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The state of harm reduction in North America in 2017

Guest Editor: Prof Ernest Drucker
Editors-in-Chief: Prof Nick Crofts and Dr Euan Lawson

Are we anywhere near there yet? The state of harm reduction in North America in 2017

AIDS was first seen among people who inject drugs (PWID) in the U.S., in the form of outbreaks of Pneumocystis carinii pneumonia, in 1981 [Masur et al 1981]. In 1984, the Centers for Disease Control issued strong advice to PWID to stop sharing needles and syringes [CDC 1984], but there was widespread recognition that without provision of sterile injecting equipment this advice was unachievable for many PWID. Also that year, however, the first needle and syringe programs were begun in the Netherlands, providing a model of a most effective public health intervention to stop the spread of HIV among and from PWID [NIDA 1988]. By 1993 the evidence of the effectiveness and safety of NSP in prevention of HIV transmission was more than convincing [Lurie et al 1993], but despite this NSP were not widely implemented, at a great cost [Lurie and Drucker 1997].

Some countries have wholeheartedly adopted the public health philosophy which has become known as harm reduction, and have seen prevention or control of HIV epidemics. What has happened in the ensuing three decades in achieving control of the HIV epidemic among and from PWID in North America?

This thematic series of the Harm Reduction Journal seeks to examine progress or lack thereof, and the reasons why, in the progress of harm reduction both as a philosophy and as a practical and proven effective public health intervention in North America. 

The series was launched at the 25th Harm Reduction International Conference in Montréal in May 2017.

The Editors of the series declare no competing interests.

  1. Research

    Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks

    In Canada, funding, administration, and delivery of health services—including those targeting people who use drugs—are primarily the responsibility of the provinces and territories. Access to harm reduction se...

    Elaine Hyshka, Jalene Anderson-Baron, Kamagaju Karekezi, Lynne Belle-Isle, Richard Elliott, Bernie Pauly, Carol Strike, Mark Asbridge, Colleen Dell, Keely McBride, Andrew Hathaway and T. Cameron Wild

    Harm Reduction Journal 2017 14:50

    Published on: 26 July 2017

  2. Research

    Telling our stories: heroin-assisted treatment and SNAP activism in the Downtown Eastside of Vancouver

    This article highlights the experiences of a peer-run group, SALOME/NAOMI Association of Patients (SNAP), that meets weekly in the Downtown Eastside of Vancouver, British Columbia, Canada. SNAP is a unique ind...

    Susan Boyd, Dave Murray and Donald MacPherson

    Harm Reduction Journal 2017 14:27

    Published on: 18 May 2017

    The Erratum to this article has been published in Harm Reduction Journal 2017 14:36

  3. Review

    Supervised injection facilities in Canada: past, present, and future

    Canada has long contended with harms arising from injection drug use. In response to epidemics of HIV infection and overdose in Vancouver in the mid-1990s, a range of actors advocated for the creation of super...

    Thomas Kerr, Sanjana Mitra, Mary Clare Kennedy and Ryan McNeil

    Harm Reduction Journal 2017 14:28

    Published on: 18 May 2017

  4. Research

    A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada

    The health of people who use drugs (PWUD) is characterized by multimorbidity and chronicity of health conditions, necessitating an understanding of their health care utilization. The objective of this study wa...

    Claire E. Kendall, Lisa M. Boucher, Amy E. Mark, Alana Martin, Zack Marshall, Rob Boyd, Pam Oickle, Nicola Diliso, Dave Pineau, Brad Renaud, Tiffany Rose, Sean LeBlanc, Mark Tyndall, Olivia M. Lee and Ahmed M. Bayoumi

    Harm Reduction Journal 2017 14:16

    Published on: 12 May 2017

    The Erratum to this article has been published in Harm Reduction Journal 2017 14:42

  5. Research

    Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility

    In Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market....

    Amos Irwin, Ehsan Jozaghi, Brian W. Weir, Sean T. Allen, Andrew Lindsay and Susan G. Sherman

    Harm Reduction Journal 2017 14:29

    Published on: 12 May 2017

  6. Research

    Expanding conceptualizations of harm reduction: results from a qualitative community-based participatory research study with people who inject drugs

    The perspectives of people who use drugs are critical in understanding why people choose to reduce harm in relation to drug use, what practices are considered or preferred in conceptualizations of harm reducti...

    L. M. Boucher, Z. Marshall, A. Martin, K. Larose-Hébert, J. V. Flynn, C. Lalonde, D. Pineau, J. Bigelow, T. Rose, R. Chase, R. Boyd, M. Tyndall and C. Kendall

    Harm Reduction Journal 2017 14:18

    Published on: 12 May 2017

References
Masur, H. et al. An Outbreak of community acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction. The New England Journal Of Medicine 1981 305(24):1431-1438

Centers for Disease Control and Prevention (CDC) 'Antibodies to a Retrovirus Etiologically Associated with Acquired Immunodeficiency Syndrome (AIDS) in Populations with Increased Incidences of the Syndrome' 1984 (13 July) 33(27):377-379

National Institute on Drug Abuse. 'Needle Sharing Among Intravenous Drug Abusers: National and International perspectives' 1988

Lurie, P, Reingold, AL, Bowser, B, et al. The public health impact of needle exchange programs in the United States and abroad , Volume I . University of California. September, 1993.

Lurie P, Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet 1997 (March 1) Vol 349(9052): 604-608

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