Suchergebnisse

Zusammenfassung: Zielsetzung: Die deutsche Bundesregierung hat beschlossen, den nicht-medizinischen Cannabis-Gebrauch und -Vertrieb zu legalisieren, und Kernpunkte des vorgesehenen Regelwerks vorgelegt. Einige dieser Kernpunkte werden aus der Sicht internationaler Erfahrungen und wissenschaftlicher Evidenz zur Legalisierung – insbesondere mit Blick auf Massnahmen und Ziele öffentlicher Gesundheit – eingeschätzt und kommentiert. Methodik: Selektive Zusammenfassung und policy-analytische Anwendung wissenschaftlicher Evidenz. Ergebnisse: Ein erheblicher Anteil von Cannabis-bezogenen Gesundheitsproblemen hängt mit dem Konsum von Hochpotenz- (THC) Produkten zusammen; allerdings würden kategorische THC-Grenzwerte für legal verfügbares Cannabis diese im Gesamten wahrscheinlich nicht reduzieren sondern primär Hochrisiko-Konsumenten weiter in der Illegalität belassen. Die Mindestalter-Grenze von 18 Jahren für legales Cannabis macht primär politischen Sinn und repräsentiert nicht unbedingt optimalen Gesundheits- oder sozialen Schutz für junge Konsumenten; allerdings wird der Cannabis-Konsum bei Minderjährigen wahrscheinlich weiter hoch blieben. Eine substanz-übergreifende, gesundheits-orientierte Angleichung mit den Gesetzesregelungen für andere Substanzen (z. B. Alkohol) wäre sinnvoll. Das Fahren unter Cannabis-Einfluss ist relativ häufig, und kann zu Verletzungs- und Todesfällen, und damit erheblicher Gesundheitsbelastung führen; seine Kontrolle braucht gezielte Aufklärungs- und Abschreckungs-Maßnahmen. Cannabis-Legalisierung ist mit einschlägigen internationalen (z. B. UN) Konventionen generell schwierig zu vereinbaren, sollte aber dazu genutzt werden, diese grundsätzlich auf der Basis von Prinzipien des Gesundheitsschutzes zu erneuern. Schlussfolgerungen: Für die Cannabis-Legalisierung in Deutschland gibt es kein perfektes Regelwerk; einige Kern-Ziele werden nur über Kompromiss-Ansätze zu erreichen sein, die im Zweifelsfall angepasst werden müssen. Wenn implementiert, wird Deutschland wichtige Daten zur Cannabis-Legalisierung als Politik-Option bieten können, wozu ein systematisches und umfassendes Prozess- und Ergebnis-Monitoring durchgeführt werden muss.

The combination of intoxication and criminal responsibility has been a problem field for legal theory and practice for quite some time. While it has been argued in certain contexts that intoxication reduces or denies criminal responsibility, elsewhere it has been reasoned that intoxicated offenders should be held as (or even more so) legally responsible as sober ones. But even in legal systems where the criminal responsibility of intoxicated offenders is emphasized, legal theory and practice are confronted with the challenge of converting such values into workable jurisprudence, since many intoxicated offenders naturally lack one of the key premises for responsibility for a criminal act, namely mens rea. This article compares the very different legal philosophies and practices that have evolved around the issue of intoxication and criminal responsibility in Canada and Germany. While the Canadian system has long and in a variety of ways tried to reconcile the inherent tensions between the principles of legal culpability and the intent to punish intoxicated offenders in material law, the German system has produced a set of legal tools that allow for a pragmatic and ends-oriented approach. This article concludes that the evolution and profile of these legal schemes is likely linked to the cultural status of alcohol and drinking in the respective system context.

Cannabis, marijuana, pot, ganja - it goes by many names -- is by far the most widely used illegal substance, and accounts for more arrests than any other drug. Barely a week goes by without this drug appearing in the newpapers, and politicians have famously tied themselve in knots, trying to decide just how to deal with this recreational drug. While there have been many drug policy books on other substances - both legal and illegal, few have focused on this drug. Cannabis Policy: Moving beyond Stalemate is unique in providing the materials needed for deciding on policy about cannabis in its va

Canada legalized and regulated non-medical cannabis in October 2018, and in the lead up to this policy change much debate was generated around the Federal Government's stated objective of "keeping cannabis out of the hands of children and youth". As Canada moved through the process of passing Bill C-45 (the Cannabis Act), a contentious issue was whether the 'public health approach' to legalization with strict regulation guiding Federal policy would protect young people from accessing cannabis and from the potential harms of use. Now that we are several years post-legalization of cannabis, in this brief commentary we reconsider the arguments made about the potential consequences of legalization for youth, centered on three key concerns: that prevalence would significantly increase, that there would be greater incidence of harms to youth brain development, and that there would be increased presentations of severe mental illnesses associated with cannabis use. We also consider how focusing narrowly on clinical outcomes has neglected the association between criminalization and social inequities, where the burdens are disproportionate for marginalized and racialized youth.

Illicit opioid use in Canada and elsewhere increasingly involves a variety of opioids and non-injection routes of administration. Injection and non-injection opioid users tend to differ in various key characteristics. From a public health perspective, non-injection routes of opioid use tend to be less harmful due to lesser morbidity and mortality risks. Our study compared current injectors (80%) and non-injectors (20%) in a multi-site sample of regular illicit opioid users from across Canada ('OPICAN' study). In bivariate analysis, injectors and non-injectors differed by prevalence in social and health characteristics as well as drug use. Logistic regression analysis identified city, drug use, housing status and mental health problems as independent predictors of injection status. Further analysis revealed that the majority of current non-injectors had an injection history. Our results reinforce the need to explore potential interventions aimed at preventing the transition from non-injectors to injecting, or facilitating the transition of injectors to non-injecting, as initiated in several other contexts.

Unterschiede zwischen Ko-Gebrauchern von Kokain und Crack bei kanadischen Opioid-Konsumenten <B>Fragestellung:</B> Es wurden Unterschiede zwischen Ko-Gebrauchern von Kokain und Crack in einer kanadischen Kohorte illegaler Opioid-Konsumenten (»OPICAN«) untersucht. </P><P> <B>Methodik:</B> Kohortenteilnehmer wurden durch Schneeball-Methoden rekrutiert und mittels eines standardisierten Instrumenten-Protokolls befragt. Prävalenzraten verschiedener Substanzen sowie Unterschiede zwischen ausgewählten Indikatoren und den beiden Subgruppen wurden bivariat geprüft. </P><P> <B>Ergebnisse:</B> Zirka die Hälfte der Studienteilnehmer indizierten Ko-Konsum von Crack beziehungsweise Kokain. Erstere Gruppe zeichnete sich primär durch sozioökonomische Marginalisierung, zweitere durch eine höhere Prävalenz von Depression aus. </P><P> <B>Schlussfolgerungen:</B> Ko-Gebraucher von Opioiden mit Kokain und Crack in Kanada können als distinkte Subkulturen mit spezifischen Risikofaktoren angesehen werden. Ausgewählte Implikationen für Interventionen werden angesprochen.

In Canada, illicit drug use and addiction have traditionally been considered as a criminal justice problem and have been addressed from a legal perspective. Over the past century, a medical approach to drug addiction has slowly crept into the criminal justice processing of drug offenders. This has happened through the combination of principles of punishment with principles of addiction treatment in the sentencing of drug offenders to create a distinct application of 'compulsory drug treatment' in Canada. However, this evolution has occurred sporadically over time, with punishment and coercion as predominantly the main approach to dealing with this population. This evolution has recently culminated in Canada with the development of two criminal justice approaches to dealing with the substance use problems of drug offenders that incorporate concepts of punishment and treatment more equally than ever before – conditional sentencing and drug courts. This paper outlines the historical evolution of concepts of 'compulsory treatment', discusses such examples of contemporary 'compulsory treatment' as conditional sentencing and drug courts, and analyses the implications, concerns and challenges associated with these tools currently used in the sentencing of drug offenders in the Canadian context.

Cannabis is the most commonly used illegal drug, and is associated with well-documented adverse health outcomes, both acute and chronic. Cannabis use prevalence in Brazil is lower than in high-use regions in the Americas (e.g., North America), but concentrated among young people. Frameworks for cannabis control are increasingly shifting towards public health-oriented principles, with some countries undertaking respective policy reforms. These frameworks require a continuum of population-level interventions (e.g., prevention and treatment) including targeted prevention of adverse health outcomes among users. In this context, and based on examples from other health fields, an international expert group developed the evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG), originally for Canada, including a set of 10 recommendations based on systematic data reviews and expert consensus methods. The LRCUG form a scientific population-health prevention tool to reduce adverse public health impacts for broad application among cannabis users. In Canada, the LRCUG have been formally endorsed and are supported by leading national health organizations and government authorities within the continuum of cannabis interventions. As the LRCUG are being internationalized, this paper introduces the LRCUG's concept and content – including their original recommendations translated into Portuguese – to the Brazilian context as an evidence-based population-level intervention tool for uptake, dissemination, and discussion. Sociocultural adaptation may be required for meaningful implementation.

Cannabis is the most commonly used illegal drug, and is associated with well-documented adverse health outcomes, both acute and chronic. Cannabis use prevalence in Brazil is lower than in high-use regions in the Americas (e.g., North America), but concentrated among young people. Frameworks for cannabis control are increasingly shifting towards public health-oriented principles, with some countries undertaking respective policy reforms. These frameworks require a continuum of population-level interventions (e.g., prevention and treatment) including targeted prevention of adverse health outcomes among users. In this context, and based on examples from other health fields, an international expert group developed the evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG), originally for Canada, including a set of 10 recommendations based on systematic data reviews and expert consensus methods. The LRCUG form a scientific population-health prevention tool to reduce adverse public health impacts for broad application among cannabis users. In Canada, the LRCUG have been formally endorsed and are supported by leading national health organizations and government authorities within the continuum of cannabis interventions. As the LRCUG are being internationalized, this paper introduces the LRCUG's concept and content – including their original recommendations translated into Portuguese – to the Brazilian context as an evidence-based population-level intervention tool for uptake, dissemination, and discussion. Sociocultural adaptation may be required for meaningful implementation.

<i>Background:</i> Methadone maintenance treatment (MMT) has been the 'gold standard' pharmacotherapy treatment for illicit opioid dependence for over 30 years. It has been widely evaluated, and is generally claimed to be 'effective'. <i>Methods:</i> The objective of this paper is to review the rationale of MMT as an intervention for a biomedical disorder with primary social objectives as well as the methodological quality and evidence of MMT outcome research. Data sources included opioid dependence treatment practice, review and outcome research literature (1965–2001) in the form of peer-reviewed articles, books, monographs and reports that are preeminently cited and reviewed international studies on MMT. <i>Results/Data Synthesis:</i> Rigorous and appropriate evaluation (i.e., RCTs, intent-to-treat, patient-centered) methods in MMT evaluations are rare. Evidence of MMT's effectiveness on primary treatment objectives is mixed and appears to be largely partial and short-term. Positive outcomes may be the result of selection effects of compliant patients and loss in proportion when more rigorous standards of analysis are applied. <i>Conclusions:</i> The quality of existing MMT research, and evidence for its general effectiveness are limited. Key concepts of self-medication and psychiatric comorbidity are largely ignored in MMT treatment and research frameworks, although they may serve to explain MMT's limited treatment success. Emerging new opioid pharmacotherapies require the fundamental review of the existing MMT paradigm as well as the application of rigorous and appropriate evaluation methods for future treatment.