Pub Date : 2026-01-05DOI: 10.1016/j.drugpo.2025.105136
Charlene Weight , Andrea Mambro , Camille Dussault , Sylvie Chalifoux , Lina del Balso , Apostolia Petropoulos , Mona Lim , Alexandros Halavrezos , Bertrand Lebouche , Giada Sebastiani , Marina B. Klein , Joseph Cox , Eric Latimer , Nadine Kronfli
Background
Many individuals are released from prison with untreated hepatitis C virus (HCV) and face challenges linking to care in the community. This study evaluated the cost-effectiveness of a multidisciplinary model of care compared to standard of care (SOC) across key steps along the HCV care cascade.
Methods
A prospective, pre-post study was conducted among men incarcerated in Quebec’s largest provincial prison. Intervention participants received care from a nurse, social worker, and patient navigator before release and were offered appointment accompaniment post-release by the patient navigator. SOC participants were encouraged to undergo HCV screening and those with current HCV received a pre-release discharge HCV appointment. The analysis adopted a healthcare system perspective. The primary outcome was sustained virologic response (SVR) within 180 days post-release. Secondary outcomes included linkage to care within 90 days post-release, treatment initiation, and treatment completion. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs (Canadian dollars, C$) divided by the difference in outcomes.
Results
Comparing 20 participants with current HCV infection (HCV RNA+) in both the intervention and the SOC arms, 16 vs. 12 were linked to care, 13 vs. 4 initiated treatment, 8 vs. 2 completed treatment, and 8 vs. 2 achieved SVR, respectively. The corresponding ICERs were C$1,242, C$10,481, C$25,577, and C$25,653 per additional person achieving the outcome.
Conclusions
Our multidisciplinary model of care increased the proportion of HCV RNA+ people released from prison who subsequently achieved SVR, at an additional cost of C$25,653 per additional patient. This is only C$5,653 more than the estimated cost of direct-acting antivirals, providing an economic rationale for broader implementation.
{"title":"A cost-effectiveness analysis of a multidisciplinary model of care on hepatitis C care among people released from provincial prison in Quebec, Canada","authors":"Charlene Weight , Andrea Mambro , Camille Dussault , Sylvie Chalifoux , Lina del Balso , Apostolia Petropoulos , Mona Lim , Alexandros Halavrezos , Bertrand Lebouche , Giada Sebastiani , Marina B. Klein , Joseph Cox , Eric Latimer , Nadine Kronfli","doi":"10.1016/j.drugpo.2025.105136","DOIUrl":"10.1016/j.drugpo.2025.105136","url":null,"abstract":"<div><h3>Background</h3><div>Many individuals are released from prison with untreated hepatitis C virus (HCV) and face challenges linking to care in the community. This study evaluated the cost-effectiveness of a multidisciplinary model of care compared to standard of care (SOC) across key steps along the HCV care cascade.</div></div><div><h3>Methods</h3><div>A prospective, pre-post study was conducted among men incarcerated in Quebec’s largest provincial prison. Intervention participants received care from a nurse, social worker, and patient navigator before release and were offered appointment accompaniment post-release by the patient navigator. SOC participants were encouraged to undergo HCV screening and those with current HCV received a pre-release discharge HCV appointment. The analysis adopted a healthcare system perspective. The primary outcome was sustained virologic response (SVR) within 180 days post-release. Secondary outcomes included linkage to care within 90 days post-release, treatment initiation, and treatment completion. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs (Canadian dollars, C$) divided by the difference in outcomes.</div></div><div><h3>Results</h3><div>Comparing 20 participants with current HCV infection (HCV RNA+) in both the intervention and the SOC arms, 16 vs. 12 were linked to care, 13 vs. 4 initiated treatment, 8 vs. 2 completed treatment, and 8 vs. 2 achieved SVR, respectively. The corresponding ICERs were C$1,242, C$10,481, C$25,577, and C$25,653 per additional person achieving the outcome.</div></div><div><h3>Conclusions</h3><div>Our multidisciplinary model of care increased the proportion of HCV RNA+ people released from prison who subsequently achieved SVR, at an additional cost of C$25,653 per additional patient. This is only C$5,653 more than the estimated cost of direct-acting antivirals, providing an economic rationale for broader implementation.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105136"},"PeriodicalIF":4.4,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145895831","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 : 2026-01-05DOI: 10.1016/j.drugpo.2025.105082
Evan B Cunningham, Alice Wheeler, Behzad Hajarizadeh, Clare E French, Rachel Roche, Monineath Roth, Alex R Willing, Hossain M S Sazzad, Alison D Marshall, Guillaume Fontaine, Anna Conway, Braulio M Valencia, Justin Presseau, John W Ward, Louisa Degenhardt, Gregory J Dore, Matthew Hickman, Peter Vickerman, Lise Lafferty, Andrew Lloyd, Yumi Sheehan, Matthew J Akiyama, Nadine Kronfli, Joaquin Cabezas, Jason Grebely
Background: Hepatitis C virus (HCV) disproportionately affects incarcerated individuals, and effective interventions are needed to improve HCV care within prisons to achieve global elimination targets. This review aimed to identify and synthesise evidence on interventions to improve HCV testing, linkage to care, and direct-acting antiviral (DAA) treatment initiation among people in prison and post-release.
Methods: We systematically searched MEDLINE (PubMed), Scopus, Web of Science, Cochrane CENTRAL, and PsycINFO for studies assessing non-pharmaceutical interventions with a comparator or control group. Outcomes were HCV antibody testing, HCV RNA testing, linkage to HCV care, and treatment initiation. Randomised controlled trials (RCTs) and controlled non-randomised studies were included; data were extracted and risk of bias assessed in duplicate using standard tools (RoB 2 and ROBINS-I). This analysis was restricted to studies of interventions evaluated in prison settings or among people recently released from prison. Searches had no date restriction and were updated November 2024. This review is registered in PROSPERO (CRD42020178035).
Findings: Of 20,643 unique records, 22 studies were included (19 non-randomised; three RCTs). Simplified testing modalities had the most evidence of impact on testing and treatment outcomes: dried blood spot (DBS) testing improved antibody testing uptake in three studies (two RCTs and one non-randomised study; OR 2.90, 95 % CI 1.43-5.86) and point-of-care RNA testing improved treatment initiation in three non-randomised studies (OR 9.60, 95 % CI 3.38-27.32). Simplified opt-out screening strategies also increased antibody testing uptake in three studies (OR 20.41, 95 % CI 1.88-221.19). Other interventions simplifying testing (e.g., reflex RNA testing, broadened testing criteria) were effective in individual studies, but pooled analyses for broadened testing criteria were not statistically significant due to high heterogeneity. Single studies also showed improvements in treatment initiation using DBS testing, nurse-led care, and no-cost coverage of HCV medications.
Interpretation: Several interventions, particularly those to enhance testing, may be successful in increasing HCV testing and treatment in prisons. However, the heterogeneity of interventions, methodological limitations of included studies, and limited number of studies underscore the need for further robust research, particularly RCTs, to optimise care in this setting.
背景：丙型肝炎病毒（HCV）对监禁人员的影响不成比例，需要有效的干预措施来改善监狱内的HCV护理，以实现全球消除目标。本综述旨在确定和综合有关干预措施的证据，以改善HCV检测，与护理的联系，以及在监狱和释放后人员中开始直接作用抗病毒（DAA）治疗。方法：我们系统地检索MEDLINE （PubMed）、Scopus、Web of Science、Cochrane CENTRAL和PsycINFO，以比较组或对照组评估非药物干预措施。结果是HCV抗体检测、HCV RNA检测、与HCV护理的联系和治疗开始。纳入随机对照试验（RCTs）和非随机对照研究；使用标准工具（rob2和ROBINS-I）提取数据并评估两份偏倚风险。这一分析仅限于在监狱环境或最近从监狱释放的人中评估干预措施的研究。搜索没有日期限制，更新日期为2024年11月。本综述已在PROSPERO注册（CRD42020178035）。结果：在20,643份独特记录中，纳入了22项研究（19项非随机对照试验；3项随机对照试验）。简化的检测方式对检测和治疗结果有最明显的影响：3项研究（2项rct和1项非随机研究；OR 2.90, 95% CI 1.43-5.86）中干血斑（DBS）检测改善了抗体检测的吸收，3项非随机研究中即时RNA检测改善了治疗的开始（OR 9.60, 95% CI 3.38-27.32）。在三项研究中，简化的选择退出筛选策略也增加了抗体检测的吸收（OR 20.41, 95% CI 1.88-221.19）。其他简化检测的干预措施（例如，反射RNA检测，扩大检测标准）在个别研究中是有效的，但由于高度异质性，对扩大检测标准的合并分析没有统计学意义。单个研究也表明，使用DBS测试、护士主导的护理和HCV药物的免费覆盖在治疗开始方面有所改善。解释：一些干预措施，特别是加强检测的干预措施，可能会成功地增加监狱中的丙型肝炎病毒检测和治疗。然而，干预措施的异质性、纳入研究的方法学局限性和有限的研究数量强调了进一步强有力的研究的必要性，特别是随机对照试验，以优化这种情况下的护理。
{"title":"Interventions to improve testing, linkage to care, and treatment for hepatitis C infection in prison: a systematic review and meta-analysis.","authors":"Evan B Cunningham, Alice Wheeler, Behzad Hajarizadeh, Clare E French, Rachel Roche, Monineath Roth, Alex R Willing, Hossain M S Sazzad, Alison D Marshall, Guillaume Fontaine, Anna Conway, Braulio M Valencia, Justin Presseau, John W Ward, Louisa Degenhardt, Gregory J Dore, Matthew Hickman, Peter Vickerman, Lise Lafferty, Andrew Lloyd, Yumi Sheehan, Matthew J Akiyama, Nadine Kronfli, Joaquin Cabezas, Jason Grebely","doi":"10.1016/j.drugpo.2025.105082","DOIUrl":"https://doi.org/10.1016/j.drugpo.2025.105082","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis C virus (HCV) disproportionately affects incarcerated individuals, and effective interventions are needed to improve HCV care within prisons to achieve global elimination targets. This review aimed to identify and synthesise evidence on interventions to improve HCV testing, linkage to care, and direct-acting antiviral (DAA) treatment initiation among people in prison and post-release.</p><p><strong>Methods: </strong>We systematically searched MEDLINE (PubMed), Scopus, Web of Science, Cochrane CENTRAL, and PsycINFO for studies assessing non-pharmaceutical interventions with a comparator or control group. Outcomes were HCV antibody testing, HCV RNA testing, linkage to HCV care, and treatment initiation. Randomised controlled trials (RCTs) and controlled non-randomised studies were included; data were extracted and risk of bias assessed in duplicate using standard tools (RoB 2 and ROBINS-I). This analysis was restricted to studies of interventions evaluated in prison settings or among people recently released from prison. Searches had no date restriction and were updated November 2024. This review is registered in PROSPERO (CRD42020178035).</p><p><strong>Findings: </strong>Of 20,643 unique records, 22 studies were included (19 non-randomised; three RCTs). Simplified testing modalities had the most evidence of impact on testing and treatment outcomes: dried blood spot (DBS) testing improved antibody testing uptake in three studies (two RCTs and one non-randomised study; OR 2.90, 95 % CI 1.43-5.86) and point-of-care RNA testing improved treatment initiation in three non-randomised studies (OR 9.60, 95 % CI 3.38-27.32). Simplified opt-out screening strategies also increased antibody testing uptake in three studies (OR 20.41, 95 % CI 1.88-221.19). Other interventions simplifying testing (e.g., reflex RNA testing, broadened testing criteria) were effective in individual studies, but pooled analyses for broadened testing criteria were not statistically significant due to high heterogeneity. Single studies also showed improvements in treatment initiation using DBS testing, nurse-led care, and no-cost coverage of HCV medications.</p><p><strong>Interpretation: </strong>Several interventions, particularly those to enhance testing, may be successful in increasing HCV testing and treatment in prisons. However, the heterogeneity of interventions, methodological limitations of included studies, and limited number of studies underscore the need for further robust research, particularly RCTs, to optimise care in this setting.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":" ","pages":"105082"},"PeriodicalIF":4.4,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913515","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 : 2026-01-02DOI: 10.1016/j.drugpo.2025.105131
Alex R. Willing , Guillaume Fontaine , Carla Treloar , David Silk , Jason Grebely , Alison D. Marshall
Background
Simplification of hepatitis C virus (HCV) testing technologies has facilitated scale-up of testing and treatment of at-risk populations in various service settings. Service provider perspectives on the incorporation of simplified diagnostics into standard of care would inform optimised implementation of these technologies. The aim of this study was to qualitatively explore provider perceptions of simplified HCV testing modalities and how they envisage their implementation into standard practice in Australia.
Methods
Between October 2022 and July 2023, semi-structured interviews occurred with providers from community-based services providing care to people at-risk of HCV infection. Participants were recruited with purposeful/purposive sampling from six states/territories in Australia. Interviews were conducted via Zoom or phone call wherein participants were asked about their HCV dried blood spot (DBS) and point-of-care testing experiences and challenges to implementation. Multiple codes were informed by the Consolidated Framework for Implementation Research (CFIR) and data codes (Partnerships, Policies, Financing, Compatibility, and Adaptability) were analysed with iterative categorisation.
Results
Thirty-six providers were interviewed, of which 21 were in nursing roles, six were non-clinical (e.g., project coordinator), five were peer workers, and four were physicians. Thirty participants had point-of-care experience, and 23 had DBS experience. Overall, participants held positive views of new testing modalities but identified clear barriers to realisation of HCV elimination targets. Partnerships were identified as key enablers with linkage to HCV prescribers a noted gap. Interpretation and application of clinic or national/state policies seemed to impact timeliness of treatment or hinder care. Both testing modalities were mostly regarded as cost-effective, but long-term financing was needed for sustainability, particularly given shifts in staff workloads. Optimal implementation of testing modalities depended on compatible qualities of the testing environment, including HCV prevalence, rurality, available resources and staff, and client visit frequency (e.g., methadone clinic versus emergency department).
Conclusion
The expansion of HCV testing and care necessitates that more structural support (e.g., adequate funding and staffing) be offered to service providers. Despite the adaptability of providers, a one-size-fits-all approach will not suit the needs of all settings.
{"title":"Service provider perceptions of incorporating hepatitis C testing technologies into standard practice: Considerations for widespread implementation and scale-up","authors":"Alex R. Willing , Guillaume Fontaine , Carla Treloar , David Silk , Jason Grebely , Alison D. Marshall","doi":"10.1016/j.drugpo.2025.105131","DOIUrl":"10.1016/j.drugpo.2025.105131","url":null,"abstract":"<div><h3>Background</h3><div>Simplification of hepatitis C virus (HCV) testing technologies has facilitated scale-up of testing and treatment of at-risk populations in various service settings. Service provider perspectives on the incorporation of simplified diagnostics into standard of care would inform optimised implementation of these technologies. The aim of this study was to qualitatively explore provider perceptions of simplified HCV testing modalities and how they envisage their implementation into standard practice in Australia.</div></div><div><h3>Methods</h3><div>Between October 2022 and July 2023, semi-structured interviews occurred with providers from community-based services providing care to people at-risk of HCV infection. Participants were recruited with purposeful/purposive sampling from six states/territories in Australia. Interviews were conducted via Zoom or phone call wherein participants were asked about their HCV dried blood spot (DBS) and point-of-care testing experiences and challenges to implementation. Multiple codes were informed by the Consolidated Framework for Implementation Research (CFIR) and data codes (Partnerships, Policies, Financing, Compatibility, and Adaptability) were analysed with iterative categorisation.</div></div><div><h3>Results</h3><div>Thirty-six providers were interviewed, of which 21 were in nursing roles, six were non-clinical (e.g., project coordinator), five were peer workers, and four were physicians. Thirty participants had point-of-care experience, and 23 had DBS experience. Overall, participants held positive views of new testing modalities but identified clear barriers to realisation of HCV elimination targets. Partnerships were identified as key enablers with linkage to HCV prescribers a noted gap. Interpretation and application of clinic or national/state policies seemed to impact timeliness of treatment or hinder care. Both testing modalities were mostly regarded as cost-effective, but long-term financing was needed for sustainability, particularly given shifts in staff workloads. Optimal implementation of testing modalities depended on compatible qualities of the testing environment, including HCV prevalence, rurality, available resources and staff, and client visit frequency (e.g., methadone clinic versus emergency department).</div></div><div><h3>Conclusion</h3><div>The expansion of HCV testing and care necessitates that more structural support (e.g., adequate funding and staffing) be offered to service providers. Despite the adaptability of providers, a one-size-fits-all approach will not suit the needs of all settings.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105131"},"PeriodicalIF":4.4,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884956","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 : 2026-01-02DOI: 10.1016/j.drugpo.2025.105130
Åsa Steensland , Lisa Kastbom , Björn Johnson , Mårten Larsson , Markus Heilig , Anna Segernäs , Andrea Johansson Capusan
Introduction
Swedish physicians have conflicting obligations when managing harmful alcohol use. They are responsible for identification and treatment, while also being legally required to report unfit driving licence holders. B-Phosphatidylethanol (PEth) is a reliable and specific biomarker for alcohol use and a useful tool in the assessment. We explored general practitioners’ experiences of using PEth in the context of their legal obligation to report patients with certain alcohol-related disorders to the Swedish Transport Agency.
Methods
Individual interviews were conducted with physicians (n = 20) from 10 primary healthcare centres with different patterns of PEth utilisation. Interview data were analysed using qualitative content analysis.
Results
Results encompassed three categories: 1. Struggling to implement the regulations: difficulties in assessing driving fitness when PEth test results indicated high alcohol intake; 2. Managing reactions and roles: physicians struggled to balance legal obligation while maintaining a confidential physician-patient relationship; 3. Navigating dilemmas arising from implementing the regulations: regulations were burdensome to apply and diverse strategies emerged, where some physicians refrained from PEth testing and others avoided reporting. Some relied on standardised management approaches or used the obligation to report as a motivating factor for patients to reduce their alcohol use.
Conclusions
The results reveal that difficulties in complying with the legal obligation to report unfit drivers prevent the systematic use of PEth, obstructing the identification of harmful alcohol use and dependence. Clearer guidance on the implementation of the driving licence regulations and the clinical use of PEth are necessary to support physicians in handling this complex issue.
{"title":"Challenges in managing driving licence legislation when using B-Phosphatidylethanol to identify high levels of alcohol use in primary care patients: A qualitative study","authors":"Åsa Steensland , Lisa Kastbom , Björn Johnson , Mårten Larsson , Markus Heilig , Anna Segernäs , Andrea Johansson Capusan","doi":"10.1016/j.drugpo.2025.105130","DOIUrl":"10.1016/j.drugpo.2025.105130","url":null,"abstract":"<div><h3>Introduction</h3><div>Swedish physicians have conflicting obligations when managing harmful alcohol use. They are responsible for identification and treatment, while also being legally required to report unfit driving licence holders. B-Phosphatidylethanol (PEth) is a reliable and specific biomarker for alcohol use and a useful tool in the assessment. We explored general practitioners’ experiences of using PEth in the context of their legal obligation to report patients with certain alcohol-related disorders to the Swedish Transport Agency.</div></div><div><h3>Methods</h3><div>Individual interviews were conducted with physicians (<em>n</em> = 20) from 10 primary healthcare centres with different patterns of PEth utilisation. Interview data were analysed using qualitative content analysis.</div></div><div><h3>Results</h3><div>Results encompassed three categories: <em>1. Struggling to implement the regulations</em>: difficulties in assessing driving fitness when PEth test results indicated high alcohol intake; <em>2. Managing reactions and roles</em>: physicians struggled to balance legal obligation while maintaining a confidential physician-patient relationship; <em>3. Navigating dilemmas arising from implementing the regulations</em>: regulations were burdensome to apply and diverse strategies emerged, where some physicians refrained from PEth testing and others avoided reporting. Some relied on standardised management approaches or used the obligation to report as a motivating factor for patients to reduce their alcohol use.</div></div><div><h3>Conclusions</h3><div>The results reveal that difficulties in complying with the legal obligation to report unfit drivers prevent the systematic use of PEth, obstructing the identification of harmful alcohol use and dependence. Clearer guidance on the implementation of the driving licence regulations and the clinical use of PEth are necessary to support physicians in handling this complex issue.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105130"},"PeriodicalIF":4.4,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884955","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}
Opioid agonist therapy (OAT) is an essential tool for reducing illicit opioid use and mortality. Extended-release formulations of buprenorphine (BUP-XR) show promise in improving adherence and increasing treatment uptake, but real-world studies show mixed results. Previous studies of BUP-XR were conducted in high-income countries. This study aims to evaluate BUP-XR initiation, retention and dropout in the context of Ukraine.
Methods
A 12-months prospective single-arm, multicenter, open-label trial was conducted among 181 participants switching from sublingual buprenorphine (BUP-SL) to monthly BUP-XR injections (CAM2038/BuvidalⓇ) between February-July 2023 across 10 cities of Ukraine. Correlates of BUP-XR discontinuation due to OAT dropout and switch to BUP-SL were analyzed using competing risks cluster-robust Cox proportional hazards regression models with time-varying covariates.
Results
Despite initial interest, BUP-XR enrollment was low: 273 patients among approximately 2300 eligible agreed to switch to BUP-XR. 80 % received 2 or more, 54 % – 7 or more, and 44 % – 13 or more BUP-XR injections. By the 13th injection, 30 % switched to BUP-SL and 26 % discontinued OAT with distinct set of correlates for the two dropout reasons. 13 % of participants were prescribed supplemental BUP-SL. 74 % of participants starting on the lowest dose (64 mg) had their BUP-XR dose subsequently increased.
Conclusion
BUP-XR uptake and retention in Ukraine were lower than expected in the volatile wartime context. Availability of take-home dosing may reduce the perceived benefits of BUP-XR. Revising clinical guidelines on BUP-XR dosing, dose adjustment, and supplemental BUP-SL prescriptions may reduce the occurrence of opioid withdrawal and improve retention.
{"title":"Initiation, retention, and discontinuation of extended-release buprenorphine (BUP-XR) for opioid dependence: A single-arm multi-site trial in Ukraine","authors":"Sofiia Ohorodnik , Kyle Conroy , Kostyantyn Dumchev , Andrii Ptashchenko , Valeriia Gritsenko , Iryna Ivanchuk , Olga Morozova","doi":"10.1016/j.drugpo.2025.105107","DOIUrl":"10.1016/j.drugpo.2025.105107","url":null,"abstract":"<div><h3>Background</h3><div>Opioid agonist therapy (OAT) is an essential tool for reducing illicit opioid use and mortality. Extended-release formulations of buprenorphine (BUP-XR) show promise in improving adherence and increasing treatment uptake, but real-world studies show mixed results. Previous studies of BUP-XR were conducted in high-income countries. This study aims to evaluate BUP-XR initiation, retention and dropout in the context of Ukraine.</div></div><div><h3>Methods</h3><div>A 12-months prospective single-arm, multicenter, open-label trial was conducted among 181 participants switching from sublingual buprenorphine (BUP-SL) to monthly BUP-XR injections (CAM2038/Buvidal<sup>Ⓡ</sup>) between February-July 2023 across 10 cities of Ukraine. Correlates of BUP-XR discontinuation due to OAT dropout and switch to BUP-SL were analyzed using competing risks cluster-robust Cox proportional hazards regression models with time-varying covariates.</div></div><div><h3>Results</h3><div>Despite initial interest, BUP-XR enrollment was low: 273 patients among approximately 2300 eligible agreed to switch to BUP-XR. 80 % received 2 or more, 54 % – 7 or more, and 44 % – 13 or more BUP-XR injections. By the 13th injection, 30 % switched to BUP-SL and 26 % discontinued OAT with distinct set of correlates for the two dropout reasons. 13 % of participants were prescribed supplemental BUP-SL. 74 % of participants starting on the lowest dose (64 mg) had their BUP-XR dose subsequently increased.</div></div><div><h3>Conclusion</h3><div>BUP-XR uptake and retention in Ukraine were lower than expected in the volatile wartime context. Availability of take-home dosing may reduce the perceived benefits of BUP-XR. Revising clinical guidelines on BUP-XR dosing, dose adjustment, and supplemental BUP-SL prescriptions may reduce the occurrence of opioid withdrawal and improve retention.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105107"},"PeriodicalIF":4.4,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884954","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 : 2026-01-01DOI: 10.1016/j.drugpo.2023.103996
Benedikt Fischer , Tessa Robinson , Chris Bullen , Valerie Curran , Didier Jutras-Aswad , Maria Elena Medina-Mora , Rosalie Pacula , Jürgen Rehm , Robin Room , Wim van den Brink , Wayne Hall
{"title":"Las ‘Guías para el Uso de Cannabis de Menor Riesgo (GUCMR)’: RECOMENDACIONES [The ‘Lower-Risk Cannabis Use Guidelines (LRCUG)’: RECOMMENDATIONS (SPANISH)]","authors":"Benedikt Fischer , Tessa Robinson , Chris Bullen , Valerie Curran , Didier Jutras-Aswad , Maria Elena Medina-Mora , Rosalie Pacula , Jürgen Rehm , Robin Room , Wim van den Brink , Wayne Hall","doi":"10.1016/j.drugpo.2023.103996","DOIUrl":"10.1016/j.drugpo.2023.103996","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 103996"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9294315","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 : 2026-01-01DOI: 10.1016/j.drugpo.2025.105076
Danielle Dawson , Wayne Hall , Isabella Goodwin , Beatriz H. Carlini , Dan I. Lubman , David Hammond , Tom P Freeman , Valentina Lorenzetti
Background: As cannabis policies have become more liberalized internationally, cannabis products have become increasingly accessible, diversified and potent as indicated by the amount of delta-9-tetrahydrocannabinol (THC) they contain. The THC content of cannabis products is often inconsistently reported, limiting opportunities to inform consumers about health risks and safer consumption practices. We explored consumers’ preferences on the type of THC information (i.e., standard units, concentration, total content) that should be displayed on cannabis products in legal markets. Methods: A convenience sample of 575 adults from various U.S. states who reported cannabis use within the past 12 months was recruited via Amazon Mechanical Turk. Respondents completed a survey assessing cannabis use and related attitudes, which included a subsection focused on potential metrics that could be used to report THC content. Descriptive and inferential statistical analyses were conducted. Results: Majority of respondents considered it important for cannabis products to include information on Standard THC Units (e.g., 5 milligrams of THC), THC concentration (%), or the total content of THC on cannabis product labels. When comparing Standard THC Units, THC concentration or both options, Standard THC Units were the preferred metric, p<.001. Consumer preferences for these three metrics did not signficantly differ across U.S. state cannabis policy environments, sex, and frequency of cannabis use when compared using multinomial logistic regression. Conclusions: These exploratory findings preliminarily support the potential value of standardized THC dose labelling, particularly in the form of a standardized metric such as the Standard THC Unit, as a tool to better inform consumer decision-making and promote safer patterns of use. The findings require replication in more representative samples using additional THC metrics, including but not limited to, THC milligrams as a response option.
{"title":"Exploring THC labelling preferences to communicate the strength of cannabis products: Insights from U.S. consumers","authors":"Danielle Dawson , Wayne Hall , Isabella Goodwin , Beatriz H. Carlini , Dan I. Lubman , David Hammond , Tom P Freeman , Valentina Lorenzetti","doi":"10.1016/j.drugpo.2025.105076","DOIUrl":"10.1016/j.drugpo.2025.105076","url":null,"abstract":"<div><div>Background: As cannabis policies have become more liberalized internationally, cannabis products have become increasingly accessible, diversified and potent as indicated by the amount of delta-9-tetrahydrocannabinol (THC) they contain. The THC content of cannabis products is often inconsistently reported, limiting opportunities to inform consumers about health risks and safer consumption practices. We explored consumers’ preferences on the type of THC information (i.e., standard units, concentration, total content) that should be displayed on cannabis products in legal markets. Methods: A convenience sample of 575 adults from various U.S. states who reported cannabis use within the past 12 months was recruited via Amazon Mechanical Turk. Respondents completed a survey assessing cannabis use and related attitudes, which included a subsection focused on potential metrics that could be used to report THC content. Descriptive and inferential statistical analyses were conducted. Results: Majority of respondents considered it important for cannabis products to include information on Standard THC Units (e.g., 5 milligrams of THC), THC concentration (%), or the total content of THC on cannabis product labels. When comparing Standard THC Units, THC concentration or both options, Standard THC Units were the preferred metric, <em>p</em><.001. Consumer preferences for these three metrics did not signficantly differ across U.S. state cannabis policy environments, sex, and frequency of cannabis use when compared using multinomial logistic regression. Conclusions: These exploratory findings preliminarily support the potential value of standardized THC dose labelling, particularly in the form of a standardized metric such as the Standard THC Unit, as a tool to better inform consumer decision-making and promote safer patterns of use. The findings require replication in more representative samples using additional THC metrics, including but not limited to, THC milligrams as a response option.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105076"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828880","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 : 2026-01-01DOI: 10.1016/j.drugpo.2025.104921
Sarah E. Zemore , Camillia K. Lui , Amy A. Mericle , Libo Li , Priscilla Martinez , Christine Timko
Background
Second-wave mutual-help groups (MHGs) for addiction (e.g., SMART Recovery) are prevalent and promising, but limited studies have examined their effectiveness. We examined 1) the comparative effectiveness of second-wave MHGs for supporting alcohol use disorder recovery and 2) correlates of MHG involvement.
Methods
Data were pooled from the Peer ALternatives for Addiction (PAL) Study 2015 and 2021 Cohorts (N = 1152), which recruited adults via collaboration with MHG directors and recovery-related organizations. Eligibility criteria included U.S. residence, lifetime alcohol use disorder, and past-30-day in-person/online attendance at Women for Sobriety, LifeRing, SMART, and/or a 12-step group. Surveys were administered at baseline, 6 months, and 12 months (response rates=81–88 %), and assessed MHG choice (defined using attendance), MHG involvement (5-item scale; e.g., regular/home group, volunteering/service) and alcohol outcomes (below).
Results
In lagged, multivariate generalized estimating equations, greater MHG involvement strongly predicted higher odds of alcohol abstinence (OR=2.62, p<.001), lower odds of alcohol problems (OR=0.39, p<.01), and fewer drinking days (IRR=0.12, p<.001) at follow-ups. MHG choice was unrelated to outcomes either alone or in interaction with MHG involvement, suggesting comparable effectiveness for all second-wave MHGs (vs. 12-step). Predictors of greater MHG involvement included older age, a total abstinence (vs. other) goal, and 2015 (vs. 2021) Cohort.
Conclusions
Findings suggest comparable effectiveness for the targeted second-wave alternatives (vs. 12-step) among community members attending MHGs, indicating that alcohol service providers, courts, and policymakers should consider referring to and supporting these alternatives. Still, variation in SMART’s program across time and geography suggests caution in interpreting the results for SMART.
{"title":"Second-wave mutual-help groups: Examining effectiveness for individuals with alcohol use disorders in the longitudinal, U.S. national PAL Study cohorts","authors":"Sarah E. Zemore , Camillia K. Lui , Amy A. Mericle , Libo Li , Priscilla Martinez , Christine Timko","doi":"10.1016/j.drugpo.2025.104921","DOIUrl":"10.1016/j.drugpo.2025.104921","url":null,"abstract":"<div><h3>Background</h3><div>Second-wave mutual-help groups (MHGs) for addiction (e.g., SMART Recovery) are prevalent and promising, but limited studies have examined their effectiveness. We examined 1) the comparative effectiveness of second-wave MHGs for supporting alcohol use disorder recovery and 2) correlates of MHG involvement.</div></div><div><h3>Methods</h3><div>Data were pooled from the Peer ALternatives for Addiction (PAL) Study 2015 and 2021 Cohorts (<em>N</em> = 1152), which recruited adults via collaboration with MHG directors and recovery-related organizations. Eligibility criteria included U.S. residence, lifetime alcohol use disorder, and past-30-day in-person/online attendance at Women for Sobriety, LifeRing, SMART, and/or a 12-step group. Surveys were administered at baseline, 6 months, and 12 months (response rates=81–88 %), and assessed MHG choice (defined using attendance), MHG involvement (5-item scale; e.g., regular/home group, volunteering/service) and alcohol outcomes (below).</div></div><div><h3>Results</h3><div>In lagged, multivariate generalized estimating equations, greater MHG involvement strongly predicted higher odds of alcohol abstinence (OR=2.62, <em>p</em><.001), lower odds of alcohol problems (OR=0.39, <em>p</em><.01), and fewer drinking days (IRR=0.12, <em>p</em><.001) at follow-ups. MHG choice was unrelated to outcomes either alone or in interaction with MHG involvement, suggesting comparable effectiveness for all second-wave MHGs (vs. 12-step). Predictors of greater MHG involvement included older age, a total abstinence (vs. other) goal, and 2015 (vs. 2021) Cohort.</div></div><div><h3>Conclusions</h3><div>Findings suggest comparable effectiveness for the targeted second-wave alternatives (vs. 12-step) among community members attending MHGs, indicating that alcohol service providers, courts, and policymakers should consider referring to and supporting these alternatives. Still, variation in SMART’s program across time and geography suggests caution in interpreting the results for SMART.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 104921"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765644","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 : 2026-01-01DOI: 10.1016/j.drugpo.2025.104938
Christina Chwyl , Adrianne R. Wilson-Poe , Kim A. Hoffman , Alissa Bazinet , Kellie Pertl , Jason B. Luoma , Don des Jarlais , Sarann Bielavitz , P. Todd Korthuis
There remain significant gaps in knowledge about best practices for facilitated psychedelic care and psychedelic-assisted therapy. To inform the development of service models that support safe and beneficial experiences, this qualitative study explored expert perspectives on current and ideal standards of care, including key practices (e.g., screening, adapting care to diverse contexts) and regulatory and research challenges that influence service delivery. Online focus groups (n = 8) were conducted with a purposive U.S. sample of people with psychedelic content knowledge expertise, including providers (psychiatrists, clinical psychologists, addiction medicine experts, and licensed/unlicensed practitioners) and harm reduction specialists. Transcripts were analyzed through Thematic Analysis team-based coding using a combined inductive-deductive approach within a semantic framework. Participants (N = 38, mean age 47 (SD = 10) years, 53 % women, 84 % white) had an average of 10 years of psychedelic service experience (SD = 11) across diverse settings, including festivals/events, service centers, and clinical, research, ceremonial, community and ‘underground’ contexts. Five key themes emerged: (1) ‘Strengthening Safety through Credibility and Accountability’; (2) ‘Advancing Culturally Responsive and Inclusive Psychedelic Care’; (3) ‘Healing in Community: The Crucial Role of Ongoing Support and Integration’; (4) ‘Ensuring Safe Psychedelic Use: Preparation, Screening, Vulnerability, and Medication Management’; and (5) ‘Providing Informed Guidance and Navigating Legal and Informational Gray Areas.’ Overall, results underscore the need for stronger provider accountability structures, culturally inclusive practices, accessible and integrated community support, robust safety and screening protocols, and clearer guidelines to help providers navigate legal complexities, ensure safety, and optimize outcomes across diverse populations.
{"title":"Building standards of psychedelic care: Qualitative examination of expert perspectives on safety, inclusion, and accountability","authors":"Christina Chwyl , Adrianne R. Wilson-Poe , Kim A. Hoffman , Alissa Bazinet , Kellie Pertl , Jason B. Luoma , Don des Jarlais , Sarann Bielavitz , P. Todd Korthuis","doi":"10.1016/j.drugpo.2025.104938","DOIUrl":"10.1016/j.drugpo.2025.104938","url":null,"abstract":"<div><div>There remain significant gaps in knowledge about best practices for facilitated psychedelic care and psychedelic-assisted therapy. To inform the development of service models that support safe and beneficial experiences, this qualitative study explored expert perspectives on current and ideal standards of care, including key practices (e.g., screening, adapting care to diverse contexts) and regulatory and research challenges that influence service delivery. Online focus groups (<em>n</em> = 8) were conducted with a purposive U.S. sample of people with psychedelic content knowledge expertise, including providers (psychiatrists, clinical psychologists, addiction medicine experts, and licensed/unlicensed practitioners) and harm reduction specialists. Transcripts were analyzed through Thematic Analysis team-based coding using a combined inductive-deductive approach within a semantic framework. Participants (<em>N</em> = 38, mean age 47 (<em>SD =</em> 10) years, 53 % women, 84 % white) had an average of 10 years of psychedelic service experience (<em>SD</em> = 11) across diverse settings, including festivals/events, service centers, and clinical, research, ceremonial, community and ‘underground’ contexts. Five key themes emerged: (1) ‘<em>Strengthening Safety through Credibility and Accountability’</em>; (2) ‘<em>Advancing Culturally Responsive and Inclusive Psychedelic Care</em><strong>’</strong>; (3) ‘<em>Healing in Community: The Crucial Role of Ongoing Support and Integration</em>’; (4) <strong>‘</strong><em>Ensuring Safe Psychedelic Use: Preparation, Screening, Vulnerability, and Medication Management’</em>; and (5) <em>‘Providing Informed Guidance and Navigating Legal and Informational Gray Areas.’</em> Overall, results underscore the need for stronger provider accountability structures, culturally inclusive practices, accessible and integrated community support, robust safety and screening protocols, and clearer guidelines to help providers navigate legal complexities, ensure safety, and optimize outcomes across diverse populations.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 104938"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849407","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 : 2026-01-01DOI: 10.1016/j.drugpo.2023.103995
Benedikt Fischer , Tessa Robinson , Chris Bullen , Valerie Curran , Didier Jutras-Aswad , Maria Elena Medina-Mora , Rosalie Pacula , Jürgen Rehm , Robin Room , Wim van den Brink , Wayne Hall
{"title":"Die ‘Richtlinien für die Risiko-Reduzierung beim Cannabiskonsum (RRRCK)’: EMPFEHLUNGEN","authors":"Benedikt Fischer , Tessa Robinson , Chris Bullen , Valerie Curran , Didier Jutras-Aswad , Maria Elena Medina-Mora , Rosalie Pacula , Jürgen Rehm , Robin Room , Wim van den Brink , Wayne Hall","doi":"10.1016/j.drugpo.2023.103995","DOIUrl":"10.1016/j.drugpo.2023.103995","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 103995"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9177394","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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