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Clinical Effects of 2C-B Abuse
Published in Ornella Corazza, Andres Roman-Urrestarazu, Handbook of Novel Psychoactive Substances, 2018
Esther Papaseit, Clara Pérez-Mañá, Débora González, Francina Fonseca, Marta Torrens, Magí Farré
In relation to drug checking content, 2C-B has been intermittently detected on the illegal drug market in several countries over the last two decades (Soares et al., 2004). In Spain, between 2006 and 2009, the percentage of drug samples containing 2C-B doubled from 2.6% to 5.1%. In addition, the samples evolved from powder to tablet form and showed low falsification rates with other synthetic phenethylamines and piperazines (Caudevilla-Gálligo et al., 2012). In the Netherlands in 2013, 2C-B was the fourth most commonly detected drug in NPS drug sample checking by the Drug Information and Monitoring System (DIMS) (1.2%, n = 67) (Hondebrink, Nugteren-van Lonkhuyzen, Van Der Gouwe, & Brunt, 2015).
Patient safety
Published in Prem Puri, Newborn Surgery, 2017
This systems approach has been the philosophy underlying the vast majority of patient safety work. Highly influential in this approach is Reason’s12 “Swiss cheese model.” In this model, the multiple layers of defense that an organization has are represented by slices of Swiss cheese. For example, when prescribing a drug in the neonatal unit, the layers of defense that are intended to ensure the baby receives the correct dose of the correct medication are as follows: the initial writing of the prescription by the doctor; the pharmacist in the unit checking the prescription; the nurse responsible for administering the drug checking the prescription and drawing up the medication; and the nurse and his or her colleague administering the drug to the patient. However, these layers of defense are not perfect. Like Swiss cheese, they contain holes, or latent errors that can allow active errors to pass through the system and reach the patient, causing harm. In the example of the drug prescription, the doctor might be distracted by an emergency in the labor ward while writing the prescription (a latent error) and write up 10 times the intended dose of the drug (the active error). That day, the ward pharmacist is off sick, and no cover is available, so the prescription is not checked before it is time to administer the drug (another latent error). The nurse drawing up the medication usually has a calculator to assist in checking drug doses, but the battery has run out, so it cannot be used (the third latent error). As he knows and trusts the doctor who wrote the prescription, he or she draws up the drug as prescribed without repeating the calculations used to derive the dose (an active error). The second nurse that she gets to check the drug is her junior colleague and does not like to challenge her work (the final latent error) and so countersigns the prescription without checking the quantities herself (an active error), and a fatal overdose is delivered to the neonate. Any one of the layers of defense could have recognized the error and prevented it from reaching the patient. It was only when several latent and active errors coincided that the holes in the cheese lined up, allowing the patient to be harmed (Figure 24.1).
Harm reduction and substance use treatments in Germany: a conversation with Benjamin Löhner
Published in Journal of Social Work Practice in the Addictions, 2022
There really are a broad variety of different services, including outpatient counseling and harm reduction services like drug consumption sites. Drug consumption rooms or drug consumption sites are not available all over Germany, only in a few federal states. Drug consumption sites are not available everywhere because the federal government has not yet created a legal framework for those services. Some other services, mainly in the field of harm reduction such as drug checking, are not universally available in Germany. Rose:What is drug checking?Löhner:Developed in Switzerland in the 1990s, the rationale is that the prohibition on illegal drugs creates a black market, and the black market leads to users not knowing what ingredients are in the drugs, which creates new risks for the users. Not knowing is risky, so drug checking services allow drug users to give a tiny part of their drug, for example, of their ecstasy pill, and it gets analyzed in a chemical laboratory, and then users get back the results and know what’s in the pill. Drug checking is usually carried out in clubs or at music festivals, but there are also drug-checking services where all user groups can go and analyze their substances.
The utility of visual appearance in predicting the composition of street opioids
Published in Substance Abuse, 2021
Karen McCrae, Evan Wood, Mark Lysyshyn, Samuel Tobias, Dean Wilson, Jaime Arredondo, Lianping Ti
Drug checking, one such promising harm reduction intervention, aims to insert a degree of accountability into the unregulated drug market by providing personalized information regarding the composition of drug samples to PWUD. While originally implemented in recreational drug use settings in the electronic dance scene,3 recently established drug checking programs in North America have begun to target people who use unregulated opioids in an effort to help them identify risks in the drug supply and enable them to make better informed decisions about their drug use. In this context, drug checking seeks to address the ongoing opioid overdose epidemic through better understanding of the toxic drug supply.4 Furthermore, such services have the potential to rapidly generate data on the nature of the street drug supply that can then be used by PWUD, local community partners, and public health officials – information potentially of critical importance in the midst of the ongoing crisis. Early evidence suggests that this harm reduction measure may be useful; several studies suggest a high willingness to use drug checking services among people who use opioids,5–7 and preliminary evidence suggests that this population of PWUD may adopt overdose risk reduction measures as a result of drug checking including reducing dosage, disposing of unexpected substances, and not using alone as frequently.8,9
Effect of witnessing an overdose on the use of drug checking services among people who use illicit drugs in Vancouver, Canada
Published in The American Journal of Drug and Alcohol Abuse, 2020
Tara Beaulieu, Kanna Hayashi, Ekaterina Nosova, M-J Milloy, Kora DeBeck, Evan Wood, Thomas Kerr, Lianping Ti
That only a small proportion of PWUD in the study reported using drug checking services was surprising given that drug checking services are available at various supervised injection and overdose prevention sites in the region (20–23), and given that studies that have shown a high willingness to use drug checking services among PWUD populations (16,17,30). There appears to be a discordance between availability and willingness to use drug checking services and uptake of drug checking services. This discordance may be partially attributable to a sense of invincibility, or an ambivalent view of death (31,32). In Vancouver, a qualitative study involving 18 people who inject drugs (PWID) found that perceived invincibility was a common narrative which diminished the potential impact of an overdose warning campaign (32). In Australia, a qualitative study involving 60 PWID found that 28 (47%) were apathetic toward death. It could be that PWUD have a high level of trust in their dealer (33), or they are aware of the limitations of current drug checking interventions (e.g., inability to detect some analogues present at low concentrations, or inability to provide quantitative information) (1,34). Some may not utilize drug checking services because they may not have an alternative source for acquiring opioids (19,32). Other reasons for the discordance between availability and uptake may include time, or competing risk priorities (e.g., mitigating risk associated with income-generation activities, securing accommodations, avoiding arrest) (35,36).