O objeto deste estudo é a concepção Redução de Danos, optou-se pelo estudo qualitativo, exploratório e de campo. O objetivo principal é identificar e analisar as concepções dos profissionais de um Centro de Atenção Psicossocial Álcool e outras Drogas da cidade de São Paulo acerca da Redução de Danos. Foi desenvolvido com profissionais da equipe técnica de saúde mental e o coordenador do serviço. O marco conceitual teórico deste estudo é a Reforma Psiquiátrica e os pressupostos da Redução de Danos. Para a obtenção do material empírico a técnica empregada foi à entrevista semi-estruturada. Os instrumentos para coleta de dados contemplam a caracterização sociodemográfica dos colaboradores e um roteiro para entrevista que foi gravada. Os dados foram transcritos e analisados sob a luz do método Hermenêutico Dialético. Na análise emergiram quatro categorias: dificuldade em classificar a gravidade do consumo; a droga para encobrir as necessidades de grupos sociais desfavorecidos; a droga como necessidade de todas as classes nos tempos atuais e formas da RD de trabalhar com o consumo. O resultado aponta que para os sujeitos deste estudo a RD se posiciona como uma abordagem que se opõe ao modelo hegemônico de guerra as drogas e não parte do ponto único e exclusivo do uso de drogas como doença. Afirmam que a RD não é contra a abstinência e visa diminuir riscos e danos a saúde considerando todo o contexto, o desejo e as possibilidades de cada pessoa. Nesse sentido, amplia a oferta e as possibilidades de cuidados para as pessoas que fazem uso prejudicial dos diversos psicoativos. / The object of this study is the concept of Harm Reduction. It was opted to use a field research, with exploratory and qualitative approach. The main objective was to identify and analyze the views about Harm Reduction of professionals from a Psychosocial Care Center for Alcohol and Other Drugs in São Paulo. The study as developed throughout all of the professional categories, e.g. higher-level, technical and coordinators of the staff. The theoretical framework of this study is the Psychiatric Reform and the assumptions of Harm Reduction. To obtain the empirical data, it were used semi-structured interviews as technique. The instruments for data collection include the sociodemographic characteristics of the members of the staff and a guide for the interviews, which were recorded. Data was transcribed and analyzed under the view of the Hermeneutic Dialectic method. In the analysis, four categories emerged: e.g. difficulties in classifying the severity of consumption; drugs as a way to cover the needs of disadvantaged groups; drugs as a need for all classes in the current times and ways of working with Harm Reduction and the consumption. The result shows that for the subjects in this study the Harm Reduction stands as an approach that opposes the hegemonic model of the war on drugs and not part of the one and only point of drug use as a disease. Claim that the Harm Reduction is not against abstinence and aims to reduce health risks and damage considering the entire context, the desire and the possibilities of each person. In this sense, extends the offer and the possibilities of care for people who make use of the various harmful psychoactive.

Syftet med studien är att undersöka patienters liv med opioidberoende innan och efter inskrivning på LARO-behandlingen, samt vilka erfarenheter av bemötande som finns. LARO är en substitutionsbehandling vid opioidberoende. Studien utforskar vilka attityder och bemötande LARO-patienter upplever, med en teoretisk utgångspunkt ur harm reduction. Studien har en explorativ ansats och gjordes med kvalitativa intervjuer. Materialet har analyserats med hjälp av direkt innehållsanalys, samt kopplats till teori och tidigare forskning. Resultatet visar på en tydlig skadereducering för samtliga deltagare sen de började med läkemedelassisterad behandling. Erfarenheterna av negativa bemötanden har varit många och är överrepresenterade i jämförelse mot de positiva. Bemötandet har kunnat kopplas till de olika teoretiska synsätten, och åsikterna har ändrats i kast med kunskapen om behandlingsmetoden ökar. LARO ger patienterna en möjlighet till att leva och motståndarna saknar vetenskaplig grund för sina åsikter.

This present work, inserted in the research line called formation, knowledge and professional development linked to the post graduation program in Education at the Santa Maria Federal University, aims to understand the conceptions about drugs among a group of academical students who are in a period of training for teachers. The analysis is guided by the perspective of Michel Foucault about the conformation of the discursive and no discursive practices. Also is made a brief comment about the concept that permeates educational practices on drugs. With the purpose of contributing for emergency of education practices founded in a no prohibitionist point of view, was introduced the experience of harm reduction program on the municipal office of health in Santa Maria developed during the period between july 2002 and march 2009. / A presente dissertação de mestrado está inserida na linha de pesquisa Formação, Saberes e Desenvolvimento Profissional do Programa de Pós-graduação em Educação da Universidade Federal de Santa Maria UFSM. Teve como objetivo compreender que concepções sobre drogas circulavam entre um grupo de estudantes universitários em formação docente. Os dados foram analisados a partir da perspectiva foucaultiana sobre a conformação das práticas discursivas ao não-discursivo. Também foi realizado um breve comentário sobre noções proibicionistas que permeiam as práticas educacionais sobre drogas. Com o propósito de contribuir para a emergência de práticas educacionais pautadas em pressupostos não proibicionistas do uso de drogas, foi apresentada a experiência do Programa de Redução de Danos da Secretaria Municipal de Saúde de Santa Maria/RS durante o período que compreende julho de 2002 a março de 2009.

Opioid overdose fatalities have quadrupled in the United States since the turn of the century, and are becoming increasingly recognized as a nationwide epidemic. While naloxone (narcan) has long been the standard treatment for overdose in clinical settings, it has not been issued to opioid users or their family members in the U.S. until relatively recently. As naloxone distribution and overdose training become more widespread, they are being incorporated into more and more abstinence-oriented settings including detoxes, halfway houses, and outpatient methadone and suboxone treatment programs. This qualitative study explored whether the staff at such programs found that training their patients to use naloxone was disruptive or controversial, and whether they found it difficult to reconcile these trainings’ basis in harm reduction with their personal and organizational philosophies about substance use and recovery. Ten subjects from Eastern and Central Massachusetts were interviewed about their experience introducing naloxone to their patients under the aegis of the Massachusetts Department of Public Health’s Opioid Overdose Prevention Pilot Program, and their interviews were analyzed from a descriptive phenomenological perspective. This approach seeks to distill the essence of a phenomenon by analyzing the narratives of those who have experienced it, and has been found especially useful when exploring questions that have not yet been studied in depth. The analysis identified eleven recurring themes, grouped into four broad domains (What is overdose prevention training? What is narcan? What is harm reduction? What is the goal of treatment?). These themes suggested that while subjects overwhelmingly experienced naloxone distribution and overdose prevention training as positive additions to their workplace, this experience did not necessarily lead to more engagement with the broader concept of harm reduction.

Despite harm reduction’s social justice roots, the broader understanding of harm reduction is often influenced by morals and values which leaves harm reduction to be conceptualized within a morality policy domain. This study adopts the Qualitative-Narrative Policy Framework (Q-NPF) (Gray & Jones, 2016), to explore the policy beliefs and values that steer current harm reduction policy documents in British Columbia. Four questions guide this study: i) What are the underlying beliefs and values steering harm reduction policy in B.C.? ii) How are these beliefs and values narrated through policy?, iii) In what way do the underlying policy beliefs align with principles of social justice for harm reduction?, and iv) How have policy beliefs shifted since the 2016 public health emergency declaration? The social justice lens for harm reduction (Pauly, 2008) serves as this study’s analytical framework and is supplemented by the Systems Health Equity Lens (Pauly, Shahram, van Roode, Strosher & MacDonald, 2018); both of which emphasize the need for harm reduction to acknowledge and address social and structural conditions that contribute to substance use harms and their inequitable distribution. As this study reveals, there is an ongoing tension between equity-related and non-equity policy beliefs and values characterized within policy documents, thus fueling a policy climate with incongruent and contradictory beliefs. Further, equity-related beliefs are positioned in the confines of equitable access, thus they are not equity-oriented in entirety. Additionally, there have been minimal shifts in policy beliefs since the post-2016 public health emergency declaration yet shifts occur in terms of the specific constructs which form equity-related and non-equity beliefs. Finally, the study outlines potential implications of these beliefs and proposes recommendations to improve harm reduction policy in terms of becoming equity-oriented. This study also outlines methodological contributions to the Q-NPF for future policy narrative and analysis studies. / Graduate / 2022-08-15

The aim of this study has been to analyze the current Swedish drug policy discussion in mass media. In the discussion several different dividing lines are drawn up which highlights different standpoints in the drug policy. The study's methodological starting point is qualitative text analysis and analysis from the third dimension which entails that the macrolevel perspective is in focus. The study's theoretical referens frame originates from the problemperspective and the labeling theory. The results are showing that the dividing lines in the discussion are about the different points of view; harm reduction or prohibition. This is connected to the current drug policy debate about a decriminalization and legalization, or if Sweden should continue to keep a prohibition drug policy. In the discussion decriminalization is presented as a solution which would open up for the insertion of new harm reduction strategies, while a prohibition politic is considered to have a preventative effect on the whole population. The drug problems are complex which in turn make them really be about socioeconomical factors, class distinctions, stigmatization and labeling. The conclusion is that we stand before a possible change, that would mean parting from the prohibiton drug policy that is very firmly cemented in our society. The topical drug policy discussion in mass media is dominated by participants that advocate a conversion of the current drug policy which could be seen as an indicator that change is forthcoming. However, at the same time there is unwillingness amongst leading politicians in Sweden to open up for transformation which could amount to the Swedish drug policy to continue to be as it is. / Syftet med denna studie har varit att analysera aktuell svensk narkotikapolitisk debatt i massmedia. I debatten dras ett antal skiljelinjer upp som markerar olika narkotikapolitiska ståndpunkter. Studiens metodologiska utgångspunkt är kvalitativ textanalys och analys ur tredje dimensionen, vilket innebär att makroperspektivet är i fokus. Studiens teoretiska referensram utgår från problemperspektiv och stämplingsteorin.  Resultatet visar på att skiljelinjerna i debatten markeras av de olika synsätten om skademinimering eller prohibition. Detta har ett samband med den pågående narkotikapolitiska diskussionen i massmedia om avkriminalisering och legalisering eller om Sverige ska fortsätta driva en repressiv narkotikapolitik. I den massmediala debatten framställs avkriminalisering som en lösning som skulle kunna öppna upp för införandet av nya skademinimerande insatser, medan en repressiv politik anses ha en preventiv effekt på befolkningen i helhet. Narkotikaproblematiken är komplex, vilket gör att problematiken egentligen tycks handla om socioekonomiska faktorer, klasskillnader, stämpling och stigma.  Slutsatsen är att vi står inför ett eventuellt skifte inom svensk narkotikapolitik, vilket skulle innebära ett avsteg från den repressiva narkotikapolitiken. Den aktuella narkotikapolitiska debatten i massmedia domineras av aktörer som förespråkar en förändring av nuvarande narkotikapolitik, detta skulle kunna ses som en indikator på att en förändring är på gång. Samtidigt finns det en ovillighet bland ledande politiker att öppna upp för en förändring, vilket likväl kan innebära att den svenska narkotikapolitiken fortsättningsvis kommer förbli oförändrad.

Background: In Kazakhstan, opioid substitution therapy (OST) has been a controversial topic since its introduction in 2008. Aim: To examine and analyse factors influencing approach towards OST among OST patients, opioid-dependent drug users who could re-consider engagement in this therapeutic method, as well as attitudes of selected key organisations and their representatives. Methods: A survey method complemented by semi-structured individual and group interviews has been selected. One hundred respondents participated in the study between October and December 2015. The first group consisted of 46 OST patients. The second group consisted of 54 respondents who met criteria for opioid dependence. This group included patients of residential treatment centres, former OST patients and current injecting drug users. Key persons were interviewed about their attitudes. Results: Patients receiving OST, with the average treatment duration of 29.4 months, reported improved health, improved social functioning and financial well-being, as well as reduction of their involvement in crime. This group showed better results in all examined categories. Most (80 %) were satisfied with the treatment, even though a number of shortcomings have been reported. All OST patients considered necessary to expand the availability...

Hepatitis C virus (HCV) affects up to 45,000 people in Sweden today. Although it is a very treatable disease, the prevalence of HCV is extremely high within the population of people who inject drugs (PWID). This study examines the direct effect of needle exchange programs (NEPs) on HCV rates in Sweden. Previous research has shown that NEPs reduce the transmission of other blood-borne diseases among PWID. Using an interrupted time series (ITS) analysis, this study investigates if there are statistically significant differences between HCV rates in Swedish counties before and after the implementation of NEPs. The study also investigates via linear regression to see if there is a relationship between sterile injecting equipment (needles and syringes) dispensed and HCV rates in the counties where NEPs exist. While there has been a steady decrease in HCV rates across the country as a whole, the ITS analyses show no statistically significant differences in HCV rates due to the opening of NEPs. Because of the relatively recent introduction of NEPs in Sweden, more data points post-intervention may be needed before we can truly see the effect they have on regional HCV rates. There is also no relationship between the number of needles and syringes dispensed and county HCV rates. However, Sweden falls far short of the 300 syringes/needles per user per year recommendation of the World Health Organization at this time. Standardized data collection and further research can help answer these questions more clearly.

Background: In this work, I deal with adequacy of services and needs of clients within the No Biohazard program. The purpose of the evaluation is important particularly for directors and program managers. It is the directors and managers who are often asked to justify the need for their programs. Client satisfaction is believed to be a concept that is well understood by clients, the public, public authorities and other institutions that provide funding to these organizations (WHO, UNDCP & EMCDDA, 2000). Aims: The main goal was to find out the satisfaction of clients with the offered interventions offered by the No Biohazard program to clients, optionally how particular aspects of interventions could be improved. Research questions identify sources of dissatisfaction with the interventions offered. Partial goals also include finding out the level of client satisfaction with the local and time availability of No Biohazard, creating a proposal to increase the level of No Biohazard and finally designing an inventory of Harm Reduction material that could be offered to outreach program clients. Research file: The research sample is drug users who should meet the EMCDDA definition of problem drug users. I chose respondents to the research through institutions - it was an institutional selection with a...

Background: Cannabis drugs are the most used illicit drug in the Czech Republic. About 1,78 million people use cannabis, most of them are young people aged 15-34 years (Mravčík et al., 2020). Use in the young age, regular and intensive use of large amounts of cannabis is associated with the negative impact on health and life of users. Previous studies have described the harm redcution strategies, less is known about relative occurrence of the hram reduction stategies, especially in the czech environment. Aims: The aim of the study was to investigate what kind of harm reduction strategies are used by cannabis users. Methods: The research was conducted as a quantitative study. This mapping study was aimed to describe the behaviour of cannabis users in relation to use of the harm reduction strategies, and to explore the relative occurrence of these strategies. As a method of data collection was used a questionnaire survey. Results: Most frequently emerged harm reduction strategies among cannabis users are in relation to the effects of use on physical health. Most of these strategies focus on minimising the harms associated with smoking cannabis, particularly marijuana cigarettes. Mental health strategies are based on the concept of set, where users often do not use if they observe negative feelings...