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Background: Amidst a national surge in overdose deaths among racial and ethnic minoritized people and people who use stimulants (cocaine or methamphetamines), our objective was to understand how these groups are adapting to a rapidly changing illicit drug supply. Methods: We conducted semi-structured interviews with 64 people who use drugs and who self-identified as Black, Hispanic, Multiracial, or other Non-White race in three states (Michigan, New Jersey, and Wisconsin). Transcribed interviews were coded thematically. Results: Most respondents used stimulants alone or in combination with opioids. Respondents perceived that the drug supply had become more unpredictable and dangerous but differed in their personal perception of risk and their adaptations. For example, respondents had very mixed perceptions of their own risk of being harmed by fentanyl, and differing opinions about whether fentanyl test strips would be useful. Xylazine, a novel adulterant in the opioid drug supply that has received public health and media attention, was not well known within the sample. Conclusion: Our study highlights the challenges experienced by minoritized people who use drugs in responding to a changing drug supply, underscoring the limits of public health approaches focused solely on individual behavioral change. [ABSTRACT FROM AUTHOR]

Abstract Background Amidst a national surge in overdose deaths among racial and ethnic minoritized people and people who use stimulants (cocaine or methamphetamines), our objective was to understand how these groups are adapting to a rapidly changing illicit drug supply. Methods We conducted semi-structured interviews with 64 people who use drugs and who self-identified as Black, Hispanic, Multiracial, or other Non-White race in three states (Michigan, New Jersey, and Wisconsin). Transcribed interviews were coded thematically. Results Most respondents used stimulants alone or in combination with opioids. Respondents perceived that the drug supply had become more unpredictable and dangerous but differed in their personal perception of risk and their adaptations. For example, respondents had very mixed perceptions of their own risk of being harmed by fentanyl, and differing opinions about whether fentanyl test strips would be useful. Xylazine, a novel adulterant in the opioid drug supply that has received public health and media attention, was not well known within the sample. Conclusion Our study highlights the challenges experienced by minoritized people who use drugs in responding to a changing drug supply, underscoring the limits of public health approaches focused solely on individual behavioral change.

BackgroundXylazine is an increasingly common adulterant in the North American unregulated drug supply that is associated with adverse health outcomes (e.g., skin infections, overdose). However, there are significant knowledge gaps regarding how xylazine was initially identified and how syringe services program (SSP) staff and clients (people who use drugs) responded to its emergence.MethodsFrom June-July 2023, we conducted qualitative interviews with medical (e.g., clinicians) and frontline SSP staff (e.g., outreach workers) and adult clients with a history of injection drug use at a Miami-based SSP. Inductive memos identified emergent codes; thematic analysis involving team consensus established final themes.ResultsFrom interviews with SSP staff (n = 8) and clients (n = 17), xylazine emergence was identified at different times, in various ways. Initially, during summer 2022, clients identified a "tranquilizer-like substance" that worsened sedation and withdrawal and caused wounds. SSP medical staff later identified this adulterant as xylazine by treating new medical cases and through diverse information-sharing networks that included professional societies and news sources; however, frontline SSP staff and clients needed additional educational resources about xylazine and its side effects. With limited guidance on how to reduce harm from xylazine, SSP clients altered their drug consumption routes, reduced drug use, and relied on peers' experiences with the drug supply to protect themselves. Some individuals also reported preferring xylazine-adulterated opioids and increasing their drug use, including the use of stimulants to avoid over sedation.ConclusionsXylazine's emergence characterizes the current era of unprecedented shifts in the unregulated drug supply. We found that xylazine spurred important behavioral changes among people who use drugs (e.g., transitioning from injecting to smoking). Incorporating these experiences into early drug warning surveillance systems and scaling up drug-checking services and safer smoking supply distribution could help mitigate significant health harms caused by xylazine and other emergent adulterants.

Abstract Background Xylazine is an increasingly common adulterant in the North American unregulated drug supply that is associated with adverse health outcomes (e.g., skin infections, overdose). However, there are significant knowledge gaps regarding how xylazine was initially identified and how syringe services program (SSP) staff and clients (people who use drugs) responded to its emergence. Methods From June–July 2023, we conducted qualitative interviews with medical (e.g., clinicians) and frontline SSP staff (e.g., outreach workers) and adult clients with a history of injection drug use at a Miami-based SSP. Inductive memos identified emergent codes; thematic analysis involving team consensus established final themes. Results From interviews with SSP staff (n = 8) and clients (n = 17), xylazine emergence was identified at different times, in various ways. Initially, during summer 2022, clients identified a “tranquilizer-like substance” that worsened sedation and withdrawal and caused wounds. SSP medical staff later identified this adulterant as xylazine by treating new medical cases and through diverse information-sharing networks that included professional societies and news sources; however, frontline SSP staff and clients needed additional educational resources about xylazine and its side effects. With limited guidance on how to reduce harm from xylazine, SSP clients altered their drug consumption routes, reduced drug use, and relied on peers’ experiences with the drug supply to protect themselves. Some individuals also reported preferring xylazine-adulterated opioids and increasing their drug use, including the use of stimulants to avoid over sedation. Conclusions Xylazine’s emergence characterizes the current era of unprecedented shifts in the unregulated drug supply. We found that xylazine spurred important behavioral changes among people who use drugs (e.g., transitioning from injecting to smoking). Incorporating these experiences into early drug warning surveillance systems and scaling up drug-checking services and safer smoking supply distribution could help mitigate significant health harms caused by xylazine and other emergent adulterants.

Drug checking services (DCS) allow people who use drugs to submit substances of concern for chemical analysis and then provide results and specialized counselling when needed. DCS intersect risk management, from a public health perspective, with an activist take that provides people who use drugs with agency over their use by helping them detect and avoid unwanted substances. This paper presents data from an exploratory study of people's motivations for using the Boom Festival DCS and the meanings attributed to their interactions with the service. Semi-structured interviews (n = 22; mean age 29 years, range 24–43; 68% cisgender men) were conducted, and an inductive approach was applied informed by Iterative Categorization and reflexive thematic analysis. Participant narratives were organized around three themes: "Drug Checking as a Responsible Practice", "Drug Checking as a Care Practice," and "Drug Checking as a (Mis)trust Practice". Through these themes, the analysis focuses on the concepts of risk and the ideals of responsibility, care and trust among people using the DCS. Our findings expand the current literature that demonstrates the usefulness of DCS as an intervention to mitigate individual risks of drug use by demonstrating the more communitarian potential of this type of intervention as a means to expand the social networks of people who use drugs and support a "culture of care" among partygoers. Our participants relied on friends and trusted suppliers to get information about drugs and make informed decisions. Hence, there is a potential for those involved in drug use and supply to actively participate in harm reduction services, particularly DCS, as a way to disseminate information to a broader audience that does not want or cannot access the service. [ABSTRACT FROM AUTHOR]

Abstract Background Fentanyl test strips (FTS) are lateral flow immunoassay strips designed for detection of ng/mL levels of fentanyl in urine. In 2021, the US Centers for Disease Control and the Substance Abuse and Mental Health Administration stated that federal funds could be used for procurement of FTS for harm reduction strategies approved by the government such as drug checking. The market for FTS has expanded rapidly in the US and Canada. However, there is no regulatory oversight by either government to ensure proper function of FTS that are being marketed for drug checking. Main body Many brands of FTS have rapidly entered the harm reduction market, creating concerns about the reproducibility and accuracy of their performance from brand to brand and lot to lot. Some examples are provided in this Comment. Similar problems with product quality were observed in the mid 2000’s when lateral flow immunoassays for malaria were funded in many countries and again in 2020, when COVID-19 tests were in huge demand. The combination of high demand and low levels of regulation and enforcement led some manufacturers to join the goldrush without adequate field testing or quality assurance. We argue that the harm reduction community urgently needs to set a lot checking program in place. A set of simple protocols for conducting the tests and communicating the results have been developed, and are described in the following Perspectives paper in this issue. Conclusion In the absence of governmental regulation and enforcement, the harm reduction community should implement a FTS lot checking program. Based on previous experience with the malaria diagnostic lot checking program, this inexpensive effort could identify products that are not suitable for harm reduction applications and provide valuable feedback to manufacturers. Dissemination of the results will help harm reduction organizations to ensure that FTS they use for drug checking are fit for the purpose.

Abstract Background The Global Drug Facility (GDF) of the Stop TB Partnership was launched in 2001 with the goal of increasing access to quality-assured tuberculosis (TB) drugs and products. We aimed to describe the TB drugs and prices available from the GDF over time and to assess trends. Methods We searched the internet, including an internet archive, for past and recent GDF Product Catalogs and extracted the listed TB drugs and prices. We calculated the lowest price for the most common drug formulations assuming drugs with similar active pharmaceutical ingredients (APIs) are substitutes for each other. We assessed time trends in the TB drugs and prices offered by the GDF in univariable regressions over the longest possible period. Results We identified 43 different GDF Product Catalogs published between November 2001 and May 2024. These product catalogs included 122 single medicines (31 APIs), 28 fixed-dose combinations (9 API combinations), and 8 patient kits (8 API regimens and other materials). The number of TB drugs listed in the GDF Product Catalog increased from 9 (8 APIs) to 55 (32 APIs). The price decreased for 17, increased for 19, and showed no trend for 12 APIs. The price of 15 (53.6%) of 28 APIs used against drug-resistant TB decreased, including the price of drugs used in new treatment regimens. The decreasing price trend was strongest for linezolid (-16.60 [95% CI: -26.35 to -6.85] percentage points [pp] per year), bedaquiline (-12.61 [95% CI: -18.00 to -7.22] pp per year), cycloserine (-11.20 [95% CI: -17.40 to -4.99] pp per year), pretomanid (-10.47 [95% CI: -15.06 to -5.89] pp per year), and rifapentine (-10.46 [95% CI: -12.86 to -8.06] pp per year). The prices of 16 (61.5%) of 23 APIs for standard drug-susceptible TB treatment increased, including rifampicin (23.70 [95% CI: 18.48 to 28.92] pp per year), isoniazid (20.95 [95% CI: 18.96 to 22.95] pp per year), ethambutol (9.85 [95% CI: 8.83 to 10.88] pp per year), and fixed-dose combinations thereof. Conclusions The number of TB drugs available from the GDF has substantially increased during its first 23 years of operation. The prices of most APIs for new TB treatments decreased or remained stable. The prices of most APIs for standard drug-sensitive TB treatment increased.

Background: The Global Drug Facility (GDF) of the Stop TB Partnership was launched in 2001 with the goal of increasing access to quality-assured tuberculosis (TB) drugs and products. We aimed to describe the TB drugs and prices available from the GDF over time and to assess trends. Methods: We searched the internet, including an internet archive, for past and recent GDF Product Catalogs and extracted the listed TB drugs and prices. We calculated the lowest price for the most common drug formulations assuming drugs with similar active pharmaceutical ingredients (APIs) are substitutes for each other. We assessed time trends in the TB drugs and prices offered by the GDF in univariable regressions over the longest possible period. Results: We identified 43 different GDF Product Catalogs published between November 2001 and May 2024. These product catalogs included 122 single medicines (31 APIs), 28 fixed-dose combinations (9 API combinations), and 8 patient kits (8 API regimens and other materials). The number of TB drugs listed in the GDF Product Catalog increased from 9 (8 APIs) to 55 (32 APIs). The price decreased for 17, increased for 19, and showed no trend for 12 APIs. The price of 15 (53.6%) of 28 APIs used against drug-resistant TB decreased, including the price of drugs used in new treatment regimens. The decreasing price trend was strongest for linezolid (-16.60 [95% CI: -26.35 to -6.85] percentage points [pp] per year), bedaquiline (-12.61 [95% CI: -18.00 to -7.22] pp per year), cycloserine (-11.20 [95% CI: -17.40 to -4.99] pp per year), pretomanid (-10.47 [95% CI: -15.06 to -5.89] pp per year), and rifapentine (-10.46 [95% CI: -12.86 to -8.06] pp per year). The prices of 16 (61.5%) of 23 APIs for standard drug-susceptible TB treatment increased, including rifampicin (23.70 [95% CI: 18.48 to 28.92] pp per year), isoniazid (20.95 [95% CI: 18.96 to 22.95] pp per year), ethambutol (9.85 [95% CI: 8.83 to 10.88] pp per year), and fixed-dose combinations thereof. Conclusions: The number of TB drugs available from the GDF has substantially increased during its first 23 years of operation. The prices of most APIs for new TB treatments decreased or remained stable. The prices of most APIs for standard drug-sensitive TB treatment increased. [ABSTRACT FROM AUTHOR]

Background: Fentanyl test strips (FTS) are lateral flow immunoassay strips designed for detection of ng/mL levels of fentanyl in urine. In 2021, the US Centers for Disease Control and the Substance Abuse and Mental Health Administration stated that federal funds could be used for procurement of FTS for harm reduction strategies approved by the government such as drug checking. The market for FTS has expanded rapidly in the US and Canada. However, there is no regulatory oversight by either government to ensure proper function of FTS that are being marketed for drug checking. Main body: Many brands of FTS have rapidly entered the harm reduction market, creating concerns about the reproducibility and accuracy of their performance from brand to brand and lot to lot. Some examples are provided in this Comment. Similar problems with product quality were observed in the mid 2000's when lateral flow immunoassays for malaria were funded in many countries and again in 2020, when COVID-19 tests were in huge demand. The combination of high demand and low levels of regulation and enforcement led some manufacturers to join the goldrush without adequate field testing or quality assurance. We argue that the harm reduction community urgently needs to set a lot checking program in place. A set of simple protocols for conducting the tests and communicating the results have been developed, and are described in the following Perspectives paper in this issue. Conclusion: In the absence of governmental regulation and enforcement, the harm reduction community should implement a FTS lot checking program. Based on previous experience with the malaria diagnostic lot checking program, this inexpensive effort could identify products that are not suitable for harm reduction applications and provide valuable feedback to manufacturers. Dissemination of the results will help harm reduction organizations to ensure that FTS they use for drug checking are fit for the purpose. [ABSTRACT FROM AUTHOR]

Unaffordable medical treatment and inflated drug prices have become a challenging issue for lawmakers worldwide. To reduce the financial burden and standardize the pharmaceutical market, the Chinese government has issued several detailed regulations, including the measures of drug recruitment and procurement in one and volume purchasing to not only ensure the high quality of approved drugs but also lower the cost of the production and sell procedure. In this work, to have a thorough overview of the enforcement of these regulations, we attempted to critically analyze the data of our hospital's centralized procurement of drugs from 2019 to 2022. We identified some concerns, such as the difficulty in determining the "quantity" of drug procurement, out-of-stock of collectively procured drugs, difficulty in managing the preallocation of associated funds, incomplete centralized procurement systems, etc. Therefore, it is essential to promote a multidimensional strategy, including the combination of the medical insurance reform and drug centralized procurement policies, strict controlling of the forecast quantity of drugs to ensure stable drug supply, improvement of the relevant policies for retaining the surplus of centralized procurement drug medical insurance funds, secureness of the drug procurement system platform, and available reference and guidance for subsequent centralized quantity procurement of drugs. [ABSTRACT FROM AUTHOR]

Background: Despite the increase in fentanyl-involved overdose deaths in Canada, there have been no national-level studies evaluating the proportion of illicit opioids containing fentanyl or fentanyl analogues in Canada. Methods: This cross-sectional exploratory study characterized trends in fentanyl, carfentanil and other fentanyl analogues within opioids seized by law enforcement agencies in Canada from 2012 to 2022 and submitted to the Health Canada Drug Analysis Service (DAS). Analyses were stratified by province/region. Mann-Kandell tests were used to test for trends. Results: A total of 157,616 samples containing any opioid (“opioid-containing samples”) were submitted to the DAS from Canadian provinces between 2012 and 2022, of which 81,165 (51.5%) contained fentanyl or a fentanyl analogue. The percentage of opioid-containing samples that were positive for fentanyl or a fentanyl analogue increased from 3.0% (95% CI: 2.6–3.4%) in 2012–68.3% (67.7–68.9%) in 2022 (p < 0.001 for trend). The percentage of opioid-containing samples that were positive for fentanyl or a fentanyl analogue increased between 2012 and 2022 in all regions. In 2022, the percentage of samples containing fentanyl or an analogue followed an east-to-west gradient: 15.8% (13.3–18.6%) of samples in Atlantic Canada and 84.7% (83.6–85.7%) in British Columbia. Carfentanil was present in 4.9% (4.6–5.2%) of opioid-containing samples in Canada in 2022 and 19.7% (18.3–21.2%) of opioid-containing samples in Alberta. Conclusions: The illicit opioid supply in Canada increasingly contains toxic synthetic opioids. As of 2022, important regional differences existed in the illicit opioid supply in Canada.

For the health system to function well, the population must have equitable access to quality, affordable pharmaceutical supplies; however, pharmaceutical systems in Africa are challenged by inadequate funding, drug stock outs and irregular supplies, a shortage of trained pharmacy personnel, and a lack of systems for drug regulation and quality. Faith-based health providers, as private, not-for-profit actors, have long complemented public sector efforts in the supply of pharmaceuticals in Africa. However, the contribution of faith-based health providers in pharmaceutical systems has not been formally studied. This study examines the nature and function of faith-based healthcare providers in improving access to pharmaceutical supplies in Africa. To do so, we conducted an exploratory qualitative systematic review to identify documents that contain information on faith-based involvement in pharmaceutical supply in Africa. The review identified 20 articles for inclusion. These articles were analyzed using thematic, narrative analysis. The analysis revealed a significant evidence gap relating to the contribution of private-not-for-profit, faith-based providers to African pharmaceutical systems. The review suggests that while faith-based drug supply organizations have existed for a long time and contribute significantly to national pharmaceutical systems, there is very little known about the nature of faith-based pharmaceutical providers and how they complement public sector pharmaceutical systems. In many contexts, faith-based involvement in pharmaceutical systems improved access for the general population and increased the supply of pharmaceuticals in national systems. Faith-based drug supply organizations also often provide pharmaceutical supplies to both rural and urban areas, often targeting rural and remote areas particularly. The review also indicates that faith-based drug supply organizations improved access to medicines and related commodities and, despite a lack of regulation in many contexts, have the potential to make a positive contribution to quality assurance of pharmaceuticals. In summary, the analysis confirmed that faith-based involvement in pharmaceutical supply chains contributes to strengthening the national health system by complementing the public pharmaceutical system through improved access to medicines and related commodities in Africa. These conclusions corroborate the need to continually document and acknowledge faith-based healthcare providers’ efforts which could guide the formulation of stringent, evidence-based strategies.

Background: Fentanyl is a pressing concern in the current drug supply. Social media data can provide access to near real-time understanding of drug trends that may complement official mortality data. Design: The total number of fentanyl-related posts and the total number of posts for eight drug subreddit categories (alcohol, cannabis, hallucinogens, multi-drug, opioids, over the counter, sedatives, stimulants) were collected from 2013 to 2021 using the Pushshift Reddit dataset. The proportion of fentanyl-related posts as a fragment of total subreddit posts was examined. Linear regressions described the rate of change in post volume over time. Results: Overall, fentanyl-related content increased across drug-related subreddits from 2013 to 2021 (1292% increase, linear trend p ≤ 0.001). Opioid subreddits (30.62 per 1000 posts, linear trend p ≤ 0.001) had the most fentanyl-related content during the examined time period. Multi-drug (5.95 per 1000; p ≤ 0.01), sedative (3.23 per 1000, p ≤ 0.01), and stimulant (1.60 per 1000, p ≤ 0.01) subreddits also had substantial increases in fentanyl-related content. The greatest increases occurred in the multi-drug (1067% 2013:2021) and stimulant (1862% 2014:2021) subreddits. Conclusion: Fentanyl-related posts on Reddit trended upward, with the fastest rate of change for multi-substance and stimulant subreddits. Beyond opioids, harm reduction and public health messaging should ensure inclusion of individuals who use other drugs. [ABSTRACT FROM AUTHOR]

Past research into illicit online markets suggests that trust is produced by governance, reputation systems and the formation of social ties. In this paper, we draw on accounts of abstract and institutional trust, examining whether using a market is associated with general positive beliefs about product quality. Using data from the 2018 Global Drug Survey (n  = 25,471) we utilize propensity score matching and multilevel linear regression to examine the association between having purchased drugs online and general expectations about product quality in value, weight, purity and price. We find strong evidence of a positive association between general beliefs and individual experience. This suggests that trust in illicit online markets can extend beyond interpersonal relations and towards an abstract market. [ABSTRACT FROM AUTHOR]

In March 2020, the UK was placed in lockdown following the spread of the Covid-19 virus. Just as legitimate workplaces made changes to enable their employees to work from home, the illicit drugs trade also made alternative arrangements, adapting its supply models to ensure continuity of operations. Based upon qualitative interviews with 46 practitioners, this paper assesses how front-line professionals have experienced and perceived the impact of Covid-19 on child criminal exploitation and County Lines drug supply in the UK. Throughout the paper, we highlight perceived adaptations to the County Lines supply model, the impact of lockdown restrictions on detection and law enforcement activities aimed at County Lines, and on efforts to safeguard children and young people from criminal exploitation. Our participants generally believed that the pandemic had induced shifts to County Lines that reflected an ongoing evolution of the drug supply model and changes in understanding or attention because of Covid-19 restrictions, rather than a complete reconstitution of the model itself. Practitioners perceived that Covid-19 has had, and continues to have, a significant impact on some young people's vulnerability to exploitation, on the way in which police and frontline practitioners respond to County Lines and child criminal exploitation, and on the way illegal drugs are being moved and sold. [ABSTRACT FROM AUTHOR]

Background: This study, it was aimed to determine the opinions and experiences of family physicians regarding the practice of obtaining reported drugs directly from the pharmacy during the Covid-19 pandemic period. Materials and Methods: The research is of cross-sectional type. The population of the research consisted of 427 family physicians who are actively working in Şanlıurfa and are members of Şanlıurfa Association of Family Physicians (ŞUAHED). 206 family physicians participated in the study. Research data were collected with a structured questionnaire. The application of the questionnaire was done electronically using the ŞUAHED communication phrase. Results: It was determined that 94.2% of family physicians were satisfied or very satisfied with the application. As the positive aspects of the application; As the negative aspects of the application; It was determined that 2 different answers were given regarding the concern that the drug did not reach the patient and the vulnerability, and these were between 46.1 and 68.4%, and there was a response regarding the continued administration of the drugs that were removed from the treatment, and this was at the level of 59.2%. Conclusions: Significant experience has been gained with the application. The application should not be used only as a crisis application. It should be added to the health system by making arrangements for its negative aspects and improvements for its positive aspects. [ABSTRACT FROM AUTHOR]

Abstract Background Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade. Methods We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. Results PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. Conclusion PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD.

The aim of the article is the structure and content specification of the subject area professional term “drug supply” in order to deepen and concretize the conceptual apparatus in the field of the pharmaceutical activity.Materials and methods. The review presents the analysis of 389 titles of scientific pharmaceutical publications for the periods of 1995–1998 and 2010–2019. The selection of publications was carried out by the random sampling based on the phrases: «drug provision», «medical care», «provision of medicines», «pharmaceutical care», «medicinal services», «drug supply» and their English-language counterparts in Russian and foreign electronic information sources. A methodological base of the study was a cluster analysis of the subject area concept of “drug supply” according to the methodology proposed by E.A. Korzhavykh and I.V. Voronovich. In this study, a cluster was interpreted as a set of publications in which a certain pair of terms was simultaneously cited with a preset frequency of co-citation.Results. When analyzing the publications, two clusters of the “drug supply” concept were formed for the time periods indicated above. The comparison of the clusters showed an increase in the activity of the scientific research to expand the structure and content of the subject area of the “drug supply” concept. For the modern cluster, 124 co – cited pairs of lexical units were selected. They were grouped into 9 hierarchy levels according to the strength of relationship between an interval of 10 units and mentioning frequencies of the “drug supply” term. At the final stage, a graphical model of the “drug supply” concept cluster was formed. It was established that the lexical units included from the first to the fifth level, are the cluster nucleus of the “drug supply” concept as the most stable part of the lexical array, which it is advisable to rely on when developing a definition for the concept under study.Conclusion. Thus, the subject field of the “drug supply” concept is characterized by the scientific research, reflecting the socio-economic significance of the objects under study in the field of pharmaceutical activities, and its content is characterized by a high level of pharmaceutical knowledge which describes the most stable elements that make it possible to formulate an adequate definition of the “drug supply” definition.

The application of restrictive public health measures because of COVID-19 has affected all areas of life, including drug use, drug market, and the response of law enforcement and health, education, and social care institutions to the drug phenomenon. In Lithuania students who used psychoactive substances irregularly were more likely to reduce the use of these substances or abstained during quarantine. However, those who used these substances regularly increased the use during quarantine. The provision of harm reduction services was not interrupted, but the package of health services was reduced. There were disruptions in the number of clients entering treatment. Participation in the Early Intervention Programme in Lithuania for young people who are experimenting with alcohol or drugs increased but did not reach the pre-pandemic level. The pandemic also affected workplace-based prevention. The drug market situation remained stable, although the number of the quantities seized indicated some annual variations, caused by changes in supply and demand during the COVID-19 pandemic.

The COVID-19 pandemic has changed the world and imposed restrictions and rules that democratic countries could not have foreseen. The global health and social care system was put under enormous pressure, and preventing it from a total collapse became the primary objective. This paper looks at how the pandemic affected the illicit drug market, people who use drugs and services designed to support and help them. Based on the available studies and administrative statistics from 2019 and 2020, illicit drug use and need for services remained the same despite the pandemic. Services quickly adopted new operating rules and became available for the target group. There is ample evidence that in some cases illicit drug use (e.g. cannabis) even gained in popularity as a coping method for anxiety and stress. The drug supply fell only temporarily due to the COVID-19, to which it quickly adapted through new IT and crypto possibilities (dark web).

Objective: to assess the economic burden of ankylosing spondylitis (AS) and non-radiological axial spondyloarthritis (nr-axSpA) in the Russian Federation, as well as the availability and economic prospects for more complete provision of biological disease-modifying antirheumatic drugs (bDMARDs) to patients with AS and nr-axSpA.Patients and methods. The prevalence of AS and nr-axSpA and organizational aspects of providing with bDMARDs to this category of patients were analyzed.A variant model has been developed in Microsoft Excel, allows to calculate the indicators of the economic burden of AS and nr-axSpA in the Russian Federation, taking into account the economic losses associated with disability, as well as the low availability of bDMARDs. During study preparation, data from real clinical practice and the opinions of experts in the field of AS from various regions of the Russian Federation were studied.The economic burden was calculated as the sum of direct and indirect costs per patient and the population. Additionally, the specific economic burden per capita was determined.Results and discussion. According to expert estimates, the prevalence of AS and nr-axSpA today is 105.0 and 33.2 thousand people, respectively.The current economic burden of the AS for 2019 is estimated at 21.9 billion rubles per population, or 395.5 thousand rubles for 1 patient. The ratio of direct and indirect costs was 1:4, i.e. 4.7 billion rubles – direct costs (84.3 thousand rubles per 1 patient) and 17.2 billion rubles – indirect costs (311.2 thousand rubles per 1 patient). The burden per capita – 149 rubles.Nr-axSpA's current economic burden in 2019 reached 3.0 billion rubles, or 182.9 thousand rubles for 1 patient. The ratio of direct and indirect costs is estimated as 2:5, or 0.9 billion rubles – direct costs (53.0 thousand rubles per 1 patient) and 2.2 billion rubles – indirect costs (130.0 thousand rubles per 1 patient). The burden per capita – 21 rubles.Conclusion. The economic burden of AS and nr-axSpA can be reduced by providing patients with bDMARDs in the required amount: 15% of patients with AS and 10% with nr-axSpA. Due to the imperfection of the regulatory framework, patients with nr-axSpA experience serious difficulties in receiving this therapy within the framework of preferential drug coverage and compulsory health insurance. With the provision of bDMARDs for about 15 and 10% of patients with AS and nr-axSpA, respectively, on the horizon of 5 years, a decrease in disability by 75% and temporary disability by 60% is expected. At the same time, the economic burden for 5 years will decrease by about 40% for each nosology.

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Psoriasis (PS) is a chronic inflammatory skin disease, and it increasingly appears also in the elderly population. There is a rising interest in drug therapy for PS, especially for people receiving care in nursing homes (NH). Which PS-related drugs are prescribed in the time before nursing home admission (NHA), and to what extent does the supply of drugs change after NHA? Which specialties prescribe PS-related drugs? Statutory health insurance data were examined for people with PS, aged ≥ 65 years, who were newly admitted to a NH in the period 2011–2014 and observed for one year before and after NHA. Changes in prescription prevalence (pre-post comparison) were examined for significant differences. Prescriptions of PS-relevant drugs were measured by defined daily dose and stratified according to the prescribing specialist group. The analysis included 718 insured persons with PS (76.2% female, mean age 83.3 years). Systemic therapeutics played a minor role (pre: 2.6% vs. post: 2.1%) in drug therapy. Topical steroids had a high share of about 40% in the pre–post comparison. Overall, the proportion of people with PS who received treatment remained at a comparable level before and after NHA. A structured assessment of the skin is crucial, specifically in people with cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl's dramatic increase in the recreational drug supply over the past decade. Methods: We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. Results: PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. Conclusion: PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的以长三角三省一市（A、B、C、D）为例，描述耐药结核病定点医院抗结核治疗药品供应现状，基于耐 药结核病诊疗指南分析探讨耐多药和利福平耐药结核病（MDR/RR-TB）患者治疗的可及性。方法采用自行设计 的机构调查表对长三角三省一市耐药结核病定点医院进行问卷调查，了解医院基本情况、药晶使用、短缺、报销 政策等现状。结果调查的20种抗结核治疗药物在不同地区、不同医院的覆盖率不同，其中特立齐酮（Trd）、普瑞 马尼（Pretomanid）、德拉马尼（Dim）和乙硫异烟胺（Eto）等药物的使用覆盖率较低，分别为2.7%、5.4%、5.4%、 5.4%。对照药品供应目录及世界卫生组织和我国耐多药诊疗指南中推荐的规范化耐多药肺结核治疗方案，有5家 医院（A有2家，D有3家）尚不能满足标准治疗方案的药岛基本要求。利奈哇胺（Lzd）、氯法齐明（Cfiz）、环丝氨 酸（Cs）、卷曲霉素（Cm）和乙胺丁醇（EBM）等药晶在使用的医院均出现过不同程度的短缺，其中，B2作为市级 专科医院，药晶短缺情况较为严重，该医院使用药晶中87.5%均出现过短缺。绝大多数调查的药晶均已纳入医疗 保险或通过政府采购免费提供的方式惠及患者。结论部分耐多药肺结核定点医院仍然存在治疗不规范、不合理 的现象。完善医疗供应机制，避免因药品短缺而造成的治疗不规则，提高医疗保险补偿范围，扩大可报销的药品 种类依然是目前急需解决的问题。. [ABSTRACT FROM AUTHOR]

Recalls of some batches of metformin have occurred due to the detection of N-nitrosodimethylamine (NDMA) in amounts above the acceptable intake (AI) of 96 ng per day. Prior to the recalls, an international regulatory laboratory network had been monitoring drugs for nitrosamine impurities with each laboratory independently developing and validating multiple analytical procedures to detect and measure nitrosamines in metformin drugs used in their jurisdictions. Here, we provide an overview of the analysis of metformin active pharmaceutical ingredients (APIs) and drug products with 1090 samples (875 finished dosage forms (FDFs) and 215 API samples) tested beginning in November of 2019 through July of 2020. Samples were obtained internationally by a variety of approaches, including purchased, received from firms via information requests or selected by regional regulatory authorities (either at wholesalers or during GMP inspections). Only one nitrosamine (NDMA) was detected and was only present in some batches of metformin products. For API samples, 213 out of 215 lots tested had no measurable level of NDMA. For FDF samples tested, the number of batches with NDMA above the AI amount for patient safety was 17.8% (156/875). Based on these data, although the presence of NDMA was of concern, 82.2% of the samples of metformin drug products tested met quality and safety standards for patients. Regulatory agencies continue to collaborate extensively and work with marketing authorization holders to understand root causes of nitrosamine formation and agree on corrective actions to mitigate the presence of NDMA in future metformin batches. [ABSTRACT FROM AUTHOR]

Abstract Background Pharmacists as the trustee of pharmacy services must adhere to ethical principles and evaluate their professionalism. Pharmacists may sometimes show different unethical behaviors in their interactions, so it is essential to understand these behaviors. The present study aimed to determine the challenges of ethical behaviors based on a principles-based approach in the area of drug supply in pharmacies. Methods This qualitative content analysis was conducted in Kerman in 2018. A number of key players in the field of medication supply were selected using snowball sampling to interview. An effort was made to select samples with maximum variation. Exclusion criteria include having less than 3 years of work experience in pharmacy and supervision, not willing to participate in the interview, and not participating in the interview for 3 times. The participants in this study consisted of pharmacy technicians (n = 5), patients (n = 6), pharmacists (n = 8), inspectors of insurance companies (n = 4), and inspectors of food and drug administration (n = 3). Data were analyzed using directed content analysis by Maxqda software version 10 (VERBI Software, Berlin, Germany). The principles of “Beauchamp and Childress Ethics” theory including autonomy, beneficence, non-maleficence, and justice were selected as the main principles. Results After data analysis, 8 main categories and 26 subcategories were obtained. The main categories include patient privacy, patient independence, communication principles, patient-centered services, drug supplier, patient harm avoidance, supervision, and distributive, procedural, and interactional justice. The subcategories include increasing patient awareness, culturizing prescription, and rational drug use, confidentiality and privacy, and pharmacist-patient relationship/communication, which were the main ethical challenges in the area of drug supply at pharmacies. Conclusions According to a principle-based approach, the greatest challenges were related to two principles of autonomy and beneficence. The policymakers in the healthcare system should emphasize patient independence, patient privacy, and patient-centered services. The results of this study can be used as a tool to introduce ethical challenges to policymakers and develop educational contents, the chart of professional ethics in pharmacies, and accreditation measures of pharmacies.

The article presents the description of structural, organizational and methodological issues of health technology assessment (HTA) of French drugs as well as the state-reimbursable list of drugs. The HTA is conducted by an independent public body – French National Authority for Health (HAS). HAS evaluates medical products, procedures, services and technologies from a medical and economic points of view to make cost recovery decisions. HAS consists of two committees providing HTA: Transparency Committee and the Economic and Public Health Assessment Committee. Thus, the French HTA consists of two separate components within the same agency. The result of HAS evaluation of a drug is a conclusion on the level of clinical value and clinical added value, as well as the methodological quality of the studies and the size of the target patient population. Based on the evaluation results, HAS gives recommendations for the National Union of Health Insurance Funds, the Economic Committee for Healthcare Products and Ministry of Health and publishes its opinion on the HAS website. HAS decisions are of a recommendatory nature – the final decision whether to include the drug in reimbursement lists are made by the Ministry of Health and published in the Official Journal of French republic.

Background: Xylazine is an increasingly common adulterant in the North American unregulated drug supply that is associated with adverse health outcomes (e.g., skin infections, overdose). However, there are significant knowledge gaps regarding how xylazine was initially identified and how syringe services program (SSP) staff and clients (people who use drugs) responded to its emergence., Methods: From June-July 2023, we conducted qualitative interviews with medical (e.g., clinicians) and frontline SSP staff (e.g., outreach workers) and adult clients with a history of injection drug use at a Miami-based SSP. Inductive memos identified emergent codes; thematic analysis involving team consensus established final themes., Results: From interviews with SSP staff (n = 8) and clients (n = 17), xylazine emergence was identified at different times, in various ways. Initially, during summer 2022, clients identified a "tranquilizer-like substance" that worsened sedation and withdrawal and caused wounds. SSP medical staff later identified this adulterant as xylazine by treating new medical cases and through diverse information-sharing networks that included professional societies and news sources; however, frontline SSP staff and clients needed additional educational resources about xylazine and its side effects. With limited guidance on how to reduce harm from xylazine, SSP clients altered their drug consumption routes, reduced drug use, and relied on peers' experiences with the drug supply to protect themselves. Some individuals also reported preferring xylazine-adulterated opioids and increasing their drug use, including the use of stimulants to avoid over sedation., Conclusions: Xylazine's emergence characterizes the current era of unprecedented shifts in the unregulated drug supply. We found that xylazine spurred important behavioral changes among people who use drugs (e.g., transitioning from injecting to smoking). Incorporating these experiences into early drug warning surveillance systems and scaling up drug-checking services and safer smoking supply distribution could help mitigate significant health harms caused by xylazine and other emergent adulterants., Competing Interests: Competing interests The authors declare that they have no competing interests. Additional Declarations: No competing interests reported.

The application of restrictive public health measures because of COVID-19 has affected all areas of life, including drug use, drug market, and the response of law enforcement and health, education, and social care institutions to the drug phenomenon. In Lithuania students who used psychoactive substances irregularly were more likely to reduce the use of these substances or abstained during quarantine. However, those who used these substances regularly increased the use during quarantine. The provision of harm reduction services was not interrupted, but the package of health services was reduced. There were disruptions in the number of clients entering treatment. Participation in the Early Intervention Programme in Lithuania for young people who are experimenting with alcohol or drugs increased but did not reach the pre-pandemic level. The pandemic also affected workplace-based prevention. The drug market situation remained stable, although the number of the quantities seized indicated some annual variations, caused by changes in supply and demand during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has changed the world and imposed restrictions and rules that democratic countries could not have foreseen. The global health and social care system was put under enormous pressure, and preventing it from a total collapse became the primary objective. This paper looks at how the pandemic affected the illicit drug market, people who use drugs and services designed to support and help them. Based on the available studies and administrative statistics from 2019 and 2020, illicit drug use and need for services remained the same despite the pandemic. Services quickly adopted new operating rules and became available for the target group. There is ample evidence that in some cases illicit drug use (e.g. cannabis) even gained in popularity as a coping method for anxiety and stress. The drug supply fell only temporarily due to the COVID-19, to which it quickly adapted through new IT and crypto possibilities (dark web). [ABSTRACT FROM AUTHOR]

Copyright of Signos is the property of Universidad Santo Tomas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Exercise is an effective, low-risk treatment strategy for people with high blood pressure. Therefore, the aim of this study was to investigate the effect of cardiac environmental function training on body composition and blood pressure response in patients with hypertension. One of the main indicators of the quality of medical care provided is the availability of effective, safe and high-quality medicines (MP) beside the medical movements for the population. In the course of the study, the analysis of medical movements and drugs for the treatment of cardiovascular diseases (CVD) included in the list of vital and essential drugs (VED) was carried out. The identification of aspects in the analysis of the most important movements and drugs for the treatment of CVD and the proposal of relevant recommendations is of high practical importance for improving the quality of drug supply to the population. Considering the precautionary aspects of resistance training with the cardiac peripheral function system for people with hypertension can be used to increase strength, body composition and also the treatment of hypertension along with available cardiac drugs. [ABSTRACT FROM AUTHOR]

The North American overdose crisis has continued at unprecedented rates with more than 100,000 overdose deaths occurring in the United States (US) in 2022. Overdose deaths have increasingly been polysubstance-involved, with novel substances (e.g., xylazine) complicating overdose risk and health outcomes. Understanding the effects of—and responses to—a changing drug supply among people who use drugs is critical to modifying harm reduction strategies to be more responsive to people's needs. This qualitative study draws on data collected from May to December 2022 in Rhode Island. Data include in-depth interviews with 50 people who use drugs and observational fieldwork in spaces frequented by participants (e.g., encampments, drop-in centers). Qualitative data were analyzed thematically drawing on concepts of situated rationality. Participants described significant changes in the drug supply, with many attributing these transitions to COVID-19. Most participants characterized the local supply as " synthetic " with textures, color, and taste evolving. Notably, participants emphasized adverse outcomes related to available supplies, including during use (e.g., intense burning sensations) and post-consumption (e.g., heavy sedation, ongoing withdrawal, necrosis). Given the complex supply, participants highlighted the increased risk of overdose and shared how they altered their use practices to manage evolving health risks. Our results underscore how people who use drugs characterized the local drug supply, including perceived changes to supply contents. Implementing and scaling up harm reduction interventions that reduce risk and reinforce the agency of people who use drugs are urgently needed to effectively address the overdose crisis. [ABSTRACT FROM AUTHOR]

Background. The introduction of innovative drugs has significantly increased the treatment effectiveness in patients with relapsed/refractory multiple myeloma (RRMM), but the question of whether these expensive options can be financially secured remains open.Objective: to assess the cost of triplets of targeted drugs ixazomib, carfilzomib, elotuzumab and daratumumab with lenalidomide and dexamethasone used in the treatment of RRMM, and to determine possible payment options for this therapy at the level of the Russian Federation subjects.Material and methods. The cost of an annual course of treatment with the studied regimens with centralized purchases and the cost of targeted drugs per hospitalization case were calculated based on the maximum registered prices, recommended doses and treatment regimens. The normative legal acts regulating the payment of drug therapy for multiple myeloma were analyzed and possible financing channels and their limitations were identified. Using the example of the Volgograd and Saratov Regions, tariffs under the compulsory medical insurance system were calculated and their sufficiency in covering the cost of targeted therapy was estimated.Results. The cost of an annual course of triplet therapy per patient in the case of centralized procurement of drugs ranged from 5.51 million rubles (regimen with ixazomib) up to 8.03 million rubles (regimen with carfilzomib). The cost per hospitalization, depending on the number of doses, ranged from 80,667–242,000 rubles (ixazomib, 1–3 doses) in the Saratov Region up to 239,618–958,472 rubles (daratumumab, 1–4 doses) in the Volgograd Region. Possible reimbursement channels are High-Cost Nosologies (HCN), Obligatory Medical Insurance (OMI) and Regional Drug Coverage (RDC) programs, nevertheless triplet therapy cannot be purchased via the single channel and the combination of them is required. It has been shown that, in most cases, the costs for a case of targeted drug treatment in studied regions are covered by the average tariff for the corresponding diagnosis-related group (DRG), except for cases with a maximum duration in a day hospital setting. An analysis of the RDC lists and the procurement of drugs in the studied regimens at the expense of regional budgets showed that lenalidomide, ixazomib, carfilzomib, elotuzumab and daratumumab are included in the restrictive list in regions 77, 74, 66, 63 and 47, but they are purchased only in regions 15, 24, 6, 4 and 6, respectively.Conclusion. The use of a triplet with ixazomib is characterized by the lowest costs, which indicates its greater economic attractiveness relative to carfilzomib, daratumumab and elotuzumab in the treatment of patients with RRMM. The tariffs established in the current DRG model retain the possibility of paying for treatment with the high-cost medicines at the expense of the OMI funds in combination with the HCN or RDC programs. There are reasons to believe that the expansion of the list of 14 HCN program will increase the provision of patients with highly effective therapy and also reduce the financial burden on the regions.

This article considers 'County Lines' drug markets, specifically in the context of the interventions available to the British Transport Police to deal with this damaging criminal modality. Further, this article identifies the active role the organisation is playing in protecting the interests of vulnerable people. Through a review of contemporary literature and a qualitative empirical study involving influential practitioners in the field, this article identifies that encouraging steps are being taken to deal with this complex problem and that the sharing of information between agencies remains one of the key challenges to overcome. [ABSTRACT FROM AUTHOR]

Unaffordable medical treatment and inflated drug prices have become a challenging issue for lawmakers worldwide. To reduce the financial burden and standardize the pharmaceutical market, the Chinese government has issued several detailed regulations, including the measures of drug recruitment and procurement in one and volume purchasing to not only ensure the high quality of approved drugs but also lower the cost of the production and sell procedure. In this work, to have a thorough overview of the enforcement of these regulations, we attempted to critically analyze the data of our hospital's centralized procurement of drugs from 2019 to 2022. We identified some concerns, such as the difficulty in determining the "quantity" of drug procurement, out-of-stock of collectively procured drugs, difficulty in managing the preallocation of associated funds, incomplete centralized procurement systems, etc. Therefore, it is essential to promote a multidimensional strategy, including the combination of the medical insurance reform and drug centralized procurement policies, strict controlling of the forecast quantity of drugs to ensure stable drug supply, improvement of the relevant policies for retaining the surplus of centralized procurement drug medical insurance funds, secureness of the drug procurement system platform, and available reference and guidance for subsequent centralized quantity procurement of drugs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Cao, Ren, Zhao, Wang and Fang.)

Background: Despite the increase in fentanyl-involved overdose deaths in Canada, there have been no national-level studies evaluating the proportion of illicit opioids containing fentanyl or fentanyl analogues in Canada., Methods: This cross-sectional exploratory study characterized trends in fentanyl, carfentanil and other fentanyl analogues within opioids seized by law enforcement agencies in Canada from 2012 to 2022 and submitted to the Health Canada Drug Analysis Service (DAS). Analyses were stratified by province/region. Mann-Kandell tests were used to test for trends., Results: A total of 157,616 samples containing any opioid ("opioid-containing samples") were submitted to the DAS from Canadian provinces between 2012 and 2022, of which 81,165 (51.5%) contained fentanyl or a fentanyl analogue. The percentage of opioid-containing samples that were positive for fentanyl or a fentanyl analogue increased from 3.0% (95% CI: 2.6-3.4%) in 2012-68.3% (67.7-68.9%) in 2022 (p < 0.001 for trend). The percentage of opioid-containing samples that were positive for fentanyl or a fentanyl analogue increased between 2012 and 2022 in all regions. In 2022, the percentage of samples containing fentanyl or an analogue followed an east-to-west gradient: 15.8% (13.3-18.6%) of samples in Atlantic Canada and 84.7% (83.6-85.7%) in British Columbia. Carfentanil was present in 4.9% (4.6-5.2%) of opioid-containing samples in Canada in 2022 and 19.7% (18.3-21.2%) of opioid-containing samples in Alberta., Conclusions: The illicit opioid supply in Canada increasingly contains toxic synthetic opioids. As of 2022, important regional differences existed in the illicit opioid supply in Canada., (© 2024 The Author(s).)

The aim is to analyze the medical records of patients with malignant lymphoproliferative diseases (LPD) in the Russian Federation in 2016- 2017. Materials and methods. Treating physicians in 75 regions of the Russian Federation were asked to fill the survey questionnaire containing 9 types of malignant LPDs (according to the ICD-10 classification). The questions covered the epidemiology of LPD (prevalence, resistant forms, relapses and mortality), the existence of specialized institutions and beds, the costs of medical care in patients with malignant LPD, and the financial support of pharmacotherapy in these patients during their hospital stay. Results. We found that the most common malignant LPD in 2016-2017 was Hodgkin’s lymphoma (73.5 and 73.4%, respectively). The prevalence of resistant forms and recurrences of malignant LPD over this period accounted for 6.8% of the total patient population. In 2017, the number of patients who died was 7.5% less than that in 2016. There are 815 and 1,763 specialized institutions of the oncology and hematology profiles that provide medical care to children and adult patients, respectively. Among the malignant LPDs, the highest costs of drug therapy in 2016 pertained to lymphosarcoma, and in 2017 – to Hodgkin’s lymphoma. In the system of compulsory health insurance (OMC), the largest spending for both adult and pediatric patients in 2016 and 2017 was accounted for Hodgkin’s lymphoma; a similar result was obtained for the cost of therapy based on high-tech medical care. Conclusion. In 2017, the total number of patients with malignant LPD in the Russian Federation increased by 2.65% as compared to 2016, while the proportion of primary LPD decreased by 1.2%. In 2017, the total costs of drug supply in patients with malignant LPD in the RF increased by 55.35% as compared with 2016.

An urgent task is to carry out regular quality control and rational prescribing of drugs, changes to the drug formulary lists for the purpose of positive influence on the processes of pharmaceutical provision, especially children affected with gastritis and duodenitis. The aim of the work was to create a list of the recommended groups of drugs for further development of the local insurance and formulary drug lists used for treatment of children with gastritis and duodenitis using modern information technologies. Methods of peer reviews, questionnaires, direct observation, modeling, and information analysis were used in the process. The objects of study were regulatory and legislative documents, medication treatments sheets, price lists of wholesale pharmaceutical companies, forms of expert assessments. Science-based guidelines for the assessment of the economic costs for the inclusion of medicines in local formulary drug lists of health care institutions to help children with gastritis and duodenitis in the acute stage, in specialized hospitals, taking into account peculiarities of the disease under study at the regional level were formed. According to the results of a comprehensive study of pharmaceutical provision for treatment of children with gastritis and duodenitis, in addition to an expert evaluation of medicines, recommendations for the creation of a local formulary drug list were made and recommended list of drug groups was determined by 15 INN drugs to be used in the development of a local drug formulary list for pharmacotherapy of the pathology under study.

The paper examines the international experience of drug supply and the risks faced by countries using various systems of drug provision to the population in the outpatient settings. The option of introducing a system of drug supply or drug insurance with co-payment by outpatients is discussed.

The coronavirus disease-19 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus that was first detected at the end of December 2019. The epidemic has affected various regions of China in different degrees. As the situations evolve, the COVID-19 had been confirmed in many countries, and made a assessment that it can be characterized as a pandemic by the World Health Organization on March 11, 2020. Drugs are the main treatment of COVID-19 patients. Pharmaceutical service offers drug safety ensurance for COVID-19 patients. According to COVID-19 prevention and control policy and requirements, combined with series of diagnosis and treatment plans, pharmacists in the first provincial-level COVID-19 diagnosis and treatment unit in Jilin Province in Northeast China have established the management practices of drug supply and pharmaceutical care from four aspects: personnel, drugs supply management, off-label drug use management and pharmaceutical care. During the outbreak, the pharmaceutical department of THJU completed its assigned workload to ensure drug supply. So far, no nosocomial infections and medication errors have occurred, which has stabilized the mood of the staff and boosted the pharmacists' confidence in fighting the epidemic. For the treatment of COVID-19, pharmacists conducted adverse reaction monitoring and participated in the multidisciplinary consultation of COVID-19. Up to now, the COVID-19 patients admitted to THJU have not shown any new serious adverse reactions and been cured finally. The hospital pharmacy department timely adjusted the work mode, and the formed management practices is a powerful guarantee for the prevention and control of the COVID-19 epidemic. This paper summarized the details and practices of drug supply and pharmaceutical services management to provide experience for the people who involving in COVID-19 prevention and contain in other abroad epidemic areas. [ABSTRACT FROM AUTHOR]