A critical examination of the definition of ‘psychoactive effect’ in Australian drug legislation

As the number of new ‘psychoactive substances’ detected globally has risen exponentially, the policy response of assessing and prohibiting each new substance individually has become increasingly unworkable. In an attempt to disrupt the availability of new as-yet-unscheduled substances, Ireland (2010), Poland (2011), Romania (2012), New Zealand (2013), Australia (2015) and the United Kingdom (2016) have enacted generic or blanket ban legislation that prohibits all ‘psychoactive substances’ that are not already regulated or belong to exempt categories. How such generic legislation defines ‘psychoactive substance’ is therefore crucial. While there is a growing critical literature relating to blanket bans of ‘psychoactive substances’, the Australian legislation is yet to be described or critically analysed. In this commentary, we aim to draw the attention of local and international drug policy scholars to Australia’s newest legislative approach to ‘psychoactive substances’. Using the Australian experience as a case study, we first describe and trace the origins of this generic banning approach, especially focusing on how ‘psychoactive effect’ came to be defined. Then, we critically examine the assumptions underpinning this definition and the possibilities silenced by it, drawing on the work of poststructuralist and critical scholars. In doing so, we explore and raise a series of questions about how this legislation works to stabilise drugs, drug harms and drug effects, as well as addiction realities; how the category of ‘psychoactive substances’ is produced through this legislation; and some of the material-discursive effects which accompany this rendering of the ‘problem’. We offer this commentary not as a comprehensive discussion of each of these elements but rather as a starting-point to promote further discussion and debate within the drug policy field. To this end, we conclude with a suggested research agenda that may help guide such future work.     

‘Being human’ and the ‘moral sidestep’ in drug policy: Explaining government inaction on opioid-related deaths in the UK

BackgroundWith drug-related deaths at record levels in the UK, the government faces two potential sources of pressure to implement more effective policies. One source is the individuals and families who are most likely to suffer from such deaths; i.e. working class people living in de-industrialised areas. The other source is experts who argue for different policy on the basis of research evidences.AimThis article aims to explain why, in the face of these two potential sources of pressure, the UK government has not implemented effective measures to reduce deaths.MethodThe article uses critical realist discourse analysis of official documents and ministerial speeches on recent British drug policy (2016–2018). It explore this discourse through the theoretical lens of Archer's (2000) ideas on ‘being human’ and by drawing on Sayer's (2005) work on the ‘moral significance of class’.ResultsMembers of economically ‘residual’ groups (including working class people who use heroin) are excluded from articulating their interests in ‘late welfare capitalism’ in a project of depersonalising ‘class contempt’ through which politicians cast the people most likely to die as passive, ‘vulnerable’ ‘abjects’. Conservative politicians dismiss ‘evidence-based’ ideas on the reduction of drug-related death through a ‘moral sidestep’. They defend policy on the basis of its relevance to conservative moral principles, not effectiveness. This is consistent with the broader moral and political pursuit of partial state shrinkage which Conservative politicians and the social groups they represent have pursued since the 1970s.     

‘The great unmentionable’: Exploring the pleasures and benefits of ecstasy from the perspectives of drug users

There is limited evidence about the prevalence of mental illness and substance misuse comorbidity (comorbidity) and its current management. This hampers service development in the UK. We measured the prevalence of comorbidity in community mental health teams (CMHTs) and drug and alcohol services in four urban UK centres. We also described the patterns of comorbidity, assessed the health and social care needs of patients and described current management.

Among CMHT patients, 44% report past year problem drug use and/or harmful alcohol use. The majority of drug (74.5%) and alcohol patients (80.6%) had a past year psychiatric disorder. In each population most comorbid patients exhibit multiple disorders and have greater community care needs than non-comorbid patients. Comorbid status did not restrict access to interventions provided through the patient's allocated service, but joint management between services was uncommon.

Resources need to be deployed to enable substance misuse services to provide evidence-based interventions to a higher proportion of comorbid patients. The treatment need of comorbid CMHT patients are likely to be best met by mainstream mental health services. However, CMHTs need to develop these competencies through staff training and research into the effectiveness of novel interventions tailored to UK service contexts.     

‘It's our safe sanctuary’: Experiences of using an unsanctioned overdose prevention site in Toronto,Ontario

BackgroundOverdose prevention sites (OPSs) are spaces where people can consume drugs under the supervision of trained volunteers or staff and receive help in the event of an overdose. Unsanctioned OPSs are a grassroots response to the current opioid crisis in Canada.MethodsWe used rapid evaluation methods to study the experiences of 30 individuals accessing the smoking and injection services at the first unsanctioned OPS in Toronto, Ontario using semi-structured interviews. Data were analyzed using an applied thematic analysis approach to identify emergent themes related to service user experiences, characteristics of the risk environment, and recommended changes to the service model.ResultsThe OPS represented a safe sanctuary and brought a sense of belonging to a community that often experiences discrimination. Valued aspects included: shelter; protection from violence; safety from overdoses; free equipment; information about health and social services; food and beverages; and socializing and connecting with others. Integrating peer workers in the design and delivery of services encouraged service users to visit the site. The OPS changed the risk environment by: providing access to the first supervised smoking service in Toronto; having few explicit rules and a communal approach to making new rules; allowing assisted injection, and negotiating with police to allow people to access the site with minimal contact. Service users noted the need to ensure a safe space for women and recommended extended hours of operation and moving to a more permanent space with heat and lighting for both smoking and injecting drugs.ConclusionThe unsanctioned OPS in Toronto served an important role in defining new, community-led, flexible responses to opioid overdose-related deaths at a time of markedly increasing mortality. Providing harm reduction services in diverse settings and expanding services to include smoking and assisted injection may increase access for marginalized people who use drugs.     

Challenges and opportunities of ‘good governance’ for drug policy: the case of the development of Belgian drug policy between 1996 and 2003

Aims: Studying the characteristics of the science-policy nexus in the field of drugs emerged in parallel with an interest in the principles of good governance. Centre-stage is the processes through which policy is informed, especially with regard to the role of non-government actors, contrasting with the widely accepted view that drug policymaking is a prerogative of governments. Through the lens of what is defined as good governance in drug policy, this article examines the processes underpinning the drug-policy change in Belgium between 1996 and 2003. Methods: The paper is based on an analysis of 164 policy documents and 1067 newspaper articles, and 55 interviews with a range of stakeholders including policymakers, professionals, scientists and journalists. Findings: Some distinctive features were found relating to the mechanisms through which evidence was mobilised and eventually informed policy change in Belgium. Evidence-imbued leadership, evaluation, coordination, the engagement of different stakeholders and the role of the parliament played key roles. Conclusions: Several characteristics of good governance make the use of evidence more likely. However, governance processes seem to be challenged in highly sensitive discussions (e.g. on cannabis policy). Another challenge may be how the principles of good governance can be consolidated in the long term.     

Beyond drug dealing: Developing and extending the concept of ‘social supply’ of illicit drugs to ‘minimally commercial supply’

A concept of ‘social supply’ has emerged in the UK that describes drug transactions that are almost exclusively to friends and acquaintances and that are non-commercially motivated. Social suppliers are increasingly understood not to be drug dealers ‘proper’ and many argue that the criminal justice system should consider and process them differently to commercially motivated suppliers. Recent (2012) changes to sentencing guidelines in England and Wales that have attempted to accommodate this will continue to struggle to deal with social supply however due to a continued reliance on how culpability is defined. This article explores the rationale for understanding social supply activities as a specific form of supply and a new (lesser) separate offence and also outlines a rationale for extending the concept to one of ‘minimally commercial supply’ something that explicitly accommodates the real-life circumstance of most supply transactions and is also inclusive of addicted user-dealers of heroin/other substances whom might reasonably be seen as closer to social suppliers than to drug dealers proper.     

Promoting family-focused approaches within adult drug services: The potential of the ‘Senses Framework’

BackgroundPolicies across countries promote family-focused engagement with adult drugs services however this is rarely offered routinely and relationships with carers are often poor. Research in mental health and older people's services suggests that improving the relationships between carers and service providers is fundamental to enhancing the quality of services. One example is the Senses Framework which assesses the extent to which services are relationship-centred and provides deeper insight into the areas that require further improvement. The aim of this paper is to establish the extent to which relationship-centred care, as defined by the Senses Framework, is expressed in the interactions between carers, services providers and policy makers in adult drug service settings.MethodsA qualitative study, involving 8 focus groups and 32 individual interviews, was undertaken to explore carers’, service providers’ and policy makers’ experiences and understandings of family and carer involvement with drug services in Scotland, United Kingdom.ResultsTensions exist between carers, service providers and policy makers however there are also areas of commonality in which participants shared experiences and understandings of family and carer involvement with services. Our findings go beyond existing research which focuses largely on describing of the poor quality of relationships between carers, service providers and policy makers by providing a deeper theoretical insight into the nature of these relationships. In so doing, by focusing on the senses of belonging, continuity, security, achievement, purpose and significance, we present the possibility of resolving such tensions.ConclusionsWe think that implementing relationship-centred approaches to care, such as that in the Senses Framework, would provide a greater sense of therapeutic and strategic direction for those delivering and commissioning adult drug services in many countries.     

Promoting public awareness of randomised clinical trials using the media: the ‘Get Randomised’ campaign

AIM

To increase public awareness and understanding of clinical research in Scotland.

METHODS

A generic media campaign to raise public awareness of clinical research was launched in 2008. The ‘Get Randomised’ campaign was a Scotland-wide initiative led by the University of Dundee in collaboration with other Scottish universities. Television, radio and newspaper advertising showed leading clinical researchers, general practitioners and patients informing the public about the importance of randomised clinical trials (RCTs). ‘Get Randomised’ was the central message and interested individuals were directed to the http://www.getrandomised.org website for more information. To assess the impact of the campaign, cross-sectional surveys were conducted in representative samples of 1040 adults in Scotland prior to campaign launch and again 6 months later.

RESULTS

There was an improvement in public awareness of clinical trials following the campaign; 56.7% [95% confidence interval (CI) 51.8, 61.6] of the sample recalled seeing or hearing advertising about RCTs following the campaign compared with 14.8% (10.8, 18.9) prior to the campaign launch (difference = 41.4%; 95% CI for difference 35.6, 48.3; P < 0.01). Of those who recalled the advertising, 49% felt that the main message was that people should take part more in medical research. However, on whether they would personally take part in a clinical trial if asked, there was little difference in response following the campaign [‘yes’ 31.3% (28.4, 34.1) prior; 30.4% (27.6, 33.2) following; difference =−0.9%; 95% CI for difference −4.8, 3.1%; P= 0.92].

CONCLUSIONS

It is possible to raise public awareness of clinical research using the media, but further efforts may be required to influence individuals'' decisions to take part in clinical research.     

The effect of pimozide on variable-interval performance: A test of the ‘anhedonia’ hypothesis of the mode of action of neuroleptics

A quantitative behavioural test system based on Herrnstein's (1970) equation was used to test a prediction derived from the anhedonia hypothesis of neuroleptic action, that pimozide should increase the value of the behavioural parameter K _H (the reinforcement frequency needed to maintain the half-maximal response rate in variable-interval schedules). On the basis of theoretical considerations, it was shown that the equation implies that a drug which exerts such an effect on K _H must have a more profound suppressant effect on performance maintained by low reinforcement frequencies than on performance maintained by high reinforcement frequencies. Fifteen rats were trained under variable-interval 10-s and variable-interval 100-s schedules, and the effect of pimozide (0.125, 0.25, 0.33, and 0.5 mg/kg) was tested on performance maintained under each schedule. The drug suppressed performance maintained under both schedules in a dose-dependent manner, and there was no tendency for the drug to exert a greater effect on performance maintained under the lower reinforcement frequency. These results do not provide any evidence that the effect of pimozide on variable-interval performance is due to an anti-hedonic effect; rather, they are compatible with the hypothesis that pimozide impairs the capacity to respond.     

‘Silk Road’, the virtual drug marketplace: A single case study of user experiences

Background: The online promotion of ‘drug shopping’ and user information networks is of increasing public health and law enforcement concern. An online drug marketplace called ‘Silk Road’ has been operating on the ‘Deep Web’ since February 2011 and was designed to revolutionise contemporary drug consumerism. Methods: A single case study approach explored a ‘Silk Road’ user's motives for online drug purchasing, experiences of accessing and using the website, drug information sourcing, decision making and purchasing, outcomes and settings for use, and perspectives around security. The participant was recruited following a lengthy relationship building phase on the ‘Silk Road’ chat forum. Results: The male participant described his motives, experiences of purchasing processes and drugs used from ‘Silk Road’. Consumer experiences on ‘Silk Road’ were described as ‘euphoric’ due to the wide choice of drugs available, relatively easy once navigating the Tor Browser (encryption software) and using ‘Bitcoins’ for transactions, and perceived as safer than negotiating illicit drug markets. Online researching of drug outcomes, particularly for new psychoactive substances was reported. Relationships between vendors and consumers were described as based on cyber levels of trust and professionalism, and supported by ‘stealth modes’, user feedback and resolution modes. The reality of his drug use was described as covert and solitary with psychonautic characteristics, which contrasted with his membership, participation and feelings of safety within the ‘Silk Road’ community. Conclusion: ‘Silk Road’ as online drug marketplace presents an interesting displacement away from ‘traditional’ online and street sources of drug supply. Member support and harm reduction ethos within this virtual community maximises consumer decision-making and positive drug experiences, and minimises potential harms and consumer perceived risks. Future research is necessary to explore experiences and backgrounds of other users.     

Iterating ‘addiction’: Residential relocation and the spatio-temporal production of alcohol and other drug consumption patterns

Addiction is generally understood to be characterised by a persistent pattern of regular, heavy alcohol and other drug consumption. Current models of addiction tend to locate the causes of these patterns within the body or brain of the individual, sidelining relational and contextual factors. Where space and place are acknowledged as key factors contributing to consumption, they tend to be conceived of as static or fixed, which limits their ability to account for the fluid production and modulation of consumption patterns over time. In this article we query individualised and decontextualised understandings of the causes of consumption patterns through an analysis of accounts of residential relocation from interviews undertaken for a large research project on experiences of addiction in Australia. In conducting our analysis we conceptualise alcohol and other drug consumption patterns using Karen Barad’s notions of intra-action and spatio-temporality, which allow for greater attention to be paid to the spatial and temporal dimensions of the material and social processes involved in generating consumption patterns. Drawing on 60 in-depth interviews conducted with people who self-identified as experiencing an alcohol and other drug addiction, dependence or habit, our analysis focuses on the ways in which participant accounts of moving enacted space and time as significant factors in how patterns of consumption were generated, disrupted and maintained. Our analysis explores how consumption patterns arose within highly localised relations, demonstrating the need for understandings of consumption patterns that acknowledge the indivisibility of space and time in their production. In concluding, we argue for a move away from static conceptions of place towards a more dynamic conception of spatio-temporality, and suggest the need to consider avenues for more effectively integrating place and time into strategies for generating preferred consumption patterns and initiating and sustaining change where desired.     

The misuse of the ‘Gateway Theory’ in US policy on drug abuse control: A secondary analysis of the muddled deduction

Much research (mostly from general population surveys) suggests that people typically use alcohol, tobacco and then marijuana, so called ‘gateway drugs’, prior to any potential use of ‘hard drugs’ like cocaine powder, crack and heroin. Other research (mostly with surveys of special populations) indicates that hard-drug use is associated with numerous social problems such as crime, routine violence, and lower productivity. A muddled interpretation of these separate findings has been widely misused in support of the US drug abuse prevention policies to suggest that gateway drugs cause hard-drug use and its associated problems. This paper superimposes secondary analyses of data from the National Household Survey on Drug Abuse (NHSDA) and the Arrestee Drug Abuse Monitoring (ADAM) program. The findings indicate that (1) extremely few members of the general population become persistent daily hard-drug-using criminal offenders; and (2) an increasing percentage of daily hard-drug-using criminal offenders did not follow the gateway sequence of substance use progression. These results strongly suggest that the use of gateway drugs by youths is not the central cause of hard-drug use and its associated problems. Thus, fighting the use of gateway drugs by youths may not be a particularly appropriate approach to drug abuse prevention.     

A systematic review of the literature on ‘medication wastage’: an exploration of causative factors and effect of interventions

Introduction Reducing any wastage, including that of medications, is a paramount objective in promoting appropriate utilisation of finite resources. The objective was to systematically review the published literature, the possible causative factors associated with medication wastage and the effectiveness of any interventions to reduce wastage. Method A systematic review of studies published in English was identified from the following databases: Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, PubMed, Science Citation Index and The Cochrane Library. Data extraction and critical appraisal was undertaken independently by two researchers. Results and discussion Title, abstract and full paper screening reduced the 14,157 studies to 42. A general definition of medication wastage was reported in one paper only. ‘Medication changed’, ‘patient death’, ‘resolution of patient’s condition’ and ‘expired medications’ were most commonly cited reasons for wastage. Only two studies were identified reporting wastage as a research outcome measure following intervention. Conclusion The systematic review has identified a limited literature on medication wastage with a lack of consistency of terms. There is a paucity of robust research focusing on the impact of healthcare interventions on outcomes around medication wastage.     

Enacting ‘more-than-human’ care: Clients’ and counsellors’ views on the multiple affordances of chatbots in alcohol and other drug counselling

Forms of artificial intelligence (AI), such as chatbots that provide automated online counselling, promise to revolutionise alcohol and other drug treatment. Although the replacement of human counsellors remains a speculative prospect, chatbots for ‘narrow AI’ tasks (e.g., assessment and referral) are increasingly being used to augment clinical practice. Little research has addressed the possibilities for care that chatbots may generate in the future, particularly in the context of alcohol and other drug counselling. To explore these issues, we draw on the concept of technological ‘affordances’ and identify the range of possibilities for care that emerging chatbot interventions may afford and foreclose depending on the contexts in which they are implemented. Our analysis is based on qualitative data from interviews with clients (n=20) and focus group discussions with counsellors (n=8) conducted as part of a larger study of an Australian online alcohol and other drug counselling service. Both clients and counsellors expressed a concern that chatbot interventions lacked a ‘human’ element, which they valued in empathic care encounters. Most clients reported that they would share less information with a chatbot than a human counsellor, and they viewed this as constraining care. However, clients and counsellors suggested that the use of narrow AI might afford possibilities for performing discrete tasks, such as screening, triage or referral. In the context of what we refer to as ‘more-than-human’ care, our findings reveal complex views about the types of affordances that chatbots may produce and foreclose in online care encounters. We conclude by discussing implications for the potential ‘addiction futures’ and care trajectories that AI technologies offer, focussing on how they might inform alcohol and other drug policy, and the design of digital healthcare.     

Exploring the micro-politics of normalisation: Narratives of pleasure,self-control and desire in a sample of young Australian ‘party drug’ users

This article explores the micro-politics of recreational use of illicit ‘party drugs’ in a social network of young Australians. These young people often engage in extended sessions of concurrent alcohol and other drug use, and regularly emphasise the pleasures associated with this use. However, as well-integrated young people, they are also exposed to the discourses of non-using friends, family and the wider society, which represent illicit drug use as a potential moral threat. Some group members invoked the need for self-control in relation to illicit drug use and had developed a number of strategies to cease or regulate their use. However, they struggled to regulate pleasure and drew on popular understandings of ‘excessive’ drug use as indicative of flawed neo-liberal subjectivity. Other group members rejected the need for self-control, choosing instead to emphasise the value of unrestrained bodily pleasure facilitated by the heavy use of illicit drugs. These co-existing discourses point to the complex ways in which illicit drug users try to challenge the stigma associated with their drug use. Our analysis suggests that future accounts of illicit drug use, and harm reduction initiatives, need to be more attentive to the micro-politics of normalisation. How should harm reduction respond to those who articulate its ethos but pursue pleasure in practice? What should harm reduction say to those who reject regulation on the grounds that it stifles pleasure? Discussing ways to incorporate pleasure into harm reduction should be central to the future development of policy and practice.