| 2013 | |
| [20] | Harms caused by China's 1906–17 opium suppression intervention , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractAbstract Between 1906 and 1917 China (under the Imperial and then Republican regimes) enacted a highly effective intervention to suppress the production of opium. Evidence from British Foreign Office records suggest that the intervention was centred, in many areas, upon a highly repressive incarnation of law enforcement in which rural populations had their property destroyed, their land confiscated and/or were publically tortured, humiliated and executed. Crops were forcefully eradicated and resistance was often brutally suppressed by the military. As few farmers received compensation or support for alternative livelihood creation the intervention pushed many deeper into poverty. Importantly, the repressive nature of the opium ban appears to have been a contributing factor to the fragmentation of China, highlighting the counter-productivity of repressive interventions to reduce drug crop production. Keywords |
| [19] | The OxyContin crisis: Problematisation and responsibilisation strategies in addiction, pain, and general medicine journals , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground OxyContin® (Purdue Pharma, L.P., Stamford, CT) is now widely regarded as a drug of abuse fueling a larger opioid health crisis. While coverage in the North American press about OxyContin overwhelmingly focused upon the problems of related crime and addiction/misuse and the perspectives of law enforcement officials and police, coverage in those fields of medicine most intimately concerned with OxyContin—pain medicine and addiction medicine—was more nuanced. Methods In this article, we draw upon the constructivist social problems tradition and Hunt's theory of moral regulation in a qualitative analysis of 24 medical journal articles. We compare and contrast pain medicine and addiction medicine representations of the OxyContin problem, the agents responsible for it, and proposed solutions. Results While there are some significant differences, particularly concerning the nature of the problem and the agents responsible for it, both pain medicine and addiction medicine authors ‘take responsibility’ in ways that attempt to mitigate the potential appropriation of the issue by law enforcement and regulatory agencies. Conclusions The responses of pain medicine and addiction medicine journal articles represent strategic moves to recapture lost credibility, to retain client populations and tools necessary to their jobs, and to claim a seat at the table in responding to the OxyContin crisis. KeywordsSocial problems |
| [18] | First insights into community pharmacy based buprenorphine-naloxone dispensing in Finland , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground Finnish community pharmacies have been permitted to dispense buprenorphine-naloxone since February 2008. This study explored the dispensing practices, service experiences, problems encountered and opportunities for future development. Methods In August 2011, a questionnaire was mailed to all Finnish community pharmacies dispensing buprenorphine-naloxone (n&xa0;=&xa0;69). Results Sixty-four pharmacies responded (93%), of which 54 had dispensed buprenorphine-naloxone to 155 clients since 2008. Forty-eight pharmacies had 108 current clients (10% of all buprenorphine-naloxone clients in Finland). Overall satisfaction with buprenorphine-naloxone dispensing was high, with all respondents indicating dispensing had gone ‘well’ or ‘very well’. Fourteen pharmacies (26%) had experienced one or more problems, predominately in relation timing or non-collection of doses. Problems were more common in pharmacies with more than one buprenorphine-naloxone client (odds ratio 1.39, 95% confidence interval 1.05–1.86). Most pharmacies (n&xa0;=&xa0;43, 80%) identified opportunities for improvement, including the need for more education and financial remuneration. Forty-six pharmacies (85%) were willing to dispense buprenorphine-naloxone to more clients; however, 43 pharmacies (80%) perceived that supervision of buprenorphine-naloxone dosing is not a suitable task for pharmacists in Finland. Conclusion Provision of buprenorphine-naloxone in Finnish community pharmacies has remained relatively small-scale. As experiences have been generally positive and problems rare, it may be possible to expand these services. KeywordsOpioid substitution treatment |
| [17] | Injection drug users’ involvement in drug dealing in the downtown eastside of Vancouver: Social organization and systemic violence , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractAbstractBackground Illicit drug markets are a key component of the risk environment surrounding injection drug use. However, relatively few studies have explored how injection drug users’ (IDUs) involvement in drug dealing shapes their experiences of drug market-related harm. This exploratory qualitative study aims to understand IDUs’ dealing activities and roles, as well as the perceived benefits and risks related to participation in illicit drug markets, including experiences of drug market violence. Methods Ten \IDUs\ with extensive involvement in drug dealing activities were recruited from the Vancouver Injection Drug User Study (VIDUS) and participated in semi-structured qualitative interviews, which elicited discussion of experiences dealing drugs, perceived benefits and hazards related to dealing, and understandings of drug market violence. Results Participant's involvement in drug market activities included corporate sales, freelance or independent sales, and opportunistic sales termed “middling” as well as drug market-related hustles entailing selling bogus drugs and robbing dealers. Participants primarily dealt drugs to support their own illicit drug use, and we found that arrest and criminal justice involvement, hazards stemming from drug debts, and drug market-related violence were key risks related to dealing activities. Conclusion The challenges of managing personal consumption while selling drugs exacerbates the hazards associated with drug dealing. Efforts to address drug dealing among \IDUs\ should consider both drug dependency and the material conditions that propel drug users towards dealing activities. Interventions should explore the potential of combining enhanced drug treatment programs with low threshold employment and alternative income generation opportunities. Keywords |
| [16] | The impact of New Zealand's 2008 prohibition of piperazine-based party pills on young people's substance use: Results of a longitudinal, web-based study , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground The last decade has seen the emergence of a new phenomenon in recreational substance use with the availability of herbal and synthetic, unregulated, psychoactive drugs in the market place; alongside this, international concern has developed in relation to their use and associated harms. New Zealand (NZ) was one of the first countries to experience this new phenomenon, with products containing chemicals of the piperazine group – mainly benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP). In 2008, the \NZ\ Government prohibited these substances, but allowed a 6-month amnesty period for possession. Our study aimed to obtain a measure of change in \BZP\ use over time. Methods This study used a longitudinal, web-based survey, with data collected at two time points from the same participants. The first survey was carried out 3 months after \BZP\ prohibition, and included retrospective questions for the 6 months preceding the survey. The second survey was conducted 9 months after prohibition and also included retrospective questions for the 6 months preceding the survey. Results 273 sets of paired data were identified. The use of \BZP\ party pills (p&xa0;<&xa0;0.0001) and legally available smokeable products (p&xa0;=&xa0;0.002) reduced over time. A majority of users of party pills obtained them from friends or from their own stockpiled supplies. The misuse of prescription drugs (p&xa0;=&xa0;0.02) increased over time, whereas statistically significant increases in stimulant or alcohol use were not noted. Conclusion Following prohibition of piperazine-based party pills, we noted a significant reduction in the proportions of participants using them. The observed increase in the misuse of prescription medicines may relate to their perceived ‘quality’, or as being less ‘illegal’ than illicit drugs. KeywordsDrug policy |
| [15] | Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractAbstractBackground Crack use constitutes a major problem in cities across Brazil. While existing data suggest that crack use is generally concentrated among disenfranchised young people with extensive health problems and crime involvement, extensive data gaps exist. To address this issue, this study aimed to assess key characteristics of young crack users in two Brazilian cities. Methods N&xa0;=&xa0;160 regular and young adult (ages 18–24) crack users were recruited by community-based methods in the cities of Rio de Janeiro (Southeast) and Salvador (Northeast). Assessments included an interviewer-administered questionnaire on key social, drug use, health and service use characteristics, as well as serological testing of HBV, \HCV\ and \HIV\ status, and were conducted anonymously between November 2010 and June 2011. Participants provided informed consent and received transportation vouchers following assessment completion. The study was approved by institutional ethics review boards. Results The majority of participants were: male, with less than high school education, unstably housed (Rio only); gained income from legal or illegal work; arrested by police in past year (Salvador only); had numerous daily crack use episodes and shared paraphernalia (Salvador only); co-used alcohol, tobacco, cannabis and cocaine; had no injection history; rated physical and mental health as ‘fair’ or lower (Salvador only); had unprotected sex; were never \HIV\ tested; were not HIV, \HBV\ or \HCV\ positive; and did not use existing social or health services, but desired access to crack user specific services. Conclusion Crack users in the two Brazilian sites featured extensive socio-economic marginalization, crack and poly-drug use as well as sexual risk behaviours, and compromised health status. Social and health service utilization are low, yet needs are high. There is an urgent need for further research and for targeted interventions for crack use in Brazil. Keywords |
| [14] | Patterns of alcohol, tobacco and cannabis use and related harm in city, regional and remote areas of Australia , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground Prevalence of substance use and related harms differs across geographic locations, with prevalence increasing with remoteness. This paper builds on previous research, investigating patterns of problematic use by remoteness. Methods Analysis of the National Drug Strategy Household Survey (NDSHS) data from 2007 by geographic location (in accordance with the Australian Standard Geographical Classification (ASGC) remoteness index). Results Problematic cannabis use was predicted by demographics; older males with less education were more likely to report problematic cannabis use regardless of location. Younger, less educated males in inner regional and remote areas were more likely to report risky alcohol consumption for short term harms, while older, less educated males in outer regional and remote areas were more likely to report daily drinking. People from remote areas were significantly more likely to report driving under the influence of alcohol. Conclusions It is clear that men with lower levels of education were significantly more likely to report problematic alcohol and cannabis use patterns. An additional level of risk is associated with living in inner regional and remote areas, particularly in relation to risky drinking. Findings suggest a complex relationship between remoteness and substance use which requires further investigation. KeywordsRural |
| [13] | Structural factors that promote stigmatization of drug users with hepatitis C in hospital emergency departments , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground Interventions to mediate the stigmatization of people affected with HCV, particularly those who use illicit drugs, have been largely focused on changing health care practitioners’ attitudes and knowledge regarding Hepatitis C and illicit drug use and these have had disappointing results. There is a need for research that examines factors beyond individual practitioners that explains why and how stigmatization of the population occurs within health care and informs interventions to mitigate these factors. Methods The research was intended to identify structural factors that contribute to the structural stigmatization of people within hospital Emergency Departments who are current users of illicit drugs and are \HCV\ positive. The research had an interpretive description design and occurred in Nova Scotia, Canada. The year-long qualitative study entailed individual interviews of 50 service providers in hospital \EDs\ or community organizations that served this population. Results The research findings generated a model of structural stigmatization that greatly expands the current understanding of stigmatization beyond individual practitioners’ attitudes and knowledge and internal structures to incorporate structures external to hospitals, such as physician shortages within the community and the mandate of \EDs\ to reduce wait times. Conclusions The research reported herein has conceptualized stigmatization beyond an individualistic approach to incorporate the multifaceted ways that such stigmatization is fostered and supported by internal and external structures. KeywordsIllicit drug use |
| [12] | The Cedar Project: Impacts of policing among young Aboriginal people who use injection and non-injection drugs in British Columbia, Canada , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractAbstractBackground Policing has profound health implications for people who use illicit drugs. Among Aboriginal communities, distrust of police is common, due partly to legacies of colonial policing. In response to the paucity of research among Aboriginal people who use drugs, this paper aims to: (1) Describe the policing experiences of young Aboriginal people who use drugs; (2) Identify policing activities associated with unsafe injection practices; and (3) Elucidate barriers to positive police relations. Methods The Cedar Project is a cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. This mixed-methods study (N&xa0;=&xa0;372) used period prevalence from 2007 to 2010 to describe policing experiences, mixed effects regression models to identify correlates of policing activities, and thematic qualitative analysis to assess attitudes to police relations. Results Many participants were stopped by police (73%), experienced physical force by police (28%), had drug equipment confiscated (31%), and changed location of drug use because of police (43%). Participants who reported dealing drugs (40%) were significantly more likely to experience police engagement. Among participants in Prince George, 4% reported to have had non-consensual sex with members of the criminal justice system. Policing activity was significantly associated with syringe sharing, rushed injection, and reused syringe. Due to personal experience, practical concerns, and intergenerational legacies of unfair policing practices, most participants did not want a positive relationship with police (57%). Desire for a positive relationship with police was directly associated with being helped by police, and inversely associated with being stopped by police and experiencing physical force by police. Conclusion Policing activities may be impacting the well-being of Aboriginal people who use drugs. Due to focused prosecution of street-level drug dealing, some police may favor enforcement over harm reduction. Positive police engagement and less aggressive policing may enhance perceptions of police among young Aboriginal people who use drugs. Keywords |
| [11] | Keeping the focus on safer practices: A Safer Practices Lens , In International Journal of Drug Policy, volume 24, no. 5, 2013. () [bibtex] [doi] |
| [10] | Opiate substitution treatment to reduce in-prison drug injection: A natural experiment , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground There is emerging evidence that opiate substitution treatment (OST) in prison is associated with reduced injecting drug use (IDU). In Australia \OST\ is available in prison for men and women in all jurisdictions except Queensland, where it is available only for women. The aim of this study was to examine the association between in-prison \OST\ and in-prison \IDU\ in New South Wales (NSW) and Queensland. Methods Cross-sectional survey of Australian prisoners in \NSW\ (N&xa0;=&xa0;1128) and Queensland (N&xa0;=&xa0;1325). Lifetime \IDU\ and in-prison \IDU\ measured by self-report. Results Lifetime history of \IDU\ was significantly more common among females than males in both jurisdictions. Among those with a lifetime history of IDU, the lifetime prevalence of in-prison \IDU\ was significantly higher for males than females in both jurisdictions, however the magnitude of this sex difference was considerably greater in Queensland than in NSW. Conclusion Provision of \OST\ in prison is associated with a reduced lifetime prevalence of in-prison drug injection, among those with a lifetime history of IDU. Irrespective of \OST\ policies, women with a history of \IDU\ are less likely than their male counterparts to inject in prison; reasons for this novel and replicable sex difference require further examination. KeywordsAustralia |
| [9] | Building partnerships between law enforcement and harm reduction programs , In International Journal of Drug Policy, volume 24, no. 5, 2013. () [bibtex] [doi] |
| [8] | ‘Silk Road’, the virtual drug marketplace: A single case study of user experiences , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground: The online promotion of ‘drug shopping’ and user information networks is of increasing public health and law enforcement concern. An online drug marketplace called ‘Silk Road’ has been operating on the ‘Deep Web’ since February 2011 and was designed to revolutionise contemporary drug consumerism. Methods: A single case study approach explored a ‘Silk Road’ user's motives for online drug purchasing, experiences of accessing and using the website, drug information sourcing, decision making and purchasing, outcomes and settings for use, and perspectives around security. The participant was recruited following a lengthy relationship building phase on the ‘Silk Road’ chat forum. Results: The male participant described his motives, experiences of purchasing processes and drugs used from ‘Silk Road’. Consumer experiences on ‘Silk Road’ were described as ‘euphoric’ due to the wide choice of drugs available, relatively easy once navigating the Tor Browser (encryption software) and using ‘Bitcoins’ for transactions, and perceived as safer than negotiating illicit drug markets. Online researching of drug outcomes, particularly for new psychoactive substances was reported. Relationships between vendors and consumers were described as based on cyber levels of trust and professionalism, and supported by ‘stealth modes’, user feedback and resolution modes. The reality of his drug use was described as covert and solitary with psychonautic characteristics, which contrasted with his membership, participation and feelings of safety within the ‘Silk Road’ community. Conclusion: ‘Silk Road’ as online drug marketplace presents an interesting displacement away from ‘traditional’ online and street sources of drug supply. Member support and harm reduction ethos within this virtual community maximises consumer decision-making and positive drug experiences, and minimises potential harms and consumer perceived risks. Future research is necessary to explore experiences and backgrounds of other users. KeywordsEthnopharmacy |
| [7] | ‘You’ve got m@il: Fluoxetine coming soon!’: Accessibility and quality of a prescription drug sold on the web , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground The increasing phenomenon of online pharmacies has potential for serious public health problems. This study aimed to evaluate the possibility of accessing a prescription drug in the absence of a prescription for an Italian purchaser. Methods Fluoxetine pills were ordered from several online pharmacies. The study included website analysis, and the quality of the received product including packaging, chemical and microbiological analyses. Results Orders could be placed correctly on 61 of the 98 selected websites, and a sales transaction was concluded successfully on 17 websites. Thirteen drug samples were eventually received. In one case it was necessary to fill in a questionnaire before ordering the drugs. All websites displayed aggressive marketing strategies. There was wide variation in terms of domain registration, company base (when declared) and manufacturer's location (mostly India). All pills were delivered in sealed blister packs showing the lot number and manufacturer's details. A leaflet was enclosed in one case only. In three cases we received more pills than ordered, and in one case Viagra pills as a free gift. Pharmacopoeia microbiological requirements were satisfied. Chemical analysis revealed that the active principle was always present, although many samples did not meet the Pharmacopoeia “other impurities” or “total impurities” criteria. Heavy metals and solvents regulated by the Pharmacopoeia did not exceed the set limits; some of the non-regulated ones were also assessed, in some cases with a positive result (e.g. styrene). Conclusion About 20% of purchase attempts resulted in delivery of the drugs, even in the absence of a medical prescription. Traceability was poor and drug quality was generally worse compared to conventional pharmacy-purchased products. Based on all these broad-spectrum results, user safety appears not to be globally guaranteed. KeywordsInternet |
| [6] | An ambiguous monolith – The Swedish drug issue as a political battleground 1965–1981 , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground The drug problem has been a highly ideologized topic in the political debate in Sweden ever since the mid-1960s. The aim of the article is to investigate dominant conceptions of drugs, drug use, society and the individual in the political discussions on drug use in Sweden during the years 1965–1981. Methods The empirical basis for the textual analysis consists of 146 parliamentary bills and 135 parliamentary protocols. Results The unwanted drug appear as a sensitive litmus paper, an indication that something had gone wrong in society and as a suggestion of how the good society could be accomplished. The drug problem was connected to ideological core values such as class struggle, Christianity or criticism of urbanism and modernity. Conclusion The analysis suggests that the drug problem was used as political ammunition, to pick holes in political opponents and to highlight one's own ideological stance. The hegemonic conversational order, the consensual spirit and the agreement that this was the most serious problem, did not hamper these political moves. Rather, the cross-party conception of the problem's severity and accelerating deterioration contributed to a common ground for political arguments and ideological visions. It also meant that the political discussions moved away from the more obvious drug policy issues. Keywords20th century |
| [5] | The role of child protection in cannabis grow-operations , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractBackground This unique social work research examined the rationale for child protection interventions with families found living in illegal cannabis grow operations, based on the assumption of risk in the presence of probable medical harm. Methods The study examined the household, family and individual characteristics of 181 children found living in cannabis grow operations in two regions in British Columbia, Canada. Data was collected on-site on the physical characteristics of the homes, the health characteristics of the children, and their prescription drug history. Comparison of prescription drug use was also made with a group of children from the same geographic areas. Results This study found that there was no significant difference between the health of the children living in cannabis grow operations and the comparison group of children, based on their prescription history and their reported health at the time. Conclusion The findings of this study challenge contemporary child welfare approaches and have implications for both child protection social workers and the policymakers who develop frameworks for practice. KeywordsChild welfare |
| [4] | Injecting behaviour and service use among young injectors in Albania, Moldova, Romania and Serbia , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractAbstractBackground This study examines socio-demographic profiles, injecting risk and use of health services among young injectors (15–24) in Albania, Moldova, Romania and Serbia. The objective was to provide age-disaggregated data to identify differences between adolescents (<18) and youth (18–24), and help fill the gap in knowledge on the youngest injectors in this region. Methods Cross sectional surveys were conducted in each country using chain-referral sampling to reach diverse networks of people who use drugs (PWID). In Albania and Romania, surveys were conducted in the capitals, respectively, Bucharest and Tirana. Respondents were recruited from 3 cities in Moldova (Chisinau, Balti and Tiraspol) and Serbia (Belgrade, Novi Sad and Nis). Data were collected on risk behaviours, service use and contact with police and other authorities. Analysis focused on associations between unsafe injecting behaviour and key determinants including demographic background, source of needles/syringes, use of harm reduction services and interactions with law enforcement. Results Although drug use and health-seeking varied across settings, sources of injecting equipment were significantly associated with sharing needles and syringes in Moldova, Romania and Serbia. Obtaining equipment from formal sources (pharmacies, needle-exchange programmes) reduced likelihood of sharing significantly, while being stopped by the police or incarcerated increased it. Adolescents relied on pharmacies more than public sector services to obtain equipment. Conclusion Adolescents comprise a small proportion of \PWID\ in this region, but have poorer access to harm reduction services than older peers. Engaging young \PWID\ through private and public sector outlets might reduce unsafe practices, while use of the justice system to address drug use complicates efforts to reach this population. Keywords |
| [3] | The doping myth: 100&xa0;m sprint results are not improved by doping , In International Journal of Drug Policy, volume 24, no. 5, 2013. () [bibtex] [doi] |
| [2] | The contractual governance of drug users in treatment , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractOne of the challenges for drug treatment services is how to engage drug users effectively. This commentary examines one particular strategy for enhancing engagement that appears to have spread quite rapidly in recent years: the use of contract-like written agreements between treatment service providers and users. The development of the contractual governance of drug users in treatment is located in the wider context of emerging social control strategies and practices. In particular, insights are drawn from the socio-legal literature which has begun to examine these new control practices in diverse domains. The commentary also reports on the findings of a national survey of all 149 local authority areas in England that was designed to provide a preliminary mapping of the extent of contractual governance in treatment settings (response rate&xa0;=&xa0;62%). In spite of the fact that the use of contracts between drug services and service users does not feature in the national drug policy framework, our survey strongly indicates that it is a widespread practice. Although these agreements can take on many different forms, typically they set out the responsibilities and requirements placed on users and, somewhat less frequently, what the service commits to providing for them. This novel practice of contractual governance may be viewed as having considerable potential but it also raises important issues concerning justice and rights. We conclude by arguing that this is an important area of emerging practice which raises significant theoretical and policy questions and the need for further research. KeywordsRegulation |
| [1] | Patterns of excess alcohol consumption among school children in two English comprehensive schools , In International Journal of Drug Policy, volume 24, no. 5, 2013.AbstractAbstractBackground The patterns of excess alcohol consumption among children aged 11–15 years are not routinely assessed in England and neither are the alcohol consumption patterns of adolescents aged 16–18 years. The aim of the present research was to examine patterns of excess alcohol consumption among English school children aged 11–18 years. Methods 1230 children and adolescents, aged 11–18 years were surveyed about their alcohol consumption, and specifically their hazardous drinking, binge drinking and problem drinking. Results Sixteen per cent of 11 year olds and 71% of 18 year olds reported having drunk any alcohol in the previous seven days. Thirty-two per cent (n&xa0;=&xa0;199) of girls and 24% (n&xa0;=&xa0;142) of boys gave an affirmative answer to at least one of the \CAGE\ questions, indicating possible problem drinking. Hazardous drinking was associated with norms and age; binge drinking and problem drinking were associated with norms, age and gender. Conclusions The study provides further evidence to support the case that excessive alcohol consumption among girls now exceeds that of boys. It would be valuable to collect data on patterns of excess alcohol consumption routinely to enable policy makers to target information and resources appropriately. Keywords |