International Journal of Drug Policy最新文献

{"title":"Wound-associated agents in the unregulated drug supply: Evidence from a statewide drug checking program","authors":"Emily M. Martin ,&nbsp;Kristin E. Schneider ,&nbsp;Edward Sisco ,&nbsp;Meghan G. Appley ,&nbsp;Margaret Rybak ,&nbsp;Rae Elkasabany ,&nbsp;Gregory M. Burnett ,&nbsp;Susan G. Sherman","doi":"10.1016/j.drugpo.2024.104677","DOIUrl":"10.1016/j.drugpo.2024.104677","url":null,"abstract":"<div><h3>Background</h3><div>While the unregulated drug market has seen dramatic increases in fentanyl adulteration in the past decade, other adulterants have impacted the recent volatility of the drug supply. There has been recent documentation related to the presence of wound-associated substances; however, there is a lack of data showing the prevalence of these substances across unregulated drug market samples over time. The aim of this paper is to examine known and potential wound-associated agents’ (xylazine, levamisole, medetomidine) prevalence in Maryland's unregulated drug supply.</div></div><div><h3>Methods</h3><div>Using data from Maryland's statewide drug checking program, Rapid Analysis of Drugs (RAD), this paper discusses samples that were voluntarily provided at participating syringe service programs and analyzed at the National Institute of Standards and Technology between October 2021 and October 2023 (N= 2,210). We calculated prevalence and chi-square significance to assess co-occurrence of wound-associated agents and other substances and evaluated xylazine's prevalence over time.</div></div><div><h3>Results</h3><div>Xylazine was detected in 33.4 % of samples and primarily co-occurred with fentanyl; heroin and related compounds; and other opioids, stimulants, and anesthetics. Xylazine's prevalence decreased over time and varied geographically. Levamisole and medetomidine occurred in 1.9 % and 0.7 % of samples respectively with no significant co-occurrence.</div></div><div><h3>Conclusion</h3><div>These findings emphasize the importance of statewide monitoring amid an evolving drug market, especially regarding wound-associated agents. Drug checking, safer supply, overdose prevention, and non-stigmatizing wound care services for people who use drugs are instrumental in mitigating the health consequences of the unregulated drug supply.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104677"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792610","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":"Trends in young people accessing English alcohol treatment services: 2014 to 2023","authors":"Karen P. Hayhurst ,&nbsp;Sam Burnett ,&nbsp;Stefan Jahr ,&nbsp;Dylan Mangan ,&nbsp;Tim Millar ,&nbsp;Oliver Rigby ,&nbsp;Andrew Jones","doi":"10.1016/j.drugpo.2024.104663","DOIUrl":"10.1016/j.drugpo.2024.104663","url":null,"abstract":"<div><h3>Background</h3><div>Recent reports suggest that the prevalence of alcohol consumption has reduced among young people in England. We used whole population, English substance use treatment data to examine whether there has been a corresponding decrease in the number of young people accessing specialist alcohol treatment. We also examined the trend among young people with the highest levels of alcohol treatment need.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of all young people (&lt;18 years) entering specialist treatment for alcohol use in all publicly funded services in England between 1 April 2014 and 31 March 2023 (<em>N</em> = 40,119). Analysis of alcohol use severity used complete-case information on indicators of frequency and quantity of alcohol consumption (<em>n</em> = 37,801, 94 %). An examination of trends over time also used the cohort (<em>N</em> = 562,037) of adults (18+ years) entering alcohol treatment over the same period.</div></div><div><h3>Results</h3><div>There was a 42 % decline in the number of young people entering treatment for alcohol use in England (from 6522 to 3771 per annum). The proportion of the total alcohol treatment population accounted for by young people also decreased from 6.8 % to 4.1 % over the same period. A less steep decline of 24 % (from 508 to 388) was observed in the number of young people entering treatment with severe alcohol use.</div></div><div><h3>Conclusions</h3><div>Despite the overall reduction in the number of young people accessing alcohol treatment between 2014/15 and 2022/23, it will be necessary to monitor whether this decreasing trend continues, especially among those young people with the most severe alcohol treatment needs. Further research is required to determine to what extent this reduction in treatment numbers is due to reduced treatment capacity rather than changes in treatment need.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104663"},"PeriodicalIF":4.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759785","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":"Prospective association of interventions for at-risk families with illicit drug use among young students in Taiwan","authors":"Yi-Nuo Lee ,&nbsp;Tan-Wen Hsieh ,&nbsp;An-Jou Chen ,&nbsp;Jen-Huoy Tsay ,&nbsp;Chuan-Yu Chen","doi":"10.1016/j.drugpo.2024.104653","DOIUrl":"10.1016/j.drugpo.2024.104653","url":null,"abstract":"<div><h3>Background</h3><div>Young people who use illicit drugs disproportionately experience multiple problems in individual, family, and school domains. With a focus on illicit drug-using middle schoolers, the present study aims to characterize intervention services for risk indicators and to examine the prospective associations with reinitiated use throughout adolescence.</div></div><div><h3>Methods</h3><div>A retrospective cohort of 1605 adolescents was identified from the 2013 to 2016 national school-based indicated prevention program serving illicit drug-using students in Taiwan. Reinitiated use of illicit drugs was confirmed by the Drug Abuse Big Datasets comprising police arrest records. Information concerning the history of intervention services—attention deficit hyperactivity disorder (ADHD) treatment, intervention for at-risk families, and school dropout consultation—was ascertained from national administrative data. A cohort of young adolescents from the general population (<em>n</em> = 809,477) was sampled for comparison. The Cox proportional hazards model was used to evaluate the risk of drug use.</div></div><div><h3>Results</h3><div>Nearly 80 % of illicit drug-involved middle schoolers used ketamine only, and 17 % used amphetamine or methamphetamine. Over a four-year follow-up, 35 % of middle schoolers were re-reported for drug use, with police arrest being the major source. A history of ADHD treatment was not linked with illicit drug use, whereas dropping out in early schooling can elevate middle schoolers’ hazard by 46 %. Notably, receiving services targeting at-risk families in late childhood can lower the hazard by 43 %, with the reduction even greater when non-school-attending adolescents were included.</div></div><div><h3>Discussion</h3><div>To reduce progression into advanced drug involvement and substance use disorders, an integrated model of school-based interventions is urgently needed.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104653"},"PeriodicalIF":4.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746363","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 effect of smokeless tobacco (SLT) excise taxes on SLT use among youth","authors":"Yanyun He ,&nbsp;Hojin Park ,&nbsp;Kai-Wen Cheng ,&nbsp;Qian Yang ,&nbsp;Zezhong Zhang ,&nbsp;Ce Shang","doi":"10.1016/j.drugpo.2024.104664","DOIUrl":"10.1016/j.drugpo.2024.104664","url":null,"abstract":"<div><h3>Background</h3><div>Smokeless Tobacco (SLT) use prevalence among youth in the United States (US) is comparable to youth prevalence of cigarette smoking. However, it is in general understudied compared to cigarettes and draws less attention nowadays compared to e-cigarettes (ECs).</div></div><div><h3>Aim</h3><div>We estimate the own- and cross-tax elasticities of SLT use among US youth and explicitly test how SLT use changes in response to taxes on SLT, cigarettes, ECs, and beer.</div></div><div><h3>Methods</h3><div>We standardized SLT taxes for chewing tobacco, moist snuff, dry snuff, and snus, and computed average SLT taxes. We implemented a logit regression model within the state- and year-fixed effects framework.</div></div><div><h3>Results</h3><div>A 10 % increase in SLT excise taxes reduced youth SLT use by 4 % (<em>p</em> &lt; 0.01). This result is primarily driven by males, Whites, multiple non-Hispanic races, other races, and individuals living in non-Appalachian states. In addition, a 10 % increase in cigarette taxes increases youth SLT use by 8 % (<em>p</em> &lt; 0.05), suggesting substitutional effects. A 10 % increase in EC and beer taxes reduce SLT use by 0.5 % and 2.4 % (<em>p</em> &lt; 0.01), respectively, suggesting complementary effects.</div></div><div><h3>Conclusion</h3><div>Raising excise taxes on SLT products can effectively curtail their usage among the youth population. Furthermore, increasing EC and beer taxes reduces youth SLT use. However, an increase in cigarette taxes leads to an unintended consequence of promoting SLT use among youth. In addition, increasing SLT taxes does not appear to significantly impact the disparities in youth SLT use by whether living in Appalachian states. Future research is needed to assess whether SLT taxes reduce disparities in use by rural/urban divisions.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104664"},"PeriodicalIF":4.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746364","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":"Haven't I waited long enough? The role of wait times and subjective impairment in cannabis-related driving behavior","authors":"Ayelet Har-Even ,&nbsp;Nehama Lewis ,&nbsp;Hadar Eliash-Fizik ,&nbsp;Sharon R. Sznitman","doi":"10.1016/j.drugpo.2024.104654","DOIUrl":"10.1016/j.drugpo.2024.104654","url":null,"abstract":"<div><h3>Background</h3><div>Driving under the influence of cannabis (DUIC) poses a significant public health threat. This study explores DUIC through a multifaceted lens, examining correlates of various wait times between cannabis use and driving, subjective perceptions of impairment, and differences between medical and non-medical cannabis users.</div></div><div><h3>Method</h3><div>Cross-sectional data from 979 cannabis users in Israel were collected through an online survey. DUIC risk was measured using reported wait times (categorized as low, moderate, and high risk) and driving while feeling cannabis effects. Logistic and multinomial regression identified correlates of DUIC risk.</div></div><div><h3>Results</h3><div>23 % of the respondents drove within two hours of use (high risk), 37 % waited 3 to 6 h (moderate risk), and 40 % waited over 7 h (low risk). Multinomial regression showed that being male (RRR = 2.11, <em>p</em> &lt; 0.001), having a medical cannabis license (RRR = 4.14, <em>p</em> &lt; 0.01), more frequent cannabis and alcohol co-use (RRR = 1.18, <em>p</em> &lt; 0.05), and more frequent cannabis use (RRR = 1.21, <em>p</em> &lt; 0.001) were associated with moderate risk compared to low risk. Being male (RRR = 1.89, <em>p</em> &lt; 0.01) and reporting higher cannabis use frequency (RRR = 1.70, <em>p</em> &lt; 0.001) was associated with high DUIC risk. Cannabis use frequency was a significant predictor of subjective DUIC (AOR = 1.26, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Findings highlight the need for targeted prevention efforts, particularly for male and frequent cannabis users. The complex relationship between medical cannabis use and DUIC risk warrants further investigation to inform evidence-based policies and interventions.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104654"},"PeriodicalIF":4.4,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746362","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":"Growing practices and the use of potentially harmful chemical additives from a web survey of mainly small-scale cannabis growers in 18 countries.","authors":"Simon Lenton, Gary Potter, Davide Fortin, Ashely Granville, Jodie Grigg, Eric Sevigny, Chris Wilkins, Tom Decorte, Monica Barratt","doi":"10.1016/j.drugpo.2024.104662","DOIUrl":"https://doi.org/10.1016/j.drugpo.2024.104662","url":null,"abstract":"<p><strong>Background: </strong>There is emerging recognition of the risks of harmful chemical pesticides, fertilizers and 'nutrients' by cannabis growers. One group of chemicals, Plant Growth Regulators (PGRs), many of which have been banned from food crops for decades, have been found unlisted in a number of fertilizers and supplements marketed at cannabis growers.</p><p><strong>Methods: </strong>This paper predominately uses data from a 2020-21 convenience web survey of mainly small-scale, recent (last 5yrs) cannabis growers from 18 countries (n = 11,479). We describe their growing practices and use of chemicals and employ logistic regression to explore predictors of chemical use. We also compare chemical use in our 2020-21 sample with that from our 2012-13 data in the 3 countries (Australia, Denmark, UK) where respondents were asked about their use of growing chemicals in both surveys.</p><p><strong>Results: </strong>In 2020-21, 26 % of recent cannabis growers reported use of chemicals. Growers who were at highest odds of using chemicals were male, older, living in urban/cities, not growing for environmental reasons, growing in order to sell, growing where they believed cannabis was legal, and growing under artificial light in soil or non-soil media. We found significant reductions in the proportions of our samples who reported using chemical fertilizers in the 3 countries where we collected data in both waves.</p><p><strong>Conclusion: </strong>Growers using soil and artificial light comprised over half of all the chemical users in the sample. Efforts at informing and educating growers about the problems of chemical fertilizer, nutrient and pesticide use should include all growers including those who grow in soil under artificial light. Possible explanations for the apparent decrease in chemical use from our 2012-13 to 2020-21 samples are discussed. Stricter regulation of the legal cannabis fertilizer market is required to empower growers to reduce the toxicity of cannabis they grow, distribute and consume.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":" ","pages":"104662"},"PeriodicalIF":4.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752042","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":"National impact of a constraining regulatory framework on pregabalin dispensations in France, 2020–2022","authors":"Julia de Ternay ,&nbsp;Claire Meley ,&nbsp;Patrick Guerin ,&nbsp;Sébastien Meige ,&nbsp;Nicolas Grelaud ,&nbsp;Benjamin Rolland ,&nbsp;Mathieu Chappuy","doi":"10.1016/j.drugpo.2024.104660","DOIUrl":"10.1016/j.drugpo.2024.104660","url":null,"abstract":"<div><h3>Background</h3><div>Pregabalin is a drug approved for neuropathic pain, epilepsy and general anxiety disorder. However, pregabalin is also an increasing cause of diversion and misuse, and, for this reason, the French health authorities have decided in 2021 to classify it as a narcotic drug, requiring secured prescription pads. Our study aimed to evaluate the impact of this measure on pregabalin dispensation patterns.</div></div><div><h3>Methods</h3><div>Using data from a national representative sample of 12,690 French community pharmacies, we assessed the impact of the new regulatory framework, implemented in June 2021, on the total monthly quantity of pregabalin dispensed by conducting an interrupted time-series (ITS) analysis. We built a counterfactual model to predict what would have happened without the intervention. We conducted the same analyses in the subsample of pregabalin dispensations exceeding the maximum recommended dosage of 600 mg per day. Additionally, we compared (1) the number of pregabalin dispensations (2) the co-dispensing of opioids and/or benzodiazepines one year before and one year after the regulation.</div></div><div><h3>Results</h3><div>Following the regulatory change, there was an immediate and significant drop of 38,475,375 mg (95 %CI [-66,931,799 mg; -10,018,951 mg] in pregabalin dispensations. This decline continued in the following months, with a decrease of 4,788,107 mg (95 %CI: [-8,888,326 mg; -687,888 mg] per month. The counterfactual model predicted that, without the intervention, there would have been no notable change in pregabalin dispensations. The ITS analyses showed no significant change in pregabalin dispensations following the new regulation for the subsample with doses exceeding 600 mg per day. Concurrently, there was a significant decrease in co-dispensing of opioids (18.4 % pre-regulation versus 11.6 % post-regulation, <em>p</em> &lt; 0.001) and benzodiazepines (21.4 % pre-regulation versus 11.7 % post-regulation, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>The constraining regulation adopted in 2021 by the French health authorities significantly curtailed total pregabalin dispensing in community pharmacies. Our findings underscore the importance of regulatory measures to limit the misuse of a prescribed medication.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104660"},"PeriodicalIF":4.4,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707133","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":"Suboptimal uptake and placement of a mandatory alcohol pregnancy warning label in Australia","authors":"Tazman Davies ,&nbsp;Paula O'Brien ,&nbsp;Jacqueline Bowden ,&nbsp;Bella Sträuli ,&nbsp;Asad Yusoff ,&nbsp;Michelle Jongenelis ,&nbsp;Alexandra Jones ,&nbsp;Aimee Brownbill ,&nbsp;Tanya Chikritzhs ,&nbsp;Julia Stafford ,&nbsp;Simone Pettigrew","doi":"10.1016/j.drugpo.2024.104661","DOIUrl":"10.1016/j.drugpo.2024.104661","url":null,"abstract":"<div><h3>Background</h3><div>Mandatory pregnancy warning labels are an important public health measure to signal the harms of drinking alcohol during pregnancy. Ensuring these labels are salient is critical to enhancing their effectiveness. On 31 July 2020, Australia mandated that alcoholic beverages labelled from 1 August 2023 display a pregnancy warning label. This study assessed uptake and placement of this warning on alcohol containers after the policy start date.</div></div><div><h3>Methods</h3><div>Between August and November 2023, data collectors obtained images of 4026 unique alcoholic beverages available for sale across four major Australian alcohol retailers in Sydney (three physical stores and one online store). Product images were investigated to assess overall uptake of the mandatory pregnancy warning label and its placement on products (i.e., front, side, back, top, or bottom). Analyses were conducted overall and stratified across six alcohol product categories.</div></div><div><h3>Results</h3><div>Two-thirds (63 %) of products displayed the mandatory pregnancy warning label. Uptake was lowest for spirits (50 %), followed by wine (65 %), cider (79 %), premix drinks (79 %), beer (83 %), and other alcoholic beverages (e.g., sake and soju) (91 %). The mandatory pregnancy warning label was most commonly located on the back (88 %) and less commonly on the side (8 %), bottom (3 %), top (1 %), or front (0.3 %).</div></div><div><h3>Conclusion</h3><div>To increase uptake of the mandatory pregnancy warning label, policymakers should consider mandating that all alcoholic beverages available for sale, not just products labelled from 1 August 2023, display the warning. Existing requirements could be revised to ensure that the label is more prominently displayed.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104661"},"PeriodicalIF":4.4,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707134","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":"How does climate change impact people who use alcohol and other drugs? A scoping review of peer reviewed literature","authors":"Sarah MacLean ,&nbsp;Julia de Nicola ,&nbsp;Kimberlea Cooper ,&nbsp;Heather Downey ,&nbsp;Jacqui Theobald ,&nbsp;Lisa de Kleyn ,&nbsp;Todd Denham ,&nbsp;Eleanor Costello ,&nbsp;Lauren Rickards","doi":"10.1016/j.drugpo.2024.104649","DOIUrl":"10.1016/j.drugpo.2024.104649","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>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.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 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":"OA","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 ,&nbsp;Kristen S. Regenauer ,&nbsp;Thanh Lu ,&nbsp;Sean M. Murphy ,&nbsp;Alexandra L. Rose ,&nbsp;Yvonne Akinyi Ochieng ,&nbsp;John Joska ,&nbsp;Sybil Majokweni ,&nbsp;Lena S. Andersen ,&nbsp;Bronwyn Myers ,&nbsp;Steven A. Safren ,&nbsp;Jessica F. Magidson","doi":"10.1016/j.drugpo.2024.104632","DOIUrl":"10.1016/j.drugpo.2024.104632","url":null,"abstract":"<div><h3>Introduction</h3><div>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 <em>Khanya</em>, a brief peer-delivered behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence compared to enhanced treatment as usual (ETAU).</div></div><div><h3>Methods</h3><div>Adults living with HIV (<em>N</em> = 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 <em>Khanya</em> 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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> = 0.03) but only the <em>Khanya</em> arm demonstrated significant increases at 6-months (<em>p</em> = 0.02). At 6-months, 59% of participants in <em>Khanya</em> had any employment (from 13% at baseline), compared to 38% in ETAU (from 29% at baseline).</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 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}