By E. Tom. Pacific Northwest College of Art.
These can be broadly divided into use specifcally for the drugs’ ‘mind manifesting’ effects cheap 2.5mg lozol overnight delivery, as part of a planned personal or group exploration buy lozol 1.5 mg, experience buy generic lozol 2.5 mg online, or ritual lozol 1.5mg sale, and use more as an adjunct or enhancer of another recreational activity, in a variety of social settings—such as music concerts, parties, nightclubs and so on. These plant based psychedelics have a long history of ritualised/ sacramental/shamanic use in various cultures. Examples include the Native American sacramental use of peyote cactus, indigenous Andean use of San Pedro cactus, indigenous Amazonian use of ayahuasca, and the widespread use of psilocybin mushrooms, which refects their geographical ubiquity. The use of ayahuasca and peyote/San Pedro cacti outside of these loca- lised indigenous cultures has been small scale and largely limited to a ritualised/spiritual context. The preparation of the plants for consump- tion is quite diffcult and laborious, the brewed drinks that need to be consumed unpleasant, and in the case of ayahuasca, there are often 93 side effects including vomiting and diarrhoea. They have therefore, unsurprisingly perhaps, not become a feature of the recreational or party drug scene (unlike ‘magic’ mushrooms—see below) and are only a marginal concern for regulation. The current legal status of psychedelic drugs in plant form is some- what ambiguous and confusing. This refects the obvious practical problems of attempting to prohibit access to naturally occurring plants, or determining precise criteria for the point at which the owner of the plant/drug becomes the subject of punitive sanctions. Article 32 of the 1971 convention itself does provide an additional exemption: A State on whose territory there are plants growing wild which contain psychotropic substances from among those in Schedule1 and which are traditionally used by certain small, clearly deter- mined groups in magical or religious rites, may, at the time of signature, ratification or accession, make reservations concerning these plants, in respect of the provisions of article 7, except for the provisions relating to international trade. A number of such exceptions have been implemented and exist in domestic law, providing a functioning legal model for ritual/sacra- mental use of psychedelics. There are clearly lessons for wider regulatory models to be learnt from traditional ritual use. Such use operates within well established social/ cultural controls, ensuring that use is only very occasional, and that set and setting are clearly delineated through careful ritualised preparation. Under such a model, users are very well informed and organised; it is supported by mentoring and peer guidance, with a corresponding respect for the potentially profound and intense nature of the drug experience. For users seeking the more exploratory psychedelic experience, a group/society/club type model could be based on some of the lessons 149 1 2 3 Introduction Five models for regulating drug supply The practical detail of regulation of traditional ritual use. Proposed discussion model for regulation of psychedelics b a s i c r e g u l a t o r y m o d e l > A membership based psychedelic group/club model that would combine elements of the specialist pharmacist model (a trained and licensed vendor with specifc responsibilities), licensed premises for sale and consumption, and licensed users (a membership system with a requirement for training, and potentially meeting certain health criteria). Price controls > The existing illicit market for psychedelics is relatively small, with prices low enough, and use generally infrequent enough, for price to not be an important factor in using decisions—so the usefulness of price controls as a regulatory tool would be marginal. Packaging controls > Supply of psychedelic drugs for use in licensed premises would not require specifc packaging controls. They might also be licensed to administer benzodiazepines, which dampen or negate intense psychedelic related distress. Volume sales/rationing controls > If sales are for onsite supervised use, rationing is not an issue, as the drugs are dispensed for immediate use direct to the user by the vendor (consumption can be supervised). Degree of intoxication/mindset of purchaser/user > Vendors would be required to refuse sales to those clearly intoxicated, according to a clear set of guidelines. Licences/membership requirements for purchasers/users > Access to membership of a psychedelic club/group could be conditional on participation in training sessions to establish a clear understanding of the potential positive and negative effects of different forms of psychedelic use, stressing the importance of set and setting, risks and responsibilities, etc. How such criteria could be 152 4 5 6 Making a regulated system happen Regulated drug markets in practice Appendices objectively evaluated and implemented without being discriminatory or inconsistent is problematic; perhaps the best option would be for appropriate questions to be built into an informal membership interview (potentially also used to establish that training was adequate). Relevant information would, however, have to be volunteered (unless a requirement for a doctor’s ‘all clear’ was mandated). Once a member had established themselves as a responsible, informed and non-problematic user over a certain period they could then potentially graduate to being able to take out supplies for personal use. Pharmacy sales model A licensed user/pharmacy-sales model could operate for certain psychedelics, potentially alongside a group model described above. This could either be for already established group members, or allow access based on a similar training/vetting process. Lower threshold licensed sales for psilocybin (‘magic’) mushrooms Psilocybin or ‘magic’ mushrooms are distinct from the other psyche- delics discussed here in some key respects.
A brief description and diagnostic criteria are included to assist the medical xix officer to make a diagnosis cheap 2.5mg lozol with mastercard. These guidelines also make provision for referral of patients with more complex and uncommon conditions to facilities with the resources for further investigation and management buy cheap lozol 2.5 mg line. The dosing regimens provide the recommended doses used in usual circumstances however the final dose should take into consideration capacity to eliminate the medicine buy cheap lozol 1.5mg online, interactions and co-morbid states 1.5 mg lozol with visa. It is important to remember that the recommended treatments provided in this book are guidelines only and are based on the assumption that prescribers are competent to handle patients’ health conditions presented at their facilities. Adopting a more flexible approach promotes better utilisation of resources with healthcare provided that is more convenient for patients. Conditions and medicines are cross referenced in two separate indexes of the book. The section on Patient Education in Chronic Conditions aims to assist health workers to improve patient adherence and health. These systems should not only support the regulatory pharmacovigilance plan but should also provide pharmacoepidemiology data that will be required to inform future essential medicines decisions as well as local interventions that may be required to improve safety. To facilitate reporting, a copy of the Adverse Drug Reaction form and guidance on its use has been provided at the back of the book. Feedback Comments that aim to improve these treatment guidelines will be appreciated. The submission form and guidelines for completing the form are included in the book. Paediatric Dose Calculation Paediatric doses are mostly provided in the form of weight-band dosing tables according to age. In particular, do not use age bands if the child appears small for his/her age or is malnourished. These standardised paediatric weight- band dosing tables for specific conditions are contained in an appendix. Prescription Writing Medicines should be prescribed only when they are necessary for treatments following clear diagnosis. In certain conditions simple advice and general and supportive measures may be more suitable. In all cases carefully consider the expected benefit of a prescribed medication against potential risks. This is important during pregnancy where the risk to both mother and foetus must be considered. All prescriptions should: » be written legibly in ink by the prescriber with the full name and address of the patient, and signed with the date on the prescription form; » specify the age and, in the case of children, weight of the patient; xxi » have contact details of the prescriber e. In all prescription writing the following should be noted: » The name of the medicine or preparation should be written in full using the generic name. A zero should be written in front of the decimal point where there is no other figure, e. Avoid Greek and Roman frequency abbreviations that cause considerable confusion – qid, qod, tds, tid, etc. Consider whether the number of items is too great to be practical for the patient, and check that there are no redundant items or potentially important drug interactions. Check that the script is dated and that the patient’s name and identification number are on the prescription form. Only then should the prescriber sign the script, and as well as provide some other way for the pharmacy staff to identify the signature if there are problems (print your name, use a stamp, or use a prescriber number from your institution’s pharmacy). Patient Adherence Adherence is the extent to which a person’s behaviour – taking medication, following a diet and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider. Poor adherence results in less than optimal management and control of the illness and is often the primary reason for suboptimal clinical benefit.
Low doses: slight increase in pulse and breathing rate buy cheap lozol 1.5 mg; increased blood pressure and Short-term Symptoms heart rate effective lozol 2.5 mg; shallow breathing discount 2.5mg lozol with visa; face redness and sweating buy cheap lozol 1.5mg line; numbness of the hands or of Use feet; and loss of coordination. High doses: lowered blood pressure, heart rate, and breathing; nausea; vomiting; blurred vision; ficking up and down of the eyes; drooling; loss of balance; dizziness; violence; suicidal thoughts; seizures, coma, and death. Long-term Memory loss, problems with speech and thinking, depression, psychosis, weight loss, Consequences of Use anxiety. Opioids can cause euphoria and are sometimes used nonmedically, leading to overdose deaths. Short-term Symptoms For oxycodone specifcally: Pain relief, sedation, respiratory depression, constipation, of Use papillary constriction, and cough suppression. For fentanyl specifcally: Fentanyl is about 100 times more potent than morphine as an analgesic and results in frequent overdoses. Extended or chronic use of oxycodone containing Consequences of Use acetaminophen may cause severe liver damage. Abuse of opioid medications can lead and Health Effects to psychological dependence. Older adults: higher risk of accidental misuse or abuse because many older adults have Other Health-related multiple prescriptions, increasing the risk of drug-drug interactions, and breakdown of Issues drugs slows with age; also, many older adults are treated with prescription medications for pain. In Combination with Dangerous slowing of heart rate and breathing leading to coma or death. Alcohol Withdrawal Restlessness, anxiety, muscle and bone pain, insomnia, diarrhea, vomiting, cold fashes Symptoms with goose bumps, and muscle tremors. Treatment Optionsiv • Methadone Medications • Buprenorphine • Naltrexone (oral and extended-release injectable) Behavioral therapies that have helped treat addiction to heroin may be useful in Behavioral Therapies treating prescription opioid addiction. In Combination with Dangerous slowdown of heart rate and breathing, coma, and death. Alcohol Must be discussed with a health care professional; barbiturate withdrawal can Withdrawal Symptoms cause a serious abstinence syndrome that may even include seizures. More research is needed to determine if behavioral therapies can be used to treat Behavioral Therapies addiction to prescription sedatives. Short-term Symptoms of Use High doses: dangerously high body temperature and irregular heartbeat; seizures; and death from heart failure or suicide. For amphetamines specifcally: Paranoia, picking at the skin, preoccupation with one’s own thoughts, and auditory and visual hallucinations. Long-term Consequences of Use Heart problems, psychosis, anger, paranoia, addiction, and chronic sleep problems. Issues In Combination with Masks the depressant action of alcohol, increasing risk of alcohol overdose; may Alcohol increase blood pressure and jitters. Behavioral therapies that have helped treat addiction to cocaine or methamphetamine Behavioral Therapies may be useful in treating prescription stimulant addiction. More research is needed to determine if psilocybin is addictive and whether Behavioral Therapies behavioral therapies can be used to treat addiction to this or other hallucinogens. Teens and young adults tend to abuse this drug at bars, nightclubs, concerts, and parties. It has been used to commit sexual assaults due to its ability to sedate and incapacitate unsuspecting victims. Long-term Consequences of Use Physical and psychological dependence; cardiovascular collapse; and death and Health Effectsiii Other Health-related Sometimes used as a date rape drug. Issues In Combination with Exaggerated intoxication, severe sedation, unconsciousness, and slowed heart rate Alcohol and breathing, which can lead to death. Headache; muscle pain; extreme anxiety, tension, restlessness, confusion, irritability; Withdrawal Symptoms numbness and tingling of hands or feet; hallucinations, delirium, convulsions, seizures, or shock. More research is needed to determine if behavioral therapies can be used to treat Behavioral Therapies addiction to Rohypnol® or other prescription sedatives. More research is needed to determine if salvia is addictive, but behavioral therapies Behavioral Therapies can be used to treat addiction to dissociative drugs. Kidney damage or failure; liver damage; high blood pressure, enlarged heart, or Long-term changes in cholesterol leading to increased risk of stroke or heart attack, even in Consequences of Use young people; hostility and aggression; extreme mood swings; anger (“roid rage”); and Health Effects paranoid jealousy; extreme irritability; delusions; impaired judgment. Males: shrunken testicles, lowered sperm count, infertility, baldness, development of Other Health-related breasts, increased risk for prostate cancer.
Investigational and Special Access Program Medication Investigational and special access program medication must be prescribed order lozol 2.5mg without prescription. An investigational drug is a medication that has been approved for human clinical trials by Health Canada and the practice setting discount lozol 1.5mg visa. Special access program medications refer to drugs that are not on a practice setting’s formulary or approved for general use buy 1.5mg lozol with mastercard, and require special authorization through the Canada Food and Drug Act (1985) cheap 2.5mg lozol otc. Guideline 26: Nurses administering investigational or special access program medication must have the necessary information (e. Placebos The administration of placebos to clients without their knowledge and consent is inappropriate and unethical. Cosmetic Procedures The number of clients who receive cosmetic procedures in Canada is on the rise. Some examples of the services provided are Botox injections, dermal fillers, use of laser for a number of purposes, fat and cellulite manipulation, chemical peels and hair transplants. Nurses require additional education and experience to ensure that they are competent if they engage in these interventions. Nurses are responsible for attaining, maintaining and evaluating their competence in the performance of any intervention or activity. Nurses involved in these procedures need to carefully consider whether they: fully understand all of the risks and benefits associated with the procedures and equipment are aware of the possible complications and what is required to deal with such complications can provide appropriate recommendations and counseling to clients considering those procedures have the technical capacity to provide the service skillfully and safely have liability protection for their practice Any Schedule 1 medication such as Botox requires a client-specific order to administer it. The authorized prescriber is responsible for assessing the client, determining the need for medication and providing the order. Guideline 27: Any Schedule 1 medication such as Botox requires a client assessment and a client specific order from the authorized prescriber prior to the administration of the medication. Immunizations Additional knowledge, skill, and competence are required to administer vaccines. For information on medication and vaccine schedules please see the Schedule Drugs Regulation under the Pharmacy and Drug Act (2000) at http://www. For nurses employed in public health and some other settings, the Medical Officer of Health provides authority to nurses to administer Schedule 1 and 2 vaccines and epinephrine as part of a provincial immunization program and Alberta Immunization Policy. The nurse administering immunizations is responsible for following the applicable legislation and regulation and for ensuring that a client-specific order is obtained when required. Guideline 28: The nurse administering immunizations is responsible for following the applicable legislation and regulation and for ensuring that a client specific order is obtained when required. Alberta has a comprehensive immunization program where universal immunization coverage is provided (Alberta Health and Wellness, 2007). For information on Alberta Health’s immunization policy go to their website at: www. Nurses who immunize clients must have knowledge of the scientific evidence supporting the effectiveness of vaccines, understand the immunization process and must have the knowledge, skill and judgment to assess the appropriateness of administering the vaccine to an individual client. The medication/drug scheduling categories are outlined by the Alberta Pharmacy and Drug Act (2000) and are aligned with the national drug schedule. The four categories are: Alberta Drug Schedules Schedule I Drugs that require a prescription from an authorized prescriber. Can be self-selected by clients for use from a pharmacy but the pharmacist must be present to offer assistance if needed. These clients may be completely independent or require some assistance, such as help with opening containers, mechanical aids or preparing/ preloading medication. Practice settings should have appropriate policy in place and safe medication storage areas to support self-administration of medication by clients. Guideline 32: Nurses are responsible for assessing and documenting the client’s ability for self-administration of medication. In order for a client or nurse to administer a client’s own medications in these practice settings, the nurse needs to verify the medication with a pharmacist, have an authorized prescriber’s order for the medication, and be supported by the practice setting policy. Home Care and Supportive Living Settings In settings such as home care and supportive living, the client may not be able to manage their medications on their own and require assistance.