Background The alcohol licensing system in Northern Ireland (NI) stipulates that a new pub or off-licence can only open if an existing pub or off-licence closes and ‘surrenders’ its licence. In 2022, the NI Department for Communities commissioned a statutory, independent review of this system. This paper summarizes key findings, highlighting suboptimal outcomes and identifying lessons for future licensing design. Methods A mixed-method study, including: manual analysis of licensing records; geospatial mapping of outlet density; interviews with national and local stakeholders; community focus groups; and observational visits to outlets in selected areas. Results Our study identified a range of suboptimal outcomes, including: a persistent increase in numbers of off-licences relative to pubs; the de facto operation of licences as private assets; monopolization of supply by international producers; lack of outlet diversity; widespread anti-competitive practices, including use of objections to extract payment; weak enforcement and limited scope to revoke licences. Conclusion While capping specific outlet types, the ‘surrender principle’ produces outcomes that benefit incumbent businesses and large producers, while doing little to promote public health or support diverse social spaces. Several lessons can be learnt to support better regulation in similar legal environments elsewhere.

Background Since 2014, England has seen a steady increase in the number of people who use crack cocaine in the community. Increasing access to care-planned psychosocial drug treatment, which prioritizes the cessation of all drug use, has been a key policy response. Within this context, we present the first qualitative exploration of the needs of out-of-treatment people who use crack in England. Methods We conducted 36 semi-structured interviews with people who use crack who had not engaged in structured’ treatment for at least a year in a Northern English town (‘Northton’). Results Participants described Northton as suffused with violent and visible crack markets. Most were street homeless, highly stigmatized, and with little access to legitimate income. Very few could imagine how drug treatment might help their situation. Conclusions The participants emphasized the limited appeal of intensive psychosocial drug treatment focused on stopping all drug use. With extensive evidence highlighting the lack of any ‘gold standard’ intervention for crack, we call for a reorientation of drug policy to prioritize the self-described basic and survival needs of people who use drugs. Low-threshold offers of food and pragmatic support appear invaluable. Environmental interventions to reduce crack availability and associated violence are also essential.

Background Due to late-life stressors some individuals start drinking problematically later in life. Late-onset drinkers comprise one-third of older problem drinkers, yet research on this group regarding recovery is scarce. Because their alcohol problem manifests later in life, late-onset drinkers may have acquired greater reserves of social recovery capital (SRC) than their early-onset counterparts. This study investigates that assumption. Methods Using a qualitative comparative methodology, semi-structured interviews were undertaken on nine early- and nine late-onset problem drinkers in recovery (≥50-years-old). Interpretative phenomenological analysis (IPA) was used to analyze, interpret and compare the participants’ recovery narratives. Results The results are presented within the two domains of SRC (social group memberships and family relationships supportive of recovery). Membership of mutual aid groups and peer-based recovery support was present and beneficial to recovery across both groups. Late-onset participants had a greater diversity of social groups than early-onset participants. Late-onset participants had supportive family relationships in recovery, whereas the families of early-onset participants were ambivalent about recovery. Conclusions The findings suggest that late-onset problem drinkers in recovery have greater reserves and access to SRC than their early-onset counterparts. These findings can inform recovery practitioners and healthcare professionals how recovery is sustained among older problem drinkers.

Background Opioids occupy an ambivalent position in contemporary healthcare: they are recognized as effective pain relief but remain heavily stigmatized due to their association with addiction. Drawing on Scambler’s stigma framework, this article examines how Belgian Dutch-language policy documents construct the concepts of ‘dependence’ and ‘addiction’ in the context of chronic pain management. Methods We analyzed 32 policy documents on opioid use for chronic non-cancer pain using Fairclough’s critical discourse analysis to explore how language reflects and reproduces power relations and ideologies. Results We constructed two distinct discourses. Dependence is typically framed biomedically as a physiological outcome of long-term opioid use, positioning physicians as central to prevention and monitoring. Addiction, by contrast, is constructed as a complex risk associated with opioid treatment, where patients are portrayed as morally accountable and physicians as responsible for detecting psychosocial vulnerabilities and intervening early. Conclusion The biomedical framing of dependence shifts moral responsibility to the medicated body, reinforcing physician authority while obscuring patients’ lived experiences. The addiction discourse extends moral accountability to prescribers, emphasizing professional responsibility for risk management. Together, these discourses embed stigma within institutional practices, reconfiguring rather than removing moral judgment and shaping how responsibility, deviance, and control are understood in healthcare.

Background Image and performance-enhancing drug (IPED) use is an emerging health concern in Australia, particularly within needle and syringe programs (NSPs). This study examined trends in IPED equipment access, demographic shifts, and metropolitan–regional disparities in Queensland (2016–2023). Methods A retrospective observational analysis used data from Queensland NSPs and the Queensland Injectors Health Network (QuIHN) (2016–2023). Statistical tests (paired t-tests, ANOVA, Chi-square) assessed changes in demographics and regional access patterns. Results Access to IPED injection equipment via QNSP services declined from 12.4% (2016–2019) to 8.7% (2021–2023, p < 0.01), with requests nearly halving in 2020 during the pandemic. Access among clients aged 16–24 years dropped 4.2% post-COVID (p < 0.05). QuIHN services increased from 9.5% to 17.9% (p < 0.01). Regional sites recovered faster than metropolitan ones, increasing provision nearly twice as quickly (1.56% vs. 0.94% per month). Younger people (18–24 years) showed rising initiation rates over the study period. Conclusion IPED equipment provision increased prior to 2020 and stabilized post-pandemic at elevated levels. Rising service provision among younger clients highlights the need for targeted education and accessible harm reduction services, while regional differences emphasize the importance of alternative service delivery models, ongoing monitoring, and coordinated stakeholder engagement.

Background This study presents a long-term evaluation of the Slovenian drug checking service (DCS), focusing on service utilization, drug market trends, and its role in reaching hidden populations of people who use drugs (PWUD). In Slovenia, the DCS evolved from nongovernmental organization-led initiatives into a nationally funded and policy-integrated public health measure. Methods We analyzed data collected through questionnaires completed by PWUD at the time of sample submission (n = 2,759) and later upon receiving the test results (n = 153). Results A key finding is that the service effectively reaches hidden populations, as 82.9% of service users had no prior contact with any drug support services. Analysis of 5,518 samples revealed cocaine and MDMA as the most frequently submitted substances and led to the identification of numerous new psychoactive drugs, resulting in an average of 24 public health warnings per year. Conclusions The Slovenian DCS demonstrates its value as a key public health tool for drug market monitoring and harm reduction counseling. The DCS has the potential to contribute to risk reduction by providing PWUD with crucial information. This is supported by findings that nearly a quarter of service users expressed an intention not to use a substance after receiving an unexpected result.

Introduction Alcohol contributes to at least 16% of ambulance call-outs in Scotland, placing a significant burden on emergency services. This study aimed to explore the circumstances behind these incidents from the perspective of practicing Scottish Ambulance Service (SAS) clinicians. Methods We conducted in-depth qualitative interviews (median duration: 81 minutes) with 31 SAS staff, purposively sampled for diversity in gender (10 women, 21 men), region, and length of service (1–50 years; median 10). Interviews were transcribed and thematically analyzed using both deductive and inductive approaches. Results Alcohol-related call-outs typically involved either chronic heavy drinking patterns mainly at home with co-existing mental, social, or emotional issues or acute intoxication in social settings. Clinicians reported a large volume of incidents and felt the public underestimated the proportion caused by chronic problems. Conclusion Strategies, policies, and interventions aiming to reduce pressure on emergency services must consider how to provide or improve accessible care for people with chronic alcohol problems, as well as how to reduce acute intoxication to help reduce the amount alcohol related calls SAS staff attend.

Background Researchers with lived or living experience of their subjects of study are uniquely positioned to generate impactful insights by integrating experiential and scholarly knowledge. However, people researching substance use face challenges that may prevent them from actively using their experience in their scholarship. Methods In this commentary, we review the issues facing researchers with lived/living experience of drug use and how these can be addressed. Results Many drug researchers report using illicit drugs, but stigma and systemic barriers discourage disclosure. Greater openness in the substance use field requires a collective effort from researchers and institutions to actively value and support those who disclose lived/living experience. This would promote inclusivity, reduce stigma, and strengthen the field through more impactful and reflexive work. Conclusion Creating an environment where researchers can safely disclose lived/living experience of drug use is essential to harnessing the unique insights of these scholars and fostering more ethical, inclusive, and impactful research on substance use.

Background People in prison are entitled to the same healthcare that is provided in their wider community. However, despite the high healthcare needs of the prison population, the prison setting imposes constraints on prescribing practices due to concerns regarding misuse and diversion of medication. Methods The analysis is based on interviews with prison healthcare professionals (N = 11), people experiencing imprisonment (N = 39), and fieldnotes conducted in prison (N = 156 hours). The empirical data are explored in the theoretical framework of Lipsky (2010 [1980]) about street-level bureaucrats and of Lorber (1975) on categorisations of ‘problem’ patients. Results Prescribing decisions are shaped by perceptions of certain individuals as ‘problem’ patients, influencing access to medication. This perception fosters suspicion among healthcare staff, often resulting in deprescribing or the withdrawal of medication, which has a profound impact on the access to medication and the well-being of people in prison. Conclusion Healthcare professionals’ decision-making is affected by the prison setting, where security and risk considerations are significant. It is important to be aware of how the prison setting affects the opportunity to put patient’s need first and to consider how the consequences of being a ‘problem’ patient can be minimized.