Invitation to comment

This blog is for researchers, providers, users, community groups, policy makers, and others who are interested in reframing America's response to drug use using the approach exemplified by the 2nd National Conference. The conference is designed to be the "table" where the stakeholders and those most affected by methamphetamine can come together to create solutions that are based in science and compassion. We invite law enforcement and criminal justice professionals as well as treatment providers and harm reductionists because they all have a role to play, and by working together, we hope to reduce the harms associated with drug use and the harms associated with bad drug policy. We invite you to comment and send us news and information to post. Weclome to the table!
Showing posts with label policy. Show all posts
Showing posts with label policy. Show all posts

Wednesday, December 20, 2006

Jonathan Caulkins:
A mathematician looks at what works and what doesn’t in America’s war on drugs

Posted on Carnegie Mellon Today, Dec 18, 2006

For more than 15 years, Professor Jonathan Caulkins has turned his mathematical model-building talents to one of the most intractable and emotion-laden social questions of all: drug abuse.

“America’s drug problem is more severe than that of any other developed country,” Caulkins says. “America has more drug dependence, more overdose deaths, more drug-related HIV-infections, and more drug-related violence. Its impact is widespread and costly; it taxes our criminal justice system, our hospitals, our schools. The cost in dollars and in lives is enormous.”

Yet, despite these high stakes, Caulkins believes that much of U.S. policy is distorted by wishful thinking, bureaucratic silos, and simple misinterpretation of the data. “When you have such a long term and costly problem as drug use has been, it makes sense to root strategies in objective evidence of what works and what doesn’t,” Caulkins says. “We have not always done that.”

After leading the Drug Policy Research Center at the Rand Corporation and designing innovative and influential efforts to assess cocaine control strategies, Caulkins became concerned that the lessons from cocaine were being generalized too broadly to other drugs at different stages in the cycle of adoption. When experts in dynamic modeling approached him about marrying methods from mathematical biosciences, epidemiology, and product diffusion modeling with traditional drug policy analysis, Caulkins jumped at the opportunity.

He now brings this dynamic modeling perspective to a range of problems pertaining to drugs, crime, violence, delinquency and prevention to understand the effect of policy initiatives on those problems as they evolve over time.

The markets for drugs are in some crucial respects not really that different from markets for other types of consumer products. Consumer product marketers, of course, want to expand product sales, while drug policy makers want to curtail them, but the underlying math of the models is the same, Caulkins says.

Drug use follows well-documented cycles of introduction, growth, and maturity. A newer drug, such as methamphetamine, requires a different response than does a “mature” product such as heroin or cocaine. Just as marketers use different tactics with brand new products and established brands, so the approaches to curbing drug use must differ.

“We need to make data-driven decisions about when to emphasize prevention and when to emphasize enforcement,” Caulkins says. “No one approach is the single right answer at every point. In the early phase of a drug epidemic, for example, treatment programs are not as important as they are in the later stages, when users are older, have more health problems, and may be more compliant with treatment. On the other hand, law enforcement has a much more dramatic impact on containing the spread of a drug early in the cycle, but almost none once a drug is in widespread use.”

Caulkins’s fresh approach is attracting attention. He was named a Robert Wood Johnson Foundation Health Policy Fellow in 2006, which is supporting his current project, “Synthesizing Lessons for Drug Policy and Policy Research.”

“We will not have more success in coping with drug abuse until we have a more dispassionate debate,” Caulkins says. “We must look more systematically at what has worked and when it has worked.

“Let’s take a more dynamic approach to respond to a dynamic problem.”

Tuesday, December 19, 2006

Needle Exchange and Drug Treatment More Effective HIV Prevention
By Yale School of Medicine
Dec 18, 2006, 07:00

(HealthNewsDigest.com).. New Haven, Conn.- For injection drug users, the
most productive and cost-effective approach to managing the spread of HIV is
expanding syringe exchange and drug treatment, as well as promoting
antiretroviral treatment for those already infected with HIV, according to a
new study by researchers at Yale School of Medicine.

Published in the January issue of American Journal of Public Health, the
authors, led by Yale Public Health professor Robert Heimer, found that the
Centers for Disease Control and Prevention's (CDC) new approach of promoting
HIV testing, "Advancing HIV Prevention," may not be best for injection drug
users.

Heimer, professor in the Department of Epidemiology and Public Health at
Yale School of Medicine, said the CDC policy is based on the presumption
that the HIV epidemic can be curtailed in great part by promoting HIV
testing and that more resources should go to expanded testing of high-risk
populations. However, the results reported in this study revealed that
testing was already widespread for urban injectors.

Heimer and co-authors analyzed interviews conducted with 1,543 injection
drug users in five cities, including New Haven and Hartford, CT,
Springfield, MA, Chicago, IL, and Oakland, CA. Access to sterile syringes
through syringe exchanges or at pharmacies with a prescription was not
available in all cities. Injection drug users who participated in the study
were asked if they had been tested for HIV and if they had ever been told
they were HIV positive. From this, the research team estimated what
percentage had never been tested and what percentage did not know their
status.

Ninety-three percent of injectors had been tested, and of those currently in
need of testing, 90 percent were tested in the past three years and 70
percent within the past year. Less than three percent were infected with HIV
without their knowledge. Women and syringe-exchange participants were more
likely to have been tested at least once, and in the recent past. The team
estimated the number of undetected infections among urban injection drug
users in the United States to be fewer than 40,000.

"Our results highlight the need for shifting prevention dollars for urban
injection drug users," said Heimer, who is also an associate professor of
pharmacology at Yale. "It is more important to expend scant resources on
effective primary and secondary preventive programs including access to
clean syringes and helping users get into treatment for their addiction."

Heimer emphasized needle exchange programs, substitution therapy like
methadone and buprenorphine, and engaging those injection drug users already
infected with HIV in supportive anti-retroviral therapy. He said these
approaches have been shown to decrease the incidence of new infections at
rates sufficient to save money.

"When it comes to urban injection drug users, money will be wasted on
low-impact, low-yield counseling and testing programs," said Heimer.
"Prevention programs should not be compelled to generalize and accept a
single approach to preventing disease transmission. Injection drug users
should not be lumped in with other high risk groups. Instead, tailored
programs designed with their unique needs in mind will yield better
outcomes."

Since the study was conducted, Heimer and his colleagues have been working
to immunize injection drug users against hepatitis B, as well as developing
other interventions designed to reduce HIV infections in drug using
populations.

Other authors on the study were Lauretta Grau, Erin Curtin, Kaveh Khoshnood
and Merrill Singer.

Citation: American Journal of Public Health, Vol. 97, No. 1 (January 2007)
Barack Obama's Meth Menace
The Huffington Post
by Maia Szalavitz

Barack Obama is a dream candidate in so many ways. The mere idea of someone who can write (and presumably therefore think) in a complex yet compelling fashion is almost irresistibly seductive, especially now. Unfortunately, in terms of drug policy, despite his candid and refreshing discussion of his own use, he apparently remains part of our on-going national nightmare.

While no politician is perfect on every issue, Obama's support of the Byrne grant program to fight methamphetamine-- which is prominently highlighted on his website-- is deeply troubling. This program is opposed by both Grover Norquist's Americans for Tax Reform and the American Conservative Union on the right-- and the ACLU and George Soros' Open Society Institute on the left. Arianna covered it here.

Even the government's own watchdog Office on Management and Budget doesn't support Byrne grants: it gave them a 13% rating for results and accountability. Randomly answering the questions on a standardized multiple-choice test would likely produce a better grade than that! The Bush administration pushed to eliminate Byrne funding last year-- but Obama supported a Senate bill which provided $900 million dollars.
read the rest...
Drugs: why we should medicalise, not criminalise
The TimesOnline
December 14, 2006
Mary Ann Sieghart

If you are a desperate drug addict and you are neither a trust fund babe nor a doctor with a prescription pad, you really have only three ways to pay for your habit: you steal, you deal or you sell your body. For those poor young women who have too many scruples to steal or deal, prostitution is often the only answer. Some 95 per cent of prostitutes, according to a Home Office study, are what they call “problematic drug users”.

And now five prostitutes in Suffolk have been murdered and the rest fear for their lives. One of the victims, Gemma Adams, an intelligent, piano-playing, pony-riding, middle-class girl, had turned to prostitution, like many other such women, after becoming addicted to heroin and crack. This week her parents issued photos of her in happier days, to help people understand that she was a person, not just a prostitute.

Yet even the law degrades prostitutes, valuing their lives at less than that of a middle-class, piano-playing girl. When Dianne Parry’s daughter, Hanane (another heroin addict turned prostitute), was murdered and dismembered in 2003, the Criminal Injuries Compensation Authority offered Mrs Parry only half the money that a parent of a non-prostitute would receive. It wasn’t the £5,000 that Mrs Parry cared about, but the devaluing of her daughter’s life.

And it is not just the law on compensation that should be changed. It is the law on drugs themselves. Drug addiction is a medical condition; it should not be treated as a criminal offence. The crime that results from drug addiction is a direct result of the drugs’ illegality. The organised criminal gangs, with their violence, corruption and money laundering; the street gangs, with their gun crime, stabbings and intimidation; the muggers, burglars, car thieves and shoplifters, who steal to fund their habit; the dealers who try to create new addicts; and finally, the prostitutes who put their health and lives at risk; all this crime and suffering could be wiped out if the drugs were available, free, on prescription. Some 50 to 80 per cent of prisoners are in jail for crimes related to raising money to buy drugs. Nearly half of women prisoners are there specifically for drug offences and nearly three-quarters have had a drug problem. The cost to the criminal justice system is huge. The cost to the individuals, their families and wider society is greater still.

In European cities, where heroin is available on prescription, property crimes by drug-users have dropped by as much as a half. And think of the effect that widespread prescribing would have on turf wars, gang violence, gun crime, street dealing and prostitution. An excellent report from the Transform drug policy foundation* also points out: “The largest single profit opportunity for organised crime would evaporate, and with it the largest single source of police corruption.”

Transform estimates that the prison population would fall by between a third and a half, ending overcrowding and the need to build more jails. Billions of pounds spent enforcing prohibition and coping with its consequences would be saved. Hundreds of thousands could be treated as patients rather than criminals. The number of drug-related deaths would fall dramatically. And desperate young women could be rescued from pimps, potential rapists and murderers.

At the same time, unstable countries such as Afghanistan and Colombia, which have become almost ungovernable thanks to the distorting and corrupting effects of the drugs trade, could sell their products legally to Western governments for medical use.

Of course we should try to get drug addicts off their drugs. It is good that waiting times are now shorter for rehabilitation. But treatment doesn’t work unless users really, really want to give up. And even then, they often relapse because the cravings are so strong. So it is not surprising that enforced treatment and rehabilitation is so unsuccessful. A National Audit Office report on the Government’s Drug Treatment and Testing Order, a court-administered mandatory programme for addicts, found that 80 per cent of offenders were reconvicted within two years.

It is much more sensible to prescribe a maintenance dose for addicts, which they must take under supervision so they cannot sell it on, until they are ready to try to give up. That way, they can attempt to lead a normal life, to refrain from crime, to stay off the streets, even to hold down a job, until they can wean themselves off the drugs.
read the rest...

Monday, December 18, 2006

Huntsman makes tackling meth epidemic a top priority
Deseret Morning News, Friday, December 15, 2006
By Dennis Romboy

Gov. Jon Huntsman Jr. and his wife have made friends with the people in their neighborhood, including some hooked on methamphetamine.

A residential treatment center called House of Hope is a couple of doors down from the Governor's Mansion on South Temple. Their neighbors are moms who are trying to fight meth addiction, said Mike Mower, the governor's spokesman.

The Huntsmans visited women in the house and Mary Kaye Huntsman had them over for a tea party.

"The governor realizes the insidious nature of meth use and its disproportionate use among young women, often young mothers," Mower said.

To turn that tide, Huntsman's proposed state budget includes $5.1 million a year (half from Medicaid) to place 600 more women in treatment programs, giving priority to those involved with the Utah Division of Child and Family Services.
read the rest...
Women, Meth, and Children
by Terri Hurst, MSW

Women are often overlooked when it comes to treatment for meth use, especially women with children. Women usually enter treatment through the criminal justice system and by that time, CPS (Child Protective Services) has intervened.

Women who are not allowed access to their children while in treatment have a greater likelihood of relapse and are not as successful in completing treatment. It is also important for children to remain connected to their mother, unless severe abuse has taken place. Just because a mom uses meth, it does not make her a "bad" mother.

With the prevalence of ice in Hawaii, many women have lost their children due to harsh laws that are not focused on keeping families together. This goes against the Hawaiian principle of "ohana" or family and the importance of family within the Hawaiian culture. While ice use is inter-generational in the islands, it is even more important that children of meth users see that their parents can recover from drug use and that parents teach their children about ice so that they can stop the cycle of use. Women's Way, which is located on the island of Oahu, is a residential treatment program run by the Salvation Army - Family Treatment Services. Women's Way is the only subtance abuse treatment program on the islands that works with women and children. The program targets women who are pregnant and using or who have children between the ages of 0 - 3 years of age. For more information, call: (808) 732-2802 x 39

In Utah, where meth rates are also extremely high for both men and women, there are two programs that work specifically with women and children. The Volunteers of America, Center for Women and Children works with women who have children aged 10 years and younger. The Program Director stated that "meth is the number one problem we see." For more information call: (801) 261-9177

Also, Valley Mental Health offers the Cottonwood Family Treatment Center, which is a residential treatment program geared specifically for meth use among women with children. For more information call: (801) 263-7225
Satan's son?
Montana Meth Project advertising does one thing well - it inspires creative writing.

Thanks to the aggressive, slick, and lurid advertising campaign mounted by the Montana Meth Project high school students are thoroughly versed in the purportedly inevitable consequences of meth use: a disgusting, rotting mouth; cheap sex in dirty bathrooms; scabs and oozing wounds; and crime.

Evidence of the campaign's success to scare kids straight was printed in the Billings Gazette in the form of a letter from "crystal" penned by a local high school student.

"I have very serious long-term affects. Signs that you have been hanging with me could be rotten teeth, nasty oozing scabs and a disgusting odor coming from your body. I can be injected through your mouth, nose or veins."

What appears to be a creative writing project probably in response to yet another "horrors of meth" news story is family values-inspired drug porn. Meth provides, like marijuna, heroin, and crack before it, the chance for Americans to indulge their need to be voyuers and peer into the world of the nasty "other." This time around, we feed our desires with scenes of sweet young kids being turned into thieves and whores by methamphetamine.

All of the kids featured in the Montana Meth Project video and print ads are actors. They get paid to portray drug users. The women who are all too often exposed on drug and law enforcement websites, however, are real. Their lives are summed up by mug shots, which are arrayed in chronological order typically progressing from a shot of a pretty blonde who becomes, over the course of ten years and ten busts, a haggy old crone with no teeth because she couldn't kick the habit.

In the act of laying out a woman's life in her mug shots and summing it all up to drug use is a convenient, and apparently legal, way of stripping drug users of their humanity and privacy. Like the portrayals of young users in the Montana Meth Project ads, they become part of a public peep show and the poster children of the drug warriors.

What the Montana Meth Project ads and the mug shots don't do is talk about the many reasons people turn to drugs, and they certainly don't address the realities of our world where the pressure to perform and produce and stay skinny and take care of the kids can be overwhelming.

A better use of our ad space and air time would be to engage young people in an honest conversation about turning complex problems, like methamphetamine use, into lurid stereotypes and why we find it so hard find the humanity in others.

Thursday, December 14, 2006

Methamphetamine Myths
from P. Bench at Addiction Help-Blog
Sometimes the right information can turn on some lights. Read this carefully, it may just brighten you. As methamphetamine continues to spread across the U.S., the crystalline powder attracts new users in new areas. Various myths about meth may have helped alert the community to the problem and have even prompted Governmental action. Regardless, these myths have also misled uncountable Americans, including various law enforcement and substance abuse professionals. And that's just the tip of the iceberg.
read the rest...
AG Proposes Program to Treat Meth-Exposed Officers
KSL-TV
December 14th, 2006 @ 12:50pm

WEST VALLEY CITY, Utah (AP) -- Attorney General Mark Shurtleff is proposing a treatment program for police officers exposed to methamphetamine that he'd like to be available for free.
Shurtleff met with some 150 police officers and firefighters here Wednesday about the New York Rescue Workers Detoxification Program.
Earlier, Shurtleff said such a program might be paid for by donations, but now the Legislature, which convenes in January, is likely to get involved.
"It's all about competing for money," Shurtleff said, adding he'd talked to Senate President John Valentine, R-Orem, who indicated the Legislature would be interested in looking for funding for the project.

read the rest...

"What Do the 2006 Election Results Mean for Drug Policy Reform?"
Analysis from Drug Policy Alliance
Democrats have taken control of the U.S. House for the first time in 12 years, picking up at least 27 House seats from Republicans. And Democrats picked up at least five Senate seats and may win the other seat they need to take control of the Senate (Virginia is still undecided). Ten local marijuana law reform initiatives also won big yesterday. But voters rejected three important statewide marijuana initiatives, and approved a measure in Arizona that will undercut the state’s successful treatment-instead-of-incarceration law. What does all this mean for drug policy reform?
read the rest...