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The impact of COVID-19 on gambling behavior and the gambling industry itself has been widely speculated. Prior studies have shown how boredom, social isolation, poor mental health, and financial hardships, all of which have been associated with COVID-19, can aggravate problem gambling behaviors in patients with gambling disorders while also luring newcomers. Few studies have used methods other than self-report to assess longitudinal behavioral changes in gambling behavior before versus during the pandemic. The present study addresses this gap by using an interrupted time series approach on data obtained from the Swedish Gambling Authority measuring taxation on gambling vendors' revenue between January 2019 and November 2021. March, June, and October 2020 were chosen as interruption points as they correspond to the pandemic's commencement, the return of elite sports, and the second wave of cases in Sweden, respectively. We hypothesized that the pandemic would be associated with both temporary changes for select gambling types and long-term increases in online gambling. Results revealed the pandemic's onset was associated with transient effects at each point of interruption, as well as long-term upward trends in total gambling and commercial online gambling, excluding horse betting and the state-owned operator for online casinos and betting. The present study's findings, although consistent with the theory that gambling activity could increase during the pandemic, contradict previous studies that found no changes or a decrease from pre-COVID-19 levels. Findings indicate that the pandemic and Sweden's reaction to it were associated with increased use of some gambling products. [ABSTRACT FROM AUTHOR]

Background: The WHO Access, Watch, and Reserve (AWaRe) antibiotic classification framework aims to balance appropriate access to antibiotics and stewardship. We aimed to identify how patterns of antibiotic consumption in each of the AWaRe categories changed across countries over 15 years.Methods: Antibiotic consumption was classified into Access, Watch, and Reserve categories for 76 countries between 2000, and 2015, using quarterly national sample survey data obtained from IQVIA. We measured the proportion of antibiotic use in each category, and calculated the ratio of Access antibiotics to Watch antibiotics (access-to-watch index), for each country.Findings: Between 2000, and 2015, global per-capita consumption of Watch antibiotics increased by 90·9% (from 3·3 to 6·3 defined daily doses per 1000 inhabitants per day [DIDs]) compared with an increase of 26·2% (from 8·4 to 10·6 DIDs) in Access antibiotics. The increase in Watch antibiotic consumption was greater in low-income and middle-income countries (LMICs; 165·0%; from 2·0 to 5·3 DIDs) than in high-income countries (HICs; 27·9%; from 6·1 to 7·8 DIDs). The access-to-watch index decreased by 38·5% over the study period globally (from 2·6 to 1·6); 46·7% decrease in LMICs (from 3·0 to 1·6) and 16·7% decrease in HICs (from 1·8 to 1·5), and 37 (90%) of 41 LMICs had a decrease in their relative access-to-watch consumption. The proportion of countries in which Access antibiotics represented at least 60% of their total antibiotic consumption (the WHO national-level target) decreased from 50 (76%) of 66 countries in 2000, to 42 (55%) of 76 countries in 2015.Interpretation: Rapid increases in Watch antibiotic consumption, particularly in LMICs, reflect challenges in antibiotic stewardship. Without policy changes, the WHO national-level target of at least 60% of total antibiotic consumption being in the Access category by 2023, will be difficult to achieve. The AWaRe framework is an important measure of the effort to combat antimicrobial resistance and to ensure equal access to effective antibiotics between countries.Funding: US Centers for Disease Control and Prevention. [ABSTRACT FROM AUTHOR]

Purpose: The use of radioprotectors and radiomitigators could improve the therapeutic index of radiation therapy. With the intention of accelerating translation of radiation-effect modulators (radioprotectors and mitigators), the Radiation Research Program and SBIR (Small Business Innovation Research) Development Center within the National Cancer Institute issued 4 Requests for Proposals (RFPs) from 2010 to 2013. Twelve SBIR contract awards in total were made in response to the 4 RFPs from September 2011 through September 2014. Here, we provide an update on the status of SBIR contract projects for the development of radiation-effect modulators.Methods and Materials: To assess the status of research and development efforts under the 4 RFPs on radiation-effect modulators, we searched PubMed for research articles, google.com for published abstracts, clinicaltrials.gov for ongoing or completed clinical trials, and company websites for press releases and other news. All information obtained and reported here is publicly available and thus protects the intellectual property of the investigators and companies.Results: Of the 12 SBIR projects funded, 5 (42%) transitioned successfully from phase 1 to phase 2 SBIR funding, and among the Fast-Track contracts, this rate was 100% (3 of 3). The Internet search identified 3 abstracts and 6 publications related to the aims of the SBIR contracts. One-third of the companies (4 of 12) have successfully launched a total of 8 clinical trials to demonstrate the safety and efficacy of their investigational agents. Two drugs are in clinical trials for their indication as a radioprotector, and 2 drugs are under evaluation for their anticancer properties (an immunomodulator and a small molecule inhibitor).Conclusions: The National Cancer Institute's SBIR has provided pivotal funding to small businesses for the development of radioprotectors and radiomitigators, which resulted in multiple early-phase clinical trials. Longer follow-up is needed to determine the full impact of these novel therapeutics that enter clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: We described the population of daily smokers purchasing cigarettes on Indian reservations (IRs), estimated the rates of cigarette purchasing on IRs for diverse populations of daily smokers in the U.S., and assessed the trends in the period from 2010-11 to 2014-15.Methods: We used the 2010-11 and 2014-15 Tobacco Use Supplement to the Current Population Survey data for adult daily smokers as well as additional information, e.g., state excise tax on tobacco (n = 33,871).Results: Daily smokers who purchased cigarettes on IRs were primarily 45+ years old, non-Hispanic (NH) White, resided in a state with an IR, paid less than $4.50 per pack, and purchased cigarettes in the state of their residency. The majority of purchases on IRs were made in New York (28%), Oklahoma (14%), Washington (10%), Arizona (9%), and Florida (6%). The rate of purchasing cigarettes on IRs decreased from 4% in 2010-11 to 3% in 2014-15 (p = 0.012). The rates were higher for females than males (OR = 1.23, CI = 1.09:1.40) and heavy than non-heavy smokers (OR = 1.35, CI = 1.17:1.55). Higher state excise tax on tobacco, on average, was associated with purchasing cigarettes on IRs.Conclusions: The rate of purchasing cigarettes on IRs is relatively low and has decreased in recent years. However, the rates differ across sociodemographic factors of daily smokers, including the state of residency and purchase. Purchasing cigarettes on IRs at lower prices can affect smokers' intentions to quit and can reduce federal and state efforts toward a tobacco-free nation. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Fritillaria cirrhosa D. Don bulbs contain alkaloids and are one of the most intensively exploited alpine Himalayan medicinal species. In terms of proprietary medicines, our study shows that 210 F. cirrhosa products are offered by 46 suppliers, most of which (44) are situated in China and two in Nepal. A widespread commercial use is as one of the main ingredients in cough syrups. A well known example is "Nin Jiom Pei Pa Koa Herbal Cough & Throat Syrup", which typically contains more F. cirrhosa than any other herbal ingredient in the formulation. The biggest market for F. cirrhosa bulbs is China, where demand exceeds supply of this wild harvested species for use in traditional Chinese medicine (TCM). Cross-border trade from Nepal to China occurs in significant quantities. Bhutan also imports F. cirrhosa bulbs from Nepal. In addition, F. cirrhosa is registered as an active ingredient in traditional herbal medicinal preparations in Australia, Canada, Hong Kong SAR, Malaysia, Republic of Korea, Singapore and Taiwan. There is also an export trade in F. cirrhosa to Europe. Assessing how much F. cirrhosa is traded is complex, however, due to a “look-alike” challenge, as nine Chinese Fritillaria species are traded in Europe ( Fritillaria cirrhosa, F. delavayi, F. hupehensis, F. pallidiflora, F. przewalskii, F. thunbergii, F. unibracteata, F. ussuriensis and F. walujewii ). Aims of the study The aims of this review were to assess the scale of the global trade in F. cirrhosa , and to synthesise studies of the impacts of wild harvest on F. cirrhosa populations and on the extent of emerging cultivation initiatives as an alternative to wild harvest. Methods Firstly, we reviewed published information on studies on impacts of wild F. cirrhosa harvest from across the geographic range of this species. Secondly, global trade data for F. cirrhosa were analysed. Results The principal demand for F. cirrhosa bulbs is in China, where hundreds of different companies produce Fritillaria preparations. Trade data also show that in 2013, China exported over 44 tonnes of F. cirrhosa bulbs to Taiwan and 26.7 tonnes to the Republic of Korea. Extensive commercial use and limited wild stocks result in a high price (2000 – 3800 CNY per kg (around US$ 303 –560 per kg in 2017)) for F. cirrhosa bulbs. Prices of cultivated Fritillaria bulbs are much lower (600–680 CNY per kg in 2017) than wild harvested bulbs. But due to very specific growth requirements of F. cirrhosa , cultivation is not yet able to meet total demand. The consequence is continued exploitation of wild stocks. At the same time, however, an increasing proportion of the demand is met by cultivation of alternative Fritillaria species that are easier to grow than F. cirrhosa . The air-dry mass of F. cirrhosa bulbs varies between 0.0917 and 0.1116 g per bulb. This represents 8960 – 10,900 bulbs/kg or 8.9 – 10.9 million bulbs per tonne. Current demand therefore represents billions of bulbs per year. Conclusions Demand for F. cirrhosa bulbs, particularly from China, makes this species one of the most intensively harvested alpine Himalayan medicinal bulbs. Although F. cirrhosa is listed as a Class III protected species in China, billions of these tiny, wild harvested bulbs are sold per year. Due to demand exceeding supply, the price of F. cirrhosa bulbs has increased dramatically. Between 2002 and 2017, for example, the price of wild harvested F. cirrhosa bulbs increased over nine-fold, from the equivalent of US$60 in 2002 to US$560 per kg in 2017. To date, cultivation has been unable to meet the entire market demand for F. cirrhosa bulbs, although other Fritillaria species are successfully cultivated on a larger scale. [ABSTRACT FROM AUTHOR]

Background: Recognising the lack of research on daytime drinking practices in areas with managed night-time economies (NTEs), this qualitative study explores the phenomena in the London Borough of Islington; a rapidly gentrifying area with a highly regulated night-time economy (NTE). The objectives were to (i) Characterise the daytime drinking spaces of the local alcohol environment and (ii) Theorise the ways in which these spaces, and the practices and performativities within them, are situated within broader social and economic trends.Methods: Adopting a legitimate peripheral participation approach to data collection, 39 licensed premises were visited in Islington and on-site observations carried out between the hours of 12 pm and 6 pm using a semi-structured observation guide. Observations were written-up into detailed fieldnotes, uploaded to NVivo and subject to a thematic analysis.Findings: The daytime on-premises alcohol environment was characterised by two main trends: the decline of traditional pubs and a proliferation of hybrid establishments in which alcohol was framed as part of a suite of attractions. The consumption trends that the latter exemplify are implicated in processes of micro-cultural production and 'hipster capitalism'; and it is via this framing that we explore the way the diverse local drinking spaces were gendered and classed. Hybrid establishments have been regarded as positive in terms of public health, crime and safety. However, they could also help introduce drinking within times and contexts where it was not previously present.Conclusion: The intersection of an expanding hipster habitus with Local Authority efforts to tackle 'determined drunkenness' create very particular challenges. The operating practices of hybrid venues may feed into current alcohol industry strategies of promoting 'new moments' in which consumers can drink. They blur the divisions between work and play and produce temporal and classed divisions of drinking. [ABSTRACT FROM AUTHOR]

Health insurance companies curb price-insensitive behavior and the moral hazard of insureds by means of cost-sharing, such as tiered co-payments or reference pricing in drug markets. This paper evaluates the effect of price limits - below which drugs are exempt from co-payments - on prices and on demand. First, using a difference-in-differences estimation strategy, we find that the new policy decreases prices by 5 percent for generics and increases prices by 4 percent for brand-name drugs in the German reference price market. Second, estimating a nested-logit demand model, we show that consumers appreciate co-payment exempt drugs and calculate lower price elasticities for brand-name drugs than for generics. This explains the different price responses of brand-name and generic drugs and shows that price-related co-payment tiers are an effective tool to steer demand to low-priced drugs. [ABSTRACT FROM AUTHOR]

There has been much interest recently in the relationship between economic conditions and mortality, with some studies showing that mortality is pro-cyclical, while others find the opposite. Some suggest that the aggregation level of analysis (e.g. individual vs. regional) matters. We use both individual and aggregated data on a sample of 20-64 year-old Swedish men from 1993 to 2007. Our results show that the association between the business cycle and mortality does not depend on the level of analysis: the sign and magnitude of the parameter estimates are similar at the individual level and the aggregate (county) level; both showing pro-cyclical mortality. [ABSTRACT FROM AUTHOR]

Objectives: California Senate Bill 41 (SB41), effective January 2012, is a human immunodeficiency virus/hepatitis C virus prevention measure designed to expand syringe access among injection drug users (IDUs) by allowing pharmacies to sell syringes without a prescription. This study assesses self-reported implementation of SB41 and characterizes barriers amenable to intervention.Design: Interviewer-administered survey.Setting and Participants: Fresno and Kern Counties, CA. Pharmacists and other pharmacy staff (n = 404) at 212 pharmacies.Outcome Measure: Self-reported nonprescription pharmacy sales to known or suspected IDUs.Results: Overall, 29.3% of participants said their pharmacy would sell nonprescription syringes to a known or suspected IDU, whereas a far higher proportion (79.3%) would sell nonprescription syringes to a person with diabetes. More than one-half said that their pharmacy requires nonprescription syringe purchasers to enter their signature and name and address in a log book although that is not required under SB41. Fewer than 2 out of 3 participants (61.1%) knew that it is legal to sell nonprescription syringes to IDUs. That knowledge, as well as having syringe sales practices based on both store policy and discretion, were positively associated with IDU syringe sales after controlling for other factors. Working at an independent pharmacy, agreeing that only people with "medical conditions" such as diabetes should be able to buy syringes, and viewing syringe sales to IDUs as "not good business" were independently but negatively associated with IDU syringe sales.Conclusion: This study complements an earlier syringe purchase trial documenting low participation in voluntary nonprescription syringe sales under SB41 in Fresno and Kern Counties. In the absence of legislation requiring mandatory syringe sales, interventions should be developed to increase knowledge of the law and frame addiction as a medical condition, with a special focus on independent pharmacies. Informational interventions should stress the need to eliminate log book documentation requirements, which may serve as a barrier to IDU purchase. [ABSTRACT FROM AUTHOR]

An application of the Bayesian Belief Network (BBN) modelling is presented as a support in establishing process safety related key performance indicators (KPIs) for business management purposes. A relation to the managers' trust into results of risk analysis results is made. The case study deals with a possible spill, ignition, and explosion of methanol during a ship tanker unloading operation at the liquid cargo terminal at the port of Koper, Slovenia. Considerations of business impacts of such a major accident proved to be of particular relevance to the top management. Besides direct financial costs indirect economic impacts, like longer business interruption and impact to reputation, caused stronger concern due to their possible overall financial scope. This finding triggered a management requirement for establishing new, direct, measurable KPIs in association with multiple organizational safety improvement measures. Despite their small individual contribution to overall risk reduction, they are altogether effective in better understanding of the benefits of risk analysis for business. The BBN modelling assisted in identifying dominant contributors to key failure events, which was the guidance for proposing the meaningful, measurable business relevant KPIs. Benefits of such KPIs rely on regular monitoring by mid and top managers. [ABSTRACT FROM AUTHOR]

Objectives: This study looks at market exclusivity time for the top selling originator drugs in Canada. Total sales for drugs without competition were also calculated.Methods: A list of the top selling originator drugs by dollar sales from 2009 to 2015 inclusive, except for 2010, was compiled along with their annual sales. Health Canada databases were used to extract the following information: generic name, date of Notice of Compliance (NOC, date of marketing authorization), whether the product was a small molecule drug or a biologic, and date of NOC for a generic or biosimilar. Market exclusivity time was calculated in days for drugs.Results: A total of 121 drugs were identified. There were 96 small molecule drugs (63 with a generic competitor and 33 with no generic competitor) and 25 biologics (none with a biosimilar competitor). The 63 drugs with a competitor had a mean market exclusivity time of 4478 days (12.3 years) (95% CI 4159-4798). The 58 drugs without competition had total annual sales of Can$8.59 billion and were on the market for a median of 5357 days (14.7 years) (interquartile range 3291-6679) as of January 31, 2017.Conclusions: Top selling originator drugs in Canada have a considerably longer period of market exclusivity than the 8 to 10 years that the research-based pharmaceutical industry claims. [ABSTRACT FROM AUTHOR]

Purpose: There is a widening range of antidiabetic medications available; however changes in consumption patterns remain poorly documented. The aim of this study is to analyze the evolution of consumption of antidiabetic medications during the period 2001-2014 in an Andalusian region.Methods: All antidiabetic medicines on the market were selected for analysis. Consumption data were obtained for the 15-year period and were expressed in defined daily doses (DDD) per 1000 inhabitants per day (DHD).Results: During the study period consumption of insulins grew only a 2.2%, from 17.9 DHD to 18.3 DHD, while oral agents increased a 27.6%, from 41.3 DHD to 52.7 DHD. Consumption of sulfonylureas was gradually reduced from 30.1 DHD to 16.4 DHD but metformin (alone) usage increased from 4.3 DHD to 23.7 DHD, and was the most consumed agent in 2014. A rise in consumption of dipeptidyl peptidase-4 inhibitors and "other hypoglycemic agents" was also noticed. Overall expenditure in antidiabetic medications increased notably from 4.5 in 2001 to 14.4 million euros in 2014.Conclusion: We highlight the market uptake of antidiabetic drugs commercialized during the last decade; despite further exploration is needed to clarify the cost-benefit ratio of these new antidiabetic medicines. [ABSTRACT FROM AUTHOR]

Background: The European market for cannabis derivatives is being transformed. The cultivation of cannabis within the EU and the shift of demand from hashish to domestic marihuana are key aspects of this transformation. Spain, formerly central to the trade of Moroccan hashish, is becoming a marihuana-producing country. The emergence of "import-substitution" has been researched in other EU countries, but thus far the Spanish case remains undocumented.Methods: This paper is based on analysis of data of 748 cannabis plantations seized by Spanish police in 2013. The sample comprises reports of seizures identified through a survey of online news and police reports. "Event-analysis" methods were applied to these sources.Results: The analysis offers a typology of plantations, a profile of participants and the different production systems, and a model of regional distribution. Half of the plantations were small (less than 42 plants) and half contained between 100 and 1000 plants, with an average size of 261 plants. About three-quarters of plants were cultivated indoors using stolen electricity. 86% of all plants seized were from large-scale plantations (more than 220 plants). Most plantations were located along the Mediterranean coast, where population and tourism are concentrated. Over three-quarters of those indicted by police were Spanish (85%). Among the foreign owners of big plantations, Dutch nationals predominated. The number of seized plants by province was directly associated with the number of grow shops (β=0.962, p<0.001).Conclusion: The rise of large-scale cannabis plantations in the Spanish Mediterranean coast is increasingly replacing import of Moroccan hashish. Indoor cultivation supported by grow shops, that provide the technology and know-how, seem to be the dominant form of organization in this emerging industry. Large-scale plantations may have met most of the demand for marihuana in 2013. [ABSTRACT FROM AUTHOR]

Background: Secondary syringe exchangers (SSEs) are a vital component of harm reduction efforts among persons who inject drugs (PWIDs). However, little research has explored how secondary exchange occurs, nor why SSEs do their work. This study looks at secondary exchange as an act of resilience within the PWID risk environment. It asks how secondary syringe exchangers utilize syringes to improve their mental and material well-being.Methods: This article draws on findings from semi-structured in-depth interviews of 30 SSEs. It is also informed by 4 years of participant observation as a volunteer and site supervisor at the San Francisco Aids Foundation syringe exchange sites, and 1 year of participant observation with SSEs and their clients.Results: This study finds that SSEs use syringes as a resource to support three discursive practices - those of merchants, public health workers, and samaritans. These discursive practices correlate to their work and educational backgrounds, and to their accounts of charging for syringes, disseminating public health information, and helping their clients in various ways.Conclusion: SSEs hold heterogeneous motivations and operate in multiple contexts. Many SSEs see themselves as, and behave as, informal health care workers or helpers in their community. They could be utilized, with minimal training and encouragement, to disseminate additional harm reduction information and materials. [ABSTRACT FROM AUTHOR]

Background: The establishment of a regulated legal market for new psychoactive substances (NPS, 'legal highs') under New Zealand's Psychoactive Substances Act (PSA) 2013 created a new commercial sector for psychoactive products, previously limited to alcohol and tobacco.Aim: To explore how the newly-recognised 'legal high' industry (LHI) viewed and responded to the changing regulatory and market environment.Methods: In-depth interviews with six key informants (KI) from the LHI: a leading entrepreneur, chemist, industry spokesperson, retailer, product buyer and a researcher commissioned by the LHI - were conducted, transcribed and analysed thematically. Formative work for the study included review of official LHI documents (websites, public submissions, self-regulation documents).Results: The LHI stakeholders espoused an idealistic mission of shifting recreational users of alcohol, tobacco and illegal drugs towards "safer alternatives". Passage of the PSA was viewed as a success after years of lobbying led by pioneering LHI actors. The growth and professionalisation of the LHI resulted in an increasingly commercial market which challenged idealistic views of the original operators. LHI KI reported the targeting of young and low income customers, price cutting and increasing the strength of products as business strategies. Attempts by the LHI to self-regulate did not prevent escalation in the strength of products and fall in retail prices. The LHI reported outsourcing of manufacturing and exporting of their products to other countries, demonstrating an international business model.Conclusion: There was a tension between profit and idealistic motivations within the LHI and this increased as the sector became more commercialised. While the LHI distanced itself from both alcohol and tobacco, they reported the use of similar marketing, business and political lobbying strategies. Rules for engagement with new 'addictive consumption industries' are required to clarify the role they are permitted to play in the development of regulatory regimes for new psychoactive substances. [ABSTRACT FROM AUTHOR]

Background: Policies undergirding the American War on Drugs assume that drug offenders respond rationally to adjustments in sanction certainty and severity. Previous studies find that instead of absolute deterrence, or the termination of criminal activity, drug offenders employ restrictive deterrence, or a variety of risk management strategies. Extant research and current drug policy both fail to examine the interaction of risk perception, management techniques, and life course events or circumstances.Methods: This dynamic examination of apprehension avoidance strategies relies on in-depth interviews mapping out the careers of 20 drug sellers in Philadelphia, Pennsylvania. It examines their risk perceptions and risk management strategies and techniques, exploring rationales for shifts in offending behavior.Results: Respondents were highly risk-averse but used a narrow definition of sanctions relevant to shaping future offending behavior, typically making small adjustments in sales techniques. Rationales for these shifts included sanctions, personal preference, and life course events or circumstances. Only one attributed lasting desistance from offending to a sanction, although life course events such as parenthood and employment were associated with short-term and planned desistance.Conclusions: The limited relevance of sanctions to offenders' thinking about risk avoidance contextualizes the widespread failure of policies designed to deter drug sales. Findings support a growing conclusion that severity of punishment is a less powerful deterrent than certainty and that adjustments in certainty after arrest are offense-specific. The relationship of life course events - especially employment - to desistance and resumed offending suggest that social policies may be more effective than criminal justice sanctions in reducing drug offending. [ABSTRACT FROM AUTHOR]

Objectives: To examine barriers to nonprescription syringe sales (NPSS) in pharmacies by examining resistant pharmacists' willingness to provide syringes to people who inject drugs (PWID) and their current practices for provision or refusal.Methods: Qualitative, semi-structured, in-depth interviews with community pharmacists in California, Kansas, Mississippi, and New Jersey. Participants include seventeen community pharmacists who expressed ethical concerns about providing syringes drawn from a larger sample of 71 community pharmacists participating in a study of ethical decision-making. Analysis captures pharmacists' descriptions of their experiences providing syringes to suspected PWID.Results: Pharmacists who identified syringes as a key ethical issue exhibited significant ambivalence about providing syringes to PWID. Most of these pharmacists were aware of harm reduction logics, but endorsed them to varying degrees. Moral concerns about supplying PWID with syringes were mediated by law and organizational policy. Many pharmacists who considered syringes an ethical challenge allayed their concerns by creating informal policy and engaging in deterrence practices designed to dissuade PWID from coming to the pharmacy.Conclusions: As heroin abuse rates continue to rise, pharmacists are undoubtedly integral allies in the fight to prevent the spread of communicable diseases like HIV/AIDS and Hepatitis C. Education should be aimed at identifying barriers to NPSS resulting from resistant pharmacists' attitudes and practices. Increased education paired with favorable law and organizational policy and decentralization of syringe provision could increase access to clean needles and decrease public health risks. [ABSTRACT FROM AUTHOR]

Background: Since 2011, we have witnessed the rise of 'dark net' drug marketplaces known as cryptomarkets. Cryptomarkets operate on the same model as eBay as they provide a platform where authorized vendors can set up a virtual shop and place listings. Building on a growing body of literature that seeks to understand cryptomarket participants, this paper seeks to explain the decision of cryptomarket vendors to take on risk.Methods: We collected data on Silk Road 1 (SR1), the first cryptomarket launched in 2011. We propose a multilevel model that takes into account the characteristics of listings, vendors and their environment to explain the decision of vendors to take on risk.Results: Our results demonstrate that all levels in the model significantly explain the decision to take on risk. Risk taking, operationalized as a willingness to ship drugs across international borders, was associated with the weights of drug packages mailed, the vendors' reputations and numbers of listings, the country-level perceived effectiveness of law enforcement according to experts, and the opportunities available to vendors as measured by the wealth and the drug expenditures of potential customers.Conclusions: Our results support some previous research findings on the factors explaining risk taking. We extend existing literature by emphasizing the relevance of the environment of drug dealers to predict risk taking. [ABSTRACT FROM AUTHOR]

Background: Cryptomarkets are digital platforms that use anonymising software (e.g. Tor) and cryptocurrencies (e.g. Bitcoin) to facilitate peer-to-peer (P2P) trade of goods and services. Their emergence has facilitated access to a wide range of high-quality psychoactive substances, according to surveys of users. In this paper, we ask the question 'How does changing access to drugs through cryptomarkets affect the drug use and harm trajectories of their users?'Methods: We conducted a digital ethnography spanning 2012-2014, a period that included the seizure of the original Silk Road marketplace and forum by law enforcement. Using encrypted online chat, we interviewed 17 people who reported using Silk Road to purchase illicit drugs. The interviews were in-depth and unstructured, and also involved the use of life history timelines to trace trajectories. Transcripts were analysed thematically using NVivo.Results: For some, Silk Road facilitated initiation into drug use or a return to drug use after cessation. Typically, participants reported experiencing a glut of drug consumption in their first months using Silk Road, described by one participant as akin to 'kids in a candy store'. There was evidence that very high availability reduced the need for drug hoarding which helped some respondents to moderate use and feel more in control of purchases made online. Cryptomarket access also appeared to affect solitary and social drug users differently. Most participants described using other cryptomarkets after the closure of Silk Road, albeit with less confidence.Conclusion: In the context of high levels of drug access, supply and diversity occurring within a community regulated environment online, the impacts of cryptomarkets upon drug use trajectories are complex, often posing new challenges for self-control, yet not always leading to harmful outcomes. A major policy challenge is how to provide support for harm reduction in these highly volatile settings. [ABSTRACT FROM AUTHOR]

Background: To date monitoring of cryptomarkets operating on the dark net has largely focused on market size and substance availability. Less is known of country specific differences in these indicators and how they may corroborate population prevalence estimates for substance use in different countries.Methods: All substance listings from the cryptomarket Agora were recorded over seven time points throughout February and March 2015. Agora was chosen due to its size as the second largest cryptomarket operating and the level of detail of information provided in individual substance listings. Data were collated and the number of unique sellers selling each substance by country of origin was analysed.Results: An average of 14,456.7 substance listings were identified across sampled days from 868.7 unique sellers. The top five countries by number of listings were the USA, United Kingdom, Australia, China and the Netherlands, collectively accounting for 61.8% of all identified listings and 68% of all unique sellers. Australia was over represented in terms of sellers per capita, while China was over represented in new psychoactive substance (NPS) listings. When examined by number of listings per seller, the Netherlands and China stood out as particularly large, likely due to these countries' role in the local production of various illicit and new psychoactive substances.Conclusions: Numbers of sellers by country of origin appear to be influenced by several factors. Australia's overrepresentation in sellers per capita may indicate its relative geographical isolation and the potential for profit margins from selling online, while China's overrepresentation in NPS listings may reflect domestic production of these substances. Continued monitoring will provide enhanced understanding of the increasingly complex and globalised nature of illicit drug markets. [ABSTRACT FROM AUTHOR]

Background: In spite of globalizing processes 'offline' retail drug markets remain localized and - in recent decades - typically 'closed', in which dealers sell primarily to known customers. We characterize drug cryptomarkets as 'anonymous open' marketplaces that allow the diffusion of drugs across locales. Where cryptomarket customers make stock-sourcing purchases for offline distribution, the cryptomarket may indirectly serve drug users who are not themselves cryptomarket customers, thereby increasing the drug diffusing capacity of these marketplaces. Our research aimed to identify wholesale activity on the first major cryptomarket, Silk Road 1.Methods: Data were collected 13-15 September 2013. A bespoke web crawler downloaded content from the first major drug cryptomarket, Silk Road 1. This generated data on 1031 vendors and 10,927 drug listings. We estimated monthly revenues to ascertain the relative importance of wholesale priced listings.Results: Wholesale-level revenue generation (sales for listings priced over USD $1000.00) accounted for about a quarter of the revenue generation on SR1 overall. Ecstasy-type drugs dominated wholesale activity on this marketplace, but we also identified substantial wholesale transactions for benzodiazepines and prescription stimulants. Less important, but still generating wholesale revenue, were cocaine, methamphetamine and heroin. Although vendors on the marketplace were located in 41 countries, wholesale activity was confined to only a quarter of these, with China, the Netherlands, Canada and Belgium prominent.Conclusions: The cryptomarket may function in part as a virtual broker, linking wholesalers with offline retail-level distributors. For drugs like ecstasy, these marketplaces may link vendors in producer countries directly with retail level suppliers. Wholesale activity on cryptomarkets may serve to increase the diffusion of new drugs - and wider range of drugs - in offline drug markets, thereby indirectly serving drug users who are not cryptomarket customers themselves. Cryptomarkets provide researchers and policy makers with a rich source of drug monitoring information. Further research should ascertain whether their virtual location may reduce the violence associated with middle market drug activity. We caution that conflict may instead manifest in other ways, including threats, fraud, and blackmail. [ABSTRACT FROM AUTHOR]

Background: Cryptomarkets are digital platforms that use anonymising software (e.g. Tor) and cryptocurrencies (e.g. Bitcoin) to facilitate trade of goods and services, most notably illicit drugs. Cryptomarkets may reduce systemic violence compared with in-person drug trading because no face-to-face contact is required and disputes can be resolved through a neutral third party. In this paper, we describe the purchasing behaviour of cryptomarket users and then compare the self-reported experiences of threats, violence and other drug-market concerns when obtaining drugs from cryptomarkets with obtaining drugs through friends, known dealers and strangers.Methods: The Global Drug Survey was completed in late 2014 by a self-selected sample who reported accessing drugs through cryptomarkets in the last 12 months (N=3794).Results: Their median age was 22 years and 82% were male. The drug types most commonly obtained through cryptomarkets were MDMA/Ecstasy (55%), cannabis (43%) and LSD (35%). Cryptomarket users reported using a median of 2 sources in addition to cryptomarkets to access drugs, the most common being in-person friendships (74%), in-person dealers (57%) and open markets/strangers (26%). When asked to nominate the main source they would use if cryptomarkets were unavailable, 49% nominated friends, 34% known dealers and 4% strangers. 'Threats to personal safety' (3%) and 'experiencing physical violence' (1%) were less often reported when using cryptomarkets compared with sourcing through friends (14%; 6%), known dealers (24%; 10%) or strangers (35%; 15%). Concerns about drug impurities and law enforcement were reported more often when using the alternative source, while loss of money, waiting too long and not receiving the product were more often reported when using cryptomarkets.Conclusion: Cryptomarkets are associated with substantially less threats and violence than alternative market types used by cryptomarket customers, even though a large majority of these alternatives were closed networks where violence should be relatively less common. [ABSTRACT FROM AUTHOR]

The Netherlands has seen an increase in Δ9-tetrahydrocannabinol (THC) concentrations from approximately 8% in the 1990s up to 20% in 2004. Increased cannabis potency may lead to higher THC-exposure and cannabis related harm. The Dutch government officially condones the sale of cannabis from so called 'coffee shops', and the Opium Act distinguishes cannabis as a Schedule II drug with 'acceptable risk' from other drugs with 'unacceptable risk' (Schedule I). Even in 1976, however, cannabis potency was taken into account by distinguishing hemp oil as a Schedule I drug. In 2011, an advisory committee recommended tightening up legislation, leading to a 2013 bill proposing the reclassification of high potency cannabis products with a THC content of 15% or more as a Schedule I drug. The purpose of this measure was twofold: to reduce public health risks and to reduce illegal cultivation and export of cannabis by increasing punishment. This paper focuses on the public health aspects and describes the (explicit and implicit) assumptions underlying this '15% THC measure', as well as to what extent these are supported by scientific research. Based on scientific literature and other sources of information, we conclude that the 15% measure can provide in theory a slight health benefit for specific groups of cannabis users (i.e., frequent users preferring strong cannabis, purchasing from coffee shops, using 'steady quantities' and not changing their smoking behaviour), but certainly not for all cannabis users. These gains should be weighed against the investment in enforcement and the risk of unintended (adverse) effects. Given the many assumptions and uncertainty about the nature and extent of the expected buying and smoking behaviour changes, the measure is a political choice and based on thin evidence. [ABSTRACT FROM AUTHOR]

Background: The Uruguayan Cannabis Clubs (UCCs) constitute one of three ways to obtain cannabis under the new cannabis regulation laws. These organizations, formed by up to 45 adults and with a legal limit to grow up to 99 plants, appear to provide a safe method of procuring cannabis in a country that is trying to regulate aspects of cannabis production and distribution. This article describes the operations of the UCCs and the challenges these organizations face.Methods: The paper draws on data from in-depth interviews conducted with representatives of UCCs and conversations with government officials conducted between March and August of 2015. We collected information about membership, facilities and forms of organization, methods of cannabis cultivation and distribution, and activities within the community.Results: This article describes how UCCs are formed, their resources, rules for cannabis production and distribution; and their relationships with government institutions and the community. Data show that UCCs face four main challenges: compliance with the extant regulation, financial sustainability, tolerance from the community, and collective action dilemmas.Conclusions: Organizational challenges are as frequent in Uruguay as in other country where cannabis clubs exist, however this paper shows that in order to be sustainable, UCCs need to address issues of collective action, financial sustainability, and possible competition with cannabis distribution via pharmacies that could diminish membership. In the case of Uruguay, UCCs are part of a regulation effort, though they may not be preferred over other legal alternatives already in place. [ABSTRACT FROM AUTHOR]

Background: Cannabis social clubs (CSCs) in Spain are non-profit organisations that connect regular adult cannabis users. One of their functions is to supply cannabis to the closed circuit of members. The CSCs do not breach any international treaties. The aim of the paper is to present the findings of a qualitative study among Spanish CSCs in order to assess their potential for minimising the harm resulting from cannabis use (such as respiratory and mental health risks, the risk of dependence, and social risks).Method: A convenience sample of 11 CSCs was selected from four regions of Spain - the Basque country, Catalonia, the Balearic Islands, and Galicia. 94 respondents took part in 14 focus groups (FGs). The number of participants in a FG ranged from two to 12. A semi-structured interview guide and a structured questionnaire were used in the FG.Findings: Members described a variety of risk minimising features of the CSCs: the availability of a quality product and mechanisms for its control, availability of different strains of cannabis and knowledge about their different psychoactive effects, increased control over personal cannabis use, informal information sharing and interaction, reduced stigma, and reduced criminal risks.Conclusions: The fact that the CSCs have no incentive to increase members' consumption means that they should be considered to be feasible spaces for the implementation of public health policies. Policy objectives could include a requirement that CSC members have control over the quality of cannabis, that different strains of cannabis are available together with information on their effects, that quantity of cannabis at intake is restricted and planned for each member, and that harm minimisation activities are both formally and informally implemented in the clubs. [ABSTRACT FROM AUTHOR]

Background: Washington State legalized the sale of recreational cannabis in 2012. This paper describes the unfolding of the market regulatory regime in an eastern portion of the state, including field descriptions to illustrate the setting.Methods: We made observations and conducted interviews of the local supply chain comprising a producer/processor, analytic facility, and retail establishments as well as querying the state director of the regulatory board.Results: Interviews and observations of facilities suggest an overwhelming concern for black market diversion drives state regulatory efforts. The ongoing dialogue between market actors and the state has resulted in a more equitable distribution of profits at different stages in the process. State safety regulations have thus far been shifted to independent laboratories. Banks and insurance companies have slowly begun making inroads into the industry, despite federal prohibition.Conclusion: The law was conceived as a social justice remedy, but the bulk of the legal and regulatory activity surrounds cannabis marketplace management. This has been characterized by concerns for black market diversion, producer/processor profits, and a hands-off approach to safety regulation. Minor cannabis violations as a pathway to criminal justice system involvement have been reduced substantially but disproportionate enforcement upon racial/ethnic minorities continues. [ABSTRACT FROM AUTHOR]

Background: Understanding how price policies will affect alcohol consumption requires estimates of the impact of price on consumption among different types of drinkers and across different consumption settings. This study aims to estimate how changes in price could affect alcohol demand across different beverages, different settings (on-premise, e.g., bars, restaurants and off-premise, e.g., liquor stores, supermarkets), and different levels of drinking and income.Methods: Tobit analysis is employed to estimate own- and cross-price elasticities of alcohol demand among 11 subcategories of beverage based on beverage type and on- or off-premise supply, using cross-sectional data from the Australian arm of the International Alcohol Control Survey 2013. Further elasticity estimates were derived for sub-groups of drinkers based on their drinking and income levels.Results: The results suggest that demand for nearly every subcategory of alcohol significantly responds to its own price change, except for on-premise spirits and ready-to-drink spirits. The estimated demand for off-premise beverages is more strongly affected by own price changes than the same beverages in on-premise settings. Demand for off-premise regular beer and off-premise cask wine is more price responsive than demand for other beverages. Harmful drinkers and lower income groups appear more price responsive than moderate drinkers and higher income groups.Conclusion: Our findings suggest that alcohol price policies, such as increasing alcohol taxes or introducing a minimum unit price, can reduce alcohol demand. Price appears to be particularly effective for reducing consumption and as well as alcohol-related harm among harmful drinkers and lower income drinkers. [ABSTRACT FROM AUTHOR]

Background: Recent research has demonstrated that both poor self-regulation and favorable implicit associations toward alcohol can play important roles in predicting drinking. Less well studied, however, is how the interplay between implicit associations and self-regulation may impact decisions about alcohol consumption. Behavioral economics is one important tool that may provide insight into the cognitive processes that impact demand for alcohol and drinking decisions.Methods: Healthy young adult participants completed an Implicit Association Task (IAT) that measured the strength of associations between approach/avoid attributes and target alcohol/neutral images. Impaired self-regulation was assessed by a classic delay discounting task. Participants also completed an Alcohol Purchase Task (APT), which yields multiple behavioral economic indices, chief among which are intensity (the number of drinks a participant would consume if the drinks were free) and elasticity (the degree to which an increased per-drink price impacts the number of drinks consumed in a hypothetical drinking situation). Finally, participants completed a timeline follow-back assessment of past-90-day drinking.Results: Findings indicated that implicit approach associations toward alcohol predicted increased demand for alcohol on the APT. Although delay discounting did not have a direct effect on demand for alcohol, there was a significant interaction between IAT and delay discounting, such that higher implicit alcohol approach associations predicted particularly high demand for alcohol among participants with poorer self-regulation. APT and IAT, in turn, predicted self-reported drinking behavior.Conclusions: These results suggest that favorable attitudes toward alcohol, together with poor self-regulation, can significantly impact drinking decisions in healthy young adults. [ABSTRACT FROM AUTHOR]

This paper examines the association between the prevalence of various types of outdoor food and beverage advertising found on the building exteriors and properties of retail food outlets and community racial/ethnic and socioeconomic composition in a nationwide sample of food outlets in the U.S. Our major finding from multivariable analysis is that food stores in low-income communities have higher prevalence of all food and beverage ads, including those for unhealthy products such as regular soda, controlling for community racial/ethnic composition and other covariates. This adds to growing research pointing to socioeconomic disparities in food and beverage marketing exposure. [ABSTRACT FROM AUTHOR]

Background: Quantifying an illegal phenomenon like a drug market is inherently complex due to its hidden nature and the limited availability of reliable information. This article presents findings from a recent estimate of the production, consumption and export of Dutch cannabis and discusses the opportunities provided by, and limitations of, mathematical models for estimating the illegal cannabis market.Methods: The data collection consisted of a comprehensive literature study, secondary analyses on data from available registrations (2012-2014) and previous studies, and expert opinion. The cannabis market was quantified with several mathematical models. The data analysis included a Monte Carlo simulation to come to a 95% interval estimate (IE) and a sensitivity analysis to identify the most influential indicators.Results: The annual production of Dutch cannabis was estimated to be between 171 and 965tons (95% IE of 271-613tons). The consumption was estimated to be between 28 and 119tons, depending on the inclusion or exclusion of non-residents (95% IE of 51-78tons or 32-49tons respectively). The export was estimated to be between 53 and 937tons (95% IE of 206-549tons or 231-573tons, respectively).Conclusion: Mathematical models are valuable tools for the systematic assessment of the size of illegal markets and determining the uncertainty inherent in the estimates. The estimates required the use of many assumptions and the availability of reliable indicators was limited. This uncertainty is reflected in the wide ranges of the estimates. The estimates are sensitive to 10 of the 45 indicators. These 10 account for 86-93% of the variation found. Further research should focus on improving the variables and the independence of the mathematical models. [ABSTRACT FROM AUTHOR]

Background: International drug law enforcement agencies have identified an apparent rise in high level drug traffickers choosing to deal in multiple different drugs. It is hypothesised that this may be a "deliberate modus operandi" and that the formation of "portfolios of trades" may make such traffickers more profitable, harmful and resilient to changes in drug supply and policing. In this paper we provide the first exploration of the extent, nature and harms of poly-drug trafficking at Australian borders.Methods: Two different methods were used. First, we used Australian Federal Police (AFP) data on all commercial level seizures at the Australian border from 1999 to 2012 to identify the proportion of seizures that were poly-drug and trends over time. Second, we used unit-record data on a sub-set of 20 drug trafficking cases and linked-cases (defined as the original drug trafficking case and all other criminal cases that were connected via common offenders and/or suspects) to compare the profiles of poly-drug and mono-drug traffickers, including: the total weight and type of drug seized, the value of assets seized, and the level of involvement in other crime (such as money laundering and corruption).Results: Between 5% and 35% of commercial importations at the Australian border involved poly-drug trafficking. Poly-drug trafficking occurred in almost every year of analysis (1999-2012), but it increased only slightly over time. Compared to mono-drug traffickers poly-drug traffickers were characterised by: larger quantities of drugs seized, larger networks, longer criminal histories and more involvement in other types of serious crime.Conclusion: Some fears about poly-drug traffickers may have been overstated particularly about the inherent escalation of this form of trafficking. Nevertheless, this suggests poly-drug traffickers are likely to pose added risks to governments and law enforcement than mono-drug traffickers. They may necessitate different types of policy responses. [ABSTRACT FROM AUTHOR]

Background: A growing body of literature aims to improve understanding of the operations of drug trafficking markets through conducting interviews with dealers and traffickers. Insight into how these individuals conduct business can provide evidence to inform the efforts by policy makers, law enforcement and practitioners to disrupt illicit markets. This paper aims to make a contribution to this evidence base by extending the number of European countries in which interviews have been conducted with incarcerated drug dealers and traffickers.Methods: It draws on interviews with 135 men convicted of offences related to the distribution or sale of heroin or cocaine and imprisoned in Italy, Slovenia and Germany. The research was conducted as part of the Reframing Addictions Project (ALICE-RAP) funded by the European Commission. The sample was diverse. It included a range of nationalities and some individuals who were members of organised crime groups. The majority of the interviewees were dealers who sold at the retail and street level, but there were some who were importers and wholesalers.Findings: Most dealers in each of the three countries reported having more than one regular supplier, and were able to respond to periods of over and under supply without losing customers. Supply arrangements varied in terms of frequency and quantities bought. Dealers engaged in repeated transactions and their relationships with customers were based on trust and reputation. Dealers aimed to sell to regular customers and to provide drugs of good quality. While dealers sought to maximise their profits by cutting drugs with cutting agents, the quality of drugs that they sold could affect their reputation and thus their profits and position in the market. Lastly, while there are some significant differences in the approach between those involved in organised crime groups and those who are not, and between street dealers and those operating at higher levels of the market, there were striking similarities in terms of the day-to-day operational concerns and modes of relationship management.Conclusions: Interviewees' arrangements for securing supplies of drugs provide support to the notion that drug markets are resilient and flexible. Our findings correspond with other empirical research in relation to the centrality of trust in the practical operation of supply and sale of drugs. The research highlights some differences, but important similarities between dealers who were part of organised crime groups and those who were not; dealers all faced some common challenges and adopted some common responses to these. [ABSTRACT FROM AUTHOR]

Background: For more than 30 years, the main strategy to control illicit coca crops has been forced eradication. Despite the importance of social investment and persistent poverty in areas where illicit crops are grown, there is no empirical evidence of the effect of social expenditures on preventing and reducing the expansion of illicit crops.Methods: This paper analyses how social investment in conjunction with eradication affects new coca crops. The model is tested using a dataset consisting of annual data for 440 contiguous municipalities that had coca in any year between 2001 and 2010. The analysis includes the two main techniques used to control illicit crops, manual eradication and aerial spraying.Results: Aerial spraying is effective in deterring farmers from increasing the size of their new coca fields, but this effect is small. Social investment, in addition to generating social welfare, has a significant negative relationship with new coca crops, 0.09-hectare reduction in new coca crops per additional 50-cent spent in social investment (human capital and infrastructure) per inhabitant.Conclusion: Social investment emerges as a complementary and effective strategy to control illicit crops. [ABSTRACT FROM AUTHOR]

Background: In the 1960s and the 1970s, Morocco and Lebanon became major producers of hashish for export to markets in West and Central Europe, Africa and the Middle East. By using a comparative approach, this paper aims to evaluate changes in production in the traditional areas of cannabis cultivation in the Rif (Morocco) and the Beqaa (Lebanon) and to better understand the role that these countries play in current trends in the global cultivation and consumption of cannabis.Methods: The comparative approach takes in account the historical and institutionnal context, and the perception of cannabis in those two country. We rely on primary field research done in the Rif (from 2002) and in the Beqaa (from 1995) in the form of interviews and observations with farmers and intermediaries. Acreage and production estimates of hashish for both countries have been triangulated from different sources.Results: Maghreb and Middle East have a long history of consumption, production and marketing of cannabis. Over the past 12 centuries, migration, trade and different spiritual practices and trends have led to the expansion of cannabis markets. This long period is marked by stages and rifts caused by foreign interference, a worldwide prohibition of cannabis at the beginning of the 20th century and increased global demand in the 1960s and the 1970s. Morocco and Lebanon are among the most important producers of hashish to be exported for trade for the last fifty years. The global prohibition of cannabis and the global sustained demand have created opportunities for poor farmers in the Rif and the Beqaa regions to survive and get wealthy. It is difficult to understand the reasons why areas producing cannabis are steadily increasing. If the Rif and the Beqaa share some features (such are marginalized areas of production, repressive legislation, huge international demand, range of comparable tasks and Mediterranean climate suitable for growing cannabis, etc.) then a comparison between the two countries makes it more easy to notice differences in contexts, in local and international markets (Stability in Morocco, instability in Lebanon; traditional market in Morocco, absence of local market in Lebanon, etc.) In Morocco, the stability and specialized skills among Moroccan growers of hashish have enhanced a competitive economy with various production areas, products and qualities, but also prices and strategies due to competition between Moroccan and European producers. Moreover, Morocco produces cannabis for its significant local market.Conclusion: As shown by comparing Morocco and Lebanon, allows us to examine their perverse effects caused by a global prohibition. The criminalization of growers has only increased their marginalized situation. The enforced eradication of cannabis has limited the cultivation for a short time but not in any sustainable way (resumption of cannabis cultivation in a time of conflict in Lebanon; replacement of local variety by hybrids in Morocco). The cultural heritage of cannabis and its social functions should not be ignored. In the light of the new global changes in the cannabis cultivation (Import substitution, technical progress in developed countries, etc.), hashish producers in the south countries are likely to face uncertain future. [ABSTRACT FROM AUTHOR]

Background: Illegal drug markets are shaped by multiple forces, including local actors and broader economic, political, social, and criminal justice systems that intertwine to impact health and social wellbeing. Ethnographic analyses that interrogate multiple dimensions of drug markets may offer both applied and theoretical insights into drug use, particularly in developing nations where new markets and local patterns of use traditionally have not been well understood. This paper explores the emergent drug market in Kisumu, western Kenya, where our research team recently documented evidence of injection drug use.Methods: Our exploratory study of injection drug use was conducted in Kisumu from 2013 to 2014. We draw on 151 surveys, 29 in-depth interviews, and 8 months of ethnographic fieldwork to describe the drug market from the perspective of injectors, focusing on their perceptions of the market and reports of drug use therein.Results: Injectors described a dynamic market in which the availability of drugs and proliferation of injection drug use have taken on growing importance in Kisumu. In addition to reports of white and brown forms of heroin and concerns about drug adulteration in the market, we unexpectedly documented widespread perceptions of cocaine availability and injection in Kisumu. Examining price data and socio-pharmacological experiences of cocaine injection left us with unconfirmed evidence of its existence, but opened further possibilities about how the chaos of new drug markets and diffusion of injection-related beliefs and practices may lend insight into the sociopolitical context of western Kenya.Conclusions: We suggest a need for expanded drug surveillance, education and programming responsive to local conditions, and further ethnographic inquiry into the social meanings of emergent drug markets in Kenya and across sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Drug pricing is an example of a priority setting in a developing country with official requirements for the use of cost-effectiveness (CE) evidence.Objective: To describe the role of economic evidence in drug pricing decisions in Jordan.Methods: A prospective review of all applications submitted between November 2013 and May 2015 to the Jordan Food and Drug Association's drug pricing committee was carried out. All applications that involved requests for CE evidence were reviewed. Details on the type of study, the extent, and whether the evidence submitted was part of the formal deliberations were extracted and summarized.Results: The committee reviewed a total of 1608 drug pricing applications over the period of the study. CE evidence was requested in only 11 applications. The submitted evidence was of limited use to the committee due to concerns about quality, relevance of studies, and lack of pharmacoeconomic expertise. There were also no clear rules describing how CE would inform pricing decisions.Conclusions: Limited local data and health economic experience were the main barriers to the use of economic evidence in drug pricing decisions in Jordan. In addition, there are no official rules describing the elements and process by which the CE evidence would inform drug pricing decisions. This study summarized accumulated observations for the current use of economic evaluations and evidence-based decision making in Jordan. Recommendations have been proposed to applicants and key decision makers to enhance the role of economic evidence in influencing health policies and evidence-based decision making across priority settings. [ABSTRACT FROM AUTHOR]

Highlights: [•] This study aims to investigate the correlation between the ads on YouTube with firm’s performance. [•] Both popularity and effective ad characteristics related positively to sales. [•] Firms are advised to note the massive potential for free advertising such platforms can provide. [Copyright &y& Elsevier]

The World Health Organization recognizes universities as an important health-promotion setting, including in healthy food provision. Previous research shows that healthy food retail interventions also need to consider commercial sustainability, including financial outcomes, and should take a holistic approach to consumer experience. Our aim was to determine the health behavior and commercial outcomes of a multicomponent traffic light–based healthy vending policy implemented as one part of a holistic university food policy. The hypothesis was that purchases of less healthy "red" beverages would decrease compared with predicted sales, that purchases of healthier "green" and "amber" alternatives would increase, and that there would be no change in revenue. A quasi-experimental design evaluated a real-world food policy using monthly aggregated sales data to compare pre-intervention (January 2016 to March 2018) and post-intervention period sales (December 2018 to December 2019). Electronic sales data were collected from 51 beverage vending machines across 4 university campuses in Victoria, Australia. A multicomponent policy was implemented between April and November 2018. Beverages were classified using a voluntary state government traffic light framework. Policy included display ≤20% red beverages and ≥50% green beverages; machine traffic light labeling; health-promoting machine branding; review of machine placement; and recycled bottle packaging. Changes in red, amber, and green volume sales, and revenue compared with predicated sales. Interrupted time series analysis of sales data compared post-policy sales with predicted sales. In the 13th month post-policy implementation, there was a 93.2% (95% CI +35.9% to +150.5%) increase in total beverage volume sold and an 88.6% (95% CI +39.2% to +138.1%) increase in revenue. There was no change in red beverage volume sold, but increases in green (+120.8%; 95% CI +59.0% to +182.6%) and amber (+223.2%; 95% CI +122.4% to +323.9%) volume sold. Sustained behavior change and commercial outcomes suggest that holistic vending interventions can effectively promote healthier beverage sales. [ABSTRACT FROM AUTHOR]

This study analyzes the interactive effects of oligopoly pricing, state taxation, and anti-smoking regulations on retail cigarette prices by state, using panel data for the 50 US states between 1960 and 1990. The results indicate that cigarette producers do price-discriminate by state, though the effect is not large relative to the final retail price. There are two further results: (1) state taxes are more than passed on - a 1-cent state tax increase results in a price increase of 1.11 cents, and (2) sellers offset state and local anti-smoking laws with lower prices, thereby blunting effects of the regulations. [ABSTRACT FROM AUTHOR]

This study finds that the mean IRR for 1980-84 U.S. new drug introductions is 11.1%, and the mean NPV is 22 million (1990 dollars). The distribution of returns is highly skewed. The results are robust to plausible changes in the baseline assumptions. Our work is also compared with a 1993 study by the OTA. Despite some important differences in assumptions, both studies imply that returns for the average NCE are within one percentage point of the industry's cost of capital. This is much less than what is typically observed in analyses based on accounting data. [ABSTRACT FROM AUTHOR]

Background: Personal vaporisers are gaining popularity as an alternative route of administration for a range of substances. Online cryptomarkets are becoming increasingly popular among people who use substances due to their perceived anonymity, ease of use, and reduced risk of violence compared to traditional face-to-face dealers. We examined the diversity of substances marketed for use in a personal vaporiser on these marketplaces.Methods: Vaping related listings were extracted from three online cryptomarkets ('Agartha', 'Cryptonia', and 'Tochka') using The Onion Router browser. Data collection occurred between October and November 2019.Results: We identified 1929 listings from 201 unique sellers. The top product on Agartha, Cryptonia, and Tochka were vape cartridges prefilled with the e-liquid (70.4 %, 39.4 %, 52.3 % respectively). The most common substance in these products was cannabis oil (96.1 %, 82.1 %, 87.8 %), followed by synthetic cannabinoids (3.7 %, 9.7 %, 9.8 %) and psychedelic substances (0.2 %, 6.4 %, 1.2 %). Vendors were primarily from the USA. Many products offered worldwide shipping (96.3 %, 42.4 %, 51.2 %).Conclusion: Vaping products listed on online cryptomarkets in 2019 primarily contained cannabis oils. Future studies should continue to examine cryptomarkets to identify emerging trends of substances that can be used in personal vaporisers. [ABSTRACT FROM AUTHOR]

Improving and innovating are key strategies for organizations to meet both strengthening and sustainable developing. How to address resource-allocation contradiction given balancing ambidextrous innovation has remained largely unexplored. This paper develops a new mathematical model considering the expected profit of exploitation and exploration, success rate of exploitation and exploration, and discount factor. Findings are summarized as follows: 1) The larger the ratio (the cash flow from exploitation divides by that from exploration), the more resource is allocated to exploitation, which is the opposite case for exploration; 2) The larger the success rate of exploitation or exploration, the smaller amount of resource allocation. And the relationship between the allocation and success rate follows the rule of diminishing marginal return; 3) Profit maximization does not sacrifice the balance of exploitation and exploration innovation. This model is easy to be understood and operated by top managers, specifically the decision variables in the model are close to company's operation and easy to be measured or evaluated. • This paper investigates the resource allocation mechanism to achieve ambidexterity under certain constraints. • The model provided by this paper is easy to be understood and operated by top managers. • The decision variables in the model are close to company's operation and easy to be measured or evaluated. [ABSTRACT FROM AUTHOR]

Although evidence exists for an association between income level and diet quality, a causal relationship has not been established. A number of studies found that the price of nutritious food and the time cost to prepare foods are economically driven reasons for this relationship. However, in addition to economic constraints, low-income individuals and families face a number of additional challenges linked with food choice, eating behaviors, and diet-related chronic conditions that contribute to diet quality and health. Low-income individuals have a higher burden of employment-, food-, and housing-related insecurity that threaten the livelihood of their household. Poverty and exposure to these insecurities are hypothesized to activate biobehavioral and psychological mechanisms-endocrine, immune, and neurologic systems-that influence food choice and consumption. Examples of biobehavioral and psychological factors that influence diet are stress, poor sleep, and diminished cognitive capacity. High levels of stress, poor sleep, and cognitive overload compound the challenges of economic constraints, creating a mentality of scarcity that leads to poor diet quality. [ABSTRACT FROM AUTHOR]