Injection drug use (IDU) poses significant public health risks, including the transmission of blood-borne infections such as hepatitis B (HBV) and hepatitis C (HCV). This study aims to evaluate the prevalence of risk behaviors associated with IDU and the prevalence of HBV and HCV among people who inject drugs (PWID) in Georgia.
Methods
A cross-sectional study was conducted in seven cities of Georgia in 2022, involving 2005 PWID aged ≥18 years. Participants were recruited using respondent-driven sampling. Data were collected through face-to-face interviews and blood samples were collected for HCV/HBV testing.
Results
The majority of study participants (98.6%) were males, 63.2% were older than 40 years, and 51.3% had a history of imprisonment. 24.4% reported using a needle/syringe previously used by someone else. HCV seropositivity was found in 58.1% of respondents, with 32.1% of anti-HCV positive individuals testing positive for HCV RNA. HBV surface antigen was detected in 2.5%. Only 7.5% reported being vaccinated for hepatitis B and 27.8% expressed willingness to be vaccinated. 33.9% had HCV treatment history. HCV prevalence was significantly higher among males, older PWID, those with a history of incarceration and history of sharing needles used by others.
Conclusion
Our findings highlight the high prevalence of HCV and low HBV vaccination rates among PWID in Georgia, emphasizing the need for strengthened harm reduction strategies. Expanding sterile injection access, integrating HBV vaccination, and removing structural barriers are key to improving prevention and testing efforts and linkage to care.
{"title":"Risk behaviors and prevalence of hepatitis B and C among people who inject drugs in Georgia: integrated bio-behavioral survey (IBBS)","authors":"Kanchelashvili Giorgi , Butsashvili Maia , Kochlamazashvili Marika , Gulbiani Lasha , Abashidze Giga , Kamkamidze Tina , Abzianidze Tinatin , Adamia Sopio , Chelidze Nikoloz , Stvilia Ketevan , Kamkamidze George","doi":"10.1016/j.drugpo.2026.105177","DOIUrl":"10.1016/j.drugpo.2026.105177","url":null,"abstract":"<div><h3>Introduction</h3><div>Injection drug use (IDU) poses significant public health risks, including the transmission of blood-borne infections such as hepatitis B (HBV) and hepatitis C (HCV). This study aims to evaluate the prevalence of risk behaviors associated with IDU and the prevalence of HBV and HCV among people who inject drugs (PWID) in Georgia.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in seven cities of Georgia in 2022, involving 2005 PWID aged ≥18 years. Participants were recruited using respondent-driven sampling. Data were collected through face-to-face interviews and blood samples were collected for HCV/HBV testing.</div></div><div><h3>Results</h3><div>The majority of study participants (98.6%) were males, 63.2% were older than 40 years, and 51.3% had a history of imprisonment. 24.4% reported using a needle/syringe previously used by someone else. HCV seropositivity was found in 58.1% of respondents, with 32.1% of anti-HCV positive individuals testing positive for HCV RNA. HBV surface antigen was detected in 2.5%. Only 7.5% reported being vaccinated for hepatitis B and 27.8% expressed willingness to be vaccinated. 33.9% had HCV treatment history. HCV prevalence was significantly higher among males, older PWID, those with a history of incarceration and history of sharing needles used by others.</div></div><div><h3>Conclusion</h3><div>Our findings highlight the high prevalence of HCV and low HBV vaccination rates among PWID in Georgia, emphasizing the need for strengthened harm reduction strategies. Expanding sterile injection access, integrating HBV vaccination, and removing structural barriers are key to improving prevention and testing efforts and linkage to care.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105177"},"PeriodicalIF":4.4,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192229","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 : 2026-02-11DOI: 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":"2026-02-11","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 : 2026-02-11DOI: 10.1016/j.drugpo.2026.105182
Teodora Groshkova, Alexander Söderholm, Marieke Liem, Kim Moeller, Seán Redmond, Paul Griffiths, Karin Svanberg, Célia Bobet, Liesbeth Vandam, Marica Ferri, Andrew Cunningham
Not applicable.
不适用。
{"title":"Breaking the cycle: addressing the evolving dynamic of violence associated with the European drug market","authors":"Teodora Groshkova, Alexander Söderholm, Marieke Liem, Kim Moeller, Seán Redmond, Paul Griffiths, Karin Svanberg, Célia Bobet, Liesbeth Vandam, Marica Ferri, Andrew Cunningham","doi":"10.1016/j.drugpo.2026.105182","DOIUrl":"10.1016/j.drugpo.2026.105182","url":null,"abstract":"<div><div>Not applicable.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"150 ","pages":"Article 105182"},"PeriodicalIF":4.4,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182902","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 : 2026-02-06DOI: 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":"2026-02-06","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 : 2026-02-05DOI: 10.1016/j.drugpo.2025.105062
Louisa Degenhardt, Matthew Hickman, Frederick L Altice, Jason Grebely, Sophia Taylor, Michelle Lynch, Aleksa Kamenjas, 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 Kamenjas, 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":"https://doi.org/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":"2026-02-05","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 : 2026-02-05DOI: 10.1016/j.drugpo.2025.105069
Thomas Santo, Matthew Hickman, Frederick L Altice, Jason Grebely, Sophia Taylor, Michelle Lynch, Aleksa Kamenjaš, Jack Marsden, Lucy T Tran, Paige Webb, Olivia Price, Christel Macdonald, Linda Montanari, Luis Royuela, Anja Busse, Jack Stone, Filipa Alves da Costa, Justin Berk, Colleen Daniels, Evan Cunningham, Peter Vickerman, Behzad Hajarizadeh, Keith Sabin, Annette Verster, Michael Farrell, Louisa Degenhardt
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 192,500) 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.
{"title":"Global coverage of interventions for reduction of injecting drug use-related harm, HIV, viral hepatitis and tuberculosis in prisons and other carceral settings: A systematic review.","authors":"Thomas Santo, Matthew Hickman, Frederick L Altice, Jason Grebely, Sophia Taylor, Michelle Lynch, Aleksa Kamenjaš, Jack Marsden, Lucy T Tran, Paige Webb, Olivia Price, Christel Macdonald, Linda Montanari, Luis Royuela, Anja Busse, Jack Stone, Filipa Alves da Costa, Justin Berk, Colleen Daniels, Evan Cunningham, Peter Vickerman, Behzad Hajarizadeh, Keith Sabin, Annette Verster, Michael Farrell, Louisa Degenhardt","doi":"10.1016/j.drugpo.2025.105069","DOIUrl":"https://doi.org/10.1016/j.drugpo.2025.105069","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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 192,500) 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.</p><p><strong>Interpretation: </strong>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.</p><p><strong>Funding: </strong>Australian National Health and Medical Research Council.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":" ","pages":"105069"},"PeriodicalIF":4.4,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133322","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 : 2026-02-03DOI: 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":"2026-02-03","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 : 2026-02-03DOI: 10.1016/j.drugpo.2026.105175
Ronja Maria Järvelin
This study examines the emergence of problematic cannabis use as a dynamic, networked, and affective process. Drawing on Actor-Network Theory and Deleuze’s concept of affect, the analysis explores how shifting assemblages of human and non-human actors shape agency over time. The data consist of interviews with 23 participants and 16 written accounts submitted by individuals who self-identified their cannabis use as problematic. Through close reading of participants' narratives combined with network mapping, three phases were identified: opening, sustaining, and restricting networks. In the opening phase, network relations expand affective capacity by opening up new ways of thinking and extending the body’s range of movement in space. In the sustaining phase, these relations stabilize as cannabis becomes part of everyday routines that reproduce familiar rhythms rather than generating new openings. In the restricting phase, configurations involving specific material fixators (such as the bed, sofa, or digital devices) begin to limit spatial, emotional, and embodied possibilities, resulting in a contraction of affective capacity. These phases offer a heuristic framework for analyzing how problematic use stabilizes within socio-material assemblages, rather than as an outcome of isolated individual vulnerabilities. This perspective contributes to ongoing discussions in drug research by emphasizing relational dynamics and may inform treatment by identifying core networked actors that sustain or limit agency. Future research should examine how restricting networks may unravel and give rise to new affective landscapes.
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Pub Date : 2026-01-30DOI: 10.1016/j.drugpo.2026.105172
Ana Millot , François Topart , Janet Hoek , Karine Gallopel-Morvan
Background
In France, the evidence-based policies recommended by the World Health Organization SAFER program remain poorly implemented, despite relatively high levels of alcohol consumption and alcohol-related harms. To understand this paradox, we used Kingdon’s Multiple Streams Approach (MSA) as framework to analyze how members of the French parliament perceive alcohol and how alcohol industry and public health actors influence their decision-making.
Methods
We conducted twenty-five interviews with French deputies and senators from different political parties and regions. We built the interview guide following the three MSA streams: problem, policy, and political. We performed a thematic content analysis of the interview data using Nvivo to manage the data.
Results
The interviewed deputies and senators held ambivalent views on alcohol (problem stream): they acknowledged its health and social harms, but also emphasized its cultural and economic benefits. They supported low-evidence-based alcohol policies (e.g., education and targeted prevention) and showed limited support for Minimum Unit Pricing (MUP) policies (policy stream). Several arguments used by the alcohol industry against MUP emerged, including negative economic effects and illicit trade. The interviewed deputies and senators also reported more frequent interactions with alcohol industry actors than with public health actors (political stream).
Conclusion
In line with the MSA streams, our findings suggest that ambivalent framing of alcohol, weak support for evidence-based measures and a wine-favorable political environment may explain the weak alcohol control policies in France. Future research should include additional stakeholders to capture the full set of dynamics that contribute to policy inertia.
{"title":"Barriers to evidence-based alcohol policies in France: Insights from interviews with parliament members","authors":"Ana Millot , François Topart , Janet Hoek , Karine Gallopel-Morvan","doi":"10.1016/j.drugpo.2026.105172","DOIUrl":"10.1016/j.drugpo.2026.105172","url":null,"abstract":"<div><h3>Background</h3><div>In France, the evidence-based policies recommended by the World Health Organization SAFER program remain poorly implemented, despite relatively high levels of alcohol consumption and alcohol-related harms. To understand this paradox, we used Kingdon’s Multiple Streams Approach (MSA) as framework to analyze how members of the French parliament perceive alcohol and how alcohol industry and public health actors influence their decision-making.</div></div><div><h3>Methods</h3><div>We conducted twenty-five interviews with French deputies and senators from different political parties and regions. We built the interview guide following the three MSA streams: problem, policy, and political. We performed a thematic content analysis of the interview data using Nvivo to manage the data.</div></div><div><h3>Results</h3><div>The interviewed deputies and senators held ambivalent views on alcohol (problem stream): they acknowledged its health and social harms, but also emphasized its cultural and economic benefits. They supported low-evidence-based alcohol policies (e.g., education and targeted prevention) and showed limited support for Minimum Unit Pricing (MUP) policies (policy stream). Several arguments used by the alcohol industry against MUP emerged, including negative economic effects and illicit trade. The interviewed deputies and senators also reported more frequent interactions with alcohol industry actors than with public health actors (political stream).</div></div><div><h3>Conclusion</h3><div>In line with the MSA streams, our findings suggest that ambivalent framing of alcohol, weak support for evidence-based measures and a wine-favorable political environment may explain the weak alcohol control policies in France. Future research should include additional stakeholders to capture the full set of dynamics that contribute to policy inertia.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105172"},"PeriodicalIF":4.4,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078482","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 : 2026-01-30DOI: 10.1016/j.drugpo.2026.105176
Kim Moeller , Kamilla Haugen , Marieke Liem
The European cocaine market has undergone rapid transformations in recent years, with supply increasing and shifting geographically from southern to northwestern ports. These changes have implications for Northern Europe, as shorter distribution routes may affect prices, purity, and consumption. An unstable cocaine market may also increase risks of drug-related systemic violence.
This commentary assesses the utility of EU cocaine market indicators by examining trends in the Netherlands, Denmark and Sweden. Using data on price, purity and aggregate use reported to the European Union Drugs Agency (EUDA), we evaluate the quality and consistency of these indicators. We found that reporting for wholesale price and purity was highly inconsistent, while retail-level data were more complete, particularly from 2007 to 2023. Wastewater analysis provided a proxy for aggregate use.
Consistent with theoretical expectations, the markets in the three countries appear integrated, suggesting a supply route originating in the Netherlands and moving northward. Data deficiencies constrain research and policymaking at a time when a changing market increases risks of instability and violence.
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