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  [3048 journals]
  • 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)
       
  • From ecstasy to MDMA: Recreational drug use, symbolic boundaries, and drug
           trends
    • Authors: Marit Edland-Gryt; Sveinung Sandberg; Willy Pedersen
      Pages: 1 - 8
      Abstract: Publication date: December 2017
      Source:International Journal of Drug Policy, Volume 50
      Author(s): Marit Edland-Gryt, Sveinung Sandberg, Willy Pedersen
      Background Ecstasy pills with MDMA as the main ingredient were introduced in many European countries in the 1980s, and were often linked to the rave and club scenes. However, use gradually levelled off, in part as a response to increased concerns about possible mental health consequences and fatalities. Extensive use of MDMA now seems to be re-emerging in many countries. In this study, we investigated the cultural and social meaning associated with MDMA use in Oslo, Norway, with an emphasis on how users distinguish MDMA crystals and powder from “old ecstasy pills”. Methods Qualitative in-depth interviews (n=31, 61,3% males) were conducted with young adult party-goers and recreational MDMA/ecstasy users (20–34 years old, mean age 26.2 years). Results Research participants emphasised three important perceived differences between the MDMA crystals and ecstasy pills: (i) The effects of MDMA were described as better than ecstasy; (ii) MDMA was regarded as a safer drug; (iii) Users of MDMA crystals were described as more distinct from and less anchored in out-of-fashion rave culture than those using ecstasy. These differences were an important part of the symbolic boundary work MDMA users engaged in when justifying their drug use. Conclusion MDMA has re-emerged as an important psychoactive substance in Oslo’s club scene. One important reason for this re-emergence seems to be its perceived differentiation from ecstasy pills, even though the active ingredient in both drugs is MDMA. This perceived distinction between MDMA and ecstasy reveals the importance of social and symbolic meanings in relation to psychoactive substance use. Insights from this study can be important in terms of understanding how trends in drug use develop and how certain drugs gain or lose popularity.

      PubDate: 2017-09-05T13:37:35Z
      DOI: 10.1016/j.drugpo.2017.07.030
      Issue No: Vol. 50 (2017)
       
  • ‘Affording’ new approaches to couples who inject drugs: A novel
           fitpack design for hepatitis C prevention
    • Authors: Suzanne Fraser; Carla Treloar; Sandra Gendera; Jake Rance
      Pages: 19 - 35
      Abstract: Publication date: December 2017
      Source:International Journal of Drug Policy, Volume 50
      Author(s): Suzanne Fraser, Carla Treloar, Sandra Gendera, Jake Rance
      Background In the West, hepatitis C is predominantly transmitted via the sharing of contaminated drug-injecting equipment. Although the majority of this sharing occurs between sexual partners, the responsibility for avoiding transmission has long been conceived as an individual responsibility, with prevention measures such as the distribution of sterile injecting equipment such as injecting packs (‘fitpacks’) aimed at individuals without regard for the social contexts of injecting. In this article we draw on the work of Bruno Latour to reconceptualise the fitpack. We argue that the fitpack is not inert or neutral in its meaning or effects, that instead it ‘affords’ particular meanings and actions, for example, that injecting is an individual practice and safety an individual responsibility. Method To challenge these affordances, we developed a new fitpack prototype aimed at couples, along with related health promotion messages. We asked 13 couples who inject drugs to examine and reflect on these new objects and messages. Results Overall, we found a high level of support for the broad idea of couples-oriented materials, as well as for our prototype and associated materials. Participants identified opportunities for improving the materials and commented on implications of the symbols and language used. Together the interviews demonstrated ways in which the new fitpacks and messages could afford couples-oriented safe injecting, and better recognition of relationships that are often dismissed by researchers and health care providers as insincere. Conclusions These findings demonstrate that first, there is a need and desire for a greater range in harm reduction resources. Second, it is essential to find ways of better acknowledging the validity and value of relationships between people who inject. Third, and more broadly, recognition must be given to the role of technological objects in materialising meanings and, as Latour might put it, ‘moralities’, and in turn to interrogating these meanings and moralities.

      PubDate: 2017-10-08T13:22:48Z
      DOI: 10.1016/j.drugpo.2017.07.001
      Issue No: Vol. 50 (2017)
       
  • “I love having benzos after my coke shot”: The use of psychotropic
           medication among cocaine users in downtown Montreal
    • Authors: Rossio Motta-Ochoa; Karine Bertrand; Nelson Arruda; Didier Jutras-Aswad; Élise Roy
      Pages: 15 - 23
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Rossio Motta-Ochoa, Karine Bertrand, Nelson Arruda, Didier Jutras-Aswad, Élise Roy
      Background Cocaine abuse is a major public health issue due to its role in the HIV and hepatitis C virus (HCV) epidemics in North America. A significant area of concern among people who use cocaine (PWUC), injected or smoked, is their frequent misuse of prescription drugs, particularly psychotropic medication (PM), such as tranquilizers, sedatives, stimulants, and antipsychotics. This paper aims to describe and understand practices of PM use among PWUC in downtown Montreal. Method Ethnographic methods including participant observation and semi-structured interviews were used in an iterative manner. Results Two thirds of the 50 participants were male. They ranged in age from 20 to 60 and most were homeless. A significant proportion of them reported polydrug use patterns that included frequent concomitant opioid use (heroin and/or prescription opioids (PO)). Benzodiazepine-based tranquilizers and the atypical antipsychotic quetiapine were the most frequently used PM. Routes of PM administration were oral, nasal and, to a lesser degree, intravenous. Five main PM use practices were identified: 1) “downers” from cocaine high (benzodiazepines and quetiapine); 2) enhancers of heroin/PO effects (benzodiazepines); 3) reducers or suppressors of heroin/PO withdrawal symptoms (benzodiazepines); 4) enablers of a different type of “trip” (benzodiazepines); and 5) treatment for mental and physical problems (benzodiazepines and quetiapine). Conclusion PM use practices showed several complementary functions that PM fulfill in a context of polydrug use. The soothing and stimulating effects of PM reinforce the patterns of drug use among participants, posing various risks including overdose, HIV/HCV transmission, PM dependence and accidents. The results highlight the need for clinicians to assess clients’ substance use patterns when prescribing PM and to question PWUC about PM use. The findings also underline certain unmet service needs in relation to overdose, HIV/HCV and mental health prevention/treatment among cocaine users.

      PubDate: 2017-08-25T12:33:37Z
      DOI: 10.1016/j.drugpo.2017.07.012
      Issue No: Vol. 49 (2017)
       
  • ‘Slamming’ among men who have sex with men accessing general drug
           services, in response to Schmidt, AJ et al., 2016, Illicit drug use among
           gay and bisexual men in 44 cities: Findings from the European MSM Internet
           Survey (EMIS)
    • Authors: Rachel Glass; Vivian D. Hope; Claire Tanner; Monica Desai
      Pages: 24 - 25
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Rachel Glass, Vivian D. Hope, Claire Tanner, Monica Desai


      PubDate: 2017-09-05T13:37:35Z
      DOI: 10.1016/j.drugpo.2017.07.028
      Issue No: Vol. 49 (2017)
       
  • Support of supervised injection facilities by emergency physicians in
           Canada
    • Authors: Noam Katz; Lynne Leonard; Lorne Wiesenfeld; Jeffrey J. Perry; Venkatesh Thiruganasambandamoorthy; Lisa Calder
      Pages: 26 - 31
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Noam Katz, Lynne Leonard, Lorne Wiesenfeld, Jeffrey J. Perry, Venkatesh Thiruganasambandamoorthy, Lisa Calder
      Background Despite evidence supporting the implementation of supervised injection facilities (SIFs) by multiple stakeholders, no evaluation of emergency physicians’ attitudes has ever been documented towards such facilities in Canada or internationally. The primary goal of our study was to determine the opinions and perceptions of emergency physicians regarding the implementation of SIFs in Canada. Methods We conducted a national electronic survey of staff and resident emergency physicians in Canada using an iteratively designed survey tool in consultation with content experts. Invitations to complete the survey were sent via email by the Canadian Association of Emergency Physicians. Inclusion criteria required respondents to have treated an adult patient in a Canadian emergency department within the preceding 6 months. The primary measure was the proportion of respondents who would support, not support or were unsure of supporting SIFs in their community with the secondary measure being the likelihood of respondents to refer patients to a SIF if available. Results We received 280 responses out of 1353 eligible physicians (20.7%), with the analysis conducted on 250 responses that met inclusion criteria (18.5%). The majority of respondents stated they would support the implementation of SIFs in their community (N=172; 74.5%) while 10.8% (N=25) would not and 14.7% (N=34) did not know. The majority of respondents said they would refer their patients to SIFs (N=198; 84.6%), with 4.3% (N=10) who would not and 11.1% (N=26) who were unsure. Conclusion The findings from our study demonstrate that the majority of emergency physician respondents in Canada support the implementation of such sites (74.5%) while 84.6% of respondents would refer patients from the emergency department to such sites if they did exist. Given that many Canadian cities are actively pursuing the creation of SIFs or imminently opening such sites, it appears that our sample population of emergency physicians would both support this approach and would utilize such facilities in an effort to improve patient-centered outcomes for this often marginalized population.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.013
      Issue No: Vol. 49 (2017)
       
  • Polydrug use and its association with drug treatment outcomes among
           primary heroin, methamphetamine, and cocaine users
    • Authors: Linwei Wang; Jeong Eun Min; Emanuel Krebs; Elizabeth Evans; David Huang; Lei Liu; Yih-Ing Hser; Bohdan Nosyk
      Pages: 32 - 40
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Linwei Wang, Jeong Eun Min, Emanuel Krebs, Elizabeth Evans, David Huang, Lei Liu, Yih-Ing Hser, Bohdan Nosyk
      Background Polydrug use may challenge effective treatment for substance use disorders. We evaluate whether secondary substance use modifies the association between treatment and primary drug use among primary heroin, cocaine and methamphetamine (MA) users. Methods Data were obtained from prospective cohort studies on people who use illicit drugs (PWUD) in California, USA. Using repeated monthly data on self-reported secondary substance use (heroin, cocaine, MA, alcohol or marijuana; ≥1day in a month), primary drug use (≥1day in a month), and treatment participation, collected via timeline follow-back, we fitted generalized linear mixed multiple regression models controlling for potential confounders to examine the interactions between treatment and secondary substance use on the odds of primary heroin, cocaine and MA use, respectively. Results Included in our study were 587 primary heroin, 444 primary MA, and 501 primary cocaine users, with a median of 32.4, 13.3 and 18.9 years of follow-up, respectively. In the absence of secondary substance use, treatment was strongly associated with decreased odds of primary drug use (adjusted odds ratios (aORs): 0.25, 95% CI: 0.24, 0.27, 0.07 (0.06, 0.08), and 0.07 (0.07, 0.09)) for primary heroin, MA, and cocaine users, respectively. Secondary substance use of any kind moderated these associations (0.82 (0.78, 0.87), 0.25 (0.21, 0.30) and 0.53 (0.45, 0.61), respectively), and these findings were consistent for each type of secondary substance considered. Moreover, we observed different associations in terms of direction and magnitude between secondary substance use and primary drug use during off-treatment periods across substance types. Conclusion This study demonstrates secondary substance use moderates the temporal associations between treatment and primary drug use among primary heroin, MA and cocaine users. Disparate patterns of polydrug use require careful measurement and analysis to inform targeted treatment for polydrug users.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.009
      Issue No: Vol. 49 (2017)
       
  • Using nominal group technique among clinical providers to identify
           barriers and prioritize solutions to scaling up opioid agonist therapies
           in Ukraine
    • Authors: Lynn Madden; Martha J. Bojko; Scott Farnum; Alyona Mazhnaya; Tatiana Fomenko; Ruthanne Marcus; Declan Barry; Irina Ivanchuk; Viktor Kolomiets; Sergey Filippovych; Sergey Dvoryak; Frederick L. Altice
      Pages: 48 - 53
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Lynn Madden, Martha J. Bojko, Scott Farnum, Alyona Mazhnaya, Tatiana Fomenko, Ruthanne Marcus, Declan Barry, Irina Ivanchuk, Viktor Kolomiets, Sergey Filippovych, Sergey Dvoryak, Frederick L. Altice
      Background Opioid agonist therapies (OAT) like methadone and buprenorphine maintenance treatment remain markedly under-scaled in Ukraine despite adequate funding. Clinicians and administrators were assembled as part of an implementation science strategy to scale-up OAT using the Network for Improvement of Addiction Treatment (NIATx) approach. Methods Nominal Group Technique (NGT), a key ingredient of the NIATx toolkit, was directed by three trained coaches within a learning collaborative of 18 OAT clinicians and administrators to identify barriers to increase OAT capacity at the regional “oblast” level, develop solutions, and prioritize local change projects. NGT findings were supplemented from detailed notes collected during the NGT discussion. Results The top three identified barriers included: (1) Strict regulations and inflexible policies dictating distribution and dispensing of OAT; (2) No systematic approach to assessing OAT needs on regional or local level; and (3) Limited funding and financing mechanisms combined with a lack of local/regional control over funding for OAT treatment services. Conclusions NGT provides a rapid strategy for individuals at multiple levels to work collaboratively to identify and address structural barriers to OAT scale-up. This technique creates a transparent process to address and prioritize complex issues. Targeting these priorities allowed leaders at the regional and national level to advocate collectively for approaches to minimize obstacles and create policies to improve OAT services.

      PubDate: 2017-09-29T23:35:22Z
      DOI: 10.1016/j.drugpo.2017.07.025
      Issue No: Vol. 49 (2017)
       
  • Medicalization of cannabis: What does it mean'
    • Authors: Dana Zarhin; Maya Negev; Simon Vulfsons; Sharon Szintman
      Pages: 54 - 57
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Dana Zarhin, Maya Negev, Simon Vulfsons, Sharon Szintman
      Background Despite the frequent use of the phrase “medicalization of cannabis,” it is not clear what it means to different stakeholders involved in medical cannabis (MC) policy development. This report examines Israeli stakeholders’ understandings of how cannabis should be medicalized. Methods Following principles of constructivist grounded theory method, we analyzed Israeli parliament protocols and different policy documents related to MC policy and legislation. Results and discussion There was support for the incorporation of cannabis into medicine across the various stakeholders. Nonetheless, controversies remained surrounding how cannabis should be medicalized. Specifically, whereas most stakeholders argued that cannabis should be medicalized as a medication by relying on the biomedical model of medicine, others contended that cannabis should be medicalized as a treatment, akin to how complementary or alternative treatment has been co-opted by medicine. Biomedicalization of cannabis was the dominant frame, and was supported by the Ministry of Health, which has been entrusted to oversee the MC program in Israel. Conclusion Due to its extensive experience with MC policy and its pioneering research, many consider Israel to be a leading actor in the global MC arena. It is therefore possible that other countries will follow Israel’s lead in its path to the biomedicalization of cannabis.

      PubDate: 2017-09-29T23:35:22Z
      DOI: 10.1016/j.drugpo.2017.07.032
      Issue No: Vol. 49 (2017)
       
  • Re-examining blood donor deferral criteria relating to injecting drug use
    • Authors: Brendan Quinn; Clive Seed; Anthony Keller; Lisa Maher; David Wilson; Michael Farrell; Sharon Caris; Jennifer Williams; Annie Madden; Alexander Thompson; Joanne Pink; Margaret E. Hellard
      Pages: 9 - 17
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Brendan Quinn, Clive Seed, Anthony Keller, Lisa Maher, David Wilson, Michael Farrell, Sharon Caris, Jennifer Williams, Annie Madden, Alexander Thompson, Joanne Pink, Margaret E. Hellard
      Background and aims Potential Australian blood donors are deferred indefinitely if they report a history of injecting drug use (IDU), or for 12 months if they report having engaged in sexual activity with someone who might have ever injected. Given incremental improvements in blood safety, this study sought to examine whether Australia’s IDU-related eligibility criteria reflected current scientific evidence, were consistent with international best practice and, if current IDU-related policies were to be changed, how this should happen. Methods An expert committee was formed to review relevant literature with a focus on issues including: the epidemiology of IDU in Australia and key transfusion-transmissible infections (TTIs) among Australian people who inject drugs (PWID); and, ‘non-compliance’ among PWID regarding IDU-related blood donation guidelines. International policies relating to blood donation and IDU were also reviewed. Modelling with available data estimated the risk of TTIs remaining undetected if the Blood Service’s IDU-related guidelines were changed. Results Very few (<1%) Australians engage in IDU, and IDU risk practices are reported by only a minority of PWID. However, the prevalence of HCV remains high among PWID, and IDU remains a key transmission route for various TTIs. Insufficient data were available to inform appropriate estimates of cessation and relapse among Australian PWID. Modelling findings indicated that the risk of not detecting HIV becomes greater than the reference group at a threshold of non-admission of being an active PWID of around 1.8% (0.5–5.1%). Excluding Japan, all Organisation for the Economic Co-operation and Development member countries permanently exclude individuals with a history of IDU from donating. Conclusion Numerous research gaps meant that the study’s expert Review Committee was unable to recommend altering Australia’s current IDU-related blood donation guidelines. However, having identified critical knowledge gaps and future areas of research, the review made important steps toward changing the criteria.

      PubDate: 2017-07-01T17:52:12Z
      DOI: 10.1016/j.drugpo.2017.05.058
      Issue No: Vol. 48 (2017)
       
  • Understanding experiences of and rationales for sharing crack-smoking
           equipment: A qualitative study with persons who smoke crack in Montréal
    • Authors: Hélène Poliquin; Karine Bertrand; Jorge Flores-Aranda; Élise Roy
      Pages: 18 - 26
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Hélène Poliquin, Karine Bertrand, Jorge Flores-Aranda, Élise Roy
      Background The distribution of safer crack-smoking equipment has been implemented in several Canadian cities to reduce potential health risks such as transmission of blood borne viruses (BBV). Little is known about the perspectives of persons who smoke crack (PWSC) on sharing crack-smoking materials or using in settings where safer crack-smoking equipment is provided. This paper presents data from the perspective of PWSC in Montréal on their experiences of, and rationales for, sharing crack-smoking equipment, in light of the risks of BBV transmission. Methods This qualitative study is based on analyses of BBV risk behaviours among people who use cocaine. Thirty-two semi-structured interviews were conducted in low-threshold community centres for persons who use drugs. Twenty-six interviewees who used cocaine also smoked crack, and constitute a subsample for analyses. Interview transcripts were coded inductively and analyzed thematically from a symbolic interactionist perspective. Results Participants demonstrated personal agency by adopting strategies to minimise sharing of smoking equipment. These included being firm in refusal to share, smoking alone, and keeping an extra pipe to give to others. Nonetheless, sharing seemed to be commonplace and was attributed to contextual and personal factors. These were linked to the social dynamics among smokers; economic reasons such as wanting to keep the accumulated crack resin; practical reasons such as lacking own smoking equipment; being ashamed to purchase or acquire crack pipes; fatalism; poor personal agency; and ambivalence or scepticism towards BBV transmission risks. Conclusion To reinforce harm reduction for PWSC, interventions aimed at reducing barriers to safer smoking practices should be developed at both structural and individual levels.

      PubDate: 2017-07-01T17:52:12Z
      DOI: 10.1016/j.drugpo.2017.05.059
      Issue No: Vol. 48 (2017)
       
  • Assessing support for supervised injection services among community
           stakeholders in London, Canada
    • Authors: Geoff Bardwell; Ayden Scheim; Sanjana Mitra; Thomas Kerr
      Pages: 27 - 33
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Geoff Bardwell, Ayden Scheim, Sanjana Mitra, Thomas Kerr
      Objectives Few qualitative studies have examined support for supervised injection services (SIS), and these have been restricted to large cities. This study aimed to assess support for SIS among a diverse representation of community stakeholders in London, a mid-sized city in southwestern Ontario, Canada. Methods This qualitative study was undertaken as part of the Ontario Integrated Supervised Injection Services Feasibility Study. We used purposive sampling methods to recruit a diversity of key informants (n=20) from five sectors: healthcare; social services; government and municipal services; police and emergency services; and the business and community sector. Interview data, collected via one-to-one semi structured interviews, were coded and analyzed using thematic analyses through NVivo 10 software. Results Interview participants unanimously supported the implementation of SIS in London. However, participant support for SIS was met with some implementation-related preferences and/or conditions. These included centralization or decentralization of SIS; accessibility of SIS for people who inject drugs; proximity of SIS to interview participants; and other services and strategies offered alongside SIS. Discussion The results of this study challenge the assumptions that smaller cities like London may be unlikely to support SIS. Community stakeholders were supportive of the implementation of SIS with some preferences or conditions. Interview participants had differing perspectives, but ultimately supported similar end goals of accessibility and reducing community harms associated with injection drug use. Future research and SIS programming should consider these factors when determining optimal service delivery in ways that increase support from a diversity of community stakeholders.

      PubDate: 2017-07-01T17:52:12Z
      DOI: 10.1016/j.drugpo.2017.05.009
      Issue No: Vol. 48 (2017)
       
  • Seroprevalence of HCV and HIV infection among clients of the nation’s
           longest-standing statewide syringe exchange program: A cross-sectional
           study of Community Health Outreach Work to Prevent AIDS (CHOW) Project
           participants, Hawai‘i, 2012
    • Authors: Thomas P. Salek; Alan R. Katz; Stacy M. Lenze; Heather M. Lusk; Dongmei Li; Don C. Des Jarlais
      Pages: 34 - 43
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Thomas P. Salek, Alan R. Katz, Stacy M. Lenze, Heather M. Lusk, Dongmei Li, Don C. Des Jarlais
      Background The Community Health Outreach Work to Prevent AIDS (CHOW) Project is the first and longest-standing statewide integrated and funded needle and syringe exchange program (SEP) in the US. Initiated on O‘ahu in 1990, CHOW expanded statewide in 1993. The purpose of this study is to estimate the prevalences of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, and to characterize risk behaviors associated with infection among clients of a long-standing SEP through the analysis of the 2012 CHOW evaluation data. Methods A cross-sectional sample of 130 CHOW Project clients was selected from January 1, 2012 through December 31, 2012. Questionnaires captured self-reported exposure information. HIV and HCV antibodies were detected via rapid, point-of-care FDA-approved tests. Log-binomial regressions were used to estimate prevalence proportion ratios (PPRs). A piecewise linear log-binomial regression model containing 1 spline knot was used to fit the age–HCV relationship. Results The estimated seroprevalence of HCV was 67.7% (95% confidence interval [CI]=59.5–75.8%). HIV seroprevalence was 2.3% (95% CI=0–4.9%). Anti-HCV prevalence demonstrated age-specific patterns, ranging from 31.6% through 90.9% in people who inject drugs (PWID) <30 to ≥60 years respectively. Age (continuous/year) prior to spline knot at 51.5 years (adjusted PPR [APPR]=1.03; 95% CI=1.02–1.05) and months exchanging syringes (quartiles) (APPR=1.92; 95% CI=1.3–3.29) were independently associated with anti-HCV prevalence. Conclusion In Hawai‘i, HCV prevalence among PWID is hyperendemic demonstrating age- and SEP duration-specific trends. Relatively low HIV prevalence compared with HCV prevalence reflects differences in transmissibility of these 2 blood-borne pathogens and suggests much greater efficacy of SEP for HIV prevention.

      PubDate: 2017-08-05T11:31:28Z
      DOI: 10.1016/j.drugpo.2017.06.009
      Issue No: Vol. 48 (2017)
       
  • Retention in medication-assisted treatment programs in
           Ukraine—Identifying factors contributing to a continuing HIV epidemic
    • Authors: Kostyantyn Dumchev; Sergii Dvoryak; Olena Chernova; Olga Morozova; Frederick L. Altice
      Pages: 44 - 53
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Kostyantyn Dumchev, Sergii Dvoryak, Olena Chernova, Olga Morozova, Frederick L. Altice
      Background Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004. Methods Data from clinical records of 2916 patients enrolled in OAT at thirteen sites from 2005 to 2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates. Results Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to not being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested—a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67). Conclusion Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems.

      PubDate: 2017-08-15T12:04:31Z
      DOI: 10.1016/j.drugpo.2017.05.014
      Issue No: Vol. 48 (2017)
       
  • Development and validation of a novel scale for measuring interpersonal
           factors underlying injection drug using behaviours among injecting
           partnerships
    • Authors: Meghan D. Morris; Torsten B. Neilands; Erin Andrew; Lisa Maher; Kimberly A. Page; Judith A. Hahn
      Pages: 54 - 62
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Meghan D. Morris, Torsten B. Neilands, Erin Andrew, Lisa Maher, Kimberly A. Page, Judith A. Hahn
      Background People who inject drugs with sexual partners or close friends have high rates of syringe/ancillary equipment sharing and HIV and hepatitis C virus (HCV) infection. Although evidence suggests that interpersonal factors underlie these higher risk profiles, there is no quantitative measure of how interpersonal factors operate within injecting relationships. We aimed to develop and validate a quantitative scale to assess levels of injecting drug-related interpersonal factors associated with risky injecting behaviours within injecting partnerships. Methods We conducted qualitative interviews with 45 people who inject drugs (PWID) who reported having injecting partners to inform item development, and tested these items in a quantitative study of 140 PWID from San Francisco, USA, to assess internal reliability (Cronbach’s alpha) and validity (convergent, and discriminant validity). Results With results from the qualitative interview data, we developed the Interpersonal Dynamics in Injecting Partnerships (IDIP) scale with 54 final items for 5 subscales of injecting-related interpersonal factors. Exploratory factor analysis revealed 5 factors (“trust”, “power”, “risk perception”, “intimacy”, and “cooperation”) with eigenvalues of 14.32, 6.18, 3.55, 2.46, and 2.14, explaining 57% of the variance, and indicating good internal reliability (alpha: 0.92–0.68). Strong convergent validity was observed in bivariate logistic regression models where higher levels of trust, intimacy, and cooperation within partnerships were positively associated with partners sharing needles and injecting equipment, whereas higher levels of power and risk perception were negatively associated with partners sharing needles and injecting equipment. Conclusions These findings offer strong evidence that the IDIP scale provides a psychometrically sound measure of injecting drug-related interpersonal dynamics. This measurement tool has the potential to facilitate additional investigations into the individual and collective impact of trust, intimacy, power, cooperation, and risk perception on injection drug using behaviours and engagement in HIV and HCV testing and treatment among PWID in a variety of settings.

      PubDate: 2017-08-15T12:04:31Z
      DOI: 10.1016/j.drugpo.2017.05.030
      Issue No: Vol. 48 (2017)
       
  • Understanding interactions of formerly incarcerated HIV-positive men and
           transgender women with substance use treatment, medical, and criminal
           justice systems
    • Authors: Nina T. Harawa; Bita Amani; Jane Rohde Bowers; Jennifer N. Sayles; William Cunningham
      Pages: 63 - 71
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Nina T. Harawa, Bita Amani, Jane Rohde Bowers, Jennifer N. Sayles, William Cunningham
      Background Low levels of medical care engagement have been noted for HIV-positive people leaving systems of incarceration in the United States. Substance misuse frequently co-occurs with criminal justice involvement in individuals who are living with HIV. Methods We analyzed data from in-depth interviews with 19 HIV-positive individuals who were currently or formerly incarcerated in order to elucidate challenges faced in accessing care and maintaining HIV treatment regimens when cycling out of (and often back into) custody. Our thematic analysis used an ecosocial framework to describe participants’ shifts between substance use treatment, medical care, and criminal justice systems. Results Dominant themes included the dramatic increase in HIV-treatment-related autonomy required following release from jail because of differences in care delivery between custody-based and community-based care systems; the important, but temporary stabilization provided by residential substance use treatment programmes; and the inconsistency of substance use treatment approaches with chronic care models of disease management. Conclusion Enhanced integration of criminal justice, medical care, and substance use treatment institutions in planning for reentry of HIV populations may ease the impact of the dramatic shifts in context that often dissuade linkage and retention. This integration should include coordination with custody release processes, periodic assessments for active substance misuse in HIV treatment settings, support for (re)establishing health-promoting social networks, and options for long-term, residential substance use treatment programmes.

      PubDate: 2017-08-15T12:04:31Z
      DOI: 10.1016/j.drugpo.2017.05.013
      Issue No: Vol. 48 (2017)
       
  • A typology of vaping: Identifying differing beliefs, motivations for use,
           identity and political interest amongst e-cigarette users
    • Authors: Hannah Farrimond
      Pages: 81 - 90
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Hannah Farrimond
      Background The aim of this study was to identify and differentiate socially shared accounts of e-cigarette use (vaping) using Q-methodology, combining factor analysis with qualitative comments. Methods Seventy statements on e-cigarettes, drawn from media, academic and online discussions, were sorted by participants along a continuum of agreement/disagreement, commenting on strongly ranked items. Each participant thus created their own ‘account’ of their vaping. A by-person correlation matrix of the sorts was conducted, then factor analysed, to identify similar accounts (p<0.01). Fifty-five UK vapers participated by post, 55% male, mean age of 46, 84% only vaping/16% vaping and smoking, 95% vaping daily. Results Three accounts of e-cigarettes were identified. The first two were associated with having quit smoking; the third with ongoing tobacco smoking and vaping. In Factor One, ‘Vaping as Pleasure’, vaping was characterized as enjoyable, with long-term use envisaged and a medical model of vaping rejected. Factor One participants also held a strong vaping identity and were politically motivated to maintain the rights of adults to vape. In Factor Two, ‘Vaping as Medical Treatment’, vaping was understood as a pragmatic choice about how to medicate one’s smoking addiction, with the aim being to treat and ultimately reduce nicotine dependence. In Factor Three, ‘Ambivalent E-Cigarette Use’, participants reported fewer benefits and harboured more negative beliefs about e-cigarettes; they also strongly rejected a vaper identity, having no interest in online forums or being labelled a ‘vaper’ themselves. Conclusion The UK e-cigarette users in this sample were not a homogeneous group; differing in their beliefs, motivations for use, identity and political interest. In particular they diverged on whether they accepted a medicalized account of vaping and identified as a vaper. Public health messages targeted to one group of e-cigarette users may not resonate with others.

      PubDate: 2017-08-25T12:33:37Z
      DOI: 10.1016/j.drugpo.2017.07.011
      Issue No: Vol. 48 (2017)
       
  • Differences in prevalence, socio-behavioral correlates, and psychosocial
           distress between club drug and hard drug use in Taiwan: Results from the
           2014 National Survey of Substance Use
    • Authors: Wei J. Chen; Shang-Chi Wu; Wen-Ing Tsay; Yen-Tyng Chen; Po-Chang Hsiao; Ya-Hui Yu; Te-Tien Ting; Chuan-Yu Chen; Yu-Kang Tu; Jiun-Hau Huang; Hao-Jan Yang; Chung-Yi Li; Carol Strong; Cheng-Fang Yen; Chia-Feng Yen; Jui Hsu
      Pages: 99 - 107
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Wei J. Chen, Shang-Chi Wu, Wen-Ing Tsay, Yen-Tyng Chen, Po-Chang Hsiao, Ya-Hui Yu, Te-Tien Ting, Chuan-Yu Chen, Yu-Kang Tu, Jiun-Hau Huang, Hao-Jan Yang, Chung-Yi Li, Carol Strong, Cheng-Fang Yen, Chia-Feng Yen, Jui Hsu
      Background This study examined variation between users of ‘club’ and ‘hard’ drugs in Taiwan in terms of prevalence of use and demographics and psychosocial characteristics. Methods Data were derived from a survey of 17,837 Taiwanese civilians, aged 12–64 years, using stratified, multi-stage, random sampling. Participants completed a computer-assisted self-interview on tablet computers which covered use of legal substances, sedatives/hypnotics and prescription analgesics; use of illicit drugs/inhalants, risky sexual experiences; expectations of drugs; and psychological distress. Findings Approximately 1.29% of respondents reported ever using an illicit drug in their lifetime; prevalence estimates of club drugs (mainly ketamine, marijuana, and ecstasy) were slightly higher than hard drugs (mainly methamphetamine and heroin). Concurrent use of legal substances, particularly problematic use of alcohol and tobacco, as well as non-medical use of prescription drugs, were strong correlates of illicit drug use in general, with club drug use exhibiting an extremely strong association with alcohol use. Club drug users were demographically different from hard drug users, including in terms of their gender, age, and level of educational attainment. They were also more likely to be divorced or widowed, to report risky sexual partnerships and more depressive symptoms than hard drug users. Conclusions Our findings indicate drug type specific distinct psychosocial characteristics, which may warrant further attention in the design of treatment and intervention programs.

      PubDate: 2017-08-25T12:33:37Z
      DOI: 10.1016/j.drugpo.2017.07.003
      Issue No: Vol. 48 (2017)
       
  • Worries about others’ substance use—Differences between alcohol,
           cigarettes and illegal drugs'
    • Authors: Inger Synnøve Moan; Elisabet E. Storvoll; Ingunn Olea Lund
      Pages: 108 - 114
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Inger Synnøve Moan, Elisabet E. Storvoll, Ingunn Olea Lund
      Background While it is well documented that many experience harm from others’ substance use, little is known about the psychological strain associated with others’ use. The aims were: (1) to describe the prevalence of worries about others’ alcohol, cigarette and illegal drug use, (2) whose substance use people worry about, (3) the overlap in worries, and (4) to examine how worries about others’ use of each substance vary according to demographics, own substance use and experience of harm from others’ use. Methods A population survey was conducted among 16–64year old Norwegians (N=1667). Respondents’ reported on worries about others’ alcohol, cigarette and illegal drug use, measures of experiences of harm from others’ use of the three substances, and own substance use. Results Worries about others’ drinking were most prevalent. Among those who worried, others’ cigarette and illegal drug use caused more frequent worry. While worry about cigarette use was mostly associated with family members’ use, worry about others’ alcohol and illegal drug use more often concerned friends’/acquaintances’ use. About half worried about others’ use of at least one substance. Across all three substances, experience of harm from others’ substance use was most strongly related to worries. Conclusion Worries about others’ substance use are common and reflect the prevalence of use of the substances in the population. In sum, the findings suggest that worry about others’ alcohol and illegal drug use is primarily related to acute harm while worry about others’ cigarette smoking is more related to chronic harm.

      PubDate: 2017-08-25T12:33:37Z
      DOI: 10.1016/j.drugpo.2017.07.014
      Issue No: Vol. 48 (2017)
       
  • Why are some people who have received overdose education and naloxone
           
    • Authors: Stephen Koester; Shane R. Mueller; Lisa Raville; Sig Langegger; Ingrid A. Binswanger
      Pages: 115 - 124
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Stephen Koester, Shane R. Mueller, Lisa Raville, Sig Langegger, Ingrid A. Binswanger
      Background Overdose Education and Naloxone Distribution (OEND) training for persons who inject drugs (PWID) underlines the importance of summoning emergency medical services (EMS). To encourage PWID to do so, Colorado enacted a Good Samaritan law providing limited immunity from prosecution for possession of a controlled substance and/or drug paraphernalia to the overdose victim and the witnesses who in good faith provide emergency assistance. This paper examines the law’s influence by describing OEND trained PWIDs’ experience reversing overdoses and their decision about calling for EMS support. Methods Findings from two complementary studies, a qualitative study based on semi-structured interviews with OEND trained PWID who had reversed one or more overdoses, and an on-going fieldwork-based project examining PWIDs’ self-identified health concerns were triangulated to describe and explain participants’ decision to call for EMS. Results In most overdose reversals described, no EMS call was made. Participants reported several reasons for not doing so. Most frequent was the fear that despite the Good Samaritan law, a police response would result in arrest of the victim and/or witness for outstanding warrants, or sentence violations. Fears were based on individual and collective experience, and reinforced by the city of Denver’s aggressive approach to managing homelessness through increased enforcement of misdemeanors and the imposition of more recent ordinances, including a camping ban, to control space. The city’s homeless crisis was reflected as well in the concern expressed by housed PWID that an EMS intervention would jeopardize their public housing. Conclusion Results suggest that the immunity provided by the Good Samaritan law does not address PWIDs’ fear that their current legal status as well as the victim’s will result in arrest and incarceration. As currently conceived, the Good Samaritan law does not provide immunity for PWIDs’ already enmeshed in the criminal justice system, or PWID fearful of losing their housing.

      PubDate: 2017-09-17T22:18:16Z
      DOI: 10.1016/j.drugpo.2017.06.008
      Issue No: Vol. 48 (2017)
       
  • Elimination of hepatitis C virus infection among PWID: The beginning of a
           new era of interferon-free DAA therapy
    • Authors: Jason Grebely; Julie Bruneau; Philip Bruggmann; Magdalena Harris; Matthew Hickman; Tim Rhodes; Carla Treloar
      Pages: 26 - 33
      Abstract: Publication date: September 2017
      Source:International Journal of Drug Policy, Volume 47
      Author(s): Jason Grebely, Julie Bruneau, Philip Bruggmann, Magdalena Harris, Matthew Hickman, Tim Rhodes, Carla Treloar


      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.08.001
      Issue No: Vol. 47 (2017)
       
  • Restrictions on access to direct-acting antivirals for people who inject
           drugs: The European Hep-CORE study and the role of patient groups in
           monitoring national HCV responses
    • Authors: J.V. Lazarus; K. Safreed-Harmon; S.R. Stumo; M. Jauffret-Roustide; M. Maticic; T. Reic; E. Schatz; J. Tallada; M. Harris
      Pages: 47 - 50
      Abstract: Publication date: September 2017
      Source:International Journal of Drug Policy, Volume 47
      Author(s): J.V. Lazarus, K. Safreed-Harmon, S.R. Stumo, M. Jauffret-Roustide, M. Maticic, T. Reic, E. Schatz, J. Tallada, M. Harris


      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.05.054
      Issue No: Vol. 47 (2017)
       
  • Healthcare contact and treatment uptake following hepatitis C virus
           screening and counseling among rural Appalachian people who use drugs
    • Authors: Dustin B. Stephens; April M. Young; Jennifer R. Havens
      Pages: 86 - 94
      Abstract: Publication date: September 2017
      Source:International Journal of Drug Policy, Volume 47
      Author(s): Dustin B. Stephens, April M. Young, Jennifer R. Havens
      Background Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings. Methods 503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis. Results 150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider. Conclusion While only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.05.045
      Issue No: Vol. 47 (2017)
       
  • ‘Enjoying the kick’: Locating pleasure within the drug
           consumption room
    • Authors: Tristan Duncan; Cameron Duff; Bernadette Sebar; Jessica Lee
      Abstract: Publication date: Available online 12 October 2017
      Source:International Journal of Drug Policy
      Author(s): Tristan Duncan, Cameron Duff, Bernadette Sebar, Jessica Lee
      Background Harm reduction policy and praxis has long struggled to accommodate the pleasures of alcohol and other drug use. Whilst scholars have consistently highlighted this struggle, how pleasure might come to practically inform the design and delivery of harm reduction policies and programs remains less clear. The present paper seeks to move beyond conceptual critiques of harm reduction’s ‘pleasure oversight’ to more focused empirical analysis of how flows of pleasure emerge, circulate and, importantly, may be reoriented in the course of harm reduction practice. Methods We ground our analysis in the context of detailed ethnographic research in a drug consumption room in Frankfurt, Germany. Drawing on recent strands of post-humanist thought, the paper deploys the concept of the ‘consumption event’ to uncover the manner in which these facilities mediate the practice and embodied experience of drug use and incite or limit bodily potentials for intoxication and pleasure. Results Through the analysis, we mapped a diversity of pleasures as they emerged and circulated through events of consumption at the consumption room. Beyond the pleasurable intensities of intoxication’s kick, these pleasures were expressed in a range of novel capacities, practices and drug using bodies. In each instance, pleasure could not be reduced to a simple, linear product of drug use. Rather, it arose for our participants through distinctive social and affective transformations enabled through events of consumption at the consumption room and the generative force of actors and associations of which these events were composed. Conclusion Our research suggests that the drug consumption room serves as a conduit through which its clients can potentially enact more pleasurable, productive and positive relations to both themselves and their drug use. Acknowledging the centrality of pleasure to client engagement with these facilities, the paper concludes by drawing out the implications of these findings for the design and delivery of consumption room services.

      PubDate: 2017-10-14T13:25:01Z
      DOI: 10.1016/j.drugpo.2017.07.005
       
  • Afterword
    • Authors: Carla Treloar; Martin Holt
      Abstract: Publication date: Available online 10 October 2017
      Source:International Journal of Drug Policy
      Author(s): Carla Treloar, Martin Holt


      PubDate: 2017-10-14T13:25:01Z
      DOI: 10.1016/j.drugpo.2017.09.003
       
  • The need for accuracy and validity in research on nightlife and drinking:
           A commentary on Devilly et al. and recommendations for future research
    • Authors: Peter Miller; Tanya Chikritzhs Nicolas Droste Amy Pennay Stephen Tomsen
      Abstract: Publication date: December 2017
      Source:International Journal of Drug Policy, Volume 50
      Author(s): Peter G. Miller, Tanya Chikritzhs, Nicolas Droste, Amy Pennay, Stephen Tomsen
      Research on nightlife and drinking faces many unique challenges, and validity in research is an important concern. A recent publication by Devilly et al. entitled “SmartStart: Results of a large point of entry study into preloading alcohol and associated behaviours” contains definitions and assumptions about prior work that require more careful consideration. Important issues include: using a definition of pre-drinking which is the same as previous work so that valid comparison can be made, reporting of blood alcohol concentration (BAC) levels that comply with other work, accurate reporting of response rates, and careful consideration of sampling approaches to maximise ethical integrity. Ensuring consistency of definition and accurate representation of previous literature regarding BAC, pre-drinking and energy drink use, is important for supplying the broader community with reliable information on which policy decisions can be made.

      PubDate: 2017-10-08T13:22:48Z
       
  • From mundane medicines to euphorigenic drugs: How pharmaceutical pleasures
           are initiated, foregrounded, and made durable
    • Authors: Henry Bundy; Gilbert Quintero
      Abstract: Publication date: Available online 3 October 2017
      Source:International Journal of Drug Policy
      Author(s): Henry Bundy, Gilbert Quintero
      Background Examining how pharmaceuticals are used to induce pleasure presents a unique opportunity for analyzing not only how pleasure is assembled and experienced through distinct consumption practices but also how mundane medicines can become euphorigenic substances. Methods Drawing on qualitative research on the non-medical use of prescription drugs by young adults in the United States, this paper utilizes Actor–Network Theory (ANT) to examine how prescription medicines come to produce pleasure. Results Our research found an indeterminacy of experience as individuals were initiated into prescription drug pleasures. We also found that euphorigenic effects coalesce and are foregrounded through subsequent use, and that pleasure and other forms of gratification are made durable through repeated and deliberate pharmaceutical consumption. Conclusion Understanding how individuals are socialized into pharmaceutical pleasure, and how assemblages act to constitute the euphorigenic potential of pharmaceutical misuse, may allow for more context-appropriate intervention efforts. We suggest that the euphorigenic properties ascribed to prescription drugs are not inherent in their pharmaceutical formulations, but instead emerge through interactions within networks of heterogeneous actants.

      PubDate: 2017-10-08T13:22:48Z
      DOI: 10.1016/j.drugpo.2017.08.006
       
  • Themed collection: "Comparing drug policies"
    • Abstract: Publication date: Available online 28 September 2017
      Source:International Journal of Drug Policy


      PubDate: 2017-09-29T23:35:22Z
       
  • Psychedelic pleasures: An affective understanding of the joys of tripping
    • Authors: Frederik
      Abstract: Publication date: Available online 13 September 2017
      Source:International Journal of Drug Policy
      Author(s): Frederik Bøhling
      Background This paper considers the pleasures of psychedelic drugs and proposes a Deleuzian understanding of drugged pleasures as affects. In spite of a large body of work on psychedelics, not least on their therapeutic potentials, the literature is almost completely devoid of discussions of the recreational practices and pleasures of entheogenic drugs. Yet, most people do not use psychedelics because of their curative powers, but because they are fun and enjoyable ways to alter the experience of reality. Methods In the analytical part of the paper, I examine 100 trip reports from an internet forum in order to explore the pleasures of tripping. Results The analyses map out how drugs such as LSD and mushrooms – in combination with contextual factors such as other people, music and nature – give rise to a set of affective modifications of the drug user’s capacities to feel, sense and act. Conclusion In conclusion it is argued that taking seriously the large group of recreational users of hallucinogens is important not only because it broadens our understanding of how entheogenic drugs work in different bodies and settings, but also because it may enable a more productive and harm reductive transmission of knowledge between the scientific and recreational psychedelic communities.

      PubDate: 2017-09-17T22:18:16Z
       
  • Desiring assemblages: A case for desire over pleasure in critical drug
           studies
    • Authors: Peta Malins
      Abstract: Publication date: Available online 9 September 2017
      Source:International Journal of Drug Policy
      Author(s): Peta Malins
      While critical drug researchers have long pushed for an acknowledgement of pleasure in discourses of drug use, few have explored the alternative possibilities offered by Deleuze and Guattari’s concept of desire. In this paper I map out some of the conceptual differences between pleasure and desire and explore the opportunities opened up by attending more closely to desire in critical drug studies. I suggest that while discourses of pleasure do make an important intervention into and against dominant narratives of risk, harm, and addiction, they may inadvertently be working to keep in place the very binaries and forms of neoliberal western subjectivity that support those narratives. I argue that a Deleuzo–Guattarian ontology of desire is a better tool with which to make sense of the complex relations that form between drugs and bodies, challenge medical and criminal responses to drug use, and bring forth assemblages that enhance, rather than diminish, bodily capacities.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.018
       
  • Making medicine; producing pleasure: A critical examination of medicinal
           cannabis policy and law in Victoria, Australia
    • Authors: Kari Lancaster; Kate Seear; Alison Ritter
      Abstract: Publication date: Available online 6 September 2017
      Source:International Journal of Drug Policy
      Author(s): Kari Lancaster, Kate Seear, Alison Ritter
      Several jurisdictions around the world have introduced policies and laws allowing for the legal use of cannabis for therapeutic purposes. However, there has been little critical discussion of how the object of ‘medicinal cannabis’ is enacted in policy and practice. Informed by Carol Bacchi’s poststructuralist approach to policy analysis and the work of science and technology studies scholars, this paper seeks to problematise the object of ‘medicinal cannabis’ and examine how it is constituted through governing practices. In particular, we consider how the making of the object of ‘medicinal cannabis’ might constrain or enact discourses of pleasure. As a case example, we take the Victorian Law Reform Commission’s review of law reform options to allow people in the Australian state of Victoria to be treated with medicinal cannabis. Through analysis of this case example, we find that although ‘medicinal cannabis’ is constituted as a thoroughly medical object, it is also constituted as unique. We argue that medicinal cannabis is enacted in part through the production of another object (so-called ‘recreational cannabis’) and the social and political meanings attached to both. Although both ‘substances’ are constituted as distinct, ‘medicinal cannabis’ relies on the ‘absent presence’ of ‘recreational cannabis’ to define and shape what it is. However, we find that contained within this rendering of ‘medicinal cannabis’ are complex enactments of health and wellbeing, which open up discourses of pleasure. ‘Medicinal cannabis’ appears to challenge the idea that the effects of ‘medicine’ cannot be understood in terms of pleasure. As such, the making of ‘medicinal cannabis’ as a medical object, and its invocation of broad notions of health and wellbeing, expand the ways in which drug effects can be acknowledged, including pleasurable and desirable effects, helping us to think differently about both medicine and other forms of drug use.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.020
       
  • Thinking with pleasure: Experimenting with drugs and drug research
    • Authors: Kane Race
      Abstract: Publication date: Available online 5 September 2017
      Source:International Journal of Drug Policy
      Author(s): Kane Race
      Within the field of drug and alcohol studies, researchers think about pleasure or against it; we analyse, consider, investigate, invoke or ignore it. The philosophically inclined may think of pleasure or write on it, but in each of these scenarios pleasure is kept at an arm’s length while the researcher appears to remain unmoved – detached observers, objective scientists, conceptual experts, program directors, sharp critics, policy advocates – sober judges whose sovereignty is secured by the formal conventions of positivist research, established theory, institutional authority and/or disciplinary knowledge. This paper asks what happens when pleasure is allowed to emerge as a constitutive element in the relations of drug and alcohol research. What happens when we conceive our work as thinking with pleasure, rather than simply researching pleasure or thinking about it' I return to the later work of Foucault, reading it alongside conceptions of the experiment drawn from Science and Technology Studies, arguing that both the pleasures of drug consumption and drug research might be conceived more generatively as mutually implicated in events.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.019
       
  • Risky pleasures and drugged assemblages: Young people’s consumption
           practices of AOD in Madrid
    • Authors: Montserrat Cañedo; Enrique Moral
      Abstract: Publication date: Available online 4 September 2017
      Source:International Journal of Drug Policy
      Author(s): Montserrat Cañedo, Enrique Moral
      Background Drawing on a research project that we carried out on the functionality of “excessive” consumption practices in the lifestyles of young people in Madrid, this article aims to understand how (dis)pleasurable states emerge during young people’s consumption of alcohol and other drugs. Methods This article claims that these states derive from “drugged assemblages,” that is, a set of (human and non-human) actants that intra-act to produce different effects. Although pleasure can be one of these effects, it is not always guaranteed: consumption practices are assemblages that fluctuate between pleasure and displeasure, and the former can be reached or not depending on the characteristics acquired by the assemblage. It is this fluctuation that makes pleasures “risky.” Drugged assemblages also configure and are configured by specific spatial-temporal and material apparatuses or dispositifs. We will analyse botellones, night-clubs and raves as examples of this kind of dispositif, focusing on how they work as a holistic frame where drugged assemblages emerge. Results Finally, we will focus on the different strategies and practices that young people, in constant intra-action with other agencies, develop in order to achieve and keep a “controlled loss of control” within the limits and potentials offered by these contexts, in a constant effort to avoid the risks that may result from the blurred line that divides pleasure and displeasure. Conclusion In this sense, we will argue that, despite the criticisms it has received, it is possible to make Measham’s concept of “controlled loss of control” compatible with a post-humanist theoretical framework.

      PubDate: 2017-09-05T13:37:35Z
      DOI: 10.1016/j.drugpo.2017.08.002
       
 
 
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