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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]

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 and aims Electronic tracking systems (ETS) are used extensively in pharmacies across the United States and Australia to control suspicious sales of pseudoephedrine. This study measures the impact of one ETS-Project STOP-on the capacity of police to reduce production, supply and possession of methamphetamine. Design Using official police data of incidents of production, supply and possession from January 1996 to December 2011 ( n = 192 data points/months over 16 years), we used a quasi-experimental, time-series approach. Setting The State of Queensland, Australia. Participants No individual participants are included in the study. The unit of analysis is reported police incidents. Measurements The study examines the impact of the ETS on production ( n = 5938 incidents), drug supply and trafficking ( n = 20 094 incidents) and drug possession or use ( n = 118 926) of methamphetamine. Findings Introduction of the ETS in November 2005 was associated with an insignificant decrease ( P = 0.15) in the production of methamphetamine. The intervention was associated with a statistically significant increase in supply incidents ( P = 0.0001). There was no statistically significant effect on the incidence of possession ( P = 0.59). Conclusions Electronic tracking systems can reduce the capacity of people to produce methamphetamine domestically, but seem unlikely to affect other aspects of the methamphetamine problem such as possession, distribution and importation. [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]

Objectives Drug shortages have risen steadily in the USA. Systemic antibiotics are most frequently in short supply raising concerns about public health safety and patient care. We sought to assess the prevalence and characteristics of systemic antibiotics in short supply as reported by federal agencies and private healthcare providers in the USA on 1 June 2011. Methods Data derived from the US Food and Drug Administration, American Society of Health- System Pharmacists and the Brigham and Women's Hospital. The units of analysis were active ingredient(s) and route of administration. Key findings Overall, 18 antibiotic active ingredients, with 20 routes of administration, were in short supply on 1 June 2011. The prevalence varied from 5.7% reported by the Food and Drug Administration and Brigham and Women's Hospital to 28.3% reported by the American Society of Health-System Pharmacists. Injectable antibiotics had the highest (28.3%) level of shortage. Shortages occurred because of problems with manufacturing (35.0%) and raw materials (15%.0), and for unknown reasons (45.0%). The average duration of the shortages was 591.7 ± 304.9 days. Conclusions Over one-fifth of the systemic antibiotics (one-quarter of the injectables) marketed in the USA were reported to be in short supply on 1 June 2011. One-half of the shortages were attributed to problems with manufacturing and raw materials although reasons for shortages are often unknown. [ABSTRACT FROM AUTHOR]

Background: Unprecedented drug shortages announced by the US Food and Drug Administration (FDA) have severely affected therapeutic access, patient safety, and public health. With continued shortages, patients may seek drugs online. Objective: To assess the prevalence of online marketing for current FDA shortage drugs and potential patient safety risks. Methods: We performed a descriptive study of the prevalence of online marketing for shortage drugs--that is, offers for sale of each drug, including characteristics of online drug sellers and intermediary sites marketing these drugs. Results: Of the 72 FDA shortage-listed drugs, 68 (94%) were offered for sale online. We found 291 offers for these drugs, the vast majority (n = 207, 71.1%) by online drug sellers selling direct to consumers. Intermediary sites included data aggregators (n = 22, 8%), forum links (n = 23, 8%), and personal page data links (n = 34, 12%), as well as Flickr social media links (n = 5, 2%), all advertising drugs without a prescription. Of the 91 online drug sellers identified, 31 (34%) had more than 1 shortage drug offered for sale, representing most (n = 148, 71%) of all online drug seller sales offers. The majority of these online drug sellers (n = 21, 68%) were on the National Association of Boards of Pharmacy (NABP) Not Recommended Sites list. Finally, for shortage drugs with an online drug seller (n = 58, 85%), 53 (91%) had at least one site on the Not Recommended list and 21 (36%) had only sites on the Not Recommended list. Conclusions: FDA shortage drugs are widely marketed over the Internet. Suspect online drug sellers and intermediaries dominate these sales offers. As a critical risk management issue, patients, providers, and policymakers should be extremely cautious in procuring shortage drugs through Internet sourcing. [ABSTRACT FROM AUTHOR]