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Building standards of psychedelic care: Qualitative examination of expert perspectives on safety, inclusion, and accountability 迷幻药治疗标准的建立:安全性、包容性和问责制专家观点的定性检验。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2026-01-01 DOI: 10.1016/j.drugpo.2025.104938
Christina Chwyl , Adrianne R. Wilson-Poe , Kim A. Hoffman , Alissa Bazinet , Kellie Pertl , Jason B. Luoma , Don des Jarlais , Sarann Bielavitz , P. Todd Korthuis
There remain significant gaps in knowledge about best practices for facilitated psychedelic care and psychedelic-assisted therapy. To inform the development of service models that support safe and beneficial experiences, this qualitative study explored expert perspectives on current and ideal standards of care, including key practices (e.g., screening, adapting care to diverse contexts) and regulatory and research challenges that influence service delivery. Online focus groups (n = 8) were conducted with a purposive U.S. sample of people with psychedelic content knowledge expertise, including providers (psychiatrists, clinical psychologists, addiction medicine experts, and licensed/unlicensed practitioners) and harm reduction specialists. Transcripts were analyzed through Thematic Analysis team-based coding using a combined inductive-deductive approach within a semantic framework. Participants (N = 38, mean age 47 (SD = 10) years, 53 % women, 84 % white) had an average of 10 years of psychedelic service experience (SD = 11) across diverse settings, including festivals/events, service centers, and clinical, research, ceremonial, community and ‘underground’ contexts. Five key themes emerged: (1) ‘Strengthening Safety through Credibility and Accountability’; (2) ‘Advancing Culturally Responsive and Inclusive Psychedelic Care; (3) ‘Healing in Community: The Crucial Role of Ongoing Support and Integration’; (4) Ensuring Safe Psychedelic Use: Preparation, Screening, Vulnerability, and Medication Management’; and (5) ‘Providing Informed Guidance and Navigating Legal and Informational Gray Areas.’ Overall, results underscore the need for stronger provider accountability structures, culturally inclusive practices, accessible and integrated community support, robust safety and screening protocols, and clearer guidelines to help providers navigate legal complexities, ensure safety, and optimize outcomes across diverse populations.
在促进致幻剂护理和致幻剂辅助治疗的最佳实践方面,仍存在显著的知识差距。为了为支持安全和有益体验的服务模式的发展提供信息,本定性研究探讨了专家对当前和理想护理标准的看法,包括关键实践(例如,筛查、使护理适应不同情况)以及影响服务提供的监管和研究挑战。在线焦点小组(n = 8)由具有致幻剂内容知识专业知识的美国人组成,包括提供者(精神科医生、临床心理学家、成瘾医学专家和有执照/无执照的从业者)和减少危害专家。通过基于主题分析团队的编码,在语义框架内使用组合的归纳-演绎方法分析转录本。参与者(N = 38,平均年龄47 (SD = 10)岁,53%的女性,84%的白人)平均有10年的迷幻药服务经历(SD = 11),包括节日/活动、服务中心、临床、研究、仪式、社区和“地下”环境。出现了五个关键主题:(1)“以诚信和问责加强安全”;(2)“促进文化响应和包容性迷幻药护理”;(3)“社区治疗:持续支持和融合的关键作用”;(4)确保安全使用致幻剂:制备、筛选、脆弱性和药物管理;和(5)“提供明智的指导,穿越法律和信息的灰色地带。”总体而言,结果强调需要建立更强大的提供者问责结构、文化包容性实践、可获得和综合的社区支持、健全的安全和筛查协议,以及更明确的指导方针,以帮助提供者应对法律复杂性、确保安全并优化不同人群的结果。
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引用次数: 0
Die ‘Richtlinien für die Risiko-Reduzierung beim Cannabiskonsum (RRRCK)’: EMPFEHLUNGEN “降低大麻使用风险指南(RRCK)”。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2026-01-01 DOI: 10.1016/j.drugpo.2023.103995
Benedikt Fischer , Tessa Robinson , Chris Bullen , Valerie Curran , Didier Jutras-Aswad , Maria Elena Medina-Mora , Rosalie Pacula , Jürgen Rehm , Robin Room , Wim van den Brink , Wayne Hall
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引用次数: 0
Les ‘Lignes Directrices Pour l'Usage du Cannabis à Moindre Risque (LUCMR)’: RECOMMENDATIONS [The ‘Lower-Risk Cannabis Use Guidelines (LRCUG)’: RECOMMENDATIONS (FRENCH)] 《低风险大麻使用指南》(LRCUG):建议(法国)
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2026-01-01 DOI: 10.1016/j.drugpo.2023.103994
Benedikt Fischer , Tessa Robinson , Chris Bullen , Valerie Curran , Didier Jutras-Aswad , Maria Elena Medina-Mora , Rosalie Pacula , Jürgen Rehm , Robin Room , Wim van den Brink , Wayne Hall
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引用次数: 0
Scoping review of the characteristics and implementation of routine outcome monitoring and feedback for adults and young people accessing alcohol and other drug use treatment 审查成年人和年轻人接受酒精和其他药物使用治疗的特点和实施常规结果监测和反馈的范围。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2026-01-01 DOI: 10.1016/j.drugpo.2025.105071
Alison K. Beck , Leanne Hides , Robert Stirling , Briony Larance , Gabrielle Campbell , Amanda L. Baker , Suzie Hudson , John Marsden , Nina Pocuca , Jason P. Connor , Michael Farrell , Peter J. Kelly

Background

Routinely monitoring therapeutic processes and outcomes is central to evidence-based Alcohol and Other Drug (AOD) use treatment. However, it remains unclear how this routinely captured data is ‘fed back’ to AOD clinicians and clients and used to inform treatment.

Objectives

This scoping review examined evaluations of routine outcome monitoring and feedback in young people and adults accessing AOD treatment to describe: a) the nature and extent of evidence; b) the development, characteristics and use of feedback and c) implementation considerations.

Methods

A systematic search of 11 online databases produced 796 articles. Independent title/abstract and full-text screening identified 20 evaluations for inclusion. Data extraction was performed independently by two researchers.

Results

Evaluations were primarily conducted in the USA (11/20), using non-randomised designs (14/20). Understanding of feedback is complicated by heterogeneity and missing information, but commonalities included technology-assisted outcome assessment to generate immediate, weekly, multi-dimensional feedback comprising a visual representation of change across time. Explicit guidance for using feedback in AOD treatment was rare (1/20). Implementation considerations are discussed across a) fidelity and training practices, b) participant and provider experience and c) barriers and enablers.

Discussion and Conclusions

Efforts to examine how best to generate, present and use feedback to inform AOD treatment are needed. Optimising the use of feedback across treatment settings will require examination of the interplay between feedback characteristics and clinician, client and contextual variables. Improved attention to idiographic outcomes, benchmarks, diversity considerations, health literacy, treatment context, training, fidelity and the reporting of evaluations are warranted.
背景:常规监测治疗过程和结果是循证酒精和其他药物(AOD)使用治疗的核心。然而,目前尚不清楚如何将这些常规捕获的数据“反馈”给AOD临床医生和客户,并用于指导治疗。目的:本范围审查审查了获得AOD治疗的年轻人和成年人的常规结果监测和反馈评估,以描述:a)证据的性质和范围;B)反馈的发展、特点和使用;c)实施时的考虑。方法:系统检索11个在线数据库,得到796篇文献。独立的标题/摘要和全文筛选确定了20个评价纳入。数据提取由两位研究者独立完成。结果:评估主要在美国进行(11/20),采用非随机设计(14/20)。对反馈的理解因异质性和信息缺失而变得复杂,但共性包括技术辅助的结果评估,以生成即时的、每周的、多维的反馈,包括对时间变化的可视化表示。在AOD治疗中使用反馈的明确指导很少(1/20)。本文从以下几个方面讨论了实现方面的考虑:a)保真度和培训实践;b)参与者和提供者经验;c)障碍和促成因素。讨论和结论:需要努力研究如何最好地产生、呈现和使用反馈来指导AOD治疗。在治疗设置中优化反馈的使用将需要检查反馈特征与临床医生、客户和环境变量之间的相互作用。有必要更多地关注具体结果、基准、多样性考虑、保健知识、治疗背景、培训、忠诚和评估报告。
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引用次数: 0
Hepatitis C treatment in a jail setting: A retrospective cohort analysis of low-barrier initiation of direct acting antivirals 监狱环境中的丙型肝炎治疗:直接作用抗病毒药物低屏障起始的回顾性队列分析
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2026-01-01 DOI: 10.1016/j.drugpo.2025.105125
Justin Berk, Matthew J Akiyama, Nicole Schachman, Reed Junkin, Aprotim Bhowmik, Deborah Davis, Saengnapha Williams, Josiah Rich, Matthew Murphy

Introduction

A significant proportion of individuals with hepatitis C virus (HCV) experience incarceration. Jails house individuals who are pre-trial or for short sentences and represent a critical setting to expand HCV treatment access. Low-barrier treatment models may help overcome implementation barriers to initiating treatment in jail settings. In 2021, the Rhode Island Department of Corrections began implementing low-barrier HCV treatment including take-home medications for those released before completing therapy in both a jail (pre-trial) and prison (sentenced) setting. This study aimed to evaluate response to therapy for HCV infection between individuals who initiated treatment in jail versus those who initiated in prison.

Methods

This study was an observational cohort of people receiving low-barrier HCV treatment initiation between January 2021 and September 2023 at the Rhode Island Department of Corrections. Logistic regression compared individuals who initiated therapy in jail to those initiating in prison. The primary outcome sustained virological response 12 weeks after treatment completion (SVR12).

Results

Of 160 individuals who initiated treatment during incarceration, 84 initiated in jail and 76 in prison. SVR12 was similar between individuals who initiated HCV treatment in jail (85%) and those who initiated in prison (86%). There was no statistical difference in likelihood of SVR12 between those initiating in a jail versus a prison in unadjusted bivariate analysis or an adjusted model. Individuals completing treatment in-facility were more likely to achieve SVR12.

Conclusion

Jail-based HCV treatment initiation is feasible. However, individuals released with medication face challenges in linkage to care. Improved discharge planning and community linkage are critical to post-release treatment success.
相当大比例的丙型肝炎病毒(HCV)感染者经历过监禁。监狱关押审前或刑期较短的个人,是扩大丙型肝炎病毒治疗可及性的关键场所。低障碍治疗模式可能有助于克服在监狱环境中开始治疗的实施障碍。2021年,罗德岛惩教局开始实施低屏障丙型肝炎治疗,包括为那些在监狱(审前)和监狱(判刑)环境中完成治疗前获释的人提供带回家的药物。本研究旨在评估在监狱中开始治疗的个体与在监狱中开始治疗的个体对HCV感染治疗的反应。该研究是一项观察性队列研究,研究对象是2021年1月至2023年9月在罗德岛惩教局接受低屏障丙型肝炎治疗的患者。Logistic回归比较了在监狱中开始治疗的个体和在监狱中开始治疗的个体。主要结局是在治疗完成后12周持续出现病毒学应答(SVR12)。结果160人在监禁期间开始治疗,84人在监狱开始治疗,76人在监狱开始治疗。在监狱中开始HCV治疗的个体(85%)和在监狱中开始治疗的个体(86%)之间的SVR12相似。在未调整的双变量分析或调整的模型中,在监狱中与在监狱中开始的人之间,SVR12的可能性没有统计学差异。在机构内完成治疗的个体更有可能达到SVR12。结论基于监狱启动HCV治疗是可行的。然而,药物释放的个人面临着与护理联系的挑战。改善出院计划和社区联系对释放后治疗的成功至关重要。
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引用次数: 0
Framing decriminalization: A mixed-methods study on media narratives, government resources, misinformation, and public support of British Columbia’s drug decriminalization policy 框架非犯罪化:对不列颠哥伦比亚省毒品非犯罪化政策的媒体叙述、政府资源、错误信息和公众支持的混合方法研究。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-12-30 DOI: 10.1016/j.drugpo.2025.105123
Farihah Ali , Shannon Chellew Paternostro , Sameer Imtiaz , Cayley Russell , Mark Asbridge , Louisa Degenhardt , Elaine Hyshka , Kurt Lock , M. Eugenia Socias , Dan Werb , Jürgen Rehm

Introduction

British Columbia’s (BC) three-year drug decriminalization policy–introduced in January 2023 and amended just over a year later in 2024–had multiple goals, including reducing drug use stigma, shifting perceptions of drug use from a criminal to a health issue, and improving health outcomes for people who use drugs. As part of the policy, the BC government was required to implement public education tools to raise awareness and build understanding of the policy. However, little is known about the scope or impact of these public education efforts or how the information environment shaped public perceptions and attitudes toward the policy. To address these gaps, this study examines: 1) how BC’s decriminalization policy was communicated and represented across government and media sources, and 2) how exposure to these information sources influenced public support and perceptions of safety.

Methods

This mixed-methods study analyzed 98 government resources, 301 media articles, and a cross-sectional public opinion survey of 1200 BC residents. Content analyses of government resources and media articles examined government resource and media source intent, misinformation, misleading narratives, and perspectives, while the public opinion survey assessed information exposure, policy support, and perceived safety.

Results

Approximately one-quarter of all sources were government resources, and among those with publication dates, only 13 % were released prior to the policy’s implementation and 9 % contained misinformation, representing a missed opportunity for expectation-setting and public education. In contrast, 34 % of media articles contained misinformation, commonly misrepresenting the policy’s intent and linking decriminalization to increased crime, disorder, and public drug use. Survey findings showed no significant associations between specific information sources and outright opposition. However, respondents exposed to multiple information sources were significantly less likely to report a neutral stance compared to support (OR [95 % CI]: 0.31 [0.15–0.65]). Those accessing official/academic sources or multiple sources were also less likely to feel less safe (OR [95 % CI]: 0.22 [0.07–0.71] and 0.43 [0.24–0.78]).

Conclusion

These findings highlight critical gaps in government communication and the dominance of misrepresentative media framing in shaping public attitudes. Effective drug policy requires not only legislative change but also proactive, coordinated, and sustained public education strategies to counter misinformation, reduce stigma, and build lasting support.
导读:不列颠哥伦比亚省(BC)的三年毒品非刑事化政策于2023年1月出台,并在一年后的2024年进行了修订,该政策有多个目标,包括减少吸毒的耻辱,将吸毒的观念从犯罪转变为健康问题,以及改善吸毒者的健康状况。作为该政策的一部分,卑诗省政府被要求实施公共教育工具,以提高人们对该政策的认识和理解。然而,人们对这些公共教育努力的范围和影响知之甚少,也不知道信息环境如何塑造公众对政策的看法和态度。为了解决这些差距,本研究考察了:1)不列颠哥伦比亚省的非犯罪化政策如何在政府和媒体来源中传播和代表,以及2)这些信息来源的暴露如何影响公众的支持和对安全的看法。方法:这项混合方法研究分析了98个政府资源,301篇媒体文章,以及对公元前1200名居民的横断面民意调查。政府资源和媒体文章的内容分析检查了政府资源和媒体来源的意图、错误信息、误导性叙述和观点,而公众舆论调查评估了信息暴露、政策支持和感知安全。结果:大约四分之一的信息来源是政府资源,在那些有发布日期的信息来源中,只有13%是在政策实施之前发布的,9%包含错误信息,这意味着错过了设定期望和公众教育的机会。相比之下,34%的媒体文章包含错误信息,通常歪曲了政策的意图,并将非刑事化与犯罪增加、混乱和公共吸毒联系起来。调查结果显示,具体的信息来源和直接的反对意见之间没有明显的联系。然而,与支持相比,暴露于多种信息来源的受访者更不可能报告中立立场(OR [95% CI]: 0.31[0.15-0.65])。那些访问官方/学术来源或多个来源的人也不太可能感到不安全(or [95% CI]: 0.22[0.07-0.71]和0.43[0.24-0.78])。结论:这些发现突出了政府沟通的关键差距,以及塑造公众态度的虚假媒体框架的主导地位。有效的毒品政策不仅需要立法改革,还需要积极、协调和持续的公共教育战略,以打击错误信息,减少耻辱,并建立持久的支持。
{"title":"Framing decriminalization: A mixed-methods study on media narratives, government resources, misinformation, and public support of British Columbia’s drug decriminalization policy","authors":"Farihah Ali ,&nbsp;Shannon Chellew Paternostro ,&nbsp;Sameer Imtiaz ,&nbsp;Cayley Russell ,&nbsp;Mark Asbridge ,&nbsp;Louisa Degenhardt ,&nbsp;Elaine Hyshka ,&nbsp;Kurt Lock ,&nbsp;M. Eugenia Socias ,&nbsp;Dan Werb ,&nbsp;Jürgen Rehm","doi":"10.1016/j.drugpo.2025.105123","DOIUrl":"10.1016/j.drugpo.2025.105123","url":null,"abstract":"<div><h3>Introduction</h3><div>British Columbia’s (BC) three-year drug decriminalization policy–introduced in January 2023 and amended just over a year later in 2024–had multiple goals, including reducing drug use stigma, shifting perceptions of drug use from a criminal to a health issue, and improving health outcomes for people who use drugs. As part of the policy, the BC government was required to implement public education tools to raise awareness and build understanding of the policy. However, little is known about the scope or impact of these public education efforts or how the information environment shaped public perceptions and attitudes toward the policy. To address these gaps, this study examines: 1) how BC’s decriminalization policy was communicated and represented across government and media sources, and 2) how exposure to these information sources influenced public support and perceptions of safety.</div></div><div><h3>Methods</h3><div>This mixed-methods study analyzed 98 government resources, 301 media articles, and a cross-sectional public opinion survey of 1200 BC residents. Content analyses of government resources and media articles examined government resource and media source intent, misinformation, misleading narratives, and perspectives, while the public opinion survey assessed information exposure, policy support, and perceived safety.</div></div><div><h3>Results</h3><div>Approximately one-quarter of all sources were government resources, and among those with publication dates, only 13 % were released prior to the policy’s implementation and 9 % contained misinformation, representing a missed opportunity for expectation-setting and public education. In contrast, 34 % of media articles contained misinformation, commonly misrepresenting the policy’s intent and linking decriminalization to increased crime, disorder, and public drug use. Survey findings showed no significant associations between specific information sources and outright opposition. However, respondents exposed to multiple information sources were significantly less likely to report a neutral stance compared to support (OR [95 % CI]: 0.31 [0.15–0.65]). Those accessing official/academic sources or multiple sources were also less likely to feel less safe (OR [95 % CI]: 0.22 [0.07–0.71] and 0.43 [0.24–0.78]).</div></div><div><h3>Conclusion</h3><div>These findings highlight critical gaps in government communication and the dominance of misrepresentative media framing in shaping public attitudes. Effective drug policy requires not only legislative change but also proactive, coordinated, and sustained public education strategies to counter misinformation, reduce stigma, and build lasting support.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105123"},"PeriodicalIF":4.4,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879319","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}
引用次数: 0
What does 'polysubstance' really mean? Comparing drug-involved deaths in CDC records vs. detailed medical examiner data from Los Angeles “多物质”到底是什么意思?比较疾病预防控制中心记录的与毒品有关的死亡人数与洛杉矶法医的详细数据。
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-12-30 DOI: 10.1016/j.drugpo.2025.105129
Joseph R. Friedman , Ruby Romero , Arthur Funnell , David Goodman-Meza , Chelsea L. Shover

Introduction

Complex polysubstance use is increasing in the United States. However, most epidemiological literature relies on traditional data sources, especially CDC WONDER, which is limited to employing two ICD-10 codes concurrently. We leverage complete medical examiner records from Los Angeles County to examine the limitations of CDC WONDER data for detecting polysubstance drug deaths.

Methods

Drug-involved deaths occurring in Los Angeles County were described using the CDC WONDER system and Los Angeles County Medical Examiner data. Annual single-drug involvement rates were compared between the two data sources. The average number of drugs, and the proportion of polysubstance deaths involving 3 or more substances was summarized by year. UpSet plot visualization was employed for complex set analysis.

Results

Overall concordance in single-substance death counts between CDC WONDER and medical examiner records was high among n = 6 substances assessed. The average number of drugs reported per death had a skewed distribution and increased from 1.72 in 2012 to 2.29 in 2023. The percentage of polysubstance deaths with 3+ drugs increased from 51% in 2012 to 74% in 2023. The number of unique polysubstance combinations with 3+ substances increased from 11 in 2012 to 57 in 2023.

Discussion

Although concordance is high for single-substance involvement rates, CDC WONDER fails to capture the majority of polysubstance deaths adequately, as about three-quarters of these deaths are incompletely described using its 2-drug limit. This limitation has worsened as deaths increasingly involve more drugs on average. We illustrate a huge variety of polysubstance combinations that can be seen in medical examiner deaths. As the overdose crisis grows increasingly polysubstance in nature, improving the epidemiological tracking of deaths involving multiple drugs, and drugs not captured by ICD-10 codes currently, is of paramount importance.
在美国,复合多物质的使用正在增加。然而,大多数流行病学文献依赖于传统的数据来源,特别是CDC WONDER,它仅限于同时使用两个ICD-10代码。我们利用洛杉矶县完整的法医记录来检验CDC WONDER数据在检测多物质药物死亡方面的局限性。方法:使用CDC WONDER系统和洛杉矶县法医数据描述洛杉矶县发生的与药物有关的死亡。比较两种数据来源的年度单一药物受累率。按年汇总药物的平均数量和涉及3种及3种以上药物的多物质死亡比例。复集分析采用颠覆图可视化。结果:在评估的n = 6种物质中,CDC WONDER单物质死亡计数与法医记录之间的总体一致性很高。每例死亡报告的平均药物数量分布不均匀,从2012年的1.72种增加到2023年的2.29种。使用3种以上药物的多物质死亡比例从2012年的51%增加到2023年的74%。具有3种以上物质的独特多物质组合从2012年的11种增加到2023年的57种。讨论:虽然单一药物介入率的一致性很高,但CDC WONDER未能充分捕获大多数多药物死亡,因为大约四分之三的这些死亡使用其2种药物限制不完整地描述。随着平均死亡人数越来越多地涉及更多的药物,这种限制变得更加严重。我们说明了在法医死亡中可以看到的各种各样的多物质组合。由于过量危机的性质越来越多,因此,改善对涉及多种药物以及目前未被《国际疾病分类-10》代码所涵盖的药物的死亡的流行病学追踪至关重要。
{"title":"What does 'polysubstance' really mean? Comparing drug-involved deaths in CDC records vs. detailed medical examiner data from Los Angeles","authors":"Joseph R. Friedman ,&nbsp;Ruby Romero ,&nbsp;Arthur Funnell ,&nbsp;David Goodman-Meza ,&nbsp;Chelsea L. Shover","doi":"10.1016/j.drugpo.2025.105129","DOIUrl":"10.1016/j.drugpo.2025.105129","url":null,"abstract":"<div><h3>Introduction</h3><div>Complex polysubstance use is increasing in the United States. However, most epidemiological literature relies on traditional data sources, especially CDC WONDER, which is limited to employing two ICD-10 codes concurrently. We leverage complete medical examiner records from Los Angeles County to examine the limitations of CDC WONDER data for detecting polysubstance drug deaths.</div></div><div><h3>Methods</h3><div>Drug-involved deaths occurring in Los Angeles County were described using the CDC WONDER system and Los Angeles County Medical Examiner data. Annual single-drug involvement rates were compared between the two data sources. The average number of drugs, and the proportion of polysubstance deaths involving 3 or more substances was summarized by year. UpSet plot visualization was employed for complex set analysis.</div></div><div><h3>Results</h3><div>Overall concordance in single-substance death counts between CDC WONDER and medical examiner records was high among <em>n</em> = 6 substances assessed. The average number of drugs reported per death had a skewed distribution and increased from 1.72 in 2012 to 2.29 in 2023. The percentage of polysubstance deaths with 3+ drugs increased from 51% in 2012 to 74% in 2023. The number of unique polysubstance combinations with 3+ substances increased from 11 in 2012 to 57 in 2023.</div></div><div><h3>Discussion</h3><div>Although concordance is high for single-substance involvement rates, CDC WONDER fails to capture the majority of polysubstance deaths adequately, as about three-quarters of these deaths are incompletely described using its 2-drug limit. This limitation has worsened as deaths increasingly involve more drugs on average. We illustrate a huge variety of polysubstance combinations that can be seen in medical examiner deaths. As the overdose crisis grows increasingly polysubstance in nature, improving the epidemiological tracking of deaths involving multiple drugs, and drugs not captured by ICD-10 codes currently, is of paramount importance.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105129"},"PeriodicalIF":4.4,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865317","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}
引用次数: 0
“A never-ending cycle”: The structural, economic and social (re)production of blood-borne virus transmission and bacterial infection amongst people who inject drugs in Queensland prisons “永无止境的循环”:从结构上、经济上和社会上(再)造成昆士兰州监狱中注射毒品的人血液传播病毒和细菌感染
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-12-27 DOI: 10.1016/j.drugpo.2025.105126
Jodie M.A. Mamic , Emma Kill , Geoff Davey , Steph Reeve , Emily Cooper , Idin Panahi , Geoff Spurling , Graham Brown , Timothy Piatkowski

Introduction

Illicit drug-related harms remain a significant public health issue globally and in Australia, particularly among people who inject drugs (PWIDs) in prison settings where access to harm reduction (HR) is severely limited. This study aimed to explore the experiences of PWIDs incarcerated in Queensland prisons, focusing on how the prison environment shaped their risk of blood-borne viruses (BBVs) and injection-related bacterial infections (IRBIs), and to identify ways current HR interventions could be improved.

Methods

The study recruited 30 PWIDs aged 29–52 who had experienced incarceration in Queensland and overdosed within the past three years. Participants were recruited via social media and lived-experience organisations providing culturally safe support. Semi-structured interviews were audio-recorded, transcribed, and analysed using a critical realism framework and reflexive thematic analysis to identify and develop common themes.

Results

Participants described how structural, economic, and social factors within Queensland prisons foster risky injecting practices and elevate BBV and IRBI risks. Limited access to HR resources, punitive policies, and inadequate healthcare led to reliance on informal economies and unsafe behaviours such as equipment sharing and syringe cutting. Stigma and fear further hindered healthcare access. Participants emphasised the need for expanded HR measures, including needle and syringe programs, delivered within enabling environments that reduce barriers and promote peer support.

Discussion

These findings suggest more consideration regarding policy changes to enhance the accessibility of HR interventions, including needle and syringe programs in Queensland prisons.
在全球和澳大利亚,与非法毒品有关的危害仍然是一个重大的公共卫生问题,特别是在监狱环境中注射吸毒者中,因为在监狱环境中获得减少伤害服务的机会严重有限。本研究旨在探讨被关押在昆士兰州监狱的PWIDs的经历,重点关注监狱环境如何影响他们患血源性病毒(bbv)和注射相关细菌感染(IRBIs)的风险,并确定当前人力资源干预措施的改进方法。方法本研究招募了30名年龄在29-52岁之间的PWIDs,他们在过去三年内经历过昆士兰州的监禁和过量用药。参与者是通过社交媒体和提供文化安全支持的现场体验组织招募的。对半结构化访谈进行录音、转录,并使用批判现实主义框架和反身性主题分析进行分析,以确定和发展共同主题。结果参与者描述了昆士兰监狱内的结构、经济和社会因素如何助长危险的注射行为,并提高BBV和IRBI风险。获得人力资源的机会有限、惩罚性政策和不充分的医疗保健导致对非正规经济的依赖以及设备共享和注射器切割等不安全行为。耻辱感和恐惧进一步阻碍了获得医疗服务。与会者强调需要扩大人力资源措施,包括针头和注射器规划,在减少障碍和促进同伴支持的有利环境中提供。这些研究结果表明,需要更多地考虑政策变化,以提高人力资源干预措施的可及性,包括昆士兰监狱的针头和注射器项目。
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引用次数: 0
Reduced risk of overdose among clients of a safer opioid supply program in Southwestern Ontario: A pre-post observational cohort study 在安大略省西南部的一个更安全的阿片类药物供应项目的客户中减少过量的风险:一项前后观察队列研究
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-12-27 DOI: 10.1016/j.drugpo.2025.105124
Gillian Kolla , Jerri-Lyn Lewis , Adrian Guta , Ashley Schaff , Megan Boyle , Kourteney King , Carol Strike , Mohammad Karamouzian

Introduction

North America faces an ongoing overdose crisis driven by a volatile and toxic drug supply comprised primarily of fentanyl, fentanyl analogues and other adulterants. Safer opioid supply (SOS) programs prescribe pharmaceutical opioids to individuals at high risk of overdose mortality. This study evaluated changes in non-fatal overdose prevalence in the 6 months after SOS program initiation among SOS participants in Kitchener-Waterloo, Canada.

Methods

We analyzed data from a pre-post observational cohort of clients enrolled in a SOS program between July 2021 and October 2023. Baseline surveys were completed upon program entry, with follow-up surveys after 6 months. We compared non-fatal overdose prevalence between baseline and follow-up using McNemar’s test and calculated adjusted odds ratios (aOR) using generalized estimating equation (GEE) models, controlling for potential confounders including homelessness, hospitalization, daily fentanyl use, and incarceration.

Results

Among 100 participants completing follow-up (out of 162 who completed a baseline survey), overdose prevalence decreased significantly from 60 % (95 % Confidence Interval (CI): 50–69) at baseline to 15 % (95 % CI: 9–23) at follow-up (p < 0.001). Overdose incidence rates declined from 48.5 to 3.3 per 100 person-months. After adjusting for confounders, participants had 83 % lower odds of overdose during follow-up (aOR 0.17, 95 % CI: 0.08–0.38).

Discussion

Participants in a SOS program experienced significant reductions in non-fatal overdose during the 6 months following program initiation. SOS clients are a high-risk population with elevated overdose rates at baseline; these results support expanding safer supply programs as part of a comprehensive set of strategies to address the overdose crisis.
北美面临着由主要由芬太尼、芬太尼类似物和其他掺假物组成的挥发性和有毒药物供应所导致的持续过量危机。更安全的阿片类药物供应(SOS)计划向有过量死亡风险的个体开出药物阿片类药物。本研究评估了加拿大基奇纳-滑铁卢地区SOS参与者在SOS项目启动后6个月内非致命性药物过量发生率的变化。方法:我们分析了2021年7月至2023年10月期间参加SOS项目的患者的前后观察队列数据。基线调查在项目开始时完成,6个月后进行随访调查。我们使用McNemar试验比较了基线和随访期间的非致命性药物过量患病率,并使用广义估计方程(GEE)模型计算了调整后的优势比(aOR),控制了潜在的混杂因素,包括无家可归、住院、每日芬太尼使用和监禁。结果在100名完成随访的参与者中(162名完成基线调查的参与者中),药物过量患病率从基线时的60%(95%置信区间(CI): 50-69)显著下降到随访时的15% (95% CI: 9-23) (p < 0.001)。药物过量发生率从每100人月48.5下降到3.3。在调整混杂因素后,参与者在随访期间服用过量的几率降低了83% (aOR 0.17, 95% CI: 0.08-0.38)。SOS项目的参与者在项目启动后的6个月内经历了非致命性药物过量的显著减少。SOS客户是高危人群,基线时用药过量率升高;这些结果支持扩大更安全的供应计划,作为解决过量危机的综合战略的一部分。
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引用次数: 0
Building consensus on drug policy in New Zealand through deliberative workshops 通过审议性讲习班在新西兰就毒品政策达成共识
IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2025-12-26 DOI: 10.1016/j.drugpo.2025.105128
Rose Crossin , Anna Doak , Oliver Winter

Background

New Zealand’s (NZ) drug policy has largely retained a criminal justice focus for over 50 years, despite multiple reviews recommending legislative overhaul, and public support for a health-based approach. Deliberative democracy, including mechanisms such as citizens assemblies, have been identified as a potential mechanism to overcome some of the inertia within drug policy. This project aimed to 1) engage with a group of citizens to try to develop a group consensus on how best to respond to drugs in NZ, and 2) explore how community members’ diverse views were affected by deliberation, and their experiences of a deliberative workshop process.

Methods

Seven deliberative workshops were held with a group of ten retirees living in Christchurch NZ. Participants were asked to engage in group discussions that may (or may not) lead to a group consensus. Workshops included discussions with expert guest speakers, reading and discussion of journal articles and reports. The final session was a debrief, the purpose of which was to understand what influenced participants’ views, and the experience of the deliberative workshop process.

Results

The group produced a consensus statement and set of recommendations for politicians and policymakers, which emphasised a health-based approach to drugs. The value of dialogue, mutual learning, and deliberation to achieve change arose from analysis of the debrief.

Conclusions

This study highlights the potential value of deliberative democracy and demonstrates that a group of ‘lay’ citizens can reach nuanced, thoughtful, and practical solutions for drug policy.
背景50多年来,尽管多次审查建议进行立法改革,公众支持以健康为基础的做法,但新西兰的毒品政策在很大程度上仍以刑事司法为重点。协商民主,包括公民集会等机制,已被确定为克服毒品政策内某些惰性的潜在机制。该项目旨在1)与一群公民接触,试图就如何最好地应对新西兰的毒品问题达成群体共识;2)探索社区成员的不同观点如何受到审议的影响,以及他们在审议研讨会过程中的经历。方法对居住在新西兰基督城的10名退休人员进行了7次研讨。参与者被要求参与小组讨论,小组讨论可能(也可能不会)导致小组共识。讲习班包括与专家嘉宾进行讨论,阅读和讨论期刊文章和报告。最后一届会议是一次汇报,其目的是了解影响与会者意见的因素,以及审议讲习班进程的经验。该小组为政治家和决策者提出了一份共识声明和一套建议,强调以健康为基础的药物处理方法。对话、相互学习和深思熟虑以实现变革的价值来自对汇报的分析。这项研究突出了协商民主的潜在价值,并表明一群“外行”公民可以就毒品政策达成细致入微、深思熟虑和实用的解决方案。
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期刊
International Journal of Drug Policy
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