International Journal of Drug Policy

Editorial Board

2010-07-01

Cannabis policy: Time to move beyond the psychosis debate

Daniel Werb, Benedikt Fischer, Evan Wood — 2010-04-09

Cannabis is the world's most commonly used illicit drug (), and a debate over competing policy approaches to govern its use has been at the forefront of the greater discourse concerning the effectiveness of current drug policies. Indeed, the importance of the cannabis question is evident from the many organisations dedicated to research, lobbying, public education and social marketing on both sides of the argument, including Partnership for a Drug-Free America, Drug-Free America Foundation, the NORML Foundation, the Drug Policy Alliance, and many other advocates and lobbyists ().

Illicit drugs policy through the lens of regulation

Alison Ritter — 2009-12-14

Abstract: The application of regulatory theory to the problem of illicit drugs has generally been thought about only in terms of ‘command and control’. The international treaties governing global illicit drug control and the use of law enforcement to dissuade and punish offenders have been primary strategies. In this paper I explore the application of other aspects of regulatory theory to illicit drugs—primarily self-regulation and market regulation. There has been an overreliance on strategies from the top of the regulatory pyramid. Two other regulatory strategies – self-regulation and market regulation – can be applied to illicit drugs. Self-regulation, driven by the proactive support of consumer groups may reduce drug-related harms. Market strategies such as pill-testing can change consumer preferences and encourage alternate seller behaviour. Regulatory theory is also concerned with partnerships between the state and third parties: strategies in these areas include partnerships between police and pharmacies regarding sale of potential precursor chemicals. Regulatory theory and practice is a rich and well-developed field in the social sciences. I argue that governments should consider the full array of regulatory strategies. Using regulatory theory provides a rationale and justification to strategies that are currently at the whim of politics, such as funding for user groups. The greater application of regulatory approaches may produce more flexible and structured illicit drug policies.

The case for small-scale domestic cannabis cultivation

Tom Decorte — 2010-02-22

Abstract: The shift to (inter)regional production, trade and domestic cultivation has become an irreversible international trend. Until now, the focus of most empirical work has been on large-scale, commercially oriented and professionally organized segments of the cannabis industry, often based on police data and on the perspective of law enforcement agencies.This paper offers a review of recent Dutch-language research that focuses on cannabis cultivation. Empirical studies were identified through literature searches using relevant search terms and Web of Science, Elin, Social Science Research Network and Elsevier ScienceDirect.The paper presents the main findings of Dutch and Belgian empirical work on the factors that stimulated the import substitution process on the cannabis market, aspects related to quality and potency issues, typologies of cannabis growers, and (unintended) effects of pursued policies. In the light of this (selective) review the author offers some commentary and analysis concerning the claims made by different stakeholders, and concludes with some reflections on future research and on policy implications. The author outlines the importance of small-scale, independent or ideologically oriented cannabis cultivation as an underresearched market segment. The author also makes a case for greater toleration of small-scale cannabis cultivation, to secure the least worst of cannabis markets.

Clean Olympians? Doping and anti-doping: The views of talented young British athletes

Andrew Bloodworth, Michael McNamee — 2010-01-07

Abstract: Background: Review articles suggest a small but significant proportion (between 3 and 12%) of male adolescents have used anabolic-androgenic steroids (AAS) at some point (Yesalis and Bahrke, 2000; Calfee and Fadale, 2006). In sport, the use of prohibited substances or processes to enhance performance, collectively referred to as ‘doping’, is banned by both sports’ National and International Governing Bodies, and by the World Anti-Doping Agency (WADA) who run an extensive testing programme and educational initiatives designed to foster anti-doping attitudes.Method: A total of 40 talented male and female athletes (mean average age 19.6 years) from 13 different sports attended 12 focus groups held over the UK intended to investigate athletes’ attitudes toward doping. Focus group transcriptions were analysed and coded with the use of QSR NVivo 8.Results: Athletes in general did not report a significant national doping problem in their sport, but exhibited sporting xenophobia with regard to both doping practices and the stringency of testing procedures outside of the UK. Athletes often viewed doping as ‘unnatural’ and considered the shame associated with doping to be a significant deterrent. Athletes perceived no external pressure to use performance enhancing drugs. In response to hypothetical questions, however, various factors were acknowledged as potential ‘pressure’ points: most notably injury recovery and the economic pressures of elite sport. Finally, a significant minority of athletes entertained the possibility of taking a banned hypothetical performance enhancing drug under conditions of guaranteed success and undetectability.Conclusions: The athletes in this study generally embraced those values promoted in anti-doping educational programmes, although there were some notable exceptions. That the social emotion of shame was considered a significant deterrent suggests anti-doping efforts that cultivate a shared sense of responsibility to remain ‘clean’ and emphasise the social sanctions associated with being deemed a ‘drugs cheat’, resonate with this atypical social group.

The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy

Balasingam Vicknasingam, Suresh Narayanan, Goh Teik Beng, Sharif Mahsufi Mansor — 2010-01-21

Abstract: Background: Ketum (krathom) has been mentioned in the literature as a traditional alternative to manage drug withdrawal symptoms though there are no studies indicating its widespread use for this purpose. This study examines the reasons for ketum consumption in the northern areas of peninsular Malaysia where it is widely used.Methods: A cross-sectional survey of 136 active users was conducted in the northern states of Kedah and Penang in Malaysia. On-site urine screening was done for other substance use.Findings: Ketum users were relatively older (mean 38.7 years) than the larger substance using group. Nearly 77% (104 subjects) had previous drug use history, whilst urine screening confirmed 62 subjects were also using other substances. Longer-term users (use >2 years) had higher odds of being married, of consuming more than the average three glasses of ketum a day and reporting better appetite. Short-term users had higher odds of having ever used heroin, testing positive for heroin and of using ketum to reduce addiction to other drugs. Both groups used ketum to reduce their intake of more expensive opiates, to manage withdrawal symptoms and because it was cheaper than heroin. These findings differ from those in neighbouring Thailand where ketum was used primarily to increase physical endurance.Conclusions: No previous study has shown the use of ketum to manage opioid withdrawal symptoms except for a single case reported in the US. Ketum was described as affordable, easily available and having no serious side effects despite prolonged use. It also permitted self-treatment that avoids stigmatisation as a drug dependent. The claims of so many subjects on the benefits of ketum merits serious scientific investigation. If prolonged use is safe, the potential for widening the scope and reach of substitution therapy and lowering its cost are tremendous, particularly in developing countries.

Opportunities for enhancing and integrating HIV and drug services for drug using vulnerable populations in South Africa

Charles D.H. Parry, Petal Petersen, Tara Carney, Richard Needle — 2009-12-28

Abstract: Background: Little has been done to improve the integration of drug use and HIV services in sub-Saharan Africa where substance use and HIV epidemics often co-exist.Methods: Data were collected using rapid assessment methods in two phases in Cape Town, Durban and Pretoria, South Africa. Phase I (2005) comprised 140 key informant and focus group drug using interviewees and 19 service providers (SPs), and Phase 2 (2007) comprised 69 drug using focus group interviewees and 11 SPs.Results: Drug users put themselves at risk for HIV transmission through various drug-related sexual practices as well as through needle sharing. Drug users in both phases had limited knowledge of the availability of drug treatment services, and those that had accessed treatment identified a number of barriers, including affordability, stigma and a lack of aftercare and reintegration services. SPs identified similar barriers. Drug users displayed a general awareness of both HIV transmission routes and prevention strategies, but the findings also indicated a number of misperceptions, and problematic access to materials such as condoms and safe injection equipment. Knowledge around HIV treatment was low, and VCT experiences were mixed. SPs recognized the importance of integrating HIV and substance use services, but barriers such as funding issues, networking/referral gaps and additional burden on staff were reported in Phase 2.Conclusion: A comprehensive, accessible, multi-component intervention strategy to prevent HIV risk in drug users needs to be developed including community outreach, risk reduction counselling, VCT and substance use treatment.

Drug use and the risk of HIV infection amongst injection drug users participating in an HIV vaccine trial in Bangkok, 1999–2003

2010-01-15

Abstract: Background: HIV spread rapidly amongst injecting drug users (IDUs) in Bangkok in the late 1980s. In recent years, changes in the drugs injected by IDUs have been observed. We examined data from an HIV vaccine trial conducted amongst IDUs in Bangkok during 1999–2003 to describe drug injection practices, drugs injected, and determine if drug use choices altered the risk of incident HIV infection.Methods: The AIDSVAX B/E HIV vaccine trial was a randomized, double-blind, placebo-controlled trial. At enrolment and every 6 months thereafter, HIV status and risk behaviour were assessed. A proportional hazards model was used to evaluate demographic characteristics, incarceration, drug injection practices, sexual activity, and drugs injected during follow-up as independent predictors of HIV infection.Results: The proportion of participants injecting drugs, sharing needles, and injecting daily declined from baseline to month 36. Amongst participants who injected, the proportion injecting heroin declined (98.6–91.9%), whilst the proportions injecting methamphetamine (16.2–19.6%) and midazolam (9.9–31.9%) increased. HIV incidence was highest amongst participants injecting methamphetamine, 7.1 (95% CI, 5.4–9.2) per 100 person years. Injecting heroin and injecting methamphetamine were independently associated with incident HIV infection.Conclusions: Amongst AIDSVAX B/E vaccine trial participants who injected drugs during follow-up, the proportion injecting heroin declined whilst the proportion injecting methamphetamine, midazolam, or combinations of these drugs increased. Controlling for heroin use and other risk factors, participants injecting methamphetamine were more likely to become HIV-infected than participants not injecting methamphetamine. Additional HIV prevention tools are urgently needed including tools that address methamphetamine use.

Warning labels on alcohol containers as a source of information on alcohol consumption in pregnancy among New Zealand women

Sherly M. Parackal, Mathew K. Parackal, John A. Harraway — 2009-11-20

Abstract: Background: The addition of a warning label on alcohol containers is a policy measure yet to be adopted in New Zealand. The current study aims to report the rating of a national sample of 16–40-year-old non-pregnant New Zealand women on a warning label on alcohol containers as a source of information on risks associated with alcohol consumption in pregnancy.Methods: A nationwide, cross-sectional survey was conducted in 2005 on a random sample of 1129 non-pregnant women aged 16–40 years. Data were collected via an interviewer-administered questionnaire using a Web-assisted telephone interviewing system.Results: Overall, the survey achieved a response rate of 65%. Just over half of the women surveyed (53%; 95% CI 50.2–56.0) gave a high rating for a warning label as a source of information on alcohol consumption in pregnancy. Women below 30 years of age and who were of non-European ethnicity were more likely to give a high rating compared with older women and European women, respectively (p<0.05).Conclusions: Introduction of a warning label on alcohol containers in New Zealand may be effective in increasing awareness of the risks associated with alcohol consumption in pregnancy among at-risk drinkers, namely, younger women and New Zealand women of Maori and Pacific ethnicities. However, to accentuate behavioural change, other prevention approaches within a health promotion framework may be needed to complement this approach.

Longitudinal trajectories of ketamine use among young injection drug users

Stephen E. Lankenau, Jennifer Jackson Bloom, Charles Shin — 2010-02-08

Abstract: Background: Ketamine is a dissociative anaesthetic that became increasingly popular in the club and rave scene in the 1980s and 1990s. Reports surfaced in the late 1990s indicating that ketamine was being injected in several U.S. cities by young injection drug users (IDUs). Since all studies on ketamine injection were cross-sectional, a longitudinal study was undertaken in 2005 to determine: characteristics of young IDUs who continue to inject ketamine; frequency of ketamine injection over an extended time period; risks associated with ongoing ketamine injection; and environmental factors that impact patterns of ketamine use.Methods: Young IDUs aged 16–29 with a history of injecting ketamine (n=101) were recruited from public locations in Los Angeles and followed during a 2-year longitudinal study. A semi-structured instrument captured quantitative and qualitative data on patterns of ketamine injection and other drug use. A statistical model sorted IDUs who completed three or more interviews (n=66) into three groups based upon patterns of ketamine injection at baseline and follow-up. Qualitative analysis focused on detailed case studies within each group.Results: IDUs recruited at baseline were typically in their early 20s, male, heterosexual, white, and homeless. Longitudinal injection trajectories included: “Moderates,” who injected ketamine several times per year (n=5); “Occasionals,” who injected ketamine approximately once per year (n=21); and “Abstainers,” who did not inject any ketamine during follow-up (n=40). Findings suggest that ketamine is infrequently injected compared to other drugs such as heroin, cocaine, and methamphetamine. Most IDUs who begin injecting ketamine will stop or curb use due to: negative or ambivalent experiences associated with ketamine; an inability to find the drug due to declining supply; or maturing out of injecting drugs more generally.Conclusion: Reducing ketamine injection among young IDUs may best be accomplished by targeting particular groups of IDUs identified in this study, such as homeless youth and homeless travellers.

Local politics and retail cannabis markets: The case of the Dutch coffeeshops

Marije Wouters, Annemieke Benschop, Dirk J. Korf — 2010-02-01

Abstract: Background: Cannabis coffeeshops are concentrated in specific areas in the Netherlands; close to 80% of Dutch municipalities have no coffeeshops. We investigated why such wide local differences exist.Methods: Regression analyses were carried out on data regarding the number of coffeeshops per municipality, local council seat distribution and area demographic characteristics. A contrast analysis of municipalities with no/few vs. many coffeeshops was also performed.Results: Whether a town has one or more coffeeshops can be predicted in part by its population size, but more strongly by political composition of the local council. The larger the percentage of progressive councillors, the greater the probability that coffeeshops are allowed. The number of coffeeshops in a town depends primarily on the demand for cannabis (reflected in factors like local population size); it generally has little to do with national-level party political preferences about drug policy.Conclusion: Both the demand for coffeeshops and local political preference influence coffeeshop policy in the Netherlands.

Women's health and use of crack cocaine in context: Structural and ‘everyday’ violence

Vicky Bungay, Joy L. Johnson, Colleen Varcoe, Susan Boyd — 2010-02-01

Abstract: Background: There is increasing public health evidence that women who use crack cocaine and are street-involved experience significant health problems and are more isolated with regards to accessing harm reduction and other health-related services. Simultaneously, there is growing acknowledgement that structural and ‘everyday’ violence are significant factors influencing the health of women who use illegal drugs. Little research has examined how these social processes play out for women who use crack cocaine.Methods: A critical ethnography informed by the theoretical constructs of structural and everyday violence and intersectionality was undertaken to explore women's use of crack cocaine within an inner-city neighbourhood in Western Canada. Data collection included baseline survey (n=126), participant observation and field notes, informal interviews (n=53), and in-depth interviews (n=13).Results: Based on thematic and theoretical analysis two interrelated themes were identified that reflected the interrelationships between women's use of crack, poverty, discrimination, racism, gendered relations of power, and legal policies and practices: (a) the context of health care; and (b) the smoking context.Conclusions: Structural inequities and ‘everyday’ violence are perilously damaging for women who use crack. Interventions to reduce these inequities are urgently needed if we are to reduce the significant suffering of women who are street-involved and use crack cocaine.

Drug testing in sport: The attitudes and experiences of elite athletes

Matthew Dunn, Johanna O. Thomas, Wendy Swift, Lucinda Burns, Richard P. Mattick — 2010-01-15

Abstract: Background: This study aimed to investigate, among a sample of elite Australian athletes, the extent to which this group supports drug testing as a deterrent to drug use.Method: Data was collected from a convenience sample of (n=974) elite Australian athletes who self-completed a questionnaire, and semi-structured telephone surveys with key experts.Results: The athletes surveyed endorsed testing for banned substances as an effective way of deterring drug use; believed that the current punishments for being caught using a banned substance was of the appropriate severity; and indicated that there should be separate policies regarding illicit drug (ID) and performance-enhancing drug (PED) use.Conclusion: A large proportion of elite athletes in Australia endorse drug testing as an effective means of deterring drug use. They perceive a difference between being detected using a PED and an ID and believe that penalties should reflect this difference. Future research may wish to investigate attitudes towards newer methods employed to detection drug use.

Erratum to “Assessing a drop box program: A spatial analysis of discarded needles” [Int. J. Drug Policy 21(3) (2010) 208–214]

Luc de Montigny, Anne Vernez Moudon, Barbara Leigh, Sun Young Kim — 2010-05-20

The publisher regrets the name of the fourth author appeared incorrectly in this article. The author name now appears correctly above.