Suchergebnisse

ObjectivesIllegal drug use continues to be a major threat to community health and safety. We used international drug surveillance databases to assess the relationship between multiple long-term estimates of illegal drug price and purity.DesignWe systematically searched for longitudinal measures of illegal drug supply indicators to assess the long-term impact of enforcement-based supply reduction interventions.SettingData from identified illegal drug surveillance systems were analysed using an a priori defined protocol in which we sought to present annual estimates beginning in 1990. Data were then subjected to trend analyses.Main outcome measuresData were obtained from government surveillance systems assessing price, purity and/or seizure quantities of illegal drugs; systems with at least 10 years of longitudinal data assessing price, purity/potency or seizures were included.ResultsWe identified seven regional/international metasurveillance systems with longitudinal measures of price or purity/potency that met eligibility criteria. In the USA, the average inflation-adjusted and purity-adjusted prices of heroin, cocaine and cannabis decreased by 81%, 80% and 86%, respectively, between 1990 and 2007, whereas average purity increased by 60%, 11% and 161%, respectively. Similar trends were observed in Europe, where during the same period the average inflation-adjusted price of opiates and cocaine decreased by 74% and 51%, respectively. In Australia, the average inflation-adjusted price of cocaine decreased 14%, while the inflation-adjusted price of heroin and cannabis both decreased 49% between 2000 and 2010. During this time, seizures of these drugs in major production regions and major domestic markets generally increased.ConclusionsWith few exceptions and despite increasing investments in enforcement-based supply reduction efforts aimed at disrupting global drug supply, illegal drug prices have generally decreased while drug purity has generally increased since 1990. These findings suggest that expanding efforts ...

BackgroundAs of 2021, 21 US states and territories allowed recreational cannabis use. Although previous research has identified an overall increase in prevalence of cannabis use after legalization, it has been less clear how this change will affect different parts of the population, including older adults, and specifically Baby Boomers, born 1946-1964, given their historically higher rates of use and a higher prevalence of comorbid conditions that could be either exacerbated or addressed by cannabis use. In this study we assessed whether implementation of recreational retail sales in California was associated with increased prevalence of cannabis use among Baby Boomers.MethodsWe conducted a retrospective study of cannabis use prevalence one year before and after the implementation of recreational retail sales in California using the California Health Interview Survey (CHIS), a statewide public health surveillance dataset.ResultsWe found that cannabis use prevalence did not change among Baby Boomers but increased among non-Baby Boomers. Most of the factors found to be predictive of cannabis use in past research did not predict cannabis use among Baby Boomers.ConclusionsBaby Boomers did not change their consumption of cannabis in the first year after opening the retail market, despite previous research suggesting that cannabis consumption increases with access, and most previously identified predictors of use did not identify people who use cannabis in this generation. Further research is needed to determine whether these effects persist over time.

The National Institute on Drug Abuse (NIDA) was formed in September, 1973 from a Division of the National Institute on Mental Health (NIMH), from the three-decade old Addiction Research Center (ARC) in Lexington Kentucky, and from the two year old Special Action Office for Drug Abuse Prevention (SAODAP), the original White House drug office. The legislation authorizing NIDA was passed by both Houses of Congress and signed by the president with bipartisan unanimity in response to the drug abuse epidemic, which had begun in the late 1960s. NIDA was the embodiment of the new Federal drug abuse strategy that, for the first time, balanced the traditional focus on law enforcement (supply reduction) with a new focus on treatment, prevention, and research (what became known as demand reduction). The current article offers a review of the early history of NIDA and its implications for future research.

BACKGROUND:As countries embark on public health-oriented drug law reform, health impact evaluations are needed. In 2012, Mexico mandated the narcomenudeo reform, which depenalised the possession of small amounts of drugs and instituted drug treatment instead of incarceration. We investigated the past and future effect of this drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico. METHODS:In this epidemic modelling study, we used data from the El Cuete IV cohort study to develop a deterministic model of injecting and sexual HIV transmission in people who inject drugs in Tijuana between 2012 and 2030. The population was stratified by sex, incarceration status, syringe confiscation by the police, HIV stage, and exposure to drug treatment or rehabilitation (either opioid agonist treatment or compulsory drug abstinence programmes). We modelled the effect of these exposures on HIV risk in people who inject drugs, estimating the effect of observed and potential future reform enforcement levels. FINDINGS:In 2011, prior to the narcomenudeo reform, 547 (75%) of 733 people who inject drugs in the El Cuete cohort reported having ever been incarcerated, on average five times since starting injecting. Modelling estimated the limited reform implementation averted 2% (95% CI 0·2-3·0) of new HIV infections in people who inject drugs between 2012 and 2017. If implementation reduced incarceration in people who inject drugs by 80% from 2018 onward, 9% (95% CI 4-16) of new HIV infections between 2018 and 2030 could be averted, with 21% (10-33) averted if people who inject drugs were referred to opioid agonist treatment instead of being incarcerated. Referral to compulsory drug abstinence programmes instead of prison could have a lower or potentially negative impact with -2% (95% CI -23 to 9) infections averted. INTERPRETATION:Mexican drug law reform has had a negligible effect on the HIV epidemic among people who inject drugs in Tijuana. However, appropriate implementation could markedly reduce HIV incidence if linked to opioid agonist treatment. Unfortunately, compulsory drug abstinence programmes are the main type of drug rehabilitation available and their expansion could potentially increase HIV transmission. FUNDING:National Institute on Drug Abuse, UC San Diego Center for AIDS Research.

Purpose: This study assessed the knowledge, attitudes, and practices of managers of Hispanic-occupied multiunit housing (MUH) related to the prevalence and prevention of secondhand smoke (SHS), thirdhand tobacco smoke, and secondhand marijuana smoke (SHMS). Methods: A narrative analysis was conducted of 20 interviews with live-in apartment managers. Their opinions on policies and an educational fotonovela were also gathered. Results: The properties were located in 10 cities within the Los Angeles County, representing a wide array of local policies and practices. Only two managers were correctly informed of the existing MUH smoking policies in their cities. Participants reported ambiguity in city laws and company rules regarding smoking. Managers do not distinguish between smoking recreational marijuana and medicinal marijuana. Several respondents believed the landlords have more power to create rules. Most favored a total ban on smoking of all substances on the premises. Conclusions: Most managers report low agency in being able to pass no-smoking rules. Participants support smoking policies that include all smokable products. Managers would like new government policies, manager trainings, tenant education, and ways to enforce rules to protect apartment tenants from SHS and SHMS. Educational interventions should coincide with the timing of key manager/tenant activities. Results can be used in policy development and educational interventions.

BackgroundAs countries embark on public health-oriented drug law reform, health impact evaluations are needed. In 2012, Mexico mandated the narcomenudeo reform, which depenalised the possession of small amounts of drugs and instituted drug treatment instead of incarceration. We investigated the past and future effect of this drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico.MethodsIn this epidemic modelling study, we used data from the El Cuete IV cohort study to develop a deterministic model of injecting and sexual HIV transmission in people who inject drugs in Tijuana between 2012 and 2030. The population was stratified by sex, incarceration status, syringe confiscation by the police, HIV stage, and exposure to drug treatment or rehabilitation (either opioid agonist treatment or compulsory drug abstinence programmes). We modelled the effect of these exposures on HIV risk in people who inject drugs, estimating the effect of observed and potential future reform enforcement levels.FindingsIn 2011, prior to the narcomenudeo reform, 547 (75%) of 733 people who inject drugs in the El Cuete cohort reported having ever been incarcerated, on average five times since starting injecting. Modelling estimated the limited reform implementation averted 2% (95% CI 0·2-3·0) of new HIV infections in people who inject drugs between 2012 and 2017. If implementation reduced incarceration in people who inject drugs by 80% from 2018 onward, 9% (95% CI 4-16) of new HIV infections between 2018 and 2030 could be averted, with 21% (10-33) averted if people who inject drugs were referred to opioid agonist treatment instead of being incarcerated. Referral to compulsory drug abstinence programmes instead of prison could have a lower or potentially negative impact with -2% (95% CI -23 to 9) infections averted.InterpretationMexican drug law reform has had a negligible effect on the HIV epidemic among people who inject drugs in Tijuana. However, appropriate implementation could markedly reduce HIV incidence if ...

Intro -- Contents -- Preface -- Chapter 1 -- Opioid Treatment Programs and Related Federal Regulations( -- Summary -- Medication-Assisted Treatment (MAT) -- Methadone -- Buprenorphine -- Naltrexone -- Regulatory Framework -- Federal Food, Drug, and Cosmetic Act (FFDCA) -- Controlled Substances Act (CSA) -- Opioid Treatment Programs (OTPs) -- OTP Accreditation -- OTP Certification -- OTP Registration -- DATA-Waived Providers (DWPs) -- Practitioner Requirements -- Medication Requirements -- Chapter 2 -- Increase in Illicit Fentanyl Overdose Deaths* -- Summary -- What Is Fentanyl? -- Rise of Fentanyl Overdoses -- Availability of Fentanyl -- Policy Considerations -- Chapter 3 -- The Opioid Epidemic and the Food and Drug Administration: Legal Authorities and Recent Agency Action( -- Summary -- FDA Approval of Prescription Drugs and the Challenges of Opioids -- FDA Authority and Recent Agency Action Related to the Opioid Epidemic -- Decreasing Exposure and Preventing New Addiction -- Supporting the Treatment of Those with Opioid Use Disorder -- Fostering the Development of Novel Pain Treatment Therapies -- Improving Enforcement and Assessing Benefit Risk -- Selected Opioid-Related Bills in the 115th Congress That Would Amend the FD&C Act -- Chapter 4 -- High Intensity Drug Trafficking Areas (HIDTA) Program( -- Summary -- HIDTA Designations -- Coordination -- Funding -- HIDTA Issues for Consideration -- Unit of Inclusion -- County-Level Drug Trafficking Data -- Criteria for Inclusion -- Program Effectiveness -- Program Scope -- Use of Funds for Treatment and Prevention Initiatives -- Heroin Response Strategy -- HIDTA as an ONDCP Component -- Chapter 5 -- Legal Authorities Under the Controlled Substances Act to Combat the Opioid Crisis( -- Summary -- Brief Background on the Opioid Epidemic -- Overview of the CSA

ImportanceAs marijuana continues to be legalized in many states, little is known about best regulatory practice, exposing the population to significant potential harm.ObjectiveTo assess the extent to which potential best practices, including those from tobacco control, were incorporated into state and local marijuana policies in California.Design and settingCalifornia legalized medical marijuana in 1996 and adult recreational use in 2016, effective in January 2018. A cross-sectional study with data collection and analysis from February 1 to November 30, 2019, measured the adoption of potential demand reduction and youth protection best practices, including restrictions on sales, products, marketing, warnings, and taxation. Laws in effect by January 31, 2019, were verified and all 539 California local jurisdictions were studied.Main outcomes and measuresAdoption of potential best practices in marijuana laws for demand reduction and youth protection.ResultsThe laws of 534 of California's 539 jurisdictions (99%) were successfully identified; 263 of these 534 jurisdictions (49%) allowed any retail sale of marijuana, covering 57% of the state's population. More than one-third of jurisdictions allow sales of marijuana for adult recreational use (203 of 534 [38%]); of those, 122 allow storefront dispensaries and 81 allow sales by delivery only. A total of 257 of 534 jurisdictions (48%) allow medical sales. Of 147 jurisdictions allowing medical or adult use dispensaries, 93 (63%) limited the number of licenses, with a mean of 1 store for every 19 058 residents (range, 154-355 143). The state imposed no limits on number of dispensaries or deliverers. Forty-two jurisdictions increased the state-specified distances required between dispensaries and schools. Only 8 jurisdictions allowing retail sales imposed restrictions on products exceeding state regulations; 1 prohibited sale of flavored products, 3 prohibited sale of marijuana-infused beverages, and 5 imposed additional restrictions on edible marijuana products. No jurisdictions limited potency of products sold, although 1 established a potency-linked tax. The state did not limit or tax potency, except for establishing a standard 10-mg dose of tetrahydrocannabinol for edible marijuana products, nor did they limit manufacturing or sale of flavored products. The state required only a health warning in 6-point font on packages. Twenty-seven jurisdictions required additional health warnings in stores or on packages, 27 allowed onsite consumption of marijuana products, and 13 allowed marijuana-related events. More than half of jurisdictions legalizing any cannabis commerce (154 of 289 [53%]) did not tax marijuana locally and little revenue was captured for prevention. Much of the state excise and cultivation taxes is slated for youth substance use prevention and treatment.Conclusions and relevanceIn implementing legalization of marijuana in California, local policies varied widely. Where marijuana was legalized, many lessons from tobacco control to reduce demand, limit harm, and prevent youth use were not adopted, potentially creating greater risk of harm.