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International Journal of Drug Policy
Journal Prestige (SJR): 1.441
Citation Impact (citeScore): 3
Number of Followers: 474  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0955-3959
Published by Elsevier Homepage  [3185 journals]
  • Taking opioids in times of crisis: Institutional oversight, chronic pain
           and suffering in an integrated healthcare delivery system in the U.S.
    • Abstract: Publication date: December 2019Source: International Journal of Drug Policy, Volume 74Author(s): Inga Gruß, Alison Firemark, Meghan Mayhew, Carmit K. McMullen, Lynn L. DeBar BackgroundOpioid treatment for chronic pain has garnered heightened public attention and political pressure to control a devastating public health crisis in the United States (U.S.). Resulting policy changes, together with ongoing public and political attention, have pushed health care systems and providers to lower doses or deprescribe and taper patients off opioids. However, little attention has been paid to the impact of such practice changes on patients who had relied on opioid treatment to manage their chronic pain. The aim of this article is to explore experiences with opioid-related care under aggressive tapering efforts and concomitant heightened monitoring and institutional oversight among patients with chronic pain in an integrated delivery system through in-depth interviews.MethodsWe interviewed 97 patients with chronic pain who were assigned to the usual care arm of the Pain Program for Active Coping and Training (PPACT) study. These patients had been prescribed opioids as part of their treatment regimens and taken opioids closely monitored by their health care providers. We followed the framework method for coding and analysing transcripts using NVivo 12.ResultsThe experiences of these patients during this period of change can be understood through three interconnected themes: (1) many patients taking opioids experience debilitating physical side effects; (2) navigating opioid treatment contributes to significant emotional distress among many patients with chronic pain and; (3) the quality of patients’ relationship with their primary care provider can be negatively affected by negotiations regarding long-term opioid treatment for chronic pain.ConclusionWe highlight the importance of utilizing communication approaches that are patient-centered and include shared decision making during the tapering and/or deprescribing processes of opioids and ensuring alternative pain treatments are available to patients with chronic pain.
  • “Another thing to live for”: Supporting HCV treatment and cure among
           Indigenous people impacted by substance use in Canadian cities
    • Abstract: Publication date: December 2019Source: International Journal of Drug Policy, Volume 74Author(s): M.E. Pearce, K. Jongbloed, L. Demerais, H. MacDonald, W.M. Christian, R. Sharma, N. Pick, E.M. Yoshida, P.M. Spittal, M.B. Klein BackgroundColonization and colonial systems have led to the overrepresentation of Indigenous people impacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care.MethodsForty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization.ResultsTaken together, participants’ stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care.ConclusionThere are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.
  • Medical marijuana. What can we learn from the experiences in Canada,
           Germany and Thailand'
    • Abstract: Publication date: December 2019Source: International Journal of Drug Policy, Volume 74Author(s): Jürgen Rehm, Tara Elton-Marshall, Bundit Sornpaisarn, Jakob Manthey Cannabis policies are changing globally, and medical marijuana programs are part of these changes. Drawing from the examples of two high-income (Canada, an early adopter of medical marijuana, and Germany, a late adopter) and one middle-income (Thailand) countries, we illustrate two main pressures underlying these recent changes. First, in many high-income countries, cannabis has been used to self-medicate for different ailments and diseases, even though there is no evidence of effectiveness for many of these conditions. Second, the cannabis industry is pressuring governments and decision-makers to allow for medical marijuana use with lenient regulations—without specifying medical conditions (indications) and requiring only a prescription from a health professional to obtain it. As a result, demand is likely to increase, even in countries with low prevalence of use. Cannabis policy-makers need to consider a balance between the medical benefits of medical marijuana and the potential public health consequences and cost.
  • Young men's alcohol consumption experiences and performances of
    • Abstract: Publication date: Available online 12 September 2019Source: International Journal of Drug PolicyAuthor(s): Samantha Wilkinson, Catherine Wilkinson BackgroundBy creating a dichotomy between those who are ‘out-of-control’ ‘binge drinkers’ and those for whom alcohol contributes to friendship fun, academic and alcohol policy literature often fail to acknowledge the nuances in the diverse drinking practices of men.MethodsThis paper engages with findings from a multiple qualitative method research project (comprising of individual and friendship group interviews; diaries; and participant observation), conducted with 16 young men, aged 15–24: eight living in the middle-class area of Chorlton, and eight living in the working-class area of Wythenshawe, Manchester, United Kingdom.ResultsThis paper provides fine-grained insights into the doings, complexities and contradictions of masculinity in the context of drinking. Young men are shown to tap into different co-existing versions of masculinity, one of which is based on the exclusion of femininity (i.e. they act as tough guys), while another version is more inclusive (i.e. it allows for displays of care).ConclusionThis paper shows a much more complex image of young men's drinking practices than has hitherto been conceptualised in the existing literature, and brings to the fore doings of alternative masculinities. This has important implications for alcohol policy interventions targeting men, in that the complexities and contradictions of masculinity in relation to drinking must be taken seriously.
  • The limits of single-group interrupted time series analysis in assessing
           the impact of smoke-free laws on short-term mortality
    • Abstract: Publication date: November 2019Source: International Journal of Drug Policy, Volume 73Author(s): Gregorio Barrio, María J. Belza, Rocío Carmona, Juan Hoyos, Elena Ronda, Enrique Regidor BackgroundDecreases in circulatory/respiratory morbimortality after the January-2006 Spanish partial smoke-free law have been found using designs without control groups, such as single-group interrupted time series (ITS), which are prone to biases. The aim was to reassess the law’s impact on mortality using ITS designs with robustness checks.MethodsA comprehensive cohort of people aged ≥25 in each calendar-year of 2002–2007, living in 13 of 18 Spanish regions, was followed up between 01/2002 and 12/2007. The law included a smoking ban in indoor public and workplaces, allowing exceptions in catering, hospitality and leisure venues, and other interventions. Post-law changes in monthly coronary/respiratory mortality were estimated using segmented regression, adjusting for relevant covariates, including seasonality, extreme temperatures, influenza incidence and air pollution. The validity of results was assessed using control outcomes, hypothetical law dates, and non-equivalent control groups, analysing their results as difference-in-differences (DID) designs.ResultsSignificant immediate post-law decreases in coronary, respiratory and non-tobacco-related mortality were observed among people aged ≥70. A significant immediate post-law decrease in respiratory mortality (−12.7%) was also observed among people age 25–69, although this was neutralized by a subsequent upward trend before 1.5 years. More favourable post-law changes in coronary/respiratory mortality among the target (people aged 25–69) than control groups (people aged ≥70 or women aged ≥80) were not identified in DID designs. Establishing hypothetical law dates, immediate decreases began in February/March 2005 with maxima between April and July 2005.ConclusionsAfter robustness checks, the results do not support a clear positive impact of the 2006 Spanish smoke-free law on short-term coronary/respiratory mortality. The favourable immediate changes observed pre- and post-law could derive mainly from the harvesting effect of the January-2005 cold wave. This highlights the risks of assessing the impact of health interventions using both morbimortality outcomes and designs without a control group and adequate robustness checks.
  • Evidence that social-economic factors play an important role in drug
           overdose deaths
    • Abstract: Publication date: Available online 28 August 2019Source: International Journal of Drug PolicyAuthor(s): Gene M. Heyman, Nico McVicar, Hiram Brownell BackgroundDrug overdose deaths in the United States increased from approximately 16,000 per year in 2001 to 41,000 per year in 2014. Although every US state witnessed an increase, the increases were much larger in some states than others. There was also variation as a function of race and ethnicity. Non-Hispanic Whites accounted for more than 80% of the deaths, and in some states their rates were about ten times greater per capita than Hispanics and Non-White rates. State and temporal differences provide an opportunity to evaluate explanations of what is driving drug overdose deaths. In this report, we evaluate the degree to which state level variation in opioid prescription rates and social-economic conditions explain state level variation in overdose death rates.Methods and dataWe used publicly available data from the Center for Disease Control (CDC), Bureau of Labor Statistics (BLS), Drug Enforcement Agency (DEA) and the Opportunity Insights project.ResultsLegally prescribed opioids, social capital and work force participation accounted for 53–69% of the between-state variation in overdose deaths in Non-Hispanic Whites. Prescriptions and the two social economic measures accounted for about the same amounts of unique variation, but shared variation among the three independent variables was the strongest predictor of overdose deaths. Panel regression results of the year-to-year changes in overdose deaths were similar. However, the pattern of correlations for Hispanics and Non-Whites was quite different. Neither opioid prescriptions nor social capital were significant predictors of overdose deaths in the between-state and between-year Hispanic and Non-White regression analyses.ConclusionsCommon variation in opioid prescriptions rates, social capital, and work force participation proved the strongest predictor of drug overdose deaths in Non-Hispanic Whites. We discuss reasons why the same did not hold for the Hispanic/Non-White population.
  • Narratives of people who inject drugs on factors contributing to opioid
    • Abstract: Publication date: December 2019Source: International Journal of Drug Policy, Volume 74Author(s): Jamie Suki Chang, Emily Behar, Phillip O. Coffin BackgroundIn recent years, there has been increasing national and global attention to opioid overdoses. In San Francisco, it is estimated that the population of people who inject drugs (PWID) has more than doubled in the past ten years. The risk factors for opioid overdose have been examined closely, but firsthand accounts of PWID who have experienced overdoses are less documented. In this paper, we use two theories - lay expertise and structural vulnerabilities - as frameworks to frame and qualitatively examine the narratives of PWID surrounding their recent overdose experiences.MethodsAudio-recorded semi-structured open-ended motivational interviewing counseling sessions were conducted with PWID in San Francisco who have experienced at least one non-fatal overdose event (N = 40). Participants discussed the context of recent opioid overdoses, either witnessed or personally experienced, focusing on their perceptions of unique contributing factors. Interview data were coded and analysed using ATLAS.ti. We used a thematic content analysis approach to qualitatively analyze data queries and generate themes. We used theories of structural vulnerability and lay expertise to frame the analysis.ResultsUsing quotes from the participants, we report four central themes that contributed to participants' overdose experiences: 1) Social Dynamics and Opioid Expertise; 2) Uncertain Supply, Composition, Source; 3) Balancing Polysubstance Use, and 4) Emotional Pain.ConclusionAs PWID described their overdose experiences, many factors that contributed to their overdoses were situated at the structural level. The everyday, lived experiences of PWID often competed or conflicted with public health messages and approaches. The accumulated expertise of PWID about everyday risk factors can be leveraged by public health practitioners to inform and improve overdose prevention interventions and messages.
  • Cost-effectiveness analysis of alternative naloxone distribution
           strategies: First responder and lay distribution in the United States
    • Abstract: Publication date: Available online 19 August 2019Source: International Journal of Drug PolicyAuthor(s): Tarlise Townsend, Freida Blostein, Tran Doan, Samantha Madson-Olson, Paige Galecki, David W. Hutton BackgroundThe U.S. is facing an unprecedented number of opioid-related overdose deaths, and an array of other countries have experienced increases in opioid-related fatalities. In the U.S., naloxone is increasingly distributed to first responders to improve early administration to overdose victims, but its cost-effectiveness has not been studied. Lay distribution, in contrast, has been found to be cost-effective, but rising naloxone prices and increased mortality due to synthetic opioids may reduce cost-effectiveness. We evaluate the cost-effectiveness of increased naloxone distribution to (a) people likely to witness or experience overdose (“laypeople”); (b) police and firefighters; (c) emergency medical services (EMS) personnel; and (d) combinations of these groups.MethodsWe use a decision-analytic model to analyze the cost-effectiveness of eight naloxone distribution strategies. We use a lifetime horizon and conduct both a societal analysis (accounting for productivity and criminal justice system costs) and a health sector analysis. We calculate: the ranking of strategies by net monetary benefit; incremental cost-effectiveness ratios; and number of fatal overdoses.ResultsHigh distribution to all three groups maximized net monetary benefit and minimized fatal overdoses; it averted 21% of overdose deaths compared to minimum distribution. High distribution to laypeople and one of the other groups comprised the second and third best strategies. The majority of health gains resulted from increased lay distribution. In the societal analysis, every strategy was cost-saving compared to its next-best alternative; cost savings were greatest in the maximum distribution strategy. In the health sector analysis, all undominated strategies were cost-effective. Results were highly robust to deterministic and probabilistic sensitivity analysis.ConclusionsIncreasing naloxone distribution to laypeople and first responder groups would maximize health gains and be cost-effective. If feasible, communities should distribute naloxone to all groups; otherwise, distribution to laypeople and one of the first responder groups should be emphasized.
  • “A spray bottle and a lollipop stick”: An examination of policy
           prohibiting sterile injecting equipment in prison and effects on young men
           with injecting drug use histories
    • Abstract: Publication date: Available online 16 August 2019Source: International Journal of Drug PolicyAuthor(s): Shelley Walker, Kate Seear, Peter Higgs, Mark Stoové, Mandy Wilson BackgroundAustralian young male prisoners with histories of injecting drug use are more likely to report injecting in prison, to do so more frequently, and to be involved in more un-safe injecting-related practices than their older counterparts. Despite international evidence that prison needle and syringe programs are both feasible and effective in reducing the harms associated with injecting drug use in prison, these young men do not have access to such equipment.MethodsWe critically analyse the interview transcripts of 28 young men with histories of injecting drug use who were recently released from adult prisons in Victoria, Australia, and prison drug policy text. We use Bacchi’s ‘What’s the problem represented to be'’ approach to examine how the ‘problem’ of injecting drug use in prison is represented in prison drug policy, including the assumptions that underpin these problematisations, and the subjectification and lived effects that are produced for the young men in our study.ResultsOur analysis reveals how prison drug policy enables the creation and re-use of homemade injecting equipment crafted from unsterile items found in prison, and that in doing so the policy produces a range of stigmatising subjectification effects and other harmful material effects (such as hepatitis C virus transmission and injecting related injury and harms). Findings highlight, how injecting drug use is represented in policy silences other ways of understanding the ‘problem’ that may have less harmful effects for incarcerated young men who inject drugs.ConclusionWe argue that somewhat paradoxically, the approach of prohibiting access to sterile injecting equipment in prison—which is constituted as a solution for addressing such harms—in fact helps to produce them.
  • Trajectories of alcohol use problems based on early adolescent alcohol
           use: Findings from a 35 year population cohort
    • Abstract: Publication date: December 2019Source: International Journal of Drug Policy, Volume 74Author(s): Joseph M. Boden, Giles Newton-Howes, James Foulds, Janet Spittlehouse, Susan Cook BackgroundEarly exposure to alcohol in adolescence is associated with a range of long term harms. Better understanding of trajectories of alcohol use from adolescence to early adulthood would help target prevention strategies to high risk groups.MethodsChristchurch (New Zealand) general population birth cohort (n = 1265). A latent trajectory model of drinking behaviour at age 14–16 was used to predict drinking outcomes at age 18–35, net of covariate factors known to be associated with substance use outcomes in this cohort.ResultsThree classes of adolescent alcohol use were identified. These were: occasional drinkers, emergent binge drinkers and increasing heavy drinkers.ConclusionsThis analysis identifies three groups of adolescent alcohol users with differing patterns of use. Emergent binge drinkers likely require public policy responses to alcohol use whereas increasing heavy drinkers are potentially able to be identified individually on the basis of patterns of alcohol use and social variables. This group may benefit from psychosocial interventions and are unlikely to respond to a broad public health approach.
  • Potential public health impacts of medical cannabis availability on
           opioid-related harms' Urgent but un-answered questions from Canada
    • Abstract: Publication date: November 2019Source: International Journal of Drug Policy, Volume 73Author(s): Benedikt Fischer, Wayne Jones, Wayne Hall, Paul Kurdyak
  • Divergent estimates of HIV incidence among people who inject drugs in
    • Abstract: Publication date: Available online 10 August 2019Source: International Journal of Drug PolicyAuthor(s): Olga Morozova, Robert E. Booth, Sergii Dvoriak, Kostyantyn Dumchev, Yana Sazonova, Tetiana Saliuk, Forrest W. Crawford BackgroundDivergent estimates of HIV incidence among people who inject drugs (PWID) in Ukraine have been reported in modeling studies, longitudinal cohort studies, and recent infection assays used in cross-sectional surveys. Estimates range from 0.65 to 24.8 infections per 100 person-years with substantial regional variation. In this paper, we study the sources of this discrepancy.MethodsWe compared baseline characteristics of study subjects recruited in the cross-sectional integrated bio-behavioral surveillance surveys (IBBS) in 2011 and 2013, with those from the longitudinal network intervention trial (network RCT) conducted between 2010 – 2013, the study that found a remarkably high incidence of HIV among PWID in Ukraine. The analysis was conducted for two cities: Mykolaiv and Odesa.ResultsSignificant differences were found in the characteristics of study subjects recruited in the IBBS surveys and the network RCT, in particular in Odesa, where the mismatch in the estimates of HIV incidence is greatest. In Odesa, recent syringe sharing was about three times as prevalent in the network RCT as in the IBBS; 39% of the network RCT and 16–18% of the IBBS participants indicated stimulants rather than opiates as their drug of choice; 97% of respondents in the network RCT and 45% in the IBBS-2013 reported injecting in a group over half of the time; and the average monthly number of injections in the network RCT was about twice that in the IBBS studies.ConclusionsDifferences in study designs and sampling methodologies may be responsible for the substantial differences in HIV incidence estimates among PWID in Ukraine. The potential sources of selection bias differed between the studies and likely resulted in the recruitment of lower risk individuals into the IBBS studies compared to the network RCT. Risk stratification in the population of PWID may have implications for future surveillance and intervention efforts.
  • Drinking comfortably' Gender and affect among Danish pre-partiers
    • Abstract: Publication date: Available online 7 August 2019Source: International Journal of Drug PolicyAuthor(s): Maria Dich Herold, Geoffrey Hunt BackgroundThe aim of this paper is to examine the relationship between youthful drinking practices and gender within the domestic pre-party (prior to a night out), an arena, which has been relatively ignored in existing qualitative research on youthful alcohol use. An examination of the relationships between gender and drinking practices in this context is important for three reasons. First, pre-parties are associated with heavy drinking, which has traditionally been associated with masculinity. Second, because pre-drinking takes place in the private sphere of the home, it is therefore ‘controlled’ in terms of who can participate and hence what precisely is the gender composition. Third, whilst being located in the private sphere of the home, pre-party practices are nevertheless informed by the (hyper) gendered environments of public drinking spaces in the Night-Time Economy (NTE), most dominantly mainstream clubs and bars. We suggest that such characteristics allow for the emergence of specific gendered relationships, activities and affectivities, thereby demarcating the pre-party as a particular gendered drinking space.MethodsWe draw on narrative data from 140 in-depth face-to-face interviews with young Danish alcohol users between 18–25 years of age. The interviews were part of a large-scale research project on the gendered aspects of youthful alcohol use and intoxication. Theoretically, we draw on a combination of the ‘doing gender’ paradigm (West & Zimmerman, 1987) and affect theoretical notions on (un)comfortability (Ahmed, 2014). We propose that these perspectives mark out the pre-party as a particularly gendered drinking space.ResultsWhile our analysis supports the observation of existing qualitative studies, that pre-partying is not merely motivated by the possibility of becoming intoxicated in a cheap and un-surveilled way before going out, we especially argue that pre-partying is fueled by a desire for 'comfortability', which seems almost impossible to disassemble from the gendering that pre-partying also entails. Our analysis therefore contributes to the ongoing academic discussion around the relationship between ‘intoxicated femininity’ and ‘intoxicated masculinity’ by suggesting that we need to take the affective implications of young people’s (gendered) drinking practices into account in a thorough discussion of the relationship between youthful alcohol use and gender.
  • Young women’s narratives on sex in the context of heavy alcohol use:
           Friendships, gender norms and the sociality of consent
    • Abstract: Publication date: Available online 7 August 2019Source: International Journal of Drug PolicyAuthor(s): Mie Birk Jensen, Geoffrey Hunt BackgroundAlthough young women’s friendships remain understudied in drinking contexts, some researchers have pointed to how young women can make use of each other to manage sexual advances when drinking. In this paper, we explore how young women make use of friends to negotiate their sexual boundaries, and construct the meaning of sexual experiences in a context of heavy alcohol use.MethodsThe data stems from a large scale research project at the Centre for Alcohol and Drug Research, Aarhus University, which included 140 interviews with young Danes between the ages of 18–25. In the present study, we primarily use narratives from 33 in-depth interviews with young women, who recall their personal sexual experiences with men in the context of heavy alcohol use.ResultsWe find that these young women make meaning of their sexual experiences in relation to friends through a negotiation of their emotional response as well as dominant gender norms. We argue that friends may serve to prevent sexual regret and offer support in instances where young women feel regret after engaging in sex when drinking heavily. However, we also argue that friends may encourage a more humorous approach in recounting sexual encounters in the context of heavy alcohol use, which may contradict their initial feelings of the encounter and gloss over issues of sexual consent.ConclusionWith this article we point to how young women's ability to negotiate the meaning of their sexual experiences as well as that of sexual consent more generally, are interlinked with prevalent gender norms that play out in the context of friendships. The young women in our study narrated friends as more central to negotiations of sexual boundaries than sexual partners when in a context of heavy alcohol use.On this basis, we develop the term ‘social consent’, which we suggest that future studies and preventive efforts should take into account in order to challenge the gender norms that can serve to normalize sexual violence in drinking contexts.
  • How the U.S.-Mexico border influences adolescent substance use: Youth
           participatory action research using photovoice
    • Abstract: Publication date: Available online 26 July 2019Source: International Journal of Drug PolicyAuthor(s): Elizabeth Salerno Valdez, Josephine Korchmaros, Samantha Sabo, David O. Garcia, Scott Carvajal, Sally Stevens IntroductionThe purpose of this study is to use Youth Participatory Action Research (YPAR) methods and Photovoice to identify the perceived environmental factors that influence substance use among adolescents living at the U.S.-Mexico border.MethodsOne academic and a local youth health coalition engaged in Youth Participatory Action Research (YPAR) using Photovoice and qualitative methods to examine the perceived factors influencing adolescent substance use in their border community.ResultsIdentified novel risk factors for adolescent substance use on the border included the normalization of drug trafficking, normalization of substance use, and cross-border access to substances. Novel protective factors included living in a close-knit binational community and having strong binational family and social support systems. The findings also illustrate a nexus of 'factors' wherein risk and protective elements overlap.ConclusionThis study contributes to the broader literature on international border health and how living in a border space influences adolescent substance use. The examination of influential border-bound factors provides a more complete understanding of the experiences of youth living on the U.S.-Mexico border, and informs the field of the importance of considering the border experience for future prevention and risk reduction efforts with border adolescents.
  • Communicating THC levels and ‘dose’ to consumers: Implications for
    • Abstract: Publication date: Available online 25 July 2019Source: International Journal of Drug PolicyAuthor(s): David Hammond In a well-regulated drug market, consumers should be able to understand and titrate their dose with little difficulty. In the cannabis market, despite substantial increases in THC levels over time, users have had limited information on the strength of their products. In principle, cannabis legalization provides greater opportunity to communicate clear, accurate information to consumers through packaging and labelling standards. However, jurisdictions that have legalized cannabis have experienced an increase in adverse events from higher strength products, particularly from edibles and other concentrates. What little research exists suggests that current regulatory practices of labelling THC levels on packages may be ineffective due to consumer difficulties understanding numbers (e.g., mg vs. percentage), and the different ways THC levels are communicated across product categories. In particular, current labelling practices provide little guidance in terms of ‘dose expression’—how THC ‘dose’ translates into consumption amounts for specific products. The current paper identifies five principles to guide cannabis labelling and packaging regulations, including considerations for numeric THC labelling, the use of standard servings or dose across different product forms, strategies to communicate ‘dose expression’, and ‘dose-unit packaging’. Overall, there is a need for regulated cannabis markets to develop more effective packaging and labelling standards to allow consumers to effectively titrate their THC intake, with the goal of promoting lower-risk cannabis use.
  • The prevalence of non-fatal overdose among people who inject drugs: A
           multi-stage systematic review and meta-analysis
    • Abstract: Publication date: Available online 24 July 2019Source: International Journal of Drug PolicyAuthor(s): Samantha Colledge, Amy Peacock, Janni Leung, Sarah Larney, Jason Grebely, Matthew Hickman, Evan Cunningham, Adam Trickey, Jack Stone, Peter Vickerman, Louisa Degenhardt BackgroundPeople who inject drugs (PWID) are at an elevated risk of fatal overdose in the first year after experiencing a non-fatal event. Such non-fatal events may also result in overdose-related sequelae, ranging from physical injury to paralysis. Given variation in drug markets and treatment availability across countries and regions, we may see similar variations in non-fatal overdose prevalence. Monitoring non-fatal overdose prevalence among PWID is essential for informing treatment intervention efforts, and thus our review aims to estimate the global, regional, and national prevalence of non-fatal overdose, and determine characteristics associated with experiencing such an event.MethodsWe conducted a systematic review and meta-analyses to estimate country, regional, and global estimates of recent and lifetime non-fatal overdose prevalence among PWID. Using meta-regression analyses we also determined associations between sample characteristics and non-fatal overdose prevalence.ResultsAn estimated 3.2 (1.8–5.2) million PWID have experienced at least one overdose in the previous year. Among PWID, 20.5% (15.0–26.1%) and 41.5% (34.6–48.4%) had experienced a non-fatal event in the previous 12 months and lifetime respectively. Frequent injecting was strongly associated with PWID reporting recent and lifetime non-fatal overdose. Estimates of recent non-fatal overdose were particularly high in Asia and North America.ConclusionAround one in five PWID are at an elevated risk of fatally overdosing every year, however there is substantial geographical variation. In countries with higher rates of non-fatal overdose there is need to introduce or mainstream overdose prevention strategies such as opioid agonist treatment and naloxone administration training programs.
  • Understanding the reasons for using methamphetamine by sexual minority
           people in Dhaka, Bangladesh
    • Abstract: Publication date: November 2019Source: International Journal of Drug Policy, Volume 73Author(s): Sharful Islam Khan, Mohammad Niaz Morshed Khan, A.M. Rumayan Hasan, Samira Dishti Irfan, Lily Ming-Sha Horng, Ezazul Islam Chowdhury, Tasnim Azim BackgroundInternationally, methamphetamine use is prevalent among males who have sex with males (MSM) and transgender women (hijra), with studies showing its association with risky sexual behaviours leading to HIV transmission. This study aimed to explore the underlying reasons for methamphetamine use among MSM and hijra in Bangladesh.MethodsWe conducted 30 in-depth interviews with MSM and hijra and six focus groups with MSM, hijra and service providers. Data were thematically analysed using manual data analysis procedures.FindingReasons cited for using methamphetamine varied across feminized MSM (i.e. kothis), masculine MSM (i.e. panthis), male sex workers and hijra. For sex workers, increased sexual pleasure and consequent ability to take more clients increased their income. For panthis, methamphetamine enhanced feelings of masculinity and sexual prowess. Kothis were able to feel more feminine due to their ability to receive multiple partners each night. For all participants, methamphetamine restored self-esteem and relieved the stress resulting from stigma.ConclusionsFindings indicate that reasons for using methamphetamine are not only rooted in the individual’s psyche but also grounded in the socio-cultural expectations about masculinities and femininities in Bangladeshi society. Limited knowledge about the complexities concerning methamphetamine use mean that appropriate counselling and treatment services are non-existent in Bangladesh. The study findings can be used to refine national and international harm reduction policies so as to incorporate and address methamphetamine use.
  • The movement and translation of drug policy ideas: The case of ‘new
    • Abstract: Publication date: November 2019Source: International Journal of Drug Policy, Volume 73Author(s): Natalie Thomas, Melissa Bull, Rachel Dioso-Villa, Kate Smith Introduction'New recovery' can be conceptualised as both a social movement and a broader policy agenda to restructure treatment service systems towards 'recovery-oriented systems of care'. Emerging initially out of the United States, new recovery has gained currency as a policy agenda in other jurisdictions - perhaps most distinctly in the United Kingdom. In 2012, the ideas behind 'new recovery' were debated in the Australian alcohol and other drug field as the Victorian government sought to incorporate recovery principles into policy and service design. This paper uses the policy transfer and policy translation literature to understand how international policy ideas about 'new recovery' were negotiated in the Australian context, focusing specifically on the role of non-government actors in the process.MethodsThis paper draws on an analysis of policy documents, organisational documents and interviews with representatives from the Australian non-government alcohol and other drug sector to consider how new recovery was translated into Victorian drug policy.ResultsThe interactions between organisations and actors — including bureaucrats, governmental agencies and policy entrepreneurs — facilitated the circulation and translation of policy ideas in the Victorian context. Despite this, the analysis suggests that policy transfer was largely a symbolic exercise: overall, some of the key features of new recovery policy from the United States and the United Kingdom, such as encouraging peer-led recovery and mutual aid, were not incorporated in the Victorian policy. NGOs resisted what they considered to be some of the more problematic elements of 'new recovery', and informed the local translation of the policy.DiscussionThe results have implications for understandings of the relationship between social movements, non-government organisations and the state, as well as the dynamics of knowledge transfer in drug policy.
  • Can e-cigarettes improve the well-being of people with mental health
    • Abstract: Publication date: Available online 24 July 2019Source: International Journal of Drug PolicyAuthor(s): Julia E.H. Brown, Coral Gartner, Adrian Carter This Viewpoint considers the merits of e-cigarettes as a harm-minimisation tool for clozapine-treated schizophrenia patients. It argues that e-cigarettes may be a gateway not to smoking tobacco, but rather to engagement in more desirable health attitudes amongst this particularly marginalised population group. In our opinion, this presents clinicians with valuable opportunities to engage their patients more effectively in healthcare strategies, beginning with but not limited to tobacco-free e-cigarettes.
  • Reproducibility on science: Challenges and advances in Brazilian alcohol
    • Abstract: Publication date: Available online 24 July 2019Source: International Journal of Drug PolicyAuthor(s): Raquel B. De Boni, Mauricio T.L. de Vasconcellos, Pedro N. Silva, Carolina Coutinho, Jurema Mota, Julia N.B. Peixoto, Neilane Bertoni, Francisco I. Bastos BackgroundReproducibility in Science is challenging and may be hard to achieve in alcohol research. Previous general population surveys in Brazil have estimated the prevalence of alcohol dependence to be around 10%. We aim to estimate alcohol use and dependence using different methods and definitions.MethodsThe 3rd Brazilian Household Survey on Substance Use (BHSU-3) was a nationwide, probability sample survey that interviewed 16,273 individuals. DSM-IV-TR criteria were used to determine alcohol dependence. In the BHSU-2 (covering only Brazil’s 108 largest municipalities), alcohol dependence was defined as fulfilling 2/6 DSM-III criteria. Using the BHSU-3 data, alcohol use was estimated at: [1] the national level, [2] BHSU-2 municipalities, taking into consideration the sample design, and [3] BHSU-2 municipalities, ignoring the sample design. Alcohol dependence was calculated using: BHSU-3 and BHSU-2 definitions, two denominators ([A] population and [B] 12-month drinkers), and [1], [2], [3].ResultsLifetime alcohol use ranged from 66.4% (95%CI:64.8–68.0 [1]) to 70.1% ([95%CI:69.1–71.0], [3]). The estimated population presenting with alcohol dependence ranged from N = 2.3 million (BHSU-3 definition, [1]) to N = 4.3 million (BHSU-2 definition, [1]). In the first case, the prevalence among the general population [A] and drinkers [B] was 1.5% (95%CI:1.2–1.8) and 3.5% (95%CI:2.8–4.2), respectively. In second case, prevalence was 2.8% (95%CI:2.4–3.3, [A]) and 6.6% (95%CI:5.6–7.6, [B]).ConclusionsPrevalence of alcohol dependence may vary as much as 4.3 times, analyzing the same dataset in different ways. Brazilian research on alcohol is funded by governmental research and policy-making agencies, providing subsidies for alcohol policy in the country. It is crucial that sufficient methodological information is provided in order to guarantee reproducibility and consistency over time.
  • ‘I feel like I have to become part of that identity’: Negotiating
    • Abstract: Publication date: Available online 22 July 2019Source: International Journal of Drug PolicyAuthor(s): Emily Nicholls Whilst women’s excessive alcohol consumption has traditionally been regarded as a potential threat to health, safety and even femininity, recent research highlights the important role that alcohol plays in many young women’s lives. Drawing on data from semi-structured interviews with women aged 18–25 in Newcastle, UK, this paper will consider the role that alcohol can play in the negotiation of female friendships in the Night Time Economy, highlighting the ways in which young women may regard alcohol as a tool to enhance socialising, trust and intimacy (both when pre-drinking and in bars, pubs and clubs). The role of alcohol in ‘doing’ gender and femininity will also be explored, as young women collectively display feminine identities through particular drinking choices and practices that may include heavy drinking and drunkenness. Finally, I will consider the implications for young women who do not engage in these collective practices of alcohol consumption and suggest avenues for future work on the under-researched topic of the experiences of non-drinkers.
  • Drug sellers’ neutralizations of guiltless drug sales and avoidance of
           “drug dealer” identities
    • Abstract: Publication date: November 2019Source: International Journal of Drug Policy, Volume 73Author(s): Timothy Dickinson, Scott Jacques BackgroundDespite a wealth of empirical exploration on neutralization theory, several aspects of the theory remain underexplored. For instance, one task of neutralization research is to investigate whether and how neutralizations vary with offender characteristics. A second underexplored area is whether the neutralizations offenders present when directly asked about feelings of guilt are similar or dissimilar to those they have incorporated into their narrative identities described during interviews. A third underexplored issue is whether offenders that exhibit little guilt for committing mala prohibita crimes use neutralizations in a similar manner as those who do not express guilt for committing mala in se crimes.MethodsThe present study examines these questions by drawing from data collected from interviews with 33 active drug sellers from St. Louis, Missouri, USA and 30 active drug sellers from Atlanta, Georgia, USA.ResultsWe find that these offenders’ neutralizations vary by drug type and by differential access to resources. We also find that, in addition to the neutralizations they give when asked about guilt, these offenders also preemptively neutralize feelings of guilt by constructing identities counter to bad “drug dealers” throughout their storied identities.ConclusionWe conclude by suggesting that neutralizations vary by offender characteristics due to the differing background expectancies of offenders’ social groups. We also suggest that neutralizing the repercussions of immoral actions is not always a static, monothematic technique. It is instead an active, complex, and interactional process that occurs as persons make sense of who they are and what they are doing. Finally, we argue that studies of neutralization theory relying on direct, standardized questions or the presentation of abstract vignettes may fail to capture a sizable part of the neutralization process among offenders.
  • Seeking legitimacy for broad understandings of substance use
    • Abstract: Publication date: November 2019Source: International Journal of Drug Policy, Volume 73Author(s): Niki Kiepek, Katinka Van de Ven, Matthew Dunn, Cynthia Forlini This commentary invites discussion about implicit and explicit factors that impede research about substance use from a nuanced perspective that recognises potential benefits and advantages. It is argued that explicit efforts to engage in scholarship beyond those informed by theoretical and philosophical assumptions that substance use is inherently risky and problematic can enhance genuine inquisition about substance use and transform which discourses and interpretations are legitimised. Prioritisation of scholarly funding and publication has largely been predicated on the notion that illicit substances pose an inherent risk for individual and social harm. This has implicitly and explicitly influenced what type of research has been conducted and how substance use is constructed. Researchers who engage in scholarship that suspends assumptions of risk and problems associated with substance use may become subject to judgement about their credibility, ethics, and expertise. Moving forward, we suggest that conscientiously attending to broad, nuanced experiences associated with substance use will contribute to a stronger evidence base. Equal opportunity should be given to examine the complexity of lived experiences. It may also be timely to consider what brings value to scholarly pursuit, recognising that health is but one valued social outcome. Perhaps other outcomes, such as human rights, compassion, and justice are equally commendable. To advance substance use scholarship, it is essential that decision-makers (e.g., funding bodies, editors) embrace research that does not conform to assumptions of risk or inherent problems as exclusively legitimate, advocate for scholarship that resists conforming to dominant discourses, and create spaces for critical perspectives and interpretations.
  • Legal and policy changes urgently needed to increase access to opioid
           agonist therapy in the United States
    • Abstract: Publication date: November 2019Source: International Journal of Drug Policy, Volume 73Author(s): Corey S. Davis, Derek H. Carr The United States continues to face a public health crisis of opioid-related harm, the effects of which could be dramatically reduced through increased access to opioid agonist therapy with the medications methadone and buprenorphine. Despite overwhelming evidence of their efficacy, unduly restrictive federal, state, and local regulation significantly impedes access to these life-saving medications. We outline immediate, concrete steps that federal, state, and local governments can take to change law from barrier to facilitator of evidence-based treatment for opioid use disorder. These include removing onerous restrictions on the prescription and dispensing of buprenorphine and methadone for opioid agonist therapy, requiring insurance coverage of these medications, and mandating that they be provided in correctional settings and promoted by drug courts. Finally, we argue that jurisdictions should proactively offer opioid agonist therapy to individuals at high risk of overdose, remove barriers to establishing methadone treatment facilities, and address underlying social determinants and barriers to treatment. These changes have the ability to save thousands of lives annually.
  • Who or what do young adults hold responsible for men’s drunken
    • Abstract: Publication date: Available online 19 July 2019Source: International Journal of Drug PolicyAuthor(s): Sarah MacLean, Jakob Demant, Robin Room BackgroundMen are more likely than women to perpetrate serious violence when they have consumed alcohol, but alcohol does not affect all men in the same way. This paper considers young adults’ attribution about agency (the capacity to act) in men’s drunken violence.MethodsInterviews about alcohol use in night-time venues, streets or private parties were conducted with 60 young adults aged 18–24 in Melbourne, Australia, and analysed thematically. Participants included seven men who identified as having initiated violence when drunk.ResultsSome interviewees stated that men chose to be violent, or that men’s violence when they were drunk was purposeful and therefore involved some component of choice. However, much alcohol-related violence enacted by young men was understood (both by men who reported violence and by other young adults) as impelled by forces outside their control. These forces were: diffusely defined effects of drinking alcohol; proclivities of men and masculinity, and the interaction of alcohol and men’s bodies to override capacity for judgement and produce an irresistible urge to fight. The latter was at times explained as caused by the mutually reinforcing actions of alcohol and testosterone, providing a particularly persuasive account of men’s violence as biologically-determined.ConclusionThese categories encapsulate a set of discursive resources that contribute to the rationalisation, naturalisation and production of men’s violence. Participants tended to regard alcohol, masculinities and testosterone as inciting violence predictably and consistently, suggesting that men themselves had relatively little agency over its occurrence. In contrast, research evidence indicates that these actors do not cause violence in any uniform way and that their effects are contingent on changing configurations of factors. Highlighting discrepancies between young adults’ understandings of responsibility for men’s drunken violence, and those expressed in research, presents additional opportunities for intervention.
  • E-cigarette use is associated with susceptibility to tobacco use among
           Australian young adults
    • Abstract: Publication date: Available online 27 June 2019Source: International Journal of Drug PolicyAuthor(s): Michelle I. Jongenelis, Elizabeth Jardine, Caitlin Kameron, Daniel Rudaizky, Simone Pettigrew BackgroundCalls have been made to relax current Australian regulations related to e-cigarettes to increase the accessibility of the devices for smoking cessation purposes. However, e-cigarettes have been found to increase risk of initiation of conventional cigarette smoking, especially among young adults. To assist in guiding the development of policy in Australia, the present study examined whether e-cigarette use among Australian young adults who have never smoked a tobacco cigarette is associated with susceptibility to future tobacco cigarette use.MethodAn online web panel provider recruited 519 never smokers aged 18–25 years (55% female; average age = 21.21 years, SD = 2.32). Respondents completed an online survey that assessed their curiosity about tobacco smoking, willingness and intentions to smoke, and a number of individual and social factors. Cross-sectional regression analyses were conducted to assess the association between e-cigarette use and susceptibility to tobacco cigarette use while controlling for multiple covariates.ResultsCuriosity about tobacco smoking, willingness to smoke, and intentions to smoke were significantly higher among users of e-cigarettes than never users. The relationship between e-cigarette use and susceptibility to future tobacco cigarette use remained significant after controlling for numerous covariates.ConclusionE-cigarette use, even just one or two puffs, has the potential to increase susceptibility to tobacco cigarette use among Australian young adults. Findings suggest that increasing the availability of e-cigarettes by relaxing current strict regulations surrounding their sale may have unintended consequences.
  • ‘It’s good being part of the community and doing the right thing’:
           (Re)problematising ‘community’ in new recovery-oriented policy and
           consumer accounts
    • Abstract: Publication date: Available online 20 June 2019Source: International Journal of Drug PolicyAuthor(s): Renae Fomiatti The renewed focus on ‘recovery’ in alcohol and other drug policy over the last decade has been subject to sustained international attention and academic critique. However, little scholarly work has addressed how new recovery discourse has harnessed the ideals of community participation and cohesion and how people who use drugs, the targets of such proposals, experience these injunctions. Analysing the two most recent Australian National Drug Strategies – in which new recovery has featured – and interviews with people who inject drugs, I draw on Bacchi’s problematisation approach to make visible the politics of community in new recovery. My analysis demonstrates that there has been a shift in the way new recovery is framed from recovery through community reintegration and reconnection to recovery through ‘evidence-based’ treatment. However, community endures as an important dividing practice that targets people who regularly use drugs as dependent, unproductive and marginal to social life, while also claiming to be the solution to the disorder attributed to alcohol and other drug use. In the second half of this article, I draw on people’s accounts of regular drug use and recovery to explore the ‘lived effects’ of these problematisations and to pursue a critical practice of thinking otherwise. I argue that these accounts disrupt and contest the problematisations and promises underpinning recovery through community reintegration by: 1) drawing attention to the way in which the boundaries of community exclude inclusion for people who use drugs, and emphasising people’s already existing social relationships; 2) making present hitherto silenced and unproblematised barriers to social connection; and 3) critiquing the normative fantasies of healthy society and citizenship that underpin recovery. In concluding I consider the politics of appeals to community in new recovery-oriented policy, and suggest the need to foreground consumer accounts in problematisation-oriented analyses in order to better contest authoritative enactments of drug ‘problems’ that bear little resemblance to the challenges people face.
  • Harm reduction and the opioid crisis: Emerging policy challenges
    • Abstract: Publication date: Available online 31 May 2019Source: International Journal of Drug PolicyAuthor(s): Alissa Greer, Alison Ritter
  • Research in fractured digital spaces
    • Abstract: Publication date: Available online 16 May 2019Source: International Journal of Drug PolicyAuthor(s): Angus Bancroft The internet is a medium for research, a place for the exchange of drugs and knowledge, and a method for governing and surveilling drug users. Opportunities for drug research with and in digital spaces are expanding, using internet mediated methods such as online surveys, web scraping, and research with web communities and users of cryptomarkets and apps. As the sphere of social data grows, so does the degree to which data itself is a product of fractured, governed, privatised set of spaces. Research often has to work with these structural aspects and researchers have to be aware of the structural mediation of their data. The opportunities for research also demand that researchers consider the validity of traditional scientific hierarchies such as the assumed superiority of probability sampling, and parse the naturally occurring taxonomies that are produced by the systems they research. A positive development has been the growth of internet focused researchers who operate in and outwith the academy and who are creating an independent research infrastructure with potential for a democratic research politics.
  • Digital figurations in the online trade of illicit drugs: A qualitative
           content analysis of darknet forums
    • Abstract: Publication date: Available online 1 May 2019Source: International Journal of Drug PolicyAuthor(s): Gerrit Kamphausen, Bernd Werse IntroductionThis article analyses the factors of trust, logistics, and conflict on darknet markets (DNMs) and forums that are dedicated to selling illicit drugs. The analysis is conducted by utilising Elias (1978) theoretical concept of ‘figuration,’ which refers to the communicative constellations that eventuate between actors.MethodsA qualitative content analysis was applied to a sample collected from darknet forums related to darknet markets, independent forums with trade sections, and separate vendor shops. The main categories trust, logistics, and conflict are analysed, and certain subcategories are also explored, including operational security (opsec), vouching, and shilling. These terms are commonly used to describe the trading of drugs on the darknet.ResultsUsers of DNMs and forums discuss vendors, their products, and security-related features. Vouching and shilling are attempts to strengthen trust, logistics are used to secure the trade, while conflicts reflected in forum discussion threads often arise when logistics fail. Logistics may fail due to different reasons and actors involved in the associated figurations. The (anticipated) presence of actors in disguise is crucial for all of the main categories.ConclusionNotions of trust, logistics, and conflict express attempts to cope with or circumvent risks imposed on users of DNMs by other users (e.g., scamming) or law enforcement (e.g., the interception of packages). Due to the illicit nature of the trade, these notions have to be constantly negotiated through digital communication.
  • Sellers’ risk perceptions in public and private social media drug
    • Abstract: Publication date: Available online 1 May 2019Source: International Journal of Drug PolicyAuthor(s): Silje Anderdal Bakken, Jakob Johan Demant IntroductionFrom the early use of pagers and cellular phones to the darknet and smartphones, technological developments have facilitated drug deals in various ways, especially by altering time and space boundaries. Traditional drug market literature theorises about how physical markets, within which sellers act according to their risk perceptions and motivation, are led by supply, demand, and enforcement. However, there is an almost absolute research gap in understanding how this relates to digital markets and social media markets in particular. It is expected that the plasticity of technology makes digital markets highly mouldable so that the sellers are able to shape markets according to their use.Research aimThe aim of the study is to describe and understand drug dealing on social media within the structure of existing markets. We aim to do so by analysing how drug sellers’ risk perceptions and motivations form and are formed by social media technology.MethodsWe conducted a three-month digital ethnographic study on Facebook and Instagram in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden), as well as 107 semi-structured qualitative interviews with sellers (2/3 of the sample) and buyers (1/3 of the sample) using online markets within the same countries.ResultsDrug dealing on social media varies according to the structure of the chosen media and users’ risk perceptions and motivations. Two market forms are suggested: 1) public digital markets (e.g., Facebook groups and Instagram) allow sellers to expand their customer lists, but the risk is quite high, while 2) private digital markets are based on one-on-one communication and demand greater knowledge but are perceived as more secure. Sellers choose which media to use and how to use them based on perceived risk and, therefore, have a significant impact on the formation of social media drug markets.
  • Learning from the past, looking to the future - Is there a place for
           injectable opioid treatment among Australia’s responses to opioid
    • Abstract: Publication date: Available online 9 April 2019Source: International Journal of Drug PolicyAuthor(s): Vendula Belackova, Allison M. Salmon, Marianne Jauncey, James Bell In the 1990s, a trial of prescribing pharmaceutical heroin for people with opioid-dependence had support from Australian State Health Ministers. However, in 1997 the proposal was vetoed by the federal Prime Minister in face of a negative tabloid media campaign. The debate then shifted to abstinence-orientated treatments. Later on, reduced heroin availability took opioid-related harms away from public sight. In this commentary, we aimed to explore the current need and the options to implement such program, lately referred to as supervised injectable opioid treatment (SIOT), in Australia. We argue that with the aging populations of opioid-dependent people who have not benefited from existing treatment options, increased misuse of prescription opioids, rising overdose rates, and the risk of unfolding overdose crisis, it seems timely to pilot SIOT here. Since the 1990s, seven RCTs as summarised in two systematic literature reviews, demonstrated that SIOT is effective for treatment-resistant opioid dependence. A sustainable SIOT model should, however, respond to key concerns related to its delivery, such as the lack of a patient exit strategy and the high cost of indefinite treatment. Evidence from long-term studies seem to support the notion that SIOT could be provided as a medium duration treatment (as opposed to short-term or indefinite), with the clear aim to stabilise patients, gradually wean them off injectable medication and transfer to opioid assisted treatment (OAT). Also, SIOT could be integrated into the existing public OAT clinics in Australia. This would reduce costs, but also provide a more patient-centred response to opioid dependence and further improve the acceptability and efficiency of OAT. The controversy that developed in the past should be mitigated by advances in research since the first Australian enquiry, use of a registered medication (open-label hydromorphone) rather than pharmaceutical heroin, and setting up clear treatment aims.
  • Chronic pain management among people who use drugs: A health policy
           challenge in the context of the opioid crisis
    • Abstract: Publication date: Available online 8 April 2019Source: International Journal of Drug PolicyAuthor(s): Lise Dassieu, Jean-Luc Kaboré, Manon Choinière, Nelson Arruda, Élise Roy BackgroundIn Canada, the rise in prescription opioid (PO) overdoses and addiction is a major public health concern. Various health authorities have recently recommended that physicians use caution when prescribing opioids, especially to people with histories of substance use. As a result, fewer therapeutic options are available for people who use drugs (PWUD) and suffer from chronic non-cancer pain (CNCP). This paper examines how PWUD describe their experiences with CNCP management in the context of the opioid crisis.MethodsThis qualitative study is based on in-depth interviews with Montreal (Canada) PWUD experiencing CNCP for 3 months or more.ResultsMost of the 25 participants (27–61 years; 10 women, 15 men) were polysubstance users (cocaine, opioids, amphetamine, etc.) suffering from CNCP for several years, with multiple additional health and social problems. The majority were unsatisfied with their CNCP management. They felt labelled as “addicts” and stigmatized within the healthcare system. Many participants had been denied PO, even those with severe CNCP and those who were not opioid-dependent. Participants expressed a desire to access non-pharmacological CNCP therapies, but these were often too expensive. Some PWUD were offered methadone to relieve CNCP and found this inappropriate. As a last resort several participants reported self-medicating CNCP with street drugs, increasingly known to be laced with fentanyl.ConclusionPWUD with CNCP are affected by two opioid crises: the PO crisis and the street-opioid crisis. The lack of a coherent policy that addresses their pain management produces reoccurring problems when seeking CNCP relief. Restrictive prescription measures implemented in response to the PO crisis may have consequences similar to prohibitionist policies: they heighten overdose risks for PWUD by increasing exposure to street drugs laced with fentanyl. Improving access to diverse CNCP management options for PWUD can help reduce harms related to street-opioid use.
  • Monitoring new psychoactive substances: Exploring the contribution of an
           online discussion forum
    • Abstract: Publication date: Available online 7 April 2019Source: International Journal of Drug PolicyAuthor(s): Damien Rhumorbarbe, Marie Morelato, Ludovic Staehli, Claude Roux, David-Olivier Jaquet-Chiffelle, Quentin Rossy, Pierre Esseiva BackgroundThe rapid emergence of new psychoactive substances (NPS) is a challenge for public health authorities and law enforcement. The phenomenon is strengthened since the increase of the Internet usage. Not only used to trade NPS, the Web is an important source of information for both potential drug consumers and experienced users. Discussion forums are among these sources of information. They are meeting points for different groups of users and include a wide range of trip reports, questions and consumption tips. Since the discussions are archived over a long period, they can be used to monitor the interest of consumers for particular substances over time. This research aims at understanding the contribution of data extracted from a major online discussion forum within a systematic monitoring process.MethodData were collected from a discussion forum (i.e. Drugs-forum). Within the sections of the forum, the titles, content of discussion, number of replies, and the date of the first discussion were crawled and stored in a dedicated database. The intensity of the discussions related to 42 substances considered as NPS was measured through an indicator allowing to assess the popularity of substances. Furthermore, the appearance of 15 substances on the forum was compared to the date of formal notification to the EU early warning system.ResultsAn evolution of the different classes of substances, as well as an evolution of specific substances within a class were highlighted. Some substances were discussed for a long period of time (e.g. Kratom, 25i-NBOMe, MDPV) while others were discussed very briefly (e.g. 5-MeO-DPT, NM-2AI). Out of the fifteen substances subjected to a risk assessment from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), nine of them appeared on the forum before or at the same time as their first date of notification to the EU early warning system.ConclusionIn line with previous research on doping products, this article shows the potential of the monitoring of online forums in the context of psychoactive substances. Besides, the system designed to collect the data is flexible and can be systematically updated to fuel a monitoring process. It informs not only on the presence/absence of a substance in discussions between consumers, but also on its evolution over time. Such results could benefit academic research and organizations studying the NPS phenomenon. Precisely, it could complement existing early warning systems and benefit law enforcement agencies and policy makers.
  • Surveying drug consumption: Assessing reliability and validity of the
           European Web Survey on Drugs questionnaire
    • Abstract: Publication date: Available online 6 April 2019Source: International Journal of Drug PolicyAuthor(s): Kateřina Škařupová, Nicola Singleton, João Matias, Viktor Mravčík BackgroundThe European Web Survey on Drugs aimed to obtain in-depth data on consumption of cannabis, ecstasy/MDMA, cocaine, and amphetamines in different populations of drug users in 16 European countries. This paper examines test-retest reliability, the consistency and the comprehensibility of the prevalence and frequency of use questions in the Czech part of the survey.MethodsA baseline web survey was performed (N = 610) with follow-up data collection in a sub-sample of volunteers providing email addresses (N = 158). The baseline sample was self-selecting, responding to advertisements made available through multiple channels designed to attract diverse samples of drug users. Test-retest analysis was conducted for core questionnaire items.ResultsRespondents to the follow-up were predominantly socially integrated; 91% reported last year cannabis use, 42% used Ecstasy/MDMA, 23% amphetamines, and 27% reported cocaine use. Test-retest reliability was rated moderate to good (reliability coefficients between 0.55–0.87) for most prevalence items with sufficient sample sizes. Items assessing frequency of use were more reliable for most substances when asking about the exact number of days used, compared to categorical items that implicitly assume a regular pattern of use and were interpreted differently by different respondents.ConclusionsSimplicity and unambiguity of questions increase the reliability of results. Tools measuring drug consumption need to take into consideration the irregularity of drug using patterns. Question testing is important to increase validity and support a correct interpretation of the data.
  • Engagement with medical cannabis information from online and mass media
           sources: Is it related to medical cannabis attitudes and support for
    • Abstract: Publication date: Available online 21 February 2019Source: International Journal of Drug PolicyAuthor(s): Nehama Lewis, Sharon R. Sznitman BackgroundThe legalization of medical and recreational cannabis is a topic of continued debate in countries around the world. It has been suggested that medical cannabis legalization influences cannabis legalization for recreational purposes through increased media attention toward the positive health effects of cannabis. However, the nature of media coverage is likely to vary across mass media and online sources (internet and social media). In addition, effects of information engagement on attitudes may vary depending on whether information was actively sought or obtained incidentally during patterns of regular media use (scanned).MethodsThis study uses data from an online survey of Israeli adults (N = 554) to test the association between information seeking and scanning about medical cannabis (from mass media and online sources) and attitudes toward medical cannabis. Furthermore, we test indirect effects of media engagement on attitudes toward cannabis legalization through medical cannabis attitudes.ResultsSeeking and scanning for information about medical cannabis from online sources, but not from mass media sources, were associated with positive attitudes toward medical cannabis. Engagement with medical cannabis information from online sources was also indirectly associated with greater support for cannabis legalization, through positive attitudes related to medical cannabis.ConclusionThe results suggest that one mechanism through which medical cannabis legalization is associated with cannabis legalization for all purposes is public engagement with information about medical cannabis in the media, particularly from the internet and social media channels. As increasingly more jurisdictions are expected to legalize medical cannabis, with resulting increase in media attention, support for recreational cannabis legalization may be expected to grow.
  • Comparing Canadian and United States opioid agonist therapy policies
    • Abstract: Publication date: Available online 11 February 2019Source: International Journal of Drug PolicyAuthor(s): Kelsey C. Priest, Lauren Gorfinkel, Jan Klimas, Andrea A. Jones, Nadia Fairbairn, Dennis McCarty Canada and the United States (U.S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT)—buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited OAT access. Through a non-systematic literature scan and a review of publicly available policy documents, we examined and compared OAT policies and practice at the federal (Canada vs. U.S.) and local levels (British Columbia [B.C.] vs. Oregon). Differences and similarities were noted between federal and local OAT policies, and subsequently OAT access. In Canada, OAT policy control has shifted from federal to provincial authorities. Conversely, in the U.S., federal authorities maintain primary control of OAT regulations. Local OAT health insurance coverage policies were substantively different between B.C. and Oregon. In B.C., five OAT options were available, while in Oregon, only two OAT options were available with administrative limitations. The differences in local OAT access and coverage policies between B.C. and Oregon, may be explained, in part, to the differences in Canadian and U.S. federal OAT policies, specifically, the relaxation of special federal OAT regulatory controls in Canada. The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U.S. policymakers and health officials could consider adopting Canada’s regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.
  • The triple wave epidemic: Supply and demand drivers of the US opioid
           overdose crisis
    • Abstract: Publication date: Available online 2 February 2019Source: International Journal of Drug PolicyAuthor(s): Daniel Ciccarone
  • The value of unsolicited online data in drug policy research
    • Abstract: Publication date: Available online 31 January 2019Source: International Journal of Drug PolicyAuthor(s): Oskar Enghoff, Judith Aldridge We alert readers to the value of using unsolicited online data in drug policy research by highlighting web-based content relevant to drug policy generated by four distinct types of actor: people who consume, supply or produce illicit drugs, online news websites and state or civil society organisations. These actors leave ‘digital traces’ across a range of internet platforms, and these traces become available to researchers to use as data – although they have not been solicited by researchers, and so have not been created specifically to fulfil the aims of research projects. This particular type of data entails certain strengths, limitations and ethical challenges, and we aim to assist researchers in understanding these by drawing on selected examples of published research using unsolicited online data that have generated valuable drug policy insights not possible using other traditional data sources. We argue for the continued and increased importance of using unsolicited online data so that drug policy scholarship keep pace with recent developments in the global landscape of drug policies and illicit drug practices.
  • Principles, practice, and policy vacuums: Policy actor views on
           provincial/territorial harm reduction policy in Canada
    • Abstract: Publication date: Available online 30 January 2019Source: International Journal of Drug PolicyAuthor(s): Elaine Hyshka, Jalene Anderson-Baron, Arlanna Pugh, Lynne Belle-Isle, Andrew Hathaway, Bernadette Pauly, Carol Strike, Mark Asbridge, Colleen Dell, Keely McBride, Kenneth Tupper, T. Cameron Wild IntroductionCanada is experiencing a new era of harm reduction policymaking and investment. While many provinces and territories are expanding access to these services, harm reduction policy and policymaking varies across the country. The present study, part of the Canadian Harm Reduction Policy Project (CHARPP), described policy actors’ views on formal harm reduction policies in Canada’s 13 provinces and territories.MethodsAs part of CHARPP’s mixed-method, multiple case study, we conducted qualitative interviews with 75 policy actors, including government officials, health system leaders, senior staff at community organizations, and advocates with self-identified lived experience of using drugs. Interviews were conducted in English or French, and recorded and transcribed verbatim. We used latent content analysis to inductively code the data and generate main findings. NVivo 11 was used to organize the transcripts.ResultsParticipants expressed divergent views on formal provincial/territorial policies and their impact on availability of harm reduction programs and services. While some identified a need to develop new policies or improve existing ones, others resisted bureaucratization of harm reduction or felt the absence of formal policy was instead, advantageous. Instances where harm reduction was advanced outside of formal policymaking were also described.DiscussionPrevious CHARPP research documented wide variability in quantity and quality of formal harm reduction policies across Canada, and characterized official policy documents as serving largely rhetorical rather than instrumental functions. The present findings highlight diverse ways that actors used their discretion to navigate these weak policy contexts. Participants’ views and experiences sometimes referred to strengthening policy support, but institutionalization of harm reduction was also resisted or rejected. Results suggest that actors adopt a range of pragmatic strategies to advance harm reduction services in response to policy vacuums characteristic of morality policy domains, and challenge assumptions about the utility of formal policies for advancing harm reduction.
  • CALL FOR PAPERS SPECIAL ISSUE: The Risk Environment in Rural Areas
    • Abstract: Publication date: Available online 15 January 2019Source: International Journal of Drug PolicyAuthor(s):
  • Call for Papers,Themed Collection: “Gendered perspectives on young
           adults’ alcohol intoxication”
    • Abstract: Publication date: Available online 14 January 2019Source: International Journal of Drug PolicyAuthor(s):
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