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“They talk about it like it's an overdose crisis when in fact it's basically genocide”: The experiences of Indigenous peoples who use illicit drugs in Vancouver's Downtown Eastside neighbourhood "他们说得好像这是一场吸毒过量危机,而实际上这基本上是一场种族灭绝:温哥华市中心东区使用非法药物的原住民的经历
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-04 DOI: 10.1016/j.drugpo.2024.104631
Jennifer Lavalley , Linda Steinhauer , Dino (Boomer) Bundy , Thomas Kerr , Ryan McNeil
Indigenous Peoples who use illicit drugs (IPWUID) are disproportionately represented among toxic drug poisoning deaths in Canada. These drug-related harms are framed by the historical and ongoing trauma related to settler colonialism and are acutely visible in Vancouver, Canada's Downtown Eastside - a low-income neighbourhood that is an epicenter of the drug poisoning crisis and characterized by entrenched poverty, substance use, violence, and homelessness. This study was undertaken to examine the experiences and perspectives of IPWUID in the Downtown Eastside regarding the drug poisoning crisis and the responsiveness of harm reduction programs within the context of settler colonialism. Indigenous-led qualitative interviews were conducted with 16 IPWUID recruited by Indigenous peer researchers. Indigenous ways of knowing were embedded throughout the entire research design to ensure research was culturally congruent. Interview transcripts were analyzed thematically and interpreted by drawing on concepts of social violence and racial capitalism. Our analysis reviewed three key themes that centered the experiences of IPWUID in Vancouver's Downtown Eastside in relation to the drug poisoning crisis: (1) that the drug poisoning crisis is understood as a form of genocide toward Indigenous Peoples; (2) that the crisis is experienced within the context of pervasive distrust and adversarial relationships with police rooted in structurally racist experiences of place-based policing practices; and (3) that there is a desire for culturally-safe harm reduction care with Indigenous representation, cultural integration, and that addresses inequities and injustice stemming from colonialism and structural racism. Findings demonstrate how responses to the drug poisoning crisis among IPWUID need to respond to social and materials conditions perpetuated by colonialism and racial capitalism, while also centering IPWUID through the development and implementation of Indigenous-led and culturally safe harm reduction approaches.
在加拿大的有毒药物中毒死亡案例中,使用非法药物的原住民(IPWUID)所占比例过高。这些与毒品有关的伤害是由定居殖民主义相关的历史和持续创伤造成的,在加拿大温哥华的下城东区非常明显--这是一个低收入社区,是毒品中毒危机的中心,其特点是根深蒂固的贫困、药物使用、暴力和无家可归。本研究旨在考察下城东区 IPWUID 在定居者殖民主义背景下,对毒品中毒危机和减低伤害计划的反应方面的经验和观点。由原住民主导的定性访谈由原住民同行研究人员对招募的 16 名 IPWUID 进行。原住民的认知方式贯穿了整个研究设计,以确保研究与文化相一致。通过借鉴社会暴力和种族资本主义的概念,对访谈记录进行了专题分析和解释。我们的分析回顾了三个关键主题,它们集中反映了温哥华市中心东区 IPWUID 在毒品中毒危机中的经历:(1) 毒品中毒危机被理解为对土著人民的一种种族灭绝形式;(2) 该危机是在普遍存在的不信任和与警察的敌对关系的背景下经历的,而这种不信任和敌对关系植根于基于地方警务实践的结构性种族主义经验中;(3) 人们渴望获得具有土著代表性、文化融合的文化上安全的减低伤害护理,以解决源于殖民主义和结构性种族主义的不平等和不公正问题。研究结果表明,应对 IPWUID 毒品中毒危机需要应对殖民主义和种族资本主义造成的社会和物质条件,同时还要通过制定和实施由土著人主导的、文化上安全的减低伤害方法,以 IPWUID 为中心。
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引用次数: 0
Bridging the gap: Exploring consumer experiences and motivations for transitioning between illicit and regulated cannabis markets 缩小差距:探索消费者在非法和受管制大麻市场之间过渡的经历和动机。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-02 DOI: 10.1016/j.drugpo.2024.104644
Jennifer R. Donnan , Rachel Howells , Sylvia Farooq , Myles Maillet , Laura M. Harris-Lane

Background

Canada pioneered the non-medical legalization of cannabis production and sales, witnessing substantial growth in the regulated market over the last five years, post-legalization. However, persistent barriers hinder many consumers from transitioning to the legal market, necessitating a nuanced understanding of their behaviors for targeted policy interventions. This study aims to improve understanding of cannabis consumers’ unregulated purchase decisions in British Columbia (B.C.), and to explore motivational factors for transitioning to the legal market.

Methods

We conducted semi-structured interviews with cannabis consumers in B.C., who were at least 19 years old and purchased some or all of their cannabis through unregulated sources. Interviews were transcribed and an inductive thematic analysis was conducted using NVivo. Through coding iterations, we moved from descriptive to analytic codes, and finally mapped the codes to themes aligned with the Five Stages of Consumer Decision Making model.

Results

Participants (N = 31) represented a broad range of demographic characteristics (i.e., gender, age, education, income). Four themes were identified: seeking information, evaluation of alternatives, purchase decision, and post purchase evaluation. Despite purchasing all or some of their cannabis from the unregulated market, most participants were supportive of legalization and felt that legal cannabis is safe, accessible, and of reasonable quality. However, several barriers prevent consumers from regularly accessing the regulated market, including: price, lack of sales and promotions, potency, limited product variety, and inadequate product interaction.

Conclusion

This study delineates barriers that obstruct consumers' transition to the regulated market. These findings, aligned with considerations for public health and safety, offer valuable insights to inform cannabis policy and promote a more effective and consumer-oriented regulatory framework.
背景:加拿大开创了大麻生产和销售非医疗合法化的先河,在合法化后的过去五年里,受监管市场出现了大幅增长。然而,持续存在的障碍阻碍了许多消费者向合法市场过渡,因此有必要深入了解他们的行为,以便采取有针对性的政策干预措施。本研究旨在加深对不列颠哥伦比亚省(B.C.)大麻消费者不受管制的购买决策的了解,并探讨向合法市场过渡的动机因素:我们对不列颠哥伦比亚省的大麻消费者进行了半结构式访谈,这些消费者至少 19 岁,通过非管制渠道购买部分或全部大麻。我们对访谈内容进行了誊写,并使用 NVivo 进行了归纳式主题分析。通过编码迭代,我们从描述性编码转向分析性编码,最后将编码映射到与消费者决策五阶段模型相一致的主题上:参与者(N = 31)代表了广泛的人口特征(即性别、年龄、教育程度、收入)。确定了四个主题:寻求信息、评估替代品、购买决策和购买后评估。尽管大部分或部分大麻是从不受监管的市场上购买的,但大多数参与者都支持大麻合法化,并认为合法大麻安全、易获得且质量合理。然而,一些障碍阻碍了消费者经常进入受管制市场,其中包括:价格、缺乏销售和促销、效力、产品种类有限以及产品互动不足:本研究描述了阻碍消费者过渡到规范市场的障碍。这些研究结果与对公共健康和安全的考虑相一致,为制定大麻政策提供了有价值的见解,并促进了更加有效和以消费者为导向的监管框架。
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引用次数: 0
A place-based spatial analysis of racial inequities in overdose in St. Louis County Missouri, United States 对美国密苏里州圣路易斯县用药过量的种族不平等现象进行基于地点的空间分析。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-11-02 DOI: 10.1016/j.drugpo.2024.104611
Phillip L. Marotta , Benjamin CB Leach , William D. Hutson , Joel M. Caplan , Brenna Lohmann , Charlin Hughes , Devin Banks , Stephen Roll , Yung Chun , Jason Jabbari , Rachel Ancona , Kristen Mueller , Ben Cooper , Theresa Anasti , Nathaniel Dell , Rachel Winograd , Robert Heimer

Objective

The objective of this study was to identify place features associated with increased risk of drug-involved fatalities and generate a composite score measuring risk based on the combined effects of features of the built environment.

Methods

We conducted a geospatial analysis of overdose data from 2022 to 2023 provided by the St. Louis County Medical Examiner's Office to test whether drug-involved deaths were more likely to occur near 54 different place features using Risk Terrain Modeling (RTM). RTM was used to identify features of the built environment that create settings of heightened overdose risk. Risk was estimated using Relative Risk Values (RRVs) and a composite score measuring Relative Risk Scores (RRS) across the county was produced for drugs, opioids, and stimulants, as well as by Black and White decedents.

Results

In the model including all drugs, deaths were more likely to occur in close proximity to hotels/motels (RRV=39.65, SE=0.34, t-value=10.81 p<.001), foreclosures (RRV=4.42, SE=0.12, t-value = 12.80, p<.001), police departments (RRV=3.13, SE=0.24, t-score=4.86, p<.001), and restaurants (RRV=2.33, SE=0.12, t-value=7.16, p<.001). For Black decedents, deaths were more likely to occur near foreclosures (RRV=9.01, SE=0.18, t-value =11.92, p<.001), and places of worship (RRV= 2.51, SE=0.18, t-value = 11.92, p<.001). For White decedents, deaths were more likely to occur in close proximity to hotels/motels (RRV=38.97, SE=0.39, t-value=9.30, p<.001) foreclosures (RRV=2.57, SE=0.16, t-value =5.84, p<.001), restaurants (RRV=2.52, SE=0.17, t-value=5.33, p<.001) and, auto painting/repair shops (RRV=0.04, SE=0.18, t-value =3.39, p<.001).

Conclusion

These findings suggest that places of worship, the hospitality industry, and housing authorities may be physical features of the environment that reflect social conditions that are conducive to overdose. The scaling up of harm reduction strategies could be enhanced by targeting places where features are co-located.
研究目的本研究的目的是确定与涉毒死亡风险增加相关的地点特征,并根据建筑环境特征的综合影响生成衡量风险的综合评分:我们对圣路易斯郡法医办公室提供的2022年至2023年吸毒过量数据进行了地理空间分析,利用风险地形模型(RTM)检验了54个不同地点的特征是否更有可能导致涉毒死亡。风险地形模型用于确定建筑环境中哪些地方会增加吸毒过量的风险。使用相对风险值(RRV)对风险进行估算,并针对毒品、阿片类药物和兴奋剂以及黑人和白人死者得出衡量全县相对风险分数(RRS)的综合分数:在包括所有毒品的模型中,死亡更有可能发生在酒店/旅馆附近(RRV=39.65,SE=0.34,t 值=10.81):这些研究结果表明,宗教场所、酒店业和住房当局可能是环境的物理特征,反映了有利于吸毒过量的社会条件。针对这些特征共存的场所,可以加强减少伤害战略的推广。
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引用次数: 0
Examining the association between trenbolone, psychological distress, and aggression among males who use anabolic-androgenic steroids 研究使用合成代谢雄性类固醇的男性群勃龙、心理压力和攻击性之间的关系
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-31 DOI: 10.1016/j.drugpo.2024.104636
Timothy Piatkowski , Dominique De Andrade , David Neumann , Calvert Tisdale , Matthew Dunn
Introduction: The link between anabolic-androgenic steroid (AAS) use and psychosocial effects such as aggression and violence is contentious. Few studies differentiate between types of AAS. This study focuses on trenbolone to assess its psychological risks and effects on aggression compared to other AAS. We hypothesised that there would be a positive relationship between trenbolone dosage and both psychological distress and aggression among people who use AAS. Methods: Using purposive and snowball sampling of people using AAS, we conducted an online survey to investigate the relationship between trenbolone use and other AAS use. Participants completed sections on demographics, trenbolone and other illicit drug use, the Kessler Psychological Distress Scale, and the Buss and Perry Aggression Questionnaire. Data were analysed using multinominal and multivariable regression. Results: The study included 282 males using AAS. Over 33% (n=93) reported currently using trenbolone, with 55.3% (n=156) of participants reporting having used trenbolone in the past, and 11.7% (n=33) reporting having never used trenbolone. Those who had never used trenbolone were not significantly different on age, height, weight, and BMI compared to those who had. After controlling for age and BMI, dose of trenbolone was significantly (p=0.045) associated with higher levels of verbal aggression. Conclusion: The study highlights trenbolone's association with increased verbal aggression among males using AAS, particularly at higher doses. Further research should continue to differentiate between AAS types and the accompanying health harms.
导言:合成代谢雄性类固醇(AAS)的使用与社会心理影响(如攻击和暴力)之间的联系存在争议。很少有研究区分 AAS 的类型。本研究以曲勃龙为重点,评估其与其他 AAS 相比对心理风险和攻击行为的影响。我们的假设是,在使用 AAS 的人群中,群勃龙剂量与心理困扰和攻击行为之间存在正相关关系。研究方法我们采用有目的的和滚雪球式的方法对使用 AAS 的人群进行了在线调查,以研究使用群勃龙和使用其他 AAS 之间的关系。参与者填写了有关人口统计学、使用群勃龙和其他非法药物、凯斯勒心理压力量表以及布斯和佩里攻击性问卷的部分。数据采用多项式和多变量回归法进行分析。研究结果研究对象包括 282 名使用 AAS 的男性。超过 33% 的参与者(人数=93)表示目前正在使用群勃龙,55.3% 的参与者(人数=156)表示过去曾使用过群勃龙,11.7% 的参与者(人数=33)表示从未使用过群勃龙。从未使用过曲勃龙的人与使用过的人相比,在年龄、身高、体重和体重指数方面没有明显差异。在控制了年龄和体重指数后,使用群勃龙的剂量与较高的言语攻击水平有显著相关性(p=0.045)。结论这项研究强调了群勃龙与使用合成动情激素(AAS)的男性言语攻击性增加有关,尤其是在剂量较大的情况下。进一步的研究应继续区分 AAS 类型及其对健康的危害。
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引用次数: 0
Developing a mobile-based brief intervention to reduce cannabis-impaired driving among youth: An intervention mapping approach 开发基于手机的简短干预措施,减少青少年因大麻而受损的驾驶行为:干预映射法。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-30 DOI: 10.1016/j.drugpo.2024.104626
Robert Colonna , Patricia Tucker , Angela Mandich , Liliana Alvarez
Behaviour change interventions delivered via smartphones have the potential to reduce youth cannabis use and driving under the influence of cannabis (DUIC). Countless smartphone applications (either downloadable or web-based) are available to help reduce substance use and impaired driving. However, most are developed without evidence-based content and theory, and many have poor user engagement. This study aims to: (1) describe the systematic development and theoretical foundations of a youth DUIC smartphone intervention, and (2) describe the pre-testing among a sample of youth and adult cannabis educators (prior to efficacy testing). A 6-step Intervention Mapping approach was utilized to combine theory, evidence, and user feedback to develop and implement the ‘High Alert’ intervention. This evidence-based and iterative process entailed: (1) conducting a needs assessment, (2) identifying intervention objectives, which map on the following DUIC determinants: knowledge, attitudes, risk perception, perceived norms, and self-efficacy, (3) selecting intervention theory and design, (4) developing of the intervention, (5) implementation, and (6) evaluation. Application of Intervention Mapping resulted in a smartphone web-based application that could support reductions in cannabis use and DUIC. The ‘High Alert’ intervention was created to include four modules with contents focusing on educating youth on the dangers and legal risks of DUIC, limiting risky situations, avoiding riding with an impaired driver, planning a safe ride home, and promoting safer cannabis use. Future research will test the efficacy of the intervention in reducing risky cannabis use and DUIC among youth.
通过智能手机进行行为改变干预有可能减少青少年使用大麻和在大麻影响下驾车(DUIC)。目前有无数的智能手机应用程序(可下载或基于网络)可帮助减少药物使用和受损驾驶。然而,大多数应用程序的开发都没有基于证据的内容和理论,而且许多应用程序的用户参与度很低。本研究旨在:(1) 描述青少年 DUIC 智能手机干预措施的系统开发和理论基础;(2) 描述在青少年和成人大麻教育者样本中进行的预测试(在功效测试之前)。在开发和实施 "高度警惕 "干预措施时,采用了六步干预映射法,将理论、证据和用户反馈结合起来。这个以证据为基础的迭代过程包括:(1)进行需求评估;(2)确定干预目标,这些目标映射了以下 DUIC 决定因素:知识、态度、风险认知、感知规范和自我效能;(3)选择干预理论和设计;(4)制定干预措施;(5)实施;以及(6)评估。应用 "干预映射 "的结果是开发出了一款基于智能手机的网络应用程序,该程序可帮助减少大麻使用和酒驾和醉驾。高度警惕 "干预措施包括四个模块,其内容重点是教育青少年了解酒后驾车的危险和法律风险、限制危险情况、避免与酒驾者同车、计划安全回家以及促进更安全地使用大麻。未来的研究将检验该干预措施在减少青少年危险使用大麻和酒后驾车方面的效果。
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引用次数: 0
Impacts of the COVID-19 pandemic on the availability and retail price of unregulated drugs in Vancouver, Canada: An interrupted time-series analysis, 2018-2022 COVID-19 大流行对加拿大温哥华非管制药品供应和零售价格的影响:2018-2022年间断时间序列分析。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-30 DOI: 10.1016/j.drugpo.2024.104633
Anmol Swaich , Delaney Ignatieff , M-J Milloy , JinCheol Choi , Thomas Kerr , Kanna Hayashi

Background

Impacts of the COVID-19 pandemic on unregulated drug markets in North America have not been well characterized. We sought to estimate potential changes in the availability and retail price of unregulated drugs in Vancouver, Canada pre- vs. post-emergence of the COVID-19 pandemic.

Methods

We used self-report data from two prospective cohorts of people who use drugs in Vancouver. We employed interrupted time series analyses to identify changes in the monthly prevalence of immediate availability (i.e., within 10 minutes vs. any longer) and median retail price of crystal methamphetamine, powder cocaine, crack cocaine, and ‘down’ (the local term for unregulated opioids, e.g., heroin, fentanyl, etc), post-pandemic emergence (i.e. post-July 2020).

Results

Between 2018 and 2022 among 739 participants, the monthly prevalence of immediate availability significantly decreased for all drugs immediately post- emergence of the pandemic (all p<0.05). The monthly prevalence of immediate availability of cocaine declined most (-18.1%, 95% confidence interval [CI]: -25.9, -10.4) and the immediate availability of ‘down’ declined least (-13.0%, 95% CI:-18.8, -7.3). In analyses of median price, the only significant change was in the price of cocaine, which increased by $3.46 per 0.5 grams (95% CI:1.0, 5.9) immediately post-emergence of the pandemic.

Conclusion

While more research is needed to investigate reasons for the observed trends, the stagnant price amidst decreased availability for all drugs examined in this study (save cocaine) may reflect decreased purity/increased contamination of unregulated drugs following the beginning of the pandemic in our study setting. These findings may have implications for drug policy and practice approaches, particularly in regions where synthetic psychoactive substances are increasingly dominating the unregulated drug supply.
背景:COVID-19 大流行对北美非管制药品市场的影响尚未得到很好的描述。我们试图估算 COVID-19 大流行前后加拿大温哥华未管制药品的供应和零售价格的潜在变化:我们使用了温哥华两组前瞻性吸毒者的自我报告数据。我们采用了间断时间序列分析,以确定大流行出现后(即 2020 年 7 月后)冰毒、可卡因粉、快克可卡因和 "down"(当地术语,指不受管制的阿片类药物,如海洛因、芬太尼等)的每月即时供应率(即 10 分钟内与更长时间内)和零售价中位数的变化:结果:2018 年至 2022 年间,在 739 名参与者中,大流行出现后所有药物的每月即时供应流行率显著下降(所有 pConclusion):虽然还需要更多的研究来调查所观察到的趋势的原因,但本研究中调查的所有毒品(除可卡因外)在供应减少的同时价格却停滞不前,这可能反映了在我们的研究环境中,大流行开始后未受管制的毒品纯度下降/污染增加。这些发现可能会对毒品政策和实践方法产生影响,特别是在合成精神活性物质日益主导不受管制的毒品供应的地区。
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引用次数: 0
Co-designing the INHSU Prisons Hepatitis C Advocacy Toolkit using the Advocacy Strategy Framework 利用宣传战略框架共同设计 INHSU 监狱丙型肝炎宣传工具包。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-30 DOI: 10.1016/j.drugpo.2024.104628
SJ Walker , O Dawson , Y Sheehan , LB Shrestha , AR Lloyd , J Sheehan , N Maduka , J Cabezas , N Kronfli , MJ Akiyama , INHSU Prisons

Background

The World Health Organization (WHO) has established targets to eliminate the hepatitis C virus (HCV) by 2030. Prisons are a key focus of elimination efforts, however, access to HCV services in prisons remains low globally. With the aim of increasing advocacy efforts to help address this gap, the International Network on Health and Hepatitis in Substance Users (INHSU) Prisons, developed a Prisons Hepatitis C Advocacy Toolkit.

Methods

Toolkit development involved a co-design process to ensure advocacy resources met end-user needs. A scoping study was conducted, involving a web-based survey and in-depth interviews, to understand advocacy resource needs of key stakeholders from countries of different socio-economic strata. Data were analysed, and suggested advocacy resources were mapped onto the Advocacy Strategy Framework with the audiences resources are targetting and the changes they aim to influence. Advocacy resources were co-developed and validated by interview participants before incorporation into the web-based platform.

Results

Survey responses (n = 181) and interview data (n = 25) highlighted several barriers to enhancing HCV services in prisons globally, and an understanding that advocacy efforts are needed to bring about this change. Advocacy resources were suggested for influencing three key audiences: policymakers/funders, implementers, and community. Thereafter, a suite of 20 de novo tools were co-developed with key stakeholders including case studies of evidence-based models of HCV care, policy briefs, HCV infographics, and fact sheets about how to leverage funding and build advocacy campaigns. Findings underscore the importance of capitalising on the knowledge and expertise of potential end-users, to ensure Toolkit resources are context-specific and match their needs.

Conclusion

The Toolkit holds promise for progressing the WHO elimination goals by increasing advocacy efforts for enhanced prison HCV services globally. The co-design of Toolkit resources with potential end-users has increased its potential accessibility, acceptability, and inclusivity for a globally diverse audience.
背景:世界卫生组织(WHO)制定了到 2030 年消除丙型肝炎病毒(HCV)的目标。监狱是消除丙型肝炎病毒工作的重点,然而,在全球范围内,监狱中获得丙型肝炎病毒服务的机会仍然很少。为了加大宣传力度,帮助缩小这一差距,国际监狱药物使用者健康和肝炎网络(INHSU)开发了一套监狱丙型肝炎宣传工具包:方法:工具包的开发包括一个共同设计过程,以确保宣传资源满足最终用户的需求。开展了一项范围界定研究,包括网络调查和深入访谈,以了解来自不同社会经济阶层国家的主要利益相关者对宣传资源的需求。对数据进行了分析,并将建议的宣传资源与宣传战略框架以及资源所针对的受众和旨在影响的变化进行了映射。在将宣传资源纳入网络平台之前,由访谈参与者共同开发和验证:调查回复(n = 181)和访谈数据(n = 25)强调了在全球范围内加强监狱HCV服务的若干障碍,并认识到需要通过宣传工作来实现这一改变。为影响三个关键受众(政策制定者/资助者、实施者和社区)提出了宣传资源建议。随后,我们与主要利益相关者共同开发了一套 20 种全新工具,包括以证据为基础的 HCV 护理模式案例研究、政策简报、HCV 信息图表以及关于如何利用资金和开展宣传活动的概况介绍。研究结果强调了利用潜在最终用户的知识和专长的重要性,以确保工具包资源符合具体情况并满足他们的需求:结论:该工具包有望通过在全球范围内加强监狱丙型肝炎病毒服务的宣传工作,推进世卫组织消除丙型肝炎病毒的目标。与潜在最终用户共同设计工具包资源,提高了工具包对全球不同受众的潜在可及性、可接受性和包容性。
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引用次数: 0
Framework for opioid use disorder screening and diagnosis in carceral settings 囚禁环境中阿片类药物使用障碍筛查和诊断框架。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-30 DOI: 10.1016/j.drugpo.2024.104627
Helen E. Jack , Catherine L. Smith , Lauren Brinkley-Rubinstein , Justin Berk
In the United States, the opioid overdose crisis disproportionately affects incarcerated individuals, with opioid overdose risk in the two weeks after release 50 times higher than the general population. As a response, many prisons and jails are starting to offer medication for opioid use disorder (MOUD), including methadone or buprenorphine, during incarceration or prior to release. One implementation barrier is how to identify who would benefit from treatment, given that opioid use disorder screening and diagnostic testing are imperfect, particularly in criminal-legal settings. Prisons and jails use a variety of OUD assessment strategies, including brief self-report screening tools, diagnostic interviews, review of pre-incarceration medical records, and urine drug screening, all of which may lead to false positive and false negative results. In this essay, we apply a common framework from epidemiology and other fields to conceptualize OUD assessment in carceral settings: individuals assessed for OUD can be those with OUD who are correctly offered MOUD (“true positives”), those without OUD who are offered MOUD (“false positives”), those with OUD who are not offered MOUD (“false negatives”), and those without MOUD who are not offered MOUD (“true negatives”). We discuss these assessment and treatment outcomes from the perspectives of people who are incarcerated, security staff, and healthcare staff. This framework may inform discussions between medical staff and security personnel on the implementation of MOUD programs.
在美国,阿片类药物过量危机对在押人员的影响尤为严重,释放后两周内阿片类药物过量的风险是普通人群的 50 倍。作为应对措施,许多监狱和看守所开始在监禁期间或释放前提供治疗阿片类药物使用障碍 (MOUD) 的药物,包括美沙酮或丁丙诺啡。鉴于阿片类药物使用障碍筛查和诊断检测并不完善,尤其是在刑事法律环境中,如何确定哪些人将从治疗中受益是实施过程中的一个障碍。监狱和看守所使用各种 OUD 评估策略,包括简短的自我报告筛查工具、诊断访谈、入狱前医疗记录审查和尿液药物筛查,所有这些都可能导致假阳性和假阴性结果。在这篇文章中,我们运用流行病学和其他领域的通用框架,对囚禁环境中的药物依赖性评估进行概念化:接受药物依赖性评估的个体可以是那些被正确提供 "谅解备忘录 "的患有药物依赖性的个体("真阳性")、那些被提供 "谅解备忘录 "的未患有药物依赖性的个体("假阳性")、那些未被提供 "谅解备忘录 "的患有药物依赖性的个体("假阴性")以及那些未被提供 "谅解备忘录 "的未患有药物依赖性的个体("真阴性")。我们从被监禁者、安保人员和医护人员的角度来讨论这些评估和治疗结果。这一框架可为医务人员和安保人员之间就实施MOUD项目进行讨论提供参考。
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引用次数: 0
Predictors of treatment outcomes for Hepatitis C infection in a nationwide elimination program in Iceland: The treatment as prevention for Hepatitis C (TraP HepC) study 冰岛全国范围内消除丙型肝炎计划中丙型肝炎感染治疗效果的预测因素:丙型肝炎预防治疗(TraP HepC)研究。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-24 DOI: 10.1016/j.drugpo.2024.104616
Sigurdur Olafsson , Thorvardur Jon Love , Ragnheidur Hulda Fridriksdottir , Thorarinn Tyrfingsson , Valgerdur Runarsdottir , Ingunn Hansdottir , Ottar Mar Bergmann , Einar Stefan Björnsson , Birgir Johannsson , Bryndis Sigurdardottir , Arthur Löve , Guðrún Erna Baldvinsdottir , Marianna Thordardottir , Ubaldo Benitez Hernandez , Maria Heimisdottir , Margaret Hellard , Magnus Gottfredsson , the TraP Hep C working group

Background

Limited data exists about treatment outcomes in nationwide hepatitis C virus (HCV) elimination programs where injection drug use (IDU) is the main mode of transmission. In 2016 Iceland initiated the HCV elimination program known as Treatment as Prevention for Hepatitis C (TraP HepC). Factors associated with HCV cure in this population are examined.

Methods

Unrestricted access was offered to direct acting antiviral agents (DAAs). Testing and harm reduction was scaled up and re-treatments were offered for those who did not attain cure. Cure rates for the first 36 months were assessed and factors associated with failure to achieve cure analysed using multivariable logistic regression.

Results

Treatment was initiated for 718; 705 consented for the study. Median age was 44 years (IQR 35–56), history of IDU reported by 593 (84.1 %), recent IDU by 234 (33.2 %); 48 (6.8 %) were homeless. Of 705 patients, 635 achieved cure (90.1 %) during the first treatment. A total of 70 (9.9 %) patients initiated two or more treatments, resulting in 673 participants cured (95.5 %). By multivariable analysis, homelessness was the only statistically significant independent factor associated with not achieving cure (OR 2.67, 95 % CI 1.32–5.41) after first treatment attempt.

Conclusion

By reengagement in care and prompt retreatment when needed, a cure rate of 95.5 % was achieved. Unstable housing, a potentially actionable factor is associated with poor outcome.
背景:在以注射吸毒(IDU)为主要传播方式的全国性丙型肝炎病毒(HCV)消除计划中,有关治疗效果的数据十分有限。2016 年,冰岛启动了名为 "丙型肝炎预防治疗"(TraP HepC)的丙型肝炎病毒消除计划。本文研究了该人群中与丙型肝炎病毒治愈相关的因素:方法:不受限制地提供直接作用抗病毒药物(DAAs)。扩大了检测和减低危害的范围,并为未治愈者提供再治疗。对最初 36 个月的治愈率进行了评估,并使用多变量逻辑回归分析了与未能治愈相关的因素:718人接受了治疗,705人同意参加研究。中位年龄为 44 岁(IQR 35-56),593 人(84.1%)报告有注射吸毒史,234 人(33.2%)近期有注射吸毒史;48 人(6.8%)无家可归。在 705 名患者中,有 635 人(90.1%)在首次治疗中治愈。共有 70 名患者(9.9%)接受了两次或两次以上的治疗,结果有 673 人治愈(95.5%)。通过多变量分析,无家可归是与首次治疗后未治愈相关的唯一具有统计学意义的独立因素(OR 2.67,95 % CI 1.32-5.41):结论:通过重新参与治疗并在必要时及时进行再治疗,治愈率达到了 95.5%。住房不稳定是导致疗效不佳的潜在因素。
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引用次数: 0
Social forces shaping evidence production: A study of the swiss cannabis pilot trials 影响证据生产的社会力量:瑞士大麻试点试验研究。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-10-23 DOI: 10.1016/j.drugpo.2024.104623
Sharon R. Sznitman , Reto Auer , Jonathan Christopher Havinga , Alessandro Casalini , Barbara Broers

Aim

The evidence-based policy paradigm has been criticized for poorly representing drug and other health policy processes, with evidence showing various social forces influencing knowledge translation. However, less research has examined the social forces influencing knowledge production. Applying a social constructivist lens, this study investigates how politics, power, economics, philosophy, and discourse influence the evidence generating processes related to drug policy.

Methods

Using Swiss cannabis pilot trials as a case study, thematic content analysis was conducted on qualitative interview data from 18 stakeholders, including scientists, policy makers, pharmacists, physicians, cannabis producers, and current and former employees of the Swiss Federal Office of Public Health.

Results

The study reveals how social forces collectively shape scientific evidence generating processes, with political imperatives and stakeholder interests often taking precedence over purely scientific considerations. Contrary to the presumed opposition between positivist and interpretivist stances, informants demonstrated a commitment to both, dedicating themselves to positivist research agendas while highlighting the influence of harm reduction discourse on the pilot trials.

Conclusions

The Swiss cannabis pilot trials illustrate how social forces can shape the production of policy-relevant evidence, transforming evidence-based policy into policy-based evidence. Asymmetries in actor resources and power, along with the adjustment of evidence production to align with contextual realities, play significant roles in this process. Recognizing the complex social dimensions of evidence generating processes is crucial for a more reflexive and power-sensitive understanding of drug policymaking.
目的:有证据表明,各种社会力量影响着知识的转化,而循证政策范式因不能很好地反映药物和其他卫生政策的制定过程而饱受批评。然而,对影响知识生产的社会力量的研究较少。本研究采用社会建构主义视角,探讨政治、权力、经济、哲学和话语如何影响与药物政策相关的证据生成过程:方法:以瑞士大麻试点试验为案例,对 18 位利益相关者的定性访谈数据进行了主题内容分析,这些利益相关者包括科学家、政策制定者、药剂师、医生、大麻生产商以及瑞士联邦公共卫生局的现任和前任员工:研究揭示了社会力量如何共同影响科学证据的产生过程,政治需要和利益相关者的利益往往优先于纯粹的科学考虑。与假定的实证主义和解释主义立场之间的对立相反,信息提供者表现出了对两者的承诺,他们致力于实证主义研究议程,同时强调了减害论述对试点试验的影响:瑞士大麻试点试验说明了社会力量如何影响政策相关证据的生产,将循证政策转变为循证证据。在这一过程中,行为者资源和权力的不对称以及为适应环境现实而对证据生产进行的调整发挥了重要作用。认识到证据生成过程的复杂社会层面,对于以更加自省和对权力敏感的方式理解药物决策至关重要。
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引用次数: 0
期刊
International Journal of Drug Policy
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