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Little is known about how to build consensus and effect normative change towards harm reduction in these settings. The aim of this paper is to identify key factors relevant to achieving organisational change and effecting a shift towards the adoption of harm reduction policies and practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study included twelve UK universities and employed a qualitative research design which included semi-structured interviews with university policy makers (n\u2009=\u200912) and focus groups with students (4 groups with an overall total of 24 students). The universities were at different points in the process of implementing a harm reduction approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was strong support for harm reduction approaches by both university staff and student participants, but there was confusion and misunderstanding around the concept of harm reduction. Some students were unsure about whether or not their university had a harm reduction policy. This highlights the need for clearer communication and education around harm reduction. A number of challenges in developing and implementing harm reduction strategies were identified including securing resources and gaining institutional support and leadership \u2018buy-in\u2019. Fears of stakeholders around the reputational risks to universities in advocating for harm reduction needed to be countered. Policy change often relied on committed individuals or \u2018champions\u2019 in the institutions to drive strategy development; however, there was also evidence of a \u2018community of practice\u2019 emerging amongst the network of institutions that had implemented harm reduction strategies which provided support and shared knowledge and experiences. Co-production strategies involving students, staff and external stakeholders were vital in gaining consensus and fostering ownership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study has highlighted that there is strong support for a shift away from zero-tolerance approaches to student drug use, although this needs to be accomplished incrementally and in ways that address stakeholder concerns and safeguard university reputations. Working with a \u2018whole system\u2019 philosophy was identified as good practice whereby university policy was embedded within a local or city-wide approach which helped to facilitate the acceptance and development of harm reduction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12954-025-01351-4","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T10:13:11Z","timestamp":1764583991000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Building consensus for harm reduction approaches in UK universities: a qualitative study with staff and students"],"prefix":"10.1186","volume":"22","author":[{"given":"Karen","family":"Duke","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betsy","family":"Thom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Drayson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille","family":"Alexis-Garsee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Graham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swetha","family":"Guruprasad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"1351_CR1","unstructured":"Black C. 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