Prescription Pills Research Articles

Medication Burden Before and After Prescription of Biologics in Patients with Inflammatory Bowel Disease

Background: Biologics are a cornerstone in the treatment of severe cases of inflammatory bowel disease (IBD) and aim to control the disease and improve quality of life. This study investigated changes in nonbiologic medication prescriptions for IBD patients initiating biologic therapy in Germany. Methods: This study used data from anonymized pharmacy records in the German longitudinal prescription (LRx) database and included biologic-naive IBD patients who received their first biologic therapy prescription between 2016 and 2022. Changes in prescription rates and pill counts for nonbiologic medications (corticosteroids, 5-aminosalicylates (5-ASA), proton pump inhibitors, analgesics, immunosuppressants, Vitamin D, iron, and antibiotics) before and after the initiation of biologic therapy were assessed using descriptive statistics, McNemar’s tests, and Poisson regression models, adjusting for age and sex. Results: A total of 29,559 biologic-naive IBD patients were included. Prior to index, 91.2% received at least one nonbiologic medication prescription, where corticosteroids and 5-ASA were the most common. Postindex, the overall prescription rate decreased to 87.7%, with significant reductions in prescriptions observed for corticosteroids, 5-ASA, and immunosuppressants (p-values < 0.001). The mean (SD) pill count dropped from 704 (1712) to 514 (1651), with the largest mean differences (95% CI) having been for corticosteroids (−77.9 [−80.3 to −75.5]), 5-ASA (−61.6 [−65.2 to −58.1]), and immunosuppressants (−55.0 [−57.5 to −52.6]). Older patients tended to have greater decreases in pill counts for corticosteroids and 5-ASA, while males showed statistically significant reductions in pill count for immunosuppressants compared with females. Conclusion: This study demonstrates that the prescription of nonbiologic medications significantly decreased after biologic therapy initiation. The use of biologics may therefore lead to improved disease management and potentially better patient outcomes.

Empowerment of Augmented Reality (AR) for Patient Education and Engagement: Medication Adherence Programs' Impact on Public Health Outcomes

The entire effectiveness of pharmacological treatment depends on patients taking their medications as prescribed. Patient education is a vital component of the endeavours to enhance adherence to medications. However, many people still fail to take their prescription pills as prescribed. In addition to having access to healthcare, those who follow their doctors' orders greatly improve their chances of a positive outcome. The unfortunate reality is that many people do not take their medications as prescribed, which has led to deteriorating health, higher healthcare costs, and more overall costs. Hence, this paper presents the Smart Augmented Reality-based Patient Medication Adherence Program (SAR-PMAP) model for effective patient education and engaging medication. The augmented reality spectacles help those with trouble keeping track of their medication, and the model encourages patients to take their prescriptions as prescribed. Users may easily go to their homes with the aid of the navigation functions, and patients with impaired eyesight can benefit from the audio option that gives out the date and time. Given all this data, the Medication Coach Intelligent Agent (MCIA) takes the lead in making comprehensive decisions so patients can get autonomous, individualized, and unobtrusive treatments.

Suspected Counterfeit M-30 Oxycodone Pill Exposures and Acute Withdrawals Reported from a Single Hospital - Toxicology Investigators Consortium Core Registry, U.S. Census Bureau Western Region, 2017-2022.

Availability of counterfeit prescription pills (counterfeit pills) containing illegally made fentanyl, including counterfeit M-30 oxycodone (counterfeit M-30) pills, has risen sharply in the United States and has been increasingly linked to overdose deaths. In 2023, approximately 115 million counterfeit pills were seized in U.S. High Intensity Drug Trafficking Areas. However, clinical data on counterfeit pill-related overdoses are limited. Medical toxicology consultations during 2017-2022 from one U.S. Census Bureau Western Region hospital participating in the Toxicology Investigators Consortium Core Registry were analyzed. A total of 352 cases suspected to involve counterfeit M-30 pills, including 143 (40.6%) cases of fentanyl exposure and 209 (59.4%) cases of acute withdrawal were identified; consultations increased from three in 2017, to 209 in 2022. Patients aged 15-34 years accounted for 95 (67.4%) exposure cases. Among all patients with exposures, 81.1% were hospitalized, 69.0% of whom were admitted to an intensive care unit. Additional substances were detected in 131 (91.6%) exposures. Providing outreach to younger persons misusing prescription pills, improving access to and distribution of harm reduction tools including fentanyl test strips and naloxone, and promoting linkage of persons treated for overdose in hospitals to harm reduction and substance use treatment services are strategies to reduce morbidity associated with use of counterfeit M-30.

Curbing the Opioid Crisis: Optimal Dynamic Policies for Preventive and Mitigating Interventions

Problem statement: This paper addresses the challenge of effectively responding to the opioid epidemic stemming from prescription pills through a public health lens. It centers on the strategic distribution of resources across diverse interventions aimed at preventing and mitigating the consequences of opioid use disorder (OUD) and overdose occurrences. Methodology: This paper proposes a decision aid tool built on the expected utility theory that leverages a Susceptible-Infected-Removed compartmental model to simulate the dynamics of the epidemic in a population. This model then feeds into a Markov Decision Process (MDP) model to generate optimal policies upon the current state of the epidemic. The optimal policies allocate the intervention budget to primary preventive and mitigating interventions in each decision period by minimizing the cost of fatal overdoses relative to the population’s number of individuals with OUD, considering the impact magnitude of each intervention, based on the current state of the epidemic. A 10-year simulation of the epidemic’s progression is conducted to assess the dynamic efficacy of the proposed decision tool. Results: The findings reveal an average reduction of 29% in total costs compared to the scenario without interventions and a decrease of 12% in total costs on average compared to the scenario with a 50-50 allocation. The extensive sensitivity analysis of key parameters validates the decision aid tool. We observe that it is optimal to allocate a significant portion of the budget to prevention when the rate of opioid pill acquisition rises. Even with a heightened rate of fatal overdoses, it remains optimal to mostly invest in preventive interventions, as long as fatal overdose rates are lower than opioid access rates. Practical implications: This study provides practitioners with a tool to effectively address the opioid epidemic and enhance public health by deciding how to allocate their budget to various levels of intervention.

Substances in Counterfeit Prescription Pills Seized by Law Enforcement, 2017-2022

This study examines substances identified during testing of counterfeit prescription pills seized by law enforcement in Rhode Island from 2017 to 2022.

Suspected North Carolina counterfeit pill-involved deaths, 2020-2022.

The NC Office of the Chief Medical Examiner regularly assumes jurisdiction over deaths that are suspicious, unusual or unattended by a medical professional. In recent years, the presence of counterfeit pills is occasionally suggested by investigatory notes and/or scene findings that document reported consumption of prescription drugs, or prescription drugs on scene, which are not reflected in the final autopsy findings after toxicological analysis of the decedent's blood samples. Counterfeit pill consumption is a major public health hazard worthy of attention from the forensic toxicology community. Seventy-five cases from January 2020 to December 2022 serve as a convenience sample of cases where prescription pills including formulations of alprazolam, oxycodone and hydrocodone were specifically referenced during the death scene investigation as recently consumed, yet an unexpected substance was found during toxicological analysis rather than the expected pharmaceutical drug. Of note, novel benzodiazepines detected included flualprazolam, etizolam, clonazolam metabolite (8-aminoclonazolam), bromazolam, flubromazolam and desalkylflurazepam. Decedents' ages ranged from 16 to 69, across 33 different NC counties. Case notes indicated that eight of the decedents obtained pills through direct personal relationships, six decedents obtained them from "the street" and one decedent likely purchased pills online. Pills were largely consumed orally or through insufflation. Seven case reports contained indication that decedents knew or suspected the counterfeit nature of their pills. This study describes the context and characteristics of 2020-2022 suspected counterfeit pill-involved deaths in NC to further the understanding of the forensic science community, law enforcement partners, public health stakeholders and those potentially at risk through the consumption of counterfeit pills.

Evaluating the rate of reversal of fentanyl-induced respiratory depression using a novel long-acting naloxone nanoparticle, cNLX-NP.

Fentanyl and fentanyl analogs (F/FA) have become increasingly common adulterants in counterfeit prescription pills and illicit street drug mixtures due to their ease of synthesis and exceedingly high potency. The ongoing epidemic of fatal overdoses fueled by F/FA continues to highlight the need for longer-acting therapies than naloxone (NLX), the current gold-standard for reversing opioid overdoses, which shows limited efficacy to prevent renarcotization associated with F/FA toxicity. A novel opioid reversal agent based on covalent naloxone nanoparticles (cNLX-NP) has been shown to blunt fentanyl-induced respiratory depression out to 48 hr, demonstrating its potential therapeutic utility. The purpose of this study was to characterize how rapidly cNLX-NP reverses fentanyl-induced respiratory effects as well as the duration of its protective effects. Sprague Dawley male rats (n=6/group) were tested on an oximeter for baseline percent arterial oxygen saturation (%SaO2) challenged with 0.1 mg/kg SC fentanyl and 15min later given 10 mg/kg IM doses of NLX, nalmefene (NLMF), or cNLX-NP and continuously monitored via oximetry for 10 minutes. One week later the experiment was repeated using a 1:1 mixture of NLX:cNLX-NP as the reversal agent in the rats that previously received NLX alone. While both NLX and NLMF rapidly reversed %SaO2 to baseline within 1min, rats that received cNLX-NP did not return to >90% SaO2 levels until 9min after administration. Similarly, heart and breath rates returned to baseline within 1min of treatment with NLX and NLMF but did not return to baseline until 10 minutes after cNLX-NP administration. In contrast, NLX:cNLX-NP reversed all fentanyl-induced respiratory depressive effects within one minute. While cNLX-NP alone may not sufficiently reverse F/FA overdose in a timely manner, mixing free NLX with cNLX-NP can provide a mechanism to both rapidly reverse fentanyl-related effects and maintain extended protection against synthetic opioid toxicity. These data support further development of cNLX-NP as a fast-acting and long-lasting antidote to treat F/FA-induced respiratory depression and overdose, and potentially prevent renarcotization in humans.

Nationwide, County-Level Analysis of the Patterns, Trends, and System-Level Predictors of Opioid Prescribing in Surgery in the US: Social Determinants and Access to Mental Health Services Matter.

The diversion of unused opioid prescription pills to the community at large contributes to the opioid epidemic in the US. In this county-level population-based study, we aimed to examine the US surgeons' opioid prescription patterns, trends, and system-level predictors in the peak years of the opioid epidemic. Using the Medicare Part D database (2013 to 2017), the mean number of opioid prescriptions per beneficiary (OPBs) was determined for each US county. Opioid-prescribing patterns were compared across counties. Multivariable linear regression was performed to determine relationships between county-level social determinants of health (demographic, eg median age and education level; socioeconomic, eg median income; population health status, eg percentage of current smokers; healthcare quality, eg rate of preventable hospital stays; and healthcare access, eg healthcare costs) and OPBs. Opioid prescription data were available for 1,969 of 3,006 (65.5%) US counties, and opioid-related deaths were recorded in 1,384 of 3,006 counties (46%). Nationwide, the mean OPBs decreased from 1.08 ± 0.61 in 2013 to 0.87 ± 0.55 in 2017; 81.6% of the counties showed the decreasing trend. County-level multivariable analyses showed that lower median population age, higher percentages of bachelor's degree holders, higher percentages of adults reporting insufficient sleep, higher healthcare costs, fewer mental health providers, and higher percentages of uninsured adults are associated with higher OPBs. Opioid prescribing by surgeons decreased between 2013 and 2017. A county's suboptimal access to healthcare in general and mental health services in specific may be associated with more opioid prescribing after surgery.

The rise of depression and the risk of suicide: Understanding dysphoria in modern society

Abstract Problem Depression is on the rise and can result in the intense despair that underlies suicide risk. Description of the Problem Modern society has changed in ways that disrupt personal life, reduce lasting values, and create a disconnect from close interpersonal relations. It is important to understand the prevalence of despair and the high rates of death by suicide. Results A comprehensive scoping review identified five relevant factors that play a role in the rise of distress and despair across society. First, many people rely on alcohol or drugs to temporarily suppress emotional reactions. Drug abuse has become commonplace. Further, the over-use of antidepressant medications may result in the social and emotional causes of depression remaining untreated. Second, prescription pills and guns are the most common methods used in a suicidal act and both are commonplace throughout the U.S. Third, many adults struggle with occupational stress and chronic financial worries. In addition, many adults feel their job is repetitive and mundane, providing a source of income but little benefit to person or society. Fourth, many people experience pervasive feelings of loneliness and social isolation, often feeling disconnected from family and friends. Some aspects of social isolation may be related to an excessive use of technology that has changed social interactions in ways that are not helpful. Fifth, many people have been losing hope or lack meaning in life. As society becomes filled with interpersonal conflict, political strife, and suppressed hatred, feelings of hopelessness can grow. Some people have reached a level of fatigue over the assorted crises facing the world today. Lessons The rising suicide rates are not a time-limited epidemic, but despair has become endemic to modern society, quietly undermining the emotional lives of many people. Societal changes can promote positive mental health by addressing each of these five factors. Key messages • Mental Health professionals can promote non-pharmacological means of managing stress and depression. • All fields can encourage supportive and compassionate bonds when confronted with people in distress.

Knowledge and Perceptions of PharmD Students on Opioid Use and Misuse

ObjectiveThis study aimed to measure the knowledge and perceptions of the student pharmacists toward opioid use and misuse. MethodsThis survey included student pharmacists from the first, second, and third years who participated voluntarily and anonymously. Differences in knowledge and perceptions among participants’ responses were analyzed by comparing responses using the χ2 test. ResultsA total of 138 student pharmacists participated in the survey. All 3 class years reported that the most common age for opioid abuse and addiction is 18–25 years. The top reasons for opioid misuse were identified as easy access to drugs (82%), health conditions (85%), lack of knowledge (83%), and experimentation (82%). Over half of the students believed that healthcare providers, pharmaceutical companies, friends, and the community all have a shared responsibility in addressing opioid misuse. The majority of the student pharmacists also believed that education is the most effective way to combat opioid misuse. ConclusionThe student pharmacists at the University of Maryland Eastern Shore School of Pharmacy had a strong understanding of the dangers of opioid misuse. They identified 18–25 years as the age range most susceptible to opioid misuse. They also identified the most common reasons for opioid misuse, with some disagreement about whether prescription pills or street drugs were the main cause. However, the majority of students agreed that education is the most effective way to address opioid misuse. These findings highlight the need for ongoing education and awareness about the risks of opioid misuse and the role of education in addressing this public health crisis.

The prescription drug monitoring program in a multifactorial approach to the opioid crisis: PDMP data, Pennsylvania, 2016–2020

BackgroundPrescription opioids remain an important contributor to the United States opioid crisis and to the development of opioid use disorder for opioid-naïve individuals. Recent legislative actions, such as the implementation of state prescription drug monitoring programs (PDMPs), aim to reduce opioid morbidity and mortality through enhanced tracking and reporting of prescription data. The primary objective of our study was to describe the opioid prescribing trends in the state of Pennsylvania (PA) as recorded by the PA PDMP following legislative changes in reporting guidelines, and discuss the PDMP’s role in a multifactorial approach to opioid harm reduction.MethodsState-level opioid prescription data summaries recorded by the PA PDMP for each calendar quarter from August 2016 through March 2020 were collected from the PA Department of Health. Data for oxycodone, hydrocodone, and morphine were analyzed by quarter for total prescription numbers and refills. Prescription lengths, pill quantities, and average morphine milliequivalents (MMEs) were analyzed by quarter for all 14 opioid prescription variants recorded by the PA PDMP. Linear regression was conducted for each group of variables to identify significant differences in prescribing trends.ResultsFor total prescriptions dispensed, the number of oxycodone, hydrocodone, and morphine prescriptions decreased by 34.4, 44.6, and 22.3% respectively (p < 0.0001). Refills fluctuated less consistently with general peaks in Q3 of 2017 and Q3 of 2018 (p = 0.2878). The rate of prescribing for all opioid prescription lengths decreased, ranging in frequency from 22 to 30 days (47.5% of prescriptions) to 31+ days of opioids (0.8% of prescriptions) (p < 0.0001). Similarly, decreased prescribing was observed for all prescription amounts, ranging in frequency from 22 to 60 pills (36.6% of prescriptions) to 60–90 pills (14.2% of prescriptions) (p < 0.0001). Overall, the average MME per opioid prescription decreased by 18.9%.ConclusionsPer the PA PDMP database, opioid prescribing has decreased significantly in PA from 2016 to 2020. The PDMP database is an important tool for tracking opioid prescribing trends in PA, and PDMPs structured similarly in other states may enhance our ability to understand and influence the trajectory of the U.S. opioid crisis. Further research is needed to determine optimal PDMP policies and practices nationwide.

Prescription drug abuse in migrants from Middle Eastern and North African countries: a review

IntroductionIn recent years, there has been a rise in misuse of low-cost prescription pills across Middle Eastern and North African (MENA) countries. In Algeria, Tunisia and Morocco, for example, the consumption of prescription medications has dramatically increased, particularly amongst young and marginalized groups. Drugs such as clonazepam and pregabalin are extremely popular in these regions, as they are relatively inexpensive and perceived as safe. With the migration of MENA citizens to Europe, it is likely that mental health services will come across substance use disorders related to these medications.ObjectivesThe authors aim to analyse prescription medication misuse reports from MENA countries, specifically pregabalin and clonazepam, and review the pharmacological, neurobiological and social factors that contribute to their potential for abuse.MethodsNarrative review of articles referenced on PubMed and Google Scholar.ResultsPregabalin and clonazepam are widely used in psychiatry and neurology. Pregabalin is an alpha 2 omega ligand with supposed GABA-mimetic properties. Anecdotal reports suggest that pregabalin, used recreationally in amounts up to 3-20 times the therapeutic doses, possesses both sedative and psychedelic effects. Experimenters are mainly individuals with a history of recreational polydrug use, who are aware that pregabalin is not included in standard drug monitoring tests, with this molecule being used in some instances as a legal substitute of common illegal drugs. Clonazepam is a benzodiazepine that combines high potency and a long duration of action and is said to cause euphoria at doses over 8mg. It is very popular and affordable, placing consistently in the top three of benzodiazepines sales across the globe. Clonazepam has potential for tolerance build up and severe withdrawal symptoms. These medications are frequently used together and in combination with other substances such as alcohol and opiates, increasing the risk for respiratory failure and death.ConclusionsPrescription medications such as pregabalin and clonazepam are extremely accessible, inexpensive and highly addictive substances, whose abuse is well disseminated across MENA countries. With migratory flows from this region, the prevalence of misuse of these drugs in Europe is expected to increase. Therefore, physicians should be aware of their potential for abuse and carefully evaluate patients’ previous history before prescribing these medications.Disclosure of InterestNone Declared

An Accurate Deep Learning–Based System for Automatic Pill Identification: Model Development and Validation

Medication errors account for a large proportion of all medical errors. In most homes, patients take a variety of medications for a long period. However, medication errors frequently occur because patients often throw away the containers of their medications. We proposed a deep learning-based system for reducing medication errors by accurately identifying prescription pills. Given the pill images, our system located the pills in the respective pill databases in South Korea and the United States. We organized the system into a pill recognition step and pill retrieval step, and we applied deep learning models to train not only images of the pill but also imprinted characters. In the pill recognition step, there are 3 modules that recognize the 3 features of pills and their imprints separately and correct the recognized imprint to fit the actual data. We adopted image classification and text detection models for the feature and imprint recognition modules, respectively. In the imprint correction module, we introduced a language model for the first time in the pill identification system and proposed a novel coordinate encoding technique for effective correction in the language model. We identified pills using similarity scores of pill characteristics with those in the database. We collected the open pill database from South Korea and the United States in May 2022. We used a total of 24,404 pill images in our experiments. The experimental results show that the predicted top-1 candidates achieve accuracy levels of 85.6% (South Korea) and 74.5% (United States) for the types of pills not trained on 2 different databases (South Korea and the United States). Furthermore, the predicted top-1 candidate accuracy of our system was 78% with consumer-granted images, which was achieved by training only 1 image per pill. The results demonstrate that our system could identify and retrieve new pills without additional model updates. Finally, we confirmed through an ablation study that the language model that we emphasized significantly improves the pill identification ability of the system. Our study proposes the possibility of reducing medical errors by showing that the introduction of artificial intelligence can identify numerous pills with high precision in real time. Our study suggests that the proposed system can reduce patients' misuse of medications and help medical staff focus on higher-level tasks by simplifying time-consuming lower-level tasks such as pill identification.

The association between concussions and vaping among a nationally representative sample of U.S. adolescents

Background Concussions represent an important health threat that is crucial to study. Prior research has established a relationship between concussions and substance use. Specifically, studies find higher rates of drugs use, such as alcohol, marijuana, non-medical prescription pills, and illegal drugs among individuals who have suffered a concussion compared to those who have not. Unfortunately, research has yet to determine whether this link extends to a newer and increasingly popular form of adolescent drug use, vaping. Methods The current study investigates the association between concussions and various vaping activities (flavor vaping, nicotine vaping, marijuana vaping, variety score) on a nationally representative sample of U.S. 8th and 10th grade adolescents from the 2019 Monitoring the Future Survey. Results Results indicate that adolescents who were diagnosed with a concussion in their lifetime have higher odds of engaging in all types of vaping compared to adolescents who have never been diagnosed with a concussion. Conclusions The findings of this study support any policy or program aimed at increasing awareness about the connection between concussions and drug use and considering early interventions to potentially reduce substance use among adolescents who suffer concussions.

1.106 Fentanyl Hits Social Media: Lethally Laced Pills Are Causing Crisis for Youth in America

Rates of illicit prescription pill use are increasingly high among young people, and overdoses are among the leading causes of preventable death. The authors aimed to review recent literature on the use of controlled substances, such as opioids and benzodiazepines, among teenagers and young adults in the United States. Specifically, the authors explored how these drugs are being obtained via social media platforms. The authors sought to determine how common, and how dangerous, this practice has been since the start of the COVID-19 pandemic.

Impact of an Electronic Health Record Pain Medication Prescribing Tool on Opioid Prescriptions for Postoperative Pain in Hand, Orthopedic, Plastic, and Spine Surgery Across a Health Care System

We hypothesized that a pain management prescribing tool embedded in the electronic health record system of a multihospital health care system would decrease prescription opioids for postoperative pain by hand, orthopedic, plastic, and spine surgeons. A prescribing tool for postoperative pain was designed for hand, orthopedic, plastic, and spine surgeons and implemented into electronic discharge order sets in a 10-hospital health care system. Stakeholders were educated on tool use in person and/or by email on 2 occasions. A dashboard was created to monitor opioid pill quantities and morphine milligram equivalents (MMEs) prescribed. Overall compliance with the suggested opioid amounts was assessed for 20 months after tool implementation. A subgroup of 6 hand surgeons, one of whom was instrumental in designing the tool, were evaluated for MMEs prescribed, opioid refills, patient emergency room visits, and patient readmissions within 30 days after discharge. Comparisons in this subgroup were made from 12 months before to 15 months after tool implementation. The mean system-wide compliance with the suggested opioid pill quantities and MMEs prescribed in all 4 specialties improved by less than 5%. In the subgroup of hand surgeons, 5 of whom championed tool use, prescribed MMEs decreased by 10% during each of the 4 quarters before launching the tool and contracted an additional 26% in the first quarter after tool implementation. Opioid refills held steady at 5%, and there were no emergency room visits or readmissions within 30 days after discharge in this patient subgroup. The prescribing tool had a negligible impact on system-wide compliance with suggested prescription opioid pill quantities and MMEs. In a small group of surgeons who championed the use of the tool, there was a significant and sustained decline in MMEs prescribed without adversely impacting patient refills, emergency room visits, or readmissions. An electronic prescribing tool to assist surgeons in lowering opioid prescription pill quantities and MMEs may have a negligible impact on prescribing behavior in a multihospital health care system.

Correlates of heroin use, pharmaceutical fentanyl misuse, and dual heroin-fentanyl use: evidence from the USA

PurposeThe emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention and intervention. This paper aims to examine sociodemographic correlates as well as health and substance use characteristics of different groups of opioid users.Design/methodology/approachThis paper used the 2015–2019 National Survey on Drug Use and Health to examine distinctions between groups (n = 11,142) of individuals who misuse prescription opioids, use heroin but not fentanyl, misuse pharmaceutical fentanyl but not heroin and use both heroin and fentanyl. Multinomial and logistic regression models were used to identify these distinctions.FindingsFew sociodemographic differences emerged between the prescription opioid group and pharmaceutical fentanyl misuse group. While those who misuse fentanyl have higher odds of using other drugs and experiencing certain mental health problems than those misusing prescription pills, both the heroin and fentanyl–heroin use groups reported considerably poorer health and substance use indicators relative to those who solely misuse fentanyl. It is also notable that both heroin use groups are more highly associated with cocaine and methamphetamine use than those misusing fentanyl alone.Research limitations/implicationsWhile this study identifies important distinctions between the opioid use groups studied, individuals using both heroin and pharmaceutical fentanyl report the poorest health and substance use characteristics. Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention and clinical work amid shifting patterns of opioid use.Practical implicationsImportant differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention and clinical work amid shifting patterns of opioid use.Originality/valueThis study highlights distinctions between pharmaceutical fentanyl users, heroin users and users of both substances.

Genuine and counterfeit prescription pill surveillance in Washington, D.C.

For the first time in Washington, D.C., an in-depth analysis of counterfeit pills has been performed as part of a larger initiative to understand the city’s illicit drug supply. Over a 56-month period, 567 pills that were physically identified as a pharmaceutical were analyzed using gas chromatography mass spectrometry (GC-MS) and gas chromatography flame ionization detection (GC-FID). Out of the 567 pills submitted to our laboratory, 119 were confirmed to be counterfeit. Beginning in 2018, an increase in counterfeit pills was observed in suspected pharmaceutical submissions. By 2021, 62.5% of all pill exhibits were determined to be counterfeit. Most of the counterfeit pills submitted during this time frame had a ’30M′ imprint with blue coloring, consistent with the physical identification of a 30 mg Oxycodone tablet. Fentanyl was the number one identified psychoactive substance detected in counterfeit pills (75.4%), however, other opioids, precursors, and a novel benzodiazepine were also identified. This preliminary research hopes to illustrate counterfeit pill trends in Washington, D.C. and highlight the importance of analyzing pharmaceuticals in addition to suspected illicit substances. This surveillance is ongoing and collaboration with neighboring jurisdictions is anticipated in the future.

PrEP Familiarity, Interest, and Usage Among 364 Black and Hispanic Adults in Indiana.

Pre-exposure prophylaxis, or PrEP, is a once-daily preventative prescription pill against HIV for adults or adolescents who have sex or inject drugs. PrEP may be especially useful among Black and Hispanic Americans, who are particularly at risk for HIV in the United States. In spite of this vulnerability, rates of PrEP use in Black and Hispanic communities are low. Here, we examined familiarity with, prior usage of, and future interest in PrEP among 364 Black and Hispanic Indiana residents. Indiana is an important context for this work, due to severe HIV outbreaks in the area over the last 8 years. Around half of all participants had never heard of PrEP, with Hispanic participants being less familiar than Black participants. Prior PrEP use was low, at around 10%, and was lower for Hispanic than Black participants. Around 21% of all participants reported interest in PrEP after learning of it in our study. Further, participants identified strategies that would make discussions about PrEP with a medical provider more comfortable. Black and Hispanic participants reported feeling the most comfortable with addressing PrEP usage with providers if: (a) the provider was the one who brought up the subject of PrEP, (b) there was written information available to the patient (i.e., brochures), and (c) the patient already knew they qualified for the prescription in terms of personal eligibility and insurance coverage. Additional provider and patient education, as well as openness on the part of the provider, can help to lessen the disparities associated with PrEP need and actual PrEP usage.

Structure Activity Relationships of Illicit Fentanyl Analogs

Fentanyl is a highly potent and efficacious mu opioid receptor (MOR) agonist with significant abuse potential. More than 70% of opioid overdose deaths involve fentanyl or one of its analogs; recently the DEA announced that 2 in 5 counterfeit prescription pills contain a lethal dose of fentanyl. However, little is known about the novel fentanyl analogs (fentalogs) flooding the illicit drug market. It is presumed that these novel fentalogs are also potent, highly efficacious MOR agonists and they are driving the increase in opioid overdoses, but pharmacological data on these compounds are scarce. We have determined the affinity for and agonist activity of a library of novel fentanyl analogs in vitro. We found that structure greatly alters affinity and agonist activity; in this library, affinity at MOR ranged from 0.4 nM to almost 400 nM – fentanyl displays 1.6 nM affinity for MOR. Based on the data collected from this library, we have been able to construct structure‐activity relationships which may allow us to predict which fentalogs are potent agonists and are likely to carry significant abuse liability. Conversely, we have discovered new high affinity, low efficacy compounds which could be developed into novel rescue therapies.