The International journal on drug policy
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Int. J. Drug Policy · Dec 2019
Comparative StudyComparing Canadian and United States opioid agonist therapy policies.
Canada and the United States (U. S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT)-buprenorphine (with and without naloxone) and methadone. ⋯ The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U. S. policymakers and health officials could consider adopting Canada's regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.
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Int. J. Drug Policy · Dec 2019
Associations between perceived illicit fentanyl use and infectious disease risks among people who inject drugs.
Over the last several years, fentanyl has been introduced into the illicit drug supply in the United States. While the impact of fentanyl on overdose fatalities is clear, the increase in fentanyl use may also be affecting drug use practices with implications for infectious disease transmission. We conducted a cross-sectional survey to explore associations of perceived illicit fentanyl use with opioid use frequency, injection frequency and syringe sharing among people who inject drugs in two California cities. ⋯ People reporting perceived illicit fentanyl use were at increased risk for injection-related infectious disease risks. Actions must be taken to reduce these risks, including improved access to syringe service programs and opioid treatment and consideration of innovative approaches, such as supervised consumption services.
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Int. J. Drug Policy · Dec 2019
Evidence that social-economic factors play an important role in drug overdose deaths.
Drug overdose deaths in the United States increased from approximately 16,000 per year in 2001 to 41,000 per year in 2014. Although every US state witnessed an increase, the increases were much larger in some states than others. There was also variation as a function of race and ethnicity. Non-Hispanic Whites accounted for more than 80% of the deaths, and in some states their rates were about ten times greater per capita than Hispanic and Non-White rates. State and temporal differences provide an opportunity to evaluate explanations of what is driving drug overdose deaths. In this report, we evaluate the degree to which state level variation in opioid prescription rates and social-economic conditions explain state level variation in overdose death rates. ⋯ Common variation in opioid prescriptions rates, social capital, and work force participation proved the strongest predictor of drug overdose deaths in Non-Hispanic Whites. We discuss reasons why the same did not hold for the Hispanic/Non-White population.
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Int. J. Drug Policy · Dec 2019
Supply of codeine combination analgesics from Australian pharmacies in the context of voluntary real-time recording and regulatory change: A simulated patient study.
In recent years there have been growing concerns regarding non-prescription codeine use in Australia. Efforts to mitigate risks associated with non-prescription codeine, such as addiction and toxicity, have been primarily through two initiatives; regulatory changes restricting their availability, and voluntary live-recording supply of non-prescription codeine combination analgesics (CCAs). This study sought to explore the supply of CCAs in the climate of regulatory change. ⋯ Mandatory legislative regulation of pharmacist supply of non-prescription codeine was more likely to be complied with than voluntary recording. Compliance with pharmacist supply for DPRs appeared to improve following the announcement of regulatory change to prescription-only, whereas voluntary recording of supply did not appear to change.
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Int. J. Drug Policy · Dec 2019
Prescription drug monitoring programs operational characteristics and fatal heroin poisoning.
Prescription drug monitoring programs (PDMP), by reducing access to prescribed opioids (POs), may contribute to a policy environment in which some people with opioid dependence are at increased risk for transitioning from POs to heroin/other illegal opioids. This study examines how PDMP adoption and changes in the characteristics of PDMPs over time contribute to changes in fatal heroin poisoning in counties within states from 2002 to 2016. ⋯ There is a consistent, positive association between state PDMP adoption and heroin poisoning mortality. However, this varies by PDMP type, with Proactive PDMPs associated with a small reduction in heroin poisoning deaths. This raises questions about the potential for PDMPs to support efforts to decrease heroin overdose risk, particularly by using proactive alerts to identify patients in need of treatment for opioid use disorder. Future research on mechanisms explaining the reduction in heroin poisonings after enactment of Proactive PDMPs is merited.