2019 National Drug Threat Assessment
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Effect of Intranasal Ketamine Vs Fentanyl on Pain
1 PROTOCOL SYNOPSIS 2 STUDY TITLE: 3 Pain Reduction with Intranasal Medications for Extremity Injuries (PRIME): A Randomized Clinical 4 Noninferiority Trial of Intranasal Ketamine vs. Fentanyl 5 6 PROTOCOL TITLE 7 Pain Reduction with Intranasal Medications for Extremity injuries (PRIME) 8 9 PRINCIPAL INVESTIGATOR: 10 Theresa M. Frey, MD 11 Assistant Professor Clinical Pediatrics 12 Division of Pediatric Emergency Medicine 13 Cincinnati Children’s Hospital Medical Center 14 513-636-7966 15 [email protected] 16 17 CO-INVESTIGATORS: 18 Matthew R. Mittiga, MD 19 Todd A. Florin, MD, MSCE 20 Michelle C. Caruso, PharmD, BCPS 21 Nanhua Zhang, PhD 22 Yin Zhang, MS 23 24 I. ABSTRACT 25 26 Introduction: Inadequate pain control in the emergency department, particularly in the pediatric 27 population, is a major health concern. The intranasal route of medication administration is gaining 28 popularity secondary to its rapid onset of action, minimal discomfort for the patient and relative 29 simplicity. When pediatric patients present with moderate to severe pain from traumatic injuries, 30 opioids are currently the most frequently used class of analgesia, but they may not always be the best 31 option for numerous reasons. Sub-dissociative dosing of ketamine has been shown to be an effective 32 alternative to opioids in providing adequate pain relief. 33 34 Objectives: The objectives of this study are to 1) determine if intranasal ketamine is non-inferior to 35 intranasal fentanyl in reduction of pain in children presenting with extremity injuries and 2) define and 36 compare the level of sedation and respiratory side effect profile associated with intranasal ketamine and 37 fentanyl. -
Organized Crime and Terrorist Activity in Mexico, 1999-2002
ORGANIZED CRIME AND TERRORIST ACTIVITY IN MEXICO, 1999-2002 A Report Prepared by the Federal Research Division, Library of Congress under an Interagency Agreement with the United States Government February 2003 Researcher: Ramón J. Miró Project Manager: Glenn E. Curtis Federal Research Division Library of Congress Washington, D.C. 20540−4840 Tel: 202−707−3900 Fax: 202−707−3920 E-Mail: [email protected] Homepage: http://loc.gov/rr/frd/ Library of Congress – Federal Research Division Criminal and Terrorist Activity in Mexico PREFACE This study is based on open source research into the scope of organized crime and terrorist activity in the Republic of Mexico during the period 1999 to 2002, and the extent of cooperation and possible overlap between criminal and terrorist activity in that country. The analyst examined those organized crime syndicates that direct their criminal activities at the United States, namely Mexican narcotics trafficking and human smuggling networks, as well as a range of smaller organizations that specialize in trans-border crime. The presence in Mexico of transnational criminal organizations, such as Russian and Asian organized crime, was also examined. In order to assess the extent of terrorist activity in Mexico, several of the country’s domestic guerrilla groups, as well as foreign terrorist organizations believed to have a presence in Mexico, are described. The report extensively cites from Spanish-language print media sources that contain coverage of criminal and terrorist organizations and their activities in Mexico. -
Biased Versus Partial Agonism in the Search for Safer Opioid Analgesics
molecules Review Biased versus Partial Agonism in the Search for Safer Opioid Analgesics Joaquim Azevedo Neto 1 , Anna Costanzini 2 , Roberto De Giorgio 2 , David G. Lambert 3 , Chiara Ruzza 1,4,* and Girolamo Calò 1 1 Department of Biomedical and Specialty Surgical Sciences, Section of Pharmacology, University of Ferrara, 44121 Ferrara, Italy; [email protected] (J.A.N.); [email protected] (G.C.) 2 Department of Morphology, Surgery, Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy; [email protected] (A.C.); [email protected] (R.D.G.) 3 Department of Cardiovascular Sciences, Anesthesia, Critical Care and Pain Management, University of Leicester, Leicester LE1 7RH, UK; [email protected] 4 Technopole of Ferrara, LTTA Laboratory for Advanced Therapies, 44122 Ferrara, Italy * Correspondence: [email protected] Academic Editor: Helmut Schmidhammer Received: 23 July 2020; Accepted: 23 August 2020; Published: 25 August 2020 Abstract: Opioids such as morphine—acting at the mu opioid receptor—are the mainstay for treatment of moderate to severe pain and have good efficacy in these indications. However, these drugs produce a plethora of unwanted adverse effects including respiratory depression, constipation, immune suppression and with prolonged treatment, tolerance, dependence and abuse liability. Studies in β-arrestin 2 gene knockout (βarr2( / )) animals indicate that morphine analgesia is potentiated − − while side effects are reduced, suggesting that drugs biased away from arrestin may manifest with a reduced-side-effect profile. However, there is controversy in this area with improvement of morphine-induced constipation and reduced respiratory effects in βarr2( / ) mice. Moreover, − − studies performed with mice genetically engineered with G-protein-biased mu receptors suggested increased sensitivity of these animals to both analgesic actions and side effects of opioid drugs. -
Clandestine Drug Lab General Cleanup Guidance
Clandestine Drug Lab General Cleanup Guidance DIVISION OF ENVIRONMENTAL HEALTH i Minnesota Department of Health (MDH) Division of Environmental Health Minnesota Pollution Control Agency (MPCA) Clandestine Drug Lab General Cleanup Guidance September 2010 VERSION, Clarification to Table 1 March 2013 FOR MORE INFORMATION, CONTACT: MINNESOTA DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH PO BOX 64975 ST. PAUL, MN 55164-0975 TEL: 651-201-4899 TOLL FREE: 888-657-3908 FAX: 651-201-4606 TDD: 651-201-5797 TO REQUEST THIS DOCUMENT IN ANOTHER FORMAT, SUCH AS LARGE PRINT, BRAILLE OR CASSETTE TAPE, CALL 651-201-4911; TDD 651-201-5797 OR TOLL-FREE THROUGH THE MN RELAY SERVICE, 1-800-627-3529.TABLE OF CONTENT ii TABLE OF CONTENTS Clandestine Drug Lab .................................................................................................................. i General Cleanup ..........................................................................................................................i Guidance ..................................................................................................................................i TABLE OF CONTENTS ............................................................................................................. iii ACKNOWLEDGEMENTS ........................................................................................................... v ACKNOWLEDGEMENTS ........................................................................................................... v I. INTRODUCTION .................................................................................................................. -
Medications to Treat Opioid Use Disorder Research Report
Research Report Revised Junio 2018 Medications to Treat Opioid Use Disorder Research Report Table of Contents Medications to Treat Opioid Use Disorder Research Report Overview How do medications to treat opioid use disorder work? How effective are medications to treat opioid use disorder? What are misconceptions about maintenance treatment? What is the treatment need versus the diversion risk for opioid use disorder treatment? What is the impact of medication for opioid use disorder treatment on HIV/HCV outcomes? How is opioid use disorder treated in the criminal justice system? Is medication to treat opioid use disorder available in the military? What treatment is available for pregnant mothers and their babies? How much does opioid treatment cost? Is naloxone accessible? References Page 1 Medications to Treat Opioid Use Disorder Research Report Discusses effective medications used to treat opioid use disorders: methadone, buprenorphine, and naltrexone. Overview An estimated 1.4 million people in the United States had a substance use disorder related to prescription opioids in 2019.1 However, only a fraction of people with prescription opioid use disorders receive tailored treatment (22 percent in 2019).1 Overdose deaths involving prescription opioids more than quadrupled from 1999 through 2016 followed by significant declines reported in both 2018 and 2019.2,3 Besides overdose, consequences of the opioid crisis include a rising incidence of infants born dependent on opioids because their mothers used these substances during pregnancy4,5 and increased spread of infectious diseases, including HIV and hepatitis C (HCV), as was seen in 2015 in southern Indiana.6 Effective prevention and treatment strategies exist for opioid misuse and use disorder but are highly underutilized across the United States. -
Responses to Information Requests Responses to Information Requests
Home Country of Origin Information Responses to Information Requests Responses to Information Requests Responses to Information Requests (RIR) are research reports on country conditions. They are requested by IRB decision makers. The database contains a seven-year archive of English and French RIR. Earlier RIR may be found on the European Country of Origin Information Network website. Please note that some RIR have attachments which are not electronically accessible here. To obtain a copy of an attachment, please e-mail us. Related Links • Advanced search help 15 August 2019 MEX106302.E Mexico: Drug cartels, including Los Zetas, the Gulf Cartel (Cartel del Golfo), La Familia Michoacana, and the Beltrán Leyva Organization (BLO); activities and areas of operation; ability to track individuals within Mexico (2017-August 2019) Research Directorate, Immigration and Refugee Board of Canada 1. Overview InSight Crime, a foundation that studies organized crime in Latin America and the Caribbean (Insight Crime n.d.), indicates that Mexico’s larger drug cartels have become fragmented or "splintered" and have been replaced by "smaller, more volatile criminal groups that have taken up other violent activities" (InSight Crime 16 Jan. 2019). According to sources, Mexican law enforcement efforts to remove the leadership of criminal organizations has led to the emergence of new "smaller and often more violent" (BBC 27 Mar. 2018) criminal groups (Justice in Mexico 19 Mar. 2018, 25; BBC 27 Mar. 2018) or "fractur[ing]" and "significant instability" among the organizations (US 3 July 2018, 2). InSight Crime explains that these groups do not have "clear power structures," that alliances can change "quickly," and that they are difficult to track (InSight Crime 16 Jan. -
FARC During the Peace Process by Mark Wilson
PERRY CENTER OCCASIONAL PAPER NOVEMBER 2020 FARC During the Peace Process By Mark Wilson WILLIAM J. PERRY CENTER FOR HEMISPHERIC DEFENSE STUDIES National Defense University Cover photo caption: FARC leaders Iván Márquez (center) along with Jesús Santrich (wearing sunglasses) announce in August 2019 that they are abandoning the 2016 Peace Accords with the Colombian government and taking up arms again with other dissident factions. Photo credit: Dialogo Magazine, YouTube, and AFP. Disclaimer: The views expressed in this paper are those of the author and are not an official policy nor position of the National Defense University, the Department of Defense nor the U.S. Government. About the author: Mark is a postgraduate candidate in the MSc Conflict Studies program at the London School of Economics. He is a former William J. Perry Center intern, and the current editor of the London Conflict Review. His research interests include illicit networks as well as insurgent conflict in Colombia specifically and South America more broadly. Editor-in-Chief: Pat Paterson Layout Design: Viviana Edwards FARC During the Peace Process By Mark Wilson WILLIAM J. PERRY CENTER FOR HEMISPHERIC DEFENSE STUDIES PERRY CENTER OCCASIONAL PAPER NOVEMBER 2020 FARC During the Peace Process By Mark Wilson Introduction The 2016 Colombian Peace Deal marked the end of FARC’s formal military campaign. As a part of the demobilization process, 13,000 former militants surrendered their arms and returned to civilian life either in reintegration camps or among the general public.1 The organization’s leadership were granted immunity from extradition for their conduct during the internal armed conflict and some took the five Senate seats and five House of Representatives seats guaranteed by the peace deal.2 As an organiza- tion, FARC announced its transformation into a political party, the Fuerza Alternativa Revolucionaria del Común (FARC). -
Methamphetamine & Opioid Response Initiative
Billings Metro VISTA Project Methamphetamine & Opioid Response Initiative: A Community Assessment July 2019 AmeriCorps VISTAs: Nick Fonte and Amy Trad Table of Contents EXECUTIVE SUMMARY ......................................................................................................................................... 3 INTRODUCTION ....................................................................................................................................................... 4 Section 1: Area of Study ............................................................................................................................................ 4 Section 2: Methamphetamine vs. Opioids ................................................................................................................. 5 KEY STAKEHOLDERS ............................................................................................................................................ 6 Section 1: Community Organizations/Non-profits .................................................................................................... 6 Section 2: Statewide and Local Initiatives ................................................................................................................ 9 RELEVANT DATA ................................................................................................................................................... 11 Section 1: Methamphetamine and Opioids in the News ......................................................................................... -
National Vital Statistics Report: Drugs Most Frequently Involved In
National Vital Statistics Reports Volume 67, Number 9 December 12, 2018 Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016 by Holly Hedegaard, M.D., M.S.P.H., and Brigham A. Bastian, B.S., National Center for Health Statistics; James P. Trinidad, M.P.H., M.S., U.S. Food and Drug Administration; Merianne Spencer, M.P.H., and Margaret Warner, Ph.D., National Center for Health Statistics Abstract overdose deaths involving methadone decreased from 1.4 per 100,000 in 2011 to 1.1 in 2016. The 10 most frequently Objective—This report identifies the specific drugs involved mentioned drugs often were found in combination with each most frequently in drug overdose deaths in the United States other. The drugs most frequently mentioned varied by the intent from 2011 through 2016. of the drug overdose death. In 2016, the drugs most frequently Methods—Record-level data from the 2011–2016 National mentioned in unintentional drug overdose deaths were fentanyl, Vital Statistics System–Mortality files were linked to electronic heroin, and cocaine, while the drugs most frequently mentioned files containing literal text information from death certificates. in suicides by drug overdose were oxycodone, diphenhydramine, Drug overdose deaths were identified using the International hydrocodone, and alprazolam. Classification of Diseases, Tenth Revision underlying cause- Conclusions—This report identifies patterns in the specific of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Drug drugs most frequently involved in drug overdose deaths from mentions were identified by searching the literal text in three 2011 through 2016 and highlights the importance of complete fields of the death certificate: the causes of death from Part I, and accurate reporting in the literal text on death certificates. -
What Are the Treatments for Heroin Addiction?
How is heroin linked to prescription drug abuse? See page 3. from the director: Research Report Series Heroin is a highly addictive opioid drug, and its use has repercussions that extend far beyond the individual user. The medical and social consequences of drug use—such as hepatitis, HIV/AIDS, fetal effects, crime, violence, and disruptions in family, workplace, and educational environments—have a devastating impact on society and cost billions of dollars each year. Although heroin use in the general population is rather low, the numbers of people starting to use heroin have been steadily rising since 2007.1 This may be due in part to a shift from abuse of prescription pain relievers to heroin as a readily available, cheaper alternative2-5 and the misperception that highly pure heroin is safer than less pure forms because it does not need to be injected. Like many other chronic diseases, addiction can be treated. Medications HEROIN are available to treat heroin addiction while reducing drug cravings and withdrawal symptoms, improving the odds of achieving abstinence. There are now a variety of medications that can be tailored to a person’s recovery needs while taking into account co-occurring What is heroin and health conditions. Medication combined with behavioral therapy is particularly how is it used? effective, offering hope to individuals who suffer from addiction and for those around them. eroin is an illegal, highly addictive drug processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties The National Institute on Drug Abuse (NIDA) has developed this publication to Hof poppy plants. -
Exposures Associated with Clandestine Methamphetamine Drug Laboratories in Australia
Rev Environ Health 2016; 31(3): 329–352 Jackie Wright*, John Edwards and Stewart Walker Exposures associated with clandestine methamphetamine drug laboratories in Australia DOI 10.1515/reveh-2016-0017 Received April 20, 2016; accepted June 7, 2016; previously published Introduction online July 18, 2016 Illicit drugs such as amphetamine-type stimulants (ATS) Abstract: The clandestine manufacture of methamphet- (1) are manufactured in Australia within clandestine amine in residential homes may represent significant laboratories that range from crude, makeshift operations hazards and exposures not only to those involved in the using simple processes to sophisticated operations. These manufacture of the drugs but also to others living in the laboratories use a range of chemical precursors to manu- home (including children), neighbours and first respond- facture or “cook” ATS that include methylamphetamine, ers to the premises. These hazards are associated with more commonly referred to as methamphetamine (“ice”) the nature and improper storage and use of precursor and 3,4-methylenedioxymethamphetamine (MDMA or chemicals, intermediate chemicals and wastes, gases and “ecstasy”). In Australia the primary ATS manufactured methamphetamine residues generated during manufac- in clandestine drug laboratories is methamphetamine ture and the drugs themselves. Many of these compounds (2), which is the primary focus of this review. Clandes- are persistent and result in exposures inside a home not tine laboratories are commonly located within residential only during manufacture but after the laboratory has been homes, units, hotel rooms, backyard sheds and cars, with seized or removed. Hence new occupants of buildings for- increasing numbers detected in Australia each year (744 merly used to manufacture methamphetamine may be laboratories detected in 2013–2014) (2). -
Getting Through Amphetamine Withdrawal – a Guide for People
Amphetamine_wdl_220404.qxd 28/04/2004 12:19 PM Page i GETTING THROUGH AMPHETAMINE WITHDRAWAL A guide for people trying to stop amphetamine use Amphetamine_wdl_220404.qxd 28/04/2004 12:19 PM Page ii GETTING THROUGH AMPHETAMINE WITHDRAWAL CONTENTS About this book x Making the decision to stop using amphetamines x Amphetamine withdrawal x What is withdrawal? x How long will the symptoms last? What kinds of symptoms will I have? x Getting started x Organise a safe environment x Organise support x Structure your day x The role of medication x Getting through withdrawal x Cravings x Sleep x September 1996 Relaxing x Revised May 2004 Mood swings x © Turning Point Alcohol and Drug Centre Inc. Strange thoughts x 54-62 Gertrude Street, Fitzroy VIC 3065 Eating again x T: 03 8413 8413 Aches and pains x F: 03 9416 3420 High-risk situations x Counselling x E: [email protected] It’s all too much x www.turningpoint.org.au Sex and withdrawal x Original edition by Dr Nik Lintzeris, Dr Adrian Dunlop and After withdrawal x David Thornton What next? x Updated (2004) by Dr Adrian Dunlop, Sandra Hocking, Dr Getting back on track if you ‘slip up’ x Nicole Lee and Peter Muhleisen Notes for supporters x Cartoonist: Mal Doreian Useful contact numbers x ISBN 0_958 6979_1_4 1 Amphetamine_wdl_220404.qxd 28/04/2004 12:19 PM Page 2 GETTING THROUGH AMPHETAMINE WITHDRAWAL MAKING THE DECISION TO STOP USING AMPHEATMINES ABOUT THIS BOOK This book is written for people who are thinking about You may find it helpful to make a list of the positives and the or trying to stop using amphetamines, even if just for a negatives about using amphetamines.