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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.

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.

Cannabis as a recreational drug is prohibited in Nigeria. Consequently, the open use of cannabis attracts both formal and informal sanctions. As such, there is much stigma on users' faces across social spaces. This has led to innovations in drug use. Recently, non-medical use of tramadol has been rising across each of the gender categories. This study aims to understand (1) tramadol use prompts, (2) the sudden surge in gendered recreational use of tramadol and (3) the gendered challenges of recreational tramadol use among Nigerian university students.

Data were collected between December 2021 and October 2022. The researcher conducted 20 semi-structured interviews, with participants chosen purposefully from acquaintances and others selected through chain referral. The selection criteria included knowledge of a particular tramadol tablet and willingness to participate. This study got ethical approval from the Anambra State Ministry of Health (Ref: MH/AWK/M/321/354) and oral consent was obtained before the interviews. The participants were assured of confidentiality. The interviews were conducted in English (the formal Nigerian language) and lasted between 30 and 65 min. The data collected were transcribed and coded manually, and themes generated.

Findings suggest that peer pressures accounted for entry-level drug use. However, cannabis-related stigma is attributed to the surge in tramadol use across gender categories. Furthermore, academic pressure and sexuality are major reasons for tramadol use. The challenges associated with tramadol use include headaches and addiction.

This study, to the best of the author’s knowledge, presents alternative data on the surge in tramadol use among Nigerian university students.

Cannabis use continues to increase worldwide, and a number of nation states are changing their cannabis policies. Policy changes require research into key populations, namely, people who use cannabis. This study aims to examine sociodemographic differences of young Finns who reported using cannabis mainly for self-medication versus mainly recreationally, as well as their reported effects of cannabis use.

The data come from an anonymous online survey (N = 247, 70.0% males, 25.9% females, 4.1% other) that was analysed using multiple logistic regression. The authors focused on whether various demographic indicators differed between those who reportedly used cannabis mainly for recreational purposes and mainly for self-medicinal purposes. The authors also qualitatively examined the respondents’ experienced effects of cannabis, both desired and undesired.

Being older and female, living in a smaller city and earlier age of initiation of cannabis use were statistically significant in predicting the medicinal use of cannabis. The majority of recreational effects were related to themes such as relaxation and pleasure, but many participants also reported desired medical effects. Similarly, many participants reported several undesired effects.

Understanding especially young people’s motivations to use cannabis, which include using it for various medical effects, can improve the design of harm reduction and treatment programmes as well as enhance the well-being of people who use cannabis.

This study gives a nuanced account of sociodemographic factors and motivations of young people who use cannabis in Finland as well as the reported effects it has on them, which complements data from national drug surveys.

This study aims to explore the experiences of living through the COVID-19 pandemic for people who faced homelessness and dealt with mental health and/or substance use challenges.

This qualitative study was comprised of 26 1:1 interviews (16 men and 10 women), conducted between February and May 2021 with people who experienced homelessness in North East England during the COVID-19 pandemic. An inductive reflexive thematic analysis was undertaken, with input from individuals with lived experience who were involved throughout the study.

Four themes were developed. The first theme, lack of support and exacerbation of mental health and substance use difficulties, highlighted how the lack of in-person support and increased isolation and loneliness led to relapses or new challenges for many people’s mental health and substance use. The second theme, uncertainty and fear during the pandemic, explored how the “surreal” experience of the pandemic led to many people feeling uncertain about the future and when things would return to normal. The third theme, isolation and impacts on social networks, discussed how isolation and changes to relationships also played a role in mental health and substance use. Finally, opportunity for reflection and self-improvement for mental health and substance use, explored how some people used the isolated time to re-evaluate their recovery journey and focus on self-improvement.

The experiences shared within this study have important implications for planning the future delivery and commissioning of health and social care services for people facing homelessness, such as sharing information accessibly through clear, consistent and simple language.

As one of the few papers to involve people with lived experience as part of the research, the findings reflect the unique narratives of this population with a focus on improving services.

This study is an analysis that aims to understand the rationale behind the concept of value creation contained in the integrated reporting (IR) framework. As such, the authors examined the quality of the disclosures made in integrated reports by measuring the level to which the six capitals (6Cs) have been integrated into disclosures on value creation.

The IR framework’s value creation model focuses on six content elements and three guiding principles. Hence, the present analysis combines content analysis with quantitative measures in the form of a bespoke Integrated Disclosure Index. The index measures the level of integration found in the disclosures instead of the mere presence or absence of mentioned capitals, content elements and guiding principles in isolation. The present sample comprised the 2016 integrated/sustainability reports for 184 listed companies sourced from the Integrated Reporting Examples Database.

The 6Cs are well disclosed in form but only partially disclosed in substance. Further, overall levels of integration between the capitals, the content elements and the guiding principles are higher than average. Disclosures on materiality, business models and stakeholder relationships are somewhat lacking, as are the related medium- and long-term disclosures on outlook.

The paper contributes to the academic debate on IR by building a case for holistically assessing the substance of integrated reports. Considering that the IR value creation model can underpin and align with the 17 UN sustainable development goals, the authors show how the fundamental concept of the 6Cs sustaining value creation is understood and implemented differently across the various elements and principles of the IR framework.

This research also provides guidance for overcoming some of the practical hurdles associated with assessing the quality of reports because the authors provide tools for spotlighting the substance of disclosures over their form.

This paper delves into the substance of integrated reports by assessing how well the 6Cs have been integrated into disclosures on the content elements and guiding principles of the IR framework. In contrast to previous IR research that has mainly analysed capital, elements and principles in isolation, the authors develop an index assessing the integration of these three fundamental concepts of IR.