Fiona Measham’s research while affiliated with University of Liverpool and other places

This paper explores the relationship between socio-demographic characteristics, self-reported alkyl nitrite (‘poppers’) use and sexual behaviours against a backdrop of UK policy change and ambiguity surrounding legal status. In 2024, the Advisory Council on the Misuse of Drugs recommended a unique, government-initiated, legal exemption from the Psychoactive Substances Act 2016 for poppers, because of its use by gay and bisexual men to reduce the risk of injury during anal sexual intercourse. Data from the annual convenience sample English Festival Study 2014–23 (n = 11,566) were used for Bayesian regression analyses of self-reported poppers use in three-time frames: lifetime, past year and past month use. Gay men were significantly more likely to report poppers use and particularly those reporting past-year participation in anal sex. Providing a critical analysis of recent trends in UK drug policy, the authors highlight how differential discrimination occurs within drug control where targeted exemption meets the politics of protected characteristics in UK law. This paper argues that poppers, therefore, provide a unique example in UK drug policy of how an apparent liberalization of legislative control could bolster the overarching drug prohibition regime while maintaining the appearance of rationality and fairness.

Background Drug checking services (DCS) provide harm reduction support and advice to individuals based on chemical analysis of submitted substances of concern. Whilst there are currently no DCS in Scotland, community-based services are being planned in three cities. Methods In this paper, we report qualitative findings based on interviews with 43 participants, focused on perceptions of DCS and their implementation. Participants were relevant professionals, those with experience of drug use, and family members of those with experience of drug use. The Consolidated Framework for Implementation Research (CFIR) was used to inform data collection and analysis. We report findings under nine constructs/themes across the five CFIR domains. Results Participants noted the importance of DCS being implemented in low-threshold, trusted services with a harm reduction ethos, and outlined a range of further service design considerations such as speed of testing, and information provided through the analysis process. In relation to the ‘inner setting’, a key finding related to the potential value of leveraging existing resources in order to expand both reach and effectiveness of drug trend communication. The approach of local and national police to DCS, and the attitudes of the public and local community, were described as important external factors which could influence the success (or otherwise) of implementation. Bringing together a range of stakeholders in dialogue and developing tailored communication strategies were seen as ways to build support for DCS. Overall, we found high levels of support and perceived need for DCS amongst all stakeholder groups. Conclusions Our findings present initial implementation considerations for Scotland which could be further explored as DCS are operationalised. Further, our focus on implementation contexts is relevant to research on DCS more generally, given the minimal consideration of such issues in the literature.

Drug checking services (DCS) enable individuals to voluntarily submit a small amount of a substance for analysis, providing information about the content of the substance along with tailored harm reduction support and advice. There is some evidence suggesting that DCS may lead to behaviour and system change, with impacts for people who use drugs, staff and services, and public health structures. The evidence base is still relatively nascent, however, and several evidence gaps persist. This paper reports on qualitative interviews with forty-three participants across three Scottish cities where the implementation of community-based DCS is being planned. Participants were drawn from three groups: professional participants; people with experience of drug use; and affected family members. Findings focus on perceived harm reduction impacts of DCS delivery in Scotland, with participants highlighting the potential for drug checking to impact a number of key groups including: individual service users; harm reduction services and staff; drug market monitoring structures and networks; and wider groups of people who use and sell drugs, in shaping their interactions with the drug market. Whilst continued evaluation of individual health behaviour outcomes is crucial to building the evidence base for DCS, the findings highlight the importance of extending evaluation beyond these outcomes. This would include evaluation of processes such as: information sharing across a range of parties; engagement with harm reduction and treatment services; knowledge building; and increased drug literacy. These broader dynamics may be particularly important for evaluations of community-based DCS serving individuals at higher-risk, given the complex relationship between information provision and health behaviour change which may be mediated by mental and physical health, stigma, criminalisation and the risk environment. This paper is of international relevance and adds to existing literature on the potential impact of DCS on individuals, organisations, and public health structures.

The exact number of drug-related deaths at UK music festivals in recent years is unknown, and there are no standard processes for reporting or accessing data on medical incidents at these events. For the purposes of this commentary, a table of all known drug-related deaths at music festivals from 2017 to 2023 was collated by cross-referencing media and social media content with a national database contributed to by coroners, and personal communications with stakeholders, bereaved families and associated organisations. The search identified 32 potential drug-related deaths, 18 of which have been confirmed. These deaths, and the circumstances surrounding them, are pieced together here in consideration of the value of developing a greater understanding of the context to festival-related drug-related deaths. This commentary concludes by arguing for the introduction of a comprehensive, standardised and publicly accessible national database of drug-related medical incidents at UK music festivals in real time, with the aims of improving our ability to assess trends in drug-related harm and to evaluate the effectiveness of existing and emergent interventions by support services, in line with the current government drug strategy.

Background Scotland currently has the highest rates of drug-related deaths in Europe, so drug checking services are being explored due to their potential role in reducing these deaths and related harms. Drug checking services allow individuals to submit presumed psychoactive drug samples for analysis, and then receive individualised feedback and counselling. This paper explores participants’ views on the advantages and challenges of three hypothetical service models, to inform future service delivery in Scotland. Methods Semi-structured interviews were conducted with 43 people: 27 professional stakeholders, 11 people with experience of drug use, and five family members across three cities. Vignettes were used to provide short descriptions of three hypothetical service models during the interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Results Participants identified advantages and challenges for each of the three potential service models. The third sector (not-for-profit) model was favoured overall by participants, and the NHS substance use treatment service was the least popular. Participants also noted that multiple drug checking sites within one city, along with outreach models would be advantageous, to meet the diverse needs of different groups of people who use drugs. Conclusions Drug checking services need to be tailored to local context and needs, with a range of service models being possible, in order to meet the needs of a heterogeneous group of people who use drugs. Addressing issues around stigma, accessibility, and concerns about the potential impact of accessing drug checking on access to and outcomes of drug treatment, are essential for successful service delivery.

Purpose The purpose of this paper is to present some of the continued resistance and challenges faced by drug checking services (DCS) and review how the existing literature and the contributions to the special issue address them, with a view to making recommendations. Design/methodology/approach The existing literature and the contributions to the special issue are reviewed. Findings Drug checking cannot be equated with quality control. With the appropriate equipment and chemistry staff, DCS can provide quantitative analysis and reliable results. When the product does not match expectations, service users discard the tested substance of concern. To more easily compare the results of different studies and better evaluate drug checking, standardisation of measures is desirable. Uptake of drug checking, notably in festivals, is low and depends in part on the capacity of DCS. Drug checking has added value in monitoring drug markets and is complementary with chemical (forensic) analysis. Originality/value This paper interrogates in a relatively comprehensive way the continued resistance to drug checking in light of theoretical and empirical research to derive recommendations that are specific to drug checking and that are addressed to health professionals, researchers and also to policymakers.

Purpose The 3,4-methylenedioxymetamphetamine (MDMA) content in ecstasy tablets has increased enormously throughout Europe across the past decade. This study aims to determine whether this is caused by the production of “stronger” tablets (more mg MDMA per mg of tablet), or if tablets have simply been getting larger and heavier (more mg of tablet in total). Design/methodology/approach A data set of 31,716 ecstasy tablets obtained in 2012–2021 by 10 members of the Trans European Drug Information (TEDI) network was analysed. Findings The MDMA mass fraction in ecstasy tablets has remained virtually unchanged over the past 10 years, with increased MDMA contents being attributed almost exclusively to increased tablet weight. These trends seem to be uniform across Europe, despite varying sampling and analytical techniques being used by the TEDI participants. The study also shows that while tablet weight correlates perfectly with MDMA content on a yearly basis, wide variations in the MDMA mass fraction make such relations irrelevant for determining the MDMA content of individual tablets. Research limitations/implications These results provide new opportunities for harm reduction, given that size is a tangible and apparently accurate characteristic to emphasise that one tablet does not simply equate to one dose. This is particularly useful for harm reduction services without the resources for in-house quantification of large numbers of ecstasy tablets, although the results of this study also show that chemical analysis remains crucial for accurate personalised harm reduction. Originality/value The findings are both new and pertinent, providing a novel insight into the market dynamics of ecstasy tablet production at a transnational level.

Purpose This study aims to assess service user characteristics, uptake and outcomes for drug checking services offered to over 250,000 English festival-goers in summer 2018 and to compare findings with earlier years, wider festival-goers and the general population. Design/methodology/approach A total of 2,672 substances of concern were submitted by the public and tested by chemists in mobile laboratories on 24 show days at seven festivals. Results were embedded in 2,043 individually tailored brief interventions (BI) delivered by health professionals to 4,240 service users. Comparative data were collected through anonymous self-report surveys with 1,291 respondents at five of the same festivals. Findings Three percent of drug-using festival-goers received BI, 95% of whom had not previously accessed health services regarding their alcohol or other drug use. Drug checking service users were significantly more likely to be younger, male and past month polydrug users with a wider range of drugs consumed in the last month compared with the general festival population. For samples matching purchase intent, nearly half intended to reduce dosage, with younger and female service users significantly more likely to reduce dosage. For substances identified as other than expected, nearly two thirds disposed of them. Social implications Festivals are potential sites to deliver innovative health interventions and to monitor their outcomes, reduce the risk of poisoning and overdose, and facilitate access to follow-up support services. Originality/value This study suggests that there is value in event-based services that provide risk reduction communications directly to young adults engaged in higher risk drug use compared with wider event and general populations.