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1 – 10 of 21Esben Houborg and Rasmus Munksgaard Andersen
The purpose of this paper is to map research communities related to heroin-assisted treatment (HAT) and the scientific network they are part of to determine their structure and…
Abstract
Purpose
The purpose of this paper is to map research communities related to heroin-assisted treatment (HAT) and the scientific network they are part of to determine their structure and content.
Design/methodology/approach
Co-authorship as the basis for conducting social network analysis with regard to degree, weighted degree, betweenness centrality, and edge betweenness centrality.
Findings
A number of central researchers were identified on the basis of the number of their collaborative relations. Central actors were also identified on the basis of their position in the research network. In total, 11 research communities were constructed with different scientific content. HAT research communities are closely connected to medical, psychiatric, and epidemiological research and very loosely connected to social research.
Originality/value
The first mapping of the collaborative network HAT researchers using social network methodology.
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Frank Zobel and Larissa J. Maier
The Swiss drug policy once was very progressive in the 1990s when the harm related to drug use was most visible to the public. Failure of repression opened the room for more…
Abstract
The Swiss drug policy once was very progressive in the 1990s when the harm related to drug use was most visible to the public. Failure of repression opened the room for more innovative harm reduction approaches. In 2008, the four-pillar model including the legal basis for substitution and heroin-assisted treatment of opioid use disorders as well as for other harm reduction facilities was approved by the population that had learned about the success of these measures. Less violence, better health outcomes among people who use drugs and less stigma supported the change of attitudes in the population towards a public health-based approach when dealing with drug use. Switzerland first received heavy criticism for the autonomous policy change at the international level while it is nowadays often cited as best practice example for dealing with people with an opioid use disorder. Otherwise, the country has usually been quiet in drug policy discussions at the UN level. Nevertheless, Switzerland’s reappointment to the Commission on Narcotic Drugs, the central drug policy-making body within the United Nations for a period of four years starting in 2018 is promising, given their unblemished recommendation for human rights-based drug policies including the abolition of the death penalty for drug offences, among other things. Alongside cannabis policy changes at the international level, Switzerland witnessed an unexpected development in cannabis availability and sales. However, the country is still rather conservative with regard to current cannabis policies, although cannabis with less than 1% of THC can be sold legally and the possession of up to 10 g will be followed by a fine only, if at all. Switzerland is open to experiment with new regulations but only if the law allows for that. To conclude, the strong sense of connectedness with the international community may support Switzerland’s next steps towards public health and evidence-based harm reduction.
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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…
Abstract
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?
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Bagga Bjerge, Karen Duke and Vibeke Asmussen Frank
The purpose of this paper is to examine the shifting roles of medical professionals as stakeholders in opioid substitution treatment (OST) policies and practices in Denmark and…
Abstract
Purpose
The purpose of this paper is to examine the shifting roles of medical professionals as stakeholders in opioid substitution treatment (OST) policies and practices in Denmark and the UK within the past 15 years.
Design/methodology/approach
The paper is based on literature reviews, documentary analyses and key informant interviews with a range of stakeholders involved in OST and policy in Denmark and UK. The study is part of the EU-funded project: Addictions and Lifestyles in Contemporary Europe: Reframing Addictions Project.
Findings
Denmark and the UK are amongst those few European countries that have long traditions and elaborate systems for providing OST to heroin users. The UK has a history of dominance of medical professionals in drugs treatment, although this has been recently challenged by the recovery movement. In Denmark, a social problem approach has historically dominated the field, but a recent trend towards medicalisation can be traced. As in all kinds of policy changes, multiple factors are at play when shifts occur. We examine how both countries’ developments around drugs treatment policy and practice relate to broader societal, economic and political changes, how such divergent developments emerge and how medical professionals as stakeholders enhanced their roles as experts in the field through a variety of tactics, including the production and use of “evidence”, which became a key tool to promote specific stakeholder’s perspectives in these processes.
Originality/value
The paper contributes to current policy and practice debates by providing comparative analyses of drug policies and examination of stakeholder influences on policy processes.
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Vibeke Asmussen Frank, Bagga Bjerge, Karen Duke, Axel Klein and Blaine Stothard
Vibeke Asmussen Frank, Bagga Bjerge, Karen Duke, Axel Klein and Blaine Stothard
The purpose of this paper is to examine the content of the strategy and assess its claims to be evidence based.
Abstract
Purpose
The purpose of this paper is to examine the content of the strategy and assess its claims to be evidence based.
Design/methodology/approach
This study is a close-reading of the text with commentary on specific content and reference to wider contexts.
Findings
The strategy makes use of evidence in its sections on treatment. Much evidence, including that of the UK ACMD, is dismissed or ignored. The issue of funding in times of austerity is not considered in the strategy. The range and complexity of drug use and users are not fully considered.
Research limitations/implications
The strategy can be seen as an idealised ambition with little basis in reality without funding to support its aims.
Social implications
There is no consideration of the impact of macro-economic policy on the extent of drug misuse.
Originality/value
Other commentaries on the strategy are emerging. This paper is a more extensive consideration than has so far appeared.
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This extended review of Stimson and Oppenheimer’s classic book Heroin Addiction aims to highlight its contribution to the literature and consider its contemporary relevance for…
Abstract
Purpose
This extended review of Stimson and Oppenheimer’s classic book Heroin Addiction aims to highlight its contribution to the literature and consider its contemporary relevance for research, policy and practice.
Design/methodology/approach
The review examines the core themes of the longitudinal study that the book presents by bringing it in to dialogue with a recent “living history” project on John Marks’ radical heroin prescribing in the 1980s and 1990s.
Findings
The three core themes explored are treatment as containment; the balance between therapy and social control; and the benefits of heroin versus methadone.
Originality/value
The book is a “timeless classic” that still resonates with contemporary concerns and has much to tell us about heroin addiction and its treatment.
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