Pub Date : 2026-01-01DOI: 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
{"title":"Les ‘Lignes Directrices Pour l'Usage du Cannabis à Moindre Risque (LUCMR)’: RECOMMENDATIONS [The ‘Lower-Risk Cannabis Use Guidelines (LRCUG)’: RECOMMENDATIONS (FRENCH)]","authors":"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","doi":"10.1016/j.drugpo.2023.103994","DOIUrl":"10.1016/j.drugpo.2023.103994","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 103994"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9294316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 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.
{"title":"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","authors":"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","doi":"10.1016/j.drugpo.2025.105071","DOIUrl":"10.1016/j.drugpo.2025.105071","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Discussion and Conclusions</h3><div>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.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"147 ","pages":"Article 105071"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 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.
{"title":"Hepatitis C treatment in a jail setting: A retrospective cohort analysis of low-barrier initiation of direct acting antivirals","authors":"Justin Berk, Matthew J Akiyama, Nicole Schachman, Reed Junkin, Aprotim Bhowmik, Deborah Davis, Saengnapha Williams, Josiah Rich, Matthew Murphy","doi":"10.1016/j.drugpo.2025.105125","DOIUrl":"10.1016/j.drugpo.2025.105125","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105125"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 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.
{"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 , Shannon Chellew Paternostro , Sameer Imtiaz , Cayley Russell , Mark Asbridge , Louisa Degenhardt , Elaine Hyshka , Kurt Lock , M. Eugenia Socias , Dan Werb , 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}
Pub Date : 2025-12-30DOI: 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.
{"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 , Ruby Romero , Arthur Funnell , David Goodman-Meza , 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}
Pub Date : 2025-12-27DOI: 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.
{"title":"“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","authors":"Jodie M.A. Mamic , Emma Kill , Geoff Davey , Steph Reeve , Emily Cooper , Idin Panahi , Geoff Spurling , Graham Brown , Timothy Piatkowski","doi":"10.1016/j.drugpo.2025.105126","DOIUrl":"10.1016/j.drugpo.2025.105126","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Discussion</h3><div>These findings suggest more consideration regarding policy changes to enhance the accessibility of HR interventions, including needle and syringe programs in Queensland prisons.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105126"},"PeriodicalIF":4.4,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-27DOI: 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.
{"title":"Reduced risk of overdose among clients of a safer opioid supply program in Southwestern Ontario: A pre-post observational cohort study","authors":"Gillian Kolla , Jerri-Lyn Lewis , Adrian Guta , Ashley Schaff , Megan Boyle , Kourteney King , Carol Strike , Mohammad Karamouzian","doi":"10.1016/j.drugpo.2025.105124","DOIUrl":"10.1016/j.drugpo.2025.105124","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> < 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).</div></div><div><h3>Discussion</h3><div>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.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105124"},"PeriodicalIF":4.4,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-26DOI: 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.
{"title":"Building consensus on drug policy in New Zealand through deliberative workshops","authors":"Rose Crossin , Anna Doak , Oliver Winter","doi":"10.1016/j.drugpo.2025.105128","DOIUrl":"10.1016/j.drugpo.2025.105128","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105128"},"PeriodicalIF":4.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-24DOI: 10.1016/j.drugpo.2025.105122
Esben Houborg, Julie Elisabeth Brummer, Tobias Kammersgaard, Michael Mulbjerg Pedersen
Background
This study investigated the implementation of Denmark's partial decriminalization of possession of illicit drugs for personal use with its criteria of socioeconomically disadvantaged individuals dependent on drugs other than cannabis. The focus was on assessing trends in the frequency and proportion of cases settled with warnings as an alternative to criminal sanctions before and after legislative changes in 2004.
Methods
We graphed the frequency and proportion of warning decisions issued over time (2003–2020) for drug possession among cases classified as eligible or ineligible, with eligibility defined as the offender being both socioeconomically disadvantaged and dependent on drugs other than cannabis. Mixed effects logistic regression was used to examine the interaction between eligibility status and date of offense on the odds of receiving a warning instead of a fine and to examine additional offender- and case-related factors associated with receiving a warning among eligible cases after the 2004 legislative changes. Changepoint time series analyses were also carried out to identify important changes in sentencing trends over time. Data sources included the National Police of Denmark's case management system and national health, crime, population, and labor registers.
Results
The findings indicated that the proportion of eligible cases receiving warnings remained low throughout the study period, with fewer than 16 % of eligible cases settled with a warning, rather than a fine, in any given year. Interaction analysis showed that the policy resulted in relatively more lenient decisions for eligible cases compared with ineligible cases, although the overall use of warnings declined. Additionally, both offender-related factors (e.g., sex) and case-related factors (e.g., police district, type of drug) were associated with the odds of receiving a warning among eligible cases.
Conclusion
The study highlights persistent challenges in implementing the decriminalization policy, indicating the need for legislative clarity, consistent enforcement practices, and targeted education for law enforcement. Future research should monitor the impact of recent legislative amendments and explore strategies to address systemic barriers in drug policy reform.
{"title":"Between decriminalization policy and police practice: Implementation of warnings for marginalized people dependent on drugs in Denmark","authors":"Esben Houborg, Julie Elisabeth Brummer, Tobias Kammersgaard, Michael Mulbjerg Pedersen","doi":"10.1016/j.drugpo.2025.105122","DOIUrl":"10.1016/j.drugpo.2025.105122","url":null,"abstract":"<div><h3>Background</h3><div>This study investigated the implementation of Denmark's partial decriminalization of possession of illicit drugs for personal use with its criteria of socioeconomically disadvantaged individuals dependent on drugs other than cannabis. The focus was on assessing trends in the frequency and proportion of cases settled with warnings as an alternative to criminal sanctions before and after legislative changes in 2004.</div></div><div><h3>Methods</h3><div>We graphed the frequency and proportion of warning decisions issued over time (2003–2020) for drug possession among cases classified as eligible or ineligible, with eligibility defined as the offender being both socioeconomically disadvantaged and dependent on drugs other than cannabis. Mixed effects logistic regression was used to examine the interaction between eligibility status and date of offense on the odds of receiving a warning instead of a fine and to examine additional offender- and case-related factors associated with receiving a warning among eligible cases after the 2004 legislative changes. Changepoint time series analyses were also carried out to identify important changes in sentencing trends over time. Data sources included the National Police of Denmark's case management system and national health, crime, population, and labor registers.</div></div><div><h3>Results</h3><div>The findings indicated that the proportion of eligible cases receiving warnings remained low throughout the study period, with fewer than 16 % of eligible cases settled with a warning, rather than a fine, in any given year. Interaction analysis showed that the policy resulted in relatively more lenient decisions for eligible cases compared with ineligible cases, although the overall use of warnings declined. Additionally, both offender-related factors (e.g., sex) and case-related factors (e.g., police district, type of drug) were associated with the odds of receiving a warning among eligible cases.</div></div><div><h3>Conclusion</h3><div>The study highlights persistent challenges in implementing the decriminalization policy, indicating the need for legislative clarity, consistent enforcement practices, and targeted education for law enforcement. Future research should monitor the impact of recent legislative amendments and explore strategies to address systemic barriers in drug policy reform.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105122"},"PeriodicalIF":4.4,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.drugpo.2025.105121
Mira Lehberger, Anne-Katrin Kleih, Kai Sparke
In 2024, Germany became the most populous European country to legalize home cannabis cultivation. This study provides the first empirical evidence on both public support for and engagement in home cultivation in this new regulatory context. Using survey data from a representative online-panel (n = 1500), we conducted hierarchical regression analyses to examine the factors associated with attitudinal outcomes (support for legalization) and behavioral outcomes (self-reported cultivation in the past or present). Results show that sociodemographic associations with support and cultivation are largely explained by cannabis experience. Among these factors, age and consumption emerged as the most consistent correlates across models. Expectations regarding the consequences of legalization were strongly associated with support but showed little relation to actual cultivation behavior. People who have cultivated expressed substantially higher support and more favorable expectations than those who have not, although participants overall tended to evaluate legalization positively. The only consistently negative expectation shared across groups was that legalization may increase cannabis use in society. Overall, support for legalization appears to be influenced by a broad set of expectations about societal consequences, whereas cultivation behavior is more closely tied to individual experience and personal motivations. While the study is situated in the German context, its insights are relevant beyond national borders: as the largest EU member state to legalize home cultivation, Germany’s experience may provide valuable lessons for other jurisdictions considering similar reforms.
{"title":"Public attitudes and lifetime home cannabis cultivation – a survey after legalization in Germany","authors":"Mira Lehberger, Anne-Katrin Kleih, Kai Sparke","doi":"10.1016/j.drugpo.2025.105121","DOIUrl":"10.1016/j.drugpo.2025.105121","url":null,"abstract":"<div><div>In 2024, Germany became the most populous European country to legalize home cannabis cultivation. This study provides the first empirical evidence on both public support for and engagement in home cultivation in this new regulatory context. Using survey data from a representative online-panel (<em>n</em> = 1500), we conducted hierarchical regression analyses to examine the factors associated with attitudinal outcomes (support for legalization) and behavioral outcomes (self-reported cultivation in the past or present). Results show that sociodemographic associations with support and cultivation are largely explained by cannabis experience. Among these factors, age and consumption emerged as the most consistent correlates across models. Expectations regarding the consequences of legalization were strongly associated with support but showed little relation to actual cultivation behavior. People who have cultivated expressed substantially higher support and more favorable expectations than those who have not, although participants overall tended to evaluate legalization positively. The only consistently negative expectation shared across groups was that legalization may increase cannabis use in society. Overall, support for legalization appears to be influenced by a broad set of expectations about societal consequences, whereas cultivation behavior is more closely tied to individual experience and personal motivations. While the study is situated in the German context, its insights are relevant beyond national borders: as the largest EU member state to legalize home cultivation, Germany’s experience may provide valuable lessons for other jurisdictions considering similar reforms.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105121"},"PeriodicalIF":4.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828905","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}
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