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This study aims to examine the relationship between medication for opioid use disorder (MOUD) among pregnant individuals, referral source, mental health, political affiliation and substance use policies in all 50 states in the USA.

This study describes MOUD receipt among pregnant people with an opioid use disorder (OUD) in 2018. The authors explored sociodemographic differences in MOUD receipt, referrals and co-occurring mental health disorders. The authors included a comparison of MOUD receipt among states that have varying substance use policies and examined the impact of these policies and the political affiliation on MOUD. The authors used multilevel binary logistic regression to examine effects of individual and state-level characteristics on MOUD.

Among 8,790 pregnant admissions with OUD, the majority who received MOUD occurred in the Northeast region (71.52%), and 14.99% were referred by the criminal justice system (n = 1,318). Of those who were self-referred, 66.39% received MOUD, while only 30.8% of referrals from the criminal justice system received MOUD. Those referred from the criminal justice system or who had a co-occurring mental health disorder were least likely to receive MOUD. The multilevel model showed that while policies were not a significant predictor, a state’s political affiliation was a significant predictor of MOUD.

The study has some methodological limitations; a state-level analysis, even when considering the individual factors, may not provide sufficient description of community-level or other social factors that may influence MOUD receipt. This study adds to the growing literature on the ineffectiveness of prenatal substance use policies designed specifically to increase the use of MOUD. If such policies are consistently assessed as not contributing to substantial increase in MOUD among pregnant women over time, it is imperative to investigate potential mechanisms in these policies that may not facilitate MOUD access the way they are intended to.

Findings from this study aid in understanding the impact that a political affiliation may have on treatment access; states that leaned more Democratic were more likely to have higher rates of MOUD, and this finding can lead to research that focuses on how and why this contributes to greater treatment utilization. This study provides estimates of underutilization at a state level and the mechanisms that act as barriers, which is a stronger assessment of how state-specific policies and practices are performing in addressing prenatal substance use and a necessary step in implementing changes that can improve the links between pregnant women and MOUD.

To the best of the authors’ knowledge, this is the first study to explore individual-level factors that include mental health and referral sources to treatment that lead to MOUD use in the context of state-level policy and political environments. Most studies estimate national-level rates of treatment use only, which can be useful, but what is necessary is to understand what mechanisms are at work that vary by state. This study also found that while substance use policies were designed to increase MOUD for pregnant women, this was not as prominent a predictor as other factors, like mental health, being referred from the criminal justice system, and living in a state with more Democratic-leaning affiliations.

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

In 2017, the opioid epidemic was declared a public health emergency in the United States. The federal and state governments are still struggling to contain the crisis through various legislations and to stem the tide of overdoses and deaths. This paper looks specifically at the issue of high prescriptions of opioids disbursed to patients by physicians.

This paper evaluates this evolving policy issue through a critical review and synthesis of academic literature, government policy documents (at states and national levels) and articles in the popular press.

Over-prescription is a legal problem because it inevitably leads to diversion of these substances for non-medical usage. The Prescription Drug Monitoring Program (PDMP) laws have been passed by all 50 states and the main policy responses are covered. However, there are hindrances to their effectiveness, which have to be addressed. Two state level policy alternatives are discussed as potential solutions — PDMP mandates and Pain Management Clinic Laws (PMCLs). After a comparative evaluation, it is recommended that all states should pass the mandatory PDMP review and usage laws urgently.

This is the first detailed policy evaluation on the specific and time-sensitive aspect of physician over-prescribing, within the larger opioid abuse problem. Moreover, critique on the public health leadership issue is raised.

People who use drugs (PWUD) have been disproportionately affected by the COVID-19 pandemic. This study aims to examine changes in illicit opioid use and related factors among incarcerated PWUD in Quebec, Canada, during the pandemic.

The authors conducted an observational, cross-sectional study in three Quebec provincial prisons. Participants completed self-administered questionnaires. The primary outcome, “changes in illicit opioid consumption,” was measured using the question “Has your consumption of opioid drugs that were not prescribed to you by a medical professional changed since March 2020?” The association of independent variables and recent changes (past six months) in opioid consumption were examined using mixed-effects Poisson regression models with robust standard errors. Crude and adjusted risk ratios with 95% confidence intervals (95% CIs) were calculated.

A total of 123 participants (median age 37, 76% White) were included from January 19 to September 15, 2021. The majority (72; 59%) reported decreased illicit opioid consumption since March 2020. Individuals over 40 were 11% less likely (95% CI 14–8 vs 18–39) to report a decrease, while those living with others and with a history of opioid overdose were 30% (95% CI 9–55 vs living alone) and 9% (95% CI 0–18 vs not) more likely to report decreased illicit opioid consumption since March 2020, respectively.

The authors identified possible factors associated with changes in illicit opioid consumption among incarcerated PWUD in Quebec. Irrespective of opioid consumption patterns, increased access to opioid agonist therapy and enhanced discharge planning for incarcerated PWUD are recommended to mitigate the harms from opioids and other drugs.

This chapter discusses how ‘hidden’ populations of women who use drugs (WWUD) in coastal Kenya became ‘visible’ through accessing health, harm reduction and rights services. This effort was facilitated by the Muslim Education and Welfare Association (MEWA) and their work with community leaders. Mapping undertaken by MEWA outreach workers identified women who use opioids and other substances in isolated drug use settings. MEWA introduced daily meals in identified sites, needle and syringe services and residential rehabilitation services for opioid withdrawal. The introduction of residential adherence services for HIV and tuberculosis and the provision of methadone enabled compliance with the 90-90-90 UN HIV cascade. These services achieved sustained HIV viral load suppression at 83% and a 100% cure rate for tuberculosis among WWUD. In addition, disclosure and partner risk tracing was established in the ‘drug dens’ for women who test positive for STIs. The introduction of women-only hours once per week at the drop-in centre contributed to a better understanding of drug dependency among outreach workers and clinicians. Policies on gender-based violence were also refined, leading to an increase in reported cases. Programmes targeting families were introduced to promote effective communication and improve parenting skills. Access barriers to social security programmes were tackled by a network of paralegal officers in partnership with Kenyan authorities. Finally, entrepreneurship training and mentorship programmes were implemented to build resilience among WWUD.

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 chapter explores the norms and assumptions that frame and sustain international drug policy and the international drug control regime. Drug policy is conceptualised as a ‘policy fiasco’ that persists despite extensive evidence of goal failure. The absence of effective monitoring and evaluation, impact assessment, stakeholder participation and mainstreaming of rights-based approaches, conflict sensitivity and gender sensitivity is emphasised, substantiating the argument that drug policy is a case study of ‘institutional path dependence’. Drug policy has repeatedly missed targets for achievement of a ‘drug free world’. This is explained through reference to the counterproductive and ‘unintended consequences’ of a drug policy approach of criminalisation. The impacts of drug policy enforcement are shown to be negative, pernicious and disproportionately born by the poor, by vulnerable communities and those subject to discrimination on account of race, gender and class.

The opioid epidemic in the USA, the new psychoactive substances emerging on the market and the recent increase in cocaine treatment demands in Western Europe, all emphasise the importance of monitoring the use and harms of drugs over time. To be informed about new consumption patterns, this study aims to study the trends among people entering treatment for substance use in Belgium.

Belgian data from the Treatment Demand Indicator collected between 2015 and 2019 were used. A reference group of treatment units was selected to allow for comparisons between the different years. Trend analysis was performed by using a joinpoint regression among different regions and groups of clients.

The drugs of choice that were most frequently mentioned among the 23,000 analysed treatment episodes were alcohol and cannabis. Both remained relatively stable over time. Heroin seemed to be decreasing significantly at the national level, but increased in Brussels. Benzodiazepines decreased significantly in Flanders and Brussels, but not in Wallonia. On the other hand, reports of crack cocaine increased significantly in the three regions with a more pronounced trend in Wallonia and Brussels. Substances such as fentanyl, methamphetamine, ketamine or volatile inhalants have been mentioned significantly more by people entering treatment in 2019, although their contribution to the total number is still limited.

To the best of the authors’ knowledge, this study is the first to evaluate trends for all drugs of choice at a national and regional level. These results might not only benefit national policymakers but also other countries with similar alcohol or drug use patterns.