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Previous research has found that people who use anabolic androgenic steroids (hereafter ‘steroids’) typically describe these drugs as safe. However, research exploring the inside perspective on steroid risk has focussed on steroids in general, and failed to examine how particular steroids are viewed and experienced. During my online ethnographic research in bodybuilding communities, I found discussion of one particular steroid said to cause significant physical, psychological, social and sexual harm: trenbolone. Trenbolone is a veterinary drug used to increase muscle in beef cattle that has been found to have neurodegenerative and genotoxic effects on animals. It has been used by bodybuilders since the 1980s, and recent research has found it to be one of the most popular steroids used by bodybuilders. If trenbolone is described by bodybuilders as causing significant harm, why do so many bodybuilders use it? This chapter attempts to answer this question through a description of bodybuilder folk models of trenbolone risk. Using a social life of drugs approach it describes: (1) the effects of trenbolone; (2) how these effects are given meaning as either harms or benefits, and then weighed against each other; (3) how the risks of trenbolone are reduced through harm reduction strategies and (4) the role of online communities in negotiations of trenbolone risk. Trenbolone was found to occupy a mythical status in bodybuilding communities, in part because of the conflicted relationship bodybuilders have with the drug. This conflicted relationship illustrates the inherent ambivalence of drugs, which are always both remedy and poison.

This article provides an overview of the opportunities enforcement has to undertake activities to reduce harms caused by drug markets. Four pathways are open to the police in relation to drug harm‐reduction: reducing the amount of drug use; reducing the harm that drug users experience; reducing the harms that drug users impose on others; and reducing the harms caused by drug markets. It is the latter pathway that is the main focus of this article, which draws on a range of international examples. After highlighting that ‘not all dealers are equally destructive’ it is argued that one aim for enforcement could be to shape the drug market by making the most noxious forms of selling uncompetitive relative to less harmful practices.

The purpose of this paper is to compare the response to HIV/AIDS and drug use (drugs harm reduction) with tobacco harm reduction.

Analysis of historical and contemporary sources, combined with personal knowledge of key stakeholders in the history and development of both fields.

Both drugs harm reduction and tobacco harm reduction share a similar objective – to reduce health risks for people who are unwilling or unable to stop using their drug of choice. Both also share a broader public health aim of helping people to make healthier decisions. Drugs harm reduction – as a response to HIV/AIDS – included the adoption of a wide range of radical harm reduction interventions and was a public health success. It became an established part of the professional Public Health agenda. In contrast the Public Health response to e-cigarettes and tobacco harm reduction has ranged from the negative to the cautious. A recent Public Health England report is exceptional for its endorsement of e-cigarettes.

Highlights contradictions in Public Health responses to drugs and tobacco; and that public health interventions can be implemented without and despite the contribution of professional Public Health.

This paper aims to consider the nature of cannabis-related harms under the UK’s Misuse of Drugs Act (MDA). Written for the specific context of this four-paper special section on 50 years of the MDA, it argues that the MDA may cause more harm than it prevents.

An opinion piece offering a structured overview of cannabis-related harms under prohibition. It summarises existing evidence of the ways in which prohibition may exacerbate existing – and create new – harms related to the production, distribution, use and control of cannabis.

The paper argues that prohibition of cannabis under the MDA may cause more harm than it prevents.

It has long been argued that the MDA does not accurately or fairly reflect the harms of the substances it prohibits, and much existing research points to different ways in which drug prohibition can itself be harmful. The originality of this paper lies in bringing together these arguments and developing a framework for analysing the contribution of prohibition to drug-related harm.

As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to address substance use behind bars. The purpose of this study is to present a summary of research surrounding prison-based harm reduction programs.

This narrative review of the international literature summarizes the harms associated with prison drug use followed by an overview of the literature surrounding three prison-based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone distribution.

A collection of international research has found that these three harm reduction programs are safe and feasible to implement in carceral settings. Additionally, these services can effectively reduce some of the harms associated with prison drug use (e.g. risky injection practices, needle sharing, fatal overdoses, etc.). However, these practices are underused in correctional settings in comparison to their use in the community.

Various policy recommendations are made based on the available literature, including addressing ethical concerns surrounding prison populations’ rights to the same standard of health care and services available in the community. By taking a public health approach to prison drug use, harm reduction practices can provide a marginalized, high-risk population of incarcerated individuals with life-saving services rather than punitive, punishment-oriented measures.

Deciding the best course of treatment for a drug or alcohol user can be a complex one. Continuing our look at harm reduction and abstinence, we ask what the best plans are for Nigella, a young woman with mental health problems who uses heroin to prevent recurring self‐harm. In a refreshing and challenging critique Lesley Don explores the decision‐making process towards that treatment. Should Nigella stop her heroin use? If she does, will she self‐harm? Which harm is more desirable? And why, as professionals, do we seek one solution over another?

This article considers the recent public debate in the UK on drug classification and the role of the Advisory Council of the Misuse of Drugs, particularly following David Nutt's departure as Chair of the ACMD. It suggests that there have been flaws in the arguments on both sides, and considers some of the implications for wider debate on regulation and control.

In this paper, academics and managers of specialist services reflect on the shifting policy and funding landscapes that shape service provision for drug‐using sex workers in England and Ireland. The paper outlines the harm reduction and holistic principles that underpinned much original service provision concerned with public health in the face of an HIV epidemic and the limitations of services that equate drug use minimisation with sex work minimisation. It concludes that an ‘exiting’ and victim discourse dovetails with the well‐funded crime and disorder agenda, and that lobbyists on these issues are proving to be natural allies against harm reduction.

To present the view that harm arising from aggressive marketing and sales of health-related products and services (including dangerous and defective ones) in order to maximize profits should be a cause of concern for public health academics and practitioners.

The discussion is conducted using biomedical ethics principles and supported using various real-world examples.

Harm arising from aggressive marketing and sales of health-related products and services (including dangerous and defective ones) in order to maximize profits should be a cause of concern for public health academics and practitioners. In the area of products, the most obvious would be tobacco products. In the case of pharmaceutical drugs, it would include overuse or inappropriate use because of aggressive marketing. It would also include harm caused by the continued promotion and sale of a drug in the face of evidence that it has significant negative side effects. Brody and Light’s “Inverse Benefit Law,” that is, the benefit-to-harm ratio of drugs tends to vary inversely with how aggressively drugs are marketed is discussed. Harm is also evident in health-related services, for example, misuse of ultrasonography for sex-selective abortion. This chapter will discuss how the risk of harm is increased because of questionable marketing strategies used by drug companies.

One limitation is that no attempt to quantify the harm done (e.g., through economic evaluation techniques) is carried out.

This chapter presents the view that much more attention should be paid to this aspect of medicalization as a public health threat.