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In the year after the elimination of a waiver requirement to prescribe buprenorphine, the number of prescribers increased above the anticipated value, but the number of persons who received the drug did not.

The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.

This paper reviews evidence of how drug control has been used to uphold colonial power structures in select countries. It demonstrates the racist and xenophobic impact of drug control policy and proposes a path to move beyond oppressive systems and structures. The ‘colonization of drug control’ refers to the use of drug control by states in Europe and America to advance and sustain the systematic exploitation of people, land and resources and the racialized hierarchies, which were established under colonial control and continue to dominate today. Globally, Black, Brown and Indigenous peoples are disproportionately targeted for drug law enforcement and face discrimination across the criminal system. These communities face higher arrest, prosecution and incarceration rates for drug offenses than other communities, such as majority populations, despite similar rates of drug use and selling among (and between) different races. Current drug policies have contributed to an increase in drug-related deaths, overdoses and sustained transnational criminal enterprises at the expense of the lives of people who use drugs, their families and greater society. This review provides further evidence of the need to reform the current system. It outlines a three-pillared approach to rebuilding drug policy in a way that supports health, dignity and human rights, consisting of: (1) the decriminalization of drugs and their use; (2) an end to the mass incarceration of people who use drugs; (3) the redirection of funding away from ineffective and punitive drug control and toward health and social programs.

In this analysis of Medicare data and a data set of state laws, adoption of legislation to restrict the prescribing and dispensing of opioid medications was not associated with reductions in potentially hazardous use of opioids among disabled Medicare beneficiaries. States have responded to rising rates of prescription-opioid overdose by adopting laws that restrict the prescribing and dispensing of controlled substances. In 2010, after the adoption of many new controlled-substance restrictions, rates of prescription-opioid overdose dipped slightly before reaching a historic high in 2014. 1 – 3 The relationship between legal restrictions and prescription-opioid use remains unclear, because previous research evaluated one or two laws, short time periods, or few states. 4 – 6 Comprehensive national analyses of controlled-substance restrictions and prescription-opioid use do not yet exist. Successful regulation of prescription opioids involves a difficult balance. Well-designed laws may reduce misuse and overdose. However, . . .

Globally, punitive drug control upholds racist and colonial structures. Marginalised and racialised communities, including Indigenous peoples, are disproportionately targeted and affected by punitive drug policy in law enforcement, judicial and carceral systems, and policy implementation. Power imbalances also exist at the international level, with high income countries exerting influence over drug policy in low- and middle-income countries. This paper examines that influence through financial and material aid, technical assistance, capacity building, education and awareness campaigns and the interaction between the vested interests of the private sector and the State, specifically via the Prison Industrial Complex and land and resource grabbing in conflict and post-conflict contexts. The global war on drugs entrenches power imbalances and reproduces mechanisms of racial control and subordination. To begin to decolonise drug policy, the financial and material basis of these mechanisms must be illuminated and dismantled and this paper offers recommendations on how to move forward (Dangerous Drugs Ordinance, 1923; Carrier et al., 2020).

Under the law of asset forfeiture, a person loses ownership of money and property that were used in or constitute the proceeds of a crime. Asset forfeiture is a significant financial consequence for people who have (in some cases, tenuous) contact with the criminal system. Asset forfeiture also is a crucial way that federal, state, and local governments generate revenue from criminal investigation and prosecution. In the federal system, the government's acquisition of forfeited assets (such as cash, electronics, cars, and homes) brings in around $2 billion in annual revenue. Every year, the federal government transfers hundreds of millions of these dollars to state and local law enforcement agencies, making asset forfeiture a lucrative federal-state enterprise. This article makes three contributions. First, it provides the first scholarly examination of how the federal government has engaged in asset forfeiture by using comprehensive data of the Department of Justice's roughly 1.2 million federal asset forfeitures between 1998 and 2019 matched to county-level population data over that period. Second, this empirical analysis reveals inequality in the government's use of asset forfeiture. Specifically, the government more actively engages in revenue-generating forfeitures in districts with larger Black and Hispanic populations. This disparity is partly driven by the government's extensive use of forfeiture in the districts that border Mexico - a phenomenon the literature has not yet recognized. The same disparity is not present in forfeitures that do not generate revenue. Forfeiture thus resembles a practice by which governments derive revenue from fines and fees in ways that unfairly burdens poor communities of color. Finally, I argue that by lacking the empirical scrutiny this article provides, much scholarly and public debate about asset forfeiture misunderstands both the harms and benefits of asset forfeiture by overlooking asset forfeiture's potential to make communities safer while important individual and distributive harms. This article concludes by considering avenues for reform.

Virtually every U.S. state has implemented a PDMP to address high-risk opioid-prescribing and opioid-seeking behaviors. Many stakeholders, however, have expressed doubts about their utility and concerns regarding their potential unintended consequences.

Objective. In the United States, per-capita opioid dispensing has increased concurrently with analgesic-related mortality and morbidity since the 1990s. To deter diversion and abuse of controlled substances, most states have implemented electronic prescription drug monitoring programs (PDMPs). We evaluated the impact of state PDMPs on opioid dispensing. Methods. We acquired data on opioids dispensed in a given quarter of the year for each state and the District of Columbia from 1999 to 2008 from the Automation of Reports and Consolidated Orders System and converted them to morphine milligram equivalents (MMEs). We used multivariable linear regression modeling with generalized estimating equations to assess the effect of state PDMPs on per-capita dispensing of MMEs. Results. The annual MMEs dispensed per capita increased progressively until 2007 before stabilizing. Adjusting for temporal trends and demographic characteristics, implementation of state PDMPs was associated with a 3% decrease in MMEs dispensed per capita (p= 0.68). The impact of PDMPs on MMEs dispensed per capita varied markedly by state, from a 66% decrease in Colorado to a 61% increase in Connecticut. Conclusions. Implementation of state PDMPs up to 2008 did not show a significant impact on per-capita opioids dispensed. To control the diversion and abuse of prescription drugs, state PDMPs may need to improve their usability, implement requirements for committee oversight of the PDMP, and increase data sharing with neighboring states.

According to the World Health Organization (WHO) [1], NMRAs contribute to promoting and protecting public health and safety by ensuring that. * medicines are of the required quality, safety, and efficacy; * health professionals and patients have the necessary information to enable them to use medicines rationally; * medicines are appropriately manufactured, stored, distributed, and dispensed; * illegal manufacturing and trade are detected and adequately sanctioned; * promotion and advertising are fair, balanced, and aimed at rational drug use; and * access to medicines is not hindered by unjustified regulatory work. Afterward, the medicines were registered by Kenya and Uganda (although the medicines were eligible for registration in all EAC countries, the manufacturer decided to register them in only 3). Because of this new regional approach to product assessment, these medicines were available in EAC countries sooner than they would have been otherwise. [...]the EAC MRH initiative was expected to identify a funding mechanism that would allow it to sustain and broaden its regulatory activities after the catalytic donor support available for the first 5 years expired. The initiative’s Medicines Evaluation & Registration Working Group, led by Tanzania’s NMRA, created this CTD as part of the program’s larger mandate of harmonizing technical requirements, standards, and standard operating procedures (SOPs) for medicines assessment and registration across the region [8]. Because the EAC’s CTD is based on the formats used by ICH and the WHO’s Prequalification Programme, EAC Partner States can easily leverage dossiers previously submitted to other regulatory authorities, such as the WHO, US Food and Drug Administration, or European Medicines Agency.