Drug Problems Research Articles

Associations and mediating factors between adverse childhood experiences and substance use behaviours in early adulthood: A population-based longitudinal study

BackgroundResearch has demonstrated positive associations between adverse childhood experiences (ACEs) and substance use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and substance misuse among emerging adults is also not fully understood and few studies have investigated potential mediating factors. MethodsWe analysed data from the Child Cohort of the Growing Up in Ireland study, a nationally representative longitudinal sample of children recruited at 9 years of age (n = 4,729). Logistic regression was used to examine individual and cumulative ACE exposure relationships with substance use at age 20 years. Mediation analyses were used to assess whether parental and peer relationships and school engagement mediate ACE history associations with substance use behaviours. ResultsACE exposure relationships with current cannabis use, other illicit drug use and problematic drug use were observed. In particular, young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80, 95 % CI: 1.29, 2.51) and approximate three-fold (OR=2.94, 95 % CI: 2.06, 4.19) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACEs during the study period. Mediation analyses suggested that parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours. ConclusionsChildren who have experienced ACEs are at higher risk of future substance use and problematic drug use. In supporting these children, identified mediators such as interpersonal relationships and school engagement may help guide selection of prevention interventions.

Prevalence of problematic drug use in Martinique in 2006: The NEMO study

ObjectivesSubstance use disorders are of worldwide public health interest. Local estimates of problematic drug use provide useful indicators to regional public health agencies in developing prevention and treatment programs. The purpose of the current study was to estimate the prevalence of problematic drug use in Martinique. MethodsThe capture-recapture method was applied to a multisource data collection (eight specialized drug and two law enforcement sources) to provide an estimate of drug use (opiates, cocaine hydrochloride, crack (cocaine base), stimulants and/or hallucinogens). Data collection was organized over a period of six consecutive months (September 2005 to March 2006) and concerned all persons residing in Martinique longer than three months and who had consumed at least one of the studied drugs in the month prior to the study. ResultsWe identified 287 cases (86% male; mean age 36.1±9.6 years), 98% of whom had used crack. Comorbid use of illicit drugs other than alcohol and cannabis was 4%. Our study showed that patients with problematic drug use in Martinique is estimated to be 1.936 [95% CI: 964,2907] in a total population of 380.863 (INSEE, 1999). Prevalence rates were 5.0 per thousand among the global population and 7.7 per thousand in the adult population aged 15–64 years. ConclusionsOur study is the first to provide relevant data on the extent of problematic drug use in Martinique for health policies and decision-makers.

Improving Interprofessional Provider Perceptions About Opioid Use Disorder in the Acute Care Setting Through a Blended Educational Simulation Intervention

Background The influx of patients in the acute care setting with opioid use disorder (OUD) has outpaced many hospitals’ ability to educate interprofessional staff. This creates distressing experiences for interprofessional staff and patients, leading to moral distress and burnout in staff and poor patient outcomes. Objective The purpose of this study was to improve interprofessional staff knowledge, attitudes, and perceptions toward working with patients who have OUD using a blended classroom-simulation–based curriculum. Methods A preintervention and postintervention design was selected. Interprofessional staff (n = 46) participated in a blended classroom-simulation educational intervention focused on the neurobiology of OUD, stigma reduction, pain management, and harm reduction principles, followed by 3 high-fidelity simulation scenarios. Participants completed the Drug and Drug Problems Perceptions Questionnaire to measure staff self-perceived knowledge, skills, and attitudes when working with patients who use drugs before, immediately after, and again 3 and 6 months postintervention. Results Most respondents were nurses with an average of 7.6 (SD, 9.6) years of experience. The majority did not have prior training in substance use disorder before (75.6%). There was a statistically significant decrease in mean Drug and Drug Problems Perceptions Questionnaire scores across the total score mean: 55.2 (95% confidence interval, 52.2-58.3) versus 45.5 (95% confidence interval, 43.9-47.1), P < .001. Decreased score indicates improved attitude and perception. Discussion A curriculum consisting of a blended classroom-simulation intervention was successful at improving several domains regarding perceptions of caring for patients with OUD. This educational intervention can serve as a model for health care systems with goal of improving patient outcomes and staff well-being.

SOCIALIZATION OF THE DANGERS AND EFFECTS OF DRUG AND PSYCHOTROPIC USE FOR THE PROGRESS OF THE NATION (STOP DRUGS)

<p><strong><em>ABSTRACT</em></strong></p><p>The service team carried out a community service program because the juvenile drug problem was already very worrying. The community really hopes that schools can prevent the harm and spread of drugs. However, there are several problems faced by the partner school, SMPN 1 Kras, including: the teacher council lacks the capacity and understanding of drug problems and dangers; lack of training and media socialization and education about the dangers of drugs; and lack of media development and socialization and education facilities about the dangers of drugs in partner schools. Departing from these problems, the service team provides solutions through community service activities, namely: a) Providing education to adolescents about: Dangers of Drugs and How to Avoid Drugs through training and seminars on the dangers of drugs, b) Improving the ability of adolescents to develop media used for socialization of the dangers of drugs. This service activity will be carried out for three days through training and socialization methods or methods. The results of the activity are known that there is an increase in understanding of various types of drugs, the impact on adolescents, and how to prevent them, Increasing the ability of adolescents, BK teachers, and homeroom teachers in making socialization and education media on the dangers of drugs using or utilizing social media, Building synergy of cooperation between partners and the service team of the BK study program of SMPN 1 KRAS in preventing the dangers of drugs for students at SMPN 1 KRAS in particular and the revitalization of the existence and role of PIK R in SMPN 1 KRAS to educate teenagers about the dangers of drugs.</p><p><strong>Keywords</strong>: <em>NAPZA; Socialization; Adolescent.</em></p>

Validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale.

Stigma against people who have alcohol and drug problems severely affects their health and well-being. An instrument based on stigma theory assessing individual-level stigma is essential for a comprehensive understanding of their stigma. We evaluated the validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale (SU-SMS-J) among a population who had alcohol or drug use problems. Adults with experience in substance use disorders from psychiatry outpatient departments and rehabilitation facilities participated in the self-administered questionnaire survey. Confirmatory factor analysis was conducted to test the structural validity of the 5-factor model proposed in other language versions, and factor loadings and correlation between the subscales were confirmed. The correlations between the SU-SMS-J and psychometric properties related to substance use (e.g., severity of substance use, motivation to change) were investigated to assess concurrent validity. Internal consistency was assessed using Cronbach's alpha coefficients. Data from 126 participants were analyzed. The 5-factor model was acceptable with good or reasonable model fit indices. The correlations between subscales were weak to moderate, and this result suggested the SU-SMS-J assessed different but related components of stigma: enacted, anticipated, and internalized stigma from different stigma sources (family and healthcare workers). The SU-SMS-J and subscales showed moderate concurrent validity. Internal consistency was mostly sufficient, with Cronbach's alpha coefficients of 0.86 for all items and 0.66-0.93 for subscales. The SU-SMS-J is valid and reliable for use among populations with substance use problems in various settings in Japan.

Smart Cancer-Targeting and Super-Sensitive Sensing of Eu3+/Tb3+-Induced Hyaluronan Characteristic Nano-Micelles with Effective Drug Loading and Release

To avoid the critical problems of effective drugs not being carried to their targeted cancers and their quantity and location not being sensed in situ, this work presents a completely new innovative strategy to achieve both smart cancer targeting (SCT) and super-sensitive sensing (SSS), where one drug carrier works for effective drug loading and release. Herein, malignant melanoma treatment is used as an example of reliable detection and effective therapy. We report two characteristic dumbbell-like nano-micelles and spherical-like nano-micelles of hyaluronan induced by the Eu3+/Tb3+ complexes for effective drug loading and release, respectively. These special Eu3+/Tb3+-loaded nano-micelles (marked as ENM and TNM) have strong and sharp red/green luminescence that can sensitively detect the malignant melanoma drug dacarbazine through changes in fluorescence intensity. Cytotoxicity experiments confirmed that both ENM and TNM are not toxic to normal cells at very high concentrations of 4 mM. However, when loaded with cancer drugs (D-ENM and D-ENM), they both killed cancer cells with more than 40% efficacy at this concentration. The in vivo experiments confirmed that D-ENM and D-TNM can effectively target cancer cells in tissue and effectively impede cancer growth. The detection limits of ENM and TNM in sensing cancer drugs can reach 0.456 μg/mL and 0.139 μg/mL, respectively. Therefore, the reported Eu3+/Tb3+-induced hyaluronan nano-micelles (ENM and TNM) are distinguished carriers of this cancer drug and excellent in situ sensors, and they have highly therapeutic effects with extremely low toxicity to normal cells.

Bempedoic Acid, the First-in-Class Oral ATP Citrate Lyase Inhibitor with Hypocholesterolemic Activity: Clinical Pharmacology and Drug–Drug Interactions

Bempedoic acid is a new drug that improves the control of cholesterol levels, either as monotherapy or in combination with existing lipid-lowering therapies, and shows clinical efficacy in cardiovascular disease patients. Thus, patients with comorbidities and under multiple therapies may be eligible for bempedoic acid, thus facing the potential problem of drug–drug interactions (DDIs). Bempedoic acid is a prodrug administered orally at a fixed daily dose of 180 mg. The dicarboxylic acid is enzymatically activated by conjugation with coenzyme A (CoA) to form the pharmacologically active thioester (bempedoic acid–CoA). This process is catalyzed by very-long-chain acyl-CoA synthetase 1 (ACSVL1), expressed almost exclusively at the hepatic level. Bempedoic acid–CoA is a potent and selective inhibitor of ATP citrate lyase (ACL), a key enzyme in the biosynthetic pathway of cholesterol and fatty acids. The drug reduces low-density lipoprotein–cholesterol (LDL-C) (20–25%), non-high-density lipoprotein–cholesterol (HDL-C) (19%), apolipoprotein B (apoB) (15%), and total cholesterol (16%) in patients with hypercholesterolemia or mixed dyslipidemia. The drug has a favorable pharmacokinetics profile. Bempedoic acid and its metabolites are not substrates or inhibitors/inducers of cytochrome P450 (CYP450) involved in drug metabolism. On the other hand, bempedoic acid–glucuronide is a substrate for organic anion transporter 3 (OAT3). Bempedoic acid and its glucuronide are weak inhibitors of the OAT2, OAT3, and organic anion-transporting polypeptide 1B1 (OATP1B1) and 1B3 (OATP1B3). Thus, bempedoic acid could inhibit (perpetrator) the hepatic uptake of OATP1B1/3 substrate drugs and the renal elimination of OAT2 and OAT3 substrates and could suffer (victim) the effect of OAT3 transporter inhibitors, reducing its renal elimination. Based on these pharmacological characteristics, here, we describe the potential DDIs of bempedoic acid with concomitant medications and the possible clinical implications.

Development of bacterial resistance in Germany from 2008 to 2022 - major culprit pathogens, antibacterial drugs, and prescribing practices.

Rising bacterial resistance is a global threat, causing rising financial burdens on healthcare systems and endangering effective treatment of bacterial infections. To ensure the efficacy of antibacterial drugs, it is essential to identify the most dangerous pathogens and vulnerable antibacterial drugs. Previous research by our group suggested irrational outpatient prescribing practices in Germany, supporting a growing bacterial resistance. This study analyses developments and characteristics for the ten most prescribed antibacterial drugs in Germany from 2008 to 2022. Conclusions are based on the development of bacterial resistance levels and an analysis of correlations between pathogens. We identified cefuroxime axetil, sulfamethoxazole-trimethoprim and nitrofurantoin as the most problematic drugs. Particularly problematic pathogens include E. faecalis, E. faecium, K. pneumoniae, and P. mirabilis. Besides increasing bacterial resistance, they are characterised by a high proportion of significant positive correlations, indicating a high potential for mutually reinforcing resistance development. Alarmingly, most of the antibacterial drugs analysed showed a growing resistance to at least one of the analysed pathogens. In most cases, the best treatment option is threatened by increasing bacterial resistance. We also identified several differences between current bacterial resistance data and therapeutic guidelines. In aggregate, our findings support irrational prescribing behaviour and underscore the urgent need for improved prescribing practices to counter rising bacterial resistance in Germany. Moreover, therapeutic guidelines for bacterial infections, the "holy grail" of pharmacotherapy, must be updated more frequently.

Sustainability of opioid agonist therapy programmes in Belarus, the Republic of Moldova, Tajikistan and Ukraine in the context of transition from Global Fund support during 2020–2023

BackgroundMost national programmes of opioid agonist therapy (OAT) in Eastern Europe and Central Asia are at a critical juncture for building their sustainability due to decreasing support from the Global Fund and other international HIV funders. Therefore, it is timely to identify the status, trends, opportunities and risk factors of OAT preparedness in the face of donor transition.MethodsThe study assessed the OAT sustainability progress in 4 countries: Belarus, the Republic of Moldova, Tajikistan and Ukraine. The study used a comparative country case study design with qualitative methods and two data points in 2020 and 2022–2023. In total, 363 sources were reviewed and used, 83 interviews with key informants and 13 focus groups were conducted with clients, using a joint methodology and a defined Framework with three dimensions: ‘Policy & Governance’; ‘Finance & Resources’; and, ‘Services’.ResultsAll four countries have made improvements to increase OAT sustainability, though it varied. In 2022, Ukraine had a substantial degree of sustainability, followed by Belarus and Moldova with a moderate degree, while Tajikistan’s sustainability was at moderate-to-high risk. No country achieved a high degree of OAT sustainability in any of the three dimensions measured. However, a high degree of sustainability was reported for at least one indicator in Belarus, Moldova and Ukraine: ‘Medicines’; ‘Financial resources’; ‘Evidence and information systems’; ‘Service Accessibility’; or, ‘Service integration & quality’. On average, the greatest improvement between 2020 and 2022 was seen for ‘Availability & coverage’; ‘Financial resources’; ‘Service quality & integration’; and, ‘Service accessibility’. The highest risks across the countries, notably in Belarus and Tajikistan, were recorded for the indicator, ‘Availability and coverage’. Of concern is that the least progress, or even a decline, was found in ‘Human resources’.ConclusionsOAT sustainability in the 4 analysed countries remains at risk, despite progress in all countries. Managing HIV donor transition can have positive effects in addressing financial sustainability, especially inspired by Ukraine’s continued progress despite economic contraction and Russia’s invasion. More attention is needed to non-financial aspects of OAT sustainability in donor transition planning. The directions that could have multifaceted positive influence for OAT long-term resilience and scale up for impact on drug problems include decentralisation outside of health settings and broader drug treatment financial and management transformation, together with drug policy reforms. Thus far, viable solutions for sustainability of OAT in conflict areas appear unlikely. Building OAT resilience should remain high on the agenda of national stakeholders, technical partners and donors.

The ethical aspects of the drug problem

The drug problem has many aspects. One of the most important is the ethical one. In fact, morality concerns the drug problem from a fourfold point of view: from the point of view of production, trade and dealing; from the point of view of consumption; from the point of view of the treatment of drug addicts; from the point of view of drug ‘liberalisation’.

Exploring MPC1 as a potential ferroptosis-linked biomarker in the cervical cancer tumor microenvironment: a comprehensive analysis

BackgroundThe increasing problems of drug and radiotherapy resistance in cervical cancer underscores the need for novel methods for its management. Reports indicate that the expression of MPC1 may be associated with the tumor microenvironment and the occurrence of ferroptosis in cervical cancer. The objective of this study was to visually illustrate the prognostic significance and immunological characterization of MPC1 in cervical cancer.MethodsThe expression profile and prognostic significance of MPC1 were analyzed using various databases, including UALCAN, TIMER2, GEPIA2, and Kaplan–Meier Plotter. TISIDB, TIMER2, and immunohistochemical analysis were used to investigate the correlation between MPC1 expression and immune infiltration. GO enrichment analysis, KEGG analysis, Reactome analysis, ConsensusPathDB, and GeneMANIA were used to visualize the functional enrichment of MPC1 and signaling pathways related to MPC1. The correlation analysis was carried out to examine the relationship between MPC1 and Ferroptosis gene in TIMER 2.0, ncFO, GEPIA Database and Kaplan–Meier Plotter.ResultsWe demonstrated that the expression levels of MPC1 in cervical cancer tissues were lower than those in normal cervical tissues. Kaplan–Meier survival curves showed shorter overall survival in cervical cancer patients with low levels of MPC1 expression. The expression of MPC1 was related to the infiltrating levels of tumor-infiltrating immune cells in cervical cancer. Moreover, MPC1 expression was associated with the iron-mediated cell death pathway, and several important ferroptosis genes were upregulated in cervical cancer cells. Furthermore, after knocking down MPC1 in HeLa cells, the expression of these genes decreased.ConclusionThese findings indicate that MPC1 functions as a prognostic indicator and plays a role in the regulation of the ferroptosis pathway in cervical cancer.

Assisted resolution and self-change: differences between healthcare systems.

This editorial discusses a study by Day and colleagues, in which the authors investigated the prevalence of resolution of alcohol and other drug problems in the UK and compared people who resolved their problems with and without treatment.

Svenska narkotikapolisföreningens tidskrift - polisens bild av ett problem?

Aim: To analyze how the Police in Sweden perceives the drug problem and how it relates to changes in drug politics in the direction of liberalization. Method: The material analyzed consists of a content-analysis of the magazine of the Swedish Narcotic Police Association, covering 145 issues since the start in 1988, concentrating on lead articles, editorials and other articles on principles and politics. Results: The magazine demonstrate an alarmistic view of the drug problem, criticize government agencies and the media for liberal views, question the motives of proponents of decriminalization and legalization, leaves the costs of control of drug interventions aside, and sees the Police as guardian of status quo and as the defender of the goal of Swedish drug policy: "a drug-free society".

중독회복자의 심리적 고통과 삶의 질 관계에서 회복자본의 매개효과

The aim of this study was to explore the level of quality of life among individuals in addiction recovery and to examine whether psychological distress affects the quality of life and recovery capital has a mediating effect on this relationship. To do this, original data from the ‘Stigma Perceived by Individuals with Addiction Study’ conducted by the Korea Addicts Right Center in 2023 were used. Recovering individuals who used community addiction organizations and facilities for alcohol, drug, and gambling problems participated in a self-report survey both online and offline. Using SPSS PROCESS macro, mediation analysis was conducted with a sample of 226 recovering addicts. First, the level of quality of life among recovering individuals was found to be low. Second, psychological distress had a direct effect on the quality of life among recovering individuals. Third, recovery capital had a mediating effect on the relationship between psychological distress and quality of life. Based on these findings, suggestions were made to alleviate psychological distress and enhance recovery capital to improve the quality of life for individual in addiction recovery.

Illicit drug use in Limerick City: A stakeholder and policy analysis using multiple streams model.

The changing drug situation in Ireland has led to the development of various drug policies. This paper aims to use Limerick City as a case study to examine approaches to policy development. The study is qualitative and uses a hybrid technique that combines document, content, and stakeholder analysis. Kingdon's multiple streams model underpins this study. In addition, guidelines for the systematic search for grey literature were adopted as the search strategy. Problem Stream: Illicit drug use and its related problems have changed. The increasing availability of drugs, increasing usage and changes in the types of drugs being used have led to increased drug-related crimes, adverse health outcomes and elevated demand for treatment services. Local drug policies and initiatives emerge by recognising drug-related problems in the region. Policy Stream: The current national drug strategy 2017-2025 which informs action plans in Limerick is the first to focus on a unified health approach. Some national policies have evolved to ensure that guidelines meet current service needs. However, these changes have occurred in some cases with no clear actions. Political Stream: Statutory, voluntary and community stakeholders provide drug addiction and drug addiction-related services, which have evolved rapidly since their first introduction. The Mid-West Regional Drug Task Force was identified as essential in coordinating stakeholders locally. One area for improvement is limited evidence of the voices of persons who take drugs included in service/policy development. This regional analysis also suggests that local implementation of policies concerning dual diagnosis and supervised injection facilities can be further expanded. Despite the challenges experienced by stakeholders in Limerick, a hands-on approach has been adopted in the creation of strategies to tackle the drug problem. The approaches to drug policy development have delivered continuous development of services. However, services remain underdeveloped in areas removed from the capital city of Dublin. Navigating the complex drug landscape reveals that inclusivity, adaptation, and ongoing research are critical components of successful and long-lasting drug policies.

Psychosocial Factors and Psychological Adjustment Among Adolescents and Young Adults: A Comparative Analysis of Occasional Drug Craving and Non-Craving.

The rate of drug craving not only in Pakistan is escalating rapidly, but also from a wide range of cultures and geographically have been impacted by the drug problem. Recently, drug cravings among young Pakistani school and college students have significantly increased, particularly illegal substances like hashish, heroin, and ecstasy. We recruited 338 students and gathered demographic and drug-craving data through a survey. To assess the study variables, we used the parental acceptance-rejection short version, peer pressure questionnaire, and adult personality assessment scale. The prevalence rate of occasional drug craving was 44.1% (tobacco, 39.9%; heroin, 1.8%; ice, 0.6%; and others), and 55.9% have never tried them. Initially, drug craving at the first onset at the age of 14 in friend gatherings (15.7%) in stressful situations (11.2%), high-income families, particularly in joint family systems with paternal rejection, peer enforcement, and maladjustment had a higher risk than affectionate parents and conventional peers. Stepwise binary logistic regression analysis disclosed that age, socioeconomic status, father affection, hostility, rejection, negligence, peer influences, and psychosocial adjustment, mother hostility were independently associated with occasional drug cravings. Findings suggested the high prevalence of occasional drug cravings in Pakistani students in the capital territory. Furthermore, the demographic and other social and clinical aspects could be linked. This study carried out theoretical significance in understanding the predictors of occasional drug craving and psychological adjustment, highlighting the peer and parent's roles and the educational institutions.

The drug-dependent pregnant woman: therapeutic and ethical reflections

In our approach the drug addict is considered essentially a sick person, with his own clinical specificity, both somatic and, above all, psychic. In dealing with the drug problem we believe that the ‘independent variable’ is not the drug, but the person who uses it; and that this must be leveraged to solve the problem.

Are long-term alcohol health harms overlooked in individuals with illicit drug problems? Alcohol-related morbidity and mortality in a Danish cohort of clients in residential rehabilitation for drug use disorders

Abstract Aims This study described the burden of alcohol-related morbidity and mortality among those who had been enrolled in residential treatment for drug use disorders in Denmark and investigated whether self-reported information on alcohol use provided at treatment admission can be used to assess risk for future serious alcohol-related harms. Methods At baseline (entry in drug use disorder treatment during 2000–10), clients completed a European adaptation of the Addiction Severity Index-5. We tracked 4981 clients through 2018 using multiple national registers to identify fully (100%) alcohol-attributable hospital contacts and deaths. Results The death rate due to fully alcohol-attributable causes was 411 per 100 000 person-years, with an average of 0.18 fully alcohol-attributable hospital contacts per person-year. Using the Addiction Severity Index-5 alcohol composite score as a predictor in an adjusted competing risks regression model, a higher score was associated with a higher risk of alcohol-related death. The alcohol composite score was a significant predictor of alcohol-related hospital contacts in an adjusted recurrent events model. Conclusions A substantial proportion of people originally identified as experiencing drug use disorders have alcohol problems that need to be monitored and managed to prevent serious complications. By demonstrating the predictive power of self-reported data, our study concludes that the Addiction Severity Index-5 can be used to identify individuals with drug use disorders at risk for severe long-term alcohol-related health outcomes.

Sex workers' professional agency, quality of life, and problematic substance use in Finland.

Sex workers suffer considerable marginalization that limits their choices and exposes them to various types of harm. Hence, it is important to examine sex workers' professional agency and its association with quality of life. In the current study, we investigated professional agency, quality of life, and problematic substance use among sex workers in Finland. Using an online survey, we collected data from 136 sex workers contacted through Finnish sex work organizations and social media platforms. We conducted correlational analyses between the study variables and linear regression analyses with professional agency as the independent variable and quality of life and problematic alcohol and drug use as dependent variables. As expected, in the regression analyses, professional agency was strongly positively associated with quality of life (β = 0.86, p < 0.001) and negatively associated with problematic alcohol (β = -0.38, p = 0.002) and drug (β = -0.69, p < 0.001) use. Professional agency explained as much as 73% of the variance in quality of life. Most sex workers rated their quality of life as either good or very good. Our results underscore the importance of professional agency to sex workers' well-being, explaining a substantial proportion of the variance in quality of life. Promoting agency should therefore be at the heart of sex work policymaking. However, as most of the respondents were Finnish-born cis women, our results might not generalize to foreign-born, male, and gender diverse sex workers. Future studies should prioritize reaching these populations to ensure broader representativeness.

Drug problems and treatment services at the community level: findings from a national sample of key informants in Nigeria

ABSTRACT Aims This study aimed to provide community-level perspectives on substance use, related health and social harms and utilization of treatment for substance use disorders in Nigeria. Methods The study is based on descriptive-qualitative data from semi-structured interviews with a purposive sample of 2,787 key informants (e.g. police officers, health workers) from the 36 states of Nigeria. Results The findings highlight social, economic, legal, academic, occupational and health problems linked to drug consumption. Drug-related problems extended beyond individuals who consume drugs to impact close relations and local communities. Government-funded facilities (e.g. general hospitals, specialist psychiatric facilities) were thought to be more available, accessible and acceptable to people seeking treatment for substance use disorders than other types of facilities (e.g. faith-based facilities, NGO treatment centers). The provision and uptake of services in these facilities are constrained by financial cost and inadequate specialist services for drug use owing to shortage of skilled professionals. Conclusion There exist a need to improve access to substance use disorder treatment through development of skilled manpower, expansion of health service coverage and strengthening of community-based services. Further, prioritizing healthcare services and combating stigma against people who use drugs could contribute to uptake of services.