Expanding access to medications to treat opioid use disorder (OUD), such as buprenorphine, is an evidence-based response to the mounting drug overdose crisis. However, concerns about buprenorphine diversion persist and contribute to limited access.
To inform decisions about expanding access, a scoping review was conducted on publications describing the scope of, motivations for, and outcomes associated with diverted buprenorphine in the U.S.
In the 57 included studies, definitions for diversion were inconsistent. Most studied use of illicitly-obtained buprenorphine. Across studies, the scope of buprenorphine diversion ranged from 0% to 100%, varying by sample type and recall period. Among samples of people receiving buprenorphine for OUD treatment, diversion peaked at 4.8%. Motivations for using diverted buprenorphine were self-treatment, management of drug use, to get high, and when drug of choice was unavailable. Associated outcomes examined trended toward positive or neutral, including improved attitudes toward and retention in MOUD.
Despite inconsistent definitions of diversion, studies reported a low scope of diversion among people receiving MOUD, with inability to access treatment as a motivating factor for using diverted buprenorphine, and increased retention in MOUD as an outcome associated with use of diverted buprenorphine. Future research should explore reasons for diverted buprenorphine use in the context of expanded treatment availability to address persistent barriers to evidence-based treatment for OUD.

Psychoactive substance use and the regulations that govern it both have the potential to lead to harm. A \'public health approach\' (PHA) is frequently invoked as a means of addressing these harms, but the term is used in inconsistent and contradictory ways. This study systematically reviewed the English-language academic literature to understand how a public health approach to substance use is defined and described.
This review employed thematic synthesis, a methodology designed to rigorously synthesize qualitative evidence. Eligible articles were published in peer-reviewed journals, in the English language, with full text available, and focused primarily on substance use. There were no limits on year of publication. Original research, opinion/commentary, and reviews were included. The searches were conducted in October 2021 in CINAHL, Embase, Medline, PAIS Index, PsycINFO, Scopus, Sociological Abstracts, and Web of Science.
272 articles from 25 countries, published between 1950 and 2021, were synthesized. Definitions of a PHA have changed over time and differ by substance. The most commonly cited characteristics of a PHA were: for alcohol, regulation, e.g. of price and availability (54% of articles); for cannabis: regulation (68%); for illicit drugs: that a PHA is distinct from a criminal justice approach (63%); for opioids: substance use disorder treatment (55%); and for tobacco: regulation (62%).
There is no consensus on the definition of a public health approach to substance use, but there is substantial agreement when it comes to PHAs to specific substances. There are also similarities in how they are described for legal substances versus illicit ones. This review found areas of disagreement regarding the extent to which PHAs should focus on individual-level factors. Policymakers, academics, and others developing or implementing PHAs to substance use should be explicit about their aims and objectives - as well as the premises and assumptions underlying them.

We were engaged by policy stakeholders to undertake a scoping review of cannabis measurement instruments to inform the evaluation of cannabis legalization impacts. We identified instruments employed in population-based or clinical research to screen and assess cannabis use, including measurement properties. We also identified the content domains included in each instrument and gaps in the measurement of key priority areas as established by policy stakeholders.
We followed PRISMA and conducted searches on MEDLINE, PsycINFO, Web of Science, EMBASE, HAPI, Scopus and grey literature. We included publications from the past 15 years that reported the use of an instrument to measure cannabis use. Six study team members calibrated screening and data abstraction, independently identified records and abstracted data.
Across 915 included publications, we identified 187 unique instruments covering seven content domains and 35 subdomains. The most identified instruments were the Composite International Diagnostic Interview, the Timeline Follow-Back and the National Epidemiologic Survey on Alcohol and Related Conditions (109/915; 91/915; 64/915). The Canadian Cannabis Survey addressed the most subdomains (22/35). Frequency of use, prevalence of use, and mental health impacts were the most addressed subdomains (110/187; 94/187; 67/187) and storage, growing cannabis, and second-hand exposure were the least addressed (1/187; 4/187; 6/187).
This research identified instruments and domains critical to the assessment of public health impacts of cannabis legalization, which can facilitate the harmonization of measures to inform policy development. Future research should develop new instruments for less commonly-addressed constructs and thoroughly explore psychometric properties of existing instruments.

Internationally, many supervised consumption services (SCS) include drug inhalation (smoking). However, most research is focused on SCS for people who inject drugs. We aimed to: (1) synthesize the literature on including inhalation or other forms of non-injection drug use (e.g., oral, intranasal) within SCS; (2) describe the state of the science on the feasibility of this practice and its outcomes; and (3) outline an agenda for future evaluation research in this area.
We searched 9 academic and 13 grey literature databases and ultimately included 40 studies. Thirty-two studies (80%) reported findings from feasibility or needs assessments. From these studies, we extracted information on willingness to use these services, perspectives of people who use drugs and other stakeholders, and recommendations for implementation. Eight studies (20%) evaluated including inhalation in SCS, from which we extracted data on associated outcomes. Data were analysed using narrative synthesis and descriptive statistics.
We found high willingness to use SCS including inhalation among people who use drugs, especially those experiencing structural vulnerability. Research emphasized a need for implementation to account for the social nature of drug inhalation, and to limit potential occupational hazards associated with passive inhalation. Positive outcomes associated with inhalation within SCS included improved health and safety of people who use drugs and decreased public drug use. However, this evidence was based primarily on a limited number of studies with designs of mixed quality.
Our review demonstrates feasibility of, and need for, implementing SCS including inhalation, and some potential positive outcomes associated with this practice. However, more comprehensive and systematic evaluations of including inhalation as well as other forms of non-injection drug use (e.g., oral, intranasal, rectal) within SCS should be conducted.

OBJECTIVE: In the past two decades, human antibiotic consumption has increased globally, contributing to the emergence and spread of antimicrobial resistance and needing urgent effective actions. Our objectives were to systematically identify and collate studies exploring non-biomedical factors influencing healthcare consumers\' antibiotic use globally, in order to inform future interventions to improve practices in antibiotic use.
METHODS: Data sources were PubMed, EMBASE, PsycINFO, and Cochrane. Study eligibility criteria were original and empirical studies that identified factors for healthcare consumers\' antibiotic use. Participants were healthcare consumers. Assessment of risk of bias used adapted BMJ survey appraisal tools, the Critical Appraisal Skills Programme checklist, and the Mixed Methods Appraisal Tool for quality assessment. Methods of data synthesis employed the Social Ecological Framework and Health Belief Model for data synthesis. We did random-effects meta-analyses to pool the odds ratios of risk factors for antibiotic use.
RESULTS: We included 71 articles for systematic review and analysis; 54 were quantitative, nine were qualitative, and eight were mixed-methods studies. Prevalent non-prescription antibiotic use and irresponsible prescriptions were reported globally, especially in low-to-middle-income countries. Barriers to healthcare-wait time, transportation, stigmatization-influenced people\'s practices in antibiotic use. Further, lack of oversight and regulation in the drug manufacturing and a weak supply chain have led to the use of substandard or falsified antibiotics. Knowledge had mixed effects on antibiotic use behaviours. Meta-analyses identified pro-attitudes towards self-medication with antibiotics, relatives having medical backgrounds, older age, living in rural areas, and storing antibiotics at home to be risk factors for self-medication with antibiotics.
CONCLUSIONS: Non-prescription antibiotic use and irresponsible prescriptions in the community are prevalent in all WHO regions and are driven largely by a mixed collection of non-biomedical factors specific to the respective setting. Future antimicrobial resistance strategies should incorporate an implementation science approach for community-based complex interventions that address drivers of the target behaviours tailored to local contexts.

Most of the existing research on supervised consumption services (SCS) is focused on injection drug use. Less is known about the applicability of SCS for people who consume drugs orally, intranasally, or through inhalation. This is problematic because people who use drugs through modes other than injection are also at risk of overdose death and other harm, and experience barriers accessing health and social services. We aimed to describe existing SCS models that accommodate these alternate routes of drug consumption, and synthesize available information on characteristics of program participants.
We conducted a systematic scoping review of 9 peer-reviewed and 13 grey literature databases on SCS that incorporate non-injection routes of consumption. We screened 22,882 titles, and excluded 22,843 (99.8%) articles. We ultimately included 39 (0.2%) full-text articles; 28 (72%) of these articles explicitly identified SCS that permit alternate routes of consumption and 21 (54%) discussed characteristics of participants who consume drugs through non-injection routes. Data on study characteristics, terms and definitions, and site and program participant characteristics were extracted and double-coded. Extracted data were analyzed using descriptive statistics and narrative synthesis.
Included articles describe 48 SCS that permit non-injection routes of consumption, most of which were located in Germany. The majority of these SCS were legally sanctioned and had models of care that were largely comparable to supervised injection services. Notable differences included physical infrastructure such as ventilated rooms or outdoor areas to accommodate inhalation, and shorter time limits on non-injection drug consumption episodes. Program participants engaging in non-injection forms of consumption were typically men over the age of 30 and structurally vulnerable (e.g., experiencing homelessness or unstable housing).
Extant academic and grey literature indicates that site characteristics and demographics of program participants of SCS that permit non-injection routes of consumption largely reflect those of supervised injection services. Further research on the range of existing SCS that incorporate non-injection routes of consumption is needed to ensure high quality service provision, and improved health outcomes for people who consume drugs via oral, intranasal, and inhalation routes.

The United States (US) and Canada are in the midst of an opioid overdose epidemic. Many people who use illicit drugs (PWUD) do not call an emergency number 911 at the scene of an overdose due to fear of arrest. In the US and Canada, when an individual calls 911, both emergency medical services (EMS) and police are notified to attend the overdose event. In response, many settings in North America have introduced drug-related \'Good Samaritan\' laws (GSLs) that aim to encourage PWUD to call 911 by providing legal immunity (mainly protections from drugs possessed for personal use) to those at the scene of the overdose. However, little is known about the effectiveness of these laws in increasing calls to 911.
We conducted a literature review of the published literature between 2005 and 2019 to examine the effectiveness of GSLs. Searches were referenced using keywords that included: \"good samaritan\", \"overdose\", \"emergency services\", and \"drug use\".
Among 68 articles identified, after eligibility screening, 12 publications were deemed to meet the inclusion criteria. These publications were largely quantitative observational studies (9/12), with a minority (3/12) being qualitative in design. Two major themes emerged: \"knowledge of GSLs and calling EMS\" and \"overdose-related hospital admissions and mortality assessment\".
At this time, the current body of evidence regarding the effectiveness of GSLs in increasing calls to EMS and reducing drug-related harms is limited and mixed. Studies show that PWUD have low levels of knowledge regarding GSLs while some evidence suggests their effectiveness in increasing calls to EMS at the scene of an overdose. Given the current overdose crisis, further investigation is warranted to establish the effectiveness of these laws in reducing drug-related harms.

Background: A number of countries are legalizing the supply of cannabis or are considering doing so. Beyond top-level design questions (e.g., who gets to supply and how will it be taxed?) lie many equally important and thorny regulatory issues concerning retail sale and use. These issues will often be hammered out at the local and state/provincial level by policy makers who are generalists, not experts in substance misuse, let alone cannabis.Objectives: This review provides a framework for thinking about the role of regulation and delves into three important topics with which these leaders will wrestle: Where and when can cannabis be sold? What can retailers sell? And where can their products be used?Methods: Literature review and drawing parallels with alcohol and tobacco regulation.Results: The common thread across these questions is that the public health interest is both nuanced and in conflict with other stakeholder interests, such as companies\' desire to maximize sales and profits and governments\' desire for tax revenues.Conclusion: There is a need for data and oversight structures that ensure that public health will not lose out over time.

Objectives: The aim of this study was to review reimbursement environment as well as pricing and reimbursement requirements for drugs in selected Central and Eastern Europe (CEE) countries. Methods: A questionnaire-based survey was performed in the period from November 2016 to March 2017 among experts involved in reimbursement matters from CEE countries: Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Romania. A review of requirements for reimbursement and implications of Health Technology Assessment (HTA) was performed to compare the issues in above-mentioned countries. For each specified country, data for reimbursement costs, total pharmaceutical budget, and total public health care budget in the years 2014 and 2015 were also collected. Questionnaires were distributed via emails and feedback data were obtained in the same way. Additional questions, if any, were also submitted to respondents by email. Pricing and reimbursement data were valid for March 2017. Results: The survey revealed that the relation of drug reimbursement costs to total public healthcare spending ranged from 0.12 to 0.21 in the year 2014 and 2015 (median value). It also revealed that pricing criteria for drugs, employed in the CEE countries, were quite similar. External reference pricing as well as internal reference pricing were common in mentioned countries. Positive reimbursement lists were valid in all countries of the CEE region, negative ones were rarely used; reimbursement decisions were regularly revised and updated in the majority of countries. Copayment was common and available levels of reimbursement differed within and between the countries and ranged from 20 to 100%. Risk-sharing schemes were often in use, especially in the case of innovative, expensive drugs. Generic substitution was also possible in all analyzed CEE countries, while some made it mandatory. HTA was carried out in almost all of the considered CEE countries and HTA dossier was obligatory for submitting a pricing and reimbursement application. Conclusions: Pricing and reimbursement requirements are quite similar in the CEE region although some differences were identified. HTA evaluations are commonly used in considered countries.

Within drug policy scholarship there is a growing body of literature applying ideational and social constructionist approaches to address the complexity of drug policy making and the apparent failure of the evidence-based policy paradigm to free the process from controversy and contestation. Ideational approaches are concerned with the roles played by ideas and beliefs in policy making, while social construction explores the way policy problems are constructed, and agendas are set and delineated by dominant frames and narratives. Interest in these approaches has developed over the last two decades, but has rapidly gained momentum over the last five years. There has been limited reflection on the state of the field, therefore it is timely to conduct a review of the literature to assess the value of these approaches, capture emerging themes and issues, and identify gaps in the literature to support future research directions. Using the Arksey and O\'Malley framework, a scoping review was conducted to survey the breadth of the field. Following database and hand searching, 48 studies from 1996 to 2016 were selected for inclusion in the review. A narrative synthesis was undertaken and the literature was grouped into five broad theoretical approaches: ideational policy theory, problem construction, narratives and frames (including media analysis), construction of target populations, and policy transfer and mobilities. The majority of the studies are focused on single countries and drug policy issues, with few studies undertaking comparative work or reflecting on general theoretical developments in the literature. This study found that the Arksey and O\'Malley framework was effective in capturing a potentially diverse field of literature and demonstrates the importance of ideational and social constructionist approaches to drug policy scholarship. Further research is required to achieve expanded geographic coverage, test policy making models and undertake comparative work.