Towards a social harm approach in drug policy.

In this paper, we explore how the social harm approach can be adapted within drug policy scholarship. Since the mid-2000s, a group of critical criminologists have moved beyond the concept of crime and criminology, towards the study of social harm. This turn proceeds decades of research that highlights the inequities within the criminal legal system, the formation of laws that protect the privileged and punish the disadvantaged, and the systemic challenge of the effectiveness of retribution and punishment at addressing harm in the community. The purpose of this paper is to first identify parallels between the social harm approach and critical drug scholarship, and second to advocate for the adoption of a social harm lens in drug policy scholarship. In the paper, we draw out the similarities between social harm and drug policy literatures, as well as outline what the study of social harm can bring to an analysis of drug policy. This includes a discussion on the ontology of drug crime, the myth of drug crime and the ineffective use of the crime control system in response to drug use. The paper then discusses how these conversations in critical criminology and critical drugs scholarship can be brought together to inform future drug policy research. This reflection details the link between social harm and the impingement of human flourishing, explores the role of decolonizing drug policy, advocates for the centralization of lived experience within the research process and outlines how this might align with harm reduction approaches. We conclude by arguing that the social harm approach challenges the idea that neutrality is the goal in drug policy and explicitly seeks to expand new avenues in activist research and social justice approaches to policymaking.

When self-direction meets conformity: Surfacing Schwartz's 10 basic human values in drug policy dialogue with lived/living experience participants.

BACKGROUND: Research on values is gaining in popularity within drug policy scholarship. To date, research has focused on analysing values within policy, through documentary analysis and interviews with key stakeholders. We extend this research enquiry to investigate the values that emerge from drug policy debate with those who have lived and/or living experience of using drugs. METHODS: We used workshop data collected from the ESRC-funded Drug Policy Voices project as the basis for our analysis. Within the workshops, participants were given a range of drug policy scenarios to discuss. We selected three scenarios for this paper which discussed policies related to cannabis, heroin, and MDMA/ecstasy. We coded the workshop data using Schwartz's ten basic values, which is a framework that perceives values as the core 'motivators of action' that underpin choices, attitudes and behaviours. RESULTS: We found that the values of 'self-direction', 'security' and 'conformity' were prominent across this participant group, when discussing these policy topics. Yet the drug policy preferences discussed in the workshops revealed that it is the combinations of values that nuance preferences. Security combined with self-direction supports policies that enhance personal responsibility for change; self-direction combined with hedonism supports freedom to use drugs, whereas self-direction combined with conformity and achievement supports recovery policies; and conformity combined with tradition and power supports abstinence-based drug prevention. CONCLUSION: Schwartz's ten basic values provided a useful framework for surfacing values that underpin drug policy preferences. These exploratory findings demonstrate that identifying values within dialogue is a complex process and reinforces opposing values can explain policy preference differences. More importantly, policy preferences were underpinned by combinations of values including those that are apparently opposing in Schwartz's circumplex.

The importance of PEOPLE who use drugs within drug policy reform debates: Findings from the UK Drug Policy Voices online survey.

BACKGROUND: Drug Policy Voices is a UK-based project designed to integrate the voices and experiences of people who use drugs (PWUD) into debates about drug policy reform. An online survey was conducted in 2020 to understand opinions connected to drug use and drug policy. We used a blended values approach combining Moral Foundations Theory (Haidt and Joseph, 2004; Haidt and Graham, 2007) and MacCoun and Reuter's (2001) four philosophical positions that underpin the drug policy. This paper asks, what values do people who use drugs hold surrounding drug use and drug policy, and what factors predict these values? METHODS: We used online-purposive sampling and achieved 1217 survey responses, which captured sociodemographic characteristics, patterns of drug use, sourcing and supply of drugs used within the last 12 months, experiences of criminal justice sanctions in connection to drugs, and experiences of alcohol or other drug treatment. In addition, we devised 37 attitudinal questions about drug use and drug policy, which included both progressive and prohibitionist value positions. RESULTS: The exploratory factor analysis revealed a six-factor solution that identified important value positions for this respondent group, which are personal autonomy, paternalism 1; paternalism 2; legal injustice 1; legal injustice 2; and neoliberal governance. Age, gender, religious beliefs, political views, identifying as a recreational drug taker, using drugs recently, and having experience of working or studying in the substance use/drug policy field are predictors of these value positions. CONCLUSION: The Drug Policy Voices survey has identified collective values and ideology connected to lived experience that illustrate a clear goal conflict with prohibitionist ideology. PWUD have valuable contributions to make to the policy reform debate, but we must acknowledge that opinions are not formed through drug-related experiences alone. The findings of this research highlight the importance of emphasising the person who uses drugs within participatory approaches.

Rethinking enhancement substance use: A critical discourse studies approach.

BACKGROUND: We draw on both interdisciplinary enhancement substance use research and critical drug studies scholarship to reconceptualise enhancement substance use. Our critical discourse approach illuminates how a variety of substances are positioned as tools for self-improvement. In reconceptualising enhancement substance use, we ask what different substances can be positioned as providing enhancement? How are they positioned as tools for achieving enhancement or self-improvement goals? What discursive repertoires are employed to achieve these aims? METHODS: Forty interviews were conducted with people who use substances, such as ayahuasca, psilocybin, cocaine, alcohol, nootropics and non-prescription pharmaceuticals, including Adderall and modafinil. To explore the meanings of and motivations for substance consumption, we apply the sociocognitive approach (SCA) pioneered by Teun van Dijk (2014; 2015) and examine language through the triangulation of cognition, discourse and society. We analyse how different substances are positioned as tools for achieving enhancement or self-improvement goals. RESULTS: We identify three distinct discursive repertoires that frame substance use as enhancement: the discourse of transformation, the discourse of healing and the discourse of productivity. When accounting for enhancement substance use, our participants employ a number of discursive strategies, including ideological polarisation or 'othering', analogies, examples, maxims, metaphors and figurative speech. We also find evidence of interdiscursivity with most participants drawing on more than one discourse when speaking about how substances are positioned as providing enhancement. CONCLUSION: We conclude that the concept of enhancement has wider applicability than current understandings allow. We argue that if we reframe all substance use as providing enhancement or achieving a self-improvement goal, we have the potential to destigmatise substance use and eliminate the over-simplistic binaries that surround it.

Deconstructing prohibitionist ideology: A sociocognitive approach to understand opinions on UK drug policy and the law.

BACKGROUND: There is increasing support to include people who use drugs (PWUD) into debates about drug policy reform in order to improve policy legitimacy and outcomes. The aim of this paper is thus to critically analyse the perspectives of PWUD on UK drug policy and the law. This is the first empirical study to apply the four philosophical positions that underpin drug policy debates: Millian liberalism, legal moralism, strict libertarianism and paternalism (MacCoun and Reuter, 2001) to understand opinions and ideology. METHODS: Forty interviews were conducted with PWUD about the meaning of and motivation for their substance consumption and about their opinions on drug policy and the law. The responses were analysed using the sociocognitive approach pioneered by van Dijk 2014; 2015 from the field of critical discourse studies. The analysis involved connecting personal experiences, knowledge and opinions to broader values, attitudes and ideology, specifically the analysis focused upon the extent to which participants challenged or supported prohibitionist ideology. RESULTS: The opinions of those PWUD studied were diverse and complex. There was some support for prohibition, but overwhelmingly there was resistance and challenge to it. We theorise the challenge to prohibitionist ideology on a continuum from anti-prohibition to pro-reform. Key themes from the analysis included: knowledge gaps regarding terminology; uncertainty about and lack of consideration of policy and reform; political dissonance; apprehension about public attitudes and behaviours; reform rooted in social welfare and human rights ideology; and apathy through counter-culture. CONCLUSION: The findings demonstrate a lack of clarity amongst some PWUD regarding drug policy and reform. Educational initiatives outlining the different reform approaches would therefore provide PWUD with invaluable knowledge and help facilitate their enagement into reform debates. Despite a lack of clarity and consistency within opinions, participants were united in their discussion of human rights, health, economics and education; therefore these topics could help frame future approaches that seek to include PWUD into debates about drug policy.

Delivery dilemmas: How drug cryptomarket users identify and seek to reduce their risk of detection by law enforcement.

BACKGROUND: Cryptomarkets represent an important drug market innovation by bringing buyers and sellers of illegal drugs together in a 'hidden' yet public online marketplace. We ask: How do cryptomarket drug sellers and buyers perceive the risks of detection and arrest, and attempt to limit them? METHODS: We analyse selected texts produced by vendors operating on the first major drug cryptomarket, Silk Road (N=600) alongside data extracted from the marketplace discussion forum that include buyer perspectives. We apply Fader's (2016) framework for understanding how drug dealers operating 'offline' attempt to reduce the risk of detection and arrest: visibility reduction, charge reduction and risk distribution. RESULTS: We characterize drug transactions on cryptomarkets as 'stretched' across time, virtual and physical space, and handlers, changing the location and nature of risks faced by cryptomarket users. The key locations of risk of detection and arrest by law enforcement were found in 'offline' activities of cryptomarket vendors (packaging and delivery drop-offs) and buyers (receiving deliveries). Strategies in response involved either creating or disrupting routine activities in line with a non-offending identity. Use of encrypted communication was seen as 'good practice' but often not employed. 'Drop shipping' allowed some Silk Road vendors to sell illegal drugs without the necessity of handling them. CONCLUSION: Silk Road participants neither viewed themselves as immune to, nor passively accepting of, the risk of detection and arrest. Rational choice theorists have viewed offending decisions as constrained by limited access to relevant information. Cryptomarkets as 'illicit capital' sharing communities provide expanded and low-cost access to information enabling drug market participants to make more accurate assessments of the risk of apprehension. The abundance of drug market intelligence available to those on both sides of the law may function to speed up innovation in illegal drug markets, as well as necessitate and facilitate the development of law enforcement responses.

Adding Spice to the Porridge: The development of a synthetic cannabinoid market in an English prison.

BACKGROUND: In 2014, the annual report of the Her Majesty's Chief Inspector of Prisons (HMIP) for England and Wales raised concerns regarding New Psychoactive Substance (NPS) use in custody, specifically the consumption of synthetic cannabinoids. To date, however, the use of these substances in prison populations, and the markets that have emerged to facilitate it, have been under-researched. METHODS: Our research was conducted in an English adult male prison using multi-method techniques. These included: in-depth interviews and focus groups with prison staff and prisoners; observations of prisoner-led focus groups, workshops and restorative justice circles involving discussion of synthetic cannabinoid use and markets; and analysis of routinely collected prison data measuring drug seizures, incidents of violence and incidents of self-harm. RESULTS: The findings highlight: (1) the scale and nature of synthetic cannabinoid markets in a custodial setting and the motivations for establishing them; (2) the nature and motivations for synthetic cannabinoids use in prison; and (3) the impact synthetic cannabinoid markets in this setting have upon prisoners, the prison system and the wider criminal justice system. The policy implications of the stated motivations for use and reported problems are discussed in relation to both prison and community settings, and the recently implemented Psychoactive Substance Act (2016). CONCLUSION: The paper concludes that the rise in synthetic cannabinoid use in custody and the size of the drug market are posing significant challenges to the management of offenders; including healthcare, appropriate detection techniques, license recall and sanctions for both use and supply. We argue that the primary motivation for consumption in this setting is the avoidance of drug use detection, and that this is likely to supersede other motivations for consumption in the future. We propose a revision of the use of mandatory drug tests (MDTs) both in prisons and in the management of offenders in the community.

Functional fun: Legitimising adult recreational drug use.

BACKGROUND: Recent statistics from the Crime Survey for England and Wales report a slight increase in past year drug use for the over thirty-age range (Home Office, 2014). This paper explores how adult 'recreational' drug takers account for their illicit consumption alongside otherwise conforming lives. METHODS: Twenty-six in-depth interviews were conducted with individuals between the ages of 30 and 59. Each participant had taken drugs in the past year, their main source of income was not a result of criminal activity and they were not currently receiving drug treatment. Discursive Psychology was used to analyse how the participants describe, reason and justify their use. RESULTS: The analysis resulted in the development of three discursive frameworks that demonstrate the different ways in which illicit drug use can be legitimised. The 'drug cultures' framework achieves this through highlighting the accommodation of drugs within social networks. The 'planned celebration' framework outlines the occasional frequency of drug use to legitimise consumption. The 'situational opportunity' framework positions the wide access and availability of drugs as the influence of their behaviour. CONCLUSION: If drug takers can articulate their ability to control their use and maintain functionality within their lives, then both drug taker and drug use may be legitimated. In order to better understand the conceptualisation of drug use and the acceptable boundaries of behaviour, this research has demonstrated that it is more appropriate to conceptualise drug use on a spectrum that runs from control through to dysfunction, rather than either recreational or problematic.

Self-care management practices for the home health nurse: staying hale and hearty through enhanced self-care and ergonomics--with a case study.

Ergonomics provides a broad framework for home healthcare nurses to improve their individual physical, psychological, cognitive, and spiritual well-being through application of models for self-care planning. As the individual becomes stronger, more resilient and work hardy, the benefits to the individual, along with the work organization and ultimately the clients, grow exponentially. This article seeks to explore the relevant ergonomic domains and assist home healthcare nurses to develop self-care planning practices that lead to healthy lifestyles and improved quality of life.

Adults with sickle cell disease: an interdisciplinary approach to home care and self-care management with a case study.

The complexity of caring for adults with sickle cell disease (SCD) strains the confines of a care-segregated medical system. As treatment protocols have dramatically improved since 1990, many patients with SCD are now living well beyond their 6th decade of life. This improved survival rate presents opportunities and challenges for the home healthcare nurse in the management of adult patients with SCD. The home healthcare nurse is essential in the coordination of interdisciplinary health team members to reduce pain episodes and the potentially catastrophic complications of renal failure, pulmonary disease, and cardiovascular events. In addition, the home healthcare nurse serves as patient advocate for the transition from acute care to home, as well as advocate for healthcare maintenance of vision, musculoskeletal involvement, and social and psychological support. This article seeks to provide a viable network for home healthcare nurses to establish self-care management and support of the adult patient with SCD.

Keeping it real: evidence-based practice in home healthcare.

Evidence-based practice (EBP) is a vital element of home health nursing. As healthcare becomes more costly, and more complex care is rendered in the home, the need for systematic inquiry to address the needs of clients and families is imperative. This essential systematic inquiry into nursing interventions and evaluation of clients' responses to those interventions may well transform the home health industry.The ultimate goal of nursing care is to optimize quality outcomes for patients, families, and populations, as well as healthcare providers and systems. Using a clinical case study, the authors discuss a step-by-step EBP process incorporating the nursing process from assessment of current practice to formulating a well-defined clinical question that addresses an identified problem through evaluation of the selected interventions effectiveness and efficacy.

Strategies to increase racial/ethnic student participation in the nursing profession.

The nursing profession has fewer racial and ethnic minority groups than the United States population, at large (Campbell, n.d.). Racial/ethnic minority students have lower admission and retention rates than White non-Hispanic students. A review of strategies reveals that to recruit and retain racial/ethnic minority students, schools of nursing will have to use interventions that reach diverse student populations, make connections with middle and high school students, support students during the application process, and mentor current students.

Insulin management: a guide for the home health nurse.

The number of Americans with diabetes mellitus (diabetes) has skyrocketed in the past 2 decades. An estimated 21 million Americans have the disease, and approximately 6 million additional people are unaware that they even have diabetes (National Diabetes Educational Program [NDEP] Fact Sheet, 2007). Among all the developed nations on the globe, the United States leads the world in cases of diabetes, 90% of which are type 2 diabetes (Kitis & Emirogluk, 2006; National Diabetes Fact Sheet, 2005). Unfortunately, these numbers are expected to climb even higher.