International Journal of Drug Policy最新文献

{"title":"How does climate change impact people who use alcohol and other drugs? A scoping review of peer reviewed literature.","authors":"Sarah MacLean, Julia de Nicola, Kimberlea Cooper, Heather Downey, Jacqui Theobald, Lisa de Kleyn, Todd Denham, Eleanor Costello, Lauren Rickards","doi":"10.1016/j.drugpo.2024.104649","DOIUrl":"https://doi.org/10.1016/j.drugpo.2024.104649","url":null,"abstract":"<p><strong>Background: </strong>The world has experienced devastating extreme weather events, alongside slow-onset processes including increasing temperature means, that scientists agree are manifestations of human-induced climate change. Even with radical action to reduce greenhouse gas emissions, effects of climate change will become increasingly severe.</p><p><strong>Objectives: </strong>The aim of this review was to classify impacts of climate change for people who use alcohol and other drugs (AoD), as reflected in peer reviewed literature.</p><p><strong>Method: </strong>A scoping review was conducted to achieve this. Included studies involved a human population, a climate change related exposure, and an AoD outcome. Studies were published in English between 1998 and November 2023. Exposure events of interest included extreme heat, fires, storms, floods, droughts, and longer-term environmental changes. 8,204 studies were screened, with 82 included for data extraction and narrative analysis.</p><p><strong>Results: </strong>Most papers describe increased AoD use, with smaller numbers showing decreased or unchanged substance use. Some studies identify unplanned withdrawal, changed drug markets, disrupted service access, specific physiological vulnerabilities of AoD users to extreme heat, and compounding effects on mental health. We note the relative absence of peer reviewed studies investigating impacts of climate change on AoD use in low-and middle-income countries. Further, few studies consider impacts that occur because of long-term or gradual climatic shifts such as environmental changes that are detrimental to livelihoods.</p><p><strong>Conclusion: </strong>It is crucial to document effects of a changing climate on people who use AoD so that policy and services can meet future needs. We call for research to remedy gaps identified in this review.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"104649"},"PeriodicalIF":4.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693733","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":"Increases in employment over six months following Khanya: A secondary analysis of a pilot randomized controlled trial of a peer-delivered behavioral intervention for substance use and HIV medication adherence in Cape Town, South Africa.","authors":"Jennifer M Belus, Kristen S Regenauer, Thanh Lu, Sean M Murphy, Alexandra L Rose, Yvonne Akinyi Ochieng, John Joska, Sybil Majokweni, Lena S Andersen, Bronwyn Myers, Steven A Safren, Jessica F Magidson","doi":"10.1016/j.drugpo.2024.104632","DOIUrl":"https://doi.org/10.1016/j.drugpo.2024.104632","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence suggests that brief, skills-based behavioral interventions are effective at improving clinical outcomes related to substance use and HIV, but little data exists on whether such interventions can incidentally improve employment. We examined preliminary changes in employment over six months following Khanya, a brief peer-delivered behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence compared to enhanced treatment as usual (ETAU).</p><p><strong>Methods: </strong>Adults living with HIV (N = 61) with at least moderate substance use and ART non-adherence were recruited from a primary care clinic in Khayelitsha, South Africa, a community with high rates of unemployment. Participants were randomized 1:1 to Khanya versus ETAU and assessed at baseline, 3- and 6-months. Employment was categorized as unemployed, casually, or full-time employed. Multilevel modeling was used to predict log odds and probability of categorical employment status over time, by arm.</p><p><strong>Results: </strong>At baseline, 78.7% of the sample were unemployed, 16.4% were casually employed, and 4.9% were employed full-time. There was a significant increase in employment in both treatment arms at 3-months (p = 0.03) but only the Khanya arm demonstrated significant increases at 6-months (p = 0.02). At 6-months, 59% of participants in Khanya had any employment (from 13% at baseline), compared to 38% in ETAU (from 29% at baseline).</p><p><strong>Conclusions: </strong>Study data suggest a brief behavioral intervention for substance use and ART adherence may support employment among people with HIV living in a resource-constrained community. However, future research with larger sample sizes and longer-term follow ups is needed to replicate these findings.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"104632"},"PeriodicalIF":4.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693652","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":"The criminal careers of Australian drug traffickers.","authors":"Don Weatherburn, Michael Farrell, Wai-Yin Wan, Sara Rahman","doi":"10.1016/j.drugpo.2024.104650","DOIUrl":"https://doi.org/10.1016/j.drugpo.2024.104650","url":null,"abstract":"<p><strong>Background: </strong>Very few studies have examined the criminal careers of drug traffickers. Our aim in this study was to determine (a) the percentage of drug traffickers who cease involvement in crime following their first conviction for drug trafficking, (b) the factors that affect the likelihood and speed of re-offending among drug traffickers, (c) the factors that affect the rate of reoffending among drug traffickers and (d) the scale of drug trafficker involvement in crimes other than drug trafficking.</p><p><strong>Methods: </strong>We characterize the criminal careers of a sample of 30,020 cases of offenders convicted of drug trafficking in New South Wales (NSW), Australia over the 29-year period between 2000 and 2023, focussing on how drug charge, trafficker type, and drug and alcohol use affect the risk and frequency of offending. We use a combination of descriptive statistics, cure fraction regression and negative binomial regression. Our controls in the regression analyses consist of age, age of first conviction and number of prior convictions.</p><p><strong>Results: </strong>The 'cure' rate among males aged 30-39 who were first convicted between 19 and 35 years of age, whose principal offence is trafficking in a non-commercial quantity of heroin, who have three prior convictions and who score 'moderate' in terms of the LSI-R drug/alcohol scale is 31 per cent. The instantaneous risk of re-offending among ATS, heroin, cannabis and ecstasy traffickers ranges between 62 and 82 per cent higher than among cocaine traffickers. Convicted drug traffickers commit a wide variety of offences but only a small proportion are convicted of drug offences before or after their first conviction for drug trafficking.</p><p><strong>Conclusions: </strong>The present study raises two important questions for future research. The first concerns whether those involved in drug trafficking in Australia rely on it as a primary source of income or whether it is just one of several income-generating criminal activities they switch between in the course of a criminal career. The second question is why there are such marked differences in the risk, speed and frequency of offending among traffickers of different drugs.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"104650"},"PeriodicalIF":4.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693654","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":"Impact of the COVID-19 pandemic on cannabis cultivation and use in 18 countries.","authors":"Bernd Werse, Gerrit Kamphausen, Thomas Friis Søgaard, Daniel Bear, Martin Audran, Chris Wilkins, Gary Potter, Davide Fortin, Pekka Hakkarainen, Rita Faria, Jorge Quintas, Jodie Grigg, Marie Jauffret-Roustide, Monica J Barratt","doi":"10.1016/j.drugpo.2024.104652","DOIUrl":"https://doi.org/10.1016/j.drugpo.2024.104652","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic and the accompanying measures to mitigate infection affected many areas of society, including the supply and use of cannabis. This paper explored how patterns of behaviour among people who cultivate cannabis were affected by the COVID-19 pandemic and restrictions.</p><p><strong>Methods: </strong>An anonymous web survey of people who cultivated cannabis was conducted from Aug 2020 to Sep 2021, spanning 18 countries and 11 languages (N = 11,479). Descriptive statistics and mean comparison tests were conducted.</p><p><strong>Results: </strong>Most cannabis growers reported that their practices were relatively unaffected by the COVID-related restrictions. While 35.2 % reported difficulties buying cannabis from their usual dealer, <10 % stated that access to materials needed for growing was impaired during the pandemic. Over one-quarter (28.2 %) of respondents increased their cannabis use and 21.4 % also increased cannabis cultivation (more than twice as many as those who said they were growing less or not anymore) while COVID restrictions were in place. People who lost their job or were casually employed were more likely to increase use and cultivation. Overall, the pandemic had little impact on reasons for growing, however, difficulties obtaining cannabis were mentioned as the most prevalent COVID-19-related growing motive. A small number (16 %) reported starting their growing activity during the pandemic. Italian and Portuguese growers were more likely to report shortages in supply and increases in their growing activity.</p><p><strong>Conclusions: </strong>This study is the first to document an increase in cannabis cultivation activity following COVID restrictions. Increased home cultivation was not only driven by higher use as a result of home isolation, but also by disruptions of wider illegal cannabis supply. Limitations of this study include the non-representativeness of the sample as well as differences in approaches and duration of restrictions in different countries.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":" ","pages":"104652"},"PeriodicalIF":4.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693732","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":"\"No penalties. No arrests. No jails\": Perspectives on drug decriminalization among people who inject drugs in Sydney.","authors":"George Christopher Dertadian, Vicki Sentas","doi":"10.1016/j.drugpo.2024.104657","DOIUrl":"https://doi.org/10.1016/j.drugpo.2024.104657","url":null,"abstract":"<p><p>The decriminalization of drug possession in varied forms is gaining some traction around the world. Yet prospects for people with lived and living experience of drug use to influence the direction of drug law and policy reform remains bound by stigma and exclusion. This study considers the aspirations for decriminalization of people who inject drugs through 20 semi-structured qualitative interviews with the clients of the Sydney injecting centre. What does decriminalization mean for those most criminalised by drug law and policy? The study found that participants' views of what is possible for decriminalization are mediated by the same structures and experiences of criminalization, incarceration and exclusion that has disrupted their lives. Participants anticipate the need to mobilise incremental and partial changes associated with de facto models, including fines, increased police discretion (and therefore power) and treatment orders. At the same time, participants collective imaginary also exceeds the limits of a police-controlled depenalization. We document people's claims on a future drug policy that speaks to a world without criminal drug offences, punitive controls and the exclusion of people who use drugs from the policy table.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"104657"},"PeriodicalIF":4.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689159","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":"Tackling the overdose crisis through unionization a response to Rivera & Friedman (2024).","authors":"Abdullah Shihipar, Brandon D L Marshall","doi":"10.1016/j.drugpo.2024.104659","DOIUrl":"https://doi.org/10.1016/j.drugpo.2024.104659","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"104659"},"PeriodicalIF":4.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689143","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":"\"Tethered to this ball and chain\": Women's perspectives on bodily agency within opioid treatment programs.","authors":"Aden McCracken, Kristina Brant, Carl Latkin, Abenaa Jones","doi":"10.1016/j.drugpo.2024.104645","DOIUrl":"https://doi.org/10.1016/j.drugpo.2024.104645","url":null,"abstract":"<p><strong>Background: </strong>Methadone Maintenance Treatment (MMT) reduces the risks associated with opioid use disorder (OUD), including overdose mortality and HIV/HCV transmission, and promotes patient well-being. Nonetheless, MMT is highly underutilized in the United States, with less than 10 % of those with OUD receiving MMT. This study examines how women's feelings of bodily agency while receiving MMT through Opioid Treatment Programs (OTPs) can impact treatment retention.</p><p><strong>Methods: </strong>In-depth interviews were conducted with 20 women in Pennsylvania with a lifetime history of criminal legal involvement and use of medications for opioid use disorder (MOUD), and 12 substance use disorder (SUD) treatment professionals who work with criminal-legal involved women using MOUD. A thematic analysis was conducted using iterative rounds of inductive coding.</p><p><strong>Results: </strong>While women attested to the profound benefits which methadone treatment can provide, they also described how both formal and informal policies in the OTP system can taper these benefits by diminishing their feelings of bodily agency. Women reported a lost sense of bodily agency due to being unable to provide input in the dosing process, navigating strict requirements that tied medication receipt to compliance, and facing mistreatment or threats of punishment when committing perceived transgressions. Women responded through actions that reclaimed bodily agency, by either leaving treatment or using illicit drugs while in treatment; both of these actions can end women's engagement with treatment. Finally, evidence suggests that these feelings of lost agency may be particularly prevalent among female patients due to gendered judgments about women's histories and capabilities.</p><p><strong>Conclusion: </strong>Findings suggest the need for MMT programs to shift toward patient-centered, trauma-informed care informed by harm-reductionist principles. Concrete policy recommendations include reducing measures of surveillance, prohibiting administrative discharge due to the use of other substances, and expanding access to methadone beyond OTPs.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"104645"},"PeriodicalIF":4.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683062","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":"Opioid agonist treatment programs and hepatitis C virus elimination in Taiwan: Ways of expanding the care cascade in screening and treatment","authors":"Yu-Chu Ella Chung ,&nbsp;Ching-Ing Tseng ,&nbsp;Sheng-Chang Wang ,&nbsp;Chieh-Liang Huang ,&nbsp;Lian-Yu Chen ,&nbsp;Raoh-Fang Pwu ,&nbsp;Ching-Ching Claire Lin ,&nbsp;An-Nie Chung ,&nbsp;Jing-Shu Lin ,&nbsp;Wei J. Chen","doi":"10.1016/j.drugpo.2024.104658","DOIUrl":"10.1016/j.drugpo.2024.104658","url":null,"abstract":"<div><h3>Background</h3><div>One key population related to achieving the global goal of hepatitis C virus (HCV) elimination is people who inject drugs (PWID). By surveying opioid agonist treatment (OAT) programs nationwide in Taiwan, this study aimed to examine (1) the current status of HCV care cascade provision by OAT programs and (2) the opinions of the programs’ directors on integrating the HCV care cascade into OAT programs.</div></div><div><h3>Methods</h3><div>From September to November 2022, questionnaires were sent via administrative networks to case managers for information on daily operation and routine booking and to directors for information on the HCV care cascade of 185 OAT programs. The responses of the 125 OAT programs that provided information from both case managers and directors were included for subsequent analyses.</div></div><div><h3>Results</h3><div>Among the 125 OAT programs, 91 (73 %) offered HCV antibody testing, and 69 (55 %) offered HCV treatment services. The provision of HCV antibody testing was associated with being general hospital- or psychiatric hospital-based and having more care team personnel, whereas the provision of HCV treatment was associated with being general hospital-based. However, on-site HCV treatment was found to be rarely offered, and the future willingness to do so remained low.</div></div><div><h3>Conclusion</h3><div>Our survey revealed that the provision of HCV screening and treatment in OAT programs in Taiwan has substantial room for improvement. Increasing the number of care personnel for satellite-dispensing OAT programs is key to expanding the service for HCV screening, as more issues related to multidisciplinary medical resources are involved in the provision of HCV treatment. Our results point to some options that might help accomplish these goals.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104658"},"PeriodicalIF":4.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630579","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":"Bridging the gap: An environmental scan of post-overdose program features and evaluation measures","authors":"Mikayla Ferg ,&nbsp;Sabrina S. Rapisarda ,&nbsp;Elena Soranno ,&nbsp;Nikki Lewis ,&nbsp;Andy Ottoson ,&nbsp;Cynthia A. Tschampl","doi":"10.1016/j.drugpo.2024.104651","DOIUrl":"10.1016/j.drugpo.2024.104651","url":null,"abstract":"<div><h3>Background</h3><div>Prior overdose incident is a predictor of future non-fatal and fatal overdoses. Therefore, the period immediately following a non-fatal overdose is critical for engaging with survivors; however, they often do not access or receive services immediately after experiencing an overdose. To efficiently reach this high-risk population and provide survivors with services, novel interventions including post-overdose outreach programs have been developed.</div></div><div><h3>Methods</h3><div>Using PRISMA guidelines, we conducted an environmental scan of the academic and gray literature on post-overdose programs to identify key features and measures used to evaluate post-overdose programs. Using the Donabedian quality framework we then analyzed the frequency of measures by type of initiating stakeholder.</div></div><div><h3>Results</h3><div>Of the 36 studies included for final extraction, 14 were descriptive studies, ten were evaluation studies, eight studies identified facilitators and barriers, and four were program design toolkits. Initiator entity types included emergency departments (EDs; <em>n</em> = 10), public health agencies (<em>n</em> = 5), community-based organizations (<em>n</em> = 4), emergency medical services (EMS) (<em>n</em> = 4), law enforcement agencies (<em>n</em> = 4), and some combination or unknown (<em>n</em> = 9). We identified six key features of post-overdose programs across the literature: program theory, team composition, identifying and contacting clients, service provision, public private partnerships, and referrals. We extracted 223 operationalized measures, of which we analyzed 173 and categorized them as client experience (<em>n</em> = 2), structural (<em>n</em> = 12), process (<em>n</em> = 69), and outcome measures (<em>n</em> = 90). Public health agency-initiated programs reported all the experience-related measures (<em>n</em> = 2) and the most outcome measures (<em>n</em> = 23). Programs initiated by EDs reported the most process measures (<em>n</em> = 20), whereas community-based agencies reported the most structural measures (<em>n</em> = 12). Only two of the 223 measures related to stigma.</div></div><div><h3>Conclusion</h3><div>There are six common features across all post-overdose programs and different initiating organization types had differing foci for their evaluation measures. The key features and evaluation measure clusters identified in this environmental scan can help inform future post-overdose programs assess the comprehensiveness of their evaluations, inform funding agencies on the range of existing measures (and gaps) to consider, and support evaluators in study design.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104651"},"PeriodicalIF":4.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630563","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":"‘It's not just a matter of taking the drug. It's about changing the way you function in your society too’: Narratives of power and resistance in the lived experiences of opioid agonist therapy consumers in regional Victoria, Australia","authors":"Tejaswini Patil ,&nbsp;Jane Mummery","doi":"10.1016/j.drugpo.2024.104625","DOIUrl":"10.1016/j.drugpo.2024.104625","url":null,"abstract":"<div><div>Opioid Agonist Therapy (OAT) has initiated extensive discussion regarding its efficacy, cost-effectiveness and best practice delivery. Although this discussion has been dominated by pharmacologists, clinicians, pharmacists and public policy-makers, there is increasing interest in examining OAT consumer experience and voice, particularly regarding consumers’ navigation and experience of the social field of their treatment. Concerned with the expression and circulation of power and resistance, Michel Foucault's work offers rich resources for examining OAT consumers’ experience and navigation of the social field of their treatment, including the administration of OAT as a harm reduction and social welfare intervention and consumers’ efforts to shape their relationships with medical and allied health professionals and other stakeholders. In the case of this study, Foucault's conceptions of power provide a productive means to critically interrogate the experience of 16 OAT consumers participating in pharmacotherapy treatments within a community pharmacy model in regional Victoria, Australia. Through the application of Foucauldian analyses of subjects and power to OAT participant accounts, precisely what the participant responses in our study have shown is that the relationship between OAT practitioners and consumers is neither always oppositional nor binary. Findings suggest that practitioners must pay attention to the everyday interactions they have with consumers (and others)—to how they communicate, listen, understand, present and provide solutions. Interactions with consumers should be treated as sites that produce complex power relations with moral and ethical implications for subjects, including consumers, practitioners and other stakeholders. Both practitioner and consumers need to remember that they are both productive subjects locked in a complex assemblage of practices and social discourses that circumscribe the social field of opioid treatments.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104625"},"PeriodicalIF":4.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630576","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}