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L: The Occupational Exposure Limit means the maximum permissible concentration order cheap ropinirole line, of a chemical agent in the air at the workplace to which workers may be exposed Oxidant: A substance that readily oxidizes (removes electrons from) something chemically order cheap ropinirole online. Common drinking water oxidants are chlorine order ropinirole 0.25 mg fast delivery, chlorine dioxide buy ropinirole master card, ozone, and potassium permanganate. Pathogens: Microorganisms that can cause disease in humans, other organisms or animals and plants. They may be bacteria, viruses, or protozoa and are found in sewage, in runoff from animals, farms or rural areas populated with domestic and/or wild animals, and in water. Water Treatment Manual: Disinfection There are many types of microorganisms which do not cause disease. Mathematically, pH is the negative logarithm (base 10) of the hydrogen ion concentration, [H+]. The pH may range from 0 to 14, where 0 is most acidic, 14 most basic, and 7 neutral. Plug flow: The travel of water through a tank, pipe, or treatment process unit in such a fashion that the entire mass or volume is discharged at exactly the theoretical detention time of the unit. For chlorination byproducts) systems, precursors are constituents of natural organic matter, comprising suspended solids, turbidity, colour and dissolved organic carbon. In addition, for ozonation systems, the bromide ion (Br-) is a precursor material. Secondary The application of a chemical disinfectant at the end of a treatment Disinfection: system or at some appropriate point along the distribution network to maintain the disinfection residual throughout the system to consumers. Slow Sand A filter that consists of a bed of fine sand and relies on a biologically Filtration: active layer on top of the sand, called Schmutzdecke, to filter out particles. Surface water can be running (as in streams and rivers) or quiescent (as in lakes, reservoirs, impoundments and ponds). Tracer: A foreign substance (such a dye) mixed with or attached to a given substance for subsequent determination of the location or distribution of the foreign substance. Tracer study: A study using a substance that can readily be identified in water (such as a dye) to determine the distribution and rate of flow in a tank, pipe, ground water, or stream channel. Turbidimeter: An instrument for measuring and comparing the turbidity of liquids by passing light through them and determining how much light is reflected by the suspended particulate matter in the liquid. Water The phenomenon of oscillations in the pressure of water in a closed Hammer: conduit flowing full, which results from a too rapid acceleration or retardation of flow. Momentary pressures greatly in excess of the normal static or pumping pressure may be produced in a closed pipe from this phenomenon. Absence of characterisation of the raw water source Conduct catchment risk assessment and/or establish monitoring programme. Urban Waste Water discharge upstream with potential to cause microbial Ensure appropriate treatment and robust disinfection system in place contamination with appropriate monitors and alarms on key equipment. Storm water overflow upstream with potential to cause microbial contamination Ensure appropriate treatment and robust disinfection system in place with appropriate monitors and alarms on key equipment. On site systems/ septic tanks upstream with potential to cause microbial Ensure appropriate treatment and robust disinfection system in place contamination with appropriate monitors and alarms on key equipment. Presence of Cryptosporidium in raw water Liaison with stakeholders to prevent contamination of surface waters. Appropriate treatment in place for Cryptosporidium removal/inactivation and consider additional treatment if needed. Contamination Ensure appropriate treatment and robust disinfection system in place with appropriate monitors and alarms on key equipment. Water Treatment Manual: Disinfection Hazard Control Abattoirs - Organic and Microbial Contamination Liaison with stakeholder to prevent contamination of surface waters. Ensure appropriate treatment and robust disinfection system in place with appropriate monitors and alarms on key equipment. Wildlife - Organic and Microbial Contamination Consider additional fencing/security to prevent wildlife if possible. Recreational use causing microbial contamination Regulate or influence recreational use to prevent or reduce contamination. Forestry felling causing increased sedimentation of the raw water and Turbidity monitor at intake, ability to shut off intake if raw water beyond challenging disinfection acceptable limits. Catchment: Ground Water Supply Hazard Control Geology - swallow holes (surface water ingress) associated with raw water Turbidity monitoring to identify deterioration in quality, appropriate source treatment to deal with source water. Consider closing intake or switching to other sources if raw water quality deteriorates. Well head casing incomplete or borehole unsealed causing intrusion of surface Secure and maintain well head to prevent contamination. Well head not secured against livestock access causing microbial Protect well-head with appropriate cover. Water Treatment Manual: Disinfection Hazard Control contamination Infiltration gallery influenced by surface water causing microbial contamination Monitor source water. Land drains causing preferential pathway for pollution of shallow well source Re-route land drains. Catchment: Surface Water or Groundwater Supply Hazard Control Vandalism – deliberate contamination of source and unauthorised access Appropriate security and alarm system for site. Raw Water Intake Hazard Control Direct surface water abstraction causing variability in water quality Change abstraction point to minimise variability in raw water. Intake not secured against livestock access causing microbial contamination Install and maintain fencing in the vicinity of the intake. Lake source intake point vulnerable to variation due to streams/ stratification/ Change abstraction point to minimise variability in raw water. Raw Water Storage Hazard Control Susceptible to flooding / contamination Consider flood defences. Unauthorised access resulting in deliberate contamination Appropriate security and alarm system for site. Lockable covers on all Water Treatment Manual: Disinfection access points to water supply. Wildlife access to raw water tank causing contamination Erect fencing or cover to prevent wildlife access. Sludge build up in raw water tank causing contamination Regular inspection and maintenance programme. Leaking impounding reservoir causing ingress of contamination Regular inspection and maintenance programme. Raw Water Line Hazard Control Pipe corroded or not watertight causing intrusion of Surface Water Regular inspection and maintenance programme. Raw water serving consumers without disinfection or other treatment Ensure asset records are kept up to date and authorised connections refer to these records. Treatment plant operating above design capacity Ensure treatment plant is operating within acceptable limits. Plant data can be used to verify this By-passing of any stage of treatment Appropriate alarms to notify when individual processes are bypassed. Frequent and significant flow variations through the works Consider intermediate storage to smooth out flow variations. Verify with plant data Coagulation/Flocculation/Clarification Stage Hazard Control Chemicals delivered to incorrect storage vessel Ensure chemical deliveries are overseen by competent treatment works personnel. Floc carry over due to inappropriate/inadequate dosing regime Regular dose optimisation. Floc carry over due to overloading of the plant/ surge flows Operate process within design parameters. Floc carry over due to poor adjustment/maintenance/design of lamella plates Regular inspection and maintenance programme Floc carry over due to poor maintenance or flooding of settlement channels Regular inspection and maintenance programme. Consider covering settlement channels if flooding a serious risk Floc carry over due to variations in raw water characteristics Regular inspection and dose optimisation Floc carry over due to effects of weather condition Regular inspection and maintenance programme. Floc carry over due to inadequate cleaning of clarifiers Regular inspection and maintenance programme Water Treatment Manual: Disinfection Hazard Control Floc carryover due to poor settlement/ unstable sludge blanket Regular inspection. Floc carryover due to sludge float/ scraper not operating properly Regular inspection and maintenance programme Floc carryover due to sludge concentrators not operating properly Regular inspection and maintenance programme Floc carryover due to sludge bleeds not operating properly Regular inspection and maintenance programme Floc carryover due to insufficient sludge draw off Regular inspection and maintenance programme Chemicals used after expiration date – ineffective chemicals Ensure chemicals are stored appropriately and used within expiry date Inadequate storage areas for chemical stocks, risk of running out of treatment Ensure storage is adequate for required chemical stockpile.

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Early results from a school alcohol harm minimization study: The School Health and Alcohol Harm Reduction Project buy ropinirole 2 mg lowest price. Benefts of universal intervention effects on a youth protective shield 10 years after baseline purchase generic ropinirole line. Effects of family risk factors on dosage and efcacy of a family-centered preventive intervention for rural African Americans buy ropinirole cheap online. Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation purchase ropinirole 0.5mg visa. Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Longitudinal effects of universal preventive intervention on prescription drug misuse: Three randomized controlled trials with late adolescents and young adults. Preventing escalation in problem behaviors with high-risk young adolescents: Immediate and 1-year outcomes. Substance use and delinquency among middle school girls in foster care: A three-year follow-up of a randomized controlled trial. Brief, personality-targeted coping skills interventions and survival as a non–drug user over a 2-year period during adolescence. Long-term effects of a personality- targeted intervention to reduce alcohol use in adolescents. Preventing substance use among adolescent girls: 1-year outcomes of a computerized, mother–daughter program. Reducing the risks of alcohol use among urban youth: Three-year effects of a computer-based intervention with and without parent involvement. Brief alcohol interventions for adolescents and young adults: A systematic review and meta-analysis. Identifcation, prevention, and treatment revisited: Individual-focused college drinking prevention strategies 1999–2006. Individual-level interventions to reduce college student drinking: A 1557 meta-analytic review. Screening and brief interventions for alcohol use in college health centers: A review. Face-to-face versus computer-delivered alcohol interventions for college drinkers: A meta-analytic review, 1998 to 2010. Defning and characterizing differences in college alcohol intervention efcacy: A growth mixture modeling application. Indicated prevention for college student marijuana use: A randomized controlled trial. Single-session alcohol interventions for heavy drinking college students: A systematic review and meta-analysis. Efcacy of expectancy challenge interventions to reduce college student drinking: A meta-analytic review. Brief motivational interventions for college student drinking may not be as powerful as we think: An individual participant‐level data meta‐analysis. Brief motivational and parent interventions for college students: A randomized factorial study. Efcacy of alcohol interventions for frst-year college students: A meta-analytic review of randomized controlled trials. A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students. Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. Prevention interventions of alcohol problems in the workplace: A review and guiding framework. The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. Case closed: Research evidence on the positive public health impact of the age 21 minimum legal drinking age in the United States. Youth problem behaviors 8 years after implementing the Communities That Care prevention system: A community-randomized trial. Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial. Enhanced enforcement of laws prohibiting sale of alcohol to minors: Systematic review of effectiveness for reducing sales and underage drinking. The state sets the rate: The relationship among state-specifc college binge drinking, state binge drinking rates, and selected state alcohol control policies. Youth drinking in the United States: Relationships with alcohol policies and adult drinking. Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm. The affordability of alcoholic beverages in the European Union: Understanding the link between alcohol affordability, consumption and harms. Effects of alcohol tax and price policies on morbidity and mortality: A systematic review. Drinking, driving, and deterrence: The effectiveness and social costs of alternative policies. Multilevel spatiotemporal change-point models for evaluating the effect of an alcohol outlet control policy on changes in neighborhood assaultive violence rates. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Changes in density of on-premises alcohol outlets and impact on violent crime, Atlanta, Georgia, 1997– 2007. Multilevel spatio-temporal dual changepoint models for relating alcohol outlet destruction and changes in neighbourhood rates of assaultive violence. Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: Two Community Guide systematic reviews. Effectiveness of policies maintaining or restricting days of alcohol sales on excessive alcohol consumption and related harms. Effectiveness of policies restricting hours of alcohol sales in preventing excessive alcohol consumption and related harms. Effectiveness of bans and laws in reducing trafc deaths: Legalized Sunday packaged alcohol sales and alcohol-related trafc crashes and crash fatalities in New Mexico. Recommendations on privatization of alcohol retail sales and prevention of excessive alcohol consumption and related harms. Changes in trafc crash mortality rates attributed to use of alcohol, or lack of a seat belt, air bag, motorcycle helmet, or bicycle helmet, United States, 1982–2001. New research fndings since the 2007 Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking: A review. The impact of underage drinking laws on alcohol‐related fatal crashes of young drivers. Countermeasures that work: A highway safety countermeasure guide for state highway safety offices (7th ed. Effectiveness of ignition interlocks for preventing alcohol-impaired driving and alcohol-related crashes: A Community Guide systematic review. Impact of state ignition interlock laws on alcohol-involved crash deaths in the United States. Alcohol policies and impaired driving in the United States: Effects of driving-vs. Monitoring the Future national survey results on drug use, 1975-2014: Volume I, secondary school students (Vol. The effects of minimum legal drinking age 21 laws on alcohol-related driving in the United States. Traffic safety facts 2014: A compilation of motor vehicle crash data from the fatality analysis reporting system and the general estimates system. Lowered legal blood alcohol limits for young drivers: Effects on drinking, driving, and driving-after-drinking behaviors in 30 states. Associations between selected state laws and teenagers’ drinking and driving behaviors. Relationships between local enforcement, alcohol availability, drinking norms, and adolescent alcohol use in 50 California cities.

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In addition to the relatively complex way in which many drugs are eliminated effective ropinirole 0.5mg, the additional pres- ence of active metabolites creates yet another level of consideration or complexity to the interpretation order ropinirole 1 mg visa. A simpler way to consider elimination is this analogy: a baseball dropped by a 10-year-old child sitting in a tree house buy generic ropinirole 1 mg, high above the ground buy 0.25 mg ropinirole fast delivery, will fall straight down (alcohol zero order elimination). If that same 10-year-old then drops a maple leaf attached to an acorn, it should hit the ground at about the same time as the baseball (other drugs with zero order elimination). It will drop much more slowly—as it is tossed and turned in the breeze—than the baseball or the leaf and acorn. The leaf’s size also changes during its descent as pieces break off in the wind (changing drug half-life); this also causes its rate of descent to slow. Eventually the leaf gets to the ground, but not in a straight line nor in a necessarily highly predictable time frame (drug first order elimination). The effect of a drug is a result of the drug’s interaction at a given receptor site. Drugs that affect the central nervous system must reach and bind to specific receptors for their effects to be exhibited. These drugs act to either stimulate or depress certain areas of the brain to achieve a response, i. Typically, an increase in the concentration of the drug modulates the receptor response and enhances the pharmacologic effect. A relationship exists between the amount of drug administered (dose) and the corresponding effect (response) on the body, including the extent to which it may “impair” normal function. Residual effects may exist long after the “acute” effects of the drug have been experienced (Table 5). The link between the amount of drug and its effect over time is the basis for establishing therapeutic and toxic drug concentrations. These ranges are widely published for clinical purpos- es, but there are no “therapeutic concentrations” for many illicit drugs. Remember: A habitual drug user may develop a tolerance to the toxic effects of a drug, allowing him or her to withstand concentra- tions of drug that may be highly toxic or even fatal in a naïve (inexpe- rienced) subject. For example, after consuming ethanol, a person tends to feel more excited and euphoric during the initial absorp- tion phase than during the elimination phase, during which time they may feel more sedated and depressed (Mellanby effect). However, several hours later, the same drug concentration may coincide with confusion, depression, anxiety and exhaustion during the elimination phase. For the purpose of determining impairment, acute or chronic toxicity, blood is considered by most to be the preferred specimen. While a number of laboratories across the country use urine samples with great success, the presence of the drug in urine is an indication of drug exposure over a period of hours, days or even weeks (evidence of past use). For this reason, additional information such as obser- vations, behavior or clinical signs is very important to the toxicologist. With the exception of ethanol, there is so far no widely accepted correla- tion between the drug concentration in blood and a corresponding level of driving impairment among the scientific community. What is more, factors such as tolerance can have a profound effect on the pharmacodynamic response in an individual. A quantity of cocaine sufficient to produce a mild “buzz” in a chronic user could be acutely cardiotoxic in a naïve (inexperienced) user, resulting in coma and death. Remember: Vital signs, symptoms and behavioral response observed by clinicians and law enforcement personnel are highly relevant during toxicological interpretation. D rugs can impair driving by affecting some of the important skills necessary for safe operation of a vehicle (Table 6). In fact, drug manufac- turers commonly issue warnings for prescription or over-the-counter drugs, indicating that the drug may impair mental or physical abilities required for performing hazardous tasks such as driving. Coordination Coordination and psychomotor control are essential because driving is a physical task. Drugs that affect nerves and muscles may impair braking, steering, acceleration and manipulation of the vehicle. Braking too suddenly or too late, or using the wrong amount of force on the steering wheel and over- or under-correcting, can result from drug impairment. Judgment / Decision-making Drivers must process information and then make appropriate decisions. Some drugs affect cognition and have the potential to impair the ability to concentrate, detect, anticipate risk, avoid hazards or make emergency decisions. For example, stimulants like cocaine or methamphetamine can produce exhilaration, excitement and feelings of mental and physical power. Drugs that can produce visual or auditory distortions, or drugs that can affect per- ception of time and distance (e. Visual disturbances are also reported with other drugs, such as cocaine, which can cause flashes of light in peripher- al vision, known as “snow lights. This is sometimes observed as weaving or the inability to maintain the vehicle within the lane (the constant minor over-correc- tions seen in an attempt to stay within the lane). Reaction Time A driver must not only receive information, but must also process it, make a decision, and then react. Slowed reaction times (reaction deficits), particularly with respect to braking and steering, may result in character- istic driving behavior, for example, striking a fixed object, rear-ending another vehicle, or failure to make an evasive maneuver. Divided Attention and Multitasking Driving requires divided attention, rather than focused attention. Drivers must observe road signals and monitor pedestrians and other vehicles in addition to the environment. At the same time, they must effectively operate the gas, gears, braking and steering systems. While many of these functions are well learned, the driving task itself has a high demand for information processing. Ingestion of depressant drugs or marijuana may impair divided attention skills, as may stimulants, which may produce hypervigilance, preoccupation or distractibility. Progressive symptoms and impairment of some commonly encountered drugs are summarized in Table 6. Differences between individuals as well as differences within the same individual at different times can produce different responses. A week later that same individual again has a headache, takes two aspirin, but the headache remains, although to a lesser degree. Another person never takes aspirin for headaches, only acetaminophen, because aspirin causes ringing in her ears and doesn’t seem to make the headache go away. The scientific evaluation of driving performance is technically and logis- tically complex. Although more than half (56%) (12) of people who reported driving after marijuana use claimed that the drug did not affect their ability to drive, it is highly questionable whether or not individuals can assess their own driving per- formance. For ethical and safety reasons, on-the-road driving studies using “real-world” doses of drugs like cocaine and methamphetamine are not feasible. Therefore, a toxicologist must rely on a number of approaches, which may include: • Empirical Considerations:What is the pharmacology of the drug? There are advantages and disadvantages associated with each approach and these are summarized in Table 7. Collectively, these approaches can provide a toxicologist with a great deal of useful information. Taken together, the scientific literature helps determine whether the drug effects are compatible with safe driving, and specifically how they might impair a person’s ability to drive. Drugs may affect normal behavior by enhancing or impairing human performance, such as cognition or psychomotor skills. The same drug may be capable of either enhancing or impairing performance, depend- ing on the dose and pattern of drug use. Real-world doses of methamphetamine far exceed those used in the controlled studies. Epidemiological studies, as well as empirical knowledge of the drug effects at elevated dose, strongly suggest that methamphetamine can impair skills necessary for safe driving. Individuals may claim their driving ability was enhanced through drug use, so be aware of study conditions and be able to explain the relative merits and caveats. In a similar manner, studies that evaluate drug combi- nations are readily misrepresented. For example, laboratory studies have shown that a single low dose of stimulant (methamphetamine) can offset sedation caused by a depressant (alcohol).

At higher concentrations (10-15%) sodium hypochlorite (with a pH of around 13) burns and is corrosive order discount ropinirole on line. Commercial solutions are less hazardous and easier to handle than elemental chlorine ropinirole 2mg lowest price. The pH of sodium hypochlorite is high because sodium hydroxide is used in its manufacture to increase stability of the product cheap ropinirole 1 mg without prescription. Mixing of hypochlorite with certain organic based cleaning compounds may also result in the emission of explosive gasses buy ropinirole 2mg. Piping and material handling equipment containing stainless steel, aluminum, carbon steel or other metals such as copper, nickel and cobalt should also be avoided as they accelerate the rate of decomposition. The stability of stored sodium hypochlorite Sodium hypochlorite at higher concentrations becomes increasingly unstable and degrades to chlorate thereby affecting the storage life and decreasing concentrations with time. This degradation accelerates in higher temperatures and in the presence of sunlight. Dilution greatly reduces degradation, especially for solutions delivered in concentrations less than 7% to 8%. Degradation also happens when sodium 172 Environmental Protection Agency Water Treatment Manual: Disinfection Appendix 2. These characteristics must be kept in mind during transport, storage and use of sodium hypochlorite. Storage containers or tanks should be sited out of sunlight in a cool area and should be vented to the outside of the building. Sodium hypochlorite storage procedures should be arranged to minimize this slow natural decomposition. Where existing storage volumes of 15% hypochlorite are greater than 28 days, consideration should be given to lowering the concentration of product delivered to 10% or lower in order to extend the product shelf life, reduce the rate of degradation and the consequent formation of chlorates. Dosage rates must be adjusted by operator in accordance with an operating procedure to compensate for progressive loss in chlorine content due to the storage age of chemical. Hypochlorite storage and dosing installations The design of storage installations should pay particular attention to spill containment including containment for 110% contents of the largest tank, no uncontrolled floor drains, an overflow from chemical storage tanks that discharges to the containment area and separate containment areas for incompatible chemicals should be provided. Where fiberglass is used for reinforcement in tank walls, the fibres must be protected from the sodium hypochlorite with a sufficient depth of coating. Vent(s) from bulk tanks should be sized at 100-150% of fill pipe diameter to prevent excess pressures or vacuum during filling and should be terminated at a suitable external location, remote from air intakes, doors, windows, and parked vehicles, in a downward aspect with a fine corrosion resistant mesh to prevent contamination. Fill points should be located directly over containment area and provision should be also made for a ball shut off valve to prevent backflow of chemical when hose is disconnected, and to guard against any unauthorized filling without the presence of appropriate site personnel. A liquid sensor that activates audible and visual alarms, at a high level set point, should be provided on bulk storage tanks. The alarms must be mounted at locations that will alert both the treatment system operator and tank truck delivery driver to prevent overfilling of bulk tank(s). Emergency overflows from tanks should discharge to the containment area at a level of typically 300mm from floor level. To cater for accidental splashes of hypochlorite chemicals on the skin or in the eyes, emergency eye washes and showers should be provided between the location of the hazard and the nearest means of egress. These drench showers and eyewashes should be located throughout the facility following on-site risk assessment of accidental exposure. Flush eyes and skin for at least 15 minutes and seek medical treatment after exposures. Where drums are used, provisions should be made for disposing of drums in accordance with a site- specific procedure which will prohibit rinsing out of drums, prevent their exposed to internal contamination and minimize personal and environmental exposure to chemicals. As with all hazardous chemicals, feed lines should be ideally routed overground along cable trays through readily accessible floor ducting. Underground buried ducting should be avoided unless secondary contained within a sealed sleeve. Feed lines should be color-coded yellow, labelled with chemical name, and show arrows to indicate direction of flow. Control of gasfication Operators should be aware, when taking delivery of Sodium Hypochlorite that the solution is active particularly at higher concentration and will release a large proportion of gas in solution and during subsequent degradation during subsequent storage. The release of gas from the solution temporarily affects the dosing system by creating a gas lock in the dosing system resulting in a loss of prime and a lower applied chlorine dose for that period. After receiving a delivery of sodium hypochlorite, it should be allowed to stand for a few hours or over night, before utilizing the chemical to liberate much of the gas contained within the liquid. The concentration of bulk sodium hypochlorite deliveries should be monitored relative to specification particularly following a new delivery but also on an ongoing basis, as the stocks of hypochlorite ages, so that chlorine dosing can be adjusted accordingly. The most common dosing systems use diaphragm metering pumps with a pulsation damper, a pressure relief valve, a calibration cylinder and a loading valve. Some dosing pump suppliers offer auto-degas valves systems as part the dosing system design. Gas is typically removed from the suction line through a vent valve and directed back to the storage tank with a small amount of liquid. Bulk hypochlorite dosing systems should be installed with a flooded suction to aid in the prevention of gasification. Pump suction lines should be always below the minimum tank liquid level and be installed downwards from the tank to the pump. Delivery lines should slope upward from the metering pump without loops or pipe configurations which will trap sodium hypochlorite between two closed valves and be fitted with anti-siphon valves. Relative to commercial sodium hypochlorite (5-15%) it is less hazardous and also a more stable chemical compound. Most proprietary systems also possess automatic safeguards which shut down the system if a fault is detected. Consequently a parallel room ventilation system will assure the hydrogen gas is quickly dispersed. As hydrogen will rise to the ceiling, the room ventilation system should be designed to provide for exhaust air to exit near the ceiling. The vent should exceed the size of the tank’s largest inlet or outlet nozzle by two inches. The vents should have a vinyl insect screen attached to the end to keep debris or insects out of the tank. Every atmospheric pressure rated tank must be protected at all times by properly sized vent pipes in order to prevent build-up of pressure or vacuum conditions. Operators should never remove an access hatch or work on the storage tank until the requirements of a site specific operating procedure has been complied with. Calcium Hypochlorite Calcium hypochlorite is another chlorinating chemical used infrequently in an Irish context. It is used primarily in smaller water supply disinfection applications and in swimming pools. It is a white, dry solid containing approximately 65% chlorine, and is commercially available in granular and tablet form. Calcium hypochlorite is particularly reactive in the solid form with associated fire or explosive hazard if handled improperly. All forms of calcium hypochlorite should be properly stored in accordance with manufacturer’s instructions in a cool, dark, dry place in closed corrosion resistant containers. Calcium hypochlorite should be stored away from heat and organic materials that can be readily oxidized. Improperly stored calcium hypochlorite has caused spontaneous combustion fires in the past Granular calcium hypochlorite, if stored out of closed containers can lose about 18% of its initial available chlorine in 40 days. Consequently stocks should be dated and controlled and used in rotation so as to minimise deterioration in storage. Solutions should be prepared on a batch basis for use following mixing and special provision for the separation of diluted calcium hypochlorite from inert materials as follows: from granular product, by the provision of a separate mixing tank upstream of the dosing tank and mechanically mixing. Following proper mixing the inert insoluble material is allowed to settle prior to decantation of the dissolved liquid only to the dosing tank. Hygiene and good housekeeping at treatment/disinfection installations Due to the importance of water as a food product, the importance of good hygiene practices by operators and the elimination of the potential public health hazard posed by uncontrolled ingress by 176 Environmental Protection Agency Water Treatment Manual: Disinfection Appendix 2. Where appropriate, this training should include the actions required if one of these personnel has an illness (for example gastroenteritis or Hepatitis A) that could pose a risk of contamination of the drinking water supply or spread of the illness to other personnel. Hygienic practices are particularly important for multifunctional personnel who may work on both water supply and sewage.

According to these estimates discount 1 mg ropinirole fast delivery, the production of laboratory in the Russian Federation was producing opium in 2010 amounted to 4 order 0.25 mg ropinirole fast delivery,860 mt buy ropinirole australia, a 38% decrease acetylated opium and seven installations in Greece were from 2009 buy ropinirole in india. Potential heroin production amounted to involved in repackaging and adulterating heroin. High levels of morphine seizures were reported not be either consumed or converted into heroin, how- outside of Afghanistan in 2010, however. Morphine is ever, as seizures of final or intermediate products may primarily used to produce heroin as there is limited take place and opiate stockpiling may be occurring illicit morphine use worldwide. Given the security situation, the vast majority of demand and is likely to be less than the potential pro- Afghan heroin is estimated to be produced in the coun- duction levels (which are calculated by multiplying the try, especially in the southern provinces. Thus, it is neces- number of heroin manufacturing laboratories destroyed sary to estimate global opiate demand, taking into in Afghanistan supports this assumption. The largest quantities of opiates continued to be 45 over the period 2004-2006, and a marked increase in seized by Turkey and the Islamic Republic of Iran, coun- opium production over the period 2005-2007 was mir- tries that serve as transit points for heroin trafficked rored in an increase in heroin seizures over the period from Afghanistan on the ‘Balkan route’ to West and 2006-2008. Although much is known about drug suppliers, con- Illicit drug seizure totals can be susceptible to two main sumers, traffickers and routes, interdiction remains dif- factors: 1) the available supply of the drug, and 2) the ficult. Law enforcement efforts are frustrated by the fact effectiveness of law enforcement efforts. Since law that international traffickers constantly change their enforcement efforts and practices do not necessarily methods and routes, high profits may fuel high-level evolve in concert in different countries, at a global level, corruption, and international cooperation initiatives the law enforcement component plays a smaller role in take time to become effective. The increased heroin seizures The trend in global heroin seizures appears to follow therefore likely reflect, at least in part, an increased that in opium production with a delay of one year. This is in line with the Map 10: Seizures of heroin and morphine, 2009 (countries and territories reporting seizures* of more than 10 kg) Russian Federation West & Central Europe 3. Opium seizures in a given year are compared to with 1998,46 the growth in heroin seizures has kept pace the average opium production in that year and the previ- with, and slightly outperformed, the growth in opium ous year. Assuming that one 500 kilogram of heroin or morphine is equivalent to 7-10 kg of opium, and comparing total seizures in 2009 with the 400 average opium production in 2008 and 2009,48 a range of 16-20% for the interception rate for opiates can be 300 200 46 The year 2008 is chosen as a baseline because, over the period 1996- 1998, seizures of opium and heroin, as well as opium production, 100 were all relatively stable, suggesting that the opiates market was close to equilibrium. Opium (raw and prepared) 48 Opium production in 2008 is considered along with that in 2009 to allow for the time required for processing and for the opiates to reach Morphine the markets where they are seized. The global Heroin from northern Myanmar enters China via increase in opium seizures since 2002 is mainly due to Yunnan province; according to Chinese authorities, increasing quantities seized in the Islamic Republic of heroin seizures in Yunnan province rose from 2. In 2006, in Afghanistan registered a more pronounced increase, the Islamic Republic of Iran replaced Turkey as the rising from 390 kg (seized in 234 cases) in 2008 to 1. Since then, the Islamic Republic of Iran and Turkey have seized the largest and second-largest, respectively, annual Heroin trafficking from Afghanistan to the Asia-Pacific heroin totals worldwide. Over the period 2002-2008, region is increasing, also supported by drug seizures heroin seizures in both these countries increased mark- reported by Pakistan. Among those cases in which the edly, but in 2009, seizures stabilized both in the Islamic destination of the consignment was identified as a coun- Republic of Iran, at 25 mt (compared to 23 mt in 2008) try or region other than Pakistan, the proportion of and in Turkey, at 16 mt (compared to 15 mt in 2008). The emergence of this new route countries have been erratic in recent years, but over the around 2005-2006 also appears to have caused a drop in long term, a distinct increase has been observed. Over heroin seizures in the region, suggesting that regional the period 2003-2009, heroin seizures in East Europe law enforcement needs time to adapt to the new route. This was also concurrent with a sharp increase in opium production in Afghanistan. This increase may have led West and Central Europe to a surplus of opiates, some of which may have found The trend in bulk heroin seizures in West and Central their way to the Asia-Pacific region. Europe does not mirror the increased supply of Afghan opium or the increased levels of heroin seizures in the 49 National Narcotics Control Commission of China, presentation at the Twentieth Anti-Drug Liaison Officials’ Meeting for International Islamic Republic of Iran and Turkey. Expressed in heroin equivalents assuming 1kg of heroin to be equivalent to 1 kg of morphine and 10 kg of opium. In 2008, the Heroin seizures also increased sharply in Canada, from wholesale purity of heroin of Mexican origin was at its 16 kg in 2007 to 102 kg in 2008 and 213 kg in 2009. Canada assessed In recent years, heroin seizures have increased signifi- that 94% of the ‘dode’ that reached its market originated in the United States, with the remaining 6% originating cantly in Egypt. In 2008, Egypt seized 211 kg of heroin, in the Netherlands, and that the affordability of ‘dode’ accounting for two thirds of total heroin seizures in had the potential to create a market beyond the tradi- Africa, and registering the third consecutive year-on- tional cultural groups. In 2009, seizures fell to 159 kg, remaining significantly higher than the levels registered in this The United States is also affected by non-medical use of country over the period 1995-2006. In the past, Egypt prescription opioids, and reported significant seizures of has also reported seizures of opium and opium capsules. In 2009, significant quantities of heroin were also seized Africa in Nigeria, 104 kg. Although this represents a sharp Heroin seizures in Africa rose sharply, from 311 kg in increase from the level in 2008 (12 kg), seizures were 2008 to 515 kg in 2009. South Africa registered the largest seizure total as Nigeria may serve as a transit point for limited quanti- 69 World Drug Report 2011 Fig. Over the 2004-2008 period, Pakistan reported tems capable of producing scientifically sound demand, significant, albeit declining, numbers of seized heroin supply and seizure statistics. Accordingly, the statistics consignments intended for Nigeria (36 such seizures in and estimates provided on opiate demand and flows 2008 and 16 in 2009). According to the United States should be viewed as the best current approximations. Department of Justice, organizations responsible for Heroin flow figures used in this section are indicative trafficking heroin originating in South-West Asia into and should be taken with caution. The purpose of pro- the United States included some that were based in West ducing these statistics is to estimate i) the main flows Africa. Nigeria has been mentioned as a transit country and changes in the routes over time, and ii) provide for heroin by Australia and the United States in recent threat and risk analysis for production, transit and des- years. The volumes and routes discussed are ficked on its territory in 2009 was intended for the not fixed and change according to changes in demand, United States, with 40% intended for Europe and 10% drug availability, or risk perceptions of drug traffickers. Therefore, it is essential to monitor flows every year to observe changes in the market and routes, which can Trafficking routes and volumes inform global strategies and policies regarding public health and security ramifications. Heroin from Myanmar is mainly trafficked to Heroin trafficking from production countries to con- China and Mexican heroin is mainly trafficked to the sumer markets requires a global network of routes and United States of America. Afghan heroin, however, is facilitation by domestic and international criminal trafficked to every region of the world except Latin groups. As such, trafficking routes for Afghan heroin ing, the global movement of heroin from Afghanistan are the main focus of this section. Estimating the graphic reasons, while others are preferred due to a lack volumes, that is, the global flow of opiates, requires data of law enforcement. Global heroin and opium seizures are used to identify opiate trafficking routes and It is estimated that some 460-480 mt of heroin was to help estimate the size of the flows in each country. Of this, some addition to seizure data, information was drawn from 375 mt reached consumers and the rest was seized. Afghanistan continued to be the main supplier for the global heroin market, producing 380 mt (83%). Available demand data was used as the key variable to estimate the size of the global heroin and opium flows. Despite the complexity of heroin trafficking routes, The robustness of demand data varies considerably, and some global movements can be generalized for Afghan the data are subject to frequent revisions and changes. From the production areas, heroin is trafficked overland Indian heroin, 15, Colombian heroin, 1, in three main directions: i) to Nimroz, Farah and Hirat 3% 0% provinces along the border with the Islamic Republic of Mexican heroin, 40, 9% Iran, ii) to eastern and northern Afghanistan, or iii) to Pakistan’s Balochistan borders. Some 160 mt were trafficked to Pakistan, 115 mt to the Islamic Republic of Iran and 90 mt to some Central Asian coun- tries (Tajikistan, Uzbekistan and Turkmenistan). The majority is thought to have entered overland into Pakistan’s Balochistan the Islamic Republic of Iran and some Central Asian province from Afghanistan’s Hilmand and Kandahar countries before moving to the main consumer markets provinces, facilitated by the limited law enforcement in West and Central Europe, East Europe, and East and capacity on both sides and the strong presence of the South-East Asia. The bor- Heroin flows from Afghanistan… ders of Afghanistan’s Nangarhar and Kunar provinces with Pakistan’s Federally Administered Tribal Area also Afghanistan continues to dominate global heroin supply. At least 30 mt were trafficked Main destination markets from Balochistan to the Islamic Republic of Iran. The Once Afghan opiates have entered neighbouring Paki- remaining 108 mt were moved internally to Pakistan’s stan, Islamic Republic of Iran and Central Asia, it is industrial capitals, Karachi and Lahore, as well as to trafficked to the main international consumption mar- other coastal or border locations for onward trafficking kets – West and Central Europe, East Europe, East and to Europe, South-East Asia, South Asia and Africa by sea South-East Asia and South Asia. The declining opium production in Myanmar reach other smaller consumption markets. West and Central Europe …to the Islamic Republic of Iran In 2009, users in West and Central Europe consumed some 70 mt of pure heroin. Thus, an esti- Islamic Republic of Iran from Afghanistan and Pakistan mated 75-80 mt of heroin were trafficked to West and in 2009.

ropinirole 0.5 mg amex

This condition is similar to neurolept analgesia but results from the administration of a single drug discount ropinirole online amex. Phencyclidine was the first drug used for this purpose order 2 mg ropinirole with visa, but the frequent occurrence of unpleasant hallucinations and psychological problems soon led to its abandonment discount ropinirole 1mg on-line. These effects are much less frequent with ketamine hydrochloride (2‐[o‐chlorophenyl]‐2‐[methylamino] cyclohexanone hydrochloride purchase ropinirole; Ketalar), which is available for intravenous or intramuscular injection. Ketamine Hydrochloride (Ketalar) Description: Ketamine is a non‐narcotic, non‐barbiturate anesthetic which produces a dissociative mental state characterized by sedation, amnesia and analgesia. Its pharmacological action is characterized by profound analgesia, normal pharyngeal‐ laryngeal reflexes. It selectively depresses neuronal function in parts of the cortex (especially association areas) and thalamus, while simultaneously stimulating parts of the limbic system, including the hippocampus. This creates what is termed a functional disorganization of nonspecific pathways in midbrain and thalamic areas. There is also evidence that ketamine depresses transmission of impulses in the medial medullary reticular formation, which is important to transmission of the affective‐emotional components of nociception from the spinal cord to higher brain centers. There is some evidence that ketamine occupies opiate receptors in the brain and spinal cord, which could account for some of the analgesic effects. Effects on the Respiratory System: Ketamine has minimal effects on the central respiratory drive as reflected by an unaltered response to carbon dioxide. Arterial blood gases are generally preserved when ketamine is used alone for anesthesia or analgesia. However, with the use of adjuvant sedatives or anesthetic drugs, respiratory depression can occur. Ketamine has been shown to affect ventilatory control in children and should be considered a possible respiratory depressant when given to them in bolus doses. When it is given to patients with reactive airway disease and bronchospasm, pulmonary compliance is improved. Ketamine is as effective as halothane or enflurane in preventing experimentally induced bronchospasm. The mechanism for this effect is probably a result of the sympathomimetic response to ketamine, but there are isolated bronchial smooth muscle studies showing that ketamine can directly antagonize the spasmogenic effects of carbachol and histamine. Owing to its bronchodilating effect, ketamine has been used to treat status asthmaticus unresponsive to conventional therapy. A potential respiratory problem is the increased salivation that follows ketamine. This can produce upper airway obstruction, which can be further complicated by laryngospasm. The increased secretions may also contribute to or further complicate laryngospasm. Also, although swallow, cough, sneeze, and gag reflexes are relatively intact after ketamine, there is evidence that silent aspiration can occur during ketamine anesthesia. Effects on the Cardiovascular System: Ketamine also has unique cardiovascular effects; it stimulates the cardiovascular system and is usually associated with increases in blood pressure, heart rate, and cardiac output. Other anesthetic induction drugs either cause no change in hemodynamic variables or produce vasodilation with cardiac depression. The increase in hemodynamic variables is associated with increased work and myocardial oxygen consumption. The normal heart is able to increase oxygen supply by increased cardiac output and decreased coronary vascular resistance, so that coronary blood flow is appropriate for the increased oxygen consumption. It is also interesting that a second dose of ketamine produces hemodynamic effects less than or even opposite to those of the first dose. The hemodynamic changes after anesthesia induction with ketamine tend to be the same in healthy patients and those with a variety of acquired or congenital heart diseases. In patients with congenital heart disease, there are no significant changes in shunt directions or fraction or systemic oxygenation after ketamine induction of anesthesia. In patients who have elevated pulmonary artery pressure (as with mitral valvular and some congenital lesions), ketamine seems to cause a more pronounced increase in pulmonary than in systemic vascular resistance. The mechanism by which ketamine stimulates the circulatory system remains enigmatic. It appears not to be a peripheral mechanism such as baroreflex inhibition, but rather to be central. Ketamine also causes the sympathoneuronal release of norepinephrine, which can be detected in venous blood. Blockade of this effect is possible with barbiturates, benzodiazepines, and droperidol. Myocardial depression has been demonstrated in isolated rabbit hearts, intact dogs, chronically instrumented dogs, and isolated canine heart preparations. However, in isolated guinea pig hearts, ketamine was the least depressant of all the major induction drugs. The fact that ketamine may exert its myocardial effects by acting upon myocardial ionic currents (which may exert different effects from species to species or among tissue types) may explain the tissue and animal model variances in direct myocardial action. The centrally mediated sympathetic responses to ketamine usually override the direct depressant effects of ketamine. There are some peripheral nervous system actions of ketamine that play an undetermined role in the hemodynamic effects of the drug. Ketamine inhibits intraneuronal uptake of catecholamines in a cocaine‐like effect and inhibits extraneuronal norepinephrine uptake. Usage: Ketamine can be used as a supplement or adjunct to regional anesthesia, extending the usefulness of the primary (local anesthetic) form of anesthesia. In this setting ketamine can be used prior to the application of painful blocks, but more commonly it is used for sedation or supplemental anesthesia during long or uncomfortable procedures. We use it mainly as a mild means for restraining the animal (changing collars etc. It is distributed as Ketalar by Parke‐Davis and as Ketaset or Ketaject by Bristol Laboratories. Species Restraint (mg/kg) Preanesthetic (mg/kg) Aotus trivirgatus (owl) 10‐12 20‐25 mg/kg Cebus capuchin 13‐15 25‐30 Cercopithicus aethiops 10‐12 25‐30 Macaca Fascicullaris. Nitrous oxide has minimal effects on cardiovascular dynamics, but still can depress myocardial contractility. In addition, nitrous oxide in combination with opioids is usually associated with significant cardiovascular depression. While fentanyl alone produces no ventricular dysfunction (even in the presence of significant coronary artery stenosis), the addition of nitrous oxide can result in significant cardiovascular depression. Myocardial ischemia and dysfunction may occur during inhalation of nitrous oxide as coronary blood flow decreases as a result of hypotension and an increase in coronary vascular resistance. Other studies demonstrate that nitrous oxide does not exacerbate myocardial ischemia. Myocardial dysfunction with nitrous oxide may not be evident with routine monitoring (i. Nitrous oxide may be valuable and safe as a supplement to opioid anesthesia in children undergoing repair of congenital cardiac defects. Dosage and Administration: We typically use this in 1lt/min with 1lt/min Oxygen flow (50%). The vapor pressure of isoflurane resembles that of halothane so that it can be administered in a halothane‐type vaporizer. Isoflurane has the largest circulatory margin of safety of all potent halogenated agents. It produces the least myocardial depression at a given multiple of the minimum alveolar concentration. In young animals it may increase heart rate, and thus it is occasionally associated with tachycardia. Similar to halothane, isoflurane does cause respiratory depression, and hence it should be used carefully, with continuous monitoring of the animal. In our procedures, we usually restrain the animal with Ketamine, and we perform the intubation under propofol or barbiturate anesthesia. Induction of surgical anesthesia is therefore accomplished with lower isoflurane concentrations. Isoflurane was the most slowly metabolized of the fluorinated inhaled anesthetics until the recent introduction of desflurane.

Licences for purchasers/users > In the frst instance at least (certainly for pilot schemes) a system would be established under which only licensed individuals would be allowed access for personal use only ropinirole 0.25mg amex. Limitations in allowed locations for consumption > Public consumption would be a fneable offence in most locations buy discount ropinirole 1mg on line. Potential models for regulation of lower strength cocaine preparations As already highlighted order 0.25 mg ropinirole free shipping, coca tea has a usage and public health profile in the Andean regions not dissimilar to that of coffee and conventional tea in much of the rest of the world cheap ropinirole 0.25 mg with amex. There is no reason why it could not be made more widely available on a similar basis, 74 for those who desire it. Its use in the short to medium term would be likely to remain largely within its cultural homeland. On an international level, it would probably find most market share in the speciality tea market. There is no particular reason to think it would replace or seriously encroach on coffee and tea markets where they are established. They might also compete in the substantial, and rapidly growing higher caffeine content ‘energy drinks’ market, sharing shelf space with products like Red Bull. Whilst coca tea has a natural limit to its active content, processed beverages would not. They would therefore have to be subject to additional tiers of regulation, so that active content could be controlled and limited, appropriate information incorporated into labelling and packaging, and other appropriate controls with regards to advertising/promotions established. Such drinks would presumably (depending on active content levels and related risk assessments) be made available under a licensed sales model similar to that governing alcohol sales. Alternatively, they might only be available over the counter in pharmacies, as Red Bull is in certain European countries. Of course, such regulation might not just cover coca based drinks; there is a strong case that the packaging, promotion and availability of some caffeine based energy drinks should also be more 75 strictly regulated. Such coca based beverages have the potential to absorb some of the user demand for cocaine powder. Many recreational consumers, if given a choice, would prefer a stimulant beverage that has a safer, slower release effect than that of a snorted powder. This preference could be further encouraged by using pricing and availability controls to make coca based energy beverages more attractive than snorted powder alternatives. Such a development could both be a benefcial form of risk reduc- tion, and potentially contribute to a more moderate and responsible culture of stimulant consumption—a culture which has, in the past few decades, moved in the opposite direction. Regulators would, however, need to consider the particular risks of such products being consumed 75 Such calls have increasingly come from a variety of medical authorities. Griffths, ‘Caffeinated energy drinks—a growing problem’, Drug and Alcohol Dependence, January 1, 2009. They should be aware, for example, how cocaine use has been associated with problem- atic patterns of drinking. Illustrating this potential concern is the rise of caffeine-based energy drink/alcohol spirit cocktails in some markets. The popular Red Bull and vodka cocktail is perhaps the most visible example of this. Some pre-mixed combination beverage products have also emerged which cash in on this caffeine/alcohol cocktail trend. Such cocktails are prob- lematic because the stimulant/depressant effects of their component drugs can, to some degree, cancel each other out. An additional concern around the potential for coca/alcohol cocktails is that co-administration of cocaine and alcohol leads to the formation of cocaethylene within the body. This is a drug with similar properties to cocaine; it is, however, thought to have higher cardiovascular and liver toxicity. Regulatory models could respond to these concerns with a combina- tion of availability restrictions and risk education. These could include restrictions on the sale of coca based drinks over a given strength in alcohol off-licences and bars, limiting such drinks to over-the-counter pharmacy sales only, prohibiting pre-mixed combination drinks or cocktails, enforcing specifc warnings on packaging, and placing appro- priate controls on advertising, promotion and branding. For example, it helps combat altitude sickness, and delivers certain locally benef- cial nutrients. As such, it seems relatively unlikely that there would be a substantial market for traditional Andean style coca leaf chewing in the wider world, even if no legal obstacles to its production and export existed. Other culturally/regionally specifc stimulants such as khat and betel nut have similarly not found signifcant wider markets. However, since cocaine is absorbed far more effciently through the palate than through the stomach, there might be potential for the devel- opment of more consumer friendly coca leaf based products. A quantity of coca leaf, plus an alkali additive, could be contained in a perme- able, tea bag-like pouch, which would sit inside the mouth. Coca based products could also take the form of lozenges or chewing gums, to be consumed much like current similar nicotine substitution products. Such products would require levels of regulation appropriate to the levels of risk they present. These are, however, assumed to be relatively low; such products would probably require levels of regulation akin to comparable nicotine replacement products. Were such products to emerge they would generally sit within the func- tional/benefcial/lifestyle arenas of stimulant using behaviours. They would presumably not have a signifcant impact on recreational or 76 problematic patterns of use beyond, arguably, helping foster a culture of more moderate, sensible use. As with non smoked tobacco products, however, regulators and public health offcials have often struggled to reconcile the active promotion of such new products with their public health principles, which emphasise reduced use (see: Tobacco harm reduction, page 108). A clear case can be made that oral tobacco products are dramatically safer substitutes for smoked tobacco. However, the extent of a similar substitution with cocaine products is not established. On the other hand, such products are likely to emerge in some form under a new legal regime, and thus at least warrant consideration. Additionally, their emergence may merely serve to expand consumer choice between products, such as tobacco/nicotine or coffee, that serve a similar function and cultural role. Amphetamine itself (the name derived from its full chemical name: alpha-methylphenethylamine) is the parent compound for a large number of derivatives, each with a slightly different molecular forma- tion, of which there are four main types: * Amphetamine; racemic variation; dextroamphetamine (Dexedrine) * Methyl-amphetamine; racemic variation dexmethamphetamine (more commonly known as just methamphetamine) * Ketoamphetmaines; cathine and cathinone (the active ingredients in khat) * Pseudo-amphetamines; methylphenidate (Ritalin) etc. Across the globe, amphetamines are the second most popular illegal drug 77 after cannabis. They are, like cocaine, associated with a spectrum of using behaviours and preparations that span from functional/medical, through recreational, to problematic. These behaviours are correspond- ingly associated with a wide spectrum of risks and regulatory challenges. This might include provision of more risky preparations, such as powders or inject- Medically prescribed Dexedrine tablets (dexamphetamine sulphate) able forms, only under much more restrictive regimes. The usefulness of amphetamines for a range of medical applications— 78 from over the counter nasal decongestants and cold remedies, to treatments for attention-defcit hyperactivity disorder and narcolep- sy—means that, unlike cocaine, many amphetamines are in wide legal circulation in a number of forms. This means that they are both more accessible (including diversion/conversion for non-medical use), and their risks, use and misuse are arguably better understood and accom- modated, both medically and socially. Proposed discussion model for regulation of amphetamine b a s i c r e g u l a t o r y m o d e l s > Dexamphetamine (and potentially some other amphetamines)—would be available in pill form under the specialist pharmacist model only—initially under a licensed purchaser model. Price controls > Fixed unit prices or minimum/maximum prices could be specifed, with taxation included on a per unit weight or % basis. Amphetamine prices are, however, generally relatively low anyway and are correspondingly less of a factor in using decisions. A reduction in price could thus serve to undermine illicit production and supply without necessarily encouraging use. As with all drug pricing, developments would have to be based on cautious experimentation and close monitoring of key outcomes. Powder would be in fxed unit sachets or wraps, which would be provided within a sealed container. Summary information and prominent warnings on containers (and wraps/sachets) could be augmented by a more detailed printed information insert in the container. Labelling would prominently specify ‘not for medical use’ to help maintain the market distinction between medical and non-medical supply. Volume sales/rationing controls > Volume of sales per purchaser (per day/week/ month) would have an upper limit established (and/or an escalating volume/price structure) that would be set at a realistic level for personal use (once weekly/four times a month perhaps), but well below what would be seen as problematic level/frequency (i. There would need to be a realistic acceptance that some degree of sharing would take place in social settings—even if sales are limited and on the purchaser/personal use only basis. Degree of intoxication of purchaser > Vendors would be required to refuse sales to those clearly intoxicated, according to a clear set of guidelines.

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