Transcript Drug Policy and the Public Good

Drug Policy
and the Public Good
Ingeborg Rossow,
Norwegian Institute for Alcohol and Drug Research
Presentation at ECAD Mayors’ conference, Varna May 13th 2011
The literature review
Characteristics of Addiction-focused, Integrative
Policy Research Projects
 A programmatic sequence of integrative
literature reviews and statistical reporting
organized around a common theme.
Characteristics of Addiction-focused, Integrative
Policy Research Projects
 Typical duration: 2 to 5 years.
Characteristics of Addiction-focused, Integrative
Policy Research Projects
 Rely heavily on the population-based public
health sciences, such as epidemiology,
medical sociology and health economics.
Characteristics of Addiction-focused, Integrative
Policy Research Projects
 Interdisciplinary, cross-national
collaboration among social and behavioral
scientists.
Characteristics of Addiction-focused, Integrative
Policy Research Projects
 Intellectual independence
 Managerial autonomy
Characteristics of Addiction-focused, Integrative
Policy Research Projects
 Sponsored by professional societies and
public health organizations
WHO Global Burden of Disease Project
Leading risk factors as causes of disease burden (DALYs)
High income countries
1
Tobacco
10.7
2
Alcohol
6.7
3
Overweight/obesity
6.5
4
High blood pressure
6.1
5
High blood glucose
4.9
6
Physical inactivity
4.1
7
High cholesterol
3.4
8
Illicit drugs
2.1
9
Occupational risks
1.5
10 Low fruit/veg intake 1.3
WHO Global Burden of Disease Project
Leading risk factors as causes of disease burden (DALYs)
Middle income countries
1
Alcohol
7.6
2
High blood pressure
5.4
3
Tobacco
5.4
4
Overweight/obesity
3.6
5
High blood glucose
3.4
6
Unsafe sex
3.0
7
Physical inactivity
2.7
8
High cholesterol
3.4
9
Occupational risks
1.5
10
Low fruit/veg intake 1.3
Relations among drug use,
mediating variables and consequences
Pattern of use
Type of Substance
Intoxication
Toxic
effects*
Chronic
Disease
Dependence
Accidents/Injuries
(acute disease)
Acute
Social
Problems
Chronic
Social
Problems
Mean harm scores for 20 substances
Source: Nutt et al. (2010)
The ’drug problem’

Individual level
– Consequences of drug use
– Drug use associates

Society level
– Prevalence of users and harm to users
– Harm to others
– Concentration
Spatial
 Temporal

The policy ’tool box’

Supply control
– Cultivation, production, trafficking
– Enforcement, interdiction, incarceration

Demand reduction
– Education, community prevention
– Early intervention
– Treatment, harm minimization
What works?
Summary of policy options reviewed in
Drug Policy and the Public Good
Types of Evidence
Randomized controlled clinical trials
 Descriptive epidemiology
 Quasi-experimental/correlational
studies
 Natural experiments
 Qualitative research
 Health services research
 Historical research

Supply Control


Restrictions on drug supply are directed at
different stages of the drug distribution chain,
including cultivation, production, and
trafficking.
Research indicates that efforts by developed
countries to curtail cultivation of drugproducing plants in developing countries have
not reduced aggregate drug supply or use in
downstream markets.
Supply Control

The lack of systematic research on the policy
options most often used to control drug supply
(e.g., enforcement, interdiction, incarceration)
poses a major barrier to applying these
measures effectively.
Supply Control

There is a general imbalance between supply
control and demand reduction activities and
investments in most countries
Demand Reduction:
Prevention

School-based drug education and
community prevention programs have
a collectively modest impact.
Demand Reduction:
Prevention

Early intervention programs have shown
more promise, especially when screening
and brief interventions are conducted
systematically in primary care and other
health care settings.
Demand Reduction:
Treatment and Harm Minimization

Services for opiate dependent individuals
have the strongest supporting evidence;
and they are also effective ways to reduce
drug-related crime and the spread of HIV
infection.
Demand Reduction:
Treatment and Harm Minimization

Some harm reduction programs, such as
needle exchange programs, may reduce
high risk injection practices and engage
injection drug users in treatment and
health services.
The Synergistic Relationship between
Supply Control and Demand Reduction


Public health measures are designed to
complement rather than supplant supply
control approaches to drug misuse.
For example, enforcement of drug laws
can channel large numbers of drug users
into treatment through diversion schemes
that provide alternatives to incarceration.
CONCLUSIONS

1. There is no one “drug problem” within
or across countries, nor is there one “silver
bullet” that will solve “the” drug problem
CONCLUSIONS

2. Many supply control policies have
unintended consequences, and therefore
should be viewed with a sense of caution
CONCLUSIONS

3. Efforts to control drug supplies in low
income countries have not achieved their
intended aims
CONCLUSIONS

4. Approaches based on incarceration of
drug users are also unlikely to achieve
their intended aims
CONCLUSIONS

5. Demand reduction policies can make a
positive difference in many countries,
especially treatment, harm reduction and
early intervention
CONCLUSIONS

6. Public health concepts and programs
linked to demand reduction have been
underutilized and could make a positive
contribution to drug control efforts.
CONCLUSIONS


7. A considerable amount of scientific
research is available to inform the
development and implementation of
effective drug policy.
Among the 43 options presented in the book,
17 show some evidence of effectiveness in at
least one country.
CONCLUSIONS


8. Yet, current drug policy in most societies
takes little or limited account of this research
Policies that have shown little or no evidence
of effectiveness continue to be the preferred
options of many countries and international
organizations.
Thank you!