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This paper aims to explore the role of tramadol in pain management and the impact of regulatory measures on supply and medical access in Ghana and other African countries.

The study adopted an exploratory design and qualitative methods to explore the perspectives of different actors, including officials of regulatory agencies, law enforcement agents, health-care providers and non-medical tramadol users. Data were collected through individual and group interviews, and transcripts were subjected to thematic analysis.

Findings show that tramadol fills a critical gap in treating pain across Ghana in areas with an acute shortage of opioid analgesics due to scheduling-related barriers. This was partly due to porous borders allowing for an influx of tramadol into the countries. The study further found that most tramadol purchases in Ghana and other West African countries were made from market traders rather than from health-care settings and were mainly generic medicines categorised as “substandard/spurious/falsely-labelled/falsified/counterfeit medical products” within the World Health Organization standards.

Although the findings are instructive, there were some limitations worth noting. The study encountered several limitations, especially with the non-medical users, because the environment is highly criminalised, People who use drugs were unwilling to avail themselves for fear of law enforcement officers’ harassment. Obtaining ethical clearance had its own bureaucracy – challenges that delayed the study time frame.

Placing tramadol under the list of internationally controlled substances would create barriers to access to effective pain medications, particularly by the poor, and encourage victimisation of users by law enforcement authorities.

The study is based on empirical research on tramadol use and regulation in African countries, contributing to knowledge in an under-researched subject area on the continent. The comparative approach further adds value to the research.

This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD) symptomatology for individuals who misuse substances.

Systematic searches across six databases (PsycINFO, Embase, Scopus, Medline, CINAHL and ProQuest), hand searching and citation chaining were conducted between June and August 2021. Key search terms included BPD, substance use, therapy and effect. Study and sample characteristics, interventions, outcome measures and key findings were extracted. Quality assessment and a narrative synthesis approach were used to explore strengths, limitations and relationships between and within studies.

Seven eligible reports were included and showed mostly adequate quality. Mixed samples, designs, outcomes, definitions and implementation varied. Treatment completion did not differ significantly between those who did and did not misuse substances. Interventions demonstrated effectiveness in relation to psychiatric symptoms, hospital admissions, self-efficacy and impulsive and self-mutilating (cutting, burning, etc.) behaviours. No effects were found for suicidal or parasuicidal (threats, preparation and attempts) behaviours.

This review only considers individuals with diagnoses of BPD who are not accessing substance misuse treatment. Radically open dialectical behaviour therapy (DBT), therapeutic communities and other interventions are available as interventions for substance misuse (Beaulieu et al., 2021). Based on the findings of this review, it should not be assumed that such interventions affect substance misuse rather than BPD symptomatology. Therefore, future research might explore the effectiveness of these interventions on BPD symptomatology despite this not being the primary target for intervention.

Despite McCrone et al. (2008) noting the cost of this population’s difficulties to both themselves and services, the limited number of studies in this area is astonishing. Despite a lack of quality in the data available, there i some evidence to support the use of DBT and general psychiatric management (GPM) interventions for those with BPD and concurrent substance misuse. It is therefore of principal importance that health and social care services action Public Health England’s (2017) recommendations. Individuals with coexisting BPD and substance misuse would then receive support from any professional they see, who could then refer for psychological therapies.

Although the reports appear to show that DBT, integrated therapies and GPM may be effective for this population, conclusions cannot be drawn with high levels of confidence due to heterogeneity among studies. The findings indicate that future, high-quality research is needed to test the effects of interventions on BPD symptomatology for those who misuse substances. Randomised controlled trials with sufficient statistical power, homogeneous outcomes and standardised methodological approaches are needed.

Through its 1922 Act on poisonous substances and more recent national normative guidance, Morocco attempts to address high prevalence of HIV among people who inject illegal opioids, and to lift legal and policy barriers to the availability of opioid-based essential controlled medicines. This paper aims to map the Moroccan opioid regulation environment, with a focus on responses to the legal and illegal markets.

The policy paper focuses on legal provisions for the control of opioids for pain relief and methadone for substitution therapies. It reviews existing reported data from official national, regional and international sources, studies and grey literature. It allows, by presenting the current state of affairs, to measure the limited pace of policy changes.

The authors provide a clear mapping of the laws and regulations restricting access to opioids in Morocco; the health impacts on populations; and an overall overview of institutional barriers to policy change despite more efforts such as the introduction of opioid agonist therapies.

Due to limited available data and sources, the policy paper exploits the maximum of existing evidence from national and international sources to provide an overall review of opioid control policies in Morocco.

To the best of the authors’ knowledge, this policy paper is among the first to explore the legal environment of opioid use and control in Morocco, to highlight policy reforms, and to analyse the barriers to access to opioids.

In Chapter 4, the author will discuss the youth drinking epidemic regionwide, in order to demonstrate why the impacts of alcohol products on youths are concerning. The author will present the major youth drinking trends within SEA, to further study how the rampant alcohol trade regionally has adversely affected local youths to a troublesome degree. The author will point out the causes of the youth drinking epidemic, which are susceptibility and toxic culture. Next, the author will evaluate the national and regional costs of youth drinking, discussing how such a lifestyle results in consequences in relation to delinquency. The author will recommend policies for alcohol control that the SEA governments should take into account when amending or forming their policies to contain the epidemic of youth drinking. The outputs of Chapter 4 will draw a close association between youth smoking, youth drinking, and youth sexual misconduct. Therefore, the author indicates that these youth delinquency problems should be addressed simultaneously in order to eradicate the issues of holistic youth misbehaviours in the long term.

The purpose of this research was to determine the level of nonylphenols (NPs) present in wastewater from the first launder of new activewear garments purchased in Aotearoa, New Zealand.

Fifteen garments were purchased and prepared, and each was laundered separately. Wastewater was collected from each of the garments being laundered and tested for NPs, along with the controls.

According to the obtained results, detectable levels of NPs were present in all the garments tested.

The results obtained from the detection of NPs present in activewear garments is the first study of its kind in New Zealand and adds to the understanding of the distance that toxic chemicals can travel when used in textile manufacturing.

The purpose of this study is to examine the politics, political economy, and fallout of hawkish regulatory policy on prescription drugs in Nigeria. Hawkish regulatory policy on prescription drug in Nigeria, such as opioid analgesics, is a very complex and multifaceted one, which usually involves the interplay of many factors and parties.

Policy manuals, official government gazettes (legislations, regulations, Acts and decrees), academic literature and a direct ethnographic observation of events surrounding the regulation of prescription drugs were reviewed and engaged.

The results revealed that Nigerian and global political economy and politics interface to define the direction of the new restrictive opioid policy, with resultant friction between prohibition and consumption. The reviews showed that the overarching “get-tough” and “repressive” policy are not necessarily founded on empirical evidence of an increase in prescription drug sales or use, but more as a product of the interplay of both internal and external politics and the prevailing socioeconomic order.

Instead of borrowing extensively from or being influenced by repressive Western drug laws and perspectives, Nigerian policymakers on prescription opioids should take control of the process by drawing up a home-grown policy that is less intrusive and punitive in nature for better outcomes. A mental sea change is required to understand the intrigues of Western power in Nigeria’s politics and political economy to avoid the continuous symptomatic failure of drug policy.

The politics and economic influence of the United Nations, USA and Western powers, as well as the axiom of moral panic of prescription drugs scares within the Nigerian environment, are particularly significant in the making of the emerging hawkish policy on prescription drugs in Nigeria.

In 2017, the opioid epidemic was declared a public health emergency in the United States. The federal and state governments are still struggling to contain the crisis through various legislations and to stem the tide of overdoses and deaths. This paper looks specifically at the issue of high prescriptions of opioids disbursed to patients by physicians.

This paper evaluates this evolving policy issue through a critical review and synthesis of academic literature, government policy documents (at states and national levels) and articles in the popular press.

Over-prescription is a legal problem because it inevitably leads to diversion of these substances for non-medical usage. The Prescription Drug Monitoring Program (PDMP) laws have been passed by all 50 states and the main policy responses are covered. However, there are hindrances to their effectiveness, which have to be addressed. Two state level policy alternatives are discussed as potential solutions — PDMP mandates and Pain Management Clinic Laws (PMCLs). After a comparative evaluation, it is recommended that all states should pass the mandatory PDMP review and usage laws urgently.

This is the first detailed policy evaluation on the specific and time-sensitive aspect of physician over-prescribing, within the larger opioid abuse problem. Moreover, critique on the public health leadership issue is raised.

The purpose of this paper is to analyse how novel homicide defences predicated on contemporary neuroscience align with legal insanity.

Doctrinal analysis, systematic investigation of relevant statutes and cases, was used to elucidate how the law of insanity is evolving. Cases represent the first recorded instance of a particular neuroscientific defence. US appellate cases were categorised according to the mechanism of action of neurotransmitter relied upon in court. A case study approach was also used to provide a contextualised understanding of the case outcome in depth.

Findings broadly depict how the employment of expert testimony runs parallel with our contemporary understanding of key neurotransmitters and their function in human behaviour. Generally, medico-legal evidence concerning neuromodulating agents and violent behaviour was inconclusive. However, the outcome of defence strategy may depend on the underlying neurotransmitter involved.

This study shows that as more discoveries are made about the neurobiological underpinnings of human behaviour; this new knowledge will continue to seep into the US court system as innovative defence strategies with varying success. Medical and legal practitioners may gauge the success of a defence depending on the neuromodulating agent.

Many scholars have focused on the role of neuroimaging as neuroscientific evidence and how it is used is shaping US criminal jurisprudence. To the best of the author’s knowledge, no study has incorporated the true origin of neuroscientific evidence as being underpinned by the understanding of neurotransmitters.

Those who care for people with schizophrenia and substance use disorders (PLS-SUD) are faced with the complex demands of a long journey to recovery. For the carers, this translates into specific needs related to various areas of their lives. However, few studies have contributed to the understanding of these carers’ needs. The purpose of this qualitative evaluative study is to identify, understand and prioritize the needs of PLS-SUD carers in the context of intervention design from the viewpoint of carers themselves (n = 9), those they were accompanying (n = 5) and other key actors involved (n = 10).

A design of action research was employed. Data analysis was done in three phases: concept map analysis, thematic analysis and transversal analysis of the results from two focus groups, 28 interview transcriptions and a logbook.

Over 60 needs were identified. After review, 39 of those were selected for prioritization. For needs related to the carers’ role as clients of the health-care system, the committee prioritized the needs for support, sharing with other carers and improving their own well-being. For the role of supporter, knowledge about substance use disorders and their interactions with psychotic disorders as well as skills such as communication and problem resolution were considered priorities. Needs to be prioritized relating to the role of partner were fewer.

The results of this study highlight the diversity and complexity of the needs experienced by carers.

This is among the first needs surveys carried out by stakeholders to describe the needs of PLS-SUD carers.