Legal Drugs Research Articles

B-166 Effect of Urine Adulteration on Quantifying both Delta 8- and Delta 9-carboxy tetrahydrocannabinol using a New UPLC-tandem Mass Spectrometry Method

Abstract Background The legality and use of marijuana is a controversial topic. With increased prevalence of usage, cannabis detection for legal, medical, and workforce drug testing is on the rise. LC-MS/MS quantification of delta 9-carboxy tetrahydrocannabinol (delta 9-THC-COOH) in urine is accepted as the standard to detect marijuana use. One challenge faced by testing laboratories has been identifying adulterated samples. Many products/reagents can be used to manipulate the urine to avoid positive drug testing results. In this study, we developed a dilute-and-shoot strategy to separate and quantify both the delta 8- and 9-THC-COOH in urine samples and tested the effects of adulteration using a combination of nitrite and/or acids which can be used to mask cannabinoid use. Methods Five authentic delta 8- and 9-THC-COOH positive specimens, and one spiked sample were treated with strong acids (1N HCL or 10% TCA), 500 µg/mL nitrite, or a combination. After hydrolysis with sodium hydroxide, the analytes were quantified using a 6495 Mass Spectrometer coupled to a StreamSelect LC system (Agilent). LC separation was performed with a CORTECS T3 column utilizing a shallow gradient. In addition, twelve urine specimens with varying concentrations of delta 8- and 9-THC-COOH were treated with nitrite and screened using a delta 9-THC-COOH immunoassay on the Roche Cobas C501 and analyzed by LC-MS/MS. Results Nitrite did not change the physical appearance or the pH of the urine samples. Strong acid treatment also did not alter the appearance but did drop the urine pH ≤2. Pre-treated specimens with 1N HCL, 10% TCA, or 500 µg/mL of nitrite did not affect the delta 8- and 9-THC-COOH concentrations up to 6 days (refrigerated); however, specimens treated with strong acid combined with 500 µg/mL of nitrite for 30 min made both analytes undetectable. Additional experiments confirmed that 0.5 and 1 mol/L of nitrite lowered the concentration of all analytes, including internal standard, to undetectable levels in 48 h. Twelve additional specimens were collected, 3 with delta 8-THC-COOH, 3 with delta 9-THC-COOH, and 6 with both. All 12 samples screened positive using the Roche immunoassay and were quantified using the LC-MS/MS method. After treatment with 0.5 mol/L of nitrite, 10 of the 12 samples were negative using the immunoassay, but 2 samples remained positive. However, all nitrite treated specimens were negative (<LLOQ) using the LC-MS/MS method and the internal standard was eliminated. Later experiments confirmed that the delta 8- and 9-THC-COOH could be eliminated with as little as 0.1 mol/L nitrite for 30 min. Conclusion The unique dilute-and-shoot method can separate and quantify delta 8- and 9-THC-COOH. In addition, high concentrations of nitrite were shown to degrade both analytes along with the isotopically labeled internal standard. As a result, labs can distinguish true negative delta 8- and 9-THC-COOH (no analyte peaks) from nitrite adulterated specimens since the adulterated samples have no peaks for both the analytes and internal standard. A limitation of the study is that only sodium nitrite was tested. Other adulterants, such as potassium nitrite, pyridinium chlorochromate, peroxide etc. require further investigation.

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.

Decriminalization of Narcotics in Jordanian Legislation: Theory and Practice

This study delves into recent legislation in Jordan regarding the decriminalization of narcotics and traces the evolution of related legislation in the country. It explores the definition and underlying philosophy of decriminalization while examining arguments from both proponents and opponents of drug decriminalization from a jurisprudential perspective. Additionally, the research sheds light on practices that have emerged in response to the decriminalization of narcotics in other jurisdictions. The study thoroughly examines the advantages and disadvantages of decriminalizing narcotics, analyzing its potential impact on drug consumption. Finally, the researcher proposes the implementation of a gradual and partial systematic plan within Jordanian legislation to address the growing trend of drug decriminalization. The paper also provides insights into the stances of the United States and other countries on this issue and how their legislations have addressed it.

"We just don't have the space for it": Geographies of survival and spatial triage in overdose prevention sites.

This study explores the role of Overdose Prevention Sites (OPS) within the geographies of survival of vulnerably housed people who use drugs (PWUD) in Vancouver, British Columbia (BC), Canada. In BC, OPS are low-barrier spaces where people may use drugs under monitoring of trained staff. OPS have been established by people who use drugs, activists, and allied organizations as an emergency measure to prevent overdose deaths. However, OPS have other important uses for PWUD who are vulnerably housed and rely on public spaces for survival. Drawing on two years (2018-2020) of ethnographic fieldwork and interviews with fifty-five people who work at and/or use OPS, we explore how OPS operators negotiated multiple and at times competing uses of service space for everyday survival. Data analysis was guided by critical urban theory to explore the place of OPS within PWUD's geographies of survival, with attention to how different uses of space were negotiated within the context of an illicit drug poisoning crisis and urban control practices that displace and exclude unhoused and vulnerably housed PWUD from the city. We find that OPS accommodated other important potential uses of space for unhoused and vulnerably housed PWUD who relied on public space for survival and were routinely displaced by revanchist urban control strategies. Low-barrier approaches and facility enhancements to OPS improved program accessibility and enabled PWUD to use the sites more broadly to meet survival needs including for mutual-aid, sheltering, and income-generation. However, these secondary uses of OPS presented multiple operational challenges as service volumes increased. We observed processes of 'spatial triage' emerge within sites to manage these challenges, which we characterise as a pragmatic set of rules, procedures, and spatial practices that constrained broader uses of OPS within PWUD's geographies of survival. While spatial triage offered a pragmatic way of prioritizing service delivery to address the most acute survival threats of overdose fatality, these practices had unintended and inequitable impacts on service access. Our findings indicate the need for complementary structural changes as part of overdose responses to reduce the need for spatial triage (i.e., safe, affordable housing and drug decriminalisation) and service innovations to mitigate potential harms (e.g., Expanded drop-in and chill spaces, temporary storage spaces for service user).

Cannabis Policy Adaptation: Exploring Frameworks of State Policy Characteristics

Thirty-six states adopted some form of legalized cannabis by 2020, and policy characteristics varied considerably across the states. Nineteen of those states initially adopted legalized cannabis via ballot measure, and seventeen initially adopted via legislation. Implementation of cannabis policy across these types of policy adoption differed substantially in process and policy design. To characterize the policy environment, we develop a unique coding scheme for legalized cannabis with policy characteristics aggregated into three policy bundles. The pharmaceutical bundle treats cannabis as a legal but regulated drug. The permissive bundle allows greater individual discretion on cannabis use. The fiscal bundle treats cannabis as a potential revenue source. Using these policy bundles from the years 1994-2020, we explore how states continue to modify their policy approaches in the implementation period and assess the factors shaping policy adaptation over time, such as administrative capacity, partisan control, state fiscal health, and economic factors.

Decriminalization thresholds for drug possession: A multi-criteria policy analysis framework.

Decriminalization of personal possession of drugs has been proposed as an approach to mitigate the harms of drug prohibition. Despite growing interest, particularly in Canadian settings, analyses of approaches to defining the parameters of what constitutes personal possession within decriminalization models are lacking. Using the Province of British Columbia, Canada, as a case study, we undertook an evidence-based multi-criteria policy analysis of three models for defining personal possession: 1) a model that defines personal possession as the absence of evidence of drug trafficking; 2) a cumulative threshold of 15grams; and 3) a cumulative threshold of 2.5grams. We utilized data from four sources: qualitative interviews with 16 experts, including representatives from government and law enforcement; Vancouver Police drug seizure data; self-reported drug consumption data from longitudinal cohorts of people who use drugs in Vancouver; and publicly available government documents (e.g., the Government of BC's submission for decriminalization). Data was used to identify and define evaluation criteria which reflect the stated policy objectives of decriminalization alongside other policy considerations. This framework was used to conduct a multi-criteria policy analysis of the three different models. The seven evaluation criteria included: 1) reduction in interactions with police; 2) reduction of police drug seizures; 3) coverage for those with high consumption; 4) impact on equity-deserving groups; and acceptance on the part key stakeholders, including: 5) people who use drugs; 6) law enforcement; and 7) the public. The model that performed the best was the cumulative threshold model of 15grams. Findings highlight that different threshold models advance and constrain the stated policy objectives of drug decriminalization to varying degrees. This analysis provides a framework that other jurisdictions considering decriminalization could use to help inform determinations of threshold levels based on stated policy objectives.

Substance use, psychiatric symptoms, personal mastery, and social support among COVID-19 long haulers: A compensatory model.

Substance use has become a critical health concern during the COVID-19 pandemic, and emerging attention has been paid to people with the persistent symptoms of COVID-19 (COVID-19 long haulers) due to their high vulnerability. However, scant research has investigated their substance use and relevant psychosocial factors. The current study was to (1) examine substance use behaviors (i.e., legal drug use, illicit drug use, and non-medical use of prescription drugs); and (2) assessed their associations with psychiatric symptoms (i.e., depression, anxiety, and post-traumatic stress disorder) and psychosocial factors (i.e., personal mastery and social support) among COVID-19 long haulers. In January-March 2022, 460 COVID-19 long haulers (50% female), with an average age of 32, completed online surveys regarding their demographics, substance use, psychiatric symptoms, and psychosocial factors. In the past three months, the most commonly used or non-medically used substances were tobacco (82%) for legal drugs, cocaine (53%) for illicit drugs, and prescription opioids (67%) for prescription drugs. Structural equation modeling suggested that psychiatric symptoms were positively associated with substance use behaviors (βs = 0.38 to .68, ps < 0.001), while psychosocial factors were negatively associated with substance use behaviors (βs = -0.61 to -0.43, ps < 0.001). Substance use is common in COVID-19 long haulers and psychiatric symptoms are the risk factors. Personal mastery and social support appear to offer protection offsetting the psychiatric influences. Substance use prevention and mental health services for COVID-19 long haulers should attend to personal mastery and social support.

"All carrots and no stick": Perceived impacts, changes in practices, and attitudes among law enforcement following drug decriminalization in Oregon State, USA.

By passing Ballot Measure 110 (BM 110), Oregon became the first U.S. state to decriminalize noncommercial possession of drugs that are illegal under the Controlled Substances Act.This study examined the perceived impacts of BM 110 on law enforcement and Oregon communities. Our team visited four geographically distinct Oregon counties in August 2022 (two urban, two rural). The qualitative study involved conducting 34 hour-long interviews with law enforcement, other criminal legal system personnel, and representatives from emergency medical services/fire and substance use treatment and harm reduction agencies. Interviewees were asked about their perceptions of BM 110's effects on law enforcement, their communities, and agencies. Law enforcement interviewees viewed BM 110 as a failure; they perceived it resulted in an erosion of their authority. They expressed frustration that they could not use drug possession as a "tool" for investigations to pursue and build cases, establish probable cause, and impose what they believed necessary for social order. Law enforcement personnel in all four counties indicated they routinely seized drugs and drug paraphernalia during encounters with people using drugs, even when that was the only offense being committed. Police lacked knowledge that BM 110 included support for harm reduction services, housing assistance, and employment support. Law enforcement personnel had different opinions and practices regarding issuing Class E violations; those who did not issue them viewed them as a waste of time because they are not entry points into the criminal legal system. This study provides insights into drug decriminalization in Oregon. This examination is critical for informing BM 110's continued implementation as Oregon proceeds with increased treatment and support service provision. Our findings have important implications regarding other states' design and implementation of drug policy alternatives, including ones that remove law enforcement's role in addressing drug use.

Does drug decriminalization increase unintentional drug overdose deaths?: Early evidence from Oregon Measure 110

This paper evaluates the causal effect of drug decriminalization on unintentional drug overdose deaths in a context with relatively poor access to drug treatment services. Using the synthetic control method, I find that when Oregon decriminalized small amounts of drugs in February 2021, it caused 182 additional unintentional drug overdose deaths to occur in Oregon in 2021. This represents a 23% increase over the number of unintentional drug overdose deaths predicted if Oregon had not decriminalized drugs.

PERANCANGAN USER INTERFACE PADA START-UP KESEHATAN HEALTHY MENGGUNAKAN METODE DESIGN THINKING

Health is everyone's priority. When a person experiences health problems, the best effort will be made by the patient and his family. Because complete information about health services, medicines and supporting medical devices is crucial and most sought after. Healthy digital start-ups are designed to find solutions and bridge these difficulties by connecting Pharmacy partners and Medical Device Stores who are able to provide BPOM-certified legal drug products and quality medical devices with users, in this case patients and their families. In this study, the method used was "design thinking, analysis using SWOT and feasibility study analysis using TELOS. The UI design testing process used 10 Usability Heurisitic indicators with a test result of 87%. This proves that the digital start-up designed has answered user needs.

'Drug decriminalization' in Canada: a plea for a nuanced, evidence-informed, and realistic approach towards improved health outcomes.

Canada has been home to an exceptional public health crisis of illicit (mainly synthetic opioid but increasingly other) drug deaths for numerous years. Despite extensive health-oriented interventions, this crisis remains acute and devastating. Earlier this year, the federal and British Columbia governments implemented the 'drug decriminalization initiative' (DDI) which exempts drug users from criminal enforcement of small amounts of personal drug possession; this has been promoted as a 'solution' for the drug-death crisis. This commentary examines and discusses that while decriminalization of drug use is fundamentally required to align drug policy with principles of health, evidence-based consideration of the drug death crisis' essential dynamics as well as enforcement realities substantially curtail the DDI's plausible prospects to significantly reduce the drug-fatality toll. Decriminalization efforts elsewhere ('Portugal model') are set in distinct ecologies and parameters, and not readily transferable to Canadian contexts. While the DDI has symbolic value for policy reform, for decriminalization to provide tangible benefits for drug users and public health, its scope and design require fundamental reconsideration and improvement. Meanwhile, given the principally causal role of toxic drug supply for the current drug-death epidemic, more effective health and life-saving measures-specifically involving 'safer supply'-need to be urgently implemented to alleviate this crisis.

“Criminalization Causes the Stigma”: Perspectives From People Who Use Drugs

Introduction In light of North America's persisting drug toxicity crisis, alternative drug policy approaches such as decriminalization, legalization, regulation, and safer supply have increasingly come to the forefront of drug policy discourse. The views of people who use drugs toward drug policy and drug law reform in the Canadian context are essential, yet largely missing from the conversation. The aim of this study was to capture the opinions, ideas, and attitudes of people who use drugs toward Canadian drug laws and potential future alternatives. Methods This paper was developed as part of the Canadian Drug Laws Project, a cross-jurisdictional qualitative study conducted in British Columbia, Canada between July and September 2020. The qualitative data are from 24 semi-structured interviews with a diverse sample of people who use illegal drugs. Interviews were recorded, transcribed, coded, and analyzed thematically by the research team. Results Two main themes and corresponding sub-themes are presented: (1) The experience of stigma as a consequence of criminalization; (2) The perceived benefits of drug law reform. Participants spoke in-depth about their experiences living within a criminalized drug policy context and offered suggestions for new pathways forward. Their perspectives illuminate how Canada's drug laws may shape public attitudes toward people who use drugs and the consequent manifestations of structural, social, and self-stigma experienced by people who use drugs. Conclusion Participants openly and profoundly believed that current drug laws produced and propagated the public attitudes and structural inequities experienced by people who use drugs in Canada. This matters, not only because our findings highlight the fact that people who use drugs experience stigma in tangible and clearly impactful ways, but it also suggests that the criminlilization of drugs shapes the experience of structural, social, and self stigma. Finally, participants believed that efforts to destigmatize people who use drugs would be ineffectual without the enactment of more robust forms of drug law reform such as the decriminalization of illegal drugs.

Translating Kratom-Drug Interactions: From Bedside to Bench and Back.

Kratom is a botanical natural product belonging to the coffee family, with stimulant effects at low doses and opioid-like effects at higher doses. During the last two decades, kratom has been purported as a safer alternative to pharmaceutical and illicit drugs to self-manage pain and opioid withdrawal symptoms. Kratom alkaloids, typically mitragynine, have been detected in biologic samples from overdose deaths. These deaths are often observed in combination with other drugs and are suspected to result from polyintoxications. This review focuses on the potential for kratom to precipitate pharmacokinetic interactions with object drugs involved in these reported polyintoxications. The legal status, chemistry, pharmacology, and toxicology are also summarized. The aggregate in vitro and clinical data identified kratom and select kratom alkaloids as modulators of cytochrome P450 (P450) enzyme activity, notably as inhibitors of CYP2D6 and CYP3A, as well as P-glycoprotein-mediated efflux activity. These inhibitory effects could increase the systemic exposure to co-consumed object drugs, which may lead to adverse effects. Collectively, the evidence to date warrants further evaluation of potential kratom-drug interactions using an iterative approach involving additional mechanistic in vitro studies, well designed clinical studies, and physiologically based pharmacokinetic modeling and simulation. This critical information is needed to fill knowledge gaps regarding the safe and effective use of kratom, thereby addressing ongoing public health concerns. SIGNIFICANCE STATEMENT: The botanical kratom is increasingly used to self-manage pain and opioid withdrawal symptoms due to having opioid-like effects. The legal status, chemistry, pharmacology, toxicology, and drug interaction potential of kratom are reviewed. Kratom-associated polyintoxications and in vitro-in vivo extrapolations suggest that kratom can precipitate pharmacokinetic drug interactions by inhibiting CYP2D6, CYP3A, and P-glycoprotein. An iterative approach that includes clinical studies and physiologically based pharmacokinetic modeling and simulation is recommended for further evaluation of potential unwanted kratom-drug interactions.

Lost lives and opportunities for the legacy of harm reduction in Scotland, UK

Lost lives and opportunities for the legacy of harm reduction in Scotland, UK

Estimation of legal and illegal drugs consumption in Valencia City (Spain): 10 years of monitoring

Wastewater-based epidemiology (WBE) approach provides objective, quantitative, near real-time profiles of illicit drug consumption by monitoring the concentration of unchanged parent drugs or their metabolites entering the municipal sewage system. Valencia is the third most populous city in Spain (an important country for the use and transit of several of these drugs). Estimations of consumption over long periods of time will help get better understanding of spatial and temporal trends in the use of licit and illicit drugs. Accordingly, applying the “best practice” protocol, 16 drugs of abuse and metabolites were monitored in this study, and 8 were daily measured during one-two weeks between 2011 and 2020 at the inlet of three wastewater treatment plants of Valencia City. Analysis of the selected compounds was performed by liquid chromatography-triple quadrupole mass spectrometry, and the concentrations obtained were used to back-calculate the consumption data. Cannabis, tobacco, and cocaine were the most consumed drugs whereas opioids were less used. Cannabis and cocaine consumption are on average 2.7–23.4 and 1.1–2.3 g/day/1000inh, respectively, and their use tended to increase since 2018. Weekly profiles were characterized by higher consumption of cocaine, ecstasy, and heroin during weekends compared to weekdays. Similarly, during “Las Fallas” (main local festivity), increased use of cocaine and amphetamine-type stimulants, mainly MDMA, was measured. WBE proved to be an objective and useful methodology to get more insight on temporal drugs of abuse consumption, and the changes derived from local festivities.

Alcohol and substance dependence in the United Arab Emirates: a scoping review protocol

IntroductionDespite cultural, religious and legal constraints, alcohol and drug abuse is rising in the United Arab Emirates (UAE). Therefore, we aim to produce a scoping review to summarise available scientific...

Drugs, Willpower, and the Colonial Biopolitics of Addiction in Vietnam

This article examines the early twentieth-century transformation of the opium addict in colonial Vietnam into a distinct category of person, diseased and in need of special forms of intervention. Braiding together French and Vietnamese discourses around drug use and its social consequences, the article traces the development of a specifically colonial biopolitics of addiction. While the proliferation of both legal and illegal drugs came to signify different kinds of risk for French and Vietnamese audiences, this article argues that the coalescence of these discourses around the notions of willpower and self-determination nevertheless represented a powerful new assertion of state and social control over the body of the addict.

The Impact of Decriminalizing Enhancement Drugs on Society

The decriminalization of enhancement drugs has had a major impact on society. These drugs, which are designed to increase physical and mental performance, have become increasingly popular among athletes and other individuals seeking an edge in their chosen field. Decriminalizing these substances has allowed for more open discussion about their use and potential benefits while also removing the stigma associated with them as well as any legal ramifications that may have been attached previously. This shift in attitude towards enhancement drug use is likely to lead to increased research in the area, leading to a better understanding of how they work and what effects they can produce when used responsibly. In this opinion, I briefly discuss topics related to the criminalization of enhancement drugs. First, I investigate the question, “What is an enhancement drug?” using my own research. Second, I explore how drug use is regulated. Finally, I situate these debates in relation to calls for drug decriminalization. The regulation of drug use is a complex issue that involves legal, social, and health considerations. Decriminalization has been proposed to address the negative consequences of drug use and reduce the harms associated with criminalization. I conclude by exploring the potential implications of decriminalization for society and discuss the need for further research in this field.

Drug decriminalization: The importance of policy change for the health and wellbeing of children and youth in Canada.

The criminalization of drug use and possession has demonstrable harms on the health of children and youth, with disproportionate effects on Black people, Indigenous people, people from other racially oppressed communities, and people living in poverty. Drug decriminalization, by separating personal possession and use of drugs from the criminal justice system, allows for a health-based approach to drug policy. Paediatricians are well-positioned to advocate for policies within a decriminalization framework to prioritize the physical and mental health of children and youth.

From punishment to help? Continuity and change in the Norwegian decriminalization reform proposal.

In 2018 the Norwegian government appointed a committee to prepare the implementation of a drug decriminalization reform. The overall goal of the committee was to propose a model where responsibility for society's response to the use and possession of illegal drugs for personal use would be transferred from the justice sector to the health service, under the catchphrase 'from punishment to help'. While the proposal ultimately did not get the necessary backing in parliament, the proposed reform still constitutes a very comprehensive and recent proposal for reforming national drug policy and it provides an ideal case for studying contemporary discourses on 'drug decriminalization'. The analysis of this reform proposal is guided by the post-structuralist "What's the Problem Represented to be" (WPR) approach, which is used for investigating the problem representation(s) in the proposal, as well as the rationalities, practices and deep-seated assumptions underpinning these. In doing this, the paper explores how the strategy represents both changes and continuities in discourses around illicit drugs and the people who use them. Based on the WPR approach, two problem representations in the proposal are identified: the 'problem of illicit drug use' and the 'problem of criminalization'. However, the 'problem of illicit drug use' is argued to be the authoritative representation, that takes precedence over the other. In that regard, the paper points to how the proposed shift from the justice sector to the health sector would only be partial, given that the role of the police and drug law enforcement would be retained in the reform. Furthermore, the paper points to how illicit drug use continued to be fundamentally pathologized in the proposed reform. The paper concludes with a discussion about the overall ambition of shifting from a crime-centered to a health-centered approach to people who use drugs and some reflections on the potential of an additional rights-based approach is provided.