International Journal of Drug Policy最新文献

{"title":"Impact and cost-effectiveness of interventions to eliminate hepatitis C virus among people who inject drugs in Haiphong, Vietnam","authors":"Adam Trickey ,&nbsp;Josephine G. Walker ,&nbsp;Pham Minh Khue ,&nbsp;Tran Thi Hong ,&nbsp;Nguyen Thanh Binh ,&nbsp;Catherine Quillet ,&nbsp;Roselyne Vallo ,&nbsp;Sandra Bivegete ,&nbsp;Khuat Thi Hai Oanh ,&nbsp;Hannah Fraser ,&nbsp;Duong Thi Huong ,&nbsp;Todd Pollack ,&nbsp;Vo Thi Tuyet Nhung ,&nbsp;Don Des Jarlais ,&nbsp;Vu Hai Vinh ,&nbsp;Nicolas Nagot ,&nbsp;Didier Laureillard ,&nbsp;Jack Stone ,&nbsp;Peter Vickerman","doi":"10.1016/j.drugpo.2025.104898","DOIUrl":"10.1016/j.drugpo.2025.104898","url":null,"abstract":"<div><h3>Background</h3><div>In Haiphong, Vietnam, most hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). As part of multiple respondent-driven sampling (RDS) surveys among PWID in Haiphong, an intervention (DRIVE-C) provided HCV testing and treatment in 2019. Centres providing opiate agonist treatment (OAT) or antiretroviral therapy (ART) also provided HCV testing and linkage-to-treatment in 2021/22. We modelled the impact and cost-effectiveness of HCV testing and treatment for PWID in Haiphong.</div></div><div><h3>Methods</h3><div>An HCV transmission model among PWID and former injectors was calibrated in a Bayesian framework using data from Haiphong. A status quo (SQ) scenario modelled past interventions, with no future HCV treatment. A future intervention scenario modelled the impact of providing HCV testing and linkage-to-treatment in OAT and ART centres, and annual RDS survey interventions over 2025–2030, each testing 1400 PWID. We estimated the incremental cost-effectiveness ratio (ICER) per disability adjusted life-year (DALY) averted for the future scenario compared to SQ over 2025–2054 (3 % annual discount rate).</div></div><div><h3>Results</h3><div>For the SQ scenario, HCV incidence decreased from 8.1 (95 % credibility interval 5.1–13.6) per 100 person-years (/100pyrs) in 2015 to 5.3/100pyrs (3.0–9.6) in 2023 and increases to 6.2/100pyrs (3.5–10.7) in 2030. In the future intervention scenario, incidence decreases to 2.7/100pyrs (1.0–6.4) by 2030. The mean ICER is €884/DALY averted; cost-effective at a willingness-to-pay threshold of €2334 (57 % of Vietnam’s 2023 GDP per capita).</div></div><div><h3>Conclusions</h3><div>Using RDS surveys and other care settings to scale-up HCV-testing and treatment are cost-effective strategies to reduce HCV incidence among PWID in Vietnam.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104898"},"PeriodicalIF":4.4,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329873","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":"Corrigendum to “Sociological investigations of human enhancement drugs: The case of microdosing psychedelics” [International Journal of Drug Policy 95 (2021) 103099]","authors":"Dimitrios Liokaftos","doi":"10.1016/j.drugpo.2025.104895","DOIUrl":"10.1016/j.drugpo.2025.104895","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104895"},"PeriodicalIF":4.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329874","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":"Implementation of a multi-component alcohol policy in Ireland: A qualitative study exploring barriers and facilitators to implementation","authors":"Susan Calnan ,&nbsp;Karen Matvienko-Sikar ,&nbsp;Niamh Fitzgerald ,&nbsp;Sheila Gilheany ,&nbsp;Zubair Kabir","doi":"10.1016/j.drugpo.2025.104870","DOIUrl":"10.1016/j.drugpo.2025.104870","url":null,"abstract":"<div><h3>Background</h3><div>In Ireland, the Public Health (Alcohol) Act represents the first Irish policy attempt to address alcohol harms through an explicitly public health approach. Lauded internationally, the Act aligns with ‘best buy’ policy recommendations, encompassing a suite of measures targeting the pricing, visibility, advertising and health labelling of alcohol products. Recognising the importance of implementation in the policy process, this study sought to examine the implementation of this multi-component alcohol policy.</div></div><div><h3>Methods</h3><div>We conducted 15 qualitative interviews with a range of participants with direct knowledge or experience of implementing the Public Health (Alcohol) Act. Participants included policy stakeholders, private sector implementation actors and public health/alcohol policy experts. In the analysis, we used the updated Consolidated Framework for Implementation Research (CFIR) to map barriers and facilitators to implementation of this policy.</div></div><div><h3>Results</h3><div>The study found that barriers and facilitators to implementation were reported for all five domains of CFIR across 21 constructs. Private sector actors placed a greater emphasis on cost-related factors as perceived barriers, whereas policy stakeholders and public health policy experts underlined the reported persistence of industry lobbying as a barrier. All categories of participant perceived a lack of planning for both implementation and policy evaluation, a dearth of resources for inner setting actors and a lack of high-level leadership during policy implementation. Participants also noted the complexity of implementation, lack of relational connections and gaps in innovation design as barriers to implementation. Facilitators included the reported expertise of and relational connections with key individuals, and the policy’s alignment with international ‘best buy’ policy recommendations.</div></div><div><h3>Conclusions</h3><div>Given the range of challenges perceived in implementing this comprehensive alcohol policy, our study underlines the need for strategic implementation planning, for ongoing evaluation and monitoring of the policy measures, and for adequate resourcing of inner setting actors. The study also notes the importance of anticipating and planning for continued industry lobbying during the implementation phase, acknowledging the reality of the “politics of implementation”.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104870"},"PeriodicalIF":4.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321483","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":"Linkage to hepatitis C virus care in a binational cohort study of People who inject drugs on the U.S.-Mexico border","authors":"Bo Shan Go ,&nbsp;Daniela Abramovitz ,&nbsp;Irina Artamonova ,&nbsp;Alicia Harvey-Vera ,&nbsp;Natasha Martin ,&nbsp;Gudelia Rangel ,&nbsp;Christian B. Ramers ,&nbsp;Samantha Tweeten ,&nbsp;Winston Tilghman ,&nbsp;Steffanie A. Strathdee ,&nbsp;Robert G. Deiss","doi":"10.1016/j.drugpo.2025.104899","DOIUrl":"10.1016/j.drugpo.2025.104899","url":null,"abstract":"<div><h3>Background</h3><div>People who inject drugs (PWID) experience high rates of Hepatitis C Virus (HCV) infection in the U.S.-Mexico border region, but their care continuum is poorly characterized.</div></div><div><h3>Methods</h3><div>We analysed the HCV care continuum (linkage to care, initiation and completion of treatment) in a cohort of PWID in Tijuana, Mexico and San Diego. We also used multivariable Poisson regression to identify factors associated with linkage to HCV care among PWID in San Diego and Tijuana who reported prior HCV diagnosis.</div></div><div><h3>Results</h3><div>Among 133 PWID with active HCV infection in San Diego, 50.4 %, 16 % and 14.3 % reported prior awareness of their diagnosis; linkage to care and treatment completion; corresponding proportions for 21 PWID in Tijuana were 19 %, 14.3 % and 0 %. In multivariable analysis, factors independently associated with increased linkage to HCV care included receiving medication for opioid use disorder (MOUD) (Adjusted Prevalence Ratio [adjPR] 1.38; 95 % CI: 1.23–1.54) and HIV-seropositivity (adjPR 1.87 (95 %CI: 1.32–2.66). Tijuana residency (adjPR: 0.73; 95 % CI: 0.70–0.75) and younger age (adjPR 0.94 per 5-year age decrease; 95 % CI: 0.89–0.99) were independently associated with decreased linkage to care. Among PWID with a prior HCV diagnosis, 52.6 % and 40.7 % reported linkage to care in San Diego and Tijuana respectively.</div></div><div><h3>Conclusions</h3><div>Our study shows poor linkage to HCV-related care among PWID in both San Diego and Tijuana, along with low treatment completion. MOUD programs could be an efficient touchpoint to improve access to HCV care.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104899"},"PeriodicalIF":4.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321340","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":"Problem representations in Swedish youth substance use treatment: staff views on what is treatable and less treatable","authors":"Mats Ekendahl,&nbsp;Petra Kvarmans,&nbsp;Patrik Karlsson","doi":"10.1016/j.drugpo.2025.104897","DOIUrl":"10.1016/j.drugpo.2025.104897","url":null,"abstract":"<div><div>Swedish youth substance use problems are mainly treated at so-called Maria clinics, multidisciplinary units employing both medical and psychosocial staff. Interventions include assessments of substance use and health, urine testing, counselling and education about drug harms. The study analyzes how treatment staff represent youth problems in interviews so that they align with such interventions. We draw on Carol Bacchi’s (2009) post-structuralist “What’s the problem represented to be” (WPR) approach to policy analysis. It assumes that “problems” should be approached analytically as posterior rather than anterior to solutions; that they are calibrated in discourse and practice to fit with certain interventions. This is important since problematizations can ultimately authorize policy targets, determine resource allocation and steer who gets what help. We thus assert that staff discussions about patient groups and working methods include legitimization of why some, but not other, youth substance use problems are considered apt for Maria clinic treatment. Twenty interviews with professionals who work with youth substance use treatment in the Stockholm region were conducted. The results show that the participants primarily evoked patients with demarcated drug problems, who became motivated to treatment, submitted to adult monitoring and learned to care for their health and everyday routines. Three examples of other youth problems that were represented as less aligned with this treatment are also illustrated; adolescents with severe comorbidity, criminal identities and irrelevant support needs. The analysis highlights how the Maria clinic treatment appeared to be geared towards adolescents who can be effectively treated, responsibilized and deterred from substance use. We discuss whether adolescents who were considered less relevant for this treatment, namely those described as particularly unhealthy, rebellious or chaotic, are more adequate targets of intervention than the occasional cannabis users who receive a lot of attention in Swedish policy and practice.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104897"},"PeriodicalIF":4.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312729","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":"Reinfection following successful direct-acting antiviral therapy for hepatitis C virus infection among people with recent injecting drug use: the SHARP-C study","authors":"Joshua Ang ,&nbsp;Behzad Hajarizadeh ,&nbsp;Shane Tillakeratne ,&nbsp;Gregory J Dore ,&nbsp;Carla Treloar ,&nbsp;Janaki Amin ,&nbsp;Jodi van Dyk ,&nbsp;Louisa Degenhardt ,&nbsp;Tanya Applegate ,&nbsp;Adrian Dunlop ,&nbsp;Chris Fraser ,&nbsp;Brian Conway ,&nbsp;Alexander Wong ,&nbsp;Dennaye Fuchs ,&nbsp;Jeff Powis ,&nbsp;Kate Mason ,&nbsp;Edward J Gane ,&nbsp;Martin Weltman ,&nbsp;Phillip Read ,&nbsp;Marianne Martinello ,&nbsp;Evan B Cunningham","doi":"10.1016/j.drugpo.2025.104859","DOIUrl":"10.1016/j.drugpo.2025.104859","url":null,"abstract":"<div><h3>Background</h3><div>Injecting drug use following treatment for hepatitis C virus (HCV) may result in reinfection, potentially reversing individual, and population benefits of HCV treatment. The aim of this study was to evaluate the incidence of HCV reinfection following successful direct acting antiviral (DAA) therapy among people with recent injecting drug use.</div></div><div><h3>Methods</h3><div>This analysis used data from an observational cohort study of people with recent injecting drug use (previous six months) following successful DAA treatment in Australia, Canada, and New Zealand. Participants were either recruited prior to commencing DAA therapy or after a documented sustained virological response (SVR). Participants were assessed three-monthly for HCV reinfection. Reinfection was defined as recurrence of virus distinct from the initial infecting strain or recurrence after confirmed cure at or after 12 weeks post-treatment. Person-time of observation and Cox proportional hazard models were used to calculate reinfection incidence and associated factors.</div></div><div><h3>Results</h3><div>Among 112 participants who contributed follow-up time at risk of reinfection (113 person-years of follow-up time), the median age was 43 years, 34 % were female, and 86 % reported injecting drug use in the month prior to enrolment. Eleven cases of reinfection were observed for an incidence of 9.7/100 person-years (95 % confidence interval [CI], 5.4–17.4) overall, 11.1/100 person-years (95 % CI, 6.1–20.0) among people who reported injecting drugs during follow-up, and 24.3/100 person-years (95 % CI, 7.8–75.3) among those who reported sharing needles/syringes during follow-up. All cases of HCV reinfection occurred among people reporting injecting drug use during the study.</div></div><div><h3>Conclusions</h3><div>The relatively high incidence of reinfection seen in this study underscores the importance of targeted harm reduction measures and monitoring for HCV reinfections within the first year following successful treatment among people who inject drugs. Additional research into integrated models of care incorporating harm reduction and supporting reducing risk of reinfection and HCV treatment are needed.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104859"},"PeriodicalIF":4.4,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307206","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":"China’s fentanyl control alone cannot resolve the fentanyl crisis in the United States","authors":"Xiaohu Xie ,&nbsp;Wenhua Zhou","doi":"10.1016/j.drugpo.2025.104896","DOIUrl":"10.1016/j.drugpo.2025.104896","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104896"},"PeriodicalIF":4.4,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312730","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":"Identifying barriers and facilitators to accessing harm reduction services in prisons: A systematic narrative synthesis","authors":"O. Varsaneux ,&nbsp;M. Charest ,&nbsp;K. Ma ,&nbsp;J. Stone ,&nbsp;M. Brouwers ,&nbsp;N. Kronfli ,&nbsp;A. Krentel","doi":"10.1016/j.drugpo.2025.104761","DOIUrl":"10.1016/j.drugpo.2025.104761","url":null,"abstract":"<div><h3>Background</h3><div>Drug use is prevalent in carceral settings globally. Although a comprehensive harm reduction package for people in prison (PIP) is recommended by international agencies, its implementation is limited. The aim of this systematic narrative synthesis was to explore barriers and facilitators to accessing harm reduction services (HRS) in prisons.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, PsycINFO, SCOPUS, and CINAHL for English and French language articles published before June 26, 2024. Studies evaluating any HRS defined as condoms, pre-exposure prophylaxis, post-exposure prophylaxis, opioid agonist therapy, needle syringe programs, and hepatitis B vaccination in prison were included. Two independent reviewers evaluated articles selected for full text review. Disagreements were resolved by consensus. We performed a qualitative content analysis based on the Socio-Ecological Model, utilizing constant comparative methods to generate themes and subthemes.</div></div><div><h3>Results</h3><div>A total of 8,324 unique articles were identified, 400 were eligible for full text review, and 94 were included in the final analysis; 80 studies (85%) were conducted in high-income countries. Individual-level barriers included fear of repercussions due to HRS participation, interpersonal-level barriers such as negative perceptions of HRS in PIP and staff, institutional-level barriers such as limited resource allocation and public policy/societal-level barriers including rigid administrative policies. Facilitators of HRS use included education about risk prevention, positive previous experiences with HRS, and support from prison leadership.</div></div><div><h3>Conclusion</h3><div>Several multi-level barriers and facilitators to accessing prison-based HRS exist. To improve HRS uptake, implementing holistic education for PIP and carceral employees, enhancing awareness of HRS through peer-led initiatives, and ensuring buy-in and support from prison leadership will be important. Furthermore, allocation of specific resources and enhanced policies that promote HRS will be beneficial.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104761"},"PeriodicalIF":4.4,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288931","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 pre-post study of the impact of a multidisciplinary model of care on linkage to hepatitis C care following release from prison: The Beyond Prison Walls study","authors":"Nadine Kronfli ,&nbsp;Andrea Mambro ,&nbsp;Allen O’Brien ,&nbsp;Camille Dussault ,&nbsp;Sylvie Chalifoux ,&nbsp;Lina del Balso ,&nbsp;Apostolia Petropoulos ,&nbsp;Mona Lim ,&nbsp;Alexandros Halavrezos ,&nbsp;Bertrand Lebouche ,&nbsp;Giada Sebastiani ,&nbsp;Marina B. Klein ,&nbsp;Joseph Cox","doi":"10.1016/j.drugpo.2025.104873","DOIUrl":"10.1016/j.drugpo.2025.104873","url":null,"abstract":"<div><h3>Background</h3><div>Many people are released from prison with untreated hepatitis C virus (HCV) and fail to link to care due to competing priorities. We compared linkage to HCV care among individuals who engaged in a multidisciplinary model of care versus in standard of care, and examined factors associated with linkage to care.</div></div><div><h3>Methods</h3><div>We conducted a prospective, quasi-experimental pre-post study in Quebec’s largest provincial prison. Participants in the intervention arm met with a nurse, social worker, and patient navigator and were offered appointment accompaniment post-release. Participants in the control arm received a pre-release discharge appointment. The primary outcome was linkage to HCV care, defined as a documented visit with an HCV care provider within 90 days of release. Bayesian logistic regression was used to determine the impact of the intervention on linkage and to analyze relationships between covariates of interest and linkage. Probability differences and 95 % credible intervals (95 % CrI) were calculated.</div></div><div><h3>Results</h3><div>Overall, 648 participants underwent HCV screening; 19 and 20 had current HCV infection in the control and intervention arms, respectively. Among these, 2 (11 %) and 14 (80 %) were linked to care post-release, respectively. Intervention participants had a + 70 % (45 %, 88 %) difference in linkage to care versus control participants. Among intervention participants, those who were successfully contacted post-release were more likely to be linked to care [+64 % (14 %, 90 %)] than those who were not.</div></div><div><h3>Conclusions</h3><div>A multidisciplinary model of care increased linkage to HCV care among untreated individuals released from prison. Future interventions should support similar models, leveraging social support networks to maximize continuity of care.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104873"},"PeriodicalIF":4.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263724","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":"Speed and smoking kill: A time-varying survival analysis linking methamphetamine use, cigarette smoking, and mortality in sexual minority men","authors":"Grace Yi ,&nbsp;Marjan Javanbakht ,&nbsp;Allison D. Rosen ,&nbsp;Pamina Gorbach ,&nbsp;Jesse Clark ,&nbsp;Steven Shoptaw","doi":"10.1016/j.drugpo.2025.104874","DOIUrl":"10.1016/j.drugpo.2025.104874","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Sexual minority men (SMM) in the US experience high rates of methamphetamine use and are disproportionately affected by HIV. Unlike prior studies among treatment-seeking populations, this study examined associations between methamphetamine use, smoking, and mortality in a community-based cohort of SMM, half of whom have HIV. Using time-varying survival models, we assessed how dynamic patterns of substance use impact mortality risk over time.</div></div><div><h3>Design and Setting</h3><div>This longitudinal cohort study followed <em>N</em> = 541 SMM in Los Angeles from two community-based sites (2014–2023). Substance use and health outcomes data were collected biannually through behavioral surveys and clinical evaluations. Deaths were defined using the Los Angeles Medical Examiner Database or direct reports from participants’ family or friends. We used Cox proportional hazards regression with time-varying covariates to assess the association between methamphetamine use, cigarette smoking, and mortality risk.</div></div><div><h3>Findings</h3><div>There were <em>N</em> = 19 observed deaths in our cohort. Daily methamphetamine use (aHR=4.45, 95 % CI 1.33–14.9), weekly methamphetamine use (aHR=3.32, 95 % CI 1.09–10.1) and smoking more than ½ pack of cigarettes per day (aHR=3.28, 95 % CI 1.07–10.0) were significantly and independently associated with increased risk of mortality, after adjusting for confounders.</div></div><div><h3>Conclusions</h3><div>Findings confirm that consistent methamphetamine use and cigarette smoking above a threshold frequency of use significantly increase mortality risk among otherwise healthy SMM. Comprehensive interventions including behavioral therapies and risk screening are warranted to mitigate early mortality and improve health outcomes among SMM.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104874"},"PeriodicalIF":4.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263061","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}