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A recent court decision about the right to possess a certain amount of cannabis for private use has also raised questions about harder drugs, the Sunday press writes. Last month the Federal Court ruled that police have no right to confiscate cannabis if it amounts to less than 10 grams, is destined for personal use, and if the user in question is not caught in the act of smoking it publicly. According to the SonntagsZeitung newspaper, that decision could also now set a precedent for other drugs. Two prominent legal experts told the paper that the principle also applies to harder drugs like heroin, cocaine — a popular drug in Swiss cities — and crack, which is currently causing problems particularly in Geneva. Justice authorities are concerned about this, the paper writes: it quotes police in St Gallen and in Zurich who want the concrete implications of the recent decision to be spelled out at the national level rather than left open for interpretation. One major question is related to the amount of each drug deemed acceptable to be held for private use: only the 10 grams for cannabis is specifically defined by law. In St Gallen, for example, authorities set this as 2 grammes of cocaine: that is, some 25 lines, which would have a street value of around CHF Dear Swiss Abroad, what difficulties did you encounter when your foreign spouse applied for Swiss nationality? Tell us your experiences. Swiss food regulations do not allow raw milk to be sold for direct consumption. However, a loophole allows raw milk vending machines to do just that. Is Swiss neutrality misunderstood? Or has the Swiss model of neutrality now become obsolete? This content was published on Oct 21, Several hundred employees of the Stahl Gerlafingen steel company demonstrated in Bern on Monday morning against the company's plans to dismantle the plant. 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This content was published on Oct 21, Ukrainian Prime Minister Denys Shmyhal says anger toward Switzerland over the Sino-Brazilian peace plan was due to a 'misunderstanding'. More: SWI swissinfo. You can find an overview of ongoing debates with our journalists here. Please join us! If you want to start a conversation about a topic raised in this article or want to report factual errors, email us at english swissinfo. This content was published on Jun 2, Switzerland's capital city, Bern, has signalled its intent to conduct a scientific pilot trial of controlled cocaine sales. This content was published on Feb 6, In terms of European cocaine usage, half of the top ten cities are Swiss. SWI swissinfo. Swiss perspectives in 10 languages. Search Close. Menu Close. Search Search. About us. International Geneva. Foreign affairs. Swiss Politics. Multinational companies. Swiss Abroad. Switzerland: How To. Special reports. Cocaine consumption in Swiss cities is above the European average. 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Swiss police face confusion about hard drug rules

Buying Heroin Thun

Official websites use. Share sensitive information only on official, secure websites. Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases. This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population. Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain. Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers. Keywords: Analgesics—opioid , chronic pain , healthcare disparities , health services accessibility , human rights , medical indigency , pain management , palliative care. But that I can save him from days of torture, that is what I feel as my great and ever new privilege. Pain is a more terrible lord of mankind than even death itself. Pain, often called the fifth vital sign, can significantly influence an individual's health status and can have serious negative consequences, including morbidity and mortality. Pain is one of the most common symptoms associated with cancer. Forty-seven percent of patients whose treatment for cancer pain is controlled by their primary physicians feel that their treatment only partially controls the pain. Certain types of cancer pain, including neuropathic and cancer-induced bone pain, can be particularly challenging to treat. According to Brennan et al, a large gap exists between the increasingly sophisticated understanding of the pathophysiology of pain and the widespread inadequacy of its treatments. The morphine consumption rate in most regions does not reflect actual morphine needs for pain management. In contrast, consumption levels in Asian, African, and Middle Eastern countries have stagnated or decreased despite international efforts to change political views on opioid use for pain management. Worldwide distribution of morphine consumption in Source: International Narcotics Control Board. Opioid abuse affects availability. In , Afghanistan produced more than 6, metric tons of opium, yet that quantity was insufficient to meet the world's actual morphine needs, estimated to be approximately 6, metric tons. Therefore, the need for effective working partnerships and international collaborations is urgent to minimize suffering from unnecessary pain. The personal perceptions of physicians and patients, as well as restrictions within healthcare systems, contribute to the unnecessary suffering that results from nonexistent or inadequate pain management services. Physicians may have personal biases regarding gender, race, and ethnicity that affect their attitudes toward patients' pain. They may also lack adequate pain education and training, including pain assessment skills. Patients may fear that the presence of pain indicates a serious illness and interpret a prescription for opioids as a sign of impending death, or they may believe that the use of pain medication will lead to addiction and uncomfortable side effects. Patients may be unable to adequately articulate their level of pain to a physician. The healthcare system may struggle with insufficient funds, leading to inadequate treatment for low-income patients, decreased access to specialized pain care, and an increase in outpatient care that may not be optimal for pain management. Poor reimbursement policies, multiple pain assessment tools with inconsistent results, and strict legal requirements for pain physicians and clinics are other healthcare system—related factors that lead to inadequate treatment of pain. Approximately , people were diagnosed with cancer in the United Kingdom UK in , equating to an incidence of approximately per , According to the Office for National Statistics, in the mortality rate for females with cancer was per ,, and the mortality rate for males with cancer was per ,, with 74, female deaths and 81, male deaths from cancer. Diagnosed cases of cancer by sex in the United Kingdom, Reports suggest that underutilization of a multidisciplinary care approach between palliative care and pain medicine may contribute to inadequate pain management among patients in the UK. The WHO 3-step analgesic ladder model has provided a cost-effective pain treatment approach for many cancer sufferers; however, different models of analgesia treatment must be developed to address the increasing complexity of cancer and its treatments. Opioid use for chronic noncancer pain remains controversial; the safety and efficacy of long-term opioid use is described as uncertain. The American Cancer Society estimated that 1,, new cancer cases would be diagnosed in the US in In a review of current pain management in US palliative care, Green et al found that disparities existed among different racial and ethnic groups with regard to pain perception, assessment, and treatment. The expansion and improvement of palliative care have been achieved by increasing education and research of cancer in several medical disciplines, changing institutional attitudes, and developing national guidelines for the improved assessment of cancer care at the national level. The level of palliative care support has increased in more than hospitals since when these hospitals reported that they had palliative care programs. The intention of the initiative is to improve the quality of life for patients with cancer through effective pain control. Malaysia has a highly accessible public healthcare system, yet palliative medicine is still not an established discipline. Fear of addiction is among patients' most common concerns, as there is some confusion regarding the legality of opioid use in Malaysia. Additional barriers include the lack of formal medical education in palliative care and the lack of adequate facilities in smaller clinics to prepare or stock cheap oral morphine. Recent campaigns to raise public awareness of opioid use for cancer pain have been carried out to support the provision of good palliative care. The annual occurrence of cancer in India is estimated to be about 90 cases per , people, but because cancer is not required to be reported, this figure could be an underestimate. In , the annual incidence of cancer is projected to be 1,, and the total number of cases is projected to be 6 million, based on rates. India accounted for the consumption of kg of morphine in , a decrease from kg in Access to morphine for cancer pain in India appears to be limited, with most morphine given via the parenteral route. In recent years, cancer facilities such as cancer detection and prevention clinics and hospitals routinely have dispensed oral morphine for cancer pain management as a result of improved medical education. However, patients with cancer still receive inadequate opioid therapy for their pain. They are often too ill to travel to cancer facilities and possess limited financial capacity for opioid treatment. For example, some national laws prohibit or restrict opioid use throughout the duration of therapy, limiting dosages and concentrations regardless of clinical conditions and medical needs. The cost of opioid therapy is also prohibitively expensive for the majority of the population. Strategies for promoting opioid utilization for pain control have been ongoing since the WHO Palliative Care Program projects were implemented in Latin America. Positive outcomes have been seen in various countries, such as the creation of a national pain relief program in Colombia and a national palliative care program in Uruguay, as well as the newly founded Latin American Palliative Care Association that aims to improve pain control strategies. In , global mean consumption of morphine in milligrams per capita was 5. Some significant movements to improve morphine availability have been made in various African countries in recent years. Much of the opioid use in developed countries is associated with chronic noncancer pain, with the risk of potential addiction and dependence. Evidence-based guidelines by BPS, the American Pain Society APS , and WHO aim to develop a multidisciplinary approach to the use of chronic opioid therapy for adults with noncancer pain, with the goal of reducing a diversion to abuse. The key recommendations for initiating chronic opioid therapy include 1 an accurate physical assessment and examination, including a psychiatric history by clinicians; 2 a short trial of chronic opioid therapy as an option for patients with moderate or severe noncancer pain that has an adverse impact on function or quality of life; 3 stringent monitoring of patients with a history of drug abuse, psychiatric issues, and behavioral problems; 4 frequent evaluation of patients using chronic opioid therapy, with drug therapy discontinued when necessary; and 5 assistance for patients in meeting therapeutic goals and gradually decreasing dosage to manage intolerable adverse effects, such as aberrant drug-related behavior. Advances in the delivery of medication have improved their pharmacokinetic profiles and minimized unwanted side effects. These advances have been particularly important in expanding the utility of existing medications to better serve a variety of patients. Extended-release formulations of medications, including opioid agents, allow for simpler dosing regimens, improved patient satisfaction, and improved patient compliance. In addition, they provide more stable blood concentrations of therapeutic agents and may avoid the peaks and troughs of immediate-release drugs, resulting in fewer adverse effects that occur at peak concentrations and fewer periods of inadequate treatment caused by low drug concentrations at trough points. Transdermal and transmucosal delivery systems are attractive options for palliative care patients for whom enteral delivery may be limited by nausea, malabsorption, or dysphagia; these delivery systems are also a good option for drugs with poor oral bioavailability. Many opiate medications have poor oral bioavailability, and their utility has been greatly enhanced by the development of transmucosal preparations eg, Actiq, Fentora and transdermal formulations eg, Duragesic. Transmucosal agents allow for rapid treatment of breakthrough pain, while Duragesic patches deliver a basal rate of fentanyl to treat chronic pain. Ionsys is an iontophoretic transdermal fentanyl delivery system under development that would allow patient-controlled analgesia PCA through the active delivery of transdermal fentanyl on patient demand with the added safety of timing lockouts. New transmucosal formulations of the opioid sufentanil may be able to provide rapid and enduring pain control through a sublingual PCA system, known as Zalviso. Sufentanil is an analog of fentanyl that is approximately 10 times more potent than fentanyl and 1, times more potent than morphine; it provides superior analgesia with lower rates of respiratory depression than fentanyl or morphine after intravenous IV administration. However, sufentanil is extremely lipophilic, resulting in a short duration of action caused by rapid redistribution into lipid-rich tissues in the body. The advantage of this technology is that it does not require the placement of an IV line or classic PCA equipment. Clinical data have been positive. Delivery systems such as the Flector Patch and Voltaren Gel allow targeted application of antiinflammatory agents with decreased systemic absorption, which may result in an improved safety profile and fewer side effects. In addition to these transdermal and sublingual delivery systems, intranasal delivery systems of morphine Rylomine and fentanyl are being investigated, as are intranasal, oral, and sublingual formulations of medications such as ketamine. The APS has called pain the fifth vital sign in an attempt to increase the awareness of pain among healthcare professionals. Untreated or undertreated pain significantly decreases a patient's quality of life by causing sleep disorders, depression, impaired activity, mood alterations, abnormal appetite, inability to focus, and poor hygiene. Opioids are a popular choice for the treatment of intractable painful conditions, but barriers to effective pain assessment and management exist in both developed and developing countries. Huge disparities exist in opiate production vs actual needs, as well as in the distribution of morphine in developed countries vs developing countries. Imbalances between opioid consumption and availability persist despite international efforts in recent years. Opioid distribution must be improved throughout the world. Healthcare professionals and patients are often concerned about the side effects of opioid analgesics, particularly the potential for tolerance and addiction. Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy potentially will enhance the outlook for future chronic pain management. The authors have no financial or proprietary interest in the subject matter of this article. As a library, NLM provides access to scientific literature. Ochsner J. 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