Virtually hidden: a theoretical framework for understanding and conceptualising online drug use pornography

Online drug use pornography has been freely available through websites on the open internet for at least 7 years. Surprisingly there is almost no exploration of its nature, character or impacts on both performers and those engaging with this type of content within the research literature. Nor is it an issue that has engaged health care providers and other statutory and non-statutory agencies even though it may have implications within their respective domains. A preliminary scoping of the online environment is used to propose a theoretical framework that combines Goffman’s performance theory with that of Turner and Schechner’s positioning of ritual theory within performance theory, Butler’s concept of performativity online and Luppichi’s concept of the ‘technoself’. Utilising the proposed theoretical framework, it is postulated that the presence, performance and engagement of online drug use pornography is a social boundary testing and possibly breaking performance centred on iterative relationships between performer and consumers of this content.info:eu-repo/semantics/publishedVersio

The impacts and service responses to injecting cathinones and novel opioids amongst marginalized drug using populations – a scoping review

Background: A growing body of literature reports on the injection of synthetic cathinones (SC) and novel synthetic opioids (NSO) in marginalized drug-using (MDU) populations. This review seeks to establish what is known about the injection of SCs and NSOs impacts on MDUs. Method: A six-stage iterative scoping literature review was conducted in relation to SCs, NSOs, MDU impacts and service responses. Searches were conducted through Pubmed™ and Google Scholar™. Results: Two Thousand and Ninety-Nine search items were retrieved. After duplicates were removed (n = 880), articles were screened for injecting drug use by MDUs leading to the removal of a further 1102 articles. Three articles were identified through a hand search, yielding a total of 22 articles for appraisal. Conclusions: SC injection has largely dissipated in many regions due to service and policy responses and changes in the drug market. Responses to NSO have been less effective, with extensive use and opioid overdosing due to contamination and adulteration within the illicit drug market. These impacts have stimulated innovative responses such as fentanyl test strips and housing-based consumption sites. The evidence for their effectiveness is not established. In this context, the underlying environmental and structural factors shaping the risk of these populations should be addressed.info:eu-repo/semantics/acceptedVersio

The impacts and service responses to Injecting Synthetic Cathinones and Novel Synthetic Opioids amongst marginalised drug using populations – a scoping review

Background: A growing body of literature reports on the injection of synthetic cathinones (SC) and novel synthetic opioids (NSO) in marginalized drug-using (MDU) populations. This review seeks to establish what is known about the injection of SCs and NSOs impacts on MDUs. Method: A six-stage iterative scoping literature review was conducted in relation to SCs, NSOs, MD impacts and service responses. Searches were conducted through Pubmed™ and Google Scholar™. Results: Two Thousand and Ninety-Nine search items were retrieved. After duplicates were removed (n =880), articles were screened for injecting drug use by MDUs leading to the removal of a further 1102 articles. Three articles were identified through a hand search, yielding a total of 22 articles for appraisal. Conclusions: SC injection has largely dissipated in many regions due to service and policy responses and changes in the drug market. Responses to NSO have been less effective, with extensive use and opioid overdosing due to contamination and adulteration within the illicit drug market. These impacts have stimulated innovative responses such as fentanyl test strips and housing-based consumption sites. The evidence for their effectiveness is not established. In this context, the underlying environmental and structural factors shaping the risk of these populations should be addressed

Virtually Hidden: A Theoretical Framework for understanding and conceptualising Online Drug Related Pornography

Online drug use pornography has been freely available through websites on the open internet for at least 7 years. Surprisingly there is almost no exploration of its nature, character or impacts on both performers and those engaging with this type of content within the research literature. Nor is it an issue that has engaged health care providers and other statutory and non-statutory agencies even though it may have implications within their respective domains. A preliminary scoping of the online environment is used to propose a theoretical framework that combines Goffman’s performance theory with that of Turner and Schechner’s positioning of ritual theory within performance theory, Butler’s concept of performativity online and Luppichi’s concept of the ‘technoself’. Utilizing the proposed theoretical framework, it is postulated that the presence, performance and engagement of online drug use pornography is a social boundary testing and possibly breaking performance centred on iterative relationships between performer and consumers of this content

A qualitative study of physical activity and dietary practices of people accessing opioid agonist treatment in Ireland

Background: Active heroin use presents a time of chaotic behaviours, while opioid agonist treatment (OAT) offers an opportunity for people with opiate substance use disorder to improve health and functioning. Lifestyle behaviours of physical activity and healthy dietary practices are increasingly studied for their role in maintaining physical and mental health among people with mental disorders. Aim: This research aimed to explore service user experiences of change with respect to physical activity and dietary practices since entering OAT. This research also explored barriers and facilitators to positive lifestyle behaviours among those accessing OAT. Methods: Qualitative descriptive interviews were conducted with (n=10) service users using pre-determined themes to explore the aforementioned topic. Results: Participants largely viewed lifestyle behaviours as having improved since entering OAT. A number of barriers, such as methadone related symptomology, physical ill-health, and social circumstances were impeding lifestyle behaviours. Physical activity was also impacted by a number of psychological barriers, such as perceived stigma. Facilitators to lifestyle behaviours discussed by participants demonstrated new routines and support structures associated with the OAT service. Conclusions: Lifestyle behaviours appear to be positively modified during OAT allied to additional health care supports in place for service users and a potential for improved health and social function. A number of barriers, particularly psychological, remain with respect to behaviour change for this population. This research explores these, with learnings for services to support behaviour change

Responding to COVID-19 : emerging practices in addiction medicine in 17 countries

Following the classification of the Coronavirus disease (COVID-19) as a pandemic by the World Health Organization (WHO), countries were encouraged to implement urgent and aggressive actions to change the course of the disease spread while also protecting the physical and mental health and well-being of all people. The challenges and solutions of providing prevention, treatment, and care for those affected with issues related to substance use and addictive behaviors are still being discussed by the global community. Several international documents have been developed for service providers and public health professionals working in the field of addiction medicine in the context of the pandemic (1–3), however, less is known about country-level responses. In the current paper we, as individual members of the Network of Early Career Professionals working in Addiction Medicine (NECPAM), discuss emerging country-level guidelines developed in the 6 months following the outbreak.The South African Medical Research Councilhttp://www.frontiersin.org/Psychiatryam2022Family Medicin

Electronic cigarettes for smoking cessation

Background Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e‐liquid. Some people who smoke use ECs to stop or reduce smoking, but some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. This is an update of a review first published in 2014. Objectives To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke achieve long‐term smoking abstinence. Search methods We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 February 2021, together with reference‐checking and contact with study authors. Selection criteria We included randomized controlled trials (RCTs) and randomized cross‐over trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. To be included, studies had to report abstinence from cigarettes at six months or longer and/or data on adverse events (AEs) or other markers of safety at one week or longer. Data collection and analysis We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow‐up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included changes in carbon monoxide, blood pressure, heart rate, blood oxygen saturation, lung function, and levels of known carcinogens/toxicants. We used a fixed‐effect Mantel‐Haenszel model to calculate the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data from these studies in meta‐analyses. Main results We included 56 completed studies, representing 12,804 participants, of which 29 were RCTs. Six of the 56 included studies were new to this review update. Of the included studies, we rated five (all contributing to our main comparisons) at low risk of bias overall, 41 at high risk overall (including the 25 non‐randomized studies), and the remainder at unclear risk. There was moderate‐certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.69, 95% confidence interval (CI) 1.25 to 2.27; I2 = 0%; 3 studies, 1498 participants). In absolute terms, this might translate to an additional four successful quitters per 100 (95% CI 2 to 8). There was low‐certainty evidence (limited by very serious imprecision) that the rate of occurrence of AEs was similar) (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs occurred rarely, with no evidence that their frequency differed between nicotine EC and NRT, but very serious imprecision led to low certainty in this finding (RR 1.37, 95% CI 0.77 to 2.41: I2 = n/a; 2 studies, 727 participants). There was moderate‐certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non‐nicotine EC (RR 1.70, 95% CI 1.03 to 2.81; I2 = 0%; 4 studies, 1057 participants). In absolute terms, this might again lead to an additional four successful quitters per 100 (95% CI 0 to 11). These trials mainly used older EC with relatively low nicotine delivery. There was moderate‐certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.60, 95% CI 0.15 to 2.44; I2 = n/a; 4 studies, 494 participants). Compared to behavioral support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.70, 95% CI 1.39 to 5.26; I2 = 0%; 5 studies, 2561 participants). In absolute terms this represents an increase of seven per 100 (95% CI 2 to 17). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was no evidence that the rate of SAEs differed, but some evidence that non‐serious AEs were more common in people randomized to nicotine EC (AEs: RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants; SAEs: RR 1.17, 95% CI 0.33 to 4.09; I2 = 5%; 6 studies, 1011 participants, very low certainty). Data from non‐randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued use. Very few studies reported data on other outcomes or comparisons and hence evidence for these is limited, with confidence intervals often encompassing clinically significant harm and benefit. Authors' conclusions There is moderate‐certainty evidence that ECs with nicotine increase quit rates compared to ECs without nicotine and compared to NRT. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the size of effect, particularly when using modern EC products. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, though evidence indicated no difference in AEs between nicotine and non‐nicotine ECs. Overall incidence of SAEs was low across all study arms. We did not detect any clear evidence of harm from nicotine EC, but longest follow‐up was two years and the overall number of studies was small. The evidence is limited mainly by imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up‐to‐date information, this review is now a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status