Controlled Substance Analysis

As a nation, we have left it up to the individual states to monitor and manage the use of prescription drugs, specifically controlled substances. There have been many professional organizations, along with state and national agencies who have offered strategies to help states reduce over prescribing of controlled substances like opiates and benzodiazepines. Grant money has been available for program development and support with this endeavor. Prescription Monitoring Programs, or PDMPs is one strategy that has been in the forefront of state's opportunities to monitor and manage the dispensing of controlled substance.

Objective-An epidemic of prescription drug abuse is disproportionately impacting the mentally ill. We examined the utility of a state prescription drug monitoring database for assessing recent controlled substance prescribing to patients presenting for dual diagnosis treatment. Method-In a community mental health center that provides integrated dual diagnosis care, we queried the Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) system for all cases that were open as of August 2, 2011, and had been practitioner-diagnosed (per DSM-IV criteria) by January 2, 2012. INSPECT provided a record of controlled substance dispensations to each patient; diagnostic evaluation was conducted blind from prescription data compilation covering the prior 12 months. Demographic data, insurance status, and DSM-IV diagnoses were compiled from the clinic's electronic medical record. Results-The sample (N = 201) was 51% female, 56% white, and two-thirds uninsured. Over 80% were dually diagnosed with substance use disorders and psychotic, mood, or anxiety

The opioid crisis in the United States has had devastating effects on communities across the country, leading many states to pass legislation that limits the prescription of opioid medications in an effort to reduce the number of overdose deaths. This study investigates the impact of South Carolina’s prescription limit law (S.C. Code Ann. 44-53-360), which aims to reduce opioid overdose deaths, on opioid prescription rates. The study utilizes South Carolina Reporting and Identification Prescription Tracking System (SCRIPTS) data and proposes a distance classification system to group records based on proximity and evaluates prescription volumes in each distance class. Prescription volumes were found to be highest in classes with pharmacies located further away from the patient. An Interrupted Time Series (ITS) model is utilized to assess the policy impact, with benzodiazepine prescriptions as a control group. The ITS models indicate an overall decrease in prescription volume, but wit...

In a recent press release Joseph A. Califano, Jr., Chairman and President of the National Center on Addiction and Substance Abuse at Columbia University called for a major shift in American attitudes about substance abuse and addiction and a top to bottom overhaul in the nation’s healthcare, criminal justice, social service, and eduction systems to curtail the rise in illegal drug use and other substance abuse. Califano, in 2005, also noted that while America has been congratulating itself on curbing increases in alcohol and illicit drug use and in the decline in teen smoking, abuse and addition of controlled prescription drugs-opioids, central nervous system depressants and stimulants-have been stealthily, but sharply rising. All the statistics continue to show that prescription drug abuse is escalating with increasing emergency department visits and unintentional deaths due to prescription controlled substances. While the problem of drug prescriptions for controlled substances con...

The scheduling of cannabis under the Controlled Substances Act (CSA) has established legal precedents that determine how scientific evidence affects its regulation in the United States. This background challenges three common fallacies that make it seem marijuana prohibition is the only viable policy outcome. A contemporary effort to reschedule cannabis is based on recent findings that have established that marijuana lacks the high potential for abuse required for Schedule I or Schedule II status under the CSA. The primary policy issue is not, then, whether marijuana is the best medicine but instead whether people who use it medically should be treated as criminals.

Prescription drug monitoring programs (PDMP) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the impact of a state-mandated PDMP on opioid prescribing by Emergency Medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 Emergency Departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time-series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law mandated PDMP use on August 25th, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% CI 10.8% to 14.1%) to 10.2% (95% CI 8.8% to 11.8%). For each month between September, 2016 to March, 2017, there was a mean decline of 0.46% (95% CI -0.38% to -0.53%) in the percenta...

ABSTRACTIntroductionThe Diversion Alert Program (DAP) was established to curb the misuse of drugs and help identify people in need of substance use disorder (SUD) treatment. Law enforcement compiled arrest data into a database accessible by health care providers. The objectives of this investigation were to identify regional and demographic differences in drug use and misuse in Maine.MethodsAll arrests (N = 11,234) reported to the DAP from 2013 to 2018 were examined by county, arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution of controlled pharmaceuticals (schedule I-V). Opioids were converted to oral morphine mg equivalents (MME). County and zip-code heat maps were constructed.ResultsThe counties with the most arrests per capita were Cumberland, Androscoggin, and Penobscot. Opioids were the most common drug class in arrests in all counties except Aroostook, w...

This article aims to explore the statistics observed in the Pacific Northwest regarding substance abuse, as Oregon and Washington have been shown to be most affected given the increased treatment admissions for opioid utilization and mortality related to medication overdose. Using PubMed and National Conference of State Legislatures database, articles detailing prescription drug abuse statistics, programs, and laws were collected and analyzed in order to identify possible solutions. Many studies report that pain medication prescriptions have seen a rise in recent years, however, there still exists an inadequacy in pain management. This increase in prescriptions may also contribute to the rising number in substance misuse and subsequently overdose deaths. Pharmacists can have a global effect on abuse prevention if certain monitoring strategies are implemented and enforced. Health-care providers and pharmacists should contribute to abuse prevention by helping to detect fraudulent pres...

Prescription drug monitoring programs (PDMP) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the impact of a state-mandated PDMP on opioid prescribing by Emergency Medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 Emergency Departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time-series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law mandated PDMP use on August 25th, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% CI 10.8% to 14.1%) to 10.2% (95% CI 8.8% to 11.8%). For each month between September, 2016 to March, 2017, there was a mean decline of 0.46% (95% CI -0.38% to -0.53%) in the percenta...

Prescription opioids have increasingly been involved in overdose deaths and treatment admissions. Disposal programs may play an important role in curbing this trend. The objectives of this study were to: (1) quantify the prescription opioids returned for disposal to a local takeback program, and (2) explore selected drug characteristics that may predict the quantity of unused opioids. Leftover prescription opioid medications returned for disposal to a community drug take-back event were quantified and analyzed according to controlled substances schedule, formulation, number of active ingredients, and directions for use. Days' supply of medication remaining, calculated using the number of dosage units remaining divided by the maximum number of dosage units per day allowed by the prescriber, was the primary outcome variable. Opioid prescriptions returned for disposal had greater than 60 % of the amount dispensed remaining unused. Short-acting C-II and C-III combination opioids accounted for greater than 80 % of the prescriptions returned. Day supply dispensed was the strongest predictor of day supply remaining, regardless of other drug characteristics. These findings indicate that disposal programs are effective at removing unused medication from patient homes. To reduce leftover medication, prescriber education programs should address the amount to be prescribed. Continual monitoring of quantities prescribed and returned for disposal may be useful in evaluating the effects of these programs on leftover medication. Further research on drug characteristics may inform prescribing practices and reduce leftover medication. Key Points Opioid prescriptions returned for disposal had [60 % of the amount dispensed remaining unused. Day supply dispensed was the strongest predictor of day supply remaining.

Marijuana is the most widespread abused, trafficked, and consumed drug in America. Although according to federal law, the use, consumption, and distribution of marijuana are illegal, approximately two-thirds of the State Governments in the U.S. and the District of Columbia have legalized marijuana for either medical or recreational purposes. Due to the passing of new controversial marijuana legislation at the state levels of government, which started with the passing of Amendments 64 and Initiative 502, respectively, in Colorado and Washington in 2012, the federal government is faced with many challenges associated with enforcing and preventing the illegal diversion of marijuana and marijuana products. Although state legislation may be passed to legalize marijuana for particular jurisdictions, under the Controlled Substances Act (CSA), distribution and possession of marijuana is still illegal on a federal level, and marijuana is classified as a Schedule I controlled substance. Contr...

Background: Seizures have the potential to cause significant morbidity and mortality, and are a common reason EMS are requested for a child. An evidence-based guideline (EBG) for pediatric prehospital seizures was published and has been implemented as protocol in multiple EMS systems. Knowledge translation and protocol adherence in medicine can be incomplete. In EMS, systems-based factors and providers' attitudes and beliefs may contribute to incomplete knowledge translation and protocol implementation. Objective: The purpose of this study was to identify paramedic attitudes and beliefs regarding pediatric seizure management and regarding potential barriers to and enablers of adherence to evidence-based pediatric seizure protocols in multiple EMS systems. Methods: This was a qualitative study utilizing semi-structured interviews of paramedics who recently transported actively seizing 0-17 year-old patients in three different urban EMS systems. Interviewers explored the providers' decision-making during their recent case and regarding seizures in general. Interview questions explored barriers to and enablers of protocol adherence. Two investigators used the grounded theory approach and constant comparison A c c e p t e d M a n u s c r i p t to independently analyze transcribed interview recordings until thematic saturation was reached. Findings were validated with follow-up member-checking interviews. Results: Several themes emerged from the 66 interviewed paramedics. Enablers of protocol adherence included point-of-care references, the availability of different routes for midazolam, and availability of online medical control. Systems-level barriers included equipment availability, controlled substance management, infrequent pediatric training, and protocol ambiguity. Provider-level barriers included concerns about respiratory depression, provider fatigue, preferences for specific routes, febrile seizure perceptions, and inaccurate methods of weight estimation. Paramedics suggested system improvements to address dose standardization, protocol clarity, simplified controlled substance logistics, and equipment availability. Conclusions: Paramedics identified enablers of and barriers to adherence to evidence-based pediatric seizure protocols. The identified barriers existed at both the provider and systems levels. Paramedics identified multiple potential solutions to overcome several barriers to protocol adherence. Future research should focus on using the findings of this study to revise seizure protocols and to deploy measures to improve protocol implementation. Future research should also analyze process and outcome measures before and after the implementation of revised seizure protocols informed by the findings of this study.

Marijuana is the most widespread abused, trafficked, and consumed drug in America. Although according to federal law, the use, consumption, and distribution of marijuana are illegal, approximately two-thirds of the State Governments in the U.S. and the District of Columbia have legalized marijuana for either medical or recreational purposes. Due to the passing of new controversial marijuana legislation at the state levels of government, which started with the passing of Amendments 64 and Initiative 502, respectively, in Colorado and Washington in 2012, the federal government is faced with many challenges associated with enforcing and preventing the illegal diversion of marijuana and marijuana products. Although state legislation may be passed to legalize marijuana for particular jurisdictions, under the Controlled Substances Act (CSA), distribution and possession of marijuana is still illegal on a federal level, and marijuana is classified as a Schedule I controlled substance. Contr...

Relative to beneficiaries with unintentional OOD, more individuals with intentional OOD had no opioid prescription in the study period (39.9% vs. 46.8%, p=0.0004). In our adjusted model, the odds of intentional vs. unintentional OOD was lower among beneficiaries age$65 versus age,65 (OR=0.22; 95%CI=0.16-0.30), Black versus White (OR=0.59; 95%CI=0.42-0.82), and with opioid therapy .90 days versus ,90 days (OR=0.65; 95%CI=0.52-0.80). The odds of mental illness diagnosis was almost 5 times higher among intentional vs. unintentional OOD groups (OR=4.86; 95%CI=3.912-6.037). Conclusions: One in ten OOD events among Medicare beneficiaries was intentional. Shorter duration of opioid therapy and mental illness may be associated with increased risk of intentional OOD. Findings suggest interventions aimed at preventing OOD should consider intentionality and include mental health support particularly among beneficiaries with psychiatric disorders.

Prescription drug monitoring programs (PDMP) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the impact of a state-mandated PDMP on opioid prescribing by Emergency Medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 Emergency Departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time-series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law mandated PDMP use on August 25 th , 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% CI 10.8% to 14.1%) to 10.2% (95% CI 8.8% to 11.8%). For each month between September, 2016 to March, 2017, there was a mean decline of 0.46% (95% CI −0.38% to −0.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as by patient diagnosis.

Prescription drug monitoring programs (PDMP) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the impact of a state-mandated PDMP on opioid prescribing by Emergency Medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 Emergency Departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time-series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law mandated PDMP use on August 25th, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% CI 10.8% to 14.1%) to 10.2% (95% CI 8.8% to 11.8%). For each month between September, 2016 to March, 2017, there was a mean decline of 0.46% (95% CI -0.38% to -0.53%) in the percenta...

Controlled prescription opioid use is perceived as a national problem attributed to all specialties. Our objective was to provide a descriptive analysis of prescriptions written for controlled opioids from a database of emergency department (ED) visits prior to the enactment of the I-STOP law, which requires New York prescribers to consult the Prescription Monitoring Program (PMP) prior to prescribing Schedule II, III, and IV controlled substances for prescriptions of greater than five days duration. Methods: We conducted a retrospective medical record review of patients 21 years of age and older, who presented to the ED between July 1, 2011-June 30, 2012 and were given a prescription for a controlled opioid. Our primary purpose was to characterize each prescription as to the type of controlled substance, the quantity dispensed, and the duration of the prescription. We also looked at outliers, those patients who received prescriptions for longer than five days. Results: A total of 9,502 prescriptions were written for opioids out of a total 63,143 prescriptions for 69,500 adult patients. Twenty-six (0.27%) of the prescriptions for controlled opioids were written for greater than five days. Most prescriptions were for five days or less (99.7%, 95% CI [99.6 to 99.8%]). Conclusion: The vast majority of opioid prescriptions in our ED prior to the I-STOP legislature were limited to a five-day or less supply. These new regulations were meant to reduce the ED's contribution to the rise of opioid related morbidity. This study suggests that the emergency physicians' usual prescribing practices were negligibly limited by the new restrictive regulations. The ED may not be primarily contributing to the increase in opioid-related overdoses and death. The effect of the I-STOP regulation on future prescribing patterns in the ED remains to be determined.

In addition to the regulation of prescriptive authority and prescribing practices conducted by individual states, the prescription of controlled substances is also regulated at the federal level by the US Drug Enforcement Administration (DEA). While there are variations in state laws relative to controlled substance prescribing, federal law is uniform across states as established by the Controlled Substances Act (21 United States Code § 801‐890) and the DEA Regulations (Title 21, Code of Federal Regulations). The only controlled substance for which states have authorized use that is outside the regulations set forth in the Controlled Substances Act is marijuana for the treatment of certain medical conditions. A review of statutes and administrative rules for all 50 states and the District of Columbia revealed that certified midwives (CMs) are authorized to prescribe controlled substances only in the state of New York, and there are variations across states in the regulation of contr...

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Prescription Drug Monitoring Programs (PDMP) are statewide databases that collect data on prescription of controlled substances. New York State mandates prescribers to consult the PDMP registry before prescribing a controlled substance such as opioid analgesics. The effect of mandatory PDMP on opioid drug prescriptions by dentists is not known. This study investigates the impact of mandatory PDMP on frequency and quantity of opioid prescriptions by dentists in a dental urgent care center. Based on the sample size estimate, we collected patient records of a 3-month period before and two consecutive 3-month periods after the mandatory PDMP implementation and analyzed the data on number of visits, treatment types and drug prescriptions using Chi-square tests. For patients who were prescribed pain medications, 452 (30.6%), 190 (14.1%), and 140 (9.6%) received opioid analgesics in the three study periods respectively, signifying a statistically significant reduction in the number of opio...

In the United States and internationally, providers have adopted guidelines on the management of prescription opioids for chronic noncancer pain (CNCP). For "high-risk" patients with co-occurring CNCP and a history of substance use, guidelines advise that providers monitor patients using urine toxicology screening tests, develop opioid management plans, and refer patients to substance use treatment. We report primary care provider experiences in the safety net interpreting and implementing prescription opioid guideline recommendations for patients with CNCP and substance use. We interviewed primary care providers who work in safety net settings (N = 23) on their experiences managing CNCP and substance use. We analyzed interviews using a content analysis method. Providers found management plans and urine toxicology screening tests useful for informing patients about clinic expectations of opioid therapy and substance use. However, they described that guideline-based clinic ...

Guideline recommendations to reduce prescription opioid misuse among patients with chronic non-cancer pain include the routine use of urine toxicology tests for high-risk patients. Yet little is known about how the implementation of urine toxicology tests among patients with co-occurring chronic non-cancer pain and substance use impacts primary care providers' management of misuse. In this paper, we present clinicians' perspectives on the benefits and challenges of implementing urine toxicology tests in the monitoring of opioid misuse and substance use in safety net healthcare settings. We interviewed 23 primary care providers from six safety net healthcare settings whose patients had a diagnosis of co-occurring chronic non-cancer pain and substance use. We transcribed, coded, and analyzed interviews using grounded theory methodology. The benefits of implementing urine toxicology tests for primary care providers included less reliance on intuition to assess for misuse and th...

Background: The supply of controlled drugs is limited in the Far East, despite the prevalence of health disorders that warrant their prescription. Reasons for this include strict regulatory frameworks, limited financial resources, lack of appropriate training amongst the medical profession and fear of addiction in both general practitioners and the wider population. Consequently, the weak opioid tramadol has become the analgesic most frequently used in the region to treat moderate to severe pain. Methods: To obtain a clearer picture of the current role and clinical use of tramadol in Southeast Asia, pain specialists from 7 countries in the region were invited to participate in a survey, using a questionnaire to gather information about their individual use and experience of this analgesic. Results: Fifteen completed questionnaires were returned and the responses analyzed. Tramadol is used to manage acute and chronic pain caused by a wide range of conditions. Almost all the specialists treat moderate cancer pain with tramadol, and every one considers it to be significant or highly significant in the treatment of moderate to severe non-cancer pain. The reasons for choosing tramadol include efficacy, safety and tolerability, ready availability, reasonable cost, multiple formulations and patient compliance. Its safety profile makes tramadol particularly appropriate for use in elderly patients, outpatients, and for long-term treatment. The respondents strongly agreed that tighter regulation of tramadol would reduce its medical availability and adversely affect the quality of pain management. In some countries, there would no longer be any appropriate medication for cancer pain or the long-term treatment of chronic pain. Conclusions: In Southeast Asia, tramadol plays an important part in the pharmacological management of moderate to severe pain, and may be the only available treatment option. If it were to become a controlled substance, the standard of pain management in the region would decline.

Background: Trends of opioid prescribing in the NHS have been well published, yet trends for the same in private prescribing have not been widely established. Aim: To assess trends and geographical variation of controlled opioids prescribed by private prescribers in England. Design and setting: A retrospective observational study in English primary healthcare. Methods: Data on Schedule 2 and 3 controlled opioids ("controlled opioids") was obtained from the NHS Business Services Authority (BSA) using freedom of information (FOI) requests between 01 January 2014 and 30 November 2021. Absolute counts and rates of the number of items dispensed per cumulative number of registered private prescribers were calculated and stratified over time, by opioid type, and geographical region. Results: 128,341 items of controlled opioids were prescribed by private prescribers in England between January 2014 and November 2021, which decreased by 50% from 23,339 items (4.09 items/prescriber) in 2014 to 11,573 items (1.49 items/prescriber) in 2020. Methadone (36%) was the most common controlled opioid prescribed privately, followed by morphine (18%), buprenorphine (16%), and oxycodone (12%). Prescriptions were highest in London (74%), followed by the SouthEast of England (7%). A proportion of items (n=462, 0.35%) were prescribed by "unidentified doctors" where the prescription is not readily attributable to an individual prescriber by the BSA. Conclusions: Controlled opioids prescribed by private prescribers in England decreased and were primarily prescribed in London. To ensure patient safety, the monitoring and surveillance of controlled opioids dispensed privately should continue and items linked to "unidentified doctors" should be addressed further.

Objective. To determine the effectiveness of using music to assist pharmacy students in developing empathy toward patients with opioid use disorder. Methods. Students were given an extra credit assignment as part of an elective course in neuropsychiatry. Students were to listen to the autobiographical album, The Heroin Diaries Soundtrack, about the life of rock music star Nikki Sixx and his struggles with heroin addiction. They were then required to write a reflection about how the lyrics and music from the album affected their personal views on persons with opioid use disorder. Results. Eighteen of 25 students in the course completed the assignment. Students' response to the assignment was universally positive. Many commented on their previous views that opioid use was a choice and a problem for law enforcement to manage. Students stated how their perspectives changed significantly after listening to the music and developing an appreciation for the symptoms and problems related to opioid use disorder and attempts to abstain. Many students remarked how the musical accompaniment to the lyrics and narration helped shape their emotional response. Conclusion. Health professions students often have difficulty understanding mental illnesses, including substance use disorders. Music can be used to enhance student's empathy toward patients with mental health and substance use disorders. Music and other art forms may be especially useful when teaching subject matter related to the affective domain.

To examine the effect on the trade in opioids through online illicit markets ("cryptomarkets") of the US Drug Enforcement Administration's ruling in 2014 to reschedule hydrocodone combination products. Interrupted time series analysis. 31 of the world's largest cryptomarkets operating from October 2013 to July 2016. The proportion of total transactions, advertised and active listings for prescription opioids, prescription sedatives, prescription steroids, prescription stimulants, and illicit opioids, and the composition of the prescription opioid market between the US and elsewhere. The sale of prescription opioids through US cryptomarkets increased after the schedule change, with no statistically significant changes in sales of prescription sedatives, prescription steroids, prescription stimulants, or illicit opioids. In July 2016 sales of opioids through US cryptomarkets represented 13.7% of all drug sales (95% confidence interval 11.5% to 16.0%) compared with a ...

Marijuana is the most widespread abused, trafficked, and consumed drug in America. Although according to federal law, the use, consumption, and distribution of marijuana are illegal, approximately two-thirds of the State Governments in the U.S. and the District of Columbia have legalized marijuana for either medical or recreational purposes. Due to the passing of new controversial marijuana legislation at the state levels of government, which started with the passing of Amendments 64 and Initiative 502, respectively, in Colorado and Washington in 2012, the federal government is faced with many challenges associated with enforcing and preventing the illegal diversion of marijuana and marijuana products. Although state legislation may be passed to legalize marijuana for particular jurisdictions, under the Controlled Substances Act (CSA), distribution and possession of marijuana is still illegal on a federal level, and marijuana is classified as a Schedule I controlled substance. Contr...

ABSTRACTIntroductionThe Diversion Alert Program (DAP) was established to curb the misuse of drugs and help identify people in need of substance use disorder (SUD) treatment. Law enforcement compiled arrest data into a database accessible by health care providers. The objectives of this investigation were to identify regional and demographic differences in drug use and misuse in Maine.MethodsAll arrests (N = 11,234) reported to the DAP from 2013 to 2018 were examined by county, arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution of controlled pharmaceuticals (schedule I-V). Opioids were converted to oral morphine mg equivalents (MME). County and zip-code heat maps were constructed.ResultsThe counties with the most arrests per capita were Cumberland, Androscoggin, and Penobscot. Opioids were the most common drug class in arrests in all counties except Aroostook, w...

Evaluation methodology, the researcher in residence has highlighted the culture changes that are key to delivering the aspirations of the Community MH Service framework. These include; the narrative of "no wrong door", an increased and open range of offers and interventions, blended staffing models across traditional organisational boundaries, partnership working, the role of lived experience and the ambition of addressing inequalities. Conclusion. OMH, the product of Community MH Transformation in Somerset, is a radical and co produced redesign of MH services in partnership with the VCSE and Local Authority that has improved access and support to all people in Somerset.

Marijuana is the most widespread abused, trafficked, and consumed drug in America. Although according to federal law, the use, consumption, and distribution of marijuana are illegal, approximately two-thirds of the State Governments in the U.S. and the District of Columbia have legalized marijuana for either medical or recreational purposes. Due to the passing of new controversial marijuana legislation at the state levels of government, which started with the passing of Amendments 64 and Initiative 502, respectively, in Colorado and Washington in 2012, the federal government is faced with many challenges associated with enforcing and preventing the illegal diversion of marijuana and marijuana products. Although state legislation may be passed to legalize marijuana for particular jurisdictions, under the Controlled Substances Act (CSA), distribution and possession of marijuana is still illegal on a federal level, and marijuana is classified as a Schedule I controlled substance. Contr...

Prescription drug monitoring programs are statewide databases available to clinicians to track prescriptions of controlled medications. These programs may provide valuable information to assess the history and use of controlled substances and contribute to clinical decisionmaking in the emergency department (ED). The widespread availability of the programs raises important ethical issues about beneficence, nonmaleficence, respect for persons, justice, confidentiality, veracity, and physician autonomy. In this article, we review the ethical issues surrounding prescription drug monitoring programs and how those issues might be addressed to ensure the proper application of this tool in the ED. Clinical decisionmaking in regard to the appropriate use of opioids and other controlled substances is complex and should take into account all relevant clinical factors, including age, sex, clinical condition, medical history, medication history and potential drug-drug interactions, history of a...

BackgroundTrends of opioid prescribing in the NHS has been well published, yet trends for the same in private prescribing have not been widely established.AimTo assess trends and geographical variation of controlled opioids prescribed by private prescribers in England.Design and settingA retrospective observational study in English primary healthcare.MethodsData on Schedule 2 and 3 controlled opioids (“controlled opioids”) was obtained from the NHS Business Services Authority (BSA) using freedom of information (FOI) requests between 01 January 2014 and 30 November 2021. Absolute counts and rates of the number of items dispensed per cumulative number of registered private prescribers were calculated and stratified over time, by opioid type, and geographical region.Results128,341 items controlled opioids were prescribed by private prescribers in England between January 2014 and November 2021, which decreased by 50% from 23,339 items (4.09 items/prescriber) in 2014 to 11,573 items (1.4...

Hospitals, clinics, and organizations using controlled substances must have policies and procedures in place for disposing of these substances and to avoid potential drug diversion as well as environmental pollution. Challenging, particularly to hospitals, is the ability to dispose of the waste of any number of hundreds of products every day, some of which require specific handling and protocols for safety. Incineration might be appropriate but many hospitals and certainly smaller clinics lack the appropriate facilities. Clinics and facilities that use controlled substances must maintain adequate and detailed records, but individual healthcare systems impose their own specific requirements. Some, for example, require drug disposal to be witnessed. However, recordkeeping systems must be robust and frequently audited to prevent diversion. Most healthcare systems want to dispose of controlled substances in an environmentally responsible way but in addition to federal laws in the United States, most states have their own environmental agencies and may have local regulations. Navigating this system can be complex, and since all regulations are subject to change, it requires vigilance and expertise.

Introduction Over the last 20-years there has been increasing opioid related deaths, in the context of a worldwide epidemic of misuse including addiction and overdose. Startlingly, opioid commencement is usually iatrogenic. Most published data is from the USA with little evidence from UK surgical practice. Methods Retrospective analysis of surgical unit opioid prescriptions. Data included opioids prescribed on discharge, 1, 3- and 6-months post-discharge usage and milligrams-of-morphine equivalence(mgEq) used to compare regimes. Results One hundred cases reviewed. 35% of patients were opioid naïve on admission and of these 20%, 5.71% and 8.57% remained on opioids at 1, 3- and 6-months post discharge respectively. Females more likely to remain on long-term opioids at 6 months at lower doses (42% v 30%). Only 6% of discharge summaries recommended GP follow-up and assessment of opioid requirements. Furthermore, none were prescribed a tapering dosage regime on-discharge. Patients receiv...

Define opioid abuse and addiction. • Explain how opioid abuse presents in the healthcare setting. • Identify patient factors that increase the risk for development of opioid use disorder. • Demonstrate effective teaching techniques for patients using or requiring opioids for pain control. • Design a pain management strategy for a patient that minimizes risk of opioid misuse and addresses the need to control pain.

ABSTRACTIntroductionThe Diversion Alert Program (DAP) was established to curb the misuse of drugs and help identify people in need of substance use disorder (SUD) treatment. Law enforcement compiled arrest data into a database accessible by health care providers. The objectives of this investigation were to identify regional and demographic differences in drug use and misuse in Maine.MethodsAll arrests (N = 11,234) reported to the DAP from 2013 to 2018 were examined by county, arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution of controlled pharmaceuticals (schedule I-V). Opioids were converted to oral morphine mg equivalents (MME). County and zip-code heat maps were constructed.ResultsThe counties with the most arrests per capita were Cumberland, Androscoggin, and Penobscot. Opioids were the most common drug class in arrests in all counties except Aroostook, w...

Background: The supply of controlled drugs is limited in the Far East, despite the prevalence of health disorders that warrant their prescription. Reasons for this include strict regulatory frameworks, limited financial resources, lack of appropriate training amongst the medical profession and fear of addiction in both general practitioners and the wider population. Consequently, the weak opioid tramadol has become the analgesic most frequently used in the region to treat moderate to severe pain. Methods: To obtain a clearer picture of the current role and clinical use of tramadol in Southeast Asia, pain specialists from 7 countries in the region were invited to participate in a survey, using a questionnaire to gather information about their individual use and experience of this analgesic. Results: Fifteen completed questionnaires were returned and the responses analyzed. Tramadol is used to manage acute and chronic pain caused by a wide range of conditions. Almost all the specialists treat moderate cancer pain with tramadol, and every one considers it to be significant or highly significant in the treatment of moderate to severe non-cancer pain. The reasons for choosing tramadol include efficacy, safety and tolerability, ready availability, reasonable cost, multiple formulations and patient compliance. Its safety profile makes tramadol particularly appropriate for use in elderly patients, outpatients, and for long-term treatment. The respondents strongly agreed that tighter regulation of tramadol would reduce its medical availability and adversely affect the quality of pain management. In some countries, there would no longer be any appropriate medication for cancer pain or the long-term treatment of chronic pain. Conclusions: In Southeast Asia, tramadol plays an important part in the pharmacological management of moderate to severe pain, and may be the only available treatment option. If it were to become a controlled substance, the standard of pain management in the region would decline.

Education Report (SAPER) specifically with recommendations on core curricular content and delivery processes on substance misuse and substance use disorder (SUD). This report provides information on the committee's process to address the charges, background information and resources pertaining to the charges, and rationale for SUD being a critical topic for curriculum at colleges and schools of pharmacy. This committee offers several recommendations to the Association of Colleges of Pharmacy (AACP) pertaining to the committee charges.

This article aims to explore the statistics observed in the Pacific Northwest regarding substance abuse, as Oregon and Washington have been shown to be most affected given the increased treatment admissions for opioid utilization and mortality related to medication overdose. Using PubMed and National Conference of State Legislatures database, articles detailing prescription drug abuse statistics, programs, and laws were collected and analyzed in order to identify possible solutions. Many studies report that pain medication prescriptions have seen a rise in recent years, however, there still exists an inadequacy in pain management. This increase in prescriptions may also contribute to the rising number in substance misuse and subsequently overdose deaths. Pharmacists can have a global effect on abuse prevention if certain monitoring strategies are implemented and enforced. Health-care providers and pharmacists should contribute to abuse prevention by helping to detect fraudulent pres...

Background: Opioid switching to methadone is reported frequently to improve pain control in patients with an unacceptable balance between pain control and side effects during treatment with first line opioids, but carries a risk of drug accumulation and respiratory depression. To justify this risk it is required that less risky treatments are tried beforehand and that a sufficiently large proportion of patients experience a long-lasting improvement in pain control. Research questions: How large was the proportion of patients remaining on long term methadone treatment after a switch from a strong opioid to methadone? How long had the patients been treated with opioids before the switch to methadone? Methods: Longitudinal pharmacoepidemiological study from the complete national Norwegian Prescription Database. Results: One hundred and thirty (77%) cancer patients received more than one dispensed prescription of methadone. Forty-nine (40%) chronic non-malignant pain (CNMP) patients con...

This article aims to explore the statistics observed in the Pacific Northwest regarding substance abuse, as Oregon and Washington have been shown to be most affected given the increased treatment admissions for opioid utilization and mortality related to medication overdose. Using PubMed and National Conference of State Legislatures database, articles detailing prescription drug abuse statistics, programs, and laws were collected and analyzed in order to identify possible solutions. Many studies report that pain medication prescriptions have seen a rise in recent years, however, there still exists an inadequacy in pain management. This increase in prescriptions may also contribute to the rising number in substance misuse and subsequently overdose deaths. Pharmacists can have a global effect on abuse prevention if certain monitoring strategies are implemented and enforced. Health-care providers and pharmacists should contribute to abuse prevention by helping to detect fraudulent pres...

As a party to the three major treaties on drugs, Nigeria is obliged to control the manufacture, use, distribution and possession of drugs. Drug control efforts in Nigeria rely heavily on interdiction, arrest and the criminal justice system. Adjudicatory control is one of the main mechanisms utilized in the criminal justice approach to drug control. Adjudicatory control is administered by the judiciary at the federal level, with the Federal High Court of Nigeria as the first and primary forum for dealing with drug cases. The Court controls drugs by establishing whether substances are considered to be narcotic or psychotropic under existing laws. Furthermore, it processes alleged offenders through a schematized mechanism of arraignment, trial, verdict and sentencing. In this context, the present article reviews 2,506 court cases to analyse the function of the Court as an institution of drug control. The analysis shows, among other things, that there is a wide disparity in the length of adjudicatory processes and sentences imposed for similar offences. Moreover, the possession and use of otherwise licit painkillers are being prosecuted under provisions enacted to control narcotic and psychotropic substances. This raises uncertainties in drug control efforts in particular, as the drugs that are expressly prohibited are not classified at all, not even according to their degree of harm to society. The result is a wide latitude of discretion afforded to executive and judicial officers in dealing with drug cases. Judicially, such latitude results in a disproportionate focus on possession of small quantities of narcotics, in contrast to larger quantities.