International Journal of Drug Policy最新文献_第5页

The Züri Can study: Can regulated cannabis sales promote lower-risk cannabis use? Mini-review and study protocol Züri Can 研究：规范大麻销售能否促进低风险大麻使用？小综述和研究方案

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-11 DOI: 10.1016/j.drugpo.2024.104610

Maximilian Buschner, Nadine Heckel, Patricia Dürler, Etna J․ E. Engeli, Sophie Schneider, Eva M. Havelka, Carlos Nordt, Marcus Herdener

Background and Aims

Recreational use of cannabis is illegal in most countries. Despite this, it is the third most commonly used psychoactive substance worldwide. As a result of this discrepancy, a growing number of countries have begun to reassess their legal approach to cannabis in recent years. While the health risks of cannabis and potential harm reduction measures are increasingly well understood, there are still significant gaps in knowledge about which regulatory and supply models are effective in promoting lower-risk cannabis use.

In this paper, we outline the Züri Can study, which implements and evaluates a regulatory framework for cannabis sales in the city of Zurich, Switzerland, between 2023 and 2026. In addition, we illustrate how the study addresses current knowledge gaps to provide further insight into the potential future regulation of cannabis in Switzerland.

To embed the study in the present scientific and political context, we first provide a brief overview of the state of knowledge on cannabis-related health risks and means of reducing them, along with lessons learned from other countries that have implemented varying regulatory systems.

Design and Measurements

2,100 participants will be able to legally purchase cannabis either at a pharmacy, a cannabis social club, or the municipal drug information center over a three-year period. As part of this observational study, participants will be evaluated regarding their cannabis use habits and motives, their knowledge of lower-risk use, and their mental and physical health, among other parameters.

Established harm reduction strategies are implemented as an integral part of the study design.

Comments

The study will contribute to a better understanding of the impact of different cannabis distribution models on cannabis use patterns and related health outcomes. The results are expected to assist Swiss and international policy makers in developing evidence-based and public health-oriented regulatory frameworks for cannabis.

背景和目的在大多数国家，娱乐性使用大麻是非法的。尽管如此，大麻却是全球第三大最常用的精神活性物质。由于这种差异，近年来越来越多的国家开始重新评估其对大麻的法律态度。虽然人们对大麻的健康风险和潜在的减害措施有了越来越深入的了解，但在哪些监管和供应模式能有效促进低风险大麻使用方面仍存在巨大的知识差距。在本文中，我们概述了 Züri Can 研究，该研究实施并评估了 2023 年至 2026 年期间瑞士苏黎世市的大麻销售监管框架。此外，我们还说明了该研究如何解决当前的知识缺口，从而为瑞士未来可能的大麻监管提供更深入的见解。为了将该研究纳入当前的科学和政治背景，我们首先简要概述了与大麻相关的健康风险和降低风险的方法的知识状况，以及从其他实施了不同监管制度的国家吸取的经验教训。设计和测量2,100 名参与者将能够在三年内通过药店、大麻社交俱乐部或市级毒品信息中心合法购买大麻。作为这项观察性研究的一部分，将对参与者的大麻使用习惯和动机、对低风险使用的了解以及他们的身心健康等参数进行评估。这项研究将有助于更好地了解不同大麻销售模式对大麻使用模式和相关健康结果的影响。预计研究结果将有助于瑞士和国际政策制定者制定以证据为基础、以公共健康为导向的大麻监管框架。

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引用次数: 0

Trends in alcohol expenditure among risky drinkers: A population study in England, 2014–2023 危险饮酒者的酒精支出趋势：英格兰人口研究，2014-2023 年。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-10 DOI: 10.1016/j.drugpo.2024.104615

Sarah Jackson , Melissa Oldham , Colin Angus , Claire Garnett , Luke Wilson , John Holmes , Jamie Brown

Background

This study aimed to estimate time trends in alcohol expenditure among risky drinkers in England over the past decade, to understand whether these trends are driven by changes in prices paid or volumes purchased, and to explore differences between population subgroups.

Methods

Nationally-representative monthly cross-sectional survey. Participants were 44,382 adults (≥18y) drinking at risky levels (AUDIT-C ≥ 5; ‘risky drinkers’). Linear regression modelled trends between March-2014 and October-2023 in (i) mean weekly inflation-adjusted expenditure on alcohol, (ii) mean weekly alcohol consumption in units, and (iii) mean inflation-adjusted expenditure per unit of alcohol, overall and by age, gender, social grade, region, and smoking status.

Results

There was an uncertain decrease in mean weekly expenditure from £18.90 [95 %CI=£18.30-£19.50] in March-2014 to £17.90 [£17.60-£18.30] in May-2016, then an uncertain increase to £18.60 [£18.30-£18.90] between May-2016 and June-2018. This was followed by a further decline to £16.90 [£16.60-£17.30] by April-2021 and subsequent rise to £18.60 [£17.90-£19.40] by October-2023. Changes in weekly alcohol expenditure were more closely mirrored by changes in mean expenditure per unit of alcohol than by changes in mean weekly alcohol consumption in units. Notable subgroup differences included sharp rises in weekly alcohol expenditure since 2021 among younger ages (driven by a rise in expenditure per unit of alcohol) and current smokers (driven by a rise in weekly units of alcohol consumed).

Conclusions

In England, the average amount adult risky drinkers reported spending on alcohol each week has fluctuated since 2014, with a notable decrease around the start of the COVID-19 pandemic in 2020 and a subsequent rise since restrictions were lifted and since the cost-of-living crisis has led to high rates of inflation. Except for current smokers, this pattern appears to have been driven predominantly by changes in the price paid per unit rather than changes in consumption.

研究背景：本研究旨在估算过去十年间英格兰高风险饮酒者的酒精支出时间趋势，了解这些趋势是由支付价格的变化还是购买量的变化引起的，并探讨不同人口亚群之间的差异：方法：具有全国代表性的月度横断面调查。参与者为 44,382 名成年人（≥18 岁），他们的饮酒量达到了危险水平（AUDIT-C ≥ 5；"危险饮酒者"）。线性回归模拟了 2014 年 3 月至 2023 年 10 月期间：(i) 经通货膨胀调整后的平均每周酒类支出；(ii) 以单位为单位的平均每周酒类消费；(iii) 经通货膨胀调整后的平均每单位酒类支出的总体趋势，以及按年龄、性别、社会等级、地区和吸烟状况分类的趋势：平均每周支出从2014年3月的18.90英镑[95 %CI=18.30-19.50英镑]不确定地降至2016年5月的17.90英镑[17.60-18.30英镑]，然后在2016年5月至2018年6月期间不确定地增至18.60英镑[18.30-18.90英镑]。随后，到 2021 年 4 月将进一步下降至 16.90 英镑[16.60-17.30 英镑]，到 2023 年 10 月将上升至 18.60 英镑[17.90-19.40 英镑]。与每周平均酒精消费单位的变化相比，每周平均酒精消费单位的变化更能反映每周酒精消费支出的变化。值得注意的亚组差异包括：自 2021 年以来，年轻群体的每周酒精支出急剧上升（受每单位酒精支出上升的影响），以及当前吸烟者的每周酒精支出急剧上升（受每周酒精消费单位上升的影响）：在英格兰，成年风险饮酒者报告的每周平均饮酒支出自 2014 年以来一直在波动，在 2020 年 COVID-19 大流行开始前后出现明显下降，而在限制取消后以及生活费用危机导致高通胀率后又出现上升。除当前吸烟者外，这种模式似乎主要是由单位支付价格的变化而非消费量的变化所驱动。

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引用次数: 0

Experiences of misuse and symptoms of dependence among people who use gabapentinoids: A qualitative systematic review 使用加巴喷丁类药物者的滥用经历和依赖症状：定性系统综述。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-10 DOI: 10.1016/j.drugpo.2024.104605

Amy G. McNeilage , Alison Sim , Suzanne Nielsen , Bridin Murnion , Claire E. Ashton-James

Background

Gabapentinoids are among the most widely prescribed pain medications worldwide. However, there is growing evidence of harms associated with their use. The aim of this study was to systematically review and synthesise qualitative research exploring lived experiences of gabapentinoid (pregabalin and/or gabapentin) misuse and symptoms of dependence.

Methods

Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, PsycINFO) and grey literature sources were searched from inception to September 2023. The methodological quality of included studies was appraised using a modified 11-item version of the Critical Appraisal Skills Programme qualitative checklist, and higher quality studies were prioritised in the thematic synthesis. Confidence in the overall findings of the review was assessed using the GRADE-CERQual approach. The review was prospectively registered on PROSPERO (CRD42023401832).

Results

Twenty-six articles representing 21 original studies were included. The majority used interview methods and were of high methodological quality. Motives for gabapentinoid misuse included getting high, potentiating or offsetting the effects of other drugs, self-medicating for pain, distress, insomnia, or withdrawal symptoms, and substituting for another drug. Symptoms of dependence included the rapid development of tolerance and a severe withdrawal syndrome often involving psychiatric symptoms. Harms including dissociation, loss of consciousness, and overdose were generally reported as a consequence of polysubstance use. Confidence in most of the review findings was moderate with low confidence in one finding.

Conclusion

This review provides rich qualitative insights into the potential motives for gabapentinoid misuse as well as the diverse lived experiences of dependence symptomatology. Considering the increasing prescribing of these medications globally, and the potential for public health challenges resulting from misuse, the findings of this review can be used to develop more effective harm reduction strategies.

背景：加巴喷丁类是全球处方最广的止痛药物之一。然而，越来越多的证据表明，使用这些药物会对人体造成伤害。本研究旨在对探讨加巴喷丁（普瑞巴林和/或加巴喷丁）滥用和依赖症状的生活经历的定性研究进行系统回顾和综合：检索了从开始到 2023 年 9 月的六个数据库（MEDLINE、Scopus、Web of Science、CINAHL、EMBASE、PsycINFO）和灰色文献来源。采用 "批判性评估技能计划 "定性检查表的 11 个项目修订版对纳入研究的方法学质量进行评估，并在专题综合中优先考虑质量较高的研究。采用 GRADE-CERQual 方法对综述总体结论的可信度进行了评估。该综述在 PROSPERO（CRD42023401832）上进行了前瞻性注册：共纳入 26 篇文章，代表 21 项原创研究。大部分研究采用访谈法，方法质量较高。滥用加巴喷丁类药物的动机包括获得快感、增强或抵消其他药物的作用、自我治疗疼痛、痛苦、失眠或戒断症状，以及替代其他药物。依赖性症状包括迅速产生耐受性和严重的戒断综合症，通常涉及精神症状。一般报告称，多种物质的使用会造成伤害，包括精神分裂、意识丧失和用药过量。大多数综述结果的可信度为中等，其中一项结果的可信度较低：本综述提供了有关滥用加巴喷丁类药物的潜在动机以及依赖症状的不同生活经历的丰富定性见解。考虑到这类药物在全球范围内的处方量不断增加，以及滥用可能带来的公共卫生挑战，本综述的研究结果可用于制定更有效的减低危害策略。

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引用次数: 0

Psychomodulatory substances: New legislative framework for control of psychoactive substances in Czechia 精神调节物质：捷克管制精神活性物质的新立法框架。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-09 DOI: 10.1016/j.drugpo.2024.104603

Viktor Mravčík , Jana Michailidu , Petr Pleva , Matyáš Lucký , Lucia Kiššová , Jindřich Vobořil

This article challenges drug prohibition advocated by UN conventions as the prevailing regulatory model for psychoactive substances, highlighting its ineffectiveness, harmfulness and outdated nature. At the same time, the conventions exclude some psychoactive substances from international regulation, leaving control to individual countries. Presenting an innovative approach, this article outlines an approach to the legal regulation of psychomodulatory substances (psychoactive substances with low health and societal risk) in non-medical contexts. Acknowledging the potential benefits of such psychoactive substances and balancing them with potential harms, it suggests stringent rules for marketing, safety, and preventing sales to minors. This approach aims to quell illicit markets, safeguard vulnerable populations, and encourage controlled use. Through a case study of the Czech Republicʼs introduction of a new category of psychomodulatory substances, this article showcases a paradigm shift from the prevailing repressive approach to drug regulation. This adaptive model effectively navigates the regulatory void, offering a viable alternative to the UNʼs prohibition framework.

这篇文章对联合国公约所倡导的作为精神活性物质主流监管模式的毒品禁令提出了质疑，强调了其无效性、危害性和过时性。同时，这些公约还将一些精神活性物质排除在国际监管之外，由各个国家进行管制。本文提出了一种创新方法，概述了在非医疗背景下对精神调节物质（健康和社会风险较低的精神活性物质）进行法律监管的方法。文章承认此类精神活性物质的潜在益处，并在潜在危害与益处之间达成平衡，同时建议对营销、安全和防止向未成年人销售制定严格的规则。这种方法旨在遏制非法市场，保护弱势群体，鼓励有控制地使用。本文通过对捷克共和国引入一类新的精神调节物质的案例研究，展示了现行压制性药品监管方法的范式转变。这种适应性模式有效地填补了监管空白，为联合国的禁药框架提供了一个可行的替代方案。

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引用次数: 0

The use of health utility in cost-utility analysis: A systematic review in substance use disorders 在成本效用分析中使用健康效用：对药物使用障碍的系统回顾。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-09 DOI: 10.1016/j.drugpo.2024.104570

Anh Dam Tran , Xin Zhan , Annaëlle Vinzent , Lorelie Flood , Tian Bai , Erinn Gallagher , Gregory S. Zaric

Background and aim

We aim to identify within-trial and modelled Cost-Utility Analysis (CUA) in substance use disorders (SUD) and review the applicability assessment associated with health utility used in modelled CUA.

Study design and methods

We searched Medline, Embase, EconLit and the Pharmaceutical Benefits Advisory Committee (PBAC) databases. A global systematic literature search was undertaken to determine the CUA of SUD interventions. Key characteristics of the studies and use of health utility were described. The applicability assessment associated with health utility used in modelled CUA was reviewed using The Health Utility Application Tool (HAT).

Results

The final review retrieved 49 CUA (14 within-trial and 35 modelled CUA). Three major health utility measurements were used - standard gamble, EQ-5D-5L and SF-6D. EQ-5D-5L was mainly used in within-trial CUA, whereas standard gamble, EQ-5D-5L and SF-6D were equally cited in modelled CUA and within-trial CUA. Twenty-nine articles using modelled CUA citing health utilities from published literature were assessed. Only half and one-third of CUA studies described the type of quality-of-life measure and value sets used in health utility studies, respectively. Only two-thirds showed the authors addressed questions about the similarities in clinical conditions, and health state description between health utility studies and economic evaluation studies.

Conclusion

Justifications for chosen health utilities in modelled CUA studies were mostly absent in SUD. We suggested health economists use the HAT to make judgements when assessing health utility from published estimates. The use of this tool will increase the reliability of economic evaluation carried out to assist government and policymakers in making informed decisions around health topics.

背景和目的：我们旨在确定药物使用障碍（SUD）的试验内和模型成本效用分析（CUA），并审查模型成本效用分析中使用的与健康效用相关的适用性评估：我们检索了 Medline、Embase、EconLit 和药品福利咨询委员会 (PBAC) 数据库。为确定 SUD 干预措施的 CUA，我们进行了全球系统性文献检索。对研究的主要特点和健康效用的使用进行了描述。使用 "健康效用应用工具"（HAT）对建模 CUA 中使用的健康效用进行了适用性评估：最终审查检索到 49 项 CUA（14 项试验内 CUA 和 35 项模拟 CUA）。使用了三种主要的健康效用测量方法--标准赌注、EQ-5D-5L 和 SF-6D。EQ-5D-5L 主要用于试验内 CUA，而标准赌注、EQ-5D-5L 和 SF-6D 在模拟 CUA 和试验内 CUA 中的引用率相同。评估了 29 篇使用模拟 CUA 的文章，这些文章引用了已发表文献中的健康效用。只有一半和三分之一的 CUA 研究分别描述了生活质量测量的类型和健康效用研究中使用的价值集。只有三分之二的研究表明，作者解决了健康效用研究和经济评估研究在临床条件和健康状态描述方面的相似性问题：结论：在 SUD 中，模拟 CUA 研究中选择健康效用的理由大多不充分。我们建议卫生经济学家在根据已公布的估计值评估健康效用时使用 HAT 做出判断。该工具的使用将提高经济评估的可靠性，从而帮助政府和政策制定者围绕健康主题做出明智决策。

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引用次数: 0

Access and care for people with opioid use disorder in U.S. skilled nursing facilities: A policy commentary 美国专业护理机构对阿片类药物使用障碍患者的访问和护理：政策评论。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-08 DOI: 10.1016/j.drugpo.2024.104607

Shivani Nishar , Jon Soske , Rahul Vanjani , Simeon D. Kimmel , Corinne Roma , Patience M. Dow

Referrals for people with opioid use disorder (OUD) to skilled nursing facilities (SNFs) are increasing in the United States (U.S.). Further, legal guidance from the U.S. Department of Justice states that people with OUD cannot be discriminated against by health care institutions because of OUD or treatment with medications for OUD (MOUD). As such, SNFs are an important touchpoint for initiating or continuing MOUD, particularly amid rising drug-related overdose deaths among older adults and because people with OUD experience frailty and other geriatric syndromes at younger chronological ages. Informed by research, clinical expertise, and lived experience, this commentary describes policy and practice opportunities to help address challenges faced by people with OUD in gaining access to care and MOUD in SNFs. We propose opportunities to intervene against barriers that impede SNF placement and access to MOUD for people with OUD, including further revisions to 42 CFR Part 8 regulations to extend waivers for certification as opioid treatment programs (OTPs) to SNFs, allowing them to administer and dispense methadone in the same way as hospitals. If passed, proposed federal changes under the Modernizing Opioid Treatment Act would eliminate the requirement for methadone to be dispensed through OTPs, offering another opportunity to improve access to methadone for SNF residents. Also, we propose national and state-level investment in mobile substance use disorder services and partnerships with OTPs and hospital-based addiction consult services. We also recognize the need for more compassionate attitudes toward people with OUD in healthcare settings and discuss opportunities to address stigma. Although people with OUD are referred to SNFs for skilled care needs and not specifically for OUD care, it is essential for SNFs to be prepared to continue MOUD. It is both legally mandated and imperative that people with OUD have access to high quality and equitable SNF care.

在美国，将阿片类药物使用失调症（OUD）患者转介到专业护理机构（SNFs）的情况越来越多。此外，美国司法部的法律指南规定，医疗机构不得因阿片类药物使用障碍或阿片类药物使用障碍药物治疗（MOUD）而歧视阿片类药物使用障碍患者。因此，SNF 是开始或继续 MOUD 治疗的重要接触点，尤其是在老年人中与药物过量相关的死亡人数不断上升的情况下，而且由于 OUD 患者在较年轻时就会出现虚弱和其他老年综合症。本评论以研究、临床专业知识和生活经验为基础，描述了政策和实践机会，以帮助解决 OUD 患者在获得护理和 SNF 中的 MOUD 方面所面临的挑战。我们提出了一些机会来干预那些阻碍 SNF 安置和 OUD 患者获得 MOUD 的障碍，包括进一步修订 42 CFR 第 8 部分的规定，将阿片类药物治疗计划 (OTP) 认证的豁免权扩展至 SNF，允许它们以与医院相同的方式管理和分配美沙酮。如果《阿片类药物治疗现代化法案》（Modernizing Opioid Treatment Act）中的联邦修改提案获得通过，将取消美沙酮必须通过 OTPs 配发的要求，从而为改善 SNF 居民获得美沙酮的机会提供另一个契机。此外，我们还建议在国家和州一级对流动药物使用障碍服务进行投资，并与 OTP 和医院成瘾咨询服务建立合作关系。我们还认识到在医疗机构中需要对 OUD 患者采取更富有同情心的态度，并讨论了解决污名化问题的机会。虽然 OUD 患者被转介到 SNFs 是为了满足专业护理需求，而不是专门为了 OUD 护理，但 SNFs 必须做好继续开展 MOUD 的准备。让 OUD 患者获得优质、公平的 SNF 护理既是法律规定，也是当务之急。

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引用次数: 0

Historical and theoretical roots of the big events framework 大事件框架的历史和理论根源。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-07 DOI: 10.1016/j.drugpo.2024.104606

Samuel R. Friedman , Diana Rossi , David C. Perlman

This article traces the evolution of the Big Events framework since it began as an attempt to understand why sociopolitical transitions in the Former Soviet Union, South Africa, and Indonesia were followed by HIV outbreaks. Big Events frameworks have evolved over time, but all versions try to concretize how macrosocial changes lead to social, personal and environmental changes that shape risk environments and drug use or other behavioral patterns in ways that may lead to epidemics. Important stages in the evolution of the Big Events framework included understanding that the sequelae of Big Events were contingent rather than deterministic, and the development of new survey measures to understand pathways through which Big Events affect social and epidemiologic outcomes. On a broader level, the Big Events framework is a useful crystallization and application of more abstract sociological, social epidemiologic and Marxist frameworks about upstream/downstream relationships and how major social changes are related to epidemics. As such, they raise issues of how to conduct research on dialectical interaction processes. On another level, this article traces the Big Events “style of thought” as Mannheim (Mannheim, 1971) termed it, within the historical context of changes in public health and social science theory, particularly during and after the 1960s.

本文追溯了 "大事件 "框架的演变过程，该框架最初是为了理解前苏联、南非和印度尼西亚的社会政治转型为何会导致艾滋病爆发。随着时间的推移，大事件框架也在不断演变，但所有版本都试图具体说明宏观社会变革如何导致社会、个人和环境的变化，这些变化以可能导致流行病的方式塑造了风险环境、毒品使用或其他行为模式。大事件框架演变的重要阶段包括认识到大事件的后遗症是偶然的而非决定性的，以及制定新的调查措施以了解大事件影响社会和流行病学结果的途径。在更广泛的层面上，大事件框架是更抽象的社会学、社会流行病学和马克思主义框架的有益结晶和应用，涉及上游/下游关系以及重大社会变革与流行病的关系。因此，它们提出了如何开展辩证互动过程研究的问题。在另一个层面上，本文在公共卫生和社会科学理论变化的历史背景下，特别是在 20 世纪 60 年代期间和之后，追溯了曼海姆（Mannheim，1971 年）所称的大事件 "思想风格"。

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引用次数: 0

Looking beyond drugs: A scoping review of recovery in the context of illicit substance use among adolescents and young adults 超越毒品：对青少年使用非法药物情况下的康复进行范围界定审查。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-07 DOI: 10.1016/j.drugpo.2024.104598

Cameron R. Eekhoudt , Monique Sandhu , Caroline Mniszak , Trevor Goodyear , Roxanne Turuba , Kirsten Marchand , Skye Barbic , Danya Fast

Background

Despite extensive literature exploring the harms associated with illicit substance use among young people who use drugs (YPWUD), the concept of “recovery” among this population has received significantly less attention. Addressing this literature gap can inform efforts to better support YPWUD as they pursue their goals.

Objective

To examine the qualitative literature on how young people (< 30 years of age) understand and navigate substance use recovery and healing in the context of illicit substance use, including how interventions and caregivers are implicated in these processes.

Methods

The design for this scoping review was guided by Arksey and O'Malley's framework and informed by Levac et al. refinements. We surveyed five bibliographic databases for English, peer-reviewed, empirical studies published between 1999 and 2023. Studies were independently reviewed by two reviewers. We charted, synthesized, and assessed studies for common themes.

Findings

A total of 28 articles met the inclusion criteria for this scoping review. Studies show varied definitions and enactments of recovery as part of a continuum of substance use care, frequently extending beyond the notion of recovery as abstinence. Caregivers providing emotional, material, and social support are crucial to recovery; however, the challenges of supporting a young person's recovery are manifold, including misaligned expectations about recovery definitions and processes.

Conclusion

Findings underscore the need for recovery-oriented care that aligns with young people's diverse and shifting needs, goals, and contexts. Recovery programs must range from harm reduction to abstinence-based approaches across institutional and non-institutional settings and actively engage YPWUD and caregivers.

背景：尽管有大量文献探讨了吸毒青少年（YPWUD）使用非法药物的危害，但对这一人群中 "康复 "概念的关注却少得多。弥补这一文献空白可以为更好地支持吸毒青少年实现其目标提供参考：研究有关年轻人（30 岁以下）在非法使用药物的背景下如何理解和引导药物使用康复和治疗的定性文献，包括干预措施和护理人员如何参与这些过程：本次范围界定综述的设计以 Arksey 和 O'Malley 的框架为指导，并参考了 Levac 等人的改进意见。我们在五个文献数据库中调查了 1999 年至 2023 年间发表的经同行评审的英文实证研究。研究报告由两名审稿人独立审阅。我们绘制了图表，进行了综合，并评估了研究的共同主题：共有 28 篇文章符合本次范围界定审查的纳入标准。研究表明，康复是药物使用护理连续体的一部分，其定义和表现形式各不相同，常常超越了康复即戒断的概念。提供情感、物质和社会支持的护理人员对康复至关重要；然而，支持年轻人康复的挑战是多方面的，包括对康复定义和过程的期望不一致：研究结果强调了以康复为导向的护理的必要性，这种护理应符合年轻人多样化且不断变化的需求、目标和背景。康复计划的范围必须从减少伤害到基于禁欲的方法，跨越机构和非机构环境，并积极吸引青年戒毒者和照顾者的参与。

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引用次数: 0

Repurposing prescribed hydromorphone: Alternative uses of safer supply and tablet-injectable opioid agonist treatment to meet unaddressed health needs 处方氢吗啡酮的再利用：更安全的供应和片剂注射阿片激动剂治疗的替代用途，以满足未解决的健康需求。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-07 DOI: 10.1016/j.drugpo.2024.104601

Andrew Ivsins , Jeanette M. Bowles , Manal Mansoor , Thomas Kerr , Geoff Bardwell

Background

In response to the ongoing overdose crisis in Canada, a number of opioid agonist treatment and safer supply programs provide people at high overdose risk with daily-dispensed tablet hydromorphone, with some requiring witnessed ingestion and others providing take-away doses. While these programs are intended to reduce overdose events by limiting people's use of the contaminated drug supply, the experiences of people receiving hydromorphone vary. In this article we explore the ways people repurpose hydromorphone to address unmet needs.

Methods

This article draws on in-depth qualitative interviews from two studies evaluating hydromorphone tablet distribution programs in British Columbia, Canada. We used thematic analysis to identify themes related to repurposing hydromorphone. We compared themes across the two studies to identify any similarities or differences in relation to the ways study participants discussed repurposing hydromorphone tablets. We utilize vignettes – snapshots of participant experiences – to analyse and represent the data.

Results

Four vignettes demonstrate how hydromorphone tablets are often being used to address and resolve unmet needs of people who use drugs. While most participants reported reducing their use of illicit drugs, a variety of instrumental uses of tablet hydromorphone were also discussed, including reducing anxiety, addressing sleep issues, withdrawal management, and managing chronic pain.

Conclusion

Our findings demonstrate how people who use drugs are maximizing the benefits of tablet hydromorphone distribution to address unmet needs. Hydromorphone distribution programs represent a public health and harm reduction intervention that is usefully addressing experiences related to structural vulnerabilities (such as inadequate pain management), which are often overlooked amongst stigmatized groups.

背景：为了应对加拿大持续不断的用药过量危机，一些阿片类激动剂治疗和更安全供应计划向用药过量风险高的人群提供每日配发的片剂氢吗啡酮，其中一些计划要求见证摄入，另一些计划则提供外带剂量。虽然这些计划旨在通过限制人们使用受污染的药物供应来减少用药过量事件，但接受氢吗啡酮治疗的人的经历却各不相同。本文将探讨人们如何重新利用氢吗啡酮来满足未满足的需求：本文借鉴了对加拿大不列颠哥伦比亚省氢吗啡酮片剂分发项目进行评估的两项研究的深入定性访谈。我们使用主题分析来确定与氢吗啡酮再利用相关的主题。我们比较了两项研究的主题，以确定研究参与者讨论氢吗啡酮片剂再利用方式的异同。我们利用小故事--参与者的经历快照--来分析和呈现数据：结果：四个小故事展示了氢吗啡酮片剂如何经常被用于满足和解决吸毒者未得到满足的需求。虽然大多数参与者报告说他们减少了非法药物的使用，但也讨论了氢吗啡酮片剂的各种工具性用途，包括减轻焦虑、解决睡眠问题、戒断管理和控制慢性疼痛：我们的研究结果表明了吸毒者如何最大限度地利用片剂氢吗啡酮的分发来满足未满足的需求。氢吗啡酮分发项目代表了一种公共健康和减低伤害的干预措施，它正在有效地解决与结构性弱点（如疼痛管理不足）相关的经历，而这些经历在被污名化的群体中往往被忽视。

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引用次数: 0

The intersection of substance use stigma and anti-Black racial stigma: A scoping review 药物使用污名化与反黑人种族污名化的交叉：范围审查。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-05 DOI: 10.1016/j.drugpo.2024.104612

Rashmi Ghonasgi , Maria E. Paschke , Rachel P. Winograd , Catherine Wright , Eva Selph , Devin E. Banks

Background

Substance use stigma poses a barrier to treatment and recovery from substance use disorder. Stigma is amplified when intersecting with other stigmatized identities, particularly Black racial identity. Despite increasing attention to the intersecting roles of racial and substance use stigma, it is unknown how these stigmas interact to impact treatment and health outcomes among Black people who use drugs. This scoping review examines empirical research documenting differential impacts of race and racism on substance use stigma.

Methods

We systematically searched PsychInfo and PubMed databases. Eligible studies were conducted in the U.S.; examined a Black sample, subsample, or experimental condition/variable (i.e., in a vignette); and measured substance use stigma (excluding alcohol or nicotine). Qualitative studies describing a theme related to substance use stigma were also included.

Results

Of 1431 unique results, 22 articles met inclusion criteria. The most measured substance use stigma type was interpersonal (e.g., discrimination). Most quantitative findings (n = 15) suggested that Black members of the general public endorse less substance use stigma and Black people who use drugs face less substance use stigma relative to their White counterparts. Qualitative studies (n = 7) suggested stigma was a more common and pernicious substance use treatment barrier for Black people compared to White. Across methods, racial prejudice was associated with substance use stigma, supporting hegemonic ideas that substance use is stereotypically characteristic of Black people.

Conclusions

The interaction between substance use stigma and race is complex and varies by in-group and out-group raters as a function of racial identity and identity as a person who uses drugs. Contradictory findings reflect methodological differences, emphasizing the need for more unified measurement of substance use stigma. More research is needed among Black people who use drugs to improve understanding of the impact of these intersecting stigmas on racial inequities in substance use treatment, morbidity, and mortality.

背景：药物使用污名化对药物使用障碍的治疗和康复构成了障碍。当污名与其他被污名化的身份（尤其是黑人种族身份）交织在一起时，污名就会被放大。尽管种族鄙视和药物使用鄙视的交叉作用日益受到关注，但这些鄙视是如何相互作用影响吸毒黑人的治疗和健康结果的，目前还不得而知。本范围界定综述研究了记录种族和种族主义对药物使用成见的不同影响的实证研究：我们系统地检索了 PsychInfo 和 PubMed 数据库。符合条件的研究均在美国进行；研究了黑人样本、子样本或实验条件/变量（即小故事）；并测量了药物使用耻辱感（不包括酒精或尼古丁）。此外，还包括描述与药物使用羞辱相关主题的定性研究：在 1431 项独特的结果中，有 22 篇文章符合纳入标准。衡量最多的药物使用羞辱类型是人际羞辱（如歧视）。大多数定量研究结果（n = 15）表明，与白人相比，一般公众中的黑人成员认可的药物使用成见较少，使用毒品的黑人面临的药物使用成见也较少。定性研究（n = 7）表明，与白人相比，成见对黑人来说是一种更常见、更有害的药物使用治疗障碍。在各种方法中，种族偏见与药物使用成见相关，支持了药物使用是黑人刻板印象的霸权思想：药物滥用成见与种族之间的相互作用是复杂的，并且由于种族身份和吸毒者身份的不同，群体内和群体外的评价者也各不相同。相互矛盾的研究结果反映了方法上的差异，强调了对药物使用耻辱感进行更统一测量的必要性。需要在吸毒黑人中开展更多研究，以更好地了解这些相互交织的污名对药物使用治疗、发病率和死亡率方面种族不平等的影响。

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引用次数: 0