Pub Date : 2025-12-11DOI: 10.1016/j.drugpo.2025.105081
Julia E. Noguchi , Yu Li , Carolyn J. Park , Jacqueline E. Goldman , Leah C. Shaw , Jane A. Buxton , Scott E. Hadland , Susan G. Sherman , Katie B. Biello , Brandon D.L. Marshall
Background
People experiencing homelessness have been disproportionately affected by the overdose crisis in the United States. We assessed whether an association exists between homelessness and fentanyl test strip (FTS) use to avoid drug overdose among people who use drugs in Rhode Island.
Methods
We recruited 505 participants aged 18–65 from September 2020 to February 2023 as part of the Rhode Island Prescription Illicit Drug Study (RAPIDS). Baseline data assessed correlates of past-month FTS use through bivariate and multivariable analyses. We used generalized estimating equations (GEE) to estimate the longitudinal association between past-month homelessness and FTS use over 12 months.
Results
At baseline, 19.3 % of the sample reported having used FTS in the past month, which was more commonly reported by those who were experiencing homelessness (22.6 %) compared to those who were housed (14.4 %), p = 0.021. In bivariable GEE analysis, past month homelessness was not associated with past-month FTS use (OR=1.22, 95 %CI: 0.95-–1.56, p = 0.117). In multivariable GEE analysis, homelessness was not associated with FTS use, but regular use of crystal methamphetamine was (aOR = 2.13, 95 %CI: 1.42–3.19; p < 0.001). The odds of FTS use among persons recruited in 2023 increased by 165 % (aOR=2.65, 95 %CI: 1.22–5.76; p < 0.001) compared to those recruited in 2020.
Conclusions
We found that housing status was not independently and longitudinally associated with FTS use; however, people who used crystal methamphetamine were more than twice as likely to have used FTS in the past month. Future research exploring how differential housing situations may affect uptake of harm reduction services is needed to prevent fentanyl overdose.
{"title":"Fentanyl test strip use and homelessness among people who use drugs in Rhode Island","authors":"Julia E. Noguchi , Yu Li , Carolyn J. Park , Jacqueline E. Goldman , Leah C. Shaw , Jane A. Buxton , Scott E. Hadland , Susan G. Sherman , Katie B. Biello , Brandon D.L. Marshall","doi":"10.1016/j.drugpo.2025.105081","DOIUrl":"10.1016/j.drugpo.2025.105081","url":null,"abstract":"<div><h3>Background</h3><div>People experiencing homelessness have been disproportionately affected by the overdose crisis in the United States. We assessed whether an association exists between homelessness and fentanyl test strip (FTS) use to avoid drug overdose among people who use drugs in Rhode Island.</div></div><div><h3>Methods</h3><div>We recruited 505 participants aged 18–65 from September 2020 to February 2023 as part of the Rhode Island Prescription Illicit Drug Study (RAPIDS). Baseline data assessed correlates of past-month FTS use through bivariate and multivariable analyses. We used generalized estimating equations (GEE) to estimate the longitudinal association between past-month homelessness and FTS use over 12 months.</div></div><div><h3>Results</h3><div>At baseline, 19.3 % of the sample reported having used FTS in the past month, which was more commonly reported by those who were experiencing homelessness (22.6 %) compared to those who were housed (14.4 %), <em>p</em> = 0.021. In bivariable GEE analysis, past month homelessness was not associated with past-month FTS use (OR=1.22, 95 %CI: 0.95-–1.56, <em>p</em> = 0.117). In multivariable GEE analysis, homelessness was not associated with FTS use, but regular use of crystal methamphetamine was (aOR = 2.13, 95 %CI: 1.42–3.19; <em>p</em> < 0.001). The odds of FTS use among persons recruited in 2023 increased by 165 % (aOR=2.65, 95 %CI: 1.22–5.76; <em>p</em> < 0.001) compared to those recruited in 2020.</div></div><div><h3>Conclusions</h3><div>We found that housing status was not independently and longitudinally associated with FTS use; however, people who used crystal methamphetamine were more than twice as likely to have used FTS in the past month. Future research exploring how differential housing situations may affect uptake of harm reduction services is needed to prevent fentanyl overdose.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105081"},"PeriodicalIF":4.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745241","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 : 2025-12-11DOI: 10.1016/j.drugpo.2025.105102
Daniel Gudiño Pérez , Celeste Macevicius , Alexa Norton , Phoenix Beck-McGreevy , Marion Selfridge , Jeremy Kalicum , Karen Urbanoski , Brittany Barker , Amanda Slaunwhite , Jaime Arredondo , Bruce Wallace , Bernie Pauly
Background
Risk Mitigation Guidance (RMG) was released in response to the dual public health emergencies of COVID-19 and overdose in British Columbia (BC), Canada. RMG enabled the provision of prescribed alternatives to the unregulated drug supply for people at risk of COVID-19 and overdose. Our objective was to gain insight into how health planners in BC problematized the dual health emergencies and the impacts of such on the design and implementation of RMG.
Methods
Qualitative interviews (n = 28) were conducted with health planners across BC about their understanding of RMG, the implementation process, and context. Carol Bacchi’s “What’s the Problem Represented to be?” framework was used to interrogate the data and guide analysis.
Results
From the perspectives of health planners, RMG was a solution to the primary problem of COVID-19 and to reduce spread of the virus. We identified four problem representations related to the problematization of safer supply as a COVID-19 response: 1) COVID-19 opened a window of opportunity; 2) dual public health emergency, but COVID-19 as the priority ‘problem’; 3) the effects of making COVID-19 problem priority; 4) expanding understandings of safer supply beyond COVID-19.
Conclusion
Our study builds on the importance of evaluating problem representations in the process of policymaking. The RMG illustrates how crisis-driven policymaking shapes problem representations, enabling rapid intervention through the COVID-19 response while constraining responses to the toxic drug emergency. As a medicalized emergency response, the RMG addressed contagion but failed to confront the structural drivers of toxic drug deaths. Our study highlights the needs for prescribed safer supply models to directly address the unregulated toxic drug supply.
{"title":"Problem representation of the Risk Mitigation Guidance (RMG) within the context of dual public health emergencies of COVID-19 and toxic drug deaths in British Columbia, Canada","authors":"Daniel Gudiño Pérez , Celeste Macevicius , Alexa Norton , Phoenix Beck-McGreevy , Marion Selfridge , Jeremy Kalicum , Karen Urbanoski , Brittany Barker , Amanda Slaunwhite , Jaime Arredondo , Bruce Wallace , Bernie Pauly","doi":"10.1016/j.drugpo.2025.105102","DOIUrl":"10.1016/j.drugpo.2025.105102","url":null,"abstract":"<div><h3>Background</h3><div>Risk Mitigation Guidance (RMG) was released in response to the dual public health emergencies of COVID-19 and overdose in British Columbia (BC), Canada. RMG enabled the provision of prescribed alternatives to the unregulated drug supply for people at risk of COVID-19 and overdose. Our objective was to gain insight into how health planners in BC problematized the dual health emergencies and the impacts of such on the design and implementation of RMG.</div></div><div><h3>Methods</h3><div>Qualitative interviews (<em>n</em> = 28) were conducted with health planners across BC about their understanding of RMG, the implementation process, and context. Carol Bacchi’s “What’s the Problem Represented to be?” framework was used to interrogate the data and guide analysis.</div></div><div><h3>Results</h3><div>From the perspectives of health planners, RMG was a solution to the primary problem of COVID-19 and to reduce spread of the virus. We identified four problem representations related to the problematization of safer supply as a COVID-19 response: 1) COVID-19 opened a window of opportunity; 2) dual public health emergency, but COVID-19 as the priority ‘problem’; 3) the effects of making COVID-19 problem priority; 4) expanding understandings of safer supply beyond COVID-19.</div></div><div><h3>Conclusion</h3><div>Our study builds on the importance of evaluating problem representations in the process of policymaking. The RMG illustrates how crisis-driven policymaking shapes problem representations, enabling rapid intervention through the COVID-19 response while constraining responses to the toxic drug emergency. As a medicalized emergency response, the RMG addressed contagion but failed to confront the structural drivers of toxic drug deaths. Our study highlights the needs for prescribed safer supply models to directly address the unregulated toxic drug supply.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105102"},"PeriodicalIF":4.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745172","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 : 2025-12-09DOI: 10.1016/j.drugpo.2025.105101
David S. Evans , Eamon Keenan
Background
Medically Supervised Injecting Facilities (MSIFs) are locations where illicit drugs can be injected using sterile equipment under professional supervision. They aim to reduce risks associated with public injecting and injecting alone such as overdose and related harms. Evidence shows that MSIFs reduce overdoses, public injecting and related litter, and increase service engagement. Ireland’s first MSIF opened in December 2024. The study assesses its impact during its first four months.
Methods
All publicly accessible areas within 500 metres of the facility were patrolled weekly before and after it opened (September 2024-April 2025). Discarded needles, crack pipes, public injecting, loitering, and weight of discarded items were recorded. Weather data was controlled for and client uptake (number of unique clients using MSIF) was obtained. Generalised linear models and bivariate correlations compared pre and post changes.
Results
Attendance increased almost fivefold during the study period. The average number of discarded needles per patrol decreased by 20 % (from 3.14 before to 2.50 after, p = 0.288). Each additional client attending was associated with a 5 % reduction in discarded needles (IRR = 0.95, 95 % CI: 0.92–0.99, p = 0.008). Crack pipes declined by 20 % (p = 0.545), with a 59 % reduction in the weight of drug-related litter (p < 0.001). Loitering declined by 45 % (p = 0.002) while public injecting remained rare (one before, one after).
Conclusions
Early evidence suggests community level benefits after four months including reduced drug-related litter and public loitering. Continued monitoring is required to assess long-term impact.
{"title":"Dublin’s supervised injecting facility: An assessment of its impact on discarded needles","authors":"David S. Evans , Eamon Keenan","doi":"10.1016/j.drugpo.2025.105101","DOIUrl":"10.1016/j.drugpo.2025.105101","url":null,"abstract":"<div><h3>Background</h3><div>Medically Supervised Injecting Facilities (MSIFs) are locations where illicit drugs can be injected using sterile equipment under professional supervision. They aim to reduce risks associated with public injecting and injecting alone such as overdose and related harms. Evidence shows that MSIFs reduce overdoses, public injecting and related litter, and increase service engagement. Ireland’s first MSIF opened in December 2024. The study assesses its impact during its first four months.</div></div><div><h3>Methods</h3><div>All publicly accessible areas within 500 metres of the facility were patrolled weekly before and after it opened (September 2024-April 2025). Discarded needles, crack pipes, public injecting, loitering, and weight of discarded items were recorded. Weather data was controlled for and client uptake (number of unique clients using MSIF) was obtained. Generalised linear models and bivariate correlations compared pre and post changes.</div></div><div><h3>Results</h3><div>Attendance increased almost fivefold during the study period. The average number of discarded needles per patrol decreased by 20 % (from 3.14 before to 2.50 after, <em>p</em> = 0.288). Each additional client attending was associated with a 5 % reduction in discarded needles (IRR = 0.95, 95 % CI: 0.92–0.99, <em>p</em> = 0.008). Crack pipes declined by 20 % (<em>p</em> = 0.545), with a 59 % reduction in the weight of drug-related litter (<em>p</em> < 0.001). Loitering declined by 45 % (<em>p</em> = 0.002) while public injecting remained rare (one before, one after).</div></div><div><h3>Conclusions</h3><div>Early evidence suggests community level benefits after four months including reduced drug-related litter and public loitering. Continued monitoring is required to assess long-term impact.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105101"},"PeriodicalIF":4.4,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726702","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 : 2025-12-09DOI: 10.1016/j.drugpo.2025.105106
William H. Eger , Shelby L. Huffaker , Elana Forman , Jessica Smith , Chris F. Akiba , Rose Laurano , Sheila V. Patel , Barrot H. Lambdin , Alexis M. Roth , Angela R. Bazzi
Background
Amidst population-level transitions from injecting to smoking unregulated drugs, US. syringe services programs (SSPs) are increasingly distributing safer smoking equipment.
Methods
We conducted qualitative interviews with representatives of 27 geographically diverse U.S. SSPs from May 2023–March 2024. Guided by the Consolidated Framework for Implementation Research, we explored programs’ experiences distributing safer smoking equipment, including staff perceptions on challenges to implementation and sustainment. Thematic analysis identified key findings.
Results
We interviewed 41 SSP representatives, including leadership (63 %), frontline (22 %), and clinical and clinical support staff (15 %). Two critical incidents–fentanyl adulteration of unregulated drug supplies and the COVID-19 pandemic–drove the adoption of this intervention. Interviewees perceived that safer smoking equipment facilitated client engagement, expanded SSPs’ reach into previously underserved communities, and promoted individual health by reducing the adverse consequences of injecting drugs. Barriers to implementation and sustainment included program staff and leadership concerns about limited evidence on the public health benefits of safer smoking equipment, stigma and negative local attitudes, funding restrictions, and cost (particularly for glass pipes). Strategies to support implementation included incrementally piloting safer smoking equipment, partnering with diverse funders, and adapting services to navigate resource constraints. Nevertheless, limited funding and legal support hindered broader adoption, reach and sustainability.
Conclusions
Implementation of safer smoking equipment represents a critical evolution in harm reduction programming that may engage underserved communities in the range of evidence-based prevention services offered by SSPs. Flexible funding and supportive implementation climates are needed to support SSPs in providing this impactful service.
{"title":"Integration of safer smoking equipment in U.S. syringe services programs: Qualitative insights from program staff","authors":"William H. Eger , Shelby L. Huffaker , Elana Forman , Jessica Smith , Chris F. Akiba , Rose Laurano , Sheila V. Patel , Barrot H. Lambdin , Alexis M. Roth , Angela R. Bazzi","doi":"10.1016/j.drugpo.2025.105106","DOIUrl":"10.1016/j.drugpo.2025.105106","url":null,"abstract":"<div><h3>Background</h3><div>Amidst population-level transitions from injecting to smoking unregulated drugs, US. syringe services programs (SSPs) are increasingly distributing safer smoking equipment.</div></div><div><h3>Methods</h3><div>We conducted qualitative interviews with representatives of 27 geographically diverse U.S. SSPs from May 2023–March 2024. Guided by the Consolidated Framework for Implementation Research, we explored programs’ experiences distributing safer smoking equipment, including staff perceptions on challenges to implementation and sustainment. Thematic analysis identified key findings.</div></div><div><h3>Results</h3><div>We interviewed 41 SSP representatives, including leadership (63 %), frontline (22 %), and clinical and clinical support staff (15 %). Two critical incidents–fentanyl adulteration of unregulated drug supplies and the COVID-19 pandemic–drove the adoption of this intervention. Interviewees perceived that safer smoking equipment facilitated client engagement, expanded SSPs’ reach into previously underserved communities, and promoted individual health by reducing the adverse consequences of injecting drugs. Barriers to implementation and sustainment included program staff and leadership concerns about limited evidence on the public health benefits of safer smoking equipment, stigma and negative local attitudes, funding restrictions, and cost (particularly for glass pipes). Strategies to support implementation included incrementally piloting safer smoking equipment, partnering with diverse funders, and adapting services to navigate resource constraints. Nevertheless, limited funding and legal support hindered broader adoption, reach and sustainability.</div></div><div><h3>Conclusions</h3><div>Implementation of safer smoking equipment represents a critical evolution in harm reduction programming that may engage underserved communities in the range of evidence-based prevention services offered by SSPs. Flexible funding and supportive implementation climates are needed to support SSPs in providing this impactful service.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105106"},"PeriodicalIF":4.4,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726823","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}
Drug-related early warning systems (EWS) comprise interdisciplinary networks that interpret data to detect and mitigate drug-related harms. The cross-disciplinary literature on EWS highlights the need for EWS to integrate community, scientific, and technical knowledges. Internationally, certain drug-related EWS collect incidental reports of noteworthy drug events provided by people who use drugs (PWUD). This qualitative study explored the potential benefits, risks, principles and approaches associated with implementing systematic mechanisms for community drug reporting, to inform the development of a nation-wide reporting system in Australia.
Methods
Data were drawn from 20 semi-structured interviews with Australian EWS practitioners plus three advisory meetings engaging 14 staff from community-based and peer-led organisations representing PWUD. Discussions focused on the prospect of collecting, analysing and sharing community data to support drug-related EWS. Thematic analysis was conducted on interview transcripts and advisory meeting minutes.
Results
Benefits ascribed to collecting incidental drug reports from communities included the faster detection of concerns and providing context for analytically verified data. Concerns were raised about data privacy and criminalisation, difficulty verifying community reports and spreading misinformation. It was suggested that community reporting initiatives should be led by PWUD; prioritise community engagement; be open to reports of benefits and harms, be underpinned by robust moderation, with data used to inform diverse harm reduction communications.
Conclusions
The systematic collection of and response to experiential reports provided by PWUD has potential to improve drug-related EWS. Such systems must be underpinned by strong governance, remain open to collecting reports of benefits plus harms and be led by communities.
{"title":"Incorporating experiential reports provided by people who use drugs into drug-related early warning systems: benefits, risks principles and approaches","authors":"Jack Freestone , Cilla Zhou , Stassi Kypri , Molly Howes , Emily Ebdon , Laura Purcell , Paul Dessauer , Clancy Beckers , Brittany Chapman , Sonya Weith , Mitch Lamb , Brendan Clifford , Krista J Siefried , Monica J Barratt , Amy Peacock , Rachel Sutherland , Jess Doumany , Peta Gava , Megan Standfield , Rebecca Kavanagh , Nadine Ezard","doi":"10.1016/j.drugpo.2025.105098","DOIUrl":"10.1016/j.drugpo.2025.105098","url":null,"abstract":"<div><h3>Introduction</h3><div>Drug-related early warning systems (EWS) comprise interdisciplinary networks that interpret data to detect and mitigate drug-related harms. The cross-disciplinary literature on EWS highlights the need for EWS to integrate community, scientific, and technical knowledges. Internationally, certain drug-related EWS collect incidental reports of noteworthy drug events provided by people who use drugs (PWUD). This qualitative study explored the potential benefits, risks, principles and approaches associated with implementing systematic mechanisms for community drug reporting, to inform the development of a nation-wide reporting system in Australia.</div></div><div><h3>Methods</h3><div>Data were drawn from 20 semi-structured interviews with Australian EWS practitioners plus three advisory meetings engaging 14 staff from community-based and peer-led organisations representing PWUD. Discussions focused on the prospect of collecting, analysing and sharing community data to support drug-related EWS. Thematic analysis was conducted on interview transcripts and advisory meeting minutes.</div></div><div><h3>Results</h3><div>Benefits ascribed to collecting incidental drug reports from communities included the faster detection of concerns and providing context for analytically verified data. Concerns were raised about data privacy and criminalisation, difficulty verifying community reports and spreading misinformation. It was suggested that community reporting initiatives should be led by PWUD; prioritise community engagement; be open to reports of benefits and harms, be underpinned by robust moderation, with data used to inform diverse harm reduction communications.</div></div><div><h3>Conclusions</h3><div>The systematic collection of and response to experiential reports provided by PWUD has potential to improve drug-related EWS. Such systems must be underpinned by strong governance, remain open to collecting reports of benefits plus harms and be led by communities.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105098"},"PeriodicalIF":4.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716351","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 : 2025-12-05DOI: 10.1016/j.drugpo.2025.105103
Patrick J. Burke
Purpose
This study examines the effects of arresting or killing leaders of organized criminal groups (OCGs) on drug market violence in six Latin American countries. It is the first cross-national study of leadership decapitations, and the first to include both state-perpetrated and OCG-perpetrated decapitations as independent variables.
Method
Leadership removals and drug market violence were identified using the Armed Conflict Location and Event Dataset (ACLED). The three outcome variables are: (1) inter-OCG battle deaths, (2) battle deaths from armed confrontations between state forces and OCGs, and (3) a combined measure of the two. I estimate the effects of leadership decapitations using a series of linear regressions with two-way fixed effects. The panel dataset includes Mexican, Venezuelan, and Brazilian states, and departments in El Salvador, Honduras, and Guatemala (N = 136), measured monthly between 2022 and 2024.
Results
The main models and several robustness checks show that state-perpetrated decapitations are most consistently associated with an increase in state-OCG battle deaths. In contrast, OCG-perpetrated decapitations are associated with an increase in inter-OCG battle deaths. In both cases, effects tend to diminish within a few months of the decapitation.
Conclusion
OCG-perpetrated decapitations likely trigger violent contestation over the drug trade between and within OCGs. However, state decapitations likely trigger violence through other mechanisms, including the state’s intent to incapacitate target OCGs, and the latter attempting to send costly signals of strength to rivals by attacking state forces. Implications for policy and future research are discussed.
{"title":"Organized criminal violence and leadership decapitation in Latin America’s drug wars","authors":"Patrick J. Burke","doi":"10.1016/j.drugpo.2025.105103","DOIUrl":"10.1016/j.drugpo.2025.105103","url":null,"abstract":"<div><h3>Purpose</h3><div>This study examines the effects of arresting or killing leaders of organized criminal groups (OCGs) on drug market violence in six Latin American countries. It is the first cross-national study of leadership decapitations, and the first to include both state-perpetrated and OCG-perpetrated decapitations as independent variables.</div></div><div><h3>Method</h3><div>Leadership removals and drug market violence were identified using the Armed Conflict Location and Event Dataset (ACLED). The three outcome variables are: (1) inter-OCG battle deaths, (2) battle deaths from armed confrontations between state forces and OCGs, and (3) a combined measure of the two. I estimate the effects of leadership decapitations using a series of linear regressions with two-way fixed effects. The panel dataset includes Mexican, Venezuelan, and Brazilian states, and departments in El Salvador, Honduras, and Guatemala (<em>N</em> = 136), measured monthly between 2022 and 2024.</div></div><div><h3>Results</h3><div>The main models and several robustness checks show that state-perpetrated decapitations are most consistently associated with an increase in state-OCG battle deaths. In contrast, OCG-perpetrated decapitations are associated with an increase in inter-OCG battle deaths. In both cases, effects tend to diminish within a few months of the decapitation.</div></div><div><h3>Conclusion</h3><div>OCG-perpetrated decapitations likely trigger violent contestation over the drug trade between and within OCGs. However, state decapitations likely trigger violence through other mechanisms, including the state’s intent to incapacitate target OCGs, and the latter attempting to send costly signals of strength to rivals by attacking state forces. Implications for policy and future research are discussed.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105103"},"PeriodicalIF":4.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688271","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 : 2025-12-05DOI: 10.1016/j.drugpo.2025.105104
Jeffrey K. Hom , Kathryn Heley , Linnea I. Laestadius
{"title":"When words and images diverge: Challenges of AI-generated drug use representations","authors":"Jeffrey K. Hom , Kathryn Heley , Linnea I. Laestadius","doi":"10.1016/j.drugpo.2025.105104","DOIUrl":"10.1016/j.drugpo.2025.105104","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105104"},"PeriodicalIF":4.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693574","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 : 2025-12-05DOI: 10.1016/j.drugpo.2025.105100
Zongbo Li , Tanvi V. Chiddawar , Leah C. Shaw , Ashleigh Dennis , Amy Lieberman , Alexandra Kingsepp , Andrew J. Trinidad , Ellenie Tuazon , Alice E. Welch , Avik Chatterjee , Bruce R. Schackman , Eva A. Enns , Alexander Y. Walley , Traci C. Green , Karla D. Wagner , Rachel P. Winograd , Czarina N. Behrends , Erika L. Crable , Brandon D.L. Marshall , Xiao Zang
Background
Since 1999, drug overdose deaths have surged in the United States. There is considerable geographic variability in overdose patterns, state laws, overdose prevention infrastructure, and opioid settlement amounts and investments. To guide localized overdose prevention, it is important to analyze these data and understand heterogeneity.
Methods
In this descriptive analysis across six states—Massachusetts, Minnesota, Missouri, Nevada, New York, and Rhode Island, we compared five key domains essential to understanding overdose epidemics, prevention, and policy responses: (1) drug overdose mortality trends by substance and race/ethnicity (2018–2023); (2) state harm reduction laws; (3) availability and coverage of overdose prevention services; (4) opioid settlement funding and spending; and (5) availability and comprehensiveness of publicly available overdose-related data. Data were drawn from publicly available sources and legal information confirmed using Westlaw.
Results
All states experienced rising overdose death rates between 2018 and 2023, with significant racial/ethnic disparities. All states have enacted laws to increase access to naloxone. Naloxone distribution rates vary widely, but most states have high availability. Implementation of other harm reduction services differed across states, as well as drug paraphernalia laws. Opioid settlement funding per capita and transparency in spending and planning also differed across states. Some dashboards provided detailed fatal and nonfatal overdose and intervention data stratified by sociodemographics.
Conclusion
State-specific differences in overdose patterns, harm reduction laws, prevention infrastructure, and settlement spending underscore the need for localized, tailored strategies. This study’s state-specific profiles lay the groundwork for more advanced decision-support tools to guide effective overdose prevention.
{"title":"A descriptive study of drug overdose epidemics, overdose prevention efforts, and opioid settlement fund distribution across six states","authors":"Zongbo Li , Tanvi V. Chiddawar , Leah C. Shaw , Ashleigh Dennis , Amy Lieberman , Alexandra Kingsepp , Andrew J. Trinidad , Ellenie Tuazon , Alice E. Welch , Avik Chatterjee , Bruce R. Schackman , Eva A. Enns , Alexander Y. Walley , Traci C. Green , Karla D. Wagner , Rachel P. Winograd , Czarina N. Behrends , Erika L. Crable , Brandon D.L. Marshall , Xiao Zang","doi":"10.1016/j.drugpo.2025.105100","DOIUrl":"10.1016/j.drugpo.2025.105100","url":null,"abstract":"<div><h3>Background</h3><div>Since 1999, drug overdose deaths have surged in the United States. There is considerable geographic variability in overdose patterns, state laws, overdose prevention infrastructure, and opioid settlement amounts and investments. To guide localized overdose prevention, it is important to analyze these data and understand heterogeneity.</div></div><div><h3>Methods</h3><div>In this descriptive analysis across six states—Massachusetts, Minnesota, Missouri, Nevada, New York, and Rhode Island, we compared five key domains essential to understanding overdose epidemics, prevention, and policy responses: (1) drug overdose mortality trends by substance and race/ethnicity (2018–2023); (2) state harm reduction laws; (3) availability and coverage of overdose prevention services; (4) opioid settlement funding and spending; and (5) availability and comprehensiveness of publicly available overdose-related data. Data were drawn from publicly available sources and legal information confirmed using Westlaw.</div></div><div><h3>Results</h3><div>All states experienced rising overdose death rates between 2018 and 2023, with significant racial/ethnic disparities. All states have enacted laws to increase access to naloxone. Naloxone distribution rates vary widely, but most states have high availability. Implementation of other harm reduction services differed across states, as well as drug paraphernalia laws. Opioid settlement funding per capita and transparency in spending and planning also differed across states. Some dashboards provided detailed fatal and nonfatal overdose and intervention data stratified by sociodemographics.</div></div><div><h3>Conclusion</h3><div>State-specific differences in overdose patterns, harm reduction laws, prevention infrastructure, and settlement spending underscore the need for localized, tailored strategies. This study’s state-specific profiles lay the groundwork for more advanced decision-support tools to guide effective overdose prevention.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105100"},"PeriodicalIF":4.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693575","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}
The opioid epidemic continues to claim lives at alarming rates, disproportionately affecting marginalized communities, with structural barriers preventing equitable access to lifesaving interventions such as naloxone. Harm reduction vending machines (HRVMs) offer a promising solution to this issue, providing low-barrier access to naloxone and other harm reduction supplies. This study examines the impact of different HRVM access models on product utilization, specifically focusing on an outdoor HRVM, Project HOPE, located in Bakersfield, California. Initially, the machine required participant registration and imposed product limits; however, these restrictions were removed in August 2023 to improve access. An interrupted time series analysis of data from June to October 2023 reveal a significant increase in product utilization following the shift to unrestricted access, with increases in demand for naloxone kits, safer injection kits, wound care kits, and other basic needs supplies. The findings suggest that removing barriers to HRVM access, including registration requirements and product limits, can significantly improve the utilization of harm reduction supplies, potentially reducing opioid-related fatalities and promoting health equity. Further research is needed to evaluate the long-term impacts of unrestricted HRVM access models on overdose prevention and other health outcomes.
{"title":"Breaking barriers: evaluating access models for harm reduction vending machines","authors":"Ashleigh Herrera , Bradley Conner , Presleigh Beshirs , Ricky Bluthenthal","doi":"10.1016/j.drugpo.2025.105079","DOIUrl":"10.1016/j.drugpo.2025.105079","url":null,"abstract":"<div><div>The opioid epidemic continues to claim lives at alarming rates, disproportionately affecting marginalized communities, with structural barriers preventing equitable access to lifesaving interventions such as naloxone. Harm reduction vending machines (HRVMs) offer a promising solution to this issue, providing low-barrier access to naloxone and other harm reduction supplies. This study examines the impact of different HRVM access models on product utilization, specifically focusing on an outdoor HRVM, Project HOPE, located in Bakersfield, California. Initially, the machine required participant registration and imposed product limits; however, these restrictions were removed in August 2023 to improve access. An interrupted time series analysis of data from June to October 2023 reveal a significant increase in product utilization following the shift to unrestricted access, with increases in demand for naloxone kits, safer injection kits, wound care kits, and other basic needs supplies. The findings suggest that removing barriers to HRVM access, including registration requirements and product limits, can significantly improve the utilization of harm reduction supplies, potentially reducing opioid-related fatalities and promoting health equity. Further research is needed to evaluate the long-term impacts of unrestricted HRVM access models on overdose prevention and other health outcomes.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105079"},"PeriodicalIF":4.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679104","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 : 2025-12-03DOI: 10.1016/j.drugpo.2025.105099
George Kamkamidze , Emeli J. Anderson , Liana Shengelaia , Lasha Gulbiani , Giorgi Kanchelashvili , Tinatin Abzianidze , Maia Butsashvili
Background
In the Eastern European country of Georgia, people who inject drugs (PWID) are disproportionately affected by both HIV and hepatitis C virus (HCV) infections. In 2016, it was estimated that over 2 % of adults in Georgia engaged in injection drug use. Updated population size estimates are needed to inform the national public health response to IDU, HIV, and HCV.
Methods
Data were from the 2022 Integrated Bio-Behavioral Surveillance Survey of PWID in Georgia. Participants were recruited from seven cities (n = 2005). Two methods were used to estimate the population size of PWID: the Network Scale-Up (NSU) method and the Multiplier Benchmark Method (MBM). The former used social network data from the general population (n = 680) to estimate the proportion of PWID in an individual’s social network. The MBM used external data of PWID and a multiplier estimated from internal data to generate an estimate of the total population size of PWID for each dataset. An anchor multiplier tool was used to combine the results from the two methods.
Results
The final estimate resulted in a population size of 54,342 PWID in Georgia, corresponding to a prevalence of 1.4 % among all age groups and 2.4 % among adults aged 18–64.
Conclusion
IDU remains a substantial challenge in Georgia, with an estimated 1.5 % of the population engaging in IDU. These findings underscore the need for targeted interventions and improved engagement of PWID in prevention, treatment, and care services across the country.
{"title":"Two methods to estimate the population size of people who inject drugs in the country of Georgia: implications for the EECA region","authors":"George Kamkamidze , Emeli J. Anderson , Liana Shengelaia , Lasha Gulbiani , Giorgi Kanchelashvili , Tinatin Abzianidze , Maia Butsashvili","doi":"10.1016/j.drugpo.2025.105099","DOIUrl":"10.1016/j.drugpo.2025.105099","url":null,"abstract":"<div><h3>Background</h3><div>In the Eastern European country of Georgia, people who inject drugs (PWID) are disproportionately affected by both HIV and hepatitis C virus (HCV) infections. In 2016, it was estimated that over 2 % of adults in Georgia engaged in injection drug use. Updated population size estimates are needed to inform the national public health response to IDU, HIV, and HCV.</div></div><div><h3>Methods</h3><div>Data were from the 2022 Integrated Bio-Behavioral Surveillance Survey of PWID in Georgia. Participants were recruited from seven cities (<em>n</em> = 2005). Two methods were used to estimate the population size of PWID: the Network Scale-Up (NSU) method and the Multiplier Benchmark Method (MBM). The former used social network data from the general population (<em>n</em> = 680) to estimate the proportion of PWID in an individual’s social network. The MBM used external data of PWID and a multiplier estimated from internal data to generate an estimate of the total population size of PWID for each dataset. An anchor multiplier tool was used to combine the results from the two methods.</div></div><div><h3>Results</h3><div>The final estimate resulted in a population size of 54,342 PWID in Georgia, corresponding to a prevalence of 1.4 % among all age groups and 2.4 % among adults aged 18–64.</div></div><div><h3>Conclusion</h3><div>IDU remains a substantial challenge in Georgia, with an estimated 1.5 % of the population engaging in IDU. These findings underscore the need for targeted interventions and improved engagement of PWID in prevention, treatment, and care services across the country.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105099"},"PeriodicalIF":4.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679061","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号