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Nicotine is consumed by one in five of the global adult population, mostly by smoking tobacco cigarettes. Modern electronic cigarettes came onto the market from around 2007 and have considerable potential to improve population health by displacing tobacco smoking. The purpose of this study is to map the use of e-cigarettes, but this is difficult due to absence of data sources for many countries.

The global number of vapers was estimated to be 68 million in 2020. New data in 2021 offered an opportunity to update that estimate. The method of assumed similarity was used for countries with missing data. The average prevalence of vaping was calculated for each World Health Organization region, World Bank income classification group and the legal status of e-cigarettes in each country. The number of vapers was calculated for the adult population. The estimate was refined by adjusting for changes in market value size and the actual year of surveys.

Population prevalence data on e-cigarette used were available for 48 countries. We estimate that there were 82 million vapers worldwide in 2021: 9.2 million in the Eastern Mediterranean region; 5.6 million in the African region; 20.1 million in the European region; 16.8 million in the Americas; 16.0 million in the Western Pacific region; and 14.3 million in South-East Asia.

Global, regional and national estimates of the numbers of vapers are important indicators of trends in nicotine use, and monitoring the uptake of vaping is important to inform international and national policy.

The Framework Convention on Tobacco Control (FCTC) has been broadly successful but less so in the Global South. This paper aims to effectively design interventions that to mitigate tobacco-related harms in the Global South, further understanding of interventions in this environment will be helpful, in line with FCTC recommendations. The first objective was to locate and review all published literature relating to tobacco control interventions in the Global South. The second objective was to provide information on research trends within Global South tobacco control interventions.

A literature search was conducted across six databases.

Despite the FCTC detailing the significance of the research, studies are still lacking in the Global South. There are significant research gaps such as longitudinal studies, harm reduction and randomized controlled trials.

Limitations arose from differences in study designs of reviewed studies, making it more complex to assess all studies under the same rubric.

Results indicate significant potential for tobacco control interventions in the Global South, potentially moving toward FCTC goals, but also highlight several areas of concern.

There is much evidence on the effectiveness of tobacco control in the Global North, especially in some parts of Europe and the USA. However, the evidence base in the Global South is far more limited. This paper provides an overview of Global South tobacco control interventions and suggests areas of concern, in line with the FCTC 15 years on.

This case study examines unique overdose risks and prevention strategies for women who have used heroin during pregnancy in New York City. The overdose crisis has resulted in increased efforts to implement drug user health services; yet, pregnant and parenting women who use drugs continue to be left behind. Three women who currently use heroin and had experienced at least one pregnancy during their heroin use history were interviewed using semi-structured qualitative interviews. Their experiences documented in this case study illustrate several gender-specific considerations when responding to the overdose crisis in New York City. Overwhelmingly, barriers to healthcare and overdose prevention were correlated with perceived stigma and the fear of or actual loss of child custody. Compassionate, gender-responsive interventions remain largely absent in policy and practice, especially for pregnant women. The shared experiences highlighted in this case study should be used to develop improved drug user health policies and practices as well as increase overall advocacy efforts for women of reproductive age who use drugs.

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

This paper aims to overview the need for tobacco harm reduction, the consumer products that facilitate tobacco harm reduction and the barriers to its implementation. The worldwide endemic of tobacco smoking results in the death of over seven million smokers a year. Cigarette quit rates are very low, from 3%–12%, and relapse rates are high, from 75%–80% in the first six months and 30%–40% even after one year of abstinence. In addition, some smokers do not desire to quit. Cigarette substitution in tobacco harm reduction is one strategy that may reduce the burden of morbidity and mortality.

This review examines the displacement of smoking through substitution of non-combustible low-risk products such as snus, heated tobacco products and e-cigarettes.

Toxicological testing, population studies, clinical trials and randomized controlled trials demonstrate the potential reductions in exposures for smokers. Many barriers impede the implementation of product substitution in tobacco harm reduction. These products have been subjected to regulatory bans and heavy taxation and are rejected by smokers and society based on misperceptions about nicotine, sensational media headlines and unsubstantiated fears of youth addiction. These barriers will need to be addressed if tobacco harm reduction is to make the maximum impact on the tobacco endemic.

This review provides the rationale for tobacco harm reduction, evaluates the current products available and identifies the barriers to implementation.

Recreational drug use is widespread. It is argued that it has reached a phase of ‘normalisation’ among youth and has become a part of mainstream culture. While there is a substantive body of literature addressing substance use in club settings, the world of music festivals is underexplored. The research aims to fill this gap by analysing patterns of drug use and implementation of harm reduction measures among Polish and Hungarian women at music festivals. This explorative inquiry used an online questionnaire, which was shared via social media channels. The data collection lasted for one month during the summer of 2017.

The study found that over 95% (N=510) of women use psychoactive substances at festivals. The most popular drugs are alcohol and cannabis, and the least popular cocaine and psilocybin. The majority of women declare moderate use of alcohol and light to moderate use of cannabis. One-fifth of the respondents report a moderately heavy use of 3,4-methylenedioxymethamphetamine and 8% heavy use of amphetamine. There are numerous positive weak relationships between the intensity of use of various substances. Increased use of drugs is also related to increased frequency of combining them. Low prevalence of illicit drugs testing is observed. There seems to be a negative correlation between the intensity of substance use and the adoption of harm reduction measures. The results have high practical relevance primarily for harm reduction and medical services. Especially cases of moderately heavy and heavy use should be of interest, even more so given that combining substances seems to be prevalent. The data suggest that we can distinguish between two groups: one aware and implementing various measures of harm reduction and second not adopting any of them. There is a need for more widespread drug education and harm reduction promotion, which should be implemented in a favourable legal and policy environment.

While there is increasing interest in implementing drug checking within overdose prevention, we must also consider how to scale-up these responses so that they have significant reach and impact for people navigating the unpredictable and increasingly complex drug supplies linked to overdose. The purpose of this paper is to present a distributed model of community drug checking that addresses multiple barriers to increasing the reach of drug checking as a response to the illicit drug overdose crisis.

A detailed description of the key components of a distributed model of community drug checking is provided. This includes an integrated software platform that links a multi-instrument, multi-site service design with online service options, a foundational database that provides storage and reporting functions and a community of practice to facilitate engagement and capacity building.

The distributed model diminishes the need for technicians at multiple sites while still providing point-of-care results with local harm reduction engagement and access to confirmatory testing online and in localized reporting. It also reduces the need for training in the technical components of drug checking (e.g. interpreting spectra) for harm reduction workers. Moreover, its real-time reporting capability keeps communities informed about the crisis. Sites are additionally supported by a community of practice.

This paper presents innovations in drug checking technologies and service design that attempt to overcome current financial and technical barriers towards scaling-up services to a more equitable and impactful level and effectively linking multiple urban and rural communities to report concentration levels for substances most linked to overdose.

This chapter discusses how ‘hidden’ populations of women who use drugs (WWUD) in coastal Kenya became ‘visible’ through accessing health, harm reduction and rights services. This effort was facilitated by the Muslim Education and Welfare Association (MEWA) and their work with community leaders. Mapping undertaken by MEWA outreach workers identified women who use opioids and other substances in isolated drug use settings. MEWA introduced daily meals in identified sites, needle and syringe services and residential rehabilitation services for opioid withdrawal. The introduction of residential adherence services for HIV and tuberculosis and the provision of methadone enabled compliance with the 90-90-90 UN HIV cascade. These services achieved sustained HIV viral load suppression at 83% and a 100% cure rate for tuberculosis among WWUD. In addition, disclosure and partner risk tracing was established in the ‘drug dens’ for women who test positive for STIs. The introduction of women-only hours once per week at the drop-in centre contributed to a better understanding of drug dependency among outreach workers and clinicians. Policies on gender-based violence were also refined, leading to an increase in reported cases. Programmes targeting families were introduced to promote effective communication and improve parenting skills. Access barriers to social security programmes were tackled by a network of paralegal officers in partnership with Kenyan authorities. Finally, entrepreneurship training and mentorship programmes were implemented to build resilience among WWUD.

Recent studies have shown that people who attend electronic dance music events and use drug checking services (DCS) are a predominantly white male, highly educated middle-class population. However, there is still a lack of data beyond sociodemographic characteristics that must be addressed. This paper aims to describe the drug use patterns and protective behavior strategies (PBS) used by testers and nontesters at Boom Festival 2018 and analyze the relationship between these behaviors and the decision to use the DCS.

This is an exploratory research based on a cross-sectional design using baseline data collected at the Boom Festival from testers (N = 343) and nontesters (N = 115).

Nontesters presented, in general, slightly higher frequencies of use for most drugs, whereas testers tended to adopt PBS more frequently. Moreover, testers planned their drug use more often than nontesters and set more limits on the amount of drugs they used in one session. Both of these behaviors work as predictors for using the DCS.

Our data suggest that DCS might not be easily accessible to all people who use drugs, reaching almost exclusively highly educated people that already apply several harm reduction strategies. Actions should be taken to promote service accessibility.

To the best of the authors’ knowledge, this paper is the first to compare the demographics, drug use and PBS adoption of DCS users with nonusers who attended the same festival.