Drugs Use Out Of Control
Older Americans taking more medications
The proportion of older Americans taking at least five medications or supplements went up in a recent study.
The increase in people using multiple medications - known as polypharmacy - paralleled an increase in the number of older Americans at risk for major drug interactions, researchers found.
"That’s a concern from a public health standpoint, because it’s getting worse," said Dima Qato, the study's lead author from the University of Illinois at Chicago.
Qato and her colleagues previously reported that polypharmacy is common among older Americans. More than half were taking prescription and nonprescription medications between 2005 and 2006.
There have been a lot of changes in U.S. regulations and the pharmacy market since that time, however. Some of those changes include new and less expensive generic drugs and the implementation of Medicare Part D, which is the prescription component of the government-run health insurance program for the elderly or disabled.
To evaluate the change in polypharmacy over time, the researchers compared the 2005-2006 results to data collected from 2010-2011.
Participants in the study were between the ages of 62 and 85 and were living at home. The researchers interviewed 2,351 people in 2005-2006 and 2,206 in 2010-2011.
Overall, about 67 percent were taking five or more medications or supplements in 2010-2011, up from about 53 percent in 2005-2006.
Use of cholesterol-lowering statins rose from about 34 percent to about 46 percent, the researchers reported in JAMA Internal Medicine. The proportion of people taking blood-thinning medications also increased, from about 33 percent to 43 percent, and use of omega-3 fish oil pills rose from about 5 percent to about 19 percent.
Along with the increase in polypharmacy, the researchers found the risk of major drug interactions nearly doubled, going from about 8 percent to about 15 percent.
"I think we have to keep in mind that while it’s important to improve access to medications, we need to make sure they’re used safely," said Qato.
On one hand, the new results can be seen as positive, said Dr. Michael Steinman, a gerontologist at the University of California, San Francisco.
"We’re treating more people with medications that could potentially help them," he said. "But when people have four or five chronic conditions, medications quickly balloon to a large number."
It's important to ensure clear communication between everyone involved in a patient's care, including the patient, said Steinman, who wrote an editorial accompanying the new study.
"You can get rid of problems and excess medications by talking with your doctors," he said.
A separate study reported in the same issue of the journal found that nearly 42 percent of adults did not tell their doctors about the use of complementary or alternative medicine, which includes - among other things - supplements, herbs, homeopathy, special diets and acupuncture.
Many patients said they didn't tell their doctors about these alternative medicines because they weren't asked or because their doctors didn't need to know that information, write Judy Juo and Pamela Jo Johnson, of the University of Minnesota in Minneapolis.
"If a person is talking with their doctor about the medications they’re using, they should be talking about all the medications they’re using," said Steinman.
Source : Reuters (March 2016)
How Too Much Medicine Can Kill You
During a recent clinic consultation, I saw Mary, in her early 60s, with type 2 diabetes. She was concerned that the muscle pains in her legs may have been a result of the cholesterol-lowering statin drug she was taking. “But I’m scared of stopping it.” She explained how a specialist nurse had told her a clot could break off from her aorta, travel to her brain and cause a massive stroke.I assured her that even in those with established heart disease, who stand to gain most from taking the drug, the risk of death from stopping the medication for two weeks to see if the side-effects would go was close to 1 in 10,000 .
Unfortunately, such misinformation and fear-mongering is common. One of the root causes is undoubtedly driven by the commercial interests of the pharmaceutical industry.
As cardiologist Peter Wilmshurst points out in a talk he gave at the Centre for Evidence-Based Medicine last year, the drug and device industry has an ethical and legal responsibility to produce profit for their shareholders but not to sell patients and doctors the best treatment. But the real scandal, he says, is the failure of regulators and the collusion of sorts between doctors, institutions and medical journals.
According to Peter Gøtzsche, professor of research design and analysis at the University of Copenhagen, prescription drugs are the third most common cause of death after heart disease and cancer. In an analysis published in the BMJ, he estimated that every year psychiatric drugs, including anti–depressants and dementia drugs, are responsible for half-a-million deaths in those aged over 65.
Between 2007 and 2012, the majority of the largest 10 pharmaceutical companies all paid considerable fines for various misdemeanours that included marketing drugs for off-label uses, misrepresentation of research results and hiding data on harms. But as long as these criminal acts generate profit, they will continue unabated.
Medical journals and the media can also be manipulated to serve not only as marketing vehicles for the industry, but also be complicit in silencing those who call for more independent scrutiny of scientific data.
Corporate greed and systematic political failure has brought healthcare to its knees
Earlier this year, the editor of the Lancet, Richard Horton, wrote that possibly half of the published medical literature may simply be untrue and that science had “taken a turn towards darkness”.
It is therefore welcome news that several weeks ago Britain’s chief medical officer, Dame Sally Davies, called for an inquiry into the safety of medicines to restore the public’s trust. But what is disappointing is that she has asked the Academy of Medical Sciences to carry out the review. As one respected senior academic, who did not wish to be named, told me, it was “hardly independent” and it was akin to asking “foxes to guard the hen coop”. And it’s worth noting that the academy has not signed up to the AllTrials campaign started by Ben Goldacre, which calls for all results of all clinical trials to be made available to doctors, researchers and patients.
AdvertisementBut real political will to address these issues has also been lacking. Rather than pursuing his current obsession with new contracts, the health secretary, Jeremy Hunt, would be doing doctors and the British public a far greater service by choosing to attack the manipulations and excesses of vested interests contributing to an inefficient health service.
In July, Sir Bruce Keogh, former cardiac surgeon and medical director of NHS England, said that as many as 10-15% of medical and surgical treatments in the NHS should not have been carried out on patients.
This comes only a month after the Academy of Medical Royal Colleges, the independent organisation representing the UK’s 220,000 doctors, launched a campaign to reduce the harms of too much medicine, stating commercial conflicts of interest, defensive medicine and biased reporting in medical journals as root causes.
One of the academy’s recommendations asks for commissioners to consider different payment incentives for doctors that focus on providing quality care by having sensible conversations with patients about the value of a treatment. Better this than one incentivised by the volume of drug prescriptions or number of operations undertaken.
Professor Chris Ham, chief executive of health thinktank the King’s Fund, says: “Many doctors aspire to excellence in diagnosing disease; far fewer unfortunately aspire to the same standards of excellence in diagnosing what patients want.” And he’s absolutely right.
Three months later, Mary feels like a “new woman” after her muscle pains disappeared within a week of stopping her statins and her quality of life is now much improved, tolerating a lower dose of the drug. She also began following a high-fat Mediterranean diet that was low in sugar and other refined carbs after I told her it would be more effective than any pill we could give her to reduce her risk of heart attack or stroke. She has already lost weight and even her type 2 diabetes is better controlled.
Corporate greed and systematic political failure have brought healthcare to its knees. There are too many misinformed doctors and misinformed patients. It’s time for greater transparency and stronger accountability, so that doctors and nurses can provide the best quality care for the most important person in the consultation room – the patient. As John Adams, the second US president, said: “The preservation of the means of knowledge amongst the lowest ranks is of more importance to the public than all the property of all the rich men in the country.” It’s time to restrain the harms of too much medicine.
Source : The Guardian (Nov. 2015)
Inspector General Faults Medicare for Not Tracking ‘Extreme’ Prescribers
More than 700 doctors nationwide wrote prescriptions for elderly and disabled patients in highly questionable and potentially harmful ways, according to a critical report of Medicare's drug program released today.
The review by the inspector general of the U.S. Department of Health and Human Services flags those doctors as "very extreme" in their prescribing – and says that Medicare should do more to investigate or stop them.
The study mirrors a ProPublica investigation last month that found Medicare had failed to protect patients from doctors and other health professionals who prescribed large quantities of potentially harmful, disorienting or addictive drugs.
Medicare's prescription drug program was launched in 2006 and now accounts for about one of every four drugs dispensed nationwide. Last year, the government spent $62 billion subsidizing the drugs of 32 million people.
"Strong oversight of the Medicare prescription drug program is critical for protecting patients from harm," Sen. Tom Carper, D-Del., said in an email.
Carper chairs the Senate Homeland Security and Governmental Affairs Committee, which has scheduled a hearing Monday about prescription abuse in the Medicare program, known as Part D.
The inspector general's report focused on the prescribing of nearly 87,000 general-care physicians, such as family practitioners and internists, in urban and suburban areas in 2009. These doctors accounted for about half of all the prescribing in the program that year.
The review found more than 2,200 doctors whose records stood out in one of several areas: prescriptions per patient, brand name drugs, painkillers and other addictive drugs or the number of pharmacies that dispensed their orders.
Of those, 736 were flagged as "extreme outliers." Their patterns, the report says, raised questions about whether the prescriptions were "legitimate or necessary."
For instance, 24 doctors wrote more than 400 prescriptions for at least one patient, including refills dispensed. One Ohio physician did so more than a dozen times, according to the report. The average doctor wrote 13 per patient.
In another case, an Illinois doctor had prescriptions filled by 872 pharmacies in 47 states and Guam. General-care doctors, on average, had prescriptions for all their Medicare patients filled by 52 pharmacies.
The cost to the government was enormous in some instances. Medicare paid $9.7 million for the prescriptions of one California doctor alone – that is 151 times more than the cost of an average doctor's tally, the report says.
Most of this physician's drugs were supplied by just two pharmacies, both of which had previously been identified by the inspector general as having questionable billing practices.
All told, the drugs ordered by the doctors labeled "extreme outliers" cost Medicare $352 million, the report says.
While some of this may have been appropriate, the report says, "prescribing high amounts on any of these measures may indicate that a physician is prescribing drugs which are not medically necessary or that he or she has an inappropriate incentive, such as a kickback, to order certain drugs."
Sen. Tom Coburn of Oklahoma, the ranking Republican on Carper's committee, said no one wants Medicare to tell doctors which drugs to prescribe. But the government does have a responsibility in preventing fraud and abuse, he said.
Medicare officials "should be using their data to make sure those practicing medicine are practicing medicine and not practicing a sham," said Coburn, who is also an obstetrician.
The inspector general's report calls on the Centers for Medicare and Medicaid Services (CMS), which oversees the program, to step up scrutiny of doctors with questionable prescribing patterns. It urged CMS to direct its fraud contractor to expand its analysis of prescribers and train the private insurers that administer Part D on how to spot problem prescribers.
Medicare also should send doctors report cards comparing their prescribing to their peers, the report says.
In a response to the inspector general, the Medicare agency wrote that it agreed with the recommendations, has been working to reduce overuse of narcotics and plans to expand its use of data to flag questionable prescribing.
"We must balance these efforts with ensuring that beneficiaries have access to the medicines they need," a CMS spokesman said Wednesday in a statement.
For ProPublica's investigation, reporters analyzed four years of Medicare prescription drug data and examined the prescriptions of all health professionals across specialties. It examined all prescribers – 1.7 million in 2010 alone – not just those in general-care specialties or mostly urban areas.
The new report from the inspector general is the latest to find oversight problems in Part D. Previous reports found that insurers have paid for prescriptions from doctors who were barred by Medicare or whose identities were unknown to insurers or Medicare.
Coburn said Medicare has had repeated warnings that it was failing to properly oversee the program.
"This is incompetency and lack of somebody being held accountable," he said. "It's fixable."
Source : Fierce Pharma
Link to Source
Inside the Growing Prescription Pill Epidemic That's Ravaging Communities
What started out as a situation in poor isolated areas of the country left to their own devices has taken root and spread, across Appalachia and beyond.
KERMIT, W.Va. -- It takes less than a minute to drive past Kermit, five to tour the place entirely. An old coal mining town with barely 300 residents and one blinking light between the train tracks, Kermit has no supermarket, no clothing store, no main drag. Main Street is really a side street with rows of cottages, its biggest building, the Kermit community center, empty and boarded.
Yet in this tiny town, the Kermit Sav-Rite Pharmacy used to be as busy as a New York deli. Six employees worked the counter, lines at the drive-through window snaked around the square cinder-block building, and the parking lot was full day and night.
Of course, everyone in Kermit — just about everyone in the wooded hollows of Mingo County — knew the Sav-Rite was a pill mill. It handed out Xanax, Lortabs, Vicodin — all manner of the prescription painkillers and anti-anxiety drugs that are crippling Appalachia like a rogue disease — to anyone with an excuse. Kermit, which sits in the poorest, most remote corner of southwest West Virginia at the Kentucky border, was drawing pill addicts from all over the Eastern seaboard. People were throwing pill parties in the parking lot. Trading pills, buying, selling, injecting, snorting, the works.
This went on for years before the law could stop it. In February, more than two years after the DEA and FBI stormed the Sav-Rite, seizing cases of files, its owner, John T. Wooley, pleaded guilty to selling prescription pills by fraudulent means. Wooley, in cahoots with a pill mill “pain management” clinic that existed to sell scripts, was filling prescriptions as if the fate of mankind depended on it. The Kermit Sav-Rite, along with another one Wooley owned in a tiny hamlet about 10 miles from Kermit, together doled out enough hydrocodone, the main ingredient in Vicodin and Lortabs, for every man, woman and child in West Virginia (population: 1. 8 million). The Sav-Rites moved almost 3.2 million dosage units of hydrocodone in 2006, the year the U.S. attorney used to make a case, compared with the national average of 97,000. Wooley, who sold the Kermit store a few months ago (he lost the other to the feds’ raid), faces four years in prison and a $250,000 fine at his sentencing in May. At 76 years old, he could probably better afford the fine than the time. Agents who raided the Kermit store said cash drawers were so stuffed they couldn’t close.
But shutting down pill mills in these parts is like playing Whac-A-Mole: As soon as a lawless “pain management” clinic or pharmacy is smacked down, others spring up. Investigations take years before prosecutions can be secured. And pill mills are only part of the problem. Most often, pill addicts get their drugs from friends or on the street. Drug gangs from cities like Detroit, Atlanta and Columbus, Ohio, have also moved in on the action, setting up drug “stores” in residences and other fronts. Almost fondly, people here recall when Oxycontin was jokingly called “hillbilly heroin ”and pill addicts were “pillbillies.” No one is joking now. What is happening in Appalachia, about 10 years into an explosion of prescription drug abuse, is so pervasive a problem that law enforcement officials say they cannot solve it alone.
The West Virginia newspapers offer daily examples of what the Mingo County sheriff, Lonnie Hannah, calls the “spinoffs of drug abuse”: Murders, assaults, robberies, burglaries, domestic violence, child abuse, child neglect, elder abuse, DUIs, overdose deaths. West Virginia, the ninth smallest state, has the highest rate of prescription drug overdose deaths in the nation.
Hannah estimates that two-thirds of the crimes and incidents his department handles are related to pill abuse. Chasing down pill dealing is more than enough work by itself. “It’s all over the county,” Hannah said, at his headquarters in the city of Williamson (nickname: Pill-iamson), the Mingo County seat. Authorities keep busting pill mills and dealers in the city of 3,000 residents, only to see them start up again. “Whenever we move in,” Hannah said, “they move around to someplace else.”
People in these parts have a word for pill abuse: "pilling." So much of it goes on that everyone has a story. They know someone who has abused or is abusing pills. They know parents who have lost custody of their children or neighbors who have lost good jobs or friends who have died because of them. They are shocked to hear that in some places in the country, say, San Francisco, pilling is neither a word nor a fact of life.
But that could be changing. As the Centers for Disease Control and Prevention keeps warning, prescription drug abuse is spreading. Pills, especially Xanax, the anti-anxiety drug manufactured by Pfizer, and Vicodin, Loracet and Lortabs, highly addictive opioid painkillers familiar to anyone who has had a wisdom tooth removed, are being abused more and more, all over. What started out as a situation in poor isolated areas of the country left to their own devices has taken root and spread, across Appalachia and beyond.
You can find pockets of pill abuse from Orange County, Calif., to Staten Island, NY (sometimes now called Pill Island). Nationally, the abuse of prescription pain relievers, as evidenced by treatment submissions, has gone up 430 percent in the last decade, according to a new report by the Substance Abuse and Mental Health Services Administration in Washington, D.C. The report says states with the highest rise in prescription painkiller abuse include Maine, Vermont, Delaware, Kentucky, Maryland, Arkansas, Rhode Island and West Virginia.
Last June, pill addiction on Long Island raged into the headlines when a 33-year-old Army veteran, David Laffer, shot and killed four people in a Medford pharmacy while he robbed the store for hydrocodone. A Vicodin addict, he had been getting the drug through doctor shopping — going from one doctor to another to sidestep the monthly limit for scripts — until he lost his job and his insurance.
“If there is a discussion of doctor shopping and prescription pill abuse,” Laffer said upon his sentencing to life without parole, “then perhaps some good can come from this.”
Laffer’s story lingered for barely more than a news cycle. But the spread of pilling may be the saving grace for Appalachia and the other mostly poor, mostly rural parts of the country where little white pills are leveling entire communities.
They offer the cautionary tale: Political leaders, health professionals and community groups in these parts who have been crying for help can show the rest of the country what can happen when pilling runs rampant.
- - - - - - - - - - - -
Once, maybe just a few years ago, domestic mayhem like the kind described in the March 28 Williamson Daily News would have been the talk of Mingo County for days on end.
A 911 call brought sheriff’s deputies to unincorporated Dingess, a cluster of houses off a gutted path that can only generously be called a road. A couple had been fighting over pills.
Officers found 32-year-old Charles Earnest Chapman bleeding from stab wounds over his left eye and his abdomen, blood all over the house, a small white pill and pill residue by a children’s play area, and two kids, barely toddlers, hanging out of wide-open windows. In the yard lay an empty bottle of Lortabs, 90 mg. April Dawn Vance, 24 years old, had stabbed Chapman and fled the house, she told officers, after Chapman had knocked her to the ground, beat her and choked her. The children became wards of the state, the couple wards of the county jail.
The story did not prompt a single comment in the local news. Nor did this home invasion, reported the same week: In Williamson, Mingo County’s big city, with 3,000 residents, a man arrested for robbing a house admitted to another robbery where he and a cohort stalked an 85-year-old man, busted into his house, beat him to the floor and stole $340 from his wallet. Police said the man admitted he used the money he stole from the elderly man to buy pills. The Williamson police chief advised residents to lock their doors and windows and be vigilant.
Shootings have become news briefs. On April 2, a 33-year-old Mingo County woman, an admitted pill addict, was sentenced to 40 years in prison for shooting her husband to death during an argument.
Too many pill stories have knocked the shock out of the populace. Southwest West Virginia in the age of pilling is like a country that has been living with war for so long, people could barely remember peace.
Ask people how pilling started and most blame coal mining and Oxycontin. Miners spend much of their time in backbreaking positions, crouched, bent and folded over, and men anxious to keep their jobs have long relied on strong painkillers to keep going. Oxycontin began making the rounds here in the late 1990s. Its maker, Purdue Pharma, touted it aggressively to doctors as a safer alternative to hydrocodone-based pills like Percocet or Vicodin because of its time-release formulation.
That proved a boon to Purdue Pharma, which sold over $1 billion worth of Oxycontin a year. It also proved a lie: In 2007, Purdue Pharma pleaded guilty in federal court in Virginia to misleading doctors and patients by making false claims about Oxycontin’s safety. It paid a $600 million fine, the only time that Big Pharma has been publicly implicated in the pill abuse epidemic.
These days, the coal mining industry in West Virginia is rife with pilling. In March, a lobbyist for the West Virginia Coal Association told state lawmakers that the association suspects that miners from Kentucky and Virginia who were suspended after failing mandatory drug tests are now working in West Virginia. West Virginia is considering mandatory drug testing as well, especially after several incidents. In one recent accident, the lobbyist said, a miner high on prescription drugs crashed a locomotive into a mine car, killing a co-worker.
Oxycontin, public health experts and addicts themselves will tell you, is not the most-abused prescription drug in West Virginia. In 2010, the drug was reformulated to make it harder for addicts to crush, snort and inject it. But public health experts say that even before then, by the mid-2000s, hydrocodone-based pills like Vicodin and Lortabs, and Xanax (generically, alprazolam), a benzodiazepine used to treat anxiety and panic disorder, were the drugs of choice in the dirt-poor areas of Appalachia, along with methadone and Percocet. Research on why points to “social determinants” such as poverty, lack of education and lack of opportunities, said Robert Pack, a public health expert at the East Tennessee University College of Public Health who has been studying pill abuse since 2002.
Mingo County (population.: 27,000), which became famous for the Hatfield-McCoy feud of the late 19th century and the Matewan union-busting massacre of 1920, is second only to its neighboring county, McDowell, for the highest rate of overdose deaths from pills in West Virginia. Both counties are poor, McDowell the poorest in the state.
But the women at Crossroads, a kind of halfway house for recovering addicts in the town of Gilbert, at the southern end of Mingo County, come from very mixed backgrounds. Some come from broken homes and awful childhoods, others from loving parents. Some never finished high school, others are college graduates.
They consider themselves lucky. They landed in jail or committed to mental wards and were forced to go clean.
Crossroads, run by the Mingo County STOP (the Strong Through Our Plan Coalition, a nonprofit community organization focused on drug prevention and treatment), requires a 90-day commitment. But many of the women end up staying longer, some longer than a year, as they earn high school equivalency diplomas and, often, try to regain custody of children they lost to the state.
Crossroads is a white single-wide trailer with a big sign on it; the whole town knows what it is and why its residents are there. But that has not hurt their job prospects. Every woman at Crossroads has a job. Local employers like hiring them, they say, since they know the women are clean and routinely drug-tested.
On a recent visit, the women were buzzing over the break-in, the night before, of one of Gilbert’s four pharmacies. The thieves had sawed through concrete dividing the building’s cinder blocks, the same break-in technique used at the Kermit Sav-Rite some months ago.
Long discussions with six of the eight women, who ranged in age from 21 to 37, found few patterns. Several had started using pills after doing other drugs. Others were given a pill by a friend. One had become hooked after receiving a legitimate prescription.
Most ended up on the Oxy Express, driving 15 hours with others, every two weeks, to central Florida to obtain scripts from pill mills there. Until recent crackdowns in Florida, it was the go-to place for pill heads from Appalachia to get their drugs. They’d buy cheap prescriptions and come up and sell them for five times what they paid. The general price on the street for pills is $1 per milligram, so that a 30 mg. Lortab costs $30. But in rural southern West Virginia, because of the demand, the pills cost more: 30 milligrams for $40, 90 milligrams for $100.
Now, the women said, more pill users are heading to Georgia and other states.
Several of the women became criminals: thieves, armed robbers. One of them had just found out that her best friend and pill partner, 21 years old, had been sentenced to 30 years in prison for armed robbery.
Christine, a 35-year-old recovering opioid addict from Charleston, S.C. — she did heroin, pills, “anything I could shoot up” — works as a bookkeeper at a local company. She had done drugs all through college and for years on end afterward, supporting her habit by selling pills and manufacturing methamphetamine. She was saved, after two overdoses in a month, when her mother and brother had her committed to a hospital. Now, a year and a half after entering Crossroads, she is a sponsor to other women and to inmates at the county jail.
Gilbert, with 450 residents, is not exactly a haven from pilling. Its nickname is Pillbert. The former executive director of Crossroads was forced to quit when she confessed that she herself was in active addiction. Her husband, a church pastor, was fired from the church after he was spotted at a methadone clinic, receiving treatment for his pill addiction.
But the women at Crossroads tend to come from other parts of the county, or outside it altogether. For them, Gilbert is safer than returning to their own towns.
Christine said she thinks Gilbert will be a great place to raise her son, now 3 years old. She is hoping to get him back from her sister in Columbus within a year. “Of course," she said, “nowhere is completely safe.”
Source : AlterNet
Link to Source
Designer Drugs Use Out Of Control
VIENNA — Dangerous drugs that may seem safe at first because they're made to dodge bans are being produced more quickly and in greater numbers, often with instructions readily available online, a watchdog warned Wednesday.
Governments should step up their efforts to crack down on so-called designer drugs by closely monitoring abuse trends and making new substances illegal as soon as possible, the International Narcotics Control Board said in its annual report.
"Given the health risks posed by the abuse of designer drugs, we urge governments to adopt national control measures to prevent the manufacture, trafficking in and abuse of these substances," said Hamid Ghodse, the board's president.
While 16 such new drugs are currently being monitored in Europe, Japan recently placed 51 under national control, the report said, adding that a growing number of countries and regions have detected such stimulants.
According to the report, designer drugs are often made by tweaking the molecular structure of illegal substances to create a new product with a comparable effect. They include the party drug mephedrone, sometimes also known as "meow meow," whose effects are reported to be similar to cocaine, amphetamine and ecstasy.
"They can be easily manufactured, as instructions on their manufacture and a description of their pharmacological effects are often found on the Internet," the report said, adding governments should consider making groups of substances illegal at a time to slow the process of finding replacements for them.
The report also included these findings:
- The United States continues to be a prime destination for shipments of illegal drugs and recorded an increase in the abuse of all drugs except cocaine in 2009. It also continues to see an increase in the illegal distribution of prescription drugs, with abuse on the rise among young people. According to government data, so-called pain clinics in some states dispense or prescribe large amounts of prescription opioids to people with no need for them. Canada, meanwhile, remains one of the world's main sources for illegally made synthetic drugs, especially ecstasy and methamphetamine and is also a "significant supplier" of high-potency cannabis.
- The large profits generated by the illegal drug trade make it possible for criminal groups to engage in large-scale corruption that includes paying off police to let them operate more freely. This can impact the credibility and efficiency of a country's criminal justice system and weaken the rule of law. In turn, it also can undermine international cooperation to crack down on drugs. In Mexico, for example, corruption continues to obstruct efforts to fight drug trafficking.
- In Europe, the abuse of cocaine is spreading from the western part of the continent to other areas and in some countries such as Denmark, Spain and Britain, cocaine may be replacing amphetamine and ecstasy. Europe is also the world's largest market for opiates, with the Russian Federation having the highest number of abusers.
- Central America and the Caribbean continue to be a transit area for large-scale smuggling of illegal drugs and the situation is worsened by endemic corruption, poverty and high unemployment. There is concern that earthquake-hit Haiti, already regarded as a major transit area for drug shipments to North America before the January 2010 disaster, is becoming more of a hotspot for such activity.
- In some South American countries, financial support for efforts to address drug-related problems are insufficient. The governments of Bolivia and Peru should take measures to reduce the area under coca bush cultivation and to fight the production and trafficking of cocaine. The abuse of cocaine appears to be increasing in Argentina, Brazil, Chile and Uruguay. Although Colombia is still the main source of cocaine detected in Europe, Peru is becoming increasingly important.
- In Africa, there has been an increase in the abuse of almost all types of drugs over the past few years, with cannabis topping the list. Large-scale smuggling of cocaine from South America through West Africa appears to have picked up again last year after the number of seizures reported in the region fell in 2008 and 2009 after peaking in 2007. The cocaine is largely destined for Europe and North America.
- In East and Southeast Asia, an issue of "paramount concern" is the increase in trafficking, production and abuse of synthetic drugs. South Asia, meanwhile, has become one of the prime areas for drug traffickers to obtain ephedrine and pseudoephedrine for the production of methamphetamine.
- In Afghanistan, the number of opium-free provinces remained the same in 2010 but a rise in opium prices may push farmers to grow more poppy this year.
Source : Huffington Post
Link to Source