Harm Reduction Journal
April 11, 2021
Brian Pilecki, Jason B. Luoma, Geoff J. Bathje et al.
135 citations
As clinical trials show strong evidence for psychedelic-assisted therapy's benefits, many people are using psychedelics on their own rather than waiting for legal medical access. Therapists have an ethical duty to support these clients, but incorporating psychedelics into traditional psychotherapy poses risks given their prohibited status. This paper explicates these risks and describes ways therapists can mitigate them while practicing within legal and ethical boundaries. A harm reduction approach is emphasized as a useful framework for conducting therapy around clients' psychedelic use. Therapists can meet with clients before and after personal psychedelic experiences to help minimize risk and maximize benefit. Common clinical scenarios in this growing area are discussed.
Harm Reduction Journal
July 9, 2019
Thomas Anderson, Rotem Petranker, Adam Christopher et al.
130 citations
A mixed-methods study of an active microdosing community categorizes the experiences participants report, identifying high-potential avenues for future scientific research. The resulting taxonomy distills intervention targets from participant reports to help allocate research funding efficiently. Microdosing research complements full-dose psychedelic studies as clinical treatments and neuropharmacological mechanisms are developed. The framework aims to guide researchers and clinicians as experimental microdosing research begins in earnest.
Harm Reduction Journal
September 4, 2017
Martin Andersson, Mari Persson, Anette Kjellgren
93 citations
People with treatment-resistant cluster headache and migraine often turn to online forums to discuss alternative pharmacological treatments, including illicit psychoactive substances. A qualitative thematic analysis of discussions on three forums found that patients are in a desperate and vulnerable situation, viewing such substances as a last resort. Psilocybin, lysergic acid diethylamide, and related psychedelic tryptamines were reportedly effective for both preventing and treating attacks, while cannabis results were more unpredictable. Users showed little interest in psychoactive effects, often using sub-psychoactive doses to avoid them. No severe adverse events were reported, but desperation sometimes led to risky behavior in obtaining and testing treatments.
Harm Reduction Journal
January 1, 2013
Levente Móró, József Rácz
82 citations
A Hungarian online community called Daath, run by the 'Hungarian Psychedelic Community' since 2001, provides peer-led harm reduction services for users of hallucinogenic and related substances. The website serves about 1200 visitors daily and has over 8000 registered members. Daath offers online services such as a discussion board and an Ecstasy pill database, along with offline activities like field testing of Ecstasy pills and a documentary film about psychedelics. The community operates with a strong commitment to harm reduction without promoting drug use. The review outlines Daath's history, growth, guidelines, and activities over the past decade, and discusses future challenges and trends in harm reduction.
Harm Reduction Journal
January 1, 2007
Rachael Butler, Janie Sheridan
78 citations
Young New Zealanders aged 17–23 who used BZP-party pills in the previous year did so mainly during weekend social occasions and dance parties, seeking stimulant effects and enhanced socialisation. They often combined the pills with other legal and illicit drugs, especially alcohol. Many experienced physical and emotional negative effects, none life-threatening or long-term, and some reduced their use because of adverse effects. Risky behaviours included taking large doses, mixing substances, and driving while under the influence. The findings suggest that although users were not suffering excessive or dangerous harm, the potentially risky patterns of use indicate a need for harm reduction interventions.
Harm Reduction Journal
November 28, 2019
Martin Andersson, Anette Kjellgren
35 citations
Psychedelic microdosing—taking tiny, repeated doses of substances like LSD or psilocybin—is used for therapeutic and enhancement purposes, with predominantly beneficial effects reported, especially for depression. Intentions for use influence outcomes. Social interactions on YouTube focus on discussing views, strategies for optimal results, minimizing risks, and sharing emotional support. Microdosing may offer some benefits of full-dose interventions with fewer adverse reactions, but repeated exposure over extended periods could introduce additional risks.
Harm Reduction Journal
July 24, 2022
Madelene Palmer, Olivia Maynard
29 citations
People who use psychedelics recreationally adopt more harm reduction practices with experience, and those practices are linked to more emotional breakthroughs and fewer challenging experiences. In a mixed-methods online survey of 163 participants, greater use of harm reduction strategies in the most recent trip compared to the first trip was associated with higher scores on the Emotional Breakthrough Inventory and lower scores on the Challenging Experience Questionnaire, especially for the first experience. Participants emphasized the importance of 'set and setting' over specific drug details for enhancing positive effects. The findings inform the development of harm reduction advice for recreational psychedelic use.
Harm Reduction Journal
December 10, 2023
Silvia L. Cruz, Miguel Bencomo-Cruz, María E. Medina-Mora et al.
10 citations
At an outdoor electronic music festival near Mexico City, 40 young adults (mostly single men aged 22–48) provided 51 drug samples for voluntary, confidential testing. Most samples contained the expected drug plus adulterants such as methylene-dioxy-ethyl-amphetamine, methylene-dioxy-propyl-amphetamine, hydroxyamphetamine, and the antidepressant venlafaxine. Fentanyl was detected in 2 of 4 cocaine samples and in 14 of 22 MDMA samples. These adulterants, especially fentanyl and amphetamine-like substances, pose serious health risks. The authors urge monitoring of adulterants at festivals and call for prevention, treatment, and harm reduction policies in Mexico, including naloxone distribution and drug-assisted therapies.
Harm Reduction Journal
August 9, 2023
Hagit Bonny-Noach, Barak Shapira, Pinchas Baumol et al.
9 citations
Among 1,206 Israeli nature rave party attendees surveyed online, the most common illicit substances used in the past year were cannabis (62.2%), LSD (41.4%), MDMA (31.7%), mushrooms/psilocybin (23.9%), ketamine (19.6%), and cocaine (17.2%). A weak but significant association appeared between harm reduction behaviors and positive attitudes toward harm reduction interventions (r = .26) and drug testing kits (r = .33). While positive harm reduction attitudes were higher, implementing corresponding behaviors proved more difficult. Stronger associations with high harm reduction behaviors included positive attitudes toward drug testing kits (odds ratio 4.53) and harm reduction interventions (odds ratio 4.06). Formal harm reduction policies and prevention programs are needed.
Harm Reduction Journal
November 5, 2024
Chris Wilkins, Jose Romeo, Marta Rychert et al.
8 citations
In a large online survey of 23,500 New Zealanders who used cannabis and at least one other substance in the same six-month period, substantial proportions reported that cannabis use led them to use less alcohol (60%), synthetic cannabinoids (60%), morphine (44%), and methamphetamine (40%). About seven out of ten said cannabis had no impact on their use of LSD, MDMA, or cocaine. One in five reported that cannabis led to more tobacco use. Co-use patterns varied by age, ethnicity, and lifestyle: young adults (21–35) were more likely to report reduced drinking and methamphetamine use, while Māori were more likely to report reduced use of alcohol, tobacco, methamphetamine, and LSD.
Harm Reduction Journal
December 6, 2023
Yula Milshteyn, Moshe Bensimon
8 citations
Regular attendees of rave music parties in Israel who use psychedelic drugs report feeling insecure and anxious due to the government's strict drug ban policy, and they perceive stigma from law enforcement and society. Short-term negative experiences include hallucinations and disorientation, while positive experiences include intensified sensory perceptions, emotional release, self-acceptance, and a greater appreciation of life and nature. The study suggests that reducing police presence and adopting harm reduction policies could increase participants' sense of security, reduce stigmatization, and lower overdose risk.
Harm Reduction Journal
July 28, 2023
Théo Willeman, Nathan Grundig, Christine Pochon et al.
8 citations
Between February and September 2021, a study of 45 samples from 33 people who use 3-MMC in Auvergne-Rhône-Alpes, France, found that the purity of the powder ranged from 21% to 98%. Most users were male (91%), median age 40, and regular users who bought the drug online via the Clear Web. Intravenous use was reported by 15.2% of participants. Other drugs, including 4-CEC, 4-MMC, and 2-FDCK, were also detected. Drug testing was requested by 86% of users, indicating a strong desire for harm reduction services. The data suggest that drug-checking programs can help this population.
Harm Reduction Journal
March 21, 2024
Jai Whelan, Geoff Noller, Ryan D Ward
6 citations
MDMA is widely used in Aotearoa New Zealand and is the main drug analyzed by legal drug checking services. An online survey of 915 people who use MDMA (60.7% female, ages 18-65, median 24) found that most carried out harm reduction behaviors relatively frequently, but those who reported experiencing harm from MDMA or a substance mistaken for MDMA engaged in these behaviors less often. Reagent testing was used by 42.3% of the sample, and 27% had used KnowYourStuffNZ services, with 95.9% of clients learning about harm reduction and 53.3% changing their behavior. Harm was reported by 14.4% of the sample, primarily physical or psychological, and potential MDMA dependence was apparent in 6.9%. The findings emphasize the need for greater availability of drug checking services.
Harm Reduction Journal
October 18, 2024
Nicolas Fabresse, Eurydice Papias, Alma Heckenroth et al.
3 citations
Drug checking services use analytical methods to identify substances in samples from people who use drugs. A quantitative LC-UV method was cross-validated against a reference LC-HRMS method at the DrugLab in Marseille, France. Across 102 samples, differences between the two methods for each molecule were ≤20%, with significant correlations for cocaine, ketamine, MDMA, heroin, amphetamine, caffeine, acetaminophen, and levamisole. LC-HRMS gave lower concentrations for cocaine and acetaminophen but higher values for other substances. The results demonstrate that LC-UV is accurate and reliable for simple drug matrices in a harm reduction context, though ongoing proficiency testing is needed to monitor accuracy over time.
Harm Reduction Journal
May 23, 2024
Jai Whelan, Ryan D Ward, Geoff Noller
2 citations
MDMA is less harmful than many other drugs but still causes significant harms, including deaths. Sixty people who use MDMA in southern Aotearoa New Zealand, aged 18 to 67 (median 21), shared their views on harm and harm reduction in 14 focus groups. Five themes emerged: mindset and setting matter; looking after your body and mind and not overdoing it; other substances increase risk and harm; trusted friends and peers are protective; and valid information is key for healthy self-determination, with a subtheme that drug checking is essential harm reduction. These findings aim to inform national drug policy and improve harm reduction practices for consumers and organisations.
Harm Reduction Journal
February 6, 2026
Keaton Hudson-Buhagiar, Jonathan Brett, Alanah Spillane et al.
1 citation
Among heterosexual Australians who use GHB, three patterns of use—occasional, regular, or daily—emerged. Four key themes were identified: escapism (managing mental health symptoms, enhancing confidence, facilitating sex, and alleviating body consciousness in women); diverse understandings of overdose, including intentional dosing to achieve unconsciousness and misconceptions about using stimulants to counter toxicity, with fear of police delaying help-seeking; stigma from both drug-using and non-using peers; and gendered harm reduction practices where women protect each other from harms, especially sexual violence. Findings point to gaps in public health education on overdose management and intentional risk-taking.
Harm Reduction Journal
March 29, 2026
Piotr Siuda, Paweł Matuszewski
An analysis of the largest Polish drug forum, Hyperreal, found that health-related posts about psychoactive substances had moderate quality. Topic modeling of 159,145 posts revealed associations between specific drugs and health topics—such as ketamine with depression, marijuana with symptom relief, amphetamines with cardiovascular issues, and fentanyl with palliative care—that mirrored medical literature, indicating knowledge grounded in evidence rather than anecdote. However, expert evaluation using a custom questionnaire showed significant informational gaps. The mean quality score was 35.67 out of a possible range, with factual accuracy rated moderate and safety aspects—especially dosage guidance and encouragement to consult specialists—scoring lowest. The findings highlight the need to improve content quality on drug forums for harm reduction.
Harm Reduction Journal
March 2, 2026
Cianna J Piercey, Joseph Cameron, Riley Ahern et al.
Kratom, a psychoactive botanical, is increasingly used in the United States. A survey of 102 participants (average age 22.34 years, 39.2% women) recruited from ethnobotanical tea bars in Northern Colorado found that 75.5% had experienced at least one adverse reaction. Adverse reactions most commonly occurred when kratom was consumed on an empty stomach, with certain foods, without adequate hydration, or combined with other substances. Participants used strategies like stopping or pacing use, adjusting hydration and food intake, and resting to mitigate reactions, though the effectiveness of these techniques remains unknown. The findings suggest that contextual factors may contribute to adverse reactions, highlighting the need for more research to inform harm reduction and public health messaging.
Harm Reduction Journal
February 14, 2026
Camilo Obregón-berg, Bruno Fuentealba-Donoso, Isidora Vidal et al.
At 22 electronic music events in Santiago, Chile, a peer-led drug-checking program analyzed 992 samples from attendees. Over 80% of samples expected to be MDMA contained MDMA, while 10% contained MDA instead and 8% were adulterated with methamphetamine. All cocaine samples contained cocaine, but 71% were adulterated. Ketamine was the only substance in 42% of ketamine samples; 33% contained ketamine and MDMA, 15% had ketamine plus other substances, and 10% had no detectable substances. Tusi samples varied widely. Excluding tusi, about 70% of samples matched expectations, 14% were adulterated, and 16% lacked the expected drug. The findings highlight the need for expanded harm reduction services in Chile.
Harm Reduction Journal
September 29, 2025
Yen-Chun Kuo, Sheng-Chang Wang, Chuan-Yu Chen
Illicit ketamine use is strongly linked to increased suicidality, especially among recent users. In a study of 379 people in northern Taiwan, recent ketamine users had four times higher past-month suicidality (95% CI 1.35–12.27) and past users had 3.4 times higher risk (95% CI 1.01–11.45) compared with those who never used ketamine. The prevalence of middle to high suicide risk was 10.8% among recent users, 5.0% among past users, and lower among non-users. Excess risk appeared exclusively in suicidal ideation. Street ketamine users also had higher rates of major depressive disorder, disadvantaged socioeconomic status, legal issues, and lifetime suicide attempts (25%). Even past users remain at higher risk, underscoring the need for suicide risk assessments in community drug services.
Harm Reduction Journal
February 5, 2022
Joseph J Palamar, İbrahim Sönmez
Dance festivals create high-risk environments for drug use, particularly for inexperienced attendees. Interviews with 35 North American experts identified four key risk factors: attendees unfamiliar with party drugs, risky drug purchasing from strangers, dangerous consumption practices driven by fear of security, and festival-specific environmental hazards like crowding, heat, dehydration, exhaustion from long event days, and inadequate medical response. These modifiable factors can guide prevention and harm reduction efforts.