From the document: "Cyber threat actors are aware of--and deliberately target--single points of failure. A compromise or failure of a Water and Wastewater (WWS) Sector organization could cause cascading impacts throughout the Sector and other critical infrastructure sectors [hyperlink]. There are many aspects of the large and complex WWS Sector that pose challenges to raising cyber resilience sector wide: [1] Governance and regulation involve a mix of federal and state, local, tribal, and territorial authorities. [2] Cybersecurity maturity levels across the sector are disparate. [3] Often, WWS Sector utilities must prioritize limited resources toward the functionality of their water systems over cybersecurity. [4] Universal solutions to cyber challenges in a diverse, target-rich, and resource-poor environment are unfeasible. To provide meaningful cybersecurity support to the WWS Sector that can help with these challenges, CISA [Cybersecurity and Infrastructure Security Agency]--in conjunction with the Environmental Protection Agency (EPA) and the Federal Bureau of Investigation (FBI), as well as the federal government and WWS Sector partners listed in this guide's acknowledgement section--has created this joint Incident Response Guide (IRG) for the WWS Sector. The unique value of this joint IRG is that it provides WWS Sector owners and operators information about the federal roles, resources, and responsibilities for each stage of the cyber incident response (IR) lifecycle. Sector owners and operators can use this information to augment their respective IR plans and procedures. By empowering individual WWS Sector utilities, the authors of this guide--CISA, FBI, EPA, and the acknowledged federal government and WWS Sector partners--aim to drive improvements to cyber resilience and incident response across the WWS Sector."

From the document: "The healthcare sector is particularly vulnerable to cybersecurity risks and the stakes for patient care and safety are particularly high. Healthcare facilities are attractive targets for cyber criminals in light of their size, technological dependence, sensitive data, and unique vulnerability to disruptions. And cyber incidents in healthcare are on the rise. For instance, HHS tracks large data breaches through its Office for Civil Rights (OCR), whose data shows a 93% increase in large breaches reported from 2018 to 2022 (369 to 712), with a 278% increase in large breaches reported to OCR involving ransomware from 2018 to 2022. Cyber incidents affecting hospitals and health systems have led to extended care disruptions caused by multi-week outages; patient diversion to other facilities; and strain on acute care provisioning and capacity, causing cancelled medical appointments, non-rendered services, and delayed medical procedures (particularly elective procedures). More importantly, they put patients' safety at risk and impact local and surrounding communities that depend on the availability of the local emergency department, radiology unit, or cancer center for life-saving care. [...] This paper provides an overview of HHS' [U.S. Department of Health and Human Services'] proposed framework to help the healthcare sector address these cybersecurity threats and protect patients."

By Global Commission on Drug Policy 

Illegal drug markets provide an immense source of power and revenue for organized criminal groups. That has remained the case despite the vast investment of political, financial, social, and military capital into the global “war on drugs,” which has also generated a vast and tragic human cost. Far from curtailing drug markets, which are in fact expanding in scale and complexity worldwide, repressive criminal justice and military responses to drug trafficking have exacerbated the already profound impacts of drug-related organized crime, from prolific violence in certain states to increased corruption, and undermined political and economic stability. Deep-seated schisms continue in international debates on drug policy. Despite renewed commitment to the prohibitionist approach at the March 2019 Ministerial Declaration of the United Nations (UN) Commission on Narcotic Drugs (CND), there is increasing acknowledgement within the UN system of the harms of the current drug control regime, and the need to pursue options such as decriminalization of use and possession for personal use. Countries are increasingly adopting decriminalization models, and the legalization and regulation of cannabis for recreational use is becoming a reality in a number of jurisdictions. Yet at the same time, other countries have moved in the opposite direction, redoubling efforts to eradicate drug use through punitive approaches which harm health and human rights. Given this highly polarized context, the need for reform-minded states to advocate for evidence-based responses to organized crime and drug trafficking is greater than ever. This report supports this effort by building on the five key pathways towards improving drug policy as outlined in the Global Commission’s 2014 report. Alongside strategies to ensure the health and safety of those using drugs, this coherent five-fold program advocates for refocused enforcement responses to drug trafficking and organized crime as an essential part of drug policy reform. This report provides an overview of how the global “war on drugs” has, counter to its ostensible aims, fed and empowered transnational organized crime. More effective responses to transnational organized crime and drug trafficking – through both targeted and measured law enforcement approaches and development strategies which counter the root causes of organized crime – are possible and may be enacted even while markets remain illegal. The legal regulation of drugs offers an unprecedented opportunity to move drugs markets out of criminal control, as the Global Commission stated last year, but also presents new challenges for countering organized crime. This report explores lessons learned both in a context of prohibition and of a legally regulated market. Implementation of more progressive drug policies has often been held back by the international control regime; through a lack of coherence among UN entities, between regional bodies, and the deep-seated conservatism in the international regime. As such, this report considers the past record of the international drug control regime with respect to the fight against drug trafficking, and how more effective coordination could be achieved in the future, if political will is to be found. 

Geneva: The Global Commission, 2020. 52p.

By Beau Kilmer | Bryce Pardo | Toyya A. Pujol | Jonathan P. Caulkins

Background and aims: Synthetic opioids, mostly illegally manufactured fentanyl (IMF), were mentioned in 60% of United States (US) drug overdose deaths in 2020, with dramatic variation across states that mirrors variation in IMF supply. However, little is known about IMF markets in the United States and how they are changing. Researchers have previously used data from undercover cocaine, heroin, and methamphetamine purchases and seizures to examine how their use and related harms respond to changes in price and availability. This analysis used US Drug Enforcement Administration (DEA) data to address two questions: (i) “To what extent does IMF supply vary over time and geography?” and (ii) “What has happened to the purity-adjusted price of IMF?” Methods: We developed descriptive statistics and visualizations using data from 66 713 observations mentioning IMF and/or heroin from the DEA’s System to Retrieve Information from Drug Evidence (STRIDE; now STARLIMS) from 2013 to 2021. Price regressions were estimated with city-level fixed effects examining IMF-only powder observations with purity and price information at the low-to-medium wholesale level (>1 g to ≤100 g; n = 964). Results: From 2013 to 2021, the share of heroin and/or IMF observations mentioning IMF grew from near zero to more than two-thirds. The share of heroin observations also containing IMF grew from <1% to 40%. There is important geographic variation: in California, most IMF seizures involved counterfeit tablets, whereas New York and Massachusetts largely involved powder formulation. The median price per pure gram of IMF powder sold at the >10 to ≤100 g level fell by more than 50% from 2016 to 2021; regression analyses suggested an average annual decline of 17% (P < 0.001). However, this price decline appears to have been driven by observations from the Northeast. Conclusions: Since 2013, the illegally manufactured fentanyl problem in the United States has become more deadly and more diverse. 

Addiction. 2022;117:2745–2749. 

By Julia A Dilley, Susan M Richardson, Beau Kilmer, Rosalie Liccardo Pacula, Mary B Segawa, Magdalena Cerdá

Methods| The Washington Healthy Youth Survey (HYS) 2 is an anonymous, school-based survey of 8th, 10th, and 12th graders and the state’s primary source of information about health behavior among youths. The HYS has been implemented in the fall of even-numbered years since 2002, using a simple random sample of public schools to generate a state-representative sample. Response rates (incorporating school and student response) in 2016 were 80% for 8th grade, 69% for 10th grade, and 49% for 12th grade. The study was approved by the Washington State Institutional Review Board, whose general policy waives informed patient consent when data are de-identified. We Generated Covariate-adjusted prevalence estimates, modeling as closely as possible to Cerdá et al. Prevalence was based on modeled estimates (ie, SUDAAN predMARG [RTI International] postestimation command). Because the the MTF is not designed to provide state-representative estimates, the article generated covariate-adjusted modeled prevalence estimates for each state. The article suggested complex association between legalization and cannabis use among youths: increases in prevalence among Washington 8th and 10th graders, but not among 12th graders, relative to use in states without legalization of recreational marijuana.

The authors noted that, “the sample design may lead to discrepancies between MTF results and those found in other large-scale surveillance efforts.”1(p148) The purpose of the present study was to assess whether trends in cannabis use prevalence among youths from Washington’s state-based youth survey are consistent with findings from the MTF.

JAMA pediatrics, 173(2) 2019

By Bridget E. Weller,  Stephen Magura,  Dawn R. Smith, Matthew M. Saxton, Piyadarsha Amaratunga

  Background: Drug monitoring by drug testing of individuals under arrest provides an opportunity to detect drug use patterns within geographic areas. However, women have been omitted from large-scale monitoring efforts in criminal justice populations. The purpose of this study was to examine whether gender differences exist in drug use indicated by oral fluid collected in one U.S. jail. Methods: The study analyzed data collected in 2019-2020 from individuals under arrest (N = 191). Twenty-four percent of the sample identified as female. Oral fluid specimens were collected and then analyzed with enzyme-linked immunosorbent assay and liquid chromatography/tandem mass spectrometry. Logit regression models examined gender differences. Results: Women were more likely to test positive for methamphetamines than men (41% versus 22%, OR = 0.42, 95% CI 0.21-0.84). Significant gender differences were not found for other substances (marijuana, cocaine, and opioids), legality of drugs, or overall drug use. Conclusions: Because the National Institute on Drug Abuse aims to promote health equity, future drug monitoring in criminal justice populations should employ sampling approaches representing both women and men. This research would identify possible gender-based patterns of drug use and inform gender-based policies and clinical practices to prevent and treat drug misuse.

J Subst Use. 2023 ; 28(4): 541–544. 

By Tara N. Richards; Justin Nix; Bradley A. Campbell; Emily Wright; Caralin C. Branscum; Sheena L. Gilbert; Michaela Benson-Goldsmith; Emily K. Meinert

This final report for the National Institute of Justice (NIJ) Award 2019-MU-MU-0095 describes a research project that used a variety of methods to evaluate the activities undertaken by stakeholders in the Minnesota Sexual Assault Initiative (MN SAKI) project, including the following four goals: eliminating untested sexual assault kits (SAKs); building capacity for criminal justice agencies to test SAKs, pursuing all investigatory leads, providing victim referrals, and prosecuting cases resulting from testing; and strengthening victim services. The authors also completed a cost-benefit analysis of MN SAKI Project’s SAK testing efforts. The report provides details and outcomes regarding each of the project goals; it discusses SAK outcomes, costs, and benefits, and discusses the project findings and implications. The document's appendixes provide the following documents: Bureau of Criminal Apprehension Report on the MN Law Enforcement Agency Survey of Untested Rape Kits as Required by SF0878; MDT Interview Questions; Stakeholder Informed Consent Form; Victim Reaction Form; Victim-Survivor Experiences Interview Guide; Victim-Survivor Informed Consent Form; ViCAP Interview Guide; Minnesota Track-Kit Patient Guide; and Minnesota SAKI Victim-Survivor Notification Guide. 
Final report to the U.S. National Institute of Justice, 2023. 218p.

By Karamoja–Turkana and the Community Research Team 

Ipoln the Karamoja and Turkana border regions of Uganda and Kenya, there is widespread violence including armed robbery, rape, and human rights abuses, yet community complaints about failures of governance remain largely unaddressed. This Policy Briefing highlights how different insecurities reinforce one another in ways exacerbated by the international border. It stresses the need for fulfilment of the two governments’ commitments to cross-border solutions, and suggests that international policy actors can help communities gain leverage with governments towards building trustworthy and effective peace and security institutions.

IDS Policy Briefing 214,

Brighton, UK: Institute of Development Studies, 2023. 4p.

By Jacob Bor, Atheendar S Venkataramani, David R Williams, Alexander C Tsai

Background Police kill more than 300 black Americans—at least a quarter of them unarmed—each year in the USA. These events might have spillover effects on the mental health of people not directly affected. Methods In this population-based, quasi-experimental study, we combined novel data on police killings with individual-level data from the nationally representative 2013–15 US Behavioral Risk Factor Surveillance System (BRFSS) to estimate the causal impact of police killings of unarmed black Americans on self-reported mental health of other black American adults in the US general population. The primary exposure was the number of police killings of unarmed black Americans occurring in the 3 months prior to the BRFSS interview within the same state. The primary outcome was the number of days in the previous month in which the respondent’s mental health was reported as “not good”. We estimated difference-in-differences regression models—adjusting for state-month, monthyear, and interview-day fixed effects, as well as age, sex, and educational attainment. We additionally assessed the timing of effects, the specificity of the effects to black Americans, and the robustness of our findings. Findings 38 993 (weighted sample share 49%) of 103710 black American respondents were exposed to one or more police killings of unarmed black Americans in their state of residence in the 3 months prior to the survey. Each additional police killing of an unarmed black American was associated with 0·14 additional poor mental health days (95% CI 0·07–0·22; p=0·00047) among black American respondents. The largest effects on mental health occurred in the 1–2 months after exposure, with no significant effects estimated for respondents interviewed before police killings (falsification test). Mental health impacts were not observed among white respondents and resulted only from police killings of unarmed black Americans (not unarmed white Americans or armed black Americans). Interpretation Police killings of unarmed black Americans have adverse effects on mental health among black American adults in the general population. Programmes should be implemented to decrease the frequency of police killings and to mitigate adverse mental health effects within communities when such killings do occur.

Lancet 2018; 392: 302–10 

By The International Labour Association

Occupational Safety and Health (OSH) measures are key to building an inclusive, integrated and gender-responsive approach to preventing and eliminating violence and harassment in the world of work, a new International Labour Organization (ILO) report finds. According to the report more than one-in-five people in employment have experienced violence and harassment. This issue can affect all types of workplaces and can also occur during commutes, work-related trips, events, digital communications, social activities and in home-based offices. The report emphasizes that OSH frameworks tackle root causes of violence and harassment by addressing underlying risks such as inadequate work organization, factors related to specific tasks (e.g. working alone or constantly interacting with third parties), and working conditions that produce high stress levels that in turn lead to violence and harassment. Occupational safety and health frameworks that are based on workplace cooperation and social dialogue, mobilize both employers and workers to create working environments free from violence and harassment, the analysis says

Geneva, SWIT: ILO, 2024. 5p.

By Lucia Bird Ruiz Benitez de Lugo, Mouhamadou Kane, Jason Eligh and Lyes Tagziria

Across Africa, the GI-TOC has documented the proliferation of synthetic drugs, the resulting transformation of drugs markets and the escalation of drug-related harm. The nature of synthetic drug markets – with their low barriers to entry and flexible supply chains – makes them attractive to criminal actors and difficult to respond to. The response in Africa is further hampered by a dearth of evidence regarding the scope and scale of the synthetic drug market. This report explores how synthetic drug markets respond to programming seeking to disrupt them. Tramadol is used as a lens through which to consider existing response frameworks to synthetic drugs in the ECOWAS region and more broadly.

ENACT Africa, 2024.

By Alessia Rossi

Organised crime is one of the most important threats to the functioning of the rule of law and democracy. This research will analyse why the ‘ndrangheta, with its structure, ranks among the most powerful mafias. Specifically, consideration will be paid to cocaine trafficking, which is their most profitable supply channel. One of their main strengths is having ‘ndrine located all over the world, especially in Latin America. There, brokers manage to contract with key organisations, such as the Urabeños. Moreover, to carry out operations mainly via containers, they have trusted corrupt accomplices in the ports. In the latter, the ‘ndrangheta may not only have influence but even be embedded, as in the case of the port of Gioia Tauro. Finally, it will be examined not only the transnational approach but also the need for a national response of increasing port security in limiting the infiltration of the Calabrian mafia.  

Fiesole FI, Italy:  Transnational Governance of the European University Institute, 2023. 43p.

By TRAFFIC

The research, conducted by a team of experts, focused on Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan. It began with an in-depth examination of social media platforms, where illegal wild species trade activities often thrive.

While these countries have made efforts to align their legal systems with international conventions and treaties, the study identified noticeable gaps and weaknesses in the enforcement of these laws. Ambiguous definitions, inadequate penalties, and shortcomings in regulating online trade were among the key issues identified.

The current legal frameworks in Central Asia are not effectively addressing the challenges posed by illegal wild species trade. To ensure the long-term success of sustainable trade, it is crucial to address these gaps and strengthen enforcement mechanisms.

The study provides a set of recommendations to address the identified shortcomings. These include clarifying definitions, enhancing penalties for offenders, and improving regulations for online trade. By implementing these recommendations, Central Asian countries can take significant steps towards curbing illegal wild species trade and promoting sustainable economic growth.

The findings of this study must urge policymakers to prioritise the enforcement of laws to stop steep declines of biodiversity in their countries. Sustainable and legal trade can only thrive when supported by robust and effective legal frameworks.

Cambridge, UK: TRAFFIC International, 2024. 101p.

By Serene C.L. Chng, Salman Saaban, Anongrakh Wechit, Kanitha Krishnasamy

Although the Oriental Magpie-robin Copsychus saularis is still a commonly seen species in many parts of Malaysia, high demand for it as a cage bird domestically and in neighbouring countries has resulted in trapping and smuggling of Malaysian populations. Analysis of seizure data for this species, as it implicated Malaysia, shows an escalation of international trafficking in recent years to feed the persistent demand for the pet trade. Overall, at least 26,950 Oriental Magpie-robins were seized from 44 incidents that implicated Malaysia from January 2015–December 2020, averaging at least 613 birds per seizure. These seizures took place in Indonesia, Malaysia and Singapore. Of these, Malaysian and Indonesian authorities definitively reported that 17,314 (64%) birds were being smuggled from Malaysia to Indonesia. This points to Malaysian populations of the Oriental Magpie-robin being increasingly targeted to feed demand in neighbouring countries, particularly Indonesia. At least 17,736 (66%) of all birds were confiscated in just 2020, signifying a current and possibly growing problem. This could be due to an increase in enforcement effort, coupled with dwindling populations in parts of Indonesia to supply birds for trade. A total of 23 seizures occurred in Malaysia, all were confined to the states of Johor, Melaka, Sarawak and Sabah involving a total of 17,997 birds. Most incidents in the first three states pointed to cross-border smuggling (the case in Sabah was a confiscation on premises). In eight of the Malaysian seizures, where birds were being trafficked to Indonesia, at least 16 Indonesian nationals were arrested, strongly suggesting networks of smugglers moving birds between the two countries. Many of these were reported to be illegal immigrants, indicating an additional national security concern.

TRAFFIC, Southeast Asia Regional Office, Petaling Jaya, Selangor, Malaysia: 2021. 20p.

By David Bright and Simone J Deegan 

Outlaw motorcycle gangs (OMCGs) are often reported to be disproportionately involved in crime. Debate continues about the relationship between the organisational structure of these groups and the extent and types of criminal activities undertaken by group members. A systematic review of the existing literature was conducted to examine the organisational structures that underpin the criminal activity of OMCGs. The available empirical research, though scant, supports the notion that, at least in some clubs or chapters, the structure of OMCGs facilitates criminal activities by individuals or small cliques, sometimes in collaboration with non-members. 

Australia.. Australian Institute of Criminology. Trends & issues in crime and criminal justice no. 621. March 2021. 16p

By Josef Job G. Raymundo, Emerson Y. Sy, and Serene C.L. Chng

The Philippines has a rich hornbill diversity, but many species are found in a restricted range and threatened by habitat loss, hunting for wild meat and cultural objects, and the live bird trade.

This threat is reinforced by the discovery of 143 live hornbills from nine taxa for sale online from 2018-2022, reported in Farmers of the Forest in Cages: The Online Trade of Hornbills in the Philippines.

While the Luzon Tarictic Hornbill was the most recorded species in the study (73% of all individuals), five Endangered Visayas Tarictic Hornbill Penelopides panini were also offered for sale.

Two-thirds of traders recorded were in central Luzon and likely sourced wild hornbills within or from nearby provinces, said the report authors.

Seizure records during the same period showed a further 66 hornbills seized in 24 incidents.

TRAFFIC, Southeast Asia Regional Office, Petaling Jaya, Selangor, Malaysia, 2023. 24p.

By Bakytbek Tokubek uulu, Sanjar Kurmanov, Louisa Musing

Law enforcement agencies in Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan can greatly benefit from systematically collecting, analysing, and sharing data with neighbouring countries on illegal wild species traders, networks, and trade routes. By doing so, these agencies can effectively bring these criminals to justice.

The report comprises four main parts: Guidance on Illegal Wild species Trade Data Collection, Guidance on Illegal Wild species Trade Data Analysis, Guidance on Illegal Wild species Trade Data Sharing, and Training and Capacity Building Resources to Support Law Enforcement Agencies Tackling the Illegal Wild species Trade.

The Guidance also includes examples of best practices from other countries, including European Union Member States. Additionally, the report references existing resources such as the ICCWC Wild species and Forest Crime Analytic Toolkit and consolidates various tools and resources from initiatives like CITES, the World Customs Organisation (WCO), and the United Nations Office on Drugs and Crime (UNODC) websites.

The report acts as a guidance tool, urging law enforcement agencies to adopt best practices in combating illegal wild species trade. By understanding the intricacies of this criminal activity and leveraging data-driven approaches, agencies can significantly enhance their effectiveness in tackling this global issue.

Cambridge, UK: TRAFFIC, 2024. 36p.

By Bakytbek Tokubek uulu, Louisa Musing, Amy Woolloff, Kanaat Musuraliev, Sanjar Kurmanov, Stephanie von Meibom S

Central Asia boasts a remarkable array of ecosystems, harbouring a diverse range of animals, plants and fungi, from majestic Saker falcons to the slow Steppe Tortoises alongside the unique Saiga antelope and various wild species of Bovidae, including Argali Mountain sheep and Siberian Ibex and plants like liquorice root that is used in herbal remedies and teas globally. While the assessment primarily focuses on the trade in animal and plant species listed in CITES Appendices, it also encompasses information on nationally protected but non-CITES-listed species.

The report, part of a trio of Central Asia publications, identifies several species that frequently appear in country seizure records, indicating the need for regional collaboration to combat illegal trade.

Notably, the Saiga Antelope emerges as the most frequently reported species in seizure records from government agencies in Kazakhstan, with smaller records in Kyrgyzstan and Uzbekistan. The Saker Falcon also features prominently in seizure records from Kazakhstan, Kyrgyzstan, and Uzbekistan, with additional reports of live falcons seized upon import to the UAE from Tajikistan. Kazakhstan and Uzbekistan have seized several thousand live specimens of the Steppe Tortoise.

Beyond providing a comprehensive overview of wild species trade, the study aims to identify common challenges and propose solutions to assist national agencies in coordinating efforts to combat illegal trade while effectively managing and regulating legal wild species trade.

Cambridge, UK: TRAFFIC, 2024. 90p.

By Robby Roks & Lieselot Bisschop & Richard Staring

As an important gateway to Europe, the Port of Rotterdam is known for its high-quality facilities and efficiency, but also attracts organised crime groups who use the transatlantic legal trade flows to traffic cocaine. Based on a qualitative study, consisting of 73 interviews with public and private actors, an analysis of 10 criminal investigations and field visits to public and private organisations in the port, this article examines how organised crime groups involved in cocaine trafficking take advantage of or adapt to the socio-spatial relations in the Port of Rotterdam. First, we pay attention to which physical spaces in the port of Rotterdam provide opportunities for cocaine trafficking. Second, we examine how the occupational and legal environment in which people, private companies and law enforcement agencies in the port work and interact provide opportunities for cocaine trafficking. Our findings demonstrate that increased security measures by both public and private actors directed at physical spaces result in a displacement to new spaces in and around the port of Rotterdam. Furthermore, the current socio-spatial relations in the port of Rotterdam also make the role of people on the inside – referring to a whole range of public and private employees – increasingly indispensable. 

Trends in Organized Crime (2021) 24:171–188 

By Sarah S. Shin, Kate LaForge, Erin Stack, Justine Pope, Gillian Leichtling, Jessica E. Larsen, Judith M. Leahy, Andrew Seaman, Daniel Hoover, Laura Chisholm, Christopher Blazes, Robin Baker, Mikaela Byers, Katie Branson & P. Todd Korthuis

Background

Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade.

Methods

We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes.

Results

PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers.

Conclusion

PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD.

Harm Reduction Journal volume 19, Article number: 76 (2022)