Drug Policy Research Articles

Amigos de la Hoja de Coca: history of a pioneering coca leaf fair-trade

Purpose The leaves of the Erythroxylum “coca” plant are a well-known food, beverage, and nutraceutical in their native Andean region. A decade ago, the European non-profit “Amigos de la Hoja de Coca” (Friends of the Coca Leaf) operated a short-lived fair-trade in raw coca leaves between Bolivia and the European Union. The chronicles of this initiative can be insightful, as interest in natural, wellness, and self-care products continues rising in Europe. Design/methodology/approach Historical review of the inception, and documentation of the organisation of the scheme and its outcome, via all primary sources available. Findings From the 1990s to the early 2010s, civil society groups organised several campaigns to normalise coca leaf in Europe, finding echo at the European Parliament, culminating in 2012-2013 when a periodical distribution system was set-up: growers in Bolivia shipped 150 g. coca leaf packets directly to Friends of the Coca Leaf members in Europe. Initially, most parcels reached their recipients without issue but after technical hurdles and reduced political support, the scheme was eventually discontinued. Originality/value European civil society campaigns surrounding coca have been poorly documented. Historically, Friends of the Coca Leaf emerged alongside Cannabis social clubs, but only the latter has prospered. While Friends of Coca Leaf was short-lived, its political outcomes (both at the institutional level and via a fair and do-it-yourself trade initiative) may prove inspirational to current drug policy reform discussions.

Client preferences for the design and delivery of injectable opioid agonist treatment services: Results from a best-worst scaling task.

Clinical trials support injectable opioid agonist treatment (iOAT) for individuals with opioid use disorder (OUD) for whom other pharmacological management approaches are not well-suited. However, despite substantial research indicating that person-centered care improves engagement, retention and health outcomes for individuals with OUD, structural requirements (e.g. drug policies) often dictate how iOAT must be delivered, regardless of client preferences. This study aimed to quantify clients' iOAT delivery preferences to improve client engagement and retention. Cross-sectional preference elicitation survey. Metro Vancouver, British Columbia, Canada. 124 current and former iOAT clients. Participants completed a demographic questionnaire package and an interviewer-led preference elicitation survey (case 2 best-worst scaling task). Latent class analysis was used to identify distinct preference groups and explore demographic differences between preference groups. Most participants (n = 100; 81%) were current iOAT clients. Latent class analysis identified two distinct groups of client preferences: (1) autonomous decision-makers (n = 73; 59%) and (2) shared decision-makers (n = 51; 41%). These groups had different preferences for how medication type and dosage were selected. Both groups prioritized access to take-home medication (i.e. carries), the ability to set their own schedule, receiving iOAT in a space they like and having other services available at iOAT clinics. Compared with shared decision-makers, fewer autonomous decision-makers identified as a cis-male/man and reported flexible preferences. Injectable opioid agonist treatment (iOAT) clients surveyed in Vancouver, Canada, appear to prefer greater autonomy than they currently have in choosing OAT medication type, dosage and treatment schedule.

“It's going to get pretty tippy”: Stakeholder perspectives on the (dys)function of a four pillars drug strategy

A ‘drug strategy’ is a policy document that structures the priorities and directions for interventions for drug related issues within a particular jurisdiction and/or context. A ‘pillars’ drug strategy concentrates efforts through clustering separated columns of activity, such as law enforcement, harm reduction, treatment, and prevention. In this study, we examined drug policy stakeholders’ perspectives on the structure, function, and fit of a four pillar drug strategy framework in Vancouver, Canada. Utilizing qualitative interview data from fifteen drug policy stakeholders, we examine perspectives on Vancouver's four pillar drug strategy that was implemented over 20 years ago. Our findings are organized under three main themes: (1) the notion of ‘balance’ of efforts, resources, and attention across the pillars; (2) how the pillars function as a cohesive whole; (3) whether the pillars’ architecture is still fit-for-purpose. The architecture of four discrete pillars did not enable a sense of cohesion and collaboration of efforts, and instead elicited a sense of competition, conflict, fragmentation, simplicity, and rigidity of the strategy as a whole. These findings suggest that, in practice, a four pillars framework may be structurally dysfunctional in working towards a common goal. Our study questions the effectiveness of a commonly used 'pillars' framework and whether it needs to be reenvisaged.

Hemp-based psychoactive use and risk among young adults: Trend theory, policy, and regulation beyond legality

BackgroundHemp-based psychoactives comprise a burgeoning legal substance market with rising trends in use across the U.S. and Canada as well as parts of Europe. Currently, scant empirical research on the use of these Novel Psychoactive Substances (NPS) exists. By examining policy, market conditions, consumer uptake, and related risks, this research extends theory on drug trends by describing the regulatory environments that shape the emergence and popularity of psychoactive hemp-based products among young adults. MethodsRelying on ethnographic fieldwork of hemp-based markets across 3 U.S. state hemp and cannabis policy contexts as well as in-depth interviews with 40 young adult cannabis consumers recruited across 10 U.S. states, we examined how regulatory conditions shape hemp-based psychoactive markets, trends in their use, and associated risks. ResultsYoung adults are motivated to consume hemp-based psychoactives due to the regulatory and market environments that facilitate the production of highly potent products that are inexpensive and easily accessible. States that regulate hemp-based psychoactives as cannabis, do not provide hemp markets with a competitive advantage and as such see minimal uptake. In the absence of hemp specific policies, substantial variations in product potencies, insufficient dosing information, and unscrupulous product packaging practices may increase related risks. ConclusionTrend theory provides insight into the complex relationships that exist between drug policy, markets, and the proliferation of legal highs. Understanding the contextual significance that both market and regulatory conditions have on legal drug production, distribution, and consumption may better inform approaches to reduce the risks commonly associated with novel psychoactive substances like hemp-based psychoactives.

Unpacking the process of developing South Africa's national drug policy - lessons for universal health coverage.

South Africa's National Drug Policy (NDP) was first issued in 1996, at a time of considerable political change. To revisit the lessons learned from the process of development and initial implementation of the NDP. Six in-depth face-to-face interviews were held with purposively-selected key actors. Interviews, which followed pre-determined semi-structured questions, but were allowed to explore additional areas, were recorded and transcribed, and then subjected to abductive thematic analysis, informed by the Walt and Gilson model. Three key themes emerged, described as 'evidence', 'trust' and 'looking forward'. A paucity of evidence backed some of the key concepts in the NDP, and these have not been addressed as evidence has matured. The lack of trust which characterised the policy process impacted on the ways in which actors were able to or not able to engage, and therefore on the resultant content and the choices exercised. The coherence of the policy, its articulation with other health reforms, and its contribution to subsequent efforts to ensure universal health coverage in South Africa have all been weakened by the failure to revise the document over time. As South Africa advances its plans for universal health coverage, there is an urgent need to revisit key components of the NDP which are no longer fit for purpose.

Advancing early access policies for innovative cancer drugs: a scoping review and explorative analysis in the Italian setting.

Considering the clinical impact of innovative cancer therapies, policy makers strive to balance timely access and thorough value-assessment. While some European countries promoted early access schemes, Italy does not yet display a consolidated strategy for innovative drugs or for medicines targeting pathologies with a high unmet need. To better understand the risks and opportunities of early access strategies that could be applied in the Italian setting, we performed a scoping review, searching the PubMed and Web of Science databases and interviewing two field experts. The review results were complemented with an exemplificative quantitative analysis for a subset of innovative oncology drugs, to assess the clinical and economic impact of the price and reimbursement negotiation. Our study suggests that early access schemes developed in Germany and France, combining a free-pricing period, pay-back mechanism, and arbitration, could serve as a basis for developing a feasible strategy in Italy. The quantitative analysis indicated that timely access to innovative drugs could have potentially prevented many cancer progressions, associated with a significant healthcare expenditure. Albeit not allowing to express a conclusive assessment, this study proposes a potential early access strategy for Italy and highlights the need for opening a debate on the opportunities and risks of such schemes.

Political constructions of people who use drugs in the Philippines: A qualitative content analysis

BackgroundThis paper examines the political constructions of people who use drugs in the Philippines throughout the presidency of Rodrigo Duterte (2016–2022), during which the government engaged in a ‘war on drugs’ and promoted a punitive drug regime. MethodsBuilding on and drawing inspiration from the global drug policy scholarship that has looked at the ways in which drugs are framed and problematised in various domains, this study used qualitative content analysis to review 96 documents from national government agencies - including strategic action plans, directives, memorandums, guidelines, annual reports, and legislative measures. ResultsForemost, the study finds that various terms were interchangeably used to refer to ‘drug users’ - dependent, offender, personality, abuser - and all of them contributed to the problematisation of people who use drugs as a societal “menace”. As “drug dependents”, they were likewise portrayed as necessitating treatment or rehabilitation. Moreover, presented as victims or passive subjects, their agency and subjectivity are not acknowledged in the documents, even as counter-discourses, mainly from opposition lawmakers, challenge these portrayals and call for people-centered, harm reduction approaches. ConclusionOverall, these overlapping framings cast people who use drugs simultaneously as victims, criminals, deviants, and sick individuals to the detriment of their security, health, and well-being - and to the retrogression of drug policy in the country.

Analysis and mapping of harm reduction research in the context of injectable drug use: identifying research hotspots, gaps and future directions

BackgroundHarm reduction is a crucial approach in addressing the multifaceted challenges of injectable drug use. This paper presents an analysis and mapping of the existing literature on harm reduction research in the context of injectable drug use. By reviewing a comprehensive set of scholarly articles, this study identifies research hotspots, knowledge gaps, and future directions in the field. The findings provide valuable insights for researchers, policymakers, and practitioners to guide future research efforts and inform evidence-based harm reduction interventions.MethodsData for the study was obtained from the Scopus database, using keywords and phrases related to harm reduction and injectable drug use. Validation methods were employed to verify the accuracy and comprehensiveness of the search strategy. Data analysis involved identifying growth patterns, key contributors, mapping frequent terms, identifying research hotspots, and identifying emerging research directions.ResultsA total of 971 articles were found, with a notable increase from 2015 to 2022. The International Journal of Drug Policy (n = 172, 17.7%) and the Harm Reduction Journal (n = 104, 10.7%) were the most prolific journals, and the United States (n = 558, 57.5%) had the highest number of publications. The Johns Hopkins University (n = 80, 8.5%) was the most prolific institution. Mapping of frequent author keywords revealed the main keywords, including harm reduction, HIV, hepatitis C, and opioid overdose. The highly cited articles cover a broad time span and focus on topics like naloxone distribution, HIV and hepatitis C transmission, while recent articles concentrate on emerging issues such as the impact of the COVID-19 pandemic, fentanyl-related concerns, stigma reduction, and needle and syringe programs. Both sets of articles share a common focus on harm reduction strategies, but recent publications highlight current challenges and developments in the field.ConclusionsThis study provides insights into research landscape on harm reduction in injectable drug use. Research is concentrated in high-income countries, emphasizing the need for more research in low- and middle-income countries. Recent publications focus on emerging challenges like COVID-19 and fentanyl. Research gaps highlight the need for studies in diverse populations, social determinants, program evaluation, and implementation strategies to enhance harm reduction interventions.

Change from Above or Pressure from Below? The Diffusion of Cannabis Reform in Latin America

What explains variation in the adoption of cannabis regulation reforms, both for medical and recreational purposes, across Latin America? This article argues that social mobilisation is essential to understand where debates for reform emerge and become stronger. Yet it further contends that policy adoption depends on the existence of pro‐reform elite political coalitions. These coalitions in turn depend on whether drug policy becomes a legislative priority and on specific conditions of the party system. The article compares four countries that show variation in the timing and content of reform: Argentina, Chile, Paraguay and Uruguay.

The impact of centralized band purchasing of pharmaceuticals on innovation of Chinese pharmaceutical firms: an empirical study based on double difference models.

In 2018, China began to gradually promote the pilot policy of centralized band purchasing of medicines. Implementing this policy has resulted in a significant decrease in drug prices. However, there needs to be a clear consensus on the impact and mechanism of action on the innovation of pharmaceutical companies. Therefore. Taking the data of Chinese Shanghai and Shenzhen A-share pharmaceutical listed companies from 2016 to 2022 as a sample, this paper empirically investigates the impact of the centralized banded purchasing policy of drugs on the innovation of pharmaceutical enterprises by using a double difference model and further analyzes the mechanism of its action. The results show that implementing the centralized banded purchasing policy can promote pharmaceutical enterprises' innovation input and output, which is robust under the parallel trend and placebo tests. Further exploring the impact mechanism of the centralized band purchasing policy on pharmaceutical enterprises' innovation, it can be found that it promotes innovation inputs through three channels: government subsidies, enterprise profits, and operating income. In addition, the impact of centralized band purchasing on enterprise innovation is heterogeneous in terms of region, enterprise nature, and scale. Therefore, the positive effects of the centralized band purchasing policy on promoting innovation in pharmaceutical enterprises should be fully recognized, and enterprise heterogeneity should be taken into account when implementing the policy. This study provides empirical evidence on the implementation effect of the centralized banded purchasing policy and provides lessons for continuously optimizing the policy to promote the high-quality development of pharmaceutical enterprises.

Epidemiology of drug arrests in the United States: Evidence from the national survey on drug use and health, 2015–2019

ObjectiveFollowing changes to drug criminalization policies, we re-examine the epidemiology of drug arrests among people who use drugs (PWUD) in the U.S. MethodsSerial cross-sectional data from the National Survey on Drug Use and Health (2015–2019) were utilized. Past-year illicit drug use (excluding cannabis) and drug arrests were described by year, area of residence, drug use characteristics and participant demographics. Adjusted associations between race and drug arrest were estimated using multivariable logistic regression. ResultsPast-year illicit drug use remained consistent over time and was highest among non-Hispanic (NH) white respondents. Of those reporting past-year illicit drug use (n = 25,429), prevalence of drug arrests remained stable over time overall and in metro areas while increasing in non-metro areas. Arrests were elevated among NH Black participants and those with lower income, unemployment, housing transience, non-metro area residence, polysubstance use, history of drug injection, substance use dependence and past-year drug selling. Adjusted odds of drug arrest remained significantly higher among NH Black individuals [aOR 1.92, 95% CI 1.30, 2.84]. ConclusionDespite recent shifts away from punitive drug policies, we detected no reduction in drug arrests nationally and increasing prevalence in non-metro areas. Despite reporting the lowest level of illicit substance use and drug selling, NH Black individuals had significantly increased odds of arrest across years. Findings highlight the need for further examination of policy implementation and policing practices in different settings, with more research focused non-metro areas, to address enduring structural racism in drug enforcement and its consequences for health.

호주의 불법 마약 관련 법과 통제정책:한국과의 간략한 비교

This paper provides a comprehensive overview of Australian drug laws, highlighting the evolution of laws from the late 19th century to the present, and comparing them with South Korean drug policies. It begins by exploring the historical context of Australian drug laws, highlighting the shift from minimal intervention in the late 19th century, characterized by the widespread use of drugs like opium and morphine, to more stringent drug control policies in the early 20th century. This change was influenced by international developments and domestic concerns, notably racial prejudices and the rise of international drug conventions. The paper then delves into the legal frameworks governing drug offences in Australia, explaining the interplay of federal and state laws. It outlines the specific provisions and penalties, with an emphasis on the Criminal Code Act 1995(Cth) and the definitions of serious drugs. A detailed examination of drug offences under Federal law is provided, including distribution, production, import-export and possession offences, along with their respective penalties. Furthermore, the paper discusses the enforcement and prosecution of drug laws in Australia, detailing the roles of law enforcement agencies, the prosecution process, and the judiciary's role in interpreting and applying these laws. It also highlights the shift in Australian drug policy towards harm reduction and public health approaches. This section includes case studies of harm reduction initiatives in Australia. A notable aspect of the paper is the comparison between Australian and South Korean drug laws, elucidating their similarities and differences. While both countries adopt a strict stance on illicit drugs and have similar drug classification systems, they differ in their approach to personal use and possession, harm reduction focus, legal status of cannabis, and cultural perceptions of drug use. The paper concludes by emphasizing the complexity of drug legislation and policy in Australia, shaped by international conventions and domestic priorities. It notes that Australian drug laws strike a balance between prohibition, control, and public health, providing valuable insights for international audiences. The paper also recognizes the dynamic nature of Australian drug law, suggesting that its evolution could significantly influence global drug policy, especially with emerging challenges like synthetic drugs and online drug trafficking.

Legislation to Drug Control: Cognitive and Empirical Analysis

Drug addiction is a significant issue that affects individuals' bodily and mental health, family and social relationships, and society as a total. The rising incidences of drug addiction are global concerns, with policymakers, administrators, and social activists worldwide working to address this issue. Legislation plays an essential role in controlling drug-related issues, aiming to mitigate the harmful sound effects of drug abuse on individuals and the social order. This paper presents a cognitive and empirical analysis of drug control legislation, focusing on its impact, effectiveness, and challenges. Using a multidisciplinary approach, the study examines the cognitive processes involved in drug policy decision-making and the empirical evidence supporting different legislative measures. The analysis highlights the complexities of drug control legislation, including the tension between enforcement and public health approaches, the influence of socio-cultural factors on policy outcomes, and the need for evidence-based interventions.

“In Sweden you are worthless. In Denmark you get an identity again” – on being perceived and received as a person who uses drugs in different drug policy settings

BackgroundPolicies to address substance use differ greatly between settings, where goals may range from zero-tolerance to harm reduction. Different approaches impact formats of care, policing, and even interpersonal interactions, and may play a role in the labelling and stigmatization of people who use drugs (PWUD). Where Sweden has a more restrictive policy, aiming to have a society free from drugs, Denmark has embraced harm reduction principles. The aim of this study was to explore PWUDs’ experiences of interpersonal interactions, policing, and service formats in the two countries.MethodsThe data consists of 17 qualitative semi-structured interviews with Swedish PWUD who have been in both Sweden and Denmark. Recruitment took place at harm reduction sites in both countries, and through snowball sampling.ResultsParticipants reflected on how they were perceived by those in public spaces, and received by care systems and personnel. In public settings in Sweden, participants felt they were ignored, rendered invisible, and lost their humanity. In Denmark, they were perceived and acknowledged, valued as people. This was simultaneously linked to being embodied by the availability of differing service offerings and policing practices, which solidified their “right to be out” in public. Reflecting on their reception in the treatment system, strict formatting in Sweden caused participants to feel that an identity was projected upon them, limiting their opportunities or growth of new facets of identity. Care relations in Denmark fostered more opportunity for autonomy and trust.ConclusionA zero-tolerance policy and associated public discourses could solidify and universalize stigmatizing categorizations as a central feature of PWUD identity and reception from those around them, exacerbating social exclusion. Conversely, harm reduction-centered policies fostered positive interactions between individuals with care providers, public, and police, which may promote inclusion, empowerment, and wellbeing.

HPR59 Do All US Payer Archetypes Consider the Same Sources of Evidence to Inform Their Drug Policies?

HPR59 Do All US Payer Archetypes Consider the Same Sources of Evidence to Inform Their Drug Policies?

Drug Policy in Poland — Medical Treatment or Penalisation?

The objective of this paper is to outline drug policy in Poland in pre-and post-political transition period. In the study, the author examines the period from the end of the Second World War to the present day, with a focus on the Polish government’s shaping of specifi c areas of drug policy. Two main policy schemes are presented, both of which used to predominate with varying intensity across the periods in question. The fi rst of these, the repressive or otherwise prohibitive model, which consists primarily in the predominance of penalisation over other solutions. The second, the permissive one, that focuses on the ‘treatment over penalisation’ principle and represents a certain shift from the restrictive model of drug prevention. The paper concludes with a summary highlighting examples of permissive solutions applied in some countries and emphasising the need to fi nd a balance between sanctioning and treatment in order to effectively respond to the drug-related challenges in Poland.ResumenEl objetivo del artículo es presentar la política de drogas en Polonia en el periodo anterior y posterior a la transformación política. El artículo analiza el periodo que va desde el fi nal de la Segunda Guerra Mundial hasta la actualidad, haciendo hincapié en la confi guración de determinadas áreas de la política de drogas por parte del Estado polaco. Se presentan dos modelos principales, que fueron visibles con diferente intensidad en cada periodo. El primero, el modelo represivo o prohibicionista, basado principalmente en el predominio de la represión penal sobre otras soluciones. El segundo, el permisivo, que se centra en el principio de “curar en lugar de castigar” y representa una especie de distanciamiento del modelo restrictivo de prevención de las drogas. El artículo concluye con un resumen en el que se indican ejemplos de soluciones permisivas utilizadas en algunos países y se subraya la necesidad de encontrar un equilibrio entre el castigo y el tratamiento para responder efi cazmente a los problemas generados por las drogas en Polonia.Palarbas clave: Palabras clave: drogadicción, droga, contraacción, represividad, permisividad

„Der Park als Problemraum“. Regieren städtischer Drogenkulturen am Beispiel des Görlitzer Parks

Abstract. The governing of urban drug use and its economies represents a central aspect of urban governmentality and has played an important role in the production and control of public space in numerous cities of the Global North since the 1970s. Urban drug cultures are often the subject of moral panics and urban policing. At the same time, geographical engagement with the spatial dimensions and effects of governing urban drug cultures is surprisingly rare. Using the example of Görlitzer Park in Berlin's Friedrichshain-Kreuzberg district, this paper examines the spatializing discourses and practices of urban drug policies and shows how looking at the governing of illicit drugs provides a productive lens for analysing forms of urban exclusion, marginalization, and normalization. From a geographical perspective, it is particularly interesting to examine how this form of urban governance mobilizes spatial approaches and representations of space, i.e., how urban drug cultures are spatialized in multiple ways.

Closing doors, opening windows – Adaptations and opportunities for harm reduction services during the COVID-19 pandemic in Europe

Background Across Europe, harm reduction services experienced significant disruptions during the COVID-19 pandemic. This study analyses the experiences of harm reduction service providers during the pandemic in 34 European cities, focusing on their main challenges, adaptations, and opportunities for change. A closer examination of Athens and Dublin offers an in-depth look into these experiences. Methods A mixed-methods approach is used, integrating qualitative and quantitative data. Two surveys conducted in 2020 and 2021 involved 34 European cities. In-depth and informal interviews with four local experts from Athens and Dublin complemented the analysis. Results Despite significant disruptions, many harm reduction services scaled up their operations and achieved favorable policy reforms that were met with resistance before the pandemic. In Athens, major gains were opening the first housing program, the first drug consumption room, and the liberalization of naloxone. In Dublin, new housing, lowered thresholds for methadone provision, benzodiazepine provision, and improved naloxone availability were key gains. Conclusion The pandemic triggered opportunities for policymakers to reframe matters of social equity in the field of drug policies, opening policy windows to further advance harm reduction. Based on these lessons, recommendations to improve social justice and equity for people who use drugs are provided.

Effect of centralized volume-based procurement of drugs on business performance of listed pharmaceutical enterprises

Since March 2018, China has conducted five rounds of negotiations for the inclusion of drugs in the medical insurance system and implemented eight batches of centralized drug procurement. The role of the medical insurance department as a strategic purchaser in the pharmaceutical market has been continuously strengthened, playing a crucial role in controlling the unreasonable growth of medical expenses and reducing the economic burden on patients. The policy of centralized drug procurement, by exchanging quantity for price, can significantly reduce drug prices and lower the profit level of companies. However, being included in the centralized drug procurement catalog can bring a substantial and stable market share to the winning companies. Therefore, the impact of the centralized drug procurement policy on the operational performance of winning companies and how their business decisions should be adjusted remain to be thoroughly explored from both theoretical and empirical perspectives. To assess the impact of the centralized drug procurement policy on the operational performance of companies, this study takes publicly listed pharmaceutical manufacturing companies from 2016 to 2020 as the sample and conducts empirical analysis using methods such as difference in difference (propensity score) matching (PSM-DID). The results showed that the centralized volume-based procurement of drugs policy had a significant negative impact on the business performance of bidding listed pharmaceutical manufacturing companies, indicating that the increase in the sales of bidding drugs could not fully make up for the profit loss caused by the price reduction in the short term. Pharmaceutical manufacturing companies should further adjust their market competition strategies, actively engage in research and development innovation. The government should guide pharmaceutical companies to improve their operational performance while ensuring the quality of drug supply by optimizing the supporting innovative incentive policies in the centralized drug procurement policy.

The impact of precursor regulations on illicit drug markets: An analysis of Cunningham et al.ʼs studies

This review examines a series of twelve studies led by James K. Cunningham and his team, focusing on the effects of precursor regulation on illicit drug markets. Their research shows that the regulation of chemicals essential for the production of drugs such as heroin, cocaine, and methamphetamine is associated with several positive outcomes. These include a decrease in drug purity, a reduction in seizures, lower demand for treatment and hospitalization, and an increase in drug prices. According to the research, this decrease in harmful outcomes results from a combination of diminished overall consumption and a reduction in harm per dose. However, this review identifies some inconsistencies within their studies. These inconsistencies include premature assumptions about the timing of intervention impacts, uneven influences of similar interventions, variations in the implementation of these interventions, and the disregard of alternate explanations for sudden shifts in drug markets. Cunningham's work can be considered one of the most substantial contributions in this field. However, to secure the full confidence of the drug policy community in the authenticity of their findings, they must effectively address the issues identified in this review.