A versatile tool to unravel the uptake diversity of a front-line anticancer drug, cisplatin, within a cancer cell population is proposed herein based on single-cell inductively coupled plasma mass spectrometry. The interested researcher is provided with a tutorial to help adapt such cutting-edge methodology and know-how to reliable data processing.

Site-specific assessment of illicit drug consumption patterns in South Korea via wastewater-based epidemiology.

Supply-side opioid restrictions and the retail pharmacy market.

First Year Student Pharmacist Approaches to Resolving Community Pharmacy Drug Diversion in Skills Lab Simulations

Abstract Background Antimicrobials and anthelmintics are among the most used veterinary drugs for the treatment and prevention of animal diseases. However, information on antimicrobial usage in food animals remains limited in communities of southern Ethiopia. Therefore, this study aimed to assess the handling and management practices, sources, and usage of veterinary drugs among food animal producers and veterinary practitioners in the Wolaita Zone. Methods A cross-sectional, questionnaire-based survey was conducted between May and August 2021. A pre-tested questionnaire, comprising three sections and a total of 50 questions, was used to collect data from purposively selected 101 veterinary professionals and 149 animal owners. Results This preliminary survey revealed that the distribution of antimicrobials and anthelmintic drugs is inadequate, with limited sources and a wide range of trade names, primarily imported from a few manufacturing countries. Among the veterinary drugs available in the district, those manufactured in and imported from China were the most widely distributed in veterinary drug stores. The study also identified inappropriate transportation and storage conditions. Furthermore, critical and unethical practices were observed, including the sale of drugs without a prescription, failure to advise animal owners on drug withdrawal periods, and the administration of veterinary drugs by non-professionals. Antimicrobials (60.86%) and anthelmintics (39.14%) were the most commonly available and frequently used drugs for the treatment of musculoskeletal, integumentary, digestive, respiratory, reproductive, and systemic diseases. Conclusion This study revealed the presence of inappropriate handling and management practices, a limited diversity of veterinary drugs, and insufficient attention by the veterinary profession to proper drug handling in the study area, all of which may compromise drug quality, safety, and effectiveness. Therefore, continuous awareness programs for food animal producers, capacity building and training for veterinary professionals, routine drug quality assessments, and the strict regulation and enforcement of drug control and administration are strongly recommended.

Cervical cancer is one of the common gynecological malignancies that threaten women's health. Its etiology is complex, among which persistent human papillomavirus (HPV) infection is the main pathogenic factor. Due to the lack of obvious early symptoms, many patients are already in the middle and late stages when diagnosed. Although conventional chemotherapy can alleviate the disease, some patients will still experience recurrence or metastasis, indicating that the existing treatment methods are still limited. In recent years, immunotherapy technology has been continuously improved, especially the application of immune checkpoint inhibitors (ICIs) has provided a new direction for the treatment of cervical cancer. This article systematically reviews the common treatment methods and emerging immunosuppressive treatment strategies for cervical cancer, including chemotherapy, radiotherapy, anti-angiogenic therapy and bispecific immunoconjugates, and discusses their basic principles, mechanisms of action and drug side effects. Although some immunotherapy regimens have shown certain efficacy in clinical practice, existing studies are still insufficient in terms of drug diversity and mechanism interpretation. In the future, more new immunosuppressive drugs and treatment methods need to be further developed to improve the prognosis and survival rate of patients with cervical cancer.

Background The harm reduction effects of police drug diversion (PDD) are influenced by how people engage with diversion, which is moderated by their motivation to change. Underlying influences can be revealed by examining the contexts and mechanisms which trigger and support participants’ motivation for engagement and change. Methods The qualitative phase of a realist evaluation of three PDD programs in England used semi-structured interviews with police officers, diversion practitioners, and divertees. Collaborative, abductive analysis focused on contexts and mechanisms of motivation and the nature of engagement. Results Contexts featuring positive interactions were moderated by negative perceptions of intervention environments, course content and delivery, and feelings of dissatisfaction with drug policy and legislation. Short PDD programs without individually tailored support worked well in triggering consequential thinking to motivate some people involved in experimental and/or occasional drug use. More intensive, longer and individualized forms seemed to be more effective in supporting and building motivation among people with more complex needs. Neither form of PDD succeeded in motivating people who believed their substance use was beneficial, unproblematic, or who disagreed with current drug laws. Conclusion Findings suggest that PDD programs require careful tailoring to the diverse needs of people who are diverted.

Survival of first line biological and targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis in Chile.

The 340B Drug Pricing Program, established in 1992, was designed to help safety-net healthcare providers stretch scarce resources by allowing them to purchase outpatient medications at significant discounts. However, the program's dramatic expansion, particularly following the Affordable Care Act, and the rise of contract pharmacy arrangements have led to increasing scrutiny regarding its current function and impact. This study examines the flow of funds within the modern 340B ecosystem, with a particular focus on contract pharmacies, pharmacy benefit managers (PBMs), third-party administrators (TPAs), and vertically integrated health systems. Using a detailed mapping of financial transactions, the analysis identifies key areas where profit incentives diverge from the program's original intent. Covered entities (CEs) often generate substantial profits by purchasing drugs at 340B-discounted rates and receiving standard reimbursements from public and private payers, including Medicare and commercial insurers. These profits are not required to be reinvested in care for underserved populations. Additionally, the use of contract pharmacies and TPAs has introduced significant complexity, increasing the risks of drug diversion and duplicate discounts, particularly with Medicaid and Medicare rebate programs. Vertically integrated PBM pharmacy chains dominate the landscape, often capturing outsized revenue. Legal and regulatory ambiguities further complicate oversight and enforcement. This paper provides an overview of the current 340B funds flow through contract pharmacies, highlighting areas of misalignment with the program's mission. In doing so, it informs ongoing legislative and administrative reform efforts, emphasizing the need to re-center the program around its intended beneficiaries, low-income and vulnerable patients.

Diabetes is a common endocrine disorder increasingly encountered in patients requiring treatment with psychoactive drugs. The pharmacotherapy options for diabetes have expanded in recent years and now include 14 oral hypoglycemic drugs from five pharmacologic classes, as well as insulin. The diversity of drugs raises the need for clinicians to be aware of potential drug interactions. Fortunately, few drug interactions of major clinical significance involving psychoactive drugs with oral hypoglycemics have been described in the medical literature. The newer drugs for treatment of type 2 diabetes are discussed, and considerations are given for avoiding or minimizing drug interactions when prescribing psychoactive drugs to patients with diabetes. Psychopharmacology Bulletin. 2002;36(2):40-52

Opioid-Induced Hyperalgesia and Inflammaging in the Management of Spine Pain: The Case for Genetically Directed Dopamine Homeostasis.

ABSTRACT This article advances knowledge about the initiation of police innovation in the context of drugs policing. Drawing on the findings of a qualitative research project, it provides an original account of the emergence of police drug diversion schemes in England and Wales by analysing the complex interactions between individual, organisational and environmental determinants. The concept of institutional entrepreneurship is applied to examine the role of diversion entrepreneurs in the innovation process. These are the key police actors behind local schemes who had an interest in changing the institutional status quo. Diversion entrepreneurs wove together various forms of knowledge to frame problems and persuade stakeholders that diversion would address policing priorities and reduce demand by reducing reoffending and the resources needed to deal with people caught committing minor drug-related offences. Police budget cuts had created fertile ground for diversion as police organisations were leaning towards more proactive styles of policing which focus on prevention by addressing the underlying causes of crime. Making the case for diversion also required diversion entrepreneurs to highlight the shortcomings of existing practices and present diversion as a viable alternative to traditional enforcement interventions that seek to tackle drug problems through criminal sanctions. This involved interpretive struggles over the police role and managing perceptions of risk. It is argued that police scholars should pay closer attention to institutional entrepreneurship within police organisations to enhance understanding of processes of innovation and cultural change.

The criminalisation of drug use and stigma create barriers to healthcare and harm reduction, limiting access due to fear of legal consequences and mistrust of health services. Queensland’s Drug Diversion Program (DDP) aims to address these issues by redirecting people into support services. This study explored the lived-living experiences of people who use drugs, assessing their perceptions of the DDP through semi-structured interviews with 30 participants (Mean age = 28, SD = 4.6; 25 men, 5 women). Key themes included: societal and familial challenges before program entry, positive reception of diversion, mixed experiences with health services, and post-program outcomes emphasising accessibility and personalisation. Findings highlight that stigma, criminalisation, and service gaps shape how participants access care. While the DDP builds trust and offers critical support, limitations in awareness and cultural responsiveness remain. Enhancing program flexibility and visibility, alongside broader reform, is key to improving outcomes.

Abstract This article explores how discretion is managed and exercised across senior, middle, and street levels of policing. It uses qualitative data from two studies in England. The first, a study across three police force areas, involved interviews and focus groups with 221 people who were designers, deliverers, and recipients of police-led drug diversion. The second study used 354 hours of ethnographic observation and 21 interviews to examine stop-and-search practices in one other police force. Rather than a simply expanding scope of discretion at lower levels of the hierarchy, the findings reveal a multi-level process of cascading constraints and subsidiary discretion. At each level, we observe the exercise of occupational professionalism and autonomous judgement, but higher-level constraints shape how discretion is applied in pursuit of organizational professionalism.

Prior research suggests that men and women have different needs and experiences in drug courts. Some studies find sex differences in outcomes, but others do not. Using administrative data from a Florida drug court, we examined the equality of coefficients of predictors of intermediate outcomes for men and women. Importantly, the impact of incentives on graduation was stronger for women (in the positive direction) and the direction of the effect of program length was in opposite directions for men and women. It was positive for men but negative for women. Other z-tests indicated that coefficients were not significantly different between men and women. As results indicate that this drug court operates similarly for both sexes, we conclude that this program is following Best Practices related to equity and that drug courts are a viable community-based treatment program for both men and women with substance use disorders in the legal system.

First professional year student Pharmacists' approaches to resolving drug diversion incidents in a community pharmacy simulation.

Automated dispensing cabinet (ADC) medication overrides can contribute to increased risks of drug diversion, medication errors, and waste. To reduce ADC overrides, a multidisciplinary process improvement initiative was conducted over 3 years to identify, evaluate, and monitor medication overrides, with an initial goal of quarterly 5% reductions in the override rate. Lean Six Sigma process improvement methodology identified the root causes of inappropriate medication overrides. Through a series of interventions, both targeted and institution wide, the process improvement initiative addressed technological, process, and cultural root causes. The only clinical units excluded in this project were intraoperative areas. Targeted interventions included automated pharmacy dispensing of high-use as-needed medications and correction of interface errors between the ADC and electronic health record. System-wide interventions included updating ADC override reasons to align with policy, implementation of an approved medication override list, education, data transparency, and linking ADC override pulls to the medication administration record. The rate of overrides decreased from 6.18% at baseline to 4.41% during the initial phase of targeted interventions (29% reduction from baseline; P < 0.001), with continued improvements following organization-wide interventions to achieve an override rate of 2.13% by the control phase (65% reduction from baseline; P < 0.001). No preventable adverse drug events related to initiative changes were reported during the study period. Through utilization of Lean Six Sigma methodology and involvement of a multidisciplinary process improvement team, the initiative achieved a significant and sustained reduction in the rate of medication overrides.

Nurses enrolled in certified registered nurse anesthetist programs are taught to be experts in complex pharmaceutical agents, often under high stakes conditions. Such conditions may create maladaptive coping mechanisms, such as substance use. However, exploration of student registered nurse anesthetists' (SRNAs) perceptions of substance use and drug diversion have only been minimally described in the literature. The study aims were to (a) investigate SRNAs' ratings of the American Association of Nurse Anesthesiology's (AANA) recommended strategies to reduce drug diversion and (b) analyze qualitative responses to open-ended items related to the use of substances. Approximately 400 students responded to an online survey in March 2021. The survey was randomly sent to 3,000 SNRAs who were members of the AANA (return rate of 13%). Descriptive statistics and paired t-tests were calculated to determine differences between strategies viewed as effective and strategies that have been implemented. A descriptive content analysis was conducted to derive themes from four open-ended questions. For all 11 AANA strategies, the means for effectiveness were significantly higher than means for strategies that were implemented, indicating that strategies were seen as effective, but were not being implemented. The highest scored perceived effectiveness strategy was "Creating a safe environment for prompt reporting." Themes captured a high-pressured, high-stakes educational environment, characterized by rigidity and incivility. Policies to support a safe environment to encourage students to self-report substance use, an awareness of alternative-to-discipline programs, and reintegration into educational programs should be formulated and implemented by educational institutions.

Background It is increasingly suggested that clinical guidelines and practices be updated to permanently expand relaxation around access to opioid agonist treatment (OAT) take-home doses after COVID-19. Despite a risk of OAT drug diversion, flexibility in take-home doses is valued by patients and associated with improved quality of life and retention. However, few studies have examined the effects of changes to take-home dose policies on prescribing practices and patient outcomes, with mixed results. Aims This protocol relates to three inter-related studies. The first study will examine the impact of guidance issued on March 13th 2020 to all clinicians involved in the delivery of OAT to give the maximum number of take-home doses having given due consideration to the safety of the patient, on prescribing practices for take-home doses of methadone and buprenorphine in primary care. The second study will examine the association between increased take-home doses of OAT following March 13th 2020 guidance and treatment discontinuation in primary care. The third study will examine methadone-related deaths in Ireland before and after the guidance issue, and whether methadone-related deaths varied by whether the deceased was on OAT treatment at the time of death. Methods Retrospective observational studies will be carried out. The first study will use a time series design to examine changes in prescribing practices of take-home doses. The second study will use a retrospective cohort study design with proportional hazard Cox models to evaluate the association between increased take-home doses and treatment discontinuation. The third study will use a repeated cross-sectional study design with interrupted time series analysis, stratified by OAT treatment status, to assess changes in methadone-related deaths. Discussion It is anticipated that the studies will generate evidence with potential to inform both clinical and policy decision making with respect to take-home dosing of OAT.

The impact of a voluntary alcohol and other drug diversion program on reoffending, imprisonment, and health.