International Journal of Drug Policy最新文献

{"title":"Necropolitics of the North: A rapid ethnography examining the effects of the closure of one of Northern Ontario’s only supervised consumption sites","authors":"Lucas Tucker ,&nbsp;Francisco Ibanez-Carasco ,&nbsp;Brooke Legault ,&nbsp;Dawn Cameron ,&nbsp;Janett Michaud ,&nbsp;Guy Seguin ,&nbsp;Emily Groot ,&nbsp;Amreetha Jayathilake ,&nbsp;Kaela Pelland ,&nbsp;Amber Fritz ,&nbsp;Heidi Eisenhauer ,&nbsp;Geoff Bardwell","doi":"10.1016/j.drugpo.2025.104869","DOIUrl":"10.1016/j.drugpo.2025.104869","url":null,"abstract":"<div><h3>Background</h3><div>People who use drugs (PWUD) in Northern, rural, and smaller urban Canadian communities are disproportionately affected by drug-related harms and face barriers such as limited resources and heightened stigma. Supervised consumption sites (SCS) are intended to address individual and community harms. In 2024, the only SCS in Sudbury, a small city in Northern Ontario, Canada, closed due to a lack of provincial funding. In this paper, we explore the impact of this closure on PWUD.</div></div><div><h3>Methods</h3><div>We conducted a community-based rapid ethnography inclusive of naturalistic observations and qualitative semi-structured interviews (<em>n</em> = 27). Data were analyzed thematically using a participatory analytic approach and analysis was informed by theories of necropolitics and structural violence.</div></div><div><h3>Results</h3><div>Following the closure of the SCS site, participants perceived a reduction in access to harm reduction services, as well as negative impacts on personal well-being. Participants reported that the SCS’s closure forced local PWUD to begin unsafe consumption practices, resulting in increased overdose risk, physical health issues, and social stigma. The closure negatively affected safety, social connectedness, availability, and ease of access to harm reduction supplies.</div></div><div><h3>Conclusions</h3><div>The SCS closure has exacerbated already limited support for PWUD in Sudbury and increased their exposure to a variety of risks and harms. Necropolitics of the state deem PWUD as unworthy of living, resulting in structural violence and the creation of death worlds for PWUD.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104869"},"PeriodicalIF":4.4,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241588","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":"Like birds of a feather? A multi-case study on the connections between cannabis, tobacco, alcohol and pharmaceutical companies in legalized cannabis markets","authors":"Marthe Ongenaert,&nbsp;Tom Decorte","doi":"10.1016/j.drugpo.2025.104863","DOIUrl":"10.1016/j.drugpo.2025.104863","url":null,"abstract":"<div><h3>Background</h3><div>As of 2024, cannabis legalization in Northern American countries has spurred industry growth, intersecting with alcohol, tobacco, and pharmaceuticals. This study examines the investments and employee movement between five cannabis companies and alcohol, tobacco and pharmaceutical companies in order to explore the connections between the industries. While these relationships may bolster cannabis businesses, they also pose risks such as profit-driven practices that could undermine public health protections.</div></div><div><h3>Method</h3><div>An exploratory and descriptive approach was used to analyze business investments and employee flow between five cannabis companies (Canopy Growth, Aurora Cannabis, Tilray, Cronos Group, and Organigram) and alcohol, tobacco, and pharmaceutical companies. Data was collected through Nexis Uni, corporate reports, press releases, and LinkedIn, documenting financial transactions and management transitions.</div></div><div><h3>Results</h3><div>The results reveal investment relationships between the five cannabis companies and companies from the alcohol, tobacco, and pharmaceutical sectors. Some cannabis companies have secured substantial investments from alcohol and tobacco firms, which view cannabis as both a competitor and an opportunity for market expansion. These investments often come with influence, allowing industries to shape the cannabis market. Additionally, employee flows indicate cross-industry expertise transfer, particularly in management, finance, and strategy. This suggests that traditional companies are strategically positioning themselves within the cannabis sector, while cannabis companies are leveraging expertise form other sectors to drive innovation.</div></div><div><h3>Conclusion</h3><div>The connections between cannabis and traditional industries raise concerns over market dynamics and public health risks by importing profit-driven tactics that weaken regulations and public safety. By drawing on lessons from established industries, future studies can help navigate the balance between industry growth and societal well-being, ensuring that cannabis commercialization does not come at the expense of consumer health.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104863"},"PeriodicalIF":4.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223165","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":"Negotiating the divide: Science, politics, and institutional boundaries in Swiss cannabis regulation","authors":"Sharon R. Sznitman ,&nbsp;Reto Auer ,&nbsp;Jonathan Christopher Havinga ,&nbsp;Alessandro Casalini ,&nbsp;Barbara Broers","doi":"10.1016/j.drugpo.2025.104865","DOIUrl":"10.1016/j.drugpo.2025.104865","url":null,"abstract":"<div><h3>Aim</h3><div>Cannabis policy developments worldwide typically follow separate tracks for medical and non-medical use, even in jurisdictions pursuing both forms of legalization. As these parallel regulatory frameworks evolve, understanding how stakeholders negotiate and maintain boundaries between these domains become crucial for effective policy development. Using Swiss cannabis policies as a case study, this study examines how stakeholders engage in boundary work related to medical and non-medical cannabis regulation.</div></div><div><h3>Methods</h3><div>Thematic content analysis was conducted on qualitative interview data from 18 stakeholders involved in Swiss cannabis policy.</div></div><div><h3>Results</h3><div>Two distinct forms of boundary work emerged. <em>Conceptual boundary work</em> involved using discursive methods to legitimize medical cannabis as scientific while positioning non-medical cannabis in the social/political domain. <em>Structural boundary work</em> manifested through institutional mechanisms, particularly health insurance reimbursement and pharmacy distribution. Insurance reimbursement served as a key structural element distinguishing medical from non-medical cannabis. However, using pharmacies as distribution points in non-medical cannabis regulatory pilot projects was identified as problematic, potentially undermining intended boundaries between domains.</div></div><div><h3>Conclusions</h3><div>The study reveals that stakeholders engage in boundary work as a strategic tool to navigate the complexity of maintaining boundaries between medical and non-medical cannabis systems. Relying on scientific discourse to legitimize medical cannabis while keeping non-medical cannabis in the social/political sphere may create artificial distinctions that do not reflect the complex reality of cannabis use. Policymakers aiming to reduce blurred boundaries should carefully consider how policy elements may undermine intended separations between domains.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104865"},"PeriodicalIF":4.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223164","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":"Beyond the label: analyzing the presence and information behind the QR codes on alcohol containers in 13 European countries","authors":"","doi":"10.1016/j.drugpo.2025.104862","DOIUrl":"10.1016/j.drugpo.2025.104862","url":null,"abstract":"<div><h3>Introduction</h3><div>Digital labelling through quick-response (QR) codes is increasingly proposed by the alcohol producers to inform consumers without significantly modifying their original labels. Current alcohol labelling policy discourse in Europe often revolves around the advantages and disadvantages of digital labelling, yet evidence on actual practices and the information provided through QR codes is lacking. This study aimed to assess the presence of QR codes on alcohol labels in 13 European countries, as well as the accessibility and content of the information behind those.</div></div><div><h3>Methods</h3><div>The study methodology was developed with the EVID-ACTION Youth Network, with members sampling stores and products based on a co-developed mapping protocol. Thirty-four stores in 25 cities across 13 European countries were visited between April and August 2024. Descriptive analysis was conducted by beverage type and country.</div></div><div><h3>Results</h3><div>Of 1815 products examined, 31 % contained QR codes (23 % beers, 37 % wines, 30 % spirits). Most QR codes (84 %) were positioned on the back of containers, and 61 % had no explanatory text about their purpose. Most accessed websites were in local languages (75 %), with 36 % requiring age information to enter. Websites most commonly contained brand/drink information (46 %), followed by nutritional information (42 %), health information (42 %), and ingredient information (41 %).</div></div><div><h3>Discussion</h3><div>Almost a third of alcoholic beverages in 13 European countries contained QR code. However, most labels did not specify the purpose of the code. Furthermore, given the website content, there is concern that they serve as a promotional tool rather than providing access to nutritional and risk information.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"142 ","pages":"Article 104862"},"PeriodicalIF":4.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185751","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":"Prevalence and correlates of multiple injections per injection episode among people who inject drugs in rural U.S. communities","authors":"L. Sarah Mixson ,&nbsp;William Zule ,&nbsp;Stephanie A. Ruderman ,&nbsp;Judith Feinberg ,&nbsp;Thomas J. Stopka ,&nbsp;Adams L. Sibley ,&nbsp;Suzan M. Walters ,&nbsp;Georgiy Bobashev ,&nbsp;Ryan Cook ,&nbsp;Karli R. Hochstatter ,&nbsp;Carolyn A. Fahey ,&nbsp;Lawrence J Ouellet ,&nbsp;Rob Fredericksen ,&nbsp;Hannah L.F. Cooper ,&nbsp;April M. Young ,&nbsp;Jon Zibbell ,&nbsp;Dalia Khoury ,&nbsp;Peter D. Friedmann ,&nbsp;William C. Miller ,&nbsp;P. Todd Korthuis ,&nbsp;Joseph Delaney","doi":"10.1016/j.drugpo.2025.104837","DOIUrl":"10.1016/j.drugpo.2025.104837","url":null,"abstract":"<div><h3>Background</h3><div>Multiple injections per injection episode (MIPIE) is increasingly common among people who inject drugs (PWID). While MIPIE may lower overdose risk, it could elevate infectious disease risk. This study examined the prevalence of MIPIE among rural PWID in the United States and its associations with injection behaviors associated with disease transmission (e.g., syringe mediated drug sharing, receptive supply sharing) and health outcomes (e.g., hepatitis C virus (HCV) status, naloxone possession, and overdose).</div></div><div><h3>Methods</h3><div>The Rural Opioid Initiative includes eight research cohorts of rural people who use drugs from across the U.S., recruited from 01/2018 to 03/2020. MIPIE was dichotomized as any vs. none using the question: “How many times in the past 30 days did you inject more than one time in one sitting?” We employed a fixed effects meta-analytic approach to examine cross-sectional associations through adjusted regression analyses.</div></div><div><h3>Results</h3><div>Among 2441 PWID, most reported MIPIE (71% [n=1729]). In adjusted analyses, MIPIE was associated with a higher prevalence of past 30-day receptive syringe sharing (Prevalence Ratio (PR)=2.02; 95% confidence interval (CI)=1.74–2.34), syringe-mediated drug sharing (PR=1.92; 95%CI=1.69–2.18), receptive supply sharing (PR=1.99; 95%CI=1.75–2.26), distributive supply sharing (PR=2.30; 95%CI=1.99–2.65), HCV (PR=1.26; 95%CI=1.11–1.44), naloxone possession (PR=1.32; 95%CI=1.17–1.50), overdose ever (PR=1.42; 95%CI=1.25-1.57), and overdose in the prior 90 days (PR=2.09; 95%CI=1.52–2.87).</div></div><div><h3>Conclusions</h3><div>MIPIE is a common practice among rural PWID and is associated with injection behaviors associated with disease transmission, HCV, and overdose. Intervention studies should develop harm reduction strategies that address both overdose prevention and infectious disease mitigation related to MIPIE.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104837"},"PeriodicalIF":4.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178410","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":"Heroin injection to fentanyl smoking: Examining temporal trends in substance type and route of administration among people who inject drugs in Los Angeles, CA and Denver, CO, USA between 2021–2022","authors":"Siddhi S. Ganesh ,&nbsp;Rebecca P. Smeltzer ,&nbsp;Jesse Lloyd Goldshear ,&nbsp;Pooja Shah ,&nbsp;Karen Corsi ,&nbsp;Jimi Huh ,&nbsp;Ricky N. Bluthenthal","doi":"10.1016/j.drugpo.2025.104864","DOIUrl":"10.1016/j.drugpo.2025.104864","url":null,"abstract":"<div><h3>Introduction</h3><div>In the US, fentanyl is replacing heroin in illicit drug markets. We examined temporal effects of changing substance use patterns and self-reported skin abscesses among people who inject drugs (PWID).</div></div><div><h3>Methods</h3><div>We surveyed 472 PWID in Los Angeles, CA and Denver, CO during 2021/22. Survey items covered demographics, drug use patterns (type, frequency, and route of administration), injection-related risk behaviors, and self-reported skin abscesses over the last 3 months.</div></div><div><h3>Analysis</h3><div>We used baseline data to determine if heroin and fentanyl use patterns and health outcomes changed over time. We reclassified the sample into three – 6-month participant recruitment periods (Period 1: Apr to Sep 2021 [<em>n</em> = 256/54 %]; Period 2: Oct to Mar 2021/22 [<em>n</em> = 129/27 %]; Period 3: Apr to Sep 2022[<em>n</em> = 87/18 %]). We used bivariable analyses to determine factors associated with daily injection of any drug, daily non-injection fentanyl use, and abscesses. Regression analyses were conducted to determine factors associated with these changing substance use patterns and abscesses.</div></div><div><h3>Results</h3><div>We observed statistically significant changes in the following: daily injection (78 % in Period 1 to 56 % in Period 3; <em>p</em> &lt; 0.001), daily heroin use (46 % in P1 to 28 % in P3;), daily fentanyl smoking (18 % in Period 1 to 33 % in Period 3) and abscesses (43 % in P1 to 32 % in). In multivariable robust Poisson regression models, participants recruited in later periods with lower risk of daily injection and abscesses and higher risk of daily non-injection fentanyl use.</div></div><div><h3>Discussion</h3><div>Changes in the illicit opioid market have resulted in decreased injection and increased non-injection fentanyl use. Lower injection drug use may be leading to lower risk for abscesses among PWID.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104864"},"PeriodicalIF":4.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178402","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":"Willingness and contextual considerations for supervised consumption sites: a mixed-methods study among people who inject drugs in Stockholm","authors":"Elin Holmén ,&nbsp;Martin Kåberg ,&nbsp;Elin Lundeberg ,&nbsp;Jessica Storbjörk ,&nbsp;Anders Hammarberg","doi":"10.1016/j.drugpo.2025.104866","DOIUrl":"10.1016/j.drugpo.2025.104866","url":null,"abstract":"<div><h3>Background</h3><div>Sweden faces high rates of overdose mortality, but supervised consumption sites (SCSs), where people can use drugs under healthcare supervision, have not been adopted. No studies have assessed the willingness of Swedish people who inject drugs to use a future SCS or their views on potential rules.</div></div><div><h3>Methods</h3><div>This mixed-methods study applied a risk-environment approach and collected data from people who inject drugs in Stockholm using a 28-item survey and qualitative interviews.</div></div><div><h3>Results</h3><div>Most of the 219 survey respondents reported significant risk factors, including unstable housing, previous opioid overdose, and public drug use. Among participants, 158 (72.1 %) were willing to use an SCS, while 61 (27.9 %) were unsure or unwilling. In multivariate analysis, opioid use (AOR 3.24; CI 1.31–8.02), public injection (AOR 5.22; CI 2.35–11.56), and overdose within the past year (AOR 6.89; CI 1.66–28.56) predicted willingness to use an SCS. The most common reason was “I want to avoid stress” (82.2 %). For the 61 participants unwilling or unsure, the main reason was “already having a safe place for drug use” (78.75 %). Certain rules, like bans on groin/neck injection and assisted injection, were less accepted among both survey and interview respondents. Qualitative data revealed reluctance to inject in front of SCS staff due to privacy concerns.</div></div><div><h3>Conclusion</h3><div>Our results suggest high SCS acceptability among a marginalised cohort of people who inject drugs in Stockholm. Results confirm and extend prior research by illuminating their perceptions, including important preferences to consider when designing a future SCS in Sweden.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"143 ","pages":"Article 104866"},"PeriodicalIF":4.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178401","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":"System dynamics modeling to inform implementation of evidence-based prevention of opioid overdose and fatality: A state-level model from the New York HEALing Communities Study","authors":"Nasim S. Sabounchi ,&nbsp;Rachel L. Thompson ,&nbsp;Matthew R. Lootens ,&nbsp;David W. Lounsbury ,&nbsp;Gary Hirsch ,&nbsp;Derek Blevins ,&nbsp;Turner C. Canty ,&nbsp;Nabila El-Bassel ,&nbsp;Louisa Gilbert ,&nbsp;Pedro Mateu-Gelabert ,&nbsp;Daniel J. Feaster ,&nbsp;Bruce D. Rapkin ,&nbsp;Terry T.-K. Huang","doi":"10.1016/j.drugpo.2025.104843","DOIUrl":"10.1016/j.drugpo.2025.104843","url":null,"abstract":"<div><h3>Background</h3><div>As part of the New York HEALing Communities Study, we modeled the opioid epidemic in New York State (NYS) to help coalition members understand short- and long-term capacity-building needs and trade-offs in choosing the optimal mix of harm reduction, treatment, and prevention strategies.</div></div><div><h3>Methods</h3><div>We built and validated a system dynamics simulation model of the interdependent effects of exposure to opioids, opioid supply and overdose risk, community awareness of overdose risk, naloxone supply and use, and treatment for opioid use disorder (OUD). We simulated overdose and fatality rates, OUD prevalence, and related measures from 2012 to 2032 for the NYS population aged ≥12 and tested policy scenarios for reducing future overdose deaths.</div></div><div><h3>Results</h3><div>Increasing naloxone distribution by 50 % led to a 10 % decrease in overdose deaths, but only minimally reduced OUD prevalence (1 %) by 2032. Enhancing by 50 % medications for OUD (MOUD) initiations and prevention efforts each led to substantial decreases in deaths (29 % and 25 %, respectively) and OUD prevalence (27 % and 6 %) by 2032. Simultaneously increasing naloxone distribution and MOUD initiations by 50 % resulted in 38 % fewer deaths, while adding prevention efforts alongside resulted in 56 % fewer fatalities. Sensitivity analyses of the models’ feedback loops demonstrated similar relative impacts.</div></div><div><h3>Conclusions</h3><div>A combination of evidence-based strategies while also promoting prevention should be prioritized to reduce overdose fatality. Sustained community awareness and prevention efforts are needed even as overdoses and deaths decline due to the significant effects of the community awareness feedback loop on the epidemic trends.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"142 ","pages":"Article 104843"},"PeriodicalIF":4.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146908","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 proportionality approach to the ethics of drug policy","authors":"Mary Jean Walker","doi":"10.1016/j.drugpo.2025.104861","DOIUrl":"10.1016/j.drugpo.2025.104861","url":null,"abstract":"<div><div>This paper applies a proportionality approach to examining the ethics of drug policy. The principle of proportionality states that to be ethically permissible a policy should be likely to impose only burdens that are proportionate to its benefits. I develop an analysis of proportionality judgements as involving two important kinds of ethical reasoning, characterised as consequentialist and deontological, which often interact with each other. I then apply the analysis to examples of drug policies to show how it assists in identifying forms of ethical reasoning potentially informing policy decisions and how they can interact, and identifying normative claims required for the policy to be ethically justifiable. In doing so, the proportionality approach aims to prompt assessment of normative commitments that may affect policy decisions.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"142 ","pages":"Article 104861"},"PeriodicalIF":4.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139587","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":"Off-label GLP-1 weight-loss medicine use among online bodybuilders: Folk pharmacology, risk and harm reduction","authors":"Luke A. Turnock ,&nbsp;Evelyn Hearne ,&nbsp;Jennifer Germain ,&nbsp;Mikey Hirst ,&nbsp;Honor D. Townshend ,&nbsp;Lambros Lazuras","doi":"10.1016/j.drugpo.2025.104854","DOIUrl":"10.1016/j.drugpo.2025.104854","url":null,"abstract":"<div><h3>Background</h3><div>GLP-1 medicines (e.g. Semaglutide; Tirzepatide) are diabetes medicines that have recently been approved for weight loss purposes. These drugs are increasingly common, with many users accessing these medicines for off-label lifestyle-oriented purposes. While recent research has explored increased interest in these drugs, to date no studies have explored their use in bodybuilding cultures. With bodybuilders often at the forefront of experimental drug use, and diffusing knowledge of drugs to other populations, this research examines bodybuilders’ understandings of use and risk of GLP-1 medicines, and community approaches to harm reduction.</div></div><div><h3>Methods</h3><div>This research adopted a netnographic approach, exploring 12,392 unique posts from 160 threads across two popular bodybuilding forums. Qualitative thematic analysis of posts was undertaken.</div></div><div><h3>Findings</h3><div>Bodybuilders frequently undertook experimental approaches to GLP use, including ‘stacking’ multiple compounds and ‘cycling’ between them, presenting risk. GLPs’ utility for bodybuilding was questioned by some owing to their muscle-wastage effects, but many bodybuilders combined them with anabolic-androgenic steroids (AAS) to off-set these side-effects. In addition to their weight-loss properties, many users discussed the drugs’ anti-ageing properties, and older men appear to be a significant emerging user population. While displacing potentially dangerous fat burners in bodybuilders’ folk pharmacologies, GLPs nonetheless presented risks of hypoglycaemia when combined with AAS, and broader harms. Harm reduction information was frequently shared in forum spaces as part of bodybuilders’ communal folk pharmacology, but some enabling behaviours likely to heighten risk were also identified.</div></div><div><h3>Discussion</h3><div>We examine the likely implications of these findings for public health, with particular reference to the practices of ‘cycling’ and ‘stacking’ GLP medicines and the risk this presents, particularly when combined with drugs such as AAS and far burners. We discuss the need for harm reduction services such as drug testing services, and the need for healthcare professionals to be aware of anti-ageing motivations for use among older men. Continued research into novel GLP use is needed.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"142 ","pages":"Article 104854"},"PeriodicalIF":4.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131414","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}