Transcript File - Lawrence Phillips

An MCDA framework for evaluating
and appraising government policy
for psychoactive drugs
Professor Larry Phillips
London School of Economics
and
Facilitations Limited
OR58 Annual
Conference
7 September 2016
2
Context
• Collaboration: DrugScience + Frisch Centre
▫ DrugScience (Professor David Nutt is founder and Chair)
▫ Ragnar Frisch Centre for Economic Research (Ole Rogeberg is
the lead researcher)
▫ Funded by the Norwegian Research Council.
• Purpose
▫ Develop an analytic framework for describing, measuring,
assessing and discussing drug policy
• Decision conferences
▫
▫
▫
▫
10-11 September 2015 and 20-21 January 2016
18 participants, various backgrounds
Phillips & Nutt facilitating
Three models to test framework: alcohol, cannabis and heroin
3
Policy (Strategy) Table
Production
Sale/distribution
Illegal (strong
sanctions)
Illegal (weak sanctions de jure or de facto
decriminalized)
Illegal (strong
sanctions)
Illegal (weak sanctions de jure or de facto
decriminalized)
Purchase
Purchase volume
(for legal users)
None - illegal
Illegal (strong
sanctions)
Illegal (weak sanctions - Per person quotas
de jure or de facto
decriminalized)
Per purchase quotas
Legal with restrictions Only gifting between
for individuals (e.g,
individuals (no money
legal to brew wine, not involved)
spirits; grow cannabis,
not more than 5 plants,
grow "magic mushrooms" in limited
volume)
Only adult licensed
users (e.g., tested for
knowledge of harms
and principles of safe
use)
Legal with restrictions
for groups (e.g.,
cannabis clubs where
users combine to
finance growing for
members)
State-run retail stores
(e.g., state alcohol
monopolies)
Only adults (age
restrictions)
Self set quotas
changeable with lag
State controlled
State-licensed retail
stores or pharmacies
No restrictions
No restrictions
No restrictions for
companies
Only mail-order
No restrictions for
companies or
individuals
No restrictions - any
retail store
Possession
Use
Illegal (strong
sanctions)
Illegal (weak sanctions de jure or de facto
decriminalized)
Illegal (strong
sanctions)
Illegal (weak sanctions de jure or de facto
decriminalized)
Limited quantity per
person (e.g., for
personal use)
Only in specific,
certified venues (e.g.
pubs or on-site
consumption with
monitoring such as user
rooms or use retreats)
34,300 combinations
No restrictions
Only in private homes
Only in specific licensed
venues or private
homes
Anywhere except
certain public spaces
(e.g, indoor smoking
bans)
No restrictions
4
Policy (Strategy) Table
Production
Sale/distribution
Illegal (strong
sanctions)
Illegal (weak sanctions de jure or de facto
decriminalized)
Illegal (strong
sanctions)
Illegal (weak sanctions de jure or de facto
decriminalized)
Purchase
Purchase volume
(for legal users)
None - illegal
Illegal (strong
sanctions)
Illegal (weak sanctions - Per person quotas
de jure or de facto
decriminalized)
Possession
Use
Illegal (strong
sanctions)
Illegal (weak sanctions de jure or de facto
decriminalized)
Illegal (strong
sanctions)
Illegal (weak sanctions de jure or de facto
decriminalized)
Legal with restrictions Only gifting between
for individuals (e.g,
individuals (no money
legal to brew wine, not involved)
spirits; grow cannabis,
not more than 5 plants,
grow "magic mushrooms" in limited
volume)
Only adult licensed
users (e.g., tested for
knowledge of harms
and principles of safe
use)
Per purchase quotas
Limited quantity per
person (e.g., for
personal use)
Only in specific,
certified venues (e.g.
pubs or on-site
consumption with
monitoring such as user
rooms or use retreats)
Legal with restrictions
for groups (e.g.,
cannabis clubs where
users combine to
finance growing for
members)
State-run retail stores
(e.g., state alcohol
monopolies)
Only adults (age
restrictions)
Self set quotas
changeable with lag
No restrictions
Only in private homes
State controlled
State-licensed retail
stores or pharmacies
No restrictions
No restrictions
No restrictions for
companies
Only mail-order
No restrictions for
companies or
individuals
No restrictions - any
retail store
Only in specific licensed
venues or private
homes
Anywhere except
certain public spaces
(e.g, indoor smoking
bans)
No restrictions
5
Policy options
Production
Sale/distribution
Purchase
Illegal (strong
sanctions)
Illegal (weak
sanctions - de jure
or de facto
decriminalized)
Absolute Prohibition
State Control
Decriminalisation
Free Market
Purchase volume
(for legal users)
Possession
Illegal (strong
sanctions)
Illegal (weak
sanctions - de jure
or de facto
decriminalized)
Illegal (strong
sanctions)
Illegal (weak
sanctions - de jure
or de facto
decriminalized)
State controlled
State-licensed retail
Only adults (age
stores or
restrictions)
pharmacies
Limited quantity
Only in specific
Per purchase quotas per person (e.g., for licensed venues or
personal use)
private homes
No restrictions for
companies or
individuals
No restrictions - any
No restrictions
retail store
No restrictions
None - illegal
Per person quotas
Illegal (strong
sanctions)
Illegal (weak
sanctions - de jure
or de facto
decriminalized)
Use
No restrictions
Illegal (strong
sanctions)
Illegal (weak
sanctions - de jure
or de facto
decriminalized)
No restrictions
6
Drug Harm Policy
Value Tree
7 impacts
Health
Social
Political
Public
Crime
Economic
Costs
27 evaluation criteria
(with clear definitions)
7
Cluster
Criterion
Harm to user
Harm to others
Health
More harmful substances
Encourages treatment
Product quality
Social
Education
Medical use
Research
Human rights
Individual liberty
Community cohesion
Family cohesion
Political International development &
security
Industry influence on
governments
Public
Promotes well-being
Children and young
Protects vulnerable
Religious/cultural value
Crime
Criminalises users
Reduces acquisitive crime
Reduces violent crime
Prevents corporate crime
Prevents criminal industry
Economic Generates state revenue
Reduces economic costs
Cost
Introduction
Maintenance
Definition
Prevents medical harms to a user resulting from consumption of intended substance; includes blood-borne viruses
(BBV)
Prevents health harms (including BBVs) to third parties due to either indirect exposure (e.g., second hand smoking)
and behavioural responses to consumption (e.g., injury due to alcohol induced violence)
Decreases consumption of more harmful substances or increases consumption of less harmful substances (e.g.,
cannabis prohibition leading to synthetic cannabinoids)
Encourages treatment of substance-use problems
Assures the quality of products due to mislabelled or counterfeit/adulterated product, unknown dose/purity
Improves education about drugs
Policy does not impede medical use
Policy does not impede research
Policy does not interfere with human rights as distinct from the individual’s right to use.
Policy does not interfere with individual liberty (individual’s right to use)
Policy does not undermine social cohesion in communities
Policy does not undermine family cohesion
Policy does not undermine international development and security
Impedes drug industry influence on governments (less lobbying is preferable)
Promotes social and personal well-being
Protects children and young people
Protects vulnerable groups other than children and young people
Respects religious or cultural values
Does not criminalise users
Reduces acquisitive crime to finance use
Reduces violent crime due to illegal markets
Prevents corporate crime, e.g. money-laundering, tax evasion
Extent to which the policy discourages illegal market activity
Generates state revenue
Reduces public financial costs not directly related to the enforcement policy (e.g., spillover effects on health policy
budgets)
Financial costs of introducing the policy
Financial costs of enforcing the policy
8
Scoring the options
Direct scoring of harm
100
Least harm
80
60
40
Relative
Strength
of
Harm
20
0
Most harm
9
But, the four policies are all
hypothetical states about the future.
There are no data about the future.
So, how reliable (repeatable)
and valid (represent actual harm)
are direct preference judgements?
UK drug harms: 2010
ISCD results 2010
Europe drug harms: 2013
Europe results 2013
UK 2010 vs. Europe 2013
80
70
Direct preference
judgements are reliable
and valid in a decision
conference if:
60
50
UK
• Criteria are defined
clearly
• Group members
represent differing
perspectives
• Peer review occurs
face-to-face
• Group is properly
facilitated
40
30
r = 0.993
20
10
0
0
20
40
Europe
60
80
13
Swing-weighting the criteria
“How big is the difference between most and least preferred options and how much do you care about it?”
1. Weight swings below each node, e.g., Health Impacts.…….Economic Impacts.…………………..Costs
2. Weight most important swings across the nodes.
Purpose of weights:
To ensure
comparability of
units of preference
across the model.
(They do not
represent absolute
importance.)
14
MCDA results
Alcohol
Cannabis
For both drugs, a legal but strictly regulated market is
judged to yield the best outcomes overall.
15
Alcohol
State control vs.
Decriminalisation
State control
better
Decriminalisation
better
16
Cannabis
State control vs.
Decriminalisation
State control
better
Decriminalisation
better
17
Sensitivity analyses at each node
cannabis
State Control
remains most
preferred option
over a wide
range of weights.
Also for alcohol.
18
Current state
1. Alcohol results confirm current public health
and medical opinion. Not so for cannabis.
2. For both substances, a legal but strictly
regulated market is judged to yield the best
outcomes overall.
3. Was there a ‘reformist bias’ in the group?
4. Need further research by other teams.
5. We now have the beginnings of a coherent
analytic framework for describing, measuring,
assessing and discussing drug policy
19
A guide to further reading
Multi-criteria
analysis: a manual,
2000
(Dodgson, Spackman,
Pearman & Phillips)
Chapter 6 is an
MCDA tutorial.
Cambridge University
Press, 1993
The book that
introduced MCDA in
1976 (Wiley).
UIT Cambridge Ltd,
2012
Explains the harms of
misusing psychoactive
legal & illegal drugs.