natgillin/translations-raw huggingface dataset:
A European study on cocaine use (powder and crack cocaine) found an association between crack use and social and mental health problems; however, the study also reported that crack cocaine use itself is not sufficient to explain the social or mental health problems (Haasen et al., 2005).
Vendar pa študija poroča tudi, da uživanje crack kokaina samo po sebi ni dovolj, da bi z njim razložili socialne težave ali težave z duševnim zdravjem (Haasen et al., 2005).
A recent study of 585 cocaine and crack clients in Scotland found that the crack users are more likely to have a longer history of problematic drug use and more involvement in criminal activities (Neale and Robertson, 2004, cited in the United Kingdom national report).
Nedavna raziskava med 585 osebami, ki se na Škotskem zdravijo zaradi uživanja kokaina in crack kokaina, je pokazala, da je pri uživalcih crack kokaina bolj verjetno, da imajo daljšo zgodovino problematičnega uživanja drog in da so večkrat vpleteni v kriminalne dejavnosti (Neale in Robertson, 2004, citirano v nacionalnem poročilu Združenega kraljestva).
Looking at the profile of cocaine clients in outpatient settings, it appears that new clients using cocaine as their primary drug are usually older than other drug consumers: 70 % are in the 20–34 years age group with a smaller group (13 %)
Če pogledamo profil oseb, ki se zaradi uživanja kokaina zdravijo izvenbolnišnično, kaže, da so nove osebe, ki uživajo kokain kot primarno drogo, ponavadi starejše od drugih uživalcev drog: 70 % jih je v starostni skupini od 20 do 34 let,
15 6 aged between 35 and 39 years (
15 6 manjša pa je starostna skupina (13 %) od 35 do 39 let (
It should be noted that Spain, a country usually reporting high treatment demands for cocaine, has not yet provided data.
Opomniti je treba, da Španija, država, v kateri ponavadi poročajo o pogostem povpraševanju po zdravljenju zaradi uživanja kokaina, še ni posredovala podatkov.
This overall figure reflects a wide variation between countries: in most countries treatment demands related to cocaine use are quite low, but in the Netherlands (37 %) and, historically, Spain (26 % in 2002) the proportion of all clients who ask for treatment for cocaine use is far higher.
Ta skupni odstotek odraža velike razlike med državami: v večini držav je povpraševanje po zdravljenju zaradi uživanja kokaina precej redko, vendar je na Nizozemskem (37 %) in v preteklosti v Španiji (26 % leta 2002) delež vseh oseb, ki zaprosijo za zdravljenje zaradi uživanja kokaina, veliko večji.
In the most recent data available, a group of countries report percentages of cocaine clients among all treatment clients between 5 % and 10 % (Denmark, Germany, France, Ireland, Italy, Cyprus, Malta, the United Kingdom and Turkey), whereas in the remaining countries
V najnovejših razpoložljivih podatkih skupina držav poroča, da deleži oseb, ki se zdravijo zaradi uživanja kokaina, izmed vseh, ki se zdravijo, znašajo med 5 % in 10 % (Danska, Nemčija, Francija, Irska, Italija, Ciper, Malta, Združeno kraljestvo in Turčija), v drugih državah pa so ti deleži zelo majhni (152).
15 3 clients demanding treatment for primary cocaine use (
Po poročilih je skupaj okrog 12 % vseh novih prošenj za zdravljenje povezanih
15 4 secondary drug by around 12 % of new clients (
), navaja kokain kot sekundarno drogo.
Cocaine is often used in combination with another illicit or licit subsidiary drug, often cannabis (31.6 %), opioids (28.6 %) or alcohol (17.4 %) (157).
Kokain se pogosto uporablja skupaj z drugimi prepovedanimi ali dovoljenimi drogami, pogosto s konopljo (31,6 %), opiati (28,6 %) ali alkoholom (17,4 %) (157).
Local studies of drug injectors suggest that, in some areas, the combination of heroin and cocaine within an injection may be becoming more popular (sometimes referred to by drug injectors as ‘speedballing’).
Lokalne študije injicirajočih uživalcev drog na nekaterih območjih kažejo, da mešanica heroina in kokaina v injekciji verjetno postajala bolj priljubljena (injicirajoči uživalci drog jo včasih imenujejo „speedball“).
The combination of opioids and cocaine is currently more apparent in the treatment data.
Kombinacija opiatov in kokaina je trenutno bolj razvidna iz podatkov o zdravljenju.
Among clients reporting primary use of opioids, 31 % in Italy, 42 % in the Netherlands and 44 % in the United Kingdom report a secondary cocaine use.
Od oseb, ki poročajo o primarnem uživanju opiatov, jih o sekundarnem uživanju kokaina poroča 31 % v Italiji, 42 % na Nizozemskem in 44 % v Združenem kraljestvu.
Among primary cocaine users, 28 % in Italy and 38 % in the United Kingdom report secondary use of opioids.
Od primarnih uživalcev kokaina jih o sekundarnem uživanju opiatov poroča 28 % v Italiji in 38 % v Združenem kraljestvu.
Treatment of cocaine dependence
Zdravljenje odvisnosti od kokaina
The increasing trends among clients seeking treatment for cocaine use reported in previous years is continuing; from 1999 to 2004, an analysis that interpolates for unreported data suggests that the proportion of new clients demanding treatment for cocaine use grew from around 10 % to 20 % during this period (based on 17 EU countries and Bulgaria
Trend povečevanja števila oseb, ki se želijo zdraviti zaradi uživanja kokaina, o katerem se je poročalo v prejšnjih letih, se nadaljuje. Za obdobje od leta 1999 do 2004 analiza, s katero se interpolirajo manjkajoči podatki, kaže, da se je delež novih oseb, ki povprašujejo po zdravljenju zaradi uživanja kokaina, v tem obdobju povečal za približno 10 % do 20 % (podatki temeljijo na 17 državah EU, Bolgariji in Romuniji (155).
Overall, most cocaine treatment demands in Europe are not related to crack cocaine: around 80 % of new outpatient cocaine clients are reported to be using cocaine hydrochloride (cocaine powder), with less than 20 % using
Na splošno večina povpraševanj po zdravljenju zaradi uživanja kokaina v Evropi ni povezanih s crack kokainom: okrog 80 % oseb, ki se na novo izvenbolnišnično zdravijo zaradi uživanja kokaina, uporablja kokainov hidroklorid (kokainov prah), manj od 20 % pa crack kokain.
There is not enough evidence to support pharmacological treatment for cocaine or other psychostimulant dependence.
Vendar pa so lahko uživalci crack kokaina še posebej velik izziv za zdravstvene službe, ker imajo ponavadi bolj marginaliziran socialni profil od uporabnikov kokainovega prahu. Evropska študija o uživanju kokaina (v prahu in crack kokaina) je
However, in their comprehensive review of the use of pharmacotherapies for psychostimulant users, Shearer and Gowing (2004) conclude that substitution therapy, which is successful in the case of opioid and nicotine dependence and has the potential for attracting and retaining users in treatment, has not yet been adequately tested in stimulant
V nekaterih državah, tudi v Združenih državah in Združenem kraljestvu, se trenutno precej vlaga v razvoj možnosti
) See footnote (70).) See Figure TDI-2 in the 2006 statistical bulletin.)
151) Glej prikaz TDI-2 v Statističnem biltenu 2006.152) Glej tabelo TDI-5 v Statističnem biltenu 2006; za španske podatke glej leto poročanja 2002.
See Table TDI-4 in the 2006 statistical bulletin.) See Table TDI-23 in the 2006 statistical bulletin.)
153) Glej tabelo TDI-4 v Statističnem biltenu 2006.154) Glej tabelo TDI-23 v Statističnem biltenu 2006.
See Figure TDI-1 in the 2006 statistical bulletin.) See Table TDI-10 in the 2006 statistical bulletin.)
155) Glej prikaz TDI-1 v Statističnem biltenu 2006.156) Glej tabelo TDI-10 v Statističnem biltenu 2006.
Chapter 5: Cocaine and crack cocaine users. A review of the literature on the responses to and effectiveness of cocaine treatment, including responses to mental health disorders among crack cocaine users, has
Poglavje 5: Kokain in crack kokain zdravljenja z imunoterapijo, tako da bi razvili protitelesa, ki lahko kokain v krvnem obtoku prestrežejo, preden doseže centralni živčni sistem (glej polje imunoterapija za odvisnike od kokaina).
Combining several specific psychosocial treatment interventions is currently considered the most promising treatment option for cocaine and other psychostimulant users.
Trenutno velja, da je najbolj obetavna možnost za uživalce kokaina in drugih psihostimulansov združevanje več posebnih psihosocialnih zdravstvenih intervencij.
The combination of the community reinforcement approach (CRA) with contingency management has been shown to reduce cocaine use in the short term (Higgins et al., 2003; Roozen et al., 2004).
Izkazalo se je, da združitev pristopa krepitve skupnosti („community reinforcement approach“, CRA) in obvladovanja nepredvidenih okoliščin („contingency management“) kratkoročno zmanjšuje uživanje kokaina (Higgins et al., 2003; Roozen et al., 2004).
In some countries, including the United States and the United Kingdom, there is currently substantial investment in building up immunotherapy treatment options by developing antibodies that can intercept cocaine in the bloodstream before it reaches the central nervous system (see box on immunotherapy for cocaine addicts).
Skupaj z obvladovanjem nepredvidenih okoliščin – načinom zdravljenja, katerega cilj je vplivati na vedenje zdravljenih oseb, tako da se jim ponudijo smiselne spodbude, npr. darila, potrdila ali posebne pravice, kadar je njihov vzorec urina brez sledov kokaina – se dosegajo pozitivni učinki na uživanje drog in psihosocialno delovanje v času zdravljenja in pri preverjanju po zdravljenju odvisnikov od kokaina, ki se zdravijo izvenbolnišnično, čeprav je bilo videti, da so učinki na uživanje kokaina omejeni na obdobje zdravljenja (Higgins et al., 2003).
In combination with contingency management — a method that aims to influence clients’ behaviour by offering meaningful incentives, e.g. presents, vouchers or privileges for cocaine-free urine samples — positive effects on drug use and psychosocial functioning have been achieved during the treatment phase and post-treatment follow-up in cocaine-dependent outpatients,although effects on cocaine use appeared to be limited to thetreatment period (Higgins et al., 2003).
V novih pristopih k zdravljenju zelo problematičnih skupin odvisnikov od heroina, ki uživajo kokain ali crack kokain, je zmanjševanje škode primarni cilj zdravljenja in uporabljajo vedenjske terapije, predvsem pristope obvladovanja nepredvidenih okoliščin, v kombinaciji z metadonskim vzdrževalnim programom ali zdravljenjem s heroinom (Schottenfeld et al., 2005; van den Brink, 2005; Poling et al., 2006).
In contrast to heroin addiction, which can be treated with agonists such as methadone or antagonists such as naltrexone, there are currently no medical treatments available for cocaine addiction.
V nasprotju s heroinskimi odvisniki, ki jih je mogoče zdraviti z agonisti, kot je metadon, ali antagonisti, kot je naltrekson, trenutno ni na voljo zdravljenja za odvisnost od kokaina.
The reason for this would appear to be the mechanism of action through which cocaine exerts its effects on the brain neurotransmitters dopamine and serotonin.
Zdi se, da bi bil razlog za to lahko mehanizem delovanja, prek katerega kokain učinkuje na možganska nevrotransmitorja dopamin in serotonin.
Whereas heroin binds to brain opioid receptors, such as the mu receptors, and therefore mimics the action of the brain’s own endorphins, cocaine inhibits the reabsorption of dopamine (and indeed serotonin) from the neuronal synapse once it has had its effect, leading to a build-up of the transmitter, thus prolonging and strengthening its effect.
Medtem ko se heroin veže na možganske receptorje za opioide, kot so receptorji mu, in zato posnema delovanje možganom lastnih endorfinov, pa kokain zadržuje reabsorbcijo dopamina (in seveda serotonina) iz nevronske sinapse, potem ko je dosegel svoj učinek, kar pripelje do krepitve transmitorja ter s tem do podaljšanja in krepitve njegovega učinka.
New approaches to the highly problematic groups of cocaine- and crack-using heroin users focus on harm reduction as primary treatment goal and apply behavioural therapies, in particular contingency management approaches, in combination with methadone maintenance programmes or heroin-assisted treatment (Schottenfeld et al., 2005; van den Brink, 2005; Poling et al., 2006).
To ne pomeni, da ni mogoče razviti zdravljenja za kokainsko odvisnost, pomeni pa, da ga bo verjetno težje razviti in da bo morda vključevalo drugačne koncepte od tistih, ki se uporabljajo pri razvoju zdravljenja heroinske odvisnosti.
This does not necessarily mean that it is not possible to develop a medical treatment for cocaine addiction, only that it may be more difficult to do so and may involve different concepts from those used in the development of treatments for heroin dependence.
V Evropi je bil razvoj pristopov za zmanjševanje škode, osredotočenih na uživanje kokaina, omejen. To bi se lahko zdaj pričelo spreminjati, ker večja ozaveščenost o razširjenosti uživanja kokaina in težav, povezanih z njim, spodbuja zanimanje za razvoj odzivanja na potrebe uživalcev kokaina.
One exciting strand of research is the use of immunotherapy, i.e. the development of a vaccine that would effectively ‘neutralise’ the action of cocaine by preventing the drug from reaching the brain.
Zanimiv niz raziskav vključuje uporabo imunoterapije, tj. razvoja cepiva, ki bi učinkovito „nevtraliziralo“ delovanje kokaina, tako da drogi prepreči, da doseže možgane.
The basic concept has undergone limited testing.
Osnovni koncept je bil omejeno preskušen.
A vaccine developed in the United Kingdom was tested in a small number of cocaine addicts, 18 in total, over a period of 14 weeks.
Cepivo, razvito v podjetju v Združenem kraljestvu, so 14 dni preskušali na majhnem številu kokainskih odvisnikov (18).
It was found that three quarters of the vaccinated cohort of cocaine addicts were able to remain drug free for a period of three months with no untoward sideeffects.
Ugotovili so, da so tri četrtine cepljene kohorte kokainskih odvisnikov lahko tri mesece ostale brez drog brez kakršnih koli neprijetnih stranskih učinkov.
In addition, after six months, both those who relapsed and those who did not stated that the feelings of euphoria were not as potent as prior to vaccination.
Poleg tega so po šestih mesecih vsi tisti, ki so znova začeli uživati kokain, in tisti, ki ga niso, izjavili, da občutki evforije niso bili tako močni kot pred cepljenjem.
As a result of these findings, the vaccine, known as drug–protein conjugate TA-CD, is undergoing phase 2 clinical trials.
Zaradi teh ugotovitev je cepivo, znano kot konjugat droge in proteina TA-CD, v drugi fazi kliničnih preskušanj.
An alternative immunotherapeutic approach involves the development of monoclonal antibodies to cocaine, but this has only been tested preclinically.
Alternativni imunoterapevtski pristop vključuje razvoj monoklonskih protiteles za kokain, vendar je bil preskušen zgolj predklinično.
The potential benefit of the cocaine vaccine TA-CD has raised ethical concerns about the use of a vaccine: who would receive it, who would make the decision and on what criteria, etc.
Potencialna korist kokainskega cepiva TA-CD je povečala etično zaskrbljenost glede uporabe cepiva: kdo bi ga prejel, kdo bi sprejel odločitev in po kakšnih merilih itd.
In Europe, the development of harm reduction approaches that target cocaine use has been limited. This might now be beginning to change as increased awareness of both the extent of cocaine use and the problems associated with it stimulates interest in developing responses to address the needs of cocaine users.
Zaradi resnih zdravstvenih in socialnih težav, povezanih z uživanjem crack kokaina, obstaja več izkušenj z razvojem storitev za to skupino, čeprav so dejavnosti omejene na sorazmerno majhno število evropskih mest, ki so imela večje težave s crack kokainom.
As cocaine use can escalate quickly, brief interventions that can alert users to the fact that they may be beginning to experience negative consequences due to their use of the drug may also be worth exploring.
V številnih mestih so se na uživalce crack kokaina osredotočili programi dela na terenu, ki poskušajo navezati stik s skupino, za katero pogosto velja,
Annual report 2006: the state of the drugs problem in Europe and some lowthreshold programmes specifically target crack-using sex workers to transmit safer sex and drug use messages and to distribute condoms and lubricants (see selected issue on gender).
Letno poročilo 2006: stanje v zvezi s problemom drog v Evropi da je težko delati z njo.
Although overall the evidence base remains relatively weak, some studies have suggested that benefits can accrue.
Čeprav so dokazi na splošno še vedno relativno redki, so nekatere študije nakazale, da se koristi lahko povečujejo.
For example, one study of an innovative outreach treatment programme in Rotterdam (Henskens, 2004, cited in the Dutch national report) identified factors that were observed to be important for treating this group of clients, who are often difficult to engage in conventional drug services.
Študija inovativnega programa zdravljenja na terenu v Rotterdamu (Henskens, 2004, citirano v nizozemskem nacionalnem poročilu) je na primer opredelila dejavnike, ki so se pokazali za pomembne pri zdravljenju te skupine oseb, ki jih je pogosto težko vključiti v konvencionalne načine zdravljenja odvisnosti od drog.
Compulsive patterns of crack and cocaine use may be associated with an increase in sexual health risk-taking,
Kompulzivne vzorce uživanja crack kokaina in kokaina je mogoče povezati s povečevanjem tveganja na področju spolnih bolezni, zato so nekateri nizkopražni programi posebej namenjeni spolnim delavkam, ki uživajo crack heroin, in jih obveščajo o varnejši spolnosti in uživanju drog ter delijo kondome in lubrikante (glej izbrano vprašanje o spolu).
A more controversial approach has been adopted in some cities in Europe, where the concept of safe consumption rooms, usually targeting drug injection, has been extended to drug inhalation.
Bolj sporen pristop se uporablja v nekaterih evropskih mestih, kjer se je koncept varnih prostorov za uživanje drog, ponavadi namenjen injicirajočim uživalcem, razširil na inhaliranje drog.
Rooms for supervised inhalation have been opened in several Dutch, German and Swiss cities (EMCDDA, 2004c).
Prostori za nadzorovano kajenje so se odprli v več nizozemskih, nemških in švicarskih mestih (EMCDDA, 2004c).
Although the supervision of consumption hygiene is a main objective of such services, there is some evidence that they could also act as a conduit to other care options; for example, monitoring of one service in Frankfurt, Germany, reported that, during a six-month evaluation period in 2004, more than 1 400 consumptions were supervised, while 332 contact talks, 40 counselling sessions and 99 referrals to other drugs services were documented.
Čeprav je nadzor higiene pri uživanju glavni cilj teh storitev, obstajajo nekateri dokazi, da bi lahko te storitve služile tudi kot pot do nekaterih drugih možnosti oskrbe. Spremljanje ene take storitve v Frankfurtu v Nemčiji je na primer pokazalo, da je bilo v šestmesečnem ocenjevalnem obdobju v letu 2004 nadzorovanih 1 400 uporab droge, dokumentiranih pa je bilo 332 pogovorov, 40 svetovalnih storitev in 99 napotitev na druge storitve na področju drog.
Chapter 6Opioid use and drug injection
Poglavje 6Uživanje opiatov in vbrizgavanje drog
Heroin supply and availability (159
Ponudba in razpoložljivost heroina (159
In Europe, two forms of imported heroin are found: the commonly available brown heroin (its chemical base form) and the less common and usually more expensive white heroin (a salt form), which typically originates from South-East Asia.
V Evropi je mogoče najti dve obliki uvoženega heroina: običajno je na voljo rjavi heroin (njegova osnovna kemična oblika), manj pogosto pa ponavadi dražji beli heroin (oblika soli), ki navadno izvira iz jugovzhodne Azije.
In addition, some opioid drugs are produced within the EU, but manufacture is mainly confined to small-scale production of home-made poppy products (e.g. poppy straw, poppy concentrate from crushed poppy stalks or heads) in a number of eastern EU countries, for example Lithuania, where the market for poppy stalks and concentrate seems to have stabilised, and Poland, where production of ‘Polish heroin’ might be decreasing (CND, 2006).
Poleg tega se nekateri opiati proizvajajo v EU, vendar je proizvodnja v glavnem omejena na proizvodnjo domačih proizvodov iz vrtnega maka v majhnem obsegu (npr. koncentrat vrtnega maka iz zdrobljenih makovih stebel ali glavic) v številnih vzhodnih državah EU, na primer v Litvi, kjer je videti, da se je trg makovih stebel in koncentrata ustalil, in na Poljskem, kjer se proizvodnja „poljskega heroina“ morda zmanjšuje (CND, 2006).
Production and trafficking centre to other western European countries.
Proizvodnja in trgovanje druge zahodnoevropske države.
Heroin seizures in 2004 suggest that the southern branch has now gained the same importance as the northern branch in terms of volume smuggled (WCO, 2005; INCB, 2006a).
Zasegi heroina v letu 2004 kažejo, da je postala južna veja glede pretihotapljene količine enako pomembna kot severna (WCO, 2005; INCB, 2006a).
Since the mid1990s, heroin has been increasingly (but to a lesser extent than through the Balkan routes) smuggled to Europe through the ‘silk route’ via central Asia (in particular Turkmenistan, Tajikistan, Kyrgyzstan and Uzbekistan), the Caspian Sea and the Russian Federation, Belarus or Ukraine, to Estonia, Latvia, some of the Nordic countries and Germany (Reitox national reports, 2005; CND, 2006; INCB, 2006a).
Od srede 90. let se je vedno več heroina (vendar manj kot prek balkanskih poti) v Evropo pretihotapilo po „svileni poti“ prek Srednje Azije (predvsem Turkmenistana, Tadžikistana, Kirgizistana in Uzbekistana), Kaspijskega morja in Ruske federacije, Belorusije ali Ukrajine do Estonije, Latvije, nekaterih nordijskih držav in Nemčije (nacionalna poročila Reitox, 2005; CND, 2006; INCB, 2006a).
Although these routes are the most important, countries in the Arabian peninsula (Oman, United Arab Emirates) have become transit sites for heroin consignments from South and South-West Asia destined for Europe (INCB, 2006a).
Čeprav so te poti najbolj pomembne, so države na Arabskem polotoku (Oman, Združeni arabski emirati) postale tranzitne države za pošiljke heroina iz južne in jugozahodne Azije, namenjene v Evropo (INCB, 2006a).
In addition, heroin destined for Europe (and North America) was seized in 2004 in East and West Africa, the Caribbean, and Central and South America (CND, 2006).
Poleg tega je bil heroin, namenjen v Evropo (in Severno Ameriko), v letu 2004 zasežen v vzhodni in zahodni Afriki, na Karibih, ter v Srednji in Južni Ameriki (CND, 2006).
Heroin consumed in Europe is predominantly manufactured in Afghanistan, which remains the world leader in illicit opium supply and in 2005 accounted for 89 % of global illicit opium production, followed by Myanmar (7 %).
Leta 2004 je bilo po svetu zaseženih 210 ton opija (enakovredno 21 tonam heroina), 39,3 tone morfija in 59,2 tone heroina.
Global production of illicit opium remained relatively stable between 1999 and 2004, except in 2001, when a ban on opium poppy cultivation enforced by the Taliban regime in Afghanistan resulted in a dramatic but short-lived decline; it is estimated that about 4 670 tonnes was produced in 2005, a 4 % decline compared with 2004 (CND, 2006).
V Aziji (50 %) in Evropi (40 %) so bile še vedno zasežene največje količine heroina po svetu.
Global potential production of heroin was estimated at 472 tonnes in 2005 (495 in 2004) (UNODC, 2006).
Delež Evrope se povečuje, v glavnem zaradi večjih zasegov v jugovzhodnih evropskih državah (Turčija), v kateri je količina prvič presegla količine, zasežene v zahodni in srednji Evropi (CND, 2006).
In 2004, 210 tonnes of opium (or 21 tonnes of heroin equivalent), 39.3 tonnes of morphine and 59.2 tonnes of heroin were seized worldwide.
Heroin, ki se porabi v Evropi, se v glavnem proizvaja v Afganistanu, ki ostaja vodilni vir ponudbe prepovedanega opija na svetu in katerega proizvodnja je leta 2005 znašala 89 % svetovne proizvodnje prepovedanega opija, nato sledi Mjanmar (7 %).