International Journal of Drug Policy最新文献

{"title":"Risky alcohol use and violence against women: cause or consequence?","authors":"Don Weatherburn ,&nbsp;Sara Rahman ,&nbsp;Joanna Wang","doi":"10.1016/j.drugpo.2025.104981","DOIUrl":"10.1016/j.drugpo.2025.104981","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of the current study was to determine (a) whether there is a relationship between the quantity of alcohol consumed by a woman when drinking alcohol and the risk of physical violence and (b) whether experiencing physical violence increases the quantity of alcohol consumed by a woman.</div></div><div><h3>Methods</h3><div>The research questions were addressed by fitting a series of random and fixed effect logistic regression models to data drawn from 22 waves of the HILDA survey, a nationally representative longitudinal survey of Australian households. The dataset for the current study involves 143,517 survey responses from 15,934 women. We examine (1) the cross-sectional relationship between alcohol use and physical violence among women (2) the relationship between alcohol use (or violence) at wave t and physical violence (or alcohol use) at wave <em>t</em> + 1 and (3) the within-subject relationship between alcohol use and physical violence (and vice versa).</div></div><div><h3>Results</h3><div>The risk of is nine per cent for a woman who consumes 1–2 standard drinks at a sitting, 15 per cent for a woman who consumes 7 to 8 standard drinks at a sitting and 20 per cent for a woman who normally consumes 13 or more standard drinks at a sitting. Controlling for other factors, a woman who reports having been assaulted in the previous 12 months consumes an average of 13 per cent more alcohol at a sitting than a woman who has not been assaulted in the previous 12 months.</div></div><div><h3>Conclusion</h3><div>Prevention resources are always limited and are therefore best targeted at those who are most at risk, regardless of whether the correlate plays a causal role or is simply a signal of heightened risk. Women reporting they have been assaulted to health, welfare or criminal justice authorities should be assessed to determine whether they also have concurrent drug and alcohol problems.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 104981"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048365","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":"Parenting and heavy substance use: From neutralization theory to actor-network theory to avoid stigmatizing participants","authors":"Jukka Törrönen ,&nbsp;Ulrika Winerdal ,&nbsp;Malin Gunnarsson ,&nbsp;Eva Samuelsson","doi":"10.1016/j.drugpo.2025.104983","DOIUrl":"10.1016/j.drugpo.2025.104983","url":null,"abstract":"<div><div><em>Background:</em> By contrasting the approaches of neutralization theory (NT) and actor-network theory (ANT), we argue that research using NT can contribute to stigmatizing people with substance use problems as ‘liars,’ ‘irresponsible,’ and ’incapable.’ In contrast, ANT can help us become more sensitive to the participants’ realities and produce non-stigmatizing results. <em>Methods:</em> The data consists of 22 life stories in which participants describe the concerns their substance use caused for their parenting and how they addressed them. With ANT, we analyze what kinds of mediators in our participants’ parenting assemblages increased or decreased their capacities to mitigate the negative effects of substance use on their children. <em>Results:</em> In our analysis, we identified four parenting assemblages. The assemblages of ‘displacing substance use’ and ‘keeping up ordinary family life’ increased the participants’ capacities to move substance use away from encounters with children or to use it to strengthen their engagement with everyday life parenting practices. The assemblages of ‘losing oneself to the dominance of substances’ and ‘being moved by a traumatic past’ decreased the participants’ parenting capacities by weakening their connections to good enough parenting, or by allowing the connections from the past to dominate and mediate their present action, leading to relapse in drug use and the loss of a child. <em>Conclusion:</em> Our study suggests that by shifting the perspective from doubt and criticism (NT) to empathy and care (ANT), research can transcend mere critique and serve as a tool for empowerment, advocacy, and meaningful change.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 104983"},"PeriodicalIF":4.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026896","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":"Emergency department violence involving patients who use unregulated substances: A systemic perspective","authors":"Sunny Jiao ,&nbsp;Vicky Bungay ,&nbsp;Emily Jenkins ,&nbsp;Marilou Gagnon","doi":"10.1016/j.drugpo.2025.105007","DOIUrl":"10.1016/j.drugpo.2025.105007","url":null,"abstract":"<div><div>This paper examines emergency department staff perspectives of patient violence in the context of care provision for people who use unregulated substances. Study findings demonstrate that disconnects between what patients need and what staff can offer create conditions that contribute to staff-patient conflict and violence – disconnects situated within constrains produced by system structures. In navigating the potential for conflict, care choices of staff are shaped by factors including fear and hypervigilance, expectations of teamwork and autonomous practice, and a lack of violence prevention training. This is in contrast to the existing research concerning emergency care for people who use unregulated substances, which tends to portray substance use as a predisposing factor to patient violence, failing to acknowledge organizational structures and variations in staff practices as contributing to violence. Findings from this study have profound implications for current and future efforts of addressing patient violence in the emergency department, with the end goal of improving patient care for people who use unregulated substances.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 105007"},"PeriodicalIF":4.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041791","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":"Alcohol use and mental health distress correlates among artisanal gold miners in Ghana","authors":"Emmanuel Nyaaba,&nbsp;Vanessa Francesca Epis,&nbsp;Emma Abena Otema Sefa,&nbsp;Philip Kwarteng,&nbsp;Mohammed-Gazali Hambali","doi":"10.1016/j.drugpo.2025.104978","DOIUrl":"10.1016/j.drugpo.2025.104978","url":null,"abstract":"<div><div>Despite rising concerns about alcohol use in artisanal mining, a focused investigation into its psychosocial drivers and mental health implications within sub-Saharan Africa’s informal mining sector remains scarce. This study investigates the prevalence, motivations, and the association between alcohol use and mental health outcomes (depression, anxiety, and stress) among artisanal miners in Ghana. Using community based cross-sectional survey data from 664 miners, alcohol use was assessed using the Alcohol Use Disorders Identification Test, while symptoms of anxiety, stress, and depression were measured via the GAD-7, PSS, and PHQ-9 instruments. The findings revealed that 4 out of 5 miners (79.8 %) reported consuming alcohol within the past month. Among them, 38.1 % were classified as hazardous drinkers, while 16.4 % met criteria for binge drinking. Motivations for alcohol use included coping with harsh working conditions, easy access and affordability, social bonding, and peer influence, particularly among younger miners. Younger miners aged 18–35 years were significantly more likely than their older counterparts (&gt;35 years) to report peer pressure (33.3 % vs. 11.8 %; χ² = 24.48, <em>p</em> &lt; .001, <em>V</em> = 0.192), stress and fatigue management (56.1 % vs. 35.3 %; χ² = 18.68, <em>p</em> &lt; .001, <em>V</em> = 0.168), and pain relief (22.7 % vs. 11.8 %; χ² = 7.98, <em>p</em> = .005, <em>V</em> = 0.110) as key reasons for drinking. Multivariable regression analyses showed that alcohol use was significantly associated with higher levels of anxiety (<em>B</em> = 0.84, 95 % CI [.60, 1.08]), stress (<em>B</em> = 0.14, 95 % CI [.02, 0.26]) and depression (<em>B</em> = 0.28, 95 % CI [.11, 0.45]). However, the link between alcohol and stress was significant only among the older group. These findings highlight the urgent need for targeted, age-responsive public health interventions that integrate substance use prevention with mental health services, particularly within informal and high-risk labor environments such as artisanal mining.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 104978"},"PeriodicalIF":4.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996384","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":"Media representation of methamphetamine-related deaths: Exploring links to public stigma and support for harm reduction","authors":"Steph Kershaw ,&nbsp;Jessica Deng ,&nbsp;Georgette Borel ,&nbsp;Siobhan O’Dean ,&nbsp;Jack Wilson ,&nbsp;Louise Birrell ,&nbsp;Katrina Prior ,&nbsp;Marlee Bower ,&nbsp;Amelia Henry ,&nbsp;Emma K. Devine ,&nbsp;Matthew Sunderland ,&nbsp;Harry Sumnall ,&nbsp;Cath Chapman","doi":"10.1016/j.drugpo.2025.104980","DOIUrl":"10.1016/j.drugpo.2025.104980","url":null,"abstract":"<div><h3>Background</h3><div>Drug-related deaths are a significant and growing public health concern. In Australia, meth/amphetamine is the most common stimulant drug involved in unintentional drug-related deaths. People who use meth/amphetamine often experience stigma and are negatively portrayed in the media. Considering the influence of media on public attitudes, which in turn influences policy, this study aimed to examine the relationships between media representations of drug-related deaths and stigma towards the people who use drugs along with attitudes towards harm reduction policy.</div></div><div><h3>Methods</h3><div>Nationally representative sample of Australians (N = 1490) participated in an online experimental study where they were randomised to one of eight simulated news stories depicting a drug-related death. Each news story varied by drug type (methamphetamine or alternative stimulant (MDMA, ‘ecstasy’)), age of the character depicted (younger or older), and gender of the character depicted (female or male). Stigma towards the character depicted and support for harm reduction was assessed. Data were analysed using MANOVA.</div></div><div><h3>Results</h3><div>Among the sample (average age = 48.5 years (SD 17.73); 54.7% female). Stigma was higher towards depictions of older people compared to younger people (p &lt; .001) and those who had used methamphetamine compared to MDMA (p &lt; .001). No significant main effects on support for harm reduction were found.</div></div><div><h3>Conclusion</h3><div>Certain characteristics in news stories about drug-related deaths elicit higher stigma towards the depicted person. Thus, improving how the media report and frame drug-related deaths represents an important avenue to reduce stigma towards people who use drugs and in turn foster public support for evidence-based drug policies.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 104980"},"PeriodicalIF":4.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996383","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":"Cannabis in the wild: Analysis of street cannabis and cannabinoid composition in Australia","authors":"Valentina Lorenzetti ,&nbsp;Isabella Goodwin ,&nbsp;Erynn Christensen ,&nbsp;Rebecca Kirkham ,&nbsp;Yann Chye ,&nbsp;Peter Galettis ,&nbsp;Rebecca Gordon ,&nbsp;Nadia Solowij ,&nbsp;Murat Yücel","doi":"10.1016/j.drugpo.2025.104974","DOIUrl":"10.1016/j.drugpo.2025.104974","url":null,"abstract":"<div><h3>Background</h3><div>Australia has one of the highest rates of cannabis use globally, yet the concentration of Δ9-tetrahydrocannabinol (THC) of illicit street cannabis has not been formally assessed in over a decade. We aimed to comprehensively profile the concentration of THC, cannabidiol (CBD) and other cannabinoids in contemporary illicit street cannabis in regional Australia, assess variation over time, and examine how the amount of THC relates to consumer’s perceived product strength.</div></div><div><h3>Methods</h3><div>Participants donated two 1-gram samples of cannabis at 3 different timepoints (i.e., 6 samples total) ∼9-weeks apart, over 5 months. High-performance liquid chromatography quantified the concentrations of THC, CBD, cannabigerol, cannabichromene, cannabinol, tetrahydrocannabivarin, and their plant-based carboxylic acid precursors (THCA, CBDA, CBGA, CBNA, THCVA) in percentage and milligrams.</div></div><div><h3>Results</h3><div>Thirty-seven participants donated 127 cannabis samples. On average, one cannabis gram contained 34.8 mg THC (6.96 Standard THC units), 12.00 % <em>total</em> THC (THC+(THCA*0.877)), and 0.30 % <em>total</em> CBD (CBD+(CBDA*0.877)). THC concentrations remained stable across participants’ current and past samples over time (<em>p</em> &gt; 0.05). Finally, no correlation was found between participants' subjective assessments of cannabis strength and THC or <em>total</em> THC content in the same product (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Contemporary illicit street cannabis in regional Australia is high in THC and low in CBD. The concentration of THC is lower than international trends but appears to have increased compared to reports on illicit Australian cannabis collected over 10 years ago, while low concentrations of CBD have remained stable over time. Perceived cannabis strength may be influenced by factors beyond measurable THC concentrations, such as individual tolerance, consumption methods, or consumer expectations.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 104974"},"PeriodicalIF":4.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988381","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":"Competing coalitions in alcohol policymaking in Malawi: a retrospective case study analysis of the alcohol sachet ban","authors":"Isabelle Uny ,&nbsp;Denview Magalasi ,&nbsp;Marsha Orgill ,&nbsp;Cissie Namanda ,&nbsp;Gemma Mitchell ,&nbsp;Nazarius Mbona Tumwesigye ,&nbsp;Linda Bauld ,&nbsp;Charles Parry ,&nbsp;Niamh Fitzgerald ,&nbsp;Benjamin Kaneka","doi":"10.1016/j.drugpo.2025.104979","DOIUrl":"10.1016/j.drugpo.2025.104979","url":null,"abstract":"<div><h3>Background</h3><div>Harmful alcohol consumption has significant public health implications across Africa and disproportionately affects vulnerable populations. In Malawi, the emergence of alcohol sachets - small, affordable plastic packets containing high-strength spirits – and their consumption, has raised substantial public health concerns. In particular, the resulting access and consumption amongst young people, led to a ban on those products by the Malawi Government in 2017. This study focuses on the policy process of the sachets ban, from agenda setting, to formulation and covers the modalities for implementation.</div></div><div><h3>Methods</h3><div>Retrospective policy case study involving a documentary analysis of all key regulatory documents and in-depth interviews with thirteen policy stakeholders and key informants. The Advocacy Coalition Framework was used to guide the analysis.</div></div><div><h3>Results</h3><div>The findings reveal a long and contested process involving two primary coalitions. The pro-ban coalition (NGOs, civil society organizations, religious leaders, and government representatives), which used empirical and local evidence on sachet alcohol-related harms, particularly among young people, to emphasize the need to regulate. The opposing coalition (spearheaded by alcohol and plastics manufacturers) mounted multiple legal challenges, stalling the policy formulation of the ban. Ultimately, a strong enduring public health coalition, a high court ruling and a decisive government decision facilitated a final and complete ban in 2017.</div></div><div><h3>Conclusion</h3><div>This analysis demonstrates how public health advocates successfully countered industry interference through evidence-based advocacy, community engagement, and strategic coalition-building. The Malawi case offers valuable lessons for other African countries considering similar alcohol control measures, highlighting the role of coalitions, the importance of framing alcohol regulations as public health protections, and of developing robust implementation mechanisms.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 104979"},"PeriodicalIF":4.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931714","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":"Psychedelics for substance use disorders: are women being addressed? A scoping review","authors":"Alexandra Wojdyslawski Nigri ,&nbsp;Ilana Falcão de Arruda ,&nbsp;Catarina Gouveia Ferreira Maia ,&nbsp;Luís Fernando Tófoli ,&nbsp;Fabio Carezzato","doi":"10.1016/j.drugpo.2025.104960","DOIUrl":"10.1016/j.drugpo.2025.104960","url":null,"abstract":"<div><h3>Introduction</h3><div>Substance use disorders (SUDs) are a prevalent health issue that affects individuals globally. Research is currently being conducted on the potential use of psychedelics as a new approach to treating SUDs. Women have been shown to respond differently than men to SUDs treatments and women-specific approaches have been recommended. This scoping review explores the ways in which studies examining the potential therapeutic effect of psychedelics on SUDs-related outcomes have taken into account women’s specificities.</div></div><div><h3>Methods</h3><div>On February 19, 2024, we searched four databases—Embase, PubMed, BVS, and PsyNet—for human studies examining the potential benefits of psychedelics for drug misuse. Reference lists of included articles were also screened for additional relevant studies. Both observational and experimental designs were considered. RESULTS: Seventy-five studies were included. Eighteen had sex-balanced samples, while 46 underrepresented females (&lt;45 %). In five studies, the sex of participants was not reported, and nine included no females. Thirteen studies considered sex in their design; five reported sex-disaggregated outcomes. Eleven conducted sex-based analyses of psychedelic-related substance use outcomes, and five did so for other outcomes. Only five acknowledged sex underrepresentation as a study limitation, and none addressed sex or gender in the discussion.</div></div><div><h3>Conclusion</h3><div>The majority of reviewed studies lacked an investigation into how gender or sex affects subjects’ responses to psychedelics. Given the wide recognition of the role gender and sex play in SUDs treatment, such explorations should be encouraged.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 104960"},"PeriodicalIF":4.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931713","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":"High variation in purity of consumer-level illicit fentanyl samples in Los Angeles, September 2023–April 2025","authors":"Chelsea L. Shover ,&nbsp;Adam J. Koncsol ,&nbsp;Morgan E. Godvin ,&nbsp;David Goodman-Meza ,&nbsp;Bryce Pardo ,&nbsp;Michelle Poimboeuf ,&nbsp;Caitlin A. Molina ,&nbsp;Ruby Romero ,&nbsp;Jasmine Feng ,&nbsp;Joseph R. Friedman","doi":"10.1016/j.drugpo.2025.104977","DOIUrl":"10.1016/j.drugpo.2025.104977","url":null,"abstract":"<div><h3>Background</h3><div>The illicit manufacture of fentanyl results in product of unknown purity, contributing to overdose risk. However, data on the purity of illicitly manufactured fentanyl (IMF) in the United States typically comes from law enforcement sources and almost no information relevant to retail-level product is made available. We aim to quantify IMF purity among samples from a community-based drug checking program operating at four geographic sites in Los Angeles, California.</div></div><div><h3>Methods</h3><div>Drug samples (<em>n</em> = 1763) were obtained from participants who also answered an anonymous survey about sample characteristics. Qualitative and quantitative analysis were conducted leveraging directly observed mass spectrometry (DART-MS) and liquid chromatography mass spectrometry (LC/MS) respectively. LC/MS quantified a panel of compounds including fentanyl and fluorofentanyl. Composite IMF purity was estimated by adding the percent mass of fentanyl and fluorofentanyl.</div></div><div><h3>Results</h3><div>A total of 353 samples had either fentanyl, fluorofentanyl, or both quantified between September 2023 and April 2025. Median IMF purity was 5.8 %, mean 10.0 %, SD 11.1 %, range 0.1–64.9 %. Samples expected to be fentanyl (<em>n</em> = 308) had higher median purity (7.0 %) compared to those expected to be heroin (<em>n</em> = 24, median purity 1.4 %) or other drugs (<em>p</em> &lt; 0.001). Powder samples (<em>n</em> = 318) had higher median concentration (6.9 %) compared to pills (<em>n</em> = 11, 0.7 %) or tar (<em>n</em> = 22, 1.4 %) [<em>p</em> &lt; 0.001]. Of expected-fentanyl samples, 42.5 % (<em>n</em> = 131) had an IMF purity of &lt;5 %, while 17.5 % (<em>n</em> = 54) had purity over 20 %.</div></div><div><h3>Conclusions</h3><div>We found high variation in IMF purity among samples sold as fentanyl, even among samples obtained on the same day, in the same location. This volatility likely plays a role in high overdose risk, even among people with opioid tolerance, in the fentanyl era. Further research is needed to compare these findings to other locations across the United States.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 104977"},"PeriodicalIF":4.4,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144920405","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":"Comparison of Office for National Statistics (ONS) and National Programme on Substance Use Mortality (NPSUM) data suggests that opioid-related deaths in England & Wales have been systematically underestimated","authors":"Shuoqi Chen ,&nbsp;David Mais ,&nbsp;Caroline S. Copeland","doi":"10.1016/j.drugpo.2025.104976","DOIUrl":"10.1016/j.drugpo.2025.104976","url":null,"abstract":"<div><h3>Background</h3><div>In 2023, the Office for National Statistics (ONS) attributed 46.8 % of fatal drug poisonings in England and Wales to opioids. However, this figure likely underrepresents the true scale of opioid-related deaths, as ONS cannot identify opioid involvement when ambiguous causes (e.g., multidrug toxicity) are used. This study used ONS and National Programme on Substance Use Mortality (NPSUM) data to provide a more comprehensive estimate of opioid-related deaths in England and Wales from 2011–2022.</div></div><div><h3>Methods</h3><div>Deaths were identified as opioid-related by ONS and NPSUM where opioids were explicitly named as a cause. Further cases with ambiguous causes were identified by NPSUM as opioid-related by referring to the accompanying toxicology report.</div></div><div><h3>Findings</h3><div>ONS has increasingly underestimated opioid-related deaths. In 2011, 574 heroin/morphine-related deaths were identified by ONS; while the estimated number was 813 (95 % CIs 765–866), reflecting a 29 % underestimate. By 2022, the underestimate had extended to 36 % (1264 deaths identified by ONS; estimated number 1980 [95 % CIs 1894–2074]). This correlates with increasing polypharmacy (median number of co-administered drugs: four in 2011, six in 2022, ρ=0.81). Similar trends were observed for other specific opioids for which ONS data were available: methadone, dihydrocodeine, codeine, tramadol, and fentanyl.</div></div><div><h3>Conclusions</h3><div>Increasing polydrug use in England and Wales is likely leading to the use of ambiguous drug-related causes of death instead of every drug being individually named, resulting in an underestimation of opioid-related deaths. This discrepancy has significant implications for funding, policy and public health initiatives aimed at addressing the UK’s escalating opioid-related death crisis.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"145 ","pages":"Article 104976"},"PeriodicalIF":4.4,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144920406","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}