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Caulkins JP, Tallaksen A, Taylor J, Kilmer B, Reuter P. The Baltic and Nordic responses to the first Taliban poppy ban: Implications for Europe & synthetic opioids today. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104314. [PMID: 38183860 DOI: 10.1016/j.drugpo.2023.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
The 2000-2001 and the 2022-2023 Taliban opium bans were and could be two of the largest ever disruptions to a major illegal drug market. To help understand potential implications of the current ban for Europe, this paper analyzes how opioid markets in seven Baltic and Nordic countries responded to the earlier ban, using literature review, key informant interviews, and secondary data analysis. The seven nations' markets responded in diverse ways, including rebounding with the same drug (heroin in Norway), substitution to a more potent opioid (fentanyl replacing heroin in Estonia), and substitution to one with lower risk of overdose (buprenorphine replacing heroin in Finland). The responses were not instantaneous, but rather evolved, sometimes over several years. This variety suggests that it can be hard to predict how drug markets will respond to disruptions, but two extreme views can be challenged. It would be naive to imagine that drug markets will not adapt to shocks, but also unduly nihilistic to presume that they will always just bounce back with no lasting effects. Substitution to another way of meeting demand is possible, but that does not always negate fully the benefits of disrupting the original market. Nonetheless, there is historical precedent for a European country's opioid market switching to synthetic opioids when heroin supplies were disrupted. Given how much that switch has increased overdose rates in Canada and the United States, that is a serious concern for Europe at present. A period of reduced opioid supply may be a particularly propitious time to expand treatment services (as Norway did in the early 2000s).
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Affiliation(s)
- Jonathan P Caulkins
- Carnegie Mellon University Heinz College, 5000 Forbes Ave., Pittsburgh PA 15213, USA.
| | - Amund Tallaksen
- The Council of State Governments Justice Center, 22 Cortland St., Floor 22, New York, NY 10007, USA
| | - Jirka Taylor
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Beau Kilmer
- RAND Drug Policy Research Center, 1776 Main St., Santa Monica, CA 90401, USA
| | - Peter Reuter
- University of Maryland, 7251 Preinkert Drive, College Park, MD 20742, USA
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Farhoudian A, Radfar SR, Mohaddes Ardabili H, Rafei P, Ebrahimi M, Khojasteh Zonoozi A, De Jong CAJ, Vahidi M, Yunesian M, Kouimtsidis C, Arunogiri S, Hansen H, Brady KT, Potenza MN, Baldacchino AM, Ekhtiari H. A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic. Front Psychiatry 2021; 12:646206. [PMID: 34421664 PMCID: PMC8377291 DOI: 10.3389/fpsyt.2021.646206] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background and Aims: COVID-19 has infected more than 77 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing, and "lockdown" measures have affected drug and alcohol supply chains and subsequently their availability, price, and use patterns, with possible downstream effects on presentations of SUDs and demand for treatment. Given the lack of multicentric epidemiologic studies, we conducted a rapid global survey within the International Society of Addiction Medicine (ISAM) network in order to understand the status of substance-use patterns during the current pandemic. Design: Cross-sectional survey. Setting: Worldwide. Participants: Starting on April 4, 2020 during a 5-week period, the survey received 185 responses from 77 countries. Measurements: To assess addiction medicine professionals' perceived changes in drug and alcohol supply, price, use pattern, and related complications during the COVID-19 pandemic. Findings: Participants reported (among who answered "decreased" or "increased") a decrease in drug supply (69.0%) and at the same time an increase in price (95.3%) globally. With respect to changes in use patterns, an increase in alcohol (71.7%), cannabis (63.0%), prescription opioids (70.9%), and sedative/hypnotics (84.6%) use was reported, while the use of amphetamines (59.7%), cocaine (67.5%), and opiates (58.2%) was reported to decrease overall. Conclusions: The global report on changes in the availability, use patterns, and complications of alcohol and drugs during the COVID-19 pandemic should be considered in making new policies and in developing mitigating measures and guidelines during the current pandemic (and probable future ones) in order to minimize risks to people with SUD.
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Affiliation(s)
- Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ramin Radfar
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran.,Integrated Substance Abuse Programs Department, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hossein Mohaddes Ardabili
- Psychiatry and Behavioral Sciences Research Center, Faculty of Medicine, Ibn-e-Sina Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parnian Rafei
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ebrahimi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Khojasteh Zonoozi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehrnoosh Vahidi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Christos Kouimtsidis
- Surrey and Borders Partnership National Health Service Foundation Trust, Leatherhead, United Kingdom
| | | | - Helena Hansen
- Departments of Anthropology and Psychiatry, New York University, New York, NY, United States
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | | | - Marc N Potenza
- Yale School of Medicine, Connecticut Council on Problem Gambling and Connecticut Mental Health Center, New Haven, CT, United States
| | - Alexander Mario Baldacchino
- Division of Population and Behavior Sciences, Medical School, University of St Andrews, St Andrews, United Kingdom
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, OK, United States
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Grebely J, Cerdá M, Rhodes T. COVID-19 and the health of people who use drugs: What is and what could be? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102958. [PMID: 33183679 PMCID: PMC7837052 DOI: 10.1016/j.drugpo.2020.102958] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
SARS-CoV-2, the virus that causes COVID-19, has changed the world as we know it, and continues to do so. How COVID-19 affects people who use drugs, the environments in which they live, and capacities of response, warrants immediate attention. This special issue begins to map how COVID-19 is altering the health of people who use drugs, including in relation to patterns of drug use, service responses, harms that may relate to drug use, interventions to reduce risk of harms, COVID-19 health, and drug policies. We emphasise the need to envisage COVID-19 and its effects as a matter of intersecting ‘complex adaptive systems’: that is, the impacts of COVID-19 extend beyond the virus and related illness conditions to encompass multiple social, cultural, economic, policy and political effects; and these affect the health of people who use drugs directly as well as indirectly by altering the risk and enabling environments in which they live. We synthesize emergent evidence on the impact of COVID-19 on the health of people who use drugs. A key concern we identify is how to sustain policy and service delivery improvements prompted by COVID-19. We need to maintain an ethos of emergent adaptation and experimentation towards the creation of safer environments in relation to the health of people who use drugs.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, United States
| | - Tim Rhodes
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; London School of Hygiene and Tropical Medicine, London, UK
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Tempalski B, Williams LD, West BS, Cooper HLF, Beane S, Ibragimov U, Friedman SR. Predictors of historical change in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993-2007. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:3. [PMID: 31918733 PMCID: PMC6953254 DOI: 10.1186/s13011-019-0235-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022]
Abstract
Background Adequate access to effective treatment and medication assisted therapies for opioid dependence has led to improved antiretroviral therapy adherence and decreases in morbidity among people who inject drugs (PWID), and can also address a broad range of social and public health problems. However, even with the success of syringe service programs and opioid substitution programs in European countries (and others) the US remains historically low in terms of coverage and access with regard to these programs. This manuscript investigates predictors of historical change in drug treatment coverage for PWID in 90 US metropolitan statistical areas (MSAs) during 1993–2007, a period in which, overall coverage did not change. Methods Drug treatment coverage was measured as the number of PWID in drug treatment, as calculated by treatment entry and census data, divided by numbers of PWID in each MSA. Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition, organized support, and service symbiosis) were analyzed using mixed-effects multivariate models within dependent variables lagged in time to study predictors of later change in coverage. Results Mean coverage was low in 1993 (6.7%; SD 3.7), and did not increase by 2007 (6.4%; SD 4.5). Multivariate results indicate that increases in baseline unemployment rate (β = 0.312; pseudo-p < 0.0002) predict significantly higher treatment coverage; baseline poverty rate (β = − 0.486; pseudo-p < 0.0001), and baseline size of public health and social work workforce (β = 0.425; pseudo-p < 0.0001) were predictors of later mean coverage levels, and baseline HIV prevalence among PWID predicted variation in treatment coverage trajectories over time (baseline HIV * Time: β = 0.039; pseudo-p < 0.001). Finally, increases in black/white poverty disparity from baseline predicted significantly higher treatment coverage in MSAs (β = 1.269; pseudo-p < 0.0001). Conclusions While harm reduction programs have historically been contested and difficult to implement in many US communities, and despite efforts to increase treatment coverage for PWID, coverage has not increased. Contrary to our hypothesis, epidemiologic need, seems not to be associated with change in treatment coverage over time. Resource availability and institutional opposition are important predictors of change over time in coverage. These findings suggest that new ways have to be found to increase drug treatment coverage in spite of economic changes and belt-tightening policy changes that will make this difficult.
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Affiliation(s)
- Barbara Tempalski
- Institute for Infectious Disease Research, NDRI, Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA.
| | - Leslie D Williams
- Institute for Infectious Disease Research, NDRI, Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Brooke S West
- School of Social Work, Columbia University, New York, NY, USA
| | | | - Stephanie Beane
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Samuel R Friedman
- Department of Population Health, New York University, New York, NY, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Ayllón S, Ferreira-Batista NN. Unemployment, drugs and attitudes among European youth. JOURNAL OF HEALTH ECONOMICS 2018; 57:236-248. [PMID: 28899566 DOI: 10.1016/j.jhealeco.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 08/10/2017] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
This paper studies changes in the patterns of drug consumption and attitudes towards drugs in relation to sky-high (youth) unemployment rates brought about by the Great Recession. Our analysis is based on data for 28 European countries that refer to young people. We find that the consumption of cannabis and 'new substances' is positively related to increasing unemployment rates. An increase of 1% in the regional unemployment rate is associated with an increase of 0.7 percentage points in the ratio of young people who state that they have consumed cannabis at some point in time. Our findings also indicate that higher unemployment may be associated with more young people perceiving that access to drugs has become more difficult, particularly access to ecstasy, cocaine and heroin. According to young Europeans, when the economy worsens, anti-drug policies should focus on the reduction of poverty and unemployment, and not on implementing tougher measures against users.
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Affiliation(s)
- Sara Ayllón
- Department of Economics & EQUALITAS, University of Girona, Spain.
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Lorenzoni V, Curzio O, Karakachoff M, Saponaro A, Sanza M, Mariani F, Molinaro S. The effects of the macro-environment on treatment retention for problem cocaine users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 24:52-9. [PMID: 22884542 DOI: 10.1016/j.drugpo.2012.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 03/14/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Client dropout is commonly used as an indicator of quality and effectiveness of drug treatment. Following increasing cocaine use in recent years, research has attempted to identify predictors of retention in treatment for cocaine users but there is no consensus about how individual characteristics and system variables (referral source, treatment setting), what we term here as the "macro-environment" - effect risk of dropout. This study sought to identify macro-environmental factors and examine the way these impact upon treatment retention. METHODS A retrospective longitudinal study of an admission cohort among drug services in Vasta Romagna in Emilia Romagna Region, Italy (up to 8 years of treatment or until discharge) was conducted to determine the effect of macro-environmental variables on retention among first time admitted cocaine-dependent clients in different treatment settings. The sample consisted of 1178 clients meeting DSM-IV-R criteria for cocaine dependence. RESULTS The joint effect of individual and system factors had a significant impact on dropout rates. In particular, lower rates of dropout were observed for those treated in prison and those who had a stable home, HR: 0.09 (0.02-0.48), or lived in rehabilitation units, HR: 0.36 (0.15-0.88), and among clients referred by the local authority and those living with parents, HR: 0.60 (0.38-0.95). CONCLUSION The combined effect of individual and system factors on retention in treatment sets a critical background necessary to assess any impact of organizational dynamics and delineate the trajectory for future interventions.
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