Illicit COVID-19 products online: A mixed-method approach for identifying and preventing online health risks.

AIMS: The COVID-19 pandemic triggered a demand for vaccines, cures, and the need of related documentation for travel, work and other purposes. Our project aimed to identify the illicit availability of such products across the Dark Web Markets (DWMs). METHODS: A retrospective search for COVID-19 related products was carried out across 118 DWMs since the start of the pandemic (March 2020-October 2021). Data on vendors as well as advertised goods such as asking price, marketplace, listed date were collected and further validated through additional searches on the open web to verify the information relating to specific marketplaces. Both quantitative and qualitative methods were used for data analysis. RESULTS: Forty-two listings of unlicenced COVID-19 cures and vaccination certificates were identified across 8 marketplaces sold by 25 vendors with significant variation in prices. The listings were found to be geographically specific and followed the progression of the pandemic in terms of availability. Correlations between vendor portfolios of COVID-19 products and variety of goods of other illicit nature such as illegal weaponry, medication/drugs of abuse also emerged from our analysis. CONCLUSION: This study is one of the first attempts to identify the availability of unlicenced COVID-19 products on DWMs. The easy accessibility to vaccines, fake test certificates and hypothetical/illegal cures poses serious health risks to (potential) buyers due to the uncontrolled nature of such products. It also exposes buyers to an unwanted contact with vendors selling a variety of other dangerous illicit goods. Further monitoring and regulatory responses should be implemented to protect the health and safety of citizens especially at times of global crisis.

Profiling the vendors of COVID-19 related product on the Darknet: An observational study.

Background: In a time of unprecedented global change, the COVID-19 pandemic has led to a surge in demand of COVID-19 vaccines and related certifications. Mainly due to supply shortages, counterfeit vaccines, fake documentation, and alleged cures to illegal portfolios, have been offered on darkweb marketplaces (DWMs) with important public health consequences. We aimed to profile key DWMs and vendors by presenting some in-depth case studies. Methods: A non-systematic search for COVID-19 products was performed across 118 DWMs. Levels of activity, credibility, content, COVID-19 product listings, privacy protocols were among the features retrieved. Open web fora and other open web sources were also considered for further analysis of both functional and non functional DWMs. Collected data refers to the period between January 2020 and October 2021. Results: A total of 42 relevant listings sold by 24 vendors across eight DWMs were identified. Four of these markets were active and well-established at the time of the study with good levels of credibility. COVID-19 products were listed alongside other marketplace content. Vendors had a trusted profile, communicated in English language and accepted payments in cryptocurrencies (Monero or Bitcoin). Their geographical location included the USA, Asia and Europe. While COVID-19 related goods were mostly available for regional supply, other listings were also shipped worldwide. Interpretation: Findings emerging from this study rise important questions about the health safety of certain DWMs activities and encourage the development of targeted interventions to overcome such new and rapidly expanding public health threats. Funding: CovSaf, National Research centre on Privacy, Harm Reduction and Adversarial Influence Online (REPHRAIN), Commonwealth Fund.

Predictors of retention in the 'voluntary' and 'quasi-compulsory' treatment of substance dependence in europe.

BACKGROUND: Policies and practices related to the quasi-compulsory treatment (QCT) of substance-dependent offenders are currently implemented in many countries, despite the absence of reliable knowledge about significant predictors of treatment retention. This study aimed to identify such predictors in QCT and voluntary treatment. METHODS: Participants were treated in one of 65 institutions in 5 European countries. They were interviewed at intake on substance use, crimes committed, perceived pressure for treatment, self-efficacy, stage of change, employment, and health-related variables. Binary logistic regression models were computed to identify predictors of treatment retention at an 18-month follow-up. Moderator analyses were computed to investigate whether these predictors vary by treatment condition (QCT vs. voluntary). RESULTS: A higher number of working days in the previous month was positively associated with treatment retention, while use of heroin, crack, and multiple drugs, psychiatric problems in the previous month, and lifetime depression were negatively associated with treatment retention. Higher perceived medical pressure resulted in higher treatment retention rates only for participants in QCT. CONCLUSION: Predictors of substance abuse treatment retention are quite similar across both QCT and voluntary treatments. Perceived medical pressure is of higher relevance than the often-believed legal pressure for treatment retention in QCT.

Comparing outcomes of 'voluntary' and 'quasi-compulsory' treatment of substance dependence in Europe.

AIM: This study evaluates quasi-compulsory drug treatment (QCT) arrangements for substance-dependent offenders receiving treatment instead of imprisonment in comparison to voluntary treatment within five European countries. METHODS: Participants were interviewed with the European Addiction Severity Index, the ASI-crime module, questions on perception of pressure and self-efficacy, and the Readiness-to-Change Questionnaire at treatment entry and after 6, 12, and 18 months. RESULTS: Reductions in substance use and crime as well as improvements in health and social integration were observed in QCT and voluntary treatment groups. After controlling for various factors, subjects in the QCT and the comparison group showed similar reductions in substance use and crime over time. Study retention was comparable in both groups. CONCLUSION: QCT is as effective as voluntary treatment provided in the same services in reducing substance use and crime.

Alternate policing strategies: Cost-effectiveness of cautioning for cannabis offences.

BACKGROUND: There is increasing international interest in alternatives to the use of arrest for minor drug offences. While Australia has been at the forefront in the provision of diversionary programs for minor drug offences there remain key gaps in knowledge about the cost-effectiveness of different approaches. Here we set out to assess the cost-effectiveness of cannabis cautioning schemes whereby police refer minor cannabis use and possession offenders to education and/or treatment instead of arresting and charging them. METHODS: This study used a purpose built nation-wide online survey to evaluate cost-effectiveness of cannabis cautioning versus a traditional response for minor cannabis offences (arrest). The survey was completed by a self-selected group of detected cannabis offenders. The outcome measure was self-reported cannabis use days in the previous month post-intervention. Cost data included costs of policing, court, penalties, assessment, treatment and educational sessions. Propensity score weighting and doubly robust regression analyses were utilised to address differences between the groups. RESULTS: There were 195 respondents who reported being arrested for a cannabis possession/use offence and 355 who reported receiving a formal cannabis caution. After matching on a range of characteristics (age, prior criminal conviction, cannabis consumption, employment status, self-reported criminal activity prior to detection, severity of dependence) there was no statistically significant difference in cannabis use pre- and post-police intervention between the two groups(N=544). After matching and bootstrapping the costs there was a significant difference in costs; the mean cost for the charge group (net of fines) was $733 (SD 151) and $388 (SD 111) for the caution group. CONCLUSION: These results indicate that after matching on a range of relevant characteristics there were no differences across groups in the change in self-reported cannabis use days, but cannabis cautioning was less costly than charge/arrest. These results add to the evidence about the efficacy and desirability of alternatives to arrest both within Australia and abroad.

The impact of paying treatment providers for outcomes: difference-in-differences analysis of the 'payment by results for drugs recovery' pilot.

AIMS: To estimate the effect on drug misuse treatment completion of a pilot scheme to pay service providers according to rates of recovery. DESIGN: A controlled, quasi-experimental (difference-in-differences) observational study using multi-level random effects logistic regression. SETTING: Drug misuse treatment providers in all 149 commissioning areas in England in the financial years 2011-12 and 2012-13. PARTICIPANTS: Service users treated in England in 2011-12 and 2012-13. INTERVENTION AND COMPARATORS: Linkage of provider payments to performance indicators in eight pilot commissioning areas in England compared with all 141 non-pilot commissioning areas in England. MEASUREMENTS: Recovery was measured by successful completion of treatment (free from drugs of dependence) and engagement with services was measured by rates of declining to continue with treatment. FINDINGS: Following the introduction of the pilot scheme, service users treated in pilot areas were 1.3 percentage points [odds ratio (OR) = 0.859; 95% confidence interval (CI) = 0.788, 0.937] less likely to complete treatment compared with those treated in comparison areas. Service users treated in pilot areas were 0.9 percentage points (OR = 2.934; 95% CI = 2.094, 4.113) more likely to decline to continue with treatment compared with those treated in comparison areas. CONCLUSIONS: In the first year of the pilot 'Payment by Results for Drugs Recovery' scheme in England, linking payments to outcomes reduced the probability of completing drug misuse treatment and increased the proportion service users declining to continue with treatment.

Over a decade of syringe exchange: results from 1997 UK survey.

AIMS: To describe syringe exchange provision in the United Kingdom. DESIGN: Two-phase cross-sectional survey: phase I, establishing a sampling frame of syringe exchange coordinators (n=420); phase II, surveying the coordinators seeking data on the number of syringe exchange outlets, visits and syringes distributed during April 1997 (68% response rate). SETTING: United Kingdom. FINDINGS: In 1997, nearly all Health Authorities in the United Kingdom (96%) operated some form of syringe exchange service, except Northern Ireland. In April 1997, 1 707 000 syringes were reported as being distributed. Assuming that non-responders coordinated the median number of outlets and distributed the median number of syringes as responders, we estimate that 27 million syringes were distributed annually from over 2000 outlets in the United Kingdom. The number distributed in Scotland was 3-4 times less than in England when measured as a number per adult (15-44), drug user in treatment, or estimated injecting drug user. CONCLUSIONS: Overall, there has been a 6.5-fold increase in syringe distribution in England since 1991. The number of syringes distributed in the United Kingdom may be higher than the United States. However, there appears to be unequal distribution of syringes within the United Kingdom, which may be associated with higher levels of HCV among injectors in Scotland compared to England.

The relationship between legal status, perceived pressure and motivation in treatment for drug dependence: results from a European study of Quasi-Compulsory Treatment.

This paper reports on intake data from Quasi-Compulsory Treatment in Europe, a study of quasi-compulsory treatment (QCT) for drug dependent offenders. It explores the link between formal legal coercion, perceived pressure to be in treatment and motivation amongst a sample of 845 people who entered treatment for drug dependence in five European countries, half of them in quasi-compulsory treatment and half 'voluntarily'. Using both quantitative and qualitative data, it suggests that those who enter treatment under QCT do perceive greater pressure to be in treatment, but that this does not necessarily lead to higher or lower motivation than 'volunteers'. Many drug-dependent offenders value QCT as an opportunity to get treatment. Motivation is mutable and can be developed or diminished by the quality of support and services offered to drug-dependent offenders.