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Background: Overdose deaths related to illegal drugs in North American markets are now dominated by potent synthetic opioids such as fentanyl, a circumstance foreshadowed by often‐overlooked events in Estonia since the turn of the century. Market transitions generate important and far‐reaching implications for drug policy. Argument and analysis: The supplier‐driven introduction of illegally manufactured synthetic opioids into street opioids is elevating the risk of fatal overdose. Using the most recent overdose mortality and drug seizure data in North America, we find that overdose deaths and seizures involving synthetic opioids are geographically concentrated, but this might be changing. Examination here suggests that in some places fentanyl and its analogues have virtually displaced traditional opioids, such as heroin. The concealing of synthetic opioids in powders sold as heroin or pressed into counterfeit medications substantially increases harms. The nature and scale of the challenge posed by synthetic opioids is unprecedented in recent drug policy history. Conclusions: There is urgent need for policy and technological innovation to meet the challenges posed by illegally produced synthetic opioids. Novel interventions worth examining include supervising drug use, proactively deterring on‐line distribution and new technologies aimed at improving transparency, such as point‐of‐use drug content testing. Continuing to approach this problem only with existing policies and available methods, such as naloxone, is unlikely to be enough and will result in many premature deaths. [ABSTRACT FROM AUTHOR]

Background and aims: Debates regarding lowering the blood alcohol concentration (BAC) limit for drivers are intensifying in the United States and other countries, and the World Health Organization recommends that the limit for adults should be 0.05%. In January 2016, Uruguay implemented a law setting a zero BAC limit for all drivers. This study aimed to assess the effect of this policy on the frequency of moderate/severe injury and fatal traffic crashes. Design A quasi‐experimental study in which a synthetic control model was used with controls consisting of local areas in Chile as the counterfactual for outcomes in Uruguay, matched across population counts and pre‐intervention period outcomes. Sensitivity analyses were also conducted. Setting: Uruguay and Chile. Cases Panel data with crash counts by outcome per locality‐month (2013–2017). Intervention and comparator: A zero blood alcohol concentration law implemented on 9 January 2016 in Uruguay, alongside a continued 0.03 g/dl BAC threshold in Chile. Measurements Per‐capita moderate/severe injury (i.e. moderate or severe), severe injury and fatal crashes (2013–2017). Findings Our base synthetic control model results suggested a reduction in fatal crashes at 12 months [20.9%; P‐value = 0.018, 95% confidence interval (CI) = −0.340, −0.061]. Moderate/severe injury crashes did not decrease significantly (10.2%, P = 0.312, 95% CI = −0.282, 0.075). The estimated effect at 24 months was smaller and with larger confidence intervals for fatal crashes (14%; P = 0.048, 95% CI = −0.246, −0.026) and largely unchanged for moderate/severe injury crashes (−9.4%, P = 0.302, 95% CI = −0.248, 0.058). Difference‐in‐differences analyses yielded similar results. As a sensitivity test, a synthetic control model relying on an inferior treatment–control match pre‐intervention (measured by mean squared error) yielded similar‐sized differences that were not statistically significant. Conclusions: Implementation of a law setting a zero blood alcohol concentration threshold for all drivers in Uruguay appears to have resulted in a reduction in fatal crashes during the following 12 and 24 months. [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]

The authors present their thoughts on desistance mandates as a method of treating drug addicts within a criminal justice setting. They detail how such mandates do not prevent individuals from receiving formal treatment or participating in self-help groups but avoids forcing participants into treatment against their will.

Commentary to: Considering marijuana legalization carefully: insights for other jurisdictions from analysis for Vermont [ABSTRACT FROM AUTHOR]