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AbstractBackgroundMethodsResultsConclusionWhile debates on drug policy express a range of ethical viewpoints, many are underpinned by core ideas drawn from liberal philosophy. Much recent analysis on the moral principles underpinning drug policy debates focuses on differences between reformers and supporters of the status quo. Less attention has been given to divergences among advocates for drug policy reform, which often hinge on the interpretation and application of liberal principles.This paper examines three concepts from liberal philosophy in relation to drug policy debates: ‘positive’ and ‘negative’ freedom, rational autonomy, and social contract. The articulation of these ideas, and the extent to which they underpin different positions on policy reform, is explored with reference to three areas of advocacy: legal regulation; decriminalization; and harm reduction.Agreement on drug policy reforms does not necessarily imply shared views regarding concepts of freedom, rational autonomy, or social contract. Specific policy solutions may be supported by a range of ethical and political positions and can serve as points where divergent, and sometimes conflicting, philosophical perspectives converge.Drug policy advocacy expresses a range of underpinning moral, political, and philosophical perspectives. Recognizing commonalities and differences among these perspectives is important for coalition-building and strategic planning. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsDrug policy is prone to build on rationales based on different moralities rather than evidence. Less is known about how moralities influence drug policy implementation in practice. The aim was to analyze expressions of moralities among local policy-makers, professionals, and drug users in the context of the Stockholm needle and syringe exchange program (NSP).Using political documentation from Stockholm (2003–2016), focus group (12 NSP staff), and 32 drug user interviews, moralities concerning drug policy and harm reduction were analyzed based on moral foundations theory and boundary work.Three main moral dilemmas were identified concerning the subjects, aims, and orientation of drug policy: whether drug users are worthy of inclusion to society; if the general public should be prioritized or the health of drug users, and the orientation of practices as based on control or autonomy. Policy debate was driven by virtues such as purity and authority, whereas staff and drug users valued care, fairness and liberty.The prohibitionist and abstinence-oriented Swedish drug policy has created social boundaries on the practice-level. Hence, users’ perspectives, and those who care about them, should be extensively involved in political discussions to foster a more moral and humane drug policy. [ABSTRACT FROM AUTHOR]

Although the literature on political learning has examined the effect of policy on clients and some proximate individuals (family, friends, and community members), it has not examined the effect on professionals who implement programs. What lessons do professionals learn from implementing nominally positive (care) services for negatively constructed populations, and how do they learn them? Drawing on interviews, focus groups, and participant observation in substance‐use disorder services, we demonstrate that policy implementors learn lessons at odds with their advantaged status by proxy, witnessing how government treats clients, experiencing a system designed for negatively constructed, powerless populations, and sometimes the two together. As a result, the effect of policy may be greater than previously demonstrated. [ABSTRACT FROM AUTHOR]

Introduction: Supervised injecting facilities (SIF) have been shown to reduce negative outcomes experienced by people who inject drugs. They are often subject to intense public and media scrutiny. This article aimed to explore population attitudes to SIFs and how these changed over time in Australia. Methods: Data were drawn from the National Drug Strategy Household Survey, a national sample collecting data on illicit drug use and attitudes towards drug policy among Australians (2001–2019). Ordinal logistic regression assessed sociodemographic characteristics associated with different attitudes to SIFs and binary logistic regression assessed trends over time and by jurisdiction. Results: In 2019, 54% of respondents (95% CI 52.9, 55.1) supported SIFs, 27.5% (95% CI 26.6, 28.4) opposed and 18.4% (95% CI 17.7, 19.2) were ambivalent. Support for SIFs correlated with having a university degree (OR 1.75; 95% CI 1.58, 1.94), non‐heterosexual identity (OR 1.81, 95% CI 1.51, 2.17) and recent illicit drug use (OR = 1.74, 95% CI 1.55, 1.94). Male respondents or those living in socioeconomically disadvantaged areas had lower odds of supporting SIFs (OR 0.92, 95% CI 0.85, 1.00; OR 0.64–0.80, respectively). Between 2001 and 2019, support for SIFs increased modestly by 3.3%, those who 'don't know' by 7.4%, whereas opposition decreased by 11.7%. Between 2001 and 2019, support for SIFs increased in NSW and Queensland, whereas opposition decreased in all jurisdictions. Discussion and Conclusions: Opposition to SIFs declined over the past 20 years, but a substantial proportion of respondents are ambivalent or 'don't know enough to say'. Plain language information about SIFs and their potential benefits, targeted to those who are ambivalent/'don't know' may further increase public support. [ABSTRACT FROM AUTHOR]

Background and aims Design Setting Participants Measurements Findings Conclusions Involuntary civil commitment (ICC) is a legal process by which people are compulsorily admitted to substance use treatment. This study explored views about and promotion of ICC procedures for substance use disorders among public health‐public safety post‐overdose outreach programs and their outreach team members in Massachusetts, USA.In this mixed‐methods study, survey data were collected from post‐overdose outreach programs in 2019, and semi‐structured interviews were conducted with outreach team members in 2019 and 2020.Massachusetts, USA.We received 138 survey responses and conducted 38 interviews with post‐overdose outreach team members (law enforcement officers, recovery coaches, social workers and harm reductionists) who were majority male (57%) and white (66%).We used the survey instrument to categorize programs as more (discussed ICC at 50% or more of outreach encounters) or less ICC focused (discussed ICC at less than 50% of outreach encounters) and to identify program characteristics that corresponded with each categorization. Semi‐structured interviews explored staff perceptions of ICC effectiveness.Among 138 programs, 36% (n = 50) discussed ICC at 50% or more of outreach encounters. Discussing ICC at a majority of visits was positively associated with abstinence‐only program philosophies (36% v. 6%, P < 0.001) and collaborating with drug courts (60% v. 30%, P < 0.001), but negatively associated with naloxone distribution (48% v. 75%, P < 0.001) and referring to syringe service programs (26% v. 65%, P < 0.001). Qualitative interviews identified three themes: 1) some programs viewed ICC as a first line tool to engage overdose survivors in treatment; 2) other programs considered ICC a last resort, skeptical of its benefits and concerned about potential harms; 3) families commonly initiated discussions about ICC, reportedly out of desperation.Promotion of involuntary civil commitment (ICC) appears to vary widely across post‐overdose outreach programs in Massachusetts, USA, with approaches ranging from seeing it as a first step to treatment to being a tool of last resort. Demand for ICC among family members may relate to inadequate access to voluntary treatment. Family interest in ICC appears to be driven by inadequate availability of treatment and other services. ICC at post‐overdose outreach visits should be limited, if used at all. [ABSTRACT FROM AUTHOR]

Background: On January 31st, 2023, the province of British Columbia (BC), Canada, was granted a federal exemption allowing adults (aged 18 +) to possess up to 2.5 g of select illicit drugs. The exemption will be in place for three years (2023–2026), marking the first formal decriminalization of illicit drug policy reform in Canada. BC's decriminalization initiative is premised on several goals. This project seeks to evaluate each of these goals and their individual and combined contributions to determine the overall success of this policy. Methods: The following protocol paper provides a detailed outline of a five-year (2022-2027) national evaluation of BC's decriminalization initiative, as well as the specific objectives, methodologies, and planned analyses for eight interrelated sub-studies that comprise the evaluation. These sub-studies fall under the following five topical areas of research: 1) people who use drugs (PWUD), 2) the police and the criminal justice system, 3) the general public, 4) the health services system, and 5) an economic analysis. Additional research activities may also be explored. Results: The overall evaluation and specific sub-study designs were informed by intensive stakeholder engagement. The evaluation was developed in collaboration with an international expert committee who came together to undertake a nominal group technique to decide on the final evaluation design and corresponding logic model. The evaluation will also employ an advisory board and individual sub-study working groups comprised of experts and PWUD who will oversee the development and implementation of the overall evaluation as well as each sub-study. Discussion: This evaluation will draw on implementation science research practices to evaluate and understand the full impacts of this novel drug policy experiment. Results will be widely disseminated through manuscripts, reports, presentations, and infographics, which will be adapted and tailored for specific audiences. The protocol identifies several anticipated challenges and limitations. This evaluation's evidence-based findings will be poised to offer pivotal insights that can shape and refine the discourse on drug policy and will serve as a critical resource for understanding the multifaceted impacts of decriminalization. [ABSTRACT FROM AUTHOR]

Background: The development of drug policies has been a major focus for policy-makers across North America in light of the ongoing public health emergency caused by the overdose crisis. In this context, the current study examined stakeholders' experiences and perceptions of power and value in a drug policy-making process in a North American city using qualitative, questionnaire, and social network data. Methods: We interviewed 18 people who participated in the development of a drug policy proposal between October 2021 and March 2022. They represented different groups and organizations, including government (n = 3), people who use drugs-led advocacy organizations (n = 5), other drug policy advocacy organizations (n = 5), research (n = 3) and police (n = 2). Most of them identified as men (n = 8) and white (n = 16), and their ages ranged between 30 and 80 years old (median = 50). Social network analysis questionnaires and semi-structured qualitative interviews were administered via Zoom. Social network data were analysed using igraph in R, and qualitative data were analysed using thematic analysis. The analyses explored perceptions of value and power within a drug policy-making network. Results: The policy-making network showed that connections could be found across participants from different groups, with government officials being the most central. Qualitative data showed that inclusion in the network and centrality did not necessarily translate into feeling powerful or valued. Many participants were dissatisfied with the process despite having structurally advantageous positions or self-reporting moderately high quantitative value scores. Participants who viewed themselves as more valued acknowledged many process shortcomings, but they also saw it as more balanced or fair than those who felt undervalued. Conclusions: While participation can make stakeholders and communities feel valued and empowered, our findings highlight that inclusion, position and diversity of connections in a drug policy-making network do not, in and of itself, guarantee these outcomes. Instead, policy-makers must provide transparent terms of reference guidelines and include highly skilled facilitators in policy discussions. This is particularly important in policy processes that involve historical power imbalances in the context of a pressing public health emergency. [ABSTRACT FROM AUTHOR]

Background: Addiction and overdose death associated with high-risk prescription medications such as benzodiazepines and opioids, are significant global issues. Prescription Drug Monitoring Programs (PDMP), which allow healthcare providers to track and monitor patients' high-risk medication history have been implemented widely throughout North America and recently in Victoria, Australia. Australia's PDMP uses a red alert notification to notify healthcare providers to patients at 'high risk' of medication related harm. Very little is known about healthcare providers beliefs about the meaning of these notifications and what impact these meanings have on the clinical encounter and patient outcome. Methods: Twenty-nine interviews with Victorian healthcare providers (15 prescribers and 14 pharmacists) were thematically analyzed. Results: Red alerts were understood as being both synonymous with addiction, as well as a single data point with further investigation required to draw conclusion from. The red alert both disrupted and exposed underlying addiction stigma. Healthcare providers assumptions about patient's readiness to change influenced their decision to discuss the red alert with patients. Conclusions: How healthcare providers make sense of and response to PMDP generated red alerts can impact upon the clinical encounter, including clinical decision-making and the care that patients receive. By identifying and understanding the social factors and forces driving beliefs, attitudes and behaviors toward people who use addictive prescription medications, healthcare providers may be able to pause, assess and reflect on how these factors shape their decision making in unhelpful or unethical ways. [ABSTRACT FROM AUTHOR]

Aim: To analyze how the Police in Sweden perceives the drug problem and how it relates to changes in drug politics in the direction of liberalization. Method: The material analyzed consists of a content-analysis of the magazine of the Swedish Narcotic Police Association, covering 145 issues since the start in 1988, concentrating on lead articles, editorials and other articles on principles and politics. Results: The magazine demonstrate an alarmistic view of the drug problem, criticize government agencies and the media for liberal views, question the motives of proponents of decriminalization and legalization, leaves the costs of control of drug interventions aside, and sees the Police as guardian of status quo and as the defender of the goal of Swedish drug policy: "a drug-free society". [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionThe Philippines has one of the must punitive drug regimes in the world, as evidenced not just by Rodrigo Duterte’s drug war but previous anti-drug campaigns. This article examines the place of ‘the youth’ in the longstanding moral panic around drugs and drug policy in the Philippines.This article uses critical discourse analysis to analyze figurations of young people across three distinct periods in the Philippines’ contemporary history: Ferdinand Marcos Sr.’s early dictatorship (1972–1975), Gloria Macapagal-Arroyo’s presidency (2001–2010), and Rodrigo Duterte’s administration (2016–2022).In all three periods, young people were simultaneously invoked as a group that needs saving) and as a group that needs surveillance and discipline. Further, across the three periods, both the youth and drug use were enfolded into larger socio-political discourses (e.g. Martial Law; corruption and poverty; anti-elite politics).The ambivalence in the ways in which young people are treated in drug policy reflects and reinforces their societal construction as passive victims. Interrogating and challenging the ways in which young people figure in ‘morality politics’ can pave the way for meaningful youth engagement in drug policies and programs. [ABSTRACT FROM AUTHOR]

Background and aims: Multiple countries are considering revising cannabis policies. This study aimed to measure long‐term trends in cannabis use in the United States and compare them with alcohol use. Design and setting: Secondary analysis of United States general population survey data. Participants: The national surveys had a total of 1 641 041 participants across 27 surveys from 1979 to 2022. Measurements: Rates of use reported to the US National Survey on Drug Use and Health and its predecessors are described, as are trends in days of use reported. Four milepost years are contrasted: 1979 (first available data and end of relatively liberal policies of the 1970s), 1992 (end of 12 years of conservative Reagan‐Bush era policies), 2008 (last year before the Justice Department signaled explicit federal non‐interference with state‐level legalizations) and 2022 (most recent data available). Findings Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past‐year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15‐fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high‐frequency drinking is less common. In 2022, the median drinker reported drinking on 4–5 days in the past month, versus 15–16 days in the past month for cannabis. In 2022, past‐month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%). Conclusions: Long‐term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers. [ABSTRACT FROM AUTHOR]

This article delves into the complex dynamics of khat (Catha edulis) prohibition in the UK, with a particular focus on a Somali community in north-west London. Despite the Advisory Council on the Misuse of Drugs finding no substantial evidence of khat causing societal or medical harms and recommending public health interventions instead of prohibition, the UK Home Office classified khat as a Class C drug in June 2014. This decision raises critical questions about what constitutes a harmful drug. Based on ethnographic fieldwork conducted during the peak of prohibition discourse in 2013–14, the article explores how notions of harm operate across moral, political, and epistemological registers as people grapple with framing khat’s drug status and the effects of its use. It illustrates how prohibition discourse not only amplified perceptions of khat’s harmfulness but also sidelined the more nuanced concerns of Somali community members over persistent socioeconomic integration issues, mental health, and social marginalisation. Thus, the harm of khat may not lie in its potency as a psychoactive substance but as an object of prohibition that overshadows interventions to address the adverse conditions associated with its use among certain individuals.

Abstract Background On January 31st, 2023, the province of British Columbia (BC), Canada, was granted a federal exemption allowing adults (aged 18 +) to possess up to 2.5 g of select illicit drugs. The exemption will be in place for three years (2023–2026), marking the first formal decriminalization of illicit drug policy reform in Canada. BC’s decriminalization initiative is premised on several goals. This project seeks to evaluate each of these goals and their individual and combined contributions to determine the overall success of this policy. Methods The following protocol paper provides a detailed outline of a five-year (2022-2027) national evaluation of BC’s decriminalization initiative, as well as the specific objectives, methodologies, and planned analyses for eight interrelated sub-studies that comprise the evaluation. These sub-studies fall under the following five topical areas of research: 1) people who use drugs (PWUD), 2) the police and the criminal justice system, 3) the general public, 4) the health services system, and 5) an economic analysis. Additional research activities may also be explored. Results The overall evaluation and specific sub-study designs were informed by intensive stakeholder engagement. The evaluation was developed in collaboration with an international expert committee who came together to undertake a nominal group technique to decide on the final evaluation design and corresponding logic model. The evaluation will also employ an advisory board and individual sub-study working groups comprised of experts and PWUD who will oversee the development and implementation of the overall evaluation as well as each sub-study. Discussion This evaluation will draw on implementation science research practices to evaluate and understand the full impacts of this novel drug policy experiment. Results will be widely disseminated through manuscripts, reports, presentations, and infographics, which will be adapted and tailored for specific audiences. The protocol identifies several anticipated challenges and limitations. This evaluation’s evidence-based findings will be poised to offer pivotal insights that can shape and refine the discourse on drug policy and will serve as a critical resource for understanding the multifaceted impacts of decriminalization.

Abstract Background The development of drug policies has been a major focus for policy-makers across North America in light of the ongoing public health emergency caused by the overdose crisis. In this context, the current study examined stakeholders’ experiences and perceptions of power and value in a drug policy-making process in a North American city using qualitative, questionnaire, and social network data. Methods We interviewed 18 people who participated in the development of a drug policy proposal between October 2021 and March 2022. They represented different groups and organizations, including government (n = 3), people who use drugs-led advocacy organizations (n = 5), other drug policy advocacy organizations (n = 5), research (n = 3) and police (n = 2). Most of them identified as men (n = 8) and white (n = 16), and their ages ranged between 30 and 80 years old (median = 50). Social network analysis questionnaires and semi-structured qualitative interviews were administered via Zoom. Social network data were analysed using igraph in R, and qualitative data were analysed using thematic analysis. The analyses explored perceptions of value and power within a drug policy-making network. Results The policy-making network showed that connections could be found across participants from different groups, with government officials being the most central. Qualitative data showed that inclusion in the network and centrality did not necessarily translate into feeling powerful or valued. Many participants were dissatisfied with the process despite having structurally advantageous positions or self-reporting moderately high quantitative value scores. Participants who viewed themselves as more valued acknowledged many process shortcomings, but they also saw it as more balanced or fair than those who felt undervalued. Conclusions While participation can make stakeholders and communities feel valued and empowered, our findings highlight that inclusion, position and diversity of connections in a drug policy-making network do not, in and of itself, guarantee these outcomes. Instead, policy-makers must provide transparent terms of reference guidelines and include highly skilled facilitators in policy discussions. This is particularly important in policy processes that involve historical power imbalances in the context of a pressing public health emergency.

Background: The global drug control landscape is undergoing remarkable change. Many jurisdictions around the world, including jurisdictions in the United States, have decriminalized the possession and use of plant- and fungus-based psychedelics, such as psilocybin-containing mushrooms (PCM). With ORS 475 A, Oregon has gone a step further by becoming the first US state to legalize and regulate the cultivation, supply, and use of PCM in designated service centers. Methods: This commentary examines recent developments and presents two arguments for an alternative strategy for legalizing PCM. Results: First, a non-profit legal framework for the production, supply, and non-medical use of psilocybin may be more advantageous than a for-profit framework, especially for a naturally occurring mushroom that is typically not frequently used. Second, people who use drugs (PWUD) can demonstrate agency in the self-supply of drugs and in the adoption of responsible use and harm reduction practices. Conclusion: Community or peer-based structures may offer a viable approach to ensuring a controlled supply of PCM and a safe environment for their non-medical use. An outline of a public health-oriented regulatory approach for the non-profit, community-based cultivation, supply, and use of PCM is presented. This framework may provide a regulatory pathway for policymakers to consider. [ABSTRACT FROM AUTHOR]

Background: In the early 2020s, Australian media and public health organizations described the rapid rise in youth e-cigarette uptake, portraying this as a "peer pressure" problem wherein vulnerable young people were being led or bullied into vaping by the "cool" kids. Yet, the peer pressure framing of vaping fails to account for young people's rituals of nicotine consumption and ways social drug economies are organized. Methods: In 2023, we conducted qualitative interviews and ethnographic research with 24 young people ages 17 to 25, both vapers and nonvapers, in New South Wales, Australia. We investigated their embodied experiences of vaping, observations of peers' vaping practices, and beliefs about vaping policy. We analyzed their accounts for themes and here report our findings, illustrated with participants' quotes and an ethnographic portrait of a Sydney high school vape seller. Results: The notion that young people are "pressured" into vaping lacked emic meaning for our participants. Their accounts reveal three ways that vaping is social beyond "pressure." First, social vape market offers entrepreneurial teens money-earning opportunities, mediated by social networks and markers of peer esteem, prestige, and trust. Second, vapes are exchanged as both gifts and commodities in sharing economies, offering social opportunities and scripts for recreational interactions. Third, e-cigarettes as material objects provide esthetic and gustatory pleasures that are both individually enjoyed and socially performed in rituals of taste and display. Discussion: These three perspectives on the sociality of vaping help nuance our understanding of how and why young people vape, and also suggest why public health outreach efforts may not be effective when they reduce youth vaping uptake to peer pressure. As youth vape use is on the rise in Australia, these perspectives matter for understanding this important social phenomenon and may help policy development move beyond simplifications of youth cultural motivations. [ABSTRACT FROM AUTHOR]

Drug distribution is considered one of the most serious crimes in general and the most serious drug offense in particular. Drug distribution may cover behavior of very different levels of seriousness, ranging from the social supply of small quantities of illicit drugs in friend circles to international drug trafficking organized by powerful global crime syndicates. The article explores the criminological contexts of less serious drug distribution and penal frameworks of the relevant countries in the Baltic region. The article argues for a more nuanced penal approach to such offenses in the Lithuanian penal law.

Abstract Background Policies to address substance use differ greatly between settings, where goals may range from zero-tolerance to harm reduction. Different approaches impact formats of care, policing, and even interpersonal interactions, and may play a role in the labelling and stigmatization of people who use drugs (PWUD). Where Sweden has a more restrictive policy, aiming to have a society free from drugs, Denmark has embraced harm reduction principles. The aim of this study was to explore PWUDs’ experiences of interpersonal interactions, policing, and service formats in the two countries. Methods The data consists of 17 qualitative semi-structured interviews with Swedish PWUD who have been in both Sweden and Denmark. Recruitment took place at harm reduction sites in both countries, and through snowball sampling. Results Participants reflected on how they were perceived by those in public spaces, and received by care systems and personnel. In public settings in Sweden, participants felt they were ignored, rendered invisible, and lost their humanity. In Denmark, they were perceived and acknowledged, valued as people. This was simultaneously linked to being embodied by the availability of differing service offerings and policing practices, which solidified their “right to be out” in public. Reflecting on their reception in the treatment system, strict formatting in Sweden caused participants to feel that an identity was projected upon them, limiting their opportunities or growth of new facets of identity. Care relations in Denmark fostered more opportunity for autonomy and trust. Conclusion A zero-tolerance policy and associated public discourses could solidify and universalize stigmatizing categorizations as a central feature of PWUD identity and reception from those around them, exacerbating social exclusion. Conversely, harm reduction-centered policies fostered positive interactions between individuals with care providers, public, and police, which may promote inclusion, empowerment, and wellbeing.

AbstractBackgroundMethodsResultsConclusionDocuments are influential in shaping drug policy debates and are valuable data for drug policy research. In this article we conduct a values analysis of one drug policy document. The objectives were to assess the values within a policy document; assess the utility of Schwartz’s values framework in documentary analysis; and consider the relationship between values and policy positions.We chose the report foreword of a Special Commission in Australia for analysis. We developed deductive, theoretically-informed codes following Schwartz’s values framework, and undertook reflexive analysis of the coding process. Individual and cultural values were coded at the paragraph level and summed to analyze dominant values.Values related to structural context and drug policy; drug policy values were primarily security and universalism values; policy positions did not neatly map onto values positions; and researcher interpretations of motivations shaped the value identified.Policy documents can reveal conflicting values; these should be interpreted through inflection and emphasis specific to each occurrence. This work provides a step to future analyses that can differentiate multiple contrasting values informing a single policy position. [ABSTRACT FROM AUTHOR]

Canada is in the midst of a public health emergency in drug poisoning (overdose) deaths. In this context parents, and especially mothers, of those who have died from drug poisoning have mobilised to advocate for urgent responses and drug policy reforms. To document this emerging women‐led advocacy, we initiated a community‐academic research partnership with three parent groups representing families in Canada bereaved by drug‐related deaths. In this commentary, we describe four guiding principles we developed during the course of this project, to ensure an ethical and equitable approach to conducting our research partnership. In particular, we emphasise how we navigated parents' roles as vocal advocates for addressing drug stigma and expanding harm reduction while actively working to avoid eclipsing the need to centre the perspectives of people who use drugs. Meaningful and collaborative partnerships between academics and community groups may facilitate greater understandings of how families and communities can be allied in drug policy reforms urgently needed to prevent drug poisoning deaths. [ABSTRACT FROM AUTHOR]

This article analyzes alternative development coalitions, their contradictions and complexities, and how they promoted a steeply unequal agrarian change through illicit crop substitution. We zoom into two paramilitary-controlled territories in Colombia. We show that those programs counted with significant support from, and were actually driven by, long coalitions that included regional and national politicians, sectors of the rural rich, paramilitary leaders, Colombian government and United States agencies. [ABSTRACT FROM AUTHOR]

Stand-alone price analysis of illicit opium and coca does not explain why smallholders turn to illicit crops for coping and survival. Under conditions of precarity, illicit crop markets can stimulate productivity. They generate returns that can tame crises and relieve pressures. To smallholders facing marginalisation, violence, and climate change – growing opium and coca, despite their illegality, can reduce or spread risks and provide more predictability. Thus, rather than fix on the 'invisible hand' of price theory, the focus should be on the 'visible hand' of political entrepreneurship, interdependent relationships, and the metrics of precarity. To do this, this paper retrospectively compares illicit crop prices before and after certain historical moments in Bolivia, Myanmar, Colombia, and Afghanistan. [ABSTRACT FROM AUTHOR]

Background: Policies to address substance use differ greatly between settings, where goals may range from zero-tolerance to harm reduction. Different approaches impact formats of care, policing, and even interpersonal interactions, and may play a role in the labelling and stigmatization of people who use drugs (PWUD). Where Sweden has a more restrictive policy, aiming to have a society free from drugs, Denmark has embraced harm reduction principles. The aim of this study was to explore PWUDs' experiences of interpersonal interactions, policing, and service formats in the two countries. Methods: The data consists of 17 qualitative semi-structured interviews with Swedish PWUD who have been in both Sweden and Denmark. Recruitment took place at harm reduction sites in both countries, and through snowball sampling. Results: Participants reflected on how they were perceived by those in public spaces, and received by care systems and personnel. In public settings in Sweden, participants felt they were ignored, rendered invisible, and lost their humanity. In Denmark, they were perceived and acknowledged, valued as people. This was simultaneously linked to being embodied by the availability of differing service offerings and policing practices, which solidified their "right to be out" in public. Reflecting on their reception in the treatment system, strict formatting in Sweden caused participants to feel that an identity was projected upon them, limiting their opportunities or growth of new facets of identity. Care relations in Denmark fostered more opportunity for autonomy and trust. Conclusion: A zero-tolerance policy and associated public discourses could solidify and universalize stigmatizing categorizations as a central feature of PWUD identity and reception from those around them, exacerbating social exclusion. Conversely, harm reduction-centered policies fostered positive interactions between individuals with care providers, public, and police, which may promote inclusion, empowerment, and wellbeing. [ABSTRACT FROM AUTHOR]

The turn of the century brought a resurgence of interest in psychedelics as a treatment for addiction and other psychiatric conditions, accompanied by extensive positive media attention and private equity investment. Government regulatory bodies in Australia, Israel, Canada and the United States now permit use of psychedelics for medical purposes. In the United States, citizen action and corporate financing have led to petitions and ballot initiatives to legalize psilocybin and other psychedelics for medical and recreational use. Given this momentum, policymakers must grapple with important questions that define whether and how psychedelics are made available to the public, as well as how companies produce and promote them. The current push to broaden the production, sale, and use of psychedelics bears many parallels to the movement to legalize cannabis in the United States and other nations—most notably, the use of poorly‐evidenced therapeutic claims to create a de facto recreational market via the health care system. Experience with cannabis highlights the value of debating the question of legalization for nonmedical use as such rather than misrepresenting it as a medical issue. The lessons of cannabis policy also suggest a need to challenge hyping of psychedelic research findings; to promote rigorous clinical research on dosing and potency; to minimize the influence of for‐profit industry in shaping policies to their economic advantage; and to coordinate federal, state, and local governments to regulate the manufacture, sale and distribution of psychedelic drugs (regardless of whether they are legalized for medical and/or recreational use). [ABSTRACT FROM AUTHOR]

Alcohol use is a major determinant of health at both an individual and societal level. In New Zealand alcohol is legal and highly commercialized. Its harms are pervasive and are inadequately managed by current alcohol policy. However, contemporary methods for policy reform have also proven ineffective, and so effective alcohol regulation has been repeatedly thwarted. This essay first outlines the current state of regulatory failure and establishes the need for reform, before proposing citizens' assemblies as a solution to this public health conundrum. These are novel democratic institutions designed to secure an informed and representative public voice as the central determinant of policy. This essay contends that an appropriately designed citizens' assembly is likely to lead to alcohol policy which is more informed, evidence-based, and democratically accountable than current methods. Such an assembly would also be consistent with the Treaty of Waitangi principles and may assist in reducing alcohol-related inequities for Māori. Finally, in discussing such an assembly, this essay presents an internationally applicable model which could be employed for a range of other drug policy issues. [ABSTRACT FROM AUTHOR]

Previous research suggests that American drug sentiment is becoming more liberal. However, the absence of a reliable and valid over time measure limits our understanding of changes in drug attitudes. This project utilizes the dyad ratios algorithm and 298 administrations of 66 unique survey indicators to develop a measure of public mood toward drugs from 1969 to 2021. I find that drug mood has trended more liberal since the late 2000s. I then test for the predictors and consequences of drug mood empirically using ARMAX modeling. Results suggest that the violent crime rate, presidential rhetoric on drugs, and college attendance are not significant predictors of drug mood, but punitiveness is significant and negative. Moreover, only drug mood emerges as a significant and negative predictor of punitiveness. Granger causality tests indicate that drug mood Granger causes changes in punitiveness. These results elucidate the socio-political dynamics regarding public opinion toward drug policy. [ABSTRACT FROM AUTHOR]

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Abstract Background Access to anaesthesia and surgical care is a major problem for people living in Sub-Saharan Africa. In this region, ketamine is critical for the provision of anaesthesia care. However, efforts to control ketamine internationally as a controlled substance may significantly impact its accessibility. This research therefore aims to estimate the importance of ketamine for anaesthesia and surgical care in Sub-Saharan Africa and assess the potential impact on access to ketamine if it were to be scheduled. Methods This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach. Results The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants. Conclusion Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.

Abstract Background As of November 8, 2023, 24 states and the District of Columbia have legalized cannabis for both recreational and medical use (RMCL-states), 14 states have legalized cannabis for medical use only (MCL-states) and 12 states have no comprehensive cannabis legislation (NoCL-states). As more states legalize cannabis for recreational use, it is critical to understand the impact of such policies on driving safety. Methods Using the 2019 and 2020 Fatality Analysis Reporting System data, we performed multivariable logistic regression modeling to explore the association between state level legalization status and cannabis positivity using toxicological testing data for 14,079 fatally injured drivers. We performed a sensitivity analysis by including multiply imputed toxicological testing data for the 14,876 eligible drivers with missing toxicological testing data. Results Overall, 4702 (33.4%) of the 14,079 fatally injured drivers tested positive for cannabis use. The prevalence of cannabis positivity was 30.7% in NoCL-states, 32.8% in MCL-states, and 38.2% in RMCL-states (p

The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19. Findings suggest that countries with stronger social welfare systems pre-COVID introduced durable interventions targeting structural drivers of health. Countries with fragmented social service infrastructures implemented temporary initiatives for PWUD led by non-governmental organisations. The paper summarises the most successful early pandemic responses seen across countries and ends by calling for greater systemic investments in social protections for PWUD, diversion away from criminal-legal systems toward health interventions, and integrated harm reduction, treatment and recovery supports for PWUD.

Background: This study, using a nationally representative dataset of the U.S. workforce, examines how punitive workplace drug policies relate to opioid use/misuse and psychological distress. Methods: The sample included adults aged ≥18 years who participated in the National Survey on Drug Use and Health and were employed in 2020. Hierarchical multivariate logistical models were constructed to address the research questions. Results: The weighted, design-based estimates indicate that of 147 831 081 workers, 3.38% reported misusing opioids in the last 12 months. Having a punitive workplace policy was associated with higher rates of opioid use/misuse among workers aged ≤ 34 compared to their same-aged counterparts in nonpunitive workplaces, and among workers identifying as Black, Indigenous, or Person of Color who also experienced severe psychological distress the past year. Conclusion: Some employers may think drug testing policies are net-beneficial to worker well-being; these findings indicate such policies may interact in harmful ways with psychological distress. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the likelihood of driving after using cannabis, and of being a passenger with someone who is driving after using cannabis, in rural areas and non-rural areas before and after legalization. A multi-wave analysis of Canada's National Cannabis Survey was conducted using logistic regression with interactions to predict the prevalence of driving after using cannabis, and of being a passenger with someone who is driving after using cannabis, in relation to place of residence (rural or non-rural) and in the weeks and months before and after legalization. Three time points were compared: pre-legalization, two months following legalization and 1 year after legalization. At the national level, there are no significant differences between the predicted estimates of driving after using cannabis for those who live in rural and non-rural areas. However, when examining the impact of legalization, we found a significant increase in driving after using cannabis among rural residents directly following legalization. Furthermore, it was observed that this increase in driving after using cannabis returns to pre-legalization rates one year after legalization. By contrast, in the weeks and months following legalization, driving after using cannabis decreased among those living in non-rural areas, and slowly increased soon thereafter. No significant differences were observed, in either time period or group, in the prevalence of being a passenger with someone who is driving after using cannabis. The finding of significantly higher risk of driving after use of cannabis soon after legalization in rural areas suggests a need for more attention to address immediate concerns for public safety. The increased potential for traffic injuries and deaths in other jurisdictions contemplating legalization supports the call for more and better targeted prevention efforts in rural communities that have far too often been overlooked and under-served. [ABSTRACT FROM AUTHOR]

This article introduces an analytic of discursive and material failure, developing a spatial grammar for analysing both the discursive framing of policies as failed and the actually existing processes and effects of failed policy. Using the case of harm reduction drug policy in Budapest, I demonstrate how a successful policy was made to fail at the local and national scales, and how that failure in turn spurred the mobility of harm reduction's implementation across scales and into the European Union's Drugs Strategy. I show how focusing on policy failure exposes the politics of making and mobilizing urban policy, and how an analysis of failure can uncover unforeseen effects of the local politics of policy mobility. Analysing failure as both discursive and material allows scholars to break down policymaking processes into the political and practical elements assembled in policy mobilization. Discursive policy failures take into consideration the framing and accounting of actions, events and processes, while analysis of material failure begins with seemingly fewer political questions because of its focus on the technical. I argue that it is in understanding the relationship between material and discursive failure that the politics of urban policy mobility becomes a central question. [ABSTRACT FROM AUTHOR]

Background: As of November 8, 2023, 24 states and the District of Columbia have legalized cannabis for both recreational and medical use (RMCL-states), 14 states have legalized cannabis for medical use only (MCL-states) and 12 states have no comprehensive cannabis legislation (NoCL-states). As more states legalize cannabis for recreational use, it is critical to understand the impact of such policies on driving safety. Methods: Using the 2019 and 2020 Fatality Analysis Reporting System data, we performed multivariable logistic regression modeling to explore the association between state level legalization status and cannabis positivity using toxicological testing data for 14,079 fatally injured drivers. We performed a sensitivity analysis by including multiply imputed toxicological testing data for the 14,876 eligible drivers with missing toxicological testing data. Results: Overall, 4702 (33.4%) of the 14,079 fatally injured drivers tested positive for cannabis use. The prevalence of cannabis positivity was 30.7% in NoCL-states, 32.8% in MCL-states, and 38.2% in RMCL-states (p < 0.001). Compared to drivers fatally injured in NoCL-states, the adjusted odds ratios of testing positive for cannabis were 1.09 (95% confidence interval: 0.99, 1.19) for those fatally injured in MCL-states and 1.54 (95% confidence interval: 1.34, 1.77) for those fatally injured in RMCL-states. Sensitivity analysis yielded similar results. Conclusions: Over one-third of fatally injured drivers tested positive for cannabis use. Drivers fatally injured in states with laws permitting recreational use of cannabis were significantly more likely to test positive for cannabis use than those in states without such laws. State medical cannabis laws had little impact on the odds of cannabis positivity among fatally injured drivers. [ABSTRACT FROM AUTHOR]

This manuscript offers an overview of 11 disciplinary perspectives on the failed and destructive War on Drugs and the salutary prospects from decriminalizing drug use, including History, African American studies, Journalism, Sociology, Political Science, Cost Accounting, Urban Education, Counseling, Psychology, Nursing, and Public Health. This offers a roadmap for counselor social and political advocacy with drug policy and highlights community collaboration opportunities. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionThis study utilized foresight analysis to project drug policy trends and challenges in Finland up to 2030. It aimed to develop scenarios and strategies for addressing critical issues and to explore alternative policy options.A comprehensive methodology was employed, including scope analysis, horizon scanning, trend analysis, and scenario building along with the expert panels. This approach facilitated the identification and categorization of trends into mega-trends, emerging trends, and weak signals, ensuring a robust and inclusive analysis.Key findings include mega-trends, such as changing drug policies and rising economic burdens. Emerging trends highlight the increase in synthetic, polydrug, and prescription drug use, vulnerability in certain subgroups, and growing drug-related mortality. Weak signals point to the advent of online drug marketplaces and new treatment methods. Past foresight studies agree on market growth and policy inertia but diverge on resource allocation and older generation targeting.Developed scenarios and strategies address issues like increasing drug prevalence, service gaps, and market diversification, advocating for integrated approaches in demand reduction, governance, law enforcement, environmental protection, and harm reduction services. This research highlights the significance of participatory foresight methods in shaping Finnish drug policy, offering valuable insights for future trajectories and affirming the importance of foresight in this field. [ABSTRACT FROM AUTHOR]

While the federal government continues to pursue a punitive "War on Drugs," some states have adopted evidence-based, human-focused approaches to reducing drug-related harm. This article discusses recent legal changes in three states that can serve as models for others interested in reducing, rather than increasing, individual and community harm. [ABSTRACT FROM AUTHOR]

The present study offers an outlook on the current situation of civil society organizations (CSOs) in the field of harm reduction in Mexico. Analyzing Mexican harm reduction civil society organizations (HRCSOs) is necessary for three reasons: because they have historically represented a sensible alternative to drug policy proposals that emanate from the logic of the State; because they have the organizational and cognitive potential and the legitimacy to protect illicit substance users (with or without problematic use) from the risks and harms that drug policies may pose to this population; and because they are in a crisis that not only threatens the viability of their healthcare projects aimed at vulnerable populations but also, potentially, their own existence. The present article seeks to answer two questions—one descriptive and one explanatory: (a) What are the characteristics of Mexican CSOs that work in the field of harm reduction? (b) How do these organizations operate in a complex and dangerous environment? To answer these questions, the study uses data on the organizations' structures and dynamics that were obtained through 20 semistructured interviews that were conducted with members of these organizations. The article describes HRCSOs on three levels: (a) the individual that establishes a radical habitus and acquires the identity of a harm reduction activist through identity construction; (b) the collective of activists that, through the creation of trust, becomes an HRCSO with its structures, programs, and resources; and (c) the harm reduction social movement that, through cooperation and conflict, becomes a field of activism. The study seeks to have two contributions to literature: (a) providing a preliminary mapping of the anatomy of HRCSOs and the field in which they operate; and (b) sensitizing society and decision-makers on the transcendence of these organizations for social and political life. [ABSTRACT FROM AUTHOR]

This study aimed to investigate how Anabolic–Androgenic Steroid (AAS) users and healthcare professionals perceive the criminalisation of AAS on users' ability to seek help and, ultimately, what effect this has on the health outcomes for these consumers. This study triangulated the views (N = 24) of male (n = 8) and female (n = 7) AAS users (M age = 35.4, SD = 9.1), as well as healthcare providers (n = 9), regarding how the criminalisation of AAS had an impact on consumers' health behaviours and help-seeking. Data were analysed thematically. An overarching narrative was developed regarding the "politicogenic drug effects" which emerge from the illegality of AAS with three overarching themes. First, participants expressed challenges in seeking help and support due to the stigma and fear associated with the illegal nature of AAS use. This fear stemmed from the criminalisation of AAS and the potential legal consequences. Participants also highlighted the social challenges and the need for secrecy surrounding AAS use, which further hindered open discussions and engagement with healthcare providers. The cohort emphasised the close-knit social networks among AAS users, offering support and shared experiences but also entangled in the criminality associated with AAS use. Moreover, participants acknowledged the difficulties in promoting harm reduction initiatives due to the need for secrecy and the potential social and economic disadvantages. The escalation of AAS criminalisation that has impacted both consumers and healthcare professionals has exacerbated the challenges associated with their interaction, further impeding a relationship already fraught with obstacles. Consequently, users remain entrenched within the illicit market, with few options for harm reduction intervention. The study advocates for a rethinking of AAS policies, considering a potential reclassification aligned with the United Kingdom's Class C framework to destigmatise use and promote harm reduction. This shift would require comprehensive research to assess its impact on public health, user behaviour, and harm reduction outcomes. [ABSTRACT FROM AUTHOR]

Abstract In the Global South, young people who use drugs (YPWUD) are exposed to multiple interconnected social and health harms, with many low- and middle-income countries enforcing racist, prohibitionist-based drug policies that generate physical and structural violence. While harm reduction coverage for YPWUD is suboptimal globally, in low- and middle-income countries youth-focused harm reduction programs are particularly lacking. Those that do exist are often powerfully shaped by global health funding regimes that restrict progressive approaches and reach. In this commentary we highlight the efforts of young people, activists, allies, and organisations across some Global South settings to enact programs such as those focused on peer-to-peer information sharing and advocacy, overdose monitoring and response, and drug checking. We draw on our experiential knowledge and expertise to identify and discuss key challenges, opportunities, and recommendations for youth harm reduction movements, programs and practices in low- to middle-income countries and beyond, focusing on the need for youth-driven interventions. We conclude this commentary with several calls to action to advance harm reduction for YPWUD within and across Global South settings.

Abstract Background In January 2023, British Columbia implemented a three-year exemption to Controlled Drugs and Substances Act, as granted by the federal government of Canada, to decriminalize the personal possession of small amounts of certain illegal drugs. This decriminalization policy, the first in Canada, was announced in response to the overdose emergency in British Columbia as a public health intervention that could help curb overdose deaths by reducing the impact of criminalization and increasing access to health and social services through stigma reduction. Methods The current multi-method study examines people who use drugs’ awareness and knowledge of British Columbia’s decriminalization model through cross-sectional quantitative surveys and qualitative interviews among people who use drugs from September–November 2022, immediately prior to the implementation of decriminalization. Results Quantitative findings show that two-thirds (63%) of people who use drugs were aware of the policy, but substantial knowledge gaps existed about the legal protections afforded (threshold amount, substances included, drug trafficking, confiscation). The qualitative findings suggest that people who use drugs misunderstood the details of the provincial decriminalization model and often conflated it with regulation. Results suggest that information sharing about decriminalization were minimal pre-implementation, highlighting areas for knowledge dissemination about people who use drugs' rights under this policy. Conclusions Given that decriminalization in British Columbia is a new and landmark reform, and that the success of decriminalization and its benefits may be undermined by poor awareness and knowledge of it, efforts to share information, increase understanding, and empower the community, may be required to promote its implementation and benefits for the community.

The International Guidelines on Human Rights and Drug Policy recommend that states commit to adopting a balanced, integrated, and human rights-based approach to drug policy through a set of foundational human rights principles, obligations arising from human rights standards, and obligations arising from the human rights of particular groups. In respect of the Guidelines and standing obligations under UN Treaties, Canada must adopt stronger and more specific commitments for a human rights-based, people-centered, and public health approach. This approach must commit to the decriminalization of people who use drugs and include the decriminalization of possession, purchase, and cultivation for personal consumption. In this report, we will first turn to the legal background of Canada's drug laws. Next, we will provide an overview of ongoing law reform proposals from civil society groups, various levels of government, the House of Commons, and the Senate. We end with a three-staged approach to reform and a series of targeted recommendationscr.

Background There has been increasing concern over opioid-related harms across the world. In Australia in 2018, codeine-containing products were up-scheduled from over-the-counter access at pharmacies, to requiring a prescription. The drug regulator’s decision to up-schedule was contentious and widely debated, due to the potentially large impact on consumers and healthcare professionals. This study aimed to analyse influences on the codeine up-scheduling policy. Methods This retrospective policy analysis used the Advocacy Coalition Framework (ACF) to understand how policy actors with shared beliefs formed adversarial coalitions to shape policy. Data were drawn from documents (regulator policy documents, public submissions, news reports, organisational media releases and position statements) and semistructured interviews with 15 key policy actors. Codes were generated relating to policy processes and actor beliefs; broad themes included the role of health professionals, perceptions of opioids, impact on consumers, and the role of government in healthcare. Results Two coalitions in this policy subsystem were identified: (1) supportive [with respect to the up-scheduling], and (2) opposing. The key evident beliefs of the supportive coalition were that the harms of codeine outweighed the benefits, and that government regulation was the best pathway for protecting consumers. The opposing coalition believed that the benefits of codeine accessible through pharmacists outweighed any harms, and consumers should manage their health without any more intervention than necessary. The policy decision reflected the influence of the supportive coalition, and this analysis highlighted the importance of their public health framing of the issue, the acceptability of their experts and supporting evidence, and the perceived legitimacy of the up-scheduling process. Conclusion Understanding these coalitions, their beliefs, and how they are translated through existing policy processes and institutions provides insight for those interested in influencing future health policy. Specific lessons include the importance of strategic frames and advocacy, and engagement with formal policy processes.

The paper analyzes the effects of medicines policy on the functional separation of pharmacy and drugstore businesses from the early 19th century to the Second World War. Attempts to maintain personal and professional interests in the delivery of medicines prompted the long-standing dispute between pharmacists and druggists over the control and trade of drugs and poisons. The issue of state control generated complex processes that emphasized the professional role of pharmacists as providers of pharmaceutical services and druggists as wholesalers of medicines.

Abstract Background Rave music parties (RMP) are a world-wide socio-cultural phenomenon, where people listen to rave music while frequently consuming psychedelic drugs. Epidemiological studies have emphasized the hazardous consequences following the consumption of psychedelic drugs at RMP, and qualitative studies have shown social and psycho-spiritual experiences. Yet, phenomenological inquiry into subjective experiences of attendees is scant. This study aimed to examine physical, emotional, perceptual and social experiences of RMP participants in Israel, and their view on Israel’s policy toward rave events. In addition, the study aimed to contribute useful information for policymakers and society on rave music and psychedelic drugs experiences at RMP. Method Interpretative phenomenological analysis was used to analyze transcriptions of semi-structured interviews with 27 individuals attending RMP regularly and consume psychedelic drugs. Results Analysis revealed four significant themes: the first theme, the impact of Israel’s drug policy on participants’ sense of safety, relates to participants’ sense of insecurity and anxiety at Israeli RMP due to government drug ban policy. The second theme, the stigma on rave culture, relates to participants’ perception regarding the stigma on rave culture in law enforcement agencies and in society in general. The third theme, negative experiences, describes short-term experiences after consuming psychedelics at RMP, including hallucinations and disorientation. The fourth theme, positive experiences, describes positive sensory, emotional and self/world attitudinal aspects after consuming psychedelics at RMP. Sensory experiences included intensified auditory, visual and tactile experiences; emotional experiences included positive feelings toward others, reduced stress and ability to vent difficult emotions; self/world attitudinal aspects included self-acceptance, higher appreciation of life and connectedness to nature. Conclusions The study highlights RMP participants’ sense of insecurity due to Israel’s strict drug policy and absence of harm reduction strategies at rave scenes. The study also notes participants’ experience of stigmatization as drug addicts by society and law enforcement agencies. Reducing police presence and adopting harm reduction policies at rave scenes in Israel may increase participants’ sense of security, reduce stigmatization and decrease overdose risk. Hence, the findings may contribute to new knowledge useful for policymakers and society concerning RMP and the use of psychedelics.

In the Global South, young people who use drugs (YPWUD) are exposed to multiple interconnected social and health harms, with many low- and middle-income countries enforcing racist, prohibitionist-based drug policies that generate physical and structural violence. While harm reduction coverage for YPWUD is suboptimal globally, in low- and middle-income countries youth-focused harm reduction programs are particularly lacking. Those that do exist are often powerfully shaped by global health funding regimes that restrict progressive approaches and reach. In this commentary we highlight the efforts of young people, activists, allies, and organisations across some Global South settings to enact programs such as those focused on peer-to-peer information sharing and advocacy, overdose monitoring and response, and drug checking. We draw on our experiential knowledge and expertise to identify and discuss key challenges, opportunities, and recommendations for youth harm reduction movements, programs and practices in low- to middle-income countries and beyond, focusing on the need for youth-driven interventions. We conclude this commentary with several calls to action to advance harm reduction for YPWUD within and across Global South settings. [ABSTRACT FROM AUTHOR]