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International Journal of Drug Policy
Journal Prestige (SJR): 1.441
Citation Impact (citeScore): 3
Number of Followers: 450  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0955-3959
Published by Elsevier Homepage  [3161 journals]
  • Differences by sex in associations between injection drug risks and drug
           crime conviction among people who inject drugs in Almaty, Kazakhstan
    • Abstract: Publication date: October 2018Source: International Journal of Drug Policy, Volume 60Author(s): Phillip L. Marotta, Louisa Gilbert, Assel Terlikbayeva, Elwin Wu, Nabila El-BasselAbstractBackgroundThe criminalization of drug use leads to high rates of drug crime convictions for engaging in injection drug use behaviors, introducing barriers to HIV prevention and drug treatment for PWID. Females (FWID) face unique vulnerabilities to HIV compared to males (MWID) in Kazakhstan. This study examined sex differences in associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, and conviction for a drug crime in a sample of people who inject drugs (PWID) in Almaty, Kazakhstan.MethodsAnalyses were performed on baseline data from 510 PWID and stratified by males (MWID) (329) and females (FWID) (181) from Kazakhstan in a couples-focused HIV prevention intervention. Logistic regression analyses using mixed effects (AOR) examined associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, drug use severity, drug treatment history and conviction for a drug crime.ResultsAbout three quarters of PWID reported drug crime conviction (73.92%, n = 377). HCV infection was associated with increased odds of drug crime conviction for FWID (AOR = 4.35, CI95 = 1.83–10.31, p 
  • Drug detection dogs at Australian outdoor music festivals: Deterrent,
           detection and iatrogenic effects
    • Abstract: Publication date: October 2018Source: International Journal of Drug Policy, Volume 60Author(s): Jodie Grigg, Monica J. Barratt, Simon LentonAbstractBackgroundRecent drug-related deaths at Australian music festivals have led to increasing concern about the risk of future harm, but contention about how to effectively respond. One hotly debated strategy has been the use of drug detection dogs which currently operate at festivals across Australia, despite claims they are ineffective and contribute to risky drug use practices. This paper aims to investigate responses to the expected presence, and sightings, of drug dogs at the last festival attended.MethodsAn anonymous online survey was completed by almost 2000 Australian festival-goers. The largest subsample used in the analyses for this paper (n = 647) was 59% male and had a median age of 20 (IQR = 18–22).ResultsOf those who expected dogs to be present at their last festival (n = 647), only 4% reported that this threat led them to decide not to take drugs. Other responses included: concealing their drugs well (48%), getting someone else to carry their drugs (15%), buying their drugs inside (11%), taking less easily detected drugs (10%) and taking drugs before entering (7%). Of those who carried drugs in (n = 418), 10% concealed them internally and 1% swallowed them to retrieve inside. Of those who had drugs on their person when seeing a dog (n = 189), 10% reported consuming drugs in response. No respondents reported being detected with drugs due to a positive identification.ConclusionAlmost all festival-goers surveyed did not report being deterred from drug usage by the expected presence of drug dogs. Instead, a variety of alternative responses to avoid detection were reported, many of which could place festival-goers at greater risk of experiencing drug-related harms. In the face of mounting evidence of both ineffectiveness and iatrogenic effects, the use of drug detection dogs at Australian music festivals should be urgently reconsidered.
  • Mourning our dead: The impact of Mexico’s war on drugs on
           citizens’ depressive symptoms
    • Abstract: Publication date: October 2018Source: International Journal of Drug Policy, Volume 60Author(s): Iván Flores Martínez, Laura Helena AtuestaAbstractBackgroundResearch has shown the substantial impact on mental health for victims of drug-related crime in Mexico, especially individuals who have been heavily exposed to violence. However, the effect of drug-related violence in non-victims has been less studied because causal pathways via indirect violence are more ambiguous. We argue that drug-related violence does have an influence on the mental health of non-victims: For example, because of how violence is publicized by criminal groups, including their use of gruesome killing methods in executions, or via news about government confrontations with these criminal groups.MethodsWe estimate linear models of the effect of drug-related violence (CIDE-PPD database) on depression symptoms (MxFLS 2009–2012). We use lagged violence variables to match the time when individuals’ depression symptoms were reported, using different proxies of violence.FindingsOur findings suggest a negative effect of drug-related violence on the mental health of individuals, specifically in relation to communication used by criminal groups (narcomessages), the brutality of executions, and the confrontations between government forces (specifically local police) and criminal groups.ConclusionsOur findings suggest that the general population is a direct victim of the psychological violence imposed by the use of narcomessages. This additional effect of the war on drugs should be considered when deciding how to address the psychological effects of drug-related violence. The government should provide safer public spaces to improve perceptions about security, and more mental health services in communities that are most affected by organized crime violence. Mental health is also affected when police forces fight criminal groups. These findings corroborate the crisis of local institutions, the low confidence citizens have in police, and/or the infiltration of organized crime in local police corps. Mexico requires police reform, not only to avoid the involvement of the military in public security operations, but also to avoid social and psychological damage produced by weak police forces fighting organized crime.
  • Defining and defending drug-free bodybuilding: A current perspective from
           organisations and their key figures
    • Abstract: Publication date: October 2018Source: International Journal of Drug Policy, Volume 60Author(s): Dimitrios LiokaftosAbstractThe use of performance- and image-enhancing drugs in the past seventy years or so has sparked a number of responses, including heated public debates, the creation of dedicated organisations and drug policies, as well as the emergence of communities of practice and belief in support of or in opposition to the phenomenon. Drug-free, known in the field as ‘natural’, bodybuilding has been developing since the 1970 s as a response to a dominant bodybuilding culture where the use of performance- and image-enhancing drugs has become normalised. Recent years have seen a multiplication of national and international governing bodies, competitions, and participants in drug-free bodybuilding in different parts of the globe. As the field grows, the questions of what constitutes natural bodybuilding and who can authentically represent it become central. Adopting a multi-method, qualitative approach, this article explores the ways organisations and their key figures define and defend their versions of drug-free bodybuilding. The discussion focus is on the policies, meanings and identities embedded in these different versions, and how their production and negotiation makes sense in light of antagonisms between players in the field of natural bodybuilding as well as their relation to drug-enhanced bodybuilding and the wider world of sport. In examining this previously uncharted body culture, the article explores how the use of performance- and image-enhancing drugs provokes responses and processes of contestation and differentiation. In the process, what becomes apparent is the designation and negotiation of drug-free, natural bodies as an ongoing, dynamic, social process.
  • Situating the syringe
    • Abstract: Publication date: Available online 9 August 2018Source: International Journal of Drug PolicyAuthor(s): Nicole VitelloneAbstractWhat’s at stake when the syringe becomes a tool for thinking' Reflecting on the production of Social Science of the Syringe, this commentary describes the empirical challenges of encountering injecting drug users directly affected by Harm Reduction policies as significant stakeholders in the expression of drug problems.
  • Caring and curing: Considering the effects of hepatitis C
           pharmaceuticalisation in relation to non-clinical treatment outcomes
    • Abstract: Publication date: October 2018Source: International Journal of Drug Policy, Volume 60Author(s): Magdalena Harris, Tim RhodesAbstractBackgroundThe development of simplified and effective hepatitis C (HCV) pharmaceuticals enables treatment scale up among the most marginalised. This potentiates a promise of viral elimination at the population level but also individual level clinical and non-clinical benefits. Reports of transformative non-clinical outcomes, such as changes in self-worth and substance use, are primarily associated with arduous interferon-based treatments that necessitate intensive care relationships. We consider the implications of simplified treatment provision in the era of direct acting antivirals (DAAs) for the realisation of non-clinical benefits.MethodsWe draw on qualitative data from ethnographic observations and longitudinal interviews with people receiving (n = 22) and providing (n = 10) HCV treatment in London during a transition in HCV biomedicine. First generation DAAs in conjunction with interferon were standard of care for most of this time, with the promise of simplified treatment provision on the horizon.FindingsPatient accounts of care accentuate the transformative value of interferon-based HCV treatment derived through non-clinical benefits linked to identity and lifestyle change. Such care is constituted as extending beyond the virus and its biomedical effects, with nurse specialists positioned as vital to this care being realised. Provider accounts emphasise the increased pharmaceuticalisation of HCV treatment; whereby care shifts from the facilitation of therapeutic relationships to pharmaceutical access.ConclusionHCV care in the interferon-era affords identity transformations for those receiving and providing treatment. Biomedical promise linked to the increasing pharmaceuticalisation of HCV treatment has disruptive potential, shifting how care is practised and potentially the realisation of non-clinical treatment outcomes.
  • Beyond deficit and harm reduction: Incorporating the spectrum of wellness
           as an interpretive framework for cannabis consumption
    • Abstract: Publication date: October 2018Source: International Journal of Drug Policy, Volume 60Author(s): Todd SubritzkyAbstractThe cannabis academic literature is informed by dominant deficit, public health and harm reduction frameworks. However, a large majority of cannabis consumption appears to place outside the scope of these models that prioritise the identification and limitation of negative impacts. As such there are apparent analytical blind spots pertaining to: non-problematic use of cannabis (as defined by Global Commission on Drug Policy); the intersection of medical and recreational intents of use; and pleasure. This paper explores the academic and grey literature relating to the spectrum of wellness to assess its suitability as a framework for cannabis scholars. For millennia cannabis use has been associated with wellness models, particularly at the nexus of mind, body, and spirit. Despite this seemingly obvious match, the academic literature that incorporates cannabis consumption patterns into wellness conceptions is thin. The spectrum of wellness has both advantages and disadvantages compared to existing models and may be useful as a complementary framework that allows for broader examination of cannabis consumer activity.
  • Should sterile needle and syringe wastage be included within
           individual-level needle and syringe coverage measures'
    • Abstract: Publication date: October 2018Source: International Journal of Drug Policy, Volume 60Author(s): O’Keefe Daniel, Aitken Campbell, Dietze Paul
  • Health-related work productivity loss is low for patients in a methadone
           maintenance program in Vietnam
    • Abstract: Publication date: October 2018Source: International Journal of Drug Policy, Volume 60Author(s): Bach Xuan Tran, Long Hoang Nguyen, Cuong Tat Nguyen, Carl A. LatkinAbstractBackgroundData on work productivity lost are an essential component of economic evaluation regarding social issues. However, there has been limited information about the loss of work productivity due to health among patients receiving methadone maintenance treatment (MMT) in Vietnam. The objectives of this study were to explore health-related work productivity loss between urban and rural MMT patients and to identify associated factors.MethodsA cross-sectional study was conducted in five MMT clinics in Hanoi and Nam Dinh provinces. Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH) was used to measure health-related work productivity loss. In addition, data on socio-demographic, health status (measured by EuroQol-5 dimensions-5 levels – EQ-5D-5L, and EQ-Visual analogue scale – EQ-VAS) and substance use were collected. Multivariate Tobit regression was used to identify the potential factors associated with health-related work productivity loss.ResultsOf 1016 patients who participated in the study, 755 (74.6%) were employed. Of those, only 40/755 patients reported missing work due to health problems (5.3%), with the average absenteeism score of 30.6% (SD = 18.5%). Meanwhile, 164/755 respondents (21.7%) reported their impairment during work hours due to health problems. The mean weekly cost of absenteeism was at US$ 19.6 (SD = 11.8), and the mean weekly presenteeism cost was at US$ 8.7 (SD = 7.3). After adjusting for socio-economic status, having problems with mobility, usual activities, pain/discomfort, and anxiety/depression; as well as EQ-5D index and EQ-VAS score, were factors associated with work productivity loss due to health.ConclusionThe current study emphasizes the low degree of health-related work productivity loss, as well as the low rate of work impairment among MMT patients in Vietnamese urban and rural settings. Our study also highlights the necessity of appropriate pain and mental health management as well as vocational training, and the provision of job opportunities to promote the employability of patients taking MMT.
  • The impact of medically supervised injection centres on drug-related
           harms: A meta-analysis
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Tom May, Trevor Bennett, Katy HollowayAbstractBackgroundMedically Supervised Injection Centres (MSICs) are legally-sanctioned facilities where users can consume pre-obtained drugs under medical supervision. Although there is a substantial body of research exploring their effectiveness, there have been few attempts to quantify outcomes across studies. In order to determine the impact of the body of research as a whole, outcomes from studies were synthesised using meta-analysis.MethodsLiterature sources were identified through searches in four bibliographic databases. Inclusion in the final review was dependent on the study meeting certain eligibility criteria, including a minimum of pre-test, post-test, control group designs. Data were extracted and pooled in a meta-analysis using both fixed and random effects methods.ResultsEight studies met the inclusion criteria. Overall, MSICs had a significant, but small, positive effect on outcomes based on the fixed effect analysis and no effect based on random effect analysis. The results of the independent outcome analyses showed that MSICs had a significant favourable result in relation to drug-related crime and a significant unfavourable result in relation to problematic heroin use or injection. MSICs were found to have no effect on overdose mortality or syringe/equipment sharing.ConclusionWhilst the effectiveness of the early versions of MSICs remains uncertain, this should not rule out continuing to test and develop MSICs in locations where public injecting and other drug-related harms are a major problem. It is important, however, that evaluation research publishes replicable data to enable future meta-analyses and to expand the body of knowledge in the field.
  • Perceived harms and harm reduction strategies among people who drink
           non-beverage alcohol: Community-based qualitative research in Vancouver,
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Alexis Crabtree, Nicole Latham, Rob Morgan, Bernadette Pauly, Victoria Bungay, Jane A. BuxtonAbstractBackgroundThere has been increasing interest in harm reduction initiatives for street-involved people who drink alcohol, including non-beverage alcohol such as mouthwash and hand sanitizer. Limited evidence exists to guide these initiatives, and a particular gap is in research that prioritizes the experiences and perspectives of drinkers themselves. This research was conducted to explore the harms of what participants termed “illicit drinking” as perceived by people who engage in it, to characterize the steps this population takes to reduce harms, and to identify additional interventions that may be of benefit.MethodsThis participatory qualitative research drew on ethnographic approaches including a series of 14″town hall"-style meetings facilitatied and attended by people who self identify as drinking illicit or non-beverage alcohol (n = 60) in Vancouver, British Columbia. This fieldwork was supplemented with four focus groups to explore emerging issues.ResultsParticipants in the meetings described the harms they experienced as including unintentional injury; harms to physical health; withdrawal; violence, theft, and being taken advantage of; harms to mental health; reduced access to services; and interactions with police. Current harm reduction strategies involved balancing the risks and benefits of drinking in groups and adopting techniques to avoid withdrawal. Proposed future initiatives included non-residential managed alcohol programs and peer-based supports.ConclusionsIllicit drinkers describe harms and harm reductions strategies that have much in common with those of other illicit substances, and can be interpreted as examples of and responses to structural and everyday violence. Understanding the perceived harms of alcohol use by socially marginalized drinkers and their ideas about harm reduction will help tailor programs to meet their needs.
  • Awareness and access to naloxone necessary but not sufficient: Examining
           gaps in the naloxone cascade
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Karin Tobin, Catie Clyde, Melissa Davey-Rothwell, Carl LatkinAbstractBackgroundDespite promising findings of opioid overdose education and naloxone distribution (OEND) programs, overdose continues to be a major cause of mortality. The “cascade of care” is a tool for identifying steps involved in achieving optimal health outcomes. We applied the cascade concept to identify gaps in naloxone use.MethodsData came from a cross-sectional survey of 353 individuals aged 18 and older who self-reported lifetime history of heroin use.ResultsThe sample was majority male (65%) and reported use of heroin (74%) and injection (57%) in the past 6 months. Ninety percent had ever witnessed an overdose and of these 59% were in the prior year. Awareness of naloxone (90%) was high. Of those aware, over two-thirds reported having ever received (e.g. access) (69%) or been trained to use naloxone (60%). Of those who had ever received naloxone (n = 218) over one-third reported possession never (36%) or rarely/sometimes carrying naloxone (38%), while 26% reported always carrying. Nearly half of those who had ever received naloxone reported ever use to reverse an opiate overdose (45%). Among individuals who had ever received naloxone, possession often/always compared to never was associated with being female (RRR = 2.88, 95%CI = 1.31–6.27) and ever used naloxone during an overdose (RRR = 4.68, 95%CI = 2.00–11.0).ConclusionsThis study identifies that consistent possession is a gap in the naloxone cascade. Future research is needed to understand reasons for not always carrying naloxone.
  • ‘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 NewlandAbstractBackgroundPolicy 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.
  • Factors associated with lost to follow-up after hepatitis C treatment
           delivered by primary care teams in an inner-city multi-site program,
           Vancouver, Canada
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Susan Nouch, Lesley Gallagher, Margaret Erickson, Rabab Elbaharia, Wendy Zhang, Lu Wang, Nic Bacani, Deborah Kason, Holly Kleban, Laura Knebel, David Hall, Rolando Barrios, Mark HullAbstractBackgroundTreatment of hepatitis c virus (HCV) with direct-acting-antivirals (DAAs) by family physicians in primary care and addiction settings may allow treatment expansion to inner-city populations, including people who inject drugs (PWID). Real-world data however, suggests high rates of non-attendance to SVR 12 testing. This study examines outcomes of HCV treatment delivered by family physicians working in interdisciplinary treatment programs, integrated into inner-city primary care clinics.MethodsIn this prospective cohort, participants completed baseline questionnaires, including questions on demographics and substance use. Participants were recorded as achieving a sustained virologic response (SVR 12) if HCV RNA was undetectable 12 weeks following end of therapy, and were recorded as lost to follow-up (LTFU) if they did not present for an HCV follow-up visit. SVR was calculated in intention to treat (ITT) as well as modified intention to treat (mITT) analysis, which excluded those who completed treatment but had no SVR 12 result. A logistic regression model assessed factors associated with LTFU.ResultsOf 138 individuals included in the analysis, 52% were on opioid agonist therapy (OAT), 75% reported a history of injection drug use (IDU), with 25% reporting IDU in the month prior to treatment initiation. ITT SVR across all sites and genotypes was 86% and mITT was 95%. There was a significant difference in mITT for those reporting recent IDU compared to those who did not (87% vs 99% p = 0.03). While 13% were LTFU at SVR 12, participants receiving OAT in the same clinic as HCV treatment were less likely to be LTFU (aOR 0.09(0.02–0.46)).ConclusionHCV treatment by family physicians, along with interdisciplinary teams, can be successful in inner-city populations in the era of DAAs; however, follow-up after treatment is a challenge. Integrating OAT in the same location as HCV treatment may help to improve follow-up.
  • 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 CooperAbstractBackgroundNeonatal 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.
  • Integrating hepatitis C and addiction care for people who inject drugs in
           the era of direct-acting antiviral therapy
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Kathleen Bird, María Eugenia Socías, Lianping TiAbstractAs new, more tolerable and effective hepatitis C virus (HCV) treatments are available, there is a global need to consider how to maximize treatment access for groups who are most affected by HCV. A substantial number of people who inject drugs (PWID) are living with HCV, yet only a minority have received treatment. HCV treatment programs that are integrated into community-based addiction care may be a successful way to overcome barriers and increase access and uptake of HCV treatment for this population. Examples of successful HCV and addiction care integration in the community have been documented. However, potential challenges to integration exist and include changing healthcare provider roles, lack of stimulant use research and restrictive drug policies. Successful engagement of PWID in HCV care is critical step towards the elimination of HCV infection. Further research and efforts are needed in order to reach this goal.
  • Tuberculosis infection among cocaine crack users in Brazil
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Sandra Maria do Valle Leone de Oliveira, Elizeu Ferreira da Silva, Ana Rita Coimbra Motta-Castro, Vivianne de Oliveira Landgraf de Castro, Andréa Cristina Stábile, Anamaria Mello Miranda Paniago, Anete TrajmanAbstractBackgroundWHO recommends treatment for latent tuberculosis infection (LTBI) in the homeless and people who use drugs (PWUD). The optimal test for LTBI screening is uncertain.MethodsA cross-sectional study was conducted among the homeless and drug-rehabilitation clinic clients chronically using crack in Western Brazil. Participants were interviewed and offered HIV testing plus tuberculin skin testing (TST) and QuantiFeron®-Gold-in-Tube (QFT). We considered LTBI when either TST or QFT were positive. Factors associated with LTBI were adjusted in a multivariate model.ResultsAmong 372 subjects with at least one valid test, 216 (58%) had LTBI. TST was not read in 18.4%; QFT was indeterminate in 2.5%. TST detected 27 (26%) extra LTBI cases among 75 QFT-negative individuals. PWUD had over three-fold odds for LTBI. TST was 4.5 times more likely to be positive in BCG-vaccinated individuals.ConclusionGiven the high risk of progression to disease in this population, the high rates of loss to TST reading and the possibility of false-positive TST results from BCG vaccination, we endorse current CDC recommendations to use QFT for LTBI screening among the homeless and PWUD. However, because adding TST to a negative QFT increased LTBI detection considerably, TST should be considered in QFT-negative individuals.
  • Grievable lives' Death by opioid overdose in Australian newspaper
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Suzanne Fraser, Adrian Farrugia, Robyn DwyerAbstractOpioid overdose deaths are increasing in Australia and around the world. Despite this, measures aimed at reducing these deaths such as safe injecting facilities and take-home naloxone continue to face obstacles to uptake. The reasons for this are manifold, but a key contributor is public discourse on opioid consumption and overdose. In this article we explore this public discourse using Judith Butler’s work on ‘grievable lives’. The article analyses mainstream newspaper coverage of opioid overdose in Australia to map key articulations of overdose and to consider how public understandings of overdose are shaped. It then goes on to consider ways these understandings might be reshaped, looking at what have been called overdose ‘anti-memorials’ and a new website In concluding we argue that until the lives of opioid consumers come to be considered grievable, the measures known to reduce overdose deaths may struggle to find public support.
  • Profile, risk practices and needs of people who inject morphine sulfate:
           Results from the ANRS-AERLI study
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Perrine Roux, Salim Mezaache, Laélia Briand-Madrid, Marie Debrus, Nicolas Khatmi, Gwenaelle Maradan, Camélia Protopopescu, Daniela Rojas-Castro, Patrizia CarrieriAbstractAimsIn France, a non-negligible proportion of opioid-dependent individuals inject morphine sulfate. Although it has not yet been officially approved as an opioid substitution treatment (OST), some physicians can prescribe its use for people in methadone or buprenorphine treatment failure. Longitudinal data from the ANRS-AERLI study, which evaluated an educational intervention for safer injection called AERLI, provided us the opportunity to better characterize the profile, risk practices and needs of people who inject morphine sulfate (MSI), through comparison with other injectors, and to identify correlates of HIV/HCV risk practices in this group.MethodsThe national multisite ANRS-AERLI study assessed the impact of AERLI offered in volunteer harm reduction (HR) centers (“with intervention”) (n = 113) through comparison with standard HR centers (“without intervention”) (n = 127). All participants were scheduled to be followed up for 12 months and have 3 telephone interviews: at baseline, 6 months and 12 months. We compared MSI (n = 79) with other opioid injectors (n = 161) and then used a mixed logistic model to identify factors associated with HIV/HCV risk practices among MSI.FindingsOf the 240 eligible participants, 79 were regular MSI. They were less likely to use cocaine, crack or buprenorphine and to receive OST than other participants. Conversely, MSI were more likely to inject drugs more than three times a day and to report HIV/HCV risk practices. Among MSI, multivariate analysis showed that those receiving morphine sulfate as an OST were less likely to report such practices than other participants (aOR [95%CI] = 0.11 [0.02-0.61]).ConclusionOur results show that while MSI use fewer stimulants, they have more HIV/HCV risk practices than other injectors. However, when MSI are prescribed morphine sulfate as a treatment, these practices tend to decrease. Our findings suggest the importance of increasing access to morphine sulfate as a new OST in France.
  • Developing a patient-reported experience questionnaire with and for people
           who use drugs: A community engagement process in Vancouver’s Downtown
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Michelle Olding, Kanna Hayashi, Lindsay Pearce, Brittany Bingham, Michelle Buchholz, Delilah Gregg, Dave Hamm, Laura Shaver, Rachael McKendry, Rolando Barrios, Bohdan NosykAbstractPeople who use drugs (PWUD) frequently have complex health care needs, yet face multiple barriers to accessing services. Involving PWUD in health service design and evaluation can enhance the quality of data collected and ensure policy and practice improvements reflect the expressed needs of the population. However, PWUD remain largely excluded from the evaluation of health services that directly affect their lives, including development of patient-reported experience measures (PREMS) that have gained prominence in health services research and clinical practice. Detailed descriptions of PWUD participation in survey design are notably absent in the literature. In this commentary, we present a case that demonstrates how PWUD can contribute meaningfully to the development of questionnaires that assess patient-reported health care experiences. We describe the development, implementation and outcomes of a process to engage local drug user organizations in the evaluation of a redesign and reorientation of health service delivery in the Downtown Eastside (DTES) neighborhood of Vancouver, Canada. Through this process, participants contributed critical elements to the design of a patient-reported experience measure, including: (1) identifying unmet service needs in the neighborhood; (2) identifying local barriers and facilitators to care; (3) formulating questions on cultural safety; and (4) improving structure, language and clarity of the questionnaire. We highlight lessons learned from the process, reflecting on the strengths, challenges and ethical considerations associated with community-based approaches to questionnaire development. The workshop model presented here illustrates one flexible and promising approach to enabling meaningful participation of PWUD in questionnaire development.
  • Stigma and the public health agenda for the opioid crisis in America
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Patrick W. Corrigan, Katherine NieweglowskiAbstractThe current opioid crisis in the U.S. is unprecedented and calling for a nationwide reorganization of the public health prevention program. Stigma is a persistent barrier to this agenda, unfortunately with a limited body of research on substance use disorder (SUD) available to inform it. We review the broader research literature on the stigma of behavioral health (i.e., mental illness and SUD) to identify strategies to address the opioid crisis and harmful stigma. A major difference between mental illness and SUD stigma is that the latter is legally and socially sanctioned. In making sense of the behavioral strategies for stigma change, we consider three agendas for stigma prevention (prevention, rights, and self-worth). We suggest that incorporating the rights and the self-worth agendas with an in vivo focused contact model, might be most effective for an integrative strategy aimed at targeting opioid stigma. Involving people in recovery as key drivers of this agenda and evaluating the detrimental impact of using stigma as a health tool (social sanction), will bring new horizons to solving this deadly epidemic.
  • Tensions and contradictions in family court innovation with high risk
           parents: The place of family drug treatment courts in contemporary family
    • Abstract: Publication date: Available online 29 June 2018Source: International Journal of Drug PolicyAuthor(s): Judith Harwin, Karen Broadhurst, Caroline Cooper, Stephanie TaplinAbstractParental 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.
  • Making a difference' Applying Vitellone’s Social Science of the
           Syringe to performance and image enhancing drug injecting
    • Abstract: Publication date: Available online 19 April 2018Source: International Journal of Drug PolicyAuthor(s): Aaron HartAbstractVitellone’s Social Science of the Syringe investigates epistemologies of injecting drug use. She argues for a methodology that can be simultaneously sensitive to biopolitical power regimes; the trajectories of social stratification; and the resistance, creativity and dignity of human agency. She proposes a methodological focus on the syringe-in-use as an active participant in these dynamics. Harm reduction policy and service provision frameworks have paid little attention to the phenomena of performance and image enhancing drug (PIEDs) injection. One way of assessing the merit of Vitellone’s proposal is to use it to investigate these phenomena. I argue that Vitellone’s method can be used to articulate a range of significant differences between people who inject PIEDs and other people who inject drugs, and that these differences can inform harm reduction initiatives. When compared to the heroin syringe, the PIED syringe participates in different socio-economic and material contexts, gendered identities, and biopolitical governance regimes. These differences materialise in different rates of syringe sharing and blood-borne virus transmission; and different experiences of needle exchange services. I offer a thought experiment demonstrating how a different syringe might alter the structural dynamics, biopolitical governance, and the agentic choices of people who inject PIEDs. Judging by the productive effects of diffracting Vitellone’s analysis through an empirical concern with PIED injecting, I concur with Vitellone’s proposition that ‘something objective may be gained from an empirical investigation of the syringe-in-use’ (p. 33).
  • Call for papers: Problematizations in drug use policy, practice and
    • Abstract: Publication date: Available online 27 March 2018Source: International Journal of Drug PolicyAuthor(s):
  • The object in hand: Social science of the syringe
    • Abstract: Publication date: Available online 26 March 2018Source: International Journal of Drug PolicyAuthor(s): Helen Keane
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
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