International Journal of Drug Policy最新文献

{"title":"Barriers to calling emergency services amongst people who use substances in the event of overdose: A scoping review","authors":"Hannah Byles ,&nbsp;Navid Sedaghat ,&nbsp;Nathan Rider ,&nbsp;William Rioux ,&nbsp;Alexandra Loverock ,&nbsp;Boogyung Seo ,&nbsp;Avnit Dhanoa ,&nbsp;Taylor Orr ,&nbsp;Nicole Dunnewold ,&nbsp;Lisa Tjosvold ,&nbsp;S․Monty Ghosh","doi":"10.1016/j.drugpo.2024.104559","DOIUrl":"10.1016/j.drugpo.2024.104559","url":null,"abstract":"<div><h3>Background</h3><p>North America is grappling with an ongoing drug overdose crisis. While harm reduction measures like take-home naloxone kits, and supervised consumption sites, have helped reduce mortality, other strategies to address this public health emergency are required. Good Samaritan Laws (GSLs) offer legal protection for individuals who report overdoses, yet people who use substances (PWUS) may still hesitate to seek help due to concerns about existing legislation. This scoping review explores barriers preventing PWUS from calling emergency services for overdoses, along with potential solutions and facilitators to address this challenge.</p></div><div><h3>Methods</h3><p>PRISMA-ScR was used as a guide to conduct this study. Health sciences librarians searched Medline, Embase, PsychINFO, CINAHL, and SCOPUS to identify relevant articles. Six reviewers contributed to screening and extracting the articles through Covidence. Two reviewers performed thematic analysis using NVivo software to identify key barriers and facilitators.</p></div><div><h3>Results</h3><p>An initial search found 6275 articles for title and abstract screening, resulting in 48 studies meeting the inclusion criteria. The primary barrier to calling 911 pertained to concerns about police arrivng with other first responders, especially regarding their presence and involvement at the scene of overdose. This was followed by legal repercussions, including fear of arrest, incarceration, and fear of eviction, amongst others. Some studies noted the lack of knowledge or trust in GSLs as a deterrent to seeking medical assistance. Additional barriers included concerns about privacy and confidentiality, preference to manage an overdose alone/receive help from another peer, confidence in naloxone effectiveness, limited access to cell phones, peer pressure to not call for help, and identifying as Black, Indigenous, or a Person of Colour (BIPOC). Facilitators include increased GSL awareness among PWUS and law enforcement, expanded legal safeguards for 911 callers, reduced police intervention in overdose cases, and enhanced naloxone availability at key access points.</p></div><div><h3>Conclusion</h3><p>Despite the good intentions of GSLs, PWUS continue to experience significant barriers to calling emergency services in the event of an overdose. Understanding these barriers and key facilitators is necessary to inform future drug policy and advocacy efforts.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"132 ","pages":"Article 104559"},"PeriodicalIF":4.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002433/pdfft?md5=2f17bd106ec3dbc56909a8eb76aef1bd&pid=1-s2.0-S0955395924002433-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087398","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":"Guiding principles for breaking down drug-related stigma in academic writing","authors":"Ramez Bathish ,&nbsp;Annie Madden ,&nbsp;Cameron Duff ,&nbsp;Alison Ritter","doi":"10.1016/j.drugpo.2024.104515","DOIUrl":"10.1016/j.drugpo.2024.104515","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104515"},"PeriodicalIF":4.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088418","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":"Substance misuse by birth parents: Outcomes for children and young people placed into out-of-home-care","authors":"Geoffrey Leggat ,&nbsp;Emmanuel Kuntsche ,&nbsp;Sandra Kuntsche ,&nbsp;Prue Atkins ,&nbsp;Anne-Marie Laslett","doi":"10.1016/j.drugpo.2024.104544","DOIUrl":"10.1016/j.drugpo.2024.104544","url":null,"abstract":"<div><h3>Background</h3><p>There is inconsistent evidence regarding the effect of birth parent substance use on developmental outcomes for children placed into out-of-home-care (OOHC).</p></div><div><h3>Objective</h3><p>This study aims to examine how parental substance use affects outcomes of Australian children in out-of-home care, adjusting for key demographic, social and system factors.</p></div><div><h3>Participants and setting</h3><p>Four waves of survey data were collected for children and young people who agreed to participate in the Pathways of Care Longitudinal Study (POCLS) between 2011 and 2018. The study sample included 1,506 children and young people (792 with a history of parental substance misuse) aged 9 months to 17 years who participated in at least one wave of the POCLS and had linked administrative data from the Department of Communities and Justice (DCJ), NSW, Australia.</p></div><div><h3>Methods</h3><p>Multilevel longitudinal models were used to analyse the relationship of child developmental outcomes (physical health, socio-emotional wellbeing, and verbal and non-verbal cognitive ability) with parental substance misuse in their child protection history. Each model included adjustments for child demographics, family socio-economic status, child protection system factors and the unbalanced panel.</p></div><div><h3>Results</h3><p>Children in OOHC with a history of parental substance misuse were more likely to be in the typical range for verbal cognitive development compared to those in OOHC without this history. In addition, younger (9 months to 5 years) children with a record of parental substance misuse exhibited significantly more typical fine and gross motor skill development than those without this history.</p></div><div><h3>Conclusions</h3><p>Concerns that children in OOHC with a history of parental substance misuse may be more affected with regards to early-stage physical development, and later verbal cognitive development than those without this history in OOHC, may not be justified.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"132 ","pages":"Article 104544"},"PeriodicalIF":4.4,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002287/pdfft?md5=4499c59219a8d6bd42032299fab313ce&pid=1-s2.0-S0955395924002287-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049521","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":"Ignored inequities: Critical analysis of the pre-launch development of British Columbia's “Stop Overdose” campaign","authors":"Tia Greto,&nbsp;Scott D. Neufeld","doi":"10.1016/j.drugpo.2024.104546","DOIUrl":"10.1016/j.drugpo.2024.104546","url":null,"abstract":"<div><h3>Background</h3><p>Substance use stigma has been positioned as a major driver of drug toxicity mortality. In response, governmental and public health organizations across Canada have invested significant resources into mass media campaigns that target stigma. Many of these campaigns feature images or stories about people who use drugs (PWUD). Although stigma and drug toxicity death disproportionately impact racially and economically marginalized PWUD, these campaigns often over-represent White, middle-class individuals. This effectively ignores intersecting roles of racism and classism in the experience of stigma and drug toxicity mortality.</p></div><div><h3>Methods</h3><p>To investigate how this pattern of representation might occur, we examined the development process of the British Columbia (BC) Government's “Stop Overdose” anti-stigma campaign launched in 2018. We aimed to identify strategic goals, decisions, and underlying ideas that could help explain the campaign's eventual focus on White, middle-class PWUD. Through a Freedom of Information request we obtained 320 pages of documents from the BC Government outlining the real-time development, testing, and evaluation of the first wave of the campaign. We analyzed these documents using reflexive thematic analysis.</p></div><div><h3>Results</h3><p>We identified that campaign developers had a marked focus on challenging stereotypes about PWUD and humanizing PWUD, while ensuring the campaign was relevant to BC residents. To achieve these goals, campaign developers ultimately avoided images of what they deemed the inaccurately “stereotypical” marginalized drug user. Instead, they featured PWUD in more privileged social positions. By attaching labels like “co-worker” to this imagery, developers felt mainstream BC residents could relate to and have more empathy for these PWUD compared to marginalized PWUD.</p></div><div><h3>Conclusions</h3><p>In effect, these strategies perpetuated the exclusion and dehumanization of marginalized PWUD facing disproportionate harms of the drug toxicity crisis. Since anti-stigma campaigns remain a common intervention, we highlight a need for strategic approaches informed by more critical perspectives on substance use stigma.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104546"},"PeriodicalIF":4.4,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002305/pdfft?md5=91ca5454efa97bd17e14add230ea4e85&pid=1-s2.0-S0955395924002305-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040528","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":"Coverage of cervical cancer prevention interventions among people in Australia who inject drugs","authors":"Olivia Price ,&nbsp;Dorothy A. Machalek ,&nbsp;Rachel Sutherland ,&nbsp;Daisy Gibbs ,&nbsp;Samantha Colledge-Frisby ,&nbsp;Phillip Read ,&nbsp;Amy Peacock","doi":"10.1016/j.drugpo.2024.104566","DOIUrl":"10.1016/j.drugpo.2024.104566","url":null,"abstract":"<div><h3>Background</h3><p>The human papillomavirus (HPV) vaccine and regular (i.e., every five years) cervical screening are essential to prevent cervical cancer. Australia has high overall coverage of both interventions but little is known about coverage among people who inject drugs. and known barriers to preventive care among this population may extend to cervical cancer control measures.</p></div><div><h3>Methods</h3><p>Data were obtained from the 2023 Illicit Drug Reporting System interviews, in which people who regularly inject drugs participated. The sample was restricted to people with a cervix, with participants aged 25–74 years eligible for the National Cervical Screening Program and participants born after 1980 eligible for HPV vaccination. Age-standardised prevalence ratios were used to compare coverage among this sample to the Australian general population; other results were summarised descriptively.</p></div><div><h3>Findings</h3><p>Among participants eligible for screening (<em>n</em> = 243), most (96.7 %) reported lifetime uptake, while 70.2 % had been screened during the past five years, which was similar to the general population (prevalence ratio [PR]: 1.14, 95 % confidence interval [CI]: 0.96–1.31). Among those never or overdue for screening (<em>n</em> = 57), one third (31.7 %) were aware that self-sampling is available and barriers to screening varied, with similar numbers reporting personal (e.g., ‘I didn't know I needed to’), logistical (e.g., ‘I don't have time’), and test-related reasons (e.g., ‘the test is uncomfortable/painful’). Among participants eligible for HPV vaccination (<em>n</em> = 99), coverage was 27.2 %, 38 % lower than the general population (PR: 0.62, 95 % CI: 0.39–0.86).</p></div><div><h3>Conclusions</h3><p>Cervical screening coverage among this sample of people who inject drugs was similar to the Australian population. Health promotion messaging that focuses on the availability of self-sampling and the importance of regular screening may improve coverage among those overdue for screening. HPV vaccination was lower than the general population, warranting targeted efforts to offer the vaccine to eligible people who inject drugs.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"132 ","pages":"Article 104566"},"PeriodicalIF":4.4,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002500/pdfft?md5=fff8b9f076af4ec2347cf4ba7871c1ee&pid=1-s2.0-S0955395924002500-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021340","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":"Utilising Integrated Bio-behavioural Surveillance (IBBS) to investigate declining hepatitis C antibody prevalence among people who inject drugs in the Australian Needle and Syringe Program Survey","authors":"","doi":"10.1016/j.drugpo.2024.104545","DOIUrl":"10.1016/j.drugpo.2024.104545","url":null,"abstract":"<div><h3>Background</h3><p>Prevalence of hepatitis C virus (HCV) antibody (Ab) on dried blood spot (DBS) samples in the Australian Needle and Syringe Program Survey (ANSPS) decreased nationally from 57% in 2015 to 32% in 2022. We aimed to investigate potential explanations for this decline.</p></div><div><h3>Methods</h3><p>Changes in DBS HCV Ab prevalence were investigated by redefining positive cases as those with those with either a positive HCV Ab test result or a self-reported history of ever having HCV treatment (modified prevalence), examining HCV Ab prevalence by birth and age cohorts, and assessing trends in key risk behaviours.</p></div><div><h3>Results</h3><p>Overall prevalence of DBS HCV Ab declined rapidly and significantly from 57% in 2015 to 32% in 2022 (p&lt;0.001) however modified HCV Ab prevalence remained stable over time (85% and 88% in 2015 and 2022, respectively, p=0.357). The proportion of participants with negative HCV Ab and self-reported HCV infection increased from 20% in 1995 to 40% in 2022 (p&lt;0.001) and the proportion with negative HCV Ab and lifetime HCV treatment increased from 3% in 1999 to 67% in 2022 (p&lt;0.001). We also observed a decreasing trend in DBS HCV Ab prevalence in all birth and age cohorts with a noticeable acceleration in the decline commensurate with the advent of HCV DAA treatment. A long-term decreasing trend was also observed for key risk behaviours (p&lt;0.001) however the short-term trend was not significant for recent receptive syringe sharing.</p></div><div><h3>Conclusion</h3><p>The temporal decline in HCV Ab prevalence appears related to reduced sensitivity of DBS HCV Ab detection with viral clearance following treatment. Since 2016, HCV treatment uptake has increased markedly including among people who inject drugs. In this context, continuing to monitor HCV Ab prevalence by DBS testing is problematic, with a shift to surveillance of active infection the most relevant to guide policy and practice in this setting.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104545"},"PeriodicalIF":4.4,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002299/pdfft?md5=8447d1458750ca3bdc101b81f0f1ad0c&pid=1-s2.0-S0955395924002299-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005592","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":"A qualitative evaluation of a fentanyl patch safer supply program in Vancouver, Canada","authors":"Alexa Norton ,&nbsp;Andrew Ivsins ,&nbsp;Elizabeth Holliday ,&nbsp;Christy Sutherland ,&nbsp;Thomas Kerr ,&nbsp;Mary Clare Kennedy","doi":"10.1016/j.drugpo.2024.104547","DOIUrl":"10.1016/j.drugpo.2024.104547","url":null,"abstract":"<div><h3>Background</h3><p>The ongoing overdose crisis in Canada has prompted efforts to increase access to a “safer supply” of prescribed alternatives to the unregulated drug supply. While safer supply programs predominantly distribute hydromorphone tablets, the Safer Alternatives for Emergency Response (SAFER) program in Vancouver, Canada offers a range of prescribed alternatives, including fentanyl patches. However, little is known about the effectiveness of fentanyl patches as safer supply. Drawing on the perspectives and experiences of program participants, we sought to qualitatively evaluate the effectiveness of the SAFER fentanyl patch program in meeting its intended aims, including reducing risk of overdose by decreasing reliance on the unregulated drug supply.</p></div><div><h3>Methods</h3><p>As part of a larger mixed-methods evaluation of SAFER, semi-structured qualitative interviews were conducted with 17 fentanyl patch program participants between February 2022 and April 2023. Thematic analysis of interview data focused on program engagement, experiences, impacts, and challenges.</p></div><div><h3>Results</h3><p>The flexible program structure, including lack of need for daily dispensation, the extended missed dose protocol, and community pharmacy patch distribution fostered engagement and enhanced autonomy. Improved management of withdrawal symptoms and cravings due to steady transdermal dosing led to reduced unregulated drug use and overdose risk. Participants also experienced economic benefits and improvements in overall health and quality of life. However, skin irritation and patch adhesion issues were key barriers to program retention.</p></div><div><h3>Conclusion</h3><p>Our findings demonstrate the value of including fentanyl patch safer supply in the substance use continuum of care and offer insights for innovations in delivery of this intervention.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104547"},"PeriodicalIF":4.4,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002317/pdfft?md5=a8c70e1995b2fdd74bd3681dbe0f9bd3&pid=1-s2.0-S0955395924002317-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142002484","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":"20-year trends in Australian methamphetamine-related deaths, 2001–2020","authors":"Oisin Stronach ,&nbsp;Paul Dietze ,&nbsp;Michael Livingston ,&nbsp;Amanda Roxburgh","doi":"10.1016/j.drugpo.2024.104548","DOIUrl":"10.1016/j.drugpo.2024.104548","url":null,"abstract":"<div><h3>Background</h3><p>Over the past two decades methamphetamine-related harms have increased in Australia. Previous analysis of methamphetamine-related deaths has covered limited timeframes, and largely focused on drug-toxicity deaths. This paper examines long-term trends in methamphetamine-related deaths over 20 years, including deaths due to a range of specific causes.</p></div><div><h3>Methods</h3><p>Descriptive analyses were conducted on Australian methamphetamine-related deaths (2001–2023) by cause, extracted from the National Coronial Information System, an online database containing deaths reported to coroners in Australia and New Zealand. Joinpoint trend analyses were used to assess changes over time between 2001 and 2020 (with data from 2021 to 2023 likely incomplete and thus excluded).</p></div><div><h3>Results</h3><p>Unintentional drug toxicity was the cause of 49.8 % of methamphetamine-related deaths, intentional self-harm (including toxicity) 23.3 %, unintentional injury 15.1 %, natural causes 9.6 %, and assaults 2.3 %. Between 2001 and 2020, joinpoint analysis showed three trend change points among all-cause methamphetamine-related mortality rates, resulting in four distinct periods: two periods where they increased (2001–2006 – annual percentage change (APC) = 15.4 %; 2009–2016 – APC 25.5 %), and two where they decreased (2006–2009 – APC = –11.8 %; 2017–2020 – APC = –2.9 %). Similar patterns were evident among rates of intentional self-harm and unintentional injury. Deaths caused by unintentional drug toxicity saw two trend change points (2011, 2016), and rates increased across all three periods. Natural cause deaths had three trend change points (2007, 2010, 2015), and rates continued to rise after 2015, largely driven by increases in circulatory diseases.</p></div><div><h3>Conclusion</h3><p>Cause-specific models highlighted diverse trends. Recent trends show unintentional drug toxicity deaths have slightly increased, intentional self-harm stabilised, and unintentional injury and assault deaths have declined. Deaths from natural causes involving methamphetamine continued to increase, highlighting a public health concern and a potential need for early circulatory disease screening among people who use methamphetamine.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104548"},"PeriodicalIF":4.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002329/pdfft?md5=4c64af183ec399fa59764e1aed1f5441&pid=1-s2.0-S0955395924002329-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979592","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":"Using nominal group technique with people who are incarcerated in Canadian federal prisons to identify barriers and solutions to improving Prison Needle Exchange Program uptake","authors":"Lise Lafferty ,&nbsp;Frederick L Altice ,&nbsp;Frederic Leone ,&nbsp;Mark Stoové ,&nbsp;Andrew R Lloyd ,&nbsp;Behzad Hajarizadeh ,&nbsp;Nadine Kronfli","doi":"10.1016/j.drugpo.2024.104549","DOIUrl":"10.1016/j.drugpo.2024.104549","url":null,"abstract":"<div><h3>Background</h3><p>Prison needle exchange programs (PNEPs) are a critical component for harm reduction in prisons. Little is known about the PNEP access barriers for people who are incarcerated, but the low uptake in the Canadian program highlights these constraints. We aimed to identify the barriers and potential solutions for increasing PNEP coverage in the nine Canadian federal prisons where they operate.</p></div><div><h3>Methods</h3><p>Eighteen focus groups were conducted in nine prisons using nominal group technique (NGT) with two stakeholders: peer advocates and people who use or identified as potential users of the PNEP. NGT uses a round-robin technique followed by generating a list of barriers to PNEP enrolment within their prison. Participants then allocated votes to rank the highest priority barriers, followed by an identical process to generate solutions to address the top three barriers. Interview transcripts describing participant narratives during this process were de-identified and coded to generated themes. Barriers and solutions receiving &gt;10 % of votes within respective participant groups, alongside associated narratives, are discussed more fully.</p></div><div><h3>Results</h3><p>Fear of repercussions due to drug use, lack of confidentiality, and fear of being targeted and sanctioned by correctional authorities were perceived by both stakeholder groups as the top barriers inhibiting PNEP enrolment. Stigma (peer advocates) and the application process for the program (PNEP users) were also ranked as a priority. Proposed solutions included education and external oversight of PNEP (i.e., not via correctional officers) by both groups. Peer advocates regarded improving participant confidentiality and a supervised/safe injection site as potential enablers for program participation, while PNEP users identified wrap-around services as likely to improve access.</p></div><div><h3>Conclusion</h3><p>Barriers to increasing PNEP coverage in Canadian federal prisons proposed by participants highlight the importance of trust and perceived repercussions surrounding program participation. These barriers and proposed solutions highlight a need for changes in implementation to PNEP delivery if the potential health benefits of PNEPs are to be realised.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104549"},"PeriodicalIF":4.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002330/pdfft?md5=47dc72f1765bab8b3d221ae86f20316f&pid=1-s2.0-S0955395924002330-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979416","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":"“To smoke feels gender”: Exploring the transformative and emancipatory capacities of cannabis among transgender, non-binary and gender non-conforming (TGNC) youth","authors":"Christian Barborini ,&nbsp;Trevor Goodyear ,&nbsp;Hannah Kia ,&nbsp;Mark Gilbert ,&nbsp;Olivier Ferlatte ,&nbsp;Rod Knight","doi":"10.1016/j.drugpo.2024.104536","DOIUrl":"10.1016/j.drugpo.2024.104536","url":null,"abstract":"<div><h3>Background</h3><p>Transgender, non-binary and gender non-conforming (herein, “TGNC”) youth (15–24 years old) face overlapping minority stressors (e.g., gender discrimination, lack of access to gender-affirming care, rejection, violence) that contribute to mental health inequities. TGNC youth also use substances at higher rates when compared to cisgender youth, including some of the highest rates of cannabis use in Canada.</p></div><div><h3>Methods</h3><p>This community-based participatory research study provides an in-depth qualitative, photovoice-based analysis examining how cannabis use features within the gender experiences of a sample of TGNC youth in British Columbia (BC). We conducted in-depth, semi-structured interviews with 27 TGNC youth (15–24 years old) from across British Columbia. Interviews were designed to elicit discussions about the photos youth had taken as well as various gender and mental health experiences related to their cannabis use. Analysis and identification of emergent themes was guided by social constructivist grounded theory as well as queer and trans theorizing and informed by community-based research approaches through regular meetings with our team's Substance Use Beyond the Binary Youth Action Committee comprised of TGNC youth who use substances.</p></div><div><h3>Results</h3><p>Three overarching themes pertaining to cannabis use and gender experiences amongst TGNC youth in our study were generated. First, participants used cannabis purposefully and strategically to enact diverse gender expressions and embodiments. Second, participants leveraged cannabis to support introspection whilst mobilizing identity discovery and development. Finally, participants mobilized cannabis as a vehicle for accessing moments of gender euphoria and affirmation.</p></div><div><h3>Conclusions</h3><p>These findings identify how some TGNC youth use cannabis to purposefully and strategically facilitate their mental health, well-being, identity development and self-expression. This research reveals critically important experiential and embodied dimensions of cannabis use that have not historically been considered in cannabis-related policy and the provision of care, including mental health and substance use-related care.</p></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"131 ","pages":"Article 104536"},"PeriodicalIF":4.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955395924002147/pdfft?md5=84b76553822e9064cd3dbf560e358549&pid=1-s2.0-S0955395924002147-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979591","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}