The hammer and the nail: The triple lock of methods, realities and institutional contexts in Australian research on nightlife violence

There is considerable public and policy debate in Australia about measures to reduce violence associated with alcohol and young people in the night-time economy. Though overrepresented in violence, the role of men and masculinities is rarely explicitly addressed in policy responses to such violence, which rest on a narrow range of mainly quantitative research and recommendations favouring blanket alcohol restrictions. Drawing on John Law and colleagues' account of the 'double social life of methods' (2011), we analyse interviews conducted with Australian quantitative researchers about the role of gender in such violence. According to Law et al., methods inhabit and reproduce particular ecologies and reflect the concerns of those who advocate them. From this 'triple lock' of methods, realities, and institutional advocacies and contexts emerges particular modes of knowing. Participants described a research ecology in which the authority of quantitative research methods emerged in relation to an imperative to respond in a 'timely' and 'pragmatic' fashion to public policy debates, and prevailing governmental and policy priorities and public framings of violence. Though participants frequently acknowledged the role of men in violence, these arrangements sustain taken-for-granted assumptions about the properties and effects of alcohol while displacing men and masculinities from policy attention. The political consequences of these arrangements demand the development of innovative policy responses and new modes of knowing that make visible the gendering of violence.

Uncomfortable science: How mathematical models, and consensus, come to be in public policy

We explore messy translations of evidence in policy as a site of 'uncomfortable science'. Drawing on the work of John Law, we follow evidence as a 'fluid object' of its situation, also enacted in relation to a hinterland of practices. Working with the qualitative interview accounts of mathematical modellers and other scientists engaged in the UK COVID-19 response, we trace how models perform as evidence. Our point of departure is a moment of controversy in the public announcement of second national lockdown in the UK, and specifically, the projected daily deaths from COVID-19 presented in support of this policy decision. We reflect on this event to trace the messy translations of "scientific consensus" in the face of uncertainty. Efforts among scientists to realise evidence-based expectation and to manage the troubled translations of models in policy, including via "scientific consensus", can extend the dis-ease of uncomfortable science rather than clean it up or close it down. We argue that the project of evidence-based policy is not so much in need of technical management or repair, but that we need to be thinking altogether differently.

Noticed and then Forgotten: Gender in Alcohol Policy Stakeholder Responses to Alcohol and Violence

In this article, we analyse interview data on how alcohol policy stakeholders in Australia, Canada and Sweden understand the relationship between men, masculinities, alcohol and violence. Using influential feminist scholarship on public policy and liberal political theory to analyse interviews with 42 alcohol policy stakeholders, we argue that while these stakeholders view men's violence as a key issue for intervention, masculinities are backgrounded in proposed responses and men positioned as unamenable to intervention. Instead, policy stakeholders prioritise generic interventions understood to protect all from the harms of men's drinking and violence without marking men for special attention. Shared across the data is a prioritisation of interventions that focus on harms recognised as relating to men's drinking but apply equally to all people and, as such, avoid naming men and masculinities as central to alcohol-related violence. We argue that this process works to background the role of masculinities in violence, leaving men unmarked and many possible targeted responses unthinkable.

Reducing or reproducing inequalities in health? An intersectional policy analysis of how health inequalities are represented in a Swedish bill on alcohol, drugs, tobacco and gambling

BACKGROUND

According to post-structural policy analyses, policies and interventions aiming at reducing social inequalities have been found to be part in producing and reifying such inequalities themselves. Given the central role of health inequalities on the public health policy agenda globally it seems important to examine the way policy on health inequalities may potentially counteract the goal of health equity. The aim of this intersectional policy analysis, was to critically analyze the representation of health inequalities in a government bill proposing a national strategy on alcohol, drugs, tobacco and gambling, to examine its performative power, and to outline alternative representations.

METHOD

A post-structural approach to policy analysis was combined with an intersectional framework. The material was analyzed through an interrogating process guided by the six questions of the "What's the problem represented to be?" (WPR) approach. Thus, the underlying assumptions of the problem representation, its potential implications and historical background were explored. In a final step of the analysis we examined our own problem representations.

RESULTS

The recommendations found in the gender and equity perspective of the bill represented the problem of health inequalities as a lack of knowledge, with an emphasis on quantitative knowledge about differences in health between population groups. Three underlying assumptions supporting this representation were found: quantification and objectivity, inequalities as unidimensional, and categorization and labelling. The analysis showed how the bill, by opting into these partly overlapping assumptions, is part of enacting a discourse on health inequalities that directs attention to specific subjects (e.g., vulnerable) with special needs (e.g., health care), in certain places (e.g., disadvantaged neighborhoods). It also showed how underlying processes of marginalization are largely neglected in the bill due to its focus on describing differences rather than solutions. Finally, we showed how different intersectional approaches could be used to complement and challenge this, potentially counteractive, problem representation.

CONCLUSIONS

The problem representation of health inequalities and its underlying assumptions may have counteractive effects on health equity, and even though some of its strengths are raised, it seems to be profoundly entangled with a system resisting the kind of change that the bill itself advocates for. If carefully used, intersectionality has the potential to support a more comprehensive and inclusive equality-promoting public health policy and practice.

Making pandemics big: On the situational performance of Covid-19 mathematical models

In this paper, we trace how mathematical models are made 'evidence enough' and 'useful for policy'. Working with the interview accounts of mathematical modellers and other scientists engaged in the UK Covid-19 response, we focus on two weeks in March 2020 prior to the announcement of an unprecedented national lockdown. A key thread in our analysis is how pandemics are made 'big'. We follow the work of one particular device, that of modelled 'doubling-time'. By following how modelled doubling-time entangles in its assemblage of evidence-making, we draw attention to multiple actors, including beyond models and metrics, which affect how evidence is performed in relation to the scale of epidemic and its policy response. We draw attention to: policy; Government scientific advice infrastructure; time; uncertainty; and leaps of faith. The 'bigness' of the pandemic, and its evidencing, is situated in social and affective practices, in which uncertainty and dis-ease are inseparable from calculus. This materialises modelling in policy as an 'uncomfortable science'. We argue that situational fit in-the-moment is at least as important as empirical fit when attending to what models perform in policy.

"A matter of time": Evidence-making temporalities of vaccine development in the COVID-19 media landscape

This article investigates how evidence of the safety and efficacy of COVID-19 vaccines is enacted in news media via a focus on the temporality of vaccine development. We argue that time constitutes a crucial object of and mechanism for knowledge production in such media and investigate how time comes to matter in vaccine evidence-making communication practices. In science communication on vaccine development, the vaccine object (along with the practices through which it is produced) undergoes a material-discursive shift from an imagined "rushed" product to being many years in the making and uninhibited by unnecessarily lengthy processes. In both these enactments of vaccine development, time itself is constituted as evidence of vaccine efficacy and safety. This article traces how time (performed as both calendar time and as a series of relational events) is materialized as an affective and epistemic object of evidence within public science communication by analyzing the material-discursive techniques through which temporality is enacted within news media focused on the timeline of COVID-19 vaccine development. We contend that time (as evidence) is remade through these techniques as an ontopolitical concern within the COVID-19 vaccine assemblage. We furthermore argue that science communication itself is an important actor in the hinterland of public health practices with performative effects and vital evidence-making capacities.

New directions for participatory modelling in health: Redistributing expertise in relation to localised matters of concern

Participatory modelling seeks to foster stakeholder engagement to better attune models to their decision-making and policy contexts. Such approaches are increasingly advocated for use in the field of health. We review the instrumental and epistemological claims made in support of participatory modelling approaches. These accentuate participatory models as offering a better evidence-base for health policy decisions. By drawing attention to recent modelling experiments in a sector outside of health, that of water management, we outline a different way of thinking about participation and modelling. Here, the participatory model is configured in relation to matters of 'knowledge controversy', with modelling constituted as an 'evidence-making intervention' in relation to the making of science and expertise. Rather than presenting participatory models as an improved technical solution to addressing given policy problems within an evidence-based intervention approach, models are alternatively potentiated as sites for the redistribution of expertise among actor networks as they seek to engage politically in a matter of concern. This leads us to consider possible new directions for participatory modelling in the field of health.

Futures-oriented drugs policy research: Events, trends, and speculating on what might become

One concern in the field of drugs policy is how to make research more futures-oriented. Tracing trends and events with the potential to alter drug futures are seen as ways of becoming more prepared. This challenge is made complex in fast evolving drug markets which entangle with shifting social and material relations at global scale. In this analysis, we argue that drugs policy research orientates to detection and discovery based on the recent past. This narrows future-oriented analyses to the predictable and probable, imagined as extensions of the immediate and local present. We call for a more speculative approach; one which extends beyond the proximal, and one which orientates to possibilities rather than probabilities. Drawing on ideas on speculation from science and technology and futures studies, we argue that speculative research holds potential for more radical alterations in drugs policy. We encourage research approaches which not only valorise knowing in relation to what might happen but which conduct experiments on what could be. Accordingly, we trace how speculative research makes a difference by altering the present through making deliberative interventions on alternative policy options, including policy scenarios which make a radical break with the present. We look specifically at the 'Big Event' and 'Mega Trend' as devices of speculative intervention in futures-oriented drugs policy research. We illustrate how the device of Mega Trend helps to trace as well as to speculate on some of the entangling elements affecting drug futures, including in relation to climate, environment, development, population, drug production, digitalisation, biotechnology, policy and discourse.

"Undisciplined" drinking, multi-sectoralism and political power: Examining problematisations in the Botswana alcohol policy

The Botswana government has recently ramped up efforts to control alcohol consumption through various measures. These include the alcohol tax levy, reduction in trading hours for bars and other licenced premises and increased penalties for alcohol-related road offenses. Whilst these efforts have recently received considerable attention, the processes of alcohol policy development remain unknown and understudied. In this paper, I examine the alcohol policy processes in Botswana using What's the Problem Represented to be (WPR), a poststructural analytic approach that emphasises problematisations in policies. Drawing on alcohol-associated policy documents, I identify two key problematisations that relate to, (1) an emphasis on an "undisciplined" drinker, and (2) an appeal to an internationally-endorsed multi-sectoralism. I explore these problematisations as political formations and periodise them to the year 2008 when they were canonised. I argue that "undisciplined drinking" and an internationally-endorsed multi-sectoralism neglect the social and cultural contexts of drinking, pathologise drinking and do not consider other forms of knowledge. Unmaking current alcohol policy representations is needed to allow for the 'emergence' of alternative conceptualisations of the alcohol 'problem' in Botswana.

Ontological journeys: The lifeworld of opium across the Afghan-Iranian border in/out of the pharmacy

How can we conceive alternative policy models that embrace the empirical potentialities emerging from the lifeworld of drugs? The article reflects on this question, concluding that to reassess and to reinvent current policies on drugs, we need to think with a political ontology. Incidentally, the article also responds to the critique dismissing ontological inquiries as obstructing - or, at best, not informing - alternative drug policies. In an archaeological approach inspired by the work of Giorgio Agamben, the article unearths the case study of opium maintenance programme in Iran (1969-79), a forgotten policy experiment in an understudied and yet crucial geo-cultural environment for the global study of drugs. Mobilising the conceptual framework of ontological journeys, the article recomposes the lifeworld of opium within the horizons of transformative cultural practices, international borders, policy regimes and public ethics. Here, the materiality of drug consumption under the maintenance policy links with the changes in opium's transnational political economy and with shifting regimes of health and bioethical orthodoxy. Ontological journeys, hence, develop in a fluid space and time, making it possible to illuminate the lifeworld of drugs in places and times hitherto deserted by global policy studies. In building theoretical reflections upon a non-Western case, the article also incites the possibility of theory beyond Eurocentric knowledge and Euromerican cases. In this way, the article's purpose is to analyse the be-coming of opium beyond 'good' or 'evil', as a 'medicine' or a 'drug' and its real or perceived classification as 'licit' or 'illicit' across the Afghan-Iranian border. In conclusion, the article reflects upon the significance of this forgotten policy experiment, understood as an ontological journey, for contemporary drug policy and drug studies, but also for reinventing notions of care, welfare and health.

Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low- and middle-income countries

Introduction

Peer involvement of people who use drugs within HIV and harm reduction services is widely promoted yet under-utilised. Alongside political and financial barriers is a limited understanding of the roles, impacts, contexts and mechanisms for peer involvement, particularly in low- and middle-income settings. We conducted a rapid review of available literature on this topic.

Methods

Within a community-academic partnership, we used a rapid review approach, framed by realist theory. We used a network search strategy, focused on core journals and reference lists of related reviews. Twenty-nine studies were included. We developed thematic summaries framed by a realist approach of exploring interventions, their mechanisms, outcomes and how they are shaped by contexts.

Results

Reported outcomes of peer involvement included reduced HIV incidence and prevalence; increased service access, acceptability and quality; changed risk behaviours; and reduced stigma and discrimination. Mechanisms via which these roles work were trust, personal commitment and empathy, using community knowledge and experience, as well as ‘bridge’ and ‘role model’ processes. Contexts of criminalisation, under-resourced health systems, and stigma and discrimination were found to shape these roles, their mechanisms and outcomes. Though contexts and mechanisms are little explored within the literature, we identified a common theme across contexts, mechanisms and outcomes. Peer outreach interventions work through trust, community knowledge and expertise, and ‘bridge’ mechanisms (M) to counter criminalisation and constraining clinic and service delivery environments (C), contributing towards changed drug-using behaviours, increased access, acceptability and quality of harm reduction services and decreased stigma and discrimination (O).

Conclusion

Peer involvement in HIV and harm reduction services in low- and middle-income settings is linked to positive health outcomes, shaped by contexts of criminalisation, stigma, and resource scarcity. However, peer involvement is under-theorised, particularly on how contexts shape mechanisms and ultimately outcomes. Efforts to study peer involvement need to develop theory and methods to evaluate the complex mechanisms and contexts that have influence. Finally, there is a need to expand the range of peer roles, to embrace the capacities and expertise of people who use drugs.

Assembling and diversifying social contexts of recovery

Recovery from drug use is receiving increased attention in critical drug studies. Researchers point out the importance of scrutinizing the term and its meanings anew in order to better understand drug use treatment policies and their effects on the individuals they target. Informed by relational ontological thinking, this article analyses a series of empirical accounts of recovery experiences, and offers a critical assessment of the social contexts of recovery. Qualitative data collected in Azerbaijan and Germany provide distinctive reports of the differentiated experiences of youth as they make and re-make sense of their recovery within specific recovery contexts. Discussions reveal how recovery advances in relations between human and nonhuman actors including spaces, bodies, affects, and practices. On the basis of this analysis, we argue that recovery may be framed as an emergent and dynamic context that becomes with and from drug use.

What prevents health policy being 'evidence-based'? New ways to think about evidence, policy and interventions in health

BACKGROUND

Evidence-based policy decision-making is a dominant paradigm in health but realizing this ideal has proven challenging.

SOURCES OF DATA

This paper conceptually maps health policy, policy studies and social science literature critically engaged with evidence and decision-making. No new data were generated or analysed in support of this review.

AREAS OF AGREEMENT

Barriers to evidence-based policy have been documented, with efforts made to increase the uptake of evidence.

AREAS OF CONTROVERSY

Evident complexities have been regarded as a problem of translation. However, this assumes that policy-making is a process of authoritative choice, and that 'evidence' is inherently valuable policy knowledge, which has been critiqued.

GROWING POINTS

Alternative accounts urge consideration of how evidence comes to bear on decisions made within complex systems, and what counts as evidence.

AREAS TIMELY FOR DEVELOPING RESEARCH

An 'evidence-making intervention' approach offers a framework for conceptualizing how evidence and interventions are made relationally in practices, thus working with the politics and contingencies of implementation and policy-making.

Towards an ontological politics of drug policy: Intervening through policy, evidence and method

Increasing attention has been paid to matters of ontology, and its accompanying politics, in the drug policy field. In this commentary, we consider what an 'ontological politics' might mean for how we think about what drug policy is and what it might become, as well as for how we think about (and do) research in drug policy. Thinking ontopolitically questions the tacitly accepted status of 'drug problems', calls into question the realist presumptions which underpin much drug policy analysis, and provokes thinking about what counts as 'evidence' and the 'evidence-based policy' paradigm itself. We call attention to the inventive possibilities of method when grappling with the challenges thrown forth by the ontological turn, with a renewed focus on practice and relations. An ontological politics disrupts consensual claims and draws critical attention to objects that might otherwise appear 'finished' or 'ready-made', not least the things we call 'drugs' and 'drug policy'. Working with 'drug policy multiples' invites new thinking and dialogue to provoke an ethico-political mode of intervention in the field of drug policy and drugs research.

“Coming Out”: Stigma, Reflexivity and the Drug Researcher’s Drug Use

Some personal experience of illicit drug use undoubtedly exists within the population of academic drug researchers. But it is rarely acknowledged, and even more rarely reflected upon, in their published work. This is understandable: criminal, professional and social sanctions may follow public admission of illicit activities. However, to not “come out” seems contrary to some core academic principles, such as transparency in data collection and reflexivity in the research process. Coming out may present researchers with an opportunity for improving knowledge of, and policies toward, drug use. In this article, we identify reasons for and against the public disclosure of drug use and the impact of such disclosure across a range of spheres, including research, teaching, policy influence and private lives. Reasons against coming out include the risks of undermining professional reputations and hence the ability to contribute to academic and policy debates, the threat of criminal justice sanctions, and impacts on loved ones. However, coming out can have academic benefit (i.e., improving our understanding of drugs, of people who use drugs, and of drug research) and contribute to activist goals (e.g., de-stigmatization of drug use and demarginalization of people who use drugs). Both the risks and benefits of public drug use disclosure have implications for how research and researchers may influence drug policy. Two key themes, stigma and reflexivity, underpin the discussion. We do not conclude with clear recommendations for drug-using drug researchers; to come out or to not come out is a personal decision. However, we argue that there is clear merit to further open discussion on the role of disclosure and reflection on personal drug use experience among those working in drug research and drug policy—where such reflection is relevant and where such researchers feel able to do so.

WITHDRAWN: A Geology of Drug Morals

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HIV pre-exposure prophylaxis and the 'problems' of reduced condom use and sexually transmitted infections in Australia: a critical analysis from an evidence-making intervention perspective

HIV pre-exposure prophylaxis (PrEP) has been embraced in Australia, making PrEP available with public funding to people at risk of HIV. Here, we consider the associated 'problems' of reduced condom use and sexually transmissible infections (STIs), as seen by HIV professionals. Twenty-one interviews were conducted during May-August 2017. All agreed that PrEP was a valuable addition to HIV prevention, but their views about reduced condom use and STIs were variable. Using poststructural policy analysis, three main stances were identified: (1) Concerned/alarmed. PrEP was seen as causing reduced condom use, STIs and antibiotic resistance, posing threats to the general population; (2) Neutral/normalising. Stakeholders emphasised that condom use was declining and STIs increasing independently of PrEP, and that PrEP was simply a new tool to be accommodated; (3) Optimistic/critical. PrEP was seen as diminishing fear of HIV and engaging users in more frequent testing and treatment that could lead to declining STI rates. What linked all three stances was the selective performance of evidence, deploying a mixture of personal experience, clinical observations, behavioural data and epidemiology. Anticipating possible futures through evidence-making suggested practical, political and moral consequences for what PrEP could become. We encourage others to consider these consequences with care.

'Potential issues of morbidity, toxicity and dependence': Problematizing the up-scheduling of over-the-counter codeine in Australia

Until February of 2018, Australians were able to purchase low-dose codeine products (LDCPs) over-the-counter from pharmacies. In 2017, following review and public consultation, Australia's therapeutic drug regulator rescheduled LDCPs to prescription-only, in line with other higher-dose codeine and opioid products. In this article, we draw on Bacchi's 'what's the problem represented to be' approach to 'work backwards', analysing this 'solution' and the particular 'problematisation' of codeine it produces and relies on. We analyse the 'final decision and reasons for decisions' document, which outlines the consultation and decision-making process leading to the rescheduling of LDCPs. We contend that abuse and dependence of codeine by people with chronic pain is the 'problem' constituted by the decision to reschedule LDCP. We consider the ethical and political implications of this problematisation. First, we argue that this problematisation limits the ways the LDCP consumption, particularly by people with chronic pain, can be understood. This problematisation effaces the multiple reasons people with chronic pain may consume LDCPs long term and works to naturalise notions of 'misuse'. We next argue that notions of the 'legitimate patient' and the 'illegitimate consumer' or 'abuser' are in different ways positioned as primarily responsible for managing their health. From here we argue that the problematisation of LDCPs in Australia produces codeine as the sole agent of harm in ways that background wider harm-producing social arrangements. Our analysis also suggests that the 'problem' of LDCPs unreflexively reinforces medical authoring and expertise as the primary solution. Finally, we suggest that the use of LDCPs in Australia could instead be re-problematised as an issue of 'chronic health mismanagement'. Responses to this problematisation would require a reorientation away from attempts to reduce accessibility such as up-scheduling to significantly more focus on long-term healthcare engagement for people consuming LDCPs to manage chronic health issues.

Evidence-making hepatitis C cure: Towards a science that knows more carefully

There has been some controversy concerning the curative potential of new treatments for hepatitis C. This follows a systematic review of the Cochrane Collaboration questioning the clinical benefits of direct-acting antivirals (DAAs). This controversy has been debated as a matter of methods regarding how best to evidence treatment in an evidence-based medicine (EBM) approach. Drawing from science and technology studies (STS), we offer an alternative perspective. We propose a different way of thinking with evidence; one which treats 'evidencing as performative'. Using the Cochrane review and its linked published responses as a resource for this analysis, we consider how hepatitis C cure is differently made-up through the knowledge-making practices performing it. We show how matters of apparent fact in evidence-based science are enacted as matters of clinical, social and ethico-political concern. We notice hepatitis C cure as a fluid object in negotiation. We highlight the limits of current debate to advocate a more critical and careful practice-based approach to knowing hepatitis C cure. This calls upon public health researchers to reflect on the performative work of their evidencing. We propose a 'more-than' EBM approach which treats 'evidence-based' science as an 'evidence-making intervention'. We consider the implications of such an approach for the evidencing of public health interventions and for treating hepatitis C in the DAA era of 'viral elimination'.

'Being human' and the 'moral sidestep' in drug policy: Explaining government inaction on opioid-related deaths in the UK

BACKGROUND

With drug-related deaths at record levels in the UK, the government faces two potential sources of pressure to implement more effective policies. One source is the individuals and families who are most likely to suffer from such deaths; i.e. working class people living in de-industrialised areas. The other source is experts who argue for different policy on the basis of research evidences.

AIM

This article aims to explain why, in the face of these two potential sources of pressure, the UK government has not implemented effective measures to reduce deaths.

METHOD

The article uses critical realist discourse analysis of official documents and ministerial speeches on recent British drug policy (2016-2018). It explore this discourse through the theoretical lens of Archer's (2000) ideas on 'being human' and by drawing on Sayer's (2005) work on the 'moral significance of class'.

RESULTS

Members of economically 'residual' groups (including working class people who use heroin) are excluded from articulating their interests in 'late welfare capitalism' in a project of depersonalising 'class contempt' through which politicians cast the people most likely to die as passive, 'vulnerable' 'abjects'. Conservative politicians dismiss 'evidence-based' ideas on the reduction of drug-related death through a 'moral sidestep'. They defend policy on the basis of its relevance to conservative moral principles, not effectiveness. This is consistent with the broader moral and political pursuit of partial state shrinkage which Conservative politicians and the social groups they represent have pursued since the 1970s.

Great expectations: The bureaucratic handling of Swedish residential rehabilitation in the 21st century

Background and aims:

Increasingly, efforts to counteract perceived problems in drug treatment at residential rehabilitation centres have come to rely on measures drawing on evidence-based practice (EBP). However, the Swedish media, government inquiries, and international research have identified a number of problems regarding both residential rehabilitation and EBP. This suggests that caution should be exercised when placing expectations on EBP. The aim of this study is to investigate how the responsible authorities have handled increasing demands for EBP with administrative control while facing critical evaluations of their steering and implementation efforts. The study examines the maturation of a widespread treatment ideology, which aims to be based on evidence, in a country known for its restrictive drug policy and its goal of becoming a drug-free society.

Methods:

Through a qualitative textual analysis of 17 years (2000–2016) of inquiries, directives, and authority archives we have traced the interplay between problem descriptions, intended goals, and implemented solutions.

Findings:

The analysis shows that the ambition to provide care and welfare based on EBP is still an ambition. Also, the authorities’ control over the care actually provided still leaves room for improvement. Recurring criticism and the empirical material indicate that the expectations have not been met.

Conclusions:

We would like to suggest that continued frustration can be traced to the misconception that EBP is the opposite of values and ideology, and hence preferable. As drug treatment strives for scientific credibility to give it legitimacy, some types of “evidence” are preferred above others. We would like to suggest that we need to bring ideology to the fore, and openly discuss our restrictive policy goals and choices of “evidence”.

Recasting Participation in Drug Policy

Calls for “evidence-based policy” and greater community “participation” are often heard in the drug policy field. Both movements are in different ways concerned with the same questions about how “drug problems” ought to be governed and the place of “expertise” and “engagement” in democratic societies. However, these calls rely on the assumption that knowledges, publics, expertise, and issues of concern are fixed and stable, waiting to be addressed or called to action, thus obscuring ontological questions about what “participation” (be that lay or expert) may do or produce. There has been limited research in the drugs field that has taken “participation” as an object of study in itself and through critical examination attempted to open up new possibilities for its remaking. In this article, we draw on science and technology studies scholarship that has sought to illuminate the relations between public deliberation and government decision-making in public affairs involving technical claims and the generative capacity of such engagement (including for democracy itself). We describe various rationales for participation and examples of experiments that have sought to remake participatory processes in other policy domains. This literature provides fruitful ground for a reengagement with (and possibly a reconfiguration of) “evidence-based policy” or community “participation” in drug policy. Through this exploration, we hope to recast and more sensitively articulate the concept of “participation” in deliberations about public affairs involving technical claims in drug policy, thus opening up possibilities for experiments and practices that redistribute expertise, “slow down” reasoning, attend to emergent publics, and disrupt consensual claims as to “what counts” and what does not.

Making visible the politics and ethics of alcohol policy research

Although research on alcohol policy has produced a huge international literature, alcohol research and policy itself-its cultural assumptions, methods, politics and ethics-has rarely been subject to critical analysis. In this article, I provide an appreciative review of an exception to this trend: Joseph Gusfield's 1981 classic, The Culture of Public Problems: Drinking-Driving and the Symbolic Order. I first outline Gusfield's argument that the 'problem of drinking-driving' is constructed as a 'drama of individualism' centring on the 'killer drunk'. The 'culture' of drinking-driving research and policy emphasizes alcohol as the problem and locates the source of car accidents in the moral failings of the individual motorist, rather than in social institutions or physical environments. For Gusfield, this construction of the problem is the outcome of political and ethical choices rather than of 'objective' conditions. In the second part of the article, I highlight the book's remarkable foresight in anticipating later trends in critical policy analysis, and argue that it should be regarded as a sociological classic and as required reading for those working in alcohol and indeed other drug policy research. I conclude by arguing that The Culture of Public Problems remains relevant to those working in alcohol and other drug policy research, although the reasons for its relevance differ depending on readers' theoretical commitments.

Observations of the role of science in the United States medical cannabis state policies: Lessons learnt

BACKGROUND

Clinical trials have shown cannabis to be effective in the treatment of some medical conditions and there is mounting public and political pressure to enact laws enabling the use of cannabis for medicinal purposes. To date, 28 United States (U.S.) states and the District of Columbia have enacted medical cannabis laws. This study sought to identify the main issues pertaining to the development of medical cannabis laws in the U.S, including the role of scientific evidence.

METHODS

Data were collected from three groups of participants: government officials, lobbyists and medical professionals involved in the medical cannabis debate in five selected states in the U.S.; researchers from the same five states conducting funded research in the alcohol and other drugs field; and members of the International Society for the Study of Drug Policy. The data were analysed using thematic analysis.

RESULTS

Six major themes emerged in relation to the factors influencing policy: scientific evidence plays a limited role in the development of policy; the available research is limited and mixed; there is a need for clearer communication and active dissemination of evidence to policy makers; researchers need to consider what research is likely to impact on policy; scientific evidence is not a major factor in policy development; and there is a need to consider evidence within a political context.

CONCLUSION

Researchers need to be aware of the political context in which medical cannabis laws are or are not enacted and consider ways in which research findings can achieve a higher profile within this context.

‘Naloxone works’: The politics of knowledge in ‘evidence-based’ drug policy

For over 20 years, drug policy experts have been calling for the wider availability of naloxone, to enable lay overdose witnesses to respond to opioid overdose events. However, the ‘evidence base’ for peer-administered naloxone has become a key point of contention. This contention opens up critical questions about how knowledge (‘evidence’) is constituted and validated in drug policy processes, which voices may be heard, and how knowledge producers secure privileged positions of influence. Taking the debate surrounding peer-administered naloxone as a case study, and drawing on qualitative interviews with individuals (n = 19) involved in the development of naloxone policy in Australia, we examine how particular kinds of knowledge are rendered ‘useful’ in drug policy debates. Applying Bacchi’s poststructuralist approach to policy analysis, we argue that taken-for-granted ‘truths’ implicit within evidence-based policy discourse privilege particular kinds of ‘objective’ and ‘rational’ knowledge and, in so doing, legitimate the voices of researchers and clinicians to the exclusion of others. What appears to be a simple requirement for methodological rigour in the evidence-based policy paradigm actually rests on deeper assumptions which place limits around not only what can be said (in terms of what kind of knowledge is relevant for policy debate) but also who may legitimately speak. However, the accounts offered by participants reveal the ways in which a larger number of ways of knowing are already co-habiting within drug policy. Despite these opportunities for re-problematisation and resistance, the continued mobilisation of ‘evidence-based’ discourse obscures these contesting positions and continues to privilege particular speakers.