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ObjectiveTo examine prevalence and factors associated with food insecurity among people who use drugs (PWUD) during the first year of the COVID-19 pandemic and the overdose crisis.DesignThis cross-sectional study employs multivariable logistic regression to identify factors associated with self-reported food insecurity.ParticipantsPWUD who are part of three community-recruited cohorts.SettingInterviews conducted in Vancouver, Canada, via phone between July and November 2020 in adherence to COVID-19 safety procedures.ResultsAmong 765 participants, including 433 (56·6 %) men, eligible for this study, 146 (19·1 %; 95 % CI: 16·3 %, 21·9 %) reported food insecurity in the past month. Of the participants reporting food insecurity, 114 (78·1 %) reported that their hunger levels had increased since the beginning of the pandemic. In multivariable analyses, factors independently and positively associated with food insecurity included: difficulty accessing health or social services (adjusted OR (AOR) = 2·59; 95 % CI: 1·60, 4·17); having mobility difficulties (AOR = 1·59; 95 % CI: 1·02, 2·45) and engaging in street-based income generation (e.g. panhandling and informal recycling) (AOR = 2·31; 95 % CI: 1·45, 3·65).ConclusionApproximately one in five PWUD reported food insecurity during this time. PWUD with mobility issues, who experienced difficulty accessing services and/or those engaged in precarious street-based income generation were more likely to report food insecurity. Food security is paramount to the success of interventions to prevent COVID-19 and drug toxicity deaths. These findings suggest a need for a more unified state response to food insecurity that prioritises and incorporates accessibility and autonomy of the communities they serve.

This commentary explores a recent shift in British Columbia's drug policy under a novel drug "decriminalization" framework. We focus on the province's move toward "recriminalization" under this framework. In short, recriminalization was a shift in BC's drug decriminalization framework to only apply in private residences, and be removed from essentially all outdoor spaces. This policy change was completed through an agreement with the federal government amid a public health emergency. Since 2016, BC has faced a severe crisis of drug-related overdoses and poisonings, driven by a toxic and unregulated drug supply compounded by prohibitionist policies. Expert recommendations for increasing access to a regulated drug supply have repeatedly dismissed as solutions by the governing BC New Democratic Party, opting instead for measures that do not undercut the toxic drug supply. We examine the sociolegal context of the BC government decision to recriminalize drug use in 2024, including attempts to criminalize recent drug use and police suspicion of substance use. These drug law reforms, understood here as forms of biopolitical violence, reflect a broader trend of using drug policies as tools for social and spatial regulation. By analyzing the sociolegal implications of these policies, the commentary situates the BC government's actions within a framework of sanctioned biopolitical massacre, highlighting the tension between purported decriminalization efforts and the actual enforcement strategies that perpetuate harm and exclusion. This examination underscores the complex interplay between drug policy, public health crises, and state power in the context of systemic colonial and racialized control that may be adaptable to other regions considering drug law reform., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

The risk environment framework (REF) is a widely-accepted tool in policy research related to drug use. Its prevalence warrants a critical exploration of its strengths and weaknesses. This critical appraisal is a comprehensive analysis of the REF by definition and through relevant examples of its use within the context of public health evaluations, social science research, and epidemiological strategies in substance use-related policy. We examine the tensions inherent to a risk environment analysis, centering on its deficit-based lens of behavior, risk, and harm. This narrative review argues for shifts in frameworks within drug policy research away from individual- and community-level blame., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.