dissertation on drug abuse

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A Review Study of Substance Abuse Status in High School Students, Isfahan, Iran

Mah monir nahvizadeh.

Provincial Health Center, Isfahan University of Medical Sciences, Isfahan, Iran

Shohreh Akhavan

1 Vice-chancellery for Research, Isfahan University of Medical Sciences, Isfahan, Iran

Leila Qaraat

Nahid geramian, ziba farajzadegan.

2 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

Kamal Heidari

3 Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Background:

As the first experience of substance abuse often starts in adolescence, and studies have shown that drug use is mainly related to cigarette and alcohol consumption, an initial exploration of substance abuse prevalence, including cigarette and alcohol, seems to be the first step in preventing and controlling drug consumption. This study aimed to explore studies on drug use among high school students by investigating articles published in the past decade in Iran.

In this study, the databases inside the country were used to access articles related to substance abuse by students during 2001–2011, among which 7 articles on 14–19 years old high school students were studied.

The seven studied articles showed that the highest drug use prevalence pertained to cigarette and hookah, followed by alcohol, opium, ecstasy, hashish and heroin. Opium and heroin use in Kerman city were, respectively, about 4 and 5 times of their use in other studied cities.

Conclusions:

Drug use is relatively high in the adolescent and effective group of the society, which requires particular attention and prompt and immediate intervention.

INTRODUCTION

Substance abuse is a common phenomenon in the world and has invaded the human society as the most important social damage.[ 1 , 2 ] Substance abuse is a nonadaptive model of drug use, which results in adverse problems and consequences, and includes a set of cognitive, behavioral, and psychological symptoms.[ 3 ]

Iran also, due to its specific human and geographic features, has a relatively high degree of contamination.[ 4 ] The World Health Organization's report in 2005 shows that there are about 200 million opiate addicts in the world, reporting the highest prevalence in Iran and the most frequency in the 25–35 year-age group.[ 5 ] The onset of drug use is often rooted in adolescence, and studies show that substance abuse is often related to cigarette and alcohol consumption in adolescence.[ 6 ] Results of studies indicate that age, being male, high-risk behavirs, and the existence of a cigarette smoker in the family or among friends, the experience of substance abuse, inclination and positive thoughts about smoking have relationship with adolescent cigarette smoking.[ 7 ] Studies also confirm that the chance of becoming a cigarette smoker among males and females is almost equal (11.2%); however, the prevalence of regular alcohol consumption in males (22.4%) is slightly higher than in females (19.3%).[ 8 ]

Few studies have been conducted in Iran on adolescents’ patterns of substance abuse, producing various data on the prevalence and the type of consumed drugs, but there is currently no known specific pattern of substance abuse in this age group; therefore, this review study has studied drug consumption prevalence in the student population of the country by collecting various data.

This article is a narrative review focusing on studies conducted in Iran. In this research, all articles related to substance abuse and its patterns among high school students, which were conducted in Iran and published in domestic and international journals, were investigated. The articles were acquired from academic medical journals, research periodicals and the Scholar Google, Magiran, Irandoc, and Medlib. The search keywords included prevalence, substance abuse, Iranian student, and addiction.

This study explored articles in the past 10 years (2001–2011) about Iranian high school students. The full texts of the articles were often accessible in the scientific information database and magiran websites, but the full text of the article about Gilan Province was obtained after contacting the journal's office. Correspondence was made with the author of the article about Mahriz city to obtain the article as it was not published in the Toloee Behdasht journal.

These articles provide information about the consumed drug type, its prevalence in terms of the sex and age, and the experience of at-least-once consumption in the adolescent's life. Some articles had only pointed to drug consumption, which was also included in this research. Some had attended to substance abuse in general terms without distinguishing different kinds of drugs, and in some articles only psychoactive drug use, was mentioned.

The cases, in which the sample volume was not sufficient, or were not in the studied age groups, were excluded from the study. Due to different categorizations in these articles regarding the long-term prevalence of substance abuse or the experience of at-least-once consumption, in this study the shared aspect of these articles, that is, the experience of at-least-once use was adopted. Some articles had addressed the students’ predisposing factors for drug abuse, in addition to drug use prevalence, which were not included in this study for being scattered.

An initial search into the data bases yielded 11 articles, two of which were related to years before the study time frame (1997 and 1998). Furthermore, two articles were ignored, one because of its different age group (a lower age) and the other because it had addressed a particular district in Tehran with a small sample size. These results are based on 7 articles. All studies were about the 14–19 years old group, and only three studies had distinguished between the sexes. All 7 studies considered in this article were cross-sectional.

The prevalence of drug consumption in the studied cities

A study was conducted in 2003 on 500 students, from 142 high schools and vocational schools in Zahedan City, using a multi-stage cluster sampling method. In total, from the total of 259 females and 216 males who completed the questionnaire, the following results were obtained. 0.4% of the females and 2.3% of the males would usually smoke cigarette. The first experience of smoking was most often seen at the age of 14 (26.2%). The prevalence of other drugs was not studied in this research.[ 9 ] A study was conducted in 2009 on 610 students of Kerman's Male Pre-university Centers, in which the prevalence of each drug was reported, but the total consumption prevalence was not mentioned.[ 10 ]

A study in Gilan Province in 2004–2009 on 1927 high school students, including 46% females and 54% males, showed that the percentage of at-least-once use, including and excluding cigarette, was 23.7 and 12.8, respectively.[ 11 ]

A study in Karaj city in 2009–2010 on 447 high school students, including 239 females and 208 males, showed that 57% had at-least-once experience of drug use, including cigarette, of this number 56.1% were male and 43.9% were female.[ 12 ]

A study in Nazarabad city in 2007 on 400 3 rd year high school students, including 204 females and 196 males with the mean age of 17.3, showed that drug use prevalence, including and excluding cigarette, was 24.5% and 11.1%, respectively.[ 13 ] A study was performed in Lahijan city in 2004 on 2328 high school students, including 42.2% females and 57.8% males.[ 14 ] A descriptive study was conducted in 2008 on a 285-member sample of male high school students.[ 15 ]

The consumption prevalence for each drug type in different cities

A research on Kerman's Male Pre-university students yielded the following results. The consumption prevalence of hookah was 15.5%, sedatives (without medical prescription) 40.7%, alcohol 37.7%, cigarette 34.6%, strong analgesics 10.2%, nas 9.7%, opium 8.7%, hashish 6.7%, ecstasy 6.6%, and heroin 4.9%.

Consumption prevalence for each drug type in Gilan: The prevalence was 20% for cigarette, 10.5% for alcohol, 2.4% for opium, 1.2% for ecstasy, 2% for hashish, and 0.3% for heroin. In Karaj city, the consumption prevalence was 53% for hookah, 24.8% for cigarette, 13.6% for alcohol, 2% for ecstasy, 2% for opium, 1.1% for hashish, 0.4% for crystal, and 0.2% for heroin.

In Nazarabad City, the consumption prevalence was found to be 23.1% for cigarette, 2% for opium, 1% for amphetamines and ecstasy, 0.5% for heroin, 0.3% for hashish and cocaine. The male and female drug consumption was 69.7% and 36.2%, respectively, representing a significant statistical difference ( P < 0.05).

A study in Lahijan City showed that the consumption prevalence was 14.9% for cigarette, 2.4% for ecstasy, 4.1% for other drug types (with the highest rate of consumption for opium and hashish). In the Mahriz city of Yazd, the consumption prevalence among the male 3 rd year high school students in 2008 was reported 6.8% for alcohol and 3% for psychoactive substances [ Table 1 ].

The comparison of the prevalence of at-least-once drug use for each drug type in each studied region[ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]

Drug consumption prevalence for each sex

A study in Zahedan also reported that at-least-once drug use prevalence was 1.6% and 8%, respectively, among females and males; and at-least-once cigarette smoking prevalence was 7.8% and 25.2%, respectively, for females with the mean age of 15.8 and males with the mean age of 16.

In Gilan, drug use, excluding cigarette, was reported 19.1% and 5.3%, respectively, for males and females, representing a significant statistical difference ( P < 0.05). Furthermore, cigarette and drug use prevalence was 31.3% and 14.8% in males and females, respectively, showing that this rate was significantly higher in males ( P < 0.05). Cigarette use prevalence was 25.9% and 3%, respectively, for male and female students. Alcohol consumption was 16.6% and 3.4% for males and females, respectively. Opium consumption was 3.3% and 1.5% among males and females, respectively, which was a significant statistical difference (…). Drug consumption, excluding cigarette, was 19.1% and 5.3%, respectively, for males and females, pointing to a statistically significant difference ( P < 0.05). Ecstasy use prevalence was reported 3% and 1.1%, respectively, for males and females, pointing to a statistically significant difference ( P < 0.00081); 0.5% of males and 0.1% of females were heroin consumers, lacking any significant statistical difference ( P > 0.05). In Karaj city, drug consumption prevalence was studied for each sex and drug type [ Table 2 ].

The comparison of the prevalence of at-least-once drug consumption for each sex in each studied region

Drug consumption prevalence based on the age distribution in the studied populations

As the study conducted on students with the mean age of 16 in Zahedan showed that the highest incidence of the first experience of cigarette smoking belonged to the age of 14. A study in Kerman on students with the mean age of 17.9 about the age at the first experience yielded the following results for each drug type: 14 for cigarette, 14.6 for alcohol, 13.9 for hookah, 13.1 for sedatives, 15.3 for analgesics, 17 for ecstasy, 16.7 for hashish, 16.7 for heroin, 16.7 for opium, and 15.3 for naswar.

A study in Gilan indicated that drug and cigarette consumption had significantly increased in males aged 19 and above (88.9% of males aged 19 and above) ( P < 0.05). According to a study in Nazarabad, the highest drug use onset was at the age of 15–16. The students’ mean age in the Karaj study was 16.9.

Exploring the MFT performed in the USA on the 10 th graders showed that drug use had increased from 11% to 34% during 1992–1996. In 1998, 12.10% of the 8 th year and 12.5% of the 10 th graders and 25.611 th % had experienced illegal drug use in the previous month.[ 16 ] It was shown that hashish, followed by opium and alcohol, is the most commonly used illicit drug.[ 17 ] The immediate necessity of planning for reducing the consumption of these drugs among students, and consequently among university students, has become increasingly important.

Investigating addictive drugs prevalence among university students showed the prevalence in the following order: Hookah (74.5%), cigarette (67.5%), opium (6.1%), alcohol (13.5%), psychoactive pills (5.26%), hashish and heroin. Entertainment constitutes the tendency for drug consumption in most cases (47.4%).[ 18 ] Results of a meta-analysis showed that 7% of Iranian adolescents regularly smoke, and 27% had experienced smoking. The increased cigarette use prevalence among Iranian adolescents is a major public health concern.[ 19 ] Paying attention to healthy recreations for adolescents and the youth has become increasingly important and needs planning for discouraging drug use. The cross-sectional prevalence of drug use in 1997 among American 12–17 years old adolescents was reported 11.4%, which was close to drug use prevalence, excluding cigarette.[ 16 ]

Another study showed that 56% of male and 42% of female university students were drug users, which accords with the present research with regard to the higher number of the males.[ 20 ] Since, the addiction problem is an old problem in other countries, it might be better to use the solutions practiced by them to speed up our reaction in cases which adhere to our culture and customs.

At-least-once alcohol use prevalence among the 8 th year American students in 2005 and 2006 was 27% and 20%, respectively, increasing to 88% among the 12 th year students.[ 20 ] The history of hashish consumption among the 8 th , the 10 th , and the 12 th year students was 10%, 23%, and 36%, respectively, representing a remarkable difference with our country's students.[ 20 ] About 0.5% of the 8 th year and 10% of the 12 th year students consumed cocaine, and the consumption of amphetamines by the 12 th year students was 1.5%,[ 20 ] being almost close to the consumption rate of Iranian students. The open consumption of hashish is common in France by almost one-third of the population (nearly 30%), compared with the average rate of 19% in European countries; also the consumption of ecstasy and cocaine has increased over 2000–2005, although it is 4% but yet remarkable.[ 21 ]

A study on students’ knowledge of narcotics in Rafsanjan and Yazd cities showed that 5.6% of Yazdian and 10% of Rafsanjanian students had at least one addicted person in their families. Also, 2.23% of the Yazdian and 7% of the Rafsanjanian students held that narcotics could also be useful.[ 22 ] The important issue here is the existence of an addicted relative and his or her leadership role in this regard; therefore, this point suggests the further importance of the sensitivity of this age group with regard to their dependence on narcotics.

It is noteworthy that Kerman City, compared to other studied cities, has received higher rates of drug use, such that opium and heroin consumption in this city has been, respectively, almost 4 and 5 times that of other cities. These statistics also hold true clearly with regard to ecstasy and alcohol consumption, each being almost 3 times that of Karaj and Gilan. Hashish consumption in the pre-university stage in this city is also higher than in other cities, which might be related to easier drug access in Kerman.

In the cities, in which sex-distinct studies were conducted, drug consumption by males had been, with no exception, far higher than by the females, which is, almost 4 times except for hookah and then cigarette. Of course, it is not possible to judge firmly about drug use general prevalence as a result of the few studies in this field; however, the important point is the relatively high drug use among the adolescent and effective group of the society, which deserves particular attention for education and intervention in this group. It has been observed that adolescent and young crystal users, compared to nonusers, show clinical symptoms, have less control and affection in their families, with excitable, aggressive and anxious personalities, and low accountability;[ 23 ] on the other hand, behavioral problems and friend influence are among the strongest risk factors of drug consumption among adolescent consumers.

Nevertheless, it is not clear to what extent the adolescent can manage the effect of behavioral problems and peer group interaction for refusing invitations for drug consumption.[ 24 ] It has been stated that using software programs would assist in the prevention and increasing the youth's skills for reducing drug use.[ 25 ] It has been shown that adolescent inclination to and consumption of drugs decrease significantly in the 1 st year of educational intervention.[ 26 ] On the other hand, studies indicate that there is a relationship between the borderline personality disorder and the extent of drug abuse.[ 27 ]

Therefore, prevention programs for harm reduction, treatment and consultation as the main objective of the intervention structure should apply to consumers.[ 28 ] Also, emphasis should be laid upon the relationship between schools and parental care as important protective factors for adolescents’ health.[ 29 ] Adolescence is a growth period which is associated with a relatively high rate of drug use and its related disorders. Accordingly, recent progress in evaluating drug abuse among adolescents would continue for information sharing in the field of clinical and research services.[ 30 ] Therefore, attention to this group through coherent planning for damage prevention would still remain in priority.

CONCLUSIONS

Source of Support: Nil

Conflict of Interest: None declared.

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Press Releases Federal Study Examines Care Following Nonfatal Overdose Among Medicare Beneficiaries; Identifies Effective Interventions and Gaps in Care

Researchers from the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institutes of Health’s (NIH) National Institute on Drug Abuse (NIDA), Centers for Medicare & Medicaid Services (CMS), and the Centers for Disease Control and Prevention (CDC) found that among a cohort of 137,000 Medicare beneficiaries who experienced a nonfatal overdose in 2020, almost 24,000 (17.4%) experienced a subsequent nonfatal overdose, and about 1,300 (1%) died from overdose in the following year.  Results were published today in  JAMA Internal Medicine , identifying both effective interventions and significant gaps in care. 

“People who have experienced one overdose are more likely to experience another,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “But we found that when survivors received gold-standard care such as medications for opioid use disorder and naloxone, the chances of dying from an overdose in the following year drop dramatically. In short, medications for opioid use disorder, opioid overdose reversal medications, and behavioral health supports save lives.”  

The study identifies effective, lifesaving interventions following initial nonfatal overdoses. The odds of dying from a subsequent lethal overdose decreased among cohort members who received methadone (58% lower odds), buprenorphine (52% lower odds), or behavioral health assessment or crisis services (75% lower odds). The risk of overdose mortality among those who filled a prescription for naloxone was also reduced by 30%.

However, significant gaps in care were also noted. Only 4.1% of the cohort received medications for opioid use disorder (MOUD), and only 6.2% filled a prescription for naloxone, commonly known as Narcan, despite these being gold-standard interventions. Beneficiaries receiving MOUD waited a mean of 72 days between their nonfatal overdose and receiving medication.

Overall, 89% of beneficiaries in the cohort received behavioral health services in the 12 months following their nonfatal overdose for a median duration of 15 days throughout the year.

“These findings underscore the importance of high-quality care following an overdose, and the opportunities that remain to connect people with needed care. Only 4% of beneficiaries received these medications after experiencing a nonfatal overdose and—for those who did receive the medications—there was a significant delay ranging from 6 to 105 days,” said Dr. Dora Hughes, Acting Chief Medical Officer and Acting Director of the Center for Clinical Standards and Quality for CMS. “Increasing the number of beneficiaries accessing these medications in a timely manner will save lives.”

These findings contribute to the growing body of research showing that while MOUD and overdose reversal medications save lives, they are rarely incorporated into care following an overdose.

“At a time when over 100,000 people continue to die each year from overdose, we must prioritize making effective treatments and tools accessible – especially to those who are at the highest risk,” said Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse. “Connecting with someone in an emergency department or after they have experienced a nonfatal overdose provides a valuable opportunity to both support them acutely in that moment, as well as offer lifesaving tools that can protect them from future overdoses, link them into treatment, and foster recovery.” 

President Biden’s Unity Agenda for the Nation prioritizes delivering lifesaving medication and care across America in order to beat the opioid epidemic.

• The  US Department of Health and Human Services Overdose Prevention Strategy supports evidence-based treatments, including access to methadone and buprenorphine, and harm reduction strategies such as saturation of opioid overdose reversal medications.
• The Consolidated Appropriations Act of 2023 removed federal requirements for providers to have specialized waivers to prescribe buprenorphine for opioid use disorder. Now, any provider with Schedule III prescribing authority may prescribe buprenorphine products.
• The Food and Drug Administration (FDA) has approved multiple naloxone medications as over-the-counter, removing the need for a prescription.
• In 2024, SAMHSA made the first rule updates to 42 CFR Part 8 – the federal regulation that governs opioid treatment programs (OTP) – in more than two decades. This change made many COVID-era flexibilities for MOUD permanent, increasing access to medications in rural areas and for people with transportation challenges. OTP admission criteria also were updated to remove significant barriers to entry.  
• In August 2023, CDC awarded new five-year cooperative agreements to 90 state and local health departments under two distinct Overdose Data to Action (OD2A) programs. The cooperative agreements fund health departments at all levels of government to expand drug overdose data and prevention efforts and build partnerships across public health, behavioral health, health systems, communities, and public safety.
• NIH is supporting research on implementation of evidence-based practices in  healthcare ,  community , and  justice settings , as well as  novel treatment strategies for addiction , including strategies aimed at new treatment tools and  strategies to improving engagement and retention in care .
• CMS is executing a  Behavioral Health Strategy to deliver increased coverage and access to behavioral health care, including strengthened access through schools for Medicaid and CHIP eligible kids, grants and guidance to support community-based mobile crisis intervention services, increased telehealth services through Medicare for behavioral health and buprenorphine initiation, and expanded access to behavioral health providers in the Marketplace. CMS also continues to test innovative care delivery and payment models such as the Innovation in Behavioral Health, Making Care Primary, Value in Opioid Use Disorders Treatment and Maternal Opioid Misuse Models.

“CDC has a strong focus on preventing health problems before they occur, including in the overdose space,” said Allison Arwady, M.D., M.P.H., director of CDC’s Injury Center. “We work closely with our state and local partners across the country to collect data and drive local prevention actions, and just as closely to coordinate our work with our other federal agency partners. This study highlights that as a society, we are still missing many opportunities to prevent fatal overdoses, and we must continue to work together at all levels to save lives.”

If you or someone you know is struggling or in crisis, help is available. Call or text  988 or chat at  988lifeline.org . To learn how to get support for mental health, or substance use conditions, visit  FindSupport.gov . If you are ready to locate a treatment facility or provider, you can go directly to  FindTreatment.gov or call  800-662-HELP (4357) . 

Find out how you can help at CDC’s  Stop Overdose campaign.

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NIH-funded intervention did not impact opioid-related overdose death rates over evaluation period

COVID-19 pandemic and increasingly dangerous drug supply among factors that may have contributed to diminished impact of intervention

A data-driven intervention that engaged communities to rapidly deploy evidence-based practices to reduce opioid-related overdose deaths – such as increasing naloxone distribution and enhancing access to medication for opioid use disorder – did not result in a statistically significant reduction in opioid-related overdose death rates during the evaluation period, according to results from the National Institutes of Health’s HEALing (Helping to End Addiction Long-Term) Communities Study . Researchers identified the COVID-19 pandemic and increased prevalence of fentanyl in the illicit drug market – including in mixtures with cocaine and methamphetamine – as factors that likely weakened the impact of the intervention on reducing opioid-related overdose deaths.

The findings were published in the New England Journal of Medicine and presented at the College on Problems of Drug Dependence (CPDD) meeting on Sunday, June 16, 2024. Launched in 2019, the HEALing Communities Study is the largest addiction prevention and treatment implementation study ever conducted and took place in 67 communities in Kentucky, Massachusetts, New York, and Ohio – four states that have been hard hit by the opioid crisis.

Despite facing unforeseen challenges, the HEALing Communities Study successfully engaged communities to select and implement hundreds of evidence-based strategies over the course of the intervention, demonstrating how leveraging community partnerships and using data to inform public health decisions can effectively support the uptake of evidence-based strategies at the local level.

“This study brought researchers, providers, and communities together to break down barriers and promote the use of evidence-based strategies that we know are effective, including medications for opioid use disorder and naloxone,” said NIDA director, Nora D. Volkow, M.D. “Yet, particularly in the era of fentanyl and its increased mixture with psychostimulant drugs, it’s clear we need to continue developing new tools and approaches for addressing the overdose crisis. Ongoing analyses of the rich data from this study will be critical to guiding our efforts in the future.”

NIH launched the HEALing Communities Study, a four-year, multisite research study to test a set of evidence-based interventions for reducing overdose deaths across health care, justice, and behavioral health settings. Over 100,000 people are now dying annually of a drug overdose , with over 75% of those deaths involving an opioid. Numerous evidence-based practices have been proven to prevent or reverse opioid overdose, but these strategies are gravely underused due to a number of barriers.

As part of the intervention, researchers collaborated with community coalitions to implement evidence-based practices for reducing opioid overdose deaths from the Opioid-Overdose Reduction Continuum of Care Approach . These evidence-based practices focus on increasing opioid education and naloxone distribution, enhancing access to medication for opioid use disorder, and safer opioid prescribing and dispensing. The intervention also included a series of communication campaigns to help reduce stigma and increase the demand for evidence-based practices.

Communities were randomly assigned to either receive the intervention (between January 2020 and June 2022) or to the control group (which received the intervention between July 2022 and December 2023). To test the effectiveness of the intervention on reducing opioid-related overdose deaths, researchers compared the rate of overdose deaths between the communities that received the intervention immediately with those that did not during the period of July 2021 and June 2022.

Between January 2020 and June 2022, intervention communities successfully implemented 615 evidence-based practice strategies (254 related to overdose education and naloxone distribution, 256 related to medications for opioid use disorder, and 105 related to prescription opioid safety).

Despite the success in deploying evidence-based interventions in participating communities, between July 2021 and June 2022, there was not a statistically significant difference in the overall rate of opioid-involved overdose deaths between the communities receiving the intervention and those that did not, (47.2 opioid-related overdose deaths per 100,000 people in the intervention group, versus 51.7 in the control). The study team is also examining data on the impact of the intervention on total overdose deaths and examining specific drug combinations, such as stimulants and opioids, and on non-fatal opioid overdoses, among other study outcomes.

“The implementation of evidence-based interventions is critical to addressing the evolving overdose crisis,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “This study recognizes there is no quick fix to reduce opioid overdose deaths. Saving lives requires ongoing commitment to evidence-based strategies. The HEALing Communities Study facilitated the implementation of 615 evidence-based practice strategies, with the potential to yield lifesaving results in coming years.”

The authors highlight three specific factors that likely weakened the impact of the intervention on reducing opioid-related overdose deaths. First, the intervention launched two months before the COVID-19 shutdown which severely disrupted the ability to work with health care, behavioral health, and criminal legal systems in implementing evidence-based practices. Indeed, due in large part to the emergence of the COVID-19, only 235 of the 615 strategies (38%) were implemented before the comparison period began in July 2021.

Second, after communities selected which evidence-based practices they wanted to implement, they only had 10 months to implement them before the comparison period began. The authors note that this was not enough time to robustly recruit necessary staff, change clinical practice workflows, or develop new collaborations across agencies and organizations. They note more time to implement these strategies, and more time between implementation and measuring results, may be needed to observe the full impact of the intervention.

Lastly, significant changes in the illicit drug market could have impacted the effectiveness of the intervention. Fentanyl increasingly permeated the illicit drug supply, and was increasingly mixed or used in combination with stimulant drugs like methamphetamine and cocaine, or in counterfeit pills made to look like prescription medications. The increasing use of fentanyl, as well as xylazine, over the study period posed new challenges for treatment of opioid use disorder and opioid-related overdose.

“Even in the face of a global pandemic and worsening overdose crisis, the HEALing Communities Study was able to support the implementation of hundreds of strategies that we know save lives,” said Redonna Chandler, Ph.D., director of the HEALing Communities Study at NIDA. “This is an incredible feat for implementation science, and shows that when we provide communities with an infrastructure to make data-driven decisions, they are able to effectively implement evidence-based practices based on their unique needs.”

The HEALing Communities Study was supported and carried out in partnership between the National Institute of Health’s National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) through the NIH HEAL Initiative .

Helping to End Addiction Long-term®, NIH HEAL Initiative®, and HEALing Communities Study® are registered service marks of the Department of Health and Human Services.

If you or someone you know is struggling or in crisis, help is available. Call or text 988  or chat at  988lifeline.org . To learn how to get support for mental health, drug or alcohol issues, visit FindSupport.gov . If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.gov or call 800-662-HELP (4357) .

• Reference: JH Samet, et al. Community-based Cluster Randomized Trial to Reduce Opioid Overdose Deaths . New England Journal of Medicine . DOI: 10.1056/NEJMoa2401177 (2024)

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov .

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2022, nearly 49 million people in the United States had at least one substance use disorder. Substance use disorders are defined in part by continued use of substances despite negative consequences. They are also relapsing conditions, in which periods of abstinence (not using substances) can be followed by a return to use. Stigma can make individuals with substance use disorders less likely to seek treatment. Using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide .

NIH…Turning Discovery Into Health®

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• 05 June 2024

Drug-resistant infections more likely to strike women, says WHO

• Carissa Wong 0

Carissa Wong is a science journalist in London.

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Drug-resistant Escherichia coli is one of many bacteria that women might be more likely to encounter than men in some regions, owing to gendered divisions of labour. Credit: Steve Gschmeissner/Science Photo Library

Women might be more likely to develop drug-resistant infections than men — an under-recognized aspect of the growing threat of antimicrobial resistance, according to a global review led by the World Health Organization (WHO). The report finds that more than 70% of countries do not recognize gender inequalities in national plans to tackle drug-resistant infections.

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doi: https://doi.org/10.1038/d41586-024-01476-9

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Drug abuse continues to decline in china.

China's drug situation is generally under control and stable, with the scale of drug abuse continuing to decrease, according to the China Drug Situation Report 2023 issued by the office of National Narcotics Control Commission on Wednesday.

In 2023, a total of 42,000 drug-related criminal case were solved, 65,000 suspects were captured, and 25.9 tons of various drugs were seized, representing a year-on-year increase of 12.6 percent, 21 percent and 18 percent, respectively, it said.

Thanks to extensive drug prevention education, continuous implementation of the "Care for Drug Users" campaign and strengthening of rehabilitation and support for drug users, the scale of drug abuse has continued to fall, said the report.

By the end of 2023, there were 896,000 registered drug users in China, a year-on-year drop of 20.3 percent, accounting for 0.064 percent of the total population. There were nearly 4.08 million individuals who had not experienced a relapse after three years of abstinence, a year-on-year increase of 7.6 percent.

Besides, a total of 195,000 instances of drug use were dealt with throughout the year, a decrease of 1.1 percent year-on-year.

The report noted the drop in abuse of mainstream drugs. Among the registered drug users, there were 305,000 heroin users, 455,000 methamphetamine users, and 30,000 ketamine users, representing year-on-year fall of 26.7 percent, 22.6 percent, and 6.3 percent, respectively.

According to the results of the national wastewater drug monitoring by the National Narcotics Laboratory, the consumption of mainstream drugs such as methamphetamine and ketamine is on the decline, and no significant scale of fentanyl abuse has been detected so far, it said.

However, the high prices of mainstream drugs, prompted drug users to turn to more accessible, cheaper and similarly effective addictive substances, such as narcotic and psychotropic medications. Among these, the misuse of etomidate is particularly notable. Besides, drug users seeking alternatives such as dextromethorphan and compound diphenoxylate, which were non-scheduled addictive substances, also presented a significant issue, it said.

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Courts | Supreme Court rules in government’s favor in…

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Courts | Supreme Court rules in government’s favor in San Diego ‘blind mule’ drug courier case

In 6-3 opinion, the high court ruled government witnesses can testify that most drug couriers caught at mexican border know they're transporting drugs.

The case, Delilah Guadalupe Diaz v. United States of America , centered around a specific rule of evidence in federal law dealing with a defendant’s mental state and knowledge of a crime, and the opinions of experts testifying about a defendant’s criminal intent.

In essence, the court ruled that an expert can testify about the criminal intent or mental state of most defendants charged with a particular crime, and that such testimony is not too general — the jury can still decide if a specific defendant is like most other defendants or not.

The ruling has major implications for the San Diego region, where federal prosecutors charge hundreds of people each year with illegally importing drugs across the border. The most common defense for such charges is the blind mule argument, in which defendants assert they were unaware that smugglers hid drugs in their vehicles. But the ruling could also have wider implications for defendants in other kinds of cases when there are questions of criminal intent.

Local defense attorneys said Thursday the ruling is likely to turn trials into a “battle of experts” offering contradicting opinions about a defendant’s mental state — the very problem Congress sought to fix when it created the rule.

Justice Clarence Thomas authored the 6-3 majority opinion , which affirmed a previous ruling by the 9th U.S. Circuit Court of Appeals. The appeals court had ruled that Homeland Security Investigations Special Agent Andrew Flood had not violated the federal evidence rule — 704(b) — when he testified at Diaz’s trial that “in most circumstances, the driver knows they are hired … to take the drugs from point A to point B.”

Thomas wrote that Flood did not violate the rule because he did not testify specifically that Diaz knew she was transporting drugs or that all couriers know they’re transporting drugs.

“Agent Flood asserted that Diaz was part of a group of persons that may or may not have a particular mental state,” Thomas wrote. “Of all drug couriers — a group that includes Diaz — he opined that the majority knowingly transport drugs. The jury was then left to decide: Is Diaz like the majority of couriers? Or, is Diaz one of the less-numerous-but-still-existent couriers who unwittingly transport drugs? The ultimate issue of Diaz’s mental state was left to the jury’s judgment.”

‘Party agnostic’

San Diego defense attorney Danielle Iredale, who first represented Diaz and raised the issue at trial, predicted in March after the Supreme Court heard oral arguments that the decision would involve “strange bedfellows” and be close. “I don’t think the split is necessarily going to be along the typical ideological lines,” Iredale predicted after attending the oral arguments in person.

She was right.

Justice Ketanji Brown Jackson, a nominee of President Joe Biden, wrote a concurrence to Thomas’ opinion, joining the majority along with Republican-appointed justices Thomas, John Roberts, Samuel Alito, Brett Kavanaugh and Amy Coney Barrett. Justice Neil Gorsuch, a nominee of President Donald Trump, wrote the dissent, joined by justices Sonia Sotomayor and Elena Kagan, both appointees of President Barack Obama.

Jackson wrote in her concurrence that the rule in question “is party agnostic,” a point that she had focused on during oral arguments.

“Indeed, the type of mental-state evidence that Rule 704(b) permits can prove essential not only for prosecutors, but for defendants as well,” Jackson wrote.

Iredale, who runs a solo private criminal defense practice, said she was initially crestfallen Thursday after reading the decision. But she quickly turned her focus to the positives.

“Now that (the government) can call experts to testify about an entire class of people, we can do the same on the other side,” Iredale said. She said defense attorneys have typically been trepidatious in the past about opening such a door.

Tommy Vu, also a private defense attorney, held a similar view. “It is now imperative for the defense to counter with their own expert to testify about the prevalence of unknowing drug couriers (or) blind mules,” Vu told the Union-Tribune. Vu said the fear among defense attorneys is that while a defense expert can testify that only some drug couriers are blind mules, a government expert can testify that most drug couriers know what they’re doing, and jurors will side with “most” over “some.”

But Vu said Thursday’s ruling won’t affect the prevalence of blind mule defenses. “Irrespective of the Supreme Court’s ruling, this defense is rooted in truth and reality as some of our clients are in fact unknowing couriers,” he said.

The government has acknowledged that Mexican drug-smuggling groups sometimes use the vehicles of unwitting victims — such as students or workers who cross the border at routine and predictable times — but maintains that such cases are rare. San Diego defense attorneys contend the use of blind mules is more common than the government will admit and beneficial to smugglers who can track the drug load with a hidden GPS, don’t have to pay the driver and need not worry about the driver snitching, stealing the drugs or acting nervous during inspections.

Federal authorities arrested Diaz, a U.S. citizen and Moreno Valley resident, in August 2020 at the San Ysidro Port of Entry after finding some 60 pounds of methamphetamine concealed within the doors of her vehicle. She maintained from the beginning that the car belonged to her boyfriend and she didn’t know about the drugs.

Before trial, Iredale unsuccessfully attempted to block the testimony of Flood, the federal agent, that drug-trafficking organizations typically don’t use blind mules because it’s too risky. The jury convicted Diaz, who then appealed to the 9th Circuit, again unsuccessfully.

The petition asking the Supreme Court to take up the case , filed by Stanford law professor Jeffrey L. Fisher, the co-director of Stanford’s Supreme Court Litigation Clinic, cited previous reporting from the Union-Tribune . It argued that the 9th Circuit’s interpretation of the evidence rule “lightens the Government’s burden to prove knowledge beyond a reasonable doubt” by allowing sweeping generalizations about a particular class of defendants rather than evidence specific to the actual defendant.

The rule at the heart of the case states in part that “an expert witness must not state an opinion” about a defendant’s state of mind. Congress amended the rule to its current form through the Insanity Defense Reform Act of 1984 in response to the acquittal of President Ronald Reagan’s would-be assassin, John Hinckley Jr. A jury found Hinckley not guilty by reason of insanity after hearing conflicting testimony about whether he met the legal standard for insanity.

In blind mule cases, the issue becomes not whether the driver is insane, but whether the driver knows he or she is committing a crime.

Iredale said Thursday’s ruling could affect other types of cases in which criminal intent is in question, such as charges involving possession of drugs with intent to distribute. Government and defense experts can offer contrasting opinions about what “most” people who possess a certain amount of drugs plan to do with those drugs.

Vu predicted prosecutors will rely heavily on the ruling. “Going forward, we expect the government to always present such expert testimony across the board.”

The U.S. Attorney’s Office for the Southern District of California declined to comment on Thursday’s ruling.

‘An expert in mindreading’

Gorsuch was scathing in his dissent, arguing that the “upshot” of the court’s majority opinion is that “the government comes away with a powerful new tool in its pocket.”

Wrote Gorsuch: “Prosecutors can now put an expert on the stand — someone who apparently has the convenient ability to read minds — and let him hold forth on what ‘most’ people like the defendant think when they commit a legally proscribed act. Then, the government need do no more than urge the jury to find that the defendant is like ‘most’ people and convict.”

Gorsuch went on to argue that in Diaz’s case, prosecutors could have pointed to plenty of circumstantial evidence that would allow the jury to infer that she knew about the drugs and was not a blind mule.

“The government was free to argue to a jury, asking it to conclude that Ms. Diaz’s story was ‘transparently flimsy,’” Gorsuch wrote. “Day in and day out, the government secures convictions for the knowing importation of drugs in just this way … There was no need to gild the lily by calling to the stand an ‘expert’ in mindreading. And there is certainly no cause for this Court to sanction the practice.”

Gorsuch went on to write that “the problem of junk science in the courtroom is real and well documented … And perhaps no ‘science’ is more junky than mental telepathy.”

Jackson wrote in her concurrence with Thomas that she “fully (acknowledges) that there are serious and well-known risks of overreliance on expert testimony — risks that are especially acute in criminal trials.” But she wrote that there are other safeguards outside of Rule 704(b) to prevent misuse of expert testimony.

Jackson wrote that district court judges also have a role to play by providing clear and specific instructions to jurors when they hear testimony about a defendant’s mental state or criminal intent.

Diaz, the defendant in the case, remains in federal prison in Arizona. She’s expected to be released early next year.

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Rate of substance abuse alarming in Katsina – NDLEA

Despite arresting over 1, 300 suspects and seizing over 1, 300 kilograms of drugs in the past year, the Katsina State Command of the National Drug Law Enforcement Agency, NDLEA, said the state’s drug problem remains troubling.

At a press briefing to commemorate the International Day Against Drug Abuse and Illicit Trafficking, NDLEA Katsina Commander, Hassan Sani Abubakar, acknowledged the agency’s achievements but stressed that the rate of abuse and trafficking of drug and psychotropic substances remains “alarming and a serious area of concern.”

He revealed that the drug problem cuts “across all strata of community members,” suggesting widespread use.

Abubakar also highlighted the “unbecoming attitudes of some communities” that obstruct NDLEA’s efforts and as such pose potential resistance to tackling the issue.

Another worrying trend according to him is the “increased cases of women’s involvement in drug activities.”

While acknowledging these challenges, he reiterated NDLEAs unwavering commitment to taming the menace. He noted the establishment of NDLEA offices across all 34 Local Government Areas (LGAs) in Katsina as a significant step towards boosting their presence and disrupting drug dealer activities.

He particularly applauded Governor Dikko Umaru Radda’s sponsorship of the treatment of some youths for substance use disorder.

Speaking at the occasion, the Katsina State Governor, represented by Shehu Abdu Daura, Special Adviser on Drugs and Narcotics, said the Radda-led administration is taking a multi-pronged approach, with initiatives ranging from rehabilitation centres to potential emergency measures.

Recognising the severity of the drug abuse problem, Shehu hinted at the possibility of a declaration of a state of emergency. According to him, this move would signal a significant escalation in the fight against drugs, granting the government additional resources and potentially stricter legal measures.

He also noted the construction of multi-million naira reformatory centres catering to both male and female youth across the state’s three senatorial zones. These centres, he said, aim to provide rehabilitation and reintegration for those caught in the throes of drug abuse.

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