Broad evidence of xylazine in the UK illicit drug market beyond heroin supplies: Triangulating from toxicology, drug-testing and law enforcement.

BACKGROUND AND AIMS: Xylazine is a non-opioid sedative which has spread rapidly throughout the US illicit drug supply. This study aimed to describe the spread of xylazine throughout the UK illicit drug supply. METHODS: Xylazine detections in human biological samples were collated from toxicology laboratories operating in the United Kingdom with the date, location, case type, xylazine concentration and co-detected drugs (with quantifications where performed) detailed, where permitted, by the corresponding coroner. Drug-testing cases positive for xylazine were collated from the Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) drug-testing postal service with the date, location, purchase intent and co-detected drugs detailed. Drug seizures made by UK law enforcement were communicated by the Office for Health Improvement and Disparities with the date and location detailed. RESULTS: By the end of August 2023, xylazine was detected in 35 cases from throughout toxicology, drug-testing and drug seizure sources covering England, Scotland and Wales. There were no cases reported from Northern Ireland. Xylazine was detected in biological samples from 16 people. In most cases where full toxicology results were provided, xylazine was detected with heroin and/or a strong opioid (n = nine of 11), but this polydrug use pattern was not evident in all cases (n = two of 11), suggesting a wider circulation of xylazine in the UK illicit drug market beyond heroin supplies. Evidence from WEDINOS supports this claim, as all 14 drug samples (100%) submitted from across the UK contained xylazine; however, in none of these cases was heroin the purchase intent but rather counterfeit prescription medication tablets (n = 11 of 14), tetrahydrocannabinol (THC) vapes (n = two of 14) or white powder (n = one of 14). Additional evidence for the spread of illicit xylazine comes from five drug seizures made by law enforcement. CONCLUSIONS: Xylazine has penetrated the UK illicit drug market and is not limited to heroin supplies.

Coletiva de imprensa: anúncios do Governo 16/04/2021

O Vice-Governador Rodrigo Garcia anunciou nesta sexta-feira (16) a atualização do Plano São Paulo, com início da fase de transição para todo Estado até o dia 2 de maio. Nas últimas semanas, os indicadores da saúde apresentaram uma redução progressiva, com queda nas internações e diminuição da ocupação hospitalar, o que permitiu o avanço para retomada gradativa e consciente das atividades não essenciais. As medidas mais rígidas de restrição da fase vermelha, o avanço na vacinação e a expansão de leitos hospitalares resultaram em decréscimo de 1,4% ao dia em novas internações e de 0,8% ao dia em UTIs para pacientes moderados e graves com coronavírus. “A fase de transição é necessária para que possamos dar passos seguros adiante sem o risco de retroceder. O apoio da população nesse novo momento da pandemia continua sendo fundamental. Não é hora de baixarmos a guarda”, afirmou o Vice-Governador e Secretário de Governo Rodrigo Garcia. A nova fase inicia no próximo domingo (18) e está dividida em dois períodos. Na primeira semana, de 18 a 23 de abril, a flexibilização acontecerá para o setor do comércio, incluindo lojas de shopping, com funcionamento permitido das 11h às 19h. Nesse período, também será permitida a realização de cerimônias e cultos religiosos com restrições, desde que seguidos rigorosamente todos os protocolos de higiene e distanciamento social. No período de 24 a 30 de abril, além dos estabelecimentos comerciais, poderão voltar a funcionar as atividades ligadas ao setor de serviços como restaurantes e similares (lanchonetes, casas de sucos, bares com função de restaurante), salões de beleza e barbearias, atividades culturais, parques, clubes e academias. O horário de funcionamento será das 11h às 19h, com exceção das academias, que poderão abrir das 7h às 11h e das 15h às 19h. A fim de evitar aglomerações, a capacidade de ocupação permitida nos estabelecimentos na fase de transição será de 25%. O toque de recolher continua em vigência em todo o Estado, das 20h às 5h, assim como a orientação para o teletrabalho para as atividades administrativas não essenciais e escalonamento de horário na entrada e saída das atividades do comércio, serviços e indústrias. A próxima atualização do Plano SP acontecerá a partir do dia 1 de maio. O resumo com as medidas anunciadas pelo Governo do Estado está disponível na página https://issuu.com/governosp/docs/.

Carlos Lula fala sobre a falta de medicamentos para intubação

O presidente do Conass, Carlos Lula, falou sobre a necessidade de atenção especial para os medicamentos do chamado kit intubação de pacientes e alertou para o risco da falta dessas medicações já nos próximos dias, repetindo o cenário ocorrido no segundo semestre de 2020.

Ministério da Saúde atualiza informações sobre o combate à COVID-19

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Ministério da Saúde ao vivo: balanço de entregas

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Ministério da Saúde atualiza informações sobre o combate à COVID-19 - 15.10.2020

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Ministério da Saúde atualiza informações sobre o coronavírus por meio de coletiva on-line

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Ministério da Saúde atualiza informações sobre o combate à COVID-19 - 23.09.2020

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Ministério da Saúde atualiza informações sobre a COVID-19 - 03/09/2020

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Todos os estados aderem ata de compras do Ministério da Saúde para medicamentos do kit de intubação

Com isso todos os 27 estados passam a ser co-participantes da ata nacional de registros de preço Diante da impossibilidade de aquisição dos medicamentos utilizados para intubação de pacientes com Covid-19, relatada por diversos estados desde o final de abril desse, decorrentes da escassez desses produtos no mercado nacional, o Ministério da Saúde anunciou uma série de medidas para apoiar as Secretarias Estaduais de Saúde (SES) na aquisição desses itens. Uma delas foi a abertura de processo de licitação na modalidade pregão, na forma eletrônica do tipo menor preço pelo Sistema de Registro de Preços (SRP). A medida teve a adesão de todas as Unidades da Federação, o que significa que elas passam a ser co-participantes da Ata Nacional de Registros de Preço. Com isso, todas as SES estão aptas a de fato, comprar dessa ata quando a mesma for publicada. “Fizemos um esforço inédito, em tempo recorde, na adesão da Ata de Compras dos medicamentos do kit de intubação. Nessa modalidade, temos um volume muito maior de insumos, barateando o preço final”, afirma o presidente do Conass, Carlos Lula. A importância, segundo observou Carlos Lula, é o ganho em escala, pois é uma estratégia que visa homogenizar o valor das aquisições dos medicamentos. “Os preços dos insumos foram equalizados para todos os estados, garantindo o aproveitamento dos recursos públicos”, ressaltou. O prazo para a adesão terminou ontem (13/7) e foi aberto um período de 48 horas para ajustes na intenção de juízo de preço por aquelas secretarias que assim desejarem. Passado esse período, o Ministério da Saúde irá publicar o edital para a licitação dos medicamentos, por meio de pregão eletrônico. Heber Dobis, assessor técnico do Conass, explica que por se tratar de uma ata de registro de preço, as SES não precisam necessariamente adquirir tudo em uma única compra, podendo comprar quantas vezes acharem necessário obedecendo ao limite do quantitativo registrado. “O preço estará registrado e a SES apenas fará o empenho de recursos e execução da aquisição conforme a sua necessidade”, pontuou. A responsabilidade pela distribuição dos medicamentos será do Ministério da Saúde que receberá o material em seu almoxarifado central em São Paulo e fará a logística para a entrega nos estados.

It Takes a Village : Contending With Drug Shortages During Disasters.

Critical drug shortages have been widely documented during the coronavirus disease 2019 (COVID-19) pandemic, particularly for IV sedatives used to facilitate mechanical ventilation. Surges in volume of patients requiring mechanical ventilation coupled with prolonged ventilator days and the high sedative dosing requirements observed quickly led to the depletion of "just-in-time" inventories typically maintained by institutions. This manuscript describes drug shortages in the context of global, manufacturing, regional and institutional perspectives in times of a worldwide crisis such as a pandemic. We describe etiologic factors that lead to drug shortages including issues related to supply (eg, manufacturing difficulties, supply chain breakdowns) and variables that influence demand (eg, volatile prescribing practices, anecdotal or low-level data, hoarding). In addition, we describe methods to mitigate drug shortages as well as conservation strategies for sedatives, analgesics and neuromuscular blockers that could readily be applied at the bedside. The COVID-19 pandemic has accentuated the need for a coordinated, multi-pronged approach to optimize medication availability as individual or unilateral efforts are unlikely to be successful.

Unlawful dispensing practice of diazepam: a simulated client approach in community pharmacies in the north-west of Dar-es-Salaam region, Tanzania.

BACKGROUND: The use of psychotropic substances is controlled in most parts of the world due to their potential of abuse and addiction. Diazepam is one of the psychotropic substances which can be dispensed in community pharmacies in Tanzania. As per good dispensing practices and pharmacy laws, diazepam in the community pharmacies should strictly be stored in a controlled box and dispensed only by prescription. However, to our understanding little had been reported on availability and dispensing practices of diazepam in Tanzania. METHODS: A descriptive cross-sectional study which involved 178 randomly selected registered community pharmacies in Kinondoni district was conducted from January to March 2018. Simulated client approach was used to assess the availability and dispensers practice about dispensing of diazepam. Location of pharmacies was categorized as being at the centre or periphery of the Kinondoni district. Chi-squared test was used for the analysis of categorical data using SPSS version 23. The p-value of < 0.05 was considered significant. RESULT: The total of 178 community pharmacies were visited, the majority of the dispensers (89.1%) encountered were female. Most (69.1%) of the studied pharmacies were located at the centre of Kinondoni district. Diazepam was available in 91% of community pharmacies and 70% of dispensers issued diazepam without prescription. CONCLUSION: Diazepam was available in most of the community pharmacies in Kinondoni district, and the majority of the dispensers dispensed diazepam without prescription. This calls for the regulatory authorities to be more vigilant on the availability of diazepam and enhance the provision of ethical pharmacy practice in the community pharmacies.

Sleep- and Wake-Promoting Drugs: Where Are They Being Sourced, and What Is Their Impact?

Background: Recent decades have seen both an increased number of shift workers in order to deliver services 24/7, and increased potential for social interactions at all hours of the day. People have sought to engage in strategies, which either promote vigilance or facilitate sleep, with the use of sleep- and wake-promoting drugs representing one strategy. Methods: We investigated use of sleep- and wake-promoting drugs in participants (n = 377) who completed a survey investigating the type and source of sleep- and wake-promoting drugs, and their impact on sleep and performance outcomes. Results: The most commonly reported wake-promoting drugs were amphetamine and dextroamphetamin salts, modafinil, and illicit substances including methamphetamine and cocaine, while the most commonly reported sleep-promoting drugs were benzodiazepines and antihistamines. Use of a sleep-promoting drug in the past month was associated with higher odds of having poorer sleep quality (OR = 3.15) and moderate-high insomnia (OR = 3.30), while use of a wake-promoting drug was associated with poor sleep quality (OR = 3.76), or making a fatigue-related error (OR = 2.65). Conclusions: These findings represent novel data on the use and source of sleep- and wake-promoting- drugs, and suggest that despite their use, poor sleep and performance outcomes persist, likely representing individuals struggling to keep up with the 24/7 world.

Anticholinergic and sedative medication use in older community-dwelling people: A national population study in the Netherlands.

PURPOSE: To identify the proportion of older adults with a high anticholinergic/sedative load and to identify patient subgroups based on type of central nervous system (CNS)-active medication used. METHODS: A cross-sectional study of a nationwide sample of patients with anticholinergic/sedative medications dispensed by 1779 community pharmacies in the Netherlands (90% of all community pharmacies) in November 2016 was conducted. Patients aged older than 65 years with a high anticholinergic/sedative load defined as having a drug burden index (DBI) greater than 1 were included. Proportion of patients with a high anticholinergic/sedative load was calculated by dividing the number of individuals in our study population by the 2.4 million older patients using medications dispensed from study pharmacies. Patient subgroups based on type of CNS-active medications used were identified with latent class analysis. RESULTS: Overall, 8.7% (209 472 individuals) of older adults using medications had a DBI greater than 1. Latent class analysis identified four patient subgroups (classes) based on the following types of CNS-active medications used: "combined psycholeptic/psychoanaleptic medication" (class 1, 57.9%), "analgesics" (class 2, 17.9%), "antiepileptic medication" (class 3, 17.8%), and "anti-Parkinson medication" (class 4, 6.3%). CONCLUSIONS: A large proportion of older adults in the Netherlands had a high anticholinergic/sedative load. Four distinct subgroups using specific CNS-active medication were identified. Interventions aiming at reducing the overall anticholinergic/sedative load should be tailored to these subgroups.

Benzodiazepine and Z-drug prescribing in Ireland: analysis of national prescribing trends from 2005 to 2015.

AIMS: The aim of this study was to examine prescribing trends for benzodiazepines and Z-drugs to General Medical Services (GMS) patients in Ireland. METHODS: A repeated cross-sectional analysis of the national pharmacy claims database was conducted for GMS patients aged ≥16 years from 2005 to 2015. Prescribing rates per 1000 eligible GMS population were calculated with 95% confidence intervals (CIs). Negative binomial regression was used to determine longitudinal trends and compare prescribing rates across years, gender and age groups. Duration of supply and rates of concomitant benzodiazepine and Z-drug prescribing were determined. Age (16-44, 45-64, ≥65 years) and gender trends were investigated. RESULTS: Benzodiazepine prescribing rates decreased significantly from 225.92/1000 population (95% CI 224.94-226.89) in 2005 to 166.07/1000 population (95% CI 165.38-166.75) in 2015 (P < 0.0001). Z-drug prescribing rates increased significantly from 95.36/1000 population (95% CI 94.73-96.00) in 2005 to 109.11/1000 population (95% CI 108.56-109.67) in 2015 (P = 0.048). Approximately one-third of individuals dispensed either benzodiazepines or Z-drugs were receiving long-term prescriptions (>90 days). The proportion of those receiving >1 benzodiazepine and/or Z-drug concomitantly increased from 11.9% in 2005 to 15.3% in 2015. Benzodiazepine and Z-drug prescribing rates were highest for older women (≥65 years) throughout the study period. CONCLUSIONS: Benzodiazepine prescribing to the GMS population in Ireland decreased significantly from 2005 to 2015, and was coupled with significant increases in Z-drug prescribing. The study shows that benzodiazepine and Z-drug prescribing is common in this population, with high proportions of individuals receiving long-term prescriptions. Targeted interventions are needed to reduce potentially inappropriate long-term prescribing and use of these medications in Ireland.

Predictors of clinicians' underuse of daily sedation interruption and sedation scales.

PURPOSE: The purpose of the study is to identify predictors of underuse of sedation scales and daily sedation interruption (DSI). METHODS: We surveyed all physicians and seven nurses in every Belgian intensive care unit (ICU), addressing practices and perceptions on guideline recommendations. Underuse was defined for sedation scales as use less than 3× per day and for DSI as never using it. Classification trees and logistic regressions identified predictors of underuse. RESULTS: Underuse of sedation scales and DSI was found for 16.6% and 32.5% of clinicians, respectively. Strongest predictors of underuse of sedation scales were agreeing that using them daily takes much time and being a physician (rather than a nurse). Further predictors were confidence in their ability to measure sedation levels without using scales, for physicians, and nurse/ICU bed ratios less than 1.98, for nurses. The strongest predictor of underuse of DSI among physicians was the perception that DSI impairs patients' comfort. Among nurses, lack of familiarity with DSI, region, and agreeing DSI should only be performed upon medical orders best predicted underuse. CONCLUSIONS: Workload considerations hamper utilization of sedation scales. Poor familiarity, for nurses, and negative perception of impact on patients' comfort, for physicians, both reduce DSI utilization. Targeting these obstacles is essential while designing quality improvement strategies to minimize sedative use.