Assessing the impact of drug courts on provider-directed marketing efforts by manufactures of medications for the treatment of opioid use disorder
ارزیابی تأثیر دادگاه های مواد مخدر در تلاشهای بازاریابی ارائه شده توسط تولیدکنندگان دارو برای درمان اختلال استفاده از مواد مخدر-2020
Background: Opioid use disorder (OUD) has become an increasingly consequential public health concern, especially in the United States where 47,600 opioid overdose deaths occurred in 2017 (Scholl, Seth, Kariisa, Wilson, & Baldwin, 2019). Medications for OUD (MOUD) are effective for decreasing opioid-related morbidity and mortality, including within the criminal justice system (Hedrich et al., 2012; Medications for Opioid Use Disorder Save Lives, 2019; Moore et al., 2019).While a stronger evidence base exists for agonist MOUD than for antagonist MOUD, a national study of drug courts found that half prohibited agonist MOUD (Matusow et al., 2013).Furthermore, recent media reports suggest that the pharmaceutical manufacturer of an antagonist MOUD has marketed its product towards drug court judges (Goodnough & Zernike, 2017; Harper, 2017). However, no study to date has systematically examined the relationship between MOUD marketing practices and drug courts. This ecological study examines the association at the county level between MOUD manufacturer payments to prescribers and drug court locations. Method: We extracted provider-directed payments from Centers for Medicare and Medicaid Services (CMS)s Sunshine Act Open Payments data 2014–2017, isolating those records mentioning any MOUD. We compared provider-directed payments for two major MOUDs: buprenorphine and extended-release naltrexone, in counties with and without drug courts. Results: The presence of any adult drug courts in the county is associated with a 7.86 percentage-point increase in the likelihood of providers in that county receiving any MOUD-related payments (about 22.46% of the sample mean, p<0.001) and with a 10.70% increase in the amount of these payments per 1000 county residents (p<0.001). The association between other forms of drug courts such as juvenile drug courts and Driving-Under-the-Influence courts (DUI) courts are less significant and slightly smaller in magnitude compared to those of adult drug courts. We did not find significant difference between payments by the manufacturer of Vivitrol and manufacturers of Zubsolv, Bunavail, and Suboxone (oral forms of buprenorphine). Conclusions: Our results show an ecological association at the county level between MOUD manufacturer payments to prescribers and drug court presence. However, we did not examine a causal association between these variables.
Women with a substance use disorder: Treatment completion, pregnancy, and compulsory treatment
زنان مبتلا به اختلال مصرف مواد: پایان درمان ، بارداری و درمان اجباری-2020
Over the last several decades, research regarding substance use treatment programs has focused on the unique and differential outcomes of male and female illicit substance users. Research less frequently examines the unique individual and contextual factors that may influence treatment outcomes. One such population that merits special consideration is pregnant women, as substance use within this population has deleterious effects for both the women and their unborn children. The current study employs propensity score matching to determine if pregnancy and referral source to treatment affect treatment program outcomes. Findings suggest that pregnant women, compared to similarly situated nonpregnant women, are significantly less likely to complete substance use treatment; however, pregnant women who were referred to treatment by the criminal justice system were significantly more likely to complete treatment than those who entered treatment by other referral sources.
Keywords: Substance abuse treatment | Illicit drug use | Pregnant | Treatment episode data
Implications of Cannabis Legalization on Juvenile Justice Outcomes and Racial Disparities
پیامدهای قانونی شدن مواد مخدر بر نتایج عدالت نوجوانان و نابرابری های نژادی-2020
Introduction: The objective of this study is to assess the changes in rates of juvenile cannabis criminal allegations and racial disparities in Oregon after legalization of cannabis (July 2015) for adults. Methods: This study included all allegations for cannabis-related offenses that occurred from January 2012 to September 2018 in Oregon. Negative binomial regression models were used to examine monthly cannabis allegation rates over time, and tested differences between youth of color and white youth, adjusting for age, gender, and month the allegation occurred. Analysis was conducted in January−March 2019. Results: Cannabis allegation rates increased 28% among all youth and 32% among cannabis-using youth after legalization. Rates of allegations were highest for American Indian/Alaska Native and black youth. Rates for black youth were double that of whites before legalization, and this disparity decreased after legalization. For American Indian/Alaska Native youth, rates were higher than whites before legalization, and this disparity remained unchanged. Conclusions: Adult cannabis legalization in Oregon was associated with increased juvenile cannabis allegations; increases are not explained by changes in underage cannabis use. Relative disparities decreased for black youth but remained unchanged for American Indian/Alaska Native youth. Changing regulations following adult cannabis legalization could have unintended negative impacts on youth.
Police-related barriers to harm reduction linked to non-fatal overdose amongst sex workers who use drugs: Results of a community-based cohort in Metro Vancouver, Canada
موانع مربوط به پلیس در کاهش آسیب مرتبط با مصرف بیش از حد غیر کشنده در میان کارگران جنسی که مواد مخدر استفاده می کنند: نتایج یک گروه مبتنی در جامعه در مترو ونکوور ، کانادا-2020
Background: High rates of overdose and overdose-related mortality in North America represent a pressing health and social concern. Women sex workers face severe health and social inequities, which have been linked to structural factors including negative police interactions; however, little is known regarding the burden of overdose or how policing impacts overdose risk amongst sex workers who use drugs. Given this, we aimed to explore the independent effects of experiencing police-related barriers to harm reduction on non-fatal overdose amongst women sex workers who use drugs in Metro Vancouver, Canada over a 7.5-year period. Methods: Data were drawn from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women sex workers in Metro Vancouver, from 2010 to 2017. Using multivariate logistic regression with generalized estimating equations (GEE), we used a confounder modeling approach to identify the independent effect of experiencing police-related barriers to harm reduction strategies on non-fatal overdose amongst sex workers using drugs within the last six months at each study visit. Results: Amongst 624 participants, 7.7% overdosed within the last six months at baseline and 27.6% overdosed during the study period, contributing 287 non-fatal overdose events over the 7.5-year period. 68.6% reported police-related barriers to harm reduction strategies during the study. In a multivariate confounder model, exposure to police-related barriers to harm reduction strategies [AOR: 2.15, CI: 1.60–2.90] was independently associated with higher odds of non-fatal overdose after adjustment for key confounders. Conclusions: Our findings suggest that in the context of the current overdose crisis, adversarial policing practices may undermine access to lifesaving overdose prevention services and exacerbate overdose risks for marginalized women. Findings underscore the urgent need to scale-up access and remove barriers to progressive harm reduction strategies for women sex workers.
Keywords: Sex work | Drug overdose | Harm reduction | Women | Policing | Criminalization
“Its like super structural” – Overdose experiences of youth who use drugs and police in three non-metropolitan cities across British Columbia
"این مانند ساختاری فوق العاده است" - تجربیات بیش از حد مصرف جوانان در سه شهر غیر کلانشهر بریتیش کلمبیا که از مواد مخدر و پلیس استفاده می کنند-2020
Introduction: Youth who use drugs (YWUD) are vulnerable to experience or encounter drug related overdose deaths. Fentanyl has increased the risks, calling greater attention to overdose. In response, there have been increases in harm reduction services and policies such as the Good Samaritan Drug Overdose Act (GSDOA) which exempts people who witness an overdose and call 9–1–1 from being charged for possession of drugs. However, fear of police continues to be a barrier to calling 9–1–1. This paper focuses on the experiences of youth with police in overdose situations and their knowledge of GSDOA. Methods: Youth, aged 16–30, who had used drugs at least weekly, and had encountered police in the past year were recruited between May 2017 and June 2018 in three non-metropolitan cities in British Columbia, Canada. 38 participants completed qualitative interviews asking them about their experiences with police, overdose, decisions to call 9–1–1, and their understanding of the GSDOA. Their responses were coded in NVIVO and analyzed using interpretive description. Results: For many YWUD in this study, overdoses are an ever-present part of their lives and fear of fentanyl has left them concerned for themselves and others. Negative experiences occurred when police used their power without benefit to youth or were rough or disrespectful, without care for the person overdosing. Youth saw police in a positive light if they were compassionate, stepping aside for paramedics or reviving someone experiencing an overdose. Youth had very mixed knowledge of the GSDOA and were concerned about criminalization if they called 9–1–1. Conclusions: Collaboration with police and local stakeholders is required to address the concerns of YWUD and to increase awareness and penetration of policies such as the GSDOA. Changes to policing cultures that prioritize health rather than criminalize YWUD may increase youths trust of police and increase calls to 9–1–1.
Keywords: Drug overdose | Youth who use drugs | Police discretion | Naloxone | Harm reduction
Steps toward a theory of place effects on drug use: Risk, marginality, and opportunity in small and remote California towns
گامهایی برای دستیابی به نظریه اثرات مکانی بر مصرف مواد مخدر: خطر ، حاشیه و فرصت در شهرهای کوچک و دور افتاده کالیفرنیا-2020
The risk environment concept provides a framework for documenting ecological influences on drug use, and a platform to engage with social theory to identify mechanisms behind place-based health disparities. Health scientists conceptualize these mechanisms in terms of social determinants of health, social scientists in terms of syndemics and structural violence. I supplement these perspectives with Pierre Bourdieus concepts of social space, practice, and habitus to offer a broader analysis of how place shapes drug-related health risks, particularly outside of the large cities where most research is conducted. This approach encompasses inequality, conflict, and social change at multiple levels of social organization, from macrodistributions of power to trajectories of individual drug use. I offer three pointers for scholarship on drug use in nonurban places, which I illustrate with findings from an ethnographic study of opioid use and opioid-related services in California. First, replace the folk notion of “rural” with geographic categories grounded in relevant social structures and institutions, such as social networks or illicit drug markets. Second, examine how variation in the structure of social and physical space affects processes of marginalization and criminalization. Third, avoid negative definitions of nonurban places, and instead explore their distinctive institutions and opportunity structures. Following this approach, I define acquainted marginality and small-town habitus to explain how dense networks and geographic isolation shape local government and survival strategies among people who use drugs. I find that in small and remote towns, personal and professional relationships overlap in ways that augment surveillance and stigma, but can also facilitate leniency and progressive policy change. I conclude by using these findings to outline a theory of place effects on drug use and addiction to encourage future research in these directions.
Keywords: Risk environment | Rural | Social space | Practice | Acquainted marginality | Small-town habitus
Abnormal dynamic functional network connectivity of the mirrorneuron system network and the mentalizing network in patients withadolescent-onset, first-episode, drug-naïve schizophrenia
اتصال غیر عادی شبکه عملکردی پویا شبکه سیستم mirrorneuron و شبکه روانی در بیماران مبتلا به اسکیزوفرنی زودرس ، قسمت اول ، مواد مخدر ساده-2020
Previous studies based on an assumption of connectivity stationarity reported disconnections in mirrorneuron system (MNS) and mentalizing networks of schizophrenic brains with social cognitive disrup-tions. However, recent studies demonstrated that functional brain connections are dynamic, and staticconnectivity metrics fail to capture time-varying properties of functional connections. The present studyused a dynamic functional connectivity (dFC) method to test whether alterations of functional connectiv-ity in the two networks are time-varying in adolescent-onset schizophrenia (AOS) patients. We collectedresting-state fMRI data from 28 patients with AOS and 22 matched healthy controls. Static functional con-nectivity and dFC were used to explore the connectivity difference in the MNS and mentalizing networksbetween the two groups, respectively. Then a Pearson’s correlation analysis between the connectivityshowing intergroup differences and clinical scores was conducted in the AOS group. Compared withstatic functional connectivity analyses, dFC revealed state-specific connectivity decreases within theMNS network in the AOS group. Additionally, the dFC between the left middle temporal gyrus and leftV5 was negatively correlated with the item2 of PANSS negative scores across all the AOS patients. Ourfindings suggest that social dysfunctions in AOS patients may be associated with the altered integrityand interaction of the MNS and mentalizing networks, and the functional impairments in the MNS aredynamic over Keywords:Dynamic functional connectivity | Resting-State fMRI | Mirror neuron system network | Mentalizing network | Adolescent-Onset schizophrenia
Alprazolam use among a sample of Australians who inject drugs: Trends up to six years post regulatory changes
استفاده از آلپرازولام در میان نمونه استرالیایی هایی که دارو تزریق می کنند: روندهای تا شش سال پس از تغییرات نظارتی-2020
Introduction: Alprazolam is a high potency triazolobenzodiazepine that is associated with a disproportionate amount of harm compared to other benzodiazepines. In Australia, amid growing concerns of extra-medical use and harms, alprazolam was up-scheduled from Schedule 4 (prescription only) to Schedule 8 (controlled drug) on 1 February 2014, with further restrictions introduced on 1 February 2017. This study aims to examine the impact of these regulatory changes among cross-sectional samples of people who inject drugs (PWID), from 2011–2019. Methods: Data were obtained from the 2011–2019 Illicit Drug Reporting System, comprising cross-sectional samples of PWID recruited annually from Australian capital cities (approximately ~900 per year). Results: By 2019, the proportion of PWID who reported past six-month use of non-prescribed (17%) and prescribed (4%) alprazolam had halved compared to 2011 (39% and 13%, respectively), with no evidence of an increase in use of other sedative substances. Following the up-scheduling of alprazolam in 2014, there was an increase in the median last price paid for 2 mg of diverted alprazolam ($5AUD pre-rescheduling versus $7AUD post rescheduling), with 61% of those able to answer reporting that diverted alprazolam had become ‘more difficult’ to obtain post versus pre-rescheduling. The correlates associated with non-prescribed alprazolam use remained relatively consistent pre- and post-regulatory change, with past-month criminal activity, past sixmonth opioid agonist therapy and past six-month use of non-prescribed other benzodiazepines associated with non-prescribed alprazolam use in both the 2013 and 2018 samples. Conclusions: Regulatory changes appear to have resulted in sustained reductions in alprazolam use amongst our annual cross-sectional sentinel samples of PWID, although a considerable minority (17%) continued to report non-prescribed use in 2019. To achieve further reductions in non-prescribed use and associated harms, these regulatory changes need to be coupled with other interventions, such as direct consumer engagement and harm reduction messaging. Our findings suggest that people receiving opioid agonist therapy remain a key target population for such interventions.
Keywords: Alprazolam | Benzodiazepines | People who inject drugs | Regulatory change | Prescription drug misuse
Missed opportunities: Arrest and court touchpoints for individuals who fatally overdosed in Philadelphia in 2016
فرصت های از دست رفته: دستگیری و نقاط تماس دادگاه برای افرادی که در سال 2016 در فیلادلفیا بیش از حد دوز مصرف کرده بودند-2020
Background: Many studies document high risk of fatal overdose after incarceration. Few explore earlier touchpoints in criminal justice processes, like arrests and court hearings. Understanding these touchpoints is important for several reasons. Arrest and adjudicatory processes are harmful even when not resulting in incarceration. Arrests and criminal hearings also may reflect changes in overdose-related risk factors like transitions in employment and housing stability. Moreover, knowledge about these touchpoints contextualizes debate about the implementation of court-based programs like Drug Treatment Courts. This study described the incidence and accumulation of touchpoints for people who fatally overdosed in Philadelphia in 2016, and depicted how touchpoint incidence and characteristics interface with court-program eligibility. Methods: Criminal court documents were obtained for all individuals who fatally overdosed in Philadelphia in 2016 from the Philadelphia Medical Examiners Office. The characteristics of arrests and court hearings were abstracted to compile lifetime criminal histories. Latent class analysis was performed to identify whether these histories followed observably distinct patterns. Results: In 2016, 907 people fatally overdosed in Philadelphia. Of these, 605 had at least one or more of 3,926 arrests and 3,822 hearings over their lifetime. There were 488 arrests and 533 hearings in the two years before death, with public disorder charges especially common closer to death. Less than 20% of these hearings resulted in custodial sentences. Of individuals with touchpoints, only nine participated in Drug Treatment Court, consistent with findings that most individuals were ineligible. Latent class analysis suggested five distinguishable patterns in age, timing, and characteristics of touchpoints. Conclusions: The type and frequency of touchpoints preceding fatal overdose reflect a period of complex vulnerability. Few individuals qualified for court-based programming, underscoring the limitations of supporting this population in specialized court settings. Reducing incidence and improving the health impact of criminal justice touchpoints remain important public health priorities.
Keywords: Criminal justice | Opioid | Overdose death | Drug court | Latent class analysis
“Bed Bugs and Beyond”: An ethnographic analysis of North Americas first women-only supervised drug consumption site
"اشکالات بستر و فراتر از آن": تجزیه و تحلیل مردم نگاری اولین سایت مصرف مواد مخدر تحت نظارت فقط در زنان در آمریکای شمالی-2020
Background: Attention to how women are differentially impacted within harm reduction environments is salient amidst North Americas overdose crisis. Harm reduction interventions are typically ‘gender-neutral’, thus failing to address the systemic and everyday racialized and gendered discrimination, stigma, and violence extending into service settings and limiting some womens access. Such dynamics highlight the significance of North Americas first low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive), SisterSpace, in Vancouver, Canada. This study explores womens lived experiences of this unique harm reduction intervention. Methods: Ethnographic research was conducted from May 2017 to June 2018 to explore womens experiences with SisterSpace in Vancouvers Downtown Eastside, an epicenter of Canadas overdose crisis. Data include more than 100 hours of ethnographic fieldwork, including unstructured conversations with structurally vulnerable women who use illegal drugs, and in-depth interviews with 45 women recruited from this site. Data were analyzed in NVivo by drawing on deductive and inductive approaches. Findings: The setting (non-institutional), operational policies (no men; inclusive), and environment (diversity of structurally vulnerable women who use illegal drugs), constituted a space affording participants a temporary reprieve from some forms of stigma and discrimination, gendered and social violence and drug-related harms, including overdose. SisterSpace fostered a sense of safety and subjective autonomy (though structurally constrained) among those often defined as ‘deviant’ and ‘victims’, enabling knowledge-sharing of experiences through a gendered lens. Conclusion: SisterSpace demonstrates the value and effectiveness of initiatives that engage with socio-structural factors beyond the often narrow focus of overdose prevention and that account for the complex social relations that constitute such initiatives. In the context of structural inequities, criminalization, and an overdose crisis, SisterSpace represents an innovative approach to harm reduction that accounts for situations of gender inequality not being met by mixed-gender services, with relevance to other settings.
Keywords: women | drugs | violence | harm reduction | overdose | supervised consumption sites | Canada