28 de novembro

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28 de novembro
CLIPPING
28/11/2012
CLIPPING VIVAVOZ
Fonte: Correio do
Povo
Seção: Cidades
Página:15
Data: 28/11/2012
CLIPPING VIVAVOZ
Fonte: Guardian
Seção:
Página:
Data: 28/11/2012
What drugs do students take?
The world's biggest survey of drug use is underway, and the Guardian is asking UK
students to share their experiences – anonymously of course
A cannabis smoker in Porto, Portulgal, during a march in favour of legalising drugs
Photograph: Estela Silva/EPA
Like it or not, taking drugs for work, rest or play is an integral part of life for
many students. There's the gush of fresher's week alcohol, and the boozy induction
rituals for sports clubs; the stay-up-to-study use of caffeine pills and so-called smart
drugs such as Ritalin and Modafinil; and drugs taken in anticipation of pleasure, or
stress release: cannabis, cocaine, MDMA.
But what do we really know about the high and lows of the student drug experience?
And could you help us paint an accurate picture by telling us about your experiences?
The latest Global Drug Survey (GDS) , supported by the Guardian, seeks to uncover
the truth about why people take drugs, and what happens when they do.
The survey asks particpants about what drugs they use, where they get them, how
often they use them, and what the social, legal, medical and health consequences of
their drug use are.
Dr Adam Winstock of GDS, who drew up the survey, says: "There are many truths
about drugs. But mostly what we hear are the voices of those sitting in polarised camps
where debate is influenced by moral panic or hedonistic righteousness.
"Rarely is the debate informed by the voices of the hidden mass of people for whom
drug use is just one thing they do as part of the rich fabric of their lives."
Global Drug Survey 2013 is the world's biggest survey of drug use, completed by
thousands of people. It aims to provide an authentic picture of people's real drug
experiences in the UK, US, Australasia and elsewhere. The survey is confidential and
anonymised. It takes about 20 minutes to complete online.
This year's survey includes questions on:
• Drugs and sex: who uses what drugs for sex, and how do different drugs affect
sexual performance?
• Drugs and violence: to what extent does drug taking contribute to violent behaviour,
and which drugs are most likely to trigger it?
• Drugs and pleasure: which drugs have the best pleasure/harm ratio, and what level
of drug use seems to strike the best balance between pleasure and harm?
• Drugs policy: how would changes in drug policy affect your drug taking?
• Prescription drug use: who uses prescription drugs, and where do they get them?
• Drug trends: which drugs are the most popular, how much do they cost and what's
new?
You can access the 2013 drug survey here. It will be open until late December.
The results will be published next March by the Guardian, and the survey's other media
partners: NBC in the US; Fairfax Media in Australia and New Zealand; and in the UK,
Mixmag and Gay Times.
Last year's survey was completed by 15,500 respondents. The results, published in
March and reported all over the world, provided a comprehensive, up-to-date picture of
people's drug habits and experiences. Full Guardian coverage of last year's drug
survey can be found here.
Global Drug Survey is an independent, self-funded data mapping agency.
CLIPPING VIVAVOZ
Fonte: Guardian
Seção:
Página:
Data: 28/11/2012
Painkiller addiction: the plague that is sweeping the US
The US is leading the way in eradicating pain, but in doing so has created an unwanted
byproduct: painkiller addiction. Prescription pill overdoses are killing 15,000 Americans a year,
and the toll is growing
Ed Pilkington
Mark Maynard, who became addicted to painkillers when he was prescribed them for back pain
after falling off a roof. Photograph: Ed Pilkington for the Guardian
For almost two decades Geni Swartzwelder has played an elaborate game of hide-and-seek
with her daughter Heather. Every day, Geni, 52, takes a bottle of little white pills and sneaks it
away to a secret location. Every day, 32-year-old Heather then goes on a hunt for the bottle.
Many days she succeeds in finding it. Geni knows because when she counts the pills at the end
of the day, she often finds their numbers depleted.
The game began when Heather was 14. Geni noticed, haltingly at first but with growing alarm,
that her husband's opioid painkillers, prescribed after he was injured in a motorbike accident,
were coming up short: "Heather tried to convince us that we'd lost them, but there was no other
way, and in the end we concluded she had to be taking them. So I started hiding them, every
day, some place different."
Geni was forced to confront the fact that her only child had begun stealing her husband's pills
and had become hopelessly addicted to them. When her efforts to hide the drugs failed, the
Swartzwelders bought a metal safe and locked them up. That put a stop to the game, but not for
long. Heather used the family video camera to film her mother opening the safe and studied the
footage to extract the combination.
Heather's father died three years ago, but the game of hide-and-seek goes on. Now Geni hides
her own little white pills – she has end-stage cancer and takes opiate derivatives, medically
prescribed synthetic heroin, to ease the agony in her back and chest.
Geni desperately wants to increase the strength of the medicines she is taking because she is
in excruciating and intensifying pain. But she knows that, if she does, the consequences for her
daughter could be devastating: "I'm in pain, very much so, more and more each day," she says.
"But I know that if I move to stronger drugs, I could make her problems so much worse."
Geni's dilemma captures in microcosm one of the great unfolding tragedies of our time. Over
the past 20 years, societies in the developed world have made it a priority to eradicate pain,
encouraging hospitals and doctors to combat it as aggressively as they might a life-threatening
virus. A public expectation has taken hold that we should all be entitled to lead pain-free lives, in
rather the same way that we have come to expect to be able to own a car or to holiday abroad;
but the pursuit of painlessness has come at a high price. The level of prescribing of opioid
painkillers – Percocet in Geni's case – has soared, and with it the incidence of addiction, and
addiction's grim best friend: fatal overdoses.
The same escalating use and abuse of powerful painkillers can be found in rich societies from
the UK, across Europe to the antipodes. But the country that really knows all about prescription
pill excess, and the human toll it claims, is the US. Americans make up less than 5% of the
global population but consume 80% of the world's supply of opioid prescription pills. Sales of the
drugs have increased more than fourfold in the past 10 years, grossing $11bn (£7bn) annually.
To express that figure more personally, in 2010 enough of Geni's pills, or their brand-name
equivalents, were handed out by doctors to medicate every American adult with a typical dose
of hydro– codone, a pure opioid as powerful as morphine, every four hours for a month.
The more pills handed out, the more cases of addiction; the more cases of addiction, the more
illegal street trafficking of the drugs; the more illegal street trafficking, the more snorting and
injecting of the crushed pills; the more snorting and injecting, the more overdoses; the more
overdoses, the more deaths. The result is that about 15,000 Americans are dying every year
from prescription pill overdoses – triple the rate of a decade ago, according to the US
government body the Centres for Disease Control, which has declared the problem an
epidemic. The death toll exceeds that caused by heroin and cocaine combined, and in 17 states
has become the No 1 killer, surpassing even car crashes.
Apart from the sheer scale of the crisis, the profile of victims is striking. Unlike the crack cocaine
epidemic of the 80s and early 90s that wrought havoc particularly among younger African
Americans, those who succumb to a prescription pill overdose are likely to be white, male and
middle-aged.
The other factor that sets this disaster apart is its source. Track the supply of Percocet,
OxyContin, Vicodin, Opana, or several other opioid painkillers involved in overdoses, and you
will eventually arrive not at a Mexican or Colombian drug cartel or an international smuggling
ring, as might be the case with heroin or cocaine, but at the medical doctor.
"It started as a genuine attempt by doctors to help those who needed it," says Dr David
Caraway, Geni's physician. "There was a rationale to treating pain aggressively with opioids.
But 10 years down the line we have come to understand the consequences."
Caraway points out that in the late 90s the Joint Commission on Accreditation of Healthcare
Organisations, a private body that provides guidelines for hospitals, launched an initiative that
encouraged doctors to wage war on pain wherever they found it. It focused on opiate
derivatives, drugs that work by modulating pain messages as they pass up the spine to the
brain. For years, opioids had been regarded as a drug of last resort, suitable only for the most
severe cases. Now the emphasis began to shift towards prescribing them for chronic pain.
At around the same time, drug companies, led by Purdue Pharma, the manufacturer of the
leading opioid painkiller OxyContin, embarked on a massive marketing push. In 2001, Purdue
Pharma spent $200m promoting OxyContin. Primary care physicians, in particular, were
targeted, and their patients induced to try out the drug with 30-day free trial periods.
Concerns about potential addiction were assuaged in promotional videos that claimed the
incidence of addiction was less than 1%. Sales grew and grew, to about $3bn for OxyContin in
2010.
Caraway knows intimately the outcome of what he describes as this "perfect brew" of official
encouragement and Big Pharma marketing. He is a specialist in pain management and vicepresident of the professional body that represents such experts, the American Society of
Interventional Pain Physicians. He also works at a pain management centre, the Centre for Pain
Relief Tristate, right at the heart of the painkiller epidemic, in the small town of Huntington,
which sits at the intersection of three states straddling the Appalachian mountains – West
Virginia, Kentucky and Ohio.
Since the prescription pill tragedy began some 10 years ago, Appalachia has been in the thick
of it. This beautiful area of rolling, wooded hills – about as close to the pastoral idyll of rural
England as you get in the US – hides levels of poverty and poor education on which drug
addiction breeds. Appalachia has long been accustomed to high levels of addiction to tobacco,
alcohol and meths, and in the past decade it has similarly embraced "Hillbilly Heroin" as opioid
painkillers have come to be known locally.
Caraway has watched the epidemic take hold. He remembers his astonishment when he first
started seeing patients coming in with signs of addiction to massively powerful opiate
painkillers, having been put on them for comparatively mild complaints: "That was stunning to
me – that a primary care doctor would write large doses of potent opioids for relatively benign
pain conditions was extraordinary," he says.
He also remembers the moment the penny dropped – the realisation that the US was falling into
a crisis of epic proportions. It was when a patient came to see him who had been complaining of
muscle aches and pains of the sort you might feel after a long run, or if you had a light case of
flu. His doctor had put him on 540mg a day of the most commonly prescribed opioid painkiller,
OxyContin. "Let me give you a little understanding about that," Caraway says. "OxyContin is up
to two times more potent than morphine. So this is the equivalent of about 1,000mg of oral
morphine. That's a whopping dose that is every bit as potent as heroin, every bit as addictive. I
was stunned that someone would prescribe this level of medicine to someone who wasn't
suffering from end-of-life cancer."
After that experience, Caraway watched as similar cases became more and more common. And
he watched as the problem fanned out from the medical world into the realm of illicit drug
dealing as addicted patients, desperate for money to pay for their habit, began to sell the
prescription pills on the street: "I've seen it tear apart families, and lead to loss of life. The most
horrifying thing I've seen is that this is causing hopelessness leading to suicide and murder,"
Caraway says.
Among those he has tried to help wean themselves off the drugs was an engaged couple.
Shortly before the wedding, the woman overdosed on painkillers and died: "He was devastated,
but he kept on taking the pain pills," Caraway says. Other patients have included a judge who
became addicted after treatment for an injury, a sports star, whom he wouldn't name, who lost
everything – his wife, six children and home – to the habit, and CEOs of major companies.
Caraway treats patients who have severe pain and genuinely need treatment with powerful
opioids. He does not treat active abusers. Butseveral of his patients have had experiences
relating to the epidemic of painkiller addiction. Take John Brumfield, 61, who ruptured a disc in
his spine and has been on painkillers for many years. After friends heard that he was on them,
Brumfield started observing something strange: "If we had people over to the Super Bowl or a
holiday season party, I'd notice that my medicines would come up short, no matter how good
friends they were."
Twice people broke into his house to get to the drugs. Like Geni, he ended up installing a safe
to secure the drugs. And he stopped having parties: "You don't know how sad that is, to know
the lengths even your friends will go to to get these drugs," he says.
A couple of years ago Brumfield went one better – he implanted what is essentially a mobile
safe into his body. Under Caraway's supervision, he had a box embedded under the skin of his
stomach into which opiate derivatives can be injected and then pumped in micro amounts
through a tube direct into his spine: "No one can get at my drugs now. I no longer have to worry
about people I thought of as my friends trying to take it from me," Brumfield says.
Mark Maynard, 37, knows what addiction to prescription pills does to you. In 2006 he was
working on a metal roof when he slipped and fell nine metres (30 feet), smashing seven
vertebrae. He was put on OxyContin and rapidly became addicted. He had to take ever larger
doses to ease the pain, and suffered cravings when he went without. At the peak of his
addiction, he was taking each day 250mg of OxyContin, three 800mg Ibuprofen tablets, three
doses of Neurontin, two of Lyrica, plus Diazepam and Ativan. His nadir came a couple of years
ago, on Christmas Eve. He had taken his two children to his mother's house and stayed up to
wrap the presents. He took too much OxyContin and passed out; when he woke up eight hours
later he was in the living room. "I'd wet myself, the kids had gone, and I was on my own with wet
pants, not remembering anything that had happened."
After that, Maynard pulled himself together. Under Caraway's care he gradually reduced his
intake and is now on a much lower dose of painkiller and doing well. But many friends have not
been so lucky. He knows 10 or so people who are in prison or have overdosed and died as a
result of opioids.
Black-market drugs are freely available in the area, most of them trafficked through the socalled OxyContin Express: people travel down to Florida, home to many unscrupulous doctors
and their "pill mills", where prescriptions for painkillers can be bought no questions asked, and
bring the spoils back to Appalachia to be sold on the street for up to $100 a pill. "It's hard to find
people round here who don't take pain medicine," Maynard says.
Finally and very belatedly, the US authorities have begun to grapple with the problem. The
Centres for Disease Control has named painkiller abuse a No 1 priority, police have begun
closing down pill mills in Florida, physicians are being educated about the dangers of
overprescribing, and in Appalachia new rules have been introduced that require doctors who
treat more than half of their patients for chronic pain to be registered. Purdue Pharma has also
reformulated OxyContin so that if the pills are crushed, they turn into a gloop that cannot be
injected or snorted.
But now the genie is out of the pill bottle, it is very hard to put back: pill mills closed in Florida
pop up again in Georgia or Maine; addicts who were using OxyContin switch to Opana or
another brand name. The insatiable desire for Hillbilly Heroin continues unabated. "This is still
getting worse," says Caraway. "In our pursuit of 'pain-free', that elusive modern goal, we have
created a monumental problem of drug addiction, abuse, lost productivity, crime and death."
CLIPPING VIVAVOZ
Fonte: UNIAD
Seção:
Página:
Data: 28/11/2012
Iniciada campanha para projeto de iniciativa popular que pretende
limitar propaganda de cerveja
Agência Brasil - Camila Maciel
Repórter da Agência Brasil
São Paulo – Campanha do Ministério Público do Estado de São Paulo (MP-SP)
pretende reunir 1,7 milhão de assinaturas para propor, por meio de projeto de lei de
iniciativa popular, limites às propagandas de cerveja. A petição pública foi apresentada
hoje (13) em audiência na sede do MP na capital paulista. As assinaturas também
serão recolhidas pela internet.
O documento propõe alterações na Lei 9.294/96, que só restringe publicidade de
bebidas com teor alcoólico acima de 13 graus Gay-Lussac (ºGL), a exemplo do uísque
e da cachaça. O limite passaria a 0,5 ºGL. De acordo com a Constituição, a
apresentação de projeto de lei de iniciativa popular deve ser subscrito por, no mínimo,
1% do eleitorado nacional, distribuído pelo menos por cinco estados, entre outros
requisitos.
Caso a proposta seja aprovada, assim como ocorre com bebidas de concentração
alcoólica mais forte, não poderá haver propaganda de cervejas e vinhos nas
emissoras de rádio e TV fora do horário das 21h às 6h. Além disso, não será possível
associar esses produtos, por exemplo, ao esporte olímpico ou de competição, ao
desempenho saudável de qualquer atividade e à condução de veículos.
“Não tem sentido a lei deixar de fora a cerveja que é a bebida mais consumida no
país. Já está na hora de a sociedade se mobilizar para equiparar a cerveja a todas as
bebidas que já sofrem restrição. Nossa proposta é uma ampla mobilização no país
para sensibilizar o Congresso Nacional a modificar a lei”, explicou Jairo Edward de
Luca, promotor de Justiça da Infância e Juventude de São Bernardo do Campo (SP).
De Luca, que encabeça a iniciativa, informou que várias entidades já aderiram à
campanha, como Conselho Federal de Medicina, Conselho Federal de Farmácia,
Fundação Criança de São Bernardo do Campo, Instituto Alana, Aliança de Controle ao
Tabagismo, Pastoral da Sobriedade e Movimento de Combate à Corrupção Eleitoral.
“Vamos fazer novas reuniões e batalhar por novos parceiros. A gente acredita que vai
ter resistência no Congresso Nacional, mas com a mobilização devemos conseguir”,
avaliou.
A proposta tem como objetivo desestimular o consumo do produto por crianças e
adolescentes. De acordo com o professor Ronaldo Laranjeira, da Universidade
Federal de São Paulo (Unifesp), 46% de toda a bebida vendida no país são
consumidos por jovens de até 29 anos. Cerca de 6% desse total são consumidos por
menores de 18 anos, segundo levantamento nacional domiciliar coordenado pelo
pesquisador.
“O álcool é a droga mais utilizada pelos jovens, mais do que cocaína e maconha. É a
droga de começo, é a que tem mais oferta, mais propaganda e mais facilidades”,
avalia. Ele informou ainda que 90% dos adolescentes conseguem comprar bebidas
alcoólicas sem problemas.
A professora Ilana Pinsky, também da Unifesp, aponta que a exposição à publicidade
de álcool, especialmente quando se trata de crianças e adolescentes, cria conceitos
distorcidos sobre o uso da bebida. Ela cita como exemplos a construção de uma visão
positiva do típico consumidor de álcool, a difusão de atitudes positivas relacionadas ao
beber, a construção da ideia do beber como onipresente na sociedade e a ampliação
da predisposição de menores a beber antes da idade legal, com o recrutamento de
gerações de potenciais bebedores.
Usando dados de pesquisa nacional sobre consumo de álcool feita em 2012, a
professora diz que 80% dos adolescentes com idade entre 14 e 17 anos foram
expostos a publicidade de bebida nos últimos 30 dias. O percentual sobe para 86% na
faixa etária de 18 a 25 anos. “A publicidade é indireta, sutil e cumulativa. São anos e
anos em que crianças e adolescentes têm a propaganda como instrumento de
informação sobre o álcool”, criticou.
O jurista Dalmo de Abreu Dallari, professor da Faculdade de Direito da Universidade
de São Paulo (USP), destacou que a proposição de leis de iniciativa popular são
importantes não só pelo resultado que geram, mas também pelo processo de
discussão e debate que desencadeiam. “São entidades que já desenvolvem algum
trabalho nesse sentido, mas que vão intensificar sua atuação para conseguir o
envolvimento da população em torno do tema”, apontou.
O professor destacou também que, caso seja aprovada, a proposta será a quinta lei
criada por meio da iniciativa popular. “A primeira, em 1994, definiu como crime
hediondo a chacina por esquadrão da morte. Em seguida, tivemos aprovada a
cassação de mandato quando comprovada compra de votos. Tivemos ainda a criação
do Fundo Nacional de Habitação de Interesse Social, em 2005. E a quarta foi a Lei da
Ficha Limpa”, enumerou.
Edição: Davi Oliveira