to get and how to use naloxone; physical accessibility; and anonymous ways to access naloxone. Targeting residential areas for naloxone distribution was also discussed as a theme. Types of people who could/should be involved in naloxone distribution included the following: residential assistants; secondary distributors; pharmacists; UCF leadership; sorority and fraternity leaders; and student liaisons. Study results could be used to inform efforts at UCF and other colleges to expand naloxone access.

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The current opioid epidemic has had grave financial and mortal costs for our nation, and the numbers continue to climb despite our best efforts. In spite of attempts to limit the prescription of opioids and implementation of harm reduction strategies, it is clear that we are not doing enough for people struggling with drug addiction. There are many voices present in the war on drugs, however one that is noticeably absent from the conversation is that of people who inject drugs. It is clearly time to try something new which requires a fresh approach and a new point of view. Confronting the current crisis using a public health approach addresses the associated moral challenges faced in the past and provides a new lens to view potential challenges and solutions. With this new approach arises the need for a public health ethical framework to make ethically informed, community engaging, evidence based decisions on a societal, public health, and everyday level. In addition to this new public health ethics framework, the engagement of the community of people who inject drugs is no longer negotiable in order to develop more effective harm reduction interventions and policies. / Urban Bioethics

Thesis advisor: Stephen J. Pope / This dissertation attends to the crisis of addiction in the United States. The increasing number in annual overdoses and the inadequacy of national responses to curtail these preventable deaths demands an immediate moral response. In the last year, deaths caused by overdose increased by nearly 29 percent, and 20.8 million people in the United States are currently living with substance use disorders. The number of families affected by addiction presents a striking testimony to the scope of the problem. Nevertheless, there is still enormous disagreement over the nature of addiction and therefore how to best treat it. This dissertation will therefore offer a theological approach to addiction in order to advocate for a social response to this crisis.This dissertation proceeds in five chapters. In the first chapter, I evaluate the medical and moral models of addiction. This first chapter engages research in neurobiology and psychology and argues that these models are premised upon a false dichotomy between determinism and freedom of the will. The second chapter explores disagreements in bioethics over the meanings of health, disease, and illness. These different definitions contribute to the chasm between the medical and moral models of addiction. This chapter proposes a holistic account of health for understanding addiction and healing. The third chapter grounds this holistic account of health in Karl Rahner’s transcendental anthropology in order to uphold the fundamental relationality of human persons and to move past the false dichotomy presented in chapter one between determinism and freedom of the will. This chapter then offers a theological examination of sin as a power or force that preconditions freedom. It concludes by proposing a theological and relational account of autonomy. The fourth chapter engages philosophy of the mind in order to argue for a nonreductive approach to mentality that appreciates the ways in which human persons are co-constituted by bottom up and top down causality. A nonreductive approach to mentality offers a way to understand addiction as an interacting set of processes and patterns. This fourth chapter concludes by considering the possibility for responsibility by examining narrativity, vulnerability, and imagination. It argues that there is a moral responsibility to imagine a better world for people living with addictions, and to bring that world about. Finally, the fifth chapter draws upon the theological virtue of solidarity and the principle of the preferential option for the poor in order to articulate a preferential option for people living with addictions. I argue here that Church institutions can stand in solidarity with people who suffer from addiction by acting as providers, educators, and lobbyers. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Theology.

Over the last two decades, the Opioid Epidemic has caused immense harm to communities nationwide. Over 400,000 fatal opioid overdoses occurred in the United States between 1999 and 2017 (CDC, 2019). Professional counselors are among the front-line treatment providers addressing substance use, including Opioid Use Disorders. Professional counselors have a unique professional identity that is built upon humanistic values, a commitment to social justice, and client empowerment. These values align closely with contemporary approaches to substance use treatment, including harm reduction strategies. Harm reduction is an approach to substance use treatment that involves mitigating risks and improving the quality of life of individuals, regardless of their willingness or ability to stop using substances. There are several harm reduction strategies that reduce the risk of fatal opioid overdose or secondary harms of opioid use specifically, including medication-assisted treatment and the distribution of naloxone for overdose reversal. This study examined the acceptability of harm reduction strategies for Opioid Use Disorder among addiction treatment professionals, with a focus on professional counselors. In addition to measuring the level of acceptance of harm reduction for Opioid Use Disorder among professional counselors, counselors were also compared to other professionals who treat substance use. Predictors of acceptability of harm reduction for Opioid Use Disorder were examined based on overlapping components of professional counseling identity and harm reduction philosophy among professional counselors as well. The results of this study provided a baseline for the level of harm reduction acceptance among counselors who treat substance use. Counselors did not have higher levels of harm reduction acceptance for OUD compared to social workers with advanced degrees or bachelor's level substance use treatment providers. Social justice attitudes and empathy were statistically significant predictors of acceptance among counselors. This research indicates that these two factors are key components of counselor identity that explain harm reduction acceptance. The findings of this study highlight a need for more research about harm reduction acceptance for OUD among counselors, including further examination of provider factors that influence acceptance and examination of a broader array of professionals. This research contributed to the understanding of how professional counselors perceive novel approaches for addressing Opioid Epidemic. / Doctor of Philosophy / The Opioid Epidemic is a public health crisis that has led to hundreds of thousands of overdose deaths over the last two decades. Counselors are among the treatment professionals addressing substance use in the United States, including responding to the Opioid Epidemic. Harm reduction is a unique approach to substance use treatment that focuses on keeping people who use substances alive and healthy, regardless of their ability or intent to stop using substances. The current study sought to explore the perceptions of harm reduction strategies for people who use opioids among counselors, including comparing their attitudes to other professionals and exploring the impact of their professional identity. Counselors were not found to be more accepting of harm reduction than other professionals who treat substance use and social justice and empathy were key aspects of counselor professional identity that predicted accepting attitudes towards harm reduction. More research is needed to understand how counselor identity affects harm reduction perceptions.

The ongoing opioid crisis presents a significant public health challenge particularly for people who use opioids (PWUO). Naloxone is an opioid antagonist crucial to reducing opioid overdose mortality. Inconsistencies exist among PWUO in obtaining, carrying, discussing, and administering naloxone. Using sequential mixed methods, this study was aimed at investigating the use of implementation intentions on naloxone use among PWUO. Semi-structured interviews were conducted with 83 PWUO to gather individual experiences with using naloxone and contextual details regarding its use. An essentialist thematic analysis with inductive coding revealed valuable insights into where, for whom, and when naloxone is implemented. The analysis identified major themes such as caring for others' needs, knowledge gaps, reinforcement through overdose experiences, duality of overdose and compassion, and stigma. Minor themes related to syringe services program implementation and drug use were identified. Building on these qualitative findings a quantitative analysis determined the impact of implementation intentions on naloxone implementation. Participants were randomly assigned to develop implementation intentions or goal intentions for the use of naloxone. Follow-up surveys assessed changes in participants' intentions to obtain, carry, discuss, and administer naloxone and their actual implementation over a 6-month period. At the 3-month follow-up the experimental condition exhibited statistically significant positive intentions to obtain naloxone and engage in discussions about naloxone in social contexts of drug use. Changes in the magnitude of naloxone implementation were observed at the 3- and 6-month timepoints. Specifically, the self-reported discussion of naloxone showed noticeable changes in implementation frequency over time. This suggests that while implementation intentions may not have statistically significant effects on the use of naloxone it had some influence on the frequency of discussing naloxone prior to drug use. This work makes a valuable contribution to the existing literature because of its attempt to apply the Theory of Planned Behavior and implementation intentions in a novel way. Though the experimental hypothesis was not supported statistically significant observations were made for some behaviors at the 3-month follow-up. The pragmatic nature of the setting enhances the relevance of the findings and provides valuable insights for future interventions supporting PWUO. / Doctor of Philosophy / The ongoing crisis of opioid addiction poses a significant public health challenge particularly for individuals who use opioids. Naloxone is a medication that can reverse opioid overdoses and it plays a crucial role in saving lives. People who use opioids often face difficulties in accessing, carrying, discussing, and using naloxone consistently. This study was aimed at investigating the use of naloxone by employing qualitative and quantitative methods. We conducted interviews with 83 individuals who use opioids to explore their experiences and gather insights into naloxone use. These interviews provided valuable information about when, where, and for whom naloxone is used. Several important themes emerged including the significance of helping others, knowledge gaps, the influence of personal experiences, the conflict between the fear of overdose and caring for others, and the stigma associated with drug use. We investigated the impact of a specific approach called "implementation intentions" in improving naloxone use. Participants were randomly assigned to create specific plans or general goals for naloxone use. Through surveys conducted over a 6-month period we examined changes in participants' intentions and actions related to naloxone use. Although the specific approach did not yield significant improvements, we observed changes in how people discussed naloxone over time. This study contributes to the existing research by introducing innovative ideas to support positive behavioral changes among individuals who use opioids. The real-world setting in which the study took place enhances the applicability of the findings and offers valuable insights for future programs supporting individuals who use opioids.

The aim of this study is to examine the barriers, conditions, and opportunities for harm reduction social work with individuals experiencing drug-related issues in Sweden and Portugal. The study also presents how various forms of harm reduction practices are implemented in the different countries. Additionally, it will investigate how harm reduction is conducted in each country based on the experiences of social workers and how these social workers perceive the significance of harm reduction in terms of risks and opportunities for individuals with drug-related issues. The method used for this study is qualitative. To collect empirical data, qualitative, semi-structured interviews were conducted. The results of the study reveal both similarities and differences in harm reduction practices in Sweden and Portugal. The similarities between the countries' harm reduction approaches are visible in the shared professional perspectives on clients, the organization of services, and the importance of harm reduction. The findings highlight the necessity of considering the local political and societal context when constructing harm reduction programs. The differences in harm reduction between Sweden and Portugal are primarily related to barriers faced by the services and their clients. Sweden has significant barriers for clients and the development of harm reduction efforts, largely due to political control and bureaucracy, which are likely to impact client stigma and access to support. In contrast, Portugal's decriminalization and legal framework for harm reduction have resulted in extensive harm reduction services and a unified, supportive approach towards individuals with drug-related issues. However, the results indicate that there are obstacles to Portuguese harm reduction, such as low fundings and elevated employee turnover.