Stakeholders' role in contemporary "substitute drug" prescribing policies in Italy

Benefits and barriers associated with take-home-naloxone in the view of Italian service providers

Purpose

Spanning almost 30 years, Italy’s experience with take-home-naloxone (THN) provides an interesting case study on the international scene because of its specific history, regulation and trends in overdose (OD) rates. Accordingly, this study aims to contribute to the evidence base for THN and its delivery in a different setting.

Design/methodology/approach

The study focuses on service providers’ perceptions of the benefits, risks and barriers associated with THN provision. Data was collected using a mixed-methods approach as follows: an online structured questionnaire (no. of respondents = 63) and two focus groups (no. of total participants = 18).

Findings

Findings show that service providers believe the benefits of THN far outweigh the risks and accrue to services, as well as users. The study also suggests that the barriers in Italy are mostly ideological and political, and illustrates how resistance to administering THN can re-emerge when ODs are no longer a social emergency. Furthermore, the study found that health and social workers have different attitudes which are also reflected at the level of public and private services, thereby shaping slightly different models of THN supply.

Originality/value

The study suggests that barriers associated to THN are more ideological and political rather than concrete, which explains why, even where it seems long established, can easily re-emerge once ODs are no longer a social emergency.

Depoliticising addiction: Who gets to speak in European press reporting, 1991-2011?

Aims

The article presents an analysis of sources of information employed in mainstream print media reporting on addiction problems in Finland, Italy and Poland in the 1990s and 2000s.

Method

A quantitative content analysis of frequency of different sources employed in articles in daily newspapers from Finland (N = 258), Italy (N = 296), and Poland (N = 212) from the years 1991, 1998 and 2011. Semantic units were coded in Atlas.ti. The societal spheres represented were identified using a common coding scheme broadly inspired by Boltanski and Thévenot's typology of polities of worth. Transformations were identified in line with van Leeuwen's framework for trends in discourse salience over time.

Results

The study highlights different patterns of coverage of addictions in the three countries. Over time, increased salience is given to the individuals affected by addictions and experts who represent biomedical sciences. This process occurred with varying intensity and expressiveness in all countries under study.

Conclusions

Social and political sources were employed to less extent over time. The media focus seemed to shift to the affected individuals and scientific expertise. This confirms results from previous studies on a general move towards individualisation and an increased focus on more personal and technical aspects of addiction problems in the mass media.

Heroin assisted treatment and research networks

Purpose

– The purpose of this paper is to map research communities related to heroin-assisted treatment (HAT) and the scientific network they are part of to determine their structure and content.

Design/methodology/approach

– Co-authorship as the basis for conducting social network analysis with regard to degree, weighted degree, betweenness centrality, and edge betweenness centrality.

Findings

– A number of central researchers were identified on the basis of the number of their collaborative relations. Central actors were also identified on the basis of their position in the research network. In total, 11 research communities were constructed with different scientific content. HAT research communities are closely connected to medical, psychiatric, and epidemiological research and very loosely connected to social research.

Originality/value

– The first mapping of the collaborative network HAT researchers using social network methodology.

The shifting roles of medical stakeholders in opioid substitution treatment: a comparison between Denmark and the UK

Purpose

– The purpose of this paper is to examine the shifting roles of medical professionals as stakeholders in opioid substitution treatment (OST) policies and practices in Denmark and the UK within the past 15 years.

Design/methodology/approach

– The paper is based on literature reviews, documentary analyses and key informant interviews with a range of stakeholders involved in OST and policy in Denmark and UK. The study is part of the EU-funded project: Addictions and Lifestyles in Contemporary Europe: Reframing Addictions Project.

Findings

– Denmark and the UK are amongst those few European countries that have long traditions and elaborate systems for providing OST to heroin users. The UK has a history of dominance of medical professionals in drugs treatment, although this has been recently challenged by the recovery movement. In Denmark, a social problem approach has historically dominated the field, but a recent trend towards medicalisation can be traced. As in all kinds of policy changes, multiple factors are at play when shifts occur. We examine how both countries’ developments around drugs treatment policy and practice relate to broader societal, economic and political changes, how such divergent developments emerge and how medical professionals as stakeholders enhanced their roles as experts in the field through a variety of tactics, including the production and use of “evidence”, which became a key tool to promote specific stakeholder’s perspectives in these processes.

Originality/value

– The paper contributes to current policy and practice debates by providing comparative analyses of drug policies and examination of stakeholder influences on policy processes.

From criminals to celebrities: perceptions of "the addict" in the print press from four European countries from nineties to today

The article reviews portrayals of "the addict" in press items from Italy, Finland, Poland, and The Netherlands. The dataset consists of 1,327 items from four national newspapers published in 1991, 1998, 2011. The portrayals varied according to country, period, and type of addiction problem. Results can be read as four cases where different conceptualizations ("the sinner," "the sick," "the social problem," "the criminal," and "the famous") assume diverse importance. These conceptual frames-of-reference are clearly neither unambiguous nor fixed. They are constantly modified and part of different trends.

What influences changes in alcoholic beverage consumption over time? Poland in the light of the European Union Amphora study

This paper is based on the Polish country-level final report of the European Union Amphora study: contextual determinants and alcohol polices. The authors present the results of a time series analysis model designed to explore and explain the influence of selected alcoholic beverage control policy measures and unplanned sociodemographical determinants on changes in alcoholic beverage consumption from 1960 to the 2000s in Poland. Complex historical and social changes are described, which occurred during the 50 years covered by the study. The study findings confirmed that sociodemographical determinants have an important influence on alcoholic beverage consumption. Study limitations are noted and future research is suggested.