Mapping a moral panic: News media narratives and medical expertise in public debates on safer supply, diversion, and youth drug use in Canada

The ongoing overdose and drug toxicity crisis in North America has contributed momentum to the emergence of safer supply prescribing and programs in Canada as a means of providing an alternative to the highly volatile unregulated drug supply. The implementation and scale-up of safer supply have been met with a vocal reaction on the part of news media commentators, conservative politicians, recovery industry representatives, and some prominent addiction medicine physicians. This reaction has largely converged around several narratives, based on unsubstantiated claims and anecdotal evidence, alleging that safer supply programs are generating a "new opioid epidemic", reflecting an emerging alignment among key institutional and political actors. Employing situational analysis method, and drawing on the policy studies and social science scholarship on moral panics, this essay examines news media coverage from January to July 2023, bringing this into dialogue with other existing empirical sources on safer supply (e.g. Coroner's reports, program evaluations, debates among experts in medical journals). We employ eight previously established criteria delineating moral panics to critically appraise public dialogue regarding safer supply, diverted medication, and claims of increased youth initiation to drug use and youth overdose. In detailing the emergence of a moral panic regarding safer supply, we trace historic continuities with earlier drug scares in Canadian history mobilized as tools of racialized poverty governance, as well as previous backlashes towards healthcare interventions for people who use drugs (PWUD). The essay assesses the claims of moral entrepreneurs against the current landscape of opioid use, diversion, and overdose among youth, notes the key role played by medical expertise in this and previous moral panics, and identifies what the convergence of these narratives materialize for PWUD and healthcare access, as well as the broader policy responses such narratives activate.

Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review

INTRODUCTION

Xylazine, an α2-adrenoceptor agonist sedative commonly used in veterinary medicine, is not approved for human use. Nevertheless, xylazine-involved overdose rates have surged in recent years, fueled by an increasingly toxic and synthetic illicit drug supply in North America.

METHODS

This narrative review assessed major epidemiological trends in xylazine-involved overdoses in North America, aiming to identify harm reduction priorities. A literature search was conducted using four bibliographic databases (PubMed, Scopus, Embase, and ScienceDirect) and three preprint servers (medRxiv, bioRxiv, and Europe PMC) on May 28, 2023, to capture articles related to combinations of keywords such as "xylazine", "opioid", and "harm reduction".

RESULTS

Xylazine emerged as an adulterant in Puerto Rico in 2001, likely diverted from veterinary supplies. By the mid-2010s, it began proliferating across unregulated US drug markets, often contemporaneously with illicitly manufactured fentanyl (IMF), displaying characteristics of a syndemic. Initially concentrated in Northeastern regions (e.g., Philadelphia, Connecticut, Maryland), xylazine-involved overdoses later extended to the Rust Belt, Southern, and Western regions of the USA in the late 2010s and early 2020s. During this time, xylazine-involved overdoses also surged in Canada, particularly in Western provinces (British Columbia and Alberta) and Ontario with established IMF-dominated unregulated drug markets.

DISCUSSION

Over the past two decades, xylazine-involved overdoses have been rapidly rising in North America and exhibit few signs of slowing down, representing a serious public health epidemic. Numerous factors may have contributed to this, including limited epidemiological surveillance and drug checking for xylazine and emerging novel adulterants; further, barriers to comprehensive, trauma-informed, non-stigmatizing treatment and social services have also exacerbated this issue. While several epidemiological and ethnographic studies have assessed these factors in the USA, limited evidence is available in Canada where xylazine emerged more recently. This underscores the need for additional research and harm reduction measures.

CONCLUSION

Harm reduction-informed public health guidelines and programs are urgently needed to promote a safer supply, strengthen the healthcare system capacity to prevent and respond to xylazine-involved overdoses, and address social and structural disparities in health outcomes.

‘Making Ground’: An Ethnography of ‘Living With’ Harmful Methamphetamine Use and the Plurality of Recovery

The trajectories of people attempting to reduce harmful methamphetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical interactionist analysis of ethnographic fieldwork conducted with people who use methamphetamine, to examine how their experiences could undermine this binary, observing the ways participants experienced growth, change, and progress, without necessarily maintaining abstinence. These findings support a more diverse understanding of drug use trajectories, and we explore the concept of ‘living with drug use’, similar to how people live with other chronic conditions by finding ‘health in illness’. Participant experiences are also interpreted within the context of counter public health, arguing for the recognition and integration of values and goals which are divergent from the implicit aims of public health practice.

Social Construction of Target Populations: A Theoretical Framework for Understanding Policy Approaches to Perinatal Illicit Substance Screening

Perinatal illicit substance use is a nursing and public health issue. Current screening policies have significant consequences for birthing individuals and their families. Racial disparities exist in spite of targeted and universal screening policies and practices. Thus, new theoretical approaches are needed to investigate perinatal illicit substance use screening in hospital settings. The purpose of this analysis is to evaluate the social construction of target populations theory in the context of perinatal illicit substance use screening. Using the theoretical insights of this theory to interrogate the approaches taken by policy makers to address perinatal illicit substance use and screening provides the contextual framework needed to understand why specific policy tools were selected when designing public policy to address these issues. The analysis and evaluation of this theory was conducted using the theory description and critical reflection model.

Trends in Sentencing of Federal Drug Offenders: Findings From U.S. District Courts 2002–2017

This study uses 16 years (2002–2017) of federal criminal drug sentences from the U.S. Sentencing Commission (USSC) to examine trends in two criminal sentencing outcomes: whether a defendant received a prison sentence and the length of a prison sentence. Logistic and ordinary least squares regression analyses were used to assess criminal sentencing outcomes. Moderation analyses are conducted to assess variation in sentencing for specific drug offenses over time. Results demonstrate that sentencing for federal drug crimes has become less severe over time. However, there is substantial heterogeneity in sentencing across different drug types, with pharmaceutical opioid cases receiving the least leniency over time regarding the incarceration decision and methamphetamine cases experiencing the lowest reduction in the length of prison sentences from 2002 to 2017. Finally, our analysis stratified by race/ethnicity suggested that there is heterogeneity in sentencing outcomes for federal drug offenders, conditional on racial and ethnic background.

Meth Mouth, White Trash, and the Pseudo-Racialization of Methamphetamine Use in the U.S

Drug scares have historically been created for a range of purposes and with a variety of effects in the United States. Moral panics evoked by these drug scares either support or challenge dominant American ideas about race, economics, and society. In the present study, we examined newspaper accounts of methamphetamine use in the Inland Pacific Northwest of the United States in an effort to understand how the "reality" of the "meth epidemic" is socially constructed in a "meth hotspot," and reflect upon the ways that the discourse of Whiteness intersects with this construction. For our analysis, we are cognizant of the "slipperiness" of the logic of Whiteness as a concept, and the ways that an alternative logic is articulated - one that strategically embraces or distances White drug users to support notions of White dominance. We focus on the possibility that individual meth users could then be portrayed pseudo-racially as "White trash," and thus rendered outside the logic of White racial order. Our findings center on two main themes: (1) the use of fear in the construction of the meth drug scare through the sensationalization of meth, its anthropomorphization, and the depiction of the threat of the White drug user; and (2) how the logic of Whiteness is discursively reconciled within this construction. Given current mediated discourses about drug use and health in the United States that center on the emergence of the White drug user as the face of the opioid crisis, we are well served to carefully consider the recent historical precedence of the "meth epidemic" in which the public was faced with reconciling their views about drug use and the intersection of race, class, and mainstream American identity.

Drug Use During Pregnancy Policies in the United States From 1970 to 2016

As U.S. states legalize marijuana and as governmental attention is paid to the “opioid crisis,” state policies pertaining to drug use during pregnancy are increasingly important. Little is known about the scope of state policies targeting drug use during pregnancy, how they have evolved, and how they compare to alcohol use during pregnancy policies.

Method:

Our 46-year original data set of statutes and regulations in U.S. states covers the entirety of state-level legislation in this policy domain. Data were obtained through original legal research and from the National Institute on Alcohol Abuse and Alcoholism’s Alcohol Policy Information System. Policies were analyzed individually as well as by classification as punitive toward or supportive of women.

Results:

The number of states with drug use during pregnancy policies has increased from 1 in 1974 to 43 in 2016. Policies started as punitive. By the mid- to late 1980s, supportive policies emerged, and mixed policy environments dominated in the 2000s. Overall, drug/pregnancy policy environments have become less supportive over time. Comparisons of drug laws to alcohol laws show that the policy trajectories started in opposite directions, but by 2016, the results were the same: Punitive policies were more prevalent than supportive policies across states. Moreover, there is a great deal of overlap between drug use during pregnancy policies and alcohol/pregnancy policies.

Conclusion:

This study breaks new ground. More studies are needed that explore the effects of these policies on alcohol and other drug use by pregnant women and on birth outcomes.

Constructing Drug Using Victims

Sociologists and political scientists examining the social construction of public anxiety surrounding drug use in the United States have argued that racial minorities are the targets of the harshest drug laws while middle-class whites are shielded. In this article, I provide further evidence that middle-class, white drug users are shielded from harsh punishment by analyzing the process through which U.S. legislators and policy makers decide which drug users need punishment and which deserve protection and treatment. Analyzing transcripts from federal Congressional hearings, I examine the rhetoric of legislators and stakeholder witnesses concerning the use of 3,4-methylenedioxymethamphetamine (MDMA) by middle-class whites. Building on the social construction literature, I use social identity theory to demonstrate how legislators within Congressional hearings create in- and out-groups in order to categorize different drug users and dealers. My analysis of Congressional hearing language concerning white MDMA use demonstrates that Congressional speakers use rhetoric to convince committee members and the wider public that middle-class, white drug users are different from drug users of color and that the appropriate policy response is education and treatment rather than punishment. My findings highlight how middle-class, white drug users are characterized differently from drug users of color, providing further evidence that U.S. drug policy has historically favored middle-class, white drug users.