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Background: Recent drug-related deaths at Australian music festivals have led to increasing concern about the risk of future harm, but contention about how to effectively respond. One hotly debated strategy has been the use of drug detection dogs which currently operate at festivals across Australia, despite claims they are ineffective and contribute to risky drug use practices. This paper aims to investigate responses to the expected presence, and sightings, of drug dogs at the last festival attended.Methods: An anonymous online survey was completed by almost 2000 Australian festival-goers. The largest subsample used in the analyses for this paper (n= 647) was 59% male and had a median age of 20 (IQR = 18-22).Results: Of those who expected dogs to be present at their last festival (n= 647), only 4% reported that this threat led them to decide not to take drugs. Other responses included: concealing their drugs well (48%), getting someone else to carry their drugs (15%), buying their drugs inside (11%), taking less easily detected drugs (10%) and taking drugs before entering (7%). Of those who carried drugs in (n= 418), 10% concealed them internally and 1% swallowed them to retrieve inside. Of those who had drugs on their person when seeing a dog (n= 189), 10% reported consuming drugs in response. No respondents reported being detected with drugs due to a positive identification.Conclusion: Almost all festival-goers surveyed did not report being deterred from drug usage by the expected presence of drug dogs. Instead, a variety of alternative responses to avoid detection were reported, many of which could place festival-goers at greater risk of experiencing drug-related harms. In the face of mounting evidence of both ineffectiveness and iatrogenic effects, the use of drug detection dogs at Australian music festivals should be urgently reconsidered. [ABSTRACT FROM AUTHOR]

Background: Harm reduction policy and praxis has long struggled to accommodate the pleasures of alcohol and other drug use. Whilst scholars have consistently highlighted this struggle, how pleasure might come to practically inform the design and delivery of harm reduction policies and programs remains less clear. The present paper seeks to move beyond conceptual critiques of harm reduction's 'pleasure oversight' to more focused empirical analysis of how flows of pleasure emerge, circulate and, importantly, may be reoriented in the course of harm reduction practice.Methods: We ground our analysis in the context of detailed ethnographic research in a drug consumption room in Frankfurt, Germany. Drawing on recent strands of post-humanist thought, the paper deploys the concept of the 'consumption event' to uncover the manner in which these facilities mediate the practice and embodied experience of drug use and incite or limit bodily potentials for intoxication and pleasure.Results: Through the analysis, we mapped a diversity of pleasures as they emerged and circulated through events of consumption at the consumption room. Beyond the pleasurable intensities of intoxication's kick, these pleasures were expressed in a range of novel capacities, practices and drug using bodies. In each instance, pleasure could not be reduced to a simple, linear product of drug use. Rather, it arose for our participants through distinctive social and affective transformations enabled through events of consumption at the consumption room and the generative force of actors and associations of which these events were composed.Conclusion: Our research suggests that the drug consumption room serves as a conduit through which its clients can potentially enact more pleasurable, productive and positive relations to both themselves and their drug use. Acknowledging the centrality of pleasure to client engagement with these facilities, the paper concludes by drawing out the implications of these findings for the design and delivery of consumption room services. [ABSTRACT FROM AUTHOR]

Background: The use of drug detection dogs and other punitive policing methods remain common at music festivals in Australia and elsewhere, despite concern about iatrogenic effects and recommendations for their overhaul. While drug amnesty bins are a commonly implemented strategy purported to mitigate risk associated with policing, the efficacy of this intervention is debated. This paper investigates two of the most concerning iatrogenic effects of drug policing practices at Australian festivals - internal concealment and panic consumption - and explores the potential efficacy of drug amnesty bins.Methods: A stepped, mixed methods study (qual→QUANT→qual) comprised qualitative interviews with key informants and festivalgoers, and a quantitative online survey completed by almost 2000 Australian festivalgoers (52% male; median age 20 years old). Descriptive statistics were performed alongside bivariable and multivariable logistic regressions predicting internal concealment and panic consumption. Inductive thematic analysis was used to examine the qualitative data.Results: Among respondents who had ever used illicit drugs at festivals (n=1065), 23% reported hiding drugs internally to evade police detection and 17% reported panic consumption. Female respondents and respondents expecting dogs were at greater odds of reporting internal concealment. The qualitative data provided greater insight into the risky nature of internal concealment practices and panic incited by police at the gates. When asked if they would have considered discarding their drugs into a drug amnesty bin had they been concerned about detection, less than a quarter (24%) said they definitely or probably would have.Conclusion: This paper adds to the evidence regarding iatrogenic effects of punitive drug policing practices at festivals. The findings have implications for shifting away from punitive policies to ones focused on public health. Additionally, the findings suggest drug amnesty bins should not be viewed as an adequate response for averting harms from drug policing. [ABSTRACT FROM AUTHOR]

Abstract: Background: Computer simulations provide a useful tool for bringing together diverse sources of information in order to increase understanding of the complex aetiology of drug use and related harm, and to inform the development of effective policies. In this paper, we describe SimAmph, an agent-based simulation model for exploring how individual perceptions, peer influences and subcultural settings shape the use of psychostimulants and related harm amongst young Australians. Methods: We present the conceptual architecture underpinning SimAmph, the assumptions we made in building it, the outcomes of sensitivity analysis of key model parameters and the results obtained when we modelled a baseline scenario. Results: SimAmph''s core behavioural algorithm is able to produce social patterns of partying and recreational drug use that approximate those found in an Australian national population survey. We also discuss the limitations involved in running closed-system simulations and how the model could be refined to include the social, as well as health, consequences of drug use. Conclusion: SimAmph provides a useful tool for integrating diverse data and exploring drug policy scenarios. Its integrated approach goes some way towards overcoming the compartmentalisation that characterises existing data, and its structure, parameters and values can be modified as new data and understandings emerge. In a companion paper (), we use the model outlined here to explore the possible consequences of two policy scenarios. [Copyright &y& Elsevier]

Background: Drug checking services are being implemented in recreational settings across the world, however these projects are frequently accused of a lack of evidence concerning their impact on people who use drugs. This paper describes the implementation of a drug checking service at the Boom Festival 2016 and explores the impact of this service on its users' behavioural intentions.Methods: 753 drug samples were submitted to the drug checking service for chemical analysis. All drug checking users were invited to fill a pre-analysis and a post-analysis questionnaire. 310 pre- and post-analysis questionnaires answered by users of the service were successfully matched.Results: When the test results were "unexpected" (N = 86), 94.3% of the service users reported that they would not to take the drug. When the test result indicated the sample contained "the expected substance plus adulterants" (N = 41) 32% of users stated they would not take it. When the test result was "only the expected substance" (N = 370), as anticipated, 98% of the participants reported they would take it. There was a statistically significant association between users' behavioural intentions and drug-checking result (χ2(2) = 350,042, p < .001).Conclusions: These results support the hypothesis that providing drug checking services in large-scale festivals helps users to better manage their drug use and deal with drug adulteration. The data corroborates the supposition that when provided with objective information about the content of their drugs, some users consider health protecting behaviours. Additionally, these results can contribute to the design of tailored harm reduction interventions that take into consideration clients' characteristics, profiles and motivations. [ABSTRACT FROM AUTHOR]

Background: Due to misinformation and enduring discourses about pregnant women and mothers suspected of using drugs, these women continue to experience systemic discrimination. In 2014, this fact was once again made public in Canada when the Ontario government established an independent review of hair testing practices conducted by Motherisk Drug Testing Laboratory (MDTL) at Toronto's Hospital for Sick Kids. Between 2005 and 2015, MDTL tested the hair of more than 16,000 individuals for drug consumption. The results were introduced as evidence in court and resulted in both temporary and permanent loss of custody of children. Tragically, it was later discovered that the hair testing results were unreliable. This paper provides an analysis of child protection policies and practices directed at pregnant women and mothers suspected of using drugs, with a focus on the Motherisk tragedy in Ontario.Methods: Informed by feminist and critical drug perspectives, this study draws from findings in the 2015″Report of the Motherisk Hair Analysis Independent Review," produced by Honourable Susan Lang, and provides a Bacchi-informed critical analysis of Commissioner Beaman's 2018 report of the Motherisk Commission, "Harmful Impacts: The Reliance on Hair Testing in Child Protection" (HI).Results: The HI report is quite sympathetic to the plight of families and it acknowledges systemic issues and unequal power relations between families, social workers and the courts. Even though drug testing is an inadequate measure of parenting capacity, the HI report does not recommend banning the practice. In the HI report, the themes of harm reduction and drug prohibition are notably absent - while the use of gender-neutral terms, such as "parent" and "families," render mothers invisible.Conclusions: The Motherisk tragedy cannot be understood as an isolated event, rather it is part of a continuum of state and gendered violence against poor, Indigenous, and Black women in Canada. The HI report fails to consider how prohibitionist discourses about drugs, addiction, mothering, and risk lead to institutional practices such as drug testing and child apprehension. [ABSTRACT FROM AUTHOR]

Background: In a year when UK drug-related deaths and festival drug-related deaths reached their highest on record, a pilot festival drug safety testing service was introduced with the aim of reducing drug-related harm. This paper describes the operational and behavioural outcomes of this pilot and explores the relationship between drug use, supply and policing within festival grounds.Methods: Chemists in a temporary laboratory analysed 247 substances submitted by the public to a free, confidential testing service across four days at a UK festival in July 2016. Test results were returned to service users embedded in 230 healthcare consultations delivered to approximately 900 festival-goers (one in five drug using festival-goers) that included harm reduction advice and the opportunity to use a disposal service for further substances of concern. Consultation data were collected at point of care, matched with test results, coded and analysed using SPSS RESULTS: Test results revealed that one in five substances was not as sold or acquired. One in five service users utilised the disposal service for further substances of concern in their possession and another one in six moderated their consumption. Two thirds of those whose sample was missold disposed of further substances, compared with under one in ten whose sample was as sold. Service users who acquired substances onsite at the festival were more than twice as likely to have been missold them as those acquired offsite, were nearly twice as likely to use the disposal service and were on average two years younger. Women were more likely to be using the drug for the first time and more likely to use the disposal service. Test results were shared with emergency services; alerts issued across site and an unanticipated feedback loop occurred to some drug suppliers.Conclusion: This pilot suggests that festival-goers engage productively with onsite drug safety testing services when given the opportunity, such services can access harder-to-reach and new user groups and can play a part in reducing drug-related harm by identifying and informing service users, emergency services and offsite drug using communities about substances of concern. Disposals to the testing service for onward police destruction provide an externally corroborated measure of impact, reducing harm to the individual and others by removing such substances from site. Evidence of differential dealing onsite and its potential negative consequences has implications for future research and policing. [ABSTRACT FROM AUTHOR]

This paper analyses driving under the influence of alcohol and drugs (DUI) from a governmentality perspective. The paper is based on qualitative interviews with 25 persons, convicted of drink-driving and at the time of the interviews participating in Alcohol/Traffic courses in Denmark (mandatory courses for DUI-convicted people). Four drink-driver profiles are identified: regular heavy drinkers who regard themselves as addicted; regular drinkers who claim they are in control of both their alcohol use and their drink-driving; occasional multi-substance users who associate their DUI with strong feelings of control loss; and occasional drinkers or drug users with limited experience of drink-driving. The paper analyses drink-driving as a form of “failed self-governance” and shows how some of the convicted drink-drivers negotiate quilt and blame by either justifying their DUI (they were “in full control” and hence did not risk other people''s lives) or excusing it (they had “lost control” over their alcohol and/or drug intake and therefore did not engage in DUI of their own free will). [Copyright &y& Elsevier]

Abstract: Background: Between 2002 and 2005 fresh or unprepared psilocin-based ‘magic’ mushrooms were legal to possess and traffic in the UK, and commercial sales demonstrated a significant market for this hallucinogenic drug. During and after this time there has been relatively little analysis concerning how magic mushroom users accounted for their drug use, nor on the wider political and cultural discourses that might have shaped this sense making. Method: In this paper we present a critical analysis of contemporary discourses around magic mushroom use in the UK through a multi-level discourse analysis of focus group data from 20 magic mushroom users (13 male and 7 female, mean age 25 years), taken at a time when magic mushrooms were being legally sold in the UK. Results: Locating participants’ use of magic mushrooms within the context of a culture of intoxication, neo-liberalism and the legacy of 1960s psychedelic philosophy, we identify six interpretative repertoires in their talk, which were subsumed within two overarching discourses. The first discourse drew on neo-liberal rhetoric, constructing participants as rational risk managing subjects engaged in a form of calculated hedonism that was legitimated as an act of personal freedom and consumer choice. The second discourse, identified as ‘post-psychedelic’, both celebrated and problematised a collective, connected ‘hippy’ form of spirituality. Conclusion: The paper analyses the relationships between identity, consumption and citizenship by arguing that people''s ability to imagine collectivist, spiritual or interconnected social worlds has been contained within neo-liberalism rhetoric. [Copyright &y& Elsevier]

Background: People with a history of incarceration are at high risk for opioid overdose. A variety of factors contribute to this elevated risk though our understanding of these factors is deficient. Research to identify risk and protective factors for overdose is often conducted using administrative data or researcher-derived surveys and without explicit input from people with lived experience. We aimed to understand the scope of U.S. research on factors associated with opioid overdose among previously incarcerated people. We did this by conducting a narrative review of the literature and convening expert panels of people with lived experience. We then categorized these factors using a social determinants of health framework to help contextualize our findings.Methods: We first conducted a narrative review of the published literature. A search was performed using PubMed and APA PsycInfo. We then convened two expert panels consisting of people with lived experience and people who work with people who were previously incarcerated. Experts were asked to evaluate the literature derived factors for completeness and add factors that were not identified. Finally, we categorized factors as either intermediary or structural according to the World Health Organization's Social Determinants of Health (SDOH) Framework.Results: We identified 13 papers that met our inclusion criteria for the narrative review. Within these 13 papers, we identified 22 relevant factors for their role in the relationship between overdose and people with a history of incarceration, 16 were risk factors and six were protective factors. Five of these were structural factors (three risk and two protective) and 17 were intermediary factors (13 risk and four protective). The expert panels identified 21 additional factors, 10 of which were structural (six risk and four protective) and 11 of which were intermediary (eight risk and three protective).Conclusion: This narrative review along with expert panels demonstrates a gap in the published literature regarding factors associated with overdose among people who were previously incarcerated. Additionally, this review highlights a substantial gap with regard to the types of factors that are typically identified. Incorporating voices of people with lived experience is crucial to our understanding of overdose in this at-risk population. [ABSTRACT FROM AUTHOR]

Abstract: Locating development efforts within the context of globalism and global drug capitalism, this article examines the significant health and social impact both legal and illegal drugs have on international development efforts. The paper takes on an issue that is generally overlooked in the development debate and is not much addressed in the current international development standard, the Millennium Development Goals, and yet is one that places serious constraints on the ability of underdeveloped nations to achieve improvement. The relationship between psychotropic or “mind/mood altering” drugs and sustainable development is rooted in the contribution that the legal and illegal drug trade makes to a set of barriers to development, including: (1) interpersonal crime and community violence; (2) the corruption of public servants and the disintegration of social institutions; (3) the emergence of new or enhanced health problems; (4) the lowering of worker productivity; (5) the ensnarement of youth in drug distribution and away from productive education or employment; (6) the skewing of economies to drug production and money laundering. The paper emphasizes the need for new approaches for diminishing the burden placed by drugs on development. [Copyright &y& Elsevier]

Abstract: This paper reports on a qualitative study of the attitudes and risk management strategies of a sample of problem drug users in relation to driving while under the influence of drugs. Interviews were conducted with 26 individuals (21 men and 5 women) all of whom had been addicted to heroin and had admitted to driving while under the influence of illegal drugs. The drug users reported four main strategies for managing the risks associated with drug driving: attempting to limit their drug intake to their tolerance level; delaying driving after taking a drug until they felt safe; stopping driving if they felt unsafe while behind the wheel; and avoiding driving altogether under the influence of certain drugs. However, the interviewees’ accounts of their drug driving behaviour suggest that these strategies are not only far from reliable, they may also act to encourage drug driving by creating a false sense of security. The reassurance they provide may also undermine any educational messages targeting drug driving. There was little in the problem users’ accounts to suggest that media campaigns or a more effective method of detection would have much influence upon their behaviour. The paper concludes that the most realistic approach to the problem may be to incorporate drug driving interventions within drug treatment programmes. [Copyright &y& Elsevier]

Abstract: This paper explores elements of the relationships that develop between people who use illicit drugs and people who provide services to them. It focuses on expectations people who use drugs and service providers have of health and social care relationships for harm reduction, as well as facilitators and barriers to effective and ineffective interactions, and to what governments might better do to help strengthen interactions. Prior to Canada''s inaugural national harm reduction conference, informal discussion groups were organized to source local views regarding policy reform for harm reduction. One component of these discussion groups focused upon improving health and social care relationships for harm reduction. Community-based organizations providing services for harm minimisation were consulted to help develop themes and questions. Discussion groups conducted in French or English were held in 10 cities across Canada. Groups were audio-recorded, transcribed and thematically analysed. Disjuncture between understandings of the nature of health and social care relationships for harm reduction were found. Interpersonal and structural factors functioned both for and against the development of effective interactions. Differences in expectation sets held by illicit drug users and service providers may reflect the fluid experience of boundaries as a population on society''s margins moves between harm-causing and harm-reducing behaviours and identities. The research described in this paper targeted those most directly involved in receiving, developing and delivering harm reduction programmes across a very diverse nation. It did so by including representatives of those most directly involved in utilizing and providing services within the research process itself. By incorporating a process that was community-based, user-driven, and which strived to be non-judgmental, the research was able to explore suggestions for improving health and social care relationships for harm reduction proffered by professionals actively providing services, as well as a variety of users, including some isolated or structurally excluded from service access by geography, illiteracy and/or street-involvement. [Copyright &y& Elsevier]

Abstract: Over the past decade, Northern Ireland has witnessed the cessation of conflict and the emergence of the ongoing peace process. It is now dealing with new patterns of crime and with social problems either ignored or suppressed during the years of the so-called ‘Troubles’. A key example is heroin and injecting drug use. Systematic beating, exiling and torture by paramilitaries remain pervasive in many communities. Drawing on data from a qualitative study examining the emergence of the heroin scene in Ballymena, this paper presents findings that illustrate the impact of paramilitary violence on a heroin-using community. The paper describes, both from the perspective of the heroin users and the professionals seeking to help them, the violence and intimidation perpetrated by the paramilitants. The impact this rough justice has on their day to day lives is explored, as well as the difficulties it presents in influencing their decisions to utilise services such as harm reduction initiatives. The paper provides context by summarising available evidence on the extent of heroin use in Northern Ireland and presenting a brief account of current Northern Ireland drug policy. The historical relationship between paramilitary groups and communities is also briefly outlined. By way of conclusion, the paper discusses the relationship between wider societal transformation in Northern Ireland and drug-use patterns and outlines how heroin users might be assisted in dealing with the compounded nature of the challenges facing them as a result of the paramilitary threat. [Copyright &y& Elsevier]

Abstract: This paper examines the experiences of a sample of 43 pre-teenage drug users. The main reasons which they gave for using drugs were enjoyment and boredom. These are consistent with the reasons for using drugs reported in studies of older youths. While the children set firm boundaries regarding the drugs which they would and would not use, several aspects of their experiences give cause for concern. These include the ease with which they were able to obtain illegal drugs, their lack of knowledge of the risks involved with their drug-taking, the tendency of some to combine the consumption of drugs and alcohol, and the secluded or remote nature of the locations in which the drugs were used. The paper concludes by emphasising the need for interventions which address the issue of harm reduction for this population and which provide a range of alternative activities as a way of diverting young people from drugs. [Copyright &y& Elsevier]

Abstract: This paper considers the use of qualitative research in the drugs field. Proponents have traditionally claimed that by capturing participants’ lived experience through language, qualitative approaches are either the ‘antidote’ or the necessary complement to quantitative methods. The present paper troubles this over-simplistic dichotomy between quantitative and qualitative: both approaches often share the same ontological assumptions, rely on the same representational logic and are, in the context of ‘applied’ research, subject to a ‘will to truth’ born of a specific relation to policy. Poststructuralist ideas about the production of knowledge and the relationship between discourse and power are presented. Drugs research as both praxis and knowledge base may be seen as part of the machinery of advanced liberal government, which seeks to govern at a distance through the inscription of subjectivity. The drug user is produced and re-produced as a subject within research, always already positioned in relation to certain ‘truths’. We need to conceive of qualitative research and what our participants tell us differently, such that the constructive and constructed nature of knowledge and talk becomes the focus of inquiry. Discourse analysis - with its focus on construction and function within discourse - is presented as compatible with poststructuralist ideas. To illustrate the use of this approach, three interview accounts of how participants first came to use heroin are analysed. The discourses and subject positions underpinning the ‘peer pressure’, the ‘response to distress’ and the ‘risk appraisal’ account are described, and we consider how these accounts might function as ‘harm warrants’ for intervention. Criticisms of a poststructuralist approach and its implications for qualitative research within the broader field of drugs research and policy are addressed. [Copyright &y& Elsevier]

Abstract: The purpose of this paper is ‘to revision’ our approach to women''s use of drugs – which means to let go of how we have seen in order to construct new perceptions. Women use a variety of substances for a range of reasons, including pleasure. Yet, women who experience problems are left feeling stigmatised, marginalised and demoralised. The paper includes three inter-related discussions. First, two co-existing approaches to drug use, the classical and the postmodern, are explained. Second, after demonstrating how the postmodern approach is more valuable for the development of a gender-sensitive perspective, I will, with special reference to drug use, explain the complexities of two contemporary concepts, gender and embodiment. Here, I attempt to generate a deeper appreciation of these concepts in the postmodern approach. Third, I ask, ‘How can we develop a gender-sensitive, harm reduction approach’? The contention is that while harm reduction philosophies are admirable, these need to be gender-sensitive in order to be effective. A multi-levelled, ‘gender-sensitive’ view of harm reduction is put forward, as harm reduction is examined at the subjective, treatment, relationship, occupational and leisure levels. [Copyright &y& Elsevier]

Descriptions of the ‘socially excluded underclass’ have listed illicit drug use amongst the plethora of social pathologies said to typify their behaviour. Few studies, however, have explored in detail the impact of drug use on the transitions of ‘socially excluded’ youth. This paper reports research undertaken between 1999 and 2001 in a severely ‘excluded’ locale in Northeast England, which had this as an aim. Qualitative interviews with 88 young people, and with professional ‘stake-holders’ who worked with them, are used to interrogate some current debates within the drugs research literature. Firstly, a three-fold typology of the drug-using behaviour of the sample is used to critique simplistic notions of ‘normalisation’. Complete drug abstinence (coupled with wholly anti-drug views) co-existed alongside apparently widespread ‘recreational’ and ‘problematic’ drug use. At best, our evidence would support a theory of differentiated normalisation. Secondly, a broad concept of transition, that explores youth experiences holistically and that situates the shifting ‘choices’ of individual young people in the context of the legitimate and illegal opportunity structures that prevail locally is used to investigate the emergence of careers of ‘problematic’ drug use. Our evidence supports the conclusions of Parker and colleagues [New Heroin Outbreaks Amongst Young People in England and Wales (1998a)] that normative, cultural barriers between ‘recreational’ and ‘problematic’ drug use may be being eroded and that increasing proportions of ‘socially excluded’ youth are ‘crossing the Rubicon’ in drug careers that extend to heroin use. The paper concludes by emphasising the value of research that seeks to situate the biographical analysis of drug careers in context (particularly of the opportunities provided by local economies and changing drug markets) and of drugs strategies that seek to tackle the social and economic conditions that give ‘poverty drugs’ their appeal. [Copyright &y& Elsevier]

Background: This paper evaluates the impact of the AU$83 million introduction of 24-h public transport (PT) in Melbourne, Australia on Friday and Saturday nights on a sample of nightlife venues and venue patrons. This sample was selected because a primary reason for the introduction of 24 h PT was to provide a safe means of travel home for nightlife attendees.Methods: Covert venue observations (pre-post) and a convenience sample of nightlife patron interviews (post-only) were conducted to measure the impact of 24-h PT on venues and venue patrons. Specifically, the impact of 24-h PT on the proportion of people observed within venues (as rated on a 0-100% scale of venue capacity), patrons in venues showing any sign of intoxication, those who were observed to be too intoxicated to remain in the venue, patron drinking or drug taking behavior, train use, and the time and money spent in the night time economy were assessed.Results: After 24-h PT was introduced there were no significant differences overall in the proportion of people observed within venues, or significant associations with the proportion of patrons showing any sign of intoxication or proportions who were observed to be too intoxicated to remain in the venue. However, when accounting for seasonality (matching-months), observed patron intoxication increased significantly after the introduction of 24-h PT. The majority of nightlife patrons did not report a change in their pre-drinking or drug taking behavior after 24-public transport, but 44% indicated spending more time in the night time economy, 27% reported spending more money, and 56% reported increasing their train use.Conclusion: Patron reports suggest that 24-h public transport has increased the amount of time people spend in nightlife settings without obviously impacting on drinking behavior. However, supplying 24-h public transport has resulted in greater self-reported use of public transport. [ABSTRACT FROM AUTHOR]

Much research concerning drug use in the context of sexual activity among gay and bisexual men derives from public health scholarship. In this paper, we critically examine how the relationship between methamphetamine use and sexual risk practice is treated and understood in this body of research. While public health has made important contributions to establishing the link between methamphetamine use and sexual risk-taking, the precise nature of the relationship is not well defined. This creates space for ungrounded assumptions about methamphetamine use to take hold. We outline what appear to be two dominant interpretations of the methamphetamine/sexual practice relationship: the first proposes that methamphetamine has specific pharmacological properties which lead to sexual disinhibition, risky behaviour and poor health outcomes; the second proposes that methamphetamine attracts men who are already inclined toward highly sexualised interactions and risky practice, and that such men are likely to engage in these practices with or without drugs. We suggest that both interpretations are problematic in that they individualise and cast drug and sex practices as inherently risky and biopsychologically determined. We outline a more historically, socially and politically engaged way to understand methamphetamine use in the context of sexual activity by drawing on the concept of sex-based sociality and the ways in which gay and bisexual men may use methamphetamine and sex as social resources around which to build identities, establish relationships, participate in gay communities, and maximise pleasure while protecting themselves and others from harm. [ABSTRACT FROM AUTHOR]

Understanding the effects of COVID-19 mitigation for persons in group living environments is of critical importance to limiting the spread of the virus. In the U.S., residential recovery homes for persons with alcohol and drug disorders are good examples of high-risk environments where virus mitigation procedures are essential. The National Alliance for Recovery Residences (NARR) has taken recommendations developed by the Center for Disease Control (CDC) and applied them to recovery home settings. This paper describes how COVID-19 mitigation efforts in recovery homes may be influenced by two factors. First, while some houses are licensed by states with rigorous health and safety standards, others are not licensed and are subject to less oversight. These homes may be more inconsistent in adhering to mitigation standards. Second, to varying degrees, recovery homes use a social model approach to recovery that contrasts with mitigation procedures such as social distancing and stay-at-home orders. This paper provides examples of ways recovery homes have been forced to adjust to the competing demands of mitigation efforts and social model recovery. The paper also identifies multiple questions that could be addressed by provider-researcher coalitions to inform how social model recovery can navigate forward during the era of COVID-19. As we move forward during the era of COVID-19, providers are encouraged to remember that recovery homes have a history of resilience facing adversity and in fact have their origins in grassroots responses to the challenges of their times. [ABSTRACT FROM AUTHOR]

Background: Gay and bisexual men (GBM) use illicit drugs at higher rates than most other population groups and their use has been associated with sexual risk behavior. The measure of sexual sensation-seeking has been a useful tool for understanding sexual risk behavior in this population, but there is no equivalent measure for sensation-seeking in relation to drug-using behaviors.Objective: This paper explores baseline associations with illicit drug use in an online prospective observational study of licit and illicit drug use among GBM. We describe the development of a measure of drug-use sensation-seeking, and its association with illicit drug use.Methods: Australian GBM were invited to enroll online through social networking and gay community sites. Between September 2014 and July 2015, a total of 2251 GBM completed the questionnaire and 1900 men provided useable baseline data on items designed to measure drug use sensation-seeking.Results: Mean age was 32.8 years (SD 12.7). Half (50.7%) had used illicit drugs within the previous six months. Among these 963 recent users, 27.3% had used illicit drugs weekly or more often. Responses to items to measure drug use sensation-seeking formed a reliable scale (α=0.944). Within the total sample, any illicit drug use within the previous six months was associated with a higher score on the measure of drug use sensation-seeking (aOR=1.18; 95%CI=1.16-1.20). When we restricted our analyses to men who reported recent illicit drug use, it was also associated with using those drugs at least weekly in the previous six months (aOR=1.09; 95%CI=1.07-1.11).Conclusion: We developed a reliable measure of drug use sensation-seeking for this sample of GBM. Our measure predicted any use of illicit drugs within the total sample, and when restricted to men who reported illicit drug use, it also predicted more frequent use of those drugs. [ABSTRACT FROM AUTHOR]

Background: In an effort to mitigate Kentucky's prescription drug misuse, legislative intervention efforts were introduced in 2012 and 2013 to better regulate pain clinics, prescribed use of opioid analgesics, and to expand the monitoring of opioid prescriptions. The focus of this paper is primarily on opioid analgesics and heroin and the relationship of use/misuse patterns of these drugs to state drug policy initiatives.Methods: A secondary data analysis of drug treatment clients (N=52,360) was conducted to project illicit drug use trends in Kentucky. This study describes temporal and geographic trends of self-reported illicit drug use among individuals in state-funded treatment in Kentucky between fiscal year 2010 and fiscal year 2013.Results: Significant reductions in the prevalence of illicit opioid use, declined from fiscal year 2010 to fiscal year 2013 (p<.01, CI=-.298 to -.215). However, heroin use rates significantly increased over the years studied, suggesting there may be a transition from prescription opioids to heroin (p<.01, CI=.143 to .178). The analysis suggests these trends may continue.Conclusions: Findings suggest Kentucky's legislative efforts were effective in reducing illicit prescription opioid use, but heroin use has increased. One possible explanation for this relationship is that as prescription opioids became more difficult to obtain, users turned to heroin as a substitute. The finding of rising heroin use suggests a need for further policy initiatives to reduce heroin use, but the potential effectiveness of this policy remains unclear. Understanding trends may help to guide future policy efforts and pain management treatment strategies to where they might have their greatest impact. [ABSTRACT FROM AUTHOR]

Background: Cryptomarkets are digital platforms that use anonymising software (e.g. Tor) and cryptocurrencies (e.g. Bitcoin) to facilitate peer-to-peer (P2P) trade of goods and services. Their emergence has facilitated access to a wide range of high-quality psychoactive substances, according to surveys of users. In this paper, we ask the question 'How does changing access to drugs through cryptomarkets affect the drug use and harm trajectories of their users?'Methods: We conducted a digital ethnography spanning 2012-2014, a period that included the seizure of the original Silk Road marketplace and forum by law enforcement. Using encrypted online chat, we interviewed 17 people who reported using Silk Road to purchase illicit drugs. The interviews were in-depth and unstructured, and also involved the use of life history timelines to trace trajectories. Transcripts were analysed thematically using NVivo.Results: For some, Silk Road facilitated initiation into drug use or a return to drug use after cessation. Typically, participants reported experiencing a glut of drug consumption in their first months using Silk Road, described by one participant as akin to 'kids in a candy store'. There was evidence that very high availability reduced the need for drug hoarding which helped some respondents to moderate use and feel more in control of purchases made online. Cryptomarket access also appeared to affect solitary and social drug users differently. Most participants described using other cryptomarkets after the closure of Silk Road, albeit with less confidence.Conclusion: In the context of high levels of drug access, supply and diversity occurring within a community regulated environment online, the impacts of cryptomarkets upon drug use trajectories are complex, often posing new challenges for self-control, yet not always leading to harmful outcomes. A major policy challenge is how to provide support for harm reduction in these highly volatile settings. [ABSTRACT FROM AUTHOR]

Background: Cryptomarkets are digital platforms that use anonymising software (e.g. Tor) and cryptocurrencies (e.g. Bitcoin) to facilitate trade of goods and services, most notably illicit drugs. Cryptomarkets may reduce systemic violence compared with in-person drug trading because no face-to-face contact is required and disputes can be resolved through a neutral third party. In this paper, we describe the purchasing behaviour of cryptomarket users and then compare the self-reported experiences of threats, violence and other drug-market concerns when obtaining drugs from cryptomarkets with obtaining drugs through friends, known dealers and strangers.Methods: The Global Drug Survey was completed in late 2014 by a self-selected sample who reported accessing drugs through cryptomarkets in the last 12 months (N=3794).Results: Their median age was 22 years and 82% were male. The drug types most commonly obtained through cryptomarkets were MDMA/Ecstasy (55%), cannabis (43%) and LSD (35%). Cryptomarket users reported using a median of 2 sources in addition to cryptomarkets to access drugs, the most common being in-person friendships (74%), in-person dealers (57%) and open markets/strangers (26%). When asked to nominate the main source they would use if cryptomarkets were unavailable, 49% nominated friends, 34% known dealers and 4% strangers. 'Threats to personal safety' (3%) and 'experiencing physical violence' (1%) were less often reported when using cryptomarkets compared with sourcing through friends (14%; 6%), known dealers (24%; 10%) or strangers (35%; 15%). Concerns about drug impurities and law enforcement were reported more often when using the alternative source, while loss of money, waiting too long and not receiving the product were more often reported when using cryptomarkets.Conclusion: Cryptomarkets are associated with substantially less threats and violence than alternative market types used by cryptomarket customers, even though a large majority of these alternatives were closed networks where violence should be relatively less common. [ABSTRACT FROM AUTHOR]

Inhalant use refers to the use of substances such as gases, glues, and aerosols in order to achieve intoxication, while inhalant use disorder (IUD) encompasses both DSM-IV-TR criteria for inhalant abuse and dependence. Inhalant use among adolescents is an international public health concern considering the severe medical and cognitive consequences and biopsychosocial correlates. In this paper, we summarize the current state of the literature on inhalant use among adolescents focusing on social context, prevention, assessment, and treatment strategies. Psychoeducation, skills training, and environmental supply reduction are helpful strategies for preventing adolescent inhalant use, while parent and adolescent self-report as well as physician report of medical signs and symptoms can aid in assessment and diagnosis. Although research has only begun to explore the treatment of inhalant use, preliminary findings suggest that a multimodal approach involving individual counselling (i.e., CBT brief intervention), family therapy, and activity and engagement programs is the first-line treatment, with residential treatment programs indicated for more severe presentations. The limited nature of treatments developed specifically for inhalant use combined with high prevalence rates and potential for significant impairment within the adolescent population indicate the need for further research. Research should focus on understanding the social context of use, establishing the efficacy of current adolescent substance use treatments adapted for inhalant use, and exploring long-term outcomes. [ABSTRACT FROM AUTHOR]

Between 2009 and the first quarter of 2014, only one case of HIV (contracted outside Hungary) was detected among PWIDs in Hungary. However, more recent evidence suggests increased sharing of injecting paraphernalia among PWIDs. This is linked to the emergence of new designer drugs that require frequent injection, alongside funding cuts to the Hungarian needle exchange program (NEP) which has reduced access to sterile injecting equipment. During the past five years in Hungary, drug use has become increasingly discussed in moral as opposed to public health terms, and drug consumption has been re-criminalized. The largest NEP in Hungary was closed because of political pressure and government funding for regular HCV/HIV testing/counselling and seroprevalence studies among PWIDs has been stopped. This paper describes the detection of two new cases of HIV infection in PWIDs attending two NEPs in Budapest in May 2014. These new cases may indicate an unfolding HIV outbreak among PWIDs-similar to those reported in Greece and Romania. Yet the question remains: If no further HIV cases are detected, is this because there are no new cases or because there are no testing facilities for PWID? [ABSTRACT FROM AUTHOR]

Background Since their inception, harm reduction services, including needle exchange programs, have aimed to improve and update knowledge about illicit drug consumption and injection practices in order to assess and regularly revise the effectiveness of preventive strategies. Methods In this paper we describe the development of a scientific approach to obtaining this type of information through analysis of the residual content of used syringes. This was done using a validated liquid chromatography method with mass spectrometry detection to identify different molecules. Used syringes were collected from automatic injection kit dispensers at 17 sites in Paris and the surrounding suburbs each month for one year. Results In total, 3489 syringes were collected. No compounds were detected in 245 syringes. Heroin was the most commonly observed compound (42%), followed by cocaine (41%), buprenorphine (29%) and 4-methylethylcathinone (23%). These analyses also showed the increased appearance of 4-methylethylcathinone between the summer and winter of 2012. Conclusions Despite the bias involved in this approach, the method can provide rapid data on patterns of drug consumption for specific time periods and for well-defined locations. This kind of analysis enables the detection of new substances being injected and thus enables harm reduction services to revise and adapt prevention strategies. [ABSTRACT FROM AUTHOR]

Background This paper explores whether at different stages of the developmental cycle of adolescence, drug use and offending are associated with a similar set of risk factors relating to: socio-structural position, informal social control, deviant peer group contexts, and deviant lifestyle behaviours. Methods Multivariate regression was used to analyse data from the Edinburgh Study of Youth Transitions and Crime (ESYTC) self-report questionnaire. Results Early in the teenage years drug use was associated with a similar set of factors to offending. These include weak bonds to parents and teachers, and deviant lifestyle behaviours. However, later in the teenage years there were differences, e.g. drug use was associated with higher socio-economic status and importance of school, and a number of factors which were associated with offending were not associated with drug use, e.g. parent–child conflict, gang membership and hanging around. Conclusion Results show that the factors included here are more appropriate to understanding offending than drug use. Different risk factors are associated with drug use and offending in the older, but not younger teens. It is argued that later in the teenage years drug use should be understood and addressed differently to offending. This is particularly important given the tendency for the ‘drugs problem’ to increasingly be dealt with as a ‘crime problem’ (Duke, 2006). [ABSTRACT FROM AUTHOR]

Numerous myths have surrounded the drug trade in Central Asia over the past two decades. Analysts writing on the issue and the law enforcement structures of the respective countries often have no complete and accurate information about the scale of the trade, the different groups involved and the role of drugs-related money in politics. Generally there are two dominating views: the first considers Kyrgyzstan to be a virtual narco-state and overstates the involvement of politicians and police officials; the alternative underestimates the role of state representatives, describes the smuggling as more decentralised and chaotic and emphasises the role of organised crime gangs and radical Islamic organisations. Based on the interviews in the field conducted in January–March 2012, this paper analyses these alternative perspectives and the empirical evidence supporting these views. It highlights methodological problems relating to research on similar issues, elucidates networks of smuggling and their links with politics and reflects on complexities in addressing these challenges. [ABSTRACT FROM AUTHOR]

Abstract: Background: Representations of activity spaces, defined as the local areas within which people move or travel in the course of their daily activities, are unexplored among injection drug users (IDUs). The purpose of this paper is to use an activity space framework to study place and drug user health. Methods: Data for this analysis is from an epidemiological study of street-recruited IDUs in San Francisco (N =1084). Study participants reported geographic intersections of where they most often slept at night, hung out during the day, and used drugs during a 6 month time period. We used GIS software to construct and map activity space routes of street-based network paths between these intersections. We further identified if syringe exchange program (SEP) locations intersected with, participant activity space routes. We used logistic regression to estimate associations between activity space variables and HIV serostatus, syringe sharing, and non-fatal overdose, after adjusting for individual and Census tract covariates. Results: Mean activity space distance for all participants was 1.5miles. 9.6% of participants had a SEP located along their activity space. An increase in activity space distance was associated with a decrease in odds of being HIV positive. An increase in residential transience, or the number of different locations slept in by participants in a 6 month time period, was associated with higher odds of syringe sharing. Activity space distance was not independently associated with overdose or syringe sharing. Discussion: Research that locates individuals in places of perceived importance is needed to inform placement and accessibility of HIV and overdose prevention programs. More attention needs to be given to the logistics of collecting sensitive geospatial data from vulnerable populations as well as how to maximize the use of GIS software for visualizing and understanding how IDUs interact with their environment. [Copyright &y& Elsevier]

Abstract: Background: In the past decade, OxyContin diversion and misusehave been firmly established in Ontarian public discourse as serious problems requiring major intervention.This article contextualizes and theorizesthe processes through which the marketing of the prescription opioid and its subsequent problematization occurred. Theanalysis refuses the impossible choice between the ‘deserving pain patient’ and the ‘undeserving addict,’ between the war on pain and the war on drugs, and between a notion of OxyContin as either miracle panacea or destructive poison. Rather than falling in step with these binaries, OxyContinis theorized across them, or multiply, with the aim of moving beyond established moral and theoretical registers for exploring embodied consumption. Methods: This discursive study is based on a broad range of texts collected between 2009-2013: Hansard reports from the Legislative Assembly of Ontario; newspaper, magazine, and internet coverage of OxyContin; and policy documents, research reports, and position papers and news releases produced by government agencies, advocacy organizations, professional bodies, think tanks, tribal councils, and law enforcement agencies. Results: Pharmaceutical industry and state actors have attempted to dualistically parse disparate materializations of OxyContin, a tactic that intensified as media pressure helped produce the notion of a public health crisis and, implicitly, a crisis of welfare dependence. By focusing on the (impossible) task of stratifying proper from improper use, the drug's advocatessought to secure the integrity of opioid painkillers and to protect their materialization as vehicles for maintaining a body that is normal, stable, and in control, as opposed to a body of excess that threatens to expose the consumerist logic of contemporary medicine. Conclusion: Attempts to contain the multiplicity of OxyContin result in the further entrenchment of privatized and individualized approaches to pain and painkilling and serve to undermine rather than secure public health and safety. [Copyright &y& Elsevier]

Abstract: Background: National drug policies are often regarded as inconsequential, rhetorical documents, however this belies the subtlety with which such documents generate discourse and produce (and re-produce) policy issues over time. Critically analysing the ways in which policy language constructs and represents policy problems is important as these discursive constructions have implications for how we are invoked to think about (and justify) possible policy responses. Methods: Taking the case of Australia's National Drug Strategies, this paper used an approach informed by critical discourse analysis theory and aspects of Bacchi's (2009) ‘What's the Problem Represented to be’ framework to critically explore how drug policy problems are constructed and represented through the language of drug policy documents over time. Results: Our analysis demonstrated shifts in the ways that drugs have been ‘problematised’ in Australia's National Drug Strategies. Central to these evolving constructions was the increasing reliance on evidence as a way of ‘knowing the problem’. Furthermore, by analysing the stated aims of the policies, this case demonstrates how constructing drug problems in terms of ‘drug-related harms’ or alternately ‘drug use’ can affect what is perceived to be an appropriate set of policy responses. The gradual shift to constructing drug use as the policy problem altered the concept of harm minimisation and influenced the development of the concepts of demand- and harm-reduction over time. Conclusions: These findings have implications for how we understand policy development, and challenge us to critically consider how the construction and representation of drug problems serve to justify what are perceived to be acceptable responses to policy problems. These constructions are produced subtly, and become embedded slowly over decades of policy development. National drug policies should not merely be taken at face value; appreciation of the construction and representation of drug problems, and of how these ‘problematisations’ are produced, is essential. [Copyright &y& Elsevier]

Abstract: Background: The drug problem has been a highly ideologized topic in the political debate in Sweden ever since the mid-1960s. The aim of the article is to investigate dominant conceptions of drugs, drug use, society and the individual in the political discussions on drug use in Sweden during the years 1965–1981. Methods: The empirical basis for the textual analysis consists of 146 parliamentary bills and 135 parliamentary protocols. Results: The unwanted drug appear as a sensitive litmus paper, an indication that something had gone wrong in society and as a suggestion of how the good society could be accomplished. The drug problem was connected to ideological core values such as class struggle, Christianity or criticism of urbanism and modernity. Conclusion: The analysis suggests that the drug problem was used as political ammunition, to pick holes in political opponents and to highlight one's own ideological stance. The hegemonic conversational order, the consensual spirit and the agreement that this was the most serious problem, did not hamper these political moves. Rather, the cross-party conception of the problem's severity and accelerating deterioration contributed to a common ground for political arguments and ideological visions. It also meant that the political discussions moved away from the more obvious drug policy issues. [Copyright &y& Elsevier]

Abstract: Background: Data on the cocaine market appear inconsistent, as they tend to show declining prices vis-a-vis steady or increasing demand and a declining supply. This paper proposes an explanation for this trend by providing evidence of an under-estimation of the supply of cocaine. Methods: We propose a conservative estimate of cocaine production in Colombia for 2008, using data based on all reported seizures from 328 laboratories made by the counteracting organisations operating within the Colombian territory. Results: Our conservative estimate of 935 tons from the seized laboratories is at least twice the estimate declared in official statistics of 295–450 tons. We are careful to keep all variables to their minimum boundary values. Our methodology could prove to be a useful tool, especially if used in parallel with the standard tools. Moreover, its characteristics (affordability, ease of use and potential for worldwide adoption) make it a powerful instrument to counteract cocaine production. [Copyright &y& Elsevier]

Abstract: Background: The intersection of drug use, sexual pleasure and sexual risk behaviour is rarely explored when it comes to poor women who use drugs. This paper explores the relationship between sexual behaviour and methamphetamine use in a community-based sample of women, exploring not only risk, but also desire, pleasure and the challenges of overcoming trauma. Methods: Quantitative data were collected using standard epidemiological methods (N =322) for community-based studies. In addition, using purposive sampling, qualitative data were collected among a subset of participants (n =34). Data were integrated for mixed methods analysis. Results: While many participants reported sexual risk behaviour (unprotected vaginal or anal intercourse) in the quantitative survey, sexual risk was not the central narrative pertaining to sexual behaviour and methamphetamine use in qualitative findings. Rather, desire, pleasure and disinhibition arose as central themes. Women described feelings of power and agency related to sexual behaviour while high on methamphetamine. Findings were mixed on whether methamphetamine use increased sexual risk behaviour. Conclusion: The use of mixed methods afforded important insights into the sexual behaviour and priorities of methamphetamine-using women. Efforts to reduce sexual risk should recognize and valorize the positive aspects of methamphetamine use for some women, building on positive feelings of power and agency as an approach to harm minimization. [Copyright &y& Elsevier]

Abstract: Mixed methods research is increasingly being promoted in the health sciences as a way to gain more comprehensive understandings of how social processes and individual behaviours shape human health. Mixed methods research most commonly combines qualitative and quantitative data collection and analysis strategies. Often, integrating findings from multiple methods is assumed to confirm or validate the findings from one method with the findings from another, seeking convergence or agreement between methods. Cases in which findings from different methods are congruous are generally thought of as ideal, whilst conflicting findings may, at first glance, appear problematic. However, the latter situation provides the opportunity for a process through which apparently discordant results are reconciled, potentially leading to new emergent understandings of complex social phenomena. This paper presents three case studies drawn from the authors’ research on HIV risk amongst injection drug users in which mixed methods studies yielded apparently discrepant results. We use these case studies (involving injection drug users [IDUs] using a Needle/Syringe Exchange Program in Los Angeles, CA, USA; IDUs seeking to purchase needle/syringes at pharmacies in Tijuana, Mexico; and young street-based IDUs in San Francisco, CA, USA) to identify challenges associated with integrating findings from mixed methods projects, summarize lessons learned, and make recommendations for how to more successfully anticipate and manage the integration of findings. Despite the challenges inherent in reconciling apparently conflicting findings from qualitative and quantitative approaches, in keeping with others who have argued in favour of integrating mixed methods findings, we contend that such an undertaking has the potential to yield benefits that emerge only through the struggle to reconcile discrepant results and may provide a sum that is greater than the individual qualitative and quantitative parts. [Copyright &y& Elsevier]

Abstract: Background: By recounting the making of the office that contributed to the implementation of the harm reduction policy in Taiwan, this paper aims to answer two questions: Who and what assembled to make this policy possible? Which conceptual tool works best to understand what this policy-making was all about? Methods: The research was designed as a multi-sited qualitative study whose materials were collected through archival research, in-depth interviews, and direct field observation. The data were analysed on the basis of the constructivist version of grounded theory. Result: Formulating the office as an assemblage with heterogeneous components and shifting territories, the present work endeavours to show how it was constituted by way of guanxi, or webs of social relationship that blur the boundary between the private and the public, the governmental and the social. Conclusion: This “studying up” approach is hoped to elicit more research on the office in which harm reduction policies are made into the backdrop of drug users on the street. [Copyright &y& Elsevier]

Abstract: Background: There has been limited research on how recessions (or more generally, the strength of the economy) affect drug use and the related outcome of drug selling. This is especially important, given the current economic crisis. This paper aims to use a conceptual framework, previous research, and new research to predict how the current economic crisis may be affecting youth drug selling and drug use. Methods: A conceptual framework to understand how a recession could affect youth drug selling and drug use is presented, along with a review of the literature on empirical investigations on how the strength of the economy affects these behaviours among teenagers. In addition, new analyses for young adults are presented. Results: The conceptual framework postulates that a recession would have direct positive effects on the prevalence of youth drug selling but ambiguous direct effects on youth drug use. The conceptual framework also postulates that drug selling and drug use are inter-connected at the individual level and the aggregate level. Thus, any effect of a recession on one would likely affect the other in the same direction. The limited empirical evidence indicates that both drug selling and drug use among youth are higher when the economy is weaker. Conclusions: The current economic crisis will likely increase both youth drug selling and drug use relative to what they would have otherwise been. [Copyright &y& Elsevier]

Abstract: Background: Research on harm reduction has typically focused on broad-based or organisational strategies such as needle exchange and opiate substitute programmes. Less attention has been paid to the self-directed harm reduction practices of substance users themselves. Few studies have focused on sexual minority populations such as gay and bisexual men and fewer still on the marginalised groups that constitute these populations. This paper identifies self-directed harm reduction strategies among substance using ethno-racially diverse gay and bisexual men. Methods: This article presents findings from the Party Drugs Study in Toronto''s gay dance club scene, a community-based qualitative study in Toronto, Canada. We present a thematic analysis of interviews with 43 gay and bisexual men from diverse ethno-racial backgrounds about their substance use in the gay dance club scene. Findings: We identify five self-directed harm reduction strategies: rationing, controlling or avoiding mixing, controlling quality, maintaining a healthy lifestyle, and following guidelines during substance use. Conclusions: We discuss our findings in relation to prior research and to critical theory. We suggest that drug users’ awareness of possible harm, and their personal investment in harm reduction, constitute a viable platform from which community-based and public health organisations may promote and strengthen harm reduction among gay and bisexual men from ethno-racially diverse backgrounds. [Copyright &y& Elsevier]

Abstract: Background: All public services in the UK are expected to produce evidence-based policies. This principle was argued particularly strongly in relation to policies for tackling drug misuse. However, concerns have been expressed that commitment to this principle is not matched by the reality of policy making. In this paper, we examine the extent to which the UK drug strategy can be regarded as evidence-based. Methods: Focusing on case studies of policies implemented as part of the four main strands of the strategy, evidence reported by the government as forming the basis of the policy is examined as are findings of the published sources of evidence cited. Results: In most cases, the evidence was of a good quality in that it reflected the general standard of research in the area. The main problem lies in the interpretation and reporting of research results. Two of four case studies were reported as biased in terms of research study selection and in two there was some evidence that the reporting was not wholly representative of the conclusions drawn. Conclusion: There are many factors that influence the generation of policy and it is unrealistic, and perhaps disingenuous, to suggest in relation to drugs policy, that evidence is its primary focus. [ABSTRACT FROM AUTHOR]

Abstract: Over the past five years, the release of cohort studies assessing the link between cannabis and psychosis has increased attention on this relationship. Existing reviews generally conclude that these cohort studies show cannabis has a causal relationship to psychosis, or at least that one cannot be excluded. Few studies have evaluated the relative strengths and limitations of these methodologically heterogeneous cohort studies, and how their relative merits and weaknesses might influence the way the link between cannabis use and psychosis is interpreted. This paper reviews the methodological strengths and limitations of major cohort studies which have looked at the link between cannabis and psychosis, and considers research findings against criteria for causal inference. Cohort studies that assessed the link between cannabis and psychosis were identified through literature searches using relevant search terms and MEDline, PsycINFO and EMBASE. Reference lists of reviews and key studies were hand searched. Only prospective studies of general population cohorts were included. Findings were synthesised narratively. A total of 10 key studies from seven general population cohorts were identified by the search. Limitations were evident in the measurement of psychosis, consideration of the short-term effects of cannabis intoxication, control of potential confounders and the measurement of drug use during the follow-up period. Pre-existing vulnerability to psychosis emerged as an important factor that influences the link between cannabis use and psychosis. Whilst the criteria for causal association between cannabis and psychosis are supported by the studies reviewed, the contentious issue of whether cannabis use can cause serious psychotic disorders that would not otherwise have occurred cannot be answered from the existing data. Further methodologically robust cohort research is proposed and the implications of how evidence informs policy in the case of uncertainty is discussed. [Copyright &y& Elsevier]

Abstract: Background: The adverse health effects of cannabis are a source of contention in debates about policies towards the drug. Methods: This paper provides a review of epidemiological evidence on the major adverse health effects of cannabis use and considers its implications for policy. Results: The evidence strongly suggests that cannabis can adversely affect some users, especially adolescents who initiate use early and young adults who become regular users. These adverse effects probably include increased risks of: motor vehicle crashes, the development of cannabis dependence, impaired respiratory function, cardiovascular disease, psychotic symptoms, and adverse outcomes of adolescent development, namely, poorer educational outcomes and an increased likelihood of using other illicit drugs. Conclusions: Politically, evidence of adverse health effects favours the status quo in developed countries like Australia where cannabis policy has been framed by the media as a choice between two views: (1) either cannabis use is largely harmless to most users and so we should legalize, or at the very least decriminalize its use; or (2) it harms some of its users so we should continue to prohibit its use. [Copyright &y& Elsevier]

Abstract: Background: In 2006, the British Columbia (BC) government passed amendments to its Safety Standards Act. These amendments permit the routine disclosure of electrical usage information from electrical producers to BC''s municipalities, ostensibly to identify and eradicate residential cannabis growing operations (grow ops). These amendments originated in a pilot project in Surrey, BC, known as the electrical and fire safety inspection initiative (EFSI), which drew together police, firefighters and others, to identify grow ops through the process of municipal electrical inspections. Methods: This paper draws on narrative analysis to critically explore how the report of the EFSI Surrey pilot project uses a series of linked claims to generate interpretative change in the definition of the problem of grow ops. This analysis also shows how claims about grow ops are constructed and gain their potency through links with other social problems, persons, and practices. Results: Though the report of the EFSI project is a prohibitionist text replete with stock characters and themes from the history of Canadian drug policy, the problem of residential cannabis cultivation is made actionable by establishing grow operators as “superdeviants” constructed both as dangerous outsiders and as risks to a host of public safety concerns. These claims are then linked to the notion of an overwhelmed criminal justice system that establishes a “crisis” that justifies extraordinary methods of social control outside the due process of the criminal justice system. Conclusions: Construction of all cannabis cultivators as “dangerous” disavows other possibilities and shores up neo-liberal practices of government that draw on multi-partner initiatives to implement extraordinary methods of social control not necessarily subject to public accountability. [Copyright &y& Elsevier]

Abstract: Background: China''s initial response to drug use and HIV was largely ineffective but has improved with recent government endorsement of harm reduction interventions. This paper examines the views of senior key informants inside China who articulated core needs and objectives for the development of a harm reduction advocacy strategy. Methods: Thirty-nine key informants (KI) were interviewed, representing 19 stakeholder bodies selected from the Chinese government public health sector, public security sector, international agencies such as WHO, UNODC and UNAIDS, and international non-government organisations. Results: The concept of harm reduction is widely understood and considered valid. Support for harm reduction is increasing, but KIs perceived an imbalance between the rapid expansion of methadone maintenance treatment programs over needle and syringe programs and other interventions. Challenges for harm reduction identified by KIs included: policy inconsistencies; lack of skilled resources, training programs and technical capacity; poor coverage of interventions; and gaps in the sharing of information. KIs suggested numerous ways to strengthen the capacity of the government and communities to reduce drug related harm. Discussion: Increased acceptance of harm reduction in China, particularly among public security, implies a new level of optimism towards addressing the HIV epidemic among drug users, and parallels an impressive expansion of harm reduction interventions. Nevertheless, scaling up a response to the ongoing dual epidemic of drug use and HIV remains an enormous challenge. With appropriate technical education and training, ongoing advocacy, and a cohesive, coordinated multi-sectoral effort, the capacity of the government and community to adopt, support and promote measures to reduce HIV and other drug related harm would be markedly strengthened. [Copyright &y& Elsevier]

Abstract: Background: The image of cocaine as a ‘party’ drug used by more affluent members of society has begun to change as the levels of use of the drug rise amongst school aged young people. Methods: Cocaine use patterns amongst young people aged 13–16 years who were participating in the Belfast Youth Development Study, a longitudinal study of adolescent drug use was explored. Data was collected through an annual datasweep in participating schools. This paper includes data collected in years 3, 4 and 5 of the study. Results: The results show higher levels of cocaine use amongst this age group than reported in much of the existing harm reduction literature. Lifetime use was 3.8% at age 13–14 years, rising to 7.5% at 15–16 years. The profile indicated that adolescent cocaine users were more likely to be female, live in disrupted families and experience social deprivation which is similar to existing adolescent drug use profiles. There was also some evidence of experimental cocaine use amongst the sample. Conclusions: These findings provide further evidence for the development of age appropriate school focused harm reduction initiatives and continued monitoring of contemporary trends of use of cocaine amongst school aged young people. [Copyright &y& Elsevier]

Abstract: Background: Preventing the onset of injecting drug use is an important public health objective yet there is little understanding of the process that leads to injection initiation. This paper draws extensively on narrative data to describe how injection initiation is influenced by social environment. We examine how watching other people inject can habitualise non-injectors to administering drugs with a needle and consider the process by which the stigma of injecting is replaced with curiosity. Method: In-depth interviews (n =54) were conducted as part of a 2-year longitudinal study examining the behaviours of new injecting drug users. Results: Among our sample, injection initiation was the result of a dynamic process during which administering drugs with a needle became acceptable or even appealing. Most often, this occurred as a result of spending time with current injectors in a social context and the majority of this study''s participants were given their first shot by a friend or sexual partner. Initiates could be tenacious in their efforts to acquire an injection trainer and findings suggest that once injecting had been introduced to a drug-using network, it was likely to spread throughout the group. Conclusion: Injection initiation should be viewed as a communicable process. New injectors are unlikely to have experienced the negative effects of injecting and may facilitate the initiation of their drug-using friends. Prevention messages should therefore aim to find innovative ways of targeting beginning injectors and present a realistic appraisal of the long-term consequences of injecting. Interventionists should also work with current injectors to develop strategies to refuse requests from non-injectors for their help to initiate. [Copyright &y& Elsevier]

Abstract: Background: In Australia, sterile needles are distributed to people who inject drugs through formal services for the purposes of limiting the transmission of blood borne viruses (BBV). Secondary exchange (SE) involves people acquiring needles from formal services and redistributing them to others. This paper describes the extent, patterns and contexts of SE in south east Sydney, Australia and examines whether SE is independently associated with BBV risk practices. Methods: Quantitative and qualitative data were collected through a cross-sectional study using surveys and in-depth interviews. Respondents were people using community-based pharmacies to obtain sterile needles and syringes. Results: Data were collected from 229 survey respondents, over half of whom (54%) reported SE in the previous month. Of these, 40% engaged in distribution only, 25% in receipt only and 36% in both. Respondents reported passing on 21.7% of their needles to others in the last month, most commonly to friends (51.6%) and partners (27.4%). Recipients of SE were four times more likely than non-secondary exchangers to report borrowing used syringes in the last month. Respondents reported supplying sterile equipment to others to prevent reuse and to reduce risks associated with unplanned drug use. Conclusion: SE is a common activity in south east Sydney but does not appear to be highly organised, usually taking place in small networks of friends and/or partners for altruistic reasons. Harm reduction programs could capitalise on the prevalence of SE to reach injecting drug users who do not use formal distribution services. [Copyright &y& Elsevier]

Abstract: Background: Ecstasy use has increasingly become popular among young adults, many of whom view it as a safe drug with no or limited negative social and health consequences. In this paper, we explore the perceptions of ecstasy users about its recreational use as well as regarding the normalisation of use. Methods: The study participants were recruited using targeted and theoretical sampling. To be eligible, they had to be between 18 and 25 years and have used ecstasy at least four times within the past 90 days. In-depth interviews were conducted with 112 individuals. Data analysis included the constant comparison method commonly used in modified grounded theory. Results: The study participants associated their recreational ecstasy use with control, shaping both the timing and setting of their use. In addition, they supported that easy access/availability and social accommodations of use contributed to their acceptance of ecstasy use as a normal part of life. Moreover, low risk perceptions of the social and health consequences of ecstasy used were identified as resulting in normalisation. Conclusion: The study findings reveal the importance of considering recreational ecstasy use from the perspective of the users themselves for prevention efforts and when providing social and health services, including intervention strategies. In addition, the potential normalisation of ecstasy use must be considered. [Copyright &y& Elsevier]