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Injecting drug use (IDU) has traditionally been seen as a law enforcement problem and a stain on society. With the emergence of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), however, the discourse on IDU has widened to include crucial public health and human rights concerns. Economic analysis, too, has much to contribute to the policy debate. By examining the costs and benefits of drug use from the perspective of injecting drug users, economic analysis can shed light on the problem of IDU and the transmission of HIV among users. This chapter also presents new results on the economic analysis of needle exchange programmes.

Drawing on research conducted by Perpetuity, a research and consultancy service specialising in crime and community safety, this article provides an overview of the housing needs of drug and alcohol users. The article is based largely on feedback from consultation with service users, and outlines some of the barriers they face when accessing supported housing and mainstream housing; and some of the potential difficulties they can experience when trying to maintain a tenancy. It summarises the importance of partnership working when addressing housing needs among this vulnerable client group. It is essential that these matters are taken seriously and addressed accordingly.

In Britain, the last two decades have seen a considerable increase in focus on service users' involvement in the provision of services that directly affect them, particularly where service users originate from a hard to reach population such as drug users. While the National Treatment Agency and drug and alcohol action teams often extol the virtues of the involvement of drug users in their service provision, participation of this type does not come without problems of its own. Experience of drug user involvement in service provision is much more established in Europe and this article seeks to utilise European examples in illustrating the potential pitfalls of such a strategy. Case studies are examined from three countries: the Netherlands, where drug policy is relatively liberal and drug user groups have been established since the 1970s; Denmark, where drug policy is fairly well balanced between repression and tolerance and drug user groups have been established since the 1990s; and Sweden, where drug policy is relatively repressive and drug user groups are only just emerging. Salient points from these case studies are then used to form the discussion, relating European experiences to the situation in Britain.

Following the example of many northern European countries, harm reduction strategies were introduced in Italy at the beginning of the 90s in response to the spread of HIV/Aids. The peculiarities of Italian culture and tradition led to the adoption of a ‘Latin’ model, while in northern countries the culture of pragmatism and evidence‐based practices, together with a long tradition of public health policy were determinant in promoting harm reduction. In Italy, the ‘social perspective’ on the drug problem adopted by a large part of professionals working in public services and by most non‐governmental organisations (NGOs), has prompted a synergy between ‘cure’ and ‘care’ (ie. treatment and harm reduction), leading to the ‘integration’ of harm reduction and the traditional drug‐free work on addiction. As a result, since the mid 90s, public services and therapeutic communities have been cooperating to build a complex system of low to high threshold facilities. Until the 90s, most NGOs only ran drug‐free programmes in therapeutic communities, but from then onwards many began running harm reduction programmes as well, especially street units and needle exchange programmes, secondary prevention units at rave parties, drop‐in centres, and low‐threshold detoxification centres. Similarly, there has been an increase in methadone maintenance in public services, after the ‘retention in treatment’ of clients was established as the primary objective in the effort to protect users from drug related death and HIV infection. Though harm reduction interventions are far from being fully implemented, data shows that in the past 15 years the harm reduction/treatment system has reduced health risks for drug users and has been instrumental in referring a remarkable number of injecting drug users into treatment programmes. In the mean time, drugs of choice, patterns of use and ways of drug consumption have substantially changed. Now the question is, will the Italian approach be able to address these new challenges?

To expand understandings of conflict, this chapter offers a detailed assessment of how exchange is enacted within local heroin markets. Addressing drug dealing and heroin users’ buying drugs for their peers (i.e., brokering), this research expands how illegal drug markets are commonly understood. A generalized framework is presented that highlights patterns of exchange.

Findings come from a 36-month study of a demographically diverse sample of 38 heroin users in Cleveland, OH. Methods involved open-ended, semi-structured interviewing and participant observation, conducted by the author and a team of graduate students.

Instead of framing exchange as either an economic or social act, this chapter shows how trade in heroin markets is often both. Here Gudeman’s (2001) dialectic between market and community is embodied in inter-subjectivities of traders, promoting both trust and conflict. In this context, conflict is the result of perpetual ambiguity all market participants can experience.

Applying a blended notion of exchange as both social and economic offers new insight on conflict and expands its orientation beyond narratives of political economy. Here, in addition to the economics that often promote conflict, the social elements of exchange (e.g., reciprocity) are emphasized.

Research has understood conflicts in drug market operations through trader characteristics (e.g., poverty, race, class, privilege). This chapter emphasizes opportunities for conflict irrespective of individualized characteristics by outlining structural elements of exchange.

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.

In this chapter, the author examines the way in which the purchase and delivery infrastructure of darknet cryptomarkets shapes the experience of opiate drug use and dependence. It uses the concept of social time and posits that the illicit drug distribution system reshapes two temporal dimensions shaping the experience of drug users. There is the experience of time located in the pharmacology of the drug and in the body of the drug user, which evokes experiences of withdrawal and dependence. Then there is the socio-technical embedding of the delivery system and governance structures which support or impinge on the autonomy of the user. This ‘drug time’ is both a benefit and a cost of engaging in cryptomarket use. The market infrastructure can give users the opportunities to more carefully manage their drug time, while also creating new risks of non-delivery that can sharpen experiences of dope sickness. The author concludes that the growing professionalisation, digitisation, and commercialisation of the drug market increasingly embed drug time in material infrastructures mediated through technical systems.

Objective. The objective of this study was to examine practices and policies in place for the provision of targeted prevention and treatment of cocaine and Amphetamine Type Stimulant (ATS) users in prison in nine European countries. Methodology. Across nine European member states (Belgium, the Netherlands, Czech Republic, Lithuania, Slovenia, Sweden, Malta, Ireland and Portugal), interviews were conducted with ministerial representatives and professionals (i.e. service providers and security officials) working in prisons and a total of 16 focus groups with a total of 125 prisoners. Results. The use of stimulants in prison is associated with aggression and violence, financial problems, and psychological and physical problems in prisoners (depression, anxiety and psychological craving). Both security and healthcare staff in prison often feel ill‐equipped to deal with stimulant‐related problems, leading to a lack of equivalence of care for stimulant users in prison, therefore the variety and quality of drug services outside is not reflected sufficiently inside prison. There is a need for more specific product information and harm reduction material on stimulants, for clear guidelines for the management of acute stimulant intoxication and stimulant withdrawal, for structural adjustments to improve potential diagnosis of personality and psychiatric disorders, for more non‐pharmacological treatment strategies and more opportunities for prisoners to engage in purposeful activities.

The purpose of this paper is to explore the hidden social worlds of competent clandestine users of drugs controlled within the confines of the UK Misuse of Drugs Act 1971, which now includes NPS substances. The authors explore how and in what way socially competent drug users differ from others who are visible to the authorities as criminals by criminal justice bureaucracies and known to treatment agencies as defined problem drug users.

This qualitative research utilises a bricoleur ethnographic methodology considered as a critical, multi-perspectival, multi-theoretical and multi-methodological approach to inquiry.

This paper challenges addiction discourses and, drawing upon empirical evidence, argues the user of controlled drugs should not be homogenised. Using several key strategies of identity management, drug takers employ a range of risk awareness and risk neutralisation techniques to protect self-esteem, avoid social affronts and in maintaining untainted identities. The authors present illicit drug use as one activity amongst other social activities that (some) people, conventionally, pursue. The findings from this study suggest that punitive drug policy, which links drug use with addiction, crime and antisocial behaviour, is inconsistent with the experience of the participants.

Due to the small sample size (n=24) employed, the possibility that findings can be generalised is rendered difficult. However, generalisation was never an objective of the research; the experiences of this hidden population are deeply subjective and generalising findings and applying them to other populations would be an unproductive endeavour. While the research attempted to recruit an equal number of males and females to this research, gendered analysis was not a primary objective of this research. However, it is acknowledged that future research would greatly benefit from such a gendered focus.

The insights from the study may be useful in helping to inform future policy discourse on issues of drug use. In particular, the insights suggest that a more nuanced perspective should be adopted. This perspective should recognise the non-deviant identities of many drug users in the contemporary era, and challenge the use of a universally stigmatising discourse and dominance of prohibition narratives.

It is envisaged that this paper will contribute to knowledge on how socially competent users of controlled drugs identify and manage the risks of moral, medical and legal censure.

The evidence in this paper indicates that drug use is an activity often associated with non-deviant, productive members of the population. However, the continuing dominance of stigmatising policy discourses often leads to drug users engaging in identity concealment within the context of a deeply capitalist Western landscape.

The purpose of this paper is to first, inform readers of the roles, activities and contexts of drug users unions in Denmark and Sweden. Second, to show the achievements and impacts of the two. Third, to illustrate the differing social and political situations in the two countries and how they determine the priorities and activity of the unions.

The paper is written by a UK commentator who bases the text on meetings, interviews and conversations with members and representatives of the two unions. Spokespersons for both unions have contributed to, commented on and clarified draft texts and provided contextual papers and information.

The two unions have differing roles and levels of acceptance and influence according to the political and legal situations in the two countries. There are differing situations and needs in Denmark and Sweden, reflected in the levels of drug-related deaths. There is no “Scandinavian” model. In Denmark the users union is involved in high-level discussions on policy making and practice. In Sweden the new unions are starting to be involved in local discussions about provision and practice.

Danish experience shows how political acceptance of the existence of a drug using population is leading to improved health and well-being amongst that population, and to social policy responses which are inclusive of this and other marginalised groups, and to a reduction of stigma and demonisation. Swedish experience differs and can be seen as essentially prohibitionist and punitive. Many Swedish drug users are moving to Denmark because of the levels of service and social attitudes. It may be of interest to UK policy to adopt a similar approach to drug users organisations – as distinct from service users’ voices.

Strengthening the role of drug users unions in all countries and including them in national policy making discussion and debate.

Accepting the existence and needs of drug using groups in society and developing responses informed by their views and experience. Adopting inclusive social policies and recognising the variety of need and choices in treatment. Combatting stigma and demonisation.

The paper is based on extensive interviews and conversations whose results and content are recorded, not interpreted. The Danish work was conducted in Danish, adding to the number of voices and conversations it was possible to include. A distinction between policy and practice in Denmark and Sweden is established which may run counter to UK impressions of “Scandinavian” rather than national realities.