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Housing First (HF) is an evidence-based practice effective in reducing homelessness among those who experience chronic homelessness. However, a strong synthesis evaluating the effectiveness of this intervention is lacking for people who use drugs. The purpose of this study is to explore international literature databases to identify the effectiveness of the HF programme among people who use drugs.

A modified framework from Arksey and O’Malley (2005) was used, namely: identifying the research question; developing inclusion and exclusion criteria; identifying relevant studies for study selection; charting the data; and collating, summarising and reporting the results.

Three main themes were identified: substance use related outcomes, housing-related outcomes and social outcomes. There is strong evidence that HF increases housing retention and reduces homelessness among chronically homeless people who use drugs. However, literature relating to substance use and social outcomes for this population report mixed and inconclusive findings.

This scoping review concludes that additional research is required to conclusively determine whether HF is an effective intervention for homeless substance users. Future researchers must use formal assessments of substance use and ensure clear reporting of the HF intervention is accomplished. It is recommended for researchers and policymakers to consider the specific needs of the people who use drugs before implementation of HF for this population.

Differential effectiveness of HF through diagnostic subgroups such as alcohol use and drug use is varied with alcohol use being found to decrease due to the HF programme, but findings relating to other drug use outcomes are varied. As most previous studies used the Addiction Severity Index (ASI) to measure substance use among participants, however, the ASI, a self-reporting measure has unstable criterion validity and can cause under or over reporting of substance use. Structured toxicology or diagnostic assessments of substance use must be used for research instead to assist researchers in making firm conclusions about the reported rates.

The slightly poorer housing outcomes among people who use substances indicate that this group may need more intensive approaches to finding and maintaining housing. Additional services for the group that address comorbid problems and consequences relating to substance use are required. It is suggested that housing should be provided within an integrated model that offers additional support services such as case management as when well matched to clients, case management appears to be an effective intervention among homeless sub-populations, as it reduces substance use, improves quality of life and health outcomes, improves social connectedness and increases housing tenure and satisfaction.

This scoping review concludes that additional research is required to conclusively determine whether HF is an effective intervention for homeless substance users. Future researchers must use formal assessments of substance use and ensure clear reporting of the HF intervention is accomplished. It is recommended for researchers and policymakers to consider the specific needs of the people who use drugs before HF implementation for this population.

Psychedelic drugs can induce altered states of consciousness characterised by changes in visual perception, tactile sensation, cognition, and emotion. Although there is a history of misinformation surrounding these drugs, recent investigation has reinvigorated interest. However, little research has assessed the attitudes of psychedelic consumers regarding these substances. The current study aims to explore the attitudes and perceptions of people with experience with psychedelic drugs, specifically surrounding psychedelic drugs themselves and their use within Aotearoa New Zealand.

Nineteen individuals with experience of psychedelic use were recruited to participate across eight groups in semi-structured, exploratory interviews, where a range of topics associated with psychedelics were discussed. Reflexive thematic analysis of the data focussed on participants’ current perceptions and attitudes.

Four themes were produced: (1) a negative historical influence on current perceptions of psychedelics; (2) knowledge is key but not everyone has it; (3) prohibition is not working, policy needs to change; (4) psychedelics have therapeutic potential. These themes emphasise key features of people with experience of psychedelic drugs’ current views and highlight potential areas for future investigation and intervention.

Findings indicate a need for greater public knowledge and awareness of psychedelics in Aotearoa society. Findings also inform information, education and policy, which in turn will reduce the stigma and associated harm that those who have used or use psychedelic drugs may experience.

To the best of the authors’ knowledge, qualitative research aiming to understand attitudes and perspectives surrounding psychedelic drugs and their use from a drug users’ perspective have not yet been assessed.

In recent years there have been increasing calls for the use of anabolic androgenic steroids (AAS) and associated drugs to be recognized as a public health issue. In the domain of the competitive athlete and professional bodybuilder, recent decades have seen the diffusion of AAS from the hardcore gyms of the 1980s and 1990s to the mainstream exercise and fitness environments of the twenty-first century. Alongside the apparent increases in the use of these drugs, there is a growing evidence base in relation to harms – physical, psychological and (to some extent) social. But is this form of drug use a public health issue? What criteria should we use to make this judgement? What is the available evidence and has our understanding of the issue improved? By drawing on the authors' research in the United Kingdom and the wider international literature this chapter will explore these issues and attempt to answer the fundamental question – is the use of anabolic steroids a public health issue?

Previous research has found that people who use anabolic androgenic steroids (hereafter ‘steroids’) typically describe these drugs as safe. However, research exploring the inside perspective on steroid risk has focussed on steroids in general, and failed to examine how particular steroids are viewed and experienced. During my online ethnographic research in bodybuilding communities, I found discussion of one particular steroid said to cause significant physical, psychological, social and sexual harm: trenbolone. Trenbolone is a veterinary drug used to increase muscle in beef cattle that has been found to have neurodegenerative and genotoxic effects on animals. It has been used by bodybuilders since the 1980s, and recent research has found it to be one of the most popular steroids used by bodybuilders. If trenbolone is described by bodybuilders as causing significant harm, why do so many bodybuilders use it? This chapter attempts to answer this question through a description of bodybuilder folk models of trenbolone risk. Using a social life of drugs approach it describes: (1) the effects of trenbolone; (2) how these effects are given meaning as either harms or benefits, and then weighed against each other; (3) how the risks of trenbolone are reduced through harm reduction strategies and (4) the role of online communities in negotiations of trenbolone risk. Trenbolone was found to occupy a mythical status in bodybuilding communities, in part because of the conflicted relationship bodybuilders have with the drug. This conflicted relationship illustrates the inherent ambivalence of drugs, which are always both remedy and poison.

The online sourcing, supply, and purchase of illicit drugs is fast transforming drug markets worldwide. Although the long-term development of simple communications technology over time (from pagers to mobile phones) continues to impact and extend local drug supply dynamics, it is the recent developments of dark web cryptomarkets, social media applications (like Instagram), encrypted messaging applications (like WhatsApp), and surface web platforms, such as LeafedOut, that are changing the drug supply landscape online. The use of technology in drug supply has tended to go hand in hand with improving the efficiency of supply and opportunities to reduce exchange-related risks for both buyers and sellers. In relation to app-mediated supply, for example, the use of encrypted messaging provides enhanced security for arranging purchases beyond the lurking surveillance of law enforcement. Despite the perception of improved safety, however, the use of social media apps and other online platforms can expose both buyers and sellers to risk scenarios they may not fully appreciate. Drawing on two recent studies on the use of social media apps and the online platform LeafedOut as mediators of drugs supply, this chapter will consider how these mid-range (between cryptomarkets and traditional telecommunications such as basic texting/calling and material ‘street’ markets) virtual spaces are being utilised for drug supply and the extent to which this is ‘just more of the same’ or provides new structures and experiences for those engaging with it and in what ways. Consideration will also be given to contradictions in the mid-range market space where the broad perception of reduced risk from the use of encrypted messaging can in fact produce greater levels of risk for some buyers and sellers depending on how they engage with the process/es.

Although we have achieved a greater understanding of cryptomarket specifics, evidence on the consumer side of cryptomarkets is still needed – not only regarding the role of cryptomarkets on individual drug-using careers but also on the motives for buying illicit drugs from cryptomarkets. Moreover, research has indicated that national differences exist regarding different variables relating to cryptomarket use and prevalence, as well as to why users are drawn to these markets. In this chapter, the author presents the results of a Belgian case study focusing on drug cryptomarket buyers. Using an online quantitative survey (N = 99) and semi-structured interviews (N = 10), we gain exploratory insight into the motives of Belgian buyers sourcing illicit drugs from cryptomarkets and how they believe these cryptomarkets affect their drug-using careers. Results indicate that most of the respondents had bought drugs offline before buying them from cryptomarkets and that the frequency of their drug use did not change once cryptomarkets were accessed. Almost 60% of our respondents, however, consumed different drugs or a wider range of drugs following their cryptomarket use. Furthermore, most of the respondents purchased from cryptomarkets for their personal consumption, and some of them also shared their supply with friends, that is, social supply. The alternative drug offer was the principal reason why they were using cryptomarkets, followed by curiosity and the price and the quality of the drugs. Although the respondents in this study were well aware of different risks related to market vendors, market administrators, and law enforcement, these risks were considered to be minimal and part of the cryptomarket environment. The results of this case study are informative and highlight areas requiring further research.

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.

This chapter argues that models trying to explain the spread of drug use should not be based on standard epidemiological models developed to describe the spread of infectious diseases. The main weaknesses of the standard model are the lack of attention to micro-foundations and the inappropriateness of several of its assumptions in the context of drug use. An approach based on mechanisms and social interaction is argued to provide a promising alternative to the standard approach. To illustrate this, a model of the spread of drugs based on two mechanisms has been developed (observational learning and social stigma). Lastly, some of the difficulties in testing and deriving policy implications in these models are discussed.

The goals of this chapter are three-fold: (1) to outline some broad empirical regularities concerning how drug problems evolve over time, (2) to sketch some plausible mechanisms for ways in which aspects of that variation might be endogenous, and (3) to review two classes of dynamic models of drug use that have implications for how policy should vary over a drug epidemic.

We use postpartum survey data linked to medical records and city-level drug prices to estimate the demand for illicit drugs among pregnant women. We find that a $10 increase in the retail price of a gram of pure cocaine decreases illicit drug use by 12–15%. The estimated price effects for heroin are lower than for cocaine and are less robust across alternative model specifications. This study provides the first estimates of the effects of drug prices on prenatal drug use and yields important information about the potential of drug enforcement as a tool for reducing illicit drug use among pregnant women.