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Affiliation(s)
- Sanjay Agrawal
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Naci H, Forrest R, Davis C. Putting patients first in medicines regulation? BMJ 2021; 375:n2883. [PMID: 34848394 DOI: 10.1136/bmj.n2883] [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: 11/04/2022]
Affiliation(s)
- Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Robin Forrest
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Courtney Davis
- Department of Global Health and Social Medicine, King's College London, UK
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Boone CG, Antoniou T, Juurlink DN, von den Baumen TR, Kitchen SA, Richards GC, Tadrous M, Gomes T. The impact of proposed regulatory changes and rescheduling on low-dose codeine purchasing in Canada: a time-series analysis. CMAJ Open 2021; 9:E1181-E1186. [PMID: 34906994 PMCID: PMC8687488 DOI: 10.9778/cmajo.20210173] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low-dose codeine products can be purchased without a prescription in most of Canada. We explored trends in the purchasing of these products across the Canadian provinces from 2014 to 2019, evaluating the impact of Health Canada's 2016 announcement of a proposed regulatory change and the 2017 opening of a 60-day public comment period, as well as the impact of Manitoba's 2016 policy change requiring a prescription for the purchase of all codeine products in that province. METHODS We evaluated population-adjusted monthly purchasing of codeine products from January 2014 to October 2019 using the IQVIA Canadian Drug Store and Hospital Purchases Audit database, stratified by province and over-the-counter (OTC) status. The primary outcomes were change in the monthly volume of low-dose codeine purchased after the 2016 federal regulatory proposal and the 2017 period of public comment across the provinces. Our secondary analysis was the impact of Manitoba's policy change in February 2016 requiring a prescription for low-dose codeine. We conducted a time-series analysis using interventional autoregressive integrated moving average models. RESULTS Over the study period, 24 120 kg of codeine (3.025 billion units) and 937 867 kg of acetaminophen were sold as OTC, low-dose codeine products across the Canadian provinces. Health Canada's 2016 announcement did not significantly affect OTC codeine purchasing (p = 0.57). The initiation of a 60-day public comment period was associated with a roughly 44% decrease in OTC codeine purchasing (p = 0.03). In Manitoba, purchasing of the same codeine formulations decreased after rescheduling in February 2016 (p < 0.001). We observed no significant change in the rate of purchasing of higher dose codeine formulations in response to scheduling changes in Manitoba (p = 0.22). INTERPRETATION Although Health Canada's 2016 announcement of a proposed regulatory change did not appear to have an effect on OTC codeine purchasing nationally, the 60-day comment period was associated with a decrease in purchasing. Further, Manitoba's 2016 policy change was associated with a significant and sustained decrease in the overall volume of codeine purchased. Given the potential risks of codeine dependence and acetaminophen toxicity with these products, a national rescheduling strategy should be considered.
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Affiliation(s)
- Charlotte G Boone
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Tony Antoniou
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - David N Juurlink
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Teagan Rolf von den Baumen
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Sophie A Kitchen
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Georgia C Richards
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Mina Tadrous
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Tara Gomes
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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Abstract
Cocaine demand is a behavioral economic measure assessing drug reward value and motivation to use drug. The purpose of the current study was to develop a brief assessment of cocaine demand (BACD). Results from the BACD were compared with self-report measures of cocaine use. Participants consisted of treatment-seeking individuals with cocaine use disorder (N = 22). Results revealed that indices of brief demand were significantly associated with various self-report measures of cocaine use. Overall, these results support the utility of a BACD for assessing cocaine demand.
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Affiliation(s)
- Jin H Yoon
- Louis A. Faillace Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, Houston, Texas, USA
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Hooimeyer A, Bhasale A, Perry L, Fabbri A, Mohammad A, McEwin E, Mintzes B. Regulatory post-market drug safety advisories on cardiac harm: A comparison of four national regulatory agencies. Pharmacol Res Perspect 2020; 8:e00680. [PMID: 33169534 PMCID: PMC7652786 DOI: 10.1002/prp2.680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/04/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022] Open
Abstract
Information on rare adverse effects is often limited when a medication is initially approved for marketing. Medicines regulators use safety advisories to warn health professionals and consumers about emerging harms. This study aimed to identify characteristics and advice provided in cardiac safety advisories released by regulators in Australia, Canada, the United Kingdom, and the United States. This was a retrospective study of safety advisories about cardiac-related adverse events issued by these four international medicines regulators between 2010 and 2016. A descriptive overview was followed by a more detailed content analysis, focusing on recommended actions for health professionals, including monitoring advice. For the latter, we applied the systematic information for monitoring (SIM) scale to assess adequacy. Over this period, 164 safety advisories about cardiac harms were issued by the four regulators. There were 61 drugs with advisories of cardiac risk, only 9 (14.7%) of which had advisories from all regulators in countries where the drug was approved. The most common adverse events were cardiac arrhythmias (n = 97, 59.1%) and coronary artery disorders (n = 39, 23.8%). The most frequent advice to prescribers was to monitor patients (n = 74, 45.1%), although only 41.2% of these advisories provided detailed advice on how monitoring should occur. We found many differences in the decision to warn and the advice provided. Patient monitoring was most often recommended, but key information such as frequency or thresholds for action was often lacking. Healthcare professionals and consumers need consistent information about rare serious harms so that they can make informed decisions.
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Affiliation(s)
- Ashleigh Hooimeyer
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alice Bhasale
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Lucy Perry
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alice Fabbri
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- Centre for Evidence‐Based Medicine Odense (CEBMO)Odense University Hospital and University of Southern DenmarkOdenseDenmark
| | - Annim Mohammad
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Eliza McEwin
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Barbara Mintzes
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
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Luke MC. From Pharmacology Research, to Pharmacology Regulation, and Back-as Inspired by the Teachings of Dr. Gavril Pasternak. Cell Mol Neurobiol 2020; 41:835-837. [PMID: 32323151 DOI: 10.1007/s10571-020-00837-y] [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: 02/25/2020] [Accepted: 03/26/2020] [Indexed: 11/25/2022]
Abstract
Dr. Gavril Pasternak, M.D., Ph.D. was an inspiration to many of his students, including myself. It was with great sadness that I learned about the passing of Dr. Gavril Pasternak in February 2019 after his brief battle with pancreatic cancer. I worked with Dr. Pasternak while I was an undergraduate chemistry student and as one of his technicians, collaborating with Dr. Charles Inturrisi and Dr. Eliot F. Hahn on opiate agonists and antagonists for opioid receptor subtypes. Dr. Pasternak inspired me and set me on the road to a career in pharmacology and encouraged me to pursue the fruitful paradigm of moving therapeutics from bench to bedside.
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Affiliation(s)
- Markham C Luke
- Division of Therapeutic Performance, Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.
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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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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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Vreman RA, Heikkinen I, Schuurman A, Sapede C, Garcia JL, Hedberg N, Athanasiou D, Grueger J, Leufkens HGM, Goettsch WG. Unmet Medical Need: An Introduction to Definitions and Stakeholder Perceptions. Value Health 2019; 22:1275-1282. [PMID: 31708064 DOI: 10.1016/j.jval.2019.07.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 12/17/2018] [Revised: 06/10/2019] [Accepted: 07/01/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Despite increasing informal and formal use of unmet medical need (UMN) in drug development, regulation, and assessment, there is no insight into its definitions in use. This study aims to provide insight into the current definitions in use and to provide a starting point for a multi-stakeholder discussion on alignment. METHODS A scoping and a gray literature review were performed to locate definitions of UMN in literature and on stakeholder websites. These definitions were categorized and then discussed among the multi-stakeholder author group via semistructured group discussions and open session workshops with a broader stakeholder audience. Issues with the formation of a common definition and mechanisms for use were discussed. RESULTS The reviews yielded 16 definitions. Differences were evident, but all included 1 or more of the following elements: (adequacy of) available treatments (16 of 16: 100%), disease severity or burden (6 of 16: 38%), and patient population size (1 of 16: 6%). The stakeholder discussions led to a suggestion for a definition including the first 2 items and, depending on context, population size. The discussions also showed that quantification of UMN is highly dependent on the scope and the value framework in which it is used based on different stakeholder preferences and responsibilities. CONCLUSION We encourage stakeholders that want to promote alignment on the concept of UMN to prospectively discuss the scope in which they want to apply the concept, what elements they find important for consideration in each case, and how they would measure UMN within the broader regulatory or value framework applicable.
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Affiliation(s)
- Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; National Health Care Institute, Diemen, The Netherlands
| | | | - Ad Schuurman
- National Health Care Institute, Diemen, The Netherlands
| | | | | | - Niklas Hedberg
- The Dental and Pharmaceuticals Benefits Agency, Stockholm, Sweden
| | - Dimitrios Athanasiou
- World Duchenne Organization, Stichting United Parent Projects Muscular Dystrophy, Zeist, The Netherlands
| | | | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; National Health Care Institute, Diemen, The Netherlands.
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Abstract
Gorik Ooms and Johanna Hanefeld argue that low and middle income countries could increase access to medicines by forming an alliance to credibly threaten companies with compulsory licences
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Affiliation(s)
- Gorik Ooms
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Johanna Hanefeld
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Gomella LG. Is BCG a Hazardous Drug? Ask NIOSH, OSHA, and the USP. Can J Urol 2019; 26:9687-9689. [PMID: 31012830] [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: 06/09/2023]
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Parkinson B, Gumbie M, Cutler H, Gauld N, Mumford V, Haywood P. Cost-Effectiveness of Reclassifying Triptans in Australia: Application of an Economic Evaluation Approach to Regulatory Decisions. Value Health 2019; 22:293-302. [PMID: 30832967 DOI: 10.1016/j.jval.2018.09.2840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/27/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Migraine is a common, chronic, disabling headache disorder. Triptans, used as an acute treatment for migraine, are available via prescription in Australia. An Australian Therapeutic Goods Administration (TGA) committee rejected reclassifying sumatriptan and zolmitriptan from prescription medicine to pharmacist-only between 2005 and 2009, largely on the basis of concerns about patient risk. Nevertheless, pharmacist-only triptans may reduce migraine duration and free up healthcare resources. OBJECTIVES To estimate the cost-effectiveness of reclassifying triptans from prescription-only to pharmacist-only in Australia. METHODS The study design included decision-analytic modeling combining data from various sources. Behavior before and after reclassification was estimated using medical practitioner and patient surveys and also administrative data. Health outcomes included migraine frequency and duration as well as adverse events (AEs) discussed by the TGA committee. Efficacy and AEs were estimated using randomized controlled trials and observational studies. RESULTS Reclassifying triptans will reduce migraine duration but increase AEs. This will result in 337 quality-adjusted life-years gained at an increased cost of A$5.9 million over 10 years for all Australian adults older than 15 years (19.6 million). The incremental cost-effectiveness ratio was estimated to be A$17 412/quality-adjusted life-year gained. CONCLUSIONS The incremental cost-effectiveness ratio is likely to be considered cost-effective by Australian decision makers. Serotonin syndrome, a key concern of the TGA committee, had little impact on the results. Further research is needed regarding pharmacist-only triptan use by migraineurs currently using over-the-counter medicines and by nonmigraineurs, the efficacy of triptans, and the risk of cardiovascular and cerebrovascular AEs and chronic headaches with triptans.
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Affiliation(s)
- Bonny Parkinson
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia.
| | - Mutsa Gumbie
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Natalie Gauld
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Virginia Mumford
- Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Philip Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
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Holleman MS, Uyl-de Groot CA, Goodall S, van der Linden N. Determining the Comparative Value of Pharmaceutical Risk-Sharing Policies in Non-Small Cell Lung Cancer Using Real-World Data. Value Health 2019; 22:322-331. [PMID: 30832970 DOI: 10.1016/j.jval.2018.08.007] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Risk-sharing arrangements (RSAs) can be used to mitigate uncertainty about the value of a drug by sharing the financial risk between payer and pharmaceutical company. We evaluated the projected impact of alternative RSAs for non-small cell lung cancer (NSCLC) therapies based on real-world data. METHODS Data on treatment patterns of Dutch NSCLC patients from four different hospitals were used to perform "what-if" analyses, evaluating the costs and benefits likely associated with various RSAs. In the scenarios, drug costs or refunds were based on response evaluation criteria in solid tumors (RECIST) response, survival compared to the pivotal trial, treatment duration, or a fixed cost per patient. Analyses were done for erlotinib, gemcitabine/cisplatin, and pemetrexed/platinum for metastatic NSCLC, and gemcitabine/cisplatin, pemetrexed/cisplatin, and vinorelbine/cisplatin for nonmetastatic NSCLC. RESULTS Money-back guarantees led to moderate cost reductions to the payer. For conditional treatment continuation schemes, costs and outcomes associated with the different treatments were dispersed. When price was linked to the outcome, the payer's drug costs reduced by 2.5% to 26.7%. Discounted treatment initiation schemes yielded large cost reductions. Utilization caps mainly reduced the costs of erlotinib treatment (by 16%). Given a fixed cost per patient based on projected average use of the drug, risk sharing was unfavorable to the payer because of the lower than projected use. The impact of RSAs on a national scale was dispersed. CONCLUSIONS For erlotinib and pemetrexed/platinum, large cost reductions were observed with risk sharing. RSAs can mitigate uncertainty around the incremental cost-effectiveness or budget impact of drugs, but only when the type of arrangement matches the setting and type of uncertainty.
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Affiliation(s)
- Marscha S Holleman
- Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Stephen Goodall
- Center for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Naomi van der Linden
- Center for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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Affiliation(s)
- Howard K Koh
- Harvey V. Fineberg professor of the practice of public health leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School
| | - R Gil Kerlikowske
- Four-decade career in law enforcement, serving as chief of police in Seattle and Buffalo
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Sevigny EL, Caces MF. When DAWN went dark: Can the Nationwide Emergency Department Sample (NEDS) fill the surveillance gap left by the discontinued Drug Abuse Warning Network (DAWN)? Drug Alcohol Depend 2018; 192:201-207. [PMID: 30268070 DOI: 10.1016/j.drugalcdep.2018.07.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study assessed whether the Nationwide Emergency Department Sample (NEDS) could reliably fill the national drug surveillance gap caused by the discontinuation of the Drug Abuse Warning Network (DAWN). METHODS Estimates of the drug-related emergency department (ED) visits derived from DAWN (2004-2011) and NEDS (2006-2013). Estimates of the underlying reason for the drug-related ED visit, patient characteristics, and the specific drugs involved were compared for 2011, the most recent overlapping data year in DAWN and NEDS. Trends in ED visits for major drugs of abuse were then compared over the period 2004-2013. RESULTS In 2011, DAWN and NEDS produced statistically similar estimates of the overall number of drug-related ED visits (5.1 vs. 4.9 million) and those involving drug misuse or abuse (2.65 vs. 2.77 million). Among the latter, estimates by gender, age group, and patient disposition were generally consistent across data systems, suggesting that NEDS and DAWN samples draw from a similar population. Main analyses reveal statistically similar estimates across data systems in both levels and trends for cocaine, amphetamines, and narcotic pain relievers. In contrast, the number of ED visits for sedatives and heroin was significantly undercounted in NEDS, whereas marijuana-related ED visits were undercounted in DAWN. CONCLUSIONS This study demonstrates the utility of NEDS for conducting post-DAWN drug surveillance. Because NEDS cannot provide targeted surveillance of certain established (e.g., heroin) and emerging (e.g., fentanyl) drugs, however, it is critical that a data system that employs medical record-based reviews be implemented to augment the known weaknesses of NEDS.
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Affiliation(s)
- Eric L Sevigny
- Department of Criminal Justice and Criminology, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA 30303, USA.
| | - M Fe Caces
- Office of National Drug Control Policy, Executive Office of the President, Washington DC, 20503, USA.
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Affiliation(s)
- Alvaro Javier Idrovo
- Public Health Department, Universidad Industrial de Santander, Bucaramanga 680006, Colombia.
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Laverty G, Belaid L, Coulter C, Porter S. Development of a teaching model to advance skills in industrial pharmaceutical formulation and regulatory aspects. Curr Pharm Teach Learn 2018; 10:1419-1428. [PMID: 30527372 DOI: 10.1016/j.cptl.2018.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/05/2017] [Revised: 05/16/2018] [Accepted: 07/09/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND PURPOSE To design and critically evaluate a laboratory-scale pharmaceutical formulation practical that enables pharmaceutical science students to develop work-based skills relating to industrial pharmacy such as problem solving, pharmaceutical calculations, research, legal checking, communication, practical aptitude, handling of medicinal products, record keeping, and ability to interpret, analyze and report data. EDUCATIONAL ACTIVITY AND SETTING Nine laboratory practical sessions were designed whereby students formulated a range of dosage forms and conducted corrective and preventative actions (CAPAs) exercises. A master batch formula outlined the specifications for each product and a practical sheet was provided for the students to record their activities. Student evaluation of the exercise was performed via a self-administered 17-item questionnaire in the final week. FINDINGS Twenty-four students completed the workshops over two year groups (2015 year group n = 11, 2016 year group n = 13). The mean score across both groups was 15.6 out of 20. DISCUSSION The questionnaire had a 100% response rate and the majority of students agreed that the classes were a useful teaching method and that they fostered key skills required for pharmaceutical formulation and regulation. SUMMARY Laboratory classes effectively delivered course content relating to industrial-based pharmaceutical formulation and helped to develop relevant skills.
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Affiliation(s)
- Garry Laverty
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, County Antrim BT9 7BL, Northern Ireland.
| | - Luc Belaid
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, County Antrim BT9 7BL, Northern Ireland.
| | - Cathy Coulter
- Norbrook Laboratories, Carnbane Industrial Estate, Newry, Co. Down BT35 6QQ, Northern Ireland.
| | - Simon Porter
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, County Antrim BT9 7BL, Northern Ireland.
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20
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Affiliation(s)
- Scott E Hadland
- Grayken Center for Addiction/Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA
- Boston University School of Medicine, Division of General Pediatrics, Department of Pediatrics, Boston, MA, USA
| | - Leo Beletsky
- School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- UC San Diego School of Medicine, La Jolla, CA, USA
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Martin J, Cunliffe J, Décary-Hétu D, Aldridge J. Effect of restricting the legal supply of prescription opioids on buying through online illicit marketplaces: interrupted time series analysis. BMJ 2018; 361:k2270. [PMID: 29899119 PMCID: PMC5998052 DOI: 10.1136/bmj.k2270] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To examine the effect on the trade in opioids through online illicit markets ("cryptomarkets") of the US Drug Enforcement Administration's ruling in 2014 to reschedule hydrocodone combination products. DESIGN Interrupted time series analysis. SETTING 31 of the world's largest cryptomarkets operating from October 2013 to July 2016. MAIN OUTCOME MEASURES The proportion of total transactions, advertised and active listings for prescription opioids, prescription sedatives, prescription steroids, prescription stimulants, and illicit opioids, and the composition of the prescription opioid market between the US and elsewhere. RESULTS The sale of prescription opioids through US cryptomarkets increased after the schedule change, with no statistically significant changes in sales of prescription sedatives, prescription steroids, prescription stimulants, or illicit opioids. In July 2016 sales of opioids through US cryptomarkets represented 13.7% of all drug sales (95% confidence interval 11.5% to 16.0%) compared with a modelled estimate of 6.7% of all sales (3.7% to 9.6%) had the new schedule not been introduced. This corresponds to a 4 percentage point yearly increase in the amount of trade that prescription opioids represent in the US market, set against no corresponding changes for comparable products or for prescription opioids sold outside the US. This change was first observed for sales, and later observed for product availability. There was also a change in the composition of the prescription opioid market: fentanyl was the least purchased product during July to September 2014, then the second most frequently purchased by July 2016. CONCLUSIONS The scheduling change in hydrocodone combination products coincided with a statistically significant, sustained increase in illicit trading of opioids through online US cryptomarkets. These changes were not observed for other drug groups or in other countries. A subsequent move was observed towards the purchase of more potent forms of prescription opioids, particularly oxycodone and fentanyl.
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Affiliation(s)
- James Martin
- Department of Social Sciences, Swinburne University, Melbourne, Australia
| | - Jack Cunliffe
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, Kent CT2 7NF, UK
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Abstract
Parts I through III of this paper will examine several, increasingly comprehensive forms of aggregation, ranging from insurance reimbursement "lock-in" programs to PDMPs to completely unified electronic medical records (EMRs). Each part will advocate for the adoption of these aggregation systems and provide suggestions for effective implementation in the fight against opioid misuse. All PDMPs are not made equal, however, and Part II will, therefore, focus on several elements - mandating prescriber usage, streamlining the user interface, ensuring timely data uploads, creating a national data repository, mitigating privacy concerns, and training doctors on how to respond to perceived doctor-shopping - that can make these systems more effective. In each part, we will also discuss the privacy concerns of aggregating data, ranging from minimal to significant, and highlight the unique role of stigma in motivating these concerns. In Part IV, we will conclude by suggesting remedial steps to offset this loss of privacy and to combat the stigma around SUDs and mental health disorders in general.
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Affiliation(s)
- John Matthew Butler
- John Matthew Butler is a student at the Yale Law School. William C. Becker, M.D., is an Assistant Professor of Medicine at Yale School of Medicine. Keith Humphreys, Ph.D., is the Esther Ting Memorial Professor in the Department of Psychiatry at Stanford University School of Medicine and a Senior Career Scientist at the VA Health Services Research Center in Palo Alto
| | - William C Becker
- John Matthew Butler is a student at the Yale Law School. William C. Becker, M.D., is an Assistant Professor of Medicine at Yale School of Medicine. Keith Humphreys, Ph.D., is the Esther Ting Memorial Professor in the Department of Psychiatry at Stanford University School of Medicine and a Senior Career Scientist at the VA Health Services Research Center in Palo Alto
| | - Keith Humphreys
- John Matthew Butler is a student at the Yale Law School. William C. Becker, M.D., is an Assistant Professor of Medicine at Yale School of Medicine. Keith Humphreys, Ph.D., is the Esther Ting Memorial Professor in the Department of Psychiatry at Stanford University School of Medicine and a Senior Career Scientist at the VA Health Services Research Center in Palo Alto
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Kuijpers TG, Willemsen MC, Kunst AE. Public support for tobacco control policies: The role of the protection of children against tobacco. Health Policy 2018; 122:929-935. [PMID: 29859650 DOI: 10.1016/j.healthpol.2018.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 02/02/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In many countries, health advocates aim to increase public support for tobacco control policies by framing these policies in terms of child protection. We examined whether support for the protection of children is indeed associated with support for tobacco control policies, even among smokers, opponents of state intervention and opponents of a governmental role in tobacco control. METHODS We used a survey on a representative sample of Dutch adults of 18 years and older (n = 1631). The survey measured respondents' support for banning tobacco displays, raising the age of sale for tobacco to 21 years and limiting tobacco sales to specialized shops. Regression analyses were done to assess the association with respondents' support for the protection of children against tobacco. In further analyses, subgroup interactions were added. RESULTS Respondents' support for the protection of children against tobacco with legislation was positively related to support for all three policies. Associations were weaker for smokers (except for raising the age of sale) but similar for opponents of state intervention and opponents of a governmental role in tobacco control. CONCLUSION This is the first paper to empirically support the idea that emphasizing the need to protect children against tobacco enhances support for tobacco control policies. This 'child effect' is effective in all segments of the population, albeit somewhat weaker among smokers.
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Affiliation(s)
- Thomas G Kuijpers
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Marc C Willemsen
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
Treatment for opioid use disorder in the United States evolved in response to changing federal policy and advances in science. Inpatient care began in 1935 with the US Public Health Service Hospitals in Lexington, Kentucky, and Fort Worth, Texas. Outpatient clinics emerged in the 1960s to provide aftercare. Research advances led to opioid agonist and opioid antagonist therapies. When patients complete opioid withdrawal, return to use is often rapid and frequently deadly. US and international authorities recommend opioid agonist therapy (i.e., methadone or buprenorphine). Opioid antagonist therapy (i.e., extended-release naltrexone) may also inhibit return to use. Prevention efforts emphasize public and prescriber education, use of prescription drug monitoring programs, and safe medication disposal options. Overdose education and naloxone distribution promote access to rescue medication and reduce opioid overdose fatalities. Opioid use disorder prevention and treatment must embrace evidence-based care and integrate with physical and mental health care.
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Affiliation(s)
- Dennis McCarty
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon 97239, USA; , ,
- Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Kelsey C Priest
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon 97239, USA; , ,
- MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - P Todd Korthuis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon 97239, USA; , ,
- Addiction Medicine Section, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
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Abadie R, Gelpi-Acosta C, Davila C, Rivera A, Welch-Lazoritz M, Dombrowski K. "It Ruined My Life": The effects of the War on Drugs on people who inject drugs (PWID) in rural Puerto Rico. Int J Drug Policy 2018; 51:121-127. [PMID: 28716395 PMCID: PMC5851589 DOI: 10.1016/j.drugpo.2017.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 02/28/2017] [Revised: 04/12/2017] [Accepted: 06/19/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The War on Drugs has raised the incarceration rates of racial minorities for non-violent drug-related crimes, profoundly stigmatized drug users, and redirected resources from drug prevention and treatment to militarizing federal and local law enforcement. Yet, while some states consider shifting their punitive approach to drug use, to one based on drug treatment and rehabilitation, nothing suggests that these policy shifts are being replicated in Puerto Rico. METHODS This paper utilizes data from 360 PWID residing in four rural towns in the mountainous area of central Puerto Rico. We initially recruited 315 PWID using respondent-driven sampling (RDS) and collected data about risk practices and conducted HIV and HCV testing. During a second phase, we conducted 34 micro-ethnographic assays, in which we randomly recruited 34 participants from the first phase and included their ego networks in this phase. Our ethnographic inquiry produced significant data regarding the effects of the war on drugs on the local drug trade, drug availability, and injectors' social networks. RESULTS Findings suggest that repressive policing has been ineffective in preventing drug distribution and use among those in our study. This type of law enforcement approach has resulted in the disproportionate incarceration of poor drug users in rural Puerto Rico, and mainly for nonviolent drug-related crimes. In addition, incarceration exposes PWID to a form of a cruel and unusual punishment: having to quit heroin "cold turkey" while the prison environment also represents a HIV/HCV risk. In turn, the war on drugs not only diverts resources from treatment but also shapes treatment ideologies, punishing non-compliant patients. CONCLUSION Shifting the emphasis from repression to treatment and rehabilitation is likely to have a positive impact on the health and overall quality of life of PWID and their communities.
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Affiliation(s)
- R Abadie
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA; Department of Social Science, LaGuardia Community College (CUNY), 31-10 Thompson Ave, Long Island City, NY 11101, USA.
| | - C Gelpi-Acosta
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
| | - C Davila
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
| | - A Rivera
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
| | - M Welch-Lazoritz
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
| | - K Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE 68588, USA
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26
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Werb D. Post-war prevention: Emerging frameworks to prevent drug use after the War on Drugs. Int J Drug Policy 2018; 51:160-164. [PMID: 28734744 PMCID: PMC6042507 DOI: 10.1016/j.drugpo.2017.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/29/2017] [Accepted: 06/19/2017] [Indexed: 11/20/2022]
Abstract
The prevention of drug use is one of the primary goals of the War on Drugs. However, despite investment in high-profile interventions such as social marketing campaigns and enforcement-based deterrence, these efforts have generally failed. With the emergence of novel policy frameworks to control and regulate drug use, a window of opportunity exists to test approaches to drug prevention that take into account existing evidence and the rights of individuals who use drugs. Specifically, there is a growing consensus that entry into drug use is a socially-defined event that individuals experience within particular socio-structural contexts. This understanding, coupled with a distinction between the value of preventing problematic drug use rather than all drug use, provides a useful framework within which to develop effective and rights-based approaches to drug prevention.
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Affiliation(s)
- Dan Werb
- Division of Global Public Health, University of California San Diego, United States; Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.
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Elliott L, Benoit E, Campos S, Dunlap E. The long tail of a demon drug: The 'bath salts' risk environment. Int J Drug Policy 2018; 51:111-116. [PMID: 29248872 PMCID: PMC5762257 DOI: 10.1016/j.drugpo.2017.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 05/22/2017] [Revised: 09/29/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
Using the case of synthetic cathinones (commonly referred to as 'bath salts' in the US context), this paper analyses structural factors surrounding novel psychoactive substances (NPS) as contributing to the unique risk environment surrounding their use. Drawing on interviews with 39 people who use bath salts from four U.S. cities and analysis of the infrastructural, social, economic, and policy contexts, we document the unique harms related to changing contexts for illicit drug regulation, manufacture, and consumption. Findings suggest that NPS and designer drug markets, which are highly reliant upon the internet, share characteristics of the entertainment industry which has come to rely more heavily upon profits derived from the 'long tail' of myriad lesser-known products and the diminished centrality of 'superstars' and 'hits'. Findings point toward increased theoretical and policy attention to changing drug market structures, more rigorous evaluations of drug 'analogues' legislation and greater involvement with NPS education and testing by harm reduction agencies.
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Affiliation(s)
- Luther Elliott
- National Development and Research Institutes, Inc., 71 W. 23rd St., 4th Floor, New York, NY 10010, United States.
| | - Ellen Benoit
- National Development and Research Institutes, Inc., 71 W. 23rd St., 4th Floor, New York, NY 10010, United States
| | - Stephanie Campos
- National Development and Research Institutes, Inc., 71 W. 23rd St., 4th Floor, New York, NY 10010, United States
| | - Eloise Dunlap
- National Development and Research Institutes, Inc., 71 W. 23rd St., 4th Floor, New York, NY 10010, United States
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Iacobucci G. GPs call for end to "local rationing" of prescribing. BMJ 2017; 359:j5265. [PMID: 29133308 DOI: 10.1136/bmj.j5265] [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: 11/04/2022]
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Zhang T, Liu C, Ren J, Wang S, Huang X, Guo Q. Perceived impacts of the national essential medicines system: a cross-sectional survey of health workers in urban community health services in China. BMJ Open 2017; 7:e014621. [PMID: 28698322 PMCID: PMC5734402 DOI: 10.1136/bmjopen-2016-014621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the perceptions of primary care workers about the impacts of the national essential medicines policy (NEMP). SETTING A cross-sectional questionnaire survey was undertaken in 42 urban community health centres randomly selected from four provinces in China. PARTICIPANTS 791 primary care workers rated the impacts of the NEMP on a 5-point Likert scale. OUTCOME MEASURES An average score for the impacts of the NEMP on four aspects (the practice of health workers, interactions of patients with health workers, operations of health centres and provision of medicines) was calculated, each ranging from 0 to 100. A higher score indicates a more positive rating. Linear regression models were established to determine the sociodemographic characteristics (region, age, gender, profession, training, income) that were associated with the ratings. RESULTS The respondents gave an average rating score of 65.61±11.76, 63.17±13.62, 66.35±13.02 and 67.26±11.60 for the impacts of the NEMP on health workers, patients, health centres and provision of medicines, respectively. Respondents from the central region rated the NEMP higher than those from the eastern and western regions. The pharmacists (β=5.457~7.558, p<0.001) and nurses (β=2.612~3.107, p<0.05) gave a more positive rating on the NEMP than their physician counterparts. A higher income was found to be associated with a decrease in the NEMP ratings. Repetitive training was a predictor of higher ratings. CONCLUSIONS The NEMP has significant impacts (as perceived by the health workers) on health services delivery in primary care settings. However, the impacts of the NEMP vary by region, professional practice and the income level of health workers. It is important to maintain support from physicians through income subsidies (to compensate for potential loss) and training.
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Affiliation(s)
- Tao Zhang
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Chaojie Liu
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jianping Ren
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Sheng Wang
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Xianhong Huang
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Qing Guo
- School of Management, Zhejiang Chinese Medical University, Hangzhou, China
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Camacho A, Mejía D. The health consequences of aerial spraying illicit crops: The case of Colombia. J Health Econ 2017; 54:147-160. [PMID: 28570914 DOI: 10.1016/j.jhealeco.2017.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 08/21/2015] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 06/07/2023]
Abstract
This paper exploits variations in aerial spraying across time and space in Colombia and employs a panel of individual health records in order to study the causal effects of the aerial spraying of herbicides (glyphosate) on short-term health-related outcomes. Our results show that exposure to the herbicide used in aerial spraying campaigns increases the number of medical consultations related to dermatological and respiratory illnesses, as well as the number of miscarriages. These findings are robust to the inclusion of individual fixed effects, which compare the prevalence of these medical conditions for the same person under different levels of exposure to the herbicide used in the aerial spraying program over a period of 5 years. Also, our results are robust to controlling for the extent of illicit coca cultivation in the municipality of residence.
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Affiliation(s)
- Adriana Camacho
- Department of Economics, CEDE and CESED, Universidad de los Andes, Colombia(1).
| | - Daniel Mejía
- Department of Economics, CEDE and CESED, Universidad de los Andes, Colombia(1).
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Do Drug Monitoring Programs Reduce the Misuse of Opioids? Natl Bur Econ Res Bull Aging Health 2017;:1-2. [PMID: 28591976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Erviti López J, Saiz Fernández LC, Garjón Parra J. The reliability of clinical trials. The risky way towards drug deregulation. Med Clin (Barc) 2016; 147:554-557. [PMID: 27825749 DOI: 10.1016/j.medcli.2016.10.003] [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] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/09/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Juan Erviti López
- Sección de Evaluación, Asesoría del Medicamento e Investigación, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España.
| | - Luis Carlos Saiz Fernández
- Sección de Evaluación, Asesoría del Medicamento e Investigación, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España
| | - Javier Garjón Parra
- Sección de Evaluación, Asesoría del Medicamento e Investigación, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España
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Abstract
This article summarizes the regulatory scenario on biological medications in Latin America focusing on comparability studies, extrapolation of indications, interchangeability and pharmacovigilance issues. In the case of comparability studies, what is being discussed is the possibility of decreasing the clinical trials requirement, but that the molecule should be well characterized in the studies of pharmacokinetics and pharmacodynamics. With the worldwide-level approval of the first monoclonal antibody biosimilar, infliximab, extrapolation of indications are being discussed, since the behavior of the Latin America regulatory agencies has been different with regard to such issue. Another issue discussed by the regulatory agencies is the interchangeability between biological medications and their biosimilars, mainly due to the fact that there is a clear confusion on interchangeability and substitution concepts. Finally, the pharmacovigilance debate, according to what takes place globally, is related to the need for identifying and differentiating the reference biological medication and its biosimilars for traceability purposes.
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Affiliation(s)
- Ricardo Garcia
- Latin American Center for Biological Research (CLAPBio), Rua São José, 696, Alto da Boa Vista, São Paulo, SP, Brazil, ZIP 04739-001.
| | - Denizar Vianna Araujo
- Internal Medicine Department at State University of Rio de Janeiro, Boulevard 28 de setembro 77, room 329, Vila Isabel, Rio de Janeiro, Brazil, ZIP 20551-030.
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Emsley R, Fleischhacker WW, Galderisi S, Halpern LJ, McEvoy JP, Schooler NR. Placebo controls in clinical trials: concerns about use in relapse prevention studies in schizophrenia. BMJ 2016; 354:i4728. [PMID: 27613560 DOI: 10.1136/bmj.i4728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/04/2022]
Affiliation(s)
- Robin Emsley
- Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg Campus 8000, Cape Town, South Africa
| | | | | | | | - Joseph P McEvoy
- Department of Psychiatry and Health Behavior, Georgia Regents University, Augusta, Georgia, USA
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Skinner AC, Ringwalt C, Naumann RB, Roberts AW, Moss LA, Sachdeva N, Weaver MA, Farley J. Reducing Opioid Misuse: Evaluation of a Medicaid Controlled Substance Lock-In Program. J Pain 2016; 17:1150-1155. [PMID: 27497767 DOI: 10.1016/j.jpain.2016.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/01/2016] [Accepted: 07/12/2016] [Indexed: 11/19/2022]
Abstract
Opioid misuse, abuse, and overdose are a rapidly growing public health epidemic. Medicaid Lock-In Programs (MLIPs) are designed to prevent overutilization of controlled substances by Medicaid patients. However, despite widespread use, there is little information on their effect. Using North Carolina (NC) Medicaid claims data from October 2008 through June 2013, we examined changes in Medicaid-reimbursed opioid prescriptions by patients enrolled in NC's MLIP. We used mixed effects models to examine the effect of MLIP enrollment on monthly opioid claims, number of pharmacies, total days' supply, total units (ie, pills), and total Medicaid payments for opioids. In our sample of 6,148 MLIP patients, the odds of having any opioid claim in a given month was 84% lower during MLIP enrollment relative to the period before enrollment (odds ratio = .16). MLIP enrollment also corresponded with a reduction in monthly number of opioid prescriptions by 1.13, monthly number of pharmacies by .61, and monthly Medicaid expenditures by $22.78. Although MLIPs may constitute a successful component of comprehensive efforts to reduce the potential overutilization of opioids, care should be taken to ensure that programs such as MLIPs do not constrain patients' legitimate needs for analgesic medications. PERSPECTIVE Enrollment in NC's MLIP reduced the likelihood that patients would present a claim for an opioid prescription, and the number of opioid prescriptions patients secured each month. MLIPs may constitute a successful strategy for reducing the misuse, abuse, and diversion of prescription opioids. However, further research is needed to examine the program's potential unintended consequences.
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Affiliation(s)
| | - Chris Ringwalt
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca B Naumann
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew W Roberts
- Department of Pharmacy Sciences, Creighton University, Omaha, Nebraska
| | | | - Nidhi Sachdeva
- Division of Public Health, Injury and Violence Prevention Branch, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Mark A Weaver
- School of Medicine and Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joel Farley
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Bourguignon JP, Slama R, Bergman Å, Demeneix B, Ivell R, Kortenkamp A, Panzica G, Trasande L, Zoeller RT. Science-based regulation of endocrine disrupting chemicals in Europe: which approach? Lancet Diabetes Endocrinol 2016; 4:643-646. [PMID: 27312524 DOI: 10.1016/s2213-8587(16)30121-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Received: 05/20/2016] [Revised: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Jean-Pierre Bourguignon
- Pediatric Endocrinology, CHU Liège and Neuroendocrinology Unit, GIGA Neurosciences, University of Liège, B4000 Liège, Belgium.
| | - Rémy Slama
- Inserm, CNRS and University Grenoble Alpes, IAB Joint Research Center, Team of Environmental Epidemiology, Grenoble, France
| | - Åke Bergman
- Swedish Toxicology Sciences Research Center, Södertälje, Sweden
| | - Barbara Demeneix
- UMR CNRS/MNHN 7221, Department RDDM, Muséum National d'Histoire Naturelle, Paris, France
| | - Richard Ivell
- School of Biosciences & School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Andreas Kortenkamp
- Brunel University London, Institute of Environment, Health and Societies, Uxbridge, UK
| | - GianCarlo Panzica
- Department of Neuroscience, University of Torino, and Neuroscience Institute Cavalieri Ottolenghi, Orbassano, Italy
| | - Leonardo Trasande
- Departments of Pediatrics, Environmental Medicine and Population health, New York University School of Medicine, New York, NY, USA
| | - R Thomas Zoeller
- University of Massachusetts, Biology Department, Amherst, MA, USA
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Kortenkamp A, Bourguignon JP, Slama R, Bergman Å, Demeneix B, Ivell R, Panzica G, Trasande L, Zoeller RT. EU regulation of endocrine disruptors: a missed opportunity. Lancet Diabetes Endocrinol 2016; 4:649-650. [PMID: 27377541 DOI: 10.1016/s2213-8587(16)30151-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Received: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Andreas Kortenkamp
- Brunel University London, Institute of Environment, Health and Societies, Uxbridge UB8 3PH, UK.
| | - Jean-Pierre Bourguignon
- Pediatric Endocrinology, CHU Liège and Neuroendocrinology Unit, GIGA Neurosciences, University of Liège, Liège, Belgium
| | - Rémy Slama
- Inserm, CNRS and University Grenoble Alpes, IAB Joint Research Center, Team of Environmental Epidemiology, Grenoble, France
| | - Åke Bergman
- Swedish Toxicology Sciences Research Center, Södertälje, Sweden
| | - Barbara Demeneix
- UMR CNRS/MNHN 7221, Department RDDM, Muséum National d'Histoire Naturelle, Paris, France
| | - Richard Ivell
- School of Biosciences & School of Veterinary Medicine and Science, University of Nottingham, UK
| | - GianCarlo Panzica
- Department of Neuroscience, University of Torino, Orbassano, Italy; Neuroscience Institute Cavalieri Ottolenghi, Orbassano, Italy
| | - Leonardo Trasande
- Departments of Pediatrics, Environmental Medicine and Population health, New York University School of Medicine, New York, New York, USA
| | - R Thomas Zoeller
- University of Massachusetts, Biology Department, Amherst, MA, USA
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Affiliation(s)
- Silvio Garattini
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156 Milan, Italy
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41
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Schultz S, Chamberlain C, Vulcan M, Rana H, Patel B, Alexander JC. Analgesic utilization before and after rescheduling of hydrocodone in a large academic level 1 trauma center. J Opioid Manag 2016; 12:119-122. [PMID: 27194196 DOI: 10.5055/jom.2016.0323] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Hydrocodone-containing products were recently rescheduled from Drug Enforcement Agency (DEA) schedule III to schedule II due to concerns of abuse and misuse. These changes went into effect on October 6, 2014. OBJECTIVE This quality improvement project involved a retrospective analysis to determine the effect of the DEA schedule change on prescribing habits of hydrocodone-containing products as well as the remaining schedule III and IV opioids, codeine (schedule III) and tramadol (schedule IV). METHODS The authors performed a medication use evaluation at our academic level 1 trauma hospital system on outpatient use of hydrocodone-containing products, tramadol, and codeine-containing products for 6 months before and 6 months after the change to schedule II using our electronic record and pharmacy system. RESULTS A total of 88,428 prescription orders were analyzed. Comparison of prescriptions before and after the DEA schedule changes showed hydrocodone prescriptions reduced from an average of 225.97 per day to 1.20 per day. In addition, tramadol increased from 60.04 per day to 91.85 per day and codeine from 6.81 per day to 98.94 per day. CONCLUSIONS Our data show a very substantial decrease in utilization of hydrocodone-containing products and concomitant increase in the utilization of tramadol and codeine products at our hospital after the DEA schedule change.
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Affiliation(s)
| | | | | | - Humair Rana
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bhavin Patel
- Informatics Pharmacist, Department of Pharmacy, Parkland Health & Hospital System, Dallas, Texas
| | - John C Alexander
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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Nagai S, Ozawa K. Regulatory approval pathways for anticancer drugs in Japan, the EU and the US. Int J Hematol 2016; 104:73-84. [PMID: 27084259 DOI: 10.1007/s12185-016-2001-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/18/2015] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 01/03/2023]
Abstract
The Pharmaceuticals and Medical Devices Agency and the Ministry of Health, Labour and Welfare in Japan and the US Food and Drug Administration are responsible for reviewing applications and approving drugs, medical devices, and regenerative medicines. In the EU, the European Medicines Agency is responsible for the centralized authorization procedure of medicines including oncologic drugs. In this review, we discuss general pathways for the marketing authorization of oncologic drugs and other drugs in Japan, the EU, and the US. There are still unmet medical needs in oncology, whereas scientific innovation and clinical development in oncology are rapid and active, suggesting a reasonable scope for new regulatory schemes for expedited review. Because regulatory schemes are also evolving rapidly, clinicians and academic researchers may have difficulty following the updated regulations in other regions as well as those in their own countries. However, keeping current with new regulations is important for the conduct of translational research and clinical development of new therapeutic products efficiently. This review is intended to help an international audience better understand the essence of the regulatory frameworks for the marketing authorization of oncologic drugs in Japan, the EU, and the US.
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Affiliation(s)
- Sumimasa Nagai
- Division of Genetic Therapeutics, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 1088639, Japan.
| | - Keiya Ozawa
- Division of Genetic Therapeutics, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 1088639, Japan
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Andreev AI, Malkova TL, Apushkin DY, Bulatov IP, Mashchenko PS. [The comprehensive investigation of the new psychoactive substances]. Sud Med Ekspert 2016; 59:55-58. [PMID: 27070039 DOI: 10.17116/sudmed201659255-58] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article was designed to discuss the issues related to ensuring the methodological uniformity of investigations of the novel psychoactive substances based on the system of the newly established specialized laboratories. The authors propose the methodological approaches to the implementation of comprehensive chemical and pharmacological research including chemical, biological, and sociological studies. The main specific features of these approaches are the use of laboratory animals and the automation of in vivo experiments. Also, we discuss the use of the concrete results of the computational experiments designed to elucidate the parameters responsible for the chemical similarity of psychoactive substances. The mechanisms of their action are considered. The special emphasis is placed on the necessity of close cooperation between scientific and expert communities with a view to accumulation of the data on the newly developed and potentially harmful psychoactive substances as a basis for the efficacious prevention of their illegal trafficking.
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Affiliation(s)
- A I Andreev
- Perm State Pharmaceutical Academy, Perm, Russia, 614070
| | - T L Malkova
- Perm State Pharmaceutical Academy, Perm, Russia, 614070
| | - D Yu Apushkin
- Perm State Pharmaceutical Academy, Perm, Russia, 614070
| | - I P Bulatov
- Perm State Pharmaceutical Academy, Perm, Russia, 614070
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Rostova NB, Kudriashova AI. [The system of information concerning pharmaceuticals and its role in efficient using of medicines: opinion of medical specialists]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2016; 24:106-110. [PMID: 29553212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The issues of efficient application of pharmaceuticals by national authorities and supranational institutions are considered as important ones. The WHO recommends implementing twelve key propositions enhancing efficient application of pharmaceuticals. The development of independent information system concerning pharmaceuticals. The WHO recognizes that absence of neatly organized information system concerning pharmaceuticals information is usually spreading through different channels by manufacturers of medicines. The WHO determines admissible sources of information concerning pharmaceuticals and also requirements to content of presented information. The article presents results of survey of opinions of medical professionals about information sources concerning pharmaceuticals regulated in the Russian Federation and the WHO and also about actual information system concerning pharmaceuticals in the Russian Federation and its role in efficient application of medicines.
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45
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Naftali T. [MEDICAL CANNABIS]. Harefuah 2016; 155:79-133. [PMID: 27215115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The cannabis plant has been known to humanity for centuries as a remedy for pain, diarrhea and inflammation. Current research is inspecting the use of cannabis for many diseases, including multiple sclerosis, epilepsy, dystonia, and chronic pain. In inflammatory conditions cannabinoids improve pain in rheumatoid arthritis and:pain and diarrhea in Crohn's disease. Despite their therapeutic potential, cannabinoids are not free of side effects including psychosis, anxiety, paranoia, dependence and abuse. Controlled clinical studies investigating the therapeutic potential of cannabis are few and small, whereas pressure for expanding cannabis use is increasing. Currently, as long as cannabis is classified as an illicit drug and until further controlled studies are performed, the use of medical cannabis should be limited to patients who failed conventional better established treatment.
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46
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Gray RW. THE GOOD NEWS/ BAD NEWS ABOUT TENNESSEE’S OPIOID EPIDEMIC. Tenn Med 2016; 109:23. [PMID: 29718609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Vogler S, Österle A, Mayer S. Inequalities in medicine use in Central Eastern Europe: an empirical investigation of socioeconomic determinants in eight countries. Int J Equity Health 2015; 14:124. [PMID: 26541292 PMCID: PMC4635528 DOI: 10.1186/s12939-015-0261-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/29/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Equitable access to essential medicines is a major challenge for policy-makers world-wide, including Central and Eastern European countries. Member States of the European Union situated in Central and Eastern Europe have publicly funded pharmaceutical reimbursement systems that should promote accessibility and affordability of, at least essential medicines. However, there is no knowledge whether socioeconomic inequalities exist in these countries. Against this backdrop, this study analyses whether socioeconomic determinants influence the use of prescribed and non-prescribed medicines in eight Central and Eastern European countries (Bulgaria, Czech Republic, Hungary, Latvia, Poland, Romania, Slovenia, Slovakia). Further, the study discusses observed (in)equalities in medicine use in the context of the pharmaceutical policy framework and the implementation in these countries. METHODS The study is based on cross-sectional data from the first wave of the European Health Interview Survey (2007-2009). Multivariate logistic regression analyses were carried out to determine the association between socioeconomic status (measured by employment status, education, income; controlled for age, gender, health status) and medicine use (prescribed and non-prescribed medicines). This was supplemented by a pharmaceutical policy analysis based on indicators in four policy dimensions (sustainable funding, affordability, availability and accessibility, and rational selection and use of medicines). RESULTS Overall, the analysis showed a gradient favouring individuals from higher socioeconomic groups in the consumption of non-prescribed medicines in the eight surveyed countries, and for prescribed medicines in three countries (Latvia, Poland, Romania). The pharmaceutical systems in the eight countries were, to varying degrees, characterized by a lack of (public) funding, thus resulting in high and growing shares of private financing (including co-payments for prescribed medicines), inefficiencies in the selection of medicines into reimbursement and limitations in medicines availability. CONCLUSION Pharmaceutical policies aiming at reducing inequalities in medicine use require not only a consideration of the role of co-payments and other private expenditure but also adequate investment in medicines and transparent and clear processes regarding the inclusion of medicines into reimbursement.
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Affiliation(s)
- Sabine Vogler
- Department of Health Economics, WHO Collaborating Centre for Pricing and Reimbursement Policies, Gesundheit Österreich GmbH (Austrian Public Health Institute), Vienna, Austria.
| | - August Österle
- Department of Socioeconomics, Institute for Social Policy, Vienna University of Economics and Business, Vienna, Austria.
| | - Susanne Mayer
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
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Lemire F. Should CPD for opioid prescribing be mandatory? Can Fam Physician 2015; 61:1016-1015. [PMID: 26564666 PMCID: PMC4642918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Affiliation(s)
- Huseyin Naci
- LSE Health, Department of Social Policy, London School of Economics and Political Science, London, UK
| | | | - Elias Mossialos
- LSE Health, Department of Social Policy, London School of Economics and Political Science, London, UK
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