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The emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention and intervention. This paper aims to examine sociodemographic correlates as well as health and substance use characteristics of different groups of opioid users.

This paper used the 2015–2019 National Survey on Drug Use and Health to examine distinctions between groups (n = 11,142) of individuals who misuse prescription opioids, use heroin but not fentanyl, misuse pharmaceutical fentanyl but not heroin and use both heroin and fentanyl. Multinomial and logistic regression models were used to identify these distinctions.

Few sociodemographic differences emerged between the prescription opioid group and pharmaceutical fentanyl misuse group. While those who misuse fentanyl have higher odds of using other drugs and experiencing certain mental health problems than those misusing prescription pills, both the heroin and fentanyl–heroin use groups reported considerably poorer health and substance use indicators relative to those who solely misuse fentanyl. It is also notable that both heroin use groups are more highly associated with cocaine and methamphetamine use than those misusing fentanyl alone.

While this study identifies important distinctions between the opioid use groups studied, individuals using both heroin and pharmaceutical fentanyl report the poorest health and substance use characteristics. Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention and clinical work amid shifting patterns of opioid use.

Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention and clinical work amid shifting patterns of opioid use.

This study highlights distinctions between pharmaceutical fentanyl users, heroin users and users of both substances.

In this paper, academics and managers of specialist services reflect on the shifting policy and funding landscapes that shape service provision for drug‐using sex workers in England and Ireland. The paper outlines the harm reduction and holistic principles that underpinned much original service provision concerned with public health in the face of an HIV epidemic and the limitations of services that equate drug use minimisation with sex work minimisation. It concludes that an ‘exiting’ and victim discourse dovetails with the well‐funded crime and disorder agenda, and that lobbyists on these issues are proving to be natural allies against harm reduction.

The purpose of this paper is to determine pharmacists’ knowledge of legal highs (novel psychoactive substances (NPS)).

A questionnaire was handed out at two London pharmacist continuing education events in mid-2014. These events update pharmacists about developments of interest/relevance to the profession and to improve their practice. A total of 54 forms were returned; a response rate of 26 percent.

Most pharmacists had poor knowledge of NPS and many considered that NPS were not important to their work, with few having had to advise customers in this area. Despite this, the majority thought that they had insufficient information about NPS. There was a negative correlation between the age of the pharmacist and knowledge of NPS.

The sample is a self-selected one drawn from registered pharmacists working in community pharmacies in northwest London, and thus does not include hospital pharmacies. Self-selection means that respondents may only reflect those who are interested in the NPS phenomenon and not the wider pharmacy community. The geographical area covered may not be representative of London as a whole, or indeed other parts of the UK or other EU countries.

It is clear that pharmacists do not know much about NPS but would like to know more. This information might improve their practice.

Pharmacists, easier to see than general practitioners, could be a useful source of information for NPS misusers.

There have been no previous attempts to gauge the level of knowledge by pharmacists of legal highs/NPS in the UK or elsewhere to our knowledge.

The purpose of this paper is to ascertain an awareness of the management of the drug misusing guidelines in Glasgow general hospitals.

A brief literature review was carried out to establish the available evidence for the guidelines. Additionally, a survey questionnaire was sent out to junior medical staff requesting their views on the drug misusing guidelines.

A paucity of evidence relating to drug misusing guidelines was found from the literature. The Glasgow Guidelines appear to be a welcome source of information that is both comprehensive and easily accessible for staff. Junior medical staffs have broadly welcomed the guidance but would appreciate additional support on the management of patients prescribed Suboxone.

There should be an increase in training and development for junior medical staff regarding the guideline.

The Glasgow Guidelines are aimed primarily at junior medical staff whose knowledge on drug misusing patients may be scarce. Increased training and awareness should improve the management of drug misusers in general hospitals. Consequently, patients should spent less time in hospital.

Recovery is the predominant discourse within current UK drug policy, promoted as freedom from dependence. In support of such a policy driver, prison drug recovery wings have been piloted in ten prisons in England and Wales to address high drug prevalence rates in prisoner populations. The purpose of this paper is to explore the development of these specialist wings within the context of wider developments to tackle reoffending among drug-using prisoners.

The first part of the paper offers an analysis of the emergence of the recovery paradigm in the prison context through analysis of official policy documents. The second draws predominantly upon two process evaluations of the drug recovery wings, alongside literature on prison drug treatment.

There is limited empirical evidence to inform the debate about whether prisons can provide settings to facilitate recovery from the effects of illicit drug use. What is available suggests that effective therapeutic environments for recovering drug users could be established within prisons. Key components for these appear to be sufficient numbers of staff who are competent and confident in providing a dual role of support and discipline, and a common purpose of all prisoners committing to recovery from illicit drugs and supporting each other. Further research regarding the impact of drug recovery wings upon health, crime and wider social outcomes is needed.

This paper provides an updated perspective on the development of drug treatment in prisons, with a particular focus on the implications of the new recovery paradigm.

The paper covers:• nature of the drug problem ‐ drug dependence, prevalence of misuse, distribution of problematic drug‐users (PDUs) across NOMS and how drug‐related offending manifests itself• drug strategy in prisons ‐ demand reduction, supply reduction and establishing through‐care linkages, clinical services, counselling, assessment, referral, advice and through‐care services (CARATs), drug rehabilitation programmes, drug testing programmes, supply reduction initiatives, DIP linkages and wider resettlement agenda• assessing need and planning for the future ‐ needs analysis, development of the collaborative drug treatment vision, initiatives planned or under way to improve quality and amount of treatment available, and mainstreaming/integration of services to reduce re‐offending and make public environment safer.

The purpose of this paper is to describe a Service Improvement Project aimed at assessing the level of knowledge of intimate partner violence (IPV) of clinical staff working in Community Drug and Alcohol Services (CDAS) in four boroughs of South London.

Clinical staff (n=90) completed a survey which was based on the Capability Framework (Hughes et al., 2015), developed to describe the key capabilities required to work with men who misuse drug and alcohol and perpetrate IPV. Two separate surveys were prepared for clinical (core) staff (n=76) and for manager (senior) staff (n=14).

The Capability Framework provided a useful structure for identifying key strengths and gaps in knowledge and skills related to substance use and IPV treatment in frontline CDAS staff. Significant strengths which emerged in the “core staff” survey related to the importance of assessing IPV and being empathic. Gaps related to the confidence in working with these issues and receiving support. Significant strengths which emerged in the “senior staff” survey related to the availability of supervision, information and training on IPV. Gaps related to using the Capability Framework and discussing IPV in supervision.

Findings have important implications for the development of training addressing gaps in current knowledge and skills required when working with IPV in the context of drug and alcohol misuse.

This chapter introduces a simulation model to estimate the social costs of problem drug misusers in England and Wales, and how policies to increase the number of drug users in treatment may impact on both social costs and government expenditure. Consequences are divided into five domains – health, crime, social care, work, and driving. Social costs are estimated to be between £12 and £12.3 billion, and the total cost of government expenditure is around £3.5 billion. Increases in the numbers in treatment, are estimated to reduce social costs across a 5-year period by between £3.0 and £4.4 billion.

The purpose of this paper is to identify the health problems and treatment needs of drug‐misusing offenders and to draw out the implications of the findings for health education and prevention.

This analysis is based on data collected as part of the New English and Welsh Arrestee Drug Abuse Monitoring (NEW‐ADAM) programme. The survey was based on interviews and urine sample collection with over 3,000 arrestees.

The research found that young arrestees experienced a wide range of drug‐related and general health problems. The implications of this are discussed in the context of programmes implemented as part of the government's drug strategy.

The NEW‐ADAM surveys provide an original source of information on the drug and general health needs of young people at the first point of entry in the criminal justice system.