Debates about performance-enhancing substances in sport have historically been framed through prohibition, anti-doping enforcement, and ideals of fairness, natural ability, and sport integrity. The proposed Enhanced Games – an international sporting event that explicitly permits the use of performance-enhancing substances – have been presented as a profound rupture in how sport, medicine, and society understand human limits, bodily risk, and enhancement. This collection asks what it means to govern, reduce harm, and protect wellbeing in a world where the use of performance-enhancement substances is increasingly visible, normalised, and commercialised.

The Enhanced Games position themselves as rejecting prohibition, reframing enhancement as positive when transparent and regulated, and describe it as technologically inevitable. In doing so, the Games propose a departure from paternalistic-type interventions in favour of autonomy and science. However, the goals of the Enhanced Games stretch far beyond the sporting arena into the supplement and pharmaceutical industries, sparking concerns regarding competing and conflicting interests. Their scale, visibility, and commercial profile have drawn significant public attention, making questions about governance, enhancement, health, fairness, and harm increasingly urgent to address.

Importantly, this collection does not advocate for or against the Enhanced Games. Instead, it aims to provide a forum for scholarly discussion of the ethical, clinical, regulatory, and social questions raised by this proposal. Given the limited empirical literature currently examining such models of openly permitted enhancement, contributions both supporting and critically challenging this idea are particularly needed. This Collection is explicitly dedicated to examining the Enhanced Games as a social, ethical, public health, and harm reduction phenomenon.

Beyond the existence of human enhancement, the Enhanced Games themselves raise urgent questions:

• Could an openly permitted and regulated model of performance enhancement reduce or mitigate harms associated with the current prohibition of enhancement drugs in sport?
• What are the strongest arguments against such an approach, and how do these concerns compare with the potential benefits claimed by proponents?
• Who bears responsibility for risk in environments where pharmacological enhancement is permitted?
• What does autonomy look like within the Enhanced Games model?
• What constitutes informed consent in high-stakes, financially sponsored performance contexts?
• Can harm reduction meaningfully coexist with elite competition and commercial sport promoted as spectacle?
• Are the vast monetary rewards offered the Enhanced Games for athletes that break ‘world records’ a coercive offer?
• Are there differences between public perceptions of the Games and the realities of athlete participation, and how might both shape decision-making among athletes and spectators?
• Are athletes vulnerable within the Enhanced Games model?
• What lessons might this model offer for broader enhancement practices beyond sport?

The Harm Reduction Journal invites interdisciplinary contributions that critically engage with the Enhanced Games, situating them within wider enhancement cultures, drug use practices, regulatory systems, and harm reduction frameworks. The legitimacy of the Enhanced Games as an alternative model for harm reduction remains an open question. Lived-living experience perspectives on enhancement and risk are specifically encouraged.

This Collection aims to provide the first dedicated harm reduction–focused scholarly examination of the Enhanced Games. The Editors seek to promote evidence-based analysis and discussion of policy, sport governance, and public health responses to emerging enhancement models.

Scope of the Special Issue

We welcome empirical, theoretical, policy, and commentary papers addressing topics including, but not limited to:

1. Enhanced Games–Embedded Research and Case Studies

Empirical papers drawing directly on the Enhanced Games, affiliated teams, athletes, or operational settings, including, where ethically appropriate and critically engaged:

• Biomedical, performance, and health monitoring data from Enhanced Games athletes
• Case studies of elite athletes using enhancement drugs within enhancement-permissive environments
• Governance, safety, and medical oversight models implemented by the Enhanced Games
• Ethical and operational challenges encountered in practice

2. Comparative Studies, Trials, and Harm Analysis

Research examining empirical evidence that may support or challenge the implementation of the Enhanced Games, including quantitative, qualitative, mixed-methods, and trial-based studies that compare:

• Enhanced Games athletes using enhancement drugs vs elite athletes operating under prohibition-based regimes
• Elite athletes using enhancement drugs vs non-athletes using similar substances
• Consumers vs non-consumers in comparable populations (e.g., fitness, strength, or aesthetic domains)

3. Commentary, Policy, and Lived-Living Experience

Analytical and reflective contributions examining:

• Ethical, legal, and public health implications of the Enhanced Games
• Athlete autonomy, consent, coercion, and commercialisation
• Lived and living experience of athletes and others who use enhancement drugs
• Perspectives from clinicians, harm reduction workers, regulators, and policymakers
• Implications for future sport governance, drug policy, and harm reduction frameworks

This Collection supports and amplifies research related to SDG 3, Good Health and Well-Being.

All submissions in this collection undergo the journal’s standard peer review process. Where necessary, Guest Editors will ensure peer-review is provided by those unaffiliated with the Enhanced Games in any way and will ensure diversity is strongly considered with regards to gender, ethnicity, geography and lived/living experience. All manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief. As an open access publication, this journal levies an article processing fee (APC). We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit Harm Reduction Journal's Fees and Funding page, or email OAfundingpolicy@springernature.com or the Editor-in-Chief.

Recent shifts in US policy and the approach to public health have placed renewed pressure on communities that already face significant health and social challenges. Policy decisions increasingly prioritize criminalization or abstinence-based strategies over interventions that have been consistently shown to reduce harm. These choices reflect a broader trend of sidelining empirical evidence, with real-world consequences for public health.

As a result, morbidity and mortality have increased among people who use drugs, experience homelessness, or who are involved in the US criminal justice system. Rates of preventable illness and infectious disease are also rising. Rhetoric and stigma further undermine public trust and discourage engagement with health services, disproportionately affecting marginalized populations.

Harm Reduction Journal has commissioned a collection of articles to highlight how evidence-based harm reduction strategies – grounded in science, dignity and practical outcomes – can inform more effective, humane public health responses.

This Collection supports and amplifies research related to SDG 3, Good Health and Well-Being, SDG 5, Gender Equality, SDG 10, Reduced Inequalities, and SDG 16, Peace, Justice and Strong Institutions.

All submissions in this collection undergo the journal’s standard peer review process. Similarly, all manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief. As an open access publication, this journal levies an article processing fee (details here). We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit OA funding and support, or email OAfundingpolicy@springernature.com or the Editor-in-Chief.