“Can We Break Through the Identity Dilemma?”: The Multiple Governance, Identities Conflict, and Self-Managements for Chinese PWUD.

Background: Exploring why the national drug policy failed is an important issue. Based on it, this study considers both the drug governance system and the voice of people who use drugs (PWUD) to analysis drug policy effects and the lives of PWUD in the Chinese context. Methods: This study takes PWUD living in urban communities as the research participants. Using qualitative research data, exploring how individual using drug experiences are identified and classified by structural forces and how individuals manage their daily life. Results: The study finds that law enforcement agencies (Narcotics Control Office (NCO), Police Station , and Community Assistance Group (CAG)) have different attitudes toward PWUD and generate different managements, forming multiple governance models, and then shaping the multiple identity dilemma. PWUD perceive the dilemma, and they adopt the strategies of spatial isolation (hidden flow), disconnection from experience (temporal isolation), and instrumental cooperation to continuously re-adjust and achieve identity recovery from the bottom-up. Conclusion/importance: Through evaluating the effectiveness of self-management strategies, this research integrates the Chinese drug rehabilitation situation, expands the specific performance of law enforcement system, and presents the limitations and positive value of self-management strategies.

Opioid availability statistics from the International Narcotics Control Board do not reflect the medical use of opioids: comparison with sales data from Scandinavia

Objectives Opioid analgesics are essential in clinical practice, but their excessive use is associated with addiction risk. Increases in opioid prescription rates have fuelled an epidemic of opioid addiction in the USA, making statistics on medical opioid use a critical warning signal. A dramatic 150% increase in Swedish opioid access 2001–2013 was recently reported based on data from the International Narcotics Control Board (INCB; Berterame et al. 2016) in conflict with other studies of opioid use in the Nordic countries. This article aims to analyse to what degree published INCB statistics on opioids in Scandinavia (Denmark, Norway and Sweden) reflect actual medical use and study the methodological reasons for putative discrepancies. Methods Data on aggregated total national sales of opioids for the whole population, including hospitals, were collected from the Swedish e-Health Authority. Total sales data for Denmark and drugs dispensed at pharmacies in Norway are publicly available through the relevant authorities’ websites. Results INCB opioid statistics during the period 2001–2013 were markedly inconsistent with sales data from Scandinavia, calling the reliability of INCB data into question. INCB-data were flawed by (a) over-representing the volume of fentanyl, (b) under-reporting of codeine, and (c) by not including tramadol. Conclusions Opioid availability, as expressed by INCB statistics, does not reflect medical opioid use. It is crucial to underline that INCB statistics are based on the manual compilation of national production, import and export data from manufacturers and drug companies. This is not the same amount that is prescribed and consumed within the health care system. Moreover, there are methodological problems in the INCB reports, in particular concerning fentanyl, codeine and tramadol. We suggest that INCB should carefully review the quality of their data on medical opioids.