Publications by authors named "Peter Reuter"

63 Publications

Joint hypermobility and musculoskeletal injuries in a university-aged population.

Authors:
Peter R Reuter

Phys Ther Sport 2021 Feb 24;49:123-128. Epub 2021 Feb 24.

Department of Rehabilitation Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, 10501 FGCU Boulevard South, Marieb Hall 419, Fort Myers, 33912, Fort Myers, Florida, USA. Electronic address:

Objective: To explore the correlation between joint hypermobility and risk of musculoskeletal injuries in a university-aged population.

Design: Cross-sectional study using an anonymous survey.

Setting: Anatomy & Physiology lab.

Participants: 816 undergraduate Anatomy & Physiology students at a university in the United States.

Main Outcome Measures: Beighton score, self-reported musculoskeletal injuries.

Results: Athletically active study respondents reported more musculoskeletal injuries than respondents who indicated not being athletically active. Female respondents had lower rates of self-reported injuries than male respondents (55.4% vs. 65.5%; p = 0.0099; odds ratio: 1.53). The most commonly reported injury type for both women and men were quadriceps, groin and hamstring injuries. Neither male nor female respondents with generalized joint hypermobility (GJH) or localized joint hypermobility (LJH) reported higher rates of musculoskeletal injuries.

Conclusions: Athletically active young adults are at greater risk for sustaining musculoskeletal injuries; however, there is no additional increase in injury risk for young people with GJH or LJH.
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http://dx.doi.org/10.1016/j.ptsp.2021.02.009DOI Listing
February 2021

Heroin use cannot be measured adequately with a general population survey.

Addiction 2021 Mar 2. Epub 2021 Mar 2.

University of Maryland, Department of Criminology and Criminal Justice, College Park, MD, USA.

Background: Globally, heroin and other opioids account for more than half of deaths and years-of-life-lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS-based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets.

Analysis: Four sources of potential errors in NSDUH are assessed: selective non-response, small sample size, sampling frame omissions and under-reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed.

Findings: Under-reporting and selective non-response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year-to-year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three-quarters and perhaps much more.

Implications: GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard-to-track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug-related behaviors with low prevalence rates.
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http://dx.doi.org/10.1111/add.15458DOI Listing
March 2021

New synthetic drugs require new policies.

Addiction 2021 Feb 21. Epub 2021 Feb 21.

RAND Corporation, Santa Monica, CA, USA.

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http://dx.doi.org/10.1111/add.15442DOI Listing
February 2021

Imagining a fentanyl future: Some consequences of synthetic opioids replacing heroin.

Int J Drug Policy 2021 Jan 7:103086. Epub 2021 Jan 7.

RAND Corporation, United States.

For nearly a century heroin has dominated the illegal opioid trade. The global supply of heroin is estimated to generate tens of billions of dollars in revenues a year and its illegal use has long been the source of many societal harms. The arrival of inexpensive and mass-produced synthetic opioids, such as fentanyl, to parts of North America and Europe may signal the beginning of the end of heroin's dominance. Data from several places suggest that fentanyl and other synthetic opioids can quickly supplant heroin. Taking the extreme case, we calculate the estimated wholesale revenues of heroin currently and contrast that with fentanyl prospectively in the United States and in the rest of the world if fentanyl were to supplant heroin entirely. Heroin traffickers in the United States generate about $2.5 billion in revenues; the total import value of fentanyl, after replacing heroin, could be less than $100 million. For the rest of the world we project a reduction from $6.7 billion to less than $300 million. Retailer revenues on the other hand would probably rise because individuals may consume more frequently and with greater intensity due to fentanyl's shorter duration of action and so far there has been no indication of a notable reduction in retail prices. It is unlikely that heroin will entirely disappear, but very likely that globally heroin will account for a declining share of illegal opioids. Violence and corruption may decline but opioid related mortality and morbidity, as well as property crime, are likely to rise. Policy makers will face difficult challenges. Economics provides limited help in forecasting which opioid markets are likely to convert to synthetic opioids.
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http://dx.doi.org/10.1016/j.drugpo.2020.103086DOI Listing
January 2021

A Puzzling Exam: Kernohan's Notch Reimaged.

J Clin Neurosci 2020 Sep 14. Epub 2020 Sep 14.

Department of Neurology, Mayo Clinic, Rochester, MN, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jocn.2020.06.017DOI Listing
September 2020

The dawn of a new synthetic opioid era: the need for innovative interventions.

Addiction 2020 Aug 31. Epub 2020 Aug 31.

RAND Corporation, Santa Monica, CA, USA.

Background: Overdose deaths related to illegal drugs in North American markets are now dominated by potent synthetic opioids such as fentanyl, a circumstance foreshadowed by often-overlooked events in Estonia since the turn of the century. Market transitions generate important and far-reaching implications for drug policy.

Argument And Analysis: The supplier-driven introduction of illegally manufactured synthetic opioids into street opioids is elevating the risk of fatal overdose. Using the most recent overdose mortality and drug seizure data in North America, we find that overdose deaths and seizures involving synthetic opioids are geographically concentrated, but this might be changing. Examination here suggests that in some places fentanyl and its analogues have virtually displaced traditional opioids, such as heroin. The concealing of synthetic opioids in powders sold as heroin or pressed into counterfeit medications substantially increases harms. The nature and scale of the challenge posed by synthetic opioids is unprecedented in recent drug policy history.

Conclusions: There is urgent need for policy and technological innovation to meet the challenges posed by illegally produced synthetic opioids. Novel interventions worth examining include supervising drug use, proactively deterring on-line distribution and new technologies aimed at improving transparency, such as point-of-use drug content testing. Continuing to approach this problem only with existing policies and available methods, such as naloxone, is unlikely to be enough and will result in many premature deaths.
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http://dx.doi.org/10.1111/add.15222DOI Listing
August 2020

The influence of eating habits on the academic performance of university students.

J Am Coll Health 2020 Feb 6:1-7. Epub 2020 Feb 6.

Department of Rehabilitation Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, Fort Myers, Florida, USA.

To explore the correlation between eating habits of university students and academic achievement. 577 undergraduate students at a university in the United States. Students were invited to participate in an anonymous online survey that asked questions concerning health-related behaviors; participants were asked to report their current grade point average (GPA). Statistical analyses were performed using the JMP software program; a standard least squares regression was used to test whether self-reported current GPA was related to different types and rates of weekly food and drink consumption. Self-reported GPA did not change along with weekly rates of milk, vegetables, green salad, fruit juice, or fresh fruit consumption. Breakfast consumption had a positive effect on self-reported GPA, while fast food consumption had a negative effect. Healthy eating habits have a positive effect on students' academic performance. However, other factors, such as sleep habits, may be more important.
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http://dx.doi.org/10.1080/07448481.2020.1715986DOI Listing
February 2020

Has Cannabis Use Among Youth Increased After Changes in Its Legal Status? A Commentary on Use of Monitoring the Future for Analyses of Changes in State Cannabis Laws.

Prev Sci 2020 01;21(1):137-145

Department of Criminology & Criminal Justice, University of Maryland, 2220 LeFrak Hall, College Park, MD, USA.

As US states move toward various forms of adult access to cannabis, there has been a great interest in measuring the impact of such changes on adolescent cannabis use. Two recent prominent analyses have used Monitoring the Future (MTF), a nationally representative survey of students, to examine the effects. We compared MTF data for California and for Washington State with other survey data on use by adolescents in those states. In both studies, findings based on MTF were different from those using other larger, state-representative surveys. The discrepancy reflects the high within-state variation in prevalence rates and the small number of schools in MTF state samples. Using the Washington Health Youth Survey, we estimate that after recreational cannabis legalization past 30-day cannabis use prevalence in grade 8 decreased by 22.0%, in grade 10 prevalence decreased by 12.7%, and no effect in grade 12. These trends are consistent with those in states without recreational cannabis laws, suggesting that legalization did not impact adolescent use prevalence. Long-term trends in MTF are consistent with other data, but year-to-year volatility in state-level series undermines the survey's suitability for evaluation of state cannabis policy changes. Survey-based analyses at the state level need to be cross-validated with findings from other data sources. When findings are disparate and methodological rigor is equivalent, analyses of data sources specifically designed to describe state-level phenomena are more credible.
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http://dx.doi.org/10.1007/s11121-019-01068-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960330PMC
January 2020

Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students.

PeerJ 2019 11;7:e7625. Epub 2019 Sep 11.

Department of Rehabilitation Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, Fort Myers, FL, USA.

The objective of this study was to investigate the prevalence of generalized joint hypermobility (GJH) in a university-aged population, whether young adults (aged 18-25 years) with GJH are prone to sustain more musculoskeletal injuries, and are more likely to suffer from chronic musculoskeletal pain. The study used an interactive survey to gather data; GJH was assessed using a cut-off Beighton score of ≥5 in accordance with the 2017 International Classification of EDS criteria. The analyzed sample consisted of 482 female and 172 male participants from Florida Gulf Coast University (USA). The prevalence of GJH in a university-aged population can be estimated at 12.5%. Women did not have higher rates of GJH than men. However, female participants showed significantly higher rates of hypermobility of the spine as well as the right knee and elbow joints. The Beighton scores did not differ by ethnicity/race. Female participants had a lower rate of self-reported injuries than male participants, although this difference was not significant. There was no difference in the proportion of all participants classified within different categories (0; 1-4; 5-9) of Beighton scores and whether or not they reported having been injured. Male and female participants reported chronic pain of joints and neck or back at the same rates across the Beighton score categories. Female participants, however, reported higher pain intensity for chronic neck and back pain. This study increases knowledge about a correlation between GJH, musculoskeletal injuries, and chronic pain of joints, neck, and back in a university-aged population.
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http://dx.doi.org/10.7717/peerj.7625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744937PMC
September 2019

Commentary on Freeman et al. (2019): Why does cannabis potency still vary across European countries?

Authors:
Peter Reuter

Addiction 2019 06 12;114(6):1024-1025. Epub 2019 Apr 12.

School of Public Policy and Department of Criminology, University of Maryland, College Park, MD, USA.

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http://dx.doi.org/10.1111/add.14613DOI Listing
June 2019

Facing fentanyl: should the USA consider trialling prescription heroin?

Lancet Psychiatry 2018 08 21;5(8):613-615. Epub 2018 Mar 21.

School of Public Policy and Department of Criminology, University of Maryland, College Park, MD, USA. Electronic address:

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http://dx.doi.org/10.1016/S2215-0366(18)30103-2DOI Listing
August 2018

Comparing the awareness of and beliefs in sexually transmitted infections among university students in Madagascar and the United States of America.

PeerJ 2018 21;6:e4362. Epub 2018 Feb 21.

Africa Field Division, Conservation International, Gaborone, Botswana.

Young adults have a higher risk of contracting sexually transmitted infections (STIs) than other age groups. This risk may be mediated by their social and cultural setting which can impact young adults' awareness of, beliefs in, and risk of contracting STIs (including HIV/AIDS). In order to understand how these factors vary among young adults of different cultures, it is important to study these issues on a cross-cultural scale. This study aimed to increase understanding of the relationship between the culture of a place of study and: (1) STI awareness; (2) belief in STIs; and (3) self-reported STI prevalence in the study population. Survey data were collected from university students in Madagascar ( = 242 surveys in 2013) and the United States of America ( = 199 surveys in 2015). Compared to students at the American university, students at the Malagasy university: (1) did not appear to have a conclusively lower awareness of STIs; (2) did not differ in rates of belief in the existence of gonorrhea and syphilis, but had higher rates of disbelief in HIV/AIDS; and (3) were more likely to report having been infected with syphilis and gonorrhea, but not with HIV/AIDS. Students at the Malagasy university also listed different reasons than the students at the American university for why they believed in the existence of STIs. These findings highlight the need for further cross-cultural research to better adapt intervention strategies to different cultural settings.
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http://dx.doi.org/10.7717/peerj.4362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825850PMC
February 2018

Exploring the perils of cross-national comparisons of drug prevalence: The effect of survey modality.

Drug Alcohol Depend 2017 12 18;181:194-199. Epub 2017 Oct 18.

Rand Corporation, United States.

Background: There is significant interest in comparing countries on many different indicators of social problems and policies. Cross-national comparisons of drug prevalence and policies are often hampered by differences in the approach used to reach respondents and the methods used to obtain information in national surveys. The paper explores how much these differences could affect cross-country comparisons.

Methods: This study reports prevalence of drug use according to the most recent national household survey and then adjusts estimates as if all national surveys used the same methodology. The analysis focuses on European countries for which the European Monitoring Centre for Drugs and Drug Addiction reports data, the United States, Canada, and Australia. Adjustment factors are based on US data.

Findings: Adjusting for modality differences appears likely to modestly affect the rankings of countries by prevalence, but to an extent that could be important for comparisons. For example, general population surveys suggest that the US had some of the highest cannabis and cocaine prevalence rates circa 2012, but this is partially driven by the use of a modality known to produce higher prevalence estimates. This analysis shows that country rankings are partly an artifact of the mode of interview used in national general population surveys.

Conclusions: Our preliminary efforts suggest that cross-national prevalence comparisons, policy analyses and, other projects such as estimating the global burden of disease could be improved by adjusting estimates from drug use surveys for differences in modality. Research is needed to create more authoritative adjustment factors.
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http://dx.doi.org/10.1016/j.drugalcdep.2017.09.027DOI Listing
December 2017

Public health professionals' perceptions of mental health services in Equatorial Guinea, Central-West Africa.

Pan Afr Med J 2016 13;25:236. Epub 2016 Dec 13.

Temple University, Department of Biology Philadelphia, PA, 19122.

Introduction: Mental health disorders constitute 13% of global disease burden, the impacts of which are disproportionality felt in sub-Saharan Africa. Equatorial Guinea, located in Central-West Africa, has the highest per-capita investment in healthcare on the African continent, but only two studies have discussed mental health issues in the country and none of have examined the perspective of professionals working in the field. The purpose of this study was to gain a preliminary understanding of Equatoguinean health care professionals' perspectives on the mental health care system.

Methods: Nine adult participants (directors or program managers) were interviewed in July 2013 in Malabo, Equatorial Guinea from government agencies, aid organizations, hospitals, and pharmacies. Interviews were designed to collect broad information about the mental healthcare system in Equatorial Guinea including the professionals' perspectives and access to resources. This research was reviewed and approved by an ethical oversight committee.

Results: All individuals interviewed indicated that the mental health system does not currently meet the needs of the community. Professionals cited infrastructural capacity, stigmatization, and a lack of other resources (training programs, knowledgeable staff, medications, data) as key factors that limit the effectiveness of mental healthcare.

Conclusion: This study provides a preliminary understanding of the existing mental health care needs in the country, highlighting opportunities for enhanced healthcare services.
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http://dx.doi.org/10.11604/pamj.2016.25.236.10220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337280PMC
March 2017

Creating a drug law enforcement research agenda.

Authors:
Peter Reuter

Int J Drug Policy 2017 03 4;41:160-161. Epub 2017 Feb 4.

School of Public Policy and Department of Criminology, University of Maryland, College Park, MD, 20742, United States. Electronic address:

Drug law enforcement (DLE) research has been poorly funded relative to drug treatment research. The literature is slight in volume and not yet very insightful. Taking the lack of funding to represent a chronic lack of public interest in the effects of DLE, the article offers a set of suggestions for how to create of a stronger DLE research community.
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http://dx.doi.org/10.1016/j.drugpo.2017.01.005DOI Listing
March 2017

New psychoactive substances: Are there any good options for regulating new psychoactive substances?

Int J Drug Policy 2017 02 23;40:117-122. Epub 2016 Nov 23.

School of Public Policy, University of Maryland, 2101 Van Munching Hall, College Park, MD 20742, United States. Electronic address:

Advances in chemistry, technology, and globalization have contributed to the rapid development and diffusion of NPS (new psychoactive substances), creating perhaps the most serious challenge to the century-old international drug control system and to national systems. Very little is known about the effects of these substances which fall outside of national and international controls. The predominant response to the flood of NPS has been the development of more expeditious methods of prohibiting a new chemical entity. This article explores alternative mechanisms that have been considered: foodstuffs, alcohol and tobacco and medicines. None seems promising in terms of avoiding the problems of prohibition without permitting unsafe substances on the market. The article then considers whether there is a bias in the existing system toward excessive prohibition. In public discussion, no attention is given to the pleasures that users obtain from any NPS, to the possibility of substitution for a more dangerous legal or illegal drug or to the consequences of illegal markets for prohibited NPS. On the other hand, it may well be impossible to obtain meaningful assessments on any of these matters at the time when decisions are made. These complexities have led a number of countries, most recently Australia and the UK, to impose total bans, the effects of which are impossible to predict.
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http://dx.doi.org/10.1016/j.drugpo.2016.10.020DOI Listing
February 2017

A chorus of pessimism surrounding the new psychoactive substances problem.

Addiction 2017 01 17;112(1):38-39. Epub 2016 Oct 17.

School of Public Policy and Department of Criminology, University of Maryland, MD, USA.

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http://dx.doi.org/10.1111/add.13596DOI Listing
January 2017

Can new psychoactive substances be regulated effectively? An assessment of the British Psychoactive Substances Bill.

Addiction 2017 01 24;112(1):25-31. Epub 2016 May 24.

School of Public Policy, University of Maryland, College Park, MD, USA.

The regulation of new psychoactive substances (NPS) has confounded governments throughout the western world. In 2014 the UK government convened an NPS Review Expert Panel to consider a range of approaches. Ultimately the Panel recommended that the government ban all new psychoactive drugs and allow only psychoactive substances specifically exempted, such as alcohol, tobacco and those allowed as medicines. The government introduced the Psychoactive Substances Bill (PSB) in response to that recommendation. Passed in 2016, the Bill has attracted a torrent of criticism from scientists and experts. The Bill could be improved with revision, but the problems of the total ban, as envisioned by the PSB, with respect to the NPS, may be inherent: (1) defining psychoactivity is conceptually fraught, with great consequence for the scope of the prohibition; (2) operationalizing psychoactivity as a usable concept for legal control purposes is extremely difficult, perhaps impossible; and (3) the detachment of penalties for violating a total ban from establishing the harmfulness of a substance is normatively troubling. Given the uncertainties about the effects of a total ban, it is appropriate at this time for other governments to assess more fully the nature of the NPS problem, and the potential control approaches.
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http://dx.doi.org/10.1111/add.13439DOI Listing
January 2017

Comparative policy analysis for alcohol and drugs: Current state of the field.

Int J Drug Policy 2016 05 8;31:39-50. Epub 2016 Feb 8.

School of Public Policy and Department of Criminology, University of Maryland, College Park, MD 20742, USA.

Background: A central policy research question concerns the extent to which specific policies produce certain effects - and cross-national (or between state/province) comparisons appear to be an ideal way to answer such a question. This paper explores the current state of comparative policy analysis (CPA) with respect to alcohol and drugs policies.

Methods: We created a database of journal articles published between 2010 and 2014 as the body of CPA work for analysis. We used this database of 57 articles to clarify, extract and analyse the ways in which CPA has been defined. Quantitative and qualitative analysis of the CPA methods employed, the policy areas that have been studied, and differences between alcohol CPA and drug CPA are explored.

Results: There is a lack of clear definition as to what counts as a CPA. The two criteria for a CPA (explicit study of a policy, and comparison across two or more geographic locations), exclude descriptive epidemiology and single state comparisons. With the strict definition, most CPAs were with reference to alcohol (42%), although the most common policy to be analysed was medical cannabis (23%). The vast majority of papers undertook quantitative data analysis, with a variety of advanced statistical methods. We identified five approaches to the policy specification: classification or categorical coding of policy as present or absent; the use of an index; implied policy differences; described policy difference and data-driven policy coding. Each of these has limitations, but perhaps the most common limitation was the inability for the method to account for the differences between policy-as-stated versus policy-as-implemented.

Conclusion: There is significant diversity in CPA methods for analysis of alcohol and drugs policy, and some substantial challenges with the currently employed methods. The absence of clear boundaries to a definition of what counts as a 'comparative policy analysis' may account for the methodological plurality but also appears to stand in the way of advancing the techniques.
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http://dx.doi.org/10.1016/j.drugpo.2016.02.004DOI Listing
May 2016

Beyond prevalence: importance of estimating drug consumption and expenditures.

Addiction 2015 May;110(5):743-5

Heinz College, Carnegie Mellon University in Qatar, Qatar Campus, Qatar.

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http://dx.doi.org/10.1111/add.12891DOI Listing
May 2015

Response to commentaries.

Addiction 2014 Dec;109(12):1970-1

School of Social Science Administration, University of Chicago, IL, USA.

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http://dx.doi.org/10.1111/add.12732DOI Listing
December 2014

Commentary on Unick et al. (2014): policy, price and purity.

Addiction 2014 Nov;109(11):1899-900

School of Social Service Administration, University of Chicago, Chicago, IL, USA.

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http://dx.doi.org/10.1111/add.12712DOI Listing
November 2014

Cocaine's fall and marijuana's rise: questions and insights based on new estimates of consumption and expenditures in US drug markets.

Addiction 2015 May 14;110(5):728-36. Epub 2014 Jul 14.

Heinz College, Carnegie Mellon University, Pittsburgh, PA, USA; RAND Drug Policy Research Center, RAND, Santa Monica, CA, USA.

Aims: Drug policy strategies and discussions often use prevalence of drug use as a primary performance indicator. However, three other indicators are at least as relevant: the number of heavy users, total expenditures and total amount consumed. This paper stems from our efforts to develop annual estimates of these three measures for cocaine (including crack), heroin, marijuana and methamphetamine in the United States.

Methods: The estimates exploit complementary strengths of a general population survey (National Survey on Drug Use and Health) and both survey and urinalysis test result data for arrestees (Arrestee Drug Abuse Monitoring Program), supplemented by many other data sources.

Results: Throughout the 2000s US drug users spent in the order of $100 billion annually on these drugs, although the spending distribution and use patterns changed dramatically. From 2006 to 2010, the amount of marijuana consumed in the United States probably increased by more than 30%, while the amount of cocaine consumed in the United States fell by approximately 50%. These figures are consistent with supply-side indicators, such as seizures and production estimates. For all the drugs, total consumption and expenditures are driven by the minority of users who consume on 21 or more days each month.

Conclusions: Even for established drugs, consumption can change rapidly. The halving of the cocaine market in five years and the parallel (but independent) large rise in daily/near-daily marijuana use are major events that were not anticipated by the expert community and raise important theoretical, research, and policy issues.
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http://dx.doi.org/10.1111/add.12628DOI Listing
May 2015

Does tougher enforcement make drugs more expensive?

Addiction 2014 Dec 12;109(12):1959-66. Epub 2014 Mar 12.

School of Social Service Administration, University of Chicago, Chicago, IL, USA.

Aims: To review empirical research that seeks to relate marginal increases in enforcement against the supply of illicit drugs to changes in drug prices at the level of the drug supply system being targeted.

Method: Review of empirical studies.

Findings: Although the fact of prohibition itself raises prices far above those likely to pertain in legal markets, there is little evidence that raising the risk of arrest, incarceration or seizure at different levels of the distribution system will raise prices at the targeted level, let alone retail prices. The number of studies available is small; they use a great variety of outcome and input measures and they all face substantial conceptual and empirical problems.

Conclusion: Given the high human and economic costs of stringent enforcement measures, particularly incarceration, the lack of evidence that tougher enforcement raises prices call into question the value, at the margin, of stringent supply-side enforcement policies in high-enforcement nations.
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http://dx.doi.org/10.1111/add.12497DOI Listing
December 2014

The difficulty of restricting promotion of legalized marijuana in the United States.

Authors:
Peter Reuter

Addiction 2014 Mar;109(3):353-4

School of Public Policy and Department of Criminology, University of Maryland, College Park, MD, 20742-1821, USA.

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http://dx.doi.org/10.1111/add.12431DOI Listing
March 2014

Healthcare in Equatorial Guinea, West Africa: obstacles and barriers to care.

Pan Afr Med J 2014 10;19:369. Epub 2014 Dec 10.

Florida Gulf Coast University, College of Health Professions & Social Work, Fort Myers, FL, 33965, USA.

Introduction: The provision of healthcare services in developing countries has received increasing attention, but inequalities persist. One nation with potential inequalities in healthcare services is Equatorial Guinea (Central-West Africa). Mitigating these inequalities is difficult, as the Equatoguinean healthcare system remains relatively understudied.

Methods: In this study, we interviewed members of the healthcare community in order to: 1) learn which diseases are most common and the most common cause of death from the perspective of healthcare workers; and 2) gain an understanding of the healthcare community in Equatorial Guinea by describing how: a) healthcare workers gain their professional knowledge; b) summarizing ongoing healthcare programs aimed at the general public; c) discussing conflicts within the healthcare community and between the public and healthcare providers; d) and addressing opportunities to improve healthcare delivery.

Results: We found that some causes of death, such as serious injuries, may not be currently treatable in country, potentially due to a lack of resources and trauma care facilities. In addition, training and informational programs for both healthcare workers and the general public may not be effectively transmitting information to the intended recipients. This presents hurdles to the healthcare community, both in terms of having professional competence in healthcare delivery and in having a community that is receptive to medical care.

Conclusion: Our data also highlight government-facility communication as an opportunity for improvement. Our research is an important first step in understanding the context of healthcare delivery in Equatorial Guinea, a country that is relatively data poor.
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http://dx.doi.org/10.11604/pamj.2014.19.369.5552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407943PMC
February 2016

Neuropilin-1 modulates vascular endothelial growth factor-induced poly(ADP-ribose)-polymerase leading to reduced cerebrovascular apoptosis.

Neurobiol Dis 2013 Nov 28;59:111-25. Epub 2013 Jun 28.

Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University, D-35043 Marburg, Germany.

Cerebral ischemia is encompassed by cerebrovascular apoptosis, yet the mechanisms behind apoptosis regulation are not fully understood. We previously demonstrated inhibition of endothelial apoptosis by vascular endothelial growth factor (VEGF) through upregulation of poly(ADP-ribose)-polymerase (PARP) expression. However, PARP overactivation through oxidative stress can lead to necrosis. This study tested the hypothesis that neuropilin-1 (NP-1), an alternative VEGF receptor, regulates the response to cerebral ischemia by modulating PARP expression and, in turn, apoptosis inhibition by VEGF. In endothelial cell culture, NP-1 colocalized with VEGF receptor-2 (VEGFR-2) and acted as its coreceptor. This significantly enhanced VEGF-induced PARP mRNA and protein expression demonstrated by receptor-specific inhibitors and VEGF-A isoforms. NP-1 augmented the inhibitory effect of VEGF/VEGFR-2 interaction on apoptosis induced by adhesion inhibition through the αV-integrin inhibitor cRGDfV. NP-1/VEGFR-2 signal transduction involved JNK and Akt. In rat models of permanent and temporary middle cerebral artery occlusion, the ischemic cerebral hemispheres displayed endothelial and neuronal apoptosis next to increased endothelial NP-1 and VEGFR-2 expression compared to non-ischemic cerebral hemispheres, sham-operated or untreated controls. Increased vascular superoxide dismutase-1 and catalase expression as well as decreased glycogen reserves indicated oxidative stress in the ischemic brain. Of note, protein levels of intact PARP remained stable despite pro-apoptotic conditions through increased PARP mRNA production during cerebral ischemia. In conclusion, NP-1 is upregulated in conditions of imminent cerebrovascular apoptosis to reinforce apoptosis inhibition and modulate VEGF-dependent PARP expression and activation. We propose that NP-1 is a key modulator of VEGF maintaining cerebrovascular integrity during ischemia. Modulating the function of NP-1 to target PARP could help to prevent cellular damage in cerebrovascular disease.
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http://dx.doi.org/10.1016/j.nbd.2013.06.009DOI Listing
November 2013

Ultrasound destruction of air microemboli as a novel approach to brain protection in cardiac surgery.

J Cardiothorac Vasc Anesth 2013 Oct 18;27(5):876-83. Epub 2013 Jun 18.

Department of Neurology, Justus-Liebig-University, Giessen, Germany; Heart and Brain Research Group, Justus-Liebig-University, Giessen and Kerckhoff Clinic, Bad Nauheim, Germany. Electronic address:

Objective: Evaluation of a novel approach to eliminate air microemboli from extracorporeal circulation via ultrasonic destruction.

Design: In vitro proof-of-concept study.

Setting: Research laboratory.

Participants: None.

Interventions: None.

Measurements And Main Results: An extracorporeal circulation device was filled with human blood circulating at 3 L/min. Air bubbles were injected into the system. For bubble destruction, the blood in the tubing system was repeatedly insonated for 3 minutes using a therapeutic 60-kHz device, with variation of intensity and duty cycle settings, ranging from 0.2 W/cm² to 1.0 W/cm² and from duty cycle 60% to continuous wave (CW). Number and diameter of air microemboli were counted upstream and downstream of the ultrasound device by a 2-channel microemboli Doppler detector. For safety assessment, circulating blood was insonated continuously for 2 hours at 0.8 W/cm² CW and compared with circulation without insonation; and standard blood parameters were analyzed. Without treatment, 1,313 to 1,580 emboli were detected upstream, diameter ranging between 10 and 130 μm. Ultrasound treatment eliminated up to 87% of all detected bubbles in cw application (p<0.01) and showed comparable effects at intensities from 0.4 W/cm² to 1.0 W/cm² cw. Bubbles sized>15 μm almost were eliminated completely (p<0.001). Pulsed wave application rendered inferior results (p>0.05). No relevant changes of blood parameters were observed compared with control circulation.

Conclusions: Ultrasound destruction of air emboli is a very efficient method to reduce number and size of emboli. Within the limits of safety assessment, the authors could not detect relevant side effects on standard blood parameters.
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http://dx.doi.org/10.1053/j.jvca.2013.01.020DOI Listing
October 2013

Can tobacco control endgame analysis learn anything from the US experience with illegal drugs?

Authors:
Peter Reuter

Tob Control 2013 May;22 Suppl 1:i49-51

School of Public Policy and Department of Criminology, University of Maryland, 4103 Van Munching Hall, College Park, MD 20742, USA.

The goals of tobacco control endgame strategies are specified in terms of the desired levels of tobacco use and/or tobacco related health consequences. Yet the strategies being considered may have other consequences beyond tobacco use prevalence, forms and related harms. Most of the proposed strategies threaten to create large black markets with potential attendant harms: corruption, high illegal earnings, violence and/or organised crime. Western societies of course have considerable experience with these problems in the context of prohibition of drugs such as cannabis, cocaine, heroin and methamphetamine. These experiences suggest that low prevalence has been achieved only by tough enforcement with damaging unintended consequences. Tobacco prohibition (total or partial) may not present the same trade-off but there is little basis for making a projection of the scale, form and harms of the attendant black markets. Nonetheless, these harms should not be ignored in analyses of the endgame proposals.
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http://dx.doi.org/10.1136/tobaccocontrol-2012-050809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632990PMC
May 2013