International Journal of Drug Policy最新文献

{"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}

{"title":"Frequency is not enough: Characterizing heterogenous patterns of cannabis use intensity among reservation-area American Indian youth","authors":"Meghan A. Crabtree,&nbsp;Linda R. Stanley,&nbsp;Mark A. Prince,&nbsp;Randall C. Swaim","doi":"10.1016/j.drugpo.2024.104617","DOIUrl":"10.1016/j.drugpo.2024.104617","url":null,"abstract":"<div><h3>Background</h3><div>Reservation-area American Indian (AI) youth use cannabis at significantly higher rates than their national counterparts. This discrepancy is concerning, as cannabis use—particularly heavy use—can negatively impact adolescents’ health. Studies primarily use frequency to classify cannabis use intensity; however, frequency alone may not fully capture heterogenous patterns of use. This study aimed to classify AI adolescents’ cannabis use based on multiple intensity indicators, and to investigate interclass differences in problematic characteristics and outcomes of use.</div></div><div><h3>Methods</h3><div>Participants were 799 reservation-area AI youth (7–12th grade) reporting 12-month cannabis use. Latent Class Analysis (LCA) was used to distinguish cannabis use intensity patterns based on frequency, typical intoxication levels and duration. Auxiliary tests using R3STEP and BCH 3-step procedures were used to assess class predictors (age, initiation age, sex) and interclass differences in simultaneous drug use, stress-motivated use, problems quitting and cannabis-related consequences.</div></div><div><h3>Results</h3><div>Four classes emerged: Light Use (LU; 19 %), Occasional Intoxication (OI; 32 %), Mid-frequency Use(MU; 28 %), and Heavy Use (HU; 21 %). Age and initiation age correlated with membership odds in a heavier use class. Interclass differences in problematic characteristics and outcomes occurred between all classes, particularly for stress-motivated use and cannabis-related consequences—with HU reporting the most problematic characteristics and negative outcomes.</div></div><div><h3>Conclusion</h3><div>These findings suggest that accounting for multiple dimensions of usage intensity may be important in studies examining cannabis use and related problems among AI adolescents. Tailoring intervention programming to address complex cannabis use patterns, with particular focus on stress-coping skills and harm reduction, can ensure AI youth most at risk for cannabis problems gain maximal benefit from prevention efforts.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104617"},"PeriodicalIF":4.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510522","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":"Clinical and public safety risks associated with cannabis legalization and frequency of cannabis use among forensic mental health patients","authors":"Stephanie R. Penney ,&nbsp;Roland M. Jones ,&nbsp;Treena Wilkie ,&nbsp;Cory Gerritsen ,&nbsp;Sumeeta Chatterjee ,&nbsp;Gary A. Chaimowitz ,&nbsp;Alexander I.F. Simpson","doi":"10.1016/j.drugpo.2024.104622","DOIUrl":"10.1016/j.drugpo.2024.104622","url":null,"abstract":"<div><h3>Background</h3><div>There are ongoing concerns regarding the impact of Canada's cannabis legalization and commercialization on vulnerable persons such as those with serious forms of mental illness, including persons with schizophrenia-spectrum disorders and users of forensic mental health services. The primary objective of this study was to investigate the potential harms and mental health-related impacts associated with cannabis legalization on a sample of forensic patients in Ontario (<em>N</em> = 187).</div></div><div><h3>Methods</h3><div>Using a pseudo-prospective design, we investigated the frequency of cannabis use over a four-year period encompassing two years preceding and two years following the legislative change. We recorded clinical and public safety outcomes (i.e., mental health deterioration, length of stay in the forensic system, rates of hospital readmission, victimization and violence) over the same period to test relationships between these variables and rates of cannabis use.</div></div><div><h3>Results</h3><div>We found that one-third of patients either self-reported or were discovered, via urine testing, to have used cannabis over the study period. Frequency of use was lower in the pre-legalization period, and then gradually and significantly increased after legalization. Compared to patients with no cannabis use, those with one or more instances of use were more likely to be readmitted to hospital and had higher rated static risk factors for violence. However, there were no observed differences in the actual rate of violence between patients using and not using cannabis, nor differences in the rate of violence over time. Over half of the patients who used cannabis experienced a worsening of their mental health status in the week following use.</div></div><div><h3>Conclusions</h3><div>Cannabis use among those with SMI is associated with adverse clinical outcomes. Results from this study suggest that the mental health burdens associated with cannabis use have risen in terms of delayed clinical recovery and progress through the forensic system since legalization.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104622"},"PeriodicalIF":4.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510508","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":"The role of prescribed controlled substance acquisition as potential triggers of opioid overdose: A case-crossover study","authors":"Allen M. Smith ,&nbsp;Cheng Peng ,&nbsp;Austin Porter ,&nbsp;Bradley C. Martin","doi":"10.1016/j.drugpo.2024.104620","DOIUrl":"10.1016/j.drugpo.2024.104620","url":null,"abstract":"<div><div><em>Background:</em> The role of prescribed opioids and benzodiazepines as risk factors for opioid overdose are well established, however, their role as potential ‘triggers’ of opioid overdose has not been formally investigated. O<em>bjective:</em> The objective of this study was to evaluate the temporal relationship between controlled substance acquisition and opioid overdose utilizing a case-crossover design. <em>Methods:</em> This study utilized Arkansas statewide data between 2014 and 2020. Prescription Drug Monitoring Program (PDMP) data were used to assess controlled substance acquisition and fatal and non-fatal opioid overdose were assessed using linked death certificate, inpatient discharge, and emergency department (ED) data. All persons residing in Arkansas who experienced an opioid overdose or had ≥ 1 Arkansas PDMP prescription fill(s) were included. Controlled substance characteristics were described in the 7 days prior to overdose and compared to the controlled substance characteristics in 11 weekly (7-day) control windows prior to overdose. Binary controlled substance variables indicating presence or absence of: any controlled substance, opioid, benzodiazepine, stimulant, sedative, carisoprodol, opioid and benzodiazepine, and opioid and benzodiazepine and carisoprodol were created. Additionally, total morphine milliequivalents were calculated for each time window. Conditional logistic regression models were estimated and adjusted odds ratios for each controlled substance characteristic after accounting for other controlled substance, and prior overdose, and clinical characteristics derived from ED and inpatient data are reported. <em>Results:</em> A total of 2,818,135 individuals with ≥1 Arkansas PDMP record(s) (45.10 % male; 39.94 mean age) were included, of which 28,670 (1.02 %) experienced ≥1 opioid overdose. There was a significant association between opioid overdose and the acquisition of a controlled substance (OR=1.785; <em>p</em> &lt; 0.001), opioid (OR=1.992; <em>p</em> &lt; 0.001), benzodiazepine (OR=1.379; <em>p</em> &lt; 0.001), carisoprodol (OR=1.744; <em>p</em> &lt; 0.001), opioid and benzodiazepine (OR=2.203; <em>p</em> &lt; 0.001), and opioid and benzodiazepine and carisoprodol (OR=2.503; <em>p</em> &lt; 0.001), in the 7 days prior to an opioid overdose event. <em>Conclusion:</em> Controlled substance prescription acquisition, particularly opioids in combination with carisoprodol and/or benzodiazepines, are potential triggers of opioid overdose.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"134 ","pages":"Article 104620"},"PeriodicalIF":4.4,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478003","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":"Interconnected influence: Unraveling purdue pharmaceutical's role in the global response to the opioid crisis","authors":"Andrea Bowra ,&nbsp;Amaya Perez-Brumer ,&nbsp;Lisa Forman ,&nbsp;Jillian Clare Kohler","doi":"10.1016/j.drugpo.2024.104604","DOIUrl":"10.1016/j.drugpo.2024.104604","url":null,"abstract":"<div><h3>Background</h3><div>The global pharmaceutical industry has a long history of prioritizing profits over public health through widespread practices such as price gouging, deceptive marketing, and fraud. A prominent example of this issue is the mislabeling and mass-marketing of OxyContin by Purdue Pharmaceuticals (Purdue) that catalyzed the opioid crises in and beyond the United States.</div></div><div><h3>Methods</h3><div>Guided by Actor-Network Theory, this case study employs Visual Network Analysis to map the actors-networks involved in responding to the harms caused by Purdue. Data was generated from peer-reviewed and grey literature published between 2007 and 2022 (<em>n</em> = 40) and imported into Gephi visualization software where centrality metrics were applied.</div></div><div><h3>Results</h3><div>A total of 39 actors and 99 relationships were visualized based on the relational thinking that actors who are heavily interconnected with others are rendered important. Centrality measures identified the socio-technical centrality of Purdue in influencing the response to the harms it caused. Purdue exerted influence through various avenues, most prominently through the creation and cooptation of pain advocacy groups, their close ties with United States elected officials, and through embedding pro-opioid messaging in international guidance documents. In doing so, Purdue was able to extend the reach and impact of their opioid promotion, while simultaneously limiting the capacity of regulatory bodies to pursue accountability and implement policies to mitigate opioid-related harms.</div></div><div><h3>Conclusion</h3><div>This study advances understandings of the complex interplay between transnational pharmaceutical companies, global health systems, regulatory bodies, and public health. In doing so, we underscore the need for stronger regulation and increased transparency surrounding the interactions between pharma, patient groups, governments, and international organizations to better address and prevent future harms.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104604"},"PeriodicalIF":4.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478000","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":"2S/LGBTQ+ youth substance use and pathways to homelessness: A photovoice study","authors":"Trevor Goodyear ,&nbsp;Emily Jenkins ,&nbsp;John L. Oliffe ,&nbsp;Danya Fast ,&nbsp;Hannah Kia ,&nbsp;Rod Knight","doi":"10.1016/j.drugpo.2024.104621","DOIUrl":"10.1016/j.drugpo.2024.104621","url":null,"abstract":"<div><h3>Background</h3><div>Studies have posited that substance use is associated with, or contributes to, homelessness for 2S/LGBTQ+ youth. However, interconnections between these issues are poorly articulated.</div></div><div><h3>Methods</h3><div>This community-based photovoice study describes the narratives used by 2S/LGBTQ+ youth about how substance use featured in their pathways to homelessness. Employing constructionist narrative analysis, two storylines were inductively derived from participant-produced photographs and photovoice interviews with 32 2S/LGBTQ+ youth in Vancouver, Canada.</div></div><div><h3>Results</h3><div><em>Taking refuge</em> narratives centered on 2S/LGBTQ+ youths’ use of substances to cope with intersecting hardships and minority stressors they had faced growing up, and when transitioning to homelessness. <em>From playing into precarity</em> narratives focused on the shifting possibilities and tensions of what sexualized crystal methamphetamine use can surface for 2S/LGBTQ+ youth in terms of facilitating connection and release and simultaneously invoking discomforts, including eviction from their family home.</div></div><div><h3>Conclusions</h3><div>These narratives can usefully be anticipated and recognized to better understand and address the social contexts in which 2S/LGBTQ+ youth experience substance use and associated harms, especially homelessness. They affirm the need for tailored supports for 2S/LGBTQ+ youth who use drugs in the lead-up to and after becoming homeless, including the provision of care that better recognizes youths’ pursuits of becoming and belonging in the context of marginalization, and that takes a harm reduction approach to addressing the role of substance use in these pursuits.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104621"},"PeriodicalIF":4.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477999","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":"Publics in local media reporting on harm reduction: Rightfully worried local witnesses or uneducated obstacles to change","authors":"Katarina Winter ,&nbsp;Josefin Månsson","doi":"10.1016/j.drugpo.2024.104619","DOIUrl":"10.1016/j.drugpo.2024.104619","url":null,"abstract":"<div><h3>Background</h3><div>In 2018, the planned opening of a second Needle and Syringe Exchange Program (NSP) unit in Stockholm, Sweden, was stopped with reference to protests from the public. Local Stockholm media cited stakeholders who claimed that the initiative was led by politicians with “zero knowledge about what makes citizens upset” and referred to reported public concern over a preschool located near the planned NSP unit. This case highlights the significant role of the public – and the idea of public opinion – in relation to political and medial aspects of alcohol and other drug (AOD) issues. Our aim is to scrutinize how “the public” is produced in local print media reports on harm reduction measures such as the NSP, to illuminate how these representations operate and what reality/ies they co-produce.</div></div><div><h3>Methods</h3><div>We analyzed 171 articles reporting on harm reduction in local Stockholm print media from 2012 to 2023. The themes identified in the analysis emerged from a combination of data-driven empirical observations and a theory-driven approach grounded in the influential literature on publics and counterpublics by Michael Warner and Nancy Fraser.</div></div><div><h3>Results</h3><div>The overarching articulation in the material is that of a singular and homogeneous public. Public opinion regarding local experiences of individual drug use and harm reduction is depicted as being driven by fear and worry over living alongside “messy others”, thereby producing a public of worried local community witnesses. This production of the public takes on two different meanings depending on the narrative of the articles: 1) as righteous and entitled, 2) as ignorant and irrational. As a result, the public comes to operate as either a consulted public deserving consideration in the implementation of harm reduction policies or as an uneducated political obstacle to change. Consequently, the public is assigned both a counterpublic and a dominant public identity.</div></div><div><h3>Conclusions</h3><div>When the representation of the worried public is repeatedly echoed by the media, it becomes hard to ignore in policy-making processes. The implications of such media representations are significant, as they risk disguising the complex nature of publics as a diverse group of individuals while reproducing taken-for-granted ideas about local communities opposing harm reduction measures. In addition, the appropriation of a counterpublic identity narrows the discursive space for action. Taken together, the repetition of a singular worried public and the appropriation of the counterpublic position make it nearly impossible to imagine alternative public responses to harm reduction. As a consequence, this can limit well-needed policy responses to AOD issues.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104619"},"PeriodicalIF":4.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478002","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}