By T. Hauke. College of Idaho.
In Myanmar • Young plants in new coca ﬁelds are not as productive and the Lao People’s Democratic Republic buy 30 gm acticin with visa, the eradi- as mature coca bushes safe 30 gm acticin. Not • Eradicated coca ﬁelds may be replanted but have a enough information is available to consider eradication lower yields as plants are not mature carried out after the time of the annual opium survey order acticin 30 gm visa. This longevity of the coca plant full productivity faster than a newly planted ﬁeld but should purchase acticin 30gm on-line, in principle, make it easier to measure the area still be less productive than a well maintained ﬁeld under coca cultivation. In reality, the area under coca cultivation is dynamic, changes all the time and it is dif- The effect on productivity could be added to the effect ficult to determine the exact amount of land under coca of time. For example, 20 ha which were eradicated after cultivation at any specific point in time or within a given six months would only count as 10 productive hectares. There are several reasons why coca cultivation is Similarly, a factor can be introduced to reflect the dynamic, including new plantation, reactivation of pre- reduced productivity as a result of aerial spraying. Efforts viously abandoned fields, abandonment, manual eradi- are being made to improve the estimation of the net cation and aerial spraying. Depending on the purpose, different concepts of area In 2010, for the first time, the net productive area was 3 Plant disease and pests are not considered here as their impact is likely estimated in addition to the net cultivation on 31 to be captured in the coca leaf yield estimates. December, using information on manual eradication 262 Methodology Colombia, area concepts used for coca cultivation and production estimates, 2010 * All rounded and adjusted for small fields Net area (31 Dec 2010)* Average area 2009/2010 Net productive area 2010 Area under coca 62,000 67,500 77,500 cultivation (ha)* Used for coca leaf/cocaine Used for coca leaf/cocaine Application Used for area trend analysis estimate estimate (lower bound of range) (upper bound of range) and spraying of coca bush and other sources to model area. Not enough information is available to also con- the permanence (that is, the productive time span) of sider eradication carried out after the time of the annual coca fields. More research is needed on the permanence of coca fields and To estimate potential production of opium, coca leaf the consequences for coca leaf yield to improve the net and cannabis (herb and resin), the number of harvests productive area estimate. The adjustment for small fields leads with the traditional lancing method can take up to two to a higher area estimate and is considered more accu- weeks as the opium latex that oozes out of the poppy rate. Area figures for 2009 and 2010 were calculated capsule has to dry before harvesters can scrape it off and with and without adjustment for small fields for compa- several lancings take place until the plant has dried. The adjustment varies from year to year, avoid this lengthy process, yield surveyors measure the depending on the proportion of small fields present in number of poppy capsules and their size in sample plots. Thus, the adjust- poppy capsule volume indicates how much opium gum ment factor has to be calculated for each year separately. Thus, the per hectare Efforts are under way to recalculate the time series for opium yield can be estimated. In the Plurinational State of Bolivia and Peru, the coca area as estimated from satellite imagery in the second For coca bush, the number of harvests varies, as does the half of the year was used as a proxy for the net produc- yield per harvest. In calculate the potential cocaine production from coca leaf Colombia, where the security situation does not allow or the heroin production from opium - are not known. In all three coca cocaine content of the coca leaf, as well as detailed infor- cultivating countries, yield surveys are carried out only mation on the efficiency of clandestine laboratories. In the case of opium gum, for example, traffickers extract the mor- 1,300 1,232 1,264 phine contained in the gum in one process, transform 1,200 1,201 1,125 1,111 the morphine into heroin base in a second process, and 1,034 1,024 1,054 1,100 1,020 finally produce heroin hydrochloride. In the case of 1,000 cocaine, coca paste is produced from either sun-dried (in 865 842 the Plurinational State of Bolivia and Peru) or fresh coca 900 786 leaves (in Colombia), which is later transformed into 800 cocaine base, from where cocaine hydrochloride is pro- 700 duced. Such conversion factors are based on interviews with the Applying the new conversion factors to Bolivia and Peru people involved in the process, such as farmers in Using previous conversion factors Colombia, who report how much coca leaf they need to produce 1 kg of coca paste or cocaine base. Tests have also been conducted where so-called ‘cooks’ or ‘chemists’ Many cannabis farmers in Afghanistan and Morocco demonstrate how they do the processing under local conduct the first processing steps themselves, either by conditions. A number of studies conducted by enforce- removing the upper leaves and flowers of the plant to ment agencies in the main drug-producing countries produce cannabis herb or by threshing and sieving the have provided the orders of magnitude for the transfor- plant material to extract the cannabis resin. This and resin yield per hectare can be obtained by multiply- information is usually based on just a few case studies, ing the plant material yield with an extraction factor. The yield study included observation of the actual production of resin, always possible due to the sensitivity of the topic, espe- which is a process of threshing and sieving the dried cially if the processing is done by specialists and not by cannabis plants. Establishing conversion ratios is by using information from farmers on the methods used complicated by the fact that traffickers may not know and on results from scientific laboratories. Information the quality of the raw material and chemicals they use, on the yield was obtained from interviews with cannabis which may vary considerably; they may have to use a farmers. For years before 2010, the net productive tion in many cannabis-cultivating countries. In addition, significant quantities of the inter- Potential cocaine production in the Plurinational State mediate products, coca paste or morphine, are also con- of Bolivia is estimated from potential coca leaf produc- sumed in the producing countries. Some products such tion after deducting the amount of coca leaf produced as opium can be stored for extended periods of time and on 12,000 ha in the Yungas of La Paz where coca cultiva- be converted into intermediate or final products long tion is authorized under national law.
These generic biologics discount 30gm acticin free shipping, or “biosimilar designs recognizing the unique nature of specialty drugs purchase acticin 30gm without prescription. Biosimilars and collaboration between treating providers and specialty must meet rigorous safety and effcacy requirements quality acticin 30 gm, and pharmacists with expertise in medication management must also show no meaningful clinical difference from the for specifc conditions order 30gm acticin mastercard. A Coverage of a specialty drug results in signifcant study conducted in 2013 found that the approval of health care waste, poor outcomes, and higher costs when 11 biosimilars already approved for sale in Europe and patients have poor adherence, or if they discontinue use elsewhere would save approximately $250 billion in health after flling the prescription. Health plans High-Quality, Cost-Effective are also helping patients understand how to take their medications correctly by coordinating with providers Drug Coverage and making sure that patients understand the guidelines for using the medication and any potential side effects. Although health plan efforts to promote access while Condition-specifc care management support teams help lowering the growth of spending on specialty drugs patients adhere to their treatment regimen and work with have shown progress, substantial reforms are still needed providers to coordinate care. The problem facing policymakers is Many health plans now contract with specialty pharmacies urgent—growth in specialty drug prices signifcantly that supply enrollees with the specialty drugs they need outpaced growth in wages and the consumer price index between 2011 and 2013. These pharmacies in Health Affairs modeled the impact of a hypothetical have specialized capabilities to monitor and track the use specialty drug costing $100,000 per treated patient that of specialty drugs and have the necessary training and would increase total health care costs by $250 for every 0. Specialty pharmacies also employ dedicated teams of health care specialists model, such a specialty drug used by just 5% of the that can help enrollees understand how to manage their population would lead to an almost 15% increase in medication and can help ensure that these drugs are premiums (Figure 5). Figure 5: Rate and Percent Increase in Utilization and Pharmacy Management Premiums For A New Specialty Drug By covering specialty drugs for their intended uses and Costing $100,000 PerTreated Patient, monitoring the effectiveness and any side effects that occur Depending on Disease Prevalence during the therapy session, health plans can help to ensure that individuals receive safe, high-value care. For instance, drug formularies that are designed based on information regarding drug safety and effcacy help promote patient access to treatments while keeping health coverage affordable. Clinical Pathway and Bundled Payment Arrangements More health plans are exploring innovative approaches to managing specialty drugs, such as oncology drugs, for specifc conditions. By encouraging treatment consistent with evidence-based, accepted clinical guidelines and reimbursing physicians for the treatment episode as a bundled service, plans are working to reduce treatment Source: The Impact of Specialty Pharmaceuticals As Drivers of Health Care Costs. Such payment • Prohibiting abuse of the patent process by strategies can ensure access to new drugs while drug companies. Congress should take meaningful generating additional evidence on the value steps to prohibit manipulation of the patent process of these new medications to patients. As part in ways that artifcially prolong patents on brand- of a broader value-based purchasing strategy, name drugs. For example, Congress should bar certain alternative arrangements—such as outcomes-based anti-competitive settlements that prevent generics contracting or reimbursing providers a fat fee from entering the market in a timely manner, thereby for obtaining drugs, rather than a percentage of expanding the availability of low-cost, but equally the drug’s total cost—provide enhanced fnancial effective, generic drugs. Greater use and availability of as a way to promote lower-cost generic drugs to patients comparative effectiveness data is a key element and consumers. The Congressional Budget Offce in the future growth of these innovative payment estimates that prohibiting these settlements would save arrangements. Congress should are made to a drug to keep its patent from expiring shorten the exclusivity period for biologics to allow for while not providing any additional clinical beneft. By shortening the for patent challenges, including challenges involving exclusivity period, this proposal would facilitate the entry pharmaceutical patents. While specialty and • Removing barriers at the state level that other breakthrough drugs can offer lifesaving treatments restrict the use of biosimilars. By shortening the exclusivity period, when a biosimilar drug is truly interchangeable policymakers can ensure greater price competition in the with an already approved biologic. Ahead of these specialty drug area and help alleviate cost pressures for standards, some states have already adopted legislation payers and consumers. Greater transparency of clinical research and drug approval data would help physicians and patients • Expanding agencies’ authority to consider select the optimal course of treatment. In the absence of a national • Reforming Medicaid drug manufacturer process for measuring the cost-effectiveness of rebates to promote competition. Under the procedures and drugs, many providers are attempting current formula, drug manufacturers participating in to control costs by basing coverage decisions on the Medicaid must provide a specifc discount to states and relative costs of similar treatments. This Kettering Cancer Center announced in 2012 that it discount must equal the greater of either (1) 23. This encourages drug manufacturers participating To expand this evidence base in America, Congress in Medicaid to raise prices higher than what they should provide new authorizing language for the might be in a competitive market to avoid providing Patient-Centered Outcomes Research Institute private market discounts to the Medicaid population. In addition to prescription drug market and leverage market forces to reducing costs, this policy would also reduce incentives promote greater effciencies and savings. Patented Drug Extension Strategies on Healthcare Spending: A Cost-Evaluation Analysis.
Avoiding these products will decrease the likelihood you will absorb or ingest small quantities of alcohol that could sensitize your system and threaten recovery proven acticin 30gm. Please remember that this guide is only intended as a quick reference and never as a substitute for the advice of your own personal physician generic acticin 30gm otc. It is essential that you inform all of your personal physicians cheap acticin 30 gm mastercard, dentists and other health care providers of your chemical dependency history so that medications can be prescribed safely and appro- priately when they are deemed necessary acticin 30 gm visa. Never discontinue or make any changes in the doses of medication that you may have been prescribed. Doing so may result in unexpected problems such as withdrawal reactions, which in some cases can be life-threatening. The bottom line is that a recovering addict or alcoholic needs to become a good consumer. The danger is not always that a recovering addict may develop a new addiction (though this certainly can happen), but that one can be led back into dependence on their drug of choice. The latest scientifc research has proven that all the dependence- producing drugs act on the brain in the same way to produce addiction, despite having different effects or a differ- ent kind of “high” when taken. In addition, if urine drug screening is part of the recovering person’s continuing treatment program, use of many types of medications can result in falsely positive tests for the more highly addictive classes of drugs, resulting in negative consequences. Therefore, it is very important for a recovering person to learn about the different types of medications and drugs, as well as which ones present a special risk to continuing recovery and sobriety. The com- monly available medications and drugs are divided into three classes – A, B and C – to indicate three levels of risk. Class A drugs must be avoided completely, as they are well known to produce addiction and are the most dan- gerous of all. Only under very unusual conditions can Class A drugs be taken by a recovering addict or alcoholic, and only when given by a physician or dentist and with the consent of the addiction medicine physician that follows your care. These exceptional circumstances can include severe illness and injuries, including major surgery, car ac- cidents and other trauma, and tests or procedures that can only be done under sedation or anesthesia. Medication treatments for certain psychiatric conditions are in this category as are medications used for drug detoxifcation. The medications in Class B are also potentially dangerous, especially when taken by recovering persons without the guidance of a physician or another health care professional. However, under certain circumstances, the Class B group can be taken safely under a physician’s care. We strongly urge you to have an addiction medicine specialist follow your treatment when you are prescribed these medications. Class C medications are generally safe from the point of view of addiction recovery. However, overuse of any medication, even the common over-the-counter remedies, can result in unwanted side effects. People who have struggled with drug addiction or alcoholism must remain aware of the tendency to look for external solutions for internal problems and should avoid taking any of these medications on their own in order to medicate emotions and feelings. The tools of recovery, including participation at 12-Step fellowship meetings, working the Steps, or talking with a sponsor, counselor or doctor, provide safe and healthy ways to deal with the strong feelings that can come up at any time in early sobriety. The three classes of medications that appear on the following pages include both the brand name (i. On the following pages, look for the brand name listed frst, followed by the (generic name) in parentheses. For street drugs, the common name is listed frst, and the chemical name or street name is in parentheses. For each drug group in Class A and B, there is also a brief explanation of the dangers associated with taking the medication or street drug. Please note that there is a variety of cough and cold preparations that contain alcohol and that medications which can be taken in tablet form will not contain ethyl alcohol. Certain topical products, soft-gels and capsules contain ethyl alcohol and should be avoided. Please refer to the table at the end of the document for a list of alcohol-containing products to avoid.