Seven Reasons Why Drug Use Is More Serious Today

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Adolescent Addiction Course Thursday 8th March
2007 Drug Policy
Martin Frisher Department of Medicines
Management Keele University Harplands Hospital
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Topics

• Development of Drug Policy
• UK Governments Drugs Policy
• Effectiveness of Current Policy
• Alternatives to Current Policy
• Addiction Research and Evidence Based Medicine
• US War on Drugs

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UK Governments Drug Strategy

• Preventing drugs misuse
• Reducing the availability of drugs
• Reducing drug use and drug-related offending
  through treatment and support
• Reducing drug-related crime
• http//www.drugs.gov.uk/publication-search/drug-st
  rategy/strategy-facts-booklet

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UK Governments Drug Strategy

• 1.5 billion annual Government spending on
  tackling drugs
• 10,034 people employed as drug professionals up
  40 since March 2002
• 96 of secondary and 80 of primary schools have
  developed drug education policies
• 2.5 weeks average treatment waiting time, which
  is down by three quarters since 2002

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Downing Street Strategy Unit Report by John Birt

• Current government strategy is having only a
  limited impact in reducing that harm because it
  has failed to "grip" these users, and while
  nearly half are arrested each year, few enter
  treatment as a result.
• For those that do, the treatment regime has not
  coped well with the formidable difficulty of
  treating chaotic and constantly relapsing problem
  drug users
• http//image.guardian.co.uk/sys-files/Guardian/doc
  uments/2006/02/08/Drugs.pdf

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Downing Street Strategy Unit Report by John Birt

• The efforts of the police to interrupt the supply
  of drugs into Britain have been ineffective and
  has had little or no impact on reducing harms.

http//image.guardian.co.uk/sys-files/Guardian/doc
uments/2006/02/08/Drugs.pdf
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Downing Street Strategy Unit Report by John Birt

• Ministers have not yet admitted that there is
  little point to official efforts at intercepting
  the supply of illegal drugs into the country, but
  they have adopted Birt's recommended cover that
  drugs should be seized and proclaimed whenever
  possible.

http//image.guardian.co.uk/sys-files/Guardian/doc
uments/2006/02/08/Drugs.pdf
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Downing Street Strategy Unit Report by John Birt

• Birt says intervention should focus on reducing
  harm by driving users and dealers into compulsory
  registration and treatment.
• This is a powerful argument when considering that
  for every 1 spent on treatment and education, 3
  is spent on law enforcement.

http//image.guardian.co.uk/sys-files/Guardian/doc
uments/2006/02/08/Drugs.pdf
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Birt offers quick fix to drugs problem

• Danny Kushlick, director of drug charity
  Transform, describes this as "cynical in the
  extreme, given that the report acknowledges
  seizures are having little or no impact on
  reducing harm".
• He goes on "This is exactly what happened with
  the recent Home Office propaganda blitz to
  persuade us that the drug strategy is working."
• http//society.guardian.co.uk/drugsandalcohol/sto
  ry/0,,1709559,00.html

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Birt offers quick fix to drugs problem

• The coercive elements of Birt's approach - making
  the illicit use of heroin a criminal offence so
  the police can identify, arrest and drive the
  users into treatment - were rejected by
  ministers.
• http//society.guardian.co.uk/drugsandalcohol/stor
  y/0,,1709559,00.html

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Birt offers quick fix to drugs problem

• But what of his extension of heroin prescribing?
  The National Treatment Agency has launched some
  limited trials for chronic heroin users to gather
  evidence on its impact.

http//society.guardian.co.uk/drugsandalcohol/stor
y/0,,1709559,00.html
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Downing Street Strategy Unit Report by John Birt

• But Birt wanted to go much further, arguing that
  it is better to provide heroin freely to the
  260,000 who have a serious habit than allow them
  to commit crime to buy it - even at a cost of
  15,000 a year per patient. It would also
  undermine the illegal drugs trade.
• One big obstacle appears to be the reluctance of
  GPs to have heroin addicts in their waiting
  rooms. If so, then dedicated safe injection rooms
  could be the answer.

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Seven Reasons Why Drug Use Is More Serious Today

• Drug use endangers the future of a society by
  harming its youth and potentially destroying the
  lives of many young men and women
• Drug use and especially drug dealing is becoming
  a major factor in the growth of crime rates among
  the young.
• Seven in ten drug users work full-time and this
  increases the possibility of serious accidents
  caused by workers.

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Seven Reasons Why Drug Use Is More Serious Today

• Since the 1960s drug use is more widespread.
• Drugs are much more potent than they were years
  ago.
• Crack and other manufactured newer drugs offer
  potent effects at low cost.
• Illicit drug use remains extremely popular.
  Their sale is a multibillion dollar a year
  business, with major influence on many national
  economies.

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Updated Strategy 2002

• The Updated Strategy arose from a review
  conducted by the Home Affairs Select Committee,
  which found that while the Governments drug
  policy covered the right areas, a stronger
  emphasis was needed on preventing and stopping
  problematic drug use, reducing the harms from
  drug misuse and on developing more focused and
  measurable targets.

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Drug Laws and Deterrence

• If a person abuses a drug, should he or she be
  treated as a criminal or as a sick person
  inflicted with a disease?

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Drug Laws and Deterrence

• Are the laws and associated penalties effective
  deterrents against drug use or abuse, and how is
  effectiveness determined?

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Strategies for Preventing Drug Abuse

• Supply reduction
• Using drug laws to control the manufacturing and
  distribution of classified drugs
• Demand reduction strategy
• Aims to reduce the actual demand for drugs by
  working mainly with youth and teaching them to
  resist drugs

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Strategies for Preventing Drug Abuse

• Inoculation
• Aims to protect drug users by teaching them
  responsibility and explaining the effects of
  drugs on bodily and mental functioning.

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Drug Legalization Debate

• Violence and crime would decrease/increase?
• Profits associated with illegal trade would
  decrease/increase?
• Law enforcement costs would decrease/increase?
• Addiction would decrease/increase?

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Drug Legalization Debate

• Societal/health costs would decrease/increase?
• Consumption would increase/decrease?

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Areas of Compromise?

• Selective legalization?
• Control through prescription or special outlets?
• Discretionary enforcement of drug laws?

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Levels of Drug Prevention

• Level oneprimary prevention.
• Primary prevention programs refer to the very
  broad range of activities aimed at reducing the
  risk of drug use among non-users and assuring
  continued nonuse. Often targeted to at-risk
  neighborhoods/ communities and families.

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
24
Level 1

• Intrapersonal factors
• Affective education, values clarification,
  personal and social skills development
  (assertiveness and refusal skills), drug
  information and education
• Small group factors
• Peer mentoring, conflict resolution, curriculum
  infusion, clarification of peer norms,
  alternatives, strengthening families
• Systems level
• Strengthening school-family links,
  school-community links, and community support
  systems, media advocacy efforts, reduce alcohol
  marketing

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Level twosecondary prevention

• Assessment strategies identification of abuse
  subgroups and individual diagnoses
• Early intervention coupled with sanctions
• Teacher--parent team approach
• Developing healthy alternative youth culture
• Use of recovering role models

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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Levels of Drug Prevention

• Level threetertiary prevention.
• Tertiary prevention is intervention at an
  advanced state of drug use/abuse. Very similar to
  drug abuse treatment.

Drugs and Society (8th Edition, 2005) by Glen
Hanson, Peter J. Venturelli, Annette E.
Fleckenstein
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The Importance of Considering the Audience
and Approach

• Realize That Audiences Differ with Regard to Drug
  Use
• Early experimenters of drugs
• Non-problem drug usersthose who abuse drugs on
  occasion, mostly for recreation purposes
• Non-detected, committed, or secret users- those
  who abuse drugs and have no interest in stopping
• Problem users
• Former users

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Assessing the Success of Prevention Efforts

• It is difficult to measure the effects of
  prevention efforts after separating out the
  validity of the approach, the method and staff
  implemented in presentation, and broad cultural
  drug use patterns.

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Can Addiction Research Be Trusted?

• Research must be critically examined and
  interpreted for particular clinical needs and
  patient benefits.
• Just because something appears in print does
  not mean it is worthwhile or valid.

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Addiction Research

• Research directly or indirectly affects the
  practice of addiction medicine on a daily
  basis.
• There is an urgent need for good science to
  overcome stigma, prejudice, and
  misunderstanding.

Trepanation once was a scientific cure
formental illness.
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What is EBAM?Evidence-Based Addiction Medicine

• The use of current best evidence in making
  decisions about the care of patients.
• Involves combining clinical expertise with
  valid research on a topic of concern.
• Differentiates between practices based on
  sound evidence versus those founded more on 1)
  tradition, 2) outdated beliefs, or 3) junk
  science.

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Interpreting Research

• Interpretation is a matter of perception.
• Not everyone sees a research study in the
  same way.
• Becoming a more critical consumer of research
  is essential.

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Problems with Medical Research

• Surveys of research have found
• On average, half or more of journal articles
  contain errors from missing data to major
  design flaws.
• Roughly, up to 2/3 of article abstracts may
  contain data that is either inconsistent with or
  missing from the main body of the article.
• In one investigation, 80 of systematic reviews
  meta-analyses examined had serious flaws.

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U.S. War on Drugs

• Began in the early 70s, went into high gear in
  the early 80s
• Annual government spending
• 1969 - 65,000,000
• 1982 - 1,650,000,000
• 2001 over 19,000,000,000

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U.S. War on Drugs

• Number of people arrested on drug-related
  charges each year
• 1968 - 200,000
• 2001 over 1.5 million

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The War on Drugs

• zero-tolerance policy
• D.A.R.E - The Drug Abuse Resistance Education
  program
• mandatory sentencing, less and later parole
• greatly increased police enforcement
• more prisons and prisoners
• random drug testing, increased surveillance, new
  seizure and forfeiture laws

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D.A.R.E.

• From Dont You D.A.R.E, by Stephen Glass ( The
  New Republic, March 3, 1997)
• . . . study after study has shown that dare does
  not seem to work. The studies have found that
  students who go through the program are just as
  likely to use drugs as those who dont . . . Why
  isnt the case against dare better known? . . .
  For the past five years, dare has used tactics
  ranging from bullying journalists to
  manipulating the facts to mounting campaigns in
  order to intimidate government officials and stop
  news organizations, researchers and parents form
  criticizing the program . . . dare has become so
  well-known for the hardball tactics it employs to
  shut down its critics that drug researchers and
  journalists have a word for those hushed -- they
  say theyve been Dared.

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ACLU Paper 19 - Against Drug Prohibition

• More and more ordinary people, elected
  officials, newspaper columnists, economists,
  doctors, judges and even the Surgeon General of
  the United States are concluding that the effects
  of our drug control policy are at least as
  harmful as the effects of drugs themselves . .
  .The American Civil Liberties Union (ACLU)
  opposes criminal prohibition of drugs. Not only
  is prohibition a proven failure as a drug control
  strategy, but it subjects otherwise law-abiding
  citizens to arrest, prosecution and imprisonment
  for what they do in private.
• Source http// turnpike.net/-jnr/acludrug.htm

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More ACLU Arguments

• And just as most of the 1920s violence was
  not committed by people who were drunk, most of
  the drug-related violence today is not committed
  by people who are high on drugs.
• A 1989 government study of all 193
  cocaine-related homicides in New York City
  found that 87 percent grew out of rivalries and
  disagreements related to doing business in an
  illegal market. In only one case was the
  perpetrator actually under the influence of
  cocaine.