International Journal of Drug Policy最新文献

{"title":"An assessment of proposals for reforming the European union's tobacco tax directive","authors":"Ángel López-Nicolás , J. Robert Branston , Hana Ross","doi":"10.1016/j.drugpo.2025.104724","DOIUrl":"10.1016/j.drugpo.2025.104724","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104724"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081684","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":"Evaluating the impact of Canadian cannabis legalization on cannabis use outcomes in emerging adults: Comparisons to a US control sample via a natural experiment","authors":"Amanda Doggett ,&nbsp;Kyla L. Belisario ,&nbsp;André J. McDonald ,&nbsp;Mahmood Gohari ,&nbsp;Scott T. Leatherdale ,&nbsp;James G. Murphy ,&nbsp;James MacKillop","doi":"10.1016/j.drugpo.2024.104686","DOIUrl":"10.1016/j.drugpo.2024.104686","url":null,"abstract":"<div><h3>Background</h3><div>Recreational cannabis legalization marked a significant policy shift in Canada, but has been difficult to evaluate because of the absence of a control group. Although it is unfeasible to evaluate legalization using a randomized controlled trial design, sophisticated statistical techniques can employ quasi-experimental designs using natural experiments. This study evaluates the impact of cannabis legalization in a longitudinal cohort of Canadian emerging adults by comparing changes in cannabis use frequency and related consequences over time to changes in a similar cohort in a United States jurisdiction where no policy change took place.</div></div><div><h3>Methods</h3><div>Two samples of emerging adults from Hamilton, Ontario, and Memphis, Tennessee, were followed longitudinally in 4-month intervals from March 16, 2018 to March 11, 2020, with three pre-legalization and four post-legalization assessments. Doubly robust difference-in-difference (DiD) estimation was used to assess whether cannabis legalization impacted cannabis use frequency or cannabis-related consequences in the Canadian sample over time. The impact of cannabis legalization on alcohol use and alcohol-related consequences was also assessed as a control form of substance use for which no policy change took place. Cohort differences were adjusted within DiD estimation using propensity score balancing.</div></div><div><h3>Results</h3><div>Against a general trend of decreasing use over time, the DiD estimation revealed significantly greater cannabis use frequency approximately 6-months post legalization (ATT (95% CI): 0.2245 (0.0154, 0.4336)) and approximately one year post legalization (ATT (95% CI):0.3091 (0.0473, 0.5709)) in the Canadian sample compared to the American sample. Cannabis-related consequences were also greater in the Canadian sample at both of these time points (ATT (95% CI): 0.0.7610 (0.0797, 1.4423)), (ATT (95% CI): 1.0396 (0.1864, 1.8928)). These higher levels reflected less steep declines over time (i.e., attenuated ‘aging out’). Alcohol changes showed no impact of legalization at any time point, as expected.</div></div><div><h3>Conclusions</h3><div>Findings suggest that cannabis legalization was associated with smaller reductions in cannabis use frequency and adverse consequences than expected in the Canadian sample compared to the American control sample. Although the magnitude of these impacts was small, these findings suggest the start of diverging cannabis trajectories. Given that effects of legalization are hypothesized to be long-term rather than immediate, further monitoring of the impacts of cannabis legalization on developmental trends in cannabis use and related consequences is warranted.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"136 ","pages":"Article 104686"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899482","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":"Long waves of alcohol consumption and the sustainable development goals","authors":"Robin Room","doi":"10.1016/j.drugpo.2025.104703","DOIUrl":"10.1016/j.drugpo.2025.104703","url":null,"abstract":"<div><div>Though the United Nations deals with its Sustainable Development Goals (SDGs) in blocs of 15 years at a time, “sustainable” indicates a longer-term focus, aiming at steady human progress, including in public health and welfare. But the alcohol history in many countries shows “long waves” of consumption, repetitively rising, then falling, then rising again.</div><div>Underlying this dynamic are competing interests pushing in opposite directions. One set of interests, both private and governmental, seeks profits from an attractive and habit-forming product, with relative costs that have fallen with industrialisation and commercialisation. Opposed are the interests of those harmed by the effects of alcohol, and the interests of public health and welfare. With alcohol, there is also a less obvious set of interests favouring drinking: alcohol is an instrument of conviviality and collectivity, as expressed in rituals like reciprocal drink-buying and toast-offering.</div><div>The long waves result from the competition of these interests. Alcohol becomes more available by industrialisation or other factors, and alcohol consumption and harms from drinking rise. Reaction to this from public health and welfare interests results in measures driving consumption levels back down. Then to a new generation the restrictions seem unnecessary; they are removed; and consumption rises again. Long waves with different periodicity are exemplified in 3 different patterns of national history: in countries with strong temperance movement histories, in Russia, and in France.</div><div>The long waves raise an issue which challenges the steady-progress assumption of the SDGs: are moves to lower alcohol consumption sustainable? More complex thinking and policymaking may be required to deal with alcohol policies in the frame of the Sustainable Development Goals.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"136 ","pages":"Article 104703"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025227","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":"Stimulant-involved overdose deaths: Constructing dynamic hypotheses","authors":"Zeynep Hasgul ,&nbsp;Arielle R. Deutsch ,&nbsp;Mohammad S. Jalali ,&nbsp;Erin J. Stringfellow","doi":"10.1016/j.drugpo.2025.104702","DOIUrl":"10.1016/j.drugpo.2025.104702","url":null,"abstract":"<div><div>The overdose epidemic in the United States is evolving, with a rise in stimulant (cocaine and/or methamphetamine)-only and opioid and stimulant-involved overdose deaths for reasons that remain unclear. We conducted interviews and group model building workshops in Massachusetts and South Dakota. Building on these data and extant research, we identified six dynamic hypotheses, explaining changes in stimulant-involved overdose trends, visualized using causal loop diagrams. For stimulant- and opioid-involved overdose deaths, three dynamic hypotheses emerged: (1) accidental exposure to fentanyl from stimulants; (2) primary stimulant users increasingly using opioids, often with resignation; (3) primary opioid (especially fentanyl) users increasingly using stimulants to balance the sedating effect of fentanyl. For stimulant-only overdose deaths, three additional dynamic hypotheses emerged: (1) disbelief that death could occur from stimulants alone, and doubt in testing capabilities to detect fentanyl; (2) the stimulant supply has changed, leading to higher unpredictability and thus higher overdose risk; and (3) long-term stimulant use contributing to deteriorating health and increasing overdose risk. These hypotheses likely each explain a portion of the recent trends in stimulant-involved overdoses. However, confusion and uncertainty around the drug supply emerged as a central theme, underscoring the chaotic and unpredictable nature of the stimulant market. Our findings indicate the need for research to develop targeted public health interventions, including analyzing the extent of the effect of contamination on overdoses, reducing confusion about the stimulant supply, and examining historical stimulant use trends.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"136 ","pages":"Article 104702"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053844","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":"Riding the wave or controlling the flow? Commentary on Room (2025) ‘Long waves of alcohol consumption and the Sustainable Development Goals’","authors":"James Nicholls","doi":"10.1016/j.drugpo.2025.104723","DOIUrl":"10.1016/j.drugpo.2025.104723","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104723"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075503","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 risk mitigation prescribing during dual public health emergencies: A qualitative study among Indigenous people who use drugs and health planners in Northern British Columbia, Canada","authors":"Brittany Barker ,&nbsp;Alexa Norton ,&nbsp;Shawn Wood ,&nbsp;Celeste Macevicius ,&nbsp;Katherine Hogan ,&nbsp;Katt Cadieux ,&nbsp;Louise Meilleur ,&nbsp;Bohdan Nosyk ,&nbsp;Karen Urbanoski ,&nbsp;Bernie Pauly ,&nbsp;Nel Wieman","doi":"10.1016/j.drugpo.2024.104679","DOIUrl":"10.1016/j.drugpo.2024.104679","url":null,"abstract":"<div><h3>Background</h3><div>In response to the dual public health emergencies of COVID-19 and the overdose crisis, the Government of British Columbia (BC) introduced risk mitigation prescribing, or prescribed safer supply. In the context of colonialism and racism, Indigenous people are disproportionately impacted by substance use harms and experience significant barriers to receiving care, particularly those living in rural and remote communities. As part of a larger provincial evaluation, we sought to assess the implementation of risk mitigation prescribing as experienced by Indigenous people who use drugs (IPWUD) in Northern BC.</div></div><div><h3>Methods</h3><div>We used the Consolidated Framework for Implementation Research and the First Nations Perspective on Health and Wellness as conceptual frameworks to guide the study. In partnership with people with lived/living experience, we conducted 20 qualitative interviews with IPWUD. Data were supplemented by four interviews with health planners and analyzed thematically.</div></div><div><h3>Results</h3><div>Participants reported limited implementation of risk mitigation prescribing in Northern BC, with unique regional challenges and innovative facilitators to access. Analysis of supplementary health planner data was consistent with the experiences of IPWUD and together provided a comprehensive picture of implementation in Northern BC. Four themes emerged: 1) Northern socio-politico-cultural barriers to implementation (outer setting), 2) rural and remote healthcare delivery challenges (inner setting), 3) adaptability of risk mitigation prescribing on Northern wellness (intervention characteristics), and 4) Northern ingenuity, relationality and champions facilitating access (implementation process).</div></div><div><h3>Conclusions</h3><div>Implementation and access to risk mitigation prescribing in Northern BC was limited, with region-specific applicability challenges and a health service delivery model that was not able to sufficiently meet the unique service needs of IPWUD. Demonstrating Northern ingenuity, peer groups, harm reduction community champions, and telehealth services were identified as stopgap measures that promoted access and reduced inequitable implementation within the region.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"136 ","pages":"Article 104679"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878101","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":"Acceptability of hepatitis C testing using point-of-care testing and dried blood spot collection among people at risk of hepatitis C infection","authors":"Annabelle Stevens ,&nbsp;Lise Lafferty ,&nbsp;Carla Treloar ,&nbsp;Evan B. Cunningham ,&nbsp;Gregory J. Dore ,&nbsp;Jason Grebely ,&nbsp;Alison D. Marshall","doi":"10.1016/j.drugpo.2025.104720","DOIUrl":"10.1016/j.drugpo.2025.104720","url":null,"abstract":"<div><h3>Background</h3><div>Hepatitis C (HCV) testing innovations such as dried blood spot (DBS) and point-of-care testing should have fewer client-related barriers than traditional diagnostic pathways, yet there is limited evidence on their acceptability among people who inject drugs. To address this gap, this study sought to evaluate the acceptability of DBS and point-of-care testing among people at risk of HCV infection and understand the circumstances in which such testing is most preferred.</div></div><div><h3>Methods</h3><div>Participants were recruited from community sites involved in the Australian HCV Point-of-Care Testing Program. Inclusion criteria were aged ≥18 years, sufficient proficiency in the English language, history of HCV testing at least once, and informed consent. Between June and August 2023, in-depth, semi-structured interviews were conducted via telephone with clients on their perceptions and experiences of HCV DBS and point-of-care testing. Data were coded and analysed thematically with Sekhon's theoretical framework of acceptability.</div></div><div><h3>Results</h3><div>Forty participants were interviewed: 18 had previously received HCV DBS testing, 8 had received HCV point-of-care testing, 8 had experience with both, and 6 had no prior experience with either test. Most participants preferred point-of-care compared to DBS and venepuncture due to the shorter time to result and some identified that this reduced anxiety while waiting for results (burden). Among participants in this study, many felt that the provision of non-judgemental care was more important than whether testing was performed by peers (ethicality). Many participants indicated a preference for assisted collection when compared to self-collected or mail testing service (self-efficacy).</div></div><div><h3>Conclusion</h3><div>Applying Sekhon's acceptability framework highlighted remaining service gaps to bridge client HCV testing experiences, including enhanced education on testing modalities and their results, an increased need for non-judgemental care, and the use of peer support in community settings.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104720"},"PeriodicalIF":4.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075958","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":"“Basically every safety protocol we have in place to protect against overdose, parents can't access”: Mothers who use unregulated drugs’ experiences of dual public health emergencies","authors":"Jade Boyd","doi":"10.1016/j.drugpo.2025.104719","DOIUrl":"10.1016/j.drugpo.2025.104719","url":null,"abstract":"<div><h3>Background</h3><div>A growing body of research details the impacts of COVID-19 pandemic-related public health directives and service disruptions on people who use unregulated drugs, however, there is limited research on the gendered impacts, particularly among mothers.</div></div><div><h3>Methods</h3><div>To explore experiences navigating the COVID-19 pandemic during a toxic drug crisis, phone-based semi-structured interviews were conducted from May 2020–Sept. 2021 with 45 women who use unregulated drugs in British Columbia. Iterative-based thematic analysis informed by intersectional theory identified unaccounted for impacts on parents.</div></div><div><h3>Findings</h3><div>Respondents’ experiences of the COVID-19 pandemic involved contending with an increasingly toxic drug supply alongside reduced resources, including service reductions and closures and reduced access to harm reduction supplies in a context already marked by women's marginalization within treatment and policy. Mothers described pandemic-related increased custody and care barriers and burdens, resulting in inability to prioritize self-care. Decisions to prioritize associated risks of either COVID-19 or drug toxicity, given conflicting public health guidelines, were experienced as high stakes for mothers, due to their unique vulnerability to institutional scrutiny. Pandemic-informed overdose risk mitigations, such as access to legal pharmaceutical-grade alternatives to the toxic drug supply, also involved additional risks for mothers (e.g., heightened monitoring; child apprehension), thus, some respondents, responsibilized for their health and childcare, resourcefully relied upon informal, social networks to help mitigate potential harms.</div></div><div><h3>Conclusion</h3><div>While mothers and their experiences are heterogeneous, gendered distinctions impact provision and experience of health care, harm reduction and social supports. Mothers who use drugs must navigate health and care responsibilities, exacerbated by pandemic-related health barriers, while simultaneously inhabiting an unremitting state of fear of punitive measures or postapprehension despair. The continued social exclusion of mothers who use drugs, propelled by moralizing discourses framing them as deviant and consequentially undeserving, can have devastating health impacts (on individuals and communities) yet remain underaddressed.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104719"},"PeriodicalIF":4.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092964","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":"Finding the optimal length of stay for veterans in substance use disorder residential treatment using generalized propensity score modeling","authors":"Gregory M. Dams ,&nbsp;Georgina M. Gross ,&nbsp;Bethany R. Ketchen ,&nbsp;Noelle B. Smith ,&nbsp;Jennifer L. Burden","doi":"10.1016/j.drugpo.2025.104715","DOIUrl":"10.1016/j.drugpo.2025.104715","url":null,"abstract":"<div><div>Substance use disorder (SUD) residential treatment provides critical services to patients with complex clinical needs. The Department of Veterans Affairs (VA) has over 70 SUD residential programs to meet the needs of veterans with severe SUD. Prior research is mixed on what SUD residential length of stay (LOS) duration maximizes average treatment outcomes, with some studies advocating for around 30 days and others advocating for at least 90 days. Much of this research is limited by methodological issues and fails to consider both outcomes for established patients and timely access for prospective patients. The present study sought to clarify the relative benefits of different LOSs to be considered by SUD residential program decision-makers as default LOSs, upon which to be personalized by individual patient needs and clinical assessment. Using medical record data associated with N = 15,889 veterans discharging from a VA SUD residential center between 10/1/2021 and 9/30/2022, we identified an optimal LOS range balancing average treatment outcomes and ensuring new patient access/minimizing established patient diminished returns from treatment. Using a generalized propensity-weighted dose-response curve, we identified key LOSs between 35 and 49 days with different tradeoffs between enhancing outcomes and access.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104715"},"PeriodicalIF":4.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092961","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":"Monitoring hepatitis C elimination among people who inject drugs: A broader approach is required","authors":"Gregory J. Dore","doi":"10.1016/j.drugpo.2025.104712","DOIUrl":"10.1016/j.drugpo.2025.104712","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104712"},"PeriodicalIF":4.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042119","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}