Study on the present situation of narcotic drugs equipment and management in 251 primary healthcare institutions from Qiandongnan prefecture / 中国药房

OBJECTIVE To investigate the present equipment and management situation of narcotic drugs in primary healthcare institutions from Qiandongnan prefecture of Guizhou province. METHODS The questionnaire survey was conducted among pharmacy department heads and medical staff from primary healthcare institutions in Qiandongnan prefecture of Guizhou province. Descriptive statistical analysis was conducted on the survey results. RESULTS Of 251 healthcare institutions in this survey， 29 healthcare institutions were equipped with narcotic drugs， accounting for 11.55%. The reasons for the narcotic drugs unequipped were mainly as follows: insufficient attention， no storage conditions for narcotic drugs， complex program of narcotic drug management， small amount usage and so on. Among the 29 primary healthcare institutions equipped with narcotic drugs， all of them did not monitor patient usage， accounting for 100%； 29 healthcare institutions did not implement a return visit or follow-up every 3 months， accounting for 100%. CONCLUSIONS The health administration departments should strengthen the administration of narcotic drugs in primary healthcare institutions. At the same time， training on standardized management and clinical rational application of narcotic drugs for medical staff in primary healthcare institutions should be enhanced by the health administrative department.

Current legislation on medical cannabis in the European Union: historical background, movements, trends, and counter-trends lessons for Brazil / Legislação atual sobre cannabis medicinal na União Europeia: históricos, movimentos, tendências e contratendências. Lições para o Brasil

ABSTRACT BACKGROUND AND OBJECTIVES: The growing interest in the medical use of cannabis and phytocannabinoids has led European Union (EU) countries to regulate the production and access to cannabis products for their citizens. This regulation is based on international conventions, the European Medicines Agency (EMA) guidelines and legal loopholes that grant autonomy to EU member countries to authorize the production and marketing of cannabis-based drugs and foods. This summary aims to present the current status of medical cannabis legislation in the EU, highlighting the authorization of drugs, regulatory processes and the autonomy of member states in the production of magistral formulas. CONTENTS: Most EU countries allow, in some form, the legal use of cannabis and its derivatives as a drug. Since 2019, three drugs containing nabiximols, dronabinol or nabilone have been authorized on the markets of EU member states. In addition to the EMA centralized procedure for marketing authorization, cannabinoid-based products can also be authorized through regional or national processes in EU countries. This autonomy extends to the production of magistral formulas in compounding pharmacies, allowing pharmacists to prepare formulas containing cannabis for use according to a specific medical prescription and, in some situations, at scale. CONCLUSION: While it is not possible to conclude which is the ideal approach to the regulation of medical cannabis that all countries should adopt, the experience of the EU provides valuable lessons. The autonomy granted to the member states allows the expansion of the medical use of cannabis through the authorization of drugs and the production of magistral formulas. These experiences can be used as a basis for reformulations in Brazilian regulations, aiming to expand access and medical use of cannabis in the country.

RESUMO JUSTIFICATIVA E OBJETIVOS: O crescente interesse no uso medicinal da cannabis e fitocanabinoides tem levado os países da União Europeia (UE) a regulamentarem a produção e acesso a produtos canábicos para seus cidadãos. Esta regulamentação se baseia em convenções internacionais, orientações da Agência Europeia de Medicamentos (EMA) e brechas legais que concedem autonomia aos países-membros da UE para autorizar a produção e comercialização de fármacos e alimentos à base de cannabis. Este estudo teve o objetivo de apresentar a situação atual da legislação sobre cannabis medicinal na UE, destacando a autorização de fármacos, os processos de regulamentação e a autonomia dos estados-membros na produção de fórmulas magistrais. CONTEÚDO: A maioria dos países da UE permite, de alguma forma, o uso legal da cannabis e seus derivados como fármaco. Desde 2019, três fármacos contendo nabiximols, dronabinol ou nabilona foram autorizados nos mercados dos estados-membros da UE. Além do procedimento centralizado da EMA para a autorização de comercialização, os produtos à base de canabinoides também podem ser autorizados por meio de processos regionais ou nacionais dos países da UE. Essa autonomia se estende à produção de fórmulas magistrais em farmácias de manipulação, permitindo que os farmacêuticos preparem fórmulas contendo cannabis para uso de acordo com prescrição médica específica e, em algumas situações, em escala. CONCLUSÃO: Embora não seja possível concluir qual é a abordagem ideal para a regulamentação da cannabis medicinal que deve ser adotada por todos os países, a experiência da UE fornece lições valiosas. A autonomia concedida aos estados-membros permite a ampliação do uso medicinal da cannabis por meio da autorização de fármacos e da produção de fórmulas magistrais. Essas experiências podem ser utilizadas como base para reformulações na regulamentação brasileira, visando ampliar o acesso e uso medicinal da cannabis no país.

Mecanismo de los AINES y antiinflamatorios derivados para el control del dolor y la inflamación. Uso de antiinflamatorios en odontología / Mechanism of NSAIDs and derived drugs for pain and inflammation control. Use of anti-inflammatories in odontology

Las urgencias odontológicas son, quizá, las razones principales de atención en el consultorio, muchas veces el significado de dolor se encuentra acompañado por inflamación; el uso de antiinflamatorios no esteroideos (AINES) es común en el ejercicio de la odontología por la excelente respuesta analgésica y antiinflamatoria que tiene, por lo que es importante conocer la fisiopatología de la inflamación y el dolor y cómo actúan los AINES, ya que algunos de estos fármacos tienen respuestas adversas y sitios de acción importantes. Los factores de riesgo por inflamación y dolor nos obligan a conocer la variedad de fármacos que no entran en la clasificación de AINES y que tenemos a disposición, hay más opciones para la elección ante la presencia de inflamación por un factor en particular, cada uno de éstos tienen indicaciones y contraindicaciones que conoceremos, lo cual nos ampliará el conocimiento para dar una prescripción ante la presencia de eventos inflamatorios. Se realizó un estudio detallado de artículos bibliográficos de cada tema, los fármacos más usados en odontología son los AINES, hay poco uso y conocimiento de antiinflamatorios que podemos usar en urgencias, el porcentaje de uso de los AINES derivados del ácido propiónico es alto por la excelente respuesta en pacientes y otras veces por el desconocimiento de más opciones (AU)

Dental emergencies are perhaps the main reasons for care in the office, many times the meaning of pain is accompanied by inflammation, the use of non-steroidal anti-inflammatory drugs is common in the practice of dentistry due to the excellent analgesic and anti-inflammatory response it has, important is knowing the pathophysiology of inflammation and pain, how NSAIDs act, some of these drugs have adverse responses and important sites of action, risk factors for inflammation and pain require us to know the variety of drugs that do not enter the classification of NSAIDs and we have at our disposal, there are more options for choosing in the presence of inflammation due to a particular factor, each of these have indications and contraindications that we will know, it expands our knowledge to give a prescription in the presence of inflammatory events. A detailed study of bibliographic articles on each topic was carried out, the drugs most used in dentistry are NSAIDs, there is little use and knowledge of anti-inflammatories that we can use in the emergency room, the percentage of use of NSAIDs derived from propionic acid is high, due to the excellent response in patients and others due to lack of knowledge of more options (AU)

Expert consensus on quality control management of key links for narcotic drugs and class Ⅰ psychotropic substances in medical institutions of Yunnan province / 中国药房

Narcotic drugs and class Ⅰ psychotropic substances have always been special management drugs in medical institutions. Although relevant policies and regulations have been introduced at the national level ，there are problems of poor policy understanding and inconsistent implementation in medical institutions in the process of policy implementation. In order to standardize the management of narcotic drugs and class Ⅰ psychotropic substances in medical institutions of Yunnan province ， based on the preliminary research and Delphi expert consultation ，this editing group finally formed the Expert Consensus on Key Links Quality Control Management of Narcotic Drugs and Class I Psychotropic Substances in Medical Institutions of Yunnan Province by focusing on the key aspects of quality control of key links for narcotic drugs and class Ⅰ psychotropic substances in medical institutions ，aiming to provide reference for the clinical use and management of narcotic drugs and class Ⅰ psychotropic substances in medical institutions of Yunnan province.

Comparison between ropivacaine and lidocaine in prostatic peripheral nerve block anesthesia / 中华泌尿外科杂志

The present study retrospectively analyzed the clinical data of 137 patients who underwent prostate in North Jiangsu People's Hospital from June 2020 to May 2021. All patients underwent peripheral prostatic nerve block anesthesia (PPNB). The observation group received 1% ropivacaine 32 ml local, and the control group received the same dose of lidocaine. There was no significant difference in general data before puncture between the two groups ( P>0.05). All 137 cases were performed by the same surgeon. The number of puncture needles in the observation group and the control group was (20.2±2.8) and (20.2±2.9), respectively, and the difference was not statistically significant ( P>0.05). The visual analogue scores (VAS-1) of pain during puncture in the observation group and the control group were (2.62±0.74) and (2.48±0.79) points, respectively. The visual numeric score (VNS-1) was (3.03±0.88) points and (3.15±0.80) points, respectively, and there was no significant difference ( P>0.05). 30 min after puncture, VAS-2 was (0.48±0.53) points and (0.30±0.47) points, VNS-2 was (3.31±0.48) points and (3.55±0.71) points, respectively.The differences were statistically significant ( P<0.05). There was no significant difference in overall complication rate between the two groups ( P=0.661).

Paradoxo nas políticas sobre drogas: embates discursivos sobre a Lei 13. 840/2019 em portais de notícia / Paradox in drug policies: discursive clashes on news websites over Law 13. 840/2019

Resumo Parte-se da premissa de que as políticas sobre drogas são objetos construídos discursivamente a partir do envolvimento de diversos atores e de sua capacidade de produzir consensos. Dessa forma, o discurso jornalístico assume um importante papel de mediação entre os leitores e a realidade das políticas sobre drogas. Assim, objetivou-se analisar os discursos sobre a Lei 13.840/2019 em portais de notícias de massa. Trata-se de um estudo documental, de abordagem qualitativa, com aporte da Análise de Discurso Crítica, segundo o método de análise tridimensional de Fairclough. Realizou-se uma busca por notícias sobre a Lei, no período de março a junho de 2020, publicadas on-line nos portais G1, R7, Carta Capital e The Intercept Brasil. Os portais foram escolhidos por serem de acesso gratuito e apresentarem vertentes ideológicas diversas. Destaca-se o conhecimento sobre o contexto de produção da referida Lei, bem como a reprodução do discurso proibicionista hegemônico nas notícias, apesar de algumas contestações pouco claras quanto à alternativa. Observam-se representações distintas sobre a Lei de acordo com o portal em que a notícia foi publicada. Contudo, em geral, o impacto da Lei para a Rede de Atenção Psicossocial, quando mencionado, foi abordado de forma superficial.

Abstract This study is based on the premise that drug policies are discursively constructed by the engagement of different social actors and their capacity to forge consensus. Considering that people tend not to seek information on policies by themselves, the journalistic discourse plays an important role in mediating the contact between readers and the reality of drug policies. Thus, this work aims to analyze the discourses around the Act 13.840 of 2019, published at mass media portals online. This is a documental study based on the three-dimensional model for critical discourse analysis developed by Fairclough. The portals G1, R7, Carta Capital, and The Intercept Brasil (chosen due to granting free access and having different ideological perspectives) were searched for articles approaching the Act. Our results indicate that the published articles demonstrate knowledge on policy making and reinforce the hegemonic prohibitionist discourse, despite some unclear objections about possible alternatives. The representations of the Act 13.840 differed according to the publishing portal, but, in general, the articles made few considerations about the impact of the Act on the Psychosocial Support Network.

O julgamento de adolescentes varejistas do tráfico de drogas no Brasil: uma análise de processos judiciais / Legal sentences of adolescents for small-scale drug trafficking in Brazil: an analysis of judicial decisions / Sentencias judiciales contra adolescentes del microtráfico de drogas en Brasil: un análisis de las decisiones judiciales

Resumo (analítico) O objetivo do artigo é analisar os processos judiciais relativos ao ato infracional de tráfico de drogas, em Petrolina-PE (2011-2014), com base na revisão analítica das instituições e leis historicamente voltadas para a menoridade, segundo a Theory of Sentencing. Apreciou-se o conteúdo social das variáveis legais e extralegais, analisando o efeito cumulativo dos determinantes das sentenças. As decisões judiciais mais encontradas foram extinção processual e absolvição. Medidas socioeducativas de advertência, liberdade e semiliberdade são mais recorrentes que a internação. No entanto, há disparidades das sentenças em casos análogos e imputação de penas análogas em casos díspares. Conclui-se que o sistema penal é produtor e reprodutor de desigualdades sociais e a punição é percebida e utilizada como técnica de controle e transformação de adolescentes pobres apreendidos com pequenas quantidades de drogas.

Abstract (analytical) The purpose of this article is to analyze the legal sentences for drug trafficking offense in Petrolina, a city in the state of Pernambuco, in the period 2011-2014 based on the analytical review of institutions and laws that have historically targeted minorities and the Theory of Sentencing. The social content of legal and extralegal variables was analyzed, analyzing the cumulative effect of determinants for the sentences. The most frequent judicial decisions were procedural extinction and acquittal. Socioeducational measures of warnings, dropping of all charges and suspended sentences are more common than imprisonment. However, there are disparities in sentences for similar cases and the handing down of analogous sentences in disparate cases. It is concluded that the penal system is a producer and reproducer of social inequalities and punishment is perceived and used as a technique for the control and transformation of poor adolescents who are caught with small amounts of drugs.

Resumen (analítico) El objetivo del artículo es analizar los procesos judiciales de tráfico de drogas, en Petrolina-PE (2011-2014) de adolescentes, basado en la revisión analítica de las instituciones y leyes históricamente orientadas hacia las minorías y la Theory of Sentencing. Se apreció el contenido social de las variables legales y extralegales, analizando el efecto acumulativo de los determinantes de las sentencias. Las decisiones judiciales más encontradas fueron la extinción procesal y la absolución. Las medidas socioeducativas de advertencia, libertad y semilibertad son más recurrentes que la internación. Sin embargo, hay disparidades de sentencias en casos análogos e imputación de penalización análogas en casos dispares. Se concluye que el sistema penal es productor de desigualdades sociales y el castigo es percibido y utilizado como técnica de control y transformación de adolescentes pobres incautados con pequeñas cantidades de drogas.

Discussion on Using Quality Control Circle to Improve the Qualified Rate of Anesthesia Prescription in Our Hospital / 中国药学杂志

OBJECTIVE: To explore the application effect of quality control circle management in improving the qualified rate of anesthetic drugs prescription in hospital. METHODS: The quality control circle was established to explore the causes of the unqualified anesthetic drugs prescription in our hospital by using the 80/20 rule and fish-bone diagram. The measures to improve the prescription pass rate were determined, and the changes of the prescription pass rate before and after QCC management were compared through the implementation and review of the measures. RESULTS: Using the management of quality control circle, the prescription quality of inpatient anesthetic drugs was significantly improved in our hospital in 2018 and the qualified rate increased from 70.07% in 2017 to 2018 97.78% above target value of 6.69%. After continuous quality control circle management, the qualified rate of prescription increased to 99.33% in the first three quarters of 2019. CONCLUSION: The development of QCC can effectively improve the qualified rate of anesthetic drugs prescription in hospital, not only standardizing the use of anesthetic drugs, promoting drug safety of patients, but also improving the comprehensive quality of pharmacists and the quality of hospital pharmaceutical care.

Analysis on the use of narcotic drugs for inpatients / 药学实践杂志

Objective To investigate and analyze the inpatient use of narcotic drugs, provide reference for clinical norms and rational use of narcotic drugs. Methods The narcotic prescription number, usage and cost were analyzed statistically. The inpatient narcotic use was analyzed by screening the dose form, indication, and dosage. Results The injections topped the list of narcotic prescriptions from year 2016 to 2019 with 15 820 (61.4%), 15 813 (61.5%), 16 682 (64.7%) and 17 293 (71.5%) prescriptions respectively. The oral and topical narcotic drugs were less prescribed. Although pethidine hydrochloride injection prescriptions decreased year by year, it still topped in the narcotic use with 8 009 (31.1%), 7 707 (30.0%), 7 151 (27.7%) and 6 844 (28.3%) prescriptions each year. Pethidine hydrochloride injection was mostly used for patients with cancer and chronic pancreatitis. Conclusion Doctors preferred to use injectable narcotics for patients with moderate to severe pain. Improper use of narcotic drugs was noticed, such as unsuitable choice of dose form, inappropriate use of pethidine hydrochloride injection, etc. Pharmacists should keep vigilant in prescription review and medication intervention for narcotic drugs to improve the standardization and rational use of narcotics.

Anestesia libre de opioides en hemicolectomía abierta derecha extendida. Reporte de un caso y revisión / Opiod Free Anesthesia (OFA) for Open extended right colectomy. A case report and review

Opioid free anesthesia (OFA) is defined as an anesthesiologic technique where opioids are not used in the intraoperative and postoperative period. Although the mainstay of intra-operative analgesia may be opioids, current challenges are focus on reducing them and preventing the adverse effects of opioids, by rationalizing and even suspending their perioperative use, specifically at risk populations such as Obstructive Sleep Apnea Syndrome (OSAHS), obesity, Chronic Obstructive Pulmonary Disease (COPD) and cancer surgery. We present this case of OFA in a susceptible patient with complications from the use of opioids undergoing an extended right hemicolectomy. Multimodal analgesia was performed with a thoracic peridural and subanesthetic doses of intravenous agents including dexmedetomidine, ketamine and propofol, accompanied by short and long-lasting local periglotic anesthetics. The patient had given an intraand postoperative analgesia without presenting any adverse events, good recovery, early deambulation and extubation.

La anestesia libre de opioides (OFA) es una técnica anestésica donde no hay administración de opioides, tanto en el intraoperatorio como en el postoperatorio. Aunque una de las bases de la analgesia intraoperatoria podrían ser los opioides, los desafíos actuales están enfocados en reducir su uso perioperatorio, previniendo sus efectos adversos, racionalizando y limitando su empleo específicamente en poblaciones de riesgo como síndrome de apnea obstructiva del sueño (SAHOS), obesidad, enfermedad pulmonar obstructiva crónica (EPOC) y cirugía oncológica. Presentamos este caso de OFA en un paciente susceptible de complicaciones por uso de opioides sometido a una hemicolectomía derecha extendida. Se realizó analgesia multimodal con peridural torácica y dosis subanestésicas de agentes endovenosos como dexmedetomidina, ketamina y propofol, acompañado de anestésicos locales periglóticos de corta y larga duración. Se otorgó una adecuada analgesia intra y postoperatoria, el paciente no tuvo eventos adversos, presentando una buena recuperación, deambulación y extubación precoz.

Orofacial antinociceptive activity and anchorage molecular mechanism in silico of geraniol

Abstract We aimed to evaluate the orofacial antinociceptive effect of geraniol in mice and its molecular anchorage mechanism. Seven mice per group (probabilistic sample) were treated with geraniol (12.5, 25 and 50 mg/kg, i.p.), morphine (6 mg/kg, i.p.) and vehicle (saline + Tween 80 at 0.2%, i.p.) 30 minutes prior to the beginning of the experiment. Injecting glutamate (25 μM), capsaicin (2.5 μg) and formalin (2%) into the right upper lip (perinasal) of the mouse induced nociception. Behavioral analysis of the animals considered the friction time (in seconds) of the mentioned region using hind or front paws by a researcher blinded to the treatment groups. The statistical analysis was performed blindly, considering α = 5%. The results showed that in the glutamate and capsaicin tests, concentrations of 25 mg/kg and 50 mg/kg presented antinociceptive activity (p < 0.005, power> 80%). In the formalin test, geraniol was able to reduce nociception at a concentration of 50 mg/kg (p < 0.005, power> 80%). In the molecular anchorage study, high values of binding between the evaluated substance and receptors of glutamate were observed (metabotropic glutamate receptor, -87.8501 Kcal/mol; N-methyl-D-aspartate, -86.4451 Kcal/mol; α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid, -85.6755 Kcal/mol). Geraniol presented orofacial antinociceptive activity, probably by interacting with glutamate-related receptors.

Analysis of the Quality of Pharmaceutical Care for Cancer Pain Therapy in 64 Hospitals from Beijing / 中国药房

OBJECTIVE： To investigate pharmaceutical care of cancer pain therapy in medical institutions from Beijing area， and to provide reference for improving the quality of pharmaceutical care for cancer pain in medical institutions and formulating cancer pain therapy decision by public health administration departments at different levels. METHODS： Inspection results of standardized diagnosis and treatment for cancer pain were analyzed retrospectively in Beijing Pain Therapy Quality Control and Improvement Center during Feb.-Mar. 2018. Scoring results of pharmaceutical care （20 points） and its 5 sub-items （personnel participation， drug supply， drug management， outpatient prescription comment and inpatient prescription comment， 4 points each item） were analyzed statistically and classified according to hospital level and pharmaceutical care inspection results. RESULTS： A total of 64 hospitals in Beijing participated in the inspection， including 27 tertiary A hospitals （42.19％）， 21 tertiary B hospitals （32.81％）， 16 secondary hospitals or first-level hospitals （25.00％）. Pharmaceutical care in all hospitals met the inspection requirements with qualified rate of 100％. 52 hospitals performed excellently （81.25％）， and 12 hospitals were qualified for pharmaceutical care （18.75％）. Among 5 sub-items of personnel participation， drug supply， drug management， outpatient prescription comment and inpatient prescription comment， the average score of drug supply item was the highest （3.83±0.05）； the lowest was the personnel participation item （2.93±0.13）. The results of pharmaceutical care inspection in tertiary A hospitals （17.80±0.28） and tertiary B hospitals （17.78±0.30） were significantly better than those in secondary hospitals or first-level hospitals（16.16±0.50）（P＜0.01 or P＜0.05）； there was statistical significance only in the score of outpatient prescription comment among 5 sub-items（P＝0.026）. Total scores of the hospitals with excellent pharmaceutical care were significantly higher than those of the hospitals with qualified pharmaceutical care in terms of personnel participation， outpatient prescription comment and inpatient prescription comment （P＜0.01 or P＜0.05）. There was significant difference in the inspection results of pharmaceutical care among the excellent group， the qualified group and the unqualified group classified by the results of personnel participation item （P＜0.01 or P＜0.05）. CONCLUSIONS： The quality of pharmaceutical care for cancer pain therapy in medical institutions from Beijing area has reached the qualified level， but the participation of clinical pharmacists in cancer pain therapy and outpatient prescription comment still need improvement in further. The training of clinical pharmacists and information construction of narcotic drug management should be strengthened so as to improve the overall quality of pharmaceutical care for cancer pain.

Abuse or dependence of narcotic drugs and psychotropic drugs inhospital patients / 预防医学

Objective @#To understand the current situation and characteristics of narcotic drugs and psychotropic drugs abuse or dependence among hospital patients and to provide reference for strengthening the management of narcotic drugs and psychotropic drugs.@*Methods @#We collected clinical data from hospitals in Shandong and Guizhou provinces in 2016 and selected patients with history of narcotic drugs and psychotropic drugs. We investigated them through telephone or face-to-face interview,then described the characteristics of demographic information and abuse or dependence of narcotic drugs and psychotropic drugs in diagnosed drug abusers.@*Results @#A total of 280 patients with drug abuse or dependence were recruited,of which 223 cases from nine hospitals in Shandong and 57 cases from five hospitals in Guizhou. There were 170 male patients,accounting for 60.71%; 193 patients aged 45 years and above,accounting for 68.93%; 223 married patients,accounting for 80.51%; 166 patients with a education level of junior high school and below,accounting for 61.25%; 125 patients engaged in agriculture,accounting for 48.64%. Benzodiazepine was the main drugs abused or dependenced by hospital patients,accounting for 73.57%（206 cases）. There were also 83 cases of polydrug abuse,accounting for 29.64%. Among the patients with drug abuse or dependence,45.71% had no special feelings,41.07% had symptoms or felt uncomfortable after withdrawal; 64.64% was for improving their sleep quality. @*Conclusion @#Most patients with abuse or dependence of narcotic drugs and psychotropic drugs are middle- or senior-aged and have polydrug abuse. Benzodiazepine are the main abused drugs. The common reason for narcotic and psychotropic drug abuse or dependence is to have a good sleep.

Naltrexone-associated Visual Hallucinations: A Case Report

Naltrexone is a competitive antagonist of μ, δ, and κ opioid receptors. Naltrexone has been investigated for use an as anti-obesity agent in both the general population and in patients with severe mental illness, including schizophrenia. In patients with schizophrenia, however, potential psychotic symptoms due to adverse effects of naltrexone have not been investigated. Our case study, a relevant case report, and some related articles suggest that naltrexone might be associated with the emergence of visual hallucinations, which clinicians should be aware of.

Política de drogas e Saúde Coletiva: diálogos necessários / Política de drogas y Salud Colectiva: diálogos necesarios / Drug policy and Collective Health: necessary dialogues

A hegemonia atual das políticas de drogas ilícitas tem implicações à Saúde Coletiva que necessitam ser discutidas de forma aprofundada. Este ensaio procura explorar, à luz das melhores evidências, o impacto das políticas sobre drogas focadas na criminalização do plantio, comércio e consumo de substâncias psicoativas sobre a saúde das populações. O contexto de análise principal será o brasileiro. Os pontos principais abordados por este trabalho incluem a questão social das drogas e a definição do paradigma proibicionista, as evidências da relação insalubre entre tal paradigma e a saúde das populações, a problemática de um modelo de assistência aos usuários de substâncias psicoativas focado nas comunidades terapêuticas, e futuros caminhos a serem explorados na superação da proibição de drogas ilícitas como a principal forma de abordar a questão. Entre os principais elementos problemáticos da abordagem repressiva no contexto brasileiro podem ser destacados a violência e a mortalidade por homicídios, os impactos sanitários do encarceramento e o bloqueio de acesso ao sistema de saúde e a novas terapias derivadas de substâncias psicoativas atualmente proscritas. Como propostas de mudanças políticas futuras, ressalta-se a descriminalização do uso, posse e pequenas vendas de drogas; a redução da violência e da discriminação associadas ao policiamento; o foco em políticas de redução de danos; a abordagem das especificidades relacionadas ao gênero; incluir variáveis sociais como métrica do sucesso no tratamento do uso problemático de drogas. Concluindo, é relevante que a questão social e política das drogas se torne objeto de mais estudos no campo da Saúde Coletiva.

La hegemonía actual de las políticas de drogas ilícitas tiene implicaciones para la Salud Colectiva que necesitan discutirse profundamente. Este trabajo estudia, a la luz de las mejores evidencias, el impacto de las políticas sobre las drogas, enfocadas en la criminalización del cultivo, tráfico y consumo de sustancias psicoactivas, para la salud de la población. El contexto de análisis principal será el brasileño. Los puntos principales abordados por este trabajo incluyen: cuestión social de las drogas y la definición del paradigma prohibicionista; evidencias de la relación insana entre este paradigma y la salud de las poblaciones; así como la problemática de un modelo de asistencia a los consumidores de sustancias psicoactivas centrado en comunidades terapéuticas, y los futuros caminos que se exploran para que se supere la prohibición de las drogas ilícitas como la vía principal de abordaje de esta cuestión. Entre los elementos primordiales y problemáticos del enfoque represivo en el contexto brasileño se pueden destacar: violencia y mortalidad por homicidios; impactos sanitarios con conlleva el encarcelamiento y el bloqueo del acceso al sistema de salud; así como las nuevas terapias, derivadas de sustancias psicoactivas, actualmente proscritas. A modo de propuestas para posibles cambios políticos futuros, se resalta la descriminalización del consumo, posesión y venta de pequeñas cantidades de droga; la reducción de la violencia y discriminación, asociadas a la vigilancia policial; situar el centro de la cuestión en políticas de reducción de perjuicios para la salud; plantear las especificidades relacionadas con el género; así como incluir variables sociales como medir el éxito de los tratamientos relacionados con el consumo problemático de drogas. A modo de conclusión, es relevante que la cuestión social y política de las drogas se convierta en objeto de más estudios en el campo de la Salud Colectiva.

The current status of policies on illicit drugs has implications for Collective Health that need to be discussed in depth. This essay aims to explore, in light of the best evidence, the public health impact of drug policies focused on the criminalization of growing, selling, and consuming psychoactive substances. Brazil provides the context for the main analysis. The principal points addressed in this work include drugs as a social issue and the definition of the prohibitionist paradigm, evidence of the unhealthy relationship between this paradigm and the population's health, the issue of a model of care for users of psychoactive substances focused on therapeutic communities, and future paths to be explored to overcome the prohibition of illicit drugs as the principal approach to the issue. Among the main problematic elements in the repressive approach in the Brazilian context, the study highlights violence and homicides, the health impacts of incarceration and blocked access to the health system, and potential new therapies derived from currently banned psychoactive substances. As proposals for future policy changes, the study highlights decriminalization of the use, possession, and small-scale sale of drugs; the reduction of the violence and discrimination associated with policing; focus on harm reduction policies; approach to gender-related specificities; and inclusion of social variables as metrics for successful treatment of problematic drug use. In conclusion, it is relevant that the social issue and drug policy have become the object of more studies in the field of Collective Health.

O uso do Twitter como minerador de eventos adversos de medicamentos de combate à malária: o caso da doxiciclina / El uso de Twitter como localizador de eventos adversos con medicamentos de combate a la malaria: el caso de la doxiciclina / Mining in Twitter for adverse events from malaria drugs: the case of doxycycline

Durante o período de pós-comercialização, quando medicamentos são usados por grandes populações e por períodos de tempo maiores, eventos adversos (EA) inesperados podem ocorrer, o que pode alterar a relação risco-benefício dos medicamentos o suficiente para exigir uma ação regulatória. Eventos adversos são agravos à saúde que podem surgir durante o tratamento com um produto farmacêutico, os quais, no período de pós-comercialização do medicamento, podem requerer um aumento significativo de cuidados de saúde e resultar em danos desnecessários aos pacientes, muitas vezes fatais. Portanto, o quanto antes, a descoberta de EA no período de pós-comercialização é um objetivo principal do sistema de saúde. Alguns países possuem sistemas de vigilância farmacológica responsáveis pela coleta de relatórios voluntários de EA na pós-comercialização, mas estudos já demonstraram que, com a utilização de redes sociais, pode-se conseguir um número maior e mais rápido de relatórios. O objetivo principal deste projeto é construir um sistema totalmente automatizado que utilize o Twitter como fonte para encontrar EA novos e já conhecidos e fazer a análise estatística dos dados obtidos. Para isso, foi construído um sistema que coleta, processa, analisa e avalia tweets em busca de EA, comparando-os com dados da Agência Americana de Controle de Alimentos e Medicamentos (FDA) e do padrão de referência construído. Nos resultados obtidos, conseguimos encontrar EA novos e já existentes relacionados ao medicamento doxiciclina, o que demonstra que o Twitter, quando utilizado em conjunto com outras fontes de dados, pode ser útil para a farmacovigilância.

Durante el período de poscomercialización, cuando grandes poblaciones consumen medicamentos durante períodos más prolongados de tiempo, se pueden producir eventos adversos (EA) inesperados, lo que puede alterar la relación riesgo-beneficio de los medicamentos. Esta situación es suficiente para exigir una acción regulatoria. Los EA son agravios a la salud que pueden surgir durante el tratamiento con un producto farmacéutico, los cuales, durante el período de poscomercialización del medicamento, pueden requerir un aumento significativo de cuidados de salud y resultar en lesiones innecesarias para los pacientes, muchas veces fatales. Por lo tanto, el hallazgo anticipado de EA durante el período de poscomercialización es un objetivo primordial del sistema de salud. Algunos países cuentan con sistemas de vigilancia farmacológica, responsables de la recogida de informes voluntarios de EA durante la poscomercialización, pero algunos estudios ya demostraron que, con la utilización de las redes sociales, se puede conseguir un número de informes mayor y más rápido. El objetivo principal de este proyecto es construir un sistema totalmente automatizado que utilice Twitter como fuente para encontrar nuevos EA y ya conocidos, además de realizar un análisis estadístico de los datos obtenidos. Para tal fin, se construyó un sistema que recoge, procesa, analiza y evalúa tweets en búsqueda de eventos adversos, comparándolos con datos de la Agencia Americana de Control de Alimentos y Medicamentos (FDA) y del estándar de referencia construido. En los resultados obtenidos, conseguimos encontrar nuevos eventos adversos y ya existentes, relacionados con el medicamento doxiciclina, lo que demuestra que Twitter, cuando es utilizado junto a otras fuentes de datos, puede ser útil para la farmacovigilancia.

During the post-marketing period, when medicines are used by large population contingents and for longer periods, unexpected adverse events (AE) can occur, potentially altering the drug's risk-benefit ratio enough to demand regulatory action. AE are health problems that can occur during treatment with a pharmaceutical product, which in the drug's post-marketing period can require a significant increase in health care and result in unnecessary and often fatal harm to patients. Therefore, a key objective for the health system is to identify AE as soon as possible in the post-marketing period. Some countries have pharmacovigilance systems responsible for collecting voluntary reports of post-marketing AE, but studies have shown that social networks can be used to obtain more and faster reports. The current project's main objective is to build a totally automated system using Twitter as a source to detect both new and previously known AE and conduct the statistical analysis of the resulting data. A system was thus built to collect, process, analyze, and assess tweets in search of AE, comparing them to U.S. Food and Drug Administration (FDA) data and the reference standard. The results allowed detecting new and existing AE related to the drug doxycycline, showing that Twitter can be useful in pharmacovigilance when employed jointly with other data sources.

Crack cocaine use scene in the capital of the state of Santa Catarina/Brazil: the (in)visibility of users / Escenas del consumo de crack en la capital de Santa Catarina/Brasil: la (in)visibilidad del usuario / Cenas de uso do crack na capital de Santa Catarina/Brasil: a (in)visibilidade do usuário

ABSTRACT Objective: to describe the characteristics of the crack cocaine use scene, its surroundings and consequences. Method: this study was based on the Time-location Sampling methodology. Between January and June 2011, 41 crack use scenes were mapped in Florianópolis (Brazil). After randomly selecting the scenes to be observed, the days and shifts for in-depth observation were selected by lottery, for a total of 98 scenes/shifts, this atep was performed between December 2011 and March 2012. The observations were recorded in a field diary, and were examined using content analysis and discussed based on the Brazilian and international literature on the topic. Results: the results show that crack cocaine use scenes were more concentrated in the central regions of Florianópolis. Policing was very ostensive in the communities surrounding these areas, which are strongly marked by drug trafficking. Healthcare, prevention and authority actions were incipient in the locations of substance use, which shows the invisibility of crack users in society. Conclusions: more investments are needed so that public policies work to help drug users access social and healthcare services.

RESUMEN Objetivo: describir características de la escena del consumo de crack, su entorno y evoluciones. Método: utilizada metodología Time-Location Sampling. Entre enero y junio de 2011 fueron mapeadas 41 escenarios de consumo de crack en Florianópolis (Brasil). Escenarios a observarse elegidos aleatoriamente, se sortearon días y turnos para la tarea, totalizando 98 escenas/turno, etapa realizada entre diciembre 2011 u marzo 2012. Observaciones registradas en cuaderno de campo, examinadas por análisis de contenido y discutidas según literatura nacional e internacional. Resultados: los escenarios de consumo de crack se concentraron en regiones centrales de Florianópolis. Vigilancia ostensiblemente aplicada en comunidades cercanas, marcadas por el tráfico de drogas. Las acciones de cuidado, prevención y autoridad resultaron ser incipientes en lugares de consumo de la substancia, expresando la invisibilidad del usuario de crack frente a la sociedad. Conclusiones: se requieren mayores inversiones para que las políticas públicas actúen permitiendo que el consumidor de la droga acceda a equipos sociales y de cuidado.

RESUMO Objetivo: descrever as características da cena de uso do crack, seu entorno e desdobramentos. Método: o projeto se valeu da metodologia Time-Location Sampling. De janeiro a junho de 2011 foram mapeadas 41 cenas de uso de crack em Florianópolis (Brasil). Após seleção aleatória das cenas a serem observadas, sortearam-se os dias e turnos em que essas seriam observadas em detalhe, totalizando 98 cenas/turno, atapa realizada entre dezembro de 2011 a março de 2012. As observações, registradas em caderno de campo, foram examinadas via análise de conteúdo e discutidas à luz da literatura nacional e internacional. Resultados: o estudo identificou que as cenas de uso de crack se concentram nas regiões centrais de Florianópolis. O policiamento ocorre de maneira ostensiva nas comunidades próximas a estas áreas, fortemente marcadas pelo tráfico de drogas. As ações de cuidado, prevenção e autoridade se mostraram incipientes nos locais de uso da substância, o que denota a invisibilidade do usuário de crack perante a sociedade. Conclusões: são necessários maiores investimentos para que as políticas públicas atuem a fim de possibilitar que o usuário da droga acesse os equipamentos sociais e de cuidados.

Programa Farmácia Popular do Brasil: uma análise política de sua origem, seus desdobramentos e inflexões / Popular Pharmacy Program of Brazil: a political analysis of its origin, unfoldings and inflections

RESUMO O artigo se refere a uma investigação qualitativa que analisa as origens, os desdobramentos, resultados e desafios do Programa Farmácia Popular do Brasil, face à necessária integralidade da assistência farmacêutica. Para a produção dos dados, foram utilizados documentos e entrevistas semiestruturadas com informantes envolvidos com o movimento da Reforma Sanitária Brasileira e/ou a questão medicamentos/assistência farmacêutica, considerando o período de 2003 a 2016; notícias produzidas entre 2013 e 2018, disponíveis em sítios eletrônicos de instituições entendidas como atores no processo de implementação de políticas farmacêuticas. A análise dos dados revelou que, apesar dos conflitos em torno da construção da proposta, o programa resultou em ampliação do acesso aos medicamentos essenciais, redução da mortalidade e de internações por doenças crônicas. Por esse motivo, inflexões no programa, como o fechamento da modalidade rede própria, resultaram em posicionamentos de organizações da sociedade civil, também motivados diante da conjuntura de perdas de direitos sociais. Permanecem lacunas concernentes à qualidade do acesso em suas diversas dimensões de análise e à promoção do uso racional de medicamentos, na perspectiva da integralidade da Assistência Farmacêutica.

ABSTRACT The article refers to a qualitative research that analyzes the origins, unfoldings, results and challenges of the Brazilian Popular Pharmacy Program, in view of the necessary integrality of pharmaceutical assistance. For the production of the data, documents and semi-structured interviews were used with informants involved with the Brazilian Health Reform movement and the issue of medicines/pharmaceutical assistance, considering the period from 2003 to 2016; news produced between 2013 to 2018, available on electronic sites of institutions understood as actors in the process of implementing pharmaceutical policies. Analysis of the data revealed that, despite the conflicts surrounding the proposal's construction, the program resulted in increased access to essential drugs, reduced mortality and hospitalizations for chronic diseases. For this reason, inflections in the program, such as the closing of the first modality, have resulted in positions of civil society organizations, also motivated by the conjuncture of losses of social rights. Gaps remain regarding the quality of access in its various dimensions of analysis and the promotion of rational use of medicines, from the perspective of the integrality of Pharmaceutical Assistance.

Comments on the Prescriptions of Analgesic Drugs for the Patients with Cancer Pain Using PCNE Classifi-cation System / 中国药师

Objective: To analyze the prescriptions of analgesic drugs for the patients with cancer pain, and promote the rational use of narcotic and analgesic prescriptions. Methods: Using the PCNE classification system, the list of all drug-related problems (DRPs) from 115 patients admitted to the standardized treatment of cancer pain from January to December 2017 was analyzed. Re-sults: In our hospital from January to December 2017, there were 52 cases of prescribed DRPs for narcotic and analgesic drugs in the standardized treatment of cancer pain with the incidence of 45. 22% . DRPs mainly focused on treatment safety with the incidence of 72. 31% . The drug choice caused the highest incidence of DRPs accounting for 63. 24% , followed by dose selection accounting for 20. 59% . Conclusion: There are still unreasonable prescriptions of narcotic analgesia in our hospital. According to the PCNE classifi-cation system, it is necessary to strengthen the communication with clinicians, carry out education for the patients with cancer pain, and further educate pharmacy staff on the knowledge of analgesic drugs. Through the above measures, the regulation of prescription medication for narcotic analgesics can be intensified.

Development and Application of Intelligent Management System for Narcotic and Psychotropic Drugs in Central Pharmacy of Our Hospital / 中国药房

OBJECTIVE:To promote the realization of intelligent management for narcotic and first type psychotropic drugs (narcotic and psychotropic drugs for short)in hospital. METHODS:With the aid of fingerprint identification technology and hardware devices such as intelligent storage cabinet,intelligent management for narcotic and psychotropic drugs were designed and developed in our hospital,including prescription dispensing,cardinal drug supplement,empty bottle recycling,changing shifts, etc. The effects of the system were evaluated 30 d before and after the implementation of the system through comparing related indexes. RESULTS:The application of intelligent management system for narcotic and psychotropic drugs realized intelligent dispensing of narcotic and psychotropic drugs,automatic checking during cardinal drug supplement,automatic information record during empty bottle recycling,automatic record during changing shifts,intelligent and information management on"five specific management"for narcotic and psychotropic drugs. Compared with before the implementation of the system,the duration of daily changing shifts was shortened from(13.62±0.40)min to(8.67±0.33)min,shortening by 4.95 min in average(n=30).The time of prescription dispensing was shortened from(30.36±0.48)min to(10.56±0.46)min,shortening by 19.80 min(n=30). The collecting time of cardinal drug supplement was shortened from(12.72±0.97)min to(0.13±0.03)min,shortening by 12.59 min (n=30). No drug dispensing error was found after the implementation of the system. CONCLUSIONS:The system is stable and convenient,which promotes that intelligent management for narcotic and psychotropic drugs is in line with the requirements of"five specific management". It also realizes intelligent and information operation,improves work efficiency and error prevention ability.