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 © 2012 Elsevier B.V. All rights reserved. International Journal of Drug Policy0955-39592012-05-14 © 2012 Elsevier B.V. All rights reserved. healthpermissions@elsevier.comhttp://www.ijdp.org/article/PIIS0955395912000527/abstract?rss=yesAbstract: During the mid-1990s, Vancouver experienced a well characterized HIV outbreak among injection drug users (IDU) and many questioned how this could occur in the presence of a high volume needle exchange program (NEP). Specific concerns were fuelled by early research demonstrating that frequent needle exchange program attendees were more likely to be HIV positive than those who attended the NEP less frequently. Since then, some have misinterpreted this finding as evidence that NEPs are ineffective or potentially harmful. In light of continuing questions about the Vancouver HIV epidemic, we review 15 years of peer-reviewed research on Vancouver's NEP to describe what has been learned through this work. Our review demonstrates that: (1) NEP attendance is not causally associated with HIV infection, (2) frequent attendees of Vancouver's NEP have higher risk profiles which explain their increased risk of HIV seroconversion, and (3) a number of policy concerns, as well as the high prevalence of cocaine injecting contributed to the failure of the NEP to prevent the outbreak. Additionally, we highlight several improvements to Vancouver's NEP that contributed to declines in syringe sharing and HIV incidence. Vancouver's experience provides a number of important lessons regarding NEP. Keys to success include refocusing the NEP away from an emphasis on public order objectives by separating distribution and collection functions, removing syringe distribution limits and decentralizing and diversifying NEP services. Additionally, our review highlights the importance of context when implementing NEPs, as well as ongoing evaluation to identify factors that constrain or improve access to sterile syringes.Needle exchange and the HIV epidemic in Vancouver: Lessons learned from 15 years of research - Corrected ProofElaine Hyshka, Steffanie Strathdee, Evan Wood, Thomas Kerr10.1016/j.drugpo.2012.03.006International Journal of Drug Policy (2012)2012-05-14International Journal of Drug Policy2012-05-14REVIEWhttp://www.ijdp.org/article/PIIS0955395912000710/abstract?rss=yesAbstract: Background: This ethnographic study was conducted along the U.S.-Mexico border, the centre of the western hemispheric illicit drugs trade. It examines factors that encouraged or discouraged drug traffickers to “get out of the game” (a common slang reference to leaving the drug business).Methods: In-depth, life history interviews were conducted of thirty ex-traffickers in the El Paso/Ciudad Juárez area. Participants discussed their experiences exiting drug trafficking and their retrospective, often conflicted, feelings about the trade.Results: Although leaving drug trafficking is a complex and multi-faceted process, the principle factors for study participants were (1) punishment (by authorities or other traffickers), (2) self-image and identity, (3) social ties, (4) life course changes and (5) drug use/abuse.Conclusion: Traffickers often want to quit, but their divided self-identities make it difficult to relinquish the power and exhilaration they derive from the illicit drugs business. Harm reduction policies are needed that address the embeddedness of trafficker identities in dense webs of family, community, street gangs and transnational cartels, and the larger society, as well as the seductive appeal of Hollywood and pro-cartel narco-media. Traffickers need pathways that allow them to exit the illicit drugs business without surrendering their identity. Prison sentences are not enough to encourage traffickers to stop—also needed are culturally sensitive policies that help traffickers get out of the game and stay out.Getting out of the Game: Desistance from drug trafficking - Corrected ProofHoward Campbell, Tobin Hansen10.1016/j.drugpo.2012.04.002International Journal of Drug Policy (2012)2012-05-14International Journal of Drug Policy2012-05-14RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395912000503/abstract?rss=yesAbstract: The stated intention behind the establishment of the global drug prohibition regime was to protect the world from the dangers of drugs. At different points in history, drug production, use and supply have all been presented as threats to security whether human, national or international security. The international relations theory of securitization can be used as a way of explaining how and why the ‘drugs as an existential threat’ discourse holds so much power, even today. Speech acts such as the UN Single Convention on Narcotic Drugs, the UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances and Russia's ‘Rainbow-2 Plan’ clearly illustrate the development of the ‘drugs as an existential threat’ discourse at a global level with particular reference to mankind, the State and global peace and security, respectively. Analysis of these speech acts also shows how the power of the security narrative means that the global drug prohibition regime continues to remain pre-eminent despite the wealth of unintended consequences that it causes.Drugs as an existential threat: An analysis of the international securitization of drugs - Corrected ProofEmily Crick10.1016/j.drugpo.2012.03.004International Journal of Drug Policy (2012)2012-05-03International Journal of Drug Policy2012-05-03POLICY ANALYSIShttp://www.ijdp.org/article/PIIS0955395912000485/abstract?rss=yesAbstract: Background: There have been no changes to the statutory penalties for cannabis use in New Zealand for over 35years and this has attracted some criticism. However, statutory penalties often provide a poor picture of the actual criminal justice outcomes for minor drug offending.Aim: To examine criminal justice outcomes for cannabis use offences in New Zealand over the past two decades.Method: Rates of apprehension, prosecution, conviction and related criminal justice outcomes for the use of cannabis in New Zealand (per 100,000 population) were calculated for 1991–2008. The same measures were calculated (per 1000 last year cannabis users) for 1998, 2001, 2003 and 2006. Trends were tested for using logistic regression with year predicting each measure outcome and with chi-square tests.Results: The number of police apprehensions for cannabis use per year (per 100,000 population) declined from 468 in 1994 to 247 in 2008. The number of apprehensions for cannabis use per year (per 1000 cannabis users) also declined from 36 in 1998 to 21 in 2006. There were similar declines in prosecutions and convictions for cannabis use from 1991 to 2008. Those prosecuted for cannabis use in 2000–2008 were less likely than those prosecuted in 1991–1999 to be convicted and were more likely to be diverted away from the courts, ‘discharged without conviction’ and ‘convicted and discharged’.Conclusion: There has been a substantial decline in arrests for cannabis use in New Zealand over the past decade and this lead to similar declines in prosecutions and convictions for cannabis use. The decline in convictions for cannabis use was further assisted by the expansion of police diversion to include cannabis use offences. Our findings underline the importance of examining the implementation of law, as well as statutory penalties, when characterising a country's criminal justice approach to minor drug offending.Criminal justice outcomes for cannabis use offences in New Zealand, 1991–2008 - Corrected ProofChris Wilkins, Paul Sweetsur10.1016/j.drugpo.2012.03.002International Journal of Drug Policy (2012)2012-04-23International Journal of Drug Policy2012-04-23RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395912000424/abstract?rss=yesAbstract: Background: Assessing the extent to which drug research influences and impacts upon policy decision-making needs to go beyond bibliometric analysis of academic citations. Policy makers do not necessarily access the academic literature, and policy processes are largely iterative and rely on interactions and relationships. Furthermore, media representation of research contributes to public opinion and can influence policy uptake.In this context, assessing research influence involves examining the extent to which a research project is taken up in policy documents, used within policy processes, and disseminated via the media.Methods: This three component approach is demonstrated using a case example of two ongoing illicit drug monitoring systems: the Illicit Drug Reporting System (IDRS) and the Ecstasy and related Drugs Reporting System (EDRS). Systematic searches for reference to the IDRS and/or EDRS within policy documents, across multiple policy processes (such as parliamentary inquiries) and in the media, in conjunction with analysis of the types of mentions in these three sources, enables an analysis of policy influence. The context for the research is also described as the foundation for the approach.Results: The application of the three component approach to the case study demonstrates a practical and systematic retrospective approach to measure drug research influence. For example, the ways in which the IDRS and EDRS were mentioned in policy documents demonstrated research utilisation. Policy processes were inclusive of IDRS and EDRS findings, while the media analysis revealed only a small contribution in the context of wider media reporting.Conclusion: Consistent with theories of policy processes, assessing the extent of research influence requires a systematic analysis of policy documents and processes. Development of such analyses and associated methods will better equip researchers to evaluate the impact of research.Measuring research influence on drug policy: A case example of two epidemiological monitoring systems - Corrected ProofAlison Ritter, Kari Lancaster10.1016/j.drugpo.2012.02.005International Journal of Drug Policy (2012)2012-04-16International Journal of Drug Policy2012-04-16RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395912000473/abstract?rss=yesAbstract: Background: A plant with dissociative and psychoactive properties began to attract the attention of the media and United States policymakers following a well-publicized suicide in 2006 and reports that the plant served as a ‘legal high’ and substitute for cannabis. As a result, Salvia divinorum and its active ingredient, salvinorin A, were classified as Schedule I substances by the Florida Legislature on July 1, 2008. As of yet, no research has explored the efficacy of this policy or similar policies in other jurisdictions.Methods: Three self-report studies collected from young adults both prior to and following the policy's implementation are employed to investigate the potential relationship between the policy and usage rates. In addition, law enforcement personnel from the state's most populated areas were interviewed to determine the extent to which they were encountering salvia in their work.Results: It was indicated that less than two-thirds of those surveyed were aware of the drug's legal status. Lifetime prevalence of salvia use was largely unchanged. However, the rates of self-reported past year and past month use in Florida were significantly lower following the scheduling. Though use of Salvia divinorum appears to have decreased, perceptions of peer use increased markedly. Law enforcement officers and laboratories reported rarely, if ever, dealing with cases of salvia possession.Conclusions: Data suggests the classification of Salvia divinorum as a Schedule I drug was followed by a substantial reduction in recreational use. We caution that other factors may have influenced use, that the efficacy of scheduling novel substances is likely to vary by drug type, that such a reduction in reported use may only exist transiently until a sophisticated illicit market develops to replace the legitimate one, and that a state's success in regulating salvia may be related to their regulation of and enforcement of other drug prohibitions.Regulating a novel drug: An evaluation of changes in use of Salvia divinorum in the first year of Florida's ban - Corrected ProofJohn Stogner, David N. Khey, O. Hayden Griffin, Bryan Lee Miller, John H. Boman10.1016/j.drugpo.2012.03.001International Journal of Drug Policy (2012)2012-04-13International Journal of Drug Policy2012-04-13RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395912000436/abstract?rss=yesSafe Injecting Facilities (SIFs) have been operating in various locations across the developed world for over 20years (). Typically physically located in close proximity to established drug market and drug injecting precincts, SIFs provide a sanctioned space for the injection of drugs (). These ‘enabling environments’ () have been shown to have a range of public health benefits, from improvements in the management and response to acute drug overdose (), through to successful referral to other services ().Mobile safe injecting facilities in Barcelona and Berlin - Corrected ProofPaul Dietze, Rebecca Winter, Alisa Pedrana, Astrid Leicht, Xavier Majó i Roca, M. Teresa Brugal10.1016/j.drugpo.2012.02.006International Journal of Drug Policy (2012)2012-04-05International Journal of Drug Policy2012-04-05EDITORIALhttp://www.ijdp.org/article/PIIS0955395912000126/abstract?rss=yesAbstract: Background: Drug treatment courts (DTCs) have proliferated on the basis of their promise to reduce criminal recidivism among the burgeoning numbers of drug-related offenders. Empirical research on the effectiveness of DTCs indicates that they produce reductions in recidivism, primarily drawn from experiences in the US. There are no published outcome studies on Canadian DTCs. Canada's second DTC has operated in Vancouver's Downtown Eastside since 2001. We examine longitudinal changes in recidivism and characteristics of participants in the DTC in Vancouver (DTCV).Methods: DTCV participants (n=180) were included in a longitudinal cohort design (intent-to-treat), and a comparison group was derived using the propensity score matching method. Matching variables represented the domains of health, offending, and socio-economic histories as well as demographics. Annualized rates of offending were compared for the two years prior to entering DTCV and two years following programme termination.Results: Compared to the matched group of offenders, DTCV participants exhibited significantly greater reductions in offending, and a significant decrease in drug-related offences. The characteristics of DTCV participants differ significantly from those of the larger offender population in the DTES.Conclusion: Results provide empirical support for the DTCV in relation to the goal of reducing criminal recidivism. Participants in the DTCV are disadvantaged in diverse ways apart from their offence-related difficulties. These results have implications for the design of DTC programmes, as well as for future research.Drug treatment court of Vancouver: An empirical evaluation of recidivism - Corrected ProofJulian M. Somers, Lauren Currie, Akm Moniruzzaman, Faith Eiboff, Michelle Patterson10.1016/j.drugpo.2012.01.011International Journal of Drug Policy (2012)2012-03-15International Journal of Drug Policy2012-03-15RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395912000138/abstract?rss=yesAbstract: Background: There has been a rise in the illicit use of pharmaceutical opioids (“pain pills”) in the United States. Conducted with young adult non-medical users of pharmaceutical opioids, this study uses qualitative methods and cultural consensus analysis to describe risk perceptions associated with pharmaceutical opioids and to determine patterns of cultural sharing and intra-cultural variation of these views.Methods: The qualitative sub-sample (n=47) was selected from a larger sample of 396 young adults (18–23 years old), who were participating in a natural history study of illicit pharmaceutical opioid use. Qualitative life history interviews, drug ranking task, and cultural consensus analysis were used to elicit participant views about risks and harms associated with pain pills and other drugs, as well as alcohol and tobacco.Results: Cultural consensus analysis revealed that the participants shared a single cultural model of drug risks, but the level of agreement decreased with the increasing range of drugs ever used. Further, those with more extensive drug use histories differed from less “experienced” users in their views about OxyContin and some other drugs. Overall, pain pills were viewed as addicting and potentially deadly substances, but these properties were linked to the patterns and methods of use, as well as characteristics of an individual user. Further, risks associated with pharmaceutical opioids were further curtailed because they “came from the doctor,” and thus had a legitimate aspect to their use.Conclusions: This study highlights potential problems with universal approaches to substance use prevention and intervention among young people since such approaches ignore the fact that substance use education messages may be experienced differently depending on an individual's drug use history and his/her perceptions of drug risks. Findings reported here may be useful in the development of prevention and intervention programs aimed at reducing the harm associated with illicit use of pain pills.“I’m not afraid of those ones just ‘cause they’ve been prescribed”: Perceptions of risk among illicit users of pharmaceutical opioids - Corrected ProofRaminta Daniulaityte, Russel Falck, Robert G. Carlson10.1016/j.drugpo.2012.01.012International Journal of Drug Policy (2012)2012-03-15International Journal of Drug Policy2012-03-15RESEARCH PAPERhttp://www.ijdp.org/article/PIIS095539591200014X/abstract?rss=yesAbstract: Background: Injecting drug use has been documented in 158 countries and is a major contributor to HIV epidemics. People who inject drugs have poor and inequitable access to HIV services. The Global Fund to Fight AIDS, Tuberculosis and Malaria is the leading multilateral donor for HIV programmes and encourages applicants to include harm reduction interventions in their proposals. This study is the first detailed analysis of Global Fund investments in harm reduction interventions.Methods: The full list of more than 1000 Global Fund grants was analysed to identify HIV grants that contain activities for people who inject drugs. Data were collected from the detailed budgets agreed between the Global Fund and grant recipients. Relevant budget lines were recorded and analysed in terms of the resources allocated to different interventions.Results: 120 grants from 55 countries and territories contained activities for people who inject drugs worth a total of US$ 361million, increasing to US$ 430million after projections were made for grants that had yet to enter their final phase of funding. Two-thirds of the budgeted US$ 361million was allocated to core harm reduction activities as defined by the United Nations. Thirty-nine of the 55 countries were in Eastern Europe and Asia. Only three countries with generalised HIV epidemics had grants that included harm reduction activities.Conclusion: This study represents the most comprehensive assessment of Global Fund investments in harm reduction. This funding, while substantial, falls short of the estimated needs. Investments in harm reduction must increase if HIV transmission among people who inject drugs is to be halved by 2015.Global Fund investments in harm reduction from 2002 to 2009 - Corrected ProofJamie Bridge, Benjamin M. Hunter, Rifat Atun, Jeffrey V. Lazarus10.1016/j.drugpo.2012.01.013International Journal of Drug Policy (2012)2012-03-15International Journal of Drug Policy2012-03-15RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395912000163/abstract?rss=yesAbstract: Background: Heroin users who do not inject constitute a large pool of drug users with a potentially important impact on public health. We aimed to estimate the incidence of hepatitis C virus (HCV) among heroin users who had never injected (NIDUS) at baseline, and the effect of starting injecting during follow-up, other percutaneous exposures, sharing snorting paraphernalia, cocaine/crack use, and risky sexual behaviour on HCV-seroconversion.Methods: Prospective cohort of 305 HCV-negative NIDUs at baseline, aged 18–30 and street-recruited in three Spanish cities in 2001–2003. Computer-assisted personal interviews were conducted and dried blood-spot samples were collected. Bivariate and multivariable Poisson models were used.Results: Among the 305 never-injectors who were HCV-negative at baseline, 197 (64.6%) were followed-up and 21 seroconverted [HCV-incidence rate=5.8/100 person-years at risk (pyar) (95% CI: 3.6–8.9)]. HCV incidence in new-injectors was 28.4/100pyar [(95% CI, 14.7–49.7) vs. 2.8/100pyar (95% CI, 1.3–5.4)] among NIDUs. Of the risk exposures considered, starting injecting was the only predictor of HCV-seroconversion [adjusted relative risk=10.1, 95% CI: 3.8–26.7].Conclusion: The HCV-seroconversion rate was 10 times higher among new-injectors than never-injectors. No predictors other than starting injecting were found for HCV-seroconversion. Harm reduction interventions to prevent HCV infection should include prevention of drug injection.HCV seroconversion among never-injecting heroin users at baseline: No predictors identified other than starting injection - Corrected ProofMaría J. Bravo, Fernando Vallejo, Gregorio Barrio, M. Teresa Brugal, Gemma Molist, José Pulido, Luis Sordo, Luis de la Fuente, the ITINERE Project Group10.1016/j.drugpo.2012.02.002International Journal of Drug Policy (2012)2012-03-15International Journal of Drug Policy2012-03-15SHORT REPORThttp://www.ijdp.org/article/PIIS0955395912000175/abstract?rss=yesAbstract: Background: Unsafe injecting practices put injecting drug users (IDUs) at repeat exposure to infection with the hepatitis C virus (HCV). It has not yet been determined if spontaneously clearing one's primary infection influences the risk of reinfection; our aim was to estimate the relative risk of reinfection in IDUs who have cleared the virus.Methods: We conducted a retrospective study using a large database of HCV test results covering Greater Glasgow Health Board during 1993–2007 to calculate rates of infection and reinfection in current/former IDUs. The relative risk of (re)infection in previously infected compared with never-infected IDUs was estimated using Poisson regression, adjusting for age at study entry, sex, and calendar period of test.Results: Although the rate of reinfection in IDUs who were HCV antibody-positive, RNA-negative at baseline was lower (7/100 person-years, 95% CI: 5–9) than the rate of acute infection in IDUs who were HCV antibody-negative at baseline (10/100 person-years, 95% CI: 9–12), the risk of reinfection was not significantly different than the risk of initial infection (adjusted rate ratio=0.78, 95% CI: 0.57–1.08).Conclusion: We found only weak evidence for a reduced risk of HCV reinfection in IDUs who had cleared their previous infection. Further research among those who have cleared infection through antiviral therapy is needed to help inform decisions regarding treatment of IDUs.Examination of the risk of reinfection with hepatitis C among injecting drug users who have been tested in Glasgow - Corrected ProofScott A. McDonald, Sharon J. Hutchinson, Sheila O. Cameron, Hamish A. Innes, Allan McLeod, David J. Goldberg10.1016/j.drugpo.2012.02.003International Journal of Drug Policy (2012)2012-03-15International Journal of Drug Policy2012-03-15RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395912000114/abstract?rss=yesAbstract: This paper explores the position of needle exchange programmes (NEPs) in the “geography of survival” in the South Bronx neighbourhood of New York City. Stemming the spread of HIV through the provision of sterile injecting equipment, needle exchange promotes the survival of injection drug users (IDUs) in the starkest sense; yet NEPs also attract a diverse population of service users whose attendance is not necessarily related to drugs. This paper locates NEPs among a larger constellation of social services accessed by residents of poor neighbourhoods, including injection drug users, the homeless, the hungry, and those in need of medical services or just safe space. Drawing on ethnographic and interview data from a needle exchange in the South Bronx, I describe how both IDUs and others employed the organisation to make ends meet, elaborating four “off-label” usages of needle exchange: as a place to obtain basic necessities, as a source of income, as a safe space, and as a site of social contact. As harm reduction in the United States moves towards an increasingly clinical model of care, this paper considers these latent functions of needle exchange within the context of a larger struggle over the content and meaning of harm reduction services. By themselves, NEPs are clearly an unsatisfactory solution to the economic and political circumstances that drive a variety of individuals through their doors; yet, in a country that lacks a comprehensive welfare system, needle exchange arguably represents an important thread within a social safety net that is being woven from the ground up. This study may be used to argue for a (re)expanded mission for harm reduction in the United States, in the face of constant moves to narrow its mandate and reduce its budget.Needle exchange and the geography of survival in the South Bronx - Corrected ProofKatherine McLean10.1016/j.drugpo.2012.01.010International Journal of Drug Policy (2012)2012-03-14International Journal of Drug Policy2012-03-14RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395912000102/abstract?rss=yesAbstract: Background: The influence of family members, peers and sexual partners on initiation to injection drug use is well established. Furthermore, research on gender differences in injection initiation has recognized the increased vulnerability of women, in particular, to injection-related health risks, and the gendered nature of the injection initiation experience. Yet more research is needed on the interpersonal and structural dynamics that shape injection initiation within intimate partnerships.Methods: This paper draws on narrative data from semi-structured ethnographic interviews with 25, relatively stable, drug-using couples from two New York City neighbourhoods. The study was conducted between 2007 and 2009. Our analyses focus on retrospective accounts of injection initiation from IDUs who were initiated to injection (or initiated their partners) in current or former intimate partnerships. In particular we analyse narratives of injection initiation events where both partners participated as initiates or initiators.Results: Transition to injection within intimate partnerships was common, especially for women, and occurred in specific contexts. Structural and interpersonal dynamics, including the ubiquity of drugs in poor communities and the gendered nature of drug acquisition and use strategies, as well as the problem of increased drug tolerance, situational impediments to drug access, and the perceived cost–benefit of injecting, all influenced the process of initiation to injection drug use within couples. The data also suggest that, even when risks associated with injection initiation were understood, both pragmatic and emotional considerations within relationships tended to offset concerns about potential dangers.Conclusion: The findings suggest the need for a broad range of interventions (including couples-focussed interventions) to minimize rates of injection initiation within intimate partnerships.Retrospective accounts of injection initiation in intimate partnerships - Corrected ProofJanie Simmons, Sonali Rajan, James M. McMahon10.1016/j.drugpo.2012.01.009International Journal of Drug Policy (2012)2012-03-09International Journal of Drug Policy2012-03-09RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395912000084/abstract?rss=yesAbstract: This article gives a detailed account of the cocaine industry and the related violence in the Peruvian Upper Huallaga. It is argued that in this cocaine producing region violence increased during state-led forced eradication operations of the coca plants. Most of the violent incidents were closely related to the diminishing cocaine industry, but they were also related to the actions of the state security forces. Instead of receiving support from the state's security apparatus, the population mobilized its own forces to fight the violence. As will be argued, the causes of violence in this cocaine enclave are part of a dynamic interaction amongst many factors – an interaction that is influenced by the local context, a partial state vacuum, and the social utility and the economic advantages of violence. One needs to be aware that motivations of those who engage in the violent behaviour can change over time, as underlying power structures are influenced by changes in local conditions. The study covers an in-depth account of events taking place in the Upper Huallaga during the years 2003–2007. The research material was collected by several ethnographical fieldwork methods.The drugs industry and peasant self-defence in a Peruvian cocaine enclave - Corrected ProofMirella van Dun10.1016/j.drugpo.2012.01.007International Journal of Drug Policy (2012)2012-03-02International Journal of Drug Policy2012-03-02RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395911001770/abstract?rss=yesAbstract: Background: China has launched methadone maintenance treatment (MMT) and needle and syringe exchange programmes (NSEP) as part of the country's HIV prevention strategy amongst injection drug users. MMT is expanding, with backing from multiple government ministries, however, NSEP have received less political support and funding.Methods: Semi-structured, serial interviews were conducted with key informants, knowledgeable about China's harm reduction policies. Concurrent content analysis allowed for revision of the interview guide throughout the data collection process. This was combined with a systematic analysis of official government policy documents on NSEP and MMT, including white papers, legal documents, and policy statements.Findings: Early consensus between public security and public health sectors regarding methadone's dual use in HIV prevention as well as method of drug control created broad institutional support for MMT programmes amongst policy makers. In contrast, NSEP were seen as satisfying only the HIV prevention goals of the public health sector, and were perceived as condoning illicit drug use. Furthermore, NSEP's roots in China, as an experimental collaboration with international groups, created suspicion regarding its role in China's drug control policy. NSEP and MMT's distinct paths to policy development are reflected in the complex and occasionally contradictory nature of China's harm reduction strategy.Conclusions: These discrepancies highlight the need for a more politically sustainable and comprehensive integration of harm reduction projects. Recommendations include improved evaluation methods for NESP, NSEP-MMT cross-referral system, and stronger NSEP advocacy within the non-profit and public health sectors.A harm reduction paradox: Comparing China's policies on needle and syringe exchange and methadone maintenance - Corrected ProofKumi Smith, Nicholas Bartlett, Ning Wang10.1016/j.drugpo.2011.09.010International Journal of Drug Policy (2012)2012-03-01International Journal of Drug Policy2012-03-01POLICY ANALYSIShttp://www.ijdp.org/article/PIIS0955395912000059/abstract?rss=yesAbstract: Background: The dominant biomedical discourse stresses the physiological risks to the foetus or newborn posed by the prenatal use of illicit drugs. There is also a strong moral incentive for pregnant women to abstain from drugs. Yet few researchers have explored how pregnant, drug-using women themselves perceive the risks involved. The present paper investigates the reasoning by women about risks involved in prenatal drug use. Theoretically, a socio-cultural approach to risk is taken.Methods: The paper is based on fourteen ethnographic interviews with women who had used illicit drugs during pregnancy (mainly buprenorphine), had recently given birth and had regularly used prenatal services during pregnancy. The interviews were informal, semi-structured and focused on the women's experiences of pregnancy and service use. Each interview lasted about an hour. The interviews were transcribed and inductively analysed using thematic coding. Risk perceptions were identified in the interviewees’ expressions and understanding of fears, dangers, threats and worries.Results: The women were not primarily concerned about health risks: their greatest fears in connection with the prenatal use of illicit drugs were giving birth to a child with withdrawal symptoms, child protection interventions and child removal, encountering negative attitudes in seeking professional help as well as terminating drug use. The interviewees did not see abstaining from drugs as a risk-free option. On the contrary, the prospect of a drug-free life was filled with fears linked to physical and mental pain and disruptions in significant social bonds. The women made use of biomedical and nonprofessional understandings of risks. The women's friends and acquaintances played a central role as providers of knowledge about risks.Conclusion: When providing health education to pregnant women with drug problems, professionals should take women's perceptions of risk seriously, treat the women respectfully and engage them in dialogue about the risks involved. Further studies on pregnant women's perceptions of risk in using illicit drugs would be highly valuable.“Subutex is safe”: Perceptions of risk in using illicit drugs during pregnancy - Corrected ProofAnna Leppo10.1016/j.drugpo.2012.01.004International Journal of Drug Policy (2012)2012-02-27International Journal of Drug Policy2012-02-27RESEARCH PAPERhttp://www.ijdp.org/article/PIIS0955395911002325/abstract?rss=yesAbstract: Background: Needle and syringe programmes (NSPs) have been established as effective harm reduction initiatives to reduce injection drug use (IDU)-related risk behaviours, including sharing needles. On May 31, 2008, Victoria, BC's only fixed site NSP was shut down due to community and political pressure. This study examines and compares IDU trends in Victoria with those in Vancouver, BC, a city which has not experienced any similar disruption of IDU-related public health measures.Methods: Quantitative and qualitative data were collected by interviewer-administered questionnaires conducted with injection drug users (n=579) in Victoria and Vancouver between late 2007 and late 2010.Results: Needle sharing increased in Victoria from under 10% in early 2008 to 20% in late 2010, whilst rates remained relatively low in Vancouver. Participants in Victoria were significantly more likely to share needles than participants in Vancouver. Qualitative data collected in Victoria highlight the difficulty participants have experienced obtaining clean needles since the NSP closed. Recent injection of crack cocaine was independently associated with needle sharing.Conclusions: The closure of Victoria's fixed site NSP has likely resulted in increased engagement in high-risk behaviours, specifically needle sharing. Our findings highlight the contribution of NSPs as an essential public health measure.An examination of injection drug use trends in Victoria and Vancouver, BC after the closure of Victoria's only fixed-site needle and syringe programme - Corrected ProofAndrew Ivsins, Clifton Chow, Scott Macdonald, Tim Stockwell, Kate Vallance, David C. Marsh, Warren Michelow, Cameron Duff10.1016/j.drugpo.2011.11.004International Journal of Drug Policy (2012)2012-01-27International Journal of Drug Policy2012-01-27SHORT REPORThttp://www.ijdp.org/article/PIIS0955395911002337/abstract?rss=yesAbstract: Background: Driven by the rapid spread of HIV, Vietnam's response to drug use has undergone significant transformation in the past decade. This paper seeks to identify and analyse factors that prompted these changes and to investigate their impact on the lives of people who use drugs.Method: This policy analysis is based on a review of Vietnamese Government documents, peer-reviewed publications and the authors’ knowledge of and involvement in drug policy in Vietnam.Results: The last decade has witnessed a progressive change in the mindset of political leaders in Vietnam around illicit drug use and HIV issues. This has led to adoption of evidence-based interventions and the evolution of drug policy that support the scale up of these interventions. However, HIV prevalence among drug users at 31.5% remains high due to limited access to effective interventions and impediments caused by the compulsory treatment centre system.Conclusions: The twin epidemics of HIV and illicit drug use have commanded high-level political attention in Vietnam. Significant policy changes have allowed the implementation of HIV prevention and drug dependence treatment services. Nevertheless, inconsistencies between policies and a continued commitment to compulsory treatment centres remain as major impediments to the provision of effective services to drug users. It is critical that Vietnamese government agencies recognise the social and health consequences of policy conflicts and acknowledge the relative ineffectiveness of centre-based compulsory treatment. In order to facilitate practical changes, the roles of the three ministries directly charged with HIV and illicit drug use need to be harmonised to ensure common goals. The participation of civil society in the policymaking process should also be encouraged. Finally, stronger links between local evidence, policy and practice would increase the impact on HIV prevention and drug addiction treatment programming.Drug policy in Vietnam: A decade of change? - Corrected ProofThu Vuong, Robert Ali, Simon Baldwin, Stephen Mills10.1016/j.drugpo.2011.11.005International Journal of Drug Policy (2011)2011-12-30International Journal of Drug Policy2011-12-30POLICY ANALYSIShttp://www.ijdp.org/article/PIIS0955395911001642/abstract?rss=yesAbstract: Background and objectives: Iran is a country with low HIV prevalence in the general population and concentrated prevalence amongst injecting drug users (IDUs). Various studies have been carried out on HIV prevalence amongst IDUs in Iran and diverse results have been reported. This systematic review intended to find and collect all relevant studies, assess the quality of data and provide estimations on the national prevalence over time.Methods: A broad search strategy was used, including searching international and local databases, research reports, and extensive personal contacts. All studies of IDUs conducted between 1998 and 2007 including clear description of method and HIV testing and confirmative western blot test were entered and qualitatively assessed. HIV prevalence rates were pooled for gender and stratified into several categories.Results: Twenty-two studies involving 3916 IDUs were included. Half of the studies had been conducted in Tehran. Ten studies were conducted in prisons, seven in treatment centres and five in the Drop-in-centres or communities. After 2005 the pooled HIV prevalence was 18.4% [95% Confidence Interval (CI) 16.7–20.2] significantly higher than the prevalence rate before 2005 [8.7% (95% CI 7.5–10].Conclusion: HIV prevalence amongst IDUs has increased over time and has the potential to increase exponentially. Scaling up harm reduction measures, increasing their availability and coverage, and improving the quality of services is highly recommended in order to prevent a future catastrophic epidemic.HIV prevalence amongst injecting drug users in Iran: A systematic review of studies conducted during the decade 1998–2007 - Corrected ProofAfarin Rahimi-Movaghar, Masoumeh Amin-Esmaeili, Ali-akbar Haghdoost, Behnam Sadeghirad, Minoo Mohraz10.1016/j.drugpo.2011.09.002International Journal of Drug Policy (2011)2011-10-17International Journal of Drug Policy2011-10-17REVIEWhttp://www.ijdp.org/article/PIIS0955395911001630/abstract?rss=yesAbstract: Driven by opioid use, HIV prevalence is high (15–27%) amongst injection drug users (IDU) in Iran. Harm reduction programmes are associated with a reduction in high risk injecting behaviours; however, Iran has a large number of non-injecting opioid users not immediately targeted by harm reduction programmes. The vast majority of heroin injectors tend to have a history of several years of smoking opium or heroin before transitioning to injection, and a small fraction may even start their drug career by injection of opioids, behaviours that can undermine the effectiveness of the harm reduction programmes. In this study, we have reviewed evidence on the HIV epidemic, extent and pattern of opioid use, and correlates of the transition to injection in Iran. We have concluded that harm reduction policies should also emphasize prevention of the transition to injection amongst high-risk non-injecting opioid users as an additional strategy against the spread of HIV infection in Iran.Transition to injection amongst opioid users in Iran: Implications for harm reduction - Corrected ProofMohsen Malekinejad, Mohsen Vazirian10.1016/j.drugpo.2011.09.001International Journal of Drug Policy (2011)2011-10-14International Journal of Drug Policy2011-10-14POLICY ANALYSIS