“Anti-Latino bias as a motivator for drug-induced homicide law support in the United States: Evidence from a nationally representative, randomized survey experiment”

Kim Gannon; Talk

Research suggests that the resurgence of drug-induced homicide (DIH) law popularity in the United States is a means of differentially targeting people of color for drug enforcement in a context where it is increasingly unpopular to criminalize people who use drugs. Using a survey experiment on a nationally representative sample of US adults varying the race/ethnicity of a male PWSD in a mock press release (White, Black, Latino, unnamed race), we examined the relationship between racialized narratives of PWSD and support for DIH laws. Respondents rated the extent to which they support the law, the extent to which the PWSD should receive extra jail/prison time, whether they expect the law to deter drug sale, and whether they believe the law is morally justified. We used linear probability and ordered logit models to identify treatment effects while controlling for demographic factors like gender, education, and political party affiliation.

Compared to respondents shown any other PWSD, those shown a Latino PWSD were more likely to support the law (Latino-unnamed b=0.042, p<0.10; Latino-white b=0.053, p < 0.05; Latino-Black b=0.051, p<0.05) and to believe that the law is morally justified (Latino-unnamed race 0.038, p<0.10; Latino-white 0.048, p<0.05, Latino-Black 0.051, p<0.05), but not to believe that it will deter sale. They also supported higher levels of punishment (ordered logit: Latino-unnamed OR=1.18, p<0.10; Latino-white OR=1.33, p<0.05; Latino-Black OR=1.28, p<0.05). Among white, non-Hispanic respondents, we likewise saw positive differences in law support (Latino-White b=0.046, p<0.10, Latino-Black b=0.055, p<0.05), belief that the law is morally justified (Latino-Black 0.044, p<0.10), and punishment level (ordered logit: Latino-White OR=1.31, p<0.05; Latino-Black OR=1.22, p <0.10). Among Hispanic respondents, negative differences were detected in law support (Latino-Black b=-0.236, p<0.10), belief that the law will deter sale (Latino-unnamed b=-0.348, p<0.01), belief that it is morally justified (Latino-unnamed b=-0.224, p<0.10; Latino-Black b=-0.231, p<0.10), and punishment level (ordered logit Latino-unnamed OR = 0.388, p<0.10). This suggests that findings were likely driven by white, non-Hispanic respondents, as Black non-Hispanic respondents showed few statistically significant differences, and Hispanic respondents showed opposite-signed results.

“A public health approach to reducing methamphetamine harm in Aotearoa New Zealand”

Rose Crossin; Talk

Background: Methamphetamine is a significant contributor to drug harm in Aotearoa New Zealand. Social and community damage are significant components of this harm, and this is experienced inequitably by Māori communities. In our project, we aim to identify programs and approaches that aim to reduce social and community harm, and those that incorporate Māori (indigenous) perspectives. Specifically, we aim to answer; what would a public health approach to methamphetamine look like in practice, in Aotearoa New Zealand?

Methods: We conducted a systematic search of recent systematic reviews related to reducing methamphetamine-related harms (part one, complete), and of recent studies pertaining to indigenous and select harm reduction approaches to reducing methamphetamine related harm (part two, complete). This was conducted to provide an up-to-date synopsis of the evidence to guide a scenario planning exercise (part 3), using back-casting to outline the steps towards a public health response to methamphetamine in Aotearoa New Zealand.

Results: Our initial search yielded 1301 deduplicated records. The full texts of 123 records were assessed, resulting in 57 inclusions. Four additional records were included after supplementary searching, totalling 61 included studies. Only 6 studies related to indigenous approaches. Within most of the included systematic reviews of RCTs, abstinence was the most common primary outcome. In contrast, harm reduction approaches that do not have this primary aim still lead to significant benefits for people who use methamphetamine, including reductions in use. This is a particularly important knowledge gap in Aotearoa New Zealand, given that both treatment and education interventions have mixed findings on efficacy.

Conclusion: The paucity of findings relating to indigenous approaches to methamphetamine harm reduction is a clear research gap. Given the importance of culturally informed practice for both cultural safety and treatment efficacy, future research endeavours for (and led by) indigenous people ought to be prioritised to reduce these inequities. Similarly, little research was found that focussed on supporting others who are close to an individual who consumes methamphetamine, with only two studies included from a single review on this topic. Given the support that families often provide within the context of substance dependence, particularly among Indigenous populations, significantly more research attention should be focused on enabling families and caregivers to support their loved ones who use methamphetamine.

“Baseline assessment of cannabis contaminants in Dutch coffeeshops: insights from the Controlled Cannabis Supply Chain Experiment (EGC)”

Pieter Oomen; Talk

The Controlled Cannabis Supply Chain Experiment (Experiment Gesloten Coffeeshopketen, EGC) aims to evaluate the feasibility and public health impact of supplying decriminalized, quality-controlled cannabis to coffeeshops in ten Dutch municipalities. In preparation for the experiment, an exploratory baseline study was conducted to assess the prevalence of contaminants in cannabis currently available in the Netherlands. A total of 105 samples, comprising resin (hashish) and floral (weed) cannabis, were purchased from Dutch coffeeshops and analyzed for aflatoxins, heavy metals, micro-organisms, and pesticides.

Results showed no instances of aflatoxin concentrations exceeding the established limits for the EGC. However, 20% of weed samples displayed microbiological transgressions, with unclear origins and potential health impacts. Notably, one hashish sample contained lead concentrations above the allowable threshold, warranting attention despite the limited health risks associated with the detected level. Pesticides not permitted within the EGC were found in 34% of the analyzed samples, yet calculated consumer exposures were significantly below acceptable daily intake levels. Exposure to these concentrations of pesticide residues probably does not lead to additional health risks.

This baseline assessment highlights the importance of quality control in cannabis production and underscores the potential of regulatory frameworks like the EGC to mitigate public health risks associated with contaminated cannabis. These findings provide valuable insights for policymakers, public health officials, and stakeholders in the cannabis supply chain.

“Cannabis Harm Reduction Associations in Malta: Civil Society, Social Harm, and the Politics of Drug Policymaking”

Felipe Neis Araujo; Talk

In December 2021, the Maltese government passed the Authority on the Responsible Use of Cannabis Act. This measure legalised adult recreational cannabis use, cannabis harm reduction associations (social clubs) and a new regulatory body to oversee and monitor policy change. The reform marks Malta as a key actor in the ‘second wave’ of drug decriminalisation initiatives that began in the 2010s (Eastwood et al. 2016). These parallel earlier shifts in the Netherlands and parts of the US in the 1970s. Current reforms reflect local deviations from the international drug criminalisation regime. Unlike the ‘first wave’, however, the current reforms take place within a more complex global landscape, characterised by increasing civil society engagement and reduced state capacity for coercion.

This paper investigates the political process that led to cannabis legalisation in Malta and the establishment of cannabis harm reduction associations. Based on semi-structured interviews conducted in 2022 with politicians, civil servants, academics, activists, and drug treatment professionals (N=12), our research highlights the contingent nature of the reform process. While the legalisation of cannabis represents a significant policy shift, the findings reveal that these reforms were shaped by compromises that have resulted in both progressive and problematic outcomes. A key point of resistance has been the continued influence of the UN drug control regime, which serves as a reference for conservative opposition.

Our analysis concludes that cannabis policy reform in Malta was driven by a confluence of factors, including domestic social change, civil society advocacy, political leadership, and shifting trends in international drug policy. However, these changes remain vulnerable, dependent on specific political conditions rather than a broader normative shift. The fragility of cannabis reform underscores the need for deeper institutional and societal commitment to sustain long-term change that must centre harm reduction as state policy rather than party policy.

“Cross-sectional analysis of cannabis use at work in the United States: differences by occupational risk level and state-level cannabis laws.”

Ava Kucera; Talk

Background: Recreational cannabis legalization has potentially important implications for occupational health and safety, as cannabis use at work has been associated with work-related injuries. However, little research examines the extent that cannabis legalization impacts trends in workplace cannabis use.

Objective: The current study analyzed the prevalence of cannabis use at work, including by state-level cannabis laws, occupational risk, and medical cannabis use.

Methods: Data are cross-sectional from wave 6 (2023) of the International Cannabis Policy Study and includes 26,458 respondents from the US. Regression models examined trends in workplace cannabis use across state-level cannabis laws, occupational risk, reasons for cannabis use and sociodemographic characteristics among all workers, past 12-month consumers, and consumers from states with legal medical cannabis.

Results: Overall, 7.8% of workers and 20.9% of past 12-month cannabis consumers reported using cannabis at or within two hours of work in the last 30 days. Workplace cannabis consumption was highest among workers in states with ‘recreational’ cannabis laws than medical (OR=1.37, p=0.004) or illegal states (OR=1.51, p<0.003). Workers in high-risk jobs were more likely to use cannabis at work than those in lower risk jobs (OR =1.60, p<0.001). Workplace cannabis use was also greater among those using cannabis for medical versus recreational (OR = 2.36, p < 0.001) or mixed reasons (OR = 1.74, p<0.001).

Implications: Results suggest that cannabis use in the workplace is prevalent, particularly in occupational settings with greater safety concerns. The findings highlight the need for greater research and understanding of substance use in the workplace.

“Differences in substance use treatment receipt, perceived treatment need, and barriers to receiving treatment among adults with and without disabilities.”

Roberto Abadie; Talk

Background
People with disabilities (PWD) are at higher risk of experiencing substance use (SU) disorders than those without a disability. While treatment for SU reduces mortality and morbidity, currently, there are no national-level studies examining differences between US adults with and without disabilities in terms of SU treatment receipt, perceived need for treatment, and barriers to receiving treatment. To fill this gap, we employed data from the most recent National Survey on Drug Use and Health (NSDUH-2022).

Design
This cross-sectional study examined NSDUH-2022 data (n=45,546 adults) on self-reported disability and past-year SU disorder, SU treatment, unmet treatment need, and treatment barriers. Analyses included weighted prevalence estimates, chi-squared tests (corrected for the survey design), and binomial logistic regression.

Results
An estimated 11.8% of adults with a disability, versus 3.8% without a disability, reported past-year SU treatment. For adults with a past-year SU disorder who did not receive treatment, reporting a disability was associated with nearly double the odds (Adjusted Odds Ratio [AOR] 1.94; 95% Confidence Interval [CI], 1.312.87) of “unmet need” for SU treatment (after adjusting for demographics). Among adults who reported an “unmet need” for SU treatment, barriers related to cost and stigma were reported more frequently in those with, compared to without, a disability.

Conclusions
Findings highlight elevated SU treatment need and barriers for adults with disabilities. Understanding the intersection of disability with the cascade of care from access to screening to diagnosis and treatment of SU among PWD is critical to improving health outcomes in a deeply marginalized and stigmatized population.

“Do gangs monopolise illegal drug markets in small towns?”

Chris Wilkins; Talk

Background – Some small rural towns in New Zealand are said to be the exclusive territory of specific gangs with reputations for violence. Gangs are often depicted as heavily involved in the selling of methamphetamine and cannabis in NZ. Does this mean that gangs use their command of violence to establish a monopoly over sale of drugs in their town territories? Economic theory would predict that such a monopoly would manifest in gangs charging higher drug prices where they are the only seller and dominate the market.
Aims – Identify predictors of higher prices for drugs including extent of gang involvement in drug selling in small town locations.
Methods – An anonymous online convenience drug survey (New Zealand Drugs Trends Survey) was broadly promoted via Meta™ platforms (Facebook, Instagram) from August 2022 to February 2023, achieving a final sample of 13,026. Respondents were asked about the purchasing different drugs including the extent to which gangs control the sale each drug type (1=none-5=only gangs), how many different gangs were selling in the area (1=many-4=one), perceptions of the level of influence of gangs in their neighbourhood (1=none-7=very) and whether the buyer lived in a small town, rural area or city. Statistical models were used to identify predictors of the prices of methamphetamine, cannabis, ecstasy and LSD while controlling for a range of socio-economic, gang influence, and drug use variables.
Results – The price of meth significantly increased as the number of gangs involved selling in a locality decreased and the level of perceived gang influence in a locality increased. Gang involvement and influence did not predict the price of either ounces or pounds of cannabis. The price of LSD increased with the level of gang control of selling. The price of MDMA significantly increased as the number of gangs involved selling in a locality decreased. Small town location did not predict the price of any of the drug types.
Conclusions – Gangs had the greatest influence over meth, LSD and MDMA prices, but no influence over cannabis prices. Gang influence was strongest when a single gang was involved in selling in an area, but small-town location did not change the level of influence over price.

“Drug, Race and Gender: Black Women and Girls' Experiences of Drug Policing”

Bisi Akintoye; Talk

As the debate on how to improve the relationship between the police and Black communities continues, frequent and often hostile drug policing remains an inescapable part of life for many Black Britons. Much of the discussion surrounding drug policing focuses on the experiences of Black males, and the experiences of Black women and girls remain relatively unexplored. This paper analyses the historical and contemporary drug policing experiences of Black women and girls to gain insight into how drug policing drives racial disproportionalities in the CJS. Using data from 58 semi-structured qualitative interviews with young people, adults/elders and community workers residing in a north London suburb, it explores the lived experience of racialisation and criminalisation of Black women and girls through drug policing. The data illustrates that Black women and girls experience racially disproportionate stop and search, which is mediated by factors such as age, class and immigration histories. This intersectional analysis of drug policing provides important insights into how Black women and girls experience drug policing, and develop narratives about the police not only due to direct police encounters, but also vicarious policing experiences in their communities. This has significant implications for the present and future relationship between the police and Black Britons, representative of the experience of Black Britons in the British state.

“Drug use, perceived stigma, inequality, and poaching in Taiwan”

Lanying Huang; Talk

Under Taiwan's current drug policy, which prioritizes abstinence, drug users continue to face severe stigmatization. This stigma is further intensified by the perceived link between drug use and criminal behavior. In Taiwan, it is widely acknowledged that a significant proportion of incarcerated individuals are either current or former drug users. However, the mechanisms driving this group's recidivism remain insufficiently explored.
This study employed interviews with 80 native poachers (including 30 indigenous people) and 12 Vietnamese poachers to investigate the interplay between drug use, perceived stigma, and poaching. Findings reveal that perceived stigma is more strongly associated with drug use than poaching. Individuals with a history of drug use prior to engaging in poaching often either dissociate their drug use from poaching or view poaching as a less stigmatized activity compared to drug use.
Interestingly, some participants admitted that drug use and poaching reinforce each other, with poaching providing the financial means and environment conducive to drug use, while drugs serve as tools to facilitate poaching activities. Notably, certain individuals began using drugs only after entering the poaching trade, as substances were used to endure the physical demands of labor-intensive work and nocturnal activities.
This study underscores the complex dynamics between drug use, stigma, and criminal behaviors such as poaching. Addressing these issues requires a more nuanced policy approach that goes beyond abstinence goals to consider the socio-economic and cultural contexts driving such behaviors. Future interventions should prioritize reducing stigma and providing holistic support to break the cycle of drug use and criminal activities.

“Examining Factors related to Cannabis Consumers Perceptions of Healthcare Provider Stigma”

Ashley Hosker-Field; Talk

The recent legislative review of the Canadian Cannabis Act indicated that despite legalization of both medical and recreational use, cannabis consumers continue to experience stigmatization and report challenges accessing knowledgeable/supportive healthcare providers (2024). The current research examined factors related to cannabis consumers perceptions of stigma among medical professionals and the impact of perceived stigma on an individual’s likelihood to trust and consult a medical professional about their cannabis use. Researchers surveyed 1531 cannabis consumers and assessed length/frequency of cannabis consumption, reason for use, trust in medical professionals to provide accurate cannabis-related information, and perceived cannabis related healthcare provider stigma. Results indicated women, younger individuals, and longer and more frequent cannabis consumers perceived more cannabis-related stigma among healthcare providers. Additionally, cannabis consumers that indicated using for medical reasons only, reported significantly less perceived stigma than those that use cannabis for solely recreational or recreational and medical purposes. Further analyses revealed that cannabis consumers with increased perceptions of cannabis related healthcare provider stigma were less likely to consult with medical professionals about their cannabis use because they have less trust in healthcare professionals to provide accurate cannabis-related information. Findings highlight the need to identify strategies to decrease perceptions of stigma surrounding cannabis use in healthcare settings. Moreover, identifying strategies to increase cannabis consumers trust in the accuracy of cannabis knowledge among medical professionals may help to counteract the negative impact of perceived stigma on likelihood to consult healthcare providers about cannabis use, potentially contributing to more mindful and beneficial cannabis consumption practices.

“FROM BUDAPEST TO BRUSSELS: Discursive and Material Failure in Mobile Drug Policy”

Cristina Temenos; Talk

Using the case of harm reduction drug policy in Budapest, I demonstrate how a successful drug policy was made to fail at the local and national scales, and how that failure in turn spurred the mobility of harm reduction’s implementation across scales and into the European Union’s Drugs Strategy. I show how focusing on policy failure exposes the politics of making and mobilizing urban drug policy, and how an analysis of failure can uncover unforeseen effects of the local politics of policy mobility. This paper introduces an analytic of discursive and material failure, developing a spatial grammar for analysing both the discursive framing of policies as failed and the actually existing processes and effects of failed policy. Analysing failure as both discursive and material allows scholars to break down policymaking processes into the political and practical elements assembled in policy mobilization. Discursive policy failures take into consideration the framing and accounting of actions, events and processes, while analysis of material failure begins with seemingly fewer political questions because of its focus on the technical. I argue that it is in understanding the relationship between material and discursive failure that the politics of urban policy mobility becomes a central question.

“Gender identity and cannabis use in Canada and the United States”

Anastasia Marquette; Talk

Background: Few population-level cannabis studies integrate analyses of sex and gender. Therefore, little is known about how patterns of cannabis use differ by gender identity, including individuals with transgender or gender-diverse identities.
Objectives: To examine gender identity differences in patterns of cannabis consumption and indicators of problematic cannabis use, including perceived addiction, positive and negative effects (e.g., mental health, work), and comfort consuming cannabis in social settings.
Methods: Data come from the International Cannabis Policy Study’s national repeat cross-sectional surveys, conducted annually between 2018-2023 in Canada and the United States. Analysis of 281,533 respondents, including 1,161 transgender men, 1,284 transgender women, and 783 people with gender-diverse identities, was undertaken. Weighted logistic and linear regression models examined differences by gender identity.
Results: Approximately one-quarter of men, transgender men, and transgender women reported being ‘a little addicted’ to cannabis, and 12% reported being ‘very addicted’. Women (6%. OR=0.57, CI95=0.53-0.62, p<.001) and people with gender-diverse identities (6%. OR=0.47, CI95=0.24-0.91, p=.025) were less likely to report being ‘very addicted’ compared to men. People with gender-diverse identities reported greater positive personal effects from cannabis compared to men (B=0.53 CI95=0.21-0.86, p=.001), with no difference between men, women, transgender men, and transgender women. Comfort consuming cannabis across social settings was lower among women than men (B=[-0.21], CI95=[-0.23]-[-0.19], p<.001), with no differences between men, transgender men, and transgender women.
Implications: Frequent and problematic patterns of cannabis use were more common among men, transgender men, and transgender women. These disparities signal need for tailored policy change, education, and support.

“Has there been an interruption in fentanyl supply? Insights from Reddit”

Peter Reuter; Talk

The sudden and substantial decline in the number of fatal overdoses involving the synthetic opioid fentanyl in the USA, in the 12 months July 2023 to June 2024, has generated many hypotheses about causes. Possible causal factors include 1) a diminution in the pool of susceptibles as a result of high fatality rates amongst regular opioid users (2) the effects of harm reduction programs, notably the wide distribution of Narcan and (3) interruptions to the supply as the result of aggressive law enforcement against Mexican producers and traffickers. In the absence of regular and reliable measures of the state of the market, we test the hypothesis that the supply has been reduced by examination of comments on Reddit. Threads on three subreddits r/fentanyl, r/heroin, r/opiates) were examined for the frequency with which market condition related comments indicated shortages in the periods January 2020 to June 2023 and July 2023 to October 2024. For example, in r/fentanyl the term “drought” was hardly used at all in the first period (appearing in 18 of 13,682 threads) but appeared in 143 out of 3,993 threads in the second period. Analysis of terms indicating higher price and lower quality supported this finding. The analysis provides support for the claim that market conditions have tightened in the period July 2023 to late 2024, perhaps contributing to the decline in fatal overdoses.

“Impact of Canada’s Cannabis Act on drug- and alcohol-related collisions in Quebec: an interrupted time-series analysis of five major cities”

Jose Ignacio Nazif Munoz; Talk

Objective. Cannabis use impairs motor vehicle operation, yet its broader effects on traffic collisions following legalization remain unclear. This study evaluates the impact of Canada's Cannabis Act (CCA) (2018), regulating non-medical cannabis use, on traffic collisions in Quebec, focusing on overall, alcohol-related, and drug-related collisions, and incorporating data on monthly cannabis sales.
Methods. We conducted interrupted time-series analyses using Poisson regression to examine daily traffic collision rates (overall, alcohol-related, and drug-related) per annual average daily flow (AADF) in Quebec from 2015 to 2022. The AADF, representing the average number of vehicles passing a given location daily, was used as the denominator in rate calculations. Analyses were performed in five major cities: Montreal, Quebec City, Sherbrooke, Laval, and Longueuil. We investigated associations between the CCA’s implementation and cannabis sales (measured in kilograms sold per month per population) with changes in collision outcomes. Meteorological factors (e.g., temperature, precipitation) and non-pharmaceutical public health measures during the COVID-19 pandemic were controlled for.
Results. The associations between cannabis-related policies and collisions were evaluated using Incidence Rate Ratios (IRRs). In Montreal, cannabis sales were associated with a non-significant increase in overall collisions (IRR = 1.005, 95% CI: 0.988–1.023). In Quebec City, cannabis sales were linked to a similar non-significant increase (IRR = 1.012, 95% CI: 0.966–1.031), and in Sherbrooke, the trend persisted (IRR = 1.007, 95% CI: 0.987–1.028). Laval also experienced a non-significant increase (IRR = 1.015, 95% CI: 0.978–1.033), while Longueuil showed no change (IRR = 0.900, 95% CI: 0.740–1.092). For drug-related collisions, Montreal showed a non-significant increase (IRR = 1.015, 95% CI: 0.958–1.053), and Quebec City exhibited a non-significant decrease (IRR = 0.990, 95% CI: 0.942–1.022). Similar trends were observed in other cities, with no significant associations identified for either drug- or alcohol-related collisions.
Conclusions. The CCA in Quebec does not appear to have significantly altered overall, alcohol-, or drug-related traffic collision rates. These findings suggest that other factors, such as enforcement, should be studied to better understand the full impact of the CCA.

“Implementing harm reduction practices in an acute care hospital in Halifax, Nova Scotia: a qualitative process evaluation”

Maya Lowe; Talk

Introduction: Hospitals can be dangerous environments for patients who are dependent on criminalized drugs, due to stigma and written or unwritten substance use policies. A group of health care providers and community partners in Halifax have worked to implement harm reduction practices including opioid agonist therapy, needle and syringe distribution, and take-home naloxone kits. In this study, we sought to understand the experiences of health care providers trying to implement harm reduction-oriented care without institutional policy support.

Methods: 10 semi-structured interviews were conducted between October 2024 and January 2025 with purposively selected QEII Hospital staff. People with lived experience using drugs in hospital and hospital staff were engaged throughout the research process. Interview guides were informed by Normalization Process Theory, which considers how beliefs, behaviours, and context impact the implementation of interventions. Data was analyzed using thematic analysis.

Results: We identified themes related to context, mechanisms, and outcomes affecting implementation of harm reduction practices. Contextual factors included medical paternalism, fear, in-hospital resource barriers, and strong community resources. Mechanisms included collective organization, leveraging existing tools, and workarounds. Implementation outcomes affecting practice change include improved provider awareness of resources and champions, culture change, and observation of improved patient experiences and outcomes.

Conclusion: We identified several factors that have impacted the partial implementation of harm reduction practices in a hospital in Halifax. Grassroots groups of healthcare providers and community partners identified workaround mechanisms, reflecting contextual barriers and facilitators. Other institutions can learn from this model of enacting change while waiting for institutional support.

“Leveraging Digital Technologies for Harm Reduction: Opportunities, Challenges, and Global Implications from Scotland’s Experience”

Hadi Daneshvar; Talk

The global healthcare landscape has been significantly transformed by digital technologies, leading to the development and implementation of numerous devices and systems worldwide, including in the UK. However, the adoption of digital solutions in substance use and harm reduction has not progressed at the same pace. Scotland, which has the highest drug-related death rate in Europe, recorded 1,172 drug-related deaths in 2023 (a 12% increase on the previous year), underscoring the critical need for effective interventions.

Digital technologies have shown significant potential in reducing overdose deaths and improving care for individuals who use drugs. For example, the Brave mobile application, developed in North America, provides remote, non-judgmental supervision and support for individuals using drugs alone. This application was piloted in Aberdeen under the name Here4U Scotland. Funded by Scotland's Digital Lifelines program, this initiative aimed to offer virtual supervised consumption as an alternative approach to addressing rising drug-related deaths.

Despite the promise of such technologies, their implementation in Scotland faces challenges due to social and political factors. Barriers include digital inclusion issues, limited user engagement, and the integration of these technologies into existing healthcare frameworks. Overcoming these challenges is crucial for the successful deployment of digital harm reduction tools.

In this paper, we will explore various digital harm reduction projects and examine the opportunities and obstacles associated with digital transformation in this field. By analysing initiatives such as the Here4U Scotland app and others, we aim to provide insights into how digital technologies can be effectively leveraged to address Scotland’s substance use crisis. Furthermore, the findings from these initiatives have the potential to inform the adoption of digital harm reduction tools in other countries, especially those facing similar public health challenges. By understanding Scotland’s experiences, lessons can be drawn to support global efforts in using technology to address substance use issues, improve access to care, and reduce stigma. This exploration also highlights the potential for digital solutions to drive international collaboration and innovation in harm reduction strategies.

“Market revenues and economic opportunities in the legal cannabis market in Uruguay”

Marta Rychert; Talk

Background: The regulated state-controlled cannabis market in Uruguay has received international attention as an alternative to profit-maximising cannabis legalisation models. However, relatively little is known about how this market has been operationalised and the economic opportunities for private citizens. The presentation will lay foundations for the discussions of the economic aspect of social justice beyond North America.
Methods: Using a literature review, document analysis and key informant interviews conducted during recent fieldwork Uruguay (2024), we identify the key actors with a financial stake in the legal cannabis market in Uruguay, outline how they operate, estimate cannabis sector revenues, and reflect on the economic opportunities.
Results: Licensed production companies and pharmacies are key for-profit organisations involved in the recreational cannabis market in Uruguay. With prices, products and market size controlled by the government, the entrepreneurial decisions of licensed producers are limited, resulting in a focus on cost reduction. The production sector is characterised by a small number of companies that operate at economies of scale, illustrating a ‘commoditised’ cannabis market model. The pharmacy-only retail framework has created new revenue for community pharmacists but may hinder the participation of small-scale legacy players. The not-for-profit Cannabis Social Club (CSC) sector has lower entry barriers, and fewer requirements regarding products and prices, but only a few key individuals may benefit financially due to the sector non-profit regulation. Estimates of annual revenues in the licensed production (4-4.8 million USD), pharmacy point-of-sale (1.1-2.2 million USD) and CSC sectors (8-17.7 million USD) will be provided.
Conclusions: Despite not being designed to pursue economic objectives, the state-controlled cannabis market in Uruguay has created commercial opportunities for several actors. Our analysis suggests that this regulation may represent a compromise from an economic and social justice perspective.

“Overdose in Canada and the limits of crisis”

Sarah Larney; Talk

More than 49,000 people have died of opioid overdose in Canada since 2016, with mortality rates escalating year-on-year and reaching 21 per 100,000 population in 2023. The Canadian Drugs and Substances Strategy locates the origins of this trend in the over-prescribing of opioids in the late 2000s, followed by increased diversion of opioids to the illicit market, then a rapid market shift to highly potent synthetic opioids. The present-day drug supply is dominated by fentanyl and characterised in research, advocacy and drug policy as ‘toxic ’ due to the presence of various potent contaminants including xylazine, nitazenes and non-medical benzodiazepines. Despite considerable government investment in responding to this situation, and occasional brief declines in overdose deaths in some regions, there are no signs of significant and sustained reductions in overdose mortality. This situation has been constituted as a ‘crisis’. Following Janet Roitman’s work critically interrogating the stakes of crisis and what the concept of crisis enables, we ask what is being constituted as the crisis in our field at this time, and the multiple effects of this claim. We seek to understand how a focus on the toxic drug supply as central to, or being, the crisis, shapes particular narratives regarding the boundaries and causes of this problem – and therefore also the possible solutions. Drawing on recent epidemiological analyses of persistent growth in overdose deaths pre-dating the conventionally accepted beginning of the overdose crisis in Canada, and reanalysing these findings through critical sociological inquir y, we argue that the dominant framing of the overdose crisis as a relatively recent matter of drug supply and contamination minimises the contribution of broader social and economic drivers of the long-term overdose trend. In doing so, it delineates certain targets for intervention (e.g. access to regulated alternatives to the illicit drug supply), but de-emphasises others (e.g. poverty reduction measures, housing, and social support). Informed by the concepts of slow death and slow crisis, as well as discussions of the social and economic dimensions of the overdose crisis in the United States and Canada, we argue that a reconfiguration of the overdose crisis in Canada may open up new possibilities for attending to the origins and boundaries of this situation, and therefore allow for different, and more equitable and just, responses that seek to address long-standing ecological processes catalysing growth in overdose mortality.

“Relationships between motives for cannabis and cannabidiol use in co-users: results from the European Web Survey on Drugs”

Davide Fortin; Talk

Introduction. Cannabis is one of the most commonly used psychoactive substances globally. It has been shown that motives for cannabis use are related to pattern of use. Cannabidiol (CBD) is a non-intoxicating cannabis compound increasingly used for various purposes, especially among cannabis users. However, there is to date no data on the relationships between cannabis and CBD motives. Understanding such relationships and characterize co-users based on their motives for use can help adapt products characteristics and/or marketing policies to optimize users’ experience.
Methods. We selected cannabis-CBD co-users from the third wave of the European Web Survey on Drugs. We computed Bonferroni-adjusted tetrachoric correlations between cannabis and CBD self-reported motives for use (eight and nine possible motives, respectively). We also computed Spearman’s correlations between number of declared cannabis and CBD motives. Then, we performed an ascending hierarchical classification to identify cannabis-CBD co-user profiles based on their cannabis and CBD motives.
Results. The study sample comprised 15 146 participants (68.1% were men, median age of 26 years). Number of motives for cannabis and CBD use were correlated (Spearman’s ρ=0.49, p<0.001). Similar motives were generally highly correlated between substances. Cluster analysis revealed four different co-user profiles based on cannabis and CBD motives.
Discussion and Conclusions. Users of both cannabis and CBD tend to use them with the same motives. Considering the safe profile of CBD, further research should explore the potential harm-reduction role of CBD products among cannabis users.

“Risk Reduction Strategies and Pleasure Management in snortable drug use”

Nicolás Giacaman Gutiérrez; Talk

This study addresses risk reduction strategies and pleasure management regarding consumption of snortable drugs in a sample of Chilean university students. The research objectives correspond to the identification of the patterns of substance use; the description of the social learning processes of risk reduction strategies; and the identification of the risks and pleasures associated with intranasal drug use in the sample. The working assumptions were that students learn the strategies through their peers, that they use them partially, and that women are more discrete with their use than men. Using snowball sampling, a sample of 10 Chilean university students was formed: 4 men, 4 women and 2 non-binary, with residence in 3 regions of the country. Following the logic of emergent design, a questionnaire was designed and applied in the format of an online or face-to-face semi-structured interview. The transcripts were subjected to a qualitative content analysis, with the support of ATLAS.ti 9 software. The results show patterns of controlled and/or marginal consumption among the students, who learned harm reduction strategies mainly from friends, then family and even dealers. The main substances referred to are cocaine, ketamine and tusi, which have both shared risks and pleasures as well as their own. The results serve as input for public policy and highlight the need for regulation of the recreational drugs market.

“The Belgian refugee reception setting: Substance use and intervention needs”

Charlotte Yolande Luce De Kock; Talk

Background: Refugees face numerous pre, during and post migration risk factors for substance use (SU) such as post-traumatic stress as well as (structural) discrimination. Moreover, Non-Belgian nationals are underrepresented in residential SU treatment (SUT), with language being an exclusion criterion.
Methods: Replicating a European study, DrugInt studied SU patterns among applicants of international protection (AIP), training and intervention needs in the Belgian reception setting. The study employed an online survey completed by 273 respondents, including a representative sample of professionals working for the Federal Agency for the Reception of Asylum Applicants (Fedasil), complemented by 49 qualitative interviews.
Results: Mirroring other EU countries, tobacco, alcohol, and cannabis are the most commonly observed substances used, with notably high levels of non-medical psychotropic medication use. Alcohol-related incidents are the primary SU-related problems in centres. Interventions prioritise safety over evidence-based psycho-social support. When applicants access residential SUT, it typically involves brief admissions to psychiatric (crisis) units.
Conclusions: The study yielded 10 recommendations for various stakeholders, including Fedasil headquarters, reception centres, SUT services, and policymakers. Based on identified reception setting needs, an infographic, information clip, and Basic Drug Training were developed and disseminated to over 130 Fedasil staff. The reception setting is crucial for prevention and early intervention, highlighting the need to address both individual mental health determinants, like coping mechanisms, and structural factors, including housing and asylum procedures. Concerning treatment and harm reduction, structural barriers need to be address to reach equitable access for AIP.

“"The Dead Can't Recover": A Policy Analysis of Ontario's Bill 223”

Sydney Ambury; Talk

Background: Canada continues to experience an opioid crisis, with 21 people dying daily, including seven in the province of Ontario. Harm reduction services have been instrumental in reducing opioid-related harms and improving health outcomes. Despite reducing opioid-related harms, the Ontario government cited community safety concerns to justify reduced access to harm reduction services through Bill 223, the Safer Streets, Stronger Communities Act, 2024. This legislation took effect on April 1, 2025, and mandated the closure of consumption and treatment sites within 200 metres of schools and childcare centres. The majority of closed sites have been replaced by Homelessness and Addiction Recovery Treatment (HART) hubs that are focused on abstinence-based programming.
Objectives: This study aimed to: 1) compare harm reduction and recovery-oriented approaches and 2) propose evidence-based policy alternatives to address the opioid crisis.
Methods: A narrative literature review and policy analysis based on a logic model framework were conducted, integrating data from peer-reviewed research, government reports, and public health evaluations.
Results: Findings indicate that the reduction of consumption and treatment sites due to Bill 223 will exacerbate Ontario’s opioid crisis, leading to increased overdoses, disease transmission, and strain on the healthcare system. While the implementation of HART hubs will focus on recovery-oriented services, they are insufficient to mitigate the acute risks of this crisis. To combat the opioid epidemic in Ontario, a full continuum of substance use services is required, which includes the scaling up of harm reduction along with recovery-based services.

“The Politics of County Lines and Harm Reduction Policing”

Jenna Carr; Talk

The concept of county lines, defined by the National Crime Agency (2015), refers to the distribution of drugs through the exploitation of young and vulnerable individuals by organised crime groups from cities with oversaturated markets to rural and coastal areas with less drugs supply. Since its emergence, county lines has attracted significant political attention, resulting in a surge of drug policing strategies and welfare interventions aimed at safeguarding those at risk of exploitation. Since the development of the concept, academics have not only questioned the novelty of the county lines model (Spicer, 2021) but also how the politicisation of the concept has perpetuated historic issues of classist and racialised drugs policing (Koch et al., 2023).

This paper presents findings from PhD research interviews with stakeholders and practitioners involved in responding to county lines. Interviews were informed by a critical discourse analysis of drug policy related to county lines, which heavily referenced multiagency working as the recommended response to county lines exploitation. This paper examines how the concept of county lines has evolved in policy, how it is operationalised in practice, and draws conclusions on whether its political construction has hindered effective responses to vulnerability that centre harm reduction.

This paper will also consider the developments towards harm reduction policing approaches to county lines drug supply, by considering county lines as a case study to highlight the harms of drug prohibition. The findings suggest that responses to county lines are operating under a contradictory policy landscape, making responding to the perceived problem in a way that centres harm reduction more challenging. However, there have been some shifts towards harm reduction policing to respond to county lines. To conclude, this paper calls for a re-imagining of drug policy and policing that centres harm reduction over punitive measures to respond to county lines.

““They black out and they don’t remember anything”: Experiences of a rapidly shifting toxic drug supply in Vancouver, Canada”

Alexa Norton, Ryan McNeil; Talk

Background: In North America, since the outset of the COVID-19 pandemic, there has been an unprecedented rise in novel psychoactive substances in the illicit opioid supply, including fentanyl-related analogues, benzodiazepines, and xylazine. In Canada, drug market toxicity and volatility are compounding the existing overdose crisis associated with the rise of illicit fentanyl as the dominant street opioid beginning a decade ago. We sought to characterize how a rapidly shifting drug supply is impacting people who use drugs in Vancouver, Canada with a specific focus on overdose experience.

Methods: Between July and September 2024, we conducted semi-structured qualitative interviews with 31 people who use street drugs in Vancouver’s Downtown Eastside neighbourhood, a global epicentre of drug supply toxicity. Data were thematically analyzed using deductive and inductive approaches, with themes interpreted using the intersectional risk environment framework.

Results: Among participants, the adulteration of street opioids with illicit benzodiazepines and, to a lesser extent, tranquilizers, led to common experiences of memory loss, short-term blackouts, and prolonged loss of consciousness. Short and long-term loss of consciousness compounded participants’ vulnerability to everyday violence, with women and men associating these experiences with sexual assault and extreme physical violence, respectively. However, experiences of losing consciousness due to adulterants (benzodiazepines, tranquilizers) in street opioids were rarely characterized as ‘overdose,’ which was reserved for events requiring medical intervention (e.g., naloxone, emergency medical personnel). Some participants developed a preference for “benzo-dope” over time. Subsequent benzodiazepine dependence deterred individuals from engaging with supportive treatment interventions.

Conclusion: Interventions and policies that directly address the increasing toxicity and volatility of the illicit drug market (e.g., a safe and regulated drug supply) are urgently required. Efforts to address emerging benzodiazepine use and dependence are also urgently needed, as are gender-responsive and targeted strategies to reduce the risk of violence occurring because of benzodiazepine/tranquilizer “blackouts.”

“Trialing a Wearable Overdose Detection Device and Alert System among people living in a supported accommodation facility in England.”

Chris Rintoul; Talk

Background:

There were 6,620 drug related deaths across the UK in 2023. Many would have been preventable had someone recognised and responded to them.

Objectives:

We wanted to investigate the potential for wearable technology to detect overdose and send assistance to the casualty.

Methods:

In this partnership between Cranstoun, Queens University Belfast (QUB), Manchester Metropolitan University (MMU) and St Pauls Hostel (SPH), a wearable device was developed to alert staff in the hostel to potential overdoses among the people who live there. Only willing and fully informed participants wear the devices. The hostel is located in the West Midlands region of England.

Commencing in April 2024, Cranstoun funded MMU to provide the devices and alert system to SPH. QUB will evaluate the project across it’s 22 month lifespan.

The devices measure for changes in life-sign indicators such as skin oxygenation and heart rate. When a change is detected the device sends an alert which informs staff in SPH that a particular wearer of the device may be having an overdose.

The devices incorporate machine learning (AI) thereby making them less prone to false positives or false negatives over time.

Results:

The live phase of the project commenced in January 2025 after extensive testing in situ. We expect to have preliminary results by late spring 2025.

Implications:

This innovative approach is one of several currently being trialled across the UK. If ours is successful it may indicate that there is a role for wearable technology in reducing preventable overdose deaths.

“Twenty-one years of heroin-related mortality in Australia: an age-period cohort analysis”

Amanda Roxburgh; Talk

Background: Opioid-related deaths in Australia have continued to increase, in part driven by pharmaceutical opioids. Following a period of stabilisation (2001-2012), heroin deaths are again increasing. This paper aims to identify factors driving these trends.

Methods: Deaths attributed by the coroner to heroin (including other drug) toxicity (2001-2022) extracted from the NCIS, an online coronial database containing deaths in Australia and New Zealand. Joinpoint regression analysis for changepoints in trends. Age, period, and cohort analysis using the online US National Cancer Institute tool.

Results: 7,233 heroin-related deaths were identified in Australia (2001-2022); the majority (80%) among males. Deaths increased significantly (1.2 per 100,000 population, 2001-2.5 per 100,000, 2019), with a 4.04% annual percentage change (APC). One significant changepoint occurred in 2020; deaths decreased (APC -28.52%). Deaths among males increased significantly (APC 3.3%); deaths among females increased at a higher rate (APC 4.94%). Age-period-cohort analysis showed Australians aged 51 and older recorded the highest increase in heroin deaths. Period analysis showed higher mortality risk during 2011-2020, compared to 2001, partly driven by increases in co-methamphetamine toxicity (10%- 2011, 37%-2020). Cohort analysis showed relative mortality risk was highest among Generation X (born 1965-1979).

Conclusions: Increasing engagement of older Australians using heroin is crucial, particularly given concurrent methamphetamine use and underlying disease. Greater engagement of women in health/harm reduction services is also warranted. The COVID-19 pandemic has influenced trends, with disruptions in Australian heroin markets recorded early in the pandemic. This contrasts with North America, where opioid-related deaths have increased since the pandemic.

“When Traditional Methods Fail: Creative Medical-Legal Approaches to Improving Access to Care for Persons with Opioid Use Disorder”

Allison Korn, Noel Ivey; Talk

Title: When Traditional Methods Fail: Creative Medical-Legal Approaches to Improving Access to Care for Persons with Opioid Use Disorder

Background:
Throughout history, attorneys and physicians have joined together to enact change. A team of lawyers, social workers and physicians at Duke University developed a partnership in 2023 focused on supporting individuals with opioid use disorder (OUD). Project COMET, Caring for Patients with Opioid Misuse through Evidence-Based Treatment, is a hospitalist-led initiative at Duke University Hospital in Durham, NC, striving to improve the care of hospitalized patients with OUD. The Health Justice Clinic (HJC) is a law clinic course at Duke Law School addressing the legal needs of clients subjected to discrimination. Despite intensive efforts, our partnership has met significant institutional resistance, suggesting deep seated reluctance to support this type of work and entrenched stigma associated with individuals who use drugs. Furthermore, the incoming U.S. presidential administration’s political agenda includes dismantling federal government agencies including the Department of Justice (DOJ), whose Civil Rights Division historically has enforced Americans with Disability Act (ADA) protections. These real and growing challenges underscore why creative, integrated strategies like ours must persist in order to effectively assist individuals with OUD.

Objectives:
Project COMET and the HJC first connected to address barriers to treatment faced by individuals with OUD through various legal strategies, including DOJ intervention. Flagrant discrimination has led to longer lengths of hospital stays, discharging to suboptimal environments, and restricting the use of life-saving medications. To begin, we aim to understand how these and other barriers to services affect hospitalized patients with OUD by conducting patient interviews, followed by a qualitative data analysis. This analysis will not only inform legal strategies, but also interdisciplinary advocacy and policy reform.

Methods:
To allow our team to conduct patient interviews, we submitted a research project to our institution’s review board (IRB) in fall 2023. However, we have met persistent institutional resistance throughout the IRB process. As of January 2024, our project remains stalled and we are unable to collect essential data. After a series of meetings aiming to resolve IRB questions, our project remains under review. We now look to other movements led by attorney-physician partnerships for inspiration as we try and overcome these challenges. For instance, during the 1980s, there were documented cases of IRB resistance to approving qualitative research focusing on HIV/AIDS stigma and discrimination.

Implications:
These institutional and anticipated political challenges demonstrate how our work has taken on heightened importance. Undaunted, we are working to adapt to these unknowns, both within our own institution and in the broader landscape of discrimination against individuals with OUD. Applying lessons learned from past movements for interdisciplinary change, we anticipate adaptations will include strenghtening community partnerships, emphasizing our work’s connection to local public health outcomes, nurturing strong advocates within our institution, including affected individuals in the research design and implementation process. We hope to share our experiences with researchers in other institutions and across disciplines in hopes of overcoming widespread resistance to supporting and accompanying persons with OUD.