International Journal of Drug Policy最新文献

{"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}

{"title":"Feasibility of implementing viral hepatitis services into a correctional service facility in Cape Town, South Africa","authors":"Andrew Scheibe ,&nbsp;Joel Steingo ,&nbsp;Gaynor Grace ,&nbsp;Helen Savva ,&nbsp;Mark Sonderup ,&nbsp;Harry Hausler ,&nbsp;C. Wendy Spearman","doi":"10.1016/j.drugpo.2025.104710","DOIUrl":"10.1016/j.drugpo.2025.104710","url":null,"abstract":"<div><h3>Background</h3><div>Hepatitis B virus (HBV) and hepatitis C virus (HCV) are estimated to be of the most prevalent infectious diseases in correctional settings worldwide. However, viral hepatitis services have not been routinely integrated into South African correctional facilities. We aimed to assess prevalence of HBV infection and HCV infection among people accessing HIV services and assess the feasibility of viral hepatitis service integration in a South African correctional centre.</div></div><div><h3>Methods</h3><div>Voluntarily participating people in a correctional services facility were offered free hepatitis B surface antigen (HBsAg) and anti-HCV point-of-care testing in addition to routine HIV testing and treatment services on a first-come, first-served basis during June 2021–March 2022. Off-site laboratory testing (HBV and HCV molecular testing and non-invasive liver fibrosis staging) and screening for hepatocellular carcinoma informed further management. A general practitioner at the facility managed participants, with virtual support from hepatologists. Data on age and history of injecting was collected and point-of-care and laboratory results were recorded. Data were analysed using descriptive statistics.</div></div><div><h3>Results</h3><div>The median age of the 765 people who participated was 32.5 years (IQR 27.5 – 38.2), with 2.2% (17/765) reporting having ever injected a drug. The sample prevalence was 3.9% (30/765) for HBV infection, 0.5% (3/665) for HCV infection, and 1.2% (9/765) for HIV-HBV coinfection. Thirty people had reactive HBsAg point-of-care tests. Among those with reactive HBsAg point-of-care tests 90.0% (27/30) received work-up, among whom 48.1% (13/27) were monitored, 44.4% (12/27) were placed on treatment and two people were released before a management plan could be finalised. Of those treated 33.3% (4/12) started tenofovir/emtricitabine and 66.7% (8/12) antiretroviral therapy. Of the eligible participants, 27.3% (201/735) received at least one hepatitis B vaccine dose and 26.9% (54/201) received three doses. All three participants who had confirmed HCV infection were started on direct-acting antivirals. Of the two completing treatment one achieved sustained virological response at 12 weeks (SVR12), one person was released before SVR12 was done. One person was lost to follow-up. No clinical adverse events were reported.</div></div><div><h3>Conclusion</h3><div>There was a notable viral hepatitis burden among people in this correctional centre and integration of viral hepatitis services into the existing HIV services was acceptable and feasible. Further efforts to sustain and expand access to viral hepatitis services in South African correctional centres could catalyse national viral hepatitis elimination efforts.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104710"},"PeriodicalIF":4.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042100","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":"How do restrictions on opioid prescribing, harm reduction, and treatment coverage policies relate to opioid overdose deaths in the United States in 2013–2020? An application of a new state opioid policy scale","authors":"Samantha M. Doonan ,&nbsp;Katherine Wheeler-Martin ,&nbsp;Corey Davis ,&nbsp;Christine Mauro ,&nbsp;Emilie Bruzelius ,&nbsp;Stephen Crystal ,&nbsp;Zachary Mannes ,&nbsp;Sarah Gutkind ,&nbsp;Katherine M. Keyes ,&nbsp;Kara E. Rudolph ,&nbsp;Hillary Samples ,&nbsp;Stephen G. Henry ,&nbsp;Deborah S. Hasin ,&nbsp;Silvia S. Martins ,&nbsp;Magdalena Cerdá","doi":"10.1016/j.drugpo.2025.104713","DOIUrl":"10.1016/j.drugpo.2025.104713","url":null,"abstract":"<div><h3>Background</h3><div>Identifying the most effective state laws and provisions to reduce opioid overdose deaths remains critical.</div></div><div><h3>Methods</h3><div>Using expert ratings of opioid laws, we developed annual state scores for three domains: opioid prescribing restrictions, harm reduction, and Medicaid treatment coverage. We modeled associations of state opioid policy domain scores with opioid-involved overdose death counts in 3133 counties, and among racial/ethnic subgroups in 1485 counties (2013–2020). We modeled a second set of domain scores based solely on experts’ highest 20 ranked provisions to compare with the all-provisions model.</div></div><div><h3>Results</h3><div>From 2013 to 2020, moving from non- to full enactment of harm reduction domain laws (i.e., 0 to 1 in domain score) was associated with reduced county-level relative risk (RR) of opioid overdose death in the subsequent year (adjusted RR = 0.84, 95 % credible interval (CrI): 0.77, 0.92). Moving from non- to full enactment of opioid prescribing restrictions and Medicaid treatment coverage domains was associated with higher overdose in 2013–2016 (aRR 1.69 (1.35, 2.11) and aRR 1.20 (1.11, 1.29) respectively); both shifted to the null in 2017–2020. Effect sizes and direction were similar across racial/ethnic groups. Results for experts’ highest 20 ranked provisions did not differ from the all-provision model.</div></div><div><h3>Conclusions</h3><div>More robust state harm reduction policy scores were associated with reduced overdose risk, adjusting for other policy domains. Harmful associations with opioid prescribing restrictions in 2013–2016 may reflect early unintended consequences of these laws. Medicaid coverage domain findings did not align with experts’ perceptions, though data limitations precluded inclusion of several highly ranked Medicaid policies.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104713"},"PeriodicalIF":4.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030135","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":"“We can't change that while they're in the hospital”: Unveiling the manifestations of infrastructural violence and wound care for people who inject drugs","authors":"Suzanne J. Block,&nbsp;Laura N. Sisson,&nbsp;Yasemin Taban,&nbsp;Tricia Triece,&nbsp;Susan G. Sherman,&nbsp;Kristin E. Schneider,&nbsp;Jill Owczarzak","doi":"10.1016/j.drugpo.2025.104716","DOIUrl":"10.1016/j.drugpo.2025.104716","url":null,"abstract":"<div><div>Healthcare avoidance or delays for wounds and related skin- and soft-tissue infections are often attributed to negative interactions with medical providers. An infrastructural violence framework posits that healthcare infrastructure serves as a material channel for structural violence, maintaining inequities in healthcare experiences and outcomes. Infrastructural violence ensues when infrastructure is designed for some members or groups within a society while perpetuating violence among others. This study draws on the concept to understand how healthcare infrastructure creates and perpetuates inequities within the healthcare system for people who inject drugs for their wound care-related needs. Between January and September 2023, semi-structured interviews were conducted with 12 medical providers in Maryland. An abductive thematic analysis approach was followed. Healthcare infrastructure mediated the relationship between structural factors, such as policies on prescribing privileges of medications for opioid use disorder and subsequent individual health experiences. Medical providers also described how their access to training, protocols, and other resources was insufficient to meet the needs of people who inject drugs presenting to healthcare settings for wound care. A new conceptual grounding provides recommendations on extending beyond medical provider behavior change interventions in healthcare settings to create supportive infrastructure, which includes readily available and accessible policies, protocols, and resources to care for this patient population.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104716"},"PeriodicalIF":4.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of recreational cannabis retailer allocation on emergency department visits: A natural experiment utilizing lottery design","authors":"Yihong Bai ,&nbsp;Peiya Cao ,&nbsp;Chungah Kim ,&nbsp;Kristine Ienciu ,&nbsp;Antony Chum","doi":"10.1016/j.drugpo.2025.104708","DOIUrl":"10.1016/j.drugpo.2025.104708","url":null,"abstract":"<div><h3>Background</h3><div>In October 2018, Canada legalized recreational cannabis, with Ontario distributing retailer licenses through a lottery system in 2019. This study investigates the impact of recreational cannabis retailer allocation on emergency department (ED) visits related to cannabis, alcohol, and opioids.</div></div><div><h3>Method</h3><div>A longitudinal study of 278 communities in Ontario (proxied by Forward Sortation Areas, FSAs) was conducted using health administrative data from ICES for all Ontario residents covered by public health insurance. The cohort included 11,156,100 adults aged 18 and above, monitored quarterly from January 2016 to March 2023. The allocation of cannabis retailers through a randomized lottery system provided a natural experiment. Staggered difference-in-differences proposed by Callaway and Sant'Anna (CSDID) models, weighted by the inverse probability of retailer allocation, were used to estimate the impact of cannabis store openings on ED visits, comparing FSAs with and without retailers.</div></div><div><h3>Results</h3><div>No significant effects were found in cannabis-, alcohol-, or opioid-related ED visits following the allocation of cannabis retailers. Sensitivity analyses, including alternate diagnostic codes, co-use of cannabis and other substances, and cannabis use without other substances, corroborated our main findings. The null results may be due to online cannabis sales preceding retail store openings, geographic distribution minimizing access disparities, and potential spillover effects.</div></div><div><h3>Conclusion</h3><div>The allocation of recreational cannabis retailer licenses did not significantly impact acute care use. Continuous monitoring, comprehensive sales tracking, and integrated substance use prevention strategies are recommended for future policy considerations.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104708"},"PeriodicalIF":4.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025217","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":"Characteristics of supervised injection site clients and factors associated with requiring overdose intervention, Montreal, Canada, 2018–2022","authors":"Camille Zolopa ,&nbsp;Thomas D. Brothers ,&nbsp;Pascale Leclerc ,&nbsp;Jean-François Mary ,&nbsp;Carole Morissette ,&nbsp;Julie Bruneau ,&nbsp;Natasha K. Martin ,&nbsp;Elaine Hyshka ,&nbsp;Sarah Larney","doi":"10.1016/j.drugpo.2025.104711","DOIUrl":"10.1016/j.drugpo.2025.104711","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Supervised injection sites (SIS) offer a hygienic environment in which people can inject drugs under observation; as such, these harm reduction services have been on the forefront of the overdose epidemic. We sought to understand factors predictive of an overdose requiring an emergency response intervention at SIS in Montréal, Canada.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We used administrative data from all four Montréal SIS from 1 March 2018 – 31 October 2022 to first calculate the rate of onsite overdose requiring intervention (e.g., naloxone or oxygen administration, nurse or paramedic assessment, etc.) and descriptive statistics. We then used a logistic regression model, with generalized estimating equations to adjust for clients’ repeat visits, to test associations between onsite overdose intervention and client gender, age, drug injected (fentanyl vs other opioid vs non-opioid), most frequent injection location, frequency of injecting, duration of injecting, housing stability, attendance at multiple SIS, and time period (before or after 15 March 2020).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;During the observation period, Montréal SIS received 122,509 visits from 2,127 unique clients. The rate of overdose requiring intervention was 8.16 (95 % CI 7.66, 8.68) per 1000 visits. While 278 (13 %) of clients experienced an onsite overdose intervention, these clients accounted for 64,267 (52 %) SIS visits. Transgender clients (aOR = 2.28, 95 % CI 1.18, 4.41, compared to men) and clients younger than 25 were at greater risk of experiencing an onsite overdose requiring intervention (e.g., clients 35–44 had an aOR = 0.44, 95 % CI 0.30, 0.64, compared to clients younger than 25). Injecting most often in a public place was associated with greater risk of an onsite overdose requiring intervention (aOR = 3.62, 95 % CI 3.04, 4.30), while reporting unstable housing (aOR = 0.56, 95 % CI 0.47, 0.66) and attending more than one SIS (aOR = 0.13, 95 % CI 0.10, 0.16) predicted lesser risk. Compared to clients who reported injecting daily, greater risk of overdose requiring intervention was observed among those who reported injecting 3–6 days a week (aOR = 1.48, 95 % CI 1.18, 1.85), 1–2 days a week (aOR = 2.43, 95 % CI 1.90, 3.11), and “occasionally” (aOR = 2.60, 95 % CI 2.13, 3.18), but not those who reported not injecting in the past several months (aOR = 0.44, 95 % CI 0.25, 0.79). Compared to clients who had been injecting for five or more years, an injection duration of 1–4 years was associated with reduced risk of an overdose requiring intervention (aOR = 0.79, 95 % CI 0.64, 0.98), while those newer (&lt;1 year) to injecting were at greater risk of such an intervention (aOR = 2.11, 95 % CI 1.50, 2.97). Compared to clients intending to inject fentanyl, we observed a lower risk of an overdose requiring intervention for those injecting other opioids (aOR = 0.22, 95 % CI 0.18, 0.26) or non-opioids (aOR = 0.06, 95 % CI 0.04, 0.08). Inject","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104711"},"PeriodicalIF":4.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025173","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":"Likelihood of using a harm reduction vending machine among rural people who inject drugs in Appalachian Kentucky","authors":"April M Young ,&nbsp;Tasfia Jahangir ,&nbsp;Imani Belton ,&nbsp;Edward Freeman ,&nbsp;Melvin D. Livingston","doi":"10.1016/j.drugpo.2025.104709","DOIUrl":"10.1016/j.drugpo.2025.104709","url":null,"abstract":"<div><h3>Background</h3><div>Harm reduction vending machines (HRVMs) that dispense safe injection equipment and other supplies have operated globally for more than 30 years, yet few operate in the U.S., particularly in the rural epicenters of drug-related harms. This study explores likelihood of using HRVMs and correlates thereto among people who inject drugs in rural Appalachian Kentucky.</div></div><div><h3>Methods</h3><div>Respondent-driven sampling and outreach were used to recruit participants who were age 18 or older, resided in an Appalachian Kentucky county, and had used opioids and/or injected drugs to get high in the past 30 days. Interviewer-administered questionnaires elicited data on behavioral and demographic characteristics and likelihood of using HRVMs. Analyses were restricted to participants who injected in the past 6 months (<em>n</em> = 259). Generalized estimating equations were used to estimate adjusted prevalence ratios (APRs) for correlates to likelihood of using HRVMs, controlling for lifetime use of brick-and-mortar syringe service programs.</div></div><div><h3>Results</h3><div>Overall, 57 % reported being likely to use HRVMs. Participants who lacked consistent access to transportation, engaged in receptive and distributive syringe sharing, experienced more lifetime overdoses, and had unsuccessfully attempted to access medications for opioid use disorder (MOUD) reported being more likely to use HRVMs. Heroin and prescription opioid use were negatively associated with likelihood of HRVM use, as was experience of shame around drug use.</div></div><div><h3>Conclusions</h3><div>Most people who inject drugs in this rural Appalachian sample were likely to use HRVMs, with interest being highest among those at highest risk for injection-related infections and overdose and who had faced difficulty accessing MOUD.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"137 ","pages":"Article 104709"},"PeriodicalIF":4.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025209","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":"Naloxone administration and survival in overdoses involving opioids and stimulants: An analysis of law enforcement data from 63 Pennsylvania counties","authors":"Manuel Cano ,&nbsp;Abenaa Jones ,&nbsp;Sydney M. Silverstein ,&nbsp;Raminta Daniulaityte ,&nbsp;Frank LoVecchio","doi":"10.1016/j.drugpo.2024.104678","DOIUrl":"10.1016/j.drugpo.2024.104678","url":null,"abstract":"<div><h3>Background</h3><div>In consideration of rising opioid-stimulant deaths in the United States, this study explored rates of naloxone administration and survival in suspected opioid overdoses with, versus without, stimulants co-involved.</div></div><div><h3>Methods</h3><div>The study analyzed 26,635 suspected opioid-involved overdoses recorded by law enforcement/first-responders in the Pennsylvania Overdose Information Network in 63 Pennsylvania counties, January 2018–July 2024. All measures, including suspected drug involvement, were based on first-responder assessment/report. Relative frequencies and chi-square tests were first used to compare suspected opioid overdoses with, versus without, stimulants (cocaine or methamphetamine) co-involved. Next, mediation analyses tested naloxone administration as a mediator in the association between stimulant co-involvement (in opioid overdoses) and survival.</div></div><div><h3>Results</h3><div>Naloxone was reportedly administered in 72.2 % of the suspected opioid-no-cocaine overdoses, compared to 55.1 % of the opioid-cocaine-involved overdoses, and 72.1 % of the opioid-no-methamphetamine overdoses vs. 52.4 % of the opioid-methamphetamine-involved overdoses. With respect to survival rates, 18.0 % of the suspected opioid-no-cocaine overdoses ended in death, compared to 41.3 % of the opioid-cocaine overdoses; 18.1 % of the opioid-no-methamphetamine overdoses ended in death, versus 42.9 % of the opioid-methamphetamine overdoses. In mediation analyses (adjusted for demographics, county, year, and other drug co-involvement), naloxone administration mediated 38.7 % (95 % Confidence Interval [CI], 31.3–46.0 %) of the association between suspected cocaine co-involvement and survival and 39.2 % (95 % CI, 31.3–47.1 %) of the association between suspected methamphetamine co-involvement and survival.</div></div><div><h3>Conclusions</h3><div>Among suspected opioid overdoses recorded in the Pennsylvania Overdose Information Network, stimulant co-involvement was associated with lower naloxone administration and higher fatality, with naloxone partially mediating the association between stimulant co-involvement and death.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104678"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787306","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":"Trends in prescription opioid analgesic use in Australia from 2015 to 2022","authors":"Kendal Chidwick ,&nbsp;Chrianna Bharat ,&nbsp;Natasa Gisev ,&nbsp;Alys Havard ,&nbsp;Ximena Camacho ,&nbsp;Sallie-Anne Pearson ,&nbsp;Louisa Degenhardt","doi":"10.1016/j.drugpo.2024.104666","DOIUrl":"10.1016/j.drugpo.2024.104666","url":null,"abstract":"<div><h3>Background</h3><div>Recent measures to curb use and harms of pharmaceutical opioids in Australia have reduced dispensings of opioid analgesics for pain, under Australia's Pharmaceutical Benefits Scheme (PBS). But information on trends in private (self-funded) dispensings and public (government-funded) hospital opioids use is not readily available. Our study describes eight-year population-level trends in Australia's prescribed opioid analgesic use, estimating PBS dispensing claims, private dispensings and hospital use.</div></div><div><h3>Methods</h3><div>Our descriptive study used two datasets covering 2015 to 2022: national IQVIA data on all (PBS/private) pharmaceutical sales to community pharmacies, hospitals and other settings, and PBS dispensing claims data for a 10 % sample of Australian residents, extrapolated to estimate national PBS claims. We measured total units of each opioid sold/dispensed, converted into oral morphine equivalent milligrams (OME)/1000 population/day. We estimated private dispensings/public hospitals use by subtracting PBS OME from total OME sold. We calculated hospital OME using sales to hospitals. We assessed annual trends using Joinpoint regression.</div></div><div><h3>Results</h3><div>Between 2015 and 2022 total prescribed opioid analgesic use decreased by 21.2 % , from 1231.4 to 970.6 OME/1000/day (-3.4% per year, <em>p</em> &lt; 0.001). Between 2015 and 2022, PBS dispensing claims decreased by -353.4 OME/1000/day, from 1061.7 to 708.4 OME/1000/day (-5.9 % per year; <em>p</em> &lt; 0.001). In contrast, private dispensings/public hospital use increased by +92.5 OME/1000/day, from 169.7 to 262.3 OME/1000/day (+6.7 % per year; <em>p</em> &lt; 0.001). The contribution of private dispensings/public hospital use to total prescribed opioid analgesic use doubled between 2015 and 2022 from 13.8 % to 27.0 %. Opioid use in hospitals remained stable (-1.1 % per year, <em>p</em> = 0.07), accounting for 8 to 10 % of total use between 2015 and 2022.</div></div><div><h3>Discussion</h3><div>Prescribed opioid analgesic use declined between 2015 and 2022 because of reductions in PBS dispensing claims. A quarter of the reduction in PBS dispensing claims was offset by use outside the PBS. Our findings indicate a significant increase in private use, reasons for which may include accessing opioids not PBS-subsidised and circumventing PBS restrictions for PBS-subsidised opioids. Comparing multiple data sources provides a comprehensive account of prescribed opioid analgesic use in Australia.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104666"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792608","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":"Generative tension and social risk management surrounding sexualised drug use practice among men who have sex with men in highly stigmatised environments: A qualitative study from Jakarta, Indonesia","authors":"Laura Nevendorff ,&nbsp;Adam Bourne ,&nbsp;Mark Stoové ,&nbsp;Alisa Pedrana","doi":"10.1016/j.drugpo.2024.104683","DOIUrl":"10.1016/j.drugpo.2024.104683","url":null,"abstract":"<div><h3>Background</h3><div>Global policies emphasise the need for tailored interventions to reduce the harms of sexualised drug use (SDU) among men who have sex with men (MSM), including taking account of local risk environments and the influence of social norms, drug and sexual minority stigma, and cultural and political conditions. To help guide the production of local SDU harm reduction interventions, this study aimed to explore the social and structural conditions that shape the practice of, and response to, SDU by MSM in Jakarta, Indonesia.</div></div><div><h3>Methods</h3><div>Informed by an interactionism theoretical perspective and socioecological frameworks, a reflexive thematic approach was used to analyse in-depth qualitative interview data from 20 MSM who practised SDU in Jakarta. To recruit the participants, the study was promoted through local organisations providing HIV services for MSM, as well as snowball recruitment.</div></div><div><h3>Results</h3><div>To protect their SDU practice, MSM in Jakarta developed a set of social risk management strategies designed to reduce the generative tension between enabling and disabling forces caused by local social and structural environments. Enabling forces emerged primarily from within MSM networks, were extended through the interpersonal dynamics of sexual partner relationships to peer influence and reinforced by product branding and marketing on both offline and online platforms. The disabling forces, which were introduced primarily from outside the network, manifested in stigmatising social norms, politics and religious beliefs towards homosexuality and drug use, and forced MSM who practised SDU to relocate to virtual environments.</div></div><div><h3>Conclusion</h3><div>Programmatic responses seeking to mitigate the risks associated with SDU practice among sexual minority men should incorporate established mechanisms of peer networks and virtual spaces into their design to maximise reach and intervention acceptability and effectiveness.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"135 ","pages":"Article 104683"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855798","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}