The past five years have seen a dramatic turn of events against the tobacco industry, raising the question of the appropriate future path for U.S. smoking policy. This paper discusses the theory and evidence on regulation of smoking. I begin by reviewing the background on this industry. I then turn to a discussion of the motivations for regulating smoking, both external and internal to the smoker. I conclude with a discussion of future policy directions. (+info)
Changes in related drug class utilization after market withdrawal of cisapride.
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BACKGROUND: Recent Food and Drug Administration-mandated and company-initiated withdrawals of drug products from the marketplace have had an impact on utilization in related drug classes. OBJECTIVE: To investigate the impact of withdrawal of the prokinetic agent cisapride (Propulsid) on utilization of other gastrointestinal (GI) agents. STUDY DESIGN: A longitudinal, retrospective study using electronic prescription data from a state-funded geriatric prescription benefit program. PATIENTS AND METHODS: Prescription claims for 2644 patients using cisapride between January 10, 2000, and October 1, 2000, were analyzed with respect to points in time at which (1) prospective drug utilization review edits were implemented denying reimbursement of cisapride because of drug interactions, (2) the manufacturer announced its intent to cease production, and (3) the agent was withdrawn from the market. Prevalence of use, claims volume, and expenditures were compared for cisapride, proton pump inhibitors, histamine-2 receptor antagonists, and the prokinetic agent metoclopramide during these periods. RESULTS: Use of cisapride decreased precipitately even before implementation of a "medical exception only" reimbursement policy. After the change in policy, metoclopramide use increased, although this increase was not proportional to cisapride's decline. Although total GI expenditures declined within the cisapride cohort, this change had little impact on overall program GI expenditures. CONCLUSIONS: The loss of cisapride did not significantly affect program-wide costs for GI drugs. However, the withdrawal of cisapride appears to have resulted in increased use of metoclopramide, a medication with a more serious adverse effect profile than cisapride. Further study is needed to evaluate the long-term clinical impact of such therapy changes. (+info)
Implementation of the Comprehensive Methamphetamine Control Act of 1996; regulation of pseudoephedrine, phenylpropanolamine, and combination ephedrine drug products and reports of certain transactions to nonregulated persons. Final rule.
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DEA is amending its regulations to implement the requirements of the Comprehensive Methamphetamine Control Act of 1996 (MCA) with respect to the regulation of pseudoephedrine, phenylpropanolamine, and combination ephedrine drug products as List I chemicals, and the reporting of certain transactions involving pseudoephedrine, phenylpropanolamine, and combination ephedrine drug products. The MCA removed the previous exemption from regulation as List I chemicals which had applied to pseudoephedrine, phenylpropanolamine, and combination ephedrine drug products. This action makes persons who distribute the products subject to the registration requirement. Also, distributions, importations, and exportations of the products became subject to the existing chemical controls relating to regulated transactions, except in certain circumstances specified in the MCA. The MCA also requires that reports be submitted for certain distributions involving pseudoephedrine, phenylpropanolamine, and ephedrine (including drug products containing those chemicals) by Postal Service or private or commercial carrier to nonregulated persons. This final rule amends the regulations to make them consistent with the language of the MCA and to establish specific procedures to be followed to satisfy the new reporting requirement. DEA has, where possible, taken action to limit the public impact of these new requirements while remaining consistent with the intent of the MCA to attack the diversion of regulated drug products to the clandestine manufacture of methamphetamine. (+info)
Regional variation in drug purchase opportunity among youths in the United States, 1996-1997.
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This study was designed to examine geographic variation in illegal drug purchase opportunity among young people living in the United States; there was a subfocus on age, sex, and urban/rural residence. Data from the 1996-1997 National Household Surveys on Drug Abuse were analyzed; the nationally representative sample of community residents included 21,531 participants aged 12-24 years old. Respondents were asked if someone had approached them to sell them an illegal drug during the past 30 days. To protect respondents' confidentiality, there is no finegrained geographical coding of data in the National Household Surveys on Drug Abuse public use data files, but nine geographical divisional indicators are provided (i.e., West North Central, New England, etc.). Results indicated males were an estimated 1.8 times more likely than females to have had a recent illicit drug purchase opportunity, and urban residents were 1.5 times more likely than rural residents to have had a recent drug purchase opportunity. As for geographic divisions, the Pacific division surpassed all other divisions: Its residents were 1.5 times more likely to have recent drug purchase opportunities than the West North Central division (used here as a reference category). After controlling statistically for age, sex, and urban/rural residence, residence in four divisions was found to be associated with greater likelihood of an illicit drug purchase opportunity. The observed patterns of drug purchase opportunity add new features to our understanding of illicit drug involvement across the United States. (+info)
Self-medication with mood changing drugs.
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The aim of this article is to examine some of the consequences of the recent advances in neurobiology in terms of the ability of drugs to manipulate the mind. Most laymen are totally ignorant of the general mechanism underlying the brain-mind relationship and therefore of the action of mind-altering drugs. Professor Grahame-Smith considers that one of the intrinsic evils of man's neurobiological make up is that a prime motive of the brain seems to be to bring comfort, security and pleasure for itself. Therefore it is not surprising that drugs - notably the barbiturates and more recently the benzodiazepines (tranquilizers) - have been prescribed to give to the brain that peace of mind that it seeks. However, it can be argued that such drugs cannot replace anxiety with peace of mind or unhappiness or depression with happiness. The action of such drugs upon the molecules of the brain is negative - a placebo effect. (+info)
Drug courts: a primer for the family physician.
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BACKGROUND: Drug courts are a judicial response to drug-related crimes. They combine the coercive powers of the judiciary with drug treatment. This article is intended to familiarize physicians with the reasons why drug courts exist, what they are, and how physicians can assist their patients who are clients of a drug court. METHODS: Methods for this article are based upon personal experience and a search of the literature using the key words "drug rehabilitation," "drug abuse," and "criminal justice system." RESULTS: Using a three-phase approach, drug courts emphasize urine drug testing, rapid punishment for specific infractions, and therapeutic interventions. Drug courts have greatly reduced criminal and drug-using recidivism. CONCLUSION: Drug courts are effective in resolving the criminal and drug-using behaviors in drug-only, nonviolent offenders. Family physicians can become involved in the drug court process by providing treatment for patients with both drug addiction and mental health diagnoses. In addition, as patients withdraw from drugs, it is important to treat withdrawal symptoms to prevent recidivism and encourage participation in the program. (+info)
Registration and reregistration application fees. Confirmation of final rule, remanded for further notice and comment, and response to comments.
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DEA is publishing a final rule regarding the registration and reregistration fees charged to controlled substances registrants. DEA is required to charge reasonable fees relating to the registration and control of the manufacture, distribution, and dispensing of controlled substances. To address this mandate, on March 22, 1993 DEA published a final rule in the Federal Register, establishing registration fees for controlled substances registrants (58 FR 15272). Following publication of the final rule, the American Medical Association (AMA) and others filed a complaint in the United States District Court for the District of Columbia objecting to the new fees. The district court issued its final order granting the government's motion for summary judgment and disposing of all claims. The AMA appealed. The United States Court of Appeals for the District of Columbia Circuit found DEA's rulemaking to be inadequate. The appeals court remanded, without vacating, the rule to DEA, requiring the agency to provide an opportunity for meaningful notice and comment on the fee-funded components of the Diversion Control Program. DEA responded to the remand requirement through a document published in the Federal Register on December 30, 1996 (61 FR 68624). This Final Rule supplements the December 30, 1996 Federal Register document and with that document, constitutes the final rule on the Drug Diversion Control Fee Account. (+info)
Schedules of controlled substances: rescheduling of buprenorphine from schedule V to schedule III. Final rule.
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This final rule is issued by the Deputy Administrator of the Drug Enforcement Administration (DEA) to reschedule buprenorphine from a Schedule V narcotic to a Schedule III narcotic under the Controlled Substances Act (CSA). This action is based on a rescheduling recommendation by the Department of Health and Human Services (DHHS) and a DEA review indicating that buprenorphine meets the criteria of a Schedule III narcotic. The DEA published a proposed rule to reschedule buprenorphine on March 21, 2002 (67 FR 13114). The comment period was extended for an additional 30 days until May 22, 2002 (67 FR 20072). The DEA received ten comments but no requests for hearings. This final action will impose the regulatory controls and criminal sanctions of a Schedule III narcotic on those persons who handle buprenorphine or products containing buprenorphine (+info)