Elementos regulatorios sobre la marihuana, a consideración para la efectiva protección a la salud de la población / Regulatory elements on marijuana, for the effective population health protection

Resumen: Al hablar del abordaje de salud pública al uso de la marihuana se soslaya la complejidad de la protección a la población a través de intervenciones regulatorias rigurosas. Considerando la experiencia de gobiernos donde ya existen estas prácticas, se introduce la regulación como una función esencial de la salud pública, haciendo explícitos siete propósitos para el control de la marihuana. Se detallan luego los elementos técnicos, de capacidad institucional (incluyendo la capacidad técnica y financiera) y de gobernanza que deben cumplirse para cualquier regulación rigurosa de su uso. Se señala la dificultad de regular sustancias psicoactivas considerando que la capacidad de control de otras actualmente legales se ha traducido en su creciente consumo. Se expone también que no debe minimizarse la necesidad del fortalecimiento institucional y gobernanza de la autoridad regulatoria para la regulación efectiva de la marihuana.

Abstract: When discussing the public health approach to the use of marijuana, the complexity of rigorous regulatory interventions for population protection is omitted. Using the experience of governments where these practices already exist, regulation is introduced as an essential public health function, spelling out seven purposes for controlling marijuana. The technical elements of institutional capacity -including the technical and financial capacity- and of governance that must be covered by any rigorous regulation of its use are detailed below. The difficulty of regulating psychoactive substances is addressed when considering the capacity to control other legal substances manifested with their increased consumption. It is concluded that for an effective regulation of marijuana, the need for strengthening the institutional and governance aspects of the regulatory authority should not be minimized.

La gestión del desarrollo, las entidades de ciencia y los sistemas locales de innovación / Development Management, Science Institutions and Local Systems of Innovation

Se presenta un análisis sobre la relación necesaria a lograr entre los elementos: gestión del desarrollo-entidades de ciencia- sistemas locales de innovación, que se realiza en la provincia de Cienfuegos, Cuba (estudio de caso), con el objetivo de elaborar un programa de acción que asegure la articulación entre la gestión del desarrollo, las entidades de ciencia y los sistemas locales de innovación como un proceso de mejora continua, acompañado de un sistema de indicadores que permita evaluar el desempeño de la entidades de ciencia y elevar la efectividad, eficiencia y eficacia del mismo en función del desarrollo local. Se utilizó como método de investigación la consulta a expertos, a partir de cuyos resultados se definen los aspectos a tomar en consideración para dicho programa, en correspondencia con la aptitud que requieren expresar las entidades de ciencia para poder integrar las dimensiones ciencia, tecnología, innovación y medioambiente de forma equilibrada a través de las interfases. La evaluación del programa se realizó a nivel teórico y práctico. Como conclusión fundamental se derivó que la integración de la gestión de la ciencia, la tecnología, la innovación y el medioambiente a través de las entidades de ciencia, en función del desarrollo, articuladas por los sistemas locales de innovación, requiere de una adecuación de sus acciones para asegurar efectividad, eficiencia y eficacia en su desempeño.

An analysis on the necessary relationship among development management, science institutions and local innovation systems was conducted in the province of Cienfuegos, Cuba (Case study), in order to develop an action plan to ensure the coordination of development management, science institutions and local systems of innovation as a continuous improvement process, which is accompanied by a system of indicators to assess the performance of science institutions and to enhance its effectiveness and efficiency in terms of local development. Expert consultation was used as research method. Its results defined the aspects to consider for the plan, in line with the role that science institutions need to play to integrate science, technology, innovation and environment through interfaces in a balanced way. The major conclusion of the study is that the integration of science, technology, innovation and environment management through science institutions, which are interrelated by local innovation systems, requires an adaptation of their actions to ensure effectiveness and efficiency in performance conducive to development. Plan assessment was conducted at theoretical and practical level.

Las contribuciones del doctor Ramón de la Fuente en el campo de las adicciones

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Summary This paper reviews the publications of doctor Ramón de la Fuente in the field of addictions, the infrastructure he created for the study and treatment of these problems and his contributions to human resource training. Doctor Ramón de la Fuente's contributions in the field of addictions are both wide-ranging and outstanding, as they were in all issues in which he took interest. They include the development of infrastructure, research and the training of human resources. He thought that advances in knowledge could only be achieved through the integration of neuroscience and clinical and social research. His critical thought led him to question the scientific basis of many of the programs and recommendations made in the field of addictions. In his view, there was a tendency to ignore the biological basis of the disease and its link with the environment. He also suggested that social processes affected genetics and the functioning of the brain, leaving to science the challenge of determining how these processes occur. His advanced conception of the problem led him to establish an institution where multidisciplinary research would be carried out in neurosciences, clinical and social areas, this being the reason he created and promoted these three departments in the institute he created 27 years ago. Their integration was his challenge and the enormous responsibility he left to those of us who were fortunate enough to collaborate with him in the development of his institutional project. Doctor de la Fuente thought that any public policy in this field would have to be based on knowledge of the problem and its trends, and thus he proposed the development of epidemiology; a group emerged that studied addictions from a social perspective. One of the first epidemiological studies of students was conducted by doctor de la Fuente. This study, published in the early 1970s, was the forerunner of several studies that would be undertaken in this field. Doctor de la Fuente was also one of the first to describe the mental disorders induced by hallucinogenic drugs. During his time as director of the psychiatric unit in the Spanish Hospital in Mexico, patients with this dual disorder were treated in an integral fashion. Together with other well-known personalities of the time, founded one of the first self-help groups that existed in the country, at the Spanish Hospital. Later on, under the coordination of the National Institute of Psychiatry, he promoted the creation of a Treatment Center for Alcoholics and their Relatives (CAAF). The Center is also designed to help the family. The concept of treatment evolved from regarding the family as a fundamental part in the treatment of the patient to understanding that the family was also sick and required help, regardless of whether the patient wanted or not to be rehabilitated. The center's therapeutic orientation was integral, including general medicine, psychiatry, psychology and social work. From the outset, the center incorporated Alcoholics Anonymous in a perfect example of collaboration between professionals and civil society. From 1972 to 1979 and again from 1982 to 1986, doctor Ramón de la Fuente was a member of the International Narcotics Control Board (INCB). He always defended the position, now internationally acknowledged, that demand also stimulated supply and that the solution would have to come from global perspectives. The National Institute on Psychiatry is a Collaborative Center of the World Health Organization in Addictions and Mental Health. Doctor de la Fuente was its director during the period from 1977-1998. In 1988, he was appointed member of the advisory board for the Diploma Course in Addictive Behavior of the Institute of Psychiatry in London. From 1973 to 1982 and then from 1991 to 2000, he was a member of Experts' Committee of the World Health Organization, and agreed with this organization's views on the need to conceptualize the problem of addiction from a broad public health perspective. From 1980 to 1982, he collaborated in the area of the diagnosis and classification of problems related to mental disorders, alcoholism and drug dependence. His collaboration in this last issue was extremely significant since it occurred during a period of transition in regard to the way in which the problem was defined and therefore, in how it could be affected. Responsibility for the problem was no longer attributed to a small sector of chronic drinkers, and instead, drinking was regarded as the result of the consumption patterns of the general population. This new conception in turn opened up the possibility of influencing the problem on the basis of public policies capable of affecting the way alcohol is made available to the population and the consumption behavior. Part of the research that triggered this change of conception was carried out at the National Institute of Psychiatry in its capacity as Collaborative Center of the World Health Organization. The time when doctor de la Fuente directed the WHO Collaborative Center was crucial to the development of research infrastructure in its early years and to the proposal of new ways of understanding the problem from different socio-cultural perspectives other than those of developed countries where most of the research on this issue had been carried out. Given the characteristics of the phenomenon that prevailed in Mexico, doctor de la Fuente placed particular emphasis on the study of inhalants, not included in international conventions. The first studies conducted in Mexico, designed to evaluate brief interventions with problem drinkers, were carried out at the Institute. Researchers measured the impact of a brief advice for the modification of drinking patterns given by a doctor in hospital settings, lasting 5 or 10 minutes including the application of screening tests. During his mandate, collaboration agreements were established with several institutions with complementary interests, being the most outstanding those with the Public Education Secretariat, with which the Institute has conducted school surveys since 1978. He supported the creation of master's and doctoral degree programs in Medical Sciences in Psychiatry and in Health Sciences in Public Mental Health, in collaboration with UNAM, in order to include training in the field of Public Health for doctors, psychiatrists, and other professionals in the health social sciences. Given doctor de la Fuente's vast knowledge of the issue and the importance of the research he has undertaken, it is hardly surprising that doctor Guillermo Soberón, then Health Secretary, should have requested his collaboration in the formulation of National Addiction Programs. The Institute designed the projects for programs to combat alcohol abuse and alcoholism, addictions and tobacco, which were submitted for consideration by over 100 institutions in the public, social and private sectors. Doctor de la Fuente's work has had an impact on several generations of university students and nowadays on a large number of people with scientific training work in this area.