Over the past 40 years the rate of illicit drug use worldwide has risen dramatically, and with it the number of deaths reported among drug-using populations. What are the clinical, ethical and psychopathological implications of these deaths? In this book, Shane Darke and his team provide the first full, synthetic review of the epidemiology, causes, prevalence, demography, and associated risk factors of illicit-drug-related mortality. In addition, they examine and evaluate interventions to reduce these deaths. The major causes of death among illicit drug users are overdose, disease, suicide and trauma. Each is independently examined. This is an important book for all clinicians and policy-makers involved in issues relating to illicit drug use.

Over the past 40 years the rate of illicit drug use worldwide has risen dramatically, and with it the number of deaths reported among drug-using populations. What are the clinical, ethical and psychopathological implications of these deaths? In this book, Shane Darke and his team provide the first full, synthetic review of the epidemiology, causes, prevalence, demography, and associated risk factors of illicit-drug-related mortality. In addition, they examine and evaluate interventions to reduce these deaths. The major causes of death among illicit drug users are overdose, disease, suicide and trauma. Each is independently examined. This is an important book for all clinicians and policy makers involved in issues relating to illicit drug use.

"Background: Much of the research on the emergence and recent trends in the opioid epidemic in the United States examines differences by either race or place. Yet, the few studies which assess the intersection of these dimensions reveal unexpected findings, which challenge initial assumptions about the uniformity of the epidemic’s impact. As such, this thesis aims to better describe differences in trends of drug overdose mortality and drug-use outcomes for non-Hispanic Blacks and Whites across three metropolitan categories: large metro, small metro, and nonmetro.Objectives: This thesis aims to 1) present trends in all-drug and opioid-related mortality rates between 2003-2018; 2) highlight differences in changes in drug-related mortality before and after the peak of the epidemic in 2015; 3) delineate time trends in illicit drug use and prescription pain reliever misuse between 2003-2018; and 4) describe recent patterns in access to and source of drugs, for Blacks and Whites based on their metropolitan status.Methods: Drug mortality data was obtained from the Centers for Disease Control and Prevention (CDC) WONDER database for national and population level data. Drug use data was obtained from the National Survey for Drug Use and Health (NSDUH), a nationally representative annual survey. Results: For Blacks, drug-related mortality rates between 2003 to 2018 were consistently higher in large and small metro areas than in non-metro areas; such disparities by metro status did not emerge among Whites until 2011. In 2018, opioid-related deaths continued to rise for Blacks in large and small metro areas, but declined for Blacks in nonmetro areas, and for Whites in all metro categories. In contrast to drug-related mortality trends, self-reported drug use trends did not vary greatly between 2003-2018. Despite similar mortality rates prior to 2011, metro-based differences in illicit drug use and prescription pain reliever misuse among Whites were apparent over the entire time period. Among Blacks, illicit drug use was always higher in large and small metro areas; however, there were no metro-based differences in trends in prescription pain reliever misuse. Although reported drug use rates are generally lower, Blacks in all metro categories were more likely than Whites to report being approached by someone selling drugs, and this likelihood was highest among Blacks in large and small metro areas.Conclusions: The findings demonstrate that many of the common narratives in drug use and mortality trends cannot be applied across racial and metropolitan groups. In contrast to common narratives, in recent years the opioid drug overdose epidemic is worsening for Blacks in both large and small metro areas, while it is declining for Whites. Thus, recent intervention efforts may be overlooking a particularly vulnerable subpopulation. Moreover, efforts to address drug use and its outcomes among Blacks should not be limited to large-urban areas, as patterns of drug use and mortality between small and large urban areas are consistently similar. Among rural Blacks, drug-related mortality and illicit drug use were consistently lowest, in spite of heightened risks for drug use for this population. The persistence of this trend is significant and not explained by just barriers in access to prescription opioids. Empirical research is needed to better understand why rates are escalating among more urban Blacks, while remaining low for rural Blacks and declining for Whites in all metro categories. Overall, studying drug-related mortality and drug-use outcomes by race and metropolitan category reveals important differences which may otherwise be masked, and may inform more targeted and effective intervention and policy"--

Mental, neurological, and substance use disorders are common, highly disabling, and associated with significant premature mortality. The impact of these disorders on the social and economic well-being of individuals, families, and societies is large, growing, and underestimated. Despite this burden, these disorders have been systematically neglected, particularly in low- and middle-income countries, with pitifully small contributions to scaling up cost-effective prevention and treatment strategies. Systematically compiling the substantial existing knowledge to address this inequity is the central goal of this volume. This evidence-base can help policy makers in resource-constrained settings as they prioritize programs and interventions to address these disorders.

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Significant changes have taken place in the policy landscape surrounding cannabis legalization, production, and use. During the past 20 years, 25 states and the District of Columbia have legalized cannabis and/or cannabidiol (a component of cannabis) for medical conditions or retail sales at the state level and 4 states have legalized both the medical and recreational use of cannabis. These landmark changes in policy have impacted cannabis use patterns and perceived levels of risk. However, despite this changing landscape, evidence regarding the short- and long-term health effects of cannabis use remains elusive. While a myriad of studies have examined cannabis use in all its various forms, often these research conclusions are not appropriately synthesized, translated for, or communicated to policy makers, health care providers, state health officials, or other stakeholders who have been charged with influencing and enacting policies, procedures, and laws related to cannabis use. Unlike other controlled substances such as alcohol or tobacco, no accepted standards for safe use or appropriate dose are available to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively. Shifting public sentiment, conflicting and impeded scientific research, and legislative battles have fueled the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its derivatives, and this lack of aggregated knowledge has broad public health implications. The Health Effects of Cannabis and Cannabinoids provides a comprehensive review of scientific evidence related to the health effects and potential therapeutic benefits of cannabis. This report provides a research agendaâ€"outlining gaps in current knowledge and opportunities for providing additional insight into these issuesâ€"that summarizes and prioritizes pressing research needs.

The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already existâ€"like evidence-based medicationsâ€"are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.

The rate of acute drug-related mortality, or overdose deaths, among prisoners in the immediate post-release period is unacceptably high. Such incidents result from many factors, including decreased tolerance after a period of relative abstinence during imprisonment and the concurrent use of multiple drugs which, with every additional illicit drug consumed in combination with opioids, nearly doubles the risk of death from opioids. Other important factors are the lack of pre-release counselling, post-release follow-up and failure to identify those at risk. Substance dependence is a chronic disorder with high relapse rates and often requires long-term continuous treatment. There is good evidence from trials and cohort studies that opioid substitution treatment reduces the risk of overdose among opioid users. This report identifies the main areas that need to be improved in order to decrease the risk of death. Linking prison health and public health systems closely is essential to mitigating this risk. Recommendations for preventive responses are considered across all levels of the justice system. The report includes a literature review that identifies a substantial body of research from various countries; this research supports the finding that the initial post-release period presents ex-prisoners with a significantly heightened risk of acute drug-related mortality.