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International Journal of Drug Policy
Journal Prestige (SJR): 1.441
Citation Impact (citeScore): 3
Number of Followers: 459  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0955-3959
Published by Elsevier Homepage  [3161 journals]
  • Comparing Canadian and United States opioid agonist therapy policies
    • Abstract: Publication date: Available online 11 February 2019Source: International Journal of Drug PolicyAuthor(s): Kelsey C. Priest, Lauren Gorfinkel, Jan Klimas, Andrea A. Jones, Nadia Fairbairn, Dennis McCarty Canada and the United States (U.S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT)—buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited OAT access. Through a non-systematic literature scan and a review of publicly available policy documents, we examined and compared OAT policies and practice at the federal (Canada vs. U.S.) and local levels (British Columbia [B.C.] vs. Oregon). Differences and similarities were noted between federal and local OAT policies, and subsequently OAT access. In Canada, OAT policy control has shifted from federal to provincial authorities. Conversely, in the U.S., federal authorities maintain primary control of OAT regulations. Local OAT health insurance coverage policies were substantively different between B.C. and Oregon. In B.C., five OAT options were available, while in Oregon, only two OAT options were available with administrative limitations. The differences in local OAT access and coverage policies between B.C. and Oregon, may be explained, in part, to the differences in Canadian and U.S. federal OAT policies, specifically, the relaxation of special federal OAT regulatory controls in Canada. The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U.S. policymakers and health officials could consider adopting Canada’s regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.
       
  • The tripping point: The potential role of psychedelic-assisted therapy in
           the response to the opioid crisis
    • Abstract: Publication date: April 2019Source: International Journal of Drug Policy, Volume 66Author(s): Elena Argento, Kenneth W. Tupper, M. Eugenia Socias The increasing contamination of the drug supply with illicitly manufactured fentanyl and related analogs in North America has resulted in the most severe drug-overdose crisis in history. Available pharmacotherapy options for the treatment of opioid use disorder have had limited success in curbing the current crisis, and a growing body of evidence highlights the need for innovative interventions that target underlying social-structural drivers of opioid use disorder. Re-emerging clinical research suggests that psychedelic-assisted therapy has potential as an alternative treatment for refractory substance use disorders and related comorbidities. Based on the available evidence, our viewpoint supports advancing research on the potential role of psychedelic-assisted therapy within a multifaceted response to the opioid crisis.
       
  • Safety and efficacy of glecaprevir/pibrentasvir in patients with chronic
           hepatitis C genotypes 1–6 receiving opioid substitution therapy
    • Abstract: Publication date: April 2019Source: International Journal of Drug Policy, Volume 66Author(s): Jason Grebely, Gregory J. Dore, Negar N. Alami, Brian Conway, John F. Dillon, Michael Gschwantler, Franco Felizarta, Christophe Hézode, Krzysztof Tomasiewicz, Linda M. Fredrick, Emily O. Dumas, Federico J. Mensa BackgroundInternational guidelines recommend treatment of hepatitis C virus (HCV) infection in people who inject drugs (PWID), including those on opioid substitution therapy (OST). The pangenotypic combination of glecaprevir and pibrentasvir has shown high sustained virologic response at post-treatment Week 12 (SVR12) in clinical trials. Herein, we evaluate the safety and efficacy of glecaprevir/pibrentasvir in patients receiving OST.MethodsPooled data from patients with HCV genotypes 1–6 who were treated with glecaprevir/pibrentasvir for 8, 12, or 16 weeks in eight Phase 2 and 3 trials were categorized by use of OST. Treatment completion, treatment adherence, SVR12, adverse events (AEs), and laboratory abnormalities were evaluated for patients receiving and not receiving OST.ResultsAmong 2256 patients, 157 (7%) were receiving OST. Compared with patients not receiving OST, OST patients were younger (mean age, 46.8 vs 52.8 years), male (69% vs 54%), white (93% vs 80%), HCV treatment-naïve (86% vs 72%), had HCV genotype 3 (60% vs 26%), and had a history of depression or bipolar disorder (43% vs 19%). Most patients completed (OST: 98% [n/N = 154/157]; non-OST: 99% [n/N = 2070/2099]) and were adherent (received ≥90% of study drug doses) to glecaprevir/pibrentasvir treatment (OST: 98% [n/N = 121/123]; non-OST: 99% [n/N = 1884/1905] among patients with available data). In the intention-to-treat population, SVR12 rates in OST and non-OST patients were 96.2% (n/N = 151/157; 95% CI 93.2–99.2) and 97.9% (n/N = 2055/2099; 95% CI 97.3–98.5), respectively. For OST patients, reasons for nonresponse included virologic relapse (
       
  • Police attitudes towards pre-booking diversion in Baltimore, Maryland
    • Abstract: Publication date: March 2019Source: International Journal of Drug Policy, Volume 65Author(s): Saba Rouhani, Rajani Gudlavalleti, Daniel Atzmon, Ju Nyeong Park, Steven P. Olson, Susan G. Sherman BackgroundIn the context of high rates of drug-related incarceration that disproportionately affect urban communities of colour, advocates for drug policy criminal justice reform have called for alternatives to mass incarceration. The Law Enforcement Assisted Diversion (LEAD) program redirects low-level drug offenders to health and social services rather than immediately into the criminal justice system. In advance of piloting LEAD in Baltimore City, we assessed police perceptions towards harm reduction and specifically pre-booking diversion in effort to inform training and implementation activities in Baltimore City and elsewhere.MethodsWe administered a survey to Baltimore City Police Officers (N = 83) in the planned implementation district using two scales: the first measured police attitudes toward people who use drugs (PWUD), current drug policies and public health measures, and the second measured police perceptions of pre-booking diversion programs. We calculated Cronbach’s alpha (α) to assess internal consistency of both scales. Bivariate χ2 tests and multivariate logistic regression examined correlates of scale items stratified by new and seasoned officers.ResultsSeasoned officers were significantly less likely to believe that drug treatment is easily available (51% vs. 81%, p = 0.005). The belief that current policies are effective and that PWUD should be arrested for small drug purchases decreased significantly per year on the force (aOR: 0.92; 95%CI 0.85,0.99; aOR: 0.94, 95% CI 0.88, 0.99, respectively), as did concerns about needle-stick injuries (aOR: 0.85, 95% CI 0.74, 0.98). Seasoned officers were significantly more comfortable referring PWUD to social services (100% vs. 83%, p = 0.006), and agree that such pre-booking diversion could be effective in improving public safety within (72% vs. 43%; p = 0.009) and beyond the intervention area (56% vs. 33%, p = 0.04).ConclusionsThe study indicates the value of intervening early and consistently throughout police career trajectories and engaging seasoned officers as allies to promote recognition and support of public health and harm reduction strategies within ongoing police reform efforts. LEAD provides important and broad opportunities for training police to enhance their understanding the intersection of public safety and public health.
       
  • Light and heavy drinking in jurisdictions with different alcohol policy
           environments
    • Abstract: Publication date: March 2019Source: International Journal of Drug Policy, Volume 65Author(s): Simon Foster, Gerhard Gmel, Meichun Mohler-Kuo BackgroundA basic, yet untested tenet underlying alcohol control policies is that they should affect both light and heavy drinking, thereby shifting the entire population in a favourable direction. The aim of this study was to test this assumption in young Swiss men.MethodsCross-sectional self-reported data — from 5755 young Swiss men participating in the Cohort Study on Substance Use Risk Factors (C-SURF), a large cohort study on young men living within 21 jurisdictions across Switzerland — were analysed via nested logistic regression. With this approach, a set of increasingly-heavy drinking patterns was broken down into a set of nested regression models, each one estimating the probability of heavier drinking, conditional on the lighter drinking pattern. Drinking patterns relating to heavy episodic drinking (HED), heavy volume drinking (HVD) on weekends, and workweek drinking, as well as alcohol use disorder (AUD) were examined. The explanatory variable was a previously-used alcohol policy environment index (APEI) reflecting the number of alcohol control policies implemented in each jurisdiction. Conventional and multilevel logistic regression models were tested, adjusted for age, education, linguistic region, urban/rural status, attention-deficit/hyperactivity disorder, depression, sensation seeking, antisocial personality disorder, and unobserved heterogeneity between jurisdictions.ResultsFor HED, weekend HVD, and AUD, negative relationships with the APEI were found, such that with a higher APEI the probability of lighter drinking patterns was increased while the probability of heavier patterns was reduced, including a reduced probability of the heaviest patterns. These relationships were non-linear, however, and tapered off towards the heavy end of the drinking spectrum. No relationship was identified between the APEI and workweek drinking patterns.ConclusionAmong young Swiss men, stricter alcohol policy environments were associated with a global shift towards lighter drinking, consistent with the basic tenet behind the universal prevention approach.
       
  • The triple wave epidemic: Supply and demand drivers of the US opioid
           overdose crisis
    • Abstract: Publication date: Available online 2 February 2019Source: International Journal of Drug PolicyAuthor(s): Daniel Ciccarone
       
  • Youth perspectives on concurrent smoking and vaping: Implications for
           tobacco control
    • Abstract: Publication date: April 2019Source: International Journal of Drug Policy, Volume 66Author(s): Tamar M.J. Antin, Geoffrey Hunt, Emily Kaner, Sharon Lipperman-Kreda Most people who smoke cigarettes begin young. Consequently, public health efforts directed at youth are a priority. The increasing popularity of electronic nicotine delivery systems (ENDS) among youth in the United States has raised concerns in the public health community about the potential of ENDS to renormalize cigarette smoking and perpetuate nicotine addiction, creating dual users who both vape and smoke. Despite limited and inconclusive evidence about dual use for young people, restrictive approaches towards ENDS have shaped tobacco control agendas in the United States. Based on analysis of 26 interviews with young dual users in California, we explored the meanings young people ascribe to their dual using practices and how those meanings relate to the broader tobacco control environment which structures their lives. Results suggest that dual users of ENDS and cigarettes overwhelmingly perceive a utilitarian meaning of dual use and view vaping as a tool for reducing smoking-related harm in the near term and facilitating quitting smoking in the long term. Also, participants’ narratives related to Tobacco 21 laws, which prohibit sales of both ENDS and cigarettes to individuals under 21 years of age, revealed concerns about restrictive policies that limit access to less harmful tobacco products. Results of this study raise important questions about whether we are working towards further reductions in the prevalence of smoking and tobacco-related diseases.
       
  • Social network ties to nightlife and healthcare professionals and
           prescription drug misuse among young adults
    • Abstract: Publication date: April 2019Source: International Journal of Drug Policy, Volume 66Author(s): Brian C. Kelly, Mike Vuolo BackgroundNightlife scenes have been characterized as risk environments where social ecology and network ties facilitate substance use. In contrast to other substances, the prescription drug problem also has been shaped by the healthcare system. How network ties to professionals in these domains are associated with prescription drug misuse remains a key area of study.MethodsWe analyzed a sample of 404 young adults who misuse prescription drugs, recruited from nightlife venues primarily via time-space sampling. We evaluated nine types of network ties via friends and family (5 nightlife professions and 4 healthcare professions) as well as total ties in each occupational domain and their relationship to three different outcomes – frequency of misuse, escalation to non-oral use, and substance-related problems. Negative binomial, logistic, and linear regression methods were employed. We then examined mechanisms by which these network associations may operate.ResultsTies to party promoters (p 
       
  • The value of unsolicited online data in drug policy research
    • Abstract: Publication date: Available online 31 January 2019Source: International Journal of Drug PolicyAuthor(s): Oskar Enghoff, Judith Aldridge We alert readers to the value of using unsolicited online data in drug policy research by highlighting web-based content relevant to drug policy generated by four distinct types of actor: people who consume, supply or produce illicit drugs, online news websites and state or civil society organisations. These actors leave ‘digital traces’ across a range of internet platforms, and these traces become available to researchers to use as data – although they have not been solicited by researchers, and so have not been created specifically to fulfil the aims of research projects. This particular type of data entails certain strengths, limitations and ethical challenges, and we aim to assist researchers in understanding these by drawing on selected examples of published research using unsolicited online data that have generated valuable drug policy insights not possible using other traditional data sources. We argue for the continued and increased importance of using unsolicited online data so that drug policy scholarship keep pace with recent developments in the global landscape of drug policies and illicit drug practices.
       
  • Principles, practice, and policy vacuums: Policy actor views on
           provincial/territorial harm reduction policy in Canada
    • Abstract: Publication date: Available online 30 January 2019Source: International Journal of Drug PolicyAuthor(s): Elaine Hyshka, Jalene Anderson-Baron, Arlanna Pugh, Lynne Belle-Isle, Andrew Hathaway, Bernadette Pauly, Carol Strike, Mark Asbridge, Colleen Dell, Keely McBride, Kenneth Tupper, T. Cameron Wild IntroductionCanada is experiencing a new era of harm reduction policymaking and investment. While many provinces and territories are expanding access to these services, harm reduction policy and policymaking varies across the country. The present study, part of the Canadian Harm Reduction Policy Project (CHARPP), described policy actors’ views on formal harm reduction policies in Canada’s 13 provinces and territories.MethodsAs part of CHARPP’s mixed-method, multiple case study, we conducted qualitative interviews with 75 policy actors, including government officials, health system leaders, senior staff at community organizations, and advocates with self-identified lived experience of using drugs. Interviews were conducted in English or French, and recorded and transcribed verbatim. We used latent content analysis to inductively code the data and generate main findings. NVivo 11 was used to organize the transcripts.ResultsParticipants expressed divergent views on formal provincial/territorial policies and their impact on availability of harm reduction programs and services. While some identified a need to develop new policies or improve existing ones, others resisted bureaucratization of harm reduction or felt the absence of formal policy was instead, advantageous. Instances where harm reduction was advanced outside of formal policymaking were also described.DiscussionPrevious CHARPP research documented wide variability in quantity and quality of formal harm reduction policies across Canada, and characterized official policy documents as serving largely rhetorical rather than instrumental functions. The present findings highlight diverse ways that actors used their discretion to navigate these weak policy contexts. Participants’ views and experiences sometimes referred to strengthening policy support, but institutionalization of harm reduction was also resisted or rejected. Results suggest that actors adopt a range of pragmatic strategies to advance harm reduction services in response to policy vacuums characteristic of morality policy domains, and challenge assumptions about the utility of formal policies for advancing harm reduction.
       
  • Drug sourcing and motivations among a sample of people involved in the
           supply of pharmaceutical drugs in Australia
    • Abstract: Publication date: April 2019Source: International Journal of Drug Policy, Volume 66Author(s): Shann Hulme, Caitlin Elizabeth Hughes, Suzanne Nielsen BackgroundThe non-medical use (NMU) of pharmaceuticals is increasing internationally, along with mortality. Previous research indicates that end-users access pharmaceuticals through social networks, however little is known about supplier sources particularly outside the US. This study examined sourcing and motivations among a sample of people involved in pharmaceutical diversion and supply in Australia.MethodsSemi-structured, telephone interviews were conducted with 51 people involved in supplying pharmaceuticals in the previous six months. Multi-stage recruitment involved the distribution of flyers to participants of two Australian drug-monitoring programs: the Ecstasy and related Drugs Reporting System (capturing regular psycho-stimulant users) and the Illicit Drug Reporting System (capturing people who regularly inject drugs), followed by a screening of interested participants. Interviews were audio-recorded, transcribed and analysed using a mixed methods approach. First, correlates of drug sourcing and motivations were examined including demographics, frequency and quantity of supply. Second, thematic analysis of the qualitative data was undertaken on strategies for obtaining the drugs and motivating factors.ResultsDrug supplies were sourced from a variety of medical and non-medical sources, primarily legitimately obtained prescriptions (47%), friends or family (18%) and dealers (14%). Suppliers using medical sources were more likely to be unemployed/retired and reported supplying for therapeutic purposes, while suppliers using non-medical sources were more likely to be employed/students, earned higher incomes and reported supplying for recreational purposes. Those who sourced via doctor shopping (IRR = 47.5) and friends and family (IRR = 10.1) distributed higher quantities, while those who sourced legitimately obtained prescriptions (IRR = 0.1) and from illicit drug dealers (IRR = 0.0) distributed lower quantities. Similar proportions supplied for financial (65%) and altruistic (61%) reasons, however the latter supplied lower quantities (IRR = 0.1).ConclusionThis study offers novel insight into the diversion of pharmaceuticals from the supplier perspective. A nuanced policy approach is required to address varied supply practices by source and motive.
       
  • “We don’t want him worrying about how he will pay to save his life”:
           Using medical crowdfunding to explore lived experiences with addiction
           services in Canada
    • Abstract: Publication date: March 2019Source: International Journal of Drug Policy, Volume 65Author(s): Varsha Palad, Jeremy Snyder Background: The opiate crisis in Canada, among other causes, has led to increased demand and wait times for addiction-related services. One response to this situation has been for Canadians to seek crowdfunding support for services outside of the public system. However, little is known about how large this practice is, what addiction-related services Canadians seek, and what the implications of this practice are.Methods: We searched the crowdfunding platforms GoFundMe and YouCaring using keywords related to addiction. This search identified 129 crowdfunding campaigns by Canadian residents seeking addiction-related services. The authors recorded information from the campaigns and conducted a thematic analysis of their narrative content.Results: These campaigns requested $12,722,527 and were pledged $204,848 (1.6%). Thematic analysis revealed four core elements discussed in the pursuit of addiction-related crowdfunding: 1) affording treatment, including at private and/or perceived higher quality facilities; 2) surviving treatment by seeking living expenses during and before treatment; 3) life after treatment by addressing needs following receiving treatment for addiction; and 4) publicizing treatment where recipients often struggled with the need to reveal personal details as part of their campaigns.Conclusion: These findings confirm discussion in the academic and policy literature on Canadians seeking addiction-related services that wait times for public services are a significant issue for many. However, these findings also show that the costs of living expenses before and during treatment, as well as restarting lives following treatment, also create struggles for Canadians. These findings confirm and expand concerns in the literature on medical crowdfunding, where this practice is thought to raise issues around the equitable distribution of resources and the loss of personal privacy. While crowdfunding for addictionrelated services has helped some Canadians, the money raised was vastly less than that requested, came at a cost to personal privacy, and raises equity issues.
       
  • “Like being put on an ice floe and shoved away”: A qualitative study
           of the impacts of opioid-related policy changes on people who take opioids
           
    • Abstract: Publication date: April 2019Source: International Journal of Drug Policy, Volume 66Author(s): Tony Antoniou, Kari Ala-Leppilampi, Dana Shearer, Janet A. Parsons, Mina Tadrous, Tara Gomes AimsTo characterize the impacts of policies intended to improve opioid prescribing and prevent opioid-related overdose and death on individuals who take opioids.MethodsWe conducted a qualitative study using focus groups with 48 adults aged 18 years and over who had experience taking opioids. Participants were recruited from across Ontario, Canada, and separate focus groups were held for individuals taking opioids for chronic pain and individuals taking opioids for other reasons. We drew upon stigma theory to interpret participants’ accounts.ResultsFollowing analysis and interpretation, we generated three themes describing the impacts of recently implemented opioid-related policies and harm reduction interventions on people who take opioids: ‘propagating stigma: addict as dominant status’, ‘loss of autonomy’ and ‘producing/reproducing structural vulnerabilities’. Specifically, participants characterize an environment in which ‘addict’ has become the dominant social identity ascribed to people who take opioids, and where relationships with providers have become strained as participants perceive themselves to be powerless when decisions regarding opioid use and pain management are made. These shifts in identity and relationships had negative repercussions when help-seeking and exposed larger vulnerabilities related to poverty and criminalization.ConclusionsThe introduction of opioid-related policies had unintended consequences for people who take opioids. Potential measures for mitigating these consequences include ensuring that people who take opioids are involved in all facets of policy development and implementation, integrating peer workers into the care of these individuals, and respecting patient agency when decisions about pain management and opioid use are made.
       
  • Associations between state-level policy liberalism, cannabis use, and
           cannabis use disorder from 2004 to 2012: Looking beyond medical cannabis
           law status
    • Abstract: Publication date: Available online 23 January 2019Source: International Journal of Drug PolicyAuthor(s): Morgan M. Philbin, Pia M. Mauro, Julian Santaella-Tenorio, Christine M. Mauro, Elizabeth N. Kinnard, Magdalena Cerdá, Silvia S. Martins BackgroundMedical cannabis laws (MCL) have received increased attention as potential drivers of cannabis use (CU), but little work has explored how the broader policy climate, independent of MCL, may impact CU outcomes. We explored the association between state-level policy liberalism and past-year cannabis use (CU) and cannabis use disorder (CUD).MethodsWe obtained state-level prevalence of past-year CU and CUD among past year cannabis users for ages 12–17, 18–25, and 26+ from the 2004–2006 and 2010–2012 National Surveys on Drug Use and Health. States were categorized as liberal, moderate, or conservative based on state-level policy liberalism rankings in 2005 and 2011. Linear models with random state effects examined the association between policy liberalism and past-year CU and CUD, adjusting for state-level social and economic covariates and medical cannabis laws.ResultsIn adjusted models, liberal states had higher average past-year CU than conservative states for ages 12–17 (+1.58 percentage points; p = 0.03) and 18–25 (+2.96 percentage points; p = 0.01) but not for 26+ (p = 0.19). CUD prevalence among past year users was significantly lower in liberal compared to conservative states for ages 12–17 (−2.87 percentage points; p = 0.045) and marginally lower for ages 26+ (-2.45 percentage points; p = 0.05).ConclusionLiberal states had higher past-year CU, but lower CUD prevalence among users, compared to conservative states. Researchers and policy makers should consider how the broader policy environment, independent of MCL, may contribute to CU outcomes.
       
  • I like to go out and have a good time: An ethnography of a group of young
           middle class urban Indian women participating in a new drinking culture
    • Abstract: Publication date: April 2019Source: International Journal of Drug Policy, Volume 66Author(s): Sagar Murdeshwar, Sarah Riley, Alison Mackiewicz BackgroundUrban, middle-class Indians are a market demographic target of transnational alcohol companies seeking to exploit neoliberal-informed deregulation policies. Against this backdrop is an emerging drinking culture in Mumbai, in which women participate.MethodAn ethnography with a friendship group of five middle-class, heterosexually-identified women aged between 22–24 years living in Mumbai. Poststructuralist informed analysis was performed on data from market mapping and venue mapping activities, interviews and participant observations.ResultsA range of on and offline corporate marketing practices facilitated an understanding of drinking as a cool practice of freedom, individualism and equality. Participants’ echoed this sense making, but they also described their drinking as occurring in a wider context of gendered inequality and national identities that made them vulnerable to sexual harassment and being ‘against Indian culture’.ConclusionsThis paper is the first to examine how a group of women make sense of their participation in an emerging Indian drinking culture, the wider material and discursive contexts enabling this sense-making, and the consequences for who and how such women can be in the world. The study highlights important similarities between this emerging drinking culture and the culture of intoxication documented in countries with a drinking culture norm. It also highlights the potential impact of the deregulation of alcohol sales and new marketing policies on groups of Indian women; and shows the importance of taking an intersectional approach that considers the interplay of gendered and national identities when analysing the impact of alcohol marketing policies.
       
  • CALL FOR PAPERS SPECIAL ISSUE: The Risk Environment in Rural Areas
    • Abstract: Publication date: Available online 15 January 2019Source: International Journal of Drug PolicyAuthor(s):
       
  • Call for Papers,Themed Collection: “Gendered perspectives on young
           adults’ alcohol intoxication”
    • Abstract: Publication date: Available online 14 January 2019Source: International Journal of Drug PolicyAuthor(s):
       
  • Crisis support services in night-time entertainment districts: Changes in
           demand following changes in alcohol legislation
    • Abstract: Publication date: March 2019Source: International Journal of Drug Policy, Volume 65Author(s): Grant J. Devilly, Alexa Srbinovski BackgroundNight time entertainment districts (NEDs) are predominantly frequented by youth who drink alcohol before and after entry. Centres where people binge drink alcohol make use of emergency services at a greater rate than those places where alcohol is not present. Previous UK government research suggests that lengthening the hours for alcohol sales has led to a spreading of emergency service use across the night, with services required later in the night. In Queensland, the State Government has introduced more restrictive opening hours for alcohol sales in NEDs and we predicted earlier use of crisis services and, with a large preloading culture, similar or more service use.MethodsVolunteer organisations, such as the NightWatch in Brisbane, Australia, provide crisis interventions as required in these NEDs and so we used the data from their records. Every Intervention made by the NightWatch organisation is recorded in an electronic database. We analysed data, matched for time of year, by looking at a 6 month period before the new legislation and a matching 6 month period following legislation.FindingsFollowing restrictive alcohol sales, the NightWatch provided similar numbers of interventions but those that required a more involved intervention (e.g., Rest and Recovery in a shelter) were significantly more prevalent, while less involved interventions (e.g., Intoxication First Aid provided in situ on the street) were fewer. Consistent with both preloading research and research into hours of alcohol availability, it was found that the NightWatch provided their services to the same number of people as before the legislative change, but provided them earlier in the evening.InterpretationWhere there is a preloading culture, restricting alcohol sales at the end of the night appears to lead to an increased use of crisis interventions earlier in the evening. A compressed need for aid runs the risk of overloading crisis service availability unless these services are proportionately resourced.
       
  • Engaging with motherhood and parenthood: A commentary on the social
           science drugs literature
    • Abstract: Publication date: Available online 7 January 2019Source: International Journal of Drug PolicyAuthor(s): Fiona S. Martin The majority of qualitative social scientific research on the topic of parenthood and substance use focuses on mothers who use illicit drugs and their experiences of social marginalization and stigmatization. This commentary argues that new and important insights might be gained about parenting in the context of substance use by engaging more closely with everyday experiences of mothering and with contemporary theorising around motherhood and parenthood. Drawing on recent sociological studies of family life influenced by late-modern individualism and by new expert attention on the quality of parent-child relationships, the commentary proposes directions for future social research on the identities and experiences of mothers and fathers who use alcohol and other drugs.
       
  • Opportunistic assessment and treatment of people with hepatitis C virus
           infection admitted to hospital for other reasons: A prospective cohort
           study
    • Abstract: Publication date: March 2019Source: International Journal of Drug Policy, Volume 65Author(s): Fabian Chiong, Jeffrey Post BackgroundIt will be essential to find novel ways to access, diagnose and treat people with Hepatitis C Virus (HCV) infection in Australia to achieve HCV elimination.AimWe assessed the effectiveness of opportunistic HCV assessment and antiviral treatment in patients admitted to hospital for other reasons.MethodsPatients with HCV infection were referred from inpatient services at a tertiary referral centre in Sydney. Patients were assessed for HCV treatment with transient elastography (TE), HCV genotype and a clinical assessment and a summary letter was generated for all patients with a general practitioner (GP). Patients were offered treatment commencement at hospital discharge or after discharge with their GP, the infectious diseases clinic or with a gastroenterologist if they had cirrhosis. The primary outcome was the proportion of eligible patients who commenced treatment. We also undertook an intention to treat (ITT), modified intent to treat (mITT) analysis for virologic outcome (SVR12) and per protocol cure rates. An assessment of potential efficiency gains was undertaken.ResultsA total of 100 patients with a positive HCV antibody test were enrolled, of whom 70 were viraemic. The cohort included a high proportion of people who currently or previously injected drugs, indigenous patients and people previously lost to follow-up from other services. Treatment was initiated in 46 (66%) patients. The ITT was 80.4% (37/46) and mITT rate was 84.1% (37/44).The per-protocol SVR12 rate was 94.9%. Two subjects with genotype 3 and cirrhosis failed treatment, two subjects died and five were lost to follow up. The key barrier to uptake of DAA was incomplete assessment. Key inefficiencies of this model of care included referral of non-viraemic subjects, limited TE access and virologic test turnaround times.ConclusionThis model of care can complement the current efforts to increase HCV treatment in the community for those who do not access care elsewhere or are lost to follow-up.
       
  • The association between experiencing discrimination and physical and
           mental health among PWID
    • Abstract: Publication date: March 2019Source: International Journal of Drug Policy, Volume 65Author(s): Camila Couto e Cruz, Caroline L. Salom, Paul Dietze, Lucinda Burns, Rosa Alati BackgroundDiscrimination can be a daily issue in the lives of people who inject drugs (PWID). However, the extent to which discrimination is related to the health of PWID remains unclear.MethodsData focusing on discrimination against PWID and potential health correlates were collected as part of the 2013 Illicit Drug Reporting System, a national survey with 887 PWID recruited in all Australian states and territories. Experience of discrimination, its setting, perceived reason and outcome, were self-reported by participants. The Kessler-10 scale and the mental component score of the Short Form 12-Item Health Survey were used to measure mental health. Physical health was assessed using the physical component score of the Short Form 12-Item Health Survey, specifically questions assessing injecting related problems and risk behaviour. Poisson and multinomial regression analyses were performed. Models were adjusted for socio-demographic and drug-related covariates.FindingsPWID reported experiencing discrimination in pharmacies, hospitals, government services and doctors/prescribers. The most commonly reported instances of discrimination were being refused service and experiencing abuse and/or violence. Experience of discrimination was associated with mental and physical health indicators. PWID who experienced discrimination were more likely to report high or very high mental distress (ARRR = 2.4, CI95 = 1.5–3.6) and mental health problems (ARRR = 1.4, CI95 = 1.2–1.7). The mental functioning (ARRR = 1.3, CI95 = 1.1–1.4) and physical functioning (ARRR = 1.1, CI95 = 1.1–1.4) of PWID, who experienced discrimination, were also more likely to be below Australian population mean scores.ConclusionSelf-reported experience of discrimination was associated with poor mental and physical health amongst PWID.
       
  • Application of a discrete choice experiment approach to support the design
           of a hepatitis C testing service in primary care
    • Abstract: Publication date: March 2019Source: International Journal of Drug Policy, Volume 65Author(s): Andrew Radley, Marjon van der Pol, John F Dillon BackgroundAscertaining the acceptability of healthcare provision to service users is an important factor in promoting service uptake, especially for populations who are reluctant to access care. This study identified the attributes of a Hepatitis C (HCV) testing service for people prescribed Opioid Substitution Therapy (OST) and used their expressed preferences to guide design of a service, using an applied health economics approach.Materials and methodsPreferences of OST users were elicited using a discrete choice experiment. Important attributes for HCV testing were partly pre-determined by the research question and also identified using literature review and focus groups. Predetermined attributes included choice of provider and financial incentives. Other important attributes were place of testing; travel distance; attitudes and staff undertaking testing; waiting time for test results and incentive payment. The relative importance of defined attributes was assessed in 103 OST users attending 6 pharmacies from Dundee.ResultsOST users preferred testing at their “own pharmacy”, by their drug worker, followed by their general practitioner (GP). Use of another pharmacy was the least preferred option. Being treated with dignity and respect was valued most highly, with waiting time for test results and travel distance also important. Financial incentives were not considered important.ConclusionsThis study provides evidence that OST users prefer testing at their own pharmacy. The addition of a pharmacy to the providers offering HCV testing may increase uptake and support policies to eliminate HCV from our communities. Being treated with dignity and respect was highly valued and this suggests that testing uptake can be increased by developing positive relationships between OST users and test providers. Financial incentives were not found to be important.
       
  • Healing the hurt amid the drug war: Narratives of young urban poor
           Filipinos in recovering families with parental drug use
    • Abstract: Publication date: Available online 11 December 2018Source: International Journal of Drug PolicyAuthor(s): Camille Therese C. Yusay, Nico A. Canoy BackgroundThis qualitative study explores the stories of young urban poor Filipino family members living with recovering parental drug users who turn themselves in to local authorities and completed theKatatagan Kontra Droga sa Komunidad (KKDK). This is a community-based rehabilitation program during the Philippine government’s anti-illegal drugs campaign.MethodsYoung urban poor family members living with parental drug use were interviewed (n = 13) and asked to narrate their experiences of parental drug use, surrender, and recovery. Their stories were analyzed using an integrated approach to narrative analysis guided by Rhodes’ framework (2002) of risk environment.ResultsNarrative work of participants focused on the stories of their parents’ drug use and recovery after surrendering. These stories show contexts which evoke the salience of prevailing discourse (i.e., cultural organization of Filipino family) and shaming practices in the community, and how these are embodied in the lives of our young participants. In re-telling their stories of parental drug use, our young participants (re) positioned themselves in three different ways: “I am used to it”, “I was neglected”, “I am angry and hurt”. After their parents completed the community-based rehabilitation program, they reconstructed their parents’ stories of recovery as a catalyst to improve their situation as a family unit (i.e., “their change is our change”).ConclusionSet against a national anti-illegal drug campaign, our findings contribute to a contextually nuanced perspective on the impact of parental drug use on children and families living in poverty. Policy makers and interventionists (e.g., mental health practitioners, social workers, psychologists) may need to consider young people’s stories as a struggle to exercise their agency when tailoring community-based programs to respond to the needs of younger people. Challenges to advocate for psychological, social, and structural ‘healing are discussed.
       
  • Naloxone distribution, trauma, and supporting community-based overdose
           responders
    • Abstract: Publication date: Available online 5 December 2018Source: International Journal of Drug PolicyAuthor(s): Danier Shearer, Taylor Fleming, Al Fowler, Jade Boyd, Ryan McNeil
       
  • ‘Good enough’ parenting: Negotiating standards and stigma
    • Abstract: Publication date: Available online 29 July 2018Source: International Journal of Drug PolicyAuthor(s): kylie valentine, Ciara Smyth, Jamee Newland BackgroundPolicy concern with families has led to the framing of ‘good parenting’ as a skill set that parents must acquire while ‘poor parenting’ is linked to a raft of social problems, including child maltreatment. A range of professionals are responsible for monitoring parents for evidence of ‘poor parenting’, and for reporting those parents to statutory child protection authorities. Little is known about how parents in vulnerable circumstances negotiate these dual pressures of ‘good parenting’ and surveillance.MethodsEight parents who use drugs were interviewed about raising children well. The data is drawn from a project that used a positive deviance approach to understand the practices and norms that contribute to positive child outcomes in communities where positive outcomes are unexpected or statistically anomalous.ResultsParents use a range of strategies to minimise risk of harm from drug use. Participants resist negative stereotypes that portray their parenting primarily in terms of risk; and in contrast to previous research, describe feelings of guilt but not shame. Systemic barriers to safe environments include the nature of illicit drug markets and the surveillance and policing responsibilities of service agencies.ConclusionThe findings contribute to an understanding of safe and competent parenting by parents who use drugs and highlight how drug laws and fear of intervention can work against the creation of safe family environments.
       
  • Problematisation and regulation: Bodies, risk, and recovery within the
           context of Neonatal Abstinence Syndrome
    • Abstract: Publication date: Available online 17 July 2018Source: International Journal of Drug PolicyAuthor(s): Anne Whittaker, Amy Chandler, Sarah Cunningham-Burley, Paula Midgley, Lawrie Elliott, Sarah Cooper BackgroundNeonatal Abstinence Syndrome (NAS) is an anticipated effect of maternal drug use during pregnancy. Yet it remains a contested area of policy and practice. In this paper, we contribute to ongoing debates about the way NAS is understood and responded to, through different treatment regimes, or logics of care. Our analysis examines the role of risk and recovery discourses, and the way in which the bodies of women and babies are conceptualised within these.MethodsQualitative interviews with 16 parents (9 mothers, 7 fathers) and four focus groups with 27 health and social care professionals based in Scotland. All the mothers were prescribed opioid replacement therapy and parents were interviewed after their baby was born. Data collection explored understandings about the causes and consequences of NAS and experiences of preparing for, and caring for, a baby with NAS. Data were analysed using a narrative and discursive approach.ResultsParent and professional accounts simultaneously upheld and subverted logics of care which govern maternal drug use and the assessment and care of mother and baby. Despite acknowledging the unpredictability of NAS symptoms and the inability of the women who are opioid-dependent to prevent NAS, logics of care centred on ‘proving’ risk and recovery. Strategies appealed to the need for caution, intervening and control, and obscured alternative logics of care that focus on improving support for mother-infant dyads and the family as a whole.ConclusionDiffering notions of risk and recovery that govern maternal drug use, child welfare and family life both compel and trouble all logics of care. The contentious nature of NAS reflects wider socio-political and moral agendas that ultimately have little to do with meeting the needs of mothers and babies. Fundamental changes in the principles, quality and delivery of care could improve outcomes for families affected by NAS.
       
  • Tensions and contradictions in family court innovation with high risk
           parents: The place of family drug treatment courts in contemporary family
           justice
    • Abstract: Publication date: Available online 29 June 2018Source: International Journal of Drug PolicyAuthor(s): Judith Harwin, Karen Broadhurst, Caroline Cooper, Stephanie Taplin Parental substance misuse is a leading factor in child abuse and neglect and frequently results in court-mandated permanent child removal. Family drug treatment courts, which originated in the USA and are only found in adversarial family justice systems, are a radical innovation to tackle this problem. Unlike ordinary court, they treat parents within the court arena as well as adjudicating, and in this way they seek to draw a new balance between parental needs and the child’s right to timely permanency. Family drug treatment courts have spread to England, Australia and Northern Ireland and international research has found they have higher rates of parental substance misuse cessation and family reunification and lower foster care costs than ordinary courts. Yet their growth has been far from straightforward. In the USA they have not kept pace with the rise of criminal drug treatment courts and in England and Australia their numbers remain small. The central purpose of this article is to explore why the family drug treatment movement has not achieved wider impact and to consider opportunities and challenges for its future development. To address these questions we draw on evidence and experience from the USA, England and Australia. We discuss the operational challenges, tensions between children’s needs for stability and parental timescales for recovery, the impact of wider economic and political change, and issues in data evaluation. We conclude that despite the promise of family drug treatment courts as a new paradigm to address risky parenting, effecting systemic change in the courts is extremely difficult.
       
  • Call for papers: Problematizations in drug use policy, practice and
           research
    • Abstract: Publication date: Available online 27 March 2018Source: International Journal of Drug PolicyAuthor(s):
       
 
 
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