This document summarizes a systematic review on the effectiveness of drug checking interventions at reducing drug-related harms. The review identified 35 studies that evaluated drug checking services and their ability to monitor drug markets and influence individual behaviors. Monitoring studies provided unique insights into adulteration levels and purity but their impact on harm reduction was not clearly evaluated. Behavioral studies suggested drug users would reject adulterated or unknown substances based on hypothetical drug check results, but real-world impact was unclear due to study limitations. Overall, the review found promising evidence of drug checking's benefits but noted a need for better evaluating their effects on interventions and behaviors.
Historically, drugs were discovered by identifying the active ingredient from traditional remedies or by serendipitous discovery, as with penicillin. More recently, chemical libraries of synthetic small molecules, natural products or extracts were screened in intact cells or whole organisms to identify substances that had a desirable therapeutic effect in a process known as classical pharmacology. After sequencing of the human genome allowed rapid cloning and synthesis of large quantities of purified proteins, it has become common practice to use high throughput screening of large compounds libraries against isolated biological targets which are hypothesized to be disease-modifying in a process known as reverse pharmacology. Hits from these screens are then tested in cells and then in animals for efficacy
Historically, drugs were discovered by identifying the active ingredient from traditional remedies or by serendipitous discovery, as with penicillin. More recently, chemical libraries of synthetic small molecules, natural products or extracts were screened in intact cells or whole organisms to identify substances that had a desirable therapeutic effect in a process known as classical pharmacology. After sequencing of the human genome allowed rapid cloning and synthesis of large quantities of purified proteins, it has become common practice to use high throughput screening of large compounds libraries against isolated biological targets which are hypothesized to be disease-modifying in a process known as reverse pharmacology. Hits from these screens are then tested in cells and then in animals for efficacy
In these slides you can get the information of clinical trials which have four phase I,II,III, IV. before clinical trials, Pre-clinical studies should be completed.
Alcohol and drug use as a contributing factor in the commission of crime – perceptions of Australian detainees
By: Alexandra Gannoni on behalf of Dr Susan Goldsmid 2014 Australian Winter School Conference, 23-24 July
What do we know?
•Alcohol and drug misuse are key determinants in the initiation and maintenance of criminal offending
•Odds of criminal offending 2.8 to 3.8 times greater for drug users than non-drug users (Bennett, Holloway & Farrington 2008)
•Regular users of both amphetamines and heroin self-report violent and property offences at rates more than five times higher than prisoners with no history of drug abuse (Makkai & Payne 2003)
•Drug use is linked to higher recidivism rates among prison populations (Kinner 2006)
What is DUMA? Drug Use Monitoring in Australia
•Created in 1999, DUMA is the largest and longest-running ongoing survey of Australian police detainees
•Based on I-ADAM (United States-driven international project)
•Co-operative partnership between AIC, local researchers and police
Past nonmedical opioid use could predict future heroin use among teensΔρ. Γιώργος K. Κασάπης
Two studies published yesterday point to predictors of teens using drugs. Researchers in one study found that teens who used opioids when they were not prescribed for medical reasons were more likely to later use heroin. Of the nearly 3,300 high schoolers who were included in the study, those who previously used opioids were about 11% more likely to use heroin, while those who currently used opioids were about 13% more likely to use heroin.
Another study found that there was no increase in teenagers using marijuana if they lived in a state that had laws legalizing the drug. In fact, in states with recreational marijuana laws, the odds of teen marijuana use were about 10% less following legalization.
This presentation was made at the PAMM winter meeting in Verona (Italy) February 2019 and intended students to go through the basic methods used for phase I clinical trials.
In these slides you can get the information of clinical trials which have four phase I,II,III, IV. before clinical trials, Pre-clinical studies should be completed.
Alcohol and drug use as a contributing factor in the commission of crime – perceptions of Australian detainees
By: Alexandra Gannoni on behalf of Dr Susan Goldsmid 2014 Australian Winter School Conference, 23-24 July
What do we know?
•Alcohol and drug misuse are key determinants in the initiation and maintenance of criminal offending
•Odds of criminal offending 2.8 to 3.8 times greater for drug users than non-drug users (Bennett, Holloway & Farrington 2008)
•Regular users of both amphetamines and heroin self-report violent and property offences at rates more than five times higher than prisoners with no history of drug abuse (Makkai & Payne 2003)
•Drug use is linked to higher recidivism rates among prison populations (Kinner 2006)
What is DUMA? Drug Use Monitoring in Australia
•Created in 1999, DUMA is the largest and longest-running ongoing survey of Australian police detainees
•Based on I-ADAM (United States-driven international project)
•Co-operative partnership between AIC, local researchers and police
Past nonmedical opioid use could predict future heroin use among teensΔρ. Γιώργος K. Κασάπης
Two studies published yesterday point to predictors of teens using drugs. Researchers in one study found that teens who used opioids when they were not prescribed for medical reasons were more likely to later use heroin. Of the nearly 3,300 high schoolers who were included in the study, those who previously used opioids were about 11% more likely to use heroin, while those who currently used opioids were about 13% more likely to use heroin.
Another study found that there was no increase in teenagers using marijuana if they lived in a state that had laws legalizing the drug. In fact, in states with recreational marijuana laws, the odds of teen marijuana use were about 10% less following legalization.
This presentation was made at the PAMM winter meeting in Verona (Italy) February 2019 and intended students to go through the basic methods used for phase I clinical trials.
Characteristics and Outcomes of Adult Opiate Users in Abstinence-Based Resid...Siobhan Morse
Prior research in this population suggests that, overall, opiate and non-opiate addicted users have different issues and ought to be treated differently for their addiction—and that young and older adult opiate users present at treatment with different issues. This study investigated what significant differences in treatment motivation, length and outcome, if any, exist between opiate and non-opiate users and further investigates young adult (18-25 years of age) and older adult (26 and older) opiate users and the impact of any differences. Data for this study was drawn from 1972 individuals who entered voluntary, private, residential drug treatment and rehab. Study measures included the Addiction Severity Index (ASI), the Treatment Service Review (TSR), and the University of Rhode Island Change Assessment (URICA). Interviews were conducted at program intake and six-months post-discharge. Implications for addiction treatment providers and planners are discussed.
The slides from the keynote given by Dr. Dan Malone RPh, PhD at the First International Drug-Drug Interaction Knowledge Representation Workshop on October 6th 2014 (http://icbo14.com/sessions/drug-drug-interaction-knowledge-representation-workshop/). Posted with his permission.
Definition and scope of Pharmacoepidemiology ABUBAKRANSARI2
In these slides I shared the information of definition and scope of pharmacoepidemiology. Types of studies - cohort studies, cross-sectional studies etc.
Causality Assessment in PharmacovigilanceClinosolIndia
Causality assessment is the process of determining whether a particular drug or medical intervention is the cause of an adverse event or reaction that has occurred in a patient. The following are some key principles and factors that are considered in causality assessment:
Temporal relationship: The timing of the adverse event in relation to the drug or intervention is a key factor in causality assessment. If the adverse event occurs shortly after the drug is administered or the intervention is performed, this may suggest a causal relationship.
Biological plausibility: The biological mechanisms by which the drug or intervention could cause the adverse event should be considered. If there is a plausible biological mechanism for the adverse event, this may support a causal relationship.
Alternative explanations: Other factors that could have caused the adverse event, such as pre-existing medical conditions, should be considered and ruled out before attributing the event to the drug or intervention.
Dose-response relationship: If there is a clear dose-response relationship between the drug or intervention and the adverse event, this may suggest a causal relationship.
Rechallenge: If the adverse event reoccurs when the drug or intervention is readministered, this may provide further evidence for a causal relationship.
There are several methods for conducting causality assessment, including the Naranjo algorithm, the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system, and the Liverpool Causality Assessment Tool (LCAT). These methods use different criteria and scoring systems to evaluate the likelihood of a causal relationship between the drug or intervention and the adverse event.
Similar to Is drug checking effective at reducing harm? A systematic review (20)
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Is drug checking effective at reducing harm? A systematic review
1. Is drug checking effective at reducing harm?
A systematic review
Monica Barratt, Ewa Siedlecka, Alison Ritter
Drug Policy Modelling Program
2. 2
Background
• Issue 1: Adulteration of illicit substances
• Illicit markets lack quality control mechanisms
• Manufacturers may intentionally substitute cheaper drugs to
increase profit or accidentally introduce impurities
• Adulterated pills > risk due to unexpected responses
• Issue 2: Purity of illicit substances
• There are no easy ways of determining substance purity
• High dose > risk of overdose
• Issue 3: Proliferation of new/novel substances
• 100s of new substances are being identified each year
• Difficult to track health outcomes of NPS in a timely way
• NPS can be misrepresented as better-known drugs
3. 3
Terms and definitions
• Pill testing
• ‘Pill testing’ arose in context of predominantly ‘ecstasy’ tablets
• Now, drugs tested include pills, powders, capsules and blotters
• And list of ‘expected’ or ‘alleged’ drugs is very long – cf. NPS
• ‘Drug checking’ term used in this paper
• Drugs, rather than pills
• ‘Drug testing’ term associated with workplace or driver testing
• What is drug checking?
• Service for people who consume illicit drugs
• Voluntarily submit their substances for forensic analysis
• Receive their results accompanied by counselling/info as needed
• Attend service on-site or at fixed site or through post/web portal
• Netherlands, Austria, Switzerland, Portugal, Spain, Luxembourg
8. 8
A unique source of drug market intelligence
• What is unique about information from drug checking?
• Surveys and interviews ► what people think they are taking
• Police seizures ► content/purity of drugs destined for sale
• Waste water analyses ►what drugs are being consumed
• Drug checking data give us the link that connects these
together
• What is the size and nature of the discrepancy between alleged
and actual content and purity of illicit drugs?
• How does this discrepancy change over time?
9. 9
How could drug checking reduce harms?
1. individual behaviour change
2. provision of more accurate harm reduction advice
3. better clinical management
4. intervention or connection with other services
5. population-level behaviour change
6. changes in supply-side dynamics
7. detect (and respond to) novel substances more
rapidly
10. 10
Aim
To determine the effectiveness of drug checking
interventions at reducing drug-related harms
• Monitoring
• Behaviour change
• Other studies
11. 11
Methods
• Preferred Reporting of Systematic Reviews and Meta-Analyses
(PRISMA) was followed
• Search terms - drug checking, pill testing, and [purity, novel/new
psychoactive substance, content, drug market, harm reduction] with ecstasy
• 81 relevant records from scholarly DBs + 109 additional = 190
• Additional: Google Scholar, forward & backward searching, personal DB
• Inclusion criteria:
• drug checking intervention/service was conducted, or
• hypothetical drug checking scenario was tested, or
• use of testing kits (colour reagent) was described/characterised
• 84 excluded = did not report original data
• 71 excluded = did not meet topic inclusion criteria
• The remaining 35 studies were reviewed
12. 12
Year of publication
Plus n=1 no date, likely late 1990s
0
1
2
3
4
5
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
13. 13
Monitoring studies
• n=18 studies that used drug checking data to report the alleged
and actual content of drugs
• Netherlands (n=8), Spain (n=3), Portugal (n=2), USA (n=3),
Australia (n=1) and France (n=1)
• Gas Chromatography (e.g. GC/MS) / thin layer chromatography
• 11 longitudinal, 7 cross-sectional
• 15 involved off-site testing, 4 involved on-site testing, 3 involved
postal submission of samples with online results
• In all (n=6) studies spanning 1975-2005, all tablets were
allegedly ‘Ecstasy’
• Using data 2004+, n=6 studies focused on alleged/actual NPS:
mCPP, 2C-B, cathinone derivatives, 4-FA, and general NPS
14. 14
Adulteration of conventional drugs (PT, 2009-13)
Only
unexpected
Expected
combined w/
unexpected
Only
expected Fig 2,
Martins
et al.,
2015
16. 16
Mean purity of MDMA per tablet (NL)
Brunt, Niesink et al., 2012, p. 136
17. 17
How is this information being used?
• To better understand market adaptations to shortages (Linsen
et al., 2015; Brunt & Niesink, 2011; Bossong et al., 2010; Vogels et al., 2009; Spruit, 2001)
• To test drug user response to market shifts, e.g. ecstasy
users’ responses to MDMA shortage (Brunt, Niesink et al., 2012)
• To contrast drug-checking samples with police-seized drugs
(Giraudon & Bello, 2007; Camilleri & Caldicott, 2005)
• To disentangle effects/harms of ‘Ecstasy’ (Brunt, Koeter et al., 2012)
• To recruit drug users into additional research with
confidence about the drug type they have taken
(Brunt, Niesink et al., 2012; Caudevilla-Gálligo et al., 2012)
• To issue warnings when particularly harmful adulterants or
purity levels are detected (See DIMS annual reports)
19. 19
Risk of bias within & across studies (monitoring)
• Within studies
• Different methods of forensic analysis could cause bias, but most
recent studies use GC/MS backed with other methodologies
• Across studies
• Query representativeness: Samples are self-submitted: more
likely to submit adulterated tablets than MDMA-only tablets
following a negative experience?
• Furthermore, most projects run at capacity – more demand than
there is funding to complete the work
• The uses of monitoring data, e.g. for issuing warnings, have not
been evaluated. Do people react in expected ways?
• Mainly high quality peer-reviewed publications
• Verdict: low likelihood of bias
20. 20
Behavioural outcome studies (1)
• n=8 behaviours following drug checking were measured
• n=4 drug checking occurred, n=4 drug checking hypothetical
• All were cross-sectional surveys
• Year data collected / study conducted, from 1995 to 2013
• 6 countries represented [Canada, Australia(3), Netherlands(2), Germany, Austria(2), USA]
• Varied measurement of outcome variable
• Findings relate to general presence (e.g. at a festival), rather than an
individual drug checking result (Dundes, 2003; van de Wijngaart et al., 1999)
• Findings relate to hypothetical individual drug checking result (Black et al.,
2008; Dunn et al., 2007; Johnston et al., 2006; Benschop et al., 2003)
• Unclear (Kriener & Schmid, no date; Michelow & Dowden, 2015)
• There was no study found that clearly measured behavioural
responses to a specific drug checking occurrence
21. 21
Behavioural outcome studies (2)
• Most detailed results are from the 4 hypothetical scenario studies
• Three years of EDRS (2005, 2006, 2007)
• Ecstasy users reported that they would not take the pill if the test result
indicated: MDxx (0-2%), amphetamine-like (6-15%), ketamine (50-57%),
opiates (53-57%), 2C-B/I (59-68%), DXM (67-73%), PMA (68-80%),
unknown/benign/suspicious (65-76%).
• Three city European study (2002)
• 33% would not take the pill that contained 25mg MDMA (32% for 75mg, 36%
for 150mg, 41% for amphetamine and 85% for suspicious substance).
• 46% of participants would warn their friends if the pill contained 25mg of
MDMA, 43% for 75mg, 64% for 150mg, 58% for amphetamine and 82% for
suspicious substance.
• 39% would inquire about possible risks if the pill contained 25mg of MDMA,
37% for 75mg, 43% for 150mg, 41% for amphetamine and 67% for
suspicious substance.
• Most ecstasy users would reject pills where test results indicated
an unknown or suspicious substance (in hypothetical)
22. 22
Risk of bias within and across studies (behavioural)
• Within studies:
• Limitations of hypothetical design
• Limited outcome of interest – not just ‘do not take’
• Data only makes sense if presented for each different test result
• Across studies
• Services do not prioritise evaluations
• Lacking finance, time, motivation
• Behavioural impact data that have not yet been published
• Most not published in peer reviewed journals
• Legal problems may result from asking more specific questions
• Result: selective reporting problems are likely
23. 23
Other studies
• n=12 other studies
• Ethnography comparing 3 festival settings (UK, US, Portugal):
critical importance of the surrounding political-legal context on
effectiveness of peer organisations and drug checking (Ruane, 2015)
• Demographic characteristics of drug-checkers (Multiple studies)
• On-site drug checking reaches a more at-risk group than off-site
services (Hungerbuehler et al., 2011)
• Process type evaluation of drug checking interventions, e.g.
number of people using the services and reach of services, but
no outcome measures (Maier et al., 2013; Hungerbuehler et al., 2011; Kriener et
al., 2001; Tossman et al., 1999)
• Studies that provided prevalence of personal use of test kits
(colour reagent) (Barratt, 2011; Allott & Redman, 2006; Murphy et al., 2005)
24. 24
Discussion
• Monitoring capacity: strong evidence of utility (e.g. DIMS), but
also important to evaluate the interventions that arise for
monitoring (e.g. effects of warnings)
• Behavioural outcomes: shows promise, but needs a tighter
evaluation for confirmation
• Other studies: ethnographical work is important to better
understand the context within which drug checking operates
25. 25
Final thoughts
• Why have drug checking initiatives not been more widely adopted?
• Is it related to a lack of solid evidence for effectiveness?
• Assuming this is the case would reflect a naivety about the policy process
and how policy is made
• Rather, all stakeholders need to be convinced that it is a win-win:
• Police can access unique (anonymous) drug market data, which
goes above and beyond data from drug seizures
• Health can tailor responses and care to actual substance taken,
and they can access an at-risk population earlier
• Drug users can (a) access timely and tailored information, (b)
receive more relevant health care, (c) avoid adulterated drugs
• Everyone can warn each other about specific very-high-risk
substances, potentially reducing related harms and deaths
26. 26
Acknowledgements
• NDARC internal funding for research assistance
• MB is co-affiliated with NDRI/Curtin and Burnet
• MB is supported by an NHMRC Early Career Researcher
Fellowship (APP1070140)
• AR is supported by an NHMRC Senior Research Fellowship
(APP1021988)
• Thanks to Spain’s Energy Control for kindly providing images of
them in action and allowing us to use them here.
Please contact Monica for further discussion:
m.barratt@unsw.edu.au
@monicabarratt