Pub Date : 2025-10-07DOI: 10.1016/j.drugpo.2025.105024
L.L. Wynn , Chloe Barron , Kirsten Bell , Helen Keane
Anti-tobacco public health campaigns portray e-cigarettes and cigarettes as interchangeable nicotine-delivery systems, describing ‘vapes’ as a gateway to combustible tobacco use. Some vape users, however, portray vaping as producing a qualitatively different drug experience, describing the pursuit of fleeting, dizzy moments of intoxication sometimes described as ‘head spins’. Recent anti-vape campaigns have seized upon the language of head spins, describing it as a symptom of nicotine poisoning, a portrayal at odds with vape users’ phenomenological accounts of vaping experiences. Framings of vaping experiences that reduce the pleasures of vaping to a poison effect fail to explain how and why young people are drawn to vaping. We need empirical understandings of drug experiences to inform public health policy, which means listening to users and how they phenomenologically describe their embodied drug experiences. We therefore undertook a qualitative study of 24 young people, both vape users and nonusers. We found that the intoxicating effect described as `head spins’ is actively sought by vape users who see it as a distinguishing aspect of high-nicotine content vapes, compared to combustible cigarettes. Often using neuropharmacological terminology to describe the nicotine experience, participants infused jargon such as ‘dopamine’ and ‘tolerance’ with their own embodied experiences of the temporality and pleasures of vape use. Our participants described ‘head spins’ as repeatedly visiting a state of fleeing intoxication to both transform and cope with everyday life.
{"title":"‘The best spin’: Discourses of vaping intoxication, pleasure, and ‘poisoning’","authors":"L.L. Wynn , Chloe Barron , Kirsten Bell , Helen Keane","doi":"10.1016/j.drugpo.2025.105024","DOIUrl":"10.1016/j.drugpo.2025.105024","url":null,"abstract":"<div><div>Anti-tobacco public health campaigns portray e-cigarettes and cigarettes as interchangeable nicotine-delivery systems, describing ‘vapes’ as a gateway to combustible tobacco use. Some vape users, however, portray vaping as producing a qualitatively different drug experience, describing the pursuit of fleeting, dizzy moments of intoxication sometimes described as ‘head spins’. Recent anti-vape campaigns have seized upon the language of head spins, describing it as a symptom of nicotine poisoning, a portrayal at odds with vape users’ phenomenological accounts of vaping experiences. Framings of vaping experiences that reduce the pleasures of vaping to a poison effect fail to explain how and why young people are drawn to vaping. We need empirical understandings of drug experiences to inform public health policy, which means listening to users and how they phenomenologically describe their embodied drug experiences. We therefore undertook a qualitative study of 24 young people, both vape users and nonusers. We found that the intoxicating effect described as `head spins’ is actively sought by vape users who see it as a distinguishing aspect of high-nicotine content vapes, compared to combustible cigarettes. Often using neuropharmacological terminology to describe the nicotine experience, participants infused jargon such as ‘dopamine’ and ‘tolerance’ with their own embodied experiences of the temporality and pleasures of vape use. Our participants described ‘head spins’ as repeatedly visiting a state of fleeing intoxication to both transform and cope with everyday life.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105024"},"PeriodicalIF":4.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253336","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}
Overdose deaths in Canada have been rising since 2016, but long-term trends remain poorly characterized. We examined national overdose mortality trends from 1974 to 2023 and explored differences by sex, age, and province.
Methods
We conducted a retrospective analysis of accidental and undetermined‐intent poisoning deaths in the Canadian Vital Statistics Death Database, calculating crude mortality rates (CMR) using Statistics Canada population estimates. We used segmented regression to model temporal trends and calculated average annual percentage change (AAPC) for each resulting segment. Analyses were stratified by sex, age (<25, 25–44, 45–64, and ≥65), and province.
Results
Between 1974 and 2023, 80,944 overdose deaths were recorded. Segmented regression of CMR revealed three phases: a period of relative stability (AAPC: -0.28 %; 1974–1991), followed by two accelerations (AAPC: 5.46 %; 1991–2013 and AAPC: 12 %; 2013–2023) CMRs were similar by sex until 2013–15, then surged in both males (AAPC: 13.81 %; 2012–2023) and females (AAPC: 9.32 %; 2015–2023). Rates in youth (<25) were stable until the early 2000s, then rose sharply (AAPC: 30.62 %; 2014–2017) before slowing, while rates among adults aged 25–44 (AAPC: 13.59 %; 2012–2023), 45–64 (AAPC: 11.56 %; 2014–2023), and ≥65 (AAPC: 18.48 %; 2020–2023) increased in recent years. Rates increased the most in Western provinces compared to Quebec and the Atlantic provinces.
Conclusions
Canada’s overdose epidemic reflects a segmented trajectory, with marked accelerations in 1996 and 2013, driven by healthcare practices, evolving drug markets, and social vulnerabilities. Regional and demographic disparities underscore the need for targeted, historically informed public health strategies.
{"title":"Trends in accidental drug overdose mortality in Canada: An analysis from 1974 to 2023","authors":"Harika Dasari , Adelina Artenie , Julie Bruneau , Sarah Larney","doi":"10.1016/j.drugpo.2025.105022","DOIUrl":"10.1016/j.drugpo.2025.105022","url":null,"abstract":"<div><h3>Background</h3><div>Overdose deaths in Canada have been rising since 2016, but long-term trends remain poorly characterized. We examined national overdose mortality trends from 1974 to 2023 and explored differences by sex, age, and province.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of accidental and undetermined‐intent poisoning deaths in the Canadian Vital Statistics Death Database, calculating crude mortality rates (CMR) using Statistics Canada population estimates. We used segmented regression to model temporal trends and calculated average annual percentage change (AAPC) for each resulting segment. Analyses were stratified by sex, age (<25, 25–44, 45–64, and ≥65), and province.</div></div><div><h3>Results</h3><div>Between 1974 and 2023, 80,944 overdose deaths were recorded. Segmented regression of CMR revealed three phases: a period of relative stability (AAPC: -0.28 %; 1974–1991), followed by two accelerations (AAPC: 5.46 %; 1991–2013 and AAPC: 12 %; 2013–2023) CMRs were similar by sex until 2013–15, then surged in both males (AAPC: 13.81 %; 2012–2023) and females (AAPC: 9.32 %; 2015–2023). Rates in youth (<25) were stable until the early 2000s, then rose sharply (AAPC: 30.62 %; 2014–2017) before slowing, while rates among adults aged 25–44 (AAPC: 13.59 %; 2012–2023), 45–64 (AAPC: 11.56 %; 2014–2023), and ≥65 (AAPC: 18.48 %; 2020–2023) increased in recent years. Rates increased the most in Western provinces compared to Quebec and the Atlantic provinces.</div></div><div><h3>Conclusions</h3><div>Canada’s overdose epidemic reflects a segmented trajectory, with marked accelerations in 1996 and 2013, driven by healthcare practices, evolving drug markets, and social vulnerabilities. Regional and demographic disparities underscore the need for targeted, historically informed public health strategies.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105022"},"PeriodicalIF":4.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245687","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 : 2025-10-05DOI: 10.1016/j.drugpo.2025.105020
Lorena Repetto , Rosario Queirolo , Joaquín Alonso , Mafalda Pardal , Laura Atuesta , Beau Kilmer , Eliana Álvarez , Belén Sotto
Background and aims
The legalization of prohibited activities involves the creation of new (legal) markets that, in general, coexist with illegal markets. Legalization of cannabis in Uruguay was not the exception: it has generated a legal market but also promoted the emergence of new "grey" markets that operate in the intersection of legal and illegal markets. The purpose of this article is to conceptualize the grey markets accounting for its different subtypes, moving beyond a monolithic understanding.
Methods
This paper introduces a radial conceptualization for understanding cannabis grey markets, drawing on interviews with key informants including policymakers, academics, and stakeholders (n = 20), and interviews with people who frequently use cannabis (n = 50).
Results
Our findings suggest that in Uruguay there are at least three types of grey markets, which we categorize as light, standard, and dark grey. This classification stems from the illegal distribution of legally produced cannabis, which allows us to develop a typology based on two attributes: profitability and destination of the transaction. According to this typology, the light grey market involves non-profit sharing of legally grown cannabis within personal networks, primarily to cover production costs. The standard grey market includes small-scale, profit-oriented sales to a broader network of people who use cannabis. The dark grey market, on the other hand, refers to legally produced cannabis entering traditional illegal distribution channels to maximize profits.
Conclusions
Understanding the grey market's characteristics is essential for policymakers and regulators aiming to effectively legalize cannabis. Dark grey activities involve contact with the illegal market and contradict regulatory goals, prompting potential law enforcement actions. Conversely, the light grey resembles an informal market where cannabis is exchanged for goods or shared, likely acceptable to the government. Forbearance could apply to the standard grey market, although it may compete with legal markets. Assessing subtypes of grey markets contributes to a better understanding of the diverse interactions that occur within them and might enable policymakers to address each with tailored policy tools.
{"title":"Conceptualizing cannabis grey markets: A typology based on the Uruguayan case","authors":"Lorena Repetto , Rosario Queirolo , Joaquín Alonso , Mafalda Pardal , Laura Atuesta , Beau Kilmer , Eliana Álvarez , Belén Sotto","doi":"10.1016/j.drugpo.2025.105020","DOIUrl":"10.1016/j.drugpo.2025.105020","url":null,"abstract":"<div><h3>Background and aims</h3><div>The legalization of prohibited activities involves the creation of new (legal) markets that, in general, coexist with illegal markets. Legalization of cannabis in Uruguay was not the exception: it has generated a legal market but also promoted the emergence of new \"grey\" markets that operate in the intersection of legal and illegal markets. The purpose of this article is to conceptualize the grey markets accounting for its different subtypes, moving beyond a monolithic understanding.</div></div><div><h3>Methods</h3><div>This paper introduces a radial conceptualization for understanding cannabis grey markets, drawing on interviews with key informants including policymakers, academics, and stakeholders (<em>n</em> = 20), and interviews with people who frequently use cannabis (<em>n</em> = 50).</div></div><div><h3>Results</h3><div>Our findings suggest that in Uruguay there are at least three types of grey markets, which we categorize as light, standard, and dark grey. This classification stems from the illegal distribution of legally produced cannabis, which allows us to develop a typology based on two attributes: profitability and destination of the transaction. According to this typology, the light grey market involves non-profit sharing of legally grown cannabis within personal networks, primarily to cover production costs. The standard grey market includes small-scale, profit-oriented sales to a broader network of people who use cannabis. The dark grey market, on the other hand, refers to legally produced cannabis entering traditional illegal distribution channels to maximize profits.</div></div><div><h3>Conclusions</h3><div>Understanding the grey market's characteristics is essential for policymakers and regulators aiming to effectively legalize cannabis. Dark grey activities involve contact with the illegal market and contradict regulatory goals, prompting potential law enforcement actions. Conversely, the light grey resembles an informal market where cannabis is exchanged for goods or shared, likely acceptable to the government. Forbearance could apply to the standard grey market, although it may compete with legal markets. Assessing subtypes of grey markets contributes to a better understanding of the diverse interactions that occur within them and might enable policymakers to address each with tailored policy tools.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105020"},"PeriodicalIF":4.4,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240037","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 : 2025-10-03DOI: 10.1016/j.drugpo.2025.105026
Alison Ritter, Jonah Bunyon
Introduction
While the field of ‘drug policy research’ feels intuitively knowable, there are few papers examining drug policy as a research object, and exploring the different methods and categories of drug policy research. This paper aimed to provide such an analysis.
Methods
The data source was research papers published in the International Journal of Drug Policy in 2023 and 2024 (N = 453) as this journal was most likely to surface drug policy research as well as reflect the multiple disciplines that engage in this field of practice. We applied an operational definition of ‘drug policy research’: research where the object of study was a policy, or a policy process. For those papers coded as ‘Yes’ to this definition, we coded the policy topic, drug class and methods used, in addition to the category of policy research.
Results
Of the 453 papers, 34.4 % (n = 156) were coded as drug policy research, the majority of which concerned criminalisation, decriminalisation and legalisation (23.7 %, n = 37), with the second largest topic area being harm reduction policies (20.5 %, n = 32), followed by drug treatment policies (16.7 %, n = 26) and restrictions on sales, advertising, and price (17.9 %, n = 28). All major drug classes were covered. Of the 156 studies 48.7 % (n = 76) employed quantitative methods and 42.3 % (n = 66) employed qualitative methods. We worked with five categories of drug policy research: evaluation (studying policy outcomes & effects, 36.5 %); implementation (studying policy implementation, 22.4 %); mapping (documenting policy positions, 16 %); policy-making (studying policy formation, 14.1 %); and finally policy design (studying policy mechanisms, 10.9 %). Notable gaps included prevention policy research, and studies of methamphetamine, psychedelics, and illicit cannabis policies, as well as quantitative methods for mapping studies and qualitative methods for outcome studies.
Discussion
The chosen operational definition forecloses and stabilises drug policy research as a particular field of practice, with associated topics and methods. It circumscribes it to around 34 % of publications in IJDP over 2023 and 2024. If another journal (or dataset of drug research) was chosen, it may be larger or smaller and with differing primary topics and methods as well as spread across categories of policy research. Perhaps more importantly however, we highlight that ‘drug policy research’ can be made otherwise – discussing three alternative conceptualisations: as research that aims to inform policy, as street-level implementation, or as policy ecology – each of which boundary ‘drug policy research’ differently.
{"title":"An analysis of scope, topics, methods and categories of drug policy research published in the International Journal of Drug Policy","authors":"Alison Ritter, Jonah Bunyon","doi":"10.1016/j.drugpo.2025.105026","DOIUrl":"10.1016/j.drugpo.2025.105026","url":null,"abstract":"<div><h3>Introduction</h3><div>While the field of ‘drug policy research’ feels intuitively knowable, there are few papers examining drug policy as a research object, and exploring the different methods and categories of drug policy research. This paper aimed to provide such an analysis.</div></div><div><h3>Methods</h3><div>The data source was research papers published in the International Journal of Drug Policy in 2023 and 2024 (<em>N</em> = 453) as this journal was most likely to surface drug policy research as well as reflect the multiple disciplines that engage in this field of practice. We applied an operational definition of ‘drug policy research’: research where the object of study was a policy, or a policy process. For those papers coded as ‘Yes’ to this definition, we coded the policy topic, drug class and methods used, in addition to the category of policy research.</div></div><div><h3>Results</h3><div>Of the 453 papers, 34.4 % (<em>n</em> = 156) were coded as drug policy research, the majority of which concerned criminalisation, decriminalisation and legalisation (23.7 %, <em>n</em> = 37), with the second largest topic area being harm reduction policies (20.5 %, <em>n</em> = 32), followed by drug treatment policies (16.7 %, <em>n</em> = 26) and restrictions on sales, advertising, and price (17.9 %, <em>n</em> = 28). All major drug classes were covered. Of the 156 studies 48.7 % (<em>n</em> = 76) employed quantitative methods and 42.3 % (<em>n</em> = 66) employed qualitative methods. We worked with five categories of drug policy research: evaluation (studying policy outcomes & effects, 36.5 %); implementation (studying policy implementation, 22.4 %); mapping (documenting policy positions, 16 %); policy-making (studying policy formation, 14.1 %); and finally policy design (studying policy mechanisms, 10.9 %). Notable gaps included prevention policy research, and studies of methamphetamine, psychedelics, and illicit cannabis policies, as well as quantitative methods for mapping studies and qualitative methods for outcome studies.</div></div><div><h3>Discussion</h3><div>The chosen operational definition forecloses and stabilises drug policy research as a particular field of practice, with associated topics and methods. It circumscribes it to around 34 % of publications in IJDP over 2023 and 2024. If another journal (or dataset of drug research) was chosen, it may be larger or smaller and with differing primary topics and methods as well as spread across categories of policy research. Perhaps more importantly however, we highlight that ‘drug policy research’ can be made otherwise – discussing three alternative conceptualisations: as research that aims to inform policy, as street-level implementation, or as policy ecology – each of which boundary ‘drug policy research’ differently.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105026"},"PeriodicalIF":4.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219363","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 : 2025-10-03DOI: 10.1016/j.drugpo.2025.105018
Robin Room , Cassandra Hopkins , Anne-Marie Laslett
Research documenting the reach and varieties of alcohol’s harm to others than the person who drinks has emerged in the last 20 years, with studies in over 40 countries. Population surveys have asked respondents about harm to themselves or their children from others’ drinking. Staff of societal response agencies – police, hospitals, child protection agencies – have also been interviewed, along with studies of agency records and social cost analyses of alcohol’s harm to others.
While a few studies have compared cross-sectionally the relation between alcohol policies in countries or states and rates of specific harms from others’ drinking, analysis has been limited of how alcohol policies or other legal changes may reduce such rates. The new focus on alcohol’s harm to others has rarely been noticed in broader public health policy research. Neither has it received public notice; a study of the broad British newspaper discourse around minimum unit pricing policy for alcohol in Scotland found considerable mention of alcohol’s harm to others, but without any reference to the findings of the relevant research literature.
This paper reviews the situation and considers paths forward. One advance would be leveraging more data collection from the caseloads of health and other response agencies. For particular areas of harm, those controlling the relevant space need to be involved in the policy changes – e.g., employers and unions in workplaces. Alongside research on the prevalence, studies of policy change and related impacts on harm from others’ drinking, studies of policy processes and attitudes towards the harm to others paradigm amongst opinion leaders and the general public should be undertaken. To move public health interests in alcohol policy forward, alliances should be built, for example with women’s movements concerning harm to women from men’s drinking.
{"title":"Alcohol’s harm to others: A new paradigm seeking its application","authors":"Robin Room , Cassandra Hopkins , Anne-Marie Laslett","doi":"10.1016/j.drugpo.2025.105018","DOIUrl":"10.1016/j.drugpo.2025.105018","url":null,"abstract":"<div><div>Research documenting the reach and varieties of alcohol’s harm to others than the person who drinks has emerged in the last 20 years, with studies in over 40 countries. Population surveys have asked respondents about harm to themselves or their children from others’ drinking. Staff of societal response agencies – police, hospitals, child protection agencies – have also been interviewed, along with studies of agency records and social cost analyses of alcohol’s harm to others.</div><div>While a few studies have compared cross-sectionally the relation between alcohol policies in countries or states and rates of specific harms from others’ drinking, analysis has been limited of how alcohol policies or other legal changes may reduce such rates. The new focus on alcohol’s harm to others has rarely been noticed in broader public health policy research. Neither has it received public notice; a study of the broad British newspaper discourse around minimum unit pricing policy for alcohol in Scotland found considerable mention of alcohol’s harm to others, but without any reference to the findings of the relevant research literature.</div><div>This paper reviews the situation and considers paths forward. One advance would be leveraging more data collection from the caseloads of health and other response agencies. For particular areas of harm, those controlling the relevant space need to be involved in the policy changes – e.g., employers and unions in workplaces. Alongside research on the prevalence, studies of policy change and related impacts on harm from others’ drinking, studies of policy processes and attitudes towards the harm to others paradigm amongst opinion leaders and the general public should be undertaken. To move public health interests in alcohol policy forward, alliances should be built, for example with women’s movements concerning harm to women from men’s drinking.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105018"},"PeriodicalIF":4.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219364","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 : 2025-09-27DOI: 10.1016/j.drugpo.2025.105025
Lambros Lazuras , Fredrik Lauritzen , Erik Duiven , Michael Petrou , Liene Kozlovska , Julien Attuil , Jamie Brown
The use of image and performance enhancement drugs (doping) in recreational sport presents an emerging public health challenge, but there is scarce research on current preventive measures. The present research was concerned with mapping and analysing anti-doping measures in gyms and fitness centres in countries that are State Parties to the Anti-Doping Convention of the Council of Europe. Using the Anti-Doping Questionnaire of the Council of Europe, we found that only 17 (35 %) of the 49 countries that participated in the study implemented measures to tackle doping among gym and fitness centre customers and staff, and 19 countries (39 %) included measures addressing the health consequences of doping use. In the majority (83 %) of countries that took any preventive measures against doping in gyms and fitness centres, National Anti-Doping Organisations (NADOs) were involved in their implementation. Further analysis indicated key areas where doping prevention measures have developed. The implications for policy and practice in doping prevention are discussed.
{"title":"Anti-doping measures in gyms and fitness centres: A mapping of practices in the state parties of the council of Europe’s anti-doping convention","authors":"Lambros Lazuras , Fredrik Lauritzen , Erik Duiven , Michael Petrou , Liene Kozlovska , Julien Attuil , Jamie Brown","doi":"10.1016/j.drugpo.2025.105025","DOIUrl":"10.1016/j.drugpo.2025.105025","url":null,"abstract":"<div><div>The use of image and performance enhancement drugs (doping) in recreational sport presents an emerging public health challenge, but there is scarce research on current preventive measures. The present research was concerned with mapping and analysing anti-doping measures in gyms and fitness centres in countries that are State Parties to the Anti-Doping Convention of the Council of Europe. Using the Anti-Doping Questionnaire of the Council of Europe, we found that only 17 (35 %) of the 49 countries that participated in the study implemented measures to tackle doping among gym and fitness centre customers and staff, and 19 countries (39 %) included measures addressing the health consequences of doping use. In the majority (83 %) of countries that took any preventive measures against doping in gyms and fitness centres, National Anti-Doping Organisations (NADOs) were involved in their implementation. Further analysis indicated key areas where doping prevention measures have developed. The implications for policy and practice in doping prevention are discussed.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105025"},"PeriodicalIF":4.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186924","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 : 2025-09-27DOI: 10.1016/j.drugpo.2025.105017
Adams L. Sibley , Colin W. Miller , Elizabeth Joniak-Grant , Alice Bell , Malcolm Visnich , Steve Alsum , Nabarun Dasgupta
Background
Xylazine, a veterinary tranquilizer, has emerged as a widespread adulterant in the U.S. illicit drug supply, detected in over 90 % of street fentanyl samples in some regions and identified in a growing number of overdose deaths. While xylazine's health risks are well-documented, little is known about how its presence influences substance use behaviors. We aimed to explore behavioral changes among people encountering xylazine in illicit drug markets.
Methods
We conducted semi-structured in-depth interviews with people with recent overdose reversal experiences in two Midwestern cities (n= 52) as part of a larger study on naloxone administration. Participants were asked about their knowledge and perceptions of local drug supply trends. Data were analyzed using the Rigorous and Accelerated Data Reduction technique. Protection Motivation Theory provided a theoretical framework.
Results
Participants overwhelmingly preferred opioids without xylazine. Almost all reported adjusting use toward safer practices in response to xylazine exposure: using less in amount or frequency, changing route of administration, or abstaining or seeking treatment. Behavior change was motivated by fear of negative outcomes, including physical health risks (particularly chronic wounds and limb loss), not experiencing intended opioid effects, loss of functionality due to unwanted sedation, and concerns about overdose reversibility.
Conclusion
Findings suggest that people who use drugs are adapting consumption patterns and adopting harm reduction practices as coping responses to xylazine's adverse effects. Unlike previous major opioid market transitions that primarily differed in pharmacokinetics, xylazine introduces new risks while replacing desired psychoactive effects with undesirable ones. The widespread dissatisfaction with xylazine represents a unique opportunity to expand harm reduction interventions and explore safe supply policies while risk salience is high and user motivation for safer practices aligns with public health goals.
{"title":"A brick to a bundle: A qualitative study of behavioral responses to xylazine adulteration","authors":"Adams L. Sibley , Colin W. Miller , Elizabeth Joniak-Grant , Alice Bell , Malcolm Visnich , Steve Alsum , Nabarun Dasgupta","doi":"10.1016/j.drugpo.2025.105017","DOIUrl":"10.1016/j.drugpo.2025.105017","url":null,"abstract":"<div><h3>Background</h3><div>Xylazine, a veterinary tranquilizer, has emerged as a widespread adulterant in the U.S. illicit drug supply, detected in over 90 % of street fentanyl samples in some regions and identified in a growing number of overdose deaths. While xylazine's health risks are well-documented, little is known about how its presence influences substance use behaviors. We aimed to explore behavioral changes among people encountering xylazine in illicit drug markets.</div></div><div><h3>Methods</h3><div>We conducted semi-structured in-depth interviews with people with recent overdose reversal experiences in two Midwestern cities (<em>n</em> <em>=</em> 52) as part of a larger study on naloxone administration. Participants were asked about their knowledge and perceptions of local drug supply trends. Data were analyzed using the Rigorous and Accelerated Data Reduction technique. Protection Motivation Theory provided a theoretical framework.</div></div><div><h3>Results</h3><div>Participants overwhelmingly preferred opioids without xylazine. Almost all reported adjusting use toward safer practices in response to xylazine exposure: using less in amount or frequency, changing route of administration, or abstaining or seeking treatment. Behavior change was motivated by fear of negative outcomes, including physical health risks (particularly chronic wounds and limb loss), not experiencing intended opioid effects, loss of functionality due to unwanted sedation, and concerns about overdose reversibility.</div></div><div><h3>Conclusion</h3><div>Findings suggest that people who use drugs are adapting consumption patterns and adopting harm reduction practices as coping responses to xylazine's adverse effects. Unlike previous major opioid market transitions that primarily differed in pharmacokinetics, xylazine introduces new risks while replacing desired psychoactive effects with undesirable ones. The widespread dissatisfaction with xylazine represents a unique opportunity to expand harm reduction interventions and explore safe supply policies while risk salience is high and user motivation for safer practices aligns with public health goals.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105017"},"PeriodicalIF":4.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186974","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 : 2025-09-22DOI: 10.1016/j.drugpo.2025.104970
Ramez Bathish , Cameron Duff , Michael Savic
Alcohol and other drug residential rehabilitation is an abstinence-based modality for assisting people with long-standing concerns associated with their substance use. While ubiquitous, models of care in residential rehabilitation services vary widely and the impacts of the care delivered within them remain contentious. Critically, therapeutic processes in residential rehabilitation remain under-theorised with little attention given to the characteristics of “good care” within these settings. To examine this, an extended period of ethnographic fieldwork was conducted at one residential rehabilitation service in Eastern Australia, involving forty-one in-depth interviews with residents and staff, observations and documentary analysis. Drawing on critical accounts of care derived from science and technology studies, our analysis details how caring well in residential rehabilitation was enacted through repertoires of: tailoring care to the needs and preferences of individuals; choreographing care to attend to the multiple and diverse needs that circulate in residential rehabilitation; and dialoguing care to attune to the needs of those enmeshed in care relations. These repertoires also facilitated care by mitigating the totalising tendencies of institutional care, and enhancing meaningful engagement across the residential community, improving access to therapeutic resources that accrue in the program over time. This analysis emphasises the programmatic flexibility and complex, resource intensive relations necessary for the expression of “as-well-as-possible care”. It also alerts stakeholders to how systems of care both condition needs and enact vulnerabilities, challenging us to envisage new systems and relations to enable people to live better lives in accordance with their needs and preferences.
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Pub Date : 2025-09-22DOI: 10.1016/j.drugpo.2025.105015
Shane O’Mahony
The brain disease model of addiction (BDMA) is a dominant, if highly contested, model of drug addiction globally. Over many decades, researchers have marshalled evidence from animal studies, neuroimaging scans, and genome wide association studies to argue that addiction is a brain disease. However, critics have argued that the model de-emphasises social and economic contexts, downplays the phenomenon of spontaneous or natural recovery, and over-interprets neuroscientific findings. Building on this critical tradition, the current paper asks a related question: Has the claim that addiction is a brain disease helped or harmed those experiencing drug-related harm epistemically? While no definitive answer to this question is offered, the current paper argues that overall, the claim that addiction is a brain disease advanced by proponents of the BDMA has harmed substance users already experiencing multiple disadvantages epistemically.
Drawing on the concept of epistemic injustice, the current paper argues that the category ‘drugs’ creates an artificial and harmful dichotomy between those who use licit medicines and experience harm and those who use illicit substances and experience harm. Furthermore, this artificial dichotomy is compounded by racist and colonial discourses central to the war on drugs, and a rigid biological reductionism that de-emphasises social, economic, and cultural harm. The paper concludes by sketching an alternative approach rooted in epistemic justice, and a discussion of the implications of this concept for research and theory.
{"title":"The brain disease model of addiction and epistemic injustice","authors":"Shane O’Mahony","doi":"10.1016/j.drugpo.2025.105015","DOIUrl":"10.1016/j.drugpo.2025.105015","url":null,"abstract":"<div><div>The brain disease model of addiction (BDMA) is a dominant, if highly contested, model of drug addiction globally. Over many decades, researchers have marshalled evidence from animal studies, neuroimaging scans, and genome wide association studies to argue that addiction is a brain disease. However, critics have argued that the model de-emphasises social and economic contexts, downplays the phenomenon of spontaneous or natural recovery, and over-interprets neuroscientific findings. Building on this critical tradition, the current paper asks a related question: Has the claim that addiction is a brain disease helped or harmed those experiencing drug-related harm epistemically? While no definitive answer to this question is offered, the current paper argues that overall, the claim that addiction is a brain disease advanced by proponents of the BDMA has harmed substance users already experiencing multiple disadvantages epistemically.</div><div>Drawing on the concept of epistemic injustice, the current paper argues that the category ‘drugs’ creates an artificial and harmful dichotomy between those who use licit medicines and experience harm and those who use illicit substances and experience harm. Furthermore, this artificial dichotomy is compounded by racist and colonial discourses central to the war on drugs, and a rigid biological reductionism that de-emphasises social, economic, and cultural harm. The paper concludes by sketching an alternative approach rooted in epistemic justice, and a discussion of the implications of this concept for research and theory.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105015"},"PeriodicalIF":4.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104544","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 : 2025-09-20DOI: 10.1016/j.drugpo.2025.105013
Dara Ruane
Background
Prohibition-based drug policies such as recent UK draft legislation on recreational drug possession assume expanding police powers will deter use and thereby reduce harm. In fact research suggests punitive policing harms PWUD (people who use drugs) in recreational contexts by incentivising behaviours with lower legal but higher health risk. Although some vectors of this harm have been well researched (notably dog-assisted searches at festival gates), others are less understood. This article aims to help elucidate them by examining how enforcement strategies impacted participants’ ability to enact ‘responsible drug use’ at events.
Methods
An ethnographic study of volunteer drug crisis care ('psy-care') projects in three contrasting policy regimes comprised 52 days of participant observation, 23 care practitioner interviews, and a qualitative survey of 54 festivalgoers. Thematic analysis was conducted in NVivo within a grounded theory framework.
Results
Although harm reduction-based practices were preferred by holders of the ‘responsible drug use’ value system and enacted whenever policy allowed, heavily policed settings disincentivised them or rendered them impossible while favouring medically riskier behaviours with lower legal risk. Confiscation at gates negated the risk mitigation effects of pre-measured, tested 'stashes'. Information-rich transactions with accountable dealers became unfeasible, while hasty, anonymous transactions appeared safer. Drug checking services (DCS) were rare, while informal sample checks involved legal jeopardy. Vigilance for police undermined efforts to cultivate a 'set and setting' conducive to unproblematic drug experiences, while both uniformed and undercover policing obstructed access to formal and informal crisis support.
Conclusions
This article shows that tough policing incentivises risk-taking even among those for whom 'responsible drug use' and harm reduction are strongly held values, illustrating the impact of policing-related perverse incentives on PWUD in recreational settings more generally.
{"title":"Reluctant risk-takers: how law enforcement practices at festivals can obstruct safer drug use","authors":"Dara Ruane","doi":"10.1016/j.drugpo.2025.105013","DOIUrl":"10.1016/j.drugpo.2025.105013","url":null,"abstract":"<div><h3>Background</h3><div>Prohibition-based drug policies such as recent UK draft legislation on recreational drug possession assume expanding police powers will deter use and thereby reduce harm. In fact research suggests punitive policing harms PWUD (people who use drugs) in recreational contexts by incentivising behaviours with lower legal but higher health risk. Although some vectors of this harm have been well researched (notably dog-assisted searches at festival gates), others are less understood. This article aims to help elucidate them by examining how enforcement strategies impacted participants’ ability to enact ‘responsible drug use’ at events.</div></div><div><h3>Methods</h3><div>An ethnographic study of volunteer drug crisis care ('psy-care') projects in three contrasting policy regimes comprised 52 days of participant observation, 23 care practitioner interviews, and a qualitative survey of 54 festivalgoers. Thematic analysis was conducted in NVivo within a grounded theory framework.</div></div><div><h3>Results</h3><div>Although harm reduction-based practices were preferred by holders of the ‘responsible drug use’ value system and enacted whenever policy allowed, heavily policed settings disincentivised them or rendered them impossible while favouring medically riskier behaviours with lower legal risk. Confiscation at gates negated the risk mitigation effects of pre-measured, tested 'stashes'. Information-rich transactions with accountable dealers became unfeasible, while hasty, anonymous transactions appeared safer. Drug checking services (DCS) were rare, while informal sample checks involved legal jeopardy. Vigilance for police undermined efforts to cultivate a 'set and setting' conducive to unproblematic drug experiences, while both uniformed and undercover policing obstructed access to formal and informal crisis support.</div></div><div><h3>Conclusions</h3><div>This article shows that tough policing incentivises risk-taking even among those for whom 'responsible drug use' and harm reduction are strongly held values, illustrating the impact of policing-related perverse incentives on PWUD in recreational settings more generally.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105013"},"PeriodicalIF":4.4,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094973","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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