1
|
Ali F, Russell C, Greer A, Bonn M, Werb D, Rehm J. "2.5 g, I could do that before noon": a qualitative study on people who use drugs' perspectives on the impacts of British Columbia's decriminalization of illegal drugs threshold limit. Subst Abuse Treat Prev Policy 2023; 18:32. [PMID: 37322496 PMCID: PMC10268332 DOI: 10.1186/s13011-023-00547-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND In May 2022, Health Canada approved a three-year exemption from the Controlled Drugs and Substances Act decriminalizing possession of certain illegal substances for personal use among adults in the province of British Columbia. The exemption explicitly includes a cumulative threshold of 2.5 g of opioids, cocaine, methamphetamine, and MDMA. Threshold quantities are commonly included in decriminalization policies and justified within law enforcement systems to delineate personal use among people who use drugs versus drug dealers who are carrying for trafficking purposes. Understanding the impact of the 2.5g threshold can help define the extent to which people who use drugs will be decriminalized. METHODS From June-October 2022, 45 people who use drugs from British Columbia were interviewed to gain an understanding of their perceptions on decriminalization, particularly on the proposed threshold of 2.5 g. We conduced descriptive thematic analyses to synthesize common interview responses. RESULTS Results are displayed under two categories: 1) Implications for substance use profiles and purchasing patterns, including implications on the cumulative nature of the threshold and impacts on bulk purchasing, and 2) Implications of police enforcement, including distrust of police use of discretion, potential for net widening and jurisdictional discrepancies in enforcing the threshold. Results illustrate the need for the decriminalization policy to consider diversity in consumption patterns and frequency of use among people who use drugs, the inclination to purchase larger quantities of substances for reduced costs and to guarantee a safe and available supply, and the role police will play in delineating between possession for personal use or trafficking purposes. CONCLUSIONS The findings underscore the importance of monitoring the impact of the threshold on people who use drugs and whether it is countering the goals of the policy. Consultations with people who use drugs can help policymakers understand the challenges they may face when trying to abide by this threshold.
Collapse
Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, 33 Usrula Frank St., Toronto, ON, M5S 2S1, Canada.
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada.
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, 33 Usrula Frank St., Toronto, ON, M5S 2S1, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, NS, B3A 1X4, Canada
| | - Daniel Werb
- Centre On Drug Policy Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA, USA
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, 33 Usrula Frank St., Toronto, ON, M5S 2S1, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
- Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, NS, B3A 1X4, Canada
- Department of PsychiatryDalla Lana School of Public Health, &Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| |
Collapse
|
2
|
Chiu K, Thow AM, Bero L. Understanding the Dynamics of More Restrictive Medicines Policy: A Case Study of Codeine Up-Scheduling in Australia. Int J Health Policy Manag 2022; 12:6872. [PMID: 37579455 PMCID: PMC10125097 DOI: 10.34172/ijhpm.2022.6872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/19/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND There has been increasing concern over opioid-related harms across the world. In Australia in 2018, codeine-containing products were up-scheduled from over-the-counter access at pharmacies, to requiring a prescription. The drug regulator's decision to up-schedule was contentious and widely debated, due to the potentially large impact on consumers and healthcare professionals. This study aimed to analyse influences on the codeine up-scheduling policy. METHODS This retrospective policy analysis used the Advocacy Coalition Framework (ACF) to understand how policy actors with shared beliefs formed adversarial coalitions to shape policy. Data were drawn from documents (regulator policy documents, public submissions, news reports, organisational media releases and position statements) and semi-structured interviews with 15 key policy actors. Codes were generated relating to policy processes and actor beliefs; broad themes included the role of health professionals, perceptions of opioids, impact on consumers, and the role of government in healthcare. RESULTS Two coalitions in this policy subsystem were identified: (1) supportive [with respect to the up-scheduling], and (2) opposing. The key evident beliefs of the supportive coalition were that the harms of codeine outweighed the benefits, and that government regulation was the best pathway for protecting consumers. The opposing coalition believed that the benefits of codeine accessible through pharmacists outweighed any harms, and consumers should manage their health without any more intervention than necessary. The policy decision reflected the influence of the supportive coalition, and this analysis highlighted the importance of their public health framing of the issue, the acceptability of their experts and supporting evidence, and the perceived legitimacy of the up-scheduling process. CONCLUSION Understanding these coalitions, their beliefs, and how they are translated through existing policy processes and institutions provides insight for those interested in influencing future health policy. Specific lessons include the importance of strategic frames and advocacy, and engagement with formal policy processes.
Collapse
Affiliation(s)
- Kellia Chiu
- School of Pharmacy, Faculty of Medicine and Health & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
3
|
Wahbi R, Beletsky L. Involuntary Commitment as "Carceral-Health Service": From Healthcare-to-Prison Pipeline to a Public Health Abolition Praxis. J Law Med Ethics 2022; 50:23-30. [PMID: 35244001 DOI: 10.1017/jme.2022.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Involuntary commitment links the healthcare, public health, and legislative systems to act as a "carceral health-service." While masquerading as more humane and medicalized, such coercive modalities nevertheless further reinforce the systems, structures, practices, and policies of structural oppression and white supremacy. We argue that due to involuntary commitment's inextricable connection to the carceral system, and a longer history of violent social control, this legal framework cannot and must not be held out as a viable alternative to the criminal legal system responses to behavioral and mental health challenges. Instead, this article proposes true alternatives to incarceration that are centered on liberation that seeks to shrink the carceral system's grasp on individuals' and communities' lives. In this, we draw inspiration from street-level praxis and action theory emanating from grassroots organizations and community organizers across the country under a Public Health Abolition framework.
Collapse
|
4
|
Abstract
Antiretroviral pre-exposure prophylaxis (PrEP) is protective against HIV. Low utilization rates amongst HIV vulnerable populations are due in part to the high cost of PrEP. Generic PrEP offers the potential to improve health at significantly reduced costs. In this study, we examine early utilization patterns and prices for generic PrEP. We discuss the opportunities and challenges for generic PrEP to improve health among HIV vulnerable populations.
Collapse
|
5
|
Bartholomew TS, Tookes HE, Bullock C, Onugha J, Forrest DW, Feaster DJ. Examining risk behavior and syringe coverage among people who inject drugs accessing a syringe services program: A latent class analysis. Int J Drug Policy 2020; 78:102716. [PMID: 32146348 DOI: 10.1016/j.drugpo.2020.102716] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/16/2020] [Accepted: 02/23/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Injection drug use (IDU) remains a significant public health problem. IDU has been associated closely with the opioid crisis; driving overdose, HIV, and Hepatitis C (HCV) infection nationwide. Syringe services programs (SSPs) remain pivotal evidence-based interventions to reduce harm and engage subgroups of people who inject drugs (PWID). This study aims to provide policy considerations from the IDEA SSP, the first legal SSP in the state of Florida. METHODS We performed a latent class analysis on patterns of substance use among participants (N = 982) newly enrolled in a syringe services program (SSP). Associations between classes of substance use and sociodemographic variables, risky injection and sex behaviors, HIV/HCV status and syringe coverage were analyzed using the R3STEP and BCH 3-step procedures in latent class regression. RESULTS We found a three-class solution: Heroin-Dominant class (73.9%), Methamphetamine-Dominant class (9.5%) and Heroin/Cocaine class (16.6%). Compared to Heroin-Dominant class, the Heroin/Cocaine class were more likely to report homelessness, sharing works, unprotected sex, public injection, and to be HCV positive. Compared to both Heroin-Dominant and Heroin/Cocaine classes, the Methamphetamine-Dominant class were more likely to be male, Hispanic, gay or bisexual orientation, HIV positive, to report unprotected sex and sex with PWID. In addition, the lowest and highest syringe coverage were among those in the Heroin/Cocaine and Methamphetamine-Dominant classes, respectively. CONCLUSION Existing interventions among this population to mitigate infectious disease risk, such as SSPs, can be a used to engage differing PWID populations. However, multi-component, targeted preventive interventions and need-based syringe distribution policies are required to further reduce HIV and HCV risk among various PWID populations.
Collapse
Affiliation(s)
- Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Hansel E Tookes
- Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Corinne Bullock
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jason Onugha
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| |
Collapse
|
6
|
Wadsworth E, Hammond D. International differences in patterns of cannabis use among youth: Prevalence, perceptions of harm, and driving under the influence in Canada, England & United States. Addict Behav 2019; 90:171-175. [PMID: 30412908 DOI: 10.1016/j.addbeh.2018.10.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cannabis is the most widely used illicit substance in the world. An increasing number of jurisdictions have legalized medical and non-medical cannabis; comparisons across jurisdictions can help evaluate the impact of these policy innovations. The current study examined patterns of cannabis use among youth in Canada (CA), England (EN) and the United States (US). At the time of study, non-medical cannabis use was prohibited federally in all three countries; however, medical cannabis was accessible with varying restrictions in CA, EN and most US states, while non-medical cannabis was legal in four US states. METHODS Data come from an international online survey conducted in July 2017 (n = 12,064). Youth, aged 16-19, were asked about cannabis consumption, perceived access to cannabis, perceptions of harm, and driving after cannabis use. All estimates represent weighted data. RESULTS US youth were more likely to report more frequent cannabis consumption, easier access, lower perceptions of harm, and higher rates of driving after cannabis use than CA and EN youth. CA youth reported more frequent consumption, easier access, and higher rates of driving after cannabis use than EN youth. CONCLUSION CA and US youth had higher prevalence of use, easier access, lower perceived harm and higher driving rates after cannabis use in comparison to EN. These differences may reflect more permissive cannabis policies in CA and US, as well as pre-existing trends. Future waves of the international cannabis study will examine trends over time within the same countries after cannabis legalization in CA and additional US states.
Collapse
|
7
|
Abadie R, Gelpi-Acosta C, Davila C, Rivera A, Welch-Lazoritz M, Dombrowski K. "It Ruined My Life": The effects of the War on Drugs on people who inject drugs (PWID) in rural Puerto Rico. Int J Drug Policy 2018; 51:121-127. [PMID: 28716395 PMCID: PMC5851589 DOI: 10.1016/j.drugpo.2017.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/12/2017] [Accepted: 06/19/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The War on Drugs has raised the incarceration rates of racial minorities for non-violent drug-related crimes, profoundly stigmatized drug users, and redirected resources from drug prevention and treatment to militarizing federal and local law enforcement. Yet, while some states consider shifting their punitive approach to drug use, to one based on drug treatment and rehabilitation, nothing suggests that these policy shifts are being replicated in Puerto Rico. METHODS This paper utilizes data from 360 PWID residing in four rural towns in the mountainous area of central Puerto Rico. We initially recruited 315 PWID using respondent-driven sampling (RDS) and collected data about risk practices and conducted HIV and HCV testing. During a second phase, we conducted 34 micro-ethnographic assays, in which we randomly recruited 34 participants from the first phase and included their ego networks in this phase. Our ethnographic inquiry produced significant data regarding the effects of the war on drugs on the local drug trade, drug availability, and injectors' social networks. RESULTS Findings suggest that repressive policing has been ineffective in preventing drug distribution and use among those in our study. This type of law enforcement approach has resulted in the disproportionate incarceration of poor drug users in rural Puerto Rico, and mainly for nonviolent drug-related crimes. In addition, incarceration exposes PWID to a form of a cruel and unusual punishment: having to quit heroin "cold turkey" while the prison environment also represents a HIV/HCV risk. In turn, the war on drugs not only diverts resources from treatment but also shapes treatment ideologies, punishing non-compliant patients. CONCLUSION Shifting the emphasis from repression to treatment and rehabilitation is likely to have a positive impact on the health and overall quality of life of PWID and their communities.
Collapse
Affiliation(s)
- R Abadie
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA; Department of Social Science, LaGuardia Community College (CUNY), 31-10 Thompson Ave, Long Island City, NY 11101, USA.
| | - C Gelpi-Acosta
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
| | - C Davila
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
| | - A Rivera
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
| | - M Welch-Lazoritz
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
| | - K Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
| |
Collapse
|
8
|
박 지. [The War on "Red Drugs": Anticommunism and Drug Policy in Republic of Korea, 1945-1960]. Uisahak 2016; 25:77-110. [PMID: 27301856 PMCID: PMC10565043 DOI: 10.13081/kjmh.2016.25.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/20/2016] [Accepted: 03/23/2016] [Indexed: 06/06/2023]
Abstract
This paper investigates the discourses and policies on narcotics in Republic of Korea from 1945 to 1960. Since the Liberation the narcotic problem was regarded as the vestige of Japanese imperialism. which was expected to be cleaned up. The image of narcotic crimes as the legacy of the colonial past was turned into as the result of the Red Army's tactics to attack on the liberalist camp around the Korean war. The government of ROK represented the source of the illegal drugs as the Red army and the spy from North Korea. The anticommunist discourse about narcotics described the spies, who introduced the enormous amount of poppies into ROK and brought about the addicts, as the social evil. Through this discourse on poppies from North Korea, the government of ROK emphasized the immorality of the communists reinforcing the anticommunist regime, which was inevitable for the government of ROK to legitimize the division of Korea and the establishment of the government alone. This paper examines how the discourses and policies on narcotics in ROK was shaped and transformed from 1945 to 1960 focusing the relationship between the them and the political context such as anticommunism, Korean war, the division of Korea, and etc. This approach would be helpful to reveal the effect of the ROK's own political situation to the public health system involving the management for drugs.
Collapse
Affiliation(s)
- 지영 박
- 서울대학교 과학사 및 과학철학 협동과정 이메일:
| |
Collapse
|