International Journal of Drug Policy最新文献

Background: Harm reduction vending machines (HRVMs) that dispense safe injection equipment and other supplies have operated globally for more than 30 years, yet few operate in the U.S., particularly in the rural epicenters of drug-related harms. This study explores likelihood of using HRVMs and correlates thereto among people who inject drugs in rural Appalachian Kentucky.

Methods: Respondent-driven sampling and outreach were used to recruit participants who were age 18 or older, resided in an Appalachian Kentucky county, and had used opioids and/or injected drugs to get high in the past 30 days. Interviewer-administered questionnaires elicited data on behavioral and demographic characteristics and likelihood of using HRVMs. Analyses were restricted to participants who injected in the past 6 months (n = 259). Generalized estimating equations were used to estimate adjusted prevalence ratios (APRs) for correlates to likelihood of using HRVMs, controlling for lifetime use of brick-and-mortar syringe service programs.

Results: Overall, 57 % reported being likely to use HRVMs. Participants who lacked consistent access to transportation, engaged in receptive and distributive syringe sharing, experienced more lifetime overdoses, and had unsuccessfully attempted to access medications for opioid use disorder (MOUD) reported being more likely to use HRVMs. Heroin and prescription opioid use were negatively associated with likelihood of HRVM use, as was experience of shame around drug use.

Conclusions: Most people who inject drugs in this rural Appalachian sample were likely to use HRVMs, with interest being highest among those at highest risk for injection-related infections and overdose and who had faced difficulty accessing MOUD.

Background: Recreational cannabis use is increasing in Mexico, where legalization is a possibility. The current area-level socioeconomic context of cannabis use has not been studied in the country, limiting our understanding and public health response. We aimed to analyze the association between the municipal socioeconomic environment and recreational cannabis use in Mexico.

Methods: We used data from the National Survey of Drug, Alcohol and Tobacco Consumption 2016-17, the National Health and Nutrition Survey 2023, the 2015 intercensal survey and the 2020 census to study the association of municipal income and municipal education with past-year recreational cannabis use. We fitted Poisson models with robust variance to obtain prevalence ratios and assessed for effect modification by individual-level sex and age, and household-level education.

Results: For every unit increase in municipal education, we observed a 1.5 % increase in the prevalence of recreational cannabis use in 2016-17, and a 2.9 % increase in 2023. For each unit increase in municipal income, we observed a 1.5 % increase in the prevalence of recreational cannabis use in 2016-17, and a 1.8 % increase in 2023. We found no effect modification except for a single age group (20- to 29-year-olds vs to 12- to 19-year-olds).

Conclusion: Recreational cannabis use in Mexico is currently higher in more socioeconomically advantaged municipalities. Recreational cannabis use through socioeconomic areas should be monitored closely. Further research of the modifiable causes of this association could help inform current and future public health policies.

Background: News media is an important determinant of public understanding of drug policy topics. Recent media reporting around the use of synthetic drugs such as xylazine makes frequent use of non-human metaphors, including reference to the effects of 'zombie drugs'. We investigated whether presentation of news stories which included such dehumanising frames were associated with i) increased stigmatising attitudes towards people who use drugs; and ii) lower support for relevant harm reduction programmes.

Methods: We undertook a cross-sectional online experimental study with a randomised factorial design, using a nationally representative sample (UK). Participants (N = 1417) were randomly presented with one of six simulated news stories based on recent reports of the identification of xylazine in the drug market. Stories differed with respect to text (neutral or referred to either a 'zombie drug', or a drug that 'turns people into zombies'); and accompanying imagery (neutral or depicting immobile people under the influence of drugs). Stigmatising attitudes and support for harm reduction were assessed using instruments including an adapted version of the Attribution Questionnaire-Substance Use Disorders (AQ-SUD) and analysed using MANOVA.

Results: Data were obtained for 1235 participants (52 % female; mean age 47 ± 16). Attitudes towards people who use drugs were more stigmatising amongst participants presented with either of the dehumanising text conditions (both p < 0.001). There was no main effect of imagery and no interaction between text and imagery on stigma scores. Support for harm reduction programmes did not differ between conditions.

Conclusion: Our study is the first to show that dehumanising 'zombie' framing frequently used in news reporting is associated with higher public stigma towards people who use drugs. News media is an important source of public education on drugs, so to avoid reinforcing stigma the use of dehumanising language and framing, such as 'zombie' metaphors, should be avoided. Organisations working to reduce stigma towards people who use drugs should encourage news outputs and journalists to avoid this type of representation.

Background: Wider availability of cannabis through medical and recreational legalization (MCL alone and RCL+MCL) has been hypothesized to contribute to reductions in opioid use, misuse, and related harms. We examined whether state adoption of cannabis laws was associated with changes in opioid outcomes overall and stratified by cannabis use.

Methods: Using National Survey on Drug Use and Health (NSDUH) data from 2015 to 2019, we estimated cannabis law associations with opioid (prescription opioid misuse and/or heroin use) misuse and use disorder. All logistic regression models (overall models and models stratified by cannabis use), included year and state fixed effects, individual level covariates, and opioid-related state policies. Stratified analyses were restricted to individuals who reported lifetime cannabis use prior to law adoption to reduce potential for collider bias. Estimates accounted for multiple comparisons using false discovery rate (FDR) corrections and sensitivity to unmeasured confounding using e-values.

Results: Overall, MCL and RCL adoption were not associated with changes in the odds of any opioid outcome. After restricting to respondents reporting past-year cannabis use, we observed decreased odds of past year opioid misuse (adjusted odds ratio [AOR]: 0.57 [95 % confidence interval [CI]: 0.38, 0.85]; FDR p-value: 0.07), among individuals in states with MCL compared to those in states without cannabis laws. RCLs were not associated with changes in the odds of any opioid outcome beyond MCL adoption.

Conclusion: Comparing individuals in MCL alone states to those in states without such laws, we found an inconsistent pattern of decreased odds of opioid outcomes, which were more pronounced among people reporting cannabis use. The pattern did not hold for individuals in RCL states. In line with a substitution-oriented perspective, findings suggests that MCLs may be associated with reductions in opioid use among people using cannabis but additional work to replicate and expand on these findings is needed.

Background: In consideration of rising opioid-stimulant deaths in the United States, this study explored rates of naloxone administration and survival in suspected opioid overdoses with, versus without, stimulants co-involved.

Methods: The study analyzed 26,635 suspected opioid-involved overdoses recorded by law enforcement/first-responders in the Pennsylvania Overdose Information Network in 63 Pennsylvania counties, January 2018-July 2024. All measures, including suspected drug involvement, were based on first-responder assessment/report. Relative frequencies and chi-square tests were first used to compare suspected opioid overdoses with, versus without, stimulants (cocaine or methamphetamine) co-involved. Next, mediation analyses tested naloxone administration as a mediator in the association between stimulant co-involvement (in opioid overdoses) and survival.

Results: Naloxone was reportedly administered in 72.2 % of the suspected opioid-no-cocaine overdoses, compared to 55.1 % of the opioid-cocaine-involved overdoses, and 72.1 % of the opioid-no-methamphetamine overdoses vs. 52.4 % of the opioid-methamphetamine-involved overdoses. With respect to survival rates, 18.0 % of the suspected opioid-no-cocaine overdoses ended in death, compared to 41.3 % of the opioid-cocaine overdoses; 18.1 % of the opioid-no-methamphetamine overdoses ended in death, versus 42.9 % of the opioid-methamphetamine overdoses. In mediation analyses (adjusted for demographics, county, year, and other drug co-involvement), naloxone administration mediated 38.7 % (95 % Confidence Interval [CI], 31.3-46.0 %) of the association between suspected cocaine co-involvement and survival and 39.2 % (95 % CI, 31.3-47.1 %) of the association between suspected methamphetamine co-involvement and survival.

Conclusions: Among suspected opioid overdoses recorded in the Pennsylvania Overdose Information Network, stimulant co-involvement was associated with lower naloxone administration and higher fatality, with naloxone partially mediating the association between stimulant co-involvement and death.

Background: Recent measures to curb use and harms of pharmaceutical opioids in Australia have reduced dispensings of opioid analgesics for pain, under Australia's Pharmaceutical Benefits Scheme (PBS). But information on trends in private (self-funded) dispensings and public (government-funded) hospital opioids use is not readily available. Our study describes eight-year population-level trends in Australia's prescribed opioid analgesic use, estimating PBS dispensing claims, private dispensings and hospital use.

Methods: Our descriptive study used two datasets covering 2015 to 2022: national IQVIA data on all (PBS/private) pharmaceutical sales to community pharmacies, hospitals and other settings, and PBS dispensing claims data for a 10 % sample of Australian residents, extrapolated to estimate national PBS claims. We measured total units of each opioid sold/dispensed, converted into oral morphine equivalent milligrams (OME)/1000 population/day. We estimated private dispensings/public hospitals use by subtracting PBS OME from total OME sold. We calculated hospital OME using sales to hospitals. We assessed annual trends using Joinpoint regression.

Results: Between 2015 and 2022 total prescribed opioid analgesic use decreased by 21.2 % , from 1231.4 to 970.6 OME/1000/day (-3.4% per year, p < 0.001). Between 2015 and 2022, PBS dispensing claims decreased by -353.4 OME/1000/day, from 1061.7 to 708.4 OME/1000/day (-5.9 % per year; p < 0.001). In contrast, private dispensings/public hospital use increased by +92.5 OME/1000/day, from 169.7 to 262.3 OME/1000/day (+6.7 % per year; p < 0.001). The contribution of private dispensings/public hospital use to total prescribed opioid analgesic use doubled between 2015 and 2022 from 13.8 % to 27.0 %. Opioid use in hospitals remained stable (-1.1 % per year, p = 0.07), accounting for 8 to 10 % of total use between 2015 and 2022.

Discussion: Prescribed opioid analgesic use declined between 2015 and 2022 because of reductions in PBS dispensing claims. A quarter of the reduction in PBS dispensing claims was offset by use outside the PBS. Our findings indicate a significant increase in private use, reasons for which may include accessing opioids not PBS-subsidised and circumventing PBS restrictions for PBS-subsidised opioids. Comparing multiple data sources provides a comprehensive account of prescribed opioid analgesic use in Australia.

Background: Global policies emphasise the need for tailored interventions to reduce the harms of sexualised drug use (SDU) among men who have sex with men (MSM), including taking account of local risk environments and the influence of social norms, drug and sexual minority stigma, and cultural and political conditions. To help guide the production of local SDU harm reduction interventions, this study aimed to explore the social and structural conditions that shape the practice of, and response to, SDU by MSM in Jakarta, Indonesia.

Methods: Informed by an interactionism theoretical perspective and socioecological frameworks, a reflexive thematic approach was used to analyse in-depth qualitative interview data from 20 MSM who practised SDU in Jakarta. To recruit the participants, the study was promoted through local organisations providing HIV services for MSM, as well as snowball recruitment.

Results: To protect their SDU practice, MSM in Jakarta developed a set of social risk management strategies designed to reduce the generative tension between enabling and disabling forces caused by local social and structural environments. Enabling forces emerged primarily from within MSM networks, were extended through the interpersonal dynamics of sexual partner relationships to peer influence and reinforced by product branding and marketing on both offline and online platforms. The disabling forces, which were introduced primarily from outside the network, manifested in stigmatising social norms, politics and religious beliefs towards homosexuality and drug use, and forced MSM who practised SDU to relocate to virtual environments.

Conclusion: Programmatic responses seeking to mitigate the risks associated with SDU practice among sexual minority men should incorporate established mechanisms of peer networks and virtual spaces into their design to maximise reach and intervention acceptability and effectiveness.

Introduction: The emergence of xylazine into the U.S. drug supply has increased demand for wound care services among people who inject drugs (PWID). Traditional health care settings have historically been ill-equipped to accommodate the complex needs of PWID and syringe service programs (SSPs) have created wound care services to fill the gap. In doing so, many SSPs are extending the scope of their services beyond health promotion into a quasi-medical space that is largely unregulated.

Methods: We conducted 10 qualitative interviews with staff employed by eight SSP programs across six counties in the state of Maryland to explore how they have navigated shifting demand for more intensive wound care services.

Results: Contested boundaries in training of non-medical staff, lack of clarity in SSP-based providers' scope of practice, and conflicts in operational norms and standards between harm reduction and medical services are significant sources of tension that impact delivery of wound care services in SSP settings. In taking on responsibility to provide wound care services to PWID, SSPs take on significant administrative, practical, and ethical burden that increase vulnerability to medicolegal liability.

Discussion: There is a significant unmet need for increased resources, administrative support, and mentorship to guide the integration of medicalized wound care into SSP programs. Additionally, efforts to expand access to community-based wound care services for PWID should not replace efforts to promote timely access to services in more traditional healthcare settings.

Introduction: Women at midlife have increased rates of harmful drinking in many high-income countries. This cohort grew up within permissive alcohol environments that encouraged women's consumption, linking it to success, femininity, and empowerment. This research drew on notions of 'structures of feeling' and 'affective atmospheres' to explore how women at midlife describe and make sense of alcohol and drinking within their lives.

Methods: Eight friendship discussion groups and 17 individual interviews were conducted with 50 women (aged 35-59 years) in Aotearoa/New Zealand about alcohol and drinking. Transcripts were analysed using an affective-discursive approach.

Findings: Shaped by idealised femininities and alcohol's chemical affordances, particular affective atmospheres and feelings arose in women before, during, and after drinking, providing insights into women's experiences and sense-making around alcohol. Three areas of life were highly affectively charged in discussions, namely drinking that: 1) enabled bonding with partner, 2) facilitated time out from busy lives, and 3) was part of coping with life's difficulties.

Discussion and conclusions: Women at midlife experienced pressures to be economically and socially successful, to maintain slim bodies, and to have 'appropriate' feelings such as selflessness and gratitude. For women in this study, drinking alcohol was a way to achieve, and to cope with, expectations around idealised femininities and socially endorsed ways of living, being, and feeling. Repeated and routine affective experiences reinforced the role of alcohol in women's lives. Findings suggest the need for gender-transformative policies that address the structural environments of women's lives.

Background: Safer opioid supply programs in Canada have come under intense scrutiny related to the perceived risk of diversion of safer opioid supply medications. We sought to explore the experiences and perspectives of safer opioid supply medication diversion with clients of a safer opioid supply program in Toronto, Canada.

Methods: From December 2022 to August 2023, we conducted in-depth, semi-structured interviews with 25 adult clients of a safer opioid supply program in Toronto, Canada. We analyzed the data using deductive and inductive approaches via thematic analysis.

Results: Our analysis identified five themes regarding clients' perceptions and experiences with safer opioid supply diversion: (i) Compassionate sharing with others to address withdrawal symptoms; (ii) Selling or sharing due to unmet medication or survival needs of program clients; (iii) High demand for safer alternatives to those that are available in unregulated drug markets; (iv) Price of safer opioid supply medications in the unregulated drug markets as a diversion deterrent; and (v) Coerced diversion through harassment or violence.

Conclusions: These findings document experiences of medication diversion and the multifaceted and complex interplay of various individual and contextual factors that motivate safer opioid supply clients to engage in it. Future policy and safer opioid supply practice should address root causes of diversion, particularly barriers to service access and the diverse medication needs of clients.