Summary of Synthetic Opioid Testing Within the Department of Defense
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A Policy Perspective on the Global Use of Smokeless Tobacco
Curr Addict Rep DOI 10.1007/s40429-017-0166-7 TOBACCO (AH WEINBERGER, SECTION EDITOR) A Policy Perspective on the Global Use of Smokeless Tobacco Kamran Siddiqi1 & Aishwarya Lakshmi Vidyasagaran1 & Anne Readshaw1 & Ray Croucher2 # The Author(s) 2017. This article is an open access publication Abstract Keywords Smokeless tobacco . Snus . Tobacco control . Background Globally, over 300 million people consume di- Global health verse smokeless tobacco (ST) products. They are addictive, cause cancer, increased cardiovascular mortality risks and poor pregnancy outcomes. Introduction Purpose of Review To identify gaps in implementing key ST demand-reduction measures, focused literature reviews were “Smokeless tobacco” (ST) comprises tobacco products that do conducted and findings synthesized according to relevant not involve a combustion process, such as chewing, nasal and WHO Framework Convention on Tobacco Control (FCTC) oral tobacco [1•]. Globally, over 300 million people consume Articles. ST [1•], yet ST has been largely neglected in research and Recent Findings The literature supports implementation of policy arenas because it is generally regarded as less harmful ST demand-reduction measures. For taxation, labelling and than cigarettes. It is also seen as a regional rather than a global packaging, most administrations have weaker policies for ST problem, and too diverse and complex to control. than cigarettes. Capacity to regulate ST contents and offer ST use is reported in at least 116 countries worldwide, cessation support is lacking. There is poor compliance with including countries in Africa, Asia, Europe and the bans on ST advertising, promotion and sponsorship. Americas [2•]. Smokeless tobacco consumption is therefore Summary The literature on implementation of WHO a global public health issue. -
Quantitative Drug Test Menu Section 2
1 Guthrie Square, Sayre, PA 18840 Bill To: Client GMG Toxicology Laboratory Requisition Toll Free Phone (844) 617-4719 Insurance Request Date: _____/______/______ Medical Director: Hani Hojjati, MD Fax (570) 887-4729 Patient PATIENT INFORMATION (PLEASE PRINT IN BLACK INK) INSURANCE BILLING INFORMATION (PLEASE PRINT IN BLACK INK) Pt Last Name First M I PRIMARY Medicare Medicaid Other Ins. Self Spouse Child __ Subscriber Last Name First M Address Birth Date Sex M F Beneficiary/Member # Group # City Pt. SS# or MRN Claims Name and Address City ST ZIP ST ZIP Home Phone (Attach a copy of the patient's insurance card and information) SECONDARY Medicare Medicaid Other Ins. Self Spouse Child Employer Work Phone Subscriber Last Name First M Work Address City ST ZIP Beneficiary/Member # Group # __ CLIENT INFORMATION - REFERRING PHYSICIAN Claims Name and Address City ST ZIP Client Address: (Atttach a copy of the patient's insurance card and information) COLLECTION / REPORTING INFORMATION Copy to: FAX Results to __ CALL Results to Phone: Fax: Date Collected: Time Collected: AM PM Specimen Type: Urine Saliva Other ___________________ Physician Signature (legible - No Stamp) For Lab Use Only (Required for Medicare & Medicaid patient orders) Signed ABN Obtained Place Lab Label Here Contact Laboratory Medical Director (570-887-4719) with questions concerning medical necessity PHYSICIAN When ordering tests, the physician is required to make an independent medical necessity decision with regard to each test thelaboratory will bill. The physician also understands he or she is required NOTICE to (1) submit ICD-10 diagnosis supported in the patient's medical record as documentation of the medical necessity or (2) explain and have the patient sign an ABN. -
2020 International Narcotics Control Strategy Report
United States Department of State Bureau for International Narcotics and Law Enforcement Affairs International Narcotics Control Strategy Report Volume I Drug and Chemical Control March 2020 INCSR 2020 Volume 1 Table of Contents Table of Contents Common Abbreviations ..................................................................................................................................... iii International Agreements.................................................................................................................................... v INTRODUCTION ..................................................................................................................................... 1 Legislative Basis for the INCSR ......................................................................................................................... 2 Presidential Determination ................................................................................................................................. 7 Policy and Program Developments .................................................................................................... 12 Overview ......................................................................................................................................................... 13 Methodology for U.S. Government Estimates of Illegal Drug Production .......................................................... 18 Parties to UN Conventions .............................................................................................................................. -
Finland Country Drug Report 2017
Finland Country Drug Report 2017 Contents: At a glance | National drug strategy and coordination (p. 2) | Public expenditure (p. 3) | Drug laws and drug law offences (p. 4) | Drug use (p. 5) | Drug harms (p. 8) | Prevention (p. 10) | Harm reduction (p. 11) | Treatment (p. 12) | Drug use and responses in prison (p. 14) | Quality assurance (p. 15) | Drug-related research (p. 15) | Drug markets (p. 16) | Key drug statistics for Finland (p. 18) | EU Dashboard (p. 20) THE DRUG PROBLEM IN FINLAND AT A GLANCE Drug use Treatment entrants Overdose deaths Drug law offences in young adults (15-34 years) by primary drug in the last year 250 Cannabis 200 23 478 166 150 13.5 % Top 5 drugs seized 100 ranked according to quantities Cannabis, 21% 50 measured in kilograms Amphetamines, 15 % Cocaine, 0 % 0 1. Amphetamine 2011 2012 2013 2015 2014 Opioids, 52 % 2010 2007 2008 2006 9 % 17.9 % 2009 Other, 12 % 2. Herbal cannabis Other drugs Opioid substitution HIV diagnoses 3. Cannabis resin MDMA 2.5 % treatment clients attributed to injecting 4. Cocaine Amphetamines 2.4 % 14 5. Heroin Cocaine 1 % 12 3 000 10 Population 8 (15-64 years) 6 7 High-risk opioid users Syringes distributeddistributed 4 through specialised 2 3 483 757 programmes 0 13 836 2011 2012 2013 2015 2014 2010 2007 2008 2006 2009 Source: EUROSTAT (12 700 - 15 090) 5 301 000 Source: ECDC Extracted on: 26/03/2017 NB: Data presented here are either national estimates (prevalence of use, opioid drug users) or reported numbers through the EMCDDA indicators (treatment clients, syringes, deaths and HIV diagnosis, drug law offences and seizures). -
Recommended Methods for the Identification and Analysis of Fentanyl and Its Analogues in Biological Specimens
Recommended methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES Laboratory and Scientific Section UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Recommended Methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES UNITED NATIONS Vienna, 2017 Note Operating and experimental conditions are reproduced from the original reference materials, including unpublished methods, validated and used in selected national laboratories as per the list of references. A number of alternative conditions and substitution of named commercial products may provide comparable results in many cases. However, any modification has to be validated before it is integrated into laboratory routines. ST/NAR/53 Original language: English © United Nations, November 2017. All rights reserved. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. Mention of names of firms and commercial products does not imply the endorse- ment of the United Nations. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. Acknowledgements The Laboratory and Scientific Section of the UNODC (LSS, headed by Dr. Justice Tettey) wishes to express its appreciation and thanks to Dr. Barry Logan, Center for Forensic Science Research and Education, at the Fredric Rieders Family Founda- tion and NMS Labs, United States; Amanda L.A. -
DEMAND REDUCTION a Glossary of Terms
UNITED NATIONS PUBLICATION Sales No. E.00.XI.9 ISBN: 92-1-148129-5 ACKNOWLEDGEMENTS This document was prepared by the: United Nations International Drug Control Programme (UNDCP), Vienna, Austria, in consultation with the Commonwealth of Health and Aged Care, Australia, and the informal international reference group. ii Contents Page Foreword . xi Demand reduction: A glossary of terms . 1 Abstinence . 1 Abuse . 1 Abuse liability . 2 Action research . 2 Addiction, addict . 2 Administration (method of) . 3 Adverse drug reaction . 4 Advice services . 4 Advocacy . 4 Agonist . 4 AIDS . 5 Al-Anon . 5 Alcohol . 5 Alcoholics Anonymous (AA) . 6 Alternatives to drug use . 6 Amfetamine . 6 Amotivational syndrome . 6 Amphetamine . 6 Amyl nitrate . 8 Analgesic . 8 iii Page Antagonist . 8 Anti-anxiety drug . 8 Antidepressant . 8 Backloading . 9 Bad trip . 9 Barbiturate . 9 Benzodiazepine . 10 Blood-borne virus . 10 Brief intervention . 11 Buprenorphine . 11 Caffeine . 12 Cannabis . 12 Chasing . 13 Cocaine . 13 Coca leaves . 14 Coca paste . 14 Cold turkey . 14 Community empowerment . 15 Co-morbidity . 15 Comprehensive Multidisciplinary Outline of Future Activities in Drug Abuse Control (CMO) . 15 Controlled substance . 15 Counselling and psychotherapy . 16 Court diversion . 16 Crash . 16 Cross-dependence . 17 Cross-tolerance . 17 Custody diversion . 17 Dance drug . 18 Decriminalization or depenalization . 18 Demand . 18 iv Page Demand reduction . 19 Dependence, dependence syndrome . 19 Dependence liability . 20 Depressant . 20 Designer drug . 20 Detoxification . 20 Diacetylmorphine/Diamorphine . 21 Diuretic . 21 Drug . 21 Drug abuse . 22 Drug abuse-related harm . 22 Drug abuse-related problem . 22 Drug policy . 23 Drug seeking . 23 Drug substitution . 23 Drug testing . 24 Drug use . -
Drug Fact Sheet: Oxycodone
Oxycodone WHAT IS OXYCODONE? What is its effect on the mind? Oxycodone is a semi-synthetic narcotic analgesic Euphoria and feelings of relaxation are the most and historically has been a popular drug of abuse common effects of oxycodone on the brain, which among the narcotic abusing population. explains its high potential for abuse. WHAT IS ITS ORIGIN? What is its effect on the body? Oxycodone is synthesized from thebaine, a Physiological effects of oxycodone include: constituent of the poppy plant. • Pain relief, sedation, respiratory depression, constipation, papillary constriction, and cough What are common street names? suppression. Extended or chronic use of oxycodone Common street names include: containing acetaminophen may cause severe liver • Hillbilly Heroin, Kicker, OC, Ox, Roxy, Perc, and Oxy damage What does it look like? What are its overdose effects? Oxycodone is marketed alone as OxyContin® in Overdose effects include: 10, 20, 40 and 80 mg extended-release tablets • Extreme drowsiness, muscle weakness, confusion, cold and other immediate-release capsules like 5 and clammy skin, pinpoint pupils, shallow breathing, mg OxyIR®. It is also marketed in combination slow heart rate, fainting, coma, and possible death products with aspirin such as Percodan® or acetaminophen such as Roxicet®. Which drugs cause similar effects? Drugs that cause similar effects to Oxycodone How is it abused? include: Oxycodone is abused orally or intravenously. • Opium, codeine, heroin, methadone, hydrocodone, The tablets are crushed and sniffed or dissolved fentanyl, and morphine in water and injected. Others heat a tablet that has been placed on a piece of foil then inhale the What is its legal status in the United States? vapors. -
(Oxycontin®) and Oxymorphone (Opana® ER) Reference Number: ERX.NSST.17 Effective Date: 06/15 Revision Log Last Review Date: 09/16
Clinical Policy: extended-release oxycodone (OxyContin®) and oxymorphone (Opana® ER) Reference Number: ERX.NSST.17 Effective Date: 06/15 Revision Log Last Review Date: 09/16 Clinical policies are intended to be reflective of current scientific research and clinical thinking. This policy is current at the time of approval, may be updated and therefore is subject to change. This Clinical Policy is not intended to dictate to providers how to practice medicine, nor does it constitute a contract or guarantee regarding payment or results. Providers are expected to exercise professional medical judgment in providing the most appropriate care, and are solely responsible for the medical advice and treatment of members. This policy is the property of Envolve Pharmacy Solutions. Unauthorized copying, use, and distribution of this Policy or any information contained herein is strictly prohibited. By accessing this policy, you agree to be bound by the foregoing terms and conditions, in addition to the Site Use Agreement for Health Plans associated with Envolve Pharmacy Solutions. Description The intent of the criteria is to ensure that patients follow selection elements established by Envolve Pharmacy Solutions for the use of extended-release oxycodone (OxyContin®) and oxymorphone (Opana® ER). Policy/Criteria It is the policy of health plans affiliated with Envolve Pharmacy Solutions® that extended-release oxycodone (OxyContin®) and oxymorphone (Opana® ER) are medically necessary for members meeting the following criteria: Initial Approval Criteria (must meet all): A. Failure of an immediate-release (short-acting) narcotic analgesic; B. Failure of fentanyl patch and morphine extended-release tablets/capsules in the past 6 months, unless intolerant or contraindicated; C. -
Veterinary Anesthetic and Analgesic Formulary 3Rd Edition, Version G
Veterinary Anesthetic and Analgesic Formulary 3rd Edition, Version G I. Introduction and Use of the UC‐Denver Veterinary Formulary II. Anesthetic and Analgesic Considerations III. Species Specific Veterinary Formulary 1. Mouse 2. Rat 3. Neonatal Rodent 4. Guinea Pig 5. Chinchilla 6. Gerbil 7. Rabbit 8. Dog 9. Pig 10. Sheep 11. Non‐Pharmaceutical Grade Anesthetics IV. References I. Introduction and Use of the UC‐Denver Formulary Basic Definitions: Anesthesia: central nervous system depression that provides amnesia, unconsciousness and immobility in response to a painful stimulation. Drugs that produce anesthesia may or may not provide analgesia (1, 2). Analgesia: The absence of pain in response to stimulation that would normally be painful. An analgesic drug can provide analgesia by acting at the level of the central nervous system or at the site of inflammation to diminish or block pain signals (1, 2). Sedation: A state of mental calmness, decreased response to environmental stimuli, and muscle relaxation. This state is characterized by suppression of spontaneous movement with maintenance of spinal reflexes (1). Animal anesthesia and analgesia are crucial components of an animal use protocol. This document is provided to aid in the design of an anesthetic and analgesic plan to prevent animal pain whenever possible. However, this document should not be perceived to replace consultation with the university’s veterinary staff. As required by law, the veterinary staff should be consulted to assist in the planning of procedures where anesthetics and analgesics will be used to avoid or minimize discomfort, distress and pain in animals (3, 4). Prior to administration, all use of anesthetics and analgesic are to be approved by the Institutional Animal Care and Use Committee (IACUC). -
Framework Convention on Tobacco Control (WHO FCTC) Is the First Treaty Negotiated Under the Auspices of the World Health Organization
World Health Organization Geneva, Switzerland WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL World Health Organization WHO Library Cataloguing-in-Publication Data WHO Framework Convention on Tobacco Control. 1.Tobacco - supply and distribution 2.Tobacco industry - legislation 3.Tobacco smoke pollution - prevention and control 4.Tobacco use cessation 5.Treaties I.World Health Organization. ISBN 92 4 159101 3 (LC/NLM classification: HD 9130.6) © World Health Organization 2003, updated reprint 2004, 2005 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. -
COVID and Beyond Dart RC Opioid Abuse
Trends within Drug Abuse and Healthcare – COVID and Beyond Richard C. Dart, MD, PhD Director, Rocky Mountain Poison and Drug Safety, Denver Health Executive Director, RADARS® System Professor, University of Colorado School of Medicine Competing Interests RADARS® System is the property of The Denver Health and Hospital Authority (DHHA), a political subdivision of the State of Colorado. RADARS® System is supported by subscriptions from pharmaceutical manufacturers, government and nongovernment agencies for surveillance, research, and reporting services. No subscriber participated in the conception, analysis, drafting, or review of this presentation. 2 3 What Caused the US Opioid Crisis - HHS • In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers and health care providers began to prescribe them at greater rates. • Increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it came clear that these medications could indeed be highly addictive. • 2017 HHS declared a public health emergency and announced a five point strategy to combat the opioid crisis https://www.hhs.gov/opioids/about-the-epidemic/index.html 4 What Really Happened? • Health care systems and regulation • Fifth vital sign, patient “satisfaction,” etc. • Careless doctors • We knew better, but let convenience win out. • Criminal behavior • Opioid marketing • Aggressive, irresponsible • Increased supply of illicit opioids • Lack of treatment for OUD • Good, but after the fact, insufficient to meet demand • Increased demand? 5 What Happened to Rx Drug Abuse? 10 Years ago… Prescription drug abuse is the Nation's fastest-growing drug problem, and the Centers for Disease Control and Prevention has classified prescription drug abuse as an epidemic. -
Heterodimerization of Μ and Δ Opioid Receptors: a Role in Opiate Synergy
The Journal of Neuroscience, 2000, Vol. 20 RC110 1of5 Heterodimerization of and ␦ Opioid Receptors: A Role in Opiate Synergy I. Gomes, B. A. Jordan, A. Gupta, N. Trapaidze, V. Nagy, and L. A. Devi Departments of Pharmacology and Anesthesiology, New York University School of Medicine, New York, New York 10016 Opiate analgesics are widely used in the treatment of severe -selective ligands results in a significant increase in the bind- pain. Because of their importance in therapy, different strate- ing of a ␦ receptor agonist. This robust increase is also seen in gies have been considered for making opiates more effective SKNSH cells that endogenously express both and ␦ recep- while curbing their liability to be abused. Although most opiates tors. Furthermore, we find that a ␦ receptor antagonist en- exert their analgesic effects primarily via opioid receptors, a hances both the potency and efficacy of the receptor signal- number of studies have shown that ␦ receptor-selective drugs ing; likewise a antagonist enhances the potency and efficacy can enhance their potency. The molecular basis for these find- of the ␦ receptor signaling. A combination of agonists ( and ␦ ings has not been elucidated previously. In the present study, receptor selective) also synergistically binds and potentiates we examined whether heterodimerization of and ␦ receptors signaling by activating the –␦ heterodimer. Taken together, could account for the cross-modulation previously observed these studies show that heterodimers exhibit distinct ligand between these two receptors. We find that co-expression of binding and signaling characteristics. These findings have im- and ␦ receptors in heterologous cells followed by selective portant clinical ramifications and may provide new foundations immunoprecipitation results in the isolation of –␦ het- for more effective therapies.