While critical research on drug consumption predates critical drug studies by decades, we argue that the field is now stabilised enough as an entity to be named in academic publications, researcher biographies and course syllabi. Therefore, the 2025 Contemporary Drug Problems conference offered an opportunity to reflect on and interrogate what critical drug studies is and what it might become. Is it a bounded field (as enacted in this abstract and recent publications), and if so, what is included and excluded by its boundaries? Or is it better thought of as an approach, a methodology, a political ethos? What are its founding assumptions? What makes it coherent? What does it mean to do critical drug studies? To organise this admittedly inchoate mix of descriptive and normative concerns, we will address each element of the name: What makes the field critical and what should we be critical of? What substances, objects and other forces are included in its foundational category of drug and what do they have in common? And what kinds of studies are carried out by critical drug scholars and where should we turn our attention to in the future?
People who use drugs may experience comprehensive distrust in other people due to drug-related stigma and other violating experiences in services and in their life course. This may prevent them from seeking help. The goal of strengthening trust in services has been supported in street-based outreach work that aims to reach people who use drugs outside services. This discursive study analyses outreach work service user and worker interviews conducted in Finland from 2021 to 2023, asking: How do people who use drugs reflect on the meanings of trust and the risks associated with it in the interviews? What kinds of features and qualities do they associate with trustworthy outreach work encounters? How do outreach workers reflect the promotion of a trustworthy atmosphere in those encounters in the interviews? The service users constructed comprehensive distrust of several parties in their personal relationships, service systems, and society. Despite these trust-related risks they face, they constructed outreach work as trusted without question and built strong partnerships with the workers. According to service users, they were able to be honest and vulnerable with outreach workers without fear of being punished; their needs were taken seriously, and they were supported comprehensively. Workers’ reflections included verbal, bodily, practical, and choice-making strategies through which they situationally promoted trustworthy atmospheres in individual encounters. The service users’ accounts of what kind of features or qualities they considered trustworthy were in line with the workers’ strategies in building a trustworthy atmosphere in practice. To conclude, outreach work is a crucial link between the service system and people who use drugs experiencing comprehensive distrust, with the ability to build needed chains of trust between them and services. Outreach workers’ trustworthiness strategies should be widely applied in services to reach people outside service systems and to comprehensively reduce drug-related harm.
Prohibition remains the dominant policy response to drug use in Australia, with methamphetamine possession and use considered criminal offences. Despite claims that criminalisation deters use and protects community safety, global evidence suggests punitive approaches generate a cascade of social harms that disproportionately impact people who use drugs. Methamphetamine use in Australia is more prevalent in rural and regional areas than in metropolitan centres, and Australia has one of the highest rates of methamphetamine use globally, with use more prevalent among people subject to criminalisation and other forms of criminal legal contact. This study draws on 23 qualitative interviews with people who smoke methamphetamine in rural and regional Victoria, conducted between February and July 2024, to examine how criminalisation shapes everyday life. Guided by a social harm approach, the analysis centres the harms produced by prohibition, law, and institutional responses, rather than treating criminalisation as a neutral response to drug-related harm. Findings highlighted how policing, stigma, and limited health and social service infrastructure intersected to sustain cycles of surveillance, punishment, and exclusion, extending criminalisation well beyond formal legal sanctions. Many reported being permanently marked as ‘suspects’, subject to repeated police attention, and drawn into revolving sequences of arrest, court appearances, sentencing, and re-sentencing through community orders that were often difficult to meet in rural and regional contexts. For Aboriginal participants, these dynamics were further intensified by racialised policing and the enduring effects of colonial governance, compounding the harms of criminalisation in settings where access to care was already limited. Overall, findings demonstrate how prohibitionist drug laws in rural and regional settings magnify inequality, entrench stigma, and sustain cycles of punishment and control for people who use methamphetamine, rather than alleviating drug-related harm.
Tobacconists occupy a complex ethical position as legal retailers of harmful products and both participants and victims of the growing illicit tobacco trade (ITT) in Australia. This study explores the personal and professional ethics of Australian tobacconists in relation to the conduct of their business, and perspectives on ITT and customer behaviours. Qualitative ethnographic interviews were conducted with 12 tobacconist staff, owners, and managers. Drawing on theories of moral disengagement, moral drift, and harm reframing, we examine how participants justify tobacco retailing through strategies such as responsibility diffusion and strategic attribution of agency. Personal freedom and individual choice are often invoked to resolve conflicts within participant's personal ethics and reconstruct tobacco use as an exercise of autonomy. These narratives reflect broader debates in addiction science and drug policy and complicate the binary of moral actor versus industry proxy. Understanding these complexities within the ethics of tobacconists is essential to designing policies that engage retailers constructively in achieving the tobacco endgame.
The initial research enquiry concerned the political and social context of national drug policy reform. Why and how have some jurisdictions boldly contravened the international criminalization consensus set out in the United Nations 1961 Single Convention on Drugs and decriminalized cannabis, and in some cases, other controlled drugs? A qualitative case study using Malta as a small-scale (population N = 545,000) reform jurisdiction set us on a different path, exploring obstacles to the consolidation of national decriminalization initiatives after legal change. Key informant interviews in Malta (N=12) emphasized the difficulties of resetting the national political consensus. The question that emerged was not why was Malta one of the first countries to legalize, but why has progress stalled? To address this question, our analysis drew on the Advocacy Coalition Framework and the Historical Institutionalist approach. We found that progress had stalled not due to coalition behavior alone. Our analysis highlights the important role of past institutional choices, elite bargains and administrative structures in not only containing cannabis decriminalization in Malta but shaping the political forces that threaten to roll it back.
Public health research reports “alarming” levels of “risky,” or even “hazardous,” alcohol consumption among the female-dominated and historically-feminized professions of nursing and midwifery. Accounts of these practices presuppose alcohol as inherently harmful and largely enact the drinking of nurses and midwives as a maladaptive response to “cope” with the demands of a high-stress occupation. Relaying a boundary of acceptable/unacceptable and healthy/harmful responses to professional demands, we argue that such accounts minimize or erase agency and pleasure while simultaneously reiterating familiar gendered discourses of women as vulnerable. Mobilizing a narcofeminist approach that attends to the creative, liberatory, and life-affirming possibilities of psychoactive substance consumption, we analyze data drawn from interviews with 25 nurses and midwives about drinking with their colleagues. In a workforce shaped by gendered expectations of comportment and care, and normative notions of health, we examine how nurses and midwives negotiate and navigate multiple boundaries—healthy and harmful, professional and personal, appropriate practices of care, and expectations of femininity and motherhood—through and with alcohol. Centering the above tensions, our analysis illuminates how drinking together with colleagues fosters camaraderie and solidarity, plays a supportive and productive role in nurturing professional relationships and, more broadly, can be liberating and generative of a life well-lived. In conclusion, we argue that rather than reducing the drinking of nurses and midwives to a maladaptive and straightforwardly harmful effort to “cope” with work, it is better understood as part of work itself.
Canadian postsecondary students indicate high rates of cannabis use and often report therapeutic motives—using cannabis to manage mental or physical health. In quantitative studies using postsecondary student samples, therapeutic cannabis motives have been associated with more frequent and problematic cannabis use; however, these findings do not offer insight into the subjective experiences and underlying context influencing how and why postsecondary students use cannabis to manage specific aspects of their health. As such, this qualitative study explored postsecondary students’ therapeutic motives for cannabis use and factors that may influence these motives. Participants were 14 emerging adult postsecondary students in Newfoundland and Labrador, Canada, who reported using cannabis to manage their health and well-being. Semi-structured interviews were conducted, and transcripts underwent an inductive thematic analysis. Students in this study described using cannabis to manage stress, reduce anxiety, slow thoughts, and regulate emotions. Cannabis was also used to improve sleep, reduce pain, and manage nausea and appetite. While students discussed using cannabis to manage their mental health, they often expressed uncertainty about whether cannabis ameliorated or worsened their psychological well-being. Students also highlighted factors associated with increased cannabis use, including intensity of health symptoms and academic pressure. The results highlight that Canadian postsecondary students use cannabis to manage diverse health concerns, often in ways not supported by clinical evidence. These findings may be relevant to healthcare professionals, as a better understanding of postsecondary students’ cannabis motives may assist in the identification, prevention and treatment of problematic cannabis use. Further, the results indicate that postsecondary students require education on the potential harms of cannabis, as well as increased access to healthcare and alternative coping strategies for mental health and stress management.
Introduction While precise data are limited, approximately 75% of prisoners in various Iranian prisons report using drugs while incarcerated. Previous research has primarily focused on the intersection of incarceration, injection drug use, and infectious diseases, with less attention paid to the subcultural forces and institutional practices that shape prisoners' substance use. The guiding research question of this study is: How do prisoners experience and navigate drug use within Iranian prisons?Method Grounded theory was utilized to examine how drug use is reinforced and functions within the prison environment. Data were collected through semistructured interviews with 60 participants (38 men and 22 women), aged 15-65, most of whom had been incarcerated for drug-related offences. Participants were recruited through snowball, maximum variation, and theoretical sampling techniques across both governmental and non-governmental settings.Findings Five key categories emerged: coerced conformity, addiction as governance, access and supply, polydrug use pattern, and struggle for sobriety. Prisoners are coerced to conform to drug use to maintain their social status and avoid isolation, while prison authorities appeared to tolerate drug use as a means of managing institutional behavior. Methadone Maintenance Treatment functioned less as a pathway to recovery and more as a practical tool to stabilize inmates and reduce violence, often coexisting alongside widespread illicit drug availability. Finally, attempts to recovery were constrained by subcultural and structural barriers, with success limited to a small minority of participants.Conclusion The study reveals that incarceration itself perpetuates and intensifies substance use, functioning as a mechanism of survival, social integration, and institutional control. Findings indicate that therapeutic efforts of prisons in response to drug-related offences face significant subcultural, structural, and institutional barriers, underscoring the urgent need for more humane, effective, evidence-based approaches to drug use dependency that extend beyond the confines of correctional institutions.
In April 2024, Germany legalized cannabis for recreational use. Due to the country's obligation to comply with international treaties, the German government agreed on limited noncommercial cultivation and approved scientific pilot trials for commercial distribution. In addition to curbing the illegal cannabis market, German politicians cite the protection of youth from contaminated, highly potent, or synthetic products as the main argument for partial legalization. Sixteen- and seventeen-year-olds, who make up a significant proportion of people using cannabis in Germany, are excluded from legal access. Many who nevertheless choose to consume cannabis will continue to turn to the illegal market. This essay addresses the gap in current youth-focused cannabis prevention that arises from the general exclusion of minors from regulated access to cannabis and the simultaneous lack of prevention models tailored to the new political landscape and the realities of young people. It examines international research results on the neuropsychological risks of cannabis use and the effectiveness of drug prevention for adolescents and discusses the principles of risk-competent substance use. On this basis, a pragmatic approach to harm prevention is proposed that is oriented toward German youth alcohol policy: Under strictly regulated dispensing conditions, 16- and 17-year-olds can obtain limited quantities of quality-tested, tetrahydrocannabinol (THC)-reduced cannabis products. Before acquisition, a qualified person who is trusted by young people conducts an open, unbiased dialogue with the youth about individual consumption risks, encourages nonconsumption, and informs about the principles of risk-competent substance use. In this way, prevention can specifically target cannabis-using adolescents who are generally difficult to reach. As part of a global paradigm shift in cannabis policy, this harm prevention approach could be considered for international implementation as well as in relation to juvenile alcohol use.
This article examines how rural conditions are enacted differently across substance use situations among young people. Drawing on actor-network theory, the analysis traces how rural conditions manifest in specific ways rather than operating as a unified contextual backdrop. Based on qualitative interviews with young people in rural Denmark, the analysis examines two substance use sites in depth: a harbor shed and a camper van. In the shed, rurality is enacted as seclusion from adult oversight, a scarcity of youth venues, material arrangements that make the place usable across seasons, and aesthetic appreciation of outdoor space, enabling longer and wilder gatherings sustained by established local peer networks. In the camper van, rurality is enacted as distance between friends, limited transport, and economic constraints that make commercial venues prohibitive, pushing gatherings into planned weekends with sleepovers, while proximity to parents requires privacy to be actively produced through material arrangements. The analysis also shows that substances do not have stable effects. In the shed, alcohol intensifies sociality and prolongs gatherings, while cannabis shortens them by making bodies want to leave. In the camper van, alcohol reaches limits such as fatigue and loss of control that are managed through cocaine, which extends alertness and enables intimate conversation into the morning. The article concludes that neither rural conditions nor substance effects can be assumed in advance; both are produced through specific arrangements and vary across situations.
Police-led drug diversion (PDD) schemes can divert individuals caught in possession of controlled substances away from the harms associated with criminal justice pathways and toward treatment, education, or welfare support. As an alternative to prosecution, it has been established that the use of well-implemented diversion schemes may lead to reductions in reoffending, efficiencies in police time, and reductions in costs for the wider criminal justice system. However, there has been insufficient evidence to draw conclusions about the role that needs assessments play in achieving the desired aims of PDD. This paper analyzes how three PDD schemes in England provide opportunities for individuals to make life-improving changes, focusing on the role of needs assessments. Adopting a realist framework to evaluate diversion schemes in three police forces, we carried out semistructured interviews with police officers, diversion staff, individuals who had been diverted, and other stakeholders. We identified multiple opportunities to assess the needs of people who use drugs. This included the initial interaction with the police, subsequent screening processes (often referred to as “triage”), and at other points of interaction with the diversion service provider. While all schemes provided opportunities for the diverted individual to receive relevant support, there was considerable variation in how this was made available. PDD scheme components included: the duration of the program; the process of referrals to other services; the nature of support; the level of handholding and signposting; and how the support matched the individual's specific needs. Despite variation across police forces, PDD schemes can provide opportunities which enable people who use drugs to begin to recognize, communicate, or acknowledge their own needs. Our findings suggest that the breadth of harm reduction claims—which are central to many PDD scheme aims—can be better realized when assessment of individual needs leads to tailored support and meaningful engagement with health and wider social services.
While harm reduction has become increasingly embedded in urban drug policy across Europe, its local implementation remains a site of tension and controversy. Despite being backed by strong public health evidence, harm reduction services (e.g., drug consumption rooms, opioid agonist treatment centers) intersect with contested urban dynamics and diverging stakeholder expectations. This study explores how harm reduction services are perceived within the socio-spatial fabric of four cities in Belgium: Brussels, Li & egrave;ge, Ghent, and Antwerp. Twelve focus group discussions were conducted with local residents, social and healthcare professionals, and local authorities (n = 95 participants). Data were thematically analyzed, with attention to how harm reduction is framed in relation to care, safety, and urban governance. Three intersecting themes emerged. First, services were seen as essential infrastructures of care for people who use drugs in highly precarious situations. Second, they also provoked socio-spatial tensions around perceptions of nuisance, neighborhood livability, and the appropriate place of such services in the city. These tensions were shaped by differing stakeholder narratives, emphasizing public safety, health, or human rights. Third, participants underlined the need for cross-sector collaboration and more inclusive community engagement in decision-making. Overall, harm reduction services operate at the intersection of care, control, and contested urban belonging. Moving beyond binary notions of support or resistance, this study points to the importance of context-sensitive strategies that embed harm reduction within broader urban policy, social investment, and participatory governance.
In the United States, overdose fatalities involving opioids declined from 83,140 in 2023 to 54,743 in 2024—the largest single-year decline ever recorded and the fewest total drug deaths since 2019. The decline has been attributed in part to expanded access to harm reduction technologies to mitigate addiction and overdose, including expanded access to naloxone. We analyzed data on beliefs about opioid overdose reversals with naloxone among a subset of first responders in Pennsylvania, drawing from qualitative interviews with 20 emergency medical technicians, conducted in the south-central region of the Commonwealth. Participants were asked about their perceptions of the opioid problem, the challenges experienced when administering naloxone and during the pre-hospital phase generally, and their perceptions of overdose patients. Our findings reveal stigmatizing beliefs about patients who experience overdose and highlight the need for further education on naloxone's role in mitigating opioid-involved overdose regarding three principal areas: polydrug use and drug myths, recalcitrant patients, and iatrogenic harms/system-related deficits. We conclude by discussing the implications of these findings for education efforts directed toward first responders.
Substance-involved sexual violence is common and has been well studied, but less research has examined sexual violence that occurs within a criminalized drug context. A small body of research has shown how sexual violence happens within a criminalized drug-using context (i.e., injection drug use), but has not broadly connected drug criminalization as a facilitator of sexual violence. The present study uses qualitative interviews ( N = 14) with a community sample of drug-involved sexual assault survivors who were using drugs during the assault in a criminalized context to investigate whether drug criminalization is a facilitator of sexual violence. Results revealed that the criminalized drug context can facilitate sexual violence, particularly given that most of the sample relied on men for access to those drugs. Additionally, findings show that criminalized drugs impact survivors in terms of impairment and emotions felt during the assault but do not impact the communication of non-consent. Implications around consent education, harm reduction education, and “safe supply” regulation efforts are discussed.
Research on opioids predominantly focuses on risks and harms, and there is less research on pleasures, including those experienced while overdosing (e.g., nodding off and losing consciousness). While it is important to identify positive experiences from opioids, static and binary thinking about the use of opioids and their effects (i.e., pleasure vs. harm) does not capture the turbulences of the lived experience. This article draws from an interpretive phenomenology involving individual interviews among 20 people who use opioids in two small urban settings in Ontario, Canada. The focus of the study was on pleasure and euphoria. Participants described disorderly experiences seeking out and consuming potent drugs with unknown contents and varied outcomes, yet there were also imbedded elements of order. Through their daily use, they described the effects of getting high, including overdosing, as pleasurable. However, this was not a static state. Participant experiences of “coming to” were turbulent and involved both order and disorder. The inconsistencies in coming to were shaped by social and spatial dynamics. These experiences complicate dominant narratives on euphoria and overdose and illustrate continuums of both disorder and order—an in-betweenness. Deleuze and Guattari's conceptualization of chaosmos is helpful in understanding the constant state of flux of opioid use and its effects and these findings challenge the pleasure/harm binary in drug policy research.
This study examines the integration of artificial intelligence (AI) into liberal drug policy frameworks, focusing on its emerging applications, normative implications, and governance challenges. Drawing on an intersection-focused qualitative evidence synthesis combined with comparative case study analysis, the study synthesizes emerging applications in drug-use monitoring, regulated supply-chain oversight, and harm reduction. While AI offers significant potential to enhance policy responsiveness and regulatory efficiency, its deployment also raises critical concerns related to algorithmic bias, data protection, and institutional accountability. To address these tensions, the study proposes a multidimensional evaluative framework based on five criteria: effectiveness, fairness, transparency, privacy protection, and ethical alignment. The findings underscore the need for context-sensitive regulatory mechanisms that safeguard human rights, enable participatory oversight, and mitigate algorithmic harms. By integrating normative theory with structured evidence screening and comparative analysis, the study contributes a conceptually grounded framework for evaluating AI-driven governance in high-stakes public health and regulatory contexts.
The criminalization of illicit/unregulated drug distribution as "drug trafficking" has grown increasingly entangled with rhetoric and allegations of "human trafficking," producing a convergence of how trafficking across policy domains is understood and regulated by the state. This commentary traces three critical parallels across state drug and human trafficking frameworks: (1) racialized constructions of the "trafficker," (2) erasure of structural determinants of participation in informal economies, and (3) reliance on binary victim-perpetrator representations. The commentary draws on empirical research based primarily in Ontario, Canada, that involved 41 interviews with people who use drugs charged with drug offences, frontline harm reduction workers, criminal defense lawyers, and drug policy experts as a point of departure to interrogate wider structural and discursive trends in the governance of criminalized economies. Our argument is twofold: first, that the premise of "the trafficker" and use of "trafficking" as an organizing framework produces various harms across different sites of policy and practice, and second, that policymakers and harm reduction practitioners must resist the growing discursive slippage that entangles drug and human trafficking in the name of protection. Resisting trafficking frameworks is thus a policy imperative, as they erode fragile rights safeguards, consolidate carceral and racialized governance regimes, and foreclose alternative approaches that address the structural conditions shaping involvement in drug economies.
The incorporation of harm reduction into public policy has tended to be framed as replacing the dominance of criminal legal approaches to drug use with public health frameworks. However, little consideration has been given to the ways in which continued reliance on, and proximity to, the state remains problematic for the communities most harshly impacted by carceral systems. Reflecting on this tension, we draw on the work of community organizer Shira Hassan and her call for a return to the liberatory politics of the "original harm reductionists." This paper explores the similarities between what Hassan refers to as Liberatory Harm Reduction and the long-standing traditions of Black, Indigenous, and people of color community organizing to defund the police and abolish prisons. Liberatory Harm Reduction and abolitionist movements share a structural analysis that the cruelty and racism of the carceral system is not evidence that it is broken, but rather that it is working as intended-to secure and (re)produce a social ordering of society based on colonial, raced, classed, and gendered systems of power. The paper brings together Liberatory Harm Reduction and abolitionist theorizing to invite deeper thinking around how much contemporary harm reduction results in differential and often unconsidered harms. In the paper, we ask what kind of public health harm reduction could be considered liberatory, and, by extension, what kind of harm reduction practices belong on the road toward, what Mariame Kaba calls, the abolitionist horizon? We explore these questions through case studies on diversion, peer-led safe spaces, and prison-based needle and syringe programs to demonstrate the issues, tensions, and liberatory possibilities of harm reduction across the spectrum of proximity to state apparatuses.
This study analyzes Puerto Rico's digital media coverage of the overdose crisis through framing and positioning analyses of 129 articles from the top three newspapers between 2015 and 2024. Four frames were identified: Overdose and Public Health (14.7%), Health Policies and State Responsibility (23.3%), Criminalization and Morality (22.5%), and Health and Opioid Interventions (39.5%). The study found four main narratives that assign blame, risks, and solutions, shaping subjectivities and moral orders: Youth Positioning of Drug Initiation as an autobiographical account of starting opioid use; Combative Subject, representing the normalization of recovery as an ongoing effort; Police Hero, legitimizing punishment and externalizing blame; and Moral Pharmacist Entrepreneur, reinforcing surveillance practices and promoting the agenda toward benzodiazepines and tighter drug prescription and distribution controls. The findings reveal a hybrid discursive landscape in which health-related logics coexist with criminalizing rhetoric, reflecting tensions in how the overdose crisis is defined, governed, and morally negotiated in Puerto Rico.
Psychedelics are being used globally in a variety of contexts, from recreational use to controlled clinical trials of therapeutic applications. Much of what is known about psychedelic user experiences comes from quantitative studies, while qualitative research is limited and has received comparatively less attention. Qualitative research, particularly personal narratives, can highlight the nuanced impact users have experienced, which quantitative research may be unable to capture. The present study is an exploratory analysis of qualitative responses from the Global Psychedelic Survey 2023, aimed at addressing the gap between quantitative and qualitative literature in naturalistic psychedelic use. Using inductive thematic analysis, three common themes in participants' accounts of their psychedelic experiences were identified: perceived therapeutic outcomes, enhanced psychological wellbeing and personal development, and profound shifts in life perspective and meaning. Such narratives bring forth detailed accounts of the impact psychedelic users have experienced, as well as potential risks associated with and experienced by participants. Findings are discussed in the context of harm reduction, public policy, and future inquiry into psychedelic substances for health applications.
