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International Journal of Drug Policy
Journal Prestige (SJR): 1.441
Citation Impact (citeScore): 3
Number of Followers: 476  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0955-3959 - ISSN (Online) 1873-4758
Published by Elsevier Homepage  [3206 journals]
  • Perceptions and concerns of hepatitis C reinfection following prison-wide
           treatment scale-up: Counterpublic health amid hepatitis C treatment as
           prevention efforts in the prison setting
    • Abstract: Publication date: March 2020Source: International Journal of Drug Policy, Volume 77Author(s): Lise Lafferty, Jake Rance, Jason Grebely, Gregory J Dore, Andrew R Lloyd, Carla Treloar, SToP-C Study GroupAbstractBackgroundHepatitis C (HCV) infection is highly prevalent within the prison setting. Direct-acting antiviral (DAA) therapies have changed the HCV treatment landscape, offering simple treatment (with minimal side-effects) and high efficacy. These advances have enabled the first real-world study of HCV treatment as prevention (TasP), the Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study. This paper draws on data from qualitative interviews completed with SToP-C participants following prison-wide DAA treatment scale-up.MethodsSemi-structured interviews were undertaken with 23 men in prison following HCV treatment completion to identify ongoing risk practices, perceptions of strategies for HCV prevention within the prison setting, experiences of HCV treatment (as prevention), and perceptions of reinfection following cure. Analysis was undertaken using a counterpublic health lens to identify risks and perceptions of reinfection among people treated for HCV within the prison setting.ResultsParticipants identified a number of challenges of meaningful HCV ‘cure’ in the absence of increased access to prevention strategies (e.g., opioid agonist therapy and prison needle syringe programs) along with concerns that ‘cure’ was only temporary whilst incarcerated. ‘Cure’ status included self-perceptions of being “clean”, while also imposing responsibility on the individual to maintain their ‘cure’ status.ConclusionHCV DAA treatment is provided somewhat under the guise of ‘cure is easy’, but fails to address the ongoing risk factors experienced by people who inject drugs in prisons, as well as other people in prison who may be at risk of blood-to-blood exposure. Health messaging regarding HCV treatment and treatment for reinfection should be tailored to ensure patient-centred care. Health interventions in prison must address the whole person and the circumstances in which they live, not just the illness.
       
  • “You have to make some money before you can do some good”: Balancing
           the commercial, social and public health objectives in a “community
           enterprise” regulatory model for alcohol and cannabis
    • Abstract: Publication date: March 2020Source: International Journal of Drug Policy, Volume 77Author(s): Marta Rychert, Chris WilkinsAbstractIntroductionNew Zealand's alcohol licensing trusts are social enterprises that operate retail alcohol outlets in their districts and distribute profits back to the community. There have been calls for a similar “social enterprise” approach to legal cannabis sales. However, social enterprises face unique challenges in balancing commercial and social objectives.AimTo explore mechanisms that support the balancing of commercial, social and public health objectives in alcohol trusts and identify learnings for cannabis reform.MethodThematic analysis of interviews with 16 internal and external key informants (trust board members, trust retail managers, community activists, law enforcement) from two alcohol trust districts.ResultsKey informants overwhelmingly conceptualised alcohol trusts as business entities, but commercial success was also seen as a means to help the community. Interviewees’ perceptions of trusts’ social mission ranged from simple “corporate social responsibility” to a “genuine” community orientation. Despite a near-monopolistic market position, forces within and outside the trusts create pressures to conform to standard commercial behaviour, including strategic placement of alcohol outlets. Participants attributed the potential public health benefits of the trusts to reduced density of alcohol retail outlets and ease of enforcement. The pragmatic political goal of maintaining a favourable public image (to secure survival of the trust and re-election of individual trustees) was the key mechanism balancing commercial and social objectives. Ethical dilemmas related to the sale of alcohol and conflicts of interest in allocating community funds were evident. Discord was “negotiated” with the community via the public discussion and voting, providing opportunity to correct mission drift.ConclusionsThe need to maintain a positive public image (to ensure favourable electoral results) was a key mechanism helping to balance the commercial and social goals of alcohol trusts. A community trust model for retail cannabis sales could similarly provide constraints on commercial behaviour while funding community services.
       
  • Legitimizing and negotiating abstinence: Young adults’ narratives about
           practicing situational and long term abstinence in Denmark.
    • Abstract: Publication date: Available online 5 February 2020Source: International Journal of Drug PolicyAuthor(s): Vibeke A Frank, Maria D. Herold, Sidsel Schrøder, Jeanett Bjønness, Geoffrey HuntAbstractBackgroundIn this paper, we explore how Danish youth legitimize and negotiate abstaining from drinking alcohol. While most literature on abstinence focuses either on abstainers or non-drinkers, we focus on young peoples’ reasons for abstaining either for shorter or longer periods of time.MethodsThe article draws on narrative data from in-depth qualitative interviews with 140 young Danes between 18 and 25 years of age, all of whom had used alcohol in the past three months before the interview. In the analyses we identify different ways in which young Danes explain, justify and legitimize shorter or longer periods of abstinence, while still participating in friendship groups where consuming alcohol is a central part of being together.ResultsWe employ two concepts that identify what we mean when talking about abstaining from drinking alcohol. The first is ‘situational abstinence’ which covers abstaining from drinking alcohol in certain situations and for particular reasons while nevertheless consuming in other situations. The second concept, ‘long term abstinence’, covers taking a break from drinking for longer periods of time. We thus focus on young people, who participate in the Danish youth drinking cultures, but choose to abstain from drinking in certain situations and for a certain period of time. One important finding to emerge from our analysis is that while other studies show some of the same reasons for not drinking, our study shows that timing, negotiation and legitimization also play important roles. Furthermore, these roles are modified by gender.ConclusionFriendship and peer groups are central relationships for young people and are important arenas for feelings of comfort, a sense of belonging and a source of identity. If policy and/or prevention initiatives focus solely on abstaining as an individual choice or an individual concern, as for example in the ‘just say no’ campaigns, then these initiatives fail to emphasize important aspects of young people's lives.
       
  • Drugs as technologies of the self: Enhancement and transformation in LGBTQ
           cultures
    • Abstract: Publication date: April 2020Source: International Journal of Drug Policy, Volume 78Author(s): Kiran Pienaar, Dean Anthony Murphy, Kane Race, Toby LeaAbstractThe consumption of drugs has long been a mainstay of urban queer cultures and it is well-recognised that complex connections exist between sexual minoritisation and desires to chemically alter bodily experience. Yet despite evidence that rates of consumption are higher among LGBTQ populations, research exploring the gendered and sexual dynamics of these forms of consumption is limited and tends to frame such consumption as a response to stigma, marginalisation and discrimination. Against this dominant explanatory frame, this article explores the diverse experiences of LGBTQ consumers, and in so doing highlights both the pleasures and benefits of consumption, as well as potential risks and harms. Contributing to the growing body of ontopolitically oriented research that treats the materiality of drugs as emergent and contingent, we trace the ontologies of drugs, sexuality and gender that LGBTQ subjects generate through specific practices of consumption. Our analysis draws on qualitative interviews with 42 self-identified LGBTQ people from an Australian study designed to explore how sexual and gender-diverse minorities pursue particular drug effects to enhance or transform their experience of gender and/or sexuality. Our participants’ accounts illuminate how drug consumption materialises in relation to sex, desire and play where it enhances pleasure, facilitates transgression and increases endurance. In the context of gender variance, our findings suggest that drug use can transform gendered experience and enable the expression of non-normative gender identities, in the process challenging gender binarism. By considering the productive role of drugs in enacting queer identities, this article treats drugs as ‘technologies of the self’ (Foucault 1988) and explores how drug consumption, sex and gender shape each other across a range of settings. We conclude by reflecting on the implications of our findings for research and service provision, and suggest ways of engaging LGBTQ consumers in terms that address their diverse priorities and experiences.
       
  • International drug control governance: Is a joint UN programme on drugs
           relevant'
    • Abstract: Publication date: March 2020Source: International Journal of Drug Policy, Volume 77Author(s): Khalid Tinasti
       
  • Steps toward a theory of place effects on drug use: Risk, marginality, and
           opportunity in small and remote California towns
    • Abstract: Publication date: Available online 27 January 2020Source: International Journal of Drug PolicyAuthor(s): David ShowalterAbstractThe risk environment concept provides a framework for documenting ecological influences on drug use, and a platform to engage with social theory to identify mechanisms behind place-based health disparities. Health scientists conceptualize these mechanisms in terms of social determinants of health, social scientists in terms of syndemics and structural violence. I supplement these perspectives with Pierre Bourdieu's concepts of social space, practice, and habitus to offer a broader analysis of how place shapes drug-related health risks, particularly outside of the large cities where most research is conducted. This approach encompasses inequality, conflict, and social change at multiple levels of social organization, from macrodistributions of power to trajectories of individual drug use. I offer three pointers for scholarship on drug use in nonurban places, which I illustrate with findings from an ethnographic study of opioid use and opioid-related services in California. First, replace the folk notion of “rural” with geographic categories grounded in relevant social structures and institutions, such as social networks or illicit drug markets. Second, examine how variation in the structure of social and physical space affects processes of marginalization and criminalization. Third, avoid negative definitions of nonurban places, and instead explore their distinctive institutions and opportunity structures. Following this approach, I define acquainted marginality and small-town habitus to explain how dense networks and geographic isolation shape local government and survival strategies among people who use drugs. I find that in small and remote towns, personal and professional relationships overlap in ways that augment surveillance and stigma, but can also facilitate leniency and progressive policy change. I conclude by using these findings to outline a theory of place effects on drug use and addiction to encourage future research in these directions.
       
  • Drugs and drug wars as populist tropes in Asia: Illustrative examples and
           implications for drug policy
    • Abstract: Publication date: March 2020Source: International Journal of Drug Policy, Volume 77Author(s): Gideon LascoAbstractBackgroundThe Philippines may be the face of today's ‘drug wars’, but its experience is by no means exceptional - as the contemporary examples of Indonesia, Bangladesh, and Sri Lanka show. In the early 2000s Thailand's Thaksin Shinawatra also embarked on a ‘drug war’ with striking parallels to the Philippines in terms of its human toll and failed outcomes. This paper uses the framework of populism - defined as a political style - to survey punitive drug regimes in Asia and make sense of their social and political efficacies. It identifies the divisions mobilized and reinforced by populists as well as the ways in which they perform and spectacularize national crises.MethodsDrawing from journalistic and scholarly sources, as well as official documents, four case studies are presented: two historical (1970s Philippines and 2000s Thailand) and two contemporary (Bangladesh and Indonesia) to show how this style travels across the region.FindingsWhile drug wars can be understood in terms of the moral panics that surround them, this paper highlights the role of individual political actors who mobilize these panics by dramatizing crises, forging divisions, and making knowledge claims about drugs and the people who use them. Particularly for the region's ‘drug wars’, common elements include the conflation of the ‘drug menace’ with ethnic, economic ‘others’ - as well as misleading or exaggerated epidemiological and medical claims.ConclusionIf, as demonstrated by the illustrative examples in this article, those who choose to invoke drugs do so by making knowledge claims and forging divisions, then possible responses include challenging those claims (and providing evidence to do), uncoupling drugs with particular groups, and furnishing historical perspectives that belie populist claims of exceptional crises and the purported efficacy of punitive, dramatic responses.
       
  • Making up a new drug user from depenalization to repenalisation of drug
           users in Denmark
    • Abstract: Publication date: Available online 21 January 2020Source: International Journal of Drug PolicyAuthor(s): Esben Houborg, Thomas Friis Søgaard, Sif Anna Ingibergdottir MogensenAbstractBackgroundIn 2004 the Danish parliament repenalised possession of illicit drugs for personal use after it had been depenalised for 35 years. This article analyses the introduction of a more repressive drug policy in Denmark by studying how drug use and drug users were problematized in two key government whitepapers and how this problematization articulated a more general problematisation of ‘a culture of intoxication’ among young Danes. The analysis also shows how the policy change involved a change of governmentality away from a welfarist and towards a neo-liberal governmentality. The analysis particularly focuses on the implications of these problematisations for the constitution of young drug users a ‘governable subjects’.MethodsThe article takes its inspiration from research that has applied governmentality theory to analyse drug policy and particularly how the governmentalities that drug policies articulate involve different subjectifications of drug users. Within this overall framework the article also takes inspiration from Carol Bacchi's post-structural approach to policy analysis to show the assumptions about young people, drugs and how to govern them before and after the policy change.ResultsThe new drug policy articulated new ways of problematising drug use and the young drug user. Drug use was no longer defined as more or less socially conditioned but as an individual choice made by a rational actor. Punishment for violating the drug legislation should make the drug user responsible for his or her transgressions and deter others from making similar transgressions.ConclusionResearch has shown that neo-liberal discourses can lead to more empowering and harm reduction oriented drug policies. This is not the case in Denmark. Here neo-liberal discourses led to a more repressive drug policy. Briefly accounting for some of the lived effects of the new drug policy, the article shows how socially disadvantaged parts of the Danish population bears the burden on the more punitive drug policy. This more repressive drug policy goes against the trend in several other European countries that have become less repressive. However, even if Danish drug policy has become more repressive, the legal measures taken against drug users in Denmark are still fairly ‘mild’ compared with the legal measures taken against drug users in other countries.
       
  • Known fentanyl use among clients of harm reduction sites in British
           Columbia, Canada
    • Abstract: Publication date: March 2020Source: International Journal of Drug Policy, Volume 77Author(s): Mohammad Karamouzian, Kristi Papamihali, Brittany Graham, Alexis Crabtree, Christopher Mill, Margot Kuo, Sara Young, Jane A BuxtonAbstractBackgroundNorth America is in the midst of an opioid overdose epidemic and it is commonly suggested that exposure to fentanyl is unknown. Using a provincial survey of harm reduction site clients, we aimed to characterize known and unknown fentanyl use and their correlates among people who use drugs in British Columbia, Canada.MethodsWe recruited 486 clients who were>18 years old and 316 agreed to provide a urine sample for substance use testing. Reported known fentanyl use was defined as a three-level categorical variable assessing recent (i.e., in the previous three days) fentanyl exposure: (i) known exposure; (ii) unknown exposure; and (iii) no exposure. We also assessed any exposure to fentanyl (Yes vs. No) confirmed by urinalysis. Survey data were summarized using descriptive statistics. Multinomial logistic regression and modified Poisson regression models were built to examine different correlates of exposure to fentanyl.ResultsMedian age of the participants was 40 (IQR: 32–49). Out of the 303 eligible participants, 38.7% (117) reported known fentanyl use, 21.7% (66) had unknown fentanyl use, and 39.6% (120) had no recent fentanyl use. In the adjusted multinomial logistic regression model and in comparison with unknown fentanyl use, recent known fentanyl use was significantly associated with self-report of methadone use (aRRR = 3.18), heroin/morphine use (aRRR = 4.40), and crystal meth use (aRRR = 2.95). Moreover, any recent exposure to fentanyl (i.e., positive urine test for fentanyl) was significantly associated with living in urban settings (aPR = 1.49), and self-reporting recent cannabis use (aPR = 0.73), crystal meth (aPR = 1.45), and heroin/morphine use (aPR = 2.48).ConclusionThe landscape of illicit opioid use is changing in BC and more people are using fentanyl knowingly. The increasing prevalence of known fentanyl use is concerning and calls for further investments in public awareness and public policy efforts regarding fentanyl exposure and risks.
       
  • Global systematic review and ecological analysis of HIV in people who
           inject drugs: National population sizes and factors associated with HIV
           prevalence
    • Abstract: Publication date: March 2020Source: International Journal of Drug Policy, Volume 77Author(s): Sarah Larney, Janni Leung, Jason Grebely, Matthew Hickman, Peter Vickerman, Amy Peacock, Jack Stone, Adam Trickey, Kostyantyn V. Dumchev, Samantha Colledge, Evan B. Cunningham, Michael Lynskey, Richard P. Mattick, Louisa DegenhardtAbstractBackgroundPeople who inject drugs (PWID) are at elevated risk of HIV infection. Data on population sizes of PWID living with HIV are needed to inform the implementation of prevention, treatment and care programs. We estimated national population sizes of people who recently (past 12 months) injected drugs living with HIV and evaluated ecological associations with HIV prevalence in PWID.MethodsWe used national data on the prevalence of injecting drug use and of HIV among PWID, derived from systematic reviews, to estimate national population sizes of PWID living with HIV. Uncertainty was estimated using Monte Carlo simulation with 100,000 draws. We extracted data on sample characteristics from studies of HIV prevalence among PWID, and identified national indicators that have been observed or hypothesised to be associated with HIV prevalence in PWID. We used linear regression to evaluate associations between these variables and HIV prevalence in PWID.ResultsFour countries comprised 55% of the estimated global population of PWID living with HIV: Russia (572,500; 95% uncertainty interval (UI) 235,500–1,036,500); Brazil (462,000; 95% UI 283,500–674,500); China (316,500; 95% UI 171,500–493,500), and the United States (195,500; 95% UI 80,000–343,000). Greater anti-HCV prevalence and national income inequality were associated with greater HIV prevalence in PWID.ConclusionThe countries with the largest populations of PWID living with HIV will need to dramatically scale up prevention, treatment and care interventions to prevent further increases in population size. The association between anti-HCV prevalence and HIV prevalence among PWID corroborates findings that settings with increasing HCV should implement effective interventions to prevent HIV outbreaks. The association between income inequality and HIV among PWID reinforces the need to implement structural interventions alongside targeted individual-level strategies.
       
  • Between gang talk and prohibition: The transfer of blame for County Lines
    • Abstract: Publication date: Available online 17 January 2020Source: International Journal of Drug PolicyAuthor(s): Jack SpicerAbstractBackgroundThe drug supply model termed ‘County Lines’ has generated extensive attention over recent years in the UK. Associated street violence, the involvement of young people and exploitation have been the source of intense concern. However, little discussion has sought to situate this drug market ‘phenomenon’ in relation to recent austerity policies and intensifying social exclusion. Drawing on Douglas’ (1995) conceptualisation of scapegoating as a process of blame transfer, this paper provides a critical analysis of the ways that attention has been diverted from the social conditions that are arguably fundamental to driving involvement in this supply model and its associated harms.MethodsA critical discourse analysis was undertaken on publicly available content on the subject of County Lines. Sources included newspaper articles, other media outputs, official publications and parliamentary debates. These were analysed to identify scapegoating discourses. Once established, these were theoretically developed by drawing on a range of extant perspectives.ResultsThree forms of scapegoating related to County Lines were identified. A familiar process was found in the form of ‘gang talk’, with County Lines reduced as a product of these ‘evil’ groups. A notably less familiar outlet of blame was identified in the form of middle class cocaine users, with a range of powerful actors attempting to denounce this ‘imagined’ population as fuelling the market. A final form was identified in relation to drug legalisation campaigns, with an unwavering focus on prohibition also arguably serving to obfuscate underlying structural drivers.DiscussionScapegoating for the issue of County Lines has taken multiple forms. The role of these discourses in diverting attention away from the social conditions that drive these market harms should be recognised and challenged. In their place, political economy and addressing social exclusion should be at the fore of policy discussions.
       
  • Hepatitis C reinfection in prisons with broad access to Direct Acting
           Antiviral treatments
    • Abstract: Publication date: Available online 15 January 2020Source: International Journal of Drug PolicyAuthor(s): James Blogg, Thomas Wright, Colette Mcgrath, Jacqueline Clegg
       
  • Doing ontopolitically-oriented research: Synthesising concepts from the
           ontological turn for alcohol and other drug research and other social
           sciences
    • Abstract: Publication date: Available online 7 January 2020Source: International Journal of Drug PolicyAuthor(s): Suzanne FraserAbstractThe ontological turn has had a significant impact on the social sciences, including the social sciences of alcohol and other drug use. Work questioning the materiality of drugs, and the discourses of compulsion and dependence that co-constitute public understandings of drugs and their effects, is now relatively common in the field. In this article I discuss the new assumptions and methods informing the ontological turn, linking them together to produce an approach that synthesises what has become a fertile but rather piecemeal domain of critical drugs studies. In doing so, I identify and define to what I will term, following these intellectual trajectories, ‘ontopolitically-oriented research’ for the alcohol and other drug social sciences.This article will discuss two research projects: one that set out to generate new knowledge on lived experiences of addiction, and one that set out to rethink the standard illicit drug use safe injecting fitpack to better serve couples who inject together. The aim of this article will not be to report on project findings however. Instead it will provide a synthesis of research methods inspired by, and interpreted through, the ontological turn, using the projects as examples by considering them from the point of view of their ontological politics. As I will argue, the projects and their outcomes were fundamentally inspired by the insight that research not only explores and describes realities, it actively constitutes the realities it explores, playing a direct role in reconstituting realities through its conduct, outcomes and communications. I adopt the term ‘ontopolitically-oriented research’ to describe this approach. The analysis in this article will focus on the projects’ methods, describing the ways these methods were interpreted and implemented in ways best able to articulate and fulfil project aims. In concluding, the article will propose a set of features of ontopolitically-oriented research, as well as some observations on the steps, obstacles, priorities and pitfalls ontopolitically-oriented research may encounter in pursuing its aims.
       
  • The impact of rurality on opioid-related harms: A systematic review of
           qualitative research
    • Abstract: Publication date: Available online 18 December 2019Source: International Journal of Drug PolicyAuthor(s): Natalie Thomas, Katinka van de Ven, Kyle J.D. MulrooneyIntroductionOver the past decade, there has been mounting recognition that opioid use and related mortality and morbidity is a significant public health problem in rural, non-urban areas across the globe. Taking what has been termed the ‘opioid crisis’ as a starting off point, this article aims to systematically review the qualitative literature on the ways in which rurality shapes the risk for opioid-related harm.MethodsA systematic review was undertaken using database searches and secondary reference list searches for qualitative literature on rural and non-urban opioid-related harms. A total of 32 qualitative studies met the inclusion criteria. Data extraction was performed in NVivo 12 using a codebook based on the ‘risk environment’ framework.ResultsThe findings explore how rurality shapes the risk environment for opioid-related harms through four environment influences: (1) economic conditions, including economic transition and deindustrialisation that has occurred in many rural areas, and the high levels of economic distress experienced by rural residents; (2) physical conditions, including a lack of infrastructure and recreation opportunities, larger geographic distances, and limited transportation; (3) social conditions, where social networks could be both protective but also amplify risk through a lack of knowledge about treatment and risk behaviours, a lack of anonymity and stigmatisation of people who use opioids in rural areas; and (4) policy conditions including limited coverage and availability of harm reduction and drug treatment services, and stigmatising service provider practices.ConclusionsThe impact of rurality on risk of opioid-related harm is multifaceted. We suggest that future research on rural opioid use would benefit from drawing on the theoretical toolkit of rural criminology to attend to the ways the ‘rural crisis’, and attendant insecurities, anxieties and strains, impacts upon rural communities and shapes risk, along with how socio-cultural characteristics of the rural ‘organise’ risks of drug use.
       
  • ‘I feel like I have to become part of that identity’: Negotiating
           
    • Abstract: Publication date: Available online 22 July 2019Source: International Journal of Drug PolicyAuthor(s): Emily NichollsAbstractWhilst women’s excessive alcohol consumption has traditionally been regarded as a potential threat to health, safety and even femininity, recent research highlights the important role that alcohol plays in many young women’s lives. Drawing on data from semi-structured interviews with women aged 18–25 in Newcastle, UK, this paper will consider the role that alcohol can play in the negotiation of female friendships in the Night Time Economy, highlighting the ways in which young women may regard alcohol as a tool to enhance socialising, trust and intimacy (both when pre-drinking and in bars, pubs and clubs). The role of alcohol in ‘doing’ gender and femininity will also be explored, as young women collectively display feminine identities through particular drinking choices and practices that may include heavy drinking and drunkenness. Finally, I will consider the implications for young women who do not engage in these collective practices of alcohol consumption and suggest avenues for future work on the under-researched topic of the experiences of non-drinkers.
       
  • Who or what do young adults hold responsible for men’s drunken
           violence'
    • Abstract: Publication date: Available online 19 July 2019Source: International Journal of Drug PolicyAuthor(s): Sarah MacLean, Jakob Demant, Robin RoomAbstractBackgroundMen are more likely than women to perpetrate serious violence when they have consumed alcohol, but alcohol does not affect all men in the same way. This paper considers young adults’ attribution about agency (the capacity to act) in men’s drunken violence.MethodsInterviews about alcohol use in night-time venues, streets or private parties were conducted with 60 young adults aged 18–24 in Melbourne, Australia, and analysed thematically. Participants included seven men who identified as having initiated violence when drunk.ResultsSome interviewees stated that men chose to be violent, or that men’s violence when they were drunk was purposeful and therefore involved some component of choice. However, much alcohol-related violence enacted by young men was understood (both by men who reported violence and by other young adults) as impelled by forces outside their control. These forces were: diffusely defined effects of drinking alcohol; proclivities of men and masculinity, and the interaction of alcohol and men’s bodies to override capacity for judgement and produce an irresistible urge to fight. The latter was at times explained as caused by the mutually reinforcing actions of alcohol and testosterone, providing a particularly persuasive account of men’s violence as biologically-determined.ConclusionThese categories encapsulate a set of discursive resources that contribute to the rationalisation, naturalisation and production of men’s violence. Participants tended to regard alcohol, masculinities and testosterone as inciting violence predictably and consistently, suggesting that men themselves had relatively little agency over its occurrence. In contrast, research evidence indicates that these actors do not cause violence in any uniform way and that their effects are contingent on changing configurations of factors. Highlighting discrepancies between young adults’ understandings of responsibility for men’s drunken violence, and those expressed in research, presents additional opportunities for intervention.
       
  • What is a rural opioid risk and policy environment'
    • Abstract: Publication date: Available online 30 November 2019Source: International Journal of Drug PolicyAuthor(s): Richard A. Jenkins, Holly Hagan
       
  • Complex cases – Complex representations of problems
    • Abstract: Publication date: Available online 22 November 2019Source: International Journal of Drug PolicyAuthor(s): Bagga Bjerge, Louise Christensen, Jeppe OuteAbstractMany Danish drug users do not only require services related to drug use, but face other obstacles such as mental illnesses and unemployment. The services are constituted by different types of policies, which represent both overlapping and sometimes conflicting ideas of how to frame, intervene and 'fix' problems. Policy research has mainly focused on these fields separately, however, in this article, we scrutinize policies in the fields drug use and treatment, unemployment and mental health separately and we bring together our findings to conduct a cross-sectorial analysis of how and why citizens with a mix of problems related to the three fields are produced into particular 'kinds' of subjects amenable to particular kind of tools, interventions and outcomes. Methodologically, we apply an explorative, descriptive policy analysis strategy of key policy documents. We conduct an analysis of the content of policy documents in which data sources are coded focusing on key concepts and arguments as well as examining how problem representations are embedded. Analytically, we draw on constructivist approaches exploring how problems and citizens in need of help are represented in different types of policy documents as well as how interventions are legitimized and how methods, tools and outcomes of interventions are represented. The article shows how policies altogether problematize drug users with complex problems as both morally obliged to find inner motivation and willpower and as victims of poor circumstances depriving them the benefits of leading a 'normal' life. This should be 'fixed' by treatment and interventions, resulting in that socially marginalized citizens 'get better' and, hence, are being transformed into 'someone else'. Finally, we discuss the potential benefits and limitations of the ways in which the proposed problems, solutions and expected outcomes are represented.
       
  • People, places, and stigma: A qualitative study exploring the overdose
           risk environment in rural Kentucky
    • Abstract: Publication date: Available online 18 November 2019Source: International Journal of Drug PolicyAuthor(s): Monica Fadanelli, David H. Cloud, Umedjon Ibragimov, April M. Ballard, Nadya Prood, April M. Young, Hannah L.F. CooperAbstractBackgroundThough overdose rates have been increasing in US rural areas for two decades, little is known about the rural risk environment for overdoses. This qualitative study explored the risk environment for overdoses among young adults in Eastern Kentucky, a rural epicenter of the US opioid epidemic.MethodsParticipants were recruited via community-based outreach. Eligibility criteria included living in one of five rural Eastern Kentucky counties; being aged 18–35; and using opioids to get high in the past 30 days. Semi-structured interviews explored the rural risk environment, and strategies to prevent overdose and dying from an overdose. Interviews were transcribed verbatim and analyzed using constructivist grounded-theory methods.ResultsIn this sample (N = 19), participants reported using in a range of locations, including homes and outdoor settings; concerns about community stigma and law enforcement shaped the settings where participants used opioids and the strategies they deployed in these settings to prevent an overdose, and to survive an overdose. Almost half of participants reported using opioids in a “trap house” or other dealing locations, often to evade police after buying drugs, and reported that others present pressed them to use more than usual. If an overdose occurred in this setting, however, these same people might refuse to call EMS to protect themselves from arrest. Outdoor settings presented particular vulnerabilities to overdose and dying from an overdose. Most participants reported using opioids outdoors, where they skipped overdose prevention steps to reduce their risk of arrest; they worried that no one would find them if they overdosed, and that cell phone coverage would be too weak to summon EMS.ConclusionFindings suggest that initiatives to reduce overdoses in Eastern Kentucky would be strengthened by de-escalating the War on Drugs and engaging law enforcement in initiatives to protect the health of people who use opioids.
       
  • A review of network simulation models of hepatitis C virus and HIV among
           people who inject drugs
    • Abstract: Publication date: Available online 15 November 2019Source: International Journal of Drug PolicyAuthor(s): Meghan Bellerose, Lin Zhu, Liesl M. Hagan, William W. Thompson, Liisa M. Randall, Yelena Malyuta, Joshua A. Salomon, Benjamin P. LinasAbstractNetwork modelling is a valuable tool for simulating hepatitis C virus (HCV) and HIV transmission among people who inject drugs (PWID) and assessing the potential impact of treatment and harm-reduction interventions. In this paper, we review literature on network simulation models, highlighting key structural considerations and questions that network models are well suited to address. We describe five approaches (Erdös–Rényi, Stochastic Block, Watts–Strogatz, Barabási–Albert, and Exponential Random Graph Model) used to model partnership formation with emphasis on the strengths of each approach in simulating different features of real-world PWID networks. We also review two important structural considerations when designing or interpreting results from a network simulation study: (1) dynamic vs. static network and (2) injection only vs. both injection and sexual networks. Dynamic network simulations allow partnerships to evolve and disintegrate over time, capturing corresponding shifts in individual and population-level risk behaviour; however, their high level of complexity and reliance on difficult-to-observe data has driven others to develop static network models. Incorporating both sexual and injection partnerships increases model complexity and data demands, but more accurately represents HIV transmission between PWID and their sexual partners who may not also use drugs. Network models add the greatest value when used to investigate how leveraging network structure can maximize the effectiveness of health interventions and optimize investments. For example, network models have shown that features of a given network and epidemic influence whether the greatest community benefit would be achieved by allocating hepatitis C or HIV treatment randomly, versus to those with the most partners. They have also demonstrated the potential for syringe services and “buddy sharing” programs to reduce disease transmission.
       
  • Peer influence of injection drug use cessation among dyads in rural
           eastern Kentucky
    • Abstract: Publication date: Available online 15 November 2019Source: International Journal of Drug PolicyAuthor(s): Abby E. Rudolph, Elizabeth Upton, Madelyn J. McDonald, April M. Young, Jennifer R. HavensAbstractBackgroundThis analysis aims to assess whether injection drug use cessation among peers predicts injection drug use cessation among individuals and explores whether this association varies by relationship type and strength.MethodsData were collected through baseline and 6-month assessments for the Social Networks among Appalachian People study (2008–2011). Interviewer-administered surveys collected sociodemographic and drug use behaviors (past 6 months and lifetime). Participants also listed sex, drug use, and social support partners (past 6 months). Listed names were cross-referenced with survey participants to identify relationships between study participants. The analytic sample was further restricted to include only those relationship pairs where both individuals reported a history of injection drug use at baseline (n = 244 unique individuals and 746 dyads). We fit a generalized estimating equations logistic regression model to (1) assess the relationship between peer injection cessation and individual injection cessation and (2) determine whether the strength of this association differs by relationship-level variables (i.e., relationship role, relationship type, relationship duration, frequency of interaction, residential proximity).ResultsOverall, those with a network member who ceased injection drug use were more likely to stop injecting over the following 6-month period (AOR=1.65). The magnitude of this association was greater for social support partners (AOR=2.95), family members (AOR=3.56), those with whom the participant interacted at least daily (AOR=2.17), and those who the participant knew longer (AOR=2.09). Further, among family members, the effect size was greater when relationships were further restricted to immediate family members (AOR=5.35).ConclusionOur findings suggest that in this rural community, closer, more supportive relationships, may be more influential for modeling injection cessation; however, relationship-types were not mutually exclusive so differences in effect size across strata may not be statistically significant. In this setting, social support through the recovery process (including cessation attempts with peers) may increase likelihood of injection cessation.
       
  • From prohibition to regulation: A comparative analysis of the emergence
           and related outcomes of new legal cannabis policy models (Colorado,
           Washington State and Uruguay)
    • Abstract: Publication date: Available online 15 November 2019Source: International Journal of Drug PolicyAuthor(s): Ivana Obradovic
       
  • ‘I don't think there are great sex differences there’: Processes of
           discursive bridging and othering in a discussion of gendered norms related
           to alcohol, sexual behaviour, and aggression
    • Abstract: Publication date: Available online 15 November 2019Source: International Journal of Drug PolicyAuthor(s): Alexandra BogrenAbstractBackgroundExisting research indicates that sexual behaviour and aggression are particularly important to the reproduction of gendered drinking norms, both in the media and in face-to-face interaction. However, research has yet to understand in more detail the discursive processes whereby actors negotiate gendered norms related to alcohol, sexual behaviour, and aggression. This article examines how actors make symbolic distinctions between themselves and others in discussing alcohol, aggression, and sexual desire, and analyses the similarities and differences within and across gender that they identify in this process.MethodsThe study relies on individual qualitative interviews with 25 Swedish women and men. To elicit participants’ normative positions, we used a newspaper article as a probe during the interviews.ResultsFindings show that participants highlight similarities between women and men, and variation and individual differences among men and among women in discussing alcohol's effects on sexual desire and ‘sexually active behaviour’. Differences, by contrast, are most salient when they discuss alcohol and aggression and seek to distance themselves from ‘shabby bar men’, rural men, and male football hooligans who drink and fight, outgroups that are marked as working-class in the participants’ narratives.ConclusionTwo general discursive patterns were identified: discursive bridging across gender and discursive othering across class. For the participants, drinking norms are not as much about general gender differences as they are about the ‘dysfunctional’ drinking of certain groups of working-class men. These findings contribute to a more specific understanding of the reconstitution of gender boundaries in relation to drinking norms.
       
  • Young men's alcohol consumption experiences and performances of
           masculinity
    • Abstract: Publication date: Available online 12 September 2019Source: International Journal of Drug PolicyAuthor(s): Samantha Wilkinson, Catherine WilkinsonAbstractBackgroundBy creating a dichotomy between those who are ‘out-of-control’ ‘binge drinkers’ and those for whom alcohol contributes to friendship fun, academic and alcohol policy literature often fail to acknowledge the nuances in the diverse drinking practices of men.MethodsThis paper engages with findings from a multiple qualitative method research project (comprising of individual and friendship group interviews; diaries; and participant observation), conducted with 16 young men, aged 15–24: eight living in the middle-class area of Chorlton, and eight living in the working-class area of Wythenshawe, Manchester, United Kingdom.ResultsThis paper provides fine-grained insights into the doings, complexities and contradictions of masculinity in the context of drinking. Young men are shown to tap into different co-existing versions of masculinity, one of which is based on the exclusion of femininity (i.e. they act as tough guys), while another version is more inclusive (i.e. it allows for displays of care).ConclusionThis paper shows a much more complex image of young men's drinking practices than has hitherto been conceptualised in the existing literature, and brings to the fore doings of alternative masculinities. This has important implications for alcohol policy interventions targeting men, in that the complexities and contradictions of masculinity in relation to drinking must be taken seriously.
       
  • “A spray bottle and a lollipop stick”: An examination of policy
           prohibiting sterile injecting equipment in prison and effects on young men
           with injecting drug use histories
    • Abstract: Publication date: Available online 16 August 2019Source: International Journal of Drug PolicyAuthor(s): Shelley Walker, Kate Seear, Peter Higgs, Mark Stoové, Mandy WilsonAbstractBackgroundAustralian young male prisoners with histories of injecting drug use are more likely to report injecting in prison, to do so more frequently, and to be involved in more un-safe injecting-related practices than their older counterparts. Despite international evidence that prison needle and syringe programs are both feasible and effective in reducing the harms associated with injecting drug use in prison, these young men do not have access to such equipment.MethodsWe critically analyse the interview transcripts of 28 young men with histories of injecting drug use who were recently released from adult prisons in Victoria, Australia, and prison drug policy text. We use Bacchi’s ‘What’s the problem represented to be'’ approach to examine how the ‘problem’ of injecting drug use in prison is represented in prison drug policy, including the assumptions that underpin these problematisations, and the subjectification and lived effects that are produced for the young men in our study.ResultsOur analysis reveals how prison drug policy enables the creation and re-use of homemade injecting equipment crafted from unsterile items found in prison, and that in doing so the policy produces a range of stigmatising subjectification effects and other harmful material effects (such as hepatitis C virus transmission and injecting related injury and harms). Findings highlight, how injecting drug use is represented in policy silences other ways of understanding the ‘problem’ that may have less harmful effects for incarcerated young men who inject drugs.ConclusionWe argue that somewhat paradoxically, the approach of prohibiting access to sterile injecting equipment in prison—which is constituted as a solution for addressing such harms—in fact helps to produce them.
       
  • Drinking comfortably' Gender and affect among Danish pre-partiers
    • Abstract: Publication date: Available online 7 August 2019Source: International Journal of Drug PolicyAuthor(s): Maria Dich Herold, Geoffrey HuntAbstractBackgroundThe aim of this paper is to examine the relationship between youthful drinking practices and gender within the domestic pre-party (prior to a night out), an arena, which has been relatively ignored in existing qualitative research on youthful alcohol use. An examination of the relationships between gender and drinking practices in this context is important for three reasons. First, pre-parties are associated with heavy drinking, which has traditionally been associated with masculinity. Second, because pre-drinking takes place in the private sphere of the home, it is therefore ‘controlled’ in terms of who can participate and hence what precisely is the gender composition. Third, whilst being located in the private sphere of the home, pre-party practices are nevertheless informed by the (hyper) gendered environments of public drinking spaces in the Night-Time Economy (NTE), most dominantly mainstream clubs and bars. We suggest that such characteristics allow for the emergence of specific gendered relationships, activities and affectivities, thereby demarcating the pre-party as a particular gendered drinking space.MethodsWe draw on narrative data from 140 in-depth face-to-face interviews with young Danish alcohol users between 18–25 years of age. The interviews were part of a large-scale research project on the gendered aspects of youthful alcohol use and intoxication. Theoretically, we draw on a combination of the ‘doing gender’ paradigm (West & Zimmerman, 1987) and affect theoretical notions on (un)comfortability (Ahmed, 2014). We propose that these perspectives mark out the pre-party as a particularly gendered drinking space.ResultsWhile our analysis supports the observation of existing qualitative studies, that pre-partying is not merely motivated by the possibility of becoming intoxicated in a cheap and un-surveilled way before going out, we especially argue that pre-partying is fueled by a desire for 'comfortability', which seems almost impossible to disassemble from the gendering that pre-partying also entails. Our analysis therefore contributes to the ongoing academic discussion around the relationship between ‘intoxicated femininity’ and ‘intoxicated masculinity’ by suggesting that we need to take the affective implications of young people’s (gendered) drinking practices into account in a thorough discussion of the relationship between youthful alcohol use and gender.
       
  • Young women’s narratives on sex in the context of heavy alcohol use:
           Friendships, gender norms and the sociality of consent
    • Abstract: Publication date: Available online 7 August 2019Source: International Journal of Drug PolicyAuthor(s): Mie Birk Jensen, Geoffrey HuntAbstractBackgroundAlthough young women’s friendships remain understudied in drinking contexts, some researchers have pointed to how young women can make use of each other to manage sexual advances when drinking. In this paper, we explore how young women make use of friends to negotiate their sexual boundaries, and construct the meaning of sexual experiences in a context of heavy alcohol use.MethodsThe data stems from a large scale research project at the Centre for Alcohol and Drug Research, Aarhus University, which included 140 interviews with young Danes between the ages of 18–25. In the present study, we primarily use narratives from 33 in-depth interviews with young women, who recall their personal sexual experiences with men in the context of heavy alcohol use.ResultsWe find that these young women make meaning of their sexual experiences in relation to friends through a negotiation of their emotional response as well as dominant gender norms. We argue that friends may serve to prevent sexual regret and offer support in instances where young women feel regret after engaging in sex when drinking heavily. However, we also argue that friends may encourage a more humorous approach in recounting sexual encounters in the context of heavy alcohol use, which may contradict their initial feelings of the encounter and gloss over issues of sexual consent.ConclusionWith this article we point to how young women's ability to negotiate the meaning of their sexual experiences as well as that of sexual consent more generally, are interlinked with prevalent gender norms that play out in the context of friendships. The young women in our study narrated friends as more central to negotiations of sexual boundaries than sexual partners when in a context of heavy alcohol use.On this basis, we develop the term ‘social consent’, which we suggest that future studies and preventive efforts should take into account in order to challenge the gender norms that can serve to normalize sexual violence in drinking contexts.
       
  • Communicating THC levels and ‘dose’ to consumers: Implications for
           
    • Abstract: Publication date: Available online 25 July 2019Source: International Journal of Drug PolicyAuthor(s): David HammondAbstractIn a well-regulated drug market, consumers should be able to understand and titrate their dose with little difficulty. In the cannabis market, despite substantial increases in THC levels over time, users have had limited information on the strength of their products. In principle, cannabis legalization provides greater opportunity to communicate clear, accurate information to consumers through packaging and labelling standards. However, jurisdictions that have legalized cannabis have experienced an increase in adverse events from higher strength products, particularly from edibles and other concentrates. What little research exists suggests that current regulatory practices of labelling THC levels on packages may be ineffective due to consumer difficulties understanding numbers (e.g., mg vs. percentage), and the different ways THC levels are communicated across product categories. In particular, current labelling practices provide little guidance in terms of ‘dose expression’—how THC ‘dose’ translates into consumption amounts for specific products. The current paper identifies five principles to guide cannabis labelling and packaging regulations, including considerations for numeric THC labelling, the use of standard servings or dose across different product forms, strategies to communicate ‘dose expression’, and ‘dose-unit packaging’. Overall, there is a need for regulated cannabis markets to develop more effective packaging and labelling standards to allow consumers to effectively titrate their THC intake, with the goal of promoting lower-risk cannabis use.
       
 
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