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Aims: We aimed to study a latent social structure behind the variables associated with teenagers' cannabis use at the individual level and, in a social context, formed by school class. Methods: The data used come from the European School Survey Project on Alcohol and Other Drugs (ESPAD), conducted in Finland in 2011 (N=3744, response rate 89.6%). Methods used were Latent Class Analysis (LCA) and Multilevel Logistic Regression. The differences observed between pupil groups were interpreted through the concepts of social norms (conventionality of behaviour) and cultural dispositions. Findings: Four different latent classes of pupils were found: the "Conventionalists", the "Alco-rebels", the "Sub-cultural conventionalist" and the "Subcultural rebels". Although "Sub-cultural conventionalists" were aware of the cannabis culture, only a small proportion of them had ever tried cannabis. The risk for cannabis use was pronounced in all pupil groups compared to "Conventionalists", the risk being the highest among "Sub-cultural rebels." There was statistically significant variation in the cannabis use between schools, when the individual-level variables were taken into account. Conclusions: The findings stress the cultural and normative heterogeneity of school children and the importance of the school environment. The cultural competence of "Sub-cultural conventionalists" could be utilized in the preventive work.

This article analyzes the riskiness attached to illicit drug use by means of a social representations framework. The implications of these social representations are further studied through their associations with views on drug policy: restrictive control and harm reduction measures. The data for the study is from a Finnish Drug Survey (N = 3229). Latent class analysis (LCA) and multinomial logistic regression analysis were used to analyze the data. Four representational profiles of perceived risk were identified: high-risk (70% of respondents), cannabis OK (15%), experimenting OK (10%), and low-risk (2%). All illicit drug use was considered as a moderate or high risk in the high-risk profile. Cannabis was considered less risky than other substances in the cannabis OK profile and experimenting was a less risky way of use in the experimenting OK profile. Most people in the low-risk profile considered the risks related to illicit drug use as nonexistent or minor. These representational profiles were also connected to opinions on drug policy: those who saw the most risks with use tended to support restrictive control measures, while those who considered illicit drug use to be less risky were more accepting toward harm reduction measures. [ABSTRACT FROM AUTHOR]

Background: We analysed illicit stimulant use in Finland by comparing three separate datasets collected at the same time. Methods: The data used were wastewater analysis (2014 and 2018), population-based drug surveys (2014 and 2018) and European Web Survey on Drugs (2018, Finnish data). Proportions, prevalence levels and trends of stimulant use as well as their consumption were measured. Factors associated with stimulant use were assessed for past-year stimulant or amphetamine use as an outcome measure in regression analyses. Results: Both population-based drug survey and wastewater data showed that stimulant use has increased in Finland between 2014 and 2018. Disadvantaged socio-demographic background and other substance use were associated with past-year stimulant use, with no geographical variation in Finland. The socio-demographics of those reporting amphetamine use differed between population-based drug survey and web survey. In the web survey, infrequent and occasional users of amphetamine were quite alike, whereas frequent users were more likely to be unemployed or use injection as the route of administration. Conclusion: Analysis of three different data revealed findings that would have been missed and conclusions that could not have been made by using only one dataset. Putting findings from different methods into dialogue raises new questions and opens new interpretations. This analysis emphasises the importance of the prevention of frequent use and associated harm, as well as the impact of versatile drug treatment and harm reduction services on it. [ABSTRACT FROM AUTHOR]

Background : Use of drug consumption rooms is a novel harm reduction approach to reach marginalised and isolated people who used drugs, under the high risk of overdose deaths and infectious diseases. The aim of this article was to evaluate the policy opportunities and barriers of the Helsinki City initiative for establishing the first drug consumption room (DCR) in Finland from the multiple streams framework. Method : A qualitative interview research method is used to evaluate the perspectives of stakeholders. By including 23 participants, we analysed the political, social and policy level advantages and disadvantages of the current initiative. Findings : Our results show that the cost of DCRs, the COVID-19 burdens on public resources, the requirement of legislative change, public unawareness, potential policy failure of DCRs, and its impacts on electoral votes constitute the main policy barriers. On the other hand, an increase in drug-related deaths, economic benefits of DCR for society, its effects on street safety and public order, being a local initiative, prospectus change in national drug strategy plans and motivation to catch up with EU standards were underlined as policy opportunities. Four issues, leadership, moral perspective, social change and generational differences, act as mediating factors, which are fluctuated according to public opinions and political environment. Conclusion : By applying the multiple streams framework, our results show that experts' DCR problematisation is still beyond the public and political interest, which needs additional effort around problem identification and prioritisation. Besides public unawareness, the COVID-19 situation seems to be postponing policy progress since the primary attention and available funds have already been dedicated to public health. Already having a local initiative and an upcoming drug strategy plan might be good formal leverage, but unexpected events might also trigger discussions. [ABSTRACT FROM AUTHOR]

Aims: Understanding the mortality of drug users using multiple substances is helpful in preventing the harmful effects of polydrug use. We examined overall and cause-specific mortality and differences in mortality based on social background among people suspected of driving under the influence and testing positive for multiple substances (DUIMS) compared with the general Finnish population. Methods: Register data from 785 DUIMS during 2003–2006 were studied, with a reference population (n = 25,381) drawn from the general Finnish population. The effect of DUIMS on all-cause and cause-specific mortality was estimated using a Poisson regression model. Results: DUIMS had an increased risk of death compared with the general population (MRR 5.3, 95% CI 4.2–6.6). The most common causes of death in DUIMS were poisonings (37.9%) and suicides (13.6%), whereas in the reference population these were cardiovascular diseases (30.8%) and cancer (26.6%). The cause-specific risk of death among DUIMS was higher in all observed causes of death, except for cancer. The effect of DUIMS on mortality was modified by age, employment status and marital status; DUIMS was associated with an elevated risk of death especially in younger age groups and in singles. Conclusions: DUIMS indicates higher mortality, and DUIMS' profiles in causes of death differ from the general population. Elevated risk for, for instance, suicidal, accidental and violent death among those using multiple substances highlights the need to also pay attention to causes of death other than poisoning/overdose. [ABSTRACT FROM AUTHOR]

The use of multiple psychoactive substances is a widespread phenomenon among people who use drugs. Yet the concept of polydrug use is poorly defined in the social sciences. As a result, theoretical and empirical knowledge of polydrug use is underdeveloped; approaches to measuring polydrug use are inconsistent; and understandings of the cultural meanings of combining substances are limited. This article draws on a collaborative synthesis of three qualitative case studies of polydrug use from four countries: Australia and France, Finland, and Ireland. All three studies explored the practice of substance combination, or "combos" using the lens of intentionality, functionality, and social setting. In addition, the studies shared a common concern with teasing out the rationale for substance combining, and the controls used to balance pleasures with risks, beyond the simple physiological or sensory effects of substances. Our analysis leads us to recommend that a standard definition of polydrug use be adopted for future social science research—that is, the ingestion of two or more substances in combination, at the same time or in temporal proximity, so that the effects of different substances overlap. For analytical purposes, we suggest two subcategories: simultaneous and sequential intake. Moreover, we contend that it is the intention, meaning, and socio-structural context underpinning the use of substance combinations that is central to understanding polydrug use. Consequently, we suggest an adaptation of Zinberg's seminal concept to one of "drug combo, set, and setting" to incorporate an analysis of the effects of using substances together, or in sequence within a short time frame. [ABSTRACT FROM AUTHOR]

In Finland, polydrug use is generally seen as stigmatized deviant behavior. By means of the mixed methods approach, this article focuses on how people explain their polydrug use and what they attribute it to. Our findings show that these explanations vary according to sociodemography. Moreover, polydrug use is not always presented as planned and goal-oriented behavior, but also something that can occur due to sudden situational factors beyond the control of the person. Our findings implicate that the judgments regarding the deviance of polydrug use are contextual and different sociodemographic groups consider whether it is deviant behavior or not differently. [ABSTRACT FROM AUTHOR]

Aims: Although polydrug use is increasingly recognized, knowledge of different patterns of such use remains scarce and underdeveloped. This study aims to identify the various patterns and cultural forms of polydrug use. Methods: The data used consist of interviews with 56 Finnish drug users from different backgrounds who were asked to describe their experiences of using and mixing multiple substances. The analysis was conducted by reconstructing polydrug use episodes into chronological narratives, with a focus on conscious risk-taking, control and identity formation. Findings: In our analysis, we recognized four key narrative types of polydrug use based on different levels of risk evaluation and management: "social recreation", "self-discovery", "hustling" and "addiction". We interpret these narrative types as reflections of social identities shaped by different layers of drug culture and individual risk-taking strategies. Conclusions: Our findings illustrate that polydrug use is a highly diverse and heterogeneous phenomenon that ultimately operates based on the same cultural codes as drug subcultures in general, thereby representing cultural variation within the drug culture. What makes polydrug use special is that, instead of using individual substances, users combine multiple substances to achieve their goals. [ABSTRACT FROM AUTHOR]

Background/aims: Polydrug use is a complicated phenomenon that is measured in a wide variety of different ways. Using Finland as an example, we aimed to demonstrate how the prevalence and prevalence trends of concurrent polydrug use (CPU) varied in the general population based on the different measurements used.Methods: Population-based Drug Surveys conducted every 4 years during 1998-2014 were used. CPU was measured with different measurements: strict, medial and loose definition of CPU, which were based on different combinations of alcohol, illicit drugs, pharmaceutical drugs and cigarettes used during the last 12 months/30 days. Logistic regression was used to estimate the p values for assessing trends.Results: Depending on the measurements used, the prevalence of CPU in 2014 varied between 2.0 and 18.7%. Different definitions also produced contradictory trends of CPU: there was a modest increase in prevalence if it was measured with a medial (p < 0.001) or strict (p = 0.054) definition, but when measured with the loose definition (only measure that included smoking), there was a decrease in prevalence (p < 0.001).Conclusions: The prevalence of CPU varies greatly depending on the measurement used, as does the course of the prevalence trends. The concept of simultaneous polydrug use may capture the phenomenon better compared to the concept of CPU. [ABSTRACT FROM AUTHOR]

Aims: We aimed to study a latent social structure behind the variables associated with teenagers’ cannabis use at the individual level and, in a social context, formed by school class.Methods: The data used come from the European School Survey Project on Alcohol and Other Drugs (ESPAD), conducted in Finland in 2011 (N = 3744, response rate 89.6%). Methods used were Latent Class Analysis (LCA) and Multilevel Logistic Regression. The differences observed between pupil groups were interpreted through the concepts of social norms (conventionality of behaviour) and cultural dispositions.Findings: Four different latent classes of pupils were found: theConventionalists, theAlco-rebels, theSub-cultural conventionalistsand theSub-cultural rebels. AlthoughSub-cultural conventionalistswere aware of the cannabis culture, only a small proportion of them had ever tried cannabis. The risk for cannabis use was pronounced in all pupil groups compared toConventionalists, the risk being the highest amongSub-cultural rebels. There was statistically significant variation in the cannabis use between schools, when the individual-level variables were taken into account.Conclusions: The findings stress the cultural and normative heterogeneity of school children and the importance of the school environment. The cultural competence ofSub-cultural conventionalistscould be utilized in the preventive work. [ABSTRACT FROM PUBLISHER]

BACKGROUND - We examined the Finnish concept of 'nikotiiniriippuvuus' (nicotine addiction or dependency in English) in two public arenas in recent Finnish history (1970s, 1990s and 2000s). One was the biggest daily newspaper Helsingin Sanomat, the other the medical professional journal Lääkärilehti. DATA & DESIGN - A total of 102 print press items from the 1990s and the 2000s were collected through electronic archives with the search word 'nikotiiniriippuvuus'. In addition, 41 texts were collected manually from the 1970s. RESULTS - Of the items from the 1970s, only three mentioned the concept of 'riippuvuus'. Overall, we found that the use of 'nikotiiniriippuvuus' has increased greatly over time. In order to know more about the implications of this, we identified some themes as meaning-making traits surrounding the concept in the materials. The analysis points to four main meaning-making functions of the concept: i) agenda-setting, ii) introducing and explaining self-governance techniques, iii) introducing a medical understanding, and iv), mediating views on responsibility division. [ABSTRACT FROM AUTHOR]

Drug consumption rooms are one of the harm reduction interventions to handle complex social problems. The Helsinki city initiative puts drug consumption room (DCR) on a government agenda in Finland, which has also triggered a broader discussion. This study presents how stakeholders problematise and what solutions they propose for DCRs. The research is based on in-depth interviews of 23 stakeholders and the theoretical perspective of Bacchi’s approach – ‘What’s the problem represented to be?’ (WPR). The results show that while stakeholders’ solutions resemble each other on the core DCR functions, the variations are found mainly in the introduction of extended services, policy development strategy, types of drug allowance in DCRs, and drug testing options. Stigmatisation of PWUDs still leads the harm reduction services to be considered from a moral framework. Stakeholders tend to take their positions according to strategic considerations related to electoral politics, expedience and the symbolic role of policies. [ABSTRACT FROM AUTHOR]

Abstract: Smoking was once defined as an appropriate recreational substance or life comfort, but is now understood as a serious health risk and a public health problem important enough to be controlled by society. In this article the changed social position and development of tobacco regulations in Finland are studied from a perspective of social constructionism. The emergence of recent tobacco controls can be seen as a process whereby tobacco came to be defined as a social problem. I will argue that there were three primary definitions which played a decisive role in this process. Put in historical order, these three definitions contained (1) claims about harms to smokers, (2) claims about harms to others, and (3) claims about tobacco as a highly addictive drug. These conceptions together drove a complementary and mutually reinforcing re-conception of tobacco harms. Consequently, the emergence of these definitions led to the founding of new institutions, practices, and treatments. The leading value in the claim-making process was public health, which transferred the state's interest away from fiscal revenues towards lowering the costs caused by tobacco diseases. Correspondingly, medical science and medical doctors gained a position as the leading authority in the defining the tobacco issue. The latest conceptual innovation is the idea of a tobacco-free Finland by 2040, representing a strategy of ‘de-normalising’ tobacco use. The reversal in the social and cultural position of tobacco, which in Finland went from one extreme to another, was not based on pressure created by any wider social movements or organised tobacco-specific citizens groups, as in some other countries, but rather by a state health administration supported by a relatively small network of tobacco control advocates. [Copyright &y& Elsevier]

Research on cannabis cultivation has identified several factors associated with a grower's likelihood of detection by law enforcement. However, these studies are difficult to compare, as they drew from different data sources and methods, and have focused on only one geographical location. This article revisits the issue of detection using a large sample of cannabis cultivators recruited in three countries: Belgium ( n = 659), Denmark ( n = 560) and Finland ( n = 1296). Respondents were recruited in the context of a self-reported online survey conducted successively in each country between 2006 and 2008. Multivariate analyses suggest several country-specific similarities and differences. Importantly, the Finnish growers reported being arrested significantly more often than Belgians or Danes. The probability that Finnish growers would be arrested increased with time spent on growing, the size of the cultivation site and when respondents did not work alone. In Denmark, the risks increased with the size of the cultivation-related network, but decreased when respondents started growing later in life. In Belgium, no cultivation-related characteristics were associated with detection. The results indicate that the risks of apprehension for cannabis cultivation are typically country-specific. These findings are discussed in the context of country-specific policies in regards to cannabis. [ABSTRACT FROM AUTHOR]

ABSTRACT The Department of Alcohol, Drugs and Addiction started operations on 1 January 2009, when the National Institute of Public Health (KTL) and the National Research and Development Centre for Welfare and Health (STAKES) were merged. The newly formed institute, called the National Institute for Health and Welfare (THL), operates under the Finnish Ministry of Social Affairs and Health. The scope of the research and preventive work conducted in the Department covers alcohol, drugs, tobacco and gambling issues. The two main tasks of the Department are (i) to research, produce and disseminate information on alcohol and drugs, substance use, addictions and their social and health-related effects and (ii) to develop prevention and good practices with a view to counteracting the onset and development of alcohol and drug problems and the damaging effects of smoking and other addictions. The number of staff hovers at approximately 60 people. The Department is organized into three units, one specialized in social sciences (the Alcohol and Drug Research Unit), another in laboratory analytics (the Alcohol and Drug Analytics Unit) and the third primarily in preventive work (the Addiction Prevention Unit). These units incorporate a rich variety and long traditions of both research and preventive work. The mixture of different disciplines creates good opportunities for interdisciplinary research projects and collaboration within the Department. Also, the fact that in the same administrative context there are both researchers and people specialized in preventive work opens up interesting possibilities for combining efforts from these two branches. Nationally, the Department is a key player in all its fields of interest. It engages in a great deal of cooperation both nationally and internationally, and among its strengths are the high-quality, regularly collected long-term data sets. [ABSTRACT FROM AUTHOR]

Aims: To compare domestic cannabis cultivation in Denmark and Finland to describe national characteristics in small-scale cannabis growing. Design: A Web survey conducted among small-scale cannabis growers in Denmark (June to November 2008) and Finland (May to June 2009). Participants: Current cannabis growers (Denmark, 401; Finland, 1,054). Measurements: Comparisons in regard to social background, growing history, practices, purposes and motives of growing, and perceptions of risks. Findings: Cannabis was cultivated primarily for own use, but sharing with friends and avoiding criminal circles also were significant motives for growing. Finnish growers prioritized indoor cultivation, whereas the Danes were more in favor of open-air plantations. Risks of getting caught by the police were observed to be greater in Finland. Growing for medical purposes was twice as prevalent in Finland as in Denmark. Conclusions: Cannabis growing is a stronger and more novel phenomenon in Finland than in Denmark, but both countries have been influenced by international trends. Finnish and Danish small-scale cannabis cultivators can be considered to be ideologically oriented lifestyle growers. Differences in the magnitude of the phenomenon may reflect differences in the availability and quality of cannabis in national drug markets. The Internet had promoted the spreading of the trend. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: To determine the relationships between the different patterns of drinking and drug use in the general population. Design: The data from three nationwide surveys conducted in Finland in 1998, 2002 and 2004 were pooled into one dataset (n = 7,227). Participants: Population aged 15–69. Measurements: Use of illicit drugs was analyzed in relation to annual alcohol consumption, heavy episodic drinking, frequenting of pubs and restaurants, and the misuse of prescribed drugs. Respondents were divided into five different groups according to their involvement in drug cultures, i.e. ‘no contact with drug cultures’, ‘some contact with drug cultures’, ‘drug experimenters and ex-users’, ‘cannabis users’ and ‘multidrug users’. Findings: The prevalence of drug use increased along with the annual alcohol consumption, and polysubstance use was most prevalent among heavy drinkers. Heavy episodic drinking and frequenting of pubs and restaurants increased in parallel with involvement in drug cultures. Misuse of prescribed drugs was most prevalent among multidrug users. Conclusions: Polysubstance use patterns reveal an interlacing of alcohol and drug cultures. However, standard measures employed in alcohol and drug research are insufficient to capture the phenomenon in detail, and more research and the development of new approaches are needed. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

According to a frequently voiced opinion drug seizures represent 5 to 10 percent of drug traded in the market. In this article we estimate the size of the Finnish cannabis trade by calculating the number of users and the amount of the substance consumed in a year. We divide the subjects into five different groups based on the annual frequency of use: experimenters (1-4 days), modest occasional users (5-12 days), frequent occasional users (13-51 days), weekly users (52-181 days) and, finally, daily users (182-365 days). The highest number of users was found in the group of modest occasional users, while daily users were accountable for the greatest share of total consumption. According to our calculations the amount of seized cannabis corresponds to 10-23 percent of the total amount on the market which means that authorities operate more effectively than what is generally believed. [ABSTRACT FROM AUTHOR]

This paper examines the reorganization of Finnish drug policy in the light of recent major changes. The analysis is inspired by writings of criminologist David Garland on crime control and governmental control strategies (Garland, 1996, 2000, 2001), and by the British drug debate on the normalization of drug use (Parker, 2005; Parker et al., 1998; Shiner & Newburn, 1999; South, 1999). Garland distinguishes between adaptive and non-adaptive social responses to crime. Adaptive responses generally lower the objectives of public policy because the goals seem unrealistic. If you cannot get the best, you can always strive for the good. Non-adaptive or repressive responses are needed to justify the image of the State as an efficient and competent actor. The conclusion of the paper is that, after a somewhat stormy debate in Finland around the turn of the century, the adaptive and non-adaptive responses have peacefully aligned with each other. This dual-track model has become the new paradigm in Finnish drug policy: Both harm reduction and criminal control approaches are now well established and expansive. Related trends are recognized also in other countries. [ABSTRACT FROM AUTHOR]

This presentation describes the two last decades of Finnish social alcohol and drug research based on work done by the Alcohol and Drug Research Group and The Finnish Foundation for Alcohol Studies. The Group consists of 13 permanent researchers and three research secretaries. The main activity of the Foundation is to award grants for post-gradual students. In recent years alcohol studies have been heavily influenced by Finland's entry into the EU. Simultaneously, the position of drug research has been considerably strengthened. [ABSTRACT FROM AUTHOR]

• AIMS This article reports the results of a population survey in autumn 2004. First, trends in drug use are studied by comparing the 2004 data with materials collected in the same way in 1992. 1996, 1998 and 2002. Secondly. the relationship between drug use and alcohol consumption is discussed. This latter aspect is of special interest in Finland today following the changes in the alcohol environment in spring 2004 (tax cuts on alcohol, the discontinuation of the import quota within the EU and from Estonia). If alcohol consumption increases, the question is will that have the effect of driving up the consumption of other substances (addition hypothesis) or on the contrary, will drug use decrease and be substituted by increased alcohol consumption (substitution hypothesis)? • METHODS The data for the research were collected in a postal questionnaire in autumn 2004. A random sample of 3992 persons aged 15-69 was drawn from the central population register. A total of 2526 persons responded, giving a response rate of 63 per cent. In order to gain a clearer picture of the relationship between drug use and alcohol consumption, we have linked the data for 1998, 2002 and 2004 into one dataset comprising more than 7 000 respondents. • RESULTS The tendency for drug use and experimenting to increase has slowed down since the turn of the millennium. The increase in alcohol sales and tourist imports is not driving up the level of drug use. However, this study lends support to the observations by Juha Partanen (Wet high (1994)) about the close links between drug use and alcohol consumption. In the urban life-styles of younger people the use of cannabis is interwoven with frequent clubbing and party-style drinking patterns. Another indication of the intertwining of drug and alcohol cultures is found in the group of mixed users, who not only drink heavily but also use various drugs and medicines. It would seem that the risk of drug use is increased by the early onset of binge drinking. • CONCLUSION There is as yet not enough evidence to confirm the addition hypothesis. However, given the close links of drug use with alcohol consumption, it certainly is a possibility that if alcohol consumption sharply increases, this might trigger an increase in drug use and experimenting, particularly among young people. The substitution hypothesis, on the other hand, does not seem very likely. On the contrary, it seems that drug use in Finland ties in rather closely with drinking to intoxication. [ABSTRACT FROM AUTHOR]

• AIMS Official records indicate that in 1996 no more than five drug addicts in Finland received medically assisted treatment. By 2004 that figure had grown to 600- 700 persons. This article retraces the path to this crucial change. • DESIGN Several factors of this change are scrutinised. In the latter part of the 1990s. Finland saw a significant increase in drug-related harms. resulting in a gradual revision of drug policies. Medically assisted treatment was brought under the spotlight through serious public controversies, centred on two private doctors prescribing buprenorphine for their heroin-using patients. Claims-makers, representing a variety of agencies, stood up for substitution treatment. International trends in substitution treatment, as well as scientific research, facilitated the advocacy of such treatment. • RESULTS The drug user has been redefined in terms of private and public health, and civil rights, engendering a more liberal attitude towards substitution treatment. National drug policy is characterised by a joint move: social and health policy initiatives, on the one hand, and criminal policy, on the other, are running on separate tracks, making it possible to increase control powers and to expand treatment services. • CONCLUSIONS Several questions are still unresolved. For example. there has been very little debate on the widely known problem of buprenorphine abuse. [ABSTRACT FROM AUTHOR]

An obituary for statistician, mathematician and sociologist Juha Partanen is presented.

Abstract: Background: The aim of the article is to analyze changes in opioid substitution treatments (OST) in Finland. OST spread in Finland in the late 1990s and early 2000s (Phase 1). Since then, OST has become an integrated part of Finnish drug policy and is provided in various substance abuse treatment units as well as in municipal health centers (Phase 2). Methods: The paper analyses the policy around the implementation of opioid substitution treatment in Finland, focusing on identifying the key factors and the relations between them that have contributed to the implementation of OST in Finland. Results: OST has become accepted in Finland during the past ten years as a crucial element of a harm reduction strategy. Present incentives behind this development are not as clearly related to drug-specific policies as in the late 1990s; rather, they stem from both the restructuring of health care services (e.g. cost-effectiveness) and the strengthening of the medical or technico-administrative approach to the development of OST. Conclusion: Since the early 2000s, the development of substitution treatment in Finland has not taken place under explicit drug-political guidance, but largely as a result of many differing intended and unintended effects. One of the unintended effects is the fact that buprenorphine has replaced heroin as the most commonly misused opioid in Finland. [Copyright &y& Elsevier]

Background: Non-medical use of prescription drugs (NMUPD) is known to be associated with illicit drug use, but less is known about how illicit drug use has changed in NMUPD. We examined (1) the changes in illicit drug use among Finnish non-medical users of prescription drugs during the 2000s and (2) whether the trends of illicit drug use differ by non-medical use of prescription drugs in the general population.Methods: Data were derived from population-based (aged 15-69) Drug Surveys conducted in Finland in 2002, 2006, 2010 and 2014. The response rates varied between 63% and 48%. NMUPD during the last year was measured (n=252). Past-year illicit drug use among non-medical users of prescription drugs and the reference population not reporting NMUPD (n=10,967) was compared. Logistic regression was used to estimate the p-values for trends.Results: Illicit drug use has increased notably among Finnish non-medical users of prescription drugs (from 21% to 70%, p for trend<0.001). This was not explained by the respondents' gender, age, employment status or alcohol use. Among the reference population, illicit drug use also increased statistically significantly, but much more moderately (from 2.5% to 5.4%). The difference between the trends was confirmed by an interaction test (p=0.022).Conclusions: NMUPD seems to be increasingly merging with illicit drug use. This indicates an increasing prevalence of polydrug use among non-medical users of prescription drugs, which may bring about more severe harms and worse health outcomes for users and more challenges in regard to treatment. [ABSTRACT FROM AUTHOR]

Drug consumption rooms (DCRs) have been established to reach high-risk people who use drugs (PWUDs) and reduce drug-associated harm. Despite effectiveness, their establishment requires strong advocacy and efforts since moral perspectives tend to prevail over health outcomes in many countries. DCRs have generally emerged as a local response to inadequate central government policy. Likewise, the initiative of the Municipality of Helsinki in 2018 opened up a discussion between central government, society, and local actors in Finland. This would be the first DCR in Finland, which makes the policy process and the progress of the initiative interesting for analysis. In this article, the identification of agents, structures of interactions, environmental challenges, and policy opportunities are analyzed within the framework of complexity theory. Our results show that the initiative faces policy barriers that have mainly arisen from the conceptualization of DCRs in moral frameworks that result in the prolongation of political and professional actors to take a position on DCRs. [ABSTRACT FROM AUTHOR]

Background: Cannabis is the most popular illicit drug among adolescents in developed countries, including Finland. The aim of this study was to estimate 1) how cannabis experimentation among Finnish adolescents changed between 2003 and 2019, and 2) whether the associations between cannabis experiments and factors related to it, especially the use of tobacco and nicotine products, changed during the same time period.Methods: The analyses are based on the European School Survey Project on Alcohol and Other Drugs data, collected from Finnish adolescents aged 15 to 16 in 2003, 2007, 2011, 2015, and 2019 (N = 20,630).Results: Experimentation with cannabis among Finnish adolescents has increased since the beginning of our follow-up. At the same time, alcohol use and smoking have decreased markedly, and attitudes toward cannabis use have become more relaxed. The association between smoking and cannabis experimentation has become weaker over time. However, the use of tobacco and nicotine products, especially polytobacco, is still a strong risk factor for experimentation with cannabis. The higher the number of tobacco or nicotine products used, the higher the probability for cannabis experimentation.Conclusions: Experimentation with cannabis has previously been concentrated predominantly on adolescents who smoke, but recently non-smokers are increasingly trying cannabis. It is possible that alternative ways of using cannabis may have increased its use. Despite the strict cannabis policy in Finland, its use has increased, which may be an indication that youth cultures and images of different substances play a significant role in adolescents experimenting with cannabis. [ABSTRACT FROM AUTHOR]

The co-administration of different substances is a widespread practice in the context of hard drug use. Among others, alcohol combined with certain substances produces potentially dangerous interactions. This article explores how people who combine alcohol with benzodiazepines or psychostimulants perceive these practices and how they share their perceptions in Finnish and Swedish online discussions. This is carried out by analyzing discussants' use of metaphoric expressions. We found that the metaphors given to the use of these substance combinations reflect their pharmacological characteristics. Through that, the metaphors and meanings were different depending on the substance alcohol was combined with. Moreover, we found that, in the realities the metaphors create, the control of use was differently conceptualized. The different aspects of control could be divided into three categories that, however, were not related to any specific substances but overarched all metaphors: 1) controlling pharmacological risks, 2) controlling social appearance and 3) ignoring control. As our findings bring out, often the actual health dangers and risks of the studied substance combinations were bypassed, and the control was rather understood either as a form of socially appropriate behavior or wholly ignored.