RESUMO
BACKGROUND: National alcohol policies need to be systematized and evaluated to identify the gaps that should be filled by future laws. This study aims to search for and classify Brazilian public alcohol policies at the federal and state levels, based on the ten Alcohol Policy Scoring (APS) domains used by the Pan American Health Organization (PAHO), to identify any gaps METHODS: Documental research was carried out in two phases: document identification and content analysis. The search included laws, decrees, and ordinances for alcohol referred to in this text as regulatory documents (RD), enacted until December 31, 2019, in Brazil and its 26 states and the Federal District. The APS was used to classify and score the RD, which consists of ten policy domains (including pricing, availability, marketing, and health services), weighted according to the level of scientific evidence of each strategy RESULTS: We identified and categorized 435 valid RD (21 national laws and 414 state laws). Overall, Brazilian alcohol policies account for 51.6% (255/494) of the APS score. In the pricing policy domain, the second most robust indicator of the APS, the policy gap reached 87% in 25 states, demonstrating a weakness. Only the federal laws against drink-driving include all the recommended dimensions. There are important legislative contradictions in the definition of an alcoholic beverage and in the content of the policies to control marketing CONCLUSION: At the national level, the federal government adopted alcohol policies in several of the PAHO policy domains but enacted RD with little practical effect. At the subnational level, despite the autonomy to complement federal laws, the states have not yet addressed the most important gaps.
Assuntos
Organização Pan-Americana da Saúde , Política Pública , Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas , Brasil , Política de Saúde , Humanos , Estados UnidosRESUMO
Trata-se de uma revisão integrativa de vinte e seis artigos acadêmicos publicados entre 2010 e2014, em revistas indexadas e revisadas por pares, que examinaram a relação entre aprovaçãode leis de maconha medicinal nos Estados Unidos e agravos à saúde pública locais. São abordadasas motivações que levaram cientistas sociais a pesquisar as repercussões da regulaçãoda maconha medicinal para a sociedade. As buscas realizadas em cinco bases de dados possibilitarama identificação dos efeitos mais relevantes das mudanças legislativas estaduais e dareforma política federal de 2009, que impulsionou a comercialização de maconha medicinal,sobre a saúde pública. Especificamente, a revisão se concentra sobre taxas de mortalidade poroverdose de analgésico opióide, taxas de suicídio, taxas de acidente de trânsito com vítimasfatais, taxas de criminalidade, potência da maconha, desvio de maconha medicinal para adolescentes,exposições pediátricas não intencionais à maconha e prevalência de uso de maconhailegal. Admite-se que a maconha poderá ressurgir como opção terapêutica no tratamentopaliativo e complementar de um grande escopo de condições de saúde crônicas e terminais.No senso comum brasileiro, a maconha permanece vinculada ao crime, e o uso fitoterápico daerva in natura, assim como de seus extratos vegetais, carregado de estigma. Os achados destarevisão, entretanto, não sustentam os fundamentos que apoiam a validade de algumas preocupaçõespúblicas comumente relacionadas com a regulação da substância, como a exacerbaçãode crimes violentos. Na verdade, seus resultados surpreendem ao demonstrar evidências deque leis de maconha medicinal podem reduzir a violência, o suicídio, a overdose de analgésicoopióide, o uso de álcool e os danos de saúde pública a ele associados.
This is an integrative review of twenty-six academic studies published in indexed and peer-reviewedjournals, between 2010 and 2014, that examined the relations between medical marijuanalaws approval in the United States and local public health associated harms. It addressesthe motivations that led social scientists to research the impacts of medical marijuana regulationon society. The searches were carried out in five databases, allowing to identify the mostrelevant effects of state legislative changes and the 2009 federal policy reform, which boostedmedical marijuana sales, on public health. Specifically, this review focuses on opioid analgesicoverdose mortality rates, suicide rates, traffic fatality rates, crime rates, marijuana potency,medical marijuana diversion among teenagers, unintentional marijuana pediatric exposuresand prevalence of illegal marijuana use. It is assumed that marijuana may resurface as a treatmentoption in palliative and complementary care for a wide scope of chronic and terminalhealth conditions. Historically and culturally, brazilians associate marijuana as linked to crimeand therefore stigmatize it regardless of whether the substance appears as herbal or as plantextracts. However findings from this review do not support the fundamentals that reinforcethe validity of some public concerns commonly related to marijuana regulation, such as theexacerbation of violent crimes. Surprisingly, its results in fact show evidence that medicalmarijuana laws may reduce violence, suicide, opioid analgesic overdose, alcohol use and publichealth harms associated with it.