International Journal of Drug Policy最新文献

{"title":"The impact of recreational cannabis retailer allocation on emergency department visits: A natural experiment utilizing lottery design","authors":"Yihong Bai ,&nbsp;Peiya Cao ,&nbsp;Chungah Kim ,&nbsp;Kristine Ienciu ,&nbsp;Antony Chum","doi":"10.1016/j.drugpo.2025.104708","DOIUrl":"10.1016/j.drugpo.2025.104708","url":null,"abstract":"<div><h3>Background</h3><div>In October 2018, Canada legalized recreational cannabis, with Ontario distributing retailer licenses through a lottery system in 2019. This study investigates the impact of recreational cannabis retailer allocation on emergency department (ED) visits related to cannabis, alcohol, and opioids.</div></div><div><h3>Method</h3><div>A longitudinal study of 278 communities in Ontario (proxied by Forward Sortation Areas, FSAs) was conducted using health administrative data from ICES for all Ontario residents covered by public health insurance. The cohort included 11,156,100 adults aged 18 and above, monitored quarterly from January 2016 to March 2023. The allocation of cannabis retailers through a randomized lottery system provided a natural experiment. Staggered difference-in-differences proposed by Callaway and Sant'Anna (CSDID) models, weighted by the inverse probability of retailer allocation, were used to estimate the impact of cannabis store openings on ED visits, comparing FSAs with and without retailers.</div></div><div><h3>Results</h3><div>No significant effects were found in cannabis-, alcohol-, or opioid-related ED visits following the allocation of cannabis retailers. Sensitivity analyses, including alternate diagnostic codes, co-use of cannabis and other substances, and cannabis use without other substances, corroborated our main findings. The null results may be due to online cannabis sales preceding retail store openings, geographic distribution minimizing access disparities, and potential spillover effects.</div></div><div><h3>Conclusion</h3><div>The allocation of recreational cannabis retailer licenses did not significantly impact acute care use. Continuous monitoring, comprehensive sales tracking, and integrated substance use prevention strategies are recommended for future policy considerations.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104708"},"PeriodicalIF":4.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025217","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}

{"title":"Characteristics of supervised injection site clients and factors associated with requiring overdose intervention, Montreal, Canada, 2018–2022","authors":"Camille Zolopa ,&nbsp;Thomas D. Brothers ,&nbsp;Pascale Leclerc ,&nbsp;Jean-François Mary ,&nbsp;Carole Morissette ,&nbsp;Julie Bruneau ,&nbsp;Natasha K. Martin ,&nbsp;Elaine Hyshka ,&nbsp;Sarah Larney","doi":"10.1016/j.drugpo.2025.104711","DOIUrl":"10.1016/j.drugpo.2025.104711","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Supervised injection sites (SIS) offer a hygienic environment in which people can inject drugs under observation; as such, these harm reduction services have been on the forefront of the overdose epidemic. We sought to understand factors predictive of an overdose requiring an emergency response intervention at SIS in Montréal, Canada.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We used administrative data from all four Montréal SIS from 1 March 2018 – 31 October 2022 to first calculate the rate of onsite overdose requiring intervention (e.g., naloxone or oxygen administration, nurse or paramedic assessment, etc.) and descriptive statistics. We then used a logistic regression model, with generalized estimating equations to adjust for clients’ repeat visits, to test associations between onsite overdose intervention and client gender, age, drug injected (fentanyl vs other opioid vs non-opioid), most frequent injection location, frequency of injecting, duration of injecting, housing stability, attendance at multiple SIS, and time period (before or after 15 March 2020).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;During the observation period, Montréal SIS received 122,509 visits from 2,127 unique clients. The rate of overdose requiring intervention was 8.16 (95 % CI 7.66, 8.68) per 1000 visits. While 278 (13 %) of clients experienced an onsite overdose intervention, these clients accounted for 64,267 (52 %) SIS visits. Transgender clients (aOR = 2.28, 95 % CI 1.18, 4.41, compared to men) and clients younger than 25 were at greater risk of experiencing an onsite overdose requiring intervention (e.g., clients 35–44 had an aOR = 0.44, 95 % CI 0.30, 0.64, compared to clients younger than 25). Injecting most often in a public place was associated with greater risk of an onsite overdose requiring intervention (aOR = 3.62, 95 % CI 3.04, 4.30), while reporting unstable housing (aOR = 0.56, 95 % CI 0.47, 0.66) and attending more than one SIS (aOR = 0.13, 95 % CI 0.10, 0.16) predicted lesser risk. Compared to clients who reported injecting daily, greater risk of overdose requiring intervention was observed among those who reported injecting 3–6 days a week (aOR = 1.48, 95 % CI 1.18, 1.85), 1–2 days a week (aOR = 2.43, 95 % CI 1.90, 3.11), and “occasionally” (aOR = 2.60, 95 % CI 2.13, 3.18), but not those who reported not injecting in the past several months (aOR = 0.44, 95 % CI 0.25, 0.79). Compared to clients who had been injecting for five or more years, an injection duration of 1–4 years was associated with reduced risk of an overdose requiring intervention (aOR = 0.79, 95 % CI 0.64, 0.98), while those newer (&lt;1 year) to injecting were at greater risk of such an intervention (aOR = 2.11, 95 % CI 1.50, 2.97). Compared to clients intending to inject fentanyl, we observed a lower risk of an overdose requiring intervention for those injecting other opioids (aOR = 0.22, 95 % CI 0.18, 0.26) or non-opioids (aOR = 0.06, 95 % CI 0.04, 0.08). Inject","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104711"},"PeriodicalIF":4.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025173","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}

{"title":"Likelihood of using a harm reduction vending machine among rural people who inject drugs in Appalachian Kentucky","authors":"April M Young ,&nbsp;Tasfia Jahangir ,&nbsp;Imani Belton ,&nbsp;Edward Freeman ,&nbsp;Melvin D. Livingston","doi":"10.1016/j.drugpo.2025.104709","DOIUrl":"10.1016/j.drugpo.2025.104709","url":null,"abstract":"<div><h3>Background</h3><div>Harm reduction vending machines (HRVMs) that dispense safe injection equipment and other supplies have operated globally for more than 30 years, yet few operate in the U.S., particularly in the rural epicenters of drug-related harms. This study explores likelihood of using HRVMs and correlates thereto among people who inject drugs in rural Appalachian Kentucky.</div></div><div><h3>Methods</h3><div>Respondent-driven sampling and outreach were used to recruit participants who were age 18 or older, resided in an Appalachian Kentucky county, and had used opioids and/or injected drugs to get high in the past 30 days. Interviewer-administered questionnaires elicited data on behavioral and demographic characteristics and likelihood of using HRVMs. Analyses were restricted to participants who injected in the past 6 months (<em>n</em> = 259). Generalized estimating equations were used to estimate adjusted prevalence ratios (APRs) for correlates to likelihood of using HRVMs, controlling for lifetime use of brick-and-mortar syringe service programs.</div></div><div><h3>Results</h3><div>Overall, 57 % reported being likely to use HRVMs. Participants who lacked consistent access to transportation, engaged in receptive and distributive syringe sharing, experienced more lifetime overdoses, and had unsuccessfully attempted to access medications for opioid use disorder (MOUD) reported being more likely to use HRVMs. Heroin and prescription opioid use were negatively associated with likelihood of HRVM use, as was experience of shame around drug use.</div></div><div><h3>Conclusions</h3><div>Most people who inject drugs in this rural Appalachian sample were likely to use HRVMs, with interest being highest among those at highest risk for injection-related infections and overdose and who had faced difficulty accessing MOUD.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104709"},"PeriodicalIF":4.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025209","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}

{"title":"Naloxone administration and survival in overdoses involving opioids and stimulants: An analysis of law enforcement data from 63 Pennsylvania counties","authors":"Manuel Cano ,&nbsp;Abenaa Jones ,&nbsp;Sydney M. Silverstein ,&nbsp;Raminta Daniulaityte ,&nbsp;Frank LoVecchio","doi":"10.1016/j.drugpo.2024.104678","DOIUrl":"10.1016/j.drugpo.2024.104678","url":null,"abstract":"<div><h3>Background</h3><div>In consideration of rising opioid-stimulant deaths in the United States, this study explored rates of naloxone administration and survival in suspected opioid overdoses with, versus without, stimulants co-involved.</div></div><div><h3>Methods</h3><div>The study analyzed 26,635 suspected opioid-involved overdoses recorded by law enforcement/first-responders in the Pennsylvania Overdose Information Network in 63 Pennsylvania counties, January 2018–July 2024. All measures, including suspected drug involvement, were based on first-responder assessment/report. Relative frequencies and chi-square tests were first used to compare suspected opioid overdoses with, versus without, stimulants (cocaine or methamphetamine) co-involved. Next, mediation analyses tested naloxone administration as a mediator in the association between stimulant co-involvement (in opioid overdoses) and survival.</div></div><div><h3>Results</h3><div>Naloxone was reportedly administered in 72.2 % of the suspected opioid-no-cocaine overdoses, compared to 55.1 % of the opioid-cocaine-involved overdoses, and 72.1 % of the opioid-no-methamphetamine overdoses vs. 52.4 % of the opioid-methamphetamine-involved overdoses. With respect to survival rates, 18.0 % of the suspected opioid-no-cocaine overdoses ended in death, compared to 41.3 % of the opioid-cocaine overdoses; 18.1 % of the opioid-no-methamphetamine overdoses ended in death, versus 42.9 % of the opioid-methamphetamine overdoses. In mediation analyses (adjusted for demographics, county, year, and other drug co-involvement), naloxone administration mediated 38.7 % (95 % Confidence Interval [CI], 31.3–46.0 %) of the association between suspected cocaine co-involvement and survival and 39.2 % (95 % CI, 31.3–47.1 %) of the association between suspected methamphetamine co-involvement and survival.</div></div><div><h3>Conclusions</h3><div>Among suspected opioid overdoses recorded in the Pennsylvania Overdose Information Network, stimulant co-involvement was associated with lower naloxone administration and higher fatality, with naloxone partially mediating the association between stimulant co-involvement and death.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104678"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787306","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}

{"title":"Trends in prescription opioid analgesic use in Australia from 2015 to 2022","authors":"Kendal Chidwick ,&nbsp;Chrianna Bharat ,&nbsp;Natasa Gisev ,&nbsp;Alys Havard ,&nbsp;Ximena Camacho ,&nbsp;Sallie-Anne Pearson ,&nbsp;Louisa Degenhardt","doi":"10.1016/j.drugpo.2024.104666","DOIUrl":"10.1016/j.drugpo.2024.104666","url":null,"abstract":"<div><h3>Background</h3><div>Recent measures to curb use and harms of pharmaceutical opioids in Australia have reduced dispensings of opioid analgesics for pain, under Australia's Pharmaceutical Benefits Scheme (PBS). But information on trends in private (self-funded) dispensings and public (government-funded) hospital opioids use is not readily available. Our study describes eight-year population-level trends in Australia's prescribed opioid analgesic use, estimating PBS dispensing claims, private dispensings and hospital use.</div></div><div><h3>Methods</h3><div>Our descriptive study used two datasets covering 2015 to 2022: national IQVIA data on all (PBS/private) pharmaceutical sales to community pharmacies, hospitals and other settings, and PBS dispensing claims data for a 10 % sample of Australian residents, extrapolated to estimate national PBS claims. We measured total units of each opioid sold/dispensed, converted into oral morphine equivalent milligrams (OME)/1000 population/day. We estimated private dispensings/public hospitals use by subtracting PBS OME from total OME sold. We calculated hospital OME using sales to hospitals. We assessed annual trends using Joinpoint regression.</div></div><div><h3>Results</h3><div>Between 2015 and 2022 total prescribed opioid analgesic use decreased by 21.2 % , from 1231.4 to 970.6 OME/1000/day (-3.4% per year, <em>p</em> &lt; 0.001). Between 2015 and 2022, PBS dispensing claims decreased by -353.4 OME/1000/day, from 1061.7 to 708.4 OME/1000/day (-5.9 % per year; <em>p</em> &lt; 0.001). In contrast, private dispensings/public hospital use increased by +92.5 OME/1000/day, from 169.7 to 262.3 OME/1000/day (+6.7 % per year; <em>p</em> &lt; 0.001). The contribution of private dispensings/public hospital use to total prescribed opioid analgesic use doubled between 2015 and 2022 from 13.8 % to 27.0 %. Opioid use in hospitals remained stable (-1.1 % per year, <em>p</em> = 0.07), accounting for 8 to 10 % of total use between 2015 and 2022.</div></div><div><h3>Discussion</h3><div>Prescribed opioid analgesic use declined between 2015 and 2022 because of reductions in PBS dispensing claims. A quarter of the reduction in PBS dispensing claims was offset by use outside the PBS. Our findings indicate a significant increase in private use, reasons for which may include accessing opioids not PBS-subsidised and circumventing PBS restrictions for PBS-subsidised opioids. Comparing multiple data sources provides a comprehensive account of prescribed opioid analgesic use in Australia.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104666"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792608","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}

{"title":"Generative tension and social risk management surrounding sexualised drug use practice among men who have sex with men in highly stigmatised environments: A qualitative study from Jakarta, Indonesia","authors":"Laura Nevendorff ,&nbsp;Adam Bourne ,&nbsp;Mark Stoové ,&nbsp;Alisa Pedrana","doi":"10.1016/j.drugpo.2024.104683","DOIUrl":"10.1016/j.drugpo.2024.104683","url":null,"abstract":"<div><h3>Background</h3><div>Global policies emphasise the need for tailored interventions to reduce the harms of sexualised drug use (SDU) among men who have sex with men (MSM), including taking account of local risk environments and the influence of social norms, drug and sexual minority stigma, and cultural and political conditions. To help guide the production of local SDU harm reduction interventions, this study aimed to explore the social and structural conditions that shape the practice of, and response to, SDU by MSM in Jakarta, Indonesia.</div></div><div><h3>Methods</h3><div>Informed by an interactionism theoretical perspective and socioecological frameworks, a reflexive thematic approach was used to analyse in-depth qualitative interview data from 20 MSM who practised SDU in Jakarta. To recruit the participants, the study was promoted through local organisations providing HIV services for MSM, as well as snowball recruitment.</div></div><div><h3>Results</h3><div>To protect their SDU practice, MSM in Jakarta developed a set of social risk management strategies designed to reduce the generative tension between enabling and disabling forces caused by local social and structural environments. Enabling forces emerged primarily from within MSM networks, were extended through the interpersonal dynamics of sexual partner relationships to peer influence and reinforced by product branding and marketing on both offline and online platforms. The disabling forces, which were introduced primarily from outside the network, manifested in stigmatising social norms, politics and religious beliefs towards homosexuality and drug use, and forced MSM who practised SDU to relocate to virtual environments.</div></div><div><h3>Conclusion</h3><div>Programmatic responses seeking to mitigate the risks associated with SDU practice among sexual minority men should incorporate established mechanisms of peer networks and virtual spaces into their design to maximise reach and intervention acceptability and effectiveness.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104683"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855798","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}

{"title":"“It always needs a higher level of care than what I can provide”: Practical, ethical, and administrative tensions arising from the integration of wound care services into syringe service programs in Maryland","authors":"Laura N. Sisson,&nbsp;Suzanne J. Block,&nbsp;Tricia Triece,&nbsp;Emily M. Martin,&nbsp;Jill Owczarzak,&nbsp;Susan G. Sherman,&nbsp;Kristin E. Schneider","doi":"10.1016/j.drugpo.2024.104685","DOIUrl":"10.1016/j.drugpo.2024.104685","url":null,"abstract":"<div><h3>Introduction</h3><div>The emergence of xylazine into the U.S. drug supply has increased demand for wound care services among people who inject drugs (PWID). Traditional health care settings have historically been ill-equipped to accommodate the complex needs of PWID and syringe service programs (SSPs) have created wound care services to fill the gap. In doing so, many SSPs are extending the scope of their services beyond health promotion into a quasi-medical space that is largely unregulated.</div></div><div><h3>Methods</h3><div>We conducted 10 qualitative interviews with staff employed by eight SSP programs across six counties in the state of Maryland to explore how they have navigated shifting demand for more intensive wound care services.</div></div><div><h3>Results</h3><div>Contested boundaries in training of non-medical staff, lack of clarity in SSP-based providers’ scope of practice, and conflicts in operational norms and standards between harm reduction and medical services are significant sources of tension that impact delivery of wound care services in SSP settings. In taking on responsibility to provide wound care services to PWID, SSPs take on significant administrative, practical, and ethical burden that increase vulnerability to medicolegal liability.</div></div><div><h3>Discussion</h3><div>There is a significant unmet need for increased resources, administrative support, and mentorship to guide the integration of medicalized wound care into SSP programs. Additionally, efforts to expand access to community-based wound care services for PWID should not replace efforts to promote timely access to services in more traditional healthcare settings.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104685"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824609","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}

{"title":"Alcohol, affective atmospheres and structures of feeling in women at midlife","authors":"Kate Kersey ,&nbsp;Antonia C. Lyons","doi":"10.1016/j.drugpo.2024.104680","DOIUrl":"10.1016/j.drugpo.2024.104680","url":null,"abstract":"<div><h3>Introduction</h3><div>Women at midlife have increased rates of harmful drinking in many high-income countries. This cohort grew up within permissive alcohol environments that encouraged women's consumption, linking it to success, femininity, and empowerment. This research drew on notions of ‘structures of feeling’ and ‘affective atmospheres’ to explore how women at midlife describe and make sense of alcohol and drinking within their lives.</div></div><div><h3>Methods</h3><div>Eight friendship discussion groups and 17 individual interviews were conducted with 50 women (aged 35–59 years) in Aotearoa/New Zealand about alcohol and drinking. Transcripts were analysed using an affective-discursive approach.</div></div><div><h3>Findings</h3><div>Shaped by idealised femininities and alcohol's chemical affordances, particular affective atmospheres and feelings arose in women before, during, and after drinking, providing insights into women's experiences and sense-making around alcohol. Three areas of life were highly affectively charged in discussions, namely drinking that: 1) enabled bonding with partner, 2) facilitated time out from busy lives, and 3) was part of coping with life's difficulties.</div></div><div><h3>Discussion and conclusions</h3><div>Women at midlife experienced pressures to be economically and socially successful, to maintain slim bodies, and to have ‘appropriate’ feelings such as selflessness and gratitude. For women in this study, drinking alcohol was a way to achieve, and to cope with, expectations around idealised femininities and socially endorsed ways of living, being, and feeling. Repeated and routine affective experiences reinforced the role of alcohol in women's lives. Findings suggest the need for gender-transformative policies that address the structural environments of women's lives.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104680"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830471","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}

{"title":"Motivations for and perspectives of medication diversion among clients of a safer opioid supply program in Toronto, Canada","authors":"Lucas Martignetti ,&nbsp;Rod Knight ,&nbsp;Frishta Nafeh ,&nbsp;Kate Atkinson ,&nbsp;Gab Laurence ,&nbsp;Colin H Johnson ,&nbsp;Dan Werb ,&nbsp;Mohammad Karamouzian","doi":"10.1016/j.drugpo.2024.104665","DOIUrl":"10.1016/j.drugpo.2024.104665","url":null,"abstract":"<div><h3>Background</h3><div>Safer opioid supply programs in Canada have come under intense scrutiny related to the perceived risk of diversion of safer opioid supply medications. We sought to explore the experiences and perspectives of safer opioid supply medication diversion with clients of a safer opioid supply program in Toronto, Canada.</div></div><div><h3>Methods</h3><div>From December 2022 to August 2023, we conducted in-depth, semi-structured interviews with 25 adult clients of a safer opioid supply program in Toronto, Canada. We analyzed the data using deductive and inductive approaches via thematic analysis.</div></div><div><h3>Results</h3><div>Our analysis identified five themes regarding clients’ perceptions and experiences with safer opioid supply diversion: (i) Compassionate sharing with others to address withdrawal symptoms; (ii) Selling or sharing due to unmet medication or survival needs of program clients; (iii) High demand for safer alternatives to those that are available in unregulated drug markets; (iv) Price of safer opioid supply medications in the unregulated drug markets as a diversion deterrent; and (v) Coerced diversion through harassment or violence.</div></div><div><h3>Conclusions</h3><div>These findings document experiences of medication diversion and the multifaceted and complex interplay of various individual and contextual factors that motivate safer opioid supply clients to engage in it. Future policy and safer opioid supply practice should address root causes of diversion, particularly barriers to service access and the diverse medication needs of clients.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104665"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787305","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}

{"title":"Trends in e-cigarette exposures reported to an Australian poisons information centre between 2017 and 2023 with a reflection on legislative changes in 2021","authors":"Ruby K Dempsey ,&nbsp;Kamran Zia ,&nbsp;Rohan A Elliott ,&nbsp;Firouzeh Noghrehchi ,&nbsp;Anselm Wong","doi":"10.1016/j.drugpo.2024.104684","DOIUrl":"10.1016/j.drugpo.2024.104684","url":null,"abstract":"<div><h3>Background</h3><div>Australians’ use of e-cigarettes has increased dramatically in the last few years, following trends worldwide. The Australian Federal government introduced legislation on October 1st, 2021, which reclassified nicotine e-cigarettes as prescription only medicine in an attempt to curb their rapid uptake, especially amongst adolescents.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of e-cigarette exposure cases reported to the Victorian Poisons Information Centre between January 1st, 2017, and September 30th, 2023. The primary outcome was the trend in case number over the study period, analysed by breakpoint and interrupted time series analyses, as well as comparison of mean monthly calls in the 24 months before and after the introduction of the 2021 law. Secondary outcomes included shifts in route of exposure and severity pre- and post-legislation.</div></div><div><h3>Results</h3><div>There were 547 e-cigarette cases between January 2017 and September 2023. Most cases (n=454, 83%) were unintentional exposures, usually via inhalation (n = 271, 49.5%) or ingestion (n = 201, 36.8%). According to breakpoint analysis, the number of poisonings increased after March 2021 with rate ratio (RR) of 2.68 (95% CI 2.22, 3.68) and again increased after October 2021 (RR=1.66; 95% CI 1.43, 1.94). There were 103 e-cigarette exposure cases reported in the 24 months before the legislation was implemented in October 2021, and 358 in the following 24 months. The median monthly cases increased from 3 (IQR 2–4) to 15 (IQR 13–17), p &lt; 0.001. The largest increase was seen in toddlers (1 to 4 years age group) whose median monthly exposures increased from 1 (IQR 0–2) to 9 (IQR 8–11), p &lt; 0.001, but significant increases were also seen amongst infants, children and adults, p &lt; 0.001 for all. Ingestion as the route of exposure decreased proportionally from 53% (55 cases) to 23% (84 cases). Conversely, inhalation increased from 21% (22 cases) to 68% (245 cases). Severity was unchanged, except in adolescents who saw an increase from a poisoning severity score of “none” to “minor”.</div></div><div><h3>Conclusion</h3><div>The 2021 Australian federal legislation did not prevent increases in e-cigarette poisoning exposures in the context of their increased use, supporting the need for further regulation. Toddlers were identified as being particularly at-risk, suggesting educational campaigns for parents are warranted.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104684"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865761","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}