Correlation between Cocaine Prices and Purity with Trends in Emergency Department Visits in a Major Metropolitan Area

Zhu, He; Wilson, Fernando A.; Stimpson, Jim P.; Pagán, José A.

doi:10.1007/s11524-014-9899-y

Cited by 13 publications

(6 citation statements)

References 20 publications

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“…In this study cocaine co-detections had the largest increase of any co-detected substance, with 34% more cases reported in 2020 than in 2013. The purity of both powder and crack cocaine has concurrently risen in the United Kingdom (PHE, 2021), and a positive correlation between cocaine purity and emergency department visits has been observed (Zhu et al., 2014), which may explain in part the rise in fatalities with cocaine co-detections.…”

Section: Discussionmentioning

confidence: 99%

Can cannabis kill? Characteristics of deaths following cannabis use in England (1998–2020)

et al. 2022

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Background: Cannabis is the most widely used illegal drug but is rarely considered a causal factor in death. Aims: This study aimed to understand trends in deaths in England where cannabinoids were detected at post-mortem, and to evaluate the clinical utility of post-mortem cannabinoid concentrations in coronial investigations. Methods: Deaths with cannabinoid detections reported to the National Programme on Substance Abuse Deaths (NPSAD) were extracted and analysed. Results: From 1998 to 2011, on average 7% of all cases reported to NPSAD had a cannabinoid detected ( n = 110 deaths per year), rising to 18% in 2020 ( n = 350). Death following cannabis use alone was rare (4% of cases, n = 136/3455). Traumatic injury was the prevalent underlying cause in these cases (62%, n = 84/136), with cannabis toxicity cited in a single case. Polydrug use was evident in most cases (96%, n = 3319/3455), with acute drug toxicity the prevalent underlying cause (74%, n = 2458/3319). Cardiac complications were the most cited physiological underlying cause of death (4%, n = 144/3455). The median average Δ9-tetrahydrocannabinol post-mortem blood concentrations were several magnitudes lower than previously reported median blood concentrations in living users (cannabis alone: 4.3 µg/L; cannabis in combination with other drugs: 3.5 µg/L). Conclusions: Risk of death due to cannabis toxicity is negligible. However, cannabis can prove fatal in circumstances with risk of traumatic physical injury, or in individuals with cardiac pathophysiologies. These indirect harms need careful consideration and further study to better elucidate the role cannabis plays in drug-related mortality. Furthermore, the relevance of cannabinoid quantifications in determining cause of death in coronial investigations is limited.

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Section: Discussionmentioning

confidence: 99%

Can cannabis kill? Characteristics of deaths following cannabis use in England (1998–2020)

et al. 2022

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“…That is, increased PAP is associated with lower harm, and reduced PAP is associated with increased harm. All exceptions can be explained by the price series failing to adjust for purity (eg Zhu et al 2014) or the study's focus on outcomes for which theory predicts effects may differ (eg treatment). In that regard, consistent with economic theory, there were subtle differences in outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Five US studies examined the relationship between price, purity and PAP and ED admissions. All except one (which did not employ PAP: Zhu et al (2014)) found an inverse relationship between PAP and ED admissions (Table A1). This means an increase in PAP was associated with a reduction in ED admissions.…”

Section: Health Outcomesmentioning

confidence: 99%

The relationship between drug price and purity and population level harm

Hughes¹,

Hulme²,

Ritter³

2020

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In illicit drug markets, the price and purity of drugs change frequently. While it is well known that purity-adjusted price affects drug use, impacts on other outcomes are less clear. This rapid review examines the relationship between price, purity and seven population level measures of drug-related harm and any differences across three drug types. With a few exceptions, it found an inverse relationship between purity-adjusted price and drug-related harm, with higher purity-adjusted price associated with less drug-related harm, and lower purity-adjusted price associated with increased harm. This shows the value of price and purity data for predicting drug market impacts and the importance of improving price and purity data collection and analyses, particularly in Australia.

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“…Forty-six drugs were analyzed against NADAC in this process ( Supplementary Table 2) and split into categories of drug type (Supplementary Table 1). Other drugs did not share similar NADAC names and/or did not have sufficient longitudinal data to build statistical power even though they did qualify as n > 30 [19]. These drugs were not included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

Leveraging NADAC to Steer Drug Formularies in Resource-Limited Clinics

Warburton

Serafini

Shuham

et al. 2019

Journal of Scientific Innovation in Medicine

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Objectives: Free medical clinics provide healthcare to populations with limited options for insurance coverage and are thus key medical safety nets. Such clinics have limited operating budgets due in part to their lack of revenue streams through insurance reimbursements. Thus, pharmaceutical acquisitions can impose significant financial burdens in light of rising and volatile prices [1]. The goal of this study was to provide clinics with a real-time comparison of national retail pharmacy acquisition prices against clinic purchasing prices to determine potentially overpriced drugs. Methods: Historical ledger data from the East Harlem Health Outreach Program (EHHOP) at Mount Sinai was used to determine the clinic's average price and volatility for specific drugs over time. Average prices were cross-referenced against the publicly available National Average Drug Acquisition Cost (NADAC) database, which outlines the average acquisition cost of drugs by retail pharmacies across the United States. Results: This analysis demonstrated that 36% (16/45) of EHHOP drug price averages were significantly different than relative NADAC values, with 9% (4/45) more expensive and 27% (12/45) cheaper. Price volatility between EHHOP and NADAC acquisition prices varied. Assuming the NADAC benchmark for significantly more expensive EHHOP purchases resulted in potential savings of $4,424 (6% of budget) over the projected period. Conclusions: Clinic drug acquisition price comparison to NADAC database prices serves as an effective benchmark for cost reduction. In order to implement change after expensive drug identification, we developed a decision-tree model that outlines several steps that can reduce drug expenditures. Using this process can potentially save financial resources for medical clinics.

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Correlation between Cocaine Prices and Purity with Trends in Emergency Department Visits in a Major Metropolitan Area

Cited by 13 publications

References 20 publications

Can cannabis kill? Characteristics of deaths following cannabis use in England (1998–2020)

Can cannabis kill? Characteristics of deaths following cannabis use in England (1998–2020)

The relationship between drug price and purity and population level harm

Leveraging NADAC to Steer Drug Formularies in Resource-Limited Clinics

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