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International Journal of Drug Policy
Journal Prestige (SJR): 1.441
Citation Impact (citeScore): 3
Number of Followers: 433  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0955-3959
Published by Elsevier Homepage  [3163 journals]
  • Problematisation and regulation: Bodies, risk, and recovery within the
           context of Neonatal Abstinence Syndrome
    • Abstract: Publication date: Available online 17 July 2018Source: International Journal of Drug PolicyAuthor(s): Anne Whittaker, Amy Chandler, Sarah Cunningham-Burley, Paula Midgley, Lawrie Elliott, Sarah Cooper BackgroundNeonatal Abstinence Syndrome (NAS) is an anticipated effect of maternal drug use during pregnancy. Yet it remains a contested area of policy and practice. In this paper, we contribute to ongoing debates about the way NAS is understood and responded to, through different treatment regimes, or logics of care. Our analysis examines the role of risk and recovery discourses, and the way in which the bodies of women and babies are conceptualised within these.MethodsQualitative interviews with 16 parents (9 mothers, 7 fathers) and four focus groups with 27 health and social care professionals based in Scotland. All the mothers were prescribed opioid replacement therapy and parents were interviewed after their baby was born. Data collection explored understandings about the causes and consequences of NAS and experiences of preparing for, and caring for, a baby with NAS. Data were analysed using a narrative and discursive approach.ResultsParent and professional accounts simultaneously upheld and subverted logics of care which govern maternal drug use and the assessment and care of mother and baby. Despite acknowledging the unpredictability of NAS symptoms and the inability of the women who are opioid-dependent to prevent NAS, logics of care centred on ‘proving’ risk and recovery. Strategies appealed to the need for caution, intervening and control, and obscured alternative logics of care that focus on improving support for mother-infant dyads and the family as a whole.ConclusionDiffering notions of risk and recovery that govern maternal drug use, child welfare and family life both compel and trouble all logics of care. The contentious nature of NAS reflects wider socio-political and moral agendas that ultimately have little to do with meeting the needs of mothers and babies. Fundamental changes in the principles, quality and delivery of care could improve outcomes for families affected by NAS.
       
  • (Mis)understanding the intersection between development policies and data
           collection: Experiences in Afghanistan
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): David Mansfield There is a misalignment between a development community focused on improving the welfare of vulnerable populations and the challenges of addressing widespread illicit drug crop production in drug producing countries. Drawing on the example of Afghanistan, this paper argues that the reasons for the development communities failure to engage is in large part a function of the way that illicit opium poppy and the illicit economy is currently perceived and understood by policy makers, practitioners and scholars. Much of the problem lies with the various statistics used to describe and quantify opium production in Afghanistan, many of them produced by UNODC and cited repeatedly in media coverage and the academic literature. These statistics shape how we have come to understand the scale and nature of the drugs problem, and thereby have informed policy responses. This paper argues that it is critical that policy makers and scholars fully understand the veracity of drug related statistics, including their methodological and conceptual limitations, before using them as the foundations for development programmes or policy responses. Indeed, this paper argues that many of these statistics have presented a simplified and ‘profit maximising’ model of the factors influencing farmers’ livelihoods choices, which has proven deeply misleading and further alienated the development community from engaging constructively with the challenges of illicit drug production in developing countries.
       
  • Integrating hepatitis C and addiction care for people who inject drugs in
           the era of direct-acting antiviral therapy
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Kathleen Bird, María Eugenia Socías, Lianping Ti As new, more tolerable and effective hepatitis C virus (HCV) treatments are available, there is a global need to consider how to maximize treatment access for groups who are most affected by HCV. A substantial number of people who inject drugs (PWID) are living with HCV, yet only a minority have received treatment. HCV treatment programs that are integrated into community-based addiction care may be a successful way to overcome barriers and increase access and uptake of HCV treatment for this population. Examples of successful HCV and addiction care integration in the community have been documented. However, potential challenges to integration exist and include changing healthcare provider roles, lack of stimulant use research and restrictive drug policies. Successful engagement of PWID in HCV care is critical step towards the elimination of HCV infection. Further research and efforts are needed in order to reach this goal.
       
  • Tuberculosis infection among cocaine crack users in Brazil
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Sandra Maria do Valle Leone de Oliveira, Elizeu Ferreira da Silva, Ana Rita Coimbra Motta-Castro, Vivianne de Oliveira Landgraf de Castro, Andréa Cristina Stábile, Anamaria Mello Miranda Paniago, Anete Trajman BackgroundWHO recommends treatment for latent tuberculosis infection (LTBI) in the homeless and people who use drugs (PWUD). The optimal test for LTBI screening is uncertain.MethodsA cross-sectional study was conducted among the homeless and drug-rehabilitation clinic clients chronically using crack in Western Brazil. Participants were interviewed and offered HIV testing plus tuberculin skin testing (TST) and QuantiFeron®-Gold-in-Tube (QFT). We considered LTBI when either TST or QFT were positive. Factors associated with LTBI were adjusted in a multivariate model.ResultsAmong 372 subjects with at least one valid test, 216 (58%) had LTBI. TST was not read in 18.4%; QFT was indeterminate in 2.5%. TST detected 27 (26%) extra LTBI cases among 75 QFT-negative individuals. PWUD had over three-fold odds for LTBI. TST was 4.5 times more likely to be positive in BCG-vaccinated individuals.ConclusionGiven the high risk of progression to disease in this population, the high rates of loss to TST reading and the possibility of false-positive TST results from BCG vaccination, we endorse current CDC recommendations to use QFT for LTBI screening among the homeless and PWUD. However, because adding TST to a negative QFT increased LTBI detection considerably, TST should be considered in QFT-negative individuals.
       
  • Grievable lives' Death by opioid overdose in Australian newspaper
           coverage
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Suzanne Fraser, Adrian Farrugia, Robyn Dwyer Opioid overdose deaths are increasing in Australia and around the world. Despite this, measures aimed at reducing these deaths such as safe injecting facilities and take-home naloxone continue to face obstacles to uptake. The reasons for this are manifold, but a key contributor is public discourse on opioid consumption and overdose. In this article we explore this public discourse using Judith Butler’s work on ‘grievable lives’. The article analyses mainstream newspaper coverage of opioid overdose in Australia to map key articulations of overdose and to consider how public understandings of overdose are shaped. It then goes on to consider ways these understandings might be reshaped, looking at what have been called overdose ‘anti-memorials’ and a new website Livesofsubstance.org. In concluding we argue that until the lives of opioid consumers come to be considered grievable, the measures known to reduce overdose deaths may struggle to find public support.
       
  • Profile, risk practices and needs of people who inject morphine sulfate:
           Results from the ANRS-AERLI study
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Perrine Roux, Salim Mezaache, Laélia Briand-Madrid, Marie Debrus, Nicolas Khatmi, Gwenaelle Maradan, Camélia Protopopescu, Daniela Rojas-Castro, Patrizia Carrieri AimsIn France, a non-negligible proportion of opioid-dependent individuals inject morphine sulfate. Although it has not yet been officially approved as an opioid substitution treatment (OST), some physicians can prescribe its use for people in methadone or buprenorphine treatment failure. Longitudinal data from the ANRS-AERLI study, which evaluated an educational intervention for safer injection called AERLI, provided us the opportunity to better characterize the profile, risk practices and needs of people who inject morphine sulfate (MSI), through comparison with other injectors, and to identify correlates of HIV/HCV risk practices in this group.MethodsThe national multisite ANRS-AERLI study assessed the impact of AERLI offered in volunteer harm reduction (HR) centers (“with intervention”) (n = 113) through comparison with standard HR centers (“without intervention”) (n = 127). All participants were scheduled to be followed up for 12 months and have 3 telephone interviews: at baseline, 6 months and 12 months. We compared MSI (n = 79) with other opioid injectors (n = 161) and then used a mixed logistic model to identify factors associated with HIV/HCV risk practices among MSI.FindingsOf the 240 eligible participants, 79 were regular MSI. They were less likely to use cocaine, crack or buprenorphine and to receive OST than other participants. Conversely, MSI were more likely to inject drugs more than three times a day and to report HIV/HCV risk practices. Among MSI, multivariate analysis showed that those receiving morphine sulfate as an OST were less likely to report such practices than other participants (aOR [95%CI] = 0.11 [0.02-0.61]).ConclusionOur results show that while MSI use fewer stimulants, they have more HIV/HCV risk practices than other injectors. However, when MSI are prescribed morphine sulfate as a treatment, these practices tend to decrease. Our findings suggest the importance of increasing access to morphine sulfate as a new OST in France.
       
  • Developing a patient-reported experience questionnaire with and for people
           who use drugs: A community engagement process in Vancouver’s Downtown
           Eastside
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Michelle Olding, Kanna Hayashi, Lindsay Pearce, Brittany Bingham, Michelle Buchholz, Delilah Gregg, Dave Hamm, Laura Shaver, Rachael McKendry, Rolando Barrios, Bohdan Nosyk People who use drugs (PWUD) frequently have complex health care needs, yet face multiple barriers to accessing services. Involving PWUD in health service design and evaluation can enhance the quality of data collected and ensure policy and practice improvements reflect the expressed needs of the population. However, PWUD remain largely excluded from the evaluation of health services that directly affect their lives, including development of patient-reported experience measures (PREMS) that have gained prominence in health services research and clinical practice. Detailed descriptions of PWUD participation in survey design are notably absent in the literature. In this commentary, we present a case that demonstrates how PWUD can contribute meaningfully to the development of questionnaires that assess patient-reported health care experiences. We describe the development, implementation and outcomes of a process to engage local drug user organizations in the evaluation of a redesign and reorientation of health service delivery in the Downtown Eastside (DTES) neighborhood of Vancouver, Canada. Through this process, participants contributed critical elements to the design of a patient-reported experience measure, including: (1) identifying unmet service needs in the neighborhood; (2) identifying local barriers and facilitators to care; (3) formulating questions on cultural safety; and (4) improving structure, language and clarity of the questionnaire. We highlight lessons learned from the process, reflecting on the strengths, challenges and ethical considerations associated with community-based approaches to questionnaire development. The workshop model presented here illustrates one flexible and promising approach to enabling meaningful participation of PWUD in questionnaire development.
       
  • Stigma and the public health agenda for the opioid crisis in America
    • Abstract: Publication date: September 2018Source: International Journal of Drug Policy, Volume 59Author(s): Patrick W. Corrigan, Katherine Nieweglowski The current opioid crisis in the U.S. is unprecedented and calling for a nationwide reorganization of the public health prevention program. Stigma is a persistent barrier to this agenda, unfortunately with a limited body of research on substance use disorder (SUD) available to inform it. We review the broader research literature on the stigma of behavioral health (i.e., mental illness and SUD) to identify strategies to address the opioid crisis and harmful stigma. A major difference between mental illness and SUD stigma is that the latter is legally and socially sanctioned. In making sense of the behavioral strategies for stigma change, we consider three agendas for stigma prevention (prevention, rights, and self-worth). We suggest that incorporating the rights and the self-worth agendas with an in vivo focused contact model, might be most effective for an integrative strategy aimed at targeting opioid stigma. Involving people in recovery as key drivers of this agenda and evaluating the detrimental impact of using stigma as a health tool (social sanction), will bring new horizons to solving this deadly epidemic.
       
  • Corrigendum to “Heroin and fentanyl overdoses in Kentucky: Epidemiology
           and surveillance” [International Journal of Drug Policy 46 (2017)
           120–129]
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Svetla Slavova, Julia F. Costich, Terry L. Bunn, Huong Luu, Michael Singleton, Sarah L. Hargrove, Jeremy S. Triplett, Dana Quesinberry, William Ralston, Van Ingram
       
  • Aging, multimorbidity, and substance use disorders: The growing case for
           integrating the principles of geriatric care and harm reduction
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Benjamin H. Han
       
  • The effectiveness of Cytisine versus Nicotine Replacement Treatment for
           smoking cessation in the Russian Federation
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): João Mauricio Castaldelli-Maia, Silvia S. Martins, Natalie Walker BackgroundThere is just one study comparing the effectiveness of cytisine and nicotine replacement therapy (NRT) for smoking cessation. In the Russian Federation, both products are widely available as over-the-counter medications. Data on the real-world use of these medications among the general population would be informative.MethodsCross-sectional study using data from a nationally representative household survey of adults aged ≥ 15 years from the Russian Federation (part of the Global Tobacco Surveillance System Data). From the total sample (n = 11,406), 4,807 (42%) respondents stated they smoked cigarettes. Of this group, 1,403 (29%) stated they had tried to quit smoking in the past year, of which 88 (6%) had used cytisine and 186 (13%) had used NRT in their attempt.Results30-day and 90-day self-reported smoking abstinence rates for NRT were 36% and 11%, respectively. In comparison, 30-day and 90-day self-reported smoking abstinence rates for cytisine were 50% and 25%, respectively. After adjusting for age and gender, cytisine was found to be more effective than NRT for 90-day abstinence [Odds Ratio = 2.91, 95% Confidence Intervals = 1.28-6.59, p = 0.011].ConclusionsThese findings appear to support previous trial evidence that cytisine is superior to NRT in helping smokers quit.
       
  • The burgeoning recognition and accommodation of the social supply of drugs
           in international criminal justice systems: An eleven-nation comparative
           overview
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Ross Coomber, Leah Moyle, Vendula Belackova, Tom Decorte, Pekka Hakkarainen, Andrew Hathaway, Karen Joe Laidler, Simon Lenton, Sheigla Murphy, John Scott, Michaela Stefunkova, Katinka van de Ven, Marieke Vlaemynck, Bernd Werse BackgroundIt is now commonly accepted that there exists a form of drug supply, that involves the non-commercial supply of drugs to friends and acquaintances for little or no profit, which is qualitatively different from profit motivated ‘drug dealing proper’. ‘Social supply’, as it has become known, has a strong conceptual footprint in the United Kingdom, shaped by empirical research, policy discussion and its accommodation in legal frameworks. Though scholarship has emerged in a number of contexts outside the UK, the extent to which social supply has developed as an internationally recognised concept in criminal justice contexts is still unclear.MethodsDrawing on an established international social supply research network across eleven nations, this paper provides the first assessment of social supply as an internationally relevant concept. Data derives from individual and team research stemming from Australia, Belgium, Canada, Czech Republic, Finland, Germany, Hong Kong, the Netherlands, England and Wales, and the United States, supported by expert reflection on research evidence and analysis of sentencing and media reporting in each context. In situ social supply experts addressed a common set of questions regarding the nature of social supply for their particular context including: an overview of social supply research activity, reflection on the extent that differentiation is accommodated in drug supply sentencing frameworks; evaluating the extent to which social supply is recognised in legal discourse and in sentencing practices and more broadly by e.g. criminal justice professionals in the public sphere. A thematic analysis of these scripts was undertaken and emergent themes were developed. Whilst having an absence of local research, New Zealand is also included in the analysis as there exists a genuine discursive presence of social supply in the drug control and sentencing policy contexts in that country.ResultsFindings suggest that while social supply has been found to exist as a real and distinct behaviour, its acceptance and application in criminal justice systems ranges from explicit through to implicit. In the absence of dedicated guiding frameworks, strong use is made of discretion and mitigating circumstances in attempts to acknowledge supply differentiation. In some jurisdictions, there is no accommodation of social supply, and while aggravating factors can be applied to differentiate more serious offences, social suppliers remain subject to arbitrary deterrent sentencing apparatus.ConclusionDue to the shifting sands of politics, mood, or geographical disparity, reliance on judicial discretion and the use of mitigating circumstances to implement commensurate sentences for social suppliers is no longer sufficient. Further research is required to strengthen the conceptual presence of social supply in policy and practice as a behaviour that extends beyond cannabis and is relevant to users of all drugs. Research informed guidelines and/or specific sentencing provisions for social suppliers would provide fewer possibilities for inconsistency and promote more proportionate outcomes for this fast-growing group.
       
  • Assessing the effectiveness of New York’s 911 Good Samaritan
           Law—Evidence from a natural experiment
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Holly Nguyen, Brandy R. Parker BackgroundDrug overdose is the leading cause of accidental death in the United States. Nationally, opioids are the primary drugs associated with accidental overdoses. In response to increasing overdose deaths, 40 states and the District of Columbia have enacted Good Samaritan Laws (GSLs). Generally, these policies attempt to encourage witnesses or those experiencing an overdose to call 911 by providing limited immunity from arrest, charge and/or prosecution of possession of narcotics. The aim of the current study is to evaluate the effectiveness of New York State’s 911 GSL.MethodsWe exploit a difference in state law between New York State, where the policy was adopted in 2011, and New Jersey, where the policy was not adopted until 2013, to provide a reasonable comparison condition. We examine variation in accidental opioid overdose emergency department visits and inpatient admissions from 2010 to 2012 across 270 hospitals in New York and New Jersey at the quarterly level controlling for hospital fixed effects and time trends using State Emergency Department Databases (SEDD) and State Inpatient Databases (SID).ResultsAccidental opioid overdose emergency department visits and inpatient hospital admissions were increasing in both New York and New Jersey. After the enactment of New York’s 911 GSL, emergency department visits and inpatient hospital admissions for accidental heroin overdoses increased differently in New York and New Jersey, with an incident rate ratio (IRR) of 1.34 (95% CI = 1.00, 1.86). The results were inconclusive for accidental non-heroin opioid overdoses (IRR = 0.98, 95% CI = 0.86, 1.13).ConclusionsAccidental heroin overdose emergency department visits and inpatient hospital admissions increased in New York State after the enactment of the 911 GSL, consistent with the intended effect of the GSL. Preliminary evidence suggests that either persons who use heroin and/or those around them were impacted by the policy change.
       
  • An altered state' Emergent changes to illicit drug markets and
           distribution networks in scotland
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): James Densley, Robert McLean, Ross Deuchar, Simon Harding BackgroundMany efforts have been undertaken to construct an overview of various aspects of illicit drug distribution in the United Kingdom. Yet given that national, regional, and local differences can be profound, this has proven difficult, to the extent that Scotland has been largely excluded from the conversation. In addition, the level of supply being examined, the drug type, and the actors involved only add to confusion and vast differences between some findings.MethodThe current study aims to provide a holistic account, as best as possible considering variations of illegal drug supply in illicit networks, by focusing in on a particular geographical context (Scotland) and addressing drug supply at all levels. It is informed by in-depth interviews with 42 offenders involved in drug distribution from retail to wholesale/middle market to importation levels.ResultsFindings indicate Scotland's importation and distribution is evolving owing to increasingly adaptive risk mitigation by importers and distributors, and market diversification of both product and demand. While a hierarchical model still dominates the market, commuting or ‘county lines’ and increasing demand for drugs such as cannabis, but also anabolic steroids and psychoactive substances, means that home growing, online purchasing, and street-level dealership is common.ConclusionThe findings have the capacity to further inform police and practitioners about the diverse and evolving nature of drug distribution in Scotland (with a particular focus on the west of the country), so that they may become more effective in improving the safety and wellbeing of people, places and communities.
       
  • Alcohol-related absence and presenteeism: Beyond productivity loss
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Kristin Buvik, Inger Synnøve Moan, Torleif Halkjelsvik BackgroundAlcohol use by employees is associated with negative consequences for the workplace in terms of absence and poor work performance. The aims of this study were to map the prevalence of alcohol-related absence and inefficiency using survey data from a broad sample of employees, and to explore how alcohol-related absence and presenteeism are experienced and handled using data from qualitative interviews.MethodsThe prevalence data stems from a web survey completed by 1940 Norwegian employees aged 20–74 years. The qualitative data consists of analyses of 24 interviews with managers, co-workers of heavy drinking employees, and heavy drinking employees, from various lines of businesses.Results1–2% reported alcohol-related full day absence in the last 12 months, and 2% reported partial day absence; 11% reported inefficiency due to drinking the previous day. Analyses of interview data revealed that alcohol-related absence and presenteeism may cause a range of economic and practical problems. Managers reported spending a lot of resources and effort on single cases. In addition, the results showed how the presence of a heavy drinking employee may have a negative impact on the broader psychosocial environment, and cause concern for workplace safety. Due to consideration of the drinker's well-being and fear of negative reactions, problem cases can last for years.ConclusionsDespite the relatively low prevalence of alcohol-related absence and inefficiency, the study suggest that the alcohol-related problems of a few, or only one, employee may still have substantial and far-reaching negative consequences for the workplace.
       
  • Prospective associations between cannabis use and negative and positive
           health and social measures among emerging adults
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Liat Korn, Denise L. Haynie, Jeremy W. Luk, Bruce G. Simons-Morton BackgroundIn light of on-going policy changes related to cannabis use in the United States, it is important to examine possible associations between cannabis use and subsequent behaviors of public health interest. This study identified prospective associations between cannabis use during first-year post high-school and a wide range of positive and negative health and social measures one year later.MethodsData were from Waves 4 (Time 1; 1st year after high-school) and 5 (Time 2; one year later) of the NEXT Generation Health Study, a national sample of emerging adults in the United States (n = 1915; mean age = 20.2; 61% female). Multinomial logistic regressions adjusting for pertinent covariates were conducted to examine odds of substance use, nutrition, physical activity, sedentary behaviors, school performance, family relations, mental health, driving behaviors and health perceptions at Time 2.ResultsCompared with non-use, frequent use (20+ times in the past year) at Time 1 was associated with Time 2 negative health and social measures, including risky driving behaviors (AOR = 1.78, CI-1.45–2.19), depressive symptoms (AOR = 1.68, CI-1.43–1.98), unhealthy weight control behaviors (AOR = 1.55, CI-1.31–1.84), psycho-somatic symptoms (AOR = 1.55, CI-1.30–1.83), and low school achievement (AOR = 1.46, CI-1.23–1.75). Frequent users relative to non-users had a lower probability of being overweight and obese (AOR = 0.75, CI-0.60–0.92).Regarding positive measures frequent users relative to non-users had a higher probability of meeting recommendation of physical activity (AOR = 1.28, CI-1.09–1.51), but a lower probability of consuming fruits and vegetables (AOR = 0.82, CI-0.70–0.96) or attending college/university (AOR = 0.57, CI-0.44–0.75).Findingson occasional cannabis use (1–19 times in the past year) were more similar to frequent cannabis use for negative than positive health and social measures.ConclusionResults demonstrate complex prospective patterns in which significant prospective associations with most adverse measures were found for both occasional and frequent users, and with few significant associations of positive health measures mostly among occasional cannabis users.
       
  • “Once I’d done it once it was like writing your name”: Lived
           experience of take-home naloxone administration by people who inject drugs
           
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Andrew McAuley, Alison Munro, Avril Taylor BackgroundThe supply of naloxone, the opioid antagonist, for peer administration (‘take-home naloxone’ (THN)) has been promoted as a means of preventing opioid-related deaths for over 20 years. Despite this, little is known about PWID experiences of take-home naloxone administration. The aim of this study was to advance the evidence base on THN by producing one of the first examinations of the lived-experience of THN use among PWID.MethodsQualitative, face to face, semi-structured interviews were undertaken at a harm reduction service with individuals known to have used take-home naloxone in an overdose situation in a large urban area in Scotland. Interpretative Phenomenological Analysis (IPA) was then applied to the data from these in-depth accounts.ResultsThe primary analysis involved a total of 8 PWID (seven male, one female) known to have used take-home naloxone. This paper focuses on the two main themes concerning naloxone administration: psychological impacts of peer administration and role perceptions. In the former, the feelings participants encounter at different stages of their naloxone experience, including before, during and after use, are explored. In the latter, the concepts of role legitimacy, role adequacy, role responsibility and role support are considered.ConclusionThis study demonstrates that responding to an overdose using take-home naloxone is complex, both practically and emotionally, for those involved. Although protocols exist, a multitude of individual, social and environmental factors shape responses in the short and longer terms. Despite these challenges, participants generally conveyed a strong sense of therapeutic commitment to using take-home naloxone in their communities.
       
  • Disneyization: A framework for understanding illicit drug use in bounded
           play spaces
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Tim Turner BackgroundThis paper combines evidence from an ethnographic study of illicit drug use amongst tourists in Ibiza with Bryman’s (2004) theoretical model of Disneyization. The principal aim was to construct a new conceptual framework that may help scholars, practitioners and policy makers make sense of dynamic patterns of illegal drug use across bounded play spaces such as tourist resorts, music festivals and nightclubs.MethodsEthnographic fieldwork employing a grounded theory design was undertaken over three summers in tourist locations on the Balearic island of Ibiza, including nightclubs, bars, cafes, beaches, airports and hotels. Field notes from participant observation were supplemented with data from semi-structured interviews (n = 56) and secondary sources gathered from tourist marketing.ResultsThe framework of Disneyization has been discussed in terms of 5 constructs: theming, hybrid consumption, branding, performative labour and atmospheres; each having a specific role in relation to understanding illicit drug use in bounded play spaces. Thus: Theming sets the stage, by physically and symbolically demarcating space with indelible themes of hedonism that open up the possibility of illicit drug use. Hybrid-consumption blurs the distinction between legal and illegal forms of intoxication, making the trading and consumption of illegal drugs appear like a natural feature of the consumer space. Branding demonstrates how participants construct intricate hierarchies of taste and credibility related to drug of choice. Performative labour re-enforces hybrid consumption, with participants working in the bounded play spaces of Ibiza immersed within the illicit drug market. Atmospheres represents the alchemic synergy of bounded play space and is important to understanding illicit drug use as a sensorial, deeply immersive but transitory experience.ConclusionThis research offers Disneyization as a new conceptual framework for making sense of deeply complex spatial, socio-cultural, psychological and economic processes that underpin dynamic patterns of drug use in bounded play spaces.
       
  • Measuring individual-level needle and syringe coverage among people who
           inject drugs in Myanmar
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Daniel O’Keefe, Soe Moe Aung, Naanki Pasricha, Thu Wun, Soe Khaing Linn, Nay Lin, Campbell Aitken, Chad Hughes, Paul Dietze BackgroundMyanmar has prioritised people who inject drugs (PWID) as a key population for HIV mitigation efforts, with targets for needle and syringe distribution set at a population level. However, individual-level coverage, defined as the percentage of an individual’s injecting episodes covered by a sterile syringe, is a more sensitive measure of intervention coverage. We sought to examine individual-level coverage in a sample of PWID in Myanmar.MethodsWe recruited 512 PWID through urban drop-in-centres in Yangon, Mandalay and Pyin Oo Lwin. Participants were administered a quantitative questionnaire covering five domains: demographics, drug use, treatment and coverage, and injecting risk behaviour.We calculated past fortnight individual-level syringe coverage, estimating levels of sufficient (≥100% of injecting episodes covered by a sterile syringe) and insufficient (
       
  • The role of alcohol in constructing gender & class identities among young
           women in the age of social media
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Jemma Lennox, Carol Emslie, Helen Sweeting, Antonia Lyons Research suggests young women view drinking as a pleasurable aspect of their social lives but that they face challenges in engaging in a traditionally ‘masculine’ behaviour whilst maintaining a desirable ‘femininity’. Social network sites such as Facebook make socialising visible to a wide audience. This paper explores how young people discuss young women’s drinking practices, and how young women construct their identities through alcohol consumption and its display on social media. We conducted 21 friendship-based focus groups (both mixed and single sex) with young adults aged 18–29 years and 13 individual interviews with a subset of focus group respondents centred on their Facebook practices. We recruited a purposive sample in Glasgow, Scotland (UK) which included ‘middle class’ (defined as students and those in professional jobs) and ‘working class’ respondents (employed in manual/service sector jobs), who participated in a range of venues in the night time economy. Young women’s discussions revealed a difficult ‘balancing act’ between demonstrating an ‘up for it’ sexy (but not too sexy) femininity through their drinking and appearance, while still retaining control and respectability. This ‘balancing act’ was particularly precarious for working class women, who appeared to be judged more harshly than middle class women both online and offline. While a gendered double standard around appearance and alcohol consumption is not new, a wider online audience can now observe and comment on how women look and behave. Social structures such as gender and social class remain central to the construction of identity both online and offline.
       
  • A qualitative exploration of Thai alcohol policy in regulating
           availability and access
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Ratchakorn Kaewpramkusol, Kate Senior, Richard Chenhall, Sutham Nanthamongkolchai, Surasak Chaiyasong BackgroundDespite abundant alcohol control regulations and measures in Thailand, prevalence of alcohol consumption has been relatively steady for the past decade and alcohol-related harm remains high. This study aims to explore, through the perspectives of key public health stakeholders, the current performance of regulations controlling alcohol availability and access, and the future directions for the implementation of Thai alcohol policy.MethodsSemi-structured interviews were conducted with public health stakeholders from three sectors; the government, academia and civil society. Their perceptions about the current alcohol situation, gaps in the current policies, and future directions of alcohol policy were discussed. Audio data were transcribed verbatim, systematically coded and analysed.ResultsThe three key concerning issues were physical availability, economic availability and commercial access, which referred to outlet density, taxation and pricing, and compliance to stipulated regulations, respectively. First, Thailand failed to control the number of alcohol outlets. The availability problem was exacerbated by the increased numbers of liquor licences issued, without delineating the need for the outlets. Second, alcohol tax rates, albeit occasionally adjusted, are disproportionate to the economic dynamic, and there is yet a minimum pricing. Finally, compliance to age and time restrictions was challenging.ConclusionsThe lack of robustness of enforcement and disintegration of government agencies in regulating availability and access hampers effectiveness of alcohol policy. Comprehensive regulations for the control of availability of and access to alcohol are required to strengthen alcohol policy. Consistent monitoring and surveillance of the compliances are recommended to prevent significant effects of the regulations diminish over time.
       
  • Development and validation of the scale to assess satisfaction with
           medications for addiction treatment – Buprenorphine-naloxone for heroin
           addiction (SASMAT-BUNHER)
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): José Pérez de los Cobos, Joan Trujols, Saul Alcaraz, Núria Siñol, Óscar Lozano, Francisco González-Saiz, Buprenorphine Naloxone Survey Group BackgroundUntil now, no specific tool has been available to measure heroin-dependent patient satisfaction with buprenorphine-naloxone as a medication. The purpose of the present study was to develop the Scale to Assess Satisfaction with Medications for Addiction Treatment–Buprenorphine-Naloxone for Heroin addiction (SASMAT-BUNHER) and to examine its validity and reliability.MethodsThe SASMAT-BUNHER was developed from a pool of 44 self-administered items grouped into nine theoretical domains, as follows: Overall Satisfaction, Pharmacotherapy, Initiation, Anti-Addictive Effect on Heroin, Mental State, Physical State, Personal Functioning, Acceptability, and Anti-Addictive Effect on Secondary Substances. The Treatment Satisfaction Questionnaire for Medication 1.4 version (TSQM 1.4) was used for convergent validation. Participants were 316 heroin-dependent patients in maintenance treatment with buprenorphine-naloxone sublingual tablets at 16 different treatment centres.ResultsPrincipal component analysis of the SASMAT-BUNHER revealed a 5-factor structure that accounted for 65.1% of total variance. Based on similarities between empirically-obtained factors and theoretical domains, Factors 1 through 5 were named ‘Mental and Physical State’ (10 items), ‘Anti-Addictive Effect on Other Substances’ (5 items), ‘Anti-Addictive Effect on Heroin’ (4 items), ‘Personal Functioning’ (3 items), and ‘Acceptability’ (4 items). All factors showed acceptable internal consistency (Cronbach's alpha coefficients: 0.744–0.925) and test-retest reliability (intraclass correlation coefficients: 0.704–0.895). Correlation between SASMAT-BUNHER and TSQM 1.4 total scores was moderate (Pearson r = 0.552). Moreover, SASMAT-BUNHER total scores of patients reporting absence of buprenorphine-naloxone side effects were higher than those of their counterparts.ConclusionThese results support the validity and reliability of the SASMAT-BUNHER.Graphical abstractGraphical abstract for this article
       
  • Fentanyl self-testing outside supervised injection settings to prevent
           opioid overdose: Do we know enough to promote it'
    • Abstract: Publication date: August 2018Source: International Journal of Drug Policy, Volume 58Author(s): Catherine R. McGowan, Magdalena Harris, Lucy Platt, Vivian Hope, Tim Rhodes Since 2013, North America has experienced a sharp increase in unintentional fatal overdoses: fentanyl, and its analogues, are believed to be primarily responsible. Currently, the most practical means for people who use drugs (PWUD) to avoid or mitigate risk of fentanyl-related overdose is to use drugs in the presence of someone who is in possession of, and experienced using, naloxone. Self-test strips which detect fentanyl, and some of its analogues, have been developed for off-label use allowing PWUD to test their drugs prior to consumption. We review the evidence on the off-label sensitivity and specificity of fentanyl test strips, and query whether the accuracy of fentanyl test strips might be mediated according to situated practices of use. We draw attention to the weak research evidence informing the use of fentanyl self-testing strips.
       
  • Tensions and contradictions in family court innovation with high risk
           parents: The place of family drug treatment courts in contemporary family
           justice
    • Abstract: Publication date: Available online 29 June 2018Source: International Journal of Drug PolicyAuthor(s): Judith Harwin, Karen Broadhurst, Caroline Cooper, Stephanie Taplin Parental substance misuse is a leading factor in child abuse and neglect and frequently results in court-mandated permanent child removal. Family drug treatment courts, which originated in the USA and are only found in adversarial family justice systems, are a radical innovation to tackle this problem. Unlike ordinary court, they treat parents within the court arena as well as adjudicating, and in this way they seek to draw a new balance between parental needs and the child’s right to timely permanency. Family drug treatment courts have spread to England, Australia and Northern Ireland and international research has found they have higher rates of parental substance misuse cessation and family reunification and lower foster care costs than ordinary courts. Yet their growth has been far from straightforward. In the USA they have not kept pace with the rise of criminal drug treatment courts and in England and Australia their numbers remain small. The central purpose of this article is to explore why the family drug treatment movement has not achieved wider impact and to consider opportunities and challenges for its future development. To address these questions we draw on evidence and experience from the USA, England and Australia. We discuss the operational challenges, tensions between children’s needs for stability and parental timescales for recovery, the impact of wider economic and political change, and issues in data evaluation. We conclude that despite the promise of family drug treatment courts as a new paradigm to address risky parenting, effecting systemic change in the courts is extremely difficult.
       
  • Making a difference' Applying Vitellone’s Social Science of the
           Syringe to performance and image enhancing drug injecting
    • Abstract: Publication date: Available online 19 April 2018Source: International Journal of Drug PolicyAuthor(s): Aaron Hart Vitellone’s Social Science of the Syringe investigates epistemologies of injecting drug use. She argues for a methodology that can be simultaneously sensitive to biopolitical power regimes; the trajectories of social stratification; and the resistance, creativity and dignity of human agency. She proposes a methodological focus on the syringe-in-use as an active participant in these dynamics. Harm reduction policy and service provision frameworks have paid little attention to the phenomena of performance and image enhancing drug (PIEDs) injection. One way of assessing the merit of Vitellone’s proposal is to use it to investigate these phenomena. I argue that Vitellone’s method can be used to articulate a range of significant differences between people who inject PIEDs and other people who inject drugs, and that these differences can inform harm reduction initiatives. When compared to the heroin syringe, the PIED syringe participates in different socio-economic and material contexts, gendered identities, and biopolitical governance regimes. These differences materialise in different rates of syringe sharing and blood-borne virus transmission; and different experiences of needle exchange services. I offer a thought experiment demonstrating how a different syringe might alter the structural dynamics, biopolitical governance, and the agentic choices of people who inject PIEDs. Judging by the productive effects of diffracting Vitellone’s analysis through an empirical concern with PIED injecting, I concur with Vitellone’s proposition that ‘something objective may be gained from an empirical investigation of the syringe-in-use’ (p. 33).
       
  • Call for papers: Problematizations in drug use policy, practice and
           research
    • Abstract: Publication date: Available online 27 March 2018Source: International Journal of Drug PolicyAuthor(s):
       
  • The object in hand: Social science of the syringe
    • Abstract: Publication date: Available online 26 March 2018Source: International Journal of Drug PolicyAuthor(s): Helen Keane
       
 
 
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