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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]

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]

Objectives: Drug checking technologies (DCTs) have been implemented as a response to the ongoing opioid overdose epidemic. We examined the level of trust people who use drugs (PWUD) have in their drug dealers as well as their perspectives on the potential for drug dealers to use DCTs to provide knowledge of drug contents to their customers.Methods: We conducted one-to-one qualitative semi-structured interviews with 20 PWUD in Vancouver, Canada's Downtown Eastside. Participants were purposively recruited from ongoing cohort studies of PWUD and were required to currently be using stimulants and/or opioids.Results: Most participants discussed having a high level of trust for their drug dealers based on length of relationships, drug supply consistencies, and communication. Given this, participants did not identify drug checking as a priority. However, participants discussed a lower level of trust when buying drugs from an unfamiliar source. Participants also discussed how DCTs would provide knowledge to drug dealers about drug contents and how communicating test results to customers could be a risk reduction measure. Participants described privacy concerns that drug dealers might experience as well as the lack of concern that some drug dealers have about their drug supply.Conclusions: Future drug checking programming should consider ways to engage drug dealers to test their supplies and develop communication strategies to more accurately inform PWUD of drug contents and avert risks associated with using them. Additionally, drug policies that address the effects of criminalization should be considered to lessen potential barriers to DCT use by drug dealers. [ABSTRACT FROM AUTHOR]

Xylazine, a sedative analgesic drug approved as an animal tranquilizer but not for human use, has become an adulterant in the illicit opioid marketplace in North America. Recently declared an emerging health threat in the U.S., the prevalence of xylazine in overdose deaths increased 5.5-fold between 2019 and 2021. More information is needed about the impact of xylazine on opioid users and harm reduction service providers. The impact of xylazine adulteration was triangulated through examination of (1) opioid overdose fatalities in Connecticut between 2017 and 2021 reported by the Office of the Chief Medical Examiner data, (2) a convenience survey of people in Connecticut who use drugs (PWUD) regarding their knowledge of and attitude about the local illicit drug supply, and (3) semi-structured interviews of harm reduction service providers in Connecticut and Philadelphia in response to prompts on the impacts of and responses to xylazine adulteration. The presence of fentanyl or its analogues in fatal opioid overdoses was a statistically significant predictor of xylazine presence [OR = 25.0, 95%CI (10.7,81.1)] as was being Hispanic [OR = 1.36, 95%CI (1.03,1.77)]. A survey of people who used drugs revealed that 43% (n = 286) were concerned that the drug supply was always unpredictable. Three-quarters of respondents were aware of xylazine and two-thirds would use a xylazine test strip if one was available. Respondents who identified as White, Hispanic were most likely to be aware of xylazine, to have used a fentanyl test strip, and to be interested in a xylazine test strip. Respondents who injected drugs were 3.6-fold more likely than those who did not inject to endorse an interest in a xylazine test strip. Harm reduction service providers were cognizant of a range of problems surrounding the use and injection of xylazine. Although they reported implementing practices to better respond to xylazine harms, they recognized the absence of solutions to many of the problems encountered. The prevalence of xylazine has expanded, especially in combination with fentanyl. Harm reduction education efforts with fidelity to best practices have emerged, but the harms persist and community prevention needs are largely unmet. [ABSTRACT FROM AUTHOR]

Background: Rising rates of fentanyl- and polydrug-involved drug overdose deaths have prompted inquiry into the role of drug supply in fatal overdose outcomes in the United States. To date, however, there have been few empirical investigations of drug enforcement strategies on fatal overdose rates, despite knowledge that both drug use and supply are often geographically distributed. To address this limitation, we examined measures of drug enforcement as predictors of next-year fatal overdose rates in the Washington/Baltimore High Intensity Drug Trafficking Area (W/B HIDTA).Methods: We conducted mixed-effects models to examine the role of drug seizures and disruption in drug trafficking organizations (DTOs) and money laundering organizations (MLOs) on fatal overdose rates over a 5-year period (2016-2020) across 45 local jurisdictions in the W/B HIDTA region. Outcomes included any, opioid-involved, and fentanyl-involved fatal overdose.Results: Adjusting for covariates, both the total number of drug seizures and amount of cocaine seized (in dosage units per capita) positively predicted next-year opioid- and fentanyl-involved fatal overdose rates. Disruption to DTO and MLO operations did not significantly predict next-year fatal overdose rates for any outcome.Conclusion: Supply-side enforcement activities alone may have limited impact on reducing fatal overdose rates, but may serve as important markers to identify communities at high risk of fatal overdose and facilitate targeted intervention. Our findings underscore the importance of comprehensive law enforcement approaches that extend beyond drug enforcement to integrate prevention, linkage to treatment, and harm reduction strategies as needed to address the overdose epidemic. [ABSTRACT FROM AUTHOR]

Aiming to problems of high drug shortage possibility and rupture of liquidity caused by serious liquidity occupied in drug supply chain of public hospitals in China, this paper discusses effectiveness about application of Inventory Pooling theory in this section. Employing Vensim software of system dynamic, the paper establishes 2 simulation models of whole process from drug demand to supply involved by patients, hospitals, distributors and manufacturers in traditional mode and the Pooling mode respectively. By quantitative comparison and analysis, it is proved that Inventory Pooling could be an effective method to improve performance of drug supply chain in China, especially in cutting down shortage possibility and reducing liquidity occupied. [ABSTRACT FROM AUTHOR]

Objective: To identify health care-related factors associated with online pharmacy use by considering patients' prescription drug insurance coverage, number of prescriptions, health care expenditures, types of medications purchased, and health status. Methods: Data were obtained from the Agency for Healthcare Research and Quality's 2002-2010 Medical Expenditure Panel Survey. Online pharmacy users were compared with nonusers across study variables in unadjusted and adjusted comparisons using logistic regression. Survey weights were applied to generate nationally representative estimates. Results: A total of 443 online pharmacy users were identified, representing an average of 1.5 million individuals per year. Online users were found to be older and to have more prescriptions compared with nonusers, as well as to have higher health care expenditures and higher Charlson comorbidity index scores. Online users were also more likely to be privately insured, white, and married, and to be more educated. In logistic regression models, higher prescription expenditures (odds ratio [OR] 1.17 [1.05-1.32]), higher number of prescriptions (OR 5.13 [1.4-19]), medium to high income (OR 1.82 (1.3-2.5)], and use of erectile dysfunction drugs (OR 2.09 [1.06-4.10]) were associated with greater odds of online pharmacy use. Black race (OR 0.47 [0.3-0.72]), Medicaid insurance coverage (OR 0.23 [0.1-0.5]), and use of narcotic medications (OR 0.72 [0.53-0.97]) were associated with decreased odds of online pharmacy use. Conclusion: This study showed that age, race, income level, insurance coverage, high health care expenditures, and higher number of prescriptions are predictors for online pharmacy use. [ABSTRACT FROM AUTHOR]

The ability to fairly and justly distinguish between drug possession for personal use and drug possession for supply is a central feature of drug laws across the globe. Whether such distinctions pertain to decriminalisation of simple possession, or to the penalties associated with drug offences, such differentiation remains a core problem for policymakers. In this commentary, taking 91 different jurisdictions into consideration, we identify five different approaches to distinguishing personal use from supply: four of these involved quantification of an amount of drug (whether in weight or number of doses). The other approach relied on case-by-case judgement. Drawing upon survey data of drug use from nine countries, we provide an example of how the quantity bears little resemblance to drug use patterns, and does not take heterogeneity of drug use into account. While the non-quantified approach can lead to discriminatory and racialised policing, all of the quantification approaches also pose problems, largely concerned with arbitrary amounts. There appears to be no perfect way to differentiate possession for personal use from intentions to supply. This commentary opens up a number of important policy-relevant research questions given this central feature of drug policy design. [ABSTRACT FROM AUTHOR]

Abstract: Critics of the international drug-control regime contend that supply-oriented policy interventions are not just ineffective, but, in focusing almost exclusively on supply reduction, they also produce unintended adverse consequences. Evidence from the world heroin market supports their claims. The balance of the effects of policy is yet unknown, but the prospect of adverse consequences underlies a central paradox of contemporary supply-oriented policy. In this paper, we evaluate whether harm reduction, a subject of intense debate in the demand-oriented drug-policy community, can provide a unifying foundation for supply-oriented drug policy and speak more directly to policy goals. Our analysis rests on an extensive review of the literature on harm reduction and draws insight from other policy communities’ disciplines and methods. First, we explore the paradoxes of supply-oriented policy that initially motivated our interest in harm reduction; second, we consider the conceptual and technical challenges that have contributed to the debate on harm reduction and assess their relevance to a supply-oriented application; third, we examine responses to those challenges, i.e., various tools (taxonomies, models, and measurement strategies), that can be used to identify, categorize, and assess harms. Despite substantial conceptual and technical challenges, we find that harm reduction can provide a basis for assessing the net consequences of supply-oriented drug policy, choosing more rigorously amongst policy options, and identifying new options. In addition, we outline a practical path forward for assessing harms and policy options. On the basis of our analysis, we suggest pursuing a harm-based approach and making a clearer distinction between supply-oriented and supply-reduction policy. [Copyright &y& Elsevier]

Abstract: This study investigated the extent to which hydromorphone (HYD) choice and behavioral economic demand were influenced by HYD unit price (UP), alternative money reinforcement magnitude and post-session HYD supply. Heroin-dependent research volunteers (n =13) stabilized on buprenorphine 8mg/day first sampled two HYD doses (12 and 24mg IM, labeled Drug A [session 1] and Drug B [session 2]). In each of the final six sessions, volunteers were given access to a 12-trial choice progressive ratio (PR) task and could earn a HYD unit dose (2mg, fixed) or money ($2 or $4, varied across sessions), administered immediately after the work session. Before the PR task, volunteers were told which HYD supplemental dose (none, Drug A or B) would be available 3h after receiving the PR-contingent dose. PR-contingent HYD choice significantly decreased when $4 relative to $2 was concurrently available. Information about the post-session HYD supplement moderated this effect: when subjects were told a supplemental dose was available, HYD-seeking behavior decreased when the money alternative was smaller ($2), but this information did not further attenuate HYD choice, which was already low, when the money alternative was higher ($4). HYD demand elasticity was only increased by the $4 relative to $2 alternative without the HYD supplement. In summary, opioid-seeking behavior is influenced by the availability of concurrent non-drug and drug alternatives. These findings show that drug availability and non-drug alternatives interact to modulate drug-seeking behavior. [Copyright &y& Elsevier]

Abstract: Behavioral economic analysis has been used to investigate factors underlying drug consumption in laboratory animals and, increasingly, in human drug abusers. However, there are few studies in heroin abusers, especially those who are not in treatment; such studies may be valuable for understanding the mechanisms of persistent drug use. This study investigated effects of unit price (UP) and pre-session supply of hydromorphone (HYD) on choice and consumption of HYD. Heroin-dependent research volunteers (n =13) stabilized on buprenorphine 8mg/day completed this eight-session inpatient study. In sessions 1–2, participants sampled two total HYD doses (12 and 24mg IM) that could be earned in later sessions. In each of the final six sessions, volunteers were given access to a 12-trial choice progressive ratio schedule lasting 3h. On each trial, volunteers could earn a HYD unit dose (1 or 2mg, for a maximum of 12 or 24mg, respectively) or money ($2, for a maximum of $24). Fixed ratio requirements increased exponentially, generating 24 unit prices for behavioral economic analysis. Before some choice sessions, volunteers could choose (FR 1) to receive extra HYD (12 or 24mg; at 0915), whereas on other days no supplement was available. HYD choice and peak responding (breakpoint, O max) measures increased with unit dose, decreased with pre-session supplements, and were greater among volunteers who used cocaine prior to the experiment. Taking pre-session supplements decreased P max and made group-percent HYD consumption more demand-elastic. Consumption was functionally equivalent at differing FR/unit dose combinations. Thus, opioid demand in heroin-dependent individuals not in treatment is a function of drug supply, unit price, and cocaine use. [Copyright &y& Elsevier]

Abstract: Genetically identical explants of the New Zealand marine sponge Mycale hentscheli were cultured in two different habitats at 7 m depth using subsurface mesh arrays to determine the effect of environment on survival, growth and biosynthesis of the biologically active secondary metabolites, mycalamide A, pateamine and peloruside A. Two 27 cm3 explants were excised from each of 10 wild donor sponges at Capsize Point, Pelorus Sound. One explant from each donor sponge was grown in arrays next to the wild donor sponge population for 250 days, while the second explant from each donor was translocated and grown at 7 m at Mahanga Bay, Wellington Harbour for 214 days. Growth rate measured by surface area and survival of explants was monitored in situ using a digital video camera. Explant surface area correlated positively with blotted wet weight (r 2 =0.93). The mean concentration of each of the three compounds was determined analytically from 1H NMR spectra of replicate 30-g samples from each of 10 donor sponges at the start of the trial, and compared to mean concentrations in donors and explants at the end of the trial. Phenomenal growth rates were achieved for explants both at Capsize Point (3365±812%, 95% CI) and Mahanga Bay (2749±1136%, 95% CI). Explant survival was high: 100% at Capsize Point and 90% at Mahanga Bay. Wild donor sponges regressed in size and experienced 40% mortality by the end of the trial. Mycalamide A was present in relatively high concentrations in donors and explants throughout the trial. Pateamine was more variable among individuals and was present at lower concentrations in Capsize explants at the end of the trial. Peloruside A was highly variable among wild donor sponges. Only 50% of donors contained detectable concentrations of peloruside A, and only those sponges and their explants grown in their native environment at Capsize Point continued to biosynthesise peloruside A. No explants at Mahanga Bay contained peloruside A after 214 days in culture, indicating the production of this compound may be environmentally controlled. Our results demonstrate that in-sea aquaculture of M. hentscheli is a viable method for supply of mycalamide A, pateamine and peloruside A, and that environmental conditions may be critical for the biosynthesis of peloruside A. Furthermore, results show the potential to establish cultivars to maximize peloruside A yield. [Copyright &y& Elsevier]

Abstract: Objective:: To examine whether a reduction in the availability of heroin in New South Wales (NSW) in 2001 was associated with community level changes in heroin and other drug use. Method:: Data from the NSW Alcohol and Drug Information Service (ADIS) on the number of persons calling about different drug types were used to examine NSW trends in calls of concern about heroin and other drugs. ADIS is a 24-h telephone information and counselling service in NSW; data from ADIS has previously been shown to be related to trends in drug use. Data from an inner Sydney needle and syringe program on drugs injected by clients were also used to examine time trends among a sentinel group of injecting drug users (IDU). Time series analysis was used to model the series. Results:: There was a significant reduction in calls regarding heroin associated with the reduction in heroin supply. Increases in calls about cocaine and methamphetamine were also associated with the heroin shortage. The reduction in calls about heroin appeared to be sustained, whereas the increases in calls about cocaine and methamphetamine were not. Conclusions:: Decreases in heroin supply were associated with sustained decreases in the use of heroin at a community level. Substitution of other drugs probably occurred among some users, such substitution did not appear to be sustained, as the number of calls returned to pre-shortage levels. Implications:: Drug supply reduction may lead to increases in use of other drug types. The health implications of such changes need to be borne in mind by law enforcement and health services. [Copyright &y& Elsevier]

Abstract: Background: : This paper uses a unique event, the Australian heroin shortage, to see whether an abrupt, substantial and sustained change in heroin supply had different effects on harms related to heroin use among younger and older heroin users. Method: : Indicator data were examined by age group on the number of persons entering treatment for heroin and amphetamine dependence, arrests for heroin use/possession and number of drug related deaths in NSW, Australia. Data were analysed using times series analysis. Results: : There was a 41% reduction in the number of new registrations for opioid pharmacotherapy per month among 25–34 year olds, and a 26% reduction among 15–24 year olds, but no apparent changes among older age groups. Similarly, reductions in the number of non-pharmacological heroin treatment episodes were most pronounced among younger age groups. There was a 49% reduction in the number of heroin possession/use offences among those aged 15–24 years, compared to declines of 31–40% among older age groups. Declines in heroin related deaths were greatest among 15–24 year olds (65% reduction). There was no change in other drug related deaths in any age group. Conclusions: : A reduction in heroin supply was followed by greater reductions in heroin related harms among younger than older people, across a number of outcome domains. [Copyright &y& Elsevier]

Abstract: Background:: In early 2001, Australia experienced a sudden, dramatic and sustained decrease in heroin availability that was accompanied by sharp increases in price and decreases in street level purity—the so-called “heroin shortage”. These unprecedented changes occurred in a context of widespread treatment availability, which made it possible for the first time to examine the impact of a sharp reduction in heroin supply in New South Wales (NSW) on entry to and adherence with treatment for heroin dependence. Given the evidence of drug substitution by some users, the current paper also examines the effects of the shortage on entry to treatment for other forms of drug dependence. Methods:: Interrupted time-series analysis of the number of persons entering opioid pharmacotherapy and other treatment modalities in NSW for heroin dependence and for the treatment for other types of drug dependence. Findings:: The heroin shortage was associated with a reduction in the number of younger persons entering opioid pharmacotherapy. There was a dramatic decrease in the number of persons entering heroin withdrawal or “assessment only” treatment episodes. There appear to have been small improvements in adherence to and retention in heroin treatment after the reduction in heroin supply. Relatively small increases were observed in numbers being treated for cocaine dependence. Conclusions:: In the context of good treatment provision, a reduction in heroin supply appeared to produce modest improvements in intermediate outcomes. Supply and demand reduction measures, when both are implemented successfully, may be complementary. [Copyright &y& Elsevier]

Abstract: At the end of 2000, in Sydney, Australia, there was a dramatic reduction in heroin availability. This study examines how health agencies treating clients for drug and alcohol related issues were able to respond to the changes that took place in their clients and their treatment needs. Key informant interviews were conducted with 48 staff from a wide range of health services in Sydney to provide the data for a thematic analysis. Changes experienced by health agencies included changed patterns of drug use in their clients, increased aggressive incidents, changed numbers of clients accessing treatment services, and a need for more assistance from outside agencies. A strong evidence base for a range of drug treatment options, support of staff development in aggression management skills, and development of good interagency links between mental health, drug and alcohol, and law enforcement services would make health services better prepared for future changes in the drug use of their clients. [Copyright &y& Elsevier]

Background: The legalization and regulation of currently illicit drugs has come to the forefront of drug policy debates in recent years, particularly in the context of cannabis legalization and the opioid crisis in North America. However, sufficient granularity on the various aspects of a legally regulated drug supply is missing from these debates. Further, the voices and opinions of people who use drugs have generally been absent from drug law reform deliberations. This study aimed to examine the views of people who use drugs and who are deeply impacted by drug policies to understand the perceived impacts and role of government under a legalized-regulated market.Methods: Four focus groups were held with people who use drugs in Sydney, Australia.Results: Most participants supported various models of legalization, although the perspectives on these models were diverse. Overriding these views was skepticism over the government's role in regulating a legal market, as well as concern for the personal agency of people who use drugs under a medically regulated drug supply model. Some participants discussed potential harms (e.g. increases in use and initiation), but emphasized the benefits (e.g. increases in quality and safety) from legal reform.Discussion: While there was support for legal models of drug supply regulation, findings have major implications in terms of how governments and medical systems may perpetuate the oppression of people who use drugs through regulation, and urge future drug policy deliberations to include broader perspectives from the affected community. [ABSTRACT FROM AUTHOR]