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Journal Cover International Journal of Drug Policy
  [SJR: 1.074]   [H-I: 49]   [382 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0955-3959
   Published by Elsevier Homepage  [3120 journals]
  • 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)
       
  • Pharmaceutical opioid overdose deaths and the presence of witnesses
    • Authors: Rowan P. Ogeil; Jeremy Dwyer; Lyndal Bugeja; Cherie Heilbronn; Dan I. Lubman; Belinda Lloyd
      Pages: 8 - 13
      Abstract: Publication date: May 2018
      Source:International Journal of Drug Policy, Volume 55
      Author(s): Rowan P. Ogeil, Jeremy Dwyer, Lyndal Bugeja, Cherie Heilbronn, Dan I. Lubman, Belinda Lloyd
      Background In the past two decades, rates of pharmaceutical opioid use and harms resulting from their use (including death) have risen. The present study identified a series of fatal opioid overdoses where there was evidence that witnesses had noted symptoms consistent with overdose, and examined associated contextual factors. Methods A retrospective review was undertaken utilising the Coroners Court of Victoria’s Overdose Deaths Register for pharmaceutical opioid overdose deaths between 2011 and 2013. Information on the source of pharmaceutical opioids, co-contributing drugs, history of drug dependence, and mental illness was extracted and coded. Results Pharmaceutical opioids were involved in 587 deaths, and within these, 125 cases (21%) were witnessed. The majority of these witnessed deaths (77.6%) occurred at the deceased’s residence, with the witness being a partner or unrelated acquaintance who did not realise the significance of what they were witnessing. The most common contributing pharmaceutical opioids were methadone (49.6%), codeine (32.0%), and oxycodone (19.2%), with the source more often prescribed than diverted. Co-contributing drugs were involved in 110 cases, with the most common being benzodiazepines. Evidence of current dependence and mental illness was found in 53.6% of cases. Conclusion Most pharmaceutical opioid overdose deaths with a witness present occurred in the deceased’s home, with symptoms of overdose being noted, but not acted upon. These findings support the trialling of education and/or naloxone to partners and family members of people who use pharmaceutical opioids in order to reduce overdose deaths.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.12.020
      Issue No: Vol. 55 (2018)
       
  • Older Māori understandings of alcohol use in Aotearoa/New Zealand
    • Authors: Sarah Herbert; Christine Stephens; Margaret Forster
      Pages: 123 - 129
      Abstract: Publication date: April 2018
      Source:International Journal of Drug Policy, Volume 54
      Author(s): Sarah Herbert, Christine Stephens, Margaret Forster
      Background The predominant framing of indigenous people’s alcohol use as problematic has resulted in narrow understandings of indigenous alcohol use in general. In particular, there has been little exploration of how Māori, those indigenous to Aotearoa/New Zealand, contextualise and understand their alcohol use. To build on current understandings of Māori alcohol use, this study explored the broader and socially shared meanings of alcohol use from the perspectives of older Māori. Methods Hui (meeting/s) were held with five kaupapa whānau (groups with a common purpose) comprising older Māori (n = 19) who shared their perspectives on Māori alcohol use. Data were analysed using a master/counter discursive narrative analytical framework. Results The results show that older Māori drew on a number of discursive strategies to construct three cultural narratives of Māori alcohol use. These were: ‘Not all Māori are problem drinkers’, ‘There is good Māori alcohol use’, and ‘Alcohol is not the problem’. These narratives simultaneously supported and challenged the dominant narrative that problematises Māori alcohol use. Conclusion These findings can be used to inform future research to show Māori understandings of alcohol use. Such research will support the development of culturally responsive alcohol policy and health promotion initiatives aimed at addressing alcohol related issues among Māori and thereby improve Māori health and wellbeing.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2018.01.017
      Issue No: Vol. 54 (2018)
       
  • Examining the relationship between medical cannabis laws and
           cardiovascular deaths in the US
    • Authors: Rahi Abouk; Scott Adams
      Pages: 1 - 7
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Rahi Abouk, Scott Adams
      Background Several countries and many U.S. states have allowed, for cannabis to be used as therapy to treat chronic conditions or pain., This has increased the use of cannabis, particularly among older people.Because cannabis has been linked to adverse cardiac events in the medical literature, there may be unintended consequences on increased use among older people. Methods We analyze cardiac-related mortality data from the U.S. National Vital Statistics System for 1990–2014. We use difference-in-difference fixed-effects models to assess whether there are increased rates of cardiac-related mortality following passage of medical cannabis programs. We also analyze whether states with more liberal rules on dispensing cannabis show higher mortality rates. Results For men, there is a statistically significant 2.3% increase in the rate of cardiac death following passage. For women, there is a 1.3% increase that is also statistically significant. he effects increase or both men and women with age. The effects are also stronger in states with more a lax approach to cannabis dispensing. Conclusion Policymakers should be aware of a potential unintended consequence of allowing broader use of cannabis, specifically for those more at risk of cardiovascular events.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.11.022
      Issue No: Vol. 53 (2018)
       
  • The impact of OxyContin reformulation at the Sydney Medically Supervised
           Injecting Centre: Pros and cons
    • Authors: Marianne Jauncey; Michael Livingston; Allison M. Salmon; Paul Dietze
      Pages: 17 - 22
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Marianne Jauncey, Michael Livingston, Allison M. Salmon, Paul Dietze
      Background Oxycodone is implicated in a large number of overdose deaths, many involving intravenous administration of preparations designed for oral administration. International responses have included education strategies, regulatory changes, and tamper-resistant preparations to discourage injecting. Reformulated OxyContin® was introduced in Australia in April 2014 and this study examines its impact on service utilisation, defined as visits to inject drugs at the Sydney Medically Supervised Injecting Centre (MSIC) and opioid overdoses at the MSIC. Methods Data from February 2007 to February 2016 are presented for drug type injected and onsite opioid overdose. The reformulated OxyContin® effect was modelled using an interrupted time series approach. Results Client visits declined >1000 per month, or 18%, following reformulation, largely explained by a reduction in visits to inject oxycodone, partially offset by increased morphine or fentanyl injections. Despite this significant reduction in visits, there was no corresponding decrease in the number of overdoses managed, explained somewhat by a partial displacement from oxycodone to other opioids. Stable overdose numbers within the context of decreased visit numbers were consistent with increases in heroin and morphine overdose, with an extra 22 heroin and 12 morphine overdoses on average per month. This increase was offset by the decrease of 17 OxyContin®, overdoses per month. Conclusions This study replicates the trend towards substitution of OxyContin® with other opioids following the introduction of reformulated OxyContin® in Australia and extends initial findings by showing the rate of overdose per MSIC visit increased following reformulation. These unintended consequences need to be considered when evaluating the success or otherwise of these kinds of changes in product formulation.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.11.025
      Issue No: Vol. 53 (2018)
       
  • Using drugs in un/safe spaces: Impact of perceived illegality on an
           underground supervised injecting facility in the United States
    • Authors: Peter J. Davidson; Andrea M. Lopez; Alex H. Kral
      Pages: 37 - 44
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Peter J. Davidson, Andrea M. Lopez, Alex H. Kral
      Background Supervised injection facilities (SIFs) are spaces where people can consume pre-obtained drugs in hygienic circumstances with trained staff in attendance to provide emergency response in the event of an overdose or other medical emergency, and to provide counselling and referral to other social and health services. Over 100 facilities with formal legal sanction exist in ten countries, and extensive research has shown they reduce overdose deaths, increase drug treatment uptake, and reduce social nuisance. No facility with formal legal sanction currently exists in the United States, however one community-based organization has successfully operated an ‘underground’ facility since September 2014. Methods Twenty three qualitative interviews were conducted with people who used the underground facility, staff, and volunteers to examine the impact of the facility on peoples’ lives, including the impact of lack of formal legal sanction on service provision. Results Participants reported that having a safe space to inject drugs had led to less injections in public spaces, greater ability to practice hygienic injecting practices, and greater protection from fatal overdose. Constructive aspects of being ‘underground’ included the ability to shape rules and procedures around user need rather than to meet political concerns, and the rapid deployment of the project, based on immediate need. Limitations associated with being underground included restrictions in the size and diversity of the population served by the site, and reduced ability to closely link the service to drug treatment and other health and social services. Conclusion Unsanctioned supervised injection facilities can provide a rapid and user-driven response to urgent public health needs. This work draws attention to the need to ensure such services remain focused on user-defined need rather than external political concerns in jurisdictions where supervised injection facilities acquire local legal sanction.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.12.005
      Issue No: Vol. 53 (2018)
       
  • Spore forming bacteria infections and people who inject drugs:
           Implications for harm reduction
    • Authors: Karen Dunleavy; Alison Munro; Kirsty Roy; Sharon Hutchinson; Norah Palmateer; Tony Knox; David Goldberg; Vivian Hope; John Campbell; Emma Hamilton; David Liddell; Gillian Penrice; Avril Taylor
      Pages: 45 - 54
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Karen Dunleavy, Alison Munro, Kirsty Roy, Sharon Hutchinson, Norah Palmateer, Tony Knox, David Goldberg, Vivian Hope, John Campbell, Emma Hamilton, David Liddell, Gillian Penrice, Avril Taylor
      Background There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014–July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb–April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks. Methods The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May–August 2015. Multivariate logistic regression was undertaken. Between Oct 2015–January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis. Results 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394–11.349, p < 0.001) or discussed the postcard (aOR = 25.114, CI 3.188–190.550, p < 0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322–4.890, p < 0.001) or discussed the postcard (aOR = 6.707, CI 2.744 16.252, p < 0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR = 3.304 CI 1.425 7.660, p < 0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events. Conclusion More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.12.001
      Issue No: Vol. 53 (2018)
       
  • Is recovery from cannabis use problems different from alcohol and other
           drugs' Results from a national probability-based sample of the United
           States adult population
    • Authors: John F. Kelly; M. Claire Greene; Brandon G. Bergman
      Pages: 55 - 64
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): John F. Kelly, M. Claire Greene, Brandon G. Bergman
      Background The policy landscape regarding the legal status of cannabis (CAN) in the US and globally is changing rapidly. Research on CAN has lagged behind in many areas, none more so than in understanding how individuals suffering from the broad range of cannabis-related problems resolve those problems, and how their characteristics and problem resolution pathways are similar to or different from alcohol [ALC] or other drugs [OTH]. Greater knowledge could inform national policy debates as well as the nature and scope of any additional needed services as CAN population exposure increases. Method National, probability-based, cross-sectional sample of the US non-institutionalized adult population was conducted July–August 2016. Sample consisted of those who responded “yes” to the screening question, “Did you used to have a problem with alcohol or drugs but no longer do'” (63.4% response rate from 39,809 screened adults). Final weighted sample (N = 2002) was mostly male (60.0% [1.53%]), aged 25–49 (45.2% [1.63%]), non-Hispanic White (61.4% [1.64%]), employed (47.7% [1.61%]). Analyses compared CAN to ALC and OTH on demographic, clinical, treatment and recovery support services utilization, and quality of life (QOL) indices. Results 9.1% of the US adult population reported resolving a significant substance problem, and of these, 10.97% were CAN. Compared to ALC (M = 49.79) or OTH (M = 43.80), CAN were significantly younger (M = 39.41, p < 0.01), had the earliest onset of regular use (CAN M = 16.89, ALC M = 19.02, OTH M = 23.29, p < 0.01), and resolved their problem significantly earlier (CAN M = 28.87, ALC M = 37.86, OTH M = 33.06, p < 0.01). Compared to both ALC and OTH, CAN were significantly less likely to report use of inpatient treatment and used substantially less outpatient treatment, overall (p < 0.01), although CAN resolving problems more recently were more likely to have used outpatient treatment (p < 0.01). Lifetime attendance at mutual-help meetings (e.g., AA) was similar, but CAN (M = 1.67) had substantially lower recent attendance compared to ALC (M = 7.70) and OTH (M = 7.65). QOL indices were similar across groups. Conclusion Approximately 2.4 million Americans have resolved a significant cannabis problem. Compared to ALC and OTH, the pattern of findings for CAN suggest similarities but also some notable differences in characteristics and problem resolution pathways particularly regarding earlier problem offset and less use of formal and informal services. Within a shifting policy landscape, research is needed to understand how increases in population exposure and potency may affect the nature and magnitude of differences observed in this preliminary study.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.12.007
      Issue No: Vol. 53 (2018)
       
  • Making multiple ‘online counsellings’ through policy and practice: an
           evidence-making intervention approach
    • Authors: Michael Savic; Ella Dilkes-Frayne; Adrian Carter; Renata Kokanovic; Victoria Manning; Simone N. Rodda; Dan I. Lubman
      Pages: 73 - 82
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Michael Savic, Ella Dilkes-Frayne, Adrian Carter, Renata Kokanovic, Victoria Manning, Simone N. Rodda, Dan I. Lubman
      Online counselling services for a range of health conditions have proliferated in recent years. However, there is ambiguity and tension around their role and function. It is often unclear whether online counselling services are intended to provide only a brief intervention, the provision of information or referral, or constitute an alternative to face-to-face treatment. In line with recent analyses of alcohol and other drug (AOD) policy and interventions that draw on a critical social science perspective, we take an evidence-making intervention approach to examine how online counselling in the AOD field is made in policy and through processes of local implementation. In this article, we analyse how online AOD counselling interventions and knowledges are enacted in Australia’s AOD policy, and compare these enactments with an analysis of information about Australia’s national online AOD counselling service, Counselling Online, and transcripts of counselling sessions with clients of Counselling Online. We suggest that while the policy enacts online counselling as a brief intervention targeting AOD use, and as an avenue to facilitate referral to face-to-face treatment services, in its implementation in practice online counselling is enacted in more varied ways. These include online counselling as attempting to attend to AOD use and interconnected psychosocial concerns, as a potential form of treatment in its own right, and as supplementing face-to-face AOD treatment services. Rather than viewing online counselling as a singular and stable intervention object, we suggest that multiple ‘online counsellings’ emerge in practice through local implementation practices and knowledges. We argue that the frictions that arise between policy and practice enactments need to be considered by policy makers, funders, clinicians and researchers as they affect how the concerns of those targeted by the intervention are attended to.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.12.008
      Issue No: Vol. 53 (2018)
       
  • Sheltering risks: Implementation of harm reduction in homeless shelters
           during an overdose emergency
    • Authors: Bruce Wallace; Katrina Barber; Bernadette (Bernie) Pauly
      Pages: 83 - 89
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Bruce Wallace, Katrina Barber, Bernadette (Bernie) Pauly
      Background The current opioid overdose crisis in North America is heightening awareness of the need for and the challenges of implementing harm reduction, notably within complex and diverse settings such as homeless shelters. In this paper, we explore the implementation of harm reduction in homeless shelters during an emerging overdose emergency. Methods The objective of this qualitative study was to identify and understand micro-environment level factors within emergency shelters responding to homelessness and substance use, and the macro-level influences that produce and sustain structural vulnerabilities. We conducted eight focus groups with a total of 49 participants during an emerging overdose emergency. These included shelter residents (n = 23), shelter staff (n = 13), and harm reduction workers (n = 13). Results The findings illustrate the challenges of implementing an overdose response when substance use is prohibited onsite, without an expectation of abstinence, and where harm reduction services are limited to the distribution of supplies. In this context, harm reduction is partially implemented and incomplete. Shelters can be a site of risks and trauma for residents and staff due to experiencing, witnessing, and responding to overdoses. Conclusion The current overdose crisis heightens the challenges of implementing harm reduction, particularly within complex and diverse settings such as homeless shelters. When harm reduction is limited to the distribution of supplies such as clean equipment and naloxone, important principles of engagement and the development of trust necessary to the provision of services are overlooked with negative implications for service users.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.12.011
      Issue No: Vol. 53 (2018)
       
  • Changes in public order after the opening of an overdose monitoring
           facility for people who inject drugs
    • Authors: Casey León; Lena J.P. Cardoso; Salem Johnston; Sarah Mackin; Barry Bock; Jessie M. Gaeta
      Pages: 90 - 95
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Casey León, Lena J.P. Cardoso, Salem Johnston, Sarah Mackin, Barry Bock, Jessie M. Gaeta
      Background In the face of an increasingly fatal opioid crisis, Boston Health Care for the Homeless Program (BHCHP) opened the Supportive Place for Observation and Treatment (SPOT), a unique low-threshold harm reduction program for monitoring people who have injected drugs and are at imminent risk of overdose. This study examines the impact of the opening of the SPOT program on measures of injection drug-related public order in the neighborhood surrounding the facility. Methods Data was collected at 10 weeks prior and 12 weeks post SPOT implementation on: number of over-sedated individuals in public, publicly discarded syringes, publicly discarded injection-related litter, and instances of active injection drug use or exchange of drugs. Changes were evaluated using Poisson log-linear regression models. Potential confounders such as weather and police presence were measured and controlled for. Results The average number of over-sedated individuals observed in public significantly decreased by 28% (4.3 [95% Confidence Interval (CI) 2.7–6.9] v 3.1 [CI 1.4–6.8]) after SPOT opened. The opening of SPOT did not have a significant effect on the other measures of public order. The daily average number of publicly discarded syringes (28.5 [CI 24.5–33.1] v 28.4 [CI 22.0–36.5]), pieces of publicly discarded injection-related litter (376.3 [CI 358.6–394.8] v 375.0 [CI 345.8–406.6]), and observed instances of active use or exchange of drugs (0.2 [CI 0.1–0.9] v 0.1 [CI 0.0–0.1]) were not statistically significantly different after the opening of SPOT. Conclusions The opening of SPOT was associated with a significant decrease in observed over-sedated individuals. Other measures of injection-drug related public order did not improve or worsen with the opening of SPOT, however, they have been shown to improve with the implementation of a supervised injection facility.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.12.009
      Issue No: Vol. 53 (2018)
       
  • Differences in risk behaviours and HIV status between primary amphetamines
           and opioid injectors in Estonia and Russia
    • Authors: Isabel Tavitian-Exley; Mathieu Maheu-Giroux; Lucy Platt; Robert Heimer; Anneli Uusküla; Olga Levina; Peter Vickerman; Marie-Claude Boily
      Pages: 96 - 105
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Isabel Tavitian-Exley, Mathieu Maheu-Giroux, Lucy Platt, Robert Heimer, Anneli Uusküla, Olga Levina, Peter Vickerman, Marie-Claude Boily
      Background and objective People who inject drugs (PWID) account for over half of new HIV infections in Eastern Europe and central Asia, where opioids continue to be the dominant illicit drugs injected. Stimulants including amphetamines (ATS) have been associated with HIV infection risk in several settings. We sought to examine whether primary ATS injection was associated with greater HIV risk, compared to opioid injection in two European locales with significant HIV epidemics. Methods PWID in Kohtla-Järve and St. Petersburg were recruited using respondent-driven sampling in 2012–2013. Survey data on demographic characteristics, service use, injecting and sexual risk behaviours and HIV-status (and HCV in Kohtla-Järve) were compared between primary opioid and ATS injectors using logistic regression models. Results Of 591 injectors recruited in Kohtla-Järve and 811 in St. Petersburg, 195 (33%) and 27 (4%) primarily injected ATS in each city. In both cities, ATS injectors were younger than opioid injectors, initiated injection later, injected less frequently and were more likely to have been paid for sex. In both cities, PWID had high levels of multiple sex partners. In Kohtla-Järve, ATS-injectors had lower odds of back-loading and greater odds of polydrug use than opioid-injectors. In St. Petersburg, where over half of PWID reported unsafe sharing practices, ATS-injectors were less likely to report these practices. ATS-injection was negatively associated with being HIV positive in Kohtla-Järve (aOR = 0.6; 95%CI: 0.5–0.8) and St. Petersburg (aOR = 0.3; 95%CI: 0.1–0.7). ATS-injection was negatively associated with HCV-reactivity in Kohtla-Järve (aOR = 0.5; 95%CI: 0.3–0.6). Conclusions In both locations, primary ATS injection was associated with lower injecting risk behaviours, lower odds of HIV and being paid for sex compared to opioid injection. Interventions targeting the characteristics and needs of ATS injectors are needed to increase contact with services and reduce sexual and injecting risk. Harm reduction services, including sexual risk reduction, need to be expanded for all PWID in St. Petersburg.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.11.010
      Issue No: Vol. 53 (2018)
       
  • ‘You’re repulsive’: Limits to acceptable drunken
           comportment for young adults
    • Authors: Sarah MacLean; Amy Pennay; Robin Room
      Pages: 106 - 112
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Sarah MacLean, Amy Pennay, Robin Room
      Background Researchers have described a ‘culture of intoxication’ among young people. Yet drunkenness remains a socially risky practice with potential to evoke emotions of irritation and even disgust. We consider intoxicated practices that young adults in Melbourne, Australia, described as distasteful, to identify contemporary cultural forces that constrain intoxication and limit how it is enacted. Method Interviews were conducted with 60 participants in Melbourne, Australia, each with recent drinking experience. Participants were asked to provide accounts of moments when they regarded their own or others’ drunken comportment as unsociable or unpleasant. Transcripts were analysed to identify recurrent themes. Results Despite amusement when recounting drunken antics, almost everyone in the study identified some discomfort at their own or other’s drunkenness. We describe four interacting domains where lines delineating acceptable comportment appear be drawn. The first concerns intoxicated practices. Unpleasant drunken comportment often entailed a sense that the drunk person had disturbed others through an overflow of the self − extruding intimacy, sexuality, violence or bodily fluids. The second domain was gendering, with women vulnerable to being regarded as sexually inappropriate, and men as threatening. Third, the settings where intoxicated behaviour occurred influenced whether intoxicated people risked censure. Finally, the relationships between the drunk person and others, including their respective social positions and drinking patterns, shaped how they were perceived. Conclusion The capacity of alcohol to render people more open to the world is both sought and reviled. It is important to recognise that there remain limits on acceptable drunken comportment, although these are complex and contingent. These limits are enforced via people’s affective responses to drunkenness. This is form of alcohol harm reduction that occurs outside of public health intervention. Thus, cultures that constrain drinking should be supported wherever it is possible to do so without reinforcing stigmatising identities.

      PubDate: 2018-02-05T14:16:54Z
      DOI: 10.1016/j.drugpo.2017.10.005
      Issue No: Vol. 53 (2018)
       
  • Hedging bets: Applying New Zealand’s gambling machine regime to
           cannabis legalization
    • Authors: Jonathan P. Caulkins
      Pages: 113 - 114
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Jonathan P. Caulkins
      Cannabis legalization is often falsely depicted as a binary choice between status quo prohibition and legalizing production and distribution by (regulated) for-profit industry. There are, however, many more prudent architectures for legalization, such as restricting production and distribution licenses to not-for-profit entities. Wilkins describes how New Zealand applied that concept to gambling machines and proposes a parallel for cannabis legalization. Greater investment in proposing good designs along these lines, including attending to governance structures, would be valuable.

      PubDate: 2018-02-05T14:16:54Z
      DOI: 10.1016/j.drugpo.2017.12.015
      Issue No: Vol. 53 (2018)
       
  • A “not-for-profit” regulatory model for legal recreational cannabis:
           Insights from the regulation of gaming machine gambling in New Zealand
    • Authors: Chris Wilkins
      Pages: 115 - 122
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Chris Wilkins
      A dozen or more regulatory frameworks have been proposed for legal cannabis but many of the “not-for-profit” options have yet to be developed in any detail, reducing the likelihood they will be seriously considered by policy makers. New Zealand’s innovative “not-for-profit” regulatory regime for gaming machine gambling (i.e. “slot machines”) has reversed the previous increase in gambling expenditure, empowered local councils to cap the number of gambling venues, and is unique in requiring the societies operating gaming machines to distribution 40% of the gross expenditure from machines (i.e. $NZ 262 million in 2015) to community purposes (e.g. sports). However, the regime has been criticised for not addressing the concentration of gaming outlets in poorer communities, and not requiring grants to be allocated in the disadvantaged communities where outlets are located. There have also been cases of gaming societies providing community grants in exchange for direct or indirect benefits. In this paper we adapt this regulatory approach to a legal cannabis market. Under the proposed regime, licensed “not-for-profit” cannabis societies will be required to distribute 20% of cannabis sales to drug treatment and 20% to community purposes, including drug prevention. Grants must be allocated in the regions where cannabis sales are made and grant committees must be independent from cannabis societies. A 20% levy will be used to cover the wider health costs of cannabis use. A further 10% levy will be used to fund the regulator and evaluate the new regime. Local councils will have the power to decide how many, and where, cannabis retail outlets are located. Other important elements include a minimum price for cannabis, effective taxation of cannabis products, regulating CBD in cannabis products, higher taxation of traditional smoking products, advertising restricted to place-of-sale, no internet sales, and restrictions on industry involvement in regulation making and research.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.12.002
      Issue No: Vol. 53 (2018)
       
  • Learning lessons: The need for effective evaluation of regulatory change
    • Authors: Heather Wardle
      Pages: 123 - 124
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Heather Wardle


      PubDate: 2018-02-05T14:16:54Z
      DOI: 10.1016/j.drugpo.2018.01.006
      Issue No: Vol. 53 (2018)
       
  • The structured ambivalence of cannabis control in England &amp; Wales
    • Authors: David Brewster
      Pages: 125 - 132
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): David Brewster
      The two reclassifications of cannabis in England & Wales in 2004 and 2009 have been subjected to a series of academic analyses which have largely been centred on either the relationship to evidence, or in terms of the implications and realities of policing and health under the changes. However, despite the wealth of attention on this area, there have been relatively few attempts to understand these policy movements through broader criminological theoretical frameworks. One recent exception is Shiner’s (2015) utilisation of Garland’s (2001) concept of ‘structured ambivalence’. This paper seeks to test this application through drawing upon an alternative source of evidence, namely, a series of ‘elite’ qualitative interviews, and using Kingdon’s (1995) Multiple Streams model to make sense of the policy processes. In doing so, it largely corroborates Shiner’s conclusions whilst also further illuminating particular agentic aspects and their intertwining with other structural and cultural forces which led to the reclassifications. These findings demonstrate the value of triangulating evidential sources and advances knowledge about the role of individuals in pursuing policy agendas within a broader shifting political climate. This provides greater scope to further test and understand how structured ambivalence manifests itself in other cultural contexts and policy domains.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2018.01.005
      Issue No: Vol. 53 (2018)
       
  • Chemsex, risk behaviours and sexually transmitted infections among men who
           have sex with men in Dublin, Ireland
    • Authors: Ronan W. Glynn; Niamh Byrne; Siobhan O’Dea; Adam Shanley; Mary Codd; Eamon Keenan; Mary Ward; Derval Igoe; Susan Clarke
      Pages: 9 - 15
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Ronan W. Glynn, Niamh Byrne, Siobhan O’Dea, Adam Shanley, Mary Codd, Eamon Keenan, Mary Ward, Derval Igoe, Susan Clarke
      Background Drug use for or during sex (‘chemsex’) among MSM has caused concern, because of the direct effects of the drugs themselves, and because of an increased risk of transmission of sexually transmitted infections (STIs). This study aimed to assess the prevalence of chemsex, associated behaviours and STIs among attendees at Ireland’s only MSM-specific sexual health clinic in Dublin over a six week period in 2016. Methods The questionnaire collected demographic data, information on sexuality and sexual practice, self-reported history of treatment for STIs, and chemsex use. Key variables independently associated with treatment for STIs over the previous 12 months were identified using multivariable logistic regression. Results The response rate was 90% (510/568). One in four (27%) reported engaging in chemsex within the previous 12 months. Half had taken ≥2 drugs on his last chemsex occasion. One in five (23%) reported that they/their partners had lost consciousness as a result of chemsex. Those engaging in chemsex were more likely to have had more sexual partners(p<0.001), more partners for anal intercourse (p<0.001) and to have had condomless anal intercourse(p=0.041). They were also more likely to report having been treated for gonorrhoea over the previous 12 months (adjusted OR 2.03, 95% CI 1.19–3.46, p=0.009). One in four (25%) reported that chemsex was impacting negatively on their lives and almost one third (31%) reported that they would like help or advice about chemsex. Conclusion These results support international evidence of a chemsex culture among a subset of MSM. They will be used to develop an effective response which simultaneously addresses addiction and sexual ill-health among MSM who experience harm/seek help as a consequence of engagement in chemsex.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.10.008
      Issue No: Vol. 52 (2018)
       
  • Harm reduction-based and peer-supported hepatitis C treatment for people
           who inject drugs in Georgia
    • Authors: Tamar Kikvidze; Niklas Luhmann; Elisabeth Avril; Maia Butsashvili; Konstantine Labartkava; Aurélie Etienne; Diane Le Pluart; Ina Inaridze; Ana Gamezardashvili; David Kharshiladze; Julie Bouscaillou
      Pages: 16 - 19
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Tamar Kikvidze, Niklas Luhmann, Elisabeth Avril, Maia Butsashvili, Konstantine Labartkava, Aurélie Etienne, Diane Le Pluart, Ina Inaridze, Ana Gamezardashvili, David Kharshiladze, Julie Bouscaillou


      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.11.014
      Issue No: Vol. 52 (2018)
       
  • The relationship between Australian harm minimisation alcohol education
           and student uptake, consumption and harm
    • Authors: Richard Midford; Leanne Lester; Tahlia Williams; Victoria White
      Pages: 25 - 31
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Richard Midford, Leanne Lester, Tahlia Williams, Victoria White
      Background Alcohol use by young people is a public health concern in Australia because of the disproportionate harm they experience. Accordingly, governments have sought to protect young people, with school identified as an appropriate site for drug, including alcohol, prevention through education. School-based drug education programmes, however, have not been particularly effective, and even when individual programs report prevention benefits they can be criticised for being developed and evaluated by the same group. Methods This study involved secondary analysis of alcohol data from the 2011 and 2014 Australian Secondary Students Alcohol and Drug (ASSAD) surveys, to examine the relationship between the amount of alcohol education students reported receiving and their patterns of use and harm. Associations between the amount of alcohol education remembered and alcohol uptake, consumption, risky consumption and alcohol-related harm were measured using Logistic and Tobit regression techniques. As most alcohol education in Australia reflects harm minimisation aims, this research provides an independent, proxy assessment of the effect of harm minimisation education. Results In the 12- to 17-year-old student group, as a whole, there was a significant positive association between having tried alcohol and the level of alcohol education recalled. There were significant negative associations between the amount of alcohol consumed and the level of alcohol education recalled for drinkers and risky drinkers. There were no significant associations between alcohol-related harm and the level of alcohol education recalled for drinkers and risky drinkers. Conclusion Providing more harm minimisation alcohol education did not persuade students to abstain from alcohol, but rather the reverse. Providing more harm minimisation education was influential in reducing consumption by students, particularly those drinking at risky levels. This should be considered indirectly beneficial in terms of minimising harm. However, the alcohol education provided to Australian students has not directly influenced their alcohol-related harm.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.11.023
      Issue No: Vol. 52 (2018)
       
  • Kalaban: Young drug users’ engagements with law enforcement in the
           Philippines
    • Authors: Gideon Lasco
      Pages: 39 - 44
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Gideon Lasco
      Background A violent ‘war on drugs’ continues to be waged in the Philippines, even as the use of drugs − particular methamphetamine − continues to rise. Furnishing contextual background to the current situation, this paper explores how long-running law enforcement approaches in the Philippines might be viewed by those in their receiving end by presenting findings of an ethnography among marginalized young men. Methods Semi-structured interviews and focus group discussions were conducted among 20 young men throughout a 12-month period of participant-observation from December 2011 to September 2013. Findings Young people make use of various ‘tactics’ to keep using drugs and evade law enforcement, even as drug use itself is a tactic in their everyday lives. A sense of hypocrisy and injustice, borne of their own experiences, informs their view of law enforcers, whom they call kalaban (enemy). They feel they are being unfairly targeted, but in their view, this danger is just part of the perils of their everyday lives. Conclusion Young men’s resort to various tactics speaks of an agency that is often ignored in public discourses. Their ‘lay assessments of risks’ and experience-based perceptions of law enforcement raises questions about the efficacy of fear-based anti-drug campaigns. Overall, the study offers an ethnographic argument against the punitive methods being employed by the Philippines, and for measures that reframe the relationship between police and young drug users − from hostility to trust.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.11.006
      Issue No: Vol. 52 (2018)
       
  • Identifying gaps in the implementation of naloxone programs for laypersons
           in the United States
    • Authors: Barrot H. Lambdin; Jon Zibbell; Eliza Wheeler; Alex H. Kral
      Pages: 52 - 55
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Barrot H. Lambdin, Jon Zibbell, Eliza Wheeler, Alex H. Kral


      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.11.017
      Issue No: Vol. 52 (2018)
       
  • Becoming a medical marijuana user
    • Authors: Stephen E. Lankenau; Avat Kioumarsi; Megan Reed; Miles McNeeley; Ellen Iverson; Carolyn F. Wong
      Pages: 62 - 70
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Stephen E. Lankenau, Avat Kioumarsi, Megan Reed, Miles McNeeley, Ellen Iverson, Carolyn F. Wong
      Background Since marijuana became legal for medical use in California in 1996, reasons for medical use among medical marijuana patients (MMP) have become increasingly well described in qualitative studies. However, few studies have detailed how the use of marijuana for medical purposes fits into the broader career trajectories of either becoming a marijuana user or becoming a MMP, including the social influences on medical use. Methods Young adult MMP (N=40) aged 18 to 26 years old were recruited in Los Angeles, CA in 2014-15 and administered a semi-structured interview that included questions focusing on marijuana use practices before and after becoming MMP. Results MMP were categorized into three trajectory groups: primarily medical users (n=30); primarily non-medical users (n=3); and medical users who transitioned to non-medical users (n=7). Most medical users discovered medicinal effects from marijuana in the context of non-medical use as adolescents prior to becoming MMP. Becoming a mature MMP followed interactions with dispensary staff or further self-exploration of medical uses and often involved a social process that helped confirm the legitimacy of medical use and identity as a medical user. In some cases, MMP transitioned back to non-medical users as health conditions improved or remained primarily non-medical users even after becoming MMP for reasons unrelated to health, e.g., protection against arrest. Conclusion Becoming a medical marijuana user was an important career trajectory that was influenced by early discoveries of effective medicinal use, interaction with proponents of medical use at dispensaries, experiences with new kinds of medical use, and the demands of particular health condition requiring more or less treatment with marijuana.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.11.018
      Issue No: Vol. 52 (2018)
       
  • Multiple injections per injection episode: High-risk injection practice
           among people who injected pills during the 2015 HIV outbreak in Indiana
    • Authors: Dita Broz; Jon Zibbell; Carrie Foote; Jeremy C. Roseberry; Monita R. Patel; Caitlin Conrad; Erika Chapman; Philip J. Peters; Richard Needle; Cameron McAlister; Joan M. Duwve
      Pages: 97 - 101
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Dita Broz, Jon Zibbell, Carrie Foote, Jeremy C. Roseberry, Monita R. Patel, Caitlin Conrad, Erika Chapman, Philip J. Peters, Richard Needle, Cameron McAlister, Joan M. Duwve
      Background Misuse of prescription opioid analgesics (POA) has increased dramatically in the US, particularly in non-urban areas. We examined injection practices among persons who inject POA in a rural area that experienced a large HIV outbreak in 2015. Methods Between August-September 2015, 25 persons who injected drugs within the past 12 months were recruited in Scott County, Indiana for a qualitative study. Data from in-depth, semi-structured interviews were analyzed. Results All 25 participants were non-Hispanic white and the median age was 33 years (range: 19–57). All had ever injected extended-release oxymorphone (Opana® ER) and most (n=20) described preparing Opana® ER for multiple injections per injection episode (MIPIE). MIPIE comprised 2–4 injections during an injection episode resulting from needing >1mL water to prepare Opana® ER solution using 1mL syringes and the frequent use of “rinse shots.” MIPIE occurred up to 10 times/day (totaling 35 injections/day), often in the context of sharing drug and injection equipment. Conclusions We describe a high-risk injection practice that may have contributed to the rapid spread of HIV in this community. Efforts to prevent bloodborne infections among people who inject POA need to assess for MIPIE so that provision of sterile injection equipment and safer injection education addresses the MIPIE risk environment.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.12.003
      Issue No: Vol. 52 (2018)
       
  • Interpreting the Czech drug decriminalization: The glass is half full –
           Response to Cerveny, J., Chomynova, P., Mravcik, V., & van Ours, J.C.
           (2017). Cannabis decriminalization and the age of onset of cannabis use
    • Authors: Vendula Belackova; Michaela Stefunkova
      Pages: 102 - 105
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Vendula Belackova, Michaela Stefunkova


      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.10.010
      Issue No: Vol. 52 (2018)
       
  • Being in control' A thematic content analysis of 14 in-depth
           interviews with 2,4-dinitrophenol users
    • Authors: Neha Prasad Ainsworth; Elisabeth Julie Vargo; Andrea Petróczi
      Pages: 106 - 114
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Neha Prasad Ainsworth, Elisabeth Julie Vargo, Andrea Petróczi
      Background 2,4-Dinitrophenol (2,4-DNP) is a compound with multiple industrial purposes. Currently unlicensed for human consumption, it is used by the gym-going population for drastic, short-term body fat loss. Nonetheless, physiological mechanisms can lead to potentially fatal hyperthermia. Reported fatal incidents have caused concern and highlighted the need for intervention. Understanding decision-making leading to 2,4-DNP use alongside the perceived outgroup attitudes is vital to forming effective harm minimisation policies targeting current and potential users. First-hand accounts from this elusive population are scarce. Methods Fourteen novel and experienced users (13 male, 1 female) were recruited via “snowballing” techniques. Semi-structured interviews were conducted, comprising 28 questions. Thematic content analysis was conducted using 37 codes. Results Four characteristic themes emerged: 1. Users considered the Internet to be a crucial multifunctional resource directly impacting their 2,4-DNP use. 2. Users “respected” 2,4-DNP, proactively taking harm reduction measures. 3. Attitudinal polarisation towards 2,4-DNP within the gym-going community was consistent in all accounts. 4. Users perceived outgroup populations to have inherently negative attitudes towards their use. These themes fell under the all-encompassing theme of “being in control”. Conclusion For the first time, this study offers a rich detail of attitudes toward 2,4-DNP use by giving a collective voice to users. The element of control over every aspect of the users’ life appears to be a significant contributor to the successful risk-management of 2,4-DNP use. In the absence of an established safe upper limit and effective regulatory control, education is critical to harm minimisation.

      PubDate: 2018-02-05T14:16:54Z
      DOI: 10.1016/j.drugpo.2017.12.012
      Issue No: Vol. 52 (2018)
       
  • Determinants of hepatitis C antiviral effectiveness awareness among people
           who inject drugs in the direct-acting antiviral era
    • Authors: Heather Valerio; Andrew McAuley; Hamish Innes; Norah Palmateer; David J. Goldberg; Alison Munro; Avril Taylor; Sharon J. Hutchinson
      Pages: 115 - 122
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Heather Valerio, Andrew McAuley, Hamish Innes, Norah Palmateer, David J. Goldberg, Alison Munro, Avril Taylor, Sharon J. Hutchinson
      Background & aims Although people who inject drugs (PWID) are at greatest risk of hepatitis C (HCV), treatment uptake in this population has historically been low. Highly effective direct acting antiviral (DAA) treatments for HCV have recently become available. Our aim was to assess the awareness among PWID of these new therapies and their effectiveness. Methods A national survey of PWID attending injecting equipment provision sites in Scotland during 2015–2016 included questions to gauge the awareness in this population of antiviral treatment and the high cure rates associated with new therapies (defined here as >80%). Results Among 2623 PWID, 92% had ever been tested for HCV. After excluding those ever treated for HCV (n = 226), 79% were aware of HCV treatment. Awareness was more likely among those who had ever been tested and self-reported either a positive (adjusted odds ratio: 16.04, 95%CI 10.57–24.33) or negative (3.11, 2.30–4.22) test result, compared to those who were never tested. The minority of all respondents (17%) were aware of high cure rates. This awareness was more likely among those who had ever been in HCV specialist care (9.76, 5.13–18.60) and those who had not been in specialist care but had been tested and self-reported either a positive (3.91, 2.20–7.53) or negative (2.55, 1.35–4.81) test result, compared to those who had never been tested. Conclusion We found poor awareness of the high cure rates associated with DAAs among PWID in Scotland, despite relatively high rates of HCV testing in this population. Increased effort is needed to ensure population groups with high risk of HCV infection are fully informed of the highly effective antiviral medications now available to treat this chronic disease.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2017.12.014
      Issue No: Vol. 52 (2018)
       
  • “It Ruined My Life”: The effects of the War on Drugs on people who
           inject drugs (PWID) in rural Puerto Rico
    • Authors: R. Abadie; C. Gelpi-Acosta; C. Davila; A. Rivera; M. Welch-Lazoritz; K. Dombrowski
      Pages: 121 - 127
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): R. Abadie, C. Gelpi-Acosta, C. Davila, A. Rivera, M. Welch-Lazoritz, K. Dombrowski
      Background The War on Drugs has raised the incarceration rates of racial minorities for non-violent drug-related crimes, profoundly stigmatized drug users, and redirected resources from drug prevention and treatment to militarizing federal and local law enforcement. Yet, while some states consider shifting their punitive approach to drug use, to one based on drug treatment and rehabilitation, nothing suggests that these policy shifts are being replicated in Puerto Rico. Methods This paper utilizes data from 360 PWID residing in four rural towns in the mountainous area of central Puerto Rico. We initially recruited 315 PWID using respondent-driven sampling (RDS) and collected data about risk practices and conducted HIV and HCV testing. During a second phase, we conducted 34 micro-ethnographic assays, in which we randomly recruited 34 participants from the first phase and included their ego networks in this phase. Our ethnographic inquiry produced significant data regarding the effects of the war on drugs on the local drug trade, drug availability, and injectors' social networks. Results Findings suggest that repressive policing has been ineffective in preventing drug distribution and use among those in our study. This type of law enforcement approach has resulted in the disproportionate incarceration of poor drug users in rural Puerto Rico, and mainly for nonviolent drug-related crimes. In addition, incarceration exposes PWID to a form of a cruel and unusual punishment: having to quit heroin “cold turkey” while the prison environment also represents a HIV/HCV risk. In turn, the war on drugs not only diverts resources from treatment but also shapes treatment ideologies, punishing non-compliant patients. Conclusion Shifting the emphasis from repression to treatment and rehabilitation is likely to have a positive impact on the health and overall quality of life of PWID and their communities.

      PubDate: 2018-01-10T09:31:53Z
      DOI: 10.1016/j.drugpo.2017.06.011
      Issue No: Vol. 51 (2018)
       
  • The new front in the war on doping: Amateur athletes
    • Authors: April D. Henning; Paul Dimeo
      Pages: 128 - 136
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): April D. Henning, Paul Dimeo
      The war on drugs is usually associated with criminal policies aimed at stemming consumption of drugs such as heroin, cocaine, and cannabis, less so with enhancement drugs like those used in sport. As drug use in sport, or doping, has become more visibly widespread, policies aimed at combating the issue have become more restrictive, intrusive, and harsh. In this article we draw new comparisons between the wider war on drugs and recent developments in sports anti-doping. We identify a growing trend towards criminalisation of traffickers and users, and associate that with another growing trend: the testing of amateur athletes. This article reviews the current anti-doping system, including the recent amateur policies, then considers of the results of one such program in amateur cycling. We then shift to consider the possible implications for amateurs of criminal doping laws and the recent debates about allowing medical exemptions for therapeutic use of banned substances. We show that drug use in sport can be understood as a new front in the war on drugs, with some extreme measures and many negative unintended consequences. To remedy this, we argue that amateur athletes require a separate anti-doping policy focused on minimising harms of use.

      PubDate: 2018-01-10T09:31:53Z
      DOI: 10.1016/j.drugpo.2017.05.036
      Issue No: Vol. 51 (2018)
       
  • Comparing cryptomarkets for drugs. A characterisation of sellers and
           buyers over time
    • Authors: Meropi Tzanetakis
      Abstract: Publication date: Available online 12 February 2018
      Source:International Journal of Drug Policy
      Author(s): Meropi Tzanetakis
      Introduction Cryptomarkets operating on the darknet are a recent phenomenon that has gained importance only over the last couple of years (Barratt, 2012). However, they now constitute an evolving part of illicit drug markets. Although selling and buying a variety of psychoactive substances on the Internet has a long history, new technological developments enable systematic drug trading on the net.These technological innovations on the Internet allow users to proceed with (illicit) drug transactions with almost completely anonymous identities and locations. In this paper, we provide a systematic measurement analysis of structures and trends on the most popular anonymous drug marketplace, and discuss the role of cryptomarkets in drug distribution. Methods Data collection and analysis include a long-term measurement of the cryptomarket ‘AlphaBay', the most popular platform during the survey period. By developing and applying a web-scraping tool, market data was extracted from the marketplace on a daily basis during a period of twelve months between September 2015 and August 2016. The data was analysed by using business-intelligence software, which allows the linking of various data sets. We found 2188 unique vendors offering 11,925 drug items. The findings of our long-term monitoring and data analysis are compared over time and across marketplaces, offering a detailed understanding of the development of revenues generated, characterisation of countries of origin and destination, and distribution of vendors and customers over time. Results We provide a nuanced and highly detailed longitudinal analysis of drug trading on the darknet marketplace ‘AlphaBay', which was the largest cryptomarket in operation. 1) Total sales volumes for the ‘drugs' section was estimated at approximately USD 94 million for the period from September 2015 to August 2016. 2) In addition, about 64% of all sales are made with cocaine-, cannabis-, heroin-, and ecstasy-related products. 3) Average selling prices increase over time for categories including cannabis and hashish, ecstasy, opioids, psychedelics and stimulants. 4) The five most frequent countries of origin as indicated by vendors are the United States, United Kingdom, Australia, the Netherlands and Germany. Moreover, it was demonstrated that drug distribution on cryptomarkets is conducted at a regional rather than global level. 6) Furthermore, 4.88% of vendors made over USD 200,000 and were responsible for 52.9% of total revenues generated over the period analysed. In contrast, 57.51% of vendors managed to sell drug items worth less than USD 10,000 within a period of twelve months. The findings suggest that ‘AlphaBay' was a cryptomarket mainly from and for Western industrialised countries. In contrast, countries of the global South are neither among the main countries of origin nor destination countries.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2018.01.022
       
  • Prevalence and correlates of recent injecting drug use among gay and
           bisexual men in Australia: Results from the FLUX study
    • Authors: H. Bui; I. Zablotska-Manos; M. Hammoud; F. Jin; T. Lea; A. Bourne; J. Iversen; N. Bath; J. Grierson; L. Degenhardt; G. Prestage; L. Maher
      Abstract: Publication date: Available online 9 February 2018
      Source:International Journal of Drug Policy
      Author(s): H. Bui, I. Zablotska-Manos, M. Hammoud, F. Jin, T. Lea, A. Bourne, J. Iversen, N. Bath, J. Grierson, L. Degenhardt, G. Prestage, L. Maher
      Background While illicit drug use is prevalent among gay and bisexual men (GBM) in Australia, little is known about the factors associated with injecting drug use among GBM. Methods The Following Lives Undergoing Change (FLUX) study is a national, online prospective observational cohort investigating drug use among Australian GBM. Eligible participants were men living in Australia who were aged 16.5 years or older, identified as gay or bisexual or had sex with at least one man in the last year. We examined baseline data for associations between socio-demographic and behavioural characteristics and recent (last six months) injecting using log-binomial regression. Results Of 1995 eligible respondents, 206 (10.3%) reported ever injecting drugs and 93 (4.7%) had injected recently, most commonly crystal (91.4%) and speed (9.7%). Among recent injectors, only 16 (17.2%) reported injecting at least weekly; eight (8.6%) reported recent receptive syringe sharing. Self-reported HIV and HCV prevalence was higher among recent injectors than among other participants (HIV: 46.2% vs 5.0%, p < .001; HCV: 16.1% vs. 1.2%, p < .001). Recent injecting was associated with lifetime use of more drug classes (adjusted prevalence ratio (APR) = 1.31, 95% Confidence Interval (95%CI) 1.21–1.41), longer time since initiating party drug use (APR = 1.02, 95%CI 1.01–1.04), greater numbers of sex partners (2–10 sex partners: APR = 3.44, 95%CI 1.45–8.20; >10 sex partners: APR = 3.21, 95%CI 1.30–7.92), group sex (APR = 1.42, 95%CI 1.05–1.91) and condomless anal intercourse with casual partners (APR = 1.81, 95%CI 1.34–2.43) in the last six months. Conclusions Observed associations between injecting and sexual risk reflect a strong relationship between these practices among GBM. The intersectionality between injecting drug use and sex partying indicates a need to integrate harm reduction interventions for GBM who inject drugs into sexual health services and targeted sexual health interventions into Needle and Syringe Programs.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2018.01.018
       
  • Mental health, drug use and sexual risk behavior among gay and bisexual
           men
    • Authors: Garrett Prestage; Mohamed Hammoud; Fengyi Jin; Louisa Degenhardt; Adam Bourne; Lisa Maher
      Abstract: Publication date: Available online 9 February 2018
      Source:International Journal of Drug Policy
      Author(s): Garrett Prestage, Mohamed Hammoud, Fengyi Jin, Louisa Degenhardt, Adam Bourne, Lisa Maher
      Background Compared to the general population, among gay and bisexual men (GBM) prevalence rates of anxiety and depression, and of drug use, are high. Objective This paper explores the relationship between mental health, sexual risk behavior, and drug use among Australian GBM. We identify factors associated with indicators of poor mental health. Methods Between September 2014 and July 2017, 3017 GBM responded to measures of anxiety and depression in an online cohort study of drug use. Results Mean age was 35.3 years (SD 12.8). 17.9% screened positive for current moderate-severe anxiety and 28.3% for moderate-severe depression. The majority (52.2%) reported use of illicit drugs in the previous six months, including 11.2% who had used methamphetamine. One third had high (20.4%) or severe (10.6%) risk levels of alcohol consumption, and 18.3% who were current daily smokers. Most illicit drug use in general was not associated with either anxiety or depression, but men who used cannabis were more likely to show evidence of depression (p = 0.005). Among recent methamphetamine users, 28.0% were assessed as dependent: dependent users were more likely to show evidence of both depression and anxiety than were non-dependent users. High or severe risk drinking was associated with depression and daily tobacco use was associated with both anxiety and depression. Depression and anxiety was associated with: less personal support, viewing oneself as ‘feminine’, and being less socially engaged with gay men. Sexual risk behavior was not associated with either depression or anxiety. Conclusion Prevalence of anxiety and depression was high, as was prevalence of licit and illicit drug use. Substance use was associated with anxiety and depression only when the use was considered problematic or dependent. Social isolation and marginalization are strong drivers of poor mental health, even within this population for whom anxiety and depression are common.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2018.01.020
       
  • Typology of drug use in United Kingdom men who have sex with men and
           associations with socio-sexual characteristics
    • Authors: G.J. Melendez-Torres; Adam Bourne; David Reid; Ford Hickson; Chris Bonell; Peter Weatherburn
      Abstract: Publication date: Available online 2 February 2018
      Source:International Journal of Drug Policy
      Author(s): G.J. Melendez-Torres, Adam Bourne, David Reid, Ford Hickson, Chris Bonell, Peter Weatherburn
      Background Analysis of specific drug use patterns in men who have sex with men (MSM) is important in targeting HIV prevention and harm reduction interventions and in developing a fuller picture of drug use in context beyond consideration of use of specific drugs in isolation. Objectives We sought to develop a typology of recent drug use in MSM, and to explore how distribution of MSM across the classes in this typology differs by socio-sexual characteristics. Methods We examined last-year drug use reported by 16,814 MSM as part of a cross-sectional, internet-based survey of MSM living in the UK for which data were collected in late summer 2014. We tested models with between two and six classes for types of specific drug use, and related socio-sexual covariates to the classes in the best model using multinomial regression. Results Our five-class model described a range of drug use patterns, including minimal users, low-threshold users, old-skool users, chemsex-plus users and diverse users. MSM identifying as gay were more likely to not be minimal users. HIV-positive MSM were more likely to be chemsex-plus users than HIV-negative MSM. Number and type of non-steady partners, ethnicity and education were each related to class membership, though trends were complex. Conclusions Findings from associations between correlates and latent classes suggest avenues for service development beyond current attention to opiates or chemsex drugs. Our findings draw attention to heterogeneity in drug use patterns in MSM beyond what current discourse on chemsex drugs would suggest.

      PubDate: 2018-02-14T20:39:43Z
      DOI: 10.1016/j.drugpo.2018.01.007
       
  • Problematising LGBTIQ drug use, governing sexuality and gender: A critical
           analysis of LGBTIQ health policy in Australia
    • Authors: Kiran Pienaar; Dean A. Murphy; Kane Race; Toby Lea
      Abstract: Publication date: Available online 1 February 2018
      Source:International Journal of Drug Policy
      Author(s): Kiran Pienaar, Dean A. Murphy, Kane Race, Toby Lea
      It is well-established that a high prevalence of substance use is found in lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) populations; a finding that researchers attribute to the stigmatised status of non-normative sexual and gender expression, and the role of illicit drug use in the collective production of socio-sexual pleasures, expressivity and disclosure in LGBTIQ communities. Despite the connections between sexual experimentation and substance use, LGBTIQ consumption practices have rarely received the attention they deserve within the alcohol and other drug (AOD) field. In this paper, we draw on concepts from post-structuralist policy analysis to analyse how AOD consumption among sexual and gender minorities is constituted in the policies of three Australian LGBTIQ health organisations. Following Carol Bacchi’s (2009, p. xi) observation that we are “governed through problematisations rather than policies”, we consider how substance use in LGBTIQ populations has been formulated as a policy problem requiring intervention. Doing so allows us to identify the normative assumptions about minority sexual and gender identities that underpin dominant problematisations of LGBTIQ substance use. These include: a) high rates of AOD use in LGBTIQ populations constitute problems in and of themselves, regardless of individual patterns of use; b) LGBTIQ people are a vulnerable population with specialised needs; and c) sexualised drug use is associated with “disinhibition” and a range of risks (including HIV transmission, drug dependence and mental health issues). Addressing the implications of these assumptions for how LGBTIQ communities are governed, we suggest that problematisation is an embodied, situated process, and that there is much to be gained by reframing dominant problematisations of AOD consumption so that this process is better informed by the inventive practices of LGBTIQ consumers themselves.

      PubDate: 2018-02-05T14:16:54Z
      DOI: 10.1016/j.drugpo.2018.01.008
       
  • Response to the Hammoud et al paper on ‘the new MTV
           generation’
    • Authors: Mitzy Gafos; Julie Chas; Gilles Pialoux
      Abstract: Publication date: Available online 1 February 2018
      Source:International Journal of Drug Policy
      Author(s): Mitzy Gafos, Julie Chas, Gilles Pialoux


      PubDate: 2018-02-05T14:16:54Z
      DOI: 10.1016/j.drugpo.2018.01.015
       
  • Effect of ageing and time since first heroin and cocaine use on mortality
           from external and natural causes in a Spanish cohort of drug users
    • Authors: Gemma Molist; M. Teresa Brugal; Gregorio Barrio; Beatriz Mesías; Marina Bosque-Prous; Oleguer Parés-Badell; Luis de la Fuente
      Pages: 8 - 16
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Gemma Molist, M. Teresa Brugal, Gregorio Barrio, Beatriz Mesías, Marina Bosque-Prous, Oleguer Parés-Badell, Luis de la Fuente
      Background We aimed to assess the effect of ageing and time since first heroin/cocaine use on cause-specific mortality risk and age disparities in excess mortality among heroin (HUs) and cocaine users (CUs) in Spain. Methods A cohort of 15,305 HUs and 11,905 CUs aged 15–49 starting drug treatment during 1997–2007 in Madrid and Barcelona was followed until December 2008. Effects of ageing and time since first heroin/cocaine use were estimated using a competing risk Cox model and the relative and absolute excess mortality compared to the general population through directly age-sex standardized rate ratios (SRRs) and differences (SRDs), respectively. Results Mortality risk from natural causes increased with time since first heroin use, whereas that from overdose declined after having peaked in the first quinquennium. Significant effects of time since first cocaine use were not identified, although fatal overdose risk seemed higher in CUs after five years. Mortality risk from natural causes (HUs and CUs), injuries (HUs), and overdoses (CUs) increased with age, the latter without reaching statistical significance. Crude mortality rates from overdoses and injuries remained very high at age 40–59 among both HUs (595 and 217 deaths/100,000 person-years, respectively) and CUs (191 and 88 deaths/100,000 person-years). SRDs from all and natural causes were much higher at age 40–59 than 15–29 in both HUs (2134 vs. 834 deaths/100,000 person-years) and CUs (927 vs. 221 deaths/100,000 person-years), while the opposite occurred with SRRs. Conclusion The high mortality risk among HUs and CUs at all ages from both external and natural causes, and increased SRDs with ageing, suggest that high-level healthcare and harm reduction services should be established early and maintained throughout the lifetime of these populations.

      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.11.011
      Issue No: Vol. 53 (2017)
       
  • “Now drugs in Libya are much cheaper than food”: A qualitative study
           on substance use among young Libyans in post-revolution Tripoli, Libya
    • Authors: Fauzi Muftah Elamouri; Patou Masika Musumari; Teeranee Techasrivichien; Anwer Farjallah; Sufian Elfandi; Osama Fathi Alsharif; Hussein Benothman; S. Pilar Suguimoto; Masako Ono-Kihara; Masahiro Kihara
      Pages: 23 - 31
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Fauzi Muftah Elamouri, Patou Masika Musumari, Teeranee Techasrivichien, Anwer Farjallah, Sufian Elfandi, Osama Fathi Alsharif, Hussein Benothman, S. Pilar Suguimoto, Masako Ono-Kihara, Masahiro Kihara
      Background Libya is facing a rapidly growing epidemic of illicit drug use and HIV. This situation is fueled by a complex array of factors, mainly the consequences of the political and military turmoil of the Arab Spring. Although it is extensively documented in other settings that young people are one of the most vulnerable groups to both HIV and illicit drug use, no study has explored this issue among young people in Libya. The current study addresses this research gap. Methods This study is a qualitative study using in-depth interviews guided by a semi-structured questionnaire. We used a maximum variation, purposive sampling strategy to recruit male and female participants, aged 14–18 years, from schools, prisons, and community-based informal re-education and rehabilitation centers in Tripoli, Libya. Results In total, 31 participants were recruited: 6 females and 25 males. Sixteen participants were prisoners and residents of community-based informal re-education and rehabilitation centers, and 15 were recruited in schools. Risk factors for drug use included peer influence, the increased availability and affordability of drugs, disruption of social life and healthy recreational activities, and the distress and casualties of the war. Protective factors were religious beliefs and practices, good parent-child connectedness, and high self-esteem and future aspiration. Risk factors for HIV were insufficient knowledge related to HIV transmission and unsafe injection practices, such as sharing needles and syringes. Conclusion We found individual, interpersonal, family, and structural-level factors that interplayed to shape the vulnerability of young people to drug use and HIV infection in Tripoli, Libya. Structural factors, including the increased availability and affordability of drugs, provided the frame within which other factors, such as peer influence, insufficient knowledge of substance use, and HIV, operated to increase the vulnerability of young people to drugs and HIV, while religious beliefs and parent-child connectedness acted as protective factors. Multisectoral efforts and studies to quantitatively evaluate the magnitude and distribution of these problems are urgently needed.

      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.11.026
      Issue No: Vol. 53 (2017)
       
  • Role of recovery residences in criminal justice reform
    • Authors: Douglas L. Polcin
      Pages: 32 - 36
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Douglas L. Polcin
      Over the past decade there has been a clear consensus among drug policy researchers that the practice of incarcerating persons for drug offenses has been counterproductive. As a result, U.S. criminal justice policy is increasingly emphasizing alternative dispositions to incarceration for drug related arrests. In addition, large numbers of persons currently incarcerated for drug related offenses are being released into communities. However, there are serious questions about where these individuals are going to live once released and how they will access needed services. Residential recovery homes in the community are good options for those who wish to pursue abstinence from drugs. They provide a drug- and alcohol-free living environment along with social support for abstinence and successful functioning in the community. This paper reviews recent changes in drug policy the U.S. and describes the variety of recovery home options that are available to persons diverted or released from incarceration.

      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.10.009
      Issue No: Vol. 53 (2017)
       
  • The three betrayals of the medical cannabis growing activist: From
           multiple victimhood to reconstruction, redemption and activism
    • Authors: Axel Klein; Gary R. Potter
      Pages: 65 - 72
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Axel Klein, Gary R. Potter
      While cannabis has been widely used in the UK for over 50 years, it is only in recent decades that domestic cultivation has become established. Public concern, media reporting and policing policy has emphasised the role of profit motivated criminal organisations often working on a large scale and with coerced labour. However, increasingly, another population are growing for medical reasons, to help themselves and others treat or manage difficult, poorly understood, or incurable conditions. Our study sought to further understand the motives, techniques and interactions of cannabis cultivators through interviews with 48 growers and supplementary ethnographic work. As well as those motivated to grow for personal use, social and commercial supply purposes we identified a cohort growing to provide themselves and others with cannabis used for therapeutic purposes. This paper draws primarily on interviews with a sub-group of sixteen medically-motivated growers who were not only involved in treatment, but also embraced the label “activist”. Rather than develop techniques of deception they were organising to effect a change in legislation. Rejecting the image of criminal perpetrators, they presented themselves as victims of unjust government policy, an indifferent medical establishment, and brutal and immoral criminal markets. Through cultivation, association, self-healing and apomedication, they have found voice and are shifting the debate over the status of growers and of cannabis itself. The ambiguity of their position as both producers and patients challenges the assumptions underlying legal distinctions between suppliers and users, with potentially profound implications for policy.

      PubDate: 2017-12-27T08:31:15Z
      DOI: 10.1016/j.drugpo.2017.12.004
      Issue No: Vol. 53 (2017)
       
  • Down the local: A qualitative case study of daytime drinking spaces in the
           London Borough of Islington
    • Authors: Claire Thompson; Sarah Milton; Matt Egan; Karen Lock
      Pages: 1 - 8
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Claire Thompson, Sarah Milton, Matt Egan, Karen Lock
      Background Recognising the lack of research on daytime drinking practices in areas with managed night-time economies (NTEs), this qualitative study explores the phenomena in the London Borough of Islington; a rapidly gentrifying area with a highly regulated night-time economy (NTE). The objectives were to (i) Characterise the daytime drinking spaces of the local alcohol environment and (ii) Theorise the ways in which these spaces, and the practices and performativities within them, are situated within broader social and economic trends. Methods Adopting a legitimate peripheral participation approach to data collection, 39 licensed premises were visited in Islington and on-site observations carried out between the hours of 12 pm and 6 pm using a semi-structured observation guide. Observations were written-up into detailed fieldnotes, uploaded to NVivo and subject to a thematic analysis. Findings The daytime on-premises alcohol environment was characterised by two main trends: the decline of traditional pubs and a proliferation of hybrid establishments in which alcohol was framed as part of a suite of attractions. The consumption trends that the latter exemplify are implicated in processes of micro-cultural production and ‘hipster capitalism’; and it is via this framing that we explore the way the diverse local drinking spaces were gendered and classed. Hybrid establishments have been regarded as positive in terms of public health, crime and safety. However, they could also help introduce drinking within times and contexts where it was not previously present. Conclusion The intersection of an expanding hipster habitus with Local Authority efforts to tackle ‘determined drunkenness’ create very particular challenges. The operating practices of hybrid venues may feed into current alcohol industry strategies of promoting ‘new moments’ in which consumers can drink. They blur the divisions between work and play and produce temporal and classed divisions of drinking.

      PubDate: 2017-12-11T08:11:25Z
      DOI: 10.1016/j.drugpo.2017.11.019
      Issue No: Vol. 52 (2017)
       
  • Re-thinking pre-drinking: Implications from a sample of teenagers who
           drink in private settings
    • Authors: James Wilson; Rowan P. Ogeil; Tina Lam; Simon Lenton; Belinda Lloyd; Lucy Burns; Alexandra Aiken; William Gilmore; Tanya Chikritzhs; Richard Mattick; Dan I. Lubman; Steve Allsop
      Pages: 20 - 24
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): James Wilson, Rowan P. Ogeil, Tina Lam, Simon Lenton, Belinda Lloyd, Lucy Burns, Alexandra Aiken, William Gilmore, Tanya Chikritzhs, Richard Mattick, Dan I. Lubman, Steve Allsop
      Background Pre-drinking is often defined as an economically-minded set of drinking practices engaged in prior to attending public entertainment areas, such as licensed venues. This paper explores motivations and practical considerations that a sample of teenagers describes as significant to ‘pre-drinking’, despite not attending licensed premises during their most recent risky drinking session. Methods Data were derived from the mixed-methods Young Australians Alcohol Reporting System (YAARS) project. 16 participants aged 16–19 were identified as pre-drinking on their most recent risky drinking session, followed by subsequent alcohol consumption in non-licensed venues. 4 members of this subsample also undertook qualitative interviews. Results These data expand on existing understandings of pre-drinking by emphasising the breadth of motivations and practical considerations understood to shape both pre-drinking practices, and subsequent drinking in other public entertainment areas. These primarily included desires for personal enhancement and experiencing freedom over restriction, the dynamics of accessing alcohol and private space, the necessity of opportunism, and concerns regarding parents and other authority figures. Conclusions Analyses of groups obscured by dominant definitions of what constitutes ‘pre-drinking’ illuminate a broader range of motivations and concerns facing young people who drink. Such findings enhance our understanding of young people’s drinking practices, the terminology used to describe them, and the development of relevant policies and interventions.

      PubDate: 2017-12-11T08:11:25Z
      DOI: 10.1016/j.drugpo.2017.11.024
      Issue No: Vol. 52 (2017)
       
  • Experiences with compulsory drug detention among people who inject drugs
           in Bangkok, Thailand: A qualitative study
    • Authors: Thomas Kerr; Will Small; Prempreeda Pramoj Na Ayutthaya; Kanna Hayashi
      Pages: 32 - 38
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Thomas Kerr, Will Small, Prempreeda Pramoj Na Ayutthaya, Kanna Hayashi
      Background Thailand has employed a system of compulsory drug detention centres (CDDCs) where drug users are confined following arrest. Although concerns regarding CDDCs persist, research focused on CDDCs in Thailand is limited. We undertook this study to explore experiences with CDDCs among people who inject drugs (PWID) in Thailand. Methods Data were derived from the Mitsampan Community Research Project, a mixed- methods study involving PWID in Bangkok. Between July 2011 and June 2012, semi-structured, in-depth interviews were conducted with PWID who had been exposed to CDDCs. Interviews explored experiences with CDDCs, including conditions and program structure within CDDCs, and the impacts of CDDCs on on-going patterns of drug use. Audio-recorded interviews were transcribed verbatim, and a thematic analysis was conducted. Results Participants included 27 individuals, including 12 women. Participants indicated that CDDCs varied in their design and structure, although most described the conditions as being poor and unsanitary, with overcrowding and limited access to clean water and adequate nutrition. Most participants were placed in military-operated CDDCs and subjected to long hours of physical exercise and forced labour as punishment, which staff perceived as being essential to attaining a drug-free lifestyle. Many participants also experienced severe verbal abuse and violence by staff. Access to healthcare was limited and often denied, and individuals living with HIV/AIDS were typically unable to access antiretroviral therapy. None of the participants described being exposed to evidence-based addiction treatment, and most participants reported returning to drug use immediately upon release. Conclusion This study raises concerns regarding CDDCs in Thailand, including poor conditions and human rights violations within CDDCs, as well as a lack of access to appropriate healthcare and addiction treatment. CDDCs appear to be contributing to the stigmatization of drug users, while also perpetuating drug use rather meeting the intended objective of facilitating “rehabilitation”.

      PubDate: 2017-12-11T08:11:25Z
      DOI: 10.1016/j.drugpo.2017.11.016
      Issue No: Vol. 52 (2017)
       
  • Associations between medical cannabis and other drug use among unstably
           housed women
    • Authors: Meredith C. Meacham; Danielle E. Ramo; Alex H. Kral; Elise D. Riley
      Pages: 45 - 51
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Meredith C. Meacham, Danielle E. Ramo, Alex H. Kral, Elise D. Riley
      Background Several studies suggest that U.S. state-level legalization of cannabis for medical purposes may be associated with reductions in opioid use; yet its relationship with stimulant use, particularly in high-risk populations like unstably housed women, has received less attention. The purpose of this study was to estimate independent associations between medical and non-medical use of cannabis and use of stimulants and opioids among unstably housed women. Methods Cross-sectional data were analyzed from 245 women in the SHADOW study, a community based cohort in San Francisco, CA, in which HIV+ women were oversampled (126 HIV+ and 119 HIV-). Results Compared to no cannabis use in the past 6 months (51%), non-medical cannabis use (28%) was associated with a higher adjusted odds of using stimulants (Adjusted Odds Ratio [AOR]=4.34, 95% confidence interval [CI]: 2.17–8.70) and opioids (AOR=3.81, 95% CI: 1.78–8.15). Compared to no cannabis use, medical cannabis use (21%) was not significantly associated with stimulant or opioid use. Compared to non-medical cannabis use, however, medical cannabis use was associated with lower adjusted odds of using stimulants (AOR=0.42, 95% CI: 0.18–0.96). These associations were not modified by HIV status. Conclusions Associations between use of cannabis and “street drugs” depend on whether the cannabis is obtained through a medical context. Interventions, research, and policy considering the influence of cannabis on the use of other drugs may benefit by distinguishing between medical and non-medical cannabis use.

      PubDate: 2017-12-11T08:11:25Z
      DOI: 10.1016/j.drugpo.2017.11.009
      Issue No: Vol. 52 (2017)
       
  • Perceptions about supervised injection facilities among people who inject
           drugs in Philadelphia
    • Authors: Robert E. Harris; Jessica Richardson; Rosemary Frasso; Evan D. Anderson
      Pages: 56 - 61
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Robert E. Harris, Jessica Richardson, Rosemary Frasso, Evan D. Anderson
      Background People who inject drugs (PWID) are at high risk for infectious diseases, skin and soft tissue infections, and overdose. However, these harms are all avoidable when sterile injection equipment, hygienic places to inject, and medical care are accessible. Unfortunately, many PWID in the U.S lack these resources. The most vulnerable are forced to inject in public spaces, where individual risks are high and communal harms are sometimes many. Supervised Injection Facilities (SIFs) are an established intervention for reducing these harms. Despite positive experiences in other countries, little research explores how PWID in the U.S. perceive the value of such facilities. Methods We conducted a freelisting exercise with PWID (n=42) and healthcare providers (n=20) at a syringe exchange program (SEP) that provides comprehensive clinical and social services in Philadelphia to inform in-depth semi-structured interviews with PWID (n=19) at the same location. Results Participants expressed support for a potential SIF as a valuable public health intervention. They suggested that an SIF would improve PWID health while reducing the public disorder associated with injecting drugs in public. The latter was especially important to participants without stable housing, whose decision to inject furtively in secluded places was often motivated by desire not to upset community members, and particularly children. These participants acknowledged that such seclusion elevated the risk of fatal overdose. Despite similarly positive perceptions about an SIF, participants with stable housing reported that they would prefer to continue injecting at home. Conclusion Results both confirm and extend prior research about PWID and SIFs. Participants expressed support for SIFs as in prior survey research in the U.S. and in other countries. Facility location and housing status were identified as important determinants of facility use. Results extend prior research by illuminating PWID perceptions in the U.S. including motivations grounded in concern for public order.

      PubDate: 2017-12-11T08:11:25Z
      DOI: 10.1016/j.drugpo.2017.11.005
      Issue No: Vol. 52 (2017)
       
  • The diverse reasons for using Novel Psychoactive Substances - A
           qualitative study of the users' own perspectives
    • Authors: Christophe Soussan; Martin Andersson; Anette Kjellgren
      Pages: 71 - 78
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Christophe Soussan, Martin Andersson, Anette Kjellgren
      Background The increasing number of legally ambiguous and precarious Novel Psychoactive Substances (NPS) constitutes a challenge for policy makers and public health. Scientific and more in-depth knowledge about the motivations for using NPS is scarce and often consist of predetermined, non-systematic, or poorly described reasons deduced from top-down approaches. Therefore, the aim of the present study was to explore and characterize the users’ self-reported reasons for NPS use inductively and more comprehensively. Methods The self-reported reasons of a self-selected sample of 613 international NPS users were collected via an online survey promoted at the international drug discussion forum bluelight.org and later analyzed qualitatively using inductive thematic analysis. Results The analysis showed that the participants used NPS because these compounds reportedly: 1) enabled safer and more convenient drug use, 2) satisfied a curiosity and interest about the effects, 3) facilitated a novel and exciting adventure, 4) promoted self-exploration and personal growth, 5) functioned as coping agents, 6) enhanced abilities and performance, 7) fostered social bonding and belonging, and 8) acted as a means for recreation and pleasure. The consumption of NPS was also driven by 9) problematic and unintentional use. Conclusion The present study contributed to a more comprehensive understanding of the users’ own and self-reported reasons for using NPS, which needs to be acknowledged not only in order to minimize drug related harm and drug user alienation but also to improve prevention efforts and reduce the potentially counter-intuitive effects of strictly prohibitive policies.

      PubDate: 2017-12-13T08:12:07Z
      DOI: 10.1016/j.drugpo.2017.11.003
      Issue No: Vol. 52 (2017)
       
  • Ordering clinical realities: Controversy and multiplicity in alcohol and
           other drug treatment for young adults
    • Authors: Aaron Hart
      Pages: 79 - 86
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Aaron Hart
      Background Although young adults receiving treatment for alcohol and other drug (AOD) use often experience disadvantaged life circumstances, there has been little qualitative research into how treatment agencies understand and respond to intersections between these life circumstances and the AOD use of their clients. Methods This article draws on analytic techniques from science and technology studies to detail how treatment clinicians become sensitive to client life circumstances; how therapeutic plans of action are formed; and how clients respond to these processes. Ethnographic data were gathered through interviews with clinicians and agency staff, documentary analysis and field observations in a public AOD clinic treating young adults in Melbourne, Australia. Results Findings detail emerging controversies concerning dependence, dosage, mental health and AOD comorbidities, forensic treatment, and resumption of use after treatment. Conclusion I argue that each controversy can be understood as a contest between aggregated, humanist and situated modes of ordering clinical phenomena. Aggregated modes of ordering are crafted for coherence at a population level and position AOD use as the primary problem in clients’ lives. Humanist modes of ordering foreground clients’ poor life circumstances and lack of resources, and frame treatment to address AOD use as benevolent. In situated modes of ordering, the effects of AOD use are transformed by emotional, social and material entanglements and AOD use is no longer necessarily the problem in clients’ lives. I conclude that, since clinicians seem to readily abandon aggregated approaches in favour of humanist ones, and humanist modes of ordering are often ineffective insofar as they are politically disempowering and engender client resistance, the scientific task of constructing practice tools for more situated approaches in clinical AOD treatment settings seems to be a priority.

      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.11.012
      Issue No: Vol. 52 (2017)
       
  • Routes of administration for cannabis use – basic prevalence and related
           health outcomes: A scoping review and synthesis
    • Authors: Cayley Russell; Sergio Rueda; Robin Room; Mark Tyndall; Benedikt Fischer
      Pages: 87 - 96
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Cayley Russell, Sergio Rueda, Robin Room, Mark Tyndall, Benedikt Fischer
      Background Cannabis use is common, and associated with adverse health outcomes. ‘Routes of administration’ (ROAs) for cannabis use have increasingly diversified, in part influenced by developments towards legalization. This paper sought to review data on prevalence and health outcomes associated with different ROAs. Methods This scoping review followed a structured approach. Electronic searches for English-language peer-reviewed publications were conducted in primary databases (i.e., MEDLINE, EMBASE, PsycINFO, Google Scholar) based on pertinent keywords. Studies were included if they contained information on prevalence and/or health outcomes related to cannabis use ROAs. Relevant data were screened, extracted and narratively summarized under distinct ROA categories. Results Overall, there is a paucity of rigorous and high-quality data on health outcomes from cannabis ROAs, especially in direct and quantifiable comparison. Most data exist on smoking combusted cannabis, which is associated with various adverse respiratory system outcomes (e.g., bronchitis, lung function). Vaporizing natural cannabis and ingesting edibles appear to reduce respiratory system problems, but may come with other risks (e.g., delayed impairment, use ‘normalization’). Vaporizing cannabis concentrates can result in distinct acute risks (e.g., excessive impairment, injuries). Other ROAs are uncommon and under-researched. Conclusions ROAs appear to distinctly influence health outcomes from cannabis use, yet systematic data for comparative assessments are largely lacking; these evidence gaps require filling. Especially in emerging legalization regimes, ROAs should be subject to evidence-based regulation towards improved public health outcomes. Concretely, vaporizers and edibles may offer potential for reduced health risks, especially concerning respiratory problems. Adequate cannabis product regulation (e.g., purity, labeling, THC-restrictions) is required to complement ROA-based effects.

      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.11.008
      Issue No: Vol. 52 (2017)
       
  • A kind of peace: Tracking the reflexive and resilient drug war
    • Authors: Katherine McLean
      Abstract: Publication date: Available online 15 December 2017
      Source:International Journal of Drug Policy
      Author(s): Katherine McLean


      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.10.013
       
 
 
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