ArticleInternational journal of mental health systems2021
Shifting North American drug markets and challenges for the system of care.
Article in International journal of mental health systems, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Systematic review on intentional non-medical fentanyl use among people who use drugs.Frontiers in psychiatry · 2024Pooled it
- Sensitivity to change of generic preference-based instruments (EQ-5D-3L, EQ-5D-5L, and HUI3) in the context of treatment for people with prescription-type opioid use disorder in Canada.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2023Trial
- Self-Injury Mortality: Global Ascertainment and Prevention.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2026Review
- Computational design of dynamic biosensors for emerging synthetic opioids.Nature communications · 2026Article
- Computational design of dynamic biosensors for emerging synthetic opioids.bioRxiv : the preprint server for biology · 2025Article
- Chronic pain among primary fentanyl users: The concept of self-medication.European journal of pain (London, England) · 2025Article
- "Everybody looks at it as drug use instead of pain management": Experiences of chronic pain and its management among older people living with HIV who use drugs in Vancouver, British Columbia.Drug and alcohol dependence · 2024Article
- [Challenges in the treatment of opioid dependence].Der Nervenarzt · 2024Review
- Safety strategies and harm reduction for methamphetamine users in the era of fentanyl contamination: A qualitative analysis.The International journal on drug policy · 2024Article
- A Call for an Evidence-Based Strategy Against the Overdose Crisis.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2024Article
- What impact did the COVID-19 pandemic have on the variability of fentanyl concentrations in the Vancouver, Canada illicit drug supply? An interrupted time-series analysis.BMJ public health · 2023Article
- Shifting drug markets in North America - a global crisis in the making?International journal of mental health systems · 2023Article
- Article
- Article
- The Fentanyl System Shock - Are There Lessons to Learn From the COVID-19 System Shock Framework? Comment on "The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic".International journal of health policy and management · 2023Article
- Changes in supervised consumption site use and emergency interventions in Montréal, Canada in the first twelve months of the COVID-19 pandemic: An interrupted time series study.The International journal on drug policy · 2022Article
- The upcoming synthetic ultrapotent opioid wave as a foreseeable disaster.The lancet. Psychiatry · 2022Article
- Towards an International Consensus on the Prevention, Treatment, and Management of High-Risk Substance Use and Overdose among Youth.Medicina (Kaunas, Lithuania) · 2022Article
- Case report: acute care management of severe opioid withdrawal with IV fentanyl.Addiction science & clinical practice · 2022Article
- Ending the overdose epidemic by ending the war on drug users: Can this work?Journal of psychiatry & neuroscience : JPNArticle
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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 of drug 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.
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Registered trials
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