We know little about the extent psychedelic substances are consumed therapeutically and/or discussed with medical professionals despite renewed global interest in these substances. We examined self-reported responses from the 2023 International Cannabis Policy Study (ICPS) in repeated cross-sectional surveys in Canada, the United States, Australia, and New Zealand. The survey included questions on lifetime, past year, and past month use of psilocybin, LSD, MDMA, and ketamine. It inquired about respondents' discussions with medical professionals, their self-reported medical use, and related adverse events. We estimate the mean proportion rate for each of these using logistic regression methods that adjust for demographics, country, and sampling weights. Estimated results suggest nineteen per cent of all ICPS respondents reported lifetime use of one of the four substances. Psilocybin was the most commonly estimated to be used in one's lifetime and in the past year, followed by LSD and MDMA. Estimated prevalences of ever using psilocybin were higher among respondents from Canada (16.3%, CI: 15.6-16.9%) than the USA (13.0%, CI: 12.3-13.6%) and New Zealand (12.1%, CI: 10.4-13.8%). Estimated rates of psilocybin ever use in Australia were significantly lower (7.8%, CI: 6.8-8.8%). An estimated 10-20% of respondents who report ever-use of a psychedelic asked their medical provider about medical use, and over a third who had used in the past year reported experiencing an adverse health effect. Estimated rates of past month use were low for all countries. Consumer interest in therapeutic use of psilocybin, MDMA, LSD, and ketamine has surpassed the pace of clinical trials and therapeutic use provisions. These provisions do not necessarily equate to patient access and dual use motivations are not uncommon. Access via nonregulated pathways and self-initiated use in the absence of medical supervision may influence the proportion of individuals who experience adverse events.
People who use drugs are embedded in complex systems and policy settings. In this study, we investigated how construction workers who use drugs negotiated their subject positions while navigating social and work demands in the context of British Columbia's recent decriminalization policy, which aimed to reduce stigma and increase access to health and social services. Using poststructural interview analysis, we analyzed the 'things said' and the subject positions produced in 12 interviews with construction workers who use illicit drugs in British Columbia following the implementation of decriminalization. Throughout the interviews, participants produced and negotiated their subject position as people who use drugs alongside the position of the productive worker who aligned with the expectations of the responsible neoliberal subject. Within the existing decriminalization context, participants continued to be limited in how they positioned themselves and other people who use drugs by existing social and work policies and norms, which were not in line with decriminalization's objectives. However, in small and local ways, some participants navigated these tensions by defying taken-for-granted assumptions about work and drug use. Our analysis highlights the complex social structures in which drug policies are implemented and which may limit how people who use drugs position themselves and others. Policy reforms must consider how changes may align with the existing local context in which they are implemented. It is critical that people who use drugs are not categorized only as drug users in research and policy reform but considered in full, beyond narrow categories.
This study aimed to describe the prevalence, acquisition routes, and help-seeking behavior of non-medical use of over-the-counter (OTC) drugs among Japanese online survey respondents. A cross-sectional online survey using the Japan "Society and New Tobacco" Internet Survey (JASTIS) was conducted from February 23 to March 31, 2025. Past 12-month use, misuse defined as use above the recommended dose, and non-medical use among respondents reporting above-recommended-dose use of seven OTC drug categories were assessed. Acquisition sources and help-seeking behavior were also examined. Inverse probability weighting was applied to mitigate selection bias from non-probability sampling. A total of 25,424 respondents aged 15-84 years were included. The weighted prevalence of non-medical OTC drug use was 6.8%. Combination cold medicines had the highest prevalence of non-medical use (3.8%). Approximately two-thirds of respondents reporting non-medical OTC drug use reported involvement of multiple drug categories. Pharmacies or drugstores were the primary acquisition source across all drug categories (38.3-45.9%). A higher prevalence of non-medical use was observed among younger respondents (15-24 years, 11.8%) and respondents with psychiatric disorders (21.3%). Fewer than half (46.9%) of respondents reporting non-medical use sought help. Using the operational definition, 6.8% of Japanese online survey respondents reported non-medical OTC drug use after above-recommended-dose use, with frequent involvement of multiple drug categories and low help-seeking. These findings indicate the need to address drug-specific acquisition patterns and to develop accessible and non-stigmatizing support services for this population in future policy reforms.
Drug-induced homicide laws, which hold people criminally responsible for overdose deaths linked to drugs they distribute, are a prominent feature of modern United States drug policy. Some are concerned that support for these laws is bolstered by racialized assumptions about people who sell drugs. The current study examines whether and how the perceived race-ethnicity of a suspected "drug dealer" affects support for drug induced homicide laws. Participants (n = 2940) recruited from Cint Theorem were randomized to one of four vignettes which varied the race-ethnicity of a suspect who distributed drugs connected to an overdose death (Latine, Black, white, or unidentified race). Participants answered questions about their general support for a drug-induced homicide law as well as several determinants of support: beliefs about deterrence, moral justification, preference for the "homicide" charge name, and desire for additional incarceration. Compared to those shown a non-Latine suspect, respondents shown a Latine suspect had significantly greater odds of supporting drug-induced homicide laws, believing they are morally justified, and desiring additional incarceration, but were statistically indistinguishable for beliefs about deterrence and preference for the "homicide" charge name. Results were driven by non-Hispanic respondents. This is the first study of its kind to consider the Latine community as a target of punitive drug policy bias. These results suggest that race- and ethnicity-based assumptions continue to influence public opinion about drug policy, echoing the punitive racialization patterns of past "wars" on drugs.
Australian policy texts articulate priorities aimed at addressing policy 'problems'. Over two decades of research in Australia and internationally identifies, as a problem, ways in which children may be affected by their parents' alcohol consumption. This raises the question of how this problem is represented in Australian policy. The poststructuralist WPR approach was applied to an analysis of nine Australian national health and social policy texts to critically interrogate problem representations of relations between children's adverse experiences and parental alcohol consumption. Our analysis identified that across the policies, the key 'problem' was represented to be a problem of parental alcohol consumption causing children's adverse experiences. Underlying these constructions are moral judgements reflecting societal norms on acceptable alcohol consumption. Parental alcohol consumption is framed as a 'risk factor' for child maltreatment, implying that consumption is an intrinsic harm to children. Additionally, 'parents' are referred to in a gender-neutral way, erasing men's disproportionate role in drinking and related harms. Finally, personal responsibility is emphasised while social and structural determinants of health are largely ignored. The constructions of parents who drink and their children in national policy texts have implications for the framing and justification of policy actions. The neglect of consideration of elements such as gender, disadvantage and the social determinants of health represents a significant policy silence. This silence, we argue, constrains the scope of potential policy responses and limits government responsibility and accountability.
This study examines fentanyl test strip (FTS) use among people who inject drugs (PWID) in North Carolina and West Virginia and serves as a longitudinal follow-up to baseline findings from the South Atlantic Fentanyl Test Strip Study (SAFTSS). SAFTSS was established to investigate contemporaneous changes in FTS use and drug use behaviors among a rural cohort of PWID. The present analysis extends prior baseline findings by incorporating an additional 12 months of follow-up data to offer longitudinal insight into demographic and behavioral patterns of FTS use among rural PWID. We analyzed data from the same cohort described in Zibbell et al. (2024). Data was originally collected between June 2021 and March 2022, with additional post-baseline follow-up surveys conducted at 6 and 12 months. The primary outcome was past 30-day FTS use. We used mixed-effects logistic regression models to estimate the probability of past 30-day FTS use across the three survey waves. Models were estimated for both the full analytic sample and a complete case subsample. Past 30-day FTS use declined over the 12-month follow-up period in both the full analytic sample (aOR = 0.642; p < 0.05) and the complete case sample (aOR = 0.557; p < 0.01). Currently unhoused participants had lower odds of FTS use in both samples (full sample aOR = 0.679; p < 0.05; complete cases aOR = 0.611; p < 0.05). In the full analytic sample, witnessing an overdose in the prior six months was strongly associated with higher odds of FTS use (aOR = 2.444; p < 0.001), and this association remained robust in the complete case analysis (aOR = 2.257; p < 0.001). Observed declines in FTS use amongst the SAFTSS cohort at six and 12 months are consistent with baseline findings. Observed declines in fentanyl test strip use across the 12-month SAFTSS follow-up period suggests early uptake may not translate into sustained engagement in the late fentanyl era. Witnessing an overdose was strongly associated with FTS use throughout the entire study period. Participants who witnessed an overdose in the previous six months demonstrated substantially higher predicted probabilities of FTS use. These longitudinal findings reinforce baseline evidence that direct exposure to overdose events is a key motivator for engagement in harm reduction services among PWID.
Sustained attention to the harms and ineffectiveness of punitive drug law enforcement is prompting jurisdictions across the U.S. to explore safer supply and legalization of cannabis and other illicit substances. As reform debates intensify, understanding the experiences and perspectives of police officers, who play an outsized role in policy implementation, is essential. This study examines police officers' experiences with cannabis legalization and perceptions of safer supply and legalization of other drugs in Baltimore City, MD. We conducted 22 in-depth interviews with Baltimore Police Department officers purposively recruited from roll call shifts between January and June 2024. Interviews explored officers' experiences with recent drug policy reforms (de jure cannabis legalization, de facto drug decriminalization) and perspectives on potential policy solutions, including safer supply and legalization. Transcribed interviews were coded using template analysis and interpreted through a labor process framework. Officers opposed zero-tolerance criminalization of cannabis, and to some extent other substances, but criticized current models of cannabis legalization and expressed skepticism toward expanding licit access to other drugs. Officer accounts of increased public consumption, persistent illicit markets, and drug-related violence, combined with diminished enforcement authority under cannabis legalization led officers to anticipate similar challenges with safer supply and legalization of other substances. This study reveals how cannabis legalization experiences shape street-level officers' perceptions of broader drug policy reforms, highlighting critical implementation gaps around equitable market access, public substance use, and drug-related violence. Addressing these challenges is essential for both securing police buy-in and achieving sustainable, equitable drug policy reforms that meet their intended public health and safety goals.
The revival of psychedelic medicalization is often narrated as a story of scientific legitimacy and neurotherapeutic promise, yet the unusual sensitivity of psychedelics to environmental conditions has encouraged research on music, therapy, setting, and other contextual factors. Treating setting and context as the building blocks of felt atmospheres, this article examines how regulation actively shapes atmospheres of consumption for substances that alter affective and sensory perception. Debates over drug-centric versus therapy-centered models are situated within the broader issue of how law shapes contexts and settings of psychedelic consumption. Policy developments in the United States and Australia show how emerging legal pathways have variably defined personnel, setting, access, substance, and the permitted forms of "holding space" or providing support or therapy. We introduce the concept of regulatory atmospheres to describe the diffuse and sometimes invisible ways in which policy shapes the contextual conditions of psychedelic use. Although policy rarely addresses atmospheres directly, we argue that it powerfully conditions them, which the case of psychedelic drug policy makes particularly clear. Alongside emerging legal pathways, the persistent shadow cast by prohibition over underground and traditional contexts reveals how some ontologies of risk and efficacy are privileged over others.
In October 2018, Canada legalized non-medical cannabis possession and use. While a stated objective of legalization was to prevent people from entering the criminal justice system for cannabis possession, we lack evidence about whether this objective has been achieved. This study aims to compare drug offences among people who experienced incarceration in Ontario, Canada, before and after cannabis legalization. We used offence-related information for all adults who were detained or incarcerated in an Ontario provincial correctional facility between January 2015 and February 2020. We assessed non-possession drug offences and possession offences alone and in combination with other offences. We used an interrupted time series design to quantify changes associated with cannabis legalization in the rate of bookings by offence category. Legalization was associated with an immediate decrease in bookings with any Possession offences, but no evidence of change in the pre-legalization downward slope. Legalization was associated with a significant decrease in bookings with Non-possession Drug Only offences, but this was offset by an increase in bookings with Non-possession Drug + Other offences. Legalization was associated with an increase in bookings for Non-drug Only offences with no significant change from the pre-legalization slope. Cannabis legalization did not substantially change trends in charges for drug-related offences (including possession) in the population of people experiencing incarceration in Ontario.
The increasing presence of fentanyl in the illicit drug supply has been associated with rising overdose mortality in the United States, but the extent to which it is associated with nonfatal overdose morbidity remains unknown. We examined the association between the proportion of fentanyl reports in illicit drug seizures and state-level rates of nonfatal overdose emergency department (ED) visits. We conducted a longitudinal ecological analysis of 40 US states from 2021 to 2024. Outcomes were annual state-level rates of nonfatal overdose ED visits per 10,000 ED visits, obtained from Drug Overdose Surveillance and Epidemiology Syndromic Surveillance System. The proportion of fentanyl reports among all illicit drug seizure reports was obtained from the National Forensic Laboratory Information System. Annual state-level sociodemographic covariates were obtained from the American Community Survey. Adjusted associations and 95% confidence intervals (CIs) were estimated via linear regression using generalized estimating equations. After adjusting for covariates, a 10 percentage-point increase in fentanyl seizure proportion was significantly associated with higher nonfatal overdose ED visit rates: opioid-involved (2.18 increase, 95% CI: 0.89, 3.46), fentanyl-involved (0.73 increase, 95% CI: 0.27, 1.18), and cocaine-involved (0.08 increase, 95% CI: 0.01, 0.15). There was no evidence of statistically significant associations with heroin-, stimulant-, methamphetamine-, and benzodiazepine-involved overdose ED visit rates. Greater fentanyl penetration in illicit drug seizure reports was significantly associated with higher opioid-, fentanyl-, and cocaine-involved nonfatal overdose ED visit rates across states. These findings suggest that fentanyl saturation is not only a driver of overdose mortality but also contributes to nonfatal overdose burden, with important implications for health system demand and public health preparedness.
Drug consumption continues to be a major social problem, particularly among adolescents. In recent years, prevention programs based on physical activity and sport have gained increasing relevance. However, evaluating these intervention programs involves a complex multi-criteria decision-making process, often under conditions of partial or incomplete information. Decision Analysis methodology is used based on an additive multi-attribute utility function suitable for decision contexts with imprecise information. An objective hierarchy is defined across four key dimensions: implementation facilities, applicant organization experience, technical proposal quality, and financial solvency and budget adequacy. IPASDU, a web-based decision support system designed has been implemented to evaluate drug-use prevention programs grounded in physical activity and sport, based on the Decision Analysis methodology. Objectives can be activated or deactivated according to specific evaluation requirements. The system provides predefined attributes, utility components, and weights, which can be customized through utility assessment and weight elicitation techniques. IPASDU integrates sensitivity analysis tools that exploit available imprecise information, allowing evaluators to assess the robustness of program rankings. IPASDU offers a flexible and robust framework for supporting transparent and reliable evaluation of physical activity-based drug prevention programs, enhancing decision-making in complex and uncertain contexts.
UK is one of a few countries that are likely to meet WHO HCV elimination targets of reducing incidence to <2 per 100 person years in People Who Inject Drugs (PWID), but the economic case may be important for investment elsewhere and in future in UK. We illustrate the impact of real-world scaled-up HCV treatment to assess under what drug treatment costs could the investment be cost-saving. We utilised a mathematical and economic model, calibrated to public health surveillance data and HCV testing and treatment scale-up from 4 regions in UK, that projects trends in HCV prevalence and incidence among PWID from 2016 to 2030, and deaths and incremental cost-effectiveness ratio (ICER) from 2016 until 2065, compared to counterfactual of no community and prison testing and treatment scale-up. We vary HCV drug price from £1000 to £10,000 per person treated and estimate the % of runs that are cost-saving for each price. Scaling up HCV treatment in PWID is estimated to avert on average 35-60% of HCV infections over 2016-2030 in the four regions compared to a counterfactual of no treatment scale-up. Over 50 years the intervention would prevent 13 to 34% of deaths assuming current HCV treatment rates continue. The ICER is cost-saving from <£1000 to £5000 across the four regions with the average (weighted by estimated number of PWID in each region) of these threshold costs at approximately £3000 per course. The majority of costs from HCV (∼ 78% before treatment scale-up) and contribution to reducing burden is due to severe liver disease (cirrhosis and decompensated cirrhosis). Scaling up HCV testing and treatment to meet WHO elimination targets is highly cost-effective and could be cost-saving at realistic discounted drug costs. The economic case for HCV elimination can be made for countries that are not yet on track.
In Australia, methamphetamine ('ice') use has been framed as a major social problem, contributing to punitive policy responses and ongoing criminalisation through which stigma is enacted. Although smoking is the predominant route of use, little is known about how people who smoke methamphetamine experience stigma. In-depth interviews were conducted with nine people with histories of smoking methamphetamine, no lifetime history of injecting drug use; and prior interactions with the criminal legal system in Victoria, Australia. Interviews explored experiences of drug use and treatment, criminal legal involvement, stigma and wider social and economic conditions. With stigma as the primary analytic focus, data were thematically analysed using Iterative Categorisation. Findings demonstrated how stigma impacted participants' lives in multiple and intersecting ways, shaping their experiences across personal relationships and institutional settings. Stigma was enacted through criminal legal practices that normalised surveillance and neglect, social relationships marked by exclusion and conditional support, and gendered judgements that intensified moral scrutiny of women who use methamphetamine. Across these contexts, participants described experiences of stigma that limited their access to care, protection, and social support. Three themes were identified: 1) "You're just treated like an animal": Institutional stigma in policing; 2) "Everyone's calling me a crackhead, I'll go and be one": Social and relational stigma; 3) "It was kind of like everyone turned against me": Gendered stigma among women. Participants' experiences of stigma extended beyond isolated interpersonal encounters and were embedded within institutional practices and social relationships. These findings highlight how participants experienced stigma as reinforcing inequities in access to care, protection, and social support across social and institutional settings.
Carfentanil is an extremely potent synthetic fentanyl analogue often present at trace levels alongside other fentanyl analogues and long-acting sedatives, and has become increasingly prevalent in drug supplies across Canada and the United States. Currently, commonly used drug checking technologies cannot reliably identify carfentanil, limiting the effectiveness of drug checking as an overdose prevention response. This study seeks to respond to these limitations using surface-enhanced Raman spectroscopy (SERS) combined with machine learning to reliably detect carfentanil in samples of unregulated drugs submitted to a drug checking service. SERS was performed using 50 nm gold nanoparticles in solution, with a handheld Raman spectrometer, to analyze illicit drug samples (n=250) obtained through the Substance drug checking project in Victoria, Canada. A random forest classifier was optimized using SERS data (n=200) to establish a model for detecting carfentanil in complex opioid mixtures (n=50), benchmarked against mass spectrometry results. The SERS-based model successfully predicted 24 of 25 carfentanil-positive samples with concentrations from 0.06-3.93% w/w, below reported detection limits for Fourier-transform infrared and conventional Raman spectroscopy. It demonstrated high sensitivity (96%), specificity (84%), and strong discriminatory power across thresholds (AUC = 0.96). SERS paired with machine learning demonstrates strong potential for reliable identification of trace carfentanil in complex illicit mixtures, even with co-occurring fentanyl analogues. Given its portability, low cost, and sensitivity, SERS represents a promising complementary approach for community-based drug checking and has important implications for evidence-informed drug policy and harm reduction practice.
Uptake of alcohol policies has been limited in Canada. Using data from Alberta, we examined 1) patterns in support for alcohol policies among policy influencers and the general public, and 2) identified socio-demographic predictors of policy support separately among policy influencers and general public. We used survey datasets (2016-2021) obtained from the Chronic Disease Prevention Survey that collected data from policy influencers and the general public. Policies of focus were: Restrict alcohol sales to minors; re-allocation of alcohol revenue to health services; mandatory warning labels on alcoholic beverages; and tax alcohol based on ethyl content. For each, we calculated the proportion of participants who opposed, supported, or were unsure. Multinomial logistic regression was used to assess predictors of support. Response rates for policy influencers and the general public were 12% and 20.4%, respectively. Support for all policies exceeded opposition in both subgroups. In 2019, there was an increase in support and a decrease in opposition for all policies among the policy influencers, while among the general public, there was a decrease in support and an increase in opposition. The proportion of those being unsure consistently increased over time. Supporters among policy influencers were more likely to be older and females/women and, among the general public, were more likely to be older, females/women, and university graduates. Sustained support for alcohol reduction policies is evident, but addressing uncertainty and lower support among specific groups is key to ensure that policy development is both evidence-informed and socially responsive.
Organised competitive sport represents a unique socio-cultural environment in which performance demands, social influences within sport and anti-doping frameworks shape athletes' substance use behaviours. In 2021, the World Anti-Doping Agency introduced a 'Substances of Abuse' category to address athletes' drug use outside the context of sport. Athletes may use psychoactive drugs, for example, to manage sports related pressure, stress and mental health challenges rather than to enhance performance. While doping in sport remains a widely studied phenomenon, less attention has been given to psychoactive drug use behaviours among athletes involved in organised sports that are driven by motives other than performance enhancement. This scoping review explored psychosocial motivations and associated risk factors for psychoactive drug use across varied athletic populations including young, professional, elite and retired athletes. A scoping review was conducted using a systematic search strategy in the Scopus, Web of Science and PsycINFO databases. The review followed JBI guidelines and the PRISMA-ScR framework. It focused on peer reviewed studies published between 2014 and 2024. Covidence software was utilised for researchers' independent screening processes and the Sport Drug Control Model guided the review's thematic analysis. 38 studies were included. Most studies were conducted in a North American context and were primarily focused on young athletes (55.3%). Cannabis was the most examined drug (68.4%). Athletes' motives for psychoactive drug use were related to benefit appraisal, especially perceived benefits for mood enhancement (for example, relaxation after a game or coping with injuries). Risk factors included young age, male gender, low perceived competence, mood disorders, peer use, contact sports, injuries and career transitions. The findings highlight the importance of ensuring that drug use prevention and harm reduction interventions reach at-risk athletic populations, particularly adolescent athletes, while also addressing sport specific risk factors.
Canada legalized non-medical cannabis in 2018, with marketing and promotion regulated under the Cannabis Act. However, little is known about the promotional practices of licensed cannabis retailers. This study analyzed the online content of Canadian cannabis retailer websites and assessed apparent violations of federal marketing regulations. A cross-sectional content analysis of cannabis retailer websites across all 13 Canadian provinces and territories. Of the 3599 operational licensed cannabis-retail retailers (3368 private and 231 government operated) in Canada in April 2025, we included each of the government-operated cannabis retailer websites (n = 8) and a random sub-sample of private retailer websites (n = 145). Retailer website content was extracted using a standardized codebook comprising 13 promotion-related categories derived from the Cannabis Act to identify apparent violations. One or more apparent marketing violations were identified on 97% of cannabis retailer websites. Apparent violations were somewhat less common among government-operated retailers (75%) than private retailers (97%). Age verification was absent on 8.5% of websites, all of which were privately operated. Inducement-related content was most common apparent violation (86%), followed by endorsements or testimonials (46%), lifestyle promotion (23%), youth-appealing content (23%), and health or cosmetic benefit claims (22%). Promotional content that may contravene the Cannabis Act was commonly observed on Canadian cannabis retailer websites. These findings suggest that gaps exist between regulatory standards and online retail practices within Canada's legal cannabis market. As more jurisdictions consider cannabis legalization, this evidence can help inform the development and enforcement of cannabis promotion-related regulations.
To investigate the association between neighbourhood-level dimensions of marginalization and risk of opioid overdose in Ontario, Canada. We conducted a retrospective cohort study from January 1st, 2016 to December 31st, 2022 using population-level administrative data. Neighbourhood-level marginalization was measured by three dimensions (households and dwellings, material resources, and age and labour force) of the Ontario Marginalization Index. Fatal and non-fatal overdoses were extracted using ICD-10 codes. Modified (robust) Poisson regression using Generalized Estimating Equations produced risk ratios (RRs) to assess the association between neighbourhood-level marginalization and overdose while adjusting for relevant confounders. A random sample of 1,904,556 individuals was taken from all eligible Ontarians (n = 10,806,807). A total of 7,523 overdoses occurred within the observation period, 1,879 (25%) of which were fatal. The rates of all overdose and fatal overdose were 599.35 and 149.48 events per 1,000,000 person years, respectively. In multivariate models comparing all marginalization quintiles to the lowest quintile, neighbourhood residential instability, material resources, and age and labour force were significantly associated with increased risk of all overdose, as well as non-fatal and fatal overdose specifically. Residential instability showed a stronger association with fatal overdose than non-fatal overdose, whereas material resources showed a stronger association with risk of non-fatal overdose than fatal overdose in higher marginalization quintiles. Neighbourhood-level marginalization is significantly associated with risk of overdose, fatal or non-fatal. This relationship is seen independently of income and demographic factors. Addressing social disadvantage should be made a priority amidst the ongoing opioid crisis.
Take-home naloxone programs are an effective intervention for preventing opioid overdose deaths, yet little is known about public attitudes towards their availability at a population level. This study examined trends in Australian attitudes towards take-home naloxone, sociodemographic correlates of support, and jurisdictional differences, using data from the 2016 (N = 22,271), 2019 (N = 20,998), and 2022-23 (N = 20,251) National Drug Strategy Household Survey. In 2022-23, 41.8% of Australians supported the availability of take-home naloxone, 10.6% opposed it, 16.3% were ambivalent, and 31.3% reported insufficient knowledge to express a view. Support increased modestly over time, while opposition declined. Attitudes varied across sociodemographic groups, with more favourable views observed among younger respondents, those with higher educational attainment, those living in more socioeconomically advantaged areas, those who spoke English at home, residents of major cities, and those reporting recent illicit drug use. Uncertainty was particularly high among respondents aged 65 years and over and those who spoke a language other than English at home. Overall, findings indicate that take-home naloxone is not a highly polarising intervention in Australia, but rather one characterised by substantial uncertainty. While public support has strengthened alongside policy expansion, limited awareness remains a key barrier to broader community endorsement. Strengthening population-level understanding of naloxone, alongside targeted communication strategies for groups with lower awareness, may be critical to ensuring equitable access and sustained support for overdose prevention initiatives.
'Equivalence of care' refers to the principle that imprisoned people should receive healthcare services that are equivalent in quality and accessibility to those available in the community, including drug related healthcare. We aimed to examine existing evidence about women and non-binary peoples' experiences of prison-based drug-related healthcare, how this relates to the equivalence of care principle, and how researchers have conceptualised this topic. We conducted a scoping review by searching Scopus and Web of Science databases to identify qualitative research articles published between 1995 and 2023. Articles were subject to a thematic analysis to identify common themes in study findings and the researcher approaches used to address the topic. A total of 2414 articles were identified; 40 articles met inclusion criteria and were included in this review. The findings are separated into: i) study characteristics and evidence gaps; ii) characteristics of prison experiences; and iii) research approaches to the topic. Themes pertaining to prison experiences include inequivalent 'care', relative relief, and unsupported withdrawal, while researcher approaches were found to include individualising tendencies, variable conceptions of gender, and limited intersectional analyses. While our review found no studies that explicitly used the 'equivalence of care' framework to examine women and non-binary peoples' experiences of prison-based drug healthcare, it identified research that speaks to the harms of incarceration and the poor quality of prison healthcare for this cohort. The implications of this review include the need for researchers to adopt more refined, context-sensitive conceptual tools that can account for the compounded effects of systemic marginalisation in carceral health settings.