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Patient experiences of prescription drug monitoring programs: a qualitative analysis from an Australian pharmaceutical helpline. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103847. [PMID: 36067724 DOI: 10.1016/j.drugpo.2022.103847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prescription Drug Monitoring Programs (PDMP) are electronic databases that are used to track and monitor the prescribing and dispensing of controlled substances, such as opioid analgesics and benzodiazepines. PDMP have been used widely throughout North America and have recently been implemented in Australia. Several unintended harms have been associated with PDMP in North America, including increased stigma, discrimination, and dismissal from care for patients prescribed these medications. AIMS This study aimed to better understand how people who use prescription medications extramedically and their loved ones give meaning to their consumption and their treatment experiences and concerns in the context of a newly implemented real-time PDMP in Victoria, Australia. METHOD Nineteen audio recordings of telephone calls made to the PDMP Pharmaceutical Helpline were transcribed and thematically analysed. RESULTS Patients and their families were hopeful that PDMP would stop the extra medical use of medications. However, many were deeply concerned about how they would cope with withdrawal or life stressors without the support these medications afforded. Patients reported experiences of stigma and strained therapeutic relationships associated with PDMP implementation. CONCLUSION PDMP have the potential to both assist and harm patients whose prescription medication use has been identified as 'risky' by the PDMP. The findings from this study suggest that clear and open communication, as well as reflection on unconscious bias and stigma may assist healthcare providers to facilitate better patient experiences and outcomes in the context of prescription medication dependence.
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Sattler S, van Veen F, Hasselhorn F, Mehlkop G, Sauer C. An experimental test of Situational Action Theory of crime causation: Investigating the perception-choice process. SOCIAL SCIENCE RESEARCH 2022; 106:102693. [PMID: 35680355 DOI: 10.1016/j.ssresearch.2021.102693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/06/2021] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
Criminal action, according to Situational Action Theory (SAT), is a two-stage process consisting of a perception and a choice process. This Germany-wide vignette study (N = 3,088, participants recruited offline) provides an explicit and extensive test of these processes. It experimentally varied the informal moral context, deterrence (sanctions and detection risk), and possible gains of selling prescription drugs illegally in a 2x2x2×2 between-subject design. Personal morality and self-control were measured. Double-hurdle models show that personal morality served as a filter for the perception of criminal alternatives. Law-conforming moral context information, high self-control, and deterrence lowered the crime willingness. Thereby, this study underlines the usefulness of an explicit modeling of the dual-process of criminal conduct, in which certain antecedents only play a role in a certain process. While several findings corroborate assumptions from SAT, an influence of the informal moral context was only found in the choice process, not in the perception process.
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Affiliation(s)
- Sebastian Sattler
- Institute of Sociology and Social Psychology, University of Cologne, Germany; Faculty of Sociology, Bielefeld University, Germany; Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Canada.
| | - Floris van Veen
- Faculty of Economics, Law and Social Sciences, University of Erfurt, Germany.
| | - Fabian Hasselhorn
- Institute of Sociology and Social Psychology, University of Cologne, Germany.
| | - Guido Mehlkop
- Faculty of Economics, Law and Social Sciences, University of Erfurt, Germany; Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Germany.
| | - Carsten Sauer
- Faculty of Sociology, Bielefeld University, Germany.
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Soeiro T, Lacroix C, Pradel V, Lapeyre-Mestre M, Micallef J. Early Detection of Prescription Drug Abuse Using Doctor Shopping Monitoring From Claims Databases: Illustration From the Experience of the French Addictovigilance Network. Front Psychiatry 2021; 12:640120. [PMID: 34079478 PMCID: PMC8165176 DOI: 10.3389/fpsyt.2021.640120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence. Awareness of prescription drug abuse has been increasing in the last two decades, and organizations such as the International Narcotics Control Board has predicted that, worldwide, prescription drug abuse may exceed the use of illicit drugs. Assessment of prescription drug abuse tackles an issue that is hidden by nature, which therefore requires a specific monitoring. The current best practice is to use multiple detection systems to assess prescription drug abuse by various populations in a timely, sensitive, and specific manner. In the early 2000's, we designed a method to detect and quantify doctor shopping for prescription drugs from the French National Health Data System, which is one of the world's largest claims database, and a first-class data source for pharmacoepidemiological studies. Doctor shopping is a well-known behavior that involves overlapping prescriptions from multiple prescribers for the same drug, to obtain higher doses than those prescribed by each prescriber on an individual basis. In addition, doctor shopping may play an important role in supplying the black market. The paper aims to review how doctor shopping monitoring can improve the early detection of prescription drug abuse within a multidimensional monitoring. The paper provides an in-depth overview of two decades of development and validation of the method as a complementary component of the multidimensional monitoring conducted by the French Addictovigilance Network. The process accounted for the relevant determinants of prescription drug abuse, such as pharmacological data (e.g., formulations and doses), chronological and geographical data (e.g., impact of measures and comparison between regions), and epidemiological and outcome data (e.g., profiles of patients and trajectories of care) for several pharmacological classes (e.g., opioids, benzodiazepines, antidepressants, and methylphenidate).
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Clémence Lacroix
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Vincent Pradel
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Maryse Lapeyre-Mestre
- Université Paul Sabatier, Inserm, CIC 1436, Centre Hospitalier Universitaire de Toulouse, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Toulouse, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
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Chan WL, Wood DM, Dargan PI. Prescription medicine misuse in the Asia-Pacific region: An evolving issue? Br J Clin Pharmacol 2020; 87:1660-1667. [PMID: 33140471 DOI: 10.1111/bcp.14638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/10/2020] [Accepted: 10/17/2020] [Indexed: 12/16/2022] Open
Abstract
Prescription medicine misuse, especially misuse of opioids has become a major public healthcare issue in many developed countries such as the USA and Australia where this is associated with significant morbidity (Emergency Department visits due to acute toxicity) and mortality. In this review, we looked at the available data obtained from peer-reviewed articles and population surveys to gain an insight into the current situation in the Asia-Pacific region. There is currently limited information available, but data from subpopulation surveys in a number of countries suggests that prescription medicine misuse is likely to be an issue of concern from a public health perspective in the Asia-Pacific region. The available data suggest that misuse prevalence rates and the medicines that are commonly misused are similar to countries such as the USA and UK. Further studies are required to determine the overall prevalence of misuse, the harms associated with this and the sources of drugs being misused so that appropriate interventions can be implemented to tackle issues related to prescription medicine misuse in this region.
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Affiliation(s)
- Wui Ling Chan
- Emergency Department, Ng Teng Fong General Hospital, Singapore
| | - David M Wood
- Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Reader in Clinical Toxicology, King's College London, London, UK
| | - Paul I Dargan
- Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, St Thomas' Hospital, London, UK
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Liu Y, Smith NDL, Lloyd SL, Striley CW, Cottler LB. Prescription Stimulant Use and Associated Risk Factors for Non-oral Use among 10 to 18 Year Olds. J Psychoactive Drugs 2020; 52:421-432. [PMID: 32723035 DOI: 10.1080/02791072.2020.1795326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Non-medical use, especially non-oral use, of prescription stimulants is a public health concern. This study analyzed data from the National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS). Users (n = 723) were categorized as oral medical only users (n = 330, 45.6%), any oral non-medical users (n = 270, 37.3%), and any non-oral users (n = 123, 17.0%). The associations between patterns of stimulant use and risk factors were examined using logistic regression. Of the 123 any non-oral users, 79 reported using stimulants intranasally and orally, which was the most prevalent pattern of non-oral use. Among any non-oral users, the most common source of stimulants was from school (63.4%). Non-oral users primarily used stimulants to get high (74.4%) compared to 27.1% among other users. Negative consequences significantly associated with any non-oral use but not with oral non-medical use included needing stimulants to "feel ok," having trouble with teachers, bosses or friends due to stimulant use, and having anxiety and depression symptoms. In this study, non-oral use of prescription stimulants was associated with additional risks of adverse mental health outcomes compared to medical only use and other forms of non-medical use. Stimulant non-oral use interventions should emphasize the risks of intranasal use of stimulants.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville, FL, USA
| | - Nathan D L Smith
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville, FL, USA
| | - Shawnta L Lloyd
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville, FL, USA
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville, FL, USA
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville, FL, USA
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Sultan A, Hupli A. Editorial. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-03-2020-075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hulme S, Hughes CE, Nielsen S. The price and mark up of pharmaceutical drugs supplied on the black market. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102626. [PMID: 31841773 DOI: 10.1016/j.drugpo.2019.102626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/21/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Research examining illicit drug markets has shown that price affects consumption and mark ups are extremely high. However, the economics of black market pharmaceutical supply remains unknown, despite increasing harms due to pharmaceuticals. METHODS Semi-structured, telephone interviews were conducted in Australia with 51 people involved in supplying pharmaceuticals in the previous six months. Interviews were audio-recorded, transcribed and quantitative information on costs, sale price, quantity and frequency of supply were coded and used to calculate the mark up ratio for each drug transaction 'cycle', accounting for distribution via selling, gifting and trading. Mixed effects gamma regressions were used to identify predictors of price and mark up, clustering by participant. RESULTS There were 29 drugs supplied over 111 cycles, including hypnotic-sedatives (38%), pharmaceutical opioids (32%), stimulants (18%) and others (12%). Sedatives were sold at lower prices than opioids and there was a negative relationship between unit price and transaction size, consistent with a discount effect. For every dollar spent acquiring the drugs, the supplier earned a median of $3.19. Cycles involving the distribution of drugs sourced via intermediaries (e.g. friends/family) had lower mark up than drugs sourced directly from the medical system. CONCLUSION To our knowledge, this is one of few studies to analyse economic aspects of the pharmaceutical black market from a supply perspective. There were a small number of cycles that realised large profits that may warrant different types of policy responses, however for most suppliers in our sample gross revenue and gross profit was modest.
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Affiliation(s)
- Shann Hulme
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2031, Australia.
| | - Caitlin Elizabeth Hughes
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2031, Australia; Centre for Crime Policy and Research, Flinders University, SA, Australia
| | - Suzanne Nielsen
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2031, Australia; Monash Addiction Research Centre, Monash University, Peninsula Campus, McMahons Road, Frankston, VIC 3199, Australia
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Hulme S, Hughes CE, Nielsen S. What factors contributed to the misconduct of health practitioners? An analysis of Australian cases involving the diversion and supply of pharmaceutical drugs for non‐medical use between 2010 and 2016. Drug Alcohol Rev 2019; 38:366-376. [DOI: 10.1111/dar.12918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/29/2019] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Shann Hulme
- Drug Policy Modelling ProgramNational Drug and Alcohol Research Centre, UNSW Sydney Sydney Australia
| | - Caitlin Elizabeth Hughes
- Drug Policy Modelling ProgramNational Drug and Alcohol Research Centre, UNSW Sydney Sydney Australia
| | - Suzanne Nielsen
- Drug Policy Modelling ProgramNational Drug and Alcohol Research Centre, UNSW Sydney Sydney Australia
- Monash Addiction Research CentreMonash University, Peninsula Campus Melbourne Australia
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