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Janssen E, Vuolo M. Correlates of Stimulant Use among People Who Use Heroin Undergoing Treatment in Out-Patient Facilities in France, 2010-2020. Subst Use Misuse 2024; 59:353-361. [PMID: 37859423 DOI: 10.1080/10826084.2023.2270682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: Polydrug use has been implicated in driving a "fourth wave" of the overdose crisis in North America, specifically through concurrent use of stimulants and opioids, especially fentanyl. In France, however, heroin has historically been and remains the easiest-to-access opioid, accounting for most drug treatment demand. Whether similar polydrug use is increasing in Western Europe remains understudied, despite severe health implications and potential inadequate public health responses.Methods: We take advantage of a nation-wide dataset containing information on all patients serviced in treatment centers in France from 2010 to 2020. We conduct Poisson regression to determine the main predictors of stimulant use among people who use heroin (PWUH) and opioids (PWUO) generally.Results: Heroin remains the primary opioid within drug treatment in France. A decreasing number of out-patients seeking treatment for heroin use has been accompanied by an increasing trend of stimulant use over time, most commonly with powder cocaine. Our results suggest a significant increase of crack cocaine use among the most vulnerable PWUH. Concurrent use of stimulants among PWUH was positively associated with use of alcohol, cannabis, unprescribed psychotropics and hallucinogens, and negatively with tobacco. Similar results were found for all in-treatment PWUO.Conclusions: Our results uncover heterogeneity in the profiles of PWUH that should be fully acknowledged to ensure better efficiency in substance use clinical practices and policy, while simultaneously drawing attention to trends in concurrent opioid-stimulant use outside North America. We advocate for an extension of the generalized risk framework and its implementation in prevention programs.
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Affiliation(s)
- Eric Janssen
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), Paris, France
| | - Michael Vuolo
- Department of Sociology, Ohio State University, Columbus, OH, USA
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Janssen E, Vuolo M, Spilka S, Airagnes G. Predictors of concurrent heroin use among patients on opioid maintenance treatment in France: a multilevel study over 11 years. Harm Reduct J 2024; 21:15. [PMID: 38243253 PMCID: PMC10799399 DOI: 10.1186/s12954-024-00934-x] [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: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Consistent reports from health professionals suggest that heroin is commonly used by patients undergoing opioid maintenance treatment (OMT) in France, potentially jeopardizing their recovery process. However, there has been no formal epidemiological assessment on the matter. METHODS We use a yearly updated compendium retrieving information on patients admitted in treatment centres in France between 2010 and 2020. Given the hierarchical nature of the data collection, we conduct 2-level modified Poisson regressions to estimate the risks of past month heroin use among patients on OMT. RESULTS Despite an overall decreasing trend over time, heroin use among patients on OMT is indeed common, with half of patients declaring concurrent use. Our study unveils differentiated risks of heroin use vary according to the type of OMT, with patients on methadone more likely to use heroin compared to those on buprenorphine. The use of multilevel-related measures also uncovers high heterogeneity among patients' profiles, reflecting different stages in the treatment process, as well as differentiated practices across treatment centres. CONCLUSION Opioid maintenance treatment is associated with heroin use, in particular when methadone is involved. The heterogeneity among patients on OMT should be given particular attention, as it underscores the need for tailored interventions.
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Affiliation(s)
- Eric Janssen
- French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), 69 rue de Varenne, 75007, Paris, France.
| | - Mike Vuolo
- Department of Sociology, Ohio State University, 238 Townhsend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
| | - Stanislas Spilka
- French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), 69 rue de Varenne, 75007, Paris, France
- General Population Surveys Unit, Research Centre on Population Epidemiology and Health (Centre de Recherche en Epidémiologie et Santé des Populations-CESP), Unit 1018, INSERM, Villejuif, France
| | - Guillaume Airagnes
- French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), 69 rue de Varenne, 75007, Paris, France
- UFR de Médecine, Faculté de Santé, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015, Paris, France
- Population-Based Cohorts Unit, UMS 011, INSERM, 16 avenue Paul Vaillant-Couturier, 94800, Villejuif, France
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Caulkins JP, Reuter P. How much demand for money laundering services does drug selling create? Identifying the key parameters. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103652. [PMID: 35334339 DOI: 10.1016/j.drugpo.2022.103652] [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: 12/21/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The illegal drug trade is often, and plausibly, asserted to be the largest illegal market, globally and in many individual countries. It is also claimed that a large share of its revenues is laundered, though there are no estimates of that volume. We provide rough estimates of that proportion and its primary determinants. METHODS AND DATA This paper presents a model of a multi-tiered drug distribution network that is parameterized with data based on one typical, well-studied case, namely British Colombia's market for illegal opioids, supplemented by a corresponding economic interpretation of what determines the share of drug trade revenues that need to be laundered. Sensitivity with respect to key parameters is analyzed. FINDINGS We suggest that less than half and perhaps no more than a quarter of revenues from established drug markets need laundering. Key parameters governing this proportion include the price mark-up across distribution levels, transaction volumes at each market level, and the capacity of market participants to spend cash on daily living expenses. CONCLUSION This model permits estimation of the scale of money laundering associated with a particular drug market. It suggests that there are limits on money laundering controls as a way of reducing drug supply - although money laundering investigations may still be an effective way to identify and investigate high-level drug traffickers.
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Affiliation(s)
- Jonathan P Caulkins
- Heinz College, Carnegie Mellon University, 5000 Forbes Ave., Pittsburgh, PA 15237, USA.
| | - Peter Reuter
- School of Public Policy and Department of Criminology, University of Maryland, USA
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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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Janssen E, Shah J, Néfau T, Cadet-Taïrou A. Age of Initiation and Patterns of Use among People Who Inject Drugs Welcomed in Harm Reduction Facilities in France from 2006 to 2015. J Psychoactive Drugs 2019; 51:260-271. [PMID: 30704351 DOI: 10.1080/02791072.2019.1567960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This exploratory analysis of time-series cross-sectional data provides insights on trends in age at first injection among people who inject drugs in France, and on associations with recent risky injecting behaviors. Data were collected from a national survey conducted in harm reduction facilities in five phases between 2006 and 2015. Standardized questionnaires collected information on demographics, substance use, and route of administration, as well as lifetime and past-month injection. Descriptive and multilevel models were applied to account for the hierarchical structure of the data. Prevalence of lifetime and past-month injection remained stable over time, while the prevalence of daily injection increased significantly. Mean age at first injection only appeared to increase for data collected after 2010. Gender differences in mean age at first injection decreased over time, suggesting the development of converging patterns of initiation independent of sex. After controlling for covariates, early initiation of injection was unrelated to daily injection or material sharing, and associated with the number of recently injected substances. Early initiation is likely a predictor of injected polysubstance use. Findings are relevant to the planning, implementation, and evaluation of prevention programs.
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Affiliation(s)
- Eric Janssen
- a French Monitoring Centre for Drugs and Drug Addictions, Observatoire Français des Drogues et Toxicomanies (OFDT) , La Plaine Saint Denis Cedex , France
| | - Jalpa Shah
- a French Monitoring Centre for Drugs and Drug Addictions, Observatoire Français des Drogues et Toxicomanies (OFDT) , La Plaine Saint Denis Cedex , France
| | - Thomas Néfau
- a French Monitoring Centre for Drugs and Drug Addictions, Observatoire Français des Drogues et Toxicomanies (OFDT) , La Plaine Saint Denis Cedex , France
| | - Agnès Cadet-Taïrou
- a French Monitoring Centre for Drugs and Drug Addictions, Observatoire Français des Drogues et Toxicomanies (OFDT) , La Plaine Saint Denis Cedex , France
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Lebin JA, Murphy DL, Severtson SG, Bau GE, Dasgupta N, Dart RC. Scoring the best deal: Quantity discounts and street price variation of diverted oxycodone and oxymorphone. Pharmacoepidemiol Drug Saf 2018; 28:25-30. [PMID: 29766592 DOI: 10.1002/pds.4558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/21/2018] [Accepted: 04/17/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE Diverted prescription opioids are significant contributors to drug overdose mortality. Street price has been suggested as an economic metric of the diverted prescription opioid black market. This study examined variables that may influence the street price of diverted oxycodone and oxymorphone. METHODS A cross-sectional study was conducted utilizing data from the previously validated, crowdsourcing website StreetRx. Street price reports of selected oxycodone and oxymorphone products, between August 22, 2014 and June 30, 2016, were considered for analysis. Geometric means and 95% confidence intervals were calculated comparing prices per milligram of drug in US dollars. Univariate and multivariable regressions were used to examine the influence of dosage strength, drug formulation, and bulk purchasing on street price. RESULTS A total of 5611 oxycodone and 1420 oxymorphone reports were analyzed. Across various dosages and formulations, geometric mean prices per milligram ranged between $0.12 and $1.07 for oxycodone and $0.73 and $2.90 for oxymorphone. For a 2-fold increase in dosage strength, there is a 24.0% (95% CI: -28.1%, -19.6%, P < 0.001) and a 22.5% (95% CI: -24.2%, -20.8%, P < 0.001) decrease on average in price per milligram for oxycodone and oxymorphone, respectively. Lower potency, high dosage strength, crush-resistant opioids, and those purchased in bulk were significantly cheaper. CONCLUSION Street prices for diverted oxycodone and oxymorphone are influenced by multiple factors including potency, dosage, formulation, and bulk purchasing. Buyers who purchase large quantities of low potency, large dosage, crush-resistant formulation prescription opioids can expect to achieve the lowest price.
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Affiliation(s)
- Jacob A Lebin
- University of Colorado, School of Medicine, Aurora, CO, USA
| | - David L Murphy
- University of Colorado, School of Medicine, Aurora, CO, USA
| | | | - Gabrielle E Bau
- Rocky Mountain Poison and Drug Center, Denver Health Hospital Authority, Denver, CO, USA
| | - Nabarun Dasgupta
- Rocky Mountain Poison and Drug Center, Denver Health Hospital Authority, Denver, CO, USA
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health Hospital Authority, Denver, CO, USA.,Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
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Janssen E. Estimating the number of people who inject drugs: a proposal to provide figures nationwide and its application to France. J Public Health (Oxf) 2017; 40:e180-e188. [DOI: 10.1093/pubmed/fdx059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 05/10/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- Eric Janssen
- Department of General Population Surveys, French Monitoring Centre for Drugs and Drug Addictions (Observatoire Français des Drogues et Toxicomanies - OFDT), 3 Avenue du Stade de France, La Plaine Saint Denis Cedex, France
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Janssen E. Estimating the Number of Heroin Users in Metropolitan France Using Treatment Centers Data: An Exploratory Analysis. Subst Use Misuse 2017; 52:683-687. [PMID: 28026979 DOI: 10.1080/10826084.2016.1245340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND An updated prevalence estimate for heroin users in France is lacking. Accurate figures are needed to estimate the potential need for treatment. METHOD This research relies on a capture-recapture framework and, for the first time, makes use of individual data collected by a standardized survey conducted within treatment centers. Taking the hierarchical structure of data collection into consideration, a multilevel Zelterman regression model was used, thus enabling estimates at national level. RESULTS The number of heroin users was estimated to be 76,000, 95% CI = [68,000; 85,000] in 2009 (prevalence of 1.9‰ [1.7-2.1]), 101,000 in 2011, 95% CI = [66,000-137,000] (prevalence of 2.5‰ [1.6-3.4]), and 107,000 in 2013, 95% CI = [85,000-124,000] (prevalence of 2.6‰ [2.1-3.1]), with a 4:1 ratio of male:female. Less than one heroin users out of three was seen in treatment centers in 2013. CONCLUSIONS The rise in the number of heroin users is related to an increasing availability of heroin, increasing use in more remote areas, and providers targeting new types of users. The figures, however, should be completed with alternative estimates and enhance the need for a perennial monitoring.
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Affiliation(s)
- Eric Janssen
- a Department of General Population Surveys , French Monitoring Centre for Drugs and Drug Addictions , La Plaine Saint Denis , France
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Giommoni L, Aziani A, Berlusconi G. How Do Illicit Drugs Move Across Countries? A Network Analysis of the Heroin Supply to Europe. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/0022042616682426] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Illicit drugs are trafficked across manifold borders before ultimately reaching consumers. Consequently, interdiction of cross-border drug trafficking forms a critical component of the European Union’s initiative to reduce drug supplies. However, there is contradictory evidence about its effectiveness, which is due, in part, to a paucity of information about how drugs flow across borders. This study uses a network approach to analyze international drug trafficking both to and within Europe, drawing on several perspectives to delineate the factors that affect how drug shipments move across borders. The analysis explicates how drug trafficking is concentrated along specific routes; moreover, we demonstrate that its structure is not random but, rather, driven by specific factors. In particular, corruption and social and geographical proximity are key factors explaining the configuration of heroin supply to European countries. This study also provides essential insights into the disruption of traffickers’ illicit activities.
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