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Lundstrom EW, Dai Z, Groth CP, Hendricks B, Winstanley EL, Abate M, Smith GS. Comparing the effects of decreasing prescription opioid shipments and the release of an abuse deterrent OxyContin formulation on opioid overdose fatalities in WV: an interrupted time series study. Subst Abuse Treat Prev Policy 2024; 19:4. [PMID: 38178238 PMCID: PMC10768117 DOI: 10.1186/s13011-023-00587-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The 2010 release of an abuse deterrent formulation (ADF) of OxyContin, a brand name prescription opioid, has been cited as a major driver for the reduction in prescription drug misuse and the associated increasing illicit opioid use and overdose rates. However, studies of this topic often do not account for changes in supplies of other prescription opioids that were widely prescribed before and after the ADF OxyContin release, including generic oxycodone formulations and hydrocodone. We therefore sought to compare the impact of the ADF OxyContin release to that of decreasing prescription opioid supplies in West Virginia (WV). METHODS Opioid tablet shipment and overdose data were extracted from The Washington Post ARCOS (2006-2014) and the WV Forensic Drug Database (2005-2020), respectively. Locally estimated scatterplot smoothing (LOESS) was used to estimate the point when shipments of prescription opioids to WV began decreasing, measured via dosage units and morphine milligram equivalents (MMEs). Interrupted time series analysis (ITSA) was used to compare the impact LOESS-identified prescription supply changes and the ADF OxyContin release had on prescription (oxycodone and hydrocodone) and illicit (heroin, fentanyl, and fentanyl analogues) opioid overdose deaths in WV. Model fit was compared using Akaike Information Criteria (AIC). RESULTS The majority of opioid tablets shipped to WV from 2006 to 2014 were generic oxycodone or hydrocodone, not OxyContin. After accounting for a 6-month lag from ITSA models using the LOESS-identified change in prescription opioid shipments measured via dosage units (2011 Q3) resulted in the lowest AIC for both prescription (AIC = -188.6) and illicit opioid-involved overdoses (AIC = -189.4), indicating this intervention start date resulted in the preferred model. The second lowest AIC was for models using the ADF OxyContin release as an intervention start date. DISCUSSION We found that illicit opioid overdoses in WV began increasing closer to when prescription opioid shipments to the state began decreasing, not when the ADF OxyContin release occurred. Similarly, the majority of opioid tablets shipped to the state for 2006-2014 were generic oxycodone or hydrocodone. This may indicate that diminishing prescription supplies had a larger impact on opioid overdose patterns than the ADF OxyContin release in WV.
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Affiliation(s)
- Eric W Lundstrom
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US.
| | - Zheng Dai
- Health Affairs Institute, Health Sciences Center, West Virginia University, 405 Capitol Street, Suite 514, Charleston, WV, 25301, US
| | - Caroline P Groth
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US
| | - Brian Hendricks
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US
| | - Erin L Winstanley
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, 930 Chestnut Ridge Rd, Morgantown, WV, 26505, US
| | - Marie Abate
- School of Pharmacy, West Virginia University, 64 Medical Center Drive, P.O. Box 9500, Morgantown, WV, 26506-9500, US
| | - Gordon S Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US
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Bacon M, Spicer J. 'Breaking supply chains'. A commentary on the new UK Drug Strategy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103843. [PMID: 36041960 DOI: 10.1016/j.drugpo.2022.103843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/22/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Matthew Bacon
- Centre for Criminological Research, University of Sheffield, United Kingdom
| | - Jack Spicer
- Department of Social and Policy Sciences, University of Bath, United Kingdom.
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McSweeney K. Reliable drug war data: The Consolidated Counterdrug Database and cocaine interdiction in the "Transit Zone". THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 80:102719. [PMID: 32416537 DOI: 10.1016/j.drugpo.2020.102719] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND For almost three decades, a U.S. government dataset has vetted and recorded all known cocaine trafficking events in the massive Western Hemisphere 'transit zone' (including Central America, the Caribbean, eastern Pacific, and Mexico) and tracked all cocaine seizures reported by counternarcotic forces there. This is the "cocaine module" of the Consolidated Counterdrug Database (CCDB), and by U.S. law it is the exclusive source for performance data on key aspects of the drug interdiction mission, one of the foundations of U.S. supply-side drug policy. Nevertheless, the dataset remains poorly known or used among drug policy researchers despite being unclassified. To make the existence and strengths of this dataset better known, this paper describes its provenance, ongoing production, and analytical utility. METHODS The analysis draws on the archive of reports produced by the Government Accountability Office (GAO), an independent, non-partisan entity that has been tracking U.S. government agencies' drug war accounting for almost 50 years. The analysis also relies on third-party assessments of interdiction, and on correspondence with staff in the Office of National Drug Control Policy. RESULTS The CCDB emerged in the 1990s following two decades of drug war failures in the transit zone. It is an "all source" product, which curates data from a variety of sources produced by the 26 U.S. agencies and 20 foreign partners involved in transit zone interdiction. There is a high threshold for inclusion of cocaine trafficking events into the CCDB; it therefore offers a highly reliable yet conservative representation of cocaine trafficking and counternarcotic response. Instances of CCDB data in the public record yield several insights: a) the volume of cocaine moving annually through the transit zone has for the past decade well exceeded 1,000 MT/year; b) cocaine seizures in the transit zone are greater than anywhere else, and significantly higher than indicated by the UNODC's World Drug Reports; c) interdiction appears to have little to no effect on cocaine prices in the U.S.; d) interdiction is highly "outcome-ineffective"; in FY2018, for example, the U.S. and partners intercepted only 6% of the cocaine trafficking events known to have occurred in the transit zone that year; e) traffickers respond quickly and constantly to interdiction by shifting their routes and transport strategies. CONCLUSION The CCDB deserves greater attention from researchers as a high-quality dataset that: a) challenges the "unknowability" of illicit activities and underscores the need for better sharing of unclassified government data; b) opens up new ways of exploring drug enforcement policies and actions in transit areas; c) contradicts rosy assessments of drug interdiction effectiveness by unequivocally demonstrating interdiction's longstanding and persistent failure and thus the need for fundamentally different approaches.
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Affiliation(s)
- Kendra McSweeney
- Department of Geography, 1036 Derby Hall, 154 North Oval Mall, Ohio State University, Columbus, OH 43210-1341 United States.
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Townsend EA, Negus SS, Poklis JL, Banks ML. Lorcaserin maintenance fails to attenuate heroin vs. food choice in rhesus monkeys. Drug Alcohol Depend 2020; 208:107848. [PMID: 31982193 PMCID: PMC7039750 DOI: 10.1016/j.drugalcdep.2020.107848] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The current opioid crisis has reinvigorated preclinical research in the evaluation of non-opioid candidate treatments for opioid use disorder (OUD). Emerging evidence suggests 5-HT2C receptor agonists may attenuate the abuse-related effects of opioids. This study evaluated effectiveness of 7-day treatment with the clinically available 5-HT2C agonist lorcaserin (Belviq®) on heroin-vs.-food choice in rhesus monkeys. Lorcaserin effects were compared to effects produced by 7-day saline substitution and by 7-day treatment with the opioid antagonist naltrexone. METHODS Adult male (1) and female (6) rhesus monkeys were trained to respond under a concurrent schedule of food delivery (1 g pellets, fixed-ratio 100 schedule) and intravenous heroin injections (0-0.032 mg/kg/injection, fixed-ratio 10 schedule) during daily 2 h sessions. Heroin choice dose-effect functions were determined daily before and following 7-day saline substitution or 7-day continuous treatment with naltrexone (0.0032-0.032 mg/kg/h, IV) or lorcaserin (0.032-0.32 mg/kg/h, IV). RESULTS Under baseline conditions, increasing heroin doses maintained a dose-dependent increase in heroin choice. Both saline substitution and 7-day naltrexone treatment significantly attenuated heroin choice and produced a reciprocal increase in food choice. Continuous lorcaserin (0.32 mg/kg/h) treatment significantly increased heroin choice. CONCLUSIONS In contrast to saline substitution and naltrexone, lorcaserin treatment was ineffective to reduce heroin-vs.-food choice. These preclinical results do not support the therapeutic potential and continued evaluation of lorcaserin as a candidate OUD treatment.
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Affiliation(s)
- E Andrew Townsend
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - S Stevens Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Justin L Poklis
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Matthew L Banks
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
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Peterson M, Rich J, Macmadu A, Truong AQ, Green TC, Beletsky L, Pognon K, Brinkley-Rubinstein L. "One guy goes to jail, two people are ready to take his spot": Perspectives on drug-induced homicide laws among incarcerated individuals. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:47-53. [PMID: 31082662 DOI: 10.1016/j.drugpo.2019.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND As overdose deaths have increased in the United States, some lawmakers have explored punitive, "supply-side" interventions aimed at reducing the supply of fentanyl. While a rationale of seeking to protect people who use drugs is often given to justify harsh sentences for fentanyl distribution, there is no research to our knowledge on perceptions of the effect of drug-induced homicide laws among people who use drugs. METHODS We conducted semi-structured, qualitative interviews with 40 people with opioid use disorder (OUD) who were enrolled in a medication for addiction treatment (MAT) program in a unified jail and prison system in Rhode Island on attitudes surrounding increased sentences for distribution of fentanyl, including recently enacted drug-induced homicide laws. Codes were developed using a generalized, inductive method and interviews analyzed in NVivo 12 after being coded by two coders. RESULTS Most participants stated that drug-induced homicide laws would not be an effective strategy to stem the overdose crisis. We identified key themes, including discussions surrounding the autonomy of people who use drugs, widespread fentanyl prevalence as a barrier to implementation of drug-induced homicide laws, discussions of mass incarceration as ineffective for addressing substance use disorders, feelings that further criminalization could lead to violence, criminalization as a justification for interpersonal loss, and intention as meaningful to categorizing an act as homicide. CONCLUSIONS Findings highlight the importance of centering the experiences of people with OUD in creating policies surrounding the overdose epidemic, potential unintended health consequences of drug-induced homicides laws such as deterrence from calling 911 and increased violence, and how drug-induced homicide laws may undermine advances made in expanding access to OUD treatment for people who are criminal justice-involved.
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Affiliation(s)
- Meghan Peterson
- School of Public Health, Brown University, Providence, RI, United States; Center for Prisoner Health and Human Rights, Providence, RI, United States.
| | - Josiah Rich
- Center for Prisoner Health and Human Rights, Providence, RI, United States; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Alexandria Macmadu
- Center for Prisoner Health and Human Rights, Providence, RI, United States; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | - Ashley Q Truong
- Center for Prisoner Health and Human Rights, Providence, RI, United States
| | - Traci C Green
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States; Rhode Island Hospital, Providence, RI, United States
| | - Leo Beletsky
- School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States; University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Kimberly Pognon
- Center for Prisoner Health and Human Rights, Providence, RI, United States
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, United States; Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, United States
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Martin J, Cunliffe J, Décary-Hétu D, Aldridge J. Effect of restricting the legal supply of prescription opioids on buying through online illicit marketplaces: interrupted time series analysis. BMJ 2018; 361:k2270. [PMID: 29899119 PMCID: PMC5998052 DOI: 10.1136/bmj.k2270] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To examine the effect on the trade in opioids through online illicit markets ("cryptomarkets") of the US Drug Enforcement Administration's ruling in 2014 to reschedule hydrocodone combination products. DESIGN Interrupted time series analysis. SETTING 31 of the world's largest cryptomarkets operating from October 2013 to July 2016. MAIN OUTCOME MEASURES The proportion of total transactions, advertised and active listings for prescription opioids, prescription sedatives, prescription steroids, prescription stimulants, and illicit opioids, and the composition of the prescription opioid market between the US and elsewhere. RESULTS The sale of prescription opioids through US cryptomarkets increased after the schedule change, with no statistically significant changes in sales of prescription sedatives, prescription steroids, prescription stimulants, or illicit opioids. In July 2016 sales of opioids through US cryptomarkets represented 13.7% of all drug sales (95% confidence interval 11.5% to 16.0%) compared with a modelled estimate of 6.7% of all sales (3.7% to 9.6%) had the new schedule not been introduced. This corresponds to a 4 percentage point yearly increase in the amount of trade that prescription opioids represent in the US market, set against no corresponding changes for comparable products or for prescription opioids sold outside the US. This change was first observed for sales, and later observed for product availability. There was also a change in the composition of the prescription opioid market: fentanyl was the least purchased product during July to September 2014, then the second most frequently purchased by July 2016. CONCLUSIONS The scheduling change in hydrocodone combination products coincided with a statistically significant, sustained increase in illicit trading of opioids through online US cryptomarkets. These changes were not observed for other drug groups or in other countries. A subsequent move was observed towards the purchase of more potent forms of prescription opioids, particularly oxycodone and fentanyl.
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Affiliation(s)
- James Martin
- Department of Social Sciences, Swinburne University, Melbourne, Australia
| | - Jack Cunliffe
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, Kent CT2 7NF, UK
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Carroll JJ, Marshall BDL, Rich JD, Green TC. Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:136-145. [PMID: 28578864 DOI: 10.1016/j.drugpo.2017.05.023] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/27/2017] [Accepted: 05/05/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Illicit fentanyl use has become wide spread in the US, causing high rates of overdose deaths among people who use drugs. This study describes patterns and perceptions of fentanyl exposure among opioid users in Rhode Island. METHODS A mixed methods study was conducted via questionnaire with a convenience sample of 149 individuals using illicit opioids or misusing prescription opioids in Rhode Island between January and November 2016. Of these, 121 knew of fentanyl and reported known or suspected exposure to fentanyl in the past year. Semi-structured interviews were conducted with the first 47 participants. RESULTS Study participants were predominantly male (64%) and white (61%). Demographic variables were similar across sample strata. Heroin was the most frequently reported drug of choice (72%). Self-reported exposure to illicit fentanyl in the past year was common (50.4%, n=61). In multivariate models, regular (at least weekly) heroin use was independently associated with known or suspected fentanyl exposure in the past year (adjusted prevalence ratio (APR)=4.07, 95% CI: 1.24-13.3, p=0.020). In interviews, users described fentanyl as unpleasant, potentially deadly, and to be avoided. Participants reporting fentanyl exposure routinely experienced or encountered non-fatal overdose. Heroin users reported limited ability to identify fentanyl in their drugs. Harm reduction strategies used to protect themselves from fentanyl exposure and overdose, included test hits, seeking prescription opioids in lieu of heroin, and seeking treatment with combination buprenorphine/naloxone. Participants were often unsuccessful in accessing structured treatment programs. CONCLUSION Among illicit opioid users in Rhode Island, known or suspected fentanyl exposure is common, yet demand for fentanyl is low. Fentanyl-contaminated drugs are generating user interest in effective risk mitigation strategies, including treatment. Responses to the fentanyl epidemic should be informed by the perceptions and experiences of local users. The rapid scale-up of buprenorphine/naloxone provision may slow the rate of fentanyl-involved overdose deaths.
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Affiliation(s)
- Jennifer J Carroll
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St., Providence, RI 02903, USA; Division of Infectious Diseases, The Miriam Hospital, 164 Summit Ave, Providence, RI 02906, USA.
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Box G-S-121-2, Providence, RI 02912, USA
| | - Josiah D Rich
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St., Providence, RI 02903, USA; Division of Infectious Diseases, The Miriam Hospital, 164 Summit Ave, Providence, RI 02906, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Box G-S-121-2, Providence, RI 02912, USA
| | - Traci C Green
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St., Providence, RI 02903, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Box G-S-121-2, Providence, RI 02912, USA; Department of Emergency Medicine, Boston University School of Medicine, 771 Albany St., Room 1208, Boston, MA 02118, USA
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Ritter A, Stevens A. Improving knowledge on law enforcement in drug policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 41:89-90. [PMID: 28257909 DOI: 10.1016/j.drugpo.2017.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alison Ritter
- National Drug and Alcohol Research Centre, University of NSW, Australia
| | - Alex Stevens
- School of Social Policy, Sociology and Social Research, University of Kent, Australia
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