how do i write a research topic on drug abuse

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A Research Guide
Research Paper Topics
40 Drug Abuse & Addiction Research Paper Topics

40 Drug Abuse & Addiction Research Paper Topics

Drug Abuse and Sociology

Drug abuse and medicine, drug abuse and psychology.

Drug abuse and the degradation of neuron cells
The social aspects of the drug abuse. The most vulnerable categories of people
Drugs and religion. Drug abuse as the part of the sacred rituals
Chronic Lymphocytic Leukemia
Drug abuse as the part of human trafficking and as psychological defence of victims
Reversible and irreversible consequences of drug abuse
Drug abuse and minors
Ethnic and cultural traditions that may lead to drug abuse
Medical marijuana. Can legalizing it lead to drug abuse?
The ethical questions of abusing painkiller drugs or other drugs that ease the state of a person
The “club culture”. May it enhance the danger of drug abuse?
Preventing drug abuse. Mandatory examination or voluntary learning: what will help most?
The abstinence after the drug abuse. Rehabilitation and resocialization of the victims of it
The harm done by drug abuse to the family and social relations
The types of drugs and the impact of their abuse to the human body
The positive effects of drugs. May they be reached without drawbacks of drug abuse?
Alcoholics Anonymous, similar organisations and their role in overcoming the dependency
Is constant smoking a drug abuse? Quitting smoking: government and social decisions
Exotic addictions: game addiction, porn addiction etc. Do they have the effects similar to drug abuse?
Substance abuse during pregnancy and before conceiving. What additional harm it causes?
The correlation between drugs and spreading of HIV/AIDS
Drug abuse and crime rates
History of drug abuse. Opium houses, heroin cough syrup and others
Drunk driving and drunk violence. The indirect victims of alcohol abuse
The social rejection of the former drug abusers and the way to overcome it
The main causes of drug abuse in the different social groups
Drug abuse and mental health
LGBTQ+ and drug abuse
The development of drug testing. The governmental implementation of it
Geniuses and drug abuse. Did drugs really helped them to create their masterpieces?
Shall the laws about drug abuse be changed?
Health Care Information Technology
Drug abuse and global health throughout the 20-21 centuries
Personal freedom or the safety of society: can drugs be allowed for personal use?
Legal drinking age in different countries and its connection to the cultural diversity
The different attitude to drugs and drug abuse in the different countries. Why it differs so much?
Teenage and college culture. Why substance abuse is considered to be cool?
Drugs, rape and robbery. Drugging people intentionally as the way to prevent them defending themselves
12-Step Programs and their impact on healing the drug addiction
Alcohol, tobacco and sleeping pills advertising. Can it lead to more drug abuse?

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Research Guides

Drug Abuse, Addiction, Substance Use Disorder

Research Drug Abuse

Start Learning About Your Topic

Create research questions to focus your topic, find books in the library catalog, find articles in library databases, find web resources, cite your sources, key search words.

Use the words below to search for useful information in books and articles .

substance use disorder
substance abuse
drug addiction
substance addiction
chemical dependency
war on drugs
names of specific drugs such as methamphetamine, cocaine, heroin
opioid crisis

Background Reading:

It's important to begin your research learning something about your subject; in fact, you won't be able to create a focused, manageable thesis unless you already know something about your topic.

This step is important so that you will:

Begin building your core knowledge about your topic
Be able to put your topic in context
Create research questions that drive your search for information
Create a list of search terms that will help you find relevant information
Know if the information you’re finding is relevant and useful

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Gale eBooks This link opens in a new window Use this database for preliminary reading as you start your research. Try searching these terms: addiction, substance abuse

Other eBooks from the MJC Library collection:

Use some of the questions below to help you narrow this broad topic. See "substance abuse" in our Developing Research Questions guide for an example of research questions on a focused study of drug abuse.

In what ways is drug abuse a serious problem?
What drugs are abused?
Who abuses drugs?
What causes people to abuse drugs?
How do drug abusers' actions affect themselves, their families, and their communities?
What resources and treatment are available to drug abusers?
What are the laws pertaining to drug use?
What are the arguments for legalizing drugs?
What are the arguments against legalizing drugs?
Is drug abuse best handled on a personal, local, state or federal level?
Based on what I have learned from my research what do I think about the issue of drug abuse?

Why Use Books:

Use books to read broad overviews and detailed discussions of your topic. You can also use books to find primary sources , which are often published together in collections.

Where Do I Find Books?

You'll use the library catalog to search for books, ebooks, articles, and more.

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If you need materials (books, articles, recordings, videos, etc.) that you cannot find in the library catalog , use our interlibrary loan service .

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EBSCOhost Databases This link opens in a new window Search 22 databases simultaneously that cover almost any topic you need to research at MJC. EBSCO databases include articles previously published in journals, magazines, newspapers, books, and other media outlets.
Gale Databases This link opens in a new window Search over 35 databases simultaneously that cover almost any topic you need to research at MJC. Gale databases include articles previously published in journals, magazines, newspapers, books, and other media outlets.
Psychology and Behavioral Sciences Collection This link opens in a new window Contains articles from nearly 560 scholarly journals, some dating as far back as 1965
Access World News This link opens in a new window Search the full-text of editions of record for local, regional, and national U.S. newspapers as well as full-text content of key international sources. This is your source for The Modesto Bee from January 1989 to the present. Also includes in-depth special reports and hot topics from around the country. To access The Modesto Bee , limit your search to that publication. more... less... Watch this short video to learn how to find The Modesto Bee .

Use Google Scholar to find scholarly literature on the Web:

Browse Featured Web Sites:

National Institute on Drug Abuse NIDA's mission is to lead the nation in bringing the power of science to bear on drug abuse and addiction. This charge has two critical components. The first is the strategic support and conduct of research across a broad range of disciplines. The second is ensuring the rapid and effective dissemination and use of the results of that research to significantly improve prevention and treatment and to inform policy as it relates to drug abuse and addiction.
Drug Free America Foundation Drug Free America Foundation, Inc. is a drug prevention and policy organization committed to developing, promoting and sustaining national and international policies and laws that will reduce illegal drug use and drug addiction.
Office of National Drug Control Policy A component of the Executive Office of the President, ONDCP was created by the Anti-Drug Abuse Act of 1988. ONDCP advises the President on drug-control issues, coordinates drug-control activities and related funding across the Federal government, and produces the annual National Drug Control Strategy, which outlines Administration efforts to reduce illicit drug use, manufacturing and trafficking, drug-related crime and violence, and drug-related health consequences.
Drug Policy Alliance The Drug Policy Alliance (DPA) is the nation's leading organization promoting alternatives to current drug policy that are grounded in science, compassion, health and human rights.

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Last Updated: Apr 25, 2024 1:28 PM
URL: https://libguides.mjc.edu/drugabuse

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140 Drug Abuse Essay Topics & Project Topics on Drug Abuse

Looking for an interesting essay title about drugs? You will find it here! This list contains a variety of drug topics to write about, including addiction among students and other issues. But that’s not all of it! In addition to drug abuse research topics, we’ve also included plenty of essay samples for you to check out.

🏆 Best Project Topics on Drug Abuse

✍️ drug abuse essay topics for college, 👍 good drug abuse research topics & essay examples, 🎓 most interesting drug abuse research titles, 💡 simple drug abuse essay ideas, ❓ research questions on drug abuse.

Drug Abuse among Teenagers Causes and Effects
Drug Abuse and Theories Explaining It
Alcohol and Drug Abuse in the Workplace
Victimless Crimes: Drug Abuse and Sex Work
Drug Abuse in Homeless Community
Drug Abuse and Its Effects on Families
The Link Between Drug Abuse and Corruption
Juvenile Drug Abuse Problems Analysis This essay describes the problem of juvenile drug use and applies the relevant delinquency theory. Additionally, the interventions or programs to fix the issue will be highlighted.
The Theme of Drug Abuse in Egan’s Book In her novel “A Visit from the Goon Squad”, Jennifer Egan discusses a number of problems of modern society. Among them is the problem of drug abuse.
Adolescent Drug Abuse, Their Awareness and Prevention This essay provides a critique of an article written by Chakravarthy, Shah, and Lotfipour about adolescent drug abuse prevention interventions.
Drug Abuse and Alcohol-Related Crimes in Adolescents The current paper focuses on the topic of drug abuse and alcohol-related crimes among teenagers, showing that substances remain the most notable factor in juvenile crime.
Drug Abuse Relation to the Violent Behavior Various groups of drugs greatly vary and relate to violence in different ways. Any person with heavy drug habits may act negatively and involve in violent acts punishable by law.
Social Factors of Substance Drug Abuse Substance abuse refers to the pattern of continued use, despite adverse consequences. Socio determinants of substance abuse imply social factors that affect the outcome of drugs.
National Association for Alcoholism and Drug Abuse Counselors This paper will consider the fourth principle of the organization’s ethical code, which reads: “Working in a culturally diverse world.”
Psychotherapy and Counseling for Drug Abuse Treatment Drugs are the biggest vice of humanity, along with the mental and moral deviations, horrible diseases of modern times, social neglect and abuse it causes and goes along with.
Drug Abuse Case: Jenny G This paper present the case of drug abuse. Jenny G., a 48-year-old recovering IV drug abuser, presents with general malaise, anorexia, abdominal pain, and slight jaundice.
Fear Appeal in Anti-Drug Abuse Public Campaign The problem of prescription drug abuse has become a crucial concern for Florida residents. The public campaign proposes raising awareness about the dangers of prescription drugs.
Crisis of Chemical Dependence: Drug Abuse Drug abuse mainly begins during teenage. The first part of this essay discusses social and cultural determinants of substance abuse. The second part focuses on the dynamics of addiction.
Drug Abuse and Its Impact on Creativity The boosting effect of drugs on creativity is a myth because changes in thinking are a brain reaction to a narcotic that is temporary yet severe.
Drug Abuse in the United States’ Social Context Drug abuse is one of the problems affecting people in the United States. Society has contributed to the continued misuse of drugs today, through bad parenting or the environment.
Drug Abuse During Pregnancy: Policy Options Heated discussions on whether or not drug abuse during pregnancy should be illegal due to the potential risks to the developing fetus or child persist.
Leadership in Drug Abuse Program Development Within the context of a potential intervention for drug abuse, the roles and competencies of leaders are the primary emphasis of this paper.
The Drug Abuse Problem in Indiana Drug usage is one of Indiana’s most serious societal problems, affecting the state’s health, economy, behavioral, and criminal elements.
Overcoming the Drug Abuse Addiction The use of narcotic drugs brings irreparable harm to health and diminishes the quality of life. Opioid abuse is a predominant problem that continues to be a concern.
Drug Abuse Demographics in Prisons Drug abuse, including alcohol, is a big problem for the people contained in prisons, both in the United States and worldwide.
Drug Abuse at the Workplace and a Policy to Address It In this proposal, a policy to address worker substance abuse and addiction, will be discussed, with both its major goals and potential benefits being outlines.
Prescription Drug Abuse Problem Providing access to prescription drugs is among the key tasks that the modern healthcare system should fulfill to increase recovery rates.
Accessory Plus Incorporated’s Drug Abuse Case In the case of Accessory Plus Incorporated, the issue of drug abuse has been suspected. However, there is no policy framework for the company to deal with the case.
Prescription Drug Abuse as a Community Health Issue Consumption of prescription drugs in a manner that has not been prescribed by the doctor is an outstanding community health issue. This can be more harmful than people understand.
Crime Trends: Drug Abuse in Adults and Juveniles One notes a mixed trend in the different crimes over the years. Drug abuse, for example, increased steadily from the 1970s in both the adult and juvenile populations.
Drug Abuse in Correction Facilities The purpose of this article is to consider the problem of drug abuse in correctional facilities, as well as to suggest possible solutions to this problem.
The Drug Courts: The Question of Drug Abuse Drug abuse is one of the most prevalent crimes in the world. It is a concern for both local governments and international organizations.
Community Health: Prescription Drug Abuse The rising access to frequently abused prescription drugs via the internet has created public anxieties within the healthcare system in the United States.
Health Issue Analysis: Prescription Drug Abuse Prescription drug abuse is a rapidly growing epidemic that spreads worldwide. Various national and international health organizations research this field.
The Drug Abuse in the U.S. Navy: The Problem Analysis The purpose of this report is to capture drug abuse in the U.S. Navy and to analyze some of the measures that the Naval Criminal Investigative Service (NCIS) has put in place.
Drug Abuse Factors: Substance Use Disorder The various reasons for the abuse of opioids, alcohol, and nicotine account for the challenge in research and treatment.
Drug Abuse and Addiction: Risk Factors People with drug abuse issues have enhanced motivation to take drugs, increased probability of reacting to stress, emotional dysregulation, and impaired self-control.
The Relations Between Drug Abuse and Criminal Justice The purpose of this article is to use conflict theory to analyze how race, class, and gender affect drug abuse and crime in the United States.
Drug Abuse: Impaired American Society The history of American society as far as drug abuse is concerned has had a dark past where drugs and alcohol were considered a lifestyle.
The Issue of Drug Abuse in the Community of Kinsburg This paper aims to research the community of the city of Keansburg, located in the state of New Jersey and its issue of substance abuse.
Adolescent Drug Abuse: Diagnosis and Cultural Awareness The paper examines the effect of amphetamine on human and, as a consequence, the development of mental illness, namely, mood disorder.
The Problem of Prescription Drug Abuse in the United States Prescription drug abuse is a serious health concern that causes an overdose crisis in the United States. There are determinants such as social, economic, and healthcare-related issues.
A Health Issue Analysis: Prescription Drug Abuse Prescription drug abuse is one of the acutest problems of healthcare systems in the USA. In the past decade, the rate of deaths due to prescription drug overdose grew by 142%.
Drug Abuse and Drug Addiction and Various Policies Related to Drugs The harm reduction policy is concerned with reducing or minimizing the risks that are accrued to drug abuse in various societies.
Drug Abuse and Crime Correlation The correlation between drug use and crimes go, most prisoners said they commit crimes for obtaining money for drugs, so drugs are the motivation.
Drug Abuse Among Teenagers Before analyzing the causes of addiction among teenagers, we have to look at this issue from sociological point of view.
Drug Abuse Treatment in Nursing Jenny G., a 48-year-old recovering IV drug abuser, presents with general malaise, anorexia, abdominal pain, and slight jaundice. She is currently staying in a women’s shelter and looking for a job.
Drug Abuse Among Homeless People in Miami This paper aims to better assess the disaster of drug abuse among homeless people in Miami, and develop ways to counter this issue.
Drug Abuse, HIV/AIDS, and Songs on Social Issues Drug abuse and HIV/AIDS are some of the major social issues affecting society today. Songs have been used in raising awareness about social issues that affect the world.
Minimizing Prescription Drug Abuse in Oklahoma Over the past few years, the rates of prescription drug abuse in Oklahoma have grown impressively. The issue must be addressed by raising awareness via modern media.
Drug Abuse Among Adolescents and Behavior Therapy
Pharmacists and Prescription Drug Abuse
Recognizing Drug Abuse and Addiction in Older Adults
American Drug Abuse McCuen and Winkler
Prescription Drugs and Drug Abuse in the United
Drug Abuse Has Become a Real Problem
Combating Combat Drug Abuse at Australian Music Festivals
Prevention of Drug Abuse and Mental Disorders
Alcohol and Drug Abuse Are The Most Common Issues of Today‘s
Drug Abuse and Adolescent Risky Behavior
Drug Abuse Hazards Across the Board in Fiji
Drug Abuse Sociological and Psychological Causative Factors
Drug Abuse and Mental Illness in Nursing
Drug Abuse and Smoking in Our Society
Comprehensive Drug Abuse Prevention and Control Act of 1970
Drug Abuse and Addiction Among Teenagers
Neuroticism and Drug Abuse
Drug Abuse and Its Effects on the World
Drug Abuse and Its Effects on Other Members of Society
The Relationship Between the Type of Crime and Drugs
Drug Abuse Among American Teenagers
Adolescent Drug Abuse and Alcohol
Drug Abuse and Heroin Epidemic
Addiction and Opioid Use for Drug Abuse
Drug Abuse Within Teens in Hazleton
Past and Current Trends of Drug Abuse
Emergency Medical Services and Drug Abuse Among the Personnel
Impetus Toward Drug Abuse
Drug Abuse Among Professional Athletes
Drug Abuse and Treatment Centers in Afghanistan
Physiological and Behavior Effects on Drug Abuse
Psychological and Physical Aspects of Drug Abuse in Adolescent
Drug Abuse Among College Students
Alcoholism and Prescription Drug Abuse and the Elderly
Drug Abuse Within University Students in Ottawa
Drug Addiction and Drug Abuse in the United States
Capitalism, Drug Abuse, and the American Dream
Drug Abuse, Prison and Justice in Hungary
Drug Abuse and Associated Problems in Ireland
Role of the Limbic System in Drug Abuse
Alcohol and Drug Abuse Causes Domestic Violence
Drug Abuse and Its Effects on a Person’s Behavior
Drug Abuse During Central Ohio
Drug Abuse Among Health Care Professionals
Medication Addiction and Drug Abuse Problems
Drug Abuse Among Teenagers in Malaysia
Juvenile Delinquents and Drug Abuse
Factors That Are Associated With Women and Drug Abuse
Alcoholism and Drug Abuse: The Pressures and Temptations of a Teenager
Athletes’ Motivation for Performance-Enhancement Drug Abuse
Drug Abuse and the Drug Industry
Adolescent Drug Abuse and Its Effects
American Universities, Colleges, Drug Abuse and Effects
Alcohol and Drug Abuse During Pregnancy
Juveniles and Drug Abuse in America
The Link Between Schizophrenia and Drug Abuse
Drug Abuse and Its Effects on the Health and Choice of Lifestyle
Alcoholism and Drug Abuse: Roots, Effects, and Prevention
Drug Abuse and the Views of Saint Augustine, Aristotle, and Plato
Drug Abuse and Addiction Among America
How Does Drug Abuse Affect the Personal Development of Hong Kong Teenagers?
What Are Influences That Cause Drug Abuse on Youth?
How Does Prescription Drug Abuse Affect Teens?
What Are the Primary Causes and Effects of Alcoholism and Drug Abuse Among Young People?
How Does Drug Abuse Ruin Families and Destroy Relationships?
What Causes Teenage Drug Abuse?
How Can We Prevent Prescription Drug Abuse?
Why Do Children Need to Be Educated About Drug Abuse?
Who Is Most Affected by Prescription Drug Abuse?
How Does Drug Abuse Affect a Person’s Social Life?
What Are the Side Effects of Drug Abuse?
Why Do We Need to Prevent Drug Abuse?
How Does Drug Abuse Affect Public Health?
What Are the Causes and Effects of Drug Abuse?
How Can the Government Reduce Drug Abuse?
What Are the Six Forms of Drug Abuse?
Can We Reduce Drug Abuse in the Community?
What Are the 4 Steps That Lead to Drug Abuse?
How to Educate Youth About Drug Abuse?
What Are the Effects of Drug Abuse on the School?
How Does Drug Abuse Affect the Brain?
What Profession Has the Highest Rate of Drug Abuse?
How Are Drug Abuse and Crime Related?
Why Is It Important to Learn About the Risk Factors of Drug Use and Abuse?
What Is the Role of the Youth in Preventing Drug Abuse?
Are There Social Factors That Contribute to Drug Abuse?
What Is the Impact of Drug Abuse on Society?
Is There a Connection Between Drug Abuse and Crime?
What Can Be Done to Overcome the Problem of Drug Abuse?
How Can Drug Abuse Cause Violence?

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StudyCorgi. (2022, March 1). 140 Drug Abuse Essay Topics & Project Topics on Drug Abuse. https://studycorgi.com/ideas/drug-abuse-essay-topics/

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StudyCorgi . "140 Drug Abuse Essay Topics & Project Topics on Drug Abuse." March 1, 2022. https://studycorgi.com/ideas/drug-abuse-essay-topics/.

StudyCorgi . 2022. "140 Drug Abuse Essay Topics & Project Topics on Drug Abuse." March 1, 2022. https://studycorgi.com/ideas/drug-abuse-essay-topics/.

These essay examples and topics on Drug Abuse were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 8, 2024 .

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A systematic review of substance use and substance use disorder research in Kenya

Florence Jaguga

1 Department of Mental Health, Moi Teaching & Referral Hospital, Eldoret, Kenya

Sarah Kanana Kiburi

2 Department of Mental Health, Mbagathi Hospital, Nairobi, Kenya

Eunice Temet

3 Department of Mental Health & Behavioral Sciences, Moi University School of Medicine, Eldoret, Kenya

Julius Barasa

4 Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya

Serah Karanja

5 Department of Mental Health, Gilgil Sub-County Hospital, Gilgil, Kenya

Lizz Kinyua

6 Intensive Care Unit, Aga Khan University Hospital, Nairobi, Kenya

Edith Kamaru Kwobah

Associated data.

All relevant data are within the paper and its Supporting information files.

The burden of substance use in Kenya is significant. The objective of this study was to systematically summarize existing literature on substance use in Kenya, identify research gaps, and provide directions for future research.

This systematic review was conducted in line with the PRISMA guidelines. We conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and Cochrane Library) from inception until 20 August 2020. In addition, we searched all the volumes of the official journal of the National Authority for the Campaign Against Alcohol & Drug Abuse (the African Journal of Alcohol and Drug Abuse). The results of eligible studies have been summarized descriptively and organized by three broad categories including: studies evaluating the epidemiology of substance use, studies evaluating interventions and programs, and qualitative studies exploring various themes on substance use other than interventions. The quality of the included studies was assessed with the Quality Assessment Tool for Studies with Diverse Designs.

Of the 185 studies that were eligible for inclusion, 144 investigated the epidemiology of substance use, 23 qualitatively explored various substance use related themes, and 18 evaluated substance use interventions and programs. Key evidence gaps emerged. Few studies had explored the epidemiology of hallucinogen, prescription medication, ecstasy, injecting drug use, and emerging substance use. Vulnerable populations such as pregnant women, and persons with physical disability had been under-represented within the epidemiological and qualitative work. No intervention study had been conducted among children and adolescents. Most interventions had focused on alcohol to the exclusion of other prevalent substances such as tobacco and cannabis. Little had been done to evaluate digital and population-level interventions.

The results of this systematic review provide important directions for future substance use research in Kenya.

Systematic review registration

PROSPERO: CRD42020203717.

Introduction

Globally, substance use is associated with significant morbidity and mortality. In the 2017 Global Burden of Disease (GBD) study, substance use disorders (SUDs) were the second leading cause of disability among the mental disorders with 31,052,000 (25%) Years Lived with Disability (YLD) attributed to them [ 1 ]. In 2016, harmful alcohol use resulted in 3 million deaths (5.3% of all deaths) worldwide and 132.6 (5.1%) million disability-adjusted life years (DALYs) [ 2 ]. Tobacco use, the leading cause of preventable death, kills more than 8 million people worldwide annually [ 3 ]. Alcohol and tobacco use are leading risk factors for non-communicable diseases for example cardiovascular disease, cancer, and liver disease [ 3 , 4 ]. Even though the prevalence rate of opioid use is small compared to that of tobacco and alcohol use, opioid use disorder contributes to 76% of all deaths from SUDs [ 4 ]. Other psychoactive substances such as cannabis and amphetamines are associated with mental health consequences including increased risk of suicidality, depression, anxiety and psychosis [ 5 , 6 ]. In addition to the effect on health, substance use is associated with significant socio-economic costs arising from its impact on health and criminal justice systems [ 7 ].

Low- and middle-income countries (LMICs) bear the burden of substance use. Over 80% of the 1.3 billion tobacco users worldwide live in LMICs [ 3 ]. In 2016, the alcohol-attributable disease burden was highest in LMICs compared to upper-middle-income and high-income countries (HICs) [ 2 ]. In Kenya, a nationwide survey conducted in 2017 reported that over 10% of Kenyans between the ages of 15 to 65 years had a SUD [ 8 ]. In another survey, 20% of primary school children had ever used at least one substance in their lifetime [ 9 ]. Moreover, Kenya has the third highest total DALYs (54,000) from alcohol use disorders (AUD) in Africa [ 4 ] Unfortunately, empirical work on substance use in LMICs is limited [ 10 , 11 ]. In a global mapping of SUD research, majority of the work had been conducted in upper-middle income and HICs (HICs) [ 11 ]. In a study whose aim was to document the existing work on mental health in Botswana, only 7 studies had focused on substance use [ 10 ]. Information upon which policy and interventions could be developed is therefore lacking in low-and-middle income settings.

Since the early 1980s, scholars in Kenya began engaging in research to document the burden and patterns of substance use [ 12 ]. In 2001 the National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA) was established in response to the rising cases of harmful substance use in the country particularly among the youth. The mandate of the Authority was to educate the public on the harms associated with substance use [ 13 ]. In addition to prevention work, NACADA contributes to research by conducting general population prevalence surveys every 5 years and recently launched its journal, the African Journal of Alcohol and Drug Abuse (AJADA) [ 14 ]. The amount of empirical work done on substance use in Kenya has expanded since these early years but has not been systematically summarized. The evidence gaps therefore remain unclear.

In order to guide future research efforts and adequately address the substance use scourge in Kenya, there is need to document the scope and breadth of available scientific literature. The aim of this systematic review is therefore: (i) to describe the characteristics of research studies conducted on substance use and SUD in Kenya; (ii) to assess the methodological quality of the studies; (iii) to identify areas where there is limited research evidence and; (iv) to make recommendations for future research. This paper is in line the Vision 2030 [ 15 ], Kenya’s national development policy framework, which directs that the government implements substance use treatment and prevention projects and programs, and target 3.5 of the Sustainable Development Goals (SDGs) which requires that countries strengthen the treatment and prevention for SUDs [ 16 ].

Materials and methods

Protocol and registration.

In conducting this systematic review we adhered to the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [ 17 ]. A 27-item PRISMA checklist is available as an additional file to this protocol ( S1 Checklist ). Our protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42020203717.

Search strategy

A search was carried out in five electronic databases on 20 th August 2020: PubMed, PsychINFO, Web of Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and Cochrane Library. The full search strategy can be found in S1 File and takes the following form: (terms for substance use) and (terms for substance use outcomes of interest) and (terms for region) . The searches spanned the period from inception to date. No filter was applied. A manual search was done in Volumes 1, 2 and 3 (all published volumes by the time of the search) of the recently launched AJADA journal by NACADA, and additional articles identified.

[ 14 , 18 , 19 ].

Study selection

Following the initial search, all articles were loaded onto Mendeley reference manager where initial duplicate screening and removal was done. After duplicate removal, the articles were loaded onto Rayyan, a soft-ware for screening and selecting studies during the conduct of systematic reviews [ 20 ]. The abstract and titles of retrieved articles were independently screened by two authors based on a set of pre-determined eligibility criteria. A second screening of full text articles was also done independently by two authors and resulted in an 88.7% agreement. Disagreements during each stage of the screening were resolved through discussion and consensus.

Inclusion criteria

Since we sought to map existing literature on the subject, our inclusion criteria were broad. We included articles on substance use if (i) the sample or part of the sample was from Kenya, (ii) they were original research articles, (iii) they had a substance use or SUD exposure, (iv) they had a substance use or SUD related outcome such as prevalence, pattern of use, prevention and treatment, and (iv) they were published in English or had an English translation available. We included studies conducted among all age groups and studies that used all designs including quantitative, qualitative and mixed methods.

Exclusion criteria

Studies were excluded if: (i) they were cross-national and did not report country specific results (ii) they did not report substance use or SUD as an exposure, and did not have substance use or SUD related outcomes or as part of the outcomes, (iii) they were review articles, dissertations, conference presentations or abstracts, commentaries or editorials, (iv) and the full text articles were not available.

Data extraction

We prepared 3 data extraction forms based on three emerging categories of studies i.e.:

Studies reporting on the epidemiology of substance use or SUD
Studies evaluating substance use or SUD interventions and programs
Studies qualitatively exploring various themes on substance use or SUD (but not evaluating interventions or programs)

The forms were piloted by F.J. and S.K. and adjustments made to the content. Data extraction was then done using the final form by all authors and double checked by F.J. for completeness and accuracy. Discrepancies were resolved by discussion with S.K. and E.T. until consensus was achieved. The following data was extracted for each study category:

Studies reporting on the epidemiology of substance use or SUD: study design, study population characteristics, study setting, sample size, age and gender distribution, substance(s) assessed, standardized tool or criteria used, main findings (prevalence, risk factors, other key findings).
Studies evaluating substance use or SUD interventions and programs: study design, study objective, sample size, name of the intervention or program, person delivering intervention, outcomes and measures, and main findings.
Studies qualitatively exploring various aspects of substance use or SUD other than programs and interventions: study objective, methods of data collection, study setting, study population, age and gender distribution, theoretical framework used, and main findings.

Data synthesis

The results have been summarized descriptively and organized by the three categories above. Within each category, a general description of the study characteristics has been provided followed by a narrative synthesis of findings organized by sub-themes inductively derived from the data. The sub-themes within each category are as follows:

Studies reporting on the epidemiology of substance use or SUD : Epidemiology of alcohol use, epidemiology of tobacco use, epidemiology of khat use, epidemiology of cannabis use, epidemiology of opioid and cocaine use, epidemiology of other substance use (sedatives, inhalants, hallucinogens, prescription medication, emerging drugs, ecstasy).
Studies evaluating substance use or SUD interventions and programs: Individual level interventions (Individual-level interventions for harmful alcohol use, individual-level interventions for khat use, individual level intervention for substance use in general); Programs (Methadone programs, needle-syringe programs, tobacco cessation programs, out-patient SUD treatment programs); Population-level interventions : Population-level tobacco interventions, population-level alcohol interventions.
Studies qualitatively exploring various aspects of substance use or SUD other than programs and interventions : Injecting drug use and heroin use, alcohol use, substance use among youth and adolescents, other topics.

Quality assessment of the studies

Quality assessment was conducted by S.K. using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) [ 21 ]. F.J. & J.B. double checked the scores for completeness and accuracy. Any disagreements were discussed and resolved by consensus. We had initially planned to use the National Institute of Health (NIH) set of quality assessment tools but due to the diverse nature of study designs, the authors agreed to use the QATSDD tool. The QATSDD is a 16-item tool for both qualitative and quantitative studies. Each item is scored on a 4-point scale (0–3), with a total of 14 criteria for each study design and 16 for studies with mixed methods. Scoring relies on guidance notes provided as well as judgment and expertise from the reviewers. The criteria used are: (i) theoretical framework; (ii) statement of aims or objectives; (iii) description of research setting; (iv) sample size consideration; (v) representative sample of target group (vi) data collection procedure description; (vii) rationale for choice of data collection tool(s); (viii) detailed recruitment data; (ix) statistical assessment of reliability and validity of measurement tools (quantitative only); (x) fit between research question and method of data collection (quantitative only); (xi) fit between research question and format and content data collection (qualitative only); (xii) fit between research question and method of analysis; (xiii) justification of analytical method; (xiv) assessment of reliability of analytical process (qualitative only); (xv) user involvement in design and (xvi) discussion on strengths and limitations[ 21 ]. Scores are awarded for each criterion as follows: 0 = no mention at all; 1 = very brief description; 2 = moderate description; and 3 = complete description. The scores of each criterion are then summed up with a maximum score of 48 for mixed methods studies and 42 for studies using either qualitative only or quantitative only designs. For ease of interpretation, the scores were converted to percentages and classified as low (<50%), medium (50%–80%) or high (>80%) quality of evidence [ 22 ].

Search results

The search from the five electronic databases yielded 1535 results: 950 from PubMed, 173 from PsychINFO, 210 from web of science, 123 from CINAHL and 79 from Cochrane library. Thirteen additional studies were identified through a manual search of the AJADA journals (Volumes 1, 2 and 3). Studies were assessed for duplicates and 1154 articles remained after removal of duplicates. The 1154 studies underwent an initial screening based on abstracts and titles, and 946 articles were excluded. A second screen of full text articles was done for the 208 studies that were potentially eligible for the review. Twenty three studies were excluded as follows: 21 did not meet the eligibility criteria and 2 had duplicated results. A total of 185 studies were found to meet the inclusion criteria and were included in the review ( Fig 1 ).

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General characteristics of the studies

Of the 185 studies included in this review, 144 (77.8%) investigated the epidemiology of substance use or SUD, 18 (9.7%) evaluated substance use or SUD interventions and programs, and 23 (12.4%) were qualitative studies exploring perceptions on various substance use or SUD topics other than interventions and programs (Table 4). The studies were published between 1982 and 2020. The number of studies published has gradually increased in number over the years, particularly in the past decade. Fig 2 shows the publication trends for substance use research in Kenya.

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Quality assessment

The QATSDD scores ranged from 28.6% [ 23 ] to 92.9% [ 24 ]. Only 14 studies [ 12 , 23 , 25 – 36 ] (all quantitative) had scores of less than 50%. Of these, the main items driving low quality were: no mention of user involvement in study design (n = 14) [ 12 , 23 , 25 – 36 ], no explicit mention of a theoretical framework (n = 10) [ 12 , 23 , 25 – 28 , 30 , 33 , 35 , 36 ] and a lack of a statistical assessment of reliability and validity of measurement tools (n = 10) [ 12 , 23 , 25 , 28 , 30 – 33 , 35 , 36 ] Table 1 .

Studies examining the epidemiology of substance use or SUD

General description of epidemiological studies.

One hundred and forty-four studies examined the prevalence and or risk factors for various substances. The studies were published between 1982 and 2020. The four main study designs used were cross-sectional (n = 126), cohort (n = 5), case-control (n = 10), and mixed methods (n = 2). One study used a combination of the multiplier method, Wisdom of the Crowds (WOTC) method, and a published literature review to document the size of key populations [ 164 ]. The sample size for this category of studies ranged from 42 [ 130 ] to 72292 [ 128 ].

The studies were conducted in diverse settings including the community (n = 72), hospitals (n = 40), institutions of learning (n = 24), streets (n = 5), prisons and courts (n = 3), charitable institutions (n = 1), methadone maintenance therapy (MMT) clinics (n = 1), and in needle-syringe program (NSP) sites (n = 1). Of the studies conducted within the community, 12 were conducted in informal settlements. The study populations were similarly diverse as follows: general population adults & adolescents (n = 39), persons with NCDs (n = 11), primary and secondary school students (n = 15), people who inject drugs (PWID) (n = 11), general patients (n = 5), men who have sex with men (MSM) (n = 8), university and college students (n = 9), commercial sex workers (n = 7), psychiatric patients (n = 6), orphans and street connected children and youth (n = 6), people living with HIV (PLHIV) (n = 6), healthcare workers (n = 3), law offenders (n = 3), military (n = 1), and teachers (n = 1). Only one study was conducted among pregnant women [ 131 ].

Sixty-nine studies (47.6%) used a standardized diagnostic tool to assess for substance use. The Alcohol Use Disorder Identification Test (AUDIT) (n = 21) and the Alcohol, Smoking & Substance Use Involvement Screening Test (ASSIST) questionnaire (n = 10) were the most frequently used tools. Most papers assessed for alcohol ( n = 109) and tobacco use ( n = 80). Other substances assessed included khat (n = 34), opioids (n = 21), sedatives (n = 19), cocaine (n = 19), inhalants (n = 16), cannabis (n = 14), hallucinogens (n = 7), prescription medication (n = 4), emerging drugs (n = 1) and ecstasy (n = 1). Most studies (n = 93) assessed for more than one substance.

Epidemiology of alcohol use

One hundred and nine papers assessed for the prevalence and or risk factors for alcohol use. Using the AUDIT, the 12-month prevalence rate for hazardous alcohol use ranged from 2.9% among adults drawn from the community [ 97 ] to 64.6% among female sex workers (FSW) [ 77 ]. Based on the same tool, the lowest and highest 12-month prevalence rates for harmful alcohol use were both reported among FSWs i.e. 9.3% [ 80 ] and 64.0% [ 174 ] respectively, while the prevalence of alcohol dependence ranged from 8% among FSWs living with HIV [ 203 ] to 33% among MSM who were commercial sex workers [ 144 ]. The highest lifetime prevalence rate for alcohol use was reported by Ndegwa & Waiyaki [ 151 ]. The authors found that 95.7% of undergraduate students had ever used alcohol.

Alcohol use, was associated with several socio-demographic factors including being male [ 50 , 112 , 114 , 140 , 158 , 168 , 182 , 191 ], being unemployed [ 114 ], being self-employed [ 97 ], having a lower socio-economic status (SES) [ 128 ], being single or separated, living in larger households [ 97 ], having a family member struggling with alcohol use, and alcohol being brewed in the home [ 143 ]. Alcohol use was linked to various health factors including glucose intolerance [ 81 ], poor cardiovascular risk factor control [ 111 ], having a diagnosis of diabetes mellitus [ 134 ], hypertension [ 112 , 139 ], default from tuberculosis (TB) treatment [ 148 ], depression [ 113 ], psychological Intimate Partner Violence (IPV) [ 205 ], tobacco use [ 182 , 205 ], and increased risk of esophageal cancer [ 137 , 179 ]. Finally, alcohol use was associated with involvement in Road Traffic Accidents (RTAs) [ 88 ], and having injuries [ 88 , 171 ] and suicidal behavior [ 109 ].

Epidemiology of tobacco use

Eighty papers assessed for the prevalence and risk factors for tobacco use. The lifetime prevalence of tobacco use ranged from 23.5% among healthcare workers (HCWs) [ 140 ] to 84.3% among psychiatric patients [ 110 ]. The highest lifetime prevalence rate for tobacco use was reported by Ndegwa & Waiyaki [ 151 ]. The authors found that 95.7% of undergraduate students had ever used tobacco.

Tobacco use was associated with socio-demographic factors such as being male [ 112 , 140 , 168 ] and living in urban areas [ 163 ]. Several health factors were linked to tobacco use including hypertension [ 112 ], development of oral leukoplakia [ 32 ], pneumonia [ 146 ], increased odds of laryngeal cancer [ 136 ], ischemic stroke [ 100 ] and diabetes mellitus [ 134 ]. In addition, tobacco use was associated with having had an injury in the last 12 months [ 171 ], emotional abuse [ 110 ], and psychological IPV [ 205 ]. Longer duration of smoking was associated with a diagnosis of diabetes mellitus [ 73 ], lower SES [ 128 ], and hypertension [ 98 , 142 ]. Peltzer et al. [ 181 ] reported that early smoking initiation among boys was associated with ever drunk from alcohol use, ever used substances, and ever had sex. Among girls, the authors found that early smoking initiation was associated with higher education, ever drunk from alcohol use, parental or guardian tobacco use, and suicide ideation.

Epidemiology of khat use

The epidemiology of khat use was investigated by 34 studies. The lifetime prevalence rate for khat use ranged from 10.7% among general hospital patients [ 168 ] to 88% among a community sample [ 23 ]. Khat use was associated with being male [ 114 , 168 ]; unemployment [ 114 ]; being employed [ 25 ]; younger age (less than 35 years), higher level of income, comorbid alcohol and tobacco use [ 166 ] and age at first paid sex of less than 20 years among FSWs [ 195 ]. Further, khat use was associated with increased odds of negative health outcomes [ 130 , 146 , 166 , 201 ].

Higher odds of reporting psychotic [ 166 , 201 ], and PTSD (Post-Traumatic Stress Disorder) symptoms [ 201 ], having thicker oral epithelium [ 130 ], and pneumonia [ 146 ], were reported among khat users compared to non-users.

Epidemiology of cannabis use

Fourteen studies evaluated the prevalence of cannabis use. The lifetime prevalence rate of cannabis use ranged from 21.3% among persons with AUD [ 120 ] to 64.2% among psychiatric patients [ 110 ]. Cannabis use was associated with being male [ 140 , 168 ], and with childhood exposure to physical abuse [ 110 ].

Epidemiology of opioid and cocaine use

Twenty-one studies investigated the prevalence of opioid use. The lifetime prevalence rate of opioid use ranged from 1.1% among PLHIV [ 132 ] to 8.2% among psychiatric patients [ 110 ].

Nineteen studies assessed for the prevalence of cocaine use. The highest reported prevalence rates were 76.2% among PWID use (current use) [ 190 ]; 8.8% among healthcare workers (lifetime use) [ 140 ]; and 6.7% among PLHIV (lifetime use) [ 132 ].

Epidemiology of IDU

One study assessed the prevalence for IDU. Key population size estimates for PWID use was reported as 6107 for Nairobi [ 164 ]. IDU was associated with depression, risky sexual behavior [ 149 ], Hepatitis-C Virus (HCV) infection [ 173 ], and HIV-HCV co-infection [ 68 ].

Epidemiology of other substance use (sedatives, inhalants, hallucinogens and prescription medication, emerging drugs, ecstasy)

The epidemiology of sedative use was investigated by 19 studies, inhalant use by 16 studies, hallucinogen use by 7 studies, prescription medication by 4 studies, and emerging drugs and ecstasy by one study each. The highest lifetime prevalence rate for sedative use was reported as 71.4% among a sample of psychiatric patients [ 28 ], while the highest prevalence rate for inhalant use was 67% among children living in the streets [ 86 ]. The lifetime prevalence rates for hallucinogen use ranged from 1.4% among university students [ 160 ] to 3.7% among psychiatric patients [ 110 ]. The highest prevalence rate for the use of prescription medication was reported as 21.2% among PWID [ 190 ]. One study each reported on the prevalence of emerging drugs [ 122 ] and ecstasy [ 153 ]. The studies were both conducted among adolescents and youth. The authors found the lifetime prevalence rates for the two substances to be 11.8% [ 122 ] and 4.0% [ 153 ] respectively.

Studies evaluating substance use or SUD programs and interventions

General description of studies evaluating programs and interventions.

A total of eighteen studies evaluated specific interventions or programs for the treatment and prevention of substance use. These were carried out between 2009 and 2020. Eleven studies focused on individual-level interventions, 5 studies evaluated programs, and 2 studies evaluated population-level interventions. The studies used various approaches including randomized control trials (RCT) (n = 7), mixed methods (n = 3), non-concurrent multiple baseline design (n = 1), quasi experimental (n = 1), cross-sectional (n = 2), and qualitative (n = 3). One study employed a combination of qualitative methods and mathematical modeling.

Individual-level interventions

Individual-level interventions for harmful alcohol use . Nine studies evaluated either feasibility, acceptability, and or efficacy for individual-level interventions for harmful alcohol use [ 38 , 40 , 90 , 94 , 127 , 141 , 175 , 178 , 193 ]. All the interventions were tested among adult populations including persons attending a Voluntary Counseling & Testing (VCT) center (38), PLHIV [ 40 , 175 ], and adult males and females drawn from the community [ 94 , 141 ] and FSWs [ 127 , 178 ].

Two studies evaluated a six session CBT intervention for harmful alcohol use among PLHIV. The intervention was reported as feasible, acceptable [ 40 ] and efficacious [ 175 ] in reducing alcohol consumption among PLHIV. The intervention was delivered by trained lay providers.

Giusto et al [ 90 ] evaluated the preliminary efficacy of an intervention aimed at reducing men’s alcohol use and improving family outcomes. The intervention was delivered in 5 sessions by trained lay-providers, and utilized a combination of behavioral activation, motivational interviewing (MI) and gender norm transformative strategies. The intervention showed preliminary efficacy for addressing alcohol use and family related problems.

Five studies evaluated brief interventions that ranged from 1 to 6 sessions and were delivered by primary HCWs, lay providers and specialist mental health professionals [ 38 , 94 , 127 , 178 , 193 ]. The brief interventions were reported as feasible, acceptable [ 38 ], and efficacious in reducing alcohol consumption [ 94 , 127 , 178 , 193 ]. The brief interventions additionally resulted in reductions to IPV, participation in sex work [ 178 ], and risky sexual behavior [ 127 ].

One study evaluated the efficacy of a mobile delivered MI intervention and found that at 1 month, AUDIT-C scores were significantly higher for waiting-list controls compared to those who received the mobile MI [ 94 ].

Moscoe at al. [ 141 ] found no effect of a prize-linked savings account on alcohol, gambling and transactional sex expenditures among men.

Individual-level interventions for khat use . One study utilized a randomized control trial (RCT) approach to evaluate the effect of a three-session brief intervention for khat use on comorbid psychopathology (depression, PTSD, khat induced psychotic symptoms) and everyday functioning. The intervention was delivered by trained college graduates and was found to result in reduced khat use and increased functioning levels, but had no benefit for comorbidity symptoms (compared to assessments only) [ 202 ].

Individual level intervention for any substance use . One study evaluated the efficacy of a four-session psychoeducation intervention using an RCT approach. The study found that the intervention was effective in reducing the severity of symptoms of any substance abuse at 6 months compared to no intervention. The intervention was additionally effective in reducing symptoms for depression, hopelessness, suicidality, and anxiety [ 145 ].

Methadone programs . Two studies utilized qualitative methods to evaluate the perceptions of persons receiving methadone on the benefits of the programs [ 61 , 62 ]. The methadone programs were perceived as having potential to aid in recovery from opioid use and to reduce HIV transmission among PWID [ 61 , 62 ].

Needle-syringe programs (NSPs) . One paper explored the impact of NSPs programs on needle and syringe sharing among PWID. The study reported that the introduction of NSPs led to significant reductions in needle and syringe sharing [ 56 ].

Tobacco cessation programs . One study evaluated HCWs knowledge and practices on tobacco cessation and found that the knowledge and practice on tobacco cessation was inadequate [ 89 ].

Out-patient SUD treatment programs . One paper investigated the impact of community based outpatient SUD treatment services and reported a 42% substance use abstinence rate 0–36 months following treatment termination [ 84 ].

Population-level interventions

Population-level tobacco interventions . One study evaluated the appropriateness and effectiveness of HIC anti-tobacco adverts in the African context and found the adverts to be effective and appropriate [ 183 ].

Population-level alcohol interventions . One paper examined community members’ perspectives on the impact of the government’s public education messages on alcohol abuse and reported that the messages were ineffective and unpersuasive [ 55 ].

A complete description of studies investigating programs and interventions is in Table 3 .

Studies qualitatively exploring various substance use or SUD topics (other than interventions)

General description of qualitative studies.

There were 23 qualitative studies included in our review. The studies were conducted between 2004 and 2020. Data was collected using several approaches including in-depth interviews (IDIs) only (n = 6), focus group discussions (FGDs) only (n = 2), a combination of FGDs and IDIs (n = 10), a combination of observation and individual IDIs (n = 2), a combination of observation, IDIs and FGDs (n = 1), a combination of literature review, observation, IDIs and FGDs (n = 1). One study utilized the participatory research and action approach [ 60 ]. The target populations for the qualitative studies included persons using heroin (n = 3), males and females with IDU (n = 11) adolescents and youth (n = 3), FSWs (n = 2), refugees and Internally Displaced Persons (IDPs) (n = 1), and PLHIV (n = 2).

Injecting drug use and heroin use

Thirteen studies explored various themes related to IDU and heroin use with most of them (n = 8) focusing on issues related to women. Three studies explored the drivers of IDU among women and found them to include influence of intimate partners [ 48 , 49 ], stress of unexpected pregnancies [ 49 ], gender inequality, and social suffering [ 67 ]. One study found that IDU among women interfered with utilization of antenatal and maternal and child health services [ 57 ], while another reported that women who inject drugs linked IDU to amenorrhea hence did not perceive the need for contraception [ 51 ].

Mburu et al [ 47 ] explored the social contexts of women who inject drugs and found that these women experienced internal and external stigma of being injecting drug users, and external gender-related stigma of being female injecting drug users. Using a socio-ecological approach, Mburu et al [ 50 ] reported that IDU during sex work was an important HIV risk behavior. In another study, FSWs reported that they used heroin to boost courage to engage in sex work [ 65 ].

Other than IDU and heroin use among women, five studies investigated other themes. One study explored the experiences of injecting heroin users and found that the participants perceived heroin injection as cool [ 42 ]. Guise et al. 2015 [ 44 ] conducted a study to explore transitions from smoking to injecting and reported that transitions from smoking to IDU were experienced as a process of managing resource constraints, or of curiosity, or search for pleasure. One study explored the experiences of persons on MMT as regards integration of MMT with HIV treatment. The study was guided by the material perspective in sociology theory and Annmarie’s Mol’s analysis of logic of care. Persons on MMT preferred that they have choice over whether to seek care for HIV and MMT in a single, or in separate settings.

Alcohol use

Six studies focused on alcohol use. Three studies explored perceptions of service providers and communities on the effects of alcohol use. Alcohol use was perceived as having a negative impact on sexual and reproductive health [ 53 , 54 ] and on socio-economic status [ 43 , 46 ]. One study explored the reasons for alcohol use among PLHIV and found that reasons for alcohol use included stigma and psychological problems, perceived medicinal value, and poverty [ 60 ].

Youth and adolescent substance use

Three studies focused on substance use among youth and adolescents. In one study, the adolescents perceived that substance use contributed to risky sexual behavior including unprotected sex, transactional sex, and multiple partner sex [ 58 ]. The youth identified porn video shows and local brew dens as places where risky sexual encounters between adolescents occurred [ 59 ]. Ssewanyana et al. [ 63 ] utilized the socio-ecological model to explore perceptions of adolescents and stakeholders on the factors predisposing and contributing to substance use. Substance use among adolescents was perceived to be common and to be due to several socio-cultural factors e.g. access to disposable income, idleness, academic pressure, low self-esteem etc.

Epidemiology of substance use or SUD

Studies investigating the prevalence, and risk factors for substance use dominated the literature. The studies, which were conducted across a broad range of settings and populations, focused on various substances including alcohol, tobacco, cannabis, opioids, cocaine, sedatives, inhalants, hallucinogens, prescription medication, and ecstasy. In addition, a wide range of important health and socio-demographic factors were examined for their association with substance use. Most studies had robust sample sizes and were conducted using diverse designs including cross-sectional, case-control and cohort. The studies showed a significant burden of substance use among both adults and children and adolescents. In addition, substance use increased the odds of negative mental and physical health outcomes consistent with findings documented in global reports [ 2 , 3 ]. These findings highlight the importance of making the treatment and prevention for substance use and SUDs of high priority in Kenya.

Two main evidence gaps were identified within this category: The prevalence and risk factors for substance use among certain vulnerable populations for whom substance use can have severe negative consequences, had not been investigated. For example, no study had included police officers or persons with physical disability, only one study had its participants as pregnant women [ 113 ], and only 2 studies had been conducted among HCWs [ 140 , 196 ].
Few studies had explored the epidemiology of hallucinogens, prescription medication, ecstasy, IDU, and emerging substances e.g. synthetic cannabinoids. These substances are a public health threat globally [ 207 , 208 ] yet their use remains poorly documented in Kenya.

Interventions and programs

Given the significant documented burden of substance use and SUDs in Kenya, it was surprising that few studies had focused on developing and testing treatment and prevention interventions for SUDs. A possible reason for this is limited expertise in the area of intervention development and testing. For example, research capacity in implementation science has been shown to be limited in resource-poor settings such as ours [ 209 ].

Of note is that most of the tested interventions had been delivered by lay providers [ 40 , 90 , 175 ] and primary HCWs [ 38 , 127 , 178 ] indicating a recognition of task-shifting as a strategy for filling the mental health human resource gap in Kenya.

Several research gaps were identified within this category.

Out of the 11 individual-level interventions tested, nine had targeted harmful alcohol use except one which focused on khat [ 202 ] and another that targeted several substances [ 145 ]. No studies had evaluated individual-level interventions targeting tobacco and cannabis use, despite the two being the second and third most commonly used substances in Kenya [ 8 ]. Further, no individual-level interventions had focused on other important SUDs like opioid, sedative and cocaine use disorders.
Few studies had evaluated the impact of substance use population-level interventions [ 55 , 183 ]. Several cost-effective population-level interventions have been recommended by WHO e.g. mass media education and national toll free quit line services for tobacco use, and brief interventions integrated into all levels of primary care for harmful alcohol use [ 210 ]. Such strategies need to be tested for scaling up in Kenya.
None of the interventions had been tested among important vulnerable populations for whom local research already shows a significant burden e.g. children and adolescents, the Lesbian Gay Bisexual Transgender & Queer (LGBTQ) community, HCWs, prisoners, refugees, and IDPs. In addition, no interventions had been tested for police officers and pregnant women, and no studies had evaluated interventions to curb workplace substance use.
Only one study evaluated digital strategies for delivering substance use interventions [ 94 ] yet the feasibility of such strategies has been demonstrated for other mental health disorders in Kenya [ 211 ]. Moreover, the time is ripe for adopting such an approach to substance use treatment given the fact that the country currently has a mobile subscriptions penetration of greater than 90% [ 212 ].
No studies had evaluated the impact of other interventions such as mindfulness and physical exercise. Meta-analytic evidence suggests that such strategies hold promise for reducing the frequency and severity of substance use and craving [ 213 , 214 ].

Qualitative studies

The qualitative studies focused on a broad range of themes including drivers and impact of substance use, drug markets, patterns of substance use, stigma, and access to treatment. Most of the work however focused on PWID and heroin users. Future qualitative work should explore issues relating to other populations for example persons with other mental disorders, persons with physical disabilities, police officers, and persons using other commonly used substances such as tobacco, khat, and cannabis.

Limitations

The aim of this systematic review was to provide an overview of the existing literature on substance use and SUD research in Kenya. We therefore did not undertake a meta-analysis and detailed synthesis of the findings of studies included in this review. In addition, variability in measurements of substance use outcomes precluded our ability to more comprehensively summarize the study findings. For quality assessment, detailed assessments using design specific tools were not possible given the diverse methodological approaches utilized in the studies. We therefore used a single tool for the quality assessment of all studies. The results of the quality assessment are therefore to be interpreted with caution. Nonetheless this review describes for the first time the breadth of existing literature on substance use and SUDs in Kenya, identifies research gaps, and provides important directions for future research.

The purpose of this systematic review was to map the research that has been undertaken on substance use and SUDs in Kenya. Epidemiological studies dominated the literature and indicated a significant burden of substance use among both adults and adolescents. Our findings indicate that there is a dearth of literature regarding interventions for substance use and we are calling for further research in this area. Specifically, interventions ought to be tested not just for alcohol but for other substances as well, and among important at risk populations. In addition, future research ought to explore the feasibility of delivering substance use interventions using digital means, and the benefit of other interventions such as mindfulness and physical exercise. Future qualitative work should aim at providing in-depth perspectives on substance use among populations excluded from existing literature e.g. police officers, persons using other substances such as tobacco, cannabis and khat, and persons with physical disability.

Supporting information

S1 checklist, abbreviations, funding statement.

The author(s) received no specific funding for this work.

Data Availability

PLoS One. 2022; 17(6): e0269340.

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PONE-D-22-00681A systematic review of substance use and substance use disorder research in KenyaPLOS ONE

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Reviewer #1: This manuscript adds value in an under-research area by summarizing main learnings from substance use and substance use disorder research in Kenya. Major revisions are needed though for the article to be presented as a scientifically- acceptable piece. These revision include punctuation, grammar errors (eg: inappropriate use of upper case letter on line 84- 86), and overall flow of some sentences such as line 31, line 39, line 50, line 58, line 69, line 83, line 87- 91, line 104, line 172, line 175 to list a few.

In addition to these revision, below are proposed consideration:

- In the abstract, please specify the start date used in the search strategy.

- Line 53- tobacco kills 8million people where? Worldwide? On a specific continent? Please specify

-Line 57- you mentioned one consequence so far ie death which others are you referring to here?

- Line 104- inception of what?

-Line 111 who checked the duplicates? Was the software used for this or did the authors do it? It's a bit unclear

-Line 124-125: Were mixed methods studies included as well? The way this is phrased it sounds like "all designs" refers more to qualitative and quantitative studies

-Avoid over using "/" in sentences. If need be list item a "or" b throughout the manuscript. Eg: substance use or SUDs

-Line 182- 183- did you mean that 13 additional studies were identified? Please consider reviewing and rephrasing your sentences to improve clarity

-Line 185- Is "These" referring to the studies? If yes, can you be a bit more explicit?

-Line 238- are you referring to MSM who are commercial sex workers? Please use appropriate languages throughout the manuscript

- For the result presentation, it might be helpful to have as part of the main manuscript (not supplemental information) a summary table of the final literature reviewed including information on the title of the article, authors, methods, findings and gap from the articles that were included in the review instead of having long references throughout the result section.

- Line 313 Lay healthcare providers might be more appropriate same for line 314 for primary healthcare workers not primary care workers

-Line 331-332 that last sentence seems incomplete, please consider reviewing it

-Line 371- 372- What are estimates then on what has been done elsewhere in SSA? Is this conclusion based mainly on the 2 scoping work from SA and Bostwana? How about other SSA countries including countries neighboring Kenya like Uganda, Tanzania, etc?

How do you define a lot?

-Line 392- Emerging substances like which ones?

- Line 404- Was the study specifically assessing feasibility? If that was not the case, making such claim is misleading

Reviewer #2: This systematic review highlights several gaps in licit and illicit substance use (SU) and substance use disorder (SUD) literature within Kenya, with the goal of summarizing research within three broad domains: (1) epidemiologic studies, (2) intervention and/or programs and (3) qualitative studies. The authors apply sound methods, with attention to details around decision-making processes when including articles in their review. The attention to target study populations (e.g., community, hospitals, prisons, etc.) is extremely valuable and calls for additional studies within specific populations. In addition, the authors make the case that their review is needed in order to address Kenya’s Vision 2030 and moves towards accomplishing SDG’s. I commend the authors for completing this large undertaking and offer feedback to strengthen and improve their paper.

Major Edits

• There is an absolute need for SU and SUD systematic review; however, this paper may have limited applications in its current state. In the introduction, the authors state this paper will “guide future research efforts”; however, most SUD researchers work with one substance or one category of substances. It would be helpful within the key findings sections to expand on SU categories, which are discussed briefly in the introduction (e.g., tobacco, alcohol, opioids, cannabis, and stimulants.) Another option may be to reformat the paragraphs according to SU categories and discuss the current epidemiologic, interventions/programs, and qualitative studies.

• In your criteria, you do not mention whether you included studies conducted out of methadone clinics or harm reduction sites (i.e., drop-in centres, NSPs), specifically. However, when I look over the publications, several were conducted within these sites. Please clarify whether these terms were part of your search categories and include them on Page 11, lines 215-217.

• Throughout the descriptions and key findings sections, there should be more syntheses of the data instead of frequencies, which are already conveyed in your tables. For example, under the epidemiology section of SU/SUD, you say that 47% of the studies used evidence-based diagnostic tools, but this should be followed by the key findings of those studies (i.e., X-X% of participants indicated hazardous or harmful alcohol consumption, and X-X% of participants indicated alcohol dependence.) This is just one example, but all of the key finding’s sections should provide more data syntheses.

• As it stands, the key findings and other findings sections are a little difficult to follow and are heavily focused on alcohol and tobacco use. For example, in the epidemiologic key findings section the paragraphs are organized as follows: (1) youth and substance use, (2) adults and tobacco use, (3) adults and alcohol use, and (4) two case control studies. Again, this may have a better flow if the authors organized the key findings by SU categories (e.g., tobacco, alcohol, opioids, cannabis, and stimulants.) By structuring the paragraphs by SU categories, the reader is able to quickly decipher where there are gaps in the literature. Alternatively, the authors may want to consider narrowing the scope of their paper by solely focusing on alcohol and tobacco use, which seem to be the main focus throughout the paper.

• In the qualitative study key findings section, most of the studies apply frameworks and/or theories to their analysis (e.g., stages of change, risk environment framework), which should be synthesized and included as a column in Additional File 5/Qualitative Studies.

Minor Edits

• Please review the PLOS ONE Guidelines on formatting references and edit references.

• Page 11 (line 220) “People with injecting drug use” should be “people (or persons) who inject drugs.”

• Page 11 (line 221) “Men who have Sex with Men” should not contain capital letters.

• Page 11 (lines 218-225) This section does not sum up to the total studies in the epidemiology section n=144.

• Page 11 (line 210-213) Please be consistent in how you mention the study designs with corresponding references. This was completed in the interventions and programs section, but not for the epidemiological studies.

• Page 15 (lines 299-303) Conversely, please indicate in the programs and intervention section, how may studies were included in each of the study designs.

• Page 12 (line 229) typo, please change to “opioids (n=21)”

• In the findings section, please define “hospital,” and whether this includes methadone clinics.

• Page 20 (line 398) “Substance use” should be “substance use disorder.”

• Page 21 (line 423-424) “Mental disorders” should be “mental health disorders.”

• Additional File 3/Epidemiological Studies: The SU category should not include how people consume their drugs (“injection drugs”), which is only seen a few times, but what drugs categories were examined. Please be more specific than “illicit drugs.”

• Additional File 4/Interventions and Program: Please review the sample sizes for each study, particularly for those with “not reported.”

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Reviewer #2: No

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Submitted filename: PONE-D-22-00681.pdf

Author response to Decision Letter 0

12 May 2022

We thank the reviewer for this comment. We have thoroughly proof read the paper and made corrections to grammar and punctuation.

We have specified that the search was conducted from inception (line 27).

We have clarified that it is worldwide (line 58)

The paragraph has been revised to include health consequences of alcohol, tobacco and other substances (line 58-63)

Inception means from the earliest available study. This term is commonly used in systematic review searches when no date limits have been set

The Mendeley Reference manager was used to identify and remove duplicates. This has been clarified on line 116-117.

Yes, we included studies with qualitative, quantitative and mixed methods designs. This has now been clarified (line 133).

This has been corrected throughout the manuscript

The sentence has been reviewed to improve clarity (line 208)

We have reworded the sentence to make it more explicit (line 210)

The authors are referring to MSM who were commercial sex workers. We have corrected this (line 273).

We have included the tables within the main manuscript (line 367, 439, 504)

This has been corrected line 388, 391, 395, 551, 552

This sentence has been revised (line 428-430)

We have reworded the paragraph to show that we are comparing our findings with available scoping reviews (line 513-520)

How do you define a lot? We have revised this sentence and used the word “more…” (line 515)

An example has been given (line 541)

This line has been deleted (line 554).

We thank the reviewer for their comments.

We acknowledge this comment. We have organized the key findings sections by substance use categories and expanded on the findings (line 162, 266-366, 373-439, 446-503).

NSP sites has been included in the general characteristics of epidemiological studies (line 248)

• We have now provided more synthesis of data in the results section

(line 266-366, 373-439, 446-503).

We have incorporated the theoretical frameworks into the results section (line 468,478, 492, 499), and added a column presenting information on theoretical frameworks to the table 4 (line 505).

The references have been edited in line with PLOS one guidelines

This has been corrected (line 251)

This has been corrected (line 252)

Yes. This is true because some populations overlapped e.g. some studies were conducted among general population adults with NCDs.

We have now deleted references in the general description section for the intervention studies (line 375-378) and qualitative studies (448-457) to ensure uniformity

This has been indicated. Line 386-389

This has been corrected. Line 261

We have separated out studies done within hospitals and those done within methadone clinics (line 247; Kisilu et al. 2019 on table 2 line 367)

This has been corrected. Line 551

This has been corrected. Line 578

The studies described the substances as just IDU and illicit substances, and did not provide descriptions of the specific substances assessed for. We have included the phrase ‘not specified’ next to the term illicit drugs and IDU for clarity. (Table 2 line 367)

These were reviewed and appropriate sample sizes reported (table 3 line 443)

Editors’ comments

We have addressed this (line 349-354)

About data availability. All analyzed data has been included in the main manuscript and in the supporting information files 1 and 2. (line 1264)

Decision Letter 1

19 May 2022

PONE-D-22-00681R1

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Acceptance letter

26 May 2022

Dear Dr. Jaguga:

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Pathways of Addiction: Opportunities in Drug Abuse Research (1996)

Chapter: 1. introduction, 1 introduction.

Drug abuse research became a subject of sustained scientific interest by a small number of investigators in the late nineteenth and early twentieth centuries. Despite their creative efforts to understand drug abuse in terms of general advances in biomedical science, the medical literature of the early twentieth century is littered with now-discarded theories of drug dependence, such as autointoxication and antibody toxins, and with failed approaches to treatment. Eventually, escalating social concern about the use of addictive drugs and the emergence of the biobehavioral sciences during the post-World War II era led to a substantial investment in drug abuse research by the federal government (see Appendix B ). That investment has yielded substantial advances in scientific understanding about all facets of drug abuse and has also resulted in important discoveries in basic neurobiology, psychiatry, pain research, and other related fields of inquiry. In light of how little was understood about drug abuse such a short time ago, the advances of the past 25 years represent a remarkable scientific accomplishment. Yet there remains a disconnect between what is now known scientifically about drug abuse and addiction, the public's understanding of and beliefs about abuse and addiction, and the extent to which what is known is actually applied in public health settings.

During its brief history, drug abuse research has been supported mainly by the federal government, with occasional investments by major private foundations. At the federal level, the lead agency for drug abuse research is the National Institute on Drug Abuse (NIDA), which supports

85 percent of the world's research on drug abuse and addiction. Other sponsoring agencies include the National Institute of Mental Health (NIMH), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Substance Abuse and Mental Health Services Administration (SAMHSA), all in the Department of Health and Human Services; as well as the Office of Justice Programs (OJP) in the Department of Justice. Throughout the federal government, the FY 1995 investment in drug abuse research and development was $542.2 million, which represents 4 percent of the $13.3 billion spent by the federal government on drug abuse (ONDCP, 1996). By comparison, $8.5 billion (64 percent of the FY 1995 budget) was spent on criminal justice programs, 1 $2.7 billion (20 percent) on treatment of drug abuse, and $1.6 billion (12 percent) on prevention efforts.

In 1992, the General Accounting Office (GAO) released a report Drug Abuse Research: Federal Funding and Future Needs, which recommended that Congress review the place of research in drug control policy and its modest 4 percent share of the drug control budget. The report questioned whether the federal commitment to research was adequate, given the enormity of research needs (GAO, 1992), and whether adequate evaluation research was being conducted to determine the efficacy of various drug control programs. In FY 1995, drug abuse research was still little more than 4 percent of the entire drug control budget.

In January 1995, NIDA requested the Institute of Medicine (IOM) to examine accomplishments in drug abuse research and provide guidance for future research opportunities. This report by the IOM Committee on Opportunities in Drug Abuse Research focuses broadly on opportunities and priorities for future scientific research in drug abuse. After a brief review of major accomplishments in drug abuse research, the remainder of this chapter discusses the vocabulary and basic concepts used in the report, highlights the importance of the nation's investment in drug abuse research, and explores some of the factors that could improve the yield from that investment.

MAJOR ACHIEVEMENTS IN DRUG ABUSE RESEARCH

There have been remarkable achievements in drug abuse research over the past quarter of a century as researchers have learned more about the biological and psychosocial aspects of drug use, abuse, and dependence. Behavioral researchers have developed animal and human mod-

els of drug-seeking behavior, that have, for example, yielded objective measures of initiation and repeated administration of drugs, thereby providing the scientific foundation for assessments of "abuse liability" (i.e., the potential for abuse) of specific drugs (see Chapter 2 ). This information is an essential predicate for informed regulatory decisions under the Food, Drug and Cosmetic Act and the Controlled Substances Act. Taking advantage of technological advances in molecular biology, neuroscientists have identified receptors or receptor types in the brain for opioids, cocaine, benzodiazepines, and marijuana and have described the ways in which the brain adapts to, and changes after, exposure to drugs. Those alterations, which may persist long after the termination of drug use, appear to involve changes in gene expression. They may explain enhanced susceptibility to future drug exposure, thereby shedding light on the enigmas of withdrawal and relapse at the molecular level (see Chapter 3 ). Epidemiologists have designed and implemented epidemiological surveillance systems that enable policymakers to monitor patterns of drug use in the population ( Chapter 4 ) and that enable researchers to investigate the causes and consequences of drug use and abuse (Chapters 5 and 7 , respectively). Paralleling broader trends in health promotion and disease prevention in the past 20 years, the field of drug abuse prevention has made significant progress in evaluating the effectiveness of interventions implemented in a range of settings including communities, schools, and families (see Chapter 6 ).

Marked gains have also been made in treatment research, including improvements in diagnostic criteria; development of a wide range of treatment interventions and sophisticated methods to assess treatment outcome; and development and approval of Leo-alpha-acetylmethadol (LAAM), a medication for the treatment of opioid dependence. Pharmacological and psychosocial treatments, alone or in combination, have been shown to be effective for drug dependencies, and treatment has been shown to reduce drug use, HIV (human immunodeficiency virus) infection rates, health care costs, and criminal activity (see Chapter 8 ).

Drug abuse researchers have also made major contributions to knowledge in adjacent fields of scientific inquiry. For example, NIDA-sponsored research was the driving force in the identification of morphine-like substances that serve as neurotransmitters in specific neurons located throughout the central and peripheral nervous systems (Orson et al., 1994). Identification of these substances represents a dramatic breakthrough in understanding the mechanisms of pain, reinforcement, and stress. Additionally, the discovery of opioid peptides as neurotransmitters played a key role in the identification of numerous other peptide neurotransmitters (Cooper et al., 1991; Goldstein, 1994; Hokfelt et al., 1995). These discoveries have broadened the understanding of brain function and now

form the basis of many current strategies in the design of new drug treatments for neuropsychiatric disorders. Additionally, drug abuse research has contributed to the development of brain imaging techniques.

Drug abuse research has also provided a major impetus for neuropharmacological research in psychiatry since the late 1950s, when it was discovered that LSD (lysergic acid diethylamide; a hallucinogen that produces psychotic symptoms) affected the brain's serotonin systems (Cooper et al., 1991). That seminal discovery stimulated decades of research in the neuropharmacological basis of behavior and psychiatric disorders. The impact on antipsychotic research has been dramatic. In addition, stimulants (e.g., cocaine and amphetamine) were found to produce a state of paranoid psychosis, resembling schizophrenia, in some people. The actions of stimulants on the brain's dopamine pathways continue to inform researchers of the potential role of those pathways in the treatment, and perhaps the pathophysiology, of schizophrenia (Kahn and Davis, 1995). Drug abuse research also has had an impact on antidepressant research (e.g., the actions of drugs of abuse on the brain's serotonin systems have provided useful models with which to investigate the role of those systems in depression and mania). Depression is a risk factor for treatment failure in smoking cessation (Glassman et al., 1993) and depression-like symptoms are dominant during cocaine withdrawal (DiGregorio, 1990). Consequently, treatment of depression in nicotine and cocaine-dependent individuals has been an area of interest for drug abuse research.

Some drugs that are abused, most notably the opioid analgesics, have essential medical uses. Since its founding, NIDA has been the major supporter of research into brain mechanisms of pain and analgesia, analgesic tolerance, and analgesic pharmacology. The resulting discoveries have led to an understanding of which brain circuits are required to generate pain and pain relief (Wall and Melzack, 1994), have revolutionized the treatment of postoperative and cancer pain (Folly and Interesse, 1986; Car et al., 1992; Jacob et al., 1994), and have led to improved treatments for many other conditions that result in chronic pain (see Chapter 3 ).

VOCABULARY OF DRUG ABUSE

Ordinarily, scientific vocabulary evolves toward greater clarity and precision in response to new empirical discoveries and reconceptualizations. That creative process is evident within each of the disciplines of drug abuse research covered in various chapters of this report. Interestingly, however, the words describing the field as a whole, and connecting each chapter to the next, seem to defy the search for clarity and precision. Does "drug" include alcohol and tobacco? What is "abuse"? Are use and

abuse mutually exclusive categories? Are abuse and dependence mutually exclusive categories? Does use of illicit drugs per se amount to abuse? Does abuse include underage use of nicotine? Is addiction synonymous with dependence?

These ambiguities have persisted for decades because the vocabulary of drug abuse is inevitably influenced by peoples' attitudes and values. If the task were solely a scientific one, precise terminology would have emerged long before now. However, because the choice of words in this field always carries a nonscientific message, scientists themselves cannot always agree on a common vocabulary.

Consider the case of nicotine; from a pharmacological standpoint, nicotine is functionally similar to other psychoactive drugs. However, many researchers and policymakers choose to exclude nicotine from the category of drug. The same is true of alcohol; for example, other terms, such as ''chemical dependency" or "substance abuse," are often used as generic terms encompassing the abuse of nicotine and alcohol as well as abuse of illicit drugs. This semantic strategy is chosen to signify the difference in legal status among alcohol, nicotine, and illicit drugs. In recent years, however, a growing number of researchers have adopted a more inclusive use of the term drug. In the case of nicotine, this move tends to reflect a policy judgment that nicotine should be classified as a drug under the federal Food, Drug and Cosmetic Act.

In the committee's view, the term drug should be understood, in its generic sense, to encompass alcohol and nicotine as well as illicit drugs. It is very important for the general public to recognize that alcohol and nicotine constitute, by far, the nation's two largest drug problems, whether measured in terms of morbidity, mortality, or social cost. Abuse of and dependence on those drugs have serious individual and societal consequences. Continued separation of alcohol, nicotine, and illicit drugs in everyday speech is an impediment to public education, prevention, and therapeutic progress.

Although the committee uses the term drug, in its generic sense, to encompass alcohol and nicotine, the report focuses, at NIDA's request, on research opportunities relating to illicit drugs; research on alcohol and nicotine is discussed only when the scientific inquiries are intertwined. Because the report sometimes ranges more broadly than illicit drugs, however, the committee has adopted several semantic conventions to promote clarity and avoid redundancy. First, the term drug, unmodified, refers to all psychoactive drugs, including alcohol and nicotine. When reference is intended solely to illicit drugs such as heroin, cocaine, and other drugs regulated by the Controlled Substances Act, the committee says so explicitly. Occasionally, to ensure that the intended meaning is clear, the report refers to "illicit drugs and nicotine" or to "illicit drugs

and alcohol," as the case may be. Additionally, the words opiate and opioid are used interchangeably, although opiates are derivative of morphine and opioids are all compounds with morphine-like properties (they may be synthetic and not resemble morphine chemically).

The report employs the standard three-stage conceptualization of drug-taking behavior that applies to all psychoactive drugs, whether licit or illicit. Each stage—use, abuse, dependence—is marked by higher levels of use and increasingly serious consequences. Thus, when the report refers to the "use" of drugs, the term is usually employed in a narrow sense to distinguish it from intensified patterns of use. Conversely, the term "abuse" is used to refer to any harmful use, irrespective of whether the behavior constitutes a "disorder'' in the DSM-IV diagnostic nomenclature (see Appendix C ). When the intent is to emphasize the clinical categories of abuse and dependence, that is made clear.

The committee also draws a clear distinction between patterns of drug-taking behavior, however described, and the harmful consequences of that behavior for the individual and for society. These consequences include the direct, acute effects of drug taking such as a drug-induced toxic psychosis or impaired driving, the effects of repeated drug taking on the user's health and social functioning, and the effects of drug-seeking behavior on the individual and society. It bears emphasizing that adverse consequences can be associated with patterns of drug use that do not amount to abuse or dependence in a clinical sense, although the focus of this report and the committee's recommendations is on the more intensified patterns of use (i.e., abuse and dependence) since they cause the majority of the serious consequences.

DEFINITIONS AND BASIC CONCEPTS

Drug use may be defined as occasional use strongly influenced by environmental factors. Drug use is not a medical disorder and is not listed as such in either of the two most important diagnostic manuals—the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV; APA, 1994); or the International Classification of Diseases (ICD-10; WHO, 1992). (See Appendix C for DSM-IV and ICD-10 diagnostic criteria.) Drug use implies intake for nonmedical purposes; it may or may not be accompanied by clinically significant impairment or distress on a given occasion.

Drug abuse is characterized in DSM-IV as including regular, sporadic, or intensive use of higher doses of drugs leading to social, legal, or interpersonal problems. Like DSM-IV, ICD-10 identifies a nondependent but problematic syndrome of drug use but calls it "harmful use" instead

of abuse. This syndrome is defined by ICD-10 as use resulting in actual physical or psychological harm.

Drug dependence (or addiction) is characterized in both DSM-IV and ICD-10 as drug-seeking behavior involving compulsive use of high doses of one or more drugs, either licit or illicit, for no clear medical indication, resulting in substantial impairment of health and social functioning. Dependence is usually accompanied by tolerance and withdrawal 2 and (like abuse) is generally associated with a wide range of social, legal, psychiatric, and medical problems. Unlike patients with chronic pain or persistent anxiety, who take medication over long periods of time to obtain relief from a specific medical or psychiatric disorder (often with resulting tolerance and withdrawal), persons with dependence seek out the drug and take it compulsively for nonmedical effects.

Tolerance occurs when certain medications are taken repeatedly. With opiates for example, it can be detected after only a few days of use for medical purposes such as the treatment of pain. If the patient suddenly stops taking the drug, a withdrawal syndrome may ensue. Physicians often confuse this phenomenon, referred to as physical dependence, with true addiction. That can lead to withholding adequate medication for the treatment of pain because of the very small risk that addiction with drug-seeking behavior may occur.

As a consequence of its compulsive nature involving the loss of control over drug use, dependence (or addiction) is typically a chronically relapsing disorder (IOM, 1990, 1995; Meter, 1996; O'Brien and McLennan, 1996; McLennan et al., in press). Although individuals with drug dependence can often complete detoxification and achieve temporary abstinence, they find it very difficult to sustain that condition and avoid relapse over time. Most persons who achieve sustained remission do so only after a number of cycles of detoxification and relapse (Dally and Marital, 1992). Relapse is caused by a constellation of biological, family, social, psychological, and treatment factors and is demonstrated by the fact that at least half of former cigarette smokers quit three or more times before they successfully achieve stable remission from nicotine addiction (Schilling, 1992). Similarly, within one year of treatment, relapse occurs in 30-50 percent of those treated for drug dependence, although the level

of drug use may not be as high as before treatment (Daley and Marlatt, 1992; McLellan et al., in press). Unlike those who use (or even abuse) drugs, individuals with addiction have a substantially diminished ability to control drug consumption, a factor that contributes to their tendency to relapse.

Another terminological issue arises in relation to the terms addiction and dependence. For some scientists, the proper terms for compulsive drug seeking is addiction, rather than dependence. In their view, addiction more clearly signifies the essential behavioral differences between compulsive use of drugs for their nonmedical effects and the syndrome of "physical dependence" that can develop in connection with repeated medical use. In response, many scientists argue that dependence has been defined in both ICD-10 and DSM-IV to encompass the behavioral features of the disorder and has become the generally accepted term in the diagnostic nomenclature. Moreover, some scientists object to the term addiction on the grounds that it is associated with stigmatizing social images and that a less pejorative term would help to promote public understanding of the medical nature of the condition. The committee has not attempted to resolve this controversy. For purposes of this report, the terms addiction and dependence are used interchangeably.

An inherent aspect of drug addiction is the propensity to relapse. Relapse should not be viewed as treatment failure; addiction itself should be considered a brain disease similar to other chronic and relapsing conditions such as hypertension, diabetes, and asthma (IOM, 1995; O'Brien and McLellan, 1996). In the latter, significant improvement is considered successful treatment even though complete remission or cure is not achieved. In the area of drug abuse, however, many individuals (both lay and professional) expect treatment programs to perform like vaccine programs, where one episode of treatment offers lifetime immunity. Not surprisingly, because of that expectation, people are inevitably disappointed in the relatively high relapse rates associated with most treatments. If, however, addiction is understood as a chronically relapsing brain disease, then—for any one treatment episode—evidence of treatment efficacy would include reduced consumption, longer abstention periods, reduced psychiatric symptoms, improved health, continued employment, and improved family relations. Most of those results are demonstrated regularly in treatment outcome studies.

The idea that drug addiction is a chronic relapsing condition, requiring long-term attention, has been resisted in the United States and in some other countries (Brewley, 1995). Many lay people view drug addiction as a character defect requiring punishment or incarceration. Proponents of the medical model, however, point to the fact that addiction is a distinct morbid process that has characteristics and identifiable signs and

symptoms that affect organ systems (Miller, 1991; Meter, 1996). Characterization of addiction as a brain disease is bolstered by evidence of genetic vulnerability to addiction, physical correlates of its clinical course, physiological changes as a result of repeated drug use, and fundamental changes in brain chemistry as evidenced by brain imaging (Volkow et al., 1993). This is not to say that behavioral, social, and environmental factors are immaterial—they all play a role in onset and outcome, just as they do in heart disease, kidney disease, tuberculosis, or other infectious diseases. Thus, the contemporary understanding of disease fully incorporates the voluntary behavioral elements that lead many people to be skeptical about the applicability of the medical model to drug addiction. In any case, the committee embraces the disease concept, not because it is indisputable but because this paradigm facilitates scientific investigation in many important areas of knowledge, without inhibiting or distorting scientific inquiry in other parts of the field.

IMPORTANCE OF DRUG ABUSE RESEARCH

The widespread prevalence of illicit drug use in the United States is well documented in surveys of households, students, and prison and jail inmates ( Chapter 4 ). Based on the National Household Survey on Drug Abuse (NHSDA), an annual survey presently sponsored by SAMHSA, it was estimated that in 1994, 12.6 million people had used illicit drugs (primarily marijuana) in the past month (SAMHSA, 1995). That figure represents 6 percent of the population 12 years of age or older. 3 The number of heavy drug users, using drugs at least once a week, is difficult to determine. It has been estimated that in 1993 there were 2.1 million heavy cocaine users and 444,000-600,000 heavy heroin users (Rhodes et al., 1995). This population represents a significant burden to society, not only in terms of federal expenditures but also in terms of costs related to the multiple consequences of drug abuse (see Chapter 7 ).

The ultimate aim of the nation's investment in drug abuse research is to enable society to take effective measures to prevent drug use, abuse, and dependence, and thereby reduce its adverse individual and social consequences and associated costs. The adverse consequences of drug abuse are numerous and profound and affect the individual's physical health and psychological and social functioning. Consequences of drug abuse include increased rates of HIV infection and tuberculosis (TB); education and vocational impairment; developmental harms to children of

drug-using parents associated with fetal exposure or maltreatment and neglect; and increased violence (see Chapter 7 ). It now appears that injection drug use is the leading risk factor for new HIV infection in the United States (Holmberg, 1996). Most (80 percent) HIV-infected heterosexual men and women who do not use injection drugs have been infected through sexual contact with HIV-infected injection drug users (IUDs). Thus, it is not surprising that the geographic distribution of heterosexual AIDS cases has been essentially the same as the distribution of male injection drug users' AIDS cases (Holmberg, 1996) Further, the IUDs-associated HIV epidemic in men is reflected in the heterosexual epidemic in women, which is reflected in HIV infection in children (CDC, 1995). Nearly all children who acquire HIV infection do so prenatal (see Chapter 7 ).

The extent of the impact of drug use and abuse on society is evidenced by its enormous economic burden. In 1990, illicit drug abuse is estimated to have cost the United States more than $66 billion. When the cost of illicit drug use and abuse is tallied with that of alcohol and nicotine ( Table 1.1 ), the collective cost of drug use and abuse exceeds the estimated annual $117 billion cost of heart disease and the estimated annual $104 billion cost of cancer (AHA, 1992; ACS, 1993; D. Rice, University of California at San Francisco, personal communication, 1995).

As noted above, the federal government accounts for a large segment of the societal expenditure on illicit drug abuse control—spending more than $13.3 billion in FY 1995 (ONDCP, 1996). About two-thirds was devoted to interdiction, intelligence, incarceration, and other law enforcement activities. Research, however, accounts for only 4 percent of federal outlays, a percentage that has remained virtually unchanged since 1981 (ONDCP, 1996) ( Figure 1.1 ). Given the social costs of illicit drug abuse and the enormity of the federal investment in prevention and control, research into the causes, consequences, treatment, and prevention of drug abuse should have a higher priority. Enhanced support for drug abuse research would be a socially sound investment, because scientific research can be expected to generate new and improved treatments, as well as prevention and control strategies that can help reduce the enormous social burden associated with drug abuse.

THE CONTEXT OF DRUG ABUSE RESEARCH

In the chapters that follow, the committee identifies research initiatives that seem most promising and most likely to lead to successful efforts to reduce drug abuse and its associated social costs. Although the yield from these initiatives will depend largely on the creativity and skill of scientists, the many contextual factors that will also have a major bear-

TABLE 1.1 Estimated Economic Costs (million dollars) of Drug Abuse, 1990

how do i write a research topic on drug abuse

FIGURE 1.1 Federal drug control budget trends (1981-1995). NOTE: Figures are in current dollars. SOURCE: ONDCP (1996).

ing on the payoff from scientific inquiry cannot be ignored. The committee has identified six major factors that, if successfully addressed, could optimize the gains made in each area of drug abuse research: stable funding; use of a comprehensive public health framework; wider acceptance of a medical model of drug dependence; better translation of research findings into practice; raising the status of drug abuse research; and facilitating interdisciplinary research.

Stable Funding

A stable level of funding in any area of biomedical research is needed to sustain and build on research accomplishments, to retain a cadre of experts in a field, and to attract young investigators. Drug abuse research, in comparison with many other research venues, has not enjoyed consistent federal support (IOM, 1990, 1995; see also Appendix B ). The field has suffered from difficulties in recruiting and retaining young researchers and clinicians and in maintaining a stable research infrastructure (IOM, 1995). Society's capacity to contain and manage drug abuse

depends upon a stable, long-term investment in research. The vicissitudes in federal research funding often reflect changing currents in public opinion toward drugs and drug users ( Appendix B ). However, drug abuse will not disappear; it is an endemic social and public health problem. The nation must commit itself to a sustained effort. The social investment in research is an investment in "human capital" that must be sustained over the long term in order to reap the expected gains. An investment in this field is squandered if researchers who have been recruited and trained in drug abuse research are drawn to other fields because of uncertainty about the stability of future funding.

Adoption of a Comprehensive Public Health Framework

The social impact of drug abuse research can be enhanced significantly by conceptualizing goals and priorities within a comprehensive public health framework (Goldstein, 1994). All too often, public discourse about drug abuse is characterized by such unnecessary and fruitless disputes as whether drug abuse should be viewed as a social and moral problem or a health problem, whether the drug problem can best be solved by law enforcement or by medicine, whether priority should be placed on reducing supply or reducing demand, and so on. The truth is that these dichotomies oversimplify a brain disease impacted by a complex set of behaviors and a diverse array of potentially useful social responses. Forced choices of this nature also tend to inhibit or foreclose potentially useful research strategies. Confusion about social goals can lead to confusion about research priorities and can obscure the links between investigations viewing the subject through different lenses.

Some issues tend to recur. A prominent dispute centers on whether preventing drug use is important in itself or whether society should be more concerned with abuse or with the harmful consequences of use. The answer, of course, is that such a forced choice obscures, rather than clarifies, the issues. From a public health standpoint, drug use is a risk factor; the significance of use (whether of alcohol, nicotine, or illicit drugs) lies in the risk of harm associated with it (e.g., fires from smoking, impaired driving from alcohol or illicit drugs, or developmental setbacks) and in the risk that use will intensify, escalating to abuse or dependence. Those risks vary widely in relation to drug, user characteristics, social context, etc. Attention to the consequences of use and to the risk of escalation helps to set priorities (for research and policy) and provides a framework for assessing the impact of different interventions.

From a public policy standpoint, arguments about goals and priorities are fraught with controversy. From the standpoint of research strategy, however, the key lies in asking the right questions (e.g., What influ-

ences the pathways from use, to abuse, to dependence? What are the effects of needle exchange programs on illicit drug use and on HIV disease?) and in generating the knowledge required to facilitate informed policy debate. The main virtues of a comprehensive public health approach are that it helps to disentangle scientific questions from policy questions and that it encompasses all of the pertinent empirical questions, including the causes and consequences of use, abuse, and dependence, as well as the efficacy and cost of all types of interventions. In sum, the social payoff from drug abuse research can be enhanced substantially by integrating diverse strands of inquiry within a public health framework.

Acceptance of a Medical Model of Drug Dependence

Drug dependence is a chronic, relapsing brain disease that, like other diseases, can be evaluated and treated with the standard tools of medicine, including efforts in prevention, diagnosis, and treatment with medications and behavioral or psychosocial therapies. Unfortunately, the medical model of dependence is not universally accepted by health professionals and others in the treatment community; it is widely rejected within the law enforcement community and often by the public at large, which tends to view the complex and varied patterns of use, abuse, and dependence as an undifferentiated behavior rather than a medical problem.

Resistance to the medical model takes many forms. One is resistance to pharmacotherapies, such as methadone, that are seen as substituting licit drugs for illicit drugs without changing drug-taking behavior. Conversely, treatment approaches that adopt a rigid drug-free strategy preclude the use of medications for patients with other psychiatric disorders that are easily treated by pharmacotherapeutic approaches. On a subtler level, resistance to the use of pharmacotherapies is evidenced by the routine use of inadequate doses of methadone (D'Aunno and Vaughn, 1992). Finally, for others, all forms of drug abuse signify a failure of willpower or a moral weakness requiring punishment, incarceration, or moral education rather than treatment (Anglin and Hser, 1992).

Resistance to the medical model of drug dependence presents numerous barriers to research. Clinical researchers experience difficulty in soliciting participation by both treatment program administrators and patients, who are sometimes mistrustful of researchers' motives. If research involves a medication that is itself prone to abuse, there are additional regulatory requirements for drug scheduling, storage, and record keeping that act to discourage investigation (see Chapter 10 ; IOM, 1995). The ever-present threat of inappropriate intrusion by law enforcement agents has a chilling effect on treatment research (McDuff et al., 1993). All barri-

ers to inquiry, irrespective of whether they are legal or social in origin, raise the cost of research and discourage researchers from entering the field. Additionally, those barriers diminish the likelihood that a pharmaceutical company will invest in the development of antiaddiction medications (IOM, 1995). 4 Broader acceptance of the medical model of drug dependence would provide an incentive for researchers and clinicians to enter this field of research. Over time, a developing consensus in support of the medical model could facilitate common discourse, help to shape a shared research agenda within a public health framework, and diminish tensions between the research and treatment communities and the criminal justice system.

Better Translation of Research Findings into Practice and Policy

To benefit society, new research findings must be disseminated adequately to treatment providers, educators, law enforcement officials, and community leaders. In the case of prevention practices, it is often difficult for communities to change entrenched policies, particularly when combined with political imperatives for action to counteract drug abuse. In the case of treatment, technology transfer is impeded by the heterogeneity of providers and their marginalization at the outskirts of the medical community (see IOM, 1990, 1995; see also Chapter 8 ). Physicians and psychiatrists are seldom employed by specialized drug treatment facilities (approximately one-quarter employ medical doctors), and treatment is delivered by counselors whose training and supervision vary greatly and who have little access to and understanding of research results (Ball and Ross, 1991; Batten et al., 1993). These factors not only impede the transfer of research findings to the field but also impede communication from the field to the laboratory so that research designs can be modified in response to clinical realities (Pentz, 1994). Thus, there is a real need for bidirectional communication, from bench to bedside and back to the basic scientist (IOM, 1994).

The committee is aware, however, of recent technology transfer efforts in the field such as the Treatment Improvement Protocol Series, an initiative to establish guidelines for drug abuse treatment with an emphasis on incorporating research findings (SAMHSA, 1993), and the Prevention Enhancement Protocol System, a process implemented by the Center

for Substance Abuse Prevention in which scientists and practitioners develop protocols to identify and evaluate the strength of evidence on topics related to prevention interventions. Similar efforts will be invaluable for communicating and integrating research results to the treatment community.

Research frequently results in product development leading to changes in operations and an overall enhancement of the value of the enterprise. For example, in the pharmaceutical industry research often leads to the development of new medications or devices. In the public sector, however, research is often divorced from the implementation of findings and development. Research is often more basic than applied, and the fruits of research are not realized by the government, but by the private sector. Although that approach may be appropriate, it is unfortunately not always the most productive strategy for advancing research, knowledge, and product development. That is particularly true in the development of medications for opiate and cocaine addictions, where there is a great need for commitment from the private sector. However, many obstacles prevent active involvement of the pharmaceutical industry in this area of research and development (IOM, 1995).

A similar problem arises in relation to policymaking. Because debates about drug policy tend to be so highly polarized and politicized, research findings are often distorted, or selectively deployed, for rhetorical purposes. Researchers cannot prevent this practice, which is a common feature of political debate in a democratic society. However, researchers and their sponsors should not be indifferent to the disconnect between policy discourse and science. Researchers should establish and support institutional mechanisms for communicating an important message to policymakers and to the general public. Scientific research has produced a solid, and growing, body of knowledge about drug abuse and about the efficacy of various interventions that aim to prevent and control it. As long as drug abuse remains a poorly understood social problem, policy will be based mainly on wish and supposition; steps should be taken to educate policymakers about the scientific and technological advances in addiction research. Only then will it be possible for policymaking to support legislation that adequately funds new research and applies research findings. To some extent, persisting failure to reap the fruits of drug abuse research is attributable to the low visibility of the field—a problem to which the discussion now turns.

Raising the Status of Drug Abuse Research

Drug abuse research is often an undervalued area of inquiry, and most scientists and clinicians choose other disciplines in which to develop

their careers. Compared with other fields of research, investigators in drug abuse are often paid less, have less prestige among their peers, and must contend with the unique complexities of performing research in this area (e.g., regulations on controlled substances) (see IOM, 1995). The overall result is an insufficient number of basic and clinical researchers. IOM has recently begun a study, funded by the W. M. Keck Foundation of Los Angeles, to develop strategies to raise the status of drug abuse research. 5

Weak public support for this field of study is evident in unstable federal funding (see above), a lack of pharmaceutical industry investment in the development of antiaddiction medications (IOM, 1995), and inadequate funding for research training (IOM, 1995). NIDA's FY 1994 training budget, which is crucial to the flow of young researchers into the field, was about 2 percent of its extramural research budget, a percentage substantially lower than the overall National Institutes of Health (NIH) training budget, which averages 4.8 percent of its extramural research budget.

Beyond funding problems, investigators face a host of barriers to research: research subjects may pose health risks (e.g., TB, HIV/AIDS, and other infectious diseases), may be noncompliant, may deny their drug abuse problems, and may be involved in the criminal justice system. Even when research is successful and points to improvements in service delivery, the positive outcome may not be translated into practice or policy. For example, more than a year after the Food and Drug Administration's (FDA's) approval of levo-alpha-acetylmethadol (LAAM) as the first new medication for the treatment of opiate dependence in over 20 years, fewer than 1,000 patients nationwide actually had received the medication (IOM, 1995). More recently, scientific evidence regarding the beneficial effects of needle exchange programs (NRC, 1995) has received inadequate attention. Continuing indifference to scientific progress in drug abuse research inevitably depresses the status of the field, leading in turn to difficulties in recruiting new investigators.

Increasing Interdisciplinary Research

The breadth of expertise needed in drug abuse research spans many disciplines, including the behavioral sciences, pharmacology, medicine, and the neurosciences, and many fields of inquiry, including etiology, epidemiology, prevention, treatment, and health services research. Aspects of research relating to drug use tend to draw on developmental perspectives and to focus on general population samples in community settings, especially schools. Aspects of research relating to abuse and de-

pendence tend to be more clinical in nature, drawing on psychopathological perspectives. Additionally, a full account of any aspect of drug-taking behavior must also reflect an understanding of social context. The rich interplay between neuroscience and behavioral research and between basic and clinical research poses distinct challenges and opportunities.

Unfortunately, research tends to be fragmented within disciplinary boundaries. The difficulties in conducting successful interdisciplinary research are well known. Funds for research come from many separate agencies, such as the NIDA, NIMH, and SAMHSA. These agencies all have different programmatic emphases as they attempt to shape the direction of research in their respective fields. In times of funding constraints, agencies may be less inclined to fund projects at the periphery of their interests.

Additionally, NIH study sections, which rank grant proposals, are discipline specific, making it difficult for interdisciplinary proposals to ''qualify" (i.e., receive a high rank) for funding. Another problem is that the most advanced scientific literature tends to be compartmentalized within discipline or subject matter categories, making it difficult for scientists to see the whole field. The problem is exacerbated by what Tonry (1990) has called "fugitive literatures," studies carried out by private sector research firms or independent research agencies and available only in reports submitted to the sponsoring agency.

In light of lost opportunities for collaboration and interdisciplinary research, IOM (1995) previously recommended the creation and expansion of comprehensive drug abuse centers to coordinate all aspects of drug abuse research, training, and treatment. The field of drug abuse research presents a real opportunity to bridge the intellectual divide between the behavioral and neuroscience communities and to overcome the logistical impediments to interdisciplinary research.

INVESTING WISELY IN DRUG ABUSE RESEARCH

This report sets forth drug abuse research initiatives for the next decade based on a thorough assessment of what is now known and a calculated judgment about what initiatives are most likely to advance our knowledge in useful ways. This report is not meant to be a road map or tactical battle plan, but is best regarded as a strategic outline. Within each discipline of drug abuse research, the committee has highlighted priorities for future research. However, the committee did not make any attempt to prioritize recommendations across varied disciplines and fields of research. Prudent research planning must respond to newly emerging opportunities and needs while maintaining a steady commitment to the

achievement of long-term objectives. The ability to respond to new goals and needs may be the real challenge for the field of drug abuse research.

Drug abuse research is an important public investment. The ultimate aim of that investment is to reduce the enormous social costs attributable to drug abuse and dependence. Of course, drug abuse research must also compete for funding with research in other fields of public health, research in other scientific domains, and other pressing public needs. Recognizing the scarcity of resources, the committee has also considered ways in which the research effort can be harnessed most effectively to increase the yield per dollar invested. These include stable funding, use of a comprehensive public health framework, wider acceptance of a medical model of drug dependence, better translation of research findings into practice and policy, raising the status of drug abuse research, and facilitating interdisciplinary research.

The committee notes that there have been major accomplishments in drug abuse research over the past 25 years and commends NIDA for leading that effort. The committee is convinced that the field is on the threshold of significant advances, and that a sustained research effort will strengthen society's capacity to reduce drug abuse and to ameliorate its adverse consequences.

ORGANIZATION OF THE REPORT

This report sets forth a series of initiatives in drug abuse research. 6 Each chapter of the report covers a segment of the field, describes selected accomplishments, and highlights areas that seem ripe for future research. As noted, the committee has not prioritized areas for future research but, instead, has identified those areas that most warrant further exploration.

Chapter 2 describes behavioral models of drug abuse and demonstrates how the use of behavioral procedures has given researchers the ability to measure drug-taking objectively and to study the development, maintenance, and consequences of that behavior. Chapter 3 discusses drug abuse within the context of neurotransmission; it describes neurobiological advances in drug abuse research and provides the foundation for the current understanding of addiction as a brain disease. The epidemiological information systems designed to gather information on drug use in the United States are identified in Chapter 4 . The data collected from the systems provide an essential foundation for systematic study of

the etiology and consequences of drug abuse, which are addressed, respectively, in Chapters 5 and 7 . Chapter 6 addresses the efficacy of interventions designed to prevent drug abuse. The effectiveness of drug abuse treatment and the difficulties in treating special populations of drug users are discussed in Chapter 8 , while the impact of managed care on access, costs, utilization, and outcomes of treatment is addressed in Chapter 9 . Finally, Chapter 10 discusses the effects of drug control on public health and identifies areas for policy-relevant research.

Specific recommendations appear in each chapter. Although these recommendations reflect the committee's best judgment regarding priorities within the specific domains of research, the committee did not identify priorities or rank recommendations for the entire field of drug abuse research. Opportunities for advancing knowledge exist in all domains. It would be a mistake to invest too narrowly in a few fields of inquiry. At the present time, soundly conceived research should be pursued in all domains along the lines outlined in this report.

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Drug abuse persists as one of the most costly and contentious problems on the nation's agenda. Pathways of Addiction meets the need for a clear and thoughtful national research agenda that will yield the greatest benefit from today's limited resources.

The committee makes its recommendations within the public health framework and incorporates diverse fields of inquiry and a range of policy positions. It examines both the demand and supply aspects of drug abuse.

Pathways of Addiction offers a fact-filled, highly readable examination of drug abuse issues in the United States, describing findings and outlining research needs in the areas of behavioral and neurobiological foundations of drug abuse. The book covers the epidemiology and etiology of drug abuse and discusses several of its most troubling health and social consequences, including HIV, violence, and harm to children.

Pathways of Addiction looks at the efficacy of different prevention interventions and the many advances that have been made in treatment research in the past 20 years. The book also examines drug treatment in the criminal justice setting and the effectiveness of drug treatment under managed care.

The committee advocates systematic study of the laws by which the nation attempts to control drug use and identifies the research questions most germane to public policy. Pathways of Addiction provides a strategic outline for wise investment of the nation's research resources in drug abuse. This comprehensive and accessible volume will have widespread relevance—to policymakers, researchers, research administrators, foundation decisionmakers, healthcare professionals, faculty and students, and concerned individuals.

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Addiction and Violence During COVID-19

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Drug Abuse Research Paper

This sample drugs research paper on drug abuse features: 2500 words (approx. 8 pages) and a bibliography with 6 sources. Browse other research paper examples for more inspiration. If you need a thorough research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

Drug abuse, also referred to as substance or chemical abuse, is the recurrent use of a drug despite the experience of problems caused by the drug use. Difficulties arising in certain areas of a user’s life are of more importance to researchers and treatment professionals than other areas for identification of a drug abuse problem. The following are types of problems that signify drug abuse: impairment meeting major responsibilities in life, such as those regarding school, work, or home; difficulties with the law and social behavior; and aggravation of physical/medical conditions due to drug use. Drug abuse is to be contrasted with drug (chemical/substance) dependence. With drug dependence, use is considered compulsive and beyond the willful control of the user. That is, someone who is drug dependent is addicted; this is thought to be a more severe condition than drug abuse. Treatment of drug abuse is accomplished primarily using a variety of counseling and psychotherapeutic techniques employed to assist the abuser to stop using the drug, to develop new behavioral and mental coping skills, and to rehabilitate his or her life from the damage caused by the substance abuse.

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Introduction
Risk Factors and Causes of Drug Abuse
Course of Drug Abuse
Assessment of Drug Abuse
Treatment of Drug Abuse
Relapse Prevention

1. Introduction

In the discussion of drug abuse, it would be easy but inaccurate to label any regular use of a substance as abusive. Drug use in the United States is commonplace. Many people are capable of consuming drugs without developing problems. Drugs such as caffeine and alcohol, as well as prescription pharmaceutical products such as pain killing agents or antianxiety medication, are routinely and openly consumed every day in the United States (and in other countries as well). The various drugs affect the body differently and are used for specific purposes. For example, caffeine is used to remain alert and to enhance concentration, and tranquilizers are used to quell anxiety and for relaxation. However, drugs of abuse all have in common the property that they are psychoactive. For the sake of discussion, drugs may be classified with respect to different properties; one commonly employed system is in terms of the effect of the drug on the central nervous system (CNS). The following is one such classification system, with examples of drugs in each category:

CNS stimulants: Cocaine, amphetamine, and caffeine
CNS depressants: Alcohol, barbiturates, benzodiazepines, and solvent inhalants
Psychotomimetics (also known as psychedelics or hallucinogens): Marijuana, LSD, and mescaline
Narcotics/Opioids: Opium, heroin, codeine, morphine, and methadone

Substance use typically begins in adolescence. Adolescent substance use does not appear to be random; that is, it follows a fairly predictable pattern. Adolescents tend to start using substances that are legal and widely available to adults: alcohol and tobacco. Due to the fact that these drugs are the starting point for substance use, they are referred to as ‘‘gateway drugs.’’ In 1975, Kandel developed a stage model of progression of drug use that has since been revised:

Beer or wine use
Hard liquor or cigarette use
Marijuana experimentation
Alcohol abuse
Prescription drug use
Opiates and other illegal drugs

The vast majority of adolescents experiment with the gateway drugs at least one time. However, although most individuals try alcohol and tobacco, only for a minority of adolescents does use advance to abusive levels. As the stages advance, progressively fewer adolescents are found in each category. For example, alcohol will be tried by approximately 9 out of 10 students by their senior year in high school and cigarettes by approximately 6 out of 10 students by senior year. Opiates, at the last stage of the model, will be tried by only 1 out of 100 students by senior year.

Due to the high prevalence of substance use in the United States, it should be no surprise that substance-related problems are often encountered by mental health clinicians. The relatively high frequency with which substance-related problems are encountered by mental health professionals reflects the influence of the following factors: (i) Drug abuse has the potential to create or worsen all psychological symptoms, such as anxiety, depression, impulsive behavior, and antisocial behavior; and (ii) people seeking mental health services also tend to be at elevated risk for substance abuse problems. In other words, drug abuse harms people and contributes to psychiatric symptoms, and people experiencing psychological problems are apt to use drugs abusively.

2. Risk Factors And Causes Of Drug Abuse

With any medical or mental health condition, it is desirable to determine the cause or causes of the affliction. Identifying the cause(s) helps to develop prevention strategies to limit or eliminate future cases and treatment strategies for those already affected by the condition. For example, after the discovery that an absence of insulin was responsible for type 1 diabetes, effective treatment of diabetes with externally supplied insulin became possible. In addition, research is under way to develop early identification tests for intervention strategies to prevent later development of diabetes. This research has led to the isolation of faulty antibodies believed to attack the insulin-producing cells of the pancreas. The antibodies can be detected before the person is symptomatic for diabetes; experimental treatments are being used in an attempt to prevent the development of diabetes in these high-risk individuals.

Human behavior is complex and defies easy explanation. Unlike certain physical characteristics (e.g., eye color) or physical disorders that can be traced to single genes, a disorder such as drug abuse likely represents the interaction of multiple genetic and environmental influences. Complicating things further, ethics prevents us from conducting experimental studies (involving environmental or genetic manipulation) that might help us to tease apart various possible influences. One way to attempt to identify possible causes of substance abuse is to study risk factors. Risk factors are those variables associated with increased likelihood of developing a substance use disorder. Classes of risk factors are listed here with examples in each class:

Peer: Peer substance use, strong attachment to peers, and positive peer attitudes about substance use
Parent/family: Parent substance use, positive attitude about substance use, parent tolerance of adolescent substance use, and family disruption (e.g., divorce)
Personal: Early (childhood) behavior problems, poor academic performance, anxiety/depression, and low self-esteem
Biological: Genetic predisposition to substance use (e.g., a parent is a substance abuser)
Community/social: Low socioeconomic status, high availability of substances, and deviant norms that encourage use of substances

Risk factors help us to understand influences to use substances, but we know many more people use them than become abusers. Therefore, the question as to who will progress beyond experimentation and casual use to the level of abuse is not answered by risk factors alone. It appears that use of substances is more a function of external risk factors, such as peer, social, and family factors; abuse of substances appears to be more a function of personal factors, such as psychiatric, behavioral, and emotional problems.

The biopsychosocial disease model is the most widely accepted model of substance abuse and addiction. It should be clear after reviewing the list of risk factors that biological, psychological, and social factors contribute to substance abuse. The biopsychosocial model is sufficiently comprehensive to include all known contributants to substance abuse.

3. Course Of Drug Abuse

Disease conditions are defined by several common factors, such as having identifiable causes, characteristic symptoms, and established treatments. In addition, diseases have an observable course. It is important to describe the course of an illness in part so that the condition can be identified (i.e., for diagnostic purposes). Also, if the untreated progression of an illness was not known, there would be no way to judge the effectiveness of treatment. Treatment interventions endeavor, essentially, to change the course of a disease. Initial attempts to describe and classify the course of alcohol abuse depicted an ever-worsening condition that eventuated in death, unless the drinking was stopped altogether. As it turns out, the long-term outcome of regular alcohol use is not certain death. Some people who use alcohol never develop problems, some who develop problems (alcohol abusers) never become addicted, and a minority of alcohol abusers (approximately one-third) exhibit the progressive deteriorative pattern of drinking. The same overall trends may be expected with other substances of abuse as with alcohol. In 1995, Shaffer and Robbins developed a general model to describe the typical course of an addiction, consisting of the following stages:

Initiation: Experimentation with a drug is begun.
Positive consequences: At this point in the use process, only the pleasurable pharmacological and social effects of the substance are experienced.
Negative consequences: For those individuals who continue to regularly use the substance, eventually negative consequences are experienced in terms of health, relationships, work, school, finances, or the law.
Turning point: For abusers who continue despite negative consequences, there is some recognition of the damage the substance is causing in their lives and ambivalence ensues.
Active quitting: For some abusers, ambivalence is resolved in the direction of stopping use.
Relapse prevention: For those who have quit, behavior changes are maintained over time to prevent resumption of drug use.

4. Assessment Of Drug Abuse

In order to treat a condition, it must first be determined that a given individual has the condition; in other words, the diagnosis of drug abuse must be made. In medicine, objective tests via technologically advanced equipment (e.g., x-ray and magnetic resonance imagery) are often used to assist the doctor in the diagnostic process. In the evaluation of drug abuse, modern technology is hardly relevant. Biological testing, in the forms of urinalysis and evaluation of saliva and blood samples, may be used but are not the mainstay of assessment. Biological testing can determine if a specific drug or drug metabolite is present in a sample but cannot indicate anything about patterns of use, withdrawal symptoms, compulsive behavior, or consequences of use, all of which are important aspects to assess. Therefore, biological testing is confined to the role of confirming recent abstinence; this information is especially important in certain settings (e.g., criminal justice system and workplace) but of limited use in a drug abuse assessment. Since we are more interested in determining whether a pattern of abusive drug use is present or not, relevant information needs to be gathered. Therefore, the interview is the primary method by which information is acquired to make the diagnosis of drug abuse. Typically, the diagnostic interview is conducted with the person in question as well as with others in a position to observe relevant behaviors (most often family members and/or close friends). In addition to the interview, information is sometimes acquired via self-report, paper-and-pencil tests. The following information is typically obtained during a drug abuse assessment:

List all substances ever used
Age of first use of all substances
How used each substance (e.g., smoke, drink, snort, etc.)
Age of peak use, and amount used, for each substance
Number of days use substance per week, for each substance
Amount of substance used on a typical day of use
Date of last use of each substance
List all negative consequences resulting from use of substances

Diagnosing a drug abuse disorder is only one element of the assessment process. It is also necessary to determine as part of the evaluation the most appropriate setting in which treatment should take place (e.g., outpatient, halfway house, or inpatient); the proper intensity of treatment (e.g., daily treatment or monthly treatment); whether other treatment needs exist (e.g., medical and/or psychological disorders); and specific, individual treatment goals for a given person.

5. Treatment Of Drug Abuse

There is no one treatment for drug abuse. This fact is a reflection of the complexity of the condition and its diverse manifestations, and it highlights the importance of the assessment process, which is critical in helping determine the best treatment for a given individual. The treatment of drug abuse may occur in different settings, with varying degrees of professional assistance (e.g., self-help/12-step and professional help) and different modalities of professional services (e.g., individual therapy, group therapy, family therapy, and pharmacological treatment). Drug abuse treatment may be characterized as specialized treatment with one main goal: to stop the use of the substance. Treatment is primarily talking therapy—counseling and psychotherapy; in addition, medications may be employed to manage detoxification from some drugs and/or to treat coexisting psychological or medical conditions. However, regardless of the setting of treatment, the intensity of the contact schedule, or who renders the treatment, it is ultimately talking therapy that takes place. Especially early in treatment, the focus of discussion is on behavior directly related to drug use and stopping the use of the drug. Most programs and professionals recommend complete abstinence from drugs; some have the goal of harm reduction (allowing use to continue while attempting to reduce drug use to less harmful levels), but they are in the minority. As treatment progresses, and abstinence is achieved and maintained, the emphasis usually broadens to other areas of the person’s life that may need repair, such as their decision-making skills, coping skills, emotional state, and relationships. In other words, the individual suffers psychological and social damage from drug abuse and may even have had significant deficits in these areas prior to his or her drug abuse; treatment is designed to improve the psychosocial functioning of the individual once he or she is drug-free.

6. Relapse Prevention

Drug abuse has been described as a chronic, relapsing disorder. Like all chronic conditions, long-term effort must be applied for the individual to maintain abstinence from drug use. Nobody would expect the blood sugar levels of someone with diabetes to be in a healthy range if the person only complied with the prescribed care regimen for 1 month after a visit to the physician. Likewise, if a drug abuser only applies the principles of treatment for a limited period of time, resumption of abusive habits would be expected. One way to attempt to guard against a backslide into prior behavior is to extend treatment as long as possible. In addition, teaching relapse prevention skills that an abuser may use going forward in time is an integral part of drug abuse treatment. Some common elements of relapse prevention programs include identification of high-risk situations that are likely to lead to relapse, development and practice of skills to effectively cope with risky situations, enhancement of self-confidence to be able to apply coping skills when needed, learning to limit a slip to an isolated incident rather than allow it to be the beginning of a process of abuse, drug/alcohol monitoring for abstinence verification, and developing positive behaviors (e.g., working and physical exercise).

Bibliography:

Bukstein, O. (1995). Adolescent substance abuse: Assessment, prevention and treatment. New York: Wiley.
Dodgen, C. E., & Shea, W. M. (2000). Substance use disorders: ssessment and treatment. San Diego: Academic Press.
Gold, M. S. (1991). The good news about drugs and alcohol: Curing, treating and preventing substance abuse in the new age of biopsychiatry. New York: Villard.
Kandel, D. (1975). Stages in adolescent involvement in drug use. Science, 190, 912–914.
Schuckit, M. A. (1995). Educating yourself about alcohol and drugs: A people’s primer. New York: Plenum.
Shaffer, H. J., & Robbins, M. (1995). Psychotherapy for addictive behavior: A stage-change approach to meaning making. In A. M. Washton (Ed.), Psychotherapy and substance abuse: A practitioner’s handbook (pp. 103–123). New York: Guilford.

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Chan, Kin-yi Ivy. "A study of determinants of relapse in psychotropic substance abuse /." Hong Kong : University of Hong Kong, 1995. http://sunzi.lib.hku.hk/hkuto/record.jsp?B19470757.

Carr, Christopher M. "Substance abuse education with elite athletes." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/833473.

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Open access
Published: 11 May 2024

How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives

Lissa Moran 1 ,
Jeff Ondocsin 1 , 2 ,
Simon Outram 1 ,
Daniel Ciccarone 2 ,
Daniel Werb 3 , 4 ,
Nicole Holm 2 &
Emily A. Arnold 1

Harm Reduction Journal volume 21 , Article number: 92 ( 2024 ) Cite this article

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Mortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered.

We conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: “clients” (individuals who use drugs and receive harm reduction services) and “providers” (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis.

We found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.

This study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.

The opioid crisis in the U.S. consists of multiple overlapping and inter-related waves of surging opioid exposure, dependency, overdose, and death rates. Each wave has emerged from different eras of an evolving drug market and multiple intersecting contextual factors such as trends in pharmaceutical manufacturing and prescription, socioeconomic inequities, and positive supply shocks of both licit and illicit opioids [ 1 , 2 , 3 ]. Though its history can be traced back to the 1980s and 1990s, the past decade has redefined the crisis [ 4 ].

By the time the U.S. Department of Health and Human Services (HHS) declared the opioid crisis a public health emergency in 2017 [ 5 ], a wave of unprecedented magnitude had been on the rise for nearly 4 years, marked by the rapid proliferation of fentanyl and synthetic analogues into the drug market [ 4 , 6 ]. Even as mortality from heroin and prescription opioids leveled off or decreased, opioid overdose and death rates rose precipitously [ 6 ]. From 2018 to 2021, the rates of opioid overdose deaths in the U.S. nearly doubled, and by 2021, roughly 9 out of every 10 opioid overdoses in the country (88%) were fentanyl-related [ 7 ].

In California, home to the highest number of opioid-related deaths in the U.S. [ 8 ], the opioid overdose death rate curve from 2011 to 2021 tells a harrowing story. The third wave was later to arrive in California than the national average, but its onset was rapid and dramatic. Opioid overdose death rates more than tripled from 2018 to 2021, and synthetic opioid (e.g., fentanyl) deaths increased 7.2 times, responsible for 37% of opioid overdose deaths in 2018, and 86% just three years later [ 9 ].

In response, the California Department of Public Health has committed to the expansion and promotion of policies, programs, and services to combat the overdose epidemic, with a special focus on harm reduction and drug checking strategies [ 10 ].

Drug checking services

Drug checking services (DCS) have garnered particular interest as an expansion of harm reduction strategies, as they offer the opportunity for people who use drugs to test the chemical content of their own supply [ 11 , 12 ]. In doing so, people who use drugs may be afforded the possibility of changing their use behavior to remove or reduce the likelihood of harm [ 13 , 14 ]. Multiple DCS have been operating in Europe for years—particularly in venues known for high rates of recreational drug use like music festivals [ 14 , 15 ]—but are less common in North America. In the U.S. and Canada, DCS have emerged primarily in response to the needs of marginalized people who use opioids, and operate predominantly within the context of frontline services [ 16 , 17 , 18 ].

Though not mainstream or broadly implemented, studies from North America indicate that DCS are generally acceptable among people who use drugs [ 19 , 20 ], and report that both service users and providers have expressed desire for better access to DCS, legal protections for those providing and using drug checking, and advanced technologies that provide information on drug concentrations—not just drugs present—at the point of care [ 21 , 22 , 23 , 24 ]. Several studies explore the potential impact of drug checking when used at various points along the supply chain [ 25 , 26 ], with findings that suggest feasibility, acceptability, and uptake of DCS among drug sellers [ 27 ], noting particular importance to drug sellers who are embedded in their community and hold long-term trusted relationships with customers [ 28 , 29 ].

Arguably the most common and well-known drug checking modality in North America are fentanyl testing strips (FTS), or lateral flow assays, which were originally designed for the clinical use of detecting fentanyl in urine samples, but have been publicly available for several years for modified use with drug samples [ 30 , 31 , 32 , 33 ]. FTS have been a powerful tool to combat accidental fentanyl exposure: they are small, portable, relatively accessible, and detect fentanyl in minute concentrations that could still be enough to trigger an overdose in an opiate-naïve individual [ 31 , 34 ]. They have been found to be particularly useful for outreach and street use [ 13 , 25 , 35 ]. That said, FTS are not useful in the same way for those who intend to use fentanyl, where the overdose risk is not in the presence of fentanyl, but in the concentration and presence of additional adulterants like sedatives [ 36 ].

Drug checking technology has advanced, and continues to advance, such that a greater amount can be known about the chemical components of a drug sample in a shorter period of time, in a broader array of environments [ 37 ]. Multiple drug checking modalities can inform people who use drugs about the presence of unexpected adulterants, such as benzodiazepines and xylazine, among others. Technologies that offer the greatest specificity and sensitivity include Gas Chromatography Mass Spectrometry and High-Performance Liquid Chromatography, which can detect the presence and concentrations of a wide array of chemicals present in even small amounts in a sample, but must be used in a laboratory setting by a trained technician [ 37 ]. More flexible technologies have emerged, like Fourier-Transform Infrared Spectroscopy (FTIR) [ 38 ], which is semi-portable, and returns information on the main chemical components of a drug sample (above 5% concentration) in a matter of minutes [ 31 ]. Paper spray mass spectrometry is more expensive than FTIR but is just as fast, and provides quantitative results [ 39 ]. Today, multi-technology-based drug checking services are available in some areas as standalone programs, or as added components to existing harm reduction centers [ 30 , 40 ].

These innovations continue to advance amidst complex and evolving social, legal, political, and funding conditions [ 11 , 21 , 41 , 42 ]. Legally, drug checking can be complicated as a public service, requiring the handling and, often, exchange of illicit drug material, of which possession and distribution is often criminalized [ 21 ]. Harm reduction initiatives more broadly—DCS, syringe access services, naloxone distribution, HIV/HCV testing, wound care, supervised consumption sites, and medications for opioid use disorder (MOUD), among others—can at times be unpopular socially and politically, as stigma associated with addiction and drug use combined with concerns about the goals and practices of harm reduction can generate powerful community pushback [ 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Legislators and policymakers at local, state, and federal levels who rely on constituent support may therefore shy away from supporting various harm reduction strategies, despite endorsement from public health officials and robust evidence showing that harm reduction improves the health, survival, and recovery potential for people who use drugs, without compromising community safety [ 48 , 49 ]. At the same time, California was one of several states to bring lawsuits against opioid manufacturers, distributors, and pharmacy chains, alleging that they played an active and/or negligent role in the genesis and exacerbation of the opioid crisis [ 50 ]. Of the $43.3 billion in settlement funds that have been awarded thus far, California may receive nearly $4 billion [ 51 ]. These funds are specifically earmarked for activities that are to include “prevention, intervention, harm reduction, treatment and recovery services.” [ 52 ].

As the opioid crisis reaches an unprecedented magnitude and strategies to address it are at once both a priority and a topic of controversy, we aimed to explore the value of drug checking services and their role within harm reduction more broadly. In this study, we report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered. We aim to contribute to an existing qualitative evidence base exploring the value and utility of drug checking services, particularly as data are leveraged to inform political narratives, legislation, and funding allocation.

For this study, we conducted in-depth semi-structured key informant interviews across two samples: a “provider” sample and a “client” sample. The “provider” sample consisted of individuals providing clinical and harm reduction services to people who use drugs, as well as drug checking subject matter experts such as researchers and program heads. The “client” sample consisted of individuals who use drugs and were receiving harm reduction services at an agency where multiple forms of drug checking were included in the services provided.

From June to November 2022, two authors (DC & LM) conducted in-depth semi-structured key informant interviews with 11 providers—8 working in the U.S., 2 working in Canada, and one working in both countries. Included in the sample were 2 clinical providers, 4 researchers, and 5 harm reduction service providers [Table 1 ].

We employed purposive sampling of known providers first, then snowball sampling, contacting additional potential participants at informants’ recommendation. All potential participants were contacted via email and invited to participate. If the participant agreed, an appointment was made for the interview to take place over Zoom. Interviews lasted between approximately 45 and 60 min, and solicited provider perspectives on the state of the drug market in their area, the perceived needs of and challenges faced by their local client population, and their attitudes and experiences with drug checking methods and programs and integrating such programs into existing services. Verbal consent was collected at the outset of the interviews, which were then recorded. Audio from the recordings was isolated and transcribed using a secure third-party professional transcription service. All transcripts were deidentified and researchers created unique anonymous ID numbers for each participant. Participating providers were offered an honorarium of $100 in the form of a gift card. The study protocol was reviewed by the University of California San Francisco Institutional Review Board (IRB #22-36262).

Client participant ( n = 13) recruitment and data collection took place over a one-week period in November 2022 [Table 2 ].

We employed a non-random convenience sample, recruiting from four harm reduction programs in San Francisco, where clients were approached either by interviewers (NH & JO) or program staff who had been instructed on eligibility requirements. Eligible participants were at least 18 years of age, and currently using fentanyl, heroin, or methamphetamine. Clients were excluded from eligibility if they were intoxicated or otherwise unable to provide informed consent. Given that current drug use was an eligibility requirement, we assessed “intoxicated” as an inability to respond to simple questions, providing responses that are incoherent or unintelligible, or if the participant indicates that they are too high to continue. Potential participants who were eligible and interested were then formally verbally consented and interviewed on-site. Client interviews explored participants’ history of drug use and experiences with harm reduction services, as well as their awareness of, attitudes about, and experiences with various drug checking modalities. Interviews lasted approximately 30–60 min and were recorded, then submitted to the same external third-party transcription service being used for provider interviews. Participants were provided a $25 cash incentive as a token of appreciation for their time and expertise, and were provided unique ID numbers to anonymize their data. This study protocol, distinct from the protocol covering provider interviews, was reviewed and approved as well by the UCSF IRB (#22-36640).

Client interview transcripts were uploaded to Dedoose, a qualitative analytic program [ 53 ]. Four analysts (EA, LM, SO, and JO), two of whom were involved in data collection (LM & JO), read transcribed interviews from both client and provider data sets and drafted summaries which were then systematically reviewed as a team. Following the tenets of thematic analysis and adopting the framework developed by Miles and Huberman (1994) [ 54 ], the team collaboratively identified cross-cutting themes from interview summaries, covering areas of concordance, discordance, and particular importance, as well as exemplar and negative cases. Once major themes and sub-themes were identified and articulated, authors drafted analytic memos which consolidated and explored in detail each major theme.

Following publication of an article focused on findings from the provider data set [ 55 ], further analysis of the client data set included the development of a formal coding scheme (SO), based on a priori codes extracted from the interview guide, as well as codes reflecting themes and sub-themes identified in the summarizing process and further refined via ongoing weekly analytic meetings. Coding was led by the primary qualitative analyst [SO] with secondary coding by client interviewer and author [JO]. The application of codes was discussed regularly among all team members, focusing on discrepancies between primary and secondary coders, insights developed, and the potential emergent themes. Discrepancies occurred approximately 10% of the time, and these were resolved through group consensus in accordance with established qualitative research methods [ 56 ].

Through key informant interviews, we captured diverse perspectives on how existing and emerging drug checking services are being used, and their potential for future impact within the harm reduction suite of services.

We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.

The role of drug checking in overdose prevention

Service providers and clients expressed varying opinions on the extent to which information from drug checking services would prevent overdose and, indeed, whether overdose prevention is the appropriate metric by which drug checking’s impact should be measured. Clients reported diverse experiences and perspectives on how they use (or don’t use) drug checking, and expectations for their own future use.

Fentanyl test strips

Almost all client participants reported having had some experience with fentanyl testing strips (FTS), either using them personally or seeing others use them. Attitudes about FTS varied. Some expressed concern that they are difficult to use correctly or that they have heard they may be unreliable (prone to false positives or negatives):

We were using them constantly when they were telling us that all the drugs had fentanyl in them. But then we found out that if you don’t put enough water on speed, that it can come up positive because of some chemical. [Client, 40, female].

Others reported relying on them heavily and using them often:

I’ve just got to have that insurance that there’s no fentanyl in [my drugs]. … I have a drawer. Like that? That’s all full of test strips. Usually every time I come to a needle exchange, if they have them, I grab as many as I can and just put them in the drawer. [Client, 43, male].

Spectrometry

Although many had not heard of spectrometry, spectroscopy, or anything beyond FTS, once it was described what a range of drug checking services could look like, clients were interested and excited about the possibilities. Some expressed interest in using mobile or site-based spectroscopy, but were concerned about their safety, one expressing worry about “ judgment from the community ” or bystanders taking videos and calling the police, another wondering if they would be an “ easy target ” for law enforcement harassment. Those who reported having used FTIR as part of their harm reduction visits, however, had positive things to say:

Interviewer: And how do you feel about that testing service at the van? Participant: I think it’s remarkably great. Interviewer: yeah? Participant: Yeah. They answered my questions, exactly what I wanted to know. [Client, 66, male]

Some participants described high percentages of testing experiences coming back with a positive or unexpected result, like a client who said that he’d used the FTIR mobile service four times with meth from four different suppliers, and “ only one came back pure .”

Using drug checking results

What participants reported doing with the results of checking their drugs varied as well. Some participants spoke about specific situations where drug checking prompted them to avoid buying contaminated drugs.

Actually I just used [drug checking] yesterday. Luckily, I didn’t buy the heroin I was going to, because it tested for fentanyl . [Client, 32, male]

Other community members expressed disinterest in checking drugs, often citing a lack of realistic options for using test results in a way that made sense for them. One participant stated directly that they didn’t want to test because they didn’t want to have to not use drugs if they got a result they didn’t like:

What if it comes up with fentanyl in it? Then I bought it but I can’t do it? They’re not going to take it back, the people I bought it from. I mean even if I get them to write me a receipt, you know? [Client, 49, male]

Another client said that she was interested in drug checking generally, but wouldn’t bother if she only had a little bit and was relying on it to keep her from getting sick:

If I was trying to [check my drugs], I would do it when I had enough to do that, you know. Because if I was dope sick and I only had two hits of fentanyl, I probably would not [test]. [Client, 24, female]

Data from service provider interviews echoed these dynamics. We heard from provider participants that, broadly, drug checking services prevent overdose directly some of the time, but not all the time, by way of individual behavior change on a case-by-case basis. One provider—a clinician with a lengthy career in addiction medicine and harm reduction—echoed doubts about how common it would be for a patient to make use choices based on drug checking results, broadening the focus to personal harm reduction behavior change rather than abstinence behavior alone:

And then the question is, what do you do about it? I’ve had a patient who is, like, yeah, I tested it. It was positive for fentanyl. I go, well, what did you do? Well, we just used anyway because it’s all we had. And we had, like, the Narcan out, and I – I just felt really sleepy afterwards. … So I guess that’s the other question – if you do drug testing and it isn’t what you expect, like, you can’t take it back to the dealer and say, hey, this isn’t – I want a refund; right? So what do you do with that information? And if, you know, if you’re in withdrawal and you really need to use that drug, like, what kind of safeguards are you going to take if you decide, yeah, I’m going to go ahead and use this; right? [Clinician, U.S.]

Other service providers similarly drew a distinction between drug checking sparking behavior change that prevents overdose versus behavior change that reduces the risk of death from overdose, situating drug checking services as a set of tools that dovetail with existing personal harm reduction strategies.

The reality is, you know, people still are using their drugs. Now, a large proportion of people who use our service say that they’ll do something differently after, you know, accessing our service, so they maybe will do a test dose first, or start, like, start with a smaller dose, or use with a friend, or use at an SCS [supervised consumption site]. [Direct service provider, Canada].

Overdose prevention versus overdose rates

Interestingly, many service providers when asked for their perspective on the role of drug checking services in overdose prevention expressed concern about a gulf between the overdose prevention they observe at the service level versus what they see represented in population-level data.

Will drug checking save a life? Absolutely. Yes, for sure. Will it, at a population level, drop overdose rates? I don’t know the answer to that. [Researcher, U.S.]

Participants offered multiple explanations for this. One described challenges inherent in proving prevention, while another explained how population overdose rates can obscure the impact of drug checking programs when they operate within a rapidly-changing drug supply:

It will be very hard to prove within these prevention paradoxes. I think prevention is one of those things that is so important, but within our scientific frameworks … preventable events are so rare and on the grand scheme of things, they’re really hard to prove. … But will [DCS] save lives? Yeah. [Clinician, U.S.] The numbers aren’t showing [an overall decrease in overdose], right, because at the same time, even though we’re offering this service, the supply is just getting worse and worse, so overdose rates are rising. [Direct service provider, Canada].

Not every participant who commented on this gulf found it to be wide or troubling, but instead remarked on it as a neutral distance between two related but distinct constructs, one of which is a measure of what outcomes drug checking information could yield, and the other of which is a fundamental right to that information.

It’s really a great question if we’re going to see things pan out in the numbers. I certainly hope so and I certainly think so, but I think that we just have the right to know what we’re putting into our bodies, regardless of what outcome measures are. We deserve to know what’s in our drugs . [Direct service provider, U.S.]

Similarly, a direct service provider offered a structural perspective on overdose prevention, decoupling the value of drug checking services from overdose outcomes, prioritizing instead the intrinsic value of equipping people with critical information about what they are putting in their body and the importance of empowering people to make decisions with as much information as possible.

I don’t really know if [drug checking] is going to decrease the rate of overdose. In my mind, the problems that contribute to overdose are prohibition, law enforcement harassment, and everything that surrounds that that creates a shitty drug supply and then prevents people from investigating it. But what [drug checking] does do, again, is this piece around like, people should know that they can find out there’s more in their drug. … I think that it just enables people to make better educated decisions around their substance use and to understand their bodies better . [Direct service provider, U.S.]

Benefits to the overall agency, health, and wellbeing of people who use drugs

Drug checking services offer users the tools to independently identify risks in the drug supply and make decisions about what to do with that information in the short and long term. Many of the service providers interviewed for this study, when asked how drug checking would impact overdose rates, gave some version of a reframed response, repositioning the focus from the drug use decisions themselves to the importance of information in fortifying the overall agency, health, and wellbeing of people who use drugs.

The provider quoted in the above section went on to reflect on the intrinsic value of giving people information, arguing that it contributes to essential experiences of bodily autonomy and health equity:

What’s really important to me as well is just sort of building this momentum around people feeling entitled to bodily autonomy and seeing that [drug checking] is a part of [that], and having folks know that, yeah, they fucking deserve to have this information. They are entitled to know what is in their stuff. And so, that’s not the only piece to health equity and justice around substances and substance use, but I think that it’s a significant piece. [Direct service provider, U.S.]

Knowledge of what is in their drugs can also confirm users’ internal experience. One provider, who had piloted an early drug checking intervention in a major metropolitan area in the U.S., believed that drug checking for people who use drugs offers confirmation of the embodied experience of their substance use, which in this provider’s experience was often regarded with skepticism by health workers:

I think that people are able to connect experiences that they’re feeling in their body with real information. And I think that actually validates the really organic knowledge and experiential knowledge of drug users as the true experts about drugs. You know, when we were doing our project in [city] and fentanyl was not everywhere [yet]—almost 100% of the time, if someone brought us a sample and said, “I think this has fentanyl in it,” it was true. … It validates experience where people’s experiential knowledge is not really validated by an educational system. It’s always this kind of thing where public health people are telling drug users what’s true. And drug checking sort of validates that drug users actually know what’s true, and we’re just using science to confirm it.” [Direct service provider, U.S.]

Client interviews echoed this theme. Several clients recounted experiences that illustrated how navigating the drug market is becoming increasingly difficult, and that drug checking provides an important tool that they can pair with their own instincts and expertise as they try to keep themselves safe.

I can look at it and I can be like, “Wait a minute, we might want to test that.” Because speed and fentanyl are different. They actually look different than the other one, so when I start seeing traces of fentanyl being in the speed, I go, “We need to check that before we do any of it.” And, hey, sometimes I’m wrong. [Client, 43, male] The [meth] that was in the medicine bottle [tested positive for fentanyl], yeah. But I kind of knew it was going to because I packed a bowl right before and if it’s dirty … yeah, the color starts changing wrong right away. [Client, 43, male] I like that [drug checking] gives us some certainty of what’s in the drug … like with the heroin, there was stuff in that that just did not feel good. I’d love to know what they were cutting that stuff with. We used to joke it was shoe polish because it was so dark and dirty, but it’s really important what you put in your body . [Client, 48, female]

Our client data further provide evidence that people who use drugs are making health-related decisions for themselves and care about their own health and wellbeing. Woven throughout community member interviews were examples of health-seeking decision-making in users’ everyday lives, demonstrating agency in considering health behaviors and expressing both implicitly and explicitly a desire to care for themselves. Examples of these pro-health micro-decisions include choosing not to smoke out of foil (it’s “ not healthy to smoke out of ” and “ it’s going to give us Alzheimer’s or something ”) or reducing smoking marijuana due to a “ sensitive ” respiratory system. One informant laid out explicitly their hopes for their future, shaped too by an acute awareness of the risks of the current drug market:

I don’t want to be a statistic out here. I want to go back to regular life and experience all the rest of the highs that there still are out there before I die. I want to jump out of an airplane, or take a balloon ride, or ride more rollercoasters. … I don’t want to limit myself to one freaking high. … it’s not worth it anymore at all. … You’d never OD on meth before. Meth and weed were two things you just didn’t overdose on. If you did too much, you passed out and you slept it off and that was it. Now, no matter what drugs you’re doing, every time you use, it’s a 50–50 chance that you could die. [Client, 49, female]

These excerpts from client interviews highlight the demand among potential DCS users for strategies that contribute to their agency, health, and wellbeing, even within the context of continued drug use in the short- or long-term.

Impacts of drug checking services at community and systems levels

In addition to use at the individual level, participants talked extensively about the ways that they experience and imagine DCS having an impact at community and systems levels. They described the ways that drug checking could facilitate upstream regulation of the drug market, how the information and transparency made possible by checking drugs can fill a policy and regulatory vacuum, and how drug checking can empower public health surveillance systems and clinical response.

Community level regulation of the drug market

Multiple informants, both service providers and clients, reflected on the use—or potential use—of drug checking as a grassroots tool to regulate the drug market.

Participants talked about using, or thinking one could use, DCS as a vetting tool for sellers or suppliers.

And if people could get their shit tested, almost every time if not every time, not only would it help them to be safer by them regulating themselves and knowing what’s in their stuff … But I feel like if they knew exactly what was in it, they could go tell their guys that they got it from, “Look, man, I’m not buying that shit anymore if it’s like that. If that shit -- if this or that’s in it or whatever. Or if you don’t, whatever, I’m not buying it from you. I’m buying it from someone else.” And that might even make them be… It’ll hold them more accountable. [Client, 32, male]

This use was so important to one participant that they expressed interest in their samples being sent for more extensive in-lab spectrometry testing that could give them greater detail about the compounds and amounts in their sample:

Hey, [a full spectrometry report] may take a week, but at least in that week, I find out if I should go back to that person or not. [Client, 43, male]

Client participants frequently referred to DCS as a tool to “keep [suppliers] honest”; that is, as informal regulatory pressure on currently unregulated illegal drug markets. Some reported that they spread the word if drugs from a supplier come up contaminated or low-grade. One participant, who uses fentanyl, reported using FTS to ensure that what they are about to buy is, indeed, fentanyl:

I keep them [FTS] around. … Then I say, “Can I test it?” and I test it in front of them. And like some of it’s turned up negative. And so I totally outed them out on the block with it. It pisses them off – it kind of keeps them honest. … When you got a bunch of test strips, I can go down the line and keep, yeah, at least trying to keep them honest, you know. I got a pile of those things right now. That’s actually what I use them for. [Client, 40, male]

Of particular value, according to our participants, was the idea that spectrometry would provide formal documentation of drugs’ contents. Analytical evidence that something was either dangerously contaminated or not what the seller claimed it to be can shift the balance of power in the transactional dynamic, placing upstream pressure on suppliers to better monitor what they are contributing to the market.

If you could get results that are on paper or on a text or on a whatever, then you could bring it to them that, “Look, dude. I’m not fucking around. You need to make this shit right or I’m not buying it anymore.” That would be a game-changer . [Client, 32, male]

From the service provider standpoint, one participant, a drug checking technician and program manager with a longstanding history in their city’s drug scene, identified similar opportunities for DCS to impact the drug market, were it made easily accessible to those at multiple points in the drug supply chain in addition to consumers.

It’s not just people who are consuming the drugs that can use the service. It’s also people who are selling them. And so, oftentimes people who are not essentially the first or second hands that are creating the substance and then moving it down the chain towards the end consumer, they don’t know what is in their product. For folks who are selling drugs, if they’re able to come and get an ingredient list, they can then kind of know what to say to folks who are buying. [Direct service provider, U.S.]

This was not discussed as just a hypothetical. One informant who sells drugs validated this use as feasible and valuable:

I want to make sure what I’m buying is what it is. … I do sell it myself, so [spectrometry]’s a good service because that’s what I want to know is the chemical balance as to how much it is and how much it isn’t and whether it’s good every time. [Client, 66, male]

Filling a policy and regulatory vacuum

In the absence of a government or regulatory body that will monitor and report on the verified contents of illicit drugs, our data suggest that drug checking services, and spectrometry in particular, may be filling a policy and regulatory vacuum.

Clients likened the idea of having access to a list of drugs present in a sample to knowing ingredients of something that they would eat.

I mean we know what’s in our food, right? The packaging is all labeled and the ingredients are listed. It’s just too important, especially with drugs. Especially because we don’t know who’s making them. We don’t know exactly where they’re coming from. And every single one is different. Every week is different. Even if you buy it from the same person all the time, they’re always having something different. Maybe you’ll have the same thing twice or three times but that’s it. [Client, 48, female]

Providers, meanwhile, explicitly framed the value of drug checking within the context of an unmet regulatory need. One service provider qualified many of their statements about drug checking services with “until prohibition goes away,” situating DCS as being necessary only in a regulatory vacuum. Another spoke more directly to the relationship between drug checking and regulation:

And with drugs, because of prohibition, we just have this unknown, unregulated supply, and people are – what they’re putting in their bodies and what they’re purchasing is obscured, right? And so, drug checking is like a series of sort of imperfect tools to help consumers of drugs regain a little bit of control in the form of information around what it is that they are using. …. And there’s a very good argument that, if we had some kind of safe, regulated supply, we wouldn’t need drug checking at all, which is true . [Direct service provider, U.S.]

Empowering public health surveillance systems and clinical response

Data from our interviews suggest that drug checking technologies and programming may also contribute meaningfully at a structural level, to public health surveillance systems and clinical response. Aggregated sample results provide real-time data about what drug compositions are trending across regions, and what the clinical implications may be for providers treating clients who use drugs [ 57 ]. One drug checking program team posted results to their website in the hopes of informing local clinicians and public health policy makers about what was circulating in the drug supply. This program manager talked about making results available “at the societal level”:

And then at the kind of societal level what we do … [is] every other week we take all of the results from the samples that we’ve checked, and we combine them, and then we put out a report and update our website about, like, what’s circulating in the drug supply. So we talk about, you know, trends in the drug supply over that period, and new drugs that have been introduced, and what those drugs could mean, that type of thing. So service doesn’t only benefit individuals, but it also benefits the larger community by being able to say, okay, this is what we’re seeing. If you can’t access the service, you still at least know, you know, what is circulating. [Direct service provider, Canada]

Community members expressed an awareness of this function. One participant cited drug checking’s role in a larger tracking network as one of the things they value most about the service:

I liked a lot about [drug checking]. One, that it was available in the first place. Two, that it was not just doing its own thing. It was part of a larger network that was keeping track of what drugs were popping up on the streets and what their makeup was. I really like that that’s happening. [Client, 30, male]

At the point-of-service level, provider informants discussed significant benefits that drug checking could provide to clinicians and other medical professionals who work closely with people who use drugs. This informant posited specifically that having more detailed knowledge about what was circulating in the drug supply could help clinicians better formulate strategies for managing opioid use disorder and transitioning patients onto MOUD:

Understanding what’s actually in the supply… allows clinicians to tailor the care that they are providing to people who use drugs. So, you know, if they know that the average amount of fentanyl in a fentanyl sample is this and they want to transition someone off the unregulated drug supply onto, like, a pharmaceutical alternative, well, what pharmaceutical alternative is actually suitable based on what they’ve been using? [Direct service provider, Canada]

This is especially critical given the significant difficulties that have been recently reported when transitioning people using fentanyl to appropriate longitudinal services [ 58 ]. A provider we interviewed who runs a mail-based drug checking service in the U.S. reported that developing a more thorough knowledge of the drug supply outside of the current surveillance panoply may provide important clinical toxicology assistance to help physicians connect health outcomes to specific substances or components of the drug supply, and more quickly provide tailored treatment:

There’s one other really big one for me, which is that it allows us to link specific physiological harms with specific chemicals. So, we’re not just talking about dope anymore. We’re talking about this component of dope causing this specific reaction. What we have been able to do is, we’ll get calls from our central hospital on campus, and they’ll say, “We have this patient with an idiosyncratic presentation. Boom, boom, boom, boom, boom, boom. Here it is. We think it might be… You know, they’ve been injecting this, this, and this. We have some of their samples. Can we get them tested?” Or if they don’t have the samples, they’re like, “This is what the symptoms are. This is where they’re from. What are you seeing about the drug supply in their area?” And I can be like, “Well, yeah, there’s been a spike in levamisole in that area or xylazine,” you know, whatever it is. And then they can get to treatment quicker because the physicians have a more specific knowledge about the ideology of the harm that they’re observing in clinic. [Researcher, U.S.]

Negative cases

While the vast majority of participant responses reflected positive experiences with or attitudes about DCS, some participants additionally expressed ambivalence or concern. Many of these perspectives are embedded within the themes reported above, but deserve reiteration: service users expressed concerns about the accuracy of drug checking technologies, their privacy and safety relative to community stigma and law enforcement, and anxiety about having to make hard choices about drug use in the face of an unexpected result. Service providers expressed concern about the “then what” of drug checking, citing constrained choices and limits to what could be realistically expected in terms of behavior change without other supports in place. Some further lamented the challenges of translating the benefits of what they were seeing in practice to what is visible to a broader audience.

Not included in the above findings, but important to note, are two additional concerns that arose in interviews. First, service users and providers cautioned that the street drug supply changes so quickly that new compounds may be showing up on the street before they are identified in spectrometry libraries, potentially limiting their ability to accurately identify contaminants. Finally, one provider, a clinician with a longstanding career in addiction medicine and harm reduction, closed their interview with a somber caution against decontextualizing drug checking from a broader commitment to multi-method harm reduction, health equity, and social justice.

[I worry that] we’re just throwing yet another technology at a much bigger problem. My fear is that people will say, oh, now we have drug checking, so now we can stop trying to dismantle, you know, structures of racism and oppression in society, right? We can stop looking for homes for people because we have this technology that’s going to prevent people from dying. … It doesn’t work that way. [Clinician, U.S.]

While the magnitude of the opioid crisis is often communicated in terms of overdose and death rates, the harms associated with opioid use—intentional or unintentional—in an unregulated drug market extend far beyond those data points alone, and so too must the strategies leveed to combat them. Our findings demonstrate that drug checking services offer diverse benefits at the individual, community, public health, and health systems levels.

Overdose prevention and beyond

If the question is, do and will these technologies contribute to overdose prevention , our findings suggest that the answer is yes, with some important caveats. The first being that, according to our participants, they do not prevent overdose all the time. Our findings reflect that individuals make complex and highly contextualized decisions regarding their use behavior each time they use drugs. Information about the chemical composition of a drug sample sometimes leads to decisions to abstain, but more often leads to decisions to engage in other types of harm reduction behaviors—like using with a friend rather than alone, making sure to have naloxone on hand, using at a supervised consumption site, alerting others to a bad batch, using a tester first, or avoiding a certain supplier in the future. Sometimes it leads to no observable behavior change at all.

Further, DCS have not been scaled up to meet the needs of everyone at risk for overdose; until it is, it is premature to discuss population-level prevention. This study does not purport DCS to be in and of themselves sufficient to prevent overdose, but they are clearly part of a continuum of services that can prevent overdose mortality.

Many participants took care to note as well that the needs of people who use drugs are not solely to avoid overdose; people navigating drug use are whole people, and the stigmatization and criminalization of drug use regulates their access to a multitude of essential needs and liberties, like health care, housing, employment, agency, and a host of social and legal protections. Access to information that contributes to agency and autonomy, and enables more informed decision-making, is an essential service regardless of other outcomes.

Of course, among harm reductionists and researchers acquainted with the diverse and dynamic ways that harm reduction functions within communities, this is not news. Our findings reflect and reinforce much of the existing evidence from studies aiming to understand the role of drug checking within the larger constellation of harm reduction and, indeed, the role of harm reduction itself.

One recent qualitative study in particular reported themes with striking similarities to the prevailing themes from our interviews. Wallace et al. [ 59 ] explored the potential impacts of community drug checking on prospective service users, finding drug checking to “increase quality control in an unregulated market,” “improve the health and wellbeing of people who use substances,” and “mediate policies around substance use.”

Our findings further add to existing evidence that links drug checking with consumer empowerment within an opaque drug market [ 25 , 26 , 29 ] and underlines the reciprocal relationship between individual agency and the adoption of harm reduction strategies [ 46 , 60 , 61 ].

Of note is the shifting context in which many existing drug checking studies, including ours, are situated. In some areas, fentanyl appears most often as an unwanted adulterant in another drug—be it a non-opioid or a less potent opioid like heroin—and DCS are used primarily for fentanyl avoidance [ 13 , 19 ]. Increasingly, however, pockets of consumers are preferring fentanyl, as seen in our San Francisco client sample and within populations reflected in recent drug checking studies. Our data echo the broader finding that drug checking technologies are likely to be used differently by fentanyl-seeking opioid users versus fentanyl-avoiding opioid users, and differently still among those using stimulants, psychedelics, or other non-opioid drugs [ 22 , 62 ].

On the subject of behavior change—whether and how drug checking can be understood to prompt changes in drug use behavior—our findings align with existing evidence showing that drug checking is at times followed by contaminated drug disposal, and at times followed by the employment of personal harm reduction techniques such as spreading information within the community [ 30 , 63 ], and reduction in polysubstance use or dosage [ 13 , 14 , 15 , 64 ]. Lacking as we do a robust methodological-empirical foundation to assess this type of causality, whether and to what extent drug checking in various contexts leads to less use or more safe use among different populations cannot be stated concretely [ 16 , 65 , 66 ]. Whether individuals change their use behavior based on drug checking results is highly informed by such matters as how limited their access to drugs is, realistic options for modified use, and their perceived relative risks of knowingly ingesting a potentially dangerous compound or compounds versus not.

The tension at the center of harm reduction policy

The role of harm reduction services within communities have long reflected a central tension: in contrast with abstinence and criminalization models, harm reduction is often socially and politically criticized as enabling drug use and making neighborhoods less safe [ 67 , 68 , 69 ], while research consistently finds harm reduction to yield positive outcomes for both service users and surrounding communities [ 70 , 71 ]. In addition to improving the health and wellbeing of people using drugs, evidence suggests that those accessing harm reduction services are more likely to ultimately seek treatment and pursue recovery [ 49 , 70 , 72 , 73 ]. Concerns about public safety, too, while in many cases expressed in good faith, have been shown to be largely misplaced: multiple studies show harm reduction programs to have no significant impact on nearby violent or property-related crime, with some findings suggesting improved indicators of public order and safety [ 48 , 49 , 74 , 75 ]. Harm reduction strategies have additionally been found to be cost-effective in the short term and cost-saving to public monies in the medium- and long-term [ 76 ]. Nonetheless, public perception of harm reduction has historically been interwoven with deeply entrenched cultural stigmas related to race and ethnicity, socioeconomics, and an imprecise moralism that positions access to health and protection as a privilege that should be earned or denied based on behavior [ 67 , 69 , 71 ].

This tension plays out most concretely in the public policy space. Even as the opioid crisis dominates public health discourse and funding is earmarked for research and programming to combat it [ 77 ], harm reduction programs on the ground are under siege. At the federal level, the House Appropriations bill for the Fiscal Year 2024 HHS budget dramatically cuts funding to HIV/AIDS programs—a budget umbrella under which many harm reduction, substance use support and treatment programs are funded [ 78 , 79 ]. In California, a $15.2 million state grant supporting syringe access services has dried up amidst an overdose crisis at its peak, with no plans for replacement [ 80 ]. In 2022, a landmark bill (SB58) that would have authorized overdose prevention programs with supervised consumption in Los Angeles, Oakland, and San Francisco was vetoed by the Governor, despite broad support and robust evidence behind it [ 81 ]. Funds for such safe consumption sites have further been excluded from receiving opioid settlement funds in San Francisco [ 82 ], and in September of 2023, a bill was put forth by the San Francisco Mayor’s office to require drug screening and mandatory treatment for anyone receiving public services [ 83 ]. This, despite the expressly articulated commitment to and acknowledged necessity of harm reduction services—services explicitly aimed at helping people who use drugs to be more safe rather than abstaining from use—highlighted in policy language across multiple levels of government and legislature [ 10 , 84 , 85 , 86 , 87 ].

It is worth noting that one of the harm reduction sites where several of this study’s client participants were receiving services was defunded shortly after we completed data collection, and since then, overdose death rates in the city have climbed [ 88 ] and public order in that area has reportedly deteriorated [ 89 ].

The framing of effectiveness is crucial in this policy environment

In light of these tensions, we offer the findings of this study as a contribution to an evidence base that may play an increasingly central role in California’s—and the nation’s—opioid crisis response. The allowable expenditures for opioid settlement funds list “evidence-informed programs to reduce the harms associated with intravenous drug use” as a focus area [ 51 ] and California’s Overdose Prevention Initiative describes its approach as being “data-driven.” [ 10 ] The proposed HHS FY2024 budget, in addition to cutting much of the funding that covers harm reduction programming, proposes the rejection of “controversial programs” while maintaining funding for “an effective opioid response.” [ 78 ] As California faces a $68 billion budget deficit [ 90 ] and supplementary federal and settlement funds are to be apportioned based on strategy effectiveness and the body of scientific evidence, the role of research comes into sharper focus. It is the strength or weakness of the evidence base—of the complexity of the research inquiry and integrity of the data—that may ultimately frame which initiatives are eligible for support.

When asked about the place and promise of drug checking within the broader constellation of harm reduction services, it was drug users’ humanity and right to health, more so than the public health implications, that grounded many of our participants’ responses. Their responses implicated, too, the underlying operating principle that, ultimately, people make choices that make sense for them. Whether by the hand of addiction or desire, constrained options or access, or every individual’s complex hierarchy of relative dangers and needs, people’s choices are reflections of their full humanity. Approaches to stemming the tide of this crisis cannot be effective unless they are built on respect for the individuals living it, and focused on understanding their needs.

We encourage continued research and reporting on drug checking services and emerging technologies, with an emphasis on exploring effectiveness within a broad scope, reflective of the impacts of these services on whole lives and systems.

Limitations

Many of the community members we interviewed had not heard of spectrometry or spectroscopy, and the interview represented the first time they were introduced to the technology as a concept and the first time they considered whether and how they could see themselves using it in their own lives. This limits the range of our findings among the client sample, given that much of our qualitative data speaks to hypothetical future use rather than past or current use of emerging technologies. The absence of data on client use should not be interpreted to mean that participants chose not to use DCS.

Additionally, the sampling frame for clients was limited to one setting, while providers were sampled from across North America, and the small sample size for both groups may have limited saturation. Finally, providers did not reflect all North American regions where drug checking has been implemented, nor all DCS models, limiting the generalizability of findings.

Our manuscript contributes to growing evidence of the effectiveness of drug checking services in mitigating a range of risks associated with substance use, including overdose, and offer diverse benefits at the individual, community, public health, and health systems levels. For that reason, policymakers should consider allocating resources towards its implementation and scale-up in settings impacted by overdose mortality.

Data availability

Due to ethical restrictions, the data generated and analyzed during the current study are not available to those outside the study team. Data and materials are of a sensitive nature, and participants did not consent to transcripts of their interviews being publicly available. Portions of interviews about which editors have questions or concerns may be provided upon request after any details that may risk the confidentiality of the participants beyond de-identification have been removed. Researchers who meet the criteria for access to confidential data may send requests for the interview transcripts to the Human Research Protection Program (HRPP)/IRB at the University of California, San Francisco at 415-476-1814 or [email protected].

Abbreviations

Fourier–Transform Infrared Spectroscopy

Fentanyl testing strips

US Department of Health and Human Services

Medications for opioid use disorder

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Acknowledgements

This study would not have been possible without the client participants who so generously shared insights about their lives and how they access harm reduction services, and our provider key informants and their work on behalf of people who use drugs. The authors would also like to thank the staff of the Northern California HIV/AIDS Policy Research Center who supported the project during its inception, data collection, and writing.

This research was funded by the California HIV/AIDS Research Program (CHRP) to the Northern California HIV/AIDS Policy Research Center (PI Arnold), H21PC3238. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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Lissa Moran, Jeff Ondocsin, Simon Outram & Emily A. Arnold

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Jeff Ondocsin, Daniel Ciccarone & Nicole Holm

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Contributions

E.A.A. and D.C. conceptualized and designed the study; J.O., L.M., D.C., and N.H. were responsible for data collection, each conducting in-depth key informant interviews. L.M., J.O., S.O., and E.A.A. analyzed the data. L.M. led the writing of the original manuscript draft with significant contributions from J.O., S.O., and E.A.A. L.M., J.O., D.C., S.O., D.W., N.H., and E.A.A. were directly involved in iterative review and revision. E.A.A. provided supervision, project administration, and funding acquisition. All authors have read and agreed to the submitted version of the manuscript.

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Correspondence to Lissa Moran .

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Ethics approval and consent to participate.

The study was conducted in accordance with the Declaration of Helsinki and informed consent was obtained from all subjects involved in the study. The study protocol and consent procedures were reviewed and approved by the UCSF IRB (#22-36640) on 12 September 2022.

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Not applicable.

Competing interests

D.W. is a founder of DoseCheck, a commercial entity that is developing a mobile drug checking technology. D.C. reports the following relevant financial relationships during the past 12 months: (1) he is a scientific advisor to Celero Systems; and (2) he has been retained as an expert witness in ongoing prescription opioid litigation by Motley Rice, LLP. The remaining authors have no relevant financial or non-financial interests to disclose. The remaining authors have no relevant financial or non-financial interests to disclose.

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Moran, L., Ondocsin, J., Outram, S. et al. How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives. Harm Reduct J 21 , 92 (2024). https://doi.org/10.1186/s12954-024-01014-w

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The problem is that we're too late. Data were just released for 2021; it's 2024. It's as helpful to me today to combat drug overdose deaths to study the year 2021 as it is 1850. It's just a whole different ballgame out there.”

Lori Ann Post Demographer, epidemiologist, and IPR associate

Throughout its history, the U.S. has battled waves of widespread drug addiction. From painkiller addictions on Civil War battlefields to the 1980s era of crack cocaine, each crisis gives way to a new one.

Today, however, with new drugs constantly emerging, it's becoming harder to keep up with creating drug screenings and medicine to reverse overdoses. This lag leads to more overdose deaths, according to demographer, epidemiologist, and IPR associate Lori Ann Post.

Post emphasizes that we are not in a drug epidemic: We’re in a continuous, evolving drug crisis. Pandemics and epidemics have a clear beginning, middle, and end, she says, but the shape-shifting nature of the drug crisis leaves no end in sight.

The Ohio River Valley Corridor Regional Drug Data Research Center (ORVC-C) , led by Post, aims to keep history from repeating itself. The center aims to support prevention, harm reduction, treatment, public safety, and recovery services, and to create a drug data-sharing model for others. Currently, overdose death data lags two or three years behind.

“The problem is that we're too late. Data were just released for 2021; it's 2024,” Post said. “It's as helpful to me today to combat drug overdose deaths to study the year 2021 as it is 1850. It's just a whole different ballgame out there.”

“By the time we get the evidence we have, it's already too late and the problem has evolved, and it's a new variant of concern and has new treatment and needs,” she explained.

Approximately 107,622 drug overdose deaths were reported in 2021, up nearly 15% from 93,655 deaths in 2020. Over 75% of those deaths involved opioids. The COVID-19 pandemic is commonly blamed for the surge in overdose deaths, but Post said the rates were "skyrocketing" before the pandemic.

Since 1999, almost 645,000 people have died from overdoses involving opioids. This rise in opioid overdose deaths can be explained in waves, according to Post:

The first wave started in the 1990s due to an increase in opioid prescriptions.
The second wave began in 2010, marked by a sharp increase in overdose deaths involving heroin.
The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly illicitly manufactured fentanyl.
The fourth wave began around 2019 and is largely still driven by fentanyl with the addition of stimulants such as cocaine and methamphetamines.

Post explains that the fourth wave is further evolving into drug cocktails that are adulterated with animal tranquilizers . This wave is more dangerous than its predecessors, as these drug combinations are more lethal and reversal agents are limited to fentanyl overdoses.

The ORVC-C launched in October with $3.55 million in funding from the Bureau of Justice Assistance. It operates in the Ohio River Valley Corridor, encompassing Delaware, Illinois, Indiana, Maryland, Michigan, Ohio, Pennsylvania, Virginia, Washington, D.C., and West Virginia. These regions bear a lopsided burden of escalating rates of drug overdoses, individuals with substance use disorder, and drug/narcotic violations, Post says.

The Bureau of Justice Assistance has doubled the funding to create a second regional center extending the initial center to New England, New York, and New Jersey.

Within the center, Post established a Central Data Repository (CDR) and a Dissemination and Engagement Center (DEC). The CDR collects, analyzes, and shares comprehensive drug-related data from existing information collected by local, state, and national agencies. This covers labor, crime, public health indicators, and demographic data. The DEC fosters partnerships and produces educational materials to address needs as they arise.

Post says that the center processes data to provide actionable insights for policymakers, public health practitioners, law enforcement, and other stakeholders, while also ensuring accessibility for fellow researchers.

Streamlining the data collection process reduces administrative burdens. It also allows researchers to delve directly into addressing critical issues without unnecessary hurdles.

“The more people doing research on it, the better we're going to do,” she said. “The timelier the data is, the more relevant it is to solving drug use and preventing drug overdose deaths. That’s the whole point.”

Lori Ann Post is the Buehler Professor for Aging, director of the Buehler Center for Health Policy and Economics, and an IPR associate.

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🌱 marijuana essay: how to write, 🏆 best marijuana essay examples.

💡Interesting Cannabis Topics to Write about

🥇 Exciting Marijuana Essay Topics

🎓 controversial weed topics, 🔎 marijuana research paper topics, ❓ marijuana research questions.

Marijuana, also known as cannabis, is a psychoactive drug made from a plant and used for recreational and medical purposes. Being fully prohibited in some countries, it is fully legalized in others. In your essay about marijuana, you might want to focus on the pros and cons of its legalization. Another option is to discuss marijuana dependence. One more idea is to compare and contrast marijuana laws in various US states. Finally, you can discuss the business aspects of the issue.

Whether you have to write an argumentative, descriptive, or cause and effect essay, our article will be helpful. It contains marijuana topics to research and write about. You can use them for a paper, speech, or any other assignment. Best marijuana essay examples are added to inspire you even more.

Mental and physical effects of cannabis
Marijuana and mental ability: the correlation
Cannabis consumption: the key modes
Marijuana: short-term and long-term effects
Cannabis and reproductive health
History of cannabis
Legal status of marijuana in various countries: compare and contrast
Should cannabis be legalized?
Cannabis as a gateway drug
The use of marijuana for medical purposes

With the current-day process of drug legalization and the popularization of cannabis, writing a marijuana essay becomes more than a one-track, anti-drug endeavor.

Whether your stance is for or against recreational drug use, you should be able to call upon credible sources to form a well-rounded and informed opinion that may sway your readers toward your cause.

Starting from your pre-writing process and bibliography and until you write your conclusion, you need to keep in mind particular points that will make tackling any marijuana essay topics easy. From a structural and pre-writing viewpoint, you should:

Brainstorm your ideas. Doing so will allow you to decide on a particular approach to your subject.
Do your research, compiling your bibliography, and perusing various book and journals titles, as well as research papers, interviews, and statistics.
Utilizing authoritative sources to support your argument will make your writing more academic and respectable.
Write a marijuana essay outline, which should help you better your essay structurally.
Compose an eye-catching title. Marijuana essay titles are already intriguing, so do your best not merely to draw your readers in but to prepare them for your argument by demonstrating your stance on the topic.

If you are still not sure how to begin your paper, look for sample ones online. Searching for good examples will help you understand the tools that work in essay writing, which ones you can apply to your issue, and which bore the audience.

Just remember that plagiarism is a punishable offense. However, gaining some inspiration from the work of others is not!

Now you are ready to begin, having carried out the research and created guidelines for your writing process. However, an intriguing title and an issue that may easily excite people is not enough to convince your readers of your subject’s validity.

Nonetheless, the potentially provocative nature of your paper provides you with the ability to write a fail-safe marijuana essay hook. Your introduction should build upon the sentiment expressed in your title and give your audience an initiative to read further.

You can start by providing surprising statistics or describing a present drug scenario. The goal of writing an introduction is to give your readers a brief understanding of your issue and present them with partial facts, making them want to continue reading.

Do not be afraid to expand your topics and link various data together while keeping in mind an academic approach.

Adverse societal effects of marijuana use may include an increase in the number of car accident cases, especially if there is no culture of safety around recreational drug use. However, trying to link it to society’s degradation may require more evidence than mere statistics.

Understand which approach is more likely to convince your audience and be ready to respond to potential counterarguments to your facts. Treating your audience as knowledgeable is one of the central characteristics of a good essayist.

Remember to write only sentences that are relevant to your argument. A sound mental practice when writing an essay is to continuously ask yourself, whether each phrase relates to your thesis statement.

If yes, does it help advance it forward? If the answers for these questions is no, you may have to rephrase, remove, or even re-research your facts to demonstrate a compelling understanding of the issue.

Need more essential tips to get your essay started? Use IvyPanda for all your academic needs!

Reason Why Marijuana Should Be Legal This is an important consideration since data on the prevalence of Marijuana indicates that the US is still the world’s largest single market for the drug.
Alcohol and Drugs Effects on High School Students According to Martin, “society also advertises the image of individual and social happiness for alcohol and drug users; this misconception results in the societal decrease of achievement, especially, of high school age students”.
Advantages and Disadvantages of Marijuana Countries including Netherlands, Israel and Canada have lenient laws regarding the use of marijuana, cases in point that proponents of its legalisation have used to highlight the merits of legalising it.
Legalizing Marijuana: Pros and Cons The focus of this paper will be on the impact of the legalization of the U.S.economy with possible positive and negative sides of the matter.
Legalization of Marijuana: Arguments For and Against It will therefore be difficult to regulate the use of marijuana among young people and other unauthorized people if it is legalized. It should be noted that marijuana has various negative effects to the health […]
How Does Marijuana Affect the Brain? One of the profound findings of the studies is on the negative effects of marijuana on the brain. Research findings on the brain show that abuse of marijuana for a long time affects the brain […]
Should Marijuana Be Legal? It is perhaps very essential to be acquainted with an account of laws that surround marijuana in order to understand the reasons why the drug ought to be legalized.
Marijuana and Its Effects on Mental Health The effects of the use of marijuana can be comparable to those exhibited by the removal of this important part of the brain.
Usage and Effects of Marijuana In the modern world, more and more countries are recognizing the role of cannabis in bringing benefits to the population. For the purposes of better understanding the drug and navigating the modern realities, it is […]
Political Opinion on Legalization of Marijuana On the other hand, the case introduces the man as a member of the Methodist Church, and this community is known for its strict opinion about marijuana as a gateway drug.
Discretion Powers Regarding Marijuana Laws Albeit, marijuana laws in New York are favorable for the users as marijuana was fully legalized in March of 2021, allowing for both medical and recreational use.
Marijuana as an Alternative Medication for Pain Relief The PICOT question for the identified health care issue is the following: in a patient population requiring pain relief, does marijuana represent a viable alternative medication as compared to opioid-based prescription drugs for alleviating the […]
Marijuana: Properties, Effects, and Regulation At the same time, a regulated cannabis industry slowly emerges, with companies attempting to profit off of the legalization and destigmatization of marijuana.
Preventing Negative Effects of Marijuana Use The aim of the study is to ascertain specific interventions that would allow reducing cannabis use within the framework of the environment where marijuana is legal.
Analysis of Arguments: Should Marijuana Be Legalized? Pro Arguments: The majority of Americans agree on the necessity to legalize marijuana. This initiative is accompanied by concerns regarding the actual use of marijuana.
Risks and Benefits of Medical Marijuana The use of marijuana in the medical sphere is a highly debated and discussed topic. Patients with epilepsy claim that the use of marijuana prevents seizures and provides immense relief.
Medical Marijuana: Issues & Ethical Considerations The use of medical marijuana in anxiety disorders and PTSD has many concerns. Prescribing medical cannabis can potentially benefit a patient but can cause additional health and legal issues.
The Benefits of Medical Marijuana This paper aims to discuss that medical marijuana is helpful in the treatment and management of chronic pain conditions such as cancer and epilepsy.
The Issue of Legalization of Marijuana The issue of the legalization of marijuana in the territory of the state is not unambiguous, therefore it is analyzed by a large number of specialists.
Synthetic Marijuana: Physiological and Social Factors The report generated by Drug and Alcohol Dependence article in the year 2010 showed that the majority of the people who used synthetic marijuana were between the ages of 12 to 29.
Cannabis or Marijuana for Medical Use In the West, for the first time, medical use became known thanks to the work of Professor O’Shaughnessy, who personally observed the process of her treatment in India.
Marijuana Research: Personal Connection and Medical Use In the United States, military marijuana is prohibited, but initially, it was used for recreation and as a form of medicine in the twentieth century.
Marijuana Possession in a High-School Student Case Her participation in the program will be an educational experience and put the juvenile offender in touch with professionals who can understand the motives of her behavior instead of giving Jane Doe an actual criminal […]
Marijuana Legitimization and Medical Controversy The proponents of the legitimization of marijuana for medical use argue that it has numerous medical uses. Currently, in the US, there is a rather peculiar situation with the legalization of marijuana for medical use.
Workplace Policy on Marijuana Use in Michigan The legalization and decriminalization of marijuana use in 23 states of the US lead to complicated issues when it comes to the consideration of workplace policies.
Law: Legislation Regarding Marijuana Farming To evaluate the applicability of the proposed marijuana farming bill, the current marihuana production legislation needs to be reviewed, and the changes in social norms regarding criminal behavior are to be analyzed.
Marijuana Legalization: Controversial Issue in Canada Canada became the second country in the world to legalize the cultivation and consumption of cannabis in 2018. Besides, the substance is addictive, and it is challenging to stop consuming it.
Marijuana: Myths and Legal Justification Over the past decades, much attention has been drawn to the question of the categorization of marijuana in terms of the national systematization of drugs controlled by the US Drug Enforcement Administration.
Marijuana Legalization and Issues to Consider If marijuana is fully legalized, there might be a rise in use among youth, which is dangerous from the physiological point of view, and there will be no legal justification to end it.
Hip-Hop and Marijuana Use in College Students It has been estimated that over half of the college student population regularly use marijuana, while over 25% used it during past month.
Marijuana Use among American and Bolivian Students The study is a perfect example of the use of theory in a research. As such, it is possible for college students in Bolivia to have a similar deviant behavior, which in this case is […]
The Relationships Between Marijuana and the Legal System The most common ideas discussed within a framework of this debate are connected to the issues of permission to keep marijuana at home for personal needs such as medical needs, and a total ban on […]
Should Marijuana Be a Medical Option? Medical marijuana is used to refer to the use of marijuana as a physician-recommended form of medication in its natural or synthetic form.
Use of Marijuana for the Medicinal Purposes It is therefore quite evident that even though the marijuana legalization will go hand in hand with a set minimum age within which individuals will be allowed to use it, at the long run the […]
The Medicinal Value of the Marijuana: There Are Potential Benefits to a Patient Other Than Risks This article provides an insight to the effects of chemotherapy treatment to the body of the cancer victims. It defines the drug in a lengthy way including what the drug is, the effects of taking […]

💡 Interesting Cannabis Topics to Write about

Pros and Cons of Legalization of Medical Marijuana It is evident that medical treatment with the use of marijuana would be beneficial for both: patients and the government because of the opportunity to earn on taxation.
Legalization of Recreational Use of Marijuana The role of the Supreme Court in the specified case boils down to stating the conditions, in which the prescription and the following use of marijuana by the patient, can be deemed as legitimate.
The Chances of a Successful Appeal by a Marijuana Convict The Superior Court ruled that the Fourth Amendment rights of the defendant were violated; a decision that was upheld by the Court of Appeal.
Marijuana Legalization: Chronic Seizure Treatment With that said, despite numerous states already having legalized one or both applications, the federal government remains opposed to either form of legalization, and marijuana possession and use remain federal offenses.
Adverse Effects of Marijuana Use This paper aims to provide an analysis of the article that gives a perspective on the adverse health effects and harm related to marijuana use. Thus, the academic article on the adverse effects of marijuana […]
“Adverse Health Effects of Marijuana Use” by Volkow et al. Based on national marijuana studies and DSM-IV, the researchers conclude that addiction to marijuana is a non-debatable statement and that starting marijuana use in adolescence doubles or even quadruples the risks of cannabis use disorder.
Marijuana Use May Double the Risk of Accidents for Drivers According to the Department of Safety and Homeland Security, the number of Americans driving under the influence of illegal substances has risen drastically. The risk of a crash is also related to the number of […]
Legalized Marijuana: Negative and Positive Sides The economy and finance from the very beginning were anticipating that this law will bring the largest income to the state’s budget and create plenty of job opportunities under the rule of law.
Marijuana: Legislative History and Future The focus of the legislation in many states is to end the illegal sale of cannabis and monetize it for tax purposes and so that distribution can be controlled.
Ethical Perspective of the Legalization of Marijuana In spite of a popular view of the medical benefits of marijuana, doctors insist that the use of marijuana provides the same dangerous effect as other drugs.
Marijuana Legalize: Advanatages and Disadvantages The truth that marijuana is illegal and prohibited is suitably caused by the number of funds invested in the war against drugs.
Arguments for Banning the Legalization of Marijuana Marijuana is a dangerous drug that should not be legalized even if it is in the context of it containing the medicinal value.
Federalism and Medical Marijuana Needless to say, United States faced political and social challenges as well, and the disputes over federalism and over the legal use of marijuana in medicine are still the most burning and controversial issues in […]
The Effects of Marijuana on the Body, Mind and Brain Cells A drug is a substance that changes the bodily function of a body when consumed, there are several definitions of the word drug but it is believed that the most important function of a drug […]
College Students in UK and Marijuana The reasons for the punishments are very different but the result remains the same: marijuana is still used by the majority of students and is available for everyone.
Decriminalizing Marijuana for Medicinal Use Because of inconsistent and problematical data, it is impracticable to access quantitatively to what extent that drugs encourage the incidence of crime.
Psychological Effects of Marijuana Some people experience panic reactions, which tend to be temporary and often are triggered by a feeling of not being in control Marijuana’s psychological effects include a sense of euphoria or well-being, relaxation, altered time […]
Logical Benefits of Legalizing Marijuana This will be a source of revenue to the government; when the revenues increase, it means that gross domestic product for the country increases. It will be a source of income not only to the […]
Social Effects of Marijuana Research has shown that the use of marijuana affects the smoker’s day-to-day lifestyle in relation to society, the environment, and day-to-day activities.
Federal vs. State Law: Medical Marijuana in the US The main problem is that these laws and regulations have not reduced the number of people who use marijuana for medical purposes.
Medical Marijuana: Pros of Legalizing It must be admitted that at the time of the passage of these laws, histories from some, but not all, heroin users indicated that the use of marijuana had preceded the use of heroin.
Marijuana: To Legalize or Not to Legalize? Marijuana, which is also known under dozens of nicknames such as weed or pot, is now the most widespread illegal drug across the US. Moreover, the vast majority of marijuana abusers claim pot to be […]
Marijuana Legalization and Consumption Among Youth The most popular excuse among drug consumers is the instrumental use of the drug. As long as the drug influence is undermined, the number of college students willing to experience the marijuana effects will be […]
Legalization of Medical Marijuana: Help or Harm? Nowadays, a majority of people worldwide support the legalization of marijuana, and it is possible to predict that this support will keep getting stronger in the future.
Medical Marijuana Legalization Concerns This change raises political concerns and requires the government to review its economy to adapt to the use of MM. The representation of the legal process highlighted the history of previous legislations and reported on […]
Medical Marijuana: Legal and Research Concerns However, while the purpose of recreational marijuana is often disconnected from its long-term effects on people’s health in scholarly discussions, the use of medical marijuana is viewed from the point of patient’s health and the […]
Medical Marijuana in the Army: Addressing a Problematic Issue Denying the use of medicinal marijuana as one of the fastest and the most efficient ways of relieving pain in the military setting, one will inevitably infringe upon the rights of American troops.
Should Marijuana Be Legalized? Marijuana legalization is a topic of social trends and beliefs that are based not only on health but political and economic factors as well.
Marijuana Legalization and Its Benefits for Society The example of several states that have already introduced the appropriate law provides the ground for vigorous debates about the absence of the expected deterioration of the situation and emergence of multiple problems associated with […]
Marijuana Legalization in 5 Policy Frameworks The legalization of marijuana is still one of the debatable issues at the federal and state levels. For instance, the use of marijuana is prohibited at the federal level while the recreational and medical use […]
Marijuana Legalization in California The muscle relaxation effect of marijuana also appears to be a positive effect that should be used to argue for its legalization.
Legalization of Marijuana in the United States It should not be forgotten that it is a cause of numerous tragedies. Also, some studies show that the use of marijuana is especially dangerous for young people.
Medical Marijuana Legalization by National Football League However, it must be realized that some of these players are usually in excruciating pain to the point that some may have lost consciousness.
Marijuana: Users, Desired Effects and Consequences The frequent users consist of youths and adults who have abused Marijuana to the extent they have become dependent on it.
Effects of Marijuana on Memory of Long-Term Users The pivotal aim of the proposed study is to evaluate the impact of marijuana use on long-term memory of respondents. The adverse impact of marijuana after the abstinent syndrome refers to significant changes in prefrontal […]
Trends in the Use of Marijuana The researchers claim that the legalization of marijuana in California led to the development of the acceptance of marijuana use as well as the increase in this drug consumption.
Medical Marijuana Legalization Rebuttal The claim of fact is that A.C.A.continues to be beneficial despite the arguments of Republican politicians and current challenges. The claim of policy is the appeal to Republicans and Democrats to work together on the […]
Marijuana Legislation and Americans’ Contribution To identify whether patients with intractable pain hold more favorable views regarding legislation of marijuana use than the general public, it is necessary to determine various inclusion and exclusion criteria that might influence the society’s […]
Medical Marijuana Policy and Framing Approach This is a clear indication that different arguments can be presented by these actors to support the legalization and use of medical marijuana.
Policy Analysis: Rules for Growing Medical Marijuana Overall, the main goal of the document is to address the health needs of people requiring marijuana to relieve the manifestations of their illness as well as the implications of growing marijuana for medical purposes.
Marijuana Crime in California State and Federal Courts To compare the severity of the punishment that could be imposed by a federal court to what was announced at a state institution, it should be remembered that the investigation process would not take long […]
Legal Marijuana Market Analysis and Taxes Impact Consequently, the primary goal of this paper is to understand the impact of taxes on the financial stability of the market for legal marijuana with the help of the law of supply and demand and […]
Controversy Around Medical Marijuana Legalization The consideration of the problem of marijuana legalization from the perspective of public safety involves such points as crime rates and traffic accidents. The fact of economic benefits of the Cannabis legalization is also apparent: […]
The Legalization of Marijuana: Regulation and Practice It is imperative to note that legalization of marijuana is a topic that has been quite controversial and has led to numerous discussions and disagreements.
Marijuana History, Medical Purposes and Threats Although many people believe that marijuana is harmless and the access to it should be unlimited, it has a number of negative health effects and might lead to addiction.
Marijuana Use and Serious Mental Illnesses 21% of the respondents of 18 years and above claimed to have used marijuana for the first time prior to their 12th birthday.
Marijuana as an Unjustifiable Pain Reliever The debate on whether to legalize the use of marijuana has been there for the last 20 years. In addition to this, it causes panic and anxiety hence causing the user to hallucinate.
The Safety of Using Medicinal Marijuana for Pain Relief Speaking about the introduction section of the study, it is important to note that it is rather short if compared to other parts of the article as the researchers were paying more attention to presenting […]
Should Marijuana Be Treated Like Alcohol? Considering the benefits that would accompany the legalization of marijuana and its treatment like alcohol, I strongly agree with Buckley’s comparison; marijuana should be treated like alcohol. First, the use of marijuana affects the body […]
Political Issues of Marijuana in America The largest demographic groups against the legalization of marijuana include the Republicans and the southerners. Most of the Democrats continue to support the legalization of marijuana in the country.
Changes in Laws of Marijuana Regulation In addition, the study intends to uncover the impacts of the said laws and the accompanying changes. The case studies will be compared to assess the impacts of legislations on marijuana in the society.
Concepts of Legalizing Marijuana Although in most cases, most individuals associate Marijuana with numerous health complications and social problems, for example, brain damage, and violent behavior hence, supporting its illegalization, such individuals take little consideration of its significance in […]
Marijuana Legalization in Illinois The case for legalization of marijuana in Colorado evidences the need to alter federal laws prohibiting marijuana for its legalization law to have both statutory and federal backing in the state of Illinois.
Public Safety and Marijuana Legalization Some of the states have failed to tax marijuana. Hence, it is difficult to get the precise figures in terms of tax values that states could collect from marijuana.
Heroin and Marijuana Abuse and Treatment The success in the process of drug addiction treatment is only possible when the patient is willing to co-operate and has a desire to recover and defeat the habit.
The Marijuana Usage Legislation This research paper is aimed at discussing the effects that can be produced by the changes in the legislation on the use, storage, and distribution of marihuana.
Medical Marijuana Program in California The physicians should also do a periodic review of the treatment and how the patients respond to the medical marijuana. The medical marijuana is only restricted to patients who are qualified and recommended by a […]
History and Effects of Legalization of Marijuana As predicted, the legalization of marijuana in several states has led to an increase of marijuana abuse among youngsters Studies have shown a pattern of the use of cannabis and risky behavior of the individuals.
Debates Around Legalization of Medical Marijuana The supporters and opponents of the legalization of marijuana have opted to focus on either the positive or the negative aspects of the effects of the drug to support their views on policies to legalize […]
Federal Drug Laws vs. State Medical Marijuana Acts A senate bill for the case of Los angeles is on the process of considering the use of marijuana for medical purpose.
The Use of Marijuana and Its Benefits Criminalization of the use of marijuana and negative reviews as well as negative exposure from the media has driven marijuana use to the black markets with often negative consequences to the economy and society.
Medical Marijuana use for Terminal Colon Cancer The author hopes to use this paper to highlight the uses of marijuana in management of colon cancer at its terminal stage.
How New York Would Benefit From Legalized Medical Marijuana The arrests resulting from possession of marijuana in New York is quite huge compared to those in California and New Jersey states in America.
Should Be It Legal to Sell the Marijuana in the United States? What I want to know is the reasons of why so many people use such serious psychoactive drug as marijuana of their own accord and do not want to pay special attention to their activities […]
Supporting of Marijuana Legalization Among the Adult Population Proponents argue that legalization of marijuana will lead to increased revenues for the government amid economic challenges. Legalizing marijuana will not lead to cancer and deaths but will spark the debate for apparent effects of […]
Marijuana: The Issues of Legalization in the USA To understand all the possible effects of the marijuana legalization, it is necessary to pay attention to the definition and classification of the drug with references to determining the most important social and legal aspects […]
Reasons for Legalization of Marijuana The legalization of the drug would bring to an end the discrimination of the African Americans in marijuana-related arrests, reduce the sales of the drug and its use among teenagers, encourage the development of hemp […]
Legalizing Marijuana: Arguments and Counter-Arguments On the other hand, many groups have outlined that the legalization of marijuana would lead to an increase in the rate of crime in addition to opening up of the gateway to the abuse of […]
Drug use and misuse in western society: Effects of chronic marijuana use among young women and girls It is also based on the fears of the impacts of the drug use, concerns over the reduced productivity that’s likely to cause harm to the user and the society and so on.
Medical Marijuana Policy in the United States The importance of legalization of medical marijuana is that, the government will be able to monitor and control marijuana in the country.
The Arguments For and Against Marijuana Decriminalization The production, preparation, trade and use of marijuana has been prohibited in most parts of the world and a lot of resources are used every year to combat it.
The Illegal Use of Marijuana Canada is among the leading nations in the percentage use of illegal marijuana as stated in the World Drug Report of the year 2007.
Marijuana and Its Economic Value in the USA The grim reality of the economic performance of the United States of America lies in the lengthy debate over the legalization of marijuana.
Should We Legalize Marijuana For Medical Use? In addition to that, the use of Marijuana especially by smoking either for medical reasons or to heal ailments, is a social activity that will help bring them together and improve their social ties.
Why Marijuana Should Be Legalized? The government should save that money it uses in prohibiting the use of marijuana as it has no proved harm to the users.
Arguments on Why Marijuana Should Be Illegalized The greater part of the population believes that the sustained use of this product is beneficial in numerous ways. Therefore, it is clear that the negative effects of the drug outdo the constructive ones.
A Case for Legalizing Marijuana Marijuana is one of the drugs that the government policy targets and as it currently stands, the government uses a lot of resources in prosecuting and punishing marijuana consumers through the legal system.
The Marijuana Industry and Its Benefits Marijuana use also slows down the growth of cancerous tumors in the brain, lungs, and breasts; thus, it is valuable in the management of cancer.
The Decriminalization of Marijuana One of the main reasons that the supporters of this argument have progressed is that by decriminalization of marijuana, the government would save huge amounts of money that it uses on enforcing laws that relate […]
The Use of Marijuana in California The US government ensures that its use is limited to a minimum by enforcing harsh punishments to the dealers and users of marijuana.
Federal Government Should Not Legalize the Use of Marijuana On the other hand the use of marijuana actually increased in the country. It is not only the DEA or the federal government that is reluctant in the legalization of marijuana.
Issues with Marijuana Legalization in the United States This is the reason why the debate on the legalization of marijuana has been on the increase since the past 10 years.
The history of marijuana According to the new set of legislation, it was considered illegal to be found in possession of 25 grams of marijuana.
Does Legalizing Marijuana Help or Harm the United States? The latter measure is not merely being advocated by the proponents of marijuana use since the legalization of marijuana has been supported by NAACP not because it fully backs the smoking of marijuana.
Marijuana, Heroin and Prescription Opiate Abuse and How Are They Related to the Society The core issues mentioned in the article revolves around addiction and abuse of opioid agents as well as its relation to the use of heroin and marijuana.
Increasing Marijuana Use in High School The author’s concerns in the article are that the usage of marijuana is becoming prevalent among the American youth. It is evident that the author is against the publication and marketing of the medical marijuana […]
The Union: The Business Behind Getting High by Brett Harvey Some other reasons advanced by the documentary include the ability of the government to control the sale of such drugs to minors and also collection of tax revenue. The documentary espouses a number of reasons […]
The Debates on the Legal Status of Marijuana This means that the use of marijuana encourages the consumption of other drugs such as alcohol and cigarettes. Additionally, the use of marijuana is associated with increase in crime and consumption of other illicit drugs.
Marijuana Is a Healthier Alternative to Cigarettes Cigarette smoking has also been reported to cause respiratory infections due to the damage caused in the cells that prevent entry of microorganisms into the respiratory system hence reducing the immunity of the system.
Marijuana’s Negative Effects and Advantages Marijuana is the most commonly abused drug among the youths and adults in the United States and other countries in the world.
Use of Marijuana and Its Consequences The plant was grown in the United States of America for agricultural purposes during the colonial period up to the beginning of the 20th century.
Should Marijuana Drugs Be Decriminalized? The production, preparation, trade and use of marijuana has been prohibited in most parts of the world and a lot of resources are used every year to combat it. Thus, decriminalization of marijuana is likely […]
Argument About Legalizing Marijuana in America Therefore, if at all the government of the United States is to prohibit the use of marijuana in the country, it should be ready to cater for the high costs that come in hand with […]
Marijuana’s Positive and Negative Effects The main aim of creating these institutions is to evaluate the impact and the effects of marijuana on the abusers and on the environment.
Limited and Controlled Use of Marijuana The question of legalizing marijuana refers to the legal use of marijuana both in private and public places for medical use or otherwise.
The Moral and Ethical Reasons Why Marijuana should be legal It is my humble opinion that the billions of dollars being spent on the war against marijuana should be diverted to more useful projects like feeding the less fortunate in the society.
The Problem of Legalization of Marijuana and Hemp Many individuals tend to believe that the use of Marijuana is morally wrong as it alters the mental state of the user and leads to dangerous addictions and actions in the end.
Minor and Major Arguments on Legalization of Marijuana Premises 1: If marijuana were to be legalized it would be impossible to regulate its’ sell to, and use by the minors. Making marijuana illegal is denying them a right to the use of this […]
The Reasons Why Marijuana Should be Made Legal Among the reasons that support the legalization of marijuana include: the medical basis that marijuana has some benefits and that the state could gain revenue from the trade of marijuana as opposed to the costs […]
Why Is Marijuana Legalized In Some States And Not Others? I consider the legalization of marijuana to be a positive step as its prohibition entails intrusion of personal freedom and just like any other substance it is only harmful when it is not taken in […]
Marijuana Legalization and Crime Rates The possible outcome of this effort will be the safe consumption of the drug, easy monitoring, and creation of awareness to the public on the dangers of excessive use of the drug and lastly the […]
The Effect of Legalization of marijuana in the Economy of California It has been predicted that if the government legalizes the drug, there will be a lot of changes pertaining to the demand for the drug in the market and as a result, there will be […]
Marijuana Must Not Be Legalized According to the national institute of drug abuse, the active chemical in marijuana, tetrahydrocannabinol, act on the region of the brain responsible for time awareness, sensory, attention, thoughts, memory and pleasure.
Decriminalization of Marijuana The decriminalization of marijuana resulted due to public outcry over the effects of marijuana. Among the disadvantages include the saving of money and time for other businesses, promotion of the judicial justice as the centre […]
Policy Brief: Why Marijuana Use Should Be Legalized in the Us In this perspective, it is valid to argue that marijuana users may be undergoing long incarcerations in US jails due to the misconceived fantasies that took root in the public mind in the 1930’s, and […]
Medical Uses of Marijuana The feelings of hallucination make one to lose consciousness and feel as though in very different world that is full of bliss.
Should Marijuana Be Legalized in Canada?
Drug Testing and Legalization of Marijuana
Has the Time Come to Legalize Marijuana?
Framing the User: Social Constructions of Marijuana Users
Drugs and Legalization Drug Marijuana Dealing
Decriminalization and Marijuana Smoking Prevalence
Has Marijuana Become More Accepted in Today’s Culture?
Get Ready for Americas Fastest-Growing Industry: Marijuana
Clearing the Smoke Between Cigarettes and Marijuana
Key Findings and Decriminalization of Marijuana
Facts That Most People Don’t Know About Marijuana
Issues Hampering the Legalization of Marijuana
Economical Argument for the Legalization of Marijuana
Juvenile Smoking and Marijuana Use
All the Reasons Why Marijuana Should Be Legalized for Medical Purposes
Exploring the Effects and After Effects of Marijuana
Factors That Influences Teenagers to Use Marijuana
College Students Attitude Toward Marijuana Use on Campus
Drugs Case for Legalizing Marijuana
Logical Reasoning for the Legalization Marijuana
Future Trends and Marijuana for Medicinal Purposes
Countering Anti-Medical Marijuana Efforts in Massachusetts
Abnormal Psychology Problem: Excessive Use of Marijuana and Alcohol
Food and Drug Administration Bans Use of Marijuana in the US
Addiction and Smoking Marijuana Plays
Analyzing Affordable Care Act and Marijuana
Driving Under the Influence of Marijuana is Hazardous
America Requirements Medicinal Weed: Marijuana Legalization
Comparing and Contrasting Marijuana and Alcohol
Many People Believe That Marijuana Should Be Legalized
How Media Framing Effects Marijuana Prohibition and Legalization?
How Can Legalize Marijuana Help the United States?
How Does Military Jurisdiction Deal with Marijuana Now Would Legalization?
How America Will Benefit from Legal Marijuana?
How Legalizing Marijuana Will Impact Society?
Does Marijuana Cause Brain Damage?
How Marijuana Will Not Work in the US?
Does Marijuana Have Any Medicinal Uses?
How Many Individuals Smoke Marijuana in the United States?
Does Previous Marijuana Use Increase the Use of Other Drugs?
How Medical Marijuana Works?
How the Social Contract Theory Prevents the Legalization of Marijuana?
How Marijuana Affects Hauora?
Why Do Americans Enjoy Marijuana?
What are the Positive and Negative Effects of Legalizing Marijuana?
What are the Benefits and Drawbacks of Legalising Marijuana?
Does Legalizing Marijuana Make Sense?
What Are the Medical Causes and Effects of Marijuana Use?
How Are Employers Coping with Medical Marijuana Legislation?
Does Marijuana Work the Treatment of Diseases?
Does Marijuana Have Medicinal Purposes?
How Does Marijuana Law Work in District of Columbia Class?
Does Increasing the Beer Tax Reduce Marijuana Consumption?
How Legalizing Marijuana Could Help Boost the Economy?
Does Marijuana Have More Harmful or More Beneficial Effects?
How Will Marijuana Legalization Affect Public Health?
Does Marijuana Use Impair Human Capital Formation?
How Gender and Age Effects Marijuana Usage and Brain Function?
How Marijuana Affects Our Society?
How American Children Start to Smoke Marijuana and Why?
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IvyPanda . "211 Marijuana Essay Topics & Examples." February 29, 2024. https://ivypanda.com/essays/topic/marijuana-essay-examples/.

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Managing Substance Use Disorders
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Treatment of Substance Use Disorders

Millions of Americans have a substance use disorder (SUD), and it remains an important health issue in our country.
In 2022, more than one in six Americans aged 12 or older reported experiencing a SUD.
With effective treatment, recovery is possible for everyone. There is strength in getting help.

What is an SUD?

A substance use disorder (SUD) is a treatable, chronic disease characterized by a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. 1 In 2022, more than one in six Americans aged 12 or older reported experiencing a SUD. 2

SUDs can lead to significant problems in all aspects of a person's life. Patterns of symptoms resulting from substance use (drugs or alcohol) can help a doctor diagnose a person with a SUD or SUDs and connect them to appropriate treatment.

For certain drug types, some symptoms are less prominent, and in some cases, not all symptoms apply. For example, withdrawal symptoms are not specified for inhalant use.

SUDs can range in severity from mild to severe and can affect people of any race, gender, income level, or social class. A SUD can be applied to the following types of drugs: 1

Hallucinogens
Opioids (Prescription and Illegal)
Sedatives, hypnotics, or anxiolytics
Stimulants and Psychostimulants
Tobacco (nicotine)
Other (unknown) substance

Treatment and recovery options

Addiction is a disease, not a character flaw. People experiencing SUDs have trouble controlling their drug use even though they know drugs are harmful.

Overcoming an SUD is not as simple as resisting the temptation to take drugs. Recovery may involve medication to help with cravings and withdrawal as well as different forms of therapy. It may even require checking into a rehabilitation facility.

Addiction is a treatable disease

Like many other chronic conditions, treatment is available for substance use disorders. While no single treatment method is right for everyone, recovery is possible, and help is available for patients with SUDs.

Evidence-based guidelines can assist doctors with choosing the right treatment options. These guidelines help evaluate a patient's clinical needs and situation to match them with the right level of care, in the most appropriate available setting. For more information on evidence-based guidelines visit Addiction Medicine Primer .

Recovery options

There are safe and effective ways to recover from SUDs. Finding the right treatment option can be the key to a successful recovery journey.

Outpatient counseling

Helps people understand addiction, their triggers, and their reasons for using drugs. This form of treatment can be done at a doctor’s office or via telehealth appointment.

Inpatient rehabilitation

A full-time facility provides a supportive environment to help people recover without distractions or temptations.

Behavioral health care

Trained providers who help with mental health concerns.

Medications for opioid use disorder (MOUD)

Specific conditions like opioid use disorder may require medication as the first course of treatment. MOUD can help with cravings and withdrawal symptoms. 3 MOUD is effective in helping people reduce illegal opioid use, stay in treatment longer, and reduce the risk of opioid-involved overdose. 4

MOUD medications approved by the Food and Drug Administration (FDA):

Buprenorphine

Research has demonstrated that MOUD is effective in helping people recover from their OUD. 5 6 7 It is important to find what works best each individual.

Resource‎

Reducing stigma is important, addiction can happen to anyone.

SUD is a treatable, chronic disease that can affect people of any race, gender, income level, or social class. No one driving factor leads to SUD. Some people may use drugs to help cope with stress and trauma or to help with mental health issues. Some may develop a SUD after taking opioids that are prescribed to them by doctors. In any case, using drugs over time may cause changes in a person's brain, leading to intense cravings and continued use. 8

Some may view acknowledging and receiving treatment for an SUD as a sign of personal failure and weakness. The associated shame felt by patients and families can make it difficult to seek treatment. Finding a doctor who is comfortable discussing SUDs can help ensure long-term recovery.

Find treatment services

Use these resources to find services that fit your needs:

Mental Health and Addiction Insurance Help (HHS)

Health Center Locator (HRSA)

Behavioral Health Treatment Services (SAMHSA)

Opioid Treatment Program Directory by State (SAMHSA)

Buprenorphine Providers Locator (SAMHSA)

Learn more about recovery

SAMHSA Behavioral Health Treatment Services Locator

Photo collage of Tele, David, Tessa, and Britton with text "If you're struggling with prescription opioids, there is hope. Recovery is possible."

Rx Awareness: Real Stories

Photo of Britton with his quote, "Recovery is amazing - you get to a place where you're proud of yourself again."

Recovery is Possible: Know the Options

What You Need to Know About Treatment and Recovery

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Opioid Therapy and Different Types of Pain

Addiction Medicine Toolkit

Medication-Assisted Treatment (MAT) | SAMHSA

Decisions in Recovery: Treatment for Opioid Use Disorder

Stigma Reduction

Addiction Treatment Locator, Assessment, and Standards (ATLAS) Platform

A clinician writes on a notepad while meeting with a patient in an open clinic setting.

Linking People with Opioid Use Disorder to Medication Treatment

Working Together With Your Doctor to Manage Your Pain

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
Substance Abuse and Mental Health Services Administration. (2023). Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report
SAMHSA. 2022, March 22. Medications, Counseling, and Related Conditions. Retrieved from https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions
TIP 63: Medications for Opioid Use Disorder - Full Document | SAMHSA
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2014;(6): CD002207. https://doi.org/10.1002/14651858.CD002207.pub4  PMID:24500948
Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev 2009;(3): CD002209. https://doi.org/10.1002/14651858.CD002209.pub2  PMID:19588333
Fullerton CA, Kim M, Thomas CP, et al. Medication-assisted treatment with methadone: assessing the evidence. Psychiatr Serv 2014;65: 146–57. https://doi.org/10.1176/appi.ps.201300235  PMID:24248468
https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction

Overdose Prevention

Overdose prevention is a CDC priority that impacts families and communities. Drug overdose is a leading cause of preventable death in the U.S.

For Everyone

Health care providers, public health.

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40 Drug Abuse & Addiction Research Paper Topics
Drug abuse and Medicine. The obvious topic for a medical research paper. The impact of drugs on the human body, the changes in its physiology and the nature of addiction are well studied also, but, unfortunately, the drugs evolve along with the science, so the new synthetic drugs that are sometimes considered harmless "energy club pills" emerge almost every year.
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Fentanyl - Drug Profile and Specific and Drug Abuse. The drug has the effect of depressing the respiratory center, constricting the pupils, as well as depressing the cough reflex. The remainder 75% of fentanyl is swallowed and absorbed in G-tract. Cases of Drug Abuse Amongst Nursing Professionals.
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Use some of the questions below to help you narrow this broad topic. See "substance abuse" in our Developing Research Questions guide for an example of research questions on a focused study of drug abuse.. In what ways is drug abuse a serious problem?
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Research Topics. En español. The National Institute on Drug Abuse (NIDA) is the largest supporter of the world's research on substance use and addiction. Part of the National Institutes of Health, NIDA conducts and supports biomedical research to advance the science on substance use and addiction and improve individual and public health.
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The numbers for substance use disorders are large, and we need to pay attention to them. Data from the 2018 National Survey on Drug Use and Health suggest that, over the preceding year, 20.3 million people age 12 or older had substance use disorders, and 14.8 million of these cases were attributed to alcohol.When considering other substances, the report estimated that 4.4 million individuals ...
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85 percent of the world's research on drug abuse and addiction. Other sponsoring agencies include the National Institute of Mental Health (NIMH), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Substance Abuse and Mental Health Services Administration (SAMHSA), all in the Department of Health and Human Services; as well as the Office of Justice Programs (OJP) in the ...
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Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will.
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These research queries and findings are presented in the form of updates, white papers and case studies. In addition, the Butler Center for Research collaborates with the Recovery Advocacy team to study special-focus addiction research topics, summarized in monthly Emerging Drug Trends reports. Altogether, these studies provide the latest in ...
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Research papers and essays on drug topics address sociology, pharmacology, medicine, psychology, statistics, history, and criminology issues. Drug abuse is a serious problem in modern society. It's a serious issue that different countries are trying to combat. As such, educators ask learners to write academic papers and essays on drug abuse ...
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Treatment of Substance Use Disorders
SUD is a treatable, chronic disease that can affect people of any race, gender, income level, or social class. No one driving factor leads to SUD. Some people may use drugs to help cope with stress and trauma or to help with mental health issues. Some may develop a SUD after taking opioids that are prescribed to them by doctors.

40 Drug Abuse & Addiction Research Paper Topics

Drug Abuse and Sociology

Drug Abuse, Addiction, Substance Use Disorder

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140 Drug Abuse Essay Topics & Project Topics on Drug Abuse

🏆 Best Project Topics on Drug Abuse

Florence Jaguga

Sarah Kanana Kiburi

Eunice Temet

Julius Barasa

Serah Karanja

Lizz Kinyua

Edith Kamaru Kwobah

Systematic review registration

Introduction

Materials and methods

Search strategy

Study selection

Inclusion criteria

Exclusion criteria

Data extraction

Data synthesis

Quality assessment of the studies

Search results

General characteristics of the studies

Quality assessment

Studies examining the epidemiology of substance use or SUD

Epidemiology of alcohol use

Epidemiology of tobacco use

Epidemiology of khat use

Epidemiology of cannabis use

Epidemiology of opioid and cocaine use

Epidemiology of IDU

Epidemiology of other substance use (sedatives, inhalants, hallucinogens and prescription medication, emerging drugs, ecstasy)

Other topics explored by the epidemiology studies

Studies evaluating substance use or SUD programs and interventions

Individual-level interventions

Population-level interventions

Studies qualitatively exploring various substance use or SUD topics (other than interventions)

Injecting drug use and heroin use

Alcohol use

Youth and adolescent substance use

Other topics

Epidemiology of substance use or SUD

Interventions and programs

Qualitative studies

Limitations

Supporting information

Data Availability

Decision Letter 0

Author response to Decision Letter 0

Decision Letter 1

Acceptance letter

Pathways of Addiction: Opportunities in Drug Abuse Research (1996)

MAJOR ACHIEVEMENTS IN DRUG ABUSE RESEARCH

VOCABULARY OF DRUG ABUSE

DEFINITIONS AND BASIC CONCEPTS

IMPORTANCE OF DRUG ABUSE RESEARCH

THE CONTEXT OF DRUG ABUSE RESEARCH

Stable Funding

Adoption of a Comprehensive Public Health Framework

Acceptance of a Medical Model of Drug Dependence

Better Translation of Research Findings into Practice and Policy

Raising the Status of Drug Abuse Research

Increasing Interdisciplinary Research

INVESTING WISELY IN DRUG ABUSE RESEARCH

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