Published since 1884 by the Society for the Study of Addiction.
Editor-in-Chief, Robert West

We welcome suggestions and contributions from our readers. Send your material to John Witton, News and Notes Editor, Addiction, National Addiction Centre PO48, 4 Windsor Walk, London SE5 8AF. Fax +44 (0)20 7848 5966;
e-mail john.witton@kcl.ac.uk

Corrective Statements on Tobacco Product Packaging in US

Posted 10-Dec-18

CNN reports that tobacco companies started to put court-ordered "corrective statements" on tobacco product packaging in November. The statements state the harmful health effects of smoking and are a further result of federal Judge Gladys Kessler’s 2006 ruling that the tobacco industry had violated civil racketeering laws. Tobacco companies placed “corrective statement” advertisements across prime time television and newspapers in 2017 to meet Judge Kessler’s ruling, advertisements paid for by the tobacco companies. According to CNN, Mary Rouvelas, senior counsel for the American Cancer Society Cancer Action Network, said "We want to make sure that the public knows about the harms of smoking. We want to make sure that it knows about the fact that the industry intentionally manipulated nicotine, there are dangers of secondhand smoke. All those things that are in those statements are things that we think are very important to be out in the public domain."

Source:

https://edition.cnn.com/2018/11/21/health/cigarette-box-statements-bn/index.html

 

New Buprenorphine Formulation Available in Europe and Australia

Posted 10-Dec-18

Yahoo Finance reports that Australian Therapeutic Goods Administration (TGA) has approved long-acting buprenorphine products, Buvidal® Weekly and Buvidal® Monthly, for the maintenance treatment of opioid dependence. The TGA’s decision follows European Commission approval of Buvidal®, announced on 22 November. Buvidal® is slowly biodegraded over time after being injected, and its weekly and monthly formulations are intended to allow more individualised treatment for opioid dependent patients.

Source:

https://finance.yahoo.com/news/buvidal-weekly-buvidal-monthly-cam2038-220700201.html?guccounter=1

WHO Launches Alcohol Policy Package

Posted 10-Dec-18

In September the World Health Organization (WHO) released SAFER, a new initiative and technical package outlining five high-impact strategies that can help governments reduce the harmful use of alcohol and related health, social and economic consequences. The SAFER package aims to support the global target of reducing harmful use of alcohol by 10% by 2025. WHO Assistant Director-General Dr Svetlana Axelrod said “We have seen too little progress since the endorsement of the ‘Global strategy to reduce the harmful use of alcohol’ by the World Health Assembly eight years ago. But SAFER brings new impetus for action.” The recommended strategies are: strengthen restrictions on alcohol availability; advance and enforce drink driving counter measures; facilitate access to screening, brief interventions and treatment; enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion; raise prices on alcohol through excise taxes and pricing policies.

Source:

http://www.who.int/substance_abuse/safer/launch/en/

US Pharmaceutical Company Increased Naloxone Product Price by 600 Per Cent

Posted 10-Dec-18

A report from the US Senate Permanent Subcommittee on investigations found that the pharmaceutical company kaléo increased the price of its auto-injector naloxone product by more than 600 per cent in 2016. The product, EVZIO, was initially priced at $575 per unit in 2014, but did not gain widespread use. A new distribution model introduced in 2016 increased the unit price to $3,750. Kaléo’s sales force focused on ensuring doctors’ offices signed necessary paperwork indicating that EVZIO was medically necessary so that government programmes like Medicare and Medicaid would cover the drug’s costs. The model was based on patients with health insurance coverage subsidizing patients without coverage. Prescriptions for EVZIO increased, according to the Subcommittee’s report, 4,769 prescriptions were filled in 2014-15, but increased to 66,327 in 2016-17. While kaléo asserted that its model increased access to EVZIO, the subcommittee calculated that this also resulted in increased costs to Medicare by more than $142 million in the last four years.

Sources:

https://www.hsgac.senate.gov/imo/media/doc/Naloxone%20Report%20Final%20with%20Annex1.pdf  

https://www.cleveland.com/metro/index.ssf/2018/11/drug_company_raised_opoid_trea.html  

https://www.equities.com/news/naloxone-stocks-who-s-really-winning-the-battle-against-the-opioid-epidemic

EU Ban on Snus

Posted 10-Dec-18

Reuters reports that the European Court of Justice (ECJ) upheld the European Union (EU) ban on the sale of snus in a decision published in November. Snus is banned in all EU countries, except Sweden, which obtained an exemption when it joined the EU in 1995. The snus manufacturing company, Swedish Match, had brought the case to the ECJ through the British High Court, arguing that new scientific data had shown snus use to be less harmful than cigarette smoking. According to Tobacco Reporter, the ECJ ruled that ‘In its judgement the court states that EU legislature has broad discretion within the area at issue and that this implies that judicial review is limited. These limitations apply both to measures decided by the EU legislature and to the basic facts on which these measures have been based. Based on such limited review the court does not find that the ban on snus is manifestly inappropriate.”

Sources:

https://www.reuters.com/article/us-europe-court-swedish-match-idUSKCN1NR1AF

https://www.tobaccoreporter.com/2018/11/snus-ban-stands/

Michigan Votes for Legalizing Cannabis

Posted 10-Dec-18

Michigan voters approved a ballot measure in the midterm elections in November allowing adults over 21 to possess, grow and use small amounts of cannabis legally and introduce a legal and regulated system of cultivation and sales in the state. According to Forbes there will be a 10 percent excise tax on retail sales of cannabis in addition to the state’s regular six percent sales tax. Revenues will cover the cost of regulation, with the remainder used to fund schools, roads, local governments and Food and Drug Administration-approved research on the medical benefits of cannabis for military veterans with PTSD and other conditions. A measure to legalise recreational use of cannabis in North Dakota was rejected by voters. Ballot measures to allow medical use of cannabis were passed in Utah and Missouri.

Sources:

https://www.forbes.com/sites/tomangell/2018/11/06/michigan-voters-approve-marijuana-legalization/#6e0f438447a5

https://theconversation.com/marijuana-expands-into-3-more-states-but-nationwide-legalization-still-unlikely-106512?utm_source=twitter&utm_medium=twitterbutton

Addiction Paper Wins EMCDDA Award

Posted 10-Dec-18

A paper published in Addiction in 2017 has been given a European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) Scientific Award in the category “Demand reduction intervention”. The paper, “Does exposure to opioid substitution treatment in prison reduce the risk of death after release? A national prospective observational study in England” by John Marsden et al. won the award which celebrates scientific writing and distinguishes high-quality research in the field of illicit drugs.

Sources:

http://www.emcdda.europa.eu/news/2018/7/scientific-award-2018_en

http://www.publicnow.com/view/6D79184053DD6DCE1EAC202805CD0639B1354166?2018-11-14-16:00:17+00:00-xxx6911

FDA Announces Plans for Restrictions on Flavoured E-cigarettes and a Ban on Menthol Cigarettes

Posted 10-Dec-18

According to The Guardian, the US Food and Drug Administration (FDA) has announced plans to have all flavoured Electronic nicotine delivery systems (ENDS) sold in age-restricted and in-person locations. If ENDS are sold online, then rigorous age verification procedures will be expected to be in place. The FDA will publish guidance regarding best practices for online sales. Tobacco, mint and menthol flavours or non-flavoured products will be exempt from these restrictions. FDA Commissioner Scott Gottlieb said these measures are aimed at “addressing the disturbing trend of youth nicotine use and continuing to advance the historic declines we’ve achieved in recent years in the rates of combustible cigarette use among kids. The FDA also plans to seek a ban on menthol cigarettes.”

Sources:

https://www.theguardian.com/society/2018/nov/15/fda-announces-sweeping-anti-smoking-measures-to-target-teen-vaping  

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm625884.htm  

https://www.forbes.com/sites/tarahaelle/2018/11/16/public-health-experts-on-new-fda-e-cigarette-rules-its-complicated/#3f18d28e2f71

Use of Medicinal Cannabis Products in UK

Posted 05-Nov-18

The UK Government has rescheduled certain cannabis-based products to allow their medicinal use. The regulations came into force on 1 November 2018. The rescheduling follows reviews of medicinal cannabis use by the UK’s Chief Medical Officer and then by the Advisory Council on the Misuse of Drugs (ACMD). Both reviews recommended that cannabis-based products for medicinal use should be moved from Schedule 1 of the Misuse of Drugs Regulations 2001 into Schedule 2. Drugs in Schedule 1 are considered to have no medicinal value and medical cannabis use had been allowed only in exceptional circumstances and had also required a Home Office licence to be used legally. Moving cannabis-based products into Schedule 2 will mean they can be prescribed medicinally. Doctors in England have been given guidance which says cannabis-based products should be prescribed only when there is clear published evidence of their benefit and other treatment options have been exhausted. The products can be prescribed in cases of children with rare, severe forms of epilepsy; adults with vomiting or nausea caused by chemotherapy; and adults with muscle stiffness caused by multiple sclerosis. The cannabis-based products can be prescribed only by doctors listed on the specialist register of the General Medical Council. The Medicines and Healthcare products Regulatory Agency has published guidance on the supply of unlicensed cannabis-based products for medical use. The guidance includes a checklist for pharmacies dispensing cannabis-based products and states that pharmacists “should ensure before the product is ordered and administered that the prescriber is fully aware of the unlicensed status of the product.”

Sources:

https://www.bbc.co.uk/news/health-46045487

https://www.england.nhs.uk/wp-content/uploads/2018/10/letter-guidance-on-cannabis-based-products-for-medicinal-use..pdf

https://www.pharmaceutical-journal.com/news-and-analysis/news/very-few-people-likely-to-get-prescription-for-medical-cannabis-as-it-becomes-legal-in-the-uk/20205682.article?firstPass=false

EMCDDA Guide to Overdose Prevention

Posted 05-Nov-18

The European Monitoring Centre has produced an interactive guide to preventing overdose deaths. The guide reports that over 9,000 people in Europe (the 28 European Union member states, Turkey and Norway) died from overdoses in 2016, the latest reporting year. The guide outlines the factors that increase the risk of fatal and non-fatal overdoses and then describes interventions that have been developed to prevent these overdoses, concentrating particularly on take-home naloxone.

Source:

http://www.emcdda.europa.eu/topics/pods/preventing-overdose-deaths

Canada Legalizes Cannabis

Posted 05-Nov-18

The BBC reports that on 17 October Canada became the second country after Uruguay to legalize the possession and use of recreational cannabis. Canadian provinces and municipalities were given responsibility for establishing the retail outlets for legal cannabis. Around 110 shops selling cannabis opened on 17 October, according to an Associated Press survey of the provinces and reported in The Guardian. The response by the provinces has been variable. Ontario, the most populous province, does not expect any stores to open until spring 2019. Canadians will be able to order cannabis products through websites run by provinces or private retailers and have it delivered to their homes by mail. The Canadian government has also introduced new drug-impaired driving legislation which raises the maximum penalties for drug driving offences from five years to 10. The police will have expanded powers to conduct roadside tests on drivers regardless of whether they show signs of impaired driving. The new powers also apply to drunk driving, and the requirement of “reasonable suspicion” is no longer needed before conducting a sobriety test. The government has sent information to 15 million households about the new laws and there are also public awareness campaigns.

Sources:

https://www.bbc.co.uk/news/world-us-canada-45806255  

https://www.theguardian.com/world/2018/oct/17/cannabis-becomes-legal-in-canada-marijuana  

https://www.canada.ca/en/health-canada/news/2017/04/backgrounder_changestoimpaireddrivinglaws.html

FDA Action against E-cigarettes Continues

Posted 05-Nov-18

On 12 October the Federal Drug Administration (FDA) sent letters to 21 e-cigarette manufacturers requesting them to provide information to aid an FDA investigation into whether they illegally introduced more than 40 new devices and nicotine liquids to the market without receiving FDA approval. According to CNBC, British American Tobacco, Imperial Brands and Japan Tobacco are among the manufacturers that received letters. E-cigarettes introduced after 8 August 2016 needed first to undergo FDA review in order to be marketed and the FDA are checking whether new product features, formulations or flavours that were launched after this date are violating this policy. FDA Commissioner Scott Gottlieb said "Companies are on notice — the FDA will not allow the proliferation of e-cigarettes or other tobacco products potentially being marketed illegally and outside of the agency's compliance policy, and we will take swift action when companies are skirting the law."

Source:

https://www.cnbc.com/2018/10/12/fda-threatens-to-pull-new-products-from-21-e-cigarette-companies.html

US Opioid Bill Becomes Law

Posted 05-Nov-18

On 24 October the US legislature’s bipartisan bill to address the opioid crisis in the country was signed into law. According to National Public Radio, drug addiction is one of the few issues where polling shows that both Democrats and Republicans agree that it is a problem for the USA. Democrat Senator Maggie Hassan, who supported the bill, echoed the views of critics of the bill who call for more funding to tackle the crisis by saying "Experts in the field tell us that is not nearly enough." In prepared remarks at a conference on 23 October, US Health and Human Services Secretary, Alex Azar, said "We are so far from the end of the epidemic, but we are perhaps at the end of the beginning." Azar called for further efforts to expand access to medication-assisted treatment and naloxone. He also announced a new federal pilot program designed to help mothers with opioid addiction and their children.

Sources:

https://www.npr.org/2018/10/24/660205718/signing-opioid-law-trump-pledges-to-end-scourge-of-drug-addiction?t=1541155664963

https://www.politico.com/story/2018/10/23/opioid-crisis-health-secretary-932332

WHO Report on Alcohol

Posted 05-Nov-18

Alcohol was responsible for more than 5% of all deaths worldwide in 2016, according to the World Health Organization’s Global Status Report on Alcohol and Health 2018. The report, published every four years, provides an overview of alcohol consumption and harms, global policies and policy responses at a national level. Alcohol-use disorders are highest in wealthier nations, according to the report, with the highest prevalence in Europe. Ninety-five percent of countries have alcohol excise taxes, but fewer than half of them use other price strategies such as banning below-cost selling or volume discounts.

Source:

http://www.who.int/substance_abuse/publications/global_alcohol_report/en/

WHO Reviews the International Scheduling of Cannabis

Posted 05-Nov-18

Forbes reports that in October the US Food and Drug Administration (FDA) asked for public comments about the "abuse potential, actual abuse, medical usefulness, trafficking, and impact of scheduling changes on availability for medical use" of cannabis and several other substances under review by the Expert Committee on Drug Dependence (ECDD) of the World Health Organization (WHO). The comments will be considered in preparing a response from the United States to the WHO regarding the abuse liability and diversion of these substances. Cannabis is currently classified in the most restrictive category of Schedule I of the United Nation’s Single Convention on Narcotic Drugs, 1961, which deems cannabis to be of no medicinal value and restricts research into its potential benefits. The assessment of cannabis will be conducted by the ECDD in mid-November and the ECDD’s recommendations will be voted on at a meeting of the Commission on Narcotic Drugs in March 2019.

Source:

https://www.forbes.com/sites/tomangell/2018/10/10/trump-administration-seeks-public-comments-on-marijuana-reclassification/#6e80aa26749a

US Presents Global Drug Action Plan at UN

Posted 08-Oct-18

In September the US administration hosted an event at the 73rd session of the United Nations (UN) General Assembly on the “World Drug Problem.” Only delegates from UN countries that had signed a document circulated by the US, “A Global Call to Action on the World Drug Problem,” were invited to the event. The signatories to the action plan reaffirmed their commitment to the implementation of UN Conventions, as well as the “work of the Commission on Narcotic Drugs (CND) as the policymaking body of the United Nations with prime responsibility for drug control matters.” US officials called for UN member countries’ endorsement for the action plan ahead of the event, telling them it was “a final document and is not open for negotiation,” contrary to normal UN policymaking by deliberation and consensus. According to Reuters, delegates from 129 countries signed the document, including China, Mexico and Canada. But a number of other countries, including countries with, at present, cordial relations with the US, declined to sign the action plan document. Reuters reports that these countries included New Zealand and that the New Zealand Prime Minister, Jacinda Ardern, said “We have a number of challenges that are quite specific to New Zealand and the particular drugs that are present, but also on taking a health approach,” adding, “we want to do what works, and so we’re using a strong evidence base to do that.”

Sources:

https://www.theglobeandmail.com/world/article-canada-signs-on-to-us-led-renewal-of-war-on-drugs/?utm_medium=Referrer:+Social+Network+/+Media&utm_campaign=Shared+Web+Article+Links

https://assets.documentcloud.org/documents/4901223/Global-Call-to-Action-on-the-World-Drug-Problem.pdf  

https://ca.reuters.com/article/topNews/idCAKCN1M41LH-OCATP

Opioid Bill Passed by US Senate

Posted 08-Oct-18

The US Senate passed bipartisan legislation aimed at tackling the US opioid epidemic, called the Support for Patients and Communities Act, on 3 October. The bill was passed after months of hearings and negotiations across various committees in the US legislature. The US House and Senate each passed bipartisan legislation; the final package passed in the Senate is a compromise resulting from those two bills. The bill passed nearly unanimously in the Senate, with only one senator voting against it. The bill takes a wide variety of actions aimed at fighting the crisis, focusing on expanding prevention, treatment and recovery programmes as well as addressing the availability of imported synthetic drugs, especially fentanyl. The bill lifts some limits on Medicaid paying for care at treatment facilities and encourages more research and development of non-opioid pain medication and pain management. The US Department of Health and Human Services is awarding more than $1 billion in grants for states, communities and organizations working to address the opioid crisis. Commentators have observed that the measures and funding announced are not enough address the opioid epidemic. In Vox, Professor Keith Humphreys said of the bill, “This reflects a fundamental disagreement between the parties over whether the government should appropriate the large sums a massive response would require,” adding, “Congress did the next best thing — which is to find agreement on as many second-tier issues as they could.” The bill awaits presidential signing off.

Sources:

https://www.washingtonexaminer.com/policy/healthcare/senate-sends-opioid-package-to-trumps-desk

https://docs.house.gov/billsthisweek/20180924/HR6.pdf

https://www.vox.com/policy-and-politics/2018/9/28/17913938/congress-opioid-epidemic-support-bill-law

South African Court Ruling Allows Personal Use of Cannabis

Posted 08-Oct-18

Reuters reports that on 18 September South Africa’s Constitutional Court ruled in favour of a case presented by four cannabis users who had faced prosecution for using the drug and decriminalized home consumption of cannabis. In its unanimous decision the Court said “the use of cannabis must be for the personal consumption of the adult.” The ruling also approved growing cannabis for personal consumption. The ruling did not specify the amount that can be used by an adult in private use. This is to be determined by the South African parliament, which is expected to amend the laws that criminalize cannabis following the court ruling.

Sources:

https://www.reuters.com/article/us-safrica-cannabis/south-africas-highest-court-gives-green-light-to-private-use-of-cannabis-idUSKCN1LY1M7 

http://saflii.org/za/cases/ZACC/2018/30media.pdf

FDA Begins Campaign against Youth E-cigarette Use

Posted 08-Oct-18

In a Food and Drug Administration (FDA) statement released on 12 September, FDA Commissioner Scott Gottlieb announced new measures to address underage use of flavoured e-cigarettes. Gottlieb said in the statement that “E-cigs have become an almost ubiquitous -- and dangerous -- trend among teens.” Gottlieb also warned that “The FDA won’t tolerate a whole generation of young people becoming addicted to nicotine as a tradeoff for enabling adults to have unfettered access to these same products.” The FDA told five major e-cigarette manufacturers to devise ways to address youth use of their products within 60 days or the agency could require them to stop selling flavored products. CNBC reports that later in the month Gottlieb said that the FDA was considering banning the online sale of e-cigarettes. On 19 September the FDA announced it was introducing “The Real Cost” Youth E-Cigarette Prevention Campaign, aimed at reducing electronic cigarette use among 12-17-year-olds, with warning posters in high school toilets and graphic images of damaged lungs disseminated across digital platforms and social media. On 28 September the FDA seized "thousands of pages of documents" in an unannounced inspection of the leading US e-cigarette maker JUUL's San Francisco headquarters. The FDA said the inspection "sought further documentation related to JUUL's sales and marketing practices, among other things, "building on the FDA’s request in April for company materials related to how JUUL products appeal to young people.

Sources:

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm620185.htm

https://www.cnbc.com/2018/09/25/fda-weighs-ban-on-online-e-cigarette-sales-as-vaping-among-teens-rises.html

https://www.fda.gov/TobaccoProducts/PublicHealthEducation/PublicEducationCampaigns/TheRealCostCampaign/ucm620783.htm  

https://www.cnbc.com/2018/10/02/fda-seizes-documents-in-surprise-inspection-of-e-cigarette-maker-juul.html

Public Health England Collaboration with Alcohol Industry-linked Body Criticised

Posted 08-Oct-18

The decision of the UK government’s public health agency, Public Health England (PHE), to collaborate with Drinkaware, a charity funded by the alcohol industry, for a Drink Free Days campaign prompted the resignation of a PHE senior adviser, Sir Ian Gilmore, and a letter of opposition to the collaboration from over 40 public health experts. According to the BBC, the letter to the PHE said: “Industry-funded messages and social marketing campaigns should not be a substitute for publicly funded campaigns providing independent and evidence-based information.” Professor John Newton, the director of health improvement at PHE, told a national radio programme that “We have ensured that the Drinkaware campaign, which would otherwise possibly be dominated by advice from the industry, is now following our advice and is more likely to improve the health of the population than if we hadn’t got involved.” Professor Newton also said that “Drinkaware already has 10m visits a year to their website from people who drink and who want help. We see that as an opportunity to get messages out to people who are drinking.” The Guardian reported that a Drinkaware spokeswoman insisted the charity was independent and did not speak on behalf of the alcohol industry.

Sources:

https://www.bbc.co.uk/news/health-45502974

https://www.theguardian.com/society/2018/sep/13/public-health-england-urged-to-end-tie-up-with-alcohol-industry

Report on Global Tobacco Health Reduction

Posted 08-Oct-18

Knowledge Action Change, a private sector public health agency, has published No Fire, No Smoke: Global State of Tobacco Harm Reduction. In its executive summary the report says it “maps for the first time the global, regional and national availability and use of safer nicotine products, the regulatory responses to these products, and the public health potential of tobacco harm reduction.” The report observes that “Safer Nicotine Products (SNP) deliver nicotine with a significant reduction in risk as compared to combusted tobacco products” and that “Banning these products, or subjecting them to onerous regulation or high taxation effectively deny access to potentially lifesaving products.”

Source:

https://gsthr.org/download/report/Global-State-of-Tobacco-Harm-Reduction-2018.pdf

San Francisco Safe Injecting Facility Vetoed

Posted 08-Oct-18

On 30 September the Governor of California, Jerry Brown, vetoed a bill to establish a pilot safe injecting programme in San Francisco. Brown said in his veto statement that “Fundamentally, I do not believe that enabling illegal drug use in government sponsored injection centers – with no corresponding requirement that the user undergo treatment – will reduce drug use.” He also expressed fears that San Francisco officials and health professionals could be vulnerable to federal prosecution for facilitating drug use if the programme went ahead. In the San Francisco Examiner one of the co-authors of the bill, Assemblyman Scott Wiener, said “We should not allow threats from a backward federal government [to] stop us from helping people who are dying on our streets," adding, “These sites save lives, and today's veto is definitely a lost opportunity."

Sources:

https://www.gov.ca.gov/wp-content/uploads/2018/09/AB-186-veto-9.30.pdf

http://www.sfexaminer.com/202918-2/