Improving Estimates of the Prevalence of Opioid Use Disorder in the United States: Revising Keyes et al.

Objectives: The United States faces an ongoing drug overdose crisis, but accurate information on the prevalence of opioid use disorder (OUD) remains limited. A recent analysis by Keyes et al used a multiplier approach with drug poisoning mortality data to estimate OUD prevalence. Although insightful, this approach made stringent and partly inconsistent assumptions in interpreting mortality data, particularly synthetic opioid (SO)-involved and non-opioid-involved mortality.

Changes in self-reported cannabis use in the United States from 1979 to 2022.

Background And Aims: Multiple countries are considering revising cannabis policies. This study aimed to measure long-term trends in cannabis use in the United States and compare them with alcohol use.

Design And Setting: Secondary analysis of United States general population survey data.

The Baltic and Nordic responses to the first Taliban poppy ban: Implications for Europe & synthetic opioids today.

The 2000-2001 and the 2022-2023 Taliban opium bans were and could be two of the largest ever disruptions to a major illegal drug market. To help understand potential implications of the current ban for Europe, this paper analyzes how opioid markets in seven Baltic and Nordic countries responded to the earlier ban, using literature review, key informant interviews, and secondary data analysis. The seven nations' markets responded in diverse ways, including rebounding with the same drug (heroin in Norway), substitution to a more potent opioid (fentanyl replacing heroin in Estonia), and substitution to one with lower risk of overdose (buprenorphine replacing heroin in Finland).

Modeling cartel size to inform violence reduction in Mexico.

Estimating stocks and flows is an innovative first step.

America's Opioid Ecosystem: How Leveraging System Interactions Can Help Curb Addiction, Overdose, and Other Harms.

Opioids play an outsized role in America's drug problems, but they also play a critically important role in medicine. Thus, they deserve special attention. Illegally manufactured opioids (such as fentanyl) are involved in a majority of U.

Changing dynamics of drug overdoses in the United Kingdom: An attempt to replicate the Jalal et al. findings of steady exponential growth.

Background: Jalal et al. discovered that between 1979 and 2020 total rates and counts of fatal drug overdoses in the United States exhibited exponential growth at a very steady rate even though deaths from individual drugs did not. That is a startling result because it means that the different drugs are in effect "taking turns", with one growing faster just as another drug's death rate growth ebbs.

When prohibition works: Comparing fireworks and cannabis regulations, markets, and harms.

Background: Nations wrestle with whether to prohibit products that can harm consumers and third parties but whose prohibition creates illegal markets. For example, cannabis is banned in most of the world, but supply for non-medical use has been legalized in Uruguay, Canada, and much of the United States and possession restrictions have been liberalized in other countries. Likewise, supply and possession of fireworks have been subject to varying degrees of prohibition in multiple countries, with those bans prompting significant evasion.

How much illegally manufactured fentanyl could the U.S. be consuming?

The spread of illegally manufactured opioids, including fentanyl, has brought unprecedented levels of drug overdose deaths in North America. In some markets, illegally manufactured fentanyl (IMF) is essentially displacing heroin, not just being used to adulterate it. It is not possible at this time to provide an accurate point estimate of the amount of IMF consumed in the United States.

Rating the comparative efficacy of state-level cannabis policies on recreational cannabis markets in the United States.

Background: Cannabis policy is developing faster than empirical evidence about policy effects. With a panel of experts in substance use policy development and research, we identified key cannabis policies and their provisions enacted by U.S.

Rapid changes in illegally manufactured fentanyl products and prices in the United States.

Background And Aims: Synthetic opioids, mostly illegally manufactured fentanyl (IMF), were mentioned in 60% of United States (US) drug overdose deaths in 2020, with dramatic variation across states that mirrors variation in IMF supply. However, little is known about IMF markets in the United States and how they are changing. Researchers have previously used data from undercover cocaine, heroin, and methamphetamine purchases and seizures to examine how their use and related harms respond to changes in price and availability.

How much demand for money laundering services does drug selling create? Identifying the key parameters.

Background: The illegal drug trade is often, and plausibly, asserted to be the largest illegal market, globally and in many individual countries. It is also claimed that a large share of its revenues is laundered, though there are no estimates of that volume. We provide rough estimates of that proportion and its primary determinants.

The International Cannabis Toolkit (iCannToolkit): a multidisciplinary expert consensus on minimum standards for measuring cannabis use.

Background: The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use.

Methods: A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings.

Results: The expert-based consensus agreed upon a three-layered hierarchical framework.

Community perspectives on supervised consumption sites: Insights from four U.S. counties deeply affected by opioids.

Background: To address the overdose crisis in the United States, expert groups have been nearly unanimous in calls for increasing access to evidence-based treatment and overdose reversal drugs. In some places there have also been calls for implementing supervised consumption sites (SCSs). Some cities-primarily in coastal urban areas-have explored the feasibility and acceptability of introducing them.

Heroin use cannot be measured adequately with a general population survey.

Background: Globally, heroin and other opioids account for more than half of deaths and years-of-life-lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations.

Radical technological breakthroughs in drugs and drug markets: The cases of cannabis and fentanyl.

Background: Cannabis legalization and the arrival of nonmedical fentanyl are fundamentally altering North American drug markets. An essential part of that change is the ability to produce large quantities of these drugs at low costs, which is like a technological breakthrough in their production technology. This essay explores possible future consequences of these trends.

The optimal lockdown intensity for COVID-19.

One of the principal ways nations are responding to the COVID-19 pandemic is by locking down portions of their economies to reduce infectious spread. This is expensive in terms of lost jobs, lost economic productivity, and lost freedoms. So it is of interest to ask: What is the optimal intensity with which to lockdown, and how should that intensity vary dynamically over the course of an epidemic? This paper explores such questions with an optimal control model that recognizes the particular risks when infection rates surge beyond the healthcare system's capacity to deliver appropriate care.

Outcomes associated with scheduling or up-scheduling controlled substances.

Background: Many nations place drugs into various "schedules" according to their risk of abuse and/or recognized medical value that vary in terms of their restrictions. To mitigate diversion or abuse, drugs sometimes get rescheduled or are scheduled for the first time. Until now, there have not been efforts to integrate lessons from across the range of such past events.

How long should the COVID-19 lockdown continue?

Nations struggled to decide when and how to end COVID-19 inspired lockdowns, with sharply divergent views between those arguing for a resumption of economic activity and those arguing for continuing the lockdown in some form. We examine the choice between continuing or ending a full lockdown within a simple optimal control model that encompasses both health and economic outcomes, and pays particular attention to when need for care exceeds hospital capacity. The model shows that very different strategies can perform similarly well and even both be optimal for the same relative valuation on work and life because of the presence of a so-called Skiba threshold.