International Journal of Drug Policy最新文献

{"title":"A case study of the DULF compassion club and fulfillment centre—A logical step forward in harm reduction","authors":"Eris Nyx ,&nbsp;Jeremy Kalicum","doi":"10.1016/j.drugpo.2024.104537","DOIUrl":"10.1016/j.drugpo.2024.104537","url":null,"abstract":"<div><p>In 2022, the Drug User Liberation Frontʼs Compassion Club and Fulfillment Centre emerged as a groundbreaking initiative and research endeavor aimed at addressing the alarming rise in overdose deaths within Vancouverʼs Downtown Eastside. As the first of its kind, this pioneering model operated as a non-profit, low-barrier, and non-medicalized approach to regulating the volatility of the content of the illicit drug market in order to prevent overdose deaths. Going beyond traditional overdose prevention methods, the Drug User Liberation Frontʼs Compassion Club and Fulfillment Centre not only provided supervised consumption services, but also supplied rigorously tested cocaine, heroin, and methamphetamine at cost to club members. This intrinsic case study offers a unique perspective on the operation of Drug User Liberation Frontʼs Compassion Club and Fulfillment Centre, delving into its inception, development, implementation, and the challenges it faced in its operation. Ultimately, the insights garnered from the Drug User Liberation Frontʼs Compassion Club and Fulfillment Centre hold significant value for others interested in establishing similar programs or exploring de-medicalized approaches regulating substances in order to prevent overdose deaths.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104537"},"PeriodicalIF":4.4,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002214/pdfft?md5=283359b820c71d5004bf9f1c5aa24557&pid=1-s2.0-S0955395924002214-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141964295","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":"Essential/precursor chemical control research: Giommoni's review, understanding multi-replication interrupted time series analysis, and next steps","authors":"James K. Cunningham","doi":"10.1016/j.drugpo.2024.104525","DOIUrl":"10.1016/j.drugpo.2024.104525","url":null,"abstract":"<div><p>Controls on essential/precursor chemicals from commercial companies have been associated with many large downturns in illicit drug markets and attendant problems. My colleagues and I brought this to light in the studies that are the subject of Giommoni's review. McKetin et al. in an earlier review considered several of our studies on chemical controls for methamphetamine, all centered in North America. Giommoni discusses not only those studies but also our later work on chemical controls for cocaine and heroin. This later work evaluates US essential/precursor chemical policies targeting illicit drug producers outside of North America, and it examines impacts on illicit drug availability and use (the studies reviewed by McKetin et al. predominantly focused on outcomes such as drug-related hospitalizations, arrests, and treatment). Giommoni's review is a new resource that will help make the varied topics in essential/precursor chemical control research more accessible to many readers. After noting this, I discuss some common methodological misconceptions about our studies. For example, our studies generally used multi-replication interrupted time series analysis, a research design among the most powerful of all quasi-experimental designs. Authors, however, typically discuss the studies as if they used single-intervention interrupted time series analysis, a less powerful design. Multi-replication and single-intervention interrupted time series analyses also differ regarding likely confounders; awareness of this is critical to accurately assessing our findings and critiquing alternative explanations. Finally, I note that commercial chemical companies function as the silent, albeit usually unwitting, partners in the large-scale production of several illicit drugs, including fentanyl. And many governments are implementing essential/precursor chemical controls to help stymie this partnership. But they are doing so largely without evaluation and study—a poor policy practice. To remedy this, I suggest establishing multi-disciplinary applied research teams to help assess, guide and improve essential/precursor chemical control efforts.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104525"},"PeriodicalIF":4.4,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914279","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":"Racial, ethnic, and neighborhood socioeconomic disparities in local cannabis retail policy in California","authors":"Bethany J Simard ,&nbsp;Alisa A Padon ,&nbsp;Lynn D Silver ,&nbsp;Lyndsay A Avalos ,&nbsp;Aurash J Soroosh ,&nbsp;Kelly C Young-Wolff","doi":"10.1016/j.drugpo.2024.104542","DOIUrl":"10.1016/j.drugpo.2024.104542","url":null,"abstract":"<div><h3>Background</h3><p>Policies governing legal cannabis commerce can vary widely within a U.S. state when local control exists. Disproportionate distribution of policies allowing retail sale, protecting public health, or promoting equity in licensing may contribute to differences in health and economic outcomes between sociodemographic subgroups. This cross-sectional study jointly examined racial, ethnic, and neighborhood socioeconomic characteristics of Californians subject to specific local cannabis policies to identify such disparities.</p></div><div><h3>Methods</h3><p>Local laws in effect January 1, 2020, governing retail cannabis sales (bans, expanding buffers from youth-serving sites, restricting advertising, promoting equity in licensing, and capping outlets) were determined for California's 539 jurisdictions. The number of Asian, Black, Latinx, and white residents in socioeconomic advantaged versus disadvantaged neighborhoods (Census block groups) was determined using 2015–2019 American Community Survey data. We estimated proportions of the sociodemographic subpopulations covered by specific policies based on the block group's jurisdiction. To ascertain disparities in coverage proportions were compared across subgroups using Z-tests with the Bonferroni correction.</p></div><div><h3>Results</h3><p>Residents of socioeconomically advantaged neighborhoods were more likely to live in jurisdictions allowing retail cannabis commerce than those in disadvantaged neighborhoods (61.7 % versus 54.8 %). Black residents in advantaged neighborhoods were most likely to live where retailing was allowed (69 %), and white residents in disadvantaged neighborhoods least likely (49 %). Latinx and Black populations from disadvantaged neighborhoods were most likely to live in jurisdictions with stronger advertising restrictions (66 %). Equity in licensing policy was more prevalent for Black residents living in advantaged neighborhoods (57 %) than disadvantaged neighborhoods (49 %).</p></div><div><h3>Conclusions</h3><p>Local cannabis policies potentially protecting public health and social equity are unequally distributed across race, ethnicity, and socioeconomic characteristics in California. Research examining whether differential policy exposure reduces, creates, or perpetuates cannabis-related health and socioeconomic disparities is needed.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104542"},"PeriodicalIF":4.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890578","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":"Gendered pleasures, risks and policies: Using a logic of candidacy to explore paradoxical roles of alcohol as a good/poor health behaviour for Australian women early during the pandemic","authors":"Kristen Foley,&nbsp;Paul R. Ward,&nbsp;Belinda Lunnay","doi":"10.1016/j.drugpo.2024.104510","DOIUrl":"10.1016/j.drugpo.2024.104510","url":null,"abstract":"<div><p>Drinking alcohol facilitates pleasure for women while also elevating disease risk. Symbolic expectations of what alcohol ‘does in’ life per lay insight (relax, identity-work, connect) sit in tension with scientific realities about what alcohol ‘does to’ women's bodies (elevate chronic disease risks such as breast cancer). Policy must work amidst – and despite – these paradoxes to reduce harm(s) to women by attending to the gendered and emergent configurations of both realities.</p><p>This paper applies a logic of candidacy to explore women's alcohol consumption and pleasure through candidacies of wellness <em>in addition to</em> risk through candidacies of disease (e.g. breast cancer). Using qualitative data collected via 56 interviews with Australian women (<em>n</em> = 48) during early pandemic countermeasures, we explore how risk perceptions attached to alcohol (like breast cancer) co-exist with use-values of alcohol in daily life and elucidate alcohol's paradoxical role in women's heuristics of good/poor health behaviours.</p><p>Women were aged 25–64 years, experienced varying life circumstances (per a multidimensional measure of social class including economic, social and cultural capital) and living conditions (i.e. partnered/single, un/employed, children/no children). We collated coding structures from data within both projects; used deductive inferences to understand alcohol's paradoxical role in candidacies of wellness and disease; abductively explored women's prioritisation of co-existing candidacies during the pandemic; and retroductively theorised prioritisations per evolving pandemic-inflected constructions of alcohol-related gendered risk/s and pleasure/s.</p><p>Our analysis illuminates the ways alcohol was configured as a pleasure and form of wellness in relation to stress, productivity and respectability. It also demonstrates how gender was relationally enacted amidst the priorities, discourses and materialities enfolding women's lives during the pandemic. We consider the impact of policy regulation of aggressive alcohol marketing and banal availability of alcohol in pandemic environments and outline gender-responsive, multi-level policy options to reduce alcohol harms to women.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"130 ","pages":"Article 104510"},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924001956/pdfft?md5=b89e11f87a84d4eec49db42f65a2db2d&pid=1-s2.0-S0955395924001956-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898683","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":"U.S. State rates of newborns reported to child protection at birth for prenatal substance exposure","authors":"Rebecca Rebbe ,&nbsp;Margaret Lloyd Sieger ,&nbsp;Julia Reddy ,&nbsp;John Prindle","doi":"10.1016/j.drugpo.2024.104527","DOIUrl":"10.1016/j.drugpo.2024.104527","url":null,"abstract":"<div><h3>Background</h3><p>In the U.S., the opioid epidemic has revitalized national attention to newborns with prenatal substance exposure (PSE). These newborns and their caregivers have specific health and treatment needs and frequently interact with multiple systems, including child protection systems (CPS).</p></div><div><h3>Methods</h3><p>This study calculated rates of newborns (less than 15 days old) reported to CPS per 1,000 births due to PSE by state and year using data from the National Child Abuse and Neglect Data System (NCANDS). Given the lack of a clear definition of PSE reports in the data, we calculated rates using three different definitions. To examine the relationship between different state laws regarding the mandated reporting of PSE and PSE reports rates, we used panel data analysis.</p></div><div><h3>Results</h3><p>Rates of newborn reports more than doubled between 2011 and 2019. There was extensive state variability of rates including some states that were consistently more than 100 % greater than and others consistently more than 150 % less than the annual national mean. Reporting rates were not associated with state requirements to report PSE, but were positively associated with rates of diagnosed neonatal abstinence syndrome.</p></div><div><h3>Conclusion</h3><p>State-level inconsistencies in identification, reporting, and CPS responses prevent a clear understanding of the scope of the affected population and service needs.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"130 ","pages":"Article 104527"},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767640","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 recovery experiences of homeless service users with substance use disorder: A systematic review and qualitative meta-synthesis","authors":"Branagh R. O'Shaughnessy ,&nbsp;Paula Mayock ,&nbsp;Aimen Kakar","doi":"10.1016/j.drugpo.2024.104528","DOIUrl":"10.1016/j.drugpo.2024.104528","url":null,"abstract":"<div><h3>Background</h3><p>The relationship between homelessness and substance use disorder (SUD) is layered and complex. Adults pursuing recovery while dealing with homelessness and SUD face many challenges. Little research has inspected qualitative first-person accounts of recovery in the context of homelessness and SUD, and few studies have employed conceptualisations of recovery beyond abstinence. In this systematic review study, we examine the qualitative literature on the recovery experiences of adult homeless service users with SUD.</p></div><div><h3>Methods</h3><p>2,042 records were identified via database and secondary searching strategy. After title and abstract and full text screening, 15 eligible studies remained. Critical Appraisal Skills Programme quality appraisal criteria was used to assess potential bias in the studies. Meta-ethnography was employed to synthesise extracted data.</p></div><div><h3>Results</h3><p>Four themes were generated from the extracted data: Two sides of the Service Coin; Navigating Relationships; Recovery Practices and Personal Attributes; and Housing as Foundational for Recovery.</p></div><div><h3>Conclusion</h3><p>Unconditional housing, a broad array of supports, opportunities to contribute to society, and family reunification supports all facilitate the development of recovery for adults with SUD experiencing homelessness. Implications for policy are discussed.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"130 ","pages":"Article 104528"},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002135/pdfft?md5=ed9ad250b9e9ea79d86420f8e211ad66&pid=1-s2.0-S0955395924002135-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761769","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":"Using nominal group technique to identify perceived barriers and facilitators to improving uptake of the Prison Needle Exchange Program in Canadian federal prisons by correctional officers and healthcare workers","authors":"Nadine Kronfli ,&nbsp;Lise Lafferty ,&nbsp;Frederic Leone ,&nbsp;Mark Stoové ,&nbsp;Behzad Hajarizadeh ,&nbsp;Andrew R. Lloyd ,&nbsp;Frederick L. Altice","doi":"10.1016/j.drugpo.2024.104540","DOIUrl":"10.1016/j.drugpo.2024.104540","url":null,"abstract":"<div><h3>Background</h3><p>Elimination of bloodborne viruses including HIV and hepatitis C virus from prisons requires high coverage of evidence-based interventions that prevent bloodborne virus transmission, including needle and syringe programs. Canada launched a Prison Needle Exchange Program (PNEP) in nine federal prisons in 2018; however, uptake among people who inject drugs in prison remains low. We aimed to explore barriers and facilitators to improving PNEP uptake identified by correctional officers and healthcare workers.</p></div><div><h3>Methods</h3><p>Participants from nine federal prisons with PNEP completed focus groups using nominal group technique, a rapid mixed-method consensus strategy. Responses were generated, rank-ordered, and prioritized by each stakeholder group. We identified the highest-ranking responses (≥10 % of the overall votes) to questions about barriers and facilitators to PNEP uptake.</p></div><div><h3>Results</h3><p>Between September 2023 and February 2024, 16 focus groups were conducted with 118 participants (<em>n</em> = 51 correctional officers; <em>n</em> = 67 healthcare workers). Among correctional officers, the top perceived barriers were bullying from peers (22 %), fear of being targeted by correctional officers (14 %), and fear of repercussions due to drug use (13 %). The top facilitators were safe injection sites (30 %), provision of wrap-around services (16 %), and education of correctional officers (10 %). Among healthcare workers, the top perceived barriers were lack of confidentiality (16 %), fear of being targeted by correctional officers (12 %), and a long and complex application process (11 %). The top facilitators were education of correctional officers (29 %), delivery of PNEP by an external provider (15 %), automatic approval for participation in the PNEP (13 %), and safe injection sites (12 %).</p></div><div><h3>Conclusion</h3><p>Multiple modifiable barriers and solutions to improving PNEP uptake in Canadian federal prisons were identified by correctional employees. Both participant groups identified the potential for safe injection sites and education to correctional officers as enabling PNEP uptake. These data will inform Canadian efforts to improve engagement and to expand PNEP coverage.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"130 ","pages":"Article 104540"},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S095539592400224X/pdfft?md5=553ce1adbf8526bcb2a54516aad5df95&pid=1-s2.0-S095539592400224X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856755","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":"Taking the potential harms of psychedelic-assisted therapy seriously: How do we prevent or mitigate the risks to vulnerable patients?","authors":"Sharon R. Sznitman ,&nbsp;Barbara Broers ,&nbsp;Reto Auer ,&nbsp;Kali Tal","doi":"10.1016/j.drugpo.2024.104521","DOIUrl":"10.1016/j.drugpo.2024.104521","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104521"},"PeriodicalIF":4.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789529","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":"“What I should be doing is harm reduction, if I'm doing my job right”: Engagement with harm reduction principles among prosecutors enacting drug policy reform in the United States","authors":"Saba Rouhani ,&nbsp;Abigail K Winiker ,&nbsp;Leanne Zhang ,&nbsp;Susan G Sherman ,&nbsp;Sachini Bandara","doi":"10.1016/j.drugpo.2024.104541","DOIUrl":"10.1016/j.drugpo.2024.104541","url":null,"abstract":"<div><h3>Background</h3><p>Prosecutorial discretion to pursue or decline criminal charges is a powerful mechanism determining criminal justice outcomes among people who use drugs (PWUD). In the US, prosecutors are increasingly employing this tool to prevent arrest, incarceration, and subsequent health and social harms among PWUD. Many cite harm reduction as a basis for these reforms; however, the extent of prosecutors' knowledge and understanding of harm reduction principles, and how they are operationalized in the policy process, remains unclear.</p></div><div><h3>Methods</h3><p>We assess references to and application of harm reduction in the policy design and implementation process of prosecutorial drug policy reform in 14 US jurisdictions. In-depth-interviews (<em>N =</em> 16) were conducted with elected prosecutors and their policy staff from November 2021-April 2022. Through initial structured analysis, policymakers’ understanding and utilization of the term ‘harm reduction’ emerged as a salient theme which we conducted secondary thematic analysis to further explore.</p></div><div><h3>Results</h3><p>While all participants identified as progressive, there was wide variation in their ideologies, policy provisions, and engagement with harm reduction principles. Eleven participants explicitly referred to ‘reducing harms of drug use’ or ‘harm reduction’ as guiding their policy approach; the remainder did not invoke ‘harm reduction’ by name but highlighted relevant concepts like racial equity and ‘public health approaches’ as core policy tenets. While some prosecutors demonstrated familiarity with traditional harm reduction principles (meeting PWUD where they are, reducing <em>harms to them</em>), others focused on <em>harm to the wider community</em> (the ‘public,’ businesses, etc). Invocation of harm reduction was not always consistent with specific policy provisions: prosecutors implemented policies ranging from unconditional non-prosecution of drug possession to diversion, some of which were odds with core harm reduction principles of dignity and justice (i.e., involving coercive treatment incentives/requirements).</p></div><div><h3>Conclusions</h3><p>As prosecutors shift their approach to redress the harms caused by drug criminalization, clarity is needed on what a harm reduction approach to using discretionary powers entails. Targeting reform-minded prosecutors with messaging on the principles, evidence base, and best practices of harm reduction is merited.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104541"},"PeriodicalIF":4.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789528","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":"“It's going to get pretty tippy”: Stakeholder perspectives on the (dys)function of a four pillars drug strategy","authors":"Alissa Greer ,&nbsp;Naomi Zakimi ,&nbsp;Alison Ritter","doi":"10.1016/j.drugpo.2024.104538","DOIUrl":"10.1016/j.drugpo.2024.104538","url":null,"abstract":"<div><p>A ‘drug strategy’ is a policy document that structures the priorities and directions for interventions for drug related issues within a particular jurisdiction and/or context. A ‘pillars’ drug strategy concentrates efforts through clustering separated columns of activity, such as law enforcement, harm reduction, treatment, and prevention. In this study, we examined drug policy stakeholders’ perspectives on the structure, function, and fit of a four pillar drug strategy framework in Vancouver, Canada. Utilizing qualitative interview data from fifteen drug policy stakeholders, we examine perspectives on Vancouver's four pillar drug strategy that was implemented over 20 years ago. Our findings are organized under three main themes: (1) the notion of ‘balance’ of efforts, resources, and attention across the pillars; (2) how the pillars function as a cohesive whole; (3) whether the pillars’ architecture is still fit-for-purpose. The architecture of four discrete pillars did not enable a sense of cohesion and collaboration of efforts, and instead elicited a sense of competition, conflict, fragmentation, simplicity, and rigidity of the strategy as a whole. These findings suggest that, in practice, a four pillars framework may be structurally dysfunctional in working towards a common goal. Our study questions the effectiveness of a commonly used 'pillars' framework and whether it needs to be reenvisaged.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"130 ","pages":"Article 104538"},"PeriodicalIF":4.4,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002226/pdfft?md5=125b37c7129056f030ef61733eb26525&pid=1-s2.0-S0955395924002226-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141732433","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}