International Journal of Drug Policy最新文献_第6页

Heavy burden of non-fatal overdose among people who inject drugs in San Francisco, 2022 2022 年旧金山注射吸毒者非致命用药过量的沉重负担。

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.2024.104602

Bow Suprasert , Moranda Tate , Willi McFarland , Erin C. Wilson

Background

Drug overdose deaths increased by 50 % between 2017 and 2021 in San Francisco. Little is known about non-fatal overdose, which heralds future risk for morbidity and overdose death. We assessed non-fatal overdose, access to drug treatment, and overdose prevention service utilization among people who inject drugs (PWID) in San Francisco in 2022.

Methods

Data were from the National HIV Behavioral Surveillance (NHBS), a cross-sectional survey among PWID recruited by respondent-driven sampling from June-December 2022. Participants self-reported their experience of overall overdose. Logistic regression analysis identified factors associated with non-fatal overdose.

Results

Of 521 PWID, 120 (23.0 %) experienced non-fatal overdose; 207 (39.7 %) frequently injected methamphetamine and 175 (33.6 %) frequently injected heroin in the past 12 months. PWID who experienced non-fatal overdose were more likely to reside in the low-income neighborhoods (25.9 % vs. other neighborhoods 16.8 %, p = 0.022) in the past 12 months. Less than half (43.7 %) of PWID who experienced non-fatal overdose received overdose treatment. Compared to those who did not try to access treatment, adjusted odds of non-fatal overdose was 1.89 times higher among PWID who attempted to access drug treatment but were unable to (p = 0.035, 95 % CI 1.05–3.43); and 1.86 times higher among PWID who attempted to obtain medications to treat drug use but were unable to in the past 12 months (p = 0.049, 95 % CI: 1.00–3.43).

Conclusions

Non-fatal overdose was highly prevalent among PWID, including those who frequently inject stimulants. Public health surveillance will need to be vigilant in monitoring stimulant use and tracking fentanyl contamination in non-opioid drugs. PWID who were most engaged in harm reduction practices were also the most likely to experience non-fatal overdose. Expansion of substance use and overdose treatment, naloxone, fentanyl test strips, and safe drug use education are needed to reduce risk of overdose deaths among PWID.

背景：2017 年至 2021 年间，旧金山吸毒过量死亡人数增加了 50%。人们对非致命性用药过量知之甚少，而这预示着未来发病和用药过量死亡的风险。我们评估了 2022 年旧金山注射吸毒者（PWID）中的非致命性用药过量、获得药物治疗的机会以及用药过量预防服务的利用情况：数据来自全国艾滋病行为监测（NHBS），这是一项横断面调查，调查对象为 2022 年 6 月至 12 月期间通过受访者驱动抽样招募的注射吸毒者。参与者自我报告了他们总体用药过量的经历。逻辑回归分析确定了与非致命用药过量相关的因素：在 521 名吸毒者中，120 人（23.0%）有过非致命性用药过量的经历；207 人（39.7%）在过去 12 个月中经常注射甲基苯丙胺，175 人（33.6%）经常注射海洛因。在过去 12 个月中，非致命性吸毒过量的吸毒者更有可能居住在低收入社区（25.9% 对其他社区的 16.8%，p = 0.022）。不到一半（43.7%）有过吸毒过量经历的吸毒者接受过吸毒过量治疗。与那些没有尝试接受治疗的人相比，在过去12个月中尝试接受药物治疗但未能如愿的吸毒者中，非致命性用药过量的调整后几率要高出1.89倍（p = 0.035，95 % CI 1.05-3.43）；在过去12个月中尝试获得药物治疗但未能如愿的吸毒者中，非致命性用药过量的调整后几率要高出1.86倍（p = 0.049，95 % CI：1.00-3.43）：非致命性用药过量在吸毒者中非常普遍，包括那些经常注射兴奋剂的人。公共卫生监督部门在监测兴奋剂使用情况和跟踪非阿片类药物中的芬太尼污染情况时需要保持警惕。参与减低伤害实践最多的吸毒者也最有可能出现非致命性用药过量。需要扩大药物使用和用药过量治疗、纳洛酮、芬太尼试纸和安全用药教育，以降低吸毒者用药过量死亡的风险。

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引用次数: 0

Prevalence and correlates of e-cigarette source and use of e-cigarettes with nicotine: A case study of Mexico, where e-cigarettes are banned 电子烟来源和含尼古丁电子烟使用的普遍性和相关性：对禁止使用电子烟的墨西哥的案例研究。

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.2024.104609

Dèsirée Vidaña-Pérez , Katia Gallegos-Carrillo , Inti Barrientos-Gutierrez , Lizeth Cruz-Jiménez , Rosibel Rodríguez-Bolaños , Edna Arillo-Santillán , James F. Thrasher

Background

Low- and middle-income countries have increasingly banned e-cigarettes, as in Mexico. In these countries, little is known about where adults obtain e-cigarettes or who uses e-cigarettes with nicotine.

Methods

Data were analyzed from eight online surveys of Mexican adults who both smoked and used e-cigarettes (November 2018-March 2021; n = 2,060). For the e-cigarette they used most often, participants reported how they acquired it (social sources=reference; online purchase; vape shop purchase; other retail purchase) and if it contained nicotine (no=reference group; yes; don't know). Multinomial models regressed each of these outcomes on smoking- and e-cigarette-related factors, as well as sociodemographics.

Results

Almost half the sample (45.9 %) reported obtaining their e-cigarettes from social sources, with online purchase being the second most common source (28.7 %). Being male, having recently attempted to quit smoking, and more frequent e-cigarette use were positively associated with purchasing e-cigarettes (vs social sources) across all venues. Most reported that their e-cigarettes contained nicotine (58.2 %), a third reported using e-cigarettes without nicotine (35.9 %), and some did not know (5.8 %). More frequent smoking and e-cigarette use, using closed e-cigarette devices and purchasing e-cigarettes online were positively associated with using e-cigarettes with nicotine.

Conclusions

Despite Mexico's e-cigarette ban, adults who smoke access e-cigarettes through multiple sources, including online and vape shop purchases. Most participants reported using e-cigarettes with nicotine, though many did not or did not know.

背景：中低收入国家越来越多地禁止使用电子烟，墨西哥就是一个例子。在这些国家，人们对成年人从哪里获得电子烟或谁使用含尼古丁的电子烟知之甚少：分析了对吸烟和使用电子烟的墨西哥成年人进行的八次在线调查（2018 年 11 月至 2021 年 3 月；n = 2,060 人）的数据。对于他们最常使用的电子烟，参与者报告了他们获得电子烟的方式（社会来源=参考；网上购买；Vape商店购买；其他零售购买）以及是否含有尼古丁（否=参考组；是；不知道）。多项式模型将这些结果分别与吸烟和电子烟相关因素以及社会人口统计学因素进行回归：近一半的样本（45.9%）称他们从社会渠道获得电子烟，网购是第二大最常见的渠道（28.7%）。男性、最近尝试过戒烟以及更频繁地使用电子烟与在所有场所购买电子烟（与社交渠道相比）呈正相关。大多数人称他们的电子烟含有尼古丁（58.2%），三分之一的人称他们使用的电子烟不含有尼古丁（35.9%），还有一些人不知道（5.8%）。更频繁地吸烟和使用电子烟、使用封闭式电子烟设备和网购电子烟与使用含尼古丁的电子烟呈正相关：尽管墨西哥禁止使用电子烟，但吸烟的成年人仍可通过多种渠道获得电子烟，包括网购和在电子烟商店购买。大多数参与者表示使用过含尼古丁的电子烟，但很多人没有使用过或不知道。

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引用次数: 0

Use of fentanyl test strips by people who inject drugs: Baseline findings from the South Atlantic Fentanyl Test Strip Study (SAFTSS) 注射毒品者使用芬太尼试纸的情况：南大西洋芬太尼试纸研究（SAFTSS）的基线发现。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-04 DOI: 10.1016/j.drugpo.2024.104588

Jon E Zibbell , Arnie Aldridge , Nicholas Peiper , Sarah E. Duhart Clarke , Abigail Rinderle , Judith Feinberg

Background

Research published during the early fentanyl period exposed a growing concern of unwitting fentanyl exposure and a general willingness to use fentanyl test strips (FTS). A paucity of FTS studies over the last several years has restricted our ability to understand FTS use in the late fentanyl era. The South Atlantic FTS Study (SAFTSS) was established to investigate contemporaneous changes in FTS use and drug use behavior among a rural cohort of PWID.

Methods

Between June 2021 and March 2022, a total of 541 PWID completed an in-person survey. Baseline survey questions included demographics, socioeconomic characteristics, and drugs used. FTS questions covered lifetime use, past 6-months, and past 30-day use and included reasons for using FTS, levels of access, and confidence testing illicit opioids and stimulants. Multivariable analyses examined significant baseline correlates of lifetime and 30-day FTS use.

Results

Overall, more than half (58%; N=315) used FTS in their lifetime. Among lifetime FTS users, almost half (47%) used FTS in the past 6 months and 30% in the past 30 days, with an average of 13 months from last FTS use and the baseline survey. The most common reason for not using FTS was “not having them with me when I use drugs.” Less frequent reasons were “I already know it's fentanyl” followed by “FTS take too much time to use.” Among past 30-day FTS users, 74% used FTS on heroin, 55% on methamphetamine, and 33% on fentanyl. Consumer confidence using FTS was higher with illicit opioids (66%) but lower for methamphetamine (43%). In both the lifetime and past 30-day models, PWID with FTS use were more likely than non-users to have witnessed an overdose in the past six months (lifetime aOR = 2.85, p<.001; 30-day aOR=2.57, p<.01). Virtually no differences in drug use behaviors were found when comparing past 30-days FTS use to no FTS use. Women (aOR=1.68, p<.05) and non-white PWID (aOR=2.43, p<.05) were more likely than men and white PWID to have used FTS.

Conclusions

Declines in FTS use are consistent with what syringe services programs have been signaling for years. Needs assessments to gauge interest in FTS before scaling up can help ensure funding better spent on naloxone and syringes is not allocated to idle FTS. Increased FTS among women and racial minorities presents opportunities for tailored interventions. Recognizing trauma associated with witnessing overdoses as a growing component of the opioid epidemic is a critical first step toward addressing the full spectrum of drug-related harm.

背景：芬太尼早期发表的研究表明，人们越来越担心会在不知情的情况下接触到芬太尼，并普遍愿意使用芬太尼试纸（FTS）。在过去几年中，对 FTS 的研究很少，这限制了我们了解芬太尼晚期 FTS 使用情况的能力。南大西洋 FTS 研究（South Atlantic FTS Study，SAFTSS）旨在调查 FTS 使用和吸毒行为在农村感染者队列中的同期变化：方法：2021 年 6 月至 2022 年 3 月期间，共有 541 名吸毒者完成了一次面对面调查。基线调查问题包括人口统计学、社会经济特征和所使用的毒品。快速吸食毒品问题包括终生吸食、过去6个月吸食和过去30天吸食，还包括吸食快速吸食毒品的原因、获得毒品的程度以及测试非法阿片类药物和兴奋剂的信心。多变量分析研究了终生和 30 天使用 FTS 的重要基线相关因素：总体而言，半数以上（58%；N=315）的人在一生中使用过 FTS。在终生 FTS 使用者中，近一半（47%）在过去 6 个月内使用过 FTS，30%在过去 30 天内使用过 FTS，距离最后一次使用 FTS 和基线调查平均有 13 个月的时间。不使用 FTS 的最常见原因是 "吸毒时没有带着它们"。较少出现的原因是 "我已经知道是芬太尼"，其次是 "使用 FTS 需要太多时间"。在过去 30 天的 FTS 使用者中，74% 对海洛因使用了 FTS，55% 对甲基苯丙胺使用了 FTS，33% 对芬太尼使用了 FTS。使用 FTS 的消费者对非法阿片类药物的信心较高（66%），但对甲基苯丙胺的信心较低（43%）。在终生模型和过去 30 天模型中，使用 FTS 的吸毒者比不使用 FTS 的吸毒者更有可能在过去 6 个月中目睹过用药过量（终生 aOR = 2.85，p 结论：固定注射器使用率的下降与注射器服务计划多年来发出的信号是一致的。在扩大规模之前进行需求评估，以了解人们对免费注射吸毒服务的兴趣，这有助于确保本应用于纳洛酮和注射器的资金不会被分配用于闲置的免费注射吸毒服务。妇女和少数种族群体中更多的自愿戒毒服务为有针对性的干预措施提供了机会。认识到与目睹吸毒过量相关的心理创伤是阿片类药物流行的一个日益重要的组成部分，是朝着全面解决与毒品相关的伤害迈出的关键性的第一步。

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引用次数: 0

Safer supply and political interference in medical practice: Alberta's Narcotics Transition Services 更安全的供应和对医疗实践的政治干预：艾伯塔省麻醉品过渡服务。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-10-02 DOI: 10.1016/j.drugpo.2024.104600

Patty Wilson , Kate Colizza , Elaine Hyshka

Across much of Canada, opioid poisoning deaths have been increasing due to a toxic, contaminated, and unpredictable drug supply. Multiple prescribed safer supply pilot projects are being implemented and evaluated in an attempt to save lives. In the province of Alberta, however, new regulations introduced in 2022 significantly constrain safer supply prescribing by banning the prescription, dispensing, and administration of safer supply outside of a very limited number of clinics. In this commentary, we review prescribed safer supply programs in Canada and outline how the Alberta Government's change in regulations conflict with emerging evidence and efforts by other jurisdictions to address the rising opioid poisoning deaths. We examine the development of these regulations and analyze how the Alberta government shaped and justified this restrictive policy. We conclude by identifying important lessons learned from the experience in Alberta for researchers, healthcare providers, and decisionmakers in other jurisdictions.

在加拿大大部分地区，由于有毒、受污染和不可预测的药物供应，阿片类药物中毒死亡人数不断增加。为了挽救生命，多个处方药安全供应试点项目正在实施和评估中。然而，在艾伯塔省，2022 年出台的新法规极大地限制了安全用药的开具，禁止在数量非常有限的诊所之外开具、配发和使用安全用药。在这篇评论中，我们回顾了加拿大的处方安全供应计划，并概述了艾伯塔省政府对法规的修改如何与新出现的证据以及其他辖区为解决阿片类药物中毒死亡人数不断上升而做出的努力相冲突。我们研究了这些法规的制定过程，分析了艾伯塔省政府是如何制定这一限制性政策并为其辩护的。最后，我们为其他辖区的研究人员、医疗服务提供者和决策者指出了从艾伯塔省的经验中吸取的重要教训。

引用次数: 0

Utilising integrated bio-behavioural surveillance (IBBS) to investigate declining hepatitis C antibody prevalence among people who inject drugs in the Australian Needle and Syringe Program Survey. 利用综合生物行为监测 (IBBS) 调查澳大利亚针头和针筒计划调查中注射吸毒者丙型肝炎抗体流行率的下降情况。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-30 DOI: 10.1016/j.drugpo.2024.104576

Lisa Maher, Handan Wand, Sue Heard, Mitchell Starr, Farzaneh Zolala, Robert Kemp, Phillip Cunningham, Heidi Drummer, Margaret Hellard, John Kaldor, Gregory Dore

Background: Prevalence of hepatitis C virus (HCV) antibody (Ab) on dried blood spot (DBS) samples in the Australian Needle and Syringe Program Survey (ANSPS) decreased nationally from 57 % in 2015 to 32 % in 2022. We aimed to investigate potential explanations for this decline.

Methods: Changes in DBS HCV Ab prevalence were investigated by redefining positive cases as those with those with either a positive HCV Ab test result or a self-reported history of ever having HCV treatment (modified prevalence), examining HCV Ab prevalence by birth and age cohorts, and assessing trends in key risk behaviours.

Results: Overall prevalence of DBS HCV Ab declined rapidly and significantly from 57 % in 2015 to 32 % in 2022 (p < 0.001) however modified HCV Ab prevalence remained stable over time (85 % and 88 % in 2015 and 2022, respectively, p = 0.357). The proportion of participants with negative HCV Ab and self-reported HCV infection increased from 20 % in 1995 to 40 % in 2022 (p < 0.001) and the proportion with negative HCV Ab and lifetime HCV treatment increased from 3 % in 1999 to 67 % in 2022 (p < 0.001). We also observed a decreasing trend in DBS HCV Ab prevalence in all birth and age cohorts with a noticeable acceleration in the decline commensurate with the advent of HCV DAA treatment. A long-term decreasing trend was also observed for key risk behaviours (p < 0.001) however the short-term trend was not significant for recent receptive syringe sharing.

Conclusion: The temporal decline in HCV Ab prevalence appears related to reduced sensitivity of DBS HCV Ab detection with viral clearance following treatment. Since 2016, HCV treatment uptake has increased markedly including among people who inject drugs. In this context, continuing to monitor HCV Ab prevalence by DBS testing is problematic, with a shift to surveillance of active infection the most relevant to guide policy and practice in this setting.

背景：在澳大利亚针头和注射器计划调查（ANSPS）中，全国丙型肝炎病毒（HCV）抗体（Ab）在干血斑（DBS）样本中的流行率从2015年的57%下降到2022年的32%。我们旨在研究这一下降的潜在原因：通过将阳性病例重新定义为HCV Ab检测结果呈阳性或自述曾接受过HCV治疗（修正流行率）的病例，按出生组群和年龄组群检查HCV Ab流行率，并评估主要风险行为的趋势，从而调查了DBS HCV Ab流行率的变化：DBS HCV Ab 的总体流行率从 2015 年的 57% 迅速显著下降到 2022 年的 32%（p < 0.001），但修改后的 HCV Ab 流行率在一段时间内保持稳定（2015 年和 2022 年分别为 85% 和 88%，p = 0.357）。丙型肝炎病毒抗体阴性且自我报告感染丙型肝炎病毒的参与者比例从 1995 年的 20% 增加到 2022 年的 40%（p < 0.001），丙型肝炎病毒抗体阴性且终生接受丙型肝炎病毒治疗的参与者比例从 1999 年的 3% 增加到 2022 年的 67%（p < 0.001）。我们还观察到，在所有出生组群和年龄组群中，DBS HCV Ab 感染率呈下降趋势，随着 HCV DAA 治疗的出现，下降速度明显加快。我们还观察到主要风险行为呈长期下降趋势（p < 0.001），但近期共用注射器的短期趋势并不显著：HCV抗体流行率在时间上的下降似乎与DBS检测HCV抗体的灵敏度随着治疗后病毒清除而降低有关。自 2016 年以来，包括注射吸毒者在内的 HCV 治疗接受率显著上升。在这种情况下，继续通过 DBS 检测来监测 HCV Ab 感染率是有问题的，转而监测活动性感染对指导这种情况下的政策和实践最有意义。

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引用次数: 0

Beyond the 5-year recovery mark: Perspectives of researchers with lived and living experience on public engagement and discourse 超越 5 年康复大关：有生活和生命经验的研究人员对公众参与和讨论的看法

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-27 DOI: 10.1016/j.drugpo.2024.104599

Camille C. Cioffi , Ryan E. Flinn , Emily Pasman , Kim Gannon , Dudi Gold , Sean Esteban McCabe , Wayne Kepner , Martha Tillson , Jason B. Colditz , Douglas C. Smith , Robert M. Bohler , Joseph E. O'Donnell , Christi Hildebran , Barrett Wallace Montgomery , Sarah Clingan , Ryan J. Lofaro

There has been growing attention toward including people with lived and living experience (PWLLE) with substance use, substance use disorders, and recovery in public-facing activities. The goals of including PWLLE in sharing their perspectives often include demonstrating that recovery is possible, destigmatizing and humanizing people who have substance use experiences, and leveraging their lived experience to illuminate a particular topic or issue. Recently, the National Council for Mental Wellbeing issued a set of guidelines entitled, “Protecting Individuals with Lived Experience in Public Disclosure,” which included a “Lived Experience Safeguard Scale.” We offer the present commentary to bolster some of the ideas presented by the Council and to articulate suggested changes to this guidance, with the goal of reducing unintentional gatekeeping and stigma. Specifically, we offer that there are numerous problems with the recommendation to only invite people who have “five or more years of sustained recovery” to contribute to public discourse. The idea of perceived stability after five years of abstinence is not new to us or the field. We suggest that this idea excludes people who have experienced the present rapidly changing substance use landscape, people who have briefly returned to use, some young people, and people with living experience who also can valuably contribute to public discourse. We offer alternative guidelines to the National Council for Mental Wellbeing and others seeking to promote practices that are inclusive to the diversity of PWLLE.

人们越来越关注在面向公众的活动中纳入有药物使用、药物使用失调和康复方面生活经验的人士（PWLLE）。让有生活经验者参与分享他们的观点的目的通常包括：证明康复是可能的、消除有药物使用经历者的污名化和人性化，以及利用他们的生活经验来阐明特定的话题或问题。最近，全国精神健康委员会发布了一套题为 "在公开披露中保护有亲身经历的个人 "的准则，其中包括一个 "亲身经历保障量表"。我们提供本评论，以支持委员会提出的一些观点，并阐明对该指南的修改建议，目的是减少无意的把关和污名化。具体而言，我们认为只邀请 "持续康复五年或五年以上 "的人参与公共讨论的建议存在许多问题。对于我们或该领域来说，五年戒毒后的稳定性并不是一个新概念。我们认为，这一观点排除了那些经历过当前药物使用情况迅速变化的人们、那些曾短暂恢复使用药物的人、一些年轻人以及那些有生活经验的人，他们也可以为公共讨论做出有价值的贡献。我们向国家心理健康委员会和其他寻求促进包容残疾人、生活者和学习者多样性的做法的机构提供了替代指南。

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引用次数: 0

Making kin with more-than-human rights: Expert perspectives on human rights and drug policy 与超越人权的权利结亲：关于人权和毒品政策的专家观点

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-20 DOI: 10.1016/j.drugpo.2024.104597

Kate Seear, Sean Mulcahy

Globally, calls for drug law reform are growing. Importantly, many argue that reforms should be guided by human rights. These calls, while welcome, assume a shared understanding of and approach to human rights, and that human rights can effectively guide less punitive approaches to drugs. Such assumptions fail to recognise important critiques, including that human rights have not always protected the interests of those who fail to fit normative ideals of the ‘human’. Are human rights the best framework to repair drug policy injustices? This paper explores these issues, drawing on in-depth interviews conducted with 30 human rights experts – about half of whom openly identify as people who use drugs – from around the world. We find a variety of approaches to human rights, with both optimism and pessimism about their utility for drug policy. These perspectives incorporate reflections on the different ‘levels’ at which rights operate, the limitations of rights and the need to think and do rights relationally, or in more-than-human ways (e.g. Braidotti 2019; Schippers, 2019; Grear 2018; Barad 2007, 2003). This emphasis on relationality stems from identified entanglements between drug policy, animals, habitats, the environment, and humans. Combining Donna Haraway's work on ‘companion species’ (2003), ‘making kin and making kind’ (2016), with Suzanne Fraser's (Early online) call to trouble drugs, we consider ways to trouble human rights by making kin through them. We argue that rights are a potentially generative space within which to explore relationality and new kinds of kin-making. We argue for a ‘more-than-human rights’ approach, following the work of legal scholars such as Marie-Catherine Petersmann (Early online, 2022, 2021) and Emily Jones (2021). We argue that this approach allows us to be and become ‘response-able’ (that is, able to respond, following Haraway) to the world in which we live and the challenges our world faces.

在全球范围内，要求进行毒品法律改革的呼声日益高涨。重要的是，许多人认为改革应以人权为指导。这些呼吁虽然值得欢迎，但却假定人们对人权有共同的理解和方法，并假定人权可以有效地指导对毒品采取惩罚性较弱的方法。这些假设没有认识到一些重要的批评意见，包括人权并不总是能保护那些不符合 "人 "的规范性理想的人的利益。人权是修复毒品政策不公正的最佳框架吗？本文通过对世界各地 30 位人权专家的深入访谈，对这些问题进行了探讨，这些专家中约有一半公开表示自己是吸毒者。我们发现，对于人权有多种不同的看法，对其在毒品政策中的作用既有乐观的，也有悲观的。这些观点包含了对权利运作的不同 "层面"、权利的局限性以及以关系或超越人类的方式思考和处理权利的必要性的思考（例如，Braidotti，2019 年；Schippers，2019 年；Grear，2018 年；Barad，2007 年，2003 年）。对关系性的强调源于毒品政策、动物、栖息地、环境和人类之间已确定的纠葛。结合唐娜-哈拉维（Donna Haraway）关于 "伴生物种"（2003 年）、"制造亲属和制造同类"（2016 年）的研究，以及苏珊娜-弗雷泽（Suzanne Fraser）（早期在线）关于解决毒品问题的呼吁，我们考虑通过制造亲属来解决人权问题的方法。我们认为，权利是一个潜在的生成空间，可以在其中探索关系性和新型的亲属关系。我们主张采用 "超越人权 "的方法，追随玛丽-凯瑟琳-彼得斯曼（Marie-Catherine Petersmann，2022 年早期在线，2021 年）和艾米莉-琼斯（Emily Jones，2021 年）等法律学者的研究成果。我们认为，这种方法使我们能够对我们生活的世界和我们的世界所面临的挑战做出 "回应"（即能够做出回应，效仿哈拉维）。

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引用次数: 0

Psychoanalysis and psychedelics: The censored story in Argentina 精神分析与迷幻药：阿根廷的审查故事

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-20 DOI: 10.1016/j.drugpo.2024.104596

Rodolfo Olivieri , Luís Fernando Tófoli

This essay examines the combination of psychoanalytic therapy and psychedelic substances in mid-20th century Argentina. Through document analysis, it examines the intersection of psychedelics and psychoanalysis, drawing from historical texts and writings by local psychoanalysts to develop a comprehensive understanding of the distinctive clinical practices and therapeutic approaches in the Argentine context. It details the experimental use of these substances, the clinical practices developed, and the professional and societal challenges encountered. Notably, psychoanalysts Luisa de Álvarez de Toledo, Alberto Tallaferro, and Alberto Fontana conducted pioneering research, exploring the therapeutic potential of these substances and publishing their findings in academic papers and books. According to these psychoanalysts, the use of psychedelic drugs in therapy could enhance transference, catalyze catharsis, and circumvent unconscious defenses, allowing for a vivid exploration of the patient's psyche that necessitated interpretation. Despite the innovative nature of this work, resistance from within the Argentine Psychoanalytic Association led to the eventual cessation of psychedelic research in this country. The essay calls for a reconsideration of the psychoanalytic community's relationship with psychedelics, emphasizing the potential for renewed dialogue and incorporation of these substances in contemporary therapeutic practices. In conclusion, this article sheds light on an overlooked chapter of psychoanalysis in a local setting and serves as a call for future explorations in broader scenarios. The resurgence of interest in psychedelics for mental health treatment presents an opportunity for psychoanalysts to engage with emerging research, enriching both theory and practice.

本文探讨了 20 世纪中期阿根廷精神分析疗法与迷幻药的结合。通过文献分析，文章研究了迷幻药与精神分析的交集，并借鉴了历史文献和当地精神分析师的著作，以全面了解阿根廷背景下独特的临床实践和治疗方法。书中详细介绍了这些物质的试验性使用、临床实践的发展以及所遇到的专业和社会挑战。值得注意的是，精神分析师路易莎-德阿尔瓦雷斯-德托莱多、阿尔贝托-塔拉费罗和阿尔贝托-丰塔纳进行了开创性的研究，探索这些物质的治疗潜力，并将研究成果发表在学术论文和书籍中。根据这些精神分析师的观点，在治疗中使用迷幻药可以加强移情、催化宣泄、规避无意识防御，从而对患者的心理进行生动的探索，并对其进行必要的解释。尽管这项工作具有创新性，但阿根廷精神分析协会内部的抵制最终导致该国停止了迷幻药研究。这篇文章呼吁重新考虑精神分析界与迷幻药的关系，强调重新对话的潜力，并将这些物质纳入当代治疗实践中。总之，这篇文章揭示了精神分析在本地环境中被忽视的一章，并呼吁未来在更广阔的场景中进行探索。人们对用于心理健康治疗的迷幻剂重新产生了兴趣，这为精神分析师参与新兴研究、丰富理论和实践提供了机会。

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引用次数: 0

Financial incentives to increase engagement across the hepatitis C care cascade among people at risk of or diagnosed with hepatitis C: A systematic review 通过经济激励措施提高丙型肝炎高危人群或确诊丙型肝炎患者对整个丙型肝炎护理流程的参与度：系统回顾

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-18 DOI: 10.1016/j.drugpo.2024.104562

C. Shen , J. Dawe , M.W. Traeger , R. Sacks-Davis , A.E. Pedrana , J.S. Doyle , M.E. Hellard , M Stoové

Background

Reversing declining rates of people initiating and completing hepatitis C (HCV) treatment, observed in many countries, is needed to achieve global HCV elimination goals. Providing financial incentives to increase HCV testing and treatment uptake among people at-risk of or living with HCV infection could be an effective intervention. We conducted a systematic review to assess evidence regarding the effectiveness of financial incentives to improve engagement and progression through the HCV care cascade.

Methods

We searched MEDLINE, PubMed and EMBASE for studies published from January 2013 to January 2023 that evaluated financial incentives offered to people living with and at-risk of HCV to increase HCV antibody and or RNA testing, linkage to care, treatment initiation, treatment adherence, treatment completion, and sustained viral load (SVR) testing. Open-label randomised controlled trials (RCTs), controlled non-randomised studies, cohort or observation studies and mixed-methods studies were included, whereas literature reviews, case series and studies which did not report data were excluded.

Results

We identified 1,278 studies, with 21 included after full-text screening (14,913 participants); three randomised controlled trials and 18 non-randomised studies. Studies evaluated incentives aimed at improving test uptake (n = 11), engagement in care (n = 13), treatment initiation (n = 8), adherence (n = 3), completion (n = 3) and attainment of SVR (n = 5). Findings provided inconclusive evidence for the effectiveness of incentives in improving engagement in the HCV cascade of care. Determining incentive effectiveness to improve care cascade engagement was limited by low quality study designs, heterogeneity in type (cash or voucher), value (US$5 to $600) and cascade stage being incentivised. No randomised controlled trials assessed the effectiveness of incentives to promote HCV testing, and none showed an impact on treatment uptake. In non-randomised studies (observational comparative), some evidence suggested that incentives promoted HCV testing, but evidence of their role in promoting linkage to care, HCV treatment adherence and treatment completion were mixed.

Conclusion

Currently, there lacks high-quality evidence evaluating whether financial incentives improve HCV testing and treatment outcomes. Future research should seek to standardise methodologies, compare incentive types and values to enhance engagement in HCV care, and determine factors that support incentives effectiveness.

背景要实现全球消除丙型肝炎病毒（HCV）的目标，就必须扭转许多国家丙型肝炎（HCV）治疗启动率和完成率不断下降的趋势。通过经济激励措施来提高丙型肝炎病毒感染高危人群或丙型肝炎病毒感染者的丙型肝炎病毒检测率和治疗率可能是一项有效的干预措施。方法我们检索了MEDLINE、PubMed和EMBASE，以查找2013年1月至2023年1月期间发表的、评估向HCV感染者和高危人群提供经济激励以增加HCV抗体和/或RNA检测、护理链接、治疗启动、治疗依从性、治疗完成和持续病毒载量（SVR）检测的研究。我们纳入了开放标签随机对照试验 (RCT)、非随机对照研究、队列研究或观察研究以及混合方法研究，并排除了文献综述、病例系列和未报告数据的研究。结果我们共发现了 1,278 项研究，其中 21 项经过全文筛选后被纳入（14,913 名参与者）；3 项随机对照试验和 18 项非随机研究。研究评估了旨在提高检测率（11 项）、参与护理率（13 项）、开始治疗率（8 项）、坚持治疗率（3 项）、完成治疗率（3 项）和达到 SVR 率（5 项）的激励措施。调查结果显示，激励措施在提高参与 HCV 级联治疗的有效性方面并无定论。由于研究设计质量不高，激励类型（现金或代金券）、价值（5 美元至 600 美元）和被激励的级联阶段存在异质性，因此在确定激励措施对提高级联治疗参与度的有效性时受到了限制。没有随机对照试验评估了促进 HCV 检测的激励措施的有效性，也没有任何一项试验显示激励措施对治疗吸收率产生了影响。在非随机研究（观察性比较）中，一些证据表明激励措施促进了 HCV 检测，但关于激励措施在促进护理联系、HCV 治疗依从性和治疗完成方面的作用，证据不一。未来的研究应寻求标准化方法，比较激励措施的类型和价值，以提高HCV治疗的参与度，并确定支持激励措施有效性的因素。

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引用次数: 0

Synthetic opioids in Poland—A cause for concern or a media distraction? 波兰的合成类阿片--令人担忧还是媒体的干扰？

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-09-18 DOI: 10.1016/j.drugpo.2024.104595

Greg Los , Artur Malczewski

Background

The North American continent has been battling a major health crisis defined by opioids like OxyContin and fentanyl for over two decades now. In that time, it seemed that Europe is rather resilient to a similar problem, and heroin retained its position as a the most problematic opioid. This does seem to be changing and European media, including in Poland, is starting to report on growing popularity of synthetic opioids like fentanyl.

Methods

We use official data showing the number of prescriptions for synthetic opioids; data showing the percentage of people entering treatment due to different opioids; police data on drug interceptions as well as lab closures, and data on opioid related poisonings.

Results

The data demonstrates that although Polish physicians are increasingly more likely to prescribe synthetic opioids like OxyContin or Fentanyl, their problematic use remains low.

Conclusion

Poland currently does not seem to be in a position that resembles an early stage of an opioid crisis. With this article we want to calm a heated public debate that is currently taking place in Poland, and redirect attention to a much more substantial problem of synthetic cathinones.

背景二十多年来，北美大陆一直在与奥施康定和芬太尼等阿片类药物引发的重大健康危机作斗争。在此期间，欧洲似乎对类似的问题颇有抵抗力，海洛因仍然是问题最大的阿片类药物。这种情况似乎正在发生变化，包括波兰在内的欧洲媒体开始报道芬太尼等合成阿片类药物日益流行的情况。方法我们使用了显示合成阿片类药物处方数量的官方数据、显示因服用不同阿片类药物而接受治疗的人数比例的数据、警方截获毒品和关闭实验室的数据以及与阿片类药物有关的中毒事件数据。结果数据显示，尽管波兰医生越来越倾向于开具合成阿片类药物（如奥施康定或芬太尼）的处方，但其问题使用率仍然很低。通过这篇文章，我们希望平息波兰目前正在进行的一场激烈的公开辩论，并将人们的注意力重新转移到合成卡西酮这一更为实质性的问题上来。

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引用次数: 0