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Background Given the global economic recessions mediated by the COVID-19 pandemic and that many countries have implemented direct income support programs, we investigated the timing of the COVID-19 economic impact payments and opioid overdose deaths. Methods A longitudinal, observational study design that included data from the Ohio Department of Health was utilized. Statistical change point analyses were conducted to identify significant changes in weekly number of opioid overdose deaths from January 1 of 2018 to August 1 of 2020. Additional analyses including difference-in-difference, time series tests, interrupted time series regression analysis and Granger causality test were performed. Results A single change point was identified and occurred at week 16, 2020. For 2020, the median opioid overdose deaths numbers for weeks 1–16 and weeks 17–32 were 68.5 and 101, respectively. The opioid overdose deaths numbers from weeks 17–32 of 2020 were significantly higher than those in weeks 1–16 of 2020 and those in 2018 and 2019 (before and after week 16). The interrupted time series regression analysis indicated more than 203 deaths weekly for weeks 17–32 of 2020 compared to all other weeks. The result of the Granger causality test found that the identified change point (week 16 of 2020) directly influenced the increase in opioid overdose deaths in weeks 17–32 of 2020. Conclusion The identified change point may refer to the timing of many factors, not only the economic payments and further research is warranted to investigate the potential relationship between the COVID-19 economic impact payments and overdose deaths.

Background The COVID-19 pandemic has seen the implementation of unprecedented legislation and policy, including drug control measures which in some countries, like Botswana, included a temporary full alcohol sales ban. However, the association of such absolute prohibition of alcohol sales on population drinking, including hazardous drinking, during the COVID-19 period has not yet been determined. This study investigated changes in retrospectively recalled alcohol use and hazardous drinking pre (prior 5th August 2020), during (5th August to 3rd September 2020) and post (after 4th September) the second alcohol sales ban in Botswana. Predictors of hazardous drinking across the three time points were also investigated. Methods An online cross-sectional study involving a convenience sample of 1318 adults with a past 12 months drinking history in Botswana was conducted in October 2020 following a month long alcohol sales prohibition. Participants completed a modified Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alongside demographic questions. Participants were expected to retrospectively recall their alcohol use pre, during and post the second alcohol sales ban. Results The prevalence of alcohol use among participants with a past 12 months drinking history was 91.7% (95%CI= 90.1–93.1) before the second ban, 62.3% (95%CI= 59.7–64.9) during the second ban, and 90.4% (95%CI= 88.7–91.8) after the ban.. Hazardous drinking temporarily decreased by 30% during the second alcohol sales ban, and rose to the pre-ban levels of about 60% after the ban. Significant predictors of hazardous drinking at any of the three time points (pre, during and post the second ban) were being male (AOR ranging from 1.50 to 2.13 for all time points), earning between P3000-P6000 (AOR= 1.69 prior sales ban), being a student (AOR=0.56 during the sales ban), and being employed (AOR= 1.45 post the sales ban). Conclusion The alcohol sales ban was associated with short-lived changes in alcohol consumption and hazardous drinking thereby likely contributed in providing the anticipated and much needed temporary relief to the health system sought by COVID-19 pandemic measures.

Background Healthcare delivery was disrupted during the COVID-19 pandemic, requiring minimized in-person contact between patients and clinicians. During the pandemic, people with opioid use disorder (OUD) were not only at elevated risk for COVID-19, but had markedly reduced access to treatment for OUD, Hepatitis C virus (HCV) and HIV due to recommended decreased in-person visits. Methods From March 15-June 15, 2020 at the syringe services program (SSP) in New Haven, Connecticut, USA, a differentiated care model evolved with reduced clinical demands on people who inject drugs (PWID) to ensure screening and treatment for HCV, HIV and OUD, with a focus on HCV treatment. This model involved a single, bundled screening, evaluation, testing (SET) and monitoring strategy for all three conditions, minimal in-person visits, followed by tele-health communication between patients, outreach workers and clinicians. In-person visits occurred only during induction onto methadone and phlebotomy at baseline and phlebotomy 12 weeks post-treatment for HCV to measure sustained virological response (SVR). Patients received supportive texts/calls from outreach workers and clinicians. Results Overall, 66 actively injecting PWID, all with OUD, underwent bundled laboratory screening; 35 had chronic HCV infection. Participants were 40 years (mean), mostly white (N = 18) men (N = 28) and 12 were unstably housed. Two were lost to-follow-up and 2 were incarcerated, leaving 31 who started pan-genotypic direct-acting antivirals (DAAs). The mean time from referral to initial phlebotomy and initiation of DAAs was 6.9 and 9.9 days, respectively. Fourteen additional patients were newly started on buprenorphine and 6 started on methadone; three and four, respectively, were on treatment at baseline. Overall, 29 (93.5%) PWID who initiated DAAs achieved SVR; among unstably housed persons the SVR was 83.3%. Conclusions In response to COVID-19, an innovative differentiated care model for PWID at an SSP evolved that included successful co-treatment for HCV, HIV and OUD using a client-centered approach that reduces treatment demands on patients yet supports ongoing access to evidence-based treatments.

Background The COVID-19 pandemic has had an impact on mental health and alcohol use in the US, however there is little research on its impacts on cannabis use. Considering the role of cannabis as a coping strategy or self-medicating behavior, there is a need to understand how individuals who use cannabis have adapted their use amid the pandemic. Therefore, this study examined changes in self-reported cannabis use among US adults in the context of COVID-19 pandemic by (1) describing trends of use during the first 8 months of the pandemic among adults who used cannabis in this period; and (2) characterizing trends of use within sociodemographic subgroups and by state cannabis policy status. Methods The sample consisted of 1,761 US adults who used cannabis at least once during the 8-month study period from the nationally representative Understanding America Study. Linear mixed-effect models were used to model changes in the number of days of past-week cannabis use across 16 waves from March 10, 2020, to November 11, 2020. Results Compared to early March, the number of days cannabis was used per week was significantly higher at the start of April (β=0.11, 95% CI=0.03, 0.18) and May (β=0.21,95% CI=0.05, 0.36). In subsequent months (June - November), the number of days of cannabis use attenuated to levels comparable to March. Trends of cannabis use across the study period generally did not differ across sociodemographic characteristics and state cannabis policy status. Conclusion Though increases in use were marginal among many groups, the evolving pandemic and the growing concern for the mental health of segments of the U.S. population warrant close monitoring of coping behaviors, including substance use.

Despite the World Health Organization’s assertion that communities need to become involved in\ud reducing alcohol harm, evidence of community engagement in alcohol licensing decision-making in\ud England remains limited. The evaluation of the Communities in Charge of Alcohol (CICA)\ud programme offers policymakers, Licensing Authorities and public health practitioners, evidence\ud regarding a specific volunteer-led, place-based approach designed to enable community engagement\ud in licensing with the aim of reducing localised alcohol harm. The study explored factors affecting the\ud sustainable involvement of volunteers in alcohol licensing decision-making from six Licensing\ud Officers' perspectives, through semi-structured interviews. Routinely collected crime, disorder, and\ud hospital admissions data were reviewed for further context as proxies for alcohol-related harm.\ud Licensing Officers perceived sustainable engagement to be impacted by: (i) the extent of alignment\ud with statutory requirements and local political support; (ii) the ability of Licensing Officers to\ud operationalise CICA and support local assets, and; (iii) the opportunity for, and ability of, volunteers\ud to raise licensing issues. The perspectives of Licensing Officers indicate complexities inherent in\ud seeking to empower residents to engage in licensing decision-making at a community level. These\ud relate to statutory and political factors, funding, social norms regarding engagement in licensing\ud decision-making, and the need for networks between critical actors including Responsible Authorities\ud and communities. The evidence indicates that after increasing community capacity to influence\ud alcohol availability decision-making at local level, communities continue to struggle to influence\ud statutory processes to affect alcohol availability where they live and work. More understanding of\ud how to enable effective community engagement is required.

The paper develops a critical reflection on the fabulative filmic collaboration with a participant suffering from heroin addiction and creates a line of flight from the dominant biomedical, sociocultural and psychological research. The artistic research articulates a cinema practice that seeks to address the issue of addictive behaviours in a way that has rarely been investigated, with a focus on the recovery process in the long-term. The paper asks how a creative practice with mind wandering as core component allows for recovery practices to challenge recurrent, preconceived and limited representation strategies that have been widely used for people recovering from addiction as medical patients, research participants and filmic figures. Exploring addiction in the context of artistic research unveils the potential of mind wandering in the recovery from addiction. The paper advocates for mind wandering to be a starting point to reconsider therapy concepts from the hypothesis that mind wandering is a helpful tool rather than a risk factor. Artistic research enables one to see the recovery from addiction as a becoming life force, in its affirmative as well as diminishing tendencies, and asks what addiction can do and how its recovery process can become a mode of existence in its own right.

Writing in the context of proposal to expand the decriminalisation of illicit drugs in the Australian Capital Territory, Australia's smallest and most progressive jurisdiction, this article explores the key question of the use of quantitative thresholds to determine the level of drug use distinguishing personal use from trafficking. Recent literature demonstrates the use of quantitative thresholds has yielded highly divergent approaches in jurisdictions around the world. The literature also points to the underlying challenges involved in evaluating whether it is appropriate to employ quantitative figures to make that distinction, and if so how and to what ends. Harris (2011) goes so far as to describe 'conviction by numbers' as a 'lazy shorthand' that may exact an 'immeasurable cost of injustice' (3). Yet practices which do not rely on quantitative measures are at real risk of exacerbating discretionary judgments by police and prosecutors that may well result in discriminatory application of the laws. The basis on which the balance between these two countervailing considerations is struck in these discussions is not always clear. The paper focuses first on the merits of adopting an approach based on quantitative thresholds and argues that the implications of applying legally mandated drug quantities is in fact not as cut and dried as many authors have assumed. There is an important 'middle way' between the rote application of quantitative measures and their abandonment. This middle way has previously been ignored. The article then addresses exactly how and on what basis quantitative thresholds should be determined if they are to reflect and advance harm reduction principles. Finally, the paper considers and critiques arguments that quantitative thresholds should be set not only by reference to the consumption patterns of users but also in relation to the relative harm of particular substances. As a whole, the essay aims to contribute to a broader international literature on thresholds, a vexed question which matters not only in Canberra, but around the world.

The use of drug detection dogs and other punitive policing methods remain common at music festivals in Australia and elsewhere, despite concern about iatrogenic effects and recommendations for their overhaul. While drug amnesty bins are a commonly implemented strategy purported to mitigate risk associated with policing, the efficacy of this intervention is debated. This paper investigates two of the most concerning iatrogenic effects of drug policing practices at Australian festivals - internal concealment and panic consumption - and explores the potential efficacy of drug amnesty bins.A stepped, mixed methods study (qual→QUANT→qual) comprised qualitative interviews with key informants and festivalgoers, and a quantitative online survey completed by almost 2000 Australian festivalgoers (52% male; median age 20 years old). Descriptive statistics were performed alongside bivariable and multivariable logistic regressions predicting internal concealment and panic consumption. Inductive thematic analysis was used to examine the qualitative data.Among respondents who had ever used illicit drugs at festivals (n=1065), 23% reported hiding drugs internally to evade police detection and 17% reported panic consumption. Female respondents and respondents expecting dogs were at greater odds of reporting internal concealment. The qualitative data provided greater insight into the risky nature of internal concealment practices and panic incited by police at the gates. When asked if they would have considered discarding their drugs into a drug amnesty bin had they been concerned about detection, less than a quarter (24%) said they definitely or probably would have.This paper adds to the evidence regarding iatrogenic effects of punitive drug policing practices at festivals. The findings have implications for shifting away from punitive policies to ones focused on public health. Additionally, the findings suggest drug amnesty bins should not be viewed as an adequate response for averting harms from drug policing.

A common drug policy in source countries -forced eradication- has unintended consequences in multiple dimensions. Aerial spraying in particular, has social and environmental costs including, increased violence, deforestation, and adverse health outcomes. However, there is less evidence of the unintended consequences of illicit crop substitution programs, another widely used intervention. This paper illustrates an unintended effect of the largest crop substitution program in the world, namely increased violence against social leaders. Examining the recent Colombian illicit crop substitution program implemented in 2017, this paper estimates the effect on violence towards social leaders employing an event study econometric strategy. The program increased the rate of social leader killings by 481% and the probability of a killing by 122%. The findings reveal a greater effect on municipalities where leaders oppose the expansion of illicit crops, where organized crime does not hold consolidated power, and where there is a presence of illegal armed groups. This study contributes to the literature on antidrug policies by providing empirical evidence of unintended consequences for local communities.

BACKGROUND: People with a history of incarceration are at high risk for opioid overdose. A variety of factors contribute to this elevated risk though our understanding of these factors is deficient. Research to identify risk and protective factors for overdose is often conducted using administrative data or researcher-derived surveys and without explicit input from people with lived experience. We aimed to understand the scope of U.S. research on factors associated with opioid overdose among previously incarcerated people. We did this by conducting a narrative review of the literature and convening expert panels of people with lived experience. We then categorized these factors using a social determinants of health framework to help contextualize our findings. METHODS: We first conducted a narrative review of the published literature. A search was performed using PubMed and APA PsycInfo. We then convened two expert panels consisting of people with lived experience and people who work with people who were previously incarcerated. Experts were asked to evaluate the literature derived factors for completeness and add factors that were not identified. Finally, we categorized factors as either intermediary or structural according to the World Health Organization’s Social Determinants of Health (SDOH) Framework. RESULTS: We identified 13 papers that met our inclusion criteria for the narrative review. Within these 13 papers, we identified 22 relevant factors for their role in the relationship between overdose and people with a history of incarceration, 16 were risk factors and six were protective factors. Five of these were structural factors (three risk and two protective) and 17 were intermediary factors (13 risk and four protective). The expert panels identified 21 additional factors, 10 of which were structural (six risk and four protective) and 11 of which were intermediary (eight risk and three protective). CONCLUSION: This narrative review along with expert panels demonstrates a gap in the published literature regarding factors associated with overdose among people who were previously incarcerated. Additionally, this review highlights a substantial gap with regard to the types of factors that are typically identified. Incorporating voices of people with lived experience is crucial to our understanding of overdose in this at-risk population.

A substantial body of evidence demonstrates that supervised consumption services (SCS) mitigate a variety of drug-related harms, including decreasing overdose deaths, infectious disease transmission, and connecting people who use drugs (PWUD) to various health and social services. Research on SCS has predominantly been quantitative, though qualitative research on these services has increased substantially over the last decade. Qualitative methods provide a framework for developing a richer and more nuanced understanding of meanings and contexts associated with drug use, health service implementation, and experience. We present findings from a scoping review of qualitative studies on experiences of PWUD with SCS published between 1997 and 2022. In total, forty-two papers were included in this analysis. Four primary themes emerged from our analysis: 1) Influence of SCS on health and wellbeing among PWUD, 2) the physical environment of SCS can be both a facilitator and barrier to use, 3) social resources can shape and reshape the context within which PWUD benefit from SCS, and 4) various intersecting forces at play both support and harm PWUD in relation to their experiences with SCS. We discuss the primary facilitators and barriers of SCS use and conclude with suggestions to inform future qualitative research, SCS implementation, and PWUD-centered approaches to drug policy.

The history of psychedelia within the New Left counterculture often implies a cultural alignment between psychedelics and progressive values or the promise of radical communitarian social reform. In contrast to these potentials, this paper examines Silicon Valley's engagement with psychedelics, a community which has demonstrated considerable financial and personal interests in these drugs despite promoting and advancing consistently neoliberal ends. This article studies Silicon Valley's culture of psychedelic drug use through extensive analysis of published interviews by tech industrialists, news reports, and recent studies on the tech industry's proliferation of mystical and utopian rhetoric. This work finds that psychedelics and their associated practices are given unconventional mystical meanings by some high-profile tech entrepreneurs, and that these meanings are integrated into belief systems and philosophies which are explicitly anti-democratic, individualist, and essentialist. It is argued that these mystical ideas are supported by a venture capital community which profits from the expression of disruptive utopian beliefs. These beliefs, when held by the extremely wealthy, have effects on legalization policy and the ways which psychedelics are commercialized within a legal marketplace. As Silicon Valley has put considerable resources into funding research and advocacy for psychedelics, I argue that the legalization of psychedelics will likely be operationalized to generate a near-monopoly on the market and promote further inequality in the United States that is reflective of both neoliberalism, and the essentialist beliefs of Silicon Valley functionaries.

This paper explores the narratives of service users of contemporary methadone maintenance treatment services (MMT) in the Republic of Ireland to obtain their perspectives in the context of them negotiating their right to health METHODS: Participants were recruited and interviewed by a former service user of MMT services. In-depth qualitative interviews were conducted with 40 current and recent users of MMT services RESULTS: Participants overwhelmingly reported a reduced sense of personal agency because of their experiences in MMT treatment. Participants observed that their perceptions of treatment were forged by a sense of reduced autonomy, coercive and disrespectful approaches from healthcare workers. Within a system which the participants considered to be failing, the services that they accessed were predicated on a process of reward and punishment, where best practice was often ignored by practitioners, all of which resulted in adverse consequences for service users DISCUSSION: The findings indicate that there is a significant 'chasm' between human rights, policy and best practice and how these are operationalised within the structures and practices of Irish MMT services. The treatment of service users, based on human rights principles such as equality, respect, autonomy, empowerment and personal choice remains aspirational and is unlikely to be fulfilled without addressing more systemic challenges such as funding, training of staff, service culture, governance and independent oversight of MMT services.

Increasing overdose deaths attributable to illicitly manufactured fentanyl and fentanyl analogues in North America has driven international concern about the expansion of these substances into drug markets elsewhere. This paper investigates 20-year trends in fentanyl deaths in Australia, distinguishing between deaths attributable to pharmaceutical, and to illicitly manufactured fentanyl and fentanyl analogues.Analysis of fentanyl overdose deaths (2001-2021), extracted from the National Coronial Information System (NCIS).833 fentanyl-related deaths were identified, predominantly occurring among males (73%), and people with a history of injecting drug use (67%). Rates of fentanyl deaths significantly increased between 2001 and 2014 and declined between 2015 and 2021. Drug dependence remained the most significant factor in deaths among people with a history of injecting drug use (87% vs 23% without such a history), while having died by suicide was the most significant factor for those without a history of injecting drug use (20% vs 4% respectively). Three quarters (72%) of deaths were attributable to pharmaceutical fentanyl and 21% to probable pharmaceutical fentanyl, with 5% attributable to fentanyl analogues (3%) (predominantly furanylfentanyl and acetylfentanyl) and illicitly manufactured fentanyl (2%). Deaths attributable to illicitly manufactured fentanyl and fentanyl analogues occurred from 2013 onwards.Pharmaceutical fentanyl deaths in Australia have declined since 2015, in parallel with overall declines in pharmaceutical opioids (including fentanyl) dispensed since 2014. Deaths continue to occur among people with a history of injecting drug use and drug dependence. Deaths attributable to illicit fentanyl have emerged since 2013 but remain low in comparison to pharmaceutical fentanyl deaths.

Social media is increasingly being utilized to facilitate the buying and selling of illegal drugs, particularly by young people. However, the range of social media and messaging platforms means people must make 'choices' around which platforms they will use to conduct drug transactions. Polymedia theory suggests that people use different media to manage their social relationships, 'choosing' appropriate channels or platforms based on platform features and the social context of the relationship. This paper uses polymedia theory to explore how buyers and sellers navigate platform 'choice' for drug trading, and how this bears similarities to the ways in which they move between different platforms in their daily lives. We conducted anonymous online interviews with thirty-three people who buy and/or sell drugs via social media and encrypted messaging apps in New Zealand to explore the factors shaping their selection of platforms for drug transactions. Our findings highlight the importance of the relationship between the buyer and seller in shaping how interviewees weighted the relative importance of platform security and convenience. Though more commercial drug sellers exercised considerable influence in directing buyers of drugs towards a given platform, this pattern was less characteristic of how platform 'choice' was navigated in contexts of drug supply between friends. In social supply contexts, platform 'choices' were often not explicitly made, but rather exchanges were channelled through platforms already in use within the social group. We highlight the tensions that arise between seller preferences for a more secure platform and buyer preferences for greater convenience in contexts of friendship. Our findings highlight the importance of understanding social media drug market engagement as shaped by broader patterns of social media engagement, and the distinctions between different social contexts and personal relationships, consistent with polymedia theory.

People who are homeless and using substances frequently encounter barriers to accessing support. This paper aims to inform policy and practice by analysing changes in the tobacco, alcohol and illicit drug use of people experiencing homelessness.Data derive from a qualitative longitudinal study (undertaken 2020/2021) and involving telephone interviews (n = 310) conducted with 34 people accommodated in two London hotels provided as part of a UK policy response to COVID-19. The hotels offered various supports, including opioid replacement therapy, prescribed alcohol, licensed nicotine replacement therapy, and e-cigarettes. Participants' substance use data were organised by Iterative Categorization and subjected to a content analysis to identify patterns and themes..At entry to the hotel, 5/34 participants (14.7%) had never used alcohol nor illicit drugs; 10/34 (29.4%) had only ever used alcohol (mostly without a problem); 11/34 (32.4%) had ever used illicit drugs but without a problem; and 8/34 (23.5%) had ever had a problem with illicit drugs. Sub-groups had different socio-demographic characteristics, particularly regarding being/not being a UK national, sex, and homelessness duration. Tobacco smoking was common across all sub-groups (18/34; 52.9%). Participants were often anxious about living with others who were using substances, and some worried about their own substance use. Substance use was changeable, with more decreases than increases. Changes related to intrapersonal (psychological), interpersonal (social) and structural (resource-based) factors. For example, decreases were precipitated by people feeling motivated to change, separation from others who used drugs, and receiving treatment or support.Findings indicate that various interventions and accommodation models may benefit people who are homeless and using substances. An initiative that combined shelter and basic amenities, pharmacological treatment, psychosocial support, and space where substances were not available and other people using substances could be avoided resulted in an overall reduction in substance use amongst those accommodated.

U.S. states have taken varied approaches to licensing cannabis businesses under federal prohibition, but up to now there is limited research on cross-state licensing approaches. This paper provides a systematic analysis of the current licensing strategies taken by all states that have passed medical cannabis laws (MCLs)/recreational cannabis laws (RCLs). We construct comprehensive data on cannabis business licenses offered in each state, as well as metrics for license categories, cost, and issuance volume. We then analyze patterns between these metrics, also considering how long ago states implemented MCLs/RCLs, qualitative licensing aspects, state ideology and voting preference, and state cannabis taxation data. We observe that states tend to license medical cannabis more restrictively than adult-use cannabis: i.e., by offering licenses in fewer categories, at higher cost, in lower issuance volume, and more often mandating vertical integration. Additionally, states that implemented MCLs/RCLs earlier tend to offer licenses in more categories, at lower cost, and in greater volumes. Further, though states that implemented MCLs recently lean conservative and Republican, we do not observe clear relationships between ideology or voting preference and licensing policy. In our supporting results, we observe that a greater share of states with complex licensing structures impose non-retail price cannabis taxes than states overall, and we discuss how states have changed their licensing policies over time.

Drug Policy Voices is a UK-based project designed to integrate the voices and experiences of people who use drugs (PWUD) into debates about drug policy reform. An online survey was conducted in 2020 to understand opinions connected to drug use and drug policy. We used a blended values approach combining Moral Foundations Theory (Haidt and Joseph, 2004; Haidt and Graham, 2007) and MacCoun and Reuter's (2001) four philosophical positions that underpin the drug policy. This paper asks, what values do people who use drugs hold surrounding drug use and drug policy, and what factors predict these values?We used online-purposive sampling and achieved 1217 survey responses, which captured sociodemographic characteristics, patterns of drug use, sourcing and supply of drugs used within the last 12 months, experiences of criminal justice sanctions in connection to drugs, and experiences of alcohol or other drug treatment. In addition, we devised 37 attitudinal questions about drug use and drug policy, which included both progressive and prohibitionist value positions.The exploratory factor analysis revealed a six-factor solution that identified important value positions for this respondent group, which are personal autonomy, paternalism 1; paternalism 2; legal injustice 1; legal injustice 2; and neoliberal governance. Age, gender, religious beliefs, political views, identifying as a recreational drug taker, using drugs recently, and having experience of working or studying in the substance use/drug policy field are predictors of these value positions.The Drug Policy Voices survey has identified collective values and ideology connected to lived experience that illustrate a clear goal conflict with prohibitionist ideology. PWUD have valuable contributions to make to the policy reform debate, but we must acknowledge that opinions are not formed through drug-related experiences alone. The findings of this research highlight the importance of emphasising the person who uses drugs within participatory approaches.

Young people who experience multiple disadvantage have been identified as some of the most marginalised and under-serviced people in the alcohol and other drug (AOD) system. In this paper, we draw on a range of research evidence to argue that one of the challenges in responding appropriately to the needs of these young people are models of care which seek to ameliorate 'illness' rather than promote wellness. While disease approaches have some important benefits, overly-medicalised AOD treatment responses also have negative impacts. We argue that disease models rest on understandings of substance use as an individual enterprise and thereby pay insufficient attention to the material disadvantage that shape young people's substance use, creating feelings of shame, failure and a reluctance to return to care if they continue to use. Additionally we draw on literature that shows how disease models construe young people's substance use as compulsive, perpetuating deficit views of them as irrational and failing to account for the specific meanings that young people themselves give to their substance use. By focusing on clinical solutions rather than material and relational ones, medicalised treatment responses perpetuate inequity: they benefit young people whose resources and normative values align with the treatments offered by disease models, but are much less helpful to those who are under-resourced,. We suggest that alternative approaches can be found in First Nations models of care and youth programs that attend to social, cultural, and material wellbeing, making living well the focus of treatment rather than illness amelioration.

In this paper, we study whether leadership and community organisation can explain differences in the presence and expansion of coca crops in rural Afro-Colombian collective territories. Following a mixed-method approach that combines the analysis of satellite imagery, semi-structured interviews and household surveys, our results suggest that leadership and community organisation help explain differences in the presence of illegal coca crops by activating pre-existing 'stocks' of social capital that enable rural Afro-Colombian communities in the country's southern Pacific region to resist the penetration and/or expansion of illegal coca crops. Results also show that resistance is more effective when the interests and strategies of leadership and communities are aligned. We argue that the effectiveness and sustainability of resistance depend on: (a) the stock of social capital that determines organisational capabilities, (b) the specific normative content with which this capital is infused, (c) the legitimacy and influence of leadership on the community, and (d) synergies among different levels of grass-root community organisation. We conclude that investing in social capital and community capabilities is thus one way to reorient policy interventions, a goal to which the Colombian state can only partially contribute given its policy priorities and structural limitations.

Background: The pricing of illicit drugs is typically approached within the risks and prices framework. Recent sociological and economic studies of prices in online drug markets have stressed the centrality of reputation for price formation. In this paper, we propose an account of price formation that is based on the risks and prices framework, but also incorporates internal social organization to explain price variation. We assess the model empirically, and extend the current empirical literature by including payment methods and informal ranking as influences on drug pricing. Methods: We apply our model to estimate the prices of cannabis, cocaine, and heroin in two online drug markets, cryptomarkets (n = 92.246). Using multilevel linear regression, we assess the influence of product qualities, reputation, payment methods, and informal ranking on price formation. Results: We observe extensive quantity discounts varying across substances and countries, and find premia and discounts associated with product qualities. We find evidence of payment method price adjustment, but contrary to expectation we observe conflicting evidence concerning reputation and status. We assess the robustness of our findings concerning reputation by comparing our model to previous approaches and alternative specifications. Conclusion: We contribute to an emerging economic sociological approach to the study illicit markets by developing an account of price formation that incorporates cybercrime scholarship and the risks and prices framework. We find that prices in online drug markets reflect both external institutional constraint and internal social processes that reduce uncertainty.

The Stop Overdose Safely (S-O-S) initiative-developed in compliance with WHO guidelines-aims to prevent opioid overdose deaths. Under the umbrella of this initiative a multi-country project was implemented in Kazakhstan, Kyrgyzstan, Tajikistan, and Ukraine, that involved overdose recognition and response training, including the provision of take-home naloxone (THN). More than 14,000 potential overdose witnesses were trained and more than 16,000 THN kits were distributed across the participating countries. This paper reports on the qualitative component of an evaluation aiming to understand the views and experiences of S-O-S project participants.Data were drawn from focus group discussions with 257 project participants from across all four countries, including people who use and inject drugs, and others likely to witness an opioid overdose. Data were analysed thematically.Findings revealed how past experiences of trauma and loss related to overdose death were common, as was appreciation and gratitude for the opportunity to participate in the S-O-S training. Participants described how they shared knowledge and skills with others. Empowerment and destigmatising narratives featured prominently, and highlighted how for people who use drugs, feeling valued and cared about-not only by families and friends, but by health care providers, and sometimes police-was a positive outcome of their participation. Nevertheless, findings also revealed how real experiences of fear regarding police intervention was a barrier to carrying naloxone and intervening when faced with an overdose situation.Our analysis found that the S-O-S project produced positive outcomes that go well beyond saving lives. Despite identifying barriers to THN uptake, our findings support a growing body of evidence that broad access to THN as part of a continuum of care can enhance the health and wellbeing of people who use drugs and their communities, in low- to middle-income countries.

Psychedelic-assisted therapies are experiencing a re-emergence in mainstream medicine and mental health contexts. A wide variety of psychedelic-assisted therapy modalities are being utilized to address mental health issues such as substance use disorders, end of life anxiety, treatment-resistant depression, suicidality, PTSD and other conditions. The novel and inchoate acceptance of psychedelic-assisted therapies into mainstream medical and therapeutic realms raises questions of equity. Concerns have been raised that individuals and communities facing structural inequities are perhaps least able to access these treatments including Black, Indigenous and people of colour (BIPOC) as well as people who use drugs. Psychedelic-assisted therapies may exemplify the inverse law of care whereby services are most inaccessible to communities with the most need, especially if these therapies are regulated into the private sector. As legalization and wider implementation of these therapies appears to be imminent, now is a critical time to consider how health equity may be promoted within psychedelic medicine. This paper examines how the EQUIP Health Care approach (https://equiphealthcare.ca) may inform the development and provision of equity-oriented psychedelic-assisted therapies. The EQUIP approach seeks to reduce the effects of structural inequities on people's health, the impacts of discrimination and stigma, and the mismatches between usual approaches to care and the needs of people most affected by health and social inequities. Key dimensions of the EQUIP intervention include cultural safety, harm reduction, trauma and violence-informed care, and contextual tailoring.

In the UK, legislation was implemented in 2014 allowing needle and syringe provision (NSP) services to offer foil to people who inject drugs (PWID) to encourage smoking rather than injecting. This paper aims to examine the association between foil uptake and smoking or snorting heroin among PWID. This is the first large scale national study to examine foil uptake and smoking or snorting heroin among PWID post legislative change.Data from 1453 PWID interviewed via Scotland's Needle Exchange Surveillance Initiative in 2017-2018 were analysed using multivariate logistic regression.Overall, 36% of PWID had obtained foil from NSP services in the past six months. The odds of smoking or snorting heroin were higher among those who had obtained foil (Adjusted Odds Ratio (AOR) 3.79 (95% CI 2.98-4.82) p0.001) compared to those who had not. Smoking or snorting heroin was associated with lower odds of injecting four or more times daily (AOR 0.60 (95% CI 0.40-0.90) p = 0.012) and injecting into the groin or neck (AOR 0.57 (95% CI 0.46-0.71) p0.001) but increased odds of having had a skin and soft tissue infection (SSTI) (AOR 1.49 (95% CI 1.17-1.89) p = 0.001) and having experienced an overdose (AOR 1.58 (95% CI 1.18-2.10) p = 0.002) both in the past year.The promotion of smoking drugs via foil provision from NSP services may contribute to the package of harm reduction measures for PWID alongside the provision of injecting equipment. We found that those in receipt of foil were more likely to smoke or snort heroin, and that smoking or snorting heroin was associated with a lower likelihood of some risky injecting behaviours, namely frequent injecting and injecting into the groin or neck. But it remains uncertain if the provision of foil can lead to a reduction in health harms, such as SSTI and overdose. Future research is needed to understand PWID motivations for smoking drugs, obtaining foil from NSP services, and its uses particularly among polydrug users.

Residents of rural areas have been a hard-to-reach population for researchers. Geographical isolation and lower population density in rural areas can make it particularly challenging to identify eligible individuals and recruit them for research studies. If the study is about a stigmatizing topic, such as opioid overdose, recruitment can be even more difficult due to confidentiality concerns and distrust of outside researchers. This paper shares lessons learned, both successes and failures, for recruiting a diverse sample of rural participants for a multi-state research study about naloxone, an opioid overdose reversal agent. In addition, because our recruitment spanned the period before and after the COVID-19 pandemic in the U.S., we share lessons learned regarding the transition to all remote recruitment and data collection. We utilized various recruitment strategies including rural community pharmacy referrals, community outreach, participant referrals, mass emails, and social media with varying degrees of success. Among these modalities, pharmacist referrals and community outreach produced the highest number of participants. The trust and rapport that pharmacists have with rural community members eased their concerns about working with unknown researchers from outside their communities and facilitated study team members' ability to contact those individuals. Even with the limited in-person options during the pandemic, we reached our recruitment targets by employing multiple recruitment strategies with digital flyers and emails. We also report on the importance of establishing trust and maintaining honest communication with potential participants as well as how to account for regional characteristics to identify the most effective recruitment methods for a particular rural area. Our suggested strategies and recommendations may benefit researchers who plan to recruit underrepresented minority groups in rural communities and other historically hard-to-reach populations for future studies.

Background: There has been a recent increase in adulteration of opioids with low concentration actives such as fentanyl analogues and benzodiazepines. As drug checking projects using vibrational spectroscopy continue to seek confirmatory lab-based testing, the concern and reality of missing these potentially harmful substances in point-of-care testing is prevalent. Methods: A portable GC-MS was used to analyze select opioid samples acquired at a drug checking service in Victoria, Canada (n = 59). Certified reference standards of several fentanyl analogues and benzodiazepines were measured to guide targeted analysis of these samples. Results were compared with those obtained using a lab- based paper spray mass spectrometer. Results: Portable GC-MS was able to identify 62% of samples containing carfentanil and 36% of samples containing etizolam. In the case of etizolam, the success rate was higher for more potent samples: 78% of etizolam-containing samples were identified when the etizolam concentration was above 3% by weight. In comparison, infrared spectroscopy was able to detect etizolam in only 9% of the etizolam-containing samples, and is not sensitive enough to detect carfentanil at relevant concentrations. Conclusions: Portable GC-MS has potential in identifying low concentration substances in a point-of-care setting, without relying on subsequent off-site confirmatory testing. This project was funded by a grant from the Health Canada Substance Use and Addictions program, with additional support from the Vancou- ver Foundation. LG and MR are grateful to the Natural Sciences and En- gineering Research Council of Canada for CGS-M scholarships, and LG thanks the University of Victoria Department of Chemistry for a GRACE scholarship. This article was originally published as: Gozdzialski, L., Aasen, J., Larnder, A., Ramsay, M., Borden, S.A., Saatchi, A., Gill, C.G., Wallace, B., & Hore, B. (2021). Portable gas chromatography-mass spectrometry in drug checking: Detection of carfentanil and etizolam in expected opioid samples. International Journal of Drug Policy, 97, 1-4. https://doi.org/10.1016/j.drugpo.2021.103409 This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. https://viurrspace.ca/bitstream/handle/10613/24519/Gill.IJDP.2021.pdf?sequence=3

There is growing momentum to legalize medical cannabis across the United States. Positive public attitudes and permissive policies are based on growing anecdotal experiences and medical evidence that enumerate the health benefits of cannabis. Against this backdrop, Muslim stakeholders are (re)-evaluating their stance on the issue for Muslim patients who may benefit from such novel treatments, Muslim physicians who could incorporate the provision of cannabis into practices, and Muslim entrepreneurs who may seek to engage with the pharmaceutical and business aspects of the growing industry. Given this renewed interest, the Fiqh Council of North America (FCNA), a deliberative body comprised of Islamic jurists and medical consultants, examined the medical as well as religious evidence surrounding medical cannabis in order to furnish Muslim Americans with religious guidance. In 2018, they resolved that, while the use of intoxicating substances is proscribed by Islamic law, medical cannabis was permissible for Muslims to use with the following stipulations: Non-psychoactive preparations of cannabis are permitted to treat illnesses for which therapeutic effects of cannabis are certain, and psychoactive preparations are contingently permissible in cases of dire necessity. In this paper we first discuss the deliberative process and ethico-legal rationale brought to bear in furnishing the ruling, and then proceed to critically examine its conceptual gaps, practical limitations, and future implications. Clarifying the nuances around the religious permissibility of medical cannabis is important for Muslim patients and providers whose attitudes and behaviors may be informed by the ruling, as well for stakeholder groups within pharmaceutical and health policy circles who aim to address the needs of the global Muslim community that may stand to benefit from advances in medical cannabis research and therapeutics.

What implications might the use of techniques to enhance human cognition have for the kind of polities or civil societies we inhabit? What might political philosophy, if anything, have to tell us about the desirability of using drugs to increase our intellectual powers? Much of the focus in contemporary debates about human enhancement has been upon the ethical desirability of endeavouring to enhance our capacities: should we be meddling with ‘human nature’, as it were? Therapeutic uses of drugs are regarded as acceptable but enhancement is frowned upon in much of this literature. This rejection of enhancement is especially prevalent in the area of sport where there is a great deal of opposition to doping. Herein I take a somewhat different approach and explore enhancement as a problem in political philosophy and, more specifically, as a problem of distributive justice. Should the enhancement of human intellectual functioning be rejected on distributive grounds of equality? Alternatively, might it be plausibly be argued that distributive justice requires such enhancement? In this paper I shall outline two contemporary theories of justice—namely, the Egalitarianism and the Rawlsian Prioritarianism—and then consider what these principles might tell us about the political legitimacy (or otherwise) of ‘doping for intellect’.

The United Nations estimates that the world's population will reach 8.5 billion by 2030, and the populations of most countries are expected to grow older. This is case for many developed countries, including Australia, the United Kingdom, Canada, the United States of America, and member states of the European Union. Older cohorts will comprise a larger proportion of overall populations, driven in part by our increases in life expectancy. An ageing population poses challenges for governments; notably, older people tend to have multiple, chronic health conditions which can place a burden of health budgets. At the same time, we are witnessing a shift in how we respond to the health needs of our populations, with global drug policy acknowledging that some substances are contributing to increased morbidity and mortality (e.g. opioids) while others may have beneficial therapeutic effects (e.g. psylocibin, cannabis). There is general agreement that as men age their levels of testosterone decrease, and there is some evidence to suggest that there have been population-level declines in testosterone which are not associated with age. Anecdotally, testosterone is accessed by men seeking to self-medicate in the belief that they are experiencing low testosterone levels. There has also been a rise in anti-ageing clinics in the United States, providing access to testosterone replacement therapy (TRT). The non-medical use of testosterone can result in a number of adverse health events, including complications from the use of black market or underground products. Placing testosterone under a new prescribing regime may address some of these concerns, but is society ready for this change, and if so, what would this regime look like? This paper will explore the issue of how society responds to enhancement for longevity, or how we increasingly use pharmaceuticals to address and prevent illness, with a specific focus on testosterone and testosterone deficiency.

This paper explores the perceptions of 35 key informants (KIs) in a range of relevant health and community sectors regarding the stigmatisation of GBM's crystal methamphetamine use and sexual practice with view to informing stigma reduction efforts. A modified social ecological model was used to guide analysis and interpretation. At the individual level, KI participants indicated that crystal methamphetamine was used by some GBM to reduce the effects of internalised stigma. At the network level, KIs thought that some drugs and types of use could attract more stigma and that this could erode support from GBM networks for men who use crystal. KIs felt that few "mainstream" organisations could provide appropriate services for GBM who use crystal and furthermore, that there was significant work to "undo" misperceptions of the harms of crystal use. At the policy level, mass media anti-drug campaigns were seen to be a significant generator of stigma with irrelevant and patronising messages that lacked useful information. Efforts to reduce stigma about crystal methamphetamine use amongst GBM must address individual, network, organisation and policy issues and be underpinned by understandings of social power in relation to sex, sexuality, drug use, infectious status and sexual minorities.