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The article comments on the paper by B. Pardo and colleagues about the production of methamphetamine in Afghanistan. Topics discussed include the role of ephedra in the expansion of methamphetamine production in the country, the uncertainty of the Taliban's ban on drug production, and the possible increase in the manufacture of methamphetamine or other synthetic substances using synthetic precursors.

Aims: To quantify changes in (i) potency (concentration of Δ9‐tetrahydrocannabinol; %THC), (ii) price (euros/g of cannabis) and (iii) value (mg THC/euro) of cannabis resin and herbal cannabis in Europe. Design Repeated cross‐sectional study. Setting and participants: Data collected from 28 European Union (EU) member states, Norway and Turkey by the European Monitoring Centre for Drugs and Drug Addiction. Measurements Outcome variables were potency, price and value for cannabis resin and herbal cannabis in Europe, 2006–16. Inflation was estimated using the Harmonised Indices of Consumer Prices. Mixed‐effects linear regression models were used to estimate linear and quadratic time trends, with a random intercept and slope fitted to account for variation across countries. Findings Resin potency increased from a mean [95% confidence interval (CI)] of 8.14% THC (6.89, 9.49) in 2006 to 17.22 (15.23, 19.25) in 2016. Resin price increased from 8.21 euros/g (7.54, 8.97) to 12.27 (10.62, 14.16). Resin increased in value, from 11.00 mg THC per euro (8.60, 13.62) to 16.39 (13.68, 19.05). Quadratic time trends for resin potency and value indicated minimal change from 2006 to 2011, followed by marked increases from 2011 to 2016. Herbal cannabis potency increased from 5.00% THC (3.91, 6.23) to 10.22 (9.01, 11.47). Herbal price increased from 7.36 euros/g (6.22, 8.53) to 12.22 (10.59, 14.03). The value of herbal cannabis did not change from 12.65 mg of THC per euro (10.18, 15.34) to 12.72 (10.73, 14.73). All price trends persisted after adjusting for inflation. Conclusions: European cannabis resin and herbal cannabis increased in potency and price from 2006 to 2016. Cannabis resin (but not herbal cannabis) increased in the quantity of Δ9‐tetrahydrocannabinol per euro spent. Marked increases in resin potency and value from 2011 to 2016 are consistent with the emergence of new resin production techniques in European and neighbouring drug markets. [ABSTRACT FROM AUTHOR]

Background: The importance of illicit drug price data and making appropriate adjustments for purity has been repeatedly highlighted for understanding illicit drug markets. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has been collecting retail price data for a number of drug types alongside drug-specific purity information for over 15 years. While these data are useful for a number of monitoring and analytical purposes, they are not without their limitations and there are circumstances where additional adjustment needs to be considered. This paper reviews some conceptual issues and measurement challenges relevant to the interpretation of price data. It also highlights the issues with between-country comparisons of drug prices and introduces the concept of affordability of drugs, going beyond purity-adjustment to account for varying national economies.Methods: Based on a 2015 European data set of price and purity data across the heroin and cocaine retail markets, the paper demonstrates a new model for drug market comparative analysis; calculation of drug affordability is achieved by applying to purity-adjusted prices 2015 Price Level Indices (PLI, Eurostat).Results: Available data allowed retail heroin and cocaine market comparison for 27 European countries. The lowest and highest unadjusted prices per gram were observed for heroin: in Estonia, Belgium, Greece and Bulgaria (lowest) and Finland, Ireland, Sweden and Latvia (highest); for cocaine: the Netherlands, Belgium and the United Kingdom (lowest) and Turkey, Finland, Estonia and Romania (highest). The affordability per gram of heroin and cocaine when taking into account adjustment for both purity and economy demonstrates different patterns.Conclusion: It is argued that purity-adjusted price alone provides an incomplete comparison of retail price across countries. The proposed new method takes account of the differing economic conditions within European countries, thus providing a more sophisticated tool for cross-national comparisons of retail drug markets in Europe. Future work will need to examine other potential uses of the drug affordability tool.Limitations: The limitations of this measure reflect primarily the limitations of the constituent data; in addition to issues inherent in collecting accurate data on illicit markets, analysis that relies on data collected from multiple countries is susceptible to discrepancies in data collection practices from country to country. [ABSTRACT FROM AUTHOR]

Background: Drugs can act as facilitators for all types of violence, including drug-related homicide (DRH). Addressing this phenomenon is not only of importance given the severity of a homicide event and its high costs on society, but also because DRH has the potential to act as a valuable indicator or proxy of wider drug-related violent crime. However, there appears to be an important gap in terms of available European data on DRH. This study aimed to identify relevant European data sources on DRH, to assess the role of drugs in national homicide data, and to assess these sources and data in terms of monitoring potential.Methods: A critical review was conducted of existing national and international homicide data sources. A three-step approach was adopted, including systematic searches for data sources and literature, snowballing methods, and contacting professionals.Results: Data on DRH is systematically prepared in the Czech Republic, Denmark, Finland, Germany, Italy, the Netherlands, Norway, Slovakia, Sweden, and the United Kingdom (England, Wales, and Scotland). Available data suggests both between- and within country variability in relation to the role of drugs in homicide events. Based on these findings, four key obstacles can be identified in terms of the current ability to monitor DRH: missing data, fragmented data, comparability issues and data quality reservations.Conclusion: To overcome these obstacles, there is a need for an international monitoring system that incorporates DRH. Ideally, the system should employ a single shared definition, standardised terminology, one coordinating body, and the use of multiple data sources. There are several approaches towards such a system, notably expanding the European Homicide Monitor (EHM) framework. Options should be explored to incorporate DRH into this existing and growing monitoring system. [ABSTRACT FROM AUTHOR]

Aims The Randomized Injectable Opioid Treatment Trial ( RIOTT) compared supervised injectable heroin ( SIH) and supervised injectable methadone ( SIM) with optimized oral methadone ( OOM) ( ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design Multi-site randomized controlled trial ( RCT) comparing SIH versus OOM and SIM versus OOM. Setting Three supervised injectable opiate clinics in England. Participants Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment ( n = 127), randomized to either SIH( n = 43), SIM( n = 42) or OOM( n = 42). All received high levels of medical and psychosocial support. Measurements Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health ( SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [ SIH = odds ratio ( OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs ( SIH = mean change £-289.43; P < 0.001; SIM = mean change £-183.41; P < 0.001; OOM = mean change £-162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £-92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM ( SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes. [ABSTRACT FROM AUTHOR]

Aims The Randomized Injectable Opioid Treatment Trial ( RIOTT) compared supervised injectable heroin ( SIH) and supervised injectable methadone ( SIM) with optimized oral methadone ( OOM) ( ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design Multi-site randomized controlled trial ( RCT) comparing SIH versus OOM and SIM versus OOM. Setting Three supervised injectable opiate clinics in England. Participants Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment ( n = 127), randomized to either SIH( n = 43), SIM( n = 42) or OOM( n = 42). All received high levels of medical and psychosocial support. Measurements Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health ( SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [ SIH = odds ratio ( OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs ( SIH = mean change £-289.43; P < 0.001; SIM = mean change £-183.41; P < 0.001; OOM = mean change £-162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £-92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM ( SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes. [ABSTRACT FROM AUTHOR]

Introduction and Aims The study investigates patients' pre-treatment expectations of, and post-treatment satisfaction with, supervised injectable opiate treatment delivered within UK's first such clinics within the Randomised Injectable Opiate Treatment Trial ( RIOTT) ( ISRCTN0133807). Design and Methods Data were collected from 127 chronic heroin addicts recruited to RIOTT and randomised to receive supervised injectable (heroin or methadone) treatment or optimised oral maintenance treatment at supervised injectable maintenance clinics in London, Darlington and Brighton. Results Of 127 RIOTT patients, 113 (89%) provided responses to structured enquiry about treatment expectations, and 94 (74%) subsequent responses about treatment satisfaction (at six months). Patients were hoping that injectable heroin treatment would: reduce substance misuse (81%); help achieve normality, routine and structure (16%); and increase education and work prospects (15%). At six months, an area of treatment satisfaction most commonly reported by all three trial groups was reduced substance misuse (supervised injectable heroin 59%, supervised injectable methadone 56%, optimised oral methadone 54%). Most found supervision acceptable, but some desired modifications were also identified. Discussion and Conclusions Patients previously considered non-responsive to treatment appear to have similar treatment expectations and aspirations as other drug users in treatment. Supervised injectable opioid treatment patients consistently reported treatment satisfaction but also that more could be done to optimise aspects of current arrangement. This raised the challenging issue of the extent to which opinions of patients need to be taken into consideration in shaping future treatment provision. Future research may need to examine the extent of expectations 'fit' and the relationship between treatment sought and received. [Groshkova T, Metrebian N, Hallam C, Charles V, Martin A, Forzisi L, Lintzeris N, Strang J. Treatment expectations and satisfaction of treatment-refractory opioid dependent patients in Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics. Drug Alcohol Rev 2013;32:566-573] [ABSTRACT FROM AUTHOR]

Introduction and Aims Sociological work on social capital and its impact on health behaviours have been translated into the addiction field in the form of 'recovery capital' as the construct for assessing individual progress on a recovery journey. Yet there has been little attempt to quantify recovery capital. The aim of the project was to create a scale that assessed addiction recovery capital. Design and Methods Initial focus group work identified and tested candidate items and domains followed by data collection from multiple sources to enable psychometric assessment of a scale measuring recovery capital. Results The scale shows moderate test-retest reliability at 1 week and acceptable concurrent validity. Principal component analysis determined single factor structure. Discussion and Conclusions The Assessment of Recovery Capital ( ARC) is a brief and easy to administer measurement of recovery capital that has acceptable psychometric properties and may be a useful complement to deficit-based assessment and outcome monitoring instruments for substance dependent individuals in and out of treatment. [ABSTRACT FROM AUTHOR]

The study was based on a peer snowballing method involving members of a service users group in Birmingham, United Kingdom, who were asked to identify and interview members of their peer networks who had achieved 'sustained recovery' of one year. Two hundred and nineteen individuals were recruited who defined themselves as being in recovery, consisting of 132 individuals in medication maintained recovery and 87 in abstinent recovery. Those in maintained recovery were more anxious about using heroin and had lower self-efficacy, worse physical health, poorer quality of life, and more peer group members still using. Being older was associated with greater quality of life (rather than time since last use) supporting a 'maturing out' hypothesis. [ABSTRACT FROM AUTHOR]

Recovery group participation is relevant to both clinical and research activity. Its measurement with the Recovery Group Participation Scale (RGPS) is an attempt to have a measurement of participation across a range of recovery groups. The factor structure, among other psychometric properties of the scale, is however, undefined. The present study examined the factor structure of the RGPS in alcohol and drug recovery populations in Birmingham and Glasgow, United Kingdom. Participants from the Birmingham (n = 219) and Glasgow (n = 205) recovery studies who had a completed form of the RGPS formed the basis for the factor structure examination. Principal component analysis extracted one factor, which accounted for 39.3% and 67.4% in the Birmingham and the Glasgow samples, respectively. Overall scores on the RGPS were associated with higher quality-of-life scores and with greater self-esteem and social networks of nonusers in recovery. The key question that remains to be addressed is the evolving role of recovery group participation in prospective studies of growth of recovery capital and sustained recovery. [ABSTRACT FROM AUTHOR]

This article examines the academic sources and origins of the 'recovery movement' in the drugs field in the United Kingdom and considers a series of disparate evidence sources that have been applied and used in this regard. Only two of these originate in traditional addictions materials-treatment outcome and cohort studies-with the remaining studies reviewed coming from a range of other areas. In particular, the sources include a switch in focus from the specialist treatment clinic to the community, and from the therapeutic to the more broadly social. The framework for this approach is explicitly developmental and attends to the published research around crime careers and addiction careers. The final sections of the article review recent UK addiction recovery research and assess where we are and what we currently know-and as a consequence the key gaps and the methodological questions that need to be addressed. [ABSTRACT FROM AUTHOR]

This review summarises the different motivational frameworks that are commonly applied to the study of substance misuse and explores the potential of a comprehensive conceptualisation of motivation based on the self-determination theory (SDT). The most prominent conceptualisations of motivation to change amongst substance misusing patients are identified. Defining and measuring the concept of motivation within a sound theoretical framework has been a challenge. The literature lends little support to the conceptualisation of motivation as internal and external types. Promising work employs a dynamic model of motivation, but empirical research based on such a framework is still in its infancy. There is empirical support to the conceptual distinction between motivation and treatment readiness and it appears that such a distinction can be particularly useful to treatment services. Clients’ motivation has significant implications for initiating and sustaining recovery, and future conceptual and methodological improvements are needed that can improve our understanding of how people change addictive behaviours and what can be done better to assist them in their attempts to recover from addiction. [ABSTRACT FROM AUTHOR]

This study employs a developmental model (Hser, Longshore, & Anglin, 2007) for mapping alcohol- and drug-using careers, following in the tradition of work done by Blomqvist (1999). Based on a rolling sample of 269 former alcohol and heroin addicts, initially reported by Best, Ghufran, Day, Ray, & Loaring (2007), this article examines differences in trajectories of careers among problem substance users and examines reasons for achieving and maintaining desistance, based on three groups: primary drinkers (n = 98), primary heroin users (n = 104), and those who reported problems with both alcohol and drugs (n = 67).Former heroin users reported more rapid escalation to problematic use but much shorter careers involving daily use than was the case in the alcohol cohort. Alcohol and heroin users also differed in their self-reported reasons for stopping use, with drinkers more likely to report work and social reasons and drug users more likely to report criminal justice factors. In sustaining abstinence, alcohol users were slightly more likely to report partner support, while drug users were more likely to report peer support and were also more likely to emphasize the need to move away from substance-using friends than was the case for former alcohol users. Users of both alcohol and heroin were least likely to cite partner factors in sustaining recovery but were more likely to need to move away from using friends and to cite stable accommodation as crucial in sustaining abstinence. Career factors would appear to vary across substance types, with multiple-substance users having trajectories that share characteristics with the primary users of each substance. Poly-drug use patterns have significant implications for our understanding of addiction careers and desistance patterns. [ABSTRACT FROM AUTHOR]

Substance misuse during pregnancy may result in harm to both mother and child. The aims of this study were to assess changes in outcomes of women seen by a specialist perinatal addictions outreach service (1989-1991 versus 2002-2005) and compare outcomes to the local hospital maternity population (2004-2005). A cross-sectional audit of health-care records was conducted comparing the outcomes of women in 2002-2005 with earlier data from 1989-1991 and the local maternity population (2004-2005). The service was attended by 126 women, of whom 83% of opioid-dependent women started/continued opioid maintenance treatment. Of 118 babies delivered, there were two stillbirths and one early neonatal death, 20% were premature, 28% were low birth weight, 21% required the Special Care Baby Unit and 21% of babies born to opioid-dependent mothers were treated for neonatal abstinence syndrome (NAS). Fewer babies required treatment for NAS in 2002-2005 compared to 1989-1991 (21% versus 44%). There were higher rates of miscarriage (3% versus <1%), low birth weight (28% versus 9%) and premature babies (20% versus 9%) compared to the local maternity population (2004-2005). Integrated perinatal addictions treatment may deliver benefits; however, engaging women into treatment earlier and reducing substance use before conception remains the objective. [Mayet S, Groshkova T, Morgan L, MacCormack T, Strang J. Drugs and pregnancy—outcomes of women engaged with a specialist perinatal outreach addictions service. Drug Alcohol Rev 2008;27:497-503] [ABSTRACT FROM AUTHOR]

Pregnant substance misusers present an increased risk to themselves and the unborn child. The aim of this study was to investigate changes in the characteristics of women referred to a specialist perinatal addictions outreach service (1989-1991 versus 2002-2005). A cross-sectional audit of health records was conducted. Information was gathered for each woman who contacted the service (2002-2005). Data were compared to an earlier study in the same locality (1989-1991). A total of 167 pregnant substance-using women were referred between 2002 and 2005, of whom 126 made contact. The mean age was 30.2 years at 20.8 weeks' fetal gestation, with 76% not in addictions treatment, 32% from black or minority ethnic (BME) communities, 49% polysubstance users and 29% homeless. The primary substance used was illicit heroin (38%), followed by cocaine (24%). Compared to 1989-1991, there were significantly more pregnant women presenting at an older age, later gestation, with increased polysubstance use and a higher percentage of women from BME communities. This service was able to access vulnerable substance-abusing women with an altered pattern of substance use compared to over 10 years previously. However, improvements are needed for engaging all referred women and accessing women at an earlier gestation. [Mayet S, Groshkova T, Morgan L, MacCormack T, Strang J. Drugs, alcohol and pregnant women—changing characteristics of women engaging with a specialist perinatal outreach addictions service. Drug Alcohol Rev 2008;27:490-496] [ABSTRACT FROM AUTHOR]

Interventions to tackle the supply of drugs are seen as standard components of illicit drug policies. Therefore drug market-related administrative data, such as seizures, price, purity and drug-related offending, are used in most countries for policy monitoring and assessment of the drug situation. International agencies, such as the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the UN Office of Drugs and Crime, also monitor and report on the drug situation cross-nationally and therefore seek to collect and make available key data in a uniform manner from the countries they cover. However, these data are not primarily collected for this purpose, which makes interpretation and comparative analysis difficult. Examples of limitations of these data sources include: the extent to which they reflect operational priorities rather than market changes; question marks over the robustness of and consistency in data collection methods, and issues around the timeliness of data availability. Such problems are compounded by cultural, social and contextual differences between countries. Making sense of such data is therefore challenging and extreme care needs to be taken using it. Nevertheless, these data provide an important window on a hidden area, so improving the quality of the data collected and expanding its scope should be a priority for those seeking to understand or monitor drug markets and supply reduction. In addition to highlighting some of the potential pitfalls in using supply indicators for comparative analysis, this paper presents a selection of options for improvements based on the current EMCDDA programme of work to improve their supply-related monitoring and analysis. The conceptual framework developed to steer this work may have wider application. Adopting this approach has the potential to provide a richer picture of drug markets, at both national and international levels, and make it easier to compare data between countries. [ABSTRACT FROM AUTHOR]

In Europe, concentrations of ∆9-tetrahydrocannabinol (THC) in cannabis resin (also known as hash) have risen markedly in the past decade, potentially increasing risks of mental health disorders. Current approaches to international drug monitoring cannot distinguish between different types of cannabis resin which may have contrasting health effects due to THC and cannabidiol (CBD) content. Here, we compared concentrations of THC and CBD in different types of cannabis resin collected in Europe (either Moroccan-type, or Dutch-type). We then tested the ability of machine learning algorithms to classify the type of cannabis resin (either Moroccan-type, or Dutch-type) using routinely collected monitoring data on THC and CBD. Finally, we applied the optimal algorithm to new samples collected in countries where the type of cannabis resin was unknown, the UK and Denmark. Results showed that overall, Dutch-type samples had higher THC (Hedges’ g = 2.39) and lower CBD (Hedges’ g = 0.81) than Moroccan-type samples. A Support Vector Machine algorithm achieved classification accuracy exceeding 95%, with little variation in this estimate, good interpretability, and plausibility. It made contrasting predictions about the type of cannabis resin collected in the UK (94% Moroccan-type; 6% Dutch-type) and Denmark (36% Moroccan-type; 64% Dutch-type). In conclusion, we provide proof-of-concept evidence for the potential of machine learning to inform international drug monitoring. Our findings should not be interpreted as objective confirmatory evidence but suggest that Dutch-type cannabis resin has higher THC concentrations than Moroccan-type cannabis resin, which may contribute to variation in drug markets and health outcomes for people who use cannabis in Europe. [ABSTRACT FROM AUTHOR]

Background: The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use. Methods: A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings. Results: The expert‐based consensus agreed upon a three‐layered hierarchical framework. Each layer—universal measures, detailed self‐report and biological measures—reflected different research priorities and minimum standards, costs and ease of implementation. Additional work is needed to develop valid and precise assessments. Conclusions: Consistent use of the proposed framework across research, public health, clinical practice and medical settings would facilitate harmonisation of international evidence on cannabis consumption, related harms and approaches to their mitigation. [ABSTRACT FROM AUTHOR]

The iCannToolkit is a first important step to systematically gather evidence regarding the health effects of contemporary medical and non-medical cannabis use—over time, among licit and illicit settings, cultures and age groups—in order to inform policy development and to raise awareness concerning cannabis use-related risks and benefits. [ABSTRACT FROM AUTHOR]

The term ‘quality’ is ambiguous when referring to illicit drug sales, and cautious use is required in the context of a discussion of harms. Monitoring of the future trajectories for darknet markets and their implications will be important going forward. [ABSTRACT FROM AUTHOR]

Background: It has been long established that achieving recovery from an alcohol or other drug use disorder is associated with increased biobehavioral stress. To enhance the chances of recovery, a variety of psychological, physical, social, and environmental resources, known as "recovery capital", are deemed important as they can help mitigate this high stress burden. A 50-item measure of recovery capital was developed (Assessment of Recovery Capital [ARC]), with 10 subscales; however, a briefer version could enhance further deployment in research and busy clinical/recovery support service settings. To help increase utility of the measure, the goal of the current study was to create a shorter version using Item Response Theory models.Method: Items were pooled from the original treatment samples from Scotland and Australia (N=450) for scale reduction. A reduced version was tested in an independent sample (N=123), and a Receiver Operating Characteristic Curve was constructed to determine optimal cut-off for sustained remission (>12months abstinence).Results: An abbreviated 10-item measure of recovery capital captured item representation from all 10 original subscales, was invariant across participant's locality and gender, had high internal consistency (α=.90), concurrent validity with the original measure (rpb=.90), and predictive validity with sustained remission using a cut-off score of 47.Conclusion: The brief assessment of recovery capital 10-item version (BARC-10) concisely measures a single unified dimension of recovery capital that may have utility for researchers, clinicians, and recovery support services. [ABSTRACT FROM AUTHOR]

Introduction and methods: Hepatitis C virus (HCV) infections are highly prevalent amongst people who inject drugs (PWID). Despite well documented evidence of its effectiveness, suggested cost-effectiveness, and potential to reduce HCV prevalence rates, the uptake of antiviral HCV treatment by PWID is low. This nonsystematic literature review describes factors associated with the uptake, adherence, and efficacy of HCV treatment among PWID and discusses strategies to increase their uptake of treatment. Results: Low HCV treatment uptake among PWID is associated with a number of patient-related and provider-related barriers. Beliefs and fears about low efficacy and adverse effects on the patient's part are common. A substantial number of factors are associated with the chaotic lifestyle and altered social functioning of PWID, which are often associated with decompensation or relapsing into drug addiction. This may lead to perceived low adherence with treatment and low efficacy on the provider's part too, where lack of support, inadequate management of addiction, and other drug-related problems and poor treatment of side effects have been described. Practical issues such as the accessibility of treatment and finances also play a role. Strategies to improve the HCV treatment rate among PWID involve pretreatment management and assessment, a multidisciplinary approach, management of side effects, and enhanced education and counseling. Conclusion: Specific factors are associated with poorer treatment outcomes in PWID on the side of both the patient and the treatment system. However, given that PWID can achieve treatment adherence and sustained virologic response rates comparable with those in nondrug users, drug use per se should not be considered a criterion for exclusion from treatment. Further development of measures leading to higher uptake of treatment and adherence in PWID and appropriate adaptation of HCV treatment guidelines represent important tools in this regard. [ABSTRACT FROM AUTHOR]

The UK Drug Strategy has embraced the philosophy of recovery as an “individual, person-centered journey” (Her Majesty's [HM] Government, 2010, p. 19) and is supported by a local network of recovery champions. The purpose of this article is to examine proactive attempts at establishing such networks based on training and working with a mixture of people in recovery and professionals, supported by a local recovery leader. What is presented in this article is a case study of an initiative attempting to access and link recovery champions. The early stages of the initiative were planned in advance, but the later stages were evolutionary and were based on the decisions of the emerging recovery champions group. The initiative started with a series of workshops to raise awareness about recovery, and from this, to recruit an initial group of candidate champions. Small groups were successfully recruited to participate in subsequent champions workshops, and they have since translated that commitment to a range of actions and directions, which have attempted to generate a visible recovery community and to challenge stereotypes and stigma perceptions. The final section of the article will review the utility of the label of “recovery champion” and will examine the role of such networks in enabling and supporting the emergence of a local culture of recovery. [ABSTRACT FROM PUBLISHER]

There is a growing literature that seeks to evaluate the role of “recovery capital” in the resolution of substance use disorders. In this study, a structured instrument (the Assessment of Recovery Capital), along with an assessment of social networks among 176 former illicit drug users and drinkers, is measured in three locations in England. There were relationships between recovery capital and vocational activity (training or employment), physical health, psychological health, and overall quality of life, with larger social networks associated with enhanced personal and social recovery capital. The study demonstrates high levels of personal and social well-being—manifesting in engagement in community activities and strong social networks—among persons engaged in recovery support activities that was not linked to time in recovery. [ABSTRACT FROM PUBLISHER]

Introduction and Aims. The study investigates what 'recovery' means for those who describe themselves as in alcohol or drug recovery. Design and Methods. The project used multiple methods-snowballing, recruitment through recovery groups and advertisements in local press-to recruit 205 people (107 in alcohol and 98 in heroin recovery) who reported a lifetime dependence on alcohol and/or heroin; had not used their primary substance in the last year and perceived themselves to be either recovered or in recovery. They were interviewed by researchers using a structured questionnaire reported in the current paper and a semi-structured interview reported elsewhere. Results. The average time dependent for heroin users was 10.8 years and for drinkers 15.7 years, but onset and desistance were earlier for heroin. Longer time since last use of alcohol or heroin was associated with better quality of life. Greater engagement in meaningful activities was associated with better functioning, and was associated with quality of life, followed by number of peers in recovery in the social network. Heroin users in abstinent recovery generally reported better functioning than those in maintained recovery. Discussion and Conclusions. Recovery experiences vary widely, but better functioning is typically reported after longer periods and is associated with supportive peer groups and more engagement in meaningful activities, and supports models promoting the development of peer networks immersed in local communities.[Best D, Gow J, Knox T, Taylor A, Groshkova T, White W. Mapping the recovery stories of drinkers and drug users in Glasgow: Quality of life and its associations with measures of recovery capital. Drug Alcohol Rev 2012;31:334-341] [ABSTRACT FROM AUTHOR]

In both Scotland and England, the current drug strategies (HM Government, 2008; Scottish Government, 2008) have demonstrated a clear commitment to an integrated recovery-oriented model of treatment for drug problems, which represents a significant change in focus toward a more person-centered and individualized philosophy for the delivery of drug treatment in the United Kingdom. This change has met with some resistance from a range of professionals in the United Kingdom, and the purpose of the article is to make explicit these concerns and objections, classify them, and examine their foundations. A group of UK academics, policymakers, and practitioners, who met under the auspices of the UK Recovery Academy, agreed to collate a list of objections to the viability of recovery approaches in the addiction field and to assess the merits of each concern. This process resulted in a total of 26 objections that are reviewed. The article concludes with an overview of the questions remaining unanswered in the United Kingdom and an assessment of the position of the 'recovery movement' in the UK addictions field. [ABSTRACT FROM AUTHOR]

The article focuses on a study which compared the effectiveness of supervised injectable treatment with medicinal heroin or supervised injectable methadone and optimized oral methadone for chronic heroin addiction. The study included 301 chronic heroin addicts who were randomized to receive either injectable methadone, injectable heroin or oral methadone. It found that the use of supervised injectable heroin is associated with reduced use of street heroin, compared to supervised injectable methadone and optimized oral methadone. Study authors concluded that the British government should support heroin maintenance treatment for chronic heroin addicts.