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Article
Publication date: 23 May 2023

Paige Sable, Fengyan Tang, Jenifer A. Swab, Sheila Roth and Daniel Rosen

This study focuses on Emergency Medical Service (EMS) personnel and examines the impact of overdose calls for opioids and attitudes of EMS workers towards individuals with…

Abstract

Purpose

This study focuses on Emergency Medical Service (EMS) personnel and examines the impact of overdose calls for opioids and attitudes of EMS workers towards individuals with substance use disorders on EMS workers' mental well-being while accounting for self-reported sleep and social support.

Design/methodology/approach

This cross-sectional study surveyed EMS workers (N = 608) across Pennsylvania on demographic variables, frequency of overdose calls, attitudes towards opioid use and naloxone administration on measures of mental health. Multiple logistic regression models were estimated to examine the relationship of perception of opioid use and treatment and likelihood that EMS workers might experience depression.

Findings

Authors found two main findings: (1) There was a significant relationship between more negative perceptions about opioid use/naloxone and the likelihood that EMS workers might experience depression. (2) There was a significant relationship between number of overdose calls EMS workers responded to and likelihood of depression, which appeared to be alleviated by improvements in sleep and social support.

Research limitations/implications

There is potential opportunity for EMS employers to minimize the impact of the opioid epidemic on EMS worker mental health. Trainings to highlight effectiveness of treatment should be further explored, along with ways to enhance social support and improve sleep for EMS workers to protect against the stress associated with responding to this public health crisis.

Originality/value

This study adds to the literature on the impact of the opioid epidemic as it relates to mental health outcomes for EMS professionals providing frontline care to those experiencing opioid use disorders.

Details

International Journal of Emergency Services, vol. 12 no. 3
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 13 March 2017

Lauren Brinkley-Rubinstein, David H. Cloud, Chelsea Davis, Nickolas Zaller, Ayesha Delany-Brumsey, Leah Pope, Sarah Martino, Benjamin Bouvier and Josiah Rich

The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable…

Abstract

Purpose

The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable population.

Design/methodology/approach

Strategies are needed to reduce overdose deaths among those with recent incarceration. Jails and prisons are at the epicenter of the opioid epidemic but are a largely untapped setting for implementing overdose education, risk assessment, medication assisted treatment, and naloxone distribution programs. Federal, state, and local plans commonly lack corrections as an ingredient in combating overdose. Harm reduction strategies are vital for reducing the risk of overdose in the post-release community.

Findings

Therefore, the authors recommend that the following be implemented in correctional settings: expansion of overdose education and naloxone programs; establishment of comprehensive medication assisted treatment programs as standard of care; development of corrections-specific overdose risk assessment tools; and increased collaboration between corrections entities and community-based organizations.

Originality/value

In this policy brief the authors provide recommendations for implementing harm reduction approaches in criminal justice settings. Adoption of these strategies could reduce the number of overdoses among those with recent criminal justice involvement.

Details

International Journal of Prisoner Health, vol. 13 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 22 February 2021

Lois Dugmore and Saskia Bauweraerts

This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and…

Abstract

Purpose

This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings.

Design/methodology/approach

In clinical practice, shared treatment has proved challenging in light of different service models (Laker, 2006). Substance misuse works on the premise of change comes from the individual, where recovery models in mental health offer a formalised approach. One of the challenges faced by services has been the inability for mental health services to recruit and services become overstretched (Rimmer, 2018); this gave an opportunity for a new method of working to be considered. This led to the development of a new service model.

These changes were:

• Improving the interface with substance misuse services to improve access to community substance misuse services for mental health clients.

• To provide specialist staff within the dual diagnosis field to provide a clinic jointly with local drug and alcohol services.

• Introduction of substance misuse workers as team members on acute mental health and rehab wards.

• Group Substance Misuse programmes.

Findings

Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group.The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge.For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances.

Originality/value

Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups.

Details

Drugs and Alcohol Today, vol. 21 no. 2
Type: Research Article
ISSN: 1745-9265

Keywords

Open Access
Book part
Publication date: 19 November 2020

Bethany Medley

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…

Abstract

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.

Details

The Impact of Global Drug Policy on Women: Shifting the Needle
Type: Book
ISBN: 978-1-83982-885-0

Open Access
Book part
Publication date: 16 August 2023

Angus Bancroft

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…

Abstract

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.

Details

Digital Transformations of Illicit Drug Markets: Reconfiguration and Continuity
Type: Book
ISBN: 978-1-80043-866-8

Keywords

Article
Publication date: 18 January 2023

Iain McPhee and Barry Sheridan

This study focuses on emergency and strategic responses to drug-related deaths. This paper uses policy network theory and policy analysis frameworks to subject programme…

Abstract

Purpose

This study focuses on emergency and strategic responses to drug-related deaths. This paper uses policy network theory and policy analysis frameworks to subject programme development and financial decision-making processes to critical scrutiny.

Design/methodology/approach

A qualitative, case-based design focuses on Scottish Government responses to rising drug-related deaths, using publicly available data to produce interpretive critical analysis.

Findings

Analysis indicates that established drug policy communities influence emergency and strategic policy and programme development in relation to drug deaths. Results reveal that policy communities aid government to develop placebo policies and avoid policy traps associated with social determinants of drug-related deaths. This study documents a lack of transparency and accountability in financial decision-making by a third party operating on behalf of Scottish Government. To improve accountability necessitates that drug policy decisions acknowledge existing legislative duties to address socio-economic inequality in this policy area.

Research limitations/implications

In seeking convergence and corroboration publicly available data sources were identified that focus on emergency and strategic responses to drug-related deaths in Scotland. The authors recognise the potential for bias in qualitative and interpretive analysis of this data (Bowen, 2009).

Practical implications

This study provides robust critical analysis on how policy networks exert influence on spending decisions related to drug policy in Scotland. This is useful for researchers and drug policy advisors.

Originality/value

While much has been written on drug deaths in Scotland, using policy network and policy success frameworks to examine policy and programme development, provides originality of analysis in this under-researched aspect of drug policy.

Article
Publication date: 28 December 2018

Sonia Bergamo, Giuseppe Parisi and Paolo Jarre

Efforts to establish harm reduction interventions in Italy have persisted since the mid-1990s. Despite this, no sanctioned SIF has ever been implemented. The purpose of this paper…

Abstract

Purpose

Efforts to establish harm reduction interventions in Italy have persisted since the mid-1990s. Despite this, no sanctioned SIF has ever been implemented. The purpose of this paper is to provide information about a 10 year unsanctioned drug user-run SIF experience in Italy called Stanzetta.

Design/methodology/approach

The aim of the paper is to assess how Stanzetta met its objectives. Analysis was conducted compiling narrative accounts from the staff working in the NSP, which is adjacent to the Stanzetta, and conducting a simple frequency analysis of the available statistical data.

Findings

The Stanzetta unsanctioned SIF has been running for ten years and continues to be vulnerable due to its legal status. Being open 24 h/days has maximised its accessibility, but at the same time, it has encouraged a misuse of the Stanzetta. Although not trained, drug users became self-empowered to run the Stanzetta and to keep it clean, but the hygiene-health aspect is seen as one of the greatest challenges by the NSP professional staff. Over 10 years, not a single overdose death has been recorded. Drug use in the park has shifted from more visible places to the Stanzetta. As a result, the abandoned syringes have diminished in number and those disposed of correctly have increased. Moreover, no complaints from citizens or law enforcement were ever made. The neighbourhood acceptance seems to be the main goal of the peer-run unsanctioned SIF.

Research limitations/implications

The paper is based on a narrative account from the point of view of the professional staff involved, and results are specific to the context in which the study was conducted. Because of the chosen approach, the research results lack scientific generalisability. A relevant limitation is that no peer was involved in this study. Despite this, the research contributes to the information based on peer-run SIFs and makes a case for the de-medicalisation of SIFs in Europe.

Practical implications

This paper gives visibility to a long-lasting drug user-run SIF experience that was not made public mostly for an unclear legislative background about SIF in Italy.

Social implications

Efforts to establish harm reduction interventions in Italy have persisted since the mid-1990s and were undertaken primarily in response to epidemics of HIV infection and overdose (DPA, 2017). Despite this, no sanctioned SIF has ever been implemented. Primarily, this study wants to underline the urgency for an SIF pilot in Italy, and secondly the need to consider de-medicalising these services through direct support for peer-based models.

Originality/value

The Stanzetta unsanctioned SIF in Italy that has been running for ten years. Despite this, the venue continues to be vulnerable due to its legal status. For this reason, these results were never made public before. The experience showed a good working synergy between NSP professionals and the SIF peers. This model can be considered as a “light” de-medicalisation form to be explored and eventually to be implemented as a pilot SIF in Italy.

Details

Drugs and Alcohol Today, vol. 19 no. 2
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 17 December 2018

Iain McPhee, Barry Sheridan and Steve O’Rawe

The purpose of this paper is to examine the reasons and risk factors that explain the threefold increase in drug-related deaths from 267 in 1996 to 934 in 2017 in Scotland. The…

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Abstract

Purpose

The purpose of this paper is to examine the reasons and risk factors that explain the threefold increase in drug-related deaths from 267 in 1996 to 934 in 2017 in Scotland. The authors explore the known links between deprivation and problem drug use (PDU) and discuss the impact of drug policy and service provision on PDU and drug-related deaths.

Design/methodology/approach

Using quantitative data sets from the National Records of Scotland (NRS) for drug-related deaths registered in 2017 and data sets from the Scottish Index of Multiple Deprivation (SIMD), we produce statistical data on mortality rates relating to areas of deprivation, gender and age.

Findings

The data highlight the disproportionate number of deaths in the most deprived areas in comparison to the least deprived areas and the national average. Findings indicate that one quarter of male and female DRD in 2017 were under 35. When examining the least deprived vingtile, drug-related deaths account for 2.84 per 100,000 population. Based on this mortality rate calculation, the amount of drug-related deaths are 23 times higher in the most deprived area than the least deprived area.

Research limitations/implications

The research design uses data obtained from the NRS and data from Scottish Multiple Index of Deprivation. Due to the limitations of available data, the research design focused on SIMD population vingtiles.

Practical implications

This research contributes to making unarguable links between entrenched structural inequality and increased drug-related death.

Social implications

This paper contributes to knowledge on the need for drug policy advisors to recognise the importance of deprivation that plays a major part in risks of problematic drug use and harms.

Originality/value

While several national data sets have published information by SIMD vingtile, no published research has sought to investigate the disproportionate number of deaths by population in the most deprived areas.

Details

Drugs and Alcohol Today, vol. 19 no. 2
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 2 March 2015

Mikael Johansson, Jørgen Kjær and Blaine Stothard

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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

Social implications

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.

Originality/value

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.

Details

Drugs and Alcohol Today, vol. 15 no. 1
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 12 October 2021

Marina Johnson, Abdullah Albizri, Antoine Harfouche and Salih Tutun

The global health crisis represents an unprecedented opportunity for the development of artificial intelligence (AI) solutions. This paper aims to integrate explainable AI into…

Abstract

Purpose

The global health crisis represents an unprecedented opportunity for the development of artificial intelligence (AI) solutions. This paper aims to integrate explainable AI into the decision-making process in emergency scenarios to help mitigate the high levels of complexity and uncertainty associated with these situations. An AI solution is designed to extract insights into opioid overdose (OD) that can help government agencies to improve their medical emergency response and reduce opioid-related deaths.

Design/methodology/approach

This paper employs the design science research paradigm as an overarching framework. Open-access digital data and AI, two essential components within the digital transformation domain, are used to accurately predict OD survival rates.

Findings

The proposed AI solution has two primary implications for the advancement of informed emergency management. Results show that it can help not only local agencies plan their resources for timely response to OD incidents, thus improving survival rates, but also governments to identify geographical areas with lower survival rates and their primary contributing factor; hence, they can plan and allocate long-term resources to increase survival rates and help in developing effective emergency-related policies.

Originality/value

This paper illustrates that digital transformation, particularly open-access digital data and AI, can improve the emergency management framework (EMF). It also demonstrates that the AI models developed in this study can identify opioid OD trends and determine the significant factors improving survival rates.

Details

Industrial Management & Data Systems, vol. 123 no. 1
Type: Research Article
ISSN: 0263-5577

Keywords

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