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Lan Y, Lin X, Chen Q, Wang L, Sun L, Huang Z. Drug supply and assurance: a cross-sectional study of drug shortage monitoring varieties in China. BMC Public Health 2024; 24:2048. [PMID: 39080661 PMCID: PMC11289944 DOI: 10.1186/s12889-024-19361-5] [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: 04/25/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Drug shortage is a worldwide problem that seriously threatens public health. China released the most comprehensive list of key drug shortage monitoring varieties ever in 2022. We aim to analyze the attributes and characteristics of the medicines within the list to provide a reference for improving China's supply security of shortage drugs. METHODS We used public data to extract information on drug types, dosage forms, indications, classification of clinical uses, whether they were included in medical catalogs such as the National Essential Drugs, and the number of drug and active pharmaceutical ingredient (API) manufacturers. A descriptive statistical analysis was used. RESULTS Of the 980 drugs on the list, 99.59% were chemicals and 92.65% were injectables. Drugs for blood and hematopoietic organs, the cardiovascular system, and the digestive tract and metabolism ranked among the top three shortages. Verification of the medical catalogs showed that 90.41% of the drugs belonged to the national essential drugs, 95.10% were medicare drugs, 2.55% were volume-based procurement drugs, and 14.70% were for rare diseases, and 42.04% were for children. In terms of drug supply capacity, 21.33% of drug approvals are less than 10, and there were even 26 drugs for exclusive production, close to 90% of manufacturers need to purchase APIs from outside. Among the 256 APIs included in the list, 152 APIs had less than 10 manufacturers, and there were even 5 APIs produced by only one enterprise nationwide. CONCLUSIONS The situation of drug shortages in China was severe and complex, with serious shortages of medicines adapted to basic medical and healthcare needs and clinically necessary medicines, and a need to improve the production capacity of drugs and the ability to supply APIs. We recommend strengthening drug monitoring and stockpiling and accelerating the approval of shortage drugs to improve drug supply security.
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Affiliation(s)
- Yipeng Lan
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Xiaofeng Lin
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Qiannan Chen
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Li Wang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Lihua Sun
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China.
- Institute of Drug Regulatory Science, Shenyang Pharmaceutical University, Shenyang, China.
| | - Zhe Huang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China.
- Institute of Drug Regulatory Science, Shenyang Pharmaceutical University, Shenyang, China.
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McGuire AL, Cohen IG, Sisti D, Baggott M, Celidwen Y, Devenot N, Gracias S, Grob C, Harvey I, Kious B, Marks M, Mithoefer M, Nielson E, Öngür D, Pallas A, Peterson A, Schenberg EE, Summergrad P, Waters B, Williams MT, Yaden DB. Developing an Ethics and Policy Framework for Psychedelic Clinical Care: A Consensus Statement. JAMA Netw Open 2024; 7:e2414650. [PMID: 38833254 DOI: 10.1001/jamanetworkopen.2024.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
Importance As government agencies around the globe contemplate approval of the first psychedelic medicines, many questions remain about their ethical integration into mainstream medical practice. Objective To identify key ethics and policy issues related to the eventual integration of psychedelic therapies into clinical practice. Evidence Review From June 9 to 12, 2023, 27 individuals representing the perspectives of clinicians, researchers, Indigenous groups, industry, philanthropy, veterans, retreat facilitators, training programs, and bioethicists convened at the Banbury Center at Cold Spring Harbor Laboratory. Prior to the meeting, attendees submitted key ethics and policy issues for psychedelic medicine. Responses were categorized into 6 broad topics: research ethics issues; managing expectations and informed consent; therapeutic ethics; training, education, and licensure of practitioners; equity and access; and appropriate role of gatekeeping. Attendees with relevant expertise presented on each topic, followed by group discussion. Meeting organizers (A.L.M., I.G.C., D.S.) drafted a summary of the discussion and recommendations, noting points of consensus and disagreement, which were discussed and revised as a group. Findings This consensus statement reports 20 points of consensus across 5 ethical issues (reparations and reciprocity, equity, and respect; informed consent; professional boundaries and physical touch; personal experience; and gatekeeping), with corresponding relevant actors who will be responsible for implementation. Areas for further research and deliberation are also identified. Conclusions and Relevance This consensus statement focuses on the future of government-approved medical use of psychedelic medicines in the US and abroad. This is an incredibly exciting and hopeful moment, but it is critical that policymakers take seriously the challenges ahead.
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Affiliation(s)
- Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - I Glenn Cohen
- Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics, Harvard Law School, Cambridge, Massachusetts
| | - Dominic Sisti
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
| | | | - Yuria Celidwen
- Othering and Belonging Institute, Department of Psychology, University of California Berkeley
| | | | | | - Charles Grob
- Harbor-UCLA Medical Center, Torrance, California
| | - Ifetayo Harvey
- People of Color Psychedelic Collective, New York, New York
| | - Brent Kious
- Department of Psychiatry, University of Utah Health, Salt Lake City
| | - Mason Marks
- Florida State University College of Law, Tallahassee
| | - Michael Mithoefer
- Multidisciplinary Association for Psychedelic Studies (MAPS) Public Benefit Corporation, New York, New York
| | | | - Dost Öngür
- McLean Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Andrew Peterson
- Department of Philosophy, George Mason University, Fairfax, Virginia
| | | | - Paul Summergrad
- Departments of Psychiatry and Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Monnica T Williams
- School of Psychology & Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David B Yaden
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Marks M, Brendel RW, Shachar C, Cohen IG. Essentials of Informed Consent to Psychedelic Medicine. JAMA Psychiatry 2024; 81:611-617. [PMID: 38598209 DOI: 10.1001/jamapsychiatry.2024.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Importance Interest in administering psychedelic agents as mental health treatment is growing rapidly. As drugmakers invest in developing psychedelic medicines for several psychiatric indications, lawmakers are enacting legal reforms to speed access globally, and health agencies are preparing to approve these treatments. Meanwhile, US states, such as Oregon and Colorado, are making psychedelics available for supervised use outside the conventional health care system. Observations Despite legal change and potentially imminent regulatory approval in some countries, standards for integrating psychedelics into health care have lagged, including norms for designing and implementing informed consent processes. Informed consent is complicated by the unique features of psychedelics and their means of administration. Because no governments have approved any classic psychedelics for general medical or psychiatric use, only clinical researchers have obtained informed consent from trial participants. Accordingly, there is an unmet need for informed consent processes tailored to the challenges of administering psychedelics in nonresearch settings. Conclusions and Relevance Analysis of the challenges of designing and implementing psychedelic informed consent practices revealed 7 essential components, including the possibility of short- and long-term perceptual disturbances, potential personality changes and altered metaphysical beliefs, the limited role of reassuring physical touch, the potential for patient abuse or coercion, the role and risks of data collection, relevant practitioner disclosures, and interactive patient education and comprehension assessment. Because publicly available informed consent documents for psychedelic clinical trials often overlook or underemphasize these essential elements, sample language and procedures to fill the gap are proposed.
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Affiliation(s)
- Mason Marks
- Project on Psychedelics Law and Regulation (POPLAR), Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts
- Florida State University College of Law, Tallahassee, Florida
| | | | - Carmel Shachar
- Center for Health Law and Policy Innovation, Harvard Law School, Cambridge, Massachusetts
| | - I Glenn Cohen
- Project on Psychedelics Law and Regulation (POPLAR), Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts
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Nutt D, Crome I, Young AH. Is it now time to prepare psychiatry for a psychedelic future? Br J Psychiatry 2024:1-3. [PMID: 38764044 DOI: 10.1192/bjp.2024.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Australia has just rescheduled two drugs controlled under the United Nations Psychotropic Drug Conventions, psilocybin and MDMA, as treatments for treatment-resistant depression and post-traumatic stress disorder respectively. This feature explores the reasons for these developments, the opportunities and challenges they provide to psychiatry communities and how along with health systems these communities might respond to these developments.
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Affiliation(s)
- David Nutt
- Division of Psychiatry, Imperial College London, UK; and Drug Science, London, UK
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Abstract
This Viewpoint examines how US states are reforming legislation to allow access to psychedelics for therapeutic use, but federal laws consider these agents to be Schedule I drugs, and the discordance between state and federal law may create confusion and conflict.
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Affiliation(s)
- Mason Marks
- Project on Psychedelics Law and Regulation (POPLAR), Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Cambridge, Massachusetts
- Florida State University College of Law, Tallahassee
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Sanchez-Reyes OB, Zilberg G, McCorvy JD, Wacker D. Molecular insights into GPCR mechanisms for drugs of abuse. J Biol Chem 2023; 299:105176. [PMID: 37599003 PMCID: PMC10514560 DOI: 10.1016/j.jbc.2023.105176] [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: 03/03/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/22/2023] Open
Abstract
Substance abuse is on the rise, and while many people may use illicit drugs mainly due to their rewarding effects, their societal impact can range from severe, as is the case for opioids, to promising, as is the case for psychedelics. Common with all these drugs' mechanisms of action are G protein-coupled receptors (GPCRs), which lie at the center of how these drugs mediate inebriation, lethality, and therapeutic effects. Opioids like fentanyl, cannabinoids like tetrahydrocannabinol, and psychedelics like lysergic acid diethylamide all directly bind to GPCRs to initiate signaling which elicits their physiological actions. We herein review recent structural studies and provide insights into the molecular mechanisms of opioids, cannabinoids, and psychedelics at their respective GPCR subtypes. We further discuss how such mechanistic insights facilitate drug discovery, either toward the development of novel therapies to combat drug abuse or toward harnessing therapeutic potential.
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Affiliation(s)
- Omar B Sanchez-Reyes
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregory Zilberg
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John D McCorvy
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Daniel Wacker
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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King LA, Nutt DJ, Nichols DE. Remove barriers to clinical research for schedule 1 drugs with therapeutic potential. BMJ 2023; 381:981. [PMID: 37130596 DOI: 10.1136/bmj.p981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
| | - David J Nutt
- Centre for Psychedelic Research Division of Psychiatry, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - David E Nichols
- Department of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- Purdue University School of Pharmacy, West Lafayette, IN, USA
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