"Historically, harm reduction principles are actualized when individuals and groups take sometimes illegal measures to protect their communities. Once systemic structures recognize the value in these practices, they might become decriminalized and widely supported by public health institutions. As an example, supervised consumption sites have been created; these are spaces where individuals can use drugs in a sterile and monitored space with access to supplies and care. Legalized in certain European nations, Canada, and Australia, supervised consumption sites in the U.S.

"Harm reduction is a collection of concepts and strategies that can be used to reduce adverse health consequences associated with drug use [1]. Harm reduction strategies can be conceptualized as a continuum of approaches from safer drug use practices to abstinence, with an underlying core ethos of a desire to meet people where they are at.

"In a harm reduction setting, a FTS might be used to test the drug residue in a cooker or baggie for fentanyl before use of the drug. Our results show that the concentrations of diphenhydramine, methamphetamine, and MDMA commonly found in street drugs are at levels that could generate false positives on the FTS. Many cookers and small baggies hold about 0.75–1 mL of water. If we assume there is 5 mg of methamphetamine in the container that is diluted with 1 mL of water, the concentration of methamphetamine will be 5 mg/mL and would trigger a false positive on the FTS.

"In order to help prevent overdoses, lateral flow immunoassay test strips originally designed for monitoring traces of fentanyl and its analogs in urine are being explored as a drug checking technology in harm reduction contexts [17,18,19,

"Within a large cohort of people with opioid use disorder in New South Wales, Australia, we performed a self-controlled study to test the effect of incarceration and OAT transitions on the risk of hospitalization with injection drug use-associated bacterial infections. Compared to time between five and 52 weeks continuously living in the community, incidence of injecting-related infections increased before incarceration; was similar during the first two weeks of incarceration; and then substantially decreased among people in prison for more than three weeks.

"In 2006, the Vancouver Police Department (VPD), the police force within the city of Vancouver in British Columbia (BC), Canada, formalized its drug policy and endorsed harm reduction as a core pillar of its strategy, alongside prevention, treatment, and law enforcement [5].

"Oregon and Washington have recently made changes to their drug laws to fully or partially legalize possession of small amounts of drugs and increase investment in treatment access. To our knowledge, this is the first study to evaluate the association between those changes and fatal drug overdose.

"Regarding the potential for inconsistent application and enforcement of the 2.5g threshold, participants suggested that smaller, Northern, or isolated communities could be particularly vulnerable to police use of discretion, which could result in important jurisdictional disparities. For instance, many participants believed that police in rural and remote settings were more likely to criminalize and discriminate against people who use drugs.

"Our study also underscores the importance of recognizing the long history of uncertainty, punitive actions, and negative experiences with police among people who use drugs. Decriminalization in BC and implementation among police has important implications regarding building trust between people who use drugs, the community, and law enforcement. While there is the potential to reduce stigmatization and criminalization against people who use drugs, the discretionary power of law enforcement will play a large role in achieving these outcomes.

"The study’s findings emphasize that although some participants expect decriminalization to result in positive outcomes and felt as though the 2.5g threshold was appropriate, the majority of participants foresaw a number of significant limitations due to the defined threshold quantity. Our findings offer insights into what those limitations are.