Best interests and low thresholds: legal and ethical issues relating to needle and syringe services for under 18s in Sweden.

Access for legal minors to needle and syringe programmes raises a number of practical, legal and ethical challenges that traverse clinical practice, child protection and child rights. This article addresses the current legal age restriction on access to needle and syringe programmes (NSPs) in Sweden. Based on legislation and legislative preparatory works, it traces the rationale for retaining an age restriction in the context of a policy priority to improve access for people who inject drugs. Building on threshold theory and child rights literature, the article unpacks the apparent tension between protecting the low threshold nature of service provision, child protection duties of healthcare staff, and the best interests of the child. It explores whether this tension could be alleviated through replacing a legal age restriction for all with best interests assessments for each individual, and discusses the potential ethical and practical challenges involved in such a change.

Party and Play in the Closet? Exploring Club Drug Use Among Swedish Men Who Have Sex With Men.

BACKGROUND: Men who have sex with men (MSM) is a population that is less frequently the target of drug research in a Scandinavian context. OBJECTIVES: This study aims to explore: (1) the existence of club drug use among a sample of Swedish MSM, and (2) associations between club drug use and sociodemographic, sociosexual, and sexual risk behavior. METHODS: Data were drawn from a larger European study on MSM and HIV but the analytic sample consisted of the 3,004 MSM who resided in Sweden. SPSS 20.0 statistical software was used to perform the analysis. The primary outcome variable was a dichotomous measure of having used club drugs in the past 12 months vs. not. The independent variables were categorized into three domains, sociodemographic, sociosexual, and sexual risk behavior. The analysis was undertaken as a univariable analysis. RESULTS: Results show that club drug use exists in the Swedish MSM population and is particularly prevalent among gay identified, younger MSM from metropolitan areas, and among men with diagnosed HIV or other STIs. Moreover, club drug use was common among the men that had more sexual partners and took more sexual risks. These men were also more likely to have been diagnosed with an STI. CONCLUSIONS/IMPORTANCE: MSM who use club drugs have to be acknowledged in the Swedish drug policy context, as well as within clinical practice. Further research is needed to develop an understanding of the social and contextual dimensions involved in club drug use among Swedish MSM.

Child-centred harm reduction.

Harm reduction has become increasingly influential in drug policy and practice, but has developed primarily around adult drug use. Theoretical, practical, ethical and legal issues pertaining to children and adolescents under the age of majority - both relating to their own use and the effects of drug use among parents or within the family - are less clear. This commentary proposes a sub-field of drug policy at the intersection of harm reduction and childhood which we refer to as 'child-centred harm reduction'. We provide a definition and conceptual model, as well as illustrative questions that emerge through a child-centred harm reduction lens. Many people in different countries are already working on these kinds of issues, whose work needs greater recognition, analysis and support. In beginning to name and define this sub-field we hope to improve this situation, and inspire further international debate, collaboration, and innovation.

Platelet activation and aggregation by the opportunistic pathogen Cutibacterium (Propionibacterium) acnes.

Cutibacterium (Propionibacterium) acnes, considered a part of the skin microbiota, is one of the most commonly isolated anaerobic bacteria from medical implants in contact with plasma. However, the precise interaction of C. acnes with blood cells and plasma proteins has not been fully elucidated. Herein, we have investigated the molecular interaction of C. acnes with platelets and plasma proteins. We report that the ability of C. acnes to aggregate platelets is dependent on phylotype, with a significantly lower ability amongst type IB isolates, and the interaction of specific donor-dependent plasma proteins (or concentrations thereof) with C. acnes. Pretreatment of C. acnes with plasma reduces the lag time before aggregation demonstrating that pre-deposition of plasma proteins on C. acnes is an important step in platelet aggregation. Using mass spectrometry we identified several plasma proteins deposited on C. acnes, including IgG, fibrinogen and complement factors. Inhibition of IgG, fibrinogen or complement decreased C. acnes-mediated platelet aggregation, demonstrating the importance of these plasma proteins for aggregation. The interaction of C. acnes and platelets was visualized using fluorescence microscopy, verifying the presence of IgG and fibrinogen as components of the aggregates, and co-localization of C. acnes and platelets in the aggregates. Here, we have demonstrated the ability of C. acnes to activate and aggregate platelets in a bacterium and donor-specific fashion, as well as added mechanistic insights into this interaction.

Excusing exclusion: Accounting for rule-breaking and sanctions in a Swedish methadone clinic.

BACKGROUND: Methadone maintenance treatment has been subjected to much debate and controversy in Sweden during the last decades. Thresholds for getting access are high and control policies strict within the programmes. This article analyses how professionals working in a Swedish methadone clinic discuss and decide on appropriate responses to clients' rule-breaking behaviour. METHODS: The research data consist of field notes from observations of three interprofessional team meetings where different clients' illicit drug use is discussed. A micro-sociological approach and accounts analysis was applied to the data. RESULTS: During their decision-oriented talk at the meetings, the professionals account for: (1) sanctions, (2) nonsanction, (3) mildness. In accounting for (2) and (3), they also account for clients' rule-breaking behaviour. Analysis shows how these ways of accounting are concerned with locating blame and responsibility for the act in question, as well as with constructing excuses and justifications for the clients and for the professionals themselves. CONCLUSION: In general, these results demonstrate that maintenance treatment in everyday professional decision-making, far from being a neutral evidence-based practice, involves a substantial amount of professional discretion and moral judgements. Sanctions are chosen according to the way in which a deviance from the rules is explained and, in doing so, a certain behaviour is deemed to be serious, dangerous and unacceptable - or excusable.