School, parent, and student perspectives of school drug policies

BACKGROUND

Schools use a number of measures to reduce harmful tobacco, alcohol, and drug use by students. One important component is the school's drug policy, which serves to set normative values and expectations for student behavior as well as to document procedures for dealing with drug-related incidents. There is little empirical evidence of how policy directly or indirectly influence students' drug taking. This study compares how effectively schools communicate school drug policies to parents and students, how they are implemented, and what policy variables impact students' drug use at school and their perceptions of other students' drug use at school.

METHODS

Data were obtained from 3876 students attending 205 schools from 2 states in the United States and Australia, countries with contrasting national drug policy frameworks. School policy data were collected from school personnel, parents, and students.

RESULTS

Schools' policies and enforcement procedures reflected national policy approaches. Parents and students were knowledgeable of their school's policy orientation.

CONCLUSIONS

When delivered effectively, policy messages are associated with reduced student drug use at school. Abstinence messages and harsh penalties convey a coherent message to students. Strong harm-minimization messages are also associated with reduced drug use at school, but effects are weaker than those for abstinence messages. This smaller effect may be acceptable if, in the longer term, it leads to a reduction in harmful use and school dropout within the student population.

Prescription drug monitoring through the Maine Office of Substance Abuse

Although this article primarily reflects Maine's experience, it is meant to inspire you to consider the PMP applications in your own geographic region, as the article clearly demonstrates the importance of state prescription monitoring programs and their impact on patients and communities. Most important, it is imperative that health care facilities recognize and support collaboration with state services that, in due course, may assist them in avoiding exposure to litigation by those who may be injured through diversion and/or misuse of prescription medications.

Assessing environmental prevention strategies for reducing the prevalence and associated harms of methamphetamine use

Developed primarily in clandestine laboratories, methamphetamine is a highly addictive synthetic drug whose physical effects include hyperactivity, euphoria, tremors, and a sense of increased energy. While the accuracy of recent accounts suggesting a methamphetamine epidemic in the United States is unclear, these reports have nevertheless translated into significant funding allowances by the federal government. This increased funding suggests that the opportunity is ripe for the development of a scientific, environmentally-based model for methamphetamine prevention.

The legal status of medical marijuana

OBJECTIVE

To review the legal status of medical marijuana in the US.

DATA SOURCES

Relevant publications were located using LexisNexis (1982-October 2006), WestLaw (1996-October 2006), BNA Health Law Reporter (1996-October 2006), MEDLINE (1996-October 2006), EMBASE (1980-October 2006), International Pharmaceutical Abstracts (1970-October 2006), and an Internet search targeting government sites using the key words medical marijuana.

STUDY SELECTION AND DATA EXTRACTION

Federal and state medical marijuana laws were examined. Relevant cannabinoid-based drug products were reviewed. Federal and State Supreme Court and Appeal level cases involving medical marijuana were evaluated.

DATA SYNTHESIS

Marijuana is regulated as a Schedule I controlled substance and its use is prohibited under federal law. Dronabinol and nabilone are synthetic cannabinoids approved by the Food and Drug Administration and Sativex is a cannabis-based extract being evaluated in Phase III trials. The federal government sponsors a single patient compassionate use Investigational New Drug Application program providing medical marijuana for a small number of patients. Eleven states permit marijuana use for medical purposes and one state provides a defense of medical necessity. Employers do not have to provide workplace accommodations for employees using medical marijuana and can terminate them at will. Healthcare providers have First Amendment constitutional protections that allow them to discuss marijuana with patients.

CONCLUSIONS

Until the Supreme Court rules directly on the constitutionality of state medical marijuana laws, a conflict remains. Marijuana use remains illegal under federal law and states assume their medical marijuana laws to be constitutional.

Prescription drug abuse: what is being done to address this new drug epidemic? Testimony before the Subcommittee on Criminal Justice, Drug Policy and Human Resources

This comprehensive health policy review of the prescription drug abuse epidemic is based on the written and oral testimony of witnesses at a July 26, 2006 Congressional Hearing, including that of Laxmaiah Manchikanti, MD, the chief executive officer of the American Society of Interventional Pain Physicians and additions from review of the literature. Honorable Mark E. Souder, chairman of the Subcommittee on Criminal Justice, Drug Policy, and Human Resources, introduced the issue as follows: "Prescription drug abuse today is second only to marijuana abuse. In the most recent household survey, initiates to drug abuse started with prescription drugs (especially pain medications) more often than with marijuana. The abuse of prescription drugs is facilitated by easy access (via physicians, the Internet, and the medicine cabinet) and a perception of safety (since the drugs are FDA approved). In addition to the personal toll of drug abuse using prescription drugs, indirect costs associated with prescription drug abuse and diversion include product theft, commission of other crimes to support addiction, law enforcement costs, and encouraging the practice of defensive medicine." The Administration witnesses, Bertha Madras, Nora D. Volkow, MD, Sandra Kweder, MD, and Joe Rannazzisi reviewed the problem of drug abuse and discussed what is being done at the present time as well as future strategies to combat drug abuse, including prescription drug monitoring programs, reducing malprescriptions, public education, eliminating Internet drug pharmacies, and the development of future drugs which are not only tamper-resistant but also non-addictive. The second panel, consisting of consumers and advocates, included Misty Fetco, Linda Surks, and Barbara van Rooyan, all of whom lost their children to drugs, presented their stories and strategies to prevent drug abuse, focusing on education at all levels, development of resistant drugs, and non-opioid treatment of chronic pain. Mathea Falco, JD, and Stephen E. Johnson presented issues related to drug abuse and measures to curb drug abuse by various means. Stephen J. Pasierb presented startling statistics on teen drug abuse and various educational programs to deter abuse. Laxmaiah Manchikanti, MD presented an overview of prescription drug abuse, strategies to prevent drug abuse, including immediate funding and rapid implementation of NASPER, education at all levels and improving relations with the DEA and the provider community.

Can drug design inhibit abuse?

A recent federal report indicates that prescription drug abuse is now the second leading category of illicit drug use, following marijuana use. Control strategies typically focus on reducing the diversion of prescription drugs from legitimate sources. The proliferation of unregulated Internet sources, however, has rendered control strategies less effective. This study examines a new approach that focuses on reducing abusability through the use of abuse-resistant drug designs. Drugs with and without such designs are compared and abuse levels assessed using multiple sources. In every instance, drugs employing abuse-resistant designs were found to have significantly lower levels of abuse than comparator drugs without such designs.

The influence of PHARMAC's National Hospital Pharmaceutical Strategy on Quality Use of Medicines activities in New Zealand hospitals

AIM

To determine the influence of PHARMAC's National Hospital Pharmaceutical Strategy (NHPS) on Quality Use of Medicine (QUM) activities in New Zealand hospitals.

METHOD

In July 2002 and July 2004, a questionnaire-based cross-sectional survey on QUM activities was administered to chief pharmacists at all 30 New Zealand public hospitals employing a pharmacist (29 in July 2004), to examine pre and post-NHPS activity.

RESULTS

Both surveys achieved a 97% response rate. A range of QUM activities were undertaken in hospitals. Overall, Drug Utilisation Reviews (DURs) significantly decreased (67 vs 42) (p<0.05), although antimicrobial guidelines and intranet formularies significantly increased (p<0.05). PHARMAC's QUM initiatives, still evolving, did not appear to positively influence QUM activity in 2002-4. In 2004, PHARMAC put their original plans to coordinate QUM activity on hold and chose to participate in the processes of the Safe and Quality use of Medicines Group (SQM). Formed in 2003 by the District Health Boards of New Zealand, SQM focused attention on anticoagulants and high-risk medicines.

CONCLUSION

QUM activities, similar in both periods, were not positively influenced by PHARMAC's Strategy.

Some cold medicines move behind counter

Some over-the-counter (OTC) cold and allergy medicines are being moved behind the counter at pharmacies nationwide as part of the fight against illegal drug production.

Formulation considerations for the development of medications with abuse potential

The availability of increasingly sophisticated drug formulations and delivery devices has created new opportunities in drug development. These newer approaches can result in improved drug bioavailability, or they can alter key pharmacokinetic parameters in such a way as to decrease dosing interval, decrease variability, or blunt maximal concentrations that are associated with adverse events of particular concern. Special formulations or devices can also provide for easier or more convenient dosing in subpopulations of interest, such as children or the elderly. Although the key principles of abuse potential assessment and the underlying neurochemistry and pharmacology are relatively well understood, evaluation of the influences of drug formulation have received much less study. Because dose and formulation - and even the therapeutic indication - are refined over the course of development, it is usually difficult to conduct more than a cursory evaluation of the influence of formulation on the underlying abuse potential of the active pharmaceutical ingredient. Industrial sponsors would benefit from further research in areas of formulation science and pharmacokinetics that would improve the predictability of prescription drug abuse. In particular, validation of new pharmacokinetic parameters and standardization of methods to understand the consequences of product tampering could assist in gaining a better assessment of risk for controlled release formulations. Such methods could apply not only to innovator products, but also to those wishing to develop generic versions with similar pharmaceutical performance. This article proposes several factors that may be of use to industrial sponsors in making formulation choices for drugs with the potential for abuse.

Accessing health outcome data on high-cost medicines in Australia

Data on health outcomes resulting from the use of medicines provide important evidence of cost-effectiveness. Currently, clinical information on individual patients, collected by Medicare Australia to assess eligibility for subsidised treatment with high-cost medicines, is inaccessible for research. Comprehensive data on drug use and health outcomes should be made accessible, with appropriate regulation, so that the effectiveness, utility and appropriateness of our systems of access to medicines can be independently analysed. In the interests of continuous improvement in medical care and optimal use of limited resources, we strongly advocate the enhancement of Medicare Australia databases and liberalisation of arrangements for access to administrative and clinical data.

Does adherence monitoring reduce controlled substance abuse in chronic pain patients?

BACKGROUND

Opioids are used extensively for chronic pain management in the United States. The frequency of opioid use prior to presenting to interventional pain management settings and in interventional pain management settings has been shown to be above 90%. Given that controlled substance abuse and illicit drug use are prevalent phenomena, adherence monitoring of patients that are prescribed opioids is becoming common. Adherence monitoring is carried out by an appropriate history, periodic evaluation of appropriate intake of drugs, random drug testing, and pill counts. Crucial to adherence monitoring is an initial controlled substance agreement and repeated review of the terms of this agreement with on-going education. However, the effect of adherence monitoring on drug abuse is unclear.

OBJECTIVE

To identify controlled substance abuse through implementation of the terms of a controlled substance agreement, including periodic review and monitoring outside the organization.

STUDY DESIGN

Prospective evaluation with historical controls.

METHODS

Five hundred consecutive patients receiving prescription controlled substances were followed in a prospective manner. The evaluation consisted of a chart review to monitor controlled substance intake, with special attention to drugs obtained from outside the organization. Data collection for this purpose included information from records, pharmacies, referring physicians, and all the physicians involved in the treatment of the patient.

RESULTS

Results from 500 consecutive patients were evaluated. Controlled substance abuse was seen in 9% of patients; overall, 5% of patients were obtaining controlled substances from other physicians, and 4% from illegal sources.

CONCLUSION

Adherence monitoring, including controlled substance agreements and various periodic measures of compliance was associated with a 50% reduction in opioid abuse.

Analysis for Identification in Amnesty Bin Samples from Dance Venues

The analysis of unknown substances discarded in amnesty bins, first described by Ramsey et al, from a large central London club and 7 smaller clubs in Manchester, UK are described. The contents of the bins were collected between July 2003 and March 2004. Solid dosage formulations were identified using the TICTAC database, chemical tests, and GC-MS screening. Drugs that could not be readily identified were subjected to other analytical techniques. The goal was to document the current range of drugs available on the dance scene and compare the findings between the London club, which had been the subject of a previous survey, and Manchester clubs. More than 1000 tablets, capsules, and powder doses were discarded in the amnesty bins. Tablets containing only MDMA (ecstasy) were found to be >94% and >84% of the total in London and Manchester, respectively. Although the quantities of tablets and powders recovered were different between London and Manchester, the proportions of the drugs were remarkably similar. The most common drugs found in powders in London and Manchester respectively were cocaine (29%, 40%), amphetamine (25%, 26%), ketamine (19%, 20%), and MDMA (19%, 11%).

Screening suspected counterfeit Viagra and imitations of Viagra with near-infrared spectroscopy

We describe a near-infrared spectroscopy (NIRS) method for fast-screening Viagra tablets, counterfeit Viagra tablets, and imitations of Viagra. The method can (1) check the homogeneity of a batch; (2) distinguish counterfeits and imitations from authentic Viagra; (3) screen for the presence of sildenafil citrate, the pharmacologically active substance in Viagra, irrespectively of the excipients present; (4) and detect whether similar samples have been previously analysed. We applied the method to 103 samples with a diversity of appearance, chemical composition, and origin. Other analytical methods confirmed the positive screening results for sildenafil citrate and the presence of other pharmacological active substances. The NIRS screening indicated the absence of sildenafil citrate in the presence of another pharmacological substance for only 2 samples, where the reference methods showed the presence of sildenafil citrate in addition to that of clomifene citrate. Otherwise, the method gave no false positive or negative results. The NIRS screening method is very fast and reliable for detecting counterfeits and imitations, and it correctly predicts the presence or absence of sildenafil citrate in 98% of the samples.