The EMCDDA's 10th scientific monograph, entitled Harm reduction: evidence, impacts and challenges provides a comprehensive overview of the harm reduction field. Part I of the monograph looks back at the emergence of harm reduction approaches and their diffusion, and explores the concept from different perspectives, including international organisations, academic researchers and drug users. Part II is dedicated to current evidence and impacts of harm reduction and illustrates how the concept has broadened to cover a wide range of behaviours and harms. Part III addresses the current challenges and innovations in the field. The core audience of the monograph comprises policymakers, healthcare professionals working with drug users, as well as the wider interested public -- EU Bookshop.

This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.

Millions of Americans use e-cigarettes. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults. Given their relatively recent introduction, there has been little time for a scientific body of evidence to develop on the health effects of e-cigarettes. Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research.

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Harm Reduction is a philosophy of public health intended as a progressive alternative to the prohibition of certain potentially dangerous lifestyle choices. Recognising that certain people always have and always will engage in behaviours which carry risks, the aim of harm reduction is to mitigate the potential dangers and health risks associated with those behaviours. Harm Reduction in Substance Use and High-Risk Behaviour offers a comprehensive exploration of the policy, practice and evidence base of harm reduction. Starting with a history of harm reduction, the book addresses key ethical and legal issues central to the debates and developments in the field. It discusses the full range of psychoactive substances, behaviours and communities with chapters on injecting, dance drugs, stimulant use, tobacco harm reduction, alcohol use and sex work. Written by an international team of contributors, this text provides an essential panorama of harm reduction in the 21st century for educators and researchers in addiction and public health, postgraduate students and policy makers.

The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already existâ€"like evidence-based medicationsâ€"are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.

The ebook edition of this title is Open Access and freely available to read online. Examining the impact of drug criminalisation on a previously overlooked demographic, this book argues that women are disproportionately affected by a flawed policy approach.

The War on Drugs' has traditionally had total abstinence as its target. The contributors to this book take a new and challenging approach to problem drug use, arguing that abstinence is not the only solution. They believe that existing methods of treatment and control have been inadequate in controlling or improving drug problems and they propose a radical alternative: reducing the harm associated with the use of illicit drugs. International in scope, the book covers a broad range of drugs, and of social and individual problems. The spread of HIV infection, which has been described as a greater threat to individual and public health than drug misuse is also considered. The contributors give an overview of the current theories and practices that have helped to minimise the harmful effects of drugs and describe national and city-level strategies towards drug problems. They also cover the drug policies of several agencies and organisations world-wide, including police, doctors, community groups and local authorities. Concentrating on reducing drug-related harm, this in an important contribtuion to the debate on the future shape of drug control systems. It questions the role and function of existing drug laws and discusses how harm reduction will shape day-to-day work with drug users. Provocative and persuasive, it should be read by all policy-makers and practitioners faced with drugs problems, and will do much to help establish new strategies for dealing with drug use, strategies that minimise rather than exacerbate drug-related harm.