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The purpose of this study is to understand the complex interplay between illicit opioids trade and consumption practices and state policies that aim to reduce their misuse.

The study adopted an exploratory design. Data were gathered through in-depth interviews with 31 commercially oriented drug dealers in Uyo, Nigeria. The framework approach was used in data analyses, while “friction” provided the interpretive lens.

Accounts revealed public concerns over the misuse of tramadol and other opioids among young people and the associated health and social harms. These concerns provided support for enforcement-based approaches to prescription opioids control, including police raids on pharmacy stores. These measures did not curtail opioids supply and consumption. Instead, they constrained access to essential medicines for pain management, encouraged illegal markets and fuelled law enforcement corruption in the form of police complicity in illegal tramadol trade.

The findings reveal the frictions of drug control in Nigeria, wherein enforcement-based approaches gained traction through public concerns about opioids misuse but also faced resistance due to the persistence of non-medical use and illegal supply channels made possible by law enforcement complicity. These indicate a need to prioritize approaches that seek to reduce illegal supply and misuse of opioids while ensuring availability of these medications for health-care needs.

The study is unique in its focus on the creative tension that exists between state control measures and local opioids supply and consumption practices.

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.

Chapter 6 explores the cultural impact of mental health, addiction, and dual diagnosis challenges with a specific focus on Irish society. The chapter takes a staggered approach whereby each type of challenge is separated and discussed individually, before being joined together through discussions on dual diagnosis as presented in Section 6.4. These discussions are designed to highlight the cultural deviance that is perceived by other people towards those with such diagnosis over the years that such diagnosis have been prevalent in history. In particular, the discussions around dual diagnosis here will strengthen the discussion in Chapter 4: ‘The Conundrum of Dual Diagnosis’ and will set the groundwork for the remainder of this text.

The purpose of this paper is to interrogate if the legal status of a cannabis affects money laundering activity. The legal status of cannabis continues to evolve globally; at the same time, its market remains enormous. Much of this market represents dirty money from criminal acts, which often requires laundering. In the context of changing cannabis regulations, legislation, and policies, the authors propose the possible implications such changes may have on the extent of money laundering.

This paper proposes the implications of the evolution of cannabis regulations on money laundering activities, using the theoretical underpinning of rational choice. Using Australia as a replicable critical case study, the paper, using the Walker gravity model and using United Nations Office on Drugs and Crime-reported prices of cannabis from 2003 to 2017 and Australian Criminal Intelligence Commission reports empirically validates the effects of cannabis regulations on the proceeds available for laundering.

This study finds support for the argument that prohibitive measures toward cannabis use contribute to increases in the need to launder generated proceeds.

The findings can be replicated in other countries and may contribute to novel propositions within the debate on the legalization of cannabis use, which has, thus, far primarily focused on the areas of health, crime, taxation and education.

To the best of the authors’ knowledge, no study has yet attempted to provide an economic analysis of the effects of cannabis policy changes on money laundering.

The current review aims to focus on how risk and protective factors for self-harm in secure mental health hospitals are captured in the literature.

Fifty-seven articles were included in a systematic review, drawn from an initial 1,119 articles, post duplicate removal. Databases included Psycinfo, Psycarticles, Psycnet, Web of Science and EBSCO host. A thematic analysis was used, which included a meta-ethnographic approach for considering qualitative papers.

There was a clear focus on risk factors, with eight identified (in order of occurrence): raised emotional reactivity and poor emotion regulation; poor mental health; traumatic experiences; personality disorder diagnosis and associated traits; increased use of outward aggression – dual harm; constraints of a secure environment and lack of control; previous self-harm and suicide attempts; and hopelessness. Protective factors featured less, resulting in only three themes emerging (in order of occurrence): positive social support and communication; positive coping skills; and hope/positive outlook.

This includes a proposal to move focus away from “risk” factors, to incorporate “needs”, in terms of individual and environmental factors. There is also a need for more attention to focus on developing high quality research in this area.

The research captures an area where a synthesis of research has not been comprehensively undertaken, particularly with regards to capturing protective as well as risk factors.

This paper aims to explore the misuse of prescription opioids, associated consumption cultures and the emergence of “informal governing images” among young men in Nigeria.

Using a qualitative research approach involving purposive sampling: six in-depth interviews, one focus group discussion and key informant interviews with two health-care professionals using the transgressive theory approach, this paper explores consumption cultures, motivations and the resultant “informal governing images” associated with the misuse of prescription opioids among young local street high-risk users in Nigeria.

Findings show complex expressions of diverse consumption practices, such as grinding, sniffing and concoction of tramadol (TM)with other opioids. The “puff-puff pass” practice serves as induction for new users of opioids commonly accessed through street drug dealers and pharmacists sold via backdoors. Codeine mixtures with different brands of soft drinks for dilution are used to achieve a “lower high” while a concoction of different opioids, with alcohol, and spirits obtains a “higher high”. Manufacturers’ indelible colouring and bottling discourage the non-medical use of opioids. Desiring to be awake for nocturnal activities, mostly “yahoo-yahoo” (internet fraud), sexual enhancement and dosage competitions, are motivations for the non-medical use of prescription opioids. These consumption cultures create “misuse circuits”, leading to the emergence of “informal governing images” triggered by threats from formal controls.

This paper, therefore, concludes that pharmaceutical industries should also add colourings to TM and codeine just like they did in rophinol to discourage the non-medical use of prescription opioids among young people in Nigeria.

This paper concludes that rather than branding and packaging in such a way that concealability is difficult for high-risk users as the best way to discourage the non-medical consumption of prescription opioids in Nigeria, the focus should be on addressing youth poverty and unemployment and improving access to treatment for drug use disorders, instead of calling for more enforcement-based measures.

This is an original research.

This study uses autoethnography to examine the impact of the Misuse of Drugs Act 1971 on policing and public health in the UK. Bridging the gap between scholarly discourse and practical law enforcement insights, this paper aims to highlight the cognitive dissonance experienced by frontline officers when using policing methods that conflict with evidence-based practices and personal values. It critiques routine police procedures, highlighting the ineffectiveness of criminal sanctions in reducing drug offences and the resultant damage to community trust and police legitimacy.

Using autoethnography and critical reflection that combines personal narrative and ethnographic observation, this paper presents a practitioner's perspective on the challenges of enforcing low-level drug offences. It integrates the author's experiences as a neighbourhood police officer in Camden Town, London, with theoretical analysis to highlight the practical realities of drug law enforcement at the intersection of law enforcement and public health.

This research reveals contradictions between current drug law enforcement strategies and public health objectives, and the consequences for law enforcement. It highlights the risks of limiting police discretion and preventing their ability to respond appropriately to complex needs. The paper emphasises the need for public health and trauma-informed policing strategies to mitigate the adverse effects on vulnerable and disadvantaged communities.

Improved public health outcomes: prioritising treatment and support over punishment. Adoption of trauma-informed practices: reducing marginalisation, stigma and improved experiences of police interaction. Improved trust and legitimacy: when the public perceive policing as fair and aligned with community values, it strengthens procedural justice and police legitimacy. Enhanced officer well-being: an improved working environment and experience, through more meaningful, impactful work and improved interactions and relationships with the public. Policy change: policymakers should recognise the discretionary role of police when developing drug policy and acknowledge the risks associated with enforcement approaches that conflict with community needs and broader policing objectives.

Offering a novel critique of prohibitionist drug policies within the British context, this paper advocates for a cultural shift towards public health and trauma-informed approaches in UK policing. It emphasises the importance of recognising police officers' discretionary role as “citizen-agents” and the integration law enforcement approaches with harm reduction initiatives for enhanced procedural justice and police legitimacy.

This, the first chapter of this text provides an introduction to a social world that is constructed through cultural attitudes, with a long history of the so-called ‘insane’ or deviants being excluded from society. In many cases, this was due to their behaviour resulting from an addiction issue, mental ill health or as is often the case, both. The chapter begins with an introduction to what led to the conceptualisation of this text. Once this occurs, the interplay between the ‘normal’ and the deviant, as discussed above, is played through an examination of the cultural perceptions of both mental health and addiction. In addition, to support this, a brief historical timeline of mental health, addiction and dual diagnosis is described and visually depicted. Finally, the chapter concludes with an introduction to both editors of this text who then describe what will be discussed in the chapters that follow.

The second chapter of this text provides an introduction to policy relating to mental health, addiction and dual diagnosis from three jurisdictions [Ireland, UK and Australia], chosen because of their close links to Irish people and mental health service provision. The chapter begins with an introduction, reflecting on key points raised in Chapter 1 and how they are relevant to this present chapter. A critical exploration of the policies within these three jurisdictional areas is then presented to highlight the strategic direction of mental health and addiction service provision within the three jurisdictions. This includes the acknowledgement that mental health and addiction services need to be integrated as the presence of dual diagnosis in modern society increases at an alarming rate. Finally, this chapter concludes with a link to each of the policies mentioned herein for those who wish to explore these issues further.

The COVID-19 pandemic has affected many industries, and reports indicate that this includes the illicit drug market. Recent research suggests that the homeless are particularly vulnerable during the pandemic, and the UK Government has acted to house rough sleepers. Research is scarce regarding homeless people’s experiences of the illicit drug market. This study aims to explore homeless people’s experiences of the drug supply in the UK during COVID-19.

Eight homeless people who use illicit drugs, residing in hostels for homeless people in Southampton, participated in semi-structured one-on-one telephone-based interviews.

A thematic analysis revealed five themes: availability of drugs, presence of dealers, quality of drugs, finances and personal experiences. Participants reported varying experiences of the drug supply, with lockdown measures expressed as the main reason for reduced supplies, as users found it difficult to find dealers and generate income for purchasing drugs.

The results may lack generalisability to the wider population, such as rough sleepers and drug dealers, suggesting a need for further research into people’s experiences of the drug supply during COVID-19. Research on this topic could be more in-depth through the use of research methods that are convenient for the homeless population.

Services should invest in harm reduction services and encourage homeless people who use drugs to engage in substitution treatment. Homeless services should provide psychological support for homeless people who use drugs.

The changes in homeless people’s behaviour following the pandemic may have implications for their interactions with the rest of society (e.g. begging in town centres may reduce). These changes in behaviour may also change the way society can best support homeless people.

The results are partially consistent with other research findings about the illicit drug supply; however, they also suggest that some individuals experienced minimal change in the illicit drug supply.