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Date: April 30, 2024 Tue
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33 results foundAuthor: Torok, Michelle Title: Comparative Rates of Violent Crime Amongst Methamphetamine and Opioid Users: Victimisation and Offending Summary: Background There have been marked changes in methamphetamine use over the past decade as more potent forms of the drug have become increasingly available, particularly crystalline methamphetamine. A major concern of stronger potency methamphetamine is the increased potential for harm, such as psychotic symptoms and violent behaviour. Little is currently known about what effects methamphetamine use has on violent behaviour. The current research was undertaken to improve our understanding of the association between methamphetamine use and violent victimisation and offending. Comprehensive measures including prevalence, type of offence, circumstances surrounding victimisation and offending, and the predictors of violent behaviour were used to achieve a more complex understanding of the issues surrounding methamphetamine use and violence. Methodology A sample of 400 regular methamphetamine and heroin users from the greater Sydney region were interviewed face-to-face regarding their lifetime and most recent experiences of violent victimisation and offending. Participants in the study were recruited through advertisements placed in needle and syringe programs (NSPs), therapeutic communities, street press publications, and word of mouth. To be eligible for inclusion in the survey, respondents had to be at least 18 years of age, have a satisfactory understanding of English, and have used either methamphetamine or illicit opiates at least weekly over the past 12 months. The sample was categorised into three key groups based on whether they used methamphetamine or heroin most regularly: primary methamphetamine users (PM), primary heroin users (PH), and combined primary methamphetamine and heroin users (PMH). Only physical violence was measured in this study, which included assault, armed robbery, homicide, and sexual assault. Key findings Violent victimisation The lifetime risk of violent victimisation was nearly universal. Across the whole sample, 95% had ever been a victim of violence, and nearly half (46%) had experienced victimisation in the past 12 months. The overwhelming majority had been victimised on multiple occasions across a lifetime measure. Methamphetamine use was not a significant risk factor for violent victimisation. The results indicate that the major predictors of violent victimisation among illicit drug users were severity of alcohol use, a predisposition towards antisocial behaviour (i.e. a childhood history of Conduct Disorder), and drug dealing. The data indicates that being involved in illicit drug markets substantially increases the risk of victimisation and that, at some point, those who remain in these environments have a high risk of being assaulted Almost two-thirds of those who had been victimised were also under the influence of a substance at the time they were last victimised. The substances that were most commonly used prior to the most recent victimisation episode were alcohol (25%), psychostimulants (24%), and illicit opioids (24%). Nearly one-quarter of the respondents had used multiple substances prior to most recently being victimised. Violent offending The prevalence of violent offending was also high, with 82% having ever committed a violent crime, and approximately two in five having violently offended in the past 12 months. There were no group differences in the risk of lifetime offending. In the past 12 months, however, the PM group was more likely to have committed a violent crime than the PH group (51% v 35%). Nearly three-quarters (74%) of the sample had ever committed more than one violent crime. Methamphetamine use significantly increased the risk of violent offending in the past 12 months, particularly more frequent methamphetamine use. The increased risk of violent offending associated with methamphetamine use was consistent across a number of indicators, including being at greater risk for being arrested for assault and weapon offences in the preceding 12 months, and methamphetamine users being at greater risk of committing violent crime within the past month. Apart from methamphetamine use, other factors that were found to increase the risk of committing violence were heavier alcohol use, Conduct Disorder, selling drugs, and being younger. Risk perceptions of violence The majority of the sample perceived that it would be 'unlikely' or 'very unlikely' that they would be either a victim of violence (78%) or violent offender (87%) in the following 12 months, despite the high prevalence of violent victimisation and offending experienced in the previous 12 months. The majority of respondents had also witnessed high levels of victimisation and offending, and this also appears to have no impact on their own perceived risk of being exposed to violence in the future. Among those who had recently (i.e. in the last 12 months) been a victim of violence, or physically assaulted someone, the perceived risk of future victimisation and offending was higher than those who had not recently been exposed to violence. Key points: Summary of violent crime among illicit drug users - Violent victimisation was almost universal, with 95% of the sample having ever been victimised, and 46% having been a victim of violence in the past 12 months. - Violent offending was also highly prevalent, with 82% of respondents having committed a violent crime across their lifetime, and 41% having done so in the past 12 months. - Methamphetamine use did not increase the lifetime, or past 12 month, risk of violent victimisation. - Heavier methamphetamine use was associated with a significantly higher risk of violent offending in the past 12 months. - The main form of methamphetamine used did not affect risk of violent victimisation or offending. - The perceived risk of being a victim or offender of a violent crime in the following 12 months was very low, despite the high rates of victimisation, and of committing violent crime, in the past 12 months. Details: Hobart, Tasmania: National Drug Law Enforcement Research Fund, 2008. 43p. Source: Internet Resource: Monograph no. 32: Accessed April 17, 2018 at: http://www.ndlerf.gov.au/sites/default/files/publication-documents/monographs/monograph32.pdf Year: 2008 Country: Australia URL: http://www.ndlerf.gov.au/sites/default/files/publication-documents/monographs/monograph32.pdf Shelf Number: 117106 Keywords: Drug Abuse and AddictionDrug Abuse and CrimeDrug-Related ViolenceMethamphetaminesOpioidsVictimizationViolent Crime |
Author: Rodwell, Laura Title: What Do Police Data Tell Us About Criminal Methods of Obtaining Prescription Drugs? Summary: Recent reports suggest that the illicit use of prescription medicines, particularly pharmaceutical opioids is increasing in Australia. The aim of this study was to use police data to examine: (1) whether this increase is reflected in police crime data; (b) some of the criminal methods by which these medicines are obtained; and (c) which particular medicines have been most commonly sought through these methods over time. Details: Sydney: NSW Bureau of Crime Statistics and Research, 2010. 12p. Source: Internet Resource; Crime and Justice Bulletin, No. 139 Year: 2010 Country: Australia URL: Shelf Number: 118722 Keywords: Drug Abuse and AddictionOpioidsPrescription FraudPrescription Medicines |
Author: Bradford, Deborah Title: Modelling Supply Rates of High-Strength Oxycodone Across New South Wales Summary: The objective of this research was to develop a statistical methodology for identifying areas with aberrantly high supply levels of 80mg oxycodone controlled-release (CR) tablets, a prescription medicine that is currently a target for illicit diversion in Australia. The intention in developing this methodology was to provide assistance to the Pharmaceutical Services unit of the New South Wales Department of Health in monitoring supply and prescribing of high-strength prescription opioids. Statistical analysis focused on modelling variations across New South Wales (from 2006 to 2009) in wholesale supply rates of 80mg oxycodone CR tablets while controlling for relevant demographic and public health characteristics of each area. This analysis identified a number of Local Government Areas with supply levels of 80mg oxycodone CR tablets that were significantly higher than that predicted by the statistical model. In contrast to analysis of raw unadjusted supply counts of this medicine, which were highest in areas with large populations, statistical modelling identified mainly regional areas as those with unexpectedly high supply rates of 80mg oxycodone CR tablets. The current findings highlight the importance of controlling for relevant population level characteristics related to indications for opioid prescribing when evaluating trends in supply of these medicines. Details: Sydney: NSW Bureau of Crime Statistics and Research, 2011. 12p. Source: Internet Resource: Contemporary Issues in Crime and Justice, No. 148: Accessed June 30, 2011 at: http://www.lawlink.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/CJB148.pdf/$file/CJB148.pdf Year: 2011 Country: Australia URL: http://www.lawlink.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/CJB148.pdf/$file/CJB148.pdf Shelf Number: 121929 Keywords: Drug Abuse and AddictionOpioidsPrescription Drugs (Australia)Prescription Fraud |
Author: Larance, Briony Title: The Diversion and Injection of the Pharmaceutical Opioids Used in Opioid Substitution Treatment: Fidings from the Australian Post-Marketing Surveillance Studies of Buprenorphine-Naloxone, 2006-2008 Summary: Opioid substitution treatment (OST) is effective in treating opioid dependence, and results in significant reductions in the negative health consequences and adverse effects on public order. In Australia, OST is highly regulated: it is available only with an individual patient authority, there is licensing of doctors, and a strong focus on supervised administration of medication. Adherence with OST is important for maximising a range of positive treatment outcomes, but is especially important in preventing injection, "leakage" of prescribed medication to the illicit market, overdose and mortality. The introduction of an opioid agonist-antagonist formulation in Australia was a new approach that was hoped to result in lower levels of injection of the medication. By deterring injection, buprenorphine-naloxone (registered as Suboxone) may reduce its attractiveness in illicit markets. Post-marketing surveillance of the diversion and injection of Suboxone was required as a condition of the product's registration in Australia. Reckitt Benckiser approached the National Drug and Alcohol Research Centre to conduct the study independently, by way of an untied educational grant. 1.1. Terminology Post-marketing surveillance studies are usually observational in design and monitor the safety of new medications being used in real-life applications. Pre-marketing (clinical) studies usually involve detailed protocol constraints and small sample sizes, and although they may suggest which medications are likely (or not likely) to be misused, they are limited in their ability to detect and quantify actual misuse. Diversion is used in this report to describe the unsanctioned supply of regulated pharmaceuticals from legal sources to the illicit drug market, or to a user for whom the drugs were not intended. Adherence is used to describe the taking of medication in accordance with prescription directions and the meeting of all the specified conditions of treatment (e.g. consumption of the dose under supervision, attendance at designated dosing times, meeting requests for urinalysis, etc). Non-adherence is, therefore, any use of a medication by the individual to whom it was prescribed where the medication was not taken exactly as directed. This includes (but is not limited to) removing all or part of a supervised dose from the dosing site for personal use or diversion to illicit markets, splitting doses, stockpiling doses, taking more or less than the prescribed dose, and injection of prescribed medication(s). This report seeks to answer the following questions: (i) Is there injection of the agonist-antagonist formulation - buprenorphine naloxone - following its large-scale introduction into treatment programs for opioid dependence? (ii) To what extent is buprenorphine-naloxone injected compared to existing OST formulations, and in particular compared to the mono-buprenorphine product, among those receiving treatment and among out-of-treatment injecting drug users (IDU)? (iii) Is diverted buprenorphine-naloxone less attractive in illicit markets? (iv) What influences the diversion and/or injection of buprenorphine-naloxone? Details: Sydney: National Drug and Alcohol Research Centre, University of New South Wales, 2009. 143p. Source: Internet Resource: Technical Report No. 302: Accessed August 22, 2011 at: http://www.med.unsw.edu.au/NDARCWeb.nsf/resources/TR+298-302/$file/TR+302.pdf Year: 2009 Country: Australia URL: http://www.med.unsw.edu.au/NDARCWeb.nsf/resources/TR+298-302/$file/TR+302.pdf Shelf Number: 122461 Keywords: Drug Abuse and AddictionDrug Abuse TreatmentIllicit DrugsOpioidsPrescription Medicines |
Author: Larney, Sarah Title: Opioid Substitution Treatment in Prison and Post-Release: Effects on Criminal Recidivism and Mortality Summary: Heroin dependence is a chronic condition associated with significant health and social harms. The most effective treatment for heroin dependence is opioid substitution treatment (OST), in which long-acting opioid medications such as methadone or buprenorphine are prescribed with the goal of reducing heroin use and associated harms. Internationally, OST is rarely available in prisons, despite the high proportion of heroin users among prisoners. Furthermore, limited research attention has been given to examining how prison-based OST can reduce the harms of heroin dependence. This thesis reports on two systematic literature reviews and three data linkage studies on the effects of prison-based and post-release OST. The first systematic review found that there is good evidence that prison OST reduces heroin use and needle and syringe sharing among prison inmates. The second review found that the evidence relating to the effects of prison OST on post-release outcomes is inconsistent and has limitations. As such, four data linkage studies were undertaken to assess incarceration, offending and mortality outcomes for a cohort of 375 male heroin users recruited in prisons in New South Wales (NSW), Australia, in 1996-7. Data were linked for the nearly ten-year period 1 June 1997 – 31 December 2006. The first data linkage study assessed whether the baseline data for the cohort could be linked to other databases with sufficient sensitivity and specificity to obtain reliable and valid results regarding episodes of OST. Results showed that maximum sensitivity and specificity were achieved when participants’ aliases were included as identifiers during the linkage process, and that enrolment in OST during the observation period had been reliably ascertained by linkage. The second data linkage study demonstrated that exposure to OST while in prison did not in itself reduce risk of re-incarceration; rather, it was continuation of treatment as the individual returned to the community that reduced the risk of returning to prison. Among participants who remained in OST post-release, risk of re-incarceration was, on average, 80% that of participants not in OST. The third study, assessing re-offending, did not find a relationship between OST exposure and criminal convictions; however, there were indications of bias in the analysis as a result of informative censoring. The fourth data linkage study analysed mortality outcomes for the cohort. Participant mortality was six times that seen in the age-, sex- and calendar-adjusted NSW population, but was moderated while in OST and while in prison. Although mortality was elevated in the 28 days immediately after release from prison in comparison to all other time at liberty, this difference was not statistically significant; a larger sample size may have resulted in a significant finding in this regard. Although OST has been studied extensively, few studies have employed data linkage to examine long-term treatment outcomes, particularly in relation to treatment participation while in prison. The evidence presented in this thesis provides support for the provision of OST in prisons, and for programs that facilitate prisoners’ access to post-release OST. Integration of prisoner healthcare into public health systems may assist in improving continuity of OST as well as general standards of care. Future research should explore how the duration of pre-release treatment affects post-release outcomes and how OST can be combined with therapeutic approaches that address other risk factors for offending. Further follow-ups of the cohort would provide insights into the course and consequences of heroin use in Australia. Details: Sydney: National Drug and Alcohol Research Centre, University of New South Wales, 2010. 192p. Source: Internet Resource: Thesis: Accessed September 3, 2011 at: http://www.idpc.net/sites/default/files/library/OST-in-prison-and-post-release-effects-on-criminal-recidivism-and-mortality.pdf Year: 2010 Country: Australia URL: http://www.idpc.net/sites/default/files/library/OST-in-prison-and-post-release-effects-on-criminal-recidivism-and-mortality.pdf Shelf Number: 122636 Keywords: Drug Abuse TreatmentDrug OffendersDrug Treatment ProgramsHeroinOpioidsPrisoner ReentryRecidivismSubstance Abuse (Australia) |
Author: 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: Wedd, Alan Title: Ohio Multijurisdictional Task Force Trend Analysis: 2010-2013 Summary: This report presents data from Ohio multijurisdictional task forces funded by the Office of Criminal Justice Services (OCJS) through the JAG/Byrne grant program. As a requirement of the JAG grants, task forces submitted two semi-annual performance reports to OCJS highlighting their activities and accomplishments for calendar years 2010 ¡V 2013. The data from these performance reports was analyzed in this multi-year report. To provide a clear account of the data while accounting for the different number of task forces funded each year, data are typically presented as both averages and totals. Summary - The total number of task forces funded by the JAG/Byrne grant program increased from 32 in 2010 to 38 in 2013. - Task forces increased their average number of felony indictments while decreasing the average number of new cases worked. This indicates that task forces became more efficient from 2010 to 2013. - Task forces obtained more indictments for street drugs between 2010 and 2013, primarily due to large increases in indictments for heroin trafficking and possession. They also recorded more seizures for nearly every type of street drug collected in this study during the same time period. - Indictments for pharmaceutical drugs increased during the reporting period. Oxycodone, hydrocodone, and alprazolam were the most frequently seized/diverted drugs by the task forces. Details: Columbus, OH: Ohio Office of Criminal Justice Services, 2014. 17p. Source: Internet Resource: Accessed October 1, 2014 at: http://publicsafety.ohio.gov/links/2010-2013_DTF_Report.pdf Year: 2014 Country: United States URL: http://publicsafety.ohio.gov/links/2010-2013_DTF_Report.pdf Shelf Number: 133526 Keywords: Drug Abuse and Addition (Ohio)Drug EnforcementDrug OffendersOpioidsPrescription Drug Abuse |
Author: New York State. Heroin and Opioid Task Force Title: Combatting the Heroin and Opioid Crisis Summary: Across the state the Task Force has heard from families who have loved ones addicted to heroin or other opioids, who have overdosed or have had serious health problems as a result of their addiction. Heroin overdose is now the leading cause of accidental death in the state. Between 2005 and 2014, upstate New York has seen an astonishing 222 percent increase in admissions to OASAS certified treatment programs among those 18 to 24 years of age for heroin and other opioids; Long Island has seen a 242 percent increase among the same age group for heroin and other opioids. In all, approximately 1.4 million New Yorkers suffer from a substance use disorder. Heroin and opioid addiction is now a major public health crisis in New York State. Further work must continue to fully realize the Governor's vision for a more responsive, accessible, and compassionate health care system for patients, as well as stronger education, prevention, and enforcement measures. The Task Force recommends that study and work on these issues continue as a high priority, so that New York can remain in the forefront when it comes to helping patients and their families. New York has taken important steps to address the urgent needs of those in critical condition and to prevent future generations from suffering from the disease of addiction. For the 2016 fiscal year, New York State allocated over $1.4 billion to the Office of Alcoholism and Substance Abuse Services (OASAS) to fight this battle including funding for 1,455 beds for patients in crisis; 2,221 beds for inpatient rehabilitation programs; 5,247 beds for intensive residential programs; 2,142 beds for community residential programs; 1,842 beds in supportive living programs; and 265 beds in residential rehabilitation programs for youth. Additionally, OASAS provides more than $74 million to fund prevention services through 165 providers serving communities in every county, including 1,400 schools across the state. The State has also enacted legislation to address this growing epidemic. In 2012 the State enacted the Prescription Drug Reform Act, overhauling the way prescription drugs are dispensed and tracked in New York to improve safeguards for drugs that are prone to abuse. The Act updated the Prescription Monitoring Program (PMP) Registry (also known as I-STOP) to require pharmacies to report information about dispensed controlled substances on a "real time" basis, as well as require health care practitioners to consult the PMP Registry before prescribing or dispensing certain controlled substances most prone to abuse and diversion. The Act also mandated electronic prescription of controlled substances, updated the Controlled Substances Schedules, improved education and awareness efforts for prescribers, and established a safe disposal program for prescription drugs. By the end of 2015, I-STOP had led to a 90 percent decrease in "doctor shopping" - when patients visit multiple prescribers and pharmacies to obtain prescriptions for controlled substances within a three-month time period. Earlier this year, New York State entered into an agreement with New Jersey to share PMP data both ways and prevent "doctor shopping" across state borders. In 2014, the State enacted legislation that granted Good Samaritan protections to individuals who administer an opioid antagonist like naloxone, expanded access to naloxone by allowing nonpatient-specific prescriptions, enacted insurance reforms to improve treatment options for individuals suffering from addiction, directed OASAS to create a wraparound services demonstration program to provide services to adolescents and adults for up to nine months after successful completion of a treatment program, and enhanced penalties to crack down on illegal drug distribution. Despite being on the forefront of nationally-recognized best practices, the epidemic continues to grow in New York. In response, Governor Andrew M. Cuomo convened a team of experienced healthcare providers, policy advocates, educators, parents, and New Yorkers in recovery to serve on a Heroin and Opioid Task Force and develop a comprehensive plan to bring the crisis under control. The Task Force's work was informed by two executive meetings, eight listening sessions across the state, and the 246 comments submitted through www.ny.gov/herointaskforce. This public process resulted in the following recommendations - broken into four areas: prevention, treatment, recovery, and enforcement - to continue to address the crisis. Details: Albany, NY: The Task Force, 2016. 34p. Source: Internet Resource: Accessed September 19, 2016 at; https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/HeroinTaskForceReport_3.pdf Year: 2016 Country: United States URL: https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/HeroinTaskForceReport_3.pdf Shelf Number: 140350 Keywords: Drug Abuse and AddictionDrug EnforcementDrug TreatmentHeroinIllegal DrugsOpioidsPrescription Drug Abuse |
Author: Alpert, Abby Title: Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids Summary: Overdose deaths from prescription opioid pain relievers nearly quadrupled between 1999 and 2010, making this the worst drug overdose epidemic in U.S. history. In response, numerous supply-side interventions have aimed to limit access to opioids. However, these supply disruptions may have the unintended consequence of increasing the use of substitute drugs, including heroin. We study the consequences of one of the largest supply disruptions to date to abusable opioids – the introduction of an abuse-deterrent version of OxyContin in 2010. Our analysis exploits across state variation in exposure to the OxyContin reformulation. Using data from the National Survey on Drug Use and Health (NSDUH), we show that states with higher pre-2010 rates of OxyContin misuse experienced larger reductions in OxyContin misuse, permitting us to isolate consumer substitution responses. We estimate large differential increases in heroin deaths immediately after reformulation in states with the highest initial rates of OxyContin misuse. We find less evidence of differential reductions in overall opioid-related deaths, potentially due to substitution towards other opioids, including more harmful synthetic opioids such as fentanyl. Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin. Details: Cambridge, MA: National Bureau of Economic Research, 2017. 59p. Source: Internet Resource: NBER Working Paper Series: Working paper 23031: Accessed January 26, 2017 at: http://www.nber.org/papers/w23031.pdf Year: 2017 Country: United States URL: http://www.nber.org/papers/w23031.pdf Shelf Number: 145428 Keywords: Drug Abuse and AddictionDrug Abuse PolicyOpioidsOpioids EpidemicOxyContinPrescription Drugs |
Author: Sindicich, Natasha Title: Patient Motivations, Perceptions and Experiences of Opioid Substitution Therapy in Prison Summary: People with opioid dependence are overrepresented in correctional settings (AIHW, 2013; Indig et al., 2010). Opioid substitution therapy (OST) is an effective treatment for opioid dependence, reducing illicit opioid use (Mattick, Breen, Kimber, & Davoli, 2009, 2014) and mortality (Degenhardt et al., 2011). OST is provided in correctional settings in many jurisdictions around the world (HRI, 2014), but there has been limited examination of the patient experience of opioid substitution therapy (OST) in correctional settings. Unexplored issues include reasons for entering (or not entering) treatment; patient perceptions of advantages and disadvantages of OST in prison; and preferences to cease or remain in treatment on release from prison. This latter issue is of particular importance, as clinicians report that patients often wish to cease OST prior to release, even when informed of the risk of overdose and benefits of remaining in treatment. This qualitative study aimed to examine patient motivations for, and perceptions and experiences of, OST in prisons in New South Wales (NSW), Australia. Forty-seven participants were recruited from seven correctional centres across NSW between September 2012 and October 2013. All participants had a recorded history of opioid use and/or dependence. To ensure a broad range of perspectives were obtained, participants were selected on the basis of specific exposures to OST: Exposure group A (n=7): New inductions to OST. These individuals were within 28 days of commencing OST at the time of interview. They may have been in OST previously, in community or custodial settings; Exposure group B (n=11): Continuing OST from the community. This group of patients had been in OST prior to custody, and were in treatment in custody for at least 28 days before interview (i.e. had some familiarity with the opioid treatment program in prison). Exposure group C (n=10): Commenced OST in custody. These participants were in treatment for at least 28 days before interview (i.e. had some familiarity with the opioid treatment program in prison). Exposure group D (n=9): Voluntarily ceased OST in custody. Exposure group E (n=10): Patients who reported heroin use on reception to prison, but have not entered OST or have declined to be placed on the OST waiting list during this custodial sentence. The sample was predominantly male (n=32; 68%), and 18 participants (38%) identified as Aboriginal and/or Torres Strait Islander. The average age of participants was 35 years. Three-quarters (n=35, 75%) of the sample were sentenced, 11 were on remand, and one participant was unsure of sentencing status. The majority (n=42; 89%) reported a previous incarceration history. Twenty-eight participants were currently prescribed OST (methadone n=27, 57%; buprenorphine-naloxone-naloxone n=1, 2%). Findings by exposure group Among new OST inductions (Group A, n=7), reasons for commencing OST included wanting to abstain from drug use in prison and in the community upon release, as well as to aid with opioid withdrawal. Some participants noted the role of OST in the management of chronic pain. Benefits of OST identified by this group included elimination of opioid cravings, and the financial advantages of not buying drugs in prison. Criticisms of the opioid treatment program reported by this group included the waiting period to enter the program, with over half reporting drug use during this period in order to manage withdrawal symptoms. All participants in this group reported a willingness to stay in OST post-release, with two participants noting that they would prefer to be switched from methadone to buprenorphine formulations due to the lower frequency of administration (every second day) and higher number of ‘take-away’ doses available, which was deemed more practical for meeting employment commitments. Almost all (10/11) Group B patients (continuing OST from the community) were satisfied to remain in OST. Most (7/11) were willing to continue with OST post-release, so as to avoid drug relapse. As in Group A, two participants reported a preference to switch from methadone to buprenorphine-naloxone formulations post-release. For those who were wanting to cease treatment prior to release, reasons for this included pressure from family members and friends, the stigma attached to OST, the long-term nature of OST, and the perceived side-effects of poor dental health and appearing "stoned". Group C (n=10) were current OST patients who had commenced OST during this custodial period. Participants in this group reported drug use and unsafe injecting practices while in prison before commencing treatment. Most (6/10) reported that they would remain in OST post-release, at least until they felt they were stable and had a daily routine in the community. Those who wanted to cease treatment prior to release reported that they were primarily on OST for the management of their chronic pain and that on their release, they would seek other medication, often the preferred opioid analgesic they were prescribed prior to custody. Group D (n=9) had ceased OST during their current incarceration period. Around half (4/9) of participants in this group expressed interest in re-starting OST. Motivations for restarting OST included wanting to cease drug use in prison, and prevention of opioid withdrawal. Again, it was reported that drug use and unsafe injecting practices occurred during waiting periods to enrol in treatment. Reasons for ceasing OST related to release from prison and a reluctance to continue in OST due to the long-term nature of treatment, daily stressors of obtaining methadone in the community, and previous unsuccessful attempts OST episodes in the community. Group E (n=10) were people with a history of opioid use and/or dependence who had not entered OST in this period of incarceration. Seven participants in this group reported prior OST in the community or during previous incarcerations. Six of the ten participants in this group reported that they would like to be in OST, preferably prescribed a buprenorphine-naloxone formulation. Recurrent themes across groups Perceptions of opioid treatment program operation Participants were critical of the time taken to be assessed for OST and commenced on treatment. Participants perceived that this process was expedited if they reported drug use in prison to health centre staff; however, drug use is not a high priority indication for treatment entry per se (unlike pregnancy or HIV seropositivity, for example), so it is unclear if this perception was valid. Once treatment had commenced, participants perceived that there was a lack of monitoring and limited discussion of long-term treatment plans, particularly in relation to ceasing OST. Some participants questioned the motivations of other OST patients; for example, people with no recent history of opioid use who requested assessment for the opioid treatment program, or patients who deliberately requested higher doses of medicine than necessary in order to feel intoxicated. Intentions to cease OST prior to or on release Around one-third of current OST patients reported an intention to cease OST prior to or on release from prison. Participants identified aspects of OST in the community that they perceived as restrictive (e.g. daily dosing; difficulties in travelling to clinics within opening hours; difficulties going away from home). Some participants expressed concern that attending an OST clinic would result in drug use and/or crime as a result of exposure to past associates. Participants also expressed concern about the long-term nature of OST, with the perception that OST was replacing one addiction for another and in conflict with the goal of being "drug free". Participants also identified the stigma attached to OST as a reason for ceasing treatment prior to release. For some participants, this issue was framed in terms of where best to withdraw from OST, specifically methadone – in custody, or in the community. These participants identified the prison setting as a more fitting environment for managing withdrawal. Drug use in prison, including buprenorphine-naloxone diversion Across groups there was consensus that drugs including cannabis, heroin, methamphetamine, and buprenorphine-naloxone diverted from the opioid treatment program. Availability and pricing of drugs varied by prison. Drugs were injected and smoked. Awareness of the risk of blood borne virus transmission via sharing of needles and syringes was high, with specific mentions of risk of hepatitis C virus (HCV) and HIV transmission. Participants reported use of needles and syringes by multiple people despite these risks. The issue of buprenorphine-naloxone diversion from the opioid treatment program was mentioned by 18 participants. Diversion appeared to occur largely in the context of patients being "stood over"; that is, being forced to give their buprenorphine-naloxone to someone else. Participants reported that people engaged in stand over behaviour to obtain buprenorphine-naloxone for their own use (medicating withdrawal symptoms, or getting intoxicated) or to sell for profit. Use of OST for chronic pain Five participants were prescribed methadone for the treatment of chronic pain. Participants generally stated a preference for other analgesic medicines. Methadone was, however, perceived as more effective for pain relief than other options available in the prison setting (e.g. ibuprofen). Naltrexone for the treatment of opioid dependence Over half of participants (27/47) had heard of naltrexone (either oral or implant formulation). There was some scepticism regarding the utility of naltrexone treatment for opioid dependence in the prison settings, primarily because participants believed that those prescribed naltrexone would continue to use, or commence using, non-opioid drugs. Discussion and conclusions Treatment seeking was often precipitated by drug use and injecting in prison. OST was also sought to medicate opioid withdrawal symptoms. Keeping prison-based OST numbers within a range that results in safe management both in custody and upon release to the community has led to delays in accessing OST for those patients seeking to commence treatment in prison, and patients clearly have strong negative views about this approach. Among some participants, the waiting list appeared to act as a barrier to initiating the process of commencing OST. Balancing the needs of opioid dependent patients against operational and capacity issues, and safety and security concerns, are ongoing challenges for clinical staff. With some exceptions, benefits of OST in prison were largely framed in terms of avoiding negative experiences or outcomes, rather than as direct positive benefits of treatment. These findings highlight that although OST is perceived as preventing negative outcomes, it is not necessarily seen as producing positive outcomes for the individual, such as better health or quality of life. This is line with previous research that has reported the considerable ambivalence that many opioid dependent persons have towards OST (Harris & Rhodes, 2013). Diversion of buprenorphine-naloxone from the opioid treatment program appeared to most commonly occur in the context of patients being "stood over" for their medicine, although there may also be patients who voluntarily engage in diversion. The potential for diversion of buprenorphine products used for OST in correctional settings has been previously identified (Gordon et al., 2014; Kinlock, Gordon, Schwartz, & Fitzgerald, 2010; Magura et al., 2009), and the combination buprenorphine-naloxone film was introduced into NSW correctional centres specifically in response to concerns regarding diversion of the mono-buprenorphine formulation (administered sublingually). Policies and procedures for reducing the incidence of diversion and for responding to identified cases of diversion are in place in correctional health centres in NSW. Despite the identified benefits of OST in prison, there was considerable ambivalence among patients regarding continuation of OST once released. Balancing the preference of many patients to cease OST prior to release against patient safety post-release is a substantial challenge for correctional health care providers. The weeks immediately after release from prison are associated with an elevated risk of drug-related death (compared to other time at liberty) (Merrall et al., 2010), and exposure to OST during this period is highly protective against mortality (Degenhardt et al., 2014). As such, correctional health care providers in NSW are trained to advise patients to remain in OST through their transition to the community, and are reluctant to assent to patient requests to cease OST prior to release. This tension between patient preference and evidence-informed clinical practice appears to be perceived by patients as a lack of consultation and/or poor treatment planning. Further work is needed examining provider perspectives of OST in prison, and determining models of care to enhance post-release engagement in OST. Participants reported that injecting drug use occurred in prisons. Awareness of the potential for HCV or HIV transmission through the sharing of injecting equipment was high; nonetheless, participants reported that sharing of needles and syringes was common. Participants perceived a needle and syringe program as feasible for the prevention of re-use of injecting equipment. This study has generated unique data on patient perspectives of OST in correctional settings. We have described patient perspectives on entry to, experiences of, and retention in, OST in prison and post-release. Our findings have highlighted the challenges facing opioid treatment providers in prison in addressing patient ambivalence towards OST and preferences to cease OST prior to release, and can inform the development of policies and clinical practices that are mindful of patient perspectives and concerns. These results are suggestive of the need for further work examining how best to attract and retain opioid dependent prisoners in treatment, including provider perspectives; evaluation of programs designed to increase post-release retention in OST (and other care), and quantitative analyses of retention in OST in prison and post-release. Details: Sydney: NATIONAL DRUG AND ALCOHOL RESEARCH CENTRE, UNIVERSITY OF NEW SOUTH WALES, 2016. 43p. Source: Internet Resource: Technical Report Number 332: Accessed February 24, 2017 at: https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/Technical%20Report%20Number%20332.pdf Year: 2016 Country: Australia URL: https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/Technical%20Report%20Number%20332.pdf Shelf Number: 141212 Keywords: Correctional ProgramsDrug Abuse and AddictionDrug Abuse TreatmentDrug OffendersOpioidsSubstance Abuse Treatment |
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: Ghandnoosh, Nazgol Title: Opioids: Treating and 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. This report examines the sources of the opioid crisis, surveys health and justice policy responses at the federal and state levels, and draws on lessons from past drug crises to provide guidance on how to proceed. The War on Drugs did not play a major role in ebbing past cycles of drug use, as revealed by extensive research and the reflections of police chiefs. In 2014, the National Research Council concluded: The best empirical evidence suggests that the successive iterations of the war on drugs- through a substantial public policy effort-are unlikely to have markedly or clearly reduced drug crime over the past three decades. Growing public awareness of the limited impact and devastating toll of the War on Drugs has encouraged many policymakers and criminal justice practitioners to begin its winding down. The number of people imprisoned nationwide for a drug offense skyrocketed from 24,000 in 1980 to a peak of 369,000 in 2007. It has since declined by nearly one-quarter, reaching approximately 287,000 people in the most recent count. The lessons from past drug crises and the evidence base supporting a public health approach can guide policymakers as they seek an end to the current opioid crisis. Details: Washington, DC: The Sentencing Project, 2017. 35p. Source: Internet Resource: Accessed January 31, 2018 at: https://www.sentencingproject.org/wp-content/uploads/2017/12/Opioids-Treating-an-Illness-Ending-a-War.pdf Year: 2017 Country: United States URL: https://www.sentencingproject.org/wp-content/uploads/2017/12/Opioids-Treating-an-Illness-Ending-a-War.pdf Shelf Number: 148950 Keywords: Drug Abuse and AddictionDrug Abuse TreatmentDrug TreatmentOpioidsWar on Drugs |
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: 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: 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: 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: 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: 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: 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: Drug Policy Alliance Title: An Overdose Death is Not a Murder: Why Drug-Induced Homicide Laws are Counterproductive and Inhumane Summary: The country is in the middle of a tragic increase in drug overdose deaths. Countless lives have been lost - each one leaving an irreparable rift in the hearts and lives of their families and friends. These tragedies are best honored by implementing evidence-based solutions that help individuals, families, and communities heal and that prevent additional avoidable deaths. This report examines one strategy that the evidence suggests is intensifying, rather than helping, the problem and calls for leaders to turn towards proven measures to address the increasing rates of overdose deaths. In the 1980s, at the height of the draconian war on drugs, the federal government and a host of states passed "drug-induced homicide" laws intended to punish people who sold drugs that led to accidental overdose deaths with sentences equivalent to those for manslaughter and murder. For the first 15-20 years, these laws were rarely used by police or prosecutors, but steadily increasing rates of drug overdose deaths across the country have led the law enforcement community to revive them. Currently, 20 states - Delaware, Colorado, Florida, Illinois, Kansas, Louisiana, Michigan, Minnesota, New Hampshire, New Jersey, North Carolina, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Vermont, Washington, West Virginia, Wisconsin, and Wyoming - have drug-induced homicide laws on the books. A number of other states, while without specific drug-induced homicide statutes, still charge the offense of drug delivery resulting in death under various felony-murder, depraved heart, or involuntary or voluntary manslaughter laws. These laws and prosecutions have proliferated despite the absence of any evidence of their effectiveness in reducing drug use or sales or preventing overdose deaths. In fact, as this report illustrates, these efforts exacerbate the very problem they seek to remediate by discouraging people who use drugs from seeking help and assistance. Although data are unavailable on the number of people being prosecuted under these laws, media mentions of drug-induced homicide prosecutions have increased substantially over the last six years. In 2011, there were 363 news articles about individuals being charged with or prosecuted for drug-induced homicide, increasing over 300 percent to 1,178 in 2016. Based on press mentions, use of drug-induced homicide laws varies widely from state to state. Since 2011, midwestern states Wisconsin, Ohio, Illinois, and Minnesota have been the most aggressive in prosecuting drug-induced homicides, with northeastern states Pennsylvania, New Jersey, and New York and southern states Louisiana, North Carolina, and Tennessee rapidly expanding their use of these laws. Further signaling a return to failed drug war tactics, in 2017 alone, elected officials in at least 13 states - Connecticut, Idaho, Illinois, Maine, Maryland, Massachusetts, New Hampshire, New York, Ohio, South Carolina, Tennessee, Virginia, and West Virginia - introduced bills to create new drug-induced homicide offenses or strengthen existing drug-induced homicide laws. Prosecutors and legislators who champion renewed drug-induced homicide enforcement couch the use of this punitive measure, either naively or disingenuously, as necessary to curb increasing rates of drug overdose deaths. But there is not a shred of evidence that these laws are effective at reducing overdose fatalities. In fact, death tolls continue to climb across the country, even in the states and counties most aggressively prosecuting drug-induced homicide cases. As just one example, despite ten full-time police officers investigating 53 potential drug-induced homicide cases in Hamilton County, Ohio in 2015, the county still recorded 100 more opioid-related overdose deaths in 2016 than in 2015. This should be unsurprising. Though the stated rationale of prosecutors and legislators throughout the country is that harsh penalties like those associated with drug-induced homicide laws will deter drug selling, and, as a result, will reduce drug use and related harms like overdose, we have heard this story before. Drug war proponents have been repeating the deterrence mantra for over 40 years, and yet drugs are cheaper, stronger, and more widely available than at any other time in US history. Supply follows demand, so the supply chain for illegal substances is not eliminated because a single seller is incarcerated, whether for drug-induced homicide or otherwise. Rather, the only effect of imprisoning a drug seller is to open the market for another one. Research consistently shows that neither increased arrests nor increased severity of criminal punishment for drug law violations results in less use (demand) or sales (supply). In other words, punitive sentences for drug offenses have no deterrent effect. Unfortunately, the only behavior that is deterred by drug-induced homicide prosecutions is the seeking of life-saving medical assistance. Increasing, and wholly preventable, overdose fatalities are an expected by-product of drug-induced homicide law enforcement. The most common reason people cite for not calling 911 in the event of an overdose is fear of police involvement. Recognizing this barrier, 40 states and the District of Columbia have passed "911 Good Samaritan" laws, which provide, in varying degrees, limited criminal immunity for drug-related offenses for those who seek medical assistance for an overdose victim. This public health approach to problematic drug use, however, is rendered useless by enforcement of drug-induced homicide laws. People positioned to save lives are unlikely to call 911 if they fear being charged with murder or manslaughter. Jennifer Marie Johnson called 911 when her husband overdosed after she gave him methadone; she is currently serving six years in Minnesota prison for drug-induced homicide. Erik Scott Brown received an enhanced sentence of 23 years in federal prison partly because he failed to call 911 after a friend, whom he had supplied with one tenth of a gram of heroin, fatally overdosed. According to his testimony, the reason he did not call 911 was because drugs were present at the scene. Prosecutors - by their own admissions - want to make "examples" of these types of cases. But elevating punishments for drug-induced homicide charges has a chilling effect on seeking medical assistance and, as a result, leads to more, not fewer, avoidable overdose fatalities. This is especially true when police and prosecutors widely abuse their discretion in investigating and prosecuting drug-induced homicide cases. The vast majority of charges are sought against those in the best positions to seek medical assistance for overdose victims - family, friends, acquaintances, and people who sell small amounts of drugs, often to support their own drug addiction. Despite police and prosecutor promises to go after upper echelon drug manufacturers and distributors, that rarely happens. Out of the 32 drug-induced homicide prosecutions identified by the New Jersey Law Journal in the early 2000s, 25 involved prosecution of friends of the decedent who did not sell drugs in any significant manner. After analyzing the 100 most recent cases of drug-induced homicide in southeastern Wisconsin (as of February 2017), Wisconsin's Fox6 reported that nearly 90 percent of those charged were friends or relatives of the person who died, or the lowest people in the drug supply chain, who were often selling to support their own substance use disorder. A Chicago Tribune review of drug-induced homicide cases between 2011 and 2014 in various Illinois counties showed that the defendant was typically the last person who was with the person who overdosed. Law enforcement must be held accountable for this appalling misuse of discretion; particularly when it discourages the seeking of medical care and wastes resources that could otherwise be spent on interventions that have actually been proven successful at reducing overdose deaths. Unchecked police and prosecutorial discretion in drug-induced homicide cases is particularly ominous given the severity of sentences and the racist history of drug war enforcement. Although rates of drug use and selling are comparable across racial lines, black and Latino people are far more likely to be stopped, searched, arrested, prosecuted, convicted and incarcerated for drug law violations than are white people. When, in response to the overdose crisis, Maine Governor Paul Le Page states that "black dealers" and "guys with the name D-Money, Smoothie, Shifty" are the root of the problem by bringing drugs from places like Brooklyn into his rural state, he lays it bare. Most elected officials and prosecutors advocating a punishment-oriented approach to a public health crisis are more careful with their language than Le Page - targeting "pushers" and "those people" - but the implication is the same. Enforcement of drug war policies has historically targeted black and Latino communities, and drug-induced homicide prosecutions appear to follow this pattern. While comprehensive data are not available, the district attorney of one predominantly white suburban county in Illinois with a black population of only 1.6 percent has charged four black men from Chicago with drug-induced homicide (making up 35 percent of the total prosecutions), and one prosecutor in Minnesota appears to have charged predominately black people with drug-induced homicide. Though we cannot draw any conclusions from these sparse facts, if law enforcement utilizes drug-induced homicide like it has other tools of the drug war, we can reasonably expect that the result will be future cases like James Linder's, a black man from Chicago who is serving 28 years in federal prison after being sentenced by an all-white jury in rural Illinois. Unfortunately, the harms of a highly punitive response to drug use and sales expand far beyond the effects of the actual punishment. Indeed, criminalizing people who sell and use drugs, through means like drug-induced homicide charges, amplifies the risk of fatal overdoses and diseases by increasing stigma and marginalization and driving people away from needed medical care, treatment, and harm reduction services. On the other hand, proven strategies are available to reduce the harms associated with drug misuse, treat dependence and addiction, improve immediate overdose responses, enhance public safety, and prevent fatalities. These strategies include expanding access to the life-saving medicine naloxone and training in how to administer it; enacting and implementing legal protections that encourage people to call for medical help for overdose victims; training people how to prevent, recognize, and respond to an overdose; increasing access to opioid agonist treatment such as methadone and buprenorphine, and to other effective, non-coercive drug treatments; authorizing drug checking and safe consumption sites; and improving research on promising drug treatments. Each of these strategies has evidence to support its effectiveness. Drug-induced homicide laws have none. They have not proven successful at either reducing overdose deaths or curtailing the use or sale of illegal drugs. And yet, ironically, prosecutors and legislators wield this punitive sword with impunity. They are not required to show results in support of their faulty rationale, and they are not held accountable for utterly wasted resources. We simply cannot let our elected officials off the hook that easily anymore. Not when it could be your child, friend or, simply, fellow human being, who dies from a drug overdose or is locked up for murder due to our elected officials' failures to embrace proven, life-saving public health interventions in favor of wasteful, destructive punishments. Details: Washington, DC: Drug Policy Alliance, 2017. 80p. Source: Internet Resource: Accessed January 11, 2019 at: https://www.drugpolicy.org/sites/default/files/dpa_drug_induced_homicide_report_0.pdf Year: 2017 Country: United States URL: http://www.drugpolicy.org/resource/DIH Shelf Number: 154109 Keywords: 911 Good Samaritan LawsDrug DealersDrug Overdose DeathDrug War PoliciesDrug-Induced Homicide Evidence-Based SolutionsOpioidsProsecutorial DiscretionPublic Health Approach |
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: InSight Crime Title: Criminal Game Changers 2018 Summary: Welcome to InSight Crime's Criminal GameChangers 2018, where we highlight the most important trends in organized crime in the Americas over the course of the year. From a rise in illicit drug availability and resurgence of monolithic criminal groups to the weakening of anti-corruption efforts and a swell in militarized responses to crime, 2018 was a year in which political issues were still often framed as left or right, but the only ideology that mattered was organized crime. Some of the worst news came from Colombia, where coca and cocaine production reached record highs amidst another year of bad news regarding the historic peace agreement with the region's oldest political insurgency, the Revolutionary Armed Forces of Colombia (Fuerzas Armadas Revolucionarias de Colombia - FARC). The demobilization of ex-FARC members has been plagued by government ineptitude, corruption, human rights violations, and accusations of top guerrilla leaders' involvement in the drug trade. And it may have contributed directly and indirectly to the surge in coca and cocaine production. It was during this tumult that Colombia elected right wing politician Ivan Duque in May. Duque is the protege of former president and current Senator Alvaro Uribe. Their alliance could impact not just what's left of the peace agreement but the entire structure of the underworld where, during 2018, ex-FARC dissidents reestablished criminal fiefdoms or allied themselves with other criminal factions; and the last remaining rebel group, the National Liberation Army (Ejercito de Liberacion Nacional - ELN), filled power vacuums in Colombia and neighboring Venezuela, making it one of our three criminal winners this year. Meanwhile, a new generation of traffickers emerged, one that prefers anonymity to the large, highly visible armies of yesteryear. Also of note in 2018 was a surge in synthetic drugs, most notably fentanyl. The synthetic opioid powered a scourge that led to more overdose deaths in the United States than any other drug. Fentanyl is no longer consumed as a replacement for heroin. It is now hidden in counterfeit prescription pills and mixed into cocaine and other legacy drugs. It is produced in Communist-ruled China and while much of it moves through the US postal system, some of it travels through Mexico on its way to the United States. During 2018, the criminal groups in Mexico seemed to be shifting their operations increasingly around it, especially given its increasing popularity, availability, and profitability. The result is some new possibly game changing alliances, most notably between Mexican and Dominican criminal organizations. Among these Mexican criminal groups is the Jalisco Cartel New Generation (Cartel Jalisco Nueva Generacion - CJNG), another of our three criminal winners for 2018. The CJNG has avoided efforts to weaken it with a mix of sophisticated public relations, military tactics and the luck of circumstance - the government has simply been distracted. That is not the say it is invulnerable. The group took some big hits in its epicenter in 2018, and the US authorities put it on its radar, unleashing a series of sealed indictments against the group. Mexico's cartels battled each other even as they took advantage of booming criminal economies. The result was manifest in the record high in homicides this year. The deterioration in security opened the door to the July election of leftist candidate Andres Manuel Lopez Obrador. AMLO, as he is affectionately known, did not necessary run on security issues, but he may have won on them, and in the process, inherited a poisoned security chalice from his predecessor. While Pena Nieto can claim to have arrested or killed 110 of 122 criminal heads, AMLO faces closer to a thousand would-be leaders and hundreds of criminal groups.... Details: s.l.: Insight Crime, 2019. Source: Internet Resource: Accessed March 25, 2019 at: https://www.insightcrime.org/wp-content/uploads/2019/01/CRIMINAL-GAMECHANGERS-2018-InSight-Crime.pdf Year: 2019 Country: Latin America URL: https://www.insightcrime.org/wp-content/uploads/2019/01/CRIMINAL-GAMECHANGERS-2018-InSight-Crime.pdf Shelf Number: 155157 Keywords: CocaineCriminal NetworksDrug CartelsDrug TraffickingFentanylIllicit DrugsOpioidsOrganized CrimeWar on Drugs |
Author: Felbab-Brown, Vanda Title: Mexico's Out-of-Control Criminal Market Summary: This paper explores the trends, characteristics, and changes in the Mexican criminal market, in response to internal changes, government policies, and external factors. It explores the nature of violence and criminality, the behavior of criminal groups, and the effects of government responses. Over the past two decades, criminal violence in Mexico has become highly intense, diversified, and popularized, while the deterrence capacity of Mexican law enforcement remains critically low. The outcome is an ever more complex, multi-polar, and out-of-control criminal market that generates deleterious effects on Mexican society and makes it highly challenging for the Mexican state to respond effectively. Successive Mexican administrations have failed to sustainably reduce homicides and other violent crimes. Critically, the Mexican government has failed to rebalance power in the triangular relationship between the state, criminal groups, and society, while the Mexican population has soured on the anti-cartel project. Since 2000, Mexico has experienced extraordinarily high drug- and crime-related violence, with the murder rate in 2017 and again in 2018 breaking previous records. The fragmentation of Mexican criminal groups is both a purposeful and inadvertent effect of high-value targeting, which is a problematic strategy because criminal groups can replace fallen leaders more easily than insurgent or terrorist groups. The policy also disrupts leadership succession, giving rise to intense internal competition and increasingly younger leaders who lack leadership skills and feel the need to prove themselves through violence. Focusing on the middle layer of criminal groups prevents such an easy and violent regeneration of the leadership. But the Mexican government remains deeply challenged in middle-layer targeting due to a lack of tactical and strategic intelligence arising from corruption among Mexican law enforcement and political pressures that makes it difficult to invest the necessary time to conduct thorough investigations. In the absence of more effective state presence and rule of law, the fragmentation of Mexican criminal groups turned a multi-polar criminal market of 2006 into an ever more complex multi-polar criminal market. Criminal groups lack clarity about the balance of power among them, tempting them to take over one another's territory and engage in internecine warfare. The Mexican crime market's proclivity toward violence is exacerbated by the government's inability to weed out the most violent criminal groups and send a strong message that they will be prioritized in targeting. The message has not yet sunk in that violence and aggressiveness do not pay. For example, the destruction of the Zetas has been followed by the empowerment of the equally aggressive Cartel de Jalisco Nueva Generacion (CJNG). Like the Zetas, the Jalisco group centers its rule on brutality, brazenness, and aggressiveness. Like the Zetas and unlike the Sinaloa Cartel, the CJNG does not invest in and provide socio- economic goods and governance in order to build up political capital. Equally, the internal re-balancing among criminal groups has failed to weed out the most violent groups and the policy measures of the Mexican governments have failed to reduce the criminal groups' proclivity toward aggression and violence. The emergence of the CJNG has engulfed Mexico and other supply-chain countries, such as Colombia,in its war with the Sinaloa Cartel. The war between the Sinaloa Cartel and CJNG provides space for local criminal upstarts, compounds instability by shifting local alliances, and sets off new splintering within the two large cartels and among their local proxies. To the extent that violence has abated in particular locales, the de-escalation has primarily reflected a "narco-peace," with one criminal group able to establish control over a particular territory and its corruption networks. It is thus vulnerable to criminal groups' actions as well as to high-value targeting of top drug traffickers. In places such as Ciudad Juarez, Tijuana, and Monterrey, local law enforcement and anti-crime socio-economic policies helped in various degrees to reduce violence. When the narco-peace was undermined, the policies proved insufficient. At other times, the reduction of violence that accompanied a local narco-peace gave rise to policy complacency and diminished resources. Socio-economic policies to combat crime have spread resources too thinly across Mexico to be effective. Violence in Mexico has become diversified over the past decade, with drug trafficking groups becoming involved in widespread extortion of legal businesses, kidnapping, illegal logging, illegal fishing, and smuggling of migrants. That is partially a consequence of the fragmentation, as smaller groups are compelled to branch out into a variety of criminal enterprises. But for larger groups, extortion of large segments of society is not merely a source of money, but also of authority. Violence and criminality have also become "popularized," both in terms of the sheer number of actors and also the types of actors involved, such as "anti-crime" militias. Widespread criminality increases the coercive credibility of individual criminals and small groups, while hiding their identities. Low effective prosecution rates and widespread impunity tempt many individuals who would otherwise be law-abiding citizens to participate in crime. Anti-crime militias that have emerged in Mexico have rarely reduced violence in a sustained way. Often, they engage in various forms of criminality, including homicides, extortion, and human rights abuses against local residents, and they undermine the authority of the state. Government responses to the militias-including acquiescence, arrests, and efforts to roll them into state paramilitary forces-have not had a significant impact. In fact, the strength and emergence of militia groups in places such as Michoacan and Guerrero reflect a long-standing absence of the government, underdevelopment, militarization, and abuse of political power. In places such as Guerrero, criminality and militia formation has become intertwined with the U.S. opioid epidemic that has stimulated the expansion of poppy cultivation in Mexico. The over-prescription of opioids in the United States created a major addiction epidemic, with users turning to illegal alternatives when they were eventually cut off from prescription drugs. Predictably, poppy cultivation shot up in Mexico, reaching some 30,000 hectares in 2017. Areas of poppy cultivation are hotly contested among Mexican drug trafficking groups, with their infighting intensely exacerbating the insecurity of poor and marginalized poppy farmers. Efforts to eradicate poppy cultivation have often failed to sustainably reduce illicit crop cultivation and complicated policies to pacify these areas, often thrusting poppy farmers deeper into the hands of criminal groups that sponsor and protect the cultivation. Eradication is easier than providing poppy farmers with alternative livelihoods. Combined with the Trump administration's demands for eradication, the Enrique Peea Nieto administration, and Mexico historically, showed little interest in seriously pursuing a different path. Poppy eradication in Mexico does not shrink the supply of illegal opioids destined for the U.S. market, since farmers replant poppies after eradication and can always shift areas of production. The rise of fentanyl abuse in the United States, however, has suppressed opium prices in Mexico. Drug trafficking organizations and dealers prefer to traffic and sell fentanyl, mostly supplied to the United States from China, because of its bulk-potency-profit ratio. The CJNG became a pioneer in fentanyl smuggling through Mexico into the United States, but the Sinaloa Cartel rapidly developed its own fentanyl supply chain. Although the drug is deadly, the Sinaloa Cartel's means of distribution remain non- violent in the United States. Fentanyl enters the United States from Mexico through legal ports of entry. In the short term, fentanyl has not altered the dynamics of Mexico's criminal market, but in the long term, fentanyl can significantly upend global drug markets and the prioritization of drug control in U.S. agendas with other countries. If many users switch to synthetic drugs, the United States may lose interest in promoting eradication of drug crops. Such a switch would also weaken the power of criminal and insurgent groups who sponsor illicit crop cultivation. Even if they switch to the production of synthetic drugs, they will only have the capacity to sponsor the livelihoods of many fewer people, thus diminishing their political capital with local populations and making it less costly for the government to conduct counter-narcotics operations. Mexico's violence can decline in two ways. First, a criminal group can temporarily win enough turf and establish enough deterrence capacity to create a narco-peace, as has been the case so far. Alternatively, violence can decline when the state at last systematically builds up enough deterrence capacity against the criminals and realigns local populations with the state, from which they are now often alienated. Mexico must strive to achieve this objective. Details: Washington, DC: Foreign Policy at Brookings Institute, 2019. 29p. Source: Internet Resource: Accessed March 27, 2019 at: https://www.brookings.edu/wp-content/uploads/2019/03/FP_20190322_mexico_crime-2.pdf Year: 2019 Country: Mexico URL: https://www.brookings.edu/wp-content/uploads/2019/03/FP_20190322_mexico_crime-2.pdf Shelf Number: 155192 Keywords: Criminal CartelsDrug MarketsDrug TraffickingFentanylHomicidesNarcoticsOpioidsOrganized CrimeSocioeconomic Conditions and CrimeViolence |
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 |