Pub Date : 2024-11-13DOI: 10.1016/j.drugpo.2024.104651
Mikayla Ferg , Sabrina S. Rapisarda , Elena Soranno , Nikki Lewis , Andy Ottoson , Cynthia A. Tschampl
Background
Prior overdose incident is a predictor of future non-fatal and fatal overdoses. Therefore, the period immediately following a non-fatal overdose is critical for engaging with survivors; however, they often do not access or receive services immediately after experiencing an overdose. To efficiently reach this high-risk population and provide survivors with services, novel interventions including post-overdose outreach programs have been developed.
Methods
Using PRISMA guidelines, we conducted an environmental scan of the academic and gray literature on post-overdose programs to identify key features and measures used to evaluate post-overdose programs. Using the Donabedian quality framework we then analyzed the frequency of measures by type of initiating stakeholder.
Results
Of the 36 studies included for final extraction, 14 were descriptive studies, ten were evaluation studies, eight studies identified facilitators and barriers, and four were program design toolkits. Initiator entity types included emergency departments (EDs; n = 10), public health agencies (n = 5), community-based organizations (n = 4), emergency medical services (EMS) (n = 4), law enforcement agencies (n = 4), and some combination or unknown (n = 9). We identified six key features of post-overdose programs across the literature: program theory, team composition, identifying and contacting clients, service provision, public private partnerships, and referrals. We extracted 223 operationalized measures, of which we analyzed 173 and categorized them as client experience (n = 2), structural (n = 12), process (n = 69), and outcome measures (n = 90). Public health agency-initiated programs reported all the experience-related measures (n = 2) and the most outcome measures (n = 23). Programs initiated by EDs reported the most process measures (n = 20), whereas community-based agencies reported the most structural measures (n = 12). Only two of the 223 measures related to stigma.
Conclusion
There are six common features across all post-overdose programs and different initiating organization types had differing foci for their evaluation measures. The key features and evaluation measure clusters identified in this environmental scan can help inform future post-overdose programs assess the comprehensiveness of their evaluations, inform funding agencies on the range of existing measures (and gaps) to consider, and support evaluators in study design.
{"title":"Bridging the gap: An environmental scan of post-overdose program features and evaluation measures","authors":"Mikayla Ferg , Sabrina S. Rapisarda , Elena Soranno , Nikki Lewis , Andy Ottoson , Cynthia A. Tschampl","doi":"10.1016/j.drugpo.2024.104651","DOIUrl":"10.1016/j.drugpo.2024.104651","url":null,"abstract":"<div><h3>Background</h3><div>Prior overdose incident is a predictor of future non-fatal and fatal overdoses. Therefore, the period immediately following a non-fatal overdose is critical for engaging with survivors; however, they often do not access or receive services immediately after experiencing an overdose. To efficiently reach this high-risk population and provide survivors with services, novel interventions including post-overdose outreach programs have been developed.</div></div><div><h3>Methods</h3><div>Using PRISMA guidelines, we conducted an environmental scan of the academic and gray literature on post-overdose programs to identify key features and measures used to evaluate post-overdose programs. Using the Donabedian quality framework we then analyzed the frequency of measures by type of initiating stakeholder.</div></div><div><h3>Results</h3><div>Of the 36 studies included for final extraction, 14 were descriptive studies, ten were evaluation studies, eight studies identified facilitators and barriers, and four were program design toolkits. Initiator entity types included emergency departments (EDs; <em>n</em> = 10), public health agencies (<em>n</em> = 5), community-based organizations (<em>n</em> = 4), emergency medical services (EMS) (<em>n</em> = 4), law enforcement agencies (<em>n</em> = 4), and some combination or unknown (<em>n</em> = 9). We identified six key features of post-overdose programs across the literature: program theory, team composition, identifying and contacting clients, service provision, public private partnerships, and referrals. We extracted 223 operationalized measures, of which we analyzed 173 and categorized them as client experience (<em>n</em> = 2), structural (<em>n</em> = 12), process (<em>n</em> = 69), and outcome measures (<em>n</em> = 90). Public health agency-initiated programs reported all the experience-related measures (<em>n</em> = 2) and the most outcome measures (<em>n</em> = 23). Programs initiated by EDs reported the most process measures (<em>n</em> = 20), whereas community-based agencies reported the most structural measures (<em>n</em> = 12). Only two of the 223 measures related to stigma.</div></div><div><h3>Conclusion</h3><div>There are six common features across all post-overdose programs and different initiating organization types had differing foci for their evaluation measures. The key features and evaluation measure clusters identified in this environmental scan can help inform future post-overdose programs assess the comprehensiveness of their evaluations, inform funding agencies on the range of existing measures (and gaps) to consider, and support evaluators in study design.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104651"},"PeriodicalIF":4.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-11DOI: 10.1016/j.drugpo.2024.104625
Tejaswini Patil , Jane Mummery
Opioid Agonist Therapy (OAT) has initiated extensive discussion regarding its efficacy, cost-effectiveness and best practice delivery. Although this discussion has been dominated by pharmacologists, clinicians, pharmacists and public policy-makers, there is increasing interest in examining OAT consumer experience and voice, particularly regarding consumers’ navigation and experience of the social field of their treatment. Concerned with the expression and circulation of power and resistance, Michel Foucault's work offers rich resources for examining OAT consumers’ experience and navigation of the social field of their treatment, including the administration of OAT as a harm reduction and social welfare intervention and consumers’ efforts to shape their relationships with medical and allied health professionals and other stakeholders. In the case of this study, Foucault's conceptions of power provide a productive means to critically interrogate the experience of 16 OAT consumers participating in pharmacotherapy treatments within a community pharmacy model in regional Victoria, Australia. Through the application of Foucauldian analyses of subjects and power to OAT participant accounts, precisely what the participant responses in our study have shown is that the relationship between OAT practitioners and consumers is neither always oppositional nor binary. Findings suggest that practitioners must pay attention to the everyday interactions they have with consumers (and others)—to how they communicate, listen, understand, present and provide solutions. Interactions with consumers should be treated as sites that produce complex power relations with moral and ethical implications for subjects, including consumers, practitioners and other stakeholders. Both practitioner and consumers need to remember that they are both productive subjects locked in a complex assemblage of practices and social discourses that circumscribe the social field of opioid treatments.
{"title":"‘It's not just a matter of taking the drug. It's about changing the way you function in your society too’: Narratives of power and resistance in the lived experiences of opioid agonist therapy consumers in regional Victoria, Australia","authors":"Tejaswini Patil , Jane Mummery","doi":"10.1016/j.drugpo.2024.104625","DOIUrl":"10.1016/j.drugpo.2024.104625","url":null,"abstract":"<div><div>Opioid Agonist Therapy (OAT) has initiated extensive discussion regarding its efficacy, cost-effectiveness and best practice delivery. Although this discussion has been dominated by pharmacologists, clinicians, pharmacists and public policy-makers, there is increasing interest in examining OAT consumer experience and voice, particularly regarding consumers’ navigation and experience of the social field of their treatment. Concerned with the expression and circulation of power and resistance, Michel Foucault's work offers rich resources for examining OAT consumers’ experience and navigation of the social field of their treatment, including the administration of OAT as a harm reduction and social welfare intervention and consumers’ efforts to shape their relationships with medical and allied health professionals and other stakeholders. In the case of this study, Foucault's conceptions of power provide a productive means to critically interrogate the experience of 16 OAT consumers participating in pharmacotherapy treatments within a community pharmacy model in regional Victoria, Australia. Through the application of Foucauldian analyses of subjects and power to OAT participant accounts, precisely what the participant responses in our study have shown is that the relationship between OAT practitioners and consumers is neither always oppositional nor binary. Findings suggest that practitioners must pay attention to the everyday interactions they have with consumers (and others)—to how they communicate, listen, understand, present and provide solutions. Interactions with consumers should be treated as sites that produce complex power relations with moral and ethical implications for subjects, including consumers, practitioners and other stakeholders. Both practitioner and consumers need to remember that they are both productive subjects locked in a complex assemblage of practices and social discourses that circumscribe the social field of opioid treatments.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104625"},"PeriodicalIF":4.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630576","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 : 2024-11-10DOI: 10.1016/j.drugpo.2024.104655
Udo Bonnet
{"title":"Gabapentinoids: Considerations on their contextual harmfulness and psychological dependence potential","authors":"Udo Bonnet","doi":"10.1016/j.drugpo.2024.104655","DOIUrl":"10.1016/j.drugpo.2024.104655","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104655"},"PeriodicalIF":4.4,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630573","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 : 2024-11-09DOI: 10.1016/j.drugpo.2024.104630
Hojin Park , Dong Won Yoon , Qian Yang , Yanyun He , Bing Han , Yuyan Shi , Ce Shang
Background
As of August 2023, 20 states in the US have established recreational cannabis retail markets and impose excise taxes on these products. However, there is significant heterogeneity in the bases (i.e., characteristics that taxes are applied to, such as price, weight, and potency), rates, and collection points (e.g., cultivation vs. wholesale) of excise taxes on recreational cannabis across states.
Methods
We constructed a novel cannabis excise tax measure in $ per flower oz, which is comparable across different tax bases. Specifically, ad valorem excise taxes based on wholesale and retail prices and THC-based taxes were converted to excise taxes ($) per oz using monthly state-level prices between 2014 and 2023. We also calculated tax incidence (i.e., taxes as a percentage of the retail prices) and analyzed its association with tax bases and converted taxes using ordinary least square (OLS) regressions.
Results
The mean and median values of converted excise taxes on recreational cannabis flowers were $37.93 and $37.55 per oz, respectively. The tax incidence for recreational cannabis was 18 %, lower than the incidence of e-cigarette and cigarette excise taxes. During 2014–2023, real cannabis taxes and prices have decreased significantly over time. In addition, tax bases and converted excise taxes were not associated with tax incidence.
Conclusion
As the prices and taxes of recreational cannabis continue to decrease, tax incidence remains low and is not significantly associated with tax bases or rates, posing concerns about whether the current levels of excise taxes are large enough in reducing cannabis use. Future research shall investigate this matter using converted cannabis taxes empirically. In addition, the wide range of tax magnitude and incidence across states suggests that tax avoidance opportunities may exist for recreational cannabis users who live in higher-taxed states to purchase in neighboring states with lower taxes.
{"title":"Recreational cannabis excise taxation in the USA: Constructing a comparable tax measure for empirical analysis","authors":"Hojin Park , Dong Won Yoon , Qian Yang , Yanyun He , Bing Han , Yuyan Shi , Ce Shang","doi":"10.1016/j.drugpo.2024.104630","DOIUrl":"10.1016/j.drugpo.2024.104630","url":null,"abstract":"<div><h3>Background</h3><div>As of August 2023, 20 states in the US have established recreational cannabis retail markets and impose excise taxes on these products. However, there is significant heterogeneity in the bases (i.e., characteristics that taxes are applied to, such as price, weight, and potency), rates, and collection points (e.g., cultivation vs. wholesale) of excise taxes on recreational cannabis across states.</div></div><div><h3>Methods</h3><div>We constructed a novel cannabis excise tax measure in $ per flower oz, which is comparable across different tax bases. Specifically, ad valorem excise taxes based on wholesale and retail prices and THC-based taxes were converted to excise taxes ($) per oz using monthly state-level prices between 2014 and 2023. We also calculated tax incidence (i.e., taxes as a percentage of the retail prices) and analyzed its association with tax bases and converted taxes using ordinary least square (OLS) regressions.</div></div><div><h3>Results</h3><div>The mean and median values of converted excise taxes on recreational cannabis flowers were $37.93 and $37.55 per oz, respectively. The tax incidence for recreational cannabis was 18 %, lower than the incidence of e-cigarette and cigarette excise taxes. During 2014–2023, real cannabis taxes and prices have decreased significantly over time. In addition, tax bases and converted excise taxes were not associated with tax incidence.</div></div><div><h3>Conclusion</h3><div>As the prices and taxes of recreational cannabis continue to decrease, tax incidence remains low and is not significantly associated with tax bases or rates, posing concerns about whether the current levels of excise taxes are large enough in reducing cannabis use. Future research shall investigate this matter using converted cannabis taxes empirically. In addition, the wide range of tax magnitude and incidence across states suggests that tax avoidance opportunities may exist for recreational cannabis users who live in higher-taxed states to purchase in neighboring states with lower taxes.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104630"},"PeriodicalIF":4.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.drugpo.2024.104648
Andrew Scheibe , Andreia Teixeira , Mamadu Aliu Djaló , Miriam Nascimento Pereira , Kátia Ribeiro Barreto , Ibrahima Ba , Lucia Bird , Jason Eligh
Background
Little data exists on the use of cocaine, methamphetamine, tramadol and heroin or related health conditions in Guinea Bissau. We aimed to estimate drug use practices and the prevalence of selected blood-borne infections, depression and population size estimates of people who use injectable drugs in Guinea-Bissau.
Methods
We used respondent-driven sampling to recruit adults who use injectable drugs in this cross sectional survey in three cities (Bissau, Bafatá and Gabú) between July and September 2022. Participants completed an interviewer administered survey enquiring about sociodemographic characteristics, drug use practices and mental health. Rapid diagnostic testing was done for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV). Data was weighted in RDS-Analyst using self-reported network size and Gile's Sequential Sampling Estimator. Population size estimates were generated using the two point capture-recapture method.
Results
Overall, 750 participants were recruited. People who use drugs were estimated to be mostly unemployed males aged between 25 and 49 years. Methamphetamine and crack cocaine were most commonly used. Prevalence of ever injecting ranged from 6 % to 44 %. Between 44 % and 52 % of people experience symptoms of depression. Prevalence ranges from 1.9 % to 5.2 % for HIV, and 5.7–8.3 % for HBsAg and 0.42–0.66 % for anti-HCV. The population estimates of people who use injectable drugs were 1637 in Bissau, 1314 in Bafatá and 424 in Gabú.
Conclusion
Methamphetamine and crack cocaine are the most commonly used injectable drugs in Guinea-Bissau. Symptoms of depression are common among people who use drugs in the country. Access to evidence-based drug use treatment and harm reduction interventions that integrate mental health care services are needed to improve the health and wellbeing of people who use drugs in Guinea-Bissau.
{"title":"Drug use patterns and health problems among people who use drugs in Guinea-Bissau (2022): A cross-sectional survey using respondent-driven sampling","authors":"Andrew Scheibe , Andreia Teixeira , Mamadu Aliu Djaló , Miriam Nascimento Pereira , Kátia Ribeiro Barreto , Ibrahima Ba , Lucia Bird , Jason Eligh","doi":"10.1016/j.drugpo.2024.104648","DOIUrl":"10.1016/j.drugpo.2024.104648","url":null,"abstract":"<div><h3>Background</h3><div>Little data exists on the use of cocaine, methamphetamine, tramadol and heroin or related health conditions in Guinea Bissau. We aimed to estimate drug use practices and the prevalence of selected blood-borne infections, depression and population size estimates of people who use injectable drugs in Guinea-Bissau.</div></div><div><h3>Methods</h3><div>We used respondent-driven sampling to recruit adults who use injectable drugs in this cross sectional survey in three cities (Bissau, Bafatá and Gabú) between July and September 2022. Participants completed an interviewer administered survey enquiring about sociodemographic characteristics, drug use practices and mental health. Rapid diagnostic testing was done for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV). Data was weighted in RDS-Analyst using self-reported network size and Gile's Sequential Sampling Estimator. Population size estimates were generated using the two point capture-recapture method.</div></div><div><h3>Results</h3><div>Overall, 750 participants were recruited. People who use drugs were estimated to be mostly unemployed males aged between 25 and 49 years. Methamphetamine and crack cocaine were most commonly used. Prevalence of ever injecting ranged from 6 % to 44 %. Between 44 % and 52 % of people experience symptoms of depression. Prevalence ranges from 1.9 % to 5.2 % for HIV, and 5.7–8.3 % for HBsAg and 0.42–0.66 % for anti-HCV. The population estimates of people who use injectable drugs were 1637 in Bissau, 1314 in Bafatá and 424 in Gabú.</div></div><div><h3>Conclusion</h3><div>Methamphetamine and crack cocaine are the most commonly used injectable drugs in Guinea-Bissau. Symptoms of depression are common among people who use drugs in the country. Access to evidence-based drug use treatment and harm reduction interventions that integrate mental health care services are needed to improve the health and wellbeing of people who use drugs in Guinea-Bissau.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104648"},"PeriodicalIF":4.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.drugpo.2024.104634
Jean-François Crépault , Brian Emerson , Elaine Hyshka , Carol Strike , Robin Room , Jürgen Rehm
<div><h3>Background</h3><div>The risks associated with substance use can be framed in many ways. In Canada, the consumption of psychoactive substances has at various times been considered a moral, criminal, or medical issue. In the past decade, substance use has increasingly been framed as a public health issue. This study sought to trace the historical development and evolution of the concept of a public health approach to substance use in Canada through a critical review of the academic literature.</div></div><div><h3>Methods</h3><div>Critical review is a method designed to systematically search a body of literature, take stock of its evolution and current state, identify conceptual contributions, and compare schools of thought. Systematic searches were conducted in February and March 2023 in five English-language databases (CINAHL, Medline, PsycInfo, Scopus, Web of Science) and three French-language databases (Cairn.info, Érudit, SDM Repère). Eligible articles were written in English or French by a first author based in Canada, focused primarily on substance use, and published in 2020 or earlier.</div></div><div><h3>Results</h3><div>64 articles, published between 1896 and 2020, were synthesized. We found that while public health has been used as a framing for substance use in Canada for at least 120 years, what that means and what it implies for public policy has changed over time. During the first several decades covered in this review, we periodically see the emergence of new conceptualizations of the problem of substance use and its framing as a public health issue. For example, between the 1890s and 1980s, the dominant view of alcohol evolves from that of a social problem, to a disease, to a population health issue. In the 1990s we see the last of these paradigmatic shifts. From that point onwards, the dominant conceptualization is one that prioritizes drug policy harms over drug harms; correspondingly, proposed solutions center on harm reduction, regulation, and policy reform. Beginning in the 2000s, we see detailed proposals for a comprehensive public health framework to substance use, with authors setting out to define the premises, objectives, and components of such a framework.</div></div><div><h3>Conclusion</h3><div>Overall we found a gradual convergence towards a potential Canadian model for a public health approach to substance use: a model based on principles including human rights and equity, in which psychoactive substances are neither criminalized nor commercialized, but rather strictly regulated, proportionately to the risks they pose, in a manner that optimizes the health of the population. At present, governments across Canada appear to be moving in the opposite direction: drug policy is leaning further into criminalization for already illicit substances and further into commercialization for legal ones. Treating psychoactive substances as either the objects of criminal law or as harmless commodities are both associated with
{"title":"Substance use as a public health issue: A critical review of the Canadian literature, 1896–2020","authors":"Jean-François Crépault , Brian Emerson , Elaine Hyshka , Carol Strike , Robin Room , Jürgen Rehm","doi":"10.1016/j.drugpo.2024.104634","DOIUrl":"10.1016/j.drugpo.2024.104634","url":null,"abstract":"<div><h3>Background</h3><div>The risks associated with substance use can be framed in many ways. In Canada, the consumption of psychoactive substances has at various times been considered a moral, criminal, or medical issue. In the past decade, substance use has increasingly been framed as a public health issue. This study sought to trace the historical development and evolution of the concept of a public health approach to substance use in Canada through a critical review of the academic literature.</div></div><div><h3>Methods</h3><div>Critical review is a method designed to systematically search a body of literature, take stock of its evolution and current state, identify conceptual contributions, and compare schools of thought. Systematic searches were conducted in February and March 2023 in five English-language databases (CINAHL, Medline, PsycInfo, Scopus, Web of Science) and three French-language databases (Cairn.info, Érudit, SDM Repère). Eligible articles were written in English or French by a first author based in Canada, focused primarily on substance use, and published in 2020 or earlier.</div></div><div><h3>Results</h3><div>64 articles, published between 1896 and 2020, were synthesized. We found that while public health has been used as a framing for substance use in Canada for at least 120 years, what that means and what it implies for public policy has changed over time. During the first several decades covered in this review, we periodically see the emergence of new conceptualizations of the problem of substance use and its framing as a public health issue. For example, between the 1890s and 1980s, the dominant view of alcohol evolves from that of a social problem, to a disease, to a population health issue. In the 1990s we see the last of these paradigmatic shifts. From that point onwards, the dominant conceptualization is one that prioritizes drug policy harms over drug harms; correspondingly, proposed solutions center on harm reduction, regulation, and policy reform. Beginning in the 2000s, we see detailed proposals for a comprehensive public health framework to substance use, with authors setting out to define the premises, objectives, and components of such a framework.</div></div><div><h3>Conclusion</h3><div>Overall we found a gradual convergence towards a potential Canadian model for a public health approach to substance use: a model based on principles including human rights and equity, in which psychoactive substances are neither criminalized nor commercialized, but rather strictly regulated, proportionately to the risks they pose, in a manner that optimizes the health of the population. At present, governments across Canada appear to be moving in the opposite direction: drug policy is leaning further into criminalization for already illicit substances and further into commercialization for legal ones. Treating psychoactive substances as either the objects of criminal law or as harmless commodities are both associated with","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104634"},"PeriodicalIF":4.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630593","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 : 2024-11-06DOI: 10.1016/j.drugpo.2024.104629
Qiushi Chen , Glenn Sterner , Danielle Rhubart , Robert Newton , Bethany Shaw , Dennis Scanlon
The ongoing opioid epidemic has been met with the inadequate use of data-informed approaches to respond to the crisis. Although data relevant to opioid and substance use do exist and have been utilized for research in the literature and practice, they have not been prepared for cross-sector coordination and for providing practical intelligence to inform policy planning directly. In this article, we share our views on how data can better serve the purposes of informing policy and planning to maximize population health and safety benefits. Based on our experience in advising state policymakers on developing settlement allocation strategies based on empirical data, we discuss several issues in the data, including coverage, specificity in drug types, time relevance, geographic units, and access, which may hinder data-informed policymaking. Following these discussions, we envision a coordinated data and policy framework as an ideal case to ensure access to meaningful and timely data and harness the full potential of the data to inform policy to combat the continuing epidemic.
{"title":"Creating a robust coordinated data and policy framework for addressing substance use issues in the United States","authors":"Qiushi Chen , Glenn Sterner , Danielle Rhubart , Robert Newton , Bethany Shaw , Dennis Scanlon","doi":"10.1016/j.drugpo.2024.104629","DOIUrl":"10.1016/j.drugpo.2024.104629","url":null,"abstract":"<div><div>The ongoing opioid epidemic has been met with the inadequate use of data-informed approaches to respond to the crisis. Although data relevant to opioid and substance use do exist and have been utilized for research in the literature and practice, they have not been prepared for cross-sector coordination and for providing practical intelligence to inform policy planning directly. In this article, we share our views on how data can better serve the purposes of informing policy and planning to maximize population health and safety benefits. Based on our experience in advising state policymakers on developing settlement allocation strategies based on empirical data, we discuss several issues in the data, including coverage, specificity in drug types, time relevance, geographic units, and access, which may hinder data-informed policymaking. Following these discussions, we envision a coordinated data and policy framework as an ideal case to ensure access to meaningful and timely data and harness the full potential of the data to inform policy to combat the continuing epidemic.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104629"},"PeriodicalIF":4.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593159","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}
With greater attention given to midlife women's drinking in research and in media representations of ‘wine mums’, we suggest that focusing on static gender roles (e.g., women as mothers) risks overlooking complex and dynamic features of women's lives. We draw on the concept of thick intersectionality to explore how everyday experiences of women's lives and multiple identities shape their drinking practices.
Methods
This study draws on interviews with Australian women in their forties and fifties who were employed, had school-aged children and drank alcohol. We present four detailed accounts as interpreted narratives.
Results
Close analysis of the stories of four women highlights important features of women's lives. Drinking practices were often intertwined with gendered labour, power inequalities and managing stresses borne from these. Gender, class, relationality, life course transitions, affect and various aspects of labour dynamics (temporality, autonomy and unseen labour) were prominent in the accounts. Alongside this health, geography, life histories and culture interacted in women's narratives and the various identities and roles they moved between, co-producing drinking practices in different ways.
Conclusion
By juxtaposing women's stories with ‘wine mum’ stereotypes, and the broader feminisation of drinking, we highlight how women's drinking practices are influenced not only by static identities, but the complex interplay between gender, a myriad of fluid social categories, and day-to-day life. We suggest that attending to context and women's everyday experiences is crucial for generating a nuanced understanding of drinking beyond women's traditional gender roles.
{"title":"Uncorking the ‘wine mum’: Exploring the complexity of Australian women's everyday lives and drinking practices","authors":"Gabriel Caluzzi , Megan Cook , Maree Patsouras , Cassandra J.C. Wright , Emmanuel Kuntsche , Sandra Kuntsche","doi":"10.1016/j.drugpo.2024.104637","DOIUrl":"10.1016/j.drugpo.2024.104637","url":null,"abstract":"<div><h3>Background</h3><div>With greater attention given to midlife women's drinking in research and in media representations of ‘wine mums’, we suggest that focusing on static gender roles (e.g., women as mothers) risks overlooking complex and dynamic features of women's lives. We draw on the concept of thick intersectionality to explore how everyday experiences of women's lives and multiple identities shape their drinking practices.</div></div><div><h3>Methods</h3><div>This study draws on interviews with Australian women in their forties and fifties who were employed, had school-aged children and drank alcohol. We present four detailed accounts as interpreted narratives.</div></div><div><h3>Results</h3><div>Close analysis of the stories of four women highlights important features of women's lives. Drinking practices were often intertwined with gendered labour, power inequalities and managing stresses borne from these. Gender, class, relationality, life course transitions, affect and various aspects of labour dynamics (temporality, autonomy and unseen labour) were prominent in the accounts. Alongside this health, geography, life histories and culture interacted in women's narratives and the various identities and roles they moved between, co-producing drinking practices in different ways.</div></div><div><h3>Conclusion</h3><div>By juxtaposing women's stories with ‘wine mum’ stereotypes, and the broader feminisation of drinking, we highlight how women's drinking practices are influenced not only by static identities, but the complex interplay between gender, a myriad of fluid social categories, and day-to-day life. We suggest that attending to context and women's everyday experiences is crucial for generating a nuanced understanding of drinking beyond women's traditional gender roles.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104637"},"PeriodicalIF":4.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1016/j.drugpo.2024.104635
Mihili P. Gunaratne , Ashwini Kedar , Allison M. McFall , Aylur K. Srikrishnan , Shanta Chingtham , Pradeep Amrose , Jiban J. Baishya , Archit K. Sinha , Shruti H. Mehta , Sunil S. Solomon
Background
Reinfection with hepatitis C virus (HCV) following successful treatment with direct-acting antivirals (DAAs) is a threat to achieving the World Health Organization viral hepatitis elimination goals. Given the limited data among people who inject drugs (PWID) from low-and-middle-income countries (LMICs), we characterized HCV reinfection among PWID in Imphal, India.
Methods
Our study population included PWID who achieved a sustained virologic response (SVR) after DAA treatment at community-based treatment programs located in harm reduction centers. Reinfection rates per 100 person-years (PY) were calculated overall and by select characteristics. Poisson regression was used to estimate incidence rate ratios and correlates of reinfection.
Results
Among 1267 PWID who achieved SVR and were screened for this study, 315 instances of reinfection were documented over 2395 PY of follow-up with an incidence rate (IR) of 13.2 per 100 PY (95 % CI: 11.8, 14.7). The incidence of reinfection was highest among those 18–24 years old (20.0 per 100 PY, 95 % CI: 16.9, 23.8) and in multivariable analysis, age remained independently associated with reinfection risk. Those 18–24 years old had the highest incidence (adjusted incidence rate ratio (aIRR) compared to 45–54 years: 4.94 [95 % CI: 2.59, 9.42]). The use of medication for opioid use disorder (MOUD) was also associated with reinfection in those reporting recent injection (aIRR: 1.57 [95 % CI: 1.19, 2.09]).
Conclusions
The high reinfection rate among PWID in Imphal, a setting with comprehensive harm reduction programs, highlights the need to integrate and innovate models of HCV care and harm reduction service delivery with a particular emphasis on young PWID.
{"title":"High hepatitis C virus reinfection in a community-based sample of people who inject drugs in Imphal, India","authors":"Mihili P. Gunaratne , Ashwini Kedar , Allison M. McFall , Aylur K. Srikrishnan , Shanta Chingtham , Pradeep Amrose , Jiban J. Baishya , Archit K. Sinha , Shruti H. Mehta , Sunil S. Solomon","doi":"10.1016/j.drugpo.2024.104635","DOIUrl":"10.1016/j.drugpo.2024.104635","url":null,"abstract":"<div><h3>Background</h3><div>Reinfection with hepatitis C virus (HCV) following successful treatment with direct-acting antivirals (DAAs) is a threat to achieving the World Health Organization viral hepatitis elimination goals. Given the limited data among people who inject drugs (PWID) from low-and-middle-income countries (LMICs), we characterized HCV reinfection among PWID in Imphal, India.</div></div><div><h3>Methods</h3><div>Our study population included PWID who achieved a sustained virologic response (SVR) after DAA treatment at community-based treatment programs located in harm reduction centers. Reinfection rates per 100 person-years (PY) were calculated overall and by select characteristics. Poisson regression was used to estimate incidence rate ratios and correlates of reinfection.</div></div><div><h3>Results</h3><div>Among 1267 PWID who achieved SVR and were screened for this study, 315 instances of reinfection were documented over 2395 PY of follow-up with an incidence rate (IR) of 13.2 per 100 PY (95 % CI: 11.8, 14.7). The incidence of reinfection was highest among those 18–24 years old (20.0 per 100 PY, 95 % CI: 16.9, 23.8) and in multivariable analysis, age remained independently associated with reinfection risk. Those 18–24 years old had the highest incidence (adjusted incidence rate ratio (aIRR) compared to 45–54 years: 4.94 [95 % CI: 2.59, 9.42]). The use of medication for opioid use disorder (MOUD) was also associated with reinfection in those reporting recent injection (aIRR: 1.57 [95 % CI: 1.19, 2.09]).</div></div><div><h3>Conclusions</h3><div>The high reinfection rate among PWID in Imphal, a setting with comprehensive harm reduction programs, highlights the need to integrate and innovate models of HCV care and harm reduction service delivery with a particular emphasis on young PWID.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104635"},"PeriodicalIF":4.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577888","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 : 2024-11-04DOI: 10.1016/j.drugpo.2024.104618
Vira Pravosud , Stanton Glantz , Salomeh Keyhani , Pamela M. Ling , Lauren K. Lempert , Katherine J. Hoggatt , Deborah Hasin , Nhung Nguyen , Francis Julian L. Graham , Beth E. Cohen
Background
Little is known about whether cannabis legalization impacts cannabis use uptake or has spillover effects on co-use of cannabis and tobacco/nicotine (using both in the past 30 days). We determined associations of cannabis legalization with self-reported (1) current (past 30-day) cannabis use; (2) current (“now”) tobacco/nicotine use (smoking or electronic cigarette use); and (3) current co-use of cannabis and tobacco/nicotine and how prevalence is changing over time.
Methods
In this longitudinal study, a web-based survey was administered to a nationally representative, population-based panel of US adults in 2017, 2020, and 2021. We used weighted unadjusted binomial logistic GEE models to assess changes in prevalence of cannabis, tobacco/nicotine use and co-use and weighted, adjusted binary logistic GEE models to assess associations of cannabis legalization with cannabis, tobacco/nicotine use and co-use.
Results
A total of 9003 participants (age range = 18–94, mean age = 47.9 [±17.4 SD] years; 4696 females [weighted 52.0 %]) completed the survey in 2017; 5979/8529 (70.1 %) in 2020 and 5420/7305 (74.2 %) in 2021 from the original cohort who remained available. Current cannabis use significantly increased +3.3 % between 2017 and 2021, while tobacco/nicotine use significantly declined (−1.9 %); co-use of cannabis and tobacco/nicotine did not change significantly (+0.2 %). Both medical and recreational cannabis legalization was associated with increased current cannabis use; the independent effect of recreational cannabis legalization was 1.13 times larger than medical. There were no statistically significant differences in tobacco/nicotine use and co-use prevalence by legalization status.
Conclusion
Cannabis legalization increases cannabis use but is not associated with changes in tobacco/nicotine use or co-use. Legalization should be coupled with public health efforts.
{"title":"Cannabis legalization and changes in cannabis and tobacco/nicotine use and co-use in a national cohort of U.S. adults during 2017–2021","authors":"Vira Pravosud , Stanton Glantz , Salomeh Keyhani , Pamela M. Ling , Lauren K. Lempert , Katherine J. Hoggatt , Deborah Hasin , Nhung Nguyen , Francis Julian L. Graham , Beth E. Cohen","doi":"10.1016/j.drugpo.2024.104618","DOIUrl":"10.1016/j.drugpo.2024.104618","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about whether cannabis legalization impacts cannabis use uptake or has spillover effects on co-use of cannabis and tobacco/nicotine (using both in the past 30 days). We determined associations of cannabis legalization with self-reported (1) current (past 30-day) cannabis use; (2) current (“now”) tobacco/nicotine use (smoking or electronic cigarette use); and (3) current co-use of cannabis and tobacco/nicotine and how prevalence is changing over time.</div></div><div><h3>Methods</h3><div>In this longitudinal study, a web-based survey was administered to a nationally representative, population-based panel of US adults in 2017, 2020, and 2021. We used weighted unadjusted binomial logistic GEE models to assess changes in prevalence of cannabis, tobacco/nicotine use and co-use and weighted, adjusted binary logistic GEE models to assess associations of cannabis legalization with cannabis, tobacco/nicotine use and co-use.</div></div><div><h3>Results</h3><div>A total of 9003 participants (age range = 18–94, mean age = 47.9 [±17.4 SD] years; 4696 females [weighted 52.0 %]) completed the survey in 2017; 5979/8529 (70.1 %) in 2020 and 5420/7305 (74.2 %) in 2021 from the original cohort who remained available. Current cannabis use significantly increased +3.3 % between 2017 and 2021, while tobacco/nicotine use significantly declined (−1.9 %); co-use of cannabis and tobacco/nicotine did not change significantly (+0.2 %). Both <em>medical</em> and <em>recreational</em> cannabis legalization was associated with increased current cannabis use; the independent effect of recreational cannabis legalization was 1.13 times larger than medical. There were no statistically significant differences in tobacco/nicotine use and co-use prevalence by legalization status.</div></div><div><h3>Conclusion</h3><div>Cannabis legalization increases cannabis use but is not associated with changes in tobacco/nicotine use or co-use. Legalization should be coupled with public health efforts.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104618"},"PeriodicalIF":4.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577886","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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