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Purpose To present and discuss the results of the National Hospital and Health-System Controlled Substances Drug Diversion Prevention & Surveillance Program Assessment Survey. Methods The survey was emailed to 1,529 chief pharmacy officers utilizing the list of directors of pharmacy from the American Society of Health-System Pharmacists. The survey opened September 15, 2021, and closed October 4, 2021. Forty-nine questions were included in 5 different sections, and participants were also given the option to respond to 39 additional questions. Results The survey response rate was 12.75%, with the results showing consistencies in practice around drug security and human resource management. Sixty-two percent of sites had a formalized drug diversion committee, half of which had been implemented since 2018. Adoption of electronic controlled substance systems continues to increase, with 50% of sites having implemented such a system in the previous 3 years. At the time of the survey, 18% of organizations did not have an electronic system, but 90% of sites had implemented or intended to implement one by 2023. Over 40% of sites that utilized an electronic system were looking to upgrade to a next-generation system. Most organizations had 0.5 to 1 full-time equivalent dedicated to diversion prevention, and two-thirds of sites had a formalized diversion committee. The majority of sites defined "significant loss" by utilizing professional judgement, based on the scenario, as a percentage of inventory or as a range of units. Community practice consensus is needed around auditing adjustments to controlled substance inventory and for perpetual inventory processes. Respondents reported 1 to 2 (29%), 3 to 5 (26%), and more than 10 (26%) formal drug diversion investigations annually. Conclusion This first-time survey provided significant insight into the realities of drug diversion prevention practices in hospitals and health systems nationally. [ABSTRACT FROM AUTHOR]

Introduction: This paper explores the fate of South Australia's highly regarded Police Drug Diversion Initiative over the past 10 years. Methods: The paper uses historical and legal analysis, including publicly available data as to rates of drug use, arrests and diversions, media reports, legislation and Hansard debates. Results: In the mid‐2010s, amidst growing anxiety about levels of amphetamine‐type stimulants use in Adelaide, a coroner's report became the poster child for what was seen by the Liberal opposition as the excessive leniency and 'waste of resources' of the Police Drug Diversion Initiative. Despite being universally praised for its efficacy, the Liberal government, when elected, passed amendments to the legislation which 'capped' diversions at two. This ended the period in which diversions from criminal to social justice systems was mandatory for all persons charged with simple drug possession. But since then, the diversion rate in South Australia has plummeted in ways that cannot be explained merely because of these amendments. Discussion and Conclusions: The most highly regarded scheme for diversion of minor drug offenders to treatment is no longer effective. Indeed, the best scheme in the country may now be the worst. The essay draws attention to a catastrophe whose extent is not yet fully appreciated and suggests ways in which we can begin to explain why such a small change has had such dramatic and unforeseen consequences. Like some sort of perverse alchemy, Australia's gold standard for drug diversion has been turned into lead. [ABSTRACT FROM AUTHOR]

Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers.

Purpose Challenges with monitoring and detecting drug diversion in healthcare facilities continue to be a trending topic amid the opioid epidemic. This article aims to provide insight into the expansion of an academic medical center's drug diversion and controlled substances compliance program. The justification and structure of a multihospital, centralized program are discussed. Summary Establishing dedicated controlled substances compliance and drug diversion resources has become increasingly common as awareness of the widespread healthcare impact has grown. One academic medical center recognized the value in expanding from 2 dedicated full-time equivalents (FTEs) with a scope of one facility to multiple FTEs with a scope of 5 facilities. The expansion included considering current practices at each facility, establishing the centralized team's scope, gaining organizational support, recruiting a diverse team, and forming an effective committee structure. Conclusion There are multiple organizational benefits from establishing a centralized controlled substances compliance and drug diversion program, including standardization of processes, associated efficiencies, and effective risk mitigation by identifying inconsistent practices across the multifacility organization. [ABSTRACT FROM AUTHOR]

Support within the nursing community for those coping with substance misuse has been lacking for over a hundred years. A review of the history of substance use disorders in nursing reveals that nurses still encounter similar risks, stigma, and punishments today. Kristin, a nurse for over 30 years, tells her story of trials, tribulations, and triumphs with substance use. She shares how having to face early recovery on her own sparked the development of the Wisconsin Peer Alliance for Nurses (WisPAN). WisPAN offers a community for nurses in recovery to provide peer support to those taking their first steps on the journey toward recovery. [ABSTRACT FROM AUTHOR]

Background: Substance misuse is an occupational health problem for anesthesia providers (APs). More than 10% of nurse anesthetists misuse and divert medications. No standard exists for addressing AP drug diversion. The purpose of this quality improvement project was to evaluate the use of a knowledge and needs assessment to inform the development of a successful drug diversion prevention program for certified registered nurse anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs). Methods: A 28-item questionnaire, using the health belief model (HBM) and the risk perception attitude (RPA) framework, was developed to assess knowledge, beliefs, and practices of substance misuse and diversion. RPA groups were determined by level of belief in self-risk and perceived efficacy of prevention strategies. The survey was emailed to 100 CRNAs and over 100 SRNAs. Survey results were organized using the RPA framework. Findings: One hundred twelve surveys were completed. The RPA avoidant category (high-risk belief and low perceived efficacy of preventive interventions) comprised 52.5% of CRNAs; SRNAs were divided primarily among the RPA responsive category with high perceived risk and high-efficacy beliefs (38.9%) and the indifferent category of low-risk beliefs and low perceived efficacy (31.9%). Conclusions/Applications to Practice: Anesthesia providers have varying beliefs regarding drug misuse and diversion risks and perceptions of their ability to be successful with preventive strategies. Failure to address nurse anesthesia needs-based diversion prevention may result in missed opportunities to educate this group. Implementation of RPA-tailored interventions by health care organizations may produce effective, long-term outcomes for drug diversion within the profession. [ABSTRACT FROM AUTHOR]

Significant opportunities to improve treatment for substance use disorders can occur within the criminal justice system. This article will review the current system of care, understand current interventions available, and explore recommendations to better address community needs. With rising numbers of substance use and substance related deaths, this threat to the community is predicted to only worsen without intervention. There are multiple points in the justice system throughout the pretrial, court, and sentencing periods where the opportunity to help people with substance use disorder may occur. These points of diversion can focus on a more rehabilitative approach to crimes in the context of substance use disorder rather than punitive incarceration without adequate treatment. Police diversion can be increased and new police metrics incentivizing such efforts can be implemented in place of informal disposition by officers. Further training of law enforcement officers and continued development of support staff will help change practice allowing those with substance use disorders in the criminal justice system to connect to appropriate services. Data collection for research and analysis of recidivism among those engaged with diversion services compared to those who have not will help further guide future policy and resources for such programs. [ABSTRACT FROM AUTHOR]

Pharmacy robberies are a common occurrence. From 2010 to 2019, there were over 7500 prescription drug-related armed robbery incidents in the United States. A lecture on pharmacy robbery was added to the pharmacy curriculum in 2017 at Butler University. The primary objective of this study was to assess whether the pharmacy robbery lecture given during the first year of the pharmacy program is adequate, with a secondary objective comparing the results of this survey to one conducted prior to the curricular addition. This information provides an opportunity for schools of pharmacy to consider adding or enhancing drug diversion content into their curriculum. A cross-sectional survey of all students enrolled in each professional year of the Doctor of Pharmacy program was conducted spring 2022 to collect information on pharmacy students' knowledge and experience regarding community pharmacy robberies and their perceptions of the pharmacy robbery education in the curriculum. A total of 285 of 407 students responded for a 70% response rate. More than half (53.5%) feel the pharmacy robbery education received is adequate and 63.9% feel prepared to properly manage a pharmacy robbery situation. The survey asked two pharmacy robbery knowledge-based questions and most students selected the correct response to both (89.9% and 97.8%). More than one-fourth (27.1%) of the respondents reported that the pharmacy they work/worked at had been robbed. When asked if students considered changing their career path because of pharmacy robberies, 9% responded yes. Pharmacy robbery still exists, and having proper education helps students prepare for and handle community pharmacy robbery situations. [ABSTRACT FROM AUTHOR]

In South Africa, 62% of female sex workers (FSW) are estimated to be living with HIV. Qualitative research indicates that FSW share antiretroviral therapy (ART) with peers to surmount treatment barriers. We quantitatively described ART sharing, its correlates, and its relationship with viral suppression (VS) among FSW living with HIV in eThekwini, South Africa. Among FSW on ART (n = 890), 30% ever shared (gave and/or received) ART. Sharing ART was more likely among those with higher levels of alcohol use, illicit drug use, depression severity, and physical/sexual violence in the adjusted model. There was a positive, dose-response relationship between number of pills given to peers in the last 30 days and VS likelihood (aPR: 1.05, 95% CI: 1.02, 1.08; p < 0.01). Giving pills may strengthen peer relationships, which may facilitate ART adherence. ART distribution through peer networks holds promise as a context-appropriate intervention for improving ART adherence among FSW in this setting. [ABSTRACT FROM AUTHOR]

Introduction Controlled substance waste processes in perioperative areas can be cumbersome. Streamlining this process is a critical component of improving operating room efficiency. At our institution, unused controlled substances require a two-person waste prior to disposal. We hypothesized that access to a centrally located automated medication dispensing system to conduct medication waste would decrease the amount of time required to perform a two-person waste and dispose of unused medications after the completion of a case. We further hypothesized that a decrease in the time required to waste would improve user satisfaction with the waste process. Methods This was a single-center, retrospective, IRB-approved quality assurance analysis. Research Electronic Data Capture (REDCap, Stony Brook, NY, United States) software was used to design an anonymous survey, which was distributed via email from 06/09/2021 to 09/09/2021. Wilcoxon signed-rank tests were used to compare before and after paired responses for individuals. Analyses were performed using SAS 9.4 © (Cary, NC, United States) software. Results Participants reported a significant decrease in time carrying used narcotics after a surgical case. For the primary outcome, median (IQR) scores demonstrated a significant decrease from 2, representing "10-20 minutes" (IQR 1-3), to 1, indicating "<10 minutes" (IQR 1-2) spent carrying used narcotics (p < 0.0001). Reported satisfaction with the process significantly increased from 2 to 3 points, on a scale of 5, after using the new centrally located Pyxis (p < 0.0001). Participants reported the wasting process as less time-consuming, carried fewer used controlled substances, and were less likely to wait until the end of the shift to waste. Conclusions By improving the ergonomics of the waste process after adding a Pyxis system in a more central location, the time anesthesia clinicians spent carrying used controlled substances decreased. Additionally, provider satisfaction increased, likely related to the ease of finding a partner to witness wasted medications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board issued approval IRB2022-00122. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Parikh et al.)

Aims: The French Ministry of Health scheduled opioid cough suppressants as prescription‐only drugs on 12 July 2017. The present study assessed the impact of this regulation on the diversion modalities of the concerned drugs and the related drug pholcodine by analysing the national OSIAP (Ordonnances Suspectes Indicateur d'Abus Possible) database. Methods: Medical prescriptions with at least 1 mention of codeine, dextromethorphan, ethylmorphine, noscapine or pholcodine for cough suppression recorded in 2013–2019 were extracted from OSIAP. Annual mentioning rates were estimated by dividing numbers of mentions over those of prescriptions recorded the year considered. A descriptive analysis compared the characteristics of prescriptions before and after 12 July 2017. Results: Overall, 832 mentions of the requested drugs were retrieved on 827 prescription forms. Codeine was the most frequent (n = 809, 8.7%) with 6 additional mentions of codeine/ethylmorphine combination, followed by dextromethorphan (n = 11, 0.1%) and pholcodine (n = 6, 0.1%). There was no mention of noscapine. Annual mentioning rates varied between 0 and 0.3% for all drugs except codeine. Codeine mentioning rates ranged between 0.3% (n = 2) and 0.7% (n = 9) before 12 July 2017 and increased to 10.1% (n = 61) thereafter in 2017, 16.1% (n = 314) in 2018, and 19.8% (n = 414) in 2019. The profile of subjects evolved accordingly with an increased male/female ratio (10.0 vs. 1.5 before) and decreased age (23 vs. 40 y before, P <.001). Discussion: The sharp increase of recourse to falsified prescription forms indicates that codeine diversion continues despite restricted access, whereas the other drugs studied do not seem to have been impacted. [ABSTRACT FROM AUTHOR]

The development of a substance use disorder within an anesthesia provider is complex and multifactorial. Substance use disorder is considered the number one occupational hazard for anesthesia professionals, and it is estimated that 10%-15% of anesthesia providers will experience a substance use disorder. High stress levels within the workplace environment contribute to the risk of an anesthesia professional developing a substance use disorder. This article will discuss strategies to prevent, recognize, and treat substance use disorder within the workplace. [ABSTRACT FROM AUTHOR]

Background: Over the past 20 years or so, the drug misuse scenario has seen the emergence of both prescription-only and over-the-counter (OTC) medications being reported as ingested for recreational purposes. OTC drugs such as antihistamines, cough/cold medications, and decongestants are reportedly the most popular in being diverted and misused.Objective: While the current related knowledge is limited, the aim here was to examine the published clinical data on OTC misuse, focusing on antihistamines (e.g., diphenhydramine, promethazine, chlorpheniramine, and dimenhydrinate), dextromethorphan (DXM)- and codeine-based cough medicines, and the nasal decongestant pseudoephedrine.Methods: A systematic literature review was carried out with the help of Scopus, Web of Science databases, and the related gray literature. For data gathering purposes, both the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PROSPERO guidelines were followed (PROSPERO identification code CRD42020209261).Results: After completion of the selection, eligibility, and screening phases, some 92 articles were here taken into consideration; case reports, surveys, and retrospective case series analyses were included. Findings were organized according to the specific OTC recorded. Most articles focused here on DXM (n = 54) and diphenhydramine (n = 12). When specified, dosages, route(s) of administration, toxicity symptoms (including both physical and psychiatric ones), and outcomes were here reported.Conclusion: Results from the systematic review showed that the OTC misusing issues are both widespread worldwide and popular; vulnerable categories include adolescents and young adults, although real prevalence figures remain unknown, due to a lack of appropriate monitoring systems. Considering the potential, and at times serious, adverse effects associated with OTC misusing issues, healthcare professionals should be vigilant, and ad hoc preventative actions should be designed and implemented.

Background: Over the past 20 years or so, the drug misuse scenario has seen the emergence of both prescription-only and over-the-counter (OTC) medications being reported as ingested for recreational purposes. OTC drugs such as antihistamines, cough/cold medications, and decongestants are reportedly the most popular in being diverted and misused. Objective: While the current related knowledge is limited, the aim here was to examine the published clinical data on OTC misuse, focusing on antihistamines (e.g., diphenhydramine, promethazine, chlorpheniramine, and dimenhydrinate), dextromethorphan (DXM)- and codeine-based cough medicines, and the nasal decongestant pseudoephedrine. Methods: A systematic literature review was carried out with the help of Scopus, Web of Science databases, and the related gray literature. For data gathering purposes, both the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PROSPERO guidelines were followed (PROSPERO identification code CRD42020209261). Results: After completion of the selection, eligibility, and screening phases, some 92 articles were here taken into consideration; case reports, surveys, and retrospective case series analyses were included. Findings were organized according to the specific OTC recorded. Most articles focused here on DXM (n = 54) and diphenhydramine (n = 12). When specified, dosages, route(s) of administration, toxicity symptoms (including both physical and psychiatric ones), and outcomes were here reported. Conclusion: Results from the systematic review showed that the OTC misusing issues are both widespread worldwide and popular; vulnerable categories include adolescents and young adults, although real prevalence figures remain unknown, due to a lack of appropriate monitoring systems. Considering the potential, and at times serious, adverse effects associated with OTC misusing issues, healthcare professionals should be vigilant, and ad hoc preventative actions should be designed and implemented. [ABSTRACT FROM AUTHOR]

Background: Technology in the form of Automated Dispensing Cabinets (ADCs), Barcode Medication Administration (BCMA), and closed-loop Electronic Medication Management Systems (EMMS) are implemented in hospitals to assist with the supply, use and monitoring of medications. Although there is evidence to suggest that these technologies can reduce errors and improve monitoring of medications in general, little is known about their impact on controlled medications such as opioids.Objectives: This review aimed to fill this knowledge gap by synthesising literature to determine the impact of ADCs, BCMA and closed-loop EMMS on clinical work processes, medication safety, and drug diversion associated with controlled medications in the inpatient setting.Methods: Eight databases (Medline, Pubmed, Embase, Scopus, Web of Science, PsycINFO, CINAHL, and ScienceDirect) were searched for relevant papers published between January 2000 and May 2019. Qualitative, quantitative, and mixed-methods empirical studies published in English that reported findings on the impact of ADCs, BCMA and/or closed-loop EMMS on controlled medications in the inpatient setting were included.Results: In total, 16 papers met the inclusion criteria. Eleven studies reported on ADCs, four on BCMA, and only one on closed-loop EMMS. Only four studies focused on controlled medications, with the remainder reporting only incidental findings. Studies reported the elimination of manual end-of-shift counts of controlled medications after ADC implementation but cases of drug diversion were reported despite introducing ADCs. Three quantitative studies reported reductions in medication errors after implementing BCMA, but medications labelled with wrong barcodes and unreadable barcodes led to confusion and administration errors.Conclusions: More quality, targeted research is needed to provide evidence on the benefits and also risks of implementing technology to safeguard against inappropriate use of controlled medications in the inpatient setting. Processes need to be in place to supplement technological capabilities, and resources should be made available for post-implementation evaluations and interventions. [ABSTRACT FROM AUTHOR]

Daniel E Buffington,1,2 Alyson Lozicki,2 Thomas Alfieri,3 T Christopher Bond3 1University of South Florida, College of Medicine, 2University of South Florida, College of Pharmacy, Tampa, FL 33617, USA; 3Purdue Pharma LP, Medical Affairs, Stamford, CT 06901, USA Purpose: Drivers of excess controlled substance disposal behaviors are not well understood. A survey of patients who had received opioid-based medications was conducted to inform the design of future innovative drug take-back programs. Methods: This was a cross-sectional survey study conducted in 152 participants who received treatment with an opioid within the previous 2 years and had possession of unused medication following either switching to a different opioid or discontinuation of pain. Results: Approximately one-third of patients had disposed of their unused opioid medication. Education about the importance of and appropriate methods for drug disposal was associated with a significantly increased likelihood of patients disposing of unused medication, and it was observed that patients prescribed an immediate-release/short-acting opioid were twice as likely to keep their medication compared to those prescribed an extended-release/long-acting opioid. The most commonly reported methods for disposal were via drug return kiosks and flushing the medication down the toilet. Some of the most impactful drivers of unused opioid disposal were routine practice of disposing of all unused drugs and instruction from a health care provider, and the most common driver of keeping unused medication was the desire to have it on-hand should there be a need to treat pain in the future. Over 80 % of patients indicated that they would be more likely to use a drug take-back service if they were offered compensation or if the kiosk was in a location that they visited frequently, and approximately half of the patients indicated that they would be willing to request an initial partial fill of an opioid prescription to reduce the volume of unused medication. Conclusion: There is a clear need to increase patient awareness about the importance and methods of proper medication disposal, and a great opportunity for health care providers to increase patient education efforts. These study findings also highlight key areas for improvement in drug take-back programs that may promote and incentivize more patients to utilize the services. Keywords: pain management, patient education, drug diversion, medication safety, drug take back

(1) Background: Over the last decade, misuse and diversion of medications has appeared to be increasingly concerning phenomena, including a range of different molecules. As current knowledge on the abuse of centrally acting anticholinergics is limited, the aim of the present study is to review the relevant published data, focusing on the following molecules: benztropine, biperiden, scopolamine, orphenadrine, and benzhexol/trihexyphenidyl (THP). (2) Methods: A systematic literature review was carried out using Pubmed, Scopus, and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Research methods were registered on PROSPERO (CRD42021257293). (3) Results: A total of 48 articles, including case reports, surveys, and retrospective case series analyses, were included. Most articles focused on benzhexol/THP (n = 25), and benztropine (n = 4). The routes of administration were mostly oral, and macrodoses together concomitant illicit drugs, e.g., cocaine, have been recorded. Toxidromes included both physical (e.g., tachycardia, tachypnoea, dilatated pupils, dry skin, urinary retention, ataxia, etc.) and psychiatric symptoms (e.g., anxiety, agitation, delirium, etc.). Fatal outcomes were very rare but reported. (4) Conclusion: Results from the present study show that anticholinergic misusing issues are both widespread worldwide and popular. Considering the potential adverse effects associated, healthcare professionals should be vigilant and monitor eventual misusing issues.

Drawing on a multisite sample of 40 persons who sell, share, or use diverted buprenorphine to manage opioid use disorder, in this study we describe why individuals seek to obtain buprenorphine outside of formal treatment contexts, and between-site variation regarding their motives and means. Findings indicate that both the provision and purchase of diverted buprenorphine support user-defined risk minimization strategies to avoid withdrawal, reduce heroin use, and satiate opioid cravings in periods of lowered tolerance. We also found that a subset of the sample used buprenorphine recreationally, and that it functioned to extend or augment illicit drug use careers. Implications of the findings are discussed in light of federal and state drug control and treatment policies. [ABSTRACT FROM AUTHOR]

For businesses that store physical goods, managing product inventories and financial cost accounting controls are critical. Pharmacies are under considerable scrutiny, due to the nature of their merchandise, making internal controls even more vital. Due to the emergence of COVID-19 and government mitigation strategies, the US economy has seen significant macro- and microeconomic e ects. COVID-19 has changed the pharmacy working environment, which could theoretically increase rates of employee drug diversion. Therefore, better inventory management could reduce the misuse of pharmaceutical drugs from fraudulent and drug diversion activities. The author explored secondary findings to create a multidisciplinary conceptual analysis of the reasons why internal controls executed with greater diligence may be needed to avoid damaging financial, legal, and health outcomes. The author also provides a review of available internal control methods that can be used to mitigate diversion. [ABSTRACT FROM AUTHOR]

Background: Gabapentinoid drugs (gabapentin and pregabalin) are effective in neuropathic pain, which has a prevalence of ∼7%. Concerns about increased prescribing have implications for patient safety, misuse, and diversion. Drug-related deaths (DRDs) have increased and toxicology often implicates gabapentinoids. We studied national and regional prescribing rates (2006-2016) and identified associated sociodemographic factors, co-prescriptions and mortality, including DRDs.Methods: National data from the Information Service Division, NHS Scotland were analysed for prescribing, sociodemographic, and mortality data from the Health Informatics Centre, University of Dundee. DRDs in which gabapentinoids were implicated were identified from National Records of Scotland and Tayside Drug Death Databases.Results: From 2006 to 2016, the number of gabapentin prescriptions in Scotland increased 4-fold (164 630 to 694 293), and pregabalin 16-fold (27 094 to 435 490). In 2016 'recurrent users' (three or more prescriptions) had mean age 58.1 yr, were mostly females (62.5%), and were more likely to live in deprived areas. Of these, 60% were co-prescribed an opioid, benzodiazepine, or both (opioid 49.9%, benzodiazepine 26.8%, both 17.1%). The age-standardised death rate in those prescribed gabapentinoids was double that in the Scottish population (relative risk 2.16, 95% confidence interval 2.08-2.25). Increases in gabapentinoids contributing to cause of DRDs were reported regionally and nationally (gabapentin 23% vs 15%; pregabalin 21% vs 7%). In Tayside, gabapentinoids were implicated in 22 (39%) of DRDs, 17 (77%) of whom had not received a prescription.Conclusions: Gabapentinoid prescribing has increased dramatically since 2006, as have dangerous co-prescribing and death (including DRDs). Older people, women, and those living in deprived areas were particularly likely to receive prescriptions. Their contribution to DRDs may be more related to illegal use with diversion of prescribed medication. [ABSTRACT FROM AUTHOR]

The characteristics of opioid prescribing and administration in cancer centers include large quantities and less restrictive regulatory mandates governing cancer-related pain, which may increase the risk of drug diversion by staff members. The purpose of this article is to provide a framework for creating respectful investigative processes for staff suspected of drug diversion. Organizations, including cancer centers, need to engage in careful oversight of potential drug diversions while simultaneously promoting a psychologically safe work environment for individuals to successfully seek help. [ABSTRACT FROM AUTHOR]

Malingering of ADHD symptoms is a potential means of nonmedical use of prescription stimulants (NMUPS). The Subtle ADHD Malingering Screener (SAMS) provides a potential avenue for identification of symptom malingering. However, no real world evidence of this scale has been published to date. The goal of this study was to examine patterns of use of stimulant prescriptions and to evaluate the ability of the SAMS to identify NMUPS. This study employed a cross-sectional observational design to administer an online, self-administered survey instrument in a convenience sample of college-enrolled young adults with a prescription for stimulant medications at a campus pharmacy. Respondents were asked about their prescription characteristics, nonmedical use and drug diversion behavior, along with ratings on the SAMS. Over 33% of respondents self-reported past-year NMUPS and 18% reported past-year drug diversion. Over 35% of respondents rated NMUPS as being slight or no risk and 55% were classified by the SAMS as likely to be malingering or exaggerating their symptoms. Individuals reporting past-year NMUPS or diversion consistently scored higher on the SAMS. The SAMS showed potential for future application in the pharmacy setting. Further research is needed to evaluate the relationship of SAMS to NMUPS or drug diversion. The results of this study also highlight several growing issues with the diagnosis and treatment of ADHD among young adults enrolled in college. Addressing perception of risk, social norms, and providing healthcare professionals with tools to prevent misdiagnosis is critical to the management of this issue. [ABSTRACT FROM AUTHOR]

Background: More than 47,000 people in the United States died from opioid drug overdoses in 2017. Among college students, opioid drugs are the second most abused drug. Objective: This study aimed to examine if an educational intervention impacted college students' attitudes towards prescription opioid drugs (POD). Methods: Two hundred forty-two participants (72 males, 21 ± 3 years) from an American university participated. After collecting demographic data (questionnaire 1; Q1), investigators recited a narrative in which the protagonist was injured and prescribed POD. Next, participants rated their agreement on 10 Likert prompts and two visual analog scales (VAS) before (Q2) and after (Q3) an educational intervention, then noted (Q4) which topics were most or least influential in any changed responses. Results: 7/10 Likert prompts (all p < 0.002) and both VAS (both p < 0.001) changed between Q2 and Q3. Educational intervention topics related to risk were most influential and topics related to alternative therapies were least influential. Conclusion/Importance: Educational interventions may be beneficial for college students. Any interventions that are employed should focus on risks associated with POD use. [ABSTRACT FROM AUTHOR]

Prescription monitoring programs (PMPs) house and monitor data about the prescribing practices of health care providers, as well as medications received by patients. PMPs aim to promote the appropriate use of prescription opioids by providing this information to prescribers and dispensers. Our objective in this systematic review was to comprehensively identify and assess the available evidence about the impact of PMPs on opioid prescribing and dispensing, multiple provider use for obtaining opioids, inappropriate opioid prescribing, and the extent of nonmedical prescription opioid use. We used a comprehensive search strategy and included study designs that could determine changes in outcomes with the implementation of a PMP. We included 24 studies; 75% of studies were conducted in the United States, and studies encompassed data years from 1993 to 2014. Overall, we did not find evidence to support an association between PMPs and decreased opioid prescribing and dispensing. We found limited, but inconsistent, evidence that PMPs were associated with reduced schedule II opioid prescribing and dispensing, as well as multiple provider use. Covariate adjustment was often inadequate in analyses, as was the timing of outcome and PMP measurement. Future studies should broaden their geographic scope to other countries and use more recent data with standard measurement. PERSPECTIVE: This systematic review aimed to determine the effectiveness of PMPs in changing prescribing practices and prescription opioid use. The findings from this review will inform policymakers and PMP administrators about the current state of the evidence on program effectiveness. [ABSTRACT FROM AUTHOR]

Richard N Rosenthal,1 Viral V Goradia2 1Department of Psychiatry, Addiction Institute at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, 2Department of Psychiatry, Upstate Medical University, Syracuse, NY, USA Abstract: Opioid use disorders (OUDs) have long been a global problem, but the prevalence rates have increased over 20 years to epidemic proportions in the US, with concomitant increases in morbidity and all-cause mortality, but especially opioid overdose. These increases are in part attributable to a several-fold expansion in the prescription of opioid pain medications over the same time period. Opioid detoxification and psychosocial treatments alone have each not yielded sufficient efficacy for OUD, but μ-opioid receptor agonist, partial agonist, and antagonist medications have demonstrated the greatest overall benefit in OUD treatment. Buprenorphine, a μ-opioid receptor partial agonist, has been used successfully on an international basis for several decades in sublingual tablet and film preparations for the treatment of OUD, but the nature of formulation, which is typically self-administered, renders it susceptible to nonadherence, diversion, and accidental exposure. This article reviews the clinical trial data for novel buprenorphine delivery systems in the form of subcutaneous depot injections, transdermal patches, and subdermal implants for the treatment of OUD and discusses both the clinical efficacy of longer-acting formulations through increasing consistent medication exposure and their potential utility in reducing diversion. These new delivery systems also offer new dosing opportunities for buprenorphine and strategies for dosing intervals in the treatment of OUD. Keywords: opioid use disorder, buprenorphine, drug diversion, drug implants, depot medications, maintenance therapy, treatment adherence

Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Sociedade Brasileira de Anestesiologia. Published by Elsevier España S.L.U. All rights reserved.)

Objectives This research looked at whether notifying prescribers and pharmacies about patients who use multiple providers to obtain opioids reduces their prescribing activity (including use of multiple providers, numbers of opioid prescriptions, or amounts of opioids obtained). Design Nevada's prescription drug monitoring program (PDMP) identified patients using multiple providers to obtain opioids and assigned them alternately to an intervention or control group. Controlled substance prescription histories were sent only to intervention patients' providers. Subsequent opioid purchases by patients in both groups were compared. Setting All pharmacies and dispensers in the state are required to report every prescription for Schedule II–IV opioids dispensed to the PDMP. Subjects All patients receiving opioids from more than four different Nevada prescribers and more than four pharmacies during the previous six months assigned to the intervention (N = 436) or control group (N = 441). Methods We used ordinary least squares regression to estimate notification effects on each outcome, accounting for preexisting differences among groups. Results Providers receiving unsolicited notices were 13% less likely to continue prescribing to patients than providers not notified. Eighty-four percent of the intervention patients' prescribers discontinued prescribing to them after assignment, compared with 80.5% of the control group's prescribers—who were not notified. Because patients in both groups found other prescribers to replace discontinued prescribers, notification had at most a small effect on patients' use of multiple providers, numbers of opioid prescriptions, or amounts of opioids purchased. Conclusions Requiring prescribers to solicit patients' prescription histories is likely to be a more effective use of PDMP resources than proactive notification. [ABSTRACT FROM AUTHOR]

This article describes findings from an Australian mixed method study, and explores young people's perceptions of police. We focus on the nature of positive experiences, and the potential for positive encounters to improve outcomes for young offenders affected by problematic alcohol and other drug use. Buber's concept of dialogical interaction is used to articulate the components of a positive experience and how this increases police legitimacy. In doing so, we demonstrate that, despite negative experiences, young people can be sympathetic to the tensions of modern policing, and can envisage police as positive role models. As such, police can enhance outcomes for 'vulnerable' young people through more respectful interactions. [ABSTRACT FROM AUTHOR]

Purpose: Diverted prescription opioids are significant contributors to drug overdose mortality. Street price has been suggested as an economic metric of the diverted prescription opioid black market. This study examined variables that may influence the street price of diverted oxycodone and oxymorphone. Methods: A cross‐sectional study was conducted utilizing data from the previously validated, crowdsourcing website StreetRx. Street price reports of selected oxycodone and oxymorphone products, between August 22, 2014 and June 30, 2016, were considered for analysis. Geometric means and 95% confidence intervals were calculated comparing prices per milligram of drug in US dollars. Univariate and multivariable regressions were used to examine the influence of dosage strength, drug formulation, and bulk purchasing on street price. Results: A total of 5611 oxycodone and 1420 oxymorphone reports were analyzed. Across various dosages and formulations, geometric mean prices per milligram ranged between $0.12 and $1.07 for oxycodone and $0.73 and $2.90 for oxymorphone. For a 2‐fold increase in dosage strength, there is a 24.0% (95% CI: −28.1%, −19.6%, P < 0.001) and a 22.5% (95% CI: −24.2%, −20.8%, P < 0.001) decrease on average in price per milligram for oxycodone and oxymorphone, respectively. Lower potency, high dosage strength, crush‐resistant opioids, and those purchased in bulk were significantly cheaper. Conclusion: Street prices for diverted oxycodone and oxymorphone are influenced by multiple factors including potency, dosage, formulation, and bulk purchasing. Buyers who purchase large quantities of low potency, large dosage, crush‐resistant formulation prescription opioids can expect to achieve the lowest price. [ABSTRACT FROM AUTHOR]

Over the last few years reports have indicated an increase in the number, type and availability of new psychoactive substances belonging to the benzodiazepine class. These molecules may pose high risks to users, since the majority have never undergone clinical trials or tests so their pharmacology and toxicology is largely unknown. However the new drug scenario emerging from the COVID-19 global pandemic seems to play a role in increasing the diversion of prescribed benzodiazepines and Z-drug. A brief presentation of this phenomenon is hereby presented. The awareness and response activities at national and international levels related to this issue should be enforced. [ABSTRACT FROM AUTHOR]

For businesses that store physical goods, managing product inventories and financial cost accounting controls are critical. Pharmacies are under considerable scrutiny, due to the nature of their merchandise, making internal controls even more vital. Due to the emergence of COVID-19 and government mitigation strategies, the US economy has seen significant macro- and microeconomic effects. COVID-19 has changed the pharmacy working environment, which could theoretically increase rates of employee drug diversion. Therefore, better inventory management could reduce the misuse of pharmaceutical drugs from fraudulent and drug diversion activities. The author explored secondary findings to create a multidisciplinary conceptual analysis of the reasons why internal controls executed with greater diligence may be needed to avoid damaging financial, legal, and health outcomes. The author also provides a review of available internal control methods that can be used to mitigate diversion.

Recently, a range of prescription and over-the-counter (OTC) drugs have emerged as being used recreationally, either on their own or in combination with other substances, both licit and illicit, including new psychoactive substances (NPS). Among them, the misuse of prescription drugs involves not only traditionally recorded substances, such as benzodiazepines and opioid pain relievers, but also gabapentinoids (e.g., pregabalin and gabapentin); some antidepressants, e.g., bupropion and venlafaxine; some second-generation antipsychotics, e.g., quetiapine and olanzapine. Moreover, the use of some OTC for recreational purposes appears on the increase, especially in vulnerable categories such as young people/youths, including the use of high dosages of the antidiarrheal loperamide; first-generation antihistamines, e.g., promethazine, cyclizine, and diphenhydramine; cough and cold preparations containing dextromethorphan and/or codeine. In this context, the role of the Internet has rapidly increased, playing a significant role both in the diffusion of emerging trends of drug misuse among users and experimenters, and the marketing, sale, and distribution of drugs through online pharmacies. This phenomenon within the context of a rapidly modifying drug scenario is a globally recognized health problem, determining severe adverse consequences, including fatalities, and represents a challenge for clinicians in general, psychiatrists, public health, and drug-control policies.

Background In May 2012, the New Hampshire (NH) Division of Public Health Services (DPHS) was notified of 4 persons with newly diagnosed hepatitis C virus (HCV) infection at hospital X. Initial investigation suggested a common link to the hospital cardiac catheterization laboratory (CCL) because the infected persons included 3 CCL patients and a CCL technician. NH DPHS initiated an investigation to determine the source and control the outbreak. Methods NH DPHS conducted site visits, case patient and employee interviews, medical record and medication use review, and employee and patient HCV testing using enzyme immunoassay for anti-HCV, reverse-transcription polymerase chain reaction for HCV RNA, nonstructural 5B (NS5B) and hypervariable region 1 (HVR1) sequencing, and quasispecies analysis. Results HCV HVR1 analysis of the first 4 cases confirmed a common source of infection. HCV testing identified 32 of 1074 CCL patients infected with the outbreak strain, including 3 patients coinfected with >1 HCV strain. The epidemiologic investigation revealed evidence of drug diversion by the HCV-infected technician, evidenced by gaps in controlled medication control, higher fentanyl use during procedures for confirmed cases, and building card key access records documenting the presence of the technician during days when transmission occurred. The employee’s status as a traveling technician led to a multistate investigation, which identified additional cases at prior employment sites. Conclusions This is the largest laboratory-confirmed drug diversion–associated HCV outbreak published to date. Recommendations to reduce drug diversion risk and to conduct outbreak investigations are provided. [ABSTRACT FROM AUTHOR]