Contemporary Perspective on Supply Chain Management Regarding Drug Sourcing Shortages

Safeguarding the supply of drugs and satisfying the needs of patients is a strategic priority of any healthcare system especially in these pandemic times. The pharmaceutical supply chain is subject to many pressures including non-availability and shortage of requisite drugs. A drug shortage is a deficiency in the supply of medicines or products that affects the ability of a patient to get the required treatment in due time. The roots of drug shortages are multifaceted, varied, and the issue can be due to supply or demand. However, the situation affects almost every stakeholder in the healthcare system, which is why collaboration is a must to deal with drug shortages. Hence, adopting an exploratory and single-case approach of the largest public hospital in the context of Namibia, the objective of this chapter is to provide a contemporary perspective of supply chain management re drug sourcing shortages, analyze the causes of drug shortages, recommend measures to minimize the crisis, and suggest strategies for enhanced efficiency in drug supply.

Sharp Increases in Drug Overdose Deaths Among High-School-Age Adolescents During the US COVID-19 Epidemic and Illicit Fentanyl Crisis

Although overdose deaths in the US have increased exponentially for the past four decades, these shifts have historically affected adults, while pediatric overdose rates remained stable. However, this may be changing, given that the illicit drug supply has become increasingly hazardous in recent years, as illicitly-manufactured-fentanyls (IMFs) and other synthetic opioid and benzodiazepine analogues are increasingly sold as heroin and counterfeit prescription pills. We calculated drug overdose deaths per 100,000 population by 5-year age groups for the 2010-2021 period. For high-school-aged adolescents (age 14-18), we stratified rates by race/ethnicity, census region, associated substance, and ICD-10 cause-of-death intent categories. Adolescent overdose mortality saw a sharp increase between 2019 and 2020, from 2.35 per 100,000 to 4.58 per 100,000, representing a 94.3% increase, the largest percent increase of any 5-year age group. American Indian or Alaska Native (AIAN) adolescents, Latinx adolescents, and adolescents in the West census region were disproportionately affected, overdose death rates 2.15, 1.31, and 1.68 times the national average in 2021, respectively. Trends were driven by fatalities involving IMFs, which nearly tripled from 2019 to 2020, and represented 76.6% of adolescent overdose deaths in 2021. Sharp increases in adolescent drug overdose deaths, despite flat or declining drug use rates, and no increase in deaths from alcohol or most drugs, reinforce that rising fatalities are likely driven by an increasingly toxic, IMF-contaminated drug supply. Rising racial disparities in overdose require a prevention approach that ameliorates deep-seated social and economic inequalities as well as poor access to mental and physical healthcare and social services for AIAN and Latinx adolescents. Our results should also be understood in the context of rising rates of adolescent mental illness during the COVID-19 pandemic. These findings highlight the urgent need for accurate, harm-reduction-oriented education for early adolescents about the risks of an evolving drug supply, as well as greater access to naloxone and services that check drugs for the presence of IMFs.

RESULTS OF THE STUDY OF PUBLIC SATISFACTION ABOUT THEAVAILABILITY AND QUALITY OF THE DRUG SUPPLY SYSTEM IN RUSSIA

The article analyzes the results of monitoring the availability and quality of the drug supply system among the population of various age groups and financial situation. The purpose of this study is to study the satisfaction of citizens in the drug supply system in Russia and to build a medical and social portrait of the patient, which was developed based on the analysis of the results of a sociological survey conducted in dynamics for 2019-2021. In the course of the research, such methods as: sociological, study and generalization of experience, analytical, methods of descriptive statistics were used. The results of the sociological study indicate the need for additional work to improve the availability and quality of LLR and the level of awareness of patients about the system of drug reimbursement. The obtained data can be used for health management bodies at various hierarchical levels, confirm the special social significance of solving this problem and the need to introduce preventive measures to involve patients in healthy lifestyle, increase public confidence in domestic drugs.

Covid-19 and child criminal exploitation in the UK: implications of the pandemic for county lines

In March 2020, the UK was placed in lockdown following the spread of the Covid-19 virus. Just as legitimate workplaces made changes to enable their employees to work from home, the illicit drugs trade also made alternative arrangements, adapting its supply models to ensure continuity of operations. Based upon qualitative interviews with 46 practitioners, this paper assesses how front-line professionals have experienced and perceived the impact of Covid-19 on child criminal exploitation and County Lines drug supply in the UK. Throughout the paper, we highlight perceived adaptations to the County Lines supply model, the impact of lockdown restrictions on detection and law enforcement activities aimed at County Lines, and on efforts to safeguard children and young people from criminal exploitation. Our participants generally believed that the pandemic had induced shifts to County Lines that reflected an ongoing evolution of the drug supply model and changes in understanding or attention because of Covid-19 restrictions, rather than a complete reconstitution of the model itself. Practitioners perceived that Covid-19 has had, and continues to have, a significant impact on some young people’s vulnerability to exploitation, on the way in which police and frontline practitioners respond to County Lines and child criminal exploitation, and on the way illegal drugs are being moved and sold.

Requirements Identification for a Blockchain-Based Traceability Model for Animal-Based Medicines

In this paper, the traceability of heparin medicine will be studied. Currently, the registration of traceability data is conducted in a decentralized manner. With blockchain implementation, the traceability systems that use this data could become semi-automated, increasing the quality, security, and confidence of the information generated in the supply chain. This paper presents the essential requirements and activities wherein information must be collected within the heparin drug supply chain, focusing on the animal raw materials production link and its requirements. Blockchain technology is proposed to increase traceability and reliability in relation to the current situation. It also fulfills all the requirements identified if used as part of a traceability system. These requirements are: the existence of a consensus mechanism; anonymity; protocol, efficiency, and consumption; immutability; ownership and management; and approval time. We conclude the paper by presenting the mapping of requirements and entities and critical activities for adopting blockchain technology to support the traceability of raw materials from animals used in heparin production.

Approaches to the justification of targeted subsidies for drugs in providing medical care in ambulatory conditions in military medical organizations

This study presents the results of the analysis of the funding mechanisms for drug supply of assigned contingents in the provision of outpatient medical care in military medical organizations. Existing approaches to determining methods for optimizing the need for drugs are considered. In addition, this paper presented approaches to the formation of a formulary list of medicinal products of a military medical organization. This study also showed the possibility of using pharmacoeconomic assessment in justifying targeted subsidies for drug supply. The relevance of the analysis of the assortment structure for entry into the approved list of vital and essential medicines is emphasized. A possible algorithm for substantiating a targeted subsidy for drug supply in the provision of outpatient medical care within the framework of military health care involved eight stages. First, the incidence of attached contingents entitled to drug supply at the expense of the Russian Ministry of Defense for outpatient treatment was analyzed. Second, the nomenclature of medicines was determined by comparing the incidence pattern of attached contingents with the list of medicines presented in the standards of medical care and clinical recommendations. Third, groups of drugs (with specific and wide spectrum of action) normally used are distinguished, considering the uniqueness of consumption when predicting (planning) demand. Fourth, the need for medicines were formulated using the normative method, modeling method, and logicoeconomic and other methods for determining the need, taking into account the peculiarities of their application in medical, social, and economic conditions of the military medical organization. Fifth, the created drug list was optimized based on the combined ABC-VEN analysis. Sixth, the formal list of the military medical organization was optimized by taking into account the results of pharmacoeconomic research on the treatment of specific diseases. Seventh, an analysis of the assortment structure in relation to the list of vital and essential drugs was performed to further substantiate their economic, clinical, and pharmacoeconomic effectiveness. Eighth, a targeted subsidy for drug supply was calculated, and application was filed, which contained calculations of planned costs with the appendix of the list of planned drugs for purchase, as well as commercial proposals justifying its cost.

Pharmacoeconomic analysis of drug supply of the military personnel with chronic bronchitis

Despite the superiority of bronchitis in the structure of respiratory diseases in the military personnel, its course develops with certain peculiarities due to the peculiarities of military service. Consequently, the optimization of the costs of providing the military personnel with medicines is becoming more and more of medical and social importance. Reasonable selection of medicines in the treatment of chronic bronchitis is the result of the choice of effective and safe drugs, considering the cost of the components for military health care. Aim. To perform a pharmacoeconomic analysis of drug supply to the military personnel with chronic bronchitis. Materials and methods. The materials of the study were a database of drugs registered in Ukraine, presented on the official website of the State Institution “State Expert Center” of the Ministry of Health of Ukraine. The study employed “cost – effectiveness” method, which allows comparing the cost of a particular treatment method and its effectiveness. Results. The scheme of the pharmacoeconomic analysis method has been offered. According to the results of the previously formed list of drugs for the treatment of military personnel with chronic bronchitis, a further analysis of the proposed range of drugs is conducted using an expert survey. By calculating the efficacy ratio within each presented pharmacotherapeutic group, a 10-item list of the most optimal drugs for the treatment of chronic bronchitis has been compiled. Conclusions. Pharmacoeconomic analysis of medical supply to the military personnel is a constructive solution in the process of identifying manufacturers as potential suppliers of medicines to cover the needs of the medical service of the Armed Forces of Ukraine. Based on the results of the pharmacoeconomic analysis of the drug supply to military personnel with chronic bronchitis, a recommended list of drugs for their treatment has been formed. However, this list can be expanded to include drugs with the highest efficacy – according to the expert assessment. In the future it may become the basis for inclusion of drugs in the clinical protocols of medical care and could be used for the development of cost standards for the relevant nosological forms, which will improve the efficiency and quality of treatment and will provide economic benefits.