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AbstractBackgroundMethodsResultsConclusionsDrug policy is prone to build on rationales based on different moralities rather than evidence. Less is known about how moralities influence drug policy implementation in practice. The aim was to analyze expressions of moralities among local policy-makers, professionals, and drug users in the context of the Stockholm needle and syringe exchange program (NSP).Using political documentation from Stockholm (2003–2016), focus group (12 NSP staff), and 32 drug user interviews, moralities concerning drug policy and harm reduction were analyzed based on moral foundations theory and boundary work.Three main moral dilemmas were identified concerning the subjects, aims, and orientation of drug policy: whether drug users are worthy of inclusion to society; if the general public should be prioritized or the health of drug users, and the orientation of practices as based on control or autonomy. Policy debate was driven by virtues such as purity and authority, whereas staff and drug users valued care, fairness and liberty.The prohibitionist and abstinence-oriented Swedish drug policy has created social boundaries on the practice-level. Hence, users’ perspectives, and those who care about them, should be extensively involved in political discussions to foster a more moral and humane drug policy. [ABSTRACT FROM AUTHOR]

Currently, over 5.7 million adults 65+ are projected to have a SUD, and the number of fatal overdose deaths among older adults is rising in both community and facility settings. This exploratory study involved surveys of 37 nursing facilities (NF) in Kentucky in order to identify current admission practices to screen, prevent, and/or address resident substance use. Respondents indicated that they were ill-equipped to address such problems and fail to offer specialized programs for residents or training for staff. Training and best practices for residents, their families, and staff should be established to address residents with substance use and SUD. [ABSTRACT FROM AUTHOR]

Introduction: Supervised injecting facilities (SIF) have been shown to reduce negative outcomes experienced by people who inject drugs. They are often subject to intense public and media scrutiny. This article aimed to explore population attitudes to SIFs and how these changed over time in Australia. Methods: Data were drawn from the National Drug Strategy Household Survey, a national sample collecting data on illicit drug use and attitudes towards drug policy among Australians (2001–2019). Ordinal logistic regression assessed sociodemographic characteristics associated with different attitudes to SIFs and binary logistic regression assessed trends over time and by jurisdiction. Results: In 2019, 54% of respondents (95% CI 52.9, 55.1) supported SIFs, 27.5% (95% CI 26.6, 28.4) opposed and 18.4% (95% CI 17.7, 19.2) were ambivalent. Support for SIFs correlated with having a university degree (OR 1.75; 95% CI 1.58, 1.94), non‐heterosexual identity (OR 1.81, 95% CI 1.51, 2.17) and recent illicit drug use (OR = 1.74, 95% CI 1.55, 1.94). Male respondents or those living in socioeconomically disadvantaged areas had lower odds of supporting SIFs (OR 0.92, 95% CI 0.85, 1.00; OR 0.64–0.80, respectively). Between 2001 and 2019, support for SIFs increased modestly by 3.3%, those who 'don't know' by 7.4%, whereas opposition decreased by 11.7%. Between 2001 and 2019, support for SIFs increased in NSW and Queensland, whereas opposition decreased in all jurisdictions. Discussion and Conclusions: Opposition to SIFs declined over the past 20 years, but a substantial proportion of respondents are ambivalent or 'don't know enough to say'. Plain language information about SIFs and their potential benefits, targeted to those who are ambivalent/'don't know' may further increase public support. [ABSTRACT FROM AUTHOR]

This article addresses the debate on drugs use in the Partido Obrero during 1996-2009. In light of an international turn on the subject, we wonder about its impact on this trotskyist organization and worker's intervention in the discussion. To achieve this, we will analyze internal documents and the party's newspaper, in addition to recovering testimonies from former militants. Our approach will be from a marxist point of view, taking up the contributions on the subject of its first organizations, which problematized its impact on the working class. We registered the existence of three slogans: legalization, decriminalization, and the creation of alternative therapeutic communities. These are combined with a series of valuations on consumption, which strain the Argentinian left's traditional conceptions. We conclude that the labor sectors had little participation in the discussion, which has not been altered by the changes in world drug policy. [ABSTRACT FROM AUTHOR]

Recent research has yielded important insight into the characteristics and behaviours of officers who commit misconduct across the UK, USA and Australia. However, there remains little research into illicit substance use by sworn police. Considering substance use by police through the lens of police misconduct, this paper employs correlation and regression analyses using a sample of 489 sworn officers, to analyse whether individual types of misconduct, or the overall volume of misconduct committed, were predictive of an officer returning a positive drug test during departmental random drug testing. Findings suggested that neither individual types of misconduct, or the overall number of complaints received by officers were useful in predicting a positive drug test. However, a current or historical association with a known offender held a strong relationship with returning a positive drug test. Pivotally, holding a second job (outside of the agency) was also a significant predictor of a positive drug test. The findings of this research hold important implications for drug testing policy and procedure of policing agencies, and for understanding which factors may suggest that an officer is at risk of drug use. [ABSTRACT FROM AUTHOR]

AbstractBackground: Several studies link racism with drug use disparities among systemically marginalized populations. However, few invite Black Americans to discuss how they perceive racism’s impact on their drug use. Objectives: To examine qualitative accounts from N=40 Black adults reporting non-medical prescription opioid use on their experiences of racism and drug use. Results: A deductive structural tabular thematic analysis informed by Jones’s (2000) levels of racism resulted in two themes: (a) Experiences of Racism (subthemes: Denying Experiences of Racism and Endorsing Experiences of Racism) and (b) Race, Racism, and Drug Use (subthemes: Rejecting Race and Racism’s Impact on Drugs and Rejecting Race and Racism’s Impact on Drugs). Conclusions: Participants provided examples of internalized, personally mediated, and institutionalized racism associated with their drug use. Implications for policy, practice, and research are discussed. Specifically, implications detail how to center Black Americans and demonstrate anti-racism when developing treatment strategies and drug policies. [ABSTRACT FROM AUTHOR]

Background and aims Design Setting Participants Measurements Findings Conclusions Involuntary civil commitment (ICC) is a legal process by which people are compulsorily admitted to substance use treatment. This study explored views about and promotion of ICC procedures for substance use disorders among public health‐public safety post‐overdose outreach programs and their outreach team members in Massachusetts, USA.In this mixed‐methods study, survey data were collected from post‐overdose outreach programs in 2019, and semi‐structured interviews were conducted with outreach team members in 2019 and 2020.Massachusetts, USA.We received 138 survey responses and conducted 38 interviews with post‐overdose outreach team members (law enforcement officers, recovery coaches, social workers and harm reductionists) who were majority male (57%) and white (66%).We used the survey instrument to categorize programs as more (discussed ICC at 50% or more of outreach encounters) or less ICC focused (discussed ICC at less than 50% of outreach encounters) and to identify program characteristics that corresponded with each categorization. Semi‐structured interviews explored staff perceptions of ICC effectiveness.Among 138 programs, 36% (n = 50) discussed ICC at 50% or more of outreach encounters. Discussing ICC at a majority of visits was positively associated with abstinence‐only program philosophies (36% v. 6%, P < 0.001) and collaborating with drug courts (60% v. 30%, P < 0.001), but negatively associated with naloxone distribution (48% v. 75%, P < 0.001) and referring to syringe service programs (26% v. 65%, P < 0.001). Qualitative interviews identified three themes: 1) some programs viewed ICC as a first line tool to engage overdose survivors in treatment; 2) other programs considered ICC a last resort, skeptical of its benefits and concerned about potential harms; 3) families commonly initiated discussions about ICC, reportedly out of desperation.Promotion of involuntary civil commitment (ICC) appears to vary widely across post‐overdose outreach programs in Massachusetts, USA, with approaches ranging from seeing it as a first step to treatment to being a tool of last resort. Demand for ICC among family members may relate to inadequate access to voluntary treatment. Family interest in ICC appears to be driven by inadequate availability of treatment and other services. ICC at post‐overdose outreach visits should be limited, if used at all. [ABSTRACT FROM AUTHOR]

Chloroquine is still used as a first-line treatment for uncomplicated Plasmodium vivax malaria in India and resistance to this therapy can act as a major hurdle for malaria elimination. It is difficult to monitor drug-efficacy and drug resistance through in vivo and in vitro studies in case of Plasmodium vivax so analysis of molecular markers serves as an important tool to track resistance. Molecular methods that are currently in use for detecting single nucleotide polymorphisms in resistant genes including Polymerase chain reaction (PCR), Realtime-Polymerase chain reaction require highly sophisticated labs and are time consuming. So, with this background the study has been designed to optimize Loop Mediated Isothermal Amplification Assay to detect single nucleotide polymorphisms in chloroquine resistance gene of Plasmodium vivax in field settings. Eighty-eight Plasmodium vivax positive samples were collected. Pvmdr1 gene was amplified for all the samples and sequenced. Obtained sequences were analyzed for the presence of single nucleotide polymorphisms in the target gene. Further Loop Mediated Isothermal Amplification Assay primer sets were designed for the target mutants and the assay was optimized. Clinical as well as analytical sensitivity and specificity for the assay was calculated. Double mutants with variations at T958M and F1076L were detected in 100% of the Plasmodium vivax clinical isolates with haplotype M958 Y976 Y1028 L1076. Designed primers for Loop Mediated Isothermal Amplification Assay successfully detected both the mutants (T958M and F1076L) in 100% of the isolates and do not show cross-reactivity with other strains. So, the assay was 100% sensitive and specific for detecting single nucleotide polymorphisms in the target Pvmdr1 gene. Limit of detection was found to be 0.9 copies/µl and lowest DNA template concentration detected by designed assay was 1.5 ng/µL. Observed prevalence of single nucleotide polymorphisms in Pvmdr 1 gene is indicating a beginning of trend towards chloroquine resistance in Plasmodium vivax. The present study optimized LAMP for detecting single nucleotide polymorphisms in Plasmodium vivax cases in field settings, thus would help in finding significant hubs of emerging chloroquine drug resistance and ultimately helping in the management of suitable antimalarial drug policy. [ABSTRACT FROM AUTHOR]

Background: On January 31st, 2023, the province of British Columbia (BC), Canada, was granted a federal exemption allowing adults (aged 18 +) to possess up to 2.5 g of select illicit drugs. The exemption will be in place for three years (2023–2026), marking the first formal decriminalization of illicit drug policy reform in Canada. BC's decriminalization initiative is premised on several goals. This project seeks to evaluate each of these goals and their individual and combined contributions to determine the overall success of this policy. Methods: The following protocol paper provides a detailed outline of a five-year (2022-2027) national evaluation of BC's decriminalization initiative, as well as the specific objectives, methodologies, and planned analyses for eight interrelated sub-studies that comprise the evaluation. These sub-studies fall under the following five topical areas of research: 1) people who use drugs (PWUD), 2) the police and the criminal justice system, 3) the general public, 4) the health services system, and 5) an economic analysis. Additional research activities may also be explored. Results: The overall evaluation and specific sub-study designs were informed by intensive stakeholder engagement. The evaluation was developed in collaboration with an international expert committee who came together to undertake a nominal group technique to decide on the final evaluation design and corresponding logic model. The evaluation will also employ an advisory board and individual sub-study working groups comprised of experts and PWUD who will oversee the development and implementation of the overall evaluation as well as each sub-study. Discussion: This evaluation will draw on implementation science research practices to evaluate and understand the full impacts of this novel drug policy experiment. Results will be widely disseminated through manuscripts, reports, presentations, and infographics, which will be adapted and tailored for specific audiences. The protocol identifies several anticipated challenges and limitations. This evaluation's evidence-based findings will be poised to offer pivotal insights that can shape and refine the discourse on drug policy and will serve as a critical resource for understanding the multifaceted impacts of decriminalization. [ABSTRACT FROM AUTHOR]

Background: Most national programmes of opioid agonist therapy (OAT) in Eastern Europe and Central Asia are at a critical juncture for building their sustainability due to decreasing support from the Global Fund and other international HIV funders. Therefore, it is timely to identify the status, trends, opportunities and risk factors of OAT preparedness in the face of donor transition. Methods: The study assessed the OAT sustainability progress in 4 countries: Belarus, the Republic of Moldova, Tajikistan and Ukraine. The study used a comparative country case study design with qualitative methods and two data points in 2020 and 2022–2023. In total, 363 sources were reviewed and used, 83 interviews with key informants and 13 focus groups were conducted with clients, using a joint methodology and a defined Framework with three dimensions: 'Policy & Governance'; 'Finance & Resources'; and, 'Services'. Results: All four countries have made improvements to increase OAT sustainability, though it varied. In 2022, Ukraine had a substantial degree of sustainability, followed by Belarus and Moldova with a moderate degree, while Tajikistan's sustainability was at moderate-to-high risk. No country achieved a high degree of OAT sustainability in any of the three dimensions measured. However, a high degree of sustainability was reported for at least one indicator in Belarus, Moldova and Ukraine: 'Medicines'; 'Financial resources'; 'Evidence and information systems'; 'Service Accessibility'; or, 'Service integration & quality'. On average, the greatest improvement between 2020 and 2022 was seen for 'Availability & coverage'; 'Financial resources'; 'Service quality & integration'; and, 'Service accessibility'. The highest risks across the countries, notably in Belarus and Tajikistan, were recorded for the indicator, 'Availability and coverage'. Of concern is that the least progress, or even a decline, was found in 'Human resources'. Conclusions: OAT sustainability in the 4 analysed countries remains at risk, despite progress in all countries. Managing HIV donor transition can have positive effects in addressing financial sustainability, especially inspired by Ukraine's continued progress despite economic contraction and Russia's invasion. More attention is needed to non-financial aspects of OAT sustainability in donor transition planning. The directions that could have multifaceted positive influence for OAT long-term resilience and scale up for impact on drug problems include decentralisation outside of health settings and broader drug treatment financial and management transformation, together with drug policy reforms. Thus far, viable solutions for sustainability of OAT in conflict areas appear unlikely. Building OAT resilience should remain high on the agenda of national stakeholders, technical partners and donors. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionIn the early twentieth century, ayahuasca gained popularity in northern Brazil, causing political tension due to moral hostility. However, over the course of the century, despite the proscription of DMT and the intensification of the ‘War on Drugs’, three phases of cumulative political gains eventually led to the full regulation of ayahuasca, in 2010. How was this achieved?This paper provides a comprehensive reassessment of the existing literature on ayahuasca in Brazil, utilizing social movement theory. Emphasis is placed on framing methods, or how movements strategically present their aims to particular audiences, in order to effect political change.First, ayahuasca churches constructed a religious frame that emphasized their Christian pedigree. Second, when harassment intensified, ayahuasca was reframed as a charitable endeavour. Finally, in the transition to democracy, the religions added a scientific frame, collaborating with the state to review scientific evidence and establish policy parameters for regulation.Framing ayahuasca as Christian and focusing on charity and science were neither straightforward nor unproblematic, but did allow ayahuasca groups to successfully avoid persecution, establish relationships with powerful actors, and eventually achieve full regulation. This case study provides unique insights into the role of social movements in successful drug policy reform, especially how movements can strategically adapt to and influence prevailing moral codes, resulting in concrete political victories. [ABSTRACT FROM AUTHOR]

The text discusses various symposiums and programs in Australia focused on drug and alcohol-related issues, including drug checking services, decriminalization of illicit drugs, and treatment for culturally diverse populations. The programs aim to provide value-based healthcare, culturally inclusive treatment, and support for CALD communities in accessing services. The research emphasizes the importance of culturally competent approaches and tailoring treatment programs to meet the unique needs of diverse populations. [Extracted from the article]

Australian national, state and territory school‐based drug education policies advise that volatile substance use (VSU) should be excluded from general drug education curriculum for fear of alerting young people to the intoxicating properties of substances such as petrol, sprays and glues. We review evidence from the United States and United Kingdom on the effects of including volatile substances in school‐based drug education, to argue that these policies are due for reconsideration. Nitrous oxide and nitrites are classified as volatile substances along with solvents such as those listed above, although their patterns of use, effects and harms are different. In an era of widespread social media access, more young people than in the past are likely to have heard about VSU. But because VSU is often short‐term, parents and teachers may be unaware when young people in their care consume volatile substances. The general silence about VSU in schools, difficulty in detecting use and the varying sets of risks associated with inhaling different substances mean that young people may be unaware of toxicity or harm reduction strategies when they consume volatiles as drugs. We consider some implementation challenges to be negotiated if VSU education were introduced in Australian schools. [ABSTRACT FROM AUTHOR]

Global drug policy is currently dominated by great enthusiasm about human rights, including the idea that rights can generate less punitive approaches to drugs. But if human rights were an effective framework for the prevention of punitive approaches towards drugs, why haven't they prevented them previously? One possibility is that rights are less reliable for those society considers 'less than human'. In Western liberal contexts that valorise voluntarity, rationality, authenticity, and order, people who use drugs figure as compulsive, irrational, duplicitous and chaotic. Rights can reproduce these logics of abjection, including through the repetition of ideas about drugs and proper ways of being. A body of critical drug scholarship seeks to intervene in these constructions. This work mobilises 'habit' as an otherwise to 'addiction' and argues that habit is the foundation of realities. Habits, and thus realities, can be changed. This paper draws on these approaches to explore whether insights from critical drug scholarship can help to generate something after rights, made possible by new habits and modes of connection. To make this argument, we consider habits as a site of both repetition and rupture. We ask whether habits can help us rethink or disrupt rights, and the 'human' therein. [ABSTRACT FROM AUTHOR]

Background: The development of drug policies has been a major focus for policy-makers across North America in light of the ongoing public health emergency caused by the overdose crisis. In this context, the current study examined stakeholders' experiences and perceptions of power and value in a drug policy-making process in a North American city using qualitative, questionnaire, and social network data. Methods: We interviewed 18 people who participated in the development of a drug policy proposal between October 2021 and March 2022. They represented different groups and organizations, including government (n = 3), people who use drugs-led advocacy organizations (n = 5), other drug policy advocacy organizations (n = 5), research (n = 3) and police (n = 2). Most of them identified as men (n = 8) and white (n = 16), and their ages ranged between 30 and 80 years old (median = 50). Social network analysis questionnaires and semi-structured qualitative interviews were administered via Zoom. Social network data were analysed using igraph in R, and qualitative data were analysed using thematic analysis. The analyses explored perceptions of value and power within a drug policy-making network. Results: The policy-making network showed that connections could be found across participants from different groups, with government officials being the most central. Qualitative data showed that inclusion in the network and centrality did not necessarily translate into feeling powerful or valued. Many participants were dissatisfied with the process despite having structurally advantageous positions or self-reporting moderately high quantitative value scores. Participants who viewed themselves as more valued acknowledged many process shortcomings, but they also saw it as more balanced or fair than those who felt undervalued. Conclusions: While participation can make stakeholders and communities feel valued and empowered, our findings highlight that inclusion, position and diversity of connections in a drug policy-making network do not, in and of itself, guarantee these outcomes. Instead, policy-makers must provide transparent terms of reference guidelines and include highly skilled facilitators in policy discussions. This is particularly important in policy processes that involve historical power imbalances in the context of a pressing public health emergency. [ABSTRACT FROM AUTHOR]

This study aimed to analyze worldwide sales of new therapeutic agents and to estimate the time it takes for product sales to exceed industry-wide average drug development costs. Data obtained from company reports were analyzed to track worldwide sales of new medicines approved by the US Food and Drug Administration from 1995 to 2014. All sales figures were reported in 2019 US dollars. Kaplan-Meier curves were used to evaluate the time it took for discounted product sales to exceed the average costs associated with developing 1 new drug (accounting for the costs of failed trials), using published estimates of these costs. Based on data for 361 of 558 new therapeutic agents approved over the study period (median follow-up 13.2 years), mean sales revenue per product was $15.2 billion through the end of 2019; the median was $6.7 billion. These products jointly generated global sales of $5.5 trillion since approval. Revenues were highly skewed, with the 25 best selling products (7%, 25 of 361) accounting for 38% of this amount ($2.1 trillion of $5.5 trillion). Approximately 47% of products had discounted sales that exceeded the estimated industry-wide average costs of development within 5 years of approval, and 75% within 10 years. After attributing potential production, marketing, and other costs, these numbers dropped to 21% of products within 5 years of approval, and 46% within 10 years. Sales of new medicines approved from 1995 to 2014 were highly skewed, but many products had net discounted sales that exceeded the industry-wide average costs of development within 10 years of approval. An understanding of how sales revenues accrue in the years after initial approval, alongside data on business costs, can inform discussions about how to incentivize private investment in innovation while ensuring affordable prices for patients and the healthcare system. • Little is known about how much drug companies earn in sales revenues for new medicines and how long it takes them to recover the costs of research and development. • Based on data for 361 of 558 new therapeutic agents approved by the US Food and Drug Administration from 1995 to 2014, median worldwide sales per product was $6.7 billion through 2019 (median follow-up 13.2 years). Approximately 2 in 10 drugs had net discounted sales that exceeded the industry-wide average cost of development within 5 years of approval, and 1 in 2 within 10 years of approval (after accounting for production, marketing, and other costs). • Companies generated large revenues on sales of new drugs approved from 1995 to 2014, although sales were highly skewed. An understanding of the revenues earned by pharmaceutical companies on brand-name drugs, alongside data on business costs, can inform discussions about how to incentivize private investment in innovation while ensuring affordable prices for patients and the healthcare system. [ABSTRACT FROM AUTHOR]

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Aim: To analyze how the Police in Sweden perceives the drug problem and how it relates to changes in drug politics in the direction of liberalization. Method: The material analyzed consists of a content-analysis of the magazine of the Swedish Narcotic Police Association, covering 145 issues since the start in 1988, concentrating on lead articles, editorials and other articles on principles and politics. Results: The magazine demonstrate an alarmistic view of the drug problem, criticize government agencies and the media for liberal views, question the motives of proponents of decriminalization and legalization, leaves the costs of control of drug interventions aside, and sees the Police as guardian of status quo and as the defender of the goal of Swedish drug policy: "a drug-free society". [ABSTRACT FROM AUTHOR]

AbstractKnowing whether vaccine protection wanes over time is important for health policy and drug development. However, quantifying waning effects is difficult. A simple contrast of vaccine efficacy at two different times compares different populations of individuals: those who were uninfected at the first time versus those who remain uninfected until the second time. Thus, the contrast of vaccine efficacy at early and late times can not be interpreted as a causal effect. We propose to quantify vaccine waning using the challenge effect, which is a contrast of outcomes under controlled exposures to the infectious agent following vaccination. We identify sharp bounds on the challenge effect under non-parametric assumptions that are broadly applicable in vaccine trials using routinely collected data. We demonstrate that the challenge effect can differ substantially from the conventional vaccine efficacy due to depletion of susceptible individuals from the risk set over time. Finally, we apply the methods to derive bounds on the waning of the BNT162b2 COVID-19 vaccine using data from a placebo-controlled randomized trial. Our estimates of the challenge effect suggest waning protection after 2 months beyond administration of the second vaccine dose. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionThe Philippines has one of the must punitive drug regimes in the world, as evidenced not just by Rodrigo Duterte’s drug war but previous anti-drug campaigns. This article examines the place of ‘the youth’ in the longstanding moral panic around drugs and drug policy in the Philippines.This article uses critical discourse analysis to analyze figurations of young people across three distinct periods in the Philippines’ contemporary history: Ferdinand Marcos Sr.’s early dictatorship (1972–1975), Gloria Macapagal-Arroyo’s presidency (2001–2010), and Rodrigo Duterte’s administration (2016–2022).In all three periods, young people were simultaneously invoked as a group that needs saving) and as a group that needs surveillance and discipline. Further, across the three periods, both the youth and drug use were enfolded into larger socio-political discourses (e.g. Martial Law; corruption and poverty; anti-elite politics).The ambivalence in the ways in which young people are treated in drug policy reflects and reinforces their societal construction as passive victims. Interrogating and challenging the ways in which young people figure in ‘morality politics’ can pave the way for meaningful youth engagement in drug policies and programs. [ABSTRACT FROM AUTHOR]

Europe has been at the forefront of harm reduction since its inception. These important early steps were in large part a response to the dramatically expanding HIV epidemic, and investing in these innovative interventions early and robustly had a transformative effect. This brought about not just pioneering services but also pioneering policy changes. However, while Western Europe and Member States in the European Union often have been at the vanguard of harm reduction innovation and vocal advocates for public health and human rights-based drug policy reform, the situation has been much different in the "wider" WHO European region, which also includes Eastern and Southeastern Europe as well as Central Asia. This is a result not just of limited budgets for health, but also of punitive laws and policies and persistent stigma and discrimination. Even as harm reduction has demonstrated huge successes in Europe, there is a need to move forward a wider array of services to respond to an evolving and increasingly complex drug situation in Europe. Instead, it is a lack of political will and of political courage that is holding back the establishment, expansion, and deepening of these essential, lifesaving interventions. Responding proactively and effectively to this changing drug situation will require redoubled investment in public health and harm reduction approaches. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionAs the UN urges states to move from harsh punishments for drug offences towards treatment programmes, Indonesia has adopted a bifurcated penal policy. Most of those convicted are sentenced to imprisonment or death, but some ‘minor’ offenders are diverted to drug treatment centres. We explore the moralities that shape drug policy, justice professionals’ interpretation and application of laws and policies, and judgements about who is deserving of diversion.We draw on experiences and perceptions of 136 Indonesian criminal justice professionals, through in-depth qualitative interviewing and focus groups, to reveal the moral landscapes shaping policy and practice.Justice narratives blur penal concerns with moral judgments about drug offending, with normative responses shaping punishments in law and practice. While there is some compassion for ‘minor’ drug offenders, driving rationales for diversion, drug traffickers are regarded as morally deserving of prison and capital punishment, with traditionalist perceptions of harm amplified by a purgative rationale.This article highlights the analytical potential of moralities such as ‘compassion’ and ‘traditionalism’ in criminal justice research and policy in Southeast Asia. Understanding the formation and navigation of these normative values may assist in challenging harsh penal policy in Indonesia and the wider region. [ABSTRACT FROM AUTHOR]

This article explores the significance of outcomes research in measuring the effectiveness of medical treatments and interventions for better patient outcomes and healthcare delivery. It discusses the different types of outcomes research and how it supports fairness, evidence-based healthcare, and personalized medicine. The article also addresses the current trends and challenges in outcomes research, including the evaluation of treatment outcomes in vulnerable patient groups and addressing socioeconomic and cultural differences. It emphasizes the importance of patient-centered research initiatives and adaptable policy development in addressing healthcare inequalities and public health emergencies. Additionally, the article discusses the challenges in developing pharmaceutical policies and the need for ethical principles and transparency in clinical outcomes research, particularly in low- and middle-income countries. It introduces Frontiers in Pharmacology - Drugs Outcomes Research and Policies as a platform for sharing research and policies with the scientific community. The author acknowledges the assistance of Colin Pillai in preparing the manuscript and declares no financial conflicts of interest. [Extracted from the article]

Objective Methods Results Conclusions This study examined prescription trends for benign prostatic hyperplasia (BPH) drug therapy in Japan over the past decade, focusing on drugs rated as grade A according to Japanese clinical guidelines.Using the National Database Open Data, this study analyzed prescription data from the fiscal years of 2014 to 2021, tracking α1‐blockers, 5α‐reductase inhibitors, and phosphodiesterase type 5 inhibitors. We adjusted for demographics and calculated medication costs to determine prescribing patterns and changes in drug utilization.Prescriptions for α1‐blockers increased from 9898 per 1000 males in 2014 to 12 613 in 2021. Prescriptions for 5α‐reductase inhibitors rose from 1441 per 1000 males in 2014 to 2310 in 2021. Tadalafil prescriptions saw a significant increase, from 900 in 2015 to 2520 in 2021. Despite these increases, the overall market size for BPH drugs decreased from 664 million dollars in 2014 to 279 million dollars in 2021, indicating a shift toward generic medications driven by healthcare policies.Although BPH medication prescriptions are increasing, driven by Japan's aging population and clinical guidelines, market dynamics are shifting owing to generic and government price adjustments. This analysis underscores the changing BPH treatment landscape in Japan, highlighting the importance of continuous evaluation of treatment efficacy and cost‐effectiveness in evolving healthcare policies and demographics. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effects of the transparent online open procurement arrangement on the prices, volumes, and costs of medicines in Ningxia, China. Methods: Data were extracted from the Ningxia pharmaceutical procurement platform, covering 16 months of purchase orders (December 2019 to March 2021) prior to the implementation of the transparent online open procurement policy and 20 months of purchase orders after the implementation of the policy (April 2021 to November 2022). Interrupted time series (ITS) analysis was performed to evaluate the effects of the transparent online open procurement policy on the prices, volumes, and total costs of the purchase orders. Results: After implementation of the transparent online open procurement policy, the average price of purchased medicines showed a declining trend by 0.012 Yuan per month, while the total volume of purchase orders declined at a rate by 1.741 million per month measured by the smallest formulation units and the total costs of the purchase orders decreased at a rate by 5.525 million Yuan per month. Conclusion: The transparent online open procurement policy resulted in reduced prices, lowered volumes, and lowered total costs of purchased orders of medicines. [ABSTRACT FROM AUTHOR]

Medicines are an essential element for all health systems. This makes them an indispensable social good of quality and effectiveness for health problems. From a public health perspective, it is important to have health regulations as a fundamental instrument of health protection. This paper aims to characterize the role of health regulation of medicines from four historical, political and socioeconomic determinants of Mexico, and present the strategies implemented by Comisión Federal para la Protección contra Riesgos Sanitarios (Cofepris, in Spanish) to close gaps in universal access to medicines. Discussion. In the 21st century, the constant increase of population without access to health care entails a great challenge for the State to reduce gaps between supply and demand and to focus such policies on the functions of regulating, providing and reporting. For Mexico, the last two centuries have reflected a national drug policy model that permeated a health regulation that prioritizes efficiency, quality, and pre-market with little attention to universal access to medicines and other health supplies. Faced with this, the current administration of the Cofepris promotes a paradigm shift, orienting its action strategies to regulatory optimization and reduction of asymmetry of direct information to the population which also takes into account access to health supplies. Conclusions. In the Region of the Americas, the actions of National Regulatory Agencies such as Cofepris are crucial for the solidification of a public policy model focused not only on the efficacy and quality of medicines, but also regulatory optimization that supports the objectives and goals of universal access to essential medicines and other health supplies. [ABSTRACT FROM AUTHOR]

Using data from A-share pharmaceutical manufacturing listed companies between 2011 and 2021, this paper constructs a difference in differences (DID) model to systematically analyze the impact of China's Marketing Authorization Holder (MAH) system pilot policy on pharmaceutical enterprise innovation. Our findings indicate that implementing the MAH system can significantly stimulate innovation in pharmaceutical enterprises, both in terms of input and output. Additionally, local intellectual property protection positively moderates the incentive effect of MAH system on pharmaceutical innovation. The results of our heterogeneity analysis further demonstrate that the pilot policy of the MAH system exerts a stronger incentive effect on the innovation behavior of non-state-owned enterprises and enterprises in the growth and mature stage. Moreover, we provide evidence for the long-term impact of MAH system on innovation within pharmaceutical companies. [ABSTRACT FROM AUTHOR]

With the increasing pipeline of cell and gene therapies (CGTs) and the expected surge in the number of approvals, understanding the market access landscape becomes crucial for timely patient access. This study evaluates the challenges Dutch stakeholders encounter in CGT market access, offering insights for improving time-to-patient access. A traditional literature review was conducted to identify market access challenges and solutions for CGTs. Based on the findings, participants for semi-structured interviews, designed using an interview guide adapted to the Dutch context, were selected to capture diverse perspectives on market access. This review included 124 relevant articles out of 2449, covering several aspects of market access of CGTs. Subsequently, interviews with 16 stakeholders from academia, patient advocacy groups, manufacturers, health insurers, payers, hospital pharmacists, healthcare practitioners, and the Association of Innovative Medicines were conducted. Stakeholders identified challenges and proposed solutions for reimbursement package management, clinical trials, health economics, payment models, and procedural and organisational aspects. Thematic analysis revealed unique country-specific challenges and solutions in the Netherlands. This research provides insights into these challenges and potential solutions, emphasising the need for collaborative efforts among stakeholders to develop practical and multidisciplinary measures to improve the market access landscape for CGTs in the country. [ABSTRACT FROM AUTHOR]

This paper studies the channel strategies of drug suppliers in the drug supply chain under the zero‐plus drug pricing policy. With the popularity of e‐commerce and online shopping, supply chain firms have begun considering expanding their business to online channels. In this paper, we construct a game model to explore the impact of the pharmaceutical supply chain's development of online channels on supply chain members. We conclude that under the zero profits policy, increasing the public hospital's public welfare level will increase the price of drugs, decrease the price of medical services, and reduce the overall cost of patients. In addition, the greater the sensitivity of medical services, the lower the likelihood that a drug supplier will open an online pharmacy, and the lower the level of public good, the greater the likelihood that a drug supplier will open an online pharmacy. In addition, under certain conditions, patients can receive a higher level of medical service and spend less on healthcare under a dual‐channel strategy. Finally, under a dual‐channel strategy, an appropriate profit‐sharing mechanism can eliminate instability in the pharmaceutical supply chain. [ABSTRACT FROM AUTHOR]

With the increasing pipeline of cell and gene therapies (CGTs) and the expected surge in the number of approvals, understanding the market access landscape becomes crucial for timely patient access. This study evaluates the challenges Dutch stakeholders encounter in CGT market access, offering insights for improving time-to-patient access. A traditional literature review was conducted to identify market access challenges and solutions for CGTs. Based on the findings, participants for semi-structured interviews, designed using an interview guide adapted to the Dutch context, were selected to capture diverse perspectives on market access. This review included 124 relevant articles out of 2449, covering several aspects of market access of CGTs. Subsequently, interviews with 16 stakeholders from academia, patient advocacy groups, manufacturers, health insurers, payers, hospital pharmacists, healthcare practitioners, and the Association of Innovative Medicines were conducted. Stakeholders identified challenges and proposed solutions for reimbursement package management, clinical trials, health economics, payment models, and procedural and organisational aspects. Thematic analysis revealed unique country-specific challenges and solutions in the Netherlands. This research provides insights into these challenges and potential solutions, emphasising the need for collaborative efforts among stakeholders to develop practical and multidisciplinary measures to improve the market access landscape for CGTs in the country.

In this article the authors offer their perspective on the changes in the Dutch harm reduction field. From the 1970s to the 1990s, the Netherlands emerged as a leader in harm reduction services, driven by grassroots movements like the Medisch-sociale Dienst Heroïne Gebruikers (MDHG) (Medisch-sociale Dienst Heroïne Gebruikers (MDHG) translates to Medical-Social Service Heroin Users in English) in Amsterdam and Junkiebond in Rotterdam. These organisations advocated for health-centred policies, initiated needle exchange programmes, and created safe consumption spaces. Their efforts led to significant public health improvements and policy shifts towards harm reduction, reducing HIV and hepatitis rates among people who use drugs. By the 1980s, harm reduction became institutionalised within local health and social care systems, leading to notable declines in drug-related harm and crime. However, from the 2000s, a shift towards security and crime prevention emerged, influenced by socio-political changes. Increased criminal justice measures and budget cuts for harm reduction services strained the system, making it harder to address emerging drug trends and the complex needs of people who use drugs. Despite challenges, there is renewed momentum for reform, particularly at the local level, advocating for the responsible regulation of psychoactive substances. Amsterdam Mayor Femke Halsema's 2024 conference on drug regulation exemplifies this shift, calling for policies that address prohibition failures and centre harm reduction. International bodies like the UN High Commissioner for Human Rights support this approach, emphasising a health and rights-based framework. As the Netherlands navigates these evolving dynamics, there is a pressing need to reinvest in harm reduction infrastructure, ensuring it meets diverse community needs and reaffirms its foundational rights-affirming principles. [ABSTRACT FROM AUTHOR]

At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS. [ABSTRACT FROM AUTHOR]

The present study explores the symbolic meanings a group of illicit drug dealers give to drugs. We do so by analyzing interviews with 33 individuals actively involved in selling a range of drugs including, but not limited to, marijuana, cocaine, crack-cocaine, ecstasy, heroin, methamphetamine, and various pharmaceuticals. Specifically, we explore the meanings these individuals give to drugs themselves, rather than the meanings they give to the use or sale of drugs. Such an examination is important because the meanings dealers give to drugs can shape dealers’ drug-related decisions and their own self-views. We find that these individuals not only viewed drugs as market products but also as symbolizing their personal and social identities. Additionally, drugs could embody risk for the dealers, act as a means of social control, or represent nontraditional currency. Finally, the absence of drugs fronted to others was viewed by the dealers as a sign of disrespect. We discuss implications for drug control policy, decision-making theoretical frameworks such as deterrence and rational choice, and for understanding of social supply markets of illicit drugs. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduced by the Hatch‐Waxman Amendments of 1984, 505(b)(2) applications permit the US Food and Drug Administration to rely, for approval of a new drug application, on information from studies not conducted by or for the applicant and for which the applicant has not obtained a right of reference. This pathway is designed to circumvent the unnecessary duplication of studies already conducted on a previously approved drug. It can lead to a considerably more efficient and expedited route to approval compared to a traditional development path. Model‐informed drug development refers to the utilization of a diverse array of quantitative models in drug development to streamline the decision‐making process. In this approach, diverse quantitative models that integrate knowledge of physiology, disease processes, and drug pharmacology are employed to address drug development challenges and guide regulatory decisions. Integration of these model‐informed approaches into 505(b)(2) regulatory submissions and decision‐making can further expedite the approval of new drugs. This article discusses some applications of model‐informed approaches that were used to support 505(b)(2) drug development and regulatory actions. Specifically, various quantitative models such as population pharmacokinetic and exposure‐response models have been employed to provide evidence of effectiveness, guide dosing in subgroups such as subjects with hepatic or renal impairment, and inform policies. These case study examples collectively underscore the significance of model‐informed approaches in drug development and regulatory decisions associated with 505(b)(2) submissions. [ABSTRACT FROM AUTHOR]

Background: In 2018, the UK Government published its Serious Violence Strategy setting out the Government's commitment to adopting a public health approach to 'serious violence' in England and Wales and encouraging a multi-agency, whole system public health approach to violence prevention. There has been very little research attention and commentary on the roles of alcohol and illegal drugs in the construction of "serious violence" within the Strategy. Method: Drawing on thematic analysis of key policy documents, the ways in which drugs and alcohol have been conceptualised in recent violence policy in the English and Welsh context are explored through the analytical framework of "framing". Results: The overwhelming emphasis on violence associated with the drugs market has skewed attention towards exceptional and sensationalist forms of "serious" violence and diverted it from more common and widespread forms of "everyday" violence, including domestic and alcohol-related violence. Omitting these from the policy purview has implications for those affected and how resources are allocated. Conclusion: To advance inclusive and holistic violence prevention, a wider framing of violence is required and both illegal drugs and alcohol need to be embedded for meaningful working across populations and organisational boundaries. [ABSTRACT FROM AUTHOR]

Background: Over the past decades, US Congress enabled the US Food and Drug Administration (FDA) to facilitate and expedite drug development for serious conditions filling unmet medical needs with five special designations and review pathways: orphan, fast track, accelerated approval, priority review, and breakthrough therapy. Objectives: This study reviews the FDA's five special designations for drug development regarding their safety, efficacy/clinical benefit, clinical trials, innovation, economic incentives, development timelines, and price. Methods: We conducted a keyword search to identify studies analyzing the impact of the FDA's special designations (orphan, fast track, accelerated approval, priority review, and breakthrough therapy) on the safety, efficacy/clinical benefit, trials, innovativeness, economic incentives, development times, and pricing of new drugs. Results were summarized in a narrative overview. Results: Expedited approval reduces new drugs' time to market. However, faster drug development and regulatory review are associated with more unrecognized adverse events and post-marketing safety revisions. Clinical trials supporting special FDA approvals frequently use small, non-randomized, open-label designs. Required post-approval trials to monitor unknown adverse events are often delayed or not even initiated. Evidence suggests that drugs approved under special review pathways, marketed as "breakthroughs", are more innovative and deliver a higher clinical benefit than those receiving standard FDA approval. Special designations are an economically viable strategy for investors and pharmaceutical companies to develop drugs for rare diseases with unmet medical needs, due to financial incentives, expedited development timelines, higher clinical trial success rates, alongside greater prices. Nonetheless, patients, physicians, and insurers are concerned about spending money on drugs without a proven benefit or even on drugs that turn out to be ineffective. While European countries established performance- and financial-based managed entry agreements to account for this uncertainty in clinical trial evidence and cost-effectiveness, the pricing and reimbursement of these drugs remain largely unregulated in the US. Conclusion: Special FDA designations shorten clinical development and FDA approval times for new drugs treating rare and severe diseases with unmet medical needs. Special-designated drugs offer a greater clinical benefit to patients. However, physicians, patients, and insurers must be aware that special-designated drugs are often approved based on non-robust trials, associated with more unrecognized side effects, and sold for higher prices. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionDocuments are influential in shaping drug policy debates and are valuable data for drug policy research. In this article we conduct a values analysis of one drug policy document. The objectives were to assess the values within a policy document; assess the utility of Schwartz’s values framework in documentary analysis; and consider the relationship between values and policy positions.We chose the report foreword of a Special Commission in Australia for analysis. We developed deductive, theoretically-informed codes following Schwartz’s values framework, and undertook reflexive analysis of the coding process. Individual and cultural values were coded at the paragraph level and summed to analyze dominant values.Values related to structural context and drug policy; drug policy values were primarily security and universalism values; policy positions did not neatly map onto values positions; and researcher interpretations of motivations shaped the value identified.Policy documents can reveal conflicting values; these should be interpreted through inflection and emphasis specific to each occurrence. This work provides a step to future analyses that can differentiate multiple contrasting values informing a single policy position. [ABSTRACT FROM AUTHOR]

Introduction: The national volume-based drug procurement policy initiated in China since 2018 represents a significant reform in China's pharmaceutical distribution system. It has largely squeezed out the price bubble of low-end generic drugs, making competition in the pharmaceutical sales segment more intense and transparent. This policy intervenes in the distribution link of the pharmaceutical industry by intensifying market competition, thereby enhancing the innovation willingness and R&D capabilities of pharmaceutical companies. Methods: Taking the national volume-based drug procurement policy as the policy shock, we used the multi-period difference-in-difference method to study the impact of the policy on innovation input, innovation output quantity and innovation output quality of listed pharmaceutical companies and its impact mechanism. Results: We found that the volume-based policy can significantly promote the pharmaceutical companies' innovation input and the innovation output quality, but significantly reduced the innovation output quantity. For innovative and generic drug companies, this policy has limited impact on innovative drug companies, but force generic drug companies to pay more attention to cost control and market positioning, and the quality and cost-effectiveness of R&D output to ensure competitiveness in the market. For bid-winning and nonwinning companies, the policy has a greater innovation incentive for nonwinning companies than winning companies, by imposing greater survival pressure on non-winning companies, forcing them to increase R&D investment intensity and adopt the innovation strategy of preferring quality to quantity. Discussion: The results show that the national volume-based drug procurement policy should be expanded to lower drug prices and lighten the medical burden on patients, with enhanced quality and safety supervision. Additionally, it suggests cautious application of such policies to innovative and high-end generic drugs to encourage continued pharmaceutical innovation and industry advancement. [ABSTRACT FROM AUTHOR]

Background: The World Health Organisation Essential Medicines List (WHO EML) guides National Essential Medicines Lists and Standard Treatment Guidelines for clearly identified disease priorities especially in low- and middle-income countries. This study compares the degree to which the basket of medicines recommended for rheumatic diseases in children and young people in National Essential Medicines Lists of countries in the WHO Africa region, corresponds to the 2021 WHO EML and WHO EML for children, as a proxy of availability. Methods: An online search of the WHO medicines and health technology portal, the Health Ministry websites of the 54 African countries, PUBMED and Google Scholar, with search terms for 'National Essential Medicines List', AND/OR 'standard treatment guidelines' AND/OR 'Lista Nacional de Medicamentos Essenciais' AND/ OR 'Liste Nationale de Medicaments Essentiels' AND Africa AND/OR < Name of African country > was conducted. The number of medicines on the national lists were compared according to a predefined template of medicines; and the percentage similarity calculated. Descriptive statistics were derived using STATA. Results: Forty-seven countries in the WHO Africa region have developed a National Essential Medicines List. Eleven countries do not have any medicines listed for rheumatic diseases. The majority of countries had less than or equal to 50% similarity with the WHO EML for rheumatic disease in children and young people, median 3 medicines (IQR 1— 4). The most common medicines on the national lists from Africa were methotrexate, sulfasalazine and azathioprine, with etanercept available in 6 countries. Seven countries had only one medicine, acetylsalicylic acid listed in the section 'Juvenile Joint diseases'. A multiple linear regression model for the predictors of the number of medicines on the national lists established that 20% of the variability was predicted by health expenditure per capita, socio-demographic index and the availability of rheumatology services (adult and/or paediatric) p = 0.006, with socio-demographic index (p = 0.035, 95% CI 0.64—16.16) and the availability of rheumatology services (p = 0.033, 95% CI 0.13 – 2.90) significant. Conclusion: Four countries (8.5%) in Africa have updated their National Essential Medicines Lists to reflect adequate care for children and young people with rheumatic diseases. Moving forward, efforts should focus on aligning available medicines with the WHO EML, and strengthening healthcare policy for rheumatology and pharmaceutical services, for affordable access to care and medicines. [ABSTRACT FROM AUTHOR]

Bolivia's 'coca yes, cocaine no' policy towards drug crops offers a useful lens to examine Evo Morales government's decolonisation efforts, as unlike other government attempts, it had both local and international aspects. Using ethnographic data from the Chapare, one of Bolivia's two principal coca growing regions, this article traces how the Morales government's development policy between 2006-2019 broke with U.S.-led militarised eradication and crop substitution. Partially assisted by a European Union municipal strengthening program, coca policy was 'nationalised', permitting registered growers to cultivate a limited amount of the leaf. Unlike U.S.- financed 'alternative development', the new approach fostered self-determination, revalued coca's traditional role and front-loaded development assistance. These reflect both decolonisation goals and international development best practices. And yet, despite significant achievements, particularly in reducing violent confrontation with the state, the overarching international prohibitionist paradigm, domestic dynamics, and a steady demand for cocaine put the brakes on just how far domestic innovation in development-oriented drug control strategies can go. [ABSTRACT FROM AUTHOR]

Drug treatment courts are challenged by the ongoing trend of marijuana legalization. In states where it is legal for adult citizens to consume marijuana for medical and recreational purposes, treatment courts need to determine whether participants should be allowed to consume or possess marijuana. By analyzing the written policies of treatment courts in states that have legalized recreational and medical marijuana, this study explores how treatment courts address such challenges. The review shows a large percentage of drug treatment courts have yet to clearly communicate their marijuana policies with the participants in writing. However, among the drug treatment courts that have established marijuana-specific policies, the vast majority of courts continue to ban the use of marijuana while a few courts allow medical marijuana use on an individual basis. [ABSTRACT FROM AUTHOR]

To map the studies reporting the use of psychedelics in clinical and non-clinical settings by people reporting an eating disorder (ED) and their outcomes. To be included, peer-reviewed articles had to be written in English or Spanish and had to address the usage of psychedelics by people reporting an ED. Searches were conducted on PubMed, Scopus, and Web of Science. Data on key study characteristics and the findings from the studies were charted using a standardised form. Two reviewers independently charted the data from the included articles. Quality appraisal was conducted for all included studies. Six studies reporting the use of ayahuasca, DMT/5-MEO-DMT, LSD/1P-LSD, San Pedro/mescaline, psilocybin, and ketamine were included. After the psychedelic experiences, many participants reported diminished ED symptoms, reductions in anxiety, self-harm, suicidality, and problematic substance use, significant improvements in depression and wellbeing, and changes in self-perception, and some showed complete remission. Several participants felt profound spiritual healing and reported achieving deep insights into the psychological origins of their ED. All the qualitative studies met 100% of the quality appraisal criteria, whereas the quantitative studies were rated from between 20% and 60%. All included studies suggest that psychedelics promise therapeutic value for eating disorders. These findings are preliminary, and randomised controlled trials are necessary to prove psychedelic-assisted psychotherapy efficacy and long-term implications for eating disorders. Major changes in drug policy are urgent to facilitate research about psychedelics. Trial registration: ClinicalTrials.gov identifier: NCT04661514. Trial registration: ClinicalTrials.gov identifier: NCT04052568. Trial registration: ClinicalTrials.gov identifier: NCT04505189. [ABSTRACT FROM AUTHOR]

Canada is in the midst of a public health emergency in drug poisoning (overdose) deaths. In this context parents, and especially mothers, of those who have died from drug poisoning have mobilised to advocate for urgent responses and drug policy reforms. To document this emerging women‐led advocacy, we initiated a community‐academic research partnership with three parent groups representing families in Canada bereaved by drug‐related deaths. In this commentary, we describe four guiding principles we developed during the course of this project, to ensure an ethical and equitable approach to conducting our research partnership. In particular, we emphasise how we navigated parents' roles as vocal advocates for addressing drug stigma and expanding harm reduction while actively working to avoid eclipsing the need to centre the perspectives of people who use drugs. Meaningful and collaborative partnerships between academics and community groups may facilitate greater understandings of how families and communities can be allied in drug policy reforms urgently needed to prevent drug poisoning deaths. [ABSTRACT FROM AUTHOR]

Copyright of Celal Bayar Üniversitesi Saglik Bilimleri Enstitüsü Dergisi is the property of Celal Bayar University Health Sciences Institute Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and Objectives: Treatment of chronic hepatitis B (CHB) with nucelos(t)ide analogues (NA) can improve outcomes, but NA treatment is expensive for insurance plans. Materials and Methods: The Centers for Medicare & Medicaid Services database was assessed from 2012 to 2021 to assess the use of NA for CHB in patients on Medicaid. Data extracted included the number of claims, units, and costs of each agent stratified by originator and generic. Results: Over the study period, 1.9 billion USD was spent on NA, with spending peaking in 2016 at $289 million US, which has subsequently decreased. Lower expenditures since 2016 have been associated with increased use of generics. The use of generic tenofovir or entecavir led to savings of $669 million US over the study period. Conclusions: Increased generic use has significantly reduced expenditures for NA drugs; policy shifts towards generic drug use may help with sustainability. [ABSTRACT FROM AUTHOR]

This study reviewed and compared fentanyl's potential impact on public health in India and China, two nations linked to its production and distribution. A comparison of China and India's governance structures, historical experiences with opioids, ideologies, and drug policies on the potential for domestic fentanyl use showed that fentanyl will likely become a more significant threat to Indian society. India's relatively weak governance, historical acceptance of opium, and permissive drug culture facilitate an environment conducive to the production and use of fentanyl. In contrast, China's strong central government, the Opium Wars, the historical effects of opium addiction, and adherence to conservative Confucian ethics will likely contribute to opposition to fentanyl use. Understanding these disparities is paramount for policymakers and public health officials in both nations to develop and customise strategies to confront the challenges posed by fentanyl. [ABSTRACT FROM AUTHOR]

This article analyzes alternative development coalitions, their contradictions and complexities, and how they promoted a steeply unequal agrarian change through illicit crop substitution. We zoom into two paramilitary-controlled territories in Colombia. We show that those programs counted with significant support from, and were actually driven by, long coalitions that included regional and national politicians, sectors of the rural rich, paramilitary leaders, Colombian government and United States agencies. [ABSTRACT FROM AUTHOR]