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Skull Superior sagittal sinus Scalp Dura mater Transverse sinus Arachnoid mater over medulla oblongata (a) Temporal bone Skin of scalp Periosteum Bone of skull Periosteal Meningeal Dura mater Superior sagittal sinus Subdural space Subarachnoid area Arachnoid mater Pia mater Arachnoid villus Blood vessel Falx cerebri (in longitudinal fissure only) 14 (b) secures the brain within the cranial cavity. The cavity created at this level is the big superior sagittal sinus, which collects blood draining from the brain tissue. The center layer, the weblike arachnoid mater, underlies the dura mater and is partially separated from it by the subdural area. Its threadlike projections bridge the subarachnoid space and connect to the innermost membrane, the pia mater. Specialized projections of the arachnoid tissue known as arachnoid villi protrude via the dura mater to permit the cerebrospinal fluid to drain again into the venous blood by way of the superior sagittal sinus and different dural sinuses. The cerebrospinal fluid is regularly shaped by the choroid plexuses, small capillary knots hanging from the roof of the ventricles of the brain. Cerebrospinal fluid varieties a watery cushion that protects the fragile brain tissue against blows to the top. Activity three Tracing the Pathway of Cerebrospinal Fluid in the Brain Obtain a threedimensional model of the ventricles, and hint the trail of cerebrospinal fluid circulation by way of the interior brain cavities from the lateral ventricles to the subarachnoid house. Testing methods Person is requested to sniff and identify aromatic substances, similar to oil of cloves and vanilla. Vision and visible field are determined with eye chart and by testing the purpose at which the individual first sees an object (finger) moving into the visible subject. Eye inside seen with ophthalmoscope to detect swelling of optic disc (point at which optic nerve leaves the eye) and to observe blood vessels. Pupillary reflex is tested with penlight (pupils should constrict when illuminated). Sensations of ache, touch, and temperature are tested with security pin and hot and cold objects. Motor department assessed by asking individual to clench the enamel, open the mouth in opposition to resistance, and transfer the jaw aspect to aspect. Anterior two-thirds of tongue is examined for ability to style candy (sugar), salty, sour (vinegar), and bitter (quinine) substances. Oculomotor Mixed-motor fibers to inferior oblique and superior, inferior, and medial rectus muscle tissue, which direct eyeball; to levator palpebrae muscles of eyelid; to iris and easy muscle controlling lens shape and pupil measurement. Mixed-provides motor fibers to superior oblique muscle (an extrinsic eye muscle). Mixed-conducts sensory impulses from pores and skin of face and anterior scalp, from mucosae of mouth and nose. Mixed-supplies motor fibers to muscles of facial expression and to lacrimal and salivary glands; carries sensory fibers from taste receptors of anterior tongue. Glossopharyngeal Purely sensory-transmits impulses for senses of equilibrum and listening to. Mixed-motor fibers serve pharyngeal muscle tissue and salivary glands; sensory fibers carry impulses from pharynx, posterior tongue (taste buds), and strain receptors of carotid artery. Mixed-motor fibers serve muscle tissue of tongue and sensory fibers carry impulses from tongue. Sternocleidomastoid and trapezius muscles are checked for energy by asking person to rotate head and elevate shoulders in opposition to resistance. Only one pair, the vagus nerves, extends into the thoracic and belly cavities. The cranial nerves are numbered so as, and typically their names replicate the most important buildings they management. A catchy saying which may allow you to to remember the cranial nerves in order is "On occasion our trusty truck acts funny-very good automobile anyhow. Most cranial nerves are blended nerves (containing each motor and sensory fibers), but three pairs-optic, olfactory, and vestibulocochlear-are purely sensory. Those of the combined cranial nerves are found both in the brain and in peripheral ganglia. However, the synapse points of the first cranial nerves, the olfactory bulbs, are seen on the mannequin, so establish these. Relatively speaking, which of those constructions is clearly much bigger in people

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Modification of danger factors has a helpful impact on subsequent morbidity and mortality, and includes smoking cessation, management of hypertension, maintaining ideal physique weight, common exercise and glycaemic control in diabetes mellitus. In addition, aspirin and statins reduce subsequent danger: Aspirin (75 mg daily, p. Symptomatic remedy Acute attacks are treated with sublingual glyceryl trinitrate pill or spray (p. Patients ought to be inspired to use this earlier than exertion, quite than ready for the ache to develop. The primary side effect is a extreme bursting headache, which is relieved by inactivating the tablet both by swallowing or spitting it out. Ischaemic heart illness 449 Most sufferers would require common prophylactic remedy. Some patients would require mixture remedy and revascularization for those not controlled on medical therapy: -Adrenergic blocking medicine (p. They loosen up the coronary arteries and cut back the force of left ventricular contraction, thereby reducing oxygen demand. The side effects (postural dizziness, headache, ankle oedema) are the results of systemic vasodilatation. They are available in quite a lot of slow-release preparations, including infiltrated skin plasters, buccal pellets and long-acting oral nitrate preparations. Nicorandil combines nitrate-like exercise with potassium-channel blockade; it has each arterial and venous vasodilating properties. Studies assist an initial strategy of optimum medical administration in patients with secure angina signs, however revascularization must be thought of in patients who stay symptomatic regardless of two anti-anginals. This method is most useful for isolated, proximal, non-calcified atheromatous plaques. Bare metallic stents may be preferred in sufferers requiring anticoagulation and early surgery. Less commonly, the saphenous vein from the leg is anastomosed between the proximal aorta and coronary artery distal to the obstruction. Surgery efficiently relieves angina in about 90% of instances and, when carried out for left main stem obstruction or three-vessel illness, an improved lifespan and quality of life may be anticipated. In most patients the angina eventually recurs because of accelerated atherosclerosis within the graft (particularly vein grafts), which could be treated by stenting. In some patients, chest pain is absent and presentation is with collapse, arrhythmia or new-onset heart failure. Other causes of chest pain should be Ischaemic heart illness 451 thought-about in all sufferers. In the absence of contraindications, aspirin (300 mg initially, then seventy five mg every day, p. It reduces the chance of subsequent vascular events and deaths and is sustained indefinitely. Heparin interferes with thrombus formation at the site of plaque rupture and reduces the danger of ischaemic events and death. The synthetic pentasaccharide, fondaparinux, inhibits issue Xa of the coagulation cascade. Oral medicine is sustained indefinitely after hospital discharge, excluding clopidogrel, which is stopped after 12 months. Coronary stenting might stabilize the disrupted coronary plaque and reduces angiographic restenosis rates compared to angioplasty alone. It is type of at all times the end result of rupture of an atherosclerotic plaque, with the event of thrombosis and whole occlusion of the artery. Clinical features Central chest pain much like that occurring in angina is the most typical presenting symptom. Unlike angina, it often occurs at rest, is extra extreme and lasts for some hours. The pain might radiate to the left arm, neck or jaw and is often related to sweating, breathlessness, nausea, vomiting and restlessness.

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Much less numerous than the red blood cells, white blood cells are protective, pathogen-destroying cells which would possibly be transported to all components of the body within the blood or lymph. They are categorized into two main teams, relying on whether or not they contain conspicuous granules of their cytoplasm. There are three kinds of granulocytes: Neutrophil: Still on the first microscope, flip your attention to the cell on the finish of the pointer, a neutrophil. Neutrophils perform as energetic phagocytes, and their number will increase explosively throughout acute infections. The granules comprise a quantity of chemical substances including histamine, a vasodilator that helps mediate the inflammatory response. The dark blue nucleus is mostly kidney-shaped, and its ample cytoplasm stains gray-blue. It functions as an lively phagocyte (the "long-term cleanup group"), increasing dramatically in quantity throughout continual infections similar to tuberculosis. Students are often asked to record the leukocytes so as from the most abundant to the least ample. The following silly phrase might help you with this task: Never let monkeys eat bananas (neutrophils, lymphocytes, monocytes, eosinophils, basophils). Platelets Also at station 5, notice the small clusters of dark-staining, irregularly shaped our bodies that appear a lot smaller than the other formed elements; these are platelets. The regular platelet count in blood ranges from a hundred and fifty,000 to 400,000 per cubic millimeter. Platelets are needed for the clotting process that happens in plasma when blood vessels are ruptured. There are two types: Lymphocyte: At station four, observe the smallest of the leukocytes, which is roughly the size of a pink blood cell. When a person enters a hospital as a patient, a number of hemato logic (blood) exams are routinely carried out to determine basic stage of well being. Materials similar to cotton balls, lancets, and alcohol swabs are utilized in almost the entire following diagnostic checks. Dispose properly of all supplies (glassware to the "bleach bucket" and disposable items to the autoclave bag) immediately after use. A little preplan ning will save you the discomfort of having to puncture your finger a quantity of occasions. An various to using your individual blood is using heparin ized blood samples equipped by your instructor. Thus blood collected and saved in such tubes will be appropriate for all exams besides coagulation time testing. Total White and Red Blood Cell Counts the handcounting approach for figuring out complete white and red blood cell counts, sometimes accomplished in scholar labs, is outdated as a end result of most medical companies now have comput erized gear for performing blood counts. It is necessary, however, to know the typical blood rely values of healthy individuals and to perceive what abnormal counts might indicate. An abnormally low white blood cell rely (leukopenia) might point out measles, infectious hepatitis or cirrhosis, tuberculosis, or excessive antibiotic or Xray remedy. Normal hematocrit values for the man and girl, respectively, are 42�52% and 37�47%. If potential (and if the centrifuge allows), all members of the category ought to prepare their capillary tubes at the same time so the centrifuge may be properly balanced and run solely once. Obtain two heparinized capillary tubes, capillary tube sealer or modeling clay, a lancet, alcohol swabs, and a few cotton balls. Quickly jab the pointed end into the ready finger to produce a free move of blood. This loading procedure balances the centrifuge and prevents blood from spraying all over the place by centrifugal force. When all of the tubes have been loaded, make certain the centrifuge is properly balanced, and secure the centrifuge cover. Use instructor-provided animal blood, or prepare your finger as previously described. As quickly because the blood has dried and misplaced its glossy look, match its colour, underneath pure light, with the colour requirements by transferring the specimen under the comparability chart in order that the blood stain seems at all the varied openings. Record your outcomes as the proportion of hemoglobin concentration and as grams per a hundred ml of blood under.

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Australia has a needle- and syringe-exchange program, which has been operating in the state of New South Wales since 1986. As a half of its hurt reduction strategy (discussed later), the state of New Mexico distributes needles and Narcan (used in cases of overdose) to heroin addicts. While drug coverage in the United States has changed little for the reason that Harrison Act in 1914, important modifications have occurred elsewhere. The time period "refers to insurance policies, programmes and practices that goal to cut back the adverse health, social and financial penalties of the use of legal and illegal psychoactive medicine, and are primarily based on a powerful dedication to public health and human rights" (Cook, Bridge, and Stimson 2010: 37). In hurt discount approaches the utilization of medication is accepted as a reality, and focus is placed on decreasing hurt whereas use continues. In 1990, the primary ever International Conference on the Reduction of Drug Related Harm was held in Liverpool, England. Instead, this method examines harm from two factors of view: hurt to the community and harm to the drug user. If a policy or program is expected to cut back mixture hurt, it ought to be accepted; whether it is expected to increase mixture harm, it must be rejected. The prevalence of drug use should play no special and separate position" (Reuter and Caulkins 1995: 1060). As Jonathan Caulkins (1996: 232) notes, however, "trying to translate the concept of hurt discount into formal phrases brings out key philosophical questions that have to be addressed. It acknowledges that while carrying risks, drug use also provides the consumer with advantages that have to be taken into account if drugusing habits is to be understood. From a neighborhood perspective containment and amelioration of drug-related harms may be a extra pragmatic or feasible option than efforts to remove drug use totally. No moralistic judgment is made both to condemn or to support use of medication, regardless of the stage of use or mode of consumption. Therefore, the first precedence is to lower the unfavorable penalties of drug use to the consumer and to others somewhat than focusing on lowering the drug use itself. Harm discount neither excludes nor presumes the long-term therapy goal of abstinence. In some instances, reduction of degree of use could additionally be one of the effective forms of hurt discount. Balancing costs and benefits: A pragmatic means of figuring out, measuring, and assessing the relative importance of drug-related problems, their associated harms, and costs and benefits of intervention is carried out in order to focus sources on precedence issues. The evaluation extends past the instant pursuits of customers to embrace broader group and societal interests. Because of this rational strategy, harm reduction approaches theoretically lend themselves to evaluation of impacts compared to some other, or no, intervention. In apply, nonetheless, such evaluations are sophisticated due to the variety of variables to be examined in each the brief and the long term. Priority of quick objectives: Most harm reduction applications have a hierarchy of goals, with the quick focus on proactively participating people, goal groups, and communities to address their most urgent needs. Achieving probably the most immediate and practical targets is normally viewed as first steps toward risk-free use or, if applicable, abstinence. The focus is on lowering the dangerous consequences of drug use rather than on reducing drug use per se. In place of the "war" analogy and "whole victory" rhetoric, even small steps that cut back hurt are supported. For instance, intravenous use could be made safer by way of needle-exchange packages. Risk can be further lowered by substituting methadone for heroin or different authorized substances for cocaine and then by moderating the use of drugs-including nicotine and alcohol-en route to abstinence when that is attainable (Marlatt, Somers, and Tapert 1993). In a dramatic change in policy, China has moved from zero tolerance of heroin in favor needle change and methadone remedy (McNeil 2015). And hurt discount seems to sanction using illicit substances, thereby sending out "the mistaken message. Instead of focusing on preventing use, harm discount attempts to forestall abuse (Cohen 1996).

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In 2003 it was revealed that methadone, often prescribed for treating continual ache, is being diverted to the black market and abused by leisure drug customers, often with lethal penalties. There have been an alarming number of methadone overdose fatalities, which since 1997 have surpassed these from heroin. Massive quantities of prescription opiates are being stolen previous to medical dispensing and doubtlessly being fed into Copyright 2018 Cengage Learning. In 2012, authorities in New York City arrested fourteen persons for promoting prescription medicine in an open-air market. Participants would stand outside a busy prepare station pretending to be on their approach to work. But a physician prescribing high doses of pain treatment, similar to OxyContin, runs the risk of scrutiny by state and federal officers involved with prescription fraud, doctor buying, overprescribing, and the diversion of prescription drugs to the black market. Doctors receive little training in medical college about coping with ache and there are relatively few docs who focus on pain management. And prescription monitoring by authorities companies threatens to compromise the ache treatment practices which have taken a very long time to be realized, bringing the warfare on medicine directly in opposition to the warfare on ache (Fischer, Gittins, and Rehm 2008). There is growing concern over the use of prescription opioids by the elderly struggling with persistent pain. Elderly opioid customers undergo from larger unwanted effects than their younger counterparts: nausea and vomiting, which often leads to constipation requiring additional drugs, creating cycles of constipation and diarrhea. Long-term use could cause kidney and cardiac damage, and opioids affect balance, growing the hazard of falls and fractures within the aged (Span 2016). The substance was launched two decades ago to exchange sodium pentothal that has disagreeable unwanted effects. Propofol is extraordinarily dangerous-depresses respiration and blood stress to the purpose of death if not constantly monitored ("Propofol Abuse Growing Problem for Anesthesiologists" 2007; Belluck 2009). Side effects include blurred vision, loss of coordination, belly pain, and rapid heartbeat. But if an individual takes stimulants when ingesting, the mix can doubtlessly override this protective mechanism and lead to life-threatening penalties (Ashton 2008). These prescription drugs include Adderall, Concerta, Focalin, Ritalin, Provigil (monafinil), and Vyvanse; the two most popular are reportedly Adderall and Provigil. According to Margaret Talbot (2009: 32), these neuroenhancers are used by "high-functioning, overcommitted individuals to turn into higher-functioning and extra overcommitted. Alan Schwarz (2012: 1) reviews that strain over grades and competition for school admissions are encouraging high school students to resort to the nonmedical use prescription stimulants. What are the natural substances that produce results just like those of the artificial hallucinogens Like other explanations for shaping human habits, the misuse of psychoactive substances can be understood in phrases of nature v. Supporters of the nature position counsel that we will perceive conduct primarily by genetic, organic, or other properties inherent within the particular person. Proponents of the nurture position look to the social setting for causal factors; they imagine human conduct is largely the product of social interplay. A third view considers drug misuse as determined by the interaction of nature and nurture. Explanations for drug misuse typically rely upon the discipline of the observer: biology, psychology, and sociology. Although many theories of drug use offered by these disciplines may appear aggressive and even conflicting, every supplies a partial rationalization for drug misuse and has necessary treatment and policy implications. Indeed, the "real" rationalization may be a combination of biological, psychological, and sociological elements. The sociology of drug misuse notes that the phenomenon tends to be clustered in environments which are characterised by social conditions and relationships that cause despair, frustration, hopelessness, and basic emotions of alienation. However, in these environments, drug users are only a small fraction of the populace. Why do people who are uncovered to the identical bodily setting react differently to the use and abuse of drugs PsychOlOgy Of Drug use anD abuse Psychology examines individual human behavior, and clinicians try and deal with abnormal or dysfunctional conduct. Some psychological theories of drug use and abuse are primarily based on persona: "Drug addiction is primarily a character disorder. It represents one type of abortive adjustment to life that individuals with sure character predispositions could choose under appropriate situations of availability and sociocultural attitudinal tolerance" (Ausubel 1978: 77).

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Spread within the chest Tumour could immediately contain the pleura and ribs, causing pain and bone fractures. In addition, the tumour may directly contain the oesophagus, coronary heart or superior vena cava (causing upper limb oedema, facial congestion and distended neck veins). Metastatic illness Metastases are mostly to bone (presenting with ache and sometimes spinal twine compression) and mind (change in character, epilepsy, focal neurological signs). Poor prognosis Non-metastatic manifestations these are rare apart from finger clubbing (Table eleven. Approximately 10% of small cell tumours produce ectopic hormones giving rise to paraneoplastic syndromes. There are sometimes no bodily indicators, although lymphadenopathy, signs of a pleural effusion, lobar collapse or unresolved pneumonia may be present. Investigations the purpose of investigation is to affirm the diagnosis, decide the histology and assess tumour spread as a guide to therapy. Confirm the diagnosis the chest X-ray will normally be abnormal by the point a lung most cancers is causing symptoms. Tumours often seem as a spherical shadow, the edge of which regularly has a fluffy or spiked appearance. There may be proof of cavitation, lobar collapse, a pleural effusion or secondary pneumonia. Spread through the lymphatic channels provides rise to lymphangitis carcinomatosis, appearing as streaky shadowing all through the lung. A minority of tumours are confined to the central airways and mediastinum without an 556 Respiratory illness Table 11. Neurological obvious change on chest X-ray and in sufferers with suspicious symptoms. Bronchoscopy is used to obtain biopsies for histological investigation and washings for cytology. Assess spread of the tumour At bronchoscopy, involvement of the primary 2 cm of either the primary bronchus or of the recurrent laryngeal nerve (vocal wire paresis) indicates inoperability. Carcinoma of the lung 557 Determine affected person suitability for major operation Physical examination and respiratory perform checks. Treatment Treatment of lung cancer includes a quantity of completely different modalities and is greatest planned by a multidisciplinary group. Palliative radiotherapy is helpful for bone pain, haemoptysis and superior vena cava obstruction (p. Small cell lung cancer Limited illness (confined to a single anatomical or radiation field) is handled with combined chemo- and radiotherapy, with 25% survival at 5 years. Extensive disease is treated with chemotherapy, with a median survival of 9�13 months and 2-year survival of 20%. Symptomatic remedies Local therapies corresponding to endoscopic laser therapy, endobronchial irradiation and transbronchial stenting are used to treat distressing signs arising from airway narrowing. Malignant pleural effusions must be aspirated to dryness and a sclerosing agent. In the terminal phases, the standard of life must be maintained as far as possible. In addition to general nursing, counselling and medical care, sufferers may have oral or intravenous opiates for pain (given with laxatives to prevent constipation), and prednisolone might enhance the appetite. The differential prognosis is usually from other solitary nodules on the chest X-ray (Table eleven. Metastatic tumours within the lung Metastases in the lung are widespread, usually presenting as spherical shadows 1. The commonest primary sites are the kidney, prostate, breast, bone, gastrointestinal tract, cervix or ovary. Treatment is with oral analgesia, local infiltration or an intercostal nerve block.

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That the liberal Dutch angle toward medicine attracts drug traffickers is an argument "built on the belief that (potential) drug traffickers rationally consider and compare international locations in order to determine from which to operate. Collins notes that much of the Ecstasy entering different European international locations originates within the Netherlands. The Dutch have recognized this downside and responded by organising a particular nationwide unit to combat synthetic medicine. Crack cocaine has additionally been an issue in the Netherlands, though its use is primarily among a stable subset of polydrug users who also abuse heroin and methadone (de Kort and Cramer 1999). But regardless of higher visibility of drug users and the ready availability of medicine within the Netherlands, this "has not led to high(er) domestic drug use" (von Solinge 2004: 107). The most dramatic change in Western European drug policy occurred in Portugal, a country of virtually 11 million individuals and a member of the European Union that shares the Iberian Peninsula with its bigger neighbor to the east, Spain. Largely Catholic and socially conservative, Portugal had followed a prohibitive, abstinence-oriented coverage approach that criminalized and penalized not only the availability but in addition the demand for medication. This regime was characterised by a considerable interference with personal liberties by way of the criminalization and sanctioning of drug consumption and possession; it reflected a choice for defense of the person and the society towards the hazards brought on by medication. However, early in 1998, the reform-oriented Socialist government appointed an professional fee to propose a drug technique. Some months later, the fee published its report that contained a range of evidence-based recommendations for coverage reform. The fee pointed to the antagonistic effects of the restrictive method towards drug customers and recommended "decriminalization" (Adam and Raschzok 2014: 499). In 2000, the Portuguese Parliament adopted a significant drug law reform by passing a legislation that excluded illegal Copyright 2018 Cengage Learning. Instead, it introduced administrative, noncustodial sanctions for both regardless of worldwide legal commitments calling into query the conformity of this step with international regulation (Adam and Raschzok 2014). Responsibility for drug control was shifted from the Justice Department to the Health Department (Specter 2011). While drug trafficking and furnishing medication to a minor continue to be legal offenses, possession for personal use is an administrative offense-think parking tickets-not against the law. The police are required to problem citations for drug use or possession, that are referred to the Comiss�es para a Dissuas�o da Toxicodepend�ncia (Commission for Dissuasion of Drug Addiction) whose regional three-member panels-usually a lawyer, a well being care provider, and a social worker or psychologist-are liable for adjudicating administrative drug offenses and making evaluation and remedy recommendations. They have the power to impose community work and fines however focus is on getting dependent drug customers into remedy. Dilapidated housing has been changed, and at present the world is an ordinary blue-collar community with mothers pushing child strollers, males smoking outside cafes, and buses going up and down the cobbled primary avenue (Hatton and Mendoza 2010). With large sums not expended for enforcement, prosecution, and imprisonment, funding for treatment elevated and the drug-dependent, free of each stigma and prosecution, took benefit of remedy opportunities in report numbers (Greenwald 2009). As a result of the policy change, "the common public is more likely to admit to past or current drug use and to search or encourage other drug users to get hold of help. On the other hand decriminalization is seen as sending the mistaken message and rising the sense of social acceptability and tolerance of drug use" (Hughes and Stevens 2007: 7). More knowledge are required before drawing any agency conclusions, and ultimately these conclusions may only apply to Portugal and its unique circumstances, such as its history of disproportionately high rates of heroin use. Chad Nilson (2007) outlines the idea for Austrian drug coverage: There should be a balance between the use of health instruments aimed toward decreasing demand for drugs and legislation enforcement instruments geared toward lowering the supply of drugs. Because the purpose of a drug-free society is unrealistic, measures must be taken to cut back the social and bodily hurt brought on by drug use. Police officers in Austria lack the discretion frequent within the United States and other democracies-they must course of all offenses they see or investigate, even the smallest quantities of drug possession. A drug-dependent individual charged with a crime faces imprisonment during which she or he undergoes drug treatment and could be released from jail if she or he agrees to long-term remedy in the community. In a few regions in Austria, there are applications designed to reintegrate the formerly drug-dependent into the labor market by employing them in varied postal services and renovation work. Other areas present short-term housing together with employment companies to recovering drug customers (Nilson 2007). Switzerland A considerably ambiguous position between criminalization and legalization was adopted in Zurich, Switzerland: containment. Vigorous police motion drove hard-core customers into a park close to the heart of town, where open drug sale and use were tolerated.