The historical foundations of the narcotic drug control regime

This paper outlines the institutional history of the international narcotic drug control regime. It details the evolution of the control system, from its foundations at the beginning of the twentieth century - a period of mass, unregulated narcotic drug use - to the current period. The paper argues that the contemporary control model is ill-positioned to address the dynamic and rapidly changing nature of the global narcotics trade. The persistence of anachronistic guiding first principles, specifically the utopian idea of prohibition, is identified as the key impediment to the adoption of a more humane and effective policy approach. But while there is growing pressure for a revision of founding ideas, this is not supported by a host of powerful actors that includes the United States.Crime and Society,Post Conflict Reconstruction,Alcohol and Substance Abuse,Pharmaceuticals&Pharmacoeconomics,Pharmaceuticals Industry

Reintegration and Long-Term Development: Linkages and Challenges. Thematic Working Paper 5.

This working paper explores reinsertion and reintegration processes and how these connect (or are expected to connect) with donor-led strategies for post-conflict reconstruction and long-term development. DDR has long been recognised as essential for post-conflict stability, but in the 2000s, there has been emphasis on enhancing the linkages between short-term, time-bound DDR process and long-term reconstruction and development programmes and processes in post-conflict states. The importance of situating reintegration into the wider context of long-term development has been stressed by the UN, whose best practice guidelines emphasise that reintegration should: 'support a broader national strategic plan for reconciliation, reconstruction and development.' This does not suggest a restructuring of DDR activities, which aim to establish an environment conducive to long-term economic development rather than fostering long-term development, but a bridging of short- and long-term agendas

Drug Crop Production, Poverty, and Development: Spanish

As member states of the United Nations take stock of the drug control system, a number of debates have emerged among governments about how to balance international drug laws with human rights, public health, alternatives to incarceration, and experimentation with regulation. This series intends to provide a primer on why governments must not turn a blind eye to pressing human rights and public health impacts of current drug policies.The cultivation of drug crops such as opium poppy, coca, and cannabis is a vital source of economic and physical security for poor, marginalized, and vulnerable communities in the Global South. International drug control strategies that have targeted cultivators with violent state coercion and eradication strategies have fueled displacement, ecological damage, and land poverty, while exacerbating existing problems of malnutrition and infectious disease. Such approaches have proved particularly counterproductive in conflict contexts, where an assumed nexus between drug revenues and the financing of terrorism and insurgency has undermined prospects for peace and stability.At its 20th session in 1998, the UNODC recognized that alternative development (AD) approaches could and should be used to reduce reliance on illicit cultivation by fostering livelihood opportunities in the formal economy. In the period since, AD has been rolled out in cultivation zones and evolved into more complex development interventions. However, rather than reducing global drug volumes, they have displaced cultivation into new areas and generated shifts in types of drug manufacture. In sum, they are doing more harm than good.Drawing together research from the AD experience of a diversity of countries and regions, Drug Crop Production, Poverty, and Development argues that AD programs cannot succeed in a broader context of the ongoing criminalization of cultivators and cultivation; UNODC use of inappropriate metrics; and poor AD program design, monitoring, and evaluation. AD programs continue to be chronically underfunded, poorly integrated into poverty reduction and development strategies and are usually conditional upon the prior eradication of crops. Effective responses to this supply side dynamic must recognize cultivation as a problem of development and security in complex and fragile environments, with new and evidence-based policies that acknowledge the role and value of these crops in distinct cultures and contexts

Dealing with synthetics: time to reframe the narrative.

Key Points: • Despite adjustments over its lifetime, the contemporary international drug control regime has had an historical emphasis in on ‘narcotic’ drugs, such as opium, heroin and cocaine, rather than on a range of synthetic substances. • Associated policy inertia has resulted in disproportionate attention on counter-narcotic policies and operations in the Global South and in many ways inadequate responses to the synthetic market, including production that is frequently located in the Global North. • Possible explanations for this focus on plant-based drugs are manifold and complex. They include the fact that the control regime began with concerns over opium-smoking in the ‘orient’, a concentration of drug crops in the Global South, the energies of colonialism (which have been intimately tied up with ‘drug wars’), broader geo-political imperatives and the focus of policy metrics on drug crops. • The market for synthetic drugs has grown exponentially in recent years, becoming the second-most illicit drugs consumed after cannabis. In 2014, the UN estimated that there were 35.7 million users of amphetamine type stimulants (including prescription stimulants), and 19.4 million users of ecstasy. These synthetic drugs outstripped the estimated totals of opioids and cocaine combined. • Alongside this consumption is that of New Psychoactive Substances that fall outside the control regime and its schedules, which the regime is now attempting to integrate into national and international controls. • While there was some awareness of the advent of new synthetic drugs in the aftermath of the Second World War and since the 1960s, it is only over recent years, and especially in the wake of the 2016 UNGASS in New York, that a truly serious understanding of the challenges posed by proliferating synthetic drugs has begun to emerge from the international drug control regime. • This is timely since, considering its policy history and contemporary dynamics, it is now time to reframe the narrative surrounding the way the international community deals with synthetic drugs

DNA repair deficiency biomarkers and the 70-gene ultra-high risk signature as predictors of veliparib/carboplatin response in the I-SPY 2 breast cancer trial.

Veliparib combined with carboplatin (VC) was an experimental regimen evaluated in the biomarker-rich neoadjuvant I-SPY 2 trial for breast cancer. VC showed improved efficacy in the triple negative signature. However, not all triple negative patients achieved pathologic complete response and some HR+HER2- patients responded. Pre-specified analysis of five DNA repair deficiency biomarkers (BRCA1/2 germline mutation; PARPi-7, BRCA1ness, and CIN70 expression signatures; and PARP1 protein) was performed on 116 HER2- patients (VC: 72 and concurrent controls: 44). We also evaluated the 70-gene ultra-high risk signature (MP1/2), one of the biomarkers used to define subtype in the trial. We used logistic modeling to assess biomarker performance. Successful biomarkers were combined using a simple voting scheme to refine the 'predicted sensitive' group and Bayesian modeling used to estimate the pathologic complete response rates. BRCA1/2 germline mutation status associated with VC response, but its low prevalence precluded further evaluation. PARPi-7, BRCA1ness, and MP1/2 specifically associated with response in the VC arm but not the control arm. Neither CIN70 nor PARP1 protein specifically predicted VC response. When we combined the PARPi-7 and MP1/2 classifications, the 42% of triple negative patients who were PARPi7-high and MP2 had an estimated pCR rate of 75% in the VC arm. Only 11% of HR+/HER2- patients were PARPi7-high and MP2; but these patients were also more responsive to VC with estimated pathologic complete response rates of 41%. PARPi-7, BRCA1ness and MP1/2 signatures may help refine predictions of VC response, thereby improving patient care

The demand for sports and exercise: Results from an illustrative survey

Funding from the Department of Health policy research programme was used in this study.There is a paucity of empirical evidence on the extent to which price and perceived benefits affect the level of participation in sports and exercise. Using an illustrative sample of 60 adults at Brunel University, West London, we investigate the determinants of demand for sports and exercise. The data were collected through face-to-face interviews that covered indicators of sports and exercise behaviour; money/time price and perceived benefits of participation; and socio- economic/demographic details. Count, linear and probit regression models were fitted as appropriate. Seventy eight per cent of the sample participated in sports and exercise and spent an average of £27 per month and an average of 20 min travelling per occasion of sports and exercise. The demand for sport and exercise was negatively associated with time (travel or access time) and ‘variable’ price and positively correlated with ‘fixed’ price. Demand was price inelastic, except in the case of meeting the UK government’s recommended level of participation, which is time price elastic (elasticity = −2.2). The implications of data from a larger nationally representative sample as well as the role of economic incentives in influencing uptake of sports and exercise are discussed.This article is available through the Brunel Open Access Publishing Fund

Severe Histoplasmosis in Travelers to Nicaragua

We investigated an outbreak of unexpectedly severe histoplasmosis among 14 healthy adventure travelers from the United States who visited a bat-infested cave in Nicaragua. Although histoplasmosis has rarely been reported to cause serious illness among travelers, this outbreak demonstrates that cases may be severe among travelers, even young, healthy persons

Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model

BACKGROUND: Sudden cardiac death (SCD) and pump failure death (PFD) are common endpoints in chronic heart failure (CHF) patients, but prevention strategies are different. Currently used tools to specifically predict these endpoints are limited. We developed risk models to specifically assess SCD and PFD risk in CHF by combining ECG markers and clinical variables. METHODS: The relation of clinical and ECG markers with SCD and PFD risk was assessed in 597 patients enrolled in the MUSIC (MUerte Súbita en Insuficiencia Cardiaca) study. ECG indices included: turbulence slope (TS), reflecting autonomic dysfunction; T-wave alternans (TWA), reflecting ventricular repolarization instability; and T-peak-to-end restitution (ΔαTpe) and T-wave morphology restitution (TMR), both reflecting changes in dispersion of repolarization due to heart rate changes. Standard clinical indices were also included. RESULTS: The indices with the greatest SCD prognostic impact were gender, New York Heart Association (NYHA) class, left ventricular ejection fraction, TWA, ΔαTpe and TMR. For PFD, the indices were diabetes, NYHA class, ΔαTpe and TS. Using a model with only clinical variables, the hazard ratios (HRs) for SCD and PFD for patients in the high-risk group (fifth quintile of risk score) with respect to patients in the low-risk group (first and second quintiles of risk score) were both greater than 4. HRs for SCD and PFD increased to 9 and 11 when using a model including only ECG markers, and to 14 and 13, when combining clinical and ECG markers. CONCLUSION: The inclusion of ECG markers capturing complementary pro-arrhythmic and pump failure mechanisms into risk models based only on standard clinical variables substantially improves prediction of SCD and PFD in CHF patients