Co-designing polysubstance use harm reduction messaging with and for young adults: findings from a participatory, intersectional citizen jury and community survey (The ‘Vibe Check’ Project)

Co-designing polysubstance use harm reduction messaging with and for young adults: findings from a participatory, intersectional citizen jury and community survey (The ‘Vibe Check’ Project) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Co-designing polysubstance use harm reduction messaging with and for young adults: findings from a participatory, intersectional citizen jury and community survey (The ‘Vibe Check’ Project) Sasha Bailey*, Florens Groot*, Lyra Egan, Zachary Bryant, Thomas Norman, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7171854/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Background Polysubstance use is highly prevalent among young adults, yet harm reduction research has traditionally excluded their meaningful involvement. The Vibe Check Project aimed to meaningfully involve young adults with lived/living experience of polysubstance use to identify key polysubstance use harms and best-practice digital harm reduction strategies using a participatory, peer-led approach. Methods This two-phase study included: (1) a cross-sectional online survey (March–June 2025) of 81 young adults (aged 18–30, living in NSW) who had used more than one psychoactive drug concurrently in the past year; and (2) a 7-hour online citizen jury with a randomly selected subset (n = 8) of survey participants. Survey items were co-developed with a peer researcher and Youth Advisory Board, and comprised quantitative and qualitative questions on polysubstance use patterns, motivations, and harm perceptions. Jurors were tasked with deliberating and reaching consensus on two domains: 1) the main harms arising from polysubstance use among young adults, 2) the best ways for leveraging digital, online, and social media platforms to address these. Quantitative data were analysed descriptively in RStudio, and qualitative survey responses and citizen jury transcripts were analysed using summative content and deductive thematic analysis in NVivo. Results Survey responses indicated that interaction effects between drugs were the most concerning harm for young adults. Citizen jurors reached unanimous consensus on three key harms: (1) balancing self-reflection and peer dynamics in the face of unclear and unpredictable drug effects (2) navigating life after polysubstance use, particularly comedowns and poor decisions made under impaired judgement; and (3) unintended, undesirable development of tolerance and/or dependence. Jurors also unanimously recommended digital harm reduction should be educational, practical, brief, engaging, and accessible, championing diverse lived/living experiences through partnership with trusted, reputable community sector organisations, rather than social media influencers. Conclusions This is the first known study to use a citizen jury with young adults to address polysubstance use harms. The participatory, peer-led approach generated youth-driven, consensus-based recommendations for digital harm reduction in practice. Findings emphasise the important role of planning and self-reflection, the double-edged sword of peers and peer influence, and partnerships with trusted community sector organisations for effective polysubstance use harm reduction. young adults polysubstance use harm reduction intersectionality participatory research citizen juries Figures Figure 1 Figure 2 Background For many young adults aged 18 to 30 years 1 , polysubstance use – the deliberate or unintentional use of more than one legal (e.g., prescribed) and/or illicit substance concurrently or in close temporal proximity – allows one to enhance and/or prolong a positive experience, mitigate or moderate the effect of another substance, and/or soothe uncomfortable withdrawal symptoms or comedowns. 2 While polysubstance use and indeed ‘isolated’ substance use do not result necessarily in substance use-related harms, epidemiological studies have found that polysubstance use is associated with higher risk of mental ill-health, 3 – 6 headaches and other pain 4 , lower educational attainment 6 – 8 , reduced control over one’s use or ability to achieve a positive effect or ‘high’ 6 , 7 , school and/or work problems 6 , 7 , 7 and justice system involvement. 6 – 8 Measurement of polysubstance use is commonly based on reports of multiple substances used within a given timeframe (e.g., past 6-months or 30 days) failing to distinguish sequential from concurrent polysubstance use. 9 It remains unclear how to apply evidence-guided principles of harm reduction to reduce potential harms from polysubstance use among young people. Mindful consumption and benefit maximisation 10 represents a bold and strengths-based paradigmatic advancement in contemporary harm reduction thinking. This approach focuses principally on promoting thoughtful drug use and enhancing positive experiences, subsequently facilitating successful harm reduction. Accordingly, polysubstance use, relative to ‘isolated’ substance use, may in theory afford young adults greater opportunities to realise the potential positive benefits of substances. 10 – 12 Conventional harm reduction approaches focusing on promoting safer, managed use, including abstinence, have been criticised 13 by drug policy advocates and academics as being inadvertently stigmatising 10 and over-reliant on epidemiological studies which take an ‘increased use increased harm’ approach to measurement and analysis. 14 , 15 While a focus on harms is important from a population health promotion lens 14 , this can miss the potential to explain how and why young adults engage in the social practices 11 of polysubstance use, which polysubstance use harms are perceived of utmost concern to young adults, and how evidence may guide the improvement of young adults’ polysubstance use experiences. The meaningful involvement of young adults who engage in polysubstance use is critical for successful polysubstance use harm reduction conceptualisation, messaging, and delivery. 16 , 17 Yet the meaningful involvement of young adults as distinct from their older adult peers 17 – 23 remains significantly under researched, missing an invaluable opportunity to capitalise on young adults’ experiential knowledge, community connectedness, and access and literacy regarding emerging digital technologies. 16 , 17 Urgent participatory research is warranted to better understand how harm reduction practitioners can leverage digital technologies, such as social media, to successfully disseminate polysubstance use harm reduction messaging with contemporary young adults. 24 Citizen juries, an increasingly popular participatory research method, are an effective means of ascertaining consensus via active deliberation between ‘citizens’ (peer researchers) acting as ‘jurors’. 25 – 29 Through these intentionally democratic and deliberative processes, citizen juries are effective for participatory research with individuals who have been historically underrepresented in certain research domains (e.g., incarcerated populations 30 ), as well as for research where there may be significant heterogeneity in perspectives within and between different ‘peer’ stakeholder groups (e.g., school-based vaccination programs). 31 Despite young adults being historically underrepresented in harm reduction research 16 and, moreover, significant variation in views regarding the scope of harm reduction having been observed, 14 , 24 to our knowledge, no research has undertaken citizen juries with young adults in the context of drug harm reduction research. Given the non-uniform distribution of polysubstance use among young adults, intentionally engaging diverse constellations of young adults is necessary for the equitable involvement of young adults in harm reduction efforts. 16 Higher polysubstance use prevalence has been previously observed among gender and sexuality diverse (‘LGBTQA’) young adults 32 – 35 , particularly trans and gender diverse (‘trans’) young adults 36 , 37 , young adults from lower socio-economic backgrounds, 38 – 40 and young adults living in rural, regional, or remote backgrounds. 41 Critically, intersectionality theory 42 provides a useful process-oriented 43 rather than identity-based 44 , 45 framework for understanding how young adults do not have siloed social experiences (of gender, sexuality, affluence, and urbanicity, for example) and indeed how polysubstance use experiences are shaped by the multiple interacting aspects of one’s socio-relational experiences and socially constructed backgrounds and identities. The meaningful involvement of young adult peers navigating socio-relational processes of drug use while crossing multiple, competing axes of power, oppression, and privilege represents a dire research gap. The present study (The ‘Vibe Check’ Project) sought to address the aforementioned research gaps by conducting a participatory research study comprising a community-based survey and follow-up citizen jury. An intersectionality lens toward polysubstance use experiences and potential harms was adopted by directing concerted attention toward how these socio-relational polysubstance use experiences and harms were shaped by socio-relational experiences of social gender, sexuality, affluence, and geographical location. This participatory research study was guided by two primary research objectives: To identify the key potential harms associated with polysubstance reported by young adults, and To identify the best strategies for preventing these harms. Methods The ‘Vibe Check’ Project employed a participatory research approach to conduct an online cross-sectional survey and citizen jury with young adults. A lived experience peer researcher (FG) was involved with the development of a Lived Experience Partnership grant proposal to support the study, and was subsequently employed as a professional research assistant on the project. A core working group was established with junior research staff members (SB, LE, ZB) to oversee the project, and optional attendance was invited from the peer researcher (FG) to balance time and costs while also facilitating input into key decisions where feasible. Ad-hoc wider working group meetings were held with whole team. The study was conducted in two stages – Phase 1: a community survey, and Phase 2: a citizen jury. Ethics approval was provided by the University of Sydney Human Research Ethics Committee (HREC 2024/HE001655). Stage 1: Community survey Study design and sample Between March 2025 and June 2025, an online cross-sectional anonymous survey administered via REDCap (v15.3.3) 46 was open to a) young people aged 18 to 30 years, b) living in the state of New South Wales (NSW), Australia, and c) who within the preceding 12 months used more than one psychoactive drug at the same time (within the same day). Participants and recruitment Participants were recruited predominantly via social media, namely Facebook, Instagram, and LinkedIn. $ 100 was allocated to advertise in NSW generally, and $ 400 was allocated to target specific areas of NSW that were outside of major cities 47 and/or had a lower ranked relative socioeconomic advantage and disadvantage index 48 , according to the Australia Bureau of Statistics. Study advertisements were also disseminated to members of The Matilda Centre Youth Advisory Board (YAB) and Youth Engagement Network. Data collection Validated measures of substance use and harms were administered 49 – 52 however given the lack of available validated polysubstance use measures, survey items regarding polysubstance use were iteratively co-developed via input from drug and alcohol and epidemiology experts, the peer researcher, and the YAB. Main take-away messages from consulting the YAB included thoroughly reviewing the survey to simplify questions the YAB highlighted as unclear. For example, it was recommended to allow participants options to describe their gender in free-text option and also select a ‘prefer not to disclose’ option. For tobacco and vaping questions, it was recommended to ask participants to specify the day(s) of the week they smoke the most and the average number of cigarettes smoked on those days and remove redundant questions not relevant for the Vibe Check project. YAB members also recommended emphasising to participants via survey instructions that their responses are confidential by adding a disclaimer. Survey items comprised a mixture of fixed-option (quantitative) and free-text open-ended (qualitative) questions pertaining to patterns, correlates, motivations, and harm reduction perceptions of polysubstance use among young adults. Written, informed consent was collected prior to survey commencement. The full survey instrument is provided in Supplementary Materials A . Data analysis Quantitative items were summarised descriptively using counts and proportions for categorical variables and means and standard deviations for continuous variables in RStudio Version 4.2.2. Qualitative data were exported to NVivo for summative content analysis, an analytic approach appropriate for providing high-level overview descriptions of qualitative datasets smaller and briefer in nature (e.g., survey free-text responses). 53 Stage 2: Citizen jury Participants who completed the online survey were invited to express interest in participating in a follow-up 7hr (including 30min paid break) citizen jury held online via Zoom. Citizen juries are an effective means of exploring people’s perspectives on complex health research topics with the view to achieving policy-relevant consensus. 27 , 30 , 31 , 54 Citizen jury invitations were sent to a randomly selected sample of survey respondents who had expressed interest in the citizen jury. REDCap Survey ID numbers were entered into RStudio, and a command line randomly printed eight numbers denoting invitation status. Jury composition and governance Jurors were young people aged 18 to 30 years living in NSW who had recently used more than one psychoactive drug at the same time (on the same day) within the past 12 months. No additional inclusion/exclusion criteria were applied. Jurors were not required to have previously engaged in research or advocacy activities relating to polysubstance use harm reduction. Prospective jurors were informed that the study involved a group discussion that would follow the format of a ‘citizen jury’ where they would act as a juror alongside other participants, ‘to deliberate and reach consensus on two jury questions relating to harms arising from polysubstance use among Australian young adults’. At the end of the citizen jury sessions, participants were also informed they would be invited to provide written feedback summarising their final recommendations on polysubstance use harms and strategies for reducing these harms for Australian youth, along with questions about their experience of participating in the citizen jury. Jurors were informed prior to the day that they would not be required to share their name with other jurors and were encouraged to update their Zoom display name accordingly prior to joining the Zoom meeting. Participants were compensated AUD $ 35.41/hr; such that at the end of the citizen jury session (7hrs max including 30min paid lunch break), each participant received an AUDa $ 250 gift voucher by email to thank them for their time and effort. If a participant withdrew before the end of the study, their voucher would be pro-rated, although no withdrawals were observed. Procedures The citizen jury was facilitated by a peer researcher (FG; a young trans woman), with support from senior members of the research team (SB, LE; both young adults). Though an informed member of the research team, the facilitator was tasked with remaining impartial, asking neutral non-leading follow-up questions and avoiding pre-empting consensus. The facilitator and two senior members of the research team had two preparatory Zoom meetings prior to the jury event where questions, concerns, and hypothetical troubleshooting scenarios were discussed. These three team members communicated iteratively to co-plan an ‘agenda’ for the day’s proceedings. This agenda is provided in Supplementary Materials B however in brief the plan was as follows: greeting and acknowledgement of country (5mins); introduction of research team members in attendance (5mins); expert presentations (30mins); presentation on findings from Phase 1: Vibe Check community survey (10mins); information about citizen jury methods and rules of engagement (10mins); deliberation session 1 (2.5hrs); lunch break (30mins); deliberation session 2 (2.5hrs); and de-brief/check-out (30mins). One week prior to the event, jurors received a pre-jury information pack which provided information about the research team, background topics (‘what is polysubstance use?’, ‘What are the potential harms from polysubstance use?’, and ‘The role of harm reduction’). This information pack also summarised an overview of The Vibe Check Project, including preliminary findings from the Phase 1 survey. The information pack explained what a citizen jury entailed and gave a summative description of the role of jurors (see Supplementary Materials C ). As is convention with citizen juries, jurors were presented with a series of brief recorded expert presentations to aid in evidence-based deliberation and consensus-reaching. The YAB and peer researcher were consulted on the roster of topics/presenters and it was agreed that presenters should provide high-level epidemiological research about polysubstance use and harm reduction, and community-based speakers presenting on successful polysubstance use harm reduction campaigns and programs, particularly those targeting LGBTQA + youth, rural/regional youth, or those leveraging digital mediums. Hence, four, 10min expert presentations were provided to jurors: 1) ‘Polysubstance use among young people in Australia’, delivered by an expert in epidemiology and prevention of substance use among youth (CC); 2) ‘Polysubstance use harms and harm reduction’, delivered by a research expert in substance use prevention and harm reduction (KC); 3) ‘Communicating polysubstance use harm reduction strategies to young people in Australia’ including the Path2Help and Text The Effects initiatives, delivered by a member of the evidence team of the Alcohol and Drug Foundation (ADF) (NB), Australia’s leading organisation for preventing and minimising alcohol and other drug harms, and 4) ‘Polysubstance use harm reduction tips and strategies’, delivered by the Harm Reduction team of ACON Health Limited, Australia’s largest LGBTQ + community health organisation (GB). Expert presentations are available upon reasonable request addressed to the corresponding author. Deliberation sessions comprised a series of ‘incremental’ questions prompting interactive, engaging group discussion. These culminated in a ‘final deliberation question’ where the facilitator (FG) activated a Zoom whiteboard activity displaying the key deliberation question (Session 1: What are the key harms associated with polysubstance use among young adults in Australia; Session 2: How can we use digital, online, and social media platforms to reduce and minimise the three main harms identified from deliberation session 1 among young people in Australia?). Following optional engagement with the Whiteboard activity, jurors were invited by the facilitator to share their key recommendations. The facilitators, with support from senior research staff in attendance, synthesised these recommendations in an open-ended manner using follow-up questions, with the a priori aim of distilling three key recommendations per deliberation session. Once these key recommendations were distilled, the facilitator read each of these one-by-one aloud where jurors verbally or via the ‘thumbs up’ Zoom function, voted and signalled their agreement, thus representing consensus. Data collection and analysis A Zoom auto generated transcript was cleaned in Microsoft Word. 55 This clean transcript was then imported into NVivo for deductive thematic analysis. The citizen jury transcript was coded by a peer researcher (FG) who developed summative themes cutting across prevalent, salient codes. Rather than ‘confirming’ these codes and preliminary themes, a senior research staff member reviewed the codebook and built off these to distil key themes resembling rationales underpinning the consensus-based recommendations reached in each deliberation session. This represented a synergy of lived experience partnership where the latter person provided complementary, adjunct, additional interpretation and meaning making. The peer researcher (FG) and senior staff member (SB) met online during this process to ensure continuous communication within this participatory process. Citizen jury findings were then discussed and triangulated with survey findings. Results Stage 1: Community survey Participant characteristics In total, 39 young adults completed the community survey. The average age was 24 years (SD = 3.4). Four in five (82%) were cisgender, and one in five (18%) were trans. Over half of participants (59%) were young women (cis or trans), and one in four (23%) were young men (cis or trans). Five participants (13%) were non-binary and two (5%) were gender diverse. Most participants were heterosexual (n = 17, 44%), followed by bisexual or bi+ (n = 9, 23%), gay or lesbian (n = 5, 13%), and queer (n = 5, 13%). Full details regarding sample demographic characteristics are available in Supplementary Materials D . Patterns and contexts of polysubstance use Among participants, the most common substances used in combinations of alcohol and/or other drugs used at the same time within the preceding 12 months were alcohol (n = 33, 84.6%), tobacco (n = 19, 48.7%), cannabis (n = 17, 43.6%), and MDMA (n = 14, 35.9%). Alcohol was most commonly cited substance used first within participants’ named polysubstance use combinations (n = 19, 52.8%). Young adults most commonly used named polysubstance use combinations around friend(s) (n = 28, 77.8%), at mainstream clubs and ‘nights out’ (n = 28, 71.8%), private home-based social gatherings with friends (n = 27, 69.2%), LGBTQA + clubs, events, ‘nights out’, and music festivals (n = 16, 41.0%), and bush doofs (n = 13, 33.3%). Perceptions, experiences, and strategies for reducing harms As shown in Fig. 1 below, the top six potential harms arising from polysubstance use that were of most concern to young adult respondents were ‘interaction effects between certain drugs’ (45.7%), ‘being annoying or inconvenient to your friends’ (45.7%), ‘spending too much money on substances’ (45.7%), ‘developing drug tolerance’ (22.9%), ‘having an accident or injury yourself’ (20%), and ‘developing drug dependence’ (17.2%), respectively. Full results are available in Supplementary Materials D . 3.1.4 Harm reduction messages and preferences for communicating these via social media and mobile app platforms Among those who provided an open-ended response on advice they would give to someone who was considering engaging in polysubstance use for the first time, to have fun and feel safe, the most common recurring theme mentioned by 21 of the 23 respondents related to the importance of ‘ preparing ’, ‘ planning ’, ‘ measuring’ , and, where feasible, ‘ testing ’ for the ideal ‘ dosage ’ and ‘ timing’ of the drugs one is considering to use. For example, as one participant noted: ‘ maybe play around with dosages/timings to ensure correct high without causing too much damage to future self (i.e., hangover etc)’ . It was noted that it would also be strategic to consider trying drugs that you had never used/co-used, ‘ by themselves first’ , without other substances. Five of 23 respondents also noted the importance of being around people they ‘trust’: ‘ Knowing that the people you are with love and support you is easily the biggest factor to whether the experience is good or bad.’ Among the 39 community survey respondents, the most commonly voted social media or digital app platform that would be best to share polysubstance use harm reduction messaging and resources for young adults was Instagram (n = 32, 82%), followed by mainstream dating apps (n = 15, 39%), and LGBTQA + dating apps typically used by gay men (e.g., Grindr, Scruff) (n = 12, 31%). LinkedIn (n = 1, 3%) and TikTok (n = 5, 13%) were the least preferred media. Full results are available in Supplementary Materials D . Stage 2: Citizen jury The citizen Jury was held Friday 2nd May 2025 9am to 4pm online via Zoom. In attendance were five jurors who met the inclusion criteria and were aged 18 to 30. Identifying key polysubstance use harms Harm 1: Navigating self-reflection and peer dynamics in the face of unclear and unpredictable drug effects Young adult jurors collectively articulated a key potential harm arising from polysubstance use pertaining to the unclear and unpredictable drug effect and interactions; a complexity further muddied by varying levels of planning, ‘research’ and self-reflection undertaken by oneself and the extent to which peers were supportive versus exerting of peer pressure. Uncertainty and unpredictability Jurors acknowledged that engaging in polysubstance use meant necessarily acknowledging and accepting a level of not knowingness or inexperience of certain drug effects, including potentially adverse drug interactions. So I wrote [one key polysubstance use potential harm being] the unpredictability of effects, but I… was thinking that in terms of mental health impacts and then also physical health. So, yeah, not knowing the effects of what mixing drugs, can have on… your mental health and physical health while you're taking the drug, but then also the prolonged effects after the drug is worn off or during the come down. The harm relating to unintended, adverse drug interactions lies in how these undermine and de-rail one’s desired, expected drug effects thus diminishing agency over one’s curated polysubstance use experience. …I think a lot of people, plan, for like, an occasion to take drugs, especially, when they're mixing them. And when things go a bit off track with the plan… it can become riskier. Like they might plan to only have a certain amount but then someone offers more… or a different kind of drug that they weren't planning to take… and that can sort of derail things a little, they haven't sort of set themselves up for that. Planning, doing research and knowing yourself to prepare for polysubstance use experiences Participants highlighted the harm reduction utility of ‘ preparing’ for polysubstance use experiences via planning, research, and self-reflection. ‘ Planning’ activities included ensuring full mobile phone better charge to prevent ‘someone’s phone going flat’ and communicate when someone is ‘ changing spots’ , ‘ setting reminders to drink water ’, ‘ using an apple watch to keep track of heart rate. ’ As one juror notes: “ I always make sure I have a plan on how I’m getting home (or who I am crashing with). I am less likely to partake when I don’t have that in place ”. Similarly, ‘ doing research ’ included seeking information about potential drug effects and interactions, including those relating to prospective substances to be used (e.g., avoiding use of multiple ‘ depressants’ ) and/or psychiatric medication (e.g., ‘ anti-depressants ’). Lastly, young adult jurors highlighted the importance of spending time getting to ‘ know yourself ’, reflecting on your own expectations and boundaries relating to prospective polysubstance use experiences. I don’t feel like a lot of people actually really take time to learn about their own boundaries … something that's, really key is like, knowing yourself … you might know that like certain things make you anxious and that impacts your setting choice... when people put the effort in to learn those things about themselves, they can have a much better experience, and plan a bit better. Or even if it's more spontaneous, they can have in their mind like here are sort of my limits… Self-reflection represented an important vehicle for distinguishing one’s own polysubstance use aspirations from their friends: …if you're using drugs, it's pretty likely that a lot of your friends are as well. And that, to some extent you might define, like your baseline for what normal drug use is based on what your friends are doing Peer support vs peer pressure Jurors agreed that the presence of trusted peers as critical for ‘ safe’ , ‘ comfortable’ polysubstance use experiences, especially when (co-)using certain drugs for the first time. “… if you're doing a substance like, by yourself for the first time, you don't really know what to do…. I think that's a pretty risky drug use scenario, but … I wouldn't necessarily say the same thing about like… trying a substance with a friend who's like experiencing it and is starting low and slow. Like-minded peers were tantamount for creating a sense of community which enhanced the overall positive shared experience of taking substances together: “I think kind of finding a sense of community, is important in these events …because … people are more likely to … feel comfortable taking substances or mixing substances. But then also, I guess, the reverse of that … can build community in a way… or just that shared experience of taking substances together. And if everyone is kind of on… a similar wavelength I guess (laughs)…I think the sense of community can be really strong at certain social settings.” However, jurors noted that peers can hold differing, conflicting polysubstance use aspirations and, at times, may exert pressure on young adults to engage in polysubstance use in a way they are not ‘prepared’ for. a lot of people not only take drugs - or drink - or smoke because they're around their friends or people that they're trying to ingratiate themselves with. I think it's easy to get caught up in the moment as well and sometimes in social settings, and you kind of just go along with maybe what your friends are doing or what you might be feeling in that particular moment. Almost all discussions of polysubstance use peer pressure were in reference to peer colleagues and supervisors in workplaces, particularly those in the ‘hospitality’, ‘entertainment’, and ‘sex work’ industries. I've known several people who have, like, never used drugs before and then they go into a workplace, and they're pressured or encouraged to use drugs to get through their shift, or… to work overtime, like maybe they're doing, overtime or things like that. And then, they have ended up not being able to stop and worrying about how they're using drugs, and I do think this is quite a widespread problem, especially in hospitality industry, especially in entertainment industry, sex work as well. Yeah, it's… when I hear people expressing regrets about drugs, it often does involve workplaces and feeling, pressured to do it. When people don't feel pressured, they're not expressing regret over it. I personally work hospitality jobs [and] there's also a bit of a work hard play hard culture sometimes… where like, if you're getting off your shift at 2am, and then going to the pub, I feel like it's, even if no one's explicitly pressuring you, there's a kind of implicit social pressure to use other drugs because, again, it's 2am and that's when you're starting drinking… Harm 2: Navigating life after polysubstance use experiences Unanimous juror consensus identified that navigating life ‘after’ polysubstance use experiences, including navigating ‘comedowns’ and coming to terms with decisions made under impaired judgement, were a key potential harm arising from polysubstance use. Comedowns The time following polysubstance use may though not always, involve ‘comedowns’: a vulnerable time of raw emotions ‘after the drug is worn off’. Jurors commented that comedowns were sometimes ‘expected’ and thus ‘planned for’, but at times were unpredictable’. Jurors emphasised self-care ‘during and after’ comedowns. …the come down could be, really unpredictable, especially if you haven't used that combination before, or like you're doing it at like a dose you haven't before. … especially during the come down period. I've had friends that have gone into, like depressive periods for days or so and then also physical… harm. I think for me, I'm most worried about being hospitalized potentially. Risk of impaired judgements and decision-making Jurors unanimously acknowledged that when engaging in polysubstance use, young adults were sometimes exposed to risks of making poor decisions with impaired judgements with potential long-lasting negative implications far beyond a discrete polysubstance use experience. … sometimes you can feel like, it's not you who is making decisions that you are. And so I think that can be really harmful because people end up doing stuff that they either wouldn't ordinarily do, or something that they weren't planning to be doing in the first place. Driving, having sex… aggression… that disconnection can be really harmful, especially in higher doses because it'll affect people's lives… for the rest of their lives, especially if something negative happens. Harm 3: Unintended, undesirable tolerance and/or dependence Tolerance and dependence Participants noted that developing tolerance or dependence was harmful because it compromised agency and control over one’s decisions in relation to polysubstance use. Tolerance also threatened participants’ ability to make reliable plans about their polysubstance use affective experience, with their choice of substances being influenced considerably by necessity to take a higher dose to achieve a certain affective state, distinct from perhaps previously choosing substances for other reasons or no specific reason at all. Cross-tolerance to multiple drugs, and repeated use of the combinations due to lack of desired effects was considered a vehicle for further harms, namely reduced agency over one’s personalised, curated, and desired polysubstance use experience, feeling they need to use/co-use more to counter tolerance and achieve ‘equal’ enjoyment. Developing tolerance, esp cross-tolerance to multiple drugs / Increasing doses over time to fight tolerance I've had a few friends who… are trying to reduce their drug use, but they're finding it quite difficult due to dependence on multiple substances. So, in terms of finding treatment, in terms of kind of identifying… like, if there's a particular drug they want to cut down on, it is a bit of a… confusing process as well. Effects of unintended, undesirable tolerance and/or dependence impacted one’s financial health too, with many citing greater financial costs and “financial strain” associated with one’s substance use, and overspending on polysubstance use occasions. … there isn't there doesn't seem to be any sort of kind of helpline that's, directly addresses that intersection of financial, kind of… constraints and you know polydrugs use or drug use or substance use in general, but doing things like oh, you know partnering with like the national debt helpline to create resources that directly address that area, so young people feel a bit more confident if they do get a step forward and take that, first step The financial parameters of polysubstance use risks of tolerance/dependence were further complicated due to ‘free’ ‘accessibility’ of substances being common: … when something is offered for free, like no catch, so to speak, that can increase the chance that people will be more likely to just do it because it's not costing them anything… (laughs) financially, or it does cost in other ways probably, but yeah, availability, like, when I'm thinking about my friends who were dealing with these workplaces that pressured them to use drugs, they weren't pressuring them to buy them, they had them freely available, and that can feel like more pressure to participate, because it's like, offered for free…. I think as well when something is offered for free, like no catch, so to speak, that can increase the chance that people will be more likely to just do it because it's not costing them anything… Recommendations for harm reduction Recommendation 1. Harm reduction resources should be interactive, engaging, accessible, using short form content Interactivity Online modules like the TripSit drug combo checker, online chat forums (e.g. Reddit, Bluelight), Q&A chatbots for topics on polysubstance use and related harms (e.g. Nurse Nettie, ADF’s Drug Info Bot), and mental health and dosage trackers, were praised for their interactive functionality providing a variety of ‘choice’ for users seeking specific polysubstance use harm reduction advice. Infographics and question-and-answer (Q&A) functions were also suggested as exemplars of interactivity. the combo chart from TripSit which is a bit overwhelming, it's not great, but the great thing is they have an alternative which comes in the form of like a little interactive ..page where you put in like two drugs that you might want to experiment with and it tells you if it's got like high synergy low synergy if it's something you should you know avoid, due to really high risk, and I think that's the thing with these different sort of harm reduction activities is giving choice, and giving different options, I think we identified that earlier but just want to emphasize it Audience engagement Jurors highlighted the importance of taglines prompting users to self-reflect, hashtags, shareable posts (e.g. on social media) to promote engagement and relatability with young adults. I thought about those gambling posters which are like, what's the phrase they use? They're like… (exhales) I can't even think of it. Juror 2: Wh-What's gambling really costing you? Juror 3: Yeah, stuff like that, but… not that judgy (laughs). I thought some sort of check-in, some sort of cue, for someone to check in with themself about, if they're becoming dependent, or building a tolerance and it's not, in a way that they want… But I don't know, what words to use for that… But .. the idea of the cue or check-in, like someone sees something and they, reflect… Respecting audience diversity was also seen as key, signalling a need for different advertisements for different platforms and different demographics I guess for me I feel like there's like, maybe two different kinds of harm minimization messages I'd want to see, like one of which would be more like, general informative content where like a digital approach could work well. Like it's stuff you want someone to know a week or a month before they're going to use. But then I think there [is] like a separate class of like harm minimization messages that I would want to deliver as close as possible before someone was like considering using drugs. That like, frankly like what I would want to see on an Instagram ad and what I would want to see on the club bathroom are not necessarily the same thing… But I think they're both important. Accessibility Optimising accessibility of polysubstance use harm reduction messaging particularly via leveraging multiple social media platforms and provision of captioning were discussed by jurors. One juror referenced the curb cut effect in terms of normalising certain approaches to harm reduction such as ‘sharp bins’: there's an accessibility factor here because different platforms have different levels of accessibility for different people, like I personally always use captions, whenever they're available. Caption quality varies depending, like if they're automatic, if you've done them yourself etc. Like I think that's really important to think about, when you're thinking of where to put your messages. But I think, the only way to really combat this is to spread the message across multiple platforms (smiles)… or like multiple formats as well. Like not just video, or not just posters, or you know like, varied. Yeah. Short form content Brief, easy to engage with content prioritising the communication of meaning and messaging rather than articulating these in a written form, were key factors for effective polysubstance use harm reduction campaigns. If you have a wall of text, no one’s going to read it. I mentioned before, but I really like short videos, like, not necessarily like ads, but like short videos. I've seen ones from other countries as well, do them pretty well… But like they can… they can sort of take many formats like you can also get sort of screenshots from the video to have a more, static message… And, the other thing is catchphrases (smiles), or hashtags are also very like they stick in my brain very easily, and they're also very shareable. Recommendation 2. Harm reduction resources should champion diverse lived/living experiences Juror consensus revealed that the championing of lived/living experiences to encapsulate the breadth of polysubstance use realities was critical for harm reduction efforts. Suggested action-oriented strategies for operationalising this included campaign messaging and storylines reflecting how some young adult who use polysubstance use may also make active decisions at other times to not partake in polysubstance. Moreover, jurors underscored the importance of harm reduction campaigns actively combatting intra-group judgement and stigma between peers, focusing on how to ‘have fun’. Most jurors agreed that the strengths-based depiction of successful ‘harm reduction in practice’, even in small forms and gestures, would foster positive receptions among young adults engaging with prospective polysubstance use harm reduction messaging. You know, those ads that are like, don't do drugs, you know, they have this scary message, there's like some little story, or even like ones that are about like car accidents, you've seen those ones, they're like, really intense. I feel like what if you reversed it? And like, you had a story where someone was doing drugs, and a friend was looking out for them and it turned out fine. It's like, you don't see that, people don't see how things can be okay (smiles). I feel like that would go a long way. And showing how easy it is to just look out for each other, it could just be like a little video about noticing the signs of potential overdose or something. Like naloxone, there's a lot of that training around, but I've never seen like a little video about it unless I was in a training session (smiles). But like, I would love to see a positive spin on those sort of intense moments, you know. “… demonstrating situations in which like a harm almost happened but was like prevented or mitigated by a harm reduction technique I think is a really good potential like, video format … Content, I think definitely social media content, ... I suppose like roleplays, or like you know sharing stories from young people with experiences, ... not one absolutely good or bad, but you know showing the nuance… Capturing authentic lived/living experience of polysubstance use among contemporary young adults, particularly those engaging in polysubstance use while also navigating multiple axes of power, oppression, and privilege, would be invaluable for reducing polysubstance use harms. …you really need to make sure there's a diversity in the people you're showing as well, like, someone who's disabled might have a different experience than, someone who has something else going on or like maybe someone's living rural, we don't see a lot of content about people living rurally… Showing people have done this before to ease unpredictability fears Recommendation 3: Harm reduction resources should be educational and practical Jurors recommended that polysubstance use harm reduction resources should be educational, promoting literacy around how tolerance builds, signs of dependence, and tips for reflection, self-care, and aftercare. Skill-building education around active conversation techniques, understanding and developing healthy boundaries, and enacting harm reduction ‘in action’ were also discussed. Jurors noted that the value of these topics pertained to their normalising of prospective polysubstance users to be aware of themselves and their own boundaries. So, I think, content that would demystify like drug combinations specifically to reduce, harm that comes about from that… but making sure to use plain language and real scenarios […] but just harm reduction tips but without… the morals around it, or people's judgment… Sharing experiences and encouraging people to share, have conversations around polysubstance use and then also education on active conversation techniques that people can… employ with their friends or… trusted individuals and even organizations and the language around polysubstance use. It was tacitly presupposed that young adults seeking these resources would likely be doing so to conduct ‘research’ planning ahead of a prospective polysubstance use occasion. Henceforth, jurors underscored the important of educational resources incorporating drug and mental health literacy psychoeducation, including risk profiles of different combinations, managing comedowns, set and setting information, and information about where to seek assistance generally and at specific events and venues. Jurors noted the wide availability of many existing resources thus recommending future resources should, where appropriate, direct young adults to existing, trusted resources, online and in-person, to avoid ‘double up’ or inadvertently generating an overwhelming ‘list’ of resources. “Encourage people to know what and how much they’re taking, and encourage people to check a reputable source about potential interactions before using substances together” The need for polysubstance use harm reduction education was also identified in the context of travel and tourism to engage safely in polysubstance use overseas. Particularly, jurors noted a paucity of resources guiding how to navigate safe polysubstance use abroad within the parameters of local laws and cultural norms and expectations. Jurors reflected on a lack of awareness of available drug alerts provided overseas and sources of support (e.g., helplines, services) available abroad. I think sometimes that might be someone's first experience taking drugs, going traveling or overseas or something like that. And… the only drug related things I see in regards to travel is about taking prescription meds to other places. But there's no information really, about recreational drugs or other drugs. Sometimes it mentions if like certain ones are illegal, but that's about it. It doesn't really, mention anything else. Like, for example, we have our drug alerts here, like what if, on pages people used to plan their travel, it's like also giving them alerts about that place that they're planning to go to… because if you're not familiar with where you're going, how do you know where to find that information? Filling the knowledge gap on the interrelation/interaction of polysubstance use and financial health was also noted as an important topic for education to help support informed decisions-making about polysubstance use. Recommendation 4. Harm reduction resources should be disseminated in partnership with trusted, reputable community sector organisations. Jurors vehemently recommended harm reduction practitioners partnering with trusted local Australian organisations with high community buy-in to provide credibility of information, mentioning Australian Drug Foundation, ACON Health Limited, CanTEST and NUAA as examples. Jurors noted the potential utility of disseminating polysubstance use harm reduction messaging via peer influencers on YouTube or TikTok but expressed a preference reputable community organisations (e.g., Headspace, ReachOut) were more appropriate. I don't know if people like influencers would particularly be willing to like, sort of share, in that way (smiles), or any public figure, so I feel like it really is, more likely and beneficial to come from like an organization of some kind. And honestly, ACON comes to mind for this, but like, I'm sure there are possibly others that could also be useful. I also think having like an organization sort of behind something like this, gives it a bit more credibility to people who aren't familiar with like using drugs, or what that's like. So like, if they're seeing this is authorized by ACON or like, Australian government, and it's a positive message about this sort of thing, they're more likely to accept that, maybe (laughs). Alternatively, some jurors mentioned a centralised polysubstance use information resource that could direct people to existing p polysubstance use support and informational resources. i think there would be benefit to having a centralised organisation or program that can provide information and resources Discussion To our knowledge, this is the first participatory research-based study involving a citizen jury to meaningfully involve young adults with lived/living experience of using drugs in harm reduction research. This peer-led study generated clear consensus points regarding the key potential harms associated with polysubstance use and best-practice recommendations for addressing these, among young adults. This study was aware of intersectionality principles throughout all study activities, including sampling methods and team composition, thus offering a substantial contribution advancing equitable polysubstance use harm reduction research with young adults. Citizen jurors reached unanimous consensus regarding three key potential harms associated with polysubstance use among young adults: 1) balancing self-reflection and peer dynamics in the face of unclear and unpredictable drug effects; 2) navigating life after polysubstance use experiences, particularly comedowns and poor decisions made under impaired judgement; and 3) unintended and undesirable drug tolerance and/or dependence development. Citizen jury-identified key polysubstance use harms aligned with community survey responses indicating ‘interaction effects between certain drugs’ was the key potential harm arising from polysubstance use of most concern to young adults. Unanimous consensus among young adult jurors was also reached regarding how digital, online, and social media platforms can be optimally used to reduce and minimise the key harms aforementioned. Specifically, jurors identified four best-practice recommendations asserting that polysubstance use harm reduction resources should 1) be interactive, engaging, and accessible, using short form content; 2) champion diverse lived/living experiences of polysubstance use among contemporary young adults; 3) be educational and practical; and 4) prioritise dissemination in partnership with trusted, reputable community sector organisations, rather than social media influencers. Jurors’ recommendations for strengths-based harm reduction resources depicting ‘what to do’ rather than ‘what not to do’ align with community survey respondents reporting polysubstance use experiences were much more commonly associated with enjoyable times than unexpected negative physical and/or emotional effects. Critical to this are those harm reduction strategies involving planning, doing research, and knowing yourself helped young adults prepare preventing and reducing a cascade of potential polysubstance use harms, including unexpected, unpredictable drug effects, interactions, comedowns, avoiding regrettable decisions made under impaired judgement, and resisting peer pressure to partake in polysubstance use without preparation. Jurors cautioning the engagement of social media influencers aligns with community survey respondents stating that ‘TikTok’ was the least preferred social media or digital app platform for sharing polysubstance use harm reduction messaging and resources for young adults. These findings illustrate the impact of meaningfully involving young adults in harm reduction research via participatory-based citizen juries. Future participatory research in partnership with young adults and trusted, reputable community sector organisations is required to optimise the dissemination of polysubstance use harm reduction materials. This study highlights the critical role of peers for young adults having safe, comfortable, and enjoyable experiences of polysubstance use. Notwithstanding, peers may pressure young adults to engage in polysubstance use in ways they are not prepared for. Harm reduction must account for the double-edged sword of peers given nearly four in five (78%) of young adult survey respondents indicated that they were most commonly around friends when using their primary polydrug combination. Peer influence can also be leveraged to prevent polysubstance use harms as indicated by survey respondents perceiving ‘being annoying or inconvenient to your friends’ as the second most important polysubstance use harm. Additional participatory research with young adults and their peers is required to better elucidate how to leverage peer influence dynamics to encourage young adults’ to engage in polysubstance use harm reduction activities. This study benefitted from strong involvement of young adult peers throughout the research process, namely through the research team comprising multiple peer researchers and iterative consultation with a Youth Advisory Board. Involvement of young adult peers enabled the design of bespoke, relatable questions regarding polysubstance use harms and harm reduction strategies spanning quantitative (community survey) and qualitative (citizen jury) methods of data collection. Notwithstanding, findings should interpreted with caution due to small community survey sample size and that only one citizen jury was conducted. Moreover, this participatory study targeted young adults living NSW specifically and hence findings may not generalisable to other states/territories within Australia. This study demonstrates the value and feasibility of engaging young adults with lived/living experience of drug use in participatory harm reduction research. By incorporating peer leadership, intersectionality, and citizen jury methods, the research identified meaningful, consensus-based insights into the harms of polysubstance use and actionable, youth-informed strategies for addressing them. While findings are context-specific and exploratory, they offer a strong foundation for future co-designed harm reduction initiatives with young people across diverse settings. Declarations Funding This project was funded by Lived Experience Research Partnership Grant from The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney. Author Contribution All authors were involved in the conceptualisation, funding acquisition, methodology, and writing - review & editing of this project. SB and FG led data curation and formal analysis, with support from ZB. SB, FG, and LE led investigation via citizen juries. SB, LE, ZB led project administration with supervision led by CC and KC. SB and CC led validation of data results. SB and FG led writing - original draft preparation. Acknowledgement The Vibe Check team would like to thank those members of the Youth Advisory Board within The Matilda Centre for Research in Mental Health who provided strategic feedback on this project as part of their regular roles and responsibilities. The team would like to thank those young adults living across New South Wales who generously shared their time and wisdom via partaking in the community survey and/or citizen jury. Data Availability Community survey and citizen jury data is privately available upon reasonable request directed to the corresponding author and subject to approval by the wider Vibe Check team. Community survey tool, citizen jury agenda, pre-jury information pack, and raw descriptive results are available in Supplementary Materials. References Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223–8. Boileau-Falardeau M, Contreras G, Gariépy G, Laprise C. 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Supplementary Files Tables.docx SupplementaryMaterialsA.pdf SupplementaryMaterialsB.docx SupplementaryMaterialsC.docx SupplementaryMaterialsD.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 27 Aug, 2025 Reviews received at journal 26 Aug, 2025 Reviews received at journal 17 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers invited by journal 06 Aug, 2025 Editor assigned by journal 21 Jul, 2025 Submission checks completed at journal 21 Jul, 2025 First submitted to journal 20 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7171854","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496740309,"identity":"65250885-f410-4375-860f-a6fb86edcb59","order_by":0,"name":"Sasha Bailey*","email":"data:image/png;base64,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","orcid":"","institution":"University of Melbourne","correspondingAuthor":true,"prefix":"","firstName":"Sasha","middleName":"","lastName":"Bailey*","suffix":""},{"id":496740311,"identity":"3e60c97c-618b-41f1-b6d1-e6ec11a6c775","order_by":1,"name":"Florens Groot*","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"Florens","middleName":"","lastName":"Groot*","suffix":""},{"id":496740313,"identity":"fceb3b48-d135-4606-a174-5824949b221b","order_by":2,"name":"Lyra Egan","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"Lyra","middleName":"","lastName":"Egan","suffix":""},{"id":496740314,"identity":"fd0e788c-c8b2-49f5-ba4f-b23233daa416","order_by":3,"name":"Zachary Bryant","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"Zachary","middleName":"","lastName":"Bryant","suffix":""},{"id":496740315,"identity":"dc6190df-9186-40cf-9f15-e8507ab8e046","order_by":4,"name":"Thomas Norman","email":"","orcid":"","institution":"La Trobe University","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"Norman","suffix":""},{"id":496740316,"identity":"99e427cf-bb41-4fe0-b7e3-cfc2f1144484","order_by":5,"name":"Georgina Bell","email":"","orcid":"","institution":"ACON Health Limited. Sydney NSW","correspondingAuthor":false,"prefix":"","firstName":"Georgina","middleName":"","lastName":"Bell","suffix":""},{"id":496740317,"identity":"2ee74c2d-2f72-4f15-afa7-485e8938e27e","order_by":6,"name":"Nataly Bovopoulos","email":"","orcid":"","institution":"The Alcohol and Drug Foundation","correspondingAuthor":false,"prefix":"","firstName":"Nataly","middleName":"","lastName":"Bovopoulos","suffix":""},{"id":496740318,"identity":"6ba74cae-d943-4c6f-84a4-b969d76ef323","order_by":7,"name":"Katrina E. Champion^","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"Katrina","middleName":"E.","lastName":"Champion^","suffix":""},{"id":496740319,"identity":"adb3653f-aa37-4c75-8628-4c5e9d3358e0","order_by":8,"name":"Cath Chapman^","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"Cath","middleName":"","lastName":"Chapman^","suffix":""}],"badges":[],"createdAt":"2025-07-20 22:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7171854/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7171854/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88890629,"identity":"ee01473c-f964-4b8c-97d6-1213cbd97a5a","added_by":"auto","created_at":"2025-08-12 12:46:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":53785,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7171854/v1/e54a705f57ac5942cdd225d5.png"},{"id":88890628,"identity":"9febea12-b873-48a3-8de6-f6a94e56a01d","added_by":"auto","created_at":"2025-08-12 12:46:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":101255,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7171854/v1/f9dc2519c4f19fb42204c715.png"},{"id":88896980,"identity":"272d74d4-ee70-4a69-855d-cdcdee766d78","added_by":"auto","created_at":"2025-08-12 13:10:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1339371,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7171854/v1/6dff99de-14f4-47ea-9f68-e63f0c744def.pdf"},{"id":88890627,"identity":"6556fb1b-f557-45e5-a3b3-b7a687748fa1","added_by":"auto","created_at":"2025-08-12 12:46:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":33617,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7171854/v1/da5d4008ef822f76726aed38.docx"},{"id":88890631,"identity":"44aecda9-a422-4c23-97ff-20eb462dcc7f","added_by":"auto","created_at":"2025-08-12 12:46:33","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":97460,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialsA.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7171854/v1/72cbf7834c242eab0fff3a0a.pdf"},{"id":88890633,"identity":"9d5e346a-ff2e-451c-8e69-66f138e1faf7","added_by":"auto","created_at":"2025-08-12 12:46:33","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":25685,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialsB.docx","url":"https://assets-eu.researchsquare.com/files/rs-7171854/v1/9724e6da6422c9a7864ee0aa.docx"},{"id":88890640,"identity":"d3d29ce9-8c82-412c-a333-61cc28200d50","added_by":"auto","created_at":"2025-08-12 12:46:33","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":420637,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialsC.docx","url":"https://assets-eu.researchsquare.com/files/rs-7171854/v1/1c95d9cde0f060991e4c6de1.docx"},{"id":88890643,"identity":"ca05c1d0-63e9-46e1-8a12-da53672f09dd","added_by":"auto","created_at":"2025-08-12 12:46:33","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":28823,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialsD.docx","url":"https://assets-eu.researchsquare.com/files/rs-7171854/v1/0bbd7c5dd7c13c3fc6d8df34.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Co-designing polysubstance use harm reduction messaging with and for young adults: findings from a participatory, intersectional citizen jury and community survey (The ‘Vibe Check’ Project)","fulltext":[{"header":"Background","content":"\u003cp\u003eFor many young adults aged 18 to 30 years\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, polysubstance use – the deliberate or unintentional use of more than one legal (e.g., prescribed) and/or illicit substance concurrently or in close temporal proximity – allows one to enhance and/or prolong a positive experience, mitigate or moderate the effect of another substance, and/or soothe uncomfortable withdrawal symptoms or comedowns.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e While polysubstance use and indeed ‘isolated’ substance use do not result necessarily in substance use-related harms, epidemiological studies have found that polysubstance use is associated with higher risk of mental ill-health,\u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e headaches and other pain\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, lower educational attainment\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, reduced control over one’s use or ability to achieve a positive effect or ‘high’\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, school and/or work problems \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003eand justice system involvement.\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Measurement of polysubstance use is commonly based on reports of multiple substances used within a given timeframe (e.g., past 6-months or 30 days) failing to distinguish sequential from concurrent polysubstance use.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e It remains unclear how to apply evidence-guided principles of harm reduction to reduce potential harms from polysubstance use among young people.\u003c/p\u003e\u003cp\u003eMindful consumption and benefit maximisation\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e represents a bold and strengths-based paradigmatic advancement in contemporary harm reduction thinking. This approach focuses principally on promoting thoughtful drug use and enhancing positive experiences, subsequently facilitating successful harm reduction. Accordingly, polysubstance use, relative to ‘isolated’ substance use, may in theory afford young adults greater opportunities to realise the potential positive benefits of substances.\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Conventional harm reduction approaches focusing on promoting safer, managed use, including abstinence, have been criticised\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e by drug policy advocates and academics as being inadvertently stigmatising\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e and over-reliant on epidemiological studies which take an ‘increased use increased harm’ approach to measurement and analysis.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e While a focus on harms is important from a population health promotion lens\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, this can miss the potential to explain how and why young adults engage in the social practices\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e of polysubstance use, which polysubstance use harms are perceived of utmost concern to young adults, and how evidence may guide the improvement of young adults’ polysubstance use experiences.\u003c/p\u003e\u003cp\u003eThe meaningful involvement of young adults who engage in polysubstance use is critical for successful polysubstance use harm reduction conceptualisation, messaging, and delivery.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Yet the meaningful involvement of young adults as distinct from their older adult peers\u003csup\u003e\u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21 CR22\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e–\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e remains significantly under researched, missing an invaluable opportunity to capitalise on young adults’ experiential knowledge, community connectedness, and access and literacy regarding emerging digital technologies.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Urgent participatory research is warranted to better understand how harm reduction practitioners can leverage digital technologies, such as social media, to successfully disseminate polysubstance use harm reduction messaging with contemporary young adults.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eCitizen juries, an increasingly popular participatory research method, are an effective means of ascertaining consensus via active deliberation between ‘citizens’ (peer researchers) acting as ‘jurors’.\u003csup\u003e\u003cspan additionalcitationids=\"CR26 CR27 CR28\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e–\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Through these intentionally democratic and deliberative processes, citizen juries are effective for participatory research with individuals who have been historically underrepresented in certain research domains (e.g., incarcerated populations\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e), as well as for research where there may be significant heterogeneity in perspectives within and between different ‘peer’ stakeholder groups (e.g., school-based vaccination programs).\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Despite young adults being historically underrepresented in harm reduction research\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e and, moreover, significant variation in views regarding the scope of harm reduction having been observed,\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e to our knowledge, no research has undertaken citizen juries with young adults in the context of drug harm reduction research.\u003c/p\u003e\u003cp\u003eGiven the non-uniform distribution of polysubstance use among young adults, intentionally engaging diverse constellations of young adults is necessary for the equitable involvement of young adults in harm reduction efforts.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Higher polysubstance use prevalence has been previously observed among gender and sexuality diverse (‘LGBTQA’) young adults\u003csup\u003e\u003cspan additionalcitationids=\"CR33 CR34\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e–\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e, particularly trans and gender diverse (‘trans’) young adults\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e, young adults from lower socio-economic backgrounds,\u003csup\u003e\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e–\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e and young adults living in rural, regional, or remote backgrounds.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e Critically, intersectionality theory\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e provides a useful process-oriented\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e rather than identity-based\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e framework for understanding how young adults do not have siloed social experiences (of gender, sexuality, affluence, and urbanicity, for example) and indeed how polysubstance use experiences are shaped by the multiple interacting aspects of one’s socio-relational experiences and socially constructed backgrounds and identities. The meaningful involvement of young adult peers navigating socio-relational processes of drug use while crossing multiple, competing axes of power, oppression, and privilege represents a dire research gap.\u003c/p\u003e\u003cp\u003e The present study (The ‘Vibe Check’ Project) sought to address the aforementioned research gaps by conducting a participatory research study comprising a community-based survey and follow-up citizen jury. An intersectionality lens toward polysubstance use experiences and potential harms was adopted by directing concerted attention toward how these socio-relational polysubstance use experiences and harms were shaped by socio-relational experiences of social gender, sexuality, affluence, and geographical location. This participatory research study was guided by two primary research objectives:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo identify the key potential harms associated with polysubstance reported by young adults, and\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo identify the best strategies for preventing these harms.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe ‘Vibe Check’ Project employed a participatory research approach to conduct an online cross-sectional survey and citizen jury with young adults. A lived experience peer researcher (FG) was involved with the development of a Lived Experience Partnership grant proposal to support the study, and was subsequently employed as a professional research assistant on the project. A core working group was established with junior research staff members (SB, LE, ZB) to oversee the project, and optional attendance was invited from the peer researcher (FG) to balance time and costs while also facilitating input into key decisions where feasible. Ad-hoc wider working group meetings were held with whole team. The study was conducted in two stages – Phase 1: a community survey, and Phase 2: a citizen jury. Ethics approval was provided by the University of Sydney Human Research Ethics Committee (HREC 2024/HE001655).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage 1: Community survey\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy design and sample\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBetween March 2025 and June 2025, an online cross-sectional anonymous survey administered via REDCap (v15.3.3)\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e was open to a) young people aged 18 to 30 years, b) living in the state of New South Wales (NSW), Australia, and c) who within the preceding 12 months used more than one psychoactive drug at the same time (within the same day).\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants and recruitment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants were recruited predominantly via social media, namely Facebook, Instagram, and LinkedIn. \u003cspan\u003e$\u003c/span\u003e100 was allocated to advertise in NSW generally, and \u003cspan\u003e$\u003c/span\u003e400 was allocated to target specific areas of NSW that were outside of major cities\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e and/or had a lower ranked relative socioeconomic advantage and disadvantage index\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e, according to the Australia Bureau of Statistics. Study advertisements were also disseminated to members of The Matilda Centre Youth Advisory Board (YAB) and Youth Engagement Network.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eValidated measures of substance use and harms were administered\u003csup\u003e\u003cspan additionalcitationids=\"CR50 CR51\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e–\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e however given the lack of available validated polysubstance use measures, survey items regarding polysubstance use were iteratively co-developed via input from drug and alcohol and epidemiology experts, the peer researcher, and the YAB. Main take-away messages from consulting the YAB included thoroughly reviewing the survey to simplify questions the YAB highlighted as unclear. For example, it was recommended to allow participants options to describe their gender in free-text option and also select a ‘prefer not to disclose’ option. For tobacco and vaping questions, it was recommended to ask participants to specify the day(s) of the week they smoke the most and the average number of cigarettes smoked on those days and remove redundant questions not relevant for the Vibe Check project. YAB members also recommended emphasising to participants via survey instructions that their responses are confidential by adding a disclaimer. Survey items comprised a mixture of fixed-option (quantitative) and free-text open-ended (qualitative) questions pertaining to patterns, correlates, motivations, and harm reduction perceptions of polysubstance use among young adults. Written, informed consent was collected prior to survey commencement. The full survey instrument is provided in \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSupplementary Materials A\u003c/span\u003e.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eQuantitative items were summarised descriptively using counts and proportions for categorical variables and means and standard deviations for continuous variables in RStudio Version 4.2.2.\u003c/p\u003e\u003cp\u003eQualitative data were exported to NVivo for summative content analysis, an analytic approach appropriate for providing high-level overview descriptions of qualitative datasets smaller and briefer in nature (e.g., survey free-text responses).\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage 2: Citizen jury\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants who completed the online survey were invited to express interest in participating in a follow-up 7hr (including 30min paid break) citizen jury held online via Zoom. Citizen juries are an effective means of exploring people’s perspectives on complex health research topics with the view to achieving policy-relevant consensus.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e Citizen jury invitations were sent to a randomly selected sample of survey respondents who had expressed interest in the citizen jury. REDCap Survey ID numbers were entered into RStudio, and a command line randomly printed eight numbers denoting invitation status.\u003c/p\u003e\u003cp\u003e\u003cb\u003eJury composition and governance\u003c/b\u003e\u003c/p\u003e\u003cp\u003eJurors were young people aged 18 to 30 years living in NSW who had recently used more than one psychoactive drug at the same time (on the same day) within the past 12 months. No additional inclusion/exclusion criteria were applied. Jurors were not required to have previously engaged in research or advocacy activities relating to polysubstance use harm reduction. Prospective jurors were informed that the study involved a group discussion that would follow the format of a ‘citizen jury’ where they would act as a juror alongside other participants, ‘to deliberate and reach consensus on two jury questions relating to harms arising from polysubstance use among Australian young adults’. At the end of the citizen jury sessions, participants were also informed they would be invited to provide written feedback summarising their final recommendations on polysubstance use harms and strategies for reducing these harms for Australian youth, along with questions about their experience of participating in the citizen jury.\u003c/p\u003e\u003cp\u003eJurors were informed prior to the day that they would not be required to share their name with other jurors and were encouraged to update their Zoom display name accordingly prior to joining the Zoom meeting. Participants were compensated AUD \u003cspan\u003e$\u003c/span\u003e35.41/hr; such that at the end of the citizen jury session (7hrs max including 30min paid lunch break), each participant received an AUDa \u003cspan\u003e$\u003c/span\u003e250 gift voucher by email to thank them for their time and effort. If a participant withdrew before the end of the study, their voucher would be pro-rated, although no withdrawals were observed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe citizen jury was facilitated by a peer researcher (FG; a young trans woman), with support from senior members of the research team (SB, LE; both young adults). Though an informed member of the research team, the facilitator was tasked with remaining impartial, asking neutral non-leading follow-up questions and avoiding pre-empting consensus. The facilitator and two senior members of the research team had two preparatory Zoom meetings prior to the jury event where questions, concerns, and hypothetical troubleshooting scenarios were discussed.\u003c/p\u003e\u003cp\u003eThese three team members communicated iteratively to co-plan an ‘agenda’ for the day’s proceedings. This agenda is provided in \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSupplementary Materials B\u003c/span\u003e however in brief the plan was as follows: greeting and acknowledgement of country (5mins); introduction of research team members in attendance (5mins); expert presentations (30mins); presentation on findings from Phase 1: Vibe Check community survey (10mins); information about citizen jury methods and rules of engagement (10mins); deliberation session 1 (2.5hrs); lunch break (30mins); deliberation session 2 (2.5hrs); and de-brief/check-out (30mins).\u003c/p\u003e\u003cp\u003eOne week prior to the event, jurors received a pre-jury information pack which provided information about the research team, background topics (‘what is polysubstance use?’, ‘What are the potential harms from polysubstance use?’, and ‘The role of harm reduction’). This information pack also summarised an overview of The Vibe Check Project, including preliminary findings from the Phase 1 survey. The information pack explained what a citizen jury entailed and gave a summative description of the role of jurors (see \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSupplementary Materials C\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs is convention with citizen juries, jurors were presented with a series of brief recorded expert presentations to aid in evidence-based deliberation and consensus-reaching. The YAB and peer researcher were consulted on the roster of topics/presenters and it was agreed that presenters should provide high-level epidemiological research about polysubstance use and harm reduction, and community-based speakers presenting on successful polysubstance use harm reduction campaigns and programs, particularly those targeting LGBTQA + youth, rural/regional youth, or those leveraging digital mediums. Hence, four, 10min expert presentations were provided to jurors: 1) ‘Polysubstance use among young people in Australia’, delivered by an expert in epidemiology and prevention of substance use among youth (CC); 2) ‘Polysubstance use harms and harm reduction’, delivered by a research expert in substance use prevention and harm reduction (KC); 3) ‘Communicating polysubstance use harm reduction strategies to young people in Australia’ including the Path2Help and Text The Effects initiatives, delivered by a member of the evidence team of the Alcohol and Drug Foundation (ADF) (NB), Australia’s leading organisation for preventing and minimising alcohol and other drug harms, and 4) ‘Polysubstance use harm reduction tips and strategies’, delivered by the Harm Reduction team of ACON Health Limited, Australia’s largest LGBTQ + community health organisation (GB). Expert presentations are available upon reasonable request addressed to the corresponding author.\u003c/p\u003e\u003cp\u003eDeliberation sessions comprised a series of ‘incremental’ questions prompting interactive, engaging group discussion. These culminated in a ‘final deliberation question’ where the facilitator (FG) activated a Zoom whiteboard activity displaying the key deliberation question (Session 1: What are the key harms associated with polysubstance use among young adults in Australia; Session 2: How can we use digital, online, and social media platforms to reduce and minimise the three main harms identified from deliberation session 1 among young people in Australia?). Following optional engagement with the Whiteboard activity, jurors were invited by the facilitator to share their key recommendations. The facilitators, with support from senior research staff in attendance, synthesised these recommendations in an open-ended manner using follow-up questions, with the a priori aim of distilling three key recommendations per deliberation session. Once these key recommendations were distilled, the facilitator read each of these one-by-one aloud where jurors verbally or via the ‘thumbs up’ Zoom function, voted and signalled their agreement, thus representing consensus.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection and analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA Zoom auto generated transcript was cleaned in Microsoft Word.\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e This clean transcript was then imported into NVivo for deductive thematic analysis. The citizen jury transcript was coded by a peer researcher (FG) who developed summative themes cutting across prevalent, salient codes. Rather than ‘confirming’ these codes and preliminary themes, a senior research staff member reviewed the codebook and built off these to distil key themes resembling rationales underpinning the consensus-based recommendations reached in each deliberation session. This represented a synergy of lived experience partnership where the latter person provided complementary, adjunct, additional interpretation and meaning making. The peer researcher (FG) and senior staff member (SB) met online during this process to ensure continuous communication within this participatory process. Citizen jury findings were then discussed and triangulated with survey findings.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eStage 1: Community survey\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn total, 39 young adults completed the community survey. The average age was 24 years (SD\u0026thinsp;=\u0026thinsp;3.4). Four in five (82%) were cisgender, and one in five (18%) were trans. Over half of participants (59%) were young women (cis or trans), and one in four (23%) were young men (cis or trans). Five participants (13%) were non-binary and two (5%) were gender diverse. Most participants were heterosexual (n\u0026thinsp;=\u0026thinsp;17, 44%), followed by bisexual or bi+ (n\u0026thinsp;=\u0026thinsp;9, 23%), gay or lesbian (n\u0026thinsp;=\u0026thinsp;5, 13%), and queer (n\u0026thinsp;=\u0026thinsp;5, 13%). Full details regarding sample demographic characteristics are available in \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSupplementary Materials D\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatterns and contexts of polysubstance use\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong participants, the most common substances used in combinations of alcohol and/or other drugs used at the same time within the preceding 12 months were alcohol (n\u0026thinsp;=\u0026thinsp;33, 84.6%), tobacco (n\u0026thinsp;=\u0026thinsp;19, 48.7%), cannabis (n\u0026thinsp;=\u0026thinsp;17, 43.6%), and MDMA (n\u0026thinsp;=\u0026thinsp;14, 35.9%). Alcohol was most commonly cited substance used first within participants\u0026rsquo; named polysubstance use combinations (n\u0026thinsp;=\u0026thinsp;19, 52.8%). Young adults most commonly used named polysubstance use combinations around friend(s) (n\u0026thinsp;=\u0026thinsp;28, 77.8%), at mainstream clubs and \u0026lsquo;nights out\u0026rsquo; (n\u0026thinsp;=\u0026thinsp;28, 71.8%), private home-based social gatherings with friends (n\u0026thinsp;=\u0026thinsp;27, 69.2%), LGBTQA\u0026thinsp;+\u0026thinsp;clubs, events, \u0026lsquo;nights out\u0026rsquo;, and music festivals (n\u0026thinsp;=\u0026thinsp;16, 41.0%), and bush doofs (n\u0026thinsp;=\u0026thinsp;13, 33.3%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceptions, experiences, and strategies for reducing harms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Fig. 1 below, the top six potential harms arising from polysubstance use that were of most concern to young adult respondents were \u0026lsquo;interaction effects between certain drugs\u0026rsquo; (45.7%), \u0026lsquo;being annoying or inconvenient to your friends\u0026rsquo; (45.7%), \u0026lsquo;spending too much money on substances\u0026rsquo; (45.7%), \u0026lsquo;developing drug tolerance\u0026rsquo; (22.9%), \u0026lsquo;having an accident or injury yourself\u0026rsquo; (20%), and \u0026lsquo;developing drug dependence\u0026rsquo; (17.2%), respectively. Full results are available in \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSupplementary Materials D\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.4 Harm reduction messages and preferences for communicating these via social media and mobile app platforms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong those who provided an open-ended response on advice they would give to someone who was considering engaging in polysubstance use for the first time, to have fun and feel safe, the most common recurring theme mentioned by 21 of the 23 respondents related to the importance of \u0026lsquo;\u003cem\u003epreparing\u003c/em\u003e\u0026rsquo;, \u0026lsquo;\u003cem\u003eplanning\u003c/em\u003e\u0026rsquo;, \u0026lsquo;\u003cem\u003emeasuring\u0026rsquo;\u003c/em\u003e, and, where feasible, \u0026lsquo;\u003cem\u003etesting\u003c/em\u003e\u0026rsquo; for the ideal \u0026lsquo;\u003cem\u003edosage\u003c/em\u003e\u0026rsquo; and \u0026lsquo;\u003cem\u003etiming\u0026rsquo;\u003c/em\u003e of the drugs one is considering to use. For example, as one participant noted: \u0026lsquo;\u003cem\u003emaybe play around with dosages/timings to ensure correct high without causing too much damage to future self (i.e., hangover etc)\u0026rsquo;\u003c/em\u003e. It was noted that it would also be strategic to consider trying drugs that you had never used/co-used, \u0026lsquo;\u003cem\u003eby themselves first\u0026rsquo;\u003c/em\u003e, without other substances. Five of 23 respondents also noted the importance of being around people they \u0026lsquo;trust\u0026rsquo;: \u0026lsquo;\u003cem\u003eKnowing that the people you are with love and support you is easily the biggest factor to whether the experience is good or bad.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 39 community survey respondents, the most commonly voted social media or digital app platform that would be best to share polysubstance use harm reduction messaging and resources for young adults was Instagram (n\u0026thinsp;=\u0026thinsp;32, 82%), followed by mainstream dating apps (n\u0026thinsp;=\u0026thinsp;15, 39%), and LGBTQA\u0026thinsp;+\u0026thinsp;dating apps typically used by gay men (e.g., Grindr, Scruff) (n\u0026thinsp;=\u0026thinsp;12, 31%). LinkedIn (n\u0026thinsp;=\u0026thinsp;1, 3%) and TikTok (n\u0026thinsp;=\u0026thinsp;5, 13%) were the least preferred media. Full results are available in \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSupplementary Materials D\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStage 2: Citizen jury\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe citizen Jury was held Friday 2nd May 2025 9am to 4pm online via Zoom. In attendance were five jurors who met the inclusion criteria and were aged 18 to 30.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIdentifying key polysubstance use harms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHarm 1: Navigating self-reflection and peer dynamics in the face of unclear and unpredictable drug effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYoung adult jurors collectively articulated a key potential harm arising from polysubstance use pertaining to the unclear and unpredictable drug effect and interactions; a complexity further muddied by varying levels of planning, \u0026lsquo;research\u0026rsquo; and self-reflection undertaken by oneself and the extent to which peers were supportive versus exerting of peer pressure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUncertainty and unpredictability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJurors acknowledged that engaging in polysubstance use meant necessarily acknowledging and accepting a level of not knowingness or inexperience of certain drug effects, including potentially adverse drug interactions.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003eSo I wrote\u003c/em\u003e [one key polysubstance use potential harm being] \u003cem\u003ethe unpredictability of effects, but I\u0026hellip; was thinking that in terms of mental health impacts and then also physical health. So, yeah, not knowing the effects of what mixing drugs, can have on\u0026hellip; your mental health and physical health while you\u0026apos;re taking the drug, but then also the prolonged effects after the drug is worn off or during the come down.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe harm relating to unintended, adverse drug interactions lies in how these undermine and de-rail one\u0026rsquo;s desired, expected drug effects thus diminishing agency over one\u0026rsquo;s curated polysubstance use experience.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u0026hellip;I think a lot of people, plan, for like, an occasion to take drugs, especially, when they\u0026apos;re mixing them. And when things go a bit off track with the plan\u0026hellip; it can become riskier. Like they might plan to only have a certain amount but then someone offers more\u0026hellip; or a different kind of drug that they weren\u0026apos;t planning to take\u0026hellip; and that can sort of derail things a little, they haven\u0026apos;t sort of set themselves up for that.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003ePlanning, doing research and knowing yourself to prepare for polysubstance use experiences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants highlighted the harm reduction utility of \u0026lsquo;\u003cem\u003epreparing\u0026rsquo;\u003c/em\u003e for polysubstance use experiences via planning, research, and self-reflection. \u0026lsquo;\u003cem\u003ePlanning\u0026rsquo;\u003c/em\u003e activities included ensuring full mobile phone better charge to prevent \u0026lsquo;someone\u0026rsquo;s phone going flat\u0026rsquo; and communicate when someone is \u0026lsquo;\u003cem\u003echanging spots\u0026rsquo;\u003c/em\u003e, \u0026lsquo;\u003cem\u003esetting reminders to drink water\u003c/em\u003e\u0026rsquo;, \u0026lsquo;\u003cem\u003eusing an apple watch to keep track of heart rate.\u003c/em\u003e\u0026rsquo; As one juror notes: \u0026ldquo;\u003cem\u003eI always make sure I have a plan on how I\u0026rsquo;m getting home (or who I am crashing with). I am less likely to partake when I don\u0026rsquo;t have that in place\u003c/em\u003e\u0026rdquo;. Similarly, \u0026lsquo;\u003cem\u003edoing research\u003c/em\u003e\u0026rsquo; included seeking information about potential drug effects and interactions, including those relating to prospective substances to be used (e.g., avoiding use of multiple \u0026lsquo;\u003cem\u003edepressants\u0026rsquo;\u003c/em\u003e) and/or psychiatric medication (e.g., \u0026lsquo;\u003cem\u003eanti-depressants\u003c/em\u003e\u0026rsquo;).\u003c/p\u003e\n\u003cp\u003eLastly, young adult jurors highlighted the importance of spending time getting to \u0026lsquo;\u003cem\u003eknow yourself\u003c/em\u003e\u0026rsquo;, reflecting on your own expectations and boundaries relating to prospective polysubstance use experiences.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003eI don\u0026rsquo;t feel like a lot of people actually really take time to learn about their own boundaries\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026hellip; something that\u0026apos;s, really key is like, knowing yourself \u0026hellip; you might know that like certain things make you anxious and that impacts your setting choice... when people put the effort in to learn those things about themselves, they can have a much better experience, and plan a bit better. Or even if it\u0026apos;s more spontaneous, they can have in their mind like here are sort of my limits\u0026hellip;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eSelf-reflection represented an important vehicle for distinguishing one\u0026rsquo;s own polysubstance use aspirations from their friends:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u0026hellip;if you\u0026apos;re using drugs, it\u0026apos;s pretty likely that a lot of your friends are as well. And that, to some extent you might define, like your baseline for what normal drug use is based on what your friends are doing\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003ePeer support vs peer pressure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJurors agreed that the presence of trusted peers as critical for \u0026lsquo;\u003cem\u003esafe\u0026rsquo;\u003c/em\u003e, \u0026lsquo;\u003cem\u003ecomfortable\u0026rsquo;\u003c/em\u003e polysubstance use experiences, especially when (co-)using certain drugs for the first time.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; if you\u0026apos;re doing a substance like, by yourself for the first time, you don\u0026apos;t really know what to do\u0026hellip;. I think that\u0026apos;s a pretty risky drug use scenario, but \u0026hellip; I wouldn\u0026apos;t necessarily say the same thing about like\u0026hellip; trying a substance with a friend who\u0026apos;s like experiencing it and is starting low and slow.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLike-minded peers were tantamount for creating a sense of community which enhanced the overall positive shared experience of taking substances together:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think kind of finding a sense of community, is important in these events \u0026hellip;because \u0026hellip; people are more likely to \u0026hellip; feel comfortable taking substances or mixing substances. But then also, I guess, the reverse of that \u0026hellip; can build community in a way\u0026hellip; or just that shared experience of taking substances together. And if everyone is kind of on\u0026hellip; a similar wavelength I guess (laughs)\u0026hellip;I think the sense of community can be really strong at certain social settings.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHowever, jurors noted that peers can hold differing, conflicting polysubstance use aspirations and, at times, may exert pressure on young adults to engage in polysubstance use in a way they are not \u0026lsquo;prepared\u0026rsquo; for.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003ea lot of people not only take drugs - or drink - or smoke because they\u0026apos;re around their friends or people that they\u0026apos;re trying to ingratiate themselves with.\u003c/p\u003e\n \u003cp\u003eI think it\u0026apos;s easy to get caught up in the moment as well and sometimes in social settings, and you kind of just go along with maybe what your friends are doing or what you might be feeling in that particular moment.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eAlmost all discussions of polysubstance use peer pressure were in reference to peer colleagues and supervisors in workplaces, particularly those in the \u0026lsquo;hospitality\u0026rsquo;, \u0026lsquo;entertainment\u0026rsquo;, and \u0026lsquo;sex work\u0026rsquo; industries.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI\u0026apos;ve known several people who have, like, never used drugs before and then they go into a workplace, and they\u0026apos;re pressured or encouraged to use drugs to get through their shift, or\u0026hellip; to work overtime, like maybe they\u0026apos;re doing, overtime or things like that. And then, they have ended up not being able to stop and worrying about how they\u0026apos;re using drugs, and I do think this is quite a widespread problem, especially in hospitality industry, especially in entertainment industry, sex work as well. Yeah, it\u0026apos;s\u0026hellip; when I hear people expressing regrets about drugs, it often does involve workplaces and feeling, pressured to do it. When people don\u0026apos;t feel pressured, they\u0026apos;re not expressing regret over it.\u003c/em\u003e\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eI personally work hospitality jobs [and] there\u0026apos;s also a bit of a work hard play hard culture sometimes\u0026hellip; where like, if you\u0026apos;re getting off your shift at 2am, and then going to the pub, I feel like it\u0026apos;s, even if no one\u0026apos;s explicitly pressuring you, there\u0026apos;s a kind of implicit social pressure to use other drugs because, again, it\u0026apos;s 2am and that\u0026apos;s when you\u0026apos;re starting drinking\u0026hellip;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eHarm 2: Navigating life after polysubstance use experiences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnanimous juror consensus identified that navigating life \u0026lsquo;after\u0026rsquo; polysubstance use experiences, including navigating \u0026lsquo;comedowns\u0026rsquo; and coming to terms with decisions made under impaired judgement, were a key potential harm arising from polysubstance use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComedowns\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe time following polysubstance use may though not always, involve \u0026lsquo;comedowns\u0026rsquo;: a vulnerable time of raw emotions \u0026lsquo;after the drug is worn off\u0026rsquo;. Jurors commented that comedowns were sometimes \u0026lsquo;expected\u0026rsquo; and thus \u0026lsquo;planned for\u0026rsquo;, but at times were unpredictable\u0026rsquo;. Jurors emphasised self-care \u0026lsquo;during and after\u0026rsquo; comedowns.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u0026hellip;the come down could be, really unpredictable, especially if you haven\u0026apos;t used that combination before, or like you\u0026apos;re doing it at like a dose you haven\u0026apos;t before.\u003c/p\u003e\n \u003cp\u003e\u0026hellip; especially during the come down period. I\u0026apos;ve had friends that have gone into, like depressive periods for days or so and then also physical\u0026hellip; harm. I think for me, I\u0026apos;m most worried about being hospitalized potentially.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eRisk of impaired judgements and decision-making\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJurors unanimously acknowledged that when engaging in polysubstance use, young adults were sometimes exposed to risks of making poor decisions with impaired judgements with potential long-lasting negative implications far beyond a discrete polysubstance use experience.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026hellip; sometimes you can feel like, it\u0026apos;s not you who is making decisions that you are. And so I think that can be really harmful because people end up doing stuff that they either wouldn\u0026apos;t ordinarily do, or something that they weren\u0026apos;t planning to be doing in the first place. Driving, having sex\u0026hellip; aggression\u0026hellip; that disconnection can be really harmful, especially in higher doses because it\u0026apos;ll affect people\u0026apos;s lives\u0026hellip; for the rest of their lives, especially if something negative happens.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eHarm 3: Unintended, undesirable tolerance and/or dependence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTolerance and dependence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants noted that developing tolerance or dependence was harmful because it compromised agency and control over one\u0026rsquo;s decisions in relation to polysubstance use. Tolerance also threatened participants\u0026rsquo; ability to make reliable plans about their polysubstance use affective experience, with their choice of substances being influenced considerably by necessity to take a higher dose to achieve a certain affective state, distinct from perhaps previously choosing substances for other reasons or no specific reason at all. Cross-tolerance to multiple drugs, and repeated use of the combinations due to lack of desired effects was considered a vehicle for further harms, namely reduced agency over one\u0026rsquo;s personalised, curated, and desired polysubstance use experience, feeling they need to use/co-use more to counter tolerance and achieve \u0026lsquo;equal\u0026rsquo; enjoyment.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDeveloping tolerance, esp cross-tolerance to multiple drugs / Increasing doses over time to fight tolerance\u003c/p\u003e\n \u003cp\u003eI\u0026apos;ve had a few friends who\u0026hellip; are trying to reduce their drug use, but they\u0026apos;re finding it quite difficult due to dependence on multiple substances. So, in terms of finding treatment, in terms of kind of identifying\u0026hellip; like, if there\u0026apos;s a particular drug they want to cut down on, it is a bit of a\u0026hellip; confusing process as well.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eEffects of unintended, undesirable tolerance and/or dependence impacted one\u0026rsquo;s financial health too, with many citing greater financial costs and \u0026ldquo;financial strain\u0026rdquo; associated with one\u0026rsquo;s substance use, and overspending on polysubstance use occasions.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u0026hellip; there isn\u0026apos;t there doesn\u0026apos;t seem to be any sort of kind of helpline that\u0026apos;s, directly addresses that intersection of financial, kind of\u0026hellip; constraints and you know polydrugs use or drug use or substance use in general, but doing things like oh, you know partnering with like the national debt helpline to create resources that directly address that area, so young people feel a bit more confident if they do get a step forward and take that, first step\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe financial parameters of polysubstance use risks of tolerance/dependence were further complicated due to \u0026lsquo;free\u0026rsquo; \u0026lsquo;accessibility\u0026rsquo; of substances being common:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u0026hellip; when something is offered for free, like no catch, so to speak, that can increase the chance that people will be more likely to just do it because it\u0026apos;s not costing them anything\u0026hellip; (laughs) financially, or it does cost in other ways probably, but yeah, availability, like, when I\u0026apos;m thinking about my friends who were dealing with these workplaces that pressured them to use drugs, they weren\u0026apos;t pressuring them to buy them, they had them freely available, and that can feel like more pressure to participate, because it\u0026apos;s like, offered for free\u0026hellip;.\u003c/p\u003e\n \u003cp\u003eI think as well when something is offered for free, like no catch, so to speak, that can increase the chance that people will be more likely to just do it because it\u0026apos;s not costing them anything\u0026hellip;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations for harm reduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation 1. Harm reduction resources should be interactive, engaging, accessible, using short form content\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInteractivity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnline modules like the TripSit drug combo checker, online chat forums (e.g. Reddit, Bluelight), Q\u0026amp;A chatbots for topics on polysubstance use and related harms (e.g. Nurse Nettie, ADF\u0026rsquo;s Drug Info Bot), and mental health and dosage trackers, were praised for their interactive functionality providing a variety of \u0026lsquo;choice\u0026rsquo; for users seeking specific polysubstance use harm reduction advice. Infographics and question-and-answer (Q\u0026amp;A) functions were also suggested as exemplars of interactivity.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003ethe combo chart from TripSit which is a bit overwhelming, it\u0026apos;s not great, but the great thing is they have an alternative which comes in the form of like a little interactive ..page where you put in like two drugs that you might want to experiment with and it tells you if it\u0026apos;s got like high synergy low synergy if it\u0026apos;s something you should you know avoid, due to really high risk, and I think that\u0026apos;s the thing with these different sort of harm reduction activities is giving choice, and giving different options, I think we identified that earlier but just want to emphasize it\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAudience engagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJurors highlighted the importance of taglines prompting users to self-reflect, hashtags, shareable posts (e.g. on social media) to promote engagement and relatability with young adults.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eI thought about those gambling posters which are like, what\u0026apos;s the phrase they use? They\u0026apos;re like\u0026hellip; (exhales) I can\u0026apos;t even think of it. Juror 2: Wh-What\u0026apos;s gambling really costing you? Juror 3: Yeah, stuff like that, but\u0026hellip; not that judgy (laughs). I thought some sort of check-in, some sort of cue, for someone to check in with themself about, if they\u0026apos;re becoming dependent, or building a tolerance and it\u0026apos;s not, in a way that they want\u0026hellip; But I don\u0026apos;t know, what words to use for that\u0026hellip; But .. the idea of the cue or check-in, like someone sees something and they, reflect\u0026hellip;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eRespecting audience diversity was also seen as key, signalling a need for different advertisements for different platforms and different demographics\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eI guess for me I feel like there\u0026apos;s like, maybe two different kinds of harm minimization messages I\u0026apos;d want to see, like one of which would be more like, general informative content where like a digital approach could work well. Like it\u0026apos;s stuff you want someone to know a week or a month before they\u0026apos;re going to use. But then I think there [is] like a separate class of like harm minimization messages that I would want to deliver as close as possible before someone was like considering using drugs. That like, frankly like what I would want to see on an Instagram ad and what I would want to see on the club bathroom are not necessarily the same thing\u0026hellip; But I think they\u0026apos;re both important.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAccessibility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOptimising accessibility of polysubstance use harm reduction messaging particularly via leveraging multiple social media platforms and provision of captioning were discussed by jurors. One juror referenced the curb cut effect in terms of normalising certain approaches to harm reduction such as \u0026lsquo;sharp bins\u0026rsquo;:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003ethere\u0026apos;s an accessibility factor here because different platforms have different levels of accessibility for different people, like I personally always use captions, whenever they\u0026apos;re available. Caption quality varies depending, like if they\u0026apos;re automatic, if you\u0026apos;ve done them yourself etc. Like I think that\u0026apos;s really important to think about, when you\u0026apos;re thinking of where to put your messages. But I think, the only way to really combat this is to spread the message across multiple platforms (smiles)\u0026hellip; or like multiple formats as well. Like not just video, or not just posters, or you know like, varied. Yeah.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eShort form content\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBrief, easy to engage with content prioritising the communication of meaning and messaging rather than articulating these in a written form, were key factors for effective polysubstance use harm reduction campaigns.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eIf you have a wall of text, no one\u0026rsquo;s going to read it.\u003c/p\u003e\n \u003cp\u003eI mentioned before, but I really like short videos, like, not necessarily like ads, but like short videos. I\u0026apos;ve seen ones from other countries as well, do them pretty well\u0026hellip; But like they can\u0026hellip; they can sort of take many formats like you can also get sort of screenshots from the video to have a more, static message\u0026hellip; And, the other thing is catchphrases (smiles), or hashtags are also very like they stick in my brain very easily, and they\u0026apos;re also very shareable.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation 2. Harm reduction resources should champion diverse lived/living experiences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJuror consensus revealed that the championing of lived/living experiences to encapsulate the breadth of polysubstance use realities was critical for harm reduction efforts. Suggested action-oriented strategies for operationalising this included campaign messaging and storylines reflecting how some young adult who use polysubstance use may also make active decisions at other times to not partake in polysubstance. Moreover, jurors underscored the importance of harm reduction campaigns actively combatting intra-group judgement and stigma between peers, focusing on how to \u0026lsquo;have fun\u0026rsquo;. Most jurors agreed that the strengths-based depiction of successful \u0026lsquo;harm reduction in practice\u0026rsquo;, even in small forms and gestures, would foster positive receptions among young adults engaging with prospective polysubstance use harm reduction messaging.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eYou know, those ads that are like, don\u0026apos;t do drugs, you know, they have this scary message, there\u0026apos;s like some little story, or even like ones that are about like car accidents, you\u0026apos;ve seen those ones, they\u0026apos;re like, really intense. I feel like what if you reversed it? And like, you had a story where someone was doing drugs, and a friend was looking out for them and it turned out fine. It\u0026apos;s like, you don\u0026apos;t see that, people don\u0026apos;t see how things can be okay (smiles). I feel like that would go a long way. And showing how easy it is to just look out for each other, it could just be like a little video about noticing the signs of potential overdose or something. Like naloxone, there\u0026apos;s a lot of that training around, but I\u0026apos;ve never seen like a little video about it unless I was in a training session (smiles). But like, I would love to see a positive spin on those sort of intense moments, you know.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; demonstrating situations in which like a harm almost happened but was like prevented or mitigated by a harm reduction technique I think is a really good potential like, video format \u0026hellip;\u003c/em\u003e\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eContent, I think definitely social media content, ... I suppose like roleplays, or like you know sharing stories from young people with experiences, ... not one absolutely good or bad, but you know showing the nuance\u0026hellip;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eCapturing authentic lived/living experience of polysubstance use among contemporary young adults, particularly those engaging in polysubstance use while also navigating multiple axes of power, oppression, and privilege, would be invaluable for reducing polysubstance use harms.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u0026hellip;you really need to make sure there\u0026apos;s a diversity in the people you\u0026apos;re showing as well, like, someone who\u0026apos;s disabled might have a different experience than, someone who has something else going on or like maybe someone\u0026apos;s living rural, we don\u0026apos;t see a lot of content about people living rurally\u0026hellip;\u003c/p\u003e\n \u003cp\u003eShowing people have done this before to ease unpredictability fears\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation 3: Harm reduction resources should be educational and practical\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJurors recommended that polysubstance use harm reduction resources should be educational, promoting literacy around how tolerance builds, signs of dependence, and tips for reflection, self-care, and aftercare. Skill-building education around active conversation techniques, understanding and developing healthy boundaries, and enacting harm reduction \u0026lsquo;in action\u0026rsquo; were also discussed. Jurors noted that the value of these topics pertained to their normalising of prospective polysubstance users to be aware of themselves and their own boundaries.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eSo, I think, content that would demystify like drug combinations specifically to reduce, harm that comes about from that\u0026hellip; but making sure to use plain language and real scenarios [\u0026hellip;] but just harm reduction tips but without\u0026hellip; the morals around it, or people\u0026apos;s judgment\u0026hellip;\u003c/p\u003e\n \u003cp\u003eSharing experiences and encouraging people to share, have conversations around polysubstance use and then also education on active conversation techniques that people can\u0026hellip; employ with their friends or\u0026hellip; trusted individuals and even organizations and the language around polysubstance use.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eIt was tacitly presupposed that young adults seeking these resources would likely be doing so to conduct \u0026lsquo;research\u0026rsquo; planning ahead of a prospective polysubstance use occasion. Henceforth, jurors underscored the important of educational resources incorporating drug and mental health literacy psychoeducation, including risk profiles of different combinations, managing comedowns, set and setting information, and information about where to seek assistance generally and at specific events and venues. Jurors noted the wide availability of many existing resources thus recommending future resources should, where appropriate, direct young adults to existing, trusted resources, online and in-person, to avoid \u0026lsquo;double up\u0026rsquo; or inadvertently generating an overwhelming \u0026lsquo;list\u0026rsquo; of resources.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Encourage people to know what and how much they\u0026rsquo;re taking, and encourage people to check a reputable source about potential interactions before using substances together\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe need for polysubstance use harm reduction education was also identified in the context of travel and tourism to engage safely in polysubstance use overseas. Particularly, jurors noted a paucity of resources guiding how to navigate safe polysubstance use abroad within the parameters of local laws and cultural norms and expectations. Jurors reflected on a lack of awareness of available drug alerts provided overseas and sources of support (e.g., helplines, services) available abroad.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eI think sometimes that might be someone\u0026apos;s first experience taking drugs, going traveling or overseas or something like that. And\u0026hellip; the only drug related things I see in regards to travel is about taking prescription meds to other places. But there\u0026apos;s no information really, about recreational drugs or other drugs. Sometimes it mentions if like certain ones are illegal, but that\u0026apos;s about it. It doesn\u0026apos;t really, mention anything else. Like, for example, we have our drug alerts here, like what if, on pages people used to plan their travel, it\u0026apos;s like also giving them alerts about that place that they\u0026apos;re planning to go to\u0026hellip; because if you\u0026apos;re not familiar with where you\u0026apos;re going, how do you know where to find that information?\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eFilling the knowledge gap on the interrelation/interaction of polysubstance use and financial health was also noted as an important topic for education to help support informed decisions-making about polysubstance use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation 4. Harm reduction resources should be disseminated in partnership with trusted, reputable community sector organisations.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJurors vehemently recommended harm reduction practitioners partnering with trusted local Australian organisations with high community buy-in to provide credibility of information, mentioning Australian Drug Foundation, ACON Health Limited, CanTEST and NUAA as examples. Jurors noted the potential utility of disseminating polysubstance use harm reduction messaging via peer influencers on YouTube or TikTok but expressed a preference reputable community organisations (e.g., Headspace, ReachOut) were more appropriate.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eI don\u0026apos;t know if people like influencers would particularly be willing to like, sort of share, in that way (smiles), or any public figure, so I feel like it really is, more likely and beneficial to come from like an organization of some kind. And honestly, ACON comes to mind for this, but like, I\u0026apos;m sure there are possibly others that could also be useful. I also think having like an organization sort of behind something like this, gives it a bit more credibility to people who aren\u0026apos;t familiar with like using drugs, or what that\u0026apos;s like. So like, if they\u0026apos;re seeing this is authorized by ACON or like, Australian government, and it\u0026apos;s a positive message about this sort of thing, they\u0026apos;re more likely to accept that, maybe (laughs).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eAlternatively, some jurors mentioned a centralised polysubstance use information resource that could direct people to existing p polysubstance use support and informational resources.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003ei think there would be benefit to having a centralised organisation or program that can provide information and resources\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this is the first participatory research-based study involving a citizen jury to meaningfully involve young adults with lived/living experience of using drugs in harm reduction research. This peer-led study generated clear consensus points regarding the key potential harms associated with polysubstance use and best-practice recommendations for addressing these, among young adults. This study was aware of intersectionality principles throughout all study activities, including sampling methods and team composition, thus offering a substantial contribution advancing equitable polysubstance use harm reduction research with young adults.\u003c/p\u003e\u003cp\u003eCitizen jurors reached unanimous consensus regarding three key potential harms associated with polysubstance use among young adults: 1) balancing self-reflection and peer dynamics in the face of unclear and unpredictable drug effects; 2) navigating life after polysubstance use experiences, particularly comedowns and poor decisions made under impaired judgement; and 3) unintended and undesirable drug tolerance and/or dependence development. Citizen jury-identified key polysubstance use harms aligned with community survey responses indicating \u0026lsquo;interaction effects between certain drugs\u0026rsquo; was the key potential harm arising from polysubstance use of most concern to young adults.\u003c/p\u003e\u003cp\u003eUnanimous consensus among young adult jurors was also reached regarding how digital, online, and social media platforms can be optimally used to reduce and minimise the key harms aforementioned. Specifically, jurors identified four best-practice recommendations asserting that polysubstance use harm reduction resources should 1) be interactive, engaging, and accessible, using short form content; 2) champion diverse lived/living experiences of polysubstance use among contemporary young adults; 3) be educational and practical; and 4) prioritise dissemination in partnership with trusted, reputable community sector organisations, rather than social media influencers.\u003c/p\u003e\u003cp\u003eJurors\u0026rsquo; recommendations for strengths-based harm reduction resources depicting \u0026lsquo;what \u003cem\u003eto\u003c/em\u003e do\u0026rsquo; rather than \u0026lsquo;what \u003cem\u003enot\u003c/em\u003e to do\u0026rsquo; align with community survey respondents reporting polysubstance use experiences were much more commonly associated with enjoyable times than unexpected negative physical and/or emotional effects. Critical to this are those harm reduction strategies involving planning, doing research, and knowing yourself helped young adults prepare preventing and reducing a cascade of potential polysubstance use harms, including unexpected, unpredictable drug effects, interactions, comedowns, avoiding regrettable decisions made under impaired judgement, and resisting peer pressure to partake in polysubstance use without preparation.\u003c/p\u003e\u003cp\u003eJurors cautioning the engagement of social media influencers aligns with community survey respondents stating that \u0026lsquo;TikTok\u0026rsquo; was the least preferred social media or digital app platform for sharing polysubstance use harm reduction messaging and resources for young adults. These findings illustrate the impact of meaningfully involving young adults in harm reduction research via participatory-based citizen juries. Future participatory research in partnership with young adults and trusted, reputable community sector organisations is required to optimise the dissemination of polysubstance use harm reduction materials.\u003c/p\u003e\u003cp\u003eThis study highlights the critical role of peers for young adults having safe, comfortable, and enjoyable experiences of polysubstance use. Notwithstanding, peers may pressure young adults to engage in polysubstance use in ways they are not prepared for. Harm reduction must account for the double-edged sword of peers given nearly four in five (78%) of young adult survey respondents indicated that they were most commonly around friends when using their primary polydrug combination. Peer influence can also be leveraged to prevent polysubstance use harms as indicated by survey respondents perceiving \u0026lsquo;being annoying or inconvenient to your friends\u0026rsquo; as the second most important polysubstance use harm. Additional participatory research with young adults and their peers is required to better elucidate how to leverage peer influence dynamics to encourage young adults\u0026rsquo; to engage in polysubstance use harm reduction activities.\u003c/p\u003e\u003cp\u003eThis study benefitted from strong involvement of young adult peers throughout the research process, namely through the research team comprising multiple peer researchers and iterative consultation with a Youth Advisory Board. Involvement of young adult peers enabled the design of bespoke, relatable questions regarding polysubstance use harms and harm reduction strategies spanning quantitative (community survey) and qualitative (citizen jury) methods of data collection. Notwithstanding, findings should interpreted with caution due to small community survey sample size and that only one citizen jury was conducted. Moreover, this participatory study targeted young adults living NSW specifically and hence findings may not generalisable to other states/territories within Australia.\u003c/p\u003e\u003cp\u003eThis study demonstrates the value and feasibility of engaging young adults with lived/living experience of drug use in participatory harm reduction research. By incorporating peer leadership, intersectionality, and citizen jury methods, the research identified meaningful, consensus-based insights into the harms of polysubstance use and actionable, youth-informed strategies for addressing them. While findings are context-specific and exploratory, they offer a strong foundation for future co-designed harm reduction initiatives with young people across diverse settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis project was funded by Lived Experience Research Partnership Grant from The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors were involved in the conceptualisation, funding acquisition, methodology, and writing - review \u0026amp; editing of this project. SB and FG led data curation and formal analysis, with support from ZB. SB, FG, and LE led investigation via citizen juries. SB, LE, ZB led project administration with supervision led by CC and KC. SB and CC led validation of data results. SB and FG led writing - original draft preparation.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe Vibe Check team would like to thank those members of the Youth Advisory Board within The Matilda Centre for Research in Mental Health who provided strategic feedback on this project as part of their regular roles and responsibilities. The team would like to thank those young adults living across New South Wales who generously shared their time and wisdom via partaking in the community survey and/or citizen jury.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eCommunity survey and citizen jury data is privately available upon reasonable request directed to the corresponding author and subject to approval by the wider Vibe Check team. Community survey tool, citizen jury agenda, pre-jury information pack, and raw descriptive results are available in Supplementary Materials.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoileau-Falardeau M, Contreras G, Gari\u0026eacute;py G, Laprise C. Patterns and motivations of polysubstance use: a rapid review of the qualitative evidence. Health Promot Chronic Dis Prev Can. 2022;42(2):47\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBlack N, Noghrehchi F, Yuen WS, Aiken A, Clare PJ, Chan G, et al. Transitions to polysubstance use: Prospective cohort study of adolescents in Australia. 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Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eInductive content analysis: A guide for beginning qualitative researchers. Focus on Health Professional Education: A Multi-Professional Journal. 2022;23(1):111\u0026thinsp;\u0026ndash;\u0026thinsp;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGooberman-Hill R, Horwood J, Calnan M. Citizens' juries in planning research priorities: process, engagement and outcome. Health Expect. 2008;11(3):272\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcMullin C. Transcription and Qualitative Methods: Implications for Third Sector Research. Voluntas. 2023;34(1):140\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"young adults, polysubstance use, harm reduction, intersectionality, participatory research, citizen juries","lastPublishedDoi":"10.21203/rs.3.rs-7171854/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7171854/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePolysubstance use is highly prevalent among young adults, yet harm reduction research has traditionally excluded their meaningful involvement. The \u003cem\u003eVibe Check Project\u003c/em\u003e aimed to meaningfully involve young adults with lived/living experience of polysubstance use to identify key polysubstance use harms and best-practice digital harm reduction strategies using a participatory, peer-led approach.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis two-phase study included: (1) a cross-sectional online survey (March\u0026ndash;June 2025) of 81 young adults (aged 18\u0026ndash;30, living in NSW) who had used more than one psychoactive drug concurrently in the past year; and (2) a 7-hour online citizen jury with a randomly selected subset (n\u0026thinsp;=\u0026thinsp;8) of survey participants. Survey items were co-developed with a peer researcher and Youth Advisory Board, and comprised quantitative and qualitative questions on polysubstance use patterns, motivations, and harm perceptions. Jurors were tasked with deliberating and reaching consensus on two domains: 1) the main harms arising from polysubstance use among young adults, 2) the best ways for leveraging digital, online, and social media platforms to address these. Quantitative data were analysed descriptively in RStudio, and qualitative survey responses and citizen jury transcripts were analysed using summative content and deductive thematic analysis in NVivo.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSurvey responses indicated that interaction effects between drugs were the most concerning harm for young adults. Citizen jurors reached unanimous consensus on three key harms: (1) balancing self-reflection and peer dynamics in the face of unclear and unpredictable drug effects (2) navigating life after polysubstance use, particularly comedowns and poor decisions made under impaired judgement; and (3) unintended, undesirable development of tolerance and/or dependence. Jurors also unanimously recommended digital harm reduction should be educational, practical, brief, engaging, and accessible, championing diverse lived/living experiences through partnership with trusted, reputable community sector organisations, rather than social media influencers.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis is the first known study to use a citizen jury with young adults to address polysubstance use harms. The participatory, peer-led approach generated youth-driven, consensus-based recommendations for digital harm reduction in practice. Findings emphasise the important role of planning and self-reflection, the double-edged sword of peers and peer influence, and partnerships with trusted community sector organisations for effective polysubstance use harm reduction.\u003c/p\u003e","manuscriptTitle":"Co-designing polysubstance use harm reduction messaging with and for young adults: findings from a participatory, intersectional citizen jury and community survey (The ‘Vibe Check’ Project)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-12 12:46:28","doi":"10.21203/rs.3.rs-7171854/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-27T18:43:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-26T23:55:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T18:10:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167591036242424239584950272597825225678","date":"2025-08-06T15:56:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266485721261967738390867057721332738215","date":"2025-08-06T15:16:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-06T14:56:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-21T15:10:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-21T12:29:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Harm Reduction Journal","date":"2025-07-20T21:54:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f8cd11f8-927c-4bb5-81a4-09c058500e4f","owner":[],"postedDate":"August 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-01-20T16:57:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-12 12:46:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7171854","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7171854","identity":"rs-7171854","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}