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Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012

July 3, 2014 Comments off

Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012
Source: Morbidity and Mortality Weekly Report (CDC)

Background:
Overprescribing of opioid pain relievers (OPR) can result in multiple adverse health outcomes, including fatal overdoses. Interstate variation in rates of prescribing OPR and other prescription drugs prone to abuse, such as benzodiazepines, might indicate areas where prescribing patterns need further evaluation.

Methods:
CDC analyzed a commercial database (IMS Health) to assess the potential for improved prescribing of OPR and other drugs. CDC calculated state rates and measures of variation for OPR, long-acting/extended-release (LA/ER) OPR, high-dose OPR, and benzodiazepines.
Results: In 2012, prescribers wrote 82.5 OPR and 37.6 benzodiazepine prescriptions per 100 persons in the United States. State rates varied 2.7-fold for OPR and 3.7-fold for benzodiazepines. For both OPR and benzodiazepines, rates were higher in the South census region, and three Southern states were two or more standard deviations above the mean. Rates for LA/ER and high-dose OPR were highest in the Northeast. Rates varied 22-fold for one type of OPR, oxymorphone.

Conclusions:
Factors accounting for the regional variation are unknown. Such wide variations are unlikely to be attributable to underlying differences in the health status of the population. High rates indicate the need to identify prescribing practices that might not appropriately balance pain relief and patient safety.

Implications for Public Health:
State policy makers might reduce the harms associated with abuse of prescription drugs by implementing changes that will make the prescribing of these drugs more cautious and more consistent with clinical recommendations.

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UN World Drug Report 2014

July 2, 2014 Comments off

World Drug Report 2014
Source: United Nations
From press release (PDF):

Drug use prevalence is stable around the world, according to the 2014 World Drug Report of the United Nations Office on Drugs and Crime (UNODC), with around 243 million individuals, or 5 per cent of the world’s population aged 15- 64 having used an illicit drug in 2012. Problem drug users meanwhile numbered about 27 million, roughly 0.6 per cent of the world’s adult population, or 1 in every 200 people.

Not an ‘Ebay for Drugs': The Cryptomarket ‘Silk Road’ as a Paradigm Shifting Criminal Innovation

June 6, 2014 Comments off

Not an ‘Ebay for Drugs': The Cryptomarket ‘Silk Road’ as a Paradigm Shifting Criminal Innovation
Source: Social Science Research Network

The online cryptomarket Silk Road has been oft-characterised as an ‘eBay for drugs’ with customers drug consumers making personal use-sized purchases. Our research demonstrates that this was not the case. Using a bespoke web crawler, we downloaded all drugs listings on Silk Road in September 2013. We found that a substantial proportion of transactions on Silk Road are best characterised as ‘business-to-business’, with sales in quantities and at prices typical of purchases made by drug dealers sourcing stock. High price-quantity sales generated between 31-45% of revenue, making sales to drug dealers the key Silk Road drugs business. As such, Silk Road was what we refer to as a transformative, as opposed to incremental, criminal innovation. With the key Silk Road customers actually drug dealers sourcing stock for local street operations, we were witnessing a new breed of retail drug dealer, equipped with a technological subcultural capital skill set for sourcing stock. Sales on Silk Road increased from an estimate of $14.4 million in mid 2012 to $89.7 million by our calculations. This is a more than 600% increase in just over a year, demonstrating the demand for this kind of illicit online marketplace. With Silk Road functioning to considerable degree at the wholesale/broker market level, its virtual location should reduce violence, intimidation and territorialism. Results are discussed in terms of the opportunities cryptomarkets provide for criminologists, who have thus far been reluctant to step outside of social surveys and administrative data to access the world of ‘webometric’ and ‘big data’.

Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel

June 5, 2014 Comments off

Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel (PDF)
Source: Mayo Clinic Proceedings

Objective
To summarize available information about outbreaks of infections stemming from drug diversion in US health care settings and describe recommended protocols and public health actions.

Patients and Methods
We reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by health care personnel in US health care settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included health care setting(s), infection type(s), specialty of the implicated health care professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to blood-borne pathogens, and resolution of the investigation.

Results
We identified 6 outbreaks over a 10-year period beginning in 2004; all occurred in hospital settings. Implicated health care professionals included 3 technicians and 3 nurses, one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining 4 outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus infection was transmitted to 84 patients. In each of these outbreaks, the implicated health care professional was infected with hepatitis C virus and served as the source; nearly 30,000 patients were potentially exposed to blood-borne pathogens and targeted for notification advising testing.

Conclusion
These outbreaks revealed gaps in prevention, detection, and response to drug diversion in US health care facilities. Drug diversion is best prevented by health care facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies.

See also press release: CDC Report: Patients Harmed After Health Care Providers Steal Patients’ Drugs

European Drug Report 2014: Trends and developments

June 2, 2014 Comments off

European Drug Report 2014: Trends and developments
Source: European Monitoring Centre for Drugs and Drug Addiction

How many new drugs were detected in Europe over the last year? Is cannabis getting stronger? How many Europeans have ever used an illicit drug? What are the latest drug policy developments in the region? These are just some of the questions explored in the European Drug Report: Trends and developments. This report provides a top-level overview of the long-term drug-related trends and developments at European level, while homing in on emerging problems in specific countries. Such a perspective is valuable, as it allows differing national experiences to be understood within the broader European context.

On the Distributed Costs of Drug-Related Homicides

May 27, 2014 Comments off

On the Distributed Costs of Drug-Related Homicides
Source: Center for Global Development

Reliable estimates of the effects of violence on economic outcomes are scarce. We exploit the manyfold increase in homicides in 2008-2011 in Mexico resulting from its war on organized drug traffickers to estimate the effect of drug-related homicides on house prices. We use an unusually rich dataset that provides national coverage on house prices and homicides and exploit within-municipality variations. We find that the impact of violence on housing prices is borne entirely by the poor sectors of the population. An increase in homicides equivalent to one standard deviation leads to a 3% decrease in the price of low-income housing. In spite of this large burden on the poor, the willingness to pay in order to reverse the increase in drug-related crime is not high. We estimate it to be approximately 0.1% of Mexico’s GDP.

Methamphetamine trafficking increases, new psychoactive substances flood markets, according to new UNODC report

May 26, 2014 Comments off

Methamphetamine trafficking increases, new psychoactive substances flood markets, according to new UNODC report
Source: United Nations Office on Drugs and Crime

Synthetic drugs are taking an ever-greater share of the illicit drugs market, according to a new report by the United Nations Office on Drugs and Crime (UNODC). New psychoactive substances (NPS) are also flooding a market for synthetic drugs long dominated by amphetamine-type stimulants (ATS), such as ecstasy and methamphetamine, which are more widely used than cocaine, opium or heroin.

Rates of methamphetamine seizures are higher than ever across the world, largely driven by the rise in seizures in East and South-East Asia as well as in North America, according to the 2014 Global Synthetic Drugs Assessment . Methamphetamine, which can seriously harm users, continues to spread in Asia, posing a growing challenge to health care providers and drug control authorities dealing with large youthful populations. Methamphetamine supply grew rapidly in Asia, already the largest market for ATS, between 2008 and 2012 when methamphetamine seizures tripled to 36 tons.

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