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We are currently witnessing a shift in the approach to combat traffic and consumption of illegal harmful drugs, being cannabis legalization a prominent example. In this paper, we study how to optimally regulate the market for cannabis, in a setting where consumers differ in their utility from consumption of the psychoactive component of cannabis, THC, and suffer from misperception of the health damage it causes. We analyze this problem through a vertical differentiation model, where a black market firm and a public firm compete in prices and qualities (THC content). A paternalistic government would like to correct for the misperceived health damage caused by cannabis consumption, as well as to reduce the size of the black market. It is the undesirability of black market profits what explains that the first-best allocation cannot be decentralized. We find two possible equilibria, depending on whether the public firm serves those consumers with the highest or lowest willingness to pay for quality. Paradoxically, when the public firm serves those consumers with higher taste for THC, a lower average health damage is achieved together with a better economic result for the public firm.

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Objective: This systematic review aims to summarize the findings of studies that investigated the risk, precocity and intensity of psychosis in cannabis users, taking into account the status of legalization and/or decriminalization of cannabis use in different countries. Methodology: Articles published up to May 2018 were included, in English, Portuguese and Spanish, all extracted from the PubMed and SciELO databases, respecting the inclusion and exclusion criteria. Results: 19 studies from 18 countries were included. The relationship of cannabis use and the onset of psychotic symptoms was sufficiently substantiated. However, there was no data that supported an increase in the risk, precocity or intensity of psychosis in cannabis users from countries with higher levels of legalization/decriminalization of cannabis use to the date of the present study. Conclusion: The use of cannabis is associated with the development of psychosis. So far, there is no data pointing to an increase in the precocity, risk or intensity of psychosis in cannabis users, due to the legalization or decriminalization of the use of cannabis. However, the absence of data to date does not exclude these possibilities, since none of the studies analyzed in this review specifically assessed the effects of legalization/decriminalization policies on those outcomes. Therefore, prospective studies focused on the effects of legalization or decriminalization policies should be conducted in countries such as Canada, Spain, the United States of America (some states), the Netherlands, and Uruguay.

Objetivo: esta revisión sistemática pretende resumir los hallazgos de los estudios que investigaron el riesgo, la precocidad y la intensidad de la psicosis en los consumidores de cannabis, teniendo en cuenta el estado de legalización y/o despenalización del consumo de cannabis en diferentes países. Metodología: fueron incluidos artículos publicados hasta mayo de 2018, en lengua inglesa, portuguesa y española, todos extraídos de las bases de datos PubMed y SciELO, respetando los criterios de inclusión y exclusión. Resultados: se incluyeron 19 estudios de 18 países. La relación entre el consumo de cannabis y el inicio de síntomas psicóticos estuvo suficientemente fundamentada. Sin embargo, no hubo datos que respaldaran un aumento en el riesgo, la precocidad o la intensidad de la psicosis en los consumidores de cannabis de países con niveles más altos de legalización/despenalización del uso de cannabis hasta la fecha del presente estudio. Conclusión: el consumo de cannabis está asociado con el desarrollo de psicosis. Hasta el momento, no hay datos que indiquen un aumento en la precocidad, el riesgo o la intensidad de la psicosis en usuarios de cannabis, debido a la legalización o despenalización del uso de cannabis. Sin embargo, la ausencia de datos hasta la fecha no excluye estas posibilidades, ya que ninguno de los estudios analizados en esta revisión evaluó específicamente los efectos de las políticas de legalización/despenalización en esos resultados. Por ello, los estudios prospectivos centrados en los efectos de las políticas de legalización o despenalización deben llevarse a cabo en países como Canadá, España, los Estados Unidos de América (algunos estados), los Países Bajos y Uruguay.

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The Latin American and Caribbean adolescent fertility rates are among the highest in the world: about 1.7 million children are born to teen mothers every year, and most of them are declared unintended pregnancies. The region also has the highest rate of unintended pregnancy of any world region, and nearly half of such pregnancies end in abortion. However, fewer than 18 percent of the region's women live in countries where abortion is broadly legal. This paper estimates the causal effect of abortion legalization on adolescent fertility in Uruguay using official data on legal abortions provided after the 2012 reform. We employed a difference-in-differences strategy, classifying states by whether they are responsive or unresponsive to the reform. The results suggest that abortion reform had a negative impact on the adolescent birth rate by 2.5-2.8 births per thousand adolescents aged 15-19 (a 4 percent decrease from the preintervention average). Additionally, we exploited variation in reform implementation intensity through the estimation of fixed-effect linear regression models and found consistent results. Our findings are robust to controlling for a concurrent large-scale program of contraceptive implants. We conclude that legislation aimed at enhancing rights and reducing avoidable deaths and complications from unsafe abortions may also have spillover effects that help reduce adolescent fertility.

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BACKGROUND AND AIMS: In 2013, Uruguay became the first country to legalize and regulate the production and distribution of cannabis for recreational use. We measured whether Uruguay's non-commercial model of recreational cannabis legalization was associated with changes in the prevalence of risky and frequent cannabis use among secondary school students. DESIGN: We used data from repeated cross-sectional surveys of secondary students in Uruguay and Chile (2007-2018). Using a difference-in-difference approach, we evaluated changes in the prevalence of past-year, past-month, any risky and frequent cannabis use following enactment (2014) and implementation (2016) of cannabis legalization among the full sample of secondary students and among students who reported past-year/month use. We examined changes separately for students ages 12 to 17, and students for whom cannabis became legally accessible, ages 18 to 21. SETTING: Uruguay and Chile (2007-2018). PARTICIPANTS: Secondary school students in 8th, 10th and 12th grade (n = 204 730). MEASUREMENTS: Past-year and past-month cannabis use; any risky cannabis use measured with the Cannabis Abuse Screening Test (CAST); and frequent cannabis use (10+ days in the past-month). FINDINGS: We found a decrease in past-year and past-month use following enactment or implementation. Among students ages 18 to 21, post-enactment, we observed a transitory increase in 2014 that decreased thereafter for: any risky use among those who reported past-year use (prevalence difference [PD] = 13.5%; 95% CI: 2.0, 24.9), frequent use in the full sample (PD = 4.5%; 95% CI: 1.0, 8.1), and frequent use among those who reported past-month use (PD = 16.8%; 95% CI: 1.9, 31.8). CONCLUSION: The legalization of recreational cannabis in Uruguay was not associated with overall increases in either past-year/past-month cannabis use or with multi-year changes in any risky and frequent cannabis use among young people.

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INTRODUCTION: Cannabis is probably the most commonly used illicit drug. It is often regarded as a relatively nonharmful experience, even though evidence indicates otherwise. Legalization of non-medical cannabis, which has already taken place in several countries, is currently a controversial issue. OBJECTIVE: To provide an up-to-date overview of current models and policies and their outcomes that can inform future political decisions regarding non-medical cannabis use. METHODS: PubMed/MEDLINE and Google Scholar scientific databases were searched for articles written in English, Spanish, and Portuguese published between 1990 and December 2020. The reference lists of these articles were similarly used as bibliography sources. Gray literature was also included. RESULTS: While non-medical cannabis has been decriminalized in many countries, it has only been legalized in Uruguay, Canada, and some U.S. states. Several benefits of legalization were identified: decreases in cannabis-related crimes, law-enforcement and judicial costs; reduction in synthetic cannabis supply; decline in black economies and possible diminution of other illegal drug buying; and tax revenue increases. Reported legalization problems included: increases in cannabis use; cannabis-related disorders; and cannabis-related accidents and hospitalizations. Harm-reduction strategies are available in the scientific literature. CONCLUSION: Growing, although incomplete, evidence exists to guide policy makers, minimize cannabis-related harm, and positively contribute to public health, if the legalization path is to be followed. Dialogue between legislators and science should be encouraged. There are more than a few legalization pathways, with diverse economic, social and health wellbeing effects. Public health-driven, instead of profit-driven models, seem to offer the most benefits regarding non-medical cannabis legalization. Most of the true public health effects of cannabis legalization are still unknown, for we are still in the early stages of these policies and their implications. Future studies should address the medium-to-long-term social, economic, and health consequences of legalization policies.

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Introduction: Adverse events are common and are responsible for a significant burden in the healthcare setting. Such issues can vary according to the local culture and relevant policies. The current literature on the subject primarily addresses Anglo-Saxon cultures; this study focused on understanding the perception of disclosure in a middle-income country in Latin America. Methods: In this descriptive study conducted from June-August, 2021, an online self-administered survey about disclosure practice used a convenience sample of 995 Brazilian healthcare professionals. Results: Based on two different outcomes presented following a hypothetical adverse event (outcome 1: death; outcome 2: no permanent damage), 77.9% of participants fully agree that disclosure should be performed in both scenarios. Although 67.1% claimed that disclosure changes the perception of the institution by those involved, only 8.3% fully agree that there would be a reduction in trust regarding the institution. Despite only 11.5% of participants fully agreeing that disclosure increases the chance of legal action against professionals and institutions, 92.7% fully or partially agree that judicialization was possible in scenario 1, and 72.4% agree it was possible in scenario 2. Of the participants, 64.2% claimed they already faced a "disclosure" situation, and 44.3% fully believe that the person directly involved in the adverse event should participate in the disclosure. Conclusion: In this sample of professionals from a middle-income country in Latin America, the practice of disclosure was considered ethical, and the majority of respondents affirmed that it should always be performed. Nonetheless, this call for transparency collides with participants' perception of a higher risk of legal action when disclosure is performed after a negative outcome situation.

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INTRODUCTION: Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. METHODS: PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. RESULTS: The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). CONCLUSIONS: Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.

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Abstract Introduction Cannabis is probably the most commonly used illicit drug. It is often regarded as a relatively nonharmful experience, even though evidence indicates otherwise. Legalization of non-medical cannabis, which has already taken place in several countries, is currently a controversial issue. Objective To provide an up-to-date overview of current models and policies and their outcomes that can inform future political decisions regarding non-medical cannabis use. Methods PubMed/MEDLINE and Google Scholar scientific databases were searched for articles written in English, Spanish, and Portuguese published between 1990 and December 2020. The reference lists of these articles were similarly used as bibliography sources. Gray literature was also included. Results While non-medical cannabis has been decriminalized in many countries, it has only been legalized in Uruguay, Canada, and some U.S. states. Several benefits of legalization were identified: decreases in cannabis-related crimes, law-enforcement and judicial costs; reduction in synthetic cannabis supply; decline in black economies and possible diminution of other illegal drug buying; and tax revenue increases. Reported legalization problems included: increases in cannabis use; cannabis-related disorders; and cannabis-related accidents and hospitalizations. Harm-reduction strategies are available in the scientific literature. Conclusion Growing, although incomplete, evidence exists to guide policy makers, minimize cannabis-related harm, and positively contribute to public health, if the legalization path is to be followed. Dialogue between legislators and science should be encouraged. There are more than a few legalization pathways, with diverse economic, social and health wellbeing effects. Public health-driven, instead of profit-driven models, seem to offer the most benefits regarding non-medical cannabis legalization. Most of the true public health effects of cannabis legalization are still unknown, for we are still in the early stages of these policies and their implications. Future studies should address the medium-to-long-term social, economic, and health consequences of legalization policies.

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Abstract Introduction Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. Methods PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. Results The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). Conclusions Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.

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Resumen La regulación normativa y la jurisprudencia referente a la formalización de la práctica de la prostitución ha tenido avances significativos en el Estado Colombiano. Sin embargo, persisten una serie de dificultades que hace que el ejercicio de esta actividad se vea frustrada por falta de garantías en el ejercicio de los derechos, haciendo que los personas que ejercen esta actividad económica, se vean inmersas en la informalidad que históricamente ha caracterizado esta labor.

Abstract The normative regulation and jurisprudence regarding the formalization of the practice of prostitution has had significant advances in the Colombian State. However, there are still a series of difficulties, which frustrate the exercise of this activity due to the lack of guarantees in the exercise of rights, by causing people, who exercise this economic activity, to be immersed in the informality, which has historically characterized this work.

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An effective approach to drug regulation is a growing concern. Since 2012, 10 US States and Uruguay have taken the step to revoke prohibition and legalize the recreational cannabis market. Based on the findings from a study ('Cannalex') carried out in 2015-2017 in Colorado, Washington and Uruguay by the French Monitoring Centre for Drugs and Drug Addiction (OFDT) and the Institute of Security and Justice (INHESJ), relying on a hundred of in-depth interviews analyzed in line with the existing official statistics and studies, this paper shows heterogeneous policy-making models and contexts for reform. It also examines the early outcomes of the cannabis policy change. A mixed picture is emerging from the regulatory regimes currently implemented. This paper discusses the reform processes and their early outcomes, with a specific focus on the less documented area: the political processes that led to legalizing cannabis, analyzed with qualitative data. It argues that the different outcomes reported across Colorado, Washington and Uruguay are framed by the regulatory options that were taken, depending on specific dynamics of reform. The discussion focuses on some hot topics raised by the effective regulations, stressing that the array of cannabis regulatory options is a public debate that has just begun.

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BACKGROUND: In 2013, Uruguay became the first country in the world to legalize recreational cannabis, instituting a non-commercial state regulatory model of production and supply. This study provides the first empirical evidence on its impacts on adolescent use of cannabis and related risks. METHODS: We use a generalization of the synthetic control method (SCM) to estimate the impact of legalization in Uruguay on adolescent past year and month cannabis use, perceived availability of cannabis and perceived risk of cannabis use. We compare biennial high school student self-reported survey data from Montevideo and regions in the interior of Uruguay post-legalization (2014-2018) and post initial implementation (2015-2018) to a synthetic counterfactual constructed using a weighted combination of 15 control regions in Chile. RESULTS: We find no evidence of an impact on cannabis use or the perceived risk of use. We find an increase in student perception of cannabis availability (58% observed vs. 51% synthetic control) following legalization. CONCLUSION: Our findings provide some support for the thesis that Uruguay's state regulatory approach to cannabis supply may minimize the impact of legalization on adolescent cannabis use. At the same time, our study period represents a period of transition: pharmacy access, by far the most popular means of access, was not available until the summer of 2017. Additional study will be important to assess the longer-term impacts of the fully implemented legalization regime on substance use outcomes.

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O presente artigo objetiva analisar práticas de judicialização da saúde na atualidade como um dos efeitos da biopolítica contemporânea. A gestão de riscos e perigos é colocada no centro das encomendas pelo direito à saúde e dispara uma inflação judicial como pedido de segurança. Problematizar essa racionalidade produtora de biocidadanias por uma bioletigimidade é uma preocupação neste ensaio teórico. O Estado Democrático de Direito nasce com a emergência de uma sociedade de direitos e a extensão da Medicina Social como balizas da política da vida, pautada no governo da saúde, em prol do aumento de capacidades e desempenhos. Assim, a biopolítica passa a ser modulada pela produção da autonomia e do ativismo dos sujeitos biológicos. Esses biocidadãos seriam demandantes do acesso à saúde, ao exercício de capacidades e à possibilidade de escolher formas de viver.

This article aims to examine legalization of health practices in the present as one of the effects of contemporary biopolitics. The management of risks and dangers is placed in the center of the orders for the right to health and triggers a judicial inflation as application security. Problematize this producer biocitizenships rationality by a biolegitimacy is a concern, this theoretical essay. The democratic state is born along with the emergence of a society of rights and the extension of social medicine as beacons of political life, based on the health government in support of capacity building and performance. Thus, biopolitics becomes modulated by the production of autonomy and activism of biological subjects. These would biocitizens plaintiffs access to health, exercise capacity and the ability to choose ways of living.

Este artículo tiene como objetivo examinar la legalización de prácticas de salud en el presente como uno de los efectos de la biopolítica contemporánea. La gestión de los riesgos y peligros que se coloca en el centro de los pedidos para el derecho a la salud y provoca una inflación judicial como garantía de la aplicación. Problematizar estos biociudadanias productores racionalidad por un biolegitimidad es una preocupación, este ensayo teórico. El Estado democrático nace junto con la aparición de una sociedad de derechos y la extensión de la medicina social como faros de la vida política, basada en el gobierno de la salud en apoyo de la creación de capacidades y el rendimiento. Por lo tanto, la biopolítica se convierte modulados por la producción de la autonomía y el activismo de temas biológicos. Estos haría biociudadanos demandantes el acceso a la salud, la capacidad de ejercicio y la capacidad de elegir formas de vida.

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Jurisdictions considering or implementing alternatives to cannabis supply prohibition will confront several decisions that will influence health, safety, and social equity outcomes. This essay highlights 14 of these design considerations, which all conveniently begin with the letter P: 1) Production, 2) Profit motive, 3) Power to regulate, 4) Promotion, 5) Prevention and treatment, 6) Policing and enforcement, 7) Penalties, 8) Prior criminal records, 9) Product types, 10) Potency, 11) Purity, 12) Price, 13) Preferences for licenses, and 14) Permanency. For each factor, the paper explains why it is important, describes the various approaches, and highlights how some of the jurisdictions that have legalized have addressed these choices. The primary audiences are decision makers considering alternatives to prohibiting cannabis supply and analysts making projections or conducting evaluations of these changes.

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ABSTRACT Barbadians, like their Caribbean neighbours, are not newcomers to using herbs for medicinal purposes. It has been suggested that prior to the 1930s and beyond, the herb Cannabis sativa was being used for various ailments. Much of the present debate in Barbados revolves around the increasing recognition that the condemned plant seen as injurious to society, especially the youth, represents a potential treatment for several illnesses. This article specifically examines the social construction of marijuana as a drug or substance of abuse versus its use as a medicine and the impact of the present prohibitionist policy on its use especially as a medicine.

RESUMEN Los barbadenses, al igual que sus vecinos caribeños, no son advenedizos en cuanto al uso de hierbas con propósitos medicinales. Se ha sugerido que antes y después de la década de 1930, la hierba Cannabis sativa era ya utilizada para tratar varias dolencias. Gran parte del actual debate en Barbados gira en torno al creciente reconocimiento de que dicha planta - condenada por considerársele perjudicial para la sociedad y especialmente para la juventud - representa hoy un tratamiento potencial de varias enfermedades. Este artículo examina específicamente la construcción social de la marihuana como droga o sustancia de abuso, frente a su uso como medicamento. Asimismo, se aborda el impacto de la políticas prohibicionistas actuales sobre su uso, especialmente como medicamento.

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BACKGROUND AND AIMS: In 2013, Uruguay became the first country in the world to fully regulate its marijuana market. This ambitious policy was also an unexpected one: none of the usual explanations for legalization of marijuana in other contexts was present in the Uruguayan case. This paper offers an explanation of why Uruguay legalized marijuana. Drawing on Kingdon's theoretical approach, we argue that a window of opportunity opened in mid-2012, making it both necessary and possible for the government to move towards legalization. METHODS: A congruence case study using evidence from a series of interviews with political actors and policy makers, media reports and official documents. RESULTS: There is evidence that marijuana legalization was possible in Uruguay because of the coincidence of a demand for more public safety (problem stream) with the presence of pro-legalization leaders in strategic political positions (policy stream) and a favorable political environment (political stream) CONCLUSIONS: Applying Kingdon's theory of windows of opportunity, Uruguay may have moved towards full regulation of its marijuana market in 2013 because of the convergence of a specific set of problem, policy and political circumstances in May 2012.

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Advocacy by feminists and healthcare providers was essential in passing the 2012 bill legalizing abortion in Uruguay, which was primarily framed in terms of a public health imperative. Prior to legalization, a group of influential physicians had established a "harm reduction" approach consisting of pre- and postabortion counseling with a focus on safer abortion methods. The existence of a network of providers from this initiative facilitated the implementation of abortion services after legalization. Particularities of the Uruguayan model include a strong focus on medical abortion, and a multidisciplinary approach to patient counseling. The implementation of services was largely successful, and rates of abortion-related morbidity and mortality have decreased. Remaining concerns include high rates of conscientious objection and insufficient human resources to staff interdisciplinary counseling teams. The focus on medical abortion has led to a lack of method choice. Finally, data collection gaps complicate monitoring and identification of barriers to access.

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In 2006, a Colombian Constitutional Court decision legalized abortion in cases of risk to a woman's physical or mental health, fetal malformation incompatible with life, or rape or incest. This decision resulted from legal action brought by feminist groups, and frames abortion as a human right. Advocates played a key role in implementing the new law by educating providers and the public about its broad interpretations. Healthcare providers and facilities did not have an organized response to the new law. Nonprofit organizations filled this gap, and provide a majority of legal abortions throughout the country. Civil society facilitated implementation of the new law by providing legal accompaniment to women facing barriers to accessing abortions. Despite these efforts, few legal abortions are performed each year, and clandestine, often unsafe abortions continue to prevail. Lack of information about the new law, stigma, and fluctuating political will remain key barriers.

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