International Journal of Drug Policy最新文献

{"title":"Changes in cannabis attitudes and perceptions in the five years following recreational legalization in Canada: Findings from an observational cohort study of community adults","authors":"Amanda Doggett ,&nbsp;Kyla L. Belisario ,&nbsp;André J. McDonald ,&nbsp;Jane De Jesus ,&nbsp;Emily Vandehei ,&nbsp;Jessica Gillard ,&nbsp;Laura Lee ,&nbsp;James MacKillop","doi":"10.1016/j.drugpo.2025.104782","DOIUrl":"10.1016/j.drugpo.2025.104782","url":null,"abstract":"<div><h3>Background</h3><div>Social acceptability and perceived risks/benefits are key attitudinal factors that influence substance use, and a major concern about cannabis legalization is an increase in more favourable attitudes ultimately leading to greater cannabis misuse. This study investigated perceptions of cannabis acceptability and risks/benefits over the 5 years following legalization in Canada, the first G7 nation to have legalized cannabis nationally, in a longitudinal observational cohort of community adults.</div></div><div><h3>Methods</h3><div>Participants (60 % female, median age = 29, 48% reporting cannabis use pre-legalization) were non-clinical adults from the general community who were assessed up to 11 times from September 2018 to October 2023 (mean waves = 9.9). Overall temporal attitudinal changes and whether changes were moderated by pre-legalization cannabis use status were examined.</div></div><div><h3>Results</h3><div>Significant increases over time were present for social acceptability of any recreational cannabis use (OR [95% CI]: 1.06 [1.05, 1.07]) and trying cannabis (1.02 [1.01, 1.03]), while acceptability of medical cannabis use decreased (0.95 [0.94, 0.96]). Meanwhile, regular cannabis use was perceived as riskier (0.97 [0.96, 0.98]) and addiction potential was perceived as greater (0.94 [0.93, 0.95]) over time. Perceived health-related benefits of cannabis were significantly less likely to be endorsed over time, while there were significant increases in perceived risks, including exacerbating stress, anxiety, and depression; exacerbating existing medical conditions; and disrupting sleep. Moderator analyses found participants not using cannabis pre-legalization showed significantly steeper increases towards greater social acceptability of occasional and regular use, and less steep increases in endorsement of cannabis-related risks.</div></div><div><h3>Conclusions</h3><div>Shifting social acceptability of cannabis post-legalization in Canada is paralleled by increases in perceived health-related risks and decreases in perceived benefits. Continued surveillance of attitudinal changes following legalization in Canada is warranted to inform the impacts in the largest national legal cannabis jurisdiction as well as other jurisdictions considering regulatory reform.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104782"},"PeriodicalIF":4.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851588","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":"Barriers to accessing medications for opioid use disorder among rural individuals","authors":"Anna M. Morenz ,&nbsp;Robin M. Nance ,&nbsp;L. Sarah Mixson ,&nbsp;Judith Feinberg ,&nbsp;Gordon Smith ,&nbsp;P. Todd Korthuis ,&nbsp;Mai T. Pho ,&nbsp;Wiley D. Jenkins ,&nbsp;Peter D Friedmann ,&nbsp;Thomas J. Stopka ,&nbsp;Laura C. Fanucchi ,&nbsp;William C. Miller ,&nbsp;Vivian F. Go ,&nbsp;Ryan Westergaard ,&nbsp;David W. Seal ,&nbsp;William A. Zule ,&nbsp;Heidi M. Crane ,&nbsp;Joseph A. Delaney ,&nbsp;Judith I. Tsui","doi":"10.1016/j.drugpo.2025.104805","DOIUrl":"10.1016/j.drugpo.2025.104805","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with opioid use disorder living in rural areas face barriers to accessing medications for treatment (MOUD), including finding prescribing clinicians and difficulties with transportation. This study sought to describe self-reported barriers to MOUD access in rural areas and associations between desired MOUD type and barriers encountered or perceived.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional study of Rural Opioid Initiative participants who ever used opioids and sought MOUD treatment, who were surveyed from 2018 to 2020 about access to MOUD. Multivariable logistic regressions explored the association between MOUD type and barriers while controlling for age, gender, race, and study site.</div></div><div><h3>Results</h3><div>Of 2906 participants who used opioids and sought MOUD, 826 (28.4 %) were unable to access MOUD. In logistic regression models, lack of transportation was a more common barrier for those seeking methadone versus sublingual buprenorphine (adjusted odds radio [aOR] 1.87, 95 % confidence interval (CI) 1.24–2.81). A long wait list was more common for those seeking injectable naltrexone than sublingual buprenorphine (aOR 1.68, 95 % CI 1.05–2.69). Lack of doctors or programs and affordability were more common for those seeking injectable versus sublingual buprenorphine (aOR 7.84, 95 % CI 4.87–12.63 and aOR 1.89, 95 % CI 1.26–2.83, respectively).</div></div><div><h3>Conclusions</h3><div>Access barriers vary by MOUD type for rural individuals with OUD. Compared to sublingual buprenorphine, methadone access was hindered more by transportation difficulties, while injectable long-acting buprenorphine was hindered more by affordability and finding a doctor or program. These barriers highlight the need to de-regulate and expand locations for methadone access and prescribing, and to improve affordability and prescriber uptake of newer MOUDs, such as injectable buprenorphine.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104805"},"PeriodicalIF":4.4,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848427","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":"Investigating drug trends among people who inject drugs: Temporal, geographical and operational analyses of used syringes in Sydney, Australia","authors":"H. Fursman ,&nbsp;J.A. Brown ,&nbsp;R. Riseley ,&nbsp;E. Silins ,&nbsp;M. Bartlett ,&nbsp;J. Latimer ,&nbsp;S. Chadwick ,&nbsp;C. Roux ,&nbsp;M. Morelato","doi":"10.1016/j.drugpo.2025.104803","DOIUrl":"10.1016/j.drugpo.2025.104803","url":null,"abstract":"<div><h3>Background</h3><div>Understanding drug use among people who inject drugs (PWID) is frequently based on self-reported data. Whilst insightful, it can be subjective and provides limited information on the drug composition. The chemical analysis of the residual drug content in used syringes has been shown to complement self-reported information. Chemical analysis can confirm the main drug injected and detect other components, such as adulterants. Drug use is dynamic; hence temporal, geographical and operational analyses might provide greater insight into market behaviours and the consumption trends of PWID.</div></div><div><h3>Objectives</h3><div>This study aims to examine the residual drug content of used syringes over time and space to observe trends in injecting drug use. Operational sampling was also investigated as a tool to characterise emerging health crises through targeted implementations.</div></div><div><h3>Methods</h3><div>Used syringes (<em>n</em> = 2148) were collected through multiple periods (2022 – 2024) across different locations in metropolitan and Western Sydney, including the Uniting Medically Supervised Injecting Centre (MSIC). The residual drug content was extracted from the used syringes before detection via gas chromatography–mass spectrometry (GC–MS) and ultra-performance liquid chromatography – tandem mass spectrometry (UPLC-MS/MS). The syringes collected from MSIC were compared to the drugs self-reported by MSIC clients.</div></div><div><h3>Results</h3><div>Within all samples, heroin and methamphetamine were the most frequently injected drugs, followed by pharmaceutical opioids. Temporal drug trends remained relatively static, whereas distinct sub-populations of PWID emerged from geographical analyses. Polydrug and adulterant analysis identified the presence of a diverse range of drugs within syringes, including some drugs of concern, such as fentanyl within heroin syringes. Operational sampling identified protonitazene as the likely cause of an emerging overdose cluster.</div></div><div><h3>Implications</h3><div>This research aligns well with Australia's harm minimisation approach to drugs and has broader implications for harm minimisation globally. It holds great potential for harm reduction at an individual level for PWID by providing insights into the current drug market. Targeted applications of syringe analysis may be the only tool to gather information on drug use among PWID when traditional data sources are unavailable. Hence, broader implementations at the national level might capture unique insights into injecting drug consumption trends.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104803"},"PeriodicalIF":4.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848458","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":"A step forward or a missed opportunity? Malaysia's recent amendment to the drug dependants (treatment and rehabilitation) 1983 bill","authors":"N.A. Mohd Salleh ,&nbsp;Balasingam Vicknasingam","doi":"10.1016/j.drugpo.2025.104806","DOIUrl":"10.1016/j.drugpo.2025.104806","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104806"},"PeriodicalIF":4.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839541","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":"\"I don't know how you can overdose smoking them:\" Perceptions of overdose risks among persons who use illicit fentanyl-laced counterfeit pills","authors":"Raminta Daniulaityte ,&nbsp;Kaylin Sweeney ,&nbsp;Patricia Timmons ,&nbsp;Madeline Hooten ,&nbsp;Elisabeth Williams ,&nbsp;Haley Coles ,&nbsp;Danielle Russell ,&nbsp;Frank LoVecchio","doi":"10.1016/j.drugpo.2025.104808","DOIUrl":"10.1016/j.drugpo.2025.104808","url":null,"abstract":"<div><h3>Aims</h3><div>Illicitly manufactured fentanyl (IMF) remains the primary driver of overdose mortality in the US. Western states saw significant increases in IMF-laced counterfeit pain pills (“blues”). This qualitative study, conducted in Phoenix, Arizona, provides an in-depth understanding of how overdose-related risks are viewed and experienced by people who use “blues.”</div></div><div><h3>Methods</h3><div>Between 11/2022–12/2023, the study recruited 60 individuals who used “blues” using targeted and network-based recruitment. Qualitative interviews were recorded, transcribed, and analyzed using NVivo.</div></div><div><h3>Results</h3><div>The sample included 41.7 % women, and 56.7 % whites. 55.3 % had prior overdose, but most (62.2 %) rated their current risk as none/low. Risk perceptions centered on a multi-level calculus of drug market conditions, individual vulnerabilities, and behavioral factors. Smoking was considered a “normative” way of using “blues”, and most viewed it as protective against overdose in comparison to injection and other routes of use. Drug market conditions and the unpredictability of “blues” were emphasized as important factor of overdose risk. However, some believed that over time, the quality/consistency of “blues” improved, and they became less risky. Many also expressed fears about the emerging local availability of powder fentanyl and its risk. Views about safer dosing, polydrug use, tolerance, and health emphasized personal responsibility and individual vulnerability to overdose risks. Discussions of protective behaviors, including take-home naloxone, varied bases on the perceptions of overdose risks.</div></div><div><h3>Conclusions</h3><div>The findings emphasize the need for close monitoring of local IMF markets and design of comprehensive interventions and risk communication strategies to address perceptions that minimize IMF-laced counterfeit pill risks.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104808"},"PeriodicalIF":4.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839540","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 War on Drugs is a war on women: Louisiana's Abortion Law","authors":"Maryanne Alderson Diaz,&nbsp;Dina Perrone","doi":"10.1016/j.drugpo.2025.104804","DOIUrl":"10.1016/j.drugpo.2025.104804","url":null,"abstract":"<div><div>This commentary explores the criminalization of abortion in Louisiana by arguing that it mirrors the punitive policies of the War on Drugs. We critically analyze the reclassification of abortion-inducing drugs like Mifepristone and Misoprostol as controlled substances to demonstrate how these laws disproportionately impact women, particularly those who are poor and Black and Brown. Drawing on parallels to the racial caste system perpetuated by the War on Drugs, we argue that these policies are less about public health and more about social control, with severe implications for reproductive autonomy and justice. By linking the scheduling of Mifepristone and Misoprostol to the War on Drugs, we show how abortion criminalization and abortion medication criminalization extend the arm of the American legal system to police and punish Black and Brown bodies and communities. We conclude by calling for a reevaluation of these legal frameworks to prevent further marginalization and harm.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104804"},"PeriodicalIF":4.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839542","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 not just running the test”: Operator experiences of implementing a decentralised hepatitis C point-of-care testing program in Australia","authors":"Grace K. Burton-McKeich ,&nbsp;Lise Lafferty ,&nbsp;Carla Treloar ,&nbsp;Corey Markus ,&nbsp;Susan Matthews ,&nbsp;Tanya L. Applegate ,&nbsp;Louise Causer ,&nbsp;Jason Grebely ,&nbsp;Alison D. Marshall","doi":"10.1016/j.drugpo.2025.104800","DOIUrl":"10.1016/j.drugpo.2025.104800","url":null,"abstract":"<div><h3>Background</h3><div>The decentralisation of hepatitis C virus (HCV) point-of-care testing is a core part of Australia's strategy to meet WHO elimination targets. However, little is known about the experiences of providers implementing these interventions and thus what is needed to improve integration. The study aim was to understand operator experiences, including the challenges and enablers, of implementing point-of-care testing as part of a National Point-of-Care Testing Program.</div></div><div><h3>Methods</h3><div>Providers who were enrolled in the National Program and qualified to perform point-of-care testing were invited to participate in semi-structured qualitative interviews between April and August 2023. Data were analysed according to iterative categorisation and themes were organised according to Service delivery, Resources, and Governance—elements of the Health Systems Dynamics Framework.</div></div><div><h3>Results</h3><div>Of the 31 participants, most were from New South Wales (<em>n</em> = 17), were practicing clinicians (<em>n</em> = 18), worked in outpatient or community health clinics (<em>n</em> = 21), and had no previous experience using a molecular point-of-care testing device (<em>n</em> = 24). Many participants struggled to deliver HCV testing and treatment according to national HCV management guidelines. Some participants avoided using the point-of-care testing device altogether. Others found it challenging to manage the administrative load of delivering the National Program, including planning outreach and following-up clients. These challenges were exacerbated by workforce shortages, difficult-to-navigate IT systems, and a lack of specific implementation advice from Program leadership.</div></div><div><h3>Conclusions</h3><div>This study illustrates several challenges to and enablers of adopting a decentralised HCV point-of-care testing program, highlighting the need to further explore what providers require to effectively implement these interventions.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104800"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839672","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":"“Either way, they will use. And so, probably, would you:” A critical discourse analysis of harm reduction portrayal in United States opinion news media","authors":"Hannah A. Carlon,&nbsp;Hanna M. Hebden,&nbsp;Nina C. Christie,&nbsp;Felicia R. Tuchman,&nbsp;David I.K. Moniz-Lewis,&nbsp;Cassandra L. Boness,&nbsp;Katie Witkiewitz,&nbsp;Margo C. Hurlocker","doi":"10.1016/j.drugpo.2025.104801","DOIUrl":"10.1016/j.drugpo.2025.104801","url":null,"abstract":"<div><h3>Background</h3><div>Opioid overdose deaths are declining in the United States for the first time in over five years. These reductions are partially attributed to increasing availability of harm reduction services, but services remain poorly implemented. The framing of issues in news media shapes public sentiment and uptake of services in policy and practice. The aims of this study were to: (1) content analyze United States opinion news media to describe overall attitudes towards and stigmatizing language about harm reduction; and (2) critically analyze discourses underlying articles with respect to stigma and harm reduction support.</div></div><div><h3>Methods</h3><div>Thirty-nine opinion articles across 17 United States newspapers on harm reduction published between May 2023 and April 2024 were included. Targeted analyzed content included attitudes toward harm reduction and stigmatizing language.</div></div><div><h3>Results</h3><div>Most articles had positive attitudes (32/39; 82.1 %), only 5/39 articles (12.8 %) were negative; two were balanced. Over half (22/39; 56.4 %) included stigmatizing language. Critical discourse analysis revealed pro-harm reduction articles were tied together by several threads: harm reduction strategies are evidence-based, do not increase crime, decrease stigma and systemic oppression, and policy change is needed to improve implementation. Among anti-harm reduction articles, discourses included: discriminatory stereotypes to portray opioid use and harm reduction depicted as enabling substance use, equating opioid use with crime, and dismissing systemic injustices influenced by punitive drug policy.</div></div><div><h3>Conclusions</h3><div>Contemporary United States opinion news media predominantly presents pro-harm reduction discourse, but often use stigmatizing language.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104801"},"PeriodicalIF":4.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816808","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":"State adult-use cannabis policy effects on law enforcement efforts to disrupt drug markets","authors":"Barrett Wallace Montgomery,&nbsp;Pranav Athimuthu,&nbsp;Nicholas Richardson,&nbsp;Bradley Ray","doi":"10.1016/j.drugpo.2025.104802","DOIUrl":"10.1016/j.drugpo.2025.104802","url":null,"abstract":"<div><h3>Background</h3><div>Legalizing cannabis impacts law enforcement strategies on drug deterrence. While cannabis possession arrests have fallen post-legalization, findings on racial disparities are mixed. No research has yet investigated cannabis legalization effects on police behavior in the form of drug seizures, or how it may influence the enforcement of other drugs. We sought to evaluate the effect of cannabis legalization on drug seizures and their related disparities by race to understand how law enforcement have adjusted to this rapidly shifting legal landscape.</div></div><div><h3>Methods</h3><div>Drug seizure data were collected from the National Incident Based Reporting System (NIBRS) and include state, race, and drug types from 16 states with over 95 % population coverage for 2017–2022. Treatment and control assignments were determined by whether cannabis had been legalized for adult use between 2017 and 2022. Log seizure rates and Black-white risk ratios were calculated using census data. Two-way fixed effects difference-in-differences models robust to multiple treatment periods evaluated the effect of cannabis legalization on seizure rates and Black-white risk ratios.</div></div><div><h3>Results</h3><div>Our findings indicate that cannabis legalization significantly reduced overall drug seizures, particularly those involving cannabis. Of the other seizure types tested, only one non-cannabis drug seizure rate type was significant. We found a moderate yet significant decrease in the Black-white risk ratio for cannabis seizures, though all other racial disparities in seizure rates persisted after the legalization of cannabis.</div></div><div><h3>Discussion</h3><div>Cannabis legalization was associated with reduced drug seizures overall, driven by a large reduction in cannabis seizures. There was also a significant reduction in the Black-white risk ratio for cannabis seizures, though Black individuals remained at higher risk for all drug seizure types compared to white individuals. While expected to decrease without cannabis smell to prompt seizures, non-cannabis drug seizures were unchanged except for an increase in methamphetamine seizures not involving cannabis, potentially due to shifting enforcement priorities. These results suggest that cannabis policy reform can alleviate law enforcement burdens and may improve racial disparities in drug seizures to a small extent yet highlight the continued necessity for policies addressing systemic biases in drug enforcement.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104802"},"PeriodicalIF":4.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816760","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 effectiveness of the communities that HEAL intervention on reducing non-fatal opioid overdoses: A prespecified secondary analysis of a waitlist cluster control randomized controlled trial","authors":"Louisa Gilbert ,&nbsp;Rouba Chahine ,&nbsp;Redonna Chandler ,&nbsp;Daniel J. Feaster ,&nbsp;Erin Kim ,&nbsp;Arnie Aldridge ,&nbsp;Sarah Bagley ,&nbsp;Peter Balvanz ,&nbsp;Soledad Fernandez ,&nbsp;Peter Rock ,&nbsp;Rachel A. Vickers-Smith ,&nbsp;Jennifer Villani ,&nbsp;Tracy Battaglia ,&nbsp;Jennifer Brown ,&nbsp;Heather Bush ,&nbsp;Rachel P. Chase ,&nbsp;Thomas Collins ,&nbsp;Lauren D'Costa ,&nbsp;Carolyn Damato-MacPherson ,&nbsp;James L. David ,&nbsp;Nabila El-Bassel","doi":"10.1016/j.drugpo.2025.104798","DOIUrl":"10.1016/j.drugpo.2025.104798","url":null,"abstract":"<div><h3>Introduction</h3><div>Along with a surge of opioid overdose deaths in the United States, the rates of nonfatal opioid overdose (NFOO) emergency department (ED) visits and hospitalizations have been sharply increasing.</div></div><div><h3>Methods</h3><div>In the HEALing Communities Study (HCS), we conducted a pre-specified secondary analyses to evaluate the effectiveness of the Community that HEALS (CTH) intervention on reducing the count of NFOO ED visits and hospitalizations in a multi-site cluster randomized multi-site, two-arm, parallel, community-level, open, wait list-controlled trial study, Sixty-seven communities in Kentucky, Massachusetts, New York, and Ohio were randomized to the intervention (<em>N</em> = 34) or waitlist control condition (<em>N</em> = 33) stratified by state and balanced by urban/rural classification, fatal opioid overdose rate and population size of communities. We compared the rate of NFOO per 100,000 adults aged ≥18 years between intervention and control communities from July 1, 2021, to June 30, 2022. Rates were calculated in per 100,000 or per 100 adult population measured by inpatient and ED records for intervention community residents with an ICD-10-CM code for opioid poisoning.</div></div><div><h3>Results</h3><div>Compared to control communities, intervention communities had 15 % fewer NFOO per capita (aRR = 0.85; 95 % CI = [0.74,0.96]; p-value=0.013). Effect modifications by state, urban/rural status, sex, age, race and ethnicity were not significant.</div></div><div><h3>Discussion</h3><div>These findings suggest the intervention reduced NFOO ED visits and hospitalizations. The lack of effect modifications suggests that the intervention may be effective in a wide range of communities in the U.S. Further research is needed to identify the mechanisms through which the intervention reduces NFOO.</div></div><div><h3>Trial Registration</h3><div>ClinicalTrials.gov Identifier: NCT04111939.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"140 ","pages":"Article 104798"},"PeriodicalIF":4.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821492","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}