Levels Of Drug Consumption Research Articles

A Review of the Comprehensiveness of Provincial Drug Coverage for Canadian Seniors

ABSTRACTProvincial government drug plans are the primary source of insurance for drugs taken by seniors in outpatient settings. The adequacy of this coverage has been called into question, given the increased clinical importance of pharma-ceuticals, shifts in the provision of health care from inpatient to outpatient settings, increased use of restrictive formularies, and reductions in provincial drug subsidies. To assess the adequacy of provincial coverage, we estimated what a typical single senior beneficiary of a provincial drug plan paid out-of-pocket in 1998 on prescription drugs covered by the public program, depending on his/her province of residence, level of drug consumption, and income. We compared provincial coverage for seniors with large drug costs. We also assessed provincial coverage of drugs that were introduced into the Canadian market between 1991 and 1998. The cost of drugs consumed by a senior in a given province and year was estimated by multiplying the average number of prescription drugs consumed by senior drug users by the average per-prescription costs. High drug consumption was defined as twice the average. We used the provincial drug cost sharing rules to estimate the senior's share of the total cost of drugs consumed. Mean out-of-pocket costs range from $42 to $1,302 per year, are lower for lower-income seniors, and increase with drug use, although the charge per drug decreases with the number used. There was up to a 12-fold variation among the provinces in the charges faced by seniors with similar incomes and drug use. All but one province limits costs to seniors with catastrophic drug costs, but there was 21-fold variation in the expenditure limits. The substantial variation in seniors' out-of-pocket drug costs raises questions about the distributive equity of drug subsidies in Canada. Recent evidence on the deleterious health effects of drug charges faced by seniors in Quebec and the fact that seniors in some other provinces face direct charges similar to those faced in Quebec raise the possibility of adverse consequences of drug charges in other provinces.

Illicit i.v. drugs. A public health approach.

This article explores, from a public health perspective, the harm done by Canadian drug laws, to both individuals and society. It challenges the perceived dichotomy of legalization and criminalization of intravenous drugs. The article then expands the discussion by exploring eight legal options for illicit drugs and examines how these options interact with the marginalization of users, the illicit drug black market, and levels of drug consumption. While the main focus of this article is intravenous drugs, it draws some lessons from cannabis research.

Illicit IV Drugs

This article explores, from a public health perspective, the harm done by Canadian drug laws, to both individuals and society. It challenges the perceived dichotomy of legalization and criminalization of intravenous drugs. The article then expands the discussion by exploring eight legal options for illicit drugs and examines how these options interact with the marginalization of users, the illicit drug black market, and levels of drug consumption. While the main focus of this article is intravenous drugs, it draws some lessons from cannabis research.

An Exploration of the External Validity of Self-Report amongst Arrestees

Self-report validation surveys in the USA focussing on arrestees' self-reports unequivocally demonstrate that they do not validly report their recent drug consumption despite being a highly drug involved group. Like their American counterparts, English arrestees display very high levels of drug consumption. Data used from the NEW-ADAM programme (1998) is used to explore the external validity of arrestees' self-reports to drug consumption in the 3 days prior to interview. Drug consumption in the UK has become a normalized activity among adolescents, young adults and 'clubbers'. Arrestees and young offenders have recently been added to this list. Therefore the normalization of drug use provides an interesting context through which to view the present findings amongst arrestees.

Money Laundering and Its Regulation

This article examines definitions of "money laundering" and the conceptual and actual role its regulation plays in dealing with drug markets. If laundering is prevented, incentives to become major criminals are diminished. It identifies and critiques three aspects of harm arising from laundering: facilitating crime groups' expansion, corroding financial institutions, and extent. After a discussion of laundering techniques used with drug money, including the symbiotic relationship with some otherwise legitimate ordinary businesses, the article examines the history of public- and private-sector antilaundering policies and their implementation in the United States and globally. It concludes that much detected laundering involves the same out-of-place judgments the police use, but though the proportion of routine and suspicious activity reports that yield arrests may be low, they do generate some important enforcement actions. Nevertheless, the impact of antilaundering efforts on enforcement resources, organized crime markets, or drug consumption levels remains modestly understood at present.

Comparison of individual and group cognitive‐behavioral therapy for alcohol and/or drug‐dependent patients

A randomized clinical trial was performed to evaluate the influence of two formats of cognitive-behavioral psychotherapy (individual vs. group) in the treatment of alcohol and/or drug dependent patients. Public outpatient drug dependence service. One hundred and fifty-five alcohol and/or drug-dependent patients. The patients were randomly assigned to individual (n = 77) or group (n = 78) treatment formats. The treatment was developed into two phases: acquisition (eight sessions) and maintenance (nine sessions), distributed over an 8-month period. Alcohol and drug use, severity of dependence, and alcohol- and drug-related problems were evaluated at pre-treatment and 15 months after admission to treatment. At follow-up evaluation both groups of patients presented similar levels of drug consumption, dependence and associated problems. Although group-treated patients reported slightly higher levels of alcohol consumption (both at baseline and follow-up) differences between the formats disappear if baseline levels are included as covariates. Compliance with treatment and a measure of drug severity were predictors of success for the drug dependents. The number of sessions attended and high GGT levels at admission were positively correlated with success for the alcohol dependents. The two modalities presented similar outcomes and, as the group format could present a better cost-benefit ratio, it may be used without decreasing compliance with treatment or treatment effectiveness.

An exploratory outcome audit of acupuncture treatment for pain management in a general practice

This paper describes an audit of acupuncture using a ‘trial’ group who received acupuncture and a matched control group who continued with ‘conventional’ treatment in a general practice. Outcome comparisons in terms of pain levels, disability levels and drug consumption levels were made. The acupuncture group showed reduced pain and disability levels, and reduced analgesic consumption. A more substantial trial and follow-up is planned for this year.

Drug Consumption in Workers in France: A Comparative Study at a 10-Year Interval (1996 versus 1986)

This study compared drug consumption and associated social factors in workers in France between 1986 and 1996. The same transversal survey was performed in 1986 and 1996 using the same methodology by means of an anonymous questionnaire given to the subject and answered in the presence of an occupational physician. The 1996 population (2674 subjects) was found to be older (37.0 ± 9.8 versus 35.7 ± 10.2 years) and to take more drugs (+5.1%) than the population of 1986 (2221 subjects). There were fewer manual workers in the 1996 population. In both periods, women used significantly more drugs in general and more psychoactive (mainly anxiolytic), cardiovascular, endocrine metabolic, and homeopathic drugs than men. The mean value of estimated difficulty of work was higher in subjects taking drugs in general, and especially those taking hypnotic, anxiolytic, psychoactive, antiinflammatory, and digestive drugs in 1986 as well in 1996. In 1986 as well as in 1996, manual workers took no more drugs than did nonmanual workers in general, except for analgesic and antiinflammatory drugs. Nonmanual workers used homeopathic drugs more than manual workers. The presence of extraprofessional problems was associated with an increase in consumption of drugs in general and psychoactive, hypnotic, anxiolytic, antiinflammatory, cardiovascular, digestive, and endocrine metabolic drugs in particular, in 1986 as well as in 1996. After adjustment for variables linked to drug use, there was no significant change in total drug consumption in general but a significant decrease in psychoactive (−49%) (mainly hypnotic [–71%]), and digestive (−39%) drug consumption in this population between 1986 and 1996. In contrast, analgesic use significantly increased (+36%). This study underscores the high level of drug consumption in workers (more than 40% of the subjects were taking drugs). Although there were no quantitative changes, marked qualitative modifications were found with a decrease in consumption of psychoactive (and mainly hypnotic) and digestive drugs and an increase in analgesic drug use between 1986 and 1996. Thus, specific drug information programs designed to reduce psychoactive drug consumption and to favor analgesic drugs for better pain management seem to have been (at least partly) followed. The study also underscores the importance of some social factors associated to general and specific drug use (mainly difficulty of work and presence of extraprofessional problems, and to a lesser extent, kind of work). Their weight remained similar in 1986 and 1996.

Drugs in Southern Africa: An overview

This article presents an overview of the availability and supply of various types of drug and patterns of drug use in southern Africa, a region of the developing world currently experiencing a marked period of transition. The socioeconomic diversity and multi-faceted cultural dualism so characteristic of the region are reflected in patterns and levels of drug consumption. While alcohol, both licit and illicit, is still the major drug of abuse, others including methaauolone, solvents, khat and pharmaceuticals are reported to be increasingly abused, and illegal drugs in transit through the regions, such as cocaine and heroine, are more likely to be consumed locally. Available data suggest that the cultivation of cannabis as an export commodity is also increasing. Traditional cultural uses of this drug, however, illustrate the problem of controlling drugs and preventing their abuses within the context of modernizing post-colonial societies. The development of relevant community-led drug prevention strategies...

Mortality, morbidity and drug consumption in a rural area (Spain).

A descriptive study was made of the health indicators in 5 rural municipalities of the province of Castellón (Spain), with a total of 1428 inhabitants. This population is characterized by its aging, 36.9% of all individuals being older than 65 years. A retrospective evaluation was made of the annual mortality rates between 1940 and 1990, and of morbidity and medications consumption for the period between June 1991 and May 1992. An increase in general mortality was observed during the study period, though the rates also diminished in relation to age groups, sex and cause of death. In addition, 59.45% of the study population made use of health-care services in the course of one year, an average of 2.59 drugs being prescribed per inhabitant in that same period. Morbidity in decreasing order of importance was attributed to acute respiratory disease, osteomuscular disorders, hypertension, depression and gastric pathology. Medications for the common cold and coughing were the most frequently used drugs, along with pain-killers, cardioactive agents, psycholeptics and non-sterioidal anti-inflammatory drugs (NSAIDs). Aging causes the mortality variations recorded, despite the socio-sanitary improvements observed in the zone during the study period. Aging may also be related to the important use of healthcare services and of drugs noted in the study. The highest morbidity rates and drug consumption levels corresponded to chronic diseases that deteriorate patient quality of life without actually increasing mortality.

Regulatory differences and similarities: systems in Japan.

The historic steps that led up to the present federal drug regulations in the United States are outlined as a background to the development of the current drug regulatory system in Japan, consisting of the procedures for approval of new drugs, of double-brand naming, by which the same drug under different names can be sold as ethical or over-the-counter (OTC). The more recent provisions for re-evaluation of drugs, the mechanism for monitoring adverse reactions, and the dissemination of the collected information are described. The prescription habits of physicians, the influence of the health insurance systems on these, and the strikingly high level of drug consumption in Japan, as compared with those in other industrial countries, are discussed and illustrated graphically.