Mirjam van het Loo

Decriminalization of Drug Use in Portugal: The Development of a Policy

Drug use is an increasing problem in Portugal. In response, following the advice of a select committee, the Portuguese government has recently issued a number of laws implementing a strong harm-reductionistic orientation. The flagship of these laws is the decriminalization of the use and possession for use of drugs. Use and possession for use are now only administrative offenses; no distinction is made between different types of drugs (hard vs. soft drugs) or whether consumption is private or in public. Although most people favor decriminalization in principle, doubts have been expressed about the way the law will be implemented because the law only sets a framework for those communities that wish to undertake such activities--it is an enabling law. This has led to a considerable lack of clarity and increases the risk of dissimilarity of implementation in different parts of the country. The future will show the effects.

European Criteria for the Appropriateness and Necessity of Coronary Revascularization Procedures

OBJECTIVES Large variations in the use of coronary revascularization procedures have led many countries to apply the RAND appropriateness method to develop specific criteria describing patients who should be offered these procedures. The method is based on the work of a multidisciplinary expert panel that reviews a synthesis of the scientific evidence and rates the appropriateness of a comprehensive list of indications for the procedure being studied. Previous studies, however, have all involved single-country panels. We tested the feasibility of carrying out a multinational panel to rate the appropriateness and necessity of coronary revascularization, thereby producing recommendations for common European criteria. METHODS Using the RAND methodology, a multispecialty (interventional cardiologists, non-interventional cardiologists and cardiovascular surgeons), multinational (The Netherlands, Spain, Sweden, Switzerland and the United Kingdom) panel rated the appropriateness and necessity of indications for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG). A synthesis of the evidence and list of indications for PTCA and CABG were sent to 15 panelists, three from each country, who performed their ratings in three rounds. RESULTS For PTCA, 24% of the indications were appropriate and necessary, 16% were appropriate, 43% were uncertain and 17% were inappropriate. The corresponding values for CABG were 33% appropriate and necessary, 7% appropriate, 40% uncertain and 20% inappropriate. The proportion of indications rated with disagreement was 4% for PTCA and 7% for CABG. CONCLUSION Multinational panels appear to be a feasible method of addressing issues concerning the appropriateness and necessity of medical procedures in western European countries. The criteria produced provide a common tool that can be used to measure the overuse and underuse of medical procedures and to guide decision-making.