Shifting North American drug markets and challenges for the system of care

International Journal of Mental Health Systems

George Budd¹  Vivian W. L. Tsang²  R. Michael Krausz²  Fiona Choi²  Kerry Jang²  Jean N. Westenberg³  Vijay Seethapathy⁴  James S. H. Wong⁵  Nickie Mathew⁶  Marc Vogel⁷  Conor King⁸ 

[1] Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada;Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada;Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada;Addictions and Concurrent Disorders Research Group, Institute of Mental Health, UBC, David Strangway Building, 5950 University Boulevard, V6T 1Z3, Vancouver, BC, Canada;Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada;BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada;Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada;Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada;Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada;Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada;BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada;University of Basel Psychiatric Clinics, Basel, Switzerland;Division of Substance Use Disorders, Psychiatric Services of Thurgovia, Münsterlingen, Switzerland;Victoria Police Department, Victoria, BC, Canada;

关键词: Drug markets;    Drug policy;    Fentanyl;    Overdose;    Public health crisis;   

DOI  :  10.1186/s13033-021-00512-9

来源: Springer

【 摘 要 】

Drug markets are dynamic systems which change based on demand, competition, legislation and revenue. Shifts that are not met with immediate and appropriate responses from the healthcare system can lead to public health crises with tragic levels of morbidity and mortality, as experienced Europe in the early 1990s and as is the case in North America currently. The major feature of the current drug market shift in North America is towards highly potent synthetic opioids such as fentanyl and fentanyl analogues. An additional spike in stimulant use further complicates this issue. Without understanding the ever-changing dynamics of drug markets and consequent patterns of drug use, the healthcare system will continue to be ineffective in its response, and morbidity and mortality will continue to increase. Economic perspectives are largely neglected in research and clinical contexts, but better treatment alternatives need to consider the large-scale macroeconomic conditions of drug markets as well as the behavioural economics of individual substance use. It is important for policy makers, health authorities, first responders and medical providers to be aware of the clinical implications ofdrug market changes in order to best serve people who use drugs. Only with significant clinical research, a comprehensive reorganization of the system of care across all sectors, and an evidence-driven governance, will we be successful in addressing the challenges brought on by the recent shifts in drug markets.

【 授权许可】

CC BY