Would banning menthol cigarettes, flavored cigars, and flavored e-cigarettes prompt users to seek illicit channels for obtaining them in the United States?

BACKGROUND: Banning flavors in tobacco and nicotine products may reduce youth initiation and prompt quit attempts but such bans may lead to illicit markets. We examined how likely current users would be to seek flavored products from illicit channels under various ban scenarios. METHODS: Cross-sectional surveys of 2552 current users of menthol cigarettes or flavored cigars and 2347 users of flavored e-cigarettes were conducted between 2021 and 2022 in the United States. For each ban scenario, respondents reported if they would have intentions to seek the banned flavored products from any illicit channels and identified the specific illicit channel they would consider. Logistic regressions were used to estimate how the likelihood of having intentions to seek illicit channels was associated with demographics, ban scenarios, and status of tobacco use. RESULTS: Under various ban scenarios, 24-30% of people who smoked said they would seek illicit channels to obtain the banned products compared with 21-41% of dual users and 35-39% of users of flavored e-cigarettes. Online retailers were favored by people who smoked while users of flavored e-cigarettes favored local retailers. Heavy users were more likely to say they would try illicit channels. Under bans restricting more types of flavored tobacco products, users would be less likely to try illegal channels. CONCLUSIONS: A significant proportion of users of flavored tobacco and nicotine products would not reject using illicit banned products. Tailored programs are needed to apply to the groups with a higher risk of seeking illicit channels for banned products.

A dynamic model of the opioid drug epidemic with implications for policy.

Background: The U.S. opioid epidemic has caused substantial harm for over 20 years. Policy interventions have had limited impact and sometimes backfired. Experts recommend a systems modeling approach to address the complexities of opioid policymaking.Objectives: Develop a system dynamics simulation model that reflects the complexities and can anticipate intended and unintended intervention effects.Methods: The model was developed from literature review and data gathering. Its outputs, starting in 1990, were compared against 12 historical time series. Four illustrative interventions were simulated for 2020-2030: reducing prescription dosage by 20%, cutting diversion by 30%, increasing addiction treatment from 45% to 65%, and increasing lay naloxone use from 4% to 20%. Sensitivity testing was performed to determine effects of uncertainties. No human subjects were studied.Results: The model fits historical data well with error percentage averaging 9% across 201 data points. Interventions to reduce dosage and diversion reduce the number of persons with opioid use disorder (PWOUD) by 11% and 16%, respectively, but each of these interventions reduces overdoses by only 1%. Boosting treatment reduces overdoses by 3% but increases PWOUD by 1%. Expanding naloxone reduces overdose deaths by 12% but increases PWOUD by 2% and overdoses by 3%. Combining all four interventions reduces PWOUD by 24%, overdoses by 4%, and deaths by 18%. Uncertainties may affect these numerical results, but policy findings are unchanged.Conclusion: No single intervention significantly reduces both PWOUD and overdose deaths, but a combination strategy can do so. Entering the 2020s, only protective measures like naloxone expansion could significantly reduce overdose deaths.

The complex relation between access to opioid agonist therapy and diversion of opioid medications: a case example of large-scale misuse of buprenorphine in the Czech Republic.

Opioid agonist therapy (OAT) has been available in a standard regime in the Czech Republic since 2000. Buprenorphine is the leading medication, while methadone is available only in a few specialised centres. There is an important leakage of buprenorphine onto the illicit market, and the majority of Czech opioid users are characterised by the misuse (and injecting) of diverted buprenorphine medications. Most prescribed buprenorphine for OAT is not covered by current national health insurance schemes, and patients have to pay considerable prices to afford their treatment. This affordability barrier together with limited accessibility is likely the leading factor of limited coverage of OAT and of recent stagnation in the number of patients in the official treatment programmes in the Czech Republic. It also encourages doctor shopping and the re-selling of parts of their medication at a higher price, which represents the main factor that drives the Czech illicit market for buprenorphine, but at the same time co-finances the medication of clients in official OAT programmes. Improving access to OAT by making it financially affordable is essential to further increase OAT coverage and is one of the factors that can reduce the illicit market with OAT medications.

A geographical analysis of trafficking on a popular darknet market.

Cryptomarkets are online marketplaces, located on the darknet, that facilitate the trading of a variety of illegal goods, mostly drugs. While the literature essentially focus on drugs, various other goods and products related to financial or identity fraud, firearms, counterfeit goods, as well as doping products are also offered on these marketplaces. Through the analysis of relevant data collected on a popular marketplace in 2014-2015, Evolution, this research provides an analysis of the structure of trafficking (types and proportions of products, number of vendors and shipping countries). It also aims at highlighting geographical patterns in the trafficking of these products (e.g. trafficking flows, specialisation of vendors and assessment of their role in the distribution chain). The analysis of the flow of goods between countries emphasises the role of specific countries in the international and domestic trafficking, potentially informing law enforcement agencies to target domestic mails or international posts from specific countries. The research also highlights the large proportion of licit and illicit drug listings and vendors on Evolution, followed by various fraud issues (in particular, financial fraud), the sharing of knowledge (tutorials) and finally goods, currencies and precious metals (principally luxury goods). Looking at the shipping country, there seems to be a clear division between digital and physical products, with more specific information for physical goods. This reveals that the spatial analysis of trafficking is particularly meaningful in the case of physical products (such as illicit drugs) and to a lesser extent for digital products. Finally, the geographical analysis reveals that spatial patterns on Evolution tend to reflect the structure of the traditional illicit market. However, regarding illicit drugs, country-specificity has been observed and are presented in this article.

The study of doping market: How to produce intelligence from Internet forums.

Despite the predominant role played by Internet in the distribution of doping substances, little is currently known about the online offer of doping products. Therefore, the study focuses on the detection of doping substances and suppliers discussed in Internet forums. It aims at having a comprehensive understanding of products and sellers to lead an operational monitoring of the online doping market. Thirteen community forums on the Internet were investigated and one million topics were extracted with source code scrappers. Then, a semantic analysis was conducted with a semi-automatic process to classify the relevant words according to doping matters. Additionally, the ranking of doping products, active substances and suppliers in regards to the number of contributors to the forums were established and analyzed over time. Finally, promotion methods of suppliers were evaluated. The results show that anabolic androgenic steroids, used to enhance body image and performance, are the most discussed type of products. A temporal analysis illustrates the stability of the most popular products as well as the emergence of new products such as peptides (e.g. CJC-1295). 327 suppliers were detected, mostly with dedicated websites or direct sales by e-mail as selling methods. Globally, the implemented methodology shows its ability to detect products and suppliers as well as to follow their temporal trends. The intelligence will serve the definition of online monitoring strategies (e.g. the selection of appropriate keywords). Additionally, it also allows the adjustment of customs inspection strategies and anti-doping analysis by monitoring the popular and emerging substances.