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International audience; Substance abuse (SA) among children is a recognized challenge for policymakers and law enforcement and has life-threatening consequences owing to the impact on the children's development and the consequent increase in vulnerability. This work outlines several important issues related to SA among children: (1) SA prevalence including onset, common examples, extent, and spectrum of SA; (2) the presence of new psychoactive substances, which are rapidly spreading worldwide with limitations regarding their prevalence, detection, and interventions; (3) street children and their recruitment in drug supply; (4) SA and substance use disorder pathways, risk and protective factors for the development of SA; (5) SA consequences in the case of early initiation, including deaths; and (6) current preventive interventions for the pediatric population. In conclusion, this challenge requires consistent and unremitting attention in order to execute effective prevention programs with continuous re-evaluation of the situation.

The US government and private sector are committing billions of dollars to create more secure supply chains and bring a portion of that manufacturing capacity back home. Bob Roehr reports.

Despite awareness of the role of drug use in shaping sex worker/client interactions, these dynamics remain poorly understood in the context of illicit fentanyl-driven overdose epidemics. This study examined sex workers' experiences negotiating client interactions amidst a toxic drug supply in Vancouver, Canada. Findings draw from two ethnographic studies. The first, conducted between December 2016 and May 2017, examined the rapid implementation of several low-threshold supervised consumption sites. The second investigated experiences of women accessing a women-only site from May 2017 to June 2018. Data included 200 hours of fieldwork and in-depth semi-structured interviews with 34 street-based sex workers who use illicit drugs. Data were analysed thematically with attention to the risk environment. Participants described providing harm reduction services to clients as a means to reduce overdose-related risks, thus increasing sex workers' hidden labour. Participants, comments regarding criminalisation and stigma surrounding drug use and sex work indicated a reticence to report overdoses, thereby potentially increasing the risks of overdose-related harms, including death. There is an urgent need for sex worker-led overdose prevention strategies that prioritise health and safety of sex workers and their clients with specific attention to how the criminalisation of particular drugs, practices and people contributes to overdose-related risks.

International audience; ObjectiveEpilepsy is a chronic condition treatable by cost‐effective antiepileptic drugs (AEDs), but limited access to treatment was documented. The availability and affordability of good quality of AEDs play a significant role in access to good health care. This study aimed to assess the availability, affordability, and quality of long‐term AEDs in Lao PDR.MethodA cross‐sectional study was performed in both public and private drug supply chains in urban and rural areas in Lao PDR. Data on AEDs availability and price were obtained through drug suppliers. Affordability was estimated as the number of day wages the lowest‐paid government employee must work to purchase a monthly treatment. Samples of AEDs were collected, and the quality of AEDs was assessed through Medicine Quality Assessment Reporting Guidelines.ResultsOut of 237 outlets visited, only 50 outlets (21.1% [95% CI 16.1‐26.8]) had at least one AED available. The availability was significantly different between urban (24.9%) and rural areas (10.0%), P = .017. Phenobarbital 100 mg was the most available (14.3%); followed by sodium valproate 200 mg (9.7%), phenytoin 100 mg (9.7%), and carbamazepine 200 mg (8.9%). In provincial/district hospitals and health centers, AEDs were provided free of charge. In other healthcare facilities, phenytoin 100 mg and phenobarbital 100 mg showed the best affordability (1.0 and 1.2 day wages, respectively) compared to carbamazepine 200 mg (2.3 days) and other AEDs. No sample was identified as counterfeit, but 15.0% [95% CI 7.1‐26.6] of samples were classified as of poor quality. SignificanceWe quantified and qualified the various factors contributing to the high treatment gap in Lao PDR, adding to diagnostic issues (not assessed here). Availability remains very low and phenobarbital which is the most available and affordable AED was the worst in terms of quality. A drug policy addressing epilepsy treatment gap would reduce these barriers.

Background: While antiretroviral therapy (ART) has markedly increased survival in people living with human immunodeficiency virus (PLHIV), emerging trends of co-existence of non-communicable diseases (NCDs) and HIV could negate the gains already achieved in controlling HIV. Aim: The study aimed to determine the prevalence of hypertension and diabetes mellitus in PLHIV on ART in Gweru district. Setting: Six high-volume ART sites in Gweru district under Midlands province in Zimbabwe. Methods: This was a cross-sectional study. Screening and data collection occurred over a 3-month cycle when all patients were expected to have visited the ART sites for their monthly ART drug supply. The process also allowed the identification of health system challenges regarding data management for HIV-NCD comorbidity. Poisson regression analysis was used to calculate NCD prevalence ratio (PR) in PLHIV. Results: Nearly 18 000 PLHIV registered for ART were identified. Hypertension (19.5%) and diabetes mellitus (8.4%) were the most common NCDs identified with a high proportion of those who did not know their diagnosis (over 50%). The prevalence of hypertension and/or diabetes mellitus among women was 74.9% compared to 25.1% in men (PR 3.22; 95% CI: 3.07–5.51, p = 0.0000). Other factors associated with increased prevalence of hypertension and/or diabetes mellitus were age group of ≥ 60 years (PR 2.5; 95% CI: 1.42–3.22, p = 0.00023), and duration of ≥ 5 years on ART (PR 6.4; 95% CI: 4.70–8.01, p = 0.0011). Separate data collection for NCDs and HIV was a key challenge affecting quantification of magnitude of HIV-NCDs comorbidity and subsequently management of NCDs in PLHIV. Conclusions: Indications of increasing prevalence of NCDs in PLHIV call for integrated electronic data management for HIV, TB and NCDs. This will allow active NCD case finding, and eventually improve prevalence data and treatment for HIV-NCD comorbidity. Future studies should focus on the health experiences and access to treatment in PLHIV diagnosed with NCDs; and to establish the accurate manner in which HIV status, ART and NCDs might be associated, through conducting a case control or cohort study.

Background U.S. research examining the illicit drug supply remains rare even though the information could help reduce overdoses. Relatively little is known regarding how often opioids are found in stimulants and whether temporal and geographic trends exist. We examined trends in fentanyl-cocaine and fentanyl-methamphetamine combinations in the national illicit drug supply. Methods We analysed serial cross-sectional data from the National Forensic Laboratory Information System (NFLIS) collected between January 2011 and December 2016. We restricted the analysis to cocaine (N = 1,389,968) and methamphetamine (n = 1,407,474) samples and calculated proportions containing fentanyl (including 23 related analogs) over time. Results The combined presence of fentanyl and cocaine steadily increased nationally between 2012–2016 (p = 0.01), and the number of such samples tripled from 2015 to 2016 (n = 423 to n = 1,325). Similarly, the combined presence of fentanyl and methamphetamine increased 179 % from 2015 to 2016 (n = 82–n = 272). Patterns varied widely by state; in 2016, fentanyl-cocaine samples were most common in New Hampshire (7.2 %), Connecticut (5.4 %), Ohio (2.6 %) and Massachusetts (2.1 %), whereas fentanyl-methamphetamine samples were most often in New Hampshire (6.1 %), Massachusetts (5.6 %), Vermont (2.4 %) and Maine (1.2 %). Conclusions Although relatively uncommon, the presence of fentanyl in the stimulant supply increased significantly between 2011 and 2016, with the greatest increases occuring between 2015–2016; the presence of these products was concentrated in the U.S. Northeast. Given these trends, strengthening community-based drug checking programs and surveillance within the public health infrastructure could help promote timely responses to novel threats posed by rapid shifts in the drug supply that may lead to inadvertent exposures.

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

Improving the drug supply for children is one of the priority areas of the development of the Russian healthcare service. The article presents a multi-vector marketing analysis of the national paediatric antibacterials market. The objects of the research included the state register of medicinal products and data from DSM Group marketing agency. It was found that a significant (45%) share of medicinal products (MP) of J01 Group Antibacterials for systemic use, which is formed mainly by beta-lactam products and fluoroquinolones, is provided by the foreign manufacturers. At the same time, the medicinal products in the form of tablets (33%) and powders for preparation of solution for injection (26%) account for the maximum share in the assortment profile. Analysis of the proposal with a breakdown into age restrictions showed that only 24% of the assortment of authorized medicinal products are allowed to use for children aged less than 3 years old. It has been shown that the reproduced MPs currently cover 76.3 and 90.9% of the antibacterials sales pattern in value and physical terms, respectively. At the same time, the renewal index of J01 Antibacterials for systemic use was 2% over the past 5 years. Assessment of the assortment using the multidimensional method of Boston Consulting Group showed that 70% of items within the studied category of drugs are characterized by insignificant investment attractiveness, which is largely determined by the risks of product life cycle reduction in the settings of the development of bacterial resistance. The main parameters and characteristics of the assortment of J01 Antibacterials for systemic use market demonstrate the prospects for expanding the assortment portfolio of the Russian manufacturers due to drugs in the form of children's dosage forms that meet modern pharmacotherapy concepts in paediatrics.

Today in Russia, a new paradigm in building a healthcare system is being created - a value-oriented approach to treating each patient - with the aim of achieving high quality medical care in conditions of limited funding of healthcare system. An effective system of drug provision of patients forms the basis for the quality of medical services. The article presents a review of the medicine assistance schemes at the federal level. The data have been acquired from marketing agencies, as well as reports from the executive authorities of the Russian Federation for 2014-2017. Against the background of the positive dynamics of GDP in 2017 (+ 1.5% compared 2016), the amount of funding for the «Healthcare» expenditure section decreased by 13%. In recent years, the centralized expensive drug procurement system has been noted to be formed in the field of medicine assistance schemes. In the period from 2014 to 2017, the budget allocation for the provision of essential drugs (ED) saw a 12.5% increase. At the same time, the share of people who receive free drugs is only 21.6%, the rest of the patients prefer a cash payment. The high-priced nosologies program (about 50%) holds the leading place in terms of financial investments. In Russia, the drug supply system is built on the basis of optimization of resources, so it seems promising to find successful models of interaction between the state and the population at different levels in the segment of medicine assistance schemes.

The fast-growing list of possible treatments for the novel coronavirus includes an unlikely candidate: famotidine, the active compound in the over-the-counter heartburn drug Pepcid On 7 April, the first COVID-19 patients at Northwell Health in the New York City area began receiving famotidine intravenously, at nine times the heartburn dose Unlike other drugs the 23-hospital system is testing, including Regeneron’s sarilumab and Gilead Science’s remdesivir, Northwell kept the famotidine study under wraps to secure a research stockpile before other hospitals, or even the federal government, started buying it “If we talked about this to the wrong people or too soon, the drug supply would be gone,” says Kevin Tracey, a former neurosurgeon in charge of the hospital system’s research

Coincident with the opioid epidemic in the United States has been a dramatic increase in the number of children born with neonatal abstinence syndrome (NAS), a form of withdrawal resulting from opioid exposure during pregnancy. Many research efforts on NAS have focused on short-term care, including acute symptom treatment and weaning of the infants off their drug dependency prior to authorizing their release. However, investigations into the long-term effects of prenatal opioid exposure (POE) on brain development, from the cellular to the behavioral level, have not been as frequent. Given the importance of the perinatal period for human brain development, opioid-induced disturbances in the formation and function of nascent synaptic networks and glia have the potential to impact brain connectivity and cognition long after the drug supply is cutoff shortly after birth. In this review, we will summarize the current state of NAS research, bringing together findings from human studies and preclinical animal models to highlight what is known about how POE can induce significant, prolonged deficits in brain structure and function. With rates of NAS continuing to rise, particularly in regions that already face substantial socioeconomic challenges, we speculate as to the most promising avenues for future research to alleviate this growing multigenerational threat.

Pharmacy is a place to sell and sometimes make or mix drugs. A pharmacy is also a place where pharmacists practice the pharmaceutical profession. Many patients complained that the available drugs are incomplete, because the system used is still manual, in this case still using the ledger format to see the available drug supplies. In this case, problems in the drug data collection system and drug inventory data collection are sometimes constrained in determining the stock and the amount of drugs available at the pharmacy. Therefore it is necessary to conduct an evaluation study to collect data on the supply of drugs in hospital pharmacies in order to identify the cause of out of stock and drug supply in hospital pharmacies, determine the amount in stocking of drugs and determine Production Correction Factors for each drug submitted by the manufacturer. To overcome this problem, we need an application or desktop-based system that can evaluate and determine the available inventory at hospital pharmacies. The methodology used in the development of this information system is the Spiral method, which Spiral model is one form of evolution that uses the natural iteration method which is owned by the prototyping model and combined with the systematic aspects developed with the waterfall model. Entities contained in this information system are suppliers, pharmacists, patients and leaders. &nbsp, Apotek adalah tempat menjual dan kadang membuat atau meramu obat. Apotek juga merupakan tempat apoteker melakukan praktik profesi farmasi.Banyak pasien yang berkeluh kesah karena obat yang tersedia kurang lengkap, karena sistem yang dipakai masih manual yaitu dalam hal ini masih menggunakan format buku besar untuk melihat persediaan obat yang ada. Dalam haltersebut menyebabkan masalah pada sistem pendataan obat dan pendataan persediaan obat kadang terkendala dalam menentukan stok dan banyaknya obat yang tersedia di apotik tersebut. Oleh karena itu perlu diadakan kajian evaluasi pendataan persedian obat di apotik rumah sakit dalam rangka mengidentifikasi penyebab terjadinya kehabisan stok dan persediaan obat di apotik rumah sakit, menentukan banyaknya dalam menyetok obat dan menetapkan Faktor Koreksi Produksi bagi masing-masing obat yang diserahkan oleh produsen. Untuk mengatasi masalah tersebut, maka dibutuhkan sebuah aplikasi atau sistem berbasis desktop yang dapat mengevaluasi dan menentukan persediaan yang tersedia di apotik rumah sakit. Metodologi yang digunakan dalam pengembangan sistem informasi ini adalah metode Spiral, yang mana Spiralmodel adalah salah satu bentuk evolusi yang menggunakan metode iterasi natural yang dimiliki oleh model prototyping dan digabungkan dengan aspek sistimatis yang dikembangkan dengan model waterfall. Entitas yang terdapat dalam sistem informasi ini yaitu Supplier, apoteker, pasien dan pimpinan. &nbsp

Background and importance Drug shortages pose an enormous challenge to healthcare systems globally. However, the data available are limited, as there are 53 surveys in the literature and only 54.7% (29) contain any information regarding the prevalence of drug supply issues. Aim and objectives Our aim was to develop a questionnaire based on the available surveys and collect evidence of drug shortages in Hungarian hospitals. Material and methods With an extensive literature search between 1 and 15 April 2019, we identified the relevant surveys and questionnaires, and then developed a Hungarian version with 45 questions categorised into 5 main sections: (1) institutional data and demographics; (2) prevalence and background; (3) management of drug shortages; (4) information sources; and (5) consequences of drug shortages. Data were collected between 15 May and 30 June 2019, with an online survey among hospital pharmacists. Results A total of 42 hospital pharmacist completed the survey: 36 women and 6 men, mainly >36 years of age (73.8%), from various institutions and scope of activities. We found that 52.4% experienced drug shortages more than 10 times in the past 6 months. The top five ATC groups included B (blood and blood forming organs (52.4%)), C (cardiovascular system (50%)), L (antineoplastic and immunomodulating agents (47.6%)), J (anti-infectives for systemic use (38.1%)) and N (nervous system (38.1%)). Active pharmaceutical ingredients highlighted were immunoglobulins, digoxin, sodium ferric gluconate, phytomenadione, idarubicin and amoxicillin/clavulanic acid. Original and generic drugs, and parenteral and oral dosage forms were equally affected. According to 53.7% of participants, drug shortage situations usually lasted for months. The main reasons noted were manufacturing problems (66.7%), tendering processes (54.8%) and raw material supply problems (52.4%). Serialisation was also mentioned (16%) as a cause of drug shortages. Conclusion and relevance This is the first time a drug shortage survey focusing on Hungary has been completed. The data and tendencies collected were mainly in accordance with results of previous surveys and global tendencies. However, a new finding is that drugs belonging to ATC group B were affected the most by supply disruptions in Hungary. In addition, this is the first time that serialisation was linked with drug shortages in a survey. References and/or acknowledgements No conflict of interest.

This paper provides an overview of the current global market and manufacturing landscape for hydroxychloroquine (HCQ). The capacity and capabilities of global producers to meet the potential demand for treating patients inflicted with COVID-19 by the novel corona virus SARS-CoV-2, should HCQ's efficacy be established by more definitive clinical trials, is also assessed. Given the large existing manufacturing base and abundance of raw materials for HCQ, the supply challenge can be met with considerable efforts and international cooperation. Preemptive and coordinated emergency efforts among global governments, regulatory agencies, chemical and pharmaceutical industries are imperative for meeting the potential surge in demand.

In efforts to combat organised crime, police forces have adopted variations on the pulling levers approach to individuals and groups identified with gun crime, drug supply and other serious offences. Once identified, those individuals and their networks are targeted for interventions from criminal justice agencies and their partners. When levers are pulled, criminals find their lives made intolerable by the attentions of multiple agencies. Identifying the right people for this sort of attention and the quality and currency of police intelligence are, then, key concerns for such strategies. But the choice of levers, and their implications also raise some difficult questions. The law is explicitly applied differently to those associated with organised crime than to anyone else. This paper reviews evidence from two ethnographic studies, one of police officers in three police forces in England and Wales, the other from a third-party policing arrangement in the Danish night-time economy. We seek to understand the ways in which levers are understood and used, raising questions about the efficacy of pulling levers.

Despite the positive changes in the regulation of the accordance of benefits at the federal and regional levels, this problem has not been sufficiently studied so far in the area of organizational and legal interaction between civil and military healthcare. The current order of drug supply to certain categories of citizens attached to military medical organizations results in an unjustified expenditure of resources and an increase in the burden on healthcare, which indicates the irrationality of the existing mechanisms of drug supply. In this regard, it is necessary to develop rational economic and pharmaceutical mechanisms, as a set of methods for managing and interacting the entities that determine the order of drug supply for certain categories of citizens, while optimizing the financial, information and material resources of military and civilian healthcare. Theoretical approaches to the formation of rational economic and pharmaceutical mechanisms of drug supply are presented. Rational economic and pharmaceutical mechanisms of drug supply of certain categories of citizens attached to military medical organizations have been substantiated and developed. The characteristic of integration and coordination mechanisms of interaction of military and civil health on drug supply of certain categories of citizens in a single legal space is given. As the basic mechanisms of coordination of interaction are given: information exchange; standardization; direct supervision. The results of an assessment of sound and developed rational economic and pharmaceutical mechanisms of drug supply in the areas of organizational, social and economic efficiency are presented. It is noted that the implementation of the mechanisms of drug supply in the system of preferential drug supply can contribute to the formation of a system of drug supply balanced with the available resources of the country’s population; the formation of economic and social responsibility at each level of decision-making; the optimization of transparency and controllability of financial flows; the optimization of the financial burden on the federal, regional and departmental budgets; the equal access to medicines for all categories of citizens; guaranteed drug supply to socially vulnerable groups of the population.

This article explores recent developments within the U.K. drug market: that is, the commuting of gang members from major cities to small rural urban areas for the purpose of enhancing their profit from drug distribution. Such practice has come to be known as working “County Lines.” We present findings drawn from qualitative research with practitioners working to address serious and organized crime and participants involved in street gangs and illicit drug supply in both Glasgow and Merseyside, United Kingdom. We find evidence of Child Criminal Exploitation (CCE) in County Lines activity, often as a result of debt bondage; but also, cases of young people working the lines of their own volition to obtain financial and status rewards. In conclusion, we put forward a series of recommendations which are aimed at informing police strategy, practitioner intervention, and wider governmental policy to effectively address this growing, and highly problematic, phenomenon.

Investigational tobacco products, specifically variable nicotine content research cigarettes (SPECTRUM), are available through the National Institute of Drug Abuse Drug Supply Program. Randomized controlled trials using research cigarettes are intended to support tobacco regulatory science research. The current paper provides an in-depth look into managing research cigarettes for two multi-site clinical trials and the design of a computer-based Cigarette Management System (CMS). The paper provides guidance intended for any investigator using similar products on the operating procedures under Good Clinical Practice standards and describes features of the CMS. The CMS and procedures described have been field tested for the past three years and have dispensed over 160,000 cigarette packs to participants. The CMS can accommodate a range of practical issues with real-world study implementation making it a robust application that is scalable to any study.

This article reviews data on the assessment of the incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA, arthropathic psoriasis), as well as related disability and the economic burden of these nosological entities, including their therapy with biological agents. It considers the issues of organization and quality of medical care, drug supply, normative and legal regulation. The paper also shows the important epidemiological and socioeconomic importance of RA, AS, and PsA in Russia, points out the regional peculiarities of medical care and drug provision, and proposes solutions for their optimization at the federal and local levels. In preparing this investigation, the authors have taken into account the opinions of many specialists and experts in this field from different subjects of the Russian Federation.

Pharmacy is the basic entity for the provision of pharmaceutical care. Its work is one of the factors that determine the population health in modern society. In order to identify the role of pharmacy in the system of public health protection a sociological study of the views of physicians (N=343), as an intermediate consumer of pharmaceutical care, was conducted. The study covered various aspects of the pharmacies’ work and identified the problems in the field of the population drug supply. Pharmacy is perceived by the medical community as a specialized organization that performs certain functions: dispensing of preferential medicines to separate categories of citizens, selling of medications with low prices and a wide range, production of medicines. Until now there is no integrated approach to the professional interaction between physician and pharmaceutical professional.

The problem of road traffic injuries is one of the prioritized social, medical and technological problems all over the world. The timeliness of medical care provision is of great social and economic importance. In recent years, more attention is paid to the development and improvement of drug provision, which is essential in saving lives of victims in road accidents (road accidents). The aim of our study is the development of new approaches to needs identification and creation of balanced drugs list for provision emergency medical care to victims of road traffic accidents. Methods. A visualization framework, allowing to solve the task, is the development of an intellect card "Drug Provision of Victims in Road Traffic Accidents" which makes it possible to systematize and summarize the large content of research related to planning and identification of needs. As s result, the efficiency of financial resources disbursing increases, the time for the drugs systematization and the medical standards analysis reduces. The results. The intellect card consisting of four stages: the problem study of medical assistance organization to the victims of road traffic accidents, analysis of drugs efficient use in providing medical assistance, efficient choice of drugs, method development of requirement estimation in drugs and financial resources was created. Conclusions. The results of the intellect card creation pointed necessity and relevance of new drugs list formation, regulated drug provision to the victims of road traffic accidents. Organizational steps and work criteria with the standards of rendering emergency medical care, requirement estimation in necessary medications were proposed.

Aim. To compare antiplatelet activeness of the original clopidogrel and its generic, and to evaluate the routine practice of antiplatelet drugs intake by clinically stable patients aiming prevention of atherothrombosis.Material and methods. Total number of patients that have been taking clopidogrel: 186, of those at outpatient stage 54 on original clopidogrel, the rest 132 on generic. Adenosindiphosphate-induced activeness was measured in two groups (n=57) taking consequently Plavix and Clapitax before replacement of the drug and 14 days after.Results. At interchange of the drug in group 1 (Clapitax to Plavix) and group 2 (Plavix to Clapitax) the grade of achieved effect remained, and in group 2 it showed additional non-significant decrease. Adverse events related to antiplatelet therapy were not registered. At in-patient stage, 117 patients had an interchange of the drug (incl. several times) of original clopidogrel to its various generics (n=65), and vice versa (n=52), that was related to a range of routine reasons, of those patient and relatives preferences, specifics of drug supply in a clinic.Conclusion. The found equal residual reactivity of the platelets after Clapitax and Plavix intake in two groups witness on therapeutical equivalence of the drugs.

Planning and procurement which are parts of management drug supply give the biggest effect on drug inventory and hospital’s cost. This study aimed to describe planning and procurement systems in Pharmacy Department of Muntilan Regional Public Hospital in year 2015–2016. Study was conducted by comparing the real drug management supply indicators with standard indicators. This study was conducted on December 2016 untill February 2017. Data was collected using retrospective approach for secondary data including data of finance, drug procurement and use; as well as primary data collected by interview with hospital director, and heads of pharmacy and finance department. Data was analyzed using descriptive technique. The result showed that drug management had not been fully in accordance with the standards. It was indicated from 7 measured indicators, one of them had been in accordance with the standard which was percentage of available fund compared with cost planned. The other 6 indicators had not been in accordance with the standard: percentage of drug procurement with fund allocation, percentage of drug item planned compared with the using, percentage total quantities of a drug item with the using, the procurement frequency of each drug item, frequency uncompleted of orderlist/contract, frequency of delayed rate in payment by hospital, and indicators that can’t be measured are proportion of the quantities of products actually recieved out of total quantities planned, and percentage of quantities used out of total quantities available for consumption after deduction of buffer stock.

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

“Import-from-Canada” strategies to address high prices for patented pharmaceuticals are gaining momentum in the United States. In the first two months of 2019 alone, five congressional bills incorporating such strategies were introduced; these bills have attracted bipartisan support across the fractious American political divide. At the same time, Canadian lawmakers continue their long-standing failure to take action in response to the looming threat of having Canada’s drug supply siphoned off by its more powerful neighbour. Unregulated bulk importation of pharmaceuticals originally intended for the Canadian market into the USA would lead to severe drug shortages that would undermine the Canadian health system, while also halting emerging moves towards universal Canadian pharmacare in their tracks. At the same time, this short-term approach to tackling American pricing woes would fail to heal the deep systemic issues that underpin unaffordable drug prices in the USA. This article underscores the need for Canada to take action to protect its supply of patented medicines, and suggests possible forms such action might take.

OBJETIVO: Identificar y cuantificar la prescripción potencialmente inapropiada (PPI) y otros problemas en la prescripción de medicamentos en los servicios públicos de atención médica en un estudio poblacional en los tres niveles de complejidad existentes en México. MÉTODOS: Análisis descriptivo del Estudio de Satisfacción de Usuarios del Sistema de Protección Social en Salud 2014–2016, sección de prescripción y surtimiento de medicamentos, para obtener la prevalencia de PPI en adultos mayores (≥ 65 años) con base en listados Beers, STOPP, Prescrire y BSP mediante indicadores de prescripción en AM, uno por cada listado. RESULTADOS: Al 67% de los AM se les prescribió al menos un medicamento, con una media de 2.7 medicamentos por receta. La prevalencia de PPI fue del 74% según los criterios BSP, del 67% según el listado STOPP, del 59% con los criterios Beer y del 20% con Prescrire. Las prescripciones PPI más frecuentes fueron los AINES, vasodilatadores y las sulfonilureas. CONCLUSIONES: El uso de PPI en AM es alto en México. La mayor prevalencia encontrada en este estudio puede ser reflejo de la utilización de una fuente con representatividad poblacional. La utilización parcial y adaptaciones de los criterios dificultan la comparabilidad entre estudios, sin embargo, los criterios STOPP son los que más altas prevalencias han presentado debido a que abarca un mayor número de medicamentos y su uso más habitual en el primer nivel de atención

Background Opioid overdose deaths in the United States continue to rise, with the majority of deaths involving fentanyl. Drug checking has been used in Europe and Canada to assess adulteration of the illegal drug supply, but faces legal barriers in the United States. We are presenting information from a pilot mobile program offering drug checking services to participants of a harm reduction program in Chicago, Illinois, USA. Methods Drug checking services were provided at five mobile outreach and one fixed-point drop-in location in Chicago, IL, between March 2019 and August 2020. Three technologies were used: a Fourier transform infrared spectroscopy (FTIR) spectrometer, a handheld high-pressure mass spectrometer (HPMS), and immunoassay fentanyl test strips (FTS). We report on results generated by this combination of technology during the study period. Results During the study period, 422 total samples were tested, the majority of which were sold as dope/heroin (66.7 %). Of the 282 samples sold as dope/heroin, 12.8 % matched to fentanyl on the FTIR, 47.5 % had fentanyl identified on the HPMS, and 57.8 % produced a positive FTS. Conclusions This pilot program demonstrated the feasibility of using three technologies to assess for the presence of fentanyl in user-submitted samples, revealed discordant results from the technologies, and provided information on the local drug market.

Understanding Scotland’s illegal drug market continues to challenge social scientists. Most evidently neglected are processes related to social supply, from supplier perspectives. When analyzing il...

A study was conducted in Kaduna State Nigeria to ascertain the impact of Drug Supply and laboratory services towards effective functioning of DOTS system. Six DOTS providing centres were identified for the study and in each centre, three respondents were selected based on their profession, the Medical Officer, the Pharmacist and the Laboratory Technician totaling 18. The officers were interviewed for the purpose of the research. Semi structured Interviews were conducted in this research as a means of obtaining Health workers perspective. The Interview which was conducted in their respective work station was open ended and all questions are same for all respondents. During the course of the study, all respondents agreed that the sources of drugs supply to their respective centres was the Kaduna State Tuberculosis and leprosy control Program office from the state capital and that drugs are been supplied quarterly and are adequate with slight interruption due to Logistic while for Laboratory services the respondents were of the view that there is the need to improve on it as there are cases of shortage of reagents and erratic supply of Electricity for effective Laboratory functioning.

The pharmaceutics, as well as public health in general, was not a top priority area of government funding during the reconstruction period in the USSR. The search for resources to solve public healthcare and public drug supply problems and the objective to overcome the deficit of drugs led to some radical changes in the pharmaceutical sector: introduction of economic accountability, changes in the terms of trade in pharmaceuticals, centralized management of the pharmaceutical industry and heavy regulations, improving the quality control over manufactured pharmaceutical products.

Background: We report the results from the advanced malignant mesothelioma (aMM) expansion cohort of the PEMBIB phase Ib trial (NCT02856425) evaluating the safety, efficacy & biomarkers of an antiangiogenic TKI (nintedanib = [N]) with an anti-PD1 immunotherapy (pembrolizumab = [P]). Methods: Patients (Pts) with aMM that relapsed after at least one line of platinum-based combination were treated with a combination of oral [N] (150mg BID) & IV [P] (200mg Q3W) with 7 days [N] lead-in preceded [P] initiation. Baseline and on-treatment fresh tumor & blood samples were prospectively phenotyped immune cells by flow cytometry (FC). RNAseq was run on tumor samples. Immune factors were titrated by multiplex ELISA on tumor secretome and plasma. Results: 30 aMM Pts were treated and 29 evaluable for response. Median age was 68 years old (38-85) and 86% of aMM were epithelioid. The most frequent adverse events (AE) (grades 1-3) related to the combination were liver enzymes increase, fatigue, nausea and diarrhea. 4 (13.3%) Pts developed grade 3-5 immune- related AE. Patients died of cancer progression (n=14), myocarditis with thrombo-embolic event (n=1) and COVID-19 (n=1). Median follow-up was 14.8 months (95%CI [9.70-18.2]). Best Overall Response Rates (BORR) were Partial Response (PR;n=7), Stable Disease (SD;n=17) and Progressive Disease (PD;n=5). Disease Control Rate (DCR) (defined as PR + SD) was 68.4% and 46.6% at 3 and 6 months, respectively. Analyses on fresh tumor biopsies showed that all patients increased their CD3+ T-cells and circulating levels of soluble PD1 and CXCL9 under treatment. Pts developing PR had significantly higher CD45+ and CD3+ tumor infiltrative cells at baseline compared to Pts with SD & PD as BORR. Pts with DCR at 6 months had significantly higher expression of integrins on circulating effector memory CD4+ & CD8+ T cells by FC, and higher NK, T, and myeloid dendritic cells infiltrates on baseline tumor RNAseq. Pre & on-treatment IL6 and IL8 levels in tumor secretome & plasma were higher among Pts with PD. Conclusions: With a BORR of 23% and a DCR of 47% at 6 months, [P]+[N] combination provided valuable therapeutic benefits for Pts with aMM. Flow cytometry and secretome on fresh baseline tumor biopsies are simple techniques which could be used to predict treatment efficacy in aMM Pts. Clinical trial identification: NCT02856425. Legal entity responsible for the study: Gustave Roussy. Funding: Funding: Boehringer Ingelheim;Drug supply: Boehringer Ingelheim & MSD;Sponsor: Gustave Roussy. Disclosure: C. Baldini: Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Personal, Invited Speaker: BMS;Financial Interests, Personal, Invited Speaker: AstraZeneca;Financial Interests, Institutional, Research Grant: Seattle Genetics;Financial Interests, Institutional, Research Grant: Iteos;Financial Interests, Institutional, Invited Speaker: Tahio;Financial Interests, Institutional, Research Grant: BMS. N. Chaput: Financial Interests, Institutional, Research Grant: AstraZeneca;Financial Interests, Institutional, Research Grant: BMS;Financial Interests, Institutional, Research Grant: GSK;Financial Interests, Institutional, Research Grant: Roche;Financial Interests, Institutional, Research Grant: Sanofi;Financial Interests, Institutional, Research Grant: Cytune Pharma. G. Zalcman: Financial Interests, Personal, Invited Speaker, outside the submitted work: BMS;Financial Interests, Personal, Invited Speaker, outside the submitted work: MSD;Financial Interests, Personal, Invited Speaker, outside the submitted work: AstraZeneca;Financial Interests, Personal, Invited Speaker, outside the submitted work: Boehringer Ingelheim;Non-Financial Interests, Personal, Advisory Board, outside the submitted work: Roche;Non-Financial Interests, Personal, Advisory Board, outside the submitted work: Takeda;Non-Financial Interests, Personal, Advisory Board, outside the submitted work: AstraZeneca;Non-Financial Interests, Personal, Advisory Board, outside the submitted work: AbbVie. C. Massard: Non-Financial Interests, Personal, Advisory Role: Amgen;Non-Financial Interests, Personal, Advisory Role: Astellas Pharma;Non-Financial Interests, Personal, Advisory Role: AstraZeneca;Non-Financial Interests, Personal, Advisory Role: Bayer;Non-Financial Interests, Personal, Advisory Role: BeiGene;Non-Financial Interests, Personal, Advisory Role: BMS;Non-Financial Interests, Personal, Advisory Role: Celgene;Non-Financial Interests, Personal, Advisory Role: Debiopharm Group;Non-Financial Interests, Personal, Advisory Role: Genentech/Roche;Non-Financial Interests, Personal, Advisory Role: Ipsen;Non-Financial Interests, Personal, Advisory Role: Janssen;Non-Financial Interests, Personal, Advisory Role: Lilly;Non-Financial Interests, Personal, Advisory Role: MSD;Non-Financial Interests, Personal, Advisory Role: Novartis;Non-Financial Interests, Personal, Advisory Role: Pfizer;Non-Financial Interests, Personal, Advisory Role: Sanofi;Non-Financial Interests, Personal, Advisory Role: Orion;Non-Financial Interests, Personal, Advisory Role: Taiho Pharmaceuticals;Non-Financial Interests, Personal, Advisory Role: Blueprint Medicinces;Non-Financial Interests, Personal, Advisory Role: Innate Pharma;Non-Financial Interests, Personal, Advisory Role: PharmaMar;Non-Financial Interests, Personal, Advisory Role: Faron Pharmaceuticals. J-C. Soria: Financial Interests, Personal, Stocks/Shares: AstraZeneca;Financial Interests, Personal, Stocks/Shares: Gritstone Oncology;Financial Interests, Personal, Stocks/Shares: Relay Therapeutics;Financial Interests, Personal, Member of the Board of Directors: Hookipa Pharmaceuticals;Financial Interests, Personal, Full or part-time Employment, sept 2017 to dec 2019: AstraZeneca. A. Marabelle: Financial Interests, Personal, Invited Speaker: Roche/Genentech;Financial Interests, Personal, Invited Speaker: BMS;Financial Interests, Personal, Invited Speaker: Merck Serono;Financial Interests, Personal, Invited Speaker: AstraZeneca;Financial Interests, Personal, Invited Speaker: Amgen;Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Personal, Invited Speaker: Servier;Non-Financial Interests, Personal, Principal Investigator: Roche/Genentech;Non-Financial Interests, Personal, Principal Investigator: BMS;Non-Financial Interests, Personal, Principal Investigator: MSD;Non-Financial Interests, Personal, Principal Investigator: Pfizer;Non-Financial Interests, Personal, Principal Investigator: Lytix Pharma;Non-Financial Interests, Personal, Principal Investigator: Eisai;Non-Financial Interests, Personal, Principal Investigator: AstraZeneca;Non-Financial Interests, Personal, Principal Investigator: Tesaro;Non-Financial Interests, Personal, Principal Investigator: Chugai;Non-Financial Interests, Personal, Principal Investigator: Ose Immunotherapeutics;Non-Financial Interests, Personal, Principal Investigator: Sotio;Non-Financial Interests, Personal, Principal Investigator: Molecular Partners;Non-Financial Interests, Personal, Principal Investigator: IMCheck;Non-Financial Interests, Personal, Principal Investigator: Pierre Fabre;Non-Financial Interests, Personal, Principal Investigator: Adlai Nortye;Financial Interests, Personal, Stocks/Shares: Pegascy SAS;Financial Interests, Personal, Stocks/Shares: Centessa Pharmaceuticals;Financial Interests, Personal, Stocks/Shares: HiFiBio;Financial Interests, Personal, Stocks/Shares: Shattuck Labs;Financial Interests, Institutional, Research Grant: Merus;Financial Interests, Institutional, Research Grant: BMS;Financial Interests, Institutional, Research Grant: Boehringer Ingelheim;Financial Interests, Institutional, Research Grant: Transgene;Financial Interests, Institutional, Research Grant: Fondation MSD Avenir;Financial Interests, Institutional, Research Grant: Sanofi. All other authors have declared no conflicts of interest.

Background Fentanyl test strip (FTS) programs are designed to promote fentanyl awareness and reduce overdose risk by providing people who use drugs (PWUD) with a method of testing drugs for the presence of fentanyl prior to use. In 2018, two large syringe services programs (SSP) in the U.S. Mid-Atlantic—one in Baltimore City, Maryland and one in the state of Delaware—began distributing FTS. We evaluated the implementation of these programs. Methods A convenience sample of SSP clients was surveyed in Baltimore City (urban) and Delaware (urban, suburban and rural) to assess FTS utilization patterns and drug use behaviors. Data were collected and analyzed in 2019. Results We surveyed N = 123 PWUD in Baltimore and N = 102 in Delaware. Collectively, 20,000 strips were distributed over six months. In both locations, high FTS utilization was reported (70% in Baltimore; 77% in Delaware) and clients reported testing a range of drugs including heroin, fentanyl and cocaine. Following utilization, 23% and 69% of respondents in Baltimore and Delaware adopted risk reduction behaviors (e.g., using less than intended, going slower, doing tester shot, asking someone to check on them). When asked about their level of interest in future FTS use, 49% and 74% reported being interested or very interested, respectively. Conclusion Our findings demonstrate that FTS programs could be helpful in promoting fentanyl awareness and risk reduction among PWUD and in monitoring the evolving drug supply in areas where comprehensive community-based drug checking programs have not been established.

Vor zwei Jahren fand die erste Befragung substituierender Ärztinnen und Ärzte zu ihren Erfahrungen mit der 3. Verordnung zur Änderung der Betäubungsmittel-Verschreibungsverordnung (BtMVVÄndV) statt. Diese Befragung war Bestandteil der Evaluation der 3.