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Europe has been the first home for the harm reduction movement, acknowledging its values and principles relatively early, although not without challenges. Built on successful experiences starting in the early 1980s, some pioneering European countries committed, invested in and implemented a broad spectrum of harm reduction services over the years. The HIV/AIDS epidemic helped to establish a broader recognition of the effectiveness of harm reduction policies in other countries as well by the mid-1990s. However, we argue that the adoption of harm reduction is lagging behind in important ways, leading to uneven and poor implementation of services. In this perspective-paper, we highlight some reasons that may have contributed to this, and we explore how multiple societal trends and the current conceptualisation of harm reduction have hindered further acceptance and implementation. We do this by revealing assumptions underlying the concept of harm reduction. Finally, we explore how we may move harm reduction forward as a field.

Background Although medical cannabis has been legally available by prescription in the Netherlands for more than two decades, few individuals use it. Instead, most people who use cannabis for therapeutic purposes continue to obtain it through unregulated, illicit sources. This study examined barriers to accessing prescribed cannabis from the perspectives of people using non-prescribed cannabis for medicinal purposes in the Netherlands. Methods Semi-structured qualitative interviews were conducted with thirty-three participants who used non-prescribed cannabis to manage somatic or psychiatric symptoms. Data collection and analysis were guided by Levesque and colleagues’ patient-centred access to care framework, which encompasses five dimensions of accessibility: affordability, availability, approachability, appropriateness, and acceptability. The framework provides a multidimensional view of access within healthcare systems. A deductive coding approach and thematic analysis were applied. Reporting followed the COREQ guidelines. Results Participants reported barriers across all five dimensions of the access to care framework. Key challenges included the perceived high cost of prescribed cannabis, the limited availability of prescribing physicians, restrictive medical guidelines, and a lack of accurate and accessible information. Additional barriers were the perceived poor fit between services and patient needs, particularly in terms of cannabis product variety and effectiveness, as well as persistent stigma surrounding cannabis use. While most participants expressed a preference for prescribed cannabis in principle—valuing its safety, quality, and legitimacy—these perceived barriers prevented or dissuaded them from access through the formal healthcare system. Conclusions Despite its longstanding legal status, access to prescribed cannabis in the Netherlands remains constrained by significant structural, informational, and sociocultural barriers. Addressing these barriers requires coordinated policy reforms and healthcare responses to ensure equitable, patient-centred access to prescribed cannabis and reduce reliance on unregulated sources.

Background and objectives Substance use in women is associated with unique psycho-social and physical vulnerabilities and poses complex challenges during pregnancy and motherhood. Gender-sensitive drug policy which considers the needs of women and their children could address these concerns. The objectives of this study were: (1) to systematically explore national-level drug policies’ sensitivity and responsiveness to women, pregnant women, and children; and (2) to examine the adherence of drug policies with international guidelines for gender sensitivity in drug policy. Methods The research team was diverse professional backgrounds and nine countries. A summative content analysis of national drug policy documents, action plans, and strategies was performed. Specific documents focusing on women, pregnancy, and children were analysed. Specific themes and how frequently they appeared in the documents were identified. This quantification was an attempt to explore usage indicating the relative focus of the policies. A thematic map was developed to understand how national-level drug policies conceive and address specific concerns related to women who use drugs. We adapted the UNODC checklist for gender mainstreaming to assess policies’ adherence to international guidelines. Results Twenty published documents from nine countries were reviewed. The common themes that emerged for women, pregnancy, and children were needs assessment, prevention, treatment, training, supply reduction, and collaboration and coordination. Custody of children was a unique theme for pregnant women. Specific psycho-social concerns and social reintegration were special themes for women, whereas legislation, harm reduction, research, and resource allocation were children-specific additional themes. For women-specific content analysis, special issues/concerns in women with drug misuse, need assessment, and prevention were the three most frequent themes; for the children-specific policies, prevention, training, and treatment comprised the three most occurring themes. For pregnant women/pregnancy, prevention, treatment, and child custody were the highest occurring themes. According to ratings of the countries’ policies, there is limited adherence to international guidelines which ensure activities are in sync with the specific needs of women, pregnant women and their children. Conclusion Our analysis should help policymakers revise, update and adapt national policies to ensure they are gender-responsive and address the needs of women, pregnant women and their children.

Family members of relatives with addiction (often referred to as Affected Family Members [AFMs]) experience potentially traumatic events, including psychological violence, physical violence, sexual violence, death, or accidents of relatives due to addiction. This study explores the development of stress in young adult AFMs over several years and why their stress increases or decreases. A three-year longitudinal qualitative study. Four rounds of in-depth, semi-structured individual interviews were conducted. Twenty-four students drew a stress graph. They scored their stress levels from the first interview in 2019/2020 to the last two years later on a 10-point scale and explained why their stress increased or decreased. Interpretative Phenomenological Analysis was applied. We distinguished four patterns of stress: stress remained stable (high or low;  = 3), stress increased over time (  = 5), stress decreased over time (  = 10), and stress had erratic highs and lows (  = 6). For most participants, stress related to their relatives' addiction problems was high and highly dynamic. We found factors associated with the direct stress of life with relatives with addiction problems, such as recovery, relapse, aggression, incidents, and accidents. We also found indirect effects, such as trust, intimacy issues, stressors related to education, work, coping strategies, and support. AFMs' stress persisted often over the long term, even after a relative died or contact was broken. Identifying reasons for stress increase or decrease might help AFMs, healthcare professionals, and educational professionals who want to support AFMs in managing their stress.

Excellent outcomes of angioplasty/stenting for the post-thrombotic syndrome (PTS) have been reported, notably regarding objective criteria in the vast French SFICV cohort. Differences may exist between patient-reported and objective outcomes. We investigated this possibility by using validated scales because significative correlations are discordant in the literature between patency and patient-reported characteristics. Patient-reported outcomes seem to be a more consistent tool than radiologic patency for the diagnosis and follow-up of patients displaying PTS. We retrospectively reviewed the Villalta scale and 20-item ChronIc Venous dIsease quality-of-life Questionnaire (CIVIQ-20) scores recorded after endovascular stenting for PTS at 14 centres in France in 2009–2019. We also collected patency rates, pre-operative post-thrombotic lesion severity, and the extent of stenting. We performed multivariate analyses to identify factors independently associated with improvements in each of the two scores. The 539 patients, including 324 women and 235 men, had a mean age of 44.7 years. The mean Villalta scale improvement was 7.0 ± 4.7 (p < 0.0001) and correlated with the thrombosis sequelae grade and time from thrombosis to stenting. The CIVIQ-20 score was available for 298 patients; the mean improvement was 19.2 ± 14.8 (p < 0.0001) and correlated with bilateral stenting, single thrombosis recurrence, and single stented segment. The objective gains demonstrated in earlier work after stenting were accompanied by patient-reported improvements. The factors associated with these improvements differed between the Villalta scale and the CIVIQ-20 score. These results proved that clinical follow-up with validated scores is gainful in patients treated for PTS thanks to a mini-invasive procedure.

BackgroundStudies demonstrated that adolescent e-cigarette use is associated with subsequent tobacco smoking, commonly referred to as the gateway effect. However, most studies only investigated gateways from e-cigarettes to tobacco smoking. This study replicates a cornerstone study revealing a positive association between both adolescent e-cigarette use and subsequent tobacco use; and tobacco and subsequent e-cigarette use in the Netherlands and Flanders.DesignThe longitudinal design included baseline (n=2839) and 6-month (n=1276) and 12-month (n=1025) follow-up surveys among a school-based cohort (mean age: 13.62). Ten high schools were recruited as a convenience sample. The analyses involved (1) associations of baseline e-cigarette use and subsequent tobacco smoking among never smokers; (2) associations of e-cigarette use frequency at baseline and tobacco smoking frequency at follow-up; and (3) the association of baseline tobacco smoking and subsequent e-cigarette use among non-users of e-cigarettes.FindingsConsistent with prior findings, baseline e-cigarette use was associated with higher odds of tobacco smoking at 6-month (OR=1.89; 95% CI 1.05 to 3.37) and 12-month (OR=5.63; 95% CI 3.04 to 10.42) follow-ups. More frequent use of e-cigarettes at baseline was associated with more frequent smoking at follow-ups. Baseline tobacco smoking was associated with subsequent e-cigarette use (OR=3.10; 95% CI 1.58 to 6.06 at both follow-ups).ConclusionOur study replicated the positive relation between e-cigarette use and tobacco smoking in both directions for adolescents. This may mean that the gateway works in two directions, that e-cigarette and tobacco use share common risk factors, or that both mechanisms apply.

Purpose - The purpose of this paper is to examine supervisor perceptions of police integrity situations using the measurement of police integrity instrument. Additional survey questions focused on aspects of integrity of particular relevance within the study agency. The latter concerned that agency's on-going legal arrangement with the federal government to address alleged sub-standard patterns and practices of officer/agency performance. Design/methodology/approach - In total, 478 sergeants and lieutenants from the study agency completed the survey instrument. This represented 97 percent of those asked to complete the instrument and approximately 60 percent of first-line supervisors. Findings - The results paralleled some aspects found in prior research, in particular that respondents cast themselves as having stronger integrity than their peers. Findings also illustrated potential weaknesses in efforts to enhance police integrity in light of federal intervention in the study agency. Research limitations/implications - The findings represented the first focused effort to replicate the measurement of police integrity instrument among first-line supervisors. Such personnel were key figures in efforts to modify deficient patterns and practices, making them a prime focus for research consideration. Practical implications - The skepticisms expressed by some supervisors illustrated issues worthy of consideration in future efforts to enhance integrity in police organizations. First-line supervisors play key roles in shaping officer conduct, particularly in larger agencies. As such, more consideration needs to be given to the role they play in organizational change efforts. Originality/value - In addition to informing scholarly understanding through the measurement of police integrity instrument, the findings are of importance in applied efforts to enhance integrity or otherwise modify police organizations.

ObjectivesTo propose a scale of severity for post-thrombotic venous lesions (PTVLs) after ilio-femoral deep venous thrombosis and to compare the grade with the results of endovascular treatment of ilio-femoral PTVLs.MethodsIn this retrospective monocentric observational study, we included 95 patients treated for ilio-femoral PTVLs. We proposed a four-grade scale evaluating the severity of PTVLS caudal to the common femoral vein based on CT phlebography and per-operative phlebography. For most patients, venous patency was assessed with color duplex ultrasonography and the clinical efficacy of the intervention using the Villalta and CIVIQ scores.ResultsRecanalization was successful in 100% of patients with a morbidity rate of 4%. After a mean follow-up of 21 months, the overall primary patency was 75%, the assisted primary patency 82%, and the secondary patency 93%. Secondary patency was 100% for grade 0–1, 90% for grade 2, and 63% for grade 3 (p < 0.002). There was no correlation between the extension of stenting caudally of the common femoral vein and venous patency. The mean improvements in the Villalta and CIVIQ-20 scores were, respectively, 4.6 (p < 0.0001) and 18 (p < 0.0001); scores were not correlated with the grade of PTVLs in the thigh.ConclusionVenous patency after endovascular treatment of ilio-femoral PTVLs was strongly linked to the severity of PTVLs caudal to the common femoral vein but not to the extent of stenting.

Purpose - The purpose of this paper is to examine supervisor perceptions of police integrity situations using the measurement of police integrity instrument. Additional survey questions focused on aspects of integrity of particular relevance within the study agency. The latter concerned that agency's on-going legal arrangement with the federal government to address alleged sub-standard patterns and practices of officer agency performance.Design methodology approach - In total, 478 sergeants and lieutenants from the study agency completed the survey instrument. This represented 97 percent of those asked to complete the instrument and approximately 60 percent of first-line supervisors.Findings - The results paralleled some aspects found in prior research, in particular that respondents cast themselves as having stronger integrity than their peers. Findings also illustrated potential weaknesses in efforts to enhance police integrity in light of federal intervention in the study agency.Research limitations implications - The findings represented the first focused effort to replicate the measurement of police integrity instrument among first-line supervisors. Such personnel were key figures in efforts to modify deficient patterns and practices, making them a prime focus for research consideration.Practical implications - The skepticisms expressed by some supervisors illustrated issues worthy of consideration in future efforts to enhance integrity in police organizations. First-line supervisors play key roles in shaping officer conduct, particularly in larger agencies. As such, more consideration needs to be given to the role they play in organizational change efforts.Originality value - In addition to informing scholarly understanding through the measurement of police integrity instrument, the findings are of importance in applied efforts to enhance integrity or otherwise modify police organizations.

PurposeTo assess the results of endovascular treatment in a large population of patients suffering from post-thrombotic syndrome (PTS) due to iliocaval occlusive disease.MethodsIn this retrospective multi-center study, 698 patients treated by stenting for PTS in 15 French centers were analyzed. Primary, primary assisted, and secondary patency rates were assessed, and clinical efficacy was evaluated using Villalta and Chronic Venous Insufficiency Questionnaire in 20 questions (CIVIQ-20) scores. Outcomes were compared against pre-operative CT-based severity of the post-thrombotic lesions in the thigh (4 grades).ResultsTechnical success, defined as successful recanalization and stent deployment restoring rapid anterograde flow in the targeted vessel, was obtained in 668 (95.7%) patients with a complication rate of 3.9%. After a mean follow-up of 21.0 months, primary patency, primary assisted patency, and secondary patency were achieved in 537 (80.4%), 566 (84.7%), and 616 (92.2%) of the 668 patients, respectively. Venous patency was strongly correlated to the grade of post-thrombotic changes in the thigh, with secondary patency rates of 96.0%, 92.9%, 88.4%, and 78.9%, respectively, for grades 0 to 3 (p = .0008). The mean improvements of Villalta and CIVIQ-20 scores were 7.0 ± 4.7 points (p < .0001) and 19.1 ± 14.8 points (p < .0001), respectively.ConclusionEndovascular stenting as a treatment option for PTS due to chronic iliocaval venous occlusion generates a high technical success, low morbidity, high midterm patency rate, and clinical improvement. Venous patency was strongly correlated to the severity of post-thrombotic lesions in the thigh.