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Analysis of how policy processes happen in real-world, contemporary settings is important for generating new and timely learning which can inform other drug policy issues. This paper describes and analyses the process leading to the successful establishment of Australia's first peer-administered naloxone program. Within a case study design, qualitative data were collected using semi-structured interviews with key individuals associated with the initiative (. n=. 9), and a collaborative approach to data analysis was undertaken. Central to policy development in this case was the formation of a committee structure to provide expert guidance and support. The collective, collaborative and relational features of this group are consistent with governing by network. The analysis demonstrates that the Committee served more than a merely consultative role. We posit that the Committee constituted the policy process of stakeholder engagement, communication strategy, program development, and implementation planning, which led to the enactment of the naloxone program. We describe and analyse the roles of actors involved, the goodwill and volunteerism which characterised the group's processes, the way the Committee was used as a strategic legitimising mechanism, the strategic framings used to garner support, emergent tensions and the evolving nature of the Committee. This case demonstrates how policy change can occur in the absence of strong political imperatives or ideological contestation, and the ways in which a collective process was used to achieve successful outcomes.

This project aimed to understand experiences of stigma and discrimination for people experiencing problematic alcohol and other drug (AOD) use in Queensland. Specifically, the research examined:• Experiences of stigma and discrimination;• The potential for legislation to be stigmatising;• The settings and sectors in which stigma and discrimination occur;• The impacts of stigma and discrimination on health and wellbeing and in particular on recovery and the ability to reconnect with the community; and• Circumstances where stigma is not experienced, and evidence of what works to address stigma and discrimination.In this report, stigma and discrimination are defined as follows:Stigma is labelling and stereotyping of difference, at both an individual and structural societal level, that leads to status loss (including exclusion, rejection and discrimination).Discrimination is the lived effects of stigma – the negative material and social outcomes that arise from experiences of stigma.Both stigma and discrimination rely on societal structures and systems that facilitate and create the conditions for their operation (for example unequal power is one such condition).In this project we sought to identify effective ways to reduce stigma and discrimination and provide recommendations derived from the research findings to support implementation actions by the Queensland government.

Calls for "evidence-based policy" and greater community "participation" are often heard in the drug policy field. Both movements are in different ways concerned with the same questions about how "drug problems" ought to be governed and the place of "expertise" and "engagement" in democratic societies. However, these calls rely on the assumption that knowledges, publics, expertise, and issues of concern are fixed and stable, waiting to be addressed or called to action, thus obscuring ontological questions about what "participation" (be that lay or expert) may do or produce. There has been limited research in the drugs field that has taken "participation" as an object of study in itself and through critical examination attempted to open up new possibilities for its remaking. In this article, we draw on science and technology studies scholarship that has sought to illuminate the relations between public deliberation and government decision-making in public affairs involving technical claims and the generative capacity of such engagement (including for democracy itself). We describe various rationales for participation and examples of experiments that have sought to remake participatory processes in other policy domains. This literature provides fruitful ground for a reengagement with (and possibly a reconfiguration of) "evidence-based policy" or community "participation" in drug policy. Through this exploration, we hope to recast and more sensitively articulate the concept of "participation" in deliberations about public affairs involving technical claims in drug policy, thus opening up possibilities for experiments and practices that redistribute expertise, "slow down" reasoning, attend to emergent publics, and disrupt consensual claims as to "what counts" and what does not.

The notion of 'recovery' as an overarching approach to drug policy remains controversial. This cross-national analysis considers how the problem of drugs was constructed and represented in two key reports on the place of 'recovery' in drug policy, critically examining how the problem of drugs (and the people who use them) are constituted in recovery discourse, and how these problematisations are shaped and disseminated. Bacchi's poststructuralist approach is applied to two documents (one in Britain and one in Australia) to analyse how the 'problem of drugs' and the people who use them are constituted: as problematic users, constraining alternative understandings of the shifting nature of drug use; as responsibilised individuals (in Britain) and as patients (in Australia); as worthy of citizenship in the context of treatment and recovery, silencing the assumption of unworthiness and the loss of rights for those who continue to use drugs in 'problematic' ways. The position of the organisations which produced the reports is considered, with the authority of both organisations resting on their status as independent, apolitical bodies providing 'evidence-based' advice. There is a need to carefully weigh up the desirable and undesirable political effects of these constructions. The meaning of 'recovery' and how it could be realised in policy and practice is still being negotiated. By comparatively analysing how the problem of drugs was produced in 'recovery' discourse in two jurisdictions, at two specific points in the policy debate, we are reminded that ways of thinking about 'problems' reflect specific contexts, and how we are invoked to think about policy responses will be dependent upon these conditions. As 'recovery' continues to evolve, opening up spaces to discuss its contested meanings and effects will be an ongoing endeavour.

Participatory modelling seeks to foster stakeholder engagement to better attune models to their decision-making and policy contexts. Such approaches are increasingly advocated for use in the field of health. We review the instrumental and epistemological claims made in support of participatory modelling approaches. These accentuate participatory models as offering a better evidence-base for health policy decisions. By drawing attention to recent modelling experiments in a sector outside of health, that of water management, we outline a different way of thinking about participation and modelling. Here, the participatory model is configured in relation to matters of 'knowledge controversy', with modelling constituted as an 'evidence-making intervention' in relation to the making of science and expertise. Rather than presenting participatory models as an improved technical solution to addressing given policy problems within an evidence-based intervention approach, models are alternatively potentiated as sites for the redistribution of expertise among actor networks as they seek to engage politically in a matter of concern. This leads us to consider possible new directions for participatory modelling in the field of health.

Background: The importance of engaging people who use drugs in drug policy development is increasingly acknowledged including in recent UN documents. Little scholarly attention has been paid to 'drug user representation' in the global drug policy setting of the UN such as the Commission on Narcotic Drugs (CND). This paper examines 'drug user representation' in key UN drug policy processes over three decades. Method: A mapping process was undertaken using a corpus of publicly available documents from the UNGASS on Drugs and associated CND processes to identify relevant policy processes from 1987 to 2019 (n = 15) which were then assess for presence/absence of 'drug user representation'. Those processes with positive evidence of 'drug user representation' (n = 9) were critically interrogated across three co-constitutive domains of the subjects, objects and forms of 'drug user representation'. Results: Our analysis shows that despite calls for greater involvement, dominant UN drug policy discourses and other practices delimit both the political subjectivities available to people who use/have used drugs and their capacity to bring their voices to bear in this context. The analysis also highlights that human rights-based discourses, employed by 'drug user representatives', have emerged as an important practice of resistance against the problematic and delimiting power effects of existing UN discourses, governing practices and modes of engagement. Conclusions: In addition to the practices of resistance being undertaken by 'drug user representatives', we suggest there is a need to improve how 'drug user representation' is being made possible and done in the sites of UN drug policy deliberation and, that these sites should be opened for questioning. This we argue will not only have a positive impact on political legitimacy for 'drug user representation', but on the health and human rights of people who use/have used drugs.

As the number of new 'psychoactive substances' detected globally has risen exponentially, the policy response of assessing and prohibiting each new substance individually has become increasingly unworkable. In an attempt to disrupt the availability of new as-yet-unscheduled substances, Ireland (2010), Poland (2011), Romania (2012), New Zealand (2013), Australia (2015) and the United Kingdom (2016) have enacted generic or blanket ban legislation that prohibits all 'psychoactive substances' that are not already regulated or belong to exempt categories. How such generic legislation defines 'psychoactive substance' is therefore crucial. While there is a growing critical literature relating to blanket bans of 'psychoactive substances', the Australian legislation is yet to be described or critically analysed. In this commentary, we aim to draw the attention of local and international drug policy scholars to Australia's newest legislative approach to 'psychoactive substances'. Using the Australian experience as a case study, we first describe and trace the origins of this generic banning approach, especially focusing on how 'psychoactive effect' came to be defined. Then, we critically examine the assumptions underpinning this definition and the possibilities silenced by it, drawing on the work of poststructuralist and critical scholars. In doing so, we explore and raise a series of questions about how this legislation works to stabilise drugs, drug harms and drug effects, as well as addiction realities; how the category of 'psychoactive substances' is produced through this legislation; and some of the material-discursive effects which accompany this rendering of the 'problem'. We offer this commentary not as a comprehensive discussion of each of these elements but rather as a starting-point to promote further discussion and debate within the drug policy field. To this end, we conclude with a suggested research agenda that may help guide such future work.

Background: Significant research attention has been given to understanding the processes of drug policy reform. However, there has been surprisingly little analysis of the persistence of policy in the face ofopposition and evidence of ineffectiveness. In this article we analysed just such a case – police drug detection dog policy in NSW, Australia. We sought to identify factors which may account for the continuation of this policy, in spite of counter-evidence and concerted advocacy.Methods: The analysis was conducted using the Advocacy Coalition Framework (ACF). We collated documents relating to NSW drug detection dog policy from 1995 to 2016, including parliamentaryrecords (NSW Parliament Hansard), government and institutional reports, legislation, police procedures, books, media, and academic publications. Texts were then read, coded and classified against the core dimensions of the ACF, including subsystem actors and coalitions, their belief systems and resources and venues employed for policy debate.Results: Three coalitions were identified as competing in the policy subsystem: security/law and order, civil liberties and harm reduction. Factors that aided policy stability were the continued dominance of thesecurity/law and order coalition since they introduced the drug dog policy; a power imbalance enabling the ruling coalition to limit when and where the policy was discussed; and a highly adversarial policysubsystem. In this context even technical knowledge that dogs infringed civil liberties and increased risks of overdose were readily downplayed, leading to only incremental changes in implementation ratherthan policy cessation or wholesale revision.Conclusion: The analysis provides new insights into why the accumulation of new evidence and advocacy efforts can be insufficient to drive significant policy change. It poses a challenge for the evidence-based paradigm suggesting that in highly adversarial policy subsystems new evidence is unlikely to generate policy change without broader subsystem change, such as reducing the adversarial nature and/or providing new avenues for cross-coalition learning.

Introduction and Aims: The structures of health systems impact on patient outcomes. We present and analyse the first detailed mapping of who funds alcohol and other drug (AOD) treatment and the channels and intermediaries through which funding flows from the funding sources to treatment providers. Design and Methods: The study involved a literature review of AOD treatment financing and existing diagrammatic representations of the structure of the Australian health system. We interviewed 190 key informants to particularise the AOD treatment sector, and undertook two case examples of government funded non-government organisations providing AOD treatment. Results: Funding sources include the Australian and state and territory governments, philanthropy, fund-raising and clients themselves. While funding sources align with the health sector generally and the broader social services sector, the complexity of flows from source to treatment service and the number of intermediaries are noteworthy. So too are the many sources of funding drawn on by some treatment providers. Diversification is both beneficial and disadvantageous for non-government treatment providers, adding to administrative workloads, but smoothing the risk of funding shortfalls. Government funders benefit from sharing risk. Discussion and Conclusions: Circuitous funding flows multiply the funding sources drawn on by services and put distance between the funding source and the service provider. This leads to concerns over lack of transparency about what is being purchased and challenges for the multiply funded service provider in maintaining programs and service models amid multiple and sometimes competing funding and accountability frameworks.

Summary: Interprofessional practice has been broadly endorsed as a strategy which supports the delivery of high-quality health services. Few studies have addressed the dynamics inherent to interprofessional mental health practice in an era in which client empowerment is prioritised and valued. Social work perspectives are also underexplored in the studies which have been published on interprofessional health care, despite the increasingly important role of this discipline in community mental health contexts. Through a thematic analysis of 26 semi-structured interviews, this study explored the perspectives of mental health social workers located in two geographically and culturally distinctive sites (Hong Kong and Sydney), and identified a strong theme encompassing their concerns about the facilitation of client empowerment in interprofessional settings. Findings: Participant accounts direct attention to the strategies required to co-constitute the shared territories of the different mental health professions. Findings also highlight the frustration with recent mental health reforms which aim to challenge power differentials in interprofessional decision-making. Strategies were proposed for supporting the construction of shared language among different professions, revealing the creativity and insight of practitioners in managing the conflicts arising from interactions between different professional knowledge systems. The comparison of Hong Kong and Sydney accounts highlights the importance of structural, political and cultural influences in supporting not only interprofessional collaboration but also the independence and effectiveness of distinct professional roles. Application: This article provides unique insights which aim to strengthen the contribution of social work to interprofessional practice in the promotion of empowerment-oriented interprofessional practice and education.

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Media and politicians both influence public opinion and policy responses to illicit drug issues. This study examines the contribution each may have made in Australia in 2015 to the problem and politics streams of the policy process, as outlined in Kingdon's 'multiple streams' heuristic, when a National Ice Taskforce responded to increased public, political and media concern about methamphetamine use. A retrospective content analysis compared the frequency and content of articles about methamphetamine in print media (N = 639) and federal parliament speeches (N = 158) in 2015. Peaks in the number of media articles and debates in parliament followed the establishment and interim findings of the Ice Taskforce. The findings showed that politicians more frequently framed methamphetamine use as a crisis or epidemic than the media. Both frequently portrayed cost to society as the consequence of methamphetamine use and often cited law enforcement sources. The media most frequently positioned methamphetamine users as criminal or deviant compared to politicians who did not position the user or positioned them as an addict or victim. This analysis highlights the convergence of the problem and politics streams and suggests they are not independent as first posited by Kingdon.