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Posts tagged Public Health
A Qualitative Evaluation of a Fentanyl Patch Safer Supply Program in Vancouver, Canada

By Alexa Norton, Andrew Ivsins, Elizabeth Holliday, Christy Sutherland, Thomas Kerr, Mary Clare Kennedy

Background: The ongoing overdose crisis in Canada has prompted efforts to increase access to a “safer supply” of prescribed alternatives to the unregulated drug supply. While safer supply programs predominantly distribute hydromorphone tablets, the Safer Alternatives for Emergency Response (SAFER) program in Vancouver, Canada offers a range of prescribed alternatives, including fentanyl patches. However, little is known about the effectiveness of fentanyl patches as safer supply. Drawing on the perspectives and experiences of program participants, we sought to qualitatively evaluate the effectiveness of the SAFER fentanyl patch program in meeting its intended aims, including reducing risk of overdose by decreasing reliance on the unregulated drug supply. Methods: As part of a larger mixed-methods evaluation of SAFER, semi-structured qualitative interviews were conducted with 17 fentanyl patch program participants between February 2022 and April 2023. Thematic analysis of interview data focused on program engagement, experiences, impacts, and challenges. Results: The flexible program structure, including lack of need for daily dispensation, the extended missed dose protocol, and community pharmacy patch distribution fostered engagement and enhanced autonomy. Improved management of withdrawal symptoms and cravings due to steady transdermal dosing led to reduced unregulated drug use and overdose risk. Participants also experienced economic benefits and improvements in overall health and quality of life. However, skin irritation and patch adhesion issues were key barriers to program retention. Conclusion: Our findings demonstrate the value of including fentanyl patch safer supply in the substance use continuum of care and offer insights for innovations in delivery of this intervention.

International Journal of Drug Policy Volume 131, September 2024, 104547

The Lancet Public Health Commission on Gambling

By Heather Wardle, Louisa Degenhardt, Virve Marionneau, Gerda Reith, Charles Livingstone, Malcolm Sparrow

The global gambling industry The global gambling industry is rapidly expanding, with net losses by consumers projected to reach nearly US$700 billion by 2028. Industry growth is fuelled by the rise of online gambling, widespread accessibility of gambling opportunities through mobile phones, increased legalization, and the introduction of commercial gambling to new areas. Recent expansion is most notable in low-income and middle-income countries, where regulatory infrastructure is often weak. Gambling, in some form at least, is now legally permitted in more than 80% of countries worldwide. Online gambling, given its borderless accessibility, is available everywhere via the internet. Digitalization has transformed the production and operation of commercial gambling, but the consequences of this shift and its effects on consumers have not yet been fully recognized. The production of online gambling is interconnected with an ecosystem of software, information technology infrastructure, and financial technology services. The commercial gambling industry has also developed strong partnerships in media and social media. Sponsoring and partnering with professional sports organizations provides gambling operators with marketing opportunities with huge new audiences. This far-reaching and interdependent corporate ecosystem collectively wields substantial influence over policy and has multiple points of contact through which to leverage the behavior of consumers. Online gambling products are designed to be rapid and intensive, characteristics that are associated with a higher risk of harm for consumers. The introduction of in-game betting during live matches has made online sports betting instantaneous and increased both its frequency and prevalence. Traditional gambling products, such as lotteries and bingo, now have faster cycles and are continuously accessible through smartphone apps. The boundaries between digital gaming and gambling are becoming blurred, with gaming increasingly acting as a conduit to gambling. Leveraging online digital infrastructures and surveillance data, gambling companies now have unparalleled capabilities to target consumers, including through the use of social media and influencers to engage individuals and online user data to tailor marketing to individuals, cross-sell products, and prolong user engagement. To safeguard their interests, stakeholders in the commercial gambling ecosystem deploy a range of strategies, many of which are similar to those used by other industries selling potentially addictive or health-harming products. To shape public and policy perceptions, and as they lobby policymakers directly to further their commercial interests, the industry portrays gambling as harmless entertainment and stresses the economic benefits (including tax revenues) and employment opportunities that the industry provides. The gambling industry particularly stresses the social benefits that accrue when some portion of gambling profits are used to fund education, health services, or other worthwhile social causes. According to industry narratives, responsibility for gambling harm is attributed to individuals, particularly those deemed as engaging in problematic gambling, which deflects attention from corporate conduct. The gambling industry also exerts considerable influence over research into gambling and gambling harms, which helps it retain control of the framing and messaging surrounding these issues. Industry messaging has substantially influenced gambling policy and regulation. Most policy solutions to gambling harms rest on the notion of individual responsibility. Providing support services, treatments, and protections for at-risk individuals is, of course, important. Improving these remedies further and making protective supports broadly available remains a priority. However, framing the problem in this way and narrowly focusing policy attention on a small subset of the people who gamble draws attention away from industry practices and Key messages • Commercial gambling is a rapidly growing global industry and is becoming increasingly digital. • The harms to health and wellbeing that result from gambling are more substantial than previously understood, extending beyond gambling disorder to include a wide range of gambling harms, which affect many people in addition to individuals who gamble. • The evolution of the gambling industry is at a crucial juncture; decisive action now can prevent or mitigate widespread harm to population health and wellbeing in the future. Thus far, globally, governments have paid too little attention to gambling harms and have not done enough to prevent or mitigate them. • Stronger policy and regulatory controls focused on harm prevention and the protection of public health and wellbeing, independent of industry or other competing influences, are now needed. Given the increasingly global and boundary-spanning nature of the industry, international coordination on regulatory approaches will be necessary for corporate behavior. We must also seriously examine the structures and systems that govern the design, provision, and promotion of gambling products. 

Lancet Public Health, Oct. 2024.

The Prevalence of Gambling and Problematic Gambling: a Systematic Review and Meta-Analysis 

 By Lucy T Tran, Heather Wardle, Samantha Colledge-Frisby, Sophia Taylor, Michelle Lynch, Jürgen Rehm, Rachel Volberg, Virve Marionneau, Shekhar Saxena, Christopher Bunn, Michael Farrell, Louisa Degenhardt

Gambling behaviors have become of increased public health interest, but data on prevalence remain scarce. In this study, we aimed to estimate for adults and adolescents the prevalence of any gambling activity, the prevalence of engaging in specific gambling activities, the prevalence of any risk gambling and problematic gambling, and the prevalence of any risk and problematic gambling by gambling activity. Methods We performed a systematic review and meta-analysis. We systematically searched for peer-reviewed literature (on MEDLINE, Embase, and PsycInfo) and grey literature to identify papers published between Jan 1, 2010, and March 4, 2024. We searched for any gambling, including engagement with individual gambling activities, and problematic gambling data among adults and adolescents. We included papers that reported the prevalence or proportion of a gambling outcome of interest. We excluded papers of non-original data or based on a biased sample. Data were extracted into a bespoke Microsoft Access database, with the Joanna Briggs Institute Critical Appraisal Tool used to identify the risk of bias for each sample. Representative population survey estimates were firstly meta-analyzed into country-level prevalence estimates, using metaprop, of any gambling, any risk gambling, problematic gambling, and by gambling activity. Secondly, population-weighted regional-level and global estimates were generated for any gambling, any risk gambling, problematic gambling, and specific gambling activity. This review is registered on PROSPERO (CRD42021251835). Findings We screened 3692 reports, with 380 representative unique samples, in 68 countries and territories. Overall, the included samples consisted of slightly more men or male individuals, with a mean age of 29·72 years, and most samples identified were from high-income countries. Of these samples, 366 were included in the meta-analysis. Globally, 46·2% (95% CI 41·7–50·8) of adults and 17·9% (14·8–21·2) of adolescents had gambled in the past 12 months. Rates of gambling were higher among men (49·1%; 45·5–52·6) than women (37·4%; 32·0–42·5). Among adults, 8·7% (6·6–11·3) were classified as engaging in any risk gambling, and 1·41% (1·06–1·84) were engaging in problematic gambling. Among adults, rates of problematic gambling were greatest among online casino or slots gambling (15·8%; 10·7–21·6). There were few data reported on any risk and problematic gambling among adolescent samples. Interpretation Existing evidence suggests that gambling is prevalent globally, that a substantial proportion of the population engage in problematic gambling, and that rates of problematic gambling are greatest among those gambling on online formats. Given the growth of the online gambling industry and the association between gambling and a range of public health harms, governments need to give greater attention to the strict regulation and monitoring of gambling globally 

The Lancet Public Health, August 2024. Vol 9 August 2024  

Deaths: Leading Causes for 2020

By Sally C. Curtin,  Betzaida Tejada-Vera, and Brigham A. Bastian

Objectives—This report presents final 2020 data on the 10 leading causes of death in the United States by age, race and Hispanic origin, and sex. Leading causes of infant, neonatal, and post-neonatal death are also presented. This report supplements “Deaths: Final Data for 2020,” the National Center for Health Statistics’ annual report of final mortality statistics. Methods—Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2020. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD–10) are ranked according to the number of deaths. Cause-of-death statistics are based on the underlying cause of death. Race and Hispanic-origin data are based on the Office of Management and Budget’s 1997 standards for reporting race and Hispanic origin. Results—In 2020, many of the 10 leading causes of death changed rank order due to the emergence of COVID-19 as a leading cause of death in the United States. The 10 leading causes of death in 2020 were, in rank order: Diseases of heart; Malignant neoplasms; COVID-19; Accidents (unintentional injuries); Cerebrovascular diseases; Chronic lower respiratory diseases; Alzheimer disease; Diabetes mellitus; Influenza and pneumonia; and Nephritis, nephrotic syndrome and nephrosis. They accounted for 74.1% of all deaths occurring in the United States. Differences in the rankings are evident by age, race and Hispanic origin, and sex. Leading causes of infant death for 2020 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage.   

Hyattsville, MD: National Vital Statistics Reports; Centers for Disease Control and Prevention. 2023, 115pg

Overdose mortality incidence and supervised consumption services in Toronto, Canada: an ecological study and spatial analysis

By Indhu Rammohan, Tommi Gaines, Ayden Scheim, Ahmed Bayoumi, Dan Werb

Supervised consumption services (SCS) prevent overdose deaths onsite; however, less is known about their effect on population-level overdose mortality. We aimed to characterise overdose mortality in Toronto, ON, Canada, and to establish the spatial association between SCS locations and overdose mortality events.

Canada, Lancet Public Health. 2024, 9pg