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Portugal decriminalized the public and private use, acquisition, and possession of all drugs in 2000; adopting an approach focused on public health rather than public-order priorities. Arguing that the Portuguese Drug Policy Model has not proven influential enough to emancipate drug use from the stigma that associates it either with crime or pathology, this article critically discusses the developments and current challenges the Portuguese drug policy confronts, namely the growing diversity of drug use patterns observed in Portugal as well as in Europe. To this end, international and national legal instruments concerning drugs and official local data were analysed. Despite encouraging results, conclusions indicate that these policies are marked by contradictions and ambiguities that have permeated its history since the very beginning, and modest ambitions, particularly regarding the implementation of harm reduction measures. Moreover, the polemical Supreme Court judgment that reestablished, in 2008, drug use as a crime when the quantities at play exceeded those required for an average individual’s use for 10 days, might have impacted the landscape of drug use penalization. The last decade saw an increase of punitiveness targeted at drug users, including criminal sentences of jail terms. We finish with some suggestions that could be employed in the practical application of drug policy.

The British model of harm reduction has been referenced as a pioneering approach to substance use in Europe. While many have described the development of UK drug policy through different governments, few studies have focused on the role that drug user activists played in the UK drug policy reform movement. We examine the different conceptualisations of UK drug user activists in literature, including published academic journals and grey literature (news articles, podcasts, websites and unpublished dissertations). We describe the different conceptualisations of ‘the drug user activist’ based on chronological periods relevant to drug policy, namely: Pre-Misuse of Drugs Act (1870–1971), Misuse of Drugs Act (1971–1988), Thatcherite and AIDS crisis (1988–1998), New Labour and Internet (1998–2010), and Contemporary (2010 to present). In the 1900s, we see a shift from drug users portrayed as victims coming from privileged backgrounds to middle class people who displayed problematic behaviours. After the passage of the Misuse of Drugs Act 1971, drug user activists started to organise themselves and deliver education and outreach services. This was further amplified during the AIDS crisis and the Thatcherite era where drug users were involved in developing what later became the model for the public health approach to substance use. Drug user engagement with the government was strengthened during the New Labour government with the formation of the National Treatment Authority. Outside of government, drug users formed alliances which were crucial in ensuring accountability from the government. Upon the abolishment of the NTA, the organisations of drug users weakened. Drug user activists continued their initiatives, albeit on a smaller scale, while trying to rebuild the drug user movement. Further forms of documentation are needed to develop a more holistic historical account of drug user activism in the UK.

Background The increasing hospitalization expenses for Gastric Cancer (GC) impose a notable economic burden on society. Although the Chinese government has implemented the Universal Zero Markup Drug Policy (UZMDP) to control the growth of hospitalization expenditures, costs have continued to rise. Identifying the factors influencing the hospitalization expenses of GC patients is crucial. This study aimed to analyze the trends and factors influencing hospitalization expenses of GC patients in Shanghai from 2014 to 2021. Methods Data were sourced from the Health Network of Shanghai Economic Information Center. We employed interrupted time series analysis (ITSA) to analyze the trends in various medical expenditures before and after the implementation of the UZMDP. The degree of association between various medical expenditures and hospitalization expenditures of GC patients was calculated by using the new grey relational analysis (GRA). Furthermore, multiple linear regression was employed to identify the influencing factors. Results A total of 23,335 participants were included in this study. The ITSA results showed an increasing trend in hospitalization expenses following the implementation of UZMDP. Drug expenses decreased immediately post-UZMDP, but subsequently began to rise over time. Post-UZMDP, the expenses of medical consumables, examination, and healthcare services all showed an upward trend. The new GRA indicated that the influencing factors of hospitalization expenses, in order of importance, were expenses for drugs, consumables, healthcare services, and examination. Multivariable linear regression analysis revealed that GC patients aged 60 or below incurred lower hospitalization expenses (Coefficient = -780.06, P  = 0.0398). However, factors associated with increased hospitalization expenses included longer length of stay (Coefficient = 1753.01, P  < 0.001), surgeries (Coefficient = 29,047.26, P  < 0.001), and hospitalization in the tertiary hospitals (Coefficient = 25,485.19, P  < 0.001) or secondary hospitals (Coefficient = 17,755.12, P  < 0.001). Conclusions Hospitalization expenses of GC patients in Shanghai have been rising annually from 2014 to 2021. Despite the implementation of the UZMDP, drug expenses remain a major factor in escalating hospitalization expenses. The hospitalization expenses of GC patients are significantly influenced by several factors, including the demographic characteristics of patients, the severity of diseases, and the levels of hospitals. These findings provide a basis for more effective management of the hospitalization expenses for GC patients.

\"January, 2015 will mark a century of the war on drugs in the United States: one hundred years since the first arrests under the Harrison Act. Facing down this anniversary, Johann Hari was witnessing a close relative and an ex-boyfriend bottoming out on cocaine and heroin. But what was the big picture in the war on drugs? Why does it continue, when most people now think it has failed? The reporter set out on a two-year, 20,000-mile journey through the theater of this war--to find out how it began, how it has affected people around the world, and how we can move beyond it. Chasing the Scream is fueled by dramatic personal stories of the people he meets along the way: A transsexual crack dealer in Brooklyn who wanted to know who killed her mother, and a mother in Mexico who spent years tracking her daughter's murderer across the desert. A child smuggled out of the Jewish ghetto during the Holocaust who helped unlock the scientific secrets of addiction. A doctor who pushed the decriminalization in Portugal of all drugs - from cannabis to crack. The title itself comes from a formative story of Harry Anslinger, first commissioner of the Federal Bureau of Narcotics, sent as a boy to the pharmacy for a neighbor screaming in withdrawal -- an experience which led him to fear drugs without regard to context. Always we come back to the front lines in the U.S., where we instigated the war and exported it around the globe, but where change is also coming. Powerful, propulsive, and persuasive, Chasing the Scream is the page-turning story of a century-long mistake, which shows us the way to a more humane future\"-- Provided by publisher.

Globally, punitive drug control upholds racist and colonial structures. Marginalised and racialised communities, including Indigenous peoples, are disproportionately targeted and affected by punitive drug policy in law enforcement, judicial and carceral systems, and policy implementation. Power imbalances also exist at the international level, with high income countries exerting influence over drug policy in low- and middle-income countries. This paper examines that influence through financial and material aid, technical assistance, capacity building, education and awareness campaigns and the interaction between the vested interests of the private sector and the State, specifically via the Prison Industrial Complex and land and resource grabbing in conflict and post-conflict contexts. The global war on drugs entrenches power imbalances and reproduces mechanisms of racial control and subordination. To begin to decolonise drug policy, the financial and material basis of these mechanisms must be illuminated and dismantled and this paper offers recommendations on how to move forward (Dangerous Drugs Ordinance, 1923; Carrier et al., 2020).

The zero-markup drug policy (ZMDP) was heralded as the biggest reform to China’s modern health system. However, there have been a very limited number of investigations of the ZMDP at county hospital level, and those limited county hospital studies have several limitations in terms of sample representativeness and study design. We investigated the overall and dynamic effects of ZMDP at traditional Chinese medicine (TCM) county hospitals. We obtained longitudinal data from all TCM county hospitals in 2004–16 and the implementation year of ZMDP for each hospital. We used differences-in-difference methods to identify the overall and dynamic effects of ZMDP. On average, the ZMDP reform was associated with the reduction in the share of revenue from drug sales (3.1%), revenue from western medicines sales (12.7%), revenue from medical care services (3.6%) and gross hospital revenue (3.4%), as well as increased government subsidies (24.4%). The ZMDP reform was not significantly associated with the number of annual outpatient and inpatient visits. In terms of dynamic effects, the share of revenue from drug sales decreased by 2.5% in the implementation year and by about 5% in the subsequent years. Revenue from western medicine sales fell substantially in the short term and continued to drop in the long term. Government subsidies went up strikingly in the short term and long term, and revenue from medical care services and gross revenue decreased only in the implementation year. The ZMDP achieved its stated goal through reducing the share of revenue from drug sales without disrupting the availability of healthcare services at TCM county hospitals. The success of ZMDP was mainly due to the huge growth in the government’s financial investment in TCM hospitals.