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Adam R. Winstock

Purpose The COVID-19 pandemic likely impacted cannabis distribution, access and usage worldwide. This study aims to describe self-reported changes in cannabis use and related outcomes following COVID-19-related restrictions among an... more
Purpose The COVID-19 pandemic likely impacted cannabis distribution, access and usage worldwide. This study aims to describe self-reported changes in cannabis use and related outcomes following COVID-19-related restrictions among an international sample of people who use drugs. Design/methodology/approach Using data from the Global Drug Survey COVID-19 Special Edition, the authors identified 20,417 respondents from 13 countries who reported whether the number of THC-containing cannabis usage days changed compared with February 2020 (before COVID-19 restrictions). Using descriptive statistics and a multinomial multivariable logistic regression, the authors investigated the impact of changes in cannabis use on respondents’ mental health, physical health, relationships, finances, work/study performance and cannabis-related pleasure/enjoyment. Findings Similar proportions of respondents reported that their cannabis use had stayed the same (38.2%) or increased (38.3%) compared with February 2020, while 21.9% of respondents reported a decrease. The most common reason for increased use was having more time (68.4%), while decreased use was associated with having less contact with people they use cannabis with (58.4%). The likelihood of reporting worse mental and physical health, finances, and work/study performance following COVID-19 restrictions was highest among those who reported increased cannabis use. Research limitations/implications These findings provide a unique understanding of the short-term international impact of initial COVID-19 restrictions on cannabis use, and highlight the need for policy to address the ongoing and improved provision of evidence-based mental health and other support for people who frequently use cannabis. Originality/value To the best of the authors’ knowledge, this is the world’s largest international study exploring the impacts of these changes in cannabis use following initial COVID-19 restrictions on individuals’ mental health, physical health, relationships, finances, work/study performance and cannabis-related pleasure. This study is also unique in comparing these changes across multiple continents.
Past research into illicit online markets suggests that trust is produced by governance, reputation systems and the formation of social ties. In this paper, we draw on accounts of abstract and institutional trust, examining whether using... more
Past research into illicit online markets suggests that trust is produced by governance, reputation systems and the formation of social ties. In this paper, we draw on accounts of abstract and institutional trust, examining whether using a market is associated with general positive beliefs about product quality. Using data from the 2018 Global Drug Survey (n = 25,471) we utilize propensity score matching and multilevel linear regression to examine the association between having purchased drugs online and general expectations about product quality in value, weight, purity and price. We find strong evidence of a positive association between general beliefs and individual experience. This suggests that trust in illicit online markets can extend beyond interpersonal relations and towards an abstract market.
The Global Drug Survey (GDS) runs the world’s largest online drug survey. It utilises an online, self-completed, anonymous survey which has been conducted annually since 2012. GDS is translated into multiple languages and is promoted... more
The Global Drug Survey (GDS) runs the world’s largest online drug survey. It utilises an online, self-completed, anonymous survey which has been conducted annually since 2012. GDS is translated into multiple languages and is promoted through partnerships with media organisations, harm reduction organisations and social media networks. The GDS data are drawn from a\ua0population of self-selected respondents and, to date, despite\ua0the fact that the sampling is not probability based, our papers\ua0have been published in a variety of high-impact journals
Background The initial period of COVID-19-related restrictions affected substance use in some population groups. We explored how changes in alcohol use at the beginning of the pandemic impacted the health and wellbeing of people with and... more
Background The initial period of COVID-19-related restrictions affected substance use in some population groups. We explored how changes in alcohol use at the beginning of the pandemic impacted the health and wellbeing of people with and without mental health and neurodevelopmental conditions (MHDCs). Methods Data came from the Global Drug Survey Special Edition on COVID-19 conducted in May-June 2020. Measured were; changes in drinking compared to February 2020 (pre-COVID-19 restrictions), reasons for changes, and impact on physical health, mental health, relationships, finances, work/study, and enjoyment. This study included 38,141 respondents (median age = 32 IQR 25-45; 51.9% cis man; 47.8% cis woman; 1.2% trans/non-binary; 30.2% with MHDCs e.g. depression 20.0%, anxiety 16.3%, ADHD 3.8%, PTSD 3.3%). Results A third (35.3%) of respondents with MHDCs and 17.8% without MHDCs indicated that increased drinking affected their mental health negatively (p<.001); 44.2% of respondents with MHDCS compared to 32.6% without MHDCs said it affected their physical health negatively (p<.001). Reduced drinking was associated with better mental health among a fifth (21.1%) of respondents with MHDCS and 14.4% without MHDCs (p<.001). Age, relationship status, living arrangements, employment, coping and distress were significant predictors of increases in drinking. Conclusion Among people with MHDCS, reduced alcohol consumption was associated with better mental health, while the negative effects of increased drinking were more pronounced when compared to people without MHDCS. When supporting people in reducing alcohol consumption during uncertain times, people with MHDCS may need additional support, alongside those experiencing greater levels of distress.
Introduction and AimsThe illicit manufacture of methamphetamine in clandestine laboratories is associated with significant risks to the community and environment. Currently little is known about clandestine laboratories or the individual... more
Introduction and AimsThe illicit manufacture of methamphetamine in clandestine laboratories is associated with significant risks to the community and environment. Currently little is known about clandestine laboratories or the individual ‘cooks’ who operate them; current research directly engaging with cooks is limited to three qualitative studies with small samples (n < 24) of cooks based in the USA. This descriptive brief report starts to address this knowledge gap by exploring characteristics of an international sample of self‐identified methamphetamine cooks.Design and MethodsUsing data from the 2017 and 2018 Global Drug Surveys, we identified 125 individuals from 24 countries who reported past manufacture of methamphetamine. We explored respondents' socio‐demographic characteristics and patterns of methamphetamine production using descriptive statistics.ResultsThe majority of methamphetamine cooks were male (82%) and Caucasian (70%) and, contrary to previous studies, 43%...
La Global Drug Survey est une enquete en ligne visant a etudier l’experience des usagers de drogues en population generale, menee chaque annee entre novembre et decembre. Ce volet special Covid-19 a ete realise sur sept semaines, de mai a... more
La Global Drug Survey est une enquete en ligne visant a etudier l’experience des usagers de drogues en population generale, menee chaque annee entre novembre et decembre. Ce volet special Covid-19 a ete realise sur sept semaines, de mai a juin 2020. L’enquete avait comme objectif d’explorer de maniere retrospective l’impact du confinement et des premieres semaines du deconfinement sur les consommations de produits psychoactifs en population generale. Les resultats de l’enquete mettent en evidence une augmentation du nombre de jours de consommation d’alcool, mais pas d’augmentation du binge drinking. Pour le cannabis, les usages sont restes relativement stables, meme si une augmentation relative en comparaison aux autres pays est observee. Les usages d’ecstasy et de cocaine ont baisse tout particulierement. Enfin, les benzodiazepines ont vu leur usage augmenter. La Global Drug Survey note que la pandemie a modifie les usages de produits psychoactifs, sans qu’une augmentation des conduites deregulees ne soit observee. Les usagers ont adapte leurs pratiques en fonction des modifications relatives a leur environnement de vie.
Background: Microdosing psychedelics is the practice of taking small, sub-hallucinogenic doses of lysergic acid diethylamide or psilocybin-containing mushrooms. Despite its surging popularity, little is known about the specific intentions... more
Background: Microdosing psychedelics is the practice of taking small, sub-hallucinogenic doses of lysergic acid diethylamide or psilocybin-containing mushrooms. Despite its surging popularity, little is known about the specific intentions to start microdosing and the effects of this practice. Aims: First, we aimed to replicate previous findings regarding the subjective benefits and challenges reported for microdosing. Second, we assessed whether people who microdose test their substances before consumption. Third, we examined whether having an approach-intention to microdosing was predictive of more reported benefits. Methods: The Global Drug Survey runs the world’s largest online drug survey. Participants who reported last year use of lysergic acid diethylamide or psilocybin in the Global Drug Survey 2019 were offered the opportunity to answer a sub-section on microdosing. Results: Data from 6753 people who reported microdosing at least once in the last 12 months were used for anal...
Background: Microdosing psychedelics – the practice of taking small, sub-hallucinogenic doses of substances like LSD or psilocybin-containing mushrooms – is becoming increasingly popular. Despite its surging popularity, little is known... more
Background: Microdosing psychedelics – the practice of taking small, sub-hallucinogenic doses of substances like LSD or psilocybin-containing mushrooms – is becoming increasingly popular. Despite its surging popularity, little is known about the effects of this practice. Aims: This research had three main aims. First, we attempted to replicate previous findings regarding the subjective benefits and challenges reported for microdosing. Second, we assessed whether people who microdose test their substances for purity before consumption. Third, we examined whether having an approach-intention to microdosing was predictive of more reported benefits. Methods: The Global Drug Survey (GDS) runs the world’s largest drug survey. Participants who reported last year use of LSD or psilocybin in GDS2019 were offered the opportunity to answer a sub-section on microdosing.Results: Data from 6,753 people who reported microdosing at least once in the last 12 months were used for analyses. Our result...
One of the barriers to drug policy analysis and reform is uncertainty as to the effects of possible policy changes (Shanahan & Ritter, 2012). This paper will use datafrom the Global Drug Survey to examine potential effects of policy... more
One of the barriers to drug policy analysis and reform is uncertainty as to the effects of possible policy changes (Shanahan & Ritter, 2012). This paper will use datafrom the Global Drug Survey to examine potential effects of policy changes in both the UK and Australian drug markets, based on responses on intended behaviour changes from a sample of over 6,500 self-reported drug users (aged over 16) in each country. The Global Drug Survey is an independent online survey that accesses large samples by collaborating with global media partners such as The Guardian, Mixmag and Gay Times in the UK and Fairfax Media in Australia. It asks respondents to report their drug use and includes questions on how people would change their behaviours in response to three potential policy scenarios which are based on: decriminalisation; legalisation of possession; or legalisation with sale by government monopoly. The paper presents information on the demographics of GDS respondents. It uses latent class analysis to group these respondents according to classes of drug use type that underlie the data. It then analyses the extent to which GDS respondents reported an intention to increase use in response to the different policy scenarios. It analyses differences in these intentions to increase drug use across the policy scenarios and across the classes of drug user. Finally, it uses multinomial regression analysis to test the predictors of observed differences in intentions to increase drug use. These analyses suggest that a minority of GDS respondents would increase their illicit drug use (and reduce their alcohol use) under more lenient policy scenarios. Intentions to increase drug use tended to increase under progressively more lenient policy scenarios. People whose pattern of substance use is ‘alcohol only’ (i.e. the largest group in the general population of both UK and Australia) were less likely to report an intention to increase their drug use. GDS respondents in both countries who were male, gay or bisexual, or young were more likely to report an intention to increase drug use.
Aims This exploratory study aims to model the impact of sex and age on the percentage of pre-drinking in 27 countries, presenting a single model of pre-drinking behaviour for all countries and then comparing the role of sex and age on... more
Aims This exploratory study aims to model the impact of sex and age on the percentage of pre-drinking in 27 countries, presenting a single model of pre-drinking behaviour for all countries and then comparing the role of sex and age on pre-drinking behaviour between countries. Methods Using data from the Global Drug Survey, the percentages of pre-drinkers were estimated for 27 countries from 64,485 respondents. Bivariate and multivariate multilevel models were used to investigate and compare the percentage of pre-drinking by sex (male and female) and age (16–35 years) between countries. Results The estimated percentage of pre-drinkers per country ranged from 17.8% (Greece) to 85.6% (Ireland). The influence of sex and age on pre-drinking showed large variation between the 27 countries. With the exception of Canada and Denmark, higher percentages of males engaged in pre-drinking compared to females, at all ages. While we noted a decline in pre-drinking probability among respondents in ...
Individuals who use anabolic-androgenic steroids (AAS) may engage in concurrent psychoactive drug use recreationally and/or as an additional training aid. Aside from cannabis, individuals who use AAS most commonly report concurrent use of... more
Individuals who use anabolic-androgenic steroids (AAS) may engage in concurrent psychoactive drug use recreationally and/or as an additional training aid. Aside from cannabis, individuals who use AAS most commonly report concurrent use of stimulants such as amphetamines and cocaine. In this study, we examine demographic characteristics, frequency of heavy drinking, and nightclubbing in a sample of 993 men from the Global Drug Survey 2015 who reported both AAS and psychoactive drug use before exploring the relationship between motivation for AAS use and the propensity to concurrently engage with stimulant-type substances. Results of a logistic regression analysis suggest that the propensity for concurrent use of AAS and stimulants is greater when AAS use is motivated by weight loss goals, while performance goals are associated with reduced odds of concurrent stimulant use. Identifying individuals who are at risk of polydrug use and associated harms can inform targeted harm reduction ...

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Objectives: We examined protective and non-protective effects of disadvantaged social identities and their intersections on lifetime substance use and risky alcohol consumption. Methods: Data from 90,941 participants of the Global Drug... more
Objectives: We examined protective and non-protective effects of disadvantaged social identities and their intersections on lifetime substance use and risky alcohol consumption. Methods: Data from 90,941 participants of the Global Drug Survey 2015 were analysed. Multivariable logistic regressions were used to calculate adjusted odds ratios for lifetime use of nine psychoactive substances, as well as high-risk/harmful alcohol use. Disadvantaged identities from three categories (ethnicity, sexual identity, gender), and interactions between these were compared. Results: Findings indicate that participants with disadvantaged ethnic and sexual minority identities are more likely to use psychoactive substances compared to their counterparts. The intersecting identity ‘disadvantaged ethnic identity and sexual minority’ appears to be protective compared to those with just one of these identities. While female gender appears to be highly protective in general, it is not protective among females with disadvantaged social identities. Conclusions: Stark disparities in substance use between different social identities and their intersections emphasise the importance of intersectionality theories in public health research intervention design. Future research on health equity, particularly substance use, should target individuals with intersecting identities.
Research Interests: