Excess overdose mortality immediately following transfer of patients and their care as well as after cessation of opioid substitution therapy

Aims: To investigate clustering of all-cause and overdose deaths after a transfer of patients and their care to alternative treatment provider and after the end of opioid substitution therapy (OST) in opioid-dependent individuals in specialist addiction treatment. Design, Setting and Participants: Mortality data were identified within a sample of 5,445 patients with opioid use disorder who had received OST treatment between 1st April 2008 and 31st December 2013 from a large mental healthcare provider in United Kingdom. We investigated the circumstances and distribution of the 332 deaths identified within the observation window with a specific focus on overdose deaths (n=103) after a planned discharge, drop-out and transfer between services. Measurements: Crude mortality rates for overdose mortality 7/14/28/180 days after the end of treatment/transfer for overdose mortality. Findings: Of 47 individuals who died from overdose after having been transferred between services, 9 died in the first 2 weeks (crude mortality rate [CMR] 136.4, 64.3 – 243.1 95% CI) and a further 5 died in the first month post-transfer (CMR 79.5, 44.2 – 129.7 95% CI). Of the 32 individuals who died from overdose after planned OST cessation, 5 died in the first 2 weeks (CMR 151.5, 51.1 – 319.0 95% CI) and a further 4 died in the first month post discharge (CMR 82.6, 38.4 – 151.0 95% CI). Conclusions: In the UK, opioid-dependent people who are transferred to an alternative treatment provider for continuation of their opioid substitution therapy experience high overdose mortality rates, with substantially higher rates in the first month (especially first 14 days) following transfer

The ‘drug policy ratchet’: why do sanctions for new psychoactive drugs typically only go up?

It has been much more common for drugs to be subjected to tighter rather than looser control as drugs and evidence about their effects have has emerged. We argue that there is in place a drug policy ratchet which subjects new psychoactive substances (NPS) to increasing control through the continuation of historical patterns that involve the attribution to emerging drugs of guilt by three different kinds of association: guilt by deviant association; guilt by lunatic association; and guilt by molecular association. We use our contemporary ethnographic experience of drug policy-making to show how these processes continue to be applied to policy on NPS, alongside selective, narrative use of evidence and the ‘silent silencing’ by absorption of the concept of evidence-based policy. We show that the drug policy ratchet cannot be justified as an example of the precautionary principle in action, as this principle is itself not rationally justified. We conclude that recognition of the drug policy ratchet and its mechanisms may help researchers and policy-makers to improve regulation of NPS

Deaths of individuals aged 16-24 years in the UK after using mephedrone

Objective: Mephedrone is a stimulant drug chemically related to amphetamine, with effects similar to those of amphetamine and cocaine. This study aims to analyse fatalities following ingestion of mephedrone in the UK amongst 16-24 year olds in 2009-13, providing an update on data presented at the 2nd International Conference on Novel Psychoactive Substances. Methods: A literature search was undertaken to identify published information on pharmacology, toxicity, and fatalities associated with mephedrone. Fatalities involving mephedrone were extracted from the National Programme on Substance Abuse Deaths database, which receives information on drug-related deaths from Coroners in the UK and Islands and other data suppliers. Selection criteria: deceased aged 16-24 at time of death; mephedrone directly implicated in the cause of death and/or mentioned in the Coroner’s verdict. Results: Thirty cases met the study criteria and, when known, all were of White ethnicity, most (85%) had a history of drug use and 73% were male. Two-thirds (63%) were accidental poisonings. Mephedrone was used with other substances in most cases (87%); other substances were implicated in 60% of deaths. Conclusions: Mephedrone use can have potentially fatal consequences, especially in combination with other substances. Deaths in the 16-24 years age-group continue to occur from its use in the UK, despite it being a controlled drug. Health professionals and potential consumers should be alert to this risk.Peer reviewe

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids.

We examined intervention effectiveness of strategies to prevent image- and performance-enhancing drug use. Comprehensive searches identified 14 interventions that met review inclusion criteria. Interventions were predominantly educational and delivered within school sport settings, but targeted a wide range of mediating factors. Identification of effective components was limited across studies by brief or imprecise descriptions of intervention content, lack of behavioural outcome measures and short-term follow-up times. However, studies with components in addition to information provision may be more promising. Interventions outside of sport settings are required to reflect the transition of this form of substance use to the general population

"Spice", "Kryptonite", "Black Mamba": An overview of brand names and marketing stragtegies of Novel Psychoactive Substances on the Web

Novel Psychoactive Substances (NPSs) are often sold online as “legal” and “safer” alternatives to International Controlled Drugs (ICDs) with captivating marketing strategies. Our aim was to review and summarize such strategies in terms of the appearance of the products, the brand names, and the latest trends in the illicit online marketplaces. Methods: Scientific data were searched in PsychInfo and Pubmed databases; results were integrated with an extensive monitoring of Internet (websites, online shops, chat rooms, fora, social networks) and media sources in nine languages (English, French, Farsi, Portuguese, Arabic, Russian, Spanish, and Chinese simplified/traditional) available from secure databases of the Global Public Health Intelligence Network. Results: Evolving strategies for the online diffusion and the retail of NPSs have been identified, including discounts and periodic offers on chosen products. Advertisements and new brand names have been designed to attract customers, especially young people. An increased number of retailers have been recorded as well as new Web platforms and privacy systems. Discussion: NPSs represent an unprecedented challenge in the field of public health with social, cultural, legal, and political implications.Web monitoring activities are essential for mapping the diffusion of NPSs and for supporting innovative Web-based prevention programmes.Peer reviewedSubmitted Versio

Dangerous drugs, dangerous mothers: Gender, responsibility and the problematisation of parental substance use

If, as many would have it, the ‘drugs problem’ is among the more perilous and uncompromising challenges of our times, parental substance misuse represents one of its most insidious expressions. The past 15 years has seen the ‘hidden harms’ experienced by the children of drug users emerge as a principal concern for national policy actors and local service provision. However, there has been relatively little critique of the assumptions and epistemological foundations underscoring this policy shift, or of the preoccupation with the ‘family’ in drug policy in general. Through examination of seminal policy documents relating to parental substance misuse, and using Carol Bacchi’s ‘What’s the Problem Represented to Be?’ (WPR) approach, this article attends more closely to the formulation of parental drug use as a significant policy problem, and to the family as a principal site for the constitution of drug harms

A Qualitative Study of an Integrated Maternity, Drugs and Social Care Service for Drug-using Women

Background: The care of drug-using pregnant women is a growing health and social care concern in many countries. A specialist clinic was established offering multidisciplinary care and advice to pregnant drug users in and around Aberdeen (UK) in 1997. The majority of women stabilise and reduce their drug use. By determining the needs and views of the women more appropriate services and prevention strategies may be developed. There has been little research conducted in this area and none in Scotland. Methods: This is a qualitative study that aimed to gain an understanding of the experiences of women drug users, seeking and receiving prenatal care and drug services from a specialist clinic. Twelve women participated in semi-structured one-to-one interviews. Results: The women preferred the multidisciplinary clinic (one-stop shop) to traditional prenatal care centred within General Practice. The relationships of the clients to the range of Clinic professionals and in hospital were explored as well as attitudes to Clinic care. The study participants attributed success in reducing their drug use to the combination of different aspects of care of the multi-agency clinic, especially the high level prenatal support. It is this arrangement of all aspects of care together that seem to produce better outcomes for mother and child than single care elements delivered separately. Some women reported that their pregnancy encouraged them to rapidly detoxify due to the guilt experienced. The most important aspects of the Clinic care were found to be non-judgemental attitude of staff, consistent staff, high level of support, reliable information and multi-agency integrated care. Conclusion: There is an impetus for women drug users to change lifestyle during pregnancy. The study highlighted a need for women to have access to reliable information on the effects of drugs on the baby. Further research is required to determine whether positive outcomes related to clinic attendance in the prenatal period are sustained in the postnatal period. Early referral to a specialist clinic is of benefit to the women, as they reported to receive more appropriate care, especially in relation to their drug use. A greater awareness of needs of the pregnant drug user could help the design of more effective prevention strategies

Young People, Biographical Narratives and the Life Grid: Young People's Accounts of Parental Substance Use

Research into potentially sensitive issues with young people presents numerous methodological and ethical challenges. While recent studies have highlighted the advantages of task-based activities in research with young people, the literature on life history research provides few suggestions as to effective and appropriate research tools for encouraging young people to tell their stories. This paper explores the contribution that may be made to such research by the life grid, a visual tool for mapping important life events against the passage of time and prompting wide-ranging discussion. Critical advantages of the life grid in qualitative research include: its visual element which can help to engage interviewer and interviewee in a process of constructing and reflecting on a concrete life history record; its role in creating a more relaxed research encounter supportive of the respondent’s ‘voice’; and facilitating the discussion of sensitive issues. In addition, the way in which use of the grid anchors such narratives in accounts of everyday life, often revealing interesting tensions, is explored. These points are discussed with reference to an exploratory study of young people’s experience of parental substance use