A Critical Review of the Harm Minimization Ideology in Australia

Harm minimization as a drug-policy approach represents a major step forward in Australian society's method of dealing with the myriad problems associated with illicit drug use. However, harm minimization lacks a substantial theoretical underpinning and there has been little debate about harm minimization at the sociological level. This article investigates a number of the assertions made within the harm minimization literature and the assumptions on which they are based. These assumptions are critically deconstructed from a number of points of view, including a Foucauldian perspective. Areas investigated include: the use of epidemiological data as a foundation for many harm-reduction strategies, the failure of harm minimization theories to deal adequately with the role of discourse in the drug policy arena, the harm minimization claim to amorality, the use of a utilitarian set of values, the supposed popularity of harm reduction and the idea that the current harm-reduction paradigm clearly acts as an extension of 'surveillance medicine' through the vehicle of governmentality. It is concluded that, whilst harm minimization represents the most promising advance in drug policy in the past, the lack of theoretical rigour in the development of these initiatives results in many of the claims made by proponents of harm-reduction strategies being either overly optimistic or fundamentally flawed.

Reporting of the ACT heroin trials

The aim of this research is to analyse the reports of the proposed heroin maintenance trials in the Australian Capital Territory (A.C.T.), in Melbourne print media during 1997. The proposal for trials of heroin-prescription to long-term users in the A.C.T. was based on extensive scientific research. The rejection of this proposal by Prime Minister Howard raised many questions. This study was designed to help understand what discourses and rhetorical devices were used in the reporting of heroin issues in the media and what part some sections of the media played in the government’s decision. Discourse analysis was conducted of newspaper articles from two major Melbourne newspapers, The Age and the Herald-Sun for the year 1997. All articles relating to heroin and drug-policy from the newspapers were included for analysis. Those in favour of the trials used predominantly health and social discourses. Those opposed used moral discourses supported with stereotypes, metaphors, emotive practices and ‘inaccuracies’. There were considerable differences in discourses presented by The Age and the Herald-Sun. This study demonstrates that opposition to the heroin trials relied on rhetorical strategies and sensationalistic arguments, rather than meaningful debate of scientific and social issues. Researchers should act to identify the stereotypes and metaphors used in the discourses surrounding an issue and act to disarm them.

Harm reduction as anarchist practice : a user’s guide to capitalism and addiction in North America

In spite of its origins as an illegal, clandestine, grassroots activity that took place either outside or in defiant opposition to state and legal authority, there is growing evidence to suggest that harm reduction in North America has become sanitized and depoliticized in its institutionalization as public health policy. Harm reduction remains the most contested and controversial aspect of drug policy on both sides of the Canada–US border, yet the institutionalization of harm reduction in each national context demonstrates a series of stark contrasts. Drawing from regional case study examples in Canada and the US, this article historically traces and politically re-maps the uneasy relationship between the autonomous political origins of harm reduction, contemporary public health policy, and the adoption of the biomedical model for addiction research and treatment in North America. Situated within a broader theoretical interrogation of the etiology of addiction, this study culminates in a politically engaged critique of traditional addiction research and drug/service user autonomy. Arguing that the founding philosophy and spirit of the harm reduction movement represents a fundamentally anarchist-inspired form of practice, this article concludes by considering tactics for reclaiming and re-politicizing the future of harm reduction in North America.

Substance use to enhance academic performance among Australian university students

Use of substances to enhance academic performance among university students has prompted calls for evidence to inform education and public health policy. Little is known about this form of drug use by university students outside the US. A convenience sample of n= 1729 Australian university students across four universities responded to an exploratory on-line survey. Students were asked about their lifetime use of modafinil, prescription stimulants (e.g. methylphenidate), supplements (e.g. ginkgo biloba), illicit drugs (e.g. speed), relaxants (e.g. valium) and caffeine in relation to enhancing study performance. The results show that Australian students report using substances for study purposes at a higher lifetime rate than observed among US or German students. The main reasons for use were to improve focus and attention, and to stay awake. Use of substances to enhance study outcomes was correlated with faculty of study, attitude and use of other substances. These results point to the need to develop Australian evidence to guide policy or regulatory responses to student use of substances to enhance academic performance. © 2013 Elsevier Ltd.

"Não compre, plante"? A tipificação penal das situações de cultivo de Canábis pelo Tribunal de Justiça de São Paulo

A Lei nº 11.343 de 23 de agosto de 2006 (Lei de Drogas) instituiu o Sistema Nacional de Políticas Públicas sobre Drogas e criou as diretrizes para a política de drogas brasileira. Dentre o conjunto de medidas trazidas pela lei em seu dispositivo criminal está a criação de um tipo penal específico de cultivo de plantas para produção de drogas para consumo pessoal (art. 28, §1º). O plantio para consumo recebe o mesmo tratamento jurídico-penal que o porte para consumo (art. 28), sendo previstas sanções alternativas à privação de liberdade. O §2º do art. 28 da Lei de Drogas estabelece os critérios que as autoridades competentes do sistema de justiça criminal deverão considerar na tipificação penal das situações de cultivo. Este trabalho se debruça sobre a tipificação penal de situações de cultivo de canábis em acórdãos do Tribunal de Justiça de São Paulo. A problemática de pesquisa aqui desenvolvida discute especificamente quais são os argumentos e como eles são apresentados nas decisões para justificar a determinação de que uma situação de cultivo é para fins de tráfico ou de consumo pessoal. O trabalho busca identificar como os critérios do §2º do art. 28 da Lei de Drogas são apresentados na fundamentação de decisões judiciais em que se discute na esfera criminal se uma situação de cultivo é para “consumo pessoal” ou “destinada a terceiros”. Uma pergunta central norteia a pesquisa realizada: quais os elementos e de que forma eles são utilizados nas decisões analisadas para tipificação do plantio para consumo pessoal (art. 28, §1º, da Lei de Drogas) e do plantio destinado a fornecer drogas a terceiros (art. 33, §1º, II)? Para enfrentar a problemática de pesquisa utilizamos a ferramenta de busca de acórdãos disponibilizada no sítio eletrônico do Tribunal de Justiça de São Paulo. Foram analisados 135 acórdãos do TJSP que enfrentam diretamente a controvérsia relativa à tipificação penal de situações de cultivo de canábis. Os acórdãos foram proferidos entre os anos de 1998 e 2014 e foram selecionados segundo os critérios especificados no capítulo metodológico da dissertação. Os resultados quantitativos da pesquisa dizem respeito às informações gerais dos processos, elementos de prova mencionados nos acórdãos, características das situações de cultivo e fundamentação da tipificação penal. A discussão qualitativa sobre os resultados da pesquisa é promovida em quatro frentes: (i) interpretação e valoração da quantidade de drogas; (ii) antecedentes criminais, circunstâncias da prisão e do agente; (iii) materiais de venda e outros elementos relevantes na tipificação penal; e (iv) características do conjunto probatório. As questões discutidas nestas frentes circunscrevem o problema de pesquisa e é a partir delas que é feita a análise apresentada neste trabalho. Esperamos conseguir contribuir para melhor compreensão (i) da determinação da finalidade do cultivo e (ii) das implicações jurídicas que decorrem da opção legislativa pela não utilização de critérios quantitativos na definição dos crimes de tráfico de drogas e plantio para consumo.

Propagandas de medicamentos psicoativos: Análise das informações científicas

Objective: According to the World Health Organization, medicinal drug promotion should be reliable, accurate, truthful, informative, balanced, up-to-date and capable of substantiation. The objective of the present study was to review psychoactive drug advertisements to physicians as for information consistency with the related references and accessibility of the cited references. Methods: Data was collected in the city of Araraquara, Southeastern Brazil, in 2005. There were collected and reviewed 152 drug advertisements, a total of 304 references. References were requested directly from pharmaceutical companies' customer services and searched in UNESP (Ibict, Athenas) and BIREME (SciELO, PubMed, free-access indexed journals) library network and CAPES journals. Advertisement statements were checked against references using content analysis. Results: Of all references cited in the advertisements studied, 66.7% were accessed. Of 639 promotional statements identified, 346 (54%) were analyzed. The analysis showed that 67.7% of promotional statements in the advertisements were consistent with their references, while the remaining was either partially consistent or inconsistent. Of the material analyzed, an average 2.5 (1-28) references was cited per advertisement. In the text body, there were identified 639 pieces of information clearly associated with at least one cited reference (average 3.5 pieces of information per advertisement). Conclusion: The study results evidenced difficult access to the references. Messages on efficacy, safety and cost, among others, are not always supported by scientific studies. There is a need for regulation changes and effective monitoring of drug promotional materials.

Delenda proibicionismo: apontamentos críticos ao paradigma de guerra às drogas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação do conhecimento e das condutas dos farmacêuticos, responsáveis técnicos por drogarias

Através deste estudo, avaliou-se o nível de conhecimento e conduta dos farmacêuticos, responsáveis técnicos (RT) em drogarias, quanto a alguns aspectos da legislação farmacêutica e sanitária. Foram entrevistados 45 RT em 2007, sendo que 19 desconheciam a definição dos medicamentos de referência, 21 do genérico e 25 do similar. Todos sabiam da permissão de aplicação de medicamentos injetáveis. Porém, apenas dois sabiam da permissão da aplicação de penicilínicos, metade desconhecia que é permitido fracionar medicamentos fracionáveis em drogaria, 18 não sabiam dispensar corretamente uma prescrição pelo princípio ativo e 37 acreditavam que o farmacêutico pode intercambiar qualquer medicamento de marca pelo genérico. A maioria dos RT apresentou nível regular e insatisfatório de conduta e de conhecimento sobre a legislação profissional e sanitária, o que sinaliza um problema na formação acadêmica e de atualização permanente, podendo comprometer as diretrizes da política nacional de medicamentos. Palavras-chave: Legislação de Medicamentos. Legislação Farmacêutica. Legislação Sanitária, Conhecimentos. Condutas e Prática em Saúde. Atitude do Pessoal de Saúde. ABSTRACT Assessment of knowledge and behavior of pharmacists with technical responsibility for drugstores This paper is a study of the level of knowledge and conduct of the legally responsible pharmacist-in-charge (PIC) at drugstores, regarding certain aspects of pharmaceutical and health legislation. In 2007, 45 PICs were interviewed, of whom 19 did not know the definition of original (innovative) branded drugs, 21 of generic drugs and 25 of similar branded drugs. All PICs knew that it is permitted to administer injectable drugs in the drugstore. However, only two knew that penicillins can be injected, half of them did not know that certain medicines can be fractionated in drugstores, 18 did not know how to dispense correctly a prescription for an active ingredient and 37 believed that the pharmacist can swap any brand name drug with its generic counterpart. Most PICs showed an unsatisfactory level of conduct and knowledge of the professional and health legislation, which points to problems in the undergraduate and in-service training of pharmacists, that could jeopardize the national drug policy guidelines. Keywords: Legislation, Drug. Legislation, Pharmacy. Legislation, Health. Health Knowledge. Attitudes, Practice. Attitude of Health Personnel.

Regulamentação Sanitária de Medicamentos

A regulamentação sanitária de medicamentos é uma das oito diretrizes da Política Nacional de Medicamentos. Trata-se da fiscalização e regulamentação de registro de medicamentos e da autorização de funcionamento desde os produtores até o varejo de medicamentos, bem como das restrições àqueles sujeitos a controle especial. A regulamentação sanitária de medicamentos tem como objetivo garantir eficácia, segurança, qualidade e custo aos produtos farmacêuticos. Os estudos clínicos dos medicamentos de Referência, a bioequivalência ou biodisponibilidade relativa e testes de equivalência dos medicamentos similares e genéricos são meios de avaliar a eficácia e a segurança. A qualidade é garantida lote a lote pelas Boas Práticas de Fabricação e Controle dos produtos farmacêuticos e a certificação da empresa pela ANVISA. O custo é avaliado pela câmara técnica de medicamento (CMED), que estabelece os critérios para fixação e ajuste de preços dos produtos farmacêuticos. No pós-registro, a efetividade, segurança e qualidade dos produtos são avaliadas por meio das comprovações exigidas na renovação do registro e, principalmente, pelo programa de farmacovigilância. Palavras-chave: Registro de Produtos. Medicamentos de Referência. Medicamentos Similares. Medicamentos Genéricos. Alteração de Registro de Produtos. ABSTRACT Health Regulations for Drugs The health regulation of drugs is one of eight guidelines issued within the National Drug Policy. It refers to the supervision and regulation of drug registration and the approval of operations, from the manufacturers to the retailers of medicines, as well as the restrictions that apply to drugs under special control. The health regulation of medicines is aimed at controlling the effectiveness, safety, quality and cost of pharmaceutical products. Clinical studies of brand-name (innovator) medicines, bioequivalence or relative bioavailability and the equivalence tests of generic and ‘similar’ brand-name drugs are means used to assess efficacy and safety. Quality is assured on a batch-to-batch basis by compliance with the Good Manufacturing Practices and Control of pharmaceutical products and by the certification of companies offered by ANVISA. The cost of a medicine is assessed by the Technical Chamber of Medicine (CMED), which establishes the criteria for setting and adjusting the prices of pharmaceutical products. After registration, the effectiveness, safety and quality of products are monitored by means of the tests required on renewal of registration and especially by the pharmacovigilance program. Keywords: Product Registration. Original Brand-name Drugs. Similar Drugs. Generic Drugs. Modification of Product Registration.

Opioid maintenance therapy in Switzerland: an overview of the Swiss IMPROVE study

BACKGROUND/AIMS: Switzerland’s drug policy model has always been unique and progressive, but there is a Need to reassess this system in a rapidly changing world. The IMPROVE study was conducted to gain understanding of the attitudes and beliefs towards opioid maintenance therapy (OMT) in Switzerland with regards to quality and Access to treatment. To obtain a “real-world” view on OMT, the study approached its goals from two different angles: from the perspectives of the OMT patients and of the physicians who treat patients with maintenance therapy. The IMPROVE study collected a large body of data on OMT in Switzerland. This paper presents a small subset of the dataset, focusing on the research design and methodology, the profile of the participants and the responses to several key questions addressed by the questionnaires. METHODS: IMPROVE was an observational, questionnaire-based cross-sectional study on OMT conducted in Switzerland. Respondents consisted of OMT patients and treating physicians from various regions of the country. Data were collected using questionnaires in German and French. Physicians were interviewed by phone with a computer-based questionnaire. Patients self-completed a paper-based questionnaire at the physicians’ Offices or OMT treatment centres. RESULTS: A total of 200 physicians and 207 patients participated in the study. Liquid methadone and methadone tablets or capsules were the medications most commonly prescribed by physicians (60% and 20% of patient load, respectively) whereas buprenorphine use was less frequent. Patients (88%) and physicians (83%) were generally satisfied with the OMT currently offered. The current political framework and lack of training or information were cited as determining factors that deter physicians from engaging in OMT. About 31% of OMT physicians interviewed were ≥60 years old, indicating an ageing population. Diversion and misuse were considered a significant problem in Switzerland by 45% of the physicians. CONCLUSION: The subset of IMPROVE data presented gives a present-day, real-life overview of the OMT landscape in Switzerland. It represents a valuable resource for policy makers, key opinion leaders and drug addiction researchers and will be a useful basis for improving the current Swiss OMT model.

Marijuana Legalization in Colorado -- Lessons for Colombia

In 2012 Colorado became the first jurisdiction anywhere in the world to legalize marijuana possession and use for all adults. The regulated and taxed marijuana industry that arose in Colorado following legalization was also the first of its kind and stands a model for other states considering marijuana law reform. In this brief article I discuss the results of the Colorado experiment; I demonstrate that while Colorado’s regulatory model was largely successful, it also demonstrates the limits of generating revenue through taxing and regulating marijuana. I then discuss the implications of this conclusion for post-conflict Colombia, drawing a comparison to the situation California confronts as it considers legalizing marijuana for adult use.

Perceptions of the influence of prescription medicine samples on prescribing by family physicians

Background: The provision of free prescription medicine samples is a common and traditional marketing strategy used by pharmaceutical companies, but concerns have been raised about their influence on physician prescribing behavior and patient safety. Objective: We sought to investigate the knowledge, attitudes, and behaviors of Australian family physicians regarding the use of sample prescription medications. Methods: Qualitative and quantitative techniques were used, including (1) mailed questionnaires to family physicians, (2) semistructured interviews with family physicians, and (3) sample cupboard inventories. Results: A number of issues about samples were identified by the questionnaires (208) and interviews (17 doctors), including insufficient labeling, poor record keeping, diversion of stock (personal use by doctors.. their families, practice staff and pharmaceutical representatives), and wasting of expired stock. Prescription medicine samples also influenced prescribing behavior. Australian doctors were less likely to provide samples to patients on financial grounds compared with a previous study in the United States on medical residents. Six sample cupboards were inventoried. Median wholesale value of sample cupboards was AUD $4959 (range $2395-$8709), with 6% of stock expired. Very little generic medicine was included in the sample cupboards. Conclusions: Better methods are needed to meet legislative requirements and to ensure quality use of medicines (and optimal public health) with respect to prescription medicine samples. Doctors and practice staff require training on the appropriate handling and storage of prescription medications. Alternative ways for distribution of sample medications need to be investigated.

Exploring the Life-Saving Potential of Naloxone : A Systematic Review and Descriptive Meta-Analysis of Take Home Naloxone (THN) Programmes for Opioid Users

Date of Acceptance: 21/09/2015 This study was funded by NHS Health Scotland. The opinions expressed in this paper as those of the authors alone and are not necessarily those of NHS Health Scotland. The funders had no role in the conduct of the research.