Evidence-based policy or policy-based evidence? The role of evidence in the development and implementation of the Illicit Drug Diversion Initiative

Assessing support for substance use policies among the general public and policy influencers in two Canadian provinces

BACKGROUND

Examining support for substance use policies, including those for harm reduction, among the general public and policy influencers is a fundamental step to map the current policy landscape and leverage policy opportunities. Yet, this is a knowledge gap in Canada. Our paper identifies the level of support for substance use policies in two provinces in Canada and describes how the level of support is associated with intrusiveness and sociodemographic variables.

METHODS

Data came from the 2019 Chronic Disease Prevention Survey. The representative sample included members of the general public (Alberta n = 1648, Manitoba n = 1770) as well as policy influencers (Alberta n = 204, Manitoba n = 98). We measured the level of support for 22 public policies concerning substance use through a 4-point Likert-scale. The Nuffield Council on Bioethics Intervention Ladder framework was applied to assess intrusiveness. We used cumulative link models to run ordinal regressions for identification of explanatory sociodemographic variables.

RESULTS

Overall, there was generally strong support for the policies assessed. The general public in Manitoba was significantly more supportive of policies than its Alberta counterpart. Some differences were found between provinces and samples. For certain substance use policies, there was stronger support among women than men and among those with higher education than those with less education.

CONCLUSIONS

The results highlight areas where efforts are needed to increase support from both policy influencers and general public for adoption, implementation, and scaling of substance use policies. Socio-demographic variables related to support for substance use policies may be useful in informing strategies such as knowledge mobilization to advance the policy landscape in Western Canada.

Recidivism of Individuals Who Completed Schedule I Drugs Deferred Prosecution Treatment: A Population-Based Follow-Up Study from 2008 to 2020 in Taiwan

Deferred Prosecution with Condition to Complete the Addiction Treatment (DPCCAT) is a judicial diversion program in Taiwan that shifts people who use drugs away from the label drug offender and toward the label patient. However, little is known about the effectiveness of completing a DPCCAT program on people who use drugs. Using a nationwide population-based retrospective panel data from 2008 to 2020, recidivism is defined as a person was caught urine positive and charged by a prosecutor after their completion of DPCCAT. After controlled gender, age, and region, comparisons of recidivism rates and time to relapse between Schedule I drug use only, Schedule I & II drug use, and heterogeneous group were examined. Of 24,248 participants with DPCCAT, 11,141 (46%) completed the one-year treatment program. Of completers, the five-year recidivism rates are significantly lower for the Schedule I drug use only (26%) than Schedule I & II drugs use (52%) and heterogeneous group (47%). Results from Cox regression indicated that the duration of recidivate to drug use is significantly longer for the Schedule I drug only than the other two groups after controlling for demographics. The main findings support that completion of a DPCCAT program only reduces the risk of recidivism for people who use Schedule I drug only and is less effective for polydrug users and heterogeneous group. We suggest that characteristics of people who use drugs and other criminal offenses should be taken into consideration for triage when DPCCAT is offered.

When the messenger is more important than the message: an experimental study of evidence use in francophone Africa

Background

Epistemic injustices are increasingly decried in global health. This study aims to investigate whether the source of knowledge influences the perception of that knowledge and the willingness to use it in francophone African health policy-making context.

Methods

The study followed a randomized experimental design in which participants were randomly assigned to one of seven policy briefs that were designed with the same scientific content but with different organizations presented as authors. Each organization was representative of financial, scientific or moral authority. For each type of authority, two organizations were proposed: one North American or European, and the other African.

Results

The initial models showed that there was no significant association between the type of authority or the location of the authoring organization and the two outcomes (perceived quality and reported instrumental use). Stratified analyses highlighted that policy briefs signed by the African donor organization (financial authority) were perceived to be of higher quality than policy briefs signed by the North American/European donor organization. For both perceived quality and reported instrumental use, these analyses found that policy briefs signed by the African university (scientific authority) were associated with lower scores than policy briefs signed by the North American/European university.

Conclusions

The results confirm the significant influence of sources on perceived global health knowledge and the intersectionality of sources of influence. This analysis allows us to learn more about organizations in global health leadership, and to reflect on the implications for knowledge translation practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00854-x.

Organic Collaborative Research Partnership Building: Researchers, Needle and Syringe Program Providers, and People Who Inject Drugs

(1) Background: People who inject drugs (PWID) and needle and syringe program (NSP) providers increasingly partner with researchers to explore harm reduction best practice. However, a paucity of research exists regarding how best to engage PWID and community NSP providers to generate the evidence for sustainable harm reduction services. (2) Aim: This study reports on our use of an organic community research partnership-building approach between researchers, NSP providers, and PWID in Canberra ACT, Australia. (3) Method: Survey participants included both PWID (n = 70) and NSP providers (n = 26) across primary (n = 2), secondary (n = 7), and outreach (n = 1) services in Canberra ACT. Applying an organic partnership-building strategy, we engaged with partners and adapted approaches according to information gained in the process of implementation. (4) Results: We found engaging in relationship building around partner priority activities created mutual understanding and trust premised in authenticity of the evolving partnership. Our organic approach, which included a partner audit of the research tools for relevance, resulted in high acceptance and enrolment into the research by NSP providers and PWID. Finally, we observed strong social capital building utilizing an organic approach for the sustainability of the partnership. (5) Conclusions: The results of this study provide evidence for the benefits of organic collaborative research partnership building with NSP providers and PWID for authentic service program implementation. Our approach to research partnership building resulted in strong relationships built on shared goals and objectives, mutual gains, and complementary expertise. We propose the wider use of organic approaches to developing collaborative research partnerships with NSP providers and PWID to enhance consumer responsiveness towards service provision.

'Worth the test?' Pragmatism, pill testing and drug policy in Australia

BACKGROUND

Recent deaths of young Australian music festival attendees from 'party-drug' overdoses have sparked debate about the effectiveness of drug policies. Australia is widely lauded for its harm minimisation approach to drugs, and yet, over the last 30 years, it can be argued its policies have been fragmented, sometimes inconsistent and contradictory. The present article examines the root of this inconsistency, using it as a foundation to advocate for drug policy reform. In keeping with the goals of the National Drug Strategy to promote policy innovation, there is an opportunity to learn from international studies which have shown promising findings in the reduction of party-drug use and its harms through application of pill testing.

METHOD

This paper evaluates Australia's National Drug Strategy and pill testing through a lens of pragmatism, to determine whether there is space for testing practices in contemporary policy. Specifically, the paper analyses current drug policy literature and research studies, examining a range of key drug use indicators, social and political debate and research evidence.

RESULTS

The need for policy reform, attitudinal and cultural shifts and development of stronger cross-sectoral partnerships is highlighted, to ensure a rational and logical approach that genuinely tackles drug policy-making and strategy from a broad public health perspective.

CONCLUSIONS

Using a theoretical frame of pragmatism and drawing from national and international research evidence, this paper recommends the integration of pill testing into Australia's harm minimisation strategy.

The Possible Experts: How Epistemic Communities Negotiate Barriers to Knowledge Use in Ecosystems Services Policy

The increased salience of how to value ecosystems services has driven up the demand for policy-relevant knowledge. It is clear that advice by epistemic communities can show up in policy outcomes, yet little systematic analysis exists prescribing how this can actually be achieved. This paper draws on four decades of knowledge utilisation research to propose four types of ‘possible expert’ who might be influential on ecosystems services. Broad findings of a literature review on knowledge use in public policy are reported, and the four-fold conceptualisation pioneered by Carol Weiss that defines the literature is outlined. The field is then systematised by placing these four modes of knowledge use within an explanatory typology of policy learning. With how, when, and why experts and their knowledge are likely to show up in policy outcomes established, the paper then proposes the boundaries of the possible in how the ecosystems services epistemic community might navigate the challenges associated with each learning mode. Four possible experts emerge: with political antenna and epistemic humility; with the ability to speak locally and early to the hearts and minds of citizens; with a willingness to advocate policy; and, finally, with an enhanced institutional awareness and peripheral policy vision. The paper concludes with a brief discussion of the utility of the analysis.

Political and institutional influences on the use of evidence in public health policy. A systematic review

Background

There is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making.

Methods

We conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review.

Findings

56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies.

Conclusions

This review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies.