An ecological study of the correlation between COVID-19 support payments and overdose events in British Columbia, Canada.

BACKGROUND: Pandemic income support payments have been speculatively linked to an increased incidence of illicit drug poisoning (overdose). However, existing research is limited. METHODS: Collating Canadian Emergency Response Benefit (CERB) payment data with data on paramedic attended overdose and illicit drug toxicity deaths for the province of British Columbia at the Local Health Area (LHA) level, we conducted a correlation analysis to compare overdose rates before, during and after active CERB disbursement. RESULTS: There were 20,014,270 CERB-entitled weeks identified among residents of British Columbia for the duration of the pandemic response program. Approximately 52 % of all CERB entitled weeks in the study were among females and approximately 48 % were among males. Paramedic-attended overdoses increased uniformly across the pre-CERB, CERB and post-CERB periods, while illicit drug toxicity deaths sharply increased and then remained high over the period of the study. Correlation analyses between overdose and CERB-entitled weeks approached zero for both paramedic-attended overdoses and illicit drug toxicity deaths. CONCLUSIONS: These findings suggest that attributing the pandemic increase in overdose to income support payments is unfounded. Sustained levels of unacceptably high non-fatal and fatal drug poisonings that further increased at the start of the pandemic are reflective of complex pre-existing and pandemic-driven changes to overdose risk.

Individual differences in legal and illicit cannabis purchasing behaviour in British Columbia, Canada: Findings from a 2021 cross-sectional survey.

BACKGROUND: Despite thousands of licensed cannabis retail stores operating across Canada, there remains a significant illicit cannabis market. Some cannabis users continue to buy cannabis from dealers, illicit stores, and/or illicit online retailers. METHODS: Data are from the 2021 British Columbia Cannabis Use Survey. Respondents (n = 8473) were 19 years or older, lived in British Columbia at the time of the survey, and reported using cannabis in the past 12 months. RESULTS: Buying cannabis from all types of illicit sources was more common among younger cannabis users, those who use cannabis more frequently and started using cannabis before the age of 17 (vs. 19 or older), and among those who co-use cannabis with other drugs. Specifically, buying cannabis from a dealer was more common among men, those with lower educational attainment, and those who seek the lowest prices when buying cannabis. In contrast, those using cannabis for medical (vs. non-medical) purposes were more likely to report getting cannabis from illicit retail stores, while buying cannabis from illicit websites was more common among people who use edible cannabis products. CONCLUSION: Consistent with other studies, younger and more frequent cannabis users were more likely to report buying cannabis from illicit sources. However, these findings suggest there is significant heterogeneity among those who buy cannabis from different types of illicit sources, which should be carefully considered when developing policies and strategies aimed at encouraging consumers to transition to legal sources.

What's in Stock? Drug drought anticipation during COVID-19 among people who use drugs and service providers.

BACKGROUND: As with other areas of life, drug markets have been impacted by the COVID-19 pandemic and related restrictions. This article examines how structurally vulnerable people who use drugs (PWUD) experienced and adapted to changes in street drug markets caused by lockdown measures. METHODS: The article builds on ethnographic fieldwork in two Danish cities in 2020, including in-depth interviews with 22 PWUD, and interviews with 20 service providers, including low-threshold service providers and outreach workers. RESULTS: The most consistently reported effect of lockdown measures on local drug markets related to increases in cannabis prices. Accounts of changes in drug availability varied greatly, with some participants reporting changing availability while others described the situation as similar to pre-lockdown conditions. Rather than a long-term drug shortage, changes reported by participants related to the anticipated disruption of local markets and drug scarcity, restrictions in access to cash and sellers seeking to capitalize on the crisis. CONCLUSION: Although no long-term drug scarcity was seen, the anticipation of a shortage was sufficient to impact on local drug market dynamics. Heterogeneity in PWUDs' experiences of access to drug markets during lockdown can to some degree be explained in terms of their varied embeddedness in social networks. While local markets proved resilient to lockdown measures, PWUD less embedded in social networks were more vulnerable to shifts in drug availability and to sellers' over-pricing of drugs.

The wire. Una iluminación profana / The wire. A profane illumination

Introducción: Considerada la mejor serie de televisión del siglo XXI, The wire pone en escena la ciudad de Baltimore, una de las más violentas del mundo, tomando como eje central la industria de las drogas baratas. Las dinámicas a las que da lugar esta economía ilegal sirve de matriz en la ficción para entender las instituciones de las ciudades contemporáneas y el actual contexto del lazo social. Metodología: Tomando como referencia los textos sociales de Sigmund Freud y la revisión crítica efectuada por Jacques-Alain Miller a partir de la obra de Jacques Lacan, el presente artículo aborda la función del tóxico en esta serie desde discusiones actuales del campo psicoanalítico. Resultados: Es posible corroborar que la cultura de las drogas a la que se refiere David Simon en diversas ocasiones implica un empuje a la obtención de un plus como principal horizonte de sus personajes e instituciones de las que forman parte. La lectura propuesta en el presente artículo plantea que esta mutación cultural puede ser analizada desde la noción de objeto plus de goce propuesto por Jacques Lacan. (AU)

Introduction: Considered the best television series of the 21st century, The Wire stages the city of Baltimore, one of the most violent in the world, taking the cheap drug industry as its central axis. The dynamics to which this illegal economy gives rise serves as a matrix in fiction to understand the institutions of contemporary cities and the current context of the social bond. Methodology: Taking as reference the social texts of Sigmund Freud and the critical review carried out by Jacques-Alain Miller based on the work of Jacques Lacan, this article addresses the function of the toxic in this series from current discussions in the psychoanalytic field. Results: It is possible to corroborate that the drug culture to which David Simon refers on several occasions implies a push to obtain a plus as the main horizon of his characters and institutions of which they are a part. The reading proposed in this article suggests that this cultural mutation can be analyzed from the notion of object plus jouissance proposed by Jacques Lacan. (AU)

The wire. A profane illumination / The wire. Una iluminación profana

Introduction: Considered the best television series of the 21st century, The Wire stages the city of Baltimore, one of the most violent in the world, taking the cheap drug industry as its central axis. The dynamics to which this illegal economy gives rise serves as a matrix in fiction to understand the institutions of contemporary cities and the current context of the social bond. Methodology: Taking as reference the social texts of Sigmund Freud and the critical review carried out by Jacques-Alain Miller based on the work of Jacques Lacan, this article addresses the function of the toxic in this series from current discussions in the psychoanalytic field. Results: It is possible to corroborate that the drug culture to which David Simon refers on several occasions implies a push to obtain a plus as the main horizon of his characters and institutions of which they are a part. The reading proposed in this article suggests that this cultural mutation can be analyzed from the notion of object plus jouissance proposed by Jacques Lacan. (AU)

Introducción: Considerada la mejor serie de televisión del siglo XXI, The wire pone en escena la ciudad de Baltimore, una de las más violentas del mundo, tomando como eje central la industria de las drogas baratas. Las dinámicas a las que da lugar esta economía ilegal sirve de matriz en la ficción para entender las instituciones de las ciudades contemporáneas y el actual contexto del lazo social. Metodología: Tomando como referencia los textos sociales de Sigmund Freud y la revisión crítica efectuada por Jacques-Alain Miller a partir de la obra de Jacques Lacan, el presente artículo aborda la función del tóxico en esta serie desde discusiones actuales del campo psicoanalítico. Resultados: Es posible corroborar que la cultura de las drogas a la que se refiere David Simon en diversas ocasiones implica un empuje a la obtención de un plus como principal horizonte de sus personajes e instituciones de las que forman parte. La lectura propuesta en el presente artículo plantea que esta mutación cultural puede ser analizada desde la noción de objeto plus de goce propuesto por Jacques Lacan. (AU)

Estimación del coste social del consumo de drogas ilegales en Catalunya / An estimation of the social cost of illicit drug consumption in Catalonia

Mundialmente, así como en España, el consumo de drogas ilegales es uno los principales contribuyentes a la carga mundial de morbilidad. Cuantificar los costes que las drogas ilegales imponen a la sociedad es clave para la toma de decisiones. El objetivo de este trabajo es estimar el coste social del consumo de drogas ilegales en Cataluña para un año específico y establecer una metodología para poder replicar dichas estimaciones regularmente y monitorear el impacto de los planes nacionales. Se ha realizado un estudio de coste de la enfermedad. Para la estimación de los costes de mortalidad y morbilidad se ha utilizado el enfoque de la fracción atribuible. Solo se incluyeron los costes del sector público, sanitarios y no sanitarios. El coste del consumo de drogas ilegales en Cataluña en 2011 se estimó en 326,39 millones de € (0,16% del PIB catalán en 2011; 0,15% en 2018). El 82% del coste total correspondió a costes directos; de estos, el 30,32% correspondió al sistema penal, 15,99% a hospitalizaciones, 13,48% a la policía, 17,19% a farmacia, 8,34% a tratamiento en centros especializados y 5,74% a comunidades terapéuticas, entre otros. Los costes indirectos representaron el 18% de los costes totales, principalmente pérdidas de productividad debidas a muertes por el consumo de drogas. Este estudio ha sido una oportunidad para recopilar datos de forma sistemática y pensar en los posibles rendimientos económicos que podrían obtenerse de políticas y programas efectivos destinados a reducir el consumo de drogas ilegales.(AU)

Worldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at €326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.(AU)

Availability of substances for use in personal vaporisers on three online cryptomarkets.

BACKGROUND: Personal vaporisers are gaining popularity as an alternative route of administration for a range of substances. Online cryptomarkets are becoming increasingly popular among people who use substances due to their perceived anonymity, ease of use, and reduced risk of violence compared to traditional face-to-face dealers. We examined the diversity of substances marketed for use in a personal vaporiser on these marketplaces. METHODS: Vaping related listings were extracted from three online cryptomarkets ('Agartha', 'Cryptonia', and 'Tochka') using The Onion Router browser. Data collection occurred between October and November 2019. RESULTS: We identified 1929 listings from 201 unique sellers. The top product on Agartha, Cryptonia, and Tochka were vape cartridges prefilled with the e-liquid (70.4 %, 39.4 %, 52.3 % respectively). The most common substance in these products was cannabis oil (96.1 %, 82.1 %, 87.8 %), followed by synthetic cannabinoids (3.7 %, 9.7 %, 9.8 %) and psychedelic substances (0.2 %, 6.4 %, 1.2 %). Vendors were primarily from the USA. Many products offered worldwide shipping (96.3 %, 42.4 %, 51.2 %). CONCLUSION: Vaping products listed on online cryptomarkets in 2019 primarily contained cannabis oils. Future studies should continue to examine cryptomarkets to identify emerging trends of substances that can be used in personal vaporisers.

Ecological momentary assessment of daily drug use and harm reduction service utilization among people who inject drugs in non-urban areas: A concurrent mixed-method feasibility study.

BACKGROUND: Ecological momentary assessments (EMA) can improve data accuracy and be useful for understanding the real-time co-occurrence of drug use and harm reduction service utilization among people who inject drugs (PWID); however, feasibility and acceptability of EMA in this population is unknown. METHODS: We conducted qualitative interviews (n = 45) and EMA surveys (n = 38) with PWID in cities and towns outside of Massachusetts' and Rhode Island's capital cities to 1) assess EMA feasibility and acceptability and 2) examine day-level correlations between drug use and harm reduction service utilization. RESULTS: Qualitative and quantitative data demonstrated that a 14-day EMA study was both feasible and acceptable. Interviews identified housing instability and related disruptions in cellphone access as challenges to consistent EMA participation. In the 14-day EMA study, EMA completion was high (mean = 10.1 days,SD = 5.3). High completion was associated with higher education (p = 0.005), receiving EMA via SMS text (vs. email, p = 0.017), and not having injected crack in the past month (p = 0.026). Of those who responded (n = 29), 100 % reported willingness to participate in a similar future study. Past 24 -h use of harm reduction services was positively associated with past 24 -h injection drug use (p = 0.013), but not past 24 -h syringe sharing (p = 0.197). CONCLUSION: Findings support the acceptability, feasibility, and potential utility of EMA for understanding daily experiences of PWID. Future studies should explore strategies to overcome structural barriers to maximize EMA participation, and assess how injection practices, syringe sharing, and use of harm reduction services interact to impact health risks in larger and diverse samples of PWID.

Availability, retail price and potency of legal and illegal cannabis in Canada after recreational cannabis legalisation.

INTRODUCTION AND AIMS: There is little objective market data on the price or potency of legal and illegal cannabis products following recreational cannabis legalisation. DESIGN AND METHODS: In the 2 months post-legalisation in Canada (November-December 2018), legal and illegal cannabis retailers were identified from government lists and online directories. The store location, price and Δ9-tetrahydrocannabinol (THC) and cannabidiol levels of dried herb and cannabis cookies were collected from retailer websites or Weedmaps. RESULTS: We identified 185 legal retailers (22 online stores, 163 storefronts; 65 government-run stores, 120 private stores) and 944 illegal retailers (791 delivery-only services, 157 storefronts). Relative to legal dried herb, illegal dried herb was lower in price (1 g: $10.23 vs. $11.08, ⅛ oz: $9.37/g vs. $10.88/g, ½ oz: $8.18/g vs. $8.85/g; P < 0.05 for all) and higher in potency (THC: 20.5% vs. 16.1%, cannabidiol: 2.4% vs. 1.7%; P < 0.05 for both). Legal private stores had higher prices for dried herb than government-run stores (1 g: $13.08 vs. $10.89, ⅛ oz: $12.75/g vs. $10.45/g, ½ oz: $10.85/g vs. $8.71/g, 1 oz: $8.54/g vs. $7.22/g; P < 0.05 for all). On average, one cannabis cookie in the illegal market contained 96 mg of THC and cost $1.57 per 10 mg of THC. DISCUSSION AND CONCLUSIONS: In the 2 months post-legalisation, illegal cannabis was less expensive, with higher labelled THC content than legal cannabis, although the scope of these differences was more modest than estimates from other crowdsourced and self-reported data. Direct monitoring of cannabis price and potency from legal and illegal retailers is needed to examine the impact of legalisation over time.

Synthetic cathinones - From natural plant stimulant to new drug of abuse.

As recreational substances, synthetic cathinones started to be used at the beginning of the 21st century. There is still limited data on these compounds, introduced to the illicit drug market for the most part after 2009. Considering that synthetic cathinones are currently the second largest group of new psychoactive and dangerous substances among over 670 new psychoactive substances identified in Europe and monitored by the EMCDDA, research on them should be regarded as extremely important. This review focuses on the availability of synthetic cathinones on the illicit drug market, presentation of current trends in the use of these substances, and their mechanisms of action and toxicity. The authors discuss cases of intoxication with synthetic cathinones and post-mortem diagnostics as well as the problem of combined used of synthetic cathinones with other psychoactive substances. Literature as well as clinical and forensic data indicate the need for further research on the metabolism, toxicokinetics, toxicodynamics, clinical effects, and addictive potential of synthetic cathinones, especially in the context of potential threats caused by increased consumption of this group of drugs in future.

An evidence synthesis of strategies, enablers and barriers for keeping secrets online regarding the procurement and supply of illicit drugs.

This systematic review attempts to understand how people keep secrets online, and in particular how people use the internet when engaging in covert behaviours and activities regarding the procurement and supply of illicit drugs. With the Internet and social media being part of everyday life for most people in western and non-western countries, there are ever-growing opportunities for individuals to engage in covert behaviours and activities online that may be considered illegal or unethical. A search strategy using Medical Subject Headings terms and relevant key words was developed. A comprehensive literature search of published and unpublished studies in electronic databases was conducted. Additional studies were identified from reference lists of previous studies and (systematic) reviews that had similar objectives as this search, and were included if they fulfilled our inclusion criteria. Two researchers independently screened abstracts and full-texts for study eligibility and evaluated the quality of included studies. Disagreements were resolved by a consensus procedure. The systematic review includes 33 qualitative studies and one cross-sectional study, published between 2006 and 2018. Five covert behaviours were identified: the use of communication channels; anonymity; visibility reduction; limited posts in public; following forum rules and recommendations. The same technologies that provide individuals with easy access to information, such as social networking sites and forums, digital devices, digital tools and services, also increase the prevalence of inaccurate information, loss of privacy, identity theft and disinhibited communication. This review takes a rigorous interdisciplinary approach to synthesising knowledge on the strategies adopted by people in keeping secrets online. Whilst the focus is on the procurement and supply of illicit drugs, this knowledge is transferrable to a range of contexts where people keep secrets online. It has particular significance for those who design online/social media applications, and for law enforcement and security agencies.

Using recreational cannabis to treat insomnia: Evidence from over-the-counter sleep aid sales in Colorado.

This study seeks to understand whether people substitute between recreational cannabis and conventional over-the-counter (OTC) sleep medications. UPC-level grocery store scanner data in a multivariable panel regression design were used to compare the change in the monthly market share of sleep aids with varying dispensary-based recreational cannabis access (existence, sales, and count) in Colorado counties between 12/2013 and 12/2014. We measured annually-differenced market shares for sleep aids as a portion of the overall OTC medication market, thus accounting for store-level demand shifts in OTC medication markets and seasonality, and used the monthly changes in stores' sleep aid market share to control for short-term trends. Relative to the overall OTC medication market, sleep aid market shares were growing prior to recreational cannabis availability. The trend reverses (a 236% decrease) with dispensary entry (-0.33 percentage points, 95% CI -0.43 to -0.24, p < 0.01) from a mean market share growth of 0.14 ±â€¯0.97. The magnitude of the market share decline increases as more dispensaries enter a county and with higher county-level cannabis sales. The negative associations are driven by diphenhydramine- and doxylamine-based sleep aids rather than herbal sleep aids and melatonin. These findings support survey evidence that many individuals use cannabis to treat insomnia, although sleep disturbances are not a specific qualifying condition under any U.S. state-level medical cannabis law. Investigations designed to measure the relative effectiveness and side effect profiles of conventional OTC sleep aids and cannabis-based products are urgently needed to improve treatment of sleep disturbances while minimizing potentially serious negative side effects.

Should we smoke it for you as well? An ethnographic analysis of a drug cryptomarket environment.

INTRODUCTION: Why aren't cryptomarkets more widely used? Researchers from a wide array of fields have attempted to answer this question by studying the size of drug cryptomarkets, the substances trafficked, and their structure. In this paper we address the potential acceptance of drug cryptomarkets by studying their perceived ease of use. METHODS: This paper draws on observational data collected over 350 h of unstructured observation during an ethnographic study conducted in April-September 2016 of the two most prominent drug cryptomarkets at the time, in addition to seven face-to-face semi-structured qualitative interviews. ANALYSIS: Use of cryptomarkets relies on specialised knowledge. The administrators of the cryptomarkets do not play a publicly visible role in facilitating or easing cryptomarket use while simultaneously expecting cryptomarket users to exhibit self-reliance. We argue that the current levels of complexity and obfuscation constructed in the cryptomarket environment act as a barrier to the widespread acceptance of this technology. DISCUSSION: Through studying cryptomarkets' potential for widespread use we have shed light on current barriers to their growth requirement of specialised knowledge in order to use cryptomarkets and no public efforts to bridge the knowledge gap on behalf of cryptomarket administrators. As cryptomarkets continue to develop the ease of use of these platforms are bound to change, and with them the likelihood that cryptomarket usage may increase.

Scoring the best deal: Quantity discounts and street price variation of diverted oxycodone and oxymorphone.

PURPOSE: Diverted prescription opioids are significant contributors to drug overdose mortality. Street price has been suggested as an economic metric of the diverted prescription opioid black market. This study examined variables that may influence the street price of diverted oxycodone and oxymorphone. METHODS: A cross-sectional study was conducted utilizing data from the previously validated, crowdsourcing website StreetRx. Street price reports of selected oxycodone and oxymorphone products, between August 22, 2014 and June 30, 2016, were considered for analysis. Geometric means and 95% confidence intervals were calculated comparing prices per milligram of drug in US dollars. Univariate and multivariable regressions were used to examine the influence of dosage strength, drug formulation, and bulk purchasing on street price. RESULTS: A total of 5611 oxycodone and 1420 oxymorphone reports were analyzed. Across various dosages and formulations, geometric mean prices per milligram ranged between $0.12 and $1.07 for oxycodone and $0.73 and $2.90 for oxymorphone. For a 2-fold increase in dosage strength, there is a 24.0% (95% CI: -28.1%, -19.6%, P < 0.001) and a 22.5% (95% CI: -24.2%, -20.8%, P < 0.001) decrease on average in price per milligram for oxycodone and oxymorphone, respectively. Lower potency, high dosage strength, crush-resistant opioids, and those purchased in bulk were significantly cheaper. CONCLUSION: Street prices for diverted oxycodone and oxymorphone are influenced by multiple factors including potency, dosage, formulation, and bulk purchasing. Buyers who purchase large quantities of low potency, large dosage, crush-resistant formulation prescription opioids can expect to achieve the lowest price.

Availability of legalized cannabis reduces demand for illegal cannabis among Canadian cannabis users: evidence from a behavioural economic substitution paradigm.

In the context of cannabis legalization, an important question among clinicians, policymakers, and the public is whether availability of legal cannabis will significantly reduce consumption (demand) of illegal cannabis. Using paradigms from behavioural economics, we tested the prediction that legal cannabis would be an asymmetrical substitute for illegal cannabis, with legal cannabis operating as a superior commodity based on its regulated status. In a sample of 289 adult cannabis users in Ontario, we found evidence of substitutability for both legal and illegal cannabis, but significantly lower substitutability of illegal for legal cannabis, a pattern that was also present for price elasticity (α) and Pmax. Thus, the data indicated asymmetric substitution such that the availability of legal cannabis substantially decreased demand for illegal cannabis, but a significantly smaller effect in reverse. These results suggest that the introduction of legal cannabis into the market may disrupt and reduce illegal purchases, contributing to the reduction of the potential harms associated with the illegal market. However, in revealing price windows in which legal cannabis is preferred over the contraband alternative, these data also have significant implications for pricing policies.

Retail price and availability of illicit cannabis in Canada.

INTRODUCTION: This study sought to estimate the number of illicit retailers and the average price of cannabis in the largest municipality in each province and territory in Canada by obtaining information from retailers. METHODS: Online search engines were used to identify retailers in each municipality. The advertised prices for various volumes of the least expensive, most expensive, and most popular dry herb were determined using the retailer's website, Weedmaps, or Leafly. Data was collected between October 2017 and May 2018, including two waves in Toronto to examine changes over a five-month period. RESULTS: Across the 13 municipalities, 997 cannabis retailers were identified, including 215 physical storefronts. The average price per gram of cannabis was $10.02, $7.80, and $12.30 for the most popular, least expensive, and most expensive strains, respectively. The price-per-gram decreased as purchase volume increased: purchasing one-eighth of an ounce and one ounce of cannabis led to savings of up to 9% and 27%, respectively. Prices were consistent across municipalities, although the number of outlets varied greatly. Prices were similar between storefronts and delivery-only services; however, delivery services offered larger discounts for cannabis purchased by the ounce. The five-month comparison in Toronto revealed modest changes in the number of retailers and more pronounced changes in the price of the most popular and least expensive strains. CONCLUSION: The findings depict a well-established retail cannabis market in Canada in the year prior to legalization. The average advertised price of the most popular cannabis varieties was approximately $10, which aligns with the projected retail price of cannabis from licensed sources following legalization in Canada.

Price elasticity of illegal versus legal cannabis: a behavioral economic substitutability analysis.

BACKGROUND AND AIMS: The evolving legal status of cannabis world-wide necessitates evidence-based regulatory policies to minimize risks associated with cannabis misuse. A prominent concern is the impact legalization may have on the illegal cannabis market, including whether illegal cannabis will serve as a substitute for legal cannabis. Empirical data on this issue are virtually non-existent. This study used behavioral economics to investigate substitutability of legal and illegal cannabis in legalized catchment areas in the United States. DESIGN: A substitution-based marijuana purchase task assessed estimated cannabis consumption from concurrently available legal (a dispensary) and illegal (a dealer) sources. Prices of the two options were reciprocally either held constant ($10/gram) or escalated ($0-$60/gram). SETTING: US states with legalized recreational cannabis. PARTICIPANTS: Adult cannabis users who were at least 21 years old (n = 724; mean age = 34.13; 52% female; 74% Caucasian) were recruited using online crowdsourcing. MEASUREMENTS: Mean consumption values were used in demand curve modeling to generate indices of price sensitivity and elasticity. Differences in demand indices were compared using extra sums-of-squares F-tests. FINDINGS: Both legal and illegal fixed-price cannabis options had significant positive cross-price elasticities (Ps < 0.001), indicating that higher prices motivate substitution irrespective of legality. However, the presence of a legal alternative had a substantially greater effect on consumption and elasticity of illegal cannabis (∆elasticity  = 0.0019; F(1,37)  = 160, P < 0.0001) than the presence of an illegal alternative on demand for legal cannabis (∆elasticity  = 0.0002; F(1,37)  = 48, P < 0.0001), indicating asymmetric substitution. Demand for legal cannabis was significantly greater than for illegal cannabis (P < 0.0001). CONCLUSIONS: Cannabis users treat legal cannabis as a superior commodity compared with illegal cannabis and exhibit asymmetric substitutability favoring legal product. Cannabis price policies that include somewhat higher consumer costs for legal cannabis relative to contraband (but not excessively higher costs) would not be expected to incentivize and expand the illegal market.

Illicit fentanyls in the opioid street market: desired or imposed?

BACKGROUND: Illicitly manufactured fentanyl and its analogues are appearing in countries throughout the world, often disguised as heroin or counterfeit prescription pills, with resulting high overdose mortality. Possible explanations for this phenomenon include reduced costs and risks to heroin suppliers, heroin shortages, user preferences for a strong, fast-acting opioid and the emergence of Dark Web cryptomarkets. This paper addresses these potential causes and asks three questions: (1) can users identify fentanyl; (2) do users desire fentanyl; and (3) if users want fentanyl, can they express this demand in a way that influences the supply? ARGUMENT/ANALYSIS: Existing evidence, while limited, suggests that some users can identify fentanyl, although not reliably, and some desire it, but because fentanyl is frequently marketed deceptively as other drugs, users lack information and choice to express demand effectively. Even when aware of fentanyl's presence, drug users may lack fentanyl-free alternatives. Cryptomarkets, while difficult to quantify, appear to offer buyers greater information and competition than offline markets. However, access barriers and patterns of fentanyl-related health consequences make cryptomarkets unlikely sources of user influence on the fentanyl supply. Market condition data indicate heroin supply shocks and shortages prior to the introduction of fentanyl in the United States and parts of Europe, but the much lower production cost of fentanyl compared with heroin may be a more significant factor CONCLUSION: Current evidence points to a supply-led addition of fentanyl to the drug market in response to heroin supply shocks and shortages, changing prescription opioid availability and/or reduced costs and risks to suppliers. Current drug users in affected regions of the United States, Canada and Europe appear largely to lack both concrete knowledge of fentanyl's presence in the drugs they buy and access to fentanyl-free alternatives.