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1.	Soussan, Christophe, et al. (författare) The users of Novel Psychoactive Substances: Online survey about their characteristics, attitudes and motivations 2016 Ingår i: International journal on drug policy. - elsevier : Elsevier BV. - 0955-3959 .- 1873-4758. ; 32, s. 77-84 Tidskriftsartikel (refereegranskat)abstract Background: The increasing number of Novel Psychoactive Substances (NPS) constitutes a challenge for public health agencies and researchers worldwide. Scientific studies about NPS and their users are limited and there is a need to explore the general motivations for NPS use but also to examine if and how the motivations differ between substances from separate effect classes. The aim of the present study was to investigate the characteristics, including attitudes and motivations, of a self-selected sample of international NPS users.Methods: An online survey containing questions about drug use history, attitudes, motivations for use, and WHO-5 Wellbeing Index was promoted at the drug discussion forum bluelight.org. The data was analysed using SPSS. Results: The sample consisted of 619 international NPS users with overall good emotional well-being despite extensive experience of both traditional and novel drugs. The main incentive for use of NPS in general was pleasure and enjoyment. However, going beyond the general approach to NPS revealed significant variations between drug groups. For example, the use of hallucinogens was substantially motivated by self-exploration and spiritual attainment and showed very low levels of addiction potential while the use of opioids and especially GABA activating substances was mainly motivated by coping and showed much higher levels of addiction potential. Synthetic cannabinoids were the least appreciated and least likely to be used again, and were mainly motivated by circumstances such as availability and legality.Conclusion: Understanding the different motivations for NPS use in terms of drug groups could enable more effective prevention and consequently a reduction in harm.
2.	Alawa, J., et al. (författare) Medication for opioid use disorder in the Arab World: A systematic review 2022 Ingår i: International Journal of Drug Policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 102 Tidskriftsartikel (refereegranskat)abstract Background: Opioid use disorder (OUD) is a global public health concern. The standard of care for OUD involves treatment using medications such as buprenorphine, methadone, or naltrexone. No known review exists to assess the contextual factors associated with medication for opioid use disorder (MOUD) in the Arab World. This systematic review serves as an implementation science study to address this research gap and improve the uptake of MOUD in the Arab World. Methods: Systematic searches of Medline, PsycINFO, and EMBASE, and a citation analysis, were used to identify peer-reviewed articles with original data on MOUD in the Arab World. Quality assessment was conducted using the CASP appraisal tools, and main findings were extracted and coded according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: 652 research articles were identified, and 10 met inclusion criteria for final review. Four studies considered health-systems aspects of MOUD administration, such as cost-effectiveness, the motivations for and impact of national MOUD policies, the types of social, political, and scientific advocacy that led to the adoption of MOUD in Arab countries, and the challenges limiting its wide-scale adoption in the Arab World. Six papers considered MOUD at individual and group patient levels by evaluating patient quality of life, addiction severity, patient satisfaction, and patient perspectives on opioid agonist therapy. Conclusion: Despite financial and geographic barriers that limit access to MOUD in the Arab World, this review found MOUD to be cost-effective and associated with positive health outcomes for OUD patients in the Arab World. MOUD can be successfully established and scaled to the national level in the Arab context, and strong coalitions of health practitioners can lobby to establish MOUD programs in Arab countries. Still, the relative novelty of MOUD in this context precludes an abundance of research to address its long-term delivery in the Arab World. © 2022
3.	Amundsen, Ellen J., et al. (författare) Estimating incidence of problem drug use using the Horwitz-Thompson estimator - A new approach applied to people who inject drugs in Oslo 1985-2008 2016 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 27, s. 36-42 Tidskriftsartikel (refereegranskat)abstract Background: The trend in the number of new problem drug users per year (incidence) is the most important measure for studying the diffusion of problem drug use. Due to sparse data sources and complicated statistical models, estimation of incidence of problem drug use is challenging. The aim of this study is to widen the palette of available methods and data types for estimating incidence of problem drug use over time, and for identifying the trends. Methods: This study presents a new method of incidence estimation, applied to people who inject drugs (PWID) in Oslo. The method took into account the transition between different phases of drug use progression - active use, temporary cessation, and permanent cessation. The Horwitz-Thompson estimator was applied. Data included 16 cross-sectional samples of problem drug users who reported their onset of injecting drug use. We explored variation in results for selected probable scenarios of parameter variation for disease progression, as well as the stability of the results based on fewer years of cross-sectional samples. Results: The method yielded incidence estimates of problem drug use, over time. When applied to people in Oslo who inject drugs, we found a significant reduction of incidence of 63% from 1985 to 2008. This downward trend was also present when the estimates were based on fewer surveys (five) and in the results of sensitivity analysis for likely scenarios of disease progression. Conclusion: This new method, which incorporates temporarily inactive problem drug users, may become a useful tool for estimating the incidence of problem drug use over time. The method may be less data intensive than other methods based on first entry to treatment and may be generalized to other groups of substance users. Further studies on drug use progression would improve the validity of the results.
4.	Azim, T, et al. (författare) Women, drugs and HIV 2015 Ingår i: The International journal on drug policy. - : Elsevier BV. - 1873-4758 .- 0955-3959. ; 2626 Suppl 1, s. S16-S21 Tidskriftsartikel (refereegranskat)
5.	Barrett, Damon, et al. (författare) Child-centred harm reduction 2022 Ingår i: International Journal of Drug Policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 109 Tidskriftsartikel (refereegranskat)abstract Harm reduction has become increasingly influential in drug policy and practice, but has developed primarily around adult drug use. Theoretical, practical, ethical and legal issues pertaining to children and adolescents under the age of majority – both relating to their own use and the effects of drug use among parents or within the family – are less clear. This commentary proposes a sub-field of drug policy at the intersection of harm reduction and childhood which we refer to as ‘child-centred harm reduction’. We provide a definition and conceptual model, as well as illustrative questions that emerge through a child-centred harm reduction lens. Many people in different countries are already working on these kinds of issues, whose work needs greater recognition, analysis and support. In beginning to name and define this sub-field we hope to improve this situation, and inspire further international debate, collaboration, and innovation.
6.	Bogren, Alexandra, 1976- (författare) ‘I don't think there are great sex differences there’ : Processes of discursive bridging and othering in a discussion of gendered norms related to alcohol, sexual behaviour, and aggression 2020 Ingår i: International journal of drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 81 Tidskriftsartikel (refereegranskat)abstract Background: Existing research indicates that sexual behaviour and aggression are particularly important to the reproduction of gendered drinking norms, both in the media and in face-to-face interaction. However, research has yet to understand in more detail the discursive processes whereby actors negotiate gendered norms related to alcohol, sexual behaviour, and aggression. This article examines how actors make symbolic distinctions between themselves and others in discussing alcohol, aggression, and sexual desire, and analyses the similarities and differences within and across gender that they identify in this process. Methods: The study relies on individual qualitative interviews with 25 Swedish women and men. To elicit participants’ normative positions, we used a newspaper article as a probe during the interviews. Results: Findings show that participants highlight similarities between women and men, and variation and individual differences among men and among women in discussing alcohol's effects on sexual desire and ‘sexually active behaviour’. Differences, by contrast, are most salient when they discuss alcohol and aggression and seek to distance themselves from ‘shabby bar men’, rural men, and male football hooligans who drink and fight, outgroups that are marked as working-class in the participants’ narratives. Conclusion: Two general discursive patterns were identified: discursive bridging across gender and discursive othering across class. For the participants, drinking norms are not as much about general gender differences as they are about the ‘dysfunctional’ drinking of certain groups of working-class men. These findings contribute to a more specific understanding of the reconstitution of gender boundaries in relation to drinking norms.
7.	Bogren, Alexandra, 1976- (författare) Sign of the times? Gender, sexuality, and drinking stories 2014 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 25:3, s. 359-360 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
8.	Callina, Sarah, et al. (författare) Harm, tangible or feared : Young Victorians' adverse experiences from others' drinking or drug use 2014 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 25:3, s. 401-406 Tidskriftsartikel (refereegranskat)abstract Background: Harms from alcohol experienced by someone other than the drinker have received increasing attention of late, but have not been compared to harms from others' drug use. The aim of the current study is to compare the reported harms that are attributable to the alcohol use of others to those attributable to drugs, distinguishing between different types of harm in order to highlight how reported harms may be influenced by perception and social standing of use of the substance. Method: Respondents aged 16-24 from Victoria, Australia, completed the Victorian Youth Alcohol and Drug Survey (n = 5001), including questions on demographics, drug and alcohol consumption, on the types of harms they experienced attributable to drugs and alcohol, as well as harms they perpetrated after using drugs or alcohol. Results: For both drug and alcohol related harms, reports of harms loaded into two groups using multiple correspondence analysis: tangible harms such as assault, and amenity impacts such as being annoyed by people under the influence. Amenity impacts attributed to alcohol were more likely to be experienced by those who reported drug use and vice versa, while the tangible impacts were more likely to be reported by those who used both drugs and alcohol. Conclusions: Reports of amenity impacts from others appear to be influenced by the perception of the drug in question more than tangible impacts such as assault. Particularly for amenity impacts, the greater stigma attached to drug use may make respondents more likely to consider themselves harmed by drugs than they would when compared to alcohol, something that needs to be taken into account when assessing harms by either alcohol or drugs.
9.	Crépault, Jean-François, et al. (författare) Legalization as more effective control? Parallels between the end of alcohol prohibition (1927) and the legalization of cannabis (2018) in Ontario 2021 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 97 Tidskriftsartikel (refereegranskat)abstract Background: In the 1920s, eight of nine Canadian provinces legalized alcohol sales, ending prohibition in favor of government control. Much has been written about the rise and fall of Prohibition in North America, but there is little work examining these events in the light of current drug policy debates. This paper attempts to fill some of these gaps.Methods: The aims of this paper are primarily exploratory and descriptive. Following a literature review, it draws from secondary and some primary sources to explore the debate around ending alcohol prohibition (i.e. legalizing its distribution) in Ontario between 1920 and 1927. It then uses material drawn from a comprehensive search of the Canadian House of Commons debates on cannabis legalization between 2016 and 2018 to draw parallels with the debates around alcohol legalization in Ontario about 90 years earlier.Results: While alcohol and cannabis legalization occurred in very different social and political contexts, there are similarities in both the arguments in favor of ending prohibition (ineffectiveness at preventing consumption and collateral social harms) and post-legalization debates around regulation (most notably the optimal way to replace the illicit market).Conclusion: The Canadian cannabis legalization debates of the 2010s echo the alcohol legalization debates of the 1920s in remarkable and relevant ways. Ultimately the most striking parallel may be the extent to which the political leaders advocating for legalization emphasized that their policy was not liberalization, but more effective control.
10.	Donoghoe, Martin C., et al. (författare) Access to highly active antiretroviral therapy (HAART) for injecting drug users in the WHO European Region 2002-2004 2007 Ingår i: International Journal of Drug Policy. - : Elsevier BV. - 1873-4758 .- 0955-3959. ; 18:4, s. 271-280 Tidskriftsartikel (refereegranskat)abstract Providing equitable access to highly active antiretroviral treatment (HAART) to injecting drug users (IDUs) is both feasible and desirable. Given the evidence that IDUs can adhere to HAART as well as non-IDUs and the imperative to provide universal and equitable access to HlV/AlDS treatment for all who need it, here we examine whether IDUs in the 52 countries in the WHO European Region have equitable access to HAART and whether that access has changed over time between 2002 and 2004. We consider regional and Country differences in IDU HAART access; examine preliminary data regarding the injecting status of those initiating HAART and the use of opioid substitution therapy among HAART patients, and discuss how HAART might be better delivered to injecting drug users. Our data adds to the evidence that IDUs in Europe have poor and inequitable access to HAART, with only a relatively small improvement in access between 2002 and 2004. Regional and country comparisons reveal that inequities in IDU access to HAART are worst in eastern European countries. (C) 2007 Elsevier B.V. All rights reserved.
11.	Duncan, Duane, et al. (författare) The hammer and the nail : The triple lock of methods, realities and institutional contexts in Australian research on nightlife violence 2022 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 110 Tidskriftsartikel (refereegranskat)abstract 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.
12.	Edman, Johan, 1967- (författare) An all-embracing problem description : The Swedish drug issue as a political catalyst 1982–2000 2013 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 24:6, s. 558-565 Tidskriftsartikel (refereegranskat)abstract Background: This article examines the political formulation and ideological solution of the Swedish drugproblem in 1982–2000. How was the drug problem described in the Swedish parliament at the time? Howserious was the problem and what solutions were proposed? What were the ideological implications ofthe problem description, and how was the general political and ideological solution formulated?Methods: The empirical basis for the textual analysis consists of parliamentary bills, government bills andparliamentary records discussing the drug issue during the years 1982–2000.Results: In the prevailing spirit of consensus in the Swedish parliament at the time, both left-wing andright-wing parties portrayed drugs as a threat to the nation, people and the welfare state. Still, as theideological dimension kept growing stronger, the drug question functioned even better as an arena forpolitical discussions and ideological positions than in the 1970s.Conclusion: Compared to previous decades, the problem description broadened during the 1980s and1990s, and the drug problem could be used to support arguments on almost any topic. The drug problembecame a highly politicized issue about whom or what to change when the individual and the societyclashed, but also about what the individual and/or society should be changed into.
13.	Edman, Johan (författare) An ambiguous monolith - The Swedish drug issue as a political battleground 1965-1981 2013 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 24:5, s. 464-470 Tidskriftsartikel (refereegranskat)abstract Background: The drug problem has been a highly ideologized topic in the political debate in Sweden ever since the mid-1960s. The aim of the article is to investigate dominant conceptions of drugs, drug use, society and the individual in the political discussions on drug use in Sweden during the years 1965-1981. Methods: The empirical basis for the textual analysis consists of 146 parliamentary bills and 135 parliamentary protocols. Results: The unwanted drug appear as a sensitive litmus paper, an indication that something had gone wrong in society and as a suggestion of how the good society could be accomplished. The drug problem was connected to ideological core values such as class struggle, Christianity or criticism of urbanism and modernity. Conclusion: The analysis suggests that the drug problem was used as political ammunition, to pick holes in political opponents and to highlight one's own ideological stance. The hegemonic conversational order, the consensual spirit and the agreement that this was the most serious problem, did not hamper these political moves. Rather, the cross-party conception of the problem's severity and accelerating deterioration contributed to a common ground for political arguments and ideological visions. It also meant that the political discussions moved away from the more obvious drug policy issues.
14.	Edman, Johan, et al. (författare) Conceptual carpentry as problem handling : The case of drugs and coercive treatment in social democratic welfare regimes 2014 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 25:2, s. 320-328 Tidskriftsartikel (refereegranskat)abstract Background: The drug and alcohol fields are characterised by continuous contestations of key concepts and the competing uses of concepts by various actors, in different geographies and over time. This study investigates the political processes leading to legislation enabling coercive treatment of (non-psychotic) drug users in Finland and Sweden from the 1950s until the early 1980s. The drug treatment policies are analysed through conceptual changes and innovations. Methods: The article analyses conceptual discussions in public reports in Finland and Sweden, focusing on the work preceding the first legislations where both alcohol and drug treatment were included (in Finland 1961, in Sweden 1982). Theories from conceptual history are applied. Results: The Finnish and Swedish discussions carry arguments from two periods of the Nordic welfare state: in an early development stage and a fragile situation in Finland, and in a more mature and affluent time in Sweden. The paternalistic arguments vary over time and between countries. Still, in both countries and time periods, the view of the drug problem as a youth issue, as particularly enslaving and on society's obligation to protect drug using individuals from damaging their future give enough motivation for coercive treatment. The conceptual work included avoidance of certain terms but in other cases, a broadening of their meaning, to adopt them to the political goals. Conclusion: Close analyses of conceptual history can reveal new features of drug policy struggles and show how central concepts in drugs and alcohol field are continuously contested.
15.	Edman, Johan (författare) Depoliticising the political : Market solutions and the retreat of Swedish institutional drug treatment from state management 2016 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 32, s. 93-99 Tidskriftsartikel (refereegranskat)abstract Background: This article examines developments in the Swedish drug treatment services in 1982-2000 and explores the ways in which political initiatives and the state administration's management have contributed to the major privatisations of institutional drug treatment during this period. Methods: The empirical basis for the textual analysis lies in official reports, parliamentary material and archived records from the Stockholm County Administrative Board's management of treatment facilities. Results: The major privatisations of drug treatment services in the 1980s were both unintentional and unwanted and mainly arose from a lack of bureaucratic control and ideological anchorage. The privatisations were, however, reinforced by ideologically driven NPM-oriented political initiatives in the 1990s. Conclusion: The market-oriented treatment services have failed to fulfil the needs for diversity and availability within a publicly financed sector, which deals with unevenly informed and often socio-economically weak citizens. New management models in this field must ensure that ideological considerations are taken into account to meet politically decided goals and means.
16.	Ekendahl, Mats, 1971-, et al. (författare) A matter of craving–An archeology of relapse prevention in Swedish addiction treatment 2022 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 101 Tidskriftsartikel (refereegranskat)abstract This article concerns how craving is approached and handled, how it is ‘made up’, in the practice of so-called relapse prevention (RP) for addiction problems. There is a lack of research on what RP in general, and craving in particular, ‘is’ and can become across settings. Drawing upon science and technology studies (STS) and critical addiction research, we analyze how craving is enacted in manuals and training material related to the intervention, and in interviews with professionals in the Swedish treatment system. Adopting an archeological approach, we scrutinize different layers of craving enactments in RP, in search of assumptions that give rise to what John Law refers to as ‘collateral realities’. We identified three collateral realities: 1) ‘The materialization of craving’; 2) ‘The transcendence of the individual’ and 3) ‘The merging of treatment and everyday life’ The data show that the brain, cognition, emotions and behavior are enacted in RP as demarcated targets of intervention that the individual can transcend and control. This approach, in turn, relies on the more foundational tenet that there are no clear-cut boundaries between different identities (I/me/self; body/brain/cognition), between different settings (inside/outside treatment; real/imagined situations) or between different points in time (now/then/before). We discuss the relevance and usefulness of addiction treatment realities where craving is approached as a stable object that can be effectively treated, and where interventions inaugurate neoliberal governance of responsibilized individuals.
17.	Fischer, Benedikt, et al. (författare) Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use : A comprehensive evidence and recommendations update 2022 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 99 Forskningsöversikt (refereegranskat)abstract Background: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis.Methods: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process.Results: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible.Conclusions: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
18.	Fischer, Benedikt, et al. (författare) Medical Marijuana programs : Implications for cannabis control policy – Observations from Canada 2015 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 26:1, s. 15-19 Tidskriftsartikel (refereegranskat)abstract While prohibition has been the dominant regime of cannabis control in most countries for decades, an increasing number of countries have been implementing cannabis control reforms recently, including decriminalization or even legalization frameworks. Canada has held out from this trend, although it has among the highest cannabis use rates in the world. Cannabis use is universally criminalized, and the current (conservative) federal government has vowed not to implement any softening reforms to cannabis control. As a result of several higher court decisions, the then federal government was forced to implement a ‘medical marijuana access regulations’ program in 2001 to allow severely ill patients therapeutic use and access to therapeutic cannabis while shielding them from prosecution. The program's regulations and approval processes were complex and subject to extensive criticism; initial uptake was low and most medical marijuana users continued their use and supply outside the program's auspices. This year, the government introduced new ‘marijuana for medical purposes regulations’, which allow physicians to ‘authorize’ medical marijuana use for virtually any health condition for which this is considered beneficial; supply is facilitated by licensed commercial producers. It is expected that some 500,000 users, and dozens of commercial producers will soon be approved under the program, arguably constituting – as with medical marijuana schemes elsewhere, e.g. in California – de facto ‘legalization’. We discuss the question whether the evolving scope and realities of ‘medical cannabis’ provisions in Canada offer a ‘sneaky side door’ or a ‘better third way’ to cannabis control reform, and what the potential wider implications are of these developments.
19.	Henning, April, et al. (författare) Risk and enabling environments in sport : Systematic doping as harm reduction 2021 Ingår i: International journal of drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 9 Tidskriftsartikel (refereegranskat)abstract Doping and the use of performance enhancing drugs (PEDs) are often considered and discussed as a separate issue from other types of substance use, by sporting bodies, politicians, the media, and athletes who use drugs themselves. However, perceptions and understandings of substance use in the sport and fitness world are directly related to those of substance use in the non-sport world. One way the gap between sport and non-sport substance use research can be bridged is to consider sport risk and enabling environments. Similar to non-sport contexts and drug use, it is important to analyse the environments in which doping occurs. This approach allows us to examine the dynamic interplay between risk and enabling factors, as the enabling environment shifts in response to changes produced in the risk environment, and vice versa. There are models of sport environments that have proven effective at both enabling doping by athletes and reducing harms to athletes: systematic doping. This article will use secondary literature in order to review and analyse known cases of systematic doping through the risk and enabling environment frameworks. We argue that these systems responded to anti-doping in ways that protected athletes from the risk factors established by anti-doping policy and that athletes suffered most when these systems were revealed, exposing athletes to the full range of doping harms. Further, we argue that risks within these systems (i.e. extortion, bullying) resulted from the broader prohibitive sport environment that forces doping underground and allows such abuses to occur.
20.	Hofmarcher, Thomas, et al. (författare) Societal costs of illegal drug use in Sweden 2024 Ingår i: International journal of drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 123 Tidskriftsartikel (refereegranskat)abstract Background: Illegal drug use is a public health concern with far-reaching consequences for people who use them and for society. In Sweden, the reported use of illegal drugs has been growing and the number of drug-induced deaths is among the highest in Europe. The aim of this study was to provide a comprehensive and up-to-date estimation of the societal costs of illegal drug use in Sweden, relying as much as possible on registry and administrative data. Methods: A prevalence-based cost-of-illness study of illegal drug use in Sweden in 2020 was conducted. A societal approach was chosen and included direct costs (such as costs of health care, social services, and the criminal justice system), indirect costs (such as lost productivity due to unemployment and drug-induced death), and intangible costs (such as reduced quality of life among people who use drugs and their family members). Costs were estimated by combining registry, administrative, and survey data with unit cost data. Results: The estimated societal costs of illegal drug use were 3.7 billion euros in 2020. This corresponded to 355 euros per capita and 0.78 % of the gross domestic product. The direct and intangible costs were of similar sizes, each contributing to approximately 40 % of total costs, whereas indirect costs contributed to approximately 20 %. The largest individual cost components were reduced quality of life among people who use drugs and costs of the criminal justice system. Conclusion: Illegal drug use has a negative impact on the societal aim to create good and equitable health in Sweden. The findings call for evidence-based prevention of drug use and treatment for those addicted. It is important to address the co-morbidity of mental ill-health and drug dependence, to develop low-threshold services and measures for early prevention among children and young adults, as well as to evaluate laws and regulations connected to illegal drug use.
21.	Holmén, Elin, et al. (författare) Take-Home Naloxone and risk management from the perspective of people who survived an opioid overdose in Stockholm — An analysis informed by drug, set and setting 2023 Ingår i: International journal of drug policy. - 0955-3959 .- 1873-4758. ; 115 Tidskriftsartikel (refereegranskat)abstract Background: Take-Home Naloxone (THN) programs were introduced in Sweden in 2018 —a country with one of the highest rates of overdose mortality in the EU and a severe stigmatisation of people who inject drugs. This qualitative study builds on the international research that has expanded a previously narrow and medical focus on overdose deaths. It uses Zinberg’s framework to look beyond the role of the “drug ”to include the attitudes and personality of the person ( “set ”) and contextual factors ( “setting ”). This study explores the impacts of THN from the perspective of overdose survivors. Methods: Between November 2021 and May 2022 semi-structured interviews were conducted with 22 opioid overdose survivors, recruited among clients of the Stockholm needle and syringe program. All the participants had been treated with naloxone in an overdose situation. The interviews were processed through thematic analysis using deductive and inductive coding in accordance with the theoretical framework. Results: Interviewees included men and women who used different types of drugs. THN has impacted on “drug ”in terms of naloxone-induced withdrawal symptoms and peers having to deal with survivors’ emotions. Exploring “set ”revealed feelings of shame following naloxone revival for the person who overdosed. Despite such reactions, participants retained an overwhelmingly positive attitude towards THN. Participants integrated THN into their risk management practices ( “setting ”) and some acknowledged that THN provided a new way to treat overdoses without necessarily needing to interact with authorities, especially the police. Conclusion: The THN program has influenced “drug, set and setting ”for participants, providing increased safety at drug-intake and transferring overdose management and the burden of care to the community. The lived experi- ence of participants also exposes the limitations of THN indicating that there are additional unmet needs beyond THN programs, particularly in terms of “setting ”.
22.	Howarth, David, et al. (författare) Contingent, contested and constructed : a poststructuralist response to Stevens’ ontological politics of drug policy 2021 Ingår i: International journal of drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 93 Tidskriftsartikel (refereegranskat)
23.	Johnson, Björn, et al. (författare) Diversion of methadone and buprenorphine by patients in opioidsubstitution treatment in Sweden : prevalence estimates and risk factors 2014 Ingår i: International journal of drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 26:2, s. 183-190 Tidskriftsartikel (refereegranskat)abstract Background: Diversion—patients who sell or share their medication—is a hotly debated but rela-tively unresearched phenomenon. We have investigated the prevalence of self-reported diversion ofmethadone and buprenorphine at OST programs in Sweden. We have also examined if demographic,treatment, and social factors can be associated with an increased risk of diversion. Methods: Structured interviews were conducted with 411 patients from eleven OST programs. A standard-ized questionnaire with 106 close- and five open-ended questions were used. 280 interviews were doneon site, by the researchers, while 131 interviews were conducted by specially trained patients throughprivileged access interviewing. The data were analyzed through frequency- and averages-calculations,cross-tabulations, and logistic regression analysis. Results: In total, 24.1% (n = 99) of the patients reported diversion in the past month. 67.6% (n = 277) statedthat they had diverted at some point. The peer interviews showed significantly higher levels of diver-sion (37.4% past month) compared with the researcher interviews (17.2%). Neither demographic factors,dosages, nor collection routines were associated with diversion. The likelihood of diversion was higherfor patients on mono-buprenorphine (OR = 5.64) and buprenorphine–naloxone (OR = 2.10), than amongmethadone patients. Other factors which increased the likelihood of diversion were current illicit druguse (OR = 5.60), having had patients as a primary source of illicit methadone or buprenorphine prior totreatment (OR = 3.39), and mainly socializing with active drug users (OR = 2.12). Conclusion: Self-reported diversion was considerably higher than in previous studies. This is most likelydue to the new methodological strategy we used, but may also partly be explained by low availability ofOST in Sweden, leading to a high demand for the substances by heroin users outside treatment. Effortsto decrease diversion should primarily focus on psychosocial and lifestyle-changing interventions, andexpanded access to treatment, rather than on control measures.
24.	Jones, Alan Wayne, et al. (författare) High prevalence of previous arrests for illicit drug use and/or impaired driving among drivers killed in motor vehicle crashes in Sweden with amphetamine in blood at autopsy 2015 Ingår i: International journal on drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 26:8, s. 790-793 Tidskriftsartikel (refereegranskat)abstract Background: Amphetamine, and to a lesser extent the secondary amine methamphetamine, are major recreational drugs of abuse in Sweden. These central stimulant amines are identified in blood from roughly 50% of people arrested for driving under the influence of drugs (DUID). However, much less information is available about the presence of amphetamine in blood of drivers killed in road-traffic crashes.Methods: This retrospective 10-year study (2001-2010) used a forensic toxicology database (TOXBASE) to retrieve information about road-traffic crashes when the driver had amphetamine and/or methamphetamine in autopsy blood. Forensic toxicology results were available from over 95% of all drivers killed on Swedish roads during this 10-year period.Results: Amphetamine was present in the blood of 106 drivers (3.9%) either alone or together with other psychoactive substances (e.g. alcohol, cannabis, diazepam, alprazolam, etc.). The vast majority of fatalities were male (95%) with a mean age (+/- standard deviation) of 37 +/- 11.4 years (range 16-67 years). The mean (median) and highest concentrations of amphetamine in femoral blood were 1.36 mg/L (1.0 mg/L) and 6.74 mg/L, respectively. Many of the victims (75%) had been arrested previously for use of illicit drugs or DUID. The median number of previous arrests was 4 (range 0-83) and amphetamine or methamphetamine were among the drugs identified in blood samples from 89% of cases (0-100%).Conclusion: The high prevalence of repeat DUID offending and/or use of illicit drugs among the drivers killed in road-traffic crashes suggests that an early intervention and treatment for stimulant abuse might have been more beneficial than conventional punishments for such drug-related crimes. (C) 2015 Elsevier B.V. All rights reserved.
25.	Karlsson, N, et al. (författare) A prospective cohort study of risk behaviours, retention and loss to follow-up over 5 years among women and men in a needle exchange program in Stockholm, Sweden 2021 Ingår i: The International journal on drug policy. - : Elsevier BV. - 1873-4758 .- 0955-3959. ; 90, s. 103059- Tidskriftsartikel (refereegranskat)
26.	Karriker-Jaffe, Katherine J., et al. (författare) Can alcohol policy prevent harms to women and children from men's alcohol consumption? An overview of existing literature and suggested ways forward 2023 Ingår i: International journal of drug policy. - 0955-3959 .- 1873-4758. ; 119 Tidskriftsartikel (refereegranskat)abstract The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.
27.	Lazarus, Jeffrey, et al. (författare) HIV/hepatitis coinfection in eastern Europe and new pan-European approaches to hepatitis prevention and management 2007 Ingår i: International Journal of Drug Policy. - : Elsevier BV. - 1873-4758 .- 0955-3959. ; 18:5, s. 426-432 Tidskriftsartikel (refereegranskat)abstract Issues: HIV/hepatitis coinfection in Europe; WHO European clinical protocols on the management of people coinfected with HIV/AIDS and hepatitis B or C (HBV or HCV); stakeholder recommendations for better HCV services. Introduction: The increasing availability of highly active antiretroviral therapy throughout Europe and central Asia has changed comorbidity and mortality patterns among people living with HIV/AIDS (PLWHA) as liver disease has increasingly replaced AIDS as the cause of death in PLWHA in western European countries. The average prevalence of HCV among PLWHA is 40 per cent, and much higher in countries where the HIV epidemic is driven by injecting drug use. Access to hepatitis treatment for PLWHA and IDUs is still very limited in Europe due to a lack of clear clinical management guidelines for HIV/hepatitis coinfections, high costs and a national failure to recognise hepatitis as a critical health issue. Description: In October 2006, the WHO Regional Office for Europe issued protocols for the clinical management of HIV/HCV and HIV/HBV coinfections. They include diagnostic algorithms adjusted for resource availability, and guidelines for the management of patients who do not yet need treatment, those who need only hepatitis or only HIV/AIDS treatment, and those who need both. Though the protocols should provide practical guidelines for physicians and assist in the development of national treatment standards, there is still a need for targeted prevention, treatment and care interventions. To expand access to hepatitis prevention and treatment, public awareness needs to be raised and national political leaders need to address hepatitis as a public health issue. Effective public health measures include price reductions for anti-hepatitis drugs; targeted testing, counselling and prevention activities; increased access to hepatitis B and C treatment and to HBV vaccination for the populations most at risk. (C) 2007 Elsevier B.V. All rights reserved.
28.	Lin, Qinyun, 1990, et al. (författare) Social-spatial network structures among young urban and suburban persons who inject drugs in a large metropolitan area 2023 Ingår i: INTERNATIONAL JOURNAL OF DRUG POLICY. - 0955-3959 .- 1873-4758. ; 122 Tidskriftsartikel (refereegranskat)abstract Background: Recent studies underscore the significance of adopting a syndemics approach to study opioid misuse, overdose, hepatitis C (HCV) and HIV infections, within the broader context of social and environmental contexts in already marginalized communities. Social interactions and spatial contexts are crucial structural factors that remain relatively underexplored. This study examines the intersections of social interactions and spatial contexts around injection drug use. More specifically, we investigate the experiences of different residential groups among young (aged 18-30) people who inject drugs (PWID) regarding their social interactions, travel behaviors, and locations connected to their risk behaviors. By doing so, we aim to achieve a more comprehensive understanding of the multidimensional risk environment, thereby facilitating the development of informed policies.Methods: We collected and examined data regarding young PWID's egocentric injection network and geographic activity spaces (i.e., where they reside, inject drugs, purchase drugs, and meet sex partners). Participants were stratified based on the location of all place(s) of residence in the past year i.e., urban, suburban, and transient (both urban and suburban) to i) elucidate geospatial concentration of risk activities within multidimensional risk environments based on kernel density estimates; and ii) examine spatialized social networks for each residential group.Results: Participants were mostly non-Hispanic white (59%); 42% were urban residents, 28% suburban, and 30% transient. We identified a spatial area with concentrated risky activities for each residential group on the West side of Chicago in Illinois where a large outdoor drug market area is located. The urban group (80%) reported a smaller concentrated area (14 census tracts) compared to the transient (93%) and suburban (91%) with 30 and 51 tracts, respectively. Compared to other areas in Chicago, the identified area had significantly higher neighborhood disadvantages. Significant differences were observed in social network structures and travel behaviors: suburban participants had the most homogenous network in terms of age and residence, transient participants had the largest network (degree) and more non-redundant connections, while the urban group had the shortest travel distance for all types of risk activities.Conclusion: Distinct residential groups exhibit varying patterns of network interaction, travel behaviors, and geographical contexts related to their risk behaviors. Nonetheless, these groups share common concentrated risk activity spaces in a large outdoor urban drug market area, underscoring the significance of accounting for risk spaces and social networks in addressing syndemics within PWID populations.
29.	MacLean, Sarah, et al. (författare) Who or what do young adults hold responsible for men's drunken violence? 2020 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 81 Tidskriftsartikel (refereegranskat)abstract Background: Men are more likely than women to perpetrate serious violence when they have consumed alcohol, but alcohol does not affect all men in the same way. This paper considers young adults' attribution about agency (the capacity to act) in men's drunken violence.Methods: Interviews about alcohol use in night-time venues, streets or private parties were conducted with 60 young adults aged 18-24 in Melbourne, Australia, and analysed thematically. Participants included seven men who identified as having initiated violence when drunk.Results: Some interviewees stated that men chose to be violent, or that men's violence when they were drunk was purposeful and therefore involved some component of choice. However, much alcohol-related violence enacted by young men was understood (both by men who reported violence and by other young adults) as impelled by forces outside their control. These forces were: diffusely defined effects of drinking alcohol; proclivities of men and masculinity, and the interaction of alcohol and men's bodies to override capacity for judgement and produce an irresistible urge to fight. The latter was at times explained as caused by the mutually reinforcing actions of alcohol and testosterone, providing a particularly persuasive account of men's violence as biologically-determined.Conclusion: These categories encapsulate a set of discursive resources that contribute to the rationalisation, naturalisation and production of men's violence. Participants tended to regard alcohol, masculinities and testosterone as inciting violence predictably and consistently, suggesting that men themselves had relatively little agency over its occurrence. In contrast, research evidence indicates that these actors do not cause violence in any uniform way and that their effects are contingent on changing configurations of factors. Highlighting discrepancies between young adults' understandings of responsibility for men's drunken violence, and those expressed in research, presents additional opportunities for intervention.
30.	MacLean, Sarah, et al. (författare) 'You're repulsive' : Limits to acceptable drunken comportment for young adults 2018 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 53, s. 106-112 Tidskriftsartikel (refereegranskat)abstract Background: Researchers have described a 'culture of intoxication' among young people. Yet drunkenness remains a socially risky practice with potential to evoke emotions of irritation and even disgust. We consider intoxicated practices that young adults in Melbourne, Australia, described as distasteful, to identify contemporary cultural forces that constrain intoxication and limit how it is enacted.Method: Interviews were conducted with 60 participants in Melbourne, Australia, each with recent drinking experience. Participants were asked to provide accounts of moments when they regarded their own or others' drunken comportment as unsociable or unpleasant. Transcripts were analysed to identify recurrent themes.Results: Despite amusement when recounting drunken antics, almost everyone in the study identified some discomfort at their own or other's drunkenness. We describe four interacting domains where lines delineating acceptable comportment appear be drawn. The first concerns intoxicated practices. Unpleasant drunken comportment often entailed a sense that the drunk person had disturbed others through an overflow of the self extruding intimacy, sexuality, violence or bodily fluids. The second domain was gendering, with women vulnerable to being regarded as sexually inappropriate, and men as threatening. Third, the settings where intoxicated behaviour occurred influenced whether intoxicated people risked censure. Finally, the relationships between the drunk person and others, including their respective social positions and drinking patterns, shaped how they were perceived.Conclusion: The capacity of alcohol to render people more open to the world is both sought and reviled. It is important to recognise that there remain limits on acceptable drunken comportment, although these are complex and contingent. These limits are enforced via people's affective responses to drunkenness. This is form of alcohol harm reduction that occurs outside of public health intervention. Thus, cultures that constrain drinking should be supported wherever it is possible to do so without reinforcing stigmatising identities.
31.	McDonald, R, et al. (författare) A rapid assessment of take-home naloxone provision during COVID-19 in Europe 2022 Ingår i: The International journal on drug policy. - : Elsevier BV. - 1873-4758 .- 0955-3959. ; 107, s. 103787- Tidskriftsartikel (refereegranskat)
32.	Moeller, Kim, et al. (författare) Fentanyl analogs on the Swedish webforum flashback : Interest and impact of scheduling 2021 Ingår i: International journal of drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 87 Tidskriftsartikel (refereegranskat)abstract BackgroundSweden regulates new psychoactive substances, including fentanyl analogs, individually. This reactive scheduling procedure enabled the existence of a recreational market for unscheduled fentanyl analogs sold from surface webshops. We measure the interest in 24 named fentanyl analogs and the impact of scheduling.MethodsWe scraped posts in threads on named fentanyl analogs from the Swedish internet forum Flashback.org, 2012–2019. The sample consists of 24 threads with a total of 8761 posts. We construct five measures of interest based on duration of threads, number of posts, and number of distinct posters, and fit a non-seasonal ARMA model to test if there was a change in mean activity after scheduling.ResultsAcross the five measures, there was most interest in acryl fentanyl, butyr fentanyl, and acetyl fentanyl. The number of daily posts was significantly reduced in nine out of 13 threads after scheduling.ConclusionThe scheduling of fentanyl analogs impacted interest on Flashback.org. The biggest effect sizes were from the narcotics scheduling of 2-Me-MAF, acryl, and acetyl fentanyl, while furanyl fentanyl saw the biggest reduction after health scheduling. The reductions were bigger for narcotics scheduling compared to health scheduling.
33.	Moeller, Kim, et al. (författare) Illicit drug prices and quantity discounts : A comparison between a cryptomarket, social media, and police data 2021 Ingår i: International journal of drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 91 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Illicit drugs are increasingly sold on cryptomarkets and on social media. Buyers and sellers perceive these online transactions as less risky than conventional street-level exchanges. Following the Risks & Prices framework, law enforcement is the largest cost component of illicit drug distribution. We examine whether prices on cryptomarkets are lower than prices on social media and prices reported by law enforcement on primarily offline markets.METHODS: Data consists of online advertisements for illicit drugs in Sweden in 2018, scraped from the cryptomarket Flugsvamp 2.0 (n = 826) and collected with digital ethnography on Facebook (n = 446). Observations are advertisements for herbal cannabis (n = 421), cannabis resin, hash (n = 594), and cocaine (n = 257) from 156 sellers. Prices are compared with estimates from Swedish police districts (n = 53). Three multilevel linear regression models are estimated, one for each drug type, comparing price levels and discount elasticities for each platform and between sellers on each platform.RESULTS: Price levels are similar on the two online platforms, but cocaine is slightly more expensive on social media. There are quantity discounts for all three drug types on both platforms with coefficients between -0.10 and -0.21. Despite the higher competition between sellers on cryptomarkets, prices are not lower compared to social media. Online price levels for hash and cocaine are similar to those reported by police at the 1 g level.CONCLUSION: Mean prices and quantity discounts are similar in the two online markets. This provides support for the notion that research on cryptomarkets can also inform drug market analysis in a broader sense. Online advertisements for drugs constitute a new detailed transaction-level data source for supply-side price information for research.
34.	Moeller, Kim (författare) Sisters are never alike? Drug control intensity in the Nordic countries. 2019 Ingår i: International journal on drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 73, s. 141-145 Tidskriftsartikel (refereegranskat)abstract Background: The Nordic countries — Denmark, Finland, Norway, and Sweden — have traditionally had different approaches to drug control policies. From the late 1980s to the early 1990s, Sweden and Norway were the most restrictive countries. Prior research has described how Nordic control policies became more repressive after this, but no research has examined this claim using the intensity of implementation as a measure. Methods: This study uses data collated by the EMCDDA to examine drug control intensity from 2000 to 2016. The four countries are compared on three measures: seizure numbers relative to total population, seizures numbers by type of drug relative to population, and cannabis seizures relative to the number of annual cannabis users. Standard bivariate tests for statistical significance are used to compare control intensity over time and between countries. Results: Compared to an earlier period from the late 1980s to the early 1990s, Denmark maintained the level of drug seizures to population from 2000 to 2016. Finland increased intensity by 176 percent but remained at the lowest level in the region. Norway increased by 18 percent and is currently the country with the highest enforcement intensity. Sweden reduced overall intensity by 57 percent, which decreases the level for the region by 22 percent. Sixty to seventy percent of all seizures in every country was for cannabis. Accounting for cannabis prevalence rates changes the ranking of enforcement intensity in the countries. Conclusion: Drug control intensity in the Nordic countries has harmonized over time. The disparity between the extremes of low control intensity in Finland and high intensity in Sweden has been reduced. Denmark is still comparatively lenient to users when considering high cannabis prevalence rates and Norway has taken the position as the strictest country on all control intensity measures.
35.	Moore, David, et al. (författare) Gendering practices in quantitative research on alcohol and violence : Comparing research from Australia, Canada and Sweden 2022 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 103 Tidskriftsartikel (refereegranskat)abstract In this article, we analyse the treatment of gender in Canadian and Swedish quantitative research on alcohol and violence and compare it with the treatment of gender in similar Australian research. In previously published work, we argued that Australian research on ‘alcohol-related presentations’ to emergency departments, and on alcohol and violence among young people participating in the night-time economy, tends to overlook the stark gendering of violence in its analyses and policy recommendations. It does this via a series of ‘gendering practices’ (Bacchi, 2017): omitting gender from consideration; overlooking clearly gendered data when making gender-neutral policy recommendations; rendering gender invisible via methodological considerations; displacing men and masculinities via a focus on environmental, geographical and temporal factors; and addressing gender in limited ways. We identify a similar set of gendering practices at work in Canadian and Swedish quantitative research on alcohol and violence, as well as a key difference. This key difference emerges in relation to the practice of addressing gender. Here, we see a bifurcation in the Canadian studies: between one group of articles in which gender is central to the analyses and ensuing policy recommendations, and a second group containing only one example in which gender is partially addressed. We draw attention to the differing realities of gender, alcohol and violence iterated by these contrasting knowledge practices, and offer two possible explanations for this difference. We close by asking how future research analyses and policy recommendations might differ if gender-sensitive quantitative tools were developed, gender considerations were systematically integrated, and gendered effects were taken into account when alcohol policy choices are made.
36.	Moore, David, et al. (författare) Sameness and difference : Metaphor and politics in the constitution of addiction, social exclusion and gender in Australian and Swedish drug policy 2015 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 26:4, s. 420-428 Tidskriftsartikel (refereegranskat)abstract Like any other discourse, drug policy is imagined and articulated through metaphors. In this article, we explore the metaphors and meanings at work in the current national drug policies of Australia and Sweden. Australia's approach to welfare is usually characterised as liberal-welfarist, emphasising individual difference and ‘freedom’. Sweden's approach is usually characterised as social-democratic, universalistic and paternalistic, with an emphasis on social rights, equity and sameness. How do these models of citizenship – difference versus sameness – play out in national drug policies? What are the risks and benefits of these models and the claims they allow? In the textual analysis presented here, we focus on metaphors and meanings relating to the themes of addiction, social exclusion and gender. We choose metaphor as our major analytical tool because we think that the risks and benefits of adopting different models of citizenship in drug policy need to be understood to operate at many levels and with a high degree of subtlety and abstraction. In the cases of addiction and social exclusion, a complicated picture emerges. In Australia, drug users are offered two options: sameness (and reintegration into society) or difference (and re-connection). In Sweden, drug users are excluded from society but not because they are fundamentally different from non-users. Because drug users are understood to be suffering from a temporary and curable personal affliction, the goal is to return them to sameness through care and treatment. With respect to gender, although differently expressed in the two national contexts and differently shaped by national imaginaries, both national policies adopt similar approaches: the unequal treatment of women transcends differences in national setting. Accounts of drug policy usually focus on the degree to which drug policy is, or should be, ‘evidence-based’, or on the complex political negotiations involving diverse stakeholders and interests. We suggest here another, complementary, perspective: that national imaginaries (i.e. culturally specific metaphors, symbols and beliefs, and national ideologies) shape drug policy in subtle but crucial ways.
37.	Månsson, Josefin (författare) A dawning demand for a new cannabis policy : A study of Swedish online drug discussions 2014 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 25:4, s. 673-681 Tidskriftsartikel (refereegranskat)abstract Background: This study examines how online discussions on drug policy are formulating an oppositional cannabis discourse in an otherwise prohibitionist country like Sweden. The focus of the paper is to identify demands for an alternative cannabis policy as well as analysing how these demands are linked to governance. Methods: The empirical material is 56 discussion-threads from the online message-board Flashback Forum that were active during the first eight months of 2012. Discourse theory was used to locate the discourse, and governmentality theory was used to locate the political belonging of the discourse. Results: On Flashback Forum demands for a new cannabis policy are articulated in opposition to Swedish prohibitionist discourse. The oppositional discourse is constructed around the nodal points cannabis, harm, state and freedom that fill legalisation/decriminalisation/liberalisation with meaning. The nodal points are surrounded by policy demands that get their meaning through the particular nodal. These demands originate from neo-liberal and welfarist political rationalities. Neo-liberal and welfarist demands are mixed, and participants are simultaneously asking for state and individual approaches to handle the cannabis issue. Conclusion: Swedish online discourse on cannabis widens the scope beyond the confines of drug policy to broader demands such as social justice, individual choice and increased welfare. These demands are not essentially linked together and many are politically contradictory. This is also significant for the discourse; it is not hegemonised by a political ideology. The discourse is negotiated between the neo-liberal version of an alternative policy demanding individual freedom, and the welfarist version demanding social responsibility. This implies the influence of the heritage from the social-democratic discourse, centred on state responsibility, which have been dominating Swedish politics in modern times. Consequently, this study refutes that the demand for a new cannabis policy is strictly neo-liberal.
38.	Nordgren, Johan, et al. (författare) Police officers’ attitudes and practices toward harm reduction services in Sweden : a qualitative study 2022 Ingår i: International journal of drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 104, s. 1-8 Tidskriftsartikel (refereegranskat)abstract BackgroundSince the 1980s, Swedish drug policy has combined a restrictive zero tolerance approach with the vision of a “drug-free society”. However, in recent years, access to harm reduction services has increased through local initiatives and new national guidelines. The possible success of these services may be affected in part by police drug law enforcement. The aim of this study was to explore how Swedish police officers act toward and view harm reduction services in a national drug policy setting of zero tolerance toward drug use.MethodsApplying a qualitative research design, we conducted 19 in-depth interviews with police officers who worked with drug law enforcement in Malmö. We conducted a qualitative textual analysis of the data.ResultsOfficers largely supported harm reduction services and refrained from overtly enforcing drug laws in their vicinity. Officers engaged in boundary work that assigned the responsibility of care of marginalized people who use drugs (PWUD) to the health care system, while including policing of drug market problems, young PWUD and dealers in their own jurisdiction. Opioid substitution treatment was seen as positive, although diversion of medicines was pointed out as a problem. Needle exchange programs were seen as offering important public health services and a no-go zone for the police. Several officers wanted to carry naloxone on duty but requested more information about its use.ConclusionThe general support among police officers for harm reduction services is an indication of a changing drug policy landscape in Sweden. Drug policy should take police officers’ views into consideration and there is a need for collaboration between police and harm reduction services. Further research should focus on how the police conduct boundary work since police actions may impact on the success of harm reduction services.
39.	O'Brien, Paula, et al. (författare) Influencing the global governance of alcohol : Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030 2023 Ingår i: International journal of drug policy. - 0955-3959 .- 1873-4758. ; 119 Tidskriftsartikel (refereegranskat)abstract BackgroundIn 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to strengthen implementation of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol.Methods48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments.ResultsIn framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated normal drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co regulation rather than cost-effective public health measures to prevent harms from alcohol.ConclusionThe alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.
40.	Onyeka, IN, et al. (författare) Patterns and 14-year trends in mortality among illicit drug users in Finland: the HUUTI study 2014 Ingår i: The International journal on drug policy. - : Elsevier BV. - 1873-4758 .- 0955-3959. ; 25:6, s. 1047-1053 Tidskriftsartikel (refereegranskat)
41.	Pennay, A, et al. (författare) Examining trends in the representation of young people and alcohol in Australian newspapers over twenty years (2000-2019) 2022 Ingår i: The International journal on drug policy. - : Elsevier BV. - 1873-4758 .- 0955-3959. ; 99, s. 103461- Tidskriftsartikel (refereegranskat)
42.	Pennay, Amy, et al. (författare) “There’s a lot of stereotypes going on” : A cross-national qualitative analysis of the place of gender in declining youth drinking 2022 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 108 Tidskriftsartikel (refereegranskat)abstract Introduction: Significant declines in drinking among young people have been recorded in many high-income countries over the past 20 years. This analysis explored the role of gender – which we interpret as socially constructed and relational – to provide insight into whether and how gender might be implicated in declining youth drinking.Methods: Interview data from four independent qualitative studies from Australia, Denmark, Sweden and the UK (n=194; participants aged 15-19 years) were analysed by researchers in each country following agreement about analytical focus. Findings were collated by the lead author in a process of ‘qualitative synthesis’ which involved successive rounds of data synthesis and feedback from the broader research team.Findings: Our analysis raised two notable points in relation to the role of gender in declining youth drinking. The first concerned the consistency and vehemence across three of the countries at which drinkers and states of intoxication were pejoratively described in gendered terms (e.g., bitchy, sleazy). The second related to the opportunities non- and light-drinking offered for expressing alternate and desirable configurations of femininities and masculinities.Conclusions: We identified an intolerance towards regressive constructions of gender that emphasise weakness for women and strength for men and a valorisation of gendered expressions of maturity through controlled drinking. Though subtle differences in gendered drinking practices between and within countries were observed, our findings offer insight into how young people’s enactions of gender are embedded in, and evolve alongside, these large declines in youth drinking.
43.	Rehm, Juergen, et al. (författare) The impact of alcohol taxation changes on unrecorded alcohol consumption : A review and recommendations 2022 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 99 Forskningsöversikt (refereegranskat)abstract Background: The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use.Methods: Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide.Results: Unrecorded alcohol consumption did not automatically increase with increases in taxation and subse-quent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined.Conclusions: Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments.
44.	Richert, Torkel (författare) Wasted, overdosed, or beyond saving - to act or not to act? : Heroin users' views, assessments, and responses to witnessed overdoses in Malmö, Sweden 2015 Ingår i: International journal on drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 26:1, s. 92-99 Tidskriftsartikel (refereegranskat)abstract Background: Overdose is a significant cause of death among heroin users. Frequently, other heroin users are present when an overdose occurs, which means the victim's life could be saved. There is a lack of studies that, based on heroin users own stories, examine their views, assessments, and responses to witnessed overdoses. Methods: The study is based on qualitative interviews with thirty-five heroin users who witnessed someone else's overdose. Results: The heroin users generally had a positive attitude towards assisting peers who had overdosed. A number of factors and circumstances, however, contribute to witnesses often experiencing resistance to or ambivalence about responding. The witness's own high, the difficulty in assessing the seriousness of the situation, an unwillingness to disturb someone else's high, uncertainty about the motive behind the overdose and whether the victim does or does not want assistance as well as fear of police involvement, were common factors that acted as barriers to adequate responses in overdose situations. Conclusion: The fact that being high makes it difficult to respond to overdoses, using traditional methods, argues for simpler and more effective response techniques. This can include intranasal naloxone programs for heroin users. The findings regarding the uncertainty about the intention of the overdose victim and the sensitivity to the experience of a good high argue for more up-front communication and discussion amongst using peers so that they can make their intentions clear to each other. Issues like this can be addressed in overdose education interventions. Overdose prevention measures also need to address the fact that fear of the police acts as a barrier to call emergency services. (C) 2014 Elsevier B.V. All rights reserved.
45.	Room, Robin, et al. (författare) Government monopoly as an instrument for public health and welfare : Lessons for cannabis from experience with alcohol monopolies 2019 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 74, s. 223-228 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Government monopolies of markets in hazardous but attractive substances and activities have a long history, though prior to the late 19th century often motivated more by revenue needs than by public health and welfare.METHODS: A narrative review considering lessons from alcohol for monopolization of all or part of legal markets in cannabis as a strategy for public health and welfare.RESULTS: A monopoly can constrain levels of use and harm from use through such mechanisms as price, limits on times and places of availability, and effective implementation of restrictions on who can purchase, and less directly by replacing private interests who would promote sales and press for greater availability, and as a potential test-bed for new policies. But such monopolies can also push in the opposite direction, particularly if revenue becomes the prime consideration. Drawing on the alcohol experience in recent decades, the paper discusses issues relevant to cannabis legalization in monopolization of different market levels and segments - production, wholesale, import, retail for off-site and for on-site use - and choices about the structuring and governance of monopolies and their organizational location in government, from the perspective of maximizing public health and welfare interests.CONCLUSION: While the historical record is mixed for government monopolies of attractive but hazardous commodities, experience with alcohol in recent decades shows that for public health and welfare public monopolization is generally a preferable option.
46.	Room, Robin, 1939-, et al. (författare) “Harm per litre” as a concept and a measure in studying determinants of relations between alcohol consumption and harm 2023 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 115 Tidskriftsartikel (refereegranskat)abstract The term “harm per litre” has been increasingly used in alcohol research in recent years as a concept and a comparative measure of alcohol-attributable harm in comparisons between environments, circumstances, and patterns of drinking. This essay discusses the origins of the term in connection with analyses in terms of patterns as well as levels of drinking and with concerns about differential harms from drinking different beverage types. Also discussed is the term's current primary usage, in the context of epidemiological concerns about differentially severe harms for poorer persons who drink. It is noted that these same concerns have been discussed, particularly in Britain, using the phrase “alcohol harm paradox”.“Harm per litre” was initially most often used in comparisons between rates of alcohol-attributable harm by beverage type. After 2010, the expression was applied more broadly, particularly after its use in various World Health Organization-related discussions and documents. In addition, and especially from 2018 onwards when most of the papers using this term were published, it has been used in comparisons by socioeconomic status at the individual level, and by level of socioeconomic development at the country level. Almost all the findings indicate that people with lower socioeconomic status, and countries with lower average income, e.g., low income and lower-middle income countries, incur considerably higher harm per litre (with harm being expressed in disease burden and mortality) than upper middle-income and high-income countries.“Harm per litre” is a practicable and easy-to-understand concept to compare groups of individuals or countries, and to quantify health inequalities. The next important step will need to be elucidating a better causal understanding of the processes underlying these inequalities, with an emphasis on factors which can be most easily changed by interventions.
47.	Room, Robin (författare) Reform by subtraction : The path of denunciation of international drug treaties and reaccession with reservations 2012 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 23:5, s. 401-406 Tidskriftsartikel (refereegranskat)abstract Almost all countries are parties to the international drug conventions of 1961, 1971 and 1988. These strongly bind parties with respect to their domestic regulation of controlled substances, including requirements that possession, growing or use be a criminal offense and that any regulated market in the substances be limited to use only for medical or scientific purposes. Even where countries have argued they have wiggle room, reform within the bounds of the conventions has often resulted in net-widening which nullifies the intent of the reform. Among the options for effective reform, probably the most immediately viable is the route of denunciation and reaccession with reservations - the route which Bolivia has now taken in order to legalise a regulated domestic market in coca leaves for chewing. The paper considers the existing record of reservations (by more than 30 parties to each of the conventions). Also discussed are the options for response to the reservations by other parties, which vary between the treaties, and how pursuing the option of denunciation and reaccession with reservation might potentially play out.
48.	Roumeliotis, Filip, 1980- (författare) Drug use and the constitution of homo politicus in Swedish politics 1966–1979 2024 Ingår i: International journal of drug policy. - 0955-3959 .- 1873-4758. ; 126, s. 104357-104357 Tidskriftsartikel (refereegranskat)abstract BackgroundThe 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.MethodsThe analysis is based on a close reading of parliamentary debates, political motions, and public reports and covers the period 1966–1979.ResultsDuring 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.ConclusionThe 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.
49.	Roumeliotis, Filip, 1980- (författare) Politics of prevention : The emergence of prevention science 2015 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 26:8, s. 746-754 Tidskriftsartikel (refereegranskat)abstract BackgroundThis article critically examines the political dimension of prevention science by asking how it constructs the problems for which prevention is seen as the solution and how it enables the monitoring and control of these problems. It also seeks to examine how prevention science has established a sphere for legitimate political deliberation and which kinds of statements are accepted as legitimate within this sphere.MethodsThe material consists of 14 publications describing and discussing the goals, concepts, promises and problems of prevention science. The analysis covers the period from 1993 to 2012.ResultsThe analysis shows that prevention science has established a narrow definition of “prevention”, including only interventions aimed at the reduction of risks for clinical disorders. In publications from the U.S. National Institute of Drug Abuse, the principles of prevention science have enabled a commitment to a zero-tolerance policy on drugs. The drug using subject has been constructed as a rational choice actor lacking in skills in exerting self-control in regard to drug use. Prevention science has also enabled the monitoring and control of expertise, risk groups and individuals through specific forms of data gathering. Through the juxtaposition of the concepts of “objectivity” and “morality”, prevention science has constituted a principle of delineation, disqualifying statements not adhering to the principles of prevention science from the political field, rendering ethical and conflictual dimensions of problem representations invisible.ConclusionThe valorisation of scientific accounts of drugs has acted to naturalise specific political ideals. It simultaneously marginalises the public from the public policy process, giving precedence to experts who are able to provide information that policy-makers are demanding. Alternative accounts, such as those based on marginalisation, poverty or discrimination are silenced within prevention science.
50.	Russell, Cayley, et al. (författare) Routes of administration for cannabis use - basic prevalence and related health outcomes : A scoping review and synthesis 2018 Ingår i: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 52, s. 87-96 Forskningsöversikt (refereegranskat)abstract Background: Cannabis use is common, and associated with adverse health outcomes. 'Routes of administration' (ROAs) for cannabis use have increasingly diversified, in part influenced by developments towards legalization. This paper sought to review data on prevalence and health outcomes associated with different ROAs. Methods: This scoping review followed a structured approach. Electronic searches for English-language peer-reviewed publications were conducted in primary databases (i.e., MEDLINE, EMBASE, PsycINFO, Google Scholar) based on pertinent keywords. Studies were included if they contained information on prevalence and/or health outcomes related to cannabis use ROAs. Relevant data were screened, extracted and narratively summarized under distinct ROA categories. Results: Overall, there is a paucity of rigorous and high-quality data on health outcomes from cannabis ROAs, especially in direct and quantifiable comparison. Most data exist on smoking combusted cannabis, which is associated with various adverse respiratory system outcomes (e.g., bronchitis, lung function). Vaporizing natural cannabis and ingesting edibles appear to reduce respiratory system problems, but may come with other risks (e.g., delayed impairment, use 'normalization'). Vaporizing cannabis concentrates can result in distinct acute risks (e.g., excessive impairment, injuries). Other ROAs are uncommon and under-researched. Conclusions: ROAs appear to distinctly influence health outcomes from cannabis use, yet systematic data for comparative assessments are largely lacking; these evidence gaps require filling. Especially in emerging legalization regimes, ROAs should be subject to evidence-based regulation towards improved public health outcomes. Concretely, vaporizers and edibles may offer potential for reduced health risks, especially concerning respiratory problems. Adequate cannabis product regulation (e.g., purity, labeling, THC-restrictions) is required to complement ROA-based effects.

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