International Journal of Drug Policy最新文献

{"title":"“They talk about it like it's an overdose crisis when in fact it's basically genocide”: The experiences of Indigenous peoples who use illicit drugs in Vancouver's Downtown Eastside neighbourhood","authors":"Jennifer Lavalley ,&nbsp;Linda Steinhauer ,&nbsp;Dino (Boomer) Bundy ,&nbsp;Thomas Kerr ,&nbsp;Ryan McNeil","doi":"10.1016/j.drugpo.2024.104631","DOIUrl":"10.1016/j.drugpo.2024.104631","url":null,"abstract":"<div><div>Indigenous Peoples who use illicit drugs (IPWUID) are disproportionately represented among toxic drug poisoning deaths in Canada. These drug-related harms are framed by the historical and ongoing trauma related to settler colonialism and are acutely visible in Vancouver, Canada's Downtown Eastside - a low-income neighbourhood that is an epicenter of the drug poisoning crisis and characterized by entrenched poverty, substance use, violence, and homelessness. This study was undertaken to examine the experiences and perspectives of IPWUID in the Downtown Eastside regarding the drug poisoning crisis and the responsiveness of harm reduction programs within the context of settler colonialism. Indigenous-led qualitative interviews were conducted with 16 IPWUID recruited by Indigenous peer researchers. Indigenous ways of knowing were embedded throughout the entire research design to ensure research was culturally congruent. Interview transcripts were analyzed thematically and interpreted by drawing on concepts of social violence and racial capitalism. Our analysis reviewed three key themes that centered the experiences of IPWUID in Vancouver's Downtown Eastside in relation to the drug poisoning crisis: (1) that the drug poisoning crisis is understood as a form of genocide toward Indigenous Peoples; (2) that the crisis is experienced within the context of pervasive distrust and adversarial relationships with police rooted in structurally racist experiences of place-based policing practices; and (3) that there is a desire for culturally-safe harm reduction care with Indigenous representation, cultural integration, and that addresses inequities and injustice stemming from colonialism and structural racism. Findings demonstrate how responses to the drug poisoning crisis among IPWUID need to respond to social and materials conditions perpetuated by colonialism and racial capitalism, while also centering IPWUID through the development and implementation of Indigenous-led and culturally safe harm reduction approaches.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104631"},"PeriodicalIF":4.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577887","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":"Bridging the gap: Exploring consumer experiences and motivations for transitioning between illicit and regulated cannabis markets","authors":"Jennifer R. Donnan ,&nbsp;Rachel Howells ,&nbsp;Sylvia Farooq ,&nbsp;Myles Maillet ,&nbsp;Laura M. Harris-Lane","doi":"10.1016/j.drugpo.2024.104644","DOIUrl":"10.1016/j.drugpo.2024.104644","url":null,"abstract":"<div><h3>Background</h3><div>Canada pioneered the non-medical legalization of cannabis production and sales, witnessing substantial growth in the regulated market over the last five years, post-legalization. However, persistent barriers hinder many consumers from transitioning to the legal market, necessitating a nuanced understanding of their behaviors for targeted policy interventions. This study aims to improve understanding of cannabis consumers’ unregulated purchase decisions in British Columbia (B.C.), and to explore motivational factors for transitioning to the legal market.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with cannabis consumers in B.C., who were at least 19 years old and purchased some or all of their cannabis through unregulated sources. Interviews were transcribed and an inductive thematic analysis was conducted using NVivo. Through coding iterations, we moved from descriptive to analytic codes, and finally mapped the codes to themes aligned with the <em>Five Stages of Consumer Decision Making</em> model.</div></div><div><h3>Results</h3><div>Participants (<em>N</em> = 31) represented a broad range of demographic characteristics (i.e., gender, age, education, income). Four themes were identified: seeking information, evaluation of alternatives, purchase decision, and post purchase evaluation. Despite purchasing all or some of their cannabis from the unregulated market, most participants were supportive of legalization and felt that legal cannabis is safe, accessible, and of reasonable quality. However, several barriers prevent consumers from regularly accessing the regulated market, including: price, lack of sales and promotions, potency, limited product variety, and inadequate product interaction.</div></div><div><h3>Conclusion</h3><div>This study delineates barriers that obstruct consumers' transition to the regulated market. These findings, aligned with considerations for public health and safety, offer valuable insights to inform cannabis policy and promote a more effective and consumer-oriented regulatory framework.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104644"},"PeriodicalIF":4.4,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569833","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 place-based spatial analysis of racial inequities in overdose in St. Louis County Missouri, United States","authors":"Phillip L. Marotta ,&nbsp;Benjamin CB Leach ,&nbsp;William D. Hutson ,&nbsp;Joel M. Caplan ,&nbsp;Brenna Lohmann ,&nbsp;Charlin Hughes ,&nbsp;Devin Banks ,&nbsp;Stephen Roll ,&nbsp;Yung Chun ,&nbsp;Jason Jabbari ,&nbsp;Rachel Ancona ,&nbsp;Kristen Mueller ,&nbsp;Ben Cooper ,&nbsp;Theresa Anasti ,&nbsp;Nathaniel Dell ,&nbsp;Rachel Winograd ,&nbsp;Robert Heimer","doi":"10.1016/j.drugpo.2024.104611","DOIUrl":"10.1016/j.drugpo.2024.104611","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to identify place features associated with increased risk of drug-involved fatalities and generate a composite score measuring risk based on the combined effects of features of the built environment.</div></div><div><h3>Methods</h3><div>We conducted a geospatial analysis of overdose data from 2022 to 2023 provided by the St. Louis County Medical Examiner's Office to test whether drug-involved deaths were more likely to occur near 54 different place features using Risk Terrain Modeling (RTM). RTM was used to identify features of the built environment that create settings of heightened overdose risk. Risk was estimated using Relative Risk Values (RRVs) and a composite score measuring Relative Risk Scores (RRS) across the county was produced for drugs, opioids, and stimulants, as well as by Black and White decedents.</div></div><div><h3>Results</h3><div>In the model including all drugs, deaths were more likely to occur in close proximity to hotels/motels (RRV=39.65, SE=0.34, t-value=10.81 <em>p</em>&lt;.001), foreclosures (RRV=4.42, SE=0.12, t-value = 12.80, <em>p</em>&lt;.001), police departments (RRV=3.13, SE=0.24, t-score=4.86, <em>p</em>&lt;.001), and restaurants (RRV=2.33, SE=0.12, t-value=7.16, <em>p</em>&lt;.001). For Black decedents, deaths were more likely to occur near foreclosures (RRV=9.01, SE=0.18, t-value =11.92, <em>p</em>&lt;.001), and places of worship (RRV= 2.51, SE=0.18, t-value = 11.92, <em>p</em>&lt;.001). For White decedents, deaths were more likely to occur in close proximity to hotels/motels (RRV=38.97, SE=0.39, t-value=9.30, <em>p</em>&lt;.001) foreclosures (RRV=2.57, SE=0.16, t-value =5.84, <em>p</em>&lt;.001), restaurants (RRV=2.52, SE=0.17, t-value=5.33, <em>p</em>&lt;.001) and, auto painting/repair shops (RRV=0.04, SE=0.18, t-value =3.39, <em>p</em>&lt;.001).</div></div><div><h3>Conclusion</h3><div>These findings suggest that places of worship, the hospitality industry, and housing authorities may be physical features of the environment that reflect social conditions that are conducive to overdose. The scaling up of harm reduction strategies could be enhanced by targeting places where features are co-located.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104611"},"PeriodicalIF":4.4,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569892","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":"Examining the association between trenbolone, psychological distress, and aggression among males who use anabolic-androgenic steroids","authors":"Timothy Piatkowski ,&nbsp;Dominique De Andrade ,&nbsp;David Neumann ,&nbsp;Calvert Tisdale ,&nbsp;Matthew Dunn","doi":"10.1016/j.drugpo.2024.104636","DOIUrl":"10.1016/j.drugpo.2024.104636","url":null,"abstract":"<div><div><em>Introduction:</em> The link between anabolic-androgenic steroid (AAS) use and psychosocial effects such as aggression and violence is contentious. Few studies differentiate between types of AAS. This study focuses on trenbolone to assess its psychological risks and effects on aggression compared to other AAS. We hypothesised that there would be a positive relationship between trenbolone dosage and both psychological distress and aggression among people who use AAS. <em>Methods:</em> Using purposive and snowball sampling of people using AAS, we conducted an online survey to investigate the relationship between trenbolone use and other AAS use. Participants completed sections on demographics, trenbolone and other illicit drug use, the Kessler Psychological Distress Scale, and the Buss and Perry Aggression Questionnaire. Data were analysed using multinominal and multivariable regression. <em>Results:</em> The study included 282 males using AAS. Over 33% (<em>n</em>=93) reported currently using trenbolone, with 55.3% (<em>n</em>=156) of participants reporting having used trenbolone in the past, and 11.7% (<em>n</em>=33) reporting having never used trenbolone. Those who had never used trenbolone were not significantly different on age, height, weight, and BMI compared to those who had<em>.</em> After controlling for age and BMI, dose of trenbolone was significantly (<em>p</em>=0.045) associated with higher levels of verbal aggression. <em>Conclusion:</em> The study highlights trenbolone's association with increased verbal aggression among males using AAS, particularly at higher doses. Further research should continue to differentiate between AAS types and the accompanying health harms.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104636"},"PeriodicalIF":4.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560770","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":"Developing a mobile-based brief intervention to reduce cannabis-impaired driving among youth: An intervention mapping approach","authors":"Robert Colonna ,&nbsp;Patricia Tucker ,&nbsp;Angela Mandich ,&nbsp;Liliana Alvarez","doi":"10.1016/j.drugpo.2024.104626","DOIUrl":"10.1016/j.drugpo.2024.104626","url":null,"abstract":"<div><div>Behaviour change interventions delivered via smartphones have the potential to reduce youth cannabis use and driving under the influence of cannabis (DUIC). Countless smartphone applications (either downloadable or web-based) are available to help reduce substance use and impaired driving. However, most are developed without evidence-based content and theory, and many have poor user engagement. This study aims to: (1) describe the systematic development and theoretical foundations of a youth DUIC smartphone intervention, and (2) describe the pre-testing among a sample of youth and adult cannabis educators (prior to efficacy testing). A 6-step Intervention Mapping approach was utilized to combine theory, evidence, and user feedback to develop and implement the ‘High Alert’ intervention. This evidence-based and iterative process entailed: (1) conducting a needs assessment, (2) identifying intervention objectives, which map on the following DUIC determinants: knowledge, attitudes, risk perception, perceived norms, and self-efficacy, (3) selecting intervention theory and design, (4) developing of the intervention, (5) implementation, and (6) evaluation. Application of Intervention Mapping resulted in a smartphone web-based application that could support reductions in cannabis use and DUIC. The ‘High Alert’ intervention was created to include four modules with contents focusing on educating youth on the dangers and legal risks of DUIC, limiting risky situations, avoiding riding with an impaired driver, planning a safe ride home, and promoting safer cannabis use. Future research will test the efficacy of the intervention in reducing risky cannabis use and DUIC among youth.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104626"},"PeriodicalIF":4.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548373","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":"Impacts of the COVID-19 pandemic on the availability and retail price of unregulated drugs in Vancouver, Canada: An interrupted time-series analysis, 2018-2022","authors":"Anmol Swaich ,&nbsp;Delaney Ignatieff ,&nbsp;M-J Milloy ,&nbsp;JinCheol Choi ,&nbsp;Thomas Kerr ,&nbsp;Kanna Hayashi","doi":"10.1016/j.drugpo.2024.104633","DOIUrl":"10.1016/j.drugpo.2024.104633","url":null,"abstract":"<div><h3>Background</h3><div>Impacts of the COVID-19 pandemic on unregulated drug markets in North America have not been well characterized. We sought to estimate potential changes in the availability and retail price of unregulated drugs in Vancouver, Canada pre- vs. post-emergence of the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>We used self-report data from two prospective cohorts of people who use drugs in Vancouver. We employed interrupted time series analyses to identify changes in the monthly prevalence of immediate availability (i.e., within 10 minutes vs. any longer) and median retail price of crystal methamphetamine, powder cocaine, crack cocaine, and ‘down’ (the local term for unregulated opioids, e.g., heroin, fentanyl, etc), post-pandemic emergence (i.e. post-July 2020).</div></div><div><h3>Results</h3><div>Between 2018 and 2022 among 739 participants, the monthly prevalence of immediate availability significantly decreased for all drugs immediately post- emergence of the pandemic (all p&lt;0.05). The monthly prevalence of immediate availability of cocaine declined most (-18.1%, 95% confidence interval [CI]: -25.9, -10.4) and the immediate availability of ‘down’ declined least (-13.0%, 95% CI:-18.8, -7.3). In analyses of median price, the only significant change was in the price of cocaine, which increased by $3.46 per 0.5 grams (95% CI:1.0, 5.9) immediately post-emergence of the pandemic.</div></div><div><h3>Conclusion</h3><div>While more research is needed to investigate reasons for the observed trends, the stagnant price amidst decreased availability for all drugs examined in this study (save cocaine) may reflect decreased purity/increased contamination of unregulated drugs following the beginning of the pandemic in our study setting. These findings may have implications for drug policy and practice approaches, particularly in regions where synthetic psychoactive substances are increasingly dominating the unregulated drug supply.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104633"},"PeriodicalIF":4.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548375","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":"Co-designing the INHSU Prisons Hepatitis C Advocacy Toolkit using the Advocacy Strategy Framework","authors":"SJ Walker ,&nbsp;O Dawson ,&nbsp;Y Sheehan ,&nbsp;LB Shrestha ,&nbsp;AR Lloyd ,&nbsp;J Sheehan ,&nbsp;N Maduka ,&nbsp;J Cabezas ,&nbsp;N Kronfli ,&nbsp;MJ Akiyama ,&nbsp;INHSU Prisons","doi":"10.1016/j.drugpo.2024.104628","DOIUrl":"10.1016/j.drugpo.2024.104628","url":null,"abstract":"<div><h3>Background</h3><div>The World Health Organization (WHO) has established targets to eliminate the hepatitis C virus (HCV) by 2030. Prisons are a key focus of elimination efforts, however, access to HCV services in prisons remains low globally. With the aim of increasing advocacy efforts to help address this gap, the International Network on Health and Hepatitis in Substance Users (INHSU) Prisons, developed a Prisons Hepatitis C Advocacy Toolkit.</div></div><div><h3>Methods</h3><div>Toolkit development involved a co-design process to ensure advocacy resources met end-user needs. A scoping study was conducted, involving a web-based survey and in-depth interviews, to understand advocacy resource needs of key stakeholders from countries of different socio-economic strata. Data were analysed, and suggested advocacy resources were mapped onto the Advocacy Strategy Framework with the audiences resources are targetting and the changes they aim to influence. Advocacy resources were co-developed and validated by interview participants before incorporation into the web-based platform.</div></div><div><h3>Results</h3><div>Survey responses (<em>n</em> = 181) and interview data (<em>n</em> = 25) highlighted several barriers to enhancing HCV services in prisons globally, and an understanding that advocacy efforts are needed to bring about this change. Advocacy resources were suggested for influencing three key audiences: policymakers/funders, implementers, and community. Thereafter, a suite of 20 <em>de novo</em> tools were co-developed with key stakeholders including case studies of evidence-based models of HCV care, policy briefs, HCV infographics, and fact sheets about how to leverage funding and build advocacy campaigns. Findings underscore the importance of capitalising on the knowledge and expertise of potential end-users, to ensure Toolkit resources are context-specific and match their needs.</div></div><div><h3>Conclusion</h3><div>The Toolkit holds promise for progressing the WHO elimination goals by increasing advocacy efforts for enhanced prison HCV services globally. The co-design of Toolkit resources with potential end-users has increased its potential accessibility, acceptability, and inclusivity for a globally diverse audience.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104628"},"PeriodicalIF":4.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548364","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":"Framework for opioid use disorder screening and diagnosis in carceral settings","authors":"Helen E. Jack ,&nbsp;Catherine L. Smith ,&nbsp;Lauren Brinkley-Rubinstein ,&nbsp;Justin Berk","doi":"10.1016/j.drugpo.2024.104627","DOIUrl":"10.1016/j.drugpo.2024.104627","url":null,"abstract":"<div><div>In the United States, the opioid overdose crisis disproportionately affects incarcerated individuals, with opioid overdose risk in the two weeks after release 50 times higher than the general population. As a response, many prisons and jails are starting to offer medication for opioid use disorder (MOUD), including methadone or buprenorphine, during incarceration or prior to release. One implementation barrier is how to identify who would benefit from treatment, given that opioid use disorder screening and diagnostic testing are imperfect, particularly in criminal-legal settings. Prisons and jails use a variety of OUD assessment strategies, including brief self-report screening tools, diagnostic interviews, review of pre-incarceration medical records, and urine drug screening, all of which may lead to false positive and false negative results. In this essay, we apply a common framework from epidemiology and other fields to conceptualize OUD assessment in carceral settings: individuals assessed for OUD can be those with OUD who are correctly offered MOUD (“true positives”), those without OUD who are offered MOUD (“false positives”), those with OUD who are not offered MOUD (“false negatives”), and those without MOUD who are not offered MOUD (“true negatives”). We discuss these assessment and treatment outcomes from the perspectives of people who are incarcerated, security staff, and healthcare staff. This framework may inform discussions between medical staff and security personnel on the implementation of MOUD programs.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104627"},"PeriodicalIF":4.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548374","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":"Predictors of treatment outcomes for Hepatitis C infection in a nationwide elimination program in Iceland: The treatment as prevention for Hepatitis C (TraP HepC) study","authors":"Sigurdur Olafsson ,&nbsp;Thorvardur Jon Love ,&nbsp;Ragnheidur Hulda Fridriksdottir ,&nbsp;Thorarinn Tyrfingsson ,&nbsp;Valgerdur Runarsdottir ,&nbsp;Ingunn Hansdottir ,&nbsp;Ottar Mar Bergmann ,&nbsp;Einar Stefan Björnsson ,&nbsp;Birgir Johannsson ,&nbsp;Bryndis Sigurdardottir ,&nbsp;Arthur Löve ,&nbsp;Guðrún Erna Baldvinsdottir ,&nbsp;Marianna Thordardottir ,&nbsp;Ubaldo Benitez Hernandez ,&nbsp;Maria Heimisdottir ,&nbsp;Margaret Hellard ,&nbsp;Magnus Gottfredsson ,&nbsp;the TraP Hep C working group","doi":"10.1016/j.drugpo.2024.104616","DOIUrl":"10.1016/j.drugpo.2024.104616","url":null,"abstract":"<div><h3>Background</h3><div>Limited data exists about treatment outcomes in nationwide hepatitis C virus (HCV) elimination programs where injection drug use (IDU) is the main mode of transmission. In 2016 Iceland initiated the HCV elimination program known as Treatment as Prevention for Hepatitis C (TraP HepC). Factors associated with HCV cure in this population are examined.</div></div><div><h3>Methods</h3><div>Unrestricted access was offered to direct acting antiviral agents (DAAs). Testing and harm reduction was scaled up and re-treatments were offered for those who did not attain cure. Cure rates for the first 36 months were assessed and factors associated with failure to achieve cure analysed using multivariable logistic regression.</div></div><div><h3>Results</h3><div>Treatment was initiated for 718; 705 consented for the study. Median age was 44 years (IQR 35–56), history of IDU reported by 593 (84.1 %), recent IDU by 234 (33.2 %); 48 (6.8 %) were homeless. Of 705 patients, 635 achieved cure (90.1 %) during the first treatment. A total of 70 (9.9 %) patients initiated two or more treatments, resulting in 673 participants cured (95.5 %). By multivariable analysis, homelessness was the only statistically significant independent factor associated with not achieving cure (OR 2.67, 95 % CI 1.32–5.41) after first treatment attempt.</div></div><div><h3>Conclusion</h3><div>By reengagement in care and prompt retreatment when needed, a cure rate of 95.5 % was achieved. Unstable housing, a potentially actionable factor is associated with poor outcome.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104616"},"PeriodicalIF":4.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510507","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":"Social forces shaping evidence production: A study of the swiss cannabis pilot trials","authors":"Sharon R. Sznitman ,&nbsp;Reto Auer ,&nbsp;Jonathan Christopher Havinga ,&nbsp;Alessandro Casalini ,&nbsp;Barbara Broers","doi":"10.1016/j.drugpo.2024.104623","DOIUrl":"10.1016/j.drugpo.2024.104623","url":null,"abstract":"<div><h3>Aim</h3><div>The evidence-based policy paradigm has been criticized for poorly representing drug and other health policy processes, with evidence showing various social forces influencing knowledge translation. However, less research has examined the social forces influencing knowledge production. Applying a social constructivist lens, this study investigates how politics, power, economics, philosophy, and discourse influence the evidence generating processes related to drug policy.</div></div><div><h3>Methods</h3><div>Using Swiss cannabis pilot trials as a case study, thematic content analysis was conducted on qualitative interview data from 18 stakeholders, including scientists, policy makers, pharmacists, physicians, cannabis producers, and current and former employees of the Swiss Federal Office of Public Health.</div></div><div><h3>Results</h3><div>The study reveals how social forces collectively shape scientific evidence generating processes, with political imperatives and stakeholder interests often taking precedence over purely scientific considerations. Contrary to the presumed opposition between positivist and interpretivist stances, informants demonstrated a commitment to both, dedicating themselves to positivist research agendas while highlighting the influence of harm reduction discourse on the pilot trials.</div></div><div><h3>Conclusions</h3><div>The Swiss cannabis pilot trials illustrate how social forces can shape the production of policy-relevant evidence, transforming evidence-based policy into policy-based evidence. Asymmetries in actor resources and power, along with the adjustment of evidence production to align with contextual realities, play significant roles in this process. Recognizing the complex social dimensions of evidence generating processes is crucial for a more reflexive and power-sensitive understanding of drug policymaking.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104623"},"PeriodicalIF":4.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510523","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}