Going international? Risk taking by cryptomarket drug vendors

BackgroundSince 2011, we have witnessed the rise of ‘dark net’ drug marketplaces known as cryptomarkets. Cryptomarkets operate on the same model as eBay as they provide a platform where authorized vendors can set up a virtual shop and place listings. Building on a growing body of literature that seeks to understand cryptomarket participants, this paper seeks to explain the decision of cryptomarket vendors to take on risk.MethodsWe collected data on Silk Road 1 (SR1), the first cryptomarket launched in 2011. We propose a multilevel model that takes into account the characteristics of listings, vendors and their environment to explain the decision of vendors to take on risk.ResultsOur results demonstrate that all levels in the model significantly explain the decision to take on risk. Risk taking, operationalized as a willingness to ship drugs across international borders, was associated with the weights of drug packages mailed, the vendors’ reputations and numbers of listings, the country-level perceived effectiveness of law enforcement according to experts, and the opportunities available to vendors as measured by the wealth and the drug expenditures of potential customers.ConclusionsOur results support some previous research findings on the factors explaining risk taking. We extend existing literature by emphasizing the relevance of the environment of drug dealers to predict risk taking.     

Delivery dilemmas: How drug cryptomarket users identify and seek to reduce their risk of detection by law enforcement

BackgroundCryptomarkets represent an important drug market innovation by bringing buyers and sellers of illegal drugs together in a ‘hidden’ yet public online marketplace. We ask: How do cryptomarket drug sellers and buyers perceive the risks of detection and arrest, and attempt to limit them?MethodsWe analyse selected texts produced by vendors operating on the first major drug cryptomarket, Silk Road (N = 600) alongside data extracted from the marketplace discussion forum that include buyer perspectives. We apply Fader’s (2016) framework for understanding how drug dealers operating ‘offline’ attempt to reduce the risk of detection and arrest: visibility reduction, charge reduction and risk distribution.ResultsWe characterize drug transactions on cryptomarkets as ‘stretched’ across time, virtual and physical space, and handlers, changing the location and nature of risks faced by cryptomarket users. The key locations of risk of detection and arrest by law enforcement were found in ‘offline’ activities of cryptomarket vendors (packaging and delivery drop-offs) and buyers (receiving deliveries). Strategies in response involved either creating or disrupting routine activities in line with a non-offending identity. Use of encrypted communication was seen as ‘good practice’ but often not employed. ‘Drop shipping’ allowed some Silk Road vendors to sell illegal drugs without the necessity of handling them.ConclusionSilk Road participants neither viewed themselves as immune to, nor passively accepting of, the risk of detection and arrest. Rational choice theorists have viewed offending decisions as constrained by limited access to relevant information. Cryptomarkets as ‘illicit capital’ sharing communities provide expanded and low-cost access to information enabling drug market participants to make more accurate assessments of the risk of apprehension. The abundance of drug market intelligence available to those on both sides of the law may function to speed up innovation in illegal drug markets, as well as necessitate and facilitate the development of law enforcement responses.     

药品不良反应报告184例分析

目的探讨该院药品不良反应(ADR)报告发生规律和特点。方法对184例ADR报告进行回顾性分析。结果 184例ADR中,由抗微生物药物引起的ADR居首位137例(64.0%);ADR临床表现以皮肤及附件损害最为常见183例(52.7%);严重的ADR16例(8.7%);由静脉滴注给药引起ADR最多[167例(78.0%)]。结论 ADR监测工作仍需努力改进,报告的例数和质量有待提高;加强合理用药以减少和避免ADR的发生,不断提高用药安全和ADR监测技术。     

Adolescent stigma towards drug addiction: Effects of age and drug use behaviour

The objective of this study was to examine adolescent age and experience with drug use on stigmatizing attitudes toward drug addiction. Data were derived from the  2005 cycle of the Ontario Student Drug Use Survey. In total, 4078, 7- to 12-graders completed self-administered questionnaires that included a measure of drug abuse stigma. Results indicated that stigma scores were higher among younger than older adolescents, and the decline across age was robust, occurring among both males and females and those from rural and non-rural areas. The decline, however, was stronger among non-drug users and among those who had no close friends that use drugs. Despite the age-related decline, the level of stigma in general suggested that drug abuse stigma may continue into adulthood. Findings highlight that individual attitudes toward drug use and drug abusers are salient factors for personal drug use. Given that stigma is a barrier to treatment, but reduced stigma may encourage greater adolescent use, this study highlights the need for more in-depth studies of drug stigma.     

我院开展药物咨询工作调查分析

目的总结该院药物咨询工作情况,提高药物咨询服务质量。方法回顾性分析该院2009年12月-2010年12月856次药物咨询资料,并进行分类整理,对咨询者身份、咨询内容及咨询药物的类别做出分析和总结。结果药物咨询对象以患者及家属居多,占82.01%;咨询内容以药品用法用量、不良反应为主,分别占30.14%、21.61%;咨询药品类型主要以抗生素类及心脑血管类药物为主,分别占25.12%、19.39%。结论药物咨询工作的开展为患者用药的安全性、有效性及合理性提供了有利保障,真正体现了＂以患者为中心＂的服务理念,是目前医疗改革的一个重要措施。     

Changes in patterns of drug injection concurrent with a sustained reduction in the availability of heroin in Australia

Between 1996 and 2000, heroin was the drug most frequently injected in Australia, and viable heroin markets existed in six of Australia's eight jurisdictions. In 2001, there was a dramatic and sustained reduction in the availability of heroin that was accompanied by a substantial increase in its price, and a 14% decline in the average purity of seizures analysed by forensic laboratories. The shortage of heroin constitutes a unique natural experiment within which to examine the impact of supply reduction. This paper reviews one important correlate of the shortage, namely changes in patterns of illicit drug injection. A number of studies have consistently suggested that between 2000 and 2001, there was a sizeable decrease in both prevalence and frequency of heroin injection among injecting drug users. These changes were accompanied by increased prevalence and frequency of stimulant injection. Cocaine was favoured in NSW, the sole jurisdiction in which a cocaine market was established prior to the heroin shortage; whereas methamphetamine predominated in other jurisdictions. Some data suggest that, at least in the short-term, some drug injectors left the market altogether subsequent to the reduced heroin availability. However, the findings that (1) some former heroin users switched their drug preference to a stimulant; and (2) subsequently attributed this change to the reduced availability of heroin, suggests that reducing the supply of one drug may serve to increase the use of others. Given the differential harms associated with the use of stimulants and opiates, this possibility has grave implications for Australia, where the intervention and treatment system is designed primarily to accommodate opiate use and dependence.     

门诊慢性病患者药物咨询情况分析

目的分析我院门诊慢性病(高血压、糖尿病)患者药物咨询的开展情况,探讨提高药物咨询质量的办法。方法抽查门诊慢性病患者药物咨询报告,以咨询的方式、咨询的内容和咨询的结果满意度等作为考察的指标,并进行回顾性分析。结果患者对药物选择信息的咨询占总咨询量的27.44%;对药物基本信息的咨询占47.99%,对药品相关信息的咨询占13.00%;其他信息的咨询占11.57%。结论药物咨询是慢性病患者获得用药信息的重要途径,也是提高医院药学服务质量、促进合理用药的有效办法。     

Adolescent ecstasy and other drug use in the National Survey of Parents and Youth: the role of sensation-seeking, parental monitoring and peer's drug use

The association between high sensation-seeking, close friends' drug use and low parental monitoring with ecstasy (MDMA) use in adolescence was examined in a sample of US household-dwelling adolescents aged 12-18 years (N=5049). We also tested whether associations were of stronger magnitude than associations between these correlates and marijuana or alcohol/tobacco use in adolescence. Data from Round 2 of the National Survey of Parents and Youth (NSPY) Restricted Use Files (RUF) was analyzed via Jackknife weighted multinomial logistic regression models. High sensation-seekers were more likely to be ecstasy, marijuana, and alcohol/tobacco users, respectively, as compared to low sensation-seekers. High sensation-seeking and close friends' drug use were more strongly associated with ecstasy as compared to marijuana and alcohol/tobacco use. Low parental monitoring was associated with marijuana use and alcohol/tobacco use and there was a trend for it to be associated with ecstasy use. Ecstasy use is strongly associated with peer drug use and more modestly associated with high sensation-seeking. School prevention programs should target high-sensation-seeking adolescents and also encourage them to affiliate with non-drug using peers.     

The cost of drug use in adolescence: Young people, money and substance abuse

It is now common for young people in full-time compulsory education to hold part-time jobs. However, while the 1990s experienced a rise in illicit drug use particularly among young people and an increase in the level of interest in identifying factors associated with drug use, little attention has been paid to the influence of the money young people have to spend and its potential links with drug use. Four thousand five hundred and twenty-four young people living in Northern Ireland completed a questionnaire in school year 10 (aged 13/14 years). The findings suggested that there was a positive association between the amount of money young people received (and its source) and higher rates of drug use. The study concludes that money, and how it is spent by young people, may be an important factor for consideration when investigating drug use during adolescence. The findings may help inform drug prevention strategies, particularly through advice on money management, and taking responsibility for their own money.     

Marriage, mortgage, motherhood: what longitudinal studies can tell us about gender, drug 'careers' and the normalisation of adult 'recreational' drug use

Through a consideration of quantitative and qualitative data obtained from young women aged 18-28 in the later years of the North West England Longitudinal Study, this paper explores how women's drug careers develop, progressing the authors' normalisation thesis of 'recreational' drug use from adolescence into adulthood. Longitudinal studies are here compared with repeated cross-sectional surveys more usually favoured and funded by governments. The authors argue that firstly, in relation to methodology, longitudinal studies provide a unique opportunity to elucidate how drug careers develop across the life course and to chart the various impacts of life events and transitions on these careers and vice versa. Secondly, through this exploration of gender differences in drug careers and life transitions, we develop an age and gender-sensitive understanding of how recreational drug use fits into women's adult lives. The paper concludes that the challenge for policy makers is how to address adult women's 'normalised' recreational drug use, in the face of a regime focused on educational provision aimed at adolescent prevention; public health information designed for teenagers; and treatment resources focused on predominantly male and non parenting problem drug users, and the links between addiction and acquisitive crime.     

The Melding of Drug Markets in Houston After Katrina: Dealer and User Perspectives

In the aftermath of Hurricane Katrina, the majority of routine activities in New Orleans were disrupted, including the illegal drug market. The large-scale relocation of New Orleans evacuees (NOEs), including many illegal drug users and sellers, to host cities led to a need for new sources of illegal drugs. This need was quickly satisfied by two initially distinct drug markets (1) drug dealers from New Orleans who were themselves evacuees and (2) established drug dealers in the host cities. To be expected, the two markets did not operate indefinitely in parallel fashion. This paper describes the evolving, operational relationship between these two drug markets over time, with a focus on Houston. We analyze the reciprocal evolution of these two markets at two significant points in time: at the beginning of the relocation (2005) and two years later (2007). The overall trend is towards a melding of the two drug markets, as evidenced primarily by decreases in drug-related violence and the cross-fertilization of drug tastes. We describe the process by which the two drug markets are melded over time, in order to seek a better understanding of the social processes by which drug markets in general evolve.     

Dust in the Wind: The Growing Use of Embalming Fluid Among Youth in Hartford,CT

This study suggests that use of embalming fluid as a mind-altering drug has been underreported. Based on a social network recruitment strategy, findings from a study in 2000 of 401 outreach worker-recruited polydrug-involved youth (ages 16–24 years) from the inner city of Hartford, CT indicate widespread (over 80% of study participants had used the drug at least once) and regular use of embalming fluid mixed with either marijuana or mint. This paper reports findings on frequency and distribution of use, experience, and consequences of use, access to the drug, and characteristics of embalming fluid users. Given the toxic substances that comprise embalming fluid, and the tendency, affirmed in the present study, of the drug to be associated with violent behavior, there is a need to recognize embalming fluid as a drug of concern among youth.     

2001—2005年某院抗生素使用情况及革兰阴性细菌耐药性分析

目的了解2001—2005年抗生素使用情况和使用水平以及临床分离的非发酵革兰阴性杆菌及部分肠杆菌科革兰阴性杆菌的耐药现状,为科学合理使用该类抗生素提供必要参考依据。方法调查山西医科大学第二医院2001—2005年5年间抗生素的使用消耗情况以及临床药敏试验结果,采用世界卫生组织(WHO)推荐的限定日剂量(DDD)法分析各种抗菌药的用药频度(DDDs);用VITEK2系统对临床分离菌株进行鉴定,采用K-B纸片扩散法及VITEK2系统对所分离的革兰阴性杆菌进行药敏试验,用2004版美国实验室标准化委员会(CLSI)标准对结果进行判定,用WHONET5.3软件对数据进行统计学分析。结果5年来革兰阴性杆菌分离株除2003年外呈逐年上升趋势,其构成比分别为41.0%、40.0%、45.3%、37.0%、54.0%;非发酵革兰阴性杆菌逐年上升,尤其是鲍曼不动杆菌2004、2005年其分离分别达到了182、334株,而2001年只有21株;非发酵革兰阴性杆菌耐药率普遍较高,鲍曼不动杆菌除对亚胺培南仍保持着较好的敏感性外(≤10.0%),对其他抗生素2004年以后耐药率几乎都超过了50.0%,对头孢哌酮+舒巴坦的耐药率2005年达到42.0%;在肠杆菌细菌中对亚胺培南的耐药率都很低,几乎为0,对头孢哌酮+舒巴坦的耐药率除阴沟肠杆菌外,其耐药率大部分在30.0%以下;在肠杆菌细菌中耐药最严重的为阴沟肠杆菌,除对亚胺培南外,对其他抗生素几乎都超过了50.0%。在对抗生素的使用调查中,抗生素的总DDDs2003年达到高峰,以后有下降趋势;销售金额逐年上升,但与年总药物销售金额构成比2003年达高峰,占42.8%,以后逐年下降,2005年占28.2%;头孢霉素在5年间的DDDs没有太大的变化,但复合制剂的DDDs在2004、2005年上升幅度很大,亚胺培南的DDDs5年来虽略有增加但仍保持DDDs较低水平,分别为133,140,157,254,422。喹诺酮类在连续高的DDDs后,2005年有所下降。结论细菌耐药与抗生素的过多使用有直接关系,我院通过加强对抗生素的使用管理,已经取得了一定成效,但仍存在不合理因素。     

Reducing the risks of drug use: The case for set and setting

The central proposition of this article is that if people are thoughtful, well-prepared and aware of the means and best environments for using a particular drug, then the risks associated with the use of a particular drug – any drug – can be minimal. The types of drugs discussed in this context focus on those assumed to be the most ‘addictive’ – heroin and cocaine – to those less well-known but potentially more hazardous to use without prior knowledge and preparation – such as Yage and Fly Agaric. This proposition is discussed in the context of different definitions of relatively non-problematic patterns of drug use, specifically: controlled, recreational and unobtrusive. It is concluded that while the effect of taking a particular drug is a primary motivation to the user, the role of set and setting are of fundamental importance in ensuring that the effects of that drug are as intended for and expected by the user.     

The validity and reliability of the global index of safety (GIS)

Objective: The global index of safety (GIS) is an adverse event (AE) based instrument designed to evaluate the safety profile of drugs. This paper presents the evaluation of the inter-rater reliability and validity of a 94-item GIS for antipsychotics through Rasch analysis.

Research design and methods: A total of 194 psychiatrists participating in an outpatient pharmacoepidemiologic study of olanzapine in schizophrenia rated the severity that each AE would have on a 5-point scale. Reliability was

determined through a paired comparison design involving the new independent ratings of 101 different psychiatrists participating in another study of olanzapine in acute inpatient units. Spearman's, Pearson's and Intra-class correlation (ICC) coefficients were used to estimate the interrater reliability of the AE weights. Validity was analyzed through the Rasch rating scale model.

Results: Reliability coefficient estimates were excellent (Spearman = 0.99, Pearson = 0.99, ICC = 0.98), supporting the inter-rater reliability of the item weights. Through goodness-of-fit statistics and the investigation of the hierarchy of item calibrations, Rasch analysis confirmed the validity of the instrument.

Conclusion: The data presented here on interrater reliability estimates of adverse events related to antipsychotic drugs indicate that GIS is a promising alternative for the evaluation of the safety profile of drugs.     

Drug use and drug markets in the context of political conflict: The case of Northern Ireland

The focus of this article addresses drug use and drug markets in Northern Ireland against the backdrop of the most recent Irish political conflict, e.g., 1969 to the present. Between 1969 and 1999, a total of 3289 individuals had died and more than 40?000 were injured as a result of the Northern Ireland political conflict. Extrapolating the data to Britain, comparable figures would reflect 111?000 fatalities and over one million injured (Hayes and McAllister, 2000). This paper describes how the nature of the Northern Ireland political conflict contributed to low levels of drug use in the 1970s and 1980s. In 1994, the cessation of military operations by the Irish Republican Army (IRA) and subsequently by mainstream Loyalist organizations led to the possibility of widespread political and social change. Use of certain drugs, namely heroin, appeared to increase from the mid-1990s, although the effects of political conflict on drug use are less clear during the post-ceasefire era.