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The emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention and intervention. This paper aims to examine sociodemographic correlates as well as health and substance use characteristics of different groups of opioid users.

This paper used the 2015–2019 National Survey on Drug Use and Health to examine distinctions between groups (n = 11,142) of individuals who misuse prescription opioids, use heroin but not fentanyl, misuse pharmaceutical fentanyl but not heroin and use both heroin and fentanyl. Multinomial and logistic regression models were used to identify these distinctions.

Few sociodemographic differences emerged between the prescription opioid group and pharmaceutical fentanyl misuse group. While those who misuse fentanyl have higher odds of using other drugs and experiencing certain mental health problems than those misusing prescription pills, both the heroin and fentanyl–heroin use groups reported considerably poorer health and substance use indicators relative to those who solely misuse fentanyl. It is also notable that both heroin use groups are more highly associated with cocaine and methamphetamine use than those misusing fentanyl alone.

While this study identifies important distinctions between the opioid use groups studied, individuals using both heroin and pharmaceutical fentanyl report the poorest health and substance use characteristics. Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention and clinical work amid shifting patterns of opioid use.

Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention and clinical work amid shifting patterns of opioid use.

This study highlights distinctions between pharmaceutical fentanyl users, heroin users and users of both substances.

Injectable opioid therapy (prescribing heroin for heroin addicts to inject) remains a highly controversial and expensive option. Recent research has shown significant benefits for this therapy in otherwise refractory patients. The aim of this paper is to assess the public opinion regarding heroin prescribing to addicts and to determine what effect the cost of this might have on their opinions.

Participants were asked to complete a questionnaire after reading a vignette which described current opioid maintenance therapy. Two vignettes were generated and the experimental group was randomised to receive the additional information that the cost of heroin prescribing was £15,000 per addict, per year.

Questionnaires were received from 187 subjects (response rate 74 percent). For the control group, 23 percent agreed and 58 percent disagreed with prescribing heroin to addicts (23 vs 62). For the experimental group, where the additional cost of £15,000 per addict was introduced into the vignette, 10 percent agreed and 75 percent disagreed (10 vs 71). The difference was statistically significant (p<0.05; χ²). In total, 58 percent of people were opposed to the idea that heroin should be prescribed to heroin addicts on the National Health Service but this rises to 75 percent when the annual cost of prescribed heroin (£15,000) is included.

This study supports an earlier survey that showed over 80 percent of the general public opposed the prescription of diamorphine to addicts even to reduce crime. Heroin prescribing remains controversial and lacks public support.

For most of those affected, the entrance into the 18‐month to two‐year long nightmare roller coaster ride precipitated by the onset of the diamorphine ‘shortage’ in late December 2004 was sudden. Alarmingly, as one patient's representative put it, most patients only found out that there was a problem on New Year's Eve of 2004 when they walked in to their pharmacists to make their regular collection of diamorphine ampoules only to be told either that there weren't any, or that supplies were becoming extremely scarce and hard to source.

The behaviour of patients of alcohol and other drug treatment services in the communities where the services are based has often been a major problem for the services. This study seeks to investigate the street behaviour of patients enrolled in a Medically Supervised Injectable Maintenance Clinic (MSIMC) implemented as part of the Randomised Injectable Opioid Treatment Trial (RIOTT), into the effectiveness and efficacy of providing injectable opioids versus conventional oral methadone.

Patient behaviour on the streets of Camberwell was recorded via data from records of the fortnightly Camberwell Street Population Forum (CSPF), between 12/11/2004 and 08/09/2006.

In total, 81 individuals were identified as engaging in anti‐social behaviour or being part of the street population, including seven (8.6 per cent) who had also taken part in the RIOTT. There was a clear treatment effect for RIOTT participants.

The use of CSPF records suggests a substantial treatment effect for the individuals who appeared on its register.

The purpose of this paper is to inform readers of developments in drug policy debate in Australia following the publication of the Global Commission Report. To explain the activities, discussions and findings of events organised by the Australian NGO Australia21. To provide some key contextual information and references.

Overview of international situation following publication of Global Commission Report. Summary of current Australian national policy and its origins. Summary of recent national reports and their impact on policy. Account of NGO reports and recommendations.

Civil society agencies have entered national debate on drug policy and recommended an abandonment of prohibition-based approaches, using the Global Commission Report as a catalyst. First steps have been taken to introduce this debate into the Australian parliament.

Incomplete knowledge of relevant national documentation.

Probable delay in government developing debate and acting on recommendations in an election year.

Case study of developments and debate in one jurisdiction resulting from Global Commission Report. Aligns with similar debate and moves in other nations. Adds to knowledge of developments which challenge existing international policy debate and practical approaches which reject prohibition.

The acceleration of Opioid deaths over the last decade has made it a serious national public health crisis. Alabama has not been immune to this epidemic, with dramatically increased age-adjusted drug overdose death rates. These increases have occurred in a state with limited resources for Opioid health prevention, treatment, and recovery services. This chapter introduces the term “o-CHIL” in order to better understand the multi-factorial layers of intertwining health injustices (in the plural) experienced in Alabama’s communities and their embedded public libraries. It highlights the complexities in Opioid consumer health information literacies, the culturally situated dimensions of the Opioid crisis in Alabama, and the uniquely relevant consumer health literacies in its public libraries. Findings are based on an empirical assessment of representative information support services identified in February 2020 on the websites of the 230 public libraries listed as members of the Alabama Public Library Service. The exploratory study applies website content analysis to identify seven examples of information offerings and to class offerings into three categories: (1) information sources (collections, resources); (2) information policy and planning (assigned Opioid-related role, strategic representation); and (3) connections (internal, external, news and events). The discussion potentially provides new directions, approaches, and opportunities to build collaborations of sharing within Alabama’s network of public libraries and beyond for them to better serve their local and regional communities impacted by the Opioid crisis.

With the long awaited ratification of the Lisbon Treaty on 1 December 2009, it appears that plans within Europe to achieve an ‘ever closer union’ are back on track, yet, in the field of illicit drug policy, harmonisation remains as elusive a goal as ever. Sweden and the Netherlands have long provided examples of the different paradigms of drug policy operating within Europe and this article seeks to examine whether, as European Union harmonisation moves forward, recent developments bring the two any closer to convergence on this contentious issue. In addition to changes in Swedish and Dutch drug policy, the progress of the drug policy of other European countries has been evaluated. The article concludes that the Swedes and the Dutch remain ultimately wedded to their national policies and that movement both towards increased repression of drug use and increased liberalisation of drug use can be observed among other European countries. Harmonisation of European drug policy therefore remains in a state of stalemate.

In this chapter, I examine how racial disparities in punishment for nonviolent drug crimes align with significant differences in how the black and white drug problems are constructed in media, law enforcement, and academia.

By examining differences in how the black and white drug problems have been constructed over the past 70 years for the opioids (heroin, prescription painkillers), cocaine (both powder and crack), and marijuana, I illustrate how these distinct representations of the black and white drug problems accompany more punitive policies in response to black drug epidemics even as white drug epidemics are typically met with tolerance or indifference.

Historically, powerful interest groups like media and law enforcement have benefitted from circulating myths and exaggerations about the illegal drug problem that encourage punitive drug policies. By contrast, at least some academics have benefitted from taking the opposite tack and debunking many of these myths. Unfortunately, academics have been less willing to challenge myths about the black drug problem than the white drug problem. Indeed, some academics actually reinforce many of the myths about the black drug problem promoted by media and law enforcement.

This chapter builds upon a substantial academic literature that challenges myths about illegal drug use by whites. However, it goes beyond this literature to consider the paucity of similar academic research exposing media and law enforcement myths about the black drug problem.

The purpose of this paper is to explore prevalence, contexts and motives for the use of various benzodiazepines, sedatives and opioids among injection drug users in Frankfurt’s open drug scene.

The paper uses quantitative data from ten waves of the bi-annual open drug scene survey carried out within the frames of the Frankfurt local drug monitoring system (MoSyD) and an additional sample of qualitative interviews to highlight the individual user perspectives as well as professional insights.

The results suggest that the prescription drugs act as “support drugs” when the drugs of choice are not available or affordable. Patterns of use also show that by acting to manage withdrawal symptoms, insomnia and relieving stress, prescription drugs also contribute to maintaining daily functionality.

The paper contributes to the discussion on the motives and functions of prescription drug use in an urban open drug scene.

Brazil’s street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service availability. Recently, an influx of multi-ethnic migrants within an urban drug scene in Sao Paulo was associated with heroin use, a drug normatively absent from Brazil. The purpose of this paper is to characterize and compare heroin use-related characteristics and outcomes for an attending sub-sample of clients from a large community-based treatment centre (“CRATOD”) serving Sao Paulo’s local urban drug scene.

All non-Brazilian patients (n = 109) receiving services at CRATOD for 2013–2016 were identified from patient files, divided into heroin users (n = 40) and non-heroin users (n = 69). Based on chart reviews, select socio-demographic, drug use and health status (including blood-borne-virus and other infections per rapid test methods) were examined and bi-variately compared. Multi-variate analyses examined factors independently associated with heroin use.

Most participants were male and middle-aged, poly-drug users and socio-economically marginalized. While heroin users primarily originated from Africa, they reported significantly more criminal histories, drug (e.g. injection) and sex-risk behaviors and elevated rates of BBV (e.g. Hepatitis C Virus and HIV). A minority of heroin users attending the clinic was provided methadone treatment, mostly for detoxification.

This study documented information on a distinct sample of mostly migration-based heroin users in Sao Paulo, Brazil. Based on the local experience, global migration dynamics can bring changes to established drug use cultures and services, including new challenges for drug use-related related behaviors and therapeutic interventions that require effective understanding and addressing.