International Journal of Drug Policy最新文献

Background: People who are incarcerated experience disproportionately high rates of injecting drug use and infectious disease, including HIV, viral hepatitis and tuberculosis. However, comprehensive global data regarding the availability of services that prevent and manage infectious disease, injecting drug use and related harms remain limited and outdated. We provide the first systematic review to comprehensively examine the availability and coverage of infectious disease prevention, treatment, and harm reduction services for incarcerated populations globally.

Methods: We conducted a systematic review of evidence for provision of opioid agonist treatment (OAT), needle syringe programs (NSPs), HIV testing and antiretroviral therapy (ART), hepatitis C virus (HCV) testing and direct-acting antiviral (DAA) treatment, tuberculosis screening and treatment, hepatitis B virus (HBV) testing, treatment, and vaccination in carceral settings. We searched from peer-reviewed and grey literature databases between 2000 and 2025 and used the most recent data available for each indicator.

Findings: OAT was documented in 59/207 countries (29 %), and NSPs in ten (5 %). HIV testing was documented in 86 countries (42 %) and ART in 79 countries (38 %). HCV testing was confirmed in 55 (27 %), with DAA treatment in 47 (23 %). HBV testing was identified in 51 countries (25 %), treatment in 36 (17 %), and vaccination in 41 (20 %). Tuberculosis screening was documented in 96 countries (46 %) and treatment in 81 (39 %). Fewer than 2 % (approximately 172,000) of the 11.3 million people incarcerated worldwide live in countries that offer OAT, NSPs, and treatment for HIV, HCV, HBV, and tuberculosis in at least one carceral facility. There is not a single country where incarcerated people have access to all such services in every facility. Programme level evidence was rarely available.

Interpretation: The global shortage of services that prevent and treat infectious disease and harms related to injecting drug use in carceral settings is a critical public health issue and, compared with community standards, a breach of human rights. This study underscores the urgent need for international collaboration and policy reform to scale up and stabilise services that address the health needs of incarcerated populations, ultimately improving health outcomes for both incarcerated populations and wider community.

Funding: Australian National Health and Medical Research Council.

Background: In 2022, an estimated 74,400 people in Australia were living with hepatitis C. Despite an initial rapid uptake of direct acting antiviral treatment after their approval for use in Australia in 2016, national hepatitis C testing and treatment rates have declined since 2019. In response, It's Your Right, a national health promotion campaign co-designed with and for people with lived-living experience of injecting drug use and/or hepatitis C, was implemented in all Australian states and territories in 2022. This article presents outcomes of the campaign.

Methods: A mixed methods evaluation was co-designed with peer workers from peer-led drug user organisations and community-based hepatitis organisations. Campaign outcomes included analysis of social marketing reach data, hepatitis C testing and treatment data, and client survey.

Results: It's Your Right demonstrated wide reach with >8.9 million people seeing the campaign. The campaign was memorable - 53 % of clients from the implementing organisations who were surveyed demonstrated unprompted campaign recall, while 72 % remembered the campaign when prompted. Implementing organisations documented 2595 conversations about hepatitis C with clients, conducted 1343 hepatitis C tests, referred 151 people for treatment, and utilised 1254 incentives to engage clients in hepatitis C care during the campaign period. Thirty-eight percent of survey participants spoke to a peer worker, and 31 % accessed testing, due to seeing the campaign.

Conclusion: It's Your Right was highly valued by implementing organisations and reached people in the community who inject drugs. The campaign inspired people to seek out support from peer workers and take up hepatitis C testing.

Background: Purity-adjusted prices of illicit drugs are related to drug harms. In this study we examined the time series of purity adjusted prices of crystal methamphetamine and heroin between 2009 and 2020 in Victoria, Australia, and whether this varied by rurality.

Methods: Data on purity of illicit drug seizures by Victoria Police (2009-2020; n = 47,696) were analysed alongside surveys from two prospective cohort studies of people who use drugs in metropolitan and rural Victoria. Heroin and crystal methamphetamine price, purity, and purity-adjusted price were computed for metropolitan Melbourne (2009-2020) and rural Victoria (2016-2020), adjusted for inflation.

Results: Initial rises in unadjusted crystal methamphetamine prices in metropolitan Melbourne were offset by increasing purity levels, leading to a decline in the average purity-adjusted price from AUD 1360 per pure gram (PPG) in 2009 to AUD 330 in 2019, after which it stabilised. Similarly, in rural Victoria, purity-adjusted prices declined between 2016 and 2019, followed by an increase, reaching AUD 600 PPG by 2020. Overall, average purity-adjusted prices were significantly higher in rural Victoria compared to metropolitan Melbourne. The average purity-adjusted PPG for heroin in metropolitan Melbourne increased from AUD 1300 PPG in 2009 until 2014, before declining to AUD 770 by 2020.

Conclusion: Overall declines in both crystal methamphetamine and heroin purity-adjusted prices in Victoria suggests that, by 2019, people who purchased these drugs received more drug for a given purchase than in previous years. These changes closely match trends seen in some key harms such as opioid overdose.

Background: Indigenous-led initiatives to improve access to opioid use disorder (OUD) treatment and harm reduction are helping transform care and safety for First Nations Peoples. Safer opioid supply (SOS) involves the provision of pharmaceutical-grade opioids as an alternative to the unregulated drug supply. We sought to examine trends and characteristics of First Nations Peoples initiating SOS in Ontario, Canada.

Methods: We conducted a population-based cross-sectional study of registered First Nations Peoples in Ontario with OUD, who initiated SOS between January 1, 2019 and December 31, 2023. We reported the number and rate of SOS initiations per 1000 First Nations Peoples annually, and characteristics for 2023, including sex, age (15-24, 25-44, 45-64, 65+ years), and residence in urban vs. rural regions and within vs. outside of First Nations communities RESULTS: The annual rate of SOS initiations among First Nations Peoples increased dramatically between 2019 and 2023 (0.11 to 0.65 per 1000; N = 15 to 92). In 2023, SOS initiation was similar between males and females (0.69 vs. 0.61 per 1000), with the highest rate among those aged 25-44 years (1.32 per 1000; N = 71). Most SOS initiations were among individuals residing outside vs. within First Nations communities (0.90 vs. 0.13 per 1000) and urban vs. rural regions (1.05 vs. 0.13 per 1000).

Conclusions: Overall, the rate of First Nations Peoples accessing SOS in Ontario increased almost five-fold, demonstrating growing engagement with this harm reduction approach. Future research is needed to understand First Nations People's experiences with SOS, and the impacts of program closures across Canada.

Introduction: Supervised Consumption Sites (SCS) are public health interventions aimed to reduce harms associated with illicit substance use. SCS contend with polarization and public scrutiny which hinder its implementation and operation despite robust evidence demonstrating its effectiveness at preventing fatal overdoses. In this study, we examined data from a nationwide survey to explore attitudes of PWUS (individuals with lived or living experiences of substance use), healthcare providers (HCP), and first responders towards SCS.

Methods: This is a cross-sectional study reporting data from the Canadian National Questionnaire on Overdose Monitoring (CNQOM) database. One component of the CNQOM focused on assessing attitudes towards SCS, including perspectives on client considerations, community impact, impact on emergency services, the healthcare system, and other diverse settings. Participants responded to a 5-point Likert scale and data was analyzed using the Wilcoxon Rank Sum Test.

Results: 1579 participants across Canada were included in this study, including 826 PWUS, 381 HCP, and 372 first responders. In general, participants felt that SCS positively impacted certain service aspects, such as client access and safety. However, participants held mixed attitudes towards aspects such as community benefits and healthcare resource utilization. Although participants did view SCS negatively on a few aspects, the magnitude of these perceptions was generally smaller than the positive perceptions of SCS.

Conclusion: While the findings of this study highlighted the perceived positive impacts of SCS from the perspective of key stakeholders, there is still a need to address service gaps during program development, ongoing public education, and areas where the key interest groups could be better informed about SCS.

Background: Due to concerns about misuse and diversion, eight states have scheduled gabapentin as a controlled substance. The effect of this change on patient adherence is unknown.

Objectives: To estimate the effect of Virginia's scheduling of gabapentin on medication adherence among epilepsy patients.

Research design: Using all-payer claims data from Virginia and Colorado for 2017-2019, we identified patients with focal seizures who had a claim for gabapentin, pregabalin, or levetiracetam. The primary outcome was proportion of days covered over six-month periods. Effects were estimated using a triple-difference approach comparing patients 1) pre- vs. post-policy, 2) in Virginia vs. Colorado, and 3) on gabapentin vs a comparison medication. Analyses were repeated excluding patients with opioid claims.

Results: Gabapentin scheduling in Virginia was associated with a 3.6 (SD: 1.1, p-value <0.001) percentage point decrease in proportion of days covered. The share of epilepsy patients with ≥80% of days covered decreased from 67.5% to 60.2% (adjusted difference: -7.5%, SD: 2.2, p-value <0.001). The proportion of gabapentin patients with a concurrent opioid prescription did not significantly change and excluding these patients had minimal effect.

Conclusions: In the six months following Virginia's policy change, scheduling gabapentin was associated with a decline in the proportion of days covered among epilepsy patients. Given ongoing state-level gabapentin policy changes, continued research on the impacts of scheduling gabapentin on patient care and barriers to medication access is warranted.