In 24 states, the rate of overdose mortality in rural counties is similar to or higher than it is in urban counties. While harm reduction was developed by and for people in cities, it is just as important in the country’s dispersed and geographically isolated settings as it is in New York or San Francisco.

Many states prohibit some (if not all) drug checking. Amending state laws to explicitly authorize the possession, distribution, and use of equipment to check for a range of adulterants is a critical step in combating the overdose crisis.

New reduced-risk products are providing a clear alternative to smoking, evidenced by the large number of smokers who have moved to electronic cigarettes and other reduced-risk options like oral nicotine and heat-not-burn products. In fact, smokers are transitioning to less-risky products even in the face of misinformation about these options and a regulatory environment that has made it nearly impossible for them to enter the U.S. marketplace. 

Even with competition bringing cost down, high prices remain a barrier to many people who use drugs—and real-world availability is not sufficient to meet needs.

We highlight several policies that, when operating in complement to OTC sales, can optimize community naloxone saturation.

Lower retail prices will not matter if the products are unavailable in the communities that need them most. Therefore, in Part 2 of this series on OTC naloxone access, we explain why retail availability matters and examine related research.  

Over-the-counter naloxone prices are higher than out-of-pocket consumer costs for insurance-paid prescriptions but lower than what uninsured people would have paid for the medication when it was still only available by prescription. Some suggest that the change in status will do little to reduce cost barriers. Others argue that increased market competition could drive prices down, making naloxone more affordable as more products are approved.

This paper recommends key steps stakeholders should take to break the country’s 15-year stall on reducing tobacco-related deaths, (including) four key approaches that legislators and regulators can take to create a more reasonable regulatory space for life-saving, reduced-risk products.

This analysis highlights current challenges within the tobacco control landscape and proposes modern science- and policy-based solutions to overcome them.

Despite Louisiana’s high rate of HIV diagnoses, in 2023, the Louisiana Department of Health announced an 11% drop in new diagnoses over the preceding 5-year period. This decrease is likely attributable in part to the 44% increase in PrEP uptake over the same period.

Naloxone is an effective medication that can reverse an opioid overdose and restore breathing within minutes if administered in a timely manner. However, with multiple products on the market, it can be challenging for grassroots organizations, government agencies, and policymakers to know which to prioritize and supply to consumers.

The potential health benefits of switching from cigarettes to novel products are obscured, with messaging from major health organizations often equating the risks of nicotine use to those of smoking. This inaccuracy has confused both consumers and medical professionals.

Smoking substances reduces the risk of contracting many infectious diseases, including HIV. In addition, people who smoke rather than inject avoid soft-tissue wounds and infections at the injection site as well as associated endocarditis.

Although there have been successes in HCV care and prevention, it will take a strong commitment to treatment and harm reduction to meet national goals.

To take steps toward a functioning electronic nicotine delivery system (ENDS) marketplace, clear regulatory guidelines must be established immediately—something that the Center for Tobacco Products has the purview and experience to do.

Historically, Florida is among the states with the highest number of new HIV diagnoses per 100,000 residents. This explainer explores how a recent bill changed throughout the legislative process and provides key takeaways for policymakers interested in proposing similar legislation in their state.

One challenge for sexually transmitted infection prevention is that the risk of reinfection is high if a person’s partner(s) do not receive necessary treatment. EPT is a method of delivering timely treatment to the partner(s) of a person diagnosed with chlamydia and/or gonorrhea.

In 2023, Arkansas became the first Southern state to authorize pharmacists to prescribe medications to prevent HIV directly to patients. This explainer describes how lawmakers accomplished this policy milestone.

Congress is considering placing the veterinary sedative colloquially known as “tranq” on the Controlled Substances Act alongside Schedule III drugs. Such action would not reduce overdose risk or the presence of illicit drugs in our communities. Furthermore, by deprioritizing scientific evaluation just when we need it most, these actions would potentially create long-term harms.

Although PrEP use has increased dramatically among some demographic groups, there are significant differences in PrEP use by race, sex/gender, and sexual orientation. . A key policy mechanism that could increase PrEP accessibility is expanding pharmacists’ scope of practice to include prescribing PrEP directly to a client, without involving another prescribing health care provider.

RSI examined state harm reduction policies targeting three substances: tobacco, opioids, and cannabis. Republican states tend to be fairly permissive of tobacco harm reduction but moderate to restrictive of opioid harm reduction and regulated cannabis. Democratic states lean the opposite way.

Methadone is one of the most heavily regulated prescription drugs in the United States, and people with OUD can only access it through a system of specialized but restrictive clinics called opioid treatment programs (OTPs). Providing options that facilitate supervised methadone consumption outside of OTPs could potentially safely open up the benefits of take-home doses to more vulnerable and less stable patients.

Research confirms that naloxone remains safe and effective for years after production and packaging. Research has consistently shown naloxone to remain stable—and thus effective and safe—for years beyond its set expiration date.

In 2021, the FDA approved both higher-dose naloxone products and new, longer-lasting opioid antidotes, and some government agencies have begun purchasing these products for distribution in their communities. This policy study aims to inform legislators and public health decision-makers about how high-dose naloxone fits into federal, state, and local efforts to combat the opioid overdose crisis.

PrEP and PEP are medications that decrease the likelihood of becoming infected with HIV. When taken as prescribed, PrEP reduces the risk of becoming infected with HIV from sex and intravenous drug use by 99 percent and at least 74 percent, respectively. Observational studies suggest that PEP can reduce the risk of becoming infected with HIV by more than 80 percent under real-world conditions where people miss doses and likely by much more when used as prescribed.

More than 200 people in the United States die each day of an opioid-involved overdose. Methadone is an evidence-based medication that helps individuals with opioid use disorder (OUD) reclaim their lives by curbing withdrawals and cravings. However, access is hampered by overregulation and a monopolistic system of “opioid treatment programs” (OTPs).

The Idaho Legislature recently voted to repeal their prior authorization of “safer syringe programs” (SSPs). Since 2019, Idaho’s SSPs have saved lives and protected communities across the state. Banning them will have consequences, and not just for people who use drugs.

The legislative application of harm reduction is not always consistent when it comes to substance use: Proponents of harm reduction policy for one substance may be against the approach for another. In this study, we examined the harm reduction policy landscape across three substances— tobacco, opioids, and cannabis—in all 50 states.

After nearly two decades, the World Health Organization’s Framework Convention on Tobacco Control has had little impact in saving lives. It is time for WHO to acknowledge the existence of tobacco harm reduction (THR) approaches and fully implement THR into their strategy to improve the lives of those who smoke.

PrEP and PEP are medications that decrease the likelihood of becoming infected with HIV if exposed. When taken as prescribed, PrEP reduces the risk of HIV from sex and injection drug use by 99% and at least 74% respectively. Observational studies suggest PEP can reduce the risk of HIV by more than 80% under conditions where people miss doses, and likely by much more when used as prescribed.

The Louisiana State Legislature is considering a bill that would allow pharmacists to prescribe medications that prevent HIV infection directly to patients. HB579 signals that Louisiana is serious about reducing the burden of HIV on the state.

In 2021, OnPoint NYC began operating the United States’ first publicly recognized overdose prevention centers (OPCs). Proponents point to decades of research from other countries suggesting that OPCs save lives, reduce demand for emergency medical services, and cut public drug use. Detractors continue to worry that OPCs encourage criminal activity in surrounding areas.

At the end of January, the Centers for Disease Control and Prevention (CDC) released statistics outlining the number of sexually transmitted infections (STIs) that occurred in 2022. This post updates the statistics shared in “Summarizing STI Statistics and Innovations” and explores less splashy STI news.

Sexually transmitted infections (STIs) are much more common than many people think. So common, in fact, that more than half of U.S. citizens will contract an STI at some point. Despite this, few people openly talk about their experiences with STIs, further perpetuating the stigma associated with a diagnosis.

There is new evidence that electronic nicotine-delivery systems (ENDS) products are an effective tobacco harm reduction tool, and supported by medical professionals; yet as evidence grows, the U.S. Food and Drug Administration (FDA) continues to limit access to new ENDS products.

By deterring bystanders from calling 911 in the case of an overdose, SB 718 would risk the lives of Florida’s most vulnerable residents. And by perpetuating a false narrative about fentanyl exposure, it may increase anxiety among first responders while denying them access to the training and information that could actually keep them safer in the era of fentanyl.

In the past year, 35.2 percent of U.S. adults have not had a wellness visit.

By 2034, there could be a shortage of up to 40,920 primary care physicians.

Although research on labeling standards for recreational and medicinal cannabis products is sparse, the existing research offers some suggestions on important labeling elements for legalized cannabis products.

Harm reduction must be applied in concert with other tactics to reduce deaths and improve well-being. But its current limits are not because the approach itself is lacking; rather, they are the result of insufficient funding and policy environments that continue to get in the way.

No single strategy can reverse the increase in STIs—a comprehensive approach is needed. This post provides an overview of key facts and recent news about STIs.

The FDA-CTP continues to ignore the need to establish standards that science can be applied against in the development of new products that may act to greatly reduce the health burdens associated with the use of traditional combustible tobacco products.

This policy study explores what is known about medical cannabis patients’ use patterns; describes marketplace trends and medical relevance of cannabinoid content; and suggests policies to promote safe, effective and accessible medical cannabis products for patients.

Although medication for opioid use disorder (MOUD) is currently considered the gold-standard treatment, access remains limited. Research indicates that only about one in four people living with an OUD receive targeted, medication-based treatment.

In Southeast Asia alone, which is one of the largest areas of tobacco production and consumption, approximately 1.6 million lives are lost to smoking-related disease each year.

While OTC naloxone represents an exciting shift in the visibility of naloxone, a relatively small proportion of the medication is accessed through retail pharmacies.

While treatment can be the preferred path for some pregnant people, harm reduction is another option for those who cannot or will not abstain during pregnancy.

Substance use disorder (SUD) is only one reason why people use drugs. Understanding why people use drugs can help us understand why harm reduction is such an important complement to treatment and prevention.

16.95 million doses of the opioid antagonist naloxone were dispensed in 2021. Research indicates that communities should have sufficient naloxone availability to reverse 80 percent of witnessed overdoses. States have enacted access laws to allow the drug to be sold at pharmacies without a prescription, but few communities have….

Naloxone, a safe and effective opioid overdose reversal agent, is one of many essential tools in preventing overdose deaths, but only if it is put into the right hands. Public health experts consider the goal of community saturation—defined as having sufficient community-based naloxone kits to reverse 80 percent of witnessed overdoses—to be both desirable and attainable.

Although medical advocacy organizations’ statements often offer a balanced assessment of e-cigarettes’ potential harms, the message that has been reaching policymakers and the public is that e-cigarettes are more harmful than combustible cigarettes, which is the opposite of the general scientific consensus...

In April, the Biden-Harris administration issued
unprecedented funding for harm reduction, a pragmatic public health solution to the opioid crisis that killed almost 70,000 people in the United States in 2020. Strategies to mitigate the negative health consequences of risky behaviors are not new. In 1964…

Tobacco products exist on a continuum of risk, with combustible products representing the highest risk and electronic nicotine delivery systems falling at the lower end of the risk continuum. Risk-proportionate legislation takes the risk level of tobacco products into consideration when designing regulations. That is…

As cannabis legalization continues to gain momentum, concerns from opponents in a few main areas remain consistent. Authors Stacey McKenna and Chelsea Boyd analyze the validity of five major concerns frequently used in anti-cannabis messaging and find that while some contain kernels of truth, these…

With opioid overdose deaths reaching new highs, the conversation about expanding harm reduction programs is more urgent than ever. In response, cities across the country have indicated support for opening overdose prevention centers (OPCs). OPCs, also known as supervised consumption facilities, are places where people who use drugs (PWUD) can consume drugs they acquire…

As a nation, we are far from embodying the World Health Organization’s ideal of approaching sexual health and sexuality with a positive, respectful and affirming approach. To achieve a freer and healthier society, sexual health policy should not impede individuals’ ability to decide how to engage (or not engage) in sexual activity and how to reduce the risk of undesirable outcomes.

From the time they were first introduced into the market, e-cigarettes have been at the center of a public health debate about their value as smoking-cessation devices versus their appeal to adolescents and potential youth uptake. Since 2019, elected officials in the Northeastern region of the United States—defined herein as Maryland to Maine—have put…

In the United States, half of all people will be diagnosed with a mental health disorder in their lifetime, and depression is the leading cause of years of life lost due to disability worldwide. This paper describes the current evidence for using psychedelics as a treatment for mental health disorders, explores the existing policy landscape and offers suggestions for future psychedelic policy.

Tamera Lynn Stewart had been taking prescribed opioids for 12 years to treat her chronic pain, following some cancer-related surgeries. Then one day in April 2018, her doctor told her he could no longer maintain the treatment that had worked so well for all those years.