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The landscape for international drug policy is shifting rapidly as the tensions between the objectives, assumptions and activities that are being introduced at local level are tearing apart the assumptions on which the system was founded. Countries are divided into camps that pursue different aims with drug policy. In addition to an established distinction between those that seek to reduce drug harms and those pursuing a vision of a drug-free world, some UN member states have established licit markets for products that the conventions hold are available for medical and scientific purposes. This incongruence is matched by states in the other camp who apply capital and corporal punishment ostensibly in pursuit of a public health objective. These differences over underlying values, but also in the use of evidence, and interpreting the purpose of the drug control system are no longer reconcilable. While there is pressure on maintaining the system, it no longer serves an organic function and continues mainly for the benefit of constituent members. With the dissolution of US leadership, drug policy is no longer operating within an effective international framework.

Recreational drug use is widespread. It is argued that it has reached a phase of ‘normalisation’ among youth and has become a part of mainstream culture. While there is a substantive body of literature addressing substance use in club settings, the world of music festivals is underexplored. The research aims to fill this gap by analysing patterns of drug use and implementation of harm reduction measures among Polish and Hungarian women at music festivals. This explorative inquiry used an online questionnaire, which was shared via social media channels. The data collection lasted for one month during the summer of 2017.

The study found that over 95% (N=510) of women use psychoactive substances at festivals. The most popular drugs are alcohol and cannabis, and the least popular cocaine and psilocybin. The majority of women declare moderate use of alcohol and light to moderate use of cannabis. One-fifth of the respondents report a moderately heavy use of 3,4-methylenedioxymethamphetamine and 8% heavy use of amphetamine. There are numerous positive weak relationships between the intensity of use of various substances. Increased use of drugs is also related to increased frequency of combining them. Low prevalence of illicit drugs testing is observed. There seems to be a negative correlation between the intensity of substance use and the adoption of harm reduction measures. The results have high practical relevance primarily for harm reduction and medical services. Especially cases of moderately heavy and heavy use should be of interest, even more so given that combining substances seems to be prevalent. The data suggest that we can distinguish between two groups: one aware and implementing various measures of harm reduction and second not adopting any of them. There is a need for more widespread drug education and harm reduction promotion, which should be implemented in a favourable legal and policy environment.

Human performance, particularly that of the warfighter, has been the subject of a large amount of research during the past few decades. For example, in the Medline database of medical and psychological research, 1,061 papers had been published on the topic of “military performance” as of October 2003. Because warfighters are often pushed to physiological and mental extremes, a study of their performance provides a unique glimpse of the interplay of a wide variety of intrinsic and extrinsic factors on the functioning of the human brain and body. Unfortunately, it has proven very difficult to build performance models that can adequately incorporate the myriad of physiological, medical, social, and cognitive factors that influence behavior in extreme conditions. The chief purpose of this chapter is to provide a neurobiological (neurochemical) framework for building and integrating warfighter performance models in the physiological, medical, social, and cognitive areas. This framework should be relevant to all other professionals who routinely operate in extreme environments. The secondary purpose of this chapter is to recommend various performance metrics that can be linked to specific neurochemical states and can accordingly strengthen and extend the scope of the neurochemical model.

Illicit substance use can have a detrimental effect on a young person's life, abilities, psychosocial well-being, educational participation, attainment and outcomes. It is associated with and can lead to increased vulnerability and be a serious safeguarding concern. This chapter explores the concept of illicit substance as a process of ‘normalisation’ among children and young people. It also explores the concept of ‘game playing’, poly and tertiary substance use and considers some of the implications of illicit substance use and of young people becoming involved in ‘County Lines’. Understanding the nature, scale, extent and consequences of illicit substance use, and how young people are portrayed and stigmatised by those around them are important in relation to responding appropriately to need, and in assessing safeguarding concerns. This chapter will also discuss these concerns and conclude by critically considering the implications of illicit substance use for teachers and schools, whilst considering appropriate responses which identify and reduce risk.

States in the Middle East and North Africa (MENA) have historically leaned towards conservative, reactionary models of drugs policy. The combination of authoritarian forms of government, whether dynastic monarchies (Morocco, Jordan and Persian Gulf countries), semi-military republics (Syria, Egypt and Algeria) or religiously sanctioned republics (Iran), with the strong influence of Islamic law and norms, has signified that the region has enforced strict forms of drug prohibitions. For that matter, the region is home to cultural and social norms that are less permissive than in other regions of the world: for instance, with regard to premarital sex, homosexuality, clothing, alcoholic drinks and freedom of expression. This image of the MENA region is often overplayed by media commentators and Western scholars, especially in the field of drugs policy. The almost total absence of studies of drugs policy or drugs history in the MENA, excluding works in epidemiology, speaks well about the oblivion to which the region has been relegated over the last decades. The chapter provides first a background on the main questions regarding MENA drugs policy, looking at the historical developments in drug regulations and drug trends. Then, it discusses the current policies that operate across the region and, if pertinent, the prospects of policy development. When necessary, the argument refers to contextual elements that have influenced the direction in national and transitional drugs policy. Conscious of the fact that the MENA is as vast and diverse as a continent, I have opted to focus on three paradigmatic cases (Iran, Lebanon and Saudi Arabia), which provide an adequate geographical and thematic coverage of the MENA drugs policy. The three cases cover different aspects of today’s MENA drugs policy spectrum, from draconian repressive measures to progressive harm reduction programmes. Taken in their geographical dimension one can appreciate the variety and difference that exists within the MENA region, therefore supporting one of the key objectives of this chapter, which is to provide a nuanced analysis of drugs policy against the grain of homogenising and culturally reductive approaches.

Although we have achieved a greater understanding of cryptomarket specifics, evidence on the consumer side of cryptomarkets is still needed – not only regarding the role of cryptomarkets on individual drug-using careers but also on the motives for buying illicit drugs from cryptomarkets. Moreover, research has indicated that national differences exist regarding different variables relating to cryptomarket use and prevalence, as well as to why users are drawn to these markets. In this chapter, the author presents the results of a Belgian case study focusing on drug cryptomarket buyers. Using an online quantitative survey (N = 99) and semi-structured interviews (N = 10), we gain exploratory insight into the motives of Belgian buyers sourcing illicit drugs from cryptomarkets and how they believe these cryptomarkets affect their drug-using careers. Results indicate that most of the respondents had bought drugs offline before buying them from cryptomarkets and that the frequency of their drug use did not change once cryptomarkets were accessed. Almost 60% of our respondents, however, consumed different drugs or a wider range of drugs following their cryptomarket use. Furthermore, most of the respondents purchased from cryptomarkets for their personal consumption, and some of them also shared their supply with friends, that is, social supply. The alternative drug offer was the principal reason why they were using cryptomarkets, followed by curiosity and the price and the quality of the drugs. Although the respondents in this study were well aware of different risks related to market vendors, market administrators, and law enforcement, these risks were considered to be minimal and part of the cryptomarket environment. The results of this case study are informative and highlight areas requiring further research.

This chapter depicts the burden of suicidal behavior among African American males. It describes the public health approach to preventing suicidal behavior among African American males. This approach includes assessing and describing the problem; identifying causes or risk and protective factors; developing and evaluating programs and policies; and implementing and disseminating findings and activities. The chapter provides a review of the epidemiology of fatal and non-fatal suicidal behavior; a summary of what is known about the risk and protective factors of the problem; and a descriptive analysis of the circumstances associated with suicides among young African American males is presented. Lastly, the authors give a summary of evidenced-based prevention programs which could be applied in preventing male suicidal behavior.