Pub Date : 2026-04-01Epub Date: 2026-02-12DOI: 10.1016/j.drugpo.2026.105184
Tyler Devincenzi , Luke N. Rodda
Background
Xylazine, a veterinary sedative and alpha-2 adrenergic receptor agonist not approved for human use, has emerged as a significant adulterant in the illicit fentanyl supply across the United States. While its presence has been well documented on the East Coast, systematic reporting from California remains limited.
Objective
This study characterizes the emergence, prevalence, and concentration trends of xylazine in forensic casework in San Francisco from 2022 January to 2024 December, and describes polysubstance patterns associated with its use.
Design
We retrospectively analyzed up to thirty-six (36) months of routine comprehensive toxicological testing for over 200 drugs/metabolites performed on all xylazine-positive accidental overdose deaths (AOD), driving under the influence of drugs (DUID), drug-facilitated sexual assault (DFSA), and public intoxication (PI) cases within the City and County of San Francisco, totaling 314 cases.
Results
Xylazine detections increased across all case types from 2023 to 2024 and rose steadily in AOD cases from 2022 through 2024. The majority of xylazine-positive cases were AOD. Mean and peak xylazine concentrations demonstrated year-to-year increases, with peak AOD blood and urine concentrations observed up to 31 and 2100 ng/mL, respectively. All xylazine-positive cases co-occurred with fentanyl, a fentanyl precursor or metabolite, or a fentanyl analog. Additionally, 71% of these cases involved five to eight additional drug classes.
Discussion
Xylazine has rapidly infiltrated the San Francisco illicit fentanyl supply and is frequently present in polysubstance use patterns. Rising prevalence and increasing concentrations indicate evolving market dynamics, with implications for overdose risk and forensic and public health surveillance.
{"title":"Emergence of xylazine in accidental overdose deaths, impaired drivers, sexual assaults, and public intoxications within San Francisco","authors":"Tyler Devincenzi , Luke N. Rodda","doi":"10.1016/j.drugpo.2026.105184","DOIUrl":"10.1016/j.drugpo.2026.105184","url":null,"abstract":"<div><h3>Background</h3><div>Xylazine, a veterinary sedative and alpha-2 adrenergic receptor agonist not approved for human use, has emerged as a significant adulterant in the illicit fentanyl supply across the United States. While its presence has been well documented on the East Coast, systematic reporting from California remains limited.</div></div><div><h3>Objective</h3><div>This study characterizes the emergence, prevalence, and concentration trends of xylazine in forensic casework in San Francisco from 2022 January to 2024 December, and describes polysubstance patterns associated with its use.</div></div><div><h3>Design</h3><div>We retrospectively analyzed up to thirty-six (36) months of routine comprehensive toxicological testing for over 200 drugs/metabolites performed on all xylazine-positive accidental overdose deaths (AOD), driving under the influence of drugs (DUID), drug-facilitated sexual assault (DFSA), and public intoxication (PI) cases within the City and County of San Francisco, totaling 314 cases.</div></div><div><h3>Results</h3><div>Xylazine detections increased across all case types from 2023 to 2024 and rose steadily in AOD cases from 2022 through 2024. The majority of xylazine-positive cases were AOD. Mean and peak xylazine concentrations demonstrated year-to-year increases, with peak AOD blood and urine concentrations observed up to 31 and 2100 ng/mL, respectively. All xylazine-positive cases co-occurred with fentanyl, a fentanyl precursor or metabolite, or a fentanyl analog. Additionally, 71% of these cases involved five to eight additional drug classes.</div></div><div><h3>Discussion</h3><div>Xylazine has rapidly infiltrated the San Francisco illicit fentanyl supply and is frequently present in polysubstance use patterns. Rising prevalence and increasing concentrations indicate evolving market dynamics, with implications for overdose risk and forensic and public health surveillance.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105184"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-03DOI: 10.1016/j.drugpo.2026.105178
Lei Xu , Saber Feizy , Megan E Roberts , Ce Shang , Brittney Keller-Hamilton , Darren Mays , Shyanika W Rose , Yanyun He
Background
As oral nicotine pouches (ONPs) gain popularity in the United States, the extent to which product attributes, such as price and flavor, affect sales remains unclear. Examining urban–rural differences is particularly important given longstanding disparities in smokeless tobacco use and tobacco-related health outcomes across these settings, yet little is known about whether ONP sales and attribute preferences differ between urban and rural areas.
Objectives
This study aims to examine how ONP sales are associated with product attributes and sales locations (rural vs. urban), and whether the associations between sales and attributes differ by urban/rural locations.
Methods
We linked 2021 NielsenIQ retail sales data with the National Center for Health Statistics county-level urban/rural classifications. Flavors were grouped as implicit (marketed without explicit flavor names), mint/menthol, fruity, or other. Multivariable linear regression models were used by regressing ONP sales on product attributes, rural/urban status, and their interactions.
Results
In 2021, 88% of total ONP sales occurred in urban areas, compared with 12% in rural areas. ONP sales per 1000 population were 16% higher in rural than urban areas (p < 0.001). Compared to the sales of implicitly flavored ONPs, sales of mint/menthol, fruit, and other flavors were approximately 23-fold, 4-fold, and 7-fold higher, respectively. These flavor-related differences were less pronounced in rural counties than in urban counties. The price elasticity of demand was –0.66 (p < 0.001) in urban areas and –0.33 (p < 0.001) in rural areas.
Conclusions
ONP sales exhibit significant urban–rural disparities, with rural areas showing higher per capita sales overall, but urban areas showing stronger preferences for flavored products and greater price responsiveness. As a result, regulatory measures targeting flavors or pricing may have a greater impact in urban areas compared to rural ones.
{"title":"Urban–rural disparities in oral nicotine pouch sales and flavors in the United States","authors":"Lei Xu , Saber Feizy , Megan E Roberts , Ce Shang , Brittney Keller-Hamilton , Darren Mays , Shyanika W Rose , Yanyun He","doi":"10.1016/j.drugpo.2026.105178","DOIUrl":"10.1016/j.drugpo.2026.105178","url":null,"abstract":"<div><h3>Background</h3><div>As oral nicotine pouches (ONPs) gain popularity in the United States, the extent to which product attributes, such as price and flavor, affect sales remains unclear. Examining urban–rural differences is particularly important given longstanding disparities in smokeless tobacco use and tobacco-related health outcomes across these settings, yet little is known about whether ONP sales and attribute preferences differ between urban and rural areas.</div></div><div><h3>Objectives</h3><div>This study aims to examine how ONP sales are associated with product attributes and sales locations (rural vs. urban), and whether the associations between sales and attributes differ by urban/rural locations.</div></div><div><h3>Methods</h3><div>We linked 2021 NielsenIQ retail sales data with the National Center for Health Statistics county-level urban/rural classifications. Flavors were grouped as implicit (marketed without explicit flavor names), mint/menthol, fruity, or other. Multivariable linear regression models were used by regressing ONP sales on product attributes, rural/urban status, and their interactions.</div></div><div><h3>Results</h3><div>In 2021, 88% of total ONP sales occurred in urban areas, compared with 12% in rural areas. ONP sales per 1000 population were 16% higher in rural than urban areas (<em>p</em> < 0.001). Compared to the sales of implicitly flavored ONPs, sales of mint/menthol, fruit, and other flavors were approximately 23-fold, 4-fold, and 7-fold higher, respectively. These flavor-related differences were less pronounced in rural counties than in urban counties. The price elasticity of demand was –0.66 (<em>p</em> < 0.001) in urban areas and –0.33 (<em>p</em> < 0.001) in rural areas.</div></div><div><h3>Conclusions</h3><div>ONP sales exhibit significant urban–rural disparities, with rural areas showing higher per capita sales overall, but urban areas showing stronger preferences for flavored products and greater price responsiveness. As a result, regulatory measures targeting flavors or pricing may have a greater impact in urban areas compared to rural ones.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105178"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-08DOI: 10.1016/j.drugpo.2025.105097
Hawre Jalal, Donald S Burke
Importance: Drug overdose (OD) deaths in the United States have risen exponentially for four decades and surged further during the COVID 19 pandemic; the drivers of this surge remain unclear.
Objective: To quantify excess OD mortality during COVID 19, separate its temporal components, and identify social, economic, and drug supply factors-especially Economic Impact Payments (EIPs)-linked to those components.
Design, setting, and participants: Temporal and spatial analysis of all 50 U.S. states using OD deaths (1979-2023) merged with state level data on COVID-19, unemployment, income, mobility, fentanyl seizures, opioid treatment supply, and EIP timing/amounts.
Methods: A log linear model projected the 40-year exponential trend and seasonality to establish a no-COVID baseline. Pandemic era deviations were modeled with Poisson state fixed effects regressions. Five week moving window t-tests flagged synchronous mortality spikes across states, and a two-way fixed effects event study estimated the elasticity of OD deaths to EIP related income shocks. JP Morgan Chase checking balance data validated the income-mortality link.
Results: From March 2020 to May 2023, OD deaths exceeded baseline by 67 571 (24.4 %). Sustained elevation was positively associated with income (β ≈ 0.96), fentanyl seizures, unemployment, and COVID-19 case rates, and inversely with methadone distribution. Three short lived spikes aligned with EIP disbursements, raising daily deaths by up to 85 above trend. A 10 % rise in relative income increased OD mortality 11 %; national checking balance surges and OD deaths were tightly correlated (r ≈ 0.90).
Conclusions and relevance: Pandemic era overdose deaths comprise continuing exponential growth, a COVID-19 related sustained rise tied to social disruption, and EIP linked spikes. Future relief payments should consider staggered disbursement and concurrent harm reduction measures to mitigate overdose risk.
{"title":"Dynamics of drug overdose deaths in the United States during COVID-19.","authors":"Hawre Jalal, Donald S Burke","doi":"10.1016/j.drugpo.2025.105097","DOIUrl":"10.1016/j.drugpo.2025.105097","url":null,"abstract":"<p><strong>Importance: </strong>Drug overdose (OD) deaths in the United States have risen exponentially for four decades and surged further during the COVID 19 pandemic; the drivers of this surge remain unclear.</p><p><strong>Objective: </strong>To quantify excess OD mortality during COVID 19, separate its temporal components, and identify social, economic, and drug supply factors-especially Economic Impact Payments (EIPs)-linked to those components.</p><p><strong>Design, setting, and participants: </strong>Temporal and spatial analysis of all 50 U.S. states using OD deaths (1979-2023) merged with state level data on COVID-19, unemployment, income, mobility, fentanyl seizures, opioid treatment supply, and EIP timing/amounts.</p><p><strong>Methods: </strong>A log linear model projected the 40-year exponential trend and seasonality to establish a no-COVID baseline. Pandemic era deviations were modeled with Poisson state fixed effects regressions. Five week moving window t-tests flagged synchronous mortality spikes across states, and a two-way fixed effects event study estimated the elasticity of OD deaths to EIP related income shocks. JP Morgan Chase checking balance data validated the income-mortality link.</p><p><strong>Results: </strong>From March 2020 to May 2023, OD deaths exceeded baseline by 67 571 (24.4 %). Sustained elevation was positively associated with income (β ≈ 0.96), fentanyl seizures, unemployment, and COVID-19 case rates, and inversely with methadone distribution. Three short lived spikes aligned with EIP disbursements, raising daily deaths by up to 85 above trend. A 10 % rise in relative income increased OD mortality 11 %; national checking balance surges and OD deaths were tightly correlated (r ≈ 0.90).</p><p><strong>Conclusions and relevance: </strong>Pandemic era overdose deaths comprise continuing exponential growth, a COVID-19 related sustained rise tied to social disruption, and EIP linked spikes. Future relief payments should consider staggered disbursement and concurrent harm reduction measures to mitigate overdose risk.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":" ","pages":"105097"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
People who use drugs (PWUD) are a key population for HIV, HBV and HCV. Recent HIV outbreaks among PWUD, often preceded by undetected HCV outbreaks, highlight the need for timely outbreak detection and identification of high-risk individuals. We aimed to develop an automated system for real-time outbreak detection and individual risk assessment for HIV, HBV and HCV among PWUD.
Methods
An integrated information system was developed for data recording and monitoring of PWUD served by Greek Organization against Drugs. The outbreak detection system monitored weekly diagnoses and combined different methods to detect outbreak onset, non-increasing and post-epidemic state. As illustration, their performance was prospectively assessed with sensitivity, specificity and timeliness on a previous HIV outbreak among injecting drug users in Athens, Greece. A Cox model-based risk assessment tool was developed with predictors selected by Random Survival Forest among demographic, socio-economic, behavioural and drug-related data. Performance was evaluated with time-dependent area under curve (AUC).
Results
To detect outbreak onset, all methods achieved excellent performance (sensitivity>90%, specificity>94%, no delay in alarm). To detect decline, the best-performing method achieved 58% sensitivity, 91% specificity and 14 weeks timeliness. To detect post-epidemic state, no method yielded satisfactory balance between metrics. The risk assessment tool contained six factors: age, unemployment status, age at initiation of injecting use, syringe sharing, injection as primary mode of use, injecting use in the last month; yielding AUC≅70%.
Conclusion
Our automated system efficiently monitors HIV, HBV and HCV among PWUD and identifies high-risk individuals, enabling early interventions to improve outcomes.
{"title":"Design and development of an automated surveillance system for outbreak detection and individual risk assessment for HIV and viral hepatitis B and C among people who use drugs: The Hippocrates project","authors":"Giota Touloumi , Valia Baralou , Nikos Pantazis , Argyro Karakosta , Olga Anagnostou , Dimitris Katsiris , Katerina Micha , Giorgos Pistikos , Christos Danopoulos , Kostas Rouptsos , Athanasios Theocharis","doi":"10.1016/j.drugpo.2026.105195","DOIUrl":"10.1016/j.drugpo.2026.105195","url":null,"abstract":"<div><h3>Background</h3><div>People who use drugs (PWUD) are a key population for HIV, HBV and HCV. Recent HIV outbreaks among PWUD, often preceded by undetected HCV outbreaks, highlight the need for timely outbreak detection and identification of high-risk individuals. We aimed to develop an automated system for real-time outbreak detection and individual risk assessment for HIV, HBV and HCV among PWUD.</div></div><div><h3>Methods</h3><div>An integrated information system was developed for data recording and monitoring of PWUD served by Greek Organization against Drugs. The outbreak detection system monitored weekly diagnoses and combined different methods to detect outbreak onset, non-increasing and post-epidemic state. As illustration, their performance was prospectively assessed with sensitivity, specificity and timeliness on a previous HIV outbreak among injecting drug users in Athens, Greece. A Cox model-based risk assessment tool was developed with predictors selected by Random Survival Forest among demographic, socio-economic, behavioural and drug-related data. Performance was evaluated with time-dependent area under curve (AUC).</div></div><div><h3>Results</h3><div>To detect outbreak onset, all methods achieved excellent performance (sensitivity>90%, specificity>94%, no delay in alarm). To detect decline, the best-performing method achieved 58% sensitivity, 91% specificity and 14 weeks timeliness. To detect post-epidemic state, no method yielded satisfactory balance between metrics. The risk assessment tool contained six factors: age, unemployment status, age at initiation of injecting use, syringe sharing, injection as primary mode of use, injecting use in the last month; yielding AUC<em>≅</em>70%.</div></div><div><h3>Conclusion</h3><div>Our automated system efficiently monitors HIV, HBV and HCV among PWUD and identifies high-risk individuals, enabling early interventions to improve outcomes.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105195"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-05DOI: 10.1016/j.drugpo.2025.105062
Louisa Degenhardt, Matthew Hickman, Frederick L Altice, Jason Grebely, Sophia Taylor, Michelle Lynch, Aleksa Kamenjaš, Jack Marsden, Lucy T Tran, Paige Webb, Olivia Price, Christel Macdonald, Filipa Alves da Costa, Justin Berk, Anja Busse, Evan Cunningham, Colleen Daniels, Behzad Hajarizadeh, Linda Montanari, Luis Royuela, Keith Sabin, Jack Stone, Annette Verster, Peter Vickerman, Michael Farrell, Thomas Santo
Background: This global systematic review assesses the prevalence of injecting drug use (IDU) and key infectious diseases (HIV, hepatitis C virus [HCV], tuberculosis and hepatitis B virus [HBV]) among people who are incarcerated.
Methods: We conducted a systematic search of peer-reviewed (Medline, Embase, PsycINFO), internet, and grey literature databases, from January 2000 through 2nd June 2025 and engaged international experts and relevant agencies liaising with key agencies focused on incarcerated populations (WHO, UNODC, UNAIDS and EUDA). Data on study methods, size of incarcerated populations and demographic characteristics, and prevalence of IDU, HIV, HCV, HBV and tuberculosis among incarcerated populations were extracted. Meta-analyses pooled data where multiple estimates were available for a country; regional and global estimates were calculated, weighted by incarcerated population size. We present overall country, regional and global prevalence estimates for each variable examined, stratified by sex. We then estimated the ratio of IDU, HIV, HCV, HBV and tuberculosis prevalence among incarcerated populations compared to the general population.
Results: Of 75,755 screened documents, 2,968 were eligible for data extraction. There are approximately 11,322,000 people aged 15-64 years incarcerated globally with their incarceration rate being 221 per 100,000 (29 per 100,000 among females and 404 per 100,000 among males). Substantial variation in rates across countries and regions were observed with the highest regional rate being in North America. Globally, we estimate that 11·9% of people who are incarcerated have ever injected drugs (1,348,000; 95%CI 1,061,500-1,687,000), 51·4 times higher than the general population. We estimate that 3·7% (95%CI 2·5-5·4) of people who are incarcerated globally are living with HIV (25.1· times higher than the general population); 11·7% (95%CI 7·7-17·1) have current HCV infection (15·6 times higher); 4·4% (95%CI 2·4-7·7) have current HBV infection (2·2 times higher) and 2·5% (95%CI 1·5-3·8) have active tuberculosis (45·3 times higher than the general population). There is substantial variation geographically and among females and males.
Conclusion: The substantial concentration of people with multiple risks and comorbidities requires improved strategies to screen, evaluate, treat and prevent these adverse consequences, which is crucial for global control efforts.
Funding: Australian National Health and Medical Research Council.
{"title":"The global epidemiology of injecting drug use, HIV, viral hepatitis and tuberculosis among people who are incarcerated: a multistage systematic review.","authors":"Louisa Degenhardt, Matthew Hickman, Frederick L Altice, Jason Grebely, Sophia Taylor, Michelle Lynch, Aleksa Kamenjaš, Jack Marsden, Lucy T Tran, Paige Webb, Olivia Price, Christel Macdonald, Filipa Alves da Costa, Justin Berk, Anja Busse, Evan Cunningham, Colleen Daniels, Behzad Hajarizadeh, Linda Montanari, Luis Royuela, Keith Sabin, Jack Stone, Annette Verster, Peter Vickerman, Michael Farrell, Thomas Santo","doi":"10.1016/j.drugpo.2025.105062","DOIUrl":"10.1016/j.drugpo.2025.105062","url":null,"abstract":"<p><strong>Background: </strong>This global systematic review assesses the prevalence of injecting drug use (IDU) and key infectious diseases (HIV, hepatitis C virus [HCV], tuberculosis and hepatitis B virus [HBV]) among people who are incarcerated.</p><p><strong>Methods: </strong>We conducted a systematic search of peer-reviewed (Medline, Embase, PsycINFO), internet, and grey literature databases, from January 2000 through 2nd June 2025 and engaged international experts and relevant agencies liaising with key agencies focused on incarcerated populations (WHO, UNODC, UNAIDS and EUDA). Data on study methods, size of incarcerated populations and demographic characteristics, and prevalence of IDU, HIV, HCV, HBV and tuberculosis among incarcerated populations were extracted. Meta-analyses pooled data where multiple estimates were available for a country; regional and global estimates were calculated, weighted by incarcerated population size. We present overall country, regional and global prevalence estimates for each variable examined, stratified by sex. We then estimated the ratio of IDU, HIV, HCV, HBV and tuberculosis prevalence among incarcerated populations compared to the general population.</p><p><strong>Results: </strong>Of 75,755 screened documents, 2,968 were eligible for data extraction. There are approximately 11,322,000 people aged 15-64 years incarcerated globally with their incarceration rate being 221 per 100,000 (29 per 100,000 among females and 404 per 100,000 among males). Substantial variation in rates across countries and regions were observed with the highest regional rate being in North America. Globally, we estimate that 11·9% of people who are incarcerated have ever injected drugs (1,348,000; 95%CI 1,061,500-1,687,000), 51·4 times higher than the general population. We estimate that 3·7% (95%CI 2·5-5·4) of people who are incarcerated globally are living with HIV (25.1· times higher than the general population); 11·7% (95%CI 7·7-17·1) have current HCV infection (15·6 times higher); 4·4% (95%CI 2·4-7·7) have current HBV infection (2·2 times higher) and 2·5% (95%CI 1·5-3·8) have active tuberculosis (45·3 times higher than the general population). There is substantial variation geographically and among females and males.</p><p><strong>Conclusion: </strong>The substantial concentration of people with multiple risks and comorbidities requires improved strategies to screen, evaluate, treat and prevent these adverse consequences, which is crucial for global control efforts.</p><p><strong>Funding: </strong>Australian National Health and Medical Research Council.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":" ","pages":"105062"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-11DOI: 10.1016/j.drugpo.2026.105179
Yan Yee Lee , Tianze Sun , Jason P. Connor , Coral Gartner , Germaine Lai , Heena Akbar , Carmen C.W. Lim
Aim
To estimate the absolute and relative changes in prevalence of tobacco, e-cigarette, alcohol, and illicit substance use over the past decade among Culturally and Linguistically Diverse (CALD) and non-CALD populations in Australia from 2013 to 2022/23.
Method
Data were drawn from four waves of the National Drug Strategy Household Survey (NDSHS), comprising of 91, 282 respondents (2013: n = 23, 855; 2016: n = 23, 749; 2019: n = 22, 015; 2022/23: n = 21, 663). CALD status (22.5% of weighted sample) was defined as being born outside Australia/New Zealand/United Kingdom and/or speaking a language other than English at home. Analyses calculated weighted prevalence estimates and absolute and relative changes in prevalence between 2013 and 2022/23 with 99% CI.
Findings
Between 2013 and 2022/2023, any tobacco product use declined significantly for both CALD (14.4% to 8.5%, 99%CI:8.0%, -3.7%) and non-CALD respondents (18.0% to 9.6%, 99%CI:9.6%, -7.3%). E-cigarette use (measured from 2016) increased in both populations, with CALD showing a 5-fold increase (0.8% to 4.8%; 99%CI: 2.7%, 5.2%) and non-CALD showing a 4.8-fold increase (1.3% to 7.5%; 99%CI: 5.5%, 7.0%). Risky alcohol use declined among CALD (23.2% to 13.1%, 99%CI:12.7%, -7.6%) and non-CALD respondents (43.2% to 33.9%, 99%CI:10.9%, -7.6%). Any illicit substance use remained stable among CALD respondents (10.3% to 9.0%; 99%CI: −3.2%, 0.8%) but increased among non-CALD respondents (16.0% to 18.4%; 99%CI: 1.2%, 3.8%).
Conclusions
In Australia, CALD individuals had lower prevalence of use of most tobacco products, e-cigarettes, alcohol, and illicit drugs than non-CALD individuals. Between 2013 and 2022/23, roll-your-own cigarette and waterpipe use remained stable among CALD individuals despite significant declines in non-CALD individuals. Both groups experienced steep rises in e-cigarette use between 2016 and 2022/23.
{"title":"A nationally representative repeated cross-sectional study of 10-year substance use trends among culturally and linguistically diverse Australians","authors":"Yan Yee Lee , Tianze Sun , Jason P. Connor , Coral Gartner , Germaine Lai , Heena Akbar , Carmen C.W. Lim","doi":"10.1016/j.drugpo.2026.105179","DOIUrl":"10.1016/j.drugpo.2026.105179","url":null,"abstract":"<div><h3>Aim</h3><div>To estimate the absolute and relative changes in prevalence of tobacco, e-cigarette, alcohol, and illicit substance use over the past decade among Culturally and Linguistically Diverse (CALD) and non-CALD populations in Australia from 2013 to 2022/23.</div></div><div><h3>Method</h3><div>Data were drawn from four waves of the National Drug Strategy Household Survey (NDSHS), comprising of 91, 282 respondents (2013: <em>n</em> = 23, 855; 2016: <em>n</em> = 23, 749; 2019: <em>n</em> = 22, 015; 2022/23: <em>n</em> = 21, 663). CALD status (22.5% of weighted sample) was defined as being born outside Australia/New Zealand/United Kingdom and/or speaking a language other than English at home. Analyses calculated weighted prevalence estimates and absolute and relative changes in prevalence between 2013 and 2022/23 with 99% CI.</div></div><div><h3>Findings</h3><div>Between 2013 and 2022/2023, any tobacco product use declined significantly for both CALD (14.4% to 8.5%, 99%CI:8.0%, -3.7%) and non-CALD respondents (18.0% to 9.6%, 99%CI:9.6%, -7.3%). E-cigarette use (measured from 2016) increased in both populations, with CALD showing a 5-fold increase (0.8% to 4.8%; 99%CI: 2.7%, 5.2%) and non-CALD showing a 4.8-fold increase (1.3% to 7.5%; 99%CI: 5.5%, 7.0%). Risky alcohol use declined among CALD (23.2% to 13.1%, 99%CI:12.7%, -7.6%) and non-CALD respondents (43.2% to 33.9%, 99%CI:10.9%, -7.6%). Any illicit substance use remained stable among CALD respondents (10.3% to 9.0%; 99%CI: −3.2%, 0.8%) but increased among non-CALD respondents (16.0% to 18.4%; 99%CI: 1.2%, 3.8%).</div></div><div><h3>Conclusions</h3><div>In Australia, CALD individuals had lower prevalence of use of most tobacco products, e-cigarettes, alcohol, and illicit drugs than non-CALD individuals. Between 2013 and 2022/23, roll-your-own cigarette and waterpipe use remained stable among CALD individuals despite significant declines in non-CALD individuals. Both groups experienced steep rises in e-cigarette use between 2016 and 2022/23.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105179"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-13DOI: 10.1016/j.drugpo.2026.105197
Lise Lafferty , Nashira Popovic , Elise Weiss , Behzad Hajarizadeh , Andrew R. Lloyd , Frederick L. Altice , Nadine Kronfli
Background
Prison needle exchange programs (PNEPs) reduce bloodborne virus transmission among people who inject drugs, yet global implementation remains limited. Canada introduced PNEPs in 2018, but uptake is low, and barriers to implementation persist. While perspectives of correctional officers, healthcare workers, and incarcerated individuals have been examined, little is known about how prison leadership shapes program delivery. Drawing on interviews informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we sought to identify the organisational, system, and structural/policy-level barriers to PNEP implementation from the perspectives of prison administrators.
Methods
Between January and March 2025, 27 prison leaders from custodial and medical services from nine Canadian federal prisons with operational PNEPs participated in semi-structured interviews. Data were thematically analysed using the EPIS framework.
Results
Implementation was shaped by structural tensions between harm reduction goals and “zero tolerance” custodial mandates. Outer context factors, especially union resistance, lack of policy clarity, and federal directives, created misalignment and ambiguity in program ownership. Prison climate, staff turnover, and leadership engagement influenced shifts in attitudes toward PNEPs over time. Healthcare personnel, though central to delivery, were often tasked with communicating custodial decisions, undermining trust. Intervention fit was shaped by security classification and perceived drug use patterns, with PNEPs viewed as ill-suited for minimum-security settings. Sites that streamlined approval processes and designated leadership roles were better positioned to support program uptake. Time, experiential exposure, and tailored education were key facilitators of cultural change and implementation readiness.
Conclusion
Addressing outer context barriers and clarifying responsibilities between health and corrections are critical to PNEP sustainability. Leadership engagement is essential to enabling system-wide adoption.
{"title":"Navigating harm reduction and security mandates: Prison leadership perspectives on implementing prison needle exchange programs in Canada","authors":"Lise Lafferty , Nashira Popovic , Elise Weiss , Behzad Hajarizadeh , Andrew R. Lloyd , Frederick L. Altice , Nadine Kronfli","doi":"10.1016/j.drugpo.2026.105197","DOIUrl":"10.1016/j.drugpo.2026.105197","url":null,"abstract":"<div><h3>Background</h3><div>Prison needle exchange programs (PNEPs) reduce bloodborne virus transmission among people who inject drugs, yet global implementation remains limited. Canada introduced PNEPs in 2018, but uptake is low, and barriers to implementation persist. While perspectives of correctional officers, healthcare workers, and incarcerated individuals have been examined, little is known about how prison leadership shapes program delivery. Drawing on interviews informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we sought to identify the organisational, system, and structural/policy-level barriers to PNEP implementation from the perspectives of prison administrators.</div></div><div><h3>Methods</h3><div>Between January and March 2025, 27 prison leaders from custodial and medical services from nine Canadian federal prisons with operational PNEPs participated in semi-structured interviews. Data were thematically analysed using the EPIS framework.</div></div><div><h3>Results</h3><div>Implementation was shaped by structural tensions between harm reduction goals and “zero tolerance” custodial mandates. Outer context factors, especially union resistance, lack of policy clarity, and federal directives, created misalignment and ambiguity in program ownership. Prison climate, staff turnover, and leadership engagement influenced shifts in attitudes toward PNEPs over time. Healthcare personnel, though central to delivery, were often tasked with communicating custodial decisions, undermining trust. Intervention fit was shaped by security classification and perceived drug use patterns, with PNEPs viewed as ill-suited for minimum-security settings. Sites that streamlined approval processes and designated leadership roles were better positioned to support program uptake. Time, experiential exposure, and tailored education were key facilitators of cultural change and implementation readiness.</div></div><div><h3>Conclusion</h3><div>Addressing outer context barriers and clarifying responsibilities between health and corrections are critical to PNEP sustainability. Leadership engagement is essential to enabling system-wide adoption.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105197"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-14DOI: 10.1016/j.drugpo.2026.105202
Kerri Coomber , Kira Button , Emma Masiero , Florentine Martino , Adyya Gupta , Ryan Baldwin , Peter G Miller , Kathryn Backholer , Julia Stafford
Background and aims
Alcohol home delivery is associated with increased alcohol consumption, with online marketing (including advertisements and promotions) potentially driving increased online purchases. This study aimed to understand consumers’ exposure to online advertising and promotions for alcohol home delivery and its association with alcohol purchase patterns.
Methods
Both quantitative (Study 1) and qualitative (Study 2) data were collected. Study 1 sampled 702 adult (≥18 years) Australian high-risk drinkers (AUDIT-10 score ≥8) to examine associations between purchase modality (in-store only, occasional online, and predominantly online) and exposure to, and influence of, online alcohol advertising. Study 2 collected screen recordings of online alcohol purchases from 30 Australian adult drinkers (15 low-risk and 15 high-risk drinkers), with a follow-up interview.
Results
Study 1 participants in both online purchase groups had higher odds of reporting exposure to online alcohol advertising compared to those who purchase in-store only, with predominant purchasers also more likely to see advertising daily compared to the two other groups. App notifications and virtual cart reminders were more likely to prompt predominant purchasers to complete their alcohol purchase compared to occasional purchasers. Study 2 found frequent appearance of in-platform, time-sensitive promotions, such as limited time discounts. Participants reported promotions influenced their purchasing behaviour to take advantage of special pricing. Participants also reported general exposure to online alcohol marketing sometimes leads them to make a purchase.
Conclusion
These findings show current marketing strategies encourage drinkers to purchase more alcohol. Strengthened policy initiatives are needed to help reduce alcohol-related harms due to marketing practices.
{"title":"Online marketing for alcohol home delivery and alcohol purchasing behaviour: A mixed-methods study","authors":"Kerri Coomber , Kira Button , Emma Masiero , Florentine Martino , Adyya Gupta , Ryan Baldwin , Peter G Miller , Kathryn Backholer , Julia Stafford","doi":"10.1016/j.drugpo.2026.105202","DOIUrl":"10.1016/j.drugpo.2026.105202","url":null,"abstract":"<div><h3>Background and aims</h3><div>Alcohol home delivery is associated with increased alcohol consumption, with online marketing (including advertisements and promotions) potentially driving increased online purchases. This study aimed to understand consumers’ exposure to online advertising and promotions for alcohol home delivery and its association with alcohol purchase patterns.</div></div><div><h3>Methods</h3><div>Both quantitative (Study 1) and qualitative (Study 2) data were collected. Study 1 sampled 702 adult (≥18 years) Australian high-risk drinkers (AUDIT-10 score ≥8) to examine associations between purchase modality (in-store only, occasional online, and predominantly online) and exposure to, and influence of, online alcohol advertising. Study 2 collected screen recordings of online alcohol purchases from 30 Australian adult drinkers (15 low-risk and 15 high-risk drinkers), with a follow-up interview.</div></div><div><h3>Results</h3><div>Study 1 participants in both online purchase groups had higher odds of reporting exposure to online alcohol advertising compared to those who purchase in-store only, with predominant purchasers also more likely to see advertising daily compared to the two other groups. App notifications and virtual cart reminders were more likely to prompt predominant purchasers to complete their alcohol purchase compared to occasional purchasers. Study 2 found frequent appearance of in-platform, time-sensitive promotions, such as limited time discounts. Participants reported promotions influenced their purchasing behaviour to take advantage of special pricing. Participants also reported general exposure to online alcohol marketing sometimes leads them to make a purchase.</div></div><div><h3>Conclusion</h3><div>These findings show current marketing strategies encourage drinkers to purchase more alcohol. Strengthened policy initiatives are needed to help reduce alcohol-related harms due to marketing practices.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105202"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-06DOI: 10.1016/j.drugpo.2026.105181
Benedikt Fischer , Didier Jutras-Aswad , Bernard Le Foll , Daniel T. Myran
{"title":"Outcomes and implications of British Columbia’s ‘drug decriminalization initiative’ for health-oriented drug policymaking","authors":"Benedikt Fischer , Didier Jutras-Aswad , Bernard Le Foll , Daniel T. Myran","doi":"10.1016/j.drugpo.2026.105181","DOIUrl":"10.1016/j.drugpo.2026.105181","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105181"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-14DOI: 10.1016/j.drugpo.2026.105200
Samuel Tobias , Joshua Bird , Sara M. Guzman , Heather Palis , Alexis Crabtree , Jason E. Hein , Evan Wood , Lianping Ti
Background
British Columbia (BC), Canada, continues to experience persistently high rates of unregulated drug toxicity. While the presence of fentanyl in the drug supply is well-established, less is known about how fluctuations in its concentration may influence mortality at the population level. This study describes geographic variation and temporal trends in fentanyl concentrations across BC and assesses if they are associated with unregulated drug toxicity rates.
Methods
Using a validated machine learning model that quantifies fentanyl and fluorofentanyl concentrations in unregulated opioid samples, we estimated concentrations in samples submitted to BC drug checking services from October 2018 to June 2025. We derived monthly median concentrations by geographic health service delivery area to determine historic monthly typical fentanyl strength. We then examined the relationship between fentanyl concentrations and unregulated drug toxicity mortality rates using a generalized additive mixed model (GAMM), accounting for regional heterogeneity, temporal trends, and autocorrelation.
Results
Median fentanyl concentrations varied geographically and temporally across the province, peaking provincially at 11.0% in mid-2023 before declining to 5.1% in early 2025. The GAMM estimated that, on average, each 1-percentage point increase in median fentanyl concentration was associated with a 0.072 increase in the monthly drug-related mortality rate per 100,000 population (p = 0.029).
Conclusions
Quantifying fentanyl concentrations from point-of-care drug checking data enables detection of geographic and temporal patterns in the unregulated drug supply and their associations with drug-related mortality. This approach offers a tool for harm reduction, drug supply monitoring, and policy response during the ongoing drug toxicity crisis.
{"title":"Temporal and regional associations between fentanyl concentrations in the unregulated drug supply and drug-related mortality in British Columbia, Canada","authors":"Samuel Tobias , Joshua Bird , Sara M. Guzman , Heather Palis , Alexis Crabtree , Jason E. Hein , Evan Wood , Lianping Ti","doi":"10.1016/j.drugpo.2026.105200","DOIUrl":"10.1016/j.drugpo.2026.105200","url":null,"abstract":"<div><h3>Background</h3><div>British Columbia (BC), Canada, continues to experience persistently high rates of unregulated drug toxicity. While the presence of fentanyl in the drug supply is well-established, less is known about how fluctuations in its concentration may influence mortality at the population level. This study describes geographic variation and temporal trends in fentanyl concentrations across BC and assesses if they are associated with unregulated drug toxicity rates.</div></div><div><h3>Methods</h3><div>Using a validated machine learning model that quantifies fentanyl and fluorofentanyl concentrations in unregulated opioid samples, we estimated concentrations in samples submitted to BC drug checking services from October 2018 to June 2025. We derived monthly median concentrations by geographic health service delivery area to determine historic monthly typical fentanyl strength. We then examined the relationship between fentanyl concentrations and unregulated drug toxicity mortality rates using a generalized additive mixed model (GAMM), accounting for regional heterogeneity, temporal trends, and autocorrelation.</div></div><div><h3>Results</h3><div>Median fentanyl concentrations varied geographically and temporally across the province, peaking provincially at 11.0% in mid-2023 before declining to 5.1% in early 2025. The GAMM estimated that, on average, each 1-percentage point increase in median fentanyl concentration was associated with a 0.072 increase in the monthly drug-related mortality rate per 100,000 population (<em>p</em> = 0.029).</div></div><div><h3>Conclusions</h3><div>Quantifying fentanyl concentrations from point-of-care drug checking data enables detection of geographic and temporal patterns in the unregulated drug supply and their associations with drug-related mortality. This approach offers a tool for harm reduction, drug supply monitoring, and policy response during the ongoing drug toxicity crisis.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105200"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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