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PubMed2000

From holy war to opium war? A case study of the opium economy in north-eastern Afghanistan.

This paper examines the recent growth of the opium economy in north-eastern Afghanistan. A detailed analysis of one village in Badakshan Province reveals profound changes in the local economy and social institutions. The paper describes two major shifts in the local economy: first, the switch from wheat to poppy cultivation; and second, the shift from the livestock trade to the opium trade. It then examines the underlying causes and impacts of the opium economy on social relations in the village. Although a case study of a community living on the margins of the global economy, it is argued that these changes have important implications for international policymakers. The emergence of the opium economy in north-eastern Afghanistan is symptomatic of new and expanding forms of trans-border trade associated with the restructuring of the global political economy.

Afghanistan↗
PubMed2004

Patient preferences for acute pain treatment.

BACKGROUND: Optimal treatment for acute pain is a function of an individual's willingness to make trade-offs between treatment side effects and pain control. The objective was to investigate the degree to which patients are willing to make these trade-offs. METHODS: Fifty patients undergoing major abdominal surgery were enrolled and completed interviews before and after surgery. Measures included an experience with pain questionnaire and an adaptive conjoint analysis (ACA) interview. RESULTS: Percentage of pain relief obtained post-surgery was between 70 and 80%. Eight-two per cent reported at least one moderate or severe side effect. ACA results demonstrated that pain efficacy and side effect type/severity have almost equal 'importance' scores. Patients varied in their willingness to trade-off pain efficacy for different or milder side effects. CONCLUSIONS: We conclude that people have different relative preferences for different side effects and are willing to trade-off pain relief for less upsetting and/or less severe side effects but to different degrees. Thus, physicians should consider offering pain medications with fewer side effects than narcotics as a first choice. Our study indicates the need to balance analgesia and side effects in order for patients to achieve optimal pain control.

Abdomen↗
PubMedDate not supplied

Is one paracetamol suppository of 1000 mg bioequivalent with two suppositories of 500 mg.

A common belief is that one tablet or suppository containing, e.g. 100 mg of a drug can be substituted, without any changes in the therapeutic effect, with two units of the same brand containing 50 mg of the drug. In the present study a single dose of paracetamol was administered to healthy volunteers as (a) two tablets of 500 mg, (b) two suppositories of 500 mg, and (c) one suppository of 1000 mg. There were statistically significant differences in all bioavailability parameters (t(max), C(max) and AUC) between the three treatments. The relative bioavailability of the 500 mg suppositories was 77% and that of the 1000 mg suppositories 66%. The absorption rate from suppositories was markedly lower than from the tablets. Especially low absorption rate was obtained with the suppository of 1000 mg. The two strengths, although having the same trade name, were not therefore bioequivalent.

Acetaminophen↗
PubMedDate not supplied

International illicit drug traffic: the United States response.

The Government of the United States of America recognizes the serious threat of illicit drug abuse and trafficking and the associated economic costs and social destruction. The United States Government is waging a major battle to fight drug abuse and is working to lower demand at home through education and prevention, detoxification and treatment, and research as well as to lower supply through bilateral and multilateral crop eradication programmes. The Government is also working to lower supply within the United States through a campaign of illicit drug traffic interdiction of unprecedented size and scope. Among the actions taken to counter the illegal trade were: the creation of the South Florida Task Force headed by the Vice President; the establishment of 12 Organized Crime/Drug Enforcement task forces around the country; the setting up of the National Narcotics Border Interdiction System; the increased use of military resources to assist law enforcement agencies; and the initiation of a widespread cannabis eradication programme involving aerial spraying of paraquat.

Crime↗
PubMedDate not supplied

Law enforcement and drug trafficking money: recent developments in Australian law and procedure.

The generation and movement of money is an essential element of illicit drug trafficking. Indeed, the interest of those who are often the most influential in this criminal activity is money. Society is increasingly regulated, and this regulation and the enormous sums of money illegal drug activities generate provide an opportunity to identify and follow monies forming part of the illegal drug trade. This will require the development of new investigative resources and laws. Such activities must be integrated and directed where most effective. As money and the accumulation of money, resources and assets underpin the groups of criminals who are engaged in the illegal drug trade, the most effective action against them will be achieved by destroying the financial basis of their activities.

Australia↗
PubMed1990

Projections for the future development of international drug control policies.

With the adoption of the Declaration and the Comprehensive Multidisciplinary Outline of Future Activities in Drug Abuse Control by the International Conference on Drug Abuse and Illicit Trafficking (ICDAIT) in 1987 and the formulation in 1988 of the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, the United Nations has made significant contributions to international drug control policy, in line with its responsibilities under article 55 of the Charter. Governments are acting, separately and through regional and other collective organizations, to adapt these policies to their own particular needs and to make the legislative changes needed to enable ratification of the new Convention. Simultaneously, the Commission on Narcotic Drugs continues to carry out its policy-making function by identifying areas of concern on which consensus can be achieved as well as appropriate techniques for achieving effective international co-operation as foreseen in the Charter of the United Nations. The present article draws attention to recent developments pointing to possible areas of policy formulation. These include enhanced cooperation of law enforcement agencies with overlapping jurisdictions; judicial methodology and inter-system co-operation to follow on from seizures from the illicit traffic and detention of suspects to consideration of treatment methodology; and adaptation of demand reduction techniques to target groups beyond the reach of formal educational institutions. The trend towards horizontal integration of trafficking networks is examined in the context of indications linking illicit traffic in psychotropic substances to the production and trade of chemical weapons, such as poison gas, and to the cultivation of new markets in response to the saturation of certain North American markets for specific illicit drugs.

Drug and Narcotic Control↗
PubMed1993

Preliminary finding: consumption of benzodiazepines in Brazil during the years 1988 and 1989.

This work investigates consumption of benzodiazepines in Brazil during the years 1988 and 1989, using the following sources of information provided to the Brazilian Ministry of Health by institutions that deal with benzodiazepines: (a) benzodiazepine stocks recorded at the beginning and end of each year; (b) Brazilian (internal) production of benzodiazepines; (c) imported and exported amounts of benzodiazepines; (d) amounts employed in the manufacture of brand-name products and in the making of prescription formulas. The records a, b and c furnished the 'calculated consumption', of benzodiazepines, in kilograms. The d records, on the other hand, directly furnished the 'informed consumption', also in kilograms. The data obtained were also expressed in terms of defined daily doses (DDDs)/1,000 inhabitants/day, considering the informed consumption and the Brazilian population. As for the DDDs/1000 inhabitants/day, they were found to be 23.03 and 18.48 for the years 1988 and 1989, respectively. A striking discrepancy was detected between the calculated and the informed consumption figures, the latter having exceeded the former by 2096 kg in 1988 and by 4909 kg in 1989. Diazepam was the primary drug responsible for this difference. Such results may suggest that an illicit, unrecorded trade of benzodiazepines is occurring in Brazil.

Anti-Anxiety Agents↗
PubMed2000

The influence of economic interests on alcohol control policy: a case study from Finland.

Finland's participation in the European Union has meant that Finnish markets have been opened to international competition and that the traditional alcohol policy decision-making that revolved around Alko, the state alcohol monopoly company, has become impossible. The influence of private commercial interests increased in the 1990s but not in a straightforward manner. They had their biggest influence in the mid-1990s when the 1994 Alcohol Act was drafted and accepted. After that the influence of commercial interests has declined, and nowadays the alcohol question is again discussed in terms of public health and safety and drinking among young people. Integration did not lead to the expected deregulation of alcohol control but to new forms of regulation, where EU authorities such as the Commission and the EU Court also play an important role. Alcohol policy-making is now more transparent, and free trade and competition without interference are much more stressed than previously. These are the new frames of public intervention in the alcohol question, both in the trade of alcoholic beverages and in the taking care of individuals harmed by the use of alcohol.

Alcohol Drinking↗
PubMed2005

Remembering the lizard: reconstructing sexuality in the rooms of narcotics anonymous.

The crack epidemic was devastating to poor American communities in part because of the destruction wrought by the system of exchanging sex for drugs, which was a key feature of the crack-use culture. Sex-for-drugs exchanges were often conducted under unsafe circumstances and were linked to the spread of AIDS and other STDs, as well as unplanned pregnancies. The existence of this alternative system of sexual relationships threatened the economic viability of established commercial sex work and undermined the status and power of women. Narcotics Anonymous (NA) meetings helped men and women recover from crack addiction through a well-described 12-step process. Described as the rooms, these time- and space-specific encounters helped people become sober in the context of neighborhoods that were centers of the drug trade. Because of the key role of sex in the crack culture, transformation of sexual relationships was essential to establishing and maintaining sobriety. The manner in which the rooms of NA influence the sexuality and lifeworld of addicted people is explored using Barker's theory of ecological psychology.

Adolescent↗
PubMed2000

Opium use in Turkmenistan: a historical perspective.

This paper presents a picture of how the patterns of opium use have changed in Turkmenistan over more than 100 years and the relationship between these transformations and formal and informal social controls of drug use. From the late 18th century, when opium use began to become a social problem, informal control weakened. Eventually, in the late 19th century, formal control was introduced, aimed at the prohibition of drug trade and use. From that time, the intended and unintended outcomes of implemented policies led to changes in the demographic patterns of users and the social-medical consequences of opiate use. The anti-drug policies, where criminal prohibition coexisted with strategies aimed at raising the population's general living standards and at providing free access to health care, were effective up to the early 1980s. New political and social-economic realities in the 1980-90s have radically changed the drug scene in the country, with heroin trade and use as the main concerns. The government's reaction, while following the old paths, has included new elements, based mainly on ideas of national consolidation.

Drug and Narcotic Control↗
PubMed2006

International trade agreements challenge tobacco and alcohol control policies.

This report reviews aspects of trade agreements that challenge tobacco and alcohol control policies. Trade agreements reduce barriers, increase competition, lower prices and promote consumption. Conversely, tobacco and alcohol control measures seek to reduce access and consumption, raise prices and restrict advertising and promotion in order to reduce health and social problems. However, under current and pending international agreements, negotiated by trade experts without public health input, governments and corporations may challenge these protections as constraints on trade. Advocates must recognise the inherent conflicts between free trade and public health and work to exclude alcohol and tobacco from trade agreements. The Framework Convention on Tobacco Control has potential to protect tobacco policies and serve as a model for alcohol control.

Alcohol Drinking↗
PubMedDate not supplied

Trade-offs in producing patient-specific recommendations from a computer-based clinical guideline: a case study.

This case study explored 1) how much online clinical data is required to obtain patient-specific recommendations from a computer-based clinical practice guideline, 2) whether the availability of increasing amounts of online clinical data might allow a higher specificity of those recommendations, and 3) whether that increased specificity is necessarily desirable. The "quick reference guide" version of the guideline for acute postoperative pain management in adults, developed by the Agency for Health Care Policy and Research, was analyzed. Patient-specific data items that might be used to tailor the computer's output for a particular case were grouped into rough categories depending on how likely they were to be available online and how readily they might be determined from online clinical data. The patient-specific recommendations were analyzed to determine to what degree the amount of text produced depended on the online availability of different categories of data. An examination of example recommendations, however, illustrated that high specificity may not always be desirable. The study provides a concrete illustration of how the richness of online clinical data can affect patient-specific recommendations, and describes a number of related design trade-offs in converting a clinical guideline into an interactive, computer-based form.

Adult↗
PubMed2001

Fake artesunate in southeast Asia.

Artesunate is a key antimalarial drug in the treatment of multidrug-resistant Plasmodium falciparum malaria in southeast Asia. We investigated the distribution of counterfeit artesunate tablets by use of the validated, simple, and inexpensive Fast Red TR dye technique. We also aimed to identify distinguishing characteristics of the fake drugs. Of 104 shop-bought "artesunate" samples from Cambodia, Laos, Myanmar (Burma), Thailand, and Vietnam, 38% did not contain artesunate. Characteristics such as cost and physical appearance of the tablets and packaging reliably predicted authenticity. The illicit trade in counterfeit antimalarials is a great threat to the lives of patients with malaria. The dye test will assist national malaria control authorities in urgently needed campaigns to stop this murderous trade.

Antimalarials↗
PubMedDate not supplied

Sticky business: patterns of procurement and misuse of prescription cough syrup in Houston.

Reports of recreational codeine cough syrup use have increased in Houston and in the state of Texas. Occasional and polydrug users increasingly have consumed codeine cough syrup (with or without alcohol or other drugs) over the past three years, accounting for a $40 increase in the price of an eight-ounce bottle on the underground economy. News stories regarding syrup abuse and reports of deaths by codeine overdoses suggested the need to explore this emerging drug trend. The investigator conducted a literature search of scientific journals and news media, interviews with community authorities, and guided interviews with 25 adults who reported using codeine cough syrup in the 30 days preceding their interviews. Participants were recruited through snowball sampling; interview transcripts were coded and content analyzed. Polydrug users reported a penchant for codeine syrup because it carries fewer legal consequences, is perceived as "safer" than illegal drugs, and is either free or inexpensive for users with Medicaid or private insurance. Participants reported methods for procuring syrup from physicians and hospital emergency rooms which they consumed or traded for money, goods, or services. Consumption patterns for chronic and occasional users are described. Reported side effects include a drowsy relaxed high, fatigue, loss of coordination, constipation, and urinary retention.

Antitussive Agents↗