International Journal of Drug Policy

Statement on ayahuasca

2012-03-29

Sixty years ago, the esteemed academic journal Science published a “Statement on Peyote” (), in which a handful of leading researchers, dismayed by the misinformed and demonising drug politics of the time, defended the right of the Native American Church to consume a psychedelic plant in its religious rites. Today, we feel similarly compelled to speak out on behalf of an analogous, non-indigenous religious tradition—the Brazilian ayahuasca religions, including the Santo Daime, the União do Vegetal, and other related groups (). We have studied various ritual uses of ayahuasca, participated in ceremonies and consumed the sacramental brew.

Behavioural interventions for preventing hepatitis C infection in people who inject drugs: A global systematic review

Rachel Sacks-Davis, Danielle Horyniak, Jason Grebely, Margaret Hellard — 2011-10-14

Abstract: Background: A systematic review was conducted to determine whether behavioural interventions are effective in preventing transmission of hepatitis C virus (HCV) amongst people who inject drugs.Methods: Medline, EMBASE, the Cochrane Clinical Trial Database, PSYCHINFO and hand-searching of bibliographies were used to identify controlled trials of behavioural interventions for reducing HCV transmission amongst people who inject drugs. Behavioural interventions were defined as non-pharmacological interventions that aimed to change individual behaviours without explicitly attempting to change population norms.Results: Six trials evaluating peer-education training and counselling interventions were included in the review. There was considerable variation between trials with respect to intervention duration, control and study population. Trials evaluated the impact of interventions on HCV incidence (three studies, 1041 participants) and frequency of injecting risk behaviours (six studies, 2472 participants). Amongst the three studies which measured the impact of the intervention on HCV incidence, none found a statistically significant difference between intervention and control groups. Measures of frequency of injecting risk behaviours varied greatly and could not be pooled. Only two studies (n=418, 854) showed significantly greater reductions in injecting risk behaviours in the intervention group compared with the control group.Conclusions: There was considerable variation in study design, outcome measures and magnitude, direction and statistical significance of findings between studies. Nonetheless, it is unlikely that behavioural interventions can have a considerable effect on HCV transmission. It is likely that multi-component interventions are required.

A critique of human rights based approaches should demonstrate an understanding of human rights based approaches

Damon Barrett — 2012-03-15

Jia-shin Chen's recent commentary () ‘Beyond human rights and public health: Citizenship issues in harm reduction’ demonstrates little understanding of human rights, undermining its central critique.

Well-written but misplaced: A response to Barrett's comment

Jia-shin Chen — 2012-03-15

comment criticizes my previously published commentary () for a lack of understanding of human rights based approaches because my paper is seen as “a critique of human rights based approaches”. He then offers a rich reference list demonstrating what is missing in my five-page paper. While well-written, Barrett's criticism is regrettably partial, misplaced and sometimes irrelevant because he has misread many points of mine. Therefore I feel obliged to respond.

“A Costly Turn On”: Patterns of use and perceived consequences of mephedrone based head shop products amongst Irish injectors

Marie Claire Van Hout, Tim Bingham — 2012-02-20

Abstract: Background: Mephedrone injecting has recently been reported in Romania, Slovenia, Guernsey and Ireland. The research reported here aimed to describe the experiences of a group of Irish injecting drug users, who were injecting mephedrone based headshop products prior to the introduction of legislative controls in Ireland, with particular focus on pre- and post-legislative use, effects of injecting mephedrone, settings and contexts for injecting, polydrug use and serial drug injecting, risk perceptions and harm reduction practises.Methods: Following a predevelopment phase with a Privileged Access Interviewer, in-depth interviews using a phenomenological approach were conducted with eleven attendees of a low threshold harm reduction service.Results: The findings describe the abuse potential of these mephedrone based headshop products when used by intravenous injection. Although participants were aware of risks and safe injecting practises, compulsive re injecting with excessive binge use over long periods of time was common. Nasal to injection route transitions, intense paranoia, violent behaviour and aggression, emergence of Parkinson type symptomatologies (in the form of spasms and ‘wobbling’), and permanent numbness in lower extremities were reported. Multi and serial drug injecting with heroin was used in efforts to manage the intense rush and avoid unpleasant comedown. Participants reported limb abscesses, vein clotting, damage and recession resulting from product toxicity, crystallisation of the products when diluted and flushing practises. Seven participants were homeless, with groin and street injecting common. Following legislative changes use of mephedrone products declined due to closure of headshops, increased street prices, concerns around contamination and the emergence of new street stimulant drugs.Conclusion: Continued monitoring of drug displacement patterns in post legislative time frames is advised, alongside longitudinal ethnographic research to track the diffusion of mephedrone and other cathinone derivatives within injecting networks. Further investigation of the adverse health consequences of these drugs on injection is warranted.

Virtually a drug scare: Mephedrone and the impact of the Internet on drug news transmission

Alasdair J.M. Forsyth — 2012-02-20

Abstract: Background: On the 16th April 2010 the drug mephedrone was outlawed in the UK. This followed news media reports of deaths linked to the drug. In many respects the mephedrone scare represented a familiar pattern of drug framing and legislative reaction. However, the mephedrone scare took place in the era of online news transmission.Methods: To quantify the mephedrone scare the Google Internet search-engine's Trends and News applications were monitored from when the first death was attributed to the drug until 1 year after it was banned.Results: Web interest in buying mephedrone peaked when online news stories reported deaths from the drug. Eighteen alleged mephedrone deaths were identified from online news. The fatalities which received the most Internet traffic subsequently proved false-alarms. Online interactive media widened access to alternative explanations of these alleged mephedrone deaths.Conclusion: It is contended that the advent of the Internet accelerated and inflated the mephedrone scare, but also that online media allowed [web] user-generated information transmission, rather than simple dissemination by news media to audience, fostering competing discourses to stock drug scare themes as they emerged.

Off the street and into “the cut”: Deterrence and displacement in NYC's quality of life marijuana policing

Luther Elliott, Andrew Golub, Eloise Dunlap — 2011-10-17

Abstract: This paper examines the accounts of NYC marijuana smokers about the information and values underlying decisions about where to smoke. We do so to assess the deterrent value of NYC's “quality of life” policing of marijuana in public view. Participants indicated a general awareness of escalated marijuana policing and its attendant risks and almost universally spoke of avoiding public use in high-traffic locations and in the city's cultural and commercial centres. Beyond that, however, the deterrent value of aggressive marijuana policing appears limited. Individuals without access to private space reported outdoor marijuana use as a normalized peer group activity that has increasingly been displaced to marginal and interstitial public spaces that were collectively referred to by participants as “the cut.”

Understanding the drug treatment community's ambivalence towards tobacco use and treatment

2012-01-27

Abstract: Background: Most clients in drug treatment smoke cigarettes, but few facilities provide treatment for tobacco dependence. We identify subjective experiences and social processes that may influence facility adoption of tobacco treatment policies and practices.Methods: Cross-sectional, semi-structured interviews were conducted with staff, directors and clients of 8 drug treatment facilities in the Midwestern U.S. We assembled a purposive sample stratified by ownership, methadone provision, and treatment service provision. We conducted in-person interviews with clinic directors and 54 staff and clients and employed a mixed-method analytic approach.Results: Facility policies and philosophy related to tobacco differed from those regarding alcohol and other drugs. Participants suggested facilities may not treat tobacco dependence because it does not create legal and social problems that force clients into treatment. Tobacco dependence treatment falls outside of a core function of drug treatment, which is to help clients fix legal problems caused by their drug use. Moreover, proactively treating clients for tobacco dependence creates strong ambivalence amongst staff and directors. On the one hand, staff smoking would violate core principles of drug treatment (i.e., the importance of staff abstinence from drugs of abuse); on the other, staff who smoke feel their personal rights and jobs are threatened. This situation creates strong incentives for staff to resist adoption of tobacco dependence treatment. Unlike other studies, the fear of jeopardising clients’ abstinence from other drugs did not emerge as a downside for treating tobacco dependence.Conclusions: International and national trends will probably increase the pressure to treat tobacco dependence during drug treatment. However, the U.S. context of drug treatment, as a patchwork, under-funded industry with high employee turnover, may undermine true adoption. At present, many facility staff resolve their ambivalence by reporting they “offer” treatment, but actually providing none. To facilitate dissemination of service provision, it may be useful to identify incentives for U.S. facilities that are closely aligned with the criminal justice system, help facilities define policies and treatment roles for staff who smoke, and better define the role of facilities in preventing morbidity and mortality.

Harm reduction, students and pleasure: An examination of student responses to a binge drinking campaign

Fiona Hutton — 2011-11-16

Abstract: Background: Recent debates about ‘binge drinking’ in New Zealand have positioned alcohol consumption amongst young drinkers as of concern. Research notes that students drink more heavily than their peers and that they have a higher incidence of alcohol related harms. In response, a harm reduction campaign aimed at first year university students was developed at a New Zealand university.Methods: This mixed methods study used questionnaires (225) and a small number of semi-structured interviews (4) to elicit student responses to the harm reduction campaign.Results: The majority of students in this study can be characterised as binge drinkers, although their drinking does not appear to cause them concern. The term ‘binge drinking’ is explored in three developed categories; ‘light’, ‘moderate’ and ‘heavy’ bingeing. Results are considered within a discussion of pleasure as a hindrance to harm reduction campaigns.Conclusions: The concept of ‘determined drunkenness’ and the notion of pleasure are important in students’ motivations for drinking and may contribute to the resistance they have in viewing their alcohol consumption as concerning. It is argued that students already felt that they exercised control over their drinking for pleasure and this produced contradictions in responses towards the campaign compared to actual behaviour.

The gendered trouble with alcohol: Young people managing alcohol related violence

Jo Lindsay — 2012-03-16

Abstract: Background: Alcohol related violence is a troubling backdrop to the social lives and relationships of many young people in post-industrial societies. The development of the night-time economy where young people are encouraged to drink heavily in entertainment precincts has increased the risk of violence.Methods: This paper reports on 60 individual structured in-depth interviews about the drinking biographies of young people (aged 20–24) living in Victoria, Australia. Twenty-six males and 34 females participated in the research. The participants discussed their experiences with alcohol over their life course to date. The material on alcohol related violence is analysed in this paper.Results: Just over half of the participants (33/60) recounted negative experiences with alcohol related violence. The findings demonstrate the continuing gendered nature of experiences of perpetration and victimization. Participants reported that aggression and violence perpetrated by some men was fuelled by alcohol consumption and required ongoing management. Experiences of violence were also spatialized. Men were more likely to report managing and avoiding violence in particular public settings whilst more women than men discussed managing violence in domestic settings.Conclusion: The central argument of this paper is that incidents of alcohol related violence and reactions to it are specific gender performances that occur in specific socio-cultural contexts. In contrast to research which has found some young people enjoy the adventure and excitement of alcohol related violence the mainstream participants in this study saw violence as a negative force to be managed and preferably avoided. Understanding violence as a dynamic gender performance complicates the development of policy measures designed to minimize harm but also offers a more holistic approach to developing effective policy in this domain. There is a need for greater acknowledgement that alcohol related violence in public venues and in families is primarily about particular performances of masculinity and this is where policy should be targeted in addition to venue based interventions.

Nicotine control: E-cigarettes, smoking and addiction

Kirsten Bell, Helen Keane — 2012-02-27

Abstract: Background: Over the past year or so, electronic cigarettes, more commonly known as ‘e-cigarettes’, have achieved widespread visibility and growing popularity. These products, which deliver nicotine via an inhaled mist, have caused no small amount of controversy in public health circles, and their rise has been accompanied by energetic debate about their potential harms and benefits.Methods: Interspersed with an analysis of current media coverage on e-cigarettes and the response of mainstream tobacco control and public health to these devices, this article examines the emergence of nicotine as both as an ‘addiction’ and a treatment for addiction.Results: We argue that by delivering nicotine in way that resembles the visual spectacle and bodily pleasures of smoking, but without the harms of combustible tobacco, e-cigarettes highlight the complex status of nicotine as both a poison and remedy in contemporary public health and tobacco control.Conclusion: In consequence, e-cigarettes jeopardize the carefully drawn distinctions between ‘good’ and ‘bad’ forms of nicotine.

Routine exposure to blood within hostel environments might help to explain elevated levels of hepatitis C amongst homeless drug users: Insights from a qualitative study

Joanne Neale, Caral Stevenson — 2012-02-06

Abstract: Background: Although homelessness is a risk factor for HCV infection, there is a lack of research exploring the relationship between living in a hostel for homeless people and blood-borne viruses. The tendency to focus on risky injecting practices and HCV has also eclipsed the transmission risks potentially posed by spilt and dried blood.Methods: Semi-structured qualitative interviews were conducted with 40 homeless drug users (HDUs) (29 men and 11 women). The aim of the study was to explore the support needs of HDUs staying in emergency hostels or night shelters, but blood emerged as an unexpected recurring topic within participants’ accounts. Accordingly, all blood data were coded and analysed inductively.Results: Participants reported that spilt and dried blood were routine features of hostel life, particularly in larger night shelters. Given that the hepatitis C virus can survive outside the human body for several weeks and even months, this poses a worrying but largely overlooked transmission risk. According to the HDUs interviewed, hostel providers were often slow to remove blood and other bodily waste, leaving residents to clean it themselves or to avoid soiled areas.Conclusions: The routine presence of blood within hostel environments might help to explain elevated levels of HCV amongst homeless drug users. However, there is a need for robust quantitative and qualitative research to systematically test and explore associations between HCV and hostel life. Recommendations are made for improving hostel cleanliness, apprising hostel staff and residents of HCV and other blood-borne virus transmission risks, and ensuring that blood and other bodily waste are deemed unacceptable features of any hostel setting.

Understanding the gendered patterns of substance use initiation among adolescents living in rural, central Mexico

Stephanie Ayers, Flavio Marsiglia, Steven Hoffman, Zhyldyz Urbaeva — 2012-03-15

Abstract: Background: Little is known about the age of initiation and gender differences in substance use among adolescents in rural, central Mexico.Methods: The cross-sectional data were collected from students enrolled in the Videobachillerato (VIBA) (video high school) programme in Guanajuato, Mexico. Questionnaires asked students about the age at which they had used alcohol, cigarettes, or cannabis for the first time. Kaplan–Meier Survival Functions were used to estimate if males and females were significantly different in their cumulative probabilities of initiating substances over time.Results: On average, alcohol is initiated at 14.7years of age, cigarettes at 15.1years of age, and cannabis at 16.5years of age. Over time, males had a significantly higher probability of initiating alcohol (Kaplan–Meier Failure Curve: X2=26.35, p<0.001), cigarettes (Kaplan–Meier Failure Curve: X2=41.90, p<0.001), and cannabis (Kaplan-Meier Failure Curve: X2=38.01, p<0.001) compared to females.Conclusions: These results highlight the gendered patterns of substance use initiation among adolescents in rural, central Mexico and underscore the need for gendered substance use prevention interventions with these adolescents. By putting forth efforts to understand substance use initiation patterns of adolescents living in rural, central Mexico, culturally specific and efficacious prevention efforts can be tailor-made to create lasting differences.