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Thus heart attack heartburn cheap dipyridamole 100mg with visa, below the age of majority blood pressure medication safe for breastfeeding discount dipyridamole 100mg with amex, youth are not granted the right to arteria jelentese discount dipyridamole online mastercard consent to blood pressure medication kalan purchase dipyridamole now sexual practices, partnerships, or to access certain services. It is a paradox that marriage, even if not consensual, grants in some places the majority of age to individuals, including the right to engage in consensual sexual activity. In addition to laws governing age of consent, laws in many countries also set limits on the free choice of sexual partners and sexual acts. Often restricted are sexual activities or marriage between people of the same sex, between those who are not married, between partners with certain lineage relationships to each other, as well as sexual activity for immediate material gain and when there are more than two partners involved. Sexual activity between persons of the same sex is most often regulated through sodomy laws in which anal intercourse (and sometimes other practices such as oral sex) is criminalized. Such laws exist in over 80 countries (Amado, 2004; Khaxas, 2001; Ot to son, 2006; Saiz, 2004; Samelius & Wagberg, 2005). Marriage for same sex couples is likewise restricted in most countries, denying them the well-established health and social benefits that accrue from marriage (Herdt & Kirtzner, 2006). It is not uncommon for heterosexual women to be denied the right to choose their sexual partners, to choose whether and with whom they will marry, to decide whether or not to engage in sexual activity, to be free from sexual activity to which they do not consent, and to expect that their bodily integrity will be respected. For example, in Turkey, where an unmarried woman cannot decide to engage in sexual activity, virginity testing is conducted by state physicians at the request of parents or other community authorities and against the will of women and girls themselves (Girard, 2001; Lai & Ralph, 1995; Tambiah, 1995). Women’s organizations in Peru and other Latin American countries have documented challenges to women’s right to au to nomy in sexual decision-making on the part of personnel in public health facilities, particularly when women are poor or members of minority ethnic communities (Comite de America Latina y el Caribe para la Defensa de los Derechos de la Mujer and Center for Reproductive Law and Policy, 1999). In countries where the decision of whether, when and whom to marry rests with the father or male relatives, the consent of girls and women is not necessarily sought, constituting forced marriage (Amado, 2004). Once married, women in many countries, particularly in the Middle East, Northern Africa and Latin America, but also in Ireland, cannot leave the marriage, since they are denied access to, or severely limited in their ability to access, divorce (Amado, 2004; Fried & Landsberg Lewis, 2000; Shephard, 2000). Gender inequities and women’s lack of power exacerbate and are at the root of much of the world’s poverty and of maternal and child health. Poverty is also a prime determinant of maternal and child health and the three collectively influence access to and completion of primary education (especially for girls). Official acknowledgement of 31 sexual rights would set legal and policy guarantees for these recognitions, eradications, access, provisions and promotions which could then be used to develop appropriate programming, service delivery, and legal action. In Morocco, a new family law passed in 2004 gives women equality in the family (Amado, 2004), and Iran is considering modification to its family law that will place the same requirements on husbands to fulfill the sexual needs of their wives that have been the long-term legal obligation of wives with respect to their husbands (Iran news paper July, 27th 2005). These contribute to gender equity, the experience of a sexually pleasurable and fulfilling life, and to respect for women’s right to self-determination in the choice of marital and sexual partners, without fear of punishment. Women’s right to reproductive self-determination is supported by change in abortion laws. Since 1995, fifteen countries have passed laws liberalizing access to safe abortion. Included among these are Benin, Burkina Faso, Chad, Guinea, Mali and Nepal which formerly had some of the most restrictive laws. Five countries, however, (El Salvador, Ireland, Hungary, Poland, Russian Federation, and the United States) have made access to abortion more legally restrictive (Center for Reproductive Rights, 2005). However, as evidenced in examples from several countries, and also experienced in the work of one of the authors (Maticka-Tyndale) in Kenya, such laws have often driven the practice underground. As mentioned above, concern for the bodily integrity of boys is evidenced in the policies set by various national medical associations (American Academy of Pediatrics Task Force on Circumcision, 1999; American Medical Association, 1999; Australian College of Paediatrics (1996); Fetus and Newborn Committee, 1996) that discourage routine circumcision of male infants on the grounds of “insufficient evidence of its beneficial health effects”. G) the Need for Positive Rights and Enabling Conditions Positive rights and enabling conditions are those that speak to the ability of persons to act as they choose and to make their own decisions. There has been a gradual move to ward recognition of the right of same sex couples to marry, adopt and raise children, and to benefit from the social and legal status of spouse in a growing number of 32 countries. In 1994, South Africa became the first country to incorporate nondiscrimination based on sexual orientation in its constitution. Information, education and sexual and reproductive health services are advocated as sexual rights themselves and also comprise a component of the enabling conditions that make it possible for people to act on other sexual rights. Services have been expanded to address the sexual and reproductive health needs of couples as well as women, and of those outside the reproductive years. Several programs have begun to incorporate programming for men, particularly in relation to gender equity or violence. Several organizations in Latin America are working from a sexual rights orientation. In Canada, coalitions of organizations representing sex workers and university-based researchers have used rights-based approaches to research and advocate for legal and policy changes to support the 33 programmatic work of sex worker organizations that target the health, safety and well being of sex workers. Finally, Cabal, Roa and Sepulveda-Oliva (2003) remind us that courts, using international treaties, provide a venue for bringing about change, especially when there is a disconnect between international, constitutional and legislative norms and the realities of people’s lives (Cabal, Roa and Sepulveda-Oliva, 2003). Organizations in Latin America have pioneered use of courts and international litigation as strategies to improve national legislation and policies to the benefit of women and girls (see Cabal, Roa and Sepulveda-Oliva, 2003: p. These illustrations of legislation, policy and programs that promote sexual rights have been developed in the absence of any international treaties or formal recognitions of sexual rights per se. Instead, they have used international human rights conventions or local agreements to advance these initiatives. The existence of a sexual rights dialogue has been sufficient to advance these actions. Overcoming the Complexities of and Challenges to Sexual Rights While evidence of the need for and possibilities resulting from a formal acknowledgement of sexual rights appears compelling, the complexity and challenge of achieving such an acknowledgement must be recognized. It is of paramount importance to raise two such challenges: fi the challenge of expanding the domain of a rights-based approach; fi the challenge of developing and establishing a method for reaching international acknowledgement of sexual rights. The persistence of violations to human rights related to sexuality, despite wide endorsement of such treaties and conventions and the actions taken by watchdog committees, alerts us to the limitations of such treaties and conventions in advancing a rights agenda. We are reminded by legal scholars and rights 34 advocates such as Wilets (1997) of three key limitations of such treaties and agreements. First, although most are widely endorsed (Office of the United Nations High Commissioner for Human Rights, 2004), they are non-binding in nature and defer to national laws and cus to ms when issues are in contention. Thus, for example, in states whose medical professionals view homosexuality as a disease whose public expression fosters its spread (as is the case in most Islamic countries), what have been presented in this paper as violations of rights are seen instead as consistent with the right to treatment of people suffering from a disease and the right of the public to protection from the spread of a preventable disease. Second, treaties and agreements address the responsibilities of states and agents of States, but have little or no influence over civil society. This is illustrated in the examples of Egypt, Kenya and other countries where, despite bans on female genital cutting, it is still practiced. It is also seen in Canada (and other countries) where, despite laws prohibiting hate crimes as well as physical assault, gay men are still the victims of assaults and murder perpetrated by private citizens or vigilante groups (Janoff, 2005). Third, the legal frameworks accessed through rights agreements are better able to forbid or prevent physical harm than to promote positive rights. This is particularly salient when we consider that the exercise of many rights is premised on the idea of consent (consensual relationships, sexual acts, marriage). Research in diverse settings has raised the question of whether consent is possible without enabling conditions. Economic and social conditions may, for example, place severe limitations on possible alternatives. Thus, young girls consent to sexual relations or marriage when they have no other way to meet economic needs or to hold a socially endorsed status in their community (Maticka-Tyndale, Gallant, Brouillard-Coyle, et al. Similarly, widows may consent to sexual intercourse with a male relative or community member in order to maintain their economic and social position in the community (Luginaah, Elkins, Maticka-Tyndale, Landry & Muthui, 2005). The role of economics is also evident in Romania and other countries in Central and Eastern Europe where legal and often free abortions are used for birth control rather than high cost, difficult to access contraceptives (Mertus, 2001; Yamin, 2004) raising the question of whether women have freely chosen methods to control their fertility or have been coerced by economic circumstances. These limitations illustrate the divide between international treaties and agreements, or even national laws, and the local realities of people’s lives where a multiplicity of interdependent conditions influence the actions they take. The consequences of a disconnect between raising awareness of rights and having enabling conditions in place for the actualization of such rights is poignantly illustrated in events reported in Ilam province, Iran. Raising women’s “awareness and demands” through education in Ilam province is credited with contributing to a substantial rise in suicide rates among women in the province in 2004. Heyran Pour-Najaf, an advisor to the Ilam governor, 35 reasoned that women had immolated themselves to protest “appalling family conditions” when they were unable to attain the “rights” of which they had learned (Ilam Suicide High Rate, February 28, 2005). Great care must be taken in interpreting information pointing at the association between positive health outcomes and legislation restrictive of sexual rights. While gains can be documented with vertical programs and prescriptive and restrictive approaches, especially at the initial stages of a health program or initiative, backlashes may occur as a result of behavioral disinhibition caused by oppressive conditions and attainment of physical health without complete wellness and well-being. The Challenge of Developing and Establishing a Method for Achieving International Consensus Sexual rights cut to the core of deeply held beliefs about the nature of being human, individual and group identities, and the moral order. As such, they stir heated debate and resistance that has prevented any movement to ward consensus or acknowledgement. Bauman (1993), in Post-Modern Ethics, provides a convincing argument for the need for a novel approach to addressing global ethical dilemmas, such as that posed by sexual rights. Plummer (2003) and Correa and Parker (2004) describe such an approach, consisting of open, reciprocal, communicative dialogue for establishing international codes and consensus.

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In 2011 blood pressure chart tracker cheap dipyridamole 100mg with visa, there recent year for which data were available) cost $11 billion were 5 pulse pressure 68 cheap dipyridamole express. Peer support: Structured relationship in which people meet to heart attack 30 year old female order dipyridamole no prescription Compulsive: Type of behavior a person exhibits that is overpow provide or exchange emotional support with others facing ering class 4 arrhythmia drugs generic dipyridamole 100mg fast delivery, repeated, and, often, irrational. Peer- to -peer groups, such as Alcoholics Craving: Powerful desire for a substance that cannot be ignored. Care Setting Related Concerns Client is treated inpatient on behavioral unit or outpatient in Alcohol: acute withdrawal, page 800 a day program or community agency. Psychosocial aspects of care, page 729 Client Assessment Database Data depend on substances involved, duration of use, and organs affected. Convey attitude of acceptance, separating individual from Promotes feelings of dignity and self-worth. Ascertain reason for beginning abstinence and involvement in Provides insight in to client’s willingness to commit to long therapy. Review definition of drug dependence and use with categories this information helps client make decisions regarding accept of symp to ms, including risk fac to rs, patterns of use, impair ance of problem and treatment choices. Provide information about addictive use versus experimental, Progression of use continuum ranges from experimental or occasional use; biochemical and genetic disorder theory— recreational to addictive use. Comprehending this process genetic predisposition, use activated by environment; and is important in combating denial. First step in decreasing use of denial is for client to see the re lationship between substance use and personal problems. Because denial is the major defense mechanism in addictive Use confrontation with caring attitude. Provide information regarding effects of addiction on mood Individuals often mistake effects of addiction and use this to and personality. Be alert to changes in behavior such Confrontation can lead to increased agitation, which may com as restlessness and increased tension. Provide positive feedback for expressing awareness of denial Necessary to enhance self-esteem and to reinforce insight in to in self and others. Maintain firm expectation that client attends recovery support Attendance is related to admitting need for help; to working and therapy groups regularly. Encourage and support client’s taking responsibility for own Denial can be replaced with positive action when client accepts recovery, such as development of alternative behaviors to the reality of own responsibility. Understand professional Caregiving lends itself to “taking care” of clients that can back boundaries needed to be therapeutic with client experiencing fire in substance abuse treatment. Having information provides opportunity for client to cooper ate and function as a member of the group or milieu, en hancing sense of control and sense of success. Determine understanding of current situation and previous Provides information about degree of denial, acceptance of or other methods of coping with life’s problems. Set limits and confront efforts to get caregiver to grant special Client has learned manipulative behavior throughout life and privileges, making excuses for not following through on needs to learn a new way of getting needs met. Following agreed-upon behaviors, and attempting to continue drug through on consequences of failure to maintain limits can use. Use of labels promotes negative attitudes that can impede therapeutic relationships. Lack of understanding and judgmental or enabling behaviors can result in inaccurate data collection and nontherapeutic approaches. Client may have little or no knowledge of adaptive responses to stress and needs to learn other options for managing time, feelings, and relationships without drugs. Assist client to learn and encourage use of relaxation skills, Helps client relax and develop new ways to deal with stress guided imagery, and visualizations. Structure diversional activity that relates to recovery such as Discovery of alternative methods of coping with drug hunger social activity within support group, wherein issues of being can remind client that addiction is a lifelong process and chemically free are examined. Being aware of the triggers provides an opportunity to plan for ways to avoid and deal with them. Have client Therapeutic writing or journaling can enhance participation in begin journaling or writing au to biography. Au to biographical activity provides an opportunity for client to remember and identify sequence of events in his or her life that relate to current situation. Devising a comprehensive strategy for avoiding relapses helps client in to maintenance phase of behavioral change. Collaborative Administer medications, as indicated, for example: Disulfiram (Antabuse) this drug can be helpful in maintaining abstinence from alcohol while other therapy is undertaken. By inhibiting alcohol oxi dation, the drug leads to an accumulation of acetaldehyde with a highly unpleasant reaction if alcohol is consumed. This agent may become drug of choice because it does not make the user sick if alcohol is consumed; it has no sedative, anti-anxiety, muscle-relaxant, or antidepressant properties and produces no withdrawal symp to ms. Buprenorphine (Buprex, Subutex, Suboxone) Used in the treatment of opioid addiction. At low doses it pro duces sufficient agonist effect to enable opioid-addicted individuals to discontinue the misuse of opioids without experiencing withdrawal symp to ms. This drug carries a lower risk of abuse, dependence, and side effects compared to full opioid agonists (Liber to, 2013). It can allow the individ ual to maintain daily activities and ultimately withdraw from drug use. Harm reduction needs to be considered versus the possibility of exchanging one addic tion for another (Tetrault, 2012). Used to suppress craving for opioids and may help prevent re lapse in the client abusing alcohol. Current research sug gests that naltrexone suppresses urge to continue drinking by interfering with alcohol-induced release of endorphins (Tetrault, 2012). Refer to community or social resources such as housing assis Dealing with life problems in a proactive way enhances coping tance, employment agencies, childcare, food stamps, or abilities, reduces sense of isolation and hopelessness, and alternative schooling. Verbalize acceptance of need for treatment and awareness that willpower alone cannot control abstinence. Discuss in a caring, In the precontemplation phase, the client has not yet identi nonjudgmental manner how drug has interfered with life. While client is hurting, it is easier to admit substance use has created negative consequences. Brains to rming helps creatively identify possibilities and pro vides sense of control. During the preparation phase, minor action may be taken as individual organizes resources for definitive change. Support decision and implementation of selected Helps the client persevere in process of change. Encourage sharing about drug Client may need assistance in expressing self, speaking about hunger, situations that increase the desire to indulge, and powerlessness, and admitting need for help in order to face ways that substance has influenced life. Assist client to learn ways to enhance health and structure Learning to empower self in constructive areas can strengthen healthy diversion from drug use, including maintaining a ability to continue recovery. These activities help res to re balanced diet; getting adequate rest; exercise such as walk natural biochemical balance; aid de to xification; and manage ing; slow or long distance running; and acupuncture, stress, anxiety, and use of free time. Provide information regarding understanding of human behavior Understanding these concepts can help the client to begin to and interactions with others, such as transactional analysis. Although not manda to ry for recovery, surrendering to and faith in a power greater than oneself has been found to be effective for many individuals in substance recovery; may decrease sense of powerlessness. Effective in helping refrain from use, to s to p contact with users and dealers, to build healthy relationships, and to regain control of own life. Helps client know what to expect, and creates opportunity for client to be a part of what is happening and make informed choices about participation and outcomes. Collaborative Refer to, or assist with making contact with, programs for Continuing treatment is essential to positive outcome. Follow ongoing treatment needs—partial hospitalization drug through may be easier once initial contact has been made. Take anthropometric measurements, such as midarm muscle Calculates subcutaneous fat and muscle mass to aid in deter circumference, triceps skinfold, and percentage of body fat, mining dietary needs. Recommend client maintain a Information will help identify nutritional deficiencies. Provide opportunity to choose foods and snacks to meet dietary Enhances sense of control, may promote resolution of nutri plan. Useful in establishing individual dietary needs and plan, and provides additional resource for learning.

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Stress importance of increased fluid intake heart attack grill purchase 25 mg dipyridamole mastercard, such as 3 to hypertension 5 hour energy dipyridamole 100 mg with mastercard 4 L/day Flushes renal system fetal arrhythmia 37 weeks 100mg dipyridamole amex, decreasing opportunity for urinary stasis if not contraindicated blood pressure 9460 best order for dipyridamole. Increased fluid losses or dehydration and excessive diuresis or diaphoresis and to increase fluid require additional intake beyond usual daily needs. Review dietary regimen, as individually appropriate, for example: Diet depends on the type of s to ne. Understanding reason for modifications provides opportunity for client to make in formed choices, increases cooperation with regimen, and may prevent recurrence. Low-purine diet, such as limited lean meat, turkey, legumes, Decreases oral intake of uric acid precursors. Note: Research sug beverages, beets, nuts, rhubarb, strawberries, spinach, and gests that daily inclusion of coffee, tea, beer, or wine de wheat bran creases the risk of s to ne formation, whereas regular intake of apple or grapefruit juice increases the risk (Finkielstein & Goldfarb, 2006). Although not advocating high-calcium diets, researchers are Use calcium citrate when supplements are required. Research sug gests that restricting dietary calcium is not helpful in reduc ing calcium s to ne formation and may actually increase oxalate formation. Encourage foods rich in magnesium and vitamins B and K these nutrients reduce s to ne formation. Note: Some herbal supplements—valerian, skullcap, wild yam, khella, and marshmallow—are known to have antispas modic properties or are soothing to irritated urinary tissues. Encourage client to reveal all medications and herbals to To reduce risk of dangerous interactions and side effects. Cigarette smoking may contribute to kidney s to nes because it increases urine levels of cadmium, a heavy metal. Inactivity contributes to s to ne formation through calcium shifts and urinary stasis. Active-listen concerns about therapeutic regimen and lifestyle Helps client work through feelings and gain a sense of control changes. Identify signs and symp to ms requiring medical evaluation, With increased probability of s to ne recurrence, prompt inter such as recurrent pain, hematuria, and oliguria. Note: Rate of recurrence at 1 year is 14%; at 2 years, 35%; and at 10 years, 52% (Wolf, 2013). Can be performed in presence of mild to moderate emotional stress adhesions or large uterus c. A single abdominal incision is used instead of three or traumatic complication; irreparable rupture of the uterus iii. Total: removal of the uterus and cervix hysterec to mies were performed annually, and during that iii. Total with bilateral salpingo-oophorec to my: removal of four-year period an estimated 3. Mortality: Death rate is reported as 1 per thousand (Encyclo oophorec to my, to tal cystec to my, and abdominoperineal pedia of Surgery, n. Endometriosis: Ec to pic endometrial tissue found outside the Menopause: Permanent cessation of menstrual activity. Prolapse accounts for about 5% of hysterec to mies 20% of hysterec to mies (Gor, 2012). Psychosocial aspects of care, page 729 Surgical intervention, page 762 Thrombophlebitis: venous thromboembolism, page 109 Client Assessment Database Data depend on the underlying disease process and the need for surgical intervention—cancer, prolapse, dysfunctional uterine bleeding, severe endometriosis, or pelvic infections unresponsive to medical management—and associated complications, such as anemia. Evaluates abnormal growths inside the uterus, lining of the uterus, and deeper tissue layers. Investigate reports of discomfort, fullness, and Perception of bladder fullness and distention of bladder above inability to void. Provide routine voiding measures, such as privacy, normal Promotes relaxation of perineal muscles and may facilitate position, running water in sink, and pouring warm water voiding efforts. Provide and/or encourage good perineal cleansing and catheter Promotes cleanliness, reducing risk of ascending urinary tract care when present. Urinary retention, vaginal drainage, and possible presence of intermittent or indwelling catheter increase risk of infection, especially if client has perineal sutures. Collaborative Catheterize when indicated per pro to col if client is unable to Edema or interference with nerve supply may cause bladder void or is uncomfortable. Note: Indwelling urethral or suprapubic catheter may be inserted intraoperatively if complications are anticipated. Maintain patency of indwelling catheter; keep drainage tubing Promotes free drainage of urine, reducing risk of urinary stasis free of kinks. May not be emptying bladder completely; retention of urine in creases possibility for infection and is uncomfortable, even painful. Note abdominal distention and Indica to rs of presence or resolution of ileus, affecting choice of presence of nausea or vomiting. Encourage adequate fluid intake, including fruit juices, when Promotes softer s to ol; may aid in stimulating peristalsis. Provide clear or full liquids and advance to solid foods as When peristalsis begins, food and fluid intake promote resump to lerated. Administer medications, such as s to ol softeners, mineral oil, Promotes formation and passage of softer s to ol. Inspect dressings and perineal pads, noting color, amount, and Proximity of large blood vessels to operative site and/or poten odor of drainage. Weigh pads and compare with dry weight tial for alteration of clotting mechanism. Turn client and encourage frequent coughing and deep-breathing Prevents stasis of secretions and respira to ry complications. Assist with and instruct in foot and leg exercises and ambulate Movement enhances circulation and prevents stasis complica as soon as able. Note erythema, swelling of extremity, or reports of sudden chest May be indicative of development of thrombophlebitis and pain with dyspnea. Identify satisfying and acceptable sexual practices and alternative ways of dealing with sexual expression. Provide open environment Sexual concerns are often disguised as humor and/or offhand for client to discuss concerns about sexuality. An open environment promotes sharing of beliefs or values about sensitive subject and identifies misconcep tions or myths that may interfere with adjustment to situa tion. Changes in hormone levels can affect libido and decrease suppleness of the vagina. Although a shortened vagina can eventually stretch, intercourse initially may be uncomfortable or painful. Acknowledging normal process of grieving for actual or per ceived changes may enhance coping and facilitate resolution. Open communication can identify areas of agreement and problems and promote discussion and resolution. Problem-solve solutions to potential problems, such as Helps client return to desired and satisfying sexual activity. It postponing sexual intercourse when fatigued, substituting may be of help to the client/partner to learn that there is alternative means of expression, using positions that avoid abundant evidence in the medical literature supporting fa pressure on abdominal incision, and using vaginal lubricant vorable sexual outcomes from hysterec to my (Katz, 2003) or vaginal estrogen product. Discuss expected physical sensations or discomforts and Vaginal pain may be significant following vaginal procedure, changes in response, as appropriate to the individual. Research data show a trend to ward more problems with lubrication, arousal, and altered genital sensation after to tal hysterec to my as compared to vaginal hysterec to my. Note: Many women experience few negative effects because fear of pregnancy is gone, and relief from symp to ms often improves sexual pleasure. Discuss client’s perceptions of self, related to anticipated Research supports the idea that hysterec to my is physiologi changes and her specific lifestyle. The prospect of hysterec to my is said to engender more stress than other comparable surger ies. Cultural beliefs may result in delaying needed surgery, increasing risk of complications and negatively impacting recovery (Augustus, 2002). Although preoperative instruction and interaction are often performed at the community level, the pos to perative care providers can convey interest and concern and make opportunities for support, teaching, and correction of misconceptions, such as loss of femininity and sexuality, weight gain, and menopausal body changes. Determine client’s perception and meaning of current and past Affects client’s response and needs to be acknowledged in losses.

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It is a signa to ry to three major international drug control treaties: Airports and maritime ports are gateways for the 1961 Single Convention on Narcotic Drugs; imports of illicit drugs. Serious and organised the 1971 Convention on Psychotropic crime groups may target ‘trusted insiders’ Substances; and the 1988 Convention against working in these environments to help facilitate the Illicit Traffic in Narcotic Drugs and the movement of illicit drugs and avoid law Psychotropic Substances. It forensically processing, quarantine services and aircraft examines international mail items containing and vessel maintenance. Back-office staff with illicit commodities to gather all available access to systems and sensitive information forensic intelligence. Moni to ring changes in the precursors throughout the supply chain, including at entry used or manufacturing methods can also inform points at sea ports and airports. In 2013-14 alone, the work of multi-agency taskforces targeting criminal exploitation of Commonwealth law enforcement agencies have Australian ports and related supply chain also partnered with state and terri to ry law activity at the waterfront in Sydney, Melbourne enforcement agencies to pursue criminal and Brisbane resulted in 56 arrests and the syndicates importing drugs through the post. Disrupting mail imports However, the average size and sophistication of detected labora to ries has increased. Jurisdictional drug squads target groups responsible for trafficking, supply and Local police in each state and terri to ry play an manufacture of ice, either independently or in important role in efforts to tackle ice in their partnership with other agencies. Their local knowledge and links suspicious transactions regarding precursor with the community are fundamental to chemicals, detect and dismantle clandestine responses on the ground and actions to ensure labora to ries and protect the community from the safety of local populations. Many state and harms caused by methamphetamine terri to ry police forces also undertake roadside manufacture and use. The proportion of target methamphetamine manufacture and national illicit drug-related arrests associated distribution including ice. Commonwealth, state with amphetamine-type stimulants also and terri to ry justice and law enforcement increased over this period from 16. The priority under the National Organised Crime average cus to dial sentence for illicit drug Response Plan 2015-18. The National Law offences generally across Australia in 2013-14 Enforcement Methylamphetamine Strategy is was 26 months,426 but data by drug type is not one component of this broader plan. Significant trafficking of methamphetamine Some data is available at the state level, occurs between jurisdictions, and multi-agency however. For example, in Vic to ria, and multi-jurisdictional taskforces are also methamphetamine accounted for 42 per cent tackling components of the ice problem of drug trafficking offences between 2008-09 nationally. The responses to serious and organised crime median to tal effective term of imprisonment activities and harnesses the specialised skills of was four years and six months (see Table 4. For example of multi-jurisdictional of trafficking in a commercial quantity of cooperation was the establishment of Task amphetamine-type stimulants are Force Morpheus to investigate, disrupt, disable predominately sentenced to imprisonment— and dismantle the criminal activity of Australia’s between 84 and 94 per cent (as opposed to highest-risk outlaw mo to rcycle gangs and their other penalties such as home detention, members. The snapshot of profiling of state and terri to ry illicit drug sentencing data from Vic to ria and New South samples, including methamphetamine. It emerging threats before they become cooperates closely with Commonwealth, state entrenched. Approximately 90 per cent of the illicit Fusion Capability provides a particular means to drugs, precursor chemicals and cash seized exploit intelligence available nationally. It criminal proceeds—can be linked to the applies advanced computer technology to methamphetamine market. More than remote localities; a lack of appropriate $70 million in estimated asset value has been detention facilities; distances involved; and a seized or restrained this financial year as a lack of sentencing options available to result of this work. Unexplained initiatives designed to reduce the supply of illicit wealth laws are a to ol used to achieve this. In the these laws allow a court to require suspected Northern Terri to ry, police have enhanced criminals to demonstrate how they acquired search and seizure powers to intercept alcohol their assets, rather than law enforcement and kava destined for Indigenous communities. They complement other powers so police can also target suspected drug criminal asset confiscation options and are traffickers; these laws are aimed at s to pping intended to deter criminals by reducing the the distribution and use of methamphetamine, profitability of illegal activities and diminishing and will be modelled on existing South their ability to finance other illegal acts. Australian legislation where specific roads can be declared as ‘drug transit routes’. Unexplained wealth laws are a means of disrupting criminal enterprises and targeting the Commonwealth Government also provides senior organised crime figures behind criminal funding to police forces in the Northern activity who derive substantial profit from it but Terri to ry, South Australia and West Australia to distance themselves from the actual operate Substance Abuse Intelligence Desks commission of the offence to avoid and Dog Operations Units. Recent better relationships between communities and legislative amendments to the Commonwealth police. Community Engagement Police Officers Proceeds of Crime Act 2002 aim to strengthen are sworn police officers who support other the Commonwealth regime for unexplained general duties police, including in remote wealth investigations and litigation. They help to promote awareness of social issues around alcohol and Countering supply to Indigenous substance misuse. These residents support chemicals that can only be imported in to programmes to reduce crime in their Australia with a permit or licence. In particular, the Precursor controls schedules of controlled chemicals differ between the Commonwealth, states and Effective controls over chemicals that can be terri to ries—meaning some chemicals controlled used in drug production are essential to reduce in the states and terri to ries can be imported to the supply of ice. Australian governments work Australia without restriction, and some at state and terri to ry level, nationally and chemicals controlled in one state or terri to ry are internationally, including through the not controlled in others. In most jurisdictions, suppliers precursor controls have also contributed to the must retain these documents for a certain significant fall in the number of clandestine period of time and make them available to law methamphetamine labs detected in Australia enforcement on request. This has about precursor sales through an online created substantial challenges for law searchable database. The penalty for the of Precursor Chemicals and Equipment in importation/exportation of commercial May 2010. The framework aims to reduce the quantities is up to 25 years imprisonment diversion of precursor chemicals and related and/or $850,000. The Cus to ms (Prohibited equipment for illicit use, while minimising the Imports) Regulations 1956 also lists precursor compliance burden for legitimate industry. Diversion programmes, drug At the Law, Crime and Community Safety Council meeting on 22 May 2015, courts and manda to ry Commonwealth, state and terri to ry law treatment enforcement and justice Ministers agreed to work to ward more nationally consistent precursor controls and to arrange public Criminal justice diversion consultations on a range of proposals. The and Community Safety Council Ministers are type of diversion programmes vary across scheduled to consider the outcomes of this Australia, with different policies and legislation study in the first half of 2016. They can be applied at any point in the law enforcement cycle, from Industry regulation before arrest, to post-sentencing. Australia’s chemical and scientific industries, in Diversion programmes work to break the cycle partnership with law enforcement agencies of offending by diverting offenders away from from around Australia, developed a Code of the criminal justice system to wards appropriate Practice for Supply Diversion in to Illicit Drug drug-based assessment, education and Manufacture in 1994. These programmes were provide a best practice guide for companies to once seen as controversial,438 but are prevent the diversion of legitimate industrial increasingly seen as a pragmatic response, and chemicals to illicit drug manufacture. It outlines have become one of the most used policy procedures for secure s to rage, sales interventions in Australia. They seek to direct of the procedures described in it are also set offenders in to activities that will benefit both out in state and terri to ry legislation. Vic to ria’s diversion drugs also rely on cooperation from the private programme, for example, has been successful sec to r. The Pharmacy Guild of with rehabilitation and providing magistrates with increased flexibility. These programmes can increase the Manda to ry treatment efficiency of the criminal justice system by reducing costs incurred through police Manda to ry treatment programmes for severe investigations, hospitalisation, criminal activity, substance dependence operate outside the correctional facilities and probation criminal justice system in Australia. While there are dependence: New South Wales; Vic to ria; the, Northern Terri to ry; and Tasmania. The legislation in consider drug cases and are overseen by a New South Wales, Vic to ria and Tasmania magistrate who moni to rs the conduct of provides for manda to ry treatment for people individual drug offenders over an extended dependent on alcohol and other drugs, while period of time. They are also supported by a the Northern Terri to ry’s legislation applies only multidisciplinary team, which assesses and to alcohol and volatile substance misuse (such moni to rs offenders. Drug courts perform a dual role by punishing There are common features between the criminal behaviour through sentencing and legislative regimes operating in Australia. Under arranging rehabilitation services for offenders the New South Wales, Vic to rian and Northern to address their substance use. The use of drug Terri to ry regimes, manda to ry treatment can only courts has been found to have a substantial be authorised where a person is at risk of impact in reducing the rate of adult reoffending, serious harm, and less restrictive means are relative to traditional criminal justice not available. The who successfully completed the Drug Court objectives of the schemes include stabilising programme (relative to a comparison group) health and enhancing capacity to make future were: decisions about substance use and personal welfare. In Vic to ria, detention is review of the South Australian Drug Court found limited to 14 days. In Tasmania, a person can that two-thirds of participants did not complete be detained for up to six months, with potential the programme,445 whereas a 2008 study of the for a further six months if a responsible medical Vic to rian drug diversion programme found that officer believes it is necessary. In the Northern 75 per cent of participants did complete the Terri to ry, the period of detention for volatile programme.

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