Search

Background and aims: The short‐lived regulated legal market for new psychoactive substances (NPS) in New Zealand marked a radical departure from the traditional prohibition‐based approach to drugs. This paper aimed to enhance understanding of this policy change using Punctuated Equilibrium Theory (PET). Methods: The analysis draws on 3 years of evaluative research, including interviews with key stakeholders, analysis of legislation and policy documents and academic and grey literature. Results: The reframing of the NPS issue from one of drug control to the need for stricter market regulation was achieved by the efforts of strategic policy entrepreneurs, including the legal high industry, drug law reform advocates, influential politicians and an independent legal advisory institution. This reframing was aided by the perceived saliency of the NPS problem and ineffectiveness of previous prohibition‐based responses. In the absence of any political opposition to the regulatory approach, the Psychoactive Substances Act rapidly progressed through the Parliament. However, once the interim legal market was established, portrayal of the issues shifted away from experts and lobbyists to critique from local communities, local government, animal rights activists and the media, who viewed the new regime as a source of social and health problems. The mobilization of criticism ('Schattschneider mobilization') drew on ideas of animal welfare and community safety. With a looming national election, the government responded by ending the interim market with the urgent passage of amendment legislation. Conclusions: Punctuated Equilibrium Theory (PET) helps explain how New Zealand's Psychoactive Substances Act (PSA) policy first emerged on the political agenda and how the initial positive tone of expert support for reform shifted to a tide of popular criticism during the interim regime. However, with its emphasis on explaining agenda‐setting, PET does not account for the legislative design shortcomings of the PSA. [ABSTRACT FROM AUTHOR]

Background and aims Prohibitions on producing, distributing and selling cannabis are loosening in various jurisdictions around the world. This paper describes the diversification of cannabis supply laws and discusses the challenges to and opportunities for learning from these changes. Methods We document changes in cannabis supply laws that de jure legalized cannabis production for medical and/or non-medical purposes (excluding industrial hemp) in Australasia, Europe, North America and South America. We also highlight challenges to evaluating these legal changes based on our experiences studying cannabis laws and policies in the United States. Findings As of August 2016, two countries have passed laws to legalize large-scale cannabis production for non-medical purposes at the national (Uruguay) or subnational level (four US states). At least nine other countries legally allow (or will soon allow) cannabis to be supplied for medicinal purposes. Most of the changes in cannabis supply laws have occurred since 2010. The data available in most countries are inadequate for rigorously evaluating the changes in cannabis supply laws. Conclusion The evidence base for assessing changes in cannabis supply laws remains weak. Efforts should focus upon collecting information about quantities consumed and market transactions as well as validating self-report surveys. [ABSTRACT FROM AUTHOR]

Background New Zealand has recently attempted to address the underlying drivers of the escalating new psychoactive substances ( NPS) ('legal highs') problem by establishing the world's first pre-market approval regulatory regime for NPS. NPS products which can be shown with clinical trial data to pose a 'low risk' of harm will be approved for legal manufacture and sale. Aims and method This paper critically assesses the new regime, drawing on experience of the pharmaceutical sector and legal BZP market. Findings A number of characteristics of the recreational use of NPS may not be well addressed by standard medical clinical trials, including binge use, polydrug use, use by vulnerable groups and high-risk modes of administration. The overt advertising and covert promotion of approved NPS products on the internet may make them fairly visible to young people. The black market for unapproved NPS may be difficult to suppress given that unapproved NPS will be physically identical to approved NPS. If the legal market for NPS encourages the use of NPS, alcohol and other drugs there may be an increase in drug-related harm. Alternatively, if the legal NPS market reduces the use of more harmful drugs, there may be a considerable public health benefit. Conclusions The clinical trials required for NPS products should address the characteristics of recreational NPS use. Enforcement resources and technical solutions are required to clearly distinguish legal NPS products. The impact the new NPS regime has on other drug use is a key issue and demands further study. [ABSTRACT FROM AUTHOR]

The article presents the interview summary with epidemiologist Ingeborg Rossow who discusses her experience helping patients and meeting all sorts of people, and conducting dental research. Also her participation in the alcohol and suicide prevention project aimed researchers to look at whether the association between alcohol consumption and suicide rates varied throughout different drinking cultures.

The article explores what addiction specialists in the United States might learn from Estonia regarding their response to problems relating to drug addiction and overdose. Particular focus is given to the use of fentanyl, which has been a major contributor to the overdose death epidemic in both Estonia and the United States. Other topics discussed include methodologies for harm reduction, the development of early warning systems (EWS) that can inform users of the dangers and harms of new fentanyl analogues, and the effectiveness of naloxone.

Aim: To evaluate and document the impacts of re-scheduling codeine to a prescriptiononly medication in Australia in February 2018. Design: Prospective cohort study. Participants completed an on-line survey with a range of outcome measures at four time-points, once before codeine was re-scheduled (November 2017) and three times after the event: 1 month after (February 2018), 4 months after (June 2018) and 12 months after (February 2019). Setting: Australia. Participants: Participants were 260 Australians aged 18 years and above who reported regular over-the-counter (OTC) codeine use and, at the time of the study, were not engaged in treatment for codeine dependence. Measurements: Survey measures included estimates of daily average codeine use (mg) and overall daily average opioid use [calculated using an oral morphine equivalent daily dose (OMEDD, mg)], opioid use disorder with regard to codeine use (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV), pain and pain self-efficacy, anxiety and depression and health service use. Findings: A reduction in total daily codeine use (mg) from 64.3 mg [95% confidence interval (CI) = 46.7-81.9] in November 2017 (baseline) to 27.6 mg (95% CI = 19.2-36.0) in February 2019 (final time-point) was observed. A decline in the proportion of participants who met criteria for an opioid use disorder was also evident, with 51.2% (n = 133) at baseline relative to 33.3% (n = 58) at the 12-month follow-up. This study had an overall participant retention rate of 67% at the final time-point. Conclusion: Re-scheduling codeine in Australia has been accompanied by significant reductions in codeine use and prevalence rates of opioid use disorder in a cohort of individuals who regularly use the medication, without apparent adverse impacts on pain or measures of anxiety and depression. [ABSTRACT FROM AUTHOR]

An introduction to the article "Supervised consumption sites: a nuanced assessment of the causal evidence," by J. P. Caulkins, B. Pardo and B. Kilmer is presented, which also includes insights on public drug policy in the U.S. as of 2019, notably the provision of safe injection sites for intravenous drug use.

Background and aims: Over‐the‐counter codeine products were up‐scheduled to prescription only in Australia from February 2018. This trend study aimed to identify changes in codeine supply before and after the February 2018 implementation. Design, setting and cases: Time–series regression analysis of monthly medicine supplies in Australia from 2014 to 2018. The February 2018 up‐scheduling was pre‐specified as the intervention; outlier analysis was used to detect automatically sudden unexpected changes before February 2018. Measurements Per‐capita supplies based on national data for pharmaceutical wholesales and population exposure. Weight of supplies in milligrams for low‐dose codeine (≤ 15 mg per tablet or ≤ 1.92 mg per ml, originally sold over the counter but up‐scheduled after February 2018), high‐dose combination codeine (30 mg per tablet, prescription only throughout the study period) and all codeine. Findings Several level shifts in supply occurred during the 5 years, led by one of −4.4% [95% confidence interval (CI) = −6.6 to −2.1%] in high‐dose codeine in 2015, followed by shifts in low‐dose codeine of −40.0% (CI = −46.9 to −32.3%) and −82.2% (CI = −84.3 to −79.9%), respectively, before and after February 2018. High‐dose codeine supply increased by 4.4% (CI = 1.8–7.1%) immediately after up‐scheduling. Also detected were transient increases and decreases in 2016 and 2017. Compared with pre‐2015 levels, the February 2018 up‐scheduling was associated with reductions of 45.7% (CI = 43.2–48.0%) and 89.3% (CI = 87.9–90.6%), respectively, in all and low‐dose codeine supply but no change in high‐dose codeine supply. The level shifts and transient changes were located around various regulatory activities, including public announcements and expert advisory meetings on up‐scheduling. Conclusion: Up‐scheduling of over‐the‐counter codeine products in Australia in 2018 appears to have been associated with a near halving of Australia's national codeine supply. The transition occurred in multiple forms and phases. [ABSTRACT FROM AUTHOR]

Background and aims: Opening up access to scheduled drugs such as cannabis in the United Kingdom rarely happens, yet on 1 November 2018 the United Kingdom changed the law to allow cannabis‐derived products to be prescribed for medicinal purposes, albeit in tightly controlled circumstances. This followed substantial media interest in the cases of two children with epilepsy. This article focuses upon the role of scandal in bringing about legislative change. Methods: We used political science and social policy theories (punctuated equilibrium theory and scandal theory) to guide a qualitative content analysis of media articles published in 2018 in UK national newspapers. We focused in particular on the 6‐month period prior to the policy change. Results: The concentrated attention by the media given to the suffering of children with epilepsy appears to have prompted the rapid change in policy by the UK government. A variety of strategies were used to develop a highly emotive response to garner support for reform. Media stories emphasized the injustice of two extremely sick children being unable to access the medicine they apparently needed to enable them to have a 'normal' childhood. Three groups of 'claim‐makers' were identified as important in influencing public opinion: families, high‐profile individuals and campaigning groups. Conclusions: The case of medicinal cannabis in the United Kingdom suggests that policy reform can occur when a scandal is successfully manufactured. We must be cautious, however, about over‐emphasizing the role of scandal as a driver of policy change in this context: only a limited set of circumstances will permit a prescription for cannabis‐based medicine to be issued in the United Kingdom. [ABSTRACT FROM AUTHOR]

Background and Aims: Eleven US states and the District of Columbia have legalized the non‐medical use of marijuana. Public marijuana smoking is generally prohibited, although some states have considered exemptions. This study assessed attitudes about public marijuana smoking, perceptions of harm from marijuana second‐hand smoke (SHS) and self‐reported marijuana SHS exposure. Design Internet panel survey fielded in June–July 2018. Setting: United States. Participants: US adults aged ≥ 18 years (n = 4088). Measurements Current (past‐30 day) tobacco product use, current marijuana use, opinions about public indoor marijuana smoking, perceptions of harm from marijuana SHS and self‐reported past‐7 day exposure to marijuana SHS in public indoor or outdoor areas were assessed. Weighted prevalence estimates were computed and correlates were assessed using logistic and multinomial regression. Findings Overall, 27.4% [95% confidence interval (CI) = 25.7, 29.1] of adults reported past‐week marijuana SHS exposure in indoor and/or outdoor public areas; younger adults, blacks, Hispanics, those in the Northeast or West, and current marijuana and/or tobacco users were more commonly exposed (Ps < 0.0001). More than half of adults (52.4%; 95% CI = 50.7, 54.2) regarded marijuana SHS as harmful, and most (81.0%; 95% CI = 79.5, 82.4) opposed public marijuana smoking. Correlates of favoring public marijuana smoking included being male, younger (Ps < 0.01), black or Hispanic, past‐month tobacco and/or marijuana users and perceiving no/low harm from marijuana SHS (Ps < 0.0001). Conclusion: While one in four US adults report recent marijuana second‐hand smoke exposure, a majority believe marijuana second‐hand smoke is harmful and most oppose public marijuana smoking. [ABSTRACT FROM AUTHOR]

The second edition of Drug Policy and the Public Good presents up‐to‐date evidence relating to the development of drug policy at local, national and international levels. The book explores both illicit drug use and non‐medical use of prescription medications from a public health perspective. The core of the book is a critical review of the scientific evidence in five areas of drug policy: (1) primary prevention programs in schools and other settings; (2) treatment interventions and harm reduction approaches; (3) attempts to control the supply of illicit drugs, including drug interdiction and law enforcement; (4) penal approaches, decriminalization and other alternatives; and (5) control of the legal market through prescription drug regimens. It also discusses the trend towards legalization of some psychoactive substances in some countries and the need for a new approach to drug policy that is evidence‐based, realistic and coordinated. The accumulated evidence provides important information about effective and ineffective policies. Shifting the emphasis towards a public health approach should reduce the extent of illicit drug use, prevent the escalation of new epidemics and avoid the unintended consequences arising from the marginalization of drug users through severe criminal penalties. [ABSTRACT FROM AUTHOR]

Commentary to: Can new psychoactive substances be regulated effectively? An assessment of the British Psychoactive Substances Bill [ABSTRACT FROM AUTHOR]

The authors discuss the failure of a referendum to legalize cannabis in New Zealand in 2020. They state that there were questions on if the Cannabis Legalization and Control Bill (CLCB) would have been able to reduce cannabis use over time through a commercial market and question if the referendum's defeat was due to concerns about cannabis legalization in general or about concerns about the CLCB. They comment on how the black market can pressure legal competition to lower prices.

Harmonizing global data collection on cannabis use is vital, as laws and policies are rapidly evolving. A similar need exists for measurement of medical cannabis use which, at least in the United States, occurs outside medical systems and medical record-keeping -- ultimately putting patients at risk [ABSTRACT FROM AUTHOR]

Background and Aims In the United States, overdose deaths attributed to opioid pain relievers (OPR) have quadrupled since 1999, prompting many states to adopt Prescription Drug Monitoring Programs (PMP). This study aimed to: (1) estimate the relationship of PMP strength with OPR overdose deaths across states and over time; (2) measure what threshold in PMP strength is associated with the greatest reduction in OPR overdose; and (3) assess the relationship of medical marijuana dispensaries with OPR overdose deaths. Design Panel data from the Centers for Disease Control and Prevention's (CDC's) Wide-ranging Online Data for Epidemiologic Research database (WONDER) were analyzed using fixed effects to regress state-year death rates on an index variable compiled from the Prescription Drug Abuse Policy System (PDAPS) while controlling for PMP administration, demographic factors and laws that might affect OPR overdose. Setting and Participants Age-adjusted opioid overdose death rates for all 50 states and the District of Columbia between 1999 and 2014 for a total of 816 observations. Measurements PMP strength was calculated using legal data compiled by the Prescription Drug Abuse Policy System (PDAPS). In addition to demographic controls, other covariates included laws that regulate pain clinics, access to naloxone, use of emergency services (Good Samaritan Laws) and medical marijuana. Findings PMP strength was associated negatively with OPR overdose deaths. Every 1-point increase in PMP strength was associated with a 1% [95% confidence interval (CI) = 0.2-2%] reduction in overdose deaths. When collapsed into quartiles, PMPs in the third quartile were associated with an approximately 18% (95% CI = 1.6-29%) reduction in OPR overdose death rates compared with states without a PMP. States with medical marijuana dispensaries reported a 16% (95% CI = 1-30%) reduction in OPR overdoses. Conclusions US states that have more robust prescription drug monitoring programs have fewer prescription opioid overdose deaths than states with weaker PMPs. States with medical marijuana dispensaries also report fewer opioid overdose deaths than states without these. [ABSTRACT FROM AUTHOR]

Background and aims Barriers linked to drug control systems are considered to contribute to inequitable access to controlled medicines, leaving millions of people in pain and suffering. Most studies focus on access to opioids for the treatment of severe (cancer) pain. This study aims to identify specific access barriers for patients with opioid dependence in legislation and regulations of 11 central and eastern European countries. Methods This study builds on a previous analysis of legislation and regulations as part of the EU 7th Framework Access To Opioid Medication in Europe (ATOME) project. An in-depth analysis was undertaken to determine specific barriers for patients with opioid dependence in need of opioid analgesics or opioid agonist therapy (OAT). For each country, the number and nature of specific potential barriers for these patients were assessed according to eight categories: prescribing; dispensing; manufacturing; usage; trade and distribution; affordability; penalties; and other. An additional keyword search was conducted to minimize the omission of barriers. Barriers in an additional category, language, were recorded qualitatively. Countries included Bulgaria, Cyprus, Estonia, Greece, Hungary, Latvia, Lithuania, Serbia, Slovakia, Slovenia and Turkey. Results Ten of the 11 countries (all except Estonia) showed specific potential barriers in their legislation and regulations. The total number of barriers varied from two (Slovenia) to 46 (Lithuania); the number of categories varied from one (Slovenia) to five (Lithuania). Most specific potential barriers were shown in the categories 'prescribing', 'usage' and 'other'. The total number in a single category varied from one to 18 (Lithuania, prescribing). Individual differences between countries in the same specific potential barrier were shown; for example, variation in minimum age criteria for admission to OAT ranging from 15 (Lithuania, in special cases) to 20 years (Greece). All countries had stigmatizing language in their legislation. Conclusions Patients with opioid dependence are likely to experience specific barriers to accessing opioids in addition to those experienced by other non-dependent patients. [ABSTRACT FROM AUTHOR]

The regulation of new psychoactive substances (NPS) has confounded governments throughout the western world. In 2014 the UK government convened an NPS Review Expert Panel to consider a range of approaches. Ultimately the Panel recommended that the government ban all new psychoactive drugs and allow only psychoactive substances specifically exempted, such as alcohol, tobacco and those allowed as medicines. The government introduced the Psychoactive Substances Bill (PSB) in response to that recommendation. Passed in 2016, the Bill has attracted a torrent of criticism from scientists and experts. The Bill could be improved with revision, but the problems of the total ban, as envisioned by the PSB, with respect to the NPS, may be inherent: (1) defining psychoactivity is conceptually fraught, with great consequence for the scope of the prohibition; (2) operationalizing psychoactivity as a usable concept for legal control purposes is extremely difficult, perhaps impossible; and (3) the detachment of penalties for violating a total ban from establishing the harmfulness of a substance is normatively troubling. Given the uncertainties about the effects of a total ban, it is appropriate at this time for other governments to assess more fully the nature of the NPS problem, and the potential control approaches. [ABSTRACT FROM AUTHOR]

This article presents an editorial in which the authors comment on the legal aspects of cannabis use in Europe. They discuss the inconsistencies associated with punishments related to the use of cannabis as well as other psychoactive substances, citing data from the European Monitoring Centre for Drugs and Drug Addiction.

Aims To describe patterns of cannabis use, the degree of overlap between medicinal and recreational users, and their differential use patterns, modes of consumption and sources of cannabis. Design An ongoing probability-based internet panel maintained by the market research firm GfK Group. Setting Households in Colorado, Washington, Oregon and New Mexico, USA. Participants A total of 2009 individuals from Washington ( n = 787), Oregon ( n = 506), Colorado ( n = 503) and New Mexico ( n = 213). Post stratification sampling weights were provided so that estimates could be made representative of the household population in each of these states. Respondents were aged between 18 and 91 years, with a mean age of 53 years. Methods We compare patterns of cannabis consumption for medicinal and recreational users as well as simultaneous use of alcohol and cannabis. We also examine the extent to which patterns of use differ across states that chose to legalize ( Washington and Colorado) and those that did not ( New Mexico and Oregon). Findings Rates of life-time medical cannabis use are similar in Colorado and Washington (8.8% and 8.2%) but lower in Oregon and New Mexico (6.5% and 1%). Recreational use is considerably higher than medical use across all states (41%), but highest in Oregon and Washington. Approximately 86% of people who report ever using cannabis for medicinal purposes also use it recreationally. Medical users are more likely to vaporize and consume edibles and report a higher amount (in grams) consumed, and spend more money per month than recreational users. Individuals who use cannabis do not commonly use it with alcohol, irrespective of whether they are consuming cannabis recreationally or medically. Fewer than one in five recreational users report simultaneous use of alcohol and cannabis most or all of the time and fewer than 3% of medicinal users report frequent simultaneous use of alcohol and cannabis. Conclusions In the United States, the degree of overlap between medicinal and recreational cannabis users is 86%. Medicinal and recreational cannabis users favor different modes and amounts of consumption. Only a small proportion (12%) of cannabis users usually consume cannabis and alcohol simultaneously, while concurrent use is common among recreational users. [ABSTRACT FROM AUTHOR]

The article notes the benefits of evaluating medical articles with essay commentaries, exploring commentaries written in the issue about the articles "Supervised consumption sites: a nuanced assessment of the causal evidence," "The unmaking of 'evil': claiming space for rational discourse on US drug policy," and "How much do we need to know about supervised consumption sites? It depends who's asking."

Commentary to: Can new psychoactive substances be regulated effectively? An assessment of the British Psychoactive Substances Bill [ABSTRACT FROM AUTHOR]

The article examines the legalization of cannabis in Washington State. Topics examined include how the legalization is emerging with the reduced criminalization of users, how the legalization, known as Initiative 502 (I-502) passed on November 6, 2012, and the state's focus upon science-based public education and youth-focused prevention.

A letter to the editor is presented discussing how cannabis laws influence political repression in Egypt, Tunisia, and Morocco.