Legal Psychoactive Substances Research Articles

Excessive caffeine intake inhibits steroidogenesis, folliculogenesis and disrupts utero-ovarian tissue histomorphology integrity in experimental rats, and precipitates polycystic ovary syndrome in Sprague-Dawley rats

Polycystic ovarian syndrome (PCOS) is characterized by anovulation and hyperandrogenism symptoms. Caffeine is popularly consumed and it is a legal psychoactive substance. This study evaluated the effect of excessive caffeine intake on utero-ovarian tissue in polycystic ovary syndrome rats. Twenty-four female rats randomized into group A control received 2 ml of normal saline. Group B received 4 mg/kg body weight (bwt) i.p of estradiol valerate (EV) on the first day, Group C received 100 mg/kg bwt of caffeine orally, and Group D received i.p 4 mg/kg bwt EV and 100 mg/kg bwt of caffeine orally. The experiment lasted 30 days. Histology of the ovary and uterus, oxidative and antioxidant, reproductive hormone, lipid profile, inflammatory markers, and apoptosis markers were evaluated.The ovarian histoarchitecture revealed degeneration of the theca cells, granulosa, and corpus luteum, and loss of mucin granules in the uterine tissues in PCOS, CAF, and PCO+CAF. The estrous cycle became irregular, with prolonged diestrous and proestrus phases. Marked rise in oxidative markers and decline in the activities of ovarian enzymatic antioxidants, inflammatory response, caspase-dependent apoptosis, and hormonal imbalance.Excessive caffeine consumption, therefore impaired utero-ovarian integrity, hormones, inflammatory indicators, oxidant and antioxidant parameters, apoptotic markers, and the estrous cycle.

Leading consumption patterns of psychoactive substances in Colombia: A deep neural network-based clustering-oriented embedding approach.

The number of health-related incidents caused using illegal and legal psychoactive substances (PAS) has dramatically increased over two decades worldwide. In Colombia, the use of illicit substances has increased up to 10.3%, while the consumption alcohol and tobacco has increased to 84% and 12%, respectively. It is well-known that identifying drug consumption patterns in the general population is essential in reducing overall drug consumption. However, existing approaches do not incorporate Machine Learning and/or Deep Data Mining methods in combination with spatial techniques. To enhance our understanding of mental health issues related to PAS and assist in the development of national policies, here we present a novel Deep Neural Network-based Clustering-oriented Embedding Algorithm that incorporates an autoencoder and spatial techniques. The primary goal of our model is to identify general and spatial patterns of drug consumption and abuse, while also extracting relevant features from the input data and identifying clusters during the learning process. As a test case, we used the largest publicly available database of legal and illegal PAS consumption comprising 49,600 Colombian households. We estimated and geographically represented the prevalence of consumption and/or abuse of both PAS and non-PAS, while achieving statistically significant goodness-of-fit values. Our results indicate that region, sex, housing type, socioeconomic status, age, and variables related to household finances contribute to explaining the patterns of consumption and/or abuse of PAS. Additionally, we identified three distinct patterns of PAS consumption and/or abuse. At the spatial level, these patterns indicate concentrations of drug consumption in specific regions of the country, which are closely related to specific geographic locations and the prevailing social and environmental contexts. These findings can provide valuable insights to facilitate decision-making and develop national policies targeting specific groups given their cultural, geographic, and social conditions.

Ethanol and Medical Psychotropics Co-Consumption in European Countries: Results from a Three-Year Retrospective Study of Forensic Samples in Spain.

Ethanol and medical psychotropics (MPs) are legal psychoactive substances widely consumed in Western countries that are routinely detected in standard toxicological analyses at compulsory autopsies, and toxicokinetic interactions between these drugs have been described. However, studies assessing the consequences of this co-consumption are scarce in Europe. We performed a retrospective study on toxicological results from compulsory autopsies in Spain. Thirty-five legal psychotropics, including ethanol, were measured in blood samples from 380 decedents to assess the determinants of such co-consumption. MPs were detected in 42.4% of the subjects. Polypharmacy was frequent in our series (25%), being more frequent in men than in women. More than one-third of the decedents had detectable levels of ethanol, and a significant positive association between ethanol levels and age was evident. About one-third of MPs consumers were also co-consumers of ethanol. The simultaneous consumption of ethanol and MPs was higher in men than in women. Blood alcohol concentrations (BAC) were lower in men who consumed MPs. In polypharmacy deaths, there was a significant negative association between the number of MPs consumed and BAC in men (r = -0.097; p = 0.029). Our results showed a high prevalence of co-consumption of MPs and ethanol in the European population involved in medico-legal issues and suggest that toxicokinetic interactions may be lowering BAC in men. This is a very worrying result, as it could indicate that the legal blood ethanol limits set by legislation would not be appropriate for men on MPs treatment.

Views on Using Psychoactive Substances to Self-Manage Functional Neurological Disorder: Online Patient Survey Results.

Objective: Functional neurological disorder (FND) causes a high burden of disability and distress. Although it is a common disorder, there is a pressing need for improved access to evidence-based treatments. With difficulties in finding effective treatment, some people with FND may seek alternative means of symptom relief, such as legal and illicit psychoactive substances, although the prevalence and nature of such self-management strategies are currently unclear. Additionally, psychoactive substances may represent novel treatment research opportunities, particularly for those with suboptimal improvement. The investigators examined the use of self-management techniques, as well as perspectives on novel therapies, in this patient population. Methods: An online survey was created to assess self-management strategies and views on novel treatments for FND, including psychedelic therapy. The survey was accessible for 1 month, and respondents were recruited internationally through social media and patient groups. A total of 1,048 respondents from 16 countries completed the survey. Results: Almost half (46%) of 980 respondents reported having tried legal psychoactive substances for the management of their FND symptoms and, on average, nicotine, alcohol, and cannabidiol were reported as modestly effective. Additionally, 15% of respondents reported having used illicit substances, mostly cannabis, to manage FND, with the majority reporting moderate effectiveness and experiencing no or minimal physical (90%) and psychological (95%) sequelae. Many respondents (46%) reported that they would be willing to try medically supervised psychedelic therapy (with 19% of respondents ambivalent) if it were found to be safe and effective. Conclusions: Many people with FND seek alternative means of symptom management outside usual medical care, including legal and illicit psychoactive substances. Further research exploring novel treatment options, such as psychedelics, in FND may be warranted.

SYST E MI C MANIFESTATIONS OF FUNCTIONAL, PSYCHOPHYSIOLOGICAL AND PSYCHOLOGICAL RISK FACTORS FOR THE DEVELOPMENT OF CHEMICAL ADDICTIONS IN MEN AND WOMEN

The aim of the work was to identify the links between indicators of functional and psychophysiological status with psychological characteristics that determine the risk of developing chemical addictions in men and women. The study was carried out with the participation of 309 people, 137 men and 172 women aged 18-30, students of state universities in Volgograd, Samara and Arkhangelsk. The level of consumption of legal psychoactive substances was assessed based on the results of a retrospective self-assessment by respondents of the frequency of alcohol intake and tobacco smoking experience. The psychological status of the study participants was determined by evaluating the indicators of the Freiburg multifactorial personality questionnaire, adventurousness and social destructiveness. The psychophysiological status of the subjects was assessed according to standard electroencephalography indicators. The functional status was characterized by analyzing the level of general nonspecific reactivity of the organism. As a result of the performed research, the systematic manifestation of functional, psychophysiological and psychological prerequisites for the individual formation of a person's propensity to consume legal psychoactive substances is substantiated. The combination of a high level of general nonspecific reactivity of the organism with low values of the alpha rhythm amplitude and pronounced adventurousness, both in men and women in the follicular or luteal phases of the ovarian-menstrual cycle, is a prognostic criterion for the risk of alcohol and tobacco addiction. Comprehensive accounting of phenotypic indicators of a person's predisposition to the demand for psychoactive substances is able to optimize the system of health-saving support for students.

Substance use amongst high school learners in the south of Johannesburg: Is this the new norm?

BackgroundSubstance use amongst high school learners is common in South Africa, with related risky behaviours and outcomes. Because of the social and geographical trends, studies in various parts of the country are essential to contribute to the understanding of the overall picture. The purpose of this study was to determine the prevalence of substance use, as well as the factors associated with substance use in a sample of high school learners in a suburb south of Johannesburg.MethodsA quantitative cross-sectional survey, by using a self-administered questionnaire, was conducted amongst 308 learners in four high schools. The parents of all the learners provided consent for their children to participate in the study.ResultsThe sample consisted of 308 learners who were in grades 8–12, with a mean age of 16.3. The majority (57%, n = 177) were females and 43% (n = 131) were males. The prevalence of substance use was 31% (n = 94), with 52% (n = 49) of those who use substances being male, compared with 48% (n = 45) females. Of those who used substances, 69% (n = 65) used alcohol, 10% (n = 9) smoked dagga, 5% (n = 5) smoked cigarettes, 7% (n = 7) used other substances and 46% (n = 43) were polyusers. Age, missing school because of illness, use of leisure time and friends using substances were significantly associated with the use of substances (p < 0.05).ConclusionThe prevalence of substance use was high at 31%, which is of concern because the use of legal psychoactive substances remains illegal for minors. The risky factors associated with the use of substances highlight the threat that this behaviour has on the social well-being and educational outcomes of the learners.

A call for greater policy and regulatory coherence for an expanding menu of legal psychoactive substances.

A call for greater policy and regulatory coherence for an expanding menu of legal psychoactive substances.

Emerging prospects for non-medical cannabis legalisation in New Zealand: An initial view and contextualization

New Zealand may be the next national jurisdiction where non-medical cannabis use and supply will be legalized. While the current New Zealand government's plans for possible cannabis legalization were rather unclear for some time, initial details on proposed key parameters (for example, age limits, production and supply modes, use restrictions) of a possible cannabis legalization framework have recently emerged. We provide initial basic examination and contextualization of the proposal's select key details, both vis-a-vis select legalization frameworks as they exist in other jurisdictions as well as in reference to key parameters of policy and controls governing other legal psychoactive substances in New Zealand. Overall, the proposed framework for non-medical cannabis legalization in New Zealand resembles other (e.g., Canada's) legalization models in spirit and main proposed regulations. There are, however, several proposed regulation elements where questions regarding both feasibility and/or policy coherence concerning other psychoactive substance areas arise and likely to lead to challenges or problems in practice. Evidently, substantially more thinking, consideration and development need to be invested towards a more complete and workable public health-oriented framework and roadmap for cannabis legalization in New Zealand. Furthermore, possible cannabis legalization reforms hinge on the successful outcome of a public referendum (in late 2020), adding the acute need for substantive pre-referendum public education as well as overall extrinsic uncertainty regarding the prospects of actual and material policy change.

Motives for Classical and Novel Psychoactive Substances Use in Psychedelic Polydrug Users

Novel psychoactive substances (NPS) are compounds designed to mimic the effects of existing recreational drugs (classical psychoactive substances [CPS]), while eluding established legal frameworks. Little is known about their effects and potential harms, rendering the increasing number of NPS a challenge to policy makers and researchers alike. Quantitative studies on the motives underlying NPS use are limited, though understanding them is crucial for the design of effective harm prevention strategies. The present study therefore aimed to compare motivational patterns for NPS, CPS, and legal psychoactive substance (LPS) use. An online survey including questions about lifetime drug use, demographics, and motives for use was completed by 2,319 participants of which 1,967 consented and were 18 years or older. Data on lifetime use and endorsed motives are presented for 12 psychoactive substances classified into LPS (alcohol, nicotine), CPS (cannabis, MDMA/ecstasy, amphetamines, cocaine, psilocybin, LSD, ayahuasca), and NPS (synthetic cannabinoids, stimulant, and hallucinogenic) and compared between classes. Across substances, the most frequently endorsed motives were to feel euphoric (58.0%), enhance an activity (52.3%), and broaden consciousness (48.1%). Motives for use were found to differ by substance and gender, with coping-related reasons being more frequent among female participants compared to males who indicated to use for a broad range of reasons. Motivational patterns of CPS and NPS use were largely similar to their classical analogues, this was not the case for synthetic cannabinoids, which had as main endorsed motive getting intoxicated, indiscriminate of specific qualities. This information can feed into tailoring of educational campaigns and prevention strategies.

ALCOHOL, CRIME AND SUICIDE: EMPIRICAL EVIDENCE FROM OECD COUNTRIES

Alcohol, a legal psychoactive substance in many countries, is associated with both physical and mental wellbeing. Besides diseases, such as liver cirrhosis, cardiovascular diseases, digestive system cancers, alcohol has been shown to be associated with a number of social problems, involving crime and suicide. This study aimed to investigate the long-run and causal linkages between suicide, alcohol and crime for 15 OECD countries. Panel co-integration, FMOLS, DOLS, and the Panel Granger causality tests were implemented. The empirical findings revealed that (i) there is a positive linkage between alcohol consumption and crime rate and between crime rate and suicide rate in the long run ;(ii) there is also feedback causality between alcohol consumption and crime rate and between crime rate and suicide rate.

Cannabis Legalization in Canada: Reflections on Public Health and the Governance of Legal Psychoactive Substances.

The Canadian government is “taking a public health approach to legalizing, strictly regulating and restricting access to cannabis.” There is, however, no universally accepted definition of a public health approach to cannabis. This paper presents what such an approach is, and is not, and discusses its applicability to legal psychoactive substances more generally. It critically reflects on the role of the public health sector in the governance of addictive substances and activities, noting its function of “responsibilizing” individuals and coaxing them to self-regulate—and the contradiction involved when other state actors involved in governance are actively inciting consumption of those substances and activities.

When good times go bad: managing 'legal high' complications in the emergency department.

Patients can use numerous drugs that exist outside of existing regulatory statutes in order to get “legal highs.” Legal psychoactive substances represent a challenge to the emergency medicine physician due to the sheer number of available agents, their multiple toxidromes and presentations, their escaping traditional methods of analysis, and the reluctance of patients to divulge their use of these agents. This paper endeavors to cover a wide variety of “legal highs,” or uncontrolled psychoactive substances that may have abuse potential and may result in serious toxicity. These agents include not only some novel psychoactive substances aka “designer drugs,” but also a wide variety of over-the-counter medications, herbal supplements, and even a household culinary spice. The care of patients in the emergency department who have used “legal high” substances is challenging. Patients may misunderstand the substance they have been exposed to, there are rarely any readily available laboratory confirmatory tests for these substances, and the exact substances being abused may change on a near-daily basis. This review will attempt to group legal agents into expected toxidromes and discuss associated common clinical manifestations and management. A focus on aggressive symptom-based supportive care as well as management of end-organ dysfunction is the mainstay of treatment for these patients in the emergency department.

Drug Addiction and Manifestations of Indirect Self- Destructiveness

Use and particularly abuse of psychoactive substances is considered a typical form of self-destructive behaviour; addiction itself, meanwhile is regarded as one of the forms of self-destructiveness. Indirect self-destructiveness is considered behaviour whose negative consequences are mediated by additional factors, while the relationship between the behaviour and harm is considered probable. Indirect self-destructiveness understood in that way includes not only undertaking but also abandoning acts; that is related to engaging in dangerous and aggravated risk situations, or neglecting one's health and safety. The aim of this work was to explore the indirect self-destructiveness syndrome in a treatment population of drug addicts. The Polish version of the Chronic Self-Destructiveness Scale (CS-DS) was administered among 172 patients (116 males and 56 females) in drug addiction treatment centres. Results show that self-destructiveness as a generalised behavioural tendency, as well as its more specific manifestations, score within the upper range of the average. Increasing scores by CS-DS subscales were obtained in the following order: Helplessness and Passiveness, Nicotine, Lack of Planfulness, Alcohol, Transgression, Psychoactive Substances, Personal and Social Neglects and Poor Health Maintenance. It can be assumed that nicotine, a legal psychoactive substance, acts as a substitute. While a one-factor solution resulted from factor analysis for healthy people, the patient sample was best described by a two-factor solution (I: Risky Health Neglects, II: Helplessness). The intensity of the indirect self-destructiveness syndrome in individuals treated because of drug addiction was situated close to the upper limit of average results. The highest scores for subscales were related to Helplessness and Passiveness as well as Nicotine, and the lowest to Poor Health Maintenance. The index of Psychoactive Substances turned out to be low.

Use of Psychoactive Substances and Health Consequences After Withdrawal in the Adolescence Group

Introduction. The use of psychoactive substances is an important factor of higher risk of health complications and deficits in social functioning of children and adolescents. It is a problem regarding not only particular individuals or families but it also constitutes, in further perspective, a serious social-economic problem.Aim. The aim of this study was to assess the type and frequency of using psychoactive substances as well as psychics and somatic consequences after withdrawal from psychoactive substances use in high school students groups.Material and Methods. The research was carried out in the group of 100 students from a secondary school in Toruń (61 female students, aged 18,2±0,4 and 39 male students aged 18,1±0,3). Our own questionnaire was applied and the questions included referred to socio-demographic variables, to the use psycho-active substances and the symptoms after withdrawal from them, as well as the CAGE scale for the purpose of assessing the risk of addiction to alcohol and marijuana (the modified version of the scale).Results. It has been observed that the psychoactive substances most frequently used in groups of students (female and male) included: alcohol drinks (88% vs. 79%), caffeine (75% vs. 61%), nicotine (almost 51% vs. 36%), marijuana (39% vs. 43%), hashish (almost 10% vs. 5%), “boosters” (8% vs. 10%), amphetamine (3% vs. 13%) and others. The suicidal inclinations were observed in 4,9% of female students. Probably 5% of female and from 5 to 7% of male students experienced the psychotic symptoms (hallucinations and delusions) after withdrawing from the use of psychoactive substances.Conclusions. The legal psychoactive substance most frequently used was ethyl alcohol (risk of addiction in groups: 37% of female and 23% male students) whereas the illegal substance was marihuana (risk of addiction was proved in groups: 18% of female and 35% of male students). The most important complications following the withdrawal from the use of psychoactive substances included suicidal behavior and psychotic symptoms (hallucinations and the feeling of being observed) correlated with amphetamine use. (JNNN 2014;3(3):100–106)

Legal Psychoactive Substances as Risk Factors for Sleep-Related Bruxism: A Nationwide Finnish Twin Cohort Study

Different psychoactive factors including alcohol, coffee and tobacco, are considered as risk factors for bruxism. Often, heavy drinking and generous intake of coffee are correlated with smoking. Interactions between these agents may confound studies. The aim was to investigate the possible independent effects of drinking alcohol and coffee consumption on the occurrence of bruxism. Data derived from the Finnish Twin Cohort study consisting of 12,502 twin individuals (45.6% men, 54.4% women, mean age 44 years) born during the 1930-1957. The twins responded to a questionnaire sent in 1990 (response rate of 77%) consisting of 103 multiple-choice questions, seven dealing with tobacco use, four on alcohol use, one about coffee consumption and two with bruxism. Increasing alcohol intake raised the risk for weekly bruxism even when adjusted for smoking status [heavy drinking odds ratio (OR) 1.9; 95% CI 1.23-2.84, binge drinking OR 1.6; 95% CI 1.28-2.12, and passing-out due to excessive alcohol intoxication at least twice within the previous year OR 1.5; 95% CI 1.09-2.18]. The situation was similar to that for coffee consumption of more than eight cups per day (OR 1.4; 95% CI 1.01-1.98). Interaction analyses for 'smoking with risk factors' revealed no statistically significant interactions. Current smoking was an independent risk factor for bruxism in all models (OR 2.3-2.7). Given the observed associations between alcohol drinking, binge drinking, passing-out due to excessive alcohol intake and coffee consumption, the results support our hypothesis of an independent association of both alcohol use, and coffee consumption with bruxism.

Psychoactive substances in seriously injured drivers in Denmark

This study assesses the presence of a number of psychoactive substances, including alcohol, based on blood samples from 840 seriously injured drivers admitted to five selected hospitals located in five different regions of Denmark. The study was a part of the EU 6th framework program DRUID (Driving Under the Influence of Drugs, Alcohol and Medicines). Blood samples were screened for 30 illegal and legal psychoactive substances and metabolites as well as ethanol. Danish legal limits were used to evaluate the frequency of drivers violating the Danish legislation while limit of quantification (LOQ) was used for monitoring positive drivers. Tramadol is not included in the Danish legislation therefore the general cut off, as decided in the DRUID project was used. Overall, ethanol (18%) was the most frequently identified compound (alone or in combination with other drugs) exceeding the legal limit, which is 0.53g/l in Denmark. The percentage of seriously injured drivers testing positive for medicinal drugs at levels above the Danish legal limit was 6.8%. Benzodiazepines and Z-drugs (6.4%) comprised the majority of this group. One or more illegal drugs (primarily amphetamines and cannabis) were found to be above the Danish legal limit in 4.9% of injured drivers. Young men (median age 31 years) were over-represented among injured drivers who violated Danish law for alcohol and drugs.Diazepam (4.4%), tramadol (3.2%), and clonazepam (3.0%) were the medicinal drugs most frequently detected at levels above LOQ, whereas amphetamines (5.4%) (amphetamine [5.2%] and methamphetamine [1.5%]), tetrahydrocannabinol (3.7%), and cocaine (3.3%), including the metabolite benzoylecgonine, were the most frequently detected illegal drugs. A driver could be positive for more than one substance; therefore, percentages are not mutually exclusive. Poly-drug use was observed in 112 (13%) seriously injured drivers. Tramadol was detected above DRUID cutoffs in 2.1% of seriously injured drivers. This is 3.5 times that observed in a Danish survey of randomly selected drivers. Moreover, illegal and medicinal drug levels above the Danish legal limit were present more than 10 times as frequently as in injured drivers, whereas ethanol was present more than 30 times as frequently than in randomly selected drivers. The results indicate that there is an increased risk in traffic when driving under the influence of psychoactive drugs, especially alcohol in young male drivers.

Presence of psychoactive substances in oral fluid from randomly selected drivers in Denmark

This roadside study is the Danish part of the EU-project DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) and included three representative regions in Denmark. Oral fluid samples (n=3002) were collected randomly from drivers using a sampling scheme stratified by time, season, and road type. The oral fluid samples were screened for 29 illegal and legal psychoactive substances and metabolites as well as ethanol. Fourteen (0.5%) drivers were positive for ethanol (alone or in combination with drugs) at concentrations above 0.53g/l, which is the Danish legal limit. The percentage of drivers positive for medicinal drugs above the Danish legal concentration limit was 0.4%; while, 0.3% of the drivers tested positive for one or more illicit drug at concentrations exceeding the Danish legal limit. Tetrahydrocannabinol, cocaine, and amphetamine were the most frequent illicit drugs detected above the limit of quantitation (LOQ); while, codeine, tramadol, zopiclone, and benzodiazepines were the most frequent legal drugs. Middle aged men (median age 47.5 years) dominated the drunk driving group, while the drivers positive for illegal drugs consisted mainly of young men (median age 26 years). Middle aged women (median age 44.5 years) often tested positive for benzodiazepines at concentrations exceeding the legal limits. Interestingly, 0.6% of drivers tested positive for tramadol, at concentrations above the DRUID cut off; although, tramadol is not included in the Danish list of narcotic drugs. It can be concluded that driving under the influence of drugs is as serious a road safety problem as drunk driving.

Exploration of the Comorbidity of Alcohol Use Disorders and Mental Health Disorders Among Inpatients Presenting to All Hospitals in New South Wales, Australia

ABSTRACT Alcohol is one of the most commonly used legal psychoactive substances, and its use often coexists with mental health disorders. This study explores the relationships between alcohol use and some common mental health disorders. Admissions to all New South Wales (NSW) hospitals were analyzed. The data were extracted from the NSW Department of Health Inpatient Statistics Data Collection for the period 1 July 2006 to 30 June 2007. Readmissions within 28 days were excluded. Data extraction and analyses were performed by using the SAS program. Chi-square tests and odds ratio were used to measure the association. Of the 1.8 million admissions, associations between alcohol use disorders and mental health disorders were strong (odds ratio 7.8 to 10.7, P < .001). A 33.8% of patients who used alcohol had at least 1 identifiable mental disorder. Higher comorbidity rates were observed for females (39.6%) and for those aged between 30 and 49 years. The most common mental disorders were anxiety disorders, bipolar affective disorders, major depressive disorders, personality disorders, schizophrenia, and severe stress disorders. Comorbidity with one of these mental disorders ranged from 1% to 17.6%, with significant associations (odds ratio 5.6 to 14.1). The average length of stay (ALOS) for alcohol use disorders were 6.4 days and the ALOS for the most common mental health admissions was 11.2 days. This study provides detailed information about the association between alcohol use and mental health disorders and extends our understanding of comorbidity presentations in inpatient admissions.

Tobacco and alcohol use in Cuban women

Tobacco and alcohol are currently the most widely consumed legal psychoactive substances in the world. They represent a heavy burden for health and society in almost all populations. Increasing consumption of both substances is a trend observed in women. Describe the profile of women aged ≥15 years residing in urban areas of Cuba with respect to tobacco and alcohol consumption. Basic information on tobacco and alcohol consumption by Cubans aged ≥15 years in urban areas was obtained from the Second National Survey on Risk Factors and Chronic Diseases (2001), a national descriptive cross-sectional study, the objective of which was to determine the frequency and epidemiological characteristics of the urban population's main chronic disease risk factors. Sampling design was complex stratified multi-stage cluster. Of a sample of 23,743 individuals, 22,851 were surveyed, representative of 6.8 million Cubans. A questionnaire and structured interview were used. Variables were tobacco and alcohol use, as well as sociodemographic factors: sex, age, educational level, skin color, marital status, type of full-time employment and perceived economic situation. Prevalence, with 95% confidence intervals, and male:female prevalence ratios were estimated. Women who smoked were predominantly aged 40-59 years; had completed less than university education; of black skin color; divorced; laborers, service workers or managers, and with a perceived economic situation as very poor. Women who consumed alcohol were predominantly aged 15-59 years, had at least middle school education, of mestizo or black skin color, of marital status other than widowed; there was no typical profile for occupation or perceived economic situation. Women who were both smokers and alcohol consumers were predominantly 20-59 years, of black or mestizo skin color, of marital status other than widowed; with no typical profile for educational level, occupation or perceived economic situation. The first nationwide socioeconomic profile of Cuban women using tobacco, alcohol or both constitutes a baseline for comparison to results of a new national study now under way, permitting evaluation of trends over time and effectiveness of prevention and control efforts.

Shifting from an illegal-drug policy to a psychoactive substance policy

At present, the question of drug policy is not on the public agenda in Switzerland. Since the introduction of a bill for the revision of the Federal Narcotics Act (BetmG) was rejected by the National Council in the summer of 2004, the topic has barely made the headlines. Political actors appear to be at a loss as to what should be done next. Although efforts are being made to salvage at least the uncontroversial elements of the unsuccessful plans to revise the legislation, this is not suffi cient from the perspective of public health. From this viewpoint, the aim should be to defi ne harm and benefi ts across the entire spectrum of psychoactive substance use, and to pursue a policy designed to reduce the unavoidable harm as far as possible, both for the individual and for society. In fact, however, the consumption patterns of a substantial proportion of the population – irrespective of their potential to cause harm – continue to be regarded as unlawful and hence punishable. In addition, the law is largely unenforceable. The gulf between illegal and legal use of psychoactive substances remains unchanged. Apart from the public health concerns, the credibility of state institutions is damaged by the lack of coherence in the existing regulations. The Swiss Federal Commission for Drug Issues (EKDF) has now issued a report outlining fundamental principles for a future Swiss policy on substance abuse. Rather than offering solutions that could be implemented in the short term, the report adopts a mediumto long-term perspective. It seeks to present options for the future management of psychoactive substances in Switzerland. The social changes seen in recent decades have given rise to new consumption patterns for both illegal and legal psychoactive substances, creating a need for a fundamental review of substance abuse policy. In Switzerland as well as in other, comparable countries, the shift in values that occurred in the latter half of the twentieth century has produced a pluralistic culture of individual development and experience. In this type of culture, a wide variety of value-systems coexist. New habits of consumption have arisen among different segments of the population, and the future will certainly bring even more profound changes. Increasingly, there will be a blurring of the boundaries between the medically indicated use of mental health medicines, recreational use of psychoactive substances and efforts to enhance cognitive performance with the aid of drugs. In this situation, it is hardly possible to reach a social consensus on the “correct” management of psychoactive substances. There is thus no alternative to a non-judgemental substance abuse policy that strives for pragmatic solutions. These acknowledge that the use of psychoactive substances answers a human need which is manifested in different forms in every culture of the past and present. The goal can then only be to fi nd ways of managing psychoactive substances which – bearing in mind the motives for the various forms of consumption – are designed to reduce harmful consequences for the individual and for society. New approaches to this question are also being sought in other countries. The EKDF report presents a series of recommendations, calling in particular for the development of guiding principles for substance abuse policy to provide a basis for future