Cultural Adaptation of the Guide Knowing Your Limits with Cannabis for Brazil: An Anti-Racist Approach to Social Harm, Health Equity, and Prohibitionist Environments

Aims: To culturally adapt the Knowing Your Limits with Cannabis for Brazil guide using the Ecological Validity Model (EVM) and an anti-racist framework responsive to prohibitionist environments. Design: Qualitative cultural adaptation study guided by the EVM, combining desk review, translation, development of an initial adaptation hypothesis and iterative participatory consultation. Setting: Two participant groups in the Baixada Santista region, Brazil: one community harm-reduction group and one university student group, both situated in a national context marked by cannabis criminalisation, racialised law enforcement and unequal exposure to institutional harm. Participants: Two participatory consultation groups were included: Group A, with 38 participants linked to a community harm-reduction collective, and Group B, with 9 university students who use cannabis. The groups had heterogeneous racial and gender composition and included people in socially vulnerable conditions. Measurements: Field diaries, session notes, participant contributions, and editorial records were analysed deductively across EVM dimensions, followed by synthesis into cross-cutting themes for adaptation. Anti-racism functioned as an interpretive criterion for examining stigma, epistemic erasure, institutional iatrogenesis, and racialised social harm during adaptation decisions and thematic synthesis. Findings: Analysis generated eight cross-cutting themes concerning risk, technicism, pretuguês, lexical choices, metaphors, speaker position, territorial safety, and contextual interpretation of CUDIT-R scores. Participants’ contributions indicated perceived gains in intelligibility and contextual relevance of the guide while emphasising integration of pharmacological guidance with harms produced through criminalisation in Brazil. Conclusions: In this study, anti-racist cultural adaptation required making social harm explicit and revising language, metaphors, and contextual assumptions within Brazilian harm-reduction guidance materials. These findings suggest that culturally adapting materials may more accurately reflect the unique context of prohibitionist and racialised environments, while their effects on equity and harm reduction require evaluation.