Background: Despite increased awareness of the significant health and healthcare inequalities experienced by minoritised groups, limited research considers the interaction of multiple domains of social disadvantage. This review therefore sought to explore how LGBTQ + adults’ experiences of homelessness, substance use, and criminal justice involvement impact upon their access to and use of health and social care services in the UK and Ireland. Methods: A qualitative scoping review was conducted in accordance with the PRISMA-ScR framework. Electronic database and web searches identified 26 eligible peer-reviewed and grey literature documents published between 2010–2024. The data were charted, coded, and knowledge gaps identified. Results: Data were coded thematically, clustered around the concept of normativity. Descriptive qualitative techniques were applied to explore how this was enacted and experienced. Synthesis across the literature identified experiences of discrimination and anticipated stigma that acted as barriers to accessing and engaging with services. Conclusions: Structural normativity and the privilege afforded to hegemonic population groups impacted upon this population’s access to and use of services. The review adds depth and context to questions around the lack of visibility or engagement in services by LGBTQ + people with experience of disadvantage, and contributes to the wider literature on improving service access for marginalised, underserved, or disadvantaged communities.

This paper describes the history of the development of taxonomies of psychoactive drug use, and discusses the conceptualization of three recent taxonomies: comparing their features, and considering their application in education, treatment, and harm reduction settings. Firstly, the Drugs Wheel was created in 2012, prompted by the emergence of New Psychoactive Substances and rapid developments in their legislative control. It was created in collaboration with health professionals and trainers in the drugs field, people who use drugs, and harm reduction non-government organizations, as a learning tool for NPS. Secondly, by contrast, the Drug Pyramid was an academic creation published in 2016 that aimed to conceptualize the multitude of NPS then being developed at a rate of two per week, as primarily an educational project. Finally, building from limitations identified in the previous two models, the Drugs Venn was created by the authors for the purpose of this paper and in consultation with staff at a drug checking service provider, with the intention of future application in delivery of drug checking consultations. Viewed together, each model addresses objections raised to its predecessor, and in doing so highlights the multi-dimensional nature of taxonomies, and their potential for generation of further hypotheses.

Amphetamine-type stimulants (ATS) are the second most commonly used class of illicit drugs globally, yet there is limited understanding of which factors contribute to different pathways of ATS use. We sought to compare current, former, and exposed non-ATS users’ substance use, mental/physical health, and adverse life experiences. A cross-sectional survey, using computer-assisted personal interview software, was conducted between June 2018 and March 2019 in North East England. Quota-based sampling was used to recruit 389 individuals (aged 18 to 68; 52.6% male): 137 current ATS users; 174 former users; and 78 exposed non-users. Standardized screening questionnaires captured current/prior substance use. Participants self-reported diagnoses of selected physical and mental health disorders and specific adverse life experiences. Analysis used descriptive statistics and comparative tests (including chi-square, Kruskal–Wallis and Mann–Whitney U). Early exposure to illicit substances, challenging mental health, and certain adverse life experiences (such as growing up in statutory care) were more common in individuals currently using ATS compared to those who had never used or stopped using stimulants. Multi-level interventions are needed that address the mental health, social, and economic needs of people with dependent drug use. These could include targeted efforts to support children growing up under care, integrated mental health and substance use support, and joined-up substance use interventions reflective of wider structural factors.

People who use drugs are a highly stigmatized population. This study explored within-group stigma associated with the use of synthetic cannabinoid receptor agonists (SCRA) in a sample who accessed a support service in a large city in England. We used semi-structured interviews and a questionnaire that included two measures of stigma adapted for this population. Complete data were obtained from 42 participants (69.0% male, mean age 38.5 years). Increased contact with people who use SCRA (PWUS) was associated with reduced levels of stigma, and while qualitative data mirrored some stigmatizing views found in the wider population, mitigating factors such as the attribution of social and environmental influences on the use of SCRA were identified. While intersectional stigma was identified, for example between SCRA use, homelessness, or street activities such as begging, there was also evidence of mutual support within the service. Participants helped peers who were under the influence of SCRA, suggesting the role of safe environments in reducing harm for PWUS and for those who experience intersectional stigma. Aligned with intergroup contact and attribution theories, findings supported attempts to reduce SCRA-related stigma using peer educators, and the framing of substance use disorders from a viewpoint of social inequalities.

Background: Despite the evidence supporting the importance of spiritual health to people’s wellbeing across diverse fields of treatment, the topic of spiritual health is not currently mentioned in National Health Service (NHS) training materials for social prescribers. Previous research with social prescribers has identified a need for training around spiritual health in primary care. This study sought in-depth understanding of these training needs and how they may be met. Method: Semi-structured interview data specific to the subject of training needs were extracted from interview data from a wider study, which explored barriers and facilitators to spiritual health discussions within social prescribing. UK-based social prescribers aged 18 + working in primary care were recruited purposively from different geographic areas, with data collected between December and February of 2025. An inductive, iterative approach was taken to the thematic analysis of data. Results: Findings were generated from interviews with 12 participants with three main themes: the value and need for spiritual health training , approaches to training , and the value of learning from peers and patients . However, while social prescribers interviewed broadly recognised the benefits that spiritual health training could bring to their work with patients, there were some who did not feel this was relevant to their role. Conclusions: Participants identified how integrating spiritual health discussions into social prescribing improved not only patients’ health but also their own knowledge and skills. In-person training was widely felt to be appropriate for discussions around spiritual health. However, participants noted the limitations of one-off training sessions within this context, and highlighted the potential benefits of ongoing learning within the workplace. Peer learning appears to be a valuable and useful method of training for the topic of spiritual health, recognising social prescribers’ understanding of holistic health and focusing on the relevance of spiritual health to patients. Including the topic within NHS competency frameworks and training materials would also greatly support the relevance of spiritual health to social prescribing roles.