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Official websites use. Share sensitive information only on official, secure websites. Correspondence should be addressed to either Dr. Helene Benveniste or Dr. Congwu Du at the above address. Benveniste bnl. Cocaine abuse increases the risk of life-threatening neurological complications such as strokes and seizures. Although the vasoconstricting properties of cocaine underlie its cerebrovascular effects, the mechanisms underlying its neurotoxicity remain incompletely understood. The effects of cocaine were compared with those of methylphenidate, which has similar catecholaminergic effects as cocaine except for serotonin increases but no local anesthetic properties, and of lidocaine, which has similar local anesthetic effects as cocaine but is devoid of catecholaminergic actions. To control for the hemodynamic effects of cocaine, we assessed the effects of cocaine in animals in which normal blood pressure was maintained by infusion of phenylephrine, and we also measured the effects of transient hypotension mimicking that induced by cocaine. These findings support the use of calcium channel blockers as a strategy to minimize the neurotoxic effects of cocaine. Keywords: cocaine, cerebrovascular, calcium, blood volume, oxygenation, neurotoxicity. The abuse of cocaine can lead to transient cerebral ischemia, stroke, and hemorrhages, which are believed to reflect the vasoconstricting effects of cocaine Volkow et al. The vasoactive properties of cocaine are well known clinically and are taken advantage of when it is used as a local anesthetic De et al. Indeed, studies have shown that cocaine reduces cerebral blood flow CBF and blood volume in human subjects and in laboratory animals Volkow et al. Cocaine has multiple pharmacological targets including blockade of the dopamine, serotonin, and norepinephrine transporters Ritz et al. Additionally, one must also consider the impact of the peripheral hemodynamic effects of cocaine. For example, cocaine elicits an increase in cerebrovascular resistance and a decrease in carotid blood flow Stankovic et al. In addition, repeated cocaine administration has been shown to increase voltage-sensitive calcium currents in response to membrane depolarization in prefrontal cortex pyramidal neurons Uchimura and North, ; White and Kalivas, ; Trantham-Davidson and Lavin, ; Nasif et al. Noninvasive imaging techniques such as positron emission tomography London et al. Optical techniques have also been used to monitor the cerebrovascular and functional effects of cocaine in animals Stankovic et al. One advantage of optical technology is that it can concurrently detect oxyhemoglobin and deoxyhemoglobin, thereby distinguishing changes in the total hemoglobin concentration and oxygenation Jobsis, ; Chance et al. Fluorescent indicators e. Most optical experiments have used either isolated cells or brain slices Kudo et al. Thirty-three female Sprague Dawley rats — g were divided into experimental groups as shown in Table 1. Anesthesia was maintained with 1. The femoral artery was cannulated for continuous arterial blood pressure monitoring, and the femoral vein was catheterized for administration of drugs. The electrocardiogram, intra-arterial blood pressure, respiratory rate, and body temperature were continuously recorded module ; Small Animal Instruments, Stony Brook, NY. Blood gases were monitored regularly to keep PaCO 2 in the range of 30—45 mmHg during the experiments. Figure 1 A illustrates the schematic of the experimental animal setup, and Fig. Except for group 2b, all animals were maintained with isoflurane anesthesia at 1. We included this group of animals to ensure that the findings were not attributable to the hemodynamic effects of cocaine in isoflurane-anesthetized animals see below. A , Schematic illustration of the optical diffusion fluorescence experimental setup used for all studies. B , Example of a real-time physiological monitoring acquired during experiments. A 30 g needle attached to a stereotaxic micromanipulator was inserted into the somatosensory cortex 1. After Rhod2 loading, the optical probe was positioned onto the exposed cortex area Fig. The intravenous line was flushed with 1 cc of 0. This experimental group was added to mimic the hemodynamic changes transient mild hypotension to 40—50 mmHg that occurred in the isoflurane-anesthetized group 2a rats during the cocaine challenge. Group 6 rats received phenylephrine 0. A , Hemoglobin absorbance spectrum and excitation spectra of calcium fluorescence indicator Rhod2 obtained from the surface of rat brain cortex. B , Example of calcium-dependent fluorescence recording along with the reflectance of the excitations from the cortex of the brain simultaneously at those wavelengths in response to drug challenges. AU, Arbitrary units. We used a catheter-based optical diffusion and fluorescence instrument that has been described previously Du et al. The lamp was connected to the computer-controlled monochromator to select the incident lights of , , and nm by timesharing to sequentially deliver the selected lights onto the brain surface through one arm of a Y-shaped bifurcated fiber-optic bundle Fig. The fluorescence and the diffuse-reflected light re-emitted from the brain tissue were collected by the fiber optic tip of the common leg and transferred through the outgoing leg of the bundle. A filter cube in front of PMT-F was synchronized with the monochromator to pass the fluorescence emission through while being excited at nm but block the incident light at and nm. The scattered re-emission i. The signals were digitized and stored in a personal computer for data processing. To detect the calcium fluorescence and diffuse reflectance from the cortex, the optical fiber tip was placed in contact with the cortical surface as shown in Figure 1 A. The interface between the fiber optic and the exposed brain surface was filled with gel Surgical Lubricant Sterile Bacteriostatic; E. Fougera, Melville, NY to reduce the mismatch in refractive index between optical fiber, air, and brain tissue, thus minimizing the interface specular reflection from the surface of the brain. Figure 2 A illustrates the absorbance and Rhod2 excitation spectra obtained simultaneously from the cortex. The excitation and diffuse reflectance spectra were monitored periodically. Figure 2 B shows an example of the data acquisition of the fluorescence and the reflectance signals before, during, and after intravenous administration of vehicle and drugs e. The two parameters, CBV and hemoglobin oxygenation S t O 2 , can be separately distinguished from the reflectance obtained from the cortical surface at the wavelengths of and nm. As has been described previously Du et al. B and L are assumed not to be changed during the experiments. Because both wavelengths of nm for Rhod2 excitation and nm for Rhod2-Ca fluorescence emission are the isosbestic wavelengths of tissue oxygenation as described previously Du et al. Furthermore, to minimize the interference of physiological changes e. Both parameters returned to baseline levels by 8—10 min after injection and remained within normal range for the rest of the recording period. No significant changes in body temperature were observed Fig. CBV and S t O 2 returned to baseline levels at 25 and 16 min after injection, respectively. A comparison of the temporal course for the effects of cocaine in CBV Fig. The vertical dashed lines in each graph represent the time of intravenous drug administration. The vertical lines represent the beginning of the injection or hemodynamic challenge. Intracellular calcium, as measured by Rhod2-Ca fluorescence Fig. The increase in fluorescence of Rhod2-Ca trended toward a slow recovery after 42 min. In control rats group 1 , Rhod2-Ca fluorescence did not change over time in response to the vehicle challenge Fig. Similarly to the isoflurane-anesthetized rats group 2a Fig. To clarify the potential interdependency between the intracellular calcium changes and the systemic hypotension observed in the isoflurane rats, we examined the effect of transient hypotension induced by blood withdrawal on the optical recordings. However, unlike cocaine, there was no significant Rhod2-Ca fluorescence increase Fig. This experiment suggests that the intracellular calcium increase observed after the cocaine challenge in the isoflurane-anesthetized rats is neither attributable to the transient hypotensive episode nor to the changes in CBV or S t O 2. We also tested the effect of maintaining the MABP within normal range by administering phenylephrine at the time of cocaine exposure to circumvent the transient hypotension observed with cocaine in the isoflurane-anesthetized rats Fig. Methylphenidate induced increases in the heart rate that persisted for the 35 min recording period after its administration Fig. In addition, it induced a transient increase in MABP. Peak percentage increases in heart rate and MABP corresponded to 4. The body temperature was unaffected. Intravenous lidocaine briefly 2—3 min decreased the MABP from Both parameters recovered with a minor overshoot within 3 min. The fluorescence-dependent Ca signal started to increase within 2 min and rose significantly to a maximum of In transient cerebral ischemia, there is a clear pathophysiological link between ischemia, calcium transients, and ensuing selective neuronal death Benveniste et al. For example, selective neuronal necrosis that occurs in the brain after short-term 5—15 min transient ischemia is associated with extracellular calcium decreases Benveniste et al. Furthermore, inhibition of calcium transients prevents neuronal death after a 10 min ischemic insult Benveniste et al. The fact that there was no significant change in Rhod2-Ca fluorescence in response to the transient decrease in blood pressure Fig. Interestingly, the blockade of cocaine of norepinephrine transporters in the primate heart persists hours after its administration Fowler et al. In the adult organism, cocaine is metabolized mostly through hydrolysis and enzymatically into its major metabolites, ecgonine methyl ester, benzoylecgonine, and to N -demethylation by cytochrome P enzymes to produce norcocaine Inaba, In humans, the half-life of benzoylecgonine is known to be longer than in rats Dempsey et al. Like cocaine, benzoylecgonine passes the blood—brain barrier Spiehler and Reed, , and both compounds can constrict cerebral arteries Madden and Powers, In fact, benzoylecgonine constricts cerebral arteries more than cocaine Madden and Powers, Alternatively, we cannot rule out the possibility that cocaine may induce conformational changes in ion channels that persist after the drug is no longer present in the tissue. Future studies will clarify this issue. Unlike cocaine, acute methylphenidate did not elicit a large increase in Rhod2-Ca-dependent fluorescence methylphenidate, 4. Methylphenidate, like cocaine, is a dopamine transporter and a norepinephrine transporter inhibitor but differs from cocaine in that it is devoid of local anesthetic actions and does not bind to the serotonin transporter Ritz et al. It has been known for decades that local anesthetics have the potential to permanently damage the spinal cord Ferguson and Watkins, ; Macdonald and Watkins, ; however, the mechanism behind their neurotoxic action is still unresolved. Interestingly, Gold et al. Our in vivo data strongly corroborates the data of Gold et al. In the isoflurane-anesthetized animals, the initial cocaine-induced decrease in CBV occurred in close temporal correspondence to the decrease in blood pressure Figs. The conflicting hemodynamic responses to cocaine with different anesthetic regimens could explain reported discrepancies in the literature using MRI to investigate the effects of systemic cocaine. For example, using 0. In another study, urethane was used as an anesthetic, and cocaine was found to cause widespread and dose-depended early decreases and later increases in the blood oxygenation level-dependent BOLD fMRI signal with intravenous cocaine challenges in the rat brain Luo et al. In humans, abusing intravenous cocaine has been shown to reduce regional glucose metabolism in neocortical areas, basal ganglia, and the hippocampus London et al. Studies on the effects of acute cocaine on the BOLD responses of the human brain cocaine abusers have been inconsistent with reports of increases in limbic and cortical regions Breiter et al. However, all of our data are acquired in cocaine-naive rats and cannot be directly compared with the human data acquired in subjects regularly abusing cocaine. It is well recognized that cocaine abuse is associated with neurological deficits that can be mild and transient such as facial paralysis to severe and irreversible such as permanent tetraplegia Spivey and Euerle, Indeed, studies have shown that intracellular calcium overload is a hallmark pathological finding after seizure activity Meldrum, a , b. We thank Dr. Thanos for valuable discussions regarding the pharmacokinetics and pharmacodynamics of cocaine and methylphenidate. As a library, NLM provides access to scientific literature. J Neurosci. Find articles by Congwu Du. Mei Yu 1 Medical Department and. Find articles by Mei Yu. Find articles by Nora D Volkow. Find articles by Alan P Koretsky. Find articles by Joanna S Fowler. Helene Benveniste 1 Medical Department and. Find articles by Helene Benveniste. Open in a new tab. Effect of the drug administration on the intracellular calcium in the living rat brain. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Yes, intravenous phenylephrine to maintain MABP within a normal range 70—90 mmHg during the cocaine challenge.

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How can I buy cocaine online in El Nido

This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights. To comprehend the current state of drug policies, we should invoke the Prohibition movement that took place in the USA at the beginning of the 20th century, which was based on the rejection of ethnic minorities, their supposed criminality associated with the use of psychoactive substances, and a radical religious Protestant stratum as the explanation for the phenomenon. At present, said policies are still based on repressive legal and biologically-oriented scientific conceptions. The biologically-oriented scientific approach aims to give up social theories that explain the use of substances, focusing on the analysis of the specific context and its interaction with individual differences and the wide variety of substances. The objective is to rule out the possibility of alternative comprehensive models, which may encompass the possibility of responsible management of drug use and which may repel a war against drugs. Research in social sciences helps to show - by delving into different contexts throughout history - how the design of drug policies and the tools used in politics are established by identical political values, in particular, by the specific notion of citizenship and the role of the State prevailing in each country. These governance systems include: organization of political systems, ways in which institutions can operate, balances of power that become stabilized among institutions over a certain time span, legal and administrative traditions, ability of social movements to influence those in power, and the greater or lesser legitimacy of their actions. Introduction: Drug and culture. Drugs and culture: Knowledge, consumption, and policy. Farnham, England: Ashgate; Over the past few years, the doubtful effectiveness of this repressive approach has become evident, because not only did it fail to achieve its goals at all but it causes even more severe collateral damage to public health. Wodak A. Harm Reduction and law: The impact of criminalisation on public health. En: Brigaud T, dir. The history and principles of Harm Reduction: Between public health and social change. Some of the consequences deriving from this hegemonic prohibitionist model are: disproportionate imprisonment sentences, deaths on behalf of the fight against drug trafficking, fear of repressive measures as an obstacle limiting access to treatments, exposure to structural violence, discrimination and deprivation of the right to health, strengthening of armed groups, strict regulations for the use of opioids in medical spheres, or torture and sexual abuse. McFarland M. Nueva York: HRW; Within the framework of prohibitionist policies, social and health problems among people who use drugs have been intensified in societies with a weakened welfare state and neoliberal political models that have favored open drug scenes or hidden spaces where vulnerable populations congregate and accomplish covert activities. Rhodes T. Risk environments and drug harms: a social science for harm reduction approach. International Journal of Drug Policy. The everyday violence of hepatitis C among young women who inject drugs in San Francisco. Human Organization. Epele M. Llort A. In these hidden spaces, such as shooting galleries and crack houses in the USA and Australia, 8 8. Bourgois P. In search of respect: Selling crack in el barrio. Cambridge: Cambridge University Press; Kimber J, Dolan K. Journal of Urban Health. Clua R. Salud Colectiva. In these places, characterized by unhealthy and unsafe conditions as well as material environmental limitations, users carry out activities that entail social and health risks. When using the various classes of opioids heroin, fentanyl, etc. Amsterdam: Transnacional Institute; Mata S, Fernandes L. In said environments, drug users suffer symbolic, everyday, and structural violence. McNeil R, Small W. International Journal on Drug Policy. Everyday violence refers to the normalization of violence and suffering among users and other agents involved, triggering relations of power and gender, represented by physical violence in everyday drug use scenes. Structural violence is related to social norms imposed on drug users related with the criminalization of drugs, which involves police force brutality and barriers preventing access to social and medical services. For so many reasons, and from our experience as professionals in health care services focused on drug addictions and as researchers of public policies on drugs and their impact on this population, our aim in this work is to provide theoretical and applied concepts to reflect on possible strategies to fight stigma and to promote the development of human rights among people who use drugs. To achieve this purpose, the first part of this paper offers theoretical alternatives to surpass a biologically-oriented scientific conception, by relying on models based on social sciences that advocate for the relevance of context and social learning in managing and approaching the different uses of psychoactive substances. The second part of this paper presents an array of selected experiences and research studies to implement sustainable policies and programs to mitigate stigmatization and to promote the participation of drug users in public policies with a human right approach. Both biomedicine as a scientific paradigm and the contemporary cultural idea regard the use of illegal psychoactive substances as a disease or deviant behavior. Both the brain disease model and the social deviation model are the dominant schemes toward the socio-cultural representation of this phenomenon, which also legitimate the continuity of public policies that perpetuate and enable the stigmatization of the people who use these types of substances. The different approaches, definitions, and classifications adequate for what we know as addiction have not reached enough consensus. Addiction, as a disease, was not created from the natural accumulation of scientific discoveries, 20 Reinarman C. Addiction as accomplishment: The discursive construction of disease. According to Peele, 21 Peele S. The Meaning of addiction: Compulsive experience and its interpretation. Lexington: Mass D. Heath; Nevertheless, public policies dealing with the use of psychoactive substances - though based on the premise that the population must be protected -, from a complex perspective, can prove more harmful than beneficial. From another point of view, Puerta and Pedrero 22 Puerta C, Pedrero E. Las Drogas; 2 may \[citado 20 jul \]. Taking these reflections into account, we will consider that scientific research should be focused, to a greater extent, on its efforts into the promotion of personal autonomy of users, the observation of self-regulation and harm and risk reduction strategies, and in their interaction with the social context, but not so much on the search of the origin and a biological treatment for the problem. At present, the idea that addiction is a brain disease transcends classical psychiatry and psychology, being mainly based on the postulates of human neurosciences and, especially, in neuroimaging techniques. Basically, neurosciences propose that all cultural representations may come down to and be explained as an activity of the brain or neurobiological activities. Vidal F. Todo a «la neuro»: una cocina autodestructiva. However, this field is not capable of specifying the significance of those findings or correlating causality with the function of detected brain activation events, since the complexity of human reality excessively transcends clinical tests, which can indeed be regarded as an interesting new line of research, but never as conclusive evidence. The different types of medical services to treat a disease, which are many and varied medical pluralism , use several techniques for diagnosis, detection, and treatment that, in turn, are related to different religious, ethnic, economic, political, technical, and scientific characteristics, thus configuring different health care systems that often are not independent but overlapping categories. It is well known that biomedicine and other professional medicines consider that most of these differential ways are secondary, mainly and particularly those activities known as self-care, creating an antagonistic and exclusive vision among these types of medical services. It is therefore understood that the use of any substance - in any of its multiple facets - beyond their legality or their medical, pharmaceutical control will be considered a devious, pathological use or, as we will see below, a knowledge or practice to be changed. Self-care or health lay care is seen as a structural dimension that occurs in all societies, also known as folk medicine, which exists as an answer to how the population or society understands or grasps the concept of health, and what type of answer can or should be obtained and how it should be used. A good example on the theorization of a self-regulation process through social rituals of the use of illegal substances is that they are oriented to the control and regulation of drug use experiences, and that such control occurs in the following ways: 1 maximizing the drug effect sought; 2 controlling the levels of drug use; 3 balancing adverse and positive effects of the drugs used; 4 preventing secondary problems. La cultura de drogas en la sociedad del riesgo. Barcelona: Publicaciones Grup Igia; The richness of the different health care systems, understood in a broader sense, and their different conceptions by the population will be taken into account and elaborated within medical anthropology using the theory of explanatory models. This subdiscipline in anthropology will be adapted to analyze the discourse and meanings concerning health, disease, medical attention, and prevention in relation to different health care itineraries and, to a larger extent, drug use itineraries. At the same time, these itineraries, discourses, and meanings will be analyzed accordingly as historical and sociopolitical byproducts, and in relation to personal events experienced through the body, as a device used for the production of elements necessary for the creation of social identity and as a vehicle to adapt oneself to different life situations. Medical systems describe disease as a cultural language, linking beliefs in the causes of the disease, symptom experiences, specific patterns of illness behaviors, decisions regarding alternative treatments, therapeutic practices, assessments of therapeutic results, establishing systematic relationships among these behaviors. Kleinman A. Concepts and a model for comparison of medical systems as cultural systems. In this sense, the concepts of disease and illness that Fabrega 27 Fabrega H. The study of disease in relation to culture. Behavioral Science. The idea of explanatory models or discursive ways to explain a single phenomenon emerges from those developments. In each social area or sector of a medical system, different explanatory models may stem from doctors, patients, or family to explain each particular disease episode or health-related phenomena. Explanatory models contain arguments and descriptions of any or all of the following topics: etiology of a disease, onset of symptoms, physical pathology, course of disease and treatment. In addition, they are related to different systems of knowledge and specific values centered on different values or actors within the system, thus becoming historical and sociopolitical byproducts. Hence, we can recognize the paradox put forward by the influence of culture over the disease as a psychosocial experience, under the influence of cultural standards that govern perception, assessment, and manifestation of symptoms, and that determine individual characteristics of the role played by the disease that are a part of the medical systems themselves. Representations of diseases are fundamental to the different self-regulation theories. Leventhal H. Findings and theory in the study of fear communications. Advances in Experimental Social Psychology. The common sense representation of illness danger. En: Rachman S. Contributions to medical psychology New York. New York: Pargamon; The theory of self-regulation postulates that disease and representations determining the assessment of the disease establish that the behaviors related to health processes can be triggered as a result of cognitive and emotional processes. Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research. Moreover, generalization and translation of social problems into medical and psychiatric categories legitimate the vertical models of public health that, far from being based on local knowledge and potentialities for proper management, they give priority to vertical, unilinear, monologic way of communication. Barcelona: Anthropos; During the first years, responses to the social alarm generated by the phenomenon of problematic use of psychoactive substances was framed within the so-called drug-free programs. Simultaneously, incipient criticism of these programs began: therapeutic approaches were proposed that did not give priority to withdrawal but suggested approaching the individual as a person, their relations and the environment from a position of greater respect toward individuals and an understanding of their reality. The core intention consisted in minimizing harm from a more active and participatory role of the addressees of medical services. A combination of an ecosystemic and epidemiological framework with the pragmatic findings of the theory of harm and risk reduction was suggested. Cambios sociales, cambios en los tratamientos. Monografia Humanitas. As a result, what is most appropriate, when it comes to giving a response to medical demands, is to conceive them in a complex map of multiple contact areas and itineraries. These will help design unique journeys for each person and address their needs based on the definition of objectives, depending on predominant aspects of the demands of each subject and their possibilities of obtaining the answers sought. In order to approach or embrace this way of discussing relationships based on basic rights, it is important for the medical system to accept that people who use drugs have the final say in the change proposed. To this end, we can make interventions from different levels. Nevertheless, in order to achieve coherence and articulation, it is essential to draft, in coparticipation, communal action plans to tackle drug issues. Stigmatization and criminalization toward the people who use drugs implies insisting on strategies of harm reduction to continue defending human rights and access to social and medical assistance of this population. Even if prohibitionist policies were set aside and actions for decriminalization and regulation of the use of drugs were adopted, it would be necessary to promote specific interventions to mitigate social and structural inequalities among drug users. Among these spaces, we would like to highlight associations of drug users and social and medical centers that are included in harm reduction programs. Barcelona: Grup Igia; Empowerment and self-organisations of drug users experiences and lessons learnt. In this way, people who use drugs participate as experts and as qualified agents to promote the attendance of other users at social and medical services, providing aid in health-disease-attention processes, and mobilizing within the community educational, cultural, and preventive actions for normalized management regarding drug use. De riesgos y placeres: manual para entender las drogas. Lleida: Milenio; In this sense, collaborative forces among people targeted by services and professionals have promoted the creation of harm reduction services, whether self-managed or with a mixed management model, aimed at empowering people who use drugs and creating spaces to fight social and negative consequences for health arising in open drug scenes. Following Van Dam 38 Van Dam T. A brief overview about the drug user movement. They were against the political and social policies that were being adopted in relation to heroin use. This phenomenon increasingly became a serious social problem, mainly in terms of the spread of diseases among people who injected drugs. In there were already fifteen associations focused on the defense of drug users in the Netherlands and, at a later time, groups of drug users began to organize themselves across Europe until the creation in of the International Network of People Who Use Drugs INPUD , an organization that globally centralizes the fight for the rights of poeple who use illegal drugs. At present, among associations led by drug users, we should highlight the actions accomplished by Vancouver Area Network Drug Users VANDU , an organization formed in that is completely run by people who use drugs in the Downtown Eastside of the city of Vancouver Canada. VANDU has about 1, members and since its formation they have undertaken actions to provide coverage to users administering drugs through parenteral and pulmonary routes, and advocacy to promote and extend harm reduction programs in local policies. Their initiatives included outreach interventions to contact users in public spaces; the installation of an unsanctioned supervised drug consumption room for users who inject drugs, run by peers who are trained to provide assistance to drug users in hygienic and safe conditions; and the arrangement of a little space for the use of crack cocaine in their facilities, as an alternative to avoid street violence and surpass the barriers that limit access to official drug consumption rooms where drug injection is the only method allowed and aid for drug injection is not authorized by law, among other actions. AIDS and Behavior. A special comment should be made about recent feminist approaches, which seek to break down any logic beyond prohibitionism. A good example is the Metzineres project, which is designed exclusively for women and people of dissident genders in multiple situations of vulnerability, created in in Barcelona, composed of an interdisciplinary team, which includes people who use substances with no distinction, offering therapeutic, cultural, and leisure activities and that promotes actions for a reform of drug policies from a non-heteronormative, feminist perspective. Roig A. Metzineres: cobijo y empoderamiento de mujeres que usan drogas sobreviviendo violencias \[Internet\]. Wola; 15 dic \[citado 24 jul \]. In terms of social and medical services, harm reduction programs have been developed and safer environments have been promoted. By the end of the s, in Europe and the USA various programs have been implemented with an impact on the reduction of social and health harms among drug users in vulnerable conditions. Rhodes T, Hedrich D. Harm reduction: evidence, impacts and challenges. Effectiveness of needle and syringe Programmes in people who inject drugs - An overview of systematic reviews. BMC Public Health. Supervised injection services: what has been demonstrated? Drug Alcohol Depend. Among the programs and interventions that were spread and more positively assessed globally speaking, we can mention needle exchange programs, aimed at distributing material for a hygienic and safe administration of drugs through parenteral and pulmonary routes; opioid substitution therapy programs, which consist in the controlled provision of opioids methadone, buprenorphine, morphine, etc. In several European and North American cities, there is an increasing number of social and medical centers that offer harm reduction programs and treatments for a holistic health care of people who use drugs. Public health and public order outcomes associated with supervised drug consumption facilities: a systematic review. Various ethnographic and qualitative studies explored the impact of harm reduction services to reduce vulnerability, social and medical deficiencies, and violence among drug users. In studies conducted in harm reduction centers with drug consumption rooms, the conclusion is that users are given preventive messages and receive medical attention to minimize the risk of bloodborne disease transmission and overdose crisis, as well as reducing risk practices and discarding material used when taking drugs in public spaces and other risk environments. AIDS Care. In a study carried out in one women-only drug consumption room in the city of Vancouver, participants responded positively to safety and hygiene offered in these facilities. Furthermore, on these sites, users feel that they can receive help and be connected with other social and medical services. Drug and Alcohol Dependence. A qualitative study of how Danish drug consumption rooms influence health and well-being among people who use drugs. Harm Reduction Journal. Access to health and social services for IDU: the impact of a medically supervised injection facility. Drug and Alcohol Review. Harm reduction centers that have resting areas and drug consumption rooms are perceived as safe environments to escape violence and other social risks associated with drug use in public spaces. In research studies conducted in drug consumption rooms across Vancouver and several cities in Europe, participants report that attending these facilities is a way to avoid everyday violence among users, stigma, and structural violence from police intervention. In studies focused on women, 16 Although the objectives sought by harm reduction programs are often well defined, people who use drugs continue to find barriers limiting access to these mechanisms, which have to do with social and structural forces, as well as scarce services to cover their basic needs. Within the framework of prohibitionist policies, access barriers affect differently depending on the application of harm reduction policies in the various political and geographical contexts. Depending on the degree of endurance, prosecution and criminalization provides drug users with a greater or lesser access to social and medical services. Nevertheless, in most geographical contexts the main access barrier is related to fear and police force intervention near drug services that impede or hinder social and medical attention among drug users. Implementation contexts and the impact of policing on access to supervised consumption services in Toronto, Canada: a qualitative comparative analysis. But also harm reduction services have been applied in order to reduce drug-related morbidity and mortality, disregarding social, structural, and environmental dimensions that persevere vulnerability among people who use drugs. Addressees often report that they do not resort to social and medical services because they do not trust in the professionals or because they consider that the services offered do not fit the particular reality of these populations: for instance, these specific centers do not distribute material or do not have areas for using of crack cocaine, 10 Zuffa G. Serie reforma legislativa en materia de drogas. Amsterdam: Transnational Institute; In the case of women who use drugs, absorbed in a double stigma, as a result of breaking off traditional gender roles and of using illegal drugs, 16 El doble estigma de la mujer consumidora de drogas: estudio cualitativo sobre un grupo de auto apoyo de mujeres con problemas de abuso de sustancias. Alternativas: Cuadernos de Trabajo Social. In view of the foregoing, we propose actions to increase adherence to these types of services and to cover social and health care needs of people who use drugs, and we highlight the importance of the participation of people who use illegal psychoactive substances whether in a problematical way or not when it comes to formulating public policies toward drugs. A very interesting experience in this sense is the proposal by the draft bill Regulated Coca, Guaranteed Peace \[ Coca Regulada, Paz Garantizada \] brought forward in Colombia. CocaReguladaPazGarantizada \[Internet\] \[citado 20 jul \]. In order to improve accessibility to and effectiveness of these services, it is essential to surmount situational and structural obstacles in order to maximize the impact of harm reduction programs. As regards communal contexts, outreach interventions are necessary , in which professionals and expert users health care agents connect users with harm reduction programs and services within the community. For an optimization of harm reduction services, it is necessary for these services to inspire public confidence and offer services covering actual basic needs. Atmospheres of engagement within a German drug consumption room. Rance J, Fraser S. Contemporary Drug Problems. However, we consider that significant changes are necessary to offer essential coverage that enables the mitigation of violence and criminalization among people who use illegal substances. In the case of the users of opioids in vulnerable conditions, a more precise regularization and extension of heroin-prescription programs are necessary. In clinical trials offering injectable diacetylmorphine conducted in several cities across Canada and Granada Spain , participants responded positively to the treatment aimed at improving stability in their lives, establishing a discontinuity in open drug scenes, improving social aspects such as job search and family relations, and mitigating social exclusion processes, as well as improving eating habits, personal hygiene, and follow-up of drug-related diseases. From illegal poison to legal medicine: a qualitative research in a heroin-prescription trial in Spain. Regarding homeless populations, the suggestion is to apply housing first assistance approach to harm reduction policies. This practice is based on regularly assisting homeless people, with serious mental illnesses and conditions related to the use of substances. Research studies conducted across the USA suggest the need of access to these types of programs, applying inclusive criteria - without withdrawal being a necessary requirement - and adapting the type of house and the necessary support services that have evidenced the recovery of social and medical conditions, and family and cultural re-connection of their beneficiaries. Housing and harm reduction: what is the role of harm reduction in addressing homelessness. In conclusion, we consider it crucial to apply basic principles of harm reduction to global drug policies, and widely apply these principles to other spheres of medical and social conditions of people that suffer from exclusion. Tarragona: Publicacions de la Universitat Rovira i Virgili; In fact, various research studies deny that the use of supervised drugs is impossible to control, being more common for vulnerable populations to switch from intense consumption periods to low-frequency consumption, even maintaining a self-regulated consumption, depending on social, structural, and environmental conditions. Most people that use supervised drugs adopt control mechanisms with the aim of getting positive experiences from drug use, establishing a control of the use of substances, within the group of consumption and in the setting where this occurs. Duff C. The pleasure in context. Therefore, a model based on self-regulation acknowledges the abilities of drug users, with a positive impact to mitigate stigmatization and promote preventive inclusive programs with goals other than withdrawal. For instance, several research studies focused on users of crack cocaine in Brazil 13 Factors that lead to the use of crack cocaine in combination with marijuana in Brazil: a qualitative study. Other methods mentioned by crack cocaine users include looking for recreational, occupational, or physical activities to avoid drug-related anxiety and maintain periods of control or withdrawal. Finally, it is necessary to highlight that most postulates and interventions are based on research studies conducted in clinical environments, running the risk of making generalizations centered only on users having intensive or problematical consumption patterns. Unfortunately, qualitative research studies, carried out in natural environments and from a user perspective, often have little impact on the formulation of drug policies. Qualitative social research in addictions publishing: Creating an enabling journal environment. Barcelona: Bellaterra; In general, quantitative science investigators undervalue that research studies that consider the perspective of people who use illegal psychoactive substances can be objectified, replied, and generalized, despite following strict procedures for the study of drug use. Anthropology and epidemiology on drugs: Cross-Methodological and theoretical dialogue. However, qualitative science provides a greater and more complex understanding of micro and macro dimensions of drug use, of the significances and representations among drug users, and on the characteristics of drug use in vulnerable environments where they suffer social and health harm, and different types of violence, 69 Interdisciplinary mixed methods research with structurally vulnerable populations: Case studies of injection drug users in San Francisco. En: Haro JA, coord. Buenos Aires: Lugar Editorial; That is why our emphasis is put on the importance of resorting to these types of studies for a better adaptability and credibility in specific interventions. Our aim was to challenge the idea that the use of illegal psychoactive substances can be unilaterally considered through legal and medical discourse as a socially deviated activity or as a mental condition or illness originated in the brain, a situation that has inevitably pierced the collective imaginary in a progressive and very successful way. Despite partial and not global implementation of harm and risk reduction policies at an international level, people who use illegal drugs are - explicit or implied - victims of exclusion and repression processes, carrying out secret drug use practices in hazardous environments, characterized by social, structural, and environmental conditions leading to social and health harms stigma, marginalization, and different types of violence among the most vulnerable collective groups or against standard drug use forms. Facing the disregarded biomedicalization threat of harm and risk reduction proposals - which progressively focus their efforts on health care spheres only - they should widen their proposals by having a more powerful influence on politics, in order to fight criminalization and promote stronger policies in favor of the rights of individuals and collective groups with respect to drug use. This would help promote statutes that better reflect different social and cultural realities. In order to achieve this goal, what is crucial is an articulation of social movements led by representatives of people who use illegal substances, relatives and other affected individuals, researchers and professionals in alliance with other disciplines, to be able to put pressure on different levels of administration agencies responsible for maintaining - without any self-criticism at all - prohibitionist policies overtly discredited by poor results regarding their objectives: a decrease in both demand and supply. Eliminating barriers that limit access to the right of health, increasing the coverage of medical attention services, optimizing political participation - broadly speaking - of the people who use illegal and legal psychoactive substances, taking into account specificity and diversity of each individual and collective groups made up of people who use substances and to whom services are offered, and decriminalization of drug use by amending international supervision agreements are some of the essential and indispensable premises, albeit not all, in furtherance of said objectives. In short, guiding a regulatory process regarding illegal substances different to the present-day rules. All these premises should have as a starting point a deep and complex knowledge of the multiple realities and local or regional contexts with their own cultural characteristics together with biomedical advances dedicated to the research of health issues. Only that way will the advancement in small contexts and spheres see the case of cannabis regulation , small victories, against the prohibitionism that has been erected globally as a repressive, implacable monster be the only solution to expand a social and political movement to protect and defend people who use illegal substances. To sum up, it is necessary to approach the issue discussed here more in tune with human rights within the health sphere and the right to free will. After all, the use of psychoactive substances is part of the unquestionable freedom to deal with the vicissitudes of our health and, consequently, the attention to discomforts or incidents presented by biological, social, or cultural diseases. Abrir menu. ABSTRACT This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. Plurality against biomedical singularity: different ways of understanding the concepts of health and disease The different types of medical services to treat a disease, which are many and varied medical pluralism , use several techniques for diagnosis, detection, and treatment that, in turn, are related to different religious, ethnic, economic, political, technical, and scientific characteristics, thus configuring different health care systems that often are not independent but overlapping categories. Accessibility and participation of people who use illegal psychoactive substances in harm reduction strategies Although the objectives sought by harm reduction programs are often well defined, people who use drugs continue to find barriers limiting access to these mechanisms, which have to do with social and structural forces, as well as scarce services to cover their basic needs. Strategies aimed at improving accessibility, effectiveness, and coverage of basic needs In order to improve accessibility to and effectiveness of these services, it is essential to surmount situational and structural obstacles in order to maximize the impact of harm reduction programs. Publication Dates Publication in this collection 21 July Date of issue Google Google Scholar.

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