Drug use and the constitution of homo politicus in Swedish politics 1966-1979

BACKGROUND

The emergence of the drug user as a political problem in Sweden during the 1960s presented politicians with the problem of how to fit this new character into the existing democratic order. The aim of this article is to examine how Swedish politics sought to regulate democratic participation by establishing norms that conditioned who is recognized as a political subject as well as what counts as political speech and action.

METHODS

The analysis is based on a close reading of parliamentary debates, political motions, and public reports and covers the period 1966-1979.

RESULTS

During the examined period, Swedish politics constituted the ideal subject of democratic politics, homo politicus, as a subject embedded in a community of active and politically conscious citizens endowed with the capacity to cooperate and engage in the collective formulation of the common good. Drug use therefore posed a threat to the democratic order due to its passivizing effects that inhibited the cooperation needed to uphold the democratic polity.

CONCLUSION

The perceived individualism, passivity, and inability of the drug user to engage in cooperation within a politically conscious community of citizens positioned the drug user as a threat to the democratic order. The drug user thereby became a useful figure in the political regulation of the democratic sphere and the constitution of homo politicus, the ideal subject of democratic politics.

People who use drugs' prioritization of regulation amid decriminalization reforms in British Columbia, Canada: A qualitative study

BACKGROUND

North America and the province of British Columbia (BC), Canada, is experiencing an unprecedented number of overdose deaths. In BC, overdose has become the leading cause of death for people between the ages of 10-59 years old. In January 2023, BC decriminalized personal possession of a number of illegal substances with one aim being to address overdose deaths through stigma reduction and promoting access to substance use services.

METHODS

We conducted a qualitative study to understand people who use drugs' (PWUD) perceptions of the new decriminalization policy, immediately prior to its' implementation (October-December 2022). To contextualize decriminalization within broader drug policy, we also asked PWUD what they perceived as the priority issues drug policy ought to address and the necessary solutions. Our final sample included 38 participants who used illegal drugs in the past month.

RESULTS

We identified four themes: 1) The illicit drug supply as the main driver of drug toxicity deaths 2) Concerns about the impact of decriminalization on drug toxicity deaths 3) Views towards decriminalization as a policy response in the context of the drug toxicity crisis 4) Regulation as a symbol of hope for reducing drug toxicity deaths.

CONCLUSION

From our data it became clear that many anticipated that decriminalization would have minimal or no impact on the overdose crisis. Regulation was perceived as the necessary policy approach for effectively and candidly addressing the drivers of the ongoing overdose crisis. These findings are important as jurisdictions consider different approaches to moving away from prohibition-based drug policy.

Supervised on-site dosing in injectable opioid agonist treatment-considering the patient perspective. Findings from a cross-sectional interview study in two German cities

BACKGROUND

Injectable opioid agonist treatment (iOAT) is an effective option to support people living with opioid use disorder (OUD) who have not sufficiently benefitted from oral OAT. However, iOAT has been criticised based on theoretical and practical grounds for its dosing policies: Current regulations demand supervised, on-site application and require patients to frequently visit their treatment facility. The current study aims to investigate how patients experience on-site application and derive strategies to enhance the acceptability and effectiveness of iOAT-delivery.

METHODS

This article is based on semi-structured interviews with 27 individuals currently or previously in iOAT in two German outpatient iOAT-clinics. We undertook an inductive qualitative content analysis, which included blinded, independent coding and the analysis of individual cases.

RESULTS

Comments regarding on-site application and daily visits to the clinic were grouped into positive and negative aspects, iOAT as the best alternative option, facilitators of daily visits, and suggestions for improvement. Positive aspects took the factors stability and social support in regard. Negative aspects ranged from general inconveniences to major impediments to individuals' daily lives and towards achieving psychosocial goals. Participants reported rigorous adherence to iOAT's treatment regime, often due to a perceived lack of alternative options. Meeting iOAT's demands was eased by the patients' coping-strategies and through facilitating measures implemented by iOAT-clinics. Despite acknowledgement of the potential detriments from easing regulations, take-home arrangements were frequently suggested by participants to improve iOAT.

CONCLUSIONS

Being required to attend the clinic for supervised iOAT-application is not experienced uniformly. While clinics can support their patients to cope with strict regulations, alternative approaches to iOAT-application should be considered to accommodate patients' individual needs. Examples from other treatment modalities (e.g., remote supervision and delivery services) might aid to reconcile individualisation while providing adequate safety measures and improve iOAT in the long term.

"It's professional but it's personal": Participation, personal connection, and sustained disagreement in drug policy reform

While there is widespread agreement as to the importance of increasing participation in drug policy design, drug policy literature contains limited reflection on the practices that may support inclusion and collaboration amongst policy actors, particularly when disagreement and difference are an intrinsic part of participation. Drawing on qualitative interviews and ethnographic fieldwork with actors engaged in an Australian illicit drug policy reform campaign, this paper examines how particular modes of personal connection mattered in establishing and maintaining working relationships between a range of differently situated actors. Through engagement with this case study, we argue that modes of personal connection marked by qualities such as being frank; engaged; not forcing consensus; enacting respect; listening in order to understand; and acting in ways that respected the obligations and limits that came with people's roles while also recognising one another as more than those roles, were particularly important qualities that supported connection across difference. Such personal connections seem to have been even more important for the engagement of people representing more marginal positionalities. Arguing that personal connection is already an element of both inclusion and exclusion in drug policy creation, we suggest that policy actors interested in contributing to a more diverse and rigorous policy participation space attend to how people connect, with whom, and with what space for disagreement, while also taking seriously the labour of such connection across difference.

Navigating the grey: Experiences of incremental cannabis reform in Australia

INTRODUCTION AND AIMS

There have been many changes to cannabis laws across the globe, some dramatic but more often incremental. This study explored the experiences after an incremental cannabis law reform in the Australian Capital Territory, Australia.

METHOD

Semi-structured interviews (n = 30) were conducted in March and April 2021, 14 months after the introduction of cannabis law reform, with people aged 18 and over who had grown and/or consumed cannabis in the previous 12 months. Participants were asked about recent and past cannabis use, growing cannabis and changes to their practices after the introduction of the legislation.

RESULTS

Incremental cannabis law change resulted in regulatory grey areas. How people interpreted and navigated such grey areas were connected to their relative privileges, circumstances and histories. Those who were highly policed were more likely to experience the grey areas negatively. Those who were not highly policed found the grey areas confusing or 'half-arse' (insufficiently executed), but mostly experienced the new laws positively through new cannabis cultivation or perceived reduction in stigma and fear of arrest. Those with self-identified privilege were unconcerned with grey areas of the legislation.

DISCUSSION AND CONCLUSION

Incremental policy change can result in grey areas that require some navigation. Vulnerable populations appear less likely to experience the full benefits of such incremental drug law reform. It is vital to attend to the inequities that can arise from incremental law reform so that positive experiences are shared across the population regardless of relative privilege.

Unintended harm: A qualitative study of "harm" upon people who inject drugs in Bangkok, Thailand

Given the highly pervasive health threats faced by people who inject drugs, harm reduction has been implemented in Thailand. Although harm reduction is a particularly effective public health strategy for reducing risky behavior, it is currently practiced with minimal understanding of unintended harm-drug policy, social exclusion, stigma, and discrimination-for people who inject drugs (PWID) in Thailand. This study aims to understanding the "unintended harm" encountered by people who inject drugs in Bangkok in their everyday lives through social interaction at all levels of society from macro, micro, and individual levels. In-depth interviews were conducted with 28 people who inject drugs in Bangkok (21 men and 7 women) and 4 people who are a nurse, a community leader, a policeman, and a family member (2 men and 2 women). The result shows that individuals, society, and politics are not separable phenomena and all produce harm upon people who inject drugs. These unintended harms on the macro, micro, and individual level are closely linked; each in their own way poses a threat to the health and well-being of people who inject drugs and embody negative social responses as the people who inject drugs become typecast as "deviants." In conclusion, there is an urgent need to develop a "harm reduction" model that addresses unintended harm and could be integrated within the existing socio-cultural context of Thai society.

Reprint of: The regulation project: Tools for engaging the public in the legal regulation of drugs

Lack of legal regulation and oversight of scheduled drugs in Canada has led to an unsafe drug supply responsible for the deaths of tens of thousands. In addition to contributing to the worst unregulated drug poisoning crisis in Canada's history, the policy framework prohibiting non-medical access to certain drugs has exacerbated numerous public health and safety concerns. An alternative approach to prohibition is for government to retake control of the currently illegal drug market through legal regulatory mechanisms. This paper presents the work of an ongoing international collaboration of organizations advocating legal regulation and some of the knowledge translation tools used to educate and engage the public on legal regulation within Canada. In order to encourage thinking and decision-making among stakeholders in a productive way, models of legal regulation for various substances were created as discussion tools to emerge values and considerations supporting different approaches. The models focus on five questions: 1) who has access to drugs; 2) how access is obtained; 3) where drugs can be accessed; 4) how much people can obtain; and 5) where drugs can be consumed. The models were presented to stakeholders in the context of an international meeting on legal regulation, and then adapted to a more "user-friendly" form: a collaborative negotiation-based Regulation Game, which was presented at a workshop in Montréal, Canada. Engaging different stakeholder groups on policy choices of legal regulation revealed initial barriers that we feel more confident can be overcome through creative and innovative tools such as the Regulation Game. Use of the game as a foundation for more traditional focus groups could be effective in reducing barriers to fulsome policy discussions on legal regulation.

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.

Bereaved mothers' engagement in drug policy reform: A multisite qualitative analysis

BACKGROUND

Globally, a tainted drug supply is claiming the lives of tens of thousands of people who use drugs and current measures are not quelling this crisis. Within this context, mothers who have lost a child to substance use have emerged as vocal advocates for drug policy changes. This paper explores mothers' experiences in drug policy advocacy to uncover how they are using their stories to drive policy change.

METHODS

Critical qualitative and narrative methods informed individual interviews with 43 mothers who had lost a child to substance use from across three regions in Canada: British Columbia, Prairie Provinces, and Eastern Provinces. Multisite qualitative analysis (MSQA) provided a rigorous analytical method to identify how social context informed participants' advocacy efforts within and across geographies, together with a theoretical lens from Haraway to understand mothers' activism as situated knowledge.

RESULTS

Mothers' drug policy advocacy was shaped by social context and norms, which influenced the types of advocacy targets pursued, within the constraints of the social and political ethos of each geographic region. Yet across regions, narratives of shared aims and experiences also emerged. Specifically, the notion that people of all backgrounds are dying and that losing a child to substance use can "happen to anyone" - though people who experience structural vulnerabilities are disproportionately impacted. Additionally, mothers' stories were identified as a particularly powerful tool for conveying emotional knowledge and prompting action that complements other forms of knowledge or evidence.

CONCLUSION

To date, efforts to address the drug poisoning epidemic have done little to curb casualties. Mothers whose child's death is related to substance use are one group who are bringing their experiences to advocacy efforts aimed at generating new solutions, including calls for decriminalization and legal regulation of drugs. This and other lived experience perspectives represent a critical voice in decision-making and hold the potential to inform more responsive and impactful drug policy.

Making legitimacy: Drug user representation in United Nations drug policy settings

BACKGROUND

The importance of engaging people who use drugs in drug policy development is increasingly acknowledged including in recent UN documents. Little scholarly attention has been paid to 'drug user representation' in the global drug policy setting of the UN such as the Commission on Narcotic Drugs (CND). This paper examines 'drug user representation' in key UN drug policy processes over three decades.

METHOD

A mapping process was undertaken using a corpus of publicly available documents from the UNGASS on Drugs and associated CND processes to identify relevant policy processes from 1987 to 2019 (n = 15) which were then assess for presence/absence of 'drug user representation'. Those processes with positive evidence of 'drug user representation' (n = 9) were critically interrogated across three co-constitutive domains of the subjects, objects and forms of 'drug user representation'.

RESULTS

Our analysis shows that despite calls for greater involvement, dominant UN drug policy discourses and other practices delimit both the political subjectivities available to people who use/have used drugs and their capacity to bring their voices to bear in this context. The analysis also highlights that human rights-based discourses, employed by 'drug user representatives', have emerged as an important practice of resistance against the problematic and delimiting power effects of existing UN discourses, governing practices and modes of engagement.

CONCLUSIONS

In addition to the practices of resistance being undertaken by 'drug user representatives', we suggest there is a need to improve how 'drug user representation' is being made possible and done in the sites of UN drug policy deliberation and, that these sites should be opened for questioning. This we argue will not only have a positive impact on political legitimacy for 'drug user representation', but on the health and human rights of people who use/have used drugs.

The regulation project: Tools for engaging the public in the legal regulation of drugs

Lack of legal regulation and oversight of scheduled drugs in Canada has led to an unsafe drug supply responsible for the deaths of tens of thousands. In addition to contributing to the worst unregulated drug poisoning crisis in Canada's history, the policy framework prohibiting non-medical access to certain drugs has exacerbated numerous public health and safety concerns. An alternative approach to prohibition is for government to retake control of the currently illegal drug market through legal regulatory mechanisms. This paper presents the work of an ongoing international collaboration of organizations advocating legal regulation and some of the knowledge translation tools used to educate and engage the public on legal regulation within Canada. In order to encourage thinking and decision-making among stakeholders in a productive way, models of legal regulation for various substances were created as discussion tools to emerge values and considerations supporting different approaches. The models focus on five questions: 1) who has access to drugs; 2) how access is obtained; 3) where drugs can be accessed; 4) how much people can obtain; and 5) where drugs can be consumed. The models were presented to stakeholders in the context of an international meeting on legal regulation, and then adapted to a more "user-friendly" form: a collaborative negotiation-based Regulation Game, which was presented at a workshop in Montréal, Canada. Engaging different stakeholder groups on policy choices of legal regulation revealed initial barriers that we feel more confident can be overcome through creative and innovative tools such as the Regulation Game. Use of the game as a foundation for more traditional focus groups could be effective in reducing barriers to fulsome policy discussions on legal regulation.

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.

'I could have went down a different path': Talking to people who used drugs problematically and service providers about Irish drug policy alternatives

BACKGROUND

People who use drugs problematically are consistently left out of consultations and deliberation on drug policy. This article explores how people who formerly used drugs problematically and service providers view Ireland's current drug policy and if alternative policies could be successful in an Irish context.

METHODS

Semi-structured interviews were conducted with eight people who used drugs problematically and six practitioners working with people who use drugs in Cork city, Ireland. All people who used drugs problematically had at least one year of abstinence and had been criminalised because of their drug use, all but one had served at least one custodial sentence. Participants were asked their opinions on safe injecting facilities, heroin assisted treatment, decriminalisation of drugs for personal use, depenalisation of cannabis and, the relationships between economic deprivation and problematic drug use.

RESULTS

Respondents stressed that, in Cork city, problematic drug use is closely linked with economic deprivation and social exclusion. There was a near consensus that criminalisation and penalisation do not deter consumption and produce unintended consequences. All participants supported safe injecting facilities and the decriminalisation of drugs for personal use. Participants were less certain about the utility of heroin assisted treatment and depenalisation of cannabis. Many discussions drifted away from alternatives policies towards the need for improved treatment provision.

CONCLUSION

Several participants were clear that none of the alternative policies discussed are silver bullets. Participates felt that, while they could reduce the harms caused by drugs and drug policies, the government's longer-term objectives should be increased treatment provision and, reduced social exclusion and economic deprivation.

Mathematical models as public troubles in COVID-19 infection control: following the numbers

Mathematical models are key actors in policy and public responses to the COVID-19 pandemic. The projections from COVID-19 models travel beyond science into policy decisions and social life. Treating models as 'boundary objects', and focusing on media and public communications, we 'follow the numbers' to trace the social life of key projections from prominent mathematical models of COVID-19. Public deliberations and controversies about models and their projections are illuminating. These help trace how projections are 'made multiple' in their enactments as 'public troubles'. We need an approach to evidence-making for policy which is emergent and adaptive, and which treats science as an entangled effect of public concern made in social practices. We offer a rapid sociological response on the social life of science in the emerging COVID-19 pandemic to speculate on how evidence-making might be done differently going forwards.

The legal regulation of drugs and role of government: Perspectives from people who use drugs

BACKGROUND

The legalization and regulation of currently illicit drugs has come to the forefront of drug policy debates in recent years, particularly in the context of cannabis legalization and the opioid crisis in North America. However, sufficient granularity on the various aspects of a legally regulated drug supply is missing from these debates. Further, the voices and opinions of people who use drugs have generally been absent from drug law reform deliberations. This study aimed to examine the views of people who use drugs and who are deeply impacted by drug policies to understand the perceived impacts and role of government under a legalized-regulated market.

METHODS

Four focus groups were held with people who use drugs in Sydney, Australia.

RESULTS

Most participants supported various models of legalization, although the perspectives on these models were diverse. Overriding these views was skepticism over the government's role in regulating a legal market, as well as concern for the personal agency of people who use drugs under a medically regulated drug supply model. Some participants discussed potential harms (e.g. increases in use and initiation), but emphasized the benefits (e.g. increases in quality and safety) from legal reform.

DISCUSSION

While there was support for legal models of drug supply regulation, findings have major implications in terms of how governments and medical systems may perpetuate the oppression of people who use drugs through regulation, and urge future drug policy deliberations to include broader perspectives from the affected community.

"It's about bloody time": Perceptions of people who use drugs regarding drug law reform

BACKGROUND

In Australia and elsewhere, the impacts of drug prohibition have sparked a critical dialogue about the state of current drug laws. While a range of 'experts' have offered their opinion and participation in these deliberations, the voices of the affected community have largely been excluded. This study aimed to gather the opinions and preferences of people who use drugs about the current or alternative models of drug laws, in addition to how they think drug laws could be changed Author Conflict of Interest Declaration.

METHODS

In March 2018, four focus groups (n = 37) were conducted with people who were in receipt of social welfare services in Sydney, Australia, where participants were encouraged to share their views about the current drug laws, drug law reform options, and important messages to politicians. Several themes were identified through a thematic analysis.

RESULTS

Models of drug law reform were often understood and expressed in language and constructs different to those commonly used by researchers. Opinions were diverse and there was no consensus on a preferred model, although discussions flowed around decriminalisation, legalisation, and a medical/prescription model; the latter being the preferred approach. Participants shared pessimistic views of the drug laws ever changing, and argued that public opinion would need to adjust for reform to succeed. Furthermore, they argued that the views of the affected community are vital to any drug law reform campaign.

CONCLUSIONS

Participants affinity towards a medical/prescription approach to drug regulation was an unexpected finding. This study serves as an important example of the opinions and experiential knowledge of the affected community and this knowledge could be solicited alongside other forms of 'expertise' in drug law reform campaigns.