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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. 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...

    Authors: 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
    Citation: Harm Reduction Journal 2017 14:50
  2. Housing First is an evidence-based practice intended to serve chronically homeless individuals with co-occurring serious mental illness and substance use disorders. Despite housing active substance users, harm...

    Authors: Dennis P. Watson, Valery Shuman, James Kowalsky, Elizabeth Golembiewski and Molly Brown
    Citation: Harm Reduction Journal 2017 14:30
  3. 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...

    Authors: Thomas Kerr, Sanjana Mitra, Mary Clare Kennedy and Ryan McNeil
    Citation: Harm Reduction Journal 2017 14:28
  4. 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...

    Authors: Susan Boyd, Dave Murray and Donald MacPherson
    Citation: Harm Reduction Journal 2017 14:27

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

  5. 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....

    Authors: Amos Irwin, Ehsan Jozaghi, Brian W. Weir, Sean T. Allen, Andrew Lindsay and Susan G. Sherman
    Citation: Harm Reduction Journal 2017 14:29
  6. 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...

    Authors: 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
    Citation: Harm Reduction Journal 2017 14:18
  7. 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...

    Authors: 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
    Citation: Harm Reduction Journal 2017 14:16

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

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