"Although many checkers mentioned that they had not heard of anyone being prosecuted for possession of test kits, many were more directly affected by party promoter and venue owner reluctance to allow their services due to fear of fines or even prison sentences. Checkers affiliated with formal drug checking organizations in particular expressed concern over potential legal barriers associated with drug checking at festivals or other events. The main concern cited by many formal checkers is the “RAVE Act” (the “Reducing Americans’ Vulnerability to Ecstasy Act”).

"Regardless of what led these individuals to become drug checkers, most appeared to be motivated by altruism and the desire to increase safety and minimize risks associated with others’ drug consumption. We describe their efforts in terms of altruism not only because they act in a selfless manner and donate their time and services, but also because unlike many other volunteers, drug checkers also risk arrest by handling illegal drugs, in order to promote the safety of others. Thus, they essentially place themselves under legal risk to help protect others.

• "In 2019 and 2020, alcoholic liver disease was the most frequent cause of alcohol-induced death, followed by mental and behavioral disorders due to use of alcohol (Figure 5).
   
• "From 2019 to 2020, the largest increases in rates were from alcohol-induced acute pancreatitis (50%), from 0.1 per 100,000 to 0.2, followed by mental and behavioral disorders due to use of alcohol (33%), from 3.0 to 4.0.

• "After annual increases of 7% or less between 2000 and 2018, the overall age-adjusted rate of alcohol-induced deaths increased 26%, from 10.4 per 100,000 in 2019 to 13.1 in 2020 (Figure 1).
   
• "Rates of alcohol-induced deaths for males were stable from 2000 to 2009, increased 30% from 2009 (11.3) to 2018 (14.7), and increased 26% from 2019 (15.2) to 2020 (19.2).

"In February 2023, Mexico's federal government closed the country's only methadone manufacturing plant, Psicofarma, following concerns about quality control.5 In Mexican-U.S. border cities, such as Ciudad Juarez, Mexicali, and Tijuana, where the prevalence of OUD is among the highest in the country, methadone clinics are turning new clients away as they run out of medication, limiting doses, providing doses only on alternate days, or not dosing altogether.

"The number of unintentional poisoning deaths increased from 12,186 in 1999 to 20,950 in 2004. The annual age-adjusted rate increased 62.5%, from 4.4 per 100,000 population in 1999 to 7.1 in 2004. The increase among females, from 2.3 to 4.7 per 100,000 population (103.0%), was twice the increase among males, from 6.5 to 9.5 per 100,000 population (47.1%) (Table 1). Among males, rates among whites, American Indians/Alaska Natives, and Asians/Pacific Islanders all increased approximately 50%.

"In 2021, the world set ambitious law reform targets to remove criminal laws that are undermining the HIV response and leaving key populations behind. Recognising decriminalization as a critical element in the response, countries made a commitment that by 2025 less than 10% of countries would have punitive legal and policy environments that affect the HIV response. The Global AIDS Strategy set as a target that less than 10% of countries would criminalise sex work, possession of small amounts of drugs, same-sex sexual activity, and HIV exposure, non-disclosure and transmission."

"Globally, some recent changes in cannabis policies have experimented with different ways of regulating the sale and use of cannabis. Evolving cannabis policies raise numerous potential concerns about negative side-effects.

"Some participants noted that in their country there was a move towards greater recognition of the need for public health-oriented approaches to tackle drug problems accompanied by a shift in the goals of drug policies towards reducing drug-related harms. However, the relatively limited set of indicators that has historically been used to evaluate drug policy may have limited utility for informing on outcomes relevant to this perspective.

"Long-term retention on OAT in trials and observational studies is suboptimal, which limits the effect of OAT with regard to reducing drug-related deaths.¹³¹ There was consistent evidence that retention was slightly better on methadone than buprenorphine across RCTs and observational studies at timepoints beyond 1 month, although few RCTs examined long-term retention.