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24/7 Sobriety programs largely focus on reducing alcohol consumption among justice-involved individuals whose alcohol use has led them to repeatedly threaten public safety. Participants are ordered to abstain from alcohol use and subject to frequent alcohol testing (e.g., twice daily breathalyzers, remote alcohol monitoring); those testing positive face an immediate sanction, typically a night or two in jail. Unlike drug courts and other forms of coerced substance use disorder treatment, 24/7 does not require participants to enter a treatment program or attend self-help group meetings; however, these approaches are not necessarily mutually exclusive. The empirical evidence suggests that participants largely abstain from heavy drinking while in the program and that 24/7 participation is associated with lower probability of criminal legal involvement and mortality. This evidence is largely based on research in the Great Plains states with large rural populations. Several questions remain about these programs (e.g., optimal program length, possible benefits of incorporating positive incentives, efficacy of different alcohol testing technologies), many of which can best be answered in an experimental setting. In addition to reviewing the existing research on 24/7, this paper highlights additional research questions and ideas for conducting randomized controlled trials with the program, especially in more urban areas. [ABSTRACT FROM AUTHOR]

The authors discuss a debate in the U.S. and Canada about providing a safer supply to people who use drugs. Topics include an approach to safer supply which involves offering medications to people who use drugs, how policy debates about reducing harms posed by the increasingly dangerous drug supply would be more productive, and an example of interventions sometimes referred to as safer supply.

The article discusses the significant challenges of violence and corruption in Mexico, particularly their links to illegal drug activities impacting the U.S. It mentions that estimating the size and dynamics of criminal organizations in Mexico and proposes that limiting their ability to recruit members through alternative employment opportunities is essential for reducing violence in the country.

Background and aims: Synthetic opioids, mostly illegally manufactured fentanyl (IMF), were mentioned in 60% of United States (US) drug overdose deaths in 2020, with dramatic variation across states that mirrors variation in IMF supply. However, little is known about IMF markets in the United States and how they are changing. Researchers have previously used data from undercover cocaine, heroin, and methamphetamine purchases and seizures to examine how their use and related harms respond to changes in price and availability. This analysis used US Drug Enforcement Administration (DEA) data to address two questions: (i) "To what extent does IMF supply vary over time and geography?" and (ii) "What has happened to the purity‐adjusted price of IMF?" Methods: We developed descriptive statistics and visualizations using data from 66 713 observations mentioning IMF and/or heroin from the DEA's System to Retrieve Information from Drug Evidence (STRIDE; now STARLIMS) from 2013 to 2021. Price regressions were estimated with city‐level fixed effects examining IMF‐only powder observations with purity and price information at the low‐to‐medium wholesale level (>1 g to ≤100 g; n = 964). Results: From 2013 to 2021, the share of heroin and/or IMF observations mentioning IMF grew from near zero to more than two‐thirds. The share of heroin observations also containing IMF grew from <1% to ~40%. There is important geographic variation: in California, most IMF seizures involved counterfeit tablets, whereas New York and Massachusetts largely involved powder formulation. The median price per pure gram of IMF powder sold at the >10 to ≤100 g level fell by more than 50% from 2016 to 2021; regression analyses suggested an average annual decline of 17% (P < 0.001). However, this price decline appears to have been driven by observations from the Northeast. Conclusions: Since 2013, the illegally manufactured fentanyl problem in the United States has become more deadly and more diverse. [ABSTRACT FROM AUTHOR]

This study examines the associations of 24/7 sobriety programs with reduced alcohol-involved offenses. [ABSTRACT FROM AUTHOR]

Background and aim: In Uruguay, residents age 18 and older seeking legal cannabis must register with the government and choose one of three supply mechanisms: self‐cultivation, non‐profit cannabis clubs or pharmacies. This is the first paper to measure the association between type of legal cannabis supply mechanism and traffic crashes involving injuries. Design Ecological study using ordinary least squares regression to examine how department‐level variation in registrations (overall and by type) is associated with traffic crashes involving injuries. Setting: Uruguay. Cases 532 department‐quarters. Measurements Quarterly cannabis registration counts at the department level and incident‐level traffic crash data were obtained from government agencies. The analyses controlled for department‐level economic and demographic characteristics and, as a robustness check, we included traffic violations involving alcohol for departments reporting this information. Department‐level data on crashes, registrations and alcohol violations were denominated by the number of residents ages 18 and older. Findings From 2013 to 2019, the average number of registrations at the department‐quarter level per 10 000 residents age 18 and older for self‐cultivation, club membership and pharmacy purchasing were 17.7 (SD = 16.8), 3.6 (SD = 8.6), and 25.1 (SD = 50.4), respectively. In our multivariate regression analyses, we did not find a statistically significant association between the total number of registrations and traffic crashes with injuries (β = −0.007; P = 0.398; 95% CI = −0.023, 0.01). Analyses focused on the specific supply mechanisms found a consistent, positive and statistically significant association between the number of individuals registered as self‐cultivators and the number of traffic crashes with injuries (β = 0.194; P = 0.008; 95% CI = 0.058, 0.329). Associations for other supply mechanisms were inconsistent across the various model specifications. Conclusions: In Uruguay, the number of people allowed to self‐cultivate cannabis is positively associated with traffic crashes involving injuries. Individual‐level analyses are needed to assess better the factors underlying this association. [ABSTRACT FROM AUTHOR]

The spread of illegally manufactured opioids, including fentanyl, has brought unprecedented levels of drug overdose deaths in North America. In some markets, illegally manufactured fentanyl (IMF) is essentially displacing heroin, not just being used to adulterate it. It is not possible at this time to provide an accurate point estimate of the amount of IMF consumed in the United States. Yet for various purposes (e.g. assessing changes in production levels and the appropriate role for various supply reduction efforts), it is important to have a sense of scale. This article provides guidance through two thought experiments that provide a hypothetical upper bound on U.S. consumption. The first considers a scenario in which IMF replaces heroin in all illegal opioid markets. The second starts with the number of individuals with an opioid use disorder and considers what total consumption would be if IMF was the only opioid they consumed. Both calculations suggest it is unlikely that the annual consumption of IMF in 2021 could have been more than single digit pure metric tons. For comparison, the most recent best estimates of the amount of cocaine and heroin consumed in the U.S. are 145 and 47 pure metric tons, respectively. The article also raises questions about the limitations of using traditional equianalgesic morphine equivalent dose conversions to estimate the total market consumption of IMF. [ABSTRACT FROM AUTHOR]