Drug policy and the public good: Evidence for effective interventions

King's College London, National Addiction Centre, London, UK.
The Lancet (Impact Factor: 45.22). 01/2012; 379(9810):71-83. DOI: 10.1016/S0140-6736(11)61674-7
Source: PubMed


Debates about which policy initiatives can prevent or reduce the damage that illicit drugs cause to the public good are rarely informed by scientific evidence. Fortunately, evidence-based interventions are increasingly being identified that are capable of making drugs less available, reducing violence in drug markets, lessening misuse of legal pharmaceuticals, preventing drug use initiation in young people, and reducing drug use and its consequences in established drug users. We review relevant evidence and outline the likely effects of fuller implementation of existing interventions. The reasoning behind the final decisions for action might be of a non-scientific nature, focused more on what the public and policy-makers deem of value. Nevertheless, important opportunities exist for science to inform these deliberations and guide the selection of policies that maximise the public good.

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Available from: John Strang, Jan 20, 2014
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    • "Illicit drugs are a substantial threat and problem to public health; they can cause crime, disorder, family breakdown, and community decay [4] with high costs for both drugaddicted individuals and their society [5]. "
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    ABSTRACT: aterials and methods This is a qualitative research with conventional content analysis method. Purposive sampling was applied and continued until data saturation was achieved. The participants were 22 volunteers, including outpatients, physicians and psychotherapists. The method of data collection was semi-structured face to face interview (30-40 minutes). All interviews were recorded and transcribed. Results: By content analysis two categories were obtained, including emotional and informational support. The main common theme of ...
    Full-text · Article · Jul 2015
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    • "The abuse of psychoactive substances is associated with many adverse consequences to health (Chipman et al., 2009; Degenhardt and Hall, 2012; Schuckjt, 2009) and consequently to safety at work, such as violence, accidents (Li and Bai, 2008), injuries (Trent, 1991) and absenteeism. An increasing number of countries and companies are coping with this risk (Strang et al., 2012) by the application of means of control, also in the scope of Occupational Safety and Health (OSH), such as screening for psychoactive substances in employees. "
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    ABSTRACT: Programmes for testing Alcohol and Drugs (A&D) at the workplace, at random and by surprise, are believed to have a positive impact on safety and to reduce individual’s accident risk. Despite this perception, there is limited scientific evidence and poor statistical support of this assumption. This study aims at testing whether there is such a cause-effect relationship between A&D testing and post-accident reduction, and how to quantify it. The methodology applied data-mining techniques together with classical statistics hypothesis testing. It covers a wide range of data concerning accidents, alcohol and drug tests, biographical and occupational records of a large railway transportation company in Portugal, for a period of 5½ years. Results give sound statistical evidence of individual’s accident risk decrease after being tested, by quantifying the relations between A&D testing and post-testing accidents. Results also estimate the optimal testing frequency that balances testing costs and accident reduction. Optimum rates of tests per year per worker are in the ranges ]0.5–1.0] in white-collars and professions at large, and ]0.0–0.5] in operations/technical personnel. The fraction of accident victims that are prevented by the application of optimal frequencies are around 59% for workers onboard trains, 72% for those working near trains, and 85% for white-collars. Testing at the optimal frequency generates net savings of at least 15:1, in onboard personnel. In conclusion, testing for alcohol and drugs at workplace, at random and by surprise, has a statistically significant preventive effect in overall professions, but is stronger within white-collars.
    Full-text · Article · Oct 2014 · Safety Science
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    • "Alcohol abuse and illicit drug use are strongly associated with the likelihood and number of arrests Indigenous people have experienced in the last five years [15]. Opioid substitution therapy (OST – methadone or buprenorphine), the preferred treatment for opioid dependence, has shown to be beneficial in reducing heroin use [16, 17], other drug use, crime, HIV infection, exposure to viral hepatitis, and mortality [18]. However, maintaining retention in treatment is necessary in order to maximise OST treatment outcomes [19]. "
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    ABSTRACT: Background: Although Indigenous Australians are over-represented among heroin users, there has been no study examining offending, time in custody, and opioid substitution therapy (OST) treatment utilisation among Indigenous opioid-dependent (including heroin) people at the population level, nor comparing these to non-Indigenous opioid-dependent people. The aims of this study were to compare the nature and types of charges, time in custody and OST treatment utilisation between opioid-dependent Indigenous and non-Indigenous Australians in contact with the criminal justice system. Methods: This was a population-based, retrospective data linkage study using records of OST entrants in New South Wales, Australia (1985-2010), court appearances (1993-2011) and custody episodes (2000-2012). Charge rates per 100 person-years were compared between Indigenous and non-Indigenous Australians by sex, age and calendar year. Statistical comparisons were made for variables describing the cumulative time and percentage of follow-up time spent in custody, as well as characteristics of OST initiation and overall OST treatment utilisation. Results: Of the 34,962 people in the cohort, 6,830 (19.5%) were Indigenous and 28,132 (80.5%) non-Indigenous. Among the 6,830 Indigenous people, 4,615 (67.6%) were male and 2,215 (32.4%) female. The median number of charges per person against Indigenous people (25, IQR 31) was significantly greater than non-Indigenous people (9, IQR 16) (p < 0.001). Overall, Indigenous people were charged with 33.2% of the total number of charges against the cohort and 44.0% of all violent offences. The median percentage of follow-up time that Indigenous males and females spent in custody was twice that of non-Indigenous males (21.7% vs. 10.1%, p < 0.001) and females (6.0% vs. 2.9%, p < 0.001). The percentage of Indigenous people who first commenced OST in prison (30.2%) was three times that of non-Indigenous people (11.2%) (p < 0.001). Indigenous males spent less time in OST compared to non-Indigenous males (median percentage of follow-up time in treatment: 40.5% vs. 43.1%, p < 0.001). Conclusions: Compared to non-Indigenous opioid-dependent people, Indigenous opioid-dependent people in contact with the criminal justice system are charged with a greater number of offences, spend longer in custody and commonly initiate OST in prison. Hence, contact with the criminal justice system provides an important opportunity to engage Indigenous people in OST.
    Full-text · Article · Sep 2014 · BMC Public Health
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