Drug Supply Research Articles

Purchase Profile of Hypertension Drugs of Calcium Channel Blocker Group Amlodipine Doses of 5 mg and 10 mg in Several Gorontalo City Pharmacies January - March period in 2024

Hypertension is one of the most common diseases in Indonesia, one of which in the province of Gorontalo is included in the top 10 largest diseases. According to the health data profile from the Gorontalo provincial health office in 2022, the level of hypertension in Gorontalo city reached 2,325 cases, or around 4.6%. High cases of hypertension must be balanced with the provision of hypertension drugs, one of which is the calcium channel blocker (CCB) hypertension drug, amlodipine. The purpose of this study was to see the profile of purchasing hypertension drugs from the Calcium Channel Blocker (CCB) Amlodipine group in the community in Gorontalo City, especially in pharmacy and pharmaceutical service facilities. The research method uses a random sampling observation method, namely to see drug purchases in three Gorontalo city pharmacies located in different sub-districts. Purchase tracking was carried out in January, February, and March 2024. The results showed the purchase of amlodipine drugs in the three pharmacies in different amounts. Pharmacy B dominated the purchase of drugs compared to Pharmacy A and Pharmacy C at the 5 mg and 10 mg doses, respectively. Based on the results obtained, these differences are influenced by several indicators, including drug availability, drug completeness, pharmacy strategic location, and customer satisfaction.

Assessment of infrastructure and manpower as per IPHS guideline of the primary health centers in a district of Maharashtra: a descriptive study

Background: Primary health care is provided through PHCs. Primary health care includes the curative care for the diseases, preventive, promotive and rehabilitative care to the specified population of the defined area. The aim of the study was to assess infrastructure and manpower at primary health care centres as per IPHS guidelines. Methods: This was a cross-sectional descriptive study conducted in 13 PHCs randomly selected, 1 from 13 blocks of Buldana district. A face-to-face interview was conducted using the semi structured questionnaire. Results: The 13 PHCs have MBBS medical officer. There are 10 (77%) PHC having their own building. The infrastructure for counselling room and health and wellness room is available at 11 (85%) PHCs. Major of the gap in human resource was seen in staff nurse (54%), pharmacist (23%), lab technician (46%), health assistant female (15%), counsellor (85%), dresser (77%), Data entry operator DEO (77%). Interrupted drug supply was reported for some drugs. Conclusions: The infrastructure at PHC needs to be improved and manpower at PHC can be filled up for better quality of health services delivery.

Directly Observed Therapy in Correctional Settings

What Is the Issue? Directly observed therapy ensures patient adherence to a prescribed treatment regimen by having a health care worker watch the patient take the drug (s). However, it can result in patients needing to wait to see an available health care provider, and long waits can lead to patients being late for or missing out on work, school, or other therapy. What Did We Do? We conducted a literature search to identify, gather, synthesize, and summarize relevant evidence to inform our understanding of how directly observed therapy is used and what drugs are administered via directly observed therapy in correctional settings in Canada and internationally. What Did We Find? We identified practice manuals and guidelines from Canada, British Columbia, Manitoba, Nova Scotia, Ontario, and Saskatchewan, as well as Australia and the UK, related to using directly observed therapy in correctional settings. Drugs recommended to be provided via directly observed therapy included methadone, other drugs for opioid use disorder, and drugs at high risk of misuse or diversion (e.g., benzodiazepines, opioids). Most documents noted the high risk of misuse and/or diversion, suggesting these are the main justifications for providing drugs via directly observed therapy. Some strategies that may help reduce administration or wait times include an in-possession policy (where patients keep their drugs and self-administer if possible) and long-acting injectable forms of drugs (e.g., buprenorphine, antipsychotics). In-possession is typically not recommended for drugs at high risk of misuse and diversion. Still, it may be allowed for specific drugs or on a case-by-case basis, considering factors like the particular drug, available local resources, and patient characteristics. What Does This Mean? When considering alternatives to directly observed therapy, it may be helpful to assess risks, which may be influenced by the facility, the drug being provided, and individual patients. It may also be beneficial to implement methods of monitoring drug adherence and checking for potential misuse or diversion, such as by reviewing drug administration or supply records. While some alternatives to directly observed therapy may help to reduce time spent administering drug, some potential risks include increased risk of misuse and/or diversion and higher cost of drugs. Additional time may be required initially to allow staff to learn and adapt to the new process. It may be helpful to consider alternatives to directly observed therapy as additional options for patients, allowing patients to have input into what drug they will take based on their needs and concerns.

Impact of State Telehealth Parity Laws for Private Payers on Hypertension Medication Adherence Before and During the COVID-19 Pandemic.

Telehealth has emerged as an effective tool for managing common chronic conditions such as hypertension, especially during the COVID-19 pandemic. However, the impact of state telehealth payment and coverage parity laws on hypertension medication adherence remains uncertain. Data from the 2016 to 2021 Merative MarketScan Commercial Claims and Encounters Database were used to construct the study cohort, which included nonpregnant individuals aged 25 to 64 years with hypertension. We coded telehealth parity laws related to hypertension management in all 50 US states and the District of Columbia, distinguishing between payment and coverage parity laws. The primary outcomes were measures of antihypertension medication adherence: the average medication possession ratio; medication adherence (medication possession ratio ≥80%); and average number of days of drug supply. We used a generalized difference-in-differences design to examine the impact of these laws. Among 353 220 individuals (mean [SD] age, 49.5 (7.1) years; female, 45.55%), states with payment parity laws were significantly linked to increased average medication possession ratio by 0.43 percentage point (95% CI, 0.07-0.79), and an increase of 0.46 percentage point (95% CI, 0.06-0.92) in the probability of medication adherence. Payment parity laws also led to an average increase of 2.14 days (95% CI, 0.11-4.17) in prescription supply, after controlling for state-fixed effects, year-fixed effects, individual sociodemographic characteristics and state time-varying covariates including unemployment rates, gross domestic product per capita, and poverty rates. In contrast, coverage parity laws were associated with a 2.13-day increase (95% CI, 0.19-4.07) in days of prescription supply but did not significantly increase the average medication possession ratio or probability of medication adherence. State telehealth payment parity laws were significantly associated with greater medication adherence, whereas coverage parity laws were not. With the increasing adoption of telehealth parity laws across states, these findings may support policymakers in understanding potential implications on management of hypertension.

Gold-coated D-shaped photonic crystal fiber refractive index sensor with a wide detection range and large manufacturing tolerance

A D-shaped photonic crystal fiber refractive index (RI) sensor is designed, and its performance is analyzed using the finite element method (FEM). A gold film is coated on the D-shaped surface of the fiber as a plasmonic material for surface plasmon resonance sensing. The U-shaped arrangement of holes of the same size in the fiber structure enhances the coupling resonance between the core mode and the surface plasmon polariton mode. Numerical results show that the RI range of the sensor is 1.20–1.40, the maximum wavelength sensitivity is 16008.98 nm/RIU, and the detection width is up to 0.2 RIU. In addition, this study analyzes the manufacturing tolerance for the sizes of the air holes. The results show that the manufacturing tolerance for the three types of air holes is as high as 25%, 11.1%, and 10.2% when h is 40µm. These findings lay the foundation for the mass production of sensors. The above results indicate that the sensor has remarkable advantages such as enhanced sensitivity, wide measurement range, and exceptional manufacturing stability, and has promising applications in the fields of bio-detection, drug supply detection, and water pollution control.

Reconsidering the usefulness of long-term high-dose buprenorphine.

Buprenorphine has been successfully used for decades in the treatment of opioid use disorder, yet there are complexities to its use that warrant attention to maximize its utility. While the package insert of the combination product buprenorphine\naloxone continues to recommend a maximum dose of 16 mg daily for maintenance, the emergence of fentanyl and synthetic analogs in the current drug supply may be limiting the effectiveness of this standard dose. Many practitioners have embraced and appropriately implemented novel practices to mitigate the sequelae of our current crisis. It has become common clinical practice to stabilize patients with 24 - 32 mg of buprenorphine daily at treatment initiation. Many of these patients, however, are maintained on these high doses (>16 mg/d) indefinitely, even after prolonged stability. Although this may be a necessary strategy in the short term, there is little evidence to support its safety and efficacy, and these high doses may be exposing patients to more complications and side effects than standard doses. Commonly known side effects of buprenorphine that are likely dose-related include hyperhidrosis, sedation, decreased libido, constipation, and hypogonadism. There are also complications related to the active metabolite of buprenorphine (norbuprenorphine) which is a full agonist at the mu opioid receptor and does not have a ceiling on respiratory suppression. Such side effects can lead to medical morbidity as well as decreased medication adherence, and we, therefore, recommend that after a period of stabilization, practitioners consider a trial of decreasing the dose of buprenorphine toward standard dose recommendations. Some patients' path of recovery may never reach this stabilization phase (i.e., several months of adherence to medications, opioid abstinence, and other clinical indicators of stability). Side effects of buprenorphine may not have much salience when patients are struggling for survival and safety, but for those who are fortunate enough to advance in their recovery, the side effects become more problematic and can limit quality of life and adherence.

“Smoking weed it gets you over the hump”: Cannabis co-use as a facilitator of decreased opioid use among people who inject drugs in Los Angeles, California

IntroductionOpioid overdose mortality rates have surged dramatically in the last decade due largely to fentanyl in the illicit US drug supply. As of June 2024, 38 states, three territories, namely US Virgin Islands, Guam and the Northern Mariana Islands, and the District of Columbia, allow the medical use of cannabis products. However, there remains limited qualitative community-based evidence on the role of cannabis co-use among opioid using and injecting populations. In this study, we present data from people who inject drugs (PWID)’s co-use of cannabis-opioid. MethodsWe conducted 30 one-on-one semi-structured interviews with PWID from July 2021 to April 2022 at two community sites in Los Angeles, CA, near a syringe service program and a methadone clinic. Interviews were recorded and transcribed. We used constructivist grounded theory methods for identifying and comparing the emerging themes that appeared across transcripts to construct a conceptual explanation of how PWID co-used cannabis and opioids. Participant inclusion criteria included injection drug use, opioid and cannabis use, English fluency, and age 18+ years. ResultsPWID described that cannabis co-use assisted in developing patterns of reduced opioid use in a number of ways: 1) maintain opioid cessation and/or adhere to opioid use disorder treatment by managing cessation-specific symptoms, 2) manage symptoms of opioid withdrawal episodically and, 3) decrease opioid use due to low barrier accessibility of cannabis. DiscussionParticipants reported myriad benefits of opioid and cannabis co-use for reducing patterns of opioid use. These findings have two major harm reduction implications for PWID: 1) the distribution of cannabis via low threshold peer programming and interventions can facilitate changes in opioid use patterns and 2) access to cannabis co-use, potentially alongside existing Medication for Opioid Use Disorder, in treatment settings may improve efficacy of uptake and treatment outcomes and goals for individual PWID.

Evaluation of Drug Procurement Pattern and Drug Availability for JKN Patients at X Hospital and Y Hospital, Cirebon District, January-December 2022 Period

The era of National Health Insurance (JKN) brought changes in the health care system, which required hospital pharmacists to adapt to drug regulations and planning. Procurement planning and procedures have a significant impact on the availability of drugs and the financial situation of the hospital in drug management. One of the most crucial aspects of the hospital is the availability of guaranteed goods and sufficient drug supplies in order to provide the best service. This research was conducted to evaluate the procurement and availability of drugs at X Hospital as a public hospital and Y Hospital as a private hospital in Cirebon Regency. The analysis used in this study is descriptive-evaluative, namely the research method used to obtain data in a descriptive form and a systematic analysis is carried out to evaluate based on the descriptive data. Data collection was carried out by means of in-depth interviews with the hospital and distributors as external parties who also contributed to fulfilling the availability of drugs. The data is also complemented by the results of field observations and review of document reports related to the National Formulary (Fornas), Hospital Formulus (Forkit), and Drug Needs Plan (RKO). The results of this study found that the Drug Needs Plan, procurement and availability of drugs at X Hospital and Y Hospital were in accordance with the standards. This shows that most of the drugs available and given to patients are in accordance with the drugs listed in the National Formulary. There is a difference in the pattern of procurement. Hospitals conduct procurement twice a month, but private hospitals conduct procurement patterns twice a week. The two hospitals both use the SIMRS and Teramedik management information systems for the evaluation process of drug procurement and availability

“Expected to happen”: perspectives on post-release overdose from recently incarcerated people with opioid use disorder

BackgroundOpioid-related overdose is the leading cause of death for people recently released from incarceration, however treatment with medications for opioid use disorder (MOUD) during incarceration can reduce the mortality risk. This study seeks to qualitatively analyze perceptions of post-release overdose risk from the perspectives of people who received MOUD while incarcerated in one of eight Massachusetts jails during 2021–2022 using the Risk Environment Framework to guide analyses.MethodsN = 38 participants with lived experience of MOUD treatment during incarceration who are now living in the community were interviewed on factors that may contribute to or protect against post-release overdose risk. Themes were identified inductively and deductively using the Risk Environment Framework and its domains, which organizes themes along physical, social, economic, and policy environments on both the micro- and macro- scales.ResultsThe physical risk environment included loss of opioid tolerance during incarceration, polysubstance use, and the toxicity of the regional drug supply as key producers of increased risk for post-release overdose. Social drivers of risk included peer group risk norms—including peer-driven harm reduction practices and interpersonal relationships between drug sellers and buyers—as well as macro-level social determinants of health such as housing insecurity and availability of mental health services. Economic drivers of post-release overdose risk included lack of income generation during incarceration and employment challenges. Participants discussed several aspects of policy that contribute to post-release overdose risk, including availability of harm reduction supplies, public health services, and broader policy around MOUD.ConclusionsThe perspectives of people with lived experience are vital to understanding the disproportionate risks of overdose for those recently released from incarceration. Our results highlight the intersectional factors that produce and reproduce the post-release overdose risk environment, providing support for interventions across each domain of the Risk Environment Framework. By capturing perspectives from people with lived experience of OUD and incarceration during this critical period of risk, we can better identify interventions that target and mitigate overdose-related harm in this population.

Electronic Logistic Management Information System in Public Health Facilities and Its Implications for the Medicine Supply Chain in Singida District Council, Tanzania.

The effective management of the medicine supply chain is crucial for ensuring the availability of essential medicines and supplies in public health facilities. This study aimed to determine the utilization of the electronic logistic management information system (e-LMIS) in public health facilities and its implications for the medicine supply chain. A mixed methods approach, combining both quantitative and qualitative data collection methods, was used. The study included 106 healthcare providers from 35 public health facilities in Singida District. Six key informants were interviewed using a qualitative method. Of the 106 participants, 62.3% said they were somehow competent in e-LMIS utilization. In in-depth interviews, respondents underscored the system's utility for tracking stock levels, procurements, and managing orders. Staff shortages and a lack of customized training were mentioned as major challenges hindering efficiency in managing drug supplies. This study highlighted the positive impact of e-LMIS on various aspects of the medicine supply chain, including the timely submission of orders and enhanced inventory management. Sustained management support and the regular utilization of the e-LMIS system are crucial for building and maintaining competence among healthcare providers, thereby optimizing the medicine supply chain and ultimately improving healthcare delivery.

Trace Detection of Adulterants in Illicit Opioid Samples Using Surface-Enhanced Raman Scattering and Random Forest Classification.

The detection of trace adulterants in opioid samples is an important aspect of drug checking, a harm reduction measure that is required as a result of the variability and unpredictability of the illicit drug supply. While many analytical methods are suitable for such analysis, community-based approaches require techniques that are amenable to point-of-care applications with minimal sample preparation and automated analysis. We demonstrate that surface-enhanced Raman spectroscopy (SERS), combined with a random forest classifier, is able to detect the presence of two common sedatives, bromazolam (0.32-36% w/w) and xylazine (0.15-15% w/w), found in street opioid samples collected as a part of a community drug checking service. The Raman predictions, benchmarked against mass spectrometry results, exhibited high specificity (88% for bromazolam, 96% for xylazine) and sensitivity (88% for bromazolam, 92% for xylazine) for the compounds of interest. We additionally provide evidence that this exceeds the performance of a more conventional approach using infrared spectral data acquired on the same samples. This demonstrates the feasibility of SERS for point-of-care analysis of challenging multicomponent samples containing trace adulterants.

Nitric oxide-generating metallic wires for enhanced metal implants

Metallic implants are integral in modern medicine, offering excellent biocompatibility and mechanical properties. However, implant-related infections pose a major challenge. Current drug delivery methods, such as surface-coated and drug-eluting implants, are limited by finite drug supplies and complex manufacturing steps. Recent approaches like local drug synthesis, including enzyme-prodrug therapies, present innovative solutions but are hampered by the inherent limitations of enzymes as well as complex procedures. Here, we introduce a simpler alternative: using the intrinsic properties of implant materials to activate prodrugs. Through a simple thermal treatment, metallic implants gain catalytic properties to locally generate nitric oxide, an antibacterial agent. Our findings show this treatment is non-toxic to cells, does not affect cell proliferation rates, and effectively inhibits bacterial biofilm formation. This material-driven approach eliminates the need for external chemical or enzymatic interventions, offering a promising solution to prevent implant-related infections and improve patient outcomes in implant medicine.

Management of drug supply chain information based on "artificial intelligence + vendor managed inventory" in China: perspective based on a case study.

To employ a drug supply chain information system to optimize drug management practices, reducing costs and improving efficiency in financial and asset management. A digital artificial intelligence + vendor managed inventory (AI+VMI)-based system for drug supply chain information management in hospitals has been established. The system enables digitalization and intelligentization of purchasing plans, reconciliations, and consumption settlements while generating purchase, sales, inventory reports as well as various query reports. The indicators for evaluating the effectiveness before and after project implementation encompass drug loss reporting, inventory discrepancies, inter-hospital medication retrieval frequency, drug expenditure, and cloud pharmacy service utilization. The successful implementation of this system has reduced the hospital inventory rate to approximately 20% and decreased the average annual inventory error rate from 0.425‰ to 0.025‰, significantly boosting drug supply chain efficiency by 42.4%. It has also minimized errors in drug application, allocation, and distribution while increasing adverse reaction reports. Drug management across multiple hospital districts has been standardized, leading to improved access to medicines and enhanced patient satisfaction. The AI+VMI system improves drug supply chain management by ensuring security, reducing costs, enhancing efficiency and safety of drug management, and elevating the professional competence and service level of pharmaceutical personnel.

Outcome of Severe Acute Malnutrition in Children Aged 6-59 Months Before and After the Institution of the Malnutrition Treatment Centre in the Regional Hospital Limbe, Southwest Region of Cameroon

Background: Malnutrition occurs when nutrient and energy intake do not meet, or exceed an individual’s requirements to maintain growth, immunity, and organ function. In 2020, among children 0-59 months worldwide, 21.3% (144 million) were stunted and 6.9% (47 million) were wasted. The Malnutrition Treatment Centre’s (MTC) establishment in the Regional Hospital Limbe in 2019 brought major changes in management such as free and continuous supply of therapeutic food and basic drugs, the expertise of a nutritionist and closer follow up of patients after discharge. The aim of this research was to evaluate the outcome of children with severe acute malnutrition aged 6-59 months treated at the MTC differed from those treated before the MTC’s creation. Methodology: An analytic cross sectional retrospective study was conducted from February to March 2022. The study period was from March 2016 to February 2019 (before the MTC) and March 2019 to February 2022 (after the MTC). A predesigned data extraction form was used to obtain sociodemographic data of the children and their parents, clinical findings on admission and hospital outcome. The data was entered into CDC Epi info 2.4 and analysed using SPSS. A p-value of <0.05 was considered statistically significant. Results: Out of 129 files included in the study, 35 were pre-MTC and 94 after its creation. The hospital prevalence of SAM increased from 4% to 7% after the MTC’s creation. The mean MUAC (mid-upper arm circumference) was 11.1 ± 0.98 cm. Marasmus was the most common form of SAM (90.7%). The most common admission symptoms were fever (74.4%), diarrhoea (47.2%) and vomiting (32.6%). The most common comorbidities were malaria (29.5%), gastrointestinal infection (20.9%), sepsis (18.6%) and pulmonary infection (14%). There was an increase in the recovery rate (from 71.4% to 76.6%) and the rate of weight gain (from 3.5 g/kg/day to 8.7 g/kg/day). There was also a reduction in the death rate (from 14.3% to 9.6%) and length of in-hospital admission (from 10.24 ±5.4 days to 7.3 ±3.6 days) Conclusion: The MTC led to an increase in the influx of patients with SAM at the RHL, marasmus was the most common form of SAM. There was an increase in the rate of weight gain, a decreased mortality rate and decreased length of hospital stay, thus revealing the pertinent relevance of the MTC in the management of SAM.

Influenza virus detected in Patients screened for Mycobacterium tuberculosis and HIV

A total of 1.3 million people died from tuberculosis (TB) in 2022 (including 167,000 individuals with HIV) with a large proportion of them from sub-Saharan Africa. Unfortunately, there is paucity of data on influenza virus in both tuberculosis and HIV patients in Nigeria. Hence this study was designed to investigate influenza virus in tuberculosis and HIV patients attending chest clinics in Lagos State. A total number of 400 samples were collected from four different health facilities including three general hospitals and one tertiary institution health center. The population consists of 32.8% (131/400) males and 67.2% (269/400) females of which 11% (30/269) were pregnant. Their age ranged from 7 to > 65 years. Nasopharyngeal samples were extracted for influenza RNA with QIAamp mini kit followed by RT-PCR amplification. TB and HIV tests were performed as part of clinical management. Of the total patients tested, 26.8% (90/336) were HIV positive, 7.3% (29/400) had malaria parasitaemia, 2.5% (10/400) had tuberculosis and 1.8% (7/400) was asthmatic. Furthermore, the result showed 2.3% (9/400) low molecular prevalence to influenza A virus out of which 66.7% (6/9) were females. Interestingly, out of the nine (9) influenza A virus positive patients, 66.7% (6/9) had HIV, 44.4% (4/9) had TB while 33.3% (3/9) were co-infected with TB and HIV. Ikorodu General Hospital accounted for 55.6% (5/9) molecular prevalence to influenza while 44.4% (4/9) was recorded in Badagry General Hospital. In conclusion, this study is the first report of molecular detection of influenza virus in TB and HIV patients in Nigeria. The co-infection of influenza virus in TB and HIV patients underscores the need for a national surveillance and provision of influenza vaccines and antiviral drugs for the affected individuals.

Success of Combination Therapy with Isavuconazole in a Pediatric Patient with Breakthrough Invasive Aspergillosis

AbstractThe increasing incidence of invasive fungal infections, coupled with the growing population of immunocompromised patients, has led to an increased need for antifungal agents. The newest azole, isavuconazole, plays an important role in the treatment of invasive aspergillosis in adults due to its broad spectrum, tolerability, and no need for therapeutic drug monitoring. This agent, which has not yet been approved for use in children, has significant problems with drug supply in Türkiye. We present the treatment response to isavuconazole combination therapy used in salvage treatment in a patient with breakthrough invasive aspergillosis, who had treatment failure with different antifungal combination treatment options and surgical resection.

Barriers to, and Facilitators of, Checking Drugs for Adulterants in the Era of Fentanyl and Xylazine: Qualitative Study.

Overdose deaths continue to reach new records in New York City and nationwide, largely driven by adulterants such as fentanyl and xylazine in the illicit drug supply. Unknowingly consuming adulterated substances dramatically increases risks of overdose and other health problems, especially when individuals consume multiple adulterants and are exposed to a combination of drugs they did not intend to take. Although test strips and more sophisticated devices enable people to check drugs for adulterants including fentanyl and xylazine prior to consumption and are often available free of charge, many people who use drugs decline to use them. We sought to better understand why people in the New York City area do or do not check drugs before use. We plan to use study findings to inform the development of technology-based interventions to encourage consistent drug checking. In summer 2023, team members who have experience working with people who use drugs conducted 22 semistructured qualitative interviews with a convenience sample of people who reported illicit drug use within the past 90 days. An interview guide examined participants' knowledge of and experience with adulterants including fentanyl, xylazine, and benzodiazepines; using drug testing strips; and whether they had ever received harm reduction services. All interviews were audio recorded, transcribed, and analyzed for emerging themes. Most participants lacked knowledge of adulterants, and only a few reported regularly checking drugs. Reasons for not checking included lacking convenient access to test supplies, or a place to check samples out of the public's view, as well as time considerations. Some participants also reported a strong belief that they were not at risk from fentanyl, xylazine, or other adulterants because they exclusively used cocaine or crack, or that they were confident the people they bought drugs from would not sell them adulterated substances. Those who did report testing their drugs described positive interactions with harm reduction agency staff. New forms of outreach are needed not only to increase people's knowledge of adulterated substances and awareness of the increasing risks they pose but also to encourage people who use drugs to regularly check their substances prior to use. This includes new intervention messages that highlight the importance of drug checking in the context of a rapidly changing and volatile drug supply. This messaging can potentially help normalize drug checking as an easily enacted behavior that benefits public health. To increase effectiveness, messages can be developed with, and outreach can be conducted by, trusted community members including people who use drugs and, potentially, people who sell drugs. Pairing this messaging with access to no-cost drug-checking supplies and equipment may help address the ongoing spiral of increased overdose deaths nationwide.

Oral Fentanyl Consumption and Withdrawal Impairs Fear Extinction Learning and Enhances Basolateral Amygdala Principal Neuron Excitatory-Inhibitory Balance in Male and Female Mice.

The number of opioid overdose deaths has increased over the past several years, mainly driven by an increase in the availability of highly potent synthetic opioids, like fentanyl, in the un-regulated drug supply. Over the last few years, changes in the drug supply, and in particular the availability of counterfeit pills containing fentanyl, have made oral use of opioids a more common route of administration. Here, we used a drinking in the dark (DiD) paradigm to model oral fentanyl self-administration using increasing fentanyl concentrations in male and female mice over 5 weeks. Fentanyl consumption peaked in both female and male mice at the 30 µg/mL dose, with female mice consuming significantly more fentanyl than male mice. Mice consumed sufficient fentanyl such that withdrawal was precipitated with naloxone, with males having more withdrawal symptoms, despite lower pharmacological exposure. We also performed behavioral assays to measure avoidance behavior and reward-seeking during fentanyl abstinence. Female mice displayed reduced avoidance behaviors in the open field assay, whereas male mice showed increased avoidance in the light/dark box assay. Female mice also exhibited increased reward-seeking in the sucrose preference test. Fentanyl-consuming mice of both sexes showed impaired cued fear extinction learning following fear conditioning and increased excitatory synaptic drive and increased excitability of BLA principal neurons. Our experiments demonstrate that long-term oral fentanyl consumption results in wide-ranging physiological and behavioral disruptions. This model could be useful to further study fentanyl withdrawal syndrome and behaviors and neuroplasticity associated with protracted fentanyl withdrawal.

Coping with drug shortages: A study of government-enterprise option cooperation stockpiling strategies for drugs in shortage considering API surrogate stockpiling subsidies.

Drug shortage is a global problem, and the development of government-enterprise cooperative stockpiles of drugs in shortage, combining physical and production capacity, has become one of the most important means of coping with drug shortages. However, existing studies have tended to overlook the fact that shortages of Active Pharmaceutical Ingredients (APIs) have become an important constraint on production capacity stockpiling and that the lack of incentives and provisions for coordination of benefits have led to a double marginal effect of joint stockpiling by government and enterprises of drugs in shortage. Accordingly, this study introduced the option contract to the drug supply system composed of government and pharmaceutical enterprises and used the subsidy of API storage in lieu as an important initiative to incentivize the reserve of APIs, to construct a model of shortage drug reserve under the government's leadership. This study aims to improve the effect of government-enterprise joint stockpiling of drugs in shortage, which is of great theoretical and practical significance. According to the classification of production license types of pharmaceutical enterprises, this study established a three-level supply chain decentralized decision-making model consisting of the government, formulation enterprises, and API enterprises, and a two-level supply chain centralized decision-making model consisting of the government and API Formulation (API-F) integrated enterprises, respectively. By solving the inverse order derivation, the government-enterprise option cooperation conditions and optimal decision-making strategy were derived. The study results showed that: (i) The addition of enterprise API stockpiling mode can help the government conventional reserves, and enterprise production capacity reserves, broaden the way of drug reserves, and improve the effect of government-enterprise option cooperation; (ii) when the probability of drug shortages is high, the government should prefer the cooperation of API-F integrated enterprises, which is conducive to reducing intermediate links and government costs and improving the supply responsiveness to shortages of medicines; (iii) Setting appropriate government subsidies for API storage can incentivize enterprises to stockpile APIs and improve drug production capacity and physical supply response capability. This study took the problem of socialized stockpiling of drugs in shortage as an entry point and explored the problems and solution strategies in the government-enterprise cooperative stockpiling of drugs in shortage, which not only made some theoretical contributions to the application of options contract in the government-enterprise cooperative stockpiling of drugs in shortage but also provided new ideas and theoretical basis for the improvement of the stockpiling work of drugs in shortage.

Estimated Financial Savings From Clinical Studies at Oslo Myeloma Center in the Period 2015-2021

BackgroundThe number of clinical studies in the Western world has been declining the last decade. Clinical studies offer valuable opportunities for cancer patients to access new treatments and serve as arenas for learning and competence development for health care workers. In addition to this, clinical studies can significantly contribute to financial savings for the health care system through the provision of drugs. The extent of these savings have not been evaluated before. Materials and MethodsWe assessed the financial savings from drugs provided in clinical studies conducted at Oslo Myeloma Center between 2015 and 2021. Only drugs that had marketing license or another equivalent drug with marketing license were considered to estimate savings. ResultsA total of 314 patients across 24 different studies were given treatment with drugs possessing marketing license. Drugs approved for clinical use and reimbursed by the national health care system gave a financial saving of 20.3 million USD and was considered a direct saving. Drugs not approved for clinical use, but having equivalent approved alternatives yielded a financial saving of 4.7 million USD. ConclusionClinical studies not only offer new opportunities for patients and advancements in medical treatment and knowledge but also contribute significantly to financial saving for the health care system through reduced drug expenses.