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Date: November 22, 2024 Fri
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Results for opioid crisis
10 results foundAuthor: Eisen, Lauren-Brooke Title: Criminal Justice: An Election Agenda for Candidates, Activists, and Legislators Summary: This report sets forth an affirmative agenda to end mass incarceration in America. The task requires efforts from both federal and state lawmakers. Today, criminal justice reform stands on a knife's edge. After decades of rising incarceration and ever more obvious consequences, a powerful bipartisan movement has emerged. It recognizes that harsh prison policies are not needed to keep our country safe. Now that extraordinary bipartisan consensus is challenged by the Trump administration, through inflammatory rhetoric and unwise action. Only an affirmative move to continue reform can keep the progress going. The United States has less than five percent of the world's population, but nearly one quarter of its prisoners. About 2.1 million people are incarcerated in this country, the vast majority in state and local facilities. Mass incarceration contributes significantly to the poverty rate. It is inequitable, placing a disproportionate burden on communities of color. It is wildly expensive, in some cases costing more to keep an 18-year-old in prison than it would to send him to Harvard. Our criminal justice system costs $270 billion annually, yet does not produce commensurate public safety benefits. Research conclusively shows that high levels of imprisonment are simply not necessary to protect communities. About four out of every ten prisoners are incarcerated with little public safety justification. In fact, 27 states have reduced both imprisonment and crime in the last decade. A group of over 200 police chiefs, prosecutors, and sheriffs has formed, whose founding principles state: "We do not believe that public safety is served by a return to tactics that are overly punitive without strong purpose . . . we cannot incarcerate our way to safety." In cities, states, and at the federal level, Republicans and Democrats have joined this effort. They recognize that today's public safety challenges demand new and innovative politics rooted in science and based on what works. The opioid epidemic, mass shootings, and cyber-crime all require modern responses that do not repeat mistakes of the past. Crime is no longer a wedge issue, and voters desire reform. A 2017 poll from the Charles Koch Institute reveals that 81 percent of Trump voters consider criminal justice reform important. Another, from Republican pollster Robert Blizzard, finds that 87 percent of Americans agree that nonviolent offenders should be sanctioned with alternatives to incarceration. And according to a 2017 ACLU poll, 71 percent of Americans support reducing the prison population - including 50 percent of Trump voters. But the politician with the loudest megaphone has chosen a different, destructive approach. Donald Trump, and his Attorney General Jeff Sessions, falsely insist there is a national crime wave, portraying a country besieged by crime, drugs, and terrorism - "American carnage," as he called it in his inaugural address. But, crime in the United States remains at historic lows. While violent crime and murder did increase in 2015 and 2016, new data show crime and violence declining again in 2017. The national murder rate is approximately half of what it was at its 1991 peak. Those who seek to use fear of crime for electoral gain are not just wrong on the statistics; they are also wrong on the politics. Now, to continue the progress that has been made, it is up to candidates running for office to boldly advance policy solutions backed by facts, not fear. This report offers reforms that would keep crime low, while significantly reducing incarceration. Most solutions can be enacted through federal or state legislation. While most of the prison population is under control of state officials, federal policy matters too. The federal government's prison population is larger than that of any state. Further, Washington defines the national political conversation on criminal justice reform. And although states vary somewhat in their approach to criminal justice, they struggle with similar challenges. The state solutions in this report are broadly written as "models" that can be adapted. Steps to take include: Eliminating Financial Incentives for Incarceration Enacting Sentencing Reform Passing Sensible Marijuana Reform Improving Law Enforcement Responding to the Opioid Crisis Reducing Female Incarceration Details: New York: Brennan Center for Justice at New York University School of Law, 2018. 60p. Source: Internet Resource: Solutions 2018: Accessed April 5, 2018 at: https://www.brennancenter.org/sites/default/files/publications/Criminal_Justice_An_Election_Agenda_for_Candidates_Activists_and_Legislators%20.pdf Year: 2018 Country: United States URL: https://www.brennancenter.org/sites/default/files/publications/Criminal_Justice_An_Election_Agenda_for_Candidates_Activists_and_Legislators%20.pdf Shelf Number: 149699 Keywords: Criminal Justice PolicyCriminal Justice ReformMass IncarcerationOpioid CrisisSentencing Reform |
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: Wartell, Julie Title: Prescription Drug Fraud and Misuse. 2nd edition Summary: This guide describes the problem of prescription drug fraud and misuse and reviews some of the factors that increase their risks. It then identifies a series of questions to help you analyze your local problem. Finally, it reviews responses to the problem, and what is known about them from evaluative research and police practice, For the purposes of this guide, prescription drug fraud, which falls under the broader heading of pharmaceutical diversion, is defined as the illegal acquisition of prescription drugs for personal use or profit. This definition excludes theft, burglary, backdoor pharmacies, and illegal importation or distribution of prescription drugs. This guide also discusses common forms of prescription drug diversion, as not all cases of diversion are fraudulent. For example, sharing medication and taking medication without permission are not acts categorized as fraudulent yet still warrant police attention. The related issue of prescription misuse and addiction is also covered, as many offenders become addicted and begin more widespread use through illegally obtaining prescription drugs from family and friends. "Backdoor pharmacies" are businesses not licensed/authorized to distribute pharmaceutical drugs. Prescription drug fraud and misuse is but one aspect of the larger set of problems related to the unlawful use of controlled substances. This guide is limited to addressing the particular harms created by prescription fraud and misuse. Details: Washington, DC: U.S. Department of Justice, Office of Community Oriented Policing Services, 2013. 72p. Source: Internet Resource: Problem-Specific Guides Series Problem-Oriented Guides for Police, no. 24: Accessed May 23, 2018 at: https://ric-zai-inc.com/Publications/cops-p257-pub.pdf Year: 2013 Country: United States URL: https://ric-zai-inc.com/Publications/cops-p257-pub.pdf Shelf Number: 130303 Keywords: Drug Abuse and AddictionOpioid CrisisOpioidsPrescription Drug FraudPrescription Drugs |
Author: New Jersey. Commission of Investigation Title: Corrupt Commerce: Heroin, Thievery and the Underground Trade in Stolen Goods Summary: In two years, he burned through an $800,000 inheritance, lost his home and allowed his family business to die. Desperate and broke, he found a lucrative new way to fund the heroin addiction that consumed his fortune and his life: stolen metal. He tore wire and copper pipe from buildings. He heaved manhole covers from the streets, ripped storm drains from parking lots, pulled heavy metal pins from construction barriers. Then, in an old sedan weighed down nearly to the pavement, he routinely took his haul to a booming scrap yard linked to organized crime in Hillsborough, Somerset County. There, the owner and employees readily bought the stolen metal for cash, no questions asked, not a word to the police. A hundred miles to the south, a young woman hit upon her own way to remedy the dopesickness that dictated her daily rhythms. She led a crew that shoplifted more than $100,000 in goods from major retail chains, then returned the items for gifts cards in the amount of the stolen merchandise. She sold those cards for 50 cents on the dollar to willing businesses across South Jersey. Again, no questions asked, no alert about suspicious behavior. The State Commission of Investigation has found that these circumstances are emblematic of a corrupt and enduring commerce in New Jersey's lightly regulated and often lawless world of scrap yards, pawn shops, cash-for-gold outlets and secondhand goods operations. Driven largely by the heroin and opioid epidemic, this shadowy underground economy is being exploited for profit across the state by convicted felons and elements of organized crime. In business after business, Commission investigators identified owners and employees with extensive criminal histories, including convictions for fraud, burglary, receiving stolen property, assault, firearms violations, narcotics distribution and racketeering. The SCI found evidence of drug-dealing directly from the counter at one shop, the illegal sale of handguns at another and links to a mob-related loansharking scheme at a third. At those locations and others, investigators found that owners and employees regularly accepted stolen goods, from jewelry to power tools, and in some cases directed customers to steal in-demand items likely to maximize profits upon resale. Collectively, the Commission estimates, the businesses have bought and sold tens of millions of dollars in stolen goods in recent years. This thriving marketplace, operating with little oversight or accountability, incentivizes theft and promotes destructive acts against both public and private infrastructure, putting residents in jeopardy. The widespread plundering of copper wiring and heavy-duty backup batteries from cell phone towers undermines cellular service during power outages. The theft of wire that transmits signals along train tracks delays commuters, requires costly repairs and strains an already overtaxed transit system. The removal of electricity-conducting wire from utility substations compromises the power grid. Little is off limits. Scrap hunters have ripped the risers from bleachers at schools, made off with aluminum street lamps from highways and stolen bronze vases from graves. The enormous costs of the illicit bargain between thieves and unscrupulous owners are borne by all New Jerseyans: the ratepayers who see higher bills for cell service and electricity; the consumers who pay more for goods at retail stores; the taxpayers ultimately responsible for replacing infrastructure that has vanished in the night. By providing an easy route for drug addicts and opportunists to cash in on stolen metal and merchandise, these enterprises have helped spawn an endless cycle of theft, one that law enforcement cannot keep pace with, much less end, without a muscular response from the State. The Commission carried out this investigation in keeping with its 50-year-old statutory mandate to identify and expose corruption, to highlight government laxity and gaps in oversight, to determine the effectiveness of New Jersey's laws and to inform the Governor, the Legislature, the Attorney General and the public about the influence and intrusion of organized crime. In particular, the findings set forth in this report build upon groundbreaking investigative work dating back nearly a decade when the SCI became one of the first agencies of government to identify the burgeoning opioid and heroin epidemic. Over the course of this inquiry, SCI investigators issued scores of subpoenas, analyzed banking records and conducted more than 100 interviews with law enforcement officers, metal recyclers, state and municipal officials, representatives of the telecommunications and retail industries, and the owners and employees of outfits engaged in suspect or illegal behavior. Just as significantly, the SCI interviewed those with the clearest view of interactions with these businesses: the addicts and former addicts who carried out thefts for drug money. SCI agents also conducted surveillance at suspect establishments and, in cooperation with police departments and confidential sources, participated in sting operations at scrap yards and secondhand goods stores. In those cases, items purchased by the Commission or lawfully obtained from utilities, phone companies and retail stores were sold to owners or employees with the fictive understanding the items had been stolen. The inquiry found that state and municipal regulations governing these businesses are scattershot, inadequate and unevenly enforced. The State licenses traditional pawn shops, which provide collateral-based loans, while municipalities license cash-for-gold shops, secondhand goods stores and scrap yards. Ordinances vary widely in strength and effectiveness from municipality to municipality. Laws governing some aspects of the businesses have proven to be window dressing, too minimal in scope and so erratically enforced they have failed to deter the prodigious flow of stolen goods. Equally troubling, SCI investigators found that many owners regularly flout the few rules that apply to them with little or no consequence. In some towns, the Commission found, law enforcement officials were unaware their governing bodies had passed ordinances giving police the means to crack down on the businesses - a breakdown in communication and coordination that has sapped accountability. The Commission is mindful that pawn outlets, secondhand goods stores and scrap metal recyclers contribute to the tax base in their communities and provide services helpful to the public. Local scrap yards are building blocks in the international commerce of recycled metal. In addition, not all owners and employees operate flagrantly outside the bounds of decency and the law. But in the absence of meaningful oversight, far too many of these operations have been subverted by criminal activity. The Commission recommends the State take the lead in licensing and regulating these industries. As the Legislature in recent decades has moved to root out organized crime from New Jersey's trash-hauling companies and casinos, so, too, should the State ban mob associates and those with extensive criminal records from trades that remain obvious and attractive pathways for the disposal of stolen property. Further, the Commission recommends requiring owners and employees to record all transactions in an online database accessible by law enforcement. Two such databases are already in use in neighboring states and in a minority of New Jersey municipalities, allowing investigators to more efficiently track sales, identify trends, find stolen merchandise and hold dishonest owners and employees accountable. Details: Trenton: The Commission, 2018. 108p. Source: Internet Resource: Accessed June 21, 2018 at: https://www.nj.gov/sci/pdf/Stolen%20Goods%20Report%20Final.pdf Year: 2018 Country: United States URL: https://www.nj.gov/sci/pdf/Stolen%20Goods%20Report%20Final.pdf Shelf Number: 150626 Keywords: Illegal TradeMetal TheftNarcoticsOpioid CrisisOrganized CrimeScrap Metal TheftStolen GoodsStolen PropertyTrafficking in NarcoticsUnderground Economy |
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: Australian Institute of Health and Welfare Title: Opioid harm in Australia: and comparisons between Australia and Canada Summary: Locally and internationally, the rising use of opioids is a cause of concern. All opioids-including codeine-can be addictive and their use can result in dependence, accidental overdose, hospitalisation or death. This report brings together information from a range of data sources to tell the national story of opioid use and its harmful effects. It is the first time that the AIHW has produced such a comprehensive report that presents current national data and trends on opioid use and harms in Australia. The report also presents findings from a collaboration between the AIHW and the Canadian Institute for Health Information (CIHI). This includes comparisons between ED presentations and hospitalisations in Australia and Canada, where possible, and discussion of the benefits and challenges of international collaboration. In Australia in 2016-17, 3.1 million people had 1 or more prescriptions dispensed for opioids (most commonly for oxycodone); about 40,000 people used Heroin; and about 715,000 people used Pain-killers/analgesics and pharmaceutical opioids for illicit or non-medical purposes. Opioid deaths and poisoning hospitalisations have increased in the last 10 years Legal or pharmaceutical opioids (including codeine and oxycodone) are responsible for far more deaths and poisoning hospitalisations than illegal opioids (such as heroin). Every day in Australia, nearly 150 hospitalisations and 14 emergency department (ED) presentations involve opioid harm, and 3 people die from drug-induced deaths involving opioid use. In 2016, the number of opioid deaths (1,119) was the highest number since the peak in 1999 (1,245 deaths). After 1999, the number of deaths fell to a low of 439 in 2006, then began to climb again. In 2016, opioid deaths accounted for 62% of all drug-induced deaths. From 2007 to 2016, after adjusting for differences in the age structure of the population, the rate of opioid deaths increased by 62%, from 2.9 to 4.7 deaths per 100,000 population. The increase was driven by an increase in accidental opioid deaths and in pharmaceutical opioid deaths. Similarly, from 2007-08 to 2016-17, after adjusting for age, the rate of hospitalisations per 100,000 population with a principal diagnosis (main reason for hospitalisation) of opioid poisoning increased by 25%, while the rate of hospitalisations with any diagnosis (all reasons for hospitalisation) of opioid poisoning increased by 38%. Pharmaceutical opioids are responsible for more opioid deaths and poisoning hospitalisations than heroin In 2016, the most commonly mentioned opioid in opioid deaths was Naturally derived opioids (for example, oxycodone, codeine and morphine), which was mentioned in 49% of opioid deaths. Similarly, in 2016-17, hospitalisations with a principal diagnosis of opioid poisoning were more likely to involve pharmaceutical opioids than heroin or opium. The rate per 100,000 for those by Naturally derived opioids was more than twice as high as for those by Heroin. More opioid prescriptions were dispensed but on average prescriptions were for lower doses and/or quantities In 2016-17, 15.4 million opioid prescriptions were dispensed under the Pharmaceutical Benefits Scheme (PBS) to 3.1 million people. The oral morphine equivalent (OME) is a measure of opioid use that adjusts for the difference in potency between different opioids. It converts the amount of each opioid dispensed to the amount of oral morphine that would be required to produce the same pain-relieving effect. After adjusting for differences in the age structure of the population, from 2012-13 to 2016-17, although there was a rise in the rate of prescriptions dispensed per 100,000 population and the number of people per 100,000 population receiving them (9% and 4% respectively), the OME stayed the same over the same period (989 to 987 OME mg per 1,000 population per day)-on average, the prescriptions dispensed were for lower doses and/or quantities. Oxycodone and codeine most commonly dispensed opioids -- Oxycodone was the most commonly dispensed prescription opioid in 2016-17, with 5.7 million prescriptions dispensed to 1.3 million people, followed by codeine (3.7 million prescriptions to 1.7 million people) and tramadol (2.7 million prescriptions to 600,000 people). Similar to the results for all opioid prescriptions dispensed, on average prescriptions dispensed for oxycodone were for lower doses and/or quantities. After adjusting for differences in the age structure of the population over time, from 2012-13 to 2016-17 there was approximately a 30% rise in both the number of oxycodone prescriptions dispensed per 100,000 population and the number of people receiving them per 100,000 population, but the OME over the same period remained the same (338 to 340 OME mg for oxycodone per 1,000 population per day). Higher rates of OME for opioids dispensed in Inner regional and Outer regional areas -- After adjusting for differences in the age structure of the population, the total number of prescriptions dispensed per 100,000 population was highest for Inner regional areas (74,000 per 100,000 population) and lowest for Very remote areas (38,000 per 100,000 population). The rate of OME was also highest for Inner regional areas (1,374 OME mg per 1,000 population per day), followed closely by Outer regional areas (1,362 OME mg per 1,000 population per day). These rates of OMEs are 2 times higher than in Very remote areas, which at 645 OME mg per 1,000 population per day was the lowest of all areas. 1 in 10 Australians have ever used any type of opioid for illicit or non-medical purposes In 2016, around 1 in 10 (11%) of Australians aged 14 and over had ever used at least 1 type of opioid for illicit or non-medical purposes; recent use (that is, use in the last 12 months) was much lower, at 3.7%. Most had used pharmaceutical opioids rather than illegal opioids, with 9.7% having ever used Pain-killers/analgesics and pharmaceutical opioids, compared with 1.3% who had ever used Heroin. Of people who reported non-medical use of Pain-killers/analgesics and pharmaceutical opioids, 75% had used Over-the-counter codeine products, 40% had used Prescription codeine products and 17% had used Oxycodone. Opioid use varies between Australia and Canada -- Both Australia and Canada have government-funded pharmaceuticals. Overall, there was a downward trend in both countries in the total average opioid dosage (the defined daily dose or DDD) per 1,000 people, per day prescribed in the 5 years to 2016-17. However there were slight differences in the types of opioids prescribed, with the DDD rate for hydromorphone substantially higher in Canada, and the DDD rate for tramadol and buprenorphine higher in Australia. Both countries had a similar DDD rate for fentanyl. Illicit use of fentanyl is more common in Canada than it is in Australia, while heroin use is comparatively higher in Australia than in Canada. The impact of this difference is that people using these different drugs-while they are all opioids-have different trajectories and contact with the acute care system. Fentanyl is more potent than heroin and has a greater potential to be lethal, meaning many users die before they can receive acute care. Side effects from opioid use are responsible for the greatest number of hospitalisations in both Canada and Australia Despite differences in the rates of hospital care in Australia and Canada for opioid harms-due in part to differences in systems and infrastructure for health services-there are similarities in the profiles of people most likely to receive hospital care for opioid harm. In both Australia and Canada, the greatest volume of harm treated in hospitals came from side effects from opioid use. The age distribution for people hospitalised for this reason was similar in Australia and Canada, with rates of hospitalisation increasing with increasing age, reflecting the rates of prescription opioids in both countries. Details: Canberra: AIHW, 2018. 130p. Source: Internet Resource: Accessed November 14, 2018 at: https://www.aihw.gov.au/getmedia/605a6cf8-6e53-488e-ac6e-925e9086df33/aihw-hse-210.pdf.aspx?inline=true Year: 2018 Country: Australia URL: https://www.aihw.gov.au/getmedia/605a6cf8-6e53-488e-ac6e-925e9086df33/aihw-hse-210.pdf.aspx?inline=true Shelf Number: 153417 Keywords: Drug Abuse and AddictionIllicit DrugsOpioid CrisisOpioid DeathsOpioids Prescription Drug Abuse Prescription Drugs |
Author: U.S. Department of Justice. Drug Enforcement Administration Title: 2018 National Drug Threat Assessment Summary: The 2018 National Drug Threat Assessment (NDTA)1 is a comprehensive strategic assessment of the threat posed to the United States by domestic and international drug trafficking and the abuse of illicit drugs. The report combines federal, state, local, and tribal law enforcement reporting; public health data; open source reporting; and intelligence from other government agencies to determine which substances and criminal organizations represent the greatest threat to the United States. Illicit drugs, as well as the transnational and domestic criminal organizations who traffic them, continue to represent significant threats to public health, law enforcement, and national security in the United States. Drug poisoning deaths are the leading cause of injury death in the United States; they are currently at their highest ever recorded level and, every year since 2011, have outnumbered deaths by firearms, motor vehicle crashes, suicide, and homicide. In 2016, approximately 174 people died every day from drug poisoning (see Figure 1). The opioid threat (controlled prescription drugs, synthetic opioids, and heroin) has reached epidemic levels and currently shows no signs of abating, affecting large portions of the United States. Meanwhile, as the ongoing opioid crisis justly receives national attention, the methamphetamine threat remains prevalent; the cocaine threat has rebounded; new psychoactive substances (NPS) are still challenging; and the domestic marijuana situation continues to evolve. Controlled Prescription Drugs (CPDs): CPDs are still responsible for the most drug-involved overdose deaths and are the second most commonly abused substance in the United States. As CPD abuse has increased significantly, traffickers are now disguising other opioids as CPDs in attempts to gain access to new users. Most individuals who report misuse of prescription pain relievers cite physical pain as the most common reason for abuse; these misused pain relievers are most frequently obtained from a friend or relative. Heroin: Heroin use and availability continue to increase in the United States. The occurrence of heroin mixed with fentanyl is also increasing. Mexico remains the primary source of heroin available in the United States according to all available sources of intelligence, including law enforcement investigations and scientific data. Further, significant increases in opium poppy cultivation and heroin production in Mexico allow Mexican TCOs to supply high-purity, low-cost heroin, even as U.S. demand has continued to increase. Fentanyl and Other Synthetic Opioids: Illicit fentanyl and other synthetic opioids - primarily sourced from China and Mexico - are now the most lethal category of opioids used in the United States. Traffickers- wittingly or unwittingly- are increasingly selling fentanyl to users without mixing it with any other controlled substances and are also increasingly selling fentanyl in the form of counterfeit prescription pills. Fentanyl suppliers will continue to experiment with new fentanyl-related substances and adjust supplies in attempts to circumvent new regulations imposed by the United States, China, and Mexico. Cocaine: Cocaine availability and use in the United States have rebounded, in large part due to the significant increases in coca cultivation and cocaine production in Colombia. As a result, past-year cocaine initiates and cocaine-involved overdose deaths are exceeding 2007 benchmark levels. Simultaneously, the increasing presence of fentanyl in the cocaine supply, likely related to the ongoing opioid crisis, is exacerbating the re-merging cocaine threat. Methamphetamine: Methamphetamine remains prevalent and widely available, with most of the methamphetamine available in the United States being produced in Mexico and smuggled across the Southwest Border (SWB). Domestic production occurs at much lower levels than in Mexico, and seizures of domestic methamphetamine laboratories have declined steadily for many years. Marijuana: Marijuana remains the most commonly used illicit drug in the United States. The overall landscape continues to evolve; although still illegal under Federal law, more states have passed legislation regarding the possession, use, and cultivation of marijuana and its associated products. Although seizure amounts coming across the SWB have decreased in recent years, Mexico remains the most significant foreign source for marijuana available in the United States. Domestic marijuana production continues to increase, as does the availability and production of marijuana-related products. New Psychoactive Substances (NPS): The number of new NPS continues to increase worldwide, but remains a limited threat in the United States compared to other widely available illicit drugs. China remains the primary source for the synthetic cannabinoids and synthetic cathinones that are trafficked into the United States. The availability and popularity of specific NPS in the United States continues to change every year, as traffickers experiment with new and unregulated substances. Mexican Transnational Criminal Organizations (TCOs): Mexican TCOs remain the greatest criminal drug threat to the United States; no other group is currently positioned to challenge them. The Sinaloa Cartel maintains the most expansive footprint in the United States, while Cartel Jalisco Nueva Generacion's (CJNG) domestic presence has significantly expanded in the past few years. Although 2017 drug-related murders in Mexico surpassed previous levels of violence, U.S.-based Mexican TCO members generally refrain from extending inter-cartel conflicts domestically. Colombian TCOs: Colombian TCOs' majority control over the production and supply of cocaine to Mexican TCOs allows Colombian TCOs to maintain an indirect influence on U.S. drug markets. Smaller Colombian TCOs still directly supply wholesale quantities of cocaine and heroin to Northeast and East Coast drug markets. Dominican TCOs: Dominican TCOs dominate the mid-level distribution of cocaine and white powder heroin in major drug markets throughout the Northeast, and predominate at the highest levels of the heroin and fentanyl trade in certain areas of the region. They also engage in some street-level sales. Dominican TCOs work in collaboration with foreign suppliers to have cocaine and heroin shipped directly to the continental United States and its territories from Mexico, Colombia, Venezuela, and the Dominican Republic. Family members and friends of Dominican nationality or American citizens of Dominican descent comprise the majority of Dominican TCOs, insulating them from outside threats. Asian TCOs: Asian TCOs specialize in international money laundering by transferring funds to and from China and Hong Kong through the use of front companies and other money laundering methods. Asian TCOs continue to operate indoor marijuana grow houses in states with legal personal-use marijuana laws and also remain the 3,4-Methylenedioxymethamphetamine (MDMA, commonly known as Ecstasy) source of supply in U.S. markets by trafficking MDMA from clandestine laboratories in Canada into the United States. Gangs: National and neighborhood-based street gangs and prison gangs continue to dominate the market for the street-sales and distribution of illicit drugs in their respective territories throughout the country. Struggle for control of these lucrative drug trafficking territories continues to be the largest factor fueling the street-gang violence facing local communities. Meanwhile, some street gangs are working in conjunction with rival gangs in order to increase their drug revenues, while individual members of assorted street gangs have profited by forming relationships with friends and family associated with Mexican cartels. Illicit Finance: TCOs' primary methods for laundering illicit proceeds have largely remained the same over the past several years. However, the amount of bulk cash seized has been steadily decreasing. This is a possible indication of TCOs' increasing reliance on innovative money laundering methods. Virtual currencies, such as Bitcoin, are becoming increasingly mainstream and offer traffickers a relatively secure method for moving illicit proceeds around the world with much less risk compared to traditional methods. Details: Washington, DC: DEA, 2018. 164p. Source: Internet Resource: Accessed November 14, 2018 at: https://www.dea.gov/sites/default/files/2018-11/DIR-032-18%202018%20NDTA%20final%20low%20resolution.pdf Year: 2018 Country: United States URL: https://www.dea.gov/sites/default/files/2018-11/DIR-032-18%202018%20NDTA%20final%20low%20resolution.pdf Shelf Number: 153464 Keywords: Drug Abuse and Addiction Drug CartelsDrug Enforcement Drug Trafficking GangsIllicit DrugsOpioid CrisisOrganized Crime |
Author: Canadian Institute for Health Information Title: Types of Opioid Harms in Canadian Hospitals: Comparing Canada and Australia Summary: Canada is in the midst of an opioid crisis. Opioid use can lead to addiction, as well as other to harms such as accidental overdose or poisoning, suicide, motor vehicle accidents, infections from injection use, and many other social and emotional problems.1The opioid-related death rate in Canada in 2017 was estimated at 10.9 per 100,000 population. Representatives from the Canadian Institute for Health Information (CIHI) and the Australian Institute of Health and Welfare (AIHW) worked together to produce comparable estimates of opioid use and harms in each country. The goals of the collaboration were to explore the usefulness of international comparisons, to understand the comparability of different data holdings and to learn about the differences and similarities between the 2 countries. In addition, this work will expand our understanding of Canada's opioid crisis and the impact of opioid harms beyond poisonings on hospital care. Hospital stays and emergency department (ED) visits for those suffering from 5 types of opioid harm are profiled in this report: - Accidental poisoning (including poisoning of unknown intent); - Intentional poisoning; - Opioid dependence; - Adverse drug reaction; and - Other harm. Key findings in this report include the following: - Canada and Australia are seeing different opioid challenges (fentanyl versus heroin) and have different processes in their hospitals, which makes direct comparisons difficult. - While poisoning is the most severe opioid harm, it is the tip of the iceberg, representing about a third of all opioid harms seen in hospitals and EDs. - There are 5 distinct opioid harm profiles, indicating that different strategies may be required to tackle the challenges of opioids. These profiles present differently across care settings, including the community, the ED and the hospital. A cross-setting perspective is required. – Fentanyl is the leading cause of opioid-related deaths outside of hospitals in Canada, but most patients who come to hospitals with opioid harms are seen for more commonly prescribed opioids such as codeine, morphine and oxycodone. – Individuals who use opioids typically use the health care system more frequently than the general population, and they are also more likely to leave care against medical advice. – Poisoning is more common among younger people, but a larger proportion of resources is spent on older people whose care has been complicated by opioid use. Details: Ottawa: CIHI, 2018. 78p. Source: Internet Resource: Accessed November 15, 2018 at: https://www.cihi.ca/sites/default/files/document/types-opioids-harm-report-can-aus-nov2018-en-web.pdf Year: 2018 Country: Canada URL: https://www.cihi.ca/sites/default/files/document/types-opioids-harm-report-can-aus-nov2018-en-web.pdf Shelf Number: 153476 Keywords: Drug Abuse and Addiction Drug-Related Deaths Fentanyl Illicit Drugs Opioid CrisisOpioid Epidemic Opioids |
Author: Reichert, Jessica Title: Addressing Opioid Use Disorders in Community Corrections: A Survey of Illinois Probation Departments Summary: Nearly one-third of Illinois probationers suffer from an opioid use disorder (OUD). Despite evidence that FDA-approved medications methadone, buprenorphine, and naltrexone can effectively treat OUD, many probation departments do not allow their clients to use them, even when prescribed by a healthcare provider. ICJIA researchers surveyed probation departments across the state to better understand their familiarity with, and training on, the medications, as well as barriers to their clients' access and use. This article summarizes the study's findings. Details: Chicago, Illinois: Illinois Criminal Justice Information Authority, 2018. Source: Internet Resource: Accessed May 22, 2019 at: http://www.icjia.state.il.us/articles/addressing-opioid-use-disorders-in-community-corrections-a-survey-of-illinois-probation-departments Year: 2018 Country: United States URL: http://www.icjia.state.il.us/articles/addressing-opioid-use-disorders-in-community-corrections-a-survey-of-illinois-probation-departments Shelf Number: 156007 Keywords: BuprenorphineDrug AbuseDrug UseMethadoneNaltrexoneOpioid CrisisOpioid UseSubstance AbuseSubstance Use |