Governance in EU illicit drugs policy

This commentary represents the authors’ views on EU governance in illicit drug policy, a field in which they were active for more than 10 years between them. EU drug policy has a narrow legal basis in the European Treaties and is mostly non-binding. The main policy instruments are 8-year EU Drug Strategies, underpinned by 4-year Action Plans which set out specific objectives at national, EU or international level. The approach that guides EU drug policy is known as the ‘balanced approach’. It is remarkably restrained and reflects the reality that very few Member States have either the socio-political culture or the resources to consistently apply the punitive sanctions foreseen by the UN conventions. An important feature of EU governance in the field of drugs is the proactive support that is provided to non-governmental organisations both within the EU as well as in accession, associated or third countries. At a global level, the EU is a major financial aid donor also in this field. This position is not however reflected in corresponding political clout for the EU within the UN system. EU governance on drugs has made it possible for many of its Member States to accommodate the problem rather than to “solve” what by all the evidence from the last 100 years may well be insoluble, at least by means of criminalisation and prohibition. The big question is where EU drug policy is headed in the next few years. The EU has been promoting measures and practices that target real problems. It has done so without indulging too much in unhelpful rhetoric. However, like all successful formulae this one also has a sell-by date. EU governance in the field of drugs cannot afford to stand still. It needs to find a second wind.     

A risk profile of elite Australian athletes who use illicit drugs

Much of the literature investigating the relationship between sports participation and substance use has focused upon student populations, with little focus being given to athletes who participate at elite levels. Identifying why some athletes may be at a greater risk for substance use can help in the design and implementation of prevention initiatives. Data for the current study was from 1684 self-complete surveys with elite Australian athletes. Eight percent (n = 134) of the sample reported the use of at least one of the six illicit drugs under investigation (ecstasy, cannabis, cocaine, meth/amphetamine, ketamine and GHB) in the past year. Having been offered or having had the opportunity to use illicit drugs in the past year, knowing other athletes who use drugs and identifying as a ‘full-time athlete’ were significant predictors of past-year illicit drug use, while having completed secondary education or a post-school qualification was associated with a lower likelihood of past-year illicit drug use. Athletes are part of a sportsnet that includes family, coaches, support staff and other athletes, and these relationships may encourage the use, supply and demand for drugs. The current findings suggest that relationships with some of those in the sportsnet may play an important role when understanding illicit drug use among elite athletes. As education appears to be associated with a lower likelihood of illicit drug use among this group, initiatives should encourage athletes to engage in off-field pursuits which may also help prepare them for life after sport.     

Direct and rapid characterization of illicit drugs in adulterated samples using thermal desorption electrospray ionization mass spectrometry

Foods and drinks have been adulterated with illicit drugs to facilitate criminal activities. Unfortunately, conventional analytical methods are incapable of rapidly characterizing these drugs in samples, as serious interferences from sample matrices must be removed through tedious and time-consuming pretreatment. Ambient ionization mass spectrometry (AMS) generally does not require sample pretreatment and is thus a suitable tool for directly and rapidly detecting illicit drugs in samples in different physical states. In this study, thermal desorption electrospray ionization mass spectrometry (TD-ESI/MS), an AMS technique, was utilized to efficiently characterize illicit drugs spiked in samples including drinks, powders, and jelly candies. To perform sensitive analysis, the mass analyzer was operated in multiple reaction monitoring mode to monitor the molecular and fragment ions of the target analytes. The time required to complete a typical TD-ESI/MS analysis was less than 30 s. The limits of detection (LODs) for illicit drugs were found to be 100 ppb in drinks, 100–1000 ppb in instant powders, and 1.3–6.5 ng/mm² on stamp surfaces. FM2 and nitrazepam laced in the inner layer of a jelly candy were detected by TD-ESI/MS, showcasing the advantage of the technique for direct and rapid analysis as opposed to conventional methods.     

Drug markets and distribution systems

Illicit drug markets are a part of our society. How visible and detrimental they are to their host communities has shaped enforcement action against them. Until the mid-1990s, open street-based markets were probably where most illicit drugs of dependency were bought and sold. With the steady rise in market activity, communities tired of the damage these markets caused, and demanded a police response. Quite separately, but around the same time, there was a proliferation in the ownership and use of mobile phones. Together, they provided open markets with both the impetus and the means to evolve into closed markets. Now this type of market is probably where most drugs of dependency are bought and sold. This article offers a classification of retail markets, distinguishing between open markets, closed markets, crack or dealing houses and other forms of retail system, and examines variations in the structure of distribution within these markets – mainly in the United Kingdom. At the same time, we also examine the available evidence on the ‘middle level’ drug markets that support these retail markets; and consider the relationship between supply, demand and enforcement, examining the adaptations that markets will make to enforcement and the perverse effects that enforcement may cause.     

Cannabis use stages as predictors of subsequent initiation with other illicit drugs among French adolescents: use of a multi-state model

The aim of this study was to confirm the influence of cannabis use patterns on the probability of initiation with other illicit drugs (OID). A French nationwide retrospective cohort on drug use was reconstituted on 29,393 teenagers. A Markov multi-state model was fitted, modelling all possible pathways from initial abstinence to cannabis initiation, daily cannabis use and OID initiation. The model was adjusted for tobacco and alcohol use. The risk for OID initiation appeared 21 times higher among cannabis experimenters and 124 times higher among daily cannabis users than among non-users. Tobacco and alcohol use were associated with a greater risk of moving on to cannabis initiation (hazard ratio (HR) = 1.2 for tobacco initiation, HR = 2.6 for daily tobacco use and HR = 2.8 for drunkenness initiation). The results of this study provide a confirmation of a stage process in drug use, mediated by cannabis and liable to lead to OID experiment. This is compatible with the literature on the gateway theory, but goes further by modelling the entire sequence of use. OID experiment could be a consequence of initial opportunity to use the more accessible illicit drug, cannabis.     

The cocaine and heroin markets in the era of globalisation and drug reduction policies

BackgroundDespite the large volume of public effort devoted to restrain drug supply and the growing attention given to drug demand reduction policies, the use of cocaine and heroin remains steady. Furthermore, retail drug prices have fallen significantly in Europe and the US. This puzzling evidence leads us to develop a model aiming at systematically analysing illicit drug markets.MethodsWe model the markets of cocaine and heroin from production to the final retail markets. One novelty of the analysis consists in characterising the retail market as a monopolistic competitive one. Then, upper level dealers have some market power in the retail market. This allows them to charge a markup and to earn extra profits. These extra profits attract newcomers so that profits tend to fall over time.ResultsTheoretical model was used to analyse the effect of supply containment policies on the retail market, the producer market and the export–import business. This introduces the discussion of the impact of demand reduction policies on the high level traffickers’ profit. Finally, globalisation enters in the model.ConclusionsLaw enforcement measures increase the risk premia received by the lower and higher level traffickers. Consequently, trafficking intermediation margins tend to increase. However, globalisation has the opposite effect. It lowers intermediation margins and, then, pushes retail prices down, thereby stimulating consumption. In doing so, globalisation offsets the effects of supply containment policies. Finally, we discuss how the effectiveness of supply containment policies can be enhanced by combining them with demand reduction policies.     

Globalization and the price decline of illicit drugs

BackgroundThis study aims at understanding the mechanisms underlying the dramatic decline of the retail prices of major drugs like cocaine and heroin during the past two decades. It also aims at analysing the implications of this decline for drug policies.MethodsWe use a theoretical model to identify the possible causes of this price decline. This allows us to formulate the hypothesis that the major driving force behind the price decline is a reduction of the intermediation margin (the difference between the retail and producer prices). We also develop the hypothesis that globalization has been an important factor behind the decline of the intermediation margin. We then analyse the statistical information to test these hypotheses.ResultsWe find that the decline in the retail prices of drugs is related to the strong decline in the intermediation margin in the drug business, and that globalization is the main driving force behind this phenomenon. Globalization has done so by increasing the efficiency of the distribution of drugs, by reducing the risk premium involved in dealing with drugs, and by increasing the degree of competition in the drug markets.ConclusionWe conclude that the cocaine and heroin price declines were due to a sharp fall in the intermediation margin, which was probably influenced by globalization. This phenomenon might have a strong impact on the effectiveness of drug policies, increasing the relative effectiveness of policies aiming at reducing the demand of drugs.     

Nanomaterial-based adsorbents and optical sensors for illicit drug analysis

The abuse of illicit drugs has been prevalent in recent years and is associated with crime and public health issues. To strengthen public security and fortify public health services with respect to the increasing severity of drug abuse, academic and government institutes have been devoted to constructing relative analytical methods for illicit drugs. To date, the development of sensors has been greatly emphasized due to their features of high sensitivity, prompt detection and flexible manipulation; thus, sensors can serve as alternatives to conventional sophisticated instruments. Recently, the use of nanomaterials has inspired the development of a series of innovative sample pretreatment and detection strategies in the field of analytical chemistry. Herein, this review elaborated the application of nanomaterials in analytical methods, including sample pretreatments, colorimetric sensors and fluorescent sensors. The utilization of nanomaterials in the analytical field provides novel perspectives for the development of detection platforms and facilitates the monitoring of illicit drugs in diverse complex matrices.     

Drug price transparency initiative: A scoping review

BackgroundDrug price transparency is defined as readily available information on the price of pharmaceutical drugs to either authorities or consumers. Price transparency, together with other information, helps define the value of drugs and enables informed decision making. It has also been used as a reference in drug price setting mechanisms in some countries’ pricing policies.ObjectiveTo investigate the evidence available: 1) on government initiatives to mandate transparency in drug pricing worldwide, 2) on the reported effects of drug pricing transparency initiatives on drug price, and 3) on the limitations and barriers of the implementation of drug pricing transparency.MethodsDatabases such as Medline-Ovid, Cochrane Central Register, PubMed, and Science Direct were used to search for relevant literature from inception to February 2018. A manual search of grey literature such as policy papers, governmental publications, and websites was also performed to obtain the information that was not available in the articles. Using narrative synthesis, the results were critically assessed and summarized according to its context of drug pricing approaches.ResultsOf the 4382 relevant articles located, 12 studies met the inclusion criteria for drug price transparency initiatives. Only 3 studies reported the outcomes on the regulation of drug prices. Two studies in South Africa showed that price transparency initiatives did not necessarily reduce drug prices. Another study in the Philippines indicated a reduction in medicines’ price based on the effects of government-mediated access prices. The limitations and barriers in price transparency initiatives include fragmentation of the healthcare system and nondisclosure of discounts and rebates by pharmaceutical companies.ConclusionDrug pricing transparency initiatives have been implemented in many countries and commonly coexist with a country's pricing policies. Nevertheless, due to sparse evidence, the effect of drug price transparency initiatives on price control is still inconclusive.     

如何看待医院药品价格与市场零售价格的差异

目的 :探讨医院药品价格与市场零售价格产生差异的原因。方法 :从药品质量的保证体系、药学服务、药品使用结构以及体制、运行机制等方面剖析药品价格不同的原因。结果与结论 :医院药品价格高于市场零售价格有其合理性 ,应以实事求是的眼光看待在医药市场上同一药品有不同价格的事实。     

The Elderly and the Use of Illicit Drugs: Sociological and Epidemiological Considerations

Debates over the prevalence of elderly illicit drug addicts in the population divert our attention from this group as a viable study population. Due to their decelerated lifestyle, low crime rates, and our attitudes toward the elderly as nonstreet drug users, they are likely to remain hidden from the public eye. This paper reviews past trends in drug misuse among the elderly, the lifestyle of those addicted to drugs, the complications associated with drug misuse and aging, and the problems that the elderly face with traditional treatment programs. Given our aging society, is the study of elderly street addicts and users an important area of concern?     

Least bad solutions to the 'drugs problem'

This paper examines the current difficulties being faced in Australia by policy-makers attempting to regulate the non-medical use of illegal drugs, and it is suggested that the difficulties centre upon two aspects. First, existing prohibitions are unsuccessful, with use levels rising and, in some arenas (e.g. cocaine use in the USA), quite out of control. On the other hand, a move towards decriminalization or legalization is difficult because past propaganda has been so vehement that a change now apparently risks sending the wrong messages to young people. This dilemma means that there is no solution, including inertia, which is risk-free, nor is there one free of difficulties. It is thus relevant to think in terms of 'least bad' rather than 'best' when formulating a system to face these problems. The exploration of what this least bad solution might be begins with the examination of the prominent myths (such as 'the drug-free society', 'the evil pusher', 'the user as victim' and 'the young person as cultural dope') that hinder our reasoning. Secondly, by suggesting that, in a climate of increasing crime related to drugs, inability of prohibitions to control that use and escalating health risks attendant on use (including the AIDS problem), the central policy thrust must be harm reduction and damage minimization rather than illusory goals such as widespread abstinence. The paper concludes with a discussion of some relevant evidence on alternative options.     

Markers of ethnicity and their effect on measuring illicit drug use by ethnic groups

Assessing the relative involvement of ethnic communities with illicit drugs relies on identification of ethnicity in collected information. Many of the indicators of ethnicity used in Victorian drug- and alcohol-related databases fail to provide researchers with adequate information to accurately determine ethnic or cultural orientation. Country of birth is the variable most commonly used to identify ethnicity, but it conceals Australian-born children of migrants who may identify primarily with their ethnic background. The self-identified 'ethnic/cultural background' variable collected in the Victorian methadone registry allowed us to show that many second-generation migrants do identify primarily with their ethnic/cultural background. Of the methadone permit forms examined, 31% identified the applicant as belonging to one of 70 different ethnic/cultural background groups. The most common ethnic groups were Vietnamese (22%), Greek (16%) and Italian (15%). The Victorian methadone registry implies that illicit drug use among a number of ethnic minority communities is substantial, unlike all other Victorian databases, which lack good ethnicity measures. Health-related databases should reflect the multi-cultural nature of the Victorian population; the inclusion of better ethnicity variables can allow an improved measurement about the extent of illicit drug use in ethnic minority communities and therefore illuminate a number of important education and service delivery issues.     

Truancy and illicit drug use among adolescents surveyed via street outreach

This study investigates the association linking truancy and drug-related experiences among adolescents surveyed via a street outreach program. A total of 2126 adolescents aged 12 to 18 years recruited from Taipei street sites completed a self-administered anonymous questionnaire. The lifetime prevalence of illicit drug use for adolescents with truancy was 15.0-17.9% (12.1-14.5% for ecstasy, 4.6-7.3% for ketamine, and 3.5-8.8% for marijuana), and the corresponding estimate was 3.1-3.4% for youths without truancy. Multiple logistic regression analyses showed a dose-response effect linking the maximum days of truancy with illicit drug us. After holding constant of psychosocial environmental factors and use of readily available substance (i.e., alcohol, tobacco, and betel nut), the results of survival analyses suggested that there might be reciprocal relationships operating between illicit drug use and truancy. These findings may help form programs to identify or monitor youths at risk.     

Drug utilization and expenditure of anticancer drugs for breast cancer

PurposeDrug utilization studies have proven to be an effective tool in the evaluation of rational drug use in different health care systems, including oncology. The drug utilization studies were used in many institutes to ensure the safe, effective and appropriate use of drugs being prescribed. The main aim of this study was to assess the utilization pattern of anticancer drugs in breast cancer patients.MethodA retrospective cross-sectional observational study was carried out at King Saud University Medical City (KSUMC) for 1 year from January 2016 to December 2016. All female patients diagnosed with breast cancer during this year were included in the study.ResultsA total of 101 patients were included in this study. Most patients received an average of three anticancer drugs. The most commonly prescribed medication was fluorouracil, epirubicin, and cyclophosphamide (FEC) regimen, which was used in 81% of patients. Combinations of FEC + docetaxel and FEC + docetaxel + trastuzumab were received by43% and 23% of patients, respectively. Docetaxel was the most commonly used drug in neoadjuvant setting, whereas letrozole and trastuzumab were prescribed more frequently in hormonal and targeted therapies, respectively. The total drug expenditure on anticancer therapy was approximately 3.8 million Saudi Riyals (S.R), with adjuvant therapy constituting over half of the total spending. In neoadjuvant settings, the spending cost for hormonal therapy was the highest. The condition of most breast cancer patients was improved during the study period, whereas only 29% of the included patients progressed.ConclusionFEC was the most common regimen used in this study, consistent with the National Comprehensive Cancer Network (NCCN) guideline recommendation. Our results indicated that adherence to a clinical guideline and recommended medication regimens improved patient outcomes. Our finding indicate how analyzing drug utilization pattern could benefit institutions in managing inventory and efficiently using health care resources.     

Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances--systematic review and meta-analysis

Background

Timeline Follow-Back (TLFB) is a widely used, calendar-based measure of self-reported use of (among other things) illicit substances. We examined agreement between TLFB and biological measures for illicit substances.

Methods

PubMed, PsycINFO, Cochrane CENTRAL, and EMBASE were searched in December 2010. 16,633 papers screened to identify those that measured illicit substance use by both TLFB and biological measures. We extracted data on agreement between TLFB and biological measures, sample size, study type, inclusion criteria of participants, and length of recall of TLFB.

Results

Twenty-nine papers were included, almost exclusively in substance-use-disorder populations. Some studies reported several overall agreement rates, e.g. over time. Lowest and highest weighted average agreement rates were: for cannabis, 87.3% (95% confidence interval 86.9% to 87.7%) and 90.9% (90.5% to 91.4%); for cocaine, 79.3% (79.1% to 79.6%) and 84.1% (83.9% to 84.2%); for opiates 94.0% (93.5% to 94.5%) for both weighted averages; and for studies not distinguishing between substances, 88.5% (88.4 to 88.7%) and 91.0% (90.7% to 91.2%). Higher agreement was found in populations without psychiatric comorbidity, and lower agreement in randomized controlled trials. Publication bias or selective outcome reporting bias was not detected.

Conclusions

TLFB validly detects use of illicit substances in populations with substance use disorders. Using TLFB may limit the need for biological samples, making information on illicit substance use easier and less costly to obtain and analyze.     

Drug Treatment Effectiveness: An Examination of Conceptual and Policy Issues

This paper discusses different concepts or views of what constitutes effective treatment for drug dependence and how these views are involved in policy decisions regarding treatment. The paper reviews the rise of evidence-based medicine, discusses the emergence of efficacy research, effectiveness research, and other types of outcome-based evaluations of drug user treatment, but notes that despite a growing consensus among researchers on the effectiveness of drug user treatment, substantial public skepticism about the value of treatment still exists in the United States. The paper argues that one of the primary reasons for the lack of public consensus in the United States is that there is wide disagreement over which type of problem drug dependence is and for whom it may be a problem. The paper reviews some of the most common models and their implications for evaluating effectiveness, and argues that it is the differences in perspective among these models that are at the heart of policy debate over drug treatment policy in the United States. The paper concludes that because evaluation research as currently practiced does not address these issues, its utility for policy purposes is limited in the American context.