Drug Market Research Articles

HELP PHARMACEUTICAL INDUSTRY TO BUILD MEANINGFUL PERSONALIZED HEALTHCARE PROFESSIONAL EXPERIENCE

Unlike the consumer industry, biopharma, medical technology, and wellness companies have struggled to build meaningful, personalized patient and healthcare professional (HCP) experiences. The increase in drug launches and growing competition across therapy areas has made it challenging for brands and organizations to stand out from the crowd, whether for new molecules vs. legacy brands in an established treatment area and their generic counter-parts or for new molecules in a rare disease where trust is not yet earned. The customers’ needs and preferences are changing at lightning speed. The hierarchy of engagement has transformed, disrupting the dynamic between patients and healthcare professionals. Studies (1, 2) show that drug marketers too often turn various aspects of their product profile into signals – and may inadvertently “reinforce the habitual behavior the marketer is trying to change”. We encourage pharmaceutical companies to use a “data-driven approach to uncover new opportunities for growth” and improvement, and we’re committed to delivering results that make a difference for the patient, HCPs and for the system (value-based healthcare approach). Applying the Brand Leadership Circle, a new strategic tool, will help understand the patients’ journey and other stakeholders’ needs to implement successful approaches in marketing, communications and services using systematic research methods and techniques.

Comparative Assessment of the Addictive Potential of Synthetic Cathinones by Zebrafish Conditioned Place Preference (CPP) Paradigm.

Synthetic cathinones have gained increasing popularity in the illicit drug market, yet their abuse potential remains poorly understood. In this study, zebrafish were used to compare the addictive potential of three cathinone analogs, namely pentylone, eutylone, and N-ethylpentylone (NEP). The zebrafish received various doses (0 to 60 mg/kg) of the cathinone analogs by oral gavage over two sessions per day for two consecutive days to induce conditioned place preference (CPP). Pentylone, eutylone, and NEP dose-dependently induced CPP, with NEP showing significantly higher CPP than pentylone and eutylone at the dose of 20 mg/kg. The fish that received 60 mg/kg of cathinones underwent extinction, followed by reinstatement triggered by drug priming. NEP required six sessions to meet the criteria of extinction, followed by eutylone, which required four sessions, and pentylone, which required three sessions. Furthermore, NEP and eutylone at a dose of 40 mg/kg could reinstate the extinguished CPP, while 60 mg/kg of pentylone was necessary for CPP reinstatement. The persistence of susceptibility to reinstatement was also assessed at 7 and 14 days after the initial reinstatement. The CPP induced by all three cathinone analogs could be reinstated 7 days after the initial reinstatement, whereas only CPP induced by NEP, but not pentylone and eutylone, could be reinstated again after 14 days. Considering the potency to induce CPP, resistance to extinction, and the propensity for reinstatement, the abuse liability rank order of the cathinone analogs might be as follows: NEP > eutylone > pentylone. These findings suggest that the zebrafish CPP paradigm can serve as a viable model for assessing the relative abuse liability of substances.

Is Pharmaceutical Marketing Ethical?

The pharmaceutical industry is expanding, and there are many new scientific breakthroughs in the modern day. As a result, moral concerns sparked by marketing strategies have led to intense global debates. Pharmacies are trying to market their products and maintain their competitiveness, raising concerns about potential conflicts between corporate interests and the fundamentals of medical ethics. This article takes a multidisciplinary approach, incorporating public health, bioethics, and regulatory frameworks to begin a thorough investigation of the complex ethical landscape surrounding pharmaceutical marketing. The background section shows how pharmaceutical marketing methods have evolved by closely examining empirical evidence and ethical perspectives. It demonstrates how the significant move toward direct-to- consumer advertising (DTCA) has altered the healthcare industry's operations. To illustrate how intricate modern marketing strategies are, the article closely examines various techniques, including sponsorships, patient assistance programs, physician detailing, and promotional materials. The piece's primary focus is its in-depth analysis of ethics, founded on the fundamental ideas of beneficence, justice, non-maleficence, and respect for individual liberty. Pharmaceutical marketing has been scrutinized ethically for an extended period. Opponents argue that practices such as advertising and compensating doctors to promote specific treatments are considered to breach medical ethics. Advocates argue that the current methods are beneficial for education and can be ethically utilized with adequate regulation. This study examines the various perspectives in the ongoing debate. Critics argue that drug marketing results in an excessive number of prescriptions for unnecessary medications. False information about diseases is circulated to create the perception that common illnesses require pharmacological treatment. Studies indicate that exposure to marketing is associated with increased prescription rates and expenses, with no apparent health advantages for the general population. Gifts and incentives provided to doctors for marketing purposes are viewed as manipulative and compromising the impartial examination of facts. Detailers advocate for expedited utilization of new medications before their efficacy and safety profiles are fully understood. Some argue that direct-to-consumer advertising prioritizes patients' desires over doctors' professional judgment. High marketing expenses, which are transferred to prescription pricing, create obstacles for individuals to get essential medications. Associates view marketing as a way to raise awareness for overlooked disorders and educate doctors about novel therapies. Advocates of marketing argue that false advertising is against the law and that physicians rely mostly on medical research when utilizing promotions. According to polls, numerous doctors believe that marketing does not influence them. Supporters also cite evidence indicating that patients are adhering more strictly to healthcare norms, and they argue that warnings provide patients with sufficient information to make informed judgments. Profits are used to fund future research projects that must be commercialized before the patent expires. Both parties utilize substantial evidence while also depending on assumptions regarding impacts. Critics argue that the objectives of marketing are inherently unethical in contrast to evidence-based prescribing. Advocates argue that with careful supervision, appropriate utilization is achievable, albeit adjustments may be necessary. There is limited research demonstrating the definitive effects of something as either harmful or beneficial. Choosing the correct strategy remains a challenging process that requires making compromises. Creating ethically good norms requires meticulous effort to prevent misconduct while also allowing for the dissemination of knowledge. This problem warrants a thorough examination from both an empirical and normative perspective.

Comparative Analysis of Therapeutic Efficacy and Adverse Reactions among Various Thrombolytic Agents.

Thrombosis is a major health concern that contributes to the development of several cardiovascular diseases and a significant number of fatalities worldwide. While stent surgery is the current recommended treatment according to the guidelines, percutaneous coronary intervention (PCI) is the optimal approach for acute myocardial infarction (AMI). However, in remote areas with limited resources, PCI procedures may not be feasible, leading to a delay in treatment and irreversible outcomes. In such cases, preoperative thrombolysis becomes the primary choice for managing AMI in remote settings. The market for thrombolytic drugs is continuously evolving, and identifying a safe and effective thrombolytic agent for treating AMI is crucial. This study evaluated Urokinase, Alteplase, and Recombinant Human TNK Tissue-type Plasminogen Activator for Injection (rhTNK) as representatives of first-, second-, and third-generation thrombolytic drugs, respectively. The research included in vitro thrombolysis experiments, exposure of human cardiomyocytes, zebrafish tail vein injections, and vascular endothelial transgenic zebrafish models. The findings revealed that rhTNK is the most effective thrombolytic drug with the least adverse effects and lowest bleeding rate, highlighting its potential as the preferred treatment option for AMI. The order of thrombolytic effectiveness was Urokinase < Alteplase < rhTNK, with adverse effects on cardiomyocytes post-thrombolytic therapy ranking similarly as Urokinase < Alteplase < rhTNK, while the bleeding rate after thrombolysis followed the order of Urokinase > Alteplase > rhTNK.

Marketing analysis of the pharmaceutical market of drugs for the prevention and treatment of patients with COVID-19 with central nervous system damage

Marketing analysis of the pharmaceutical market of drugs for the prevention and treatment of patients with COVID-19 with central nervous system damage

Identification of N-piperidinyl etonitazene in alternative keratinous matrices from a decomposing cadaver

This short report describes research on N-piperidinyl etonitazene, also known as etonitazepipne, in keratinous matrices (hair and nails) after death related to a suspected opioid overdose. Etonitazepipne belongs to the family of benzimidazole opioids, a class of new synthetic opioids that has penetrated the illicit drug market. Analysis in the case under study showed the presence of etonitazepipne in both hair and nails, confirming that the substance accumulates in the body with repeated intake.

Combining surface-enhanced Raman spectroscopy (SERS) and paper spray mass spectrometry (PS-MS) for illicit drug detection

There is an ongoing effort in the US illicit drug market to make new psychoactive compounds more potent and addictive. Due to continuous chemical modifications, many fentanyl analogs are developed and mixed with more traditional illicit drugs, such as cocaine and heroin. Detecting fentanyl and fentanyl analogs in these illicit drug mixtures has become more crucial because of the increased potency and associated health risks. Most confirmatory procedures require time-consuming and expensive, highly sophisticated laboratory equipment and experimental procedures, which can delay critical information that might save a victim or find a suspect. In this study, we propose miniaturizing and accelerating this process by combining surface-enhanced Raman spectroscopy (SERS) analysis and paper spray mass spectrometry (PS-MS). For this aim, dual-purposed paper substrates were developed through soaking in Au/Ag nanostars suspensions. These novel, in-house prepared paper SERS substrates showed stability for up to four weeks with and without the presence of drug compounds. Fentanyl analogs with similar SERS spectra were differentiated by coupling with PS-MS. The limit of detection (LOD) for fentanyl on the paper substrates is 34 μg/mL and 0.32 μg/mL for SERS and PS-MS, respectively. Fentanyl and fentanyl analogs show selective SERS enhancement that helped to detect trace amounts of these opioids in heroin and cocaine street samples. In short, we propose the combination of SERS/PS-MS by using modified paper substrates to develop cost-effective, sensitive, rapid, portable, reliable, and reproducible methods to detect illicit drugs, especially trace amounts of fentanyl and fentanyl analogs in illicit drug mixtures. The combination of these two category A techniques allows for the identification of illicit drugs according to the SWGDRUG guidelines.

In vitro activation of the CB1 receptor by the semi-synthetic cannabinoids hexahydrocannabinol (HHC), hexahydrocannabinol acetate (HHC-O) and hexahydrocannabiphorol (HHC-P).

Semi-synthetic cannabinoids (SSCs) including hexahydrocannabinol (HHC) are emerging on the drug market and sold openly as purportedly legal replacements for cannabis and Δ9-THC. By the beginning of 2024, 24 European countries had identified HHC, often sold openly in edibles (foods/candy), vapes and low-THC cannabis flowers and resins. The SSC market is developing rapidly, with HHC acetate (HHC-O), hexahydrocannabiphorol (HHC-P) and others recently identified. These developments may mark the first major change in the market for 'legal' replacements to cannabis since 'Spice' containing synthetic cannabinoids, such as JWH-018, emerged in 2008. Currently, there are some data available on the pharmacology of SSCs, which is crucial for understanding their effects, evaluating health risks and informing public health responses. This study focused on characterizing the in vitro activation of the human CB1 receptor by the (R)- and (S)-epimers of HHC, HHC-P and HHC-O. Using recombinant CHO-K1 cells expressing the human CB1 receptor, the potency (EC50) and efficacy were determined. It was established that (9R)-HHC and (9R)-HHC-P activated the CB1 receptor as partial agonists and with five and two times lower potency compared to JWH-018, respectively, while the (S)-epimers exhibited even lower potency. The (R)-epimer of HHC-O activate the CB1 receptor to even lesser extent and the (S)-epimer showed no activation. For HHC and HHC-P, all epimers exhibited similar level of efficacy. This available evidence suggests cannabimimetic effects of the tested SSC with the exception for the acetates that likely function as pro-drugs in vivo.

Optimizing the Amino Acid Sequence Enhances the Productivity and Bioefficacy of the RBP-Albumin Fusion Protein.

The significant growth of the global protein drug market, including fusion proteins, emphasizes the crucial role of optimizing amino acid sequences to enhance the productivity and bioefficacy. Among these fusion proteins, RBP-IIIA-IB, comprising retinol-binding protein in conjunction with the albumin domains, IIIA and IB, has displayed efficacy in alleviating liver fibrosis by inhibiting the activation of hepatic stellate cells (HSCs). This study aimed to address the issue of the low productivity in RBP-IIIA-IB. To induce structural changes, the linking sequence, EVDD, between domain IIIA and IB in RBP-IIIA-IB was modified to DGPG, AAAA, and GGPA. Among these, RBP-IIIA-AAAA-IB demonstrated an increase in yield (>4-fold) and a heightened inhibition of HSC activation. Furthermore, we identified amino acid residues that could form disulfide bonds when substituted with cysteine. Through the mutation of N453S-V480S in RBP-IIIA-AAAA-IB, the productivity further increased by over 9-fold, accompanied by an increase in anti-fibrotic activity. Overall, there was a more than 30-fold increase in the fusion protein's yield. These findings demonstrate the effectiveness of modifying linker sequences and introducing extra disulfide bonds to improve both the production yield and biological efficacy of fusion proteins.

Overview and Lifecycle Management of Generic Pharmaceutical Drugs in Mexico, Guatemala and Brazil

Objective: The generic pharmaceutical markets in Mexico, Guatemala, and Brazil are influenced by distinct regulatory frameworks, production and distribution dynamics, and marketing strategies, which shape lifecycle management. Regulatory policies, market competition, and healthcare initiatives impact accessibility, affordability, and quality, presenting both challenges and opportunities for enhancement in these areas. Summary: This thesis offers an in-depth examination of lifecycle management strategies in the generic pharmaceutical markets of Mexico, Guatemala, and Brazil. Generic drugs are crucial for increasing access to affordable healthcare, especially in emerging economies. Through comparative analysis, this research explores the regulatory frameworks, market dynamics, and key challenges in the development, approval, marketing, and post-marketing surveillance of generic drugs in these three Latin American countries. The study starts with an overview of the regulatory landscape for generic pharmaceuticals in Mexico, Guatemala, and Brazil, highlighting similarities and differences in registration requirements, approval processes, and post-approval obligations. It investigates the roles of regulatory agencies like COFEPRIS, DIGEMID, and ANVISA in ensuring the quality, safety, and efficacy of generic drugs throughout their lifecycle. Additionally, the research delves into the strategies used by pharmaceutical companies for lifecycle management of generic drugs, including variations, biowaivers, and labeling changes. Real-world case studies illustrate post-approval changes and their regulatory implications in each country, providing insights into the complexities of managing generic drug portfolios in different regulatory environments. The thesis also examines the market dynamics affecting the availability, pricing, and accessibility of generic drugs in Mexico, Guatemala, and Brazil. Factors such as patent expirations, competition, healthcare policies, and public procurement practices are analysed to understand their impact on market entry, competition, and the affordability of generic drugs. Furthermore, the study addresses the challenges and opportunities in pharmacovigilance and post-marketing surveillance of generic drugs, emphasizing the need for robust systems to detect and manage adverse drug reactions and ensure patient safety. Conclusion: The key findings highlight regulatory frameworks, market dynamics, and lifecycle management strategies in the generic pharmaceutical markets, identifying challenges and opportunities. The study reflects on implications for stakeholders and suggests areas for future research to enhance accessibility, affordability, and quality.

HPR27 Optimizing Drug Market Exclusivity in the US and EU Markets

HPR27 Optimizing Drug Market Exclusivity in the US and EU Markets

Collusion and Violence in Underground Drug Markets

Abstract Poor urban neighborhoods throughout the Americas are marked by high rates of interpersonal violence, much of which is associated with the underground drug trade. Scholars have examined the social dynamics that produce and shape violence among neighborhood residents and the state agents who police them. But less is known about the clandestine collaborations between residents and agents of the state and how those collaborations might contribute to violence. This study draws on ethnographic fieldwork and an original legal archive to analyze the links between police collusion with drug market groups and interpersonal violence. We find that 1) police provide their collaborators with powerful weapons and ammunition; 2) state agents become involved and help escalate violent territorial disputes between underground market groups; and 3) violence erupts between state agents colluding with civilian dealers and those attempting to disrupt the drug trade. These findings shed new light on the social and organizational factors shaping patterns of violence in poor neighborhoods, illuminating the ways that state agents contribute to that violence. In doing so, the findings advance our understanding of policing, drug markets, and the role of the state in shaping the everyday lives of the urban poor.

Detection of the benzodiazepine bromazolam by liquid chromatography with quadrupole time of flight mass spectrometry in postmortem toxicology casework and prevalence in Indiana (2023).

For the past 60 years, benzodiazepines such as chlordiazepoxide, diazepam, and alprazolam have been used as pharmaceutical medications for the treatment of myriad conditions including anxiety, seizures, and insomnia. In more recent years, novel benzodiazepine derivatives have emerged as illicit substances in powders and counterfeit tablets on the illicit drug market. In 2016, bromazolam, a brominated derivative of alprazolam, emerged on the illicit drug market in Europe, but the substance was not reported in the USA until 2019-2020. In this study, we report the emergence and subsequent prevalence of bromazolam in postmortem blood in the state of Indiana during 2023. Analysis was completed by a solvent protein precipitation extraction with acetonitrile and detection by liquid chromatography with quadrupole time of flight mass spectrometry. During 2023, bromazolam was detected in 94 cases across 25 counties in Indiana. It was never the sole substance detected and was commonly detected alongside fentanyl (83 cases), norfentanyl (77 cases), 4-anilino-N-phenethylpiperidine (76 cases), acetylfentanyl (49 cases), methamphetamine (32 cases), naloxone (25 cases), 11-nor-9-carboxy-tetrahydrocannabinol (24 cases), and benzoylecgonine (20 cases). After official query with the Indiana Department of Health, it was found that bromazolam was specifically included in the cause of death certification in 31 fatalities (32.9%). Due to the scarcity of information regarding this novel benzodiazepine derivative in postmortem toxicology and its involvement in fatalities, it is important that forensic toxicology laboratories consider adding bromazolam to their comprehensive scope of analysis.

A Comprehensive Study for Assessing the Demand and Supply Dynamics of Parkinson's Disease Medication in Roorkee, Uttarakhand

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra pars compacta region of the midbrain. This depletion of dopamine, a neurotransmitter crucial for regulating movement, leads to the characteristic motor symptoms of PD, including tremors, rigidity, bradykinesia, and postural instability. In India, the prevalence of PD is increasing, necessitating greater attention to the availability and distribution of appropriate medication. This comprehensive study aims to assess the demand and supply dynamics of PD medication in Roorkee, Uttarakhand. After recording the sales per week of various drugs, brands, dosage forms, and strengths available in Roorkee, it was determined that SINEMET (Carbidopa + Levodopa) is widely accessible in the region, with STALEVO, MIRAPEX (Pramipexole), and ARTANE (Trihexyphenidyl) being the other prominent brands available in local medical stores. These medications are primarily in tablet form. Sales data from different stores indicated that SINEMET (Carbidopa + Levodopa 25/250 mg) is the most popular drug in the Roorkee area for treating PD. In terms of drug type analysis, levodopa-based decarboxylase inhibitors, particularly the combination of Levodopa and Carbidopa, currently hold a dominant position in the PD drug market in the region

Costs are a major driver of antibacterial drug prescriptions in Germany: market analysis from 1985 to 2022

In recent years, several threatening developments regarding antibacterial drugs, such as rising bacterial resistance and delivery bottlenecks, have occurred. Since antibacterial drugs are crucial for modern medicine, understanding events and influencing factors relevant for long-term developments is essential. Therefore, we analyzed the number of prescriptions and costs, defined daily dose (DDD) and DDD costs of antibacterial drugs in Germany, based on the Arzneiverordnungsreport (AVR, Drug description report) between 1985 and 2022. Based on prescription rates in 2022, we selected the TOP15 and TOP5. For a more in-depth analysis, we analyzed data from the wissenschaftliches Institut der AOK (WidO, scientific institute of the AOK). The number of prescriptions increased between 1985 and 2013, but since 2014, there has been a declining trend with a noticeable COVID-related dip. Over the years, a shift in drug classes occurred. Once very popular drugs like penicillins and tetracyclines are no longer as important. Conversely, aminopenicillins and cephalosporins have become more relevant. Particularly, the TOP5 drugs have seen an increasing proportion. DDD costs have decreased in most substance classes over time. There is a strong association between decreasing costs and rising prescriptions. Falling costs have a stronger immediate impact on prescriptions that rising costs. When costs are very low, drugs might be prescribed excessively. Supply bottlenecks can also result. The main prescribers are mainly in primary care. Their share of prescription has changed little over the years, but is decreasing regarding total consumption. In comparison to other European countries, Germany ranks in the lower third regarding prescriptions. In most countries, the COVID pandemic has led to a reduced prescription of antibacterial drugs. In conclusion, we provided a comprehensive overview of the antibacterial drug market in Germany over the past four decades and identified costs as a major driver of antibacterial drug prescriptions. Increased costs may reduce uncritical prescription of antibacterial drugs, development of bacterial resistance, supply shortages and occurrence of adverse effects.

Assessment of a Single Quadrupole Mass Spectrometer Combined with an Atmospheric Solids Analysis Probe for the On-Site Identification of Amnesty Bin Drugs.

The surging number of people who abuse drugs has a great impact on healthcare and law enforcement systems. Amnesty bin drug analysis helps monitor the "street drug market" and tailor the harm reduction advice. Therefore, rapid and accurate drug analysis methods are crucial for on-site work. An analytical method for the rapid identification of five commonly detected drugs ((3,4-methylenedioxymethamphetamine (MDMA), cocaine, ketamine, 4-bromo-2,5-dimethoxyphenethylamine, and chloromethcathinone)) at various summer festivals in the U.K. was developed and validated employing a single quadrupole mass spectrometer combined with an atmospheric pressure solids analysis probe (ASAP-MS). The results were confirmed on a benchtop gas chromatography-mass spectrometry instrument and included all samples that challenged the conventional spectroscopic techniques routinely employed on-site. Although the selectivity/specificity step of the validation assessment of the MS system proved a challenge, it still produced 93% (N = 279) and 92.5% (N = 87) correct results when tested on- and off-site, respectively. A few "partly correct" results showed some discrepancies between the results, with the MS-only unit missing some low intensity active ingredients (N-ethylpentylone, MDMA) and cutting agents (caffeine, paracetamol, and benzocaine) or detecting some when not present. The incorrect results were mainly based on library coverage. The study proved that the ASAP-MS instrument can successfully complement the spectroscopic techniques used for qualitative drug analysis on- and off-site. Although the validation testing highlighted some areas for improvement concerning selectivity/specificity for structurally similar compounds, this method has the potential to be used in trend monitoring and harm reduction.

The impact of Chinese volume-based procurement on pharmaceutical market concentration.

Optimizing the pharmaceutical industrial structure is the key mission of China's healthcare reform. From the industrial structure perspective, this study empirically evaluated the impact of China's national volume-based procurement (NVBP) policy on market concentration in the hospital-end drug market. This study used drug procurement data of China's public medical institutions which obtained from the national database. A quasi-natural experiment was designed involving eleven pairs of matched treatment-control region combinations, with NVBP policy as the intervention measure. The market was defined by drug name (molecular boundary) and city/province (geographical boundary). Market changes were measured from three dimensions: the number of enterprises and products, market share, and Herfindahl-Hirschman index (HHI). Dual comparison approach and difference-in-difference (DID) method with fixed effect model were applied to quantify policy impacts. The number of enterprises and products decreased by 18 and 83 in pilot regions after NVBP policy, far more than the decreases in control regions (6 and 21). The accumulative market share of 15 bid-winning enterprises increased by 53.67% in volume and 18.79% in value, among which the increment of enterprises with low baseline market share was more prominent (66.64% and 36.40%). Among three enterprise types, the market share of generic consistency evaluation (GCE) certificated generics significantly increased, GCE uncertificated generics significantly decreased, and originators slightly decreased. DID models indicated significantly positive impact of NVBP policy on market concentration, with HHI-volume and HHI-value increasing by 49.33% (β = 0.401, p < 0.01) and 21.05% (β = 0.191, p < 0.01). The implementation of NVBP promoted the intensive drug circulation and supply of Chinese public hospitals, intensifying the exit of GCE uncertificated generics from the hospital-end market. NVBP combined with GCE standards significantly improved market concentration, which brought a positive signal of pharmaceutical industrial structure optimization in China. In the future context of normalized and institutionalized NVBP, the balance should be further sought between low drug prices and reliable hospital drug supply, sustainable industry development.

Yemeni Physicians' Attitudes and Perceived Barriers Toward Ward-Based Clinical Pharmacist in Hospital Settings.

Clinical pharmacy services (CPSs) are still in their infancy in Yemen. Furthermore, pharmacists are not members of a multidisciplinary healthcare team, so their responsibilities are limited to drug dispensing and marketing. This study examines physicians' attitudes and perceived obstacles regarding the inclusion of clinical pharmacists in hospital medical wards. A descriptive observational study was carried out using a validated, self-administered bilingual questionnaire. The study's questionnaire was conducted among physicians in three leading hospitals. Those hospitals were at the forefront of establishing clinical pharmacy units and embracing clinical pharmacy services. Data were analyzed using descriptive statistics. Sixty-five responses were included. Our data results indicated that physicians believed the most important contributions for clinical pharmacists to improve patient care were "attending medical rounds", followed by "order review". About 75% of physicians showed positive attitudes toward the clinical pharmacist role. However, more than 70% of physicians believed that clinical pharmacists should leave patient care to other healthcare professionals and focus on drug products. Not enough clinical pharmacist staff working in the health center was considered the top perceived barrier (83.1%), followed by "clinical pharmacist responsibilities were not clearly defined" and "clinical pharmacist recommendations are not properly documented". Strategies to expand clinical pharmacy services in Yemen should focus on several key areas. Protocols must be established to clearly outline the collaboration between clinical pharmacists and physicians. Additionally, fostering inter-professional relationships is crucial to overcoming resistance and increasing awareness and understanding of CPS adoption among healthcare team members.

Study of 25R-NBOHs (R = Br, Cl, Et, I): Thermal stability investigation and presumptive identification by SCXRD and PXRD data

New psychoactive substances (NPS) are present in the drug market and can be used as legal substitutes, making enforcement difficult. One of the classes of NPSs is the phenylethylamines, among which 25R-NBOHs (with R being a halogen or an alkyl group) are included. These compounds degrade when subjected to gas chromatography-mass spectrometry (GC–MS), one of the techniques routinely used to identify illicit substances, thereby complicating their identification. This study conducted the identification of NBOH samples using FTIR, XRD, and GC–MS techniques, as well as thermal analysis to obtain information that may assist in the development of new methods for the analysis of these synthetic substances. ATR-FTIR spectra presented characteristic bands of 25R-NBOH compounds (R = Br, Cl, Et, I). The UV–Vis spectra of the 25R-NBOH (R = Br, Cl, I) and 25E-NBOH samples showed a different profile, which may serve as a means to differentiate these compounds. The crystalline structure of the compounds was confirmed by comparing the experimentally obtained diffractograms with the diffraction patterns calculated using data from the Cambridge Crystallographic Data Center (CCDC) database. Thermal analysis indicated that the samples were not pure, confirming the FTIR and XRD analyses, which revealed the presence of impurities and the onset of sample degradation.

"Coke in the Dope": The Underrecognized Complications of a Cocaine-Adulterated Fentanyl Supply.

The opioid crisis, particularly the "fourth wave" involving fentanyl and stimulants, has been responsible for an alarming increase in overdose deaths in the United States. Although fentanyl contamination in cocaine has gained significant attention, the converse-cocaine-adulterated fentanyl-has been largely overlooked despite its health implications. The rise in concurrent cocaine and fentanyl overdose deaths could be attributed to various factors, from intentional polysubstance use to unintentional adulterations. Cocaine-related health issues may amplify the problem. Four potential pathways for the increased risk of overdose with cocaine-adulterated opioids include enhanced drug reinforcement, potential overdose risk with switching drug samples, altered metabolism of medications used for opioid use disorder, and increased myocardial demand juxtaposed with opioid-induced respiratory depression. With these risks, the importance of drug testing becomes paramount in the unregulated drug market. As polysubstance use overdoses surge, there is an urgent need to understand how drug supplies are changing in order to effectively identify appropriate harm reduction strategies. Specifically, further research is needed evaluating complications of low-level cocaine exposure with chronic/persistent opioid use. The hazards associated with cocaine-adulterated fentanyl emphasize the significance of understanding not only fentanyl's presence in cocaine but also cocaine's role in the fentanyl supply.