County and Demographic Differences in Drug Arrests and Controlled Substance Use in Maine

. Introduction: The Diversion Alert Program (DAP) was established to curb misuse of drugs and help identify people who may need treatment for substance use disorder (SUD). Law enforcement compiled arrest data into a database accessible by health care providers. Our objectives were to identify regional and demographic differences in drug use and misuse in Maine. Methods: All arrests (N = 11 234) reported to the DAP from 2013 to 2018 were examined by county and arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution of controlled pharmaceuticals (Schedule II-III). Opioids were converted to oral morphine milligram equivalents (MMEs). County and zip-code maps were constructed. Results: The most arrests per capita occurred in Androscoggin, Knox, and Cumberland Counties. Opioids were the most common drug class in arrests in all counties except Aroostook County, where stimulants were most common. Medical distribution of opioids varied. Although buprenorphine doubled, many prescription opioids (eg, hydrocodone, fentanyl, oxymorphone) exhibited large (\u3e 50%) reductions in distribution. Methadone was the predominant opioid statewide (56.4% of total MMEs), although there were sizable differences between regions (Presque Isle = 8.6%, Bangor = 78.9%). Amphetamine distribution increased by 67.9%. Discussion: The DAP, a unique pharmacoepidemiological resource, revealed a 6-fold difference in drug arrests by county. Regional differences in methadone may be due to heterogeneities in methadone clinic distribution. Conclusions: The decrease in most prescription opioids, but increase in prescription stimulants, may warrant continued monitoring to improve public health

Use and misuse of opioids in Maine: results from pharmacists, the prescription monitoring, and the diversion alert programs.

OBJECTIVE: Although opioids have substantial efficacy for acute pain management, escalation to opioid misuse and abuse is a persistent concern. This report assesses the current status of the opioid epidemic in Maine using three complementary data sets. METHOD: A representative sample of pharmacists (N = 275) completed an online survey regarding the extent that opioids affected their practice. A county-level analysis of opioid prescriptions (N = 1.22 million) reported to the Maine Prescription Monitoring Program (M-PMP) in 2014 and the agents implicated in arrests as reported to the Maine Diversion Alert Program (DAP, N = 2,700) in 2014/15 also was completed. RESULTS: A significantly greater number of pharmacists agreed that opioid misuse (85.9%), rather than diversion (76.8%) or access (54.2%), was a concern. Only half (56.2%) reported use of the M-PMP. Opioids were dispensed to 22.4% of residents (37.7% of women in their 80s). This was enough to supply everyone in Maine with a 16.1-day supply. Buprenorphine accounted for almost half of opioid prescriptions to young adults (46.3% women, 49.3% men). Arrests increased by 13.3% from 2014 to 2015, and the proportion of arrests that involved prescription opioids decreased while those involving stimulants and heroin were elevated. CONCLUSIONS: Pharmacists are very aware of the potential for opioid misuse, but many do not consistently use the M-PMP. There continues to be substantial legitimate use, as well as criminal activity, involving oxycodone and other prescription opioids. Continued vigilance and use of tools like the PMP and DAP are necessary to minimize nonmedical use of opioids in Maine

Detector to detector corrections: a comprehensive experimental study of detector specific correction factors for beam output measurements for small radiotherapy beams

Purpose: The aim of the present study is to provide a comprehensive set of detector specific correction factors for beam output measurements for small beams, for a wide range of real time and passive detectors. The detector specific correction factors determined in this study may be potentially useful as a reference data set for small beam dosimetry measurements.Methods: Dose response of passive and real time detectors was investigated for small field sizes shaped with a micromultileaf collimator ranging from 0.6 × 0.6 cm2 to 4.2 × 4.2 cm2 and the measurements were extended to larger fields of up to 10 × 10 cm2. Measurements were performed at 5 cm depth, in a 6 MV photon beam. Detectors used included alanine, thermoluminescent dosimeters (TLDs), stereotactic diode, electron diode, photon diode, radiophotoluminescent dosimeters (RPLDs), radioluminescence detector based on carbon-doped aluminium oxide (Al2O3:C), organic plastic scintillators, diamond detectors, liquid filled ion chamber, and a range of small volume air filled ionization chambers (volumes ranging from 0.002 cm3 to 0.3 cm3). All detector measurements were corrected for volume averaging effect and compared with dose ratios determined from alanine to derive a detector correction factors that account for beam perturbation related to nonwater equivalence of the detector materials.Results: For the detectors used in this study, volume averaging corrections ranged from unity for the smallest detectors such as the diodes, 1.148 for the 0.14 cm3 air filled ionization chamber and were as high as 1.924 for the 0.3 cm3 ionization chamber. After applying volume averaging corrections, the detector readings were consistent among themselves and with alanine measurements for several small detectors but they differed for larger detectors, in particular for some small ionization chambers with volumes larger than 0.1 cm3

A consensus protocol for functional connectivity analysis in the rat brain

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