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Date: April 30, 2024 Tue
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Results for opioid epidemic
23 results foundAuthor: Maryland. Office of the Attorney General Title: Prescription for Disaster: The Growing Problem of Prescription Drug Abuse in Maryland Summary: Maryland Attorney General J. Joseph Curran Jr. released a report which warns of a burgeoning crisis of prescription drug abuse and diversion in Maryland and nationwide which will only get worse unless federal and state officials step up efforts to address the problem. Entitled "Prescription for Disaster:The Growing Problem of Prescription Drug Abuse in Maryland," the report makes several recommendations, including the creation of an electronic prescription monitoring program, increased penalties for illegal distribution of pharmaceuticals, and a public outreach campaign to heighten awareness about the dangers of prescription drug abuse, with particular focus on the virtually unfettered youth access to controlled dangerous substances via the Internet. The report cites federal data showing that prescription drug abuse is rising faster and more consistently than abuse of illicit drugs, particularly among young people. An alarming one in five teens report having used a prescription pain reliever, like Vicodin® or OxyContin®, to get high, and they are more likely to have done so than to have experimented with most illicit drugs like Ecstasy, cocaine, crack and LSD. Maryland is no exception to national trends, with prescription drug abuse rising almost five times faster than abuse of illicit drugs. The State ranked 6th in the nation in its recent rates of admission for prescription drug abuse treatment, and law enforcement officials cite concerns that the Baltimore region is becoming a "source area" for diverted OxyContin®. Adults and teens obtain prescription drugs through prescription fraud, doctor-shopping, theft and the Internet, which is fast becoming a frightening pipeline for prescription drug diversion. While Curran said it must fall to the federal government to impose much-needed regulation on the pharmaceutical Internet trade, which he urged Congress to do, he emphasized steps the State can and should take immediately to address the problem. First, he called for illegal distribution of prescription drugs to be made a felony instead of a misdemeanor. In addition, Curran promised he would work to see that Maryland join 21 other states in establishing an electronic prescription monitoring program, in which a central database of all prescriptions written and dispensed in the State would be kept to help detect abuse and diversion. Most states surrounding Maryland, like Pennsylvania, West Virginia and Virginia, either have or will soon have such programs up and running. Curran cautioned that a prescription monitoring program must be designed carefully, drawing upon the input and expertise of pain management specialists, pharmacists, law enforcement, patient advocates and others. He has already begun discussions with medical and pharmaceutical experts, and he emphasized the importance of making sure the program would protect patient privacy and would not interfere with the legitimate use of pain relievers and other drugs. Recognizing that people already often have trouble getting prescription pain relievers and other drugs which would be of tremendous help to them, he said, "the last thing we want to do is make that problem worse. We want to keep prescription drugs out of the wrong hands, but we must make sure that doctors can provide the best care possible to their patients, and patients get the medicines they need." Finally, Curran urged an educational effort to make parents and others more aware of prescription drug abuse, its growing prevalence and warning signs, and the increasing availability of a wide range of powerful prescription drugs on the Internet. Details: Maryland: State of Maryland Office of the Attorney General, 2009. 35p. Source: Internet Resource: Accessed February 29, 2012 at http://www.oag.state.md.us/Reports/PrescriptionDrugAbuse.pdf Year: 2009 Country: United States URL: http://www.oag.state.md.us/Reports/PrescriptionDrugAbuse.pdf Shelf Number: 124325 Keywords: Abuse and AddictionDrug Abuse (Maryland)Drug ControlOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: Havnes, Ingrid Amalia Title: Violence and diversion of prescribed opioids among individuals in opioid maintenance treatment. A complementary methods study of violent crime convictions in a national cohort and qualitative interviews among prisoners Summary: Background: Opioid dependence is linked to crime, morbidity and mortality, directly through drug overdoses and indirectly via drug-related mortality, accidents, suicides and violence. Violence in general is a major health concern worldwide. Opioid maintenance treatment, OMT, is found to reduce mortality, morbidity and criminal behaviour, but less is known about the effect of OMT on violent crime. A possible negative consequence of OMT is diversion of methadone and buprenorphine and rising overdose deaths related to these medications among individuals not enrolled in OMT. The aim of this thesis is to study violent crimes prior to, during and after OMT in a national cohort and to generate new knowledge about OMT-enrolled individuals' experiences and understandings of being both violent and non-violent offenders, the role of substances in such crimes as well as their understandings and motivations related to diversion of prescribed opioids. Materials and methods: Two complementary data collection methods have been used. Violent convictions were investigated by use of cross-registry methods for a complete longitudinal national OMTcohort of 3221 individuals with an observation period of 9 years and a qualitative study among 12 imprisoned, OMT-enrolled individuals. 28 semi-structured interviews were thematically analyzed with a reflexive and interactive approach. Findings: Violent crime rates were significantly reduced during OMT compared with before treatment. The rate of convictions for violent crime during OMT was halved among those who remained in treatment. The reduction was less pronounced for those who left treatment: for this group, the rate of violent convictions after OMT was higher than before treatment. The risk of convictions for violent and non-violent crime during OMT was highest for those with violent convictions prior to treatment. In the qualitative part of the study, it was found that substances and, in particular, high-dose benzodiazepines were deliberately used to induce temporary 'antisocial selves' capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use prior to OMT. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. They were found to exhibit a considerable amount of self-control, selfregulation and/or self-initiation of external control related to intake of methadone and buprenorphine in various settings. Their acquired norm of sharing with others in a drug using community was carried along when entering OMT. Several had developed strategies to avoid selling or giving of methadone or buprenorphine to others. Giving one's opioid prescriptions to an individual in withdrawal, was seen as an act of helping. Individuals enrolled in OMT might thus be trapped between practicing norms of helping and sharing and adhering to treatment regulations. Conclusions: Opioid dependent individuals with violent convictions should have access to OMT. Treatment providers should identify individuals with histories of violent behavior. The situation that precede and motivate violent behavior and the potential role of substances prior to and after such crimes should be explored with the patient in question. What appears as a severe antisocial personality disorder may be partly explained by substance use. Treatment providers should explore the living conditions and social lives of individuals applying for and enrolled in OMT. To following OMT guidelines may entail breaking a personal and drug culture norm of sharing and helping by means of providing OMT medications to those in need. Opioid-dependent couples should be encouraged to apply for and enroll in OMT at the same time, if both are motivated for starting treatment. Some individuals might know what particular configurations of internal and external control they need in order to achieve their own treatment goals in OMT. An individual's experience and ability to execute self-control and self-regulation with regard to drug taking may be seen as a resource throughout the course of treatment. Details: Oslo: University of Oslo, 2015. 118p. Source: Internet Resource: Dissertation: Accessed August 4, 2017 at: https://www.duo.uio.no/handle/10852/42124 Year: 2015 Country: Norway URL: https://www.duo.uio.no/handle/10852/42124 Shelf Number: 146719 Keywords: Drug Abuse and CrimeDrug Abuse TreatmentDrug OffendersOpioid EpidemicOpioidsPrescription DrugsSubstance Abuse TreatmentViolent Crime |
Author: Matthew, Dayna Bowen Title: Un-burying the Lead: Public health tools are the key to beating the opioid epidemic Summary: On November 1st, the President's Commission on Combating Drug Addiction and the Opioid Crisis, chaired by Governor Chris Christie, released its report and recommendations for fighting "the worst drug overdose epidemic in U.S. history." The Report repeatedly underscores the scope and urgency of the nation's opioid epidemic that is ravaging families and communities in all 50 states. It claims 175 lives daily. In addition to these deaths, other tragic and costly health consequences of this epidemic include unprecedented increases in the incidence and prevalence of addiction, increased hospitalizations and emergency room visits, and a dramatic increase in the number of babies born with neonatal abstinence syndrome. There is much in the Report to praise. For example, the Commission recommended that the president declare the opioid crisis a national public health emergency and the president adopted this recommendation. The declaration of a public health emergency will eventually allow states to apply for and Congress to fund long-term interventions to prevent and treat drug abuse. Moreover, the Commission's recommendations that emphasize treatment and harm reduction admirably include systemic changes that would have long-term impact, such as: Development of new quality measures to incentivize early screening and treatment referrals; Waiver of Institutions for Mental Diseases (IMD) exclusions within Medicaid to expand capacity for in-patient treatment; Broad expansion of federal drug courts to divert individuals away from prison and into treatment programs; and Insurer regulations and penalties for mental health parity violations. However, this report argues that it is the Commission's final six recommendations - buried in the back of the report--that offer the most far-reaching and promising opportunities for state and federal leaders to strike at the root causes of the opioid crisis. These final recommendations, listed on the left side of Table 1 below, signal that our government may be willing to seriously address the opioid crisis as the public health emergency that it is. They aim at changing the fundamental social and environmental conditions that are risk factors for the populations among which addiction and death rates are soaring. As such, they have the greatest potential for impact because they reach the broadest segments of the community where addictions flourish. But even they do not go far enough. These good ideas need to be accompanied by action steps to implement them with the immediacy that this crisis warrants. This report suggests the logical "next steps" that should accompany the Commission's recommendations. They are listed on the right side of Table 1 below. This report proceeds in three parts. It first calls attention to the Commission's final six recommendations. It argues that these proposals, which focus on reforming housing, employment, family, criminal justice and educational determinants of opioid addiction, are the most important. interventions of all. Second, this report places the current opioid epidemic into historic context; America has seen terrible spikes in opioid and other drug related deaths in this country during two prior periods. The public health lessons from earlier epidemics provide strong support for the Commission's final six recommendations, and counsel a comprehensive approach to the social and economic risk factors associated with opioid addiction. Finally, this report asserts that the Commission's recommendations will have limited impact unless they are implemented with immediate action steps to ensure, and even expand, their concrete impact. Therefore, for each one of the Commission's final six recommendations, this report proposes a related action step for housing9 and employment,10 community engagement, and criminal justice interventions12 that are essential to defeating the worsening opioid crisis in this country. Moreover, this section urges the Administration to reach back 50 years in America's self-proclaimed drug "war" and extend the public health framework it has now adopted toward opioid addiction to the victims of America's earlier opioid crisis, and to those who became addicted to successor drugs. These victims of America's earlier opioid crises tragically were subjected to a criminal justice rather than public health approach to their disease. This report argues it is not too late to correct that error, by applying the public health framework to all populations affected by the disease of addiction. In conclusion, this report outlines a comprehensive and equitable strategy that federal, state, and local governments, as well as affected communities can take to effectively address the social determinants of opioid addiction. Details: Washington, DC: USC-Brookings Schaeffer Initiative for Health Policy , 2018. 18p. Source: Internet Resource: Accessed February 22, 2018 at: https://www.brookings.edu/wp-content/uploads/2018/01/es_20180123_un-burying-the-lead-final.pdf Year: 2018 Country: United States URL: https://www.brookings.edu/wp-content/uploads/2018/01/es_20180123_un-burying-the-lead-final.pdf Shelf Number: 149227 Keywords: Drug Abuse and AddictionDrug PolicyDrug TreatmentOpioid EpidemicOpioidsPublic Health |
Author: Singer, Jeffrey A. Title: Abuse-Deterrent Opioids and the Law of Unintended Consequences Summary: The United States has seen a surge in deaths from overdoses of opioids, including both prescription drugs and illegal opioids such as heroin. Nonmedical users and abusers often obtain prescription opioids diverted from the legal to the illegal market. In the hope of reducing opioid use, abuse, and overdoses, policymakers have focused on developing and promoting tamper-resistant or abuse-deterrent formulations (ADFs) that render diverted opioids unusable if individuals attempt to use them for nonmedical (i.e., recreational) purposes. Although the benefits of ADFs seem to be nonexistent, these formulations have led to real harms. ADFs have encouraged users to switch to more dangerous opioids, including illegal heroin. In at least one instance, the reformulation of a prescription opioid led to a human immunodeficiency virus (HIV) outbreak. Along the way, ADFs unnecessarily increase drug prices, imposing unnecessary costs on health insurance purchasers, taxpayers, and particularly patients suffering from chronic pain. Like the federal government's promotion of abuse-deterrent alcohol a century ago, these efforts are producing unintended consequences, such as making legal pain relief unaffordable for many patients and possibly increasing morbidity and mortality. Government at all levels should stop promoting ADF opioids. Congress should end or limit the ability of pharmaceutical manufacturers to impose higher costs on pain patients by using ADFs to "evergreen" their opioid patents (evergreening is a practice by which pharmaceutical manufacturers extend or renew the patent protection before the current patent expires by tweaking the formula slightly or repurposing the product). The FDA should end its policy of encouraging ADF opioids and particularly its goal of eliminating non-ADF opioids. Lawmakers should abandon efforts to require consumers to purchase coverage for costlier ADF opioids and should instead allow insurers to steer medical users of these products toward cheaper, non-ADF generic formulations. Details: Washington, DC: Cato Institute, 2018. 9p. Source: Internet Resource: Policy Analysis No. 832: Accessed April 4, 2018 at: https://www.cato.org/publications/policy-analysis/abuse-deterrent-opioids-law-unintended-consequences Year: 2018 Country: United States URL: https://www.cato.org/publications/policy-analysis/abuse-deterrent-opioids-law-unintended-consequences Shelf Number: 149664 Keywords: Drug Abuse and AddictionIllegal DrugsOpioid EpidemicOpioidsPrescription Drugs |
Author: Police Executive Research Forum Title: The Unprecedented Opioid Epidemic: As Overdoses Become a Leading Cause of Death, Police, Sheriffs, and Health Agencies Must Step Up Their Response Summary: Consider the following pieces of information: - In Philadelphia, 35 people died of heroin overdoses in less than a week last December. - In New York City, fatal drug overdoses, which numbered 1,374 in 2016, are four times more common than homicides. The police are moving mountains to analyze overdose cases quickly, in order to stop the fatalities when an extremely powerful batch of heroin or fentanyl hits the streets. - In Louisville, Kentucky, police had 52 overdose calls over a 32-hour period last February. On average, police save someone's live with naloxone about twice a day, and one person dies from an overdose every day. - In Cabell County, West Virginia, officials reported 26 drug overdoses in a five-hour period, due to a batch of heroin containing fentanyl. The county reported the highest overdose death rate in the state, with 132 deaths among a population of less than 100,000. - In Ohio, the state with the most overdose deaths, an average of 11 people died every 24 hours in 2016, and coroners report that the numbers for 2017 are even higher. In Akron, 16 drug dealers have been sentenced to long prison terms because their product was linked to fatal overdoses, but the police chief doesn't think those prosecutions have "sent a message" to other dealers or slowed down the heroin trafficking. - In Cook County, Illinois, where Chicago and some of its suburbs are located, fentanyl took hold with a vengeance in 2016, causing more than 560 fatal overdoses. When Chicago's opioid overdoses are laid out on a map of the city, it correlates closely with the locations of shootings, prompting one police official to note that "our violent crime problem is our drug problem." - In New Jersey, crime labs have backlogs, but they find a way to turn heroin analyses around in a matter of hours if fatalities are involved. - In Baltimore, where 694 people suffered fatal overdoses in 2016, the Health Department is very concerned about the high likelihood that prescription opioid pills will lead to more cases of heroin addiction. So it is taking action. The Health Department is asking doctors to provide a prescription for naloxone along with every prescription they write for opioid pain pills. The idea is that doctors will think twice about prescribing oxycodone if they have to tell their patients, "Here's a prescription for your shoulder pain. And this other prescription is in case you end up having a heroin overdose." These are a few of the stories that you will find in the report you are holding. This is PERF's third major report about the epidemic of overdoses by persons addicted to opioid drugs. In 2014 and again in 2016, we held national conferences and released reports about the crisis, focusing on what local police and other agencies were doing to reduce the carnage. This new report summarizes what we learned at a third national PERF conference, held at the New York City Police Department's headquarters in April 2017. The reason PERF continues to focus on the opioids crisis is that despite the groundbreaking work that police and other agencies are doing, the epidemic is continuing to worsen. The latest numbers, released by the Centers for Disease Control and Prevention (CDC) in August 2017, are horrible. Drug overdose deaths in 2016 totaled 64,070, a 21-percent increase over the year before. And approximately three-fourths of all drug overdose deaths are caused by opioid drugs. Let's put those numbers in context: - The 64,070 drug fatalities in 2016 outnumber the 35,092 motor vehicle fatalities in 2015. - Drug fatalities in 2016 outnumber American fatalities in the entire course of the Vietnam War, which totaled 58,200. - Drug fatalities in 2016 outnumber AIDS-related deaths in the worst year of the HIV epidemic, when 50,628 people died in 1995. - Drug fatalities in 2016 outnumber the peak year of homicides in the United States, when 24,703 people were murdered in 1991. - Drug fatalities in 2016 outnumber suicides, which have been increasing for nearly 30 years and which totaled 44,193 in 2015. Furthermore, the new CDC statistics confirm what police chiefs have been telling us-Fentanyl is driving the sharp increases in opioid-related fatalities. CDC identified 15,466 fatalities in 2016 resulting from heroin overdoses, but 20,145 fatalities caused by fentanyl or other synthetic opioids. So it is clear that police and other criminal justice agencies, along with public health departments, drug treatment and social service providers, elected officials, and others, must step up their efforts to prevent new cases of opioid addiction, while helping addicted persons through the long and difficult process of getting free of opioid drugs. Details: Washington, DC: PERF, 2017. 92p. Source: Internet Resource: Accessed April 12, 2018 at: http://www.policeforum.org/assets/opioids2017.pdf Year: 2017 Country: United States URL: http://www.policeforum.org/assets/opioids2017.pdf Shelf Number: 149796 Keywords: Drug Abuse and AddictionDrug-Related DeathsOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: U.S. Government Accountability Office Title: Illicit Opioids: While Greater Attention Given to Combating Synthetic Opioids, Agencies Need to Better Assess their Efforts Summary: What GAO Found Federal agencies collaborate with foreign governments, such as China, Mexico, and Canada, as well as with international organizations, to limit the production of illicit synthetic opioids. They do this by enhancing investigations, sharing information on emerging trends, helping to expand the regulation of illicit substances, and building capacity to thwart the distribution of illicit drugs. Federal agencies have ongoing efforts to limit the domestic availability of and enhance their response to illicit synthetic opioids. For example, federal efforts include treating overdose death scenes as crime scenes where officers collect evidence to investigate and identify the drug source. Federal agencies have also documented specific strategies to combat illicit opioids. However, only one of the five strategies we reviewed included outcome, or results-oriented measures-largely due to agency perceptions that designing such measures posed challenges. The Government Performance and Results Act Modernization Act of 2010 directs agencies to develop goals, as well as performance indicators. Without specific outcome-oriented performance measures, federal agencies will not be able to truly assess whether their respective investments and efforts are helping them to limit the availability of and better respond to the synthetic opioid threat. We also found that while federal law enforcement agencies are increasingly coordinating with the public health sector to share overdose information, both sectors reported ongoing data sharing obstacles and related challenges with the timeliness, accuracy, and accessibility of overdose data. Standards for Internal Control in the Federal Government states that information for decision-making should be appropriate, current, complete, accurate, accessible, and provided on a timely basis. Embarking on a concerted effort, led by the Office of National Drug Control Policy (ONDCP), to examine and address data related concerns will enhance agencies' efforts continue to understand and respond to the opioid epidemic. Federal agencies have adapted to the opioid epidemic by, among other things, expanding prevention programs and treatment options. For example, agencies have increased engagement with medical professionals about the implications of prescribing practices to help reduce opioid abuse, and provided additional resources to states and localities to expand the distribution and use of overdose reversal and treatment options. Why GAO Did This Study Increased illicit use of synthetic (manmade) opioids has contributed to drug-related overdose deaths. Synthetic opioids like fentanyl-a substance 100 times stronger than morphine- accounted for more than 19,000 of the nearly 64,000 overdose deaths in 2016, the most recent year for which federal data are available. GAO was asked to review U.S. agency efforts to combat illicit synthetic opioids. This report examines how U.S. agencies (1) work with international partners to limit production of illicit synthetic opioids; (2) work domestically to limit the availability of and enhance their response to these drugs and how agencies can improve their effectiveness; (3) measure performance in their documented opioid response strategies; and (4) have adapted their approaches to prevention and treatment. GAO reviewed documents that described agencies' international coordination efforts, domestic opioid reduction strategies and prevention and treatment approaches, and interviewed international and federal agency officials engaged in drug control policy. GAO also interviewed state and local law enforcement and public health officials in seven states, selected in part for their high rates of overdose deaths. What GAO Recommends GAO is making six recommendations, including that agencies develop performance metrics. DHS agreed, ONDCP did not state whether they agreed or disagreed, and DOJ did not agree with GAO's recommendations. GAO continues to believe that these recommendations remain valid. Details: Washington, DC; GAO, 2018. 94p. Source: Internet Resource: GAO-18-205: Accessed April 16, 2018 at: https://www.gao.gov/assets/700/690972.pdf Year: 2018 Country: United States URL: https://www.gao.gov/assets/700/690972.pdf Shelf Number: 149801 Keywords: Drug Abuse and AdditionDrug Control PolicyIllegal DrugsIllicit DrugsOpioid EpidemicOpioidsPrescription Drugs |
Author: United Nations Office on Drugs and Crime (UNODC) Title: Opioid overdose: preventing and reducing opioid overdose mortality Summary: Although data are limited, an estimated 70,000-100,000 people die from opioid overdose each year. Opioid overdose was the main cause of the estimated 99,000- 253,000 deaths worldwide related to illicit drug use in 2010. Opioid overdose is both preventable and, if witnessed, treatable (reversible). In its resolution 55/7 on promoting measures to prevent drug overdose, in particular opioid overdose, the Commission on Narcotic Drugs called upon Member States to include effective measures to prevent and treat drug overdose in national drug policies. In that resolution, the Commission requested the United Nations Office on Drugs and Crime (UNODC), in collaboration with the World Health Organization (WHO), to collect and circulate available best practices on the prevention and treatment of and emergency response to drug overdose, in particular opioid overdose, including on the use and availability of opioid receptor antagonists such as naloxone and other measures based on scientific evidence. This discussion paper outlines the facts about opioid overdose, the actions that can be taken to prevent and treat (reverse) opioid overdose and areas requiring further investigation. Opioids, which can be chemically synthesized or derived from the opium poppy plant, are a group of compounds that activate the brain's opioid receptors, a class of receptors that influence perceptions of pain and euphoria and are involved in the regulation of breathing. Some of the more commonly known and used opioids are morphine, heroin, methadone, buprenorphine, codeine, tramado, oxycodone and hydrocodone. They are used as medicines to treat pain and opioid dependence. If used in excess or without proper medical supervision, opioids can cause fatal respiratory depression. In cases of fatal overdose, the victim's breathing slows to the point where oxygen levels in the blood fall below the level needed to transfer oxygen to the vital organs. As oxygen saturation (normally greater than 97 per cent) falls below 86 per cent, the brain struggles to function. Typically, the individual becomes unresponsive, blood pressure progressively decreases and the heart rate slows, ultimately leading to cardiac arrest. Death can occur within minutes of opioid ingestion. But often, prior to death there is a longer period of unresponsiveness lasting up to several hours. This period is sometimes associated with loud snoring, leading to the term "unrousable snorers". Worldwide, overdose is the leading cause of avoidable death among people who inject drugs. However, it is difficult to accurately estimate the number of fatal opioid overdoses because of the poor quality or limited nature of mortality data available. According to UNODC estimates, drug-related deaths account for between 0.5 percent and 1.3 percent of all-cause mortality at the global level among persons aged 15-64. In that regard, the recent Global Burden of Diseases, Injuries, and Risk Factors Study, 2010 found that there were an estimated 43,000 deaths in 2010 due to opioid dependence and 180,000 deaths due to drug poisoning, resulting in more than 2 million years of life lost. In the United States of America alone, there were an estimated 38,329 drug poisoning deaths in 2010, including 16,651 fatal opioid overdoses related to prescription opioid analgesics in 2010, with the remainder of those deaths largely involving heroin and/or cocaine. Opioid overdose accounts for nearly half of all deaths among heroin injectors, exceeding HIV and other disease-related deaths. Overdose was reported more frequently than were other causes in the 58 cohort studies examined in a 2011 meta-analysis. That meta-analysis also indicated that overdose represented the most common specific cause of death, at 6.5 deaths per 1,000 person-years. Among the 10 per cent of people living with HIV in the United States who also inject drugs, overdose is a common cause of non-AIDS related death. A recent meta-analysis showed that HIV sero-positivity is associated with an increased risk of overdose: people who use drugs have a 74 percent greater risk of overdose if they are HIV-positive compared with their HIV-negative counterparts. In the Russian Federation, overdose is the second leading cause of death for people with HIV after tuberculosis. Nationally reported mortality data in both low-income and high-income countries are often insufficient to estimate overdose deaths. Current data on overdose mortality derive mostly from prospective cohort studies and national reporting systems, largely from high-income countries. To address these challenges, some countries have now adopted a standard case definition, contributing to an improved capacity for reliable overdose data. However, in a significant number of countries, data on overdose are limited, with the result that alternative data sources, often combined with expert opinion, are required to estimate rates. Consequently, overdose mortality generally tends to be underestimated, and nationally reported statistics in that regard are likely to be conservative. For example, against the backdrop of negligible numbers of fatal overdoses reported by national authorities of Central Asian countries, 25.1 percent of injecting drug users surveyed in Kazakhstan, Kyrgyzstan and Tajikistan in 2010 reported having witnessed someone die from an overdose in the previous 12 months. It is likely that people who use opioids also experience a high rate of non-fatal overdose. For instance, 59 percent of known heroin injectors in a study conducted in 16 Russian cities reported having had at least one non-fatal overdose in their lifetime. The proportion of heroin injectors reporting lifetime non-fatal overdose is similarly high in several other cities: 41 percent in Baltimore, 42 percent in New York City, 68 percent in Sydney, 38 percent in London, 30 percent in Bangkok, and 83 percent in Bac Ninh, Viet Nam. Non-fatal overdose can significantly contribute to morbidity, including cerebral hypoxia, pulmonary oedema, pneumonia and cardiac arrhythmia, that may result in prolonged hospitalizations and brain damage. Details: Vienna: UNODC, 2013. 28p. Source: Internet Resource: Discussion paper, UNODC/WHO: Accessed April 18, 2018 at: https://www.unodc.org/docs/treatment/overdose.pdf Year: 2013 Country: International URL: https://www.unodc.org/docs/treatment/overdose.pdf Shelf Number: 149846 Keywords: Drug Abuse and AddictionDrug OverdosesDrug-Related DeathsNarcoticsOpioid CrisisOpioid EpidemicOpioidsPrescriptions Drugs |
Author: Yeh, Brian T. Title: Legal Authorities Under the Controlled Substances Act to Combat the Opioid Crisis Summary: According to the Centers for Disease Control and Prevention, the annual number of drug overdose deaths involving prescription opioids (such as hydrocodone, oxycodone, and methadone) and illicit opioids (such as heroin and non-pharmaceutical fentanyl) has more than quadrupled since 1999. A November 2017 report issued by the President's Commission on Combating Drug Addiction and the Opioid Crisis also observed that "[t]he crisis in opioid overdose deaths has reached epidemic proportions in the United States ... and currently exceeds all other drug-related deaths or traffic fatalities." How the current opioid epidemic happened, and who may be responsible for fueling it, are complicated questions, though reports suggest that several parties likely played contributing roles, including pharmaceutical manufacturers and distributors, doctors, health insurance companies, rogue pharmacies, and drug dealers and addicts. Many federal departments and agencies are involved in efforts to combat opioid abuse and addiction, including a law enforcement agency within the U.S. Department of Justice, the Drug Enforcement Administration (DEA), which is the focus of this report. The primary federal law governing the manufacture, distribution, and use of prescription and illicit opioids is the Controlled Substances Act (CSA), a statute that the DEA is principally responsible for administering and enforcing. The CSA and DEA regulations promulgated thereunder establish a framework through which the federal government regulates the manufacture, distribution, importation, exportation, and use of certain substances which have the potential for abuse or psychological or physical dependence, including opioids. Congress enacted the CSA in 1970 to facilitate the availability of controlled substances for authorized medical, scientific, research, and industrial purposes, while also preventing these substances from being diverted out of legitimate channels for illegal purposes such as drug abuse and drug trafficking activities. The CSA aims to protect the public's health and safety from dangers posed by highly addictive or dangerous controlled substances that are diverted into the illicit market, while also ensuring that patients have access to pharmaceutical controlled substances for legitimate medical purposes such as the treatment of pain. This report describes the current federal legal regime governing opioids and other controlled substances under the CSA and its implementing regulations, including (1) the classification of various plants, drugs, and chemicals into one of five schedules based on the substance's medical use, potential for abuse, and safety or dependence liability; (2) who must register with the DEA in order to receive authorization to handle the substances (such as drug manufacturers, wholesale distributors, doctors, hospitals, pharmacies, and scientific researchers); (3) what obligations registrants must satisfy in order to maintain a valid registration (such as keeping records of drug inventories and transactions, submitting reports to the DEA, and providing security measures to safeguard controlled substances); and (4) the DEA's administrative, civil, and criminal authorities for enforcing regulatory compliance with the CSA (such as suspending or revoking a registrant's legal authority to handle controlled substances if the DEA Administrator finds that the registrant has "committed such acts as would render his registration ... inconsistent with the public interest."). The report then examines DEA initiatives and actions taken, pursuant to its legal authorities under the CSA, which specifically target the abuse of opioids. The report concludes by discussing selected opioid-related legislative proposals in the 115th Congress that would amend the CSA. Details: Washington, DC: Congressional Research Service, 2018. 36p. Source: Internet Resource: Accessed April 19, 2018 at: https://fas.org/sgp/crs/misc/R45164.pdf Year: 2018 Country: United States URL: https://fas.org/sgp/crs/misc/R45164.pdf Shelf Number: 149853 Keywords: Drug Control PolicyOpioid EpidemicOpioidsPrescription Drugs |
Author: Malatras, Jim Title: By the Numbers: Opioid Deaths Continue to Surge in New York State Summary: The opioid epidemic continues to ravage the nation. The sad fact is no matter the region of the country, there are people struggling with opioid addiction. Not only is every region touched, no group - rich or poor, rural or urban, black or white, men or women - is immune from the epidemic's devastating effects. But, as we will describe below, some groups are disproportionately affected. In April 2017, the Rockefeller Institute of Government released a report finding a 71 percent increase in drug deaths in New York State (NYS) from 2010-15. In later reports and using online interactive maps to track drug overdoses and deaths, we found that use of deadly drugs, like heroin and fentany, were rapidly growing. For example, using provisional New York State Department of Health data, we found a 54 percent increase in heroin deaths and a 50 percent increase in emergency room visits due to heroin overdoses, and a 45 percent increase in the use of life-saving overdose medication, like Naloxone, in one year alone (2014-15). Policymakers across the nation have grappled with how to address the epidemic. The solutions have varied from the president of the United States declaring the problem a national public health emergency to once unthinkable solutions in many communities, like safe injection sites. But given all the policies implemented and funding provided to battle the opioid epidemic, could the tide be turning? Recent reports suggest that some county officials are forecasting a decrease in the number of drug deaths in the coming months. It is too early to tell if that is a larger trend. Given this potential change, using the most recent Centers for Disease Control and Prevention data from 2016, we have updated our findings from April 2017 and found that opioid deaths continue to mount. In fact, from 2015 to 2016, New York saw the single greatest annual increase in drug-related deaths in six years. Details: Albany, NY: Rockefeller Institute of Government, 2018. 16p. Source: Internet Resource: accessed May 18, 2018 at: http://rockinst.org/wp-content/uploads/2018/03/2018-03-21-By-The-Numbers-Opioid-Deaths.pdf Year: 2018 Country: United States URL: http://rockinst.org/wp-content/uploads/2018/03/2018-03-21-By-The-Numbers-Opioid-Deaths.pdf Shelf Number: 150266 Keywords: Drug Abuse and AddictionDrug-Related DeathsOpioid Epidemic |
Author: Sacco, Lisa N. Title: Prescription Drug Monitoring Programs Summary: In the midst of national concern over the opioid epidemic, federal and state officials are paying greater attention to the manner in which opioids are prescribed. Nearly all prescription drugs involved in overdoses are originally prescribed by a physician (rather than, for example, being stolen from pharmacies). Thus, attention has been directed toward better understanding how opioids are being prescribed and preventing the diversion of prescription drugs after the prescriptions are dispensed. Prescription drug monitoring programs (PDMPs) maintain statewide electronic databases of prescriptions dispensed for controlled substances (i.e., prescription drugs with a potential for abuse that are subject to stricter government regulation). Information collected by PDMPs may be used to educate and inform prescribers, pharmacists, and the public; identify or prevent drug abuse and diversion; facilitate the identification of prescription drug-addicted individuals and enable intervention and treatment; outline drug use and abuse trends to inform public health initiatives; or educate individuals about prescription drug use, abuse, diversion, and PDMPs themselves. As of February 2018, 50 states, the District of Columbia, and two territories (Guam and Puerto Rico) had operational PDMPs within their borders. How PDMPs are organized and operated varies among states. Each state determines which agency houses the PDMP; which controlled substances must be reported; which types of dispensers (e.g., pharmacies) are required to submit data; how often data are collected; who may access information in the PDMP database (e.g., prescribers, dispensers, or law enforcement); the circumstances under which the information may (or must) be accessed; and what enforcement mechanisms are in place for noncompliance. PDMP costs may vary widely, with startup costs that can range as high as $450,000 to over $1.5 million and annual operating costs ranging from $125,000 to nearly $1.0 million. States finance PDMPs using monies from a variety of sources including the state general fund, prescriber and pharmacy licensing fees, state controlled substance registration fees, health insurers' fees, directsupport organizations, state grants, and/or federal grants. The federal government supports state PDMPs through programs at the Departments of Justice (DOJ) and Health and Human Services (HHS). Since FY2002, DOJ has administered the Harold Rogers Prescription Drug Monitoring Program, and in FY2017, DOJ incorporated this grant program into the new Comprehensive Opioid Abuse Program. HHS programs include National All Schedules Prescription Electronic Reporting (NASPER), State Demonstration Grants for Comprehensive Opioid Abuse Response, Opioid Prevention in States grants, State Targeted Response to the Opioid Crisis Grants, and various pilots and initiatives under the Office of the National Coordinator for Health Information Technology (ONC). Of note, NASPER last received appropriations (of $2.0 million) in FY2010. State PDMPs vary with respect to whether or how information contained in the database is shared with other states. Federal policymakers have repeatedly emphasized the importance of enhancing interstate information sharing and the interoperability of state PDMPs. In 2011, the Obama Administration included efforts to increase interstate data sharing in its action plan to counter prescription drug abuse. In 2017, a presidential commission recommended, among other things, that the Trump Administration support legislation to require DOJ to fund a "data-sharing hub" and require states receiving federal grant funds to share PDMP data. Details: Washington, DC: Congressional Research Service, 2018. 34p. Source: Internet Resource: R42593: Accessed May 25, 2018 at: https://fas.org/sgp/crs/misc/R42593.pdf Year: 2018 Country: United States URL: https://fas.org/sgp/crs/misc/R42593.pdf Shelf Number: 150372 Keywords: Drug Abuse and AddictionDrug Abuse PolicyDrug Abuse PreventionDrug RegulationOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: Minnesota Department of Health Title: Patterns of Opioid Prescribing in Minnesota: 2012 and 2015 Summary: Opioids are a class of drugs that include prescription opioid medications for pain relief - such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and fentanyl- as well as illicitly produced drugs like heroin and fentanyl-related substances (also called fentanyl analogs). While prescription opioids play a role in the management of some types of severe acute, cancer-related and end-of-life pain, increased opioid use since 1990, including for chronic pain unrelated to cancer, has resulted in sharply rising opioid addiction and overdoses, as well as increased healthcare utilization and costs. Recent Centers for Disease Control and Prevention (CDC) guidelines point out the limitations of the evidence base in support of opioid therapy for pain, recommend non-opioid therapy for chronic pain, and emphasize the risks associated with opioid therapy. In Minnesota, opioids-both prescription and illicit-were responsible for 336 overdose deaths in 2015, more than a six-fold increase since 2000. In 2016, opioid use accounted for 395 overdose deaths in Minnesota-a one-year increase of nearly 18 percent. Forty-nine percent of the opioid overdose deaths in Minnesota in 2016 were from prescription opioids. In addition to overdose deaths, opioids play a causal role in other deaths, including automobile accidents. As Minnesota, like other states, struggles with the economic, community and individual impacts of the opioid epidemic, this issue brief looks to bring new empirical evidence specific to Minnesota to discussions about the shape of the problem, contributing factors, and options for addressing them. This issue brief focuses on opioid prescription patterns among Minnesotans with private or public insurance coverage in 2012 and 2015. We explore opioid prescription trends by payer, patients' diagnoses preceding a prescription opioid fill, number of prescribers, and patients' geographic location. The results may offer insights to policy makers and payers about opportunities Key Findings: - Overall rates of opioid prescribing declined in Minnesota from 2012 to 2015, but the morphine milligram equivalents (MME) per prescription increased. - Medicare and Medicaid, where eligibility is determined by age, disability status, and/or income, covered approximately one-third of Minnesotans with general health coverage and accounted for two-thirds of opioid prescriptions filled in 2015. - Nearly one in three Minnesotans with an opioid prescription in 2015 had multiple prescribers. - In both 2012 and 2015, 6 in 10 opioid prescriptions were filled within 15 days of the patient's last medical visit; however, 1 in 10 opioid prescriptions were filled without a medical visit in the past 90 days, suggesting closer patient-prescriber communication or opioid oversight may be needed in some cases. - Prescription opioid use varied across counties. In some counties, prescription opioid use in 2015 was over times the statewide average of 523 MME per resident. to reduce unnecessary use and overuse of prescription opioids. They may also help identify additional analytic questions and contribute to assessments of the impact of policy changes currently debated by the Minnesota Legislature. Details: St. Paul, MN: The Department, 2018. 15p., app. Source: Internet Resource: Accessed May 30, 2018 at: http://www.health.state.mn.us/divs/hpsc/hep/publications/opioidbrief20185.pdf Year: 2018 Country: United States URL: http://www.health.state.mn.us/divs/hpsc/hep/publications/opioidbrief20185.pdf Shelf Number: 150407 Keywords: Drug Abuse and AdditionOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: Ospina, Guillermo Andres Title: Poppies, Opium and Heroin: Production in Colombia and Mexico Summary: Poppy cultivation in Mexico and Colombia is part of a local economy geared almost exclusively toward the illegal market abroad: it is driven by demand for heroin, primarily in the United States. North America, including Canada, is currently experiencing a major humanitarian crisis related to this use and the opioids circulating on this market. To understand the dynamics of this market and to evaluate whether political responses to the phenomenon are appropriate and effective, we present this report on opium poppy cultivation in Mexico and Colombia, which, together with Guatemala, are the poppy-producing countries of Latin America. While it was not possible to include Guatemala in this study, we attempt to provide some relevant information about this Central American country. Because the U.S. government tends to look to producing countries to explain the causes of the emergency situation in its country, it is important to consider the problem from broader and more inclusive perspectives. CONCLUSIONS AND RECOMMENDATIONS Poppy cultivation in Mexico, and, to a lesser extent, Colombia and Guatemala, expanded during the last decade, following the trend in the illegal heroin market in the United States, although official data from drug control organisations are not very reliable, lack clarity with regard to the methodologies used (especially in the case of Colombia), and have often demonstrated contradictions and incoherencies. Poppy cultivation and opium extraction were adopted decades ago by farming communities in the mountains of Mexico and Colombia, and the practice persists despite its illegality and constant efforts at eradication. It is a complementary activity in the family farming economy, providing a source of income that is alternated with food production, manufacturing and local trade to sustain economies that are, in many cases, precarious. Government policies for the control of illicit drug crops in Mexico and Colombia have consisted exclusively of forced eradication, whether manual, by police and military forces, or through aerial spraying with chemicals. In both cases, these strategies are ineffective and counterproductive as they cause the displacement of cultivation to other, more remote areas and harm the affected communities. The U.S. government should recognize the underlying causes of its opiates/opioid crisis which involves an unprecedented number of heroin and fentanyl overdoses. These causes are internal and not the result of the growing flow of heroin from Latin America. In fact, the United States should assume a certain amount of responsibility for the fact that structural failures in public health and control of the pharmaceutical industry have stimulated illegal drug production in Latin America to satisfy growing demand. In no way can farmers in Mexico, Colombia and Guatemala be blamed for the dramatic increase in opioid overdose deaths. Nor can farmers that grow poppies be criminalized for cultivating the plant for subsistence: few real options exist for substituting poppies with alternative crops due to the high price opium currently commands in the market, which is a result of increased demand. Meanwhile, the areas where crops exist are isolated, with little infrastructure and virtually no state presence or assistance. In the case of Colombia, the National Comprehensive Program for the Voluntary Substitution of Illicit Crops (PNIS) created in the context of the peace process never included poppy growers, and to date has focused exclusively on coca crops. The often-mentioned option of redirecting illicit opium production to legal, medicinal uses seems interesting. However, it poses a series of obstacles and dilemmas that are not easy to overcome in the short term. Most importantly, the high prices paid to producers in the current illicit market would be difficult to match with an economic, competitive programme for licit production of medicines. The conversion of illicit production into licit production would not only depreciate farmers' product, but would also be unviable in the international pharmaceutical industry. Meanwhile, demand for heroin for the illegal market, which would compete with production for licit purposes, would continue. Hence, it is difficult to argue that this would provide an economical solution to the scarcity of opiates for medicinal ends, or significantly reduce the illegal heroin market. Even so, the option deserves further study as a short-term alternative for certain communities that currently depend on illicit cultivation, given the absence of other viable options for alternative development and the inefficiency and deleterious consequences of forced eradication. Details: Amsterdam: Transnational Institute, 2018. 40p. Source: Internet Resource: Accessed June 4, 2018 at: https://www.tni.org/files/publication-downloads/poppiesopiumheroin_13042018_web.pdf Year: 2018 Country: Central America URL: https://www.tni.org/files/publication-downloads/poppiesopiumheroin_13042018_web.pdf Shelf Number: 150461 Keywords: Drug Markets Heroin Illegal Drugs Illegal Markets Opioid EpidemicOpium |
Author: Reichert, Jessica Title: Opioid Prescribing in Illinois: Examining Prescription Drug Monitoring Program Data Summary: Almost three times as many opioids are prescribed in the United States today as compared to 1999. Health care practitioners wrote 259 million prescriptions for opioid pain medication in 2012, which is enough to provide a full bottle of pills for almost every adult in the country. An estimated one in five patients with pain symptoms who go to their doctor's office receive an opioid prescription. In a 2015 national survey, 13 percent of adults who report taking prescription opioids also reported misuse (defined as non-medical use). Of those, 41 percent obtained opioids for free from friends or relatives. Illinois opioid prescribing is relatively low compared to other states. According to the Centers for Disease Control and Prevention, Illinois ranked 41st out of 50 states and District of Columbia on opioid prescription totals. However, prescription rates vary greatly by county, city, and medical practitioner. This article describes Illinois opioid prescription practices using Illinois Prescription Monitoring Program (ILPMP) data, focusing on trends and prescribing variations by county. A review of available research on the association between opioid prescribing, opioid misuse, and opioid use disorders also is summarized. Policy and practice implications also are included. Details: Chicago: Illinois Criminal Justice Information Authority, 2018. 21p. Source: Internet Resource: Accessed July 2, 2018 at: http://www.icjia.state.il.us/assets/articles/PMP_Article_050918.pdf Year: 2018 Country: United States URL: http://www.icjia.state.il.us/assets/articles/PMP_Article_050918.pdf Shelf Number: 150756 Keywords: Drug Abuse and AddictionOpioid EpidemicOpioidsPrescription Drug AbusePrescription Drug Monitoring |
Author: Sullivan, Riley Title: The Fiscal Impact of the Opioid Epidemic in the New England States Summary: The rise in the abuse of-and addiction to-opioids and the rapid increase in the number of fatal overdoses in recent years have made the opioid epidemic a priority for local, state, and federal policymakers. Understanding the epidemic's direct fiscal impact is key to acknowledging its scope and magnitude. While opioid abuse has many direct and indirect fiscal costs, few studies quantify them. This report assembles available data on the impact of opioid epidemic on criminal justice, treatment, and related health expenditures in the New England states. The research finds that state governments in the region spend a higher percentage on total opioid-related costs and more per capita than the national averages. Across the region, treating opioid-use disorder-on both an emergency and a long-term basis-accounts for the majority of the costs. Estimates for medical treatment expenditures associated with opioid abuse reach as high as $340 million annually in Massachusetts alone. While providing new insight the author acknowledges that the costs considered in this policy report are incomplete. It's plausible that the opioid epidemic's impact on state revenues is also significant and could affect regional fiscal health. For example, individuals incarcerated for drug crimes or in residential treatment programs are not earning wages. Evidence also suggests that non-institutionalized individuals abusing opioids are more likely out of work than employed, likewise resulting in lost revenue (Krueger 2017). The author plans to conduct further research on opioid abuse's impact on employment and labor force participation, which should contribute to a fuller understanding of the epidemic's fiscal cost to the region. However, beyond the fiscal cost is the toll opioid abuse has taken on individuals, families, and communities. The costs analyzed in this report are just a small part of the greater damage inflicted across the region and the country. Details: Boston: New England Public Policy Center; Federal Reserve Bank of Boston: 2018. 28p. Source: Internet Resource: Policy Report 18-1: Accessed July 9, 2018 at: https://www.bostonfed.org/publications/new-england-public-policy-center-policy-report/2018/the-fiscal-impact-of-the-opioid-epidemic-in-the-new-england-states.aspx#collapse2 Year: 2018 Country: United States URL: https://www.bostonfed.org/publications/new-england-public-policy-center-policy-report/2018/the-fiscal-impact-of-the-opioid-epidemic-in-the-new-england-states.aspx#collapse2 Shelf Number: 150778 Keywords: Cost AnalysisCosts of Criminal JusticeDrug Abuse and AddictionDrug Abuse TreatmentOpioid CrisisOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: Governing Institute Title: Confronting a Crisis: A Practical Guide for Policymakers to Mitigate the Opioid Epidemic Summary: Ninety-one Americans die every day from opioid overdoses. Victims come from all walks of life: a 19-year-old mother of two from Panama City, Fla., a 28-year-old Army sergeant from upstate New York, a 49-year-old juvenile court mediator from Arizona. For some, addiction started in their youth. For others, it began after an injury or surgery when a doctor prescribed opioids for pain. Opioids, a class of drugs that includes everything from prescription medications, like oxycodone, morphine, tramadol and fentanyl, to illegal drugs like heroin, have led to a public health crisis. The addictive nature of opioids and overprescribing are fueling the epidemic. In the last 15 years, the number of opioids prescribed and sold in the U.S. has quadrupled, even though the amount of pain Americans report is the same. Opioids were involved in more than 33,000 deaths in 2015, but the crisis continues to grow. Drug overdose deaths have significantly increased in Massachusetts, Florida, New York, North Carolina, West Virginia and more than a dozen other states. The opioid epidemic is a public health crisis that is tearing families apart and ruining lives. It also puts an incredible burden on government, including law enforcement agencies, justice departments and the foster care system, as children are orphaned or removed from parents and caretakers struggling with addiction. Though some states are taking significant steps to address the problem, they face continuing challenges in preventing future overdoses and addictions. Some experts contend there isn't nearly enough state or federal funding to combat the epidemic. Others say there are so many stakeholders involved that it's difficult to know where to begin to coordinate efforts. However, collaboration among state and local leaders, public health experts, health care providers, insurers and others is critical. There isn't one off-the-shelf solution to curb the epidemic, but policymakers are taking action to address the crisis and save lives. This handbook will detail those efforts and outline other steps policymakers can take to help mitigate the opioid crisis. Details: California: Governing Institute, 2017. 28p. Source: Internet Resource: Accessed November 1, 2018 at: file:///C:/Users/AuthUser/Downloads/GOV17_HANDBOOK_BCBS_V.PDF Year: 2017 Country: United States URL: http://www.governing.com/papers/Confronting-a-Crisis-A-Practical-Guide-for-Policymakers-to-Mitigate-the-Opioid-Epidemic-81958.html Shelf Number: 153137 Keywords: Drug-Related DeathsIllegal DrugsOpioid CrisisOpioid EpidemicPolicy RecommendationsPrescription MedicationPublic Health CrisisSubstance Abuse |
Author: Kilmer, Beau Title: Considering Heroin-Assisted Treatment and Supervised Drug Consumption Sites in the United States Summary: Current levels of opioid-related morbidity and mortality in the United States are staggering. Data for 2017 indicate that there were more than 47,000 opioid-involved overdose deaths, and one in eight adults now reports having had a family member or close friend die from opioids. Increasing the availability and reducing the costs of approved medications for those with an opioid use disorder (OUD) is imperative; however, jurisdictions addressing OUDs and overdose may wish to consider additional interventions. Two interventions that are implemented in some other countries but not in the United States are heroin-assisted treatment (HAT; sometimes referred to as supervised injectable heroin treatment) and supervised consumption sites (SCSs; sometimes referred to as overdose prevention sites). Given the severity of the opioid crisis, there is urgency to evaluate tools that might reduce its impact and save lives. In this mixed-methods report, the authors assess evidence on and arguments made about HAT and SCSs and examine some of the issues associated with implementing them in the United States. Key Findings -- Evidence from randomized controlled trials of HAT in Canada and Europe indicates that supervised injectable HAT - with optional oral methadone - can offer benefits over oral methadone alone for treating OUD among individuals who have tried traditional treatment modalities, including methadone, multiple times but are still injecting heroin. Although heroin cannot be prescribed in the United States because it is a Schedule I drug, it would be legal to conduct a human research trial on HAT. The literature on treating OUD with hydromorphone (e.g., Dilaudid) is less extensive than the literature on HAT; however, the existing results are encouraging. Hydromorphone trials in the United States would face fewer barriers than HAT trials. The scientific evidence about the effectiveness of SCSs is limited in quality and the number of locations evaluated. Many SCSs have been around for 15 to 30 years. Persistence does not imply effectiveness, but it seems unlikely that these SCSs - which were initially controversial in many places - would have such longevity if they had serious adverse consequences for their clients or communities. For drug consumption that is supervised, SCSs reduce the risk of a fatal overdose, disease transmission, and harms associated with unhygienic drug use practices; however, there is uncertainty about the size of the population-level effects of SCSs. There are significant legal issues surrounding the implementation of SCSs in the United States.. Both HAT and SCSs, as currently implemented, serve only a small share of people who use heroin. It is important to have a sense of potential scale limitations and costs when discussing HAT and SCSs. It might be constructive to view HAT and SCSs as exemplars of broader strategies, not as the only option within their class. Recommendations -- Given (1) the increased mortality associated with fentanyl, (2) the fact that some people who use heroin may not respond well to existing medications for OUD, (3) HAT's successful implementation abroad, and (4) questions concerning whether the success would carry over to the United States, HAT trials should be conducted in some of the U.S. jurisdictions that already provide a spectrum of social services and good accessibility to medication treatments for OUD. Conducting trials with HAT and hydromorphone are not mutually exclusive, and it may make sense to include both in the same study, as was done in Canada. Assessing the impact of injectable hydromorphone via clinical trials (with or without a HAT arm) would inform future regulatory decisions about using it as a medication treatment for OUD. Some researchers and advocates believe that, during an emergency like the present opioid crisis, the absence of a large downside risk for an intervention that has strong face validity (e.g., SCSs) may be sufficient for some decisionmakers to proceed, rather than waiting for further evidence. Nevertheless, if attempts to implement SCSs in the United States are successful, a strong research component should be incorporated into these efforts. Details: Santa Monica, CA: RAND, 2018. 93p. Source: Internet Resource: Accessed Dec. 6, 2018 at: https://www.rand.org/pubs/research_reports/RR2693.html?utm_source=WhatCountsEmail&utm_medium=Drug%20Policy%20Research%20Center%20(DPRC)+AEM:%20%20Email%20Address%20NOT%20LIKE%20DOTMIL&utm_campaign=AEM:363632650 Year: 2018 Country: United States URL: https://www.rand.org/pubs/research_reports/RR2693.html?utm_source=WhatCountsEmail&utm_medium=Drug%20Policy%20Research%20Center%20(DPRC)+AEM:%20%20Email%20Address%20NOT%20LIKE%20DOTMIL&utm_campaign=AEM:363632650 Shelf Number: 153920 Keywords: Drug Abuse and AddictionDrug Consumption FacilitiesDrug-Related DeathsFentanylOpioid EpidemicOpioidsPrescription Drug AbuseSubstance Abuse Treatment |
Author: Hedegaard, Holly Title: Drug Overdose Deaths in the United States, 1999-2017 Summary: Key findings -- Data from the National Vital Statistics System, Mortality -- In 2017, there were 70,237 drug overdose deaths in the United States. The age-adjusted rate of drug overdose deaths in 2017 (21.7 per 100,000) was 9.6% higher than the rate in 2016 (19.8). Adults aged 25-34, 35-44, and 45-54 had higher rates of drug overdose deaths in 2017 than those aged 15-24, 55-64, and 65 and over. West Virginia (57.8 per 100,000), Ohio (46.3), Pennsylvania (44.3), and the District of Columbia (44.0) had the highest age-adjusted drug overdose death rates in 2017. The age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) increased by 45% between 2016 and 2017, from 6.2 to 9.0 per 100,000. Deaths from drug overdose continue to be a public health burden in the United States. This report uses the most recent final mortality data from the National Vital Statistics System (NVSS) to update trends in drug overdose deaths, describe demographic and geographic patterns, and identify shifts in the types of drugs involved. Details: Hyattsville, MD: National Center for Health Statistics. 2018. 8p. Source: Internet Resource: NCHS Data Brief, No. 329: Accessed Dec. 7, 2018 at: https://www.cdc.gov/nchs/data/databriefs/db329-h.pdf Year: 2018 Country: United States URL: https://www.cdc.gov/nchs/data/databriefs/db329-h.pdf Shelf Number: 153940 Keywords: Drug Abuse and Addiction Drug-Related Deaths Opioid Crisis Opioid Epidemic |
Author: Harris, Katharine Neill Title: The Drug Overdose Epidemic: Not Just about Opioids Summary: The rise in opioid-related overdose deaths in the last two decades is widely regarded as an epidemic that originated with the overprescribing of prescription pain relievers in the late 1990s. But a research study published in the September issue of Science suggests that the opioid overdose crisis is actually part of a larger trend that started 40 years ago. In the study, researchers mapped drug overdose deaths in the U.S. from 1979 through 2016. The authors analyzed data from the National Vital Statistics System on 599,255 deaths in which the main cause of death was listed as accidental drug poisoning. The authors found that drug overdose fatalities have been increasing dramatically since 1979, stating that "this exponentially increasing mortality rate has tracked along a remarkably smooth trajectory for at least 38 years," suggesting that "the current wave of opioid overdose deaths may just be the latest manifestation of a more fundamental longer term process." Within this broad trend of steady growth, there is significant variation in terms of the specific drugs involved and the populations most affected by drug overdose deaths. Currently, the population most at risk for cocaine overdose is aging black males living in urban counties, while methamphetamine-related deaths skew toward white and rural male populations. For opioid-related deaths, age is a defining feature of variation in risk patterns. Deaths involving heroin and synthetic opioids are higher for people between the ages of 20 and 40, especially white males living in urban counties. In contrast, prescription opioid deaths are higher among those 40 to 60 years old, especially white females living in rural counties. Nearly every region of the country, except for the northern Midwest, has been a "hot spot" for drug overdose deaths in the last few years. Despite some limitations, this analysis provides strong evidence for the existence of a protracted drug epidemic that requires both immediate and long-term interventions. The finding that the relatively recent increase in opioid-specific overdoses may be a particularly intense manifestation of a more persistent problem implies that a major feature of the government response to opioid-involved overdoses - restricting the supply of prescription painkillers - does little to stem the overall uptick in drug-related fatalities. The fact that the increase in overdose deaths has remained constant despite varying trends for specific drugs also suggests that factors often thought to drive the overdose epidemic, such as a rise in drug use or an overabundant drug supply, are not sufficient explanations. Details: Houston, TX: Rice University's Baker Institute for Public Policy, 2018. 5p. Source: Internet Resource: Accessed December 17, 2018 at: https://www.bakerinstitute.org/media/files/files/dc464f15/bi-brief-110118-drug-overdoseepidemic.pdf Year: 2018 Country: United States URL: https://www.bakerinstitute.org/media/files/files/dc464f15/bi-brief-110118-drug-overdoseepidemic.pdf Shelf Number: 153877 Keywords: Cocaine Drug OverdoseDrug UseMethamphetamineOpioid EpidemicOpioidsPrescription Drug AbuseRural CrimeSubstance Abuse |
Author: Ghandnoosh, Nazgol Title: Opioids: Treating an Illness, Ending a War Summary: More people died from opioid-related deaths in 2015 than in any previous year. This record number quadrupled the level of such deaths in 1999. Unlike the heroin and crack crises of the past, the current opioid emergency has disproportionately affected white Americans-poor and rural, but also middle class or affluent and suburban. This association has boosted support for preventative and treatment-based policy solutions. But the pace of the response has been slow, critical components of the solution-such as health insurance coverage expansion and improved access to medication-assisted treatment-face resistance, and there are growing efforts to revamp the failed and costly War on Drugs. Details: Washington, DC: The Sentencing Project, 2018. 32p. Source: Internet Resource: Accessed January 24, 2019 at: https://www.sentencingproject.org/publications/opioids-treating-illness-ending-war/ Year: 2018 Country: United States URL: https://www.sentencingproject.org/publications/opioids-treating-illness-ending-war/ Shelf Number: 154399 Keywords: Drug Abuse and AddictionDrug Abuse and CrimeOpioid EpidemicOpioidsPrescription Drugs |
Author: Le Cour Grandmaison, Romain Title: No More Opium for the Masses: From the U.S. Fentanyl Boom to the Mexican Opium Crisis: Opportunitiee Amidst Violence? Summary: This report examines the effects of the upsurge in U.S. fentanyl use on opium producing areas in Mexico. By using available quantitative data on Mexican opium production as well as qualitative field research from opium producing communities in Nayarit and Guerrero, this paper offers valuable insights into Mexico's illicit drug trade. In particular, this paper demonstrates the extent to which certain villages in the Golden Triangle, but also in Guerrero, Nayarit, and Oaxaca rely on opium production for survival. The authors estimate that the opium economy channeled around 19 billion pesos ($1 billion dollars) to some of the poorest communities in Mexico in 2017. This is a vast amount, nearly three times the total legal agricultural output of the entire state of Guerrero. Up to around 2017, opium growers in Mexico were earning around 20,000 pesos ($1,050 dollars) a kilo of raw opium, and families could bring in up to 200,000 pesos ($10,500 dollars) per year. With the upsurge in fentanyl use, the demand for Mexican heroin has fallen sharply, by an estimated 7 billion pesos ($364 million dollars). This has had an immediate knock-on for opium producers. Farmers are now being paid around 6000 to 8000 pesos ($315 - 415 dollars) per kilo of raw opium. These losses have caused farmers' profits to disappear, village economies to dry up; and out-migration to increase. These findings have important implications for public security in Mexico, as well as major ramifications for international counter-drug efforts. Criminal groups in Mexico are nothing if not supple and adaptable to change. If current trends continue in the coming years, such groups may continue to dominate poppy-growing regions through other industries including illegal logging, illegal mining or the production of synthetic drugs. While legalization and crop substitution have been touted as possible alternatives, these should not be conceived of as silver bullets. However, if properly researched and managed, both policies could be introduced relatively cheaply and effectively. Initially at least, they would loosen the grip of organized crime groups on the regions and tie farmers to licit international markets. Combined with other broader security policies, they could integrate these marginalized areas into the country for good. Resolving this crisis requires further in-depth, policy-focused research in Mexico. It is urgent to design policies that are based on solid, updated knowledge about local dynamics of violence in the country. Any political response must be based on further research and diagnosis, conducted in the most critical opium producing regions of the country. Mexican government officials and international aid agencies should work to strengthen programs to promote long-term crop-substitution and economic development opportunities. Such policies are urgently needed to encourage local agricultural producers to focus on legitimate, locally sustainable crops and alternative industries. Recent proposals to legalize opium for the pharmaceutical industry should be considered seriously. Yet, legalization would only solve a one part of the issue, since Mexican demand for legal opioids is massively lower than the country's current illegal production. Hence, the solution must be articulated both at the national and international level, in order to tackle supply and demand simultaneously. Details: s.l.: Noria Research, Washington, DC: Mexico Institute at the Wilson Center. 2019. 35p. Source: Internet Resource: Accessed February 14, 2019 at: https://www.noria-research.com/app/uploads/2019/02/NORIA_OPIUM_MEXICO_CRISIS_PRO-1.pdf Year: 2019 Country: Mexico URL: https://www.noria-research.com/app/uploads/2019/02/NORIA_OPIUM_MEXICO_CRISIS_PRO-1.pdf Shelf Number: 154601 Keywords: FentanylIllegal DrugsIllicit Drug TradeOpioid EpidemicOpioidsOpiumOrganized Crime |
Author: Maksabedian Hernandez, Ervant J. Title: Increasing Access to Medication-Assisted Treatment for Opioid Use Disorders: Estimating Costs, Supply, and the Effects of Insurance Expansions Summary: Drug overdose deaths in America exceeded 50,000 in 2015, claiming more lives annually than gun violence and motor vehicle accidents. Of these, more than 63% of overdose deaths were due to opioids. Medication-assisted treatment is regarded as the most effective form of treatment for those struggling with an opioid use disorder. However, medication costs and insurance coverage remain identified barriers to treatment. My dissertation measures access to buprenorphine, the fastest growing form of medication-assisted treatment, and the effects of demand side interventions aiming to tackle the opioid problem in America. While some supply side interventions have mixed effectiveness or unintended consequences potentially exacerbating the problem, demand side interventions may be more effective in reducing overall demand for opioids and opioid-related deaths. Insurance expansions, such as the federal insurance parity law of 2008 or the 2014 Medicaid expansions associated with the Affordable Care Act, could have increased access to treatment. The three main insights from this dissertation are: 1) who pays for the medication matters when considering the average cost of buprenorphine maintenance treatment. Patients with public insurance have lower buprenorphine costs compared to those paying with cash-only or with commercial insurance. 2) The federal parity law for substance use disorders (MHPAEA) did not increase access to medication-assisted treatment for opioid use disorders. 3) Out-of-pocket costs for prescription opioids have decreased dramatically while costs for buprenorphine have not declined at similar pace, thus complicating access for those with an opioid use disorder. Efforts by Congress to push commercial insurers to expand coverage for addiction services have not led to lower costs for opioid treatment, unlike the experience among those with public insurance. Policymakers need to look for other ways to get commercial insurers to lower costs, particularly if further health care reform leads to a reduction in Medicaid funding and enrollment. Details: Santa Monica, CA: RAND, 2017. 125p. Source: Internet Resource: Dissertation: Accessed March 12, 2019: https://www.rand.org/pubs/rgs_dissertations/RGSD404.html Year: 2017 Country: United States URL: https://www.rand.org/pubs/rgs_dissertations/RGSD404.html Shelf Number: 154927 Keywords: Cost of InsuranceDrug Overdose DeathsMedical InsuranceOpioid EpidemicOpioidsPrescription Drug AbuseSubstance Abuse Treatment |
Author: McKendy, Laura Title: Overdose Incidents in Federal Custody, 2012/2013 - 2016/2017 Summary: The rise of drug overdose incidents, specifically those involving opioids, is a growing concern for Canadian society (British Columbia Coroners Service Death Review Panel, 2018; Special Advisory Committee on the Epidemic of Opioid Overdoses, 2018; Health Canada, 2017). While numerous reports have documented trends in the community, limited detailed data is available on trends in overdose incidents among custodial populations. This report furthers knowledge on this topic by examining all overdose incidents in federal custody over a five-year period (2012/2013 - 2016/2017), identifying the prevalence and nature of overdose incidents, the circumstances under which overdose incidents occur, the characteristics of offenders who experience overdose incidents, and patterns in the nature of staff and medical responses. Over the five-year period under examination, 330 incidents were identified for analysis. Most of these overdose incidents were unintentional and non-fatal. More specifically, over three-quarters of cases (77%) were identified as unintentional non-fatal overdose incidents, 15% were intentional non-fatal overdose incidents, and 7% were identified as fatal overdose incidents, either intentional or non-intentional. Overdose incidents have seen a notable increase in the Prairie region; in 2016/2017, 48% (42) of all overdose incidents occurred in this region, compared to 20% (8) in 2012/2013. In terms of the substances involved in overdose incidents, differences were observed across incident types. Opioids were most common in fatal overdoses and unintentional non-fatal overdose incidents, accounting for 91% and 57% of incidents respectively. Contrastingly, intentional nonfatal overdose incidents seldom involved opioids and most often involved prescription medications (e.g., anticonvulsants, antidepressants, cardiovascular medications), identified in 85% of cases. Over the five-year period examined, overdose incidents involving opioids increased in raw numbers (from 19 in 2012/2013 to 50 in 2016/2017), with a moderate increase as a percentage of all overdose incidents (from 48% to 57%). Notably, the percentage of those involving fentanyl increased from 3% (1) in 2012/2013, to 26% (23) in 2016/2017. At the same time, the percentage of overdose incidents involving heroin decreased from 25% (10) in 2012/2013, to 13% (11) in 2016/2017. When it came to fatal overdose incidents, fentanyl was the most common substance found, noted in 36% (8) of cases across the five-year period. While variation exists, certain characteristics were common among offenders who overdosed. They tended to be male (92%), Caucasian (58%) or Indigenous (36%), aged 25-34 (39%), classified as medium security (72%), serving relatively short (under 4 year) sentences (41%), with a major index offence of robbery (31%). Offenders typically had institutional histories riddled with security and discipline incidents, particularly incidents involving drugs, other contraband (excluding tobacco), and disobedience. Indigenous offenders were involved in 119 (36%) of overdose incidents over the five-year period examined. Indigenous representation was highest in the Pacific region (46%) and was higher The rise of drug overdose incidents, specifically those involving opioids, is a growing concern for Canadian society (British Columbia Coroners Service Death Review Panel, 2018; Special Advisory Committee on the Epidemic of Opioid Overdoses, 2018; Health Canada, 2017). While numerous reports have documented trends in the community, limited detailed data is available on trends in overdose incidents among custodial populations. This report furthers knowledge on this topic by examining all overdose incidents in federal custody over a five-year period (2012/2013 - 2016/2017), identifying the prevalence and nature of overdose incidents, the circumstances under which overdose incidents occur, the characteristics of offenders who experience overdose incidents, and patterns in the nature of staff and medical responses. Over the five-year period under examination, 330 incidents were identified for analysis. Most of these overdose incidents were unintentional and non-fatal. More specifically, over three-quarters of cases (77%) were identified as unintentional non-fatal overdose incidents, 15% were intentional non-fatal overdose incidents, and 7% were identified as fatal overdose incidents, either intentional or non-intentional. Overdose incidents have seen a notable increase in the Prairie region; in 2016/2017, 48% (42) of all overdose incidents occurred in this region, compared to 20% (8) in 2012/2013. In terms of the substances involved in overdose incidents, differences were observed across incident types. Opioids were most common in fatal overdoses and unintentional non-fatal overdose incidents, accounting for 91% and 57% of incidents respectively. Contrastingly, intentional nonfatal overdose incidents seldom involved opioids and most often involved prescription medications (e.g., anticonvulsants, antidepressants, cardiovascular medications), identified in 85% of cases. Over the five-year period examined, overdose incidents involving opioids increased in raw numbers (from 19 in 2012/2013 to 50 in 2016/2017), with a moderate increase as a percentage of all overdose incidents (from 48% to 57%). Notably, the percentage of those involving fentanyl increased from 3% (1) in 2012/2013, to 26% (23) in 2016/2017. At the same time, the percentage of overdose incidents involving heroin decreased from 25% (10) in 2012/2013, to 13% (11) in 2016/2017. When it came to fatal overdose incidents, fentanyl was the most common substance found, noted in 36% (8) of cases across the five-year period. While variation exists, certain characteristics were common among offenders who overdosed. They tended to be male (92%), Caucasian (58%) or Indigenous (36%), aged 25-34 (39%), classified as medium security (72%), serving relatively short (under 4 year) sentences (41%), with a major index offence of robbery (31%). Offenders typically had institutional histories riddled with security and discipline incidents, particularly incidents involving drugs, other contraband (excluding tobacco), and disobedience. Indigenous offenders were involved in 119 (36%) of overdose incidents over the five-year period examined. Indigenous representation was highest in the Pacific region (46%) and was higher The rise of drug overdose incidents, specifically those involving opioids, is a growing concern for Canadian society (British Columbia Coroners Service Death Review Panel, 2018; Special Advisory Committee on the Epidemic of Opioid Overdoses, 2018; Health Canada, 2017). While numerous reports have documented trends in the community, limited detailed data is available on trends in overdose incidents among custodial populations. This report furthers knowledge on this topic by examining all overdose incidents in federal custody over a five-year period (2012/2013 - 2016/2017), identifying the prevalence and nature of overdose incidents, the circumstances under which overdose incidents occur, the characteristics of offenders who experience overdose incidents, and patterns in the nature of staff and medical responses. Over the five-year period under examination, 330 incidents were identified for analysis. Most of these overdose incidents were unintentional and non-fatal. More specifically, over three-quarters of cases (77%) were identified as unintentional non-fatal overdose incidents, 15% were intentional non-fatal overdose incidents, and 7% were identified as fatal overdose incidents, either intentional or non-intentional. Overdose incidents have seen a notable increase in the Prairie region; in 2016/2017, 48% (42) of all overdose incidents occurred in this region, compared to 20% (8) in 2012/2013. In terms of the substances involved in overdose incidents, differences were observed across incident types. Opioids were most common in fatal overdoses and unintentional non-fatal overdose incidents, accounting for 91% and 57% of incidents respectively. Contrastingly, intentional nonfatal overdose incidents seldom involved opioids and most often involved prescription medications (e.g., anticonvulsants, antidepressants, cardiovascular medications), identified in 85% of cases. Over the five-year period examined, overdose incidents involving opioids increased in raw numbers (from 19 in 2012/2013 to 50 in 2016/2017), with a moderate increase as a percentage of all overdose incidents (from 48% to 57%). Notably, the percentage of those involving fentanyl increased from 3% (1) in 2012/2013, to 26% (23) in 2016/2017. At the same time, the percentage of overdose incidents involving heroin decreased from 25% (10) in 2012/2013, to 13% (11) in 2016/2017. When it came to fatal overdose incidents, fentanyl was the most common substance found, noted in 36% (8) of cases across the five-year period. While variation exists, certain characteristics were common among offenders who overdosed. They tended to be male (92%), Caucasian (58%) or Indigenous (36%), aged 25-34 (39%), classified as medium security (72%), serving relatively short (under 4 year) sentences (41%), with a major index offence of robbery (31%). Offenders typically had institutional histories riddled with security and discipline incidents, particularly incidents involving drugs, other contraband (excluding tobacco), and disobedience. Indigenous offenders were involved in 119 (36%) of overdose incidents over the five-year period examined. Indigenous representation was highest in the Pacific region (46%) and was higher The rise of drug overdose incidents, specifically those involving opioids, is a growing concern for Canadian society (British Columbia Coroners Service Death Review Panel, 2018; Special Advisory Committee on the Epidemic of Opioid Overdoses, 2018; Health Canada, 2017). While numerous reports have documented trends in the community, limited detailed data is available on trends in overdose incidents among custodial populations. This report furthers knowledge on this topic by examining all overdose incidents in federal custody over a five-year period (2012/2013 - 2016/2017), identifying the prevalence and nature of overdose incidents, the circumstances under which overdose incidents occur, the characteristics of offenders who experience overdose incidents, and patterns in the nature of staff and medical responses. Over the five-year period under examination, 330 incidents were identified for analysis. Most of these overdose incidents were unintentional and non-fatal. More specifically, over three-quarters of cases (77%) were identified as unintentional non-fatal overdose incidents, 15% were intentional non-fatal overdose incidents, and 7% were identified as fatal overdose incidents, either intentional or non-intentional. Overdose incidents have seen a notable increase in the Prairie region; in 2016/2017, 48% (42) of all overdose incidents occurred in this region, compared to 20% (8) in 2012/2013. In terms of the substances involved in overdose incidents, differences were observed across incident types. Opioids were most common in fatal overdoses and unintentional non-fatal overdose incidents, accounting for 91% and 57% of incidents respectively. Contrastingly, intentional nonfatal overdose incidents seldom involved opioids and most often involved prescription medications (e.g., anticonvulsants, antidepressants, cardiovascular medications), identified in 85% of cases. Over the five-year period examined, overdose incidents involving opioids increased in raw numbers (from 19 in 2012/2013 to 50 in 2016/2017), with a moderate increase as a percentage of all overdose incidents (from 48% to 57%). Notably, the percentage of those involving fentanyl increased from 3% (1) in 2012/2013, to 26% (23) in 2016/2017. At the same time, the percentage of overdose incidents involving heroin decreased from 25% (10) in 2012/2013, to 13% (11) in 2016/2017. When it came to fatal overdose incidents, fentanyl was the most common substance found, noted in 36% (8) of cases across the five-year period. While variation exists, certain characteristics were common among offenders who overdosed. They tended to be male (92%), Caucasian (58%) or Indigenous (36%), aged 25-34 (39%), classified as medium security (72%), serving relatively short (under 4 year) sentences (41%), with a major index offence of robbery (31%). Offenders typically had institutional histories riddled with security and discipline incidents, particularly incidents involving drugs, other contraband (excluding tobacco), and disobedience. Indigenous offenders were involved in 119 (36%) of overdose incidents over the five-year period examined. Indigenous representation was highest in the Pacific region (46%) and was higher among women (52%) relative to men (35%). Overdose incidents involving Indigenous offenders were somewhat less likely to involve opioids compared to incidents involving non-Indigenous offenders (45% versus 56%). Over the five-year period examined, 21 overdose incidents occurred involving women; all were non-fatal and most (71%) were unintentional. Overdose incidents involving women typically involved prescription medications (86%), while none involved opioids. Overdose incidents involving women were most common in the Ontario and Pacific regions; nine incidents (43% of all cases) occurred in both of these regions. All women involved in overdose incidents had an identified mental health disorder, while 95% (20) had histories of substance abuse. Overall, overdose incidents tended to occur when offenders were well into their sentence. At the time of incident, offenders had served, on average, 41% of their current sentence, or an average of 4.9 years. The average length of time between the most recent admission date and incident date was 3.2 years. However, variation was observed across incident type; those involved in fatal incidents had served more time (7.8 years) and had been out of the community longer (4.5 years) compared to those involved in non-fatal incidents. In terms of potential risk factors, offenders involved in overdose incidents often had histories of substance misuse and mental illness. More specifically, 95% of offenders had issues related to drugs, while 54% had issues with alcohol. In 81% of cases, substance misuse was identified as a factor linked to criminal offending. Mental illness was particularly common among those involved in intentional non-fatal overdose incidents; 92% had at least one mental health disorder identified, while 89% had histories of self-injurious/suicidal behaviour. A disproportionate number of incidents occurred at a single medium security men's institution in the Prairie region, Drumheller Institution. An institutional-level analysis suggests that the experience of Drumheller is more closely tied to the opioid crisis in the community; over threequarters (77%) of overdose incidents at Drumheller Institution involved opioids, compared to 47% at all other institutions. Fentanyl was identified in 34% of overdose incidents at Drumheller, compared to 8% at all other institutions. Overall, the number of overdose incidents at Drumheller increased from five incidents in 2012/2013, to 25 in 2016/2017. Despite a higher number of overdose incidents, Drumheller had a smaller percentage of deaths (i.e. 2%) and much higher usage of naloxone. The medication, which can temporarily reverse an opioid overdose, was used in 91% of cases at Drumheller, compared to 34% at all other institutions. The findings outlined in this report suggest that the community opioid crisis may be paralleled in custodial settings. As this crisis continues to affect the federal offender population, CSC remains committed to efforts to curb prison drug use and reduce the likelihood of overdose incidents. The widespread availability of naloxone in institutions, as well as CSC's take-home naloxone kit program, Opioid Substitution Treatment (OST) program, substance misuse programs, and the Prison Needle Exchange Program (PNEP), constitute efforts to reduce the potential harms associated with drug use and improve offender health outcomes. This report will further assist in CSC's goal of achieving safe custodial environments by contributing to knowledge on recent trends surrounding fatal and non-fatal drug overdose incidents in custody. Details: Ottawa: Correctional Service of Canada, 2018. 62p. Source: Internet Resource: No. SR-28-02: Accessed April 2, 2019 at: https://www.csc-scc.gc.ca/research/092/sr-18-02-en.pdf Year: 2019 Country: Canada URL: https://www.csc-scc.gc.ca/research/092/sr-18-02-en.pdf Shelf Number: 155268 Keywords: Drug Abuse and AddictionDrug OffendersDrug OverdoseDrug-Related DeathsIn-Custody DeathsOpioid EpidemicOpioidsPrison Deaths |
Author: Martin, William Title: Marijuana as Medicine Summary: Texas legislators are considering 17 bills in the 2019 session dealing with medical cannabis. In the report below, the authors explain how the regulated and safe provision of medical cannabis to people with demonstrated need would offer justified relief, help reduce the opioid epidemic, and save Texas millions of dollars. Details: Houston, TX: James A. Baker II Institute for Public Policy of Rice University, 2019. 11p. Source: Internet Resource: Accessed May 2, 2019 at: https://www.bakerinstitute.org/media/files/files/85a60a0f/bi-report-041519-drug-mjmed.pdf Year: 2019 Country: United States URL: https://www.bakerinstitute.org/media/files/files/85a60a0f/bi-report-041519-drug-mjmed.pdf Shelf Number: 155597 Keywords: Marijuana Medical Marijuana Opioid Epidemic |