Drug Enforcement Research Articles

DEA extends telemedicine for controlled substances until end of 2024

Last week the Drug Enforcement Administration (DEA) announced that it would extend exceptions that went into effect at the start of the COVID‐19 pandemic for telemedicine prescribing of buprenorphine. The exceptions, started in March 2020 (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.32664), allow for prescribing buprenorphine even in cases where there is no in‐person medical evaluation and were initially meant to limit the spread of the virus. Now, however, they are discussed as ways to limit the overdose crisis. The proposal applies, moreover, to all controlled substances, not just to buprenorphine.

DEA outlines new requirements for prescribers of all controlled substances

This year the Drug Enforcement Administration (DEA) provided clear information to prescribers of controlled substances on the new training requirements in order for them to get their license.

A Critical Appraisal on Controlled Drugs: Classification, Global Regulatory Provisions, and Distribution

Abstract: Controlled drugs, characterized by their potential for abuse and addiction, require stringent regulation to ensure their safe and appropriate use. This critical appraisal provides a scientifically sound examination of the classification of controlled drugs, global regulatory provisions governing their use, and the challenges associated with their distribution. Due to poor regulation, it is anticipated that 80% of the world’s population will have insufficient access to these painkillers. India needs a more robust enforcement mechanism, with the main goal of ensuring that medications are accessible to patients in need while preventing abuse and trafficking. As a result, studying the topic of “A Regulatory Need of Controlled Drugs” is important, serious, and indispensable. As a result, the authors of the present review discussed numerous regulatory authorities, drug enforcement agencies, and the storage and distribution of banned substances in India. In light of the findings, this review suggests future directions and recommendations. Strengthening international collaboration and information sharing can facilitate the development of more effective regulatory measures. Improved tracking and monitoring systems, incorporating technological advancements, hold promise for enhancing control over the distribution of controlled drugs.

“Get in and get out, get on with life”: Patient and provider perspectives on methadone van implementation for opioid use disorder treatment

BackgroundExpanding access to opioid use disorder (OUD) treatment, including methadone, is imperative to address the US overdose crisis. In June 2021, the Drug Enforcement Administration announced new regulations allowing all opioid treatment programs (OTPs) to deploy mobile medication units, or methadone vans, to dispense OUD medication treatment outside of clinic walls, ending a 13-year moratorium. We conducted a qualitative study evaluating one opioid treatment program's experience, including benefits and challenges with implementing a methadone van, to inform future policy and clinical practice. MethodsWe recruited staff and patients receiving OUD medication treatment from an OTP in San Francisco, CA. The OTP had one operating van before March 2020 and began operating an additional van in response to COVID-19-related efforts to de-populate clinic settings. We interviewed 10 providers and 20 patients from August to November 2020. We transcribed, coded, and analyzed all interviews using modified grounded theory methodologies. ResultsBoth patients and providers perceived significant benefits with receiving OUD medications using methadone vans. Patients preferred dosing at the van over the clinic because they were able to “get in and out” faster. Both staff and patients appreciated being able to use phone counseling to connect with counselors which helped reduce in-person visits and streamline workflows. Providers also noted van implementation challenges, including daily van set up, urine drug testing, and delivering counseling to patients who lacked phones. ConclusionsEased restrictions on methadone van implementation represent a new strategy for expanding OUD treatment access. In our qualitative study, patients and staff were satisfied with methadone van implementation, though the OTP still faced implementation challenges. Audio-only counseling and other workflow solutions helped facilitate implementation, and several policy considerations like maintaining audio-only counseling flexibilities are key to ensuring future van success. Methadone vans offer the potential to expand treatment uptake, while prioritizing patient-centered care.

The DEA report on ayahuasca risks: “Science” in service of prohibition?

AbstractOn February 2023, the Drug Enforcement Administration (DEA) released a document to the legal team representing the Church of the Eagle and the Condor (“CEC”). This disclosure came two years after the church, in conjunction with Chacruna Institute, submitted two FOIA requests to the DEA and the Department of Justice requesting all records pertaining to ayahuasca. This report, titled “Ayahuasca: Risks to Public Health and Safety,” was issued in July 2020. In the present article, we challenge a number of claims made in the DEA report and highlight significant factual omissions, theoretical biases, and misinterpretations of existing data. We will demonstrate that the DEA report severely downplays the safety profile and therapeutic potential of ayahuasca and overemphasizes the risks. It also fails to include current research on ayahuasca demonstrating its potential benefits.

Police officer perceptions towards drug liberalization policies in the context of an overdose crisis in British Columbia, Canada

Background British Columbia, Canada, is experiencing an overdose crisis that has pushed drug liberalization policies to the forefront of the response. This study examines police officers’ perceptions of enforcement and drug liberalization policies, including support for decriminalization and regulation or ‘safer supply’, in this context. Methods Qualitative interview data were collected in September-November 2020 from active police officers involved in drug law enforcement in British Columbia, prior to decriminalization reforms being introduced in the province. We conducted a thematic analysis of this data with a focus on police officer views towards drug enforcement and drug liberalization policies. Results Policing and reforms amid the overdose crisis has shaped officer perceptions and actions towards illegal drugs and drug policies. Although officers saw overdose as a health issue, these views coincided with a strong emphasis on supply-side policing, such as drug trafficking investigations. Policing continues to be entrenched in the overdose crisis, which has impacted the way police officers view drugs and drug use, particularly, their belief that current interventions to disrupt the illegal drug market are not working. Conclusion This study advances knowledge on the motivations for promoting drug enforcement, and enacting drug policies, in the context of an overdose crisis.

From poppy to pill: A comprehensive strategy to combat illicit synthetic drug production in Southeast Asia

AbstractThe production of illicit synthetic drugs has undergone a significant shift from China to the Golden Triangle, profoundly impacting Southeast Asia's legal systems, drug enforcement and public health. This paper reviews the production, distribution and use of illicit synthetic drugs in the region, explaining their alignment with regulatory policies in China and Southeast Asia. The public health effects resulting from the increased production and use of synthetic drugs in Southeast Asia are reviewed, emphasizing the importance of public health protections such as harm reduction, treatment and rehabilitation. This study also discusses legal mechanisms to enhance control over illicit drug activities, mainly compound‐wide legislative prohibitions targeting present and future fentanyl and methamphetamine analogues. Moreover, it underscores the urgency for collaborative efforts between China and Southeast Asian states to mitigate the influence of Chinese cartels operating in the region. By elucidating the multifaceted challenges posed by the shifting drug production landscape, this paper highlights the importance of a comprehensive approach encompassing regulatory, law enforcement and public health measures.

Pakistan’s Opioid Squeeze: Impacts of Taliban Edicts, Indian Synthetics and Chinese Regulations

This study examines how the Taliban’s opium poppy eradication edict and the westward shift in illicit fentanyl production from China to India potentiates an opioid squeeze on Pakistan from its east-west flanks, influencing Pakistan’s opioid production, distribution and use. As opioid output sputters in Afghanistan, while Indian chemists increasingly normalise illicit fentanyl production in South Asia, opportunistic Pakistani chemists will be incentivised to supply synthetic opioids to high-demand international markets, just as Pakistani farmers supply opium and heroin to international clients. This convergence has ramifications for Pakistani law, drug enforcement and public health, as domestic production increases domestic access to synthetic opioids. The article conducts an empirical examination of current trends in South Asian opioid production, distribution and use, along with an exegesis of the legal and regulatory systems in Pakistan, Afghanistan and China. This study also details how the Pakistani government should respond to this challenge legislatively, foremost through blanket ban of fentanyl and its precursors. Pakistan can reduce domestic use through evidence-based treatment programmes, including discrete and confidential treatment administered by females to female users, opioid substitution therapy, safe needle exchange programmes, culturally sensitive drug awareness campaigns, and increased data collection to detect geographic hotspot locations of opioid use and overdoses.

The End of the X-waiver: Excitement, Apprehension, and Opportunity.

With the passage of the MAT act (Mainstreaming Addiction Treatment) and the MATE Act (Medication Training and Expansion), the Drug Enforcement Agency "X-waiver" program governing the office-based prescription of buprenorphine for opioid use disorder has been immediately eliminated. The move was championed by vocal organizations with a rightful concern about buprenorphine access but was opposed by most physicians. Nonetheless, buprenorphine can now be prescribed like any schedule 3 medication. Studies show that despite rising opioid overdoses, buprenorphine prescription increases have been slow to rise and are particularly absent in rural communities. The elimination of the X-waiver may theoretically improve buprenorphine prescribing rates for opioid use disorder in rural areas, by nurse practitioners and physician assistants, and by resident physicians in teaching programs. It may also help decrease discrimination against individuals with opioid use disorder in postacute-care settings like nursing homes, physical rehabilitation centers, and in prisons and jails. Concerns include the elimination of the only focused opioid use disorder education many physicians receive (X-waiver courses) and a literature base showing that interest, rather than the X-waiver itself, remains the biggest barrier to recruiting more buprenorphine prescribers. Concerns also exist over the harms of precipitated withdrawal when buprenorphine is initiated inappropriately. The change of the elimination of the X-waiver brings about a new opportunity for Family Medicine and its parent organizations to champion the inclusion of opioid use disorder treatment within the chronic disease care models well-known to our integrated care settings.

Effects of Serial Polydrug Use on the Rewarding and Aversive Effects of the Novel Synthetic Cathinone Eutylone.

As individual synthetic cathinones become scheduled and regulated by the Drug Enforcement Administration (DEA), new ones regularly are produced and distributed. One such compound is eutylone, a novel third-generation synthetic cathinone whose affective properties (and abuse potential) are largely unknown. The following experiments begin to characterize these effects and how they may be impacted by drug history (a factor affecting reward/aversion for other drugs of abuse). Eutylone was assessed for its ability to induce conditioned taste avoidance (CTA; aversive effect) and conditioned place preference (CPP; rewarding effect) and their relationship (Experiment 1). Following this, the effects of exposure to cocaine or 3,4-methylenedioxymethamphetamine [MDMA] on eutylone's affective properties were investigated (Experiment 2). Eutylone produced dose-dependent CTA and CPP (Experiment 1), and these endpoints were unrelated. Pre-exposure to cocaine and MDMA differentially impacted taste avoidance induced by eutylone (MDMA > cocaine) and did not impact eutylone-induced place preference. These data indicate that eutylone, like other synthetic cathinones, has co-occurring, independent rewarding and aversive effects that may contribute to its abuse potential and that these effects are differentially impacted by drug history. Although these studies begin the characterization of eutylone, future studies should examine the impact of other factors on eutylone's affective properties and its eventual reinforcing effects (i.e., intravenous self-administration [IVSA]) to predict its use and abuse liability.

Effects of User Awareness on Privacy Protection of the Internet User in Tanzania. A Case Study of Drug Control and Enforcement Authority (DCEA)

This study aimed to examine the effects of user awareness on privacy protection of the Internet user. In conducting this study, the researcher employed by theory of planned behaviour by Ajzen (1985) and the descriptive research design and mixed research approach whereby data was collected from 98 respondents through questionnaire and interview. Data collected was analyzed using SPSS for quantitative data and thematic analysis was employed to analyse qualitative data obtained through interview. The results obtained from regression analysis shows that User Awareness (UA) has (β = .315, p< .001). These findings conclude that there is a positive and significant relationship between user awareness and the privacy protection behaviours among internet users. From the findings it can be concluded that user of internet needs to be aware of what data is being collected, how it be used and who will have access. This study recommends that the management of DCEA should conduct privacy impacts assessment, it also recommends that DCEA should provide an improved regular training and awareness programs for employees, moreover, it also recommends the use of data encryption services this will ensure that sensitive data are encrypted and protected in transit and at rest to protect it from unauthorized access, particularly in the event of breach or data loss. Lastly it recommends on improvement on incident response measures, whereby DCEA is required to improve its comprehensive incidence response plan for data breaches or privacy incidents, outlining how to detect, report and respond to such event promptly.

The Importance of Asserting Our Expertise

Changes in the Drug Enforcement Agency’s policy regarding treatment of patients with opiate and other substance abuse disorders shines a light on ever-evolving perceptions of best practices in healthcare and the importance of professional development to stay abreast of them.

What the X? Understanding changes in buprenorphine prescribing regulation.

Opioid use disorder remains an epidemic in the United States. Buprenorphine is a Food and Drug Administration-approved medication for opioid use disorder that is associated with decreased opioid-related mortality and morbidity. Until recently, providers had to have a specialized wavier, a Drug Enforcement Agency (DEA) X, to prescribe buprenorphine for opioid use disorder. The 2023 Consolidated Appropriations Act, signed into law by President Biden, removed X waiver requirements and implements new training requirements for all new and renewing DEA registrants. This brief report outlines the history of buprenorphine prescribing regulation, reviews the recent regulatory changes and their implications for nurse practitioner buprenorphine prescribing, and concludes by considering the importance of promoting buprenorphine access.

An inconspicuous threat to our nation-it’s time to end

It is well known that counterfeit medical products cause harm to patients and fail to treat the diseases for which they were intended. They lead to loss of confidence in medicines, healthcare providers and health systems. They are becoming common in every region of the world. It is believed that up to 10% of all medicines sold worldwide are counterfeit, with higher prevalence in regions where drug regulatory and enforcement systems are weakest. An estimated 1 in 10 medical products in low- and middle-income countries and it contributes to antimicrobial resistance and drug-resistant infections.

Kratom availability in California vape shops

Kratom products are derived from trees native to Southeast Asia and have dose-dependent stimulant and opioid-like effects. Despite being on the Drug Enforcement Administration “Drugs and Chemicals of Concern List,” kratom is legal for sale in most US states. However, there are scarce data on its availability. The goal of this study was to examine kratom availability in vape shops across the state of California and assess shop compliance with a local kratom sales ban (enacted in 2016) in San Diego City. As part of a larger study about retail tobacco marketing near colleges, availability of kratom was assessed in summer 2019 in a random sample of 614 vape shops that was stratified to compare stores near (≤ 3 miles) and distant (>3 miles) from colleges. Logistic regression examined kratom availability as a function of store type (stores that sold vape products only vs. stores selling other tobacco), nearness to college, and tract-level demographics. Kratom was available in 62.4% of observed stores and more often in vape-and-smoke (81.1%) than vape-only shops (11.5%, AOR = 40.4, 95% CI = 23.3–74.1). Kratom availability did not differ by nearness to colleges. In San Diego City, 46.2% of observed stores (95% CI = 28.8–64.5) sold kratom products. Findings indicate that kratom was available in the majority of vape shops and most commonly in vape-and-smoke shops. Widespread availability in tobacco specialty shops suggests the need for research on dual use with tobacco, kratom advertising and cross-product promotion, and the potential of state and local tobacco retail licensing to prohibit sales.

Students’ perspectives on drugs and alcohol abuse at a public university in Zambia

Access to students’ perspectives on substance abuse is essential for effective youth intervention projects development. This study aimed to explore students’ perspectives on abuse of drugs and alcohol with probable development of student-led intervention strategies. The study was conducted at public universities in Zambia. Student’s perspectives on drugs and alcohol abuse were documented using a mixed method design that employed purposive and snowball sampling to select 200 respondents to questionnaires and 10 to in-depth interviews. A humanistic theory approach was applied in the interpretation and analysis of the data collected. The findings showed that cannabis (30%) and codeine contained in Benylin (17%) were commonly abused. Further findings showed that students’ academic pressure was the leading cause of substance abuse (27%), followed by peer pressure (20%). Students knew that abuse of drugs and alcohol led to low academic performance, violence and theft, risks of contracting sexually transmitted infections (STIs), and other social maladjustments. The study recommends that institutions of learning increase student-led awareness campaigns, security surveillance on campus, and collaboration with government drug enforcement agencies. Institutions of learning should involve students in the planning of programmes to deal with drug and alcohol abuse.Contribution: The study will inform amendment of drug and alcohol abuse policies in institutions of learning. The study will contribute towards the UNESCO O3 PLUS project goal of making campuses safe and inclusive, and overall, the Sustainable Development Goal 3 and 4. The study serves as basis for scholars in the field of biblical theology engaged with justice, health and human development. The article is a contribution to the research project Biblical Theology and Hermeneutics. The results of this research can especially be utilised by scholars in the field of psychology of religion, the sociology of religion and practical theologians focusing on youth ministry.

Incentivizing Narcotics Control Through China’s Belt and Road Initiative in South and Southeast Asia

The production and distribution of narcotics in many states in South and Southeast Asia present significant challenges for China. Several of these states receive foreign investments and assistance through China’s Belt and Road Initiative (BRI), including a division of the BRI called the Health Silk Road (HSR). China has an opportunity to motivate these states to strengthen their narcotics control measures by adding conditionality clauses in the BRI/HSR investment agreements with these states. The suggested clauses could mandate measures such as improving drug enforcement, decommissioning production sites and distributors, increasing harm reduction and rehabilitation services, and establishing citizen complaint systems for narcotics issues. To ensure compliance, disincentives should be activated for states failing to meet narcotics control conditions.

Associations between opioid overdose deaths and drugs confiscated by law enforcement and submitted to crime laboratories for analysis, United States, 2014–2019: an observational study

The overdose epidemic in the United States (US) continues to generate unprecedented levels of mortality. There is urgent need for a national data system capable of yielding high-quality, timely, and actionable information on existing and emerging drugs. Public health researchers have started using law enforcement forensic laboratory data to obtain surveillance information on illicit drugs. This study is the first to use drug reports from the entire US to examine correlations between a changing drug supply and increasing opioid-involved overdose deaths (OOD) on a national scale. This study is observational and investigates associations between law enforcement drug reports and OOD for the US from 2014 to 2019. OOD data are from the Centers for Disease Control and Prevention's National Vital Statistics System restricted-use multiple cause of death files. The US Drug Enforcement Administration's National Forensic Laboratory Information System (NFLIS) contains forensic laboratory-tested drug exhibit information for the entire US (NFLIS-Drug). Counts of forensic laboratory reports and OOD were aggregated for each state by month, quarter, and year. A difference-in-differences framework was used to estimate contemporaneous and lagged associations. Between 2014 and 2019 in the US, 249,522 OOD were reported, with the annual number nearly doubling from 28,723 to 50,179. OOD involving illicitly manufactured fentanyls (IMF) also increased substantially during this period, from 19.4% to 72.9%. In addition, 3,817,438 forensic laboratory reports in the US that were reported to NFLIS-Drug contained an opioid, stimulant, or benzodiazepine. Reports of fentanyl and fentanyl-related compounds (FFRC) had the strongest association with OOD. Each additional FFRC exhibit was associated with a 2.97% (95% CI: 1.7%, 4.1%) increase in OOD per 100,000 persons per quarter. Adding to the emerging consensus, protracted growth in IMF supply was more strongly associated with OOD than all other illicit drugs reported to NFLIS-Drug over the study time period. Findings demonstrate NFLIS-Drug data usefulness for research that require proxy indicators for the illicit drugs supply. A concerted effort between public health and public safety to make NFLIS-Drug more timely could strengthen its utility as a national, public health, drug surveillance system. Sangeetha Arctic Slope Mission Services, LLC, ASMS Contract No. ASM5-00017.

Drivers of gender-based violence amongst the students in higher learning institutions: A case of Kwame Nkrumah university

This study sought to investigate the Drivers of Gender Based Violence amongst students in higher learning institutions in Zambia. The study used a descriptive case study design and data was collected using questionnaires and interviews. Simple random sampling procedure was used to target 62 participants and purposive sampling was used to collect data from 2 university staff and 1 District GBV officer. Data was collected and analyzed using themes that emerged from the literature review and objectives of the study. The main findings of the study were that the prevalent levels of Gender Based Violence amongst students in higher learning institutions were ignorance about Gender Based Violence as most students have little or no understanding on what constitutes GBV and the few who understood could not take action because of not knowing where to go. Furthermore, the findings revealed that Alcohol and Drug abuse amongst students was largely responsible for GBV, peer pressure and the environment created by the institutions. High learning institutions should take a deliberate policy to foster equality and protect every student in the institution. Further, the institutions should engage the Drug Enforcement Commission (DEC) for sensitization programs and also promote student activism. There is need for university management to review the policies to protect every student from abuse by both students and lectures

Drug disposal deserts: An assessment of receptacle availability in Kentucky community pharmacies.

The purpose of this study was to describe the county-level availability of drug disposal receptacles in Kentucky community pharmacies and show the relationship between installed receptacles and opioid analgesic (OA)/controlled substance dispensing rates, stratifying where possible by urban-rural classification. Using 2020 data from the Kentucky All Schedule Prescription Electronic Reporting program and disposal receptacle data from the US Drug Enforcement Agency, county-level comparisons were made between number of receptacles and OA/controlled substance dispensing rates. Logistic and negative binomial regression models were used to assess for differences between rural/urban county designation and odds of ≥1 disposal receptacle and compare the rates of receptacles per dispensed OA dose in rural/urban counties. While rural counties saw higher OA and controlled substance dispensing rates, the majority (55.6%) of disposal receptacles were in urban locations. The odds of having at least 1 receptacle were higher in urban counties (OR 2.60, 95% CI: 1.15, 5.92) compared to rural. The estimated rate of disposal receptacles per million dispensed OA doses was found to be 0.47 (95% CI: 0.36, 0.61) in urban counties compared to 0.32 (95% CI: 0.25, 0.42) in rural counties, with an estimated rate ratio of 1.45 (95% CI: 1.01, 2.10). A mismatch between the availability of county-level disposal receptacles in community pharmacies and the volume of dispensed OAs/controlled substances exists, resulting in fewer receptacles per dispensed OA in rural counties compared to urban counties. Future efforts are necessary to increase access to convenient disposal receptacles located in community pharmacies, particularly in rural communities.