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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.

Background Illegally manufactured potent synthetic opioids (IMPSO) like fentanyl have contributed to rises in overdose deaths in parts of North America and Europe. While many of these substances are produced in Asia, there is little evidence they have entered markets there. We consider the susceptibility to IMPSO’s encroachment in markets in the Asia-Pacific region. Methods Our analysis focuses on Australia, China, India, and Myanmar. Using a mixed-methods approach comprising interviews, literature review, and secondary data analyses, we examine factors facilitating or impeding incursion of IMPSO. Finally, we illustrate the potential for IMPSO fatalities in Australia. Results Australia reports some signs of three facilitating factors to IMPSO’s emergence: 1) existing illicit opioid markets, 2) disruption of opioid supply, and 3) user preferences. The other three countries report only existing illicit opioid markets. While diverted pharmaceutical opioids are a noted problem in Australia and India, heroin is the dominant opioid in all four countries. There are divergent trends in heroin use, with use declining in China, increasing in India, and stable in Australia and Myanmar. If IMPSO diffused in Australia as in North America from 2014 to 2018, and our assumptions generally hold, deaths from IMPSO could range from 1500–5700 over a five-year period. Conclusions This analysis and illustrative calculations serve as an early indication for policymakers. With the exception of Australia, many countries in the region fail to properly record overdose deaths or monitor changes in local drug markets. Early assessment and monitoring can give officials a better understanding of these changing threats.

Background To address the overdose crisis in the United States, expert groups have been nearly unanimous in calls for increasing access to evidence-based treatment and overdose reversal drugs. In some places there have also been calls for implementing supervised consumption sites (SCSs). Some cities—primarily in coastal urban areas—have explored the feasibility and acceptability of introducing them. However, the perspectives of community stakeholders from more inland and rural areas that have also been hard hit by opioids are largely missing from the literature. Methods To examine community attitudes about implementing SCSs for people who use opioids (PWUO) in areas with acute opioid problems, the research team conducted in-depth interviews and focus groups in four counties: Ashtabula and Cuyahoga Counties in Ohio, and Carroll and Hillsborough Counties in New Hampshire, two states with high rates of opioid overdose. Participants were policy, treatment, and criminal justice professionals, frontline harm reduction and service providers, and PWUO. Results Key informants noted benefits to SCSs, but also perceived potential drawbacks such as that they may enable opioid use, and potential practical barriers, including lack of desire among PWUO to travel to an SCS after purchasing opioids and fear of arrest. Key informants generally believed their communities likely would not currently accept SCSs due to cultural, resource, and practical barriers. They viewed publication of evidence on SCSs and community education as essential for fostering acceptance. Conclusions Despite cultural and other barriers, implementation of SCSs may be more feasible in urban communities with existing (and perhaps more long-standing) harm reduction programs, greater treatment resources, and adequate transportation, particularly if there is strong evidence to support them.

For nearly a century heroin has dominated the illegal opioid trade. The global supply of heroin is estimated to generate tens of billions of dollars in revenues a year and its illegal use has long been the source of many societal harms. The arrival of inexpensive and mass-produced synthetic opioids, such as fentanyl, to parts of North America and Europe may signal the beginning of the end of heroin's dominance. Data from several places suggest that fentanyl and other synthetic opioids can quickly supplant heroin. Taking the extreme case, we calculate the estimated wholesale revenues of heroin currently and contrast that with fentanyl prospectively in the United States and in the rest of the world if fentanyl were to supplant heroin entirely. Heroin traffickers in the United States generate about $2.5 billion in revenues; the total import value of fentanyl, after replacing heroin, could be less than $100 million. For the rest of the world we project a reduction from $6.7 billion to less than $300 million. Retailer revenues on the other hand would probably rise because individuals may consume more frequently and with greater intensity due to fentanyl's shorter duration of action and so far there has been no indication of a notable reduction in retail prices. It is unlikely that heroin will entirely disappear, but very likely that globally heroin will account for a declining share of illegal opioids. Violence and corruption may decline but opioid related mortality and morbidity, as well as property crime, are likely to rise. Policy makers will face difficult challenges. Economics provides limited help in forecasting which opioid markets are likely to convert to synthetic opioids.

This brief describes the results of a study about the surge in synthetic opioids in the United States. The authors found that limiting policy responses to existing approaches will likely be insufficient and may condemn many people to early deaths.

Researchers appraised metrics that medical research entities use to evaluate research portfolios. The work can help organizations select, develop, and revise metrics for their portfolios. This brief summarizes the findings and recommendations.

RAND Corporation researchers reviewed metrics for evaluating research portfolios used by medical research organizations and appraised their characteristics and trade-offs associated with their use. This report presents the results, categorized using a logic-model approach, to help organizations responsible for research portfolios to select, develop, and revise the metrics they use in their evaluations.

Background Some countries allow physicians to prescribe pharmaceutical-grade diamorphine to dependent users who have previously undergone treatment but are still using street-sourced heroin; this is not allowed in the US. This study provides the first nationally representative US data concerning public support for prescribing diamorphine to dependent users. We also test the hypothesis that calling it “diamorphine” instead of “heroin” increases support for this approach. Methods The RAND American Life Panel is a nationally representative, probability-based survey of US adults. Of the 3345 panel members invited to take the survey, 2530 (75.6%) provided a valid response to our question module. Respondents were randomly assigned to have the question refer to the prescribed drug as either “heroin” or “diamorphine.” The groups did not significantly differ on sex, age, race/ethnicity, or education. We compare the distribution of responses for the two groups and conduct Pearson’s chi-squared test with the Rao–Scott correction. Results For those asked whether the US should try prescribing pharmaceutical-grade “heroin,” the share answering “Yes” (20.8%) was 15 percentage points lower than those responding “No” (35.8%). When the question asked about “diamorphine,” the results were nearly reversed: the share answering “Yes” (30.6%) was almost 12 percentage points higher than those responding “No” (18.9%). The distributions of responses were significantly different (p Conclusions Support for prescribing diamorphine to dependent users is low in the US. While the results are consistent with the hypothesis that referring to heroin as diamorphine may reduce stigma associated with the substance and increase support for prescribing it, opinions may change as individuals learn they are different names for the same substance.

This case study focuses on: 1) The relationship between alcohol consumption and problem behaviours. 2) Fans' preferences and expectations regarding alcohol at international football events. 3) International approaches to managing the sale and consumption of alcohol at football events. 4) The effectiveness and fans' perception of these approaches.

Current levels of opioid-related morbidity and mortality in the United States are staggering. Data for 2017 indicate that there were more than 47,000 opioid-involved overdose deaths, and one in eight adults now reports having had a family member or close friend die from opioids. Increasing the availability and reducing the costs of approved medications for those with an opioid use disorder (OUD) is imperative; however, jurisdictions addressing OUDs and overdose may wish to consider additional interventions. Two interventions that are implemented in some other countries but not in the United States are heroin-assisted treatment (HAT; sometimes referred to as supervised injectable heroin treatment) and supervised consumption sites (SCSs; sometimes referred to as overdose prevention sites). Given the severity of the opioid crisis, there is urgency to evaluate tools that might reduce its impact and save lives. In this mixed-methods report, the authors assess evidence on and arguments made about HAT and SCSs and examine some of the issues associated with implementing them in the United States.

This working paper is part of a series of reports assessing the evidence on and arguments made about heroin-assisted treatment and supervised consumption sites and examining some of the issues associated with implementing them in the United States.

This case study examines the available evidence on violent and antisocial behaviour during the 2018 World Cup; effectiveness of policing tactics deployed during the tournament; intelligence-sharing and international cooperation between law enforcement agencies; sale and consumption of alcohol; and the facilitation of positive crowd behaviour through event organisation.

This report presents the findings of a study on approaches that have been taken to prevent and respond to antisocial and violent behaviours among football fans, and the extent to which these approaches proved effective. The report has been prepared to inform preparations for the 2022 FIFA World Cup, but is intended to be of interest to practitioners, policy-makers, academics and people interested in the field of sport spectator safety.

The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a "public health problem." Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem.

Illicit drug use continues to be an important public health and safety concern in Europe. Production, trafficking and dealing in illicit drugs constitute important criminal justice challenges in themselves, and are associated with other criminal activities. The 2005-2012 EU Drugs Strategy (as with previous strategies) was developed to complement and add value to national strategies and approaches while respecting the principles of subsidiarity and proportionality set out in the EU Treaties. The main rationale for its development was that while drugs problems vary across Member States, and are experienced at the local and national level, they are "a global issue that needs to be addressed in a transnational context." RAND Europe undertook an independent evaluation of the current Strategy and its Action Plans, addressing four research objectives: (1) to assess barriers and facilitators to the implementation of objectives and priorities at EU and Member State level, (2) to assess the relevance and influence of the Strategy with respect to national drugs policy and legislation, (3) to assess possible impact on the drugs situation in the EU, and (4) to identify key aspects and recommendations for future EU Drugs Strategies.

Cybercrime is a challenge for local and state law enforcement. The Law Enforcement Cyber Center (LECC) was established by the Bureau of Justice Assistance as a resource in combatting cybercrime. This report summarizes the LECC's activities, which aimed to raise the awareness and enhance the education and capacity of criminal justice and public safety agencies with regard to cybercrime.

The report considers the effects of the UK national minimum wage on different labour market sub-groups since 1999 when it was first launched. The findings suggest that increases in the national minimum wage had no negative employment effects on the overall UK labour market. Many of the effects following these increases were largely positive in terms of reducing pay inequality and improving the standards of living for low-paid workers.

Improving individual sleeping habits has huge implications. Small increases in sleep can make big differences to national economies. RAND Europe's novel study quantifies the economic and social costs of insufficient sleep among the global workforce.

The report summarises the existing evidence on the effectiveness of workplace related preventive health programmes, outlining the challenges involved in calculating their return on investment (ROI). The report outlines the drivers of successful workplace health promotion programmes and develops a framework to analyse the ROI of such projects.

To foster economic research on growth in poor and developing countries the Department for International Development in the UK has provided funding to several organisations focused on economic growth research. Of interest for this study were six individual programmes. The aim of this review was to compare the six programmes over time, against each other, and against relevant benchmarks to capture their performance to date.

Corruption is a phenomenon that can inflict serious political, economic and social harms to societies around the world. In addition, it poses a significant challenge to social justice and the rule of law, which may undermine trust in democratic institutions and processes. This study looks at the cost of non-Europe in relation to corruption, examining potential added value or benefits of EU-wide implementation of anti-corruption policies.

A mandatory public consultation was conducted to inform the Mid-Term Assessment of the EU Drugs Strategy 2013-2020 and the final evaluation of the EU Action Plan on Drugs 2013-2016. This document reports on the consultation's results.

Previous studies have shown that social spending is associated with better health outcomes in OECD countries. This exploratory study builds on this finding by widening the scope of the analysis, by incorporating other societal factors — namely, social capital and income inequality — and by assessing these relationships not only at the cross-national level but also at the cross-state level within the United States.

This brief presents a brief summary of findings from an evaluation of the European Commission's Evaluation of the EC Action Plan against the rising threats from antimicrobial resistance.

The Department for International Development (DfID) commissioned RAND Europe to conduct a Mid Term Review of the Strategic Impact Evaluation Fund, run by the World Bank.

RAND Europe undertook a systematic review of the evidence of effectiveness and cost effectiveness on changing the public's risk related behaviour pertaining to antimicrobial use to inform the development of a NICE public health guideline aimed at delaying antimicrobial resistance (AMR). The review considered educational interventions targeting individuals, communities or the general public delivered via any mode. Specifically, it aimed to address: 1. Which educational interventions are effective and cost-effective in changing the public's behaviour to ensure they only ask for antimicrobials when appropriate and use them correctly? 2. Which educational interventions are effective and cost-effective in changing the public's behaviour to prevent infection and reduce the spread of antimicrobial resistance? Overall, 60 studies met the inclusion criteria; 29 related to research question 1, and 36 related to research question 2 (five studies were applicable to both). The key findings are summarised in "Evidence Statements" in accordance with NICE guidelines. Evidence Statements provide a high level overview of the key features of the evidence including: the number of studies, the quality of evidence, and the direction of the estimated effect followed by a brief summary of each of the supporting studies. Studies are grouped into Evidence Statements by setting and intervention.

This infographic presents a visualisation of the main findings of our study on intolerance in Western Europe. Commissioned by the Open Society Foundations, the study aimed to situate the widely-shared perception of rising intolerance in the context of empirical evidence on high-level trends in intolerant attitudes.

The EC commissioned RAND Europe and IZA to conduct a study mapping diasporas in the EU and the US. The study provided an overview of diasporas present in Europe and the US, and delivered concrete recommendations for engaging with diasporas.