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Chua KP, Bicket MC, Bohnert ASB, Conti RM, Lagisetty P, Nguyen TD. Buprenorphine Dispensing after Elimination of the Waiver Requirement. N Engl J Med 2024; 390:1530-1532. [PMID: 38657250 DOI: 10.1056/nejmc2312906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Kao-Ping Chua
- University of Michigan Medical School, Ann Arbor, MI
| | - Mark C Bicket
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Rena M Conti
- Boston University Questrom School of Business, Boston, MA
| | | | - Thuy D Nguyen
- University of Michigan School of Public Health, Ann Arbor, MI
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Dertadian GC. The Coloniality of drug prohibition. Int J Drug Policy 2024; 126:104368. [PMID: 38452423 DOI: 10.1016/j.drugpo.2024.104368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
There have been several recent commentaries which have highlighted the relevance of the postcolonial perspective to drug prohibition and called for the decolonisation of drug policy (Daniels et al., 2021; Hillier, Winkler & Lavallée, 2020; Lasco, 2022; Mills, 2019). While these are significant interventions in the field, sparse drugs scholarship has engaged more directly with well-developed literature and concepts from Critical Indigenous Studies (Moreton-Robinson, 2016) and Indigenous Standpoint Theory (Moreton-Robinson, 2013; Nakata, 2007) and reflected on its applicability to the drug and alcohol field. In contrast to the postcolonial perspective, which understands colonisation as a historical event with contemporary impacts, Indigenous scholarship conceptualises colonisation as an active and ongoing part of how the settler-state continues to impose itself. From this vantage point I explore coloniality as a system of power and reflect on the way prohibition acts as a key arm of the settler-colonial state. The paper explores the way concepts like vulnerability, marginality, overrepresentation, disproportionality and addiction involve colonial violence, knowledge practices and narratives which are central to the way coloniality is maintained and continues to assert itself in contemporary settler societies.
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Roy PJ, Suda K, Luo J, Lee M, Anderton J, Olejniczak D, Liebschutz JM. Buprenorphine dispensing before and after the April 2021 X-Waiver exemptions: An interrupted time series analysis. Int J Drug Policy 2024; 126:104381. [PMID: 38457960 DOI: 10.1016/j.drugpo.2024.104381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Until the end of 2022, a special registration, known as the X-waiver, was required to prescribe buprenorphine in the US. Before its removal, US federal regulations trialed an X-waiver exemption, initiated on April 28, 2021, which permitted buprenorphine prescribing for up to 30 patients without additional training. We aimed to understand if these regulatory changes impacted buprenorphine dispensing. METHODS We conducted an interrupted time series analysis to understand changes in buprenorphine dispensing during the 26 weeks after the X-waiver exemption compared to the expected baseline trend established in the 26 weeks before using the IQVIA Longitudinal Prescription claims database. The primary outcome was number of new buprenorphine prescribers nationwide (defined as no prior buprenorphine prescription dispensed in the last 26 weeks). Segmented regression estimated relative changes in buprenorphine dispensing at 1, 13, and 26 weeks post-X-waiver change. RESULTS A total of 15,517,525 prescriptions filled for 1,328,172 patients (43.4 % female) ordered by 62,312 providers were included for analysis. At 26 weeks post-X-waiver change, there was no change in the number of new prescribers compared to the expected baseline trend (-2.7 % [95 % CI:-8.3,2.9]). The number of new (15.2 % [4.6,25.8]) and existing (1.7 % [0.9,2.4]) patients and patients per prescriber (4.3 % [3,5.6]) increased. Buprenorphine prescriptions reimbursed by Medicaid increased (7.5 % [6.6,8.4]) while commercial fills decreased (-3.4 % [-5.3,-1.5]). CONCLUSIONS The number of new prescribers did not increase six months post-X-waiver exemption while new patients continued to enter treatment at higher-than-expected rates. These findings suggest that additional interventions beyond the recent X-waiver removal may be needed to increase access to buprenorphine.
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Affiliation(s)
- Payel Jhoom Roy
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States.
| | - Katie Suda
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States; Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Jing Luo
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - MyoungKeun Lee
- Department of Oral and Craniofacial Sciences, Center for Craniofacial and Dental Genetics, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, United States
| | - Joel Anderton
- Department of Oral and Craniofacial Sciences, Center for Craniofacial and Dental Genetics, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, United States
| | - Donna Olejniczak
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
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Aikin KJ, Boudewyns V, Betts KR, Giombi KC, Paquin RS, Brewington M, Malik R. Implied Claims in Drug Advertising: A Review of Recent Literature and Regulatory Actions. Health Commun 2024; 39:652-665. [PMID: 36825849 DOI: 10.1080/10410236.2023.2179717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Federal agencies and self-regulatory bodies help to ensure prescription and nonprescription drug promotion contains accurate information; however, false or misleading claims may cause people to have inaccurate perceptions of a drug and inhibit their ability to make informed decisions. We conducted a systematic review assessing evidence from 2012-2021 on how consumers and healthcare providers (HCPs) interpret claims made indirectly or through inference (implied or implicit claims) as well as synthesizing prescription and nonprescription drug advertising claims that have been the subject of regulatory actions from 2017-2021. Our search identified 16 studies from the peer-reviewed literature and 26 letters or case reports issued by the Food and Drug Administration (FDA) or National Advertising Division (NAD). Results from peer-reviewed studies suggest that implied claims can result in inferences that may not be warranted by the material facts about the drug. Perceptions of a drug's efficacy and, to a lesser extent, risk, are influenced by implied and explicitly false claims in prescription drug promotion. Claims related to implied superiority and overstatement of efficacy were the most prevalent claims flagged for review and examined in the literature. These types of claims were also the subject of many of the compliance actions by the FDA and case reports from the NAD. More research is needed to understand how people interpret varying types of implied claims and the impact of such claims on key outcomes. From a policy standpoint, understanding how people interpret implied claims can inform how the FDA approaches these claims in the marketplace.
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Affiliation(s)
- Kathryn J Aikin
- U.S. Food and Drug Administration, Office of Prescription Drug Promotion
| | | | - Kevin R Betts
- U.S. Food and Drug Administration, Office of Prescription Drug Promotion
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Affiliation(s)
- Patricia J Zettler
- From the Moritz College of Law, the Drug Enforcement and Policy Center, and the James Comprehensive Cancer Center, Ohio State University, Columbus (P.J.Z.); the Department of Medical Science, Warren Alpert Medical School, Brown University, Providence, RI (E.Y.A.); and Harvard Law School and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (I.G.C.)
| | - Eli Y Adashi
- From the Moritz College of Law, the Drug Enforcement and Policy Center, and the James Comprehensive Cancer Center, Ohio State University, Columbus (P.J.Z.); the Department of Medical Science, Warren Alpert Medical School, Brown University, Providence, RI (E.Y.A.); and Harvard Law School and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (I.G.C.)
| | - I Glenn Cohen
- From the Moritz College of Law, the Drug Enforcement and Policy Center, and the James Comprehensive Cancer Center, Ohio State University, Columbus (P.J.Z.); the Department of Medical Science, Warren Alpert Medical School, Brown University, Providence, RI (E.Y.A.); and Harvard Law School and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (I.G.C.)
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Rodwin MA. Assessing US Pharmaceutical Policy and Pricing Reform Legislation in Light of European Price and Cost Control Strategies. J Health Polit Policy Law 2022; 47:755-778. [PMID: 35867553 DOI: 10.1215/03616878-10041163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article compares the pharmaceutical pricing policies employed by public and private insurers in the United States with seven price and spending control strategies employed in the United Kingdom, France, and Germany. Differences between American and European policies explain why American pharmaceutical prices and per capita spending are higher than in European nations. The article then analyzes two recent bills as examples of significant American reform ideas-H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act (introduced in 2019) and the Build Back Better Act (BBBA, introduced in 2021)-and compares them with European cost control strategies. Key drug price provisions of the BBBA were incorporated into the recently enacted Inflation Reduction Act (IRA). H.R. 3 would have used an international (mostly European) price index to cap U.S. prices; the BBBA would cap Medicare prices at a discount from average U.S. market prices. Neither bill would employ the key cost control strategies that European nations do. Both bills would have significantly less impact on prices than legislation that employs European-style cost controls. This article proposes steps that Congress could take in line with European strategies to lower purchase prices and costs for patients. These measures would have to overcome political obstacles that currently stymie reform.
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Affiliation(s)
- Phillip O Coffin
- From the San Francisco Department of Public Health and the University of California, San Francisco - both in San Francisco (P.O.C.); and Tufts University School of Medicine, Boston, and the Department of Anesthesiology, Newton-Wellesley Hospital, Newton - both in Massachusetts (A.M.B.)
| | - Antje M Barreveld
- From the San Francisco Department of Public Health and the University of California, San Francisco - both in San Francisco (P.O.C.); and Tufts University School of Medicine, Boston, and the Department of Anesthesiology, Newton-Wellesley Hospital, Newton - both in Massachusetts (A.M.B.)
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Affiliation(s)
- Hannah L F Cooper
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
| | - David H Cloud
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
| | - Laura C Fanucchi
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
| | - Michelle Lofwall
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
| | - April M Young
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
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Affiliation(s)
| | | | - Andrew Bush
- National Heart and Lung Institute, Imperial College London
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Hamilton I. The UK tinkers around the edges of drug policy but it still needs national reform. BMJ 2022; 376:o52. [PMID: 35012939 DOI: 10.1136/bmj.o52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- Adam Winstock
- Institute of Epidemiology and Health Care, University College London, London, UK
| | | | - Alex Stevens
- School of Social Policy, Sociology, and Social Research, University of Kent, UK
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Gomes T, McCormack D, Kitchen SA, Paterson JM, Mamdani MM, Proulx L, Bayliss L, Tadrous M. Projected impact of biosimilar substitution policies on drug use and costs in Ontario, Canada: a cross-sectional time series analysis. CMAJ Open 2021; 9:E1055-E1062. [PMID: 34815261 PMCID: PMC8612652 DOI: 10.9778/cmajo.20210091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Several Canadian provinces have introduced reimbursement policies mandating substitution of innovator biologics with lower-cost biosimilars. We estimated the number of patients affected and cost implications if such policy changes were to be implemented in Ontario, Canada. METHODS We conducted a cross-sectional time series analysis of Ontarians dispensed publicly funded biologics indicated for inflammatory diseases (rheumatic conditions, inflammatory bowel disease: infliximab, etanercept, adalimumab) between January 2018 and December 2019, and forecasted trends to Dec. 31, 2020. The primary source of data was pharmacy claims data for all biologics reimbursed by the public drug program. We modelled the number of patients affected and government expenditures (in nominal Canadian dollars) of several biosimilar policy options, including mandatory nonmedical biosimilar substitution, substitution in new users, introduction of a biosimilar for adalimumab, and price negotiations. In a secondary analysis, we included insulin glargine. RESULTS In 2018, 14 089 individuals were prescribed a publicly funded biologic for inflammatory diseases. A mandatory nonmedical biosimilar substitution would potentially have affected 7209 patients and saved $238.6 million from 2018 to 2020. A new-user substitution would have affected 757 patients and saved $34.2 million. If an adalimumab biosimilar were to become available, 12 928 patients would be affected by a mandatory nonmedical substitution and the 3-year savings would increase to $645.9 million (all biosimilars priced at 25% of innovator biologics). Finally, an expanded nonmedical substitution policy including insulin glargine would affect 115 895 patients and save $288.7 million (not including adalimumab). INTERPRETATION Policies designed to curb rising costs of biologics can have substantially different effects on patients and government expenditures. Such analyses warrant careful consideration of the balance between cost savings and effects on patients.
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Affiliation(s)
- Tara Gomes
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont.
| | - Daniel McCormack
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Sophie A Kitchen
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - J Michael Paterson
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Muhammad M Mamdani
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Laurie Proulx
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Lorraine Bayliss
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Mina Tadrous
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
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Pourmand A, Beisenova K, Shukur N, Tebo C, Mortimer N, Mazer-Amirshahi M. A practical review of buprenorphine utilization for the emergency physician in the era of decreased prescribing restrictions. Am J Emerg Med 2021; 48:316-322. [PMID: 34274576 DOI: 10.1016/j.ajem.2021.06.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Opioid abuse and overdose deaths have reached epidemic proportions in the last couple decades. In response to rational prescribing initiatives, utilization of prescription opioids has decreased; however, the number of deaths due to opioid overdoses continues to rise, largely driven by fentanyl analogues in adulterated heroin. Solutions to the opioid crisis must be multifaceted and address underlying opioid addiction. In recent years, buprenorphine has become a cornerstone in the treatment of opioid use disorder (OUD) and initiation of therapy in the emergency department (ED) has become increasingly common. There have also been calls by many organizations to remove the requirement for additional training and X-waiver to prescribe buprenorphine. In April 2021, the Biden Administration eased prescribing restrictions on the drug. These initiatives are expected to increase ED utilization of the buprenorphine. The purpose of this paper is to provide an updated overview of the role and use of buprenorphine in the ED setting so physicians may adapt to the changing practice environment. OBJECTIVES This is a narrative review describing the role of buprenorphine in the ED. A PubMed search was conducted using the keywords "opioid epidemic" "buprenorphine," and "medication assisted therapy", and "emergency department". All the articles that contained information on the opioid epidemic, medication assisted therapy, and the biological effects of buprenorphine, that were also relevant to pain management and the ED, were included in the review. DISCUSSION Multiple studies have pointed to the effective use of buprenorphine as a treatment for OUDs in ED patients and are superior to standard care; however, there are various barriers to its use in the ED setting. CONCLUSION Emergency physicians can influence opioid related morbidity and mortality, by familiarizing themselves with the use of buprenorphine to treat opioid withdrawal and addiction, particularly now that prescribing restrictions have been eased. Further ED research is necessary to assess the optimal use of buprenorphine in this care setting.
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Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Kamilla Beisenova
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Nebiyu Shukur
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Collin Tebo
- Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, United States
| | - Nakita Mortimer
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, United States
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Reynolds AM, Reynolds CJ, Craig-Rodriguez A. APRNs' controlled substance prescribing and readiness following Florida legislative changes. Nurse Pract 2021; 46:48-55. [PMID: 34004642 DOI: 10.1097/01.npr.0000751796.01625.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Two years after the Florida legislature expanded APRN prescribing to include schedule II-IV drugs in 2017, we studied APRN utilization of this prescriptive authority. Study results reveal that Florida APRNs are meeting the educational requirements to prescribe and apply the use of these drugs in practice, improving patient access to care.
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Olt C, Faulkenberg KD, Hsich EM. The growing dilemma of legalized cannabis and heart transplantation. J Heart Lung Transplant 2021; 40:863-871. [PMID: 34006449 DOI: 10.1016/j.healun.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/06/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
This in-depth review discusses cannabis as it relates to heart transplantation and the growing dilemma of legalization around the world creating disparities in transplant candidacy. One will learn about two of the most common cannabinoids: Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). These cannabinoids are metabolized by cytochrome P-450 and P glycoprotein, which are essential for the metabolism of drugs for transplantation, such as calcineurin inhibitors. Addiction, withdrawal, and cannabis use disorder will be reviewed as well as hyperemesis syndrome. Maintaining adequate immunosuppression will depend on a variety of factors, including drug-drug interactions, pharmacokinetics of cannabinoids and chronicity of cannabis usage. These drug interactions are further confounded by varying concentrations of cannabis products available at medical dispensaries. One will also learn about the outcomes of transplant recipients using cannabis such as graft failure and the risk of infections. Although more research is needed to establish transplant guidelines, the available data is concerning and fairness in organ distribution should not vary by transplant program or institution.
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Affiliation(s)
| | | | - Eileen M Hsich
- Heart and Vascular Institute at the Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, ON, Canada
- Department of Family and Community Medicine University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Lisa A Bero
- Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Courtney Davis
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Marc-Andre Gagnon
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
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Maynard R, Jozaghi E. The drug war must end: The right to life, liberty and security of the person during the COVID-19 pandemic for people who use drugs. Harm Reduct J 2021; 18:21. [PMID: 33596901 PMCID: PMC7887560 DOI: 10.1186/s12954-021-00474-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
Since the start of the opioid epidemic in 2016, the Downtown Eastside community of Vancouver, Canada, has lost many pioneering leaders, activists and visionaries to the war on drugs. The Vancouver Area Network of Drug Users (VANDU), the Western Aboriginal Harm Reduction Society (WAHRS), and the British Columbia Association People on Opiate Maintenance (BCAPOM) are truly concerned about the increasing overdose deaths that have continued since 2016 and have been exacerbated by the novel coronavirus (SARS-COVID-19) despite many unique and timely harm reduction announcements by the British Columbia (B.C.) government. Some of these unique interventions in B.C., although in many cases only mere announcements with limited scope, are based on the philosophy of safe supply to illegal street drugs. Despite all the efforts during the pandemic, overdose deaths have spiked by over 100% compared to the previous year. Therefore, we urge the Canadian federal government, specifically the Honorable Patty Hajdu, the federal Minister of Health, to decriminalize simple possession immediately by granting exemption under the Controlled Drugs and Substances Act. The Canadian federal government has a moral obligation under Sect. 7 of the Canadian Charter of Rights and Freedoms to protect the basic human rights of marginalized Canadians.
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Affiliation(s)
- VANDU
- The Vancouver Area Network of Drug Users (VANDU), 380 E Hastings St, Vancouver, BC V6A 1P4 Canada
| | - WAHRS
- The Western Aboriginal Harm Reduction Society (WAHRS), 380 E Hastings St, Vancouver, BC V6A 1P4 Canada
| | - BCAPOM
- The British Columbia Association People on Opiate Maintenance (BCAPOM), 380 E Hastings St, Vancouver, BC V6A 1P4 Canada
| | - Russ Maynard
- PHS Community Services Society, 9 East Hastings St., Vancouver, BC V6A 1M9 Canada
| | - Ehsan Jozaghi
- UBC Faculty of Dentistry|Nobel Biocare Oral Health Centre, 2151 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
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Skelton KR, Hecht AA, Benjamin-Neelon SE. Association of Recreational Cannabis Legalization With Maternal Cannabis Use in the Preconception, Prenatal, and Postpartum Periods. JAMA Netw Open 2021; 4:e210138. [PMID: 33630088 PMCID: PMC7907954 DOI: 10.1001/jamanetworkopen.2021.0138] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Recent studies have revealed increases in population-level cannabis use after legalization of recreational cannabis. However, the association of cannabis legalization with maternal cannabis use during important life stages remains unknown. OBJECTIVE To investigate the association of legalization of recreational cannabis with maternal cannabis use during the preconception, prenatal, and postpartum periods. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study used state-level data on women who delivered live-born infants in the US from the Pregnancy Risk Assessment Monitoring System from January 2004 to December 2018. Data from 2 states that had legalized recreational cannabis (Alaska and Maine) and 2 states that had not legalized recreational cannabis (New Hampshire and Vermont) were used. Women completed surveys 2 to 6 months after delivery, reporting preconception, prenatal, and postpartum cannabis use. EXPOSURE State recreational cannabis legalization. MAIN OUTCOMES AND MEASURES The 3 primary outcomes were self-reported cannabis use during the 12 months before pregnancy (preconception), during pregnancy (prenatal), and the 2 to 6 months after pregnancy (postpartum). A difference-in-differences analysis was used to compare changes in the prevalence of maternal cannabis use during each period before and after state legalization of recreational cannabis, controlling for maternal characteristics (age, race/ethnicity, educational level, income, cigarette smoking, and breastfeeding) and state fixed effects. State-specific survey weights were used. RESULTS The analytic sample included 23 082 women in the preconception period, 23 859 in the prenatal period, and 26 610 in the postpartum period. In each analysis, most women were married (range among all groups, 63.9%-64.8%), aged 25 to 34 years (preconception, 55.4%; prenatal, 55.9%; postpartum, 56.1%), and had an annual household income less than $50 000 (preconception, 55.7%; prenatal, 56.3%; postpartum, 55.5%). In adjusted analyses, preconception and postpartum cannabis use increased significantly in states that had legalized recreational cannabis compared with states that had not legalized it (preconception risk difference, 0.0457 [95% CI, 0.0013-0.0900]; P = .04; postpartum risk difference, 0.0539 [95% CI, 0.0259-0.0818]; P < .001). The risk difference for prenatal cannabis use was not significant (0.0070; 95% CI, -0.0120 to 0.0260; P = .47). CONCLUSIONS AND RELEVANCE In this repeated cross-sectional study, recreational cannabis legalization was associated with changes in maternal cannabis use before and after pregnancy. The findings suggest that future studies should undertake an interdisciplinary approach to maximize benefit and application of findings to future public health, health care, and policy sectors.
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Affiliation(s)
- Kara R. Skelton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Sciences, Towson University College of Health Professions, Towson, Maryland
| | - Amelie A. Hecht
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sara E. Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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21
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Burki T. Skin-whitening creams: worth the risk? Lancet Diabetes Endocrinol 2021; 9:10. [PMID: 33248480 DOI: 10.1016/s2213-8587(20)30400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022]
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Abstract
Medicine regulators rely on pivotal clinical trials to make decisions about approving a new drug, but little is known about how they judge whether pivotal trials justify the approval of new drugs. We explore this issue by looking at the positions of 3 major regulators: the European Medicines Agency, Food and Drug Administration, and Health Canada. Here we report their views and the implications of those views for the approval process. On various points, the 3 regulators are ambiguous, consistent, and demonstrate flexibility. The range of views may well reflect different regulatory cultures. Although clinical trial information from pivotal trials is becoming more available, regulators are still reluctant to provide detailed information about how that information is interpreted. As medicines and vaccines come up for approval for treatment of COVID-19, transparency in how pivotal trials are interpreted will be critical in determining how these treatments should be used.
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Affiliation(s)
- Joel Lexchin
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Janice Graham
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew Herder
- Shulich School of Law, Health Law Institute, Halifax, Nova Scotia, Canada
| | - Tom Jefferson
- Department of Continuing Education, University of Oxford, Oxford, UK
| | - Trudo Lemmens
- Faculty of Law Toronto, University of Toronto, Toronto, Ontario, Canada
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Abstract
IMPORTANCE The majority of US states have passed mandates requiring the use of electronic prescribing of controlled substances (EPCS) as a tool to reduce rates of opioid prescribing. It is not known whether increasing use of EPCS will have the intended effect. OBJECTIVE To assess the association between use of EPCS and trends in opioid prescribing. DESIGN, SETTING, AND PARTICIPANTS In this retrospective, longitudinal cohort study of all patients and prescribers in the 50 US states and the District of Columbia from 2010 to 2018, changes in state-level use of EPCS and concurrent changes in opioid prescribing in each state are described. Then the association between changes in the use of EPCS and opioid prescribing are estimated using state and year fixed-effects models that include covariates for policy change and state demographic change. Data Analysis was performed on May 5, 2020. MAIN OUTCOMES AND MEASURES The proportion of controlled substances in each state prescribed using EPCS based on opioid prescriptions per 100 persons and morphine milligram equivalents (MME) of opioids. RESULTS In 2018, the population-weighted percent of opioids prescribed using EPCS was 27%, up from 0% as of 2013. National rates of opioid prescriptions decreased from 78 prescriptions per 100 persons in 2013 to 53 in 2018. Over the same period, there was a decrease from 64 071 MME per 100 persons in 2013 to 40 906 MME per 100 persons in 2018, representing 36% of the 2013 level. By 2018, EPCS increased to 69.4% in states with mandates for its use and 23.6% in states without mandates. In multivariable models, a 10 percentage-point increase in the use of EPCS was associated with an additional 2 prescriptions per 100 persons (95% CI, 1.3-2.8) and a 0.8% (95% CI, 0.06%-1.5%) increase in MME per 100 persons. CONCLUSIONS AND RELEVANCE These data suggest that an increased use of EPCS was not associated with decreased opioid prescribing or a decrease in the amount prescribed and may have been associated with a small increase in opioid prescribing. Opioid prescribing is associated with a variety of social and public health factors, and thus, despite the appeal, EPCS adoption alone may be insufficient to reduce opioid prescribing. Policy makers should consider levers to ensure that EPCS is integrated with outside data and that information is actively used to inform prescribing decisions.
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Affiliation(s)
- Jordan Everson
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Audrey K. Cheng
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stephen W. Patrick
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stacie B. Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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Wiśniewski M, Religioni U, Merks P. Community Pharmacies in Poland-The Journey from a Deregulated to a Strictly Regulated Market. Int J Environ Res Public Health 2020; 17:ijerph17238751. [PMID: 33255672 PMCID: PMC7728088 DOI: 10.3390/ijerph17238751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022]
Abstract
Community pharmacies are the primary entities providing drugs to individual patients in Poland. The pharmacy market has been changing for many years due to significant changes in market regulations. These changes significantly affect the profitability of pharmacies, which may impact the quality of pharmacotherapy. The small number of pharmacies, which resulted from changes in the law in 2017, can influence the level of patient care. The article presents the community pharmacies market in Poland. Particular attention is paid to the legal regulations affecting community pharmacies and the impact of these regulations on the overall shape of the market. The Polish system’s specificity, including the pharmacy market indicators, has been compared with data from other European Union countries.
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Affiliation(s)
- Marcin Wiśniewski
- Association of Pharmacists of Employers of Polish Pharmacies, 01-711 Warsaw, Poland;
| | - Urszula Religioni
- Collegium of Business Administration, Warsaw School of Economics, 02-513 Warsaw, Poland;
| | - Piotr Merks
- Cardinal Stefan Wyszyński University in Warsaw Faculty of Medicine, Collegium Medicum, 01-938 Warsaw, Poland
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-067 Bydgoszcz, Poland
- Employed Pharmacist in Europe (EPhEU) Verband Angestellter Apotheker Österreichs (VAAÖ) Berufliche Interessenvertretung Spitalgasse 31/4, Vienna 1090, Austria
- Correspondence:
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Affiliation(s)
- Richard R Rousseau
- J.D. Candidate, Boston University School of Law, 2021; B.A. in Political Science, Keene State College, 2017. Many thanks to all that assisted in this Note, to my family for their constant support, and the staff members of the American Journal of Law and Medicine for all their hard work
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26
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Petruželka B, Barták M. The Identification of Precursor Regulation Impact on the Methamphetamine Market and Public Health Indicators in the Czech Republic: Time Series Structural Break Analysis. Int J Environ Res Public Health 2020; 17:E7840. [PMID: 33114689 PMCID: PMC7663038 DOI: 10.3390/ijerph17217840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND This study provides insight into the impact of methamphetamine precursor regulation, which is considered to be one of the most important tools of supply reduction and a tool with potential public health impact. METHODS It is based on a longitudinal and quasi-experimental design and it investigates the changes of methamphetamine precursor regulation in Czech Republic, which is treated as a natural experiment. The statistical analysis uses features from the generalized fluctuation test framework as well as from the F test framework to estimate structural changes in the methamphetamine-related arrests and nonfatal intoxications time series. RESULTS The analysis identified structural breaks in the majority of the methamphetamine drug market-related time series in the period related to the tightening of regulation. The results of this study show that methamphetamine precursor regulation was associated with the proliferation of international and organized crime groups and with no change in the overall number of arrests and nonfatal intoxications. CONCLUSIONS The precursor regulation ceteris paribus plausibly leads to the change in drug supply towards more organized groups and to an increasing involvement of foreign nationals at the drug market and is not effective in suppressing the methamphetamine market and in reducing the public health indicator of nonfatal methamphetamine intoxications.
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Affiliation(s)
- Benjamin Petruželka
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, 128 00 Prague, Czech Republic;
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Haffajee RL, Andraka-Christou B, Attermann J, Cupito A, Buche J, Beck AJ. A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder. Subst Abuse Treat Prev Policy 2020; 15:69. [PMID: 32928272 PMCID: PMC7491096 DOI: 10.1186/s13011-020-00312-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/03/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Evidence demonstrates that medications for treating opioid use disorder (MOUD) -namely buprenorphine, methadone, and extended-release naltrexone-are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. METHODS To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. RESULTS Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers-such as a lack of addiction treatment specialists-as additional barriers to prescribing medications to treat OUD. CONCLUSIONS Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.
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Affiliation(s)
- Rebecca L. Haffajee
- From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI USA
- RAND Corporation, Boston, MA USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MA USA
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI USA
| | - Barbara Andraka-Christou
- Department of Health Management & Informatics, University of Central Florida, Orlando, FL USA
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL USA
| | - Jeremy Attermann
- the National Council for Behavioral Health, Washington, D.C, USA
| | - Anna Cupito
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Jessica Buche
- From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Angela J. Beck
- From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI USA
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
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Pavlikova B, Freel L, van Dijk JP. Compliance with the Framework Convention on Tobacco Control in Slovakia and in Finland: Two Different Worlds. Int J Environ Res Public Health 2020; 17:E6661. [PMID: 32933121 PMCID: PMC7558294 DOI: 10.3390/ijerph17186661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022]
Abstract
The Framework Convention on Tobacco Control (FCTC) developed by the State Parties to the World Health Organization was ratified in Slovakia in 2004 and in Finland in 2005. The aim of this study was to explore and compare compliance with the FCTC in Finland and Slovakia. This is a two-country comparative study of tobacco control policy based on implementation of the FCTC in Slovakia and Finland. Compliance with the FCTC was measured similarly in Slovakia and Finland in terms of their institutional structure supporting a smoking free environment and implementation of selected articles of the FCTC. In Finland the responsibilities for anti-tobacco policy are clearly assigned. Slovakia does not have specifically responsible institutions. Finland has a clear plan for achieving the goal of a smoking-free country based on empirical evidence. Slovakia meets only the minimum standard resulting from its commitment as ratified in the FCTC and data are out of date or missing completely.
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Affiliation(s)
- Barbara Pavlikova
- Department of Labor Law and Social Security Law, Faculty of Law, Comenius University, 810 00 Bratislava, Slovakia;
| | - Lenka Freel
- Department of Labor Law and Social Security Law, Faculty of Law, Comenius University, 810 00 Bratislava, Slovakia;
| | - Jitse P. van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, 040 01 Kosice, Slovakia
- Olomouc University Social Health Institute, Theological Faculty, Palacky University, 771 47 Olomouc, Czech Republic
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Feder KA, Mojtabai R, Stuart EA, Musci R, Letourneau EJ. Florida's Opioid Crackdown and Mortality From Drug Overdose, Motor Vehicle Crashes, and Suicide: A Bayesian Interrupted Time-Series Analysis. Am J Epidemiol 2020; 189:885-893. [PMID: 32077469 DOI: 10.1093/aje/kwaa015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/22/2019] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
In 2011, Florida established a prescription drug monitoring program and adopted new regulations for independent pain-management clinics. We examined the association of those reforms with drug overdose deaths and other injury fatalities. Florida's postreform monthly mortality rates-for drug-involved deaths, motor vehicle crashes, and suicide by means other than poisoning-were compared with a counterfactual estimate of what those rates would have been absent reform. The counterfactual was estimated using a Bayesian structural time-series model based on mortality trends in similar states. By December 2013, drug overdose deaths were down 17% (95% credible interval: -21, -12), motor vehicle crash deaths were down 9% (95% credible interval: -14, -4), and suicide deaths were unchanged compared with what would be expected in the absence of reform. Florida's opioid prescribing reform substantially reduced drug overdose deaths. Reforms may also have reduced motor vehicle crash deaths but were not associated with a change in suicides. More research is needed to understand these patterns. Bayesian structural time-series modeling is a promising new approach to interrupted time-series studies.
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Giaquinto AR, Grignolo A, Liberti L, Lim JCW, Salmonson T, Sauer F, Ukwu H. Improving access to quality medicines in East Africa: An independent perspective on the East African Community Medicines Regulatory Harmonization initiative. PLoS Med 2020; 17:e1003092. [PMID: 32785224 PMCID: PMC7423065 DOI: 10.1371/journal.pmed.1003092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Alexander Giaquinto and co-authors discuss the East African Community's Medicines Regulatory Harmonization initiative.
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Affiliation(s)
| | | | - Lawrence Liberti
- Centre for Innovation in Regulatory Science, London, United Kingdom
| | - John C. W. Lim
- Centre of Regulatory Excellence, Duke—NUS Medical School, Singapore
| | | | | | - Henrietta Ukwu
- Otsuka Pharmaceutical Companies, Princeton, New Jersey, United States of America
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31
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Sillo H, Ambali A, Azatyan S, Chamdimba C, Kaale E, Kabatende J, Lumpkin M, Mashingia JH, Mukanga D, Nyabenda B, Sematiko G, Sigonda M, Simai B, Siyoi F, Sonoiya S, Ward M, Ahonkhai V. Coming together to improve access to medicines: The genesis of the East African Community's Medicines Regulatory Harmonization initiative. PLoS Med 2020; 17:e1003133. [PMID: 32785273 PMCID: PMC7423075 DOI: 10.1371/journal.pmed.1003133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hiiti Sillo and colleagues reveal how the East African Community's Medicines Regulatory Harmonization initiative improves access to important medicines in Africa.
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Affiliation(s)
- Hiiti Sillo
- World Health Organization, Geneva, Switzerland
| | - Aggrey Ambali
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | | | - Chimwemwe Chamdimba
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | - Eliangiringa Kaale
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Murray Lumpkin
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | - David Mukanga
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | | | - Margareth Sigonda
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | - Burhani Simai
- Zanzibar Food and Drug Agency, Zanzibar City, Zanzibar
| | - Fred Siyoi
- Pharmacy & Poisons Board, Nairobi, Kenya
| | | | - Mike Ward
- World Health Organization, Geneva, Switzerland
| | - Vincent Ahonkhai
- Gwynedd Consultancy, LLC, Philadelphia, Pennsylvania, United States of America
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Ndomondo-Sigonda M, Mahlangu G, Agama-Anyetei M, Cooke E. A new approach to an old problem: Overview of the East African Community's Medicines Regulatory Harmonization initiative. PLoS Med 2020; 17:e1003099. [PMID: 32785223 PMCID: PMC7423057 DOI: 10.1371/journal.pmed.1003099] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | - Emer Cooke
- World Health Organization, Geneva, Switzerland
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Arik M, Bamenyekanye E, Fimbo A, Kabatende J, Kijo AS, Simai B, Siyoi F, Azatyan S, Ambali A, Cooke E, Mashingia JH, Mwesigye JP, Ndomondo-Sigonda M, Sillo H, Sonoiya S, Tanui P, Ward M, Delano T. Optimizing the East African Community's Medicines Regulatory Harmonization initiative in 2020-2022: A Roadmap for the Future. PLoS Med 2020; 17:e1003129. [PMID: 32785229 PMCID: PMC7423061 DOI: 10.1371/journal.pmed.1003129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Margareth Ndomondo-Sigonda outlines future challenges for the East African Medicines Regulatory Harmonization initiative.
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Affiliation(s)
- Mawien Arik
- Drug and Food Control Authority, Juba, South Sudan
| | | | - Adam Fimbo
- Tanzania Medicines and Medical Devices Authority, Dar Es Salaam, Tanzania
| | | | - Agnes Sitta Kijo
- Tanzania Medicines and Medical Devices Authority, Dar Es Salaam, Tanzania
| | - Burhani Simai
- Zanzibar Food and Drug Agency, Zanzibar City, Zanzibar
| | - Fred Siyoi
- Pharmacy and Poisons Board, Nairobi, Kenya
| | | | - Aggrey Ambali
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | - Emer Cooke
- World Health Organization, Geneva, Switzerland
| | | | | | - Margareth Ndomondo-Sigonda
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
- * E-mail:
| | - Hiiti Sillo
- World Health Organization, Geneva, Switzerland
| | | | - Paul Tanui
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | - Mike Ward
- World Health Organization, Geneva, Switzerland
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Mashingia JH, Ahonkhai V, Aineplan N, Ambali A, Angole A, Arik M, Azatyan S, Baak P, Bamenyekanye E, Bizoza A, Chamdimba C, Doerr P, Fimbo A, Gisagara A, Hamad H, Harris R, Hartman D, Kabatende J, Karangwa C, Kijo AS, Lumpkin M, Maboko S, Matle D, Muhairwe A, Mwesigye JP, Nyabenda B, Schulze A, Seiter A, Sematiko G, Sigonda M, Sillo H, Simai B, Siyoi F, Sonoiya S, Tanui P, Ward M, Yano F, Mukanga D. Eight years of the East African Community Medicines Regulatory Harmonization initiative: Implementation, progress, and lessons learned. PLoS Med 2020; 17:e1003134. [PMID: 32785219 PMCID: PMC7423058 DOI: 10.1371/journal.pmed.1003134] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Jane H. Mashingia and colleagues reveal the progress made to date for the East African Community Medicines Regulatory Harmonization initiative.
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Affiliation(s)
| | - Vincent Ahonkhai
- Gwynedd Consultancy, LLC, Philadelphia, Pennsylvania, United States of America
| | | | - Aggrey Ambali
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | | | - Mawien Arik
- Drug and Food Control Authority, Juba, South Sudan
| | | | - Peter Baak
- Drug and Food Control Authority, Juba, South Sudan
| | | | | | - Chimwemwe Chamdimba
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | - Petra Doerr
- Petra Doerr Consulting Ltd., Herznach, Switzerland
| | - Adam Fimbo
- Tanzania Medicines and Medical Devices Authority, Dar Es Salaam, Tanzania
| | | | - Hidaya Hamad
- Zanzibar Food & Drug Agency, Zanzibar City, Zanzibar
| | | | - Dan Hartman
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | | | - Agnes Sitta Kijo
- Tanzania Medicines and Medical Devices Authority, Dar Es Salaam, Tanzania
| | - Murray Lumpkin
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Shani Maboko
- Tanzania Medicines and Medical Devices Authority, Dar Es Salaam, Tanzania
| | - David Matle
- Tanzania Medicines and Medical Devices Authority, Dar Es Salaam, Tanzania
| | | | | | | | | | | | | | - Margareth Sigonda
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | - Hiiti Sillo
- World Health Organization, Geneva, Switzerland
| | - Burhani Simai
- Zanzibar Food & Drug Agency, Zanzibar City, Zanzibar
| | - Fred Siyoi
- Pharmacy & Poisons Board, Nairobi, Kenya
| | | | - Paul Tanui
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | - Mike Ward
- World Health Organization, Geneva, Switzerland
| | | | - David Mukanga
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
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Barrett D, Hannah J, Lines R. What Does it Mean to Adopt a Human Rights-Based Approach to Drug Policy? Health Hum Rights 2020; 22:355-357. [PMID: 32669818 PMCID: PMC7348428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- Damon Barrett
- Lecturer, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden.
| | - Julie Hannah
- Director of the International Centre on Human Rights and Drug Policy at the University of Essex, UK
| | - Rick Lines
- Associate Professor of Criminology and Human Rights, Swansea University, UK
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Sonnenberg J, Bostic C, Halpern-Felsher B. Support for Aggressive Tobacco Control Interventions Among California Adolescents and Young Adults. J Adolesc Health 2020; 66:506-509. [PMID: 31974013 PMCID: PMC7089803 DOI: 10.1016/j.jadohealth.2019.11.302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/23/2019] [Accepted: 11/02/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study was to assess adolescent and young adult support for banning the sale of various tobacco and marijuana products and describe whether support varies by tobacco or marijuana use status. METHODS We analyzed data from a California school-based survey (N = 450) on tobacco access, perceptions, social norms, marketing, and use. RESULTS We found a majority of respondents favored gradually banning the sale of cigarettes (76%); e-cigarettes other than JUULs (55%); JUULs (59%); cigars, cigarillos, and little cigars (70%); and hookah (54%). A majority of ever and never users favored immediately banning the sale of cigarettes. Support for gradual, immediate, and drugstore bans was higher among never users for every policy except an immediate ban on cigarette sales, for which there was no difference between the 2 groups. CONCLUSIONS There is broad support for aggressive tobacco control interventions, especially for combustible tobacco products, among a sample of California youth and young adults.
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Affiliation(s)
| | - Chris Bostic
- Action on Smoking and Health, Washington, District of Columbia
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
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Gates LG, Bridgford SH. Cannabis-Related Illness in Missouri Emergency Rooms. Mo Med 2020; 117:114. [PMID: 32308231 PMCID: PMC7144698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Lancer G Gates
- Hospitalist, North Kansas City, Missouri, MSMA Member since 2003
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Abstract
This quality improvement study assesses the number of new opioid users and the number of units dispensed per prescription before and after implementation of Florida’s 2018 restriction law on opioid prescribing.
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Affiliation(s)
- Juan M. Hincapie-Castillo
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville
| | - Amie Goodin
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
| | | | - Silken A. Usmani
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
- UF Health Physicians, Gainesville, Florida
| | - Scott Martin Vouri
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
- UF Health Physicians, Gainesville, Florida
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Shevchuk V, Shevchuk O, Matyukhina N, Zatenatskyi D, Chub O. TESTING OF DRUGS IN THE IMPLEMENTATION OF CUSTOMS CONTROL IN UKRAINE: LEGAL ASPECTS. Georgian Med News 2020:165-169. [PMID: 32141872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of the study is to analyze certain aspects of the legal regulation of the examination of medicines containing narcotic drugs, psychotropic substances, or precursors in the field of customs. To achieve this goal, we analyzed the number of customs examinations carried out, new narcotic compounds identified for the first time. An analysis of the understanding of the definition "examination" and "customs examination" in the scientific literature. Two directions of the implementation of expert examinations of medicines containing narcotic drugs, psychotropic substances, or precursors in the field of customs were identified, its concept was defined. It is proposed to attribute the investigative examination to the methods of customs control. It was found out that this examination is not a forensic examination, and it can be attributed to a special class of examinations, since it has characteristic features inherent only in it: subject, tasks, objects, and research methods. Seven stages of the implementation of expert examinations of medicinal products containing narcotic drugs, psychotropic substances, or precursors during customs control are highlighted and their procedural order is analyzed.
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Affiliation(s)
- V Shevchuk
- 1Yaroslav Mudryi National Law University, Ukraine
| | - O Shevchuk
- 1Yaroslav Mudryi National Law University, Ukraine
| | - N Matyukhina
- 1Yaroslav Mudryi National Law University, Ukraine
| | | | - O Chub
- 2National Pharmaceutical University, Ukraine
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Abstract
The best policies are evidence-based, providing feasible solutions to healthcare issues to prevent unintended consequences. Nurse researchers need to generate evidence with which to create policy. The obligation to monitor the impact of policies and standards rests on nurse leaders who have the duty to advocate when policies fail. Nurses providing direct care are beholden to report failed policies. Advocacy in the situation of a failed policy often requires moral courage to prevent moral distress amongst the ranks of nurses who enact policies at the intersect of care. In this article, the impact of three healthcare policy issues on nursing end-users will be evaluated: aid in dying, titration of vasoactive medications, and the Center for Medicare and Medicaid Services 30-minute rule.
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Affiliation(s)
- Judy E Davidson
- Department of Psychiatry, University of California San Diego School of Medicine, University of California San Diego Health, La Jolla, California
| | - Mary Faith Marshall
- Center for Biomedical Ethics and Humanities, School of Medicine, School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Jonathan H Watanabe
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California
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Agarwal S, Bryan JD, Hu HM, Lee JS, Chua KP, Haffajee RL, Brummett CM, Englesbe MJ, Waljee JF. Association of State Opioid Duration Limits With Postoperative Opioid Prescribing. JAMA Netw Open 2019; 2:e1918361. [PMID: 31880801 PMCID: PMC6991309 DOI: 10.1001/jamanetworkopen.2019.18361] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Since the Centers for Disease Control and Prevention published opioid prescribing guidelines in March 2016, 31 states have implemented legislation to restrict the duration of opioid prescriptions for acute pain. However, the association of these policies with the amount of opioid prescribed following surgery remains unknown. OBJECTIVE To examine the association of opioid prescribing duration limits with postoperative opioid prescribing in Massachusetts and Connecticut, the first 2 states to implement limits after March 2016. DESIGN, SETTING, AND PARTICIPANTS This interrupted time series analysis and cross-sectional study examined immediate level and slope changes in monthly outcomes after prescribing limit implementation in Massachusetts and Connecticut. These states implemented 7-day limits on initial opioid prescriptions on March 14, 2016, and July 1, 2016, respectively. Using the 2014 to 2017 IBM MarketScan Research Database, 16 281 opioid-naive adults in these states who filled a prescription within 3 days of surgery between July 1, 2014, and November 30, 2017, were identified. Data were analyzed from December 2018 to June 2019. MAIN OUTCOMES AND MEASURES The primary outcome was the prescription size in oral morphine equivalents (OMEs) for the initial postoperative opioid prescription (one 5/325 mg hydrocodone-acetaminophen pill = 5 OMEs). Secondary outcomes included days supplied in the initial prescription and the proportion of initial prescriptions exceeding a 7-day supply. RESULTS In total, 16 281 opioid-naive patients (9708 [59.6%] female; median [interquartile range] age range, 45-54 [35-44 to 55-64] years) undergoing surgical procedures were included. In Massachusetts, there were 5340 and 5435 patients in the preimplementation and postimplementation periods, respectively. In Connecticut, there were 2869 and 2637 patients in the preimplementation and postimplementation periods, respectively. Limit implementation in Massachusetts was associated with an immediate mean level decrease in prescription size (-38 OMEs [95% CI, -44 to -32 OMEs]) and with a mean decrease in slope (-1.5 OMEs/mo [95% CI, -2.1 to -0.9 OMEs/mo]). Implementation was also associated with an immediate mean level decrease in days supplied (-0.4 days [95% CI, -0.6 to -0.2 days]) and the proportion of prescriptions exceeding a 7-day supply (-5.9 percentage points [95% CI, -7.9 to -3.9 percentage points]). In contrast, limit implementation in Connecticut was not associated with level or slope changes in any outcome. CONCLUSIONS AND RELEVANCE Opioid prescribing duration limits had a variable association with postoperative opioid prescribing in Massachusetts and Connecticut. The mean opioid prescription size filled, days supplied, and prescribing exceeding a 7-day supply decreased after limit implementation in Massachusetts only. Given the potential differences in policy dissemination and uptake, efforts to reduce opioid prescribing should also include surgeon education and evidence-based prescribing recommendations.
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Affiliation(s)
- Sunil Agarwal
- Department of Anesthesiology, Emory University, Atlanta, Georgia
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
| | - John D. Bryan
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
| | - Hsou Mei Hu
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
- Department of Surgery, Michigan Medicine, Ann Arbor
| | - Jay S. Lee
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
- Department of Surgery, Michigan Medicine, Ann Arbor
| | - Kao-Ping Chua
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | - Rebecca L. Haffajee
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Chad M. Brummett
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
- Department of Anesthesiology, Michigan Medicine, Ann Arbor
| | - Michael J. Englesbe
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
- Department of Surgery, Michigan Medicine, Ann Arbor
| | - Jennifer F. Waljee
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
- Department of Surgery, Michigan Medicine, Ann Arbor
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Kahan M, Srivastava A, Clarke S. Cannabis industry and medical cannabis clinics need regulation. Can Fam Physician 2019; 65:864-868. [PMID: 31831483 PMCID: PMC6907381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Meldon Kahan
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and Medical Director of the Substance Use Service at Women's College Hospital in Toronto, Ont
| | - Anita Srivastava
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and a family and addictions physician at St Joseph's Health Centre in Toronto
| | - Sarah Clarke
- Knowledge broker for the Mentoring, Education, and Clinical Tools for Addictions: Primary Care-Hospital Integration project at Women's College Hospital.
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Peacock A, Bruno R, Gisev N, Degenhardt L, Hall W, Sedefov R, White J, Thomas KV, Farrell M, Griffiths P. New psychoactive substances: challenges for drug surveillance, control, and public health responses. Lancet 2019; 394:1668-1684. [PMID: 31668410 DOI: 10.1016/s0140-6736(19)32231-7] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/05/2019] [Accepted: 08/08/2019] [Indexed: 12/30/2022]
Abstract
The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, TAS, Australia.
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, TAS, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Roumen Sedefov
- European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
| | - Jason White
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Paul Griffiths
- European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
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Hutchison KE, Bidwell LC, Ellingson JM, Bryan AD. Cannabis and Health Research: Rapid Progress Requires Innovative Research Designs. Value Health 2019; 22:1289-1294. [PMID: 31708066 DOI: 10.1016/j.jval.2019.05.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/09/2019] [Accepted: 05/16/2019] [Indexed: 05/18/2023]
Abstract
The United States has witnessed enormous changes concerning the acceptance of medicinal and recreational cannabis use. Sixty-three percent of the US population has access to medicinal cannabis markets, which offer increasingly diverse and potent cannabis products. Considering the rapidly changing cultural, political, and legal landscape, the scientific literature does not adequately inform public policy, medical decision making, or harm reduction approaches. The goals of this paper are to (1) investigate the state of cannabis research on medical conditions commonly treated with cannabis, (2) review the barriers that have led to large gaps between cannabis use and available empirical data, and (3) suggest a path forward with new research designs to address these gaps. Thus, we aim to advance a more nuanced understanding of the barriers to cannabis research and suggest innovative research designs necessary for rapid development of a meaningful knowledge base.
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Affiliation(s)
- Kent E Hutchison
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.
| | - L Cinnamon Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jarrod M Ellingson
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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Rychert M, Wilkins C, Noller G. Medicinal Cannabis Scheme in New Zealand: lessons from international experience and our own recent drug policy reform setbacks. N Z Med J 2019; 132:8-12. [PMID: 31581177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Marta Rychert
- SHORE & Whariki Research Centre, College of Health, Massey University
| | - Chris Wilkins
- SHORE & Whariki Research Centre, College of Health, Massey University
| | - Geoff Noller
- Department of General Practice and Rural Health, School of Medicine, University of Otago
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Abstract
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related deaths worldwide. Up to 80% of patients with HCC have concomitant cirrhosis as a result of hepatitis B or C virus, alcohol abuse, or non-alcoholic steatohepatitis.
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Affiliation(s)
- Javier Crespo
- Servicio Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, 39002
| | - Raúl J Andrade
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria.
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