Journal Cover International Journal of Drug Policy
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0955-3959
   Published by Elsevier Homepage  [3177 journals]
  • A qualitative exploration of Thai alcohol policy in regulating
           availability and access
    • Authors: Ratchakorn Kaewpramkusol; Kate Senior; Richard Chenhall; Sutham Nanthamongkolchai; Surasak Chaiyasong
      Pages: 1 - 8
      Abstract: Publication date: August 2018
      Source:International Journal of Drug Policy, Volume 58
      Author(s): Ratchakorn Kaewpramkusol, Kate Senior, Richard Chenhall, Sutham Nanthamongkolchai, Surasak Chaiyasong
      Background Despite abundant alcohol control regulations and measures in Thailand, prevalence of alcohol consumption has been relatively steady for the past decade and alcohol-related harm remains high. This study aims to explore, through the perspectives of key public health stakeholders, the current performance of regulations controlling alcohol availability and access, and the future directions for the implementation of Thai alcohol policy. Methods Semi-structured interviews were conducted with public health stakeholders from three sectors; the government, academia and civil society. Their perceptions about the current alcohol situation, gaps in the current policies, and future directions of alcohol policy were discussed. Audio data were transcribed verbatim, systematically coded and analysed. Results The three key concerning issues were physical availability, economic availability and commercial access, which referred to outlet density, taxation and pricing, and compliance to stipulated regulations, respectively. First, Thailand failed to control the number of alcohol outlets. The availability problem was exacerbated by the increased numbers of liquor licences issued, without delineating the need for the outlets. Second, alcohol tax rates, albeit occasionally adjusted, are disproportionate to the economic dynamic, and there is yet a minimum pricing. Finally, compliance to age and time restrictions was challenging. Conclusions The lack of robustness of enforcement and disintegration of government agencies in regulating availability and access hampers effectiveness of alcohol policy. Comprehensive regulations for the control of availability of and access to alcohol are required to strengthen alcohol policy. Consistent monitoring and surveillance of the compliances are recommended to prevent significant effects of the regulations diminish over time.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.04.012
      Issue No: Vol. 58 (2018)
       
  • The role of alcohol in constructing gender & class identities among
           young women in the age of social media
    • Authors: Jemma Lennox; Carol Emslie; Helen Sweeting; Antonia Lyons
      Pages: 13 - 21
      Abstract: Publication date: August 2018
      Source:International Journal of Drug Policy, Volume 58
      Author(s): Jemma Lennox, Carol Emslie, Helen Sweeting, Antonia Lyons
      Research suggests young women view drinking as a pleasurable aspect of their social lives but that they face challenges in engaging in a traditionally ‘masculine’ behaviour whilst maintaining a desirable ‘femininity’. Social network sites such as Facebook make socialising visible to a wide audience. This paper explores how young people discuss young women’s drinking practices, and how young women construct their identities through alcohol consumption and its display on social media. We conducted 21 friendship-based focus groups (both mixed and single sex) with young adults aged 18–29 years and 13 individual interviews with a subset of focus group respondents centred on their Facebook practices. We recruited a purposive sample in Glasgow, Scotland (UK) which included ‘middle class’ (defined as students and those in professional jobs) and ‘working class’ respondents (employed in manual/service sector jobs), who participated in a range of venues in the night time economy. Young women’s discussions revealed a difficult ‘balancing act’ between demonstrating an ‘up for it’ sexy (but not too sexy) femininity through their drinking and appearance, while still retaining control and respectability. This ‘balancing act’ was particularly precarious for working class women, who appeared to be judged more harshly than middle class women both online and offline. While a gendered double standard around appearance and alcohol consumption is not new, a wider online audience can now observe and comment on how women look and behave. Social structures such as gender and social class remain central to the construction of identity both online and offline.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.04.009
      Issue No: Vol. 58 (2018)
       
  • Measuring individual-level needle and syringe coverage among people who
           inject drugs in Myanmar
    • Authors: Daniel O’Keefe; Soe Moe Aung; Naanki Pasricha; Thu Wun; Soe Khaing Linn; Nay Lin; Campbell Aitken; Chad Hughes; Paul Dietze
      Pages: 22 - 30
      Abstract: Publication date: August 2018
      Source:International Journal of Drug Policy, Volume 58
      Author(s): Daniel O’Keefe, Soe Moe Aung, Naanki Pasricha, Thu Wun, Soe Khaing Linn, Nay Lin, Campbell Aitken, Chad Hughes, Paul Dietze
      Background Myanmar has prioritised people who inject drugs (PWID) as a key population for HIV mitigation efforts, with targets for needle and syringe distribution set at a population level. However, individual-level coverage, defined as the percentage of an individual’s injecting episodes covered by a sterile syringe, is a more sensitive measure of intervention coverage. We sought to examine individual-level coverage in a sample of PWID in Myanmar. Methods We recruited 512 PWID through urban drop-in-centres in Yangon, Mandalay and Pyin Oo Lwin. Participants were administered a quantitative questionnaire covering five domains: demographics, drug use, treatment and coverage, and injecting risk behaviour. We calculated past fortnight individual-level syringe coverage, estimating levels of sufficient (≥100% of injecting episodes covered by a sterile syringe) and insufficient (<100%) coverage, and examined associations between key variables and insufficient coverage via logistic regression. Results Our sample was predominately male (97%), employed (76%), and living in stable accommodation (96%), with a median age of 27. All participants reported heroin as the drug most frequently injected, and injected a median of 27 times in the past two weeks. Nineteen per cent of participants had insufficient coverage in the two weeks before interview. Insufficient coverage was positively associated with syringe re-use (AOR: 5.19, 95% CIs: 2.57, 10.48) and acquiring sterile syringes from a location other than a formal drop-in-centre (AOR: 2.04, 95% CIs: 1.08, 3.82). Participants recruited in Mandalay (AOR: 0.30, 95% CIs: 0.11, 0.80) and Pyin Oo Lwin (AOR: 0.39, 95% CIs: 0.18, 0.87) had lower odds of insufficient coverage than those recruited in Yangon. Conclusion Our study shows coverage in selected areas of Myanmar was comparable with studies in other countries. Our results inform the delivery of harm reduction services for PWID, specifically by encouraging the use of formal drop-in-centres, over other sources of syringe distribution, such as pharmacies.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.04.010
      Issue No: Vol. 58 (2018)
       
  • Medical cannabis: An oxymoron' Physicians’ perceptions of
           medical cannabis
    • Authors: Yuval Zolotov; Simon Vulfsons; Dana Zarhin; Sharon Sznitman
      Pages: 4 - 10
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Yuval Zolotov, Simon Vulfsons, Dana Zarhin, Sharon Sznitman
      Background Medical cannabis policies are changing in many places around the world, and physicians play a major role in the implementation of these policies. The aim of this study was to gain a deeper understanding of physicians’ views on medical cannabis and its possible integration into their clinic, as well as to identify potential underlying factors that influence these perceptions. Methods Qualitative narrative analysis of in-depth interviews with twenty-four Israeli physicians from three specialties (pain medicine, oncology and family medicine). Findings Physicians disclosed contrasting narratives of cannabis, presenting it as both a medicine and a non-medicine. These divergent positions co-existed and were intertwined in physicians’ accounts. When presenting cannabis as a non-medicine, physicians drew on conventional medicine and prohibition as narrative environments. They emphasized the incongruence of cannabis with standards of biomedicine and presented cannabis as an addictive drug of abuse. In contrast, physicians drew upon unconventional medicine and palliative care as narrative environments while presenting cannabis as a medicine. In this narrative, physicians emphasized positive hands-on experiences with cannabis, and pointed to the limits of conventional medicine. Conclusion Physicians did not have a consolidated perspective as to whether cannabis is a medicine or not, but rather struggled with this question. The dualistic narratives of cannabis reflect the lack of a dominant narrative environment that supports the integration of cannabis into medical practice. This may in turn indicate barriers to the implementation of medical cannabis policies. An awareness of physicians’ views and the different levels of their willingness to implement medical cannabis policies is essential for policy developments in this evolving field.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.025
      Issue No: Vol. 57 (2018)
       
  • Employment and paid work among participants in a randomized controlled
           trial comparing diacetylmorphine and hydromorphone
    • Authors: Mohammadali Nikoo; Marc Vogel; Fiona Choi; Michael J. Song; Jensen Burghardt; Zafar Zafari; Katarina Tabi; Anastasia Frank; Skye Barbic; Christian Schütz; Kerry Jang; Michael Krausz
      Pages: 18 - 24
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Mohammadali Nikoo, Marc Vogel, Fiona Choi, Michael J. Song, Jensen Burghardt, Zafar Zafari, Katarina Tabi, Anastasia Frank, Skye Barbic, Christian Schütz, Kerry Jang, Michael Krausz
      Background Employment is one of the less studied but a significant outcome of medication-assisted treatment. Thus, we aimed to explore employment outcomes of medication-assisted treatment with hydromorphone (HDM) or diacetylmorphine (DAM). The secondary aim was to estimate characteristics of this population as well as treatment-related factors associated with these outcomes. Methods This was a secondary analysis of a randomized, double blind controlled trial. A total of 102 and 100 participants were randomized to receive injectable DAM or HDM for 6 months respectively. In stage 2, 144 participants were randomized again to receive either oral or injectable forms of the medication they received for another 6 months. Participants were interviewed at 5 timepoints: before and 3, 6, 9 and 12 months after treatment assignment. Generalized estimating equations (GEE) with a logit link was fitted to determine factors related to paid work in the past 30 days. Results Mean age of participants was 44.3 (SD = 9.6) and 59 (29.2%) participants were men. At each timepoint, 6–8 (3.6%–4.1%) participants reported employment in the past 30 days and 40 to 52 (19.7%–26.7%) reported minimum 1 day of paid work. University or college education [OR = 2.12: 95% CI = (1.25, 3.62), P = 0.01] was significantly associated with paid work after adjustment for age, gender, treatment arms, timepoints, days receiving study treatment, physical health, psychological health and crack cocaine use in the past 30 days. Conclusion The rate of employment was lower among participants of this study compared to similar studies on heroin-assisted treatment. Higher education was associated with increased odds of paid work. A large gap exists between employment rate and the proportion of participants who reported paid work. Supported employment and occupational therapy could optimize the employment outcomes of this population.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.021
      Issue No: Vol. 57 (2018)
       
  • Safe and unsafe spaces: Non-fatal overdose, arrest, and receptive syringe
           sharing among people who inject drugs in public and semi-public spaces in
           Baltimore City
    • Authors: Kyle Hunter; Ju Nyeong Park; Sean T. Allen; Patrick Chaulk; Taeko Frost; Brian W. Weir; Susan G. Sherman
      Pages: 25 - 31
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Kyle Hunter, Ju Nyeong Park, Sean T. Allen, Patrick Chaulk, Taeko Frost, Brian W. Weir, Susan G. Sherman
      The spaces in which drug use occurs constitutes a key aspect of the “risk environment” of people who inject drugs (PWID). We aimed to add nuance to the characterization of “safe” and “unsafe” spaces in PWID’s environments to further understand how these spaces amplify the risk of morbidities associated with injection drug use. PWID were recruited through the Baltimore City syringe service program and through peer referral. Participants completed a socio-behavioral survey. Multivariable logistic regression was used to identify associations between utilization of public, semi-public and private spaces with arrest, non-fatal overdose, and receptive syringe sharing. The sample of PWID (N = 283) was mostly 45 years and older (54%), male (69%), Black (55%), and heroin users (96%). Compared to PWID who primarily used private settings, the adjusted odds of recent overdose were greater among PWID who mostly used semi-public and public locations to inject drugs. We also found independent associations between arrest and semi-public spaces, and between receptive syringe sharing and public spaces (all p < 0.05). This study highlights the need for safe spaces where PWID can reduce their risk of overdose, likelihood of arrest and blood-borne diseases, and the dual potential of the environment in promoting health and risk.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.026
      Issue No: Vol. 57 (2018)
       
  • An analysis of Belgian Cannabis Social Clubs’ supply practices: A
           shapeshifting model'
    • Authors: Mafalda Pardal
      Pages: 32 - 41
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Mafalda Pardal
      Background and research questions Cannabis Social Clubs (CSCs) are associations of cannabis users that collectively organize the cultivation and distribution of cannabis. As this middle ground supply model has been active in Belgium for over a decade, this paper aims to examine CSCs’ supply practices, noting any shifts from previously reported features of the model. Methods We draw on interviews with directors of seven currently active Belgian CSCs (n = 21) and their cannabis growers (n = 23). This data was complemented by additional fieldwork, as well as a review of CSCs’ key internal documents. Results Most Belgian CSCs are formally registered non-profit associations. One of the Belgian CSCs has developed a structure of sub-divisions and regional chapters. The Belgian CSCs supply cannabis to members only, and in some cases only medical users are admitted. CSCs rely on in-house growers, ensuring supply in a cooperative and closed-circuit way, despite changes to the distribution methods The associations are relatively small-scale and non-commercially driven. The introduction of formal quality control practices remains challenging. Discussion As the CSC model is often included in discussions about cannabis policy, but remains in most cases driven by self-regulatory efforts, it is important to take stock of how CSCs’ supply function has been implemented in practice – as doing so will improve our understanding of the model and of the wider range of cannabis ‘supply architectures’. This paper highlights the continuity and changes in CSC practices, noting the emergence of several different variants of the CSC model, which are classified in a first CSC typology.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.027
      Issue No: Vol. 57 (2018)
       
  • The cost-effectiveness of seven behavioural interventions to prevent drug
           misuse in vulnerable populations
    • Authors: Becky Pennington; Brendan Collins; Simon Leigh; Antony P. Martin; Lesley Owen; Alastair Fischer; Harry Sumnall; Geoff Bates
      Pages: 42 - 50
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Becky Pennington, Brendan Collins, Simon Leigh, Antony P. Martin, Lesley Owen, Alastair Fischer, Harry Sumnall, Geoff Bates
      Background The National Institute for Health and Care Excellence (NICE) developed a guideline on drug misuse prevention in vulnerable populations. Part of the guideline development process involved evaluating cost-effectiveness and determining which interventions represented good value for money. Methods Economic models were developed for seven interventions which aimed to prevent drug use in vulnerable populations. The models compared the costs (to the health and crime sectors) and health benefits (in quality-adjusted life years (QALYs)) of each intervention and its comparator. Sensitivity analysis explored the uncertainty associated with the cost of each intervention and duration of its effect. Results The reduction in drug use for each intervention partly offset the costs of the intervention, and improved health outcomes (QALYs). However, with high intervention costs and low QALY gains, none of the interventions were estimated to be cost-effective in the base case. Sensitivity analysis found that some of the interventions could be cost-effective if they could be delivered at a lower cost, or if the effect could be sustained for more than two years. Conclusions For drug misuse prevention to be prioritised by funders, the consequences of drug misuse need to be understood, and interventions need to be shown to be effective and cost-effective. Quantifying the wider harms of drug misuse and wider benefits of prevention interventions poses challenges in evaluating the cost-effectiveness of drug misuse prevention interventions. A greater understanding of the consequences of drug misuse and causal factors could facilitate development of cost-effective interventions to prevent drug misuse.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.028
      Issue No: Vol. 57 (2018)
       
  • Drug policy constellations: A Habermasian approach for understanding
           English drug policy
    • Authors: Alex Stevens; Giulia Federica Zampini
      Pages: 61 - 71
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Alex Stevens, Giulia Federica Zampini
      Background It is increasingly accepted that a view of policy as a rational process of fitting evidence-based means to rationally justified ends is inadequate for understanding the actual processes of drug policy making. We aim to provide a better description and explanation of recent English drug policy decisions. Method We develop the policy constellation concept from the work of Habermas, in dialogue with data from two contemporary debates in English policy; on decriminalisation of drug possession and on recovery in drug treatment. We collect data on these debates through long-term participant observation, stakeholder interviews (n = 15) and documentary analysis. Results We show the importance of social asymmetries in power in enabling structurally advantaged groups to achieve the institutionalisation of their moral preferences as well as the reproduction of their social and economic power through the deployment of policies that reflect their material interests and normative beliefs. The most influential actors in English drug policy come together in a ‘medico-penal constellation’, in which the aims and practices of public health and social control overlap. Formal decriminalisation of possession has not occurred, despite the efforts of members of a challenging constellation which supports it. Recovery was put forward as the aim of drug treatment by members of a more powerfully connected constellation. It has been absorbed into the practice of ‘recovery-oriented’ drug treatment in a way that maintains the power of public health professionals to determine the form of treatment. Conclusion Actors who share interests and norms come together in policy constellations. Strategic action within and between constellations creates policies that may not take the form that was intended by any individual actor. These policies do not result from purely rational deliberation, but are produced through ‘systematically distorted communication’. They enable the most structurally favoured actors to institutionalise their own normative preferences and structural positions.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.030
      Issue No: Vol. 57 (2018)
       
  • Exploring what shapes injection and non-injection among a sample of
           marginalized people who use drugs
    • Authors: Andrew Ivsins; Samona Marsh
      Pages: 72 - 78
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Andrew Ivsins, Samona Marsh
      Background Few studies have specifically explored what influences people who use drugs to consume them in certain ways (i.e., smoking, injecting). While a great deal of research has examined the transition from non-injection to injection routes of drug administration, less is known about people who use drugs (PWUD) but have never injected or have stopped injecting. This paper draws on actor-network theory to explore what moves people to inject or not, among both people who currently smoke/sniff drugs (PWSD) and people who currently inject drugs (PWID), to better understand factors that shape/influence methods of drug consumption. Methods Two-stage interviews (a quantitative survey followed by a qualitative interview) were conducted with 26 PWSD and 24 PWID. Interviews covered a range of topics related to drug use, including reasons for injecting drugs, never injecting, and stopping injecting. Data were analysed by drawing on actor-network theory to identify forces involved in shaping drug consumption practices. Results We present three transformative drug use events to illustrate how specific methods of drug consumption are shaped by an assemblage of objects, actors, affects, spaces and processes. Rather than emphasising the role of broad socio-structural factors (i.e., poverty, drug policy) participant narratives reveal how a variety of actors, both human and non-human, assembled in unique ways produce drug consumption events that have the capacity to influence or transform drug consumption practices. Conclusion Actor-network theory and event analysis provide a more nuanced understanding of drug consumption practices by drawing together complex material, spatial, social and temporal aspects of drug use, which helps identify the variety of forces involved in contexts that are thought to shape substance use. By attending to events of drug consumption we can better understand how contexts shape drug use and related harms. With greater insight into the transformative capacity of drug use events, strategies may be better tailored to prevent drug use-related harms.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.04.006
      Issue No: Vol. 57 (2018)
       
  • Big data on a big new market: Insights from Washington State’s legal
           cannabis market
    • Authors: Jonathan P. Caulkins; Yilun Bao; Steve Davenport; Imane Fahli; Yutian Guo; Krista Kinnard; Mary Najewicz; Lauren Renaud; Beau Kilmer
      Pages: 86 - 94
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Jonathan P. Caulkins, Yilun Bao, Steve Davenport, Imane Fahli, Yutian Guo, Krista Kinnard, Mary Najewicz, Lauren Renaud, Beau Kilmer
      Introduction Voters in eight U.S. states have passed initiatives to legalize large-scale commercial production of cannabis for non-medical use. All plan or require some form of “seed-to-sale” tracking systems, which provide a view of cannabis market activity at a heretofore unimagined level of detail. Legal markets also create a range of new matters for policy makers to address. Data Publicly available data were obtained on approximately 45 million individually priced items purchased in the 35 million retail transactions that took place during the first two and a half years of Washington State’s legal cannabis market. Records include product type (flower, extract, lotion, liquid edible, etc.), product name, price, and potency with respect to multiple cannabinoids, notably THC and CBD. Items sold can be traced back up the supply chain through the store to the processor and producer, to the level of identifying the specific production batch and mother plant, the firm that tested the product, and test results. Method Data visualization methods are employed to describe spatial-temporal patterns of multiple correlated attributes (e.g., price and potency) broken down by product. Text-analytic methods are used to subdivide the broad category of “extracts for inhalation” into more homogeneous sub-categories. To understand the competitiveness of the legal cannabis market in Washington we calculate the Herfindahl-Hirschman index (HHI) for processors and retailers. Results Cannabis prices fell steadily and proportionally at the processor and retailer levels. Retail and wholesale price maintained a roughly 3:1 ratio for multiple product types after some initial fluctuations. Although a wide range of edibles are sold, they account for a modest share of consumer spending; extracts for inhalation are a larger and heterogeneous market segment. The HHI indicates the cannabis market is highly competitive at the processor level, but less so for retail markets at the county level. Conclusions Washington’s state-legal cannabis market is diverse and rapidly evolving in terms of pricing, products, and organization. Post-legalization, researchers and policy makers may need to think in terms of a family of cannabis products, akin to how we think of new psychoactive substances and amphetamine-type stimulants, not a single drug “cannabis.”

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.031
      Issue No: Vol. 57 (2018)
       
  • Interventions to increase testing, linkage to care and treatment of
           hepatitis C virus (HCV) infection among people in prisons: A systematic
           review
    • Authors: Nadine Kronfli; Blake Linthwaite; Fiona Kouyoumdjian; Marina B. Klein; Bertrand Lebouché; Giada Sebastiani; Joseph Cox
      Pages: 95 - 103
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Nadine Kronfli, Blake Linthwaite, Fiona Kouyoumdjian, Marina B. Klein, Bertrand Lebouché, Giada Sebastiani, Joseph Cox
      Background While the burden of chronic hepatitis C virus (HCV) infection is significantly higher among people in prisons compared to the general population, testing and treatment uptake remain suboptimal. The aim of this systematic review was to synthesize evidence on the effectiveness of interventions to increase HCV testing, linkage to care and treatment uptake among people in prisons. Methods We searched Medline (Ovid 1996–present), Embase (Ovid 1996–present), and the Cochrane Central Register of Controlled Trials for English language articles published between January 2007 and November 2017. Studies evaluating interventions to enhance HCV testing, linkage to care and treatment uptake for people in prison were included. Two independent reviewers evaluated articles selected for full-text review. Disagreements were resolved by consensus. Results A total of 475 unique articles were identified, 29 were eligible for full text review, and six studies were included. All but one study was conducted in the pre-direct-acting antiviral (DAA) era; no studies were conducted in low- or middle-income countries. Of the six studies, all but one focused on testing. Only two were randomised controlled trials; the remaining were single arm studies. Interventions to enhance HCV testing in prison settings included combination risk-based and birth-cohort screening strategies, on-site nurse-led opt-in screening clinics with pre-test counselling and education, and systematic dried blood spot testing. All interventions increased HCV testing, but risk of study bias was high in all studies. Interventions to enhance linkage to care included facilitated referral for HCV assessment and scheduling of specialist appointments; however, risk of study bias was critical. Conclusions There is a lack of recent data on interventions to improve the HCV care cascade in people in prisons. With the introduction of short-course, well-tolerated DAAs, rigorous controlled studies evaluating interventions to improve testing, linkage and treatment uptake for people in prison are necessary.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.04.003
      Issue No: Vol. 57 (2018)
       
  • Overlap between harm reduction and HIV service utilisation among PWID in
           India: Implications for HIV combination prevention
    • Authors: M. Kumi Smith; Sunil S. Solomon; Derek A.T. Cummings; Aylur K. Srikrishnan; M. Suresh Kumar; C.K. Vasudevan; Allison M. McFall; Gregory M. Lucas; David D. Celentano; Shruti H. Mehta
      Pages: 111 - 118
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): M. Kumi Smith, Sunil S. Solomon, Derek A.T. Cummings, Aylur K. Srikrishnan, M. Suresh Kumar, C.K. Vasudevan, Allison M. McFall, Gregory M. Lucas, David D. Celentano, Shruti H. Mehta
      Background In some regions, HIV incidence is rising among people who inject drugs (PWID). Combination prevention approaches are well suited to PWID who face multiple sources of HIV risk. This analysis investigates patterns of utilisation to basic HIV services (HIV counselling and testing [HCT], antiretroviral therapy [ART]) as well as harm reduction programs (needle and syringe exchange programs [NSEP] and opioid agonist therapy [OAT]) among PWID and how utilisation of harm reduction services is associated with HIV-related care seeking behaviours. Methods Respondent-driven sampling was used to recruit 14,481 PWID across 15 cities in India. Sampling-weighted multilevel logistic regression models assessed associations between utilisation of harm reduction service and HCT and ART use among those indicated (90.3% and 5.0% of full sample, respectively). We considered both recent (prior year) and ever use of services. Results Overall, 42.3% reported prior HIV testing and 57.9% of eligible persons reported ART initiation, but overlap with NSEP and OAT use was limited. In adjusted models, recent and ever use of both NSEP and OAT were significantly associated with recent and ever HCT utilisation, respectively; however, harm reduction utilisation was not associated with ART initiation among eligible participants. Conclusions Harm reduction services may play a key role in linking PWID with HIV testing; however, they were not associated with ART initiation among eligible individuals. Moreover, a large majority who utilised NSEP and OAT were not engaged in optimal HIV care or prevention, highlighting missed opportunities and a need for stronger linkages between NSEP/OAT and HIV care and treatment, particularly among those actively injecting. These findings provide key insights to better understand how services can be linked or combined to optimise service utilisation among PWID.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.02.007
      Issue No: Vol. 57 (2018)
       
  • Opioid-related mortality in rural America: Geographic heterogeneity and
           intervention strategies
    • Authors: Khary K. Rigg; Shannon M. Monnat; Melody N. Chavez
      Pages: 119 - 129
      Abstract: Publication date: July 2018
      Source:International Journal of Drug Policy, Volume 57
      Author(s): Khary K. Rigg, Shannon M. Monnat, Melody N. Chavez
      Over the last two decades, opioid-related mortality rates have increased dramatically to become a serious public health concern in the United States. Opioid-related mortality has reached epidemic levels in certain rural areas of the U.S., such as Appalachia, New England, and the Mountain West, while remaining relatively low in others, such as the Delta South and Great Plains. Explanations for geographic variation in opioid mortality are unclear, contributing to ineffective policies and interventions. The goal of this article is to summarize the existing literature on the opioid epidemic in the rural U.S. to help guide intervention efforts. This paper 1) describes geographic heterogeneity in opioid-related mortality, with a focus on rural areas, 2) summarizes factors that likely contribute to this heterogeneity, and 3) discusses potential strategies for addressing the opioid epidemic in the hardest-hit rural communities. The information presented in this paper dispels the myth that the opioid epidemic is disproportionately rural, and demonstrates that the magnitude of the epidemic has varied considerably across different rural areas. This paper provides important insights for public health professionals, treatment practitioners, researchers, and policymakers as they work toward solutions that take into account the diversity of rural communities and the dynamic nature of the opioid epidemic.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.04.011
      Issue No: Vol. 57 (2018)
       
  • “The difference is in the tomato at the end”: Understanding the
           motivations and practices of cannabis growers operating within Belgian
           Cannabis Social Clubs
    • Authors: Mafalda Pardal
      Pages: 21 - 29
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Mafalda Pardal
      Background In Belgium, Cannabis Social Clubs (CSCs) collectively organize the cultivation and distribution of cannabis for the personal use of their members. In this paper we seek to improve understanding of the motivations and practices of cannabis growers operating within CSCs, shedding light on the cultivation process. Methods We draw on data gathered through face-to-face semi-structured interviews with the directors of seven active Belgian CSCs (n = 21) and CSC growers (n = 23). These data are complemented by additional fieldwork and a review of policies relating to CSCs’, including bylaws and growing protocols. Findings The Belgian CSCs rely on single and multiple in-house grower arrangements. Most CSC growers had been cultivating cannabis prior to joining their current CSC, albeit growing in different contexts (non-commercial and commercial). The CSC growers discussed both ideological and pragmatic motives for operating within a CSC. Cultivation took place indoors and followed organic practices. Despite their small-scale (20 plants on average), the grow sites used specialized equipment. The growers reported receiving financial compensation to cover production costs. Conclusion This paper offers new insights into a particular sector of domestic cannabis cultivation – CSC growers and their practices within those collectives – which has not been studied previously. The Belgian CSCs have decentralized production among small-scale grow sites, at a size comparable to that found in other small-scale cultivation studies. In terms of motivations and practices, CSC growers share some features typically ascribed to small-scale cannabis cultivators. At the same time, CSC growers seemed particularly engaged with the CSC model and willing to adhere to the (self-)regulated practices developed by the organizations. This had implications for the way cultivation was organized and for the role of the grower within the CSC.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.02.016
      Issue No: Vol. 56 (2018)
       
  • Representations of women and drug use in policy: A critical policy
           analysis
    • Authors: Natalie Thomas; Melissa Bull
      Pages: 30 - 39
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Natalie Thomas, Melissa Bull
      Contemporary research in the drugs field has demonstrated a number of gender differences in patterns and experiences of substance use, and the design and provision of gender-responsive interventions has been identified as an important policy issue. Consequently, whether and how domestic drug policies attend to women and gender issues is an important question for investigation. This article presents a policy audit and critical analysis of Australian national and state and territory policy documents. It identifies and discusses two key styles of problematisation of women’s drug use in policy: 1) drug use and its effect on women’s reproductive role (including a focus on pregnant women and women who are mothers), and 2) drug use and its relationship to women’s vulnerability to harm (including violent and sexual victimisation, trauma, and mental health issues). Whilst these are important areas for policy to address, we argue that such representations of women who use drugs tend to reinforce particular understandings of women and drug use, while at the same time contributing to areas of ‘policy silence’ or neglect. In particular, the policy documents analysed are largely silent about the harm reduction needs of all women, as well as the needs of women who are not mothers, young women, older women, transwomen or other women deemed to be outside of dominant normative reproductive discourse. This analysis is important because understanding how women’s drug use is problematised and identifying areas of policy silence provides a foundation for redressing gaps in policy, and for assessing the likely effectiveness of current and future policy approaches.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.02.015
      Issue No: Vol. 56 (2018)
       
  • Australian athletes’ knowledge of the WADA Prohibited Substances List
           and performance enhancing substances
    • Authors: Rhonda Orr; Matthew Grassmayr; Rona Macniven; Anne Grunseit; Mark Halaki; Adrian Bauman
      Pages: 40 - 45
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Rhonda Orr, Matthew Grassmayr, Rona Macniven, Anne Grunseit, Mark Halaki, Adrian Bauman
      Background This study investigated athlete knowledge of the World Anti-doping Agency (WADA) Prohibited Substances List and the effects of four well-known performance enhancing substances (PES). Methods A sample of 1925 elite and sub-elite athletes (mean age 20.6 years) completed a questionnaire about the banned status of 30 substances/methods and their knowledge of the effects of amphetamines, anabolic steroids, growth hormone and erythropoietin. Results Athletes showed limited understanding of the WADA Prohibited Substances List, scoring 32.2% correct, 36.3% incorrect, and 31.4% indicated they did not know the status of 30 substances. Responses of >50% correct were given for only eight substances/method: anabolic steroids, amphetamines, blood doping, erythropoietin, caffeine, vitamins/minerals, protein powders and iron. Athletes demonstrated moderate knowledge of the desired effects of the four PES (49% correct), but poor knowledge of their adverse effects (29% correct). Age, sex, ethnicity, professional/amateur status, and current competition level were significant predictors of the number of correct responses (r2 = 0.16, p < 0.05). Athletes most likely to provide correct responses were male, 19–22 year-olds, Caucasian, professional and international representatives. Conclusion This comprehensive study of anti-doping demonstrated that Australian athletes had limited knowledge of a wide range of substances and PES. Better targeted drug education towards younger and non-professional athletes and evaluation of current anti-doping programs are warranted.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.02.025
      Issue No: Vol. 56 (2018)
       
  • Is there a mismatch between policies to curtail physician opioid
           prescribing and what we know about changing physician behavior'
    • Authors: Esther K. Choo; Robert F. DeMayo; Benjamin C. Sun
      Pages: 54 - 55
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Esther K. Choo, Robert F. DeMayo, Benjamin C. Sun


      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.002
      Issue No: Vol. 56 (2018)
       
  • Fatal and non-fatal overdose among opiate users in South Wales: A
           qualitative study of peer responses
    • Authors: Katy Holloway; Rhian Hills; Tom May
      Pages: 56 - 63
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Katy Holloway, Rhian Hills, Tom May
      Background Overdose is a major cause of death among injecting drug users in Wales. Few studies, however, have explored the overdose responses of witnesses in this context. This study applies Rhodes’ concept of the ‘risk environment’ to examine how witnesses respond to opiate overdose. Method In depth, semi-structured interviews were conducted with fifty-five participants recruited from statutory and third sector drug treatment providers operating across South Wales and from two Welsh prisons. Eligibility was based on whether the person was, or had recently been, an opiate user and whether they had personally experienced or witnessed an overdose event. Results Witnesses were amenable to assisting overdosed peers. However, a number of micro- and macro-level factors impeded the successful implementation of harm reduction techniques in response to an overdose. At micro level, the social setting of injecting drug use, peer group drug use norms and difficulties in identifying an overdose were linked to ineffective response. Macro-level factors including laws governing the possession of drugs and harm reduction discourse were also found to limit the uptake of overdose response techniques. Conclusion Findings suggest a need to insert pragmatic solutions into overdose prevention programmes and training to counter the factors hindering effective responses to overdose. This includes simpler techniques and harnessing the support and knowledge of injecting drug users’ social networks. Although these will go some way to addressing specific micro-level barriers, we also emphasise the need for additional policy measures that can address the macro-environmental conditions that produce and maintain features of injecting drug users’ risk environments.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.007
      Issue No: Vol. 56 (2018)
       
  • Experiences of police contact among young adult recreational drug users: A
           qualitative study
    • Authors: Ellen M. Leslie; Adrian Cherney; Andrew Smirnov; Robert Kemp; Jake M. Najman
      Pages: 64 - 72
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Ellen M. Leslie, Adrian Cherney, Andrew Smirnov, Robert Kemp, Jake M. Najman
      Background While young adults who engage in recreational drug use are at increased risk of contact with police, their experiences of police contact have been largely overlooked. Method In-depth qualitative interviews were conducted with 70 young adult amphetamine-type stimulant (ATS; i.e., ecstasy [MDMA] and methamphetamine) users who had experienced intensive alcohol and other drug-related police contact (e.g., being arrested, charged, or raided by police). These interviews focused on perceptions of personal experiences of alcohol and other drug-related police contact and general perceptions of police and policing and were conducted as part of a larger longitudinal study of drug use among a population-based sample of young adults from South-East Queensland, Australia. Results ATS users’ perceptions of their personal interactions with police and general perceptions of police and policing were influenced by a number of factors, including police behaviour, prior contact with police, friends and family members’ contact with police, and perceptions of their own behaviour leading to their contact with police. While a majority of ATS users reported that their contact with police had either a neutral or negative impact on their general perceptions of police and policing, some ATS users reported that police contact had a positive impact. For 70% of ATS users, police contact was reported to have had an impact on their substance use behaviours, resulting in either modification of their substance use behaviours to avoid further police contact or reduction in their substance use. Conclusions These findings suggest that police contact among young adult ATS users can impact on both perceptions of police and policing and substance use behaviours, emphasising the importance of the quality and nature of police contact and its potential role in harm reduction.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.010
      Issue No: Vol. 56 (2018)
       
  • The effect of Housing First on adherence to methadone maintenance
           treatment
    • Authors: Milad Parpouchi; Akm Moniruzzaman; Stefanie N. Rezansoff; Angela Russolillo; Julian M. Somers
      Pages: 73 - 80
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Milad Parpouchi, Akm Moniruzzaman, Stefanie N. Rezansoff, Angela Russolillo, Julian M. Somers
      Background Opioid overdose deaths have become a public health crisis in North America, and those who are homeless are particularly vulnerable. Methadone maintenance treatment (MMT) may prevent overdose and death among homeless people with opioid dependence, but suboptimal medication adherence is a common limitation. Previous research found that Housing First (HF) increases antipsychotic medication adherence among formerly homeless people. However, no experimental trials have examined whether HF has a significant impact on MMT adherence. We examined the intervention effect of HF on MMT adherence in a randomized sample of homeless adults experiencing mental illness and opioid dependence in Vancouver, Canada. Methods Comprehensive administrative and self-reported data from homeless adults living with serious mental illness recruited to the Vancouver At Home study were analyzed. Only methadone recipients were included (n = 97). The medication possession ratio (MPR) was utilized as the measure of adherence, and relevant data were obtained from provincial administrative pharmacy records. Study arms were HF and treatment as usual (TAU). Student t-tests were used to test for differences in MMT MPR between HF and TAU. Results No significant differences were observed in MMT MPR between participants in HF and TAU (0.52 vs. 0.57, p = 0.559) in the post-randomization period. Conclusion HF was not associated with significantly different MMT MPR compared to TAU. Additional interventions are indicated as HF alone was insufficient to facilitate improved MMT adherence among formerly homeless adults experiencing concurrent opioid dependence and serious mental illness.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.012
      Issue No: Vol. 56 (2018)
       
  • Reconfiguring the violent encounter' Preloading, security staff and
           breathalyser use in the night-time economy
    • Authors: Hannah Farrimond; Katharine Boyd; Dreolin Fleischer
      Pages: 108 - 115
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Hannah Farrimond, Katharine Boyd, Dreolin Fleischer
      Background In a culture of preloading and late-night licenses, alcohol-related violence remains a persistent problem for police and public health. Understood as a ritualized ‘micro-social’ interaction (Collins 2009a, 2009b), entry into bars and clubs is a particular flashpoint for violence between bouncers/door staff and customers. Methods A police-led initiative to deter excessive drunkenness and preloading using hand-held breathalysers (the #RU2Drunk scheme) was investigated from the perspective of security and bar staff using the devices. Interviews (n = 18 + 12), a focus group with security staff (n = 22) and a focus group with a security company (n = 3) were conducted in two seaside towns in the South-West of England, UK. A qualitative thematic analysis was conducted. Findings Door staff emphasised the normality of ‘determined drunkenness’ and associated violence in their working lives. Breathalyser use appeared to disrupt the ‘ritual’ of the violent encounter by reconfiguring it into an interaction between customer and technology. This depersonalized the judgement about who was ‘too drunk’ to enter the venue, with the more discretionary nature of who to breathalyse hidden from customers. Other door staff found it less useful and saw it as a challenge to their authority and expertise. At a managerial level there was concern about the transfer of responsibility for policing the night time economy (NTE). Conclusion There is potential to reconfigure the violent encounter for door staff using breathalyser devices. However, this is more likely to succeed where other structural limits (e.g. restrictions on late licenses) are in place, and as part of wider policy initiatives to reconfigure the alcohol-saturated NTE leisure scene.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.008
      Issue No: Vol. 56 (2018)
       
  • Reefer madness or much ado about nothing' Cannabis legalization
           outcomes among young adults in the United States
    • Authors: Jamie E. Parnes; Joey K. Smith; Bradley T. Conner
      Pages: 116 - 120
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Jamie E. Parnes, Joey K. Smith, Bradley T. Conner
      In 2012, Colorado became one of the first two U.S. States to legalize cannabis for recreational use for adults 21 and older. Given that cannabis use holds potential physical and mental health risks, particularly among adolescent users, concerns have grown regarding changes in use following this change in policy. Studies examining medical cannabis legalization have found inconsistent changes in cannabis use and prevalence of dependence following medical implementation. However, recreational legalization holds potential unique changes, such as increased availability and social acceptance, as well as decreased price and perceived harm of use. There also may be increased interest in moving to Colorado related to the changes in cannabis laws. Based on past literature, two hypotheses were made for this study. First, college student cannabis use would increase after recreational legalization, however just for those 21 years old and older. Second, there would be a positive relation between the influence of cannabis legislation on out-of-State student’s decision to attend a Colorado university and their cannabis use. Data from 5241 undergraduate students was available to test study hypotheses using Pearson’s Chi-square, negative binomial regressions, and path analysis. Results indicated that cannabis use increased since recreational legalization for all students, but more so for those over 21 years. No differences in past month use frequency were found between pre- and post-legalization. Influence of cannabis laws on non-resident student’s decision to attend a Colorado college predicted lifetime and past 30-day use. Additionally, out-of-State students reported higher past 30-day use than in-State students. These findings may help inform other States considering recreational legalization of potential outcomes, as well as potential interventions.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.011
      Issue No: Vol. 56 (2018)
       
  • Islam and cannabis: Legalisation and religious debate in Iran
    • Authors: Maziyar Ghiabi; Masoomeh Maarefand; Hamed Bahari; Zohreh Alavi
      Pages: 121 - 127
      Abstract: Publication date: June 2018
      Source:International Journal of Drug Policy, Volume 56
      Author(s): Maziyar Ghiabi, Masoomeh Maarefand, Hamed Bahari, Zohreh Alavi
      Iran is currently discussing cannabis and opium regulations, which could bring a legalisation of drug consumption through a state supervised system. The article engages with the question of cannabis by looking at the legal interpretation of religious authorities in the Islamic Republic of Iran. The choice of Iran is justified for several reasons: firstly, Iran has a long history of drug use and cannabis has been part of the country’s intoxicant traditions since times immemorial; secondly, the Iranian state is unique in that it combines religious exegesis with political machination through official channels; finally, among all Middle East and Islamic countries, Iran is at the avant-garde in experimenting in the field of drugs policy which makes an excellent case for the study of cannabis regulation. The article is the result of a direct engagement with Iran’s leading Shi’a authorities, the maraje’-e taqlid, ‘source of emulation’. The authors redacted a list of eight questions (estefta’at) about the status of cannabis in Iranian society. It questioned cannabis’ legality in Islam, its potential medical use, the feasibility of domestic production and other relevant aspects of its social-religious life. Based on the responses, the authors analysed the difference in opinions among the religious scholars and speculate on the possibility of policy reform. Given the dearth of scholarly work about illicit drugs in the Islamic world, about which many readers might not be familiar, the article opens with an overview of the place of cannabis in the history of Islamic societies. It discusses terminological ambiguities, references in religious texts and traditions, and the general interpretations within Muslim religious schools of thought. Then, it discusses the status of cannabis in contemporary Iran before tackling the responses provided by the religious scholars. Eventually, the paper puts forward reflections about the potential implications for future policy developments on cannabis.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.03.009
      Issue No: Vol. 56 (2018)
       
  • Improving drug policy: The potential of broader democratic participation
    • Authors: Alison Ritter; Kari Lancaster; Rosalyn Diprose
      Pages: 1 - 7
      Abstract: Publication date: May 2018
      Source:International Journal of Drug Policy, Volume 55
      Author(s): Alison Ritter, Kari Lancaster, Rosalyn Diprose
      Policies concerned with illicit drugs vex governments. While the ‘evidence-based policy’ paradigm argues that governments should be informed by ‘what works’, in practice policy makers rarely operate this way. Moreover the evidence-based policy paradigm fails to account for democratic participatory processes, particularly how community members and people who use drugs might be included. The aim of this paper is to explore the political science thinking about democratic participation and the potential afforded in ‘deliberative democracy’ approaches, such as Citizens Juries and other mini-publics for improved drug policy processes. Deliberative democracy, through its focus on inclusion, equality and reasoned discussion, shows potential for drug policy reform and shifts the focus from reliance on and privileging of experts and scientific evidence. But the very nature of this kind of ‘deliberation’ may delimit participation, notably through its insistence on authorised modes of communication. Other forms of participation beyond reasoned deliberation aligned with the ontological view that participatory processes themselves are constitutive of subject positions and policy problems, may generate opportunities for considering how the deleterious effects of authorised modes of communication might be overcome.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2018.01.016
      Issue No: Vol. 55 (2018)
       
  • An (un)desirable trade of harms' How elite athletes might react to
           medically supervised ‘doping’ and their considerations of side-effects
           in this situation
    • Authors: Marie Overbye
      Pages: 14 - 30
      Abstract: Publication date: May 2018
      Source:International Journal of Drug Policy, Volume 55
      Author(s): Marie Overbye
      Background The zero-tolerance approach to doping in sport has long been criticised. Legalising ‘doping’ under medical supervision has been proposed as a better way of protecting both athletes’ health and fair competition. This paper investigates how elite athletes might react if specific doping substances were permitted under medical supervision and explore athletes’ considerations about side-effects in this situation. The results are interpreted using a framework, which views elite sport as an exceptional and risky working environment. Methods 775 elite athletes (mean age: 21.73, SD = 5.52) representing forty sports completed a web-based questionnaire (response rate: 51%) presenting a scenario of legalised, medically supervised ‘doping’. Results 58% of athletes reported an interest in one or more of the 13 proposed substances/methods. Athletes’ interest in a specific product was linked to its capacity to enhance performance levels in the athletes’ particular sport and depended on gender and age. 23% showed interest in either one or more of erythropoietin (EPO), anabolic-androgenic steroids (AAS), blood transfusions and/or Growth Hormone if permitted and provided under qualified medical supervision. Male speed and power sports athletes of increasing age had the highest likelihood of being interested in AAS (41%, age 36), female motor-skill sports athletes had the lowest (<1%, age 16). 59% feared side-effects. This fear kept 39% of all athletes from being interested in specific substances/methods whereas 18% declared their interest despite fearing the side-effects. Conclusion Interpreting results with the understanding of sport as an exceptional and risky working environment suggests that legalising certain ‘doping’ substances under medical supervision would create other/new types of harms, and this ‘trade-off of harms and benefits’ would be undesirable considering the occupational health, working conditions and well-being of most athletes. Assessing the risks and harms produced/reduced by specific drugs when considering sport as a precarious occupation may prove useful in composing the Prohibited List and reducing drug-related harm in sport.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2017.12.019
      Issue No: Vol. 55 (2018)
       
  • The perspectives of structurally vulnerable people who use drugs on
           volunteer stipends and work experiences provided through a drug user
           organization: Opportunities and limitations
    • Authors: Geoff Bardwell; Solanna Anderson; Lindsey Richardson; Lorna Bird; Hugh Lampkin; Will Small; Ryan McNeil
      Pages: 40 - 46
      Abstract: Publication date: May 2018
      Source:International Journal of Drug Policy, Volume 55
      Author(s): Geoff Bardwell, Solanna Anderson, Lindsey Richardson, Lorna Bird, Hugh Lampkin, Will Small, Ryan McNeil
      Background While drug user organizations (DUO) have received public health attention as a means to potentially reduce the harms associated with drug use, there is a lack of research on the compensation and structural forces that promote or inhibit participation in DUO. Against the backdrop of structural vulnerability experienced by people who use drugs (PWUD), we examined the impact of monetary ‘volunteer stipends’ provided through a DUO and explore their role in providing low-threshold employment opportunities and shaping participation in DUO. Methods Participants were purposively sampled to reflect a range of perspectives and experiences volunteering at Vancouver Area Network of Drug Users (VANDU) and receiving stipends. Semi-structured qualitative interviews were conducted with 23 members of VANDU. Interview transcripts were coded in Atlas.ti 7 for key a priori themes and emergent categories from the data and analyzed thematically. Results Stipends provided participants with symbolic and material recognition of the time, effort, and expertise they contribute to the organization, and functioned to facilitate ongoing participation. Payments that rewarded, skills, labour and drug-related knowledge reduced participant’s perception of stigma against PWUD. Paid work in VANDU further provided participants with non-material benefits commonly attributed to regular employment, including social connections and a sense of purpose. Participants also identified the low level of pay as a limitation of VANDU’s paid participation program. The daily demands of survival (accessing shelter, food, and drugs) posed more complex structural vulnerabilities to participate in VANDU, as small stipends were not sufficient to address these needs. Conclusion Low threshold employment opportunities within DUO may provide significant individual and public health benefits. However, these benefits are constrained by the small size of stipends. Therefore, to ensure better inclusion of PWUD, our findings recommend the development and expansion of equitable, accessible, well-paying employment programs for PWUD.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.02.004
      Issue No: Vol. 55 (2018)
       
  • A fragmented code: The moral and structural context for providing
           assistance with injection drug use initiation in San Diego, USA
    • Authors: Andy Guise; Jason Melo; Maria Luisa Mittal; Claudia Rafful; Jazmine Cuevas-Mota; Peter Davidson; Richard S. Garfein; Dan Werb
      Pages: 51 - 60
      Abstract: Publication date: May 2018
      Source:International Journal of Drug Policy, Volume 55
      Author(s): Andy Guise, Jason Melo, Maria Luisa Mittal, Claudia Rafful, Jazmine Cuevas-Mota, Peter Davidson, Richard S. Garfein, Dan Werb
      Background Injection drug use initiation is shaped by social networks and structural contexts, with people who inject drugs often assisting in this process. We sought to explore the norms and contexts linked to assisting others to initiate injection drug use in San Diego, USA, to inform the development of structural interventions to prevent this phenomenon. Methods We undertook qualitative interviews with a purposive sample of people who inject drugs and had reported assisting others to initiate injection (n = 17) and a sub-sample of people who inject drugs (n = 4) who had not reported initiating others to triangulate accounts. We analyzed data thematically and abductively. Results Respondents’ accounts of providing initiation assistance were consistent with themes and motives reported in other contexts: of seeking to reduce harm to the ‘initiate’, responding to requests for help, fostering pleasure, accessing resources, and claims that initiation assistance was unintentional. We developed analysis of these themes to explore initiation assistance as governed by a ‘moral code’. We delineate a fragmented moral code which includes a range of meanings and social contexts that shape initiation assistance. We also show how assistance is happening within a structural context that limits discussion of injection drug use, reflecting a prevailing silence on drug use linked to stigma and criminalization. Conclusions In San Diego, the assistance of others to initiate injection drug use is governed by a fragmented moral code situated within particular social norms and contexts. Interventions that address the social and structural conditions shaped by and shaping this code may be beneficial, in tandem with efforts to support safe injection and the reduction of injection-related harms.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.02.009
      Issue No: Vol. 55 (2018)
       
  • Effects of naloxone distribution to likely bystanders: Results of an
           agent-based model
    • Authors: Christopher Keane; James E. Egan; Mary Hawk
      Pages: 61 - 69
      Abstract: Publication date: May 2018
      Source:International Journal of Drug Policy, Volume 55
      Author(s): Christopher Keane, James E. Egan, Mary Hawk
      Background Opioid overdose deaths in the US rose dramatically in the past 16 years, creating an urgent national health crisis with no signs of immediate relief. In 2017, the President of the US officially declared the opioid epidemic to be a national emergency and called for additional resources to respond to the crisis. Distributing naloxone to community laypersons and people at high risk for opioid overdose can prevent overdose death, but optimal distribution methods have not yet been pinpointed. Methods We conducted a sequential exploratory mixed methods design using qualitative data to inform an agent-based model to improve understanding of effective community-based naloxone distribution to laypersons to reverse opioid overdose. The individuals in the model were endowed with cognitive and behavioral variables and accessed naloxone via community sites such as pharmacies, hospitals, and urgent-care centers. We compared overdose deaths over a simulated 6-month period while varying the number of distribution sites (0, 1, and 10) and number of kits given to individuals per visit (1 versus 10). Specifically, we ran thirty simulations for each of thirteen distribution models and report average overdose deaths for each. The baseline comparator was no naloxone distribution. Our simulations explored the effects of distribution through syringe exchange sites with and without secondary distribution, which refers to distribution of naloxone kits by laypersons within their social networks and enables ten additional laypersons to administer naloxone to reverse opioid overdose. Results Our baseline model with no naloxone distribution predicted there would be 167.9 deaths in a six month period. A single distribution site, even with 10 kits picked up per visit, decreased overdose deaths by only 8.3% relative to baseline. However, adding secondary distribution through social networks to a single site resulted in 42.5% fewer overdose deaths relative to baseline. That is slightly higher than the 39.9% decrease associated with a tenfold increase in the number of sites, all distributing ten kits but with no secondary distribution. This suggests that, as long as multiple kits are picked up per visit, adding secondary distribution is at least as effective as increasing sites from one to ten. Combining the addition of secondary distribution with an increase in sites from one to ten resulted in a 61.1% drop in deaths relative to the baseline. Adding distribution through a syringe exchange site resulted in a drop of approximately 65% of deaths relative to baseline. In fact, when enabling distribution through a clean-syringe site, the secondary distribution through networks contributed no additional drops in deaths. Conclusion Community-based naloxone distribution to reverse opioid overdose may significantly reduce deaths. Optimal distribution methods may include secondary distribution so that the person who picks up naloxone kits can enable others in the community to administer naloxone, as well as targeting naloxone distribution to sites where individuals at high-risk for opioid overdose death are likely to visit, such as syringe-exchange programs. This study design, which paired exploratory qualitative data with agent-based modeling, can be used in other settings seeking to implement and improve naloxone distribution programs.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.02.008
      Issue No: Vol. 55 (2018)
       
  • A qualitative examination of the effects of international counter-drug
           interdictions
    • Authors: Alexander G. Toth; Ojmarrh Mitchell
      Pages: 70 - 76
      Abstract: Publication date: May 2018
      Source:International Journal of Drug Policy, Volume 55
      Author(s): Alexander G. Toth, Ojmarrh Mitchell
      Background The purpose of this study is to utilize unique qualitative data to determine the effects of sporadic international drug interdictions on drug trafficking, and to assess whether the responses of drug traffickers align with rational choice theory. Methods Qualitative data obtained from 23 high-level United States Drug Enforcement Administration (DEA) informants, who are embedded in international drug trafficking groups, are examined to identify common responses to drug interdiction operations. Results The findings indicate that sporadic counter-drug interdictions do not a have permanent deterrent effect on transnational drug smuggling operations. However, these types of law enforcement operations produce temporary alterations in drug trafficking, as traffickers adopted a variety of methods to thwart the efforts of law enforcement—often by relying on information acquired from corrupt local law enforcement. The results also indicate that while interdiction operations displaced trafficking activities (temporally, spatially, and methodological), there is little evidence that drug traffickers responded to such operations by moving into new areas (i.e., malign spatial displacement). Conclusion Sporadic international drug interdiction programs do little to deter drug trafficking organizations (DTOs) from engaging in their illicit trade. Instead, DTOs adjust in a calculating manner to these operations to ensure that their illegal products reach consumer marketplaces, which is congruent with the rational choice theoretical perspective.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.02.012
      Issue No: Vol. 55 (2018)
       
  • Harnessing the language of overdose prevention to advance evidence-based
           responses to the opioid crisis
    • Authors: Alexandra B. Collins; Ricky N. Bluthenthal; Jade Boyd; Ryan McNeil
      Pages: 77 - 79
      Abstract: Publication date: May 2018
      Source:International Journal of Drug Policy, Volume 55
      Author(s): Alexandra B. Collins, Ricky N. Bluthenthal, Jade Boyd, Ryan McNeil
      Language has significant implications for how we view and respond to public health issues. Conventional moralistic messaging around drug use stigmatizes people who use drugs and inhibits the implementation of evidence-based harm reduction interventions that do not condemn drug use. However, within the context of the unprecedented North American opioid overdose crisis, we argue that shifting conventional moral messaging around overdose prevention and response strategies is key to supporting the rapid roll-out of evidence-based harm reduction interventions. Reframing overdose prevention to highlight the imperative to address the ongoing public health emergency is an important first step in implementing urgently needed response strategies.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.02.013
      Issue No: Vol. 55 (2018)
       
  • Implications of survey labels and categorisations for understanding drug
           use in the context of sex among gay and bisexual men in Melbourne,
           Australia
    • Authors: Kathleen E. Ryan; Anna L. Wilkinson; Alisa Pedrana; Brendan Quinn; Paul Dietze; Margaret Hellard; Mark Stoové
      Abstract: Publication date: Available online 7 May 2018
      Source:International Journal of Drug Policy
      Author(s): Kathleen E. Ryan, Anna L. Wilkinson, Alisa Pedrana, Brendan Quinn, Paul Dietze, Margaret Hellard, Mark Stoové
      Background Reliably measuring drug use by gay, bisexual and other men who have sex with men (GBM) in the context of sex can inform sexual health service responses. We report changing drug use patterns among GBM testing for HIV at a community-based service in Melbourne in response to behavioural survey modifications. Methods Surveys were completed by GBM prior to all HIV tests. Survey one asked about use of “party drugs for the purpose of sex” and survey two asked about specific drug use (alcohol, amyl nitrate, methamphetamine, cocaine, ecstasy, GHB, Viagra®/Cialis®) before or during sex. Differences in drug use prevalence and demographic and sexual risk correlates are reported. Results Reported drug use increased from 16.9% in survey one to 54.0% in survey two. Among GBM completing both surveys, 45% who reported no drug use in survey one reported drug use in survey two. Drug use was associated with high HIV risk behaviours across both surveys. Conclusion Survey modification improved ascertainment of drug use in the context of sex among GBM. Continued monitoring of drug use in this setting will improve our understanding the relationship between use of specific drugs and sexual health and help inform client focused health promotion.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.01.014
       
  • Prevalence of drug use during sex amongst MSM in Europe: Results from a
           multi-site bio-behavioural survey
    • Authors: Magdalena Rosińska; Lorenzo Gios; Christiana Nöstlinger; Wim Vanden Berghe; Ulrich Marcus; Susanne Schink; Nigel Sherriff; Anna-Marie Jones; Cinta Folch; Sonia Dias; Inga Velicko; Massimo Mirandola
      Abstract: Publication date: Available online 7 May 2018
      Source:International Journal of Drug Policy
      Author(s): Magdalena Rosińska, Lorenzo Gios, Christiana Nöstlinger, Wim Vanden Berghe, Ulrich Marcus, Susanne Schink, Nigel Sherriff, Anna-Marie Jones, Cinta Folch, Sonia Dias, Inga Velicko, Massimo Mirandola
      Background Substance use has been consistently reported to be more prevalent amongst Men who have Sex with Men (MSM) compared to the general population. Substance use, in particular polydrug use, has been found to be influenced by social and contextual factors and to increase the risk of unprotected intercourse among MSM. The objective of this analysis was to investigate the prevalence and predictors of drug use during a sexual encounter and to identify specific prevention needs. Methods/design A multi-site bio-behavioural cross-sectional survey was implemented in 13 European cities, targeting MSM and using Time-Location Sampling and Respondent-Driven Sampling methods Multivariable multi-level logistic random-intercept model (random effect of study site) was estimated to identify factors associated with the use of alcohol, cannabis, party drugs, sexual performance enhancement drugs and chemsex drugs. Results Overall, 1261 (30.0%) participants reported drug use, and 436 of 3706 (11.8%) reported the use of two or more drugs during their last sexual encounter. By drug class, 966 (23.0%) reported using sexual performance enhancement drugs, 353 (8.4%) – party drugs, and 142 (3.4%) the use of chemsex drugs. Respondents who reported drug use were more frequently diagnosed with HIV (10.5% vs. 3.9%) before and with other STIs during the 12 months prior to the study (16.7% vs. 9.2%). The use of all the analysed substances was significantly associated with sexual encounter with more than one partner. Discussion Substance and polydrug use during sexual encounters occurred amongst sampled MSM across Europe although varying greatly between study sites. Different local social norms within MSM communities may be important contextual drivers of drug use, highlighting the need for innovative and multi-faceted prevention measures to reduce HIV/STI risk in the context of drug use.

      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.01.002
       
  • Corrigendum to “The extent of and factors associated with self-reported
           overdose and self-reported receipt of naloxone among people who inject
           drugs (PWID) in England, Wales and Northern Ireland” [Int. J. Drug
           Policy 46 (2017) 34–40]
    • Authors: Charlotte O’Halloran; Katelyn Cullen; Jaquelyn Njoroge; Lucy Jessop; Josie Smith; Vivian Hope; Fortune Ncube
      Abstract: Publication date: Available online 4 May 2018
      Source:International Journal of Drug Policy
      Author(s): Charlotte O’Halloran, Katelyn Cullen, Jaquelyn Njoroge, Lucy Jessop, Josie Smith, Vivian Hope, Fortune Ncube


      PubDate: 2018-05-15T02:37:57Z
      DOI: 10.1016/j.drugpo.2018.04.008
       
 
 
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