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The Australian Capital Territory (ACT), a region that includes Australia's capital, Canberra, decriminalised small-scale cannabis cultivation and possession in January 2020. Here, we examined cannabis use and cultivation behaviours, experiences and attitudes of current and past small-scale ACT cannabis cultivators. ACT residents (n = 311) who currently cultivate or have previously cultivated cannabis completed a cross-sectional online survey ('CAN-ACT') and provided home-grown cannabis for phytocannabinoid analysis (optional). Reasons for cultivation included a preference for home-grown cannabis to self-supply, enjoyment of the process and avoiding criminal networks. Cannabis intake was a median of 1 gram on a typical day used and the number of plants grown per year was a median of 4. Various cultivation challenges were identified, most commonly mould, nutrient deficiency and spider mites. Cannabis samples (n = 71) generally exhibited moderate THC content (mean 8.99 ± SEM 0.51% [w/w]) and low CBD content (< 0.1%). Few samples exceeded contaminant guidelines for heavy metals or pesticides. Respondents identified various grey areas in current legislation that might lead to inadvertent criminal activity, and many (52%) remained anxious about arrest. In general, recent legislative changes appear to support community needs. Options for further legislative refinement are discussed. [ABSTRACT FROM AUTHOR]

The right to freedom of thought represents as fundamental a human interest as do rights like privacy and dignity. However, unlike these rights, freedom of thought has received comparatively little attention. This paper seeks to redress this by arguing for an expansion of what freedom of thought entails. Specifically, it argues that freedom of thought should be understood as entailing 'cognitive liberty', which has both a positive and a negative dimension. The positive dimension entitles one to self-determine the contents and processes of one's thoughts (that is, to control one's own brain chemistry); while the negative dimension protects one from direct and non-consensual interventions into one's mental states (whether done by a state or a third party). This expansion of freedom of thought is increasingly necessary as both our understanding of the human mind and our capacity to interface with it expand. This is established by reference to two case studies: the injustice of international drug policy, and the potential of neurotechnology. In each case, the focus is on how cognitive liberty, if taken seriously, creates radical new possibilities for regulation. Specifically, it can facilitate drug policy that is just and bring coherence to the regulation of neurotechnology. [ABSTRACT FROM AUTHOR]

Recent research on the potential therapeutic value of psychedelic substances has led to changes in media representation and drug policy in some U.S. states. Yet, little is known about lay perceptions of these substances. The current study aimed to describe health perceptions of psychedelic substances, test differences in perceptions of therapeutic vs. recreational use of psychedelic substances, and determine if such perceptions vary by use experience. Participants (N = 309) completed an online within-subjects experiment in which they responded to measures of positive and negative perceptions of therapeutic and recreational use of psychedelics. Endorsement of positive and negative health perceptions of psychedelics was moderate to strong. Recreational use was perceived as having more negative health consequences, while therapeutic use was perceived as having more positive health consequences. Participants who reported lifetime psychedelic use (40.7%) perceived both recreational and therapeutic uses as having more positive health consequences, and this pattern was consistent across most perception domains. The outcomes suggest that public perceptions of use may change based on reason for use. This information may aid in filling current gaps in knowledge and identifying potential targets for public health communications, and such approaches may benefit from considering prior use experience. [ABSTRACT FROM AUTHOR]

Background: The issue of veterinary pharmaceutical expiration is a significant concern in animal health facilities globally. The existence of veterinary pharmaceutical expiration can be mainly associated with inadequate inventory control, store management, and a lack of effective pharmaceutical regulatory policies and guidelines. Hence, the study aimed to evaluate expired veterinary pharmaceuticals' scope, economic impact, and contributing factors. Methods: A cross-sectional, explanatory sequential study design involving a mixed quantitative and qualitative approach was employed among 13 animal health facilities from March 2022 to December 2023 in and around Dessie town, South Wollo, Ethiopia. A key informant interview guide was used to retrieve the qualitative data that were analyzed through thematic content analysis. Then, the collected data were coded and analyzed using SPSS version 25. A mean score was used to determine the critical factors associated with veterinary pharmaceutical expiration. Results: The study found that the magnitude of expired veterinary pharmaceuticals in the fourth fiscal year was 7%. This wastage rate of veterinary pharmaceuticals led to a loss of approximately 69,564.54 USD. From expired veterinary pharmaceutical unit pack perspectives, approximately 403-unit packs (66%) expired in veterinary clinics, resulting in a loss of approximately 38,229.33 USD, and 209-unit packs (34%) expired in private veterinary pharmacies, incurring a loss of approximately 31,335.22 USD. From Anatomical Therapeutic Classification (ATC), antibiotics accounted for 14.8% of the total financial loss. Additionally, approximately 53% of liquid dosage forms were expired. The quantitative study identifies the lack of an information system and necessary software, poor store management, and lack of strict accountability as critical contributors to veterinary pharmaceutical expiration. Additionally, inadequate inventory management systems and a lack of adherence to established policies and guidelines for managing veterinary pharmaceutical expiration were the most vital contributors as key informants cited. Conclusion: The financial burden associated with expired veterinary pharmaceuticals exceeded the permissible threshold of 2%, indicating a significant concern for animal health budgets and the aquatic environment. This study underlines that the issue of veterinary pharmaceutical expiration is a critical problem that necessitates policy implications. To mitigate the expiration rate of veterinary pharmaceuticals, collaboration among multidisciplinary veterinary professionals, the Ethiopian Agricultural Authority, pharmaceutical supply chain agency, and researchers is essential. [ABSTRACT FROM AUTHOR]

In the midst of growing research and societal discourse on psychedelic substances, a consistent finding is reported: A majority of users report profound personal meaning from their experiences. This pioneering study in Sweden, a nation renowned for its strict drug policies, sought to quantify the extent of reported meaningfulness among Swedish psychedelic users. Results revealed that a majority of the sample, 58%, ranked their psychedelic experience among the top 5 most meaningful events in their lives, while 85% among the top 10. These findings align well with previous research from other types of studies and other countries. Participants acknowledged challenging and mystical aspects as part of their psychedelic experiences, and a large majority, 94%, reported positive life improvements. Factors such as a personal growth motive and supportive social networks were associated with improved well-being. Despite many study limitations, including the self-selected sample, self-reported measures, and cross-sectional design, the findings underscore the impact psychedelic experiences potentially can have on individuals’ lives. [ABSTRACT FROM AUTHOR]

There is growing recognition that our decades-long "war on drugs" has not only been a policy failure but has made our societal drug crisis worse. This is painfully evident in our response to the opioid epidemic. Efforts at comprehensive policy reform are likely to emerge first at the state and local levels. We collaborated with policy advocates and practitioners to study policy perspectives of registered Maine voters, and to investigate determinants of receptivity to drug policy reforms rooted in decriminalization and harm reduction. Our results suggest that while political ideology still impacts one's perspective on these issues, increased exposure to those with substance use disorder reduces stigma, resulting in increasingly broad, bipartisan support for policy reform. We conclude with a discussion on how policymakers addressing overdose and substance use disorder at the state and local level should consider implementing and funding evidence-based alternative approaches such as decriminalization and harm reduction. [ABSTRACT FROM AUTHOR]

Centralized drug procurement is a common practice worldwide to relieve the healthcare burden and promote high-quality development in the pharmaceutical industry. However, scholars have not yet reached an agreement on whether centralized procurement can facilitate the innovation activities of pharmaceutical firms. China's centralized volume-based procurement (CVBP) implemented in 2018 provides an ideal quasi-natural experiment to evaluate the effect of centralized procurement on the R&D investment of the firms. Drawing data from listed manufacturing firms in China's A-share market (2015–2020), the results from a difference-in-differences analysis with different model specifications indicate that the CVBP significantly promotes the pharmaceutical manufacturing firms' R&D investment. Moreover, the positive effect of the CVBP on R&D investment is stronger in pharmaceutical manufacturing firms with high marketing expenses. A series of robustness tests including the parallel trend test, placebo test, and the PSM-DID analysis show that our findings are solid. This paper advances our understanding of centralized procurement in emerging markets and provides new insights into how governments and pharmaceutical manufacturing firms can strengthen innovation. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: With the expansion of professional autonomy and prescriptive authority of advanced practice registered nurses (APRNs), interactions with industry are under greater scrutiny. As of July 1, 2021, pharmaceutical and medical device companies must publicly report all payments to APRNs through the Centers for Medicare and Medicaid Services' Open Payments website. Purpose: To gauge APRNs' familiarity with, and perceptions of the Open Payments database and discuss whether and how APRNs should respond. Methodology: Virtual workshops consisting of a didactic presentation and interactive exercises with APRNs recruited through professional networks, associations, and conferences. Transcripts were analyzed using a qualitative interpretive approach, grounded in an everyday ethics theoretical framework. Results: Thirty-six APRN clinicians, students, and faculty participated in nine workshops. Seeing sponsored meals reported in Open Payments as "payments" prompted participants to see familiar interactions in a new way. Participants valued the enhanced transparency as a way to identify risks of bias but were concerned that reporting might undermine public trust in APRNs. Emphasizing awareness as a precursor to action, participants desired greater preparation for ensuring independence in practice. Conclusions: The importance of tackling the ethical issues associated with industry interactions is heightened within the context of an existing climate of distrust within health care. However, many participants were concerned about the effects of transparency on public trust rather than how APRNs individually or collectively can be more trustworthy. Implications: Open Payments can serve as a useful tool to catalyze broader conversations about ethics, integrity in decision making, and health policy advocacy. [ABSTRACT FROM AUTHOR]

Background: The worldwide prevalence of inflammatory bowel disease (IBD) is increasing, with its potential evolution as a global disease and a consequent increase in its burden on healthcare systems. These estimates do not factor in the 'real' price of IBD, which, beyond curbing career aspirations, instilling social stigma, and impairing the quality of life in patients, could also significantly affect the environment. Aim: To highlight potential areas for intervention and develop management strategies aimed at minimising environmental impacts in the field of IBD over time. Methods: Various aspects of IBD care (organisation of IBD centres, diagnostics and therapeutics) are examined from an environmental sustainability perspective. Results: Each stage, from the patient's means of transport to the hospital to the physician's diagnostic and therapeutic decisions, contribute to CO2 and waste production. Strategies to contain the environmental impact are feasible. Some are easy to implement, such as ensuring the appropriateness of the diagnostic and therapeutic pathway for patients; others need to be implemented in synergy with healthcare providers' policies and pharmaceutical companies. Conclusions: With an inevitable increase in the number of patient visits, endoscopies, laboratory testing, and long‐term therapeutic strategies for IBD, the clinical community should be aware of environmental concerns and investigate possible strategies to reduce the environmental impact of IBD care. [ABSTRACT FROM AUTHOR]

The article discusses the regulation of psychedelics in the United States beyond the Controlled Substances Act, presenting a three-dimensional framework for characterizing policy options. It highlights the varying degrees of liberalization in psychedelic regulations at the city and state levels, emphasizing the need for guidance on non-medicalized uses and risk reduction practices. The framework categorizes psychedelic uses based on legality, therapeutic intention, and structure, providing a nuanced approach to analyzing and comparing different policy options. The article also reviews current non-federally regulated policy options to illustrate how the framework can be applied in practice. [Extracted from the article]

The journey of translating a molecular discovery into the clinic involves multiple steps and requires planning, time, effort, and money. In this review, we provide a quick guide on the technical and clinical validation parameters that are necessary for successful commercialization of molecular and other markers. We also briefly address the different options for regulatory approvals. Successful clinical implantation depends on rigorous technical and clinical validation, and the ability to develop clear guidelines for the indications for testing (i.e. which patients are eligible to have this test), the frequency of testing, and also a clear interpretation of test results. Successful implementation requires providing evidence that the results of this test can be used to improve patient care. There are currently multiple routes for implementation of clinical molecular tests, which include regulatory agency- approved companion diagnostics, laboratory developed tests, or direct-to-consumer testing. Regulatory approval is considered the gold-standard, but it requires time and resources. There is an ongoing debate about the need for regulatory approval of laboratory developed testing. Ongoing oversight is maintained through lab accreditation and proficiency testing programs, which provide a common approach to ensuring high standards and consistent performance in clinical molecular labs. Before moving into the clinic, confirmation of both the clinical and analytic validity of a new molecular test is essential. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodResultsDiscussionsDrug policies are shaped by the historical context in which substance use problems are embedded. Nonetheless, the views and published narratives of researchers and policymakers about the factors that drive substance use have not been subjected to formal analysis. By reviewing and characterizing the social–ecological themes represented in academic and policy literature in South Korea, we aim to identify opportunities for policy advancement.A scoping review was conducted in January 2024, in which academic literature was supplemented by ‘grey literature’ generated from official government documents. We included papers that discussed drivers of substance use using causal arguments or hypotheses. Two reviewers independently screened all papers for eligibility. After study selection, emerging concepts on substance use narratives were coded based on a social–ecological framework.We identified 219 academic documents and 19 from governmental data sources. Analysis of documents revealed a strong focus across both data sources on individual, rather than environmental or societal drivers of substance use behavior. Academic literature highlighted a purported link between medically prescribed opioid use in adolescents and suicidality. Government documents placed a bigger emphasis on social and global factors, such as drug trafficking, as drivers of substance use behavior.Academic documents were characterized by a lack of research on family, environmental, and societal drivers of substance use, reflecting the limitations of current substance use policies in South Korea. Research that addresses structural determinants of substance use is needed to guide coherent, evidence-based drug policy approaches. [ABSTRACT FROM AUTHOR]

Recreational cannabis legalization has become an unprecedented trend in the United States, arousing heated debates on its implications for public health. Legalizing access to recreational cannabis may shrink the illicit market as it could be a substitute for illicit substances—the substitution effect. Alternatively, recreational cannabis may serve as a gateway drug to illicit drugs and raise the risk of using illicit substances—the gateway effect. Using novel darknet transactional data along with public health databases, we add evidence to the debate by empirically investigating the impact of recreational cannabis legalization on illicit drug use and mortality. Capitalizing on a quasi-experiment opportunity in which U.S. states legalized recreational cannabis at different times, we found a significant increase in the mortality of illicit drug overdose, along with the initiation and use of illicit drugs after the policy, i.e., the gateway effect. This effect is evident in a significant surge of Bitcoin transactions on darknets—a major source of illicit drugs—after the policy. It is also particularly salient in states allowing higher dosage possession and lower excise taxes on recreational cannabis. Our study contributes novel data to address the public health debate and provide policymakers with timely regulatory recommendations on recreational cannabis legalization. [ABSTRACT FROM AUTHOR]

Background: The access to anti-cancer medications is influenced by policies formed via the convergence of various stakeholders. The aim of this study is to identify and analyse the stakeholders involved in formulating and implementing policies related to the accessibility of anti-cancer medications in Iran and their interactions that are relevant to the outcomes of these policies for the first time. Methods: To achieve the objectives, a novel multistage social network analysis (SNA)-based approach that includes three phases is proposed. First, the actors were identified by a team consisting of multidisciplinary knowledgeable experts through 15 comprehensive interviews. Then, the influence relationships of these actors were comprehensively analysed through in-depth interviews with nine key informants involved in pharmaceutical policies through a structured questionnaire. Finally, a novel network of actors was determined accordingly, and a SNA-based approach proposed to reveal the intrinsic roles and various aspects of the importance of the network's actors. Results: The study identified a total of 45 actors, which were then classified into 4 categories on the basis of their public or private nature and their foreign or domestic origin. This established network helped in creating a comprehensive view of the main actors, and can help policymakers to solve the problems related to access to anti-cancer medications more effectively and prevent the creation of these problems in the future. In this way, the network identified specific actors that can benefit from increased attention and dialogue. The computational results revealed that the Iran Food and Drug Administration (IFDA), Pharmaceutical Importer Companies (PharIc) and Pharmaceutical Manufacturing Companies (PharMC) were highly important actors in terms of their connectivity to other actors. Additionally, law enforcement agencies (LEA) have shown limited effectiveness within this network. Conclusions: This study highlights the importance of complex relationships among various actors and proposes a novel SNA-based approach to analyse them. Regarding the main steps of the proposed approach and the findings, it is imperative for pharmaceutical policy plans to involve a diverse group of experts from the beginning, prioritizing the preferences of stakeholders, and providing a patient-centred approach to prevent the worsening of resource shortages. [ABSTRACT FROM AUTHOR]

AbstractBackground: Prior to the U.S. Comprehensive Addiction and Reovery Act of 2016 (CARA) , policymaking on alcohol and drug use during pregnancy was more concentrated on alcohol than drug use policy - although the overlap between the two types of policy was high. Further, the highest levels of legislative activity were requirements to report pregnant women who used alcohol or other drugs and child abuse/neglect policy.Methods: This research brief uses rigorous legal epidemiology methodology to explore state policy activity on alcohol and other drug use during pregnancy after the U.S. Comprehensive Addiction and Recovery Act of 2016 (CARA) amended the 2010 Child Abuse Prevention and Treatment Act Reauthorization (CAPTA).Results: Since CARA, policymaking has been more concentrated on drug policy than alcohol policy, although the overlap between the two is still high. Further, since CARA, states have concentrated policy activity on priority treatment for drugs and reporting requirements.Conclusions: Even though CARA does not require reporting for the purposes of child welfare investigations, several states adopted such requirements during these years. [ABSTRACT FROM AUTHOR]

Background: Harm Reduction, conceptualized by Russell Newcombe in the late 1980s, has revolutionized how drug use, individuals who use drugs, and drug policies are understood globally. Emerging from the HIV/AIDS crisis, Harm Reduction sought to address the dire rates of drug-related infections and the overwhelming burden on healthcare providers. Early initiatives, such as Opioid Substitution Treatment (OST) and needle exchange programs, were met with resistance but gradually established new standards of care, transforming attitudes toward people who use drugs and prioritizing human-centered, rather than solely medical, approaches. Main body: This paper explores the evolution and expansion of Harm Reduction from an HIV/AIDS prevention strategy to a broader framework adopted across Europe. Although ideological barriers initially slowed adoption, Harm Reduction principles have gained acceptance, notably through EU policies promoting drug-related harm reduction and the United Nations' 2024 resolution. Through initiatives such as OST, needle exchange programs, drug consumption rooms, and drug-checking services, the European Union has demonstrated progressive success in reducing drug-related deaths and infectious diseases. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has supported this evolution by providing extensive data, scientific evidence, and policy recommendations that guide national approaches. More recently, advancements in hepatitis C treatment have created opportunities for improved health outcomes among individuals who use drugs, fostering their role as active partners in healthcare processes. Conclusion: Today's increasingly complex drug landscape, characterized by high substance availability, poly-drug use, and drug-related violence, necessitates a redefined approach to Harm Reduction. With the transformation of the EMCDDA into the European Union Drug Agency (EUDA), the agency's mandate now includes a proactive focus on anticipating, alerting, responding to, and learning from emerging drug-related challenges. Strengthening collaboration with civil society will be crucial in evolving Harm Reduction to meet future needs, ensuring that EU drug policies remain inclusive, adaptive, and aligned with the diverse realities faced by individuals who use drugs. [ABSTRACT FROM AUTHOR]

Summary Clinicians and people with narcolepsy report varied access to higher‐cost narcolepsy treatments in England associated with variations in national and local commissioning. There are no publicly available data quantifying use of these drugs to support policy decisions. We therefore aimed to describe national, regional and local prescribing trends for higher‐cost narcolepsy drugs using new national databases. We used the English prescribing dataset and secondary care medicines data to quantify volumes of high‐cost narcolepsy drugs issued between 01 January 2019 and 31 December 2022. Volumes were converted to World Health Organisation defined daily doses, to estimate the monthly number of defined daily doses of sodium oxybate, pitolisant and solriamfetol issued by each integrated care board and region. We compared national, integrated care board, and regional level issuance of each drug over time. Analysis of almost 6000 primary care prescriptions and 2000 cumulative months of secondary care pharmacy stock data, issued across 41/42 integrated care boards in England, revealed a 49.1% increase in issuance of high‐cost narcolepsy drugs between 2019 and 2022. In 2022, sodium oxybate accounted for 52.66% of issuance, pitolisant 43.09% and solriamfetol 4.25%, with 22.31% of defined daily doses issued in primary care. Three integrated care boards (NHS Southeast London, NHS Cumbria and North‐East, NHS Cheshire and Merseyside) predominate, issuing 56.33% of all defined daily doses. Variations between integrated care boards and regions differ substantially by drug and route of issuance. Our findings describe substantial variation in the use of specialist narcolepsy drugs in England, and highlight the untapped potential of using large, public domain datasets to publicly review higher‐cost drug prescribing. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus is a significant global public health burden. Although medication adherence is an inevitable consideration in managing and curing the disease, medication price is the major barrier to patients in Nepal, like any other low- and middle-income countries. Prescribing in brand-name inhibits the possibility of accessing cost-effective generic alternatives in Nepal. This study aimed to explore and examine price variations among the oral hypoglycaemic medicines (OHMs) available in the country and their distribution in various medicine-related characteristics. A cross-sectional study was conducted using a convenient sample of five tertiary care hospital pharmacies in Kathmandu, publicly accessible online pharmacy websites, and a government database to list the OHMs available in Nepal. The study determined price variations and statistically tested the association between these variations and the characteristics of the medicines. Fourteen OHMs were available as 57 generic medicine items with different formulations in Nepal. The maximum of 484.82% of price variation was found. Fourteen, fifteen and eighteen OHMs have variations of over 100%, more than 10 rupees and no price change, respectively. Except for Dipeptidyl Peptidase-IV (DPP-4) Inhibitors and Thiazolidinediones (TZDs), all other categories of OHMs have >100% of price variation in medicine items. Although Nepal itself produces most of the available OHMs, the available OHMs have price variations. Most fixed dose combinations showed no reduction in cost compared to their component medicine's mean price. This study presented and discussed the price variation scenario of OHMs with their medicine-related characteristics to develop and implement effective drug policies and programs that can address medication price-related issues to ensure access to OHMs without placing an economic burden on patients. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionWithin Hong Kong’s prohibitionist, abstinence-based approach to drug use and policy, frontline drug workers (FDWs) are the key point of contact between the state and People Who Use Drugs (PWUD). Adopting a street-level bureaucrat perspective, we examine the role of FDWs in implementing drug policy in Hong Kong.We conducted five focus groups (n = 17) with frontline drug workers (FDWs) to understand how they perceive their role in relation to the needs of PWUD, and their perceptions of the barriers to service provision.In responding to the needs of clients, FDWs engage in “moral improvization” wherein harm reduction principles inform practice. Their approach is shaped by Confucian values which center familial and social connections, and a liberal emphasis on personal responsibility, autonomy and self-control. FDWs locate barriers to the take up of services with personal characteristics of PWUD and with the abstinence macro-policy context.The findings reaffirm the importance of the “bottom up” perspective in drug policy and the role of values in shaping drug services. It furthers the idea that harm reduction is a pragmatic adaptive strategy which can be tailored to cultural contexts, with implications for the acceptability of harm reduction interventions in Hong Kong. [ABSTRACT FROM AUTHOR]

Background: Harm reduction for people who use drugs (PWUD) is an established evidence-based practice that encompasses a wide variety of services, delivery formats, and settings and has been named a priority in US drug policy. Harm reduction is focused on planning with communities and meeting PWUD where they are and encompasses a wide variety of interventions. We describe and report the feasibility, acceptability, and process implementation outcomes for an innovative pilot drug overdose harm reduction intervention, Block-by-Block (BXB), focused on training for and distribution of naloxone and test strips in areas identified as high risk for fatal overdoses. Case presentation: Beginning operations in 2022, BXB operates in five pilot sites in four Illinois counties. Through partnerships with local organizations, BXB delivers harm reduction services in a private setting (home) or in a setting not specifically focused on serving PWUD (businesses, libraries, faith-based organizations, etc.) to reach PWUD and their friends, family and neighbors living in areas disproportionately affected by opioid overdose death. The intervention theory is based on acknowledgement that harm reduction services that require PWUD to visit a mobile unit, van or community organization, may not reach those in need or their friends, neighbors, and family for a variety of reasons including stigma associated with drug use, lack of awareness about these services, or where to locate them. Services delivered include education and training in the use of naloxone and fentanyl, xylazine and benzodiazepine test strips. Leave behind materials include naloxone, test strips and handouts with information on the intervention and local resources. Conclusions: Results to date indicate that this intervention is feasible –over half (55%) of the doors approached were answered. Acceptability of the intervention as delivered is high --people at 75% of doors that were answered were interested in and received training and/or supplies. BXB is flexible in that it has been quickly adapted to changes in community conditions, the drug supply, and shifting high risk areas as they developed. This is a promising intervention that leverages available data and resources and is readily implementable in communities with support from a central program administrator and access to geo-coded data. [ABSTRACT FROM AUTHOR]

Background and aims: Injectable opioid agonist treatment (iOAT) is a valuable, patient-centred, evidence based intervention. However, limited information exists on contextual factors that may support or hinder iOAT implementation and sustainability. This study aims to examine existing research on iOAT using diacetylmorphine and hydromorphone, focusing on identifying the key barriers and facilitators to its successful implementation. Methods: A systematic search was conducted in the MEDLINE and PsycInfo databases (via Ovid) from inception to February 2024, supplemented by a comprehensive grey literature search. No restrictions were applied regarding publication type, year, or geographic location. Articles were independently screened by two reviewers. Eligible articles described the feasibility, implementation, and/or evaluation of iOAT in one or more countries, presenting perspectives on receiving, administering, or governing iOAT. Results: Forty-four publications were selected for inclusion. Barriers identified through thematic analysis included public acceptance concerns such as medication diversion, increased crime, and the Honey-Pot effect. Legal and ethical challenges identified involved enacting changes in law to make certain substances available as a medically controlled options for treatment, and addressing patient consent issues. Negative media coverage and public controversies were found to undermine acceptance, and high start-up costs especially for security, facility access, and economic feasibility were seen as additional obstacles. Regulatory barriers and stringent protocols were the most frequently cited limiting factors by patients and providers. Facilitators included the integration of trial prescriptions into comprehensive drug policy strategies and publishing data for evidence-based debates, together with ethics committees ensuring compliance with ethical standards. Developing information strategies and addressing opponents' claims improved public perception. Cost-effectiveness evidence was found to support long-term implementation, while flexible treatment protocols, inclusive spaces, and affirming therapeutic relationships were seen as important facilitators to enhance patient engagement and treatment effectiveness. Conclusions: Successful implementation of iOAT requires balancing political and social acceptability with scientific integrity, alongside strategic communication and public outreach. Further research is needed to enhance the transferability of findings across diverse socio-political contexts and address key influencing factors associated with iOAT programs. [ABSTRACT FROM AUTHOR]

Support for a human rights framework for drug policy has been growing for some years. This year, the UNODC published a chapter in the World Drug Report focussed on the right to health. In this paper, we draw attention to the conceptualisation of the right to health for people who use drugs. While one essential element is access to appropriate, high quality, and affordable healthcare, this needs to occur hand-in-hand with two other central components of the right to health – the right to conditions that promote health (the social, economic, legal, commercial, and cultural determinants of health) and the right to meaningful participation in healthcare decisions and in health policy. We consider these three components of a right to health against the current international drug control regime. More specifically we point to how the three drug conventions (1966 as amended 1972, 1971 and 1988) make explicit mention of the right to health. In this way, we argue that duties to respect, protect and provide the right to health for people who use drugs accrue through being a signatory to the drug conventions. Given that there does not appear to be international appetite to abandon the current treaties, and notwithstanding the strong impression that they reinforce a criminalisation approach to people who use drugs, the work herein may afford another avenue for effective advocacy about the right to health. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to assess the reimbursement policy for orphan drugs (ODs) in selected European countries in relation to the availability and impact of clinical evidence, health technology assessment (HTA) procedures and reimbursement decision-making. Materials and Methods: A list of authorized ODs was extracted from a web-based registry of the European Medicines Agency, including information on active substance, Anatomical Therapeutic Chemical (ATC) classification code, and therapeutic area. A country-based questionnaire survey was conducted between September 2022 and September 2023 among selected experts from 12 European countries. A descriptive and statistical analysis was performed to identify correlations between country characteristic, HTA procedures, drug indication and positive recommendations or reimbursement decisions for ODs. Results: Safety assessment for ODs was mandatory in 10 countries, while it was optional in one country (Italy) and not required in one country (Iceland). Efficacy assessment for ODs was mandatory in 11 countries and not required in one country (Iceland). The impact of safety and efficacy assessment on reimbursement decisions was rated as high in 10 countries and as low in one country (Germany). Dedicated OD legislation and policies were reported in seven countries. In two countries (Belgium, Iceland), the HTA was not mandatory, and in one country (Germany), it only had an informative function. A positive recommendation (from an HTA agency or advisory body) guaranteed reimbursement in four countries, while a negative recommendation excluded reimbursement only in one country (Iceland). The proportion of reimbursed ODs ranged from 23.5% in Iceland to 86% in Germany (p < 0.001). ODs with ATC code L represented the largest group of medicines (n = 49). They were also very frequently reimbursed ODs in the countries studied, with a mean of 61.8% (p < 0.001). Conclusion: European countries differ in terms of the impact of clinical issues and additional clinical aspects on the reimbursement policy for ODs. Reimbursement decisions were affected by OD-specific legislation, policies, and EMA authorization status. HTA dossiers and procedures significantly influenced reimbursement decisions, although some ODs were reimbursed regardless of the positive or negative recommendations. ATC codes were significantly correlated with reimbursement status and positive recommendation. [ABSTRACT FROM AUTHOR]

Background: Drug policies and interventions require an ongoing understanding of the local demand for illegal drugs. How illegal drugs are distributed to consumers is critical in the demand process. To overcome barriers to purchasing illegal drugs, people utilize their peers to purchase substances for them. These brokered drug sales allow buyers to leverage their peer networks to make purchases. For brokers, this form of exchange allows them to obtain drugs for free. This drug acquisition strategy is underappreciated in understanding how local drug market's function. Methods: This paper presents findings from a brief survey on brokering collected from a random sample (N = 241) of active illegal drug injectors recruited from two syringe services programs in Ohio, USA. Results: Findings indicate that 30-day and lifetime brokering behavior is common (71% and 90% respectively). Respondents who brokered in the last 30 days (n = 181) purchased drugs for an average of 7 people and from an average of 4 different sellers. Among this group, over 84% indicated that they used drugs with the person they brokered for, 49% reported often or always inflating the price to the buyer, and 27% indicated they removed some drug before returning to the buyer. Conclusion: Measuring brokering offers new insight on the dynamics of drug markets, how they operate, and ways to measure their activity. The demand for illegal drugs incorporates the increased use of a drug, changes in the use of different drugs, and/or a novel drug being used. Accessing drugs via brokering accommodates these dynamics. By including brokering in drug market activity, the concept and scope of illegal drug markets transform into networks and not places. [ABSTRACT FROM AUTHOR]

Background: In the early 2020s, Australian media and public health organizations described the rapid rise in youth e-cigarette uptake, portraying this as a "peer pressure" problem wherein vulnerable young people were being led or bullied into vaping by the "cool" kids. Yet, the peer pressure framing of vaping fails to account for young people's rituals of nicotine consumption and ways social drug economies are organized. Methods: In 2023, we conducted qualitative interviews and ethnographic research with 24 young people ages 17 to 25, both vapers and nonvapers, in New South Wales, Australia. We investigated their embodied experiences of vaping, observations of peers' vaping practices, and beliefs about vaping policy. We analyzed their accounts for themes and here report our findings, illustrated with participants' quotes and an ethnographic portrait of a Sydney high school vape seller. Results: The notion that young people are "pressured" into vaping lacked emic meaning for our participants. Their accounts reveal three ways that vaping is social beyond "pressure." First, social vape market offers entrepreneurial teens money-earning opportunities, mediated by social networks and markers of peer esteem, prestige, and trust. Second, vapes are exchanged as both gifts and commodities in sharing economies, offering social opportunities and scripts for recreational interactions. Third, e-cigarettes as material objects provide esthetic and gustatory pleasures that are both individually enjoyed and socially performed in rituals of taste and display. Discussion: These three perspectives on the sociality of vaping help nuance our understanding of how and why young people vape, and also suggest why public health outreach efforts may not be effective when they reduce youth vaping uptake to peer pressure. As youth vape use is on the rise in Australia, these perspectives matter for understanding this important social phenomenon and may help policy development move beyond simplifications of youth cultural motivations. [ABSTRACT FROM AUTHOR]

Objective: This study examined prescription trends for benign prostatic hyperplasia (BPH) drug therapy in Japan over the past decade, focusing on drugs rated as grade A according to Japanese clinical guidelines. Methods: Using the National Database Open Data, this study analyzed prescription data from the fiscal years of 2014 to 2021, tracking α1‐blockers, 5α‐reductase inhibitors, and phosphodiesterase type 5 inhibitors. We adjusted for demographics and calculated medication costs to determine prescribing patterns and changes in drug utilization. Results: Prescriptions for α1‐blockers increased from 9898 per 1000 males in 2014 to 12 613 in 2021. Prescriptions for 5α‐reductase inhibitors rose from 1441 per 1000 males in 2014 to 2310 in 2021. Tadalafil prescriptions saw a significant increase, from 900 in 2015 to 2520 in 2021. Despite these increases, the overall market size for BPH drugs decreased from 664 million dollars in 2014 to 279 million dollars in 2021, indicating a shift toward generic medications driven by healthcare policies. Conclusions: Although BPH medication prescriptions are increasing, driven by Japan's aging population and clinical guidelines, market dynamics are shifting owing to generic and government price adjustments. This analysis underscores the changing BPH treatment landscape in Japan, highlighting the importance of continuous evaluation of treatment efficacy and cost‐effectiveness in evolving healthcare policies and demographics. [ABSTRACT FROM AUTHOR]

Background: National pharmaceutical services units (NPSUs) – organisational units within the central government usually responsible for pharmaceutical services and management – have an increasingly narrow mandate. Anecdotal evidence points to an increasing focus, almost exclusively, on logistics management, while pharmaceutical care and policy oversight have become fragmented. This study examined NPSUs' current functions and mandates, and proposed what should be the critical functions and roles of these units going forward. Methods: Using case studies of Côte d'Ivoire, Kenya and Nepal, the study relied on a literature review and in-depth interviews. We triangulated and synthesised the findings to identify NPSUs by level in the health ministry's hierarchy and reporting line, mandate, and function. Results: We identified medicine regulation, procurement and supply chain management, selection and rational use of medicines, and pharmacy practice regulation as four broad sets of functions that NPSUs commonly have as their mandate. A clear position in the Ministry of Health's hierarchical structure, the legal or administrative framework that mandates an NPSU's functions, and national pharmaceutical policies and regulations to guide the pharmaceutical sector are three critical factors for effective functioning. It is essential to have a legislative framework that at a minimum identifies one NPSU as responsible for pharmaceutical policy and governance, serving as the steward for the pharmaceutical system. This role encompasses pharmaceutical system coordination and administrative functions, formulating and implementing policies for organising, managing, financing, regulating, monitoring, and evaluating the pharmaceutical system. As such, we recommend that NPSUs should at a minimum have four broad sets of functions: pharmaceutical policy and governance, medicine regulation, pharmacy practice regulation and procurement and supply chain management. Conclusion: The study substantiates the need for a pharmaceutical policy and governance unit that stewards the pharmaceutical system and is empowered to monitor and evaluate system performance and coordinate efforts for system strengthening. [ABSTRACT FROM AUTHOR]

Background: An explosion in a Chinese factory in 2016 caused a global shortage of essential broad-spectrum antibiotic piperacillin-tazobactam. Hitherto, no detailed, policy-relevant analysis has been conducted on this major shortage event. Thus, we aimed to (1) investigate causes; (2) describe supply chain challenges; and (3) uncover policy gaps to support possible mitigation actions. Methods: Applying an analytical framework for security of medical supply chains, we investigated the changing roles of Pfizer-led and Chinese API suppliers. We identified demand surge, capacity reduction and co-ordination failures. Triangulating between scientific literature, corporate, and regulatory documents, we analysed the impact of Western and Chinese policy contexts on supply chain resilience. Results: We uncovered 'red flags': geographically dispersed manufacturing failures due to complexity of sterile production; undetected supply chain concentration and interlinkages; and Chinese policy-led API supplier consolidation. We found these warning signals were ignored in the absence of a co-ordinated policy framework to identify and mitigate emerging global supply risks. Firstly, policy makers lacked visibility on growing 'volume dependency' in the chain. Secondly, national policy makers lacked a global view of supply risk. Thirdly, we show antibiotic API manufacturing economics were impacted by a number of non-pharmaceutical policy decisions (e.g. state aid, environmental standards, procurement rules) which contributed to supply chain vulnerability. Conclusions: Our findings suggest possible policy gaps in governance of supply chain resilience. Firstly, disclosure of API suppliers including degree of dependency may better pre-empt bottlenecks, facilitating priority setting for public investments in re-shoring where global API supply currently relies on few, or single plants; secondly, a whole-of-government approach may counter the potential impact of non-pharmaceutical policies on supply chain resilience. Our findings confirm suggestions from previous studies that international data sharing would be beneficial considering the global shortage effects which can emerge from a single point of failure. [ABSTRACT FROM AUTHOR]

Background: In recent decades, there has been an interest in clinical pharmacy practice in Türkiye with emerging studies in this area. Despite the recent emergence of diverse pharmacy practice studies in Türkiye, a comprehensive assessment of overall typology of studies and impact has not been conducted thus far. Objectives: This systematic review aims to document and assess pharmaceutical policy and practice literature published within the last 5 years in Türkiye. The other aim is to summarise the expected impact of published studies on policy and practice research. Methods: The systematic review was conducted according to the guidelines described in the PRISMA Statement. A comprehensive search approach, incorporating Medical Subject Headings (MeSH) queries and free-text terms was employed to locate pertinent literature related to pharmacy practice and policy in Türkiye. The search covered the period from January 1, 2019, to January 1, 2024, and involved electronic databases including PubMed, Medline Ovid, Scopus, ScienceDirect, Springer Link, PlosOne, and BMC. Results: In the final grouping, 73 articles met the inclusion criteria and were selected for this review. Among the quantitative studies, majority studies were cross-sectional survey studies. Through the rigorous thematic content analysis seven research domains were developed from the selected literature: drug utilisation and rational drug use, the emerging role of pharmacist, access to medicines and generic medicines, community pharmacy practice, pharmacovigilance/adverse drug reactions, and pharmacoeconomic studies. Conclusions: The pharmacist role is evolving; however, several challenges remain in fully realising the potential of pharmacists. These include regulatory barriers, limited public awareness of pharmacists' expanded roles, workforce capacity issues, and the need for ongoing professional development and training. Research studies are needed in the areas of generic prescribing, medicine adherence, intervention studies in community and hospital pharmacy practice, and on pharmacoeconomics and pharmacovigilance. [ABSTRACT FROM AUTHOR]

Background: South Africa's National Drug Policy (NDP) was first issued in 1996, at a time of considerable political change. Objectives: To revisit the lessons learned from the process of development and initial implementation of the NDP. Methods: Six in-depth face-to-face interviews were held with purposively-selected key actors. Interviews, which followed pre-determined semi-structured questions, but were allowed to explore additional areas, were recorded and transcribed, and then subjected to abductive thematic analysis, informed by the Walt and Gilson model. Results: Three key themes emerged, described as 'evidence', 'trust' and 'looking forward'. A paucity of evidence backed some of the key concepts in the NDP, and these have not been addressed as evidence has matured. The lack of trust which characterised the policy process impacted on the ways in which actors were able to or not able to engage, and therefore on the resultant content and the choices exercised. The coherence of the policy, its articulation with other health reforms, and its contribution to subsequent efforts to ensure universal health coverage in South Africa have all been weakened by the failure to revise the document over time. Conclusion: As South Africa advances its plans for universal health coverage, there is an urgent need to revisit key components of the NDP which are no longer fit for purpose. [ABSTRACT FROM AUTHOR]

Background: To reduce Medicare prescription drug expenditures, the 2022 Inflation Reduction Act (IRA) allows the Centers for Medicare & Medicaid Services (CMS) to directly negotiate with drug manufacturers on Medicare prices of high-expenditure drugs (≥$200m annual spending) which meet certain eligibility criteria. However, it is unclear what proportion of high-expenditure drugs covered by Medicare, and attributable annual drug spending, would typically be eligible for CMS negotiations in a given year. Methods: We used historical Medicare drug spending data to determine how many high-expenditure drugs, and attributable drug spending, would have been eligible for CMS negotiations had the IRA been in effect from 2016-2019, while also determining which of the IRA's eligibility criteria is most restrictive. Results: From 2016-2019, approximately one third (33.3% for Part B, 32.4% for Part D) of high-expenditure Medicare drugs would have been eligible for negotiation, with ineligible drugs accounting for 75.2% and 63.8% of spending on high-expenditure drugs in Medicare Part B and D, respectively. Most ineligible high-expenditure drugs were ineligible because they launched too recently. From 2016-2019, between 59 and 74 high-expenditure drugs were eligible per year, indicating that in some years there may not be enough eligible drugs for CMS to negotiate on the maximum number of drugs allowable by law. Conclusions: The IRA's current eligibility criteria may restrict CMS from being able to negotiate drug prices on approximately two-thirds of the high-expenditure drugs covered by Medicare and may not allow CMS to negotiate on the maximum number of drugs allowable by law. Congress could consider relaxing eligibility requirements for price negotiation, such as those pertaining to launch date recency, to ensure there are a sufficient number of high-expenditure drugs eligible for negotiation or make certain ineligible drugs contributing to significant annual Medicare spending eligible for negotiation on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Background: To guarantee uninterrupted service delivery, quality-assured products must be affordable and continuously available across all sectors, including the private sector, which provides more than 60% of healthcare services in Nigeria. We investigated the private sector availability and affordability of under 5 malaria commodities to establish the level of access in this sector. Methods: We surveyed patent medicine and pharmacy stores across seven states in Nigeria and the Federal Capital Territory to establish the availability and affordability of selected malaria commodities for children under 5 years. Availability was measured as the percentage of visited outlets with the product of interest on the day of visit, while affordability was assessed by establishing if it cost more than a day's wage for the least-paid government worker to purchase a full course of malaria diagnostic test and/or medication. Results: Artemisinin-based antimalarials for uncomplicated and severe malaria were the most available commodities. SPAQ1 and SPAQ2 used for seasonal malaria chemoprevention campaign were surprisingly also available in some outlets. However, only about half (48.3% and 53.3%) of the surveyed outlets had stock of artemether/lumefantrine (AL1) and artesunate injection, respectively. The median price of surveyed products ranged from USD (United States Dollars) 0.38 to USD 2.17 per treatment/test. Except for amodiaquine tablet and artemether injection, which cost less, all other originator brands cost the same or more than the lowest-priced generic. Antimalarial products were affordable as their median prices were not more than a day's wage for the least-paid government worker. However, when the cost of testing and treatment with artemisinin-based combination therapies (ACTs) was assessed, testing and treatment with dihydroartemisinin/piperaquine were unaffordable as the they cost more than 1.5 times the daily wage of the least-paid government worker. Conclusion: The overall private sector availability of under-five malaria commodities in surveyed locations was suboptimal. Also, testing and treatment with recommended ACTs were not affordable for all surveyed products. These findings suggest the need for interventions to improve access to affordable under-five malaria commodities. [ABSTRACT FROM AUTHOR]

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

This paper studies the channel strategies of drug suppliers in the drug supply chain under the zero‐plus drug pricing policy. With the popularity of e‐commerce and online shopping, supply chain firms have begun considering expanding their business to online channels. In this paper, we construct a game model to explore the impact of the pharmaceutical supply chain's development of online channels on supply chain members. We conclude that under the zero profits policy, increasing the public hospital's public welfare level will increase the price of drugs, decrease the price of medical services, and reduce the overall cost of patients. In addition, the greater the sensitivity of medical services, the lower the likelihood that a drug supplier will open an online pharmacy, and the lower the level of public good, the greater the likelihood that a drug supplier will open an online pharmacy. In addition, under certain conditions, patients can receive a higher level of medical service and spend less on healthcare under a dual‐channel strategy. Finally, under a dual‐channel strategy, an appropriate profit‐sharing mechanism can eliminate instability in the pharmaceutical supply chain. [ABSTRACT FROM AUTHOR]

The British model of harm reduction has been referenced as a pioneering approach to substance use in Europe. While many have described the development of UK drug policy through different governments, few studies have focused on the role that drug user activists played in the UK drug policy reform movement. We examine the different conceptualisations of UK drug user activists in literature, including published academic journals and grey literature (news articles, podcasts, websites and unpublished dissertations). We describe the different conceptualisations of 'the drug user activist' based on chronological periods relevant to drug policy, namely: Pre-Misuse of Drugs Act (1870–1971), Misuse of Drugs Act (1971–1988), Thatcherite and AIDS crisis (1988–1998), New Labour and Internet (1998–2010), and Contemporary (2010 to present). In the 1900s, we see a shift from drug users portrayed as victims coming from privileged backgrounds to middle class people who displayed problematic behaviours. After the passage of the Misuse of Drugs Act 1971, drug user activists started to organise themselves and deliver education and outreach services. This was further amplified during the AIDS crisis and the Thatcherite era where drug users were involved in developing what later became the model for the public health approach to substance use. Drug user engagement with the government was strengthened during the New Labour government with the formation of the National Treatment Authority. Outside of government, drug users formed alliances which were crucial in ensuring accountability from the government. Upon the abolishment of the NTA, the organisations of drug users weakened. Drug user activists continued their initiatives, albeit on a smaller scale, while trying to rebuild the drug user movement. Further forms of documentation are needed to develop a more holistic historical account of drug user activism in the UK. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodResultsConclusionIt has been seven years since Poland legalized medical cannabis. Doctors in Poland are allowed to prescribe medical cannabis, which can be then obtained via pharmacies. However, no evaluation has been produced to explore what this policy has achieved.This article uses online surveys (N = 571) and qualitative interviews to explore what Polish cannabis users think of the current system.Most users – medical and recreational – think that it is currently easy to obtain a prescription for medical cannabis in Poland, and medical cannabis from a pharmacy. The users seem to have a clear preference for cannabis clinics as a source of prescriptions for medical cannabis over traditional doctors. Doctors in cannabis clinics seem much more inclined to prescribe medical cannabis. Many respondents, however, agree that the current system remains too expensive, and many users also raise concerns about the quality of cannabis available from pharmacies and strain variation.This article shows the emergence of a unique drug policy/model. The access to medical cannabis has improved significantly since the early stages of the policy. Notably – contrary to the wishes of the policymakers who wanted to create a “strict” medical model with the use of pharmacies, both – medical and recreational users seem to be benefiting from the current system. [ABSTRACT FROM AUTHOR]

Since the 1990s, Vietnam has begun prioritising preventing and combating drug-related crimes (supply reduction) and rehabilitating drug users (demand reduction). In the 2000s, harm reduction approaches in relation to drug control began to be recognised as one of Vietnam's opiate substitution therapy methods before embarking on greater drug policy reform in the early 2010s. In implementing the ideology of the Communist Party of Vietnam, the anti-narcotic police forces often apply a zero-tolerance approach to drug traffickers and identify drug users as a priority applies a zero-tolerance approach to drug traffickers and identifies drug users as a priority to send them to prison or compulsory detention centres rather than apply harm reduction as the international standard model to promote health conditions for them without detention. This study conducted a qualitative content analysis of documents by collecting and analysing grey literature on drug policy resources, combined with qualitative interviews with experts and drug policy professionals. Although Vietnam (re)states its commitment to balance the three pillars of harm minimisation in its drug policy reform, my research demonstrates that unclear provisions and blurred policies remain, and the challenges associated with scaling these approaches equally may not be feasible in reality. To do this, this study briefly explains (1) why Vietnam dominates the use of supply reduction-driven measures with 'hard strikes' for drug-related crimes, including the death penalty; (2) why Vietnam continues to use compulsory detention facilities for drug users as the main component of its demand reduction policy; and (3) why Vietnam still struggles to apply harm reduction, including in relation to policing practices. Some specific recommendations are called for further consideration to support harm reduction in policing. [ABSTRACT FROM AUTHOR]

Background: Management of opioid withdrawal in hospital settings is crucial to improve treatment completion and health outcomes among patients who use opioids, such as heroin. Evidence-based clinical guidelines can support responsive provision of opioid substitution therapy (OST). In England there is no standardised application of guidance for substance dependence management across National Health Service (NHS) Hospitals. A recent review of NHS hospital policies identified varying approaches to managing opioid withdrawal and procedural barriers to timely medication. Objective: To develop a clinical guideline for opioid withdrawal management in acute NHS hospital trusts to be tested and evaluated as part of the iHOST (Improving Hospital Opioid Substitution Therapy) research intervention. Methods: We undertook a deliberative guideline development process. The University London College Hospital (UCLH) substance dependence guideline was used as a template, with key points of revision informed by evidence review, consultations with hospital staff and people with opioid dependence. A multidisciplinary working group deliberated evidence statements to develop recommendations. These were reviewed by an oversight committee comprising representatives from key stakeholder organisations. The team authored the guideline with iterative review by the oversight committee, key stakeholders and UCLH clinical governance committees. Results: Deliberation focused on three key domains: (1) identifying opioid dependence and promptly continuing existing OST prescriptions; (2) initiating or re-titrating OST; (3) ensuring safety and continuity of care at discharge. Changes to the UCLH guideline included removal of mandatory urine drug testing prior to OST; increasing initial methadone titration dose; and provision for a higher day-one titration dose when specific safety criteria are met. A new titration schedule for sublingual buprenorphine was incorporated. Discharge planning to ensure continuity of community care and reduce risk of opioid overdose was emphasised, with allowance for bridging prescriptions of OST and naloxone provision on hospital discharge. Conclusion: The iHOST clinical guideline aims to remove procedural barriers to opioid withdrawal management for hospital inpatients. It is intended to be implemented by other NHS hospitals, which could improve access to OST and reduce discrepancies in treatment access and completion. Study registration: ISRCTN47320412 https://doi.org/10.1186/ISRCTN47320412. [ABSTRACT FROM AUTHOR]

The article "Waiting to Inhale" by Akwasi Owusu-Bempah and Tahira Rehmatullah discusses the implications of cannabis legalization in North America. The authors argue that while legalization may seem like progress, it has not effectively addressed the racial and social inequalities perpetuated by prohibition. They propose a three-point framework to remedy these issues, emphasizing the importance of amnesty, revenue redistribution, and community participation in the legal cannabis industry. The article provides a critical analysis of current legalization efforts and offers a blueprint for policymakers to create truly transformative social change. [Extracted from the article]

AbstractBackgroundMethodsResultsConclusionWhile debates on drug policy express a range of ethical viewpoints, many are underpinned by core ideas drawn from liberal philosophy. Much recent analysis on the moral principles underpinning drug policy debates focuses on differences between reformers and supporters of the status quo. Less attention has been given to divergences among advocates for drug policy reform, which often hinge on the interpretation and application of liberal principles.This paper examines three concepts from liberal philosophy in relation to drug policy debates: ‘positive’ and ‘negative’ freedom, rational autonomy, and social contract. The articulation of these ideas, and the extent to which they underpin different positions on policy reform, is explored with reference to three areas of advocacy: legal regulation; decriminalization; and harm reduction.Agreement on drug policy reforms does not necessarily imply shared views regarding concepts of freedom, rational autonomy, or social contract. Specific policy solutions may be supported by a range of ethical and political positions and can serve as points where divergent, and sometimes conflicting, philosophical perspectives converge.Drug policy advocacy expresses a range of underpinning moral, political, and philosophical perspectives. Recognizing commonalities and differences among these perspectives is important for coalition-building and strategic planning. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsDrug policy is prone to build on rationales based on different moralities rather than evidence. Less is known about how moralities influence drug policy implementation in practice. The aim was to analyze expressions of moralities among local policy-makers, professionals, and drug users in the context of the Stockholm needle and syringe exchange program (NSP).Using political documentation from Stockholm (2003–2016), focus group (12 NSP staff), and 32 drug user interviews, moralities concerning drug policy and harm reduction were analyzed based on moral foundations theory and boundary work.Three main moral dilemmas were identified concerning the subjects, aims, and orientation of drug policy: whether drug users are worthy of inclusion to society; if the general public should be prioritized or the health of drug users, and the orientation of practices as based on control or autonomy. Policy debate was driven by virtues such as purity and authority, whereas staff and drug users valued care, fairness and liberty.The prohibitionist and abstinence-oriented Swedish drug policy has created social boundaries on the practice-level. Hence, users’ perspectives, and those who care about them, should be extensively involved in political discussions to foster a more moral and humane drug policy. [ABSTRACT FROM AUTHOR]

Although the literature on political learning has examined the effect of policy on clients and some proximate individuals (family, friends, and community members), it has not examined the effect on professionals who implement programs. What lessons do professionals learn from implementing nominally positive (care) services for negatively constructed populations, and how do they learn them? Drawing on interviews, focus groups, and participant observation in substance‐use disorder services, we demonstrate that policy implementors learn lessons at odds with their advantaged status by proxy, witnessing how government treats clients, experiencing a system designed for negatively constructed, powerless populations, and sometimes the two together. As a result, the effect of policy may be greater than previously demonstrated. [ABSTRACT FROM AUTHOR]

This study systematically summarizes the drug policy for rare diseases in the European Union, statistically analyzes the review and approval of drugs for rare diseases under the regulatory framework of the European Medicines Agency, so as to provide reference for the research and development of drugs for rare diseases and the formulation of related policy in China by comparing with the relevant situation in China. At present, there are 141 kinds of drugs for rare disease approved for market use in the European Union, covering 107 rare disease indications. The marketing approval of drugs for rare diseases in the European Union takes a long time and is cautious, with an average of 5. 67 years for the identification and marketing of drugs. Compared with the European Union, there is still a big gap in the definition and coverage of the catalog of rare diseases, the policy to encourage research and development and marketing, the total number of priority review and approval of drugs for rare diseases and the coverage of indications in China, especially in the innovative research and development of drugs for rare diseases. It is necessary to further improve relevant policies, establish an innovation support system, strengthen the protection of the rights and interests of researchers and developers, promote the innovative development of the drug industry for rare diseases, and better meet the drug protection needs of patients with rare diseases in China. [ABSTRACT FROM AUTHOR]

Introduction: Supervised injecting facilities (SIF) have been shown to reduce negative outcomes experienced by people who inject drugs. They are often subject to intense public and media scrutiny. This article aimed to explore population attitudes to SIFs and how these changed over time in Australia. Methods: Data were drawn from the National Drug Strategy Household Survey, a national sample collecting data on illicit drug use and attitudes towards drug policy among Australians (2001–2019). Ordinal logistic regression assessed sociodemographic characteristics associated with different attitudes to SIFs and binary logistic regression assessed trends over time and by jurisdiction. Results: In 2019, 54% of respondents (95% CI 52.9, 55.1) supported SIFs, 27.5% (95% CI 26.6, 28.4) opposed and 18.4% (95% CI 17.7, 19.2) were ambivalent. Support for SIFs correlated with having a university degree (OR 1.75; 95% CI 1.58, 1.94), non‐heterosexual identity (OR 1.81, 95% CI 1.51, 2.17) and recent illicit drug use (OR = 1.74, 95% CI 1.55, 1.94). Male respondents or those living in socioeconomically disadvantaged areas had lower odds of supporting SIFs (OR 0.92, 95% CI 0.85, 1.00; OR 0.64–0.80, respectively). Between 2001 and 2019, support for SIFs increased modestly by 3.3%, those who 'don't know' by 7.4%, whereas opposition decreased by 11.7%. Between 2001 and 2019, support for SIFs increased in NSW and Queensland, whereas opposition decreased in all jurisdictions. Discussion and Conclusions: Opposition to SIFs declined over the past 20 years, but a substantial proportion of respondents are ambivalent or 'don't know enough to say'. Plain language information about SIFs and their potential benefits, targeted to those who are ambivalent/'don't know' may further increase public support. [ABSTRACT FROM AUTHOR]

This article addresses the debate on drugs use in the Partido Obrero during 1996-2009. In light of an international turn on the subject, we wonder about its impact on this trotskyist organization and worker's intervention in the discussion. To achieve this, we will analyze internal documents and the party's newspaper, in addition to recovering testimonies from former militants. Our approach will be from a marxist point of view, taking up the contributions on the subject of its first organizations, which problematized its impact on the working class. We registered the existence of three slogans: legalization, decriminalization, and the creation of alternative therapeutic communities. These are combined with a series of valuations on consumption, which strain the Argentinian left's traditional conceptions. We conclude that the labor sectors had little participation in the discussion, which has not been altered by the changes in world drug policy. [ABSTRACT FROM AUTHOR]

Recent research has yielded important insight into the characteristics and behaviours of officers who commit misconduct across the UK, USA and Australia. However, there remains little research into illicit substance use by sworn police. Considering substance use by police through the lens of police misconduct, this paper employs correlation and regression analyses using a sample of 489 sworn officers, to analyse whether individual types of misconduct, or the overall volume of misconduct committed, were predictive of an officer returning a positive drug test during departmental random drug testing. Findings suggested that neither individual types of misconduct, or the overall number of complaints received by officers were useful in predicting a positive drug test. However, a current or historical association with a known offender held a strong relationship with returning a positive drug test. Pivotally, holding a second job (outside of the agency) was also a significant predictor of a positive drug test. The findings of this research hold important implications for drug testing policy and procedure of policing agencies, and for understanding which factors may suggest that an officer is at risk of drug use. [ABSTRACT FROM AUTHOR]

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

Background and aims Design Setting Participants Measurements Findings Conclusions Involuntary civil commitment (ICC) is a legal process by which people are compulsorily admitted to substance use treatment. This study explored views about and promotion of ICC procedures for substance use disorders among public health‐public safety post‐overdose outreach programs and their outreach team members in Massachusetts, USA.In this mixed‐methods study, survey data were collected from post‐overdose outreach programs in 2019, and semi‐structured interviews were conducted with outreach team members in 2019 and 2020.Massachusetts, USA.We received 138 survey responses and conducted 38 interviews with post‐overdose outreach team members (law enforcement officers, recovery coaches, social workers and harm reductionists) who were majority male (57%) and white (66%).We used the survey instrument to categorize programs as more (discussed ICC at 50% or more of outreach encounters) or less ICC focused (discussed ICC at less than 50% of outreach encounters) and to identify program characteristics that corresponded with each categorization. Semi‐structured interviews explored staff perceptions of ICC effectiveness.Among 138 programs, 36% (n = 50) discussed ICC at 50% or more of outreach encounters. Discussing ICC at a majority of visits was positively associated with abstinence‐only program philosophies (36% v. 6%, P < 0.001) and collaborating with drug courts (60% v. 30%, P < 0.001), but negatively associated with naloxone distribution (48% v. 75%, P < 0.001) and referring to syringe service programs (26% v. 65%, P < 0.001). Qualitative interviews identified three themes: 1) some programs viewed ICC as a first line tool to engage overdose survivors in treatment; 2) other programs considered ICC a last resort, skeptical of its benefits and concerned about potential harms; 3) families commonly initiated discussions about ICC, reportedly out of desperation.Promotion of involuntary civil commitment (ICC) appears to vary widely across post‐overdose outreach programs in Massachusetts, USA, with approaches ranging from seeing it as a first step to treatment to being a tool of last resort. Demand for ICC among family members may relate to inadequate access to voluntary treatment. Family interest in ICC appears to be driven by inadequate availability of treatment and other services. ICC at post‐overdose outreach visits should be limited, if used at all. [ABSTRACT FROM AUTHOR]

Chloroquine is still used as a first-line treatment for uncomplicated Plasmodium vivax malaria in India and resistance to this therapy can act as a major hurdle for malaria elimination. It is difficult to monitor drug-efficacy and drug resistance through in vivo and in vitro studies in case of Plasmodium vivax so analysis of molecular markers serves as an important tool to track resistance. Molecular methods that are currently in use for detecting single nucleotide polymorphisms in resistant genes including Polymerase chain reaction (PCR), Realtime-Polymerase chain reaction require highly sophisticated labs and are time consuming. So, with this background the study has been designed to optimize Loop Mediated Isothermal Amplification Assay to detect single nucleotide polymorphisms in chloroquine resistance gene of Plasmodium vivax in field settings. Eighty-eight Plasmodium vivax positive samples were collected. Pvmdr1 gene was amplified for all the samples and sequenced. Obtained sequences were analyzed for the presence of single nucleotide polymorphisms in the target gene. Further Loop Mediated Isothermal Amplification Assay primer sets were designed for the target mutants and the assay was optimized. Clinical as well as analytical sensitivity and specificity for the assay was calculated. Double mutants with variations at T958M and F1076L were detected in 100% of the Plasmodium vivax clinical isolates with haplotype M958 Y976 Y1028 L1076. Designed primers for Loop Mediated Isothermal Amplification Assay successfully detected both the mutants (T958M and F1076L) in 100% of the isolates and do not show cross-reactivity with other strains. So, the assay was 100% sensitive and specific for detecting single nucleotide polymorphisms in the target Pvmdr1 gene. Limit of detection was found to be 0.9 copies/µl and lowest DNA template concentration detected by designed assay was 1.5 ng/µL. Observed prevalence of single nucleotide polymorphisms in Pvmdr 1 gene is indicating a beginning of trend towards chloroquine resistance in Plasmodium vivax. The present study optimized LAMP for detecting single nucleotide polymorphisms in Plasmodium vivax cases in field settings, thus would help in finding significant hubs of emerging chloroquine drug resistance and ultimately helping in the management of suitable antimalarial drug policy. [ABSTRACT FROM AUTHOR]

Background: On January 31st, 2023, the province of British Columbia (BC), Canada, was granted a federal exemption allowing adults (aged 18 +) to possess up to 2.5 g of select illicit drugs. The exemption will be in place for three years (2023–2026), marking the first formal decriminalization of illicit drug policy reform in Canada. BC's decriminalization initiative is premised on several goals. This project seeks to evaluate each of these goals and their individual and combined contributions to determine the overall success of this policy. Methods: The following protocol paper provides a detailed outline of a five-year (2022-2027) national evaluation of BC's decriminalization initiative, as well as the specific objectives, methodologies, and planned analyses for eight interrelated sub-studies that comprise the evaluation. These sub-studies fall under the following five topical areas of research: 1) people who use drugs (PWUD), 2) the police and the criminal justice system, 3) the general public, 4) the health services system, and 5) an economic analysis. Additional research activities may also be explored. Results: The overall evaluation and specific sub-study designs were informed by intensive stakeholder engagement. The evaluation was developed in collaboration with an international expert committee who came together to undertake a nominal group technique to decide on the final evaluation design and corresponding logic model. The evaluation will also employ an advisory board and individual sub-study working groups comprised of experts and PWUD who will oversee the development and implementation of the overall evaluation as well as each sub-study. Discussion: This evaluation will draw on implementation science research practices to evaluate and understand the full impacts of this novel drug policy experiment. Results will be widely disseminated through manuscripts, reports, presentations, and infographics, which will be adapted and tailored for specific audiences. The protocol identifies several anticipated challenges and limitations. This evaluation's evidence-based findings will be poised to offer pivotal insights that can shape and refine the discourse on drug policy and will serve as a critical resource for understanding the multifaceted impacts of decriminalization. [ABSTRACT FROM AUTHOR]