Fentanyl, heroin, and methamphetamine-based counterfeit pills sold at tourist-oriented pharmacies in Mexico: An ethnographic and drug checking study.

BACKGROUND: Fentanyl- and methamphetamine-based counterfeit prescription drugs have driven escalating overdose death rates in the US, however their presence in Mexico has not been assessed. Our ethnographic team has conducted longitudinal research focused on illicit drug markets in Northern Mexico since 2018. In 2021-2022, study participants described the arrival of new, unusually potent tablets sold as ostensibly controlled substances, without a prescription, directly from pharmacies that cater to US tourists. AIMS: To characterize the availability of counterfeit and authentic controlled substances at pharmacies in Northern Mexico available to English-speaking tourists without a prescription. METHODS: We employed an iterative, exploratory, mixed methods design. Longitudinal ethnographic data was used to characterize tourist-oriented micro-neighborhoods and guide the selection of n=40 pharmacies in n=4 cities in Northern Mexico. In each pharmacy, samples of "oxycodone", "Xanax", and "Adderall" were sought as single pills, during English-language encounters, after which detailed ethnographic accounts were recorded. We employed immunoassay-based testing strips to check each pill for the presence of fentanyls, benzodiazepines, amphetamines, and methamphetamines. We used Fourier-Transform Infrared Spectroscopy to further characterize drug contents. RESULTS: Of n=40 pharmacies, one or more of the requested controlled substances could be obtained with no prescription (as single pills or in bottles) at 28 (70.0%) and as single pills at 19 (47.5%). Counterfeit pills were obtained at 11 pharmacies (27.5%). Of n=45 samples sold as one-off controlled substances, 18 were counterfeit. 7 of 11 (63.6%) samples sold as "Adderall" contained methamphetamine, 8 of 27 (29.6%) samples sold as "Oxycodone" contained fentanyl, and 3 "Oxycodone" samples contained heroin. Pharmacies providing counterfeit drugs were uniformly located in tourist-serving micro-neighborhoods, and generally featured English-language advertisements for erectile dysfunction medications and "painkillers". Pharmacy employees occasionally expressed concern about overdose risk and provided harm reduction guidance. DISCUSSION: The availability of fentanyl-, heroin-, and methamphetamine-based counterfeit medications in tourist-oriented independent pharmacies in Northern Mexico represents a public health risk, and occurs in the context of 1) the normalization of medical tourism as a response to rising unaffordability of healthcare in the US, 2) plummeting rates of opioid prescription in the US, affecting both chronic pain patients and the availability of legitimate pharmaceuticals on the unregulated market, 3) the rise of fentanyl-based counterfeit opioids as a key driver of the fourth, and deadliest-to-date, wave of the opioid crisis. It was not possible to distinguish counterfeit medications based on appearance of pills or geography of pharmacies, because identically-appearing authentic and counterfeit versions were often sold in close geographic proximity. Nevertheless, people who consume drugs may be more trusting of controlled substances purchased directly from pharmacies. Due to Mexico's limited opioid overdose surveillance infrastructure, the current death rate from these substances remains unknown.

Acute, chronic, and post-mortem toxicity: a review focused on three different classes of new psychoactive substances.

PURPOSE: New psychoactive substances (NPS) are not controlled under the Single Convention on Narcotic Drugs of 1961 or the 1971 Convention, but they may pose a public health threat. Knowledge of the main properties and toxicological effects of these substances is lacking. According to the current Drugs Law (Law n. 11.343/2006), the Brazilian Surveillance Agency issues directives for forbidden substances in Brazil, and structural classes of synthetic cannabinoids, cathinones, and phenylethylamines are considered illicit drugs. Considering that data on these controlled substances are scattered, the main objective of this work was to collect and organize data to generate relevant information on the toxicological properties of NPS. METHODS: We carried out a literature review collecting information on the acute, chronic, and post-mortem toxicity of these classes of NSP. We searched info in five scientific databases considering works from 2017 to 2021 and performed a statistical evaluation of the data. RESULTS: Results have shown a general lack of studies in this field given that many NPS have not had their toxicity evaluated. We observed a significant difference in the volume of data concerning acute and chronic/post-mortem toxicity. Moreover, studies on the adverse effects of polydrug use are scarce. CONCLUSIONS: More in-depth information about the main threats involving NPS use are needed.

The Effect of Online Prescription Drug Monitoring on Opioid Prescription Habits After Elective Single-level Lumbar Fusion.

INTRODUCTION: The United States opioid epidemic is a well-documented crisis stemming from increased prescriptions of narcotics. Online prescription drug monitoring programs (PDMPs) are a potential resource to mitigate narcotic misuse by tracking controlled substance prescriptions. Therefore, the purpose of this study was to evaluate opioid prescription trends after implementation of an online PDMP in patients who underwent single-level lumbar fusion. METHODS: Patients who underwent a single-level lumbar fusion between August 27, 2017, and August 31, 2020, were identified and placed categorically into one of two cohorts: an "early adoption" cohort, September 1, 2017, to August 31, 2018, and a "late adoption" cohort, September 1, 2019, to August 31, 2020. This allowed for a 1-year washout period after Pennsylvania PDMP implementation on August 26, 2016. Opioid use data were obtained by searching for each patient in the state government's online PDMP and recording data from the year before and the year after the patient's procedure. RESULTS: No significant difference was observed in preoperative opioid prescriptions between the early and late adoption cohorts. The late adoption group independently predicted decreased postoperative opioid prescriptions (ß, 0.78; 95% confidence interval [CI], 0.65 to 0.93; P = 0.007), opioid prescribers (ß, 0.81; 95% CI, 0.72 to 0.90; P < 0.001), pharmacies used (ß, 0.90; 95% CI, 0.83 to 0.97; P = 0.006), opioid pills (ß, 0.61; 95% CI, 0.50 to 0.74; P < 0.001), days of opioid prescription (ß, 0.57; 95% CI, 0.45 to 0.72; P < 0.001), and morphine milligram equivalents prescribed (ß, 0.53; 95% CI, 0.43 to 0.66; P < 0.001). CONCLUSIONS: PDMP implementation was associated with decreased postoperative opioid prescription patterns but not preoperative opioid prescribing behaviors. LEVELS OF EVIDENCE: 4.

The synthetic CB1 cannabinoid receptor selective agonists: Putative medical uses and their legalization.

More than 500 molecules have been identified as components of Cannabis sativa (C. sativa), of which the most studied is Δ9-tetrahydrocannabinol (Δ9-THC). Several studies have suggested that Δ9-THC exerts diverse biological effects, ranging from fragmentation of DNA to behavioral disruptions. Currently, it is accepted that most of the pharmacological properties of Δ9-THC engage the activation of the cannabinoid receptors, named CB1 and CB2. Interestingly, multiple pieces of evidence have suggested that the cannabinoid receptors play an active role in the modulation of several diseases leading to the design of synthetic cannabinoid-like compounds. Advances in the development of synthetic CB1 cannabinoid receptor selective agonists as therapeutical approaches are, however, limited. This review focuses on available evidence searched in PubMed regarding the synthetic CB1 cannabinoid receptor selective agonists such as AM-1235, arachidonyl-2' chloroethylamide (ACEA), CP 50,556-1 (Levonantradol), CP-55,940, HU-210, JWH-007, JWH-018, JWH-200 (WIN 55,225), methanandamide, nabilone, O-1812, UR-144, WIN 55,212-2, nabiximols, and dronabinol. Indeed, it would be ambitious to describe all available evidence related to the synthetic CB1 cannabinoid receptor selective agonists. However, and despite the positive evidence on the positive results of using these compounds in experimental models of health disturbances and preclinical trials, we discuss evidence in regards some concerns due to side effects.

New Mexico Nurse-Midwives' Controlled Substance Prescribing and Monitoring Practices.

INTRODUCTION: New Mexico, a state with a high incidence of opioid overdose deaths, requires certified nurse-midwives (CNMs) who prescribe controlled substances to use the statewide Prescription Monitoring Program (PMP). This study examined how frequently CNMs who practice in New Mexico and prescribe controlled substances use the PMP and the purposes for which they use it. METHODS: All CNMs licensed in New Mexico (N = 210) were sent a link to an anonymous online survey. CNM demographics, practice characteristics, and controlled substance prescribing practices were examined. RESULTS: Approximately 40% of CNMs licensed in New Mexico completed the survey (N = 83), 77% of whom (64/83) were providing direct clinical care services. Nearly all who were engaged in clinical care had a US Drug Enforcement Administration registration number and were registered in the PMP (97%; 62/64). Approximately 90% of those respondents (56/62) reported prescribing controlled substances. Approximately 10% (6/62) never logged into the PMP, 40% (25/62) never ran a self-report, and nearly 30% (18/62) reported never checking the PMP for patient alerts. Among those who reported prescribing controlled substances, the percentages who never logged in, never ran a self-report, and never checked for patient alerts were 7% (4/56), 37% (21/56), and 27% (15/56), respectively. Nearly half of those prescribing controlled substances (26/56) did so monthly or more often, but with respect to their own prescribing, approximately one-third of them (9/26) checked the PMP less frequently than every 6 months. DISCUSSION: Most CNMs in New Mexico are authorized to prescribe controlled substances, but the frequency of prescribing varies, and some CNMs may not be making optimal use of the state PMP for self-reports, for patient alerts, or prior to prescribing a controlled substance. Additional education pertaining to the PMP is needed, as are best practice recommendations for monitoring CNMs' controlled substance prescribing.

Programas de monitoreo de medicamentos de prescripción en los Estados Unidos de América / Prescription drug monitoring programs in the United States of America

Desde finales de la década de los años noventa, el número de muertes por sobredosis que involucran analgésicos opioides se ha cuadriplicado en los Estados Unidos de América (de 4 030 muertes en 1999 a 16 651 en 2010). Los objetivos de este artículo son proporcionar una visión general del problema de sobredosis de medicamentos de prescripción en los Estados Unidos y discutir las acciones que podrían ayudar a reducir el problema, abordando en forma directa las características de los Programas de monitoreo de medicamentos de prescripción (PDMP). Estos programas están compuestos de bases de datos a nivel estatal que vigilan las sustancias controladas. La información recopilada en las bases de datos está a disposición de las personas autorizadas por el Estado (por ejemplo, los médicos, los farmacéuticos y otros proveedores de cuidado médico) y debe ser utilizada solo con propósitos profesionales. Los proveedores pueden utilizar dicha información para evitar la interacción con otros medicamentos, la duplicación terapéutica o la identificación de conductas de búsqueda de drogas. Las agencias del orden público pueden utilizar estos programas para identificar patrones de prescripción inadecuada, dispensación o desviación.

Since the late 1990s, the number of opioid analgesic overdose deaths has quadrupled in the United States of America (from 4 030 deaths in 1999 to 16 651 in 2010). The objectives of this article are to provide an overview of the problem of prescription drug overdose in the United States and to discuss actions that could help reduce the problem, with particular attention to the characteristics of prescription drug monitoring programs (PDMPs). These programs consist of state-level databases that monitor controlled substances. The information compiled in the databases is at the disposal of authorized persons (e.g., physicians, pharmacists, and other health-care providers) and may be used only for professional purposes. Suppliers can use such information to prevent interaction with other drugs or therapeutic duplication, or to identify drug-search behavior. Law enforcement agencies can use these programs to identify improper drug prescription or dispensing patterns, or drug diversion.

Reform by subtraction: the path of denunciation of international drug treaties and reaccession with reservations.

Almost all countries are parties to the international drug conventions of 1961, 1971 and 1988. These strongly bind parties with respect to their domestic regulation of controlled substances, including requirements that possession, growing or use be a criminal offense and that any regulated market in the substances be limited to use only for medical or scientific purposes. Even where countries have argued they have "wiggle room", reform within the bounds of the conventions has often resulted in "net-widening" which nullifies the intent of the reform. Among the options for effective reform, probably the most immediately viable is the route of denunciation and reaccession with reservations--the route which Bolivia has now taken in order to legalise a regulated domestic market in coca leaves for chewing. The paper considers the existing record of reservations (by more than 30 parties to each of the conventions). Also discussed are the options for response to the reservations by other parties, which vary between the treaties, and how pursuing the option of denunciation and reaccession with reservation might potentially play out.

Prescripción de Drogas Controladas por Médicos Residentes del Hospital Central del Instituto de Previsión Social / Prescription of controlled substances by Internal Medicine Residents from the Instituto de Prevision Social

Los objetivos de este trabajo son: Determinar la prevalencia y tipo de psicofármacos recetados por los médicos residentes del Hospital Central del Instituto de Previsión Social (HCIPS), establecer la frecuencia con que se prescribe el psicofármaco, comprobar la correlación de familiares y profesionales consumidores de fármacos controlados y conocer la preparación académica legal sobre la prescripción de fármacos controlados por los médicos residentes del HCIPS. Se realizó un estudio prospectivo, descriptivo de corte transversal. Se estudiaron 100 médicos residentes del H.C.I.P.S seleccionados aleatoriamente. Los datos fueron obtenidos de una encuesta anónima. Se encontró que: 48% era de sexo masculino y 52% femenino, el 79% refirió recetar fármacos controlados y el 21% negó haber recetado fármacos controlados. De las respuestas afirmativas refirieron recetar benzodiacepinas 99%, antidepresivos 32%, opiáceos 10%, hipnóticos y antipsicóticos 61%. De los que negaron recetar psicofármacos sólo el 19% afirmó estar al tanto de la Ley del Control de Drogas en el país, a diferencia del 81% que no la conoce. De los que si recetan fármacos controlados sólo el 40 % conoce la existencia de la ley y el 60% la desconocen. De los que recetan, el 45% refirió tener al menos un familiar que consume regularmente psicofármacos a diferencia del 55% que negó tenerlo. El 9% de los médicos afirmaron consumir psicofármacos y el 91% niega su consumo. De los que recetan el 32% lo hace más de cinco veces al mes, 39% al menos una vez a la semana, 20% al menos una vez cada tres meses, 8% cada seis meses y 1% al menos una vez al año. Se concluye que los médicos egresados de las diferentes universidades omiten en porcentaje alto la observancia de las leyes y consecuentemente se encuentran expuestos a penalizaciones ante las transgresiones de las normativas vigentes. Palabras claves: Psicofarmacos, Prescripción, Fármacos controlados

The aims of this study are: determine the prevalence and type of psychopharmaceutical drugs prescribed by the residents at the Hospital Central of the Instituto de Prevision Social (HCIPS), establish the frequency of these prescriptions, look at the correlation between patients and health care providers regarding the consumption of controlled substances and to study the legal and academic preparation regarding this type of drug prescription by the medical residents of the HCIPS. This is a prospective, observational and cross sectional study. We randomly selected 100 medical residents from the HCIPS. Data was obtained from anonymous survey: 48% males, 52% females; 79% prescribed controlled substances and 21% did not. From the cohort that prescribed controlled substances: 99% prescribed benzodiazepines, 32% antidepressants, 10% opiods, and 61% hypnotics and antipsychotics medications. From the ones who refused to prescribe pshycopharmaceuticals, only 19% have knowledge about the "Controlled Substance Law" in Paraguay; 81% did not know about this law. From the ones who did prescribe these drugs, only 40% knew about this law and 60% did not know about it. Within the group that prescribed these drugs, 45% admitted that they have at least one relative that was using these drugs; 55% denies have any relatives using them. 9% of the physicians admitted to take these drugs and 91% denied their use. From the prescription group, 32% prescribe these drugs more than 5 times per month, 39% at least once a week, 20% once every three months, 8% every six months and 1% at least once a year. We concluded that physicians who graduate from different universities in Paraguay do not know about the laws related to controlled substances and they find themselves expose to be punish by breaking them. Keywords: psychotropic drugs, prescription, controlled drugs

Codigo penal boliviano con las reformas y leyes conexas: comentado y concordado

Contiene: Codigo penal. Ley penal , reglas para su aplicacion, el delito y el delincuente, las penas. Delitos contra la seguridad exterior del estado, delitos contra la funcion publica, delitos contra la funcion judicial, delitos contra la fe publica, delitos contra la economia nacional. Ley No 2298. Ley del regimen de la coca y sustancias controladas. De las diligencias de policia judicial, debates y sentencias. Ley de abolicion de prision y apremio corporal por obligaciones patrimoniales.

Legislacion y procedimiento en narcotrafico

Contiene: Ley 1008 del regimen de la coca y sustancias controladas. D.S. 21666 crea organismos de lucha contra el narcotrafico. D.S. Reglamenta la ley 1008. D.S. 22337 confiscacion de bienes. D.S. 22373 anexos del D.S. 22337. R.S. 206687 comision de bienes confiscados. El bien juridico tutelado. Lavado de dolares. La prueba de delito de narcotrafico. Querella del Ministerio Publico. Jurisprudencia.