The distribution of death as an organised exercise of state power, militarised topographies where experiencing the early burial of peers is part of the socialisation of generations of people, the ...vocabulary of homicide and slaughter integrated into the formation of black people’s experience from the time of their childhood in war-torn territories and necropolitics, which promotes a set of racialised and racialising categories and undertakings, define the political agenda, permeate televised narratives and distribute fear to market the idea of social peace. These are all part of a broad range of actions legitimised by the idea of war, including against other peoples, under another spectre of war – the so-called side effects. The selectiveness of prohibitionist drug policies is one of the tools used to perpetuate a series of injustices that are the result of a perverse regime that operates today via an economy marked by violence, which continues to have effects even today.
This paper explores the lived experience of forgiveness and uniquely its potential for discovering and negotiating new identities for people dealing with their addiction to substances, within the ...context and demands of English drug policy. Little research has focused on the development of shared meanings of forgiveness in relation to the social relationships impacted by addiction, and this paper seeks to promote such work. The paper is emergent from a co-production project examining forgiveness and its relationship to identity with Pushing Change a peer community for addressing substance misuse. Identity is at the heart of debates concerning drug addiction and criminal justice, however, little attention has been paid to the ways in which interventions shape individual identity, and the meanings of those relationships to the wider community. Through developing an understanding of forgiveness this project identified generative principles that allowed for new ways of thinking and practising forgiveness in relation to addressing substance misuse and the criminal justice system.
People who inject drugs (PWID) encounter varying forms of stigma in health services contexts, which can contribute to adverse outcomes. We explored the lived experience of stigma among PWID to ...elucidate pathways by which stigma influences health care access and utilization.
We conducted 46 qualitative interviews with PWID in California’s Central Valley between March and December 2015, as part of a multi-phase, multi-method study examining implementation of a new pharmacy syringe access law. A “risk environment” framework guided our data collection and we used a deductive/inductive approach to analyze the qualitative data.
Participants repeatedly cited the impact of stigma on syringe access, particularly in the context of meso-level pharmacist interactions. They described being denied syringe purchase as stigmatizing and embarrassing, and these experiences discouraged them from attempting to purchase syringes under the new pharmacy access law. Participants described feeling similarly stigmatized in their meso-level interactions with first responders and hospital staff, and associated this stigmatization with delayed and substandard medical care for overdoses and injection-related infections. Drug treatment was another area where stigma operated against PWID’s health interests; participants described macro-level public stigma towards methadone (e.g., equating methadone treatment with illicit drug use) as discouraging participation in this evidence-based treatment modality and justifying exclusion of methadone patients from recovery support services like sober living and Narcotics Anonymous.
Stigma played an undeniably important role in PWID’s experiences with health services access and utilization in the Central Valley. Our study illustrates the need to develop and test interventions that target drug use stigma at both structural and individual levels to minimize adverse effects on PWID health.
Aims
We reviewed available research on the use, content and safety of electronic cigarettes (EC), and on their effects on users, to assess their potential for harm or benefit and to extract evidence ...that can guide future policy.
Methods
Studies were identified by systematic database searches and screening references to February 2014.
Results
EC aerosol can contain some of the toxicants present in tobacco smoke, but at levels which are much lower. Long‐term health effects of EC use are unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to users or bystanders. EC are increasingly popular among smokers, but to date there is no evidence of regular use by never‐smokers or by non‐smoking children. EC enable some users to reduce or quit smoking.
Conclusions
Allowing EC to compete with cigarettes in the market‐place might decrease smoking‐related morbidity and mortality. Regulating EC as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on current evidence. Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to EC as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use.
In Europe, concentrations of ∆
-tetrahydrocannabinol (THC) in cannabis resin (also known as hash) have risen markedly in the past decade, potentially increasing risks of mental health disorders. ...Current approaches to international drug monitoring cannot distinguish between different types of cannabis resin which may have contrasting health effects due to THC and cannabidiol (CBD) content. Here, we compared concentrations of THC and CBD in different types of cannabis resin collected in Europe (either Moroccan-type, or Dutch-type). We then tested the ability of machine learning algorithms to classify the type of cannabis resin (either Moroccan-type, or Dutch-type) using routinely collected monitoring data on THC and CBD. Finally, we applied the optimal algorithm to new samples collected in countries where the type of cannabis resin was unknown, the UK and Denmark. Results showed that overall, Dutch-type samples had higher THC (Hedges' g = 2.39) and lower CBD (Hedges' g = 0.81) than Moroccan-type samples. A Support Vector Machine algorithm achieved classification accuracy exceeding 95%, with little variation in this estimate, good interpretability, and plausibility. It made contrasting predictions about the type of cannabis resin collected in the UK (94% Moroccan-type; 6% Dutch-type) and Denmark (36% Moroccan-type; 64% Dutch-type). In conclusion, we provide proof-of-concept evidence for the potential of machine learning to inform international drug monitoring. Our findings should not be interpreted as objective confirmatory evidence but suggest that Dutch-type cannabis resin has higher THC concentrations than Moroccan-type cannabis resin, which may contribute to variation in drug markets and health outcomes for people who use cannabis in Europe.
Previous research on stigma reduction has been primarily confined to single industries. However, industry boundaries are porous in the eyes of audience members and can hardly act as artificial ...confines to moral reevaluations. We contend that evaluative spillovers induced by stigma reduction in a focal industry diffuse to other industries that share the same vilifying label when (a) they possess the morally approved attribute that underlies the reduction of stigma, and (b) the morally approved attribute is embedded in formal rules and procedures that ensure the desired purposes. Empirically, we focus our tests on the legalization of marijuana as a medicine in several U.S. states during the period 2000–2015, which has reduced the "vice" stigma around marijuana by highlighting the "health safety" attribute of marijuana, namely its safe consumption and potential health benefits. We show that legalization generated evaluative spillovers to other "vice" industries sharing the same health safety attribute as marijuana (i.e., alcohol), but not to those that did not share it (i.e., tobacco). Those spillovers were primarily observed when the law was accompanied by a patient registration system that highlighted the health safety attribute of marijuana by limiting its use to medical purposes.
State prescription drug monitoring programs are promising tools to rein in the epidemic of prescription opioid overdose. We used data from a national survey to assess the effects of these programs on ...the prescribing of opioid analgesics and other pain medications in ambulatory care settings at the point of care in twenty-four states from 2001 to 2010. We found that the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids. This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward. Effects on overall opioid prescribing and prescribing of non-opioid analgesics were limited. Increased use of these programs and the adoption of new policies and practices governing their use may have contributed to sustained effectiveness. Future studies are needed to evaluate the policies' comparative effectiveness.
Fentanyl and fentanyl analogs are increasingly prevalent in the nation’s illicit drug supply. While fentanyl-related deaths were previously confined largely to states east of the Mississippi, they ...are now increasing rapidly throughout much of the United States. Contaminants other than fentanyl are also present in illicitly obtained drugs. Using drug checking equipment to determine the contaminants that may be present in these drugs is a promising avenue for reducing overdose-related harm.
Systematic legal review in which three trained legal researchers collected, reviewed, and coded all US state laws that specify whether the possession and distribution of drug checking equipment is generally legal, whether is it legal in the context of syringe services programs, and, where possession or distribution of drug checking equipment is not clearly legal, the potential penalties for violation.
We find that it is clearly legal to possess some or all drug checking equipment in 22 states, and clearly legal to distribute it to adults in 19 states. In 14 states where distribution of drug checking equipment is not clearly legal generally, it is legal when that equipment is obtained from a syringe services program. Potential penalties for violations range from small civil fines to multi-year jail sentences.
There are currently great variations between states regarding the legality of drug checking equipment. Clarifying, modifying, or repealing drug paraphernalia laws would likely improve access to these promising technologies, potentially reducing overdose deaths.
•Street drugs are increasingly contaminated with fentanyl and other adulterants.•Drug checking equipment can reduce overdose risk by identifying adulterants.•State laws on the legality of drug checking equipment vary widely.•Modifying state laws to legalize drug checking equipment may reduce overdose.
In 2016, the number of overdose deaths involving illicitly-manufactured fentanyl (IMF) surpassed heroin and prescription opioid deaths in the United States for the first time, with IMF-involved ...overdose deaths increasing more than 500% across 10 states from 2013 to 2016. IMF is an extremely potent synthetic opioid that is regularly mixed with heroin and often sold to unwitting consumers. Community-based organizations have started to distribute fentanyl test strips (FTS) as a strategy to identify IMF in street purchased products. We investigated the association between FTS use and changes in drug use behavior and perceived overdose safety among a community-based sample of people who inject drugs (PWID) in the United States.
Between September-October 2017, a total of 125 PWID completed an online survey about their most recent FTS use in Greensboro, North Carolina. Our first outcome of interest included whether PWID engaged in any of the following changes in drug use behavior after using FTS: used less than usual, administered tester shot, pushed syringe plunger slower than usual, and snorted instead of injected. Our second outcome of interest was whether PWID felt that FTS use made them feel better able to protect themselves from overdose. We conducted bivariate and multivariate analyses to determine the association between FTS use and these two outcomes.
Overall, 63% of the sample reported a positive FTS test result and 81% reported using FTS prior to consuming their drugs. For the outcomes, 43% reported a change in drug use behavior and 77% indicated increased perceived overdose safety by using FTS. In multivariable models adjusting for demographic and FTS correlates, PWID with a positive FTS test result had five times the odds of reporting changes in drug use behavior compared to those with a negative result. PWID who used the FTS after drug consumption were 70% less likely to report behavioral changes at subsequent drug consumption compared to those who used it before consumption. PWID who were not existing clients of the syringe services program had four times higher odds than existing clients to report increased overdose safety from using FTS.
We found that using FTS and receiving a positive test result was associated with changes in drug use behavior and perceptions of overdose safety. FTS may represent an effective addition to current overdose prevention efforts when included with other evidence-based strategies to prevent opioid overdose and related harm.
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