Get Sensible, a project by Canadian Students for Sensible Drug Policy (CSSDP), is an entirely youth-led cannabis education initiative funded by Health Canada that challenges traditional approaches to ...cannabis education by prioritizing harm reduction, evidence-based information, lived experience, and non-judgmental conversations through innovative peer-to-peer models.
In this narrative reflection, the Get Sensible team explores the necessity of centering young people in the development and implementation of cannabis education initiatives, drawing on their experience developing and disseminating the “Sensible Cannabis Education Booklets”, an illustrated series covering a range of cannabis topics in an accessible, intersectional and engaging manner.
The positive reception and impact of this campaign is a reflection of the power of truly youth-led projects for authentically connecting with young people to mobilize information in language they relate to and through mediums that resonate with them. This work considers Get Sensible's outreach strategy and approach by evaluating the impact of meeting young people where they are at, whether through social media or pop-up tabling in novel settings (e.g. skateparks and beaches).
This reflection details the value of hiring youth to lead every aspect of the project and highlights the benefits of youth-led project design and execution, including the development of print and digital resources, video series, social media content, focus groups and workshops. Through meaningful youth engagement, Get Sensible empowers young people to make informed choices about cannabis use and contribute to the development of effective, evidence-based cannabis education resources and policies.
A psychedelic industrial complex is emerging as new research on these substances and their effects is being approved. These substances show promise, but much remains unknown about their potential for ...both benefit and harm. Despite the paucity of reliable mechanistic evidence, some entrepreneurs have already begun to market psychedelic advice. We draw on some critiques of the self-help industry to propose potential parallels in the psychedelic industry. Overstated claims, cultural lore, for-profit organizations, and spiritual gurus come with the territory of both industries aimed at selling solutions for mental health disorders. We offer some guidelines for responsible research, therapy, and policy to temper these concerns, focusing on evidence-based practices, decriminalization, and rigorous therapist training.
Background
Globally, heroin and other opioids account for more than half of deaths and years‐of‐life‐lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound ...estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS‐based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets.
Analysis
Four sources of potential errors in NSDUH are assessed: selective non‐response, small sample size, sampling frame omissions and under‐reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed.
Findings
Under‐reporting and selective non‐response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year‐to‐year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three‐quarters and perhaps much more.
Implications
GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard‐to‐track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug‐related behaviors with low prevalence rates.
This article analyzes alternative development coalitions, their contradictions and complexities, and how they promoted a steeply unequal agrarian change through illicit crop substitution. We zoom ...into two paramilitary-controlled territories in Colombia. We show that those programs counted with significant support from, and were actually driven by, long coalitions that included regional and national politicians, sectors of the rural rich, paramilitary leaders, Colombian government and United States agencies.
Despite evidence that the U.S. “War on Drugs” is associated with increases in drug-related harm and other negative outcomes, all U.S. states have long criminalized most drug possession. In early ...2021, both Oregon and Washington became exceptions to this rule when they fully (Oregon) or partially (Washington) decriminalized possession of small amounts of all drugs.
We obtained arrest data for 2019 to 2021 for intervention states (Oregon and Washington) and control states (Colorado, Idaho, Montana, and Nevada). We calculated monthly rates for arrests overall and for violent crimes, drug possession, equipment possession, non-drug crimes, and a set of low-level crimes termed displaced arrests. Using an interrupted time series analysis, we examined changes in monthly arrest rates after the implementation of policy change in Oregon and Washington compared to control states.
In Oregon, there were 3 fewer drug possession arrests per 100,000 in the month after the policy change; the rate decreased throughout the post-implementation period. In Washington, there were almost 5 fewer drug possession arrests per 100,000 in the month following policy change, and the rate remained stable thereafter. Both declines were significantly greater than in comparison states. There were also statistically significant reductions in arrests for possession of drug equipment in Washington and a significant increase in displaced arrests in Oregon. There were no significant changes in overall arrests, non-drug arrests or arrests for violent crime in either state, relative to controls.
This analysis demonstrates that it is possible for state drug decriminalization policies to dramatically reduce arrests for drug possession without increasing arrests for violent crimes, potentially reducing harm to people who use drugs and their communities. Additional research is needed to determine whether these legal reforms were associated with changes in overdose rates and other drug-related harms.
Thompson explores the urgent need for lobbying Congress to restrict the Department of Justice from targeting supervised drug consumption sites. It begins by discussing the role of fentanyl in ...exacerbating the opioid crisis and the FDA's refusal to initiate an over-the-counter switch for naloxone products. The Note argues that the FDA has the legal authority to make this switch and highlights administrative law's failure to provide recourse for agency inaction. It then proposes the addition of a policy rider to an appropriations bill that restricts the DOJ from prosecuting supervised consumption sites as a potential solution. The abstract acknowledges potential obstacles but ultimately argues that this approach offers the most promising path to immunization from federal prosecution for those dedicated to giving drug users a second chance at life.
The supply of heroin into the US has changed with new source-forms and market strategies. Of particular concern is the rampant and persistent adulteration of heroin with synthetic opioids, most ...conspicuously the family of fentanyls. Medical consequences including alarming reports of increasing opioid-related overdose, chest wall rigidity syndrome and naloxone resistant overdoses demand urgent public health and policy responses. This Special Section of the International Journal of Drug Policy explores the phenomenon of substituting “traditional” heroin with new less predictable and less culturally established forms and how those forms are perceived and adopted or avoided by those who use them; it maps the consequences and explores structural risk as well as behavioral risk-factors. The research papers and commentaries presented herein discuss the supply-side shock of synthetic opioids that presents multiple overlapping challenges and paradoxes for epidemiological and toxicological surveillance, supply-side intervention, cryptomarkets and public health intervention.
‘Chemsex’ is the use of drugs before or during planned sexual events to facilitate, enhance, prolong and sustain the experience. Drugs associated with chemsex are methamphetamine, GHB/GBL, ...mephedrone, cocaine and ketamine. This review syntheses published research on the antecedents, behaviours and consequences associated with chemsex behaviours among men who have sex with men (MSM).
Papers from high income countries which were published between January 2000 and September 2018 reporting the use of chemsex drugs before or during sex were identified through Medline, Web of Science, CINAHL and Central. Results were synthesised using a narrative approach and conceptualised using a behavioural analysis framework.
The search identified 2492 publications, of which 38 were included in the final synthesis. There were wide variations in chemsex prevalence estimates due to the heterogeneous sampling in the studies. Chemsex participants have expectations that the drugs will positively affect their sexual encounters and HIV positive MSM are more likely to engage in the behaviour than HIV negative MSM. There were wide ranging prevalence estimates on injecting drugs for sexual purposes and the sharing of injecting equipment with some evidence of unsafe injecting practices. Participants were more likely to engage in condomless anal intercourse than men who do not engage in chemsex. This may increase the risk of transmission for HIV and other sexually transmitted infections.
A minority of MSM appear to engage in chemsex behaviours but they are at risk of this negatively impacting on their health and well-being. Further research is required to examine high risk chemsex behaviours, impact of chemsex on psycho-social well-being and if chemsex influences uptake of PrEP, PEP and sexual health screening.
Abstract Background In 2013, Uruguay became the first country in the world to legally regulate cannabis from seed to smoke. A growing body of research addresses drug policy reform in Uruguay. ...However, existing studies have almost completely elided its international dimension, treating the process as exclusively domestic phenomenon. Methods To consider the international dimension of drug policy reform in Uruguay, the paper draws on primary and secondary sources such as existing studies, media reports, official documents, parliamentary debates and interviews with stakeholders and policy analysts from Uruguay and elsewhere. Results The paper shows that, when, and, how international factors and actors contributed to Uruguay's drug policy reform process. Two ways in which the international dimension manifested itself are identified. First, as drug policy debate around the world changed, the context for reforms in Uruguay evolved. This resulted in a rather mixed international reaction to Uruguay's reform proposal. Second, international actors became directly involved in the process. Drug policy experts informed and legitimated cannabis reform and transnational advocates supported campaigning and mobilisation in Uruguay. Conclusion By unearthing the international dimension of Uruguay's drug policy reform, the paper adds a novel perspective to the study of drug policy reform in the Uruguay.
Aims
This paper describes the major findings and public health implications of a cross‐site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration ...program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA).
Methods
Eleven multi‐site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross‐site evaluation used a multi‐method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings.
Findings
SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi‐experimental nature of the outcome evaluation does not permit causal inferences, pre–post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost‐effective for most substances. Sixty‐nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges.
Conclusions
The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy.
PDF