Social Policy and PsychoactiveSubstances – summary
Many societies have regarded at least some psychoactive substances as a problem, but there have been very diverse approaches to dealing with them. Approaches have included regulation, taxation, treatment, persuasion, harm reduction and criminalisation, while aims have ranged from promoting public health to the preservation of social order. Social approaches to problems from psychoactive substances are set to change in coming years, with new substances entering the field along with new approaches to drug testing.
The Foresight project on Brain Science, Addiction and Drugs asked Professor RobinRoom of the University of Stockholm, Sweden, to review policy studies onpsychoactive substances.
He found that societies have a wide range of reasons for regulating psychoactivesubstances. These include avoiding harm to users and others (such as victims ofpassive smoking or of drunken driving), preserving public health, economic productivityand social order, and protecting the vulnerable, for example from domestic violence orother substance use-related crime.
As well as raising revenues and discouraging use, reasons for regulating psychoactivesubstances include restricting their use to specific purposes or groups, ensuringfairness, as with drugs in sport and perhaps in future with cognition enhancers; controlsfor religious or cultural reasons, as with Islam and alcohol; reinforcing public health; orencouraging hard work, public order and social stability. Control of drugs or of people?
Control schemes vary in exactly what they control – the purchaser (for example by age),the material, its price, its quality, or its distribution channel (for example by makingalcohol available only at a limited number of outlets). It is also possible to regulate thebehaviour of the consumer after they have consumed, for example by laws againstdriving while intoxicated, or being intoxicated in public.
In many countries such methods coexist with other preventive approaches which useeducation, advertising, deterrence and other methods to discourage the use or harmfuluse of psychoactive substances, and treatment strategies for drug users. The impact of policies
Recent decades have seen the emergence of strong international literatures on theimpact of different policies and combinations of policies on substance use andproblems. Particularly for alcohol and tobacco, there is a substantial literature onthe effects of different policies, and estimations are now available also on cost-effectiveness. These studies are from countries relevant to the UK situation, but the UK
contribution to the alcohol policy literature, for instance, has not been strong. Theinternational policy impact literature is much less developed for controls on illegal drugsand on psychopharmaceuticals. Room recommends that the UK commit itself tobuilding a tradition of policy impact studies and policy-oriented research, so that futurepolicy changes can be more strongly evidence-based. The Future
The present regime for controlling drugs of abuse seems unlikely to remain unchanged. One area which is likely to grow in importance in policy decisions in the next 20 yearsis evidence on levels of harm. Tensions on policy approaches are likely to arise atnational and international levels because of mismatches between levels of controlrelative to levels of harm and because of disagreement about the relative levels ofharm. This is likely to lead to continuing debate about the appropriate levels of controlsfor alcohol, tobacco and cannabis. If recreational drugs are ranked against scales ofharm in recent research reviews, tobacco and alcohol are regulated lightly at nationaland international levels compared to other psychoactive substances, while the oppositeapplies for cannabis.
These anomalies probably cannot be cured quickly. The economic interests behindtobacco and alcohol are very powerful. However, smoking in public places is becomingless acceptable in many parts of the world, and smokers in general will likely be facingfurther controls. Less harmful products containing nicotine but which are not smokedhave the potential to reduce the harm from smoking, but currently face impediments inthe market, for instance from EU decisions.
One approach would be to have more local rather than national or international control,to allow local factors such as the exact place in which drugs are being consumed, orthe form in which they are used, to be taken into account. One problem with thisapproach is that both drugs and people are internationally mobile and in somecircumstances will gravitate towards places with the lowest level of regulation. Novel drugs
The choices of substances by drug users tend to be conservative; MDMA is the singleexample of a substance which has come into wide use in the last three decades. Newdrugs that might become used despite this could be those which have potential toenhance mental and physical performance. New psychoactive substances might bedeveloped which enhance sexual performance (as with the success of Sildenafil (knownas Viagra), or intellectual and cognitive performance. For example, drugs to promotewakefulness or intellectual performance might become more readily available and morecommonly used.
Vaccines against drug use may be developed, possibly requiring regular top-upinjections. Their use would raise ethical issues. This, and the options for future controlof drug use, requires further research.
The full version of this review is on www.foresight.gov.uk
While the Office of Science and Technology commissioned this review, the views are thoseof the authors, are independent of Government and do not constitute government policy. Crown copyright DTI/Pub7915/3k/07/05/NP URN 05/1200
(Aspetti fisiologici, monitoraggio, diagnosi e patologie della Medico Veterinario Libero Professionista Specialista in Malattie dei Piccoli Animali Past-President SIRVAC (Società It. di Riproduzione Veterinari Animali da Compagnia) Ambulatorio Veterinario Majolino – Ranieri, Vicolo Del Forno 5, 43044 Collecchio (Pr) Fisiologia della Gravidanza In seguito all’ ovulazione e alla formazione
Chapter 22. Anxiety Disorders Claudio A. Naranjo, M.D. 1 Lara Chayab 2 1 Professor Department of Pharmacology Psychiatry and Medicine University of Toronto Toronto, Ontario CANADA and Head Neuropsychopharmacology Research Program Sunnybrook & Women’s College Health Science Centre Toronto, Ontario CANADA 2 M.Sc. Candidate Department of Pharmacology University