National Documentation Centre on Drug Use
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Behavioural effects and naloxone effectiveness with new synthetic opioids.
No full textINTRODUCTION: The global drug market has seen an emergence of potent synthetic opioids, including benzimidazole-derived substances known as nitazenes. These compounds have been implicated in fatal and non-fatal overdoses. This review aims to synthesise current evidence on the pharmacological effects, potency and naloxone responsiveness of new synthetic opioids, with a focus on synthetic opioids evaluated for international control since 2020. It highlights key findings that can inform our understanding of these substances and inform harm reduction strategies.
METHODS: A narrative review was conducted using critical reviews from the World Health Organization Expert Committee on Drug Dependence and supplementary literature. Data extraction focused on pharmacological profiles, behavioural effects, potency estimates, and naloxone effectiveness.
RESULTS: Thirteen synthetic opioids were examined, with potencies ranging from similar to morphine to exceeding that of fentanyl. Naloxone demonstrated efficacy in reversing overdose symptoms for most substances, although higher doses or infusions were occasionally required.
DISCUSSION AND CONCLUSIONS: The variability in nitazene potency and common unintended use underscores the need for widespread education, broad naloxone access and robust drug-checking initiatives. Key challenges include the detection of nitazenes in polydrug contexts and their presence in substances sold as other drugs, including falsified pharmaceuticals. Emerging evidence suggests that naloxone can reverse acute poisonings with benzimidazole opioids. However, no studies have examined the effectiveness of medications for treating opioid use disorder (e.g., methadone, buprenorphine, naltrexone) in people who are physically dependent on nitazenes. Future research should address this important knowledge gap
Effectiveness, acceptability, and feasibility of naloxone in carceral settings: a scoping review.
No full textBACKGROUND: Opioid dependence is highly prevalent within incarcerated populations, with one-fifth of all drug overdose deaths occurring among formerly incarcerated individuals. Opioid antagonists are promising in reversing overdoses, with naloxone widely recognised as a rapid and safe treatment for opioid toxicity. While community-based evidence demonstrates the efficacy of naloxone in reducing overdose deaths, its implementation in carceral settings is neither standardised nor embedded.
OBJECTIVE: This scoping review aims to systematically assess the acceptability, feasibility, and effectiveness of naloxone interventions in prisons and other detention settings globally, with the explicit goal of identifying research gaps and generating evidence to inform global prison policy, practice and future implementation research.
METHODS: A scoping review was conducted following Arksey and O'Malley's framework. Literature searches were performed in PubMed, Scopus, and Embase for English-language records published between 2000 and 2025, in line with the PRISMA Extension for Scoping Reviews guidelines. Data were analysed using narrative synthesis as informed by Popay et al. RESULTS: Of the 1764 records initially identified, 24 records met the inclusion criteria. Three themes and associated sub-themes were identified. They were (a) current provision (naloxone distribution and benefits; Take-Home Naloxone programmes on community release; naloxone (intranasal) within carceral settings; rollout of naloxone vending machines), (b) population satisfaction (acceptability and feasibility; implementation readiness) and (c) organisational factors (barriers and challenges; facilitators and suggestions).
CONCLUSION: Naloxone provision in carceral settings is acceptable, feasible, and effective in preventing opioid overdoses during incarceration and after release. Strong support exists among prisoners and staff, yet significant gaps remain, particularly regarding use in vulnerable populations such as women, younger individuals, and immigration detainees. Integrating naloxone into prison health systems, alongside staff training and peer engagement, is a critical step in reducing preventable overdose deaths and enhancing continuity of care post-release
Feelings of guilt and remorse after alcohol consumption among people who drink at increasing and higher-risk levels: a population study in England.
No full textINTRODUCTION: Feelings of guilt and remorse after drinking alcohol may act as barriers to seeking support. This study aimed to estimate the prevalence and frequency of such feelings among adults in England who drink at increasing and higher-risk levels, and differences by socio-demographic and drinking subgroups.
METHODS: We analysed data from 40,708 adults (≥ 18 years) who drink at increasing and higher-risk levels (AUDIT-C score ≥ 5) from a monthly cross-sectional survey in England from 2014 to 2022. Feelings of guilt and remorse after drinking in the past 6 months were assessed using the AUDIT. Logistic regression models were used to examine associations with socio-demographic characteristics, alcohol consumption and harm to oneself or others as a result of drinking.
RESULTS: Overall, 13.3% (95% CI 12.9%-13.6%) reported experiencing feelings of guilt or remorse after drinking in the past 6 months. Among those who reported such feelings, 95.3% (95% CI 91.4%-94.9%) experienced them less than once a month. The prevalence of guilt and remorse increased non-linearly with higher AUDIT-C scores from 9.3% (95% CI 8.8%-9.9%) among those drinking at the lightest levels within the increasing/higher-risk range [AUDIT-C = 5] to 20.9% (95% CI 17.2%-24.8%) among the heaviest [AUDIT-C = 12]. After adjusting for alcohol consumption and alcohol-related injury, these feelings were more common among women (aOR 1.38; 95% CI 1.31-1.46) and people from more advantaged social grades (aOR 1.27; 95% CI 1.20-1.36), and much less common among older than younger adults (e.g., ≥ 65 vs. 16-24 years: aOR 0.23; 95% CI 0.20-0.26).
DISCUSSION AND CONCLUSIONS: In England, around one in eight adults who drink at increasing and higher-risk levels report experiencing guilt or remorse after drinking. These feelings are more common in women, younger adults and those of a more advantaged social grade
Disease burden attributable to intimate partner violence against females and sexual violence against children in 204 countries and territories, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.
No full textBACKGROUND: Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels.
METHODS: We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor.
FINDINGS: Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023.
INTERPRETATION: IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors
Joint Committee on Drugs Use debate - European perspectives on legal, policy and operational responses to drug use: discussion.
No full textBarriers and facilitators of implementation of liver screening in an outreach-based care pathway for people experiencing homelessness and substance use disorders: a qualitative study of clinicians' and stakeholders' perspectives.
No full textBACKGROUND: People experiencing homelessness face disproportionate rates of liver disease, yet are often excluded from mainstream healthcare services. Vibration-Controlled Transient Elastography (VCTE) is a non-invasive method for liver screening increasingly used in community settings. However, evidence on implementing such screening pathways in outreach services remains limited. This study explored the views of clinicians and stakeholders on the barriers and facilitators to implementing a VCTE liver screening pathway within an assertive outreach drug and alcohol service in North West England.
METHODS: A qualitative design involving semi-structured interviews was used to explore the implementation of the pathway. Twenty participants, including frontline clinicians and stakeholders involved in service design, commissioning, and delivery, were interviewed. Data were analysed using Framework Analysis guided by the Consolidated Framework for Implementation Research (CFIR). Both deductive coding using CFIR domains and inductive coding were applied.
RESULTS: Key barriers included training costs, capacity within hepatology services, patients' difficulties in accessing healthcare, and uncertainties around continuity of funding. Facilitators included the immediate feedback provided by VCTE supporting harm reduction advice, targeted initial funding for services supporting people experiencing homelessness, a strong team culture of person-centred care, staff motivation, and the flexibility of the outreach delivery model. Challenges around interpreting results and navigating referral processes highlighted the need for stronger cross-sector collaboration and workforce development.
CONCLUSIONS: Integrating liver screening into outreach-based drug and alcohol services was considered acceptable by staff and stakeholders when supported by interagency partnerships, targeted funding, and motivated staff. Future implementation efforts should prioritise keyworker training and enhanced communication between drug and alcohol and hepatology services
Professionalism, professional identity and community pharmacy culture: The context of substance dependency through the lens of student and early career pharmacists.
No full textAIMS: This study aimed to explore the reflections of student and newly qualified pharmacists (NQPs) surrounding community pharmacy culture around substance dependency. This study explored professionalism and professional identity formation, and the possibility that a fragmented professional identity may impact behaviours and the provision of compassionate care.
DESIGN: Qualitative study: semi-structured interviews were conducted with student and exploring stigma within community pharmacy environments in relation to people with substance dependency, the community pharmacy culture and their own ideas of professionalism and their professional identity formation. Interviews were undertaken by six pharmacy student researchers, under the supervision of two experienced researchers.
SETTING: Community pharmacies across Scotland.
PARTICIPANTS: Twenty-eight participants were recruited, including undergraduates based at Scottish Schools of Pharmacy (n = 20); Foundation Year Pharmacy students (n = 2) and NQPs (n = 6). Recruitment utilised university networks and social media platforms.
MEASUREMENTS: Interviews were conducted between September and November 2023 on Microsoft Teams®, each lasting 17-60 minutes. Data underwent inductive thematic analysis via NVivo® through data familiarisation, initial coding, theme searching, reviewing and defining and reporting.
FINDINGS: Stigmatisation of people with substance dependency attending a pharmacy was a prominent observation. This included negative stereotyping, adverse treatment because of judgements made about substance use and structural stigma relating to barriers to accessing care. Positive care provision in pharmacies was evident. Pharmacy staff who were empathetic, respectful, professional and who formed long-term relationships with people with substance dependency were valuable role models for students and influenced their professional identify formation. Students appreciated the exposure to practice and the opportunity to make judgements that would mould the type of pharmacist they aspired to become. A number of participants reported that their university course poorly prepared them for the reality of supporting people with substance dependency.
CONCLUSIONS: Pharmacy practice in Scotland appears to be characterised by stigma and lack of professionalism towards people with substance dependency, although there are examples of compassionate care. Observing staff in practice allowed participants of this study to develop their own professional identity and attitudes, yet there is a need to better prepare students in undergraduate curricula
Exploring the impact of stigma on the health of inclusion health groups: a qualitative scoping review and critical analysis.
No full textBACKGROUND: Health inequalities have widened globally over the past decade, disproportionately affecting socially excluded populations broadly defined as 'inclusion health groups'. These groups, including people experiencing homelessness, migrants, sex workers, people with substance use disorders, victims of modern slavery, and those in contact with the justice system, face compounded negative health consequences often exacerbated by stigma. This scoping review aimed to examine qualitative literature exploring how stigma impacts the physical and mental health of inclusion health groups. Building on the work of Link and Phelan, Tyler, and Hatzenbuehler, this review situates stigma as a relational and structural process that operates through power, policy, and institutions to shape health outcomes among inclusion health populations.
METHODS: The review focused on identifying how stigma is conceptualised across inclusion health groups and how it functions as a shared mechanism influencing health, health behaviour, and access to care. Following the PRISMA-ScR framework, we searched Scopus, OVID Medline, and PsycINFO for qualitative studies published between 01/01/2015 and 15/03/2025. Titles, abstracts, and full texts were screened, resulting in 28 articles included for analysis.
RESULTS: Stigma was consistently identified as a barrier to healthcare access, leading to delayed treatment and worsening physical and mental health outcomes for inclusion health groups. The literature disproportionately focuses on people who use drugs, with limited research addressing other inclusion health groups, highlighting significant gaps in the field. Furthermore, existing conceptualisations of stigma frequently neglect its structural determinants, risking reinforcement of individualised explanations for poor health rather than addressing systemic drivers of inequality.
CONCLUSIONS: This review demonstrates that stigma contributes to health inequalities by limiting healthcare access and shaping negative health outcomes. There is an urgent need for research that investigates stigma's long-term health effects and moves beyond individual-level interventions to address broader structural forces perpetuating health inequalities. Future work should more explicitly engage with the concept of structural and political stigma, recognising that public health research must interrogate the upstream determinants, such as policy, governance, and social organisation, that sustain exclusion and health inequity