The International journal on drug policy
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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
Changes in Australian prescription opioid use following codeine rescheduling: A retrospective study using pharmaceutical benefits data.
In February 2018, Australia up-scheduled the 'weak' opioid codeine to a prescription only medication. This study aimed to analyse the change in prescribing trends for codeine and other commonly prescribed opioids in Australia following this policy change to determine if removal of over-the-counter codeine resulted in an increase in opioid prescribing. ⋯ Despite concerns, substitution of over-the-counter codeine with higher strength prescribed codeine has not been observed at a population level, nor has a shift to other prescribed opioids occurred. Overall, opioid prescribing in Australia has been decreasing since 2016, both for strong and weak opioids.
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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
A policy mapping analysis of goals, target populations, and punitive notions in the U.S. congressional response to the opioid epidemic.
The U.S. Congress has proposed numerous bills and resolutions in response to the opioid epidemic unfolding over the past decade. Although this legislative response has been the subject of considerable media attention and commentary, very little research has systematically analyzed congressional opioid-related legislation in terms of primary goals, focal populations, and the extent to which it includes punitive mechanisms. ⋯ This study represents the first systematic analysis of key features of the U.S. congressional response to the opioid epidemic. Results indicate that the legislative response has largely focused on acute intervention, with limited attention to upstream social determinants and goal areas such as long-term recovery support. While the legislative response is primarily non-punitive, most opioid-specific policy does not explicitly address the intersection of opioid misuse and addiction with salient social factors such as economic disinvestment and social isolation.
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Int. J. Drug Policy · Dec 2019
Attitudes and availability: A comparison of naloxone dispensing across chain and independent pharmacies in rural and urban areas in Alabama.
Fatal opioid overdoses remain the leading cause of accidental deaths in the United States, which have contributed to implementation of standing order laws that allow pharmacists to dispense naloxone to patients. Although pharmacy distribution of naloxone is a promising approach to increase access to this intervention, understanding barriers preventing greater uptake of this service is needed. ⋯ The current study demonstrates the lower availability of naloxone stocked at pharmacies in independent versus chain pharmacies, particularly in rural communities. This study also highlights several barriers preventing greater naloxone dispensing including pharmacists' attitudes and costs of naloxone. The potential benefit of standing order laws is not being fully actualized due to the structural and attitudinal barriers identified in this study. Strategies to increase naloxone access through pharmacy dispensing are discussed.