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This study explored health insurance coverage of genetic testing and potential factors associated with precision medicine (PM) reimbursement in Thailand.

The study employed a targeted review method. Thirteen PMs were selected to represent four PM categories: targeted cancer therapy candidate, prediction of adverse drug reactions (ADRs), dose adjustment and cancer risk prediction. Content analysis was performed to compare access to PMs among three health insurance schemes in Thailand. The primary outcome of the study was evaluating PM test reimbursement status. Secondary outcomes included clinical practice guidelines, PMs statement in FDA-approved leaflet and economic evaluation.

Civil Servant Medical Benefits Scheme (CSMBS) provided more generous access to PM than Universal Coverage Scheme (UCS) and Social Security Scheme (SSS). Evidence of economic evaluations likely impacted the reimbursement decisions of SSS and UCS, while the information provided in FDA-approved leaflets seemed to impact the reimbursement decisions of CSMBS. Three health insurance schemes provided adequate access to PM tests for some cancer-targeted therapies, while gaps existed for access to PM tests for serious ADRs prevention, dose adjustment and cancer risk prediction.

This was the first study to explore the situation of access to PMs in Thailand. The evidence alerts public health insurance schemes to reconsider access to PMs. Development of health technology assessment guidelines for PM test reimbursement decisions should be prioritized.

While there is increasing interest in implementing drug checking within overdose prevention, we must also consider how to scale-up these responses so that they have significant reach and impact for people navigating the unpredictable and increasingly complex drug supplies linked to overdose. The purpose of this paper is to present a distributed model of community drug checking that addresses multiple barriers to increasing the reach of drug checking as a response to the illicit drug overdose crisis.

A detailed description of the key components of a distributed model of community drug checking is provided. This includes an integrated software platform that links a multi-instrument, multi-site service design with online service options, a foundational database that provides storage and reporting functions and a community of practice to facilitate engagement and capacity building.

The distributed model diminishes the need for technicians at multiple sites while still providing point-of-care results with local harm reduction engagement and access to confirmatory testing online and in localized reporting. It also reduces the need for training in the technical components of drug checking (e.g. interpreting spectra) for harm reduction workers. Moreover, its real-time reporting capability keeps communities informed about the crisis. Sites are additionally supported by a community of practice.

This paper presents innovations in drug checking technologies and service design that attempt to overcome current financial and technical barriers towards scaling-up services to a more equitable and impactful level and effectively linking multiple urban and rural communities to report concentration levels for substances most linked to overdose.

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.

Recent studies have shown that people who attend electronic dance music events and use drug checking services (DCS) are a predominantly white male, highly educated middle-class population. However, there is still a lack of data beyond sociodemographic characteristics that must be addressed. This paper aims to describe the drug use patterns and protective behavior strategies (PBS) used by testers and nontesters at Boom Festival 2018 and analyze the relationship between these behaviors and the decision to use the DCS.

This is an exploratory research based on a cross-sectional design using baseline data collected at the Boom Festival from testers (N = 343) and nontesters (N = 115).

Nontesters presented, in general, slightly higher frequencies of use for most drugs, whereas testers tended to adopt PBS more frequently. Moreover, testers planned their drug use more often than nontesters and set more limits on the amount of drugs they used in one session. Both of these behaviors work as predictors for using the DCS.

Our data suggest that DCS might not be easily accessible to all people who use drugs, reaching almost exclusively highly educated people that already apply several harm reduction strategies. Actions should be taken to promote service accessibility.

To the best of the authors’ knowledge, this paper is the first to compare the demographics, drug use and PBS adoption of DCS users with nonusers who attended the same festival.

Drug checking is a popular method to reduce risks of drug use. In many countries, including Finland, legislation restricts implementing drug checking. The aim of this study was to explore whether some benefits of drug checking could be achieved by substance residue analysis.

Drug paraphernalia (mostly empty plastic bags) were used in the study. Participants left a sample and information about the former content to a local needle exchange point. After laboratory analysis, participants could return for the results and a short consultation on the substance(s) found. Afterward, participants were asked whether they would still use the batch.

Ninety-eight samples were received. In most cases, the samples had originally been sold as amphetamine (n = 39). Overall, laboratory results matched with supposed content in 52 cases, but in 21 cases, the sold content had been altered, in 17 cases, only other psychoactive substances were found and in 8 cases, no traces of psychoactive substances were found. Participants returned for results in two-thirds of the cases. When the laboratory result did not match participants’ expectations, the majority of participants estimated they would not use the same batch (17/25) or would use it in a different way (2/25).

While reports on drug checking are numerous, studies exploring possibilities to achieve harm-reducing benefits of drug checking by analyzing drug residues are scarce. The results of this pilot study suggest some benefits of drug checking can be achieved by substance residue analysis.

Eastern Europe and Central Asia (EECA) is home to 21% of the world’s population of people who inject drugs and it is the region with the fastest-growing HIV epidemic. HIV prevalence among women who inject drugs is significantly higher than among men in EECA. Even in places with high coverage of needle syringe programmes and HIV testing and treatment, women’s access to opioid substitution treatment is lower than men, and women’s sexual and reproductive health needs remain unaddressed. EECA has a unique system of drug registries that store the personal data of people who use drugs. Registration lowers the chances of employment and access to education and for women and increases the risk of losing custody of their children. The system of drug registries contributes to drug-related stigma. Breaches of confidentiality of drug registry data lead to the further marginalisation of women who use drugs. Criminalisation, past experience of police violence and poverty contribute to healthcare access barriers for women. There is a need for legislative changes to improve personal data protection, decriminalise drug use and reduce police violence. The positive effects of these changes would only be seen in the long term. In the interim, women need special access programmes that are designed specifically to address their needs, that provide free-of-charge services and that ensure the safety and confidentiality of personal data.

This case study examines unique overdose risks and prevention strategies for women who have used heroin during pregnancy in New York City. The overdose crisis has resulted in increased efforts to implement drug user health services; yet, pregnant and parenting women who use drugs continue to be left behind. Three women who currently use heroin and had experienced at least one pregnancy during their heroin use history were interviewed using semi-structured qualitative interviews. Their experiences documented in this case study illustrate several gender-specific considerations when responding to the overdose crisis in New York City. Overwhelmingly, barriers to healthcare and overdose prevention were correlated with perceived stigma and the fear of or actual loss of child custody. Compassionate, gender-responsive interventions remain largely absent in policy and practice, especially for pregnant women. The shared experiences highlighted in this case study should be used to develop improved drug user health policies and practices as well as increase overall advocacy efforts for women of reproductive age who use drugs.

Critical drug studies have developed a significant body of work that illuminates understanding of gender and drug use as well as drug pleasures. However, framing the study of women and their drug pleasures through critical drug studies presents potential limitations. The posthuman turn de-emphasises the primary goal of drug use: a particular subjective experience. Both the language and theoretical frameworks of new materialism potentially distance researchers, as interlocutors, from engaging the human experience of drug pleasures, rendering drug use abstract and unknowable.

In a historical context in which women’s intoxication has invoked shaming and criminalisation, control of their bodies, and silencing of dissent, scholarly activism by and inclusion of women who use drugs should be foundational to critical drug studies. Autoethnography offers a modality by which personal narrative becomes a convention of academic writing. It also presents a way of performing the self critically and authentically within conceptual frameworks that explore the complex, intersectional politics of women’s drug use, ways that are representationally missing in the scholarship. An ethics of care as part of one’s practice of the self proposes a radically different way of framing drug use. The recognition and normalisation of drug pleasures as the complicated, emergent, expressions of ethical self-care that they are for women (and all people who use drugs) promises fertile ground for future scholarly exploration. Research based in the lived experience of women who use drugs will help establish languages that resituate drug use in the phenomenology of their experience.

This chapter argues that the Americanisation of online policing has questionable impacts in Australian prosecutions involving drugs obtained and distributed through dark web cryptomarkets. The authors describe several Australian prosecutions of mid- and low-level dealers who have accessed drugs through the dark web and contrast these with the United States (US) case against the cryptomarket, AlphaBay. The discussion in this study emphasises how Australian police and courts view the relative weight of dark web activity associated with the domestic and transnational supply of illicit drugs that result in formal prosecutions. The authors suggest that large-scale forms of online and dark web police surveillance undertaken by US enforcement agencies reflect Ethan Nadelmann’s (Cops across borders: the internationalization of US criminal law enforcement, University Park: Pennsylvania State University Press, 1993) thesis on the Americanisation of global policing through transnational communications networks. The authors then explain how key elements of transnational dark web drug supply appear to have a marginal bearing on criminal investigations into low- and mid-level traffickers in Australia, which rely on conventional surveillance tactics to identify clandestine mail pickups, physical distribution methods, and irregular money trails. However, the authors then illustrate how the Americanisation of online policing that targets high-level entrepreneurs and seeks to dismantle or eliminate dark web cryptomarkets has important implications on Australian reforms aimed at enhancing online surveillance powers to target a range of crimes that are often wrongly associated with illicit drug cryptomarkets. The authors conclude by demonstrating how intensive dark web surveillance has limited direct impact on routine drug policing in Australia, with dark web communications simply another medium for facilitating the physical detection of illicit transnational drug transactions.