‘Enjoying the kick’: Locating pleasure within the drug consumption room

BackgroundHarm reduction policy and praxis has long struggled to accommodate the pleasures of alcohol and other drug use. Whilst scholars have consistently highlighted this struggle, how pleasure might come to practically inform the design and delivery of harm reduction policies and programs remains less clear. The present paper seeks to move beyond conceptual critiques of harm reduction’s ‘pleasure oversight’ to more focused empirical analysis of how flows of pleasure emerge, circulate and, importantly, may be reoriented in the course of harm reduction practice.MethodsWe ground our analysis in the context of detailed ethnographic research in a drug consumption room in Frankfurt, Germany. Drawing on recent strands of post-humanist thought, the paper deploys the concept of the ‘consumption event’ to uncover the manner in which these facilities mediate the practice and embodied experience of drug use and incite or limit bodily potentials for intoxication and pleasure.ResultsThrough the analysis, we mapped a diversity of pleasures as they emerged and circulated through events of consumption at the consumption room. Beyond the pleasurable intensities of intoxication’s kick, these pleasures were expressed in a range of novel capacities, practices and drug using bodies. In each instance, pleasure could not be reduced to a simple, linear product of drug use. Rather, it arose for our participants through distinctive social and affective transformations enabled through events of consumption at the consumption room and the generative force of actors and associations of which these events were composed.ConclusionOur research suggests that the drug consumption room serves as a conduit through which its clients can potentially enact more pleasurable, productive and positive relations to both themselves and their drug use. Acknowledging the centrality of pleasure to client engagement with these facilities, the paper concludes by drawing out the implications of these findings for the design and delivery of consumption room services.     

‘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.     

More-than-harm reduction: Engaging with alternative ontologies of ‘movement’ in UK drug services

Over the last ten years, UK drug policy has moved towards making abstinence-based recovery rather than harm reduction its primary focus. Drawing on ethnographic fieldwork involving participant observations and interviews at two London drug services, we explore how this shift towards recovery materialises through the practices of drug service delivery as an ‘evidence-making intervention’. We understand recovery's making in terms of ‘movement’. Where previous policies performed harm reduction through ‘getting people into treatment’ and ‘keeping them safe in treatment’, new policies were said to be about ‘moving people through treatment’. Approaching movement as a sociomaterial process, we observe how movement is enacted in both narrow ways, towards abstinence from drugs, and more open ways, in what we call ‘more-than-harm reduction’. We think of the latter as a speculative practice of doing or ‘tinkering with’ recovery to afford a care for clients not bound to abstinence-based outcomes. This is important given the limits associated with a recovery-orientated policy impetus. By engaging with these alternative ontologies of movement, we highlight an approach to intervening that both subverts and adheres to perceptions of recovery, embracing its movement, while remaining critical to its vision of abstinence.     

The movement and translation of drug policy ideas: The case of ‘new recovery’

Introduction'New recovery' can be conceptualised as both a social movement and a broader policy agenda to restructure treatment service systems towards 'recovery-oriented systems of care'. Emerging initially out of the United States, new recovery has gained currency as a policy agenda in other jurisdictions - perhaps most distinctly in the United Kingdom. In 2012, the ideas behind 'new recovery' were debated in the Australian alcohol and other drug field as the Victorian government sought to incorporate recovery principles into policy and service design. This paper uses the policy transfer and policy translation literature to understand how international policy ideas about 'new recovery' were negotiated in the Australian context, focusing specifically on the role of non-government actors in the process.MethodsThis paper draws on an analysis of policy documents, organisational documents and interviews with representatives from the Australian non-government alcohol and other drug sector to consider how new recovery was translated into Victorian drug policy.ResultsThe interactions between organisations and actors — including bureaucrats, governmental agencies and policy entrepreneurs — facilitated the circulation and translation of policy ideas in the Victorian context. Despite this, the analysis suggests that policy transfer was largely a symbolic exercise: overall, some of the key features of new recovery policy from the United States and the United Kingdom, such as encouraging peer-led recovery and mutual aid, were not incorporated in the Victorian policy. NGOs resisted what they considered to be some of the more problematic elements of 'new recovery', and informed the local translation of the policy.DiscussionThe results have implications for understandings of the relationship between social movements, non-government organisations and the state, as well as the dynamics of knowledge transfer in drug policy.     

‘Big data’ approaches for novel anti-cancer drug discovery

Introduction: The development of improved cancer therapies is frequently cited as an urgent unmet medical need. Recent advances in platform technologies and the increasing availability of biological ‘big data’ are providing an unparalleled opportunity to systematically identify the key genes and pathways involved in tumorigenesis. The discoveries made using these new technologies may lead to novel therapeutic interventions.

Areas covered: The authors discuss the current approaches that use ‘big data’ to identify cancer drivers. These approaches include the analysis of genomic sequencing data, pathway data, multi-platform data, identifying genetic interactions such as synthetic lethality and using cell line data. They review how big data is being used to identify novel drug targets. The authors then provide an overview of the available data repositories and tools being used at the forefront of cancer drug discovery.

Expert opinion: Targeted therapies based on the genomic events driving the tumour will eventually inform treatment protocols. However, using a tailored approach to treat all tumour patients may require developing a large repertoire of targeted drugs.     

The metabolism and drug–drug interaction potential of the selective prostacyclin receptor agonist selexipag

1.?The metabolism of selexipag has been studied in vivo in man and the main excreted metabolites were identified. Also, metabolites circulating in human plasma have been structurally identified and quantified.

2.?The main metabolic pathway of selexipag in man is the formation of the active metabolite ACT-333679. Other metabolic pathways include oxidation and dealkylation reactions. All primary metabolites undergo subsequent hydrolysis of the sulphonamide moiety to their corresponding acids. ACT-333679 undergoes conjugation with glucuronic acid and aromatic hydroxylation to P10, the main metabolite detected in human faeces.

3.?The formation of the active metabolite ACT-333679 is catalysed by carboxylesterases, while the oxidation and dealkylation reactions are metabolized by CYP2C8 and CYP3A4. CYP2C8 is the only P450 isoform catalysing the aromatic hydroxylation to P10. CYP2C8 together with CYP3A4 are also involved in the formation of several minor ACT-333679 metabolites. UGT1A3 and UGT2B7 catalyse the glucuronidation of ACT-333679.

4.?The potential of selexipag to inhibit or induce cytochrome P450 enzymes or drug transport proteins was studied in vitro. Selexipag is an inhibitor of CYP2C8 and CYP2C9 and induces CYP3A4 and CYP2C9 in vitro. Also, selexipag inhibits the transporters OATP1B1, OATP1B3, OAT1, OAT3, and BCRP. However, due to its low dose and relatively low unbound exposure, selexipag has a low potential for causing drug–drug interactions.     

The international development of the ‘Social Norms’ approach to drug education and prevention

The social norms approach to health promotion has become remarkably popular in the last 20 years, particularly in the American college system. It is an alternative to traditional fear-based approaches of health education, which a growing body of research demonstrates is often ineffective in reducing alcohol and drug misuse. The social norms approach differs by recognizing that individuals, particularly young adults, tend to overestimate how heavily and frequently their peers consume alcohol, and that these perceptions lead them to drink more heavily themselves than they would otherwise do. Similar misperceptions have been found in a range of other health and non-health behaviours. The social norms approach aims to reduce these misperceptions, and thus personal consumption, through the use of media campaigns and personal feedback. Although the numbers of completed social norms projects outside the USA is small, the evidence from them is that the approach can be equally effective in both European and Australian contexts. It is also acknowledged that as an emergent field, there are limitations to the current social norms literature. There is a lack of randomized control trial studies, a lack of clarity of the role of referent groups and a need to better understand the processes through which misperceptions are transmitted. However, despite these issues, the social norms approach represents a new avenue for reducing alcohol and drug-related harm and is an area which merits further research.     

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.     

Critical realism and the ‘ontological politics of drug policy’

This article explores the question of what we can consider to be real in drug policy. It examines two increasingly common aspects of drug policy analysis; radical constructionist critique and successionist data science. It shows how researchers using these assumptions have produced interesting findings, but also demonstrates their theoretical incoherence, based on their shared ‘flat ontology’. The radical constructionist claim that reality is produced within research methods – as seen in some qualitative studies - is shown to be unsustainably self-defeating. It is analytically ‘paralyzing’. This leads to two inconsistencies in radical constructionist studies; empirical ambivalence and ersatz epistemic egalitarianism. The Humean successionist approach of econometric data science is also shown to be unsustainable, and unable to provide explanations of identified patterns in data. Four consequent, limiting characteristics of this type of drug policy research are discussed: causal inference at a distance, monofinality, limited causal imagination, and overly confident causal claims. The article goes on to describe the critical realist approach towards ‘depth ontology’ and ‘generative causation’. It provides examples of how this approach is deployed in critical realist reviews and discourse analysis of drug policy. It concludes by arguing that critical realism enables more deeply explanatory, methodologically eclectic and democratically inclusive analysis of drug policy development and effects.     

Exploring the existence of drug policy ‘ideologies’ in Australia

Aims: Knowledge of public opinion towards drug policy is often limited to analyses of individual survey questions. There has been less thought given to the underlying structure of public opinion, and how attitudes towards different facets of drug policy, for example, law enforcement and harm reduction, might align into ideological positions. This paper aims to assess the extent to which distinct ideologies are present among the general public in Australia in relation to drug policy.

Method: The study involved a Latent Class Analysis of data taken from the 2010 National Drug Strategy Household Survey. The analysis categorized individuals into mutually exclusive groups (classes), according to their responses to 15 attitudinal items.

Findings: Six classes of individuals were identified, and were labelled as: uninformed, ambivalent, detached prohibitionists, committed prohibitionists, harm reductionists and legalizers.

Conclusions: The unique analysis presented in this paper demonstrates the existence of six distinct classes of opinions towards drug policy in an Australian sample. Whilst there were a large proportion of respondents in support of both drug legalization and harm reduction, there were also many who opposed drug legalization, yet supported harm reduction. Any assumption that supporting harm reduction automatically equates with support for legalization, is erroneous.     

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.     

“The missing ‘I’ in drug research and the epistemic justice of disclosure”

The multiple disciplines and epistemic communities of the drug research broad landscape outline the context of what we collectively and officially “know” about drug use. While there is a growing body of ethnography with people who use drugs (PWUD), researchers who are themselves out as drug users—and their unofficial expertise—are largely absent.Miranda Fricker's “epistemic injustice” framework (2007) illuminates this knowledge deficit, describing an inability to conceptualize a person's experience due to historic marginalization from the very knowledge-making that defines that experience. The disclosure of lived experience in self-reflexive critique offers an authentic way to explore the complex, intersectional politics of drug use, something that is representationally and critically missing in drug studies. Locating the missing “I” in drug research may help drug studies recognize and interrogate the hegemonies of academic discourses that influence the varieties of lived experience important to drug scholarship.     

In vitro assessment of the roles of drug transporters in the disposition and drug–drug interaction potential of olaparib

1.?In vitro assessments were conducted to examine interactions between olaparib (a potent oral inhibitor of poly[ADP-ribose] polymerase) and drug transporters.

2.?Olaparib showed inhibition of the hepatic drug uptake transporters OATP1B1 (IC₅₀ values of 20.3?μM and 27.1?μM) and OCT1 (IC₅₀ 37.9?μM), but limited inhibition of OATP1B3 (25% at 100?μM); inhibition of the renal uptake transporters OCT2 (IC₅₀ 19.9?μM) and OAT3 (IC₅₀ 18.4?μM), but limited inhibition of OAT1 (13.5% at 100?μM); inhibition of the renal efflux transporters MATE1 and MATE2K (IC₅₀s 5.50?μM and 47.1?μM, respectively); inhibition of the efflux transporter MDR1 (IC₅₀ 76.0?μM), but limited inhibition of BCRP (47% at 100?μM) and no inhibition of MRP2. At clinically relevant exposures, olaparib has the potential to cause pharmacokinetic interactions via inhibition of OCT1, OCT2, OATP1B1, OAT3, MATE1 and MATE2K in the liver and kidney, as well as MDR1 in the liver and GI tract. Olaparib was found to be a substrate of MDR1 but not of several other transporters.

3.?Our assessments indicate that olaparib is a substrate of MDR1 and may cause clinically meaningful inhibition of MDR1, OCT1, OCT2, OATP1B1, OAT3, MATE1 and MATE2K.     

‘Breaking the Cycle’ of maternal substance use through relationships: a comparison of integrated approaches

Background: To compare a novel relationship-focused intervention (RFI) for maternal substance use, offered through ‘Breaking the Cycle (BTC)’, to standard integrated treatment (SIT). Although SIT focuses on the mother–child relationship tangentially by providing basic parenting information, RFI involves a central focus on promoting healthy maternal relationships with a particular emphasis on fostering mother–child interactions.

Method: Measures in the domains of addiction, relationship capacity, and mental health were administered to 65 women receiving RFI and 25 receiving SIT, at intake (T1) and one year later (T2).

Results: While both groups of mothers improved in addiction severity, women receiving RFI also improved in mental health functioning and relationship capacity. Improvements in relationship capacity predicted addiction severity, over and above improvements in abstinence self-efficacy, social support, and mental health.

Conclusions: Findings highlight the importance of a relationship-focus in assisting mothers to make broad changes that support addiction recovery. Implications and future directions are discussed.     

‘Following the money’: The political economy of gambling research

Although clear relationships have been identified between dependent drug use and crime, the relationship is less evident in young offenders, particularly for less physically dependent users. This study investigated a sample of young drug-using offenders (aged 18–24; n = 36) accessing drug treatment through the criminal justice system in Birmingham, UK, using structured interviews for the collection of both qualitative and quantitative data. It identified high levels of heroin dependence, with frequency of use linked to both acquisitive crime and willingness to engage in treatment. The relationship between crack cocaine use and offending was less clear with more client ambivalence regarding desire to stop using the drug. Whilst most praised their treatment, and their workers, substitute prescribing was less positively endorsed. The study offers some support for diverting young dependent opiate users from criminal justice services into drug treatment, but presents a less positive prognosis for primary stimulant users.     

The presenilins as potential drug targets in Alzheimer’s disease

Alzheimer’s disease (AD) is a major neurodegenerative disorder affecting a large proportion of the elderly. Given the increasing life expectancy in developed countries, the generation of new drugs to treat AD represents one of the major challenges for the pharmaceutical industry in the coming decades. Central to the disease is the abnormal processing of amyloid precursor protein (APP) resulting in the release of the β-amyloid peptide (Aβ), the major constituent of plaques in the brains of AD patients. Mis-sense mutations causing AD have been found in the APP gene, and more recently in the presenilin genes. Remarkably, all mutations investigated cause an increased production of a particular form of the Aβ that is more prone to precipitation. Presenilins, which are multi-membrane spanning proteins, appear to specifically regulate the production of Aβ by controlling the intramembranous proteolytic cleavage of APP. Inhibition of presenilin is therefore an obvious drug target, although side-effects caused by interference with the processing of other proteins, including notch, have to be considered.