Critical Challenges in Content Moderation for People Who Use Drugs (PWUD): Insights into Online Harm Reduction Practices from Moderators

Abstract: Online communities serve as essential support channels for People Who Use Drugs (PWUD), providing access to peer support and harm reduction information. The moderation of these communities involves consequential decisions affecting member safety, yet existing sociotechnical systems provide insufficient support for moderators. Through interviews with experienced moderators from PWUD forums on Reddit, we analyse the unique nature of this work. We argue that this work constitutes a distinct form of public health intervention characterised by three moderation challenges: the need for specialised, expert risk assessment; time-critical crisis response; and the navigation of a structural conflict between platform policies and community safety goals. We demonstrate how current moderation systems are insufficient in supporting PWUD communities. For example, policies minimising platforms' legal exposure to illicit activities can inadvertently push moderators to implement restrictive rules to protect community's existence, which can limit such a vulnerable group's ability to share potentially life-saving resources online. We conclude by identifying two necessary shifts in sociotechnical design to support moderators' work: first, moving to automated tools that support human sensemaking in contexts with competing interests; and second, shifting from systems that require moderators to perform low-level rule programming to those that enable high-level, example-based instruction. Further, we highlight how the design of sociotechnical systems in online spaces could impact harm reduction efforts aimed at improving health outcomes for PWUD communities.