Purpose Spanning almost 30 years, Italy’s experience with take-home-naloxone (THN) provides an interesting case study on the international scene because of its specific history, regulation and trends in overdose (OD) rates. Accordingly, this study aims to contribute to the evidence base for THN and its delivery in a different setting. Design/methodology/approach The study focuses on service providers’ perceptions of the benefits, risks and barriers associated with THN provision. Data was collected using a mixed-methods approach as follows: an online structured questionnaire (no. of respondents = 63) and two focus groups (no. of total participants = 18). Findings Findings show that service providers believe the benefits of THN far outweigh the risks and accrue to services, as well as users. The study also suggests that the barriers in Italy are mostly ideological and political, and illustrates how resistance to administering THN can re-emerge when ODs are no longer a social emergency. Furthermore, the study found that health and social workers have different attitudes which are also reflected at the level of public and private services, thereby shaping slightly different models of THN supply. Originality/value The study suggests that barriers associated to THN are more ideological and political rather than concrete, which explains why, even where it seems long established, can easily re-emerge once ODs are no longer a social emergency.
Purpose International policy approaches to cannabis production and use are changing rapidly, and within the Irish context, alternatives to prohibition are being considered. This study aims to explore policymaker’s attitudes towards the decriminalisation and legal regulation of cannabis for recreational use in the midst of an unfolding policy process, examining the degree which a “policy window” might be open for the implementation of cannabis policy change. Design/methodology/approach Semi-structured interviews were held with eight key informants within the policy field in Dublin, Ireland. Kingdon’s (2014) Multiple Streams framework was used to consider whether the problems, policy and political streams were aligning to support progressive policy change. Findings Irish policymakers indicated broad support for the decriminalisation of cannabis. The legal regulation of cannabis received more qualified support. Existing policy was heavily criticised with criminalisation identified as a clear failure. Of particular interest was the willingness of policymakers to offer opinions which contrasted with the policy positions of their organisations. While a policy window did open – and close – subsequent governmental commitments to examine the issue of drugs policy in a more deliberative process in the near future highlight the incremental nature of policy change. Originality/value This study provides unique insight into the opinions of policymakers in the midst of a prolonged period of policy evolution. A latent aspiration for historical policy change was situated within the realpolitik of more traditional approaches to policy development, demonstrating that the alignment of Kingdon’s (2014) problem, policy and political streams are essential for change in cannabis policy.
Purpose Public support for various policy options for managing cannabis in the Caribbean and the characteristics of those most likely to support specific policy options remains largely unknown. The purpose of this study is to investigate the impact of age, sex and employment status on the public attitudes towards the full legalisation of cannabis, partial legalisation (that is for medical or religious purposes) or its continued prohibition. Design/methodology/approach Using secondary data collected from nationally representative public opinion polls conducted by Caribbean Research and Development Services from 2016-2018, this paper compares the public attitudes towards cannabis in Barbados, St. Vincent and the Grenadines, St. Lucia, Antigua and Barbuda and Dominica using a multinomial logistic model. Findings Support for the continued prohibition, legalisation or partial legalisation of cannabis varied significantly by age, employment status and country of residence. Women, people over 51 years of age and the employed were more likely to support full prohibition. Attitudes towards cannabis policy in the Caribbean are by no means homogenous, neither are the policy shifts occurring across the region, with some of these changes occurring slowly and not necessarily reflective of cultural dynamics. Originality/value This study is unique in its cross-country analysis in the Caribbean and providing valuable insight into the levels public support for cannabis legalisation. Its findings can help shape targeted public education in these countries.
Purpose This study aimed to understand the extent to which cannabis-related risk perception and COVID-19-related health worries were associated with the reported reduction in sharing cannabis smoking products to mitigate the risk of the coronavirus transmission or infection. This association was tested in two different periods in terms of toughness of national lockdown policy imposed in the first months of the pandemic in Israel. Design/methodology/approach The study population included adult recreational cannabis users who completed one of the two online cross-sectional surveys dedicated to COVID-19 and the cannabis use situation in Israel in the first half of the 2020. The two surveys were conducted six weeks apart. One survey was conducted in the period when strict lockdown measures were in place (N1 = 376). The other survey was conducted in the period when many lockdown measures were lifted (N2 = 284). Differences between the samples regarding risk perception, health stressors and reduction in sharing cannabis products were assessed using t-test. Regression analysis was used to test the independent correlates of reported reduction in sharing cannabis products. Findings Means of risk perception, health stressors and reported reduction in sharing cannabis products were higher in the sample surveyed in the period of the strict lockdown measures than in the sample surveyed in the period of eased lockdown measures. Risk perception was associated with reported reduction in sharing cannabis products only in the sample surveyed in the period of strict lockdown measures. In contrast, health stressors were related to reported reduction in sharing cannabis products in both samples. Social implications Health stressors may represent a more stable mechanism by which cannabis users engage in protective behavior during the pandemic than risk perceptions. Originality/value To the best of the authors’ knowledge, the current research is one of the first studies that examine the associations among risk perception, primary stressors and protective behavior in recreational cannabis users while referring to cannabis-related behavior other than use.
Purpose This paper aims to explore how enforced forms of social isolation arising from the first COVID-19 lockdown influenced experiences of problem substance use, relapse and coping strategies for recovery in individuals engaging with harm reduction recovery services. Design/methodology/approach A qualitative semi-structured interview design was adopted for this research. Seven participants were recruited from a harm reduction recovery organisation. During their initial interview, participants volunteered information regarding their experience of the first lockdown due to emerging concerns of the COVID-19 pandemic. Participants completed a second semi-structured interview at the end of the first lockdown regarding their experience of enforced isolation during this time. Findings Three themes identified from the analysis were isolation resulting in hindered human capabilities; adjusting to a new normal: an individual experience; and unexpected benefits to recovery resulting from isolation. While some participants reported boredom, loneliness and relapse events, others reported that the national response to the virus did not adversely affect them as they had already adjusted to living in a state of anxiety, isolation and uncertainty. These findings illuminate negative, neutral and positive aspects of substance use recovery throughout the COVID-19 lockdown as well as highlighting the complex and individualised role that social connectedness plays in relapse occurrence. Originality/value Participants reported differences in how they were affected by the pandemic, leading to theoretical implications for the effect of social isolation on recovery. For this reason, individuals with a history of dependency should be considered potentially vulnerable to the effects of enforced isolation and should be supported accordingly.
The purpose of this paper is to review the conceptual and methodological challenges of a J-shaped association between alcohol consumption (AC), coronary heart disease (CHD) and all-cause mortality. In associated papers in this journal, Skovenborg et al., 2021 reviews the evidence for the J-shaped curve, and Ellison et al., 2021 examines the advantages and drawbacks of Mendelian randomization studies of the J-shaped curve.,A number of methodological problems are common in observational research in general, and some of the methodological problems suggested for the J-shaped alcohol-CHD-associations are discussed. The extent of the methodological problems in studies of the J-shaped curve is reviewed, and the possibility that the J-shaped curve is an artifact created by reverse causality and residual confounding is discussed. Further, the issue of interaction with drinking pattern and type of alcohol is discussed.,Imprecise categorization of alcohol intake information seems to have had little effect on the J-shaped alcohol-CHD-associations, nor has it affected the ability of these studies to show increasing mortality from a range of causes with increasing AC. The problem of “sick quitters” has been resolved by large studies using lifelong abstainers or infrequent drinkers as reference group. Many studies lack information on drinking patterns with regard to regular, moderate consumption versus binge drinking. Stratified analyses by important risk factors for CHD have not significantly changed the J-shaped association observed in most epidemiologic studies.,Potential biases and residual confounding probably do not overcome the J-shaped alcohol-CDH-association observed in most epidemiologic studies; however, the existence of a J-shaped curve is challenged by some degree of uncertainty. The actual review together with the associated papers by Skovenborg et al., 2021 and Ellison et al., 2021 offers a possibility to “update your priors” and achieve greater certainty when giving your patients information on the pros and cons of alcohol intake.
Purpose This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings. Design/methodology/approach In clinical practice, shared treatment has proved challenging in light of different service models (Laker, 2006). Substance misuse works on the premise of change comes from the individual, where recovery models in mental health offer a formalised approach. One of the challenges faced by services has been the inability for mental health services to recruit and services become overstretched (Rimmer, 2018); this gave an opportunity for a new method of working to be considered. This led to the development of a new service model. These changes were: • Improving the interface with substance misuse services to improve access to community substance misuse services for mental health clients. • To provide specialist staff within the dual diagnosis field to provide a clinic jointly with local drug and alcohol services. • Introduction of substance misuse workers as team members on acute mental health and rehab wards. • Group Substance Misuse programmes. Findings Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group.The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge.For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances. Originality/value Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups.
Purpose The purpose of this paper is to re-appraise the Misuse of Drugs Act 1971 in order to develop alternative and new ideas for drug law reform. Design/methodology/approach The approach is to analyse the Act from historical and socio-legal perspectives, drawing on the inter-disciplinary field of regulation studies. Findings The Act has its roots in radical counter-cultural reform activism in the 1960s. Its innovative legal structure has enabled a diverse range of policy approaches to be possible over the last 50 years. Future drug law reform efforts need to broaden out from a narrow focus on law and also to engage more seriously with the politics of drug law and policy. Originality/value Drawing on the inter-disciplinary field of regulation studies leads to novel insights about the politics and practice of drug law reform.
Purpose This paper aims to explore multiple problematisation processes through a former needle exchange programme run by Kék Pont (a non-governmental organisation) in the 8th district of Budapest. By presenting a collage of ethnographic stories, this paper attempts to preserve tacit knowledge associated with the programme and thereby keep its office alive as a “drug place”, the operation of which was made impossible in 2014. Design/methodology/approach Drawing on the insights of Foucauldian governmentality studies and actor-network theory, this paper focusses on drug use as a problem in its spatial-material settings. Based on ethnographic fieldwork, the contribution traces multiple problematisation processes and related infrastructures. Findings From the needle exchange programme’s perspective, drug use is not a singular problem but the effect of multiple problematisation processes. Although those processes are often in conflict with each other, the question is not which one is right, but how social workers manage to hold them together. It is a fragile achievement that requires years of training and ongoing negotiation with local actors. By eliminating Kék Pont’s 8th district office, the Hungarian Government did not only hinder harm reduction in the area but it had also rendered tacit knowledge associated with the needle exchange programme as a “drug place” inaccessible. Originality/value The paper is a melancholy intervention – an attempt to preserve tacit knowledge that had accumulated at the needle exchange programme. The retelling of ethnographic stories about this “drug place” is one way of ensuring that other drug policies remain imaginable.
Purpose In November 2019, an open drug scene, commonly called “Colline du crack” and located in Paris was forcibly closed after 10 years of existence. This paper aims to understand how that space has evolved over the years to become a major hub for drug use. Design/methodology/approach The authors used a qualitative approach that included interviews with 52 people who use drugs (PWUD) and 54 field professionals and ethnographic observations. The authors asked questions about the evolution of the major sites of crack visibility in Paris and about social representations related to these spaces. They compared their datas with datas drawn from gray literature. Findings La Colline emerged on an isolated slope, away from police repression and local anti-crack organizations. In the beginning, it was a discrete, communal space regulated by PWUD. Starting in 2015, social transformations in the neighborhood turned la Colline into a central hub for dealing and using crack. La Colline became an open scene which led to its evacuation in 2019. Originality/value This paper contributes to literature on community building of drug consumers. The authors are also using a wide variety of methodological tools.
Purpose Health promotion strategies often attempt to change people’s behavior through targeting their risk perceptions. These perceptions may, however, be moderated by other factors. This study therefore aimed at investigating the trustworthiness and consistency of risk information, as well as respondent perceptions of the adequacy of amount received among a representative sample of former smokers, and how this information is related to gender, age, education level and whether using nicotine or not. Design/methodology/approach The respondents are part of a seven-year follow-up of former smokers in Sweden. Initially, 1400 respondents were contacted, whereof 705 (response rate 50%) answered a Web-survey. The majority (85 %) was still nicotine-free but some made use of nicotine in different forms. The data analysis includes descriptive statistics and logistic regressions. Findings Most respondents trusted risk information whether offered by the public authorities or came from other sources such as media, and generally perceived that there was an adequate amount. However, there were some differences between the products, where quite a few distrusted information on Nicotine Replacement Therapies (NRTs) and some perceived the information on snus and NRTs as contradictory and too little. Originality/value Knowledge about how former smokers perceive information regarding negative aspects of cigarette use may facilitate more effective risk communication with current smokers, and it may also be important for communicating information about other nicotine products to those who are trying to or who already have quit smoking.
Purpose The purpose of this paper is to illustrate the history of relevant legislation before and after the 1971 Misuse of Drugs Act (MDA). Design/methodology/approach A chronological narrative of laws and reports with concluding discussion. Findings That UK legislators have not made use of the evidence base available to them and have favoured enforcement rather than treatment approaches. That current UK practice has exacerbated not contain the use of and harms caused by illegal drugs. Research limitations/implications The paper does not cover all relevant documents, especially those from non-governmental sources. Practical implications The practical implications centre on the failure of consecutive governments to reflect on and review the impact of current legislation, especially on people who use drugs. Social implications That the situations of people who use drugs are currently ignored by the government and those proven responses which save lives and reduce harm are rejected. Originality/value The paper attempts to show the historical contexts of control and dangerousness of which the MDA is one instrument.
Purpose This paper aims to demonstrate the ways in which the Misuse of Drugs Act (MDA) militates against the interests and situations of people who use drugs. The author reflects on the author’s journey as a drug user, drugs workers and drug user organiser to critique the MDA. The author describes the impact of the MDA on the author’s early experimentation with substances and highlights the limitations of simplistic drugs prevention. The author describes how the MDA maximises drug-related risks and undermines the creation of healthy cultural norms and community learning among people who use drugs. The author talks about the author’s work as a drugs practitioner and mourns the vandalism of the UK’s harm reduction and drug treatment system. This paper describes the opportunity to use drug policy reform as a progressive electoral agenda to begin the journey towards racial and social justice. This paper calls for the rejection of the Big Drugs Lie and the repeal of the failed MDA. Design/methodology/approach Personal reflection based on experience as drug user, drugs worker and drug user organiser. Findings Successive UK Governments have used the MDA as a tool of social control and racial discrimination. The Big Drugs Lie undermines science-based and rights-compliant drug policy and drug services and criminalises and puts young people at risk. There is the potential to build a progressive political alliance to remove the impediment of the MDA and use drug policy reform as tools for racial and social justice. Practical implications The MDA maximises the harms faced by people who use drugs, stokes stigma and discrimination and has undermined the quality of drug services. The MDA needs to be exposed and challenged as a tool for social control and racial discrimination. Delivering drug policy reform as a progressive electoral strategy could maximise its potential to improve social and racial justice. Originality/value This paper represents the view of people who use drugs by a drug user, a view which is seldom expressed in the length and level of argument shown here.
Purpose This paper aims to consider the nature of cannabis-related harms under the UK’s Misuse of Drugs Act (MDA). Written for the specific context of this four-paper special section on 50 years of the MDA, it argues that the MDA may cause more harm than it prevents. Design/methodology/approach An opinion piece offering a structured overview of cannabis-related harms under prohibition. It summarises existing evidence of the ways in which prohibition may exacerbate existing – and create new – harms related to the production, distribution, use and control of cannabis. Findings The paper argues that prohibition of cannabis under the MDA may cause more harm than it prevents. Originality/value It has long been argued that the MDA does not accurately or fairly reflect the harms of the substances it prohibits, and much existing research points to different ways in which drug prohibition can itself be harmful. The originality of this paper lies in bringing together these arguments and developing a framework for analysing the contribution of prohibition to drug-related harm.
Purpose This paper aims to research people who sell cannabis in public spaces known as “drug places” in Frankfurt, Germany. A particular focus is set to the relations of identity formation, relations to other dealers and law enforcement, taking into account the concept of “street capital” as social and cultural capital accumulated in the practice of drug dealing in public. Design/methodology/approach Nine biographically oriented qualitative interviews were conducted directly within the respective “drug places” in the inner city and the margins of the local open drug scene with exclusively male subjects. Interviews were conducted in German, audio-recorded and transcribed. Data was analysed with structured qualitative content analysis. Findings All respondents had some degree of migration background, ranging from German citizens up to refugees with illegal residence permit status. Social deprivation, socio-cultural conflicts with parents, combined with often early own drug use (mainly cannabis and cocaine) and stigma had contributed to a precarious existence. Experiences of criminalisation did not discourage the respondents from the continuation of their selling activity. Violence in these settings was likely but assessed in highly different ways depending on attitudes and experiences. The same is true for diverging experiences with police, however, the threat of being criminalised is always present. Originality/value As mostly independent and solitary dealers, this study researched a rarely investigated group. While these respondents have developed skills or street capital to survive in the respective setting, they are caught between unfavourable social conditions, social exclusion, violence, law enforcement and own drug use, leading to a desperate and fatalistic mindset. Somewhat paradoxically, this fatalism may be regarded as a result of keeping control over their own actions.
Purpose On top of their legal, economic, social and institutional marginalization, marginalized drug users (MDUs) also experience political marginalization: drug policies shape their lives without their political participation. From a scientific as well as a political perspective, the inclusion of their various viewpoints and situated knowledge is a major challenge, and one to which this paper aims to contribute in light of the experiences and imaginaries of MDUs urban spaces in several German cities. Design/methodology/approach Following a socio-geographical approach, this paper interrogates how MDUs appropriate and imagine the city, drawing on Lefebvre’s Production of Space and mixing critical cartographic with grounded theory, in the attempt to both understand and reconstruct the world from the situated perspective of MDUs based on their own words, drawings and emotions. Findings The narratives and drawings of participants show another cityscape, radically different from the hegemonic discourses and mappings antagonizing MDUs and making their existence a social problem. Space appears as a means of marginalization: there are barely any places that MDUs can legitimately appropriate-least of all so-called “public space.” By contrast, MDUs’ imaginaries of an ideal city would accommodate their existence and address further social justice issues. Originality/value The notion of “public places” appears unable to express MDU’s experiences. Instead of focusing on the problem of public spaces, policymakers should tackle the question of placemaking for MDUs beyond the level of solely drug-related places.
Purpose This study aims to describe and analyse an approach in the city of Bremen (Germany) to establish streetwork-supported tolerance zones for local open drug and alcohol scenes to reduce related disorder and nuisance in public spaces. Design/methodology/approach The qualitative methodology included systematic participant observations at public sites of drug and alcohol use, and problem-centred interviews with different groups of respondents (residents, passers-by, trades people, drug users, experts from addiction help and police). Findings In residential districts, tolerance zones were well accepted by their target group and found to reduce perceived disorder and nuisance in public space. However, their success depends on the social and spatial conditions of the chosen location, its surrounding urban infrastructure, cooperation among local actors and characteristics of drug using groups. Originality/value Usually, policing of open drug scenes focuses on repression and law enforcement. The example of Bremen suggests that streetwork-supported tolerance zones dedicated to the drug scene can substantially reduce disorder and nuisance in public space.
