Amount of naloxone used to reverse opioid overdoses outside of medical practice in a city with increasing illicitly manufactured fentanyl in illicit drug supply

2018 ◽  
Vol 40 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Alice Bell ◽  
Alex S. Bennett ◽  
T. Stephen Jones ◽  
Maya Doe-Simkins ◽  
Leslie D. Williams
Keyword(s):  
Medical Practice ◽  
Illicit Drug ◽  
Drug Supply

Summary and conclusions

2018 ◽  
Author(s):  
Thomas F. Babor ◽  
Jonathan Caulkins ◽  
Benedikt Fischer ◽  
David Foxcroft ◽  
Keith Humphreys ◽  
...  
Keyword(s):  
International Organizations ◽  
Drug Policy ◽  
Drug Users ◽  
Illicit Drug ◽  
Supply And Demand ◽  
Unintended Consequences ◽  
Public Health Approach ◽  
Drug Supply ◽  
The Public ◽  
Balanced Approach

Among the 47 options reviewed in this book, most show some evidence of effectiveness in at least one country, but the evidence is less than definitive for many others, either because the interventions are ineffective, or the research is inadequate. Unfortunately, policies that have shown little or no evidence of effectiveness continue to be the preferred options of many countries and international organizations. The evidence reviewed in this book supports two overarching conclusions. First, an integrated and balanced approach to evidence-informed drug policy is more likely to benefit the public good than uncoordinated efforts to reduce drug supply and demand. Second, by shifting the emphasis toward a public health approach, it may be possible to reduce the extent of illicit drug use, prevent the escalation of new epidemics, and avoid the unintended consequences arising from the marginalization of drug users through severe criminal penalties.

Confirmed reports of bupropion sold as crack cocaine in the illicit drug supply

2021 ◽  
pp. 1-2
Author(s):  
Rachel S. Wightman ◽  
Earth Erowid ◽  
Fire Erowid ◽  
Sylvia Thyssen ◽  
Mary Wheeler ◽  
...  
Keyword(s):  
Crack Cocaine ◽  
Illicit Drug ◽  
Drug Supply

Auras of Detection: Power and Knowledge in Drug Prohibition

2021 ◽  
pp. 009145092110354
Author(s):  
Jennifer J. Carroll
Keyword(s):  
Law Enforcement ◽  
Knowledge Production ◽  
Illicit Drug ◽  
Drug Market ◽  
Epistemic Authority ◽  
People Who Use Drugs ◽  
Drug Supply ◽  
Political Implications ◽  
Starting Point ◽  
Drug Checking

Drug checking is an evidence-based strategy for overdose prevention that continues to operate (where it operates) in a legal “gray zone” due to the legal classification of some drug checking tools as drug paraphernalia—the purview of law enforcement, not public health. This article takes the emergence of fentanyl in the U.S. drug supply as a starting point for examining two closely related questions about drug checking and drug market expertise. First, how is the epistemic authority of law enforcement over the material realities of the drug market produced? Second, in the context of that authority, what are the socio-political implications of technologically advanced drug checking instruments in the hands of people who use drugs? The expertise that people who use drugs maintain about the nature of illicit drug market and how to navigate the illicit drug supply has long been discounted as untrustworthy, irrational, or otherwise invalid. Yet, increased access to drug checking tools has the potential to afford the knowledge produced by people who use drugs a technological validity it has never before enjoyed. In this article, I engage with theories of knowledge production and ontological standpoint from the field of science, technology, and society studies to examine how law enforcement produces and maintains epistemic authority over the illicit drug market and to explore how drug checking technologies enable new forms of knowledge production. I argue that drug checking be viewed as a form of social resistance against law enforcement’s epistemological authority and as a refuge against the harms produced by drug criminalization.

The Evolving Overdose Epidemic: Synthetic Opioids And Rising Stimulant-Related Harms

2020 ◽  
Author(s):  
Christopher M Jones ◽  
Faraah Bekheet ◽  
Ju Nyeong Park ◽  
G Caleb Alexander
Keyword(s):  
Illicit Drug ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Drug Supply ◽  
Synthetic Opioids ◽  
Key Stakeholders ◽  
Public Health Challenges ◽  
Concomitant Exposure ◽  
Over Time ◽  
Key Questions

Abstract The opioid overdose epidemic is typically described as having occurred in three waves, with morbidity and mortality accruing over time principally from prescription opioids (1999-2010), heroin (2011-2013) and illicit fentanyl and other synthetic opioids (2014-present). However, the increasing presence of synthetic opioids mixed into the illicit drug supply, including with stimulants such as cocaine and methamphetamine, as well as rising stimulant-related deaths, reflects the rapidly evolving nature of the overdose epidemic posing urgent and novel public health challenges. We synthesize the evidence underlying these trends, consider key questions such as where and how concomitant exposure to fentanyl and stimulants is occurring, and identify actions for key stakeholders regarding how these emerging threats, and continued evolution of the overdose epidemic, can best be addressed.

scholarly journals Increasing presence of xylazine in heroin and/or fentanyl deaths, Philadelphia, Pennsylvania, 2010–2019

2021 ◽  
pp. injuryprev-2020-043968
Author(s):  
Jewell Johnson ◽  
Lia Pizzicato ◽  
Caroline Johnson ◽  
Kendra Viner
Keyword(s):  
Public Health ◽  
United States ◽  
Drug Users ◽  
Active Drug ◽  
Illicit Drug ◽  
Adverse Outcomes ◽  
Drug Supply ◽  
Health Consequences ◽  
Potential Health ◽  
The Usa

Reports from active drug users state that xylazine, the veterinary tranquilliser, has been increasing in the illicit drug supply in Philadelphia. To describe trends and characteristics of unintentional deaths from heroin and/or fentanyl overdose with xylazine detections occurring in Philadelphia, Pennsylvania, the Philadelphia Department of Public Health analysed data on deaths from unintentional heroin and/or fentanyl overdose from the Philadelphia Medical Examiner’s Office over a 10-year period (2010–2019). Xylazine went from being detected in less than 2% cases of fatal heroin and/or fentanyl overdose between 2010 and 2015 to 262 (31%) of the 858 fatal heroin and/or fentanyl overdose cases in 2019. Currently, information is limited on the presence of xylazine in continental United States. Xylazine’s association with adverse outcomes in other locations indicates that potential health consequences should also be monitored in the USA. Whenever possible, jurisdictions should consistently test for xylazine.

Cannabis

1967 ◽  
Vol 5 (25) ◽  
pp. 97-99
Keyword(s):  
Medical Practice ◽  
Illicit Drug ◽  
Cannabis Sativa ◽  
Psychosomatic Disorders ◽  
Synthetic Analogues ◽  
Therapeutics Bulletin ◽  
The Future

Preparations from Cannabis sativa, the hemp plant, were omitted from the B.P. in 1932, and from the B.P.C. in 1949. Today, they are scarcely used in medical practice, though manufacture of a tincture of cannabis is still licenced (and one or two practitioners are known to prescribe it from time to time for psychiatric or psychosomatic disorders1). Cannabis and preparations derived from it are controlled by the Dangerous Drugs Act, yet they are more widely and increasingly used in this country and in America than any other illicit drug. But this is not the only reason for discussing their effects in the Drug and Therapeutics Bulletin: the future use of some synthetic analogues and derivatives seems probable as analgesics, antidepressants and antihypertensives.2

scholarly journals Opioid Agonist Treatment and Risk of Mortality During an Opioid Overdose Public Health Emergency: A Population-Based Retrospective Cohort Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Lindsay A Pearce ◽  
Jeong Eun Min ◽  
Micah Piske ◽  
Haoxuan Zhou ◽  
Fahmida Homayra ◽  
...  
Keyword(s):  
Relative Risk ◽  
Illicit Drug ◽  
Opioid Overdose ◽  
Drug Supply ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Risk Of Death ◽  
Synthetic Opioids ◽  
Risk Of Mortality ◽  
Stopping Treatment

IntroductionOpioid agonist treatment (OAT) is a safe and effective treatment for opioid use disorder (OUD). However, people commonly stop and start OAT and their risk of death is high immediately after stopping. The prevalence of illicitly manufactured fentanyl and other highly potent synthetic opioids have increased in the illicit drug supply globally. Yet, there is limited evidence examining the relationship between OAT and mortality when these contaminants are widely available in the illicit drug supply. Objectives and ApproachWe aimed to compare the risk of mortality on and off OAT in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply. We linked five health administrative datasets in British Columbia, Canada, creating a cohort of 55,347 people with OUD who received OAT during a 23-year period (1996 to 2018). We compared the risk of mortality on and off treatment over time, and according to time since starting or stopping treatment and by medication type. Results7,030 of 55,347 (12.7%) OAT recipients died during follow-up. All-cause SMR was substantially lower on OAT (4.6 [4.4 to 4.8]) compared to off OAT (9.7 [9.5 to 10.0]). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 [1.8 to 2.4] times higher than on OAT prior to the introduction of fentanyl, and increased to 3.4 [2.8 to 4.3] at the end of the study period (65% increase in relative risk). Conclusion / ImplicationsThe protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, while the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.

scholarly journals Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study

BMJ ◽  
2020 ◽  
pp. m772 ◽  
Author(s):  
Lindsay A Pearce ◽  
Jeong Eun Min ◽  
Micah Piske ◽  
Haoxuan Zhou ◽  
Fahmida Homayra ◽  
...  
Keyword(s):  
Relative Risk ◽  
Illicit Drug ◽  
Population Based ◽  
Opioid Use Disorder ◽  
Drug Supply ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Risk Of Mortality ◽  
Stopping Treatment

Abstract Objective To compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply. Design Population based retrospective cohort study. Setting Individual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada. Participants 55 347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018. Main outcome measures All cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply. Results 7030 (12.7%) of 55 347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk). Conclusions Retention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.

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