International Journal of Drug Policy最新文献

{"title":"Prescribing methadone in prison predicts linkage to HIV care after release from prison: A randomized and patient preference trial","authors":"Allison M. Mobley ,&nbsp;Martin P. Wegman ,&nbsp;Alexander R. Bazazi ,&nbsp;Sheela V. Shenoi ,&nbsp;Daniel J. Bromberg ,&nbsp;Ahsan Ahmad ,&nbsp;Adeeba Kamarulzaman ,&nbsp;Frederick L. Altice","doi":"10.1016/j.drugpo.2025.104733","DOIUrl":"10.1016/j.drugpo.2025.104733","url":null,"abstract":"<div><h3>Purpose</h3><div>The transition from prison is hazardous, especially for people with HIV and opioid use disorder. To determine the impact of methadone on linkage to HIV care in people with HIV and opioid use disorder, we prospectively compared those allocated to pre-release methadone or not.</div></div><div><h3>Methods</h3><div>A prospective, open-label trial of 310 people with HIV and opioid use disorder at Malaysia's largest prison were allocated to pre-release methadone up to 24 weeks before release or not by randomization (<em>n</em> = 64) or preference (<em>n</em> = 246); 296 were included in the final analytical sample. Directed acyclic graphing was used to theorize the relationship between pre-release methadone and post-release linkage to HIV care and identify confounding variables. An inverse probability weighted Cox proportional hazards model estimated the impact of pre-release methadone on linkage to HIV care through 360 days after release.</div></div><div><h3>Results</h3><div>Overall, 218 (73.6 %) of 296 study participants initiated methadone before release. Receiving pre-release methadone significantly predicted linkage to HIV care at all time points through 360 days (aHR = 1.87; 95 % CI 1.15–2.85) after release. The corresponding numbers needed to treat with pre-release methadone for one increased linkage to HIV care at 30 and 360 days were 14 (95 % CI 9.2–62.4) and 5 (95 % CI 3.4–22.0), respectively.</div></div><div><h3>Conclusions</h3><div>While treatment with methadone should be available to everyone with opioid use disorder, it should especially be included as part of an HIV treatment-as-prevention strategy for people in prisons, especially by the time of release. It can optimize HIV treatment outcomes by jumpstarting the HIV treatment cascade.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104733"},"PeriodicalIF":4.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-spatial inequalities in alcohol outlet availability: Evidence from register data in 15 urban areas in Québec, Canada","authors":"Stephanie Sersli ,&nbsp;José Arturo Jasso Chávez ,&nbsp;Sienna Longo ,&nbsp;Philippe Apparicio ,&nbsp;Martine Shareck","doi":"10.1016/j.drugpo.2025.104732","DOIUrl":"10.1016/j.drugpo.2025.104732","url":null,"abstract":"<div><h3>Background</h3><div>Alcohol spatial availability is linked with public health issues, with disadvantaged populations experiencing disproportionate harm. This study examined the association between alcohol spatial availability and area-level measures of disadvantage and sociodemographic characteristics in Québec, Canada.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis using 2021 liquor register and census data across 15 Québec urban areas. Measures included outlet counts within 800 m buffers and a spatial access index. Multilevel regression models assessed associations with composite measures of area-level disadvantage and single-item measures of area-level sociodemographic characteristics.</div></div><div><h3>Findings</h3><div>On average, Québec areas exhibited higher offsite than onsite alcohol outlet availability. We found a J-shaped relationship between offsite alcohol availability and material disadvantage, with the most disadvantaged areas having 25 % more offsite outlets (95 % CI: 1.14–1.37) than the least disadvantaged. Conversely, onsite availability was 24 % lower (95 % CI: 0.67–0.87) in the most materially disadvantaged areas. Social disadvantage was associated with higher availability of both offsite and onsite outlets, with the highest socially disadvantaged areas having nearly 15 times as many onsite outlets (IRR 14.77, 95 % CI: 13.05–16.72) compared to the least disadvantaged. Higher population density and higher percentages of young adults, new immigrants, and recent movers were also associated with higher availability.</div></div><div><h3>Conclusion</h3><div>Alcohol availability differed by outlet type and disadvantage dimension. Offsite outlets were more common in both highly and minimally materially disadvantaged areas, while onsite outlets were more common in minimally disadvantaged areas. Socially disadvantaged areas had higher availability of both types of outlets. These findings suggest the need for targeted policies to reduce alcohol outlet availability, particularly in socially disadvantaged areas.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104732"},"PeriodicalIF":4.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143369530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine to improve access to medications for opioid use disorder in Illinois, 2022–2024","authors":"Kimberly Gressick ,&nbsp;Maria Fiorillo ,&nbsp;Sarah Richardson ,&nbsp;Maria Bruni ,&nbsp;Stacey Brenner ,&nbsp;Miao Hua ,&nbsp;Nik Prachand ,&nbsp;Nicole Gastala","doi":"10.1016/j.drugpo.2025.104729","DOIUrl":"10.1016/j.drugpo.2025.104729","url":null,"abstract":"<div><h3>Background</h3><div>Globally, opioid use remains a major public health problem. In 2019, 480,000 deaths were related to opioid use. Locally, mortality from opioid-involved overdose is high among Illinois residents, with 83 % of ∼4000 overdose deaths during 2022 involving opioids. Treatment for opioid use disorder with buprenorphine, methadone, and naltrexone is approved, safe, and effective. However, significant barriers to treatment remain for many persons.</div></div><div><h3>Methods</h3><div>In response to new prescribing policy flexibilities, in May 2022, the Chicago Department of Public Health and the Substance Use Prevention and Recovery Division of the Illinois Department of Human Services partnered with a statewide opioid treatment provider, Family Guidance Centers. The partnership started an immediate opioid use disorder treatment helpline program. We performed a descriptive analysis using aggregate data from all calls for assistance with substance use received by the Illinois Helpline during May 9, 2022–March 7, 2024.</div></div><div><h3>Results</h3><div>A total of 2649 unique calls were made to the helpline from persons seeking assistance with substance use, and 1698 unique callers were connected to Family Guidance Centers for treatment initiation. Most callers were prescribed buprenorphine by telemedicine, followed by methadone during in-person treatment. In total, 1515 (89.2 %) of 1698 callers with opioid use disorder were initiated on buprenorphine or methadone through the program.</div></div><div><h3>Conclusion</h3><div>A state-wide low-barrier access to medications by telemedicine program is an effective treatment model for the initiation of medications for opioid use disorder.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104729"},"PeriodicalIF":4.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143369531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical justifications for safe supply interventions","authors":"Travis N. Rieder","doi":"10.1016/j.drugpo.2025.104721","DOIUrl":"10.1016/j.drugpo.2025.104721","url":null,"abstract":"<div><div>The argument in favor of providing people who use drugs with a pure, regulated supply—an intervention often called “safe supply”—is very straightforward. North America is in the midst of a drug overdose crisis, driven largely by a toxic illicit drug supply. The solution practically presents itself, then: we could just give people access to pure, pharmaceutical-grade drugs, so they know what they're getting and can dose accurately. This idea that we need a “safe supply” is essentially harm reductionist: since people will use drugs, we should do what we can to reduce the secondary harms of that use. Although there is some risk inherent in taking drugs like opioids, those risks are massively increased by the toxic supply, and that's a risk we can mitigate. So we should.</div><div>Although the argument is clear and simple, it has not proved very successful in North America. The deep divide between advocates of safe supply (who see it as straightforwardly implied by plausible harm reduction commitments) and opponents of any form of harm reduction (who still adhere to a War on Drugs approach) has made it possible to avoid conducting a more nuanced ethical analysis of safe supply interventions. Thus, I want to suggest that we move past the most radical positions on the permissibility of safe supply, and instead evaluate the ethical issues that arise when we consider the concrete tradeoffs that arise with specific proposals. In particular, I will argue that a crucially important question for evaluating the ethics of a candidate safe supply intervention concerns the actual mechanism of supply, which determines how “low barrier” the intervention is.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104721"},"PeriodicalIF":4.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safer supply programs: Discussions on medication diversion, sharing, and selling","authors":"Marlene Haines ,&nbsp;Emily Hill ,&nbsp;Patrick O'Byrne","doi":"10.1016/j.drugpo.2025.104731","DOIUrl":"10.1016/j.drugpo.2025.104731","url":null,"abstract":"<div><h3>Background</h3><div>Nearly 50,000 people who use drugs have died as a result of the ongoing drug poisoning crisis in Canada. To directly address concerns surrounding this crisis, safer supply pilot programs were implemented in several communities across the country. Since program implementation, discussions surrounding medication diversion have proliferated. We conducted surveys and interviews with current program participants to better understand medication diversion within the context of safer supply programs.</div></div><div><h3>Methods</h3><div>Safer supply program participants were recruited in Ottawa, Canada to complete semi-structured interviews and surveys. Surveys collected socio-demographic and substance use data. Survey results were reported using descriptive statistics. Semi-structured interviews were audio-recorded, transcribed, and analyzed thematically.</div></div><div><h3>Results</h3><div>30 people participated in this study. From interviews, seven themes arose on the topic of diversion, including 1) diversion in the context of being a person who uses drugs, 2) safety, 3) compassion, 4) meeting needs, 5) survival, 6) coercion, and 7) protecting youth.</div></div><div><h3>Conclusion</h3><div>Discussions with participants highlighted the importance of understanding why medication diversion occurs. Important factors influencing medication diversion included the need for safety, compassion, meeting needs, survival, and coercion faced by people who use drugs. Ultimately, medication diversion can be best understood as a measure implemented by people who use drugs to protect and care for their underserved community.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104731"},"PeriodicalIF":4.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the affordability of cigarettes associated with the prevalence of smoking and quitting at the regional level in Russia?","authors":"Liudmila Zasimova,&nbsp;Marina Kolosnitsyna","doi":"10.1016/j.drugpo.2025.104726","DOIUrl":"10.1016/j.drugpo.2025.104726","url":null,"abstract":"<div><h3>Introduction</h3><div>Tobacco prices and income determine the affordability of cigarettes. Affordability in turn affects smoking prevalence. Both prices and incomes can vary widely across a large country. The aim of this paper is to find out whether there is an association between affordability of cigarettes and smoking/cessation prevalence across Russian regions. We assess the proportions of people who smoke and those who smoked and quit.</div></div><div><h3>Methods</h3><div>We use microdata from a repeated survey on the living conditions of the Russian population that is representative at the regional level (2014, 2016, 2018, 2020, 2022, 77 regions). We aggregate the microdata by region and combine them with official macro data. Using descriptive and multivariable analyses, we identify factors that correlate with the prevalence of smoking and quitting in the regions.</div></div><div><h3>Results</h3><div>A one per cent increase in real prices was associated with a 0.1% decrease in the smoking prevalence rate and with a 0.2% increase in quitting prevalence rate. A 1% decrease in real income is associated with a 0.5% increase in the proportion of those who quit. The more cigarettes that can be purchased for a daily per capita income, the higher the smoking prevalence rate and the lower the proportion of quitting, with affordability elasticities of 0.1 and -0.27 respectively.</div></div><div><h3>Conclusions</h3><div>Rising real prices, as well as reduced affordability of cigarettes not only reduce the proportion of people who smoke, but also increase the proportion of those who quit. In a country with a large geographical spread and high regional income inequality, tobacco taxes should be set at the regional level to eliminate significant differences in the affordability of cigarettes.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104726"},"PeriodicalIF":4.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the association between cannabis decriminalization and legalization and cannabis arrests and related disparities: A Systematic review","authors":"Stephen D.S. McCarthy ,&nbsp;Adrienne Gaudreault ,&nbsp;Jennifer Xiao ,&nbsp;Benedikt Fischer ,&nbsp;Wayne Hall ,&nbsp;Kathryn Lee ,&nbsp;Rachel Kang ,&nbsp;Garry Aslanyan ,&nbsp;Manish M. Sood ,&nbsp;Daniel T. Myran","doi":"10.1016/j.drugpo.2025.104705","DOIUrl":"10.1016/j.drugpo.2025.104705","url":null,"abstract":"<div><h3>Background</h3><div>While a key goal of liberalizing cannabis policy is to reduce harms related to criminal justice involvement, the degree to which this occurs and how it varies by policy format is uncertain. We completed a systematic review of changes in cannabis offences overall and across subgroups after cannabis policy liberalization.</div></div><div><h3>Methods</h3><div>A search of 7 databases was conducted for studies examining changes in cannabis offences, including arrests, charges, convictions, and referrals, before and after cannabis policy changes. Four types of cannabis policy change were considered: medical legalization, non-medical decriminalization, non-medical legalization, and non-medical commercialization. Changes for each policy change were examined overall and across race/ethnicity, youth (&lt;18) vs adult (18 or 21+), and sex. Evidence was analyzed by Synthesis without Meta-analysis.</div></div><div><h3>Results</h3><div>From 2,806 studies, 17 studies set in North America were included (15 USA, 2 Canada). In regions where non-medical cannabis was criminalized, 0 % of studies (0/4) showed a significant reduction in cannabis offences after medical legalization, 100 % of studies (7/7) showed significant reductions after decriminalization, and 75 % of studies (6/8) showed significant reductions after non-medical legalization with reductions in offences ranging from 13.5 % to 78.0 % for decriminalization and 33 % to 87 % for legalization. In jurisdictions that had decriminalized cannabis use, non-medical legalization was associated with further significant reductions in cannabis offences in 67 % of studies (2/3), with reductions in offences ranging from 35 % to 84.2 %. There were insufficient studies on the effects of expanded non-medical commercial access (<em>n</em> = 2). Decriminalization was associated with a significant reduction in cannabis offences in all studies in youth (5/5) and 85 % of studies in adults (6/7). However, legalization was associated with significant reductions in youth offences in 33 % (1/3) of studies compared to 100 % (4/4) of studies in adults. Despite absolute reductions in cannabis offences after decriminalization and legalization across racial and ethnic groups, changes in relative disparities between groups were variable, increasing in some cases while decreasing in others.</div></div><div><h3>Conclusion</h3><div>Non-medical cannabis decriminalization and legalization are both associated with reductions in cannabis offences. Reductions in cannabis offences were consistently observed after legalization in adults but were not consistently observed in youth. Persistent socio-ethnic disparities in cannabis offences emphasize the need for additional mitigation strategies.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104705"},"PeriodicalIF":4.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the risk environment for peers with lived-living experience working in the alcohol and other drugs sector in Queensland","authors":"Timothy Piatkowski ,&nbsp;Emma Kill ,&nbsp;Cameron Duff ,&nbsp;Kailas Jenkins ,&nbsp;Kyra Hamilton","doi":"10.1016/j.drugpo.2025.104725","DOIUrl":"10.1016/j.drugpo.2025.104725","url":null,"abstract":"<div><h3>Introduction</h3><div>Peer workers in the Alcohol and Other Drugs (AOD) sector play a vital role in harm reduction for people who use drugs (PWUDs); however, their experiences are often shaped by complex macro- and micro-risk environments. This study explores these environments and their implications for peer workers, particularly concerning stigma, legal barriers, and organisational culture.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with 18 peers with lived-living experience of illicit drug use. Purposive sampling was employed, leveraging established peer networks and community organisations. Interviews (range = 42–90 mins) were conducted via Microsoft Teams, transcribed, and analysed. The iterative coding process involved deductive codes based on predetermined topics and inductive codes derived from identified themes.</div></div><div><h3>Results</h3><div>Participants identified key systemic challenges, including peer stigma, limited career prospects, and the complexities of navigating legal frameworks that criminalise drug use, thereby undermining the efficacy of peer work. The interplay between regulatory frameworks and societal attitudes creates barriers to employment, which disproportionately affects people with drug-related offenses. The significance of collective connection as a source of safety and support was also highlighted, particularly through peer supervision, which fosters enabling environments that promote wellbeing.</div></div><div><h3>Discussion</h3><div>Findings highlight the need for advocacy towards legal reform and the creation of inclusive organisational cultures. Recognising and valuing the LLE of peer workers is essential for enhancing harm reduction initiatives and promoting the wellbeing of PWUDs. Addressing these macro- and micro-risk factors, including the importance of peer supervision, can improve peer workers' efficacy in providing meaningful support within their communities.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104725"},"PeriodicalIF":4.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consent and violence amongst men in the context of sexualised drug use: A systematic scoping review","authors":"Dean J. Connolly ,&nbsp;Santino Coduri-Fulford ,&nbsp;Katherine Macdonald ,&nbsp;Gail Gilchrist ,&nbsp;Luke Muschialli","doi":"10.1016/j.drugpo.2025.104706","DOIUrl":"10.1016/j.drugpo.2025.104706","url":null,"abstract":"<div><div>Sexualised drug use (SDU) is a highly prevalent phenomenon of increasing public health significance in communities of men who have sex with men (MSM). This prospectively registered PRISMA-ScR-adherent systematic scoping review examines the current state of knowledge surrounding violence amongst MSM in the context of SDU. A broad search was conducted across four databases, with no restrictions. Studies citing or cited by all database-identified records retained for full-text review were retrieved and screened. Three journals were hand-searched across the past five years, and three searches were conducted on Google Scholar. In addition, 13 key opinion leaders were contacted via email to request any additional published or unpublished data. The twenty-eight studies included in the final synthesis reported mostly qualitative data from geographically diverse non-representative samples, predominantly relating to sexual violence with other typologies seldom investigated or reported. Although quantitative data were limited, sexual violence appeared common in this context and was directly associated with impaired mental health and suicidality. Some participants reported first- or second-hand accounts of non-consensual administration of incapacitating doses of GHB/GBL to men who were subsequently raped. This was frequently perpetrated by men whose age, status, or financial privilege afforded them power over their victims. While reports from some participants suggested context-specific blurring of the lines of consent, a few quotes demonstrated a dearth of knowledge surrounding the centrality of consent in lawful sex. Given the historical denigration of MSM, any efforts to further investigate or address this issue must be community-led.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"136 ","pages":"Article 104706"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards a dynamic processual model of psychedelic microdosing","authors":"Jason Hughes ,&nbsp;Joshua Stuart-Bennett ,&nbsp;Michael Dunning ,&nbsp;Hannah Farrimond","doi":"10.1016/j.drugpo.2024.104691","DOIUrl":"10.1016/j.drugpo.2024.104691","url":null,"abstract":"<div><h3>Background</h3><div>Existing research highlights an increase in psychedelic microdosing, particularly for therapeutic purposes and as a means for self-enhancement. However, we know little about the different routes into and out of microdosing, particularly by those who do not consume other illicit substances, and of the processes involved in the development, maintenance, and cessation of practices.</div></div><div><h3>Methods</h3><div>Drawing upon a trans-national interview-based study of 23 participants actively microdosing (<em>n</em> = 19), about to start (<em>n</em> = 3), or who were past users (<em>n</em> = 1), we develop a phased-based analysis of different user pathways.</div></div><div><h3>Results</h3><div>We identify key phases as: ‘Awareness/Discovery’, where participants became aware of microdosing; ‘Research/Reframing’, where they researched access, techniques, and undertook ‘stigma work’ to reframe risks; ‘Access/Supply’ where they sought reliable and safe sources of psychedelics and cultivated attitudes/practices/substances for longer-term use; ‘Experimentation/Differentiation’ where participants altered dosing levels/schedules and, inter-relatedly, differentiated ‘effects’ and ‘benefits’; ‘Independence/Incorporation’ where they stabilised practices into patterns ‘right for them’; and ‘Expansion/Advocacy’ where microdosing was linked to greater inter- and intrapersonal ‘expansiveness’.</div></div><div><h3>Conclusions</h3><div>Pathways in and out of microdosing are multilinear and differentiated. Nonetheless, a dynamic processual approach helps highlight the overall structure of changes involved which, we find, can entail a shift towards greater temporal and relational ‘expansiveness’, greater independence, and more incorporated practices. These shifts necessitated considerable ‘work’ variously to negate stigma, maintain supply, determine dose, document shifts, and other kinds of material–symbolic ‘investment’. We also show the significance of processual/phased-based models beyond psychedelics to better understand drug-use journeys and temporalities which confound conventional dependency-focused paradigms.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"136 ","pages":"Article 104691"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}