Journal Cover International Journal of Drug Policy
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0955-3959
   Published by Elsevier Homepage  [3118 journals]
  • The law on the streets: Evaluating the impact of mexico’s drug
           decriminalization reform on drug possession arrests in Tijuana, Mexico
    • Authors: J. Arredondo; T. Gaines; S. Manian; C. Vilalta; A. Bañuelos; S.A. Strathdee; L. Beletsky
      Pages: 1 - 8
      Abstract: Publication date: April 2018
      Source:International Journal of Drug Policy, Volume 54
      Author(s): J. Arredondo, T. Gaines, S. Manian, C. Vilalta, A. Bañuelos, S.A. Strathdee, L. Beletsky
      Background In 2009, Mexican Federal Government enacted “narcomenudeo” reforms decriminalizing possession of small amounts of drugs, delegating prosecution of retail drug sales to the state courts, and mandating treatment diversion for habitual drug users. There has been insufficient effort to formally assess the decriminalization policy’s population-level impact, despite mounting interest in analagous reforms across the globe. Methods Using a dataset of municipal police incident reports, we examined patterns of drug possession, and violent and non-violent crime arrests between January 2009 and December 2014. A hierarchical panel data analysis with random effects was conducted to assess the impact of narcomenudeo’s drug decriminalization provision. Results The reforms had no significant impact on the number of drug possession or violent crime arrests, after controlling for other variables (e.g. time trends, electoral cycles, and precinct-level socioeconomic factors). Time periods directly preceding local elections were observed to be statistically associated with elevated arrest volume. Conclusions Analysis of police statistics parallel prior findings that Mexico’s reform decriminalizing small amounts of drugs does not appear to have significantly shifted drug law enforcement in Tijuana. More research is required to fully understand the policy transformation process for drug decriminalization and other structural interventions in Mexico and similar regional and international efforts. Observed relationship between policing and political cycles echo associations in other settings whereby law-and-order activities increase during mayoral electoral campaigns.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.12.006
      Issue No: Vol. 54 (2018)
       
  • A qualitative study comparing physician-reported barriers to treating
           addiction using buprenorphine and extended-release naltrexone in U.S.
           office-based practices
    • Authors: Barbara Andraka-Christou; Matthew J. Capone
      Pages: 9 - 17
      Abstract: Publication date: April 2018
      Source:International Journal of Drug Policy, Volume 54
      Author(s): Barbara Andraka-Christou, Matthew J. Capone
      Aim Our aim was to compare physician-reported barriers to sublingual buprenorphine (BUP) and extended-release naltrexone (XR-NLT) prescribing in U.S. office-based practices, and to identify potential policies for minimizing these barriers. Only one previous qualitative study has examined physician-reported barriers to prescribing XR-NLT and no qualitative study has compared physician-reported barriers between the two medications. Methods Researchers conducted individual semi-structured and in-depth interviews with 20 licensed physicians in four U.S. states between January 2016 and May 2017. Interview questions included general barriers to addiction treatment in office-based settings, barriers specific to BUP and XR-NLT prescribing, and potential government policies to decrease barriers. Researchers conducted thematic analysis of transcribed interviews. They developed and pilot tested a coding template based on a sample of transcripts, independently coded transcripts in Dedoose software, conducted consensus coding to eliminate coding discrepancies, and then assessed data for themes using research questions as a guide. Results General barriers to office-based OUD treatment included limited physician education, limited insurance reimbursement, stigma, and perceptions of “difficult” patients. Barriers specific to BUP prescribing included regulatory restrictions, liability fears, and restrictions imposed by the criminal justice system. Barriers specific to XR-NLT prescribing included limited access to medically-supervised opioid detoxification, lack of awareness of the medication, and patient fears or disinterest. Participants without experience prescribing either medication emphasized barriers to treating OUD in general. Participants with experience prescribing BUP and/or XR-NLT described barriers to treating OUD in general as well as barriers specific to each medication. Policy makers should increase access to addiction medicine education, mandate insurance coverage of both medications and inpatient detoxification, prohibit excessive insurance prior authorization requirements, increase insurance reimbursement for behavioral healthcare, and incentivize interdisciplinary collaboration. Conclusions While overlap exists, some barriers to BUP prescribing differ from barriers to XR-NLT prescribing.

      PubDate: 2018-01-10T09:31:53Z
      DOI: 10.1016/j.drugpo.2017.11.021
      Issue No: Vol. 54 (2018)
       
  • Examining the relationship between medical cannabis laws and
           cardiovascular deaths in the US
    • Authors: Rahi Abouk; Scott Adams
      Pages: 1 - 7
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Rahi Abouk, Scott Adams
      Background Several countries and many U.S. states have allowed, for cannabis to be used as therapy to treat chronic conditions or pain., This has increased the use of cannabis, particularly among older people.Because cannabis has been linked to adverse cardiac events in the medical literature, there may be unintended consequences on increased use among older people. Methods We analyze cardiac-related mortality data from the U.S. National Vital Statistics System for 1990–2014. We use difference-in-difference fixed-effects models to assess whether there are increased rates of cardiac-related mortality following passage of medical cannabis programs. We also analyze whether states with more liberal rules on dispensing cannabis show higher mortality rates. Results For men, there is a statistically significant 2.3% increase in the rate of cardiac death following passage. For women, there is a 1.3% increase that is also statistically significant. he effects increase or both men and women with age. The effects are also stronger in states with more a lax approach to cannabis dispensing. Conclusion Policymakers should be aware of a potential unintended consequence of allowing broader use of cannabis, specifically for those more at risk of cardiovascular events.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.11.022
      Issue No: Vol. 53 (2018)
       
  • The impact of OxyContin reformulation at the Sydney Medically Supervised
           Injecting Centre: Pros and cons
    • Authors: Marianne Jauncey; Michael Livingston; Allison M. Salmon; Paul Dietze
      Pages: 17 - 22
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Marianne Jauncey, Michael Livingston, Allison M. Salmon, Paul Dietze
      Background Oxycodone is implicated in a large number of overdose deaths, many involving intravenous administration of preparations designed for oral administration. International responses have included education strategies, regulatory changes, and tamper-resistant preparations to discourage injecting. Reformulated OxyContin® was introduced in Australia in April 2014 and this study examines its impact on service utilisation, defined as visits to inject drugs at the Sydney Medically Supervised Injecting Centre (MSIC) and opioid overdoses at the MSIC. Methods Data from February 2007 to February 2016 are presented for drug type injected and onsite opioid overdose. The reformulated OxyContin® effect was modelled using an interrupted time series approach. Results Client visits declined >1000 per month, or 18%, following reformulation, largely explained by a reduction in visits to inject oxycodone, partially offset by increased morphine or fentanyl injections. Despite this significant reduction in visits, there was no corresponding decrease in the number of overdoses managed, explained somewhat by a partial displacement from oxycodone to other opioids. Stable overdose numbers within the context of decreased visit numbers were consistent with increases in heroin and morphine overdose, with an extra 22 heroin and 12 morphine overdoses on average per month. This increase was offset by the decrease of 17 OxyContin®, overdoses per month. Conclusions This study replicates the trend towards substitution of OxyContin® with other opioids following the introduction of reformulated OxyContin® in Australia and extends initial findings by showing the rate of overdose per MSIC visit increased following reformulation. These unintended consequences need to be considered when evaluating the success or otherwise of these kinds of changes in product formulation.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.11.025
      Issue No: Vol. 53 (2018)
       
  • Using drugs in un/safe spaces: Impact of perceived illegality on an
           underground supervised injecting facility in the United States
    • Authors: Peter J. Davidson; Andrea M. Lopez; Alex H. Kral
      Pages: 37 - 44
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Peter J. Davidson, Andrea M. Lopez, Alex H. Kral
      Background Supervised injection facilities (SIFs) are spaces where people can consume pre-obtained drugs in hygienic circumstances with trained staff in attendance to provide emergency response in the event of an overdose or other medical emergency, and to provide counselling and referral to other social and health services. Over 100 facilities with formal legal sanction exist in ten countries, and extensive research has shown they reduce overdose deaths, increase drug treatment uptake, and reduce social nuisance. No facility with formal legal sanction currently exists in the United States, however one community-based organization has successfully operated an ‘underground’ facility since September 2014. Methods Twenty three qualitative interviews were conducted with people who used the underground facility, staff, and volunteers to examine the impact of the facility on peoples’ lives, including the impact of lack of formal legal sanction on service provision. Results Participants reported that having a safe space to inject drugs had led to less injections in public spaces, greater ability to practice hygienic injecting practices, and greater protection from fatal overdose. Constructive aspects of being ‘underground’ included the ability to shape rules and procedures around user need rather than to meet political concerns, and the rapid deployment of the project, based on immediate need. Limitations associated with being underground included restrictions in the size and diversity of the population served by the site, and reduced ability to closely link the service to drug treatment and other health and social services. Conclusion Unsanctioned supervised injection facilities can provide a rapid and user-driven response to urgent public health needs. This work draws attention to the need to ensure such services remain focused on user-defined need rather than external political concerns in jurisdictions where supervised injection facilities acquire local legal sanction.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.12.005
      Issue No: Vol. 53 (2018)
       
  • Spore forming bacteria infections and people who inject drugs:
           Implications for harm reduction
    • Authors: Karen Dunleavy; Alison Munro; Kirsty Roy; Sharon Hutchinson; Norah Palmateer; Tony Knox; David Goldberg; Vivian Hope; John Campbell; Emma Hamilton; David Liddell; Gillian Penrice; Avril Taylor
      Pages: 45 - 54
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Karen Dunleavy, Alison Munro, Kirsty Roy, Sharon Hutchinson, Norah Palmateer, Tony Knox, David Goldberg, Vivian Hope, John Campbell, Emma Hamilton, David Liddell, Gillian Penrice, Avril Taylor
      Background There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014–July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb–April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks. Methods The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May–August 2015. Multivariate logistic regression was undertaken. Between Oct 2015–January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis. Results 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394–11.349, p < 0.001) or discussed the postcard (aOR = 25.114, CI 3.188–190.550, p < 0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322–4.890, p < 0.001) or discussed the postcard (aOR = 6.707, CI 2.744 16.252, p < 0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR = 3.304 CI 1.425 7.660, p < 0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events. Conclusion More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.12.001
      Issue No: Vol. 53 (2018)
       
  • Is recovery from cannabis use problems different from alcohol and other
           drugs' Results from a national probability-based sample of the United
           States adult population
    • Authors: John F. Kelly; M. Claire Greene; Brandon G. Bergman
      Pages: 55 - 64
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): John F. Kelly, M. Claire Greene, Brandon G. Bergman
      Background The policy landscape regarding the legal status of cannabis (CAN) in the US and globally is changing rapidly. Research on CAN has lagged behind in many areas, none more so than in understanding how individuals suffering from the broad range of cannabis-related problems resolve those problems, and how their characteristics and problem resolution pathways are similar to or different from alcohol [ALC] or other drugs [OTH]. Greater knowledge could inform national policy debates as well as the nature and scope of any additional needed services as CAN population exposure increases. Method National, probability-based, cross-sectional sample of the US non-institutionalized adult population was conducted July–August 2016. Sample consisted of those who responded “yes” to the screening question, “Did you used to have a problem with alcohol or drugs but no longer do'” (63.4% response rate from 39,809 screened adults). Final weighted sample (N = 2002) was mostly male (60.0% [1.53%]), aged 25–49 (45.2% [1.63%]), non-Hispanic White (61.4% [1.64%]), employed (47.7% [1.61%]). Analyses compared CAN to ALC and OTH on demographic, clinical, treatment and recovery support services utilization, and quality of life (QOL) indices. Results 9.1% of the US adult population reported resolving a significant substance problem, and of these, 10.97% were CAN. Compared to ALC (M = 49.79) or OTH (M = 43.80), CAN were significantly younger (M = 39.41, p < 0.01), had the earliest onset of regular use (CAN M = 16.89, ALC M = 19.02, OTH M = 23.29, p < 0.01), and resolved their problem significantly earlier (CAN M = 28.87, ALC M = 37.86, OTH M = 33.06, p < 0.01). Compared to both ALC and OTH, CAN were significantly less likely to report use of inpatient treatment and used substantially less outpatient treatment, overall (p < 0.01), although CAN resolving problems more recently were more likely to have used outpatient treatment (p < 0.01). Lifetime attendance at mutual-help meetings (e.g., AA) was similar, but CAN (M = 1.67) had substantially lower recent attendance compared to ALC (M = 7.70) and OTH (M = 7.65). QOL indices were similar across groups. Conclusion Approximately 2.4 million Americans have resolved a significant cannabis problem. Compared to ALC and OTH, the pattern of findings for CAN suggest similarities but also some notable differences in characteristics and problem resolution pathways particularly regarding earlier problem offset and less use of formal and informal services. Within a shifting policy landscape, research is needed to understand how increases in population exposure and potency may affect the nature and magnitude of differences observed in this preliminary study.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.12.007
      Issue No: Vol. 53 (2018)
       
  • Making multiple ‘online counsellings’ through policy and practice: an
           evidence-making intervention approach
    • Authors: Michael Savic; Ella Dilkes-Frayne; Adrian Carter; Renata Kokanovic; Victoria Manning; Simone N. Rodda; Dan I. Lubman
      Pages: 73 - 82
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Michael Savic, Ella Dilkes-Frayne, Adrian Carter, Renata Kokanovic, Victoria Manning, Simone N. Rodda, Dan I. Lubman
      Online counselling services for a range of health conditions have proliferated in recent years. However, there is ambiguity and tension around their role and function. It is often unclear whether online counselling services are intended to provide only a brief intervention, the provision of information or referral, or constitute an alternative to face-to-face treatment. In line with recent analyses of alcohol and other drug (AOD) policy and interventions that draw on a critical social science perspective, we take an evidence-making intervention approach to examine how online counselling in the AOD field is made in policy and through processes of local implementation. In this article, we analyse how online AOD counselling interventions and knowledges are enacted in Australia’s AOD policy, and compare these enactments with an analysis of information about Australia’s national online AOD counselling service, Counselling Online, and transcripts of counselling sessions with clients of Counselling Online. We suggest that while the policy enacts online counselling as a brief intervention targeting AOD use, and as an avenue to facilitate referral to face-to-face treatment services, in its implementation in practice online counselling is enacted in more varied ways. These include online counselling as attempting to attend to AOD use and interconnected psychosocial concerns, as a potential form of treatment in its own right, and as supplementing face-to-face AOD treatment services. Rather than viewing online counselling as a singular and stable intervention object, we suggest that multiple ‘online counsellings’ emerge in practice through local implementation practices and knowledges. We argue that the frictions that arise between policy and practice enactments need to be considered by policy makers, funders, clinicians and researchers as they affect how the concerns of those targeted by the intervention are attended to.

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

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

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

      PubDate: 2018-01-10T09:31:53Z
      DOI: 10.1016/j.drugpo.2017.11.010
      Issue No: Vol. 53 (2018)
       
  • Chemsex, risk behaviours and sexually transmitted infections among men who
           have sex with men in Dublin, Ireland
    • Authors: Ronan W. Glynn; Niamh Byrne; Siobhan O’Dea; Adam Shanley; Mary Codd; Eamon Keenan; Mary Ward; Derval Igoe; Susan Clarke
      Pages: 9 - 15
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Ronan W. Glynn, Niamh Byrne, Siobhan O’Dea, Adam Shanley, Mary Codd, Eamon Keenan, Mary Ward, Derval Igoe, Susan Clarke
      Background Drug use for or during sex (‘chemsex’) among MSM has caused concern, because of the direct effects of the drugs themselves, and because of an increased risk of transmission of sexually transmitted infections (STIs). This study aimed to assess the prevalence of chemsex, associated behaviours and STIs among attendees at Ireland’s only MSM-specific sexual health clinic in Dublin over a six week period in 2016. Methods The questionnaire collected demographic data, information on sexuality and sexual practice, self-reported history of treatment for STIs, and chemsex use. Key variables independently associated with treatment for STIs over the previous 12 months were identified using multivariable logistic regression. Results The response rate was 90% (510/568). One in four (27%) reported engaging in chemsex within the previous 12 months. Half had taken ≥2 drugs on his last chemsex occasion. One in five (23%) reported that they/their partners had lost consciousness as a result of chemsex. Those engaging in chemsex were more likely to have had more sexual partners(p<0.001), more partners for anal intercourse (p<0.001) and to have had condomless anal intercourse(p=0.041). They were also more likely to report having been treated for gonorrhoea over the previous 12 months (adjusted OR 2.03, 95% CI 1.19–3.46, p=0.009). One in four (25%) reported that chemsex was impacting negatively on their lives and almost one third (31%) reported that they would like help or advice about chemsex. Conclusion These results support international evidence of a chemsex culture among a subset of MSM. They will be used to develop an effective response which simultaneously addresses addiction and sexual ill-health among MSM who experience harm/seek help as a consequence of engagement in chemsex.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.10.008
      Issue No: Vol. 52 (2018)
       
  • Harm reduction-based and peer-supported hepatitis C treatment for people
           who inject drugs in Georgia
    • Authors: Tamar Kikvidze; Niklas Luhmann; Elisabeth Avril; Maia Butsashvili; Konstantine Labartkava; Aurélie Etienne; Diane Le Pluart; Ina Inaridze; Ana Gamezardashvili; David Kharshiladze; Julie Bouscaillou
      Pages: 16 - 19
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Tamar Kikvidze, Niklas Luhmann, Elisabeth Avril, Maia Butsashvili, Konstantine Labartkava, Aurélie Etienne, Diane Le Pluart, Ina Inaridze, Ana Gamezardashvili, David Kharshiladze, Julie Bouscaillou
      Backgrounds Georgia faces high HCV rates (5.4% of chronic cases in general population) with an epidemic concentrated among people who inject drugs (PWID). A National HCV Elimination Program (NHCEP), was launched in April 2015, aiming to eliminate HCV by 2020. To succeed, this program must develop tailored interventions to enroll PWID in treatment. Intervention We implemented a pilot intervention to facilitate access to and retention of PWID in the NHCEP, and to prevent reinfection after treatment. Screening was offered at a harm reduction center. PWID with positive results were followed by peer-workers during medical assessment, which lasted 73days in average, and throughout the treatment by Sofosbuvir and Ribavirin+/− PegInterferon for 12, 24 or 48 weeks delivered at a medical center. Additional prevention sessions and PCR checks were delivered to PWID 6 and 12 months after the confirmation of sustained virologic response. Results The pilot intervention screened 554 people in 5 months with 244 starting treatment. The majority of participants (98.0%, n=239) completed the treatment. The intervention, initially implemented in the capital, was replicated in a rural area. Conclusion Peer-supported and strongly integrated, comprehensive HCV care will help PWID reach high uptake and adherence to care.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.11.014
      Issue No: Vol. 52 (2018)
       
  • The relationship between Australian harm minimisation alcohol education
           and student uptake, consumption and harm
    • Authors: Richard Midford; Leanne Lester; Tahlia Williams; Victoria White
      Pages: 25 - 31
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Richard Midford, Leanne Lester, Tahlia Williams, Victoria White
      Background Alcohol use by young people is a public health concern in Australia because of the disproportionate harm they experience. Accordingly, governments have sought to protect young people, with school identified as an appropriate site for drug, including alcohol, prevention through education. School-based drug education programmes, however, have not been particularly effective, and even when individual programs report prevention benefits they can be criticised for being developed and evaluated by the same group. Methods This study involved secondary analysis of alcohol data from the 2011 and 2014 Australian Secondary Students Alcohol and Drug (ASSAD) surveys, to examine the relationship between the amount of alcohol education students reported receiving and their patterns of use and harm. Associations between the amount of alcohol education remembered and alcohol uptake, consumption, risky consumption and alcohol-related harm were measured using Logistic and Tobit regression techniques. As most alcohol education in Australia reflects harm minimisation aims, this research provides an independent, proxy assessment of the effect of harm minimisation education. Results In the 12- to 17-year-old student group, as a whole, there was a significant positive association between having tried alcohol and the level of alcohol education recalled. There were significant negative associations between the amount of alcohol consumed and the level of alcohol education recalled for drinkers and risky drinkers. There were no significant associations between alcohol-related harm and the level of alcohol education recalled for drinkers and risky drinkers. Conclusion Providing more harm minimisation alcohol education did not persuade students to abstain from alcohol, but rather the reverse. Providing more harm minimisation education was influential in reducing consumption by students, particularly those drinking at risky levels. This should be considered indirectly beneficial in terms of minimising harm. However, the alcohol education provided to Australian students has not directly influenced their alcohol-related harm.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.11.023
      Issue No: Vol. 52 (2018)
       
  • Kalaban: Young drug users’ engagements with law enforcement in the
           Philippines
    • Authors: Gideon Lasco
      Pages: 39 - 44
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Gideon Lasco
      Background A violent ‘war on drugs’ continues to be waged in the Philippines, even as the use of drugs − particular methamphetamine − continues to rise. Furnishing contextual background to the current situation, this paper explores how long-running law enforcement approaches in the Philippines might be viewed by those in their receiving end by presenting findings of an ethnography among marginalized young men. Methods Semi-structured interviews and focus group discussions were conducted among 20 young men throughout a 12-month period of participant-observation from December 2011 to September 2013. Findings Young people make use of various ‘tactics’ to keep using drugs and evade law enforcement, even as drug use itself is a tactic in their everyday lives. A sense of hypocrisy and injustice, borne of their own experiences, informs their view of law enforcers, whom they call kalaban (enemy). They feel they are being unfairly targeted, but in their view, this danger is just part of the perils of their everyday lives. Conclusion Young men’s resort to various tactics speaks of an agency that is often ignored in public discourses. Their ‘lay assessments of risks’ and experience-based perceptions of law enforcement raises questions about the efficacy of fear-based anti-drug campaigns. Overall, the study offers an ethnographic argument against the punitive methods being employed by the Philippines, and for measures that reframe the relationship between police and young drug users − from hostility to trust.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.11.006
      Issue No: Vol. 52 (2018)
       
  • Identifying gaps in the implementation of naloxone programs for laypersons
           in the United States
    • Authors: Barrot H. Lambdin; Jon Zibbell; Eliza Wheeler; Alex H. Kral
      Pages: 52 - 55
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Barrot H. Lambdin, Jon Zibbell, Eliza Wheeler, Alex H. Kral
      Background The opioid epidemic in the United States (US) continues to generate significant increases in morbidity and mortality with no sign of decline. Overdose education and naloxone distribution (OEND) programs are highly effective at preventing opioid overdose mortality. We assessed the geographical distribution of overdose mortality and OEND programs in the US. Methods We conducted a cross-sectional, ecological study of all 3142 counties in the United States. Our variables of interest included 1) county-level drug overdose mortality rates, and 2) whether the county had an established OEND program. We mapped the drug overdose mortality rates and presence of OEND programs and assessed for differences in OEND program implementation by drug overdose mortality rates with Fisher’s exact test. Results In total, 8% (254) of counties in the US had established OEND programs by 2014, and only 13% of counties with the highest overdose mortality rates (>24 deaths/100,000) had OEND programs operating within them. Counties with the lowest overdose mortality rates were least likely to have OEND programs established (p<0.001). Conclusions We identified counties experiencing a high prevalence of drug overdose mortality but lacking OEND programs. Improving access to evidence-based approaches like OEND programs is a critical component to address the country’s growing overdose epidemic.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.11.017
      Issue No: Vol. 52 (2018)
       
  • Becoming a medical marijuana user
    • Authors: Stephen E. Lankenau; Avat Kioumarsi; Megan Reed; Miles McNeeley; Ellen Iverson; Carolyn F. Wong
      Pages: 62 - 70
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Stephen E. Lankenau, Avat Kioumarsi, Megan Reed, Miles McNeeley, Ellen Iverson, Carolyn F. Wong
      Background Since marijuana became legal for medical use in California in 1996, reasons for medical use among medical marijuana patients (MMP) have become increasingly well described in qualitative studies. However, few studies have detailed how the use of marijuana for medical purposes fits into the broader career trajectories of either becoming a marijuana user or becoming a MMP, including the social influences on medical use. Methods Young adult MMP (N=40) aged 18 to 26 years old were recruited in Los Angeles, CA in 2014-15 and administered a semi-structured interview that included questions focusing on marijuana use practices before and after becoming MMP. Results MMP were categorized into three trajectory groups: primarily medical users (n=30); primarily non-medical users (n=3); and medical users who transitioned to non-medical users (n=7). Most medical users discovered medicinal effects from marijuana in the context of non-medical use as adolescents prior to becoming MMP. Becoming a mature MMP followed interactions with dispensary staff or further self-exploration of medical uses and often involved a social process that helped confirm the legitimacy of medical use and identity as a medical user. In some cases, MMP transitioned back to non-medical users as health conditions improved or remained primarily non-medical users even after becoming MMP for reasons unrelated to health, e.g., protection against arrest. Conclusion Becoming a medical marijuana user was an important career trajectory that was influenced by early discoveries of effective medicinal use, interaction with proponents of medical use at dispensaries, experiences with new kinds of medical use, and the demands of particular health condition requiring more or less treatment with marijuana.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.11.018
      Issue No: Vol. 52 (2018)
       
  • Multiple injections per injection episode: High-risk injection practice
           among people who injected pills during the 2015 HIV outbreak in Indiana
    • Authors: Dita Broz; Jon Zibbell; Carrie Foote; Jeremy C. Roseberry; Monita R. Patel; Caitlin Conrad; Erika Chapman; Philip J. Peters; Richard Needle; Cameron McAlister; Joan M. Duwve
      Pages: 97 - 101
      Abstract: Publication date: February 2018
      Source:International Journal of Drug Policy, Volume 52
      Author(s): Dita Broz, Jon Zibbell, Carrie Foote, Jeremy C. Roseberry, Monita R. Patel, Caitlin Conrad, Erika Chapman, Philip J. Peters, Richard Needle, Cameron McAlister, Joan M. Duwve
      Background Misuse of prescription opioid analgesics (POA) has increased dramatically in the US, particularly in non-urban areas. We examined injection practices among persons who inject POA in a rural area that experienced a large HIV outbreak in 2015. Methods Between August-September 2015, 25 persons who injected drugs within the past 12 months were recruited in Scott County, Indiana for a qualitative study. Data from in-depth, semi-structured interviews were analyzed. Results All 25 participants were non-Hispanic white and the median age was 33 years (range: 19–57). All had ever injected extended-release oxymorphone (Opana® ER) and most (n = 20) described preparing Opana® ER for multiple injections per injection episode (MIPIE). MIPIE comprised 2–4 injections during an injection episode resulting from needing >1 mL water to prepare Opana® ER solution using 1 mL syringes and the frequent use of “rinse shots.” MIPIE occurred up to 10 times/day (totaling 35 injections/day), often in the context of sharing drug and injection equipment. Conclusions We describe a high-risk injection practice that may have contributed to the rapid spread of HIV in this community. Efforts to prevent bloodborne infections among people who inject POA need to assess for MIPIE so that provision of sterile injection equipment and safer injection education addresses the MIPIE risk environment.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.12.003
      Issue No: Vol. 52 (2018)
       
  • Context and characteristics of illicit drug use in coastal and interior
           Tanzania
    • Authors: Jenny Tiberio; Yovin Ivo Laurent; Joel Ndayongeje; Amani Msami; Susie Welty; Alois Ngonyani; Syangu Mwankemwa; Moza Makumbuli; Willi McFarland; Meghan D. Morris
      Pages: 20 - 26
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Jenny Tiberio, Yovin Ivo Laurent, Joel Ndayongeje, Amani Msami, Susie Welty, Alois Ngonyani, Syangu Mwankemwa, Moza Makumbuli, Willi McFarland, Meghan D. Morris
      Background An increase in heroin seizures in East Africa may signal wider local consumption of illicit drugs. Most information about drug use in Tanzania is from the economic capital, Dar es Salaam, and well-travelled Zanzibar. More data are needed on the extent, trends, and characteristics of illicit drug use in the vast coast and interior of the country. Methods The study was a rapid assessment, triangulating data from in-depth interviews of primary key informants (people who use drugs [PWUD]), secondary informants (police, community members, service providers), and ethnographic mapping of hotspots in 12 regions of Tanzania. Results We conducted 436 in-depth interviews from September 2013 to August 2014. Regions were categorized as (1) nascent: drug use is beginning to take root; (2) established: drug use has existed for some time; or (3) pervasive: drug use is spreading into new sub­groups/areas. Multiple sources corroborated that illicit drug use has been increasing in all regions. Most PWUD worked in the cash economy as bus touts, labourers, fishermen, miners, or sex workers, or stole to survive or support their habit. PWUD congregated around bus stops along transit corridors, in abandoned buildings, and in low-income residential areas. Informants described less visible PWUD among military, police, and working-class people. Cannabis was the most common, smoked alone or with tobacco and heroin (“cocktail”). Heroin was available in all regions. Cocaine was less common, likely due to high price and variable availability. Substances such as petrol, shoe polish, and glue were used as inhalants. Conclusions Illicit drug use is widespread with variable features beyond cosmopolitan areas of Tanzania. Improving transportation infrastructure and economic opportunities combined with poverty and inequality appear key factors for increasing use. Findings call attention to increasing and widening drug use in Tanzania and the need to plan prevention, treatment, and harm-reduction measures nationally.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.09.012
      Issue No: Vol. 51 (2018)
       
  • Ideation, social construction and drug policy: A scoping review
    • Authors: Vanessa Gstrein
      Pages: 75 - 86
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Vanessa Gstrein
      Within drug policy scholarship there is a growing body of literature applying ideational and social constructionist approaches to address the complexity of drug policy making and the apparent failure of the evidence-based policy paradigm to free the process from controversy and contestation. Ideational approaches are concerned with the roles played by ideas and beliefs in policy making, while social construction explores the way policy problems are constructed, and agendas are set and delineated by dominant frames and narratives. Interest in these approaches has developed over the last two decades, but has rapidly gained momentum over the last five years. There has been limited reflection on the state of the field, therefore it is timely to conduct a review of the literature to assess the value of these approaches, capture emerging themes and issues, and identify gaps in the literature to support future research directions. Using the Arksey and O’Malley framework, a scoping review was conducted to survey the breadth of the field. Following database and hand searching, 48 studies from 1996 to 2016 were selected for inclusion in the review. A narrative synthesis was undertaken and the literature was grouped into five broad theoretical approaches: ideational policy theory, problem construction, narratives and frames (including media analysis), construction of target populations, and policy transfer and mobilities. The majority of the studies are focused on single countries and drug policy issues, with few studies undertaking comparative work or reflecting on general theoretical developments in the literature. This study found that the Arksey and O’Malley framework was effective in capturing a potentially diverse field of literature and demonstrates the importance of ideational and social constructionist approaches to drug policy scholarship. Further research is required to achieve expanded geographic coverage, test policy making models and undertake comparative work.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.10.011
      Issue No: Vol. 51 (2018)
       
  • “It Ruined My Life”: The effects of the War on Drugs on people who
           inject drugs (PWID) in rural Puerto Rico
    • Authors: R. Abadie; C. Gelpi-Acosta; C. Davila; A. Rivera; M. Welch-Lazoritz; K. Dombrowski
      Pages: 121 - 127
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): R. Abadie, C. Gelpi-Acosta, C. Davila, A. Rivera, M. Welch-Lazoritz, K. Dombrowski
      Background The War on Drugs has raised the incarceration rates of racial minorities for non-violent drug-related crimes, profoundly stigmatized drug users, and redirected resources from drug prevention and treatment to militarizing federal and local law enforcement. Yet, while some states consider shifting their punitive approach to drug use, to one based on drug treatment and rehabilitation, nothing suggests that these policy shifts are being replicated in Puerto Rico. Methods This paper utilizes data from 360 PWID residing in four rural towns in the mountainous area of central Puerto Rico. We initially recruited 315 PWID using respondent-driven sampling (RDS) and collected data about risk practices and conducted HIV and HCV testing. During a second phase, we conducted 34 micro-ethnographic assays, in which we randomly recruited 34 participants from the first phase and included their ego networks in this phase. Our ethnographic inquiry produced significant data regarding the effects of the war on drugs on the local drug trade, drug availability, and injectors' social networks. Results Findings suggest that repressive policing has been ineffective in preventing drug distribution and use among those in our study. This type of law enforcement approach has resulted in the disproportionate incarceration of poor drug users in rural Puerto Rico, and mainly for nonviolent drug-related crimes. In addition, incarceration exposes PWID to a form of a cruel and unusual punishment: having to quit heroin “cold turkey” while the prison environment also represents a HIV/HCV risk. In turn, the war on drugs not only diverts resources from treatment but also shapes treatment ideologies, punishing non-compliant patients. Conclusion Shifting the emphasis from repression to treatment and rehabilitation is likely to have a positive impact on the health and overall quality of life of PWID and their communities.

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

      PubDate: 2018-01-10T09:31:53Z
      DOI: 10.1016/j.drugpo.2017.05.036
      Issue No: Vol. 51 (2018)
       
  • Home closure as a weapon in the Dutch war on drugs: Does judicial review
           function as a safety net'
    • Authors: L. Michelle Bruijn; Michel Vols; Jan G. Brouwer
      Pages: 137 - 147
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): L. Michelle Bruijn, Michel Vols, Jan G. Brouwer
      Background A widespread sense of a failing criminal justice system and increased feelings of insecurity changed the response to crime into a culture of control, which is characterized by policies that punish and exclude. In the Netherlands, these influences can be witnessed in the war on drugs where local authorities use their administrative power to close homes involved in drug-related crime. Citizens can invoke judicial review over these administrative interferences by claiming that such closure results in an unfair balance between purposes, means and consequences. This paper assesses whether judicial review functions as a safety net against losing one’s home due to drug-related crime. Methods We used doctrinal legal research methods to examine the “law in the books” and empirical legal research methods to analyse the “law in action”. We used a survey to investigate how often the drug-related closure power was used in 2015, and we statistically analysed all published case law of Dutch lower courts between 2007 and 2016. Results The scope of the closure power broadened over the years and our data show that local authorities fiercely make use of this instrument. In 41.4% of the cases, citizens are successful in fighting the closure. While scholarly literature indicates that judicial courts function as safeguards by questioning the proportionality of administrative action, raising a proportionality defence does not necessarily result in a more favourable outcome for citizens. In fact, raising a proportionality defence makes it more likely to result in dismissal of the appeal. Conclusion The stretched scope of the drug-related closure power together with the relatively low success rate of citizens who fight the loss of their home and a seemingly meaningless proportionality check show no sign of a safety net against the loss of one’s home at the suit of a local authority.

      PubDate: 2018-01-10T09:31:53Z
      DOI: 10.1016/j.drugpo.2017.08.003
      Issue No: Vol. 51 (2018)
       
  • Post-war prevention: Emerging frameworks to prevent drug use after the War
           on Drugs
    • Authors: Dan Werb
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Dan Werb
      The prevention of drug use is one of the primary goals of the War on Drugs. However, despite investment in high-profile interventions such as social marketing campaigns and enforcement-based deterrence, these efforts have generally failed. With the emergence of novel policy frameworks to control and regulate drug use, a window of opportunity exists to test approaches to drug prevention that take into account existing evidence and the rights of individuals who use drugs. Specifically, there is a growing consensus that entry into drug use is a socially-defined event that individuals experience within particular socio-structural contexts. This understanding, coupled with a distinction between the value of preventing problematic drug use rather than all drug use, provides a useful framework within which to develop effective and rights-based approaches to drug prevention.

      PubDate: 2018-01-10T09:31:53Z
       
  • Transnational social movement theory and the waning war on drugs: Case
           studies from UNGASS 2016
    • Authors: Ben Mostyn; Helen Gibbon
      Abstract: Publication date: Available online 20 December 2017
      Source:International Journal of Drug Policy
      Author(s): Ben Mostyn, Helen Gibbon
      Background The United Nations Convention against Illicit Traffic in Narcotic Drugs 1988 (“1988 Convention”) expresses a strong normative preference for criminalising drug possession. Historically, the United Nations offices responsible for overseeing the treaties have held that decriminalisation of drug possession is contrary to the treaties. Leading up to and during UNGASS 2016, however, rather than emphasise criminalisation, the high-ranking officials from the drug control offices emphasised the treaties’ allowance of alternatives to punishment for drug possession offences. Methods This paper applies transnational social movement theory to analyse the political opportunity structure for drug law reform at the UN. Data was collected from documents created by important United Nations agencies in the lead up to UNGASS 2016. By analysing the statements of prominent UN officials within a social movement theory framework, we can assess whether those responsible for administering global drug policy are offering concession to drug law reform social movement and whether a political opportunity structure is opening up for drug law reformers to pursue further reforms. Results from the United Nations documents demonstrated significant reference to local drug law reforms and the benefits of non-punitive treatment of drug users. However, given the strong normative preference and mandatory language (“shall”) in the 1988 Convention, policy leaders at the UN can only offer very moderate concessions to drug law reformers – primarily the advocacy of alternatives to incarceration. Such policies still suffer many problems caused by using the criminal justice system to funnel people into treatment. Indeed, many other offices at the UN explicitly drew attention to the problem of pre-trial punishment in their contributions to UNGASS 2016. Conclusion A schism is developing at the UN as other UN offices are pointing out that advocating for alternatives to punishment is inadequate due to the many problems of “pre-trial punishment”. Social movement theory suggests that this schism represents an opening of the political opportunity structure as advocates for drug law reform can now more forcefully criticise, and even breach, the treaties and will have high-level support at the UN.

      PubDate: 2018-01-04T09:11:03Z
      DOI: 10.1016/j.drugpo.2017.11.002
       
  • Effect of ageing and time since first heroin and cocaine use on mortality
           from external and natural causes in a Spanish cohort of drug users
    • Authors: Gemma Molist; M. Teresa Brugal; Gregorio Barrio; Beatriz Mesías; Marina Bosque-Prous; Oleguer Parés-Badell; Luis de la Fuente
      Pages: 8 - 16
      Abstract: Publication date: March 2018
      Source:International Journal of Drug Policy, Volume 53
      Author(s): Gemma Molist, M. Teresa Brugal, Gregorio Barrio, Beatriz Mesías, Marina Bosque-Prous, Oleguer Parés-Badell, Luis de la Fuente
      Background We aimed to assess the effect of ageing and time since first heroin/cocaine use on cause-specific mortality risk and age disparities in excess mortality among heroin (HUs) and cocaine users (CUs) in Spain. Methods A cohort of 15,305 HUs and 11,905 CUs aged 15–49 starting drug treatment during 1997–2007 in Madrid and Barcelona was followed until December 2008. Effects of ageing and time since first heroin/cocaine use were estimated using a competing risk Cox model and the relative and absolute excess mortality compared to the general population through directly age-sex standardized rate ratios (SRRs) and differences (SRDs), respectively. Results Mortality risk from natural causes increased with time since first heroin use, whereas that from overdose declined after having peaked in the first quinquennium. Significant effects of time since first cocaine use were not identified, although fatal overdose risk seemed higher in CUs after five years. Mortality risk from natural causes (HUs and CUs), injuries (HUs), and overdoses (CUs) increased with age, the latter without reaching statistical significance. Crude mortality rates from overdoses and injuries remained very high at age 40–59 among both HUs (595 and 217 deaths/100,000 person-years, respectively) and CUs (191 and 88 deaths/100,000 person-years). SRDs from all and natural causes were much higher at age 40–59 than 15–29 in both HUs (2134 vs. 834 deaths/100,000 person-years) and CUs (927 vs. 221 deaths/100,000 person-years), while the opposite occurred with SRRs. Conclusion The high mortality risk among HUs and CUs at all ages from both external and natural causes, and increased SRDs with ageing, suggest that high-level healthcare and harm reduction services should be established early and maintained throughout the lifetime of these populations.

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

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

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

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

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

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

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

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

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

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

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

      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.11.008
      Issue No: Vol. 52 (2017)
       
  • Effectiveness of policy changes to reduce harm from unrecorded alcohol in
           Russia between 2005 and now
    • Authors: Maria Neufeld; Jürgen Rehm
      Pages: 1 - 9
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Maria Neufeld, Jürgen Rehm
      Background Consumption of unrecorded alcohol (alcohol that is not taxed and reflected in official statistics, but consumed as a beverage) has been identified as one of the main contributors to alcohol-attributable premature mortality in Russia. The problem was highlighted by a recent a mass poisoning with surrogate alcohol occurred in the Siberian city of Irkutsk. Methods Based on key publications and legislative documents, a narrative review was undertaken about alcohol-related harm reduction policies in Russia for the period between 2005 and 2017, as well as the impact of these policies on the recorded and unrecorded alcohol consumption and alcohol market. Results Various policy measures mainly targeting availability and price of recorded and unrecorded alcohol have been introduced since 2005, which generally coincided with the decreases in alcohol-related mortality observed at that time. However, regulations on medicinal and cosmetic products have remained inconsistent providing the foundations for the continued existence of a legal industry of surrogates with broad availability and misuse. Conclusion The Russian experiences of introducing alcohol policies demonstrate that there are effective measures to reduce unrecorded alcohol consumption and attributable harm. The government’s multi-level strategy of alcohol consumption and harm reduction should be pursued stringently and all the possible loop-holes for producers, sellers and distributors of illegal and/or unrecorded alcohol should be eliminated or at least critically reduced.

      PubDate: 2017-10-14T13:25:01Z
      DOI: 10.1016/j.drugpo.2017.09.006
      Issue No: Vol. 51 (2017)
       
  • Content analysis of homeless smokers’ perspectives on established and
           alternative smoking interventions
    • Authors: Susan E. Collins; Victoria E. Orfaly; Teresa Wu; Sunny Chang; Robert V. Hardy; Amia Nash; Matthew B. Jones; Leslie Mares; Emily M. Taylor; Lonnie A. Nelson; Seema L. Clifasefi
      Pages: 10 - 17
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Susan E. Collins, Victoria E. Orfaly, Teresa Wu, Sunny Chang, Robert V. Hardy, Amia Nash, Matthew B. Jones, Leslie Mares, Emily M. Taylor, Lonnie A. Nelson, Seema L. Clifasefi
      Background Cigarette smoking is 5 times more prevalent among homeless individuals than in the general population, and homeless individuals are disproportionately affected by smoking-related morbidity and mortality. Homeless smokers report interest in changing their smoking behavior; however, established smoking cessation interventions are neither desirable to nor highly effective for most members of this population. The aim of this study was to document homeless smokers’ perceptions of established smoking interventions as well as self-generated, alternative smoking interventions to elucidate points for intervention enhancement. Methods Participants (N =25) were homeless smokers who responded to semistructured interviews regarding smoking and nicotine use as well as experiences with established and alternative smoking interventions. Conventional content analysis was used to organize data and identify themes. Results Participants appreciated providers’ initiation of conversations about smoking. They did not, however, feel simple advice to quit was a helpful approach. Instead, they suggested providers use a nonjudgmental, compassionate style, offer more support, and discuss a broader menu of options, including nonabstinence-based ways to reduce smoking-related harm and improve health-related quality of life. Most participants preferred engaging in their own self-defined, alternative smoking interventions, including obtaining nicotine more safely (e.g., vaping, using smokeless tobacco) and using behavioral (e.g., engaging in creative activities and hobbies) and cognitive strategies (e.g., reminding themselves about the positive aspects of not smoking and the negative consequences of smoking). Abrupt, unaided quit attempts were largely unsuccessful. Conclusions The vast majority of participants with the lived experience of homelessness and smoking were uninterested in established smoking cessation approaches. They did, however, have creative ideas about alternative smoking interventions that providers may support to reduce smoking-related harm and enhance quality of life. These ideas included providing information about the relative risks of smoking and the relative benefits of alternative strategies to obtaining nicotine and avoiding smoking.

      PubDate: 2017-11-30T13:54:42Z
      DOI: 10.1016/j.drugpo.2017.09.007
      Issue No: Vol. 51 (2017)
       
  • ‘I have it just in case’ — Naloxone access and changes
           in opioid use behaviours
    • Authors: Sarah Cercone Heavey; Yu-Ping Chang; Bonnie M. Vest; R. Lorraine Collins; William Wieczorek; Gregory G. Homish
      Pages: 27 - 35
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Sarah Cercone Heavey, Yu-Ping Chang, Bonnie M. Vest, R. Lorraine Collins, William Wieczorek, Gregory G. Homish
      Background The past decade has seen over a four-fold increase in deaths from opioid overdose in the United States. To address this growing epidemic, many localities initiated policies to expand access to naloxone (a drug that reverses the effects of opioids); however, little is known how naloxone access affects opioid use behaviours. Methods The present qualitative study used semi-structured, in-depth interviews with inpatients at a substance use treatment centre. All patients who met study inclusion criteria (in treatment for opioid use, between the ages of 18 and 40, able to speak and understand English, and had not previously completed an interview with the research team) were invited to participate. Interviews were conducted until thematic saturation was reached (N=20) and covered the participant’s naloxone knowledge, access, and attitudes, as well as experience(s) with opioid use and opioid overdose, and their naloxone use in the context of opioid overdose. Thematic content analysis was used to analyze interview transcripts. Results Five main themes were uncovered during analysis; first, awareness about naloxone, including, content knowledge and source information for naloxone. Naloxone awareness was very common among opioid users; however, depth of knowledge varied; some participants did not make any efforts to have naloxone available, and others felt that it was “just as important as a clean needle.” The second theme explored how naloxone access intersects with drug selling. The third theme explored naloxone availability while using, including attitudes about naloxone, occasions with no naloxone availability, when naloxone is “good to have,” and when naloxone is a priority for users. The fourth theme examined changes in opioid use behaviours associated with naloxone access. Primarily, participants discussed changing how much heroin they used in a given situation to achieve a bigger high. The final theme explored naloxone behaviours that alter overdose mortality risk, such as how users distinguish when to use naloxone, dis-incentives to naloxone use, and solo opioid use. Conclusion Results indicate that though naloxone awareness was high, there was great variation in the associated attitudes and practices. Participants generally described naloxone as an important resource, but not all were inclined to carry or use it appropriately. Future research needs to examine why different groups of opioid users access naloxone differently, particularly to identify those at risk for experimental opioid use while carrying naloxone.

      PubDate: 2017-11-30T13:54:42Z
      DOI: 10.1016/j.drugpo.2017.09.015
      Issue No: Vol. 51 (2017)
       
  • Nine reasons why ecstasy is not quite what it used to be
    • Authors: Jane Mounteney; Paul Griffiths; Alessandra Bo; Andrew Cunningham; Joao Matias; Alessandro Pirona
      Pages: 36 - 41
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Jane Mounteney, Paul Griffiths, Alessandra Bo, Andrew Cunningham, Joao Matias, Alessandro Pirona
      This paper explores the recent resurgence in use of ecstasy/MDMA in Europe and highlights keys areas of continuity and divergence between the ecstasy market of the 1990s and the current MDMA market. Based on a scoping study involving a targeted multi-source data collection exercise on MDMA, it highlights nine areas that have undergone some level of change, linked with both supply and demand for the drug. Factors discussed include: innovation in production techniques; changes in precursor chemical availability; the role of online markets; competition with other stimulants and new psychoactive substances; the increased availability of high-strength MDMA; and the shift from subcultural towards more mainstream use of the drug. The paper proposes that the MDMA on Europe’s contemporary market is in some respects a third generation product with a different consumer profile, with implications that responses developed at the time of the drug’s earlier iteration, may be in need of a review and revamp.

      PubDate: 2017-11-30T13:54:42Z
      DOI: 10.1016/j.drugpo.2017.09.016
      Issue No: Vol. 51 (2017)
       
  • Effect of initiating drug treatment on the risk of drug-related poisoning
           death and acquisitive crime among offending heroin users
    • Authors: Matthias Pierce; Sheila M. Bird; Matthew Hickman; John Marsden; Graham Dunn; Toby Seddon; Tim Millar
      Pages: 42 - 51
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Matthias Pierce, Sheila M. Bird, Matthew Hickman, John Marsden, Graham Dunn, Toby Seddon, Tim Millar
      Background A recent Cochrane review of randomised trials identified a lack of evidence for interventions provided to drug-using offenders. We use routine data to address whether contact with treatment services reduces heroin users’ likelihood of a future acquisitive offence or drug-related poisoning (DRP) death. Methods Heroin-users were identified from probation assessments and linked to drug-treatment, mortality and offending records. The study cohort was selected to ensure that the subject was not: in prison, in treatment or had recently left treatment. Subjects were classed as initiators if they attended a triage appointment within two weeks of their assessment; non-initiators otherwise. Initiator and non-initiators were compared over a maximum of one year, with respect to their risk of recorded acquisitive offence or DRP-death. Balance was sought using propensity score matching and missing data were accounted for using multiple imputation. Results Nine percent of assessments identified for analysis were classed as initiators. Accounting for observed confounding and missing data, there was a reduction in DRPs associated with initiator assessments, however there was uncertainty around this estimate such that a null-effect could not be ruled out (HR: 0.42, 95% CI 0.17–1.04). There was no evidence of a decrease in the recidivism risk, in fact the analysis showed a small increase (HR: 1.10, 95% CI 1.02–1.18). Conclusion For heroin-using offenders, initial contact with treatment services does not appear to reduce the likelihood of a future acquisitive offence.

      PubDate: 2017-11-30T13:54:42Z
      DOI: 10.1016/j.drugpo.2017.09.017
      Issue No: Vol. 51 (2017)
       
  • Becoming enwinded: A new materialist take on smoking pleasure
    • Authors: Simone Dennis
      Pages: 69 - 74
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Simone Dennis
      What might new materialist perspectives bring to our understanding of smoking pleasure' In this paper, I draw on this thinking to sketch out an alternative, non-unitary smoker who is at the mercy of the whims of the breeze − a yielding I will argue is key to smoking pleasure. With these intentions in mind, rather than thinking of what the biotechnology of cigarettes accomplishes in terms of the chemical delivery of pleasure, or adding to the multiply of social and cultural reasons anthropologists have tendered to account for it, I approach smoking pleasure in and through the medium of the smoky air. This approach permits examination of how nonhuman and human agents, like cigarettes, lungs, hands and other things form momentary and contingent relation in the air, as well as the role of the air itself in ‘enwinding’ the smoker. When smoking pleasure is explored from such a perspective, the smoker can be recast as part of a complex of relations that she does not fully control, rather than the agentic centre or principal arrayer of the nonhuman world. The pleasures of smoking, and the smoker herself, I argue, are emergent and come into being precisely in these relations: ‘the smoker’ originates, terminates, and is defined in and with elements, rather than being surely and certainly attached to a particular smoker subjectivity. Chief among the complex of things and elements that make the smoker and her pleasure is the air itself − and it is the air itself that is my primary informant in this paper.

      PubDate: 2017-12-11T08:11:25Z
      DOI: 10.1016/j.drugpo.2017.11.004
      Issue No: Vol. 51 (2017)
       
  • Symbolic perceptions of methamphetamine: Differentiating between ice and
           shake
    • Authors: Heith Copes; Whitney Tchoula; Jennifer Kim; Jared Ragland
      Pages: 87 - 94
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Heith Copes, Whitney Tchoula, Jennifer Kim, Jared Ragland
      Background Although public perceptions of methamphetamine (meth) consider all forms of the drug as the same, this is not true among those who use it. Our aim is to examine how those who use meth perceive two forms of meth (ice and shake) using the theoretical framework of symbolic boundaries. Methods We rely on data collected from a photo-ethnography with people who use methamphetamine in rural Alabama. The ethnography consisted of formal interviews (with 52 participants), informal observations, and photography. Results Participants had a strong preference for ice (49 of 52 preferred ice over shake). In discussing why they prefer ice they point to the various short- and long-term health problems associated with shake. This distinction allowed them to create symbolic definitions of shake as being dirty due to impure chemicals and its users as desperate. Conclusion We argue that this symbolic differentiation of the two forms allows users to frame themselves as rational users (i.e., they avoid the unsafe form of meth) and shape use patterns and prevalence, with shake being used infrequently and often intravenously.

      PubDate: 2017-12-11T08:11:25Z
      DOI: 10.1016/j.drugpo.2017.11.007
      Issue No: Vol. 51 (2017)
       
  • Back to the core: A network approach to bolster harm reduction among
           persons who inject drugs
    • Authors: Martin Bouchard; Sadaf Hashimi; Kristen Tsai; Hugh Lampkin; Ehsan Jozaghi
      Pages: 95 - 104
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Martin Bouchard, Sadaf Hashimi, Kristen Tsai, Hugh Lampkin, Ehsan Jozaghi
      Background Injecting drugs safely almost always includes the presence of one’s social network, especially for the prevention of overdose. Yet, the systematic analysis of users’ social networks has yet to be established as a focal method in harm reduction research, and interventions. Methods This study draws from 200 interviews with persons who inject drugs recruited from North America’s first sanctioned supervised injection facility and a drug user’s advocacy group. Respondents were asked about the individuals they personally considered as facilitators of harm reduction, and the relations between them. Collectively, these 200 respondents provided over 900 individuals whom they considered as members of their harm reduction network. The aim was to locate individuals that would potentially make the network denser (harm reduction champions) and users that were situated in the “periphery” of the network, and in practice, further away from the harm reduction core. Results Of the 1135 network members, 63 individuals formed the “core” of the harm reduction network, collectively reaching approximately 70% of individuals in the network. We also uncovered 31 individuals that acted as “articulation points”– these individuals were not as connected, but were more effective at reaching peripheral individuals. Conclusion Former or current injecting drug users that were sampled were surrounded by a relatively rich harm reduction network, but the network approach showed that only a minority of individuals were true harm reduction “champions”. Recruitment of a combination of well-connected harm reduction champions, and strategically connected articulation points, would be most effective in planning network interventions that encourage harm reduction behaviors among this population.

      PubDate: 2017-12-11T08:11:25Z
      DOI: 10.1016/j.drugpo.2017.10.006
      Issue No: Vol. 51 (2017)
       
  • “All the King’s horses and all the King’s men…”: What is broken
           should not always be put back together again
    • Authors: Grant James Devilly
      Pages: 105 - 110
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Grant James Devilly


      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.11.020
      Issue No: Vol. 51 (2017)
       
  • The long tail of a demon drug: The ‘bath salts’ risk
           environment
    • Authors: Luther Elliott; Ellen Benoit; Stephanie Campos; Eloise Dunlap
      Pages: 111 - 116
      Abstract: Publication date: January 2018
      Source:International Journal of Drug Policy, Volume 51
      Author(s): Luther Elliott, Ellen Benoit, Stephanie Campos, Eloise Dunlap
      Using the case of synthetic cathinones (commonly referred to as ‘bath salts’ in the US context), this paper analyses structural factors surrounding novel psychoactive substances (NPS) as contributing to the unique risk environment surrounding their use. Drawing on interviews with 39 people who use bath salts from four U.S. cities and analysis of the infrastructural, social, economic, and policy contexts, we document the unique harms related to changing contexts for illicit drug regulation, manufacture, and consumption. Findings suggest that NPS and designer drug markets, which are highly reliant upon the internet, share characteristics of the entertainment industry which has come to rely more heavily upon profits derived from the ‘long tail’ of myriad lesser-known products and the diminished centrality of ‘superstars’ and ‘hits’. Findings point toward increased theoretical and policy attention to changing drug market structures, more rigorous evaluations of drug ‘analogues’ legislation and greater involvement with NPS education and testing by harm reduction agencies.

      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.10.007
      Issue No: Vol. 51 (2017)
       
  • A kind of peace: Tracking the reflexive and resilient drug war
    • Authors: Katherine McLean
      Abstract: Publication date: Available online 15 December 2017
      Source:International Journal of Drug Policy
      Author(s): Katherine McLean


      PubDate: 2017-12-24T08:26:10Z
      DOI: 10.1016/j.drugpo.2017.10.013
       
  • Could cannabis liberalisation lead to wider changes in drug policies and
           outcomes'
    • Authors: Brendan Hughes; Lucas Wiessing; Don Des Jarlais; Paul Griffiths
      Abstract: Publication date: Available online 9 December 2017
      Source:International Journal of Drug Policy
      Author(s): Brendan Hughes, Lucas Wiessing, Don Des Jarlais, Paul Griffiths
      Cannabis policies are changing in some countries. This may have consequences that extend beyond cannabis-specific outcomes, such as an impact on the consumption patterns of other substances. Changes in cannabis policies may also influence policy responses to other drugs, as countries re-assess the balance between law enforcement and public health objectives. If this happens, it could have important health and social consequences, especially in those countries where a ‘war on drugs’ policy perspective has inhibited investment in evidence based responses in areas such as treatment and harm reduction. The burden of disease associated with opioid use for example is large and this is an area in which treatment and harm reduction have been shown to deliver benefits. Thus if the changes in cannabis policies result in a greater willingness to invest in effective interventions for other drugs, the potential net health gains could be considerable. On the other hand, if cannabis policy changes are associated with an increase in health risk behaviours, such as driving under the influence or increased use of harmful substances such as tobacco, then significant increased health costs could result. To date most attention has been focused on recent cannabis sales liberalisation in the Americas, but experiences from elsewhere are also informative. In Europe, for example, moves towards decriminalisation of drug possession are resulting in lower rates of incarceration and arguably have reduced barriers to treatment uptake. Robust monitoring and assessment of the impact of these different policy changes is crucial to evaluating and understanding their results. It is important that such monitoring is international in scope, is not limited to issues around the use of cannabis only, and considers the interactions that may exist between cannabis policies and the approaches taken to other substances.

      PubDate: 2017-12-11T08:11:25Z
      DOI: 10.1016/j.drugpo.2017.10.004
       
 
 
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