Drug Enforcement Research Articles

Quality of Life and Resilience as Predictors of Mental Health among Police Officers

This study investigates the predictors of mental health among Philippine police officers, concentrating on the roles of quality of life and resilience. Alarming instances involving police officers drive the research, emphasizing the importance of professional stress on their mental health and conduct. The study used a descriptive-correlational methodology and polled 300 police officers from the Drug Enforcement Unit in Camarines Sur, Bicol, Philippines, to assess their quality of life, resilience, and mental health. The findings show that quality of life and resilience are strong indicators of mental health in police personnel. Quality of life includes physical, psychological, social, and environmental aspects, whereas resilience refers to the ability to deal with stress and adapt to difficult situations. The study suggests that strengthening these elements can lead to better mental health outcomes, improving general well-being and lowering occurrences of misconduct. This study emphasizes the importance of comprehensive mental health programs within the Philippine National Police that focus on building resilience and increasing officers’ quality of life. By addressing these issues, law enforcement agencies may create a healthier work environment and improve the mental health and well-being of their officers.

The Psychiatrist's Role in Treating Perinatal Opioid Use Disorder and Reducing Maternal Mortality.

Drug overdose is a leading cause of maternal mortality. Psychiatrists can play a critical role in reducing these deaths by delivering effective evidence-based treatments for perinatal opioid use disorder (POUD), including the use of buprenorphine. Medications for POUD (i.e., buprenorphine, methadone) are life-saving treatments, but only half of those who are diagnosed as having POUD will receive this treatment, which can result in an increased risk for return to opioid use, overdose, and death. Psychiatrists are well positioned to prescribe buprenorphine given the Drug Enforcement Administration's (DEA) removal of the requirement to submit a Notice of Intent to prescribe buprenorphine for the treatment of opioid use disorders. Psychiatrists who have a current DEA registration that includes Schedule III authority may now prescribe buprenorphine for opioid use disorders; the training requirements to do so are outlined herein. This article reviews the standard of care for screening, diagnosis, and treatment of POUD, and prescribing buprenorphine for POUD, as well as shared decision-making for medication selection, induction, and maintenance of buprenorphine during pregnancy, labor and delivery, and the postpartum year.

미국 마약 통합 관리 시스템을 통한 한국의 마약정책 고찰

New Psychoactive Substances (NPS) are spreading like a trend around the world, and the number of drug crimes is increasing more than ever as distribution methods evolve day by day. Recently, as the drug problem has become increasingly serious, it has become an unbearable reality with the functions and roles of existing drug-related institutions. Most countries use a combination of criminal justice punishment models that control and deter drug supply to make the drug-free society and medical & treatment models that rehabilitate addicts. In other words, supply control policies rely mainly on thorough crackdowns and strong punishment, and demand control policies pursue balanced strategies by focusing on prevention in advance through treatment and rehabilitation. However, countries that have implemented most drug policies have experienced many side effects from unbalanced policies and are making great efforts to make balanced policies to solve them. However, the results vary widely depending on the efforts and budgets of each government, also the structure of the organization that manages drugs is diverse. Current study will examine the current status of Korean drug-related institutions and review the U.S. drug integration management system(IMS). And mainly discuss the direction of Korea's drug policy through the background and historical changes of the Drug Enforcement Administration (DEA). It is meaningful in preparing a specific and practical balanced drug policy that can create a drug-free society through the advantages and disadvantages of the U.S. drug IMS . At the conclusion this study establishes a practical national system to efficiently deal with drugs and in turn protect citizen from drugs.

In Case You Haven't Heard…

Federal health authorities have intensified their scrutiny of the drug ketamine for treating mental health disorders as the mind‐altering compound grows in popularity despite the lack of regulatory approval for such use, The Washington Post reported last week. The Food and Drug Administration (FDA) warned in October about the risks of using pharmacy‐made ketamine at home, citing the case of one patient whose breathing slowed to a dangerous level after taking a large dose outside of a health care facility. Then the autopsy of actor Matthew Perry, released Dec. 15, concluded a high dose of ketamine led to his death in October — an event that, while rare, drove home the dark side of the anesthetic that can also be abused recreationally. Meanwhile, the Drug Enforcement Administration continues to craft a rule that would set new limits on how health care professionals can use telemedicine to prescribe tightly regulated drugs like ketamine. Adam Kaplin, who observed the power of ketamine while overseeing clinical trials that led to the approval of Spravato, but also saw the inconvenience and cost that comes with the FDA‐required monitoring, said he is aiming to develop a derivative of ketamine with fewer side effects. The goal, said Kaplin, chief scientific officer of Mira Pharmaceuticals, is to create a drug that the FDA will endorse as safe for patients to take at home.

Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US

BackgroundMedications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs).MethodsWe assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one’s training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines.ResultsSurvey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD.ConclusionRemoving restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course.

Operationalizing the new DEA exception: A novel process for dispensing of methadone for opioid use disorder at discharge from acute care settings.

To describe one strategy for dispensing of methadone at emergency department (ED) and hospital discharge implemented within 2 urban academic medical centers. Expanding access to medications for opioid use disorder (OUD) is a national priority. ED visits and hospitalizations offer an opportunity to initiate or continue these lifesaving medications, including methadone and buprenorphine. However, federal regulations governing methadone treatment and significant gaps in treatment availability have made continuing methadone upon ED or hospital discharge challenging. To address this issue, the Drug Enforcement Administration (DEA) granted an exception allowing hospitals, clinics, and EDs to dispense a 72-hour supply of methadone while continued treatment is arranged. Though this exception addresses a critical unmet need, guidance for operationalizing this service is limited. To facilitate expanded patient access to methadone on ED or hospital discharge at 2 Baltimore hospitals, key stakeholders within the parent health system were identified, and a workgroup was formed. Processes were established for requesting, approving, preparing, and dispensing the methadone supply using an electronic health record order set. Multidisciplinary educational materials were created to support end users of the workflow. In the first 3 months of implementation, 42 requests were entered, of which 36 were approved, resulting in 79 dispensed methadone doses. This project demonstrates feasibility of methadone dispensing at hospital and ED discharge. Further work is needed to evaluate impact on patient outcomes, such as hospital and ED utilization, length of stay, linkage to treatment, and retention in treatment.

Female Drug Enforcement Officers’ Perceptions and Experiences in the Drug-Law Enforcement World

This qualitative phenomenological study focused on the lived experiences of female drug enforcement officers in the drug enforcement field. Using quota sampling, ten female drug enforcement officers of PDEA ROXII were the participants of the study. The feminist theory helped to clarify the constructed meanings the women attached to their experiences. In-depth interviews were conducted, and the data analysis was guided by the Stevick-Colaizzi-Keen method. The findings revealed that all of the women pursued law enforcement careers because of job security, influence from family and friends, and the desire to help the country solve the problem of illegal drugs. Their job satisfaction was influenced by the successful performance of their duties through the arrest of high-value targets, a conviction of drug personalities, and their perception that they have a challenging and exciting job. Physical and physiological barriers, safety and security, number of cases handled, and desire to practice their professions also influenced their careers. This study revealed that there is gender equality perceived by the female drug enforcers in PDEA ROXII. The differences in roles and their exemptions in certain situations in the conduct of anti-illegal drug operations were not perceived as inequality but more as special treatment and protection of their male counterparts to them. This study contributes to social change by raising awareness about the current status, concerns, and accomplishments of women in law enforcement. Additionally, findings may assist police administrators and legislators in creating policies and procedures that incorporate the needs of female drug enforcement officers.

Failure of the dual orexin receptor antagonist suvorexant to engender drug discrimination in rats.

For abuse potential assessment, U.S. Food and Drug Administration (FDA) requests that new, brain-penetrating drugs are ideally compared with approved drugs that share the mechanism of action and are judged to have abuse liability by the Drug Enforcement Agency. For development of the dual orexin receptor antagonist (DORA) daridorexant, the FDA recommended conducting a rat drug discrimination paradigm against the approved, schedule IV, DORA suvorexant. Surprisingly, at suvorexant plasma levels up to three-fold the maximum concentration at the highest approved human dose, rats did not learn to discriminate the suvorexant stimulus from vehicle.

Buprenorphine Use in the United States, 2010-2019

BackgroundBuprenorphine is effective for the treatment of opioid use disorder and chronic pain, has a safer pharmacological profile than full mu-opioid agonists, and can now be prescribed by any US provider with a Drug Enforcement Administration license. This study aimed to examine a decade of buprenorphine prescribing patterns in the United States. MethodsWe abstracted opioid and buprenorphine prescribing patterns, including patient characteristics, from the 2010-2019 National Ambulatory Medical Care Survey, a national probability sample of non-federal, ambulatory encounters. DISCUSSIONAmong 248,164 ambulatory encounters, opioids were prescribed 2.6%-4.3% of the time with a rate that peaked in 2013 and has been steadily declining. Buprenorphine was infrequently prescribed. Patients receiving buprenorphine were predominantly male (59%), white (70%), younger in age, and had higher rates of substance use disorder (72%). ConclusionBuprenorphine is infrequently used, despite being effective for pain and safer than full mu-opioid agonists. The Drug Enforcement Administration recently ended the requirement for prescribers to obtain an X-waiver, which may increase the rate of buprenorphine use among US practitioners.

Overdose Prevention Centers, Crime, and Disorder in New York City

The first government-sanctioned overdose prevention centers (OPCs) in the US opened in New York City (NYC) in November 2021 amid concerns that they may increase crime and disorder, representing a significant political challenge to OPCs. To identify whether opening the first 2 government-sanctioned OPCs in the US was associated with changes in crime and disorder. In this cohort study, difference-in-differences Poisson regression models were used to compare crime, residents' requests for assistance for emergencies and nuisance complaints, and police enforcement in the vicinity of NYC's 2 OPCs with those around 17 other syringe service programs that did not offer overdose prevention services from January 1, 2019, through December 31, 2022. Changes in the volume of crimes reported by the public or observed by police; arrests for drug possession and weapons; 911 calls and 311 calls regarding crime, public nuisances, and medical events; and summonses issued by police for criminal infractions in both the immediate vicinity of the sites (ie, a hexagonal area spanning about 6 city blocks) and their wider neighborhoods (ie, a tesselated 3-hexagon array spanning about 18 city blocks). No significant changes were detected in violent crimes or property crimes recorded by police, 911 calls for crime or medical incidents, or 311 calls regarding drug use or unsanitary conditions observed in the vicinity of the OPCs. There was a significant decline in low-level drug enforcement, as reflected by a reduction in arrests for drug possession near the OPCs of 82.7% (95% CI, -89.9% to -70.4%) and a reduction in their broader neighborhoods of 74.5% (95% CI, -87.0% to -50.0%). Significant declines in criminal court summonses issued in the immediate vicinity by 87.9% (95% CI, -91.9% to -81.9%) and in the neighborhoods around the OPCs by 59.7% (95% CI, -73.8% to -38.0%) were observed. Reductions in enforcement were consistent with the city government's support for the 2 OPCs, which may have resulted in a desire not to deter clients from using the sites by fear of arrest for drug possession. In this difference-in-differences cohort study, the first 2 government-sanctioned OPCs in the US were not associated with significant changes in measures of crime or disorder. These observations suggest the expansion of OPCs can be managed without negative crime or disorder outcomes.

Dynamic changes in methadone utilisation for opioid use disorder treatment: a retrospective observational study during the COVID-19 pandemic

ObjectivesOpioid use disorder (OUD) is a major public health concern in the USA, resulting in high rates of overdose and other negative outcomes. Methadone, an OUD treatment, has been shown...

Drug-detecting bioelectronic nose based on odor cue memory combined with a brain computer interface

The international drug situation is increasingly, various new drugs are hidden in public places through changing forms and packaging, which brings new challenges to drug enforcement. This study proposes a drug-detecting bioelectronic nose based on odor cue memory combined with brain-computer interface and optogenetic regulation technologies. First, the rats were trained to generate positive memories of drug odors through food reward training, and multichannel microelectrodes were implanted into the DG region of the hippocampus for responsible memory retrieval, the spike signals of individual neurons and the local field potential signals of population neurons in the brain region were collected for pattern recognition and analysis. Preliminary experimental results have shown that when low-dose drugs are buried in a hidden area, rats can find the location of the drugs in a very short time, and when close to the relevant area, there is a significant change in the energy value and time-frequency spectrum signal coupling of the returned data, which can be extracted to indicate that the rats have found the drugs. Second, we labled the neuronal activity marker c-fos and revealed more robust activation in the DG region following odor detection. We modulated these neurons through neuroregulatory technology, so that the rats could recognize drugs by retrieving memories more quickly. We conceive that the drug-detecting rat robot can detect trace amounts of various drugs in complex terrain and multiple scenes, which is of great significance for anti-drug work in the future.

Remote tracking system eases methadone take‐home process

For anyone concerned about diversion of methadone take‐homes, there's a solution in technology. It's a remote tracking system called Sonara. Michael Giles, M.D., who was a resident in psychiatry working in an opioid treatment program (OTP, commonly known as a methadone clinic), founded Sonara Health after his experience there: he learned that many patients couldn't stay in treatment because they couldn't make it to the clinic for the required number of times to maximize methadone take‐homes. He founded Sonara before the COVID‐19 pandemic, which resulted in the federal government's liberalization of take‐home rules (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.32664). But still, many patients do not get as many take‐homes as they would like, and this is partly due to the worries by OTPs about patient and public safety, and the concerns by drug enforcement and government officials about diversion (related to public safety).

Therapeutic alignments: examining police and public health/harm reduction partnerships

ABSTRACT Ongoing calls for police reform across North America alongside the growing momentum for the removal of criminal sanctions for personal possession of drugs have placed policing agencies in an ambivalent position with respect to drug governance and people who use drugs (PWUD). Meanwhile, in response to the longstanding harms produced by drug law enforcement, calls for harm reduction policing have gained traction in recent years, resulting in collaborations between policing agencies and health services, including naloxone administration by police officers, post-overdose outreach and wellness checks, and integrated public health-public safety response and information sharing frameworks. Using situational analysis method, we consider the range of elements and actors that form these partnerships, and their broader structural, institutional, and policy effects. We detail the actual and potential implications of such forms of institutional coordination on health, equity, and the possibility of meaningful drug law reform. Our analysis reveals that rather than mitigating the harms of drug enforcement, such initiatives stand to undermine access to services and increase health system avoidance by eroding trust in public health and harm reduction among PWUD. We reason that the recasting of police as therapeutic agents and as embedded in medico-therapeutic practices reaffirms the role of punitive enforcement practices in drug governance.

Medical Cannabis Legalization: No Contribution to Rising Stimulant Rates in the USA.

There has been a pronounced increase in the use of Schedule II stimulants to treat attention-deficit hyperactivity disorder (ADHD) in the United States over the last two decades. Interestingly, chronic medical cannabis (MC) use can present with cognitive impairments that resemble ADHD symptoms. This study aimed to determine if MC legalization increased prescription stimulant distribution. Information on the distribution of methylphenidate, amphetamine, and lisdexamfetamine for 2006 to 2021 was extracted from the Drug Enforcement Administration's comprehensive database and the three-year population-corrected slopes of stimulant distribution before and after MC program implementation were compared. We found a significant main effect of time (p<0.001); however, contrary to the hypothesis, the sales status of states' MC, did not influence slopes of distribution (p=0.391). There was a significantly large interaction effect of time and MC sales status on slopes of distribution (p<0.001). Slopes of distribution rates of stimulants were significantly lower in states that proceeded to legalize MC prior to MC program implementation than those states that did not (p=0.022). After MC program implementation, however, the distribution rates of the Schedule II stimulants were not significantly different when comparing states with MC sales to those without (p=0.355). These findings suggest that MC program legalization did not contribute to certain states having rapid increases in Schedule II stimulant distribution rates over time. Other factors, including the liberalization of the adult ADHD diagnostic criteria in the DSM-5 and the introduction of Binge Eating Disorder, also likely contributed to elevations in stimulant distribution.

Zuranolone: First Approval.

Zuranolone (ZURZUVAE™) is an oral neuroactive steroid and a positive allosteric modulator of the gamma aminobutyric acid A (GABAA) receptor being developed by Sage Therapeutics and Biogen for the treatment of mood disorders. In August 2023, zuranolone received its first approval in the USA for the treatment of adults with postpartum depression [pending scheduling by the US Drug Enforcement Administration (DEA)]. This article summarizes the milestones in the development of zuranolone leading to this first approval.

A MIXTURE OF NALBUPHINE, AZAPERONE, AND MEDETOMIDINE FOR IMMOBILIZING RINGTAILS (BASSARISCUS ASTUTUS).

We evaluated a combination of nalbuphine HCl (40 mg/mL), azaperone tartrate (10 mg/mL), and medetomidine HCl (10 mg/mL), a combination known as NAM or NalMed-A, in 23 ringtails (Bassariscus astutus) during 29 handling events for a radio-collaring study in southern Oregon, US, from August 2020 to March 2022. The combination was delivered to ringtails by hand injection at 0.075 mL NAM per estimated 1 kg body mass. The mean (± standard deviation, SD) dosage calculated post hoc was 3.366 (±0.724) mg/kg nalbuphine, 0.841 (±0.181) mg/kg medetomidine, and 0.841 (±0.181) mg/kg azaperone. All captured ringtails were effectively immobilized with a mean (SD) induction time of 13.24 (±3.57) min. The medetomidine and nalbuphine components were antagonized with a combination of atipamezole and naltrexone HCl with a mean (SD) recovery time of 2.48 (±1.94) min. This combination appeared to be safe and effective for immobilizing ringtails with a low volume dose, smooth antagonism, and rapid recovery. In addition, NAM does not contain any drugs that are US Drug Enforcement scheduled, which makes it useful for immobilization procedures by wildlife professionals in the US.

In Case You Haven't Heard…

So, a [National Institute on Drug Abuse] NIDA‐funded study has found that telehealth buprenorphine initiations result in marginally longer retention rates than non‐telehealth (see page 5). The low retention rate overall — less than half of the patients in Kentucky and less than one third in Ohio — will be discussed in future issues, as will possible indications for who will do better in telehealth, and possible confounders in that study. The differences — 48% vs. 44%, and 32% vs. 28% — are not that large. The support by the federal government for telehealth is echoed by the American Society of Addiction Medicine, and almost all physicians, who support it for prescribing of all controlled substances. Somehow, the idea of physicians prescribing controlled substances without ever examining the patient — something that some 40,000 commenters, plus all the major medical associations, to a proposed rule by the Drug Enforcement Administration have said that they want (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33912) — seems odd as the nation is still reeling from overdose deaths caused, many believe, by the overprescribing of opioids more than 10 years ago. Entire opioid settlement funds, now being scooped up by anyone who can get them, are based on that premise.

Rebalancing Controlled Substance Regulations in Telemedicine

This Viewpoint elucidates major components of the proposed rules about controlled substance prescribing in telehealth, highlights evolving considerations with the US Drug Enforcement Agency’s approach, and offers potential improvements before finalization of the rules.

Three recent court decisions reframe what constitutes criminal conduct in prescribing controlled substances.

Three recent opinions issued by the United States (US) Supreme Court suggest the possibility of a new interpretation of key drug enforcement provisions in the Controlled Substances Act of 19701 (CSA) affecting prescribers of controlled sub-stances. Applying the Court's holdings in Xiulu Ruan v. US,2 Dobbs v. Jackson Women's Health Organization,3 and West Virginia v. Environmental Protection Agency4 to the Department of Justice's and the Drug Enforcement Administration's overreaching enforcement of the CSA, this paper contends that Congress should amend the CSA and rectify the broad misapplication of the law to the practice of medicine.