How adolescents cope with food insecurity in Baltimore City: an exploratory study.

OBJECTIVE: To increase our understanding about food insecurity among urban adolescents, we conducted a qualitative study in Baltimore City with adolescents to: (i) explore how adolescents experience and cope with food insecurity; and (ii) identify community-based approaches or interventions for addressing food insecurity. DESIGN: A total of eight focus groups were conducted across six neighbourhoods. To gather sociodemographic characteristics and personal data on food insecurity, all consented adolescents completed a brief questionnaire. SETTING: Six purposively selected neighbourhoods in Baltimore City, USA. PARTICIPANTS: A total of fifty-three adolescents between the ages of 14 and 19 years participated in the study. RESULTS: Although half of our sample was classified as food insecure, everyone in the focus groups was aware of adolescents who engaged in risky behaviours to get money for food. Among girls, prostituting was the most commonly mentioned behaviour, whereas for boys, it was selling drugs or stealing to get money for food. Adolescents also described tremendous stigma associated with food insecurity and agreed that food insecurity has to be viewed within a broader set of economic challenges. CONCLUSIONS: Addressing food insecurity among adolescents in disadvantaged neighbourhoods should be a high priority for policy makers and practitioners. Current feeding programmes are not addressing the needs of adolescents; as a result, adolescents are at risk for a variety of harmful behaviours and outcomes, with long-term negative health and social consequences.

A glimpse into the underground market of melanotan.

Melanotan-I and melanotan-II are alpha-melanocyte stimulating hormone (a-MSH) analogues that can be purchased illicitly online with relative ease and are injected subcutaneously to stimulate a tan. Little is known about the use of these unregulated substances. An observational survey was posted to an online forum in which participants share their experiences using melanotan-I or melanotan-II. Users were asked to complete this voluntary, anonymous survey, which had questions focusing on motivation and hesitation for and against using melanotan, difficulty in acquiring it, and plans for continuing to use melanotan in the future.

Initiation of drug dealing among a prospective cohort of street-involved youth.

BACKGROUND: Street-involved youth who use drugs may have limited income-generation options and are known to commonly become immersed in illicit drug markets to generate funds. However, little attention has been given to factors that may drive drug dealing initiation among this vulnerable population. OBJECTIVES: This longitudinal study examines drug dealing initiation among street-involved youth. METHODS: Data were derived from the At-Risk Youth Study from September 2005 to November 2014; a prospective cohort of 194 street-involved youth who use drugs aged 14-26, in Vancouver, Canada. Extended Cox model was used to identify factors independently associated with time to first drug dealing. RESULTS: Among street-involved youth who had never dealt drugs at baseline, 56 (29%) individuals initiated drug dealing during the study period for an incidence density of 13.0 per 100 person-years (95% confidence interval [CI]: 9.9-17.2). In multivariable Cox regression analysis, male gender (adjusted hazard ratio [AHR] = 1.90, 95% CI: 1.06-3.42), homelessness (AHR = 1.88, 95% CI: 1.05-3.35), crystal methamphetamine use (AHR = 2.48, 95% CI: 1.47-4.20), and crack cocaine use (AHR = 2.35, 95% CI: 1.38-4.00) were positively and independently associated with initiating drug dealing. CONCLUSION: Homelessness and stimulant drug use were key risk factors for drug dealing initiation among street-involved youth. Findings indicate that evidence-based and innovative interventions, including youth-centric supportive housing, low threshold employment programs, and stimulant addiction treatment should be implemented and evaluated as strategies to help prevent this vulnerable population from engaging in risky illegal income generation practices.

Identification and Treatment of Human Trafficking Victims in the Emergency Department: A Case Report.

BACKGROUND: Human trafficking victims experience extreme exploitation and have unique health needs, yet too often go undetected by physicians and providers in the Emergency Department (ED). We report a clinical case of human trafficking of a white, English-speaking United States citizen and discuss the features of presentation and treatment options for human trafficking victims upon presentation to the ED. CASE REPORT: A 29-year-old woman with a past medical history significant for intravenous drug abuse and recent relapse presented to the ED after a reported sexual assault. The patient was discharged that evening and returned to the ED the following day acutely suicidal. The patient divulged that she had been kidnapped and raped at gunpoint by numerous individuals as a result of a debt owed to her drug dealers. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Many human trafficking victims present to an ED during the course of their exploitation. To that end, EDs provide one of a limited set of opportunities to intervene in the human trafficking cycle of exploitation, and physicians as well as other ED staff should be equipped to respond.

A typology of drug selling among young adults in the United States.

BACKGROUND: Although studies have found that young adults who sell drugs are more likely to be involved in risky behaviors than those who do not sell drugs, there has been relatively little research that has explored heterogeneity among young adults who sell drugs. METHODS: Using a pooled sample of 18 to 25 year olds from the National Survey on Drug Use and Health (2006-2010) who report past-year drug selling (N = 5,373), this study employs latent profile analysis to specify latent groups and assess the correlates of group membership. RESULTS: Findings indicate substantial differences among young adults who sell drugs. In particular, the analysis found four groups of drug sellers: normative (49.6%), club drug users (23.6%), polysubstance users (16.0%), and criminal offenders (10.8%). Club drug users were characterized by high levels of ecstasy and hallucinogen use, polysubstance users were more likely to be depressed and anxious, White and female than the other groups. Criminal offenders were overwhelmingly male and more likely to be comprised of African-Americans and Hispanics. CONCLUSIONS: RESULTS indicate that drug selling in early adulthood varies substantially. Contrary to media and popular notions most drug sellers are not involved in crime and polysubstance using drug sellers are in clear need of mental health services. Further, most drug sellers in this age range are White. Findings suggest that policy efforts that operate under the assumption of homogeneity of drug selling may be misguided.

The Effect of Neighborhood Recorded Crime on Fear: Does Neighborhood Social Context Matter?

A number of individual and neighborhood-level factors may influence the relationship between recorded crime in one's neighborhood and fear of crime. Understanding these factors may assist in reducing fear, which has been associated with poorer physical and mental health. The aim of this study was to evaluate whether the effect of recorded crime rates on fear differs based on the neighborhood social context (social fragmentation) using hierarchical regression modelling, with separate analyses by crime type. Recorded crimes (2008-2010) and national (New Zealand) survey data were used. Higher crime in a neighborhood was associated with higher fear of crime, with only small effect size differences in feelings of fear by recorded type of crime. However, when stratified, the associations between violent and drug/alcohol crimes and fear of crime were larger for those living in highly fragmented neighborhoods compared with less fragmented neighborhoods. Efforts to alleviate fear of crime should focus on the broader neighborhood social context in which these feelings are espoused.

Sources of pharmaceutical opioids for non-medical use among young adults.

The study uses qualitative and quantitative data to describe sources of pain pills for illicit use among young adult (18- to 23-year-old) users. Respondent-driven sampling was used to recruit 383 individuals in the Columbus, Ohio, area. The sample was almost 50% Caucasian and about 55% male. Qualitative interview participants (n = 45) were selected from the larger sample. Qualitative data suggest that pharmaceutical opioid availability was so pervasive that most individuals did not have to venture outside of their immediate social networks to find people who sold or shared pills. Participants emphasized differences between those who are actively involved in obtaining pills and those who play a more passive role. Active involvement was described as going out searching for pills and paying money to obtain them. In contrast, passive role included obtaining pills when somebody offered or shared them free of charge. Multiple logistic regression analysis indicates that a more active role in obtaining pharmaceutical opioids was related to being White, more frequent use of pharmaceutical opioids, extended-release oxycodone use, and using pharmaceutical opioids to get high, as opposed to self-treating a health problem. The study results can help inform drug use epidemiology, interventions, and policy.

Applying the creating lasting family connections marriage enhancement program to marriages affected by prison reentry.

Divorce proportions are currently high in the US and they are even higher among those who are incarcerated with substance abuse problems. Although much research has examined marital interventions, only two studies have examined marital interventions with prison populations. There is some empirical evidence that incarcerated couples benefit from traditional marital therapy (O'Farrell and Fals-Stewart, 1999, Addictions: A comprehensive guidebook, New York, Oxford University Press). An adaptation of the evidence-based Creating Lasting Family Connections program was implemented with 144 married couples, where one spouse was incarcerated, in a southern state with particularly high divorce and incarceration proportions. Results suggested that married men exposed to the program had larger improvements in some relationship skills relative to a convenience sample of men not so exposed. Both husbands and wives exposed to the program exhibited similar and significant increases in relationship skills. The results were comparable to a Prevention and Relationship Enhancement Program adaptation for inmates. The implications of the findings for prevention practitioners are discussed.

The contribution of methamphetamine use to crime: Evidence from Australian longitudinal data.

BACKGROUND: To quantify the extent to which methamphetamine use is associated with increases in crime net of any premorbid risk of criminality among people who use the drug. METHODS: Four one-month data panels from 469 participants dependent on methamphetamine were drawn from the MATES cohort (N = 501). Odds ratios for within-person effects were extracted from a random intercept logistic regression model for crime during periods of methamphetamine use compared to no use. Effects were adjusted for time-varying measures of age, other substance use, and socio-economic disadvantage (income, unemployment and unstable accommodation). Involvement in crime (property crime, drug dealing, fraud, violent crime) and days of methamphetamine in the past month were assessed using the Opiate Treatment Index. RESULTS: Crime was more likely during months when participants used methamphetamine compared to when they did not (OR 13.2 95% CI 8.5-20.6; AOR 4.7 95% CI 2.8-8.0), this reflecting more property crime (OR 10.6 95% CI 6.3-18.0; AOR 5.5 95% CI 2.8-10.8), violent crime (OR 8.2 95% CI 4.2-15.9; AOR 3.4 95% CI 1.5-8.0), fraud (OR 3.4, 95% CI 2.0-5.8; AOR 1.7 95% CI 0.8-3.3) and dealing drugs (OR 18.2 95% CI 10.2-32.5; AOR 5.9 95% CI 3.0-11.9), although the adjusted relationship for fraud was not significant. Effects were dose related. CONCLUSIONS: The use of methamphetamine was associated with significant increases in crime beyond premorbid risk for criminality. Crime is a likely social consequence of methamphetamine use and efforts are needed to reduce this impact.

Ring and bring drug services: Delivery dealing and the social life of a drug phone.

BACKGROUND: Illegal drug dealers no longer compete for customers only through the quality of their products, but also in convenience and speed of delivery. This article investigates "ring and bring" drug dealing, and argues that a focus on dealers' use of mobile phones is useful for exploring current changes within retail level drug markets. METHODS: The article is based on 21 face-to-face in-depth interviews with active drug dealers in Denmark all of whom were involved in the delivery of drugs (mainly cannabis and cocaine) often to buyers' homes. RESULTS: Contrary to studies emphasising how drug dealers often take up new communication technologies with enthusiasm, the dealers in this study displayed a technological conservatist stance. Moreover, mobile phones have become key to dealers' construction of in-group hierarchies, and have led to retail level drug selling becoming more flexible, individualised and more of a service on par with other services in the consumer society. Finally, the increasing use of mobile phones has also created a situation where portfolios of drug customers, held on cell phone SIM cards, are today traded and sold alongside other commodities in the drug economy. CONCLUSION: We show how a social constructivist approach to technology can provide a more detailed and nuanced account of the socio-technical ensemble and the meaning-making processes giving shape to retail level "delivery dealing."

Trusting the source: The potential role of drug dealers in reducing drug-related harms via drug checking.

OBJECTIVES: Drug checking technologies (DCTs) have been implemented as a response to the ongoing opioid overdose epidemic. We examined the level of trust people who use drugs (PWUD) have in their drug dealers as well as their perspectives on the potential for drug dealers to use DCTs to provide knowledge of drug contents to their customers. METHODS: We conducted one-to-one qualitative semi-structured interviews with 20 PWUD in Vancouver, Canada's Downtown Eastside. Participants were purposively recruited from ongoing cohort studies of PWUD and were required to currently be using stimulants and/or opioids. RESULTS: Most participants discussed having a high level of trust for their drug dealers based on length of relationships, drug supply consistencies, and communication. Given this, participants did not identify drug checking as a priority. However, participants discussed a lower level of trust when buying drugs from an unfamiliar source. Participants also discussed how DCTs would provide knowledge to drug dealers about drug contents and how communicating test results to customers could be a risk reduction measure. Participants described privacy concerns that drug dealers might experience as well as the lack of concern that some drug dealers have about their drug supply. CONCLUSIONS: Future drug checking programming should consider ways to engage drug dealers to test their supplies and develop communication strategies to more accurately inform PWUD of drug contents and avert risks associated with using them. Additionally, drug policies that address the effects of criminalization should be considered to lessen potential barriers to DCT use by drug dealers.

Drug sellers' neutralizations of guiltless drug sales and avoidance of "drug dealer" identities.

BACKGROUND: Despite a wealth of empirical exploration on neutralization theory, several aspects of the theory remain underexplored. For instance, one task of neutralization research is to investigate whether and how neutralizations vary with offender characteristics. A second underexplored area is whether the neutralizations offenders present when directly asked about feelings of guilt are similar or dissimilar to those they have incorporated into their narrative identities described during interviews. A third underexplored issue is whether offenders that exhibit little guilt for committing mala prohibita crimes use neutralizations in a similar manner as those who do not express guilt for committing mala in se crimes. METHODS: The present study examines these questions by drawing from data collected from interviews with 33 active drug sellers from St. Louis, Missouri, USA and 30 active drug sellers from Atlanta, Georgia, USA. RESULTS: We find that these offenders' neutralizations vary by drug type and by differential access to resources. We also find that, in addition to the neutralizations they give when asked about guilt, these offenders also preemptively neutralize feelings of guilt by constructing identities counter to bad "drug dealers" throughout their storied identities. CONCLUSION: We conclude by suggesting that neutralizations vary by offender characteristics due to the differing background expectancies of offenders' social groups. We also suggest that neutralizing the repercussions of immoral actions is not always a static, monothematic technique. It is instead an active, complex, and interactional process that occurs as persons make sense of who they are and what they are doing. Finally, we argue that studies of neutralization theory relying on direct, standardized questions or the presentation of abstract vignettes may fail to capture a sizable part of the neutralization process among offenders.

"Debt on Me Head": A Qualitative Study of the Experience of Teenage Cannabis Users in Treatment.

BACKGROUND: Cannabis is the most commonly used illicit drug in most western countries. In Ireland, it now accounts for most new presentations to substance use treatment services. Cannabis use for most of these people commenced during adolescence. Although a significant amount of research has been conducted on the effects of cannabis on physical and mental health, less is known about the experiences of young cannabis users. OBJECTIVE: The aim of this study was to understand more about the experience of young, treatment-seeking, cannabis users. METHODS: This descriptive qualitative study interviewed eight adolescents who were attending outpatient treatment services for cannabis misuse in Dublin, Ireland. Data were analyzed using thematic analysis. RESULTS: Six themes were identified incorporating the early onset of cannabis and heavy use, involvement in criminality including drug dealing to pay for cannabis, ambivalence, experience of treatment, and damage to relationships. These themes are discussed in light of emerging literature. CONCLUSION: Young cannabis users in treatment can clearly identify many negative aspects of their cannabis use but are particularly ambivalent toward cannabis. Reluctance to aim for abstinence is common.

How the U.S.-Mexico border influences adolescent substance use: Youth participatory action research using photovoice.

INTRODUCTION: The purpose of this study is to use Youth Participatory Action Research (YPAR) methods and Photovoice to identify the perceived environmental factors that influence substance use among adolescents living at the U.S.-Mexico border. METHODS: One academic and a local youth health coalition engaged in Youth Participatory Action Research (YPAR) using Photovoice and qualitative methods to examine the perceived factors influencing adolescent substance use in their border community. RESULTS: Identified novel risk factors for adolescent substance use on the border included the normalization of drug trafficking, normalization of substance use, and cross-border access to substances. Novel protective factors included living in a close-knit binational community and having strong binational family and social support systems. The findings also illustrate a nexus of 'factors' wherein risk and protective elements overlap. CONCLUSION: This study contributes to the broader literature on international border health and how living in a border space influences adolescent substance use. The examination of influential border-bound factors provides a more complete understanding of the experiences of youth living on the U.S.-Mexico border, and informs the field of the importance of considering the border experience for future prevention and risk reduction efforts with border adolescents.

Drug sourcing and motivations among a sample of people involved in the supply of pharmaceutical drugs in Australia.

BACKGROUND: The non-medical use (NMU) of pharmaceuticals is increasing internationally, along with mortality. Previous research indicates that end-users access pharmaceuticals through social networks, however little is known about supplier sources particularly outside the US. This study examined sourcing and motivations among a sample of people involved in pharmaceutical diversion and supply in Australia. METHODS: Semi-structured, telephone interviews were conducted with 51 people involved in supplying pharmaceuticals in the previous six months. Multi-stage recruitment involved the distribution of flyers to participants of two Australian drug-monitoring programs: the Ecstasy and related Drugs Reporting System (capturing regular psycho-stimulant users) and the Illicit Drug Reporting System (capturing people who regularly inject drugs), followed by a screening of interested participants. Interviews were audio-recorded, transcribed and analysed using a mixed methods approach. First, correlates of drug sourcing and motivations were examined including demographics, frequency and quantity of supply. Second, thematic analysis of the qualitative data was undertaken on strategies for obtaining the drugs and motivating factors. RESULTS: Drug supplies were sourced from a variety of medical and non-medical sources, primarily legitimately obtained prescriptions (47%), friends or family (18%) and dealers (14%). Suppliers using medical sources were more likely to be unemployed/retired and reported supplying for therapeutic purposes, while suppliers using non-medical sources were more likely to be employed/students, earned higher incomes and reported supplying for recreational purposes. Those who sourced via doctor shopping (IRR = 47.5) and friends and family (IRR = 10.1) distributed higher quantities, while those who sourced legitimately obtained prescriptions (IRR = 0.1) and from illicit drug dealers (IRR = 0.0) distributed lower quantities. Similar proportions supplied for financial (65%) and altruistic (61%) reasons, however the latter supplied lower quantities (IRR = 0.1). CONCLUSION: This study offers novel insight into the diversion of pharmaceuticals from the supplier perspective. A nuanced policy approach is required to address varied supply practices by source and motive.

Sellers' risk perceptions in public and private social media drug markets.

INTRODUCTION: From the early use of pagers and cellular phones to the darknet and smartphones, technological developments have facilitated drug deals in various ways, especially by altering time and space boundaries. Traditional drug market literature theorises about how physical markets, within which sellers act according to their risk perceptions and motivation, are led by supply, demand, and enforcement. However, there is an almost absolute research gap in understanding how this relates to digital markets and social media markets in particular. It is expected that the plasticity of technology makes digital markets highly mouldable so that the sellers are able to shape markets according to their use. RESEARCH AIM: The aim of the study is to describe and understand drug dealing on social media within the structure of existing markets. We aim to do so by analysing how drug sellers' risk perceptions and motivations form and are formed by social media technology. METHODS: We conducted a three-month digital ethnographic study on Facebook and Instagram in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden), as well as 107 semi-structured qualitative interviews with sellers (2/3 of the sample) and buyers (1/3 of the sample) using online markets within the same countries. RESULTS: Drug dealing on social media varies according to the structure of the chosen media and users' risk perceptions and motivations. Two market forms are suggested: 1) public digital markets (e.g., Facebook groups and Instagram) allow sellers to expand their customer lists, but the risk is quite high, while 2) private digital markets are based on one-on-one communication and demand greater knowledge but are perceived as more secure. Sellers choose which media to use and how to use them based on perceived risk and, therefore, have a significant impact on the formation of social media drug markets.

Prevalence and correlates of selling illicit cannabis among people who use drugs in Vancouver, Canada: A ten-year prospective cohort study.

BACKGROUND: The illicit selling and use of cannabis is prevalent among marginalized people who use illicit drugs (PWUD). Given that participation in illicit drug markets has been previously associated with a range of health and social harms, we sought to examine the predictors of selling cannabis among PWUD in Vancouver, Canada, a setting with a de facto legalized cannabis market, on the eve of the planned implementation of legalized non-medical cannabis including measures to regulate the existing illicit market. METHODS: Multivariable generalized estimating equations (GEE) logistic regression was used to analyze longitudinal factors associated with selling illicit cannabis among three prospective cohorts of PWUD between September 2005 and May 2015. RESULTS: Among the 3258 participants included in this study, 328 (10.1%) reported selling illicit cannabis at baseline, and 46 (5.1%) initiated cannabis selling over the study period. In the multivariable analysis of the whole sample, factors significantly associated with selling cannabis included cannabis use (Adjusted Odds Ratio [AOR] = 4.05), dealing other drugs (AOR = 3.87), being male (AOR = 1.83), experiencing violence (AOR = 1.40), non-medical prescription opioid use (AOR = 1.32), non-custodial involvement in the criminal justice system (AOR = 1.31), being stopped by police (AOR = 1.30), crack use (AOR = 1.25), homelessness (AOR = 1.23), age (AOR = 0.96 per year) and participation in sex work (AOR = 0.67) (all p < 0.05). The subanalyses indicated that dealing drugs other than cannabis, cannabis use, and non-custodial involvement in the criminal justice system were the only factors significantly associated with selling cannabis in all four subgroups. CONCLUSION: These findings support existing evidence indicating that selling illicit cannabis is often a survival-driven strategy to support the basic needs and substance use of some PWUD. Our findings suggest jurisdictions with planned or impending cannabis legalization and regulation should consider the vulnerability of PWUD when seeking to eradicate illicit cannabis markets, for example, in setting criminal penalties for selling cannabis outside of regulatory frameworks.

'Nice people doing shady things': Drugs and the morality of exchange in the darknet cryptomarkets.

BACKGROUND: An ethnographic analysis of drug-centred cryptomarket community and exchange, this article explores the embedded values around drug distribution and consumption within this setting. Drawing on our interviews with cryptomarket users, we analyze the ways in which users claim the cryptomarket as a space of morality, empathy, trust, reciprocity, knowledge transfer, harm reduction and self-limitation. The anthropological concept of the morality of exchange is central to our theoretical approach. METHODS: Between December 2014 and July 2017, nine interviews were undertaken with users of drug cryptomarkets. These were conducted in person, using Skype video calling, and using the encrypted 'self-erasing' chat app Wickr. The researchers also used overt non-participant observation (NPO) within the cryptomarket forum. This two-pronged approach - interviews and spending time within the community via NPO - enabled a thick description style of ethnographic analysis. RESULTS: Our research reveals online drug markets less as perfect markets (working to rules of supply and demand) and more as constructive communities of interest that perform and negotiate drug use and supply. We found that participation within these interest communities had practical impact such as changing the type of drug that users consume and the ways in which they participate in street drug supply. Significantly, these values and actions mediate the interface between online action and 'meatspace' (the offline world) and reinforce that the motivations and processes of internet activity are just as 'real' as offline action. CONCLUSION: We redefine the illicit drug focused cryptomarket as a place of exchange, mediation and reciprocity. Real-time knowledge transfer with the aim of harm reduction is one example of the impact of cryptomarket interaction. We caution that this is not a space of kinship and affinity: it is not without its scams, hackers and threats. It is, however, much more than a 'drug marketplace' and to understand how users themselves conceptualise this space is fruitful for any understanding of cryptomarkets. Cryptomarket exchange is a form of social action that is not restricted to its economic value for participants.

The burgeoning recognition and accommodation of the social supply of drugs in international criminal justice systems: An eleven-nation comparative overview.

BACKGROUND: It is now commonly accepted that there exists a form of drug supply, that involves the non-commercial supply of drugs to friends and acquaintances for little or no profit, which is qualitatively different from profit motivated 'drug dealing proper'. 'Social supply', as it has become known, has a strong conceptual footprint in the United Kingdom, shaped by empirical research, policy discussion and its accommodation in legal frameworks. Though scholarship has emerged in a number of contexts outside the UK, the extent to which social supply has developed as an internationally recognised concept in criminal justice contexts is still unclear. METHODS: Drawing on an established international social supply research network across eleven nations, this paper provides the first assessment of social supply as an internationally relevant concept. Data derives from individual and team research stemming from Australia, Belgium, Canada, Czech Republic, Finland, Germany, Hong Kong, the Netherlands, England and Wales, and the United States, supported by expert reflection on research evidence and analysis of sentencing and media reporting in each context. In situ social supply experts addressed a common set of questions regarding the nature of social supply for their particular context including: an overview of social supply research activity, reflection on the extent that differentiation is accommodated in drug supply sentencing frameworks; evaluating the extent to which social supply is recognised in legal discourse and in sentencing practices and more broadly by e.g. criminal justice professionals in the public sphere. A thematic analysis of these scripts was undertaken and emergent themes were developed. Whilst having an absence of local research, New Zealand is also included in the analysis as there exists a genuine discursive presence of social supply in the drug control and sentencing policy contexts in that country. RESULTS: Findings suggest that while social supply has been found to exist as a real and distinct behaviour, its acceptance and application in criminal justice systems ranges from explicit through to implicit. In the absence of dedicated guiding frameworks, strong use is made of discretion and mitigating circumstances in attempts to acknowledge supply differentiation. In some jurisdictions, there is no accommodation of social supply, and while aggravating factors can be applied to differentiate more serious offences, social suppliers remain subject to arbitrary deterrent sentencing apparatus. CONCLUSION: Due to the shifting sands of politics, mood, or geographical disparity, reliance on judicial discretion and the use of mitigating circumstances to implement commensurate sentences for social suppliers is no longer sufficient. Further research is required to strengthen the conceptual presence of social supply in policy and practice as a behaviour that extends beyond cannabis and is relevant to users of all drugs. Research informed guidelines and/or specific sentencing provisions for social suppliers would provide fewer possibilities for inconsistency and promote more proportionate outcomes for this fast-growing group.

Examining social supply among nonmedical prescription stimulant users in the San Francisco Bay Area.

In the US, prescription stimulants are prescribed for a variety of conditions including attention deficit hyperactivity disorder (ADHD) and narcolepsy. Over the last two decades, dramatic increases in stimulant prescriptions have led to greater availability and increased risk for diversion and nonmedical use. Our own and other investigators' findings indicate that many drug "suppliers" do not fit into the traditional image of drug "dealers." These suppliers typically do not identify themselves as "dealers," but instead understand their drug distribution as sharing with people they know. Coomber and colleagues' (2007; 2013) concept of "social supply" raises the question: When friends supply or facilitate supply of drugs to friends, is this really dealing? Further, if dealing and supplying are distinct kinds of social transactions, should different types of criminal justice approaches be applied? Social supply extends our understanding of drug dealing as a complex social activity. In this article, we examine the issue of social supply among nonmedical users of prescription stimulants. We conducted a 36-month National Institute on Drug Abuse-funded project to conduct a qualitative, mixed methods study of 150 adult nonmedical prescription stimulant users in the San Francisco Bay Area. We explore intersecting factors, including life stage and social location, that contribute to decisions to use prescription stimulants nonmedically, motivations to use, knowledge about risks and benefits of prescription stimulant use, any adverse health or social consequences experienced, availability, acquisition and diversion of prescription stimulants, and differences in attitudes and behaviours. For this analysis, we rely on participants' narratives concerning prescription stimulant acquisition practices and how they understood these interactions, purchases, and exchanges with the suppliers of prescription stimulants in their social networks. The authors argue that acknowledging the distinction between social supply and "proper" drug dealing would redress the disparity between drug sharing and profiteering particularly regarding criminal sentencing.