International Journal of Drug Policy RSS feed: Articles in Press. The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world. Electronic usage: An increasing number of readers access the journal online via ScienceDirect, one of the world's most advanced web delivery systems for scientific, technical and medical information. Average monthly article downloads for this journal: 9,932* * Figure is an average based on full text articles downloaded monthly via ScienceDirect between August 2008 and March 2009 International Journal of Drug Policy is ranked 4th out of 22 journals in the SUBSTANCE ABUSE category on the 2010 Journal Citation Reports®, published by Thomson Reuters, and has an Impact Factor of 2.541.http://www.ijdp.org//inpress?rss=yesElsevier Inc.en © 2010 Elsevier B.V. All rights reserved. International Journal of Drug Policy0955-39592010-07-20 © 2010 Elsevier B.V. All rights reserved. healthpermissions@elsevier.comhttp://www.ijdp.org/article/PIIS0955395910000964/abstract?rss=yesAbstract: Background: Men who have sex with men and inject drugs (MSM-IDU) are particularly vulnerable to HIV infection and have the potential to transmit HIV across multiple populations through their male and female sexual partners and injection drug-using partners.Methods: Respondent-driven sampling was used to recruit men who reported engaging in anal sex with another man in the past 3 months, aged ≥15 years, and living in Unguja, Zanzibar. Participants responded to a face-to-face interview about their HIV and injecting risk behaviours and were tested for HIV, Hepatitis B (HBV) and C (HCV) and syphilis.Results: Among the 509 MSM who enrolled in the survey, 14% (n=66) reported injecting drugs in the past 3 months among which 66% used heroin, 60% used a needle after someone else had and 68% passed a needle to someone else after using it. MSM-IDU were significantly more likely to have two or more non-paying male receptive sex partners and to have engaged in group sex in the past month, to have symptoms of a sexually transmitted infection in past 6 months, to have been arrested or beaten in the past 12 months and to be infected with HIV and co-infected with HIV and HCV compared to MSM who did not inject drugs. MSM-IDU were less likely to have used a condom at last sex with a non-paid female partner, to know where to get a confidential HIV test and to have ever been tested for HIV compared to MSM who did not inject drugs.Conclusion: MSM-IDU, and MSM in general, in Unguja practice multiple high-risk behaviours that put them at risk for blood-borne and sexual transmission of HIV and HCV infection. Targeted interventions for MSM-IDU must account for the overlap of high-risk sexual and drug-using networks and integrate injection drug use and HIV services.HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania - Corrected ProofLisa G. Johnston, Abigail Holman, Mohammed Dahoma, Leigh Ann Miller, Evelyn Kim, Mahmoud Mussa, Asha A. Othman, Andrea Kim, Carl Kendall, Keith Sabin10.1016/j.drugpo.2010.06.001International Journal of Drug Policy (2010)2010-07-20International Journal of Drug Policy2010-07-20RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395910000976/abstract?rss=yesAbstract: Background: A key aim of supply-side drug law enforcement is to reduce drug use by increasing the retail price of drugs. Since most illicit drug users are polydrug users the effectiveness of this strategy depends on the extent to which drug users reduce their overall consumption of drugs. The literature shows that drug users do reduce their consumption of a drug when its price increases. However the extent of that decrease and the implications for the use of other drugs vary across studies.Methodology: A sample of 101 Australian methamphetamine users was surveyed using a behavioural economics approach. Participants were given a hypothetical fixed drug budget, presented with a range of drug price lists and asked how many units of each drug they would purchase. Methamphetamine and heroin prices were varied independently across trials.Results: While demand for both methamphetamine and heroin was found to be price elastic, elasticity estimates were influenced by the nature of participants’ drug dependence. The group least responsive to changes in methamphetamine price were those dependent only on methamphetamine, while the group most responsive were dependent only on heroin. Similar findings emerged in relation to changes in heroin price. Cross-price elasticity analysis showed limited substitution into other drugs as the price of methamphetamine increased. In contrast, for heroin, there was significant substitution into pharmaceutical opioids and to a lesser extent, benzodiazepines and methamphetamine. However, for the most part, the decreases in methamphetamine or heroin consumption outweighed any substitution into other drugs.Conclusion: The reduction in overall drug consumption and expenditure in response to price increases in heroin and methamphetamine observed in this sample lend support to supply-side enforcement strategies that aim to increase retail drug price. Notably, this analysis highlights the importance of accounting for the nature of users’ drug dependence in estimating price responsiveness.The effect of methamphetamine and heroin price on polydrug use: A behavioural economics analysis in Sydney, Australia - Corrected ProofJenny Chalmers, Deborah Bradford, Craig Jones10.1016/j.drugpo.2010.06.002International Journal of Drug Policy (2010)2010-07-09International Journal of Drug Policy2010-07-09RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395910000769/abstract?rss=yesIn our 2005 study of injection drug users (IDUs) in two Mexico/US border cities, 7% reported paid plasma donation, mainly in the US where it remains legal. This practice was banned in Mexico in 1987. In a response to our paper (), it was suggested that most study participants donated plasma prior to the 1980s before increased safety standards were introduced. This is not the case: 90% did not begin injecting until the late 1980s and three paid donations occurred within the prior two years. A key question is how this occurred when inspection for injection stigmata is embedded in plasma centres’ Donor History Questionnaire, and what can be done to avoid this from being repeated.The risk of using paid plasma - Corrected ProofPatricia Volkow, Kimberly C. Brouwer, Richard S. Garfein, Steffanie A. Strathdee10.1016/j.drugpo.2010.05.002International Journal of Drug Policy (2010)2010-06-21International Journal of Drug Policy2010-06-21RESPONSEhttp://www.ijdp.org/article/PIIS0955395910000757/abstract?rss=yesAbstract: Background: Cross-sectional associations suggest that body art piercing (BAP) is a risk factor for hepatitis C (HCV) infection among injection drug users. The temporal basis of the relationship has not been established.Methods: Associations between HCV seropositivity, HCV incidence, recent BAP and BAP facility availability were evaluated among IDUs followed biannually between 2004 and 2008 in Montreal, Canada. A geographic information system was used to determine the availability of BAP facilities for each participant. Statistical models included individual and neighbourhood covariates. Logistic regression was used for analysis of HCV seropositivity. Cox proportional hazards regression was used for analysis of HCV incidence.Results: Of 784 IDUs, 73% were seropositive for HCV. In multivariable logistic regression, HCV seropositivity was associated with BAP availability (OR: 1.32 95% confidence interval (CI): 1.1, 1.6) but not recent BAP. Of 145 initially HCV-negative participants, 52 seroconverted to HCV for an incidence of 27.7/100 person-years (95%CI: 20.9, 36.0). Crude hazard ratios (HR) for the association between HCV infection and BAP variables were: recent BAP, HR 0.98 (95%CI: 0.4, 2.7) and BAP facilities availability, HR 1.43 (95%CI: 1.1, 1.9). After accounting for individual and neighbourhood factors, crude associations between HCV infection and recent BAP and BAP facilities availability were: HR recent BAP, 0.96, 95%CI: 0.3, 2.7; and HR BAP facility availability, 1.21, 95%CI: 0.9, 1.7.Conclusion: BAP facility availability is a marker of neighbourhood disadvantage associated with HCV seropositivity. Longitudinal analyses accounting for behaviour risk factors and neighbourhood characteristics do not support a temporal association between BAP acquisition, BAP facility availability, and HCV infection among IDUs.Availability of body art facilities and body art piercing do not predict hepatitis C acquisition among injection drug users in Montreal, Canada: Results from a cohort study - Corrected ProofJulie Bruneau, Mark Daniel, Yan Kestens, Michal Abrahamowicz, Geng Zang10.1016/j.drugpo.2010.05.001International Journal of Drug Policy (2010)2010-06-14International Journal of Drug Policy2010-06-14RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395910000733/abstract?rss=yes provide an analysis of intravenous drug users (IDUs) in two Mexico–US border towns, some of whom donated plasma in centers on the US side of the border. Their findings demonstrate that most of the IDUs attempting to donate did so prior to the 1980s. This is confirmed through their specifying manual plasmapheresis as the collection technology; this procedure has been superseded by automated plasmapheresis for over 20 years. Nevertheless, their finding that two IDUs donated in the period 2003–2005 is of concern, as by this time the safety paradigm which has ensured the safety of plasma therapies was in place. Lack of veracity in answering the Donor History Questionnaire (DHQ) used to select plasma and blood donors or the Respondent-Driven Sampling (RDS) used by Volkow et al. is clearly potentially problematic when engaging with IDUs motivated by payment. This problem is not limited to paid donors; in a National Heart, Lung and Blood Institute (NHLBI) study of unpaid US blood donors, 51% of hepatitis C (HCV) positive and 1% of HCV negative donors admitted intravenous drug use (), despite this being an excluding factor in the DHQ. Motivating factors to donate blood and plasma are multiple and complex, and range from cash payment to volunteerism. Some forms of widely used non-cash incentives are also crucial in maintaining the motivation to donate (), and have also been associated with risk factors ().Response to Volkow P et al. – Cross-border paid plasma donation among injection drug users in two Mexico–U.S. border cities – International Journal of Drug Policy 20 (2009) 409–412 - Corrected ProofJoshua Penrod, Mary Gustafson, George Schreiber, Jan Bult, Albert Farrugia10.1016/j.drugpo.2010.04.005International Journal of Drug Policy (2010)2010-05-24International Journal of Drug Policy2010-05-24RESPONSEhttp://www.ijdp.org/article/PIIS0955395910000745/abstract?rss=yesAbstract: Background: The control of blood-borne infections including HIV and hepatitis C (HCV) amongst injecting drug users (IDUs) is a challenge for health authorities in Iran. Hence, more reliable estimates of the levels of blood-borne infections and their associated factors are critically needed.Methods: Active IDUs were recruited using peer-driven sampling in a bio-behavioural survey in 2008. Over 8 weeks, data were collected from adults living in a city in Isfahan Province who had injected drugs in the past month. Participants provided a whole blood sample and answered questions on sexual and drug-related risk characteristics. Participants were provided post-test counselling and a non-monetary incentive for their participation. Excluding two inactive cases, the initial recruits resulted in 2–8 waves of recruitment.Results: Overall, 118 IDUs including three females participated. The estimated population proportions of HIV, hepatitis B, and HCV infections were 0.7% (95% CI, 0.6–2.3), 0.7% (95% CI, 0.1–2.1), and 59.4% (95% CI, 47.4–68.7), respectively. Responses indicated that 31% (95% CI, 20–44.5) of the IDUs ever shared a needle/syringe for drug injection, and 77% (95% CI, 65–84) had ever injected an addictive solution marketed widely as Temgesic. Multivariate analyses revealed that the high prevalence of HCV infection amongst IDUs is associated with the lifetime duration of drug injection (AOR, 1.17; 95% CI, 1.01–1.34) and with having injected Temgesic (AOR, 4.73; 95% CI, 1.52–14.69).Conclusion: Our experience in Iran indicates that IDUs can be recruited effectively in a bio-behavioural survey through peer-driven sampling and using only a single primary incentive. The high prevalence of HCV associated with injecting Temgesic is important evidence for harm-reduction policies in Iran.Prevalence of HIV/HCV/HBV infections and drug-related risk behaviours amongst IDUs recruited through peer-driven sampling in Iran - Corrected ProofSaman Zamani, Ramin Radfar, Pardis Nematollahi, Reza Fadaie, Marjan Meshkati, Shahrzad Mortazavi, Abbas Sedaghat, Masako Ono-Kihara, Masahiro Kihara10.1016/j.drugpo.2010.04.006International Journal of Drug Policy (2010)2010-05-19International Journal of Drug Policy2010-05-19RESEARCH PAPERhttp://www.ijdp.org/article/PIIS095539591000071X/abstract?rss=yesAbstract: Background: The rate of hepatitis C (HCV) related liver disease progression is known to be strongly associated with alcohol consumption, yet there are very few data on alcohol use in injecting drug users (IDUs), who represent 90% of Scotland's HCV-diagnosed population. To investigate the extent of alcohol use in IDUs, we used hospitalisation with an alcohol-related diagnosis as an indicator for problematic consumption levels, and compared admission rates pre- and post-HCV diagnosis.Methods: Data for 41,062 current/former IDUs attending drug treatment/support services in Scotland from April 1995 to March 2006 were linked to the national hospital discharge database to retrieve alcohol-related episodes, and to the national HCV Diagnosis database to determine HCV-diagnosed status. Relative risks were estimated using Cox proportional hazards regression for recurrent events.Results: The proportion of IDUs with ≥1 alcohol-related admission following first attendance at drug services was greater among those diagnosed with HCV by the end of follow-up (16%) compared with those who were not (6%). For the 9145 IDUs who had been diagnosed with HCV by 31 March 2006, there was a 1.5-fold increased relative risk of an alcohol-related admission >30 days post-HCV diagnosis (95% CI: 1.2–1.7) compared with >30 days pre-HCV diagnosis, adjusted for sex, age, and deprivation.Conclusions: IDUs diagnosed with HCV infection have an increased risk of subsequent hospital admission for an alcohol-related cause. Because of the synergistic effect of HCV infection and excessive alcohol intake on the development of cirrhosis, it is imperative that alcohol intake is addressed in the management of chronic HCV infection in this population.Hospitalisation for an alcohol-related cause among injecting drug users in Scotland: Increased risk following diagnosis with hepatitis C infection - Corrected ProofScott A. McDonald, Sharon J. Hutchinson, Sheila M. Bird, Chris Robertson, Peter R. Mills, John F. Dillon, David J. Goldberg10.1016/j.drugpo.2010.04.003International Journal of Drug Policy (2010)2010-05-18International Journal of Drug Policy2010-05-18http://www.ijdp.org/article/PIIS0955395910000721/abstract?rss=yesAbstract: Background: Global prevalence of hepatitis C virus (HCV) is estimated to be around 3% with approximately 170 million people affected. In Australia, and in many other resource rich countries, injecting drug use is the single most important risk factor for acquiring HCV, with around a third of diagnoses occurring in women. This study aims to assess gender differences in hepatitis C antibody prevalence and associated risk behaviours amongst a large sample of PWID in Australia.Methods: During a one to two week period in October, PWID attending selected NSP sites are invited to participate in the Australian NSP Survey. Between 1998 and 2008, approximately 16,000 individuals completed a self-administered questionnaire and provided a capillary blood sample for HIV and HCV antibody testing. We stratified our sample by time since onset of injecting and analysed the demographic characteristics, injecting behaviours and antibody test results to determine gender differences.Results: Women were found to be at increased risk of exposure to hepatitis C in all duration of injection categories except those injecting for 17 or more years. In the early years of injecting, women also reported higher rates of receptive sharing of needles and syringe and ancillary equipment when compared to men. Last injecting heroin, methadone or buprenorphine was significantly associated with HCV antibody prevalence amongst both males and females injecting for less than 5 years.Conclusion: Findings indicate that women are at greater risk than men of HCV infection during the early years of injection through higher rates of receptive sharing of needles and syringes and/or ancillary equipment. Our results suggest that women who are new to injecting, and Indigenous women in particular, should be identified as priority populations when developing and implementing harm reduction strategies that target people who inject illicit drugs.Gender differences in hepatitis C antibody prevalence and risk behaviours amongst people who inject drugs in Australia 1998–2008 - Corrected ProofJenny Iversen, Handan Wand, Andrea Gonnermann, Lisa Maher, on behalf of the collaboration of Australian Needle and Syringe Programs10.1016/j.drugpo.2010.04.004International Journal of Drug Policy (2010)2010-05-17International Journal of Drug Policy2010-05-17RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395910000691/abstract?rss=yesAbstract: Background: Debates about cannabis policy often mention respiratory symptoms as a negative consequence of use. The cannabis vaporizer, a machine that heats the plant to release cannabinoids in a mist without smoke and other respiratory irritants, appears to have the potential to minimize respiratory complaints.Methods: Twenty frequent cannabis users (uninterested in treatment) reporting at least two respiratory symptoms completed subjective ratings of respiratory symptoms and spirometry measures prior to and following 1 month's use of a cannabis vaporizer in a pre/post-design. Outcome measures included self-reported severity of nine respiratory symptoms as well as spirometry measures, including the maximum amount of air exhaled in 1s (forced expiratory volume; FEV1) and maximum total lung volume (forced vital capacity; FVC).Results: The 12 participants who did not develop a respiratory illness during the trial significantly improved respiratory symptoms (t(11)=6.22, p=0.000065, d=3.75) and FVC, t(11)=2.90, p=0.007, d=1.75. FEV1 improved but not significantly t(11)=1.77, p=0.053, d=1.07.Conclusions: These preliminary data reveal meaningful improvements in respiratory function, suggesting that a randomized clinical trial of the cannabis vaporizer is warranted. The vaporizer has potential for the administration of medical cannabis and as a harm reduction technique.Pulmonary function in cannabis users: Support for a clinical trial of the vaporizer - Corrected ProofNicholas T. Van Dam, Mitch Earleywine10.1016/j.drugpo.2010.04.001International Journal of Drug Policy (2010)2010-05-07International Journal of Drug Policy2010-05-07SHORT REPORThttp://www.ijdp.org/article/PIIS0955395910000605/abstract?rss=yesAbstract: Background: HIV prevalence is high and risky injection practices occur frequently among injecting drug users (IDUs) in Nepal. We explored the correlates of sharing injection equipment (having injected with a needle or syringe previously used by another) among male IDUs in Kathmandu, Nepal.Methods: From August to September 2007, we anonymously interviewed 296 male IDUs in Kathmandu, Nepal, using a structured questionnaire. We performed bivariate and multivariable logistic regression analysis and identified variables associated with sharing injection equipment.Results: Over half (n=152) of the participants reported injecting drugs with a needle or syringe previously used by another in the past year. Of these, 70% reported engaging in sharing injection equipment with multiple persons. The unavailability of new needles and drinking alcohol were independently associated with sharing injection equipment among the study participants.Conclusions: IDUs who drank alcohol or who could not obtain new needles when needed were more likely to share injection equipment. Our results suggest that reducing alcohol use and increasing the availability of new needles and syringes might improve safer injection practices among male IDUs in Kathmandu, Nepal.Correlates of sharing injection equipment among male injecting drug users in Kathmandu, Nepal - Corrected ProofKrishna C. Poudel, Kalpana Poudel-Tandukar, Junko Yasuoka, Anand B. Joshi, Masamine Jimba10.1016/j.drugpo.2010.03.006International Journal of Drug Policy (2010)2010-04-23International Journal of Drug Policy2010-04-23SHORT REPORThttp://www.ijdp.org/article/PIIS0955395910000617/abstract?rss=yesAbstract: Background: The objective of this study was to evaluate needle and syringe program (NSP) policies and procedures before and after the dissemination of a set of best practice recommendations.Methods: An on-line survey of 32 core NSP managers (100% response rate) and 62 satellite NSP managers (63% response rate). The survey included items about the distribution of needles/syringes, other injection-related equipment and inhalation equipment, and use of a best practice recommendations document.Results: The majority of NSPs reported following needle and syringe best practice recommendations. Most core NSPs (88%, n=28) and satellite NSPs (84%, n=52) distributed cookers following the dissemination of the document. All core NSPs (100%, n=32) and nearly all satellite NSPs (97%, n=60) distributed sterile water ampoules in 2008, many more than in 2006. Although more NSPs distributed safer inhalation equipment in 2008, the majority did not distribute these items. More satellite NSPs (44%, n=27) distributed glass stems than the core NSPs (16%, n=5). Commonly cited implementation barriers included funding, senior management and decision-making.Conclusion: Our findings demonstrate that NSPs will implement empirically based best practice recommendations and welcome such guidance. The managers we surveyed not only reported increased implementation of practices that have been empirically shown to help reduce disease transmission among injection drug users (IDUs), they also used the best practices document for additional purposes, such as planning and advocacy, and expressed interest in having sets of recommendations developed for other areas of harm reduction. Ensuring high-quality and consistent NSP services is essential to prevent transmission of HIV among people who inject drugs and others in the community. Best practice recommendations can assist in achieving these goals.Guidelines for better harm reduction: Evaluating implementation of best practice recommendations for needle and syringe programs (NSPs) - Corrected ProofCarol Strike, Tara Marie Watson, Paul Lavigne, Shaun Hopkins, Ron Shore, Don Young, Lynne Leonard, Peggy Millson10.1016/j.drugpo.2010.03.007International Journal of Drug Policy (2010)2010-04-23International Journal of Drug Policy2010-04-23RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395910000629/abstract?rss=yesAbstract: Background: Research evidence indicates that prisoners in Iran are at risk of drug-related harm, including acquisition of blood-borne infections. In response, several prevention interventions including methadone maintenance treatment (MMT) have been introduced into prisons in Iran.Methods: This report reviews and presents some important information extracted from published articles, and available documents on HIV sentinel surveillance and provision of MMT inside correctional settings in Iran.Results: Biological surveillance data in 2005 showed that on average about 3% of prisoners in the country tested positive for HIV infection. MTT that constitutes a main component of the Prison Organisation's HIV prevention package is becoming increasingly accessible to opioid-dependent prisoners. Between 2002 and 2008, the number of opioid-dependent prisoners receiving MMT increased steadily from 100 to more than 25000.Conclusion: Experiences in Iran suggest that access to MMT would be helpful for reducing illicit drug injection in a prison setting and can be considered as a major intervention for preventing the transmission of blood-borne infections among prisoners.Scaling up methadone maintenance treatment for opioid-dependent prisoners in Iran - Corrected ProofMarziyeh Farnia, Bahman Ebrahimi, Ali Shams, Saman Zamani10.1016/j.drugpo.2010.03.008International Journal of Drug Policy (2010)2010-04-22International Journal of Drug Policy2010-04-22SHORT REPORThttp://www.ijdp.org/article/PIIS0955395910000599/abstract?rss=yesAbstract: Background: In the United States, drug-free (non-drug substitution) treatment programmes are informed by an abstinence-only, disease model. Some critics believe this model hinders treatment service utilization and retention. An alternative public health model of harm reduction suggests that drug services should have a “low-threshold” for entry and retention such that they are offered with few or no conditions, such as abstinence from drug use.Methods: Using semi-structured qualitative interviews with 15 practitioners from 9 outpatient drug-free agencies, this study examined beliefs about low threshold service provisions.Results: Respondents identified certain conditions for drug services as clinically and programmatically appropriate and necessary to ensure safety. Factors relevant to outpatient services, drug use and client dynamics were also cited. Respondents tended to support service conditions to inform treatment planning and practices.Conclusions: Practitioners in these settings accept and support some threshold of imposed service conditions as useful in treatment and service planning. When outpatient services are terminated clinically appropriate services are offered instead. Concerns for service accessibility should focus on the availability of medically intensive services.High and low threshold service provision in drug-free settings: Practitioner views - Corrected ProofMichael H. Eversman10.1016/j.drugpo.2010.03.005International Journal of Drug Policy (2010)2010-04-15International Journal of Drug Policy2010-04-15RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395910000587/abstract?rss=yesAbstract: Background: There is little knowledge about the composition and cocaine content of street cocaine, nor about what users know about it.Method: 373 cocaine users were face to face interviewed between May and December 2006 about the last sample of cocaine they had consumed and residual amounts of the substances actually used were analysed using gas phase chromatography coupled to mass spectrometry (GC–MS). Users rated the perceived quality of their product (“good”, “average”, “poor”), its “estimated percentage of cocaine” and any cutting agents it contained. Price, quantity, place of purchase (street, dealer's premise, appointment), mode of administration (sniffing, injection, smoking) and the supposed nature of the sample (natural, synthetic, no distinction ever made) were also reported. Perceived quality was modelled using multivariate multinomial regression.Results: The median cocaine content was 22%. Altogether, 343 samples contained cocaine, among which 75% contained at least one adulterant. The most frequently occurring were phenacetin (54% of the samples), caffeine (17%), paracetamol (14%), diltiazem and lidocaïne (11%). Users showed relatively poor discrimination concerning cocaine purity, and only 12% reported at least one of the detected adulterants. The major determinants of their perception of cocaine quality were: place of purchase, natural origin, price per gram, actual cocaine content and mode of administration.Conclusion: The composition of street cocaine is largely unknown to users. Users’ perceptions of cocaine quality are based partly on false beliefs and certain administration modes. This may contribute to favouring very risky practices. The effects of adulterants on users’ health should be investigated.Composition, purity and perceived quality of street cocaine in France - Corrected ProofIsabelle Evrard, Stéphane Legleye, Agnès Cadet-Taïrou10.1016/j.drugpo.2010.03.004International Journal of Drug Policy (2010)2010-04-08International Journal of Drug Policy2010-04-08RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395910000563/abstract?rss=yesAbstract: Objective: Vancouver, Canada has been the site of an epidemic of human immunodeficiency virus (HIV) amongst injection drug users (IDU). In response, the Vancouver Area Network of Drug Users (VANDU) initiated a peer-run outreach-based syringe exchange programme (SEP) called the Alley Patrol. We conducted an external evaluation of this programme, using data obtained from the Vancouver Injection Drug Users Study (VIDUS).Methods: Using generalised estimating equations (GEE) we examined the prevalence and correlates of use of the SEP amongst VIDUS participants followed from 1 December 2000 to 30 November 2003.Results: Of 854 IDU, 233 (27.3%) participants reported use of the SEP during the study period. In multivariate GEE analyses, service use was positively associated with living in unstable housing (adjusted odds ratio [AOR]=1.83, 95% confidence interval [CI]: 1.39–2.40), daily heroin injection (AOR=1.31, 95% CI: 1.01–1.70), daily cocaine injection (AOR=1.34, 95% CI: 1.03–1.73), injecting in public (AOR=3.07, 95% CI: 2.32–4.06), and negatively associated with needle reuse (AOR=0.65, 95% CI: 0.46–0.92).Conclusion: The VANDU Alley Patrol SEP succeeded in reaching a group of IDU at heightened risk for adverse health outcomes. Importantly, access to this service was associated with lower levels of needle reuse. This form of peer-based SEP may extend the reach of HIV prevention programmes by contacting IDU traditionally underserved by conventional syringe exchange programmes.An external evaluation of a peer-run outreach-based syringe exchange in Vancouver, Canada - Corrected ProofKanna Hayashi, Evan Wood, Lee Wiebe, Jiezhi Qi, Thomas Kerr10.1016/j.drugpo.2010.03.002International Journal of Drug Policy (2010)2010-04-02International Journal of Drug Policy2010-04-02SHORT REPORThttp://www.ijdp.org/article/PIIS0955395910000484/abstract?rss=yesAbstract: Background: The dominant Australian approaches to understanding illicit drug marketplaces are surveillance and criminological research. These approaches rely on the elementary neoclassical economic model of the market which focuses primarily on supply and demand. In this paper, we draw on anthropological and sociological research to develop an alternative framework for understanding Australian illicit drug marketplaces that emphasises their constituent processes.Methods: The paper draws on two years of ethnographic research among heroin user/sellers of Vietnamese ethnicity in an Australian heroin marketplace.Results: Trade and barter were key modes of exchange in this marketplace. We identified active negotiation and bargaining over price on the basis of social relationships, with dealers and customers actively working to develop and maintain such ties. Dealers set price collectively and this was shaped by moral and cultural elements such as notions of a ‘fair’ price. Social processes and relations as well as shared cultural expectations helped to generate trust and maintain order in the marketplace.Conclusion: Our ethnographic research suggests that the dominant Australian approaches to the study of illicit drug markets, with their reliance on the elementary neoclassical economic market model, ignore the social processes and social relations through which such sites are made and remade. Nor do they adequately capture the complex character of the subjects who act within these sites. If we are to expand our understanding of illicit drug markets and marketplaces in Australia, we must look beyond the conceptions offered by surveillance and criminological approaches.Beyond neoclassical economics: Social process, agency and the maintenance of order in an Australian illicit drug marketplace - Corrected ProofRobyn Dwyer, David Moore10.1016/j.drugpo.2010.03.001International Journal of Drug Policy (2010)2010-03-31International Journal of Drug Policy2010-03-31RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395910000460/abstract?rss=yesAbstract: Background: All public services in the UK are expected to produce evidence-based policies. This principle was argued particularly strongly in relation to policies for tackling drug misuse. However, concerns have been expressed that commitment to this principle is not matched by the reality of policy making. In this paper, we examine the extent to which the UK drug strategy can be regarded as evidence-based.Methods: Focusing on case studies of policies implemented as part of the four main strands of the strategy, evidence reported by the government as forming the basis of the policy is examined as are findings of the published sources of evidence cited.Results: In most cases, the evidence was of a good quality in that it reflected the general standard of research in the area. The main problem lies in the interpretation and reporting of research results. Two of four case studies were reported as biased in terms of research study selection and in two there was some evidence that the reporting was not wholly representative of the conclusions drawn.Conclusion: There are many factors that influence the generation of policy and it is unrealistic, and perhaps disingenuous, to suggest in relation to drugs policy, that evidence is its primary focus.Is UK drug policy evidence based? - Corrected ProofTrevor Bennett, Katy Holloway10.1016/j.drugpo.2010.02.004International Journal of Drug Policy (2010)2010-03-29International Journal of Drug Policy2010-03-29POLICY ANALYSIShttp://www.ijdp.org/article/PIIS0955395910000496/abstract?rss=yesAbstract: Background: Excessive alcohol consumption, particularly among young males, is an important global health problem, in part because of the increased risks of intentional and non-intentional injuries, uses of illicit drug, crime, and psychiatric disorders. There are no data available to evaluate the extent to which interventions are effective in reducing hazardous/harmful alcohol consumption among young males in Thailand. We examined the efficacy of alcohol harm reduction strategies administered as a peer-drinking group motivational intervention (PD-GMI) among Thai male undergraduates.Methods: We used a quasi-experimental study design that included two student groups assessed at baseline and at two time points post-intervention. Participants were students enrolled in two public universities and who reported alcohol consumption during the current academic year. Students in one university were assigned to an assessment-only study group (n=110); and students in the other university were assigned to a 2-h PD-GMI (n=115). This intervention was designed to (1) increase the awareness of risks associated with hazardous/harmful alcohol consumption; (2) enhance students’ motivation to change their drinking behaviours; and (3) encourage harm reduction strategies during episodes of alcohol consumption. Alcohol consumption and adverse consequences were assessed using the Alcohol Use Disorders Identification Test (AUDIT) and the Rutgers Alcohol Problem Index (RAPI).Results: Students receiving the intervention had significant reductions in mean AUDIT scores; 50.4% at baseline to 1-month and 61.2% at baseline to 3-month post-intervention. Their mean RAPI scores were also reduced; 42.0% at baseline to 1-month and 42.9% at baseline to 3-month post-intervention. Reductions in alcohol consumption and the prevalence of harmful alcohol consumption patterns were statistically significant among students in the intervention group versus those in the control group. The reductions remained after adjustments for baseline differences.Conclusions: These results suggest the efficacy of the PD-GMI intervention for reducing alcohol consumption and adverse consequences among Thai male students.A peer-drinking group motivational intervention among Thai male undergraduate students - Corrected ProofWipawan C. Pensuksan, Surasak Taneepanichskul, Michelle A. Williams10.1016/j.drugpo.2010.02.005International Journal of Drug Policy (2010)2010-03-29International Journal of Drug Policy2010-03-29SHORT REPORThttp://www.ijdp.org/article/PIIS0955395910000174/abstract?rss=yesAbstract: Background: Despite overwhelming evidence of their effectiveness, the establishment and maintenance of syringe exchange programmes (SEPs) in the US continue to draw opposition from community members, religious and political leaders, and law enforcement officials. One argument against SEPs is that they draw drug activity into the communities where they operate.Methods: We use 8 years of survey data from participants attending an SEP in Chicago to explore this argument by reviewing responses (N=4827) to a question asking participants the main reason they spend time in the area.Results: Findings show far more participants come to the area to buy drugs (60%) than to exchange needles (3.8%), and differences exist by ethnicity. More whites than blacks or Latinos reported being in the area primarily to buy drugs and use the SEP.Conclusion: Re-directing opposition from SEPs to constructive ways of addressing fundamental causes of drug markets is recommended.Misdirected opposition: Evidence opposing “not in my back yard” arguments against syringe exchange programmes - Corrected ProofChyvette T. Williams, Lawrence J. Ouellet10.1016/j.drugpo.2010.02.003International Journal of Drug Policy (2010)2010-03-16International Journal of Drug Policy2010-03-16SHORT REPORThttp://www.ijdp.org/article/PIIS0955395910000150/abstract?rss=yesAbstract: The introduction of needle and syringe programmes (NSPs) during the 1980s is credited with averting an HIV epidemic in the United Kingdom and Australia, but hepatitis C (HCV) incidence continues to rise among injecting drug users (IDUs). NSPs incorporating additional harm reduction strategies have been highlighted as an approach that may impact on HCV incidence. This systematic review sought to determine which approaches to the organisation and delivery of NSPs are effective. Fifteen databases were searched for studies published since 1990. Two reviewers screened all titles and abstracts, and data extraction and quality assessment of individual studies were undertaken independently by one reviewer and checked for accuracy by a second. Sixteen studies met the criteria for inclusion. Based on 11 studies there was no evidence of an impact of different NSP settings or syringe dispensation policies on drug injecting behaviours, but mobile van sites and vending machines appeared to attract younger IDUs and IDUs with higher risk profiles. Two studies of interventions aimed at encouraging IDUs to enter drug treatment reported limited effects, but one study found that the combination of methadone treatment and full participation in NSPs was associated with a lower incidence of HIV and HCV. In addition, one study indicated that hospital-based programmes may improve access to health care services among IDUs. Currently, it is difficult to draw conclusions on ‘what works best’ within the range of harm reduction services available to IDUs. Further studies are required which have a stated aim of evaluating how different approaches to the organisation and delivery NSPs impact on effectiveness.Optimal provision of needle and syringe programmes for injecting drug users: A systematic review - Corrected ProofLisa Jones, Lucy Pickering, Harry Sumnall, James McVeigh, Mark A. Bellis10.1016/j.drugpo.2010.02.001International Journal of Drug Policy (2010)2010-03-02International Journal of Drug Policy2010-03-02COMMENTARYhttp://www.ijdp.org/article/PIIS0955395910000149/abstract?rss=yesAbstract: Background: Opioid substitution therapy (OST) continues to face strong resistance in the former Soviet Central Asian republics. OST was discontinued by the Uzbek government in 2009. In Kyrgyzstan, with about 950 people currently receiving OST, the programme was about to be suspended in 2009. In Kazakhstan, a small pilot project serves 50 clients. Turkmenistan may introduce OST in 2010, while the Tajik Ministry of Health approved the introduction of an OST pilot in summer 2009.Methods: This paper draws upon the analysis of interests of the OST-affected groups in Tajikistan as a case study to understand the roots of resistance to OST.Results: In Tajikistan, OST may be contrary to the interests of some narcologists, law enforcement officers and drug dealers. People who use drugs do not play any role in national drug-policy making. The HIV prevention community within the Tajik executive bodies receives major financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to respond to an IDU driven epidemic, and yet it is the only group which has nothing to gain from the absence of OST.Conclusion: The Tajik government agreed to introduce OST in order not to jeopardize its future funding from GFATM. If the interests of the OST-affected groups are ignored, there is a high chance that OST in Tajikistan may remain a perpetual pilot project even despite all the necessary resources would come from GFATM and other donors. Putting “narcology on pilot” may prove helpful in both tackling the OST “perpetual pilots” and shifting the focus of public attention towards major inadequacies of the existing state-funded drug treatment systems in the region.Opioid substitution therapy in Tajikistan: Another perpetual pilot? - Corrected ProofAlisher Latypov10.1016/j.drugpo.2010.01.013International Journal of Drug Policy (2010)2010-02-25International Journal of Drug Policy2010-02-25POLICY ANALYSIShttp://www.ijdp.org/article/PIIS0955395910000113/abstract?rss=yesAbstract: Quality of life (QoL) has become an important outcome indicator in health care evaluation. A clear distinction has to be made between QoL – focussing on individuals’ subjective satisfaction with life as a whole and different life domains – and health-related QoL (HRQoL), which refers to the absence of pathology. As opiate dependence is the primary drug of most persons entering treatment and as the attention for QoL in addiction research is growing, this review of the literature intends to summarise and differentiate the available information on QoL in opiate-dependent individuals. A comprehensive literature review was conducted, including database searches in Web of Science, Pubmed and Cochrane Database of Systematic Reviews. Articles were eligible for review if they assessed QoL or HRQoL of opiate-dependent individuals, used a QoL or HRQoL instrument and reported at least one specific outcome on QoL or HRQoL. In total, 38 articles have been selected. The review showed that various instruments (n=15) were used to measure QoL, mostly HRQoL instruments. Opiate-dependent individuals report low (HR)QoL compared with the general population and people with various medical illnesses. Generally, participation in substitution treatment had a positive effect on individuals’ (HR)QoL, but long-term effects remain unclear. Psychological problems, older age and excessive alcohol use seem to be related with lower (HR)QoL scores. The assessment of QoL in research on opiate dependence is still in its infancy. Still, the chronic nature of drug use problems creates the necessity to look at outcomes beyond the direct consequences of drug dependence and based on clients’ needs. HRQoL, with its unilateral focus on the functional status of clients, does not give information on clients’ own experiences about the goodness of life, and is as a consequence unsuitable for measuring QoL. Future research starting from a subjective, multidimensional approach of the concept of QoL is required.Quality of life among opiate-dependent individuals: A review of the literature - Corrected ProofJessica De Maeyer, Wouter Vanderplasschen, Eric Broekaert10.1016/j.drugpo.2010.01.010International Journal of Drug Policy (2010)2010-02-22International Journal of Drug Policy2010-02-22REVIEWhttp://www.ijdp.org/article/PIIS0955395910000137/abstract?rss=yesAbstract: Background: The study examines the age at which drug users die and ascertains whether there is a significant difference in the causes of death (‘drug related’ versus ‘non-drug related’) according to age.Methods: Details of people reported to the North West of England's National Drug Treatment Monitoring System as dying (years 2003/2004–2007/2008) were matched by the Office for National Statistics to death notifications to identify the cause and date of death. Spearman's rank correlation was performed on median age at death by year. Mantel–Haenszel statistics tested the association between age and type of death, adjusted for year.Results: Causes of death were ascertained for 504 people. Median age at death increased significantly from 36.46 in 2003/2004 to 41.38 in 2007/2008. The odds of a person aged 40 and over dying from a non-drug related death were 3.27 the odds of a person aged less than 40 dying from a non-drug related death.Conclusion: Current focus on drug related deaths detracts attention from other causes; in particular, the types of death which disproportionately affect older drug users. Ongoing debates about reintegration into society and employment presuppose that drug users are of working age and are healthy enough to work.Older and sicker: Changing mortality of drug users in treatment in the North West of England - Corrected ProofCaryl Beynon, Jim McVeigh, Ayesha Hurst, Adam Marr10.1016/j.drugpo.2010.01.012International Journal of Drug Policy (2010)2010-02-22International Journal of Drug Policy2010-02-22SHORT REPORThttp://www.ijdp.org/article/PIIS0955395909001595/abstract?rss=yesAbstract: Amphetamine type stimulants (ATS) have become the focus of increasing attention worldwide. There are understandable concerns over potential harms including the transmission of HIV. However, there have been no previous global reviews of the extent to which these drugs are injected or levels of HIV among users. A comprehensive search of the international peer-reviewed and grey literature was undertaken. Multiple electronic databases were searched and documents and datasets were provided by UN agencies and key experts from around the world in response to requests for information on the epidemiology of use. Amphetamine or methamphetamine (meth/amphetamine, M/A) use was documented in 110 countries, and injection in 60 of those. Use may be more prevalent in East and South East Asia, North America, South Africa, New Zealand, Australia and a number of European countries. In countries where the crystalline form is available, evidence suggests users are more likely to smoke or inject the drug; in such countries, higher levels of dependence may be occurring. Equivocal evidence exists as to whether people who inject M/A are at differing risk of HIV infection than other drug injectors; few countries document HIV prevalence/incidence among M/A injectors. High risk sexual behaviour among M/A users may contribute to increased risk of HIV infection, but available evidence is not sufficient to determine if the association is causal. A range of possible responses to M/A use and harm are discussed, ranging from supply and precursor control, to demand and harm reduction. Evidence suggests that complex issues surround M/A, requiring novel and sophisticated approaches, which have not yet been met with sufficient investment of time or resources to address them. Significant levels of M/A in many countries require a response to reduce harms that in many cases remain poorly understood. More active models of engagement with M/A users and provision of services that meet their specific needs are required.Meth/amphetamine use and associated HIV: Implications for global policy and public health - Corrected ProofLouisa Degenhardt, Bradley Mathers, Mauro Guarinieri, Samiran Panda, Benjamin Phillips, Steffanie A. Strathdee, Mark Tyndall, Lucas Wiessing, Alex Wodak, John Howard, the Reference Group to the United Nations on HIV and injecting drug use10.1016/j.drugpo.2009.11.007International Journal of Drug Policy (2010)2010-02-01International Journal of Drug Policy2010-02-01REVIEWhttp://www.ijdp.org/article/PIIS0955395909001674/abstract?rss=yesAbstract: Background: Injecting drug users (IDUs) are at increased risk of acquiring and transmitting HIV and other bloodborne pathogens through the multi-person use of syringes. Although research has shown that increased access to syringes through syringe exchange programs (SEPs) is an effective strategy to reduce risky injection practices many areas of the United States still do not have SEPs. In the absence of SEPs, legislation allowing pharmacies over-the-counter sales of syringes has also been shown to reduce syringe sharing. The success of pharmacy sales however is limited by other legal stipulations, such as drug paraphernalia laws, which in turn may contribute to fear among IDUs about being caught purchasing and carrying syringes.Methods: Between 2003 and 2006, 851 out-of-treatment IDUs were recruited using street outreach in the Raleigh-Durham (North Carolina) area. Data were collected using audio-computer assisted interview (ACASI) technology. Multiple logistic regression analyses were performed to assess factors associated with purchasing syringes from pharmacies.Results: In our study sample, African-American IDUs were one-fifth as likely as white IDUs to report pharmacies as their primary source of syringes.Conclusions: Given the absence of syringe exchange programs and the relatively high prevalence of HCV and HIV among IDUs in the Raleigh-Durham area, the limited use of pharmacies as a source of syringes among African-American IDUs in this study sample is problematic. The study findings support the need for effective multilevel interventions to increase access to clean needles in this population, as well as for policy interventions, such as legalization of SEPs and elimination of penalties for carrying syringes, to reduce harm and eliminate the health threats posed by receptive syringe sharing.Racial differences in acquisition of syringes from pharmacies under conditions of legal but restricted sales - Corrected ProofElizabeth C. Costenbader, William A. Zule, Curtis C. Coomes10.1016/j.drugpo.2009.12.006International Journal of Drug Policy (2010)2010-01-25International Journal of Drug Policy2010-01-25SHORT REPORThttp://www.ijdp.org/article/PIIS0955395909001625/abstract?rss=yesAbstract: One outcome measure of law enforcement effectiveness is the reduction in drug consumption which occurs as a result of law enforcement interventions. A theoretical relationship between drug consumption and retail price has promoted the use of retail price as a surrogate measure for consumption. In the current article, retail price is examined as a potential outcome measure for the effectiveness of law enforcement.The predictions regarding the relationship between law enforcement intensity and price are only partially supported by research. Explanations for the disconnect between the drug law enforcement activity and retail price include: rapid adaptation by market players, enforcement swamping, assumptions of rational actors, short-run versus long-run effects, structure of the illicit market, simultaneous changes that affect price in perverse ways, the role of violence in markets, and data limitations. Researchers who use retail price as an outcome measure need to take into account the complex relationship between drug law enforcement interventions and the retail price of illicit drugs. Viable outcome measures which can be used as complements to retail price are worth investigation.Retail price as an outcome measure for the effectiveness of drug law enforcement - Corrected ProofDavid A. Bright, Alison Ritter10.1016/j.drugpo.2009.12.001International Journal of Drug Policy (2010)2010-01-18International Journal of Drug Policy2010-01-18REVIEW