Changes in neurologic status after traumatic brain injury in the Resuscitation Outcomes Consortium Hypertonic Saline trial.

Objectives: Traumatic brain injury (TBI) is an important public health problem resulting in significant death and disability. Emergency medical services (EMS) personnel often provide initial treatment for TBI, but only limited data describe the long-term course and outcomes of this care. We sought to characterize changes in neurologic status among adults with TBI patients enrolled in the Resuscitation Outcomes Consortium Hypertonic Saline (ROC-HS) trial. Methods: We used data from the TBI cohort of the ROC-HS trial. The trial included adults with TBI, with Glasgow Coma Scale (GCS) ≤8, and excluded those with shock (systolic blood pressure [SBP] ≤70 or SBP 71-90 with a heart rate [HR] ≥108). The primary outcome was Glasgow Outcome Scale-Extended (GOS-E; 1 = dead, 8 = no disability) determined at (a) hospital discharge and (b) 6-month follow-up. We assessed changes in GOS-E between hospital discharge and 6-month follow-up using descriptive statistics and Sankey graphs. Results: Among 1279 TBI included in the analysis, GOS-E categories at hospital discharge were as follows: favorable (GOS-E 5-8) 220 (17.2%), unfavorable (GOS-E 2-4) 664 (51.9%), dead (GOS-E 1) 321 (25.1%), and missing 74 (5.8%). GOS-E categories at 6-month follow-up were as follows: favorable 459 (35.9%), unfavorable 279 (21.8%), dead 346 (27.1%), and missing 195 (15.2%). Among initial TBI survivors with complete GOS-E, >96% followed one of three neurologic recovery patterns: (1) favorable to favorable (20.0%), (2) unfavorable to favorable (40.3%), and (3) unfavorable to unfavorable (36.0%). Few patients deteriorated from favorable to unfavorable neurologic status, and there were few additional deaths. Conclusions: Among TBI receiving initial prehospital care in the ROC-HS trial, changes in 6-month neurologic status followed distinct patterns. Among TBI with unfavorable neurologic status at hospital discharge, almost half improved to favorable neurologic status at 6 months. Among those with favorable neurologic status at discharge, very few worsened or died at 6 months. These findings have important implications for TBI clinical care, research, and trial design.

The Double Effect of COVID-19 Confinement Measures and Economic Recession on High-Risk Drug Users and Drug Services.

The ongoing COVID-19 pandemic is likely to have a profound impact on the lives of high-risk drug users and on the services responding to their needs in at least two important ways: first, through the restrictive measures introduced to mitigate the spread of the virus and, second, as a result of extensive economic downturn. Currently there is great uncertainty as to the future intensity and duration of the pandemic. In addition, the lessons we have been able to learn from previous economic downturns may be of limited applicability to the current situation, which differs in a number of significant respects. Experience nevertheless suggests that the potential consequences for drug users' health and well-being may be severe. The ongoing uncertainty serves to underline the importance of close monitoring of the drug situation and preparing flexible and innovative solutions to be able to meet new challenges which may arise.

Fentanyl analogs on the Swedish webforum flashback: Interest and impact of scheduling.

BACKGROUND: Sweden regulates new psychoactive substances, including fentanyl analogs, individually. This reactive scheduling procedure enabled the existence of a recreational market for unscheduled fentanyl analogs sold from surface webshops. We measure the interest in 24 named fentanyl analogs and the impact of scheduling. METHODS: We scraped posts in threads on named fentanyl analogs from the Swedish internet forum Flashback.org, 2012-2019. The sample consists of 24 threads with a total of 8761 posts. We construct five measures of interest based on duration of threads, number of posts, and number of distinct posters, and fit a non-seasonal ARMA model to test if there was a change in mean activity after scheduling. RESULTS: Across the five measures, there was most interest in acryl fentanyl, butyr fentanyl, and acetyl fentanyl. The number of daily posts was significantly reduced in nine out of 13 threads after scheduling. CONCLUSION: The scheduling of fentanyl analogs impacted interest on Flashback.org. The biggest effect sizes were from the narcotics scheduling of 2-Me-MAF, acryl, and acetyl fentanyl, while furanyl fentanyl saw the biggest reduction after health scheduling. The reductions were bigger for narcotics scheduling compared to health scheduling.

Illicit drug prices and quantity discounts: A comparison between a cryptomarket, social media, and police data.

BACKGROUND: Illicit drugs are increasingly sold on cryptomarkets and on social media. Buyers and sellers perceive these online transactions as less risky than conventional street-level exchanges. Following the Risks & Prices framework, law enforcement is the largest cost component of illicit drug distribution. We examine whether prices on cryptomarkets are lower than prices on social media and prices reported by law enforcement on primarily offline markets. METHODS: Data consists of online advertisements for illicit drugs in Sweden in 2018, scraped from the cryptomarket Flugsvamp 2.0 (n = 826) and collected with digital ethnography on Facebook (n = 446). Observations are advertisements for herbal cannabis (n = 421), cannabis resin, hash (n = 594), and cocaine (n = 257) from 156 sellers. Prices are compared with estimates from Swedish police districts (n = 53). Three multilevel linear regression models are estimated, one for each drug type, comparing price levels and discount elasticities for each platform and between sellers on each platform. RESULTS: Price levels are similar on the two online platforms, but cocaine is slightly more expensive on social media. There are quantity discounts for all three drug types on both platforms with coefficients between -0.10 and -0.21. Despite the higher competition between sellers on cryptomarkets, prices are not lower compared to social media. Online price levels for hash and cocaine are similar to those reported by police at the 1 g level. CONCLUSION: Mean prices and quantity discounts are similar in the two online markets. This provides support for the notion that research on cryptomarkets can also inform drug market analysis in a broader sense. Online advertisements for drugs constitute a new detailed transaction-level data source for supply-side price information for research.

Sisters are never alike? Drug control intensity in the Nordic countries.

BACKGROUND: The Nordic countries - Denmark, Finland, Norway, and Sweden - have traditionally had different approaches to drug control policies. From the late 1980s to the early 1990s, Sweden and Norway were the most restrictive countries. Prior research has described how Nordic control policies became more repressive after this, but no research has examined this claim using the intensity of implementation as a measure. METHODS: This study uses data collated by the EMCDDA to examine drug control intensity from 2000 to 2016. The four countries are compared on three measures: seizure numbers relative to total population, seizures numbers by type of drug relative to population, and cannabis seizures relative to the number of annual cannabis users. Standard bivariate tests for statistical significance are used to compare control intensity over time and between countries. RESULTS: Compared to an earlier period from the late 1980s to the early 1990s, Denmark maintained the level of drug seizures to population from 2000 to 2016. Finland increased intensity by 176 percent but remained at the lowest level in the region. Norway increased by 18 percent and is currently the country with the highest enforcement intensity. Sweden reduced overall intensity by 57 percent, which decreases the level for the region by 22 percent. Sixty to seventy percent of all seizures in every country was for cannabis. Accounting for cannabis prevalence rates changes the ranking of enforcement intensity in the countries. CONCLUSION: Drug control intensity in the Nordic countries has harmonized over time. The disparity between the extremes of low control intensity in Finland and high intensity in Sweden has been reduced. Denmark is still comparatively lenient to users when considering high cannabis prevalence rates and Norway has taken the position as the strictest country on all control intensity measures.